Difference between revisions of "Adenocarcinoma of the lung"

Jump to navigation Jump to search

Adenocarcinoma of the lung (view source)

Revision as of 21:54, 11 January 2022

10,721 bytes added ,  21:54, 11 January 2022
→‎Lepidic pattern on biopsy: tweak
 
(70 intermediate revisions by 3 users not shown)
Line 1: Line 1:
{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Bronchioloalveolar carcinoma, mucinous type.jpg
| Image      = Acinar pattern adenocarcinoma of lung -- low mag.jpg
| Width      =
| Width      =
| Caption    = Lung adenocarcinoma, mucinous. [[H&E stain]].
| Caption    = Invasive adenocarcinoma, acinar pattern (right of image) and benign lung (left of image). [[H&E stain]].
| Synonyms  =
| Synonyms  =
| Micro      = nuclear atypia, eccentrically placed nuclei, usu. abundant cytoplasm (classically with mucin vacuoles), often conspicuous [[nucleoli]], +/-[[nuclear pseudoinclusions]]
| Micro      = +/-nuclear atypia (may be absent in mucinous tumours), eccentrically placed nuclei, usu. abundant cytoplasm (classically with mucin vacuoles), often conspicuous [[nucleoli]], +/-[[nuclear pseudoinclusions]]
| Subtypes  =
| Subtypes  =
| LMDDx      = [[atypical adenomatous hyperplasia of the lung]], adenocarcinoma in situ, [[squamous cell carcinoma of the lung]], [[small cell carcinoma of the lung]], [[non-small cell lung carcinoma]], [[malignant mesothelioma]], [[Metastasis|metastatic]] [[adenocarcinoma]] (esp. [[colorectal adenocarcinoma]], breast adenocarcinoma ([[invasive ductal carcinoma of the breast]], [[invasive lobular carcinoma]]))
| LMDDx      = [[atypical adenomatous hyperplasia of the lung]], adenocarcinoma in situ, [[squamous cell carcinoma of the lung]], [[small cell carcinoma of the lung]], [[non-small cell lung carcinoma]], [[malignant mesothelioma]], [[Metastasis|metastatic]] [[adenocarcinoma]] (esp. [[colorectal adenocarcinoma]], breast adenocarcinoma ([[invasive ductal carcinoma of the breast]], [[invasive lobular carcinoma]]))
| Stains    =
| Stains    =
| IHC        = CK7 +ve, TTF-1 +ve, CK20 -ve, p40 -ve, p63 -ve (usually)
| IHC        = [[CK7]] +ve, [[TTF-1]] +ve, CK20 -ve, [[p40]] -ve, p63 -ve (usually)
| EM        =
| EM        =
| Molecular  = +/-EGFR mutations, +/-ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion)
| Molecular  = +/-KRAS mutations, +/-EGFR mutations, +/-ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion), +/-ROS1 rearrangements, +/-RET rearrangements
| IF        =
| IF        =
| Gross      =  
| Gross      =  
| Grossing  =
| Grossing  =
| Staging    = [[lung cancer staging]]
| Site      = [[lung]] - see ''[[lung tumours]]''
| Site      = [[lung]] - see ''[[lung tumours]]''
| Assdx      =
| Assdx      =
Line 25: Line 26:
| Rads      = lung mass - typically peripheral lesion (distant from large airways), may be multifocal
| Rads      = lung mass - typically peripheral lesion (distant from large airways), may be multifocal
| Endoscopy  =
| Endoscopy  =
| Prognosis  = moderate
| Prognosis  = dependent on stage (minimally invasive and noninvasive: very good; invasive: moderate)
| Other      =
| Other      =
| ClinDDx    = other [[lung tumours]] - primary and metastatic
| ClinDDx    = other [[lung tumours]] - primary and metastatic
Line 35: Line 36:
*Adenocarcinoma is the most common (primary lung cancer).<ref name=pmid19118313>{{cite journal |author=Lutschg JH |title=Lung cancer |journal=N. Engl. J. Med. |volume=360 |issue=1 |pages=87-8; author reply 88 |year=2009 |month=January |pmid=19118313 |doi=10.1056/NEJMc082208 |url=}}</ref>
*Adenocarcinoma is the most common (primary lung cancer).<ref name=pmid19118313>{{cite journal |author=Lutschg JH |title=Lung cancer |journal=N. Engl. J. Med. |volume=360 |issue=1 |pages=87-8; author reply 88 |year=2009 |month=January |pmid=19118313 |doi=10.1056/NEJMc082208 |url=}}</ref>
*Adenocarcinoma is the non-smoker tumour - [[small cell carcinoma of the lung|SCLC]] and [[squamous cell carcinoma of the lung|squamous]] are more strongly associated with [[smoking]].
*Adenocarcinoma is the non-smoker tumour - [[small cell carcinoma of the lung|SCLC]] and [[squamous cell carcinoma of the lung|squamous]] are more strongly associated with [[smoking]].
*Lung adenocarcinoma is the most common brain metastasis.<ref name=pmid22012633>{{Cite journal  | last1 = Nayak | first1 = L. | last2 = Lee | first2 = EQ. | last3 = Wen | first3 = PY. | title = Epidemiology of brain metastases. | journal = Curr Oncol Rep | volume = 14 | issue = 1 | pages = 48-54 | month = Feb | year = 2012 | doi = 10.1007/s11912-011-0203-y | PMID = 22012633 }}</ref>


