Difference between revisions of "Lung tumours"

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*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===
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===Small cell carcinoma===
===Small cell carcinoma===
*TTF-1 +ve.
*[[TTF-1]] +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>
*[[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.
*[[CK7]] -ve, [[CK20]] -ve.
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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.
*[[p40]] +ve.


===Primary vs. secondary===
===Primary vs. secondary===
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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==
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{{Main|Malignant mesothelioma}}
{{Main|Malignant mesothelioma}}


==Poorly differentiated carcinoma==
==Non-small cell lung carcinoma==
===General===
*[[AKA]] ''poorly differentiated carcinoma of the lung''.
*Should be used when the DDx is ''small cell carcinoma'' versus ''non-small cell carcinoma''.
{{Main|Non-small cell lung carcinoma}}
*''Poorly differentiated carcinoma'' leaves the surgical options on the table.
 
===IHC===
*Lack of staining with [[neuroendocrine markers]] (chromogranin A -ve, synaptophysin -ve, CD56 -ve).
*Keratins +ve.
 
===Sign out===
<pre>
Lung, Left Lower Lobe, Core Biopsy:
- POORLY DIFFERENTIATED CARCINOMA, see comment.
 
COMMENT:
The tumour stains as follows:
POSITIVE: EMA, AE1/AE3.
NEGATIVE: TTF-1, chromogranin A, synaptophysin, CD56, CD45.
 
The morphology would be compatible with small cell carcinoma or basaloid
squamous cell carcinoma. 


The neuroendocrine markers (chromogranin A, synaptophysin, CD56) and the squamoid
==Adenosquamous carcinoma of the lung==
markers available (p63, CK5/6) are negative; thus, the tumour is not further classified.
{{Main|Adenosquamous carcinoma of the lung}}
</pre>


==Lung metastasis==
==Lung metastasis==
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==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===
*Ki-67 ~17% (range 10-26%).<ref name=pmid25318848>{{Cite journal  | last1 = Liu | first1 = SZ. | last2 = Staats | first2 = PN. | last3 = Goicochea | first3 = L. | last4 = Alexiev | first4 = BA. | last5 = Shah | first5 = N. | last6 = Dixon | first6 = R. | last7 = Burke | first7 = AP. | title = Automated quantification of Ki-67 proliferative index of excised neuroendocrine tumors of the lung. | journal = Diagn Pathol | volume = 9 | issue =  | pages = 174 | month =  | year = 2014 | doi = 10.1186/s13000-014-0174-z | PMID = 25318848 }}</ref>
 
Note:
*[[Typical lung carcinoid tumour|Typical carcinoid]] is considerably lower ~2% (range 0-7%) and large cell neuroendocrine considerable higher ~81% (range 63-92%).<ref name=pmid25318848/>


==Solitary fibrous tumour of the pleura==
==Solitary fibrous tumour of the pleura==
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=Benign tumours=
=Benign tumours=
==Pulmonary apical cap==
{{Main|Pulmonary apical cap}}
A lesion that can mimic a lung neoplasm.
==Pulmonary carcinoid tumourlet==
==Pulmonary carcinoid tumourlet==
*[[AKA]] ''carcinoid tumourlet''.
*[[AKA]] ''carcinoid tumourlet''.
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*[[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=
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