Clinical Case Report Medicine ®

Bronchiole adenoma/pulmonary ciliated mucinous

nodular papillary tumor
Case series and literature review
Shanshan Liua, Xiaoshan Cai, MMb, Jianliang Pan, MMc, Shaoyun Liud, Jianjun Line, Xianwen Yue, MDf,*

Abstract
Objective: To analyze the clinical-pathological characteristics of 3 cases of bronchiolar adenoma/pulmonary ciliary mucinous
nodular papillary tumors, and to improve the understanding of bronchiolar adenoma (BA)/ciliated muconodular papillary tumors
(CMPT) (bronchiolar adenoma/ciliated muconodular papillary tumor).
Methods: Retrospective analysis was done on the clinical information, diagnosis, and treatment of 3 instances of BA/CMPT at
the Second People’s Hospital of Weifang City. By scanning the CNKI, Wanfang, VIP database, and Pubmed database using the
English key words “bronchiolar adenoma, ciliated muconodular papillary tumor,” respectively patients with comprehensive clinical
data were gathered, and studies from January 2002 to August 2021 that were relevant to the patients were examined.
Results: A total of 35 articles and 71 instances were found, including 3 cases in our hospital, for a total of 74 cases. There
were 31 males and 43 females among them, ranging in age from 18 to 84 years (average 63 years), and 15 cases had a smoking
history. The majority of them were discovered by physical examination and had no clinical symptoms. The majority of the imaging
revealed solid nodules with variable forms, with some ground-glass nodules displaying vacuole and bronchial inflation signs. BA/
CMPT are generally gray-white, gray-brown solid nodules with obvious boundaries but no envelope with a maximum dimension of
4 to 45 mm (average 10.6 mm) on gross examination. Acinar, papillary, and lepidic formations can be seen under the microscope
at high magnification; the majority of these structures are made up of tripartite epithelial components, including basal cells,
mucous cells, ciliated columnar cells, and alveolar epithelial cells, demonstrating a variety of combinations. An important basis
for diagnosis in immunohistochemistry is the continuous positive basal cell layer that is shown by p63, p40, and CK5/6. BRAF
and epidermal growth factor receptor are the genes that are most frequently mutated. All of the patients showed no signs of
metastasis or recurrence during follow-up period.
Conclusion: BA/CMPT is a rare benign tumor of lung epithelium. Because imaging and intraoperative cryosection diagnosis
are easy to be misdiagnosed as malignant, it is necessary to further improve understanding and improve immunohistochemistry
and genetic examination.
Abbreviations: BA = bronchiolar adenoma, CMPT = ciliated muconodular papillary tumors, EGFR = epidermal growth factor
receptor.
Keywords: adenomas, bronchiolar adenomas/pulmonary ciliary mucinous nodular papillary tumors, diagnosis and differentiation,
immunohistochemistry, lung neoplasms

1. Introduction cellular structure formed of basal and luminal surface cells as

the most notable histological feature. Mucous cells, ciliated
Bronchiolar adenoma (BA) is a new diagnostic word for a [1]
cells, Clara cells, and alveolar cells make up the luminal sur-
benign tumor arising from the bronchiolar mucosal epithelium. face cell layer. BA is classified as proximal (proximal type) or
The tumor is well-defined yet unenveloped, with a bilayer of

This study is approved by the Ethics Committee of Written informed consent was f
Department of Radiology, Weifang No. 2 People’s Hospital, Shandong Province,
obtained. China.
The authors have no conflicts of interest to disclose. * Correspondence: Xianwen Yue, Department of Radiology, Weifang No. 2
People’s Hospital, No. 7, Xueyuan Street, Kuiwen District, Weifang, Shandong
The datasets generated during and/or analyzed during the current study are 261041, China (e-mail: [email protected]).
available from the corresponding author on reasonable request.
Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.
All procedures performed in studies involving human participants were in This is an open access article distributed under the Creative Commons
accordance with the 1964 Helsinki declaration and its later amendments or Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and
comparable ethical standards. reproduction in any medium, provided the original work is properly cited.
a
Department of Cardiac Intensive Care and Rehabilitation, Weifang People’s How to cite this article: Liu S, Cai X, Pan J, Liu S, Lin J, Yue X. Bronchiole
Hospital, Shandong Province, China, b Department of Pathology, Weifang No. 2 adenoma/pulmonary ciliated mucinous nodular papillary tumor: Case series and
People’s Hospital, Shandong Province, China, c Department of Critical Medicine, literature review. Medicine 2023;102:50(e36559).
Weifang No. 2 People’s Hospital, Shandong Province, China, d Department of Received: 6 July 2023 / Received in final form: 15 November 2023 / Accepted:
Radiology, Weifang Yuandu Hospital, Shandong Province, China, e Department of 20 November 2023
Chest Surgery, Weifang No. 2 People’s Hospital, Shandong Province, China,
http://dx.doi.org/10.1097/MD.0000000000036559

