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Adenocarcinoma of the lung (view source)
Revision as of 21:54, 11 January 2022
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| 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 = | ||
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===Image=== | ===Image=== | ||
<gallery> | <gallery> | ||
Image:Adenocarcinoma (3950819000).jpg | Lung adenocarcinoma. (WC/Rosen) | Image:Adenocarcinoma (3950819000).jpg | Lung adenocarcinoma. (WC/Rosen) | ||
</gallery> | </gallery> | ||
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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]]. | ||
*[[Adenoid cystic carcinoma]]. | |||
*[[Non-small cell lung carcinoma]] - diagnosis should be avoided if possible. | *[[Non-small cell lung carcinoma]] - diagnosis should be avoided if possible. | ||
*[[Malignant mesothelioma]]. | *[[Malignant mesothelioma]]. | ||
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***[[Invasive ductal carcinoma of the breast]]. | ***[[Invasive ductal carcinoma of the breast]]. | ||
***[[Invasive lobular carcinoma]]. | ***[[Invasive lobular carcinoma]]. | ||
***[[Bronchiolar metaplasia]]. | |||
**Other carcinomas. | **Other carcinomas. | ||
*Carcinomas of the bronchial glands, e.g. [[adenoid cystic carcinoma]]. | *Carcinomas of the bronchial glands, e.g. [[adenoid cystic carcinoma]]. | ||
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Image: Mucinous adenocarcinoma of the lung -- high mag.jpg | MAL - high 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. | 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> | ||
<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) | ||
</gallery> | |||
=====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> | </gallery> | ||
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*[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)]. | *[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)]. | *[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/7589292780/in/photostream/ Non-mucinous adenocarcinoma in situ (flickr.com/Yale Rosen)]. | ||
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===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. | ||
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====Grading==== | ====Grading==== | ||
Graded G1-G4 - as per CAP protocol (version 3. | 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. | *G1 = lepidic. | ||
*G2 = acinar | *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: | 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> | *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== | ||
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*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. | ||
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**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== | ||
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The adenocarcinoma is positive for TTF-1 and napsin. EGFR/ALK testing was ordered. | The adenocarcinoma is positive for TTF-1 and napsin. EGFR/ALK testing was ordered. | ||
</pre> | </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===== | =====Mucinous adenocarcinoma with noncontributory stains===== | ||
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*[[Metastasis]]. | *[[Metastasis]]. | ||
*[[Lung carcinoma with ALK rearrangement]]. | *[[Lung carcinoma with ALK rearrangement]]. | ||
*[[SMARCA4-deficient adenocarcinoma of the lung]]. | |||
==References== | ==References== | ||