acinar adenocarcinoma lung pathology outlines

The authors declare that they have no competing interests. Terminology Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Invasive adenocarcinoma of lung, acinar type. Arch Pathol Lab Med 137:685–705, Tsuta K, Ishii G, Nitadori J, Murata Y, Kodama T, Nagai K, Ochiai A (2006) Comparison of the immunophenotypes of signet-ring cell carcinoma, solid adenocarcinoma with mucin production, and mucinous bronchioloalveolar carcinoma of the lung characterized by the presence of cytoplasmic mucin. showed a significantly increased 5-year recurrence-free survival for patients without STAS (“tumor islands”), in a series also of predominantly non-mucinous tumors. According to the new classification proposed by an international multidisci… A higher proportion (11/16 or 69%) of cuboidal predominant tumors showed some TTF1 positivity; of these, 9 cases (82%) showed diffuse staining and 2 (18%) showed focal reactivity (p < 0.01). Am J Surg Pathol 37:287–294. The best model (area under the receiver operating characteristic curve [AUC] = 0.749 for RFS and 0.787 for OS) was composed of a combination of predominant plus high-grade histologic pattern with a cutoff of 20% for the latter. The novel histologic International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification system of lung adenocarcinoma is a stage-independent predictor of survival. {Thunnissen, 2016 #43} An older study on breast tissue describes tissue displacement in breast tissue and in a high percentage of cases. Pulmonary adenocarcinomas resected from 2003 to 2014 were retrospectively reclassified as non-mucinous invasive adenocarcinoma, colloid carcinoma, mucinous adenocarcinoma-in-situ, minimally invasive mucinous adenocarcinoma, or invasive mucinous adenocarcinoma (WHO 2015 reference). Nonpredominant lepidic pattern correlates with better outcome in invasive lung adenocarcinoma. Righi L, Vatrano S, Di Nicolantonio F, Massa F, Rossi G, Cavazza A, Volante M, Votta A, Izzo S, Lo Iacono M, Ardissone F, Di Maio M, Novello S, Scagliotti GV, Papotti M (2016) Retrospective multicenter study investigating the role of targeted next-generation sequencing of selected Cancer genes in mucinous adenocarcinoma of the lung. It is of Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. describe the spreading of tissue fragments and individual cells through a knife surface as one of the possible artifacts in lung specimens. The definition of STATS, while accepted in the current WHO Classification, is not consensual. 4). Time-adjusted Kaplan Meier curves relating STAS to local recurrence (top) and proportion of solid growth to distant recurrence (bottom). 5 cases showed a component of solid non-cribriform growth (% solid ranged from 18 to 50%). (Geles et al. Epub 2015 Oct 17. They are connected to the outside of the body by hollow tubes called airways. Although tumors with a predominant solid growth pattern of mucin-producing cells are now classified as non-mucinous poorly differentiated adenocarcinoma, tumors with a solid component comprising < 50% of the overall tumor architecture were included provided > 50% of the tumor growth consisted of acinar or lepidic growth of mucin-producing (intracytoplasmic) mucin. Semin Thorac Cardiovasc Surg. (Xu et al. Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, Powell CA, Beer D, Riely G, Garg K, Austin JH, Rusch VW, Hirsch FR, Jett J, Yang PC, Gould M; American Thoracic Society. A total of 30 cases were included, representing 9% of all resections of pulmonary adenocarcinomas from 2003 to 2014. pure lepidic growth (outlines alveoli) lacks invasion (stromal, vascular, pleural) lacks invasive patterns (acinar, papillary, solid, micropapillary) lacks spread through airspace: no intraalveolar cells; mostly nonmucinous (type II pneumocytes or clara cells), rarely mucinous; minimal atypia; septal widening with sclerosis/elastosis is common Care was made to distinguish pre-existing pneumocytes in areas of lepidic growth. We found no correlation with distant recurrence. Mucinous adenocarcinomas have a variety of histologic patterns, and may coexist with non-mucinous areas in combined tumors. Share. FOIA (Rossi et al. Tumor size ranged from 0.6 to 8.2 cm. Current readings: pathology, prognosis, and lung cancer. 