Difference between revisions of "Adenocarcinoma of the lung"

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Adenocarcinoma of the lung (view source)

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→‎Lepidic pattern on biopsy: tweak

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 {{ Infobox diagnosis
 | Name       = {{PAGENAME}}
 | Image      = Acinar pattern adenocarcinoma of lung -- low mag.jpg
 | Width      =
@@ Line 9: / Line 9: @@
 | 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     =
-| 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         =
-| 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         =
 | Gross      =
 | Grossing   =
+| Staging    = [[lung cancer staging]]
 | Site       = [[lung]] - see ''[[lung tumours]]''
 | Assdx      =
@@ Line 51: / Line 52: @@
 ===Image===
 <gallery>
 Image:Adenocarcinoma (3950819000).jpg | Lung adenocarcinoma. (WC/Rosen)
 </gallery>
@@ Line 79: / Line 80: @@
 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.
+*[[Papillary thyroid carcinoma|Papillary carcinoma of thyroid]].
 *[[Squamous cell carcinoma of the lung]].
 *[[Small cell carcinoma of the lung]].
+*[[Adenoid cystic carcinoma]].
 *[[Non-small cell lung carcinoma]] - diagnosis should be avoided if possible.
 *[[Malignant mesothelioma]].
@@ Line 90: / Line 93: @@
 ***[[Invasive ductal carcinoma of the breast]].
 ***[[Invasive lobular carcinoma]].
+***[[Bronchiolar metaplasia]].
 **Other carcinomas.
 *Carcinomas of the bronchial glands, e.g. [[adenoid cystic carcinoma]].
 ===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>
+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.jpg | BAC - mucinous type - high mag. (WC/Yale Rosen)
 </gallery>
+=====Papillary adenocarcinoma=====
 <gallery>
-Image:Adenocarcinoma, acinar subtype (3923397562).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
+Image: Papillary adenocarcinoma of the lung -- very low mag.jpg | PAL - very low mag. (WC/Nephron)
-Image:Adenocarcinoma,_acinar_subtype_(4420421886).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
+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: Acinar pattern adenocarcinoma of lung -- low mag.jpg | Acinar LA - low mag.
+Image: Fetal adenocarcinoma of the lung -- very low mag.jpg | FAL - very low mag. (WC)
-Image: Acinar pattern adenocarcinoma of lung -- intermed mag.jpg | Acinar LA - intermed. mag.
+Image: Fetal adenocarcinoma of the lung - alt2 -- very low mag.jpg | FAL - very low mag. (WC)
-Image: Acinar pattern adenocarcinoma of lung -- high mag.jpg | Acinar LA - high mag.
+Image: Fetal adenocarcinoma of the lung -- low mag.jpg | FAL - low mag. (WC)
-Image: Acinar pattern adenocarcinoma of lung -- very high mag.jpg | Acinar LA - very high mag.
+Image: Fetal adenocarcinoma of the lung -- intermed mag.jpg | FAL - intermed. mag. (WC)
-Image: Acinar pattern adenocarcinoma of lung - alt -- very high mag.jpg | Acinar LA - very high mag.
+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)].
@@ Line 114: / Line 152: @@
 *[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)].
@@ Line 122: / Line 161: @@
 ===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>
-#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.
 #*Definition: lack of invasion into the stroma, vascular spaces and pleura.
@@ Line 134: / Line 173: @@
 ====Grading====
-Graded G1-G4 - as per CAP protocol (version 3.3.0.0):<ref>CAP Lung protocol. Version: 3.3.0.0. URL: [http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution Folders/WebContent/doc/lung-13protocol-3300.doc http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution Folders/WebContent/doc/lung-13protocol-3300.doc]. Accessed on: August 14, 2015.</ref>
+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 and papillary.
+*G2 = acinar, papillary, cribriform.
-*G3 = micropapillary, solid, mucinous.
+*G3 = micropapillary, solid, mucinous, colloid.
-*G4 = undifferentiated.
+*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  | last1 = Travis | first1 = WD. | last2 = Brambilla | first2 = E. | last3 = Noguchi | first3 = M. | last4 = Nicholson | first4 = AG. | last5 = Geisinger | first5 = KR. | last6 = Yatabe | first6 = Y. | last7 = Beer | first7 = DG. | last8 = Powell | first8 = CA. | last9 = Riely | first9 = GJ. | 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 | month = Feb | year = 2011 | doi = 10.1097/JTO.0b013e318206a221 | PMID = 21252716 }}</ref>
+*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==
@@ Line 152: / Line 195: @@
 *TTF-1 +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.
@@ Line 177: / Line 220: @@
 **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>
+*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==
@@ Line 191: / Line 237: @@
 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=====
@@ Line 291: / Line 354: @@
 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.
-===Staging note===
+===Lung cancer staging===
-*Two small tumours in one lobe is pT3.
+{{Main|Lung cancer staging}}
-*Visceral pleural involvement upgrades small tumours.
 ==See also==
@@ Line 299: / Line 361: @@
 *[[Adenocarcinoma]].
 *[[Metastasis]].
+*[[Lung carcinoma with ALK rearrangement]].
+*[[SMARCA4-deficient adenocarcinoma of the lung]].
 ==References==

Difference between revisions of "Adenocarcinoma of the lung"

Adenocarcinoma of the lung (view source)

Revision as of 21:54, 11 January 2022

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