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Mogavero A, Bironzo P, Righi L, Merlini A, Benso F, Novello S, Passiglia F. Deciphering Lung Adenocarcinoma Heterogeneity: An Overview of Pathological and Clinical Features of Rare Subtypes. Life (Basel) 2023; 13:1291. [PMID: 37374074 DOI: 10.3390/life13061291] [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: 03/29/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Lung cancer is one of the most frequently diagnosed cancers worldwide and the leading cause of cancer-related death. The 2021 World Health Organization (WHO) classification provided a detailed and updated categorization of lung adenocarcinomas with a special focus on rare histological types, including enteric, fetal and colloid types, as well as not otherwise specified adenocarcinoma, overall accounting for about 5-10% of all cases. However, rare entities are nowadays difficult to diagnose in most centers, and evidence of optimal therapeutic management for these patients is still lacking. In recent years, increasing knowledge about the mutational profile of lung cancer, in addition to the spreading diffusion of next-generation sequencing (NGS) in different centers, have been helpful in the identification of rare variants of lung cancer. Hence, the hope is that several new drugs will be available in the near future to treat these rare lung tumors, such as in targeted therapy and immunotherapy, which are often used in clinical practice for several malignancies. The aim of this review is to summarize the current knowledge about the molecular pathology and clinical management of the most common rare adenocarcinoma subtypes in order to provide a concise and updated report that can drive clinicians' choices in their routine practice.
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Affiliation(s)
- Andrea Mogavero
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Paolo Bironzo
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Luisella Righi
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Alessandra Merlini
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Federica Benso
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
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Immunoexpression of CDX2 in metastatic nonintestinal adenocarcinomas: an immunohistochemical pitfall and its pathological implications. SURGICAL AND EXPERIMENTAL PATHOLOGY 2023. [DOI: 10.1186/s42047-023-00129-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Abstract
Background
CDX2, a homeobox gene is the marker of intestinal differentiation. Its expression may lead to misdiagnosis while evaluating metastasis from unknown primary. In the present narrative, we discuss the clinical, morphological, and immunohistochemical (IHC) findings of metastatic adenocarcinoma of the lymph node that displayed nuclear immunoexpression of CDX2. However, the clinical and radiological picture supported the non-intestinal primary; prostate in one and lung in the other.
Case presentation
A 68-year-old man presented cervical lymph node enlargement. An epithelial tumor with acinar and cribriform pattern was seen that showed expression of CK, CDX2, and PSA in IHC. The patients complained of nonspecific symptoms related to both the gastrointestinal system and the prostate. Serum PSA was diagnostic (> 500 ng/ml). Similarly, core biopsy from mediastinal lymph node from a 51-year-male was received with possible differential of cancer and tuberculosis. Moderately differentiated adenocarcinoma was observed with the expression of EMA, CK 7, CDX2, and TTF1. The expression of both CDX2 and TTF1 was patchy. When the patient was called and all the details were sought the computed tomography (CT) thorax showed a lower chest wall lesion and multiple metastasis. The case was hence signed off as primary from lung on basis of clinical picture.
Conclusion
Such deviants must be reported and recorded. The knowledge of these will make a pathologist cautious and thus avoid misdiagnosis.
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Kogita Y, Ose N, Kawagishi K, Morii E, Shintani Y. Resection of a colloid adenocarcinoma of the lung: A case report. Respirol Case Rep 2023; 11:e01109. [PMID: 36844793 PMCID: PMC9944051 DOI: 10.1002/rcr2.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/11/2023] [Indexed: 02/25/2023] Open
Abstract
Colloid adenocarcinoma of the lung is a rare subtype of lung adenocarcinoma, accounting for only about 0.24% of lung cancers. Because of its rarity, long-term postoperative prognostic reports are limited. In this report, we describe a case of colloid adenocarcinoma of the lung with a 5-year recurrence-free follow-up. The patient is a 66-year-old woman. During postoperative follow-up for ovarian cancer, chest CT showed a 45 × 30 mm sized mass in the left lung with mixed low-absorption areas inside that were suspicious of cystic lesion. We suspected metastatic lung tumour, and performed lower lobectomy. Pathological examination revealed pale tumour cells forming a glandular lumen with internal mucus production. Based on the results of immunostaining we diagnosed colloid adenocarcinoma of the lung. She received postoperative adjuvant chemotherapy and is alive 4 years postoperatively without recurrence. Colloid adenocarcinoma of the lung, even if large, may have a good prognosis if completely resected.
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Affiliation(s)
- Yuya Kogita
- Department of General Thoracic SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Naoko Ose
- Department of General Thoracic SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Kotaro Kawagishi
- Department of General Thoracic SurgeryOsaka Toneyama Medical CenterOsakaJapan
| | - Eiichi Morii
- Department of PathologyOsaka University Graduate School of MedicineOsakaJapan
| | - Yasushi Shintani
- Department of General Thoracic SurgeryOsaka University Graduate School of MedicineOsakaJapan
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Yasin AKA, Mohamed A, Mohamed A, Elamin N, Al-Tikrity MA, Wazwaz B. Pulmonary Enteric Adenocarcinoma: A Very Rare Case Report from Qatar. Case Rep Oncol 2023; 16:759-764. [PMID: 37933317 PMCID: PMC10625813 DOI: 10.1159/000533220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 11/08/2023] Open
Abstract
A 78-year-old male patient presented with dyspnea, loss of appetite, and weight loss. Workup and imaging showed suspected malignant lung lesion. Biopsy was done and showed features of pulmonary enteric adenocarcinoma (PEAC). This is a very rare disease and its diagnosis is challenging.
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Affiliation(s)
- Ahmed K A Yasin
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdelaziz Mohamed
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Anas Mohamed
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Nusiba Elamin
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mustafa A Al-Tikrity
- Department of Pulmonary Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Bara Wazwaz
- Department of Pathology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Xue H, Zhou W, Zhang Z, Panayi AC, Xiong Y, Yang S, Mi B, Liu G, Liu X. Femoral head metastases from primary mucinous lung adenocarcinoma with left hip pain: A case report and literature review. Front Surg 2022; 9:987627. [PMID: 36204343 PMCID: PMC9530273 DOI: 10.3389/fsurg.2022.987627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Primary mucinous lung adenocarcinoma, a subtype of lung adenocarcinoma, is extremely rare. Currently, as there are no specific diagnostic features, it is easy to delay the diagnosis or even to misdiagnose when atypical symptoms are present. Case summary This case details a patient with primary mucinous lung adenocarcinoma and metastasis to the femoral head. The sole symptom was left hip pain and the initial diagnosis was isolated femoral head necrosis. Conclusions By presenting this rare case report and the experiences learned from it, we hope to assist clinicians to identify bone metastasis cases with non-typical symptoms in order to make the correct diagnosis as soon as possible.
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Affiliation(s)
- Hang Xue
- Department of Orthopedics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wu Zhou
- Department of Orthopedics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenhe Zhang
- Department of Orthopedics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Adriana C. Panayi
- Division of Plastic Surgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, United States
| | - Yuan Xiong
- Department of Orthopedics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shuhua Yang
- Department of Orthopedics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Bobin Mi
- Department of Orthopedics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Xianzhe Liu Guohui Liu Bobin Mi
| | - Guohui Liu
- Department of Orthopedics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Xianzhe Liu Guohui Liu Bobin Mi
| | - Xianzhe Liu
- Department of Orthopedics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Xianzhe Liu Guohui Liu Bobin Mi
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6
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Padinharayil H, Varghese J, John MC, Rajanikant GK, Wilson CM, Al-Yozbaki M, Renu K, Dewanjee S, Sanyal R, Dey A, Mukherjee AG, Wanjari UR, Gopalakrishnan AV, George A. Non-small cell lung carcinoma (NSCLC): Implications on molecular pathology and advances in early diagnostics and therapeutics. Genes Dis 2022. [DOI: 10.1016/j.gendis.2022.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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7
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The 2021 WHO Classification of Lung Tumors: Impact of advances since 2015. J Thorac Oncol 2021; 17:362-387. [PMID: 34808341 DOI: 10.1016/j.jtho.2021.11.003] [Citation(s) in RCA: 371] [Impact Index Per Article: 123.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022]
Abstract
The 2021 World Health Organisation (WHO) Classification of Thoracic Tumours was published earlier this year, with classification of lung tumors being one of the chapters. The principles remain those of using morphology first, supported by immunohistochemistry and then molecular techniques. In 2015, there was particular emphasis on using immunohistochemistry to make classification more accurate. In 2021, there is greater emphasis throughout the book on advances in molecular pathology across all tumor types. Major features within this edition are 1) broader emphasis on genetic testing than in the 2015 WHO Classification, 2) a chapter entirely dedicated to the classification of small diagnostic samples, 3) continued recommendation to document percentages of histological patterns in invasive non-mucinous adenocarcinomas, with utilization of these features to apply a formal grading system, as well as using only invasive size for T-factor size determination in part lepidic non-mucinous lung adenocarcinomas as recommended by the 8th Edition TNM Classification, 4) recognition of spread through airspaces (STAS) as a histological feature with prognostic significance, 5) moving lymphoepithelial carcinoma to squamous cell carcinomas, 6) update on evolving concepts in lung neuroendocrine neoplasm classification, 7) recognition of bronchiolar adenoma/ciliated muconodular papillary tumor (BA/CMPT) as a new entity within the adenoma subgroup, 8) recognition of thoracic SMARCA4-deficient undifferentiated tumor, and 9) inclusion of essential and desirable diagnostic criteria for each tumor.
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8
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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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9
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Liu Y, Kang L, Hao H, Zhang X, Zheng G, Guo X, Zhao H. Primary synchronous colloid adenocarcinoma and squamous cell carcinoma in the same lung: A rare case report. Medicine (Baltimore) 2021; 100:e24700. [PMID: 33578606 PMCID: PMC10545161 DOI: 10.1097/md.0000000000024700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/11/2021] [Accepted: 01/21/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Double primary lung cancer (DPLC) is a relatively rare type of lung cancers. According to whether the diagnosis interval between lesions is more than 6 months, it can be divided into synchronous DPLC (sDPLC) and metachronous DPLC (mDPLC). Here, we describe a case of sDPLC in which one of the components is a rare colloid adenocarcinoma (CA). PATIENT CONCERNS A 69-year-old male was admitted to the hospital due to chest distress and shortness of breath for 1 year, getting worse in the last 15 days. DIAGNOSIS Both HE staining and IHC supported the diagnosis of CA in the right lower lobe and moderately differentiated squamous cell carcinoma in the right upper lobe. INTERVENTIONS The patient was treated with 3 cycles of adjuvant chemotherapy with pemetrexed and lobaplatin after the right upper lobectomy, wedge resection of the right lower lobe and lymph node dissection under video-assisted thoracoscope. OUTCOMES Our plan was to follow him up with general physical examination, chest-abdomen CT and serum tumor markers every 6 months for 2 years. The patient was still alive until the last follow-up in November 2020. LESSONS CA of the lung is a rare primary lung adenocarcinoma. The diagnosis should be based on the patient's clinical characteristics, imaging examination and pathological characteristics, and also need to be differentiated from other mucinous adenocarcinomas. Interestingly, our patient developed not only a CA in the right lower lobe, but also a moderately differentiated squamous cell carcinoma in the right upper lobe.
