Difference between revisions of "Lung tumours"

Jump to navigation Jump to search

Lung tumours (view source)

Revision as of 23:44, 17 March 2019

11,728 bytes removed ,  23:44, 17 March 2019
→‎Epidemiology
 
(98 intermediate revisions by 3 users not shown)
Line 1: Line 1:
'''Lung tumours''' comes to pathology to get diagnosed.  This article basically deals with core biopsies.  Pulmonary cytopathology is dealt with in the ''[[pulmonary cytopathology]]'' article.
[[Image:Small cell carcinoma (3931938372).jpg|right|thumb|300px|A lung tumour ([[small cell carcinoma of the lung]]) - centre of image. (WC/Rosen)]]
'''[[Lung]] tumours''' comes to pathology to get diagnosed.   
 
This article deals with the surgical pathology (core biopsies, lung resections).  Pulmonary cytopathology is dealt with in the ''[[pulmonary cytopathology]]'' article.


An introduction to lung pathology is found in the ''[[pulmonary pathology]]'' article.
An introduction to lung pathology is found in the ''[[pulmonary pathology]]'' article.
Line 43: Line 46:
*Adenocarcinoma is the most common (primary lung cancer).<ref>{{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>{{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 - SCLC and squamous are more strongly associated with [[smoking]].
*Adenocarcinoma is the non-smoker tumour - SCLC and squamous are more strongly associated with [[smoking]].
Children:
*Most common lung tumour in children: metastasis (80-85% of lung tumours in children<ref name=pmid>{{Cite journal  | last1 = Dishop | first1 = MK. | last2 = Kuruvilla | first2 = S. | title = Primary and metastatic lung tumors in the pediatric population: a review and 25-year experience at a large children's hospital. | journal = Arch Pathol Lab Med | volume = 132 | issue = 7 | pages = 1079-103 | month = Jul | year = 2008 | doi = 10.1043/1543-2165(2008)132[1079:PAMLTI]2.0.CO;2 | PMID = 18605764 }}</ref>
**Most common primary tumours in children: [[inflammatory myofibroblastic tumour]], [[pleuropulmonary blastoma]], [[lung carcinoid]].<ref name=pmid26971789>{{Cite journal  | last1 = Giuseppucci | first1 = C. | last2 = Reusmann | first2 = A. | last3 = Giubergia | first3 = V. | last4 = Barrias | first4 = C. | last5 = Krüger | first5 = A. | last6 = Siminovich | first6 = M. | last7 = Botto | first7 = H. | last8 = Cadario | first8 = M. | last9 = Boglione | first9 = M. | title = Primary lung tumors in children: 24 years of experience at a referral center. | journal = Pediatr Surg Int | volume = 32 | issue = 5 | pages = 451-7 | month = May | year = 2016 | doi = 10.1007/s00383-016-3884-3 | PMID = 26971789 }}</ref>


===Distribution===
===Distribution===
Line 48: Line 55:
**Adenocarcinoma is usually periperal, i.e. smaller airways.
**Adenocarcinoma is usually periperal, i.e. smaller airways.
**Squamous cell carcinoma and small cell carcinoma are typically central.
**Squamous cell carcinoma and small cell carcinoma are typically central.
===Margins in lung===
Margin in pneumonectomy specimens include:
*Vessels (artery, vein).
*Airway (bronchus).
*Soft tissue (lymphatics, fibrous tissue and lymph nodes).<ref name=pmid21129810>{{Cite journal  | last1 = Sakai | first1 = Y. | last2 = Ohbayashi | first2 = C. | last3 = Kanomata | first3 = N. | last4 = Kajimoto | first4 = K. | last5 = Sakuma | first5 = T. | last6 = Maniwa | first6 = Y. | last7 = Nishio | first7 = W. | last8 = Tauchi | first8 = S. | last9 = Uchino | first9 = K. | title = Significance of microscopic invasion into hilar peribronchovascular soft tissue in resection specimens of primary non-small cell lung cancer. | journal = Lung Cancer | volume = 73 | issue = 1 | pages = 89-95 | month = Jul | year = 2011 | doi = 10.1016/j.lungcan.2010.11.002 | PMID = 21129810 }}</ref>
Notes:
*The traditional teaching is there are only hollow structure margins (artery, vein, airway) - yet the bronchial margin has been divided into mucosal and extramucosal.<ref>{{Cite journal  | last1 = Kaiser | first1 = LR. | last2 = Fleshner | first2 = P. | last3 = Keller | first3 = S. | last4 = Martini | first4 = N. | title = Significance of extramucosal residual tumor at the bronchial resection margin. | journal = Ann Thorac Surg | volume = 47 | issue = 2 | pages = 265-9 | month = Feb | year = 1989 | doi =  | PMID = 2537610 }}</ref>
*Peribronchovascular soft tissue involvement is a poor prognosticator but not an independent predictor if considered within the [[TNM staging]].<ref name=pmid21129810/>