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distal (distal type) based on the proportion of mucinous cells basal cells, so mucinous adenocarcinoma was considered. HE
and ciliated cells. Chang et al[2] introduced this hypothesis in staining: it is mainly composed of mucous cells, with a small
2018. The name derives from a thorough examination of papil- nucleus located at the base of cells, basal cells visible in some
lary tumors (Ciliated Muconodular Papillary Tumors, CMPT), areas, and large amounts of mucus accumulation in the glandu-
which are classified as both typical and nontypical expansions lar lumen (Fig. 6). Immunohistochemistry: TTF-1 (+), Napsin
of CMPT. Ishikawa et al,[3] a Japanese scholar, initially described A (foci+), CK5/ 6 (basal cell+), P40 (basal cell+), CK7 (+), P63
that CMPT, which is a benign or low-grade malignant papil- (basal cell+), and Ki-67 (<1%) (Fig. 7). Genetic testing: the
lary tumor that occurs in peripheral lung tissue, in 2002. It is BRAF V600E mutation (Fig. 8). Pathological diagnosis: bron-
named after its morphological traits and is composed of ciliated chiolar adenoma.
columnar cells, goblet cells, and basal cells. According to the
classical description of CMPT, a subset of proximal-type BAs
contain significant papillary features. BA/CMPT was defined 2.3. Case 3
as a subtype of epithelial tumor adenoma in the fifth edition Miss Zhang, female, 65 years old. Appeal of intermittent fever
of WHO lung tumor classification in 2021, clarifying the link before 1 month, afternoon, the highest 38 ºC, accompanied by
between the 2. This paper retrospectively analyzed 3 confirmed pharyngeal discomfort, peripheral body weakness. In the local
cases of BA/CMPT in Weifang Second People’s Hospital, and county hospital, chest CT examination showed: mixed ground
summarized and analyzed the related cases with complete data glass lesions in the middle lobe of the right lung (maximum
at home and abroad, aiming to improve the understanding of axial section diameter: about 24 mm * 21 mm), circular shape,
BA/CMPT, help the clinical accurate treatment and evaluation clear boundary, marginal lobation, uneven lesion density, tor-
of the disease, and avoid the burden brought by overdiagnosis tuous and thickened blood vessels and inflated bronchi, and
and treatment to patients. adjacent pleural adhesion (Fig. 9).One month interval to our
hospital for review of chest CT without change. First diagno-
sis: early lung cancer, with middle lobectomy of the right lung.
2. Clinical data Gross specimen: see gray, white, gray and yellow solid lesions
in the open lung, adjacent to the lung surface, the pleura was
2.1. Case 1
not wrinkled, and the volume was about 19 mm × 18 mm ×
Miss Liu, female, 49 years old. The history of hyperthyroidism 14 mm. HE staining: mainly composed of tubular glands, cells
is more than 10 years, and the abdominal teratoma resection are columnar and cilia are visible, and basal cells are not clearly
is more than 10 years. No history of smoking. The patient had shown in routine sections (Fig. 10). Immunohistochemistry:
no conscious symptoms, and chest CT examination 1 month TTF-1 (+), CK5/ 6 (basal cell+), P40 (basal cell+), P63 (basal
ago showed: mixed ground glass nodules in the outer basal cell−), Ki-67 (<1%) (Figs. 11 and 12). Genetic testing: the
segment of the left lung (axial maximum section diameter line: EGFR 19-del mutation (Fig. 13). Pathological diagnosis: bron-
14 mm * 14 mm), irregular morphology, unclear boundary, chiolar adenoma.
marginal segmentation, uneven thickened blood vessels and All patients are explicitly state written informed consent was
inflatable bronchi, and adjacent pleural adhesion (Fig. 1). One- secured from the legal guardian/next of kin for patients within