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MESH Headings
- Adenocarcinoma/pathology
- Adenocarcinoma/therapy
- Adenocarcinoma, Mucinous/metabolism
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/therapy
- Aftercare/methods
- Aged
- Biomarkers, Tumor/blood
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/therapy
- Chemotherapy, Adjuvant/methods
- Diagnosis, Differential
- Dyspnea/diagnosis
- Dyspnea/etiology
- Humans
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/metabolism
- Lung Neoplasms/pathology
- Lymph Node Excision/methods
- Male
- Neoplasm Staging/methods
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Thoracic Surgery, Video-Assisted/methods
- Tomography, X-Ray Computed/methods
- Treatment Outcome
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Affiliation(s)
- Yang Liu
- Department of Pathology, Hebei General Hospital
| | - Lin Kang
- Department of Pathology, Hebei General Hospital
| | - Han Hao
- Department of Pharmacology, Hebei Medical University
| | | | - Guona Zheng
- Department of Pathology, Hebei General Hospital
| | - Xiaowan Guo
- Department of Image, Hebei General Hospital, Shijiazhuang, China
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10
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De Michele S, Remotti HE, Del Portillo A, Lagana SM, Szabolcs M, Saqi A. SATB2 in Neoplasms of Lung, Pancreatobiliary, and Gastrointestinal Origins. Am J Clin Pathol 2021; 155:124-132. [PMID: 32914850 DOI: 10.1093/ajcp/aqaa118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Special AT-rich binding protein 2 (SATB2) immunohistochemistry (IHC) has high sensitivity and specificity for colorectal adenocarcinoma (CRC), but data on its expression in specific subsets of pulmonary, gastric, small bowel, and pancreatobiliary adenocarcinomas (ADCAs) are relatively limited or discordant. We assessed SATB2 expression in a large cohort of ADCAs from these sites to determine its reliability in distinguishing CRC from them. METHODS SATB2 IHC was performed on 335 neoplasms, including 40 lung ADCAs, 165 pancreatobiliary neoplasms (34 intraductal papillary mucinous neoplasms [IPMNs], 19 pancreatic ADCAs, 112 cholangiocarcinomas [CCs]), and 35 gastric, 13 small bowel, 36 ampullary (AMP), and 46 CRC ADCAs. The cases were evaluated for positivity (defined as ≥5% nuclear staining), and an H-score was calculated based on the percentage of SATB2+ cells and staining intensity. Analysis was performed to determine the optimal H-score threshold to separate CRC and non-CRC. RESULTS SATB2 was positive in 3% of lung, 2% of CC, 17% of gastric, 38% of small bowel, and 6% of AMP ADCAs. All pancreatic ADCA/IPMNs were negative, and 87% CRCs were positive. CONCLUSIONS SATB2 is not entirely specific for colorectal origin and can be expressed in a subset of gastrointestinal ADCAs. It is most useful in the differential of CRC vs lung and pancreatobiliary ADCAs.
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Affiliation(s)
- Simona De Michele
- Department of Pathology and Cell Biology at Columbia University Irving Medical Center, New York, NY
| | - Helen E Remotti
- Department of Pathology and Cell Biology at Columbia University Irving Medical Center, New York, NY
| | - Armando Del Portillo
- Department of Pathology and Cell Biology at Columbia University Irving Medical Center, New York, NY
| | - Stephen M Lagana
- Department of Pathology and Cell Biology at Columbia University Irving Medical Center, New York, NY
| | - Matthias Szabolcs
- Department of Pathology and Cell Biology at Columbia University Irving Medical Center, New York, NY
| | - Anjali Saqi
- Department of Pathology and Cell Biology at Columbia University Irving Medical Center, New York, NY
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11
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Nakamura D, Kondo R, Makiuchi A, Itagaki H. Successful Resection of a Giant Pulmonary Colloid Adenocarcinoma via Median Sternotomy. Case Rep Oncol 2020; 13:1097-1102. [PMID: 33082754 PMCID: PMC7548848 DOI: 10.1159/000509999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 11/20/2022] Open
Abstract
We report on a giant pulmonary colloid adenocarcinoma successfully resected using a median sternotomy approach. A 69-year-old woman visited our hospital owing to a giant mass detected on chest radiography. A giant cystic mass measuring 115 × 90 mm was detected in the right upper lung using computed tomography. We suspected mucinous adenocarcinoma and performed right upper lobectomy and mediastinal lymph node dissection with median sternotomy. The surgical field of view for the tumor and superior vena cava was satisfactory, and compression but not invasion of the superior vena cava and chest wall by the tumor was observed. The tumor was pathologically diagnosed as a colloid adenocarcinoma of stage IIIA with pT4N0M0. The postoperative course was uneventful, with no signs of recurrence at one and a half years after operation. Thus, this case demonstrates that for giant lung tumor surgery, median sternotomy is useful and safe for improving the surgical field of view.
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Affiliation(s)
- Daisuke Nakamura
- Department of Thoracic Surgery, National Hospital Organization Matsumoto Medical Center, Nagano, Japan
| | - Ryoichi Kondo
- Department of Thoracic Surgery, National Hospital Organization Matsumoto Medical Center, Nagano, Japan
| | - Akiko Makiuchi
- Department of Thoracic Surgery, National Hospital Organization Matsumoto Medical Center, Nagano, Japan
| | - Hiroko Itagaki
- Department of Diagnostic Pathology, National Hospital Organization Matsumoto Medical Center, Nagano, Japan
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12
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Rossi G, Cavazza A, Comin C, Jocollé G, Jukna A, Rotellini M, Davoli F, Colby T. Mucinous Adenomyomatous Pulmonary Hamartoma: Clinicopathologic, Immunohistochemical, and Molecular Features of 6 Cases. Int J Surg Pathol 2020; 29:273-280. [PMID: 32715806 DOI: 10.1177/1066896920945016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary hamartoma (PH) may show various combinations of mesenchymal tissues with entrapment of respiratory epithelium. An uncommon variant of PH prevalently consisting of smooth muscle with mucinous proliferation has been reported in literature under several definitions as sporadic reports. We collected a series of 6 leiomyomatous PH associated with mucinous growth from consultation files (3 cases) and multicentric revision of archival files among 128 consecutive surgically resected PH. The lesions have a prevalence for male gender (5:1) and lower lobes (5:1), with a mean age at diagnosis of 61 years. All cases were incidentally disclosed in asymptomatic patients and had an indolent behavior. At histology, 2 cases consisted uniquely of smooth muscle and 4 also showed mature adipose tissue. The mucinous proliferation consisted of a monotonous growth of columnar cells lacking p63-positive basal cells and expressing pan-CKs, MUC5A, and CK7, but negative with TTF-1, napsin, MUC1, MUC2, MUC6, CK20, and CDX2. Smooth muscle was negative with hormonal receptors. Molecular analysis using a multiplex gene panel did not reveal gene mutations, while ALK, BRAF, and ROS1 were negative. In conclusion, we describe a small series of uncommon PH with prevalent leiomyomatous mesenchymal component associated with a mucinous growth (mucinous adenomyomatous hamartoma). Despite the lack of basal cells coating mucinous proliferation and irregular architecture, the favorable outcome and lack of molecular alterations most likely lay for a benign/low-grade tumor. Pathologists should be aware of this unusual occurrence to prevent a diagnosis of overt malignancy, particularly in frozen section, small biopsy, and cytology.
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Affiliation(s)
- Giulio Rossi
- AUSL della Romagna, St. Maria delle Croci Hospital, Ravenna, Italy.,Infermi Hospital, Rimini, Italy
| | | | - Camilla Comin
- 9300University of Florence, Florence, Toscana, Italy
| | - Genny Jocollé
- Regional Hospital "Parini," ASL Valle d'Aosta, Aosta, Italy
| | | | | | - Fabio Davoli
- AUSL della Romagna, St. Maria delle Croci Hospital, Ravenna, Italy
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13
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Hermelijn SM, Wolf JL, Dorine den Toom T, Wijnen RMH, Rottier RJ, Schnater JM, von der Thüsen JH. Early KRAS oncogenic driver mutations in nonmucinous tissue of congenital pulmonary airway malformations as an indicator of potential malignant behavior. Hum Pathol 2020; 103:95-106. [PMID: 32681943 DOI: 10.1016/j.humpath.2020.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 11/30/2022]
Abstract
The potential for malignant degeneration is the most common reason for some practitioners to resect asymptomatic congenital pulmonary airway malformations (CPAMs). We aimed to investigate the potential of various immunohistochemical (IHC) and genomic biomarkers to predict the presence of mucinous proliferations (MPs) in CPAM. Archival CPAM tissue samples were re-assessed and underwent IHC analysis using a panel of differentiating markers (TTF1/CDX2/CC10/MUC2/MUC5AC/p16/p53/DICER1). In each sample, intensity of IHC staining was assessed separately in normal lung tissue, CPAM, and MP tissue, using a semiquantitative approach. Likewise, next-generation targeted sequencing of known adult lung driver mutations, including KRAS/BRAF/EGFR/ERBB2, was performed in all samples with MP and in control samples of CPAM tissue without MP. We analyzed samples of 25 CPAM type 1 and 25 CPAM type 2 and found MPs in 11 samples. They were all characterized by strong MUC5AC expression, and all carried a KRAS mutation in the MP and adjacent nonmucinous CPAM tissue, whereas the surrounding normal lung tissue was negative. By contrast, in less than half (5 out of 12) control samples lacking MP, the CPAM tissue also carried a KRAS mutation. KRAS mutations in nonmucinous CPAM tissue may identify lesions with a potential for malignant degeneration and may guide histopathological assessment and patient follow-up.
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Affiliation(s)
- Sergei M Hermelijn
- Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, 3015 GD, the Netherlands
| | - Janina L Wolf
- Department of Pathology, Erasmus University Medical Center, Rotterdam, 3015 GD, the Netherlands
| | - T Dorine den Toom
- Department of Pathology, Erasmus University Medical Center, Rotterdam, 3015 GD, the Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, 3015 GD, the Netherlands
| | - Robbert J Rottier
- Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, 3015 GD, the Netherlands
| | - J Marco Schnater
- Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, 3015 GD, the Netherlands
| | - Jan H von der Thüsen
- Department of Pathology, Erasmus University Medical Center, Rotterdam, 3015 GD, the Netherlands.