Treatment:
Treatment:
Line 50: Line 52:


===Image===
===Image===
<gallery>
<gallery>  
Image:Adenocarcinoma (3950819000).jpg | Lung adenocarcinoma. (WC/Rosen)
Image:Adenocarcinoma (3950819000).jpg | Lung adenocarcinoma. (WC/Rosen)
</gallery>
</gallery>
Line 56: Line 58:
==Microscopic==
==Microscopic==
Features:
Features:
*Nuclear atypia.
*+/-Nuclear atypia - '''important'''.
**May be absent in mucinous tumours - may look similar to foveolar epithelium.
*Eccentrically placed nuclei.
*Eccentrically placed nuclei.
*Abundant cytoplasm - classically with mucin vacuoles.
*Abundant cytoplasm - classically with mucin vacuoles.
Line 66: Line 69:


Patterns:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
Patterns:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
*Lepidic - tumour grows long the alveolar wall; means ''scaly covering''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/lepidic http://medical-dictionary.thefreedictionary.com/lepidic]. Accessed on: 8 August 2013.</ref>
*Lepidic - tumour grows long the alveolar wall; means ''scaly covering''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/lepidic http://medical-dictionary.thefreedictionary.com/lepidic]. Accessed on: 8 August 2013.</ref> At lower power, the shapes should still resemble lung acini.
*Acinar - berry-shaped glands.  
*Acinar - berry-shaped glands, smaller than lung acini.  
*Papillary - fibrovascular cores.
*Papillary - fibrovascular cores.
*Micropapillary - nipple shaped projections without fibrovascular cores.
*Micropapillary - nipple shaped projections without fibrovascular cores.
Line 77: Line 80:


