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Kraus FM, Traut A, Nilius G, Volmerig J, Koziorowski A, Stöver I, Grabellus F, Stahl M, Christoph DC. Pulmonary Adenocarcinoma with Enteric Differentiation without TTF-1 Expression Is a Very Rare Subtype with Limited Treatment Options and Poor Prognosis. Oncology 2024:1-13. [PMID: 39159621 DOI: 10.1159/000540515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 07/04/2024] [Indexed: 08/21/2024]
Abstract
INTRODUCTION Pulmonary adenocarcinoma with enteric differentiation (PAED) without thyroid transcription factor-1 (TTF-1) expression is an extremely rare variant of lung cancer. Due to its rarity, few clinicopathological and molecular studies have been performed on PAED, particularly in Caucasian patients. Therefore, it is necessary to obtain clinicopathological data of Caucasian PAED patients without TTF-1 expression, their systemic therapy options, and the efficacy of their systemic treatment. METHODS We examined the clinicopathological features of 121 cases of TTF-1-negative pulmonary adenocarcinoma at a certified German lung cancer center including 79 cases without a PAED and 42 cases with a PAED, compared these subgroups, and investigated patients' response to chemotherapy and immunotherapy as first-line treatment. By using endoscopy and/or a PET-CT, a primary adenocarcinoma of the digestive tract was excluded in all PAED patients. RESULTS A comparison of clinicopathological data of TTF-1-negative PAED and non-PAED patients revealed a significantly lower frequency of high programmed death receptor ligand 1 (PD-L1) expression in PAED resulting in the lack of single-agent immunotherapy (p = 0.032) in this subgroup. Frequencies of an activating Kirsten rat sarcoma viral oncogene homolog (KRAS) gene mutation were high in both groups (46.7% and 50.0%), but G12C gene mutations were seldomly noted (in 6.7% and 18.5% of patients with evaluable data). Median overall survival (OS) was poor in both groups (10 and 12 months). The majority of PAED patients received platinum-based and taxane-containing chemotherapy or chemo-/immunotherapy with an objective response rate (ORR) of 31.6% and a disease control rate of 57.9%. Median progression-free survival (PFS) and OS of PAED patients with systemic therapy were very poor (3.9 months and 5.9 months). CONCLUSIONS Caucasian patients with TTF-1 negative PAED have a poor prognosis with a reduced ORR to standard first-line systemic therapy and short survival times (PFS and OS).
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Affiliation(s)
- Franziska Maria Kraus
- Department of Medical Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany,
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Georg Nilius
- Department of Pneumology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
- Germany and University Hospital Witten-Herdecke, Witten, Germany
| | - Jan Volmerig
- Department of Thoracic Surgery, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | | | - Imke Stöver
- Practice for Radio-Oncology Essen, Essen, Germany
| | | | - Michael Stahl
- Department of Medical Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Daniel C Christoph
- Department of Medical Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
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2
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Tchienga D, Ascio NM, Qureshi A, Razia S, Romulo G, Asarian A, Xiao P, Nouthe B, Belinga D. CK-7 negative primary lung adenocarcinoma. J Surg Case Rep 2023; 2023:rjad316. [PMID: 37332662 PMCID: PMC10271213 DOI: 10.1093/jscr/rjad316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Cytokeratin (CK) 7 is normally expressed in the vast majority of lung adenocarcinoma (ADC). However, on rare occasions, as reported in this paper, CK7 negativity can challenge the diagnosis of pulmonary ADC. Hence, the need to use a combination of 'immunomarkers' such as thyroid transcription factor 1, Napsin A, p40, p63 and CK20.
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Affiliation(s)
- Dimitri Tchienga
- Correspondence address. St George’s University School of Medicine, True Blue, Grenada, WI, USA. Tel: 240-491-7864; E-mail:
| | - Noelani-Mei Ascio
- Department of Surgery, St George’s University School of Medicine, True Blue, Grenada, WI, USA
| | - Abid Qureshi
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA
| | - Sultana Razia
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA
| | - Genato Romulo
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA
| | - Armand Asarian
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA
| | - Philip Xiao
- Department of Pathology, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA
| | - Brice Nouthe
- Fraser Health Authority/Department of Medicine, University of British Columbia, Vancouver, Canada
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3
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Fassi E, Mandruzzato M, Zamparini M, Bianchi S, Petrelli F, Baggi A, Alberti A, Grisanti S, Berruti A. Clinical presentation and outcome of patients with enteric-type adenocarcinoma of the lung: A pooled analysis of published cases. Lung Cancer 2023; 179:107176. [PMID: 37015149 DOI: 10.1016/j.lungcan.2023.107176] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 04/03/2023]
Abstract
Enteric-type adenocarcinoma of the lung (lung-ETAC, former pulmonary enteric adenocarcinoma, PEAC) is a rare subtype of non-small cell lung cancer (NSCLC), which shares morphological and immunohistochemical features with lung and colorectal adenocarcinoma. Few data are available on patient prognosis, possible prognostic factors and systemic approach to metastatic disease. We performed a pooled analysis and a systematic review of published lung-ETAC, along with an additional case description. Thirty-one eligible publications were identified, providing data from 126 patients. In the 127 patients overall analyzed, median overall survival (OS) was 56.0 (range 36.7-75.3) months in early-stage patients and 14.0 (range 4.5-23.5) months in those with advanced/metastatic disease. Median disease-free survival (DFS) after radical surgery was 24 (range 22.6-35.1) months. Smoking status (HR 4.304, 95% CI: 1.261-14.693, p = 0.020) and node involvement (HR 1.853, 95% CI: 1.179-2.911, p = 0.007) were the negative independent prognostic factors at multivariate analysis. As regards systemic therapies for advanced cases, no firm conclusions were drawn about the efficacy of lung cancer-oriented chemotherapy regimens as opposed to colon cancer-oriented ones. Molecular analysis of lung-ETAC revealed a relatively high mutational rate, with alterations in several druggable molecular pathways, KRAS and NRAS (31%) were the most frequently mutated oncogenes, followed by ROS1 (15%), RET (13%), BRAF (11%), EGFR (8%) and ALK (6%). Moreover, 3 (15%) out of 20 cases showed DNA mismatch repair deficiency (dMMR). In conclusion, advanced lung-ETAC patients appeared to have a better prognosis compared to other subtypes of NSCLC. Moreover, the mutational rate and microsatellite instability found in lung-ETACs suggest that a significant proportion of these patients could benefit from target therapies and immunotherapy.
