Small cell carcinoma of the lung: Difference between revisions

(34 intermediate revisions by the same user not shown)

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| Caption = Lung small cell carcinoma. [[H&E stain]].

| Synonyms =

| Micro = stippled chromatin, high [[NC ratio]] with scant basophilic cytoplasm, typically small cells (~2x [[RBC]] diameter), +/-nuclear moulding, nuclei with smudgy appearance ([[Azzopardi phenomenon]]), necrosis, [[mitoses]]

| Micro = stippled chromatin, high [[NC ratio]] with scant basophilic cytoplasm, typically small cells (~2x [[RBC]] diameter), +/-nuclear moulding, nuclei with smudgy appearance ([[Azzopardi phenomenon]]), necrosis, mitoses

| Subtypes = large cell neuroendocrine carcinoma (LCNEC)

| Subtypes = histology: large cell neuroendocrine carcinoma (LCNEC); molecular subtypes: ASCL1, NEUROD1, POU2F3, YAP1

| LMDDx = poorly differentiated [[adenocarcinoma of the lung]], [[atypical carcinoid]], [[lung carcinoid]], metastatic [[small cell carcinoma]], [[lymphoma]], other [[small round blue cell tumours]]

| LMDDx = poorly differentiated [[adenocarcinoma of the lung]], [[atypical carcinoid]], [[lung carcinoid]], metastatic [[small cell carcinoma]], [[lymphoma]], other [[small round blue cell tumours]] (e.g [[Ewing sarcoma]], [[NUT carcinoma]])

| Stains = chromogranin +ve, synaptophysin +ve, CD56 +ve, NSE +ve, TTF-1 +ve

| Stains =

~~| IHC =~~

| IHC = chromogranin +ve, synaptophysin +ve, CD56 +ve, NSE +ve, TTF-1 +ve, Ki-67 (>50%)

| EM =

| Molecular =

Line 15:

| Gross =

| Grossing =

| Staging = [[lung cancer staging]]

| Site = [[lung]] - see ''[[lung tumours]]''

| Assdx =

Line 31:

Line 32:

}}

'''Small cell carcinoma of the lung''', also '''small cell lung carcinoma''' (abbreviated '''SCLC''')<ref name=pmid20943645/> is an aggressive [[malignant]] [[Lung tumours|tumour of the lung]]. It is strongly associated with [[smoking]].

Small cell carcinoma in general is dealt with in the ''[[small cell carcinoma]]'' article.

==General==

Line 41:

Line 44:

*[[typical carcinoid|Carcinoid]].

*[[atypical carcinoid|Atypical carcinoid]].

*Small cell carinoma/large cell neuroendocrine carcinoma.

*Small cell carinoma/[[large cell neuroendocrine carcinoma]] (LCNEC).

Precursor lesion - uncommonly seen:

Line 52:

Line 55:

*Central location (close to large airways) - typical.

*[[Necrosis]].

===Images===

Image:Small cell carcinoma (3931938372).jpg| Small cell carcinoma of the lung - centre of image. (WC/Rosen)

</gallery>

==Microscopic==

Line 71:

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*[[Lymphoma]].

*[[Atypical carcinoid]].

*[[Squamous cell carcinoma of the lung|Basaloid squamous cell carcinoma of the lung]].<ref>{{Cite journal | last1 = Maleki | first1 = Z. | title = Diagnostic issues with cytopathologic interpretation of lung neoplasms displaying high-grade basaloid or neuroendocrine morphology. | journal = Diagn Cytopathol | volume = 39 | issue = 3 | pages = 159-67 | month = Mar | year = 2011 | doi = 10.1002/dc.21351 | PMID = 21319315 }}</ref>

*[[Non-small cell carcinoma of the lung]].

*Other [[small round blue cell tumours]].

===~~Subtypes~~===

===Histologic subtypes===

*Large cell neuroendocrine carcinoma (LCNEC).

===Grading===

As per CAP protocol (version 3.4.0.0):<ref name=cap_protocol>CAP Lung protocol. Version: 3.4.0.0. URL: [http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf]. Accessed on: March 23, 2016.</ref>

*G4 = undifferentiated - used for small cell carcinoma and large cell carcinoma.

===Images===

Line 81:

Line 95:

Image:Lung_small_cell_carcinoma_%281%29_by_core_needle_biopsy.jpg | SCLC - high mag. (WC)

</gallery>

==IHC==

*Synaptophysin +ve.

