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Dolkar T, Absher K, Hao Z. Pulmonary pleomorphic carcinoma: current understanding illustrated through a case. BMJ Case Rep 2024; 17:e261076. [PMID: 39214577 DOI: 10.1136/bcr-2024-261076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
This article describes a case of a man in his early 40s who was diagnosed with pulmonary pleomorphic carcinoma (PPC). PPCs are rare and aggressive forms of lung cancer. Chemotherapy is of limited efficacy. We present a case that has seemingly recurred shortly after adjuvant chemotherapy and immunotherapy following an R0 resection for localised disease. Biopsy however was negative for recurrence. PPCs may bear actionable mutations and tyrosine kinase inhibitors may be used when appropriate. Immunotherapy with or without chemotherapy is emerging as the mainstay for metastatic disease despite a lack of evidence from randomised clinical trials.
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Affiliation(s)
- Tsering Dolkar
- Hospital Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Kim Absher
- Pathology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Zhonglin Hao
- Medical Oncology, University of Kentucky, Lexington, Kentucky, USA
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2
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EGFR-mutated, metastatic pulmonary pleomorphic carcinoma successfully treated with afatinib: A case report. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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3
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Chen Z, Liu J, Min L. Clinicopathological characteristics, survival outcomes and prognostic factors in pleomorphic carcinoma: a SEER population-based study. BMC Pulm Med 2022; 22:116. [PMID: 35361152 PMCID: PMC8969326 DOI: 10.1186/s12890-022-01915-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pulmonary pleomorphic carcinoma (PPC) is a rare tumor, and it usually has an aggressive clinical course and poor prognosis. We aim to analyze the clinicopathological features, management and prognostic factors of pulmonary pleomorphic carcinoma. Patients and methods Using the surveillance, epidemiology, and end results (SEER) database, we identified 461 patients of pulmonary pleomorphic carcinoma from 2004 to 2014 including clinicopathological characteristics, treatment modalities and outcome data. Results The mean age of all PPC patients was 66 years and 58% of the patients were male. Most patients (80%) were white people, 53% were found in the right lung, and lesions were mostly observed in upper lobe (56%). The median overall survival was 9 months and overall 1-, 3- and 5-year survival rate was 45%, 29%, 23%. In Kaplan–Meier analysis, age, marital status, tumor primary site, gender, laterality, SEER summary stage, chemotherapy and surgery were associated with overall survival. Patients received surgery or chemotherapy had a better OS for patients with PPC. Multivariate Cox analysis revealed that SEER summary stage, age, surgery and chemotherapy were found to be independently associated with the OS. Surgery could significantly prolong survival in patients with localized stage and regional stage (HR = 0.120, 95% CI 0.038–0.383, p < 0.001; HR = 0.351, 95% CI 0.212–0.582, p < 0.001) while it did not have great impact on survival in patients with distant stage (p = 0.192). Chemotherapy decreased risk of death by 46% (HR = 0.544, 95% CI 0.393–0.752, p < 0.001) for patients with distant stage, whereas chemotherapy did not confer survival benefits to patients with localized stage and regional stage. But radiation did not have great impact on survival of patients with different stages in this study. Conclusions PPC mostly occurred in white people, with a median age of 66 years, and men were more susceptible to this disease. The SEER summary stage, age, surgery and chemotherapy were independently associated with prognosis. Surgery should be considered for the PPC patients with localized stage or regional stage, and chemotherapy should be recommended for the treatment of patients with distant stage.
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Affiliation(s)
- Zhongzhong Chen
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan, 232007, Anhui, China
| | - Jiachang Liu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan, 232007, Anhui, China
| | - Lingfeng Min
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Dalian Medical University, Clinical Medical College of Yangzhou University, Yangzhou, 225001, Jiangsu, China.
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4
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Jeong JH, Seo HJ, Yoon SH, Hong R. Pulmonary pleomorphic carcinoma presenting as undifferentiated non-small cell carcinoma with giant cells: A case report and review of literature. Respir Med Case Rep 2020; 31:101225. [PMID: 33005565 PMCID: PMC7511725 DOI: 10.1016/j.rmcr.2020.101225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/24/2022] Open
Abstract
Pulmonary pleomorphic carcinoma (PPC) is a poorly differentiated non-small cell lung carcinoma, including squamous cell carcinoma, adenocarcinoma, or undifferentiated non-small cell lung carcinoma with at least 10% spindle and/or giant cells. Here, we report a case of PPC showing undifferentiated non-small cell lung carcinoma with giant cells. A 71-year-old man with dyspnea underwent right lobectomy because of a mass in the right upper lobe of the lung. A 5.0 × 3.0 × 1.5 cm-sized tumor was identified; microscopically, the tumor composed of undifferentiated large sized tumor cells admixed with syncytial tumor giant cells and emperipoletic giant cells. Immunohistochemically, the tumor cells were reactive for pan-cytokeratin, but negative for P40, thyroid transcription factor 1 (TTF-1), and vimentin. The tumor cells were also positive for 3 clones of programmed death-ligand 1 (PD-L1). The clinical and histologic findings supported the diagnosis of an undifferentiated non-small cell lung carcinoma with giant cells, which is a subtype of pulmonary pleomorphic carcinoma. Unfortunately, after surgery, multifocal lymph node metastasis was identified in radiologic examination. Only palliative chemotherapy was administered to the patient, although he was indicated for immunochemotherapy. Pulmonary pleomorphic carcinoma is known to have a poor prognosis, even in early stages of the disease, therefore, we should be careful in the diagnosis to ensure optimal treatment.
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Affiliation(s)
- Jae-Han Jeong
- Department of Thoracic and Cardiovascular Surgery, Republic of Korea
| | - Hong-Joo Seo
- Department of Thoracic and Cardiovascular Surgery, Republic of Korea
| | - Sung-Ho Yoon
- Department of Internal Medicine, Republic of Korea
| | - Ran Hong
- Department of Pathology College of Medicine, Chosun University, Gwangju, Republic of Korea
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Manabe S, Kasajima R, Murakami S, Miyagi Y, Yokose T, Kondo T, Saito H, Ito H, Kaneko T, Yamada K. Analysis of targeted somatic mutations in pleomorphic carcinoma of the lung using next-generation sequencing technique. Thorac Cancer 2020; 11:2262-2269. [PMID: 32578376 PMCID: PMC7396383 DOI: 10.1111/1759-7714.13536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pleomorphic carcinoma (PC) of the lung is a rare type of lung cancer with aggressive characteristics and a poor prognosis. Because it is rare, the molecular characteristics of PC remain unclear. METHODS A gene mutation analysis was performed using next-generation sequencing (NGS) in patients with PC of the lung who had undergone surgical resection. RESULTS A total of nine patients were enrolled in the study. All the patients were male and eight had a history of smoking. Eight tumors contained spindle cells and three contained giant cells. Mutations considered significant were found in eight of the nine patients: in TP53 in five patients, in MET in two patients, and in ALK, ERBB2, PIK3CA, APC, NF1, and CDKN2A in one patient each. No EGFR mutation was detected in our analysis. Co-mutations were detected in three patients: TP53 with MET and NF1, TP53 with ERBB2, and PIK3CA with CDKN2A. CONCLUSIONS TP53 mutations were detected most frequently in PC of the lung with NGS analysis. Different co-mutations were seen in several specimens. KEY POINTS Significant findings of the study This study demonstrates that mutations in the TP53 gene are frequently found and co-mutations are sometimes found in pleomorphic carcinoma of the lung using genomic profiling analysis. What this study adds Our results will help to analogize the genetic characteristics and potential target of molecular-targeted agents of pleomorphic carcinoma of the lung.
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Affiliation(s)
- Saki Manabe
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
| | - Rika Kasajima
- Molecular Pathology and Genetics DivisionKanagawa Cancer Center Research InstituteYokohamaJapan
| | - Shuji Murakami
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
| | - Yohei Miyagi
- Molecular Pathology and Genetics DivisionKanagawa Cancer Center Research InstituteYokohamaJapan
| | | | - Tetsuro Kondo
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
| | - Haruhiro Saito
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
| | - Hiroyuki Ito
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
| | - Takeshi Kaneko
- Department of PulmonologyYokohama City University Graduate School of MedicineYokohamaJapan
| | - Kouzo Yamada
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
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Chang HC, Hsu CL, Chang YL, Yu CJ. Pulmonary pleomorphic carcinoma with pembrolizumab monotherapy. Respirol Case Rep 2020; 8:e0597. [PMID: 32547767 PMCID: PMC7290282 DOI: 10.1002/rcr2.597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
Adenocarcinoma (ADC) is the most common form of lung cancer; however, some other types of lung cancer can sometimes mimic ADC. It then takes experienced pathologists and special stains to make the correct diagnosis. Here, we present a patient with pulmonary pleomorphic carcinoma who was misdiagnosed with ADC, and was treated with pembrolizumab for 13 months. The diagnosis and treatment (including immunotherapy) are also reviewed.