===Management of primary lung cancer===
===Management of primary lung cancer===
Management is currently determined by categorization into:
Management in the past was determined by categorization into:
*Small cell cancer.
*Small cell cancer.
*Non-small cell cancer (includes adenocarcinoma, squamous cell carcinoma, large cell carcinoma).
*Non-small cell cancer (includes adenocarcinoma, squamous cell carcinoma, large cell carcinoma).
Line 74: Line 91:


===Small cell carcinoma===
===Small cell carcinoma===
*CD56 +ve - sensitive.<ref name=pmid16862075>{{cite journal |author=Hiroshima K, Iyoda A, Shida T, ''et al'' |title=Distinction of pulmonary large cell neuroendocrine carcinoma from small cell lung carcinoma: a morphological, immunohistochemical, and molecular analysis |journal=Mod. Pathol. |volume=19 |issue=10 |pages=1358-68 |year=2006 |month=October |pmid=16862075 |doi=10.1038/modpathol.3800659 |url=}}</ref>
*[[TTF-1]] +ve.
*CK7 -ve, CK20 -ve.
*[[CD56]] +ve - sensitive.<ref name=pmid16862075>{{cite journal |author=Hiroshima K, Iyoda A, Shida T, ''et al'' |title=Distinction of pulmonary large cell neuroendocrine carcinoma from small cell lung carcinoma: a morphological, immunohistochemical, and molecular analysis |journal=Mod. Pathol. |volume=19 |issue=10 |pages=1358-68 |year=2006 |month=October |pmid=16862075 |doi=10.1038/modpathol.3800659 |url=}}</ref>
*[[CK7]] -ve, [[CK20]] -ve.


Note:
Note:
*CD56 - cytoplasmic.<ref>URL: [http://jcp.bmjjournals.com/content/58/9/978.full http://jcp.bmjjournals.com/content/58/9/978.full]. Accessed: 11 February 2010.</ref>
*CD56 - cytoplasmic.<ref>URL: [http://jcp.bmjjournals.com/content/58/9/978.full http://jcp.bmjjournals.com/content/58/9/978.full]. Accessed: 11 February 2010.</ref>
===Adenocarcinoma===
*[[TTF-1]] +ve.
*[[Napsin]] +ve - sensitive.<ref name=pmid22288963>{{cite journal |author=Turner BM, Cagle PT,Fukuoka J, ''et al'' |title=Napsin A, a New Marker for Lung Adenocarcinoma, Is Complementary and More Sensitive and Specific Than Thyroid Transcription Factor 1 in the Differential Diagnosis of Primary Pulmonary Carcinoma: Evaluation of 1674 Cases by Tissue Microarray |journal=Arch Pathol Lab Med. |volume=136 |issue=10 |pages=163-71 |year=2012 |month=February|pmid=22288963 |doi: 10.5858/arpa.2011-0320-OA|url=}}</ref>
*[[CK7]] +ve, [[CK20]] -ve.
===Squamous cell carcinoma===
===Squamous cell carcinoma===
*CK7 -ve, CK20 -ve.
*[[CK7]] -ve, CK20 -ve.
*HMWK +ve.
*HMWK +ve.
*Usually TTF-1 -ve.<ref>{{cite journal |author=Al-Zahrani IH |title=The value of immunohistochemical expression of TTF-1, CK7 and CK20 in the diagnosis of primary and secondary lung carcinomas |journal=Saudi Med J |volume=29 |issue=7 |pages=957-61 |year=2008 |month=July |pmid=18626520 |doi= |url=}}</ref>
*Usually TTF-1 -ve.<ref>{{cite journal |author=Al-Zahrani IH |title=The value of immunohistochemical expression of TTF-1, CK7 and CK20 in the diagnosis of primary and secondary lung carcinomas |journal=Saudi Med J |volume=29 |issue=7 |pages=957-61 |year=2008 |month=July |pmid=18626520 |doi= |url=}}</ref>
*[[p40]] +ve.


