Difference between revisions of "Pulmonary meningothelial-like nodule"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Pulmonary meningothelial-like nodule -- very low mag.jpg | |||
| Width = | |||
| Caption = Pulmonary meningothelial-like nodule. [[H&E stain]]. | |||
| Synonyms = pulmonary chemodectoma | |||
| Micro = small cell nests (expanding alveolar septa) with whorled appearance/streaming; composed of bland cells with round/ovoid nuclei without appreciable nucleoli | |||
| Subtypes = | |||
| LMDDx = [[lung tumourlet]], poorly differentiated carcinoma, [[lobular breast carcinoma]] | |||
| Stains = | |||
| IHC = PR +ve, vimentin +ve, EMA +ve, CD56 +ve, chromogranin A -ve, synaptophysin -ve, S-100 -ve | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = tan or yellow nodules - pleural or parenchymal, typically 1-3 mm | |||
| Grossing = | |||
| Site = [[lung]] | |||
| Assdx = poorly understood association with [[lung tumours]] - esp. [[lung adenocarcinoma]] | |||
| Syndromes = | |||
| Clinicalhx = typically an incidential finding | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = very common | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = | |||
| Tx = none | |||
}} | |||
'''Pulmonary meningothelial-like nodule''', abbreviated '''MLN''', is a common benign finding in the [[lung]]. | '''Pulmonary meningothelial-like nodule''', abbreviated '''MLN''', is a common benign finding in the [[lung]]. | ||
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*Very common - seen in almost half of well sampled lobectomies.<ref name=pmid19047895/> | *Very common - seen in almost half of well sampled lobectomies.<ref name=pmid19047895/> | ||
*May be grouped with ''pulmonary meningioma'' in the larger category ''primary pleuropulmonary meningothelial proliferations''.<ref name=pmid26291511>{{Cite journal | last1 = Weissferdt | first1 = A. | last2 = Tang | first2 = X. | last3 = Suster | first3 = S. | last4 = Wistuba | first4 = II. | last5 = Moran | first5 = CA. | title = Pleuropulmonary Meningothelial Proliferations: Evidence for a Common Histogenesis. | journal = Am J Surg Pathol | volume = | issue = | pages = | month = Aug | year = 2015 | doi = 10.1097/PAS.0000000000000489 | PMID = 26291511 }}</ref> | *May be grouped with ''pulmonary meningioma'' in the larger category ''primary pleuropulmonary meningothelial proliferations''.<ref name=pmid26291511>{{Cite journal | last1 = Weissferdt | first1 = A. | last2 = Tang | first2 = X. | last3 = Suster | first3 = S. | last4 = Wistuba | first4 = II. | last5 = Moran | first5 = CA. | title = Pleuropulmonary Meningothelial Proliferations: Evidence for a Common Histogenesis. | journal = Am J Surg Pathol | volume = | issue = | pages = | month = Aug | year = 2015 | doi = 10.1097/PAS.0000000000000489 | PMID = 26291511 }}</ref> | ||
*Can mimic [[metastasis|metastatic deposits]].<ref name=pmid23109985>{{Cite journal | last1 = Kfoury | first1 = H. | last2 = Arafah | first2 = MA. | last3 = Arafah | first3 = MM. | last4 = Alnassar | first4 = S. | last5 = Hajjar | first5 = W. | title = Mimicry of Minute Pulmonary Meningothelial-like Nodules to Metastatic Deposits in a Patient with Infiltrating Lobular Carcinoma: A Case Report and Review of the Literature. | journal = Korean J Pathol | volume = 46 | issue = 1 | pages = 87-91 | month = Feb | year = 2012 | doi = 10.4132/KoreanJPathol.2012.46.1.87 | PMID = 23109985 }}</ref> | *Can mimic [[metastasis|metastatic deposits]].<ref name=pmid24023559/><ref name=pmid23109985>{{Cite journal | last1 = Kfoury | first1 = H. | last2 = Arafah | first2 = MA. | last3 = Arafah | first3 = MM. | last4 = Alnassar | first4 = S. | last5 = Hajjar | first5 = W. | title = Mimicry of Minute Pulmonary Meningothelial-like Nodules to Metastatic Deposits in a Patient with Infiltrating Lobular Carcinoma: A Case Report and Review of the Literature. | journal = Korean J Pathol | volume = 46 | issue = 1 | pages = 87-91 | month = Feb | year = 2012 | doi = 10.4132/KoreanJPathol.2012.46.1.87 | PMID = 23109985 }}</ref> | ||
Associations: | Associations: | ||
| Line 23: | Line 53: | ||
==Microscopic== | ==Microscopic== | ||
Features:<ref name=pmid2830799/> | Features:<ref name=pmid2830799/> | ||
* | *Small cell nests - expanding alveolar septa. | ||
**Whorled appearance/streaming. | |||
**Composed of bland cells with round/ovoid nuclei without appreciable nucleoli. | |||
DDx: | DDx: | ||
*[[Lung tumourlet]]. | *[[Lung tumourlet]] - associated with airway.{{fact}} | ||