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14
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Smith AP, Dueber JC, Allison DB. A diagnostic review of carcinomas and sarcomas of the mediastinum: making the diagnosis on fine-needle aspiration and core needle biopsy specimens. Semin Diagn Pathol 2020; 37:187-198. [PMID: 32532552 DOI: 10.1053/j.semdp.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/11/2022]
Abstract
The mediastinum is a complex anatomic region that can pose many diagnostic challenges on fine-needle aspiration (FNA) and core needle biopsy (CNB). With the recent technological advancements in EBUS-TBNA and EUS-guided procedures, FNA/CNB is being increasingly utilized to obtain the initial and, in many cases, the only diagnosis. As a result, it is imperative to have an understanding of the pearls and pitfalls associated with both the more common and rarer malignancies that occur at this site. Although the vast majority of mediastinal malignancies encountered in routine clinical practice are metastatic carcinomas to mediastinal lymph nodes, primary tumors and tumors that directly extend into the mediastinum are also encountered. As always, a multimodal approach with clinical and radiographic correlation, a targeted IHC panel, and molecular testing when indicated are indisposable and necessary tools in the diagnostic workup of mediastinal malignancies. This review focuses on the salient diagnostic features of malignancies of epithelial and mesenchymal origin, excluding tumors of neurogenic, thymic, hematolymphoid, and germ cell origins, which are discussed in separate articles of this issue.
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Affiliation(s)
- Alexander P Smith
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, 800 Rose Street, MS 117, Lexington, KY 40536, USA
| | - Julie C Dueber
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, 800 Rose Street, MS 117, Lexington, KY 40536, USA
| | - Derek B Allison
- Department of Pathology and Laboratory Medicine, Markey Cancer Center, University of Kentucky, 800 Rose Street, MS 117, Lexington, KY 40536, USA.
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15
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Jurmeister P, Vollbrecht C, Behnke A, Frost N, Arnold A, Treue D, Rückert JC, Neudecker J, Schweizer L, Klauschen F, Horst D, Hummel M, Dietel M, von Laffert M. Next generation sequencing of lung adenocarcinoma subtypes with intestinal differentiation reveals distinct molecular signatures associated with histomorphology and therapeutic options. Lung Cancer 2019; 138:43-51. [PMID: 31634654 DOI: 10.1016/j.lungcan.2019.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/24/2019] [Accepted: 10/07/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES We aim to provide a better understanding of the molecular landscape of primary lung adenocarcinomas with intestinal differentiation. MATERIAL AND METHODS Five invasive mucinous adenocarcinomas (IMA) and seven pulmonary enteric adenocarcinomas (PEAD) were included in this study. Furthermore, we analyzed six pulmonary colloid adenocarcinomas (CAD), including one primary tumor, one metastasis, and two sample pairs consisting of the primary colloid lung tumor and a matching metastasis and an acinar component, respectively. All samples were characterized using immunohistochemistry (TTF-1, CK7, CK20, CDX2, Ki-67, ALK and PD-L1) and a next generation sequencing panel covering 404 cancer-related genes (FoundationOne® gene panel). RESULTS AND CONCLUSION While Ki-67 expression was comparably low in IMA (range: 8-15%) and in primary CAD (range: 5-8%), we observed considerably higher proliferation rates in the non-colloid tumor compartment (16%) and metastases (72%) from CAD, as well as in the PEAD-group (36-71%). The overall tumor mutational burden was lowest in IMA (2.5 mutations per megabase), intermediate in CAD (5.8 mutations per megabase) and highest in PEAD (16.8 mutations per megabase). KRAS mutations were frequent in all three tumor subtypes, but TP53 mutations were mostly limited to PEAD. While chromosomal alterations were rare in IMA, we discovered MYC amplifications in three of four CAD. Comparing primary and metastatic CAD, we observed the acquisition of multiple mutations and chromosomal alterations. PEAD had a variety of chromosomal alterations, including two cases with RICTOR amplification. PD-L1 expression (20%, 50% and 80% of tumor cells) was limited to three PEAD samples, only. In conclusion, we provide a detailed insight into the molecular alterations across and within the different subtypes of pulmonary adenocarcinomas with intestinal differentiation. From a clinical perspective, we provide data on potential treatment strategies for patients with PEAD, including immunotherapy.
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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; German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Claudia Vollbrecht
- 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 Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Anke Behnke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | - Nikolaj Frost
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Infectious Diseases and Pneumonology, 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
| | - Denise Treue
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | - Jens-Carsten Rückert
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jens Neudecker
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Leonille Schweizer
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Neuropathology, 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
| | - 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; Berlin Institute of Health (BIH), 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
| | - Manfred Dietel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Pathology, Berlin, 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; German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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16
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Bhatti V, Kwatra KS, Puri S, Calton N. Histopathological Spectrum and Immunohistochemical Profile of Lung Carcinomas: A 9-Year Study from a Tertiary Hospital in North India. Int J Appl Basic Med Res 2019; 9:169-175. [PMID: 31392181 PMCID: PMC6652278 DOI: 10.4103/ijabmr.ijabmr_66_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Lung cancer is the most common cancer worldwide and the leading cause of cancer-related death. Diagnostic bronchoscopic or percutaneous biopsies are usually small. However, judicious use of immunohistochemistry (IHC) helps in accurate subtyping, which forms the basis for molecular tests and treatment. Aim: The aim was to study the role of IHC in the diagnosis of various histological subtypes of lung cancer. Methods: This 9-year study from 2009 to 2017 included all cases diagnosed as lung carcinoma on tissue biopsies. IHC markers were selected based on histopathology, from a panel comprising CK7, CK20, CK5/6, p63, thyroid transcription factor 1 (TTF-1), napsin A, synaptophysin, chromogranin A, neuron-specific enolase, CD56, and CDX2. Metastatic cancers to the lung were excluded from the study. Results: There were 199 cases of lung carcinoma comprising squamous cell carcinoma (37.7% [n = 75]), adenocarcinoma (26.1% [n = 52]), small cell carcinoma (20.6% [n = 41]), non-small cell lung carcinoma-unclassified (10.1% [n = 20]), adenosquamous carcinoma (2.5% [n = 5]), and others (3% [n = 6]). IHC was done on 47.7% (95/199) of cases. Squamous cell carcinomas showed CK5/6 and p63 positivity in 13/13 (100%) and 12/13 (92.3%) cases, respectively. Adenocarcinomas were positive for napsin A in 12/13 (92.3%) and TTF-1 in 35/41 (85.4%) cases. Neuroendocrine markers were positive in all small cell carcinomas. Conclusion: Squamous cell carcinoma was the most common primary lung malignancy in the North Indian population, followed by adenocarcinoma and small cell carcinoma. IHC panel of TTF-1, napsin A, CK5/6, and p63 is very helpful to classify most non-small cell lung carcinomas.
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Affiliation(s)
- Vandana Bhatti
- Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | | | - Shivani Puri
- Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Nalini Calton
- Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India
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17
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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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18
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Kashima J, Kitadai R, Okuma Y. Molecular and Morphological Profiling of Lung Cancer: A Foundation for "Next-Generation" Pathologists and Oncologists. Cancers (Basel) 2019; 11:E599. [PMID: 31035693 PMCID: PMC6562944 DOI: 10.3390/cancers11050599] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 12/12/2022] Open
Abstract
The pathological diagnosis of lung cancer has largely been based on the morphological features observed microscopically. Recent innovations in molecular and genetic technology enable us to compare conventional histological classifications, protein expression status, and gene abnormalities. The introduction of The Cancer Genome Atlas (TCGA) project along with the widespread use of the next-generation sequencer (NGS) have facilitated access to enormous data regarding the molecular profiles of lung cancer. The World Health Organization classification of lung cancer, which was revised in 2015, is based on this progress in molecular pathology; moreover, immunohistochemistry has come to play a larger role in diagnosis. In this article, we focused on genetic and epigenetic abnormalities in non-small cell carcinoma (adenocarcinoma and squamous cell carcinoma), neuroendocrine tumor (including carcinoids, small cell carcinoma, and large cell neuroendocrine carcinoma), and carcinoma with rare histological subtypes. In addition, we summarize the therapeutic targeted reagents that are currently available and undergoing clinical trials. A good understanding of the morphological and molecular profiles will be necessary in routine practice when the NGS platform is widely used.
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Affiliation(s)
- Jumpei Kashima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo 113-8677, Japan.
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan.
| | - Rui Kitadai
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan.
| | - Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan.
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
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19
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Brettfeld SM, Ramos BD, Berry RS, Martin DR, Hanson JA. SATB2 Versus CDX2: A Battle Royale for Diagnostic Supremacy in Mucinous Tumors. Arch Pathol Lab Med 2019; 143:1119-1125. [PMID: 30838879 DOI: 10.5858/arpa.2018-0337-oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Metastatic mucinous tumors present a diagnostic challenge for pathologists as tumor histomorphology is often nonspecific and optimal immunoprofiles are still under investigation. OBJECTIVE.— To present a head-to-head comparison of special AT-rich sequence-binding protein 2 (SATB2) and caudal type homeobox 2 (CDX2) expression in a diverse array of primary mucinous tumors. DESIGN.— SATB2 and CDX2 immunohistochemical stains were performed on whole sections from 44 mucinous colorectal carcinomas and 175 noncolorectal mucinous tumors. A nuclear scoring system measuring intensity (0-3+) and percentage staining (0 = <5%, 1 = 5%-49%, 2 = ≥50%) was implemented, producing an additive histologic score (H-score). RESULTS.— SATB2 demonstrated acceptable accuracy at low to moderate expression levels (H-scores of 1-4). With these H-score cutoffs, overall accuracy was greater than 90%. In contrast, CDX2's accuracy rivaled that of SATB2 only at an H-score of 5 (89.0%), as its specificity suffered at lower expression levels (<70.0% at H-scores of 1-4). Using a moderate H-score cutoff of 3 or higher, significant differences for both sensitivity and specificity were identified between SATB2 and CDX2 (P = .01 for sensitivity and P < .001 for specificity), though these stains were near equivalent when each was interpreted as positive at its respective optimal H-score (SATB2 ≥ 3 and CDX2 = 5). CONCLUSIONS.— SATB2 is a more accurate marker of colorectal origin across a variety of expression levels compared with CDX2 when applied to mucinous tumors from a host of primary sites. However, these stains are near equivalent when each is interpreted at its optimal expression level.