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4
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Zuo Y, Zhong J, Bai H, Xu B, Wang Z, Li W, Chen Y, Jin S, Wang S, Wang X, Wan R, Xu J, Fei K, Han J, Yang Z, Bao H, Shao Y, Ying J, Song Q, Duan J, Wang J. Genomic and epigenomic profiles distinguish pulmonary enteric adenocarcinoma from lung metastatic colorectal cancer. EBioMedicine 2022; 82:104165. [PMID: 35901658 PMCID: PMC9334343 DOI: 10.1016/j.ebiom.2022.104165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ying Zuo
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jia Zhong
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hua Bai
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Bin Xu
- Cancer center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhijie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Weihua Li
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yedan Chen
- Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Shi Jin
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Shuhang Wang
- GCP Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xin Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Rui Wan
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jiachen Xu
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Kailun Fei
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jiefei Han
- Department of Neuro-oncology, Cancer Center Beijing Tiantan Hospital, Capital Medical University, China
| | - Zhenlin Yang
- Thoracic Surgery Department, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hua Bao
- Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Yang Shao
- Nanjing Geneseeq Technology Inc., Nanjing, China; School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jianming Ying
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Qibin Song
- Cancer center, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Jianchun Duan
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Jie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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5
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Tu LF, Sheng LY, Zhou JY, Wang XF, Wang YH, Shen Q, Shen YH. Diagnosis and treatment of primary pulmonary enteric adenocarcinoma: Report of Six cases. World J Clin Cases 2021; 9:9236-9243. [PMID: 34786410 PMCID: PMC8567515 DOI: 10.12998/wjcc.v9.i30.9236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/28/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary pulmonary enteric adenocarcinoma (PEAC) is a very rare subtype of invasive adenocarcinoma, and there have been no large studies on PEAC to date. Therefore, it is necessary to obtain much more information about the clinical and pathological features, diagnosis, differential diagnosis, and treatment of PEAC.
CASE SUMMARY All clinical data of six patients with confirmed PEAC from 2013 to 2018 were collected, and data on diagnosis, differential diagnosis, and treatment of PEAC are discussed combined with all the associated literature. The mean age of six patients was 64.0 ± 5.6 (59-73) years old. Their clinical manifestations were heterogeneous, and during their disease course, there were no gastrointestinal symptoms. There was no evidence from colonoscopy or imaging studies to suggest digestive tract tumors or new metastases. The most commonly mutated gene was KRAS (50.0%), and the pathological features of the six cases were similar to those of colorectal cancer. CDX2 (83.3%) and CK7 (66.7%) had the highest positive rates upon immunohistochemical examination. In the associated literature, 252 cases were identified, and the most commonly mutated gene was KRAS (42.9%). Additionally, CDX2 (68.3%) and CK7 (85.8%) had the highest positive rates. Patients mainly received surgery, chemotherapy, and radiotherapy, immunotherapy was not included.
CONCLUSION Positive results for CDX2 and CK7 play an important role in the diagnosis and differential diagnosis of PEAC, and immunotherapy or targeted therapy focused on KRAS needs to be further studied for the treatment of PEAC.
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Affiliation(s)
- Ling-Fang Tu
- Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Ling-Yan Sheng
- Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Jian-Ying Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Xue-Fen Wang
- Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Yue-Hong Wang
- Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Qian Shen
- Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Yi-Hong Shen
- Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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6
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Gong J, Fan Y, Lu H. Pulmonary enteric adenocarcinoma. Transl Oncol 2021; 14:101123. [PMID: 34000642 PMCID: PMC8141771 DOI: 10.1016/j.tranon.2021.101123] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/08/2021] [Accepted: 05/09/2021] [Indexed: 12/22/2022] Open
Abstract
Synthetically expounded the clinical characteristics of PEAC. Systematically described the differentiation of PEAC from primary lung adenocarcinoma and MCRC. Found patients with PEAC may have high frequencies of HER2 and MMR mutations. Proposed a new conjecture that patients with PEAC might benefit from anti-HER2 therapy and immune checkpoint inhibitors.
Pulmonary enteric adenocarcinoma (PEAC) is an exceptionally rare subtype of non–small cell lung cancer (NSCLC). It is characterized by pathological features similar to those of colorectal adenocarcinoma. Most patients with PEAC have almost no special clinical manifestations, and it is often difficult to differentiate from metastatic colorectal adenocarcinoma (MCRC). As a special type of lung adenocarcinoma, PEAC has unique mutation expression and immune characteristics; its mutation profile shows higher Kirsten rat sarcoma viral oncogene (KRAS), human epidermal growth factor receptor-2 (HER2) , DNA mismatch repair(MMR) mutation rates, and much lower epidermal growth factor receptor (EGFR) rate. So in the future, targeted therapy may tend to be a new light in the treatment of PEAC. As for immunohistochemistry (IHC), CDX-2, villin, and CK7 are significantly positive in PEAC. This review focuses on the pathologic features, immunohistochemical examination, mutation analysis, diagnosis, treatment, and prognosis of PEAC.
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Affiliation(s)
- Jiali Gong
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, PR China; Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (lung and esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022, PR China; Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022, PR China; Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, 310022, PR China
| | - Ying Fan
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (lung and esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022, PR China; Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022, PR China; Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, 310022, PR China; The First Clinical Medical College, Wenzhou Medical University, Wenzhou 325035, PR China
| | - Hongyang Lu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, PR China; Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (lung and esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022, PR China; Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022, PR China; Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, 310022, PR China.
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7
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Abstract
Pulmonary enteric adenocarcinoma (PEAC) is an extremely rare type of non-small cell lung cancer (NSCLC) with a histologic pattern that mimics metastatic colorectal cancer (MCC). The main clinical symptoms in PEAC patients are dyspnoea, coughing, hemoptysis, and chest and back pain. The first article about PEAC appeared in 1991 in the form of a case report. As a variant of invasive lung carcinoma, only a small number of case reports and clinical research studies have been carried out, and the only one guidance on diagnosis and treatment is the WHO Tumor Classification book. It is important for doctors to distinguish PEAC from MCC to extend survival time and improve the quality of life. We reviewed the existing literature regarding the diagnosis, treatment, and prognosis of PEAC to provide some valuable clinical references.
