Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2023; 11(33): 8022-8029
Published online Nov 26, 2023. doi: 10.12998/wjcc.v11.i33.8022
Pathological diagnosis and immunohistochemical analysis of minute pulmonary meningothelial-like nodules: A case report
Xin Ruan, Liu-Sheng Wu, Zheng-Yang Fan, Qi Liu, Jun Yan, Xiao-Qiang Li
Xin Ruan, Qi Liu, Xiao-Qiang Li, Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
Xin Ruan, School of Medicine, Shantou University, Shantou 515041, Guangdong Province, China
Liu-Sheng Wu, Jun Yan, School of Medicine, Tsinghua University, Beijing 100084, China
Zheng-Yang Fan, Department of Graduate School, Xinjiang Medical University, Urumchi 830011, Xinjiang Uygur Autonomous Region, China
Co-first authors: Liu-Sheng Wu, Zheng-Yang Fan, and Qi Liu.
Co-corresponding authors: Jun Yan and Xiao-Qiang Li.
Author contributions: Ruan X and Wu LS analyzed the data and wrote the paper; Li XQ designed the research; Yan J guided the research; Liu Q and Fan ZY collected and downloaded the data of our research; All the authors revised it critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work; At the beginning, the paper was designed and written by Ruan X and Wu LS as co-first authors; Later, in the first revision, Fan ZY provided the imaging image support and analysis, and Liu Q provided the experimental analysis of HE staining and immunohistochemistry in pathology; Therefore, they all have equally important contributions.
Supported by the National Natural Science Foundation of China, No. 81972829.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Yan, Doctor, Chief Doctor, School of Medicine, Tsinghua University, No. 30 Shuangqing Road, Haidian District, Beijing 100084, China. yanjun1619@tsinghua.edu.cn
Received: July 9, 2023
Peer-review started: July 9, 2023
First decision: August 30, 2023
Revised: October 10, 2023
Accepted: October 30, 2023
Article in press: October 30, 2023
Published online: November 26, 2023
Processing time: 138 Days and 2.4 Hours
Abstract
BACKGROUND

Minute Pulmonary Meningothelial-like Nodules (MPMNs) are rare benign pulmonary nodules, which are more common in elderly women and have a higher detection rate in lung tissues of patients with lung malignant diseases. Its origin is not yet clear. At present, there are few reports on the diagnostic methods such as imaging and pathological manifestations of MPMNs. This article reports a 70-year-old female patient with pulmonary adenocarcinoma combined with MPMNs and reviews of the relevant literature.

CASE SUMMARY

A 70-year-old women was admitted to our institution with feeling sour in her back and occasional cough for more than 2 mo. Computerized electronic scanning scan and 3D reconstruction images in our institution showed there were multiple ground-glass nodules in both of her two lungs. The biggest one was in the apicoposterior segment of left upper lobe, about 2.5 mm × 9 mm in size. We performed thoracoscopic resection of the left upper lung apicoposterior segment of the patient, and the final pathological report was minimally invasive adenocarcinoma. Re-examination of high resolution computed tomography 21 mo after surgery showed multiple ground-glass nodules in both lungs, and a new ground-glass nodule was found in the superior segment of the right lower lobe. We took pathological biopsy of the right upper lung and right lower lung nodules for the patient under thoracoscopy. The histomorphology of the right lower lobe nodule showed multiple lesions in the lung tissue, and the small foci in the alveolar septum were distributed in mild form of the aggregation of short spindle cells. The immunohistochemistry showed that the lesion was epithelial membrane antigen (EMA) (+), somatostatin receptor 2a (SSTR2a) (+), S-100 (-), chromogranin A (-), Syn (-), cytokeratin (-) and HMB-45 (-). The final diagnosis was minimally invasive adenocarcinoma, accompanied by MPMNs. We recommend that patients continue to receive treatment after surgery and to do regular follow-up observations.

CONCLUSION

The imaging manifestations of MPMNs are atypical, histomorphology and immunohistochemistry can assist in its diagnosis. This article reviews the relevant literature of MPMNs immunohistochemistry and shows that MPMNs are positive for EMA, SSTR2a, and progesterone receptor.

Keywords: Lung; Pathology; Immunohistochemistry; Multiple pulmonary nodules; Minute pulmonary meningothelial-like nodules; Case report

Core Tip: Minute Pulmonary Meningothelial-like Nodules (MPMNs) are rare benign pulmonary nodules, which have a higher detection rate in lung tissues of patients with lung malignant diseases. The diagnosis of MPMN is difficult and often results in unnecessary or inappropriate treatment. Therefore, it is particularly important to correctly identify and diagnose the disease. This article reports a 70-year-old female patient with pulmonary adenocarcinoma combined with MPMNs and reviews of the relevant literature in order to better identify and diagnose MPMN.