Libre Pathology - User contributions [en]

Wilms tumour

2018-10-14T05:48:12Z

Abraham: /* General */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Wilms_tumour_-_very_high_mag.jpg
| Width =
| Caption = Wilms tumour. [[H&E stain]].
| Synonyms = nephroblastoma
| Micro =
| Subtypes =
| LMDDx = [[metanephric adenoma]], nephrogenic nests, [[small round cell tumours]], Immature teratoma
| Stains =
| IHC = WT-1 +ve, CD56 +ve
| EM =
| Molecular =
| IF =
| Gross =
| Grossing =
| Site = [[kidney]] - see ''[[pediatric kidney tumours]]''
| Assdx =
| Syndromes = WAGR syndrome, [[Beckwith-Wiedemann syndrome]], [[Denys-Drash syndrome]]
| Clinicalhx =
| Signs = +/-abdominal mass
| Symptoms =
| Prevalence = most common pediatric kidney tumour
| Bloodwork =
| Rads =
| Endoscopy =
| Prognosis =
| Other =
| ClinDDx =
| Tx =
}}
'''Wilms tumour''', also '''nephroblastoma''' and '''Wilms' tumour''', is the most common [[Pediatric_kidney_tumours|pediatric kidney tumour]].<ref name=pmid10935424>{{cite journal |author=Coppes MJ, Wolff JE, Ritchey ML |title=Wilms tumour: diagnosis and treatment |journal=Paediatr Drugs |volume=1 |issue=4 |pages=251–62 |year=1999 |pmid=10935424 |doi= |url=}}</ref><ref name=pmid15738594>{{cite journal |author=Stefanowicz J, Sierota D, Balcerska A, Stoba C |title=[Wilms' tumour of unfavorable histology--results of treatment with the SIOP 93-01 protocol at the Gdańsk centre. Preliminary report] |language=Polish |journal=Med Wieku Rozwoj |volume=8 |issue=2 Pt 1 |pages=197–200 |year=2004 |pmid=15738594 |doi= |url=}}</ref>

==General==
*Common abdominal [[pediatric pathology|pediatric]] tumour.
**Affects approximately 1 in 8000 children.
**There is no sex predilection and the mean patient age at diagnosis ranges among 37 to 43 months.
*May be associated with a syndrome:<ref>URL: [http://emedicine.medscape.com/article/989398-overview http://emedicine.medscape.com/article/989398-overview]. Accessed on: 9 March 2011.</ref>
**WAGR syndrome (Wilms tumour, Aniridia (absence of iris), GU abnormalities, Retardation).<ref>{{OMIM|194072}}</ref>
**[[Beckwith-Wiedemann syndrome]].<ref>{{OMIM|130650}}</ref>
**[[Denys-Drash syndrome]].<ref>{{OMIM|194080}}</ref>

==Gross==
Features <ref name="pmid10193955">{{Cite journal | last1 = Coppes | first1 = MJ. | last2 = Arnold | first2 = M. | last3 = Beckwith | first3 = JB. | last4 = Ritchey | first4 = ML. | last5 = D'Angio | first5 = GJ. | last6 = Green | first6 = DM. | last7 = Breslow | first7 = NE. | title = Factors affecting the risk of contralateral Wilms tumor development: a report from the National Wilms Tumor Study Group. | journal = Cancer | volume = 85 | issue = 7 | pages = 1616-25 | month = Apr | year = 1999 | doi = | PMID = 10193955 }}</ref>
*Most nephroblastomas are unifocal.
**Usually solitary, rounded, multilobular masses sharply demarcated from adjacent parenchyma.
**The cut surface is most commonly pale grey or tan.
**Cyst most be prominent in some cases.
*Multifocal masses in a single kidney and bilateral primary lesions are less frequent.

===Images===
<gallery>
Image:Wilms_tumor.jpg | Wilms tumour. (WC/AFIP)
</gallery>
www:
*[http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/rnfrm.html Wilms tumour (med.utah.edu)].
*[http://www.webpathology.com/image.asp?case=73&n=1 Wilms tumour (WebPathology)].

==Microscopic==
Features - classically three components (blastema, immature stroma, tubules):<ref name=Ref_PCPBoD8_254-5>{{Ref PCPBoD8|254-5}}</ref>
#Malignant [[Small round blue cell tumours|small round blue cells]] ("blastema"):
#*The blastemal component is the least differentiated cellular element.
#*Size = ~ 2x RBC diameter.
#*Nuclear pleomorphism (variation of size, shape and staining).
#**Irregular nuclear membrane - '''important'''.
#*Scant/difficult to discern cytoplasm - basophilic (light blue).
#*Mitoses - common.
#Stroma ("immature stroma"):
#*Spindle cells:
#**Elliptical nuclear membrane.
#**Abundant loose cytoplasm.
#Epithelial components ("tubules"):
#*Primitive rossete-like tubules, well-formed maturing and mature tubules, glomerular structures and variably papillary architecture.
#**Usually clustered.
#**Usu. have a central (clear/white) space surrounded by a rim of intensely eosinophilic cytoplasm.
#**Nuclei of tubular structures often elongated and palisaded.

Other findings:
*Commonly seen in association with ''nephrogenic rests''.
**Cluster of cells small (blue) cells; lack nuclear atypia seen in Wilms tumour.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970416-8 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970416-8]. Accessed on: 28 March 2011.</ref>
*+/-Heterologous elements (skeletal muscle, smooth muscle adipose tissue, cartilage).<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
**Heterologous = doesn't normally belong there.<ref>URL: [http://www.biology-online.org/dictionary/Heterologous http://www.biology-online.org/dictionary/Heterologous]. Accessed on: 1 October 2011.</ref>

DDx:
*[[Metanephric adenoma]].
*Nephrogenic nests.
*Other [[small round cell tumours]].
*[[Synovial sarcoma]], biphasic - especially in adults.
*Immature teratoma.

Notes:
*Palisade = fence made of stakes driven into the ground.<ref>URL: [http://www.thefreedictionary.com/palisaded http://www.thefreedictionary.com/palisaded]. Accessed on: 2 February 2011.</ref>
*Approximately 30-40% Wilms tumour cases have nephrogenic rests.<ref name=pmid8047084>{{cite journal |author=Coppes MJ, Haber DA, Grundy PE |title=Genetic events in the development of Wilms' tumor |journal=N. Engl. J. Med. |volume=331 |issue=9 |pages=586–90 |year=1994 |month=September |pmid=8047084 |doi=10.1056/NEJM199409013310906 |url=}}</ref>
*The three phases are also called ''blastemal, epithelial and stromal''.<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>

===Images===
<gallery>
Image:Wilms_tumour_-_low_mag.jpg | Wilms tumour - low mag. (WC/Nephron)
Image:Wilms tumour - intermed mag.jpg | Wilms tumour - intermed. mag. (WC/Nephron)
Image:Wilms tumour - high mag.jpg | Wilms tumour - high mag. (WC/Nephron)
Image:Wilms_tumour_-_very_high_mag.jpg | Wilms tumour - very high mag. (WC/Nephron)
File:Wilms Tumor (Nephroblastoma) (4882456062).jpg | Wilms tumor - low mag. (WC/Ed Uthman)
</gallery>
www:
*[http://www.biologydisease.com/images/kidney/nephrogenic-rests/nephrogenic-rest.jpg.php Nephrogenic rests (biologydisease.com)].
*[http://www.webpathology.com/image.asp?n=1&Case=73 Wilms tumour (webpathology.com)].

===Anaplasia===
Subclassified as:<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
#Focal anaplasia.
#Diffuse anaplasia.

Criteria (all of the following):<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
#Atypical mitoses.
#Nuclear hyperchromasia.
#Nuclear size variation (of the tumour cells) > 3x.

==IHC==
*WT-1 +ve (nuclear).
*CD56 +ve.<ref name=pmid11688464>{{Cite journal | last1 = Muir | first1 = TE. | last2 = Cheville | first2 = JC. | last3 = Lager | first3 = DJ. | title = Metanephric adenoma, nephrogenic rests, and Wilms' tumor: a histologic and immunophenotypic comparison. | journal = Am J Surg Pathol | volume = 25 | issue = 10 | pages = 1290-6 | month = Oct | year = 2001 | doi = | PMID = 11688464 }}</ref>
**-ve in [[metanephric adenoma]].

==Molecular==
*Cytogenetics<ref>{{Cite journal | last1 = Md Zin | first1 = R. | last2 = Murch | first2 = A. | last3 = Charles | first3 = A. | title = Pathology, genetics and cytogenetics of Wilms' tumour. | journal = Pathology | volume = 43 | issue = 4 | pages = 302-12 | month = Jun | year = 2011 | doi = 10.1097/PAT.0b013e3283463575 | PMID = 21516053 }}</ref>
**Partial gains of 1q.
**Partial losses of 1p, 1q, 4q, 11q, 16q, 22q.
**Complete loss of chromosome 16, 11, 12, 22.
**Trisomy of chromosome 8, 12, 13, 18.

==See also==
*[[Pediatric kidney tumours]].
*[[Kidney tumours]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pediatric kidney tumours]]
[[Category:Small round blue cell tumours]]

Wilms tumour

2018-10-14T05:47:35Z

Abraham: /* General */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Wilms_tumour_-_very_high_mag.jpg
| Width =
| Caption = Wilms tumour. [[H&E stain]].
| Synonyms = nephroblastoma
| Micro =
| Subtypes =
| LMDDx = [[metanephric adenoma]], nephrogenic nests, [[small round cell tumours]], Immature teratoma
| Stains =
| IHC = WT-1 +ve, CD56 +ve
| EM =
| Molecular =
| IF =
| Gross =
| Grossing =
| Site = [[kidney]] - see ''[[pediatric kidney tumours]]''
| Assdx =
| Syndromes = WAGR syndrome, [[Beckwith-Wiedemann syndrome]], [[Denys-Drash syndrome]]
| Clinicalhx =
| Signs = +/-abdominal mass
| Symptoms =
| Prevalence = most common pediatric kidney tumour
| Bloodwork =
| Rads =
| Endoscopy =
| Prognosis =
| Other =
| ClinDDx =
| Tx =
}}
'''Wilms tumour''', also '''nephroblastoma''' and '''Wilms' tumour''', is the most common [[Pediatric_kidney_tumours|pediatric kidney tumour]].<ref name=pmid10935424>{{cite journal |author=Coppes MJ, Wolff JE, Ritchey ML |title=Wilms tumour: diagnosis and treatment |journal=Paediatr Drugs |volume=1 |issue=4 |pages=251–62 |year=1999 |pmid=10935424 |doi= |url=}}</ref><ref name=pmid15738594>{{cite journal |author=Stefanowicz J, Sierota D, Balcerska A, Stoba C |title=[Wilms' tumour of unfavorable histology--results of treatment with the SIOP 93-01 protocol at the Gdańsk centre. Preliminary report] |language=Polish |journal=Med Wieku Rozwoj |volume=8 |issue=2 Pt 1 |pages=197–200 |year=2004 |pmid=15738594 |doi= |url=}}</ref>

==General==
*Common abdominal [[pediatric pathology|pediatric]] tumour.
**Affects approximately 1 in 8000 children.
**There is no sex predilection and the mean patient age pf presentation ranges among 37 to 43 months.
*May be associated with a syndrome:<ref>URL: [http://emedicine.medscape.com/article/989398-overview http://emedicine.medscape.com/article/989398-overview]. Accessed on: 9 March 2011.</ref>
**WAGR syndrome (Wilms tumour, Aniridia (absence of iris), GU abnormalities, Retardation).<ref>{{OMIM|194072}}</ref>
**[[Beckwith-Wiedemann syndrome]].<ref>{{OMIM|130650}}</ref>
**[[Denys-Drash syndrome]].<ref>{{OMIM|194080}}</ref>

==Gross==
Features <ref name="pmid10193955">{{Cite journal | last1 = Coppes | first1 = MJ. | last2 = Arnold | first2 = M. | last3 = Beckwith | first3 = JB. | last4 = Ritchey | first4 = ML. | last5 = D'Angio | first5 = GJ. | last6 = Green | first6 = DM. | last7 = Breslow | first7 = NE. | title = Factors affecting the risk of contralateral Wilms tumor development: a report from the National Wilms Tumor Study Group. | journal = Cancer | volume = 85 | issue = 7 | pages = 1616-25 | month = Apr | year = 1999 | doi = | PMID = 10193955 }}</ref>
*Most nephroblastomas are unifocal.
**Usually solitary, rounded, multilobular masses sharply demarcated from adjacent parenchyma.
**The cut surface is most commonly pale grey or tan.
**Cyst most be prominent in some cases.
*Multifocal masses in a single kidney and bilateral primary lesions are less frequent.

===Images===
<gallery>
Image:Wilms_tumor.jpg | Wilms tumour. (WC/AFIP)
</gallery>
www:
*[http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/rnfrm.html Wilms tumour (med.utah.edu)].
*[http://www.webpathology.com/image.asp?case=73&n=1 Wilms tumour (WebPathology)].

==Microscopic==
Features - classically three components (blastema, immature stroma, tubules):<ref name=Ref_PCPBoD8_254-5>{{Ref PCPBoD8|254-5}}</ref>
#Malignant [[Small round blue cell tumours|small round blue cells]] ("blastema"):
#*The blastemal component is the least differentiated cellular element.
#*Size = ~ 2x RBC diameter.
#*Nuclear pleomorphism (variation of size, shape and staining).
#**Irregular nuclear membrane - '''important'''.
#*Scant/difficult to discern cytoplasm - basophilic (light blue).
#*Mitoses - common.
#Stroma ("immature stroma"):
#*Spindle cells:
#**Elliptical nuclear membrane.
#**Abundant loose cytoplasm.
#Epithelial components ("tubules"):
#*Primitive rossete-like tubules, well-formed maturing and mature tubules, glomerular structures and variably papillary architecture.
#**Usually clustered.
#**Usu. have a central (clear/white) space surrounded by a rim of intensely eosinophilic cytoplasm.
#**Nuclei of tubular structures often elongated and palisaded.

Other findings:
*Commonly seen in association with ''nephrogenic rests''.
**Cluster of cells small (blue) cells; lack nuclear atypia seen in Wilms tumour.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970416-8 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970416-8]. Accessed on: 28 March 2011.</ref>
*+/-Heterologous elements (skeletal muscle, smooth muscle adipose tissue, cartilage).<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
**Heterologous = doesn't normally belong there.<ref>URL: [http://www.biology-online.org/dictionary/Heterologous http://www.biology-online.org/dictionary/Heterologous]. Accessed on: 1 October 2011.</ref>

DDx:
*[[Metanephric adenoma]].
*Nephrogenic nests.
*Other [[small round cell tumours]].
*[[Synovial sarcoma]], biphasic - especially in adults.
*Immature teratoma.

Notes:
*Palisade = fence made of stakes driven into the ground.<ref>URL: [http://www.thefreedictionary.com/palisaded http://www.thefreedictionary.com/palisaded]. Accessed on: 2 February 2011.</ref>
*Approximately 30-40% Wilms tumour cases have nephrogenic rests.<ref name=pmid8047084>{{cite journal |author=Coppes MJ, Haber DA, Grundy PE |title=Genetic events in the development of Wilms' tumor |journal=N. Engl. J. Med. |volume=331 |issue=9 |pages=586–90 |year=1994 |month=September |pmid=8047084 |doi=10.1056/NEJM199409013310906 |url=}}</ref>
*The three phases are also called ''blastemal, epithelial and stromal''.<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>

===Images===
<gallery>
Image:Wilms_tumour_-_low_mag.jpg | Wilms tumour - low mag. (WC/Nephron)
Image:Wilms tumour - intermed mag.jpg | Wilms tumour - intermed. mag. (WC/Nephron)
Image:Wilms tumour - high mag.jpg | Wilms tumour - high mag. (WC/Nephron)
Image:Wilms_tumour_-_very_high_mag.jpg | Wilms tumour - very high mag. (WC/Nephron)
File:Wilms Tumor (Nephroblastoma) (4882456062).jpg | Wilms tumor - low mag. (WC/Ed Uthman)
</gallery>
www:
*[http://www.biologydisease.com/images/kidney/nephrogenic-rests/nephrogenic-rest.jpg.php Nephrogenic rests (biologydisease.com)].
*[http://www.webpathology.com/image.asp?n=1&Case=73 Wilms tumour (webpathology.com)].

===Anaplasia===
Subclassified as:<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
#Focal anaplasia.
#Diffuse anaplasia.

Criteria (all of the following):<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
#Atypical mitoses.
#Nuclear hyperchromasia.
#Nuclear size variation (of the tumour cells) > 3x.

==IHC==
*WT-1 +ve (nuclear).
*CD56 +ve.<ref name=pmid11688464>{{Cite journal | last1 = Muir | first1 = TE. | last2 = Cheville | first2 = JC. | last3 = Lager | first3 = DJ. | title = Metanephric adenoma, nephrogenic rests, and Wilms' tumor: a histologic and immunophenotypic comparison. | journal = Am J Surg Pathol | volume = 25 | issue = 10 | pages = 1290-6 | month = Oct | year = 2001 | doi = | PMID = 11688464 }}</ref>
**-ve in [[metanephric adenoma]].

==Molecular==
*Cytogenetics<ref>{{Cite journal | last1 = Md Zin | first1 = R. | last2 = Murch | first2 = A. | last3 = Charles | first3 = A. | title = Pathology, genetics and cytogenetics of Wilms' tumour. | journal = Pathology | volume = 43 | issue = 4 | pages = 302-12 | month = Jun | year = 2011 | doi = 10.1097/PAT.0b013e3283463575 | PMID = 21516053 }}</ref>
**Partial gains of 1q.
**Partial losses of 1p, 1q, 4q, 11q, 16q, 22q.
**Complete loss of chromosome 16, 11, 12, 22.
**Trisomy of chromosome 8, 12, 13, 18.

==See also==
*[[Pediatric kidney tumours]].
*[[Kidney tumours]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pediatric kidney tumours]]
[[Category:Small round blue cell tumours]]

Wilms tumour

2018-10-14T05:43:29Z

Abraham: /* Gross */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Wilms_tumour_-_very_high_mag.jpg
| Width =
| Caption = Wilms tumour. [[H&E stain]].
| Synonyms = nephroblastoma
| Micro =
| Subtypes =
| LMDDx = [[metanephric adenoma]], nephrogenic nests, [[small round cell tumours]], Immature teratoma
| Stains =
| IHC = WT-1 +ve, CD56 +ve
| EM =
| Molecular =
| IF =
| Gross =
| Grossing =
| Site = [[kidney]] - see ''[[pediatric kidney tumours]]''
| Assdx =
| Syndromes = WAGR syndrome, [[Beckwith-Wiedemann syndrome]], [[Denys-Drash syndrome]]
| Clinicalhx =
| Signs = +/-abdominal mass
| Symptoms =
| Prevalence = most common pediatric kidney tumour
| Bloodwork =
| Rads =
| Endoscopy =
| Prognosis =
| Other =
| ClinDDx =
| Tx =
}}
'''Wilms tumour''', also '''nephroblastoma''' and '''Wilms' tumour''', is the most common [[Pediatric_kidney_tumours|pediatric kidney tumour]].<ref name=pmid10935424>{{cite journal |author=Coppes MJ, Wolff JE, Ritchey ML |title=Wilms tumour: diagnosis and treatment |journal=Paediatr Drugs |volume=1 |issue=4 |pages=251–62 |year=1999 |pmid=10935424 |doi= |url=}}</ref><ref name=pmid15738594>{{cite journal |author=Stefanowicz J, Sierota D, Balcerska A, Stoba C |title=[Wilms' tumour of unfavorable histology--results of treatment with the SIOP 93-01 protocol at the Gdańsk centre. Preliminary report] |language=Polish |journal=Med Wieku Rozwoj |volume=8 |issue=2 Pt 1 |pages=197–200 |year=2004 |pmid=15738594 |doi= |url=}}</ref>

==General==
*Common abdominal [[pediatric pathology|pediatric]] tumour.
*May be associated with a syndrome:<ref>URL: [http://emedicine.medscape.com/article/989398-overview http://emedicine.medscape.com/article/989398-overview]. Accessed on: 9 March 2011.</ref>
**WAGR syndrome (Wilms tumour, Aniridia (absence of iris), GU abnormalities, Retardation).<ref>{{OMIM|194072}}</ref>
**[[Beckwith-Wiedemann syndrome]].<ref>{{OMIM|130650}}</ref>
**[[Denys-Drash syndrome]].<ref>{{OMIM|194080}}</ref>

==Gross==
Features <ref name="pmid10193955">{{Cite journal | last1 = Coppes | first1 = MJ. | last2 = Arnold | first2 = M. | last3 = Beckwith | first3 = JB. | last4 = Ritchey | first4 = ML. | last5 = D'Angio | first5 = GJ. | last6 = Green | first6 = DM. | last7 = Breslow | first7 = NE. | title = Factors affecting the risk of contralateral Wilms tumor development: a report from the National Wilms Tumor Study Group. | journal = Cancer | volume = 85 | issue = 7 | pages = 1616-25 | month = Apr | year = 1999 | doi = | PMID = 10193955 }}</ref>
*Most nephroblastomas are unifocal.
**Usually solitary, rounded, multilobular masses sharply demarcated from adjacent parenchyma.
**The cut surface is most commonly pale grey or tan.
**Cyst most be prominent in some cases.
*Multifocal masses in a single kidney and bilateral primary lesions are less frequent.

===Images===
<gallery>
Image:Wilms_tumor.jpg | Wilms tumour. (WC/AFIP)
</gallery>
www:
*[http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/rnfrm.html Wilms tumour (med.utah.edu)].
*[http://www.webpathology.com/image.asp?case=73&n=1 Wilms tumour (WebPathology)].

==Microscopic==
Features - classically three components (blastema, immature stroma, tubules):<ref name=Ref_PCPBoD8_254-5>{{Ref PCPBoD8|254-5}}</ref>
#Malignant [[Small round blue cell tumours|small round blue cells]] ("blastema"):
#*The blastemal component is the least differentiated cellular element.
#*Size = ~ 2x RBC diameter.
#*Nuclear pleomorphism (variation of size, shape and staining).
#**Irregular nuclear membrane - '''important'''.
#*Scant/difficult to discern cytoplasm - basophilic (light blue).
#*Mitoses - common.
#Stroma ("immature stroma"):
#*Spindle cells:
#**Elliptical nuclear membrane.
#**Abundant loose cytoplasm.
#Epithelial components ("tubules"):
#*Primitive rossete-like tubules, well-formed maturing and mature tubules, glomerular structures and variably papillary architecture.
#**Usually clustered.
#**Usu. have a central (clear/white) space surrounded by a rim of intensely eosinophilic cytoplasm.
#**Nuclei of tubular structures often elongated and palisaded.

Other findings:
*Commonly seen in association with ''nephrogenic rests''.
**Cluster of cells small (blue) cells; lack nuclear atypia seen in Wilms tumour.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970416-8 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970416-8]. Accessed on: 28 March 2011.</ref>
*+/-Heterologous elements (skeletal muscle, smooth muscle adipose tissue, cartilage).<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
**Heterologous = doesn't normally belong there.<ref>URL: [http://www.biology-online.org/dictionary/Heterologous http://www.biology-online.org/dictionary/Heterologous]. Accessed on: 1 October 2011.</ref>

DDx:
*[[Metanephric adenoma]].
*Nephrogenic nests.
*Other [[small round cell tumours]].
*[[Synovial sarcoma]], biphasic - especially in adults.
*Immature teratoma.

Notes:
*Palisade = fence made of stakes driven into the ground.<ref>URL: [http://www.thefreedictionary.com/palisaded http://www.thefreedictionary.com/palisaded]. Accessed on: 2 February 2011.</ref>
*Approximately 30-40% Wilms tumour cases have nephrogenic rests.<ref name=pmid8047084>{{cite journal |author=Coppes MJ, Haber DA, Grundy PE |title=Genetic events in the development of Wilms' tumor |journal=N. Engl. J. Med. |volume=331 |issue=9 |pages=586–90 |year=1994 |month=September |pmid=8047084 |doi=10.1056/NEJM199409013310906 |url=}}</ref>
*The three phases are also called ''blastemal, epithelial and stromal''.<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>

===Images===
<gallery>
Image:Wilms_tumour_-_low_mag.jpg | Wilms tumour - low mag. (WC/Nephron)
Image:Wilms tumour - intermed mag.jpg | Wilms tumour - intermed. mag. (WC/Nephron)
Image:Wilms tumour - high mag.jpg | Wilms tumour - high mag. (WC/Nephron)
Image:Wilms_tumour_-_very_high_mag.jpg | Wilms tumour - very high mag. (WC/Nephron)
File:Wilms Tumor (Nephroblastoma) (4882456062).jpg | Wilms tumor - low mag. (WC/Ed Uthman)
</gallery>
www:
*[http://www.biologydisease.com/images/kidney/nephrogenic-rests/nephrogenic-rest.jpg.php Nephrogenic rests (biologydisease.com)].
*[http://www.webpathology.com/image.asp?n=1&Case=73 Wilms tumour (webpathology.com)].

===Anaplasia===
Subclassified as:<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
#Focal anaplasia.
#Diffuse anaplasia.

Criteria (all of the following):<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
#Atypical mitoses.
#Nuclear hyperchromasia.
#Nuclear size variation (of the tumour cells) > 3x.

==IHC==
*WT-1 +ve (nuclear).
*CD56 +ve.<ref name=pmid11688464>{{Cite journal | last1 = Muir | first1 = TE. | last2 = Cheville | first2 = JC. | last3 = Lager | first3 = DJ. | title = Metanephric adenoma, nephrogenic rests, and Wilms' tumor: a histologic and immunophenotypic comparison. | journal = Am J Surg Pathol | volume = 25 | issue = 10 | pages = 1290-6 | month = Oct | year = 2001 | doi = | PMID = 11688464 }}</ref>
**-ve in [[metanephric adenoma]].

==Molecular==
*Cytogenetics<ref>{{Cite journal | last1 = Md Zin | first1 = R. | last2 = Murch | first2 = A. | last3 = Charles | first3 = A. | title = Pathology, genetics and cytogenetics of Wilms' tumour. | journal = Pathology | volume = 43 | issue = 4 | pages = 302-12 | month = Jun | year = 2011 | doi = 10.1097/PAT.0b013e3283463575 | PMID = 21516053 }}</ref>
**Partial gains of 1q.
**Partial losses of 1p, 1q, 4q, 11q, 16q, 22q.
**Complete loss of chromosome 16, 11, 12, 22.
**Trisomy of chromosome 8, 12, 13, 18.

==See also==
*[[Pediatric kidney tumours]].
*[[Kidney tumours]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pediatric kidney tumours]]
[[Category:Small round blue cell tumours]]

Wilms tumour

2018-10-14T05:40:58Z

Abraham: /* Gross */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Wilms_tumour_-_very_high_mag.jpg
| Width =
| Caption = Wilms tumour. [[H&E stain]].
| Synonyms = nephroblastoma
| Micro =
| Subtypes =
| LMDDx = [[metanephric adenoma]], nephrogenic nests, [[small round cell tumours]], Immature teratoma
| Stains =
| IHC = WT-1 +ve, CD56 +ve
| EM =
| Molecular =
| IF =
| Gross =
| Grossing =
| Site = [[kidney]] - see ''[[pediatric kidney tumours]]''
| Assdx =
| Syndromes = WAGR syndrome, [[Beckwith-Wiedemann syndrome]], [[Denys-Drash syndrome]]
| Clinicalhx =
| Signs = +/-abdominal mass
| Symptoms =
| Prevalence = most common pediatric kidney tumour
| Bloodwork =
| Rads =
| Endoscopy =
| Prognosis =
| Other =
| ClinDDx =
| Tx =
}}
'''Wilms tumour''', also '''nephroblastoma''' and '''Wilms' tumour''', is the most common [[Pediatric_kidney_tumours|pediatric kidney tumour]].<ref name=pmid10935424>{{cite journal |author=Coppes MJ, Wolff JE, Ritchey ML |title=Wilms tumour: diagnosis and treatment |journal=Paediatr Drugs |volume=1 |issue=4 |pages=251–62 |year=1999 |pmid=10935424 |doi= |url=}}</ref><ref name=pmid15738594>{{cite journal |author=Stefanowicz J, Sierota D, Balcerska A, Stoba C |title=[Wilms' tumour of unfavorable histology--results of treatment with the SIOP 93-01 protocol at the Gdańsk centre. Preliminary report] |language=Polish |journal=Med Wieku Rozwoj |volume=8 |issue=2 Pt 1 |pages=197–200 |year=2004 |pmid=15738594 |doi= |url=}}</ref>

==General==
*Common abdominal [[pediatric pathology|pediatric]] tumour.
*May be associated with a syndrome:<ref>URL: [http://emedicine.medscape.com/article/989398-overview http://emedicine.medscape.com/article/989398-overview]. Accessed on: 9 March 2011.</ref>
**WAGR syndrome (Wilms tumour, Aniridia (absence of iris), GU abnormalities, Retardation).<ref>{{OMIM|194072}}</ref>
**[[Beckwith-Wiedemann syndrome]].<ref>{{OMIM|130650}}</ref>
**[[Denys-Drash syndrome]].<ref>{{OMIM|194080}}</ref>

==Gross==
Features <ref name="pmid10193955">{{Cita publicación | apellido = Coppes | nombre = MJ. | coautores = M. Arnold, JB. Beckwith, ML. Ritchey, GJ. D'Angio, DM. Green, NE. Breslow | título = Factors affecting the risk of contralateral Wilms tumor development: a report from the National Wilms Tumor Study Group. | publicación = Cancer | volume = 85 | número = 7 | páginas = 1616-25 | mes = Apr | año = 1999 | doi = | pmid = 10193955 }}</ref>
*Most nephroblastomas are unifocal.
**Usually solitary, rounded, multilobular masses sharply demarcated from adjacent parenchyma.
**The cut surface is most commonly pale grey or tan.
**Cyst most be prominent in some cases.
*Multifocal masses in a single kidney and bilateral primary lesions are less frequent.

===Images===
<gallery>
Image:Wilms_tumor.jpg | Wilms tumour. (WC/AFIP)
</gallery>
www:
*[http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/rnfrm.html Wilms tumour (med.utah.edu)].
*[http://www.webpathology.com/image.asp?case=73&n=1 Wilms tumour (WebPathology)].

==Microscopic==
Features - classically three components (blastema, immature stroma, tubules):<ref name=Ref_PCPBoD8_254-5>{{Ref PCPBoD8|254-5}}</ref>
#Malignant [[Small round blue cell tumours|small round blue cells]] ("blastema"):
#*The blastemal component is the least differentiated cellular element.
#*Size = ~ 2x RBC diameter.
#*Nuclear pleomorphism (variation of size, shape and staining).
#**Irregular nuclear membrane - '''important'''.
#*Scant/difficult to discern cytoplasm - basophilic (light blue).
#*Mitoses - common.
#Stroma ("immature stroma"):
#*Spindle cells:
#**Elliptical nuclear membrane.
#**Abundant loose cytoplasm.
#Epithelial components ("tubules"):
#*Primitive rossete-like tubules, well-formed maturing and mature tubules, glomerular structures and variably papillary architecture.
#**Usually clustered.
#**Usu. have a central (clear/white) space surrounded by a rim of intensely eosinophilic cytoplasm.
#**Nuclei of tubular structures often elongated and palisaded.

Other findings:
*Commonly seen in association with ''nephrogenic rests''.
**Cluster of cells small (blue) cells; lack nuclear atypia seen in Wilms tumour.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970416-8 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970416-8]. Accessed on: 28 March 2011.</ref>
*+/-Heterologous elements (skeletal muscle, smooth muscle adipose tissue, cartilage).<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
**Heterologous = doesn't normally belong there.<ref>URL: [http://www.biology-online.org/dictionary/Heterologous http://www.biology-online.org/dictionary/Heterologous]. Accessed on: 1 October 2011.</ref>

DDx:
*[[Metanephric adenoma]].
*Nephrogenic nests.
*Other [[small round cell tumours]].
*[[Synovial sarcoma]], biphasic - especially in adults.
*Immature teratoma.

Notes:
*Palisade = fence made of stakes driven into the ground.<ref>URL: [http://www.thefreedictionary.com/palisaded http://www.thefreedictionary.com/palisaded]. Accessed on: 2 February 2011.</ref>
*Approximately 30-40% Wilms tumour cases have nephrogenic rests.<ref name=pmid8047084>{{cite journal |author=Coppes MJ, Haber DA, Grundy PE |title=Genetic events in the development of Wilms' tumor |journal=N. Engl. J. Med. |volume=331 |issue=9 |pages=586–90 |year=1994 |month=September |pmid=8047084 |doi=10.1056/NEJM199409013310906 |url=}}</ref>
*The three phases are also called ''blastemal, epithelial and stromal''.<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>

===Images===
<gallery>
Image:Wilms_tumour_-_low_mag.jpg | Wilms tumour - low mag. (WC/Nephron)
Image:Wilms tumour - intermed mag.jpg | Wilms tumour - intermed. mag. (WC/Nephron)
Image:Wilms tumour - high mag.jpg | Wilms tumour - high mag. (WC/Nephron)
Image:Wilms_tumour_-_very_high_mag.jpg | Wilms tumour - very high mag. (WC/Nephron)
File:Wilms Tumor (Nephroblastoma) (4882456062).jpg | Wilms tumor - low mag. (WC/Ed Uthman)
</gallery>
www:
*[http://www.biologydisease.com/images/kidney/nephrogenic-rests/nephrogenic-rest.jpg.php Nephrogenic rests (biologydisease.com)].
*[http://www.webpathology.com/image.asp?n=1&Case=73 Wilms tumour (webpathology.com)].

===Anaplasia===
Subclassified as:<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
#Focal anaplasia.
#Diffuse anaplasia.

Criteria (all of the following):<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
#Atypical mitoses.
#Nuclear hyperchromasia.
#Nuclear size variation (of the tumour cells) > 3x.

