Diagnosis and malignant analysis of mass versus pneumonia type of primary pulmonary mucinous adenocarcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FENG Yihui ¹ , ZHU Xiaolei ¹ , FANG Shaohan ² , ZHANG Xiaowen ^1,2 , LI Ning ^1,2 ,  GENG Guojun ¹

1. Fujian Medical University, Fuzhou, 350122, P. R. China;
2. Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, 360000, Fujian, P. R. China;

Corresponding author：

GENG Guojun, Email: ggj622@126.com

Keywords：

Primary pulmonary mucinous adenocarcinoma; mass type; pneumonia type; Ki-67 index; imaging characteristics; reversed hato-like sign

DOI：

10.7507/1007-4848.202303025

Video：

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Objective To investigate the relationship between primary pulmonary mucinous adenocarcinoma (PPMA) mass type and pneumonia type and their difference in malignant degree, and to analyze the role of clinical manifestations and CT features in the diagnosis of this disease. Methods The clinical data of PPMA patients admitted in the First Affiliated Hospital of Xiamen University from May 2011 to March 2022 were retrospectively analyzed. According to CT features, they were divided into a mass type group and a pneumonia type group. The clinical manifestations, CT features and the degree of malignancy between the two groups were analyzed and compared. Results A total of 57 PPMA patients were enrolled. There were 17 males and 40 females, with an average age of (53.82±10.65) years, and 28 (49%) patients had reversed hato-like sign. There were 42 patients in the mass type group and 15 patients in the pneumonia type group. PPMA often occurs in both lower lungs, with clinical manifestations mainly of coughing and expectorating white mucoid sputum. There were statistical differences between the two groups in the maximum diameter of tumor (P<0.001), boundary condition (P<0.001) and pleural indentation sign (P=0.019). There was no statistical difference between the two groups in Ki-67 index (P>0.05). Conclusion There is no statistical difference in the degree of malignancy between the two types of PPMA. Considering their clinical manifestations and differences in imaging features, it is supported that the pneumonia type is just a progression of the mass type. CT can present various manifestations, among which the reversed hato-like sign is expected to become an important imaging feature. Combined with a high proportion of solid components, pleural indentation sign, and vacuole sign, reversed hato-like sign can play a significant role in the diagnosis of PPMA.

Citation： FENG Yihui, ZHU Xiaolei, FANG Shaohan, ZHANG Xiaowen, LI Ning, GENG Guojun. Diagnosis and malignant analysis of mass versus pneumonia type of primary pulmonary mucinous adenocarcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(3): 360-365. doi: 10.7507/1007-4848.202303025 Copy

