Skip to content


  • Case report
  • Open Access
  • Open Peer Review

Primary myoepithelial carcinoma of the lung: a rare entity treated with parenchymal sparing resection

  • 1Email author,
  • 2,
  • 2 and
  • 3
Journal of Cardiothoracic Surgery20116:27

  • Received: 21 October 2010
  • Accepted: 8 March 2011
  • Published:
Open Peer Review reports


Primary lung myoepithelial carcinomas are rare neoplasms arising from the salivary glands of the respiratory epithelium. Given the rare occurrences and reports of these tumors, appropriate recommendations for resection are difficult to formulate. Although classified as low-grade neoplasms, these tumors have a significant rate of recurrence and distant metastasis.


  • Adenoid Cystic Carcinoma
  • Mucoepidermoid Carcinoma
  • Acinic Cell Carcinoma
  • Visceral Pleura
  • Myoepithelial Carcinoma


Primary salivary gland-type tumors of the lung are rare and include mucoepidermoid carcinoma, adenoid cystic carcinoma, acinic cell carcinoma, oncocytoma, epithelial-myoepithelial carcinoma, benign myoepithelioma, and mixed tumors of both benign and malignant nature [116]. Primary pulmonary myoepithelial carcinomas are exceedingly rare, with only five known prior cases reported in the English literature to date [1720]. We report a case of primary myoepithelial carcinoma of the lung and a review of the literature.

Case Report

A 63-year-old woman presented to the clinic with a history of increasing pulmonary congestion, difficulty expectorating, and low-grade hemoptysis. Her past medical history was significant for diet-controlled insulin-dependent diabetes mellitus. There was no history of cigarette or other tobacco use. Her mother had died of breast cancer in her fifties. A chest radiograph showed a large mass in the right lower lung fields, and computed tomography scanning revealed a 12.4 × 8.3 centimeter smoothly circumscribed heterogeneous mass arising in the right minor fissure and impinging upon the right atrium (Figure 1A). A fine needle aspiration was performed which yielded a diagnosis initially suspicious for schwannoma, as reviewed at an outside institution. At the time of thoracotomy, dense adhesions were dissected free of the upper and middle lobes with no evidence of tumor invasion, and the mass was resected en-bloc with pericardium and a wedge resection of the lower lobe. An additional separate lower lobe nodule was also excised and presumed to be a metastatic focus of tumor. The patient had an uneventful recovery and was discharged home on post-operative day number three.
Figure 1
Figure 1

Radiographic and gross pathologic appearance of primary pulmonary myoepithelial carcinoma. A. Computed tomography of right-sided chest mass with compression of right atrium. B. Gross pathologic appearance of right visceral pleural mass.

The patient developed a biopsy proven solitary liver/diaphragmatic metastasis diagnosed on routine follow-up at 36 months post-resection.

Pathologic Findings

Gross pathologic examination revealed the mass to be a 13 × 8 × 8 centimeter lower lobe carcinoma of myoepithelial origin involving the visceral pleura (Figure 1B).

Histologically, the mass was consistent with a malignant myoepithelial neoplasm with a fibrous capsule and 20% necrosis. The mass was thought to arise from the right lower lobe and involved the visceral pleura. The margin was focally within 0.1 cm of the tumor, but otherwise grossly free of invasion. The separate nodule was 1 cm in size and histologically similar to the primary tumor.

Immunohistochemical stains were performed and were focally positive for AE1/AE3, Bcl2, Cam5.2, S100p, GFAP, 4A4, SMA, and CD99. Stains for EMA, desmin, CD34, calponin, FLI1, myogenin, and synaptophysin were negative.


Myoepithelial carcinomas primarily arise from the salivary glands, the parotid, or the breast [21]. Rarely, they may arise in soft tissues, most often in the lower and upper limbs, occurring equally in men and women [22]. These soft-tissue tumors, distinguished from benign myoepitheliomas by their moderate or severe cytologic atypia or invasive growth pattern, recur locally in 42% of patients and metastasize to distant sites in 32%.

Primary myoepithelial carcinomas of the lung are exceedingly rare, with only 6 patients reported in the English literature, including the present report [1720]. Clinical data from these reports are summarized in Table 1. Very limited information was available for one patient [20]. Most patients were male, in their fifth or sixth decade of life at diagnosis, and smoked tobacco. Most patients presented with primarily endobronchial disease, had preoperative biopsies of their tumors, and underwent anatomic resections of these malignancies. There were no local recurrences. Almost all patients had metastatic disease, either synchronous at time of resection, or presenting as metachronous recurrence. Follow-up was less than two years for all but one patient, who died of metastatic disease to the liver five years postoperatively. One other patient died at fourteen months from synchronous metastatic adenocarcinoma. One patient was alive with disease, and two others were free of disease at relatively short follow-up intervals.
Table 1

Clinical characteristics of reported cases of myoepithelial carcinoma of the lung.





