Lung tumor: Difference between revisions

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Mikael Häggström (talk | contribs)
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<noinclude>{{Top
|author1=[[User:Mikael Häggström|Mikael Häggström]]
|author1=[[User:Mikael Häggström|Mikael Häggström]]
|author2=
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*'''[[Lung wedge resection or lobectomy]]'''
*'''[[Lung wedge resection or lobectomy]]'''
*'''[[Lung autopsy]]'''
*'''[[Lung autopsy]]'''
 
</noinclude>
==Gross processing==
==Gross processing==
As per presentation above.
As per presentation above.
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File:Large cell carcinoma of the lung .jpg|'''Large cell carcinoma''' of the lung: neoplastic cells with abundant pale eosinophilic cytoplasm.
File:Large cell carcinoma of the lung .jpg|'''Large cell carcinoma''' of the lung: neoplastic cells with abundant pale eosinophilic cytoplasm.
File:Histopathology of squamous-cell carcinoma of the lung.jpg|'''[[Squamous-cell carcinoma of the lung|Squamous-cell carcinoma (SCC) of the lung]]'''. Typical squamous-cell carcinoma cells are large with abundant eosinophilic cytoplasm and large, often vesicular, nuclei.<ref>{{cite web|url=https://dermnetnz.org/topics/squamous-cell-carcinoma-pathology/|title=Squamous cell carcinoma pathology|website=DermNetz|author=Dr Nicholas Turnbull, A/Prof Patrick Emanual|date=2014-05-03}}</ref>
File:Histopathology of squamous-cell carcinoma of the lung.jpg|'''[[Squamous-cell carcinoma of the lung|Squamous-cell carcinoma (SCC) of the lung]]'''. Typical squamous-cell carcinoma cells are large with abundant eosinophilic cytoplasm and large, often vesicular, nuclei.<ref>{{cite web|url=https://dermnetnz.org/topics/squamous-cell-carcinoma-pathology/|title=Squamous cell carcinoma pathology|website=DermNetz|author=Dr Nicholas Turnbull, A/Prof Patrick Emanual|date=2014-05-03}}</ref>
File:Histopathology of small cell carcinoma, annotated.png|'''Small-cell carcinoma''', with typical findings.<ref>Image by Mikael Häggström, MD. Source for findings: {{cite web|url=https://www.pathologyoutlines.com/topic/lungtumorsmallcell.html|title=Lung - Small cell carcinoma|website=Pathology Outlines|author=Caroline I.M. Underwood, M.D., Carolyn Glass, M.D., Ph.D.}} Last author update: 20 September 2022}}</ref>
</gallery>
</gallery>
[[File:Immunohistochemistry of adenocarcinoma with cytoplasmic versus nuclear staining for TTF-1.jpg|thumb|220px|TTF-1 needs to have nuclear staining on immunohistochemistry to count as positive. Cytoplasmic staining is disregarded for diagnostic purposes.<ref>Image by Mikael Häggström, MD. Source for significance: {{cite journal| author=Bejarano PA, Mousavi F| title=Incidence and significance of cytoplasmic thyroid transcription factor-1 immunoreactivity. | journal=Arch Pathol Lab Med | year= 2003 | volume= 127 | issue= 2 | pages= 193-5 | pmid=12562233 | doi=10.5858/2003-127-193-IASOCT | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12562233  }} </ref>]]


===Diagnostic immunohistochemistry===
Whereas large cell carcinoma is more often histologically distinct, adenocarcinoma and SCC may look alike. In such cases, an [[immunohistochemistry]] panel of TTF1, CK5/6, and p63 can be used to distinguish the two.<ref name="pmid29538329">{{cite journal| author=Inamura K| title=Update on Immunohistochemistry for the Diagnosis of Lung Cancer. | journal=Cancers (Basel) | year= 2018 | volume= 10 | issue= 3 | pages=  | pmid=29538329 | doi=10.3390/cancers10030072 | pmc=5876647 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29538329  }} </ref><ref name="pmid30235512">{{cite journal| author=Affandi KA, Tizen NMS, Mustangin M, Zin RRMRM| title=p40 Immunohistochemistry Is an Excellent Marker in Primary Lung Squamous Cell Carcinoma. | journal=J Pathol Transl Med | year= 2018 | volume= 52 | issue= 5 | pages= 283-289 | pmid=30235512 | doi=10.4132/jptm.2018.08.14 | pmc=6166010 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30235512  }} </ref>
Whereas large cell carcinoma is more often histologically distinct, adenocarcinoma and SCC may look alike. In such cases, an [[immunohistochemistry]] panel of TTF1, CK5/6, and p63 can be used to distinguish the two.<ref name="pmid29538329">{{cite journal| author=Inamura K| title=Update on Immunohistochemistry for the Diagnosis of Lung Cancer. | journal=Cancers (Basel) | year= 2018 | volume= 10 | issue= 3 | pages=  | pmid=29538329 | doi=10.3390/cancers10030072 | pmc=5876647 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29538329  }} </ref><ref name="pmid30235512">{{cite journal| author=Affandi KA, Tizen NMS, Mustangin M, Zin RRMRM| title=p40 Immunohistochemistry Is an Excellent Marker in Primary Lung Squamous Cell Carcinoma. | journal=J Pathol Transl Med | year= 2018 | volume= 52 | issue= 5 | pages= 283-289 | pmid=30235512 | doi=10.4132/jptm.2018.08.14 | pmc=6166010 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30235512  }} </ref>
In case of adenocarcinoma, in order to distinguish primary lung cancer from a gastrointestinal metastasis, the best panel, in addition to CK7 and TTF-1, may be CDX2 and/or GPA33 plus MUC2, or all of the following GI markers: CDH17, CDX2, CK20, GPA33, MUC2, and SATB2 with four positive GI markers supporting metastasis.<ref name="pmid37349623">{{cite journal| author=Malmros K, Lindholm A, Vidarsdottir H, Jirström K, Nodin B, Botling J | display-authors=etal| title=Diagnostic gastrointestinal markers in primary lung cancer and pulmonary metastases. | journal=Virchows Arch | year= 2023 | volume=  | issue=  | pages=  | pmid=37349623 | doi=10.1007/s00428-023-03583-w | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37349623  }} </ref>


==Further workup==
==Further workup==
For non-small cell carcinoma, the following algorithm can be applied:
{{NSCLC molecular workup}}
*Stages IB through IIIA: EGFR mutation analysis.
*Stages IIIB and IV: Full next generation sequencing panel (DNA and RNA) with PDL-1 immunostaining.
 
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