1.	Zhang, J, Chen, C, Zheng, H, et al. Clinicopathologic analysis of 57 cases of primary pulmonary mucinous adenocarcinoma. Zhonghua Zhong Liu Za Zhi, 2009, 31 (1): 66-68.
2.	Tian, P, Wang, Y, Wan, C, et al. CT-guided needle biopsy in the diagnosis of lung adenocarcinoma accompanied by extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue: A rare combination. Int J Clin Exp Pathol, 2015, 8(2): 2074-2078.
3.	Wang T, Yang Y, Liu X, et al. Primary invasive mucinous adenocarcinoma of the lung: Prognostic value of CT imaging features combined with clinical factors. Korean J Radiol, 2021, 22(4): 652-662.
4.	Nie K, Nie W, Zhang YX, et al. Comparing clinicopathological features and prognosis of primary pulmonary invasive mucinous adenocarcinoma based on computed tomography findings. Cancer Imaging, 2019, 19(1): 47.
5.	刘连荣, 邢志珩, 张雪君. 原发性肺黏液腺癌的影像学表现及病理基础. 临床放射学杂志, 2022, 41(9): 1788-1791.Liu LR, Xing ZH, Zhang XJ. Imaging manifestations and pathological basis of primary pulmonary mucinous adenocarcinoma. J Clin Radiol, 2022, 41(9): 1788-1791.
6.	Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: Glossary of terms for thoracic imaging. Radiology, 2008, 246(3): 697-722.
7.	Ibrahim T, Farolfi A, Scarpi E, et al. Hormonal receptor, human epidermal growth factor receptor-2, and Ki-67 discordance between primary breast cancer and paired metastases: Clinical impact. Oncology, 2013, 84(3): 150-157.
8.	Chlebowski RT, Col N, Winer EP, et al. American Society of Clinical Oncology technology assessment of pharmacologic interventions for breast cancer risk reduction including tamoxifen, raloxifene, and aromatase inhibition. J Clin Oncol, 2002, 20(15): 3328-3343.
9.	Fu Q, Liu SL, Hao DP, et al. CT radiomics model for predicting the Ki-67 index of lung cancer: An exploratory study. Front Oncol, 2021, 11: 743490.
10.	英天舒, 张晓晔. 31例原发性肺黏液腺癌的CT表现与病理特点分析. 实用癌症杂志, 2016, 31(4): 567-568, 571.Ying TS, Zhang XY. CT manifestations and pathological characteristics of 31 cases of primary lung mucinous adenocarcinoma. Pract J Cancer, 2016, 31(4): 567-568, 571.
11.	蔡雅倩, 韩丹, 张正华, 等. 原发性肺黏液腺癌CT表现. 放射学实践, 2019, 34(12): 1318-1321.Cai YQ, Han D, Zhang ZH, et al. CT manifestations of primary pulmonary mucinous adenocarcinoma. Radiol Pract, 2019, 34(12): 1318-1321.
12.	包杰, 金银华, 华奇峰, 等. 结合病理对原发性肺粘液腺癌的MSCT表现分析. 医学影像学杂志, 2020, 30(5): 871-874.Bao J, Jin YH, Hua QF, et al. Analysis of MSCT findings in primary pulmonary mucinous adenocarcinoma with pathology. J Med Imaging, 2020, 30(5): 871-874.
13.	Watanabe H, Saito H, Yokose T, et al. Relation between thin-section computed tomography and clinical findings of mucinous adenocarcinoma. Ann Thorac Surg, 2015, 99(3): 975-981.
14.	Lee HY, Cha MJ, Lee KS, et al. Prognosis in resected invasive mucinous adenocarcinomas of the lung: Related factors and comparison with resected nonmucinous adenocarcinomas. J Thorac Oncol, 2016, 11(7): 1064-1073.
15.	段劲松, 杨金伟, 刘立陶, 等. 肺腺癌实性成分CT影像与病理特征的相关性分析. 现代肿瘤医学, 2022, 30(23): 4338-4343.Duan JS, Yang JW, Liu LT, et al. Correlation between CT imaging and pathological features of solid components in lung adenocarcinoma. J Mod Oncol, 2022, 30(23): 4338-4343.
16.	Oda S, Awai K, Liu D, et al. Ground-glass opacities on thin-section helical CT: Differentiation between bronchioloalveolar carcinoma and atypical adenomatous hyperplasia. AJR Am J Roentgenol, 2008, 190(5): 1363-1368.
17.	任华, 李惠民, 虞崚崴, 等. 表现为反晕征的肺磨玻璃结节CT诊断. 中国医学计算机成像杂志, 2018, 24(2): 127-131.Ren H, Li HM, Yu LW, et al. CT diagnosis of pulmornary ground-glass nodules presented as reversed halo sign. Chin Comput Med Imaging, 2018, 24(2): 127-131.
18.	童永秀, 张彩霞, 张玮, 等. 反晕征在不同肺部疾病中的特征. 中国医学影像学杂志, 2020, 28(5): 353-356.Tong YX, Zhang CX, Zhang W, et al. Characteristics of reversed halo sign in different lung diseases. Chin J Med Imaging, 2020, 28(5): 353-356.
19.	Bourcier J, Heudes PM, Morio F, et al. Prevalence of the reversed halo sign in neutropenic patients compared with non-neutropenic patients: Data from a single-centre study involving 27 patients with pulmonary mucormycosis (2003-2016). Mycoses, 2017, 60(8): 526-533.
20.	Warth A, Cortis J, Soltermann A, et al. Tumour cell proliferation (Ki-67) in non-small cell lung cancer: A critical reappraisal of its prognostic role. Br J Cancer, 2014, 111(6): 1222-1229.
21.	Masuda D, Masuda R, Matsuzaki T, et al. Ki-67 labeling index affects tumor infiltration patterns of lung squamous cell carcinoma. Mol Med Rep, 2015, 12(5): 7303-7309.
22.	Yu JQ, Zhou Q, Zheng YF, et al. Expression of vimentin and Ki-67 proteins in cervical squamous cell carcinoma and their relationships with clinicopathological features. Asian Pac J Cancer Prev, 2015, 16(10): 4271-4275.
23.	Gioacchini FM, Alicandri-Ciufelli M, Magliulo G, et al. The clinical relevance of Ki-67 expression in laryngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol, 2015, 272(7): 1569-1576.
24.	Yin Y, Zeng K, Wu M, et al. The levels of Ki-67 positive are positively associated with lymph node metastasis in invasive ductal breast cancer. Cell Biochem Biophys, 2014, 70(2): 1145-1151.
25.	Çalik M, Demirci E, Altun E, et al. Clinicopathological importance of Ki-67, p27, and p53 expression in gastric cancer. Turk J Med Sci, 2015, 45(1): 118-128.
26.	Tang J, Gui C, Qiu S, et al. The clinicopathological significance of Ki-67 in papillary thyroid carcinoma: A suitable indicator? World J Surg Oncol, 2018, 16(1): 100.
27.	Jemal A, Ma J, Rosenberg PS, et al. Increasing lung cancer death rates among young women in southern and midwestern States. J Clin Oncol, 2012, 30(22): 2739-2744.