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Affiliation(s)
- Haiyan Li
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Cao
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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8
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Abstract
Most commonly described as sporadic, pulmonary adenocarcinoma with enteric differentiation (PAED) is a rare variant of invasive lung cancer recently established and recognised by the World Health Organization. This tumour is highly heterogeneous and shares several morphological features with pulmonary and colorectal adenocarcinomas. Our objective is to summarise current research on PAED, focusing on its immunohistochemical and molecular features as potential tools for differential diagnosis from colorectal cancer, as well as prognosis definition and therapeutic choice. PAED exhibits an 'entero-like' pathological morphology in more than half cases, expressing at least one of the typical immunohistochemical markers of enteric differentiation, namely CDX2, CK20 or MUC2. For this reason, this malignancy appears often indistinguishable from a colorectal cancer metastasis, making the differential diagnosis laborious. Although standard diagnostic criteria have not been established yet, in the past few years, a number of approaches have been addressed, aimed at defining specific immunohistochemical and molecular signatures. Based on previously published literature, we have collected and analysed molecular and immunohistochemical data on this rare neoplasm, and have described the state of the art on diagnostic criteria as well as major clinical and therapeutic implications.The analysis of data from 295 patients from 58 published articles allowed us to identify the most represented immunohistochemical and molecular markers, as well as major differences between Asian PAEDs and those diagnosed in European/North American countries. The innovative molecular approaches, exploring driver mutations or new gene alterations, could help to identify rare prognostic factors and guide future tailored therapeutic approaches to this rare neoplasm.
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9
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Auger M, Brimo F, Kanber Y, Fiset PO, Camilleri-Broet S. A practical guide for ancillary studies in pulmonary cytologic specimens. Cancer Cytopathol 2019; 126 Suppl 8:599-614. [PMID: 30156772 DOI: 10.1002/cncy.22028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/20/2018] [Accepted: 05/21/2018] [Indexed: 12/13/2022]
Abstract
Although most pulmonary cytologic specimens obtained by either exfoliation or fine needle aspirates can be reliably and accurately diagnosed based on pure morphologic criteria alone, a small proportion of cases require ancillary studies for either refining a diagnosis, for resolving a differential diagnosis or increasingly, for predictive purposes in primary lung carcinomas. This article aims to provide practical guidance on the use of common ancillary studies in pulmonary cytologic specimens. Cancer Cytopathol 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Manon Auger
- Department of Pathology, McGill University Health Center and McGill University, Montreal, Quebec, Canada
| | - Fadi Brimo
- Department of Pathology, McGill University Health Center and McGill University, Montreal, Quebec, Canada
| | - Yonca Kanber
- Department of Pathology, McGill University Health Center and McGill University, Montreal, Quebec, Canada
| | - Pierre O Fiset
- Department of Pathology, McGill University Health Center and McGill University, Montreal, Quebec, Canada
| | - Sophie Camilleri-Broet
- Department of Pathology, McGill University Health Center and McGill University, Montreal, Quebec, Canada
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10
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Kuan K, Khader SN, El Hussein S. Fine-needle aspiration of lung primary adenocarcinoma with enteric differentiation. Diagn Cytopathol 2019; 47:1076-1078. [PMID: 31241853 DOI: 10.1002/dc.24264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/28/2019] [Accepted: 06/05/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Kevin Kuan
- The Leopold G. Koss Division of Cytopathology, Montefiore Hospital and Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Samer N Khader
- The Leopold G. Koss Division of Cytopathology, Montefiore Hospital and Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Siba El Hussein
- The Leopold G. Koss Division of Cytopathology, Montefiore Hospital and Medical Center/Albert Einstein College of Medicine, New York, NY
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11
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Jurmeister P, Schöler A, Arnold A, Klauschen F, Lenze D, Hummel M, Schweizer L, Bläker H, Pfitzner BM, Mamlouk S, Sers C, Denkert C, Stichel D, Frost N, Horst D, von Laffert M, Capper D. DNA methylation profiling reliably distinguishes pulmonary enteric adenocarcinoma from metastatic colorectal cancer. Mod Pathol 2019; 32:855-865. [PMID: 30723296 DOI: 10.1038/s41379-019-0207-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/27/2018] [Accepted: 12/29/2018] [Indexed: 12/20/2022]
Abstract
Pulmonary enteric adenocarcinoma is a rare non-small cell lung cancer subtype. It is poorly characterized and cannot be distinguished from metastatic colorectal or upper gastrointestinal adenocarcinomas by means of routine pathological methods. As DNA methylation patterns are known to be highly tissue specific, we aimed to develop a methylation-based algorithm to differentiate these entities. To this end, genome-wide methylation profiles of 600 primary pulmonary, colorectal, and upper gastrointestinal adenocarcinomas obtained from The Cancer Genome Atlas and the Gene Expression Omnibus database were used as a reference cohort to train a machine learning algorithm. The resulting classifier correctly classified all samples from a validation cohort consisting of 680 primary pulmonary, colorectal and upper gastrointestinal adenocarcinomas, demonstrating the ability of the algorithm to reliably distinguish these three entities. We then analyzed methylation data of 15 pulmonary enteric adenocarcinomas as well as four pulmonary metastases and four primary colorectal adenocarcinomas with the algorithm. All 15 pulmonary enteric adenocarcinomas were reliably classified as primary pulmonary tumors and all four metastases as well as all four primary colorectal cancer samples were identified as colorectal adenocarcinomas. In a t-distributed stochastic neighbor embedding analysis, the pulmonary enteric adenocarcinoma samples did not form a separate methylation subclass but rather diffusely intermixed with other pulmonary cancers. Additional characterization of the pulmonary enteric adenocarcinoma series using fluorescence in situ hybridization, next-generation sequencing and copy number analysis revealed KRAS mutations in nine of 15 samples (60%) and a high number of structural chromosomal changes. Except for an unusually high rate of chromosome 20 gain (67%), the molecular data was mostly reminiscent of standard pulmonary adenocarcinomas. In conclusion, we provide sound evidence of the pulmonary origin of pulmonary enteric adenocarcinomas and in addition provide a publicly available machine learning-based algorithm to reliably distinguish these tumors from metastatic colorectal cancer.