*Poorly differentiated carcinoma. | *Poorly differentiated carcinoma. | ||
*[[Lobular carcinoma]].<ref name=pmid23109985>{{Cite journal | last1 = Kfoury | first1 = H. | last2 = Arafah | first2 = MA. | last3 = Arafah | first3 = MM. | last4 = Alnassar | first4 = S. | last5 = Hajjar | first5 = W. | title = Mimicry of Minute Pulmonary Meningothelial-like Nodules to Metastatic Deposits in a Patient with Infiltrating Lobular Carcinoma: A Case Report and Review of the Literature. | journal = Korean J Pathol | volume = 46 | issue = 1 | pages = 87-91 | month = Feb | year = 2012 | doi = 10.4132/KoreanJPathol.2012.46.1.87 | PMID = 23109985 }}</ref> | *[[Lobular carcinoma]].<ref name=pmid23109985>{{Cite journal | last1 = Kfoury | first1 = H. | last2 = Arafah | first2 = MA. | last3 = Arafah | first3 = MM. | last4 = Alnassar | first4 = S. | last5 = Hajjar | first5 = W. | title = Mimicry of Minute Pulmonary Meningothelial-like Nodules to Metastatic Deposits in a Patient with Infiltrating Lobular Carcinoma: A Case Report and Review of the Literature. | journal = Korean J Pathol | volume = 46 | issue = 1 | pages = 87-91 | month = Feb | year = 2012 | doi = 10.4132/KoreanJPathol.2012.46.1.87 | PMID = 23109985 }}</ref> | ||
===Images=== | ===Images=== | ||
====Case 1==== | |||
<gallery> | |||
Image: Pulmonary meningothelial-like nodule -- very low mag.jpg | PMLN - very low mag. (WC) | |||
Image: Pulmonary meningothelial-like nodule -- low mag.jpg | PMLN - low mag. (WC) | |||
Image: Pulmonary meningothelial-like nodule -- intermed mag.jpg | PMLN - intermed. mag. (WC) | |||
Image: Pulmonary meningothelial-like nodule - alt -- intermed mag.jpg | PMLN - intermed. mag. (WC) | |||
Image: Pulmonary meningothelial-like nodule -- high mag.jpg | PMLN - high mag. (WC) | |||
Image: Pulmonary meningothelial-like nodule - alt -- high mag.jpg | PMLN - high mag. (WC) | |||
Image: Pulmonary meningothelial-like nodule -- very high mag.jpg | PMLN - very high mag. (WC) | |||
</gallery> | |||
====Case 2==== | |||
<gallery> | |||
Image: Meningothelial-like nodule of lung -- very low mag.jpg | MLN - very low mag. (WC/Nephron) | |||
Image: Meningothelial-like nodule of lung -- low mag.jpg | MLN - low mag. (WC/Nephron) | |||
Image: Meningothelial-like nodule of lung -- intermed mag.jpg | MLN - intermed. mag. (WC/Nephron) | |||
Image: Meningothelial-like nodule of lung -- high mag.jpg | MLN - high mag. (WC/Nephron) | |||
Image: Meningothelial-like nodule of lung -- very high mag.jpg | MLN - very high mag. (WC/Nephron) | |||
</gallery> | |||
====www==== | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479696/figure/F2/ MLN (nih.gov)].<ref name=pmid23109985/> | *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479696/figure/F2/ MLN (nih.gov)].<ref name=pmid23109985/> | ||
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*EMA +ve (11 of 11 cases<ref name=pmid19047895/>). | *EMA +ve (11 of 11 cases<ref name=pmid19047895/>). | ||
*Vimentin +ve (10 of 14 cases<ref name=pmid2830799/>). | *Vimentin +ve (10 of 14 cases<ref name=pmid2830799/>). | ||
*PR (18 of 18 cases<ref name=pmid19047895/>). | |||
Others:<ref name=pmid2830799/> | |||
*S-100 -ve. | |||
*NSE -ve. | |||
*Cytokeratin -ve. | |||
*Actin -ve. | |||
===Images=== | |||
<gallery> | |||
Image: Pulmonary meningothelial-like nodule - PR -- intermed mag.jpg | PMLN - PR - intermed. mag. (WC) | |||
Image: Pulmonary meningothelial-like nodule - PR -- high mag.jpg | PMLN - PR - high mag. (WC) | |||
</gallery> | |||
==See also== | ==See also== | ||
Latest revision as of 03:57, 12 May 2016
| Pulmonary meningothelial-like nodule | |
|---|---|
| Diagnosis in short | |
 Pulmonary meningothelial-like nodule. H&E stain. | |
|
| |
| Synonyms | pulmonary chemodectoma |
|
| |
| LM | small cell nests (expanding alveolar septa) with whorled appearance/streaming; composed of bland cells with round/ovoid nuclei without appreciable nucleoli |
| LM DDx | lung tumourlet, poorly differentiated carcinoma, lobular breast carcinoma |
| IHC | PR +ve, vimentin +ve, EMA +ve, CD56 +ve, chromogranin A -ve, synaptophysin -ve, S-100 -ve |
| Gross | tan or yellow nodules - pleural or parenchymal, typically 1-3 mm |
| Site | lung |
|
| |
| Associated Dx | poorly understood association with lung tumours - esp. lung adenocarcinoma |
| Clinical history | typically an incidential finding |
| Prevalence | very common |
| Prognosis | benign |
| Treatment | none |
Pulmonary meningothelial-like nodule, abbreviated MLN, is a common benign finding in the lung.