**May be very weak.

*TTF-1 +ve (15 of 16 cases).<ref name=pmid16138374>{{Cite journal | last1 = Wu | first1 = M. | last2 = Szporn | first2 = AH. | last3 = Zhang | first3 = D. | last4 = Wasserman | first4 = P. | last5 = Gan | first5 = L. | last6 = Miller | first6 = L. | last7 = Burstein | first7 = DE. | title = Cytology applications of p63 and TTF-1 immunostaining in differential diagnosis of lung cancers. | journal = Diagn Cytopathol | volume = 33 | issue = 4 | pages = 223-7 | month = Oct | year = 2005 | doi = 10.1002/dc.20337 | PMID = 16138374 }}</ref>

*[[TTF-1]] +ve

**Misch ''et al.'' reported: 82.8% positive (183 +ve of 221 cases).<ref name=pmid25889870>{{Cite journal | last1 = Misch | first1 = D. | last2 = Blum | first2 = T. | last3 = Boch | first3 = C. | last4 = Weiss | first4 = T. | last5 = Crolow | first5 = C. | last6 = Griff | first6 = S. | last7 = Mairinger | first7 = T. | last8 = Bauer | first8 = TT. | last9 = Kollmeier | first9 = J. | title = Value of thyroid transcription factor (TTF)-1 for diagnosis and prognosis of patients with locally advanced or metastatic small cell lung cancer. | journal = Diagn Pathol | volume = 10 | issue = | pages = 21 | month = Apr | year = 2015 | doi = 10.1186/s13000-015-0250-z | PMID = 25889870 }}</ref>

**Wu ''et al.'' reported: 15 positive of 16 cases.<ref name=pmid16138374>{{Cite journal | last1 = Wu | first1 = M. | last2 = Szporn | first2 = AH. | last3 = Zhang | first3 = D. | last4 = Wasserman | first4 = P. | last5 = Gan | first5 = L. | last6 = Miller | first6 = L. | last7 = Burstein | first7 = DE. | title = Cytology applications of p63 and TTF-1 immunostaining in differential diagnosis of lung cancers. | journal = Diagn Cytopathol | volume = 33 | issue = 4 | pages = 223-7 | month = Oct | year = 2005 | doi = 10.1002/dc.20337 | PMID = 16138374 }}</ref>

*CK7 -ve.<ref name=pmid10874668>{{Cite journal | last1 = Gyure | first1 = KA. | last2 = Morrison | first2 = AL. | title = Cytokeratin 7 and 20 expression in choroid plexus tumors: utility in differentiating these neoplasms from metastatic carcinomas. | journal = Mod Pathol | volume = 13 | issue = 6 | pages = 638-43 | month = Jun | year = 2000 | doi = 10.1038/modpathol.3880111 | PMID = 10874668 }}</ref>

*[[CK20]] -ve.<ref name=pmid10874668/>

*Ki-67 ~80% (>50% proposed as criteria for ''large cell neuroendocrine carcinoma''<ref name=pmid25318848>{{Cite journal | last1 = Liu | first1 = SZ. | last2 = Staats | first2 = PN. | last3 = Goicochea | first3 = L. | last4 = Alexiev | first4 = BA. | last5 = Shah | first5 = N. | last6 = Dixon | first6 = R. | last7 = Burke | first7 = AP. | title = Automated quantification of Ki-67 proliferative index of excised neuroendocrine tumors of the lung. | journal = Diagn Pathol | volume = 9 | issue = | pages = 174 | month = | year = 2014 | doi = 10.1186/s13000-014-0174-z | PMID = 25318848 }}</ref>).

**Useful for separating from ''atypical carcinoid'' and ''typical carcinoid''.

Others:

*[[p63]] +ve in ~75-80% of the cases.<ref name=pmid15551738>{{Cite journal | last1 = Au | first1 = NH. | last2 = Gown | first2 = AM. | last3 = Cheang | first3 = M. | last4 = Huntsman | first4 = D. | last5 = Yorida | first5 = E. | last6 = Elliott | first6 = WM. | last7 = Flint | first7 = J. | last8 = English | first8 = J. | last9 = Gilks | first9 = CB. | title = P63 expression in lung carcinoma: a tissue microarray study of 408 cases. | journal = Appl Immunohistochem Mol Morphol | volume = 12 | issue = 3 | pages = 240-7 | month = Sep | year = 2004 | doi = | PMID = 15551738 }}</ref>

