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Atypical adenomatous hyperplasia of the lung (view source)
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'''Atypical alveolar hyperplasia of the lung''' is considered the precursor of [[lung adenocarcinoma]]. It is typically found beside lung adenocarcinoma in resection specimens.<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> | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Atypical_adenomatous_hyperplasia_--_high_mag.jpg | |||
| Width = | |||
| Caption = [[Micrograph]] showing atypical adenomatous hyperplasia. [[H&E stain]]. | |||
| Synonyms = atypical alveolar hyperplasia | |||
| Micro = enlarged alveolar lining cells with [[hobnail morphology]], round or oval hyperchromatic nuclei; spaces are typically seen between the alveolar lining cells '''important'''; limited extent (must be <5 mm); +/-nuclear enlargement (mild-to-moderate), +/-multinucleation | |||
| Subtypes = | |||
| LMDDx = [[adenocarcinoma in situ]] of lung, [[lung adenocarcinoma]], [[multifocal micronodular pneumocyte hyperplasia associated with tuberous sclerosis]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Staging = | |||
| Site = [[lung]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = relatively common | |||
| Bloodwork = | |||
| Rads = ground glass opacity (persistent) | |||
| Endoscopy = | |||
| Prognosis = benign, need to exclude [[lung adenocarcinoma]] | |||
| Other = | |||
| ClinDDx = [[pneumonia]] (chronic), [[lung tumours]] | |||
| Tx = surgical excision | |||
}} | |||
'''Atypical alveolar hyperplasia of the lung''', also '''atypical adenomatous hyperplasia''' (abbreviated '''AAH''') and '''atypical alveolar hyperplasia''', is considered the precursor of [[lung adenocarcinoma]]. It is typically found beside lung adenocarcinoma in resection specimens.<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> | |||
==General== | ==General== | ||
*Generally considered the precursor lesion to ''adenocarcinoma in situ''.<ref name=pmid17618248>{{Cite journal | last1 = Sakuma | first1 = Y. | last2 = Matsukuma | first2 = S. | last3 = Yoshihara | first3 = M. | last4 = Nakamura | first4 = Y. | last5 = Nakayama | first5 = H. | last6 = Kameda | first6 = Y. | last7 = Tsuchiya | first7 = E. | last8 = Miyagi | first8 = Y. | title = Epidermal growth factor receptor gene mutations in atypical adenomatous hyperplasias of the lung. | journal = Mod Pathol | volume = 20 | issue = 9 | pages = 967-73 | month = Sep | year = 2007 | doi = 10.1038/modpathol.3800929 | PMID = 17618248 }}</ref> | *Generally considered the precursor lesion to ''adenocarcinoma in situ''.<ref name=pmid17618248>{{Cite journal | last1 = Sakuma | first1 = Y. | last2 = Matsukuma | first2 = S. | last3 = Yoshihara | first3 = M. | last4 = Nakamura | first4 = Y. | last5 = Nakayama | first5 = H. | last6 = Kameda | first6 = Y. | last7 = Tsuchiya | first7 = E. | last8 = Miyagi | first8 = Y. | title = Epidermal growth factor receptor gene mutations in atypical adenomatous hyperplasias of the lung. | journal = Mod Pathol | volume = 20 | issue = 9 | pages = 967-73 | month = Sep | year = 2007 | doi = 10.1038/modpathol.3800929 | PMID = 17618248 }}</ref> | ||
*Precursor to [[lung adenocarcinoma]] as per [[World Health Organization]].<ref name=pmid11235908>{{Cite journal | last1 = Mori | first1 = M. | last2 = Rao | first2 = SK. | last3 = Popper | first3 = HH. | last4 = Cagle | first4 = PT. | last5 = Fraire | first5 = AE. | title = Atypical adenomatous hyperplasia of the lung: a probable forerunner in the development of adenocarcinoma of the lung. | journal = Mod Pathol | volume = 14 | issue = 2 | pages = 72-84 | month = Feb | year = 2001 | doi = 10.1038/modpathol.3880259 | PMID = 11235908 }}</ref> | |||
*Typically an incidental finding, i.e. asymptomatic.<ref name=Ref_WMSP114>{{Ref WMSP|114}}</ref> | *Typically an incidental finding, i.e. asymptomatic.<ref name=Ref_WMSP114>{{Ref WMSP|114}}</ref> | ||
| Line 8: | Line 41: | ||
Features:<ref name=Ref_WMSP114>{{Ref WMSP|114}}</ref> | Features:<ref name=Ref_WMSP114>{{Ref WMSP|114}}</ref> | ||