===Primary vs. secondary===
===Primary vs. secondary===
Line 94: Line 119:
Note:
Note:
*TTF-1 - should be nuclear staining; cytoplasmic staining is non-specific.<ref name=pmid15861215>{{cite journal |author=Compérat E, Zhang F, Perrotin C, ''et al.'' |title=Variable sensitivity and specificity of TTF-1 antibodies in lung metastatic adenocarcinoma of colorectal origin |journal=Mod. Pathol. |volume=18 |issue=10 |pages=1371–6 |year=2005 |month=October |pmid=15861215 |doi=10.1038/modpathol.3800422 |url=http://www.nature.com/modpathol/journal/v18/n10/full/3800422a.html}}</ref>
*TTF-1 - should be nuclear staining; cytoplasmic staining is non-specific.<ref name=pmid15861215>{{cite journal |author=Compérat E, Zhang F, Perrotin C, ''et al.'' |title=Variable sensitivity and specificity of TTF-1 antibodies in lung metastatic adenocarcinoma of colorectal origin |journal=Mod. Pathol. |volume=18 |issue=10 |pages=1371–6 |year=2005 |month=October |pmid=15861215 |doi=10.1038/modpathol.3800422 |url=http://www.nature.com/modpathol/journal/v18/n10/full/3800422a.html}}</ref>
**Image: [http://commons.wikimedia.org/w/index.php?title=File:Lung_adenocarcinoma_-_TTF-1_-_high_mag.jpg Nuclear staining with TTF-1 in a metastatic lung adenocarcinoma (WC)].
**Image: [http://commons.wikimedia.org/w/index.php?title=File:Lung_adenocarcinoma_-_TTF-1_-_high_mag.jpg Nuclear staining with TTF-1 in a primary lung adenocarcinoma (WC)].


==Neuroendocrine tumours==
==Neuroendocrine tumours==
Line 100: Line 125:
===Overview===
===Overview===
*This is a group of tumours that has benign (e.g. [[carcinoid]] tumour of the lung) to malignant (e.g. small cell lung carcinoma) behaviour.<ref>URL: [http://emedicine.medscape.com/article/426400-overview http://emedicine.medscape.com/article/426400-overview]. Accessed on: 20 January 2010.</ref>
*This is a group of tumours that has benign (e.g. [[carcinoid]] tumour of the lung) to malignant (e.g. small cell lung carcinoma) behaviour.<ref>URL: [http://emedicine.medscape.com/article/426400-overview http://emedicine.medscape.com/article/426400-overview]. Accessed on: 20 January 2010.</ref>
*They are thought to arise from [[pulmonary neuroendocrine cell]]s.<ref>{{cite journal |author=Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS |title=Neuroendocrine tumors of the lung: clinical, pathologic, and imaging findings |journal=Radiographics |volume=26 |issue=1 |pages=41–57; discussion 57–8 |year=2006 |pmid=16418242 |doi=10.1148/rg.261055057 |url=}}</ref>
*They are thought to arise from ''pulmonary neuroendocrine cells''.<ref>{{cite journal |author=Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS |title=Neuroendocrine tumors of the lung: clinical, pathologic, and imaging findings |journal=Radiographics |volume=26 |issue=1 |pages=41–57; discussion 57–8 |year=2006 |pmid=16418242 |doi=10.1148/rg.261055057 |url=}}</ref>


===Classification===
===Classification===
Line 108: Line 133:
*Typical carcinoid.
*Typical carcinoid.
*Atypical carcinoid.
*Atypical carcinoid.
Notes:
*[[Typical carcinoid]]-like lesions <5 mm are called [[carcinoid tumourlet]]s.