===Molecular subtypes via IHC===

Based on Baine ''et al.'' in a cohort of ~170 cases:<ref name=pmid33011388>{{cite journal |authors=Baine MK, Hsieh MS, Lai WV, Egger JV, Jungbluth AA, Daneshbod Y, Beras A, Spencer R, Lopardo J, Bodd F, Montecalvo J, Sauter JL, Chang JC, Buonocore DJ, Travis WD, Sen T, Poirier JT, Rudin CM, Rekhtman N |title=SCLC Subtypes Defined by ASCL1, NEUROD1, POU2F3, and YAP1: A Comprehensive Immunohistochemical and Histopathologic Characterization |journal=J Thorac Oncol |volume=15 |issue=12 |pages=1823–1835 |date=December 2020 |pmid=33011388 |pmc=8362797 |doi=10.1016/j.jtho.2020.09.009 |url=}}</ref>

{| class="wikitable sortable"

! IHC grouping

! Prevalence

! Other IHC

! Notes

|-

|ASCL1 +ve / NeuroD1 -ve

|41%

|TTF-1 +ve

|

|-

|ASCL1 +ve / NeuroD1 +ve

|37%

|TTF-1 +ve

|

|-

|ASCL1 -ve / NeuroD1 +ve

|8%

|TTF-1 +ve

|

|-

|ASCL1 -ve / NeuroD1 -ve

|14%

|TTF-1 -ve

|includes all POU2F3 +ve cases which are ~9% of small cell carcinoma

|}

==Molecular==

Four molecular subtypes - defined by the key transcriptional regulators:<ref>{{cite journal |authors=Rudin CM, Poirier JT, Byers LA, Dive C, Dowlati A, George J, Heymach JV, Johnson JE, Lehman JM, MacPherson D, Massion PP, Minna JD, Oliver TG, Quaranta V, Sage J, Thomas RK, Vakoc CR, Gazdar AF |title=Molecular subtypes of small cell lung cancer: a synthesis of human and mouse model data |journal=Nat Rev Cancer |volume=19 |issue=5 |pages=289–297 |date=May 2019 |pmid=30926931 |pmc=6538259 |doi=10.1038/s41568-019-0133-9 |url=}}</ref>

*ASCL1 = achaete-scute homologue 1.

*NeuroD1 = neurogenic differentiation factor 1.

*YAP1 = yes-associated protein 1.

*POU2F3 = POU class 2 homeobox 3.

==Sign out==

===Biopsy===

<pre>

Lung, Left Lower Lobe, Core Biopsy:

- SMALL CELL CARCINOMA.

</pre>

====Possible LCNEC====

<pre>

Lung, Left Lower Lobe, Core Biopsy:

- NON–SMALL CELL CARCINOMA WITH NEUROENDOCRINE (NE) MORPHOLOGY AND POSITIVE NE MARKERS, POSSIBLE LARGE CELL NEUROENDOCRINE CARCINOMA (LCNEC).

</pre>

Note:

*The above is the wording recommended by 2011 ATS/ERS/IASLC panel.<ref>{{cite journal |authors=Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, Ishikawa Y, Wistuba I, Flieder DB, Franklin W, Gazdar A, Hasleton PS, Henderson DW, Kerr KM, Petersen I, Roggli V, Thunnissen E, Tsao M |title=Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification |journal=Arch Pathol Lab Med |volume=137 |issue=5 |pages=668–84 |date=May 2013 |pmid=22970842 |pmc=4509741 |doi=10.5858/arpa.2012-0263-RA |url=}}</ref>

====Block letters====

<pre>

LOWER LOBE OF LUNG, LEFT, CORE BIOPSY:

- SMALL CELL CARCINOMA.

</pre>

===Resection===

<pre>

Left Lower Lobe, Lobectomy:

- LARGE CELL NEUROENDOCRINE CARCINOMA.

-- Margins clear.

- Two lymph nodes NEGATIVE for malignancy (0/2).

- Please see synoptic report.

Comment:

The tumour stains as follows:

POSITIVE: CD56, synaptophysin, p63 (scattered).

NEGATIVE: chromogranin A, CK5/6, TTF-1, napsin A.

</pre>

====Micro====

The sections show large cells epithelioid cells (~3-4x the size of a lymphocyte) with salt and pepper chromatin, scant basophilic cytoplasm, and focally streaming. Mitotic activity is brisk and multifocal zonal necrosis is present.