==IHC==
*WT-1 +ve (nuclear).
*CD56 +ve.<ref name=pmid11688464>{{Cite journal | last1 = Muir | first1 = TE. | last2 = Cheville | first2 = JC. | last3 = Lager | first3 = DJ. | title = Metanephric adenoma, nephrogenic rests, and Wilms' tumor: a histologic and immunophenotypic comparison. | journal = Am J Surg Pathol | volume = 25 | issue = 10 | pages = 1290-6 | month = Oct | year = 2001 | doi = | PMID = 11688464 }}</ref>
**-ve in [[metanephric adenoma]].

==Molecular==
*Cytogenetics<ref>{{Cite journal | last1 = Md Zin | first1 = R. | last2 = Murch | first2 = A. | last3 = Charles | first3 = A. | title = Pathology, genetics and cytogenetics of Wilms' tumour. | journal = Pathology | volume = 43 | issue = 4 | pages = 302-12 | month = Jun | year = 2011 | doi = 10.1097/PAT.0b013e3283463575 | PMID = 21516053 }}</ref>
**Partial gains of 1q.
**Partial losses of 1p, 1q, 4q, 11q, 16q, 22q.
**Complete loss of chromosome 16, 11, 12, 22.
**Trisomy of chromosome 8, 12, 13, 18.

==See also==
*[[Pediatric kidney tumours]].
*[[Kidney tumours]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pediatric kidney tumours]]
[[Category:Small round blue cell tumours]]

Wilms tumour

2018-10-14T05:36:52Z

Abraham: /* Gross */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Wilms_tumour_-_very_high_mag.jpg
| Width =
| Caption = Wilms tumour. [[H&E stain]].
| Synonyms = nephroblastoma
| Micro =
| Subtypes =
| LMDDx = [[metanephric adenoma]], nephrogenic nests, [[small round cell tumours]], Immature teratoma
| Stains =
| IHC = WT-1 +ve, CD56 +ve
| EM =
| Molecular =
| IF =
| Gross =
| Grossing =
| Site = [[kidney]] - see ''[[pediatric kidney tumours]]''
| Assdx =
| Syndromes = WAGR syndrome, [[Beckwith-Wiedemann syndrome]], [[Denys-Drash syndrome]]
| Clinicalhx =
| Signs = +/-abdominal mass
| Symptoms =
| Prevalence = most common pediatric kidney tumour
| Bloodwork =
| Rads =
| Endoscopy =
| Prognosis =
| Other =
| ClinDDx =
| Tx =
}}
'''Wilms tumour''', also '''nephroblastoma''' and '''Wilms' tumour''', is the most common [[Pediatric_kidney_tumours|pediatric kidney tumour]].<ref name=pmid10935424>{{cite journal |author=Coppes MJ, Wolff JE, Ritchey ML |title=Wilms tumour: diagnosis and treatment |journal=Paediatr Drugs |volume=1 |issue=4 |pages=251–62 |year=1999 |pmid=10935424 |doi= |url=}}</ref><ref name=pmid15738594>{{cite journal |author=Stefanowicz J, Sierota D, Balcerska A, Stoba C |title=[Wilms' tumour of unfavorable histology--results of treatment with the SIOP 93-01 protocol at the Gdańsk centre. Preliminary report] |language=Polish |journal=Med Wieku Rozwoj |volume=8 |issue=2 Pt 1 |pages=197–200 |year=2004 |pmid=15738594 |doi= |url=}}</ref>

==General==
*Common abdominal [[pediatric pathology|pediatric]] tumour.
*May be associated with a syndrome:<ref>URL: [http://emedicine.medscape.com/article/989398-overview http://emedicine.medscape.com/article/989398-overview]. Accessed on: 9 March 2011.</ref>
**WAGR syndrome (Wilms tumour, Aniridia (absence of iris), GU abnormalities, Retardation).<ref>{{OMIM|194072}}</ref>
**[[Beckwith-Wiedemann syndrome]].<ref>{{OMIM|130650}}</ref>
**[[Denys-Drash syndrome]].<ref>{{OMIM|194080}}</ref>

==Gross==
*Most nephroblastomas are unifocal.
**Usually solitary, rounded, multilobular masses sharply demarcated from adjacent parenchyma.
**The cut surface is most commonly pale grey or tan.
**Cyst most be prominent in some cases.
*Multifocal masses in a single kidney and bilateral primary lesions are less frequent.

===Images===
<gallery>
Image:Wilms_tumor.jpg | Wilms tumour. (WC/AFIP)
</gallery>
www:
*[http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/rnfrm.html Wilms tumour (med.utah.edu)].
*[http://www.webpathology.com/image.asp?case=73&n=1 Wilms tumour (WebPathology)].

==Microscopic==
Features - classically three components (blastema, immature stroma, tubules):<ref name=Ref_PCPBoD8_254-5>{{Ref PCPBoD8|254-5}}</ref>
#Malignant [[Small round blue cell tumours|small round blue cells]] ("blastema"):
#*The blastemal component is the least differentiated cellular element.
#*Size = ~ 2x RBC diameter.
#*Nuclear pleomorphism (variation of size, shape and staining).
#**Irregular nuclear membrane - '''important'''.
#*Scant/difficult to discern cytoplasm - basophilic (light blue).
#*Mitoses - common.
#Stroma ("immature stroma"):
#*Spindle cells:
#**Elliptical nuclear membrane.
#**Abundant loose cytoplasm.
#Epithelial components ("tubules"):
#*Primitive rossete-like tubules, well-formed maturing and mature tubules, glomerular structures and variably papillary architecture.
#**Usually clustered.
#**Usu. have a central (clear/white) space surrounded by a rim of intensely eosinophilic cytoplasm.
#**Nuclei of tubular structures often elongated and palisaded.

Other findings:
*Commonly seen in association with ''nephrogenic rests''.
**Cluster of cells small (blue) cells; lack nuclear atypia seen in Wilms tumour.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970416-8 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970416-8]. Accessed on: 28 March 2011.</ref>
*+/-Heterologous elements (skeletal muscle, smooth muscle adipose tissue, cartilage).<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
**Heterologous = doesn't normally belong there.<ref>URL: [http://www.biology-online.org/dictionary/Heterologous http://www.biology-online.org/dictionary/Heterologous]. Accessed on: 1 October 2011.</ref>

DDx:
*[[Metanephric adenoma]].
*Nephrogenic nests.
*Other [[small round cell tumours]].
*[[Synovial sarcoma]], biphasic - especially in adults.
*Immature teratoma.

Notes:
*Palisade = fence made of stakes driven into the ground.<ref>URL: [http://www.thefreedictionary.com/palisaded http://www.thefreedictionary.com/palisaded]. Accessed on: 2 February 2011.</ref>
*Approximately 30-40% Wilms tumour cases have nephrogenic rests.<ref name=pmid8047084>{{cite journal |author=Coppes MJ, Haber DA, Grundy PE |title=Genetic events in the development of Wilms' tumor |journal=N. Engl. J. Med. |volume=331 |issue=9 |pages=586–90 |year=1994 |month=September |pmid=8047084 |doi=10.1056/NEJM199409013310906 |url=}}</ref>
*The three phases are also called ''blastemal, epithelial and stromal''.<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>

===Images===
<gallery>
Image:Wilms_tumour_-_low_mag.jpg | Wilms tumour - low mag. (WC/Nephron)
Image:Wilms tumour - intermed mag.jpg | Wilms tumour - intermed. mag. (WC/Nephron)
Image:Wilms tumour - high mag.jpg | Wilms tumour - high mag. (WC/Nephron)
Image:Wilms_tumour_-_very_high_mag.jpg | Wilms tumour - very high mag. (WC/Nephron)
File:Wilms Tumor (Nephroblastoma) (4882456062).jpg | Wilms tumor - low mag. (WC/Ed Uthman)
</gallery>
www:
*[http://www.biologydisease.com/images/kidney/nephrogenic-rests/nephrogenic-rest.jpg.php Nephrogenic rests (biologydisease.com)].
*[http://www.webpathology.com/image.asp?n=1&Case=73 Wilms tumour (webpathology.com)].

===Anaplasia===
Subclassified as:<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
#Focal anaplasia.
#Diffuse anaplasia.

Criteria (all of the following):<ref name=Ref_WMSP282>{{Ref WMSP|282}}</ref>
#Atypical mitoses.
#Nuclear hyperchromasia.
#Nuclear size variation (of the tumour cells) > 3x.

==IHC==
*WT-1 +ve (nuclear).
*CD56 +ve.<ref name=pmid11688464>{{Cite journal | last1 = Muir | first1 = TE. | last2 = Cheville | first2 = JC. | last3 = Lager | first3 = DJ. | title = Metanephric adenoma, nephrogenic rests, and Wilms' tumor: a histologic and immunophenotypic comparison. | journal = Am J Surg Pathol | volume = 25 | issue = 10 | pages = 1290-6 | month = Oct | year = 2001 | doi = | PMID = 11688464 }}</ref>
**-ve in [[metanephric adenoma]].

==Molecular==
*Cytogenetics<ref>{{Cite journal | last1 = Md Zin | first1 = R. | last2 = Murch | first2 = A. | last3 = Charles | first3 = A. | title = Pathology, genetics and cytogenetics of Wilms' tumour. | journal = Pathology | volume = 43 | issue = 4 | pages = 302-12 | month = Jun | year = 2011 | doi = 10.1097/PAT.0b013e3283463575 | PMID = 21516053 }}</ref>
**Partial gains of 1q.
**Partial losses of 1p, 1q, 4q, 11q, 16q, 22q.
**Complete loss of chromosome 16, 11, 12, 22.
**Trisomy of chromosome 8, 12, 13, 18.

==See also==
*[[Pediatric kidney tumours]].
*[[Kidney tumours]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pediatric kidney tumours]]
[[Category:Small round blue cell tumours]]

Adenocarcinoma of the lung

2018-09-24T23:50:20Z

Abraham: /* Microscopic */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Acinar pattern adenocarcinoma of lung -- low mag.jpg
| Width =
| Caption = Invasive adenocarcinoma, acinar pattern (right of image) and benign lung (left of image). [[H&E stain]].
| Synonyms =
| Micro = +/-nuclear atypia (may be absent in mucinous tumours), eccentrically placed nuclei, usu. abundant cytoplasm (classically with mucin vacuoles), often conspicuous [[nucleoli]], +/-[[nuclear pseudoinclusions]]
| Subtypes =
| LMDDx = [[atypical adenomatous hyperplasia of the lung]], adenocarcinoma in situ, [[squamous cell carcinoma of the lung]], [[small cell carcinoma of the lung]], [[non-small cell lung carcinoma]], [[malignant mesothelioma]], [[Metastasis|metastatic]] [[adenocarcinoma]] (esp. [[colorectal adenocarcinoma]], breast adenocarcinoma ([[invasive ductal carcinoma of the breast]], [[invasive lobular carcinoma]]))
| Stains =
| IHC = [[CK7]] +ve, [[TTF-1]] +ve, CK20 -ve, [[p40]] -ve, p63 -ve (usually)
| EM =
| Molecular = +/-KRAS mutations, +/-EGFR mutations, +/-ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion), +/-ROS1 rearrangements, +/-RET rearrangements
| IF =
| Gross =
| Grossing =
| Staging = [[lung cancer staging]]
| Site = [[lung]] - see ''[[lung tumours]]''
| Assdx =
| Syndromes =
| Clinicalhx =
| Signs =
| Symptoms =
| Prevalence = most common primary lung tumour
| Bloodwork =
| Rads = lung mass - typically peripheral lesion (distant from large airways), may be multifocal
| Endoscopy =
| Prognosis = dependent on stage (minimally invasive and noninvasive: very good; invasive: moderate)
| Other =
| ClinDDx = other [[lung tumours]] - primary and metastatic
| Tx = surgical resection if feasible
}}
'''Adenocarcinoma of the lung''', also '''lung adenocarcinoma''', is common malignant [[lung tumour]].

==General==
*Adenocarcinoma is the most common (primary lung cancer).<ref name=pmid19118313>{{cite journal |author=Lutschg JH |title=Lung cancer |journal=N. Engl. J. Med. |volume=360 |issue=1 |pages=87-8; author reply 88 |year=2009 |month=January |pmid=19118313 |doi=10.1056/NEJMc082208 |url=}}</ref>
*Adenocarcinoma is the non-smoker tumour - [[small cell carcinoma of the lung|SCLC]] and [[squamous cell carcinoma of the lung|squamous]] are more strongly associated with [[smoking]].
*Lung adenocarcinoma is the most common brain metastasis.<ref name=pmid22012633>{{Cite journal | last1 = Nayak | first1 = L. | last2 = Lee | first2 = EQ. | last3 = Wen | first3 = PY. | title = Epidemiology of brain metastases. | journal = Curr Oncol Rep | volume = 14 | issue = 1 | pages = 48-54 | month = Feb | year = 2012 | doi = 10.1007/s11912-011-0203-y | PMID = 22012633 }}</ref>

Treatment:
*Lung adenocarcinoma may be treated with [[EGFR inhibitors]] (e.g. gefitinib (Iressa), erlotinib (Tarceva)).<ref name=pmid20855837>{{cite journal |author=Sun Y, Ren Y, Fang Z, ''et al.'' |title=Lung adenocarcinoma from East Asian never-smokers is a disease largely defined by targetable oncogenic mutant kinases |journal=J. Clin. Oncol. |volume=28 |issue=30 |pages=4616–20 |year=2010 |month=October |pmid=20855837 |doi=10.1200/JCO.2010.29.6038 |url=}}</ref>

Patients that receive EGFR inhibitors classically are:<ref name=pmid21151896>{{cite journal |author=Job B, Bernheim A, Beau-Faller M, ''et al.'' |title=Genomic Aberrations in Lung Adenocarcinoma in Never Smokers |journal=PLoS One |volume=5 |issue=12 |pages=e15145 |year=2010 |pmid=21151896 |pmc=2997777 |doi=10.1371/journal.pone.0015145 |url=}}</ref>
*Non-smokers.
*Female.
*Asian.
**Caucasians also benefit.<ref name=pmid20973798>{{Cite journal | last1 = Rosell | first1 = R. | last2 = Moran | first2 = T. | last3 = Cardenal | first3 = F. | last4 = Porta | first4 = R. | last5 = Viteri | first5 = S. | last6 = Molina | first6 = MA. | last7 = Benlloch | first7 = S. | last8 = Taron | first8 = M. | title = Predictive biomarkers in the management of EGFR mutant lung cancer. | journal = Ann N Y Acad Sci | volume = 1210 | issue = | pages = 45-52 | month = Oct | year = 2010 | doi = 10.1111/j.1749-6632.2010.05775.x | PMID = 20973798 }}</ref>

==Gross==
*Classically peripheral lesions.
*May be multifocal.

===Image===
<gallery>
Image:Adenocarcinoma (3950819000).jpg | Lung adenocarcinoma. (WC/Rosen)
</gallery>

==Microscopic==
Features:
*+/-Nuclear atypia - '''important'''.
**May be absent in mucinous tumours - may look similar to foveolar epithelium.
*Eccentrically placed nuclei.
*Abundant cytoplasm - classically with mucin vacuoles.
*Often conspicuous [[nucleoli]].
*+/-[[Nuclear pseudoinclusions]].

Negatives:
*Lack of intercellular bridges.

Patterns:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
*Lepidic - tumour grows long the alveolar wall; means ''scaly covering''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/lepidic http://medical-dictionary.thefreedictionary.com/lepidic]. Accessed on: 8 August 2013.</ref> At lower power, the shapes should still resemble lung acini.
*Acinar - berry-shaped glands, smaller than lung acini.
*Papillary - fibrovascular cores.
*Micropapillary - nipple shaped projections without fibrovascular cores.
*Solid - sheet of cells.

Notes:
*[[Lymphovascular invasion]] is common.
*Micropapillary predominant pattern and tumours with any amount of the lepidic pattern are associated with EGFR mutations.<ref name=pmid21970488>{{Cite journal | last1 = Shim | first1 = HS. | last2 = Lee | first2 = da H. | last3 = Park | first3 = EJ. | last4 = Kim | first4 = SH. | title = Histopathologic characteristics of lung adenocarcinomas with epidermal growth factor receptor mutations in the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification. | journal = Arch Pathol Lab Med | volume = 135 | issue = 10 | pages = 1329-34 | month = Oct | year = 2011 | doi = 10.5858/arpa.2010-0493-OA | PMID = 21970488 }}</ref>

DDx:
*[[Atypical adenomatous hyperplasia of the lung]] - spaced [[hobnail]] cells, mild-to-moderate nuclear atypia, small lesion (< 5 mm).
*Adenocarcinoma in situ.
*[[Papillary thyroid carcinoma|Papillary carcinoma of thyroid]].
*[[Squamous cell carcinoma of the lung]].
*[[Small cell carcinoma of the lung]].
*[[Adenoid Cystic Carcinoma]].
*[[Non-small cell lung carcinoma]] - diagnosis should be avoided if possible.
*[[Malignant mesothelioma]].
*[[Metastasis|Metastatic]] adenocarcinoma.
**[[Colorectal adenocarcinoma]].
**Breast adenocarcinoma.
***[[Invasive ductal carcinoma of the breast]].
***[[Invasive lobular carcinoma]].
***[[Bronchiolar metaplasia]].
**Other carcinomas.
*Carcinomas of the bronchial glands, e.g. [[adenoid cystic carcinoma]].

===Images===
=====Acinar adenocarcinoma=====
<gallery>
Image: Acinar pattern adenocarcinoma of lung -- low mag.jpg | Acinar LA - low mag.
Image: Acinar pattern adenocarcinoma of lung -- intermed mag.jpg | Acinar LA - intermed. mag.
Image: Acinar pattern adenocarcinoma of lung -- high mag.jpg | Acinar LA - high mag.
Image: Acinar pattern adenocarcinoma of lung -- very high mag.jpg | Acinar LA - very high mag.
Image: Acinar pattern adenocarcinoma of lung - alt -- very high mag.jpg | Acinar LA - very high mag.
</gallery>
<gallery>
Image:Adenocarcinoma, acinar subtype (3923397562).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
Image:Adenocarcinoma,_acinar_subtype_(4420421886).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
</gallery>
=====Mucinous adenocarcinoma=====
<gallery>
Image: Mucinous adenocarcinoma of the lung -- low mag.jpg | MAL - low mag.
Image: Mucinous adenocarcinoma of the lung -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous adenocarcinoma of the lung -- high mag.jpg | MAL - high mag.
Image: Mucinous adenocarcinoma of the lung -- very high mag.jpg | MAL - very high mag.
</gallery>
<gallery>
Image: Mucinous lung adenocarcinoma -- low mag.jpg | MAL - low mag.
Image: Mucinous lung adenocarcinoma -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous lung adenocarcinoma -- high mag.jpg | MAL - high mag.
Image: Mucinous lung adenocarcinoma and airway -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous lung adenocarcinoma and airway -- high mag.jpg | MAL - high mag.
Image: Mucinous lung adenocarcinoma and airway - alt -- high mag.jpg | MAL - high mag.
</gallery>
<gallery>
Image:Bronchioloalveolar carcinoma, mucinous type 2.jpg |BAC - mucinous type - low mag. (WC/Yale Rosen)
Image:Bronchioloalveolar carcinoma, mucinous type.jpg | BAC - mucinous type - high mag. (WC/Yale Rosen)
</gallery>

=====Papillary adenocarcinoma=====
<gallery>
Image: Papillary adenocarcinoma of the lung -- very low mag.jpg | PAL - very low mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- low mag.jpg | PAL - low mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- intermed mag.jpg | PAL - intermed. mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- high mag.jpg | PAL - high mag. (WC/Nephron)
</gallery>

====Fetal adenocarcinoma====
<gallery>
Image: Fetal adenocarcinoma of the lung -- very low mag.jpg | FAL - very low mag. (WC)
Image: Fetal adenocarcinoma of the lung - alt2 -- very low mag.jpg | FAL - very low mag. (WC)
Image: Fetal adenocarcinoma of the lung -- low mag.jpg | FAL - low mag. (WC)
Image: Fetal adenocarcinoma of the lung -- intermed mag.jpg | FAL - intermed. mag. (WC)
Image: Fetal adenocarcinoma of the lung -- high mag.jpg | FAL - high mag. (WC)
</gallery>

====www====
*[http://www.pathpedia.com/education/eatlas/histopathology/lung_and_bronchi/bronchioloalveolar_carcinoma_mucinous.aspx BAC mucinous type adjacent to benign (pathpedia.com)].
*[http://cancergrace.org/wp-content/uploads/2007/05/mucinous-vs-nonmucinous-bac-histology.jpg BAC mucinous and nonmucinous (cancergrace.org)].<ref>URL: [http://cancergrace.org/lung/2007/05/14/bac-mucinous-and-non-mucinous/ http://cancergrace.org/lung/2007/05/14/bac-mucinous-and-non-mucinous/]. Accessed on: 8 August 2013.</ref>
*[https://www.flickr.com/photos/pulmonary_pathology/7589291672/ Lepidic adenocarcinoma with invasive (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292214/in/photostream/ Lepidic adenocarcinoma (flickr.com/Yale Rosen)].
*[http://www.rosaicollection.org/searchresults.cfm/ Lepidic adenocarcinoma (rosaicollection.org/index.cfm)].
*[http://pathlabmed.typepad.com/surgical_pathology_and_la/2010/09/digital-case-challenge-non-mucinous-bronchioloalveolar-adenocarcinoma.html Mucinous adenocarcinoma (pathlabmed.typepad.com)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292780/in/photostream/ Non-mucinous adenocarcinoma in situ (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292496/in/photostream/ Non-mucinous adenocarcinoma in situ (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589290010/in/photostream/ Acinar adenocarcinoma (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589289274/in/photostream/ Acinar adenocarcinoma (flickr.com/Yale Rosen)].

===Classification===
Classification based on extent:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
#Adenocarcinoma in situ (AIS) - previously known as [[BAC]].
#*Subtypes: nonmucinous, mucinous, mixed mucinous/nonmucinous.
#*Definition: lack of invasion into the stroma, vascular spaces and pleura.
#*Must have a lepidic growth pattern.<ref name=pmid22214965>{{Cite journal | last1 = Borczuk | first1 = AC. | title = Assessment of invasion in lung adenocarcinoma classification, including adenocarcinoma in situ and minimally invasive adenocarcinoma. | journal = Mod Pathol | volume = 25 Suppl 1 | issue = | pages = S1-10 | month = Jan | year = 2012 | doi = 10.1038/modpathol.2011.151 | PMID = 22214965 }}</ref>
#Minimally invasive adenocarcinoma (MIA).
#*Lepidic growth with up to 5 mm of invasion.
#*Subtypes: nonmucinous (most common), mucinous (uncommon), mixed (mucinous/nonmucinous).
#*Should not have [[lymphovascular invasion]].{{fact}}
#Invasive adenocarcinoma:
#*Subtypes: micropapillary, mucinous (previously ''mucinous BAC''), colloid, fetal, enteric.

====Grading====
Graded G1-G4 - as per CAP protocol (version 3.4.0.0):<ref name=cap_protocol>CAP Lung protocol. Version: 3.4.0.0. URL: [http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf]. Accessed on: March 23, 2016.</ref>
*G1 = lepidic.
*G2 = acinar, papillary, cribriform.
*G3 = micropapillary, solid, mucinous, colloid.
*G4 = undifferentiated - '''not''' used for lung adenocarcinoma; it used for small cell carcinoma and large cell carcinoma.

Note:
*There is no consensus currently on grading - as per the international consensus guidelines of 2011.<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>

==Special stains==
*[[Mucicarmine]] +ve, cytoplasmic.
*[[PAS-diastase]] +ve, cytoplasmic.

==IHC==
Primary versus metastatic:
*TTF-1 +ve.
*CK7 +ve.
*CK20 -ve.

Panel for adenocarcinoma versus SCC:
*TTF-1 +ve.
*[[Napsin]] A +ve.
*[[p40]] -ve.<ref name=pmid22056955>{{Cite journal | last1 = Bishop | first1 = JA. | last2 = Teruya-Feldstein | first2 = J. | last3 = Westra | first3 = WH. | last4 = Pelosi | first4 = G. | last5 = Travis | first5 = WD. | last6 = Rekhtman | first6 = N. | title = p40 (ΔNp63) is superior to p63 for the diagnosis of pulmonary squamous cell carcinoma. | journal = Mod Pathol | volume = 25 | issue = 3 | pages = 405-15 | month = Mar | year = 2012 | doi = 10.1038/modpathol.2011.173 | PMID = 22056955 }}</ref>
*CK5/6 -ve.

Others:
*p63 -ve -- occasionally +ve.
*Vimentin -ve/+ve (+ve relatively common).
**Poor prognosticator.<ref>{{Cite journal | last1 = Dauphin | first1 = M. | last2 = Barbe | first2 = C. | last3 = Lemaire | first3 = S. | last4 = Nawrocki-Raby | first4 = B. | last5 = Lagonotte | first5 = E. | last6 = Delepine | first6 = G. | last7 = Birembaut | first7 = P. | last8 = Gilles | first8 = C. | last9 = Polette | first9 = M. | title = Vimentin expression predicts the occurrence of metastases in non small cell lung carcinomas. | journal = Lung Cancer | volume = 81 | issue = 1 | pages = 117-22 | month = Jul | year = 2013 | doi = 10.1016/j.lungcan.2013.03.011 | PMID = 23562674 }}</ref>

Note:
*In mucinous adenocarcinoma of the lung TTF-1 is usu. -ve (46% +ve) and napsin is usu. -ve (36% +ve).
**Positive staining is unusual but useful if present, as metastatic disease is uniformily negative for both.<ref name=pmid24651909>{{Cite journal | last1 = Rossi | first1 = G. | last2 = Cavazza | first2 = A. | last3 = Righi | first3 = L. | last4 = Sartori | first4 = G. | last5 = Bisagni | first5 = A. | last6 = Longo | first6 = L. | last7 = Pelosi | first7 = G. | last8 = Papotti | first8 = M. | title = Napsin-A, TTF-1, EGFR, and ALK Status Determination in Lung Primary and Metastatic Mucin-Producing Adenocarcinomas. | journal = Int J Surg Pathol | volume = 22 | issue = 5 | pages = 401-7 | month = Aug | year = 2014 | doi = 10.1177/1066896914527609 | PMID = 24651909 }}
</ref>

==Molecular==
*EGFR mutations (typically assessed by PCR) - respond to [[TKI]]s (e.g. [[gefitinib]], [[erlotinib]]) if:<ref name=pmid19680292>{{Cite journal | last1 = John | first1 = T. | last2 = Liu | first2 = G. | last3 = Tsao | first3 = MS. | title = Overview of molecular testing in non-small-cell lung cancer: mutational analysis, gene copy number, protein expression and other biomarkers of EGFR for the prediction of response to tyrosine kinase inhibitors. | journal = Oncogene | volume = 28 Suppl 1 | issue = | pages = S14-23 | month = Aug | year = 2009 | doi = 10.1038/onc.2009.197 | PMID = 19680292 }}</ref>
**Exon 19 deletion.
**Exon 21 L858R.
***Natural history of mutation is suspected to have a better prognosis vs. wild-type.<ref>URL: [http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r]. Accessed on: 27 April 2012.</ref>
**[[KRAS mutations]] are absent, i.e. ''wild-type KRAS''.<ref>{{Cite journal | last1 = Pao | first1 = W. | last2 = Wang | first2 = TY. | last3 = Riely | first3 = GJ. | last4 = Miller | first4 = VA. | last5 = Pan | first5 = Q. | last6 = Ladanyi | first6 = M. | last7 = Zakowski | first7 = MF. | last8 = Heelan | first8 = RT. | last9 = Kris | first9 = MG. | title = KRAS mutations and primary resistance of lung adenocarcinomas to gefitinib or erlotinib. | journal = PLoS Med | volume = 2 | issue = 1 | pages = e17 | month = Jan | year = 2005 | doi = 10.1371/journal.pmed.0020017 | PMID = 15696205 }}</ref>

*ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion).<ref name=pmid21245935>{{Cite journal | last1 = Li | first1 = Y. | last2 = Ye | first2 = X. | last3 = Liu | first3 = J. | last4 = Zha | first4 = J. | last5 = Pei | first5 = L. | title = Evaluation of EML4-ALK fusion proteins in non-small cell lung cancer using small molecule inhibitors. | journal = Neoplasia | volume = 13 | issue = 1 | pages = 1-11 | month = Jan | year = 2011 | doi = | PMID = 21245935 }}</ref>
**Associated with a poor prognosis.<ref name=pmid22134072>{{Cite journal | last1 = Yang | first1 = P. | last2 = Kulig | first2 = K. | last3 = Boland | first3 = JM. | last4 = Erickson-Johnson | first4 = MR. | last5 = Oliveira | first5 = AM. | last6 = Wampfler | first6 = J. | last7 = Jatoi | first7 = A. | last8 = Deschamps | first8 = C. | last9 = Marks | first9 = R. | title = Worse disease-free survival in never-smokers with ALK+ lung adenocarcinoma. | journal = J Thorac Oncol | volume = 7 | issue = 1 | pages = 90-7 | month = Jan | year = 2012 | doi = 10.1097/JTO.0b013e31823c5c32 | PMID = 22134072 }}</ref>
**Amenable to treatment with TKI.
**See ''[[lung carcinoma with ALK rearrangement]].
**Do ''not'' occur with EGRF mutations ''or'' KRAS mutations.<ref name=pmid23729361>{{Cite journal | last1 = Gainor | first1 = JF. | last2 = Varghese | first2 = AM. | last3 = Ou | first3 = SH. | last4 = Kabraji | first4 = S. | last5 = Awad | first5 = MM. | last6 = Katayama | first6 = R. | last7 = Pawlak | first7 = A. | last8 = Mino-Kenudson | first8 = M. | last9 = Yeap | first9 = BY. | title = ALK rearrangements are mutually exclusive with mutations in EGFR or KRAS: an analysis of 1,683 patients with non-small cell lung cancer. | journal = Clin Cancer Res | volume = 19 | issue = 15 | pages = 4273-81 | month = Aug | year = 2013 | doi = 10.1158/1078-0432.CCR-13-0318 | PMID = 23729361 }}</ref>

*ROS1 - good response to crizotinib.<ref name=pmid25264305>{{Cite journal | last1 = Shaw | first1 = AT. | last2 = Ou | first2 = SH. | last3 = Bang | first3 = YJ. | last4 = Camidge | first4 = DR. | last5 = Solomon | first5 = BJ. | last6 = Salgia | first6 = R. | last7 = Riely | first7 = GJ. | last8 = Varella-Garcia | first8 = M. | last9 = Shapiro | first9 = GI. | title = Crizotinib in ROS1-rearranged non-small-cell lung cancer. | journal = N Engl J Med | volume = 371 | issue = 21 | pages = 1963-71 | month = Nov | year = 2014 | doi = 10.1056/NEJMoa1406766 | PMID = 25264305 }}</ref>
**Approximately 1% of NSCLC.<ref name=pmid25409376>{{Cite journal | last1 = Gold | first1 = KA. | title = ROS1--targeting the one percent in lung cancer. | journal = N Engl J Med | volume = 371 | issue = 21 | pages = 2030-1 | month = Nov | year = 2014 | doi = 10.1056/NEJMe1411319 | PMID = 25409376 }}</ref>

==Sign out==
===Biopsy===
Consensus recommendations:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
*''Adenocarcinoma in situ'' (AIS) and ''minimally invasive adenocarcinoma'' should '''not''' be used in the reporting of small biopsies and cytology.
**Tumours with a non-invasive pattern are referred to by their pattern, e.g. ''lepidic growth'', '''not''' as AIS.

<pre>
Lung, Right Upper Lobe, Core Biopsy:
- INVASIVE ADENOCARCINOMA, NON-MUCINOUS.

Comment:
The adenocarcinoma is positive for TTF-1 and napsin. EGFR/ALK testing was ordered.
</pre>

=====Mucinous adenocarcinoma with noncontributory stains=====
<pre>
Lung, Right Upper Lobe, Core Biopsy:
- ADENOCARCINOMA, MUCINOUS, see comment.

Comment:
The adenocarcinoma is negative for both napsin and TTF-1. EGFR/ALK testing was ordered.

The findings are compatible with a primary or secondary adenocarcinoma; clinical and
radiologic correlation is required.
</pre>

====Block letters====
<pre>
LUNG, LEFT, BIOPSY:
- ADENOCARCINOMA, LEPIDIC GROWTH; INVASION CANNOT BE EXCLUDED IN THIS SMALL SPECIMEN.
</pre>

<pre>
LUNG, RIGHT UPPER LOBE, NEEDLE BIOPSY:
- INVASIVE ADENOCARCINOMA, NON-MUCINOUS.

COMMENT:
The tumour stains as follows:
POSITIVE: TTF-1.
NEGATIVE: p40.

The immunoprofile is compatible with lung adenocarcinoma.
</pre>

<pre>
MASS, LEFT LOWER LOBE OF LUNG, BIOPSY:
- INVASIVE ADENOCARCINOMA.

COMMENT:
The tumour is positive for TTF-1.

Tissue will be sent for molecular testing and the results reported as an addendum.
</pre>

===Resection===
<pre>
LUNG, LEFT UPPER LOBE, LOBECTOMY:
- ADENOCARCINOMA WITH AN ACINAR PATTERN, SOLID PATTERN, MICROPAPILLARY PATTERN
AND LEPIDIC PATTERN -- PATTERNS IN ORDER OF PREVALENCE.
- MARGINS NEGATIVE FOR MALIGNANCY.
- THREE LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/3).
- PLEASE SEE TUMOUR SUMMARY.
</pre>

<pre>
LUNG, RIGHT UPPER LOBE, LOBECTOMY:
- MULTIPLE ADENOCARCINOMAS (x2) WITH AN ACINAR PATTERN, SOLID PATTERN, MICROPAPILLARY PATTERN
AND LEPIDIC PATTERN -- PATTERNS IN ORDER OF PREVALENCE.
- MARGINS NEGATIVE FOR MALIGNANCY.
- FOUR LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/4).
- LYMPHOVASCULAR INVASION PRESENT.
- PLEASE SEE TUMOUR SUMMARY AND COMMENT.