DDx:
DDx:
*[[Atypical adenomatous hyperplasia of the lung]] - spaced hobnail cells, mild-to-moderate nuclear atypia, small lesion (< 5 mm).
*[[Atypical adenomatous hyperplasia of the lung]] - spaced [[hobnail]] cells, mild-to-moderate nuclear atypia, small lesion (must be <5 mm).
*Adenocarcinoma in situ.
*Adenocarcinoma in situ.
*[[Papillary thyroid carcinoma|Papillary carcinoma of thyroid]].
*[[Squamous cell carcinoma of the lung]].
*[[Squamous cell carcinoma of the lung]].
*[[Small cell carcinoma of the lung]].
*[[Small cell carcinoma of the lung]].
*[[Non-small cell lung carcinoma]] - diagnosis should be avoid if possible.
*[[Adenoid cystic carcinoma]].
*[[Non-small cell lung carcinoma]] - diagnosis should be avoided if possible.
*[[Malignant mesothelioma]].
*[[Malignant mesothelioma]].
*[[Metastasis|Metastatic]] adenocarcinoma.
*[[Metastasis|Metastatic]] adenocarcinoma.
Line 88: Line 93:
***[[Invasive ductal carcinoma of the breast]].
***[[Invasive ductal carcinoma of the breast]].
***[[Invasive lobular carcinoma]].
***[[Invasive lobular carcinoma]].
***[[Bronchiolar metaplasia]].
**Other carcinomas.
*Carcinomas of the bronchial glands, e.g. [[adenoid cystic carcinoma]].


===Images===
===Images===
=====Acinar adenocarcinoma=====
<gallery>
Image: Acinar pattern adenocarcinoma of lung -- low mag.jpg | Acinar LA - low mag.
Image: Acinar pattern adenocarcinoma of lung -- intermed mag.jpg | Acinar LA - intermed. mag.
Image: Acinar pattern adenocarcinoma of lung -- high mag.jpg | Acinar LA - high mag.
Image: Acinar pattern adenocarcinoma of lung -- very high mag.jpg | Acinar LA - very high mag.
Image: Acinar pattern adenocarcinoma of lung - alt -- very high mag.jpg | Acinar LA - very high mag.
</gallery>
<gallery>
Image:Adenocarcinoma, acinar subtype (3923397562).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
Image:Adenocarcinoma,_acinar_subtype_(4420421886).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
</gallery>
=====Mucinous adenocarcinoma=====
<gallery>
Image: Mucinous adenocarcinoma of the lung -- low mag.jpg | MAL - low mag.
Image: Mucinous adenocarcinoma of the lung -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous adenocarcinoma of the lung -- high mag.jpg | MAL - high mag.
Image: Mucinous adenocarcinoma of the lung -- very high mag.jpg | MAL - very high mag.
</gallery>
<gallery>
<gallery>
Image: Mucinous lung adenocarcinoma -- low mag.jpg | MAL - low mag.
Image: Mucinous lung adenocarcinoma -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous lung adenocarcinoma -- high mag.jpg | MAL - high mag.
Image: Mucinous lung adenocarcinoma and airway -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous lung adenocarcinoma and airway -- high mag.jpg | MAL - high mag.
Image: Mucinous lung adenocarcinoma and airway - alt -- high mag.jpg | MAL - high mag.
</gallery>
<gallery>
Image:Bronchioloalveolar carcinoma, mucinous type 2.jpg |BAC - mucinous type - low mag. (WC/Yale Rosen)
Image:Bronchioloalveolar carcinoma, mucinous type 2.jpg |BAC - mucinous type - low mag. (WC/Yale Rosen)
Image:Bronchioloalveolar carcinoma, mucinous type.jpg | BAC - mucinous type - high mag. (WC/Yale Rosen)
Image:Bronchioloalveolar carcinoma, mucinous type.jpg | BAC - mucinous type - high mag. (WC/Yale Rosen)
Image:Adenocarcinoma, acinar subtype (3923397562).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
Image:Adenocarcinoma,_acinar_subtype_(4420421886).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
</gallery>
</gallery>
www:
 
=====Papillary adenocarcinoma=====
<gallery>
Image: Papillary adenocarcinoma of the lung -- very low mag.jpg | PAL - very low mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- low mag.jpg | PAL - low mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- intermed mag.jpg | PAL - intermed. mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- high mag.jpg | PAL - high mag. (WC/Nephron)
</gallery>
 