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. Mucinous adenocarcinoma is often considered a relatively poor prognostic group among adenocarcinomas of the lung and has a high rate of pulmonary recurrence. The International Association for the Study of Lung cancer … Privacy, Help By using this website, you agree to our The proportion of invasive component, size of invasive component, size of solid invasive component, presence of STAS, TTF1 positivity, mucin cell type, and presence of histologic subtypes other than solid were correlated with outcome via Kaplan-Meier curves with log-rank statistic (JMP software, Cary, NC). (Table 1) 17 patients were female (mean age 63) and 13 cases were male (mean age 71), with a F:M ratio of 1.3:1. slide 34 of 128: Tweets by @WebPathology . (Righi et al. PubMed  Carcinoma … Springer Nature. Article  Because of the low rate of deaths due to disease, survival data were not calculated (no parameters were significant). Introduction: We retrospectively studied time to lung recurrence and time to distant … AB, FT an AP conceived of the study, and participated in its design and coordination and helped to draft the manuscript. Given these findings, we suggest that mucinous adenocarcinomas be subclassified and graded in the same manner as their non-mucinous counterparts: with specific note to percentage of solid growth, micropapillary architecture, STAS, and size of invasive component. Cancers (Basel). 2004) Although historically the term “colloid” has been used interchangeably with “mucinous”, the most recent WHO classification considers colloid carcinomas as a separate variant of adenocarcinoma, specifically defined by inconspicuous lepidic growth and airspaces distended with mucus containing tumor nests. In the 2015 WHO classification of lung tumors, minimally-invasive adenocarcinoma of the lung is defined as a small solitary adenocarcinoma measuring less than or equal to 3 cm with an invasive component less than or equal to 0.5 cm in greatest dimension. The impact of the 2015 classification on prognosis was reviewed by a PubMed search … Cai D, Li H, Wang R, Li Y, Pan Y, Hu H, Zhang Y, Gong R, Pan B, Sun Y, Chen H (2014) Comparison of clinical features, molecular alterations, and prognosis in morphological subgroups of lung invasive mucinous adenocarcinoma. In the former, most of the tumor cell cytoplasm contained mucin whereas the latter showed apical mucin and prominent PAS staining of the luminal surface. There was no association between local recurrence and other pathologic parameters (p > 0.1). 2011 Sep;8(5):381-5. doi: 10.1513/pats.201107-042ST. Am J Clin Pathol 139:160–166, Xu L, Tavora F, Burke A (2013) Histologic features associated with metastatic potential in invasive adenocarcinomas of the lung. J Thorac Oncol 10:806–814, Kamata T, Yoshida A, Shiraishi K, Furuta K, Kosuge T, Watanabe S, Asamura H, Tsuta K (2016) Mucinous micropapillary pattern in lung adenocarcinomas: a unique histology with genetic correlates. Lung adenocarcinomas are histologically and clinically heterogeneous. Types of tumor cell. (Kadota et al. (Travis et al. 8600 Rockville Pike J Thorac Oncol, Rossi G, Murer B, Cavazza A, Losi L, Natali P, Marchioni A, Migaldi M, Capitanio G, Brambilla E (2004) Primary mucinous (so-called colloid) carcinomas of the lung: a clinicopathologic and immunohistochemical study with special reference to CDX-2 homeobox gene and MUC2 expression. Eight cases (36%) showed entirely invasive architecture without a lepidic component. 2014 Aug 1;32(22):2357-64. doi: 10.1200/JCO.2013.50.1049. Terms and Conditions, 2. An autopsy study by Thunissen et al. STAS. J Thorac Oncol 10:1156–1162, Strand TE, Rostad H, Strom EH, Hasleton P (2015) The percentage of lepidic growth is an independent prognostic factor in invasive adenocarcinoma of the lung. adenocarcinoma lung pathology outlines … A cohort of 284 stage I pulmonary adenocarcinomas was used as a training set to identify histologic features associated with patient outcomes (recurrence-free survival [RFS] and overall survival [OS]). The 2015 World Health Organization (WHO) lung adenocarcinoma classification divides tumours into categories of indolent pre-invasive, minimally invasive and predominantly lepidic and, by examining predominant patterns of invasion, allows for further stratification into intermediate and high-grade tumours. Lung cancer is the most common cause of cancer-related mortality worldwide, and adenocarcinoma is currently the most common histologic subtype.1 Conventionally, adenocarcinomas have been grouped into 3 distinct grades including well, moderately, and poorly differentiated. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society: international multidisciplinary classification of lung adenocarcinoma: executive summary. (Tsuta et al. Pathologic parameters predicting poor outcome have not been extensively studied, including the presence of spread through alveolar spaces (STAS). Receiver operating characteristic curve analysis was used to select the best model, which was validated (n = 212) and tested (n = 300, including stage I-III) in independent cohorts. J Thorac Oncol 10:1444–1450, Zhao RY, Zhang J, Zhu L, Shao JC, Zhang Q, Teng HH, Qin G, Zhao LX, Ye M, Zhao JK, Ding WJ (2016) Expression of ALK protein in 7 371 pulmonary adenocarcinoma samples, with analysis of clinicopathologic features. Although considered to be more common in mucinous adenocarcinomas than in non-mucinous tumors, the frequency and significance of its presence specifically in the mucinous subset has not been investigated. National Library of Medicine The nests are floating inside airspaces and are distinguished from lepidic implants. Paulk, A., Tavora, F. & Burke, A. The relative prevalence of the neoplasm in the various salivary gland reflects the abundance of acinic cells: parotid gland (~80%) > minor salivary glands (~17%) > submandibular glands (~3%). Invasive mucinous adenocarcinoma of the lung is a subtype of invasive adenocarcinoma of the lung formerly known as mucinous bronchoalveolar carcinoma (BAC).They are more likely to be multicentric and tend to have a worse prognosis than non-mucinous types. Cribriform and signet ring cell patterns correlated with colloid areas (p = 0.002 and p = 0.003, respectively). Prevention and treatment information (HHS). Qu Y, Zhao D, Mu J, Che N, Zhang C, Liu Z, Su D, Zhou L, Zhang H, Wei L (2015) Prognostic analysis of primary mucin-producing adenocarcinoma of the lung: a comprehensive retrospective study. 5). Unable to load your collection due to an error, Unable to load your delegates due to an error. Lung cancer is the leading cause of cancer-related death in developed countries. Columnar / goblet cell type was inversely correlated with TTF-1 expression (p = 0.01). showed that in a subset of patients with peripheral, predominantly non-mucinous adenocarcinomas < 2 cm, STAS was highly associated with regional recurrence, especially in tumors that were treated with sub-lobar resections. The model consists of the following: grade 1, lepidic predominant tumor; grade 2, acinar or papillary predominant tumor, both with no or less than 20% of high-grade patterns; and grade 3, any tumor with 20% or more of high-grade patterns (solid, micropapillary, or complex gland). In keeping with findings by Strand et al. Contrary to the head and neck region, benign SGT such as pleomorphic adenomas are exceedingly rare in the pulmonary system. : a clinicopathologic study based on the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary lung adenocarcinoma classification. Adenocarcinoma; Lung; Model; Prognosis; Tumor grading. Lung adenocarcinoma is the most common brain metastasis. Manage cookies/Do not sell my data we use in the preference centre. volume 1, Article number: 3 (2018) b. PAS (with diastase pretreatment) demonstrates diffuse cytoplasmic staining with basal nuclei. Histopathology Lung-- Adenocarcinoma - YouTube. 2013 Spring;25(1):14-21. doi: 10.1053/j.semtcvs.2013.01.003. In contrast to areas of lepidic growth where the elastic framework of the lung is intact, acinar adenocarcinoma has stromal invasion, as evidenced by disruption of the elastic framework with bundles of broken elastic fibers seen on VVG stains accompanied by desmoplastic tumor stroma 10 … … Bethesda, MD 20894, Copyright Pathology and Genetics of Tumors of the lung, Pleura, Thymus and heart. There was a significant association between distant metastasis and solid invasive growth (Fig. Histopathology Lung-- Adenocarcinoma. 2009), and higher rates of recurrence (Onozato et al. Proc Am Thorac Soc. The largest diameter of the tumor was divided into < 2, 2–5, and > 5 cm size categories. Tap to unmute. Some degree of TTF-1 positivity was present in 13 cases overall (43%) (n = 11 for cuboidal predominant tumors; n = 2 for columnar predominant tumors). 2012 May 1;30(13):1438-46. doi: 10.1200/JCO.2011.37.2185. Surgical and Experimental Pathology Cookies policy. Clipboard, Search History, and several other advanced features are temporarily unavailable. Mucinous adenocarcinomas of the lung account for approximately 10–15% of lung adenocarcinomas and have been reported to portend a poorer prognosis than non-mucinous adenocarcinoma (Cai et al. 2004) Geles et al. 2013). The histopathology of lung cancer appears to be changing: The incidence of squamous cell carcinoma in the United States is declining, accompanied by the increase in the incidence of adenocarcinoma. 2015) In fact, these entities were not represented in the current study despite several cases showing entirely lepidic architecture, either because of size criterion (> 3 cm) or presence of STAS. (Geles et al. 2016; Watanabe et al. This study was approved by the Institutional Review Board of the University of Maryland Medical Center. Epub 2012 Mar 5. Copyright © 2020 International Association for the Study of Lung Cancer. Tumors were also classified similarly to non-mucinous adenocarcinomas into lepidic (in situ), acinar, papillary, micropapillary and solid types (Fig. (Strand et al. Kadota et al. Acinar-predominant adenocarcinoma of the lung is a histological subtype of non-mucinous invasive adenocarcinoma of the lung. For columnar cell predominant cases 2/14 (14%) cases showed focal TTF 1 reactivity; in none of these tumors was TTF1 diffusely positive. New International Association for the Study of Lung Cancer (IASLC) Pathology Committee Grading System for the Prognostic Outcome of Advanced Lung Adenocarcinoma. Fabio Tavora. Correspondence to J Surg Oncol 114:211–215, Onozato ML, Kovach AE, Yeap BY, Morales-Oyarvide V, Klepeis VE, Tammireddy S, Heist RS, Mark EJ, Dias-Santagata D, Iafrate AJ, Yagi Y, Mino-Kenudson M (2013) Tumor islands in resected early-stage lung adenocarcinomas are associated with unique clinicopathologic and molecular characteristics and worse prognosis. Mäkinen JM, Laitakari K, Johnson S, Mäkitaro R, Bloigu R, Lappi-Blanco E, Kaarteenaho R. Lung Cancer. Google Scholar, Kawakami T, Nabeshima K, Hamasaki M, Iwasaki A, Shirakusa T, Iwasaki H (2009) Small cluster invasion: a possible link between micropapillary pattern and lymph node metastasis in pT1 lung adenocarcinomas. Mucinous adenocarcinomas of the lung are similar to non-mucinous and both STATs and solid growth represent poor prognosticators, for local and distant recurrence, respectively. (Rossi et al. The International Association for the Study of Lung Cancer pathology panel evaluated a set of histologic criteria associated with prognosis aimed at establishing a grading system for invasive pulmonary adenocarcinoma. Adenocarcinoma (ADC) is the most common histologic type of lung cancer with an increasing prevalence, currently accounting for more than 40% of cases of non-small cell lung cancer (NSLC), occurring in smokers and non-smokers .. Adenocarcinoma is the most common (primary lung cancer). Accessibility Zhonghua Bing Li Xue Za Zhi 45:601–605, CAS  2013) A pure mucinous histologic pattern without non-mucinous elements is associated with lower stage and better prognosis than mixed tumors. Surg Exp Pathol 1, 3 (2018). Adenocarcinoma (ADC) is the most common histologic subtype of lung cancer that encompasses a heterogeneous group of malignancies with different morphologic features, etiology, and molecular changes. There was a significant association between STAS and lung recurrence (Fig. PubMed Google Scholar. Shopping. 3Department of Pathology, Hachioji Medical Center of Tokyo Medical University, Japan Abstract Background and objective: The 4th edition of the WHO Classification of Tumors of the Lung, Pleura, Thymus and Heart states that adenocarcinomas should be classified according to the predominant pattern. However, variations and mixed patterns are frequent in adenocarcinoma, and a strong correlation between mucinous and nonmucinous cells and TTF1 staining patterns has not been established in mucinous adenocarcinomas. Histologic subclassification in a manner identical to nonmucinous tumors may provide valuable prognostic information. Types of lung adenocarcinoma include lepidic, acinar, micropapillary, papillary, and solid. There was no significant correlation between mucin type and growth pattern or presence of STAS. STAS of any type was present in 22 (73%) of cases. Acinar Adenocarcinoma Acinar adenocarcinoma is a common type of adenocarcinoma with tumor cells ar-ranged in classic glandular structure on a fibroelastic stroma. Epub 2014 May 5. Non-small cell lung cancers (NSCLC) comprise 75% of all lung cancers and consist of three major histologic types: squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Similar results were seen in the validation (AUC = 0.732 for RFS and 0.787 for OS) and test cohorts (AUC = 0.690 for RFS and … not applicable. PubMed Central  Part of Results: 2015). Acinar adenocarcinoma is a histological subtype of gland-forming cancer that is diagnosed when cuboidal and/or columnar shaped malignant cells in the neoplastic tissue form acini and tubules. Percentage of invasion ranged from entirely lepidic to entirely invasive. Interobserver reproducibility revealed good agreement (k = 0.617). https://doi.org/10.1007/s13277-015-3869-1. As no standardized definition for mucinous adenocarcinoma of the lung has been established, “mucinous” was defined in this study as a mucin-producing adenocarcinoma (presence of airspace mucin pools) with intracellular mucin in at least 50% of the tumor cells. Watch later. It … The current diagnostic criteria for hepatoid adenocarcinoma of lung include typical acinar or papillary adenocarcinoma and a component resembling hepatocellular carcinoma and expressing α-fetoprotein (AFP). Solid growth in the tumor was significantly associated with distant metastases, suggesting that architectural patterns- particularly micropapillary patterns and solid growth- that are known to portend poorer prognoses in non-mucinous adenocarcinomas (Warth et al. The pathologic features of mucinous adenocarcinomas that are associated with poor prognosis have not been studied in detail. 2013; Kamata et al. The growth patterns of mucinous adenocarcinomas should be reported like reporting of non-mucinous adenocarcinomas. Acinar adenocarcinoma is the cause of roughly 90% of prostate cancer cases. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. PathologyOutlines.com website. Some glands appear as solid clusters of tumor cells and lack a recognizable lumen. 2015). FT and AB participated in the design of the study and performed the statistical analysis. All rights reserved. Similar results were seen in the validation (AUC = 0.732 for RFS and 0.787 for OS) and test cohorts (AUC = 0.690 for RFS and 0.743 for OS), confirming the predictive value of the model. This site needs JavaScript to work properly. Distinguishing hepatoid adenocarcinoma of lung from hepatocellular carcinoma metastatic to lu … 2015) Onozato et al. 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. Am J Surg Pathol 37:1100–1108, Zhang Y, Wang R, Li Y, Pan Y, Hu H, Zhang Y, Li H, Shen L, Yu Y, Sun Y, Chen H (2015) Negative thyroid transcription factor 1 expression defines an unfavorable subgroup of lung adenocarcinomas. P30 CA016087/CA/NCI NIH HHS/United States. In addition, several distinct patterns of growth have been reported, including mucinous, papillary, micropapillary, hepatoid, and signet-ring cell among others.2–13However, primary oncocytic adenocarcinomas of the lung have not … Adenocarcinoma is the non-smoker tumour - SCLC and squamous are more strongly associated with smoking. Several recent studies of mucinous tumors have noted the difficulty in distinction between colloid and invasive mucinous adenocarcinomas, and because of this, mucinous tumors have been generally grouped together. Qu et al. The model consists of the following: grade 1, lepidic predominant tumor; grade 2, acinar or papillary predominant tumor, both with no or less than 20% of high-grade patterns; and grade 3, any tumor with 20% or more of high-grade patterns (solid, micropapillary, or complex gland). Censors were set for two times points with statistics run independently: time to distant recurrence; and time to lung recurrence. In 16 cases the predominant mucin-producing cell was cuboidal type; in 14 cases, columnar cells predominated. International Agency for Research on Cancer, Lyon, France, 2015; 26-46; Zhao Y, Wang R, Shen X, Pan Y, Cheng C, et al (2016) Minor Components of Micropapillary and Solid Subtype in Lung Adenocarcinoma are Predictors of Lymph Node Metastasis and Poor Prognosis. Adenocarcinoma in situ, either serous or mucinous . 2013), however, a recent study has shown that there is no survival difference if adjusted for stage. 1a-d ). The objective of our study is to correlate histologic features, including presence and type of STAS, architectural growth patterns, percent of invasiveness, mucin cell type, and TTF1 reactivity, with clinical outcome in a series of mucinous adenocarcinomas. 2006; Wu et al. (Onozato et al. Mucinous adenocarcinoma is often considered a relatively poor prognostic group among adenocarcinomas of the lung and has a high rate of pulmonary recurrence. (Zhang et al. TTF-1 immunoreactivity, extent compared to mucin cell type. published two patients with non-invasive colloid carcinoma and a prolonged disease free survival. Tumors classified as “colloid carcinoma”, now considered a variant of invasive adenocarcinoma, were included in the study due to significant histologic overlap with “mucinous adenocarcinoma”. spreading of tissue fragments and individual cells through a knife surface. Reproducibility of the model was assessed using kappa statistics. A grading system based on the predominant and high-grade patterns is practical and prognostic for invasive pulmonary adenocarcinoma.

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