Volume fraction of dense-core granules correlates strongly with survival in disseminated (stage IV) neuroendocrine cell carcinomas of the lung of the well differentiated and small cell subtypes

Autopsy-proven determinants of immediate fire death in lungs

In immediate fire deaths, pulmonary injury may be the main source of mortality, being important to document the histologic findings for the purpose of excluding other modes of death, such as from asphyxia with no gross findings. In this context, a group of morphologic determinants have been targeted with useful makers of pulmonary injury. To facilitate the determination of whether an individual was deceased before the start of a fire and validate the importance of parenchymal alterations in pulmonary injury in fire deaths, we studied lungs in victims of fire (N = 28) and suffocation (N = 40), creating a mathematical model using cluster analysis. For this purpose, a semiquantitative analysis of the distal parenchyma was performed to evaluate the amount of bronchiolar dilatation, overinsufflation (ductal and alveolar), collapse (ductal and alveolar), passive congestion, alveolar edema, and hemorrhage (interstitial and alveolar). These 7 histologic determinants were useful to discriminate fire (bronchiolar dilatation, ductal overinsuflation, alveolar overinsuflation, alveolar hemorrhage) from suffocation lung injuries (alveolar collapse, congestion, and edema). We conclude that these determinants should be included in the routine of forensic pathology.

Using electron microscopy and multivariate cluster analysis to determine diagnosis and prognosis in cases of neuroendocrine lung carcinoma

OBJECTIVE

To establish reproducible electron microscopic criteria for identifying the four major types of neuroendocrine tumors of the lung: carcinoid; atypical carcinoid; large cell neuroendocrine carcinoma; and small cell carcinoma.

METHODS

Measurements were made on electron micrographs using a digital image analyzer. Sixteen morphometric variables related to tumor cell differentiation were assessed in 27 tumors. The examination under electron microscopy revealed that all of the tumors could be classified as belonging to one of the four categories listed above. Cluster analysis of the morphometry variables was used to group the tumors into three clusters, and Kaplan-Meier survival function curves were employed in order to draw correlations between each cluster and survival.

RESULTS

All three clusters of neuroendocrine carcinomas were found to be associated with survival curves, demonstrating the prognostic significance of electron microscopic features. The tumors fell into three well-defined clusters, which represent the spectrum of neuroendocrine differentiation: typical carcinoid (cluster 1); atypical carcinoid and large cell neuroendocrine carcinoma (cluster 2); and small cell carcinoma (cluster 3). Cluster 2 represents an intermediate step in neuroendocrine carcinogenesis, between typical carcinoid tumors and small cell carcinomas.

CONCLUSIONS

Our findings confirm that electron microscopy is useful in making the diagnosis and prognosis in cases of lung tumor.

Well-Differentiated Neuroendocrine Carcinomas: The Spectrum of Histologic Subtypes and Various Clinical Behaviors

The term "well-differentiated neuroendocrine carcinoma" was coined to describe a variety of demonstrably neuroendocrine tumors which were more aggressive (both with respect to their histologic appearance and their clinical course) than (typical) bronchial carcinoids but were also clearly distinguishable from small cell neuroendocrine carcinomas. This umbrella term encompasses a variety of tumors previously described by a variety of terms including "atypical" carcinoids, "malignant tumorlets," peripheral stage I small-cell carcinoma, as well as neoplasms described simply as "undifferentiated carcinoma" (prior to the recognition of their neuroendocrine properties). As such, this term is a broad term and is not simply synonymous with "atypical carcinoid." Over time, at least 3 subtypes have been identified based upon their histologic appearance and mitotic index, with correspondingly aggressive clinical courses.

Neuroendocrine and biologic features of primary tumors and tissue in pulmonary large cell carcinomas

BACKGROUND

Because biological behavior in lung tumors with neuroendocrine differentiation is highly dependent on cell death (apoptosis) and angiogenesis, p21(waf1/cip1) and microvessel density have been targeted as potentially useful tumor markers. We sought to validate the importance of p21(waf1/cip1) and microvessel density and study their interrelationship, analyzing clinical factors, subclassifications, and tumor and stromal markers.

METHODS

We examined p21(waf1/cip1) and other markers in tissue from 61 patients with surgically excised large cell carcinomas. The amount of tumor staining for p21(waf1/cip1) and microvessel density was evaluated by immunohistochemistry and morphometry. The study outcome was survival time until death from recurrent lung cancer.

RESULTS

Multivariate Cox model analysis demonstrated that after surgical excision, histologic subtypes were significantly related to survival time (p = 0.02), but quantitative staining of the tumor for p21(waf1/cip1) and microvessel density added prognostic information and these variables were more strongly prognostic than histologic subtype (p = 0.00). Cut points at the median staining of 3.5% and 3.0% for p21(waf1/cip1) and microvessel density, respectively, divided patients into two groups with distinctive survival times. Patients with p21(waf1/cip1) staining of more than 3.5% and microvessel density staining of more than 3.0% had a median survival time of 14 months.

CONCLUSIONS

Tumor staining for p21(waf1/cip1) and microvessel density in resected large cell carcinomas and certain other types of lung tumors was strongly related to survival. Patients with more than 3.0% staining in their tumors were at high risk of death from lung cancer and may be an appropriate target for prospective studies of adjuvant chemotherapy after surgical resection.

Tumour cell and stromal features in metastatic and non-metastatic non-small cell lung carcinomas

AIMS

Tumour cell behaviour depends on the interactions between nuclear genetic changes in the malignant cells and a stroma favourable for growth, invasion and metastasis. To evaluate such interactions, we studied the relationship between tumour cell and stromal features for proliferative factors, p53, microvessel density and metalloproteinases, controlled for the extent of the primary lesion (T1 to T4), in early (non-metastatic) and late (metastatic) non-small cell lung carcinomas (NSCLC).