month review of the chest CT showed no changes. First diag- this specific age group in this study.
nosis: early lung cancer, hence wedge resection of the lower
lobe of the left lung. Gross specimen: gray, gray, brown solid
lesions in the open lung, adjacent to the lung surface, no 2.4. Literature review
shrinkage in the pleura, and the volume was about 22 mm ×
The literature from January 2002 to August 2021 was
13 mm × 10 mm. Rapid pathology: the dilated adenoid struc-
searched with “bronchiolar adenoma, pulmonary ciliary muci-
ture in the lesion showed no obvious signs of malignancy. HE
nous nodule papillary tumor” in CNKI, Wanfang and VIP
staining: ciliated cells, mucus cells, and basal cells were seen
databases, and 13 Chinese documents were obtained and 29
in the lesion, and dilated bronchioles were seen around the
patients were included. In the PubMed database, “bronchiolar
lesion (Fig. 2). Immunohistochemistry: TTF-1 (+), Napsin A
adenoma, ciliated muconodular papillary tumor” and other
(partial +), CK5/ 6 (basal cell +), P40 (basal cell +), CK (+),
keywords, the corresponding literature search, obtained 22
P63 (basal cell +), and Ki-67 (<1%) (Fig. 3). Genetic test: no
English articles, including 42 patients. Most of the documents
mutated gene was seen (Fig. 4). Pathological diagnosis: bron-
obtained were case reports, with complete clinical, imaging
chiolar adenoma.
and pathological data. A total of 35 documents, 71 patients,
and 74 cases including 3 cases in our hospital. Clinical data
are shown in Table 1: 31 males and 43 females, age range:
2.2. Case 2 18–84 years (mean 63 years);51 cases had no obvious clini-
Miss Liu, female, 75 years old. Rectal surgery in 1984 and cal symptoms and 15 cases had smoking history; most of the
cholecystectomy in 2009 with no smoking history. The patient lesions were located in the right lower lobe, followed by the
had no conscious symptoms. Chest CT examination 1 year left lower lobe; tumor size range 4 to 45 mm (mean 10.6 mm),
ago showed multiple nodules in both lungs, the largest mixed 20 mm accounted for 95.8%; 55 lobe wedge resection, 5 seg-
ground glass nodules in the outer basal segment of the left lower pectomy and 12 lobectomy; all patients had chest CT images,
lobe (the largest maximum axial section diameter: about 7 mm 45 had solid nodules, 18 had ground glass nodules, 19 nod-
* 7 mm), circular shape, clear boundary, marginal lobulation, ules were morphologic, 8 had bronchial inflation and 18 had
uneven density of lesions, and the solid proportion was more vacuolar features; 5 patients underwent PET/ CT, 2 had low
than 50% (Fig. 5).Repeat chest CT 1 year after without change. FDG uptake and 3 had no uptake. The pathological results are
First diagnosis: early lung cancer, hence wedge resection of the shown in Table 2 and Figure 14: microscopic adenular, pap-
lower lobe of the left lung. Gross specimen: see gray, white, gray illary and adherent structures, most basal cells, mucous cells,
and yellow solid lesions in the open lung, adjacent to the lung ciliated cells and alveolar epithelial cells, some tumors with
surface, no pleura shrinkage, and the volume was about 5 mm basal cell hyperplasia or scalation, immunohistochemical TTF-
× 4 mm × 4 mm. Rapid pathology: microscopic lesions showed 1, CK7, p63 positivity, 90.5% of cases Ki67 < 5%, the most
irregular glands of varying sizes, large amounts of mucus in the mutated gene was BRAF (30.3%) and epidermal growth factor
gland lumen and surrounding normal alveolar lumen, glandular receptor (EGFR) (45.4%).One case underwent postoperative
epithelium was like a single layer of epithelium, and no obvious chemotherapy for lung cancer, while other cases did not receive

