Difference between revisions of "Non-small cell lung carcinoma"
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| Tx = surgery if feasible | | Tx = surgery if feasible | ||
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'''Non-small cell | '''Non-small cell lung carcinoma''', abbreviated '''NSCLC''', is a [[carcinoma|malignant epithelial neoplasm]] of the [[lung]] that is ''not'' [[small cell carcinoma of the lung]]. | ||
It is umbrella term that includes [[squamous cell carcinoma of lung]], [[adenocarcinoma of the lung]] and [[adenosquamous carcinoma of the lung]].<ref>{{Cite journal | last1 = Song | first1 = Z. | last2 = Lin | first2 = B. | last3 = Shao | first3 = L. | last4 = Zhang | first4 = Y. | title = Therapeutic efficacy of gefitinib and erlotinib in patients with advanced lung adenosquamous carcinoma. | journal = J Chin Med Assoc | volume = 76 | issue = 9 | pages = 481-5 | month = Sep | year = 2013 | doi = 10.1016/j.jcma.2013.05.007 | PMID = 23769878 }}</ref> | It is umbrella term that includes [[squamous cell carcinoma of lung]], [[adenocarcinoma of the lung]] and [[adenosquamous carcinoma of the lung]].<ref>{{Cite journal | last1 = Song | first1 = Z. | last2 = Lin | first2 = B. | last3 = Shao | first3 = L. | last4 = Zhang | first4 = Y. | title = Therapeutic efficacy of gefitinib and erlotinib in patients with advanced lung adenosquamous carcinoma. | journal = J Chin Med Assoc | volume = 76 | issue = 9 | pages = 481-5 | month = Sep | year = 2013 | doi = 10.1016/j.jcma.2013.05.007 | PMID = 23769878 }}</ref> | ||
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It is also known as '''large cell carcinoma'''; however, usage of ''large cell carcinoma'' is discouraged in the context of lung biopsies and [[pulmonary cytopathology|lung cytopathology]] specimens.<ref name=pmid22970842>{{Cite journal | last1 = Travis | first1 = WD. | last2 = Brambilla | first2 = E. | last3 = Noguchi | first3 = M. | last4 = Nicholson | first4 = AG. | last5 = Geisinger | first5 = K. | last6 = Yatabe | first6 = Y. | last7 = Ishikawa | first7 = Y. | last8 = Wistuba | first8 = I. | last9 = Flieder | first9 = DB. | title = Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. | journal = Arch Pathol Lab Med | volume = 137 | issue = 5 | pages = 668-84 | month = May | year = 2013 | doi = 10.5858/arpa.2012-0263-RA | PMID = 22970842 }}</ref> | It is also known as '''large cell carcinoma'''; however, usage of ''large cell carcinoma'' is discouraged in the context of lung biopsies and [[pulmonary cytopathology|lung cytopathology]] specimens.<ref name=pmid22970842>{{Cite journal | last1 = Travis | first1 = WD. | last2 = Brambilla | first2 = E. | last3 = Noguchi | first3 = M. | last4 = Nicholson | first4 = AG. | last5 = Geisinger | first5 = K. | last6 = Yatabe | first6 = Y. | last7 = Ishikawa | first7 = Y. | last8 = Wistuba | first8 = I. | last9 = Flieder | first9 = DB. | title = Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. | journal = Arch Pathol Lab Med | volume = 137 | issue = 5 | pages = 668-84 | month = May | year = 2013 | doi = 10.5858/arpa.2012-0263-RA | PMID = 22970842 }}</ref> | ||
In the clinical context, it is | In the clinical context, it is often referred to as '''non-small cell lung cancer'''; this ignores the fact that not all non-small cell lung cancer fits into the [[carcinoma]] category. | ||
''Poorly differentiated carcinoma of the lung'' and ''poorly differentiated lung carcinoma'' redirect to this article. | ''Poorly differentiated carcinoma of the lung'' and ''poorly differentiated lung carcinoma'' redirect to this article. | ||
Revision as of 02:26, 19 November 2015
| Non-small cell lung carcinoma | |
|---|---|
| Diagnosis in short | |
|
| |
| Synonyms | large cell carcinoma (term discouraged in the context of biopsies & FNAs) |
| Subtypes | NSCC favour adenocarcinoma, NSCC favour squamous cell carcinoma, NSCC-not otherwise specified |
| LM DDx | lung adenocarcinoma, lung squamous carcinoma, lung small cell carcinoma, poorly differentiated metastatic carcinoma |
| IHC | pankeratin +ve, CD56 -ve, chromogranin A -ve, synaptophysin -ve, TTF-1 +ve/-ve, p63 +ve/-ve |
| Staging | lung cancer staging |
| Site | lung - see lung tumours |
|
| |
| Clinical history | typically no history of malignancy |
| Prevalence | uncommon |
| Radiology | not suggestive of metastatic disease |
| Prognosis | usually poor |
| Clin. DDx | other lung tumours |
| Treatment | surgery if feasible |
Non-small cell lung carcinoma, abbreviated NSCLC, is a malignant epithelial neoplasm of the lung that is not small cell carcinoma of the lung.
