Bilateral orthotopic lung transplantation for the patient with lung-limited invasive mucinous adenocarcinoma - a case-based literature review

Sep 23, 2026

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Invasive mucinous adenocarcinoma (IMA) of the lung is a rare adenocarcinoma subtype featuring intrapulmonary aerogenous spread, leading to multicentric, multilobar, and bilateral disease with low distant metastasis but limited treatment options and poor prognosis. Reported outcomes for advanced IMA show median survival under one year, and recurrence after lung transplantation can be frequent. This article presents a first case of bilateral lung transplantation using cardiopulmonary bypass in a stage IVa lung-limited IMA patient without lymph node or distant metastasis. At 15 months, the patient remains stable with no recurrence or organ rejection, and the paper reviews IMA classification, clinical outcomes, protein expression, and genetic characteristics, summarizing prior transplantation results for related bronchioalveolar carcinoma (BAC).

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

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Abstract

Practice implications

Introduction

Bilateral orthotopic lung transplantation for the patient with lung-limited invasive mucinous adenocarcinoma: a case-based literature review Young Kwang Chae1,*,‡,, Youjin Oh1,2,‡,, Leeseul Kim3,‡, Joo Hee Park1, TrieArni Djunadi1, Zunairah Shah4, Liam Il-Young Chung1, Sung Mi Yoon1, Richard Duan1, Jeeyeon Lee1,5, Samuel Kim1, Ankit Bharat1,* 1Feinberg School of Medicine, Northwestern University, Chicago, IL, United States, 2Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, United States, 3Ascension Saint Francis Hospital Evanston, Evanston, IL, United States, 4Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, United States, 5School of Medicine, Kyungpook, National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea * Corresponding authors. Young Kwang Chae, MD, MPH, MBA, Department of Internal Medicine (Hematology and Oncology), Feinberg School of Medicine, Northwestern University, 645 N. Michigan Ave, Suite 1006, IL 60611, [USA E-mail:](USA E-mail: YCHAE@nm.org)[ YCHAE@nm.org](USA E-mail: YCHAE@nm.org); Ankit Bharat, MD, Department of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Arkes Pavilion, 676 N St Clair St, Suite 2140, Chicago, IL 60611, USA. E-mail: [ankit.bharat@nm.org](ankit.bharat@nm.org) ‡Contributed equally. Abstract Invasive mucinous adenocarcinoma (IMA) of lung is a unique subset of adenocarcinomas characterized by an intrapulmonary aerogenous spread resulting in multicentric, multilobar, and bilateral lesions with a low frequency of distant metastasis. The treatment options for IMA are limited, and advanced IMA has a poor prognosis, with a median survival of less than a year. Lung transplantation performed in a handful of selected patients showed improved survival outcomes and clinical improvement. However, high postoperative recurrence rates have been observed and recurrence appeared to originate from the primary tumor in many cases. Techniques, such as non-sequential double lung transplantation utilizing cardiopulmonary bypass, have been performed to reduce recurrence. Here, we present the first case of bilateral lung transplantation employing cardiopulmonary bypass in a patient with stage ⅣA lung-limited IMA without lymph node or distant metastasis. At 15 months post-transplantation, the patient remains stable with no evidence of disease recurrence or organ rejection. Additionally, we describe the classification, clinical outcomes, protein expression, and genetic characteristics of IMA. IMA was previously classified as a subset of bronchioalveolar carcinoma (BAC), which is invasive and mucinous with goblet or columnar cells secreting mucin. We reviewed and summarized the lung transplantation cases reported to date for BAC. The 5-year overall survival and disease-free survival have been reported approximately 50%(range, 39-100) and 50%(range, 35–100), respectively. The literature shows these outcomes are comparable to bilateral lung transplantation performed for non-cancerous pulmonary disease. Key words: lung cancer; transplantation; invasive mucinous adenocarcinoma; bronchioloalveolar carcinoma. Implications for practice Invasive mucinous adenocarcinoma of lung is a newly classified subset of bronchioalveolar carcinoma (BAC), characterized by diffuse bilateral involvement limited to the lungs. The available treatment options for IMA, including chemotherapy and targeted therapies, have shown limited effectiveness and poor outcomes. While lung transplantation has been performed selectively for patients with BAC, previous studies have reported a 5-year overall survival (OS) and disease-free survival of approximately 50% for patients with BAC undergoing lung transplantation. The OS is comparable to that of lung transplantation for non-cancerous pulmonary disease, which ranges from 30% to 60% at 5 years. Here, we present the first case of a patient with pathologi

FAQs

Why is invasive mucinous adenocarcinoma (IMA) of the lung considered difficult to treat?

IMA is characterized by diffuse bilateral lung involvement with limited effective treatment options, and advanced disease has a poor prognosis. The article notes chemotherapy and targeted therapies show limited effectiveness.

What makes the presented case notable?

The authors report the first bilateral lung transplantation case using cardiopulmonary bypass in a stage IVa lung-limited IMA patient without lymph node or distant metastasis. The patient remains stable at 15 months with no recurrence or rejection.

How do outcomes for lung transplantation in IMA/BAC compare to non-cancerous lung disease?

The paper summarizes that 5-year overall survival and disease-free survival for BAC patients undergoing lung transplantation are reported around 50%. These outcomes are stated to be comparable to bilateral lung transplantation for non-cancerous pulmonary disease, with 5-year survival roughly 30% to 60%.

Sep 23, 2026

Uploaded by Elsa