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Affiliation(s)
- Philipp Jurmeister
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany. .,Charité Comprehensive Cancer Center (CCCC), Berlin, Germany.
| | - Anne Schöler
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Alexander Arnold
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | - Frederick Klauschen
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dido Lenze
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | - Michael Hummel
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | - Leonille Schweizer
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hendrik Bläker
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | - Berit Maria Pfitzner
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | - Soulafa Mamlouk
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christine Sers
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Carsten Denkert
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Damian Stichel
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nikolaj Frost
- Department of Infectious Diseases and Pneumonology, Charité University Hospital Berlin, Berlin, Germany
| | - David Horst
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maximilian von Laffert
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - David Capper
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
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12
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Zhang J, Xiang C, Han Y, Teng H, Li X, Shao J, Zhu L, Han-Zhang H, Ye J, Yu K. Differential diagnosis of pulmonary enteric adenocarcinoma and metastatic colorectal carcinoma with the assistance of next-generation sequencing and immunohistochemistry. J Cancer Res Clin Oncol 2018; 145:269-279. [PMID: 30415301 DOI: 10.1007/s00432-018-2788-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/02/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Pulmonary enteric adenocarcinoma (PEAC), defined as tumors with an enteric component exceeding 50% and a histological morphology similar to colorectal cancer (CRC) and metastatic colorectal carcinoma (MCC), is an extremely rare primary lung adenocarcinoma, which was recently recognized by World Health Organization (WHO). Adenocarcinomas with intestinal differentiation have also been described in other anatomic sites, including paranasal sinuses, extrahepatic biliary tree, uterine and cervix, ovary. The morphologic spectrum and immunohistochemical profiles of PEAC overlap with those of colonic adenocarcinomas, the diagnosis of PEAC remains challenging. Currently, colonoscopy has to be performed to confirm the diagnosis, resulting in low compliance due to its invasiveness. Due to the rareness of PEAC, its molecular signature has not been comprehensively examined. METHODS In this study, we investigated the molecular signatures associated with PEAC and its histological counterparts, CRC and MCC using capture-based targeted sequencing. RESULTS We revealed that 12/13 (92.31%) PEAC patients harbored mutations in well-established driver genes for non-small cell lung cancer and none of them had mutations unique to CRC. Furthermore, 13/15 (86.7%) of MCC harbored mutations that are frequently seen in CRC. CONCLUSION Collectively, our study showed that PEAC, exhibiting a similar mutational profile with NSCLC, showed a distinctive signature from CRC and MCC. Furthermore, we derived a classification model, intergrading both IHC markers and genetic signature, to accurately diagnose PEAC.
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Affiliation(s)
- Jie Zhang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Chan Xiang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yuchen Han
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Haohua Teng
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Xiaojing Li
- Department of Pathology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Jinchen Shao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Lei Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | | | - Junyi Ye
- Burning Rock Biotech, Guangzhou, 510000, China
| | - Keke Yu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China.
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13
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Manucha V, Hansen JT, Gonzalez MF, Akhtar I. Role of cytology and immunochemistry in diagnosis of metastatic malignancies in the lung: A critical appraisal. Diagn Cytopathol 2018; 46:936-944. [PMID: 30353676 DOI: 10.1002/dc.24034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/04/2018] [Accepted: 06/07/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lung is one of the most common sites for primary and metastatic malignancies and a challenging site to diagnose primary versus a metastatic origin of the tumor on cytology. Pathologic diagnosis of the site of origin of cancer has major implications in the management and staging purposes and may have to be followed by testing for predictive/prognostic markers. The clinical history of a known extrapulmonary primary and the radiologic findings of multiple nodules in the lung are useful in arriving at the right diagnosis but is not always available. Rarely pulmonary metastasis may be the first manifestation of an extrapulmonary tumor or may even present as a single nodule. METHOD In this study, we reviewed cytomorphologic features of tumors metastatic to the lung (2014-2017) in conjunction with immunochemistry and evaluation of needle core biopsy when available. The review of the slides was performed with an emphasis on our ability to identify the site of origin in the tumors. RESULTS We identified 47 cases of metastatic tumors in the lung diagnosed on cytology. Clinical history was available in 83% cases and with aid of immunostains, a definitive diagnosis on the origin of the tumor was made in all these cases. In the remaining 8 cases, a primary origin could only be suggested. The use of immunochemistry facilitated the diagnosis but could be misleading. CONCLUSION The approach to the diagnosis of metastatic tumors in the lung on cytology should be largely guided by the previous clinical history and comparison with previous tissue/cellular material if available.
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Affiliation(s)
- Varsha Manucha
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jeffery T Hansen
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Maria F Gonzalez
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Israh Akhtar
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
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14
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Pulmonary Adenocarcinoma With Enteric Differentiation: Immunohistochemistry and Molecular Morphology. Appl Immunohistochem Mol Morphol 2018; 26:383-387. [DOI: 10.1097/pai.0000000000000440] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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15
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Chen M, Liu P, Yan F, Xu S, Jiang Q, Pan J, He M, Shen P. Distinctive features of immunostaining and mutational load in primary pulmonary enteric adenocarcinoma: implications for differential diagnosis and immunotherapy. J Transl Med 2018; 16:81. [PMID: 29587865 PMCID: PMC5870381 DOI: 10.1186/s12967-018-1449-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/15/2018] [Indexed: 02/08/2023] Open
Abstract
Background Primary pulmonary enteric adenocarcinoma (PEAC) is an extremely rare variant of invasive lung cancer. It is highly heterogeneous while shares some common morphologic and immunohistochemical features with usual pulmonary adenocarcinoma (PAC) and colorectal adenocarcinoma (CRAC), making the differential diagnosis difficult. At present there are only limited studies about distinctive features of primary PEAC and the results are often inconsistent. Methods We retrospectively analyzed total 129 primary PEACs and 50 CRACs that were published since 1991 or diagnosed in our centre. Among them eight typical samples of primary PEACs and usual PACs were detected by targeted exome sequencing. Results The combination of CK7+/CDX2+ acquires high sensitivity (71.3%) and specificity (82%) in differential diagnosis of PEACs from CRAC. The primary PEACs harbor a high incidence of KRAS mutation but almost absent of EGFR mutation. Moreover, compared with usual PACs, the primary PEACs have higher nonsynonymous tumor mutation burden and more frequent MMR mutation. Conclusions The combination of CK7+/CDX2+ immunostaining and the distinctive genetic signatures, including low incidence of sensitivity genes mutations and high tumor mutation burden, is an important supplementary to the clinical differential diagnosis of primary PEACs. Our findings thus have significant implications for development of individualized treatment strategy in these patients.