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Affiliation(s)
- Hao-Chun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
| | - Chia-Lin Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
| | - Yih-Leong Chang
- Department of Pathology National Taiwan University Cancer Center and National Taiwan University Hospital Taipei Taiwan
| | - Chong-Jen Yu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
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7
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Response to crizotinib in a patient with metastatic lung spindle cell carcinoma harboring TPM3-ROS1 fusion. Chin Med J (Engl) 2019; 132:3003-3005. [PMID: 31833905 PMCID: PMC6964956 DOI: 10.1097/cm9.0000000000000556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Baldovini C, Rossi G, Ciarrocchi A. Approaches to Tumor Classification in Pulmonary Sarcomatoid Carcinoma. LUNG CANCER-TARGETS AND THERAPY 2019; 10:131-149. [PMID: 31824199 PMCID: PMC6901065 DOI: 10.2147/lctt.s186779] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a heterogeneous category of primary lung cancer accounting from 0.3% to 3% of all primary lung malignancies. According to the most recent 2015 World Health Organization (WHO) classification, PSC includes several different variants of malignant epithelial tumors (carcinomas) histologically mimicking sarcomas showing or entirely lacking a conventional component of non-small cell lung cancer (NSCLC). Thus, this rare subheading of lung neoplasms includes pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, pulmonary blastoma, and carcinosarcoma. A diagnosis of PSC may be suspected on small biopsy or cytology, but commonly requires a surgical resection to reach a conclusive definition. The majority of patients with PSC consists of elderly, smoking men with a large, peripheral mass characterized by well-defined margins. However, presentation with a central, polypoid endobronchial lesion is well-documented, particularly in pleomorphic carcinoma and carcinosarcoma showing a squamous cell carcinoma component. As expected, PSC may pose diagnostic problems and immunohistochemistry is largely used when pathologists deal these tumors in routine practice. Indeed, PSC tends to overexpress molecules associated with the epithelial-to-mesenchymal transition, such as vimentin, but the panel of immunostains also includes epithelial markers (cytokeratins, EMA), TTF-1, p40 and negative markers (e.g., melanocytic, mesothelial and sarcoma-related primary antibodies). Although rare, PSC has increased their interest among oncologist community for different reasons: a. identification of the epithelial-to-mesenchymal phenomenon as a major mechanism of secondary resistance to tyrosine kinase inhibitors; b. over-expression of PD-L1 and effective treatment with immunotherapy; c. identification of c-MET exon 14 skipping mutation representing an effective target to crizotinib and other specific inhibitors. In this review, the feasibility of the diagnosis of PSC, its differential diagnosis and novel molecular findings characterizing this group of lung tumor are discussed.
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Affiliation(s)
- Chiara Baldovini
- Operative Unit of Pathologic Anatomy, Azienda USL della Romagna, Hospital S. Maria delle Croci, Ravenna, Italy
| | - Giulio Rossi
- Operative Unit of Pathologic Anatomy, Azienda USL della Romagna, Hospital S. Maria delle Croci, Ravenna, Italy
| | - Alessia Ciarrocchi
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia 42123, Italy
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9
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Luo T, Zhang SG, Zhu LF, Zhang FX, Li W, Zhao K, Wen XX, Yu M, Zhan YQ, Chen H, Ge CH, Gao HY, Wang L, Yang XM, Li CY. A selective c-Met and Trks inhibitor Indo5 suppresses hepatocellular carcinoma growth. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2019; 38:130. [PMID: 30885237 PMCID: PMC6421704 DOI: 10.1186/s13046-019-1104-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/11/2019] [Indexed: 11/18/2022]
Abstract
Background Human hepatocellular carcinoma (HCC) lacks effective curative therapy and there is an urgent need to develop a novel molecular-targeted therapy for HCC. Selective tyrosine kinase inhibitors have shown promise in treating cancers including HCC. Tyrosine kinases c-Met and Trks are potential therapeutic targets of HCC and strategies to interrupt c-Met and Trks cross-signaling may result in increased effects on HCC inhibition. Methods The effects of Indo5 on c-Met and Trks activity were determined with in vitro kinase activity assay, cell-based signaling pathway activation, and kinases-driven cell transformation. The in vivo anti-tumor activity was determined with xenograft mice and liver orthotopic mice models. The co-expression of c-Met and TrkB in 180 pairs of HCC and adjacent normal tissues were detected using immunohistochemical staining. Results Indo5, a novel lead compound displayed biochemical potency against both c-Met and Trks with selectivity over 13 human kinases. Indo5 abrogated HGF-induced c-Met signaling activation and BDNF/NGF-induced Trks signal activation, c-Met or TrkB-mediated cell transformation and migration. Furthermore, Indo5 significantly decreased the growth of HCC cells in xenograft mice and improved the survival of mice with liver orthotopic tumors. In addition, co-expression of c-Met and TrkB in HCC patients was a predictor of poor prognosis, and combined inhibition of c-Met and TrkB exerted a synergistic suppressive effect on HCC. Conclusions These findings indicate that Indo5 is associated with marked suppression of c-Met and Trks co-expressing HCC, supporting its clinical development as an antitumor treatment for HCC patients with co-active c-Met and Trks signaling. Electronic supplementary material The online version of this article (10.1186/s13046-019-1104-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Teng Luo
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, 102206, China.,Beijing Institute of Radiation Medicine, 27-Taiping Road, Beijing, 100850, People's Republic of China.,Institute of NBC Defence, Beijing, 102205, China
| | - Shou-Guo Zhang
- Beijing Institute of Radiation Medicine, 27-Taiping Road, Beijing, 100850, People's Republic of China
| | | | - Fei-Xiang Zhang
- Guangdong pharmaceutical university, School of Pharmacy, Guangzhou, 510006, China
| | - Wei Li
- Beijing Institute of Radiation Medicine, 27-Taiping Road, Beijing, 100850, People's Republic of China
| | - Ke Zhao
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, 102206, China
| | - Xiao-Xue Wen
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, 102206, China
| | - Miao Yu
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, 102206, China
| | - Yi-Qun Zhan
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, 102206, China
| | - Hui Chen
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, 102206, China
| | - Chang-Hui Ge
- Beijing Institute of Radiation Medicine, 27-Taiping Road, Beijing, 100850, People's Republic of China
| | - Hui-Ying Gao
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, 102206, China
| | - Lin Wang
- Beijing Institute of Radiation Medicine, 27-Taiping Road, Beijing, 100850, People's Republic of China.
| | - Xiao-Ming Yang
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, 102206, China. .,School of Chemical Engineering and Technology, Department of pharmaceutical engineering, Tianjin University, Tianjin, 300072, China.
| | - Chang-Yan Li
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, 102206, China. .,An Hui Medical University, Hefei, 230032, China. .,Guangdong pharmaceutical university, School of Pharmacy, Guangzhou, 510006, China.
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Anter A, Al-Jahel M, AbdelLatif R, AbdELmohsen M, Shata A. Pulmonary pleomorphic carcinoma harboring epidermal growth factor receptor mutation: Response to afatinib. JOURNAL OF CANCER RESEARCH AND PRACTICE 2019. [DOI: 10.4103/jcrp.jcrp_16_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yang B, Lee H, Um SW, Kim K, Zo JI, Shim YM, Jung Kwon O, Lee KS, Ahn MJ, Kim H. Incidence of brain metastasis in lung adenocarcinoma at initial diagnosis on the basis of stage and genetic alterations. Lung Cancer 2018; 129:28-34. [PMID: 30797488 DOI: 10.1016/j.lungcan.2018.12.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Patients with lung adenocarcinoma (ADC) are at higher risk of the development of brain metastasis (BM), and genetic alterations are associated with BM. PATIENTS AND METHODS A total of 598 patients with lung ADC in our institution between January 2014 and December 2014 were reviewed retrospectively. We evaluated the incidence of BM by stage and genetic alterations. RESULTS Of the 598 patients, 97 (16.2%) had BM, which occurred across all stages. The incidence of BM showed a tendency to increase as the stage increased (p < 0.001, trend test). Although patients with EGFR mutations had BM across all stages, those with ALK or K- mutations had BM only in stage III and IV diseases. Regardless of types of mutations, the incidence of BM showed a tendency to increase as the T or N staging increased (p < 0.001 for each of EGFR, ALK, and K-RAS mutations, trend test). Whereas BM incidence showed a tendency to increase as the M staging increased in patients with EGFR-mutant lung ADC (p < 0.001, trend test), there was no linear trend between M staging and ALK (p = 0.469, trend test) or K-RAS mutations (p = 0.066, trend test). After adjusting covariables, EGFR mutations were associated with BM in never-smokers (adjusted OR = 2.07, 95% CI = 1.02-4.34) and K-RAS mutations were risk factors for BM in males (adjusted OR = 3.86, 95% CI = 1.01-14.43). CONCLUSIONS BM occurred in approximately 16% of lung ADC patients, including 3% with stage I diseases. Whereas EGFR-mutant lung ADC had BM across all stages, ALK- or K-RAS-mutant lung ADC had BM only in advanced stages. EGFR mutations were risk factors for BM among never-smokers and K-RAS mutations were risk factors among males.
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Affiliation(s)
- Bumhee Yang
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sang-Won Um
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae Il Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - O Jung Kwon
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung-Ju Ahn
- Section of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hojoong Kim
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Abstract
Pulmonary sarcomatoid carcinomas belong to a group of neoplasms that remain incompletely understood. They are rare tumors of the bronchopulmonary system that incorporate a wide range of neoplasms that by definition contain a sarcomatoid component characterized by spindle or giant cells. Such classification has led to a heterogenous tumor category that includes neoplasms with different clinical, morphologic, and prognostic features. To date, the histopathologic diagnosis of pulmonary sarcomatoid carcinomas does not require the use of ancillary testing and is based on light microscopic criteria alone. However, with recent advances in immunohistochemical and molecular methods, it is becoming increasingly clear that pulmonary sarcomatoid carcinomas represent poorly differentiated or "dedifferentiated" variants of conventional non-small cell carcinomas with similar immunophenotype and molecular signatures. This review summarizes the latest insights and concepts of these unusual tumors and outlines future directions with emphasis on tumor classification and patient management.