*Enlarged alveolar lining cells with: | *Enlarged alveolar lining cells with: | ||
**Hobnail morphology - free (luminal) surface area > attached/basal surface area. | **[[Hobnail morphology]] - free (luminal) surface area > attached/basal surface area. | ||
** | **Round or oval nuclei.<ref name=pmid21252716/> | ||
**Spaces are typically seen between the cells | ***Nuclear hyperchromasia. | ||
***+/-Nuclear enlargement (mild-to-moderate). | |||
***+/-Multinucleation. | |||
*Spaces are typically seen between the cells<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> - '''important'''. | |||
*Limited extent: | *Limited extent: | ||
**<5 mm. † | **<5 mm. † | ||
DDx: | DDx: | ||
*Adenocarcinoma in situ. | *Adenocarcinoma in situ - more [[nuclear atypia]]. | ||
*[[Lung adenocarcinoma]]. | *[[Lung adenocarcinoma]]. | ||
*[[Multifocal micronodular pneumocyte hyperplasia associated with tuberous sclerosis]]<ref name=pmid18535095>{{Cite journal | last1 = Kobashi | first1 = Y. | last2 = Sugiu | first2 = T. | last3 = Mouri | first3 = K. | last4 = Irei | first4 = T. | last5 = Nakata | first5 = M. | last6 = Oka | first6 = M. | title = Multifocal micronodular pneumocyte hyperplasia associated with tuberous sclerosis: differentiation from multiple atypical adenomatous hyperplasia. | journal = Jpn J Clin Oncol | volume = 38 | issue = 6 | pages = 451-4 | month = Jun | year = 2008 | doi = 10.1093/jjco/hyn042 | PMID = 18535095 }}</ref> - classically has macrophages in the airspaces, should be consideration in younger individuals. | |||
Note: | Note: | ||
| Line 22: | Line 59: | ||
===Images=== | ===Images=== | ||
<gallery> | |||
Image: Atypical adenomatous hyperplasia -- low mag.jpg | AAH - low mag. (WC) | |||
Image: Atypical adenomatous hyperplasia -- intermed mag.jpg | AAH - intermed. mag. (WC) | |||
Image: Atypical adenomatous hyperplasia - alt -- high mag.jpg | AAH - high mag. (WC) | |||
Image: Atypical adenomatous hyperplasia -- very high mag.jpg | AAH - very high mag. (WC) | |||
</gallery> | |||
====www==== | |||
*[http://www.nature.com/modpathol/journal/v20/n9/fig_tab/3800929f1.html#figure-title AAH (nature.com)].<ref name=pmid17618248/> | *[http://www.nature.com/modpathol/journal/v20/n9/fig_tab/3800929f1.html#figure-title AAH (nature.com)].<ref name=pmid17618248/> | ||
*[http://www.jthoracdis.com/article/viewFile/1518/html/9359 AAH (jthoracdis.com)].<ref>{{Cite journal | last1 = Davidson | first1 = MR. | last2 = Gazdar | first2 = AF. | last3 = Clarke | first3 = BE. | title = The pivotal role of pathology in the management of lung cancer. | journal = J Thorac Dis | volume = 5 | issue = Suppl 5 | pages = S463-S478 | month = Oct | year = 2013 | doi = 10.3978/j.issn.2072-1439.2013.08.43 | PMID = 24163740 }}</ref> | |||
==IHC== | |||
*p53 +ve/-ve (~60% of lesions +ve).<ref name=pmid7884586>{{Cite journal | last1 = Kerr | first1 = KM. | last2 = Carey | first2 = FA. | last3 = King | first3 = G. | last4 = Lamb | first4 = D. | title = Atypical alveolar hyperplasia: relationship with pulmonary adenocarcinoma, p53, and c-erbB-2 expression. | journal = J Pathol | volume = 174 | issue = 4 | pages = 249-56 | month = Dec | year = 1994 | doi = 10.1002/path.1711740404 | PMID = 7884586 }}</ref> | |||
*Ki-67 variable. | |||
**Up to 40% in one paper<ref>{{Cite journal | last1 = Huo | first1 = Z. | last2 = Liu | first2 = HR. | last3 = Wan | first3 = JW. | title = [Atypical adenomatous hyperplasia of lung: clinicopathologic study of 8 cases and review of literature]. | journal = Zhonghua Bing Li Xue Za Zhi | volume = 36 | issue = 5 | pages = 292-6 | month = May | year = 2007 | doi = | PMID = 17706134 }}</ref> - typically lower (<10%<ref name=pmid7884586>{{Cite journal | last1 = Kerr | first1 = KM. | last2 = Carey | first2 = FA. | last3 = King | first3 = G. | last4 = Lamb | first4 = D. | title = Atypical alveolar hyperplasia: relationship with pulmonary adenocarcinoma, p53, and c-erbB-2 expression. | journal = J Pathol | volume = 174 | issue = 4 | pages = 249-56 | month = Dec | year = 1994 | doi = 10.1002/path.1711740404 | PMID = 7884586 }}</ref>). | |||
==See also== | ==See also== | ||