1. Zhang, J, Chen, C, Zheng, H, et al. Clinicopathologic analysis of 57 cases of primary pulmonary mucinous adenocarcinoma. Zhonghua Zhong Liu Za Zhi, 2009, 31 (1): 66-68.
2. Tian, P, Wang, Y, Wan, C, et al. CT-guided needle biopsy in the diagnosis of lung adenocarcinoma accompanied by extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue: A rare combination. Int J Clin Exp Pathol, 2015, 8(2): 2074-2078.
3. Wang T, Yang Y, Liu X, et al. Primary invasive mucinous adenocarcinoma of the lung: Prognostic value of CT imaging features combined with clinical factors. Korean J Radiol, 2021, 22(4): 652-662.
4. Nie K, Nie W, Zhang YX, et al. Comparing clinicopathological features and prognosis of primary pulmonary invasive mucinous adenocarcinoma based on computed tomography findings. Cancer Imaging, 2019, 19(1): 47.
5. 刘连荣, 邢志珩, 张雪君. 原发性肺黏液腺癌的影像学表现及病理基础. 临床放射学杂志, 2022, 41(9): 1788-1791.Liu LR, Xing ZH, Zhang XJ. Imaging manifestations and pathological basis of primary pulmonary mucinous adenocarcinoma. J Clin Radiol, 2022, 41(9): 1788-1791.
6. Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: Glossary of terms for thoracic imaging. Radiology, 2008, 246(3): 697-722.
7. Ibrahim T, Farolfi A, Scarpi E, et al. Hormonal receptor, human epidermal growth factor receptor-2, and Ki-67 discordance between primary breast cancer and paired metastases: Clinical impact. Oncology, 2013, 84(3): 150-157.
8. Chlebowski RT, Col N, Winer EP, et al. American Society of Clinical Oncology technology assessment of pharmacologic interventions for breast cancer risk reduction including tamoxifen, raloxifene, and aromatase inhibition. J Clin Oncol, 2002, 20(15): 3328-3343.
9. Fu Q, Liu SL, Hao DP, et al. CT radiomics model for predicting the Ki-67 index of lung cancer: An exploratory study. Front Oncol, 2021, 11: 743490.
10. 英天舒, 张晓晔. 31例原发性肺黏液腺癌的CT表现与病理特点分析. 实用癌症杂志, 2016, 31(4): 567-568, 571.Ying TS, Zhang XY. CT manifestations and pathological characteristics of 31 cases of primary lung mucinous adenocarcinoma. Pract J Cancer, 2016, 31(4): 567-568, 571.
11. 蔡雅倩, 韩丹, 张正华, 等. 原发性肺黏液腺癌CT表现. 放射学实践, 2019, 34(12): 1318-1321.Cai YQ, Han D, Zhang ZH, et al. CT manifestations of primary pulmonary mucinous adenocarcinoma. Radiol Pract, 2019, 34(12): 1318-1321.
12. 包杰, 金银华, 华奇峰, 等. 结合病理对原发性肺粘液腺癌的MSCT表现分析. 医学影像学杂志, 2020, 30(5): 871-874.Bao J, Jin YH, Hua QF, et al. Analysis of MSCT findings in primary pulmonary mucinous adenocarcinoma with pathology. J Med Imaging, 2020, 30(5): 871-874.
13. Watanabe H, Saito H, Yokose T, et al. Relation between thin-section computed tomography and clinical findings of mucinous adenocarcinoma. Ann Thorac Surg, 2015, 99(3): 975-981.
14. Lee HY, Cha MJ, Lee KS, et al. Prognosis in resected invasive mucinous adenocarcinomas of the lung: Related factors and comparison with resected nonmucinous adenocarcinomas. J Thorac Oncol, 2016, 11(7): 1064-1073.