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Affiliation(s)
- Ming Chen
- Department of Medical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China.
| | - Pu Liu
- Department of Pathology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Feifei Yan
- Department of Medical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Suzhen Xu
- Department of Medical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Qi Jiang
- Department of Medical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Jingying Pan
- Department of Medical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Mengye He
- Department of Medical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China.
| | - Peng Shen
- Department of Medical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China.
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16
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Miyaoka M, Hatanaka K, Iwazaki M, Nakamura N. CK7/CK20 Double-Negative Pulmonary Enteric Adenocarcinoma With Histopathological Evaluation of Transformation Zone Between Enteric Adenocarcinoma and Conventional Pulmonary Adenocarcinoma. Int J Surg Pathol 2018; 26:464-468. [PMID: 29411669 DOI: 10.1177/1066896918756737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We report a rare case of pulmonary enteric adenocarcinoma (PEA) exhibiting a immunohistochemical feature of CK7/CK20 double-negativity by evaluating the transformation zone between PEA and conventional pulmonary adenocarcinoma (CPA). A 75-year-old man was found to have a mass, 40 mm in diameter, in the right lower lobe on chest computed tomography, and underwent right lower lobectomy. Histologically, the tumor was composed of a PEA and CPA component. The dominant PEA component had medium to large complex glands with tall columnar cells with eosinophilic cytoplasm and brush-border. The CPA component comprised small to medium glands with cuboidal cells. Moreover, intermediate glands (INT), which had cuboidal to tall columnar cells, with morphological features between PEA and CPA, was also observed in the transformation area. Immunohistochemically, the PEA component was negative for CK7, CK20, and TTF-1, and positive for CDX2 and SATB2 (weak): the CPA component was negative for CK20, CDX2, and SATB2, and positive for CK7 and TTF-1: the INT were negative for SATB2, with intermingled positive signals for CK7, CK20, TTF-1, and CDX2. The final diagnosis was PEA based on the CPA component and not colorectal carcinoma. To distinguish CK7-negative PEA from metastatic colorectal carcinoma, careful examination for a CPA component is very useful along with clinical information. There are no reports that discuss about process of oncogenesis, de novo sequence or transformation from CPA of PEA. This is the first reported case of CK7/CK20 double-negative PEA, with analysis of the transformation zone between PEA and CPA components.
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Affiliation(s)
- Masashi Miyaoka
- 1 Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | | | | | - Naoya Nakamura
- 1 Tokai University School of Medicine, Isehara, Kanagawa, Japan
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17
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Zhao L, Huang S, Liu J, Zhao J, Li Q, Wang HQ. Clinicopathological, radiographic, and oncogenic features of primary pulmonary enteric adenocarcinoma in comparison with invasive adenocarcinoma in resection specimens. Medicine (Baltimore) 2017; 96:e8153. [PMID: 28953659 PMCID: PMC5626302 DOI: 10.1097/md.0000000000008153] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/31/2017] [Accepted: 09/01/2017] [Indexed: 12/13/2022] Open
Abstract
Primary pulmonary enteric adenocarcinoma (PEAC) is a rare subtype of primary lung adenocarcinoma. However, it is not known whether there are any distinctive clinical or molecular features.PEACs were retrospectively identified in 28 patients from July 2014 to June 2016. We compared the clinicopathological, radiographic, and oncogenic characteristics of PEAC and primary pulmonary invasive adenocarcinoma (IAC).A total of 28 PEAC patients and 92 IAC patients were compared. PEAC occurred more frequently in males (P = .008), in older patients (P = .041), in those with larger lesions (P = .001), and in those in a more advanced stage (P = .011). Radiologically, PEAC patients had larger lesions (P = .025) and more solid (P = .006); however, there were no statistically significant differences in lobulation, spiculation, pleural indentation, pleural effusion, and lymphadenopathy between PEAC and IAC. PEAC had higher values of carcinoembryonic antigen (P = .008) and carbohydrate antigen 19-9 (P < .001) than IAC. PEAC had a higher incidence (40% vs 63%, P < .001) of Kristen rat sarcoma viral oncogene homolog (KRAS) mutations and a lower incidence (10.71% vs 3.3%, P < .001) of epidermal growth factor receptor (EGFR) mutations. Villin may be a useful marker in the differential diagnosis of PEAC. KRAS mutations occurred more frequently in PEACs, which are cytokeratin 7-negative (P = .032). EGFR mutation rates were higher in PEACs, which are cytokeratin 20- and caudal type homeobox transcription factor 2-negative (P = .041).PEAC is a rare and heterogeneous nonsmall-cell lung cancer subgroup with distinctive clinicopathological, radiographic, and molecular features. These results need to be further confirmed in future studies.
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18
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Matsushima J, Yazawa T, Suzuki M, Takahashi Y, Ota S, Nakajima T, Yoshino I, Yokose T, Inoue T, Kawahara K, Nakatani Y. Clinicopathological, immunohistochemical, and mutational analyses of pulmonary enteric adenocarcinoma: usefulness of SATB2 and β -catenin immunostaining for differentiation from metastatic colorectal carcinoma. Hum Pathol 2017; 64:179-185. [DOI: 10.1016/j.humpath.2017.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 12/18/2022]
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19
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Sun WW, Xu ZH, Wang CF, Wu F, Cao JM, Cui PJ, Huang W, Jin XL, Li B, Chen KM, Gao BL, Hu JA. Pulmonary enteric adenocarcinoma with pancreatic metastasis: A case report. Oncol Lett 2017; 13:4651-4656. [PMID: 28599465 DOI: 10.3892/ol.2017.6060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/07/2017] [Indexed: 01/28/2023] Open
Abstract
Pulmonary enteric adenocarcinoma is a markedly rare pathological type of lung adenocarcinoma. As the pancreas is a relatively uncommon site for metastasis, the present case is even more unusual. A 62-year-old male was admitted to hospital following the identification of masses in the left chest wall, right abdominal wall and right upper limb, but with no respiratory symptoms. Computed tomography (CT) of the chest revealed a lump in the lung and a mass in the left chest wall, and 18F-fluorodeoxyglucose (18F-FDG) uptake by the lumps was increased. An enhanced abdominal CT revealed a hypodense and homogeneous mass on the head of the pancreas, which was slightly enhanced compared with normal pancreatic tissue. In addition, the 18F-FDG uptake of the lesion was increased and the standardized uptake value (SUV) delayed was not evidently decreased compared with SUVearly. A number of other abnormal metabolic lesions were also identified using positron emission tomography/CT, whereas no abnormal 18F-FDG uptake was identified in the gastrointestinal organ. Furthermore, rectocolonoscopy was performed to exclude diagnosis of metastatic colorectal adenocarcinoma. The hematoxylin- and eosin-stained smears of the masses in the right lung and left chest demonstrated an enteric pattern, which shared morphological and immunohistochemical (IHC) features with those of colorectal adenocarcinoma. The IHC detection revealed that the lesions in the right lung were positive for cytokeratin 7 (CK7), and negative for CK20 and thyroid transcription factor 1 (TTF-1), and the expression of caudal type homeobox 2 (CDX2) was weakly positive; the masses in the left chest wall were positive for CK7, negative for TTF-1, and CK20 and CDX2 were weakly expressed.