Pre-op Bx Diagnosis

Size (cm)

Resection Type

Local Recurrence



Present case



RLL, Pleural & parenchymal

Low grade spindle cell neoplasm


Wedge/Local excision


Yes, same lobe/pleura at time of resection, liver at 36 months

AWD at 36 months

Masuya 2005



LLL, Parenchymal & Endobronchial

Sarcoma, sarcomatoid carcinoma, carcinosarcoma





NED 15 months

Miura 2000



Right hilum, Right Main Stem, Endobronchial

No atypical cells




Yes, LLL

AWD at 7 months




RUL, Endobronchial



Sleeve bilobectomy (RUL/RML)


Yes, soft tissue left arm and hip

DOC at 14 months (metastatic synchronous adenocarcinoma)

Higashiyama 1998



LUL, Endobronchial

Squamous cell carcinoma


Sleeve lobectomy (LUL)


Yes, liver

DOD, 60 months

Sekine 1998










RLL - right lower lobe; LLL - left lower lobe; RUL - right upper lobe; LUL - left upper lobe; RML - right middle lobe; Bx - biopsy; NED - no evidence of disease; AWD - alive with disease; DOC - dead of other causes; DOD - dead of disease

Given the available reported data, there are a number of unique characteristics of the current case when compared to the previous five. This case represents the eldest and only female patient, as well as the only known never-smoker. This patient's tumor is also the greatest in size within this series, more than doubling the previous known largest of these tumors. All other patients in the series presented with a major component of endobronchial disease, whereas the current tumor was primarily pleural/parenchymal based. Finally, the current case represents the only patient treated with a limited sub-anatomic resection.

Given the relatively high rates of recurrence, low-grade malignant status, and the propensity for recurrence at distant sites, it is reasonable to consider limited sub-anatomic, parenchymal sparing resections for these patients, especially if pneumonectomy is contemplated. While this may not be adequate for endobronchial lesions involving major pulmonary segments, it is feasible for lesions presenting with primarily parenchymal or pleural based disease, as in the current case. Given the rarity of these tumors, recommendations regarding chemotherapy or radiation, either pre- or postoperatively, are difficult to formulate.



Authors’ Affiliations

Department of Surgery, Thoracic Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
Division of Thoracic Surgery, Mount Sinai Medical Center, 1190 Fifth Avenue, PO Box 1028, New York, NY 10029, USA