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13
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Lee J, Jung HA, Kim Y, Choi S, Han J, Choi YL, Lee SH, Ahn JS, Park K, Sun JM. Efficacy of mesna, doxorubicin, ifosfamide, and dacarbazine (MAID) in patients with advanced pulmonary pleomorphic carcinoma. Lung Cancer 2018; 122:160-164. [PMID: 30032825 DOI: 10.1016/j.lungcan.2018.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/08/2018] [Accepted: 06/08/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Pulmonary pleomorphic carcinoma (PC) is a rare type of lung tumor with a dismal prognosis. There is no consensus on a chemotherapy regimen for PC, and conventional platinum-based chemotherapy has been associated with disappointing response rates and PFS. In searches for a new regimen, the sarcomatoid (spindle or giant cell) component has been assumed to be susceptible to chemotherapy used for soft tissue sarcoma. MATERIALS AND METHODS The medical records of 17 patients who received mesna, doxorubicin, ifosfamide, and dacarbazine (MAID) for advanced PC between January 2010 and February 2017 were retrospectively analyzed for clinicopathological features and outcomes. RESULTS AND CONCLUSION The median age was 59 years. Sixteen patients were male, and only one patient had never smoked. Six patients achieved partial response to MAID, leading to an objective response rate of 35%. The median PFS was 2.8 months, and the median OS was 8.7 months. Hematologic toxicity-related adverse events were the most frequent, which comprised grade 3-4 anemia in 35% of patients, neutropenia in 47%, thrombocytopenia in 24%, and febrile neutropenia in 29%. No febrile neutropenia was reported in patients who received 5-day granulocyte-colony stimulating factor (G-CSF) prophylaxis. Most adverse events resolved without complications, except for one death due to sepsis. MAID is an effective, and possibly important, regimen for PC. MAID could be more safely used in clinical practice with appropriate dose modifications and G-CSF primary prophylaxis according to patients' status.
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Affiliation(s)
- Jiyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Ae Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Youjin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sangjoon Choi
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoon-La Choi
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keunchil Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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14
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Masuda K, Tokito T, Azuma K, Yanagida E, Nakamura M, Naito Y, Matsuo N, Ishii H, Yamada K, Akiba J, Hoshino T. Pulmonary pleomorphic carcinoma: A case harboring EGFR mutation treated with EGFR-TKIs. Thorac Cancer 2018; 9:754-757. [PMID: 29675860 PMCID: PMC5983202 DOI: 10.1111/1759-7714.12646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/24/2018] [Accepted: 03/25/2018] [Indexed: 11/28/2022] Open
Abstract
Pulmonary pleomorphic carcinoma (PPC) is a very rare type of primary lung cancer with an aggressive clinical course. Few reports have documented therapeutic options for PPC with EGFR mutations. Herein, we report a case of PPC with EGFR mutation treated with EGFR‐tyrosine kinase inhibitors (TKIs). A 65‐year‐old Japanese woman was diagnosed with stage IV lung adenocarcinoma with L858R point mutation in exon 21. Despite treatment with erlotinib, the patient died after two weeks as a result of rapid disease progression. Postmortem examination indicated that the thoracic tumors consisted primarily of spindle/sarcomatous components, while expression of the mutated EGFR protein was only observed in adenocarcinoma components. We speculate that the tumor was not driven by EGFR mutation. Clinicians should bear in mind the possibility of pleomorphic carcinoma if EGFR‐TKI treatment fails to achieve a clinical response for adenocarcinoma harboring an activating EGFR mutation diagnosed on the basis of small biopsy specimens.
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Affiliation(s)
- Ken Masuda
- Division of Respirology, Neurology, and Rheumatology, Kurume University Hospital, Kurume, Japan
| | - Takaaki Tokito
- Division of Respirology, Neurology, and Rheumatology, Kurume University Hospital, Kurume, Japan
| | - Koichi Azuma
- Division of Respirology, Neurology, and Rheumatology, Kurume University Hospital, Kurume, Japan
| | - Eriko Yanagida
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Masayuki Nakamura
- Division of Respirology, Neurology, and Rheumatology, Kurume University Hospital, Kurume, Japan
| | - Yoshiko Naito
- Division of Respirology, Neurology, and Rheumatology, Kurume University Hospital, Kurume, Japan
| | - Norikazu Matsuo
- Division of Respirology, Neurology, and Rheumatology, Kurume University Hospital, Kurume, Japan
| | - Hidenobu Ishii
- Division of Respirology, Neurology, and Rheumatology, Kurume University Hospital, Kurume, Japan
| | - Kazuhiko Yamada
- Division of Respirology, Neurology, and Rheumatology, Kurume University Hospital, Kurume, Japan
| | - Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Kurume University Hospital, Kurume, Japan
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15
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Chen X, Zhang Y, Lu J, Xu C, Liang J, Wang F, Sun W, Fang S, Yuan J, Wang H, Wang H, Liu X, Chen L. Pulmonary Sarcomatoid Carcinoma with ALK Rearrangement: Frequency, Clinical-Pathologic Characteristics, and Response to ALK Inhibitor. Transl Oncol 2017; 10:115-120. [PMID: 28081478 PMCID: PMC5225784 DOI: 10.1016/j.tranon.2016.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/06/2022] Open
Abstract
PURPOSE: The incidence of anaplastic lymphoma kinase (ALK) rearrangement in pulmonary sarcomatoid carcinoma (PSC) is controversial. In this study, we aimed to reveal the reliable frequency and the clinical-pathologic characteristics of pulmonary sarcomatoid carcinoma (PSC) with ALK rearrangement in Chinese population, and to provide insight into the translatability of anti-ALK treatment in this treatment-refractory disease. METHODS: Immunohistochemistry (IHC) using a Ventana anti-ALK (D5F3) rabbit monoclonal antibody was performed in 141 PSC specimens collected from multiple medical centers. IHC-positive cases were then confirmed using ALK fluorescent in situ hybridization (FISH). The incidence rates and clinical-pathologic characteristics of ALK-rearranged PSC were then analyzed. Response to ALK inhibitor crizotinib in a patient with ALK-rearranged PSC was evaluated according to the response evaluation criteria for solid tumors (RECIST) version 1.1. RESULTS: Five of 141 (3.5%) of PSCs showed ALK rearrangement-positive by IHC and then were confirmed by FISH. Two were carcinosarcomas and the other three were pulmonary pleomorphic carcinoma (PPC). Strong positive ALK rearrangement was observed in both the epithelioid and sarcomatoid components. The median age of ALK-positive patients was younger than that of ALK-negative patients. PSCs in never-smokers were more likely to harbor ALK rearrangement than those in former or current smokers (P < .05). A 40-year-old woman diagnosed with ALK-rearranged PPC experienced a partial response (−32%) to the ALK inhibitor crizotinib. CONCLUSIONS: The incidence rates of ALK rearrangement in PSC in the Chinese population are similar to those of other subtypes of NSCLC. PSCs in younger never-smokers are more often to harbor ALK rearrangement. ALK inhibitors may serve as an effective treatment for ALK-rearranged PSC.
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Affiliation(s)
- Xinru Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, PR China; State Key Laboratory of Oncology in South, China; Collaborative Innovation Center for Cancer Medicine
| | - Yu Zhang
- State Key Laboratory of Oncology in South, China; Collaborative Innovation Center for Cancer Medicine; Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, PR China
| | - Jiabin Lu
- State Key Laboratory of Oncology in South, China; Collaborative Innovation Center for Cancer Medicine; Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, PR China
| | - Chunwei Xu
- Department of Pathology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, PR China
| | - Jianzhong Liang
- State Key Laboratory of Oncology in South, China; Collaborative Innovation Center for Cancer Medicine; Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, PR China
| | - Fang Wang
- State Key Laboratory of Oncology in South, China; Collaborative Innovation Center for Cancer Medicine; Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, PR China
| | - Wenyong Sun
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, PR China
| | - Sangao Fang
- Department of Pathology, Daping Hospital and Research Institute of Surgery, The Third Military Medical University, Chongqing, PR China
| | - Jingping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Huijuan Wang
- Department of Respiratory Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Hui Wang
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, PR China; Key Laboratory of Translational Radiation Oncology, Hunan Province
| | - Xuewen Liu
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, PR China; Key Laboratory of Translational Radiation Oncology, Hunan Province.
| | - Likun Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, PR China; State Key Laboratory of Oncology in South, China; Collaborative Innovation Center for Cancer Medicine.
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16
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Lee MH, Kong DS, Seol HJ, Nam DH, Lee JI. The Influence of Biomarker Mutations and Systemic Treatment on Cerebral Metastases from NSCLC Treated with Radiosurgery. J Korean Neurosurg Soc 2016; 60:21-29. [PMID: 28061489 PMCID: PMC5223759 DOI: 10.3340/jkns.2016.0404.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/22/2016] [Accepted: 08/30/2016] [Indexed: 01/10/2023] Open
Abstract
Objective The purpose of this study was to analyze outcomes and identify prognostic factors in patients with cerebral metastases from non-small cell lung cancer (NSCLC) treated with gamma knife radiosurgery (GKS) particularly, focusing on associations of biomarkers and systemic treatments. Methods We retrospectively reviewed the medical records of 134 patients who underwent GKS for brain metastases due to NSCLC between January 2002 and December 2012. Representative biomarkers including epidermal growth factor receptor (EGFR) mutation, K-ras mutation, and anaplastic lymphoma kinase (ALK) mutation status were investigated. Results The median overall survival after GKS was 22.0 months (95% confidence interval [CI], 8.8–35.1 months). During follow-up, 63 patients underwent salvage treatment after GKS. The median salvage treatment-free survival was 7.9 months (95% CI, 5.2–10.6 months). Multivariate analysis revealed that lower recursive partition analysis (RPA) class, small number of brain lesions, EGFR mutation (+), and ALK mutation (+) were independent positive prognostic factors associated with longer overall survival. Patients who received target agents 30 days after GKS experienced significant improvements in overall survival and salvage treatment-free survival than patients who never received target agents and patients who received target agents before GKS or within 30 days (median overall survival: 5.0 months vs. 18.2 months, and 48.0 months with p-value=0.026; median salvage treatment-free survival: 4.3 months vs. 6.1 months and 16.6 months with p-value=0.006, respectively). To assess the influence of target agents on the pattern of progression, cases that showed local recurrence and new lesion formation were analyzed according to target agents, but no significant effects were identified. Conclusion The prognosis of patients with brain metastases of NSCLC after GKS significantly differed according to specific biomarkers (EGFR and ALK mutations). Our results show that target agents combined with GKS was related to significantly longer overall survival, and salvage treatment-free survival. However, target agents were not specifically associated with improved local control of the lesion treated by GKS either development of new lesions. Therefore, it seems that currently popular target agents do not affect brain lesions themselves, and can prolong survival by controlling systemic disease status.
