Difference between revisions of "Lung tumor"

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{{Top
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<noinclude>{{Top
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
|author2=
 
|author2=
 
}}
 
}}
  
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{{Comprehensiveness}}
 
==Presentations==
 
==Presentations==
 
*Bronchial lavage
 
*Bronchial lavage
 
*Lung needle biopsy
 
*Lung needle biopsy
*Tumor resection
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*'''[[Lung wedge resection or lobectomy]]'''
 
*'''[[Lung autopsy]]'''
 
*'''[[Lung autopsy]]'''
 
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</noinclude>
 
==Gross processing==
 
==Gross processing==
 
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As per presentation above.
In tumor resection and autopsy:
 
*Measure tumor size
 
*Determine location: Which lobe, and if it is peripheral, central or hilar.
 
*Margin length to pleura and hilum.
 
*Any involvement of major bronchi or blood vessels.
 
*Any abnormal hilar lymph nodes.
 
 
 
<gallery mode=packed heights=190>
 
File:Squamous cell carcinoma involving a subsegmental bronchus.jpg|'''Squamous cell carcinoma''' involving a subsegmental bronchus with distal chronic obstructive pneumonia. The tumor is seen as a rounded nodule, approximately 2 cm in diameter, proximal to a more irregular focus of chronic obstructive pneumonia with fibrosis.
 
[[File:Large cell carcinoma of the lung.jpg|thumb|'''Large cell carcinoma''', with a large multilobulated tumor adjacent to the hilum. A metastatically involved lymph node is present next to the bronchus.]]
 
</gallery>
 
  
 
==Microscopic evaluation==
 
==Microscopic evaluation==
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[[File:Pie chart of lung cancers.svg|thumb|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.<ref name=Borczuk2008>{{cite journal|author=Alain C. Borczuk|year=2008|title=Benign Tumors and Tumorlike Conditions of the Lung|journal=Archives of Pathology & Laboratory Medicine|volume=132|issue=7|url=https://www.archivesofpathology.org/doi/full/10.1043/1543-2165%282008%29132%5B1133%3ABTATCO%5D2.0.CO%3B2}}</ref>
 
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.<ref name=Borczuk2008>{{cite journal|author=Alain C. Borczuk|year=2008|title=Benign Tumors and Tumorlike Conditions of the Lung|journal=Archives of Pathology & Laboratory Medicine|volume=132|issue=7|url=https://www.archivesofpathology.org/doi/full/10.1043/1543-2165%282008%29132%5B1133%3ABTATCO%5D2.0.CO%3B2}}</ref>
  
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===Benign tumors===
 
Subsequently distribution of benign tumors and lung cancers, respectively, are as follows:<ref name=Borczuk2008/>
 
Subsequently distribution of benign tumors and lung cancers, respectively, are as follows:<ref name=Borczuk2008/>
[[File:Pie chart of lung cancers.svg|thumb|Lung cancers by relative incidence.]]
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[[File:Histopathology of a minute pulmonary meningothelial-like nodule (MPMN).jpg|thumb|'''Minute pulmonary meningothelial-like nodules''' (MPMNs) are interstitial nodular proliferations of small oval or spindle-shape cells in nests,<ref name="KurokiNakata2002">{{cite journal|last1=Kuroki|first1=Masaomi|last2=Nakata|first2=Hiroshi|last3=Masuda|first3=Toshifumi|last4=Hashiguchi|first4=Norihisa|last5=Tamura|first5=Shozo|last6=Nabeshima|first6=Kazuki|last7=Matsuzaki|first7=Yasunori|last8=Onitsuka|first8=Toshio|title=Minute Pulmonary Meningothelial-like Nodules: High-Resolution Computed Tomography and Pathologic Correlations|journal=Journal of Thoracic Imaging|volume=17|issue=3|year=2002|pages=227–229|issn=0883-5993|doi=10.1097/00005382-200207000-00008}}</ref> and do not need reporting.{{MH}}]]
 
Benign lung tumors:
 
Benign lung tumors:
 
*Hamartomas - 76%
 
*Hamartomas - 76%
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*Other - 3.3%
 
*Other - 3.3%
  
===Gallery of lung cancers===
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===Lung cancers===
 
<gallery mode=packed heights=190>
 
<gallery mode=packed heights=190>
File:Lung adenocarcinoma with lepidic growth - low magnification.jpg|'''Lung adenocarcinoma''', with lepidic pattern shown, wherein tumors cells cover alveolar walls.
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File:Lung adenocarcinoma with lepidic growth - low magnification.jpg|'''[[Lung adenocarcinoma]]''', with lepidic pattern shown, wherein tumors cells cover alveolar walls.
File:Large cell carcinoma of the lung .jpg|'''Large cell carcinoma''' of the lung: neoplastic cells with abundant pale eosinophilic cytoplasm
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File:Histopathology of lung adenocarcinoma with solid pattern.jpg|'''[[Lung adenocarcinoma]]''', with solid pattern.
File:Squamous Cell Carcinoma, Bronchial Washing, Pap Stain (8696879946).jpg|'''Squamous-cell carcinoma''' in a bronchial lavage, pap stain
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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.
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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>
 
</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>]]
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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>
  
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==Further workup==
 +
{{NSCLC molecular workup}}
 
{{Bottom}}
 
{{Bottom}}

Revision as of 18:16, 30 September 2022

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

TTF-1 needs to have nuclear staining on immunohistochemistry to count as positive. Cytoplasmic staining is disregarded for diagnostic purposes.[4]

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.[5][6]

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.[7]

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 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. . 
  5. 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. . 
  6. 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. . 
  7. . 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