  1. Doganay L, Bilgi S, Ozdil A, Yoruk Y, Altaner S, Kutlu K: Epithelial-myoepithelial carcinoma of the lung. A case report and review of the literature. Arch Pathol Lab Med. 2003, 127: e177-180.PubMedGoogle Scholar
  2. Cagirici U, Sayiner A, Inci I, Veral A: Myoepithelioma of the lung. Eur J Cardiothorac Surg. 2000, 17: 187-189. 10.1016/S1010-7940(00)00338-9.View ArticlePubMedGoogle Scholar
  3. Fulford LG, Kamata Y, Okudera K, Dawson A, Corrin B, Sheppard MN, Ibrahim NB, Nicholson AG: Epithelial-myoepithelial carcinomas of the bronchus. Am J Surg Pathol. 2001, 25: 1508-1514. 10.1097/00000478-200112000-00006.View ArticlePubMedGoogle Scholar
  4. Cho KJ, el-Naggar AK, Ordonez NG, Luna MA, Austin J, Batsakis JG: Epithelial-myoepithelial carcinoma of salivary glands. A clinicopathologic, DNA flow cytometric, and immunohistochemical study of Ki-67 and HER-2/neu oncogene. Am J Clin Pathol. 1995, 103: 432-437.View ArticlePubMedGoogle Scholar
  5. Davis PW, Briggs JC, Seal RM, Storring FK: Benign and malignant mixed tumours of the lung. Thorax. 1972, 27: 657-673. 10.1136/thx.27.6.657.View ArticlePubMedPubMed CentralGoogle Scholar
  6. Fechner RE, Bentinck BR, Askew JB: Acinic cell tumor of the lung. A histologic and ultrastructural study. Cancer. 1972, 29: 501-508. 10.1002/1097-0142(197202)29:2<501::AID-CNCR2820290241>3.0.CO;2-B.View ArticlePubMedGoogle Scholar
  7. Horinouchi H, Ishihara T, Kawamura M, Kato R, Kikuchi K, Kobayashi K, Maenaka Y, Torikata C: Epithelial myoepithelial tumour of the tracheal gland. J Clin Pathol. 1993, 46: 185-187. 10.1136/jcp.46.2.185.View ArticlePubMedPubMed CentralGoogle Scholar
  8. Moran CA, Suster S, Askin FB, Koss MN: Benign and malignant salivary gland-type mixed tumors of the lung. Clinicopathologic and immunohistochemical study of eight cases. Cancer. 1994, 73: 2481-2490. 10.1002/1097-0142(19940515)73:10<2481::AID-CNCR2820731006>3.0.CO;2-A.View ArticlePubMedGoogle Scholar
  9. Nistal M, Garcia-Viera M, Martinez-Garcia C, Paniagua R: Epithelial-myoepithelial tumor of the bronchus. Am J Surg Pathol. 1994, 18: 421-425. 10.1097/00000478-199404000-00010.View ArticlePubMedGoogle Scholar
  10. Pelosi G, Fraggetta F, Maffini F, Solli P, Cavallon A, Viale G: Pulmonary epithelial-myoepithelial tumor of unproven malignant potential: report of a case and review of the literature. Mod Pathol. 2001, 14: 521-526. 10.1038/modpathol.3880341.View ArticlePubMedGoogle Scholar
  11. Ryska A, Kerekes Z, Hovorkova E, Barton P: Epithelial-myoepithelial carcinoma of the bronchus. Pathol Res Pract. 1998, 194: 431-435. discussion 436-438View ArticlePubMedGoogle Scholar
  12. Santos-Briz A, Terron J, Sastre R, Romero L, Valle A: Oncocytoma of the lung. Cancer. 1977, 40: 1330-1336. 10.1002/1097-0142(197709)40:3<1330::AID-CNCR2820400350>3.0.CO;2-K.View ArticlePubMedGoogle Scholar
  13. Spencer H: Bronchial mucous gland tumours. Virchows Arch A Pathol Anat Histol. 1979, 383: 101-115. 10.1007/BF00427013.View ArticlePubMedGoogle Scholar
  14. Strickler JG, Hegstrom J, Thomas MJ, Yousem SA: Myoepithelioma of the lung. Arch Pathol Lab Med. 1987, 111: 1082-1085.PubMedGoogle Scholar
  15. Tsuji N, Tateishi R, Ishiguro S, Terao T, Higashiyama M: Adenomyoepithelioma of the lung. Am J Surg Pathol. 1995, 19: 956-962. 10.1097/00000478-199508000-00012.View ArticlePubMedGoogle Scholar
  16. Wilson RW, Moran CA: Epithelial-myoepithelial carcinoma of the lung: immunohistochemical and ultrastructural observations and review of the literature. Hum Pathol. 1997, 28: 631-635. 10.1016/S0046-8177(97)90088-5.View ArticlePubMedGoogle Scholar
  17. Higashiyama M, Kodama K, Yokouchi H, Takami K, Kabuto T, Tsuji N, Mano M, Ishiguro S, Ueda T, Yoshikawa H, Tatsuta M: Myoepithelioma of the lung: report of two cases and review of the literature. Lung Cancer. 1998, 20: 47-56. 10.1016/S0169-5002(98)00006-3.View ArticlePubMedGoogle Scholar
  18. Masuya D, Haba R, Huang CL, Yokomise H: Myoepithelial carcinoma of the lung. Eur J Cardiothorac Surg. 2005, 28: 775-777. 10.1016/j.ejcts.2005.08.003.View ArticlePubMedGoogle Scholar
  19. Miura K, Harada H, Aiba S, Tsutsui Y: Myoepithelial carcinoma of the lung arising from bronchial submucosa. Am J Surg Pathol. 2000, 24: 1300-1304. 10.1097/00000478-200009000-00016.View ArticlePubMedGoogle Scholar
  20. Sekine I, Kodama T, Yokose T, Nishiwaki Y, Suzuki K, Goto K, Nagai K, Kuriyama T: Rare pulmonary tumors - a review of 32 cases. Oncology. 1998, 55: 431-434. 10.1159/000011891.View ArticlePubMedGoogle Scholar
  21. Colby TV, Koss MN, Travis WD: Tumors of salivary gland type. Atlas of tumor pathology Tumors of the lower respiratory tract. Edited by: Colby TV, Koss MN, travis WD. 1995, Washington, D.C.: Armed Forces Institute of Pathology, 65-89.Google Scholar
  22. Hornick JL, Fletcher CD: Myoepithelial tumors of soft tissue: a clinicopathologic and immunohistochemical study of 101 cases with evaluation of prognostic parameters. Am J Surg Pathol. 2003, 27: 1183-1196. 10.1097/00000478-200309000-00001.View ArticlePubMedGoogle Scholar


© Sarkaria et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.