Lung tumor: Difference between revisions

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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 signifcance: {{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>]]
[[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==
{{NSCLC molecular workup}}
{{NSCLC molecular workup}}
{{Bottom}}
{{Bottom}}

Latest revision as of 21:58, 4 June 2024

Author: Mikael Häggström [note 1]

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Presentations

Gross processing

As per presentation above.

Microscopic evaluation

Lung cancers by relative incidence.

Medical imaging provides a major clue as to whether a lung tumor is benign or malignant, where lesions smaller than 2 cm are likely to be benign, whereas lesions larger than 2 cm are malignant (that is, lung cancer) in 85% of cases.[1]

Benign tumors

Subsequently distribution of benign tumors and lung cancers, respectively, are as follows:[1]

Minute pulmonary meningothelial-like nodules (MPMNs) are interstitial nodular proliferations of small oval or spindle-shape cells in nests,[2] and do not need reporting.[image 1]

Benign lung tumors:

  • Hamartomas - 76%
  • Benign fibrous mesothelioma/solitary fibrous tumor (SFT) - 12.3%
  • Inflammatory pseudotumor (IPT) - 5.4%
  • Lipoma - 1.5%
  • Leiomyoma - 1.5%
  • Other - 3.3%

Lung cancers

  • Lung adenocarcinoma, with lepidic pattern shown, wherein tumors cells cover alveolar walls.
    Lung adenocarcinoma, with lepidic pattern shown, wherein tumors cells cover alveolar walls.
  • Lung adenocarcinoma, with solid pattern.
    Lung adenocarcinoma, with solid pattern.
  • Large cell carcinoma of the lung: neoplastic cells with abundant pale eosinophilic cytoplasm.
    Large cell carcinoma of the lung: neoplastic cells with abundant pale eosinophilic cytoplasm.
  • Squamous-cell carcinoma (SCC) of the lung. Typical squamous-cell carcinoma cells are large with abundant eosinophilic cytoplasm and large, often vesicular, nuclei.[3]
    Squamous-cell carcinoma (SCC) of the lung. Typical squamous-cell carcinoma cells are large with abundant eosinophilic cytoplasm and large, often vesicular, nuclei.[3]
  • Small-cell carcinoma, with typical findings.[4]
    Small-cell carcinoma, with typical findings.[4]
TTF-1 needs to have nuclear staining on immunohistochemistry to count as positive. Cytoplasmic staining is disregarded for diagnostic purposes.[5]

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.[6][7]

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.[8]

Further workup

edit
For primary lung non-small cell carcinoma (NSCLC) stages IB - IV (such as being more than 3 cm in size), generally perform full next generation sequencing panel (DNA and RNA) with PDL-1 immunostaining. For an advanced stage NSCLC that is not a candidate for biopsy or re-biopsy, a viable alternative is “liquid biopsy” on peripheral blood for circulating tumor DNA.[9]

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ 1.0 1.1 Alain C. Borczuk (2008). "Benign Tumors and Tumorlike Conditions of the Lung ". Archives of Pathology & Laboratory Medicine 132 (7). Archived from the original. . 
  2. ↑ Kuroki, Masaomi; Nakata, Hiroshi; Masuda, Toshifumi; Hashiguchi, Norihisa; Tamura, Shozo; Nabeshima, Kazuki; Matsuzaki, Yasunori; Onitsuka, Toshio (2002). "Minute Pulmonary Meningothelial-like Nodules: High-Resolution Computed Tomography and Pathologic Correlations ". Journal of Thoracic Imaging 17 (3): 227–229. doi:10.1097/00005382-200207000-00008. ISSN 0883-5993. 
  3. ↑ Dr Nicholas Turnbull, A/Prof Patrick Emanual (2014-05-03). Squamous cell carcinoma pathology. DermNetz.
  4. ↑ Image by Mikael Häggström, MD. Source for findings: Caroline I.M. Underwood, M.D., Carolyn Glass, M.D., Ph.D.. Lung - Small cell carcinoma. Pathology Outlines. Last author update: 20 September 2022}}
  5. ↑ Image by Mikael Häggström, MD. Source for significance: Bejarano PA, Mousavi F (2003). "Incidence and significance of cytoplasmic thyroid transcription factor-1 immunoreactivity. ". Arch Pathol Lab Med 127 (2): 193-5. doi:10.5858/2003-127-193-IASOCT. PMID 12562233. Archived from the original. . 
  6. ↑ Inamura K (2018). "Update on Immunohistochemistry for the Diagnosis of Lung Cancer. ". Cancers (Basel) 10 (3). doi:10.3390/cancers10030072. PMID 29538329. PMC: 5876647. Archived from the original. . 
  7. ↑ Affandi KA, Tizen NMS, Mustangin M, Zin RRMRM (2018). "p40 Immunohistochemistry Is an Excellent Marker in Primary Lung Squamous Cell Carcinoma. ". J Pathol Transl Med 52 (5): 283-289. doi:10.4132/jptm.2018.08.14. PMID 30235512. PMC: 6166010. Archived from the original. . 
  8. ↑ Malmros K, Lindholm A, Vidarsdottir H, Jirström K, Nodin B, Botling J (2023). "Diagnostic gastrointestinal markers in primary lung cancer and pulmonary metastases. ". Virchows Arch. doi:10.1007/s00428-023-03583-w. PMID 37349623. Archived from the original. . 
  9. ↑ . National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines) - Non-Small Cell Lung Cancer. Version 3.2024. Section: Principles of molecular and biomarker analysis (2024-03-12).

Image sources

  1. ↑ Image(s) by: Mikael Häggström, M.D. Public Domain
    - Author info
    - Reusing images
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