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Figure 3. ImmunoHC P40 shows positive nuclear staining of consecutive

basal cells. ×200.

Figure 1. Female, aged 49 years old. Chest CT showed: mixed ground glass
nodules in the outer basal segment of the lower lobe of the left lung, with the
maximum section diameter of about 14 mm * 14 mm, irregular morphology,
unclear boundary, marginal lobation, uneven lesion density, tortuous blood
vessels and inflatable bronchi, adjacent pleural adhesion.

Figure 4. No processes were detected by genetic testing. Quantitative PCR

with ARMS fluorescence.

to 45 mm (mean 10.6 mm), 20 mm accounted for 95.8%. Most

of them had no clinical symptoms (51 cases, 83.6%), and chest
Figure 2. Ciliated cells (long thick arrows), mucous cells (long thin arrow) CT examination was found incidentally, and the clinical symp-
and basal cells (short thin arrow) are visible in tumors. HE staining for ×200. toms were mostly nonspecific manifestations such as cough and
sputum. Of these, 40 had studied smoking history and 25 were
nonsmokers.
special postoperative treatment. After postoperative follow-up Most of the literature focuses on the pathology of BA/CMPT,
of 1 to 120 months (mean 27 months), all patients showed no while the chest imaging findings are rarely reported in the lit-
metastasis and recurrence during follow-up. erature. All 3 cases in our hospital were ground glass lesions, 2
cases had irregular morphology, 2 cases had clear border, 3 cases
had marginal segmentation, 2 cases had inflatable bronchial fea-
3. Discussion tures in the lesion, and 2 cases showed pleural adhesion but
BA/CMPT is a rare benign tumor of lung epithelial origin, all showed single fine line findings. According to the collected
which was first reported by Japanese scholar Ishikawa[3] in 2002 literature and a hospital of 74 cases of chest imaging findings,
and named “papillary tumor (ciliated muconodular papillary the following are: 55 cases (94.8%) for peripheral nodules, 45
tumor, CMPT).” In 2018, Chang et al[2] proposed the concept cases (71.4%) for solid nodules, 18 cases (28.6%) for ground
of “bronchiolar adenoma (Bronchiolar Adenoma, BA)” and glass nodules, 19 cases (32.8%) of morphological rules, 8 cases
divided it into 2 subtypes: proximal and distal type, with CMPT (20.5%) with bronchial inflation, 18 cases (39.1%) with vacuo-
belonging to proximal BA. In the fifth edition of WHO tho- lation, bronchial inflation and vacuolation symptoms occurred
racic tumor classification in 2021,[4] combined BA and CMPT in more cases of ground glass. Five patients obtained PET/CT
as a new subtype of lung adenoma, and the ICD-O code was scans; 2 had minimal FDG uptake and 3 had no uptake. During
8140/ 0. According to the collected literature and a total of 74 imaging follow-up, the majority of cases grew gradually or
cases in our hospital, 31 cases were male and 43 female (male slowly, with an average yearly growth rate of 0.49 mm/year,[5]
to female ratio was about 1:1.7), the age of onset was 18–84 and were easily misinterpreted as malignant lung lesions for sur-
years (mean age 63 years), and more middle-aged and elderly gical treatment.
patients (68 cases over 50 years old, 91.89%).Site: right lower BA/CMP pathological gross examination, usually for a clear
lobe (32 cases, 43.2%) > left lower lobe (20 cases, 27.0%) > single nodules, cut surface gray or gray brown, solid, medium or
right upper lobe (12 cases, 16.2%) > left upper lobe (8 cases, soft texture, some cases can have microcystic changes, accom-
10.8%) > right middle lobe (2 cases, 2.7%). Lesion size range: 4 panied by mucus secretion can be glue or mucoid, no capsule,

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mostly around the lung or around the bronchioles, usually

do not appear pleural sag.[6] BA/CMP is mainly manifested as
glandular cavity or papillary structure, and the lesion is clearly
separated from the surrounding normal lung tissue. In some
cases, mucus components can be seen in the glandular cavity,
and sometimes bronchioles can be seen within or around the
lesion. Under high microscopic, 3 epithelial components can be
seen in classical lesions: ciliated cells, mucous cells and basal

Figure 8. Gene testing shows the BRAF V600E mutation. Quantitative PCR
with ARMS fluorescence.

Figure 5. Female, aged 75 years old. Chest CT showed: mixed ground glass
nodules in the outer basement segment of the lower lobe of the left lung, the
maximum section diameter was about 7 mm * 7 mm, circular shape, clear
boundary and marginal segmentation.