===Cytologic features===
===Cytologic features===
Cytologic features useful for differentiation:
Cytologic features useful for differentiation:
*Small cell carcinoma: necrosis, scant cytoplasm, mitoses.
*Small cell carcinoma: necrosis, scant cytoplasm, mitoses.
*Typical carcinoid: often more cytoplasm, no necrosis, low mitotic rate (MIB-1: scant staining).
*Typical carcinoid: often more cytoplasm, no necrosis, low mitotic rate (MIB1: scant staining).
*Atypical carcinoid: higher mitotic rate/MIB-1 than ''typical carcinoid'',<ref>WG. February 2010.</ref> no necrosis.
*Atypical carcinoid: higher mitotic rate/MIB1 than ''typical carcinoid'',<ref>Geddie, W. February 2010.</ref> no [[necrosis]].


Notes:<ref name=cancerorg_car/>
Notes:<ref name=cancerorg_car/>
Line 122: Line 150:
=Malignant tumours=
=Malignant tumours=
==Adenocarcinoma of the lung==
==Adenocarcinoma of the lung==
*AKA ''lung adenocarcinoma''.
*[[AKA]] ''lung adenocarcinoma''.
===General===
{{Main|Adenocarcinoma of the lung}}
Treatment:
*Lung adenocarcinoma may be treated with [[EGFR inhibitors]] (e.g. gefitinib (Iressa), erlotinib (Tarceva)).<ref name=pmid20855837>{{cite journal |author=Sun Y, Ren Y, Fang Z, ''et al.'' |title=Lung adenocarcinoma from East Asian never-smokers is a disease largely defined by targetable oncogenic mutant kinases |journal=J. Clin. Oncol. |volume=28 |issue=30 |pages=4616–20 |year=2010 |month=October |pmid=20855837 |doi=10.1200/JCO.2010.29.6038 |url=}}</ref>
 
Patients that receive EGFR inhibitors classically are:<ref name=pmid21151896>{{cite journal |author=Job B, Bernheim A, Beau-Faller M, ''et al.'' |title=Genomic Aberrations in Lung Adenocarcinoma in Never Smokers |journal=PLoS One |volume=5 |issue=12 |pages=e15145 |year=2010 |pmid=21151896 |pmc=2997777 |doi=10.1371/journal.pone.0015145 |url=}}</ref>
*Non-smokers.
*Female.
*Asian.
**Caucasians also benefit.<ref name=pmid20973798>{{Cite journal  | last1 = Rosell | first1 = R. | last2 = Moran | first2 = T. | last3 = Cardenal | first3 = F. | last4 = Porta | first4 = R. | last5 = Viteri | first5 = S. | last6 = Molina | first6 = MA. | last7 = Benlloch | first7 = S. | last8 = Taron | first8 = M. | title = Predictive biomarkers in the management of EGFR mutant lung cancer. | journal = Ann N Y Acad Sci | volume = 1210 | issue =  | pages = 45-52 | month = Oct | year = 2010 | doi = 10.1111/j.1749-6632.2010.05775.x | PMID = 20973798 }}</ref>
 
===Microscopic===
Features:
*Nuclear atypia.
*Eccentrically placed nuclei.
*Abundant cytoplasm - classically with mucin vacuoles.
 
Negatives:
*Lack of intercellular bridges.
 
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.
*Acinar.
*Papillary.
*Solid.
 
DDx:
*[[Metastasis|Metastatic]] adenocarcinoma.
 
====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]].
#*Subtypes: nonmucinous, mucinous, mixed mucinous/nonmucinous.
#Minimally invasive adenocarcinoma (MIA).
#*Lepidic growth with upto 5 mm of invasion.
#*Subtypes: nonmucinous (most common), mucinous, mixed mucinous/nonmucinous.
#Invasive adenocarcinoma:
#*Subtypes: micropapillary, mucinous (previously ''mucinous BAC''), colloid, fetal, enteric.
 
===IHC===
*CK7 +ve.
*TTF-1 +ve.
*CK20 -ve.
 
