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Difference between revisions of "Lung tumours"
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neuroendocrine, adenoca
(neuroendocrine, adenoca) |
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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)]. | ||
== | ==Primary adenocarcinoma== | ||
=== | ===General=== | ||
Treatment: | |||
*Lung adenocarcinoma may be treated with EGFR inhibitors (e.g. gefitinib (Iressa), erlotinib (Tarceva)).<ref>{{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> | *Lung adenocarcinoma may be treated with EGFR inhibitors (e.g. gefitinib (Iressa), erlotinib (Tarceva)).<ref>{{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> | ||
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*Female. | *Female. | ||
*Asian. (???) | *Asian. (???) | ||
===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. | |||
====Classification==== | |||
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). | |||
*Minimally invasive adenocarcinoma (MIA). | |||
**Have lepidic growth (AIS), upto 5 mm of invasion. | |||
**Usually nonmucinous. | |||
Subtypes of invasive adenocarcinoma: | |||
*Micropapillary | |||
*Mucinous. | |||
*Colloid. | |||
*Fetal. | |||
*Enteric. | |||
==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''. | |||
==Mesothelioma== | ==Mesothelioma== | ||