Non-small cell lung carcinoma

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Non-small cell lung carcinoma
Diagnosis in short
[[File:Non-small cell lung carcinoma. H&E stain.|frameless|Template:Px|alt=]]
Non-small cell lung carcinoma -- high mag.jpg
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:

Images

  • NSCLC - low mag. (WC)

  • NSCLC - intermed mag. (WC)

  • NSCLC - high mag. (WC)

  • NSCLC - very high mag. (WC)

  • NSCLC - very high mag. (WC)

IHC

Features:

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

  1. ↑ 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. ↑ 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.
  3. ↑ 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.
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