====Fetal adenocarcinoma====
<gallery>
Image: Fetal adenocarcinoma of the lung -- very low mag.jpg | FAL - very low mag. (WC)
Image: Fetal adenocarcinoma of the lung - alt2 -- very low mag.jpg | FAL - very low mag. (WC)
Image: Fetal adenocarcinoma of the lung -- low mag.jpg | FAL - low mag. (WC)
Image: Fetal adenocarcinoma of the lung -- intermed mag.jpg | FAL - intermed. mag. (WC)
Image: Fetal adenocarcinoma of the lung -- high mag.jpg | FAL - high mag. (WC)
</gallery>
 
====www====
*[http://www.pathpedia.com/education/eatlas/histopathology/lung_and_bronchi/bronchioloalveolar_carcinoma_mucinous.aspx BAC mucinous type adjacent to benign (pathpedia.com)].
*[http://www.pathpedia.com/education/eatlas/histopathology/lung_and_bronchi/bronchioloalveolar_carcinoma_mucinous.aspx BAC mucinous type adjacent to benign (pathpedia.com)].
*[http://cancergrace.org/wp-content/uploads/2007/05/mucinous-vs-nonmucinous-bac-histology.jpg BAC mucinous and nonmucinous (cancergrace.org)].<ref>URL: [http://cancergrace.org/lung/2007/05/14/bac-mucinous-and-non-mucinous/ http://cancergrace.org/lung/2007/05/14/bac-mucinous-and-non-mucinous/]. Accessed on: 8 August 2013.</ref>
*[http://cancergrace.org/wp-content/uploads/2007/05/mucinous-vs-nonmucinous-bac-histology.jpg BAC mucinous and nonmucinous (cancergrace.org)].<ref>URL: [http://cancergrace.org/lung/2007/05/14/bac-mucinous-and-non-mucinous/ http://cancergrace.org/lung/2007/05/14/bac-mucinous-and-non-mucinous/]. Accessed on: 8 August 2013.</ref>
*[https://www.flickr.com/photos/pulmonary_pathology/7589291672/ Lepidic adenocarcinoma with invasive (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589291672/ Lepidic adenocarcinoma with invasive (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292214/in/photostream/ Lepidic adenocarcinoma (flickr.com/Yale Rosen)].
*[http://www.rosaicollection.org/searchresults.cfm/ Lepidic adenocarcinoma (rosaicollection.org/index.cfm)].
*[http://pathlabmed.typepad.com/surgical_pathology_and_la/2010/09/digital-case-challenge-non-mucinous-bronchioloalveolar-adenocarcinoma.html Mucinous adenocarcinoma (pathlabmed.typepad.com)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292780/in/photostream/ Non-mucinous adenocarcinoma in situ (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292496/in/photostream/ Non-mucinous adenocarcinoma in situ (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589290010/in/photostream/ Acinar adenocarcinoma (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589289274/in/photostream/ Acinar adenocarcinoma (flickr.com/Yale Rosen)].