===Molecular===
*EGFR mutations (typically assessed by PCR) - respond to [[TKI]]s (e.g. [[gefitinib]], [[erlotinib]]) if:<ref name=pmid19680292>{{Cite journal  | last1 = John | first1 = T. | last2 = Liu | first2 = G. | last3 = Tsao | first3 = MS. | title = Overview of molecular testing in non-small-cell lung cancer: mutational analysis, gene copy number, protein expression and other biomarkers of EGFR for the prediction of response to tyrosine kinase inhibitors. | journal = Oncogene | volume = 28 Suppl 1 | issue =  | pages = S14-23 | month = Aug | year = 2009 | doi = 10.1038/onc.2009.197 | PMID = 19680292 }}</ref>
**Exon 19 deletion.
**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>
**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>
**Associated with a poor prognosis.<ref>{{Cite journal  | last1 = Yang | first1 = P. | last2 = Kulig | first2 = K. | last3 = Boland | first3 = JM. | last4 = Erickson-Johnson | first4 = MR. | last5 = Oliveira | first5 = AM. | last6 = Wampfler | first6 = J. | last7 = Jatoi | first7 = A. | last8 = Deschamps | first8 = C. | last9 = Marks | first9 = R. | title = Worse disease-free survival in never-smokers with ALK+ lung adenocarcinoma. | journal = J Thorac Oncol | volume = 7 | issue = 1 | pages = 90-7 | month = Jan | year = 2012 | doi = 10.1097/JTO.0b013e31823c5c32 | PMID = 22134072 }}</ref>
**Amenable to treatment with TKI.


==Bronchioloalveolar carcinoma==
==Bronchioloalveolar carcinoma==
Line 182: Line 159:


==Squamous cell carcinoma of the lung==
==Squamous cell carcinoma of the lung==
===General===
{{Main|Squamous cell carcinoma of the lung}}
*Strong association with smoking.
*May be treated with surgery.
 
===Microscopic===
Features:
*Central nucleus.
*Dense appearing cytoplasm, usu. eosinophilic.
*+/-Small nucleolus.
 
DDx:
*Metastatic [[squamous cell carcinoma]].
*[[Adenocarcinoma of the lung]].


==Small cell carcinoma of the lung==
==Small cell carcinoma of the lung==
*[[AKA]] ''small cell lung carcinoma'', abbreviated ''SCLC''.<ref name=pmid20943645/>
*[[AKA]] ''small cell lung carcinoma'', abbreviated ''SCLC''.<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>
 
{{Main|Small cell carcinoma of the lung}}
===General===
*Strong association with smoking.
*Typically treated with chemotherapy.
*Poor prognosis.
 
On a spectrum of lesions (benign to malignant):<ref name=pmid20943645/>
*[[lung tumourlet|Tumourlet]].
*[[typical carcinoid|Carcinoid]].
*[[atypical carcinoid|Atypical carcinoid]].
*Small cell carinoma/large cell neuroendocrine carcinoma.
 
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>
 
===Microscopic===
Features:
*Stippled chromatin.
*High [[NC ratio]], scant basophilic cytoplasm.
*Typically small cells ~2x RBC diameter.
*+/-Nuclear moulding.
*Necrosis.
*Mitoses.
 
Notes:
*There should be no nucleolus.
 
DDx:
*Metastatic [[small cell carcinoma]].
*[[Lymphoma]].
*[[Atypical carcinoid]].
*Other [[small round blue cell tumours]].
*Large cell neuroendocrine carcinoma {LCNEC).
 
Images:
*[http://commons.wikimedia.org/wiki/File:Lung_small_cell_carcinoma_%282%29_by_core_needle_biopsy.jpg SCLC - low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Lung_small_cell_carcinoma_%281%29_by_core_needle_biopsy.jpg SCLC - high mag. (WC)].


==Malignant mesothelioma==
==Malignant mesothelioma==
:Should '''not''' be confused with ''[[benign multicystic mesothelioma]]'' and ''[[benign papillary mesothelioma]]''.
:Should '''not''' be confused with ''[[benign multicystic mesothelioma]]'' and ''[[benign papillary mesothelioma]]''.
*[[AKA]] ''mesothelioma''.
{{Main|Malignant mesothelioma}}
===General===
*Prognosis sucks.
 
Locations:
*Lung.
*Primary peritoneal.
 
Epidemiology:
*Strong association with asbestos exposure.
 
Conditions associated with asbestos exposure (mnemonic ''PALM''):<ref name=Ref_PCPBoD8_375>{{Ref PCPBoD8|375}}</ref>
*Pleural plaques.
*[[Asbestosis]].
*[[Lung carcinoma]].
*Malignant mesothelioma.


