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Marghescu AȘ, Leonte DG, Radu AD, Măgheran ED, Tudor AV, Teleagă C, Țigău M, Georgescu L, Costache M. Atypical Histopathological Aspects of Common Types of Lung Cancer-Our Experience and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:112. [PMID: 38256374 PMCID: PMC10818882 DOI: 10.3390/medicina60010112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Lung cancer is among the most common oncological diseases regarding incidence and mortality, with most of these having epithelial origins. Pathological reporting of these tumors is conducted according to the 5th edition of the World Health Organisation (WHO) classification of thoracic tumours. This study aims to draw the pathologist's attention to four rare, atypical microscopic aspects that some of the most common types of lung malignancies reveal upon standard evaluation (hematoxylin-eosin stain) that make histopathological diagnosis challenging: acantholytic, pseudoangiosarcomatous, signet ring cell, and clear cell features. Each of these aspects was exemplified by a case diagnosed in the pathology department of the "Marius Nasta" Institute. Furthermore, we analyzed the classification dynamics of different WHO editions and used PubMed to review articles written in English and published in the last eleven years on this subject. Pathologists should be familiar with these unusual aspects to avoid misdiagnoses and to ensure the correct classification of tumors, which is extremely important because these tumor phenotypes have been associated with specific molecular alterations and a worse clinical evolution. There is a need to clarify the histogenesis and associated genetic mutations, given the fact that the rarity of these tumor phenotypes makes their study difficult. Some authors consider these to be overlapping entities; however, we do not encourage this, as they may exhibit different prognoses and various molecular alterations with important therapeutic implications. The signet ring cell feature was associated with ALK rearrangement in lung adenocarcinoma; thus, these patients can benefit from tailored therapy with ALK-tyrosine kinase inhibitors (ALK-TKI). Recent studies associated clear cell morphology with FGFR3-TACC3 fusion, suggesting that patients with this diagnosis may be potentially eligible for FGFR inhibitors. We described, for the first time, the pseudoangiosarcomatous pattern in a case of lung adenocarcinoma; to our knowledge this aspect has only been described until now in the context of squamous cell carcinomas.
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Affiliation(s)
- Angela-Ștefania Marghescu
- Research Department, “Marius Nasta” Institute of Pneumophthisiology, 050159 Bucharest, Romania; (A.D.R.); (C.T.); (M.Ț.); (L.G.)
- Pathology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Diana Gabriela Leonte
- Pathology Department, “Marius Nasta” Institute of Pneumophthisiology, 050159 Bucharest, Romania; (D.G.L.); (E.D.M.); (A.V.T.)
| | - Alexandru Daniel Radu
- Research Department, “Marius Nasta” Institute of Pneumophthisiology, 050159 Bucharest, Romania; (A.D.R.); (C.T.); (M.Ț.); (L.G.)
| | - Elena Doina Măgheran
- Pathology Department, “Marius Nasta” Institute of Pneumophthisiology, 050159 Bucharest, Romania; (D.G.L.); (E.D.M.); (A.V.T.)
| | - Adrian Vasilică Tudor
- Pathology Department, “Marius Nasta” Institute of Pneumophthisiology, 050159 Bucharest, Romania; (D.G.L.); (E.D.M.); (A.V.T.)
| | - Cristina Teleagă
- Research Department, “Marius Nasta” Institute of Pneumophthisiology, 050159 Bucharest, Romania; (A.D.R.); (C.T.); (M.Ț.); (L.G.)
| | - Mirela Țigău
- Research Department, “Marius Nasta” Institute of Pneumophthisiology, 050159 Bucharest, Romania; (A.D.R.); (C.T.); (M.Ț.); (L.G.)
| | - Livia Georgescu
- Research Department, “Marius Nasta” Institute of Pneumophthisiology, 050159 Bucharest, Romania; (A.D.R.); (C.T.); (M.Ț.); (L.G.)
| | - Mariana Costache
- Pathology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
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Vivek V, Nandy K, Bhatt S, Shah RA. Pseudovascular Adenoid Squamous Cell Carcinoma of Buccal Mucosa-a Rare Aggressive Variant. Indian J Surg Oncol 2021; 12:311-314. [PMID: 34295075 DOI: 10.1007/s13193-021-01335-3] [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: 05/12/2020] [Accepted: 04/20/2021] [Indexed: 11/28/2022] Open
Abstract
Pseudo-vascular adenoid squamous cell carcinoma (PASCC) is an uncommon histological variant. It is characterized by an acantholysis of the tumor cells and the formation of anastomosing spaces and channels. It gives a false appearance of glandular differentiation mimicking angiosarcoma. PASCC has been reported in the head and neck, as well as in other organs like the breast, lungs, urinary bladder, vulva, and the uterine cervix. We report a case of PASCC of the oral cavity in a recently operated case of squamous cell carcinoma of the buccal mucosa.