COMMENT:
The histology of the two adenocarcinomas resemble one another and lymphovascular
invasion is present. These findings favour that the smaller tumor is a metastasis, rather
than a synchronous primary.
</pre>

===Micro===
<pre>
Size (tissue): scant tissue (<0.5 cm).
Gland formation: focal, poorly formed.
Cell size: large.
Cytoplasm: moderate-to-abundant, grey-eosinophilic.
Nucleus location: eccentric.
Nuclear pleomorphism: moderate.
Nuclear moulding: absent.
Nucleoli: present, prominent.
Nuclear pseudoinclusions: present.
</pre>

<pre>
Number of cores: 3.
Length of cores (total): 2.0 cm.

Gland formation: present.
Cell size: large.
Cytoplasm: moderate, grey-eosinophilic.
Necrosis: none apparent.
Mucin: none.

Nucleus location: eccentric.
Nuclear pleomorphism: moderate.
Nuclear moulding: absent.
Nuclear pseudoinclusions: absent.
Nuclear shape/arrangment: cigar-like/pseudostratified.
Nucleoli: present.
</pre>

====Mucinous====
The sections show cores with well-formed glands composed of foveolar-like columnar cells with a relatively bland cytomorphology. Mitotic activity is not readily apparent. A small amount of non-lesional lung parenchyma is present.

===Lung cancer staging===
{{Main|Lung cancer staging}}

==See also==
*[[Lung tumours]].
*[[Adenocarcinoma]].
*[[Metastasis]].
*[[Lung carcinoma with ALK rearrangement]].

==References==
{{Reflist|2}}

==External links==
*[http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-staging Lung cancer staging (cancer.org)].
*[http://www.nucmedresource.com/thoracic-nodal-stations.html Thoracic lymph node stations (nucmedresource.com)].

[[Category:Diagnosis]]
[[Category:Lung tumours]]

Stomach carcinoma

2018-09-19T09:36:16Z

Abraham: /* IHC */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Signet ring cell carcinoma - very high mag.jpg
| Width =
| Caption = Stomach signet ring cell carcinoma. [[H&E stain]].
| Synonyms =
| Micro =
| Subtypes = Lauren classification: intestinal type, diffuse type; WHO classification: papillary carcinoma, tubular carcinoma, mucinous carcinoma, signet-ring carcinoma, undifferentiated carcinoma, [[adenosquamous carcinoma]]
| LMDDx = [[gastric xanthoma]], [[neuroendocrine tumour]], metastatic carcinoma (e.g.[[pancreatic ductal adenocarcinoma]], [[gastric dysplasia]]
| Stains = CK7 +ve, CK20 -ve/+ve
| IHC =
| EM =
| Molecular =
| IF =
| Gross =
| Grossing =
| Site = [[stomach]]
| Assdx =
| Syndromes = [[hereditary diffuse gastric cancer]], [[familial adenomatous polyposis]], [[Lynch syndrome]], [[Peutz-Jeghers syndrome]], [[Li-Fraumeni syndrome]]
| Clinicalhx =
| Signs =
| Symptoms =
| Prevalence = uncommon
| Bloodwork =
| Rads =
| Endoscopy = +/-[[linitis plastica]] (diffuse carcinomas), +/-ulcer with heaped (raised) edges (intestinal carcinomas)
| Prognosis = usually very poor
| Other =
| ClinDDx = benign ulcer, other gastric tumours
| Tx = surgery if feasible
}}
'''Stomach carcinoma''', also '''carcinoma of the stomach''' and '''gastric carcinoma''', is an epithelial derived [[malignant]] tumour that arises from the [[stomach]].

Many gastric carcinomas form glands and can thus be called '''gastric adenocarcinoma''' or '''adenocarcinoma of the stomach'''.

==General==
Epidemiology:
*Prognosis is often poor as it is discovered at a late stage.
*Higher prevalence in countries in the far east (e.g. Japan) - thought to be environmental, e.g. diet.

Risk factors:
*Associated with helicobacter infections, i.e. [[Helicobacter gastritis]].
*[[Alcohol]] - heavy use.<ref name=pmid21993435>{{Cite journal | last1 = Duell | first1 = EJ. | last2 = Travier | first2 = N. | last3 = Lujan-Barroso | first3 = L. | last4 = Clavel-Chapelon | first4 = F. | last5 = Boutron-Ruault | first5 = MC. | last6 = Morois | first6 = S. | last7 = Palli | first7 = D. | last8 = Krogh | first8 = V. | last9 = Panico | first9 = S. | title = Alcohol consumption and gastric cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. | journal = Am J Clin Nutr | volume = 94 | issue = 5 | pages = 1266-75 | month = Nov | year = 2011 | doi = 10.3945/ajcn.111.012351 | PMID = 21993435 }}</ref>
*Genetic syndromes:
**[[Hereditary diffuse gastric cancer]].
**[[Familial adenomatous polyposis]].
**[[Peutz-Jeghers syndrome]].
**[[Lynch syndrome]].

Note:
*Possible association with tobacco use - dependent on the study.<ref>{{Cite journal | last1 = Nomura | first1 = A. | last2 = Grove | first2 = JS. | last3 = Stemmermann | first3 = GN. | last4 = Severson | first4 = RK. | title = Cigarette smoking and stomach cancer. | journal = Cancer Res | volume = 50 | issue = 21 | pages = 7084 | month = Nov | year = 1990 | doi = | PMID = 2208177 | URL = http://cancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=2208177}}</ref>

Treatment:
*Surgical excision.
**Proximal tumours may require a complete gastrectomy as the stomach is innervated from its proximal part.

===Classification===
*Two different classification schemes.
**Lauren<ref name=pmid14320675>{{cite journal |author=LAUREN P |title=THE TWO HISTOLOGICAL MAIN TYPES OF GASTRIC CARCINOMA: DIFFUSE AND SO-CALLED INTESTINAL-TYPE CARCINOMA. AN ATTEMPT AT A HISTO-CLINICAL CLASSIFICATION |journal=Acta Pathol Microbiol Scand |volume=64 |issue= |pages=31–49 |year=1965 |pmid=14320675 |doi= |url=}}</ref> - two types:
***Intestinal type (mass forming).
***Diffuse type (infiltrative).
**WHO classification - 6 subtypes for adenocarcinoma:<ref name=Ref_PBoD823>{{Ref PBoD |823}}</ref>
**#Papillary carcinoma.
**#Tubular carcinoma.
**#Mucinous carcinoma.
**#Signet-ring carcinoma.
**#Undifferentiated carcinoma.
**#[[Adenosquamous carcinoma]].

Lame memory device ''STOMACH'':
*'''S'''ignet ring, '''T'''ubular, '''O'''h papillary, '''M'''ucinous, '''A'''denosquamouas, '''C'''rappy '''H'''igh grade (Undifferentiated).

==Gross==
Location:
*Large carcinomas preferentially involve the lesser curvature.<ref name=pmid2550682>{{Cite journal | last1 = Yamagawa | first1 = H. | last2 = Onishi | first2 = T. | title = [A clinicopathological study of early gastric cancers with a diameter larger than five centimeters]. | journal = Gan No Rinsho | volume = 35 | issue = 10 | pages = 1114-8 | month = Sep | year = 1989 | doi = | PMID = 2550682 }}</ref>
*Ulceration with heaped (raised) edges.
**Appearance of the typical intestinal type tumour.
*Diffuse wall thickening with loss of the rugae - called ''[[linitis plastica]]''.
**Typically due to diffuse carcinoma.

Main DDx of [[gastric ulcer]]:
*[[Peptic ulcer disease]] - have a "punched-out" appearance: sharp edge, no granularity of surrounding mucosa.

===Images===
<gallery>
Image:Linitis_plastica.jpg | Linitis plastica - endoscopic image. (WC)
Image:Adenocarcinoma_of_the_stomach.jpg | Ulcerating gastric carcinoma. (WC)
Image:Adenocarcinoma,_stomach,_gross_pathology_IMG0037a_lores.jpg | Ulcerating gastric carcinoma. (WC)
</gallery>

==Microscopic==
Features - variable, either of the two following:
#"Typical adenocarcinoma":
#*Gland-forming lesion that infiltrates into the lamina propria or beyond.
#*Nuclear pleomorphism - common.
#+/-Signet ring carcinoma.
#*Scattered single cells in the lamina propria or beyond with:
#**Abundant cytoplasm containing one large (mucin-filled) vacuole.
#**A peripheral nucleus (displaced by the vacuole).

DDx:
*[[Gastric xanthoma]] - may mimic signet ring cell carcinoma.
*[[Neuroendocrine tumour]] - esp. for poorly differentiated; no gland formation.
*Metastatic carcinoma.
**[[Pancreatic ductal adenocarcinoma]].
*[[Gastric dysplasia]].

===Grading===
*Moderately differentiated >=50 % glands.{{fact}}
*Poorly differentiated >=50% no glands (sheeting or nests).

===Images===
<gallery>
Image:Gastric_adenocarcinoma.jpg | Gastric adenocarcinoma. (WC)
Image:Gastric_signet_ring_cell_carcinoma_histopatholgy_%282%29_PAS_stain.jpg | Gastric SRC - PAS stain. (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case196.html Gastric adenocarcinoma - several images (upmc.edu)].

==Stains==
*Mucicarmine +ve.

==IHC==
*AE1/AE3.
*CK7 +ve.
*CK20 -ve, occasionally +ve.
*[[CDX2]] +ve.<ref name=pmid12604886>{{Cite journal | last1 = Werling | first1 = RW. | last2 = Yaziji | first2 = H. | last3 = Bacchi | first3 = CE. | last4 = Gown | first4 = AM. | title = CDX2, a highly sensitive and specific marker of adenocarcinomas of intestinal origin: an immunohistochemical survey of 476 primary and metastatic carcinomas. | journal = Am J Surg Pathol | volume = 27 | issue = 3 | pages = 303-10 | month = Mar | year = 2003 | doi = | PMID = 12604886 }}</ref>

Others:
*p53 +ve in upto 75% of cases.<ref name=pmid21772890>{{Cite journal | last1 = Zali | first1 = MR. | last2 = Moaven | first2 = O. | last3 = Asadzadeh Aghdaee | first3 = H. | last4 = Ghafarzadegan | first4 = K. | last5 = Ahmadi | first5 = KJ. | last6 = Farzadnia | first6 = M. | last7 = Arabi | first7 = A. | last8 = Abbaszadegan | first8 = MR. | title = Clinicopathological significance of E-cadherin, β-catenin and p53 expression in gastric adenocarinoma. | journal = J Res Med Sci | volume = 14 | issue = 4 | pages = 239-47 | month = Jul | year = 2009 | doi = | PMID = 21772890 }}</ref>

==Molecular==
*May have HER2 over expression - more common in intestinal-type tumours.<ref name=pmid22213295>{{Cite journal | last1 = Romiti | first1 = A. | last2 = Di Rocco | first2 = R. | last3 = Milione | first3 = M. | last4 = Ruco | first4 = L. | last5 = Ziparo | first5 = V. | last6 = Zullo | first6 = A. | last7 = Duranti | first7 = E. | last8 = Sarcina | first8 = I. | last9 = Barucca | first9 = V. | title = Somatostatin receptor subtype 2 A (SSTR2A) and HER2 expression in gastric adenocarcinoma. | journal = Anticancer Res | volume = 32 | issue = 1 | pages = 115-9 | month = Jan | year = 2012 | doi = | PMID = 22213295 }}</ref>
**Poor prognosis - like in breast cancer.
**Scoring system different than in breast cancer - complete membrane staining is not required.

==Staging==
*Sixteen (or more) lymph nodes should be assessed (as per the 7th Ed. of the UICC/AJCC staging).<ref name=pmid24744586>{{Cite journal | last1 = Deng | first1 = JY. | last2 = Liang | first2 = H. | title = Clinical significance of lymph node metastasis in gastric cancer. | journal = World J Gastroenterol | volume = 20 | issue = 14 | pages = 3967-75 | month = Apr | year = 2014 | doi = 10.3748/wjg.v20.i14.3967 | PMID = 24744586 }}</ref>
**The 5th Ed. of the UICC/AJCC staging manual stated 15 lymph nodes.<ref name=pmid24744586/>

==Sign out==
===Biopsy===
====Intestinal type====
<pre>
Stomach, Biopsy:
- INVASIVE ADENOCARCINOMA, INTESTINAL TYPE, moderately differentiated.
- Gastric mucosa with intestinal metaplasia.

Comment:
The tumour stains as follows:
POSITIVE: CK7, CDX2.
NEGATIVE: CD20.

HER2 testing has been ordered and will be reported as an addendum.
</pre>

<pre>
STOMACH, BIOPSY:
- INVASIVE ADENOCARCINOMA, INTESTINAL TYPE, MODERATELY DIFFERENTIATED.
- Gastric mucosa with moderate chronic active inflammation and extensive
intestinal metaplasia.
- Benign small bowel mucosa with erosions.
</pre>

<pre>
GASTRIC ULCER, BIOPSY:
- INVASIVE ADENOCARCINOMA, INTESTINAL-TYPE, MODERATELY DIFFERENTIATED.
</pre>

====Diffuse type====
<pre>
STOMACH, BIOPSY:
- INVASIVE ADENOCARCINOMA, DIFFUSE TYPE.

COMMENT:
A pankeratin immunostain demonstrates single (infiltrating) epithelial cells in the
lamina propria.
</pre>

=====Micro=====
The tumour consists of single cells with abundant foamy-appearing cytoplasm and eccentric
nuclei with mild nuclear atypia.

====Poorly differentiated====
<pre>
GASTRIC ULCER, BIOPSY:
- INVASIVE ADENOCARCINOMA, POORLY-DIFFERENTIATED.
</pre>

==See also==
*[[Stomach]].
*[[Siewert classification]].

==References==
{{Reflist|2}}

[[Category:Stomach]]
[[Category:Diagnosis]]

Invasive ductal carcinoma of the pancreas

2018-08-28T10:51:43Z

Abraham:

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Pancreas_adenocarcinoma_(2)_Case_01.jpg
| Width =
| Caption = Pancreatic adenocarcinoma. [[H&E stain]].
| Synonyms =
| Micro =
| Subtypes =
| LMDDx = [[chronic pancreatitis]], [[cholangiocarcinoma]]
| Stains =
| IHC =
| EM =
| Molecular = +/-[[BRCA2]] carrier
| IF =
| Gross =
| Grossing =
| Site = [[pancreas]], typically head of pancreas
| Assdx = [[pancreatic intraepithelial neoplasia]], +/-[[diabetes mellitus]]
| Syndromes =
| Clinicalhx = +/-[[smoking]]
| Signs =
| Symptoms =
| Prevalence = common for site
| Bloodwork =
| Rads = pancreatic mass
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx = [[chronic pancreatitis]], other pancreatic tumours
| Tx = surgery if possible
}}
'''Invasive ductal carcinoma of the pancreas''' is the most common type of [[pancreatic cancer]].

It is typically gland forming and thus also referred to as '''pancreatic ductal adenocarcinoma''' and '''pancreatic adenocarcinoma'''.

Less specific terms that are used when the context is clear include '''[[ductal adenocarcinoma]]''' and '''[[invasive ductal carcinoma]]'''.
==General==
*Most common type of pancreatic cancer.<ref name=Ref_WMSP>{{Ref WMSP|237}}</ref>
*Location: usually in the head ~60%.
**15% in the body, 5% tail, 20% diffuse (head, body & tail).<ref name=Ref_PBoD950>{{Ref PBoD|950}}</ref>
**The vast majority of pancreatic cancers are solitary, but multifocal disease can occur.
*Abysmal prognosis.

Risk factors:<ref name=Ref_PCPBoD8_471>{{Ref PCPBoD8|471}}</ref>
*Smoking (RR ~ 2).
*Pancreatitis.
*Family history, esp. [[BRCA2]].
*[[Diabetes mellitus]] - modest risk increase (RR ~ 1.5-2).
*Previous gastrectomy.
*Heavy drinking of alcohol may weakly increase risk.

Molecular characteristics:<ref name=Ref_PCPBoD8_470-1>{{Ref PCPBoD8|470-1}}</ref><ref name=pmid19896096>{{Cite journal | last1 = Furukawa | first1 = T. | title = Molecular pathology of pancreatic cancer: implications for molecular targeting therapy. | journal = Clin Gastroenterol Hepatol | volume = 7 | issue = 11 Suppl | pages = S35-9 | month = Nov | year = 2009 | doi = 10.1016/j.cgh.2009.07.035 | PMID = 19896096 }}</ref>
#KRAS (oncogene) mutation in ~ 90% of cases.
#CDKN2A<ref name=omim600160>{{OMIM|600160}}</ref> ([[AKA]] p16) inactivation ~ 95% of cases.
#TP53 (AKA p53).
#SMAD4.

==Gross==
Features:<ref name="pmid2015921">{{Cite journal | last1 = Hermanek | first1 = P. | title = Staging of exocrine pancreatic carcinoma. | journal = Eur J Surg Oncol | volume = 17 | issue = 2 | pages = 167-72 | month = Apr | year = 1991 | doi = | PMID = 2015921 }}</ref>
*Firm, sclerotic and poorly defined masses that replace the normal lobular architecture of the gland.
*Cut surface are yellow to white.
*The mean diameter of pancreatic head tumor is between 2.5-3.5cm.

==Microscopic==
Features:<ref name=Ref_PBoD951>{{Ref PBoD|951}}</ref>
*Often glandular, may be solid.
*Nuclei.
**May be bland - little pleomorphism.
**Often small nuclei.
**Sometimes [[coffee-bean nuclei|coffee-bean]] appearance.
*Cytoplasm - granular, abundant.
*Quasi endocrine look.
**May stain positive for endocrine markers.

Other features:
*+/-Necrosis.
*+/-Myxoid degeneration.
*+/-Cells around vessels.

DDx:
*[[Chronic pancreatitis]].<ref name=pmid16273946>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Bandyopadhyay | first2 = S. | last3 = Basturk | first3 = O. | last4 = Othman | first4 = M. | last5 = Cheng | first5 = JD. | last6 = Klöppel | first6 = G. | last7 = Klimstra | first7 = DS. | title = Chronic pancreatitis or pancreatic ductal adenocarcinoma? | journal = Semin Diagn Pathol | volume = 21 | issue = 4 | pages = 268-76 | month = Nov | year = 2004 | doi = | PMID = 16273946 }}</ref>
*[[Cholangiocarcinoma]].
*[[Pancreatic intraepithelial neoplasia]] (PanIN).

===Images===
<gallery>
Image:Pancreas_adenocarcinoma_(3)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_adenocarcinoma_(2)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_neoplasia_carcinoma_sequence.png | Normal pancreas, pancreatic intraepithelial neoplasia and pancreatic carcinoma (WC)
Image:Pancreas_FNA;_adenocarcinoma_vs._normal_ductal_epithelium_(200x).jpg| Pancreatic adenocarcinoma - cytopathology (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case384.html Pancreatic adenocarcinoma - several images (upmc.edu)].

==IHC==
Features:<ref name=Ref_Lester3>{{Ref Lester3|94}}</ref>
*CD7 +ve.
*CD20 +ve.
*SMAD4 -ve ~55% of cases -- stomach usually +ve.
*CDX2 -ve/+ve.
*CEA +ve.<ref name=pmid16183479>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Basturk | first2 = O. | last3 = Cheng | first3 = JD. | last4 = Andea | first4 = AA. | title = Ductal neoplasia of the pancreas: nosologic, clinicopathologic, and biologic aspects. | journal = Semin Radiat Oncol | volume = 15 | issue = 4 | pages = 254-64 | month = Oct | year = 2005 | doi = 10.1016/j.semradonc.2005.04.001 | PMID = 16183479 }}</ref>

==Sign out==
<pre>
MASS, PANCREAS, CORE BIOPSY:
- ADENOCARCINOMA, MODERATELY DIFFERENTIATED.
</pre>

Note:
*On biopsy, it isn't easy to separate from [[cholangiocarcinoma]]. Thus, it is better to stay vague.

==See also==
*[[Pancreas]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pancreas]]

Invasive ductal carcinoma of the pancreas

2018-08-28T10:50:46Z

Abraham:

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Pancreas_adenocarcinoma_(2)_Case_01.jpg
| Width =
| Caption = Pancreatic adenocarcinoma. [[H&E stain]].
| Synonyms =
| Micro =
| Subtypes =
| LMDDx = [[chronic pancreatitis]], [[cholangiocarcinoma]]
| Stains =
| IHC =
| EM =
| Molecular = +/-[[BRCA2]] carrier
| IF =
| Gross =
| Grossing =
| Site = [[pancreas]], typically head of pancreas
| Assdx = [[pancreatic intraepithelial neoplasia]], +/-[[diabetes mellitus]]
| Syndromes =
| Clinicalhx = +/-[[smoking]]
| Signs =
| Symptoms =
| Prevalence = common for site
| Bloodwork =
| Rads = pancreatic mass
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx = [[chronic pancreatitis]], other pancreatic tumours
| Tx = surgery if possible
}}
'''Invasive ductal carcinoma of the pancreas''' is the most common type of [[pancreatic cancer]].

It is typically gland forming and thus also referred to as '''pancreatic ductal adenocarcinoma''' and '''pancreatic adenocarcinoma'''.

Less specific terms that are used when the context is clear include '''[[ductal adenocarcinoma]]''' and '''[[invasive ductal carcinoma]]'''.
==General==
*Most common type of pancreatic cancer.<ref name=Ref_WMSP>{{Ref WMSP|237}}</ref>
*Location: usually in the head ~60%.
**15% in the body, 5% tail, 20% diffuse (head, body & tail).<ref name=Ref_PBoD950>{{Ref PBoD|950}}</ref>
**The vast majority of pancreatic cancers are solitary, but multifocal disease can occur.
*Abysmal prognosis.

Risk factors:<ref name=Ref_PCPBoD8_471>{{Ref PCPBoD8|471}}</ref>
*Smoking (RR ~ 2).
*Pancreatitis.
*Family history, esp. [[BRCA2]].
*[[Diabetes mellitus]] - modest risk increase (RR ~ 1.5-2).
*Previous gastrectomy.
*Heavy drinking of alcohol may weakly increase risk.

Molecular characteristics:<ref name=Ref_PCPBoD8_470-1>{{Ref PCPBoD8|470-1}}</ref><ref name=pmid19896096>{{Cite journal | last1 = Furukawa | first1 = T. | title = Molecular pathology of pancreatic cancer: implications for molecular targeting therapy. | journal = Clin Gastroenterol Hepatol | volume = 7 | issue = 11 Suppl | pages = S35-9 | month = Nov | year = 2009 | doi = 10.1016/j.cgh.2009.07.035 | PMID = 19896096 }}</ref>
#KRAS (oncogene) mutation in ~ 90% of cases.
#CDKN2A<ref name=omim600160>{{OMIM|600160}}</ref> ([[AKA]] p16) inactivation ~ 95% of cases.
#TP53 (AKA p53).
#SMAD4.

==Gross==
Features:
*Firm, sclerotic and poorly defined masses that replace the normal lobular architecture of the gland.
*Cut surface are yellow to white.
*The mean diameter of pancreatic head tumor is between 2.5-3.5cm.

==Microscopic==
Features:<ref name=Ref_PBoD951>{{Ref PBoD|951}}</ref>
*Often glandular, may be solid.
*Nuclei.
**May be bland - little pleomorphism.
**Often small nuclei.
**Sometimes [[coffee-bean nuclei|coffee-bean]] appearance.
*Cytoplasm - granular, abundant.
*Quasi endocrine look.
**May stain positive for endocrine markers.

Other features:
*+/-Necrosis.
*+/-Myxoid degeneration.
*+/-Cells around vessels.

DDx:
*[[Chronic pancreatitis]].<ref name=pmid16273946>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Bandyopadhyay | first2 = S. | last3 = Basturk | first3 = O. | last4 = Othman | first4 = M. | last5 = Cheng | first5 = JD. | last6 = Klöppel | first6 = G. | last7 = Klimstra | first7 = DS. | title = Chronic pancreatitis or pancreatic ductal adenocarcinoma? | journal = Semin Diagn Pathol | volume = 21 | issue = 4 | pages = 268-76 | month = Nov | year = 2004 | doi = | PMID = 16273946 }}</ref>
*[[Cholangiocarcinoma]].
*[[Pancreatic intraepithelial neoplasia]] (PanIN).

===Images===
<gallery>
Image:Pancreas_adenocarcinoma_(3)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_adenocarcinoma_(2)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_neoplasia_carcinoma_sequence.png | Normal pancreas, pancreatic intraepithelial neoplasia and pancreatic carcinoma (WC)
Image:Pancreas_FNA;_adenocarcinoma_vs._normal_ductal_epithelium_(200x).jpg| Pancreatic adenocarcinoma - cytopathology (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case384.html Pancreatic adenocarcinoma - several images (upmc.edu)].

==IHC==
Features:<ref name=Ref_Lester3>{{Ref Lester3|94}}</ref>
*CD7 +ve.
*CD20 +ve.
*SMAD4 -ve ~55% of cases -- stomach usually +ve.
*CDX2 -ve/+ve.
*CEA +ve.<ref name=pmid16183479>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Basturk | first2 = O. | last3 = Cheng | first3 = JD. | last4 = Andea | first4 = AA. | title = Ductal neoplasia of the pancreas: nosologic, clinicopathologic, and biologic aspects. | journal = Semin Radiat Oncol | volume = 15 | issue = 4 | pages = 254-64 | month = Oct | year = 2005 | doi = 10.1016/j.semradonc.2005.04.001 | PMID = 16183479 }}</ref>

==Sign out==
<pre>
MASS, PANCREAS, CORE BIOPSY:
- ADENOCARCINOMA, MODERATELY DIFFERENTIATED.
</pre>

Note:
*On biopsy, it isn't easy to separate from [[cholangiocarcinoma]]. Thus, it is better to stay vague.

==See also==
*[[Pancreas]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pancreas]]

Invasive ductal carcinoma of the pancreas

2018-08-28T10:49:06Z

Abraham:

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Pancreas_adenocarcinoma_(2)_Case_01.jpg
| Width =
| Caption = Pancreatic adenocarcinoma. [[H&E stain]].
| Synonyms =
| Micro =
| Subtypes =
| LMDDx = [[chronic pancreatitis]], [[cholangiocarcinoma]]
| Stains =
| IHC =
| EM =
| Molecular = +/-[[BRCA2]] carrier
| IF =
| Gross =
| Grossing =
| Site = [[pancreas]], typically head of pancreas
| Assdx = [[pancreatic intraepithelial neoplasia]], +/-[[diabetes mellitus]]
| Syndromes =
| Clinicalhx = +/-[[smoking]]
| Signs =
| Symptoms =
| Prevalence = common for site
| Bloodwork =
| Rads = pancreatic mass
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx = [[chronic pancreatitis]], other pancreatic tumours
| Tx = surgery if possible
}}
'''Invasive ductal carcinoma of the pancreas''' is the most common type of [[pancreatic cancer]].

It is typically gland forming and thus also referred to as '''pancreatic ductal adenocarcinoma''' and '''pancreatic adenocarcinoma'''.

Less specific terms that are used when the context is clear include '''[[ductal adenocarcinoma]]''' and '''[[invasive ductal carcinoma]]'''.
==General==
*Most common type of pancreatic cancer.<ref name=Ref_WMSP>{{Ref WMSP|237}}</ref>
*Location: usually in the head ~60%.
**15% in the body, 5% tail, 20% diffuse (head, body & tail).<ref name=Ref_PBoD950>{{Ref PBoD|950}}</ref>
**The vast majority of pancreatic cancers are solitary, but multifocal disease can occur.
*Abysmal prognosis.

Risk factors:<ref name=Ref_PCPBoD8_471>{{Ref PCPBoD8|471}}</ref>
*Smoking (RR ~ 2).
*Pancreatitis.
*Family history, esp. [[BRCA2]].
*[[Diabetes mellitus]] - modest risk increase (RR ~ 1.5-2).
*Previous gastrectomy.
*Heavy drinking of alcohol may weakly increase risk.

Molecular characteristics:<ref name=Ref_PCPBoD8_470-1>{{Ref PCPBoD8|470-1}}</ref><ref name=pmid19896096>{{Cite journal | last1 = Furukawa | first1 = T. | title = Molecular pathology of pancreatic cancer: implications for molecular targeting therapy. | journal = Clin Gastroenterol Hepatol | volume = 7 | issue = 11 Suppl | pages = S35-9 | month = Nov | year = 2009 | doi = 10.1016/j.cgh.2009.07.035 | PMID = 19896096 }}</ref>
#KRAS (oncogene) mutation in ~ 90% of cases.
#CDKN2A<ref name=omim600160>{{OMIM|600160}}</ref> ([[AKA]] p16) inactivation ~ 95% of cases.
#TP53 (AKA p53).
#SMAD4.

==Gross==
Features:<ref name="pmid2015921">{{Cita publicación | apellido = Hermanek | nombre = P. | coautores = | título = Staging of exocrine pancreatic carcinoma. | publicación = Eur J Surg Oncol | volume = 17 | número = 2 | páginas = 167-72 | mes = Apr | año = 1991 | doi = | pmid = 2015921 }}</ref>
*Firm, sclerotic and poorly defined masses that replace the normal lobular architecture of the gland.
*Cut surface are yellow to white.
*The mean diameter of pancreatic head tumor is between 2.5-3.5cm.

==Microscopic==
Features:<ref name=Ref_PBoD951>{{Ref PBoD|951}}</ref>
*Often glandular, may be solid.
*Nuclei.
**May be bland - little pleomorphism.
**Often small nuclei.
**Sometimes [[coffee-bean nuclei|coffee-bean]] appearance.
*Cytoplasm - granular, abundant.
*Quasi endocrine look.
**May stain positive for endocrine markers.

Other features:
*+/-Necrosis.
*+/-Myxoid degeneration.
*+/-Cells around vessels.

DDx:
*[[Chronic pancreatitis]].<ref name=pmid16273946>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Bandyopadhyay | first2 = S. | last3 = Basturk | first3 = O. | last4 = Othman | first4 = M. | last5 = Cheng | first5 = JD. | last6 = Klöppel | first6 = G. | last7 = Klimstra | first7 = DS. | title = Chronic pancreatitis or pancreatic ductal adenocarcinoma? | journal = Semin Diagn Pathol | volume = 21 | issue = 4 | pages = 268-76 | month = Nov | year = 2004 | doi = | PMID = 16273946 }}</ref>
*[[Cholangiocarcinoma]].
*[[Pancreatic intraepithelial neoplasia]] (PanIN).

===Images===
<gallery>
Image:Pancreas_adenocarcinoma_(3)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_adenocarcinoma_(2)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_neoplasia_carcinoma_sequence.png | Normal pancreas, pancreatic intraepithelial neoplasia and pancreatic carcinoma (WC)
Image:Pancreas_FNA;_adenocarcinoma_vs._normal_ductal_epithelium_(200x).jpg| Pancreatic adenocarcinoma - cytopathology (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case384.html Pancreatic adenocarcinoma - several images (upmc.edu)].

==IHC==
Features:<ref name=Ref_Lester3>{{Ref Lester3|94}}</ref>
*CD7 +ve.
*CD20 +ve.
*SMAD4 -ve ~55% of cases -- stomach usually +ve.
*CDX2 -ve/+ve.
*CEA +ve.<ref name=pmid16183479>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Basturk | first2 = O. | last3 = Cheng | first3 = JD. | last4 = Andea | first4 = AA. | title = Ductal neoplasia of the pancreas: nosologic, clinicopathologic, and biologic aspects. | journal = Semin Radiat Oncol | volume = 15 | issue = 4 | pages = 254-64 | month = Oct | year = 2005 | doi = 10.1016/j.semradonc.2005.04.001 | PMID = 16183479 }}</ref>

==Sign out==
<pre>
MASS, PANCREAS, CORE BIOPSY:
- ADENOCARCINOMA, MODERATELY DIFFERENTIATED.
</pre>

Note:
*On biopsy, it isn't easy to separate from [[cholangiocarcinoma]]. Thus, it is better to stay vague.

==See also==
*[[Pancreas]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pancreas]]

Invasive ductal carcinoma of the pancreas

2018-08-28T10:44:05Z

Abraham:

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Pancreas_adenocarcinoma_(2)_Case_01.jpg
| Width =
| Caption = Pancreatic adenocarcinoma. [[H&E stain]].
| Synonyms =
| Micro =
| Subtypes =
| LMDDx = [[chronic pancreatitis]], [[cholangiocarcinoma]]
| Stains =
| IHC =
| EM =
| Molecular = +/-[[BRCA2]] carrier
| IF =
| Gross =
| Grossing =
| Site = [[pancreas]], typically head of pancreas
| Assdx = [[pancreatic intraepithelial neoplasia]], +/-[[diabetes mellitus]]
| Syndromes =
| Clinicalhx = +/-[[smoking]]
| Signs =
| Symptoms =
| Prevalence = common for site
| Bloodwork =
| Rads = pancreatic mass
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx = [[chronic pancreatitis]], other pancreatic tumours
| Tx = surgery if possible
}}
'''Invasive ductal carcinoma of the pancreas''' is the most common type of [[pancreatic cancer]].

It is typically gland forming and thus also referred to as '''pancreatic ductal adenocarcinoma''' and '''pancreatic adenocarcinoma'''.

Less specific terms that are used when the context is clear include '''[[ductal adenocarcinoma]]''' and '''[[invasive ductal carcinoma]]'''.
==General==
*Most common type of pancreatic cancer.<ref name=Ref_WMSP>{{Ref WMSP|237}}</ref>
*Location: usually in the head ~60%.
**15% in the body, 5% tail, 20% diffuse (head, body & tail).<ref name=Ref_PBoD950>{{Ref PBoD|950}}</ref>
**The vast majority of pancreatic cancers are solitary, but multifocal disease can occur.
*Abysmal prognosis.

Risk factors:<ref name=Ref_PCPBoD8_471>{{Ref PCPBoD8|471}}</ref>
*Smoking (RR ~ 2).
*Pancreatitis.
*Family history, esp. [[BRCA2]].
*[[Diabetes mellitus]] - modest risk increase (RR ~ 1.5-2).
*Previous gastrectomy.
*Heavy drinking of alcohol may weakly increase risk.