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Affiliation(s)
- Min Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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17
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Weissferdt A, Kalhor N, Correa AM, Moran CA. "Sarcomatoid" carcinomas of the lung: a clinicopathological study of 86 cases with a new perspective on tumor classification. Hum Pathol 2016; 63:14-26. [PMID: 27993578 DOI: 10.1016/j.humpath.2016.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/22/2016] [Accepted: 12/01/2016] [Indexed: 12/29/2022]
Abstract
Pulmonary sarcomatoid carcinoma includes a heterogenous group of tumors difficult to diagnose and treat. We report the clinicopathological features of 86 such tumors, including 74 pleomorphic and 12 spindle cell carcinomas, and propose a novel approach to the classification of these neoplasms in an attempt to better guide patient management. The patients were 47 men and 39 women aged 36 to 87 years (mean, 63 years) who primarily presented with shortness of breath, cough, and chest pain. Eighty-six percent of patients had a smoking history. Histologically, the pleomorphic carcinomas consisted of spindle and/or giant cells with varying proportions of conventional non-small cell carcinoma in the form of adenocarcinoma (n=29), squamous cell carcinoma (n=10), or large cell carcinoma (n=18); 17 cases contained a mix of spindle and giant cells only. The 12 spindle cell carcinomas consisted of spindle cells only. Based on the combined histopathologic and immunohistochemical features of these tumors, we were able to reanalyze the spectrum of these lesions and reclassify them accordingly. Statistical analysis revealed an overall survival at 3, 5, and 10 years of 42.9%, 34.6%, and 23.5%, respectively, and a median survival of 15 months. Log-rank test showed that in multivariate analysis, only pathological T stage was a factor associated with prognosis. The current classification of pulmonary sarcomatoid carcinomas precludes optimal triaging of these tumors with the risk of denying patients access to novel treatment. Our proposal for a reclassification of these tumors would more accurately guide patient management and facilitate targeted therapies.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Neda Kalhor
- Department of Pathology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Arlene M Correa
- Department of Thoracic Surgery, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Cesar A Moran
- Department of Pathology, MD Anderson Cancer Center, Houston, TX 77030, USA
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18
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Pelosi G, Scarpa A, Forest F, Sonzogni A. The impact of immunohistochemistry on the classification of lung tumors. Expert Rev Respir Med 2016; 10:1105-21. [PMID: 27617475 DOI: 10.1080/17476348.2017.1235975] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION To highlight the role of immunohistochemistry to lung cancer classification on the basis of existing guidelines and future perspectives. AREAS COVERED Four orienting key-issues were structured according to an extensive review on the English literature: a) cancer subtyping; b) best biomarkers and rules to follow; c) negative and positive profiling; d) suggestions towards an evidence-based proposal for lung cancer subtyping. A sparing material approach based on a limited number of specific markers is highly desirable. It includes p40 for squamous cell carcinoma ('no p40, no squamous'), TTF1 for adenocarcinoma, synaptophysin for neuroendocrine tumors and vimentin for sarcomatoid carcinoma. A close relationship between genotype and phenotype also supports a diagnostic role for negative profiles. Expert commentary: Highly specific and sensitive IHC markers according to positive and negative diagnostic algorithms seem appropriate for individual patients' lung cancer subtyping.
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Affiliation(s)
- Giuseppe Pelosi
- a Department of Oncology and Hemato-Oncology , Università degli Studi di Milano , Milan , Italy
| | - Aldo Scarpa
- b Department of Pathology and Diagnostics , University and Hospital Trust of Verona , Verona , Italy.,c ARC-Net Research Centre , University and Hospital Trust of Verona , Verona , Italy
| | - Fabien Forest
- d Department of Pathology , University Hospital Center (CHU), North Hospital , Saint Etienne , France
| | - Angelica Sonzogni
- e Department of Pathology and Laboratory Medicine , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
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19
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The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol 2016; 10:1243-1260. [PMID: 26291008 DOI: 10.1097/jto.0000000000000630] [Citation(s) in RCA: 2865] [Impact Index Per Article: 358.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The 2015 World Health Organization (WHO) Classification of Tumors of the Lung, Pleura, Thymus and Heart has just been published with numerous important changes from the 2004 WHO classification. The most significant changes in this edition involve (1) use of immunohistochemistry throughout the classification, (2) a new emphasis on genetic studies, in particular, integration of molecular testing to help personalize treatment strategies for advanced lung cancer patients, (3) a new classification for small biopsies and cytology similar to that proposed in the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (4) a completely different approach to lung adenocarcinoma as proposed by the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (5) restricting the diagnosis of large cell carcinoma only to resected tumors that lack any clear morphologic or immunohistochemical differentiation with reclassification of the remaining former large cell carcinoma subtypes into different categories, (6) reclassifying squamous cell carcinomas into keratinizing, nonkeratinizing, and basaloid subtypes with the nonkeratinizing tumors requiring immunohistochemistry proof of squamous differentiation, (7) grouping of neuroendocrine tumors together in one category, (8) adding NUT carcinoma, (9) changing the term sclerosing hemangioma to sclerosing pneumocytoma, (10) changing the name hamartoma to "pulmonary hamartoma," (11) creating a group of PEComatous tumors that include (a) lymphangioleiomyomatosis, (b) PEComa, benign (with clear cell tumor as a variant) and
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20
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Pelosi G, Gasparini P, Conte D, Fabbri A, Perrone F, Tamborini E, Pupa SM, Ciravolo V, Caserini R, Rossi G, Cavazza A, Papotti M, Nakatani Y, Maisonneuve P, Pastorino U, Sozzi G. Synergistic Activation upon MET and ALK Coamplification Sustains Targeted Therapy in Sarcomatoid Carcinoma, a Deadly Subtype of Lung Cancer. J Thorac Oncol 2016; 11:718-728. [DOI: 10.1016/j.jtho.2016.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 12/26/2022]
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21
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Abstract
Pulmonary sarcomatoid carcinomas are a rare group of tumors accounting for about one percent of non-small cell lung carcinoma (NSCLC). In 2015, the World Health Organization classification united under this name all the carcinomas with sarcomatous-like component with spindle cell or giant cell appearance, or associated with a sarcomatous component sometimes heterologous. There are five subtypes: pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma and pulmonary blastoma. Clinical characteristics are not specific from the other subtypes of NSCLC. Epithelial to mesenchymal transition pathway may play a key role. Patients, usually tobacco smokers, are frequently symptomatic. Tumors are voluminous more often peripherical than central, with strong fixation on FDG TEP CT. Distant metastases are frequent with atypical visceral locations. These tumors have poorer prognosis than the other NSCLC subtypes because of great aggressivity, and frequent chemoresistance. Here we present pathological description and a review of literature with molecular features in order to better describe these tumors and perhaps introduce new therapeutics.
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22
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Retrospective analysis of the efficacy of chemotherapy and molecular targeted therapy for advanced pulmonary pleomorphic carcinoma. BMC Res Notes 2015; 8:800. [PMID: 26682906 PMCID: PMC4684621 DOI: 10.1186/s13104-015-1762-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/27/2015] [Indexed: 11/11/2022] Open
Abstract
Background Pulmonary pleomorphic carcinoma (PPC) follows an aggressive clinical course and outcomes are disappointing. Due to its rarity, however, the clinicopathological and molecular characteristics of this disease remain unclear. Methods We retrospectively evaluated the efficacy of chemotherapy and molecular targeted therapy in 16 patients with PPC who received chemotherapy or EGFR-TKI. We also investigated the status of EGFR mutation, KRAS mutation and ALK expression. Results On histologic review of the malignant epithelial component, adenocarcinoma was identified in seven cases (43.8 %), large cell carcinoma in four (25.0 %), and squamous cell carcinoma in two (12.5 %). For the sarcomatoid component, 14 cases (87.5 %) had both spindle cell tumor and giant cell and 2 (12.5 %) had giant cell. Eleven patients received cytotoxic chemotherapy as first-line but did not achieve an objective response, although one patient who received docetaxel as second-line achieved a partial response. We also found that one patient achieved long stable disease of about 9 years without progression after receiving cisplatin and gemcitabine treatment. EGFR mutation, KRAS mutation and ALK expression were investigated in 14 patients whose tumor specimens were available. EGFR mutation was observed in 2 (14.3 %) and KRAS mutation in 3 (21.4 %), while no patient was positive for ALK expression. One patient harboring EGFR exon 19 deletion was treated with gefitinib after postoperative recurrence and achieved a complete response of about 35 months. Conclusions Although advanced PPC showed a poor response to chemotherapy, one patient with EGFR mutation achieved an extended complete response. We therefore recommend the evaluation of driver gene alteration such as EGFR in the treatment of advanced PPC.