Figure 9. Female, 65 years old. Chest CT showed mixed ground glass nod-
ules in the middle lobe of the right lung, and the maximum section diame-
ter was about 24 mm * 21 mm, circular, clear boundary, marginal lobation,
uneven lesion density, tortuous and thickened vessels and inflatable bronchi.
Figure 6. Tumor cells are arranged in acini, composed of mucus cells, large
amounts of mucus accumulate in the gland lumen, and basal cells can be
distinguished in some areas. HE staining for ×200.

Figure 10. Staining shows that the tumor cells are adherent or acinar, mainly
Figure 7. ImmunoHC P63 shows positive nuclear staining of consecutive composed of columnar ciliated cells with fewer mucus cells, and basal cells
basal cells. ×100. should not be distinguished in conventional sections. HE staining for ×200.

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cells. In some cases, ciliated cells and mucous cells are few or Table 1
absent, with little nuclear atypia, and usually no pathologi-
Clinical characteristics of the BA/ CMPT cases.
cal nucleotic phase and necrosis. The cellular structure of the
bilayer in the typical case is obvious, and it is not difficult to Clinical features Male (n) Female (n) Total [n(%)]
diagnose. Sometimes, basal cells are not easy to be found in HE
staining, especially in intraoperative frozen sections, which is Age of onset (years)
easy to be confused with adenocarcinoma, and we need to use ≤20 1 1 2 (2.7)
the immunohistochemical staining markers of basal cells (p40, 21–40 0 1 1 (1.4)
 41–60 8 15 23 (31.1)
p63, CK5/6) to identify.[7] Immunohistochemistry showed the
61–80 20 25 45 (60.8)
continuous presence of basal cells in the gland lumen or around
>80 0 3 3 (4.1)
History of smoking 14 1 15 (37.5)
Smoker 4 21 25 (62.5)
Nonsmoker 19 32 51 (83.6)
Symptom 2 8 10 (16.4)
Symptomless 2 6 8 (10.8)
Have symptoms 9 11 20 (27.0)
Location 5 7 12 (16.2)
Upper lobe of left 1 1 2 (2.7)
lung 12 20 32 (43.2)
Lobe of left lung 24 31 55 (94.8)
Superior lobe of 2 1 3 (5.2)
right lung 15 31 46 (65.8)
Middle lobe of 11 10 21 (30.0)
right lung 0 1 1 (14.3)
Inferior lobe of 2 0 2 (2.9)
Figure 11. IHC CK5/6 shows cytoplasmic positive coloration of consecutive right lung 21 24 45 (71.4)
basal cells. ×200. Peripheral type 7 11 18 (28.6)
Center type 8 11 19 (32.8)
Size 19 20 39 (67.2)
≤10 5 13 18 (39.1)
11–20 12 16 28 (60.9)
21–30 4 4 8 (20.5)
>30 13 18 31 (79.5)
CT representation 2 1 3 (60.0)
Solid nodules 2 0 2 (40.0)
Grinding glass 0 0 0
nodules 19 36 55 (76.4)
Form 3 2 5 (6.9)
Regulation 6 6 12 (16.7)
Irregular 3 13 16 (94.1)
Vacuole sign 1 0 1 (5.9)
Positive 10 19 29 (55.8)
Negative 5 6 11 (21.2)
Figure 12. Immunohistochemical TTF-1 showed positive nuclear expression Air bronchogram 4 3 7 (13.5)
in tumor cells. ×200. Positive 3 0 3 (5.7)
Negative 1 0 1 (1.9)
PETCT 0 1 1 (1.9)
FDG no uptake
FDG weak uptake
FDG strong uptake
Modus operandi
Wedge
Pulmonary
segmental
Resection
Pulmonary lobectomy
After treatment
No chemotherapy
Chemotherapy
follow-up (m)
≤20
21–40
41–60
61–80
81–100
>100
Figure 13. Genetic testing revealed the EGFR 19-del mutation. Quantitative
BA = bronchiolar adenoma, CMPT = ciliated muconodular papillary tumors, EGFR = epidermal
PCR with ARMS fluorescence.
growth factor receptor.