METHODS AND RESULTS

Variables were examined for differences and correlations in the frequency of p53, AgNOR, CD34 and MMP-9 expression in primary lesions and metastases of NSCLC using a general linear model. The patients included 58 males and 22 females (mean age 62 +/- 9 years) with 19 T1 (23.8%), 40 T2 (50.0%), 14 T3 (17.5%) and seven T4 (8.8%). In late disease, AgNOR and p53 were statistically related to the extent of the primary lesion, whereas in early disease AgNOR tended to be increased in tumours without metastasis, while p53 expression tended to decrease progressively in tumours with metastasis. Microvessel density in late disease was of no statistical significance, whereas in early disease strong CD34 expression was seen in tumours with metastasis, being at its maximum in T3 primary lesions. The best marker for the extent of the lesion and its progression was MMP-9, with greater expression by tumours with metastasis than those without.

CONCLUSIONS

Different tumour cell and stromal interactions control metastasis and therefore the biological risk of NSCLC. A panel of molecular markers, such as p53, MMP-9 and CD34 could help to identify subgroups of patients that could benefit from adjuvant therapy.

Neuroendocrine tumors of the bronchopulmonary tract: a reappraisal of their classification after 20 years

This article is an overview of the classification of pulmonary neuroendocrine neoplasms, their presentation, their pathologic appearance, and their clinical management. In addition, the original classification, based on histologic features, is reassessed in the light of newer areas in study, including neurosecretory products, neuroendocrine markers, ultrastructural studies, ploidy analysis, cell adhesion markers, apoptosis, oncogene mutation analysis, and genetic alterations. The histologic classification proposed in 1983 remains the single most valuable factor in establishing the diagnosis and, together with the TNM status, the prognosis of this group of interesting neoplasms.

Entendendo o papel de marcadores biológicos no câncer de pulmão

Marcadores biológicos são componentes celulares, estruturais e bioquímicos, que podem definir alterações celulares e moleculares tanto em células normais quanto aquelas associadas a transformação maligna. Podem ser de dois tipos: 1) marcadores intermediários, que medem alterações celulares e moleculares antes do aparecimento da malignidade; 2) marcadores diagnósticos, presentes em associação com a malignidade. O processo de identificação e validação para uso clínico do marcador tem diversas etapas: identificação inicial feita em linhagens celulares do tumor em questão; teste do marcador em tecido proveniente de biópsias de pacientes com diagnóstico estabelecido do tumor em questão; teste em biópsias de tecidos normais e com processo inflamatório; teste em escarro, sangue ou urina para validação como teste não-invasivo que possa ser usado em população de alto risco. Marcadores biológicos diagnósticos sorológicos e histológicos são componentes celulares, estruturais e bioquímicos, presentes não só em células tumorais como também em células normais, que podem ser medidos quantitativamente por métodos bioquímicos, imunológicos e moleculares nos fluidos ou nos tecidos corporais, respectivamente, associados a neoplasias e possivelmente ao órgão de origem da neoplasia. Marcadores biológicos são estudados em diferentes neoplasias primárias, porém poucos tiveram seu valor clínico definido. O papel dos marcadores biológicos em câncer de pulmão ainda é incerto, pois apenas um pequeno número de marcadores foi avaliado de maneira adequada. O objetivo deste trabalho é entender o papel dos marcadores biológicos sorológicos e diagnósticos no prognóstico e sobrevida de pacientes com câncer de pulmão baseado em uma coletânea de trabalhos realizada pela autora. Apresenta-se também uma perspectiva futura para a detecção precoce do câncer de pulmão baseada no papel dos marcadores biológicos intermediários.

Stereological estimates of nuclear star volume and vessels as predictors of chemotherapy response in small cell carcinoma of the lung: a preliminary report

AIMS

This study was designed to evaluate the role of morphometric and clinical parameters in predicting chemotherapy responder patients with small cell carcinoma of the lung.

METHODS AND RESULTS

Morphometric studies were performed by means of point counting techniques. Forty-six patients were included in this study. Group 1 patients (n = 19) were those without response to chemotherapy; Group 2 (n = 27) was composed by patients with partial or complete response to chemotherapy. Logistic regression analysis was used to attain the best separation of non-responder from responder patients. Star volume of the nuclei and vessel were selected during the backward procedure as relevant variables to characterize the two groups of patients. The overall sensitivity of the model was 80.43%.

CONCLUSIONS

Our results indicate that histopathological data may help to predict the chemotherapy response in patients with small cell lung carcinoma, and encourage the use of morphometric procedures in histopathological analysis of this type of lung tumours.

Morphometric applications in anatomic pathology

The components of the cell and tissue changes in many diseases are variable and can therefore be quantified. Characterization of these quantitative changes provides data that is useful not only for making a definitive, cell- and tissue-based diagnosis of disease, but also for predicting the course of disease. The spectrum of changes found in malignant tumors, ie, cell grade, architecture, cellularity, extent of invasion, nature and extent of inflammatory reaction, exemplify this range of quantifiable features. The diagnosis and prognosis of nonneoplastic diseases, ie, myopathy and metabolic bone disease, can also be determined by quantitating tissue changes. Morphometry is the quantification of changes in the "objects" of tissues, ie, cells and organelles, and their organization, using quantitative evaluation tools. The principles of morphometry have been known for a century. With the increasing availability of affordable, powerful computer systems and increasingly flexible and user-friendly software has come easier ability to measure these changes. This article discusses the principles of morphometry with illustrations of types of analysis (ie, area fraction, object counting, shape and size analyses, and mutliparametric analyses) using examples of these applications with discussions of error sources and limitations of morphometry.