Prognostic significance of microscopic size in peripherally located scar-associated clinical stage I lung carcinomas

Prognostic significance of alveolar collapse in lung invasive adenocarcinoma and its relationship with tumor infiltrating lymphocytes

This study aims to investigate the correlations between alveolar collapse, tumor size, and tumor infiltrating lymphocytes (TILs), while also evaluating the prognostic significance of alveolar collapse in invasive lung adenocarcinoma. 355 patients with solitary invasive lung adenocarcinoma were divided into two groups based on the maximum diameter of alveolar collapse: alveolar collapse ≤ 5 mm group and alveolar collapse > 5 mm group. Differences in clinicopathological characteristics, tumor size, TILs, and prognosis were compared between the two groups. The alveolar collapse > 5 mm group had a higher mean age, larger tumor diameter, and increased TILs levels compared to the alveolar collapse ≤ 5 mm group (P < 0.05). A moderate positive correlation was observed between alveolar collapse and tumor size (r = 0.646, P < 0.001). Lung adenocarcinoma with alveolar collapse > 5 mm demonstrated superior 5-year survival and acted as an independent prognostic indicator (HR=0.152, P = 0.004) in multivariate Cox regression analysis, alongside tumor size (HR=10.172, P = 0.034) and lymph node metastasis (HR=2.88, P = 0.017). The size of alveolar collapse is associated with TILs abundance, suggesting that the immune microenvironment may play a crucial role in alveolar collapse formation. Pathologists should take note of alveolar collapse in lung adenocarcinoma.

Consolidation radiographic morphology can be an indicator of the pathological basis and prognosis of partially solid nodules

Background

Part-solid nodules (PSNs) have gradually shifted to defining special clinical subtypes. Commonly, the solid portions of PSNs show various radiological morphologies, of which the corresponding pathological basis and prognosis are unclear. We conducted a radiological–pathological evaluation to determine the histopathologic basis of different consolidation radiographic morphologies related to prognosis.

Materials and methods

A cohort of 275 patients with a surgical pathological diagnosis of lung adenocarcinoma were enrolled. Preoperative computed tomography (CT) images of the PSNs were recorded and assessed. A panel of 103 patients with complete pathological specimens was selected to examine the radiological–pathological associations, and follow-up was performed to identify the prognosis.

Results

Of the 275 patients, punctate consolidation was observed radiologically in 43/275 (15.7%), stripe consolidation in 68/275 (24.7%), and irregular consolidation in 164/275 (59.6%) patients. The radiological morphology of the solid components was significantly associated with the histopathological subtypes (P < 0.001). Visual punctate solid components on CT correlated with tertiary lymphoid structures, stripe solid components on CT correlated with fibrotic scar, and irregular solid components on CT correlated with invasion. PSNs with regular consolidation had a better prognosis than those with irregular consolidation.

Conclusion

Radiological morphology of solid components in PSNs can indicate the pathological basis and is valuable for prognosis. In particular, irregular solid components in PSNs usually indicate serious invasive growth, which should be taken with caution during assessment.

Updates in grading and invasion assessment in lung adenocarcinoma

The pathologic evaluation of lung adenocarcinoma, because of greater understanding of disease progression and prognosis, has become more complex. It is clear that histologic growth patterns reflect indolent and aggressive disease, resulting in clearer morphologic groups that can be the underpinning of a grading system. In addition, the progression of adenocarcinoma from a tumor that preserves alveolar architecture to one that remodels and effaces lung structure has led to criteria that reflect invasive rather than in-situ growth. While some of these are based on tumor cell growth pattern, aspects of this remodeling from desmoplasia to artifacts of lung collapse and sectioning, can lead to difficult to interpret patterns with lower reproducibility between observers. Such scenarios are examined to provide updates on new histologic concepts and to highlight ongoing problem areas.

Prognostic factors and survival outcome of primary pulmonary acinar cell carcinoma

Purpose

The objective of our study was to investigate the epidemiologic characteristics and prognostic factors in patients with pulmonary acinar cell carcinoma (PACC).

Methods

PACC patients diagnosed between 1975 and 2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The trend in PACC incidence was assessed using joinpoint regression software. Overall survival (OS) and disease‐specific survival (DSS) were evaluated using the Kaplan–Meier method and log‐rank test. Univariate and multivariate Cox regression analysis was performed to identify the independent prognostic factors for OS and DSS. Nomograms to predict survival possibilities were constructed based on the identified independent prognostic factors.

Results

A total of 2918 patients were identified with PACC. The mean age was 65.2 ± 8.95 years with a female to male of 1.6:1. The incidence of PACC steadily increased by an annual percentage change (APC) of 3.2% (95% CI 2.1–4.4, p < 0.05). Multivariate Cox regression analysis revealed that age, gender, race, stage, grade, tumor size, number of positive lymph nodes, surgery, and chemotherapy were independent prognostic factors for survival. Nomograms specifically for PACC were constructed to predict 1‐ and 5‐year OS and DSS possibility, respectively. The concordance index (C‐index) and calibration plots showed the established nomograms had robust and accurate performance.

Conclusion

PACC was rare but the incidence has been steadily increasing over the past four decades. Survival has improved in recent years. Surgery or chemotherapy could provide better OS and DSS. The established nomograms specifically for PACC were robust and accurate in predicting 1‐ and 5‐year OS and DSS.

Pulmonary carcinomas arising in association with scar: Cytomorphologic features in histologically confirmed cases

BACKGROUND

Lung carcinoma arising in association with scar tissue is a well-reported but much debated phenomenon. Scar tissue complicates imaging and pathologic tumor measurement for cancer staging. To the best of our knowledge, the cytological findings in lung scar carcinoma (LSC) have not been described in the literature. Therefore, the aim of this study was to characterize the findings in fine-needle aspirations (FNA) from histologically confirmed LSCs.

METHODS

LSCs were identified on retrospective search. Cases with preoperative FNA material were reviewed, including non-scar cases that were used for comparison. The clinical and histopathology findings were recorded.

RESULTS

Twenty-seven cases associated with scar tissue had material for review and 35 cases not associated with scar tissue were used for comparison. The proportion of fibrosis in resection specimens ranged from 10% to 80%. Five (19%) FNA cases were hypocellular. There was no statistically significant difference between the scar and non-scar groups in terms of overall cellularity and diagnostic categories (P = .113 and P = .17, respectively). There was correlation between cytology and dominant pattern on histology in 19 (79%) adenocarcinoma cases. Spindle cells and fibrous or fibroelastotic fragments were present in 22 (81%) cases.

CONCLUSION

This is the first study describing the cytology associated with LSCs. The presence of fibrosis did not adversely impact cellularity, which is likely due to multiple excursions and selective microdissection of tumor cells by the FNA needle. The cytomorphological and histological patterns correlated in most cases. FNA is able to provide a preoperative diagnosis of carcinoma despite the presence of fibrosis.