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Table 2
Pathological characteristics of the BA/CMPT cases.
Pathological features Male (n) Female (n) Total [n(%)]

Tumor cell
Ciliary columnar 28 32 60 (29.9)
cells 29 43 72 (35.8)
Basal cells 29 40 69 (34.3)
Mucilage cell
Immunohistochemical
CK7 (+) 17 36 53 (24.3)
MUC5AC (+) 4 13 17 (7.8)
CEA (+) 11 11 22 (10.1)
TTF-1 (+) 17 37 54 (24.8)
MUC1 (+) 6 6 12 (5.5)
P63 (+) 15 32 47 (21.6)
P53 (+) 5 4 9 (4.1)
CK20 (+) 2 2 4 (1.8)
Ki-67 2 2 4 (9.5)
0 9 25 34 (81.0)
<5% 1 3 4 (9.5) Figure 14. Distribution plots of mutated genes in BA/CMPT.
≥5% 2 1 3 (9.1)
Genic mutation 6 4 10 (30.3)
KRAS (+) 4 11 15 (45.4)
both tumors have less atypia and have adherent growth mode,
BRFR (+) 2 3 5 (15.2)
but in situ adenocarcinoma is mainly tubular glands, and the
EGFR (+)
cells are often cubic or low column. It is often misdiagnosed in
ALK (+)
frozen sections, and the differentiation between the 2 is mainly
determined by immunohistochemical labeling of basal cells to
BA = bronchiolar adenoma, CMPT = ciliated muconodular papillary tumors, EGFR = epidermal confirm.[10–12]
growth factor receptor. BA/CMPT was classified as a benign lung epithelial tumor
in the fifth edition of the WHO lung tumor classification,
with the majority of cases being solid or ground glass nod-
the papilla, which is also the key evidence for the diagnosis ules with peripheral spread discovered by chest CT. There
of BA/CMPT. Proliferation index (Ki-67 index) is generally was no recurrence or metastasis recorded during follow-up
<5%.[8] According to the pooled literature and the immuno- after sublobectomy or lung resection. However, a few CMPT
histochemical results of 74 cases in our hospital: 53 CK7 (+), malignancies progressed to mucinous adenocarcinoma[13] and
17 MUC5AC (+), 22 CEA (+), 54 TTF-1 (+), 12 MUC 1 (+), malignant ciliary mucus-nodular papillary tumors[14] were
47 P63 (+), 9 P53 (+), 4 CK20 (+), most Ki-67 low expression identified. A small number of cases have since been discov-
(0–10%), 4 were 0, 34 < 5%, 45%. Also, genetic mutations ered to have partial loss of basal cells; specialists feel that this
can be detected in some cases of BA/CMPT. According to the form of tumor is an atypical bronchiolar adenoma, which
collected literature and the genetic test results of 74 cases, can be treated clinically as benign.[15] Because BA/CMPT is a
BRAF mutations and EGFR mutations account for the major- new disease, we must continue to collect cases and undertake
ity, among which BRAF mutations are mostly V600E muta- more intensive research. The limitations of this study include
tions. The most common type of mutation in EGFR is exon the limited sample size and the need to further increase and
19 E746_S752delinsV, an extremely rare mutation in EGFR expand the sample size.
mutant lung adenocarcinoma; KRAS and HRAS mutations are
at codons 12 and 13; all AKT 1 mutations are restricted to the
E17K mutation. The presence of mutations in the above genes Acknowledgments
supports that BA/CMPT is a tumor rather than reactive hyper- This work was supported by the Health Commission of
plasia or metaplastic process.[9] Weifang (WFWSJK-2022-150, WFWSJK-2020-049, WFWS
Differential diagnosis: ① invasive mucinous adenocarci- JK-2020-078).
noma: in common is both gland cavity structure or nipple
structure, mainly have mucus secretion of columnar cells,
usually mucinous adenocarcinoma rarely cilia or only a little Author contributions
immature cilia structure, part of the gland cavity filled with
Conceptualization: Xianwen Yue.
mucus, tumor cells is relatively small, atypia is not obvious,
Data curation: Shanshan Liu, Xiaoshan Cai, Shaoyun Liu.
but there is no complete basal cells, which is different from BA/
Formal analysis: Xiaoshan Cai.
CMPPT. ② Highly differentiated mucoepidermoid carcinoma:
Resources: Shanshan Liu.
this kind of tumor can also contain large amounts of mucus
Writing – original draft: Jianliang Pan.
components, tumor cells are mainly composed of mucus cells,
Writing – review & editing: Jianjun Lin.
epidermoid cells and intermediate cells, which occurs in the
main bronchus of young people, generally without papillary
structure, immunohistochemical marker CD117 positive, References
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