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23
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Forest F, Yvorel V, Karpathiou G, Stachowicz ML, Vergnon JM, Fournel P, Tiffet O, Trombert B, Péoc'h M. Histomolecular profiling of pleomorphic, spindle cell, and giant cell carcinoma of the lung for targeted therapies. Hum Pathol 2015; 49:99-106. [PMID: 26826416 DOI: 10.1016/j.humpath.2015.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/25/2015] [Accepted: 10/01/2015] [Indexed: 11/18/2022]
Abstract
In pleomorphic, spindle cell, and giant cell carcinoma (PSCGC) of the lung, we wondered if an integrated diagnosis including morphological and immunohistochemical features could be related to molecular status. We performed immunohistochemistry on 35 PSCGCs against TTF1, napsin A, p40, ALK, ROS1, and c-MET. Mutational status regarding EGFR, KRAS, BRAF, HER2, and PIK3CA genes was established. Of 18 PSCGCs with adenocarcinomatous or "undifferentiated" carcinoma differentiation, 8 were mutated for EGFR (n = 1), KRAS (n = 2), BRAF (n = 1), HER2 (n = 3), and PIK3CA (n = 1). No PSCGC (0/4) with only squamous cell or adenosquamous (0/2) differentiation was mutated. c-MET overexpression was only seen in PSCGC with adenocarcinomatous or undifferentiated component (n = 5) without squamous cell component. ROS1 and ALK were negative. The presence of a "targetable mutation" was correlated to the presence of morphological or immunohistochemical adenocarcinomatous differentiation (P = .0137). Integrated diagnosis of an adenocarcinomatous component in PSCGC could be associated with the presence of targetable gene mutation. Because only PSCGC with adenocarcinomatous or undifferentiated carcinoma harbors mutations, whereas PSCGC with only squamous or adenosquamous differentiation does not in our study, this might represent a prescreening for patients with PSCGC to be tested for molecular targets. Our results emphasize that careful morphological examination and the use of immunohistochemistry might be useful for the selection of PSCGC tested for a mutational target.
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MESH Headings
- Adenocarcinoma/chemistry
- Adenocarcinoma/diagnosis
- Adenocarcinoma/drug therapy
- Adenocarcinoma/genetics
- Adenocarcinoma/pathology
- Adenocarcinoma of Lung
- Aged
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biopsy
- Carcinoma, Adenosquamous/chemistry
- Carcinoma, Adenosquamous/diagnosis
- Carcinoma, Adenosquamous/drug therapy
- Carcinoma, Adenosquamous/genetics
- Carcinoma, Adenosquamous/pathology
- Carcinoma, Giant Cell/chemistry
- Carcinoma, Giant Cell/diagnosis
- Carcinoma, Giant Cell/drug therapy
- Carcinoma, Giant Cell/genetics
- Carcinoma, Giant Cell/pathology
- Carcinoma, Squamous Cell/chemistry
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/pathology
- Cell Differentiation
- DNA Mutational Analysis
- Female
- France
- Genetic Predisposition to Disease
- Humans
- Immunohistochemistry
- Lung Neoplasms/chemistry
- Lung Neoplasms/diagnosis
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/pathology
- Male
- Molecular Targeted Therapy
- Mutation
- Patient Selection
- Phenotype
- Predictive Value of Tests
- Retrospective Studies
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Affiliation(s)
- Fabien Forest
- Pathology Department, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France.
| | - Violaine Yvorel
- Pathology Department, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France
| | - Georgia Karpathiou
- Pathology Department, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France
| | - Marie-Laure Stachowicz
- Pathology Department, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France
| | - Jean-Michel Vergnon
- Pneumology Department, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France
| | - Pierre Fournel
- Lucien Neuwirth Cancer Institute, 42270 Saint Priest en Jarez, France
| | - Olivier Tiffet
- Thoracic Surgery Department, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France
| | - Béatrice Trombert
- Public Health and Medical Informatics Department, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France
| | - Michel Péoc'h
- Pathology Department, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France
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24
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Liu X, Jia Y, Stoopler MB, Shen Y, Cheng H, Chen J, Mansukhani M, Koul S, Halmos B, Borczuk AC. Next-Generation Sequencing of Pulmonary Sarcomatoid Carcinoma Reveals High Frequency of Actionable MET Gene Mutations. J Clin Oncol 2015. [PMID: 26215952 DOI: 10.1200/jco.2015.62.0674] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To further understand the molecular pathogenesis of pulmonary sarcomatoid carcinoma (PSC) and develop new therapeutic strategies in this treatment-refractory disease. MATERIALS AND METHODS Whole-exome sequencing in a discovery set (n = 10) as well as targeted MET mutation screening in an independent validation set (n = 26) of PSC were performed. Reverse transcriptase polymerase chain reaction and Western blotting were performed to validate MET exon 14 skipping. Functional studies for validation of the oncogenic roles of MET exon 14 skipping were conducted in lung adenosquamous cell line H596 (MET exon 14 skipped and PIK3CA mutated) and gastric adenocarcinoma cell line Hs746T (MET exon 14 skipped). Response to MET inhibitor therapy with crizotinib in a patient with advanced PSC and MET exon 14 skipping was evaluated to assess clinical translatability. RESULTS In addition to confirming mutations in known cancer-associated genes (TP53, KRAS, PIK3CA, MET, NOTCH, STK11, and RB1), several novel mutations in additional genes, including RASA1, CDH4, CDH7, LAMB4, SCAF1, and LMTK2, were identified and validated. MET mutations leading to exon 14 skipping were identified in eight (22%) of 36 patient cases; one of these tumors also harbored a concurrent PIK3CA mutation. Short interfering RNA silencing of MET and MET inhibition with crizotinib showed marked effects on cell viability and decrease in downstream AKT and mitogen-activated protein kinase activation in Hs746T and H596 cells. Concurrent PIK3CA mutation required addition of a second agent for successful pathway suppression and cell viability effect. Dramatic response to crizotinib was noted in a patient with advanced chemotherapy-refractory PSC carrying a MET exon 14 skipping mutation. CONCLUSION Mutational events of MET leading to exon 14 skipping are frequent and potentially targetable events in PSC.
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Affiliation(s)
- Xuewen Liu
- Xuewen Liu, Mark B. Stoopler, Yufeng Shen, Jinli Chen, Mahesh Mansukhani, Sanjay Koul, Balazs Halmos, and Alain C. Borczuk, Columbia University Medical Center; Haiying Cheng, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY; Xuewen Liu, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China; and Yuxia Jia, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA
| | - Yuxia Jia
- Xuewen Liu, Mark B. Stoopler, Yufeng Shen, Jinli Chen, Mahesh Mansukhani, Sanjay Koul, Balazs Halmos, and Alain C. Borczuk, Columbia University Medical Center; Haiying Cheng, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY; Xuewen Liu, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China; and Yuxia Jia, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA
| | - Mark B Stoopler
- Xuewen Liu, Mark B. Stoopler, Yufeng Shen, Jinli Chen, Mahesh Mansukhani, Sanjay Koul, Balazs Halmos, and Alain C. Borczuk, Columbia University Medical Center; Haiying Cheng, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY; Xuewen Liu, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China; and Yuxia Jia, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA
| | - Yufeng Shen
- Xuewen Liu, Mark B. Stoopler, Yufeng Shen, Jinli Chen, Mahesh Mansukhani, Sanjay Koul, Balazs Halmos, and Alain C. Borczuk, Columbia University Medical Center; Haiying Cheng, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY; Xuewen Liu, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China; and Yuxia Jia, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA
| | - Haiying Cheng
- Xuewen Liu, Mark B. Stoopler, Yufeng Shen, Jinli Chen, Mahesh Mansukhani, Sanjay Koul, Balazs Halmos, and Alain C. Borczuk, Columbia University Medical Center; Haiying Cheng, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY; Xuewen Liu, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China; and Yuxia Jia, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA
| | - Jinli Chen
- Xuewen Liu, Mark B. Stoopler, Yufeng Shen, Jinli Chen, Mahesh Mansukhani, Sanjay Koul, Balazs Halmos, and Alain C. Borczuk, Columbia University Medical Center; Haiying Cheng, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY; Xuewen Liu, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China; and Yuxia Jia, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA
| | - Mahesh Mansukhani
- Xuewen Liu, Mark B. Stoopler, Yufeng Shen, Jinli Chen, Mahesh Mansukhani, Sanjay Koul, Balazs Halmos, and Alain C. Borczuk, Columbia University Medical Center; Haiying Cheng, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY; Xuewen Liu, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China; and Yuxia Jia, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA
| | - Sanjay Koul
- Xuewen Liu, Mark B. Stoopler, Yufeng Shen, Jinli Chen, Mahesh Mansukhani, Sanjay Koul, Balazs Halmos, and Alain C. Borczuk, Columbia University Medical Center; Haiying Cheng, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY; Xuewen Liu, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China; and Yuxia Jia, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA
| | - Balazs Halmos
- Xuewen Liu, Mark B. Stoopler, Yufeng Shen, Jinli Chen, Mahesh Mansukhani, Sanjay Koul, Balazs Halmos, and Alain C. Borczuk, Columbia University Medical Center; Haiying Cheng, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY; Xuewen Liu, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China; and Yuxia Jia, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA.