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Affiliation(s)
- Stefan M Brettfeld
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque (Drs Brettfeld, Ramos, Martin, and Hanson); and the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Dr Berry)
| | - Benjamin D Ramos
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque (Drs Brettfeld, Ramos, Martin, and Hanson); and the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Dr Berry)
| | - Ryan S Berry
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque (Drs Brettfeld, Ramos, Martin, and Hanson); and the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Dr Berry)
| | - David R Martin
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque (Drs Brettfeld, Ramos, Martin, and Hanson); and the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Dr Berry)
| | - Joshua A Hanson
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque (Drs Brettfeld, Ramos, Martin, and Hanson); and the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Dr Berry)
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20
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Hu X, Cui Q, Wang M. A Novel CAMKMT Exon3-ALK Exon20 Fusion Variant was Identified in a Primary Pulmonary Mucinous Adenocarcinoma. J Thorac Oncol 2019; 14:e11-e12. [DOI: 10.1016/j.jtho.2018.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 09/14/2018] [Accepted: 09/14/2018] [Indexed: 11/15/2022]
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21
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Yatabe Y, Dacic S, Borczuk AC, Warth A, Russell PA, Lantuejoul S, Beasley MB, Thunnissen E, Pelosi G, Rekhtman N, Bubendorf L, Mino-Kenudson M, Yoshida A, Geisinger KR, Noguchi M, Chirieac LR, Bolting J, Chung JH, Chou TY, Chen G, Poleri C, Lopez-Rios F, Papotti M, Sholl LM, Roden AC, Travis WD, Hirsch FR, Kerr KM, Tsao MS, Nicholson AG, Wistuba I, Moreira AL. Best Practices Recommendations for Diagnostic Immunohistochemistry in Lung Cancer. J Thorac Oncol 2018; 14:377-407. [PMID: 30572031 DOI: 10.1016/j.jtho.2018.12.005] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 01/04/2023]
Abstract
Since the 2015 WHO classification was introduced into clinical practice, immunohistochemistry (IHC) has figured prominently in lung cancer diagnosis. In addition to distinction of small cell versus non-small cell carcinoma, patients' treatment of choice is directly linked to histologic subtypes of non-small cell carcinoma, which pertains to IHC results, particularly for poorly differentiated tumors. The use of IHC has improved diagnostic accuracy in the classification of lung carcinoma, but the interpretation of IHC results remains challenging in some instances. Also, pathologists must be aware of many interpretation pitfalls, and the use of IHC should be efficient to spare the tissue for molecular testing. The International Association for the Study of Lung Cancer Pathology Committee received questions on practical application and interpretation of IHC in lung cancer diagnosis. After discussions in several International Association for the Study of Lung Cancer Pathology Committee meetings, the issues and caveats were summarized in terms of 11 key questions covering common and important diagnostic situations in a daily clinical practice with some relevant challenging queries. The questions cover topics such as the best IHC markers for distinguishing NSCLC subtypes, differences in thyroid transcription factor 1 clones, and the utility of IHC in diagnosing uncommon subtypes of lung cancer and distinguishing primary from metastatic tumors. This article provides answers and explanations for the key questions about the use of IHC in diagnosis of lung carcinoma, representing viewpoints of experts in thoracic pathology that should assist the community in the appropriate use of IHC in diagnostic pathology.
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Affiliation(s)
- Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan.
| | - Sanja Dacic
- Department of Pathology University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alain C Borczuk
- Department of Pathology, Weill Cornell Medicine, New York, New York
| | - Arne Warth
- Institute of Pathology, Cytopathology, and Molecular Pathology MVZ UEGP Giessen, Wetzlar, Limburg, Germany
| | - Prudence A Russell
- Anatomical Pathology Department, St. Vincent's Hospital and the University of Melbourne, Fitzroy, Victoria, Australia
| | - Sylvie Lantuejoul
- Department of Biopathology, Centre Léon Bérard, Grenoble Alpes University, Lyon, France
| | - Mary Beth Beasley
- Department of Pathology, Mount Sinai Medical Center, New York, New York
| | - Erik Thunnissen
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan and IRCCS MultiMedica, Milan, Italy
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lukas Bubendorf
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Akihiko Yoshida
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Kim R Geisinger
- Department of Pathology, The University of Mississippi Medical Center, Jackson, Mississippi
| | - Masayuki Noguchi
- Department of Pathology, Institute of Basic Medical Sciences, University of Tsukuba, Tsukuba, Japan
| | - Lucian R Chirieac
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Johan Bolting
- Department of Immunology Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Jin-Haeng Chung
- Department of Pathology and Respiratory Center, Seoul National University Bundang Hospital, Seongnam city, Gyeonggi- do, Republic of Korea
| | - Teh-Ying Chou
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Republic of China
| | - Gang Chen
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Claudia Poleri
- Office of Pathology Consultants, Buenos Aires, Argentina
| | - Fernando Lopez-Rios
- Laboratorio de Dianas Terapeuticas, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Minnesota
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Fred R Hirsch
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen University Medical School, Aberdeen, Scotland, United Kingdom
| | - Ming-Sound Tsao
- Department of Pathology, University Health Network/Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield National Health Service Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ignacio Wistuba
- Department of Translational Molecular Pathology, M. D. Anderson Cancer Center, Houston, Texas
| | - Andre L Moreira
- Department of Pathology, New York University Langone Health, New York, New York
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22
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Ogusu S, Takahashi K, Hirakawa H, Tanaka M, Komiya K, Nakamura T, Egashira R, Kai K, Takeda Y, Kimura S, Sueoka-Aragane N. Primary Pulmonary Colloid Adenocarcinoma: How Can We Obtain a Precise Diagnosis? Intern Med 2018; 57:3637-3641. [PMID: 30101926 PMCID: PMC6355410 DOI: 10.2169/internalmedicine.1153-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 76-year-old asymptomatic man was found to have a mass in the right lower lung field. Although the presence of a mucinous component in the majority of the tumor was shown by magnetic resonance imaging, the presence of cancer cells was suspected by contrast enhancement on computed tomography (CT) and based on the partial accumulation in the marginal regions of the tumor on fluorodeoxyglucose-positron emission tomography (FDG-PET). A transbronchial lung biopsy was non-diagnostic, but resection of the mass resulted in a diagnosis of colloid adenocarcinoma. The findings from combined contrast CT and FDG-PET may raise the suspicion of colloid adenocarcinoma and prompt the consideration of surgical resection.
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Affiliation(s)
- Shinsuke Ogusu
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
| | - Haruki Hirakawa
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
| | - Masahide Tanaka
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
| | - Kazutoshi Komiya
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
| | - Tomomi Nakamura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
| | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, Japan
| | - Keita Kai
- Department of Pathology, Faculty of Medicine, Saga University, Japan
| | - Yuji Takeda
- Department of Thoracic Surgery, Faculty of Medicine, Saga University, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
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Clinicopathologic analysis of 10 cases of pulmonary colloid adenocarcinoma and prognostic implication of invasive micropapillary component. Pathol Res Pract 2018; 214:2093-2098. [DOI: 10.1016/j.prp.2018.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/17/2018] [Accepted: 10/19/2018] [Indexed: 12/28/2022]
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Paulk A, Tavora F, Burke A. Pulmonary mucinous adenocarcinomas: a clinicopathologic series with emphasis on the prognostic significance of spread through alveolar spaces, and presence of solid growth component. SURGICAL AND EXPERIMENTAL PATHOLOGY 2018. [DOI: 10.1186/s42047-018-0013-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Mucinous adenocarcinoma is often considered a relatively poor prognostic group among adenocarcinomas of the lung and has a high rate of pulmonary recurrence. Pathologic parameters predicting poor outcome have not been extensively studied, including the presence of spread through alveolar spaces (STAS).
Methods
We retrospectively studied time to lung recurrence and time to distant metastasis in 30 mucinous lung tumors, in relationship to histologic parameters, including spread through alveolar spaces, tumor size, invasive size, % invasive size, growth pattern (solid or cribriform, acinar, papillary, micropapillary, and lepidic), type of mucin-producing cell, and TTF-1 positivity.
Results
Median follow-up was 40 months. There were 7 patients (23%) with lung recurrence (mean 22 months) and 7 (23%) with distant metastases (mean 3.7 months). Columnar / goblet cell type was inversely correlated with TTF-1 expression (p = 0.01). The only pathologic parameters associated with outcome were STAS for lung recurrence (p = .005) and solid/cribriform growth (≥ 20% of tumor) for distant metastasis (p = 0.003).
Conclusions
Mucinous adenocarcinomas of the lung are similar to non-mucinous prognostically, in that STAS and solid growth are poor prognosticators, for local and distant recurrence, respectively. The growth patterns of mucinous adenocarcinomas should be reported similar to reporting of non-mucinous adenocarcinomas.
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25
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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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26
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Uccella S, La Rosa S, Volante M, Papotti M. Immunohistochemical Biomarkers of Gastrointestinal, Pancreatic, Pulmonary, and Thymic Neuroendocrine Neoplasms. Endocr Pathol 2018. [PMID: 29520563 DOI: 10.1007/s12022-018-9522-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Neuroendocrine neoplasms (NENs) are a heterogeneous group of epithelial neoplastic proliferations that irrespective of their primary site share features of neural and endocrine differentiation including the presence of secretory granules, synaptic-like vesicles, and the ability to produce amine and/or peptide hormones. NENs encompass a wide spectrum of neoplasms ranging from well-differentiated indolent tumors to highly aggressive poorly differentiated neuroendocrine carcinomas. Most cases arise in the digestive system and in thoracic organs, i.e., the lung and thymus. A correct diagnostic approach is crucial for the management of patients with both digestive and thoracic NENs, because their high clinical and biological heterogeneity is related to their prognosis and response to therapy. In this context, immunohistochemistry represents an indispensable diagnostic tool that pathologists need to use for the correct diagnosis and classification of such neoplasms. In addition, immunohistochemistry is also useful in identifying prognostic and theranostic markers. In the present article, the authors will review the role of immunohistochemistry in the routine workup of digestive and thoracic NENs.
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Affiliation(s)
- Silvia Uccella
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Stefano La Rosa
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland.
- Institut Universitaire de Pathologie, CHUV, 25 rue du Bugnon, 1011, Lausanne, Switzerland.
| | - Marco Volante
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Mauro Papotti
- Department of Oncology, City of Health and Science, University of Turin, Turin, Italy
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Christianson BE, Gupta S, Vyas SG, Spartz H, Keshavamurthy JH. A diagnostic challenge: An incidental lung nodule in a 48-year-old nonsmoker. Lung India 2018; 35:251-255. [PMID: 29697085 PMCID: PMC5946561 DOI: 10.4103/lungindia.lungindia_212_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
A 43-year-old female with a medical history of renal stones, hypertension, diabetes mellitus Type 2, and depression presented to her urologist with bilateral flank pain. She complained of worsening exertional dyspnea over the last several months with recent weight gain. She also endorsed night sweats and intermittent, scant hemoptysis over the past year. She denied fever, chills, nausea, vomiting, diarrhea, constipation, hematuria, or excessive joint or muscle pain. Physical examination was unremarkable. Computed tomography scan of abdomen and pelvis demonstrated bilateral nonobstructing renal stones and a 1.8 cm × 1.7 cm nodular opacity in the right lower lobe of the lung, not present on previous scan 1 year prior. Surgical wedge resection was performed and subsequent pathologic examination demonstrated a 1.2 cm × 0.6 cm × 0.5 cm soft, gelatinous well-demarcated mass in the right lower lobe wedge specimen without gross evidence of necrosis or hemorrhage confirming colloid adenocarcinoma of the lung.