Molecular characteristics:<ref name=Ref_PCPBoD8_470-1>{{Ref PCPBoD8|470-1}}</ref><ref name=pmid19896096>{{Cite journal | last1 = Furukawa | first1 = T. | title = Molecular pathology of pancreatic cancer: implications for molecular targeting therapy. | journal = Clin Gastroenterol Hepatol | volume = 7 | issue = 11 Suppl | pages = S35-9 | month = Nov | year = 2009 | doi = 10.1016/j.cgh.2009.07.035 | PMID = 19896096 }}</ref>
#KRAS (oncogene) mutation in ~ 90% of cases.
#CDKN2A<ref name=omim600160>{{OMIM|600160}}</ref> ([[AKA]] p16) inactivation ~ 95% of cases.
#TP53 (AKA p53).
#SMAD4.

==Gross==
*Firm, sclerotic and poorly defined masses that replace the normal lobular architecture of the gland.
*Cut surface are yellow to white.
*The mean diameter of pancreatic head tumor is between 2.5-3.5cm.

==Microscopic==
Features:<ref name=Ref_PBoD951>{{Ref PBoD|951}}</ref>
*Often glandular, may be solid.
*Nuclei.
**May be bland - little pleomorphism.
**Often small nuclei.
**Sometimes [[coffee-bean nuclei|coffee-bean]] appearance.
*Cytoplasm - granular, abundant.
*Quasi endocrine look.
**May stain positive for endocrine markers.

Other features:
*+/-Necrosis.
*+/-Myxoid degeneration.
*+/-Cells around vessels.

DDx:
*[[Chronic pancreatitis]].<ref name=pmid16273946>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Bandyopadhyay | first2 = S. | last3 = Basturk | first3 = O. | last4 = Othman | first4 = M. | last5 = Cheng | first5 = JD. | last6 = Klöppel | first6 = G. | last7 = Klimstra | first7 = DS. | title = Chronic pancreatitis or pancreatic ductal adenocarcinoma? | journal = Semin Diagn Pathol | volume = 21 | issue = 4 | pages = 268-76 | month = Nov | year = 2004 | doi = | PMID = 16273946 }}</ref>
*[[Cholangiocarcinoma]].
*[[Pancreatic intraepithelial neoplasia]] (PanIN).

===Images===
<gallery>
Image:Pancreas_adenocarcinoma_(3)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_adenocarcinoma_(2)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_neoplasia_carcinoma_sequence.png | Normal pancreas, pancreatic intraepithelial neoplasia and pancreatic carcinoma (WC)
Image:Pancreas_FNA;_adenocarcinoma_vs._normal_ductal_epithelium_(200x).jpg| Pancreatic adenocarcinoma - cytopathology (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case384.html Pancreatic adenocarcinoma - several images (upmc.edu)].

==IHC==
Features:<ref name=Ref_Lester3>{{Ref Lester3|94}}</ref>
*CD7 +ve.
*CD20 +ve.
*SMAD4 -ve ~55% of cases -- stomach usually +ve.
*CDX2 -ve/+ve.
*CEA +ve.<ref name=pmid16183479>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Basturk | first2 = O. | last3 = Cheng | first3 = JD. | last4 = Andea | first4 = AA. | title = Ductal neoplasia of the pancreas: nosologic, clinicopathologic, and biologic aspects. | journal = Semin Radiat Oncol | volume = 15 | issue = 4 | pages = 254-64 | month = Oct | year = 2005 | doi = 10.1016/j.semradonc.2005.04.001 | PMID = 16183479 }}</ref>

==Sign out==
<pre>
MASS, PANCREAS, CORE BIOPSY:
- ADENOCARCINOMA, MODERATELY DIFFERENTIATED.
</pre>

Note:
*On biopsy, it isn't easy to separate from [[cholangiocarcinoma]]. Thus, it is better to stay vague.

==See also==
*[[Pancreas]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pancreas]]

Invasive ductal carcinoma of the pancreas

2018-08-28T10:34:46Z

Abraham:

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Pancreas_adenocarcinoma_(2)_Case_01.jpg
| Width =
| Caption = Pancreatic adenocarcinoma. [[H&E stain]].
| Synonyms =
| Micro =
| Subtypes =
| LMDDx = [[chronic pancreatitis]], [[cholangiocarcinoma]]
| Stains =
| IHC =
| EM =
| Molecular = +/-[[BRCA2]] carrier
| IF =
| Gross =
| Grossing =
| Site = [[pancreas]], typically head of pancreas
| Assdx = [[pancreatic intraepithelial neoplasia]], +/-[[diabetes mellitus]]
| Syndromes =
| Clinicalhx = +/-[[smoking]]
| Signs =
| Symptoms =
| Prevalence = common for site
| Bloodwork =
| Rads = pancreatic mass
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx = [[chronic pancreatitis]], other pancreatic tumours
| Tx = surgery if possible
}}
'''Invasive ductal carcinoma of the pancreas''' is the most common type of [[pancreatic cancer]].

It is typically gland forming and thus also referred to as '''pancreatic ductal adenocarcinoma''' and '''pancreatic adenocarcinoma'''.

Less specific terms that are used when the context is clear include '''[[ductal adenocarcinoma]]''' and '''[[invasive ductal carcinoma]]'''.
==General==
*Most common type of pancreatic cancer.<ref name=Ref_WMSP>{{Ref WMSP|237}}</ref>
*Location: usually in the head ~60%.
**15% in the body, 5% tail, 20% diffuse (head, body & tail).<ref name=Ref_PBoD950>{{Ref PBoD|950}}</ref>
**The vast majority of pancreatic cancers are solitary, but multifocal disease can occur.
*Abysmal prognosis.

Risk factors:<ref name=Ref_PCPBoD8_471>{{Ref PCPBoD8|471}}</ref>
*Smoking (RR ~ 2).
*Pancreatitis.
*Family history, esp. [[BRCA2]].
*[[Diabetes mellitus]] - modest risk increase (RR ~ 1.5-2).
*Previous gastrectomy.
*Heavy drinking of alcohol may weakly increase risk.

Molecular characteristics:<ref name=Ref_PCPBoD8_470-1>{{Ref PCPBoD8|470-1}}</ref><ref name=pmid19896096>{{Cite journal | last1 = Furukawa | first1 = T. | title = Molecular pathology of pancreatic cancer: implications for molecular targeting therapy. | journal = Clin Gastroenterol Hepatol | volume = 7 | issue = 11 Suppl | pages = S35-9 | month = Nov | year = 2009 | doi = 10.1016/j.cgh.2009.07.035 | PMID = 19896096 }}</ref>
#KRAS (oncogene) mutation in ~ 90% of cases.
#CDKN2A<ref name=omim600160>{{OMIM|600160}}</ref> ([[AKA]] p16) inactivation ~ 95% of cases.
#TP53 (AKA p53).
#SMAD4.

==Microscopic==
Features:<ref name=Ref_PBoD951>{{Ref PBoD|951}}</ref>
*Often glandular, may be solid.
*Nuclei.
**May be bland - little pleomorphism.
**Often small nuclei.
**Sometimes [[coffee-bean nuclei|coffee-bean]] appearance.
*Cytoplasm - granular, abundant.
*Quasi endocrine look.
**May stain positive for endocrine markers.

Other features:
*+/-Necrosis.
*+/-Myxoid degeneration.
*+/-Cells around vessels.

DDx:
*[[Chronic pancreatitis]].<ref name=pmid16273946>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Bandyopadhyay | first2 = S. | last3 = Basturk | first3 = O. | last4 = Othman | first4 = M. | last5 = Cheng | first5 = JD. | last6 = Klöppel | first6 = G. | last7 = Klimstra | first7 = DS. | title = Chronic pancreatitis or pancreatic ductal adenocarcinoma? | journal = Semin Diagn Pathol | volume = 21 | issue = 4 | pages = 268-76 | month = Nov | year = 2004 | doi = | PMID = 16273946 }}</ref>
*[[Cholangiocarcinoma]].
*[[Pancreatic intraepithelial neoplasia]] (PanIN).

===Images===
<gallery>
Image:Pancreas_adenocarcinoma_(3)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_adenocarcinoma_(2)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_neoplasia_carcinoma_sequence.png | Normal pancreas, pancreatic intraepithelial neoplasia and pancreatic carcinoma (WC)
Image:Pancreas_FNA;_adenocarcinoma_vs._normal_ductal_epithelium_(200x).jpg| Pancreatic adenocarcinoma - cytopathology (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case384.html Pancreatic adenocarcinoma - several images (upmc.edu)].

==IHC==
Features:<ref name=Ref_Lester3>{{Ref Lester3|94}}</ref>
*CD7 +ve.
*CD20 +ve.
*SMAD4 -ve ~55% of cases -- stomach usually +ve.
*CDX2 -ve/+ve.
*CEA +ve.<ref name=pmid16183479>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Basturk | first2 = O. | last3 = Cheng | first3 = JD. | last4 = Andea | first4 = AA. | title = Ductal neoplasia of the pancreas: nosologic, clinicopathologic, and biologic aspects. | journal = Semin Radiat Oncol | volume = 15 | issue = 4 | pages = 254-64 | month = Oct | year = 2005 | doi = 10.1016/j.semradonc.2005.04.001 | PMID = 16183479 }}</ref>

==Sign out==
<pre>
MASS, PANCREAS, CORE BIOPSY:
- ADENOCARCINOMA, MODERATELY DIFFERENTIATED.
</pre>

Note:
*On biopsy, it isn't easy to separate from [[cholangiocarcinoma]]. Thus, it is better to stay vague.

==See also==
*[[Pancreas]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pancreas]]

Invasive ductal carcinoma of the pancreas

2018-08-27T11:07:02Z

Abraham: /* General */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Pancreas_adenocarcinoma_(2)_Case_01.jpg
| Width =
| Caption = Pancreatic adenocarcinoma. [[H&E stain]].
| Synonyms =
| Micro =
| Subtypes =
| LMDDx = [[chronic pancreatitis]], [[cholangiocarcinoma]]
| Stains =
| IHC =
| EM =
| Molecular = +/-[[BRCA2]] carrier
| IF =
| Gross =
| Grossing =
| Site = [[pancreas]], typically head of pancreas
| Assdx = [[pancreatic intraepithelial neoplasia]], +/-[[diabetes mellitus]]
| Syndromes =
| Clinicalhx = +/-[[smoking]]
| Signs =
| Symptoms =
| Prevalence = common for site
| Bloodwork =
| Rads = pancreatic mass
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx = [[chronic pancreatitis]], other pancreatic tumours
| Tx = surgery if possible
}}
'''Invasive ductal carcinoma of the pancreas''' is the most common type of [[pancreatic cancer]].

It is typically gland forming and thus also referred to as '''pancreatic ductal adenocarcinoma''' and '''pancreatic adenocarcinoma'''.

Less specific terms that are used when the context is clear include '''[[ductal adenocarcinoma]]''' and '''[[invasive ductal carcinoma]]'''.
==General==
*Most common type of pancreatic cancer.<ref name=Ref_WMSP>{{Ref WMSP|237}}</ref>
*Location: usually in the head ~60%.
**15% in the body, 5% tail, 20% diffuse (head, body & tail).<ref name=Ref_PBoD950>{{Ref PBoD|950}}</ref>
**The vast majority of pancreatic cancers are solitary, but multifocal disease can occur.
*Abysmal prognosis.

Risk factors:<ref name=Ref_PCPBoD8_471>{{Ref PCPBoD8|471}}</ref>
*Smoking (RR ~ 2).
*Pancreatitis.
*Family history, esp. [[BRCA2]].
*[[Diabetes mellitus]] - modest risk increase (RR ~ 1.5-2).
*Previous gastrectomy.

Molecular characteristics:<ref name=Ref_PCPBoD8_470-1>{{Ref PCPBoD8|470-1}}</ref><ref name=pmid19896096>{{Cite journal | last1 = Furukawa | first1 = T. | title = Molecular pathology of pancreatic cancer: implications for molecular targeting therapy. | journal = Clin Gastroenterol Hepatol | volume = 7 | issue = 11 Suppl | pages = S35-9 | month = Nov | year = 2009 | doi = 10.1016/j.cgh.2009.07.035 | PMID = 19896096 }}</ref>
#KRAS (oncogene) mutation in ~ 90% of cases.
#CDKN2A<ref name=omim600160>{{OMIM|600160}}</ref> ([[AKA]] p16) inactivation ~ 95% of cases.
#TP53 (AKA p53).
#SMAD4.

==Microscopic==
Features:<ref name=Ref_PBoD951>{{Ref PBoD|951}}</ref>
*Often glandular, may be solid.
*Nuclei.
**May be bland - little pleomorphism.
**Often small nuclei.
**Sometimes [[coffee-bean nuclei|coffee-bean]] appearance.
*Cytoplasm - granular, abundant.
*Quasi endocrine look.
**May stain positive for endocrine markers.

Other features:
*+/-Necrosis.
*+/-Myxoid degeneration.
*+/-Cells around vessels.

DDx:
*[[Chronic pancreatitis]].<ref name=pmid16273946>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Bandyopadhyay | first2 = S. | last3 = Basturk | first3 = O. | last4 = Othman | first4 = M. | last5 = Cheng | first5 = JD. | last6 = Klöppel | first6 = G. | last7 = Klimstra | first7 = DS. | title = Chronic pancreatitis or pancreatic ductal adenocarcinoma? | journal = Semin Diagn Pathol | volume = 21 | issue = 4 | pages = 268-76 | month = Nov | year = 2004 | doi = | PMID = 16273946 }}</ref>
*[[Cholangiocarcinoma]].
*[[Pancreatic intraepithelial neoplasia]] (PanIN).

===Images===
<gallery>
Image:Pancreas_adenocarcinoma_(3)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_adenocarcinoma_(2)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_neoplasia_carcinoma_sequence.png | Normal pancreas, pancreatic intraepithelial neoplasia and pancreatic carcinoma (WC)
Image:Pancreas_FNA;_adenocarcinoma_vs._normal_ductal_epithelium_(200x).jpg| Pancreatic adenocarcinoma - cytopathology (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case384.html Pancreatic adenocarcinoma - several images (upmc.edu)].

==IHC==
Features:<ref name=Ref_Lester3>{{Ref Lester3|94}}</ref>
*CD7 +ve.
*CD20 +ve.
*SMAD4 -ve ~55% of cases -- stomach usually +ve.
*CDX2 -ve/+ve.
*CEA +ve.<ref name=pmid16183479>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Basturk | first2 = O. | last3 = Cheng | first3 = JD. | last4 = Andea | first4 = AA. | title = Ductal neoplasia of the pancreas: nosologic, clinicopathologic, and biologic aspects. | journal = Semin Radiat Oncol | volume = 15 | issue = 4 | pages = 254-64 | month = Oct | year = 2005 | doi = 10.1016/j.semradonc.2005.04.001 | PMID = 16183479 }}</ref>

==Sign out==
<pre>
MASS, PANCREAS, CORE BIOPSY:
- ADENOCARCINOMA, MODERATELY DIFFERENTIATED.
</pre>

Note:
*On biopsy, it isn't easy to separate from [[cholangiocarcinoma]]. Thus, it is better to stay vague.

==See also==
*[[Pancreas]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pancreas]]

Invasive ductal carcinoma of the pancreas

2018-08-27T10:59:42Z

Abraham: /* General */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Pancreas_adenocarcinoma_(2)_Case_01.jpg
| Width =
| Caption = Pancreatic adenocarcinoma. [[H&E stain]].
| Synonyms =
| Micro =
| Subtypes =
| LMDDx = [[chronic pancreatitis]], [[cholangiocarcinoma]]
| Stains =
| IHC =
| EM =
| Molecular = +/-[[BRCA2]] carrier
| IF =
| Gross =
| Grossing =
| Site = [[pancreas]], typically head of pancreas
| Assdx = [[pancreatic intraepithelial neoplasia]], +/-[[diabetes mellitus]]
| Syndromes =
| Clinicalhx = +/-[[smoking]]
| Signs =
| Symptoms =
| Prevalence = common for site
| Bloodwork =
| Rads = pancreatic mass
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx = [[chronic pancreatitis]], other pancreatic tumours
| Tx = surgery if possible
}}
'''Invasive ductal carcinoma of the pancreas''' is the most common type of [[pancreatic cancer]].

It is typically gland forming and thus also referred to as '''pancreatic ductal adenocarcinoma''' and '''pancreatic adenocarcinoma'''.

Less specific terms that are used when the context is clear include '''[[ductal adenocarcinoma]]''' and '''[[invasive ductal carcinoma]]'''.
==General==
*Most common type of pancreatic cancer.<ref name=Ref_WMSP>{{Ref WMSP|237}}</ref>
*Location: usually in the head ~60%.
**15% in the body, 5% tail, 20% diffuse (head, body & tail).<ref name=Ref_PBoD950>{{Ref PBoD|950}}</ref>
*Abysmal prognosis.

Risk factors:<ref name=Ref_PCPBoD8_471>{{Ref PCPBoD8|471}}</ref>
*Smoking (RR ~ 2).
*Pancreatitis.
*Family history, esp. [[BRCA2]].
*[[Diabetes mellitus]] - modest risk increase (RR ~ 1.5-2).
*Previous gastrectomy.

Molecular characteristics:<ref name=Ref_PCPBoD8_470-1>{{Ref PCPBoD8|470-1}}</ref><ref name=pmid19896096>{{Cite journal | last1 = Furukawa | first1 = T. | title = Molecular pathology of pancreatic cancer: implications for molecular targeting therapy. | journal = Clin Gastroenterol Hepatol | volume = 7 | issue = 11 Suppl | pages = S35-9 | month = Nov | year = 2009 | doi = 10.1016/j.cgh.2009.07.035 | PMID = 19896096 }}</ref>
#KRAS (oncogene) mutation in ~ 90% of cases.
#CDKN2A<ref name=omim600160>{{OMIM|600160}}</ref> ([[AKA]] p16) inactivation ~ 95% of cases.
#TP53 (AKA p53).
#SMAD4.

==Microscopic==
Features:<ref name=Ref_PBoD951>{{Ref PBoD|951}}</ref>
*Often glandular, may be solid.
*Nuclei.
**May be bland - little pleomorphism.
**Often small nuclei.
**Sometimes [[coffee-bean nuclei|coffee-bean]] appearance.
*Cytoplasm - granular, abundant.
*Quasi endocrine look.
**May stain positive for endocrine markers.

Other features:
*+/-Necrosis.
*+/-Myxoid degeneration.
*+/-Cells around vessels.

DDx:
*[[Chronic pancreatitis]].<ref name=pmid16273946>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Bandyopadhyay | first2 = S. | last3 = Basturk | first3 = O. | last4 = Othman | first4 = M. | last5 = Cheng | first5 = JD. | last6 = Klöppel | first6 = G. | last7 = Klimstra | first7 = DS. | title = Chronic pancreatitis or pancreatic ductal adenocarcinoma? | journal = Semin Diagn Pathol | volume = 21 | issue = 4 | pages = 268-76 | month = Nov | year = 2004 | doi = | PMID = 16273946 }}</ref>
*[[Cholangiocarcinoma]].
*[[Pancreatic intraepithelial neoplasia]] (PanIN).

===Images===
<gallery>
Image:Pancreas_adenocarcinoma_(3)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_adenocarcinoma_(2)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_neoplasia_carcinoma_sequence.png | Normal pancreas, pancreatic intraepithelial neoplasia and pancreatic carcinoma (WC)
Image:Pancreas_FNA;_adenocarcinoma_vs._normal_ductal_epithelium_(200x).jpg| Pancreatic adenocarcinoma - cytopathology (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case384.html Pancreatic adenocarcinoma - several images (upmc.edu)].

==IHC==
Features:<ref name=Ref_Lester3>{{Ref Lester3|94}}</ref>
*CD7 +ve.
*CD20 +ve.
*SMAD4 -ve ~55% of cases -- stomach usually +ve.
*CDX2 -ve/+ve.
*CEA +ve.<ref name=pmid16183479>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Basturk | first2 = O. | last3 = Cheng | first3 = JD. | last4 = Andea | first4 = AA. | title = Ductal neoplasia of the pancreas: nosologic, clinicopathologic, and biologic aspects. | journal = Semin Radiat Oncol | volume = 15 | issue = 4 | pages = 254-64 | month = Oct | year = 2005 | doi = 10.1016/j.semradonc.2005.04.001 | PMID = 16183479 }}</ref>

==Sign out==
<pre>
MASS, PANCREAS, CORE BIOPSY:
- ADENOCARCINOMA, MODERATELY DIFFERENTIATED.
</pre>

Note:
*On biopsy, it isn't easy to separate from [[cholangiocarcinoma]]. Thus, it is better to stay vague.

==See also==
*[[Pancreas]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pancreas]]

Invasive ductal carcinoma of the pancreas

2018-08-27T10:58:19Z

Abraham: /* General */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Pancreas_adenocarcinoma_(2)_Case_01.jpg
| Width =
| Caption = Pancreatic adenocarcinoma. [[H&E stain]].
| Synonyms =
| Micro =
| Subtypes =
| LMDDx = [[chronic pancreatitis]], [[cholangiocarcinoma]]
| Stains =
| IHC =
| EM =
| Molecular = +/-[[BRCA2]] carrier
| IF =
| Gross =
| Grossing =
| Site = [[pancreas]], typically head of pancreas
| Assdx = [[pancreatic intraepithelial neoplasia]], +/-[[diabetes mellitus]]
| Syndromes =
| Clinicalhx = +/-[[smoking]]
| Signs =
| Symptoms =
| Prevalence = common for site
| Bloodwork =
| Rads = pancreatic mass
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx = [[chronic pancreatitis]], other pancreatic tumours
| Tx = surgery if possible
}}
'''Invasive ductal carcinoma of the pancreas''' is the most common type of [[pancreatic cancer]].

It is typically gland forming and thus also referred to as '''pancreatic ductal adenocarcinoma''' and '''pancreatic adenocarcinoma'''.

Less specific terms that are used when the context is clear include '''[[ductal adenocarcinoma]]''' and '''[[invasive ductal carcinoma]]'''.
==General==
*Most common type of pancreatic cancer.<ref name=Ref_WMSP>{{Ref WMSP|237}}</ref>
*Location: usually in the head ~60%.
**15% in the body, 5% tail, 20% diffuse (head, body & tail).<ref name=Ref_PBoD950>{{Ref PBoD|950}}</ref>
*Abysmal prognosis.

Risk factors:<ref name=Ref_PCPBoD8_471>{{Ref PCPBoD8|471}}</ref>
*Smoking (RR ~ 2).
*Pancreatitis.
*Family history, esp. [[BRCA2]].
*[[Diabetes mellitus]] - modest risk increase (RR ~ 1.5-2)..

Molecular characteristics:<ref name=Ref_PCPBoD8_470-1>{{Ref PCPBoD8|470-1}}</ref><ref name=pmid19896096>{{Cite journal | last1 = Furukawa | first1 = T. | title = Molecular pathology of pancreatic cancer: implications for molecular targeting therapy. | journal = Clin Gastroenterol Hepatol | volume = 7 | issue = 11 Suppl | pages = S35-9 | month = Nov | year = 2009 | doi = 10.1016/j.cgh.2009.07.035 | PMID = 19896096 }}</ref>
#KRAS (oncogene) mutation in ~ 90% of cases.
#CDKN2A<ref name=omim600160>{{OMIM|600160}}</ref> ([[AKA]] p16) inactivation ~ 95% of cases.
#TP53 (AKA p53).
#SMAD4.

==Microscopic==
Features:<ref name=Ref_PBoD951>{{Ref PBoD|951}}</ref>
*Often glandular, may be solid.
*Nuclei.
**May be bland - little pleomorphism.
**Often small nuclei.
**Sometimes [[coffee-bean nuclei|coffee-bean]] appearance.
*Cytoplasm - granular, abundant.
*Quasi endocrine look.
**May stain positive for endocrine markers.

Other features:
*+/-Necrosis.
*+/-Myxoid degeneration.
*+/-Cells around vessels.

DDx:
*[[Chronic pancreatitis]].<ref name=pmid16273946>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Bandyopadhyay | first2 = S. | last3 = Basturk | first3 = O. | last4 = Othman | first4 = M. | last5 = Cheng | first5 = JD. | last6 = Klöppel | first6 = G. | last7 = Klimstra | first7 = DS. | title = Chronic pancreatitis or pancreatic ductal adenocarcinoma? | journal = Semin Diagn Pathol | volume = 21 | issue = 4 | pages = 268-76 | month = Nov | year = 2004 | doi = | PMID = 16273946 }}</ref>
*[[Cholangiocarcinoma]].
*[[Pancreatic intraepithelial neoplasia]] (PanIN).

===Images===
<gallery>
Image:Pancreas_adenocarcinoma_(3)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_adenocarcinoma_(2)_Case_01.jpg | Pancreatic adenocarcinoma (WC)
Image:Pancreas_neoplasia_carcinoma_sequence.png | Normal pancreas, pancreatic intraepithelial neoplasia and pancreatic carcinoma (WC)
Image:Pancreas_FNA;_adenocarcinoma_vs._normal_ductal_epithelium_(200x).jpg| Pancreatic adenocarcinoma - cytopathology (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case384.html Pancreatic adenocarcinoma - several images (upmc.edu)].

==IHC==
Features:<ref name=Ref_Lester3>{{Ref Lester3|94}}</ref>
*CD7 +ve.
*CD20 +ve.
*SMAD4 -ve ~55% of cases -- stomach usually +ve.
*CDX2 -ve/+ve.
*CEA +ve.<ref name=pmid16183479>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Basturk | first2 = O. | last3 = Cheng | first3 = JD. | last4 = Andea | first4 = AA. | title = Ductal neoplasia of the pancreas: nosologic, clinicopathologic, and biologic aspects. | journal = Semin Radiat Oncol | volume = 15 | issue = 4 | pages = 254-64 | month = Oct | year = 2005 | doi = 10.1016/j.semradonc.2005.04.001 | PMID = 16183479 }}</ref>

==Sign out==
<pre>
MASS, PANCREAS, CORE BIOPSY:
- ADENOCARCINOMA, MODERATELY DIFFERENTIATED.
</pre>

Note:
*On biopsy, it isn't easy to separate from [[cholangiocarcinoma]]. Thus, it is better to stay vague.

==See also==
*[[Pancreas]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pancreas]]

Keratins

2018-08-22T09:59:22Z

Abraham:

In pathology, '''keratins''', also '''cytokeratins''', refers to a set of [[immunostain]]s that mark intermediate filaments that are characteristic of epithelial cells, and cancers derived from epithelial cells ([[carcinoma]]s).

''Keratin'' when used in singular may refer to ''[[pankeratin]]''.

==Classification==
Divided by molecular weight:<ref>[http://www.nordiqc.org/Epitopes/Cytokeratins/cytokeratins.htm http://www.nordiqc.org/Epitopes/Cytokeratins/cytokeratins.htm]</ref>
*Low molecular weight keratins (LMWK): [[CK7|7]], 8/18, [[CK19|19]], [[CK20|20]].
*High molecular weight keratins (HWMK): 4, 10, 13, 14, 17.

==Uses==
*CK8 ([[CAM5.2]])<ref name=pmid7508102>{{cite journal |author=Murata T, Nakashima Y, Takeuchi M, Sueishi K, Inomata H |title=The diagnostic use of low molecular weight keratin expression in sebaceous carcinoma |journal=Pathol. Res. Pract. |volume=189 |issue=8 |pages=888–93 |year=1993 |month=September |pmid=7508102 |doi= |url=}}</ref> - used to look for mets from breast cancer in axillary lymph nodes.
*HWMK (e.g. K903<ref>URL: [http://www.aruplab.com/guides/ug/tests/2003978.jsp http://www.aruplab.com/guides/ug/tests/2003978.jsp]. Accessed on: 17 March 2011.</ref>) - [[squamous cell carcinoma]].

==Sarcomas and keratins==
*Most sarcomas are cytokeratin negative.

Classic exceptions:
*[[Angiosarcoma]], epithelioid.
*[[Synovial sarcoma]].
*[[Chordoma]].
*[[Desmoplastic small round cell tumour]].
*[[Epithelioid sarcoma]].

Others:
*[[Leiomyosarcoma]].

==See also==
*[[Immunohistochemistry]].
*[[Pankeratin]].

==References==
{{Reflist|1}}

[[Category:Immunohistochemistry]]

Giant cells

2018-08-13T09:18:19Z

Abraham: /* Table */

[[Image:Giant cell in bronchial wash -- very high mag.jpg|thumb|right|Giant cell from a [[pulmonary cytopathology|bronchial wash]]. [[Pap stain]].]]
'''Giant cells''' are "big" cells with multiple nuclei. They come in different flavours, which are suggestive of causality.

This article deals with the classic types of giant cells. A more general differential diagnosis of giant cells is in ''[[giant cell lesions]]''.

==Giant cell types==
List:
*Touton giant cell.
*Osteoclast-like giant cell.
*Foreign body type giant cell.

===Table===
{| class="wikitable"
| Type
| Histology
| DDx
| Other
| Image
|-
| Touton giant cell
| Nuclei form a ring around the cell periphery with eosinophilic cytoplasm centrally and foamy cytoplasm at the periphery.
| [[Juvenile xanthogranuloma]], [[xanthoma]], [[Erdheim-Chester disease]], [[fat necrosis]], [[dermatofibroma]]
| High lipid content lesions<ref>URL: [http://granuloma.homestead.com/giant_cells.html http://granuloma.homestead.com/giant_cells.html]. Accessed on: 7 February 2011.</ref>, Named after Karl Touton
| [[Image:Juvenile_xanthogranuloma_-_very_high_mag.jpg|thumb|200px|JXG (WC)]]
|-
| Epithelioid type
| scattered nuclei<ref name=Ref_InstantPath7>{{Ref InstantPath|7}}</ref>
| drug reaction, neoplasm, foreign body, infection, idiopathic, autoimmune, allergic
| [[granuloma|granulomatous inflammation]]
| [[Image:Crohn%27s_disease_-_colon_-_very_high_mag.jpg|thumb|150px|center|Granuloma (WC)]]
|-
| Langhans giant cell
| peripheral semi-circular eccentric nuclei<ref name=Ref_InstantPath7>{{Ref InstantPath|7}}</ref>
| tuberculosis, sarcoidosis.
| '''not''' to be confused with ''Langerhans cells'', Named after Theodor Langhans
| [[Image:Granulation_tissue_containg_a_poorly_formed_granuloma_with_a_Langhan%27s_giant_cell.jpg|thumb|200px|LGC (WC)]]
|-
| Osteoclast-like giant cells
| multiple bland central nuclei, ruffled cell membrane.
| osteoclasts, others
| [[AKA]] osteoclast-type giant cells
|
|}

==See also==
*[[Basics]].
*[[Giant cell lesions]] - includes a DDx of lesions with giant cells.
*[[Histiocytoses]].

==References==
{{Reflist|1}}

[[Category:Basics]]

Giant cells

2018-08-13T09:15:28Z

Abraham: /* Table */

[[Image:Giant cell in bronchial wash -- very high mag.jpg|thumb|right|Giant cell from a [[pulmonary cytopathology|bronchial wash]]. [[Pap stain]].]]
'''Giant cells''' are "big" cells with multiple nuclei. They come in different flavours, which are suggestive of causality.

This article deals with the classic types of giant cells. A more general differential diagnosis of giant cells is in ''[[giant cell lesions]]''.

==Giant cell types==
List:
*Touton giant cell.
*Osteoclast-like giant cell.
*Foreign body type giant cell.

===Table===
{| class="wikitable"
| Type
| Histology
| DDx
| Other
| Image
|-
| Touton giant cell
| Nuclei form a ring around the cell periphery with eosinophilic cytoplasm centrally and foamy cytoplasm at the periphery.
| [[Juvenile xanthogranuloma]], [[xanthoma]], [[Erdheim-Chester disease]], [[fat necrosis]], [[dermatofibroma]]
| High lipid content lesions<ref>URL: [http://granuloma.homestead.com/giant_cells.html http://granuloma.homestead.com/giant_cells.html]. Accessed on: 7 February 2011.</ref>, Named after Karl Touton
| [[Image:Juvenile_xanthogranuloma_-_very_high_mag.jpg|thumb|200px|JXG (WC)]]
|-
| Epithelioid type
| scattered nuclei<ref name=Ref_InstantPath7>{{Ref InstantPath|7}}</ref>
| drug reaction, neoplasm, foreign body, infection, idiopathic, autoimmune, allergic
| [[granuloma|granulomatous inflammation]]
| [[Image:Crohn%27s_disease_-_colon_-_very_high_mag.jpg|thumb|150px|center|Granuloma (WC)]]
|-
| Langhans giant cell
| peripheral semi-circular eccentric nuclei<ref name=Ref_InstantPath7>{{Ref InstantPath|7}}</ref>
| tuberculosis, sarcoidosis.
| '''not''' to be confused with ''Langerhans cells'', Named after Theodor Langhans
| [[Image:Granulation_tissue_containg_a_poorly_formed_granuloma_with_a_Langhan%27s_giant_cell.jpg|thumb|200px|LGC (WC)]]
|-
| Osteoclast-like giant cells
| round nuclei
| osteoclasts, others
| [[AKA]] osteoclast-type giant cells
|
|}

==See also==
*[[Basics]].
*[[Giant cell lesions]] - includes a DDx of lesions with giant cells.
*[[Histiocytoses]].

==References==
{{Reflist|1}}

[[Category:Basics]]

Giant cells

2018-08-13T09:12:57Z

Abraham: /* Table */

[[Image:Giant cell in bronchial wash -- very high mag.jpg|thumb|right|Giant cell from a [[pulmonary cytopathology|bronchial wash]]. [[Pap stain]].]]
'''Giant cells''' are "big" cells with multiple nuclei. They come in different flavours, which are suggestive of causality.

This article deals with the classic types of giant cells. A more general differential diagnosis of giant cells is in ''[[giant cell lesions]]''.