===Classification===
===Classification===
Classification based on extent:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
Classification based on extent:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
#Adenocarcinoma in situ (AIS) - previously known as [[BAC]].
#Adenocarcinoma in situ (AIS) - previously known as ''bronchioloalveolar carcinoma'' (abbreviated [[BAC]]).
#*Subtypes: nonmucinous, mucinous, mixed mucinous/nonmucinous.
#*Subtypes: nonmucinous, mucinous, mixed mucinous/nonmucinous.
#*Definition: lack of invasion into the stroma, vascular spaces and pleura.
#*Definition: lack of invasion into the stroma, vascular spaces and pleura.
#*Must have a lepidic growth pattern.<ref name=pmid22214965>{{Cite journal  | last1 = Borczuk | first1 = AC. | title = Assessment of invasion in lung adenocarcinoma classification, including adenocarcinoma in situ and minimally invasive adenocarcinoma. | journal = Mod Pathol | volume = 25 Suppl 1 | issue =  | pages = S1-10 | month = Jan | year = 2012 | doi = 10.1038/modpathol.2011.151 | PMID = 22214965 }}</ref>
#Minimally invasive adenocarcinoma (MIA).  
#Minimally invasive adenocarcinoma (MIA).  
#*Lepidic growth with up to 5 mm of invasion.
#*Lepidic growth with up to 5 mm of invasion.
#*Subtypes: nonmucinous (most common), mucinous, mixed mucinous/nonmucinous.
#*Subtypes: nonmucinous (most common), mucinous (uncommon), mixed (mucinous/nonmucinous).
#*Should not have [[lymphovascular invasion]].{{fact}}
#Invasive adenocarcinoma:
#Invasive adenocarcinoma:
#*Subtypes: micropapillary, mucinous (previously ''mucinous BAC''), colloid, fetal, enteric.
#*Subtypes: micropapillary, mucinous (previously ''mucinous BAC''), colloid, fetal, enteric.
====Grading====
Graded G1-G4 - 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>
*G1 = lepidic.
*G2 = acinar, papillary, cribriform.
*G3 = micropapillary, solid, mucinous, colloid.
*G4 = undifferentiated - '''not''' used for lung adenocarcinoma; it used for small cell carcinoma and large cell carcinoma.
Note:
*There is no consensus currently on grading - as per the international consensus guidelines of 2011.<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
==Special stains==
*[[Mucicarmine]] +ve, cytoplasmic.
*[[PAS-diastase]] +ve, cytoplasmic.


==IHC==
==IHC==
Line 120: Line 194:
Panel for adenocarcinoma versus SCC:
Panel for adenocarcinoma versus SCC:
*TTF-1 +ve.
*TTF-1 +ve.
*Napsin A +ve.
*[[Napsin]] A +ve.
*p40 -ve.<ref name=pmid22056955>{{Cite journal  | last1 = Bishop | first1 = JA. | last2 = Teruya-Feldstein | first2 = J. | last3 = Westra | first3 = WH. | last4 = Pelosi | first4 = G. | last5 = Travis | first5 = WD. | last6 = Rekhtman | first6 = N. | title = p40 (ΔNp63) is superior to p63 for the diagnosis of pulmonary squamous cell carcinoma. | journal = Mod Pathol | volume = 25 | issue = 3 | pages = 405-15 | month = Mar | year = 2012 | doi = 10.1038/modpathol.2011.173 | PMID = 22056955 }}</ref>
*[[p40]] -ve.<ref name=pmid22056955>{{Cite journal  | last1 = Bishop | first1 = JA. | last2 = Teruya-Feldstein | first2 = J. | last3 = Westra | first3 = WH. | last4 = Pelosi | first4 = G. | last5 = Travis | first5 = WD. | last6 = Rekhtman | first6 = N. | title = p40 (ΔNp63) is superior to p63 for the diagnosis of pulmonary squamous cell carcinoma. | journal = Mod Pathol | volume = 25 | issue = 3 | pages = 405-15 | month = Mar | year = 2012 | doi = 10.1038/modpathol.2011.173 | PMID = 22056955 }}</ref>
*CK5/6 -ve.
*CK5/6 -ve.