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Affiliation(s)
- Wen-Wen Sun
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Zhi-Hong Xu
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Chao-Fu Wang
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Fang Wu
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Jiu-Mei Cao
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Pei-Jing Cui
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Wei Huang
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Xiao-Long Jin
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Biao Li
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Ke-Min Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Bei-Li Gao
- Department of Respiration, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Jia-An Hu
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China
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20
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El Hammoumi MM, El Ochi R, Kabiri EH. Adenocarcinoma primario de pulmón con morfología entérica asociado a un adenocarcinoma primario de colon. Arch Bronconeumol 2016; 52:221. [DOI: 10.1016/j.arbres.2015.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/27/2015] [Accepted: 05/14/2015] [Indexed: 11/29/2022]
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21
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A case of pulmonary enteric adenocarcinoma followed up as metastatic colorectal cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.2995/jacsurg.30.696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Garajová I, Funel N, Fiorentino M, Agostini V, Ferracin M, Negrini M, Frassineti GL, Gavelli G, Frampton AE, Biasco G, Giovannetti E. MicroRNA profiling of primary pulmonary enteric adenocarcinoma in members from the same family reveals some similarities to pancreatic adenocarcinoma-a step towards personalized therapy. Clin Epigenetics 2015; 7:129. [PMID: 26677401 PMCID: PMC4681170 DOI: 10.1186/s13148-015-0162-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/07/2015] [Indexed: 02/07/2023] Open
Abstract
Background Primary pulmonary enteric adenocarcinoma (PEAC) is defined as a pulmonary adenocarcinoma with a predominant component of intestinal differentiation and tumor cells positive for at least one intestinal marker. The aim of the present study was the molecular and histological characterization of a PEAC from a patient with two other family members affected by similar lung tumors, which has never been reported before. Findings We evaluated the molecular characteristics of the proband’s PEAC by using a previously validated 47-microRNA (miRNA) cancer-specific array and a predictive method to estimate tissue-of-origin probabilities. Immunohistochemical (IHC) staining for thyroid transcription factor (TTF-1), napsin A, caudal-related homeobox 2 (CDX2), cytokeratins, and mucins, as well as mutational analyses for epidermal growth factor receptor (EGFR), Kirsten rat sarcoma viral oncogene homolog (KRAS), and anaplastic lymphoma kinase (ALK) were performed on formalin-fixed, paraffin-embedded (FFPE) tissues. The occurrence of PEAC in two family members was associated with similar clinicopathological features (age at diagnosis, smoking habit, tumor localization, multiple colonic polyps), histologic findings (TTF-1 negativity and CDX2 positivity), and genetic findings (KRAS (Gly12Asp) mutation, but no EGFR/ALK aberrations). miRNA profiling revealed similarities with non-small cell lung cancer (NSCLC; 75.98 %) and some overlap with pancreatic ductal adenocarcinoma (PDAC; 23.34 %), but not with colorectal cancer (CRC; less than 0.5 %). Notably, these PEACs share key PDAC-associated miRNAs associated with tumor aggressiveness (miR-31*/-126*/-506/-508-3p/-514). Conclusions We describe for the first time PEAC in members from the same family, associated with similar clinical and genetic features. miRNA profiling of the PEAC resembled a NSCLC signature, with partial overlap to a PDAC pattern. This could explain its aggressive behavior and therefore help to guide future tailored-therapeutic approaches. Electronic supplementary material The online version of this article (doi:10.1186/s13148-015-0162-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingrid Garajová
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, CCA room 1.52, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.,Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Niccola Funel
- Division of General and Transplant Surgery, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy.,Cancer Pharmacology Lab, AIRC Start-Up Unit, University of Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Michelangelo Fiorentino
- Department of Pathology, F. Addari Institute, S.Orsola Malpighi Hospital, University of Bologna, Viale Ercolani 4/2, 40138 Bologna, Italy
| | - Valentina Agostini
- Department of Pathology, F. Addari Institute, S.Orsola Malpighi Hospital, University of Bologna, Viale Ercolani 4/2, 40138 Bologna, Italy
| | - Manuela Ferracin
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Borsari 46, 44121 Ferrara, Italy.,Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Massimo Negrini
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Borsari 46, 44121 Ferrara, Italy.,Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via Piero Maroncelli 40, 47014 Meldola, Italy
| | - Giampaolo Gavelli
- Department of Radiology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via Piero Maroncelli 40, 47014 Meldola, Italy
| | - Adam Enver Frampton
- HPB Surgical Unit, Department of Surgery & Cancer, Hammersmith Hospital Campus, Imperial College, Du Cane Road, London, W12 0HS UK
| | - Guido Biasco
- Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Elisa Giovannetti
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, CCA room 1.52, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.,Cancer Pharmacology Lab, AIRC Start-Up Unit, University of Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy.,Cancer Pharmacology Lab, Start-Up Unit, University of Pisa, via Paradisa 2, 56124 Pisa, Italy
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23
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Lin LI, Xu CW, Zhang BO, Liu RR, Ge FJ, Zhao CH, Jia RU, Qin QH, Stojsic J, Wang Y, Xu JM. Clinicopathological observation of primary lung enteric adenocarcinoma and its response to chemotherapy: A case report and review of the literature. Exp Ther Med 2015; 11:201-207. [PMID: 26889240 DOI: 10.3892/etm.2015.2864] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/26/2015] [Indexed: 12/18/2022] Open
Abstract
Primary lung enteric adenocarcinoma is a rare type of invasive lung carcinoma. Its morphology and immunohistochemistry are those of colorectal carcinoma, but there is no associated primary colorectal carcinoma. The present study describes the case of a 53-year-old female who presented with an irritating cough and a mass around the right sternoclavicular joint. Comprehensive evaluation revealed involvement of the mediastinum, lungs, right sternoclavicular joint and right kidney. Biopsies from the mediastinal and right sternoclavicular joint tumors showed features of adenocarcinoma. Immunohistochemistry was positive for cytokeratin (CK)20 and caudal type homeobox transcription factor 2, and negative for CK7, thyroid transcription factor-1 and napsin A. Genotypic analysis identified the expression of wild-type epidermal growth factor receptor, Kirsten rat sarcoma viral oncogene homolog, serine/threonine-protein kinase B-Raf and UDP-glucuronosyltransferase 1-1. There was no expression of echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase and a moderate expression of excision repair cross-complementation group 1, ribonucleoside-diphosphate reductase large subunit and tubulin β-3 chain. A strong expression of thymidylate synthase and 677TC genotype expression of methylenetetrahydrofolate reductase was observed. Gastroscopy, enteroscopy, colorectal colonoscopy and positron emission tomography-computed tomography failed to find evidence of a gastrointestinal malignancy and primary lung enteric adenocarcinoma was diagnosed. The presence of multiple metastases did not permit curative surgery. The patient was treated with 3 monthly cycles of the XELOX chemotherapy regimen; the response was poor with progression of supraclavicular lesions. Treatment was switched to the TP regimen for 4 monthly cycles, which resulted in a significant reduction in the size of the lung lesions; however, the supraclavicular lesion responded poorly to the treatment. The patient then received 2 cycles of the FOLFIRI regimen; however, the lung and right supraclavicular lesions progressed, causing increased right upper limb pain. The pain was alleviated by palliative surgery. Following surgery, the DP regimen was employed. Follow-up of the patient remains ongoing. The present findings suggest that the early diagnosis and treatment of primary lung enteric adenocarcinoma is likely to improve patient outcome.