==Giant cell types==
List:
*Touton giant cell.
*Osteoclast-like giant cell.
*Foreign body type giant cell.

===Table===
{| class="wikitable"
| Type
| Histology
| DDx
| Other
| Image
|-
| Touton giant cell
| Nuclei form a ring around the cell periphery with eosinophilic cytoplasm centrally and foamy cytoplasm at the periphery.
| [[Juvenile xanthogranuloma]], [[xanthoma]], [[Erdheim-Chester disease]], [[fat necrosis]], [[dermatofibroma]]
| High lipid content lesions<ref>URL: [http://granuloma.homestead.com/giant_cells.html http://granuloma.homestead.com/giant_cells.html]. Accessed on: 7 February 2011.</ref>, Named after Karl Touton
| [[Image:Juvenile_xanthogranuloma_-_very_high_mag.jpg|thumb|200px|JXG (WC)]]
|-
| Epithelioid type
| scattered nuclei<ref name=Ref_InstantPath7>{{Ref InstantPath|7}}</ref>
| drug reaction, neoplasm, foreign body, infection, idiopathic, autoimmune, allergic
| [[granuloma|granulomatous inflammation]]
| [[Image:Crohn%27s_disease_-_colon_-_very_high_mag.jpg|thumb|150px|center|Granuloma (WC)]]
|-
| Langhans giant cell
| peripheral eccentric nuclei<ref name=Ref_InstantPath7>{{Ref InstantPath|7}}</ref>
| tuberculosis, sarcoidosis.
| '''not''' to be confused with ''Langerhans cells''
| [[Image:Granulation_tissue_containg_a_poorly_formed_granuloma_with_a_Langhan%27s_giant_cell.jpg|thumb|200px|LGC (WC)]]
|-
| Osteoclast-like giant cells
| round nuclei
| osteoclasts, others
| [[AKA]] osteoclast-type giant cells
|
|}

==See also==
*[[Basics]].
*[[Giant cell lesions]] - includes a DDx of lesions with giant cells.
*[[Histiocytoses]].

==References==
{{Reflist|1}}

[[Category:Basics]]

Giant cells

2018-08-02T08:54:27Z

Abraham: /* Table */

[[Image:Giant cell in bronchial wash -- very high mag.jpg|thumb|right|Giant cell from a [[pulmonary cytopathology|bronchial wash]]. [[Pap stain]].]]
'''Giant cells''' are "big" cells with multiple nuclei. They come in different flavours, which are suggestive of causality.

This article deals with the classic types of giant cells. A more general differential diagnosis of giant cells is in ''[[giant cell lesions]]''.

==Giant cell types==
List:
*Touton giant cell.
*Osteoclast-like giant cell.
*Foreign body type giant cell.

===Table===
{| class="wikitable"
| Type
| Histology
| DDx
| Other
| Image
|-
| Touton giant cell
| Nuclei form a ring around the cell periphery with eosinophilic cytoplasm centrally and foamy cytoplasm at the periphery.
| [[Juvenile xanthogranuloma]], [[xanthoma]], [[Erdheim-Chester disease]], [[dermatofibroma]]
| High lipid content lesions<ref>URL: [http://granuloma.homestead.com/giant_cells.html http://granuloma.homestead.com/giant_cells.html]. Accessed on: 7 February 2011.</ref>, Named after Karl Touton
| [[Image:Juvenile_xanthogranuloma_-_very_high_mag.jpg|thumb|200px|JXG (WC)]]
|-
| Epithelioid type
| scattered nuclei<ref name=Ref_InstantPath7>{{Ref InstantPath|7}}</ref>
| drug reaction, neoplasm, foreign body, infection, idiopathic, autoimmune, allergic
| [[granuloma|granulomatous inflammation]]
| [[Image:Crohn%27s_disease_-_colon_-_very_high_mag.jpg|thumb|150px|center|Granuloma (WC)]]
|-
| Langhans giant cell
| peripheral eccentric nuclei<ref name=Ref_InstantPath7>{{Ref InstantPath|7}}</ref>
| tuberculosis, sarcoidosis.
| '''not''' to be confused with ''Langerhans cells''
| [[Image:Granulation_tissue_containg_a_poorly_formed_granuloma_with_a_Langhan%27s_giant_cell.jpg|thumb|200px|LGC (WC)]]
|-
| Osteoclast-like giant cells
| round nuclei
| osteoclasts, others
| [[AKA]] osteoclast-type giant cells
|
|}

==See also==
*[[Basics]].
*[[Giant cell lesions]] - includes a DDx of lesions with giant cells.
*[[Histiocytoses]].

==References==
{{Reflist|1}}

[[Category:Basics]]

Malignant mesothelioma

2018-07-18T11:16:33Z

Abraham: /* Microscopic */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Malignant epithelioid mesothelioma - high mag.jpg
| Width =
| Caption = Malignant mesothelioma. [[H&E stain]].
| Micro = infiltrative atypical cells (epithelioid, spindled or both)
| Subtypes = biphasic mesothelioma, epithelioid mesothelioma, desmoplastic mesothelioma, sarcomatoid mesothelioma.
| LMDDx = mesothelial hyperplasia, [[fibrosing pleuritis]], [[adenocarcinoma]] - esp. [[lung adenocarcinoma|lung]], [[serous carcinoma]]
| Stains =
| IHC = calretinin +ve, D2-40 +ve, [[CK5/6]] +ve, WT-1 +ve, [[CK7]] +ve, CEA -ve, [[TTF-1]] -ve
| EM =
| Molecular = +/-p16 deletion
| IF =
| Gross =
| Grossing =
| Site = [[lung]], [[peritoneum]], [[omentum]], [[pericardium]]
| Assdx = [[asbestosis]]
| Syndromes =
| Clinicalhx = +/-asbestos exposure
| Signs =
| Symptoms =
| Prevalence = rare
| Bloodwork =
| Rads =
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx =
}}
'''Malignant mesothelioma''', also '''mesothelioma''', is a form of [[cancer]]. It arises from the mesothelium.

It should '''not''' be confused with ''[[benign multicystic mesothelioma]]'' and ''[[benign papillary mesothelioma]]''.

==General==
*Incidence
**Rare tumor accounting for 4-7 cases per million individuals.
**More common in men in 5th and 6th decades of life.
*Poor prognosis<ref>{{Cite journal | last1 = Haber | first1 = SE. | last2 = Haber | first2 = JM. | title = Malignant mesothelioma: a clinical study of 238 cases. | journal = Ind Health | volume = 49 | issue = 2 | pages = 166-72 | month = | year = 2011 | doi = | PMID = 21173534 }}</ref> - median survival <12 months.<ref name=pmid23413596>{{Cite journal | last1 = Mineo | first1 = TC. | last2 = Ambrogi | first2 = V. | title = Malignant pleural mesothelioma: factors influencing the prognosis. | journal = Oncology (Williston Park) | volume = 26 | issue = 12 | pages = 1164-75 | month = Dec | year = 2012 | doi = | PMID = 23413596 }}</ref>

Locations:
*Lung.
*Primary [[peritoneum|peritoneal]].
*Primary [[pericardium|pericardial]].<ref name=pmid22740748>{{Cite journal | last1 = Sardar | first1 = MR. | last2 = Kuntz | first2 = C. | last3 = Patel | first3 = T. | last4 = Saeed | first4 = W. | last5 = Gnall | first5 = E. | last6 = Imaizumi | first6 = S. | last7 = Lande | first7 = L. | title = Primary pericardial mesothelioma unique case and literature review. | journal = Tex Heart Inst J | volume = 39 | issue = 2 | pages = 261-4 | month = | year = 2012 | doi = | PMID = 22740748 }}</ref>

Epidemiology:
*Strong association with asbestos exposure.

Treatment:
*+/-Surgical debulking (cytoreduction) with heated chemotherapy - for intraperitoneal mesothelioma.<ref name=pmid24158467>{{cite journal |author=Wong J, Koch AL, Deneve JL, Fulp W, Tanvetyanon T, Dessureault S |title=Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience |journal=Ann. Surg. Oncol. |volume=21 |issue=5 |pages=1480–6 |year=2014 |month=May |pmid=24158467 |doi=10.1245/s10434-013-3341-7 |url=}}</ref>

Note:
*No association with [[smoking]].{{fact}}<ref name=pmid24351898>{{Cite journal | last1 = Offermans | first1 = NS. | last2 = Vermeulen | first2 = R. | last3 = Burdorf | first3 = A. | last4 = Goldbohm | first4 = RA. | last5 = Kauppinen | first5 = T. | last6 = Kromhout | first6 = H. | last7 = van den Brandt | first7 = PA. | title = Occupational asbestos exposure and risk of pleural mesothelioma, lung cancer, and laryngeal cancer in the prospective Netherlands cohort study. | journal = J Occup Environ Med | volume = 56 | issue = 1 | pages = 6-19 | month = Jan | year = 2014 | doi = 10.1097/JOM.0000000000000060 | PMID = 24351898 }}</ref>

===Asbestos===
Conditions associated with asbestos exposure (mnemonic ''PALM''):<ref name=Ref_PCPBoD8_375>{{Ref PCPBoD8|375}}</ref>
*[[Pleural plaques]].
*[[Asbestosis]].
*[[Lung carcinoma]].
*Malignant mesothelioma.

Possible association with asbestos exposure:
*[[Gestational trophoblastic disease]].<ref name=pmid19900938>{{Cite journal | last1 = Reid | first1 = A. | last2 = Heyworth | first2 = J. | last3 = de Klerk | first3 = N. | last4 = Musk | first4 = AW. | title = Asbestos exposure and gestational trophoblastic disease: a hypothesis. | journal = Cancer Epidemiol Biomarkers Prev | volume = 18 | issue = 11 | pages = 2895-8 | month = Nov | year = 2009 | doi = 10.1158/1055-9965.EPI-09-0731 | PMID = 19900938 }}</ref>

==Microscopic==
Features:<ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Infiltrative atypical cells - '''key feature'''.
**Infiltration into fat - ''diagnostic''.
**+/-Epithelioid cells - may be cytologically bland, i.e. benign appearing.
***Variable architecture: sheets, microglandular, tubulopapillary.
***+/-[[Psammoma bodies]].
**+/-Spindle cells.
*+/-''[[Ferruginous body]]'' - '''strongly supportive'''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/asbestos+body http://medical-dictionary.thefreedictionary.com/asbestos+body]. Accessed on: 4 November 2011.</ref>
** Looks like a (twirling) baton - segemented appearance, brown colour.
** Thin (asbestos) fiber in the core.

Notes:
*''Asbestos body'' is not strictly speaking a synonym for ''ferruginous body''.
*Don't diagnose ''mesothelioma in situ''.{{fact}}

DDx:<ref name=pmid15559051>{{Cite journal | last1 = Corson | first1 = JM. | title = Pathology of mesothelioma. | journal = Thorac Surg Clin | volume = 14 | issue = 4 | pages = 447-60 | month = Nov | year = 2004 | doi = 10.1016/j.thorsurg.2004.06.007 | PMID = 15559051 }}
</ref>
<ref name="pmid15725802">{{Cite journal | last1 = Bégueret | first1 = H. | last2 = Galateau-Salle | first2 = F. | last3 = Guillou | first3 = L. | last4 = Chetaille | first4 = B. | last5 = Brambilla | first5 = E. | last6 = Vignaud | first6 = JM. | last7 = Terrier | first7 = P. | last8 = Groussard | first8 = O. | last9 = Coindre | first9 = JM. | title = Primary intrathoracic synovial sarcoma: a clinicopathologic study of 40 t(X;18)-positive cases from the French Sarcoma Group and the Mesopath Group. | journal = Am J Surg Pathol | volume = 29 | issue = 3 | pages = 339-46 | month = Mar | year = 2005 | doi = | PMID = 15725802 }}</ref>
*[[Fibrosing pleuritis]] - should ''not'' have nodules, more cellular on the aspect adjacent to the effusion.
*Reactive mesothelial cells - may be atypical.
*Mesothelial hyperplasia.
*[[Adenocarcinoma]] - esp. [[lung adenocarcinoma]].
*[[Serous carcinoma]].
*[[Synovial sarcoma]].

===Images===
<gallery>
Image:Ferruginous_body.jpg | Ferruginous body. (WC)
Image: Malignant epithelioid mesothelioma - low mag.jpg | MM - low mag.
Image: Malignant epithelioid mesothelioma - intermed mag.jpg | MM - intermed. mag.
Image: Malignant epithelioid mesothelioma - high mag.jpg | MM - high mag.
Image: Malignant epithelioid mesothelioma - very high mag.jpg | MM - very high mag.
Image: Malignant epithelioid mesothelioma - calretinin - intermed mag.jpg | MM - calretinin - intermed. mag.
Image: Malignant epithelioid mesothelioma - calretinin - high mag.jpg | MM - calretinin - high mag.
</gallery>

====www====
*[http://www.rosaicollection.org/searchresults.cfm/ Mesothelioma (rosaicollection.org/index.cfm)].

===Subtypes===
List of subtypes - mnemonic ''BEDS'':<ref name=pmid15559051/><ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Biphasic mesothelioma.
**10%+ of epithelioid & 10%+ sarcomatoid.
*Epithelioid mesothelioma.
*Desmoplastic mesothelioma.
**Should be 50%+ dense tissue with storiform pattern & atypical cells.
*Sarcomatoid mesothelioma.
Other:
*Small cell mesothelioma.<ref name=pmid1310669>{{Cite journal | last1 = Mayall | first1 = FG. | last2 = Gibbs | first2 = AR. | title = The histology and immunohistochemistry of small cell mesothelioma. | journal = Histopathology | volume = 20 | issue = 1 | pages = 47-51 | month = Jan | year = 1992 | doi = | PMID = 1310669 }}</ref>

==Stains==
*PASD -ve.
*Mucicarmine -ve.
**Typically +ve in adenocarcinoma.

==IHC==
===Mesothelioma versus mesothelial hyperplasia===
Features:<ref name=pmid20209622>{{Cite journal | last1 = Hasteh | first1 = F. | last2 = Lin | first2 = GY. | last3 = Weidner | first3 = N. | last4 = Michael | first4 = CW. | title = The use of immunohistochemistry to distinguish reactive mesothelial cells from malignant mesothelioma in cytologic effusions. | journal = Cancer Cytopathol | volume = 118 | issue = 2 | pages = 90-6 | month = Apr | year = 2010 | doi = 10.1002/cncy.20071 | PMID = 20209622 }}</ref>
*EMA +ve ~100% (vs. ~10%).
*Desmin -ve ~5% (vs. ~85%).
*GLUT1 +ve ~50% (vs. ~10%)
*p53 +ve ~50% (vs. ~2%).

Note:
*The above are ''not'' very useful in individual cases.
*A simple pankeratin is useful for seening where epithelial cells are.

===Mesothelioma versus adenocarcinoma===
*Several panel exists - ''no agreed upon best panel''.<ref name=pmid18318582>{{cite journal |author=Marchevsky AM |title=Application of immunohistochemistry to the diagnosis of malignant mesothelioma |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=3 |pages=397-401 |year=2008 |month=March |pmid=18318582 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=132&page=397}}</ref>
**Usually two carcinoma markers + two mesothelial markers.

Panel:<ref name=pmid18318582/>
*Mesothelial markers:
**Calretinin.
**WT-1.
**D2-40.
**[[CK5/6]].
*Carcinoma markers:
**CEA (monoclonal and polyclonal).
**[[TTF-1]].
**[[Ber-EP4]].
**MOC-31.
**CD15.

===Other carcinoma markers===
*[[PAX8]] -ve.<ref name=pmid23846294>{{cite journal |author=Lee M, Alexander HR, Burke A |title=Diffuse mesothelioma of the peritoneum: a pathological study of 64 tumours treated with cytoreductive therapy |journal=Pathology |volume=45 |issue=5 |pages=464–73 |year=2013 |month=August |pmid=23846294 |doi=10.1097/PAT.0b013e3283631cce |url=}}</ref>
*Claudin-4.
**Mesothelioma may be focally positive.<ref name=pmid23775021>{{cite journal |author=Ohta Y, Sasaki Y, Saito M, ''et al.'' |title=Claudin-4 as a marker for distinguishing malignant mesothelioma from lung carcinoma and serous adenocarcinoma |journal=Int. J. Surg. Pathol. |volume=21 |issue=5 |pages=493–501 |year=2013 |month=October |pmid=23775021 |doi=10.1177/1066896913491320 |url=}}</ref>
*[[p63]] -ve.<ref name=pmid18064689>{{Cite journal | last1 = Pu | first1 = RT. | last2 = Pang | first2 = Y. | last3 = Michael | first3 = CW. | title = Utility of WT-1, p63, MOC31, mesothelin, and cytokeratin (K903 and CK5/6) immunostains in differentiating adenocarcinoma, squamous cell carcinoma, and malignant mesothelioma in effusions. | journal = Diagn Cytopathol | volume = 36 | issue = 1 | pages = 20-5 | month = Jan | year = 2008 | doi = 10.1002/dc.20747 | PMID = 18064689 }}</ref>
*[[CD138]] +ve.
**Usually -ve in mesothelioma.<ref name=pmid12866374>{{Cite journal | last1 = Chu | first1 = PG. | last2 = Arber | first2 = DA. | last3 = Weiss | first3 = LM. | title = Expression of T/NK-cell and plasma cell antigens in nonhematopoietic epithelioid neoplasms. An immunohistochemical study of 447 cases. | journal = Am J Clin Pathol | volume = 120 | issue = 1 | pages = 64-70 | month = Jul | year = 2003 | doi = 10.1309/48KC-17WA-U69B-TBXQ | PMID = 12866374 }}</ref>

==Molecular==
*p16 deletion by [[FISH]].<ref name=pmid24503757>{{cite journal |author=Hwang H, Tse C, Rodriguez S, Gown A, Churg A |title=p16 FISH deletion in surface epithelial mesothelial proliferations is predictive of underlying invasive mesothelioma |journal=Am. J. Surg. Pathol. |volume=38 |issue=5 |pages=681–8 |year=2014 |month=May |pmid=24503757 |doi=10.1097/PAS.0000000000000176 |url=}}</ref>

Notes:
*p16 IHC does ''not'' give the same result.
*Sensitivity of p16 deletion is low.

==Sign out==
<pre>
Pleural Tissue of Right Lung, Removal:
- MALIGNANT MESOTHELIOMA, epithelioid type.

Comment:
IHC confirms the morphologic impression.

The tumour stains as follows:
POSITIVE: calretinin (very strong), CK5/6.
NEGATIVE: TTF-1.
</pre>

==See also==
*[[Lung tumours]].
*[[Omentum]].
*[[Empyema peel]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pulmonary pathology]]

Malignant mesothelioma

2018-07-18T11:15:45Z

Abraham: /* Microscopic */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Malignant epithelioid mesothelioma - high mag.jpg
| Width =
| Caption = Malignant mesothelioma. [[H&E stain]].
| Micro = infiltrative atypical cells (epithelioid, spindled or both)
| Subtypes = biphasic mesothelioma, epithelioid mesothelioma, desmoplastic mesothelioma, sarcomatoid mesothelioma.
| LMDDx = mesothelial hyperplasia, [[fibrosing pleuritis]], [[adenocarcinoma]] - esp. [[lung adenocarcinoma|lung]], [[serous carcinoma]]
| Stains =
| IHC = calretinin +ve, D2-40 +ve, [[CK5/6]] +ve, WT-1 +ve, [[CK7]] +ve, CEA -ve, [[TTF-1]] -ve
| EM =
| Molecular = +/-p16 deletion
| IF =
| Gross =
| Grossing =
| Site = [[lung]], [[peritoneum]], [[omentum]], [[pericardium]]
| Assdx = [[asbestosis]]
| Syndromes =
| Clinicalhx = +/-asbestos exposure
| Signs =
| Symptoms =
| Prevalence = rare
| Bloodwork =
| Rads =
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx =
}}
'''Malignant mesothelioma''', also '''mesothelioma''', is a form of [[cancer]]. It arises from the mesothelium.

It should '''not''' be confused with ''[[benign multicystic mesothelioma]]'' and ''[[benign papillary mesothelioma]]''.

==General==
*Incidence
**Rare tumor accounting for 4-7 cases per million individuals.
**More common in men in 5th and 6th decades of life.
*Poor prognosis<ref>{{Cite journal | last1 = Haber | first1 = SE. | last2 = Haber | first2 = JM. | title = Malignant mesothelioma: a clinical study of 238 cases. | journal = Ind Health | volume = 49 | issue = 2 | pages = 166-72 | month = | year = 2011 | doi = | PMID = 21173534 }}</ref> - median survival <12 months.<ref name=pmid23413596>{{Cite journal | last1 = Mineo | first1 = TC. | last2 = Ambrogi | first2 = V. | title = Malignant pleural mesothelioma: factors influencing the prognosis. | journal = Oncology (Williston Park) | volume = 26 | issue = 12 | pages = 1164-75 | month = Dec | year = 2012 | doi = | PMID = 23413596 }}</ref>

Locations:
*Lung.
*Primary [[peritoneum|peritoneal]].
*Primary [[pericardium|pericardial]].<ref name=pmid22740748>{{Cite journal | last1 = Sardar | first1 = MR. | last2 = Kuntz | first2 = C. | last3 = Patel | first3 = T. | last4 = Saeed | first4 = W. | last5 = Gnall | first5 = E. | last6 = Imaizumi | first6 = S. | last7 = Lande | first7 = L. | title = Primary pericardial mesothelioma unique case and literature review. | journal = Tex Heart Inst J | volume = 39 | issue = 2 | pages = 261-4 | month = | year = 2012 | doi = | PMID = 22740748 }}</ref>

Epidemiology:
*Strong association with asbestos exposure.

Treatment:
*+/-Surgical debulking (cytoreduction) with heated chemotherapy - for intraperitoneal mesothelioma.<ref name=pmid24158467>{{cite journal |author=Wong J, Koch AL, Deneve JL, Fulp W, Tanvetyanon T, Dessureault S |title=Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience |journal=Ann. Surg. Oncol. |volume=21 |issue=5 |pages=1480–6 |year=2014 |month=May |pmid=24158467 |doi=10.1245/s10434-013-3341-7 |url=}}</ref>

Note:
*No association with [[smoking]].{{fact}}<ref name=pmid24351898>{{Cite journal | last1 = Offermans | first1 = NS. | last2 = Vermeulen | first2 = R. | last3 = Burdorf | first3 = A. | last4 = Goldbohm | first4 = RA. | last5 = Kauppinen | first5 = T. | last6 = Kromhout | first6 = H. | last7 = van den Brandt | first7 = PA. | title = Occupational asbestos exposure and risk of pleural mesothelioma, lung cancer, and laryngeal cancer in the prospective Netherlands cohort study. | journal = J Occup Environ Med | volume = 56 | issue = 1 | pages = 6-19 | month = Jan | year = 2014 | doi = 10.1097/JOM.0000000000000060 | PMID = 24351898 }}</ref>

===Asbestos===
Conditions associated with asbestos exposure (mnemonic ''PALM''):<ref name=Ref_PCPBoD8_375>{{Ref PCPBoD8|375}}</ref>
*[[Pleural plaques]].
*[[Asbestosis]].
*[[Lung carcinoma]].
*Malignant mesothelioma.

Possible association with asbestos exposure:
*[[Gestational trophoblastic disease]].<ref name=pmid19900938>{{Cite journal | last1 = Reid | first1 = A. | last2 = Heyworth | first2 = J. | last3 = de Klerk | first3 = N. | last4 = Musk | first4 = AW. | title = Asbestos exposure and gestational trophoblastic disease: a hypothesis. | journal = Cancer Epidemiol Biomarkers Prev | volume = 18 | issue = 11 | pages = 2895-8 | month = Nov | year = 2009 | doi = 10.1158/1055-9965.EPI-09-0731 | PMID = 19900938 }}</ref>

==Microscopic==
Features:<ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Infiltrative atypical cells - '''key feature'''.
**Infiltration into fat - ''diagnostic''.
**+/-Epithelioid cells - may be cytologically bland, i.e. benign appearing.
***Variable architecture: sheets, microglandular, tubulopapillary.
***+/-[[Psammoma bodies]].
**+/-Spindle cells.
*+/-''[[Ferruginous body]]'' - '''strongly supportive'''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/asbestos+body http://medical-dictionary.thefreedictionary.com/asbestos+body]. Accessed on: 4 November 2011.</ref>
** Looks like a (twirling) baton - segemented appearance, brown colour.
** Thin (asbestos) fiber in the core.

Notes:
*''Asbestos body'' is not strictly speaking a synonym for ''ferruginous body''.
*Don't diagnose ''mesothelioma in situ''.{{fact}}

DDx:<ref name=pmid15559051>{{Cite journal | last1 = Corson | first1 = JM. | title = Pathology of mesothelioma. | journal = Thorac Surg Clin | volume = 14 | issue = 4 | pages = 447-60 | month = Nov | year = 2004 | doi = 10.1016/j.thorsurg.2004.06.007 | PMID = 15559051 }}
</ref>
<ref name="pmid15725802">{{Cite journal | last1 = Bégueret | first1 = H. | last2 = Galateau-Salle | first2 = F. | last3 = Guillou | first3 = L. | last4 = Chetaille | first4 = B. | last5 = Brambilla | first5 = E. | last6 = Vignaud | first6 = JM. | last7 = Terrier | first7 = P. | last8 = Groussard | first8 = O. | last9 = Coindre | first9 = JM. | title = Primary intrathoracic synovial sarcoma: a clinicopathologic study of 40 t(X;18)-positive cases from the French Sarcoma Group and the Mesopath Group. | journal = Am J Surg Pathol | volume = 29 | issue = 3 | pages = 339-46 | month = Mar | year = 2005 | doi = | PMID = 15725802 }}</ref>

*[[Fibrosing pleuritis]] - should ''not'' have nodules, more cellular on the aspect adjacent to the effusion.
*Reactive mesothelial cells - may be atypical.
*Mesothelial hyperplasia.
*[[Adenocarcinoma]] - esp. [[lung adenocarcinoma]].
*[[Serous carcinoma]].
*[[Synovial sarcoma]].

===Images===
<gallery>
Image:Ferruginous_body.jpg | Ferruginous body. (WC)
Image: Malignant epithelioid mesothelioma - low mag.jpg | MM - low mag.
Image: Malignant epithelioid mesothelioma - intermed mag.jpg | MM - intermed. mag.
Image: Malignant epithelioid mesothelioma - high mag.jpg | MM - high mag.
Image: Malignant epithelioid mesothelioma - very high mag.jpg | MM - very high mag.
Image: Malignant epithelioid mesothelioma - calretinin - intermed mag.jpg | MM - calretinin - intermed. mag.
Image: Malignant epithelioid mesothelioma - calretinin - high mag.jpg | MM - calretinin - high mag.
</gallery>

====www====
*[http://www.rosaicollection.org/searchresults.cfm/ Mesothelioma (rosaicollection.org/index.cfm)].

===Subtypes===
List of subtypes - mnemonic ''BEDS'':<ref name=pmid15559051/><ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Biphasic mesothelioma.
**10%+ of epithelioid & 10%+ sarcomatoid.
*Epithelioid mesothelioma.
*Desmoplastic mesothelioma.
**Should be 50%+ dense tissue with storiform pattern & atypical cells.
*Sarcomatoid mesothelioma.
Other:
*Small cell mesothelioma.<ref name=pmid1310669>{{Cite journal | last1 = Mayall | first1 = FG. | last2 = Gibbs | first2 = AR. | title = The histology and immunohistochemistry of small cell mesothelioma. | journal = Histopathology | volume = 20 | issue = 1 | pages = 47-51 | month = Jan | year = 1992 | doi = | PMID = 1310669 }}</ref>

==Stains==
*PASD -ve.
*Mucicarmine -ve.
**Typically +ve in adenocarcinoma.

==IHC==
===Mesothelioma versus mesothelial hyperplasia===
Features:<ref name=pmid20209622>{{Cite journal | last1 = Hasteh | first1 = F. | last2 = Lin | first2 = GY. | last3 = Weidner | first3 = N. | last4 = Michael | first4 = CW. | title = The use of immunohistochemistry to distinguish reactive mesothelial cells from malignant mesothelioma in cytologic effusions. | journal = Cancer Cytopathol | volume = 118 | issue = 2 | pages = 90-6 | month = Apr | year = 2010 | doi = 10.1002/cncy.20071 | PMID = 20209622 }}</ref>
*EMA +ve ~100% (vs. ~10%).
*Desmin -ve ~5% (vs. ~85%).
*GLUT1 +ve ~50% (vs. ~10%)
*p53 +ve ~50% (vs. ~2%).

Note:
*The above are ''not'' very useful in individual cases.
*A simple pankeratin is useful for seening where epithelial cells are.

===Mesothelioma versus adenocarcinoma===
*Several panel exists - ''no agreed upon best panel''.<ref name=pmid18318582>{{cite journal |author=Marchevsky AM |title=Application of immunohistochemistry to the diagnosis of malignant mesothelioma |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=3 |pages=397-401 |year=2008 |month=March |pmid=18318582 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=132&page=397}}</ref>
**Usually two carcinoma markers + two mesothelial markers.

Panel:<ref name=pmid18318582/>
*Mesothelial markers:
**Calretinin.
**WT-1.
**D2-40.
**[[CK5/6]].
*Carcinoma markers:
**CEA (monoclonal and polyclonal).
**[[TTF-1]].
**[[Ber-EP4]].
**MOC-31.
**CD15.

===Other carcinoma markers===
*[[PAX8]] -ve.<ref name=pmid23846294>{{cite journal |author=Lee M, Alexander HR, Burke A |title=Diffuse mesothelioma of the peritoneum: a pathological study of 64 tumours treated with cytoreductive therapy |journal=Pathology |volume=45 |issue=5 |pages=464–73 |year=2013 |month=August |pmid=23846294 |doi=10.1097/PAT.0b013e3283631cce |url=}}</ref>
*Claudin-4.
**Mesothelioma may be focally positive.<ref name=pmid23775021>{{cite journal |author=Ohta Y, Sasaki Y, Saito M, ''et al.'' |title=Claudin-4 as a marker for distinguishing malignant mesothelioma from lung carcinoma and serous adenocarcinoma |journal=Int. J. Surg. Pathol. |volume=21 |issue=5 |pages=493–501 |year=2013 |month=October |pmid=23775021 |doi=10.1177/1066896913491320 |url=}}</ref>
*[[p63]] -ve.<ref name=pmid18064689>{{Cite journal | last1 = Pu | first1 = RT. | last2 = Pang | first2 = Y. | last3 = Michael | first3 = CW. | title = Utility of WT-1, p63, MOC31, mesothelin, and cytokeratin (K903 and CK5/6) immunostains in differentiating adenocarcinoma, squamous cell carcinoma, and malignant mesothelioma in effusions. | journal = Diagn Cytopathol | volume = 36 | issue = 1 | pages = 20-5 | month = Jan | year = 2008 | doi = 10.1002/dc.20747 | PMID = 18064689 }}</ref>
*[[CD138]] +ve.
**Usually -ve in mesothelioma.<ref name=pmid12866374>{{Cite journal | last1 = Chu | first1 = PG. | last2 = Arber | first2 = DA. | last3 = Weiss | first3 = LM. | title = Expression of T/NK-cell and plasma cell antigens in nonhematopoietic epithelioid neoplasms. An immunohistochemical study of 447 cases. | journal = Am J Clin Pathol | volume = 120 | issue = 1 | pages = 64-70 | month = Jul | year = 2003 | doi = 10.1309/48KC-17WA-U69B-TBXQ | PMID = 12866374 }}</ref>

==Molecular==
*p16 deletion by [[FISH]].<ref name=pmid24503757>{{cite journal |author=Hwang H, Tse C, Rodriguez S, Gown A, Churg A |title=p16 FISH deletion in surface epithelial mesothelial proliferations is predictive of underlying invasive mesothelioma |journal=Am. J. Surg. Pathol. |volume=38 |issue=5 |pages=681–8 |year=2014 |month=May |pmid=24503757 |doi=10.1097/PAS.0000000000000176 |url=}}</ref>

Notes:
*p16 IHC does ''not'' give the same result.
*Sensitivity of p16 deletion is low.

==Sign out==
<pre>
Pleural Tissue of Right Lung, Removal:
- MALIGNANT MESOTHELIOMA, epithelioid type.

Comment:
IHC confirms the morphologic impression.

The tumour stains as follows:
POSITIVE: calretinin (very strong), CK5/6.
NEGATIVE: TTF-1.
</pre>

==See also==
*[[Lung tumours]].
*[[Omentum]].
*[[Empyema peel]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pulmonary pathology]]

Malignant mesothelioma

2018-07-18T11:13:08Z

Abraham: /* Microscopic */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Malignant epithelioid mesothelioma - high mag.jpg
| Width =
| Caption = Malignant mesothelioma. [[H&E stain]].
| Micro = infiltrative atypical cells (epithelioid, spindled or both)
| Subtypes = biphasic mesothelioma, epithelioid mesothelioma, desmoplastic mesothelioma, sarcomatoid mesothelioma.
| LMDDx = mesothelial hyperplasia, [[fibrosing pleuritis]], [[adenocarcinoma]] - esp. [[lung adenocarcinoma|lung]], [[serous carcinoma]]
| Stains =
| IHC = calretinin +ve, D2-40 +ve, [[CK5/6]] +ve, WT-1 +ve, [[CK7]] +ve, CEA -ve, [[TTF-1]] -ve
| EM =
| Molecular = +/-p16 deletion
| IF =
| Gross =
| Grossing =
| Site = [[lung]], [[peritoneum]], [[omentum]], [[pericardium]]
| Assdx = [[asbestosis]]
| Syndromes =
| Clinicalhx = +/-asbestos exposure
| Signs =
| Symptoms =
| Prevalence = rare
| Bloodwork =
| Rads =
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx =
}}
'''Malignant mesothelioma''', also '''mesothelioma''', is a form of [[cancer]]. It arises from the mesothelium.

It should '''not''' be confused with ''[[benign multicystic mesothelioma]]'' and ''[[benign papillary mesothelioma]]''.

