Primary high-grade malignant epithelial–myoepithelial carcinoma of the lung: diagnostic pitfalls of a very rare lung malignancy

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ID: 334067
2026
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Ranked #103 of 147 articles by views in Interdisciplinary CardioVascular and Thoracic Surgery

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Abstract
Epithelial-myoepithelial carcinoma (EMC) is an exceptionally rare primary lung malignancy arising from submucosal bronchial glands. We report a 55-year-old man with a large paravertebral left lower lobe mass in whom bronchoscopic biopsy suggested metastatic poorly differentiated carcinoma of possible prostatic origin. Clinical work-up revealed a concomitant prostate carcinoma; however, following multidisciplinary discussion, prostatic origin was excluded and the patient underwent left lower lobectomy with mediastinal nodal dissection. Final diagnosis was primary high-grade malignant EMC, confirmed by an extended immunohistochemical panel and EWSR1 rearrangement (22q12) detected by fluorescence in situ hybridisation (FISH). A prior CT scan, retrospectively reviewed, showed a segmental consolidation four years earlier misinterpreted as pneumonia. This case illustrates the major diagnostic pitfalls of pulmonary EMC-including the coincidental discovery of a second primary tumour-and the indispensable role of molecular profiling when morphology and immunohistochemistry are inconclusive.
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Authors Cristian Rapicetta, Giacomo Santandrea, Antonio Lamesta, Massimiliano Paci
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Journal Interdisciplinary CardioVascular and Thoracic Surgery
Year 2026
DOI
10.1093/icvts/ivag276
URL
https://doi.org/10.1093/icvts/ivag276
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