Papiloma mixto escamoso y glandular de pulmón, de la sospecha clínico-radiológica hasta la confirmación histopatológica. Un reporte de caso

Pulmonary papillomas, comprising less than 1% of primary lung neoplasms, typically manifest as solitary lesions within the airways, with a predilection for occurrence between the fifth and sixth decades of life, predominantly in males. According to the World Health Organization (WHO) classification, respiratory papillomas are categorized into three types: squamous cell, glandular, and mixed squamous cell and glandular (MSGP), with squamous cell papilloma being the most prevalent. MSGPs, distinguished by their papillary configuration with both squamous and glandular epithelium, represent the rarest variant. In this case, a 70-year-old woman MSGP presented with a one-year history of cough, mucoid expectoration, right dorsal pain exacerbated by coughing, and hypoxemia. A juxta-aortic mass was reported on chest CT, which was strongly suggestive of malignancy. PET/CT confirmed hypermetabolism in the mass (SUVmax 25). Facing inconclusive transcutaneous biopsy results, the medical team opted for a left lower lobectomy with lymph node dissection. Histopathological examination revealed a 4.5 cm MSGP lesion characterized by papillae, fibrovascular cores, and squamous cells exhibiting cytological atypia, as well as focal high-grade dysplasia. This case highlights the rarity of MSGP and its diagnostic challenges, emphasizing the need for thorough evaluation and surgical intervention. The patient's symptomatic improvement and absence of papilloma recurrence during medical follow-up underscore the favorable outcomes post-surgery.