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Affiliation(s)
| | - Supriya Gupta
- Department of Radiology, Medical College of Georgia, Augusta, GA, USA
| | - Shikhar G Vyas
- Department of Pathology, Medical College of Georgia, Augusta, GA, USA
| | - Helena Spartz
- Department of Pathology, Medical College of Georgia, Augusta, GA, USA
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28
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Bae JM, Kim JH, Park JH, Park HE, Cho NY, Kang GH. Clinicopathological and molecular implications of aberrant thyroid transcription factor-1 expression in colorectal carcinomas: an immunohistochemical analysis of 1319 cases using three different antibody clones. Histopathology 2017; 72:423-432. [DOI: 10.1111/his.13398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jeong Mo Bae
- Department of Pathology; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - Jung Ho Kim
- Department of Pathology; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - Jeong Hwan Park
- Department of Pathology; SMG-SNU Boramae Medical Centre; Seoul Korea
| | - Hye Eun Park
- Department of Pathology; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - Nam-Yun Cho
- Laboratory of Epigenetics; Cancer Research Institute; Seoul National University College of Medicine; Seoul Korea
| | - Gyeong Hoon Kang
- Department of Pathology; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
- Laboratory of Epigenetics; Cancer Research Institute; Seoul National University College of Medicine; Seoul Korea
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29
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Pure mucinous (colloid) adenocarcinoma of the conjunctiva. J Cutan Pathol 2017; 45:78-83. [DOI: 10.1111/cup.13060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 11/26/2022]
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30
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Boland JM, Maleszewski JJ, Wampfler JA, Voss JS, Kipp BR, Yang P, Yi ES. Pulmonary invasive mucinous adenocarcinoma and mixed invasive mucinous/nonmucinous adenocarcinoma-a clinicopathological and molecular genetic study with survival analysis. Hum Pathol 2017; 71:8-19. [PMID: 28823574 DOI: 10.1016/j.humpath.2017.08.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/01/2017] [Accepted: 08/10/2017] [Indexed: 01/12/2023]
Abstract
Invasive mucinous adenocarcinoma is a variant of lung adenocarcinoma, which may be mixed with nonmucinous adenocarcinoma. KRAS mutations are common, but other clinical and genetic features are not clearly established. Lung adenocarcinomas (n=760) with ≥5 years of follow-up comprised 3 nonoverlapping cohorts for survival analysis. Mucinous tumors were evaluated with Ion AmpliSeq Cancer Hotspot Panel v2. Cases without detected mutations were tested for ALK and ROS1 and by OncoScan array. Fifty-seven invasive mucinous adenocarcinomas and 54 mixed mucinous/nonmucinous adenocarcinomas were identified. Mucinous tumors constituted 27 of 218 nonselected patients (12.4%), 23 of 268 never-smokers (8.6%), and 61 of 274 in a smokers cohort enriched for lepidic growth (22.3%). In the lepidic-enriched smokers, patients with mucinous tumors experienced worse overall survival (P=.006) and progression-free survival (P=.024), which persisted on multivariable analysis. No survival differences were observed in the other cohorts. KRAS mutations were common (76% of invasive mucinous adenocarcinomas, 68% of mixed mucinous/nonmucinous), and 38% of KRAS mutations occurred with other mutations, especially STK11. Six cases had potentially targetable mutations (3 ALK, 2 EGFR, 1 BRAF V600E). All ALK-rearranged tumors were mixed mucinous/nonmucinous. Four of 6 cases without hotspot mutations showed complex copy number/structural abnormalities. Pulmonary invasive mucinous adenocarcinomas and mixed nonmucinous/mucinous adenocarcinomas are clinically and genetically similar, except for a higher rate of ALK rearrangement in mixed tumors. Survival for mucinous tumors is similar to that for nonmucinous tumors in a nonselected cohort, although worse survival was seen in a cohort of smokers enriched for lepidic growth.
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Affiliation(s)
- Jennifer M Boland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905.
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905
| | | | - Jesse S Voss
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905
| | - Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905
| | - Ping Yang
- Department of Epidemiology, Mayo Clinic, Rochester, MN 55905
| | - Eunhee S Yi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905
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31
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Caliò A, Lever V, Rossi A, Gilioli E, Brunelli M, Dubini A, Tomassetti S, Piciucchi S, Nottegar A, Rossi G, Kambouchner M, Cancellieri A, Barbareschi M, Pelosi G, Doglioni C, Cavazza A, Carella R, Graziano P, Murer B, Poletti V, Chilosi M. Increased frequency of bronchiolar histotypes in lung carcinomas associated with idiopathic pulmonary fibrosis. Histopathology 2017; 71:725-735. [PMID: 28556957 DOI: 10.1111/his.13269] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 05/26/2017] [Indexed: 12/31/2022]
Abstract
AIMS The association between lung cancer and idiopathic pulmonary fibrosis (IPF) is well known, but the significance of this association is poorly understood. Bronchiolar honeycomb cysts have been proposed as possible precursors for the development of carcinoma, but limited evidence in support of this hypothesis is available. The aim of this study was to investigate this hypothesis analysing a series of carcinomas arising in IPF by immunohistochemistry. METHODS AND RESULTS Thirty-three lung carcinomas arising in patients with IPF were analysed with a panel of immunohistochemical markers. The antibodies included those against pneumocyte markers [thyroid transcription factor 1 (TTF1), napsin-A, and surfactant protein A], the goblet cell marker mucin 5AC, markers of basal/squamous cell differentiation [cytokeratin (CK) 5/6 and ΔN-p63], and markers related to enteric differentiation (CDX2, mucin 2, CK20, and villin). A series of 100 consecutive lung adenocarcinomas arising in smokers without IPF were investigated as controls. All carcinomas arising in IPF patients were peripherally located on imaging analysis. The diagnoses were: eight squamous cell carcinomas, 20 adenocarcinomas, three small-cell carcinomas (including one composite small-cell carcinoma and adenocarcinoma), and two large-cell carcinomas. Among adenocarcinomas, a 'pneumocyte' profile (TTF1/napsin-A/SPA1-triple-positive) was observed in seven of 20 (35% versus 84% in non-IPF controls, P = 0.0001). The remaining 13 adenocarcinomas (65%) showed rare histotypes: four invasive mucinous adenocarcinomas (20% in IPF patients versus 1% in non-IPF controls, P = 0.002), seven tumours (35%) that were characterized by variable expression of markers of enteric differentiation, and two tumours (10%) that showed a peculiar basaloid component. CONCLUSIONS The immunohistochemical characterization of carcinomas arising in IPF patients shows striking divergence from that in non-IPF smokers. The prevalence of rare entities showing bronchiole-related markers is in line with the hypothesis that these tumours arise from transformed small airways in honeycomb lung areas where abnormal bronchiolar proliferation takes place.
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Affiliation(s)
- Anna Caliò
- Department of Pathology AOUI, University of Verona, Verona, Italy
| | - Veronica Lever
- Department of Pathology AOUI, University of Verona, Verona, Italy
| | - Andrea Rossi
- Department of Pneumology AOUI, University of Verona, Verona, Italy
| | - Eliana Gilioli
- Department of Pathology AOUI, University of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology AOUI, University of Verona, Verona, Italy
| | | | | | | | - Alessia Nottegar
- Department of Pathology AOUI, University of Verona, Verona, Italy
| | - Giulio Rossi
- Operative Unit of Pathology, Azienda USL Valle d'Aosta, Aosta, Italy
| | | | | | | | | | | | - Alberto Cavazza
- Department of Pathology, Arcispedale S. Maria Nuova/I.R.C.C.S., Reggio Emilia, Italy
| | | | - Paolo Graziano
- Department of Pathology, San Giovanni Rotondo Hospital, San Giovanni Rotondo, Italy
| | - Bruno Murer
- Department of Pathology, Mestre Hospital, Mestre, Italy
| | | | - Marco Chilosi
- Department of Pathology AOUI, University of Verona, Verona, Italy.,Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
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32
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Wang Z, Yu M, Chen Y, Kong Y. Fluorodeoxyglucose-positron emission tomography/computed tomography imaging features of colloid adenocarcinoma of the lung: a case report. J Med Case Rep 2017; 11:202. [PMID: 28747211 PMCID: PMC5530500 DOI: 10.1186/s13256-017-1380-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/05/2017] [Indexed: 01/02/2023] Open
Abstract
Background Colloid adenocarcinoma of the lung is a rare subtype of variants of invasive adenocarcinomas. We report the appearance of this unusual entity on 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Case presentation A 60-year-old man of Chinese Han nationality coughed with a little white sputum for 1 month. Chest computed tomography showed multiple bilateral subpleural nodules and plaques accompanied by air bronchograms, which were most concentrated in the lower lobe of his right lung. Positron emission tomography indicated increased radioactivity uptake with a maximum standardized uptake value of 3.5. Positron emission tomography/computed tomography showed a soft tissue density lesion in his left adrenal gland with a maximum standardized uptake value of 4.1. The positron emission tomography/computed tomography appearance suggested a primary colloid adenocarcinoma in the lower lobe of his right lung accompanied by intrapulmonary and left adrenal gland metastases. The diagnostic rate of colloid adenocarcinoma can be increased by combining the anatomic and metabolic information of lesions. Conclusions The advantage of positron emission tomography/computed tomography in the diagnosis of colloid adenocarcinoma, as with other cancers, is the ability to locate extrapulmonary disease, facilitating clinical staging.
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Affiliation(s)
- ZhenGuang Wang
- PET/CT Center, The Affiliated Hospital of Qingdao University, No. 59, Haier Rd, Qingdao, 225001, China
| | - MingMing Yu
- PET/CT Center, The Affiliated Hospital of Qingdao University, No. 59, Haier Rd, Qingdao, 225001, China.
| | - YueHua Chen
- Intense care unit, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Kong
- PET/CT Center, The Affiliated Hospital of Qingdao University, No. 59, Haier Rd, Qingdao, 225001, China
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Genova SN, Belovezhdov VT, Bichev SN, Danev VH. Comparative Characteristics of Napsin A, TTF 1 and EGFR Mutation Expression in Mucinous Lung Cell Carcinomas. Folia Med (Plovdiv) 2017; 59:174-182. [PMID: 28704186 DOI: 10.1515/folmed-2017-0020] [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] [Received: 07/17/2016] [Accepted: 12/13/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Invasive mucinous lung adenocarcinomas are rare and account for 2%-10% of all lung adenocarcinoma cases. It is believed that Napsin A exhibits a weaker expression in mucinous adenocarcinomas compared with TTF1, but such correlation is still poorly researched. AIM The aim of the study was to determine the frequency of mucinous to nonmucinous adenocarcinomas and compare specificity and sensitivity of monoclonal Napsin A with TTF1 in mucinous adenocarcinomas and define the frequency of EGFR mutations. MATERIALS AND METHODS Eighty-four resected lung carcinomas were prospectively evaluated. All biopsies were analysed with p63, TTF1, monoclonal Napsin A, CK7, CK20 and CDX2 and were studied with real-time PCR technology. RESULTS In resected material we detected 49/84 (58.3%) adenocarcinomas and selected 21 mucinous adenocarcinomas out of 46 non-mucinous adenocarcinomas (45.6%). The most common pattern of mucinous adenocarcinomas is papillary - 24% and colloidal - 24%, followed by acinar - 19.2% and lepidic - 19.2%. mNapsin A was positive in 18/21 (85.7%) mucinous adenocarcinomas v/s 17/21 TTF1 positive (80.9%). EGFR mutations were detected in 3/21 cases with mucinous adenocarcinomas (14.3%): mucinous papillary, mucinous acinar and "salivary gland-like". CONCLUSION Our study demonstrates a high proportion of primary mucinous lung adenocarcinomas to primary non-mucinous adenocarcinomas. Sensitivity and specificity of mNapsin A and TTF1 did not show significant difference in pulmonary mucinous and non-mucinous adenocarcinomas, as mNapsin A gave greater sensitivity to mucinous adenocarcinomas. Our results indicate the same mutation frequency of EGFR in mucinous adenocarcinomas as mutation frequency detected in non-mucinous adenocarcinomas in the Bulgarian region.
