The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification

This study is a clinical pathological correlation based on 887 resected pulmonary masses. Because of the nature of the study and the source of the material there is a certain amount of selection. The patients were all males, and they had all been healthy enough to have been inducted into the armed services. Only 16 of 887 had significant other pulmonary disease. While the author draws few conclusions, the monograph itself asserts some very forceful points: second primary malignancies can and do occur and may present as pulmonary nodules; pulmonary granulomas can occur in patients with history of malignancy elsewhere; benign tumors of the lung can occur in patients who have had a previous malignancy; preoperative examination with bronchoscopy, cytologic study of the sputum, and scalene node biopsy offer a very low yield of positive diagnoses in pulmonary nodules; size cannot be used as a criterion for determining malignancy; tuberculosis

The solitary pulmonary nodule.

We present clinicopathologic data on 10 pulmonary myxoid sarcomas, which are defined by distinctive histomorphologic features and characterized by a recurrent fusion gene, that appear to represent a distinct tumor entity at this site. The patients [7 female, 3 male; aged 27 to 67 y (mean, 45 y)] presented with local or systemic symptoms (n=5), symptoms from cerebral metastasis (1), or incidentally (2). Follow-up of 6 patients showed that 1 with brain metastasis died shortly after primary tumor resection, 1 developed a renal metastasis but is alive and well, and 4 are disease free after 1 to 15 years. All tumors involved pulmonary parenchyma, with a predominant endobronchial component in 8 and ranged from 1.5 to 4 cm. Microscopically, they were lobulated and composed of cords of polygonal, spindle, or stellate cells within myxoid stroma, morphologically reminiscent of extraskeletal myxoid chondrosarcoma. Four cases showed no or minimal atypia, 6 showed focal pleomorphism, and 5 had necrosis. Mitotic indices varied, with most tumors not exceeding 5/10 high-power fields. Tumors were immunoreactive for only vimentin and weakly focal for epithelial membrane antigen. Of 9 tumors, 7 were shown to harbor a specific EWSR1-CREB1 fusion by reverse transcription-polymerase chain reaction and direct sequencing, with 7 of 10 showing EWSR1 rearrangement by fluorescence in situ hybridization. This gene fusion has been described previously in 2 histologically and behaviorally different sarcomas: clear cell sarcoma-like tumors of the gastrointestinal tract and angiomatoid fibrous histiocytomas; however, this is a novel finding in tumors with the morphology we describe and that occur in the pulmonary region.

Primary Pulmonary Myxoid Sarcoma With EWSR1-CREB1 Fusion: A New Tumor Entity

Micronodular thymic carcinoma with lymphoid hyperplasia: a clinicopathological and immunohistochemical study of five cases.

In the last few years different new pulmonary neoplastic lesions have been recognised and some of them, namely NUT carcinoma, PEComatous tumors, pneumocytic adenomyoepithelioma, pulmonary myxoid sarcoma, myoepithelial tumors/carcinomas entered in the last 2015-WHO classification of lung tumors. In addition angiomatoid fibrous histiocytoma and ciliated muconodular papillary tumor have been morphologically and genetically characterized albeit not yet included in the 2015-WHO classification.In the present paper we summarised the clinical, morphological, immunohistochemical and molecular features of these new entities. The knowledge of key histologic and molecular characteristics may help pathologists in achieving a correct diagnosis thus leading to an adequate therapeutic approach.

https://www.pathologica.it/article/download/39/63

The 2015 World Health Organization Classification of lung tumors: new entities since the 2004 Classification.

Benign myoepithelioma is extremely rare in the lung, to the best of our knowledge; only five cases have been reported in the literature. An 18-years woman complained from tiredness and fever during four months. Laboratory findings and fibroscopies were normal. CT of the thorax demonstrated a nodule in the left segment of the Fowler. Left inferior lobectomy was performed comporting a firm nodule of 25 mm, lifting the bronchial mucous membrane. Histologically, there was a proliferation of small cells of a plasmocytoid-type, with a predominantly whorled pattern. No mitotic activity or necrosis was seen in the tumor. Immuhistochemically, the tumor cells positive for smooth muscle actin, vimentine, and S100 protein. They were negatives for cytokeratine, chromogranine and HMB45. The diagnosis of benign myoepithelioma of the lung is so confirmed. The patient recovered well at 6 months follow-up. Benign myoepithelioma is a rare pulmonary neoplasm distinct from pleomorphic adenoma, which should be considered in the differential diagnosis of lung nodules.

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Benign myoepithelioma of the lung - a case report and review of the literature

Micronodular thymoma with lymphoid stroma: report of two cases and particular association with thymic lymphoid hyperplasia in one case

Tuberculosis of the Trachea

Resume Introduction L’aspergillome pulmonaire est une infection mycosique due au depot de filaments myceliens dans une cavite le plus souvent preexistante. Le traitement de choix est chirurgical. Le geste communement pratique consiste en une resection reglee. La frequence croissante des formes d’aspergillome dites simples par rapport aux formes complexes nous incite a etudier la place de la chirurgie conservatrice. But de l’etude Etablir les caracteristiques des aspergillomes qui peuvent beneficier d’une chirurgie conservatrice. Patients et methodes Il s’agit d’une etude retrospective portant sur 64 patients operes dans le service de chirurgie thoracique de l’hopital Abderrahmen-Mami de l’Ariana entre 1984 et 2008. Resultats Quatorze patients ont beneficie d’un traitement chirurgical conservateur, en l’occurrence une resection atypique emportant l’aspergillome. Les 50 autres patients ont beneficie d’un geste regle : une segmentectomie, une lobectomie ou une pneumonectomie. La mortalite perioperatoire etait de 5 %. Un cas de recidive aspergillaire a ete note chez un patient ayant eu une chirurgie conservatrice pour un aspergillome complexe. Conclusion Le traitement de l’aspergillome pulmonaire est chirurgical. Un geste conservateur peut etre propose dans les formes simples, peripheriques et de diametre inferieur a 4 cm.

Place de la chirurgie conservatrice dans l’aspergillome pulmonaire

Introduction Pulmonary Sarcomatoid Carcinoma (PSC) is a rare group of tumors accounting for about 0.4% of non-small cell lung carcinoma (NSCLC). Five subtypes were described: pleomorphic carcinoma, spindle cell carcinoma, carcinosarcoma, giant cell carcinoma and pulmonary blastoma. The diagnosis is pathological but requires a good quality sampling of the tumor. Methods On a series of 1582 patients operated on for lung cancer from 1992 to 2016, 43 patients were retrospectively identified as having been treated surgically for pulmonary sarcomatoid carcinoma. Results The population consisted of 33 males and 10 females with mean age of 55 years. Imaging findings showed a peripheral mass in the majority of cases (n=29). Careful investigation failed to discover a primitive lesion elsewhere. Six patients received induction therapy for wall involvement. Lobectomy or bilobectomy was performed in 30 patients and pneumonectomy in 11 patients. A wedge resection was performed in one patient and an exploratory thoracotomy in another. In macroscopy, the mean tumor's size was 5.2 cm (1-17.5cm). The histologic diagnoses were: pleomorphic carcinoma (n=30), carcinosarcoma (n=5), spindle cell carcinoma (n=1), giant cell carcinoma (n=3) and blastoma (n=4). Two patients died within 1 month of surgical complications and 5 died of disease within 17 months. Adjuvant therapy was performed in 6 patients. Recurrence happened in 4 patients within 12 months after operation. Median survival for all patients was 8months. Conclusions Resection of primary pulmonary sarcomatoid carcinoma is associated with an acceptable survival rate if the resection is complete. The size of the tumor is the most important prognosis factor. Nevertheless, a carefully follow-up is essential.

Aida Ayadi

Papers

Benign myoepithelioma of the lung - a case report and review of the literature

Micronodular thymoma with lymphoid stroma: report of two cases and particular association with thymic lymphoid hyperplasia in one case

Tuberculosis of the Trachea

Place de la chirurgie conservatrice dans l’aspergillome pulmonaire

Pulmonary Sarcomatoid carcinoma: a surgical diagnosis and prognostic factors