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Affiliation(s)
- V Vivek
- Department of Surgical Oncology Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India.,Thrissur, India
| | - Kunal Nandy
- Department of Surgical Oncology Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India
| | - Supreet Bhatt
- Department of Surgical Oncology Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India
| | - Rujuta Ankit Shah
- Department of Onco-pathology Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India
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Lin Y, Lin J, Xu Y, Sun H, Xie S. Uncontrollable Hemoptysis owing to Pseudoangiosarcomatous Carcinoma of the Lung. Am J Respir Crit Care Med 2021; 204:e1-e2. [PMID: 33626313 DOI: 10.1164/rccm.202004-1307im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Jie Lin
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
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Yorita K, Tsuji K, Takano Y, Kuroda N, Sakamoto K, Arii K, Yoshimoto Y, Nakatani K, Ito S. Acantholytic squamous cell carcinoma of the lung with marked lymphogenous metastases and high titers of myeloperoxidase-antineutrophil cytoplasmic antibodies: a case report. BMC Cancer 2018; 18:300. [PMID: 29548309 PMCID: PMC5857100 DOI: 10.1186/s12885-018-4218-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 03/13/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Acantholytic squamous cell carcinoma (ASQCC), histologically characterized by intercellular bridge loosening, is recognized as a rare variant of squamous cell carcinoma (SQCC). ASQCC may demonstrate a worse prognosis than conventional SQCC. Pulmonary ASQCC is particularly rare; its biological behavior and prognostic data have not been reported. CASE PRESENTATION We report the clinical and autopsy findings of a 71-year-old Japanese man with pulmonary ASQCC. Pulmonary lesions, suggestive of idiopathic interstitial pneumonia, were radiologically observed 3 and 6 years prior to the patient's most recent hospitalization; however, the patient did not undergo further medical examinations. Upon being discovered unconscious, the patient was admitted to our hospital. Dehydration and lower limb muscle weakness were noted, as were laboratory findings of coagulation abnormalities and renal dysfunction. Computed tomography helped confirm a 21-mm peripheral nodule in the upper left lobe of the lung, with associated swollen lymph nodes in the bilateral hilar, mediastinal, and para-aortic regions. Brain and spinal lesions, suggestive of neurological disturbances, were not found. Small cell lung carcinoma was suspected, upon admission, but high serum levels of squamous cell carcinoma antigen and cytokeratin-19 fragments were present. Therefore, advanced lung cancer, possibly SQCC, was diagnosed. The patient was treated with best supportive therapy, and died one month after admission. Hypercalcemia and high serum levels of parathyroid hormone-related protein (PTHrP) and myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titers were observed. Progressive renal insufficiency was absent due to improved renal function subsequent to hydration. An autopsy helped confirm the left lung tumor as an ASQCC associated with pulmonary lymphangitic carcinomatosis and multiple metastases in the lungs and lymph nodes. Skin lesions suggesting malignant tumors were absent. The metastatic lesions consisted largely of acantholytic tumor cells, and the lungs showed usual interstitial pneumonia pattern; vasculitis was absent. CONCLUSIONS This is the first reported case of pulmonary ASQCC resulting in an aggressive clinical course, with marked lymphogenous metastases and PTHrP-associated hypercalcemia. The high serum MPO-ANCA titers were clinicopathologically insignificant, but may have been related to the pulmonary interstitial lesion. Pulmonary ASQCC represents a highly malignant subset of lung cancer.
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Affiliation(s)
- Kenji Yorita
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562 Japan
| | - Kazuya Tsuji
- Department of Internal Medicine, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562 Japan
| | - Yoko Takano
- Department of Internal Medicine, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562 Japan
| | - Naoto Kuroda
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562 Japan
| | - Kei Sakamoto
- Department of Internal Medicine, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562 Japan
| | - Kaoru Arii
- Department of Internal Medicine, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562 Japan
| | - Yukio Yoshimoto
- Department of Internal Medicine, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562 Japan
| | - Kimiko Nakatani
- Department of Radiology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562 Japan
| | - Satoshi Ito
- Department of Radiology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562 Japan
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Yıldız P, Behzatoğlu K, Hacıhasanoğlu E, Okcu O, Durak H, Yücetaş U. Histological, immunohistochemical features and pathogenesis of pseudoangiosarcomatous urothelial carcinoma. Ann Diagn Pathol 2017; 30:17-20. [PMID: 28965623 DOI: 10.1016/j.anndiagpath.2017.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/07/2017] [Accepted: 05/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Pelin Yıldız
- Department of Pathology, Medical Faculty, Bezmialem University, Istanbul, Turkey
| | - Kemal Behzatoğlu
- Department of Pathology, Istanbul Education and Research Hospital, Ministry of Health, Istanbul, Turkey.
| | - Ezgi Hacıhasanoğlu
- Department of Pathology, Istanbul Education and Research Hospital, Ministry of Health, Istanbul, Turkey
| | - Oğuzhan Okcu
- Department of Pathology, Medical Faculty, RTEU Rize Education and Research Hospital, Rize, Turkey
| | - Haydar Durak
- Department of Pathology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Uğur Yücetaş
- Department of Urology, Istanbul Education and Research Hospital, Ministry of Health, Istanbul, Turkey
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Abid N, Mnif H, Charfi S, Turki H, Sallemi-Boudawara T. [Pseudoangiosarcomatous squamous cell carcinoma of the skin]. Presse Med 2012; 42:1063-5. [PMID: 23062363 DOI: 10.1016/j.lpm.2012.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/19/2012] [Indexed: 11/24/2022] Open
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