Lung tumor: Difference between revisions
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{{Top | <noinclude>{{Top | ||
|author1=[[User:Mikael Häggström|Mikael Häggström]] | |author1=[[User:Mikael Häggström|Mikael Häggström]] | ||
|author2= | |author2= | ||
}} | }} | ||
{{Comprehensiveness}} | |||
==Presentations== | ==Presentations== | ||
*Bronchial lavage | *Bronchial lavage | ||
*Lung needle biopsy | *Lung needle biopsy | ||
* | *'''[[Lung wedge resection or lobectomy]]''' | ||
*'''[[Lung autopsy]]''' | *'''[[Lung autopsy]]''' | ||
</noinclude> | |||
==Gross processing== | ==Gross processing== | ||
As per presentation above. | |||
==Microscopic evaluation== | ==Microscopic evaluation== | ||
[[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> | ||
===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: | [[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% | ||
| Line 37: | Line 29: | ||
*Other - 3.3% | *Other - 3.3% | ||
=== | ===Lung cancers=== | ||
<gallery mode=packed heights=190> | <gallery mode=packed heights=190> | ||
File: | 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 | File:Histopathology of lung adenocarcinoma with solid pattern.jpg|'''[[Lung adenocarcinoma]]''', with solid pattern. | ||
File:Squamous | 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 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> | |||
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== | |||
{{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
- Bronchial lavage
- Lung needle biopsy
- Lung wedge resection or lobectomy
- Lung autopsy
Gross processing
As per presentation above.
Microscopic evaluation
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]
.jpg){kind=link}
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 solid pattern.
-
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]
-
Small-cell carcinoma, with typical findings.[4]
![Squamous-cell carcinoma (SCC) of the lung. Typical squamous-cell carcinoma cells are large with abundant eosinophilic cytoplasm and large, often vesicular, nuclei.[3]](/index.php?title=Special:Upload&wpDestFile=Histopathology_of_squamous-cell_carcinoma_of_the_lung.jpg){kind=link}
![Small-cell carcinoma, with typical findings.[4]](/index.php?title=Special:Upload&wpDestFile=Histopathology_of_small_cell_carcinoma,_annotated.png){kind=link}
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
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
- ↑ 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
- ↑ 1.0 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. .
- ↑ 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:. ISSN 0883-5993.
- ↑ Dr Nicholas Turnbull, A/Prof Patrick Emanual (2014-05-03). Squamous cell carcinoma pathology. DermNetz.
- ↑ 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}}
- ↑ 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:. PMID 12562233. Archived from the original. .
- ↑ Inamura K (2018). "Update on Immunohistochemistry for the Diagnosis of Lung Cancer. ". Cancers (Basel) 10 (3). doi:. PMID 29538329. PMC: 5876647. Archived from the original. .
- ↑ 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:. PMID 30235512. PMC: 6166010. Archived from the original. .
- ↑ 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:. PMID 37349623. Archived from the original. .
- ↑ . 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
- ↑ Image(s) by: Mikael Häggström, M.D. Public Domain
- Author info
- Reusing images