Asian Cardiovasc Thorac Ann 2006;14:e113-e114
© 2006 Asia Publishing EXchange Ltd
Pulmonary Oncocytoma: A Rare Case
Rajaram Burrah, MS,
Usha Kini, MD1,
Marjorie Correa, MD1,
Srikrishna Srirangapatna, MCh
Department of Cardiothoracic Surgery
1 Department of Pathology, St. John’s National Academy of Health Sciences Bangalore, India
For reprint information contact: Srikrishna Srirangapatna, MCh, Tel: 91 98 8670 7676, Fax: 91 80 2206 5318, Email: svsrikrishna{at}gmail.com, St. John’s National Academy of Health Sciences, Sarjapur Road, Bangalore 560 034, India.
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ABSTRACT
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Oncocytomas are rare tumors with characteristic histological features of large eosinophilic cells with prominent nucleoli and small round nuclei. They commonly occur in the kidney and salivary glands. Their occurrence in the lungs is very rare; fewer than 6 cases being reported so far in the available world literature. We encountered one such case and present the details of the management and its outcome.
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INTRODUCTION
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Oncocytoma is an uncommon tumor of epithelial origin. It is characteristically composed of large eosinophilic cells with small round nuclei and large nucleoli. They commonly occur in the kidney, salivary glands, and thyroid. The occurrence of such neoplasms in the lungs is rare, and we present our encounter with one such case.
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CASE REPORT
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The patient was a 16-year-old girl who presented to us with a history of cough, expectoration, and occasional hemoptysis of 6 months duration. She also complained of low grade fever, which had been present during the previous month. On examination, the patient was well built and nourished. She had no clubbing, icterus or generalized lymphadenopathy. Clinical examination of the respiratory, cardiovascular, and gastrointestinal systems was normal. Chest X-Ray showed a round homogenous opacity in the left upper zone (Figure 1
). A computed tomography (CT) scan showed a mass lesion in the posterior segment of the left upper lobe (Figure 2). Investigations for tuberculosis were negative.
The patient underwent a thoracotomy which showed a mass with cystic changes in the left upper lobe abutting the fissure. The mass was excised in toto. Histopathology showed the neoplasm was composed of oncocytic cells with large vesicular nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm arranged in papillary configuration at places (Figures 3 and 4). The cells were arranged in groups with areas of necrosis and surface ulceration. The wall showed evidence of old hemorrhage with cholesterol clefts and xanthogranulomatous inflammation. The patient had an uneventful recovery in the postoperative period. In the brief follow-up period of one year, the patient remained asymptomatic and further imaging of her chest did not show any recurrence.
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Figure 3. Histopathology shows collapsed lung tissue with portion of a neoplasm with a papillary configuration at places. (Hematoxylin and eosin stain: magnification x200).
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Figure 4. Higher magnification shows the neoplasm composed of large cells with eosinophilic granular cytoplasm and vesicular nucleus with prominent nucleoli. (Hematoxylin and eosin stain: magnification x400).
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DISCUSSION
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Oncocytomas are uncommon tumors composed of mitochondria-rich oxyphilic cells called oncocytes. Though considered to be a predominantly benign lesion,1 high grade tumors with metastases are seen in a small percentage of cases.2 Fewer than six case reports of pulmonary oncocytomas have been reported to date. A review of these cases shows that most patients are relatively asymptomatic and are detected to have a mass lesion restricted to the lung on chest X-Ray. While there is one case report of a diagnosis being obtained by fine needle aspiration,3 in the majority of cases diagnosis is reached only after excision and histological examination of the specimen. The characteristic feature of an oncocyte is its granular eosinophilic cytoplasm, which is due to mitochondrial hyperplasia. As hyperplasia of other cytoplasmic organelles can produce cytoplasmic eosinophilia, electromicroscopic study may be essential to confirm the diagnosis.4
Oncocytomas are usually benign tumors; adequate surgical excision effects cure in all the patients. Oncocytoma should be considered in the differential diagnosis of a mass lesion in the lung, despite it being a rare tumor.
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REFERENCES
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- Amin MB, Crotty TB, Tickoo SK, Farrow GM. Renal oncocytoma: a reappraisal of morphologic features with clinicopathologic findings in 80 cases. Am J Surg Pathol 1997;21:1–12.[Medline]
- Morra MN, Das S. Renal oncocytoma: a review of histogenesis, histopathology, diagnosis and treatment. J Urol 1993;150(2 Pt 1):295–302.[Medline]
- Laforga JB, Aranda FI. Multicenteric oncocytoma of the lung diagnosed by fine-needle aspiration. Diagn Cytopathol 1999;21:51–4.[Medline]
- Fernandez MA, Nyssen J. Oncocytoma of the lung. Can J Surg 1982;25:332–3.[Medline]
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ABSTRACT
INTRODUCTION
