Rare pulmonary tumours: a histological and radiological overview (original) (raw)
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Rare lung tumours – possibilities and limits of diagnosis
Pneumologia
Considering the wide range of both histological and imaging types found in a small group of tumours as an incidence, they can pose real problems in both diagnosis and therapeutic conduct, being difficult to differentiate clinically, imagistically, or histologically from lung tumours commonly found in the clinic (1). Adenocarcinoma, squamous cell carcinoma, and small cell carcinoma together account for approximately 95% of all lung tumours, but the lung is the site of many other types of tumours that may be of epithelial, mesenchymal, neuroendocrine, or lympho-haematopoietic origin, and these latter together account for approximately 5% of all pulmonary tumours (2,3). With a few exceptions, both the clinical manifestations and the imaging aspect are nonspecific, many of them having features in common with the other tumours with high incidence (3). The present study was performed on a group of 82 patients diagnosed with low-incidence lung tumours, aiming at presenting the main epidemi...
Folia Histochemica Et Cytobiologica, 2023
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Small cell and squamous cell lung carcinomas: sequential occurrence at a single site
Thorax, 1987
The detection of a second primary bronchogenic carcinoma after treatment for small cell lung carcinoma is a rare' and recently described2 phenomenon. Nonetheless, at least 17 cases have been reported to date1 34 and there is now evidence to suggest that such tumours are an important late complication of small cell lung carcinoma in remission.4 In the present case the two tumours developed at the same site. To our knowledge this has not been reported before.
An Uncommon Lung Neoplasm in a Young Patient: Diagnostic Challenges
American Journal of Case Reports, 2020
Objective: Rare disease Background: Adenosquamous carcinoma of the lung (ASC) is a rare subtype of non-small-cell lung carcinoma (NSCLC), histologically defined by the presence of both squamous cell carcinoma and adenocarcinoma components. This aggressive malignancy has been rarely described in young female patients. Due to its low incidence and difficult-to-establish preoperative diagnosis, little is known about the complete clinical course for young patients with this specific NSCLC subtype. Moreover, a history of smoking is positively associated with ASC, but evidence for an association with exposure to secondhand smoke is sparse. Case Report: We present the case of a previously healthy 29-year-old woman with a long-standing history of secondhand smoke exposure, who was ultimately diagnosed with advanced ASC via fiberoptic bronchoscopy with transbronchial biopsy after a number of different investigations and treatments performed outside our service. She had visited many clinicians in 4 months of symptoms, initially presented as thoracic pain and cough thought to be due to a complicated pneumonia. Symptoms progressed despite empiric treatment and eventually included low back pain, weight loss, and night sweats. The hypothesis of tuberculosis was then investigated and discarded, at which point, 3 months after the onset of symptoms, she had a CT scan of the chest, revealing a pulmonary mass. She was referred to our hospital to further investigate this finding via fiberoptic bronchoscopy with transbronchial biopsy. During the procedure, she experienced an acute exacerbation of the low back pain, which prompted her admission in the Emergency Department, and she was later admitted to our pneumology ward. An extensive treatment plan including chemotherapy and radiotherapy was initially started, but could not be completed due to rapid disease progression, defined by pulmonary and spine metastatic implants, which limited treatment to palliative care. The patient died 6 months after the initial onset of symptoms. Conclusions: This case report shows the clinical course of a difficult and rare diagnosis, and demonstrates the high level of suspicion required for the early diagnosis of lung neoplasms in young patients.