==Non-small cell lung carcinoma==
*[[AKA]] ''poorly differentiated carcinoma of the lung''.
{{Main|Non-small cell lung carcinoma}}


Possible association with asbestos exposure:
==Adenosquamous carcinoma of the lung==
*[[Gestational trophoblastic disease]].<ref name=pmid19900938>{{Cite journal  | last1 = Reid | first1 = A. | last2 = Heyworth | first2 = J. | last3 = de Klerk | first3 = N. | last4 = Musk | first4 = AW. | title = Asbestos exposure and gestational trophoblastic disease: a hypothesis. | journal = Cancer Epidemiol Biomarkers Prev | volume = 18 | issue = 11 | pages = 2895-8 | month = Nov | year = 2009 | doi = 10.1158/1055-9965.EPI-09-0731 | PMID = 19900938 }}</ref>
{{Main|Adenosquamous carcinoma of the lung}}


===Microscopic===
==Lung metastasis==
Features:<ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*[[AKA]] ''pulmonary metastasis''.
*Infiltrative atypical cells - '''key feature'''.
{{Main|Lung metastasis}}
**+/-Epithelioid cells - may be cytologically bland, i.e. benign appearing.
***Variable architecture: sheets, microglandular, tubulopapillary.
***+/-[[Psammoma bodies]].
**+/-Spindle cells.
*+/-''Ferruginous body'' - '''strongly supportive'''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/asbestos+body http://medical-dictionary.thefreedictionary.com/asbestos+body]. Accessed on: 4 November 2011.</ref>
** Looks like a (twirling) baton - segemented appearance, brown colour.
** Thin (asbestos) fiber in the core.
 
Note:
*''Asbestos body'' is not strictly speaking a synonym for ''ferruginous body''.
 
DDx:<ref name=pmid15559051>{{Cite journal  | last1 = Corson | first1 = JM. | title = Pathology of mesothelioma. | journal = Thorac Surg Clin | volume = 14 | issue = 4 | pages = 447-60 | month = Nov | year = 2004 | doi = 10.1016/j.thorsurg.2004.06.007 | PMID = 15559051 }}
</ref>
*[[Fibrosing pleuritis]].
*Mesothelial hyperplasia.
 
Image:
*[http://commons.wikimedia.org/wiki/File:Ferruginous_body.jpg Ferruginous body (WC)].
 
====Subtypes====
List of subtypes - mnemonic ''BEDS'':<ref name=pmid15559051/><ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Biphasic mesothelioma.
**10%+ of epithelioid & 10%+ sarcomatoid.
*Epithelioid mesothelioma.
*Desmoplastic mesothelioma.
**Should be 50%+ dense tissue with storiform pattern & atypical cells.
*Sarcomatoid mesothelioma.
 
===Stains===
*PASD -ve.
*Mucicarmine -ve.
**Typically +ve in adenocarcinoma.
 
===IHC===
====Mesothelioma versus mesothelial hyperplasia====
Features:<ref name=pmid20209622>{{Cite journal  | last1 = Hasteh | first1 = F. | last2 = Lin | first2 = GY. | last3 = Weidner | first3 = N. | last4 = Michael | first4 = CW. | title = The use of immunohistochemistry to distinguish reactive mesothelial cells from malignant mesothelioma in cytologic effusions. | journal = Cancer Cytopathol | volume = 118 | issue = 2 | pages = 90-6 | month = Apr | year = 2010 | doi = 10.1002/cncy.20071 | PMID = 20209622 }}</ref>
*EMA +ve ~100% (vs. ~10%).
*Desmin -ve ~5% (vs. ~85%).
*GLUT1 +ve ~50% (vs. ~10%)
*p53 +ve ~50% (vs. ~2%).
 
====Mesothelioma versus adenocarcinoma====
*Several panel exists - ''no agreed upon best panel''.<ref name=pmid18318582>{{cite journal |author=Marchevsky AM |title=Application of immunohistochemistry to the diagnosis of malignant mesothelioma |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=3 |pages=397-401 |year=2008 |month=March |pmid=18318582 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=132&page=397}}</ref>
**Usually two carcinoma markers + two mesothelial markers.
 