==General==
*Incidence
**Rare tumor accounting for 4-7 cases per million individuals.
**More common in men in 5th and 6th decades of life.
*Poor prognosis<ref>{{Cite journal | last1 = Haber | first1 = SE. | last2 = Haber | first2 = JM. | title = Malignant mesothelioma: a clinical study of 238 cases. | journal = Ind Health | volume = 49 | issue = 2 | pages = 166-72 | month = | year = 2011 | doi = | PMID = 21173534 }}</ref> - median survival <12 months.<ref name=pmid23413596>{{Cite journal | last1 = Mineo | first1 = TC. | last2 = Ambrogi | first2 = V. | title = Malignant pleural mesothelioma: factors influencing the prognosis. | journal = Oncology (Williston Park) | volume = 26 | issue = 12 | pages = 1164-75 | month = Dec | year = 2012 | doi = | PMID = 23413596 }}</ref>

Locations:
*Lung.
*Primary [[peritoneum|peritoneal]].
*Primary [[pericardium|pericardial]].<ref name=pmid22740748>{{Cite journal | last1 = Sardar | first1 = MR. | last2 = Kuntz | first2 = C. | last3 = Patel | first3 = T. | last4 = Saeed | first4 = W. | last5 = Gnall | first5 = E. | last6 = Imaizumi | first6 = S. | last7 = Lande | first7 = L. | title = Primary pericardial mesothelioma unique case and literature review. | journal = Tex Heart Inst J | volume = 39 | issue = 2 | pages = 261-4 | month = | year = 2012 | doi = | PMID = 22740748 }}</ref>

Epidemiology:
*Strong association with asbestos exposure.

Treatment:
*+/-Surgical debulking (cytoreduction) with heated chemotherapy - for intraperitoneal mesothelioma.<ref name=pmid24158467>{{cite journal |author=Wong J, Koch AL, Deneve JL, Fulp W, Tanvetyanon T, Dessureault S |title=Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience |journal=Ann. Surg. Oncol. |volume=21 |issue=5 |pages=1480–6 |year=2014 |month=May |pmid=24158467 |doi=10.1245/s10434-013-3341-7 |url=}}</ref>

Note:
*No association with [[smoking]].{{fact}}<ref name=pmid24351898>{{Cite journal | last1 = Offermans | first1 = NS. | last2 = Vermeulen | first2 = R. | last3 = Burdorf | first3 = A. | last4 = Goldbohm | first4 = RA. | last5 = Kauppinen | first5 = T. | last6 = Kromhout | first6 = H. | last7 = van den Brandt | first7 = PA. | title = Occupational asbestos exposure and risk of pleural mesothelioma, lung cancer, and laryngeal cancer in the prospective Netherlands cohort study. | journal = J Occup Environ Med | volume = 56 | issue = 1 | pages = 6-19 | month = Jan | year = 2014 | doi = 10.1097/JOM.0000000000000060 | PMID = 24351898 }}</ref>

===Asbestos===
Conditions associated with asbestos exposure (mnemonic ''PALM''):<ref name=Ref_PCPBoD8_375>{{Ref PCPBoD8|375}}</ref>
*[[Pleural plaques]].
*[[Asbestosis]].
*[[Lung carcinoma]].
*Malignant mesothelioma.

Possible association with asbestos exposure:
*[[Gestational trophoblastic disease]].<ref name=pmid19900938>{{Cite journal | last1 = Reid | first1 = A. | last2 = Heyworth | first2 = J. | last3 = de Klerk | first3 = N. | last4 = Musk | first4 = AW. | title = Asbestos exposure and gestational trophoblastic disease: a hypothesis. | journal = Cancer Epidemiol Biomarkers Prev | volume = 18 | issue = 11 | pages = 2895-8 | month = Nov | year = 2009 | doi = 10.1158/1055-9965.EPI-09-0731 | PMID = 19900938 }}</ref>

==Microscopic==
Features:<ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Infiltrative atypical cells - '''key feature'''.
**Infiltration into fat - ''diagnostic''.
**+/-Epithelioid cells - may be cytologically bland, i.e. benign appearing.
***Variable architecture: sheets, microglandular, tubulopapillary.
***+/-[[Psammoma bodies]].
**+/-Spindle cells.
*+/-''[[Ferruginous body]]'' - '''strongly supportive'''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/asbestos+body http://medical-dictionary.thefreedictionary.com/asbestos+body]. Accessed on: 4 November 2011.</ref>
** Looks like a (twirling) baton - segemented appearance, brown colour.
** Thin (asbestos) fiber in the core.

Notes:
*''Asbestos body'' is not strictly speaking a synonym for ''ferruginous body''.
*Don't diagnose ''mesothelioma in situ''.{{fact}}

DDx:<ref name=pmid15559051>{{Cite journal | last1 = Corson | first1 = JM. | title = Pathology of mesothelioma. | journal = Thorac Surg Clin | volume = 14 | issue = 4 | pages = 447-60 | month = Nov | year = 2004 | doi = 10.1016/j.thorsurg.2004.06.007 | PMID = 15559051 }}
</ref>
<ref name="pmid15725802">{{Cita publicación | apellido = Bégueret | nombre = H. | coautores = F. Galateau-Salle, L. Guillou, B. Chetaille, E. Brambilla, JM. Vignaud, P. Terrier, O. Groussard, JM. Coindre | título = Primary intrathoracic synovial sarcoma: a clinicopathologic study of 40 t(X;18)-positive cases from the French Sarcoma Group and the Mesopath Group. | publicación = Am J Surg Pathol | volume = 29 | número = 3 | páginas = 339-46 | mes = Mar | año = 2005 | doi = | pmid = 15725802 }}</ref>

*[[Fibrosing pleuritis]] - should ''not'' have nodules, more cellular on the aspect adjacent to the effusion.
*Reactive mesothelial cells - may be atypical.
*Mesothelial hyperplasia.
*[[Adenocarcinoma]] - esp. [[lung adenocarcinoma]].
*[[Serous carcinoma]].
*[[Synovial sarcoma]].

===Images===
<gallery>
Image:Ferruginous_body.jpg | Ferruginous body. (WC)
Image: Malignant epithelioid mesothelioma - low mag.jpg | MM - low mag.
Image: Malignant epithelioid mesothelioma - intermed mag.jpg | MM - intermed. mag.
Image: Malignant epithelioid mesothelioma - high mag.jpg | MM - high mag.
Image: Malignant epithelioid mesothelioma - very high mag.jpg | MM - very high mag.
Image: Malignant epithelioid mesothelioma - calretinin - intermed mag.jpg | MM - calretinin - intermed. mag.
Image: Malignant epithelioid mesothelioma - calretinin - high mag.jpg | MM - calretinin - high mag.
</gallery>

====www====
*[http://www.rosaicollection.org/searchresults.cfm/ Mesothelioma (rosaicollection.org/index.cfm)].

===Subtypes===
List of subtypes - mnemonic ''BEDS'':<ref name=pmid15559051/><ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Biphasic mesothelioma.
**10%+ of epithelioid & 10%+ sarcomatoid.
*Epithelioid mesothelioma.
*Desmoplastic mesothelioma.
**Should be 50%+ dense tissue with storiform pattern & atypical cells.
*Sarcomatoid mesothelioma.
Other:
*Small cell mesothelioma.<ref name=pmid1310669>{{Cite journal | last1 = Mayall | first1 = FG. | last2 = Gibbs | first2 = AR. | title = The histology and immunohistochemistry of small cell mesothelioma. | journal = Histopathology | volume = 20 | issue = 1 | pages = 47-51 | month = Jan | year = 1992 | doi = | PMID = 1310669 }}</ref>

==Stains==
*PASD -ve.
*Mucicarmine -ve.
**Typically +ve in adenocarcinoma.

==IHC==
===Mesothelioma versus mesothelial hyperplasia===
Features:<ref name=pmid20209622>{{Cite journal | last1 = Hasteh | first1 = F. | last2 = Lin | first2 = GY. | last3 = Weidner | first3 = N. | last4 = Michael | first4 = CW. | title = The use of immunohistochemistry to distinguish reactive mesothelial cells from malignant mesothelioma in cytologic effusions. | journal = Cancer Cytopathol | volume = 118 | issue = 2 | pages = 90-6 | month = Apr | year = 2010 | doi = 10.1002/cncy.20071 | PMID = 20209622 }}</ref>
*EMA +ve ~100% (vs. ~10%).
*Desmin -ve ~5% (vs. ~85%).
*GLUT1 +ve ~50% (vs. ~10%)
*p53 +ve ~50% (vs. ~2%).

Note:
*The above are ''not'' very useful in individual cases.
*A simple pankeratin is useful for seening where epithelial cells are.

===Mesothelioma versus adenocarcinoma===
*Several panel exists - ''no agreed upon best panel''.<ref name=pmid18318582>{{cite journal |author=Marchevsky AM |title=Application of immunohistochemistry to the diagnosis of malignant mesothelioma |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=3 |pages=397-401 |year=2008 |month=March |pmid=18318582 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=132&page=397}}</ref>
**Usually two carcinoma markers + two mesothelial markers.

Panel:<ref name=pmid18318582/>
*Mesothelial markers:
**Calretinin.
**WT-1.
**D2-40.
**[[CK5/6]].
*Carcinoma markers:
**CEA (monoclonal and polyclonal).
**[[TTF-1]].
**[[Ber-EP4]].
**MOC-31.
**CD15.

===Other carcinoma markers===
*[[PAX8]] -ve.<ref name=pmid23846294>{{cite journal |author=Lee M, Alexander HR, Burke A |title=Diffuse mesothelioma of the peritoneum: a pathological study of 64 tumours treated with cytoreductive therapy |journal=Pathology |volume=45 |issue=5 |pages=464–73 |year=2013 |month=August |pmid=23846294 |doi=10.1097/PAT.0b013e3283631cce |url=}}</ref>
*Claudin-4.
**Mesothelioma may be focally positive.<ref name=pmid23775021>{{cite journal |author=Ohta Y, Sasaki Y, Saito M, ''et al.'' |title=Claudin-4 as a marker for distinguishing malignant mesothelioma from lung carcinoma and serous adenocarcinoma |journal=Int. J. Surg. Pathol. |volume=21 |issue=5 |pages=493–501 |year=2013 |month=October |pmid=23775021 |doi=10.1177/1066896913491320 |url=}}</ref>
*[[p63]] -ve.<ref name=pmid18064689>{{Cite journal | last1 = Pu | first1 = RT. | last2 = Pang | first2 = Y. | last3 = Michael | first3 = CW. | title = Utility of WT-1, p63, MOC31, mesothelin, and cytokeratin (K903 and CK5/6) immunostains in differentiating adenocarcinoma, squamous cell carcinoma, and malignant mesothelioma in effusions. | journal = Diagn Cytopathol | volume = 36 | issue = 1 | pages = 20-5 | month = Jan | year = 2008 | doi = 10.1002/dc.20747 | PMID = 18064689 }}</ref>
*[[CD138]] +ve.
**Usually -ve in mesothelioma.<ref name=pmid12866374>{{Cite journal | last1 = Chu | first1 = PG. | last2 = Arber | first2 = DA. | last3 = Weiss | first3 = LM. | title = Expression of T/NK-cell and plasma cell antigens in nonhematopoietic epithelioid neoplasms. An immunohistochemical study of 447 cases. | journal = Am J Clin Pathol | volume = 120 | issue = 1 | pages = 64-70 | month = Jul | year = 2003 | doi = 10.1309/48KC-17WA-U69B-TBXQ | PMID = 12866374 }}</ref>

==Molecular==
*p16 deletion by [[FISH]].<ref name=pmid24503757>{{cite journal |author=Hwang H, Tse C, Rodriguez S, Gown A, Churg A |title=p16 FISH deletion in surface epithelial mesothelial proliferations is predictive of underlying invasive mesothelioma |journal=Am. J. Surg. Pathol. |volume=38 |issue=5 |pages=681–8 |year=2014 |month=May |pmid=24503757 |doi=10.1097/PAS.0000000000000176 |url=}}</ref>

Notes:
*p16 IHC does ''not'' give the same result.
*Sensitivity of p16 deletion is low.

==Sign out==
<pre>
Pleural Tissue of Right Lung, Removal:
- MALIGNANT MESOTHELIOMA, epithelioid type.

Comment:
IHC confirms the morphologic impression.

The tumour stains as follows:
POSITIVE: calretinin (very strong), CK5/6.
NEGATIVE: TTF-1.
</pre>

==See also==
*[[Lung tumours]].
*[[Omentum]].
*[[Empyema peel]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pulmonary pathology]]

Malignant mesothelioma

2018-07-18T11:08:18Z

Abraham: /* Microscopic */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Malignant epithelioid mesothelioma - high mag.jpg
| Width =
| Caption = Malignant mesothelioma. [[H&E stain]].
| Micro = infiltrative atypical cells (epithelioid, spindled or both)
| Subtypes = biphasic mesothelioma, epithelioid mesothelioma, desmoplastic mesothelioma, sarcomatoid mesothelioma.
| LMDDx = mesothelial hyperplasia, [[fibrosing pleuritis]], [[adenocarcinoma]] - esp. [[lung adenocarcinoma|lung]], [[serous carcinoma]]
| Stains =
| IHC = calretinin +ve, D2-40 +ve, [[CK5/6]] +ve, WT-1 +ve, [[CK7]] +ve, CEA -ve, [[TTF-1]] -ve
| EM =
| Molecular = +/-p16 deletion
| IF =
| Gross =
| Grossing =
| Site = [[lung]], [[peritoneum]], [[omentum]], [[pericardium]]
| Assdx = [[asbestosis]]
| Syndromes =
| Clinicalhx = +/-asbestos exposure
| Signs =
| Symptoms =
| Prevalence = rare
| Bloodwork =
| Rads =
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx =
}}
'''Malignant mesothelioma''', also '''mesothelioma''', is a form of [[cancer]]. It arises from the mesothelium.

It should '''not''' be confused with ''[[benign multicystic mesothelioma]]'' and ''[[benign papillary mesothelioma]]''.

==General==
*Incidence
**Rare tumor accounting for 4-7 cases per million individuals.
**More common in men in 5th and 6th decades of life.
*Poor prognosis<ref>{{Cite journal | last1 = Haber | first1 = SE. | last2 = Haber | first2 = JM. | title = Malignant mesothelioma: a clinical study of 238 cases. | journal = Ind Health | volume = 49 | issue = 2 | pages = 166-72 | month = | year = 2011 | doi = | PMID = 21173534 }}</ref> - median survival <12 months.<ref name=pmid23413596>{{Cite journal | last1 = Mineo | first1 = TC. | last2 = Ambrogi | first2 = V. | title = Malignant pleural mesothelioma: factors influencing the prognosis. | journal = Oncology (Williston Park) | volume = 26 | issue = 12 | pages = 1164-75 | month = Dec | year = 2012 | doi = | PMID = 23413596 }}</ref>

Locations:
*Lung.
*Primary [[peritoneum|peritoneal]].
*Primary [[pericardium|pericardial]].<ref name=pmid22740748>{{Cite journal | last1 = Sardar | first1 = MR. | last2 = Kuntz | first2 = C. | last3 = Patel | first3 = T. | last4 = Saeed | first4 = W. | last5 = Gnall | first5 = E. | last6 = Imaizumi | first6 = S. | last7 = Lande | first7 = L. | title = Primary pericardial mesothelioma unique case and literature review. | journal = Tex Heart Inst J | volume = 39 | issue = 2 | pages = 261-4 | month = | year = 2012 | doi = | PMID = 22740748 }}</ref>

Epidemiology:
*Strong association with asbestos exposure.

Treatment:
*+/-Surgical debulking (cytoreduction) with heated chemotherapy - for intraperitoneal mesothelioma.<ref name=pmid24158467>{{cite journal |author=Wong J, Koch AL, Deneve JL, Fulp W, Tanvetyanon T, Dessureault S |title=Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience |journal=Ann. Surg. Oncol. |volume=21 |issue=5 |pages=1480–6 |year=2014 |month=May |pmid=24158467 |doi=10.1245/s10434-013-3341-7 |url=}}</ref>

Note:
*No association with [[smoking]].{{fact}}<ref name=pmid24351898>{{Cite journal | last1 = Offermans | first1 = NS. | last2 = Vermeulen | first2 = R. | last3 = Burdorf | first3 = A. | last4 = Goldbohm | first4 = RA. | last5 = Kauppinen | first5 = T. | last6 = Kromhout | first6 = H. | last7 = van den Brandt | first7 = PA. | title = Occupational asbestos exposure and risk of pleural mesothelioma, lung cancer, and laryngeal cancer in the prospective Netherlands cohort study. | journal = J Occup Environ Med | volume = 56 | issue = 1 | pages = 6-19 | month = Jan | year = 2014 | doi = 10.1097/JOM.0000000000000060 | PMID = 24351898 }}</ref>

===Asbestos===
Conditions associated with asbestos exposure (mnemonic ''PALM''):<ref name=Ref_PCPBoD8_375>{{Ref PCPBoD8|375}}</ref>
*[[Pleural plaques]].
*[[Asbestosis]].
*[[Lung carcinoma]].
*Malignant mesothelioma.

Possible association with asbestos exposure:
*[[Gestational trophoblastic disease]].<ref name=pmid19900938>{{Cite journal | last1 = Reid | first1 = A. | last2 = Heyworth | first2 = J. | last3 = de Klerk | first3 = N. | last4 = Musk | first4 = AW. | title = Asbestos exposure and gestational trophoblastic disease: a hypothesis. | journal = Cancer Epidemiol Biomarkers Prev | volume = 18 | issue = 11 | pages = 2895-8 | month = Nov | year = 2009 | doi = 10.1158/1055-9965.EPI-09-0731 | PMID = 19900938 }}</ref>

==Microscopic==
Features:<ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Infiltrative atypical cells - '''key feature'''.
**Infiltration into fat - ''diagnostic''.
**+/-Epithelioid cells - may be cytologically bland, i.e. benign appearing.
***Variable architecture: sheets, microglandular, tubulopapillary.
***+/-[[Psammoma bodies]].
**+/-Spindle cells.
*+/-''[[Ferruginous body]]'' - '''strongly supportive'''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/asbestos+body http://medical-dictionary.thefreedictionary.com/asbestos+body]. Accessed on: 4 November 2011.</ref>
** Looks like a (twirling) baton - segemented appearance, brown colour.
** Thin (asbestos) fiber in the core.

Notes:
*''Asbestos body'' is not strictly speaking a synonym for ''ferruginous body''.
*Don't diagnose ''mesothelioma in situ''.{{fact}}

DDx:<ref name=pmid15559051>{{Cite journal | last1 = Corson | first1 = JM. | title = Pathology of mesothelioma. | journal = Thorac Surg Clin | volume = 14 | issue = 4 | pages = 447-60 | month = Nov | year = 2004 | doi = 10.1016/j.thorsurg.2004.06.007 | PMID = 15559051 }}
</ref>
*[[Fibrosing pleuritis]] - should ''not'' have nodules, more cellular on the aspect adjacent to the effusion.
*Reactive mesothelial cells - may be atypical.
*Mesothelial hyperplasia.
*[[Adenocarcinoma]] - esp. [[lung adenocarcinoma]].
*[[Serous carcinoma]].
*[[Synovial sarcoma]].

===Images===
<gallery>
Image:Ferruginous_body.jpg | Ferruginous body. (WC)
Image: Malignant epithelioid mesothelioma - low mag.jpg | MM - low mag.
Image: Malignant epithelioid mesothelioma - intermed mag.jpg | MM - intermed. mag.
Image: Malignant epithelioid mesothelioma - high mag.jpg | MM - high mag.
Image: Malignant epithelioid mesothelioma - very high mag.jpg | MM - very high mag.
Image: Malignant epithelioid mesothelioma - calretinin - intermed mag.jpg | MM - calretinin - intermed. mag.
Image: Malignant epithelioid mesothelioma - calretinin - high mag.jpg | MM - calretinin - high mag.
</gallery>

====www====
*[http://www.rosaicollection.org/searchresults.cfm/ Mesothelioma (rosaicollection.org/index.cfm)].

===Subtypes===
List of subtypes - mnemonic ''BEDS'':<ref name=pmid15559051/><ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Biphasic mesothelioma.
**10%+ of epithelioid & 10%+ sarcomatoid.
*Epithelioid mesothelioma.
*Desmoplastic mesothelioma.
**Should be 50%+ dense tissue with storiform pattern & atypical cells.
*Sarcomatoid mesothelioma.
Other:
*Small cell mesothelioma.<ref name=pmid1310669>{{Cite journal | last1 = Mayall | first1 = FG. | last2 = Gibbs | first2 = AR. | title = The histology and immunohistochemistry of small cell mesothelioma. | journal = Histopathology | volume = 20 | issue = 1 | pages = 47-51 | month = Jan | year = 1992 | doi = | PMID = 1310669 }}</ref>

==Stains==
*PASD -ve.
*Mucicarmine -ve.
**Typically +ve in adenocarcinoma.

==IHC==
===Mesothelioma versus mesothelial hyperplasia===
Features:<ref name=pmid20209622>{{Cite journal | last1 = Hasteh | first1 = F. | last2 = Lin | first2 = GY. | last3 = Weidner | first3 = N. | last4 = Michael | first4 = CW. | title = The use of immunohistochemistry to distinguish reactive mesothelial cells from malignant mesothelioma in cytologic effusions. | journal = Cancer Cytopathol | volume = 118 | issue = 2 | pages = 90-6 | month = Apr | year = 2010 | doi = 10.1002/cncy.20071 | PMID = 20209622 }}</ref>
*EMA +ve ~100% (vs. ~10%).
*Desmin -ve ~5% (vs. ~85%).
*GLUT1 +ve ~50% (vs. ~10%)
*p53 +ve ~50% (vs. ~2%).

Note:
*The above are ''not'' very useful in individual cases.
*A simple pankeratin is useful for seening where epithelial cells are.

===Mesothelioma versus adenocarcinoma===
*Several panel exists - ''no agreed upon best panel''.<ref name=pmid18318582>{{cite journal |author=Marchevsky AM |title=Application of immunohistochemistry to the diagnosis of malignant mesothelioma |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=3 |pages=397-401 |year=2008 |month=March |pmid=18318582 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=132&page=397}}</ref>
**Usually two carcinoma markers + two mesothelial markers.

Panel:<ref name=pmid18318582/>
*Mesothelial markers:
**Calretinin.
**WT-1.
**D2-40.
**[[CK5/6]].
*Carcinoma markers:
**CEA (monoclonal and polyclonal).
**[[TTF-1]].
**[[Ber-EP4]].
**MOC-31.
**CD15.

===Other carcinoma markers===
*[[PAX8]] -ve.<ref name=pmid23846294>{{cite journal |author=Lee M, Alexander HR, Burke A |title=Diffuse mesothelioma of the peritoneum: a pathological study of 64 tumours treated with cytoreductive therapy |journal=Pathology |volume=45 |issue=5 |pages=464–73 |year=2013 |month=August |pmid=23846294 |doi=10.1097/PAT.0b013e3283631cce |url=}}</ref>
*Claudin-4.
**Mesothelioma may be focally positive.<ref name=pmid23775021>{{cite journal |author=Ohta Y, Sasaki Y, Saito M, ''et al.'' |title=Claudin-4 as a marker for distinguishing malignant mesothelioma from lung carcinoma and serous adenocarcinoma |journal=Int. J. Surg. Pathol. |volume=21 |issue=5 |pages=493–501 |year=2013 |month=October |pmid=23775021 |doi=10.1177/1066896913491320 |url=}}</ref>
*[[p63]] -ve.<ref name=pmid18064689>{{Cite journal | last1 = Pu | first1 = RT. | last2 = Pang | first2 = Y. | last3 = Michael | first3 = CW. | title = Utility of WT-1, p63, MOC31, mesothelin, and cytokeratin (K903 and CK5/6) immunostains in differentiating adenocarcinoma, squamous cell carcinoma, and malignant mesothelioma in effusions. | journal = Diagn Cytopathol | volume = 36 | issue = 1 | pages = 20-5 | month = Jan | year = 2008 | doi = 10.1002/dc.20747 | PMID = 18064689 }}</ref>
*[[CD138]] +ve.
**Usually -ve in mesothelioma.<ref name=pmid12866374>{{Cite journal | last1 = Chu | first1 = PG. | last2 = Arber | first2 = DA. | last3 = Weiss | first3 = LM. | title = Expression of T/NK-cell and plasma cell antigens in nonhematopoietic epithelioid neoplasms. An immunohistochemical study of 447 cases. | journal = Am J Clin Pathol | volume = 120 | issue = 1 | pages = 64-70 | month = Jul | year = 2003 | doi = 10.1309/48KC-17WA-U69B-TBXQ | PMID = 12866374 }}</ref>

==Molecular==
*p16 deletion by [[FISH]].<ref name=pmid24503757>{{cite journal |author=Hwang H, Tse C, Rodriguez S, Gown A, Churg A |title=p16 FISH deletion in surface epithelial mesothelial proliferations is predictive of underlying invasive mesothelioma |journal=Am. J. Surg. Pathol. |volume=38 |issue=5 |pages=681–8 |year=2014 |month=May |pmid=24503757 |doi=10.1097/PAS.0000000000000176 |url=}}</ref>

Notes:
*p16 IHC does ''not'' give the same result.
*Sensitivity of p16 deletion is low.

==Sign out==
<pre>
Pleural Tissue of Right Lung, Removal:
- MALIGNANT MESOTHELIOMA, epithelioid type.

Comment:
IHC confirms the morphologic impression.

The tumour stains as follows:
POSITIVE: calretinin (very strong), CK5/6.
NEGATIVE: TTF-1.
</pre>

==See also==
*[[Lung tumours]].
*[[Omentum]].
*[[Empyema peel]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pulmonary pathology]]

Malignant mesothelioma

2018-07-18T11:04:49Z

Abraham: /* Microscopic */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Malignant epithelioid mesothelioma - high mag.jpg
| Width =
| Caption = Malignant mesothelioma. [[H&E stain]].
| Micro = infiltrative atypical cells (epithelioid, spindled or both)
| Subtypes = biphasic mesothelioma, epithelioid mesothelioma, desmoplastic mesothelioma, sarcomatoid mesothelioma.
| LMDDx = mesothelial hyperplasia, [[fibrosing pleuritis]], [[adenocarcinoma]] - esp. [[lung adenocarcinoma|lung]], [[serous carcinoma]]
| Stains =
| IHC = calretinin +ve, D2-40 +ve, [[CK5/6]] +ve, WT-1 +ve, [[CK7]] +ve, CEA -ve, [[TTF-1]] -ve
| EM =
| Molecular = +/-p16 deletion
| IF =
| Gross =
| Grossing =
| Site = [[lung]], [[peritoneum]], [[omentum]], [[pericardium]]
| Assdx = [[asbestosis]]
| Syndromes =
| Clinicalhx = +/-asbestos exposure
| Signs =
| Symptoms =
| Prevalence = rare
| Bloodwork =
| Rads =
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx =
}}
'''Malignant mesothelioma''', also '''mesothelioma''', is a form of [[cancer]]. It arises from the mesothelium.

It should '''not''' be confused with ''[[benign multicystic mesothelioma]]'' and ''[[benign papillary mesothelioma]]''.

==General==
*Incidence
**Rare tumor accounting for 4-7 cases per million individuals.
**More common in men in 5th and 6th decades of life.
*Poor prognosis<ref>{{Cite journal | last1 = Haber | first1 = SE. | last2 = Haber | first2 = JM. | title = Malignant mesothelioma: a clinical study of 238 cases. | journal = Ind Health | volume = 49 | issue = 2 | pages = 166-72 | month = | year = 2011 | doi = | PMID = 21173534 }}</ref> - median survival <12 months.<ref name=pmid23413596>{{Cite journal | last1 = Mineo | first1 = TC. | last2 = Ambrogi | first2 = V. | title = Malignant pleural mesothelioma: factors influencing the prognosis. | journal = Oncology (Williston Park) | volume = 26 | issue = 12 | pages = 1164-75 | month = Dec | year = 2012 | doi = | PMID = 23413596 }}</ref>

Locations:
*Lung.
*Primary [[peritoneum|peritoneal]].
*Primary [[pericardium|pericardial]].<ref name=pmid22740748>{{Cite journal | last1 = Sardar | first1 = MR. | last2 = Kuntz | first2 = C. | last3 = Patel | first3 = T. | last4 = Saeed | first4 = W. | last5 = Gnall | first5 = E. | last6 = Imaizumi | first6 = S. | last7 = Lande | first7 = L. | title = Primary pericardial mesothelioma unique case and literature review. | journal = Tex Heart Inst J | volume = 39 | issue = 2 | pages = 261-4 | month = | year = 2012 | doi = | PMID = 22740748 }}</ref>

Epidemiology:
*Strong association with asbestos exposure.

Treatment:
*+/-Surgical debulking (cytoreduction) with heated chemotherapy - for intraperitoneal mesothelioma.<ref name=pmid24158467>{{cite journal |author=Wong J, Koch AL, Deneve JL, Fulp W, Tanvetyanon T, Dessureault S |title=Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience |journal=Ann. Surg. Oncol. |volume=21 |issue=5 |pages=1480–6 |year=2014 |month=May |pmid=24158467 |doi=10.1245/s10434-013-3341-7 |url=}}</ref>

Note:
*No association with [[smoking]].{{fact}}<ref name=pmid24351898>{{Cite journal | last1 = Offermans | first1 = NS. | last2 = Vermeulen | first2 = R. | last3 = Burdorf | first3 = A. | last4 = Goldbohm | first4 = RA. | last5 = Kauppinen | first5 = T. | last6 = Kromhout | first6 = H. | last7 = van den Brandt | first7 = PA. | title = Occupational asbestos exposure and risk of pleural mesothelioma, lung cancer, and laryngeal cancer in the prospective Netherlands cohort study. | journal = J Occup Environ Med | volume = 56 | issue = 1 | pages = 6-19 | month = Jan | year = 2014 | doi = 10.1097/JOM.0000000000000060 | PMID = 24351898 }}</ref>

===Asbestos===
Conditions associated with asbestos exposure (mnemonic ''PALM''):<ref name=Ref_PCPBoD8_375>{{Ref PCPBoD8|375}}</ref>
*[[Pleural plaques]].
*[[Asbestosis]].
*[[Lung carcinoma]].
*Malignant mesothelioma.

Possible association with asbestos exposure:
*[[Gestational trophoblastic disease]].<ref name=pmid19900938>{{Cite journal | last1 = Reid | first1 = A. | last2 = Heyworth | first2 = J. | last3 = de Klerk | first3 = N. | last4 = Musk | first4 = AW. | title = Asbestos exposure and gestational trophoblastic disease: a hypothesis. | journal = Cancer Epidemiol Biomarkers Prev | volume = 18 | issue = 11 | pages = 2895-8 | month = Nov | year = 2009 | doi = 10.1158/1055-9965.EPI-09-0731 | PMID = 19900938 }}</ref>

==Microscopic==
Features:<ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Infiltrative atypical cells - '''key feature'''.
**Infiltration into fat - ''diagnostic''.
**+/-Epithelioid cells - may be cytologically bland, i.e. benign appearing.
***Variable architecture: sheets, microglandular, tubulopapillary.
***+/-[[Psammoma bodies]].
**+/-Spindle cells.
*+/-''[[Ferruginous body]]'' - '''strongly supportive'''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/asbestos+body http://medical-dictionary.thefreedictionary.com/asbestos+body]. Accessed on: 4 November 2011.</ref>
** Looks like a (twirling) baton - segemented appearance, brown colour.
** Thin (asbestos) fiber in the core.

Notes:
*''Asbestos body'' is not strictly speaking a synonym for ''ferruginous body''.
*Don't diagnose ''mesothelioma in situ''.{{fact}}

DDx:<ref name=pmid15559051>{{Cite journal | last1 = Corson | first1 = JM. | title = Pathology of mesothelioma. | journal = Thorac Surg Clin | volume = 14 | issue = 4 | pages = 447-60 | month = Nov | year = 2004 | doi = 10.1016/j.thorsurg.2004.06.007 | PMID = 15559051 }}
</ref>
*[[Fibrosing pleuritis]] - should ''not'' have nodules, more cellular on the aspect adjacent to the effusion.
*Reactive mesothelial cells - may be atypical.
*Mesothelial hyperplasia.
*[[Adenocarcinoma]] - esp. [[lung adenocarcinoma]].
*[[Serous carcinoma]].

===Images===
<gallery>
Image:Ferruginous_body.jpg | Ferruginous body. (WC)
Image: Malignant epithelioid mesothelioma - low mag.jpg | MM - low mag.
Image: Malignant epithelioid mesothelioma - intermed mag.jpg | MM - intermed. mag.
Image: Malignant epithelioid mesothelioma - high mag.jpg | MM - high mag.
Image: Malignant epithelioid mesothelioma - very high mag.jpg | MM - very high mag.
Image: Malignant epithelioid mesothelioma - calretinin - intermed mag.jpg | MM - calretinin - intermed. mag.
Image: Malignant epithelioid mesothelioma - calretinin - high mag.jpg | MM - calretinin - high mag.
</gallery>

====www====
*[http://www.rosaicollection.org/searchresults.cfm/ Mesothelioma (rosaicollection.org/index.cfm)].

===Subtypes===
List of subtypes - mnemonic ''BEDS'':<ref name=pmid15559051/><ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Biphasic mesothelioma.
**10%+ of epithelioid & 10%+ sarcomatoid.
*Epithelioid mesothelioma.
*Desmoplastic mesothelioma.
**Should be 50%+ dense tissue with storiform pattern & atypical cells.
*Sarcomatoid mesothelioma.
Other:
*Small cell mesothelioma.<ref name=pmid1310669>{{Cite journal | last1 = Mayall | first1 = FG. | last2 = Gibbs | first2 = AR. | title = The histology and immunohistochemistry of small cell mesothelioma. | journal = Histopathology | volume = 20 | issue = 1 | pages = 47-51 | month = Jan | year = 1992 | doi = | PMID = 1310669 }}</ref>

==Stains==
*PASD -ve.
*Mucicarmine -ve.
**Typically +ve in adenocarcinoma.