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Affiliation(s)
- Sylvia N Genova
- Department of General and Clinical Pathology and Forensic Medicine, Faculty of Medicine, Medical University of Plovdiv,
Plovdiv, Bulgaria
| | - Veselin T Belovezhdov
- Department of General and Clinical Pathology and Forensic Medicine, Faculty of Medicine, Medical University of Plovdiv,
Plovdiv, Bulgaria
| | - Stoyan N Bichev
- National Genetics Laboratory, University Hospital of Obstetrics and Gynecology, SBALAG “Maichin dom”, Sofi a, Bulgaria
| | - Vladimir H Danev
- Department of General and Clinical Pathology and Forensic Medicine, Faculty of Medicine, Medical University of Plovdiv,
Plovdiv, Bulgaria
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Sonzogni A, Bianchi F, Fabbri A, Cossa M, Rossi G, Cavazza A, Tamborini E, Perrone F, Busico A, Capone I, Picciani B, Valeri B, Pastorino U, Pelosi G. Pulmonary adenocarcinoma with mucin production modulates phenotype according to common genetic traits: a reappraisal of mucinous adenocarcinoma and colloid adenocarcinoma. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2017; 3:139-152. [PMID: 28451462 PMCID: PMC5402180 DOI: 10.1002/cjp2.67] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/20/2017] [Indexed: 12/12/2022]
Abstract
Whether invasive mucinous adenocarcinoma (IMA) and colloid adenocarcinoma (ICA) of the lung represent separate tumour entities, or simply lie within a spectrum of phenotypic variability, is worth investigating. Fifteen ICA, 12 IMA, 9 ALK‐rearranged adenocarcinomas (ALKA), 8 non‐mucinous KRAS‐mutated adenocarcinomas (KRASA) and 9 mucinous breast adenocarcinomas (MBA) were assessed by immunohistochemistry for alveolar (TTF1, cytoplasmic MUC1), intestinal (CDX‐2, MUC2), gastric (membrane MUC1, MUC6), bronchial (MUC5AC), mesenchymal (vimentin), neuroendocrine (chromogranin A, synaptophysin), sex steroid hormone‐related (oestrogen and progesterone receptors), pan‐mucinous (HNF4A) and pan‐epithelial (keratin 7) lineage biomarkers and by targeted next generation sequencing (TNGS) for 50 recurrently altered cancer genes. Unsupervised clustering analysis using molecular features identified cluster 1 (IMA and ICA), cluster 2 (ALKA and KRASA) and cluster 3 (MBA) (p < 0.0001). Cluster 1 showed four histology‐independent sub‐clusters (S1 to S4) pooled by HFN4A and MUC5AC but diversely reacting for TTF1, MUC1, MUC2, MUC6 and CDX2. Sub‐cluster S1 predominantly featured intestinal‐alveolar, S2 gastrointestinal, S3 gastric and S4 alveolar differentiation. In turn, KRASA and ALKA shared alveolar lineage alongside residual MUC5AC expression, with additional focal CDX2 and diffuse vimentin, respectively. A proximal‐to‐distal scheme extending from terminal (TB) and respiratory (RB) bronchioles to alveolar cells was devised, where S3 originated from distal TB (cellular mucinous adenocarcinoma), S2 from proximal RB (secreting mucinous adenocarcinoma), S1 from intermediate RB (mucin lake‐forming colloid adenocarcinoma), S4 from distal RB (colloid alveolar adenocarcinoma), KRASA from juxta‐alveolar RB (KRAS‐mutated non‐mucinous adenocarcinoma) and ALKA from juxta‐bronchial alveolar cells (ALK‐translocated adenocarcinoma). TNGS analysis showed KRAS, LKB1, TP53, APC and CDKN2A mutation predominance. In conclusion, IMA and ICA are basket categories, which likely originate from distinct domains of stem/progenitor cells spatially distributed along bronchioles upon common molecular features and genetic alterations.
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Affiliation(s)
- Angelica Sonzogni
- Department of Pathology and Laboratory MedicineFondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Fabrizio Bianchi
- Institute for Stem-Cell Biology, Regenerative Medicine and Innovative Therapies (ISBreMIT)IRCCS Casa Sollievo della SofferenzaSan Giovanni RotondoItaly
| | - Alessandra Fabbri
- Department of Pathology and Laboratory MedicineFondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Mara Cossa
- Department of Pathology and Laboratory MedicineFondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Giulio Rossi
- Division of Anatomic PathologyRegional Hospital Umberto PariniAostaItaly
| | - Alberto Cavazza
- Department of Oncology and Advanced TechnologyOperative Unit of Pathologic Anatomy, IRCCS Azienda Arcispedale S. Maria NuovaReggio EmiliaItaly
| | - Elena Tamborini
- Department of Pathology and Laboratory MedicineFondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Federica Perrone
- Department of Pathology and Laboratory MedicineFondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Adele Busico
- Department of Pathology and Laboratory MedicineFondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Iolanda Capone
- Department of Pathology and Laboratory MedicineFondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Benedetta Picciani
- Department of Pathology and Laboratory MedicineFondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Barbara Valeri
- Department of Pathology and Laboratory MedicineFondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Ugo Pastorino
- Division of Thoracic SurgeryFondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-OncologyUniversità degli StudiMilanItaly.,Inter-Hospital Pathology DivisionScience & Technology Park, IRCCS MultiMedica GroupMilanItaly
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35
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Shah SS, Wu TT, Torbenson MS, Chandan VS. Aberrant CDX2 expression in hepatocellular carcinomas: an important diagnostic pitfall. Hum Pathol 2017; 64:13-18. [PMID: 28089540 DOI: 10.1016/j.humpath.2016.12.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/17/2016] [Accepted: 12/28/2016] [Indexed: 02/08/2023]
Abstract
CDX2 is a sensitive and specific marker of intestinal differentiation. It is routinely used in surgical pathology, as its expression within a tumor favors an origin within the gastrointestinal tract. We had anecdotally encountered occasional hepatocellular carcinomas (HCCs) that were CDX2 positive. CDX2 expression in HCC has not yet been reported, but it has also not been examined in detail. Therefore, we evaluated CDX2 expression in a large number of resected HCCs. Full tumor sections from 172 resected HCCs and 6 resected fibrolamellar carcinomas (FLCs) were stained for CDX2. Nine (5.2%) of 172 HCCs were positive for CDX2, whereas all 6 FLCs were negative. CDX2 expression in HCCs was more commonly seen in poorly differentiated tumors (5 of 16 cases, 31%) than well and moderately differentiated tumors (4 of 156 cases, 2.5%), P = .0004. No other statistically significant correlations were observed (P>.05). Results of our study show that a small subset (5%) of HCCs can be CDX2 positive. Awareness of this phenomenon is important because CDX2 expression in a liver tumor does not completely exclude a diagnosis of HCC.
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Affiliation(s)
- Sejal S Shah
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55905
| | - Tsung-Teh Wu
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55905
| | | | - Vishal S Chandan
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55905.
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Fujiwara A, Iwashiro N, Kimura N. A Resected Case of Pulmonary Enteric Adenocarcinoma. ACTA ACUST UNITED AC 2017. [DOI: 10.2482/haigan.57.758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Aki Fujiwara
- Department of Surgery, Hakodate National Hospital
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Masai K, Sakurai H, Suzuki S, Asakura K, Nakagawa K, Watanabe SI. Clinicopathological features of colloid adenocarcinoma of the lung: A report of six cases. J Surg Oncol 2016; 114:211-5. [DOI: 10.1002/jso.24302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/05/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Kyohei Masai
- Department of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Hiroyuki Sakurai
- Department of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Shigeki Suzuki
- Department of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Keisuke Asakura
- Department of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Kazuo Nakagawa
- Department of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
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38
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Lakshmanan I, Ponnusamy MP, Macha MA, Haridas D, Majhi PD, Kaur S, Jain M, Batra SK, Ganti AK. Mucins in lung cancer: diagnostic, prognostic, and therapeutic implications. J Thorac Oncol 2015; 10:19-27. [PMID: 25319180 DOI: 10.1097/jto.0000000000000404] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aberrant expression of mucins is associated with cancer development and metastasis. An overexpression of few mucins contributes to oncogenesis by enhancing cancer cell growth and providing constitutive survival signals. This review focuses on the importance of mucins both in the normal bronchial epithelial cells and the malignant tumors of the lung and their contribution in the diagnosis and prognosis of lung cancer patients. During lung cancer progression, mucins either alone or through their interaction with many receptor tyrosine kinases mediate cell signals for growth and survival of cancer cells. Also, stage-specific expression of certain mucins, like MUC1, is associated with poor prognosis from lung cancer. Thus, mucins are emerging as attractive targets for developing novel therapeutic approaches for lung cancer. Several strategies targeting mucin expression and function are currently being investigated to control lung cancer progression.