==See also==

@@ Line 5: / Line 5: @@
 | Caption    = Lung small cell carcinoma. [[H&E stain]].
 | Synonyms   =
-| Micro      = stippled chromatin, high [[NC ratio]] with scant basophilic cytoplasm, typically small cells (~2x [[RBC]] diameter), +/-nuclear moulding, nuclei with smudgy appearance ([[Azzopardi phenomenon]]), necrosis, [[mitoses]]
+| Micro      = stippled chromatin, high [[NC ratio]] with scant basophilic cytoplasm, typically small cells (~2x [[RBC]] diameter), +/-nuclear moulding, nuclei with smudgy appearance ([[Azzopardi phenomenon]]), necrosis, mitoses
-| Subtypes   = large cell neuroendocrine carcinoma (LCNEC)
+| Subtypes   = histology: large cell neuroendocrine carcinoma (LCNEC); molecular subtypes: ASCL1, NEUROD1, POU2F3, YAP1
-| LMDDx      = poorly differentiated [[adenocarcinoma of the lung]], [[atypical carcinoid]], [[lung carcinoid]], metastatic [[small cell carcinoma]], [[lymphoma]], other [[small round blue cell tumours]]
+| LMDDx      = poorly differentiated [[adenocarcinoma of the lung]], [[atypical carcinoid]], [[lung carcinoid]], metastatic [[small cell carcinoma]], [[lymphoma]], other [[small round blue cell tumours]] (e.g [[Ewing sarcoma]], [[NUT carcinoma]])
-| Stains     = chromogranin +ve, synaptophysin +ve, CD56 +ve, NSE +ve, TTF-1 +ve
+| Stains     =
-| IHC        =
+| IHC        = chromogranin +ve, synaptophysin +ve, CD56 +ve, NSE +ve, TTF-1 +ve, Ki-67 (>50%)
 | EM         =
 | Molecular  =
@@ Line 15: / Line 15: @@
 | Gross      =
 | Grossing   =
+| Staging    = [[lung cancer staging]]
 | Site       = [[lung]] - see ''[[lung tumours]]''
 | Assdx      =
@@ Line 31: / Line 32: @@
 }}
 '''Small cell carcinoma of the lung''', also '''small cell lung carcinoma''' (abbreviated '''SCLC''')<ref name=pmid20943645/> is an aggressive [[malignant]] [[Lung tumours|tumour of the lung]]. It is strongly associated with [[smoking]].
+Small cell carcinoma in general is dealt with in the ''[[small cell carcinoma]]'' article.
 ==General==
@@ Line 41: / Line 44: @@
 *[[typical carcinoid|Carcinoid]].
 *[[atypical carcinoid|Atypical carcinoid]].
-*Small cell carinoma/large cell neuroendocrine carcinoma.
+*Small cell carinoma/[[large cell neuroendocrine carcinoma]] (LCNEC).
 Precursor lesion - uncommonly seen:
@@ Line 52: / Line 55: @@
 *Central location (close to large airways) - typical.
 *[[Necrosis]].
+===Images===
+<gallery>
+Image:Small cell carcinoma (3931938372).jpg| Small cell carcinoma of the lung - centre of image. (WC/Rosen)
+</gallery>
 ==Microscopic==
@@ Line 71: / Line 79: @@
 *[[Lymphoma]].
 *[[Atypical carcinoid]].
+*[[Squamous cell carcinoma of the lung|Basaloid squamous cell carcinoma of the lung]].<ref>{{Cite journal  | last1 = Maleki | first1 = Z. | title = Diagnostic issues with cytopathologic interpretation of lung neoplasms displaying high-grade basaloid or neuroendocrine morphology. | journal = Diagn Cytopathol | volume = 39 | issue = 3 | pages = 159-67 | month = Mar | year = 2011 | doi = 10.1002/dc.21351 | PMID = 21319315 }}</ref>
+*[[Non-small cell carcinoma of the lung]].
 *Other [[small round blue cell tumours]].
-===Subtypes===
+===Histologic subtypes===
 *Large cell neuroendocrine carcinoma (LCNEC).
+===Grading===
+As per CAP protocol (version 3.4.0.0):<ref name=cap_protocol>CAP Lung protocol. Version: 3.4.0.0. URL: [http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf]. Accessed on: March 23, 2016.</ref>
+*G4 = undifferentiated - used for small cell carcinoma and large cell carcinoma.
 ===Images===
@@ Line 81: / Line 95: @@