Iaslc/Ats/Ers International Multidisciplinary Classification of Lung Adenocarcinoma‡
2014
Introduction: Adenocarcinoma is the most common histologic type of lung cancer. In order to address advances in oncology, molecular biology, pathology, radiology and surgery of lung adenocarcinoma, an international multidisciplinary classification was sponsored by the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS). This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small non-resection cancer specimens and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies. Methods: An international core panel of experts representing all three societies was formed with oncologists/pulmonologists, pathologists, radiologists, molecular biologists and thoracic surgeons. A systematic review was performed under the guidance of the ATS Documents Development and Implementation Committee. The search strategy identified 11368 citations of which 312 articles met specified eligibility criteria and were retrieved for full text review. A series of meetings were held to discuss the development of the new classification, to develop the recommendations and to write the current document. Recommendations for key questions were graded by strength and quality of the evidence according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results: The classification addresses both resection specimens, as well as, small biopsies and cytology. The terms bronchioloalveolar carcinoma (BAC) and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced such inserm-00561753, version 1-1 Feb 2011 Travis WD et al Lung Adenocarcinoma Classification 4 as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) for small solitary adenocarcinomas with either pure lepidic growth (AIS) and predominant lepidic growth with ≤5mm invasion (MIA) to define patients who, if they undergo complete resection, will have 100% or near 100% disease specific survival, respectively. AIS and MIA are usually nonmucinous, but rarely may be mucinous. Invasive adenocarcinomas are classified by predominant pattern after using comprehensive histologic subtyping with lepidic (formerly most mixed subtype tumors with nonmucinous BAC), acinar, papillary and solid patterns; micropapillary is added as a new histologic subtype. Variants include invasive mucinous adenocarcinoma (formerly mucinous BAC), colloid, fetal and enteric adenocarcinoma. This classification provides guidance for small biopsies and cytology specimens, as approximately 70 percent of lung cancers are diagnosed in such samples. Non-small cell lung carcinomas (NSCLC), in patients with advanced stage disease, are to be classified into more specific types such as adenocarcinoma or squamous cell carcinoma, whenever possible for several reasons: 1), adenocarcinoma or NSCLC not otherwise specified (NOS) should be tested for EGFR mutations since the presence of these mutations is predictive of responsiveness to EGFR tyrosine kinase inhibitors, 2) adenocarcinoma histology is a strong predictor for improved outcome with pemetrexed therapy compared to squamous cell carcinoma, and 3) potential lifethreatening hemorrhage may occur in patients with squamous cell carcinoma who receive bevacizumab. If the tumor cannot be classified based on light microscopy alone, special studies such as immunohistochemistry and/or mucin stains should be applied to classify the tumor further. Use of the term NSCLC NOS should be minimized. Conclusions: This new classification strategy is based on a multidisciplinary approach to diagnosis of lung adenocarcinoma, that incorporates clinical, molecular, radiologic, and surgical inserm-00561753, version 1-1 Feb 2011 Travis WD et al Lung Adenocarcinoma Classification 5 issues, but it is primarily based on histology. This classification is intended to support clinical practice as well as research investigation and clinical trials. As EGFR mutation is a validated predictive marker for response and progression-free survival (PFS) with EGFR tyrosine kinase inhibitors (TKIs) in advanced lung adenocarcinoma, we recommend that patients with advanced adenocarcinomas be tested for EGFR mutation. This has implications for strategic management of tissue, particularly for small biopsies and cytology samples, to maximize high quality tissue available for molecular studies. Potential impact for TNM staging include adjustment of the size T factor according to only the invasive component 1) pathologically in invasive tumors with lepidic areas or 2) radiologically by measuring the solid component of part-solid nodules.
CT findings of small cell lung carcinoma
Medicine, 2016
The purpose of this study was to clarify the recognizable computed tomography (CT) features of small cell lung carcinoma (SCLC). Contrast enhanced CT scans were reviewed retrospectively for mass location, mediastinal extension, and other concomitant findings in 142 patients with pathologically proven SCLC. SCLC was classified into hilar mass only (type I), hilar mass with ipsilateral mediastinal extension (type II), hilar mass with bilateral mediastinal extension (type III), and peripheral mass (type IV). When mediastinal lymphadenopathy (m-LAP) was indistinguishable from a hilar mass, we defined it as a mediastinal conglomerate mass (m-CM). Type IIa or IIIa had ipsilateral or bilateral m-LAP and type IIb, IIIb or IIIc had ipsilateral or bilateral m-CM. Type I (n = 8, 5.6%), type II (n = 58, 40.8%), type III (n = 55, 38.8%), and type IV (n = 21, 14.8%) were manifested. The combination of a hilar mass and m-CM was found in 68 patients (47.9%). Type IV masses showed lobulation in 11, microlobulation in 4, both lobulated and irregular margins in 4, and spiculation in 2. A total of 120 patients (84.5%) had a bronchial stenosis/obstruction; single (n = 52) and 2 or more (n = 68). Ninety-five patients (67.0%) had vascular invasion including main/lobar pulmonary artery and superior vena cava, and 55 (38.7%) had pleural effusion and/or pleural nodules. Concomitant parenchymal findings (n = 92, 64.8%) were noted: contiguous consolidation/nodule (n = 45), hematogeneous spread (n = 32), lymphangitic spread (n = 21), obstructive pneumonia (n = 22), and obstructive atelectasis (n = 14). In conclusion, the recognizable CT features of SCLC were a hilar mass with m-CM. Most of the hilar masses showed 2 or more bronchial stenoses/obstructions. Most cases of peripheral SCLC manifested as a lobulated mass rather than a spiculated mass. Vascular invasion and concomitant parenchymal findings were observed commonly. Abbreviations: CT = computed tomography, m-CM = mediastinal conglomerate mass, m-LAP = mediastinal lymphadenopathy, MRI = magnetic resonance imaging, NSCLC = nonsmall cell lung carcinoma, PA = pulmonary artery, PET = positron emission tomography, SCLC = small cell lung carcinoma, SVC = superior vena cava.
