Occurrence of cilia on the cell
surface is usually considered evidence of a non-neoplastic process. Rarely,
ciliated malignant tumors cells have been reported in pleural and ascitic
fluids from ovarian and endometrial adenocarcinomas, though not from the
cerebrospinal fluid (CSF) in association with pulmonary adenocarcinoma. We now
present a case report of a patient who initially presented with neurologic
symptoms. A CSF specimen revealed atypical cells with peripheral cilia and
some cytoplasmic pigment. Cytologic, morphologic, and immunohistochemical
analyses established this to be a metastatic adenocarcinoma of pulmonary origin
with metastases to the meninges, pelvis, and the vertebrae. Cilia are
generally the antithesis of malignancy as their presence is considered to be
evidence of proper regulation of the cell cycle within a well-differentiated
cell. This case offers the first described example of malignant ciliated cells
derived from a metastatic lung adenocarcinoma. An awareness of this unusual
presentation should aid in diagnosis and management when similar situations
are prospectively encountered.
Cite this paper
Zlotoff, D. , Kelly, C. , Kierson, M. , McGrath, C. and Gupta, P. (2013) Case report: Metastatic adenocarcinoma of the lung with filiform “ciliated” tumor cells in the cerebrospinal fluid. Case Reports in Clinical Medicine, 2, 203-207. doi: 10.4236/crcm.2013.23055.
 Koss, L.G. and Melamed, M.R. (2005) Koss’ diagnostic cytology and its histopathologic bases. 5th Edition, JB Lippincott, Philadelphia.
 Sato, S., Teruaki, K., Homma, K. and Yokoyama, A. (2010) Ciliated muconodular papillary tumor of the lung; A newly defined low-grade malignant tumor. Interactive Cardiovascular and Thoracic Surgery, 11, 685-687.
 Hendrickson, M.R. and Kempson, R.L. (1983) Ciliated carcinoma; A variant of endometrial adenocarcinoma: A report of 10 cases. International Journal of Gynecological Pathology, 2, 1-12.
 Eichhorn, J.H. and Scully, R.E. (1996) Endometriod ciliated-cell tumors of the ovary: A report of five cases. International Journal of Gynecological Pathology, 3, 248-56. doi:10.1097/00004347-199607000-00010
 Gupta, P.K., Albritton, N., Erozan, Y.S. and Frost, J.K. (1985) Occurrence of cilia in exfoliated ovarian adenocarcinoma cells. Diagnostic Cytopathology, 3, 228-231.
 Nakamura, S., Koshikawa, T., Sato, T., Hayashi, K. and Suchi, T. (1992) Extremely well differentiated papillary adenocarcinoma of the lung with prominent cilia formation. Acta Pathologica Japonica, 10, 745-750.
 Imai, T., Suga, M., Kaimori, M., Hiyama, M., Yokoyama, K. and Kurotaki, H. (2010) Peripheral pulmonary papillary adenocarcinoma with prominent cilia. Acta Cytologica, 5, 949-957.
 Ross, H.M., Daniel, H.D.J., Vivekanandan, P., Kannahgai, R., Matthew, M.Y., Wu, T-T., Makhlouf, H.R. and Torbenson, M. (2011) Fibrolamellar carcinomas are positive for CD68. Modern Pathology, 24, 390-395.
 Takashi, N., Kodama, T., Tsumuraya, M., Shimosato, Y. and Kameya, T. (1985) S-100 protein-positive Langerhans cells in various human lung cancers, especially in peripheral adenocarcinomas. Virchows Archiv A, 7, 177-189. doi:10.1007/BF00737075