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Pathology and genetics of tumours of the lung , pleura, thymus and heart

Background. Although there are many reported prognostic indicators for pulmonary adenocarcinoma, the clinicopathologic characteristics and prognostic factors of early stage adenocarcinoma have not been evaluated fully, except for several studies of nonmucinous and sclerosing bronchioloalveolar carcinoma.

Method. Two hundred thirty-six surgically resected small peripheral adenocarcinomas measuring 2 cm or less in greatest dimension were reviewed using a simple histologic classification of six types based on tumor growth patterns.

Results. Type A (localized bronchioloalveolar carcinoma [LBAC]) (n = 14) revealed replacement growth of alveolar-lining epithelial cells with a relatively thin stroma. In type B (LBAC with foci of structural collapse of alveoli) (n = 14), fibrotic foci due to alveolar collapse were observed in tumors of LBAC. Type C (LBAC with foci of active fibroblastic proliferation) (n = 141) was the largest group in this study, and foci of active fibroblastic proliferation were evident. Type D (poorly differentiated adenocarcinoma), type E (tubular adenocarcinoma) and type F (papillary adenocarcinoma with a compressive growth pattern) (n = 61) showed compressive and expanding growth. Types A and B showed no lymph node metastasis and the most favorable prognosis (100% 5-year survival) of the six types.

Conclusion. Histologic types A and B are thought to be in situ peripheral adenocarcinoma, whereas type C appears to be an advanced stage of types A and B. Conversely, types D, E, and F are small advanced adenocarcinomas with a less favorable prognosis. Cancer 1995;75:2844–52.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%2819950615%2975%3A12%3C2844%3A%3AAID-CNCR2820751209%3E3.0.CO%3B2-%23

Small adenocarcinoma of the lung. Histologic characteristics and prognosis

The prevalent theory in the pathogenesis of emphysema proposes that increased numbers of activated neutrophils and/or alveolar macrophages produce large amounts of proteases, an activity that cannot be regulated by alpha 1-antiproteases, resulting in lung destruction. However, the cells in the lung parenchyma of smokers have not been properly identified. We characterized and quantitated the inflammatory cell load in the lungs of smokers and correlated these findings with the degree of lung destruction. Twenty-one patients, six nonsmokers and 15 smokers, undergoing lung resection were studied. Lungs or lobes were fixed and stained for light microscopy and neutrophil identification and immunohistochemically stained for identification of lymphocytes and macrophages. By point counting, we determined the extent of emphysema by the volume density of the lung parenchyma (Vvalv), and the different cell numbers per cubic millimeter in all lungs. In nonsmokers Vvalv was greater than in smokers. The number of neutrophils/mm3 of lung correlated directly with the Vvalv, (r = 0.71, p < 0.01), whereas the number of alveolar macrophages (r = -0.70) and T-lymphocytes (r = -0.78) correlated negatively with the Vvalv. The number of T-lymphocytes correlated negatively with the number of neutrophils (r = -0.58) and positively with the numbers of alveolar macrophages (r = 0.77). Our data suggest that as long as the inflammatory reaction is predominantly of neutrophils there is no destruction of the lung. However, the extent of lung destruction becomes evident, and its extent is directly related to the number of alveolar macrophages and T-lymphocytes/mm3. We conclude that the T-lymphocyte might be importantly implicated in the pathogenesis of emphysema in smokers.

Alveolar inflammation and its relation to emphysema in smokers.

PURPOSE: To evaluate the prognostic importance of thin-section computed tomographic (CT) findings of peripheral lung adenocarcinomas. MATERIALS AND METHODS: The subjects were 127 patients with adenocarcinomas smaller than 3 cm in largest diameter who underwent at least a lobectomy with hilar and mediastinal lymphadenectomy. The margin characteristics of nodules and the extent of ground-glass opacity (GGO) within the nodules at preoperative thin-section CT were analyzed retrospectively. Regional lymph node metastasis (LNM) and vessel invasion (VI) were histologically examined in surgical specimens. Survival curves were calculated according to the Kaplan-Meier method. RESULTS: The frequencies of LNM (4% [1 of 24]) and VI (13% [three of 24]) in adenocarcinomas with GGO components of more than 50% were significantly lower than those with GGO components of less than 10% (LNM, P < .05; VI, P < .01). The patients with GGO components of more than 50% showed a significantly better prognosis than those with GGO com...

Peripheral lung adenocarcinoma: Correlation of thin-section CT findings with histologic prognostic factors and survival

OBJECTIVE. This study was performed to evaluate the evolution of peripheral lung adenocarcinomas using CT findings and histologic classification related to tumor doubling time.MATERIALS AND METHODS. The subjects were 34 patients, each with an adenocarcinoma smaller than 3 cm. All patients underwent chest radiography and 10 of them had previously undergone CT more than 6 months before surgery. Tumor doubling time was estimated by examining sequential radiographs using the method originally described by Schwartz. Tumor growth was also observed by studying the changes on CT in the 10 patients who had previously undergone CT. The histologic classification (types A-F) was evaluated according to the criteria of Noguchi et al.RESULTS. Five (83%) of the six adenocarcinomas with tumor types A or B showed localized ground-glass opacity on high-resolution CT. All six tumors had a tumor doubling time of more than 1 year. Fifteen (71%) of the 21 tumors with type C showed partial ground-glass opacity mixed with localiz...

