Small cell carcinoma of the lung: Difference between revisions

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| Caption    = Lung small cell carcinoma. [[H&E stain]].
| Caption    = Lung small cell carcinoma. [[H&E stain]].
| Synonyms  =
| 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    =  
| Stains    =  
| IHC        = chromogranin +ve, synaptophysin +ve, CD56 +ve, NSE +ve, TTF-1 +ve, Ki-67 (>50%)
| IHC        = chromogranin +ve, synaptophysin +ve, CD56 +ve, NSE +ve, TTF-1 +ve, Ki-67 (>50%)
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*Other [[small round blue cell tumours]].
*Other [[small round blue cell tumours]].


===Subtypes===
===Histologic subtypes===
*Large cell neuroendocrine carcinoma (LCNEC).
*Large cell neuroendocrine carcinoma (LCNEC).


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Others:
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>
*[[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==
==Sign out==
===Biopsy===
<pre>
<pre>
Lung, Left Lower Lobe, Core Biopsy:
Lung, Left Lower Lobe, Core Biopsy:
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</pre>
</pre>


===Block letters===
====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>
<pre>
LOWER LOBE OF LUNG, LEFT, CORE BIOPSY:
LOWER LOBE OF LUNG, LEFT, CORE BIOPSY:
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