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Affiliation(s)
- L I Lin
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Chun-Wei Xu
- Department of Pathology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - B O Zhang
- Department of Pathology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Rong-Rui Liu
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Fei-Jiao Ge
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Chuan-Hua Zhao
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - R U Jia
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Quan-Hong Qin
- Department of Pathology, Tianjin First Center Hospital, Tianjin 30000, P.R. China
| | - Jelena Stojsic
- Service of Histopathology, Clinical Centre of Serbia, Belgrade 11000, Serbia
| | - Yan Wang
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Jian-Ming Xu
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, P.R. China
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Immunostaining in Lung Cancer for the Clinician. Commonly Used Markers for Differentiating Primary and Metastatic Pulmonary Tumors. Ann Am Thorac Soc 2015; 12:429-35. [DOI: 10.1513/annalsats.201501-004fr] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Jessurun J. Intra-Alveolar Intestinal Epithelium: A Reappraisal of the So-Called Mucinous Goblet-Cell Rich Carcinoma Apropos of Two Cases With Prolonged Follow-up and Literature Review. Int J Surg Pathol 2015; 23:196-201. [PMID: 25627070 DOI: 10.1177/1066896915568992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary pulmonary mucin-rich lesions with abundant goblet cells growing within alveolar spaces are either classified as mucinous adenocarcinoma (previously called mucinous bronchioloalveolar carcinoma) or colloid carcinoma. Some of these lesions display a morphologic pattern characterized by paucicellular discontinuous patches of nonatypical colonic type epithelium attached to alveolar walls without evidence of invasion. Immunohistochemically, these epithelial patches express an intestinal immunophenotype (CD20+, CDX-2+, CK7-, TTF-1-). None of the lesions so far reported with these histological and immunohistochemical characteristics have recurred or metastasized. Herein we describe 2 patients with this type of intra-alveolar mucinous lesions who have been meticulously followed-up for 9 and 14 years, respectively, without evidence of disease progression. Based on their histologic appearance, immunoreactivity, and on the presence of occasional CDX-2 expressing cells in terminal airways adjacent to the lesions, we propose alternative interpretations of the mucin-producing epithelium. More important, a separate provisional category for these lesions is suggested that eliminates their force inclusion as adenocarcinomas.
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Affiliation(s)
- Jose Jessurun
- New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
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László T, Lacza Á, Tóth D, Molnár TF, Kálmán E. Pulmonary enteric adenocarcinoma indistinguishable morphologically and immunohistologically from metastatic colorectal carcinoma. Histopathology 2014; 65:283-7. [DOI: 10.1111/his.12403] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Terézia László
- Department of Pathology; Medical Faculty of Pécs University; Pécs Hungary
| | - Ágnes Lacza
- Department of Pathology; Medical Faculty of Pécs University; Pécs Hungary
| | - Dénes Tóth
- Department of Forensic Medicine; Medical Faculty of Pécs University; Pécs Hungary
| | - Tamás F Molnár
- Department of Thoracic Surgery; County Hospital Győr; Petz Aladár Hospital; Győr Hungary
- Department of Operational Medicine; Medical Faculty of Pécs University; Pécs Hungary
| | - Endre Kálmán
- Department of Pathology; Medical Faculty of Pécs University; Pécs Hungary
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Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, Ishikawa Y, Wistuba I, Flieder DB, Franklin W, Gazdar A, Hasleton PS, Henderson DW, Kerr KM, Nakatani Y, Petersen I, Roggli V, Thunnissen E, Tsao M. Diagnosis of lung adenocarcinoma in resected specimens: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Arch Pathol Lab Med 2013; 137:685-705. [PMID: 22913371 DOI: 10.5858/arpa.2012-0264-ra] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A new lung adenocarcinoma classification has been published by the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society. This new classification is needed to provide uniform terminology and diagnostic criteria, most especially for bronchioloalveolar carcinoma. It was developed by an international core panel of experts representing all 3 societies with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons.This summary focuses on the aspects of this classification that address resection specimens. The terms bronchioloalveolar carcinoma and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced, such as adenocarcinoma in situ and minimally invasive adenocarcinoma for small solitary adenocarcinomas with either pure lepidic growth (adenocarcinoma in situ) and predominant lepidic growth with invasion of 5 mm or less (minimally invasive adenocarcinoma), to define the condition of patients who will have 100% or near 100% disease-specific survival, respectively, if they undergo complete lesion resection. Adenocarcinoma in situ and minimally invasive adenocarcinoma are usually nonmucinous, but rarely may be mucinous. Invasive adenocarcinomas are now classified by predominant pattern after using comprehensive histologic subtyping with lepidic (formerly most mixed subtype tumors with nonmucinous bronchioloalveolar carcinoma), acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype. Variants include invasive mucinous adenocarcinoma (formerly mucinous bronchioloalveolar carcinoma), colloid, fetal, and enteric adenocarcinoma.It is possible that this classification may impact the next revision of the TNM staging classification, with adjustment of the size T factor according to only the invasive component pathologically in adenocarcinomas with lepidic areas.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Lin D, Zhao Y, Li H, Xing X. Pulmonary enteric adenocarcinoma with villin brush border immunoreactivity: a case report and literature review. J Thorac Dis 2013; 5:E17-20. [PMID: 23372961 DOI: 10.3978/j.issn.2072-1439.2012.06.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 05/15/2012] [Indexed: 01/15/2023]
Abstract
Pulmonary enteric adenocarcinoma, a rare histologic type of primary pulmonary adenocarcinoma with only 16 cases reported to date, has to be differentiated from metastatic colorectal carcinoma. Here we report a case of pulmonary enteric adenocarcinoma which shows villin immunoreactivity in the brush border of tumor cells. As a marker for gastrointestinal adenocarcinoma, villin has been rarely found positive like this pattern in pulmonary adenocarcinomas. This case suggests brush border immunoreactivity of villin is possible in some cases of pulmonary enteric adenocarcinomas. We suggest pathological practitioners pay attention to it.
