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A rare cause of chronic cough: solitary glandular papilloma of the lung

Please cite this paper as: Kosmidis M, Rodriguez Rodriguez R, R, Nierhoff Nierhoff N N and and Muggensturm Muggensturm P. A rare cause of chronic cough: solitary glandular papilloma of the lung. P. lung. Clin Clin Respir JJ 2015; 2014; 9:••:487–488. ••–••. DOI:10.1111/crj.12162. DOI:10.1111/crj.12162.

Authorship and Contributorship All authors contributed substantially to the paper. KM and MP conceived the paper, wrote the manuscript and did the literature search. RR performed microscopic examination of biopsy samples and created the related images. NN performed interventional bronchoscopy and created the related images.

Ethics Our patient gave written informed consent to publish this case. Conflict of interest The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Key words chronic cough – glandular papilloma – lung tumour Correspondence Maria Kosmidis, MD, Linth Hospital, Gasterstrasse 25, 8730 Uznach, Switzerland Tel: + 41 55 285 50 33 Fax: + 41 55 285 40 40 email: [email protected] Received: 28 November 2013 Revision requested: 08 April 2014 Accepted: 02 May 2014 DOI:10.1111/crj.12162

A male, 71-year-old, retired electrical engineer presented with a persistent, mildly productive cough since 4 months. No history of haemoptysis nor dyspnoea was reported. The medical history was significant for a tobacco use over 3 years in the past. Pulmonary function tests were normal. The chest radiography and CT scan demonstrated a 10-mm-sized lesion localised in the bronchus of the right lower lobe. A subsequent

bronchoscopy revealed a firm, irregularly demarcated and rose-coloured mass, completely occluding the lobar bronchus at the trifurcation of the basal lower lobe segments (8–10, Fig. 1). Histopathological examination of the tissue showed a papillary tumour with a two-layered epithelium composed of basal cuboidal cells, a luminal columnar cell layer (Figs. 2 and 3) and small foci of squamous metaplasia (not shown). There

Figure 1. Tumour in the right lower lobe bronchus, occluding segments 8–10.

Figure 2. Papillary structures and solitary glandular formation (HE, 10×).

The Clinical Clinical Respiratory Respiratory Journal Journal (2015) (2014) •• ISSN ISSN 1752-6981 1752-6981 C 2014 John Wiley & Sons Ltd V © 2014 John Wiley & Sons Ltd

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Glandular Glandular papilloma papilloma of of the the lung lung

Figure 3. Papillary structures with two-layered epithelium (HE, 20×).

were no histological criteria of dysplasia or malignancy. The findings led to the diagnosis of a solitary glandular papilloma. A bronchoscopic laser ablation was performed. Endoscopic follow-up after 4 weeks showed no recurrence (Fig. 4) so that a lobar resection was not necessary. In general, solitary endobronchial papillomas are rare neoplasms with an estimated incidence of 3.95 cases/100 000 patients/year. Among these, the glandular papilloma is the rarest subtype, particularly if localised in the peripheral airways. From the few case reports published, it is known that glandular papillomas appear in the sixth decade of life. Predominantly men are affected. Clinical presentation is commonly with cough and haemoptysis similar to other papillomas. However, they are often discovered incidentally (1). In contrast to squamous cell papillomas, glandular papillomas appear in an older age group, are less related to smoking and are negative for human papilloma virus (2). Malignant progression has not been reported.

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Kosmidis Kosmidis et et al. al.

Figure 4. Right lower lobe bronchus (segments 8–10) 4 weeks after laser resection.

Maria Kosmidis1, Regulo Rodriguez2, Norbert Nierhoff 3 and Patrick Muggensturm1 1 Department of General Internal Medicine, Linth Hospital, Uznach, Switzerland 2 Department of Pathology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland 3 Department of Pneumology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland

References 1. Tryfon S, Dramda V, Zoglopitis F, Iakovidis D, Sakkas L, Kontakiotis T, Galanis N. Solitary papillomas of the lower airways: epidemiological, clinical and therapeutic data during a 22-year period and review of the literature. J Thorac Oncol. 2012;7: 643–8. 2. Flieder DB, Koss MN, Nicholson A, Sesterhenn IA, Petras RE, Travis WD. Solitary pulmonary papillomas in adults: a clinicopathologic and in situ hybridization study of 14 cases combined with 27 cases in the literature. Am J Surg Pathol. 1998;22: 1328–42.

The The Clinical Clinical Respiratory Respiratory Journal Journal (2015) (2014) •• ISSN ISSN 1752-6981 1752-6981 C 2014 John Wiley & Sons Ltd V © 2014 John Wiley & Sons Ltd

A rare cause of chronic cough: solitary glandular papilloma of the lung.

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