Non-small cell lung carcinoma
|Non-small cell lung carcinoma|
|Diagnosis in short|
Non-small cell lung carcinoma. H&E stain.
|Synonyms||large cell carcinoma (term discouraged in the context of biopsies & FNAs)|
|Subtypes||NSCC favour adenocarcinoma, NSCC favour squamous cell carcinoma, NSCC-not otherwise specified|
|LM DDx||lung adenocarcinoma, lung squamous carcinoma, lung small cell carcinoma, poorly differentiated metastatic carcinoma, other poorly differentiated neoplasms|
|IHC||pankeratin +ve, CD56 -ve, chromogranin A -ve, synaptophysin -ve, TTF-1 +ve/-ve, p63 +ve/-ve|
|Staging||lung cancer staging|
|Site||lung - see lung tumours|
|Clinical history||no history of malignancy or no suspicion of recurrence|
|Radiology||not suggestive of metastatic disease|
|Clin. DDx||other lung tumours|
|Treatment||surgery if feasible|
In the clinical context, it is often referred to as non-small cell lung cancer; this ignores the fact that not all non-small cell lung cancer fits into the carcinoma category.
Poorly differentiated carcinoma of the lung, non-small cell carcinoma and poorly differentiated lung carcinoma redirect to this article.
- Non-small cell lung carcinoma can be considered a waffle diagnosis and as such its use should be limited.
- It is preferable to be more specific if this is possible, i.e. call adenocarcinoma or squamous cell carcinoma.
- Historically, it was sufficient to differentiate between small cell and non-small cell carcinomas, as the treatment for all non-small cell lung carcinomas was the same.
- Small cell carcinoma is typically considered non-surgical disease; thus, non-small cell carcinoma or poorly differentiated carcinoma, as a diagnosis, is less likely to exclude surgery as an option.
- Radiologic findings should not be suggestive of a metastasis.
- No history of malignancy or no suspicion of recurrence.
- Typically large cells with abundant cytoplasm.
- No stippled chromatin.
- Squamous cell carcinoma of the lung.
- Adenocarcinoma of the lung.
- Small cell carcinoma of the lung.
- Large cell variant of small cell carcinoma of the lung.
- Lung metastasis - imaging suggestive of a metastasis or a history of malignancy.
- Malignant melanoma.
- Other poorly differentiated neoplasms
- NSCC-NOS, NSCC favour adenocarcinoma, NSCC favour SCC are grade 4.
- In a large series of patients, there is no statistical difference in survival been grade 3 and grade 4.
- Lack of staining with neuroendocrine markers (chromogranin A -ve, synaptophysin -ve, CD56 -ve).
- Keratins +ve.
- If immunostains favour adenocarcinoma or squamous cell carcinoma, the case should be sign as favour adenocarcinoma or favour squamous cell carcinoma, see Sloan-Kettering algorithm below and Sign out section.
Adenocarcinoma versus squamous carcinoma
Memorial Sloan-Kettering algorithm - Rekhtman et al.:
|TTF-1\p63||p63 -ve (0% of cells)||p63 +ve <50% of cells||p63 +ve >=50% of cells|
|TTF-1 +ve >=50% of cells||Adenocarcinoma||Adenocarcinoma||Adenocarcinoma|
|TTF-1 +ve <50% of cells||Adenocarcinoma||Adenocarcinoma||Squamous carcinoma|
|TTF-1 -ve (0% of cells)||Adenocarcinoma||CK5/6 to determine||Squamous carcinoma|
International consensus terminology - Travis et al.:
|Non-small cell carcinoma, favour adenocarcinoma||TTF-1 or napsin +ve|
|Non-small cell carcinoma, favour squamous cell carcinoma||p40 or p63 +ve|
|Non-small cell carcinoma-not otherwise specified||-ve NE stains, -ve SCC stains, -ve adenoca stains|
Not otherwise specified
Lung, Left Lower Lobe, Core Biopsy: - NON-SMALL CELL CARCINOMA-NOT OTHERWISE SPECIFIED, see comment. COMMENT: The tumour stains as follows: POSITIVE: EMA, AE1/AE3. NEGATIVE: TTF-1, chromogranin A, synaptophysin, CD56, CD45, CK5/6, p63. The morphology would be compatible with small cell carcinoma or basaloid squamous cell carcinoma. The neuroendocrine markers (chromogranin A, synaptophysin, CD56) and the squamous markers (p63, CK5/6) are negative; thus, the tumour is not further classified.
Lung, Left Upper Lobe, Core Biopsy: - NON-SMALL CELL CARCINOMA, favour squamous cell carcinoma, see comment. Comment: The tumour stains as follows: POSITIVE: AE1/AE3, CK5/6, CK7. NEGATIVE: TTF-1, napsin A, p63, CDX2, CK20, S-100. EGFR/ALK testing has been ordered. The immunostains favour squamous cell carcinoma.
- Song, Z.; Lin, B.; Shao, L.; Zhang, Y. (Sep 2013). "Therapeutic efficacy of gefitinib and erlotinib in patients with advanced lung adenosquamous carcinoma.". J Chin Med Assoc 76 (9): 481-5. doi:10.1016/j.jcma.2013.05.007. PMID 23769878.
- Travis, WD.; Brambilla, E.; Noguchi, M.; Nicholson, AG.; Geisinger, K.; Yatabe, Y.; Ishikawa, Y.; Wistuba, I. et al. (May 2013). "Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification.". Arch Pathol Lab Med 137 (5): 668-84. doi:10.5858/arpa.2012-0263-RA. PMID 22970842.
- Sun, Z.; Aubry, MC.; Deschamps, C.; Marks, RS.; Okuno, SH.; Williams, BA.; Sugimura, H.; Pankratz, VS. et al. (May 2006). "Histologic grade is an independent prognostic factor for survival in non-small cell lung cancer: an analysis of 5018 hospital- and 712 population-based cases.". J Thorac Cardiovasc Surg 131 (5): 1014-20. doi:10.1016/j.jtcvs.2005.12.057. PMID 16678584.
- Rekhtman, N.; Ang, DC.; Sima, CS.; Travis, WD.; Moreira, AL. (Oct 2011). "Immunohistochemical algorithm for differentiation of lung adenocarcinoma and squamous cell carcinoma based on large series of whole-tissue sections with validation in small specimens.". Mod Pathol 24 (10): 1348-59. doi:10.1038/modpathol.2011.92. PMID 21623384.