Difference between revisions of "Lung tumours"

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Lung tumours (view source)

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→‎Malignant mesothelioma
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==Malignant mesothelioma==
==Malignant mesothelioma==
:Should '''not''' be confused with ''[[benign multicystic mesothelioma]]'' and ''[[benign papillary mesothelioma]]''.
:Should '''not''' be confused with ''[[benign multicystic mesothelioma]]'' and ''[[benign papillary mesothelioma]]''.
*[[AKA]] ''mesothelioma''.
{{Main|Malignant mesothelioma}}
===General===
*Poor prognosis - median survival <12 months.<ref name=pmid23413596>{{Cite journal  | last1 = Mineo | first1 = TC. | last2 = Ambrogi | first2 = V. | title = Malignant pleural mesothelioma: factors influencing the prognosis. | journal = Oncology (Williston Park) | volume = 26 | issue = 12 | pages = 1164-75 | month = Dec | year = 2012 | doi =  | PMID = 23413596 }}</ref>
 
Locations:
*Lung.
*Primary peritoneal.
 
Epidemiology:
*Strong association with asbestos exposure.
 
Conditions associated with asbestos exposure (mnemonic ''PALM''):<ref name=Ref_PCPBoD8_375>{{Ref PCPBoD8|375}}</ref>
*Pleural plaques.
*[[Asbestosis]].
*[[Lung carcinoma]].
*Malignant mesothelioma.
 
 
Possible association with asbestos exposure:
*[[Gestational trophoblastic disease]].<ref name=pmid19900938>{{Cite journal  | last1 = Reid | first1 = A. | last2 = Heyworth | first2 = J. | last3 = de Klerk | first3 = N. | last4 = Musk | first4 = AW. | title = Asbestos exposure and gestational trophoblastic disease: a hypothesis. | journal = Cancer Epidemiol Biomarkers Prev | volume = 18 | issue = 11 | pages = 2895-8 | month = Nov | year = 2009 | doi = 10.1158/1055-9965.EPI-09-0731 | PMID = 19900938 }}</ref>
 
===Microscopic===
Features:<ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Infiltrative atypical cells - '''key feature'''.
**+/-Epithelioid cells - may be cytologically bland, i.e. benign appearing.
***Variable architecture: sheets, microglandular, tubulopapillary.
***+/-[[Psammoma bodies]].
**+/-Spindle cells.
*+/-''Ferruginous body'' - '''strongly supportive'''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/asbestos+body http://medical-dictionary.thefreedictionary.com/asbestos+body]. Accessed on: 4 November 2011.</ref>
** Looks like a (twirling) baton - segemented appearance, brown colour.
** Thin (asbestos) fiber in the core.
 
Note:
*''Asbestos body'' is not strictly speaking a synonym for ''ferruginous body''.
 
DDx:<ref name=pmid15559051>{{Cite journal  | last1 = Corson | first1 = JM. | title = Pathology of mesothelioma. | journal = Thorac Surg Clin | volume = 14 | issue = 4 | pages = 447-60 | month = Nov | year = 2004 | doi = 10.1016/j.thorsurg.2004.06.007 | PMID = 15559051 }}
</ref>
*[[Fibrosing pleuritis]].
*Mesothelial hyperplasia.
 
Image:
*[http://commons.wikimedia.org/wiki/File:Ferruginous_body.jpg Ferruginous body (WC)].
 
====Subtypes====
List of subtypes - mnemonic ''BEDS'':<ref name=pmid15559051/><ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Biphasic mesothelioma.
**10%+ of epithelioid & 10%+ sarcomatoid.
*Epithelioid mesothelioma.
*Desmoplastic mesothelioma.
**Should be 50%+ dense tissue with storiform pattern & atypical cells.
*Sarcomatoid mesothelioma.
 
===Stains===
*PASD -ve.
*Mucicarmine -ve.
**Typically +ve in adenocarcinoma.
 
===IHC===
====Mesothelioma versus mesothelial hyperplasia====
Features:<ref name=pmid20209622>{{Cite journal  | last1 = Hasteh | first1 = F. | last2 = Lin | first2 = GY. | last3 = Weidner | first3 = N. | last4 = Michael | first4 = CW. | title = The use of immunohistochemistry to distinguish reactive mesothelial cells from malignant mesothelioma in cytologic effusions. | journal = Cancer Cytopathol | volume = 118 | issue = 2 | pages = 90-6 | month = Apr | year = 2010 | doi = 10.1002/cncy.20071 | PMID = 20209622 }}</ref>
*EMA +ve ~100% (vs. ~10%).
*Desmin -ve ~5% (vs. ~85%).
*GLUT1 +ve ~50% (vs. ~10%)
*p53 +ve ~50% (vs. ~2%).
 
====Mesothelioma versus adenocarcinoma====
*Several panel exists - ''no agreed upon best panel''.<ref name=pmid18318582>{{cite journal |author=Marchevsky AM |title=Application of immunohistochemistry to the diagnosis of malignant mesothelioma |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=3 |pages=397-401 |year=2008 |month=March |pmid=18318582 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=132&page=397}}</ref>
**Usually two carcinoma markers + two mesothelial markers.
 
Panel:<ref name=pmid18318582/>
*Mesothelial markers:
**Calretinin.
**WT-1.
**D2-40.
**CK5/6.
*Carcinoma markers:
**CEA (monoclonal and polyclonal).
**TTF-1.
**Ber-EP4.
**MOC-31.
**CD15.


=Malignant potential=
=Malignant potential=
Michael
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