15. 段劲松, 杨金伟, 刘立陶, 等. 肺腺癌实性成分CT影像与病理特征的相关性分析. 现代肿瘤医学, 2022, 30(23): 4338-4343.Duan JS, Yang JW, Liu LT, et al. Correlation between CT imaging and pathological features of solid components in lung adenocarcinoma. J Mod Oncol, 2022, 30(23): 4338-4343.
16. Oda S, Awai K, Liu D, et al. Ground-glass opacities on thin-section helical CT: Differentiation between bronchioloalveolar carcinoma and atypical adenomatous hyperplasia. AJR Am J Roentgenol, 2008, 190(5): 1363-1368.
17. 任华, 李惠民, 虞崚崴, 等. 表现为反晕征的肺磨玻璃结节CT诊断. 中国医学计算机成像杂志, 2018, 24(2): 127-131.Ren H, Li HM, Yu LW, et al. CT diagnosis of pulmornary ground-glass nodules presented as reversed halo sign. Chin Comput Med Imaging, 2018, 24(2): 127-131.
18. 童永秀, 张彩霞, 张玮, 等. 反晕征在不同肺部疾病中的特征. 中国医学影像学杂志, 2020, 28(5): 353-356.Tong YX, Zhang CX, Zhang W, et al. Characteristics of reversed halo sign in different lung diseases. Chin J Med Imaging, 2020, 28(5): 353-356.
19. Bourcier J, Heudes PM, Morio F, et al. Prevalence of the reversed halo sign in neutropenic patients compared with non-neutropenic patients: Data from a single-centre study involving 27 patients with pulmonary mucormycosis (2003-2016). Mycoses, 2017, 60(8): 526-533.
20. Warth A, Cortis J, Soltermann A, et al. Tumour cell proliferation (Ki-67) in non-small cell lung cancer: A critical reappraisal of its prognostic role. Br J Cancer, 2014, 111(6): 1222-1229.
21. Masuda D, Masuda R, Matsuzaki T, et al. Ki-67 labeling index affects tumor infiltration patterns of lung squamous cell carcinoma. Mol Med Rep, 2015, 12(5): 7303-7309.
22. Yu JQ, Zhou Q, Zheng YF, et al. Expression of vimentin and Ki-67 proteins in cervical squamous cell carcinoma and their relationships with clinicopathological features. Asian Pac J Cancer Prev, 2015, 16(10): 4271-4275.
23. Gioacchini FM, Alicandri-Ciufelli M, Magliulo G, et al. The clinical relevance of Ki-67 expression in laryngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol, 2015, 272(7): 1569-1576.
24. Yin Y, Zeng K, Wu M, et al. The levels of Ki-67 positive are positively associated with lymph node metastasis in invasive ductal breast cancer. Cell Biochem Biophys, 2014, 70(2): 1145-1151.
25. Çalik M, Demirci E, Altun E, et al. Clinicopathological importance of Ki-67, p27, and p53 expression in gastric cancer. Turk J Med Sci, 2015, 45(1): 118-128.
26. Tang J, Gui C, Qiu S, et al. The clinicopathological significance of Ki-67 in papillary thyroid carcinoma: A suitable indicator? World J Surg Oncol, 2018, 16(1): 100.
27. Jemal A, Ma J, Rosenberg PS, et al. Increasing lung cancer death rates among young women in southern and midwestern States. J Clin Oncol, 2012, 30(22): 2739-2744.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Diagnosis and malignant analysis of mass versus pneumonia type of primary pulmonary mucinous adenocarcinoma

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