==IHC==
===Mesothelioma versus mesothelial hyperplasia===
Features:<ref name=pmid20209622>{{Cite journal | last1 = Hasteh | first1 = F. | last2 = Lin | first2 = GY. | last3 = Weidner | first3 = N. | last4 = Michael | first4 = CW. | title = The use of immunohistochemistry to distinguish reactive mesothelial cells from malignant mesothelioma in cytologic effusions. | journal = Cancer Cytopathol | volume = 118 | issue = 2 | pages = 90-6 | month = Apr | year = 2010 | doi = 10.1002/cncy.20071 | PMID = 20209622 }}</ref>
*EMA +ve ~100% (vs. ~10%).
*Desmin -ve ~5% (vs. ~85%).
*GLUT1 +ve ~50% (vs. ~10%)
*p53 +ve ~50% (vs. ~2%).

Note:
*The above are ''not'' very useful in individual cases.
*A simple pankeratin is useful for seening where epithelial cells are.

===Mesothelioma versus adenocarcinoma===
*Several panel exists - ''no agreed upon best panel''.<ref name=pmid18318582>{{cite journal |author=Marchevsky AM |title=Application of immunohistochemistry to the diagnosis of malignant mesothelioma |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=3 |pages=397-401 |year=2008 |month=March |pmid=18318582 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=132&page=397}}</ref>
**Usually two carcinoma markers + two mesothelial markers.

Panel:<ref name=pmid18318582/>
*Mesothelial markers:
**Calretinin.
**WT-1.
**D2-40.
**[[CK5/6]].
*Carcinoma markers:
**CEA (monoclonal and polyclonal).
**[[TTF-1]].
**[[Ber-EP4]].
**MOC-31.
**CD15.

===Other carcinoma markers===
*[[PAX8]] -ve.<ref name=pmid23846294>{{cite journal |author=Lee M, Alexander HR, Burke A |title=Diffuse mesothelioma of the peritoneum: a pathological study of 64 tumours treated with cytoreductive therapy |journal=Pathology |volume=45 |issue=5 |pages=464–73 |year=2013 |month=August |pmid=23846294 |doi=10.1097/PAT.0b013e3283631cce |url=}}</ref>
*Claudin-4.
**Mesothelioma may be focally positive.<ref name=pmid23775021>{{cite journal |author=Ohta Y, Sasaki Y, Saito M, ''et al.'' |title=Claudin-4 as a marker for distinguishing malignant mesothelioma from lung carcinoma and serous adenocarcinoma |journal=Int. J. Surg. Pathol. |volume=21 |issue=5 |pages=493–501 |year=2013 |month=October |pmid=23775021 |doi=10.1177/1066896913491320 |url=}}</ref>
*[[p63]] -ve.<ref name=pmid18064689>{{Cite journal | last1 = Pu | first1 = RT. | last2 = Pang | first2 = Y. | last3 = Michael | first3 = CW. | title = Utility of WT-1, p63, MOC31, mesothelin, and cytokeratin (K903 and CK5/6) immunostains in differentiating adenocarcinoma, squamous cell carcinoma, and malignant mesothelioma in effusions. | journal = Diagn Cytopathol | volume = 36 | issue = 1 | pages = 20-5 | month = Jan | year = 2008 | doi = 10.1002/dc.20747 | PMID = 18064689 }}</ref>
*[[CD138]] +ve.
**Usually -ve in mesothelioma.<ref name=pmid12866374>{{Cite journal | last1 = Chu | first1 = PG. | last2 = Arber | first2 = DA. | last3 = Weiss | first3 = LM. | title = Expression of T/NK-cell and plasma cell antigens in nonhematopoietic epithelioid neoplasms. An immunohistochemical study of 447 cases. | journal = Am J Clin Pathol | volume = 120 | issue = 1 | pages = 64-70 | month = Jul | year = 2003 | doi = 10.1309/48KC-17WA-U69B-TBXQ | PMID = 12866374 }}</ref>

==Molecular==
*p16 deletion by [[FISH]].<ref name=pmid24503757>{{cite journal |author=Hwang H, Tse C, Rodriguez S, Gown A, Churg A |title=p16 FISH deletion in surface epithelial mesothelial proliferations is predictive of underlying invasive mesothelioma |journal=Am. J. Surg. Pathol. |volume=38 |issue=5 |pages=681–8 |year=2014 |month=May |pmid=24503757 |doi=10.1097/PAS.0000000000000176 |url=}}</ref>

Notes:
*p16 IHC does ''not'' give the same result.
*Sensitivity of p16 deletion is low.

==Sign out==
<pre>
Pleural Tissue of Right Lung, Removal:
- MALIGNANT MESOTHELIOMA, epithelioid type.

Comment:
IHC confirms the morphologic impression.

The tumour stains as follows:
POSITIVE: calretinin (very strong), CK5/6.
NEGATIVE: TTF-1.
</pre>

==See also==
*[[Lung tumours]].
*[[Omentum]].
*[[Empyema peel]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pulmonary pathology]]

Malignant mesothelioma

2018-07-18T10:51:42Z

Abraham: /* General */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Malignant epithelioid mesothelioma - high mag.jpg
| Width =
| Caption = Malignant mesothelioma. [[H&E stain]].
| Micro = infiltrative atypical cells (epithelioid, spindled or both)
| Subtypes = biphasic mesothelioma, epithelioid mesothelioma, desmoplastic mesothelioma, sarcomatoid mesothelioma.
| LMDDx = mesothelial hyperplasia, [[fibrosing pleuritis]], [[adenocarcinoma]] - esp. [[lung adenocarcinoma|lung]], [[serous carcinoma]]
| Stains =
| IHC = calretinin +ve, D2-40 +ve, [[CK5/6]] +ve, WT-1 +ve, [[CK7]] +ve, CEA -ve, [[TTF-1]] -ve
| EM =
| Molecular = +/-p16 deletion
| IF =
| Gross =
| Grossing =
| Site = [[lung]], [[peritoneum]], [[omentum]], [[pericardium]]
| Assdx = [[asbestosis]]
| Syndromes =
| Clinicalhx = +/-asbestos exposure
| Signs =
| Symptoms =
| Prevalence = rare
| Bloodwork =
| Rads =
| Endoscopy =
| Prognosis = very poor
| Other =
| ClinDDx =
}}
'''Malignant mesothelioma''', also '''mesothelioma''', is a form of [[cancer]]. It arises from the mesothelium.

It should '''not''' be confused with ''[[benign multicystic mesothelioma]]'' and ''[[benign papillary mesothelioma]]''.

==General==
*Incidence
**Rare tumor accounting for 4-7 cases per million individuals.
**More common in men in 5th and 6th decades of life.
*Poor prognosis<ref>{{Cite journal | last1 = Haber | first1 = SE. | last2 = Haber | first2 = JM. | title = Malignant mesothelioma: a clinical study of 238 cases. | journal = Ind Health | volume = 49 | issue = 2 | pages = 166-72 | month = | year = 2011 | doi = | PMID = 21173534 }}</ref> - median survival <12 months.<ref name=pmid23413596>{{Cite journal | last1 = Mineo | first1 = TC. | last2 = Ambrogi | first2 = V. | title = Malignant pleural mesothelioma: factors influencing the prognosis. | journal = Oncology (Williston Park) | volume = 26 | issue = 12 | pages = 1164-75 | month = Dec | year = 2012 | doi = | PMID = 23413596 }}</ref>

Locations:
*Lung.
*Primary [[peritoneum|peritoneal]].
*Primary [[pericardium|pericardial]].<ref name=pmid22740748>{{Cite journal | last1 = Sardar | first1 = MR. | last2 = Kuntz | first2 = C. | last3 = Patel | first3 = T. | last4 = Saeed | first4 = W. | last5 = Gnall | first5 = E. | last6 = Imaizumi | first6 = S. | last7 = Lande | first7 = L. | title = Primary pericardial mesothelioma unique case and literature review. | journal = Tex Heart Inst J | volume = 39 | issue = 2 | pages = 261-4 | month = | year = 2012 | doi = | PMID = 22740748 }}</ref>

Epidemiology:
*Strong association with asbestos exposure.

Treatment:
*+/-Surgical debulking (cytoreduction) with heated chemotherapy - for intraperitoneal mesothelioma.<ref name=pmid24158467>{{cite journal |author=Wong J, Koch AL, Deneve JL, Fulp W, Tanvetyanon T, Dessureault S |title=Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience |journal=Ann. Surg. Oncol. |volume=21 |issue=5 |pages=1480–6 |year=2014 |month=May |pmid=24158467 |doi=10.1245/s10434-013-3341-7 |url=}}</ref>

Note:
*No association with [[smoking]].{{fact}}<ref name=pmid24351898>{{Cite journal | last1 = Offermans | first1 = NS. | last2 = Vermeulen | first2 = R. | last3 = Burdorf | first3 = A. | last4 = Goldbohm | first4 = RA. | last5 = Kauppinen | first5 = T. | last6 = Kromhout | first6 = H. | last7 = van den Brandt | first7 = PA. | title = Occupational asbestos exposure and risk of pleural mesothelioma, lung cancer, and laryngeal cancer in the prospective Netherlands cohort study. | journal = J Occup Environ Med | volume = 56 | issue = 1 | pages = 6-19 | month = Jan | year = 2014 | doi = 10.1097/JOM.0000000000000060 | PMID = 24351898 }}</ref>

===Asbestos===
Conditions associated with asbestos exposure (mnemonic ''PALM''):<ref name=Ref_PCPBoD8_375>{{Ref PCPBoD8|375}}</ref>
*[[Pleural plaques]].
*[[Asbestosis]].
*[[Lung carcinoma]].
*Malignant mesothelioma.

Possible association with asbestos exposure:
*[[Gestational trophoblastic disease]].<ref name=pmid19900938>{{Cite journal | last1 = Reid | first1 = A. | last2 = Heyworth | first2 = J. | last3 = de Klerk | first3 = N. | last4 = Musk | first4 = AW. | title = Asbestos exposure and gestational trophoblastic disease: a hypothesis. | journal = Cancer Epidemiol Biomarkers Prev | volume = 18 | issue = 11 | pages = 2895-8 | month = Nov | year = 2009 | doi = 10.1158/1055-9965.EPI-09-0731 | PMID = 19900938 }}</ref>

==Microscopic==
Features:<ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Infiltrative atypical cells - '''key feature'''.
**Infiltration into fat - ''diagnostic''.
**+/-Epithelioid cells - may be cytologically bland, i.e. benign appearing.
***Variable architecture: sheets, microglandular, tubulopapillary.
***+/-[[Psammoma bodies]].
**+/-Spindle cells.
*+/-''[[Ferruginous body]]'' - '''strongly supportive'''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/asbestos+body http://medical-dictionary.thefreedictionary.com/asbestos+body]. Accessed on: 4 November 2011.</ref>
** Looks like a (twirling) baton - segemented appearance, brown colour.
** Thin (asbestos) fiber in the core.

Notes:
*''Asbestos body'' is not strictly speaking a synonym for ''ferruginous body''.
*Don't diagnose ''mesothelioma in situ''.{{fact}}

DDx:<ref name=pmid15559051>{{Cite journal | last1 = Corson | first1 = JM. | title = Pathology of mesothelioma. | journal = Thorac Surg Clin | volume = 14 | issue = 4 | pages = 447-60 | month = Nov | year = 2004 | doi = 10.1016/j.thorsurg.2004.06.007 | PMID = 15559051 }}
</ref>
*[[Fibrosing pleuritis]] - should ''not'' have nodules, more cellular on the aspect adjacent to the effusion.
*Reactive mesothelial cells - may be atypical.
*Mesothelial hyperplasia.
*[[Adenocarcinoma]] - esp. [[lung adenocarcinoma]].
*[[Serous carcinoma]].

===Images===
<gallery>
Image:Ferruginous_body.jpg | Ferruginous body. (WC)
Image: Malignant epithelioid mesothelioma - low mag.jpg | MM - low mag.
Image: Malignant epithelioid mesothelioma - intermed mag.jpg | MM - intermed. mag.
Image: Malignant epithelioid mesothelioma - high mag.jpg | MM - high mag.
Image: Malignant epithelioid mesothelioma - very high mag.jpg | MM - very high mag.
Image: Malignant epithelioid mesothelioma - calretinin - intermed mag.jpg | MM - calretinin - intermed. mag.
Image: Malignant epithelioid mesothelioma - calretinin - high mag.jpg | MM - calretinin - high mag.
</gallery>

===Subtypes===
List of subtypes - mnemonic ''BEDS'':<ref name=pmid15559051/><ref name=Ref_WMSP156>{{Ref WMSP|156}}</ref>
*Biphasic mesothelioma.
**10%+ of epithelioid & 10%+ sarcomatoid.
*Epithelioid mesothelioma.
*Desmoplastic mesothelioma.
**Should be 50%+ dense tissue with storiform pattern & atypical cells.
*Sarcomatoid mesothelioma.
Other:
*Small cell mesothelioma.<ref name=pmid1310669>{{Cite journal | last1 = Mayall | first1 = FG. | last2 = Gibbs | first2 = AR. | title = The histology and immunohistochemistry of small cell mesothelioma. | journal = Histopathology | volume = 20 | issue = 1 | pages = 47-51 | month = Jan | year = 1992 | doi = | PMID = 1310669 }}</ref>

==Stains==
*PASD -ve.
*Mucicarmine -ve.
**Typically +ve in adenocarcinoma.

==IHC==
===Mesothelioma versus mesothelial hyperplasia===
Features:<ref name=pmid20209622>{{Cite journal | last1 = Hasteh | first1 = F. | last2 = Lin | first2 = GY. | last3 = Weidner | first3 = N. | last4 = Michael | first4 = CW. | title = The use of immunohistochemistry to distinguish reactive mesothelial cells from malignant mesothelioma in cytologic effusions. | journal = Cancer Cytopathol | volume = 118 | issue = 2 | pages = 90-6 | month = Apr | year = 2010 | doi = 10.1002/cncy.20071 | PMID = 20209622 }}</ref>
*EMA +ve ~100% (vs. ~10%).
*Desmin -ve ~5% (vs. ~85%).
*GLUT1 +ve ~50% (vs. ~10%)
*p53 +ve ~50% (vs. ~2%).

Note:
*The above are ''not'' very useful in individual cases.
*A simple pankeratin is useful for seening where epithelial cells are.

===Mesothelioma versus adenocarcinoma===
*Several panel exists - ''no agreed upon best panel''.<ref name=pmid18318582>{{cite journal |author=Marchevsky AM |title=Application of immunohistochemistry to the diagnosis of malignant mesothelioma |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=3 |pages=397-401 |year=2008 |month=March |pmid=18318582 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=132&page=397}}</ref>
**Usually two carcinoma markers + two mesothelial markers.

Panel:<ref name=pmid18318582/>
*Mesothelial markers:
**Calretinin.
**WT-1.
**D2-40.
**[[CK5/6]].
*Carcinoma markers:
**CEA (monoclonal and polyclonal).
**[[TTF-1]].
**[[Ber-EP4]].
**MOC-31.
**CD15.

===Other carcinoma markers===
*[[PAX8]] -ve.<ref name=pmid23846294>{{cite journal |author=Lee M, Alexander HR, Burke A |title=Diffuse mesothelioma of the peritoneum: a pathological study of 64 tumours treated with cytoreductive therapy |journal=Pathology |volume=45 |issue=5 |pages=464–73 |year=2013 |month=August |pmid=23846294 |doi=10.1097/PAT.0b013e3283631cce |url=}}</ref>
*Claudin-4.
**Mesothelioma may be focally positive.<ref name=pmid23775021>{{cite journal |author=Ohta Y, Sasaki Y, Saito M, ''et al.'' |title=Claudin-4 as a marker for distinguishing malignant mesothelioma from lung carcinoma and serous adenocarcinoma |journal=Int. J. Surg. Pathol. |volume=21 |issue=5 |pages=493–501 |year=2013 |month=October |pmid=23775021 |doi=10.1177/1066896913491320 |url=}}</ref>
*[[p63]] -ve.<ref name=pmid18064689>{{Cite journal | last1 = Pu | first1 = RT. | last2 = Pang | first2 = Y. | last3 = Michael | first3 = CW. | title = Utility of WT-1, p63, MOC31, mesothelin, and cytokeratin (K903 and CK5/6) immunostains in differentiating adenocarcinoma, squamous cell carcinoma, and malignant mesothelioma in effusions. | journal = Diagn Cytopathol | volume = 36 | issue = 1 | pages = 20-5 | month = Jan | year = 2008 | doi = 10.1002/dc.20747 | PMID = 18064689 }}</ref>
*[[CD138]] +ve.
**Usually -ve in mesothelioma.<ref name=pmid12866374>{{Cite journal | last1 = Chu | first1 = PG. | last2 = Arber | first2 = DA. | last3 = Weiss | first3 = LM. | title = Expression of T/NK-cell and plasma cell antigens in nonhematopoietic epithelioid neoplasms. An immunohistochemical study of 447 cases. | journal = Am J Clin Pathol | volume = 120 | issue = 1 | pages = 64-70 | month = Jul | year = 2003 | doi = 10.1309/48KC-17WA-U69B-TBXQ | PMID = 12866374 }}</ref>

==Molecular==
*p16 deletion by [[FISH]].<ref name=pmid24503757>{{cite journal |author=Hwang H, Tse C, Rodriguez S, Gown A, Churg A |title=p16 FISH deletion in surface epithelial mesothelial proliferations is predictive of underlying invasive mesothelioma |journal=Am. J. Surg. Pathol. |volume=38 |issue=5 |pages=681–8 |year=2014 |month=May |pmid=24503757 |doi=10.1097/PAS.0000000000000176 |url=}}</ref>

Notes:
*p16 IHC does ''not'' give the same result.
*Sensitivity of p16 deletion is low.

==Sign out==
<pre>
Pleural Tissue of Right Lung, Removal:
- MALIGNANT MESOTHELIOMA, epithelioid type.

Comment:
IHC confirms the morphologic impression.

The tumour stains as follows:
POSITIVE: calretinin (very strong), CK5/6.
NEGATIVE: TTF-1.
</pre>

==See also==
*[[Lung tumours]].
*[[Omentum]].
*[[Empyema peel]].

==References==
{{Reflist|2}}

[[Category:Diagnosis]]
[[Category:Pulmonary pathology]]

Adenocarcinoma of the lung

2018-07-16T12:04:33Z

Abraham: /* Microscopic */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Acinar pattern adenocarcinoma of lung -- low mag.jpg
| Width =
| Caption = Invasive adenocarcinoma, acinar pattern (right of image) and benign lung (left of image). [[H&E stain]].
| Synonyms =
| Micro = +/-nuclear atypia (may be absent in mucinous tumours), eccentrically placed nuclei, usu. abundant cytoplasm (classically with mucin vacuoles), often conspicuous [[nucleoli]], +/-[[nuclear pseudoinclusions]]
| Subtypes =
| LMDDx = [[atypical adenomatous hyperplasia of the lung]], adenocarcinoma in situ, [[squamous cell carcinoma of the lung]], [[small cell carcinoma of the lung]], [[non-small cell lung carcinoma]], [[malignant mesothelioma]], [[Metastasis|metastatic]] [[adenocarcinoma]] (esp. [[colorectal adenocarcinoma]], breast adenocarcinoma ([[invasive ductal carcinoma of the breast]], [[invasive lobular carcinoma]]))
| Stains =
| IHC = [[CK7]] +ve, [[TTF-1]] +ve, CK20 -ve, [[p40]] -ve, p63 -ve (usually)
| EM =
| Molecular = +/-KRAS mutations, +/-EGFR mutations, +/-ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion), +/-ROS1 rearrangements, +/-RET rearrangements
| IF =
| Gross =
| Grossing =
| Staging = [[lung cancer staging]]
| Site = [[lung]] - see ''[[lung tumours]]''
| Assdx =
| Syndromes =
| Clinicalhx =
| Signs =
| Symptoms =
| Prevalence = most common primary lung tumour
| Bloodwork =
| Rads = lung mass - typically peripheral lesion (distant from large airways), may be multifocal
| Endoscopy =
| Prognosis = dependent on stage (minimally invasive and noninvasive: very good; invasive: moderate)
| Other =
| ClinDDx = other [[lung tumours]] - primary and metastatic
| Tx = surgical resection if feasible
}}
'''Adenocarcinoma of the lung''', also '''lung adenocarcinoma''', is common malignant [[lung tumour]].

==General==
*Adenocarcinoma is the most common (primary lung cancer).<ref name=pmid19118313>{{cite journal |author=Lutschg JH |title=Lung cancer |journal=N. Engl. J. Med. |volume=360 |issue=1 |pages=87-8; author reply 88 |year=2009 |month=January |pmid=19118313 |doi=10.1056/NEJMc082208 |url=}}</ref>
*Adenocarcinoma is the non-smoker tumour - [[small cell carcinoma of the lung|SCLC]] and [[squamous cell carcinoma of the lung|squamous]] are more strongly associated with [[smoking]].
*Lung adenocarcinoma is the most common brain metastasis.<ref name=pmid22012633>{{Cite journal | last1 = Nayak | first1 = L. | last2 = Lee | first2 = EQ. | last3 = Wen | first3 = PY. | title = Epidemiology of brain metastases. | journal = Curr Oncol Rep | volume = 14 | issue = 1 | pages = 48-54 | month = Feb | year = 2012 | doi = 10.1007/s11912-011-0203-y | PMID = 22012633 }}</ref>

Treatment:
*Lung adenocarcinoma may be treated with [[EGFR inhibitors]] (e.g. gefitinib (Iressa), erlotinib (Tarceva)).<ref name=pmid20855837>{{cite journal |author=Sun Y, Ren Y, Fang Z, ''et al.'' |title=Lung adenocarcinoma from East Asian never-smokers is a disease largely defined by targetable oncogenic mutant kinases |journal=J. Clin. Oncol. |volume=28 |issue=30 |pages=4616–20 |year=2010 |month=October |pmid=20855837 |doi=10.1200/JCO.2010.29.6038 |url=}}</ref>

Patients that receive EGFR inhibitors classically are:<ref name=pmid21151896>{{cite journal |author=Job B, Bernheim A, Beau-Faller M, ''et al.'' |title=Genomic Aberrations in Lung Adenocarcinoma in Never Smokers |journal=PLoS One |volume=5 |issue=12 |pages=e15145 |year=2010 |pmid=21151896 |pmc=2997777 |doi=10.1371/journal.pone.0015145 |url=}}</ref>
*Non-smokers.
*Female.
*Asian.
**Caucasians also benefit.<ref name=pmid20973798>{{Cite journal | last1 = Rosell | first1 = R. | last2 = Moran | first2 = T. | last3 = Cardenal | first3 = F. | last4 = Porta | first4 = R. | last5 = Viteri | first5 = S. | last6 = Molina | first6 = MA. | last7 = Benlloch | first7 = S. | last8 = Taron | first8 = M. | title = Predictive biomarkers in the management of EGFR mutant lung cancer. | journal = Ann N Y Acad Sci | volume = 1210 | issue = | pages = 45-52 | month = Oct | year = 2010 | doi = 10.1111/j.1749-6632.2010.05775.x | PMID = 20973798 }}</ref>

==Gross==
*Classically peripheral lesions.
*May be multifocal.

===Image===
<gallery>
Image:Adenocarcinoma (3950819000).jpg | Lung adenocarcinoma. (WC/Rosen)
</gallery>

==Microscopic==
Features:
*+/-Nuclear atypia - '''important'''.
**May be absent in mucinous tumours - may look similar to foveolar epithelium.
*Eccentrically placed nuclei.
*Abundant cytoplasm - classically with mucin vacuoles.
*Often conspicuous [[nucleoli]].
*+/-[[Nuclear pseudoinclusions]].

Negatives:
*Lack of intercellular bridges.

Patterns:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
*Lepidic - tumour grows long the alveolar wall; means ''scaly covering''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/lepidic http://medical-dictionary.thefreedictionary.com/lepidic]. Accessed on: 8 August 2013.</ref> At lower power, the shapes should still resemble lung acini.
*Acinar - berry-shaped glands, smaller than lung acini.
*Papillary - fibrovascular cores.
*Micropapillary - nipple shaped projections without fibrovascular cores.
*Solid - sheet of cells.

Notes:
*[[Lymphovascular invasion]] is common.
*Micropapillary predominant pattern and tumours with any amount of the lepidic pattern are associated with EGFR mutations.<ref name=pmid21970488>{{Cite journal | last1 = Shim | first1 = HS. | last2 = Lee | first2 = da H. | last3 = Park | first3 = EJ. | last4 = Kim | first4 = SH. | title = Histopathologic characteristics of lung adenocarcinomas with epidermal growth factor receptor mutations in the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification. | journal = Arch Pathol Lab Med | volume = 135 | issue = 10 | pages = 1329-34 | month = Oct | year = 2011 | doi = 10.5858/arpa.2010-0493-OA | PMID = 21970488 }}</ref>

DDx:
*[[Atypical adenomatous hyperplasia of the lung]] - spaced [[hobnail]] cells, mild-to-moderate nuclear atypia, small lesion (< 5 mm).
*Adenocarcinoma in situ.
*[[Papillary thyroid carcinoma|Papillary carcinoma of thyroid]].
*[[Squamous cell carcinoma of the lung]].
*[[Small cell carcinoma of the lung]].
*[[Adenoid Cystic Carcinoma]].
*[[Non-small cell lung carcinoma]] - diagnosis should be avoided if possible.
*[[Malignant mesothelioma]].
*[[Metastasis|Metastatic]] adenocarcinoma.
**[[Colorectal adenocarcinoma]].
**Breast adenocarcinoma.
***[[Invasive ductal carcinoma of the breast]].
***[[Invasive lobular carcinoma]].
**Other carcinomas.
*Carcinomas of the bronchial glands, e.g. [[adenoid cystic carcinoma]].

===Images===
=====Acinar adenocarcinoma=====
<gallery>
Image: Acinar pattern adenocarcinoma of lung -- low mag.jpg | Acinar LA - low mag.
Image: Acinar pattern adenocarcinoma of lung -- intermed mag.jpg | Acinar LA - intermed. mag.
Image: Acinar pattern adenocarcinoma of lung -- high mag.jpg | Acinar LA - high mag.
Image: Acinar pattern adenocarcinoma of lung -- very high mag.jpg | Acinar LA - very high mag.
Image: Acinar pattern adenocarcinoma of lung - alt -- very high mag.jpg | Acinar LA - very high mag.
</gallery>
<gallery>
Image:Adenocarcinoma, acinar subtype (3923397562).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
Image:Adenocarcinoma,_acinar_subtype_(4420421886).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
</gallery>
=====Mucinous adenocarcinoma=====
<gallery>
Image: Mucinous adenocarcinoma of the lung -- low mag.jpg | MAL - low mag.
Image: Mucinous adenocarcinoma of the lung -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous adenocarcinoma of the lung -- high mag.jpg | MAL - high mag.
Image: Mucinous adenocarcinoma of the lung -- very high mag.jpg | MAL - very high mag.
</gallery>
<gallery>
Image: Mucinous lung adenocarcinoma -- low mag.jpg | MAL - low mag.
Image: Mucinous lung adenocarcinoma -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous lung adenocarcinoma -- high mag.jpg | MAL - high mag.
Image: Mucinous lung adenocarcinoma and airway -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous lung adenocarcinoma and airway -- high mag.jpg | MAL - high mag.
Image: Mucinous lung adenocarcinoma and airway - alt -- high mag.jpg | MAL - high mag.
</gallery>
<gallery>
Image:Bronchioloalveolar carcinoma, mucinous type 2.jpg |BAC - mucinous type - low mag. (WC/Yale Rosen)
Image:Bronchioloalveolar carcinoma, mucinous type.jpg | BAC - mucinous type - high mag. (WC/Yale Rosen)
</gallery>

=====Papillary adenocarcinoma=====
<gallery>
Image: Papillary adenocarcinoma of the lung -- very low mag.jpg | PAL - very low mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- low mag.jpg | PAL - low mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- intermed mag.jpg | PAL - intermed. mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- high mag.jpg | PAL - high mag. (WC/Nephron)
</gallery>

====Fetal adenocarcinoma====
<gallery>
Image: Fetal adenocarcinoma of the lung -- very low mag.jpg | FAL - very low mag. (WC)
Image: Fetal adenocarcinoma of the lung - alt2 -- very low mag.jpg | FAL - very low mag. (WC)
Image: Fetal adenocarcinoma of the lung -- low mag.jpg | FAL - low mag. (WC)
Image: Fetal adenocarcinoma of the lung -- intermed mag.jpg | FAL - intermed. mag. (WC)
Image: Fetal adenocarcinoma of the lung -- high mag.jpg | FAL - high mag. (WC)
</gallery>

====www====
*[http://www.pathpedia.com/education/eatlas/histopathology/lung_and_bronchi/bronchioloalveolar_carcinoma_mucinous.aspx BAC mucinous type adjacent to benign (pathpedia.com)].
*[http://cancergrace.org/wp-content/uploads/2007/05/mucinous-vs-nonmucinous-bac-histology.jpg BAC mucinous and nonmucinous (cancergrace.org)].<ref>URL: [http://cancergrace.org/lung/2007/05/14/bac-mucinous-and-non-mucinous/ http://cancergrace.org/lung/2007/05/14/bac-mucinous-and-non-mucinous/]. Accessed on: 8 August 2013.</ref>
*[https://www.flickr.com/photos/pulmonary_pathology/7589291672/ Lepidic adenocarcinoma with invasive (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292214/in/photostream/ Lepidic adenocarcinoma (flickr.com/Yale Rosen)].
*[http://www.rosaicollection.org/searchresults.cfm/ Lepidic adenocarcinoma (rosaicollection.org/index.cfm)].
*[http://pathlabmed.typepad.com/surgical_pathology_and_la/2010/09/digital-case-challenge-non-mucinous-bronchioloalveolar-adenocarcinoma.html Mucinous adenocarcinoma (pathlabmed.typepad.com)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292780/in/photostream/ Non-mucinous adenocarcinoma in situ (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292496/in/photostream/ Non-mucinous adenocarcinoma in situ (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589290010/in/photostream/ Acinar adenocarcinoma (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589289274/in/photostream/ Acinar adenocarcinoma (flickr.com/Yale Rosen)].

===Classification===
Classification based on extent:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
#Adenocarcinoma in situ (AIS) - previously known as [[BAC]].
#*Subtypes: nonmucinous, mucinous, mixed mucinous/nonmucinous.
#*Definition: lack of invasion into the stroma, vascular spaces and pleura.
#*Must have a lepidic growth pattern.<ref name=pmid22214965>{{Cite journal | last1 = Borczuk | first1 = AC. | title = Assessment of invasion in lung adenocarcinoma classification, including adenocarcinoma in situ and minimally invasive adenocarcinoma. | journal = Mod Pathol | volume = 25 Suppl 1 | issue = | pages = S1-10 | month = Jan | year = 2012 | doi = 10.1038/modpathol.2011.151 | PMID = 22214965 }}</ref>
#Minimally invasive adenocarcinoma (MIA).
#*Lepidic growth with up to 5 mm of invasion.
#*Subtypes: nonmucinous (most common), mucinous (uncommon), mixed (mucinous/nonmucinous).
#*Should not have [[lymphovascular invasion]].{{fact}}
#Invasive adenocarcinoma:
#*Subtypes: micropapillary, mucinous (previously ''mucinous BAC''), colloid, fetal, enteric.

====Grading====
Graded G1-G4 - as per CAP protocol (version 3.4.0.0):<ref name=cap_protocol>CAP Lung protocol. Version: 3.4.0.0. URL: [http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf]. Accessed on: March 23, 2016.</ref>
*G1 = lepidic.
*G2 = acinar, papillary, cribriform.
*G3 = micropapillary, solid, mucinous, colloid.
*G4 = undifferentiated - '''not''' used for lung adenocarcinoma; it used for small cell carcinoma and large cell carcinoma.

Note:
*There is no consensus currently on grading - as per the international consensus guidelines of 2011.<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>

==Special stains==
*[[Mucicarmine]] +ve, cytoplasmic.
*[[PAS-diastase]] +ve, cytoplasmic.

==IHC==
Primary versus metastatic:
*TTF-1 +ve.
*CK7 +ve.
*CK20 -ve.

Panel for adenocarcinoma versus SCC:
*TTF-1 +ve.
*[[Napsin]] A +ve.
*[[p40]] -ve.<ref name=pmid22056955>{{Cite journal | last1 = Bishop | first1 = JA. | last2 = Teruya-Feldstein | first2 = J. | last3 = Westra | first3 = WH. | last4 = Pelosi | first4 = G. | last5 = Travis | first5 = WD. | last6 = Rekhtman | first6 = N. | title = p40 (ΔNp63) is superior to p63 for the diagnosis of pulmonary squamous cell carcinoma. | journal = Mod Pathol | volume = 25 | issue = 3 | pages = 405-15 | month = Mar | year = 2012 | doi = 10.1038/modpathol.2011.173 | PMID = 22056955 }}</ref>
*CK5/6 -ve.