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Affiliation(s)
- Imayavaramban Lakshmanan
- *Department of Biochemistry and Molecular Biology, †Department of Pathology and Microbiology, ‡Eppley Institute for Research in Cancer and Allied Diseases, §Department of Internal Medicine, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska, and ‖Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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Pulmonary mucinous adenocarcinomas: architectural patterns in correlation with genetic changes, prognosis and survival. Virchows Arch 2015; 467:675-686. [DOI: 10.1007/s00428-015-1852-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 09/10/2015] [Accepted: 09/16/2015] [Indexed: 10/23/2022]
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40
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Truini A, Santos Pereira P, Cavazza A, Spagnolo P, Nosseir S, Longo L, Jukna A, Lococo F, Vincenzi G, Bogina G, Tiseo M, Rossi G. Classification of different patterns of pulmonary adenocarcinomas. Expert Rev Respir Med 2015; 9:571-86. [PMID: 26313326 DOI: 10.1586/17476348.2015.1083428] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The epidemic increase of adenocarcinoma histology accounting for more than 50% of primary lung malignancies and the advent of effective molecular targeted-therapies against specific gene alterations characterizing this tumor type have led to the reconsideration of the pathologic classification of lung cancer. The new 2015 WHO classification provided the basis for a multidisciplinary approach emphasizing the close correlation among clinical, radiologic and molecular characteristics and histopathologic pattern of lung adenocarcinoma. The terms 'bronchioloalveolar carcinoma' and 'mixed adenocarcinoma' have been eliminated, introducing the concepts of 'adenocarcinoma in situ', 'minimally invasive adenocarcinoma' and the use of descriptive predominant patterns in invasive adenocarcinomas (lepidic, acinar, papillary, solid and micropapillary patterns). 'Invasive mucinous adenocarcinoma' is the new definition for mucinous bronchioloalveolar carcinoma, and some variants of invasive adenocarcinoma have been included, namely colloid, enteric and fetal-type adenocarcinomas. A concise update of the immunomorphologic, radiological and molecular characteristics of the different histologic patterns of lung adenocarcinoma is reported here.
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Affiliation(s)
- Anna Truini
- a 1 Lung Cancer Unit, IRCCS AOU San Martino - IST and Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Genova, Italy
| | - Poliana Santos Pereira
- b 2 Operative Unit of Pathologic Anatomy Hospital "Maggiore della Carità" of Novara, Novara, Italy
| | - Alberto Cavazza
- c 3 Department of Oncology and Advanced Technologies, Operative Unit of Oncology, Arcispedale S. Maria Nuova/ I.R.C.C.S., Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Spagnolo
- d 4 Medical University Clinic, Canton Hospital Baselland, and University of Basel, Basel, Switzerland
| | - Sofia Nosseir
- e 5 Section of Pathologic Anatomy, University Hospital Policlinico of Modena, Modena, Italy
| | - Lucia Longo
- f 6 Medical Oncology Unit, Civic Hospital "Ramazzini", Carpi, Carpi, Italy
| | - Agita Jukna
- g 7 Pathology Institute, Pauls Stradins Clinical University Hospital, Riga, Riga, Latvia
| | - Filippo Lococo
- h 8 Department of Surgery, Operative Unit of Thoracic Surgery, Arcispedale S. Maria Nuova/ I.R.C.C.S., Reggio Emilia, Reggio Emilia, Italy
| | - Giada Vincenzi
- i 9 Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Bogina
- j 10 Section of Pathologic Anatomy, Hospital "Don Calabria", Negrar, Verona, Italy
| | - Marcello Tiseo
- k 11 Division of Medical Oncology University Hospital, Parma, Italy
| | - Giulio Rossi
- l 12 University Hospital of Modena, Modena, Italy
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Qu Y, Zhao D, Mu J, Che N, Zhang C, Liu Z, Su D, Zhou L, Zhang H, Wei L. Prognostic analysis of primary mucin-producing adenocarcinoma of the lung: a comprehensive retrospective study. Tumour Biol 2015; 37:887-96. [PMID: 26254613 DOI: 10.1007/s13277-015-3869-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/30/2015] [Indexed: 01/15/2023] Open
Abstract
Although primary mucin-producing adenocarcinoma of the lung is uncommon, each subtype has distinct clinical, pathological, molecular, and prognostic characteristics. This study aimed to determine correlations between clinical and pathological features and genetic phenotypes with the prognosis. We immunohistochemically examined the protein levels of thyroid transcription factor 1 (TTF-1), Napsin A, and anaplastic lymphoma kinase (ALK) and genetically examined epidermal growth factor receptor (EGFR) and KRAS mutations in these mucin-producing tumors. A total of 75 cases of mucin-producing adenocarcinoma of the lung were examined. ALK protein positivity was 33.3 % (25/75), and primarily occurred in solid predominant with mucin production subtype (SA). KRAS mutations occurred in 22.7 % (17/75) of patients, predominantly in invasive mucinous adenocarcinoma (IMA). Positive TTF-1 and Napsin A expression was more common in SA, while they were both negative in IMA. The 1-, 3-, and 5-year progression-free survival rates of mucin-producing lung adenocarcinoma were 85, 64, and 38 %, respectively; the overall survival rates were 90, 67, and 50 %, respectively. Larger tumors, advanced stage, and lymph node metastasis were associated with poor prognosis. Mucinous minimally invasive adenocarcinoma (m-MIA) had the best prognosis, followed by IMA, SA, and acinar or papillary predominant adenocarcinoma with mucin production (A/P). KRAS mutations were an independent positive prognostic factor for postoperative progress.
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Affiliation(s)
- Yang Qu
- Department of Pathology, The General Hospital of People's Liberation Army, 28# Fuxing Road, Haidian District, Beijing, 100853, China
- Department of pathology, Beijing Chest Hospital, Capital Medical University, 97# Machang, Tongzhou District, Beijing, 101149, China
| | - Dan Zhao
- Department of pathology, Beijing Chest Hospital, Capital Medical University, 97# Machang, Tongzhou District, Beijing, 101149, China
| | - Jing Mu
- Department of pathology, Beijing Chest Hospital, Capital Medical University, 97# Machang, Tongzhou District, Beijing, 101149, China
| | - Nanying Che
- Department of pathology, Beijing Chest Hospital, Capital Medical University, 97# Machang, Tongzhou District, Beijing, 101149, China
| | - Chen Zhang
- Department of pathology, Beijing Chest Hospital, Capital Medical University, 97# Machang, Tongzhou District, Beijing, 101149, China
| | - Zichen Liu
- Department of pathology, Beijing Chest Hospital, Capital Medical University, 97# Machang, Tongzhou District, Beijing, 101149, China
| | - Dan Su
- Department of pathology, Beijing Chest Hospital, Capital Medical University, 97# Machang, Tongzhou District, Beijing, 101149, China
| | - Lijuan Zhou
- Department of pathology, Beijing Chest Hospital, Capital Medical University, 97# Machang, Tongzhou District, Beijing, 101149, China
| | - Haiqing Zhang
- Department of pathology, Beijing Chest Hospital, Capital Medical University, 97# Machang, Tongzhou District, Beijing, 101149, China.
| | - Lixin Wei
- Department of Pathology, The General Hospital of People's Liberation Army, 28# Fuxing Road, Haidian District, Beijing, 100853, China.
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Pinto R, Barros R, Pereira-Castro I, Mesquita P, da Costa LT, Bennett EP, Almeida R, David L. CDX2 homeoprotein is involved in the regulation of ST6GalNAc-I gene in intestinal metaplasia. J Transl Med 2015; 95:718-27. [PMID: 25867765 DOI: 10.1038/labinvest.2015.52] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/08/2015] [Accepted: 03/07/2015] [Indexed: 01/08/2023] Open
Abstract
De novo expression of Sialyl-Tn (STn) antigen is one of the most common features of intestinal metaplasia (IM) and gastric carcinomas, and its biosynthesis has been mostly attributed to ST6GalNAc-I activity. However, the regulation of this glycosyltransferase expression is not elucidated. In IM lesions and in the intestine, CDX2 homeobox transcription factor is co-expressed with STn and ST6GalNAc-I. We therefore hypothesized that CDX2 might induce STn expression by positive regulation of ST6GalNAc-I. We showed that ST6GalNAc-I transcript levels and CDX2 have a coordinated expression upon Caco-2 in vitro differentiation, and overexpression of CDX2 in MKN45 gastric cells increases ST6GalNAc-I transcript levels. Nine putative CDX-binding sites in the ST6GalNAc-I-regulatory sequence were identified and analyzed by chromatin immunoprecipitation in Caco-2 cells and in IM. The results showed that CDX2 protein is recruited to all regions, being the most proximal sites preferentially occupied in vivo. Luciferase assays demonstrated that CDX2 is able to transactivate ST6GalNac-I-regulatory region. The induction was stronger for the regions mapped in the neighbourhood of ATG start codon and site-directed mutagenesis of these sites confirmed their importance. In conclusion, we show that CDX2 transcriptionally regulates ST6GalNAc-I gene expression, specifically in the preneoplastic IM lesion.
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Affiliation(s)
- Rita Pinto
- 1] Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal [2] Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal [3] Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rita Barros
- 1] Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal [2] Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Isabel Pereira-Castro
- Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Patricia Mesquita
- Instituto Nacional de Investigação Agrária e Veterinária, Quinta da Fonte Boa, Vale de Santarém, Portugal
| | | | - Eric P Bennett
- Copenhagen Center for Glycomics, Departments of Cellular and Molecular Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Raquel Almeida
- 1] Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal [2] Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal [3] Faculty of Medicine, University of Porto, Porto, Portugal [4] Department of Biology, Faculty of Sciences, University of Porto, Porto, Portugal
| | - Leonor David
- 1] Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal [2] Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal [3] Faculty of Medicine, University of Porto, Porto, Portugal
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43
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Metastatic carcinoma of unknown primary: diagnostic approach using immunohistochemistry. Adv Anat Pathol 2015; 22:149-67. [PMID: 25844674 DOI: 10.1097/pap.0000000000000069] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Carcinoma of unknown primary origin (CUP) is one of the 10 most prevalent malignancies. CUP patients in whom a site of origin can be ascribed have better outcomes than those in which the primary tumor remains unidentified. Among the tools available to pathologists in approaching these lesions, immunohistochemistry is a reliable, inexpensive, and widely available resource. New markers continue to emerge, which, in combination with other historically useful antibodies, allow rapid and accurate identification of primary site in an increasing number of cases. This review discusses the approach to the diagnosis of CUP using immunohistochemistry and outlines some of the most useful markers with a particular focus on the utility of lineage-restricted transcription factors, including CDX2, NKX3-1, PAX8, SATB2, TTF-1, and SF1.
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Sousa V, Rodrigues C, Silva M, Alarcão AM, Carvalho L. Lung adenocarcinoma: Sustained subtyping with immunohistochemistry and EGFR, HER2 and KRAS mutational status. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:113-25. [PMID: 25926253 DOI: 10.1016/j.rppnen.2014.09.009] [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] [Received: 03/18/2014] [Accepted: 09/01/2014] [Indexed: 10/23/2022] Open
Abstract
Pulmonary adenocarcinomas are still in the process of achieving morphological, immunohistochemical and genetic standardization. The ATS/ERS/IASLC proposed classification for lung adenocarcinomas supports the value of the identification of histological patterns, specifically in biopsies. Thirty pulmonary adenocarcinomas were subjected to immunohistochemical study (CK7, CK5, 6, 18, CK20, TTF1, CD56, HER2, EGFR and Ki-67), FISH and PCR followed by sequencing and fragment analysis for EGFR, HER2 and KRAS. Solid pattern showed lower TTF1 and higher Ki-67 expression. TTF1 expression was higher in non-mucinous lepidic and micropapillary patterns when compared to acinar and solid and acinar, solid and mucinous respectively. Higher Ki67 expression was present in lepidic and solid patterns compared to mucinous. EGFR membranous staining had increasing expression from non-mucinous lepidic/BA pattern to solid pattern and micropapillary until acinar pattern. EGFR mutations, mainly in exon 19, were more frequent in females, together with non-smoking status, while KRAS exon 2 mutations were statistically more frequent in males, especially in solid pattern. FISH EGFR copy was correlated gross, with mutations. HER2 copy number was raised in female tumours without mutations, in all cases. Although EGFR and KRAS mutations are generally considered mutually exclusive, in rare cases they can coexist as it happened in one of this series, and was represented in acinar pattern with rates of 42.9% and 17.9%, respectively. EGFR mutations were more frequent in lepidic/BA and acinar patterns. Some cases showed different EGFR mutations. The differences identified between the adenocarcinoma patterns reinforce the need to carefully identify the patterns present, with implications in diagnosis and in pathogenic understanding. EGFR and KRAS mutational status can be determined in biopsies representing bronchial pulmonary carcinomas because when a mutation is present it is generally present in all the histological patterns.