They are also referred to as minute pulmonary meningothelial-like nodules (abbreviated MPMN) and minute pulmonary chemodectoma.[1]
General
- Benign.[2]
- Very common - seen in almost half of well sampled lobectomies.[3]
- May be grouped with pulmonary meningioma in the larger category primary pleuropulmonary meningothelial proliferations.[4]
- Can mimic metastatic deposits.[2][5]
Associations:
- More common in females (odds ratio 2).[6]
- Seen more frequently in the context of cancer - esp. adenocarcinoma.[6]
Gross
- Tan or yellow nodules - pleural or parenchymal - typically 1-3 mm.[1]
Note:
Microscopic
Features:[1]
- Small cell nests - expanding alveolar septa.
- Whorled appearance/streaming.
- Composed of bland cells with round/ovoid nuclei without appreciable nucleoli.
DDx:
- Lung tumourlet - associated with airway.[citation needed]
- Poorly differentiated carcinoma.
- Lobular carcinoma.[5]
Images
Case 1
PMLN - very low mag. (WC)
PMLN - low mag. (WC)
PMLN - intermed. mag. (WC)
PMLN - intermed. mag. (WC)
PMLN - high mag. (WC)
PMLN - high mag. (WC)
PMLN - very high mag. (WC)
Case 2
MLN - very low mag. (WC/Nephron)
MLN - low mag. (WC/Nephron)
MLN - intermed. mag. (WC/Nephron)
MLN - high mag. (WC/Nephron)
MLN - very high mag. (WC/Nephron)
www
IHC
Features:
- CD56 +ve (18 of 18 cases[3]).
- EMA +ve (11 of 11 cases[3]).
- Vimentin +ve (10 of 14 cases[1]).
- PR (18 of 18 cases[3]).
Others:[1]
- S-100 -ve.
- NSE -ve.
- Cytokeratin -ve.
- Actin -ve.
Images
PMLN - PR - intermed. mag. (WC)
PMLN - PR - high mag. (WC)
See also
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Gaffey, MJ.; Mills, SE.; Askin, FB. (Mar 1988). "Minute pulmonary meningothelial-like nodules. A clinicopathologic study of so-called minute pulmonary chemodectoma.". Am J Surg Pathol 12 (3): 167-75. PMID 2830799.
- ↑ 2.0 2.1 2.2 Lee, SK.; Kim, GJ.; Kim, YJ.; Leem, AY.; Hwang, ED.; Kim, SK.; Chang, J.; Kang, YA. et al. (Aug 2013). "Minute pulmonary meningothelial-like nodules simulating hematogenous lung metastasis: a case report.". Tuberc Respir Dis (Seoul) 75 (2): 67-70. doi:10.4046/trd.2013.75.2.67. PMID 24023559.
- ↑ 3.0 3.1 3.2 3.3 Mukhopadhyay, S.; El-Zammar, OA.; Katzenstein, AL. (Apr 2009). "Pulmonary meningothelial-like nodules: new insights into a common but poorly understood entity.". Am J Surg Pathol 33 (4): 487-95. doi:10.1097/PAS.0b013e31818b1de7. PMID 19047895.
- ↑ Weissferdt, A.; Tang, X.; Suster, S.; Wistuba, II.; Moran, CA. (Aug 2015). "Pleuropulmonary Meningothelial Proliferations: Evidence for a Common Histogenesis.". Am J Surg Pathol. doi:10.1097/PAS.0000000000000489. PMID 26291511.
- ↑ 5.0 5.1 5.2 Kfoury, H.; Arafah, MA.; Arafah, MM.; Alnassar, S.; Hajjar, W. (Feb 2012). "Mimicry of Minute Pulmonary Meningothelial-like Nodules to Metastatic Deposits in a Patient with Infiltrating Lobular Carcinoma: A Case Report and Review of the Literature.". Korean J Pathol 46 (1): 87-91. doi:10.4132/KoreanJPathol.2012.46.1.87. PMID 23109985.
- ↑ 6.0 6.1 6.2 Mizutani, E.; Tsuta, K.; Maeshima, AM.; Asamura, H.; Matsuno, Y. (May 2009). "Minute pulmonary meningothelial-like nodules: clinicopathologic analysis of 121 patients.". Hum Pathol 40 (5): 678-82. doi:10.1016/j.humpath.2008.08.018. PMID 19144385.