Panel:<ref name=pmid18318582/>
*Mesothelial markers:
**Calretinin.
**WT-1.
**D2-40.
**CK5/6.
*Carcinoma markers:
**CEA (monoclonal and polyclonal).
**TTF-1.
**Ber-EP4.
**MOC-31.


=Malignant potential=
=Malignant potential=
Line 323: Line 184:
*Abbreviated ''AAH''.
*Abbreviated ''AAH''.
*[[AKA]] ''atypical adenomatous hyperplasia of the lung''.<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>
*[[AKA]] ''atypical adenomatous hyperplasia of the lung''.<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>
 
{{Main|Atypical adenomatous hyperplasia of the lung}}
===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>
*Typically an incidental finding, i.e. asymptomatic.<ref name=Ref_WMSP114>{{Ref WMSP|114}}</ref>
 
===Microscopic===
Features:<ref name=Ref_WMSP114>{{Ref WMSP|114}}</ref>
*Enlarged alveolar lining cells with:
**Hobnail morphology - free (luminal) surface area > attached/basal surface area.
**Hyperchromasia.
*Limited extent:
**<5 mm. †
 
DDx:
*Adenocarcinoma in situ.
 
Note:
*  † [[Diagnostic size cutoff]].
 
Image:
*[http://www.nature.com/modpathol/journal/v20/n9/fig_tab/3800929f1.html#figure-title AAH (nature.com)].<ref name=pmid17618248/>


==Atypical carcinoid lung tumour==
==Atypical carcinoid lung tumour==
*[[AKA]] ''atypical carcinoid tumour of the lung''.
*[[AKA]] ''atypical carcinoid tumour of the lung''.
===General===
{{Main|Atypical lung carcinoid tumour}}
*Approximately 20% of lung carcinoids.<ref name=pmid20888248>{{Cite journal  | last1 = Naalsund | first1 = A. | last2 = Rostad | first2 = H. | last3 = Strøm | first3 = EH. | last4 = Lund | first4 = MB. | last5 = Strand | first5 = TE. | title = Carcinoid lung tumors--incidence, treatment and outcomes: a population-based study. | journal = Eur J Cardiothorac Surg | volume = 39 | issue = 4 | pages = 565-9 | month = Apr | year = 2011 | doi = 10.1016/j.ejcts.2010.08.036 | PMID = 20888248 }}</ref>
 
===Microscopic===
Features:<ref name=Ref_WMSP115>{{Ref WMSP|115}}</ref>
*Nests of cells.
**Stippled chromatin.
**Mild-to-moderate amount of cytoplasm.
*No necrosis/focal necrosis.
*Moderate mitotic rate (2-10/[[HPF]] - definition suffers from [[HPFitis]]).
 
DDx:
*[[Typical carcinoid lung tumour]].
*[[Small cell carcinoma of the lung]].
 
===IHC===
*MIB-1 moderate staining.


==Solitary fibrous tumour of the pleura==
==Solitary fibrous tumour of the pleura==
:See also: ''[[Solitary fibrous tumour]]''.
{{Main|Solitary fibrous tumour of the pleura}}
===General===
*Common.
*Benign.
*Elderly.


===Gross/radiology===
=Benign tumours=
*Chest wall.
==Pulmonary apical cap==
 
{{Main|Pulmonary apical cap}}
===Microscopic===
A lesion that can mimic a lung neoplasm.
Features:
*Spindle cells.
*Ropy collagen.
 
Image:
*[http://path.upmc.edu/cases/case216/dx.html SFT (upmc.edu)].
 
===IHC===
*CD34 +ve.


=Benign tumours=
==Pulmonary carcinoid tumourlet==
==Pulmonary carcinoid tumourlet==
*[[AKA]] ''carcinoid tumourlet''.
*[[AKA]] ''carcinoid tumourlet''.
===General===
{{Main|Pulmonary carcinoid tumourlet}}
*Neuroendocrine cell proliferation.<ref>{{Cite journal  | last1 = Bennett | first1 = GL. | last2 = Chew | first2 = FS. | title = Pulmonary carcinoid tumorlets. | journal = AJR Am J Roentgenol | volume = 162 | issue = 3 | pages = 568 | month = Mar | year = 1994 | doi =  | PMID = 8109497 | URL = http://www.ajronline.org/content/162/3/568.full.pdf }}</ref>
**Essentially a small [[typical carcinoid lung tumour|typical carcinoid]].
 