It is umbrella term that includes squamous cell carcinoma of lung, adenocarcinoma of the lung and adenosquamous carcinoma of the lung.[1]
It is also known as large cell carcinoma; however, usage of large cell carcinoma is discouraged in the context of lung biopsies and lung cytopathology specimens.[2]
In the clinical context, it is often referred to as non-small cell lung cancer; this ignores the fact that not all non-small cell lung cancer fits into the carcinoma category.
Poorly differentiated carcinoma of the lung and poorly differentiated lung carcinoma redirect to this article.
General
- Non-small cell lung carcinoma can be considered a waffle diagnosis and as such its use should be limited.
- It is preferable to be more specific if this is possible, i.e. call adenocarcinoma or squamous cell carcinoma.
- Historically, it was sufficient to differentiate between small cell and non-small cell carcinomas, as the treatment for all non-small cell lung carcinomas was the same.
- Small cell carcinoma is typically considered non-surgical disease; thus, non-small cell carcinoma or poorly differentiated carcinoma, as a diagnosis, is less likely to exclude surgery as an option.
Clinical:
- Radiologic findings should not be suggestive of a metastasis.
Microscopic
Features:
- Typically large cells with abundant cytoplasm.
- +/-Nucleoli.
- No stippled chromatin.
DDx:
- Squamous cell carcinoma of the lung.
- Adenocarcinoma of the lung.
- Small cell carcinoma of the lung.
- Large cell variant of small cell carcinoma of the lung.
- Lung metastasis - imaging suggestive of a metastasis or a history of malignancy.
IHC
Features:
- Lack of staining with neuroendocrine markers (chromogranin A -ve, synaptophysin -ve, CD56 -ve).
- Keratins +ve.
Note:
- Immunostains should not favour adenocarcinoma or squamous cell carcinoma - see Sloan-Kettering algorithm below.
Adenocarcinoma versus squamous carcinoma
Memorial Sloan-Kettering algorithm - Rekhtman et al.:[3]
| TTF-1\p63 | p63 -ve (0% of cells) | p63 +ve <50% of cells | p63 +ve >=50% of cells |
|---|---|---|---|
| TTF-1 +ve >=50% of cells | Adenocarcinoma | Adenocarcinoma | Adenocarcinoma |
| TTF-1 +ve <50% of cells | Adenocarcinoma | Adenocarcinoma | Squamous carcinoma |
| TTF-1 -ve (0% of cells) | Adenocarcinoma | CK5/6 to determine | Squamous carcinoma |
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International consensus terminology - Travis et al.:[2]
| Diagnosis | Stains |
|---|---|
| Non-small cell carcinoma, favour adenocarcinoma | TTF-1 or napsin +ve |
| Non-small cell carcinoma, favour squamous cell carcinoma | p40 or p63 +ve |
| Non-small cell carcinoma-not otherwise specified | -ve NE stains, -ve SCC stains, -ve adenoca stains |
Lung, Left Lower Lobe, Core Biopsy: - NON-SMALL CELL CARCINOMA-NOT OTHERWISE SPECIFIED, see comment. COMMENT: The tumour stains as follows: POSITIVE: EMA, AE1/AE3. NEGATIVE: TTF-1, chromogranin A, synaptophysin, CD56, CD45, CK5/6, p63. The morphology would be compatible with small cell carcinoma or basaloid squamous cell carcinoma. The neuroendocrine markers (chromogranin A, synaptophysin, CD56) and the squamous markers (p63, CK5/6) are negative; thus, the tumour is not further classified.
See also
References
- ↑ Song, Z.; Lin, B.; Shao, L.; Zhang, Y. (Sep 2013). "Therapeutic efficacy of gefitinib and erlotinib in patients with advanced lung adenosquamous carcinoma.". J Chin Med Assoc 76 (9): 481-5. doi:10.1016/j.jcma.2013.05.007. PMID 23769878.
- ↑ 2.0 2.1 Travis, WD.; Brambilla, E.; Noguchi, M.; Nicholson, AG.; Geisinger, K.; Yatabe, Y.; Ishikawa, Y.; Wistuba, I. et al. (May 2013). "Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification.". Arch Pathol Lab Med 137 (5): 668-84. doi:10.5858/arpa.2012-0263-RA. PMID 22970842.
- ↑ Rekhtman, N.; Ang, DC.; Sima, CS.; Travis, WD.; Moreira, AL. (Oct 2011). "Immunohistochemical algorithm for differentiation of lung adenocarcinoma and squamous cell carcinoma based on large series of whole-tissue sections with validation in small specimens.". Mod Pathol 24 (10): 1348-59. doi:10.1038/modpathol.2011.92. PMID 21623384.