| | - Alain C Borczuk
- Xuewen Liu, Mark B. Stoopler, Yufeng Shen, Jinli Chen, Mahesh Mansukhani, Sanjay Koul, Balazs Halmos, and Alain C. Borczuk, Columbia University Medical Center; Haiying Cheng, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY; Xuewen Liu, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China; and Yuxia Jia, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA
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EGFR and KRAS mutations in pulmonary pleomorphic carcinoma and their correlation with clinicopathologic features. Contemp Oncol (Pozn) 2015. [PMID: 26199566 PMCID: PMC4507885 DOI: 10.5114/wo.2014.43491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim of the study Pulmonary pleomorphic carcinoma (PPC) of the lung is a subset of poorly differentiated non-small cell lung cancers (NSCLCs). Because of its rarity, information on epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma viral oncogene (KRAS) mutations is controversial and sparse. The aim was to investigate the two key oncogenes’ characteristics and their correlation with clinical variables. Material and methods We retrospectively screened 110 paraffin-embedded surgically resected specimens from patients with PPC. Of these, follow-up information was available for 48 patients. We then successfully analyzed 70 PPC samples and examined EGFR and KRAS mutation status by direct sequencing. The findings were correlated with a control group of patients with other NSCLCs. Results In our department, PPC comprised about 1.57% of surgical resected cases (110/6990). 37.4% of patients smoked. EGFR mutations were detected in 11 cases (15.7%), with a significantly higher frequency in women than men (p = 0.011). KRAS mutations were detected in 10 cases (14.3%) and were more often found at age 65 or older (p = 0.02). Of interest, in PPC, all KRAS mutations occurred in never smokers. Also, most never smokers have transversion mutations (G→T) in PPCs and other NSCLCs. Conclusions Our results demonstrated a similar EGFR and KRAS mutation rate in Chinese PPC patients. EGFR tyrosine kinase inhibitors may be a treatment option for PPCs with EGFR mutations. Of note, EGFR mutations in PPC were commonly identified in women; therefore women should be high-priority candidates for mutation screening.
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Toda-Ishii M, Akaike K, Kurisaki-Arakawa A, Arakawa A, Mukaihara K, Suehara Y, Takagi T, Kaneko K, Yao T, Saito T. Sarcomatous transformation of EGFR and TP53 mutation-positive metastatic adenocarcinoma of the lungs, masquerading as a primary pleomorphic sarcoma of the proximal femur. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:3270-3278. [PMID: 26045851 PMCID: PMC4440160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/22/2015] [Indexed: 06/04/2023]
Abstract
We investigated a case of metastatic adenocarcinoma of the lungs at the left proximal femur, masquerading as a primary pleomorphic sarcoma. A 72-year-old woman presented with pain in her left thigh in conjunction with a mass that had been gradually growing over a few months. She was being treated with gefitinib for lung adenocarcinoma positive for the epidermal growth factor receptor (EGFR) mutation L858R, and had multiple bone metastases. The lung adenocarcinoma and metastases had stabilized with the treatment. The metastatic lesions in the bone had also received radiation; however, a tumor in the proximal femur kept growing despite treatment. A biopsy specimen from the proximal femur revealed the proliferation of spindle-shaped cells without an epithelial glandular component. The patient underwent en bloc resection of the proximal femur that was replaced by prosthesis. Histologically, the resected tumor was entirely composed of pleomorphic cells and tumor giant cells exhibiting no apparent glandular structures. Tumor cells were diffusely positive for p53 and focally positive for epithelial markers and EGFR, but were negative for thyroid transcription factor-1, suggesting an initial diagnosis of primary pleomorphic sarcoma. Genetic examination revealed mutations in EGFR and p53 that were of the same type as the lung tumor, leading to the final diagnosis of the femoral mass as a sarcomatous transformation of metastatic lung adenocarcinoma. However, secondary genetic alterations that might explain the acquired resistance to gefitinib could not be found in the proximal femoral tumor. The patient remains alive and the remaining lesions are well controlled.
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Affiliation(s)
- Midori Toda-Ishii
- Department of Human Pathology, Juntendo University School of MedicineHongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421 Japan
- Department of Orthopaedic Surgery, Juntendo University School of MedicineHongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Keisuke Akaike
- Department of Human Pathology, Juntendo University School of MedicineHongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421 Japan
- Department of Orthopaedic Surgery, Juntendo University School of MedicineHongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Aiko Kurisaki-Arakawa
- Department of Human Pathology, Juntendo University School of MedicineHongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Atsushi Arakawa
- Department of Human Pathology, Juntendo University School of MedicineHongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Kenta Mukaihara
- Department of Human Pathology, Juntendo University School of MedicineHongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421 Japan
- Department of Orthopaedic Surgery, Juntendo University School of MedicineHongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yoshiyuki Suehara
- Department of Orthopaedic Surgery, Juntendo University School of MedicineHongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Tatsuya Takagi
- Department of Orthopaedic Surgery, Juntendo University School of MedicineHongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of MedicineHongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University School of MedicineHongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Tsuyoshi Saito
- Department of Human Pathology, Juntendo University School of MedicineHongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421 Japan
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de León FCP, Gordillo-Domínguez LF, González-Carranza V, Torres-García S, García-Delgado C, Sánchez-Boiso A, Arenas-Huertero F, Perezpeña-Diazconti M, Eguía-Aguilar P, Baqueiro-Hernández C, Buenrostro-Márquez G, Martínez-Rodríguez S, Dhellemmes P, Castro-Sierra E. Brachmann-Cornelia de Lange syndrome with a papilloma of the choroid plexus: analyses of molecular genetic characteristics of the patient and the tumor. A single-case study. Childs Nerv Syst 2015; 31:141-6. [PMID: 25064129 DOI: 10.1007/s00381-014-2504-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/18/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE A 10-month-old girl with a Brachmann-Cornelia de Lange syndrome and a choroid plexus papilloma of the brain was studied at the Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City. METHODS AND RESULTS Presumptive papilloma of the third ventricle was evidenced on CT and MR images and removed. Pathological analysis confirmed its origin. A posterior radiosurgery was required due to a tumor relapse. Karyotypes (GTG bands) of the patient and her parents undertaken at HIMFG were normal. Array comparative genomic hybridization (array CGH) analyses of blood DNA of the patient and her parents carried out at BlueGnome's Laboratory in Cambridge, UK, set in evidence amplification of genes SPNS2, GGT6, SMTNL2, PELP1, MYBBP1A, and ALOX15 in chromosome 17p of the patient. Since MYBBP1A is a proto-oncogene and ALOX15 participates in the development of cancer and metastases of tumors, further fluorescent in situ hybridization (FISH) analyses of these two genes were implemented at HIMFG. Amplification of the two genes was found in the tumor of the case under study but not in an unrelated papilloma of the choroid plexus. DISCUSSION Further analyses of the association of choroid plexus papillomas with disorders of psycho-neural development and its relationship to molecular genetic modifications at chromosome 17p are now under way at HIMFG.
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Zhang K, Deng H, Cagle PT. Utility of Immunohistochemistry in the Diagnosis of Pleuropulmonary and Mediastinal Cancers: A Review and Update. Arch Pathol Lab Med 2014; 138:1611-28. [DOI: 10.5858/arpa.2014-0092-ra] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Immunohistochemistry has become an indispensable ancillary tool for the accurate classification of pleuropulmonary and mediastinal neoplasms necessary for therapeutic decisions and predicting prognostic outcome in the era of personalized medicine. Diagnostic accuracy has significantly improved because of the continuous discoveries of tumor-associated biomarkers and the development of effective immunohistochemical panels.
Objective
To increase the accuracy of diagnosis and classify pleuropulmonary neoplasms through immunohistochemistry.
Data Sources
Literature review, authors' research data, and personal practice experience.
Conclusions
This review article has shown that appropriately selecting immunohistochemical panels enables pathologists to effectively diagnose most primary pleuropulmonary neoplasms and differentiate primary lung tumors from a variety of metastatic tumors to the lung. The discovery of new mutation-specific antibodies identifying a subset of specific gene-arranged lung tumors provides a promising alternative and cost-effective approach to molecular testing. Knowing the utilities and pitfalls of each tumor-associated biomarker is essential to avoiding potential diagnostic errors.
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Affiliation(s)
- Kai Zhang
- From the Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania (Drs Zhang and Deng)
| | - Hongbin Deng
- From the Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania (Drs Zhang and Deng)
| | - Philip T. Cagle
- and the Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, Texas (Dr Cagle)
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Miyahara S, Hamasaki M, Hamatake D, Yamashita SI, Shiraishi T, Iwasaki A, Nabeshima K. Clinicopathological analysis of pleomorphic carcinoma of the lung: diffuse ZEB1 expression predicts poor survival. Lung Cancer 2014; 87:39-44. [PMID: 25479687 DOI: 10.1016/j.lungcan.2014.11.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/28/2014] [Accepted: 11/09/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Pleomorphic carcinoma (PC) of the lung is a rare epithelial tumor. The clinicopathological characteristics and prognostic factors of PC are controversial. The information on the ZEB1 gene, which crucially impacts survival of patients with other malignant tumors, is limited for PC. MATERIALS AND METHODS Clinicopathological characteristics of 62 patients with PC were investigated in this study. Associations between immunohistochemical expression of ZEB1 and clinical factors, including patient prognosis, were examined. The patient population consisted of 51 (82.2%) men and 11 (17.8%) women, with a mean age of 65.5 years (range, 31-81 years). RESULTS The overall survival rate of the 42 patients, for whom follow-up was available, was 68.3% at 5 years. Using TNM criteria, 7 (11.3%), 11 (17.7%), 3 (4.8%), 21 (33.8%), 15 (24.2%), 2 (3.2%), and 3 (4.8%) patients were classified under pathological stage IA, IB, IIA, IIB, IIIA, IIIB and IV carcinomas, respectively. Fifteen (24.1%) patients had tumors consisting entirely of spindle and giant cells (PC component). The other 47 (75.8%) cancers contained additional carcinoma components (i.e., adenocarcinoma (34/62, 54.8%), squamous cell carcinoma (7/62, 11.3%), adenosquamous carcinoma (4/62, 6.5%) and large cell carcinoma (2/62, 3.2%)). Four of 7 (57.1%) stage IA (<20mm) tumors consisted only of spindle and giant cells. ZEB1 expression was observed only in the PC component. Diffuse expression of ZEB1, was defined as positive nuclear staining in ≥75% of cancer cells, and was found in the PC component in 12 patients. Multivariate analysis revealed that lymph node metastasis, pleural invasion, and diffuse ZEB1 expression in the PC component predicted poorer disease-specific survival (p=0.007, 0.022, and 0.016, respectively). CONCLUSION This is the first report to indicate that ZEB1 may be used as an immunohistochemical prognosticator of PC, which may be useful for histological assessment of PC in biopsy and surgical specimens.