===Microscopic===
Features:
*Nests of cells - classic pattern.
**Salt and pepper chromatin - '''key feature'''.
*Size criterion: <= 4 mm.<ref name=pct_ucsf>URL: [http://pathhsw5m54.ucsf.edu/case7/image75.html http://pathhsw5m54.ucsf.edu/case7/image75.html]. Accessed on: 23 January 2012.</ref>
 
DDx:
*[[Typical carcinoid lung tumour]].
 
Images:
*[http://pathhsw5m54.ucsf.edu/case7/image75.html Tumourlets - several images (ucsf.edu)].


==Typical carcinoid lung tumour==
==Typical carcinoid lung tumour==
*[[AKA]] ''carcinoid tumour of the lung''.
*[[AKA]] ''carcinoid tumour of the lung''.
===General===
*[[AKA]] ''lung carcinoid''.
*Approximately 80% of lung carcinoids.<ref name=pmid20888248>{{Cite journal  | last1 = Naalsund | first1 = A. | last2 = Rostad | first2 = H. | last3 = Strøm | first3 = EH. | last4 = Lund | first4 = MB. | last5 = Strand | first5 = TE. | title = Carcinoid lung tumors--incidence, treatment and outcomes: a population-based study. | journal = Eur J Cardiothorac Surg | volume = 39 | issue = 4 | pages = 565-9 | month = Apr | year = 2011 | doi = 10.1016/j.ejcts.2010.08.036 | PMID = 20888248 }}</ref>
{{Main|Typical carcinoid lung tumour}}
 
===Microscopic===
Features:
*Nests of cells.
**Stippled chromatin.
**Moderate cytoplasm.
*No necrosis.
*Low mitotic rate.
*Size criterion: > 4 mm.<ref name=pct_ucsf>URL: [http://pathhsw5m54.ucsf.edu/case7/image75.html http://pathhsw5m54.ucsf.edu/case7/image75.html]. Accessed on: 23 January 2012.</ref>
 
DDx:
*[[Pulmonary carcinoid tumourlet]].
*[[Atypical carcinoid lung tumour]].
 
===IHC===
*MIB-1 scant staining.


==Clear cell sugar tumour of the lung==
==Clear cell sugar tumour of the lung==
*[[AKA]] ''clear cell sugar tumour''.
*[[AKA]] ''clear cell sugar tumour''.
**Abbreviated ''CCST''.
**Abbreviated ''CCST''.
===General===
{{Main|Clear cell sugar tumour of the lung}}
*A [[PEComa]].
*Benign.<ref name=pmid19119463>{{Cite journal  | last1 = Kim | first1 = WJ. | last2 = Kim | first2 = SR. | last3 = Choe | first3 = YH. | last4 = Lee | first4 = KY. | last5 = Park | first5 = SJ. | last6 = Lee | first6 = HB. | last7 = Chung | first7 = MJ. | last8 = Jin | first8 = GY. | last9 = Lee | first9 = YC. | title = Clear cell "sugar" tumor of the lung: a well-enhanced mass with an early washout pattern on dynamic contrast-enhanced computed tomography. | journal = J Korean Med Sci | volume = 23 | issue = 6 | pages = 1121-4 | month = Dec | year = 2008 | doi = 10.3346/jkms.2008.23.6.1121 | PMID = 19119463 | PMC = 2610653 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2610653/?tool=pubmed }}</ref>
 
===Microscopic===
Features:<ref name=pmid19119463/>
*Sheets or trabeculae.
*Irregular epithelioid cells with:
**Focally clear cytoplasm.
 
Images:
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802170404452 Clear cell sugar tumour of the lung (surgicalpathologyatlas.com)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2610653/figure/F3/ CCST (nih.gov)].<ref name=pmid19119463/>
 
===IHC===
*HMB-45 +ve (nuclear & cytoplasmic).


=See also=
=See also=
Line 452: Line 218:
*[[Basics]].
*[[Basics]].
*[[Heart]].
*[[Heart]].
*[[Missed endobronchial biopsy]].


=References=
=References=
Michael
48,466

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/15603...49844"

Navigation menu