Difference between revisions of "Small cell carcinoma of the lung"

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Small cell carcinoma of the lung (view source)

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      =  
| Image      = Lung_small_cell_carcinoma_%281%29_by_core_needle_biopsy.jpg
| Width      =
| Width      =
| Caption    =  
| 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, smudgy appearance [[Azzopardi phenonmenon]], 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  =
| Subtypes  = large cell neuroendocrine carcinoma (LCNEC)
| LMDDx      =
| LMDDx      = poorly differentiated [[adenocarcinoma of the lung]], [[atypical carcinoid]], [[lung carcinoid]], metastatic [[small cell carcinoma]], [[lymphoma]], other [[small round blue cell tumours]]
| 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        =
| EM        =
| Molecular  =
| Molecular  =
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| Gross      =
| Gross      =
| Grossing  =
| Grossing  =
| Site      =
| Staging    = [[lung cancer staging]]
| Site      = [[lung]] - see ''[[lung tumours]]''
| Assdx      =
| Assdx      =
| Syndromes  =
| Syndromes  =
| Clinicalhx = [[smoking]] - usually a long history, heavy
| Clinicalhx = [[smoking]] - usually a long history, heavy
| Signs      =
| Signs      = +/-hemoptysis
| Symptoms  =
| Symptoms  =
| Prevalence = not common
| Prevalence = not common
| Bloodwork  =
| Bloodwork  =
| Rads      =
| Rads      = lung mass, usu. central location
| Endoscopy  =
| Endoscopy  =
| Prognosis  = poor
| Prognosis  = poor
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| ClinDDx    = other lung tumours ([[squamous cell carcinoma of the lung]]), metastatic tumours
| ClinDDx    = other lung tumours ([[squamous cell carcinoma of the lung]]), metastatic tumours
| Tx        = medical (chemotherapy)
| Tx        = medical (chemotherapy)
}
}}
'''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 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==
==General==
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*[[typical carcinoid|Carcinoid]].
*[[typical carcinoid|Carcinoid]].
*[[atypical carcinoid|Atypical carcinoid]].
*[[atypical carcinoid|Atypical carcinoid]].
*Small cell carinoma/large cell neuroendocrine carcinoma.
*Small cell carinoma/[[large cell neuroendocrine carcinoma]] (LCNEC).


Precursor lesion - uncommonly seen:
Precursor lesion - uncommonly seen:
*Pulmonary neuroendocrine cell hyperplasia.<ref name=pmid20943645>{{Cite journal  | last1 = Travis | first1 = WD. | title = Advances in neuroendocrine lung tumors. | journal = Ann Oncol | volume = 21 Suppl 7 | issue =  | pages = vii65-71 | month = Oct | year = 2010 | doi = 10.1093/annonc/mdq380 | PMID = 20943645 }}</ref>
*Pulmonary neuroendocrine cell hyperplasia.<ref name=pmid20943645>{{Cite journal  | last1 = Travis | first1 = WD. | title = Advances in neuroendocrine lung tumors. | journal = Ann Oncol | volume = 21 Suppl 7 | issue =  | pages = vii65-71 | month = Oct | year = 2010 | doi = 10.1093/annonc/mdq380 | PMID = 20943645 }}</ref>
Clinical:
*+/-Hemoptysis.


==Gross==
==Gross==
*Central location (close to large airways) - typical.
*Central location (close to large airways) - typical.
*[[Necrosis]].
*[[Necrosis]].
===Images===
<gallery>
Image:Small cell carcinoma (3931938372).jpg| Small cell carcinoma of the lung - centre of image. (WC/Rosen)
</gallery>


==Microscopic==
==Microscopic==
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*Typically small cells ~2x RBC diameter.
*Typically small cells ~2x RBC diameter.
*+/-Nuclear moulding.
*+/-Nuclear moulding.
*Necrosis.
*Nuclei with a smudgy appearance ([[Azzopardi phenomenon]]).
*[[Necrosis]].
*Mitoses.
*Mitoses.


Notes:
Notes:
*There should be no nucleolus.
*There should be no [[nucleolus]].


DDx:
DDx:
*Poorly differentiated [[adenocarcinoma of the lung]].
*Metastatic [[small cell carcinoma]].
*Metastatic [[small cell carcinoma]].
*[[Lymphoma]].
*[[Lymphoma]].
*[[Atypical carcinoid]].
*[[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]].
*Other [[small round blue cell tumours]].
===Subtypes===
*Large cell neuroendocrine carcinoma (LCNEC).
*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===
===Images===
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Image:Lung_small_cell_carcinoma_%281%29_by_core_needle_biopsy.jpg | SCLC - high mag. (WC)
Image:Lung_small_cell_carcinoma_%281%29_by_core_needle_biopsy.jpg | SCLC - high mag. (WC)
</gallery>
</gallery>
==IHC==
==IHC==
*Synaptophysin +ve.
*Synaptophysin +ve.
**May be very weak.
**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>


==Sign out==
==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>
<pre>
LOWER LOBE OF LUNG, LEFT, CORE BIOPSY:
LOWER LOBE OF LUNG, LEFT, CORE BIOPSY:
- SMALL CELL CARCINOMA.
- SMALL CELL CARCINOMA.
</pre>
</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==
==See also==
Michael
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