Line 128: Line 202:
*Vimentin -ve/+ve (+ve relatively common).
*Vimentin -ve/+ve (+ve relatively common).
**Poor prognosticator.<ref>{{Cite journal  | last1 = Dauphin | first1 = M. | last2 = Barbe | first2 = C. | last3 = Lemaire | first3 = S. | last4 = Nawrocki-Raby | first4 = B. | last5 = Lagonotte | first5 = E. | last6 = Delepine | first6 = G. | last7 = Birembaut | first7 = P. | last8 = Gilles | first8 = C. | last9 = Polette | first9 = M. | title = Vimentin expression predicts the occurrence of metastases in non small cell lung carcinomas. | journal = Lung Cancer | volume = 81 | issue = 1 | pages = 117-22 | month = Jul | year = 2013 | doi = 10.1016/j.lungcan.2013.03.011 | PMID = 23562674 }}</ref>
**Poor prognosticator.<ref>{{Cite journal  | last1 = Dauphin | first1 = M. | last2 = Barbe | first2 = C. | last3 = Lemaire | first3 = S. | last4 = Nawrocki-Raby | first4 = B. | last5 = Lagonotte | first5 = E. | last6 = Delepine | first6 = G. | last7 = Birembaut | first7 = P. | last8 = Gilles | first8 = C. | last9 = Polette | first9 = M. | title = Vimentin expression predicts the occurrence of metastases in non small cell lung carcinomas. | journal = Lung Cancer | volume = 81 | issue = 1 | pages = 117-22 | month = Jul | year = 2013 | doi = 10.1016/j.lungcan.2013.03.011 | PMID = 23562674 }}</ref>
Note:
*In mucinous adenocarcinoma of the lung TTF-1 is usu. -ve (46% +ve) and napsin is usu. -ve (36% +ve).
**Positive staining is unusual but useful if present, as metastatic disease is uniformily negative for both.<ref name=pmid24651909>{{Cite journal  | last1 = Rossi | first1 = G. | last2 = Cavazza | first2 = A. | last3 = Righi | first3 = L. | last4 = Sartori | first4 = G. | last5 = Bisagni | first5 = A. | last6 = Longo | first6 = L. | last7 = Pelosi | first7 = G. | last8 = Papotti | first8 = M. | title = Napsin-A, TTF-1, EGFR, and ALK Status Determination in Lung Primary and Metastatic Mucin-Producing Adenocarcinomas. | journal = Int J Surg Pathol | volume = 22 | issue = 5 | pages = 401-7 | month = Aug | year = 2014 | doi = 10.1177/1066896914527609 | PMID = 24651909 }}
</ref>


==Molecular==
==Molecular==
Line 134: Line 213:
**Exon 21 L858R.
**Exon 21 L858R.
***Natural history of mutation is suspected to have a better prognosis vs. wild-type.<ref>URL: [http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r]. Accessed on: 27 April 2012.</ref>
***Natural history of mutation is suspected to have a better prognosis vs. wild-type.<ref>URL: [http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r]. Accessed on: 27 April 2012.</ref>
**KRAS mutations are absent, i.e. ''wild-type KRAS''.<ref>{{Cite journal  | last1 = Pao | first1 = W. | last2 = Wang | first2 = TY. | last3 = Riely | first3 = GJ. | last4 = Miller | first4 = VA. | last5 = Pan | first5 = Q. | last6 = Ladanyi | first6 = M. | last7 = Zakowski | first7 = MF. | last8 = Heelan | first8 = RT. | last9 = Kris | first9 = MG. | title = KRAS mutations and primary resistance of lung adenocarcinomas to gefitinib or erlotinib. | journal = PLoS Med | volume = 2 | issue = 1 | pages = e17 | month = Jan | year = 2005 | doi = 10.1371/journal.pmed.0020017 | PMID = 15696205 }}</ref>
**[[KRAS mutations]] are absent, i.e. ''wild-type KRAS''.<ref>{{Cite journal  | last1 = Pao | first1 = W. | last2 = Wang | first2 = TY. | last3 = Riely | first3 = GJ. | last4 = Miller | first4 = VA. | last5 = Pan | first5 = Q. | last6 = Ladanyi | first6 = M. | last7 = Zakowski | first7 = MF. | last8 = Heelan | first8 = RT. | last9 = Kris | first9 = MG. | title = KRAS mutations and primary resistance of lung adenocarcinomas to gefitinib or erlotinib. | journal = PLoS Med | volume = 2 | issue = 1 | pages = e17 | month = Jan | year = 2005 | doi = 10.1371/journal.pmed.0020017 | PMID = 15696205 }}</ref>


*ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion).<ref name=pmid21245935>{{Cite journal  | last1 = Li | first1 = Y. | last2 = Ye | first2 = X. | last3 = Liu | first3 = J. | last4 = Zha | first4 = J. | last5 = Pei | first5 = L. | title = Evaluation of EML4-ALK fusion proteins in non-small cell lung cancer using small molecule inhibitors. | journal = Neoplasia | volume = 13 | issue = 1 | pages = 1-11 | month = Jan | year = 2011 | doi =  | PMID = 21245935 }}</ref>
*ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion).<ref name=pmid21245935>{{Cite journal  | last1 = Li | first1 = Y. | last2 = Ye | first2 = X. | last3 = Liu | first3 = J. | last4 = Zha | first4 = J. | last5 = Pei | first5 = L. | title = Evaluation of EML4-ALK fusion proteins in non-small cell lung cancer using small molecule inhibitors. | journal = Neoplasia | volume = 13 | issue = 1 | pages = 1-11 | month = Jan | year = 2011 | doi =  | PMID = 21245935 }}</ref>
Line 141: Line 220:
**See ''[[lung carcinoma with ALK rearrangement]].
**See ''[[lung carcinoma with ALK rearrangement]].
**Do ''not'' occur with EGRF mutations ''or'' KRAS mutations.<ref name=pmid23729361>{{Cite journal  | last1 = Gainor | first1 = JF. | last2 = Varghese | first2 = AM. | last3 = Ou | first3 = SH. | last4 = Kabraji | first4 = S. | last5 = Awad | first5 = MM. | last6 = Katayama | first6 = R. | last7 = Pawlak | first7 = A. | last8 = Mino-Kenudson | first8 = M. | last9 = Yeap | first9 = BY. | title = ALK rearrangements are mutually exclusive with mutations in EGFR or KRAS: an analysis of 1,683 patients with non-small cell lung cancer. | journal = Clin Cancer Res | volume = 19 | issue = 15 | pages = 4273-81 | month = Aug | year = 2013 | doi = 10.1158/1078-0432.CCR-13-0318 | PMID = 23729361 }}</ref>
**Do ''not'' occur with EGRF mutations ''or'' KRAS mutations.<ref name=pmid23729361>{{Cite journal  | last1 = Gainor | first1 = JF. | last2 = Varghese | first2 = AM. | last3 = Ou | first3 = SH. | last4 = Kabraji | first4 = S. | last5 = Awad | first5 = MM. | last6 = Katayama | first6 = R. | last7 = Pawlak | first7 = A. | last8 = Mino-Kenudson | first8 = M. | last9 = Yeap | first9 = BY. | title = ALK rearrangements are mutually exclusive with mutations in EGFR or KRAS: an analysis of 1,683 patients with non-small cell lung cancer. | journal = Clin Cancer Res | volume = 19 | issue = 15 | pages = 4273-81 | month = Aug | year = 2013 | doi = 10.1158/1078-0432.CCR-13-0318 | PMID = 23729361 }}</ref>
*ROS1 - good response to crizotinib.<ref name=pmid25264305>{{Cite journal  | last1 = Shaw | first1 = AT. | last2 = Ou | first2 = SH. | last3 = Bang | first3 = YJ. | last4 = Camidge | first4 = DR. | last5 = Solomon | first5 = BJ. | last6 = Salgia | first6 = R. | last7 = Riely | first7 = GJ. | last8 = Varella-Garcia | first8 = M. | last9 = Shapiro | first9 = GI. | title = Crizotinib in ROS1-rearranged non-small-cell lung cancer. | journal = N Engl J Med | volume = 371 | issue = 21 | pages = 1963-71 | month = Nov | year = 2014 | doi = 10.1056/NEJMoa1406766 | PMID = 25264305 }}</ref>
**Approximately 1% of NSCLC.<ref name=pmid25409376>{{Cite journal  | last1 = Gold | first1 = KA. | title = ROS1--targeting the one percent in lung cancer. | journal = N Engl J Med | volume = 371 | issue = 21 | pages = 2030-1 | month = Nov | year = 2014 | doi = 10.1056/NEJMe1411319 | PMID = 25409376 }}</ref>