Journal of thoracic imaging, 2012
In 2011, the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society proposed a new classification for lung adenocarcinoma that included a number of changes to previous classifications. This classification now considers resection specimens, small biopsies, and cytology specimens. Two former histopathologic terms, bronchioloalveolar carcinoma and mixed subtype adenocarcinoma, are no longer to be used. For resection specimens, the new terms of adenocarcinoma in situ and minimally invasive adenocarcinoma are introduced for small adenocarcinomas showing pure lepidic growth and predominantly lepidic growth, with invasion ≤5 mm, respectively. Invasive adenocarcinomas are now classified by their predominant pattern as lepidic, acinar, papillary, and solid; a micropapillary pattern is newly added. This classification also provides guidance for small biopsies and cytology specimens. For adenocarcinomas that include both an invasive ...
Pulmonary Tumourlets: Case Report and Review of Literature
The Indian journal of chest diseases & allied sciences, 2015
We report a case of tumourlets of the lung associated with carcinoid and neuroendocrine cell hyperplasia, found incidentally in a 30-year-old woman, who underwent bullectomy for pneumothorax. These lesions are histologically similar to carcinoid, but differ in molecular pathogenesis about which little is known. Their nature and significance is debated. Here, we point out the importance of histological, clinical, and diagnostic aspects and follow-up to have evidence of eventual malignant evolution.
Journal of Thoracic Oncology, 2007
Objective: Neuroendocrine (NE) lung tumors consist of typical carcinoid (TC), atypical carcinoid (AC), large cell neuroendocrine carcinoma (LCNEC) and small cell carcinoma (SCLC). The determinant of FDG uptake for NE lung tumors has not been well elucidated. The aim of the present study is to investigate the relationship of FDG uptake and glucose transporter type 1 (Glut-1) expression in NE lung tumors. Methods: NE lung tumor patients (n=32; age, mean ± s.d.=67.8±10y; male:female=28:4) who had underwent F-18 FDG-PET before treatment were enrolled. There were 1 TC, 3 AC, 5 LCNEC, and 23 SCLC. FDG uptake was represented by maximum standardized uptake value (maxSUV). The paraffin sections of the tumor tissues were immunostained for Glut-1 (Neomarker, 1:50). The relation of FDG uptake and Glut-1 expression was assessed by Pearson correlation analysis. Results: The maxSUVs of all NE lung tumors ranged from 0.6 to 29.5 (mean±s.d.=7.7±5.4), whereas percentage Glut-1 expression ranged from 0 to 100% (18±24%). MaxSUVs of all NE lung tumors were significantly correlated with percentage Glut-1 expression (r=0.6471, p=0.0001). In subgroup analyses, maxSUV was also significantly correlated with Glut-1 expression in SCLC (n=23, r=0.6189, p=0.0016) and in non-small cell NE lung tumors (n=9, r=0.7039, p=0.0343). The maxSUV and the percentage Glut-1 expression were 1.7±2.0 and 5.0±0.0%, 7.9±3.2 and 35.0±32.4%, and 7.6±3.7 and 12.6±14.1% for AC, LCNEC, and SCLC, respectively. MaxSUV of SCLC was significantly higher than that of AC (p=0.007), but percentage Glut-1 expression was not significantly different among AC, LCNEC, and SCLC (p>0.05). One TC case had a maxSUV of 29.5 and 100% Glut-1 expression. Conclusions: In NE lung tumors, the maxSUV on FDG-PET was highly correlated with Glut-1 immunostaining positivity. This result suggests that Glut-1 expression is one of the determining factors of FDG uptake in NE lung tumors.