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Affiliation(s)
- Vitor Sousa
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Pathology Institute, Coimbra University Hospital, Coimbra, Portugal.
| | - Carolina Rodrigues
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria Silva
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana Maria Alarcão
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Lina Carvalho
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Pathology Institute, Coimbra University Hospital, Coimbra, Portugal
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Zenali MJ, Weissferdt A, Solis LM, Ali S, Tang X, Mehran RJ, Wistuba II, Moran CA, Kalhor N. An update on clinicopathological, immunohistochemical, and molecular profiles of colloid carcinoma of the lung. Hum Pathol 2015; 46:836-42. [PMID: 25776025 DOI: 10.1016/j.humpath.2014.10.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/17/2014] [Accepted: 10/22/2014] [Indexed: 11/30/2022]
Abstract
Colloid carcinoma is a rare subtype of lung adenocarcinoma characterized by abundant pools of extracellular mucin and scant malignant epithelium. Because of the rarity of these tumors, many of the reported clinicopathological and immunohistochemical characteristics are contradictory. Moreover, the molecular alterations that underlie these tumors are unknown. We present the clinicopathological, immunohistochemical, and molecular features of 13 cases of colloid carcinoma of the lung. The patients were 9 women and 4 men between the ages of 48 and 86 years. Surgical resection and staging were performed in all patients. Seven patients were in stage T1N0M0, 3 in T2N0M0, 2 in T2N1M0, and 1 in T2N0M1. The tumor was 100% mucinous in 9 patients, whereas in 4 cases, the lesions consisted of 50% to 90% mucin pools with the remainder being a noncolloid adenocarcinoma component ranging in morphology from bronchioalveolar to acinar, papillary, solid, or mixed patterns. Follow-up ranged from 35 to 128 months. Three patients died, 1 of disease and 2 of unrelated causes. The remaining 10 patients are alive at the time of reporting, 3 with recurrent disease. Immunohistochemical studies showed CK7, CK20, and CDX2 expression in all tumors, whereas TTF-1, surfactant A, and napsin A were not present or were only focally positive in most cases. Analysis showed KRAS mutations in 2 cases. All tumors were negative for ALK gene rearrangement and EGFR mutation. Our study highlights the clinicopathological, immunohistochemical, and molecular features of lung colloid adenocarcinoma and attempts to clarify some misconceptions regarding this rare tumor.
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Affiliation(s)
- Maryam J Zenali
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Annikka Weissferdt
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Luisa M Solis
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Sara Ali
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Ximing Tang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Ignacio I Wistuba
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030; Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Cesar A Moran
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Neda Kalhor
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030.
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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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47
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Pulmonary adenocarcinoma with signet ring cell features: a comprehensive study from 3 distinct patient cohorts. Am J Surg Pathol 2015; 38:1681-8. [PMID: 25007143 DOI: 10.1097/pas.0000000000000280] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Comprehensive biological characteristics of pulmonary adenocarcinomas with signet ring cell features (SRC⁺) are not well known. Herein, we systematically evaluated clinical and molecular features of SRC⁺ cases with particular attention to smoking status. Surgically treated lung adenocarcinomas (n=763) with follow-up ≥5 years in 3 cohorts were reviewed: all patients in 2006 to 2007 ("all-comers," n=222; 168 ever-smokers), a never-smoker cohort (n=266), and a cohort of ever-smokers (n=275). SRC⁺ tumors had ≥10% of SRCs agreed by 2 pathologists. SRC⁺ cases were tested for rearrangement of ALK and ROS1, as well as 187 known mutations in 10 oncogenes including EGFR, KRAS, BRAF, ERBB2, JAK2, AKT1, AKT2, KIT, MET, and PIK3CA. Overall, 53 of 763 cases (7%) were SRC⁺. In the 2006 to 2007 "all comer" cohort, 9% were SRC⁺. In the never-smoker cohort, 9% were SRC⁺. In the smoker cohort, 3% were SRC⁺. Univariable analysis showed that SRC⁺ never-smokers had shorter overall and disease-free survival (P=0.006 and 0.0004, respectively), but the significance faded in the multivariable analysis. For the other 2 cohorts, crude 5-year survival was decreased by 6% to 27% in SRC⁺ cases without reaching statistical significance. In SRC⁺ tumors, KRAS mutation was most common (29%), followed by ALK (26%), EGFR (18%), ROS1 (6%), BRAF (6%), and PIK3CA (3%). In summary, SRC⁺ tumors in never-smokers had a worse survival by univariable analysis only. SRC⁺ cases seemed enriched for ALK⁺ and ROS1⁺, and other mutations were generally in keeping with the patient's smoking status.
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48
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Hugen N, Simons M, Halilović A, van der Post RS, Bogers AJ, Marijnissen-van Zanten MA, de Wilt JH, Nagtegaal ID. The molecular background of mucinous carcinoma beyond MUC2. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2014; 1:3-17. [PMID: 27499889 PMCID: PMC4858120 DOI: 10.1002/cjp2.1] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/12/2014] [Indexed: 12/16/2022]
Abstract
The increasing interest of the oncology community in tumour classification and prediction of outcome to targeted therapies has put emphasis on an improved identification of tumour types. Colorectal mucinous adenocarcinoma (MC) is a subtype that is characterized by the presence of abundant extracellular mucin that comprises at least 50% of the tumour volume and is found in 10–15% of colorectal cancer patients. MC development is poorly understood, however, the distinct clinical and pathological presentation of MC suggests a deviant development and molecular background. In this review we identify common molecular and genetic alterations in colorectal MC. MC is characterized by a high rate of MUC2 expression. Mutation rates in the therapeutically important RAS/RAF/MAPK and PI3K/AKT pathways are significantly higher in MC compared with non‐mucinous adenocarcinoma. Furthermore, mucinous adenocarcinoma shows higher rates of microsatellite instability and is more frequently of the CpG island methylator phenotype. Although the majority of MCs arise from the large intestine, this subtype also develops in other organs, such as the stomach, pancreas, biliary tract, ovary, breast and lung. We compared findings from colorectal MC with tumour characteristics of MCs from other organs. In these organs, MCs show different mutation rates in the RAS/RAF/MAPK and PI3K/AKT pathways as well, but a common mucinous pathway cannot be identified. Identification of conditions and molecular aberrations that are associated with MC generates insight into the aetiology of this subtype and improves understanding of resistance to therapies.
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Affiliation(s)
- Niek Hugen
- Department of Surgery Radboud University Medical Center Nijmegen The Netherlands
| | - Michiel Simons
- Department of Pathology Radboud University Medical Center Nijmegen The Netherlands
| | - Altuna Halilović
- Department of Pathology Radboud University Medical Center Nijmegen The Netherlands
| | | | - Anna J Bogers
- Department of Pathology Radboud University Medical Center Nijmegen The Netherlands
| | | | - Johannes Hw de Wilt
- Department of Surgery Radboud University Medical Center Nijmegen The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology Radboud University Medical Center Nijmegen The Netherlands
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Kim MY, Kang CH, Park SH. Multifocal synchronous mucinous adenocarcinomas arising in congenital pulmonary airway malformation: a case report with molecular study. Histopathology 2014; 65:926-32. [DOI: 10.1111/his.12515] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Moon-Young Kim
- Department of Pathology; Seoul National University Hospital; Seoul South Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery; Seoul National University College of Medicine; Seoul South Korea
| | - Sung-Hye Park
- Department of Pathology; Seoul National University Hospital; Seoul South Korea
- Department of Pathology; Seoul National University College of Medicine; Seoul South Korea
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García-Labastida L, Garza-Guajardo R, Barboza-Quintana O, Rodríguez-Sanchez IP, Ancer-Rodríguez J, Flores-Gutierrez JP, Gómez-Macías GS. CDX-2, MUC-2 and B-catenin as intestinal markers in pure mucinous carcinoma of the breast. Biol Res 2014; 47:43. [PMID: 25299496 PMCID: PMC4177067 DOI: 10.1186/0717-6287-47-43] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/28/2014] [Indexed: 01/08/2023] Open
Abstract
Background Pure mucinous adenocarcinoma of the breast is a rare entity characterized by the production of variable amounts of mucin comprising 1% to 6% of breast carcinomas. Some mucinous adenocarcinomas have shown expression of intestinal differentiation markers such as MUC-2. This study examines the expression of intestinal differentiation markers in this type of breast carcinoma. Results Twenty-two cases of pure mucinous adenocarcinoma of the breast were assessed. Immunochemistry was performed for beta-catenin, CDX-2 and MUC-2. All cases were positive for B-catenin. MUC-2 positivity was observed in all cases; 63. 6% were 3 plus positive. All cases were negative for CDX-2. Conclusions These results suggest that mucinous breast carcinomas express some markers of intestinal differentiation, such as MUC-2 and beta-catenin; however, future studies with a larger series of cases and using molecular techniques that help affirm these results are needed.
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Affiliation(s)
- Laura García-Labastida
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Departamento de Anatomía Patológica y Citopatología, Madero and Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo Leon, 64460, Mexico.
| | - Raquel Garza-Guajardo
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Departamento de Anatomía Patológica y Citopatología, Madero and Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo Leon, 64460, Mexico.
| | - Oralia Barboza-Quintana
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Departamento de Anatomía Patológica y Citopatología, Madero and Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo Leon, 64460, Mexico.
| | - Irám Pablo Rodríguez-Sanchez
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Departamento de Anatomía Patológica y Citopatología, Madero and Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo Leon, 64460, Mexico.
| | - Jesús Ancer-Rodríguez
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Departamento de Anatomía Patológica y Citopatología, Madero and Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo Leon, 64460, Mexico.
| | - Juan Pablo Flores-Gutierrez
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Departamento de Anatomía Patológica y Citopatología, Madero and Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo Leon, 64460, Mexico.
| | - Gabriela Sofía Gómez-Macías
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Departamento de Anatomía Patológica y Citopatología, Madero and Gonzalitos S/N, Col. Mitras Centro, Monterrey, Nuevo Leon, 64460, Mexico.
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