Others:
*p63 -ve -- occasionally +ve.
*Vimentin -ve/+ve (+ve relatively common).
**Poor prognosticator.<ref>{{Cite journal | last1 = Dauphin | first1 = M. | last2 = Barbe | first2 = C. | last3 = Lemaire | first3 = S. | last4 = Nawrocki-Raby | first4 = B. | last5 = Lagonotte | first5 = E. | last6 = Delepine | first6 = G. | last7 = Birembaut | first7 = P. | last8 = Gilles | first8 = C. | last9 = Polette | first9 = M. | title = Vimentin expression predicts the occurrence of metastases in non small cell lung carcinomas. | journal = Lung Cancer | volume = 81 | issue = 1 | pages = 117-22 | month = Jul | year = 2013 | doi = 10.1016/j.lungcan.2013.03.011 | PMID = 23562674 }}</ref>

Note:
*In mucinous adenocarcinoma of the lung TTF-1 is usu. -ve (46% +ve) and napsin is usu. -ve (36% +ve).
**Positive staining is unusual but useful if present, as metastatic disease is uniformily negative for both.<ref name=pmid24651909>{{Cite journal | last1 = Rossi | first1 = G. | last2 = Cavazza | first2 = A. | last3 = Righi | first3 = L. | last4 = Sartori | first4 = G. | last5 = Bisagni | first5 = A. | last6 = Longo | first6 = L. | last7 = Pelosi | first7 = G. | last8 = Papotti | first8 = M. | title = Napsin-A, TTF-1, EGFR, and ALK Status Determination in Lung Primary and Metastatic Mucin-Producing Adenocarcinomas. | journal = Int J Surg Pathol | volume = 22 | issue = 5 | pages = 401-7 | month = Aug | year = 2014 | doi = 10.1177/1066896914527609 | PMID = 24651909 }}
</ref>

==Molecular==
*EGFR mutations (typically assessed by PCR) - respond to [[TKI]]s (e.g. [[gefitinib]], [[erlotinib]]) if:<ref name=pmid19680292>{{Cite journal | last1 = John | first1 = T. | last2 = Liu | first2 = G. | last3 = Tsao | first3 = MS. | title = Overview of molecular testing in non-small-cell lung cancer: mutational analysis, gene copy number, protein expression and other biomarkers of EGFR for the prediction of response to tyrosine kinase inhibitors. | journal = Oncogene | volume = 28 Suppl 1 | issue = | pages = S14-23 | month = Aug | year = 2009 | doi = 10.1038/onc.2009.197 | PMID = 19680292 }}</ref>
**Exon 19 deletion.
**Exon 21 L858R.
***Natural history of mutation is suspected to have a better prognosis vs. wild-type.<ref>URL: [http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r]. Accessed on: 27 April 2012.</ref>
**[[KRAS mutations]] are absent, i.e. ''wild-type KRAS''.<ref>{{Cite journal | last1 = Pao | first1 = W. | last2 = Wang | first2 = TY. | last3 = Riely | first3 = GJ. | last4 = Miller | first4 = VA. | last5 = Pan | first5 = Q. | last6 = Ladanyi | first6 = M. | last7 = Zakowski | first7 = MF. | last8 = Heelan | first8 = RT. | last9 = Kris | first9 = MG. | title = KRAS mutations and primary resistance of lung adenocarcinomas to gefitinib or erlotinib. | journal = PLoS Med | volume = 2 | issue = 1 | pages = e17 | month = Jan | year = 2005 | doi = 10.1371/journal.pmed.0020017 | PMID = 15696205 }}</ref>

*ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion).<ref name=pmid21245935>{{Cite journal | last1 = Li | first1 = Y. | last2 = Ye | first2 = X. | last3 = Liu | first3 = J. | last4 = Zha | first4 = J. | last5 = Pei | first5 = L. | title = Evaluation of EML4-ALK fusion proteins in non-small cell lung cancer using small molecule inhibitors. | journal = Neoplasia | volume = 13 | issue = 1 | pages = 1-11 | month = Jan | year = 2011 | doi = | PMID = 21245935 }}</ref>
**Associated with a poor prognosis.<ref name=pmid22134072>{{Cite journal | last1 = Yang | first1 = P. | last2 = Kulig | first2 = K. | last3 = Boland | first3 = JM. | last4 = Erickson-Johnson | first4 = MR. | last5 = Oliveira | first5 = AM. | last6 = Wampfler | first6 = J. | last7 = Jatoi | first7 = A. | last8 = Deschamps | first8 = C. | last9 = Marks | first9 = R. | title = Worse disease-free survival in never-smokers with ALK+ lung adenocarcinoma. | journal = J Thorac Oncol | volume = 7 | issue = 1 | pages = 90-7 | month = Jan | year = 2012 | doi = 10.1097/JTO.0b013e31823c5c32 | PMID = 22134072 }}</ref>
**Amenable to treatment with TKI.
**See ''[[lung carcinoma with ALK rearrangement]].
**Do ''not'' occur with EGRF mutations ''or'' KRAS mutations.<ref name=pmid23729361>{{Cite journal | last1 = Gainor | first1 = JF. | last2 = Varghese | first2 = AM. | last3 = Ou | first3 = SH. | last4 = Kabraji | first4 = S. | last5 = Awad | first5 = MM. | last6 = Katayama | first6 = R. | last7 = Pawlak | first7 = A. | last8 = Mino-Kenudson | first8 = M. | last9 = Yeap | first9 = BY. | title = ALK rearrangements are mutually exclusive with mutations in EGFR or KRAS: an analysis of 1,683 patients with non-small cell lung cancer. | journal = Clin Cancer Res | volume = 19 | issue = 15 | pages = 4273-81 | month = Aug | year = 2013 | doi = 10.1158/1078-0432.CCR-13-0318 | PMID = 23729361 }}</ref>

*ROS1 - good response to crizotinib.<ref name=pmid25264305>{{Cite journal | last1 = Shaw | first1 = AT. | last2 = Ou | first2 = SH. | last3 = Bang | first3 = YJ. | last4 = Camidge | first4 = DR. | last5 = Solomon | first5 = BJ. | last6 = Salgia | first6 = R. | last7 = Riely | first7 = GJ. | last8 = Varella-Garcia | first8 = M. | last9 = Shapiro | first9 = GI. | title = Crizotinib in ROS1-rearranged non-small-cell lung cancer. | journal = N Engl J Med | volume = 371 | issue = 21 | pages = 1963-71 | month = Nov | year = 2014 | doi = 10.1056/NEJMoa1406766 | PMID = 25264305 }}</ref>
**Approximately 1% of NSCLC.<ref name=pmid25409376>{{Cite journal | last1 = Gold | first1 = KA. | title = ROS1--targeting the one percent in lung cancer. | journal = N Engl J Med | volume = 371 | issue = 21 | pages = 2030-1 | month = Nov | year = 2014 | doi = 10.1056/NEJMe1411319 | PMID = 25409376 }}</ref>

==Sign out==
===Biopsy===
Consensus recommendations:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
*''Adenocarcinoma in situ'' (AIS) and ''minimally invasive adenocarcinoma'' should '''not''' be used in the reporting of small biopsies and cytology.
**Tumours with a non-invasive pattern are referred to by their pattern, e.g. ''lepidic growth'', '''not''' as AIS.

<pre>
Lung, Right Upper Lobe, Core Biopsy:
- INVASIVE ADENOCARCINOMA, NON-MUCINOUS.

Comment:
The adenocarcinoma is positive for TTF-1 and napsin. EGFR/ALK testing was ordered.
</pre>

=====Mucinous adenocarcinoma with noncontributory stains=====
<pre>
Lung, Right Upper Lobe, Core Biopsy:
- ADENOCARCINOMA, MUCINOUS, see comment.

Comment:
The adenocarcinoma is negative for both napsin and TTF-1. EGFR/ALK testing was ordered.

The findings are compatible with a primary or secondary adenocarcinoma; clinical and
radiologic correlation is required.
</pre>

====Block letters====
<pre>
LUNG, LEFT, BIOPSY:
- ADENOCARCINOMA, LEPIDIC GROWTH; INVASION CANNOT BE EXCLUDED IN THIS SMALL SPECIMEN.
</pre>

<pre>
LUNG, RIGHT UPPER LOBE, NEEDLE BIOPSY:
- INVASIVE ADENOCARCINOMA, NON-MUCINOUS.

COMMENT:
The tumour stains as follows:
POSITIVE: TTF-1.
NEGATIVE: p40.

The immunoprofile is compatible with lung adenocarcinoma.
</pre>

<pre>
MASS, LEFT LOWER LOBE OF LUNG, BIOPSY:
- INVASIVE ADENOCARCINOMA.

COMMENT:
The tumour is positive for TTF-1.

Tissue will be sent for molecular testing and the results reported as an addendum.
</pre>

===Resection===
<pre>
LUNG, LEFT UPPER LOBE, LOBECTOMY:
- ADENOCARCINOMA WITH AN ACINAR PATTERN, SOLID PATTERN, MICROPAPILLARY PATTERN
AND LEPIDIC PATTERN -- PATTERNS IN ORDER OF PREVALENCE.
- MARGINS NEGATIVE FOR MALIGNANCY.
- THREE LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/3).
- PLEASE SEE TUMOUR SUMMARY.
</pre>

<pre>
LUNG, RIGHT UPPER LOBE, LOBECTOMY:
- MULTIPLE ADENOCARCINOMAS (x2) WITH AN ACINAR PATTERN, SOLID PATTERN, MICROPAPILLARY PATTERN
AND LEPIDIC PATTERN -- PATTERNS IN ORDER OF PREVALENCE.
- MARGINS NEGATIVE FOR MALIGNANCY.
- FOUR LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/4).
- LYMPHOVASCULAR INVASION PRESENT.
- PLEASE SEE TUMOUR SUMMARY AND COMMENT.

COMMENT:
The histology of the two adenocarcinomas resemble one another and lymphovascular
invasion is present. These findings favour that the smaller tumor is a metastasis, rather
than a synchronous primary.
</pre>

===Micro===
<pre>
Size (tissue): scant tissue (<0.5 cm).
Gland formation: focal, poorly formed.
Cell size: large.
Cytoplasm: moderate-to-abundant, grey-eosinophilic.
Nucleus location: eccentric.
Nuclear pleomorphism: moderate.
Nuclear moulding: absent.
Nucleoli: present, prominent.
Nuclear pseudoinclusions: present.
</pre>

<pre>
Number of cores: 3.
Length of cores (total): 2.0 cm.

Gland formation: present.
Cell size: large.
Cytoplasm: moderate, grey-eosinophilic.
Necrosis: none apparent.
Mucin: none.

Nucleus location: eccentric.
Nuclear pleomorphism: moderate.
Nuclear moulding: absent.
Nuclear pseudoinclusions: absent.
Nuclear shape/arrangment: cigar-like/pseudostratified.
Nucleoli: present.
</pre>

====Mucinous====
The sections show cores with well-formed glands composed of foveolar-like columnar cells with a relatively bland cytomorphology. Mitotic activity is not readily apparent. A small amount of non-lesional lung parenchyma is present.

===Lung cancer staging===
{{Main|Lung cancer staging}}

==See also==
*[[Lung tumours]].
*[[Adenocarcinoma]].
*[[Metastasis]].
*[[Lung carcinoma with ALK rearrangement]].

==References==
{{Reflist|2}}

==External links==
*[http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-staging Lung cancer staging (cancer.org)].
*[http://www.nucmedresource.com/thoracic-nodal-stations.html Thoracic lymph node stations (nucmedresource.com)].

[[Category:Diagnosis]]
[[Category:Lung tumours]]

Adenocarcinoma of the lung

2018-07-11T12:02:53Z

Abraham: /* www */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Acinar pattern adenocarcinoma of lung -- low mag.jpg
| Width =
| Caption = Invasive adenocarcinoma, acinar pattern (right of image) and benign lung (left of image). [[H&E stain]].
| Synonyms =
| Micro = +/-nuclear atypia (may be absent in mucinous tumours), eccentrically placed nuclei, usu. abundant cytoplasm (classically with mucin vacuoles), often conspicuous [[nucleoli]], +/-[[nuclear pseudoinclusions]]
| Subtypes =
| LMDDx = [[atypical adenomatous hyperplasia of the lung]], adenocarcinoma in situ, [[squamous cell carcinoma of the lung]], [[small cell carcinoma of the lung]], [[non-small cell lung carcinoma]], [[malignant mesothelioma]], [[Metastasis|metastatic]] [[adenocarcinoma]] (esp. [[colorectal adenocarcinoma]], breast adenocarcinoma ([[invasive ductal carcinoma of the breast]], [[invasive lobular carcinoma]]))
| Stains =
| IHC = [[CK7]] +ve, [[TTF-1]] +ve, CK20 -ve, [[p40]] -ve, p63 -ve (usually)
| EM =
| Molecular = +/-KRAS mutations, +/-EGFR mutations, +/-ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion), +/-ROS1 rearrangements, +/-RET rearrangements
| IF =
| Gross =
| Grossing =
| Staging = [[lung cancer staging]]
| Site = [[lung]] - see ''[[lung tumours]]''
| Assdx =
| Syndromes =
| Clinicalhx =
| Signs =
| Symptoms =
| Prevalence = most common primary lung tumour
| Bloodwork =
| Rads = lung mass - typically peripheral lesion (distant from large airways), may be multifocal
| Endoscopy =
| Prognosis = dependent on stage (minimally invasive and noninvasive: very good; invasive: moderate)
| Other =
| ClinDDx = other [[lung tumours]] - primary and metastatic
| Tx = surgical resection if feasible
}}
'''Adenocarcinoma of the lung''', also '''lung adenocarcinoma''', is common malignant [[lung tumour]].

==General==
*Adenocarcinoma is the most common (primary lung cancer).<ref name=pmid19118313>{{cite journal |author=Lutschg JH |title=Lung cancer |journal=N. Engl. J. Med. |volume=360 |issue=1 |pages=87-8; author reply 88 |year=2009 |month=January |pmid=19118313 |doi=10.1056/NEJMc082208 |url=}}</ref>
*Adenocarcinoma is the non-smoker tumour - [[small cell carcinoma of the lung|SCLC]] and [[squamous cell carcinoma of the lung|squamous]] are more strongly associated with [[smoking]].
*Lung adenocarcinoma is the most common brain metastasis.<ref name=pmid22012633>{{Cite journal | last1 = Nayak | first1 = L. | last2 = Lee | first2 = EQ. | last3 = Wen | first3 = PY. | title = Epidemiology of brain metastases. | journal = Curr Oncol Rep | volume = 14 | issue = 1 | pages = 48-54 | month = Feb | year = 2012 | doi = 10.1007/s11912-011-0203-y | PMID = 22012633 }}</ref>

Treatment:
*Lung adenocarcinoma may be treated with [[EGFR inhibitors]] (e.g. gefitinib (Iressa), erlotinib (Tarceva)).<ref name=pmid20855837>{{cite journal |author=Sun Y, Ren Y, Fang Z, ''et al.'' |title=Lung adenocarcinoma from East Asian never-smokers is a disease largely defined by targetable oncogenic mutant kinases |journal=J. Clin. Oncol. |volume=28 |issue=30 |pages=4616–20 |year=2010 |month=October |pmid=20855837 |doi=10.1200/JCO.2010.29.6038 |url=}}</ref>

Patients that receive EGFR inhibitors classically are:<ref name=pmid21151896>{{cite journal |author=Job B, Bernheim A, Beau-Faller M, ''et al.'' |title=Genomic Aberrations in Lung Adenocarcinoma in Never Smokers |journal=PLoS One |volume=5 |issue=12 |pages=e15145 |year=2010 |pmid=21151896 |pmc=2997777 |doi=10.1371/journal.pone.0015145 |url=}}</ref>
*Non-smokers.
*Female.
*Asian.
**Caucasians also benefit.<ref name=pmid20973798>{{Cite journal | last1 = Rosell | first1 = R. | last2 = Moran | first2 = T. | last3 = Cardenal | first3 = F. | last4 = Porta | first4 = R. | last5 = Viteri | first5 = S. | last6 = Molina | first6 = MA. | last7 = Benlloch | first7 = S. | last8 = Taron | first8 = M. | title = Predictive biomarkers in the management of EGFR mutant lung cancer. | journal = Ann N Y Acad Sci | volume = 1210 | issue = | pages = 45-52 | month = Oct | year = 2010 | doi = 10.1111/j.1749-6632.2010.05775.x | PMID = 20973798 }}</ref>

==Gross==
*Classically peripheral lesions.
*May be multifocal.

===Image===
<gallery>
Image:Adenocarcinoma (3950819000).jpg | Lung adenocarcinoma. (WC/Rosen)
</gallery>

==Microscopic==
Features:
*+/-Nuclear atypia - '''important'''.
**May be absent in mucinous tumours - may look similar to foveolar epithelium.
*Eccentrically placed nuclei.
*Abundant cytoplasm - classically with mucin vacuoles.
*Often conspicuous [[nucleoli]].
*+/-[[Nuclear pseudoinclusions]].

Negatives:
*Lack of intercellular bridges.

Patterns:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
*Lepidic - tumour grows long the alveolar wall; means ''scaly covering''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/lepidic http://medical-dictionary.thefreedictionary.com/lepidic]. Accessed on: 8 August 2013.</ref> At lower power, the shapes should still resemble lung acini.
*Acinar - berry-shaped glands, smaller than lung acini.
*Papillary - fibrovascular cores.
*Micropapillary - nipple shaped projections without fibrovascular cores.
*Solid - sheet of cells.

Notes:
*[[Lymphovascular invasion]] is common.
*Micropapillary predominant pattern and tumours with any amount of the lepidic pattern are associated with EGFR mutations.<ref name=pmid21970488>{{Cite journal | last1 = Shim | first1 = HS. | last2 = Lee | first2 = da H. | last3 = Park | first3 = EJ. | last4 = Kim | first4 = SH. | title = Histopathologic characteristics of lung adenocarcinomas with epidermal growth factor receptor mutations in the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification. | journal = Arch Pathol Lab Med | volume = 135 | issue = 10 | pages = 1329-34 | month = Oct | year = 2011 | doi = 10.5858/arpa.2010-0493-OA | PMID = 21970488 }}</ref>

DDx:
*[[Atypical adenomatous hyperplasia of the lung]] - spaced [[hobnail]] cells, mild-to-moderate nuclear atypia, small lesion (< 5 mm).
*Adenocarcinoma in situ.
*[[Papillary thyroid carcinoma|Papillary carcinoma of thyroid]].
*[[Squamous cell carcinoma of the lung]].
*[[Small cell carcinoma of the lung]].
*[[Non-small cell lung carcinoma]] - diagnosis should be avoided if possible.
*[[Malignant mesothelioma]].
*[[Metastasis|Metastatic]] adenocarcinoma.
**[[Colorectal adenocarcinoma]].
**Breast adenocarcinoma.
***[[Invasive ductal carcinoma of the breast]].
***[[Invasive lobular carcinoma]].
**Other carcinomas.
*Carcinomas of the bronchial glands, e.g. [[adenoid cystic carcinoma]].

===Images===
=====Acinar adenocarcinoma=====
<gallery>
Image: Acinar pattern adenocarcinoma of lung -- low mag.jpg | Acinar LA - low mag.
Image: Acinar pattern adenocarcinoma of lung -- intermed mag.jpg | Acinar LA - intermed. mag.
Image: Acinar pattern adenocarcinoma of lung -- high mag.jpg | Acinar LA - high mag.
Image: Acinar pattern adenocarcinoma of lung -- very high mag.jpg | Acinar LA - very high mag.
Image: Acinar pattern adenocarcinoma of lung - alt -- very high mag.jpg | Acinar LA - very high mag.
</gallery>
<gallery>
Image:Adenocarcinoma, acinar subtype (3923397562).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
Image:Adenocarcinoma,_acinar_subtype_(4420421886).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
</gallery>
=====Mucinous adenocarcinoma=====
<gallery>
Image: Mucinous adenocarcinoma of the lung -- low mag.jpg | MAL - low mag.
Image: Mucinous adenocarcinoma of the lung -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous adenocarcinoma of the lung -- high mag.jpg | MAL - high mag.
Image: Mucinous adenocarcinoma of the lung -- very high mag.jpg | MAL - very high mag.
</gallery>
<gallery>
Image: Mucinous lung adenocarcinoma -- low mag.jpg | MAL - low mag.
Image: Mucinous lung adenocarcinoma -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous lung adenocarcinoma -- high mag.jpg | MAL - high mag.
Image: Mucinous lung adenocarcinoma and airway -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous lung adenocarcinoma and airway -- high mag.jpg | MAL - high mag.
Image: Mucinous lung adenocarcinoma and airway - alt -- high mag.jpg | MAL - high mag.
</gallery>
<gallery>
Image:Bronchioloalveolar carcinoma, mucinous type 2.jpg |BAC - mucinous type - low mag. (WC/Yale Rosen)
Image:Bronchioloalveolar carcinoma, mucinous type.jpg | BAC - mucinous type - high mag. (WC/Yale Rosen)
</gallery>

=====Papillary adenocarcinoma=====
<gallery>
Image: Papillary adenocarcinoma of the lung -- very low mag.jpg | PAL - very low mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- low mag.jpg | PAL - low mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- intermed mag.jpg | PAL - intermed. mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- high mag.jpg | PAL - high mag. (WC/Nephron)
</gallery>

====Fetal adenocarcinoma====
<gallery>
Image: Fetal adenocarcinoma of the lung -- very low mag.jpg | FAL - very low mag. (WC)
Image: Fetal adenocarcinoma of the lung - alt2 -- very low mag.jpg | FAL - very low mag. (WC)
Image: Fetal adenocarcinoma of the lung -- low mag.jpg | FAL - low mag. (WC)
Image: Fetal adenocarcinoma of the lung -- intermed mag.jpg | FAL - intermed. mag. (WC)
Image: Fetal adenocarcinoma of the lung -- high mag.jpg | FAL - high mag. (WC)
</gallery>

====www====
*[http://www.pathpedia.com/education/eatlas/histopathology/lung_and_bronchi/bronchioloalveolar_carcinoma_mucinous.aspx BAC mucinous type adjacent to benign (pathpedia.com)].
*[http://cancergrace.org/wp-content/uploads/2007/05/mucinous-vs-nonmucinous-bac-histology.jpg BAC mucinous and nonmucinous (cancergrace.org)].<ref>URL: [http://cancergrace.org/lung/2007/05/14/bac-mucinous-and-non-mucinous/ http://cancergrace.org/lung/2007/05/14/bac-mucinous-and-non-mucinous/]. Accessed on: 8 August 2013.</ref>
*[https://www.flickr.com/photos/pulmonary_pathology/7589291672/ Lepidic adenocarcinoma with invasive (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292214/in/photostream/ Lepidic adenocarcinoma (flickr.com/Yale Rosen)].
*[http://www.rosaicollection.org/searchresults.cfm/ Lepidic adenocarcinoma (rosaicollection.org/index.cfm)].
*[http://pathlabmed.typepad.com/surgical_pathology_and_la/2010/09/digital-case-challenge-non-mucinous-bronchioloalveolar-adenocarcinoma.html Mucinous adenocarcinoma (pathlabmed.typepad.com)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292780/in/photostream/ Non-mucinous adenocarcinoma in situ (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292496/in/photostream/ Non-mucinous adenocarcinoma in situ (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589290010/in/photostream/ Acinar adenocarcinoma (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589289274/in/photostream/ Acinar adenocarcinoma (flickr.com/Yale Rosen)].

===Classification===
Classification based on extent:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
#Adenocarcinoma in situ (AIS) - previously known as [[BAC]].
#*Subtypes: nonmucinous, mucinous, mixed mucinous/nonmucinous.
#*Definition: lack of invasion into the stroma, vascular spaces and pleura.
#*Must have a lepidic growth pattern.<ref name=pmid22214965>{{Cite journal | last1 = Borczuk | first1 = AC. | title = Assessment of invasion in lung adenocarcinoma classification, including adenocarcinoma in situ and minimally invasive adenocarcinoma. | journal = Mod Pathol | volume = 25 Suppl 1 | issue = | pages = S1-10 | month = Jan | year = 2012 | doi = 10.1038/modpathol.2011.151 | PMID = 22214965 }}</ref>
#Minimally invasive adenocarcinoma (MIA).
#*Lepidic growth with up to 5 mm of invasion.
#*Subtypes: nonmucinous (most common), mucinous (uncommon), mixed (mucinous/nonmucinous).
#*Should not have [[lymphovascular invasion]].{{fact}}
#Invasive adenocarcinoma:
#*Subtypes: micropapillary, mucinous (previously ''mucinous BAC''), colloid, fetal, enteric.

====Grading====
Graded G1-G4 - as per CAP protocol (version 3.4.0.0):<ref name=cap_protocol>CAP Lung protocol. Version: 3.4.0.0. URL: [http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf]. Accessed on: March 23, 2016.</ref>
*G1 = lepidic.
*G2 = acinar, papillary, cribriform.
*G3 = micropapillary, solid, mucinous, colloid.
*G4 = undifferentiated - '''not''' used for lung adenocarcinoma; it used for small cell carcinoma and large cell carcinoma.

Note:
*There is no consensus currently on grading - as per the international consensus guidelines of 2011.<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>

==Special stains==
*[[Mucicarmine]] +ve, cytoplasmic.
*[[PAS-diastase]] +ve, cytoplasmic.

==IHC==
Primary versus metastatic:
*TTF-1 +ve.
*CK7 +ve.
*CK20 -ve.

Panel for adenocarcinoma versus SCC:
*TTF-1 +ve.
*[[Napsin]] A +ve.
*[[p40]] -ve.<ref name=pmid22056955>{{Cite journal | last1 = Bishop | first1 = JA. | last2 = Teruya-Feldstein | first2 = J. | last3 = Westra | first3 = WH. | last4 = Pelosi | first4 = G. | last5 = Travis | first5 = WD. | last6 = Rekhtman | first6 = N. | title = p40 (ΔNp63) is superior to p63 for the diagnosis of pulmonary squamous cell carcinoma. | journal = Mod Pathol | volume = 25 | issue = 3 | pages = 405-15 | month = Mar | year = 2012 | doi = 10.1038/modpathol.2011.173 | PMID = 22056955 }}</ref>
*CK5/6 -ve.

Others:
*p63 -ve -- occasionally +ve.
*Vimentin -ve/+ve (+ve relatively common).
**Poor prognosticator.<ref>{{Cite journal | last1 = Dauphin | first1 = M. | last2 = Barbe | first2 = C. | last3 = Lemaire | first3 = S. | last4 = Nawrocki-Raby | first4 = B. | last5 = Lagonotte | first5 = E. | last6 = Delepine | first6 = G. | last7 = Birembaut | first7 = P. | last8 = Gilles | first8 = C. | last9 = Polette | first9 = M. | title = Vimentin expression predicts the occurrence of metastases in non small cell lung carcinomas. | journal = Lung Cancer | volume = 81 | issue = 1 | pages = 117-22 | month = Jul | year = 2013 | doi = 10.1016/j.lungcan.2013.03.011 | PMID = 23562674 }}</ref>

Note:
*In mucinous adenocarcinoma of the lung TTF-1 is usu. -ve (46% +ve) and napsin is usu. -ve (36% +ve).
**Positive staining is unusual but useful if present, as metastatic disease is uniformily negative for both.<ref name=pmid24651909>{{Cite journal | last1 = Rossi | first1 = G. | last2 = Cavazza | first2 = A. | last3 = Righi | first3 = L. | last4 = Sartori | first4 = G. | last5 = Bisagni | first5 = A. | last6 = Longo | first6 = L. | last7 = Pelosi | first7 = G. | last8 = Papotti | first8 = M. | title = Napsin-A, TTF-1, EGFR, and ALK Status Determination in Lung Primary and Metastatic Mucin-Producing Adenocarcinomas. | journal = Int J Surg Pathol | volume = 22 | issue = 5 | pages = 401-7 | month = Aug | year = 2014 | doi = 10.1177/1066896914527609 | PMID = 24651909 }}
</ref>

==Molecular==
*EGFR mutations (typically assessed by PCR) - respond to [[TKI]]s (e.g. [[gefitinib]], [[erlotinib]]) if:<ref name=pmid19680292>{{Cite journal | last1 = John | first1 = T. | last2 = Liu | first2 = G. | last3 = Tsao | first3 = MS. | title = Overview of molecular testing in non-small-cell lung cancer: mutational analysis, gene copy number, protein expression and other biomarkers of EGFR for the prediction of response to tyrosine kinase inhibitors. | journal = Oncogene | volume = 28 Suppl 1 | issue = | pages = S14-23 | month = Aug | year = 2009 | doi = 10.1038/onc.2009.197 | PMID = 19680292 }}</ref>
**Exon 19 deletion.
**Exon 21 L858R.
***Natural history of mutation is suspected to have a better prognosis vs. wild-type.<ref>URL: [http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r]. Accessed on: 27 April 2012.</ref>
**[[KRAS mutations]] are absent, i.e. ''wild-type KRAS''.<ref>{{Cite journal | last1 = Pao | first1 = W. | last2 = Wang | first2 = TY. | last3 = Riely | first3 = GJ. | last4 = Miller | first4 = VA. | last5 = Pan | first5 = Q. | last6 = Ladanyi | first6 = M. | last7 = Zakowski | first7 = MF. | last8 = Heelan | first8 = RT. | last9 = Kris | first9 = MG. | title = KRAS mutations and primary resistance of lung adenocarcinomas to gefitinib or erlotinib. | journal = PLoS Med | volume = 2 | issue = 1 | pages = e17 | month = Jan | year = 2005 | doi = 10.1371/journal.pmed.0020017 | PMID = 15696205 }}</ref>

*ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion).<ref name=pmid21245935>{{Cite journal | last1 = Li | first1 = Y. | last2 = Ye | first2 = X. | last3 = Liu | first3 = J. | last4 = Zha | first4 = J. | last5 = Pei | first5 = L. | title = Evaluation of EML4-ALK fusion proteins in non-small cell lung cancer using small molecule inhibitors. | journal = Neoplasia | volume = 13 | issue = 1 | pages = 1-11 | month = Jan | year = 2011 | doi = | PMID = 21245935 }}</ref>
**Associated with a poor prognosis.<ref name=pmid22134072>{{Cite journal | last1 = Yang | first1 = P. | last2 = Kulig | first2 = K. | last3 = Boland | first3 = JM. | last4 = Erickson-Johnson | first4 = MR. | last5 = Oliveira | first5 = AM. | last6 = Wampfler | first6 = J. | last7 = Jatoi | first7 = A. | last8 = Deschamps | first8 = C. | last9 = Marks | first9 = R. | title = Worse disease-free survival in never-smokers with ALK+ lung adenocarcinoma. | journal = J Thorac Oncol | volume = 7 | issue = 1 | pages = 90-7 | month = Jan | year = 2012 | doi = 10.1097/JTO.0b013e31823c5c32 | PMID = 22134072 }}</ref>
**Amenable to treatment with TKI.
**See ''[[lung carcinoma with ALK rearrangement]].
**Do ''not'' occur with EGRF mutations ''or'' KRAS mutations.<ref name=pmid23729361>{{Cite journal | last1 = Gainor | first1 = JF. | last2 = Varghese | first2 = AM. | last3 = Ou | first3 = SH. | last4 = Kabraji | first4 = S. | last5 = Awad | first5 = MM. | last6 = Katayama | first6 = R. | last7 = Pawlak | first7 = A. | last8 = Mino-Kenudson | first8 = M. | last9 = Yeap | first9 = BY. | title = ALK rearrangements are mutually exclusive with mutations in EGFR or KRAS: an analysis of 1,683 patients with non-small cell lung cancer. | journal = Clin Cancer Res | volume = 19 | issue = 15 | pages = 4273-81 | month = Aug | year = 2013 | doi = 10.1158/1078-0432.CCR-13-0318 | PMID = 23729361 }}</ref>

*ROS1 - good response to crizotinib.<ref name=pmid25264305>{{Cite journal | last1 = Shaw | first1 = AT. | last2 = Ou | first2 = SH. | last3 = Bang | first3 = YJ. | last4 = Camidge | first4 = DR. | last5 = Solomon | first5 = BJ. | last6 = Salgia | first6 = R. | last7 = Riely | first7 = GJ. | last8 = Varella-Garcia | first8 = M. | last9 = Shapiro | first9 = GI. | title = Crizotinib in ROS1-rearranged non-small-cell lung cancer. | journal = N Engl J Med | volume = 371 | issue = 21 | pages = 1963-71 | month = Nov | year = 2014 | doi = 10.1056/NEJMoa1406766 | PMID = 25264305 }}</ref>
**Approximately 1% of NSCLC.<ref name=pmid25409376>{{Cite journal | last1 = Gold | first1 = KA. | title = ROS1--targeting the one percent in lung cancer. | journal = N Engl J Med | volume = 371 | issue = 21 | pages = 2030-1 | month = Nov | year = 2014 | doi = 10.1056/NEJMe1411319 | PMID = 25409376 }}</ref>

==Sign out==
===Biopsy===
Consensus recommendations:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
*''Adenocarcinoma in situ'' (AIS) and ''minimally invasive adenocarcinoma'' should '''not''' be used in the reporting of small biopsies and cytology.
**Tumours with a non-invasive pattern are referred to by their pattern, e.g. ''lepidic growth'', '''not''' as AIS.

<pre>
Lung, Right Upper Lobe, Core Biopsy:
- INVASIVE ADENOCARCINOMA, NON-MUCINOUS.

Comment:
The adenocarcinoma is positive for TTF-1 and napsin. EGFR/ALK testing was ordered.
</pre>

=====Mucinous adenocarcinoma with noncontributory stains=====
<pre>
Lung, Right Upper Lobe, Core Biopsy:
- ADENOCARCINOMA, MUCINOUS, see comment.

Comment:
The adenocarcinoma is negative for both napsin and TTF-1. EGFR/ALK testing was ordered.

The findings are compatible with a primary or secondary adenocarcinoma; clinical and
radiologic correlation is required.
</pre>

====Block letters====
<pre>
LUNG, LEFT, BIOPSY:
- ADENOCARCINOMA, LEPIDIC GROWTH; INVASION CANNOT BE EXCLUDED IN THIS SMALL SPECIMEN.
</pre>

<pre>
LUNG, RIGHT UPPER LOBE, NEEDLE BIOPSY:
- INVASIVE ADENOCARCINOMA, NON-MUCINOUS.

COMMENT:
The tumour stains as follows:
POSITIVE: TTF-1.
NEGATIVE: p40.

The immunoprofile is compatible with lung adenocarcinoma.
</pre>

<pre>
MASS, LEFT LOWER LOBE OF LUNG, BIOPSY:
- INVASIVE ADENOCARCINOMA.

COMMENT:
The tumour is positive for TTF-1.

Tissue will be sent for molecular testing and the results reported as an addendum.
</pre>

===Resection===
<pre>
LUNG, LEFT UPPER LOBE, LOBECTOMY:
- ADENOCARCINOMA WITH AN ACINAR PATTERN, SOLID PATTERN, MICROPAPILLARY PATTERN
AND LEPIDIC PATTERN -- PATTERNS IN ORDER OF PREVALENCE.
- MARGINS NