J Korean Med Sci.  2009 Jun;24(3):504-510. 10.3346/jkms.2009.24.3.504.

Pulmonary Adenocarcinoma with Heterotopic Ossification

• Kim GY
• Kim J
• Kim TS
• Han J

• KMID: 1779171
• DOI: http://doi.org/10.3346/jkms.2009.24.3.504

Abstract

Pulmonary adenocarcinoma is a common malignancy that often involves calcification; however, bone formation in primary lung adenocarcinoma is extremely rare. In ten cases of primary pulmonary adenocarcinoma with heterotopic ossification, we detected immunoreactivity against TGF-beta1, osteopontin, osteocalcin and Runx2 in the fibroblastic stroma and tumor cells within the area of ossification. Our results suggest that in primary pulmonary adenocarcinoma, heterotopic ossification occurs via intramembranous bone formation. To our knowledge, only 11 other cases of pulmonary adenocarcinoma with heterotopic ossification have been reported. Here, we present ten cases of pulmonary adenocarcinoma showing heterotopic ossification with a description of previously published results and the histogenesis of heterotopic bone formation.

Keyword

Lung Neoplasms; Adenocarcinoma; Choristoma; Immunohistochemistry; Metaplasia; Ossification

MeSH Terms

Adenocarcinoma/*diagnosis/pathology
Aged
Core Binding Factor Alpha 1 Subunit/metabolism
Female
Humans
Lung Neoplasms/*diagnosis/pathology
Male
Middle Aged
Ossification, Heterotopic/*diagnosis/pathology
Osteocalcin/metabolism
Osteopontin/metabolism
Tomography, X-Ray Computed
Transforming Growth Factor beta1/metabolism

Figure

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  Fig. 1 Chest CT showing a radiodense trabecular pattern (arrow) in the center of the lung mass (patient 2).

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  Fig. 2 Bone formation in the adenocarcinoma (H&E staining, ×1).

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  Fig. 3 (A) Microscopic images showing moderately differentiated adenocarcinomas with mature bony trabeculae in the abundant fibroblastic stroma. (B) Microscopic images showing spindled fibroblastic cells and bony trabeculae with osteoblastic rimming and osteocytes. Cellular atypia is absent (H&E staining, [A] ×40; [B] ×200).

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  Fig. 4 Polarizing light microscopy showing lamellation of the trabecular bone (H&E staining, ×200).

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  Fig. 5 Immunohistochemical staining showing the presence of osteopontin (A), TGF-β1 (B), osteocalcin (C), and Runx2 (D) in the tumor and fibroblastic stromal cells. Polymer method, ×200.

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