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Case Reports
. 2021 Feb 24;14(2):e236074.
doi: 10.1136/bcr-2020-236074.

Adenoid cystic carcinoma and chronic lymphocytic leukaemia: synchronous presentations in the lung

Philip S Webb  1 , Yu Zhi Zhang  2 , Kirsten Burrell  3 , Georges Sinclair  4   5
Affiliations
Case Reports

Adenoid cystic carcinoma and chronic lymphocytic leukaemia: synchronous presentations in the lung

Philip S Webb et al. BMJ Case Rep. .

Abstract

A 59-year-old male active smoker presented with a 6-month history of cough and breathlessness and was found to have a right upper lobe mass. Histology revealed this to be an adenoid cystic carcinoma (ACC) of the lung, while local lymph node dissection revealed a synchronous diagnosis of chronic lymphocytic leukaemia (CLL). The connection between CLL and solid organ malignancy is well documented, but the reporting of ACC in this context is novel. Mechanisms linking the two processes are revealed with the possibility of causality, and heightened vigilance for the development of primary lung tumours in CLL, and their management, is recommended.

Keywords: haematology (incl blood transfusion); lung cancer (oncology).

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Presentation CT scan. A 15 mm nodule is seen to obstruct the right main bronchus, with distal plugging and partial right upper lobe collapse.
Figure 2
Figure 2
Histopathological microscopic images. (A) Endobronchial polypoid involvement by an adenoid cystic carcinoma (ACC). The tumour shows predominantly (B) tubular and focally (C) cribriform architecture. (D) In other parts of the tumour, the glands were lying within basement membrane-like matrix. (E) Individual glands comprised of either basaloid (small and centrally-placed nuclei with clear cytoplasm) or luminal (enlarged and hyperchromatic nuclei with eosinophilic cytoplasm) cells. (F) Rarely, there is a dual population of cells within the same gland where the luminal cells were surrounded by an outer layer of basaloid cells. This is a classical finding in ACC. (G) The tumour infiltrated the soft tissue plane surrounding the bronchial cartilage. (H) There was perineural invasion, another common feature of ACC. (I–K) Station 2R lymph node showed normal lymphoid follicular architecture largely effaced by a monotypic proliferation of small lymphocytes. (L) A small residual reactive follicle. (M) The lymphocytes were positive for CD3, (N) CD20 and (O) Bcl-2 in keeping with chronic lymphocytic leukaemia/small lymphocytic lymphoma. (P) Ki67 labelling index approximately 5%. Scale bar=100 µm
Figure 3
Figure 3
Station 2R lymph node lymphocytes demonstrating positive staining for CD5.
Figure 4
Figure 4
Station 2R lymph node lymphocytes demonstrating positive staining for CD23.
See this image and copyright information in PMC

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