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Affiliation(s)
- So Miyahara
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan; Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Makoto Hamasaki
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Daisuke Hamatake
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Shin-Ichi Yamashita
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Takeshi Shiraishi
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Akinori Iwasaki
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan.
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Chang J, Liu X, Wang S, Zhang Z, Wu Z, Zhang X, Li J. Prognostic value of FGFR gene amplification in patients with different types of cancer: a systematic review and meta-analysis. PLoS One 2014; 9:e105524. [PMID: 25171497 PMCID: PMC4149366 DOI: 10.1371/journal.pone.0105524] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/23/2014] [Indexed: 01/22/2023] Open
Abstract
Background Fibroblast growth factor receptor (FGFR) gene amplification has been reported in different types of cancer. We performed an up-to-date meta-analysis to further characterize the prognostic value of FGFR gene amplification in patients with cancer. Methods A search of several databases, including MEDLINE (PubMed), EMBASE, Web of Science, and China National Knowledge Infrastructure, was conducted to identify studies examining the association between FGFR gene amplification and cancer. A total of 24 studies met the inclusion criteria, and overall incidence rates, hazard risk (HR), overall survival, disease-free survival, and 95% confidence intervals (CIs) were calculated employing fixed- or random-effects models depending on the heterogeneity of the included studies. Results In the meta-analysis of 24 studies, the prevalence of FGFR gene amplification was FGFR1: 0.11 (95% CI: 0.08–0.13) and FGFR2: 0.04 (95% CI: 0.02–0.06). Overall survival was significantly worse among patients with FGFR gene amplification: FGFR1 [HR 1.57 (95% CI: 1.23–1.99); p = 0.0002] and FGFR2 [HR 2.27 (95% CI: 1.73–3.00); p<0.00001]. Conclusions Current evidence supports the conclusion that the outcomes of patients with FGFR gene amplified cancers is worse than for those with non-FGFR gene amplified cancers.
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Affiliation(s)
- Jinjia Chang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinyang Liu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shanshan Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhe Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zheng Wu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaowei Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin Li
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- * E-mail:
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Zehani A, Ayadi-Kaddour A, Marghli A, Maamouri H, Kassar L, Kilani T, El Mezni F. [Sarcomatoid carcinoma of the lung: retrospective study of 28 cases]. Ann Pathol 2014; 34:124-9. [PMID: 24703022 DOI: 10.1016/j.annpat.2013.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 10/10/2011] [Accepted: 12/18/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Sarcomatoid carcinoma (SC) of the lung is defined by the World Health Organization as poorly differentiated non-small cell carcinoma that contains a component of sarcoma or sarcoma-like elements. It represents an overall continuum of epithelial and mesenchymal differentiation. Five subtypes are recognized: pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma, and pulmonary blastoma. The diagnosis is pathological and requires a good sampling of the tumor. PATIENTS AND METHODS Twenty-eight cases of primary sarcomatoid carcinoma, diagnosed between 1993 and 2010, were reviewed retrospectively, noting the clinicopathological characteristics. RESULTS The patient population consisted of 25 males and 3 females with mean age of 62.9 years (48-75 years). The symptomatology was dominated by respiratory symptoms. Imaging features showed a pulmonary mass invading pleura or thoracic wall in 5 cases. The diagnosis was made in all cases on histological examination. These 28 tumors were divided as below: into 19 pleomorphic carcinomas, 4 giant cell carcinomas, 1 spindle cell carcinoma and 4 carcinosarcomas. Twenty-seven tumors were treated surgically. Associated treatments were neoadjuvant (3 cases) or adjuvant chemotherapy (1 case) and preoperative radiotherapy (5 cases). Deaths occurred in 7 patients. Twenty-two patients were lost to follow up. CONCLUSION These tumors are frequently symptomatic, are locally advanced, and have higher rates of recurrence. Its prognosis is worse than that of other non-small cell lung cancer.
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Affiliation(s)
- Alia Zehani
- Service d'anatomie et de cytologie pathologiques, hôpital Abderrahman Mami, Ariana, Tunisie.
| | - Aïda Ayadi-Kaddour
- Service d'anatomie et de cytologie pathologiques, hôpital Abderrahman Mami, Ariana, Tunisie
| | - Adel Marghli
- Service de chirurgie thoracique, hôpital Abderrahman Mami, Ariana, Tunisie
| | - Hela Maamouri
- Service d'anatomie et de cytologie pathologiques, hôpital Abderrahman Mami, Ariana, Tunisie
| | - Lamia Kassar
- Service de dermatologie, hôpital Mahmoud Matri, Ariana, Tunisie
| | - Tarek Kilani
- Service de chirurgie thoracique, hôpital Abderrahman Mami, Ariana, Tunisie
| | - Faouzi El Mezni
- Service d'anatomie et de cytologie pathologiques, hôpital Abderrahman Mami, Ariana, Tunisie
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Unal OU, Oztop I, Calibasi G, Baskin Y, Koca D, Demir N, Akman T, Ellidokuz H, Yilmaz AU. Relationship between epidermal growth factor receptor gene mutations and clinicopathological features in patients with non-small cell lung cancer in western Turkey. Asian Pac J Cancer Prev 2014; 14:3705-9. [PMID: 23886169 DOI: 10.7314/apjcp.2013.14.6.3705] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate epidermal growth factor receptor (EGFR) gene mutations in patients with non- small cell lung cancer (NSCLC) and to analyze any relationship with clinicopathological features and prognosis. MATERIALS AND METHODS EGFR gene exons 18-21 in 48 specimens of paraffin-embedded tumor tissue from NSCLC patients were amplified by PCR, followed by direct sequencing and analysis of links to clinicopathological features and prognosis. RESULTS EGFR mutations were detected in 18 of 48 (42.6%) patients with NSCLC. There were 9 cases of mutations in exon 20, 7 in exon 19 and 2 in exon 21. Mutations were more frequently observed in women (5/7 pts, 71.4%) than in men (13/41 pts, 31.7%) (p=0.086) and in non-smokers (5/5 pts, 100%) than smokers (13/43 pts, 30.2%). There was negative correlation of EGFR mutations with smoking status (p=0.005). EGFR mutations were more frequently observed with adenocarcinoma histology (13/32 pts, 40.6%) than in other types (5/16 pts, 31.3%) (p=0.527). The patients with EGFR mutations had better survival than those with wild- type EGFR (p=0.08). There was no association of EGFR mutations with metastatic spread. CONCLUSIONS EGFR mutations in NSCLC were here demonstrated more frequently in females, non-smokers and adenocarcinoma histology in the western region of Turkey. Patients with EGFR mutations have a better prognosis.
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Affiliation(s)
- Olcun Umit Unal
- Department of Medical Oncology, Dokuz Eylul University, Turkey.
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Harding TC, Long L, Palencia S, Zhang H, Sadra A, Hestir K, Patil N, Levin A, Hsu AW, Charych D, Brennan T, Zanghi J, Halenbeck R, Marshall SA, Qin M, Doberstein SK, Hollenbaugh D, Kavanaugh WM, Williams LT, Baker KP. Blockade of nonhormonal fibroblast growth factors by FP-1039 inhibits growth of multiple types of cancer. Sci Transl Med 2013; 5:178ra39. [PMID: 23536011 DOI: 10.1126/scitranslmed.3005414] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The fibroblast growth factor (FGF) pathway promotes tumor growth and angiogenesis in many solid tumors. Although there has long been interest in FGF pathway inhibitors, development has been complicated: An effective FGF inhibitor must block the activity of multiple mitogenic FGF ligands but must spare the metabolic hormone FGFs (FGF-19, FGF-21, and FGF-23) to avoid unacceptable toxicity. To achieve these design requirements, we engineered a soluble FGF receptor 1 Fc fusion protein, FP-1039. FP-1039 binds tightly to all of the mitogenic FGF ligands, inhibits FGF-stimulated cell proliferation in vitro, blocks FGF- and vascular endothelial growth factor (VEGF)-induced angiogenesis in vivo, and inhibits in vivo growth of a broad range of tumor types. FP-1039 antitumor response is positively correlated with RNA levels of FGF2, FGF18, FGFR1c, FGFR3c, and ETV4; models with genetic aberrations in the FGF pathway, including FGFR1-amplified lung cancer and FGFR2-mutated endometrial cancer, are particularly sensitive to FP-1039-mediated tumor inhibition. FP-1039 does not appreciably bind the hormonal FGFs, because these ligands require a cell surface co-receptor, klotho or β-klotho, for high-affinity binding and signaling. Serum calcium and phosphate levels, which are regulated by FGF-23, are not altered by administration of FP-1039. By selectively blocking nonhormonal FGFs, FP-1039 treatment confers antitumor efficacy without the toxicities associated with other FGF pathway inhibitors.