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Affiliation(s)
- Dongliang Lin
- Department of Pathology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China
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Powell M, Pfannl R, Nystrom JS. Looks like lung cancer acts like colon cancer. Clin Colorectal Cancer 2012; 12:140-4. [PMID: 23083633 DOI: 10.1016/j.clcc.2012.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 08/26/2012] [Accepted: 09/13/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Martha Powell
- Floating Hospital for Children, Department Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA 02111, USA
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Abstract
Napsin A is an aspartic protease present in the epithelial cells of the lung and kidney. Recent studies have shown that, in lung tumors, napsin A expression is restricted to lung adenocarcinomas, whereas among renal tumors, it is frequently expressed in renal cell carcinomas, especially the papillary and clear cell subtypes. Owing to its restricted expression, napsin A is a useful marker that can assist in the diagnosis of both lung adenocarcinomas and renal cell carcinomas.
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Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JHM, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D, Franklin W, Gazdar A, Gould M, Hasleton P, Henderson D, Johnson B, Johnson D, Kerr K, Kuriyama K, Lee JS, Miller VA, Petersen I, Roggli V, Rosell R, Saijo N, Thunnissen E, Tsao M, Yankelewitz D. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011; 6:244-85. [PMID: 21252716 PMCID: PMC4513953 DOI: 10.1097/jto.0b013e318206a221] [Citation(s) in RCA: 3464] [Impact Index Per Article: 266.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Adenocarcinoma is the most common histologic type of lung cancer. To address advances in oncology, molecular biology, pathology, radiology, and surgery of lung adenocarcinoma, an international multidisciplinary classification was sponsored by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small nonresection cancer specimens, and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies. METHODS An international core panel of experts representing all three societies was formed with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons. A systematic review was performed under the guidance of the American Thoracic Society Documents Development and Implementation Committee. The search strategy identified 11,368 citations of which 312 articles met specified eligibility criteria and were retrieved for full text review. A series of meetings were held to discuss the development of the new classification, to develop the recommendations, and to write the current document. Recommendations for key questions were graded by strength and quality of the evidence according to the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS The classification addresses both resection specimens, and small biopsies and cytology. The terms BAC and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced such as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) for small solitary adenocarcinomas with either pure lepidic growth (AIS) or predominant lepidic growth with ≤ 5 mm invasion (MIA) to define patients who, if they undergo complete resection, will have 100% or near 100% disease-specific survival, respectively. AIS and MIA are usually nonmucinous but rarely may be mucinous. Invasive adenocarcinomas are classified by predominant pattern after using comprehensive histologic subtyping with lepidic (formerly most mixed subtype tumors with nonmucinous BAC), acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype. Variants include invasive mucinous adenocarcinoma (formerly mucinous BAC), colloid, fetal, and enteric adenocarcinoma. This classification provides guidance for small biopsies and cytology specimens, as approximately 70% of lung cancers are diagnosed in such samples. Non-small cell lung carcinomas (NSCLCs), in patients with advanced-stage disease, are to be classified into more specific types such as adenocarcinoma or squamous cell carcinoma, whenever possible for several reasons: (1) adenocarcinoma or NSCLC not otherwise specified should be tested for epidermal growth factor receptor (EGFR) mutations as the presence of these mutations is predictive of responsiveness to EGFR tyrosine kinase inhibitors, (2) adenocarcinoma histology is a strong predictor for improved outcome with pemetrexed therapy compared with squamous cell carcinoma, and (3) potential life-threatening hemorrhage may occur in patients with squamous cell carcinoma who receive bevacizumab. If the tumor cannot be classified based on light microscopy alone, special studies such as immunohistochemistry and/or mucin stains should be applied to classify the tumor further. Use of the term NSCLC not otherwise specified should be minimized. CONCLUSIONS This new classification strategy is based on a multidisciplinary approach to diagnosis of lung adenocarcinoma that incorporates clinical, molecular, radiologic, and surgical issues, but it is primarily based on histology. This classification is intended to support clinical practice, and research investigation and clinical trials. As EGFR mutation is a validated predictive marker for response and progression-free survival with EGFR tyrosine kinase inhibitors in advanced lung adenocarcinoma, we recommend that patients with advanced adenocarcinomas be tested for EGFR mutation. This has implications for strategic management of tissue, particularly for small biopsies and cytology samples, to maximize high-quality tissue available for molecular studies. Potential impact for tumor, node, and metastasis staging include adjustment of the size T factor according to only the invasive component (1) pathologically in invasive tumors with lepidic areas or (2) radiologically by measuring the solid component of part-solid nodules.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Fujita A, Nakazato Y, Tachibana K, Kazama T, Sato K, Minato K. A Case of Pulmonary Adenocarcinoma with Enteric Differentiation. ACTA ACUST UNITED AC 2011. [DOI: 10.2482/haigan.51.188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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