==Sign out==
==Sign out==
===Biopsy===
===Biopsy===
Consensus recommendations:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
*''Adenocarcinoma in situ'' (AIS) and ''minimally invasive adenocarcinoma'' should '''not''' be used in the reporting of small biopsies and cytology.
**Tumours with a non-invasive pattern are referred to by their pattern, e.g. ''lepidic growth'', '''not''' as AIS.
<pre>
Lung, Right Upper Lobe, Core Biopsy:
- INVASIVE ADENOCARCINOMA, NON-MUCINOUS.
Comment:
The adenocarcinoma is positive for TTF-1 and napsin. EGFR/ALK testing was ordered.
</pre>
====Lepidic pattern on biopsy====
Important note: lesion '''''must''''' be >=5 mm ''and'' <=30 mm.
<pre>
Lung, Left Upper Lobe, Core Biopsy:
    - ADENOCARCINOMA, lepidic pattern.
Comment:
The tumour is stains as follows:
POSITIVE: TTF-1, napsin A, CK7.
NEGATIVE: p40.
The findings are in keeping with lepidic pattern adenocarcinoma; the differential diagnosis includes: (1) adenocarcinoma in situ, (2) minimally invasive adenocarcinoma, and (3) invasive adenocarcinoma.
Lung biomarkers (EGFR, ALK, PDL1, ROS1) have been ordered.
</pre>
=====Mucinous adenocarcinoma with noncontributory stains=====
<pre>
Lung, Right Upper Lobe, Core Biopsy:
- ADENOCARCINOMA, MUCINOUS, see comment.
Comment:
The adenocarcinoma is negative for both napsin and TTF-1. EGFR/ALK testing was ordered.
The findings are compatible with a primary or secondary adenocarcinoma; clinical and
radiologic correlation is required.
</pre>
====Block letters====
<pre>
<pre>
LUNG, LEFT, BIOPSY:
LUNG, LEFT, BIOPSY:
- ADENOCARCINOMA, LEPIDIC GROWTH; INVASION CANNOT BE EXCLUDED IN THIS SMALL SPECIMEN.
- ADENOCARCINOMA, LEPIDIC GROWTH; INVASION CANNOT BE EXCLUDED IN THIS SMALL SPECIMEN.
</pre>
<pre>
LUNG, RIGHT UPPER LOBE, NEEDLE BIOPSY:
- INVASIVE ADENOCARCINOMA, NON-MUCINOUS.
COMMENT:
The tumour stains as follows:
POSITIVE: TTF-1.
NEGATIVE: p40.
The immunoprofile is compatible with lung adenocarcinoma.
</pre>
<pre>
MASS, LEFT LOWER LOBE OF LUNG, BIOPSY:
- INVASIVE ADENOCARCINOMA.
COMMENT:
The tumour is positive for TTF-1.
Tissue will be sent for molecular testing and the results reported as an addendum.
</pre>
</pre>


Line 205: Line 351:
</pre>
</pre>


===Staging note===
====Mucinous====
*Two small tumours in one lobe is pT3.
The sections show cores with well-formed glands composed of foveolar-like columnar cells with a relatively bland cytomorphology. Mitotic activity is not readily apparent. A small amount of non-lesional lung parenchyma is present.
*Visceral pleural involvement upgrades small tumours.
 
===Lung cancer staging===
{{Main|Lung cancer staging}}


==See also==
==See also==
Line 213: Line 361:
*[[Adenocarcinoma]].
*[[Adenocarcinoma]].
*[[Metastasis]].
*[[Metastasis]].
*[[Lung carcinoma with ALK rearrangement]].
*[[SMARCA4-deficient adenocarcinoma of the lung]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
==External links==
*[http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-staging Lung cancer staging (cancer.org)].
*[http://www.nucmedresource.com/thoracic-nodal-stations.html Thoracic lymph node stations (nucmedresource.com)].


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Lung tumours]]
[[Category:Lung tumours]]
Michael
48,466

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/30793...51777"

Navigation menu