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Affiliation(s)
- Thomas C Harding
- Five Prime Therapeutics Inc., South San Francisco, CA 94080-7047, USA
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Raparia K, Villa C, DeCamp MM, Patel JD, Mehta MP. Molecular profiling in non-small cell lung cancer: a step toward personalized medicine. Arch Pathol Lab Med 2013; 137:481-91. [PMID: 23544937 DOI: 10.5858/arpa.2012-0287-ra] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Lung carcinoma is the result of sequential accumulation of genetic and epigenetic changes. Lung adenocarcinoma is a heterogeneous disease with diverse somatic mutations, and several of them include the so-called driver mutations, which may serve as "druggable" therapeutic targets. Thus, development of personalized approaches for the treatment of non-small cell lung carcinoma (NSCLC) mandates that pathologists make a precise histologic classification inclusive of routine molecular analysis of such tumors. OBJECTIVE To address the molecular mechanisms underlying NSCLC and how this knowledge reflects the multidisciplinary approach in the diagnosis and management of these patients. We will also summarize the current available and investigational personalized therapies for patients with resectable early-stage, unresectable locally advanced, and metastatic NSCLC. DATA SOURCES Peer-reviewed published literature and personal experience. CONCLUSIONS There are multiple mechanisms involved in the pathogenesis of lung cancer, which operate in parallel and involve pathways of activation and inhibition of various cellular events. Further research is essential to characterize the histologic and mutational profiles of lung carcinomas, which will ultimately translate into improved and more personalized therapeutic management of patients with lung cancer.
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Affiliation(s)
- Kirtee Raparia
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Giroux Leprieur E, Antoine M, Vieira T, Duruisseaux M, Poulot V, Rabbe N, Belmont L, Gounant V, Lavolé A, Milleron B, Lacave R, Cadranel J, Wislez M. Clinical and molecular features in patients with advanced non-small-cell lung carcinoma refractory to first-line platinum-based chemotherapy. Lung Cancer 2013; 79:167-72. [DOI: 10.1016/j.lungcan.2012.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/18/2012] [Accepted: 10/16/2012] [Indexed: 11/16/2022]
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Abstract
Pulmonary sarcomatoid carcinomas are a rare group of tumors accounting for about 1 % of non-small cell lung carcinoma (NSCLC). In 2004, World Health Organization classification united under this name all the carcinomas with sarcomatous or sarcomatous-like component with spindle cell or giant cell appearance. There are five subtypes: spindle cell carcinoma, giant cell carcinoma, pleomorphic carcinoma, carcino-sarcoma and pulmonary blastoma. Clinical characteristics are not specific from the others subtypes of NSCLC. Epithelial to mesenchymal transition pathway may play a key role. Patients are frequently symptomatic. Tumors are voluminous more often peripherical than central, with strong fixation on FDG TEP CT. Distant metastasis are frequent with atypical locations such as peritoneal or retroperitoneal sites. These tumors have poorer prognosis than the other NSCLC subtypes because of great aggressivity, and frequent chemoresistance. Here, we present a review of litterature in order to better describe these tumors.
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Yamamoto M, Manabe S, Moriyama Y, Ishii H, Tanaka S, Takahashi R, Tomaru K, Kobayashi N, Kudo M, Sasaki M, Inayama Y, Kaneko T, Ishigatsubo Y. Long-term remission achieved via combined chemotherapy and radiotherapy in a non-resectable granulocyte colony-stimulating factor producing pleomorphic carcinoma of the lung. Intern Med 2013; 52:2259-63. [PMID: 24088763 DOI: 10.2169/internalmedicine.52.0701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The prognosis is poor for patients with advanced pleomorphic carcinoma of the lung due to the generally limited response to chemotherapy and/or radiotherapy. It has been suggested the production of granulocyte colony-stimulating factor (G-CSF) by cancer cells may aggravate the disease progression. We herein report a case of a 73-year-old Japanese man with advanced G-CSF-producing pleomorphic carcinoma of the lung. First-line chemotherapy with carboplatin and paclitaxel had been suspended. Subsequent radiotherapy achieved a moderate volume reduction and an amelioration of the excessive G-CSF-related complications. Six cycles of second-line chemotherapy with docetaxel administered with good results. These combined treatments resulted in long term survival without progression of the disease.
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Affiliation(s)
- Masaki Yamamoto
- Respiratory Medicine, Yokohama City University Hospital, Japan
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Zhu Y, Li Y, Wei J, Liu X. The role of Sox genes in lung morphogenesis and cancer. Int J Mol Sci 2012; 13:15767-83. [PMID: 23443092 PMCID: PMC3546660 DOI: 10.3390/ijms131215767] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 10/26/2012] [Accepted: 11/14/2012] [Indexed: 12/17/2022] Open
Abstract
The human lung consists of multiple cell types derived from early embryonic compartments. The morphogenesis of the lung, as well as the injury repair of the adult lung, is tightly controlled by a network of signaling pathways with key transcriptional factors. Lung cancer is the third most cancer-related death in the world, which may be developed due to the failure of regulating the signaling pathways. Sox (sex-determining region Y (Sry) box-containing) family transcriptional factors have emerged as potent modulators in embryonic development, stem cells maintenance, tissue homeostasis, and cancerogenesis in multiple processes. Recent studies demonstrated that the members of the Sox gene family played important roles in the development and maintenance of lung and development of lung cancer. In this context, we summarize our current understanding of the role of Sox family transcriptional factors in the morphogenesis of lung, their oncogenic potential in lung cancer, and their potential impact in the diagnosis, prognosis, and targeted therapy of lung cancer.
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Affiliation(s)
- Yongzhao Zhu
- Key Laboratory of the Ministry of Education for Conservation and Utilization of Special Biological Resources in Western China, College of Life science, Ningxia University, Yinchuan 750021, China; E-Mails: (Y.Z.); (Y.L.)
- Institute of Stem Cell Research, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Yong Li
- Key Laboratory of the Ministry of Education for Conservation and Utilization of Special Biological Resources in Western China, College of Life science, Ningxia University, Yinchuan 750021, China; E-Mails: (Y.Z.); (Y.L.)
| | - Jun Wei
- Institute of Stem Cell Research, General Hospital of Ningxia Medical University, Yinchuan 750004, China
- Authors to whom correspondence should be addressed; E-Mails: (J.W.); or (X.L.); Tel.: +86-951-674-3751 (J.W.); +86-951-206-2037 (X.L); Fax: +86-951-206-2699 (X.L.)
| | - Xiaoming Liu
- Key Laboratory of the Ministry of Education for Conservation and Utilization of Special Biological Resources in Western China, College of Life science, Ningxia University, Yinchuan 750021, China; E-Mails: (Y.Z.); (Y.L.)
- Authors to whom correspondence should be addressed; E-Mails: (J.W.); or (X.L.); Tel.: +86-951-674-3751 (J.W.); +86-951-206-2037 (X.L); Fax: +86-951-206-2699 (X.L.)
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Pelosi G, Gasparini P, Cavazza A, Rossi G, Graziano P, Barbareschi M, Perrone F, Barberis M, Takagi M, Kunimura T, Yamada T, Nakatani Y, Pastorino U, Scanagatta P, Sozzi G, Garassino M, De Braud F, Papotti M. Multiparametric molecular characterization of pulmonary sarcomatoid carcinoma reveals a nonrandom amplification of anaplastic lymphoma kinase (ALK) gene. Lung Cancer 2012; 77:507-14. [PMID: 22705117 DOI: 10.1016/j.lungcan.2012.05.093] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/28/2012] [Accepted: 05/03/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Genetic alterations for targeting therapy are largely unexplored issues in pulmonary sarcomatoid carcinoma (PSC), a life-threatening tumor subset. METHODS EGFR, HER2, KRAS, p53, CTNNB1, BRAF and PIK3CA mutations were assessed by direct sequencing, ALK, EGFR and HER2 gene status by fluorescence in situ hybridization (FISH), and ALK protein expression by immunohistochemistry (IHC) in 20 pleomorphic carcinomas (PLC), two pulmonary blastomas (PB) and one carcinosarcoma (CS). Surgical specimens and, in case of positivity, the corresponding preoperative biopsies were analyzed. Furthermore, 51 consecutive metastatic lung adenocarcinomas (MELAD) were used as controls for FISH and IHC assays of ALK gene. RESULTS While no rearrangements of ALK were detected in PSC, relevant amplification was identified 5/23 (22%) surgical specimens and paired biopsies (four PLC and one PB, two females and three males, four current and one never smoker, aged 30-83 years). Considering tumor heterogeneity, the percentage of ALK amplified tumor cells ranged from 11% to 43%, with a mean gene copy gain (GCG ± SD) of 6.9 ± 0.8 and no signal differences between the epithelial (6.5 ± 0.9) and the sarcoma-like components (6.8 ± 0.9) of tumors. In the remaining 18 non-amplified PSC, the relevant value was 2.9 ± 0.5 in 1-80% tumor cells (p<0.001). ALK amplification was closely associated with chromosome 7 (EGFR) or 17 (HER2) polysomy (p<0.001). Out of 51 MELAD, 10 were ALK-rearranged (p=0.026) and only one amplified (p=0.009). No amplified tumors, either PSC or MELAD, expressed the relevant protein by IHC, while the 10 ALK-rearranged MELAD were strongly positive. TP53, KRAS and CTNNB1 mutations accounted for 30%, 22%, and 4% of cases, respectively, with no significant relationship with ALK amplification. No mutations for EGFR, HER2, BRAF or PIK3CA gene were observed. CONCLUSION ALK gene amplification is a nonrandom and clonally related event in a subset of PSC, but its biologic rationale deserves further investigation. KRAS mutation could represent a novel tool for therapy of such so deadly tumors with MEK inhibitors.
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Affiliation(s)
- Giuseppe Pelosi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS National Cancer Institute, Milan, Italy.
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