 Image:Lung_small_cell_carcinoma_%281%29_by_core_needle_biopsy.jpg | SCLC - high mag. (WC)
 </gallery>
 ==IHC==
 *Synaptophysin +ve.
 **May be very weak.
-*TTF-1 +ve (15 of 16 cases).<ref name=pmid16138374>{{Cite journal  | last1 = Wu | first1 = M. | last2 = Szporn | first2 = AH. | last3 = Zhang | first3 = D. | last4 = Wasserman | first4 = P. | last5 = Gan | first5 = L. | last6 = Miller | first6 = L. | last7 = Burstein | first7 = DE. | title = Cytology applications of p63 and TTF-1 immunostaining in differential diagnosis of lung cancers. | journal = Diagn Cytopathol | volume = 33 | issue = 4 | pages = 223-7 | month = Oct | year = 2005 | doi = 10.1002/dc.20337 | PMID = 16138374 }}</ref>
+*[[TTF-1]] +ve
+**Misch ''et al.'' reported: 82.8% positive (183 +ve of 221 cases).<ref name=pmid25889870>{{Cite journal  | last1 = Misch | first1 = D. | last2 = Blum | first2 = T. | last3 = Boch | first3 = C. | last4 = Weiss | first4 = T. | last5 = Crolow | first5 = C. | last6 = Griff | first6 = S. | last7 = Mairinger | first7 = T. | last8 = Bauer | first8 = TT. | last9 = Kollmeier | first9 = J. | title = Value of thyroid transcription factor (TTF)-1 for diagnosis and prognosis of patients with locally advanced or metastatic small cell lung cancer. | journal = Diagn Pathol | volume = 10 | issue =  | pages = 21 | month = Apr | year = 2015 | doi = 10.1186/s13000-015-0250-z | PMID = 25889870 }}</ref>
+**Wu ''et al.'' reported: 15 positive of 16 cases.<ref name=pmid16138374>{{Cite journal  | last1 = Wu | first1 = M. | last2 = Szporn | first2 = AH. | last3 = Zhang | first3 = D. | last4 = Wasserman | first4 = P. | last5 = Gan | first5 = L. | last6 = Miller | first6 = L. | last7 = Burstein | first7 = DE. | title = Cytology applications of p63 and TTF-1 immunostaining in differential diagnosis of lung cancers. | journal = Diagn Cytopathol | volume = 33 | issue = 4 | pages = 223-7 | month = Oct | year = 2005 | doi = 10.1002/dc.20337 | PMID = 16138374 }}</ref>
+*CK7 -ve.<ref name=pmid10874668>{{Cite journal  | last1 = Gyure | first1 = KA. | last2 = Morrison | first2 = AL. | title = Cytokeratin 7 and 20 expression in choroid plexus tumors: utility in differentiating these neoplasms from metastatic carcinomas. | journal = Mod Pathol | volume = 13 | issue = 6 | pages = 638-43 | month = Jun | year = 2000 | doi = 10.1038/modpathol.3880111 | PMID = 10874668 }}</ref>
+*[[CK20]] -ve.<ref name=pmid10874668/>
+*Ki-67 ~80% (>50% proposed as criteria for ''large cell neuroendocrine carcinoma''<ref name=pmid25318848>{{Cite journal  | last1 = Liu | first1 = SZ. | last2 = Staats | first2 = PN. | last3 = Goicochea | first3 = L. | last4 = Alexiev | first4 = BA. | last5 = Shah | first5 = N. | last6 = Dixon | first6 = R. | last7 = Burke | first7 = AP. | title = Automated quantification of Ki-67 proliferative index of excised neuroendocrine tumors of the lung. | journal = Diagn Pathol | volume = 9 | issue =  | pages = 174 | month =  | year = 2014 | doi = 10.1186/s13000-014-0174-z | PMID = 25318848 }}</ref>).
+**Useful for separating from ''atypical carcinoid'' and ''typical carcinoid''.
+Others:
+*[[p63]] +ve in ~75-80% of the cases.<ref name=pmid15551738>{{Cite journal  | last1 = Au | first1 = NH. | last2 = Gown | first2 = AM. | last3 = Cheang | first3 = M. | last4 = Huntsman | first4 = D. | last5 = Yorida | first5 = E. | last6 = Elliott | first6 = WM. | last7 = Flint | first7 = J. | last8 = English | first8 = J. | last9 = Gilks | first9 = CB. | title = P63 expression in lung carcinoma: a tissue microarray study of 408 cases. | journal = Appl Immunohistochem Mol Morphol | volume = 12 | issue = 3 | pages = 240-7 | month = Sep | year = 2004 | doi =  | PMID = 15551738 }}</ref>
+===Molecular subtypes via IHC===
+Based on Baine ''et al.'' in a cohort of ~170 cases:<ref name=pmid33011388>{{cite journal |authors=Baine MK, Hsieh MS, Lai WV, Egger JV, Jungbluth AA, Daneshbod Y, Beras A, Spencer R, Lopardo J, Bodd F, Montecalvo J, Sauter JL, Chang JC, Buonocore DJ, Travis WD, Sen T, Poirier JT, Rudin CM, Rekhtman N |title=SCLC Subtypes Defined by ASCL1, NEUROD1, POU2F3, and YAP1: A Comprehensive Immunohistochemical and Histopathologic Characterization |journal=J Thorac Oncol |volume=15 |issue=12 |pages=1823–1835 |date=December 2020 |pmid=33011388 |pmc=8362797 |doi=10.1016/j.jtho.2020.09.009 |url=}}</ref>
+{| class="wikitable sortable"
+! IHC grouping
+! Prevalence
+! Other IHC
+! Notes
+|-
+|ASCL1 +ve / NeuroD1 -ve
+|41%
+|TTF-1 +ve
+|
+|-
+|ASCL1 +ve / NeuroD1 +ve
+|37%
+|TTF-1 +ve
+|
+|-
+|ASCL1 -ve / NeuroD1 +ve
+|8%
+|TTF-1 +ve
+|
+|-
+|ASCL1 -ve / NeuroD1 -ve
+|14%
+|TTF-1 -ve
+|includes all POU2F3 +ve cases which are ~9% of small cell carcinoma
+|}
+==Molecular==
+Four molecular subtypes - defined by the key transcriptional regulators:<ref>{{cite journal |authors=Rudin CM, Poirier JT, Byers LA, Dive C, Dowlati A, George J, Heymach JV, Johnson JE, Lehman JM, MacPherson D, Massion PP, Minna JD, Oliver TG, Quaranta V, Sage J, Thomas RK, Vakoc CR, Gazdar AF |title=Molecular subtypes of small cell lung cancer: a synthesis of human and mouse model data |journal=Nat Rev Cancer |volume=19 |issue=5 |pages=289–297 |date=May 2019 |pmid=30926931 |pmc=6538259 |doi=10.1038/s41568-019-0133-9 |url=}}</ref>
+*ASCL1 = achaete-scute homologue 1.
+*NeuroD1 = neurogenic differentiation factor 1.
+*YAP1 = yes-associated protein 1.
+*POU2F3 = POU class 2 homeobox 3.
 ==Sign out==
+===Biopsy===
+<pre>
+Lung, Left Lower Lobe, Core Biopsy:
+- SMALL CELL CARCINOMA.
+</pre>
+====Possible LCNEC====
+<pre>
+Lung, Left Lower Lobe, Core Biopsy:
+- NON–SMALL CELL CARCINOMA WITH NEUROENDOCRINE (NE) MORPHOLOGY AND POSITIVE NE MARKERS, POSSIBLE LARGE CELL NEUROENDOCRINE CARCINOMA (LCNEC).
+</pre>
+Note:
+*The above is the wording recommended by 2011 ATS/ERS/IASLC panel.<ref>{{cite journal |authors=Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, Ishikawa Y, Wistuba I, Flieder DB, Franklin W, Gazdar A, Hasleton PS, Henderson DW, Kerr KM, Petersen I, Roggli V, Thunnissen E, Tsao M |title=Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification |journal=Arch Pathol Lab Med |volume=137 |issue=5 |pages=668–84 |date=May 2013 |pmid=22970842 |pmc=4509741 |doi=10.5858/arpa.2012-0263-RA |url=}}</ref>
+====Block letters====
 <pre>
 LOWER LOBE OF LUNG, LEFT, CORE BIOPSY:
 - SMALL CELL CARCINOMA.
 </pre>
+===Resection===
+<pre>
+Left Lower Lobe, Lobectomy:
+     - LARGE CELL NEUROENDOCRINE CARCINOMA.
+     -- Margins clear.
+     - Two lymph nodes NEGATIVE for malignancy (0/2).
+     - Please see synoptic report.
+Comment:
+The tumour stains as follows:
+POSITIVE: CD56, synaptophysin, p63 (scattered).
+NEGATIVE: chromogranin A, CK5/6, TTF-1, napsin A.
+</pre>
+====Micro====
+The sections show large cells epithelioid cells (~3-4x the size of a lymphocyte) with salt and pepper chromatin, scant basophilic cytoplasm, and focally streaming.  Mitotic activity is brisk and multifocal zonal necrosis is present.
 ==See also==

Small cell carcinoma of the lung: Difference between revisions

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