Difference between revisions of "Lung tumours"

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Lung tumours (view source)

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An introduction to lung pathology is found in the ''[[pulmonary pathology]]'' article.
An introduction to lung pathology is found in the ''[[pulmonary pathology]]'' article.


==Lung tumours overview==
=Lung tumours overview=
===Schematic overview of lung cancer (clinical)===
===Schematic overview of lung cancer (clinical)===
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**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 metastatic lung adenocarcinoma (WC)].


==Neuroendocrine tumours==
===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>
*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>
===Classification===
The grouping can be divided into four types:<ref name=cancerorg_car>URL: [http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_lung_carcinoid_tumor_56.asp http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_lung_carcinoid_tumor_56.asp]. Accessed on: 16 February 2011.</ref>
*Small cell carcinoma.
*Large cell neuroendocrine carcinoma.
*Typical carcinoid.
*Atypical carcinoid.
===Cytologic features===
Cytologic features useful for differentiation:
*Small cell carcinoma: necrosis, scant cytoplasm, mitoses.
*Typical carcinoid: often more cytoplasm, no necrosis, low mitotic rate (MIB-1: scant staining).
*Atypical carcinoid: higher mitotic rate/MIB-1 than ''typical carcinoid'',<ref>WG. February 2010.</ref> no necrosis.
Notes:<ref name=cancerorg_car/>
*''Large cell'' and ''small cell'' tumours behave in a similar fashion; ''large cell'' can be considered a morphological variant of ''small cell''.
*9/10 of carcinoids are ''typical'' and usually have a good prognosis, i.e. do not metastasize.
**Central location (vis-a-vis peripheral location) tends favours ''typical carcinoid'' over ''atypical carcinoid''.
=Specific types=
==Lung adenocarcinoma==
==Lung adenocarcinoma==
===General===
===General===
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#*Subtypes: micropapillary, mucinous (previously ''mucinous BAC'', colloid, fetal, enteric.
#*Subtypes: micropapillary, mucinous (previously ''mucinous BAC'', colloid, fetal, enteric.


==Neuroendocrine tumours==
==Typical carcinoid lung tumour==
===Overview===
*[[AKA]] ''carcinoid of the lung''.
*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>
===General===
*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>
*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>


===Classification===
===Microscopic===
The grouping can be divided into four types:<ref name=cancerorg_car>URL: [http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_lung_carcinoid_tumor_56.asp http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_lung_carcinoid_tumor_56.asp]. Accessed on: 16 February 2011.</ref>
Features:
*Small cell carcinoma.
*Nests of cells.
*Large cell neuroendocrine carcinoma.  
**Stippled chromatin.
*Typical carcinoid.
**Moderate cytoplasm.
*Atypical carcinoid.
*No necrosis.
*Low mitotic rate.


===Cytologic features===
===IHC===
Cytologic features useful for differentiation:
MIB-1 scant staining.  
*Small cell carcinoma: necrosis, scant cytoplasm, mitoses.
*Typical carcinoid: often more cytoplasm, no necrosis, low mitotic rate (MIB-1: scant staining).
*Atypical carcinoid: higher mitotic rate/MIB-1 than ''typical carcinoid'',<ref>WG. February 2010.</ref> no necrosis.
 
Notes:<ref name=cancerorg_car/>
*''Large cell'' and ''small cell'' tumours behave in a similar fashion; ''large cell'' can be considered a morphological variant of ''small cell''.
*9/10 of carcinoids are ''typical'' and usually have a good prognosis, i.e. do not metastasize.
**Central location (vis-a-vis peripheral location) tends favours ''typical carcinoid'' over ''atypical carcinoid''.


==Malignant mesothelioma==
==Malignant mesothelioma==
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