Evolution of peripheral lung adenocarcinomas: CT findings correlated with histology and tumor doubling time.

Peripheral lung cancers frequently possess a fibrotic focus or scar in their center or beneath the pleura. We reexamined 58 cases of peripheral lung cancer of less than 3 cm in diameter (48 adenocarcinomas, two large cell carcinomas and eight squamous cell carcinomas) which were removed surgically between June 1962 and July 1973. Analyses of the cases revealed that in adenocarcinoma with increased collagenization or hyalinization in the fibrotic focus, the degree of pleural invasion and incidence of lymph node metastasis and blood vessel invasion were greater and thus the prognosis of the patient was poorer than in cases with no or slight collagenization. The results also indicate that the characteristics of the central fibrotic focus are probably more important than the size of the tumor for estimating the prognosis of patients with peripheral adenocarcinoma of less than 3 cm in diameter. The same might be said of peripheral large-cell carcinoma. However, the prognostic importance of the fibrotic focus was not confirmed in cases of peripheral squamous-cell carcinoma. Although the central or subpleural scar has long been the basis of the scar cancer concept, alternate explanations were considered, namely, that scar formation occurred along with tumor development, rather than before, in the case of adenocarcinomas.

Prognostic implications of fibrotic focus (scar) in small peripheral lung cancers.

We reported one case of a primary liposarcoma of the lung which has been reported only in six cases to date worldwide, and we added some documented study. A 49-year-old female complained of exertional dyspnea with about 100 ml of hemoptysis. The chest X ray showed a coin lesion at the left upper field. After left pneumonectomy, the histological examination revealed liposarcoma of the lung. Six months after the operation, she died from severe dyspnea; the autopsy revealed the relapse of liposarcoma in the right lung, and no liposarcomas in other organs. This is the seventh case according to a worldwide review of the literature.

Primary liposarcoma of the lung: report of a case.

A rare lung cancer consisting in part of small cell carcinoma of intermediate cell type and in part of well-differentiated papillotubular adenocarcinoma is described. Alcian blue-PAS staining was observed in the cytoplasm of the small cell carcinoma cells; the Grimelius argyrophil reaction was also positive in the cytoplasm of these cells. Electron microscopy revealed neurosecretory granules in the cytoplasm. At autopsy, a small cell carcinoma of intermediate cell type was found with both squamous features and gland formation. The cellularity and histological pattern of this tumor suggested the existence of a transitional pattern between small cell carcinoma of intermediate cell type, squamous cell carcinoma and adenocarcinoma. From the above findings, we think that small cell carcinoma including the intermediate cell type is derived from respiratory epithelial cells of endodermal origin with dedifferentiation of those cancer cells into neurosecretory cells.

Small cell carcinoma of the lung and its histological origin. Report of a case.

胸部X線上, 肺野末梢の腫瘤状陰影を呈する279例に経皮肺穿刺生検を299回施行した.悪性腫瘍182例中165例 (90.7%) に陽性所見を得た.得られた穿刺細胞像は, 原発性肺癌では, 喀痰細胞診や経気管支的擦過細胞診などの剥離細胞像と異なる所見もあり, 詳細に検討した.組織診との一致率は81.1%であった.転移性肺腫瘍では, 穿刺細胞診より大腸癌や腎癌の一部で原発巣推定可能な所見を得た.また, 陰性例19例 (延べ21回) についての検討を行い, その原因としては, 壊死物質しか得られなかったこと, 腫瘤の位置による手技的困難なことが考えられた.合併症については, 気胸21例 (7.0%), 血痰10例 (3.3%), 胸壁播種2例 (1.0%) であった.

Percutaneous fine needle aspiration biopsy of peripheral lung lesions.

手術的に摘出された腫瘍径3cm以下の気管支の末梢に発生した小型扁平上皮癌15例及び中間層部に発生した小型扁平上皮癌4例の計19例について臨床病理学的に検討した. その結果, 末梢に発生した小型扁平上皮癌の中には胸膜の陥凹と腫瘍中心部に線維化巣のみられるものがあり, 末梢発生腺癌と胸部X線学的, 肉眼的に区別困難なことがしばしばであった. しかし, 胸膜の弾性板を越えて浸潤しているものはなく (p0), リンパ節転移のない (n0) ものが大部分で予後の良好なものが多かった. 末梢発生腺癌にみられた癌の中心部の線維化巣における膠原化の程度との腫瘍進展度, 予後との関係は認められなかった.

Takeshi Hashimoto

Papers

Prognostic implications of fibrotic focus (scar) in small peripheral lung cancers.

Primary liposarcoma of the lung: report of a case.

Small cell carcinoma of the lung and its histological origin. Report of a case.

Percutaneous fine needle aspiration biopsy of peripheral lung lesions.

Morphological Characteristics and Prognosis of the Small Size of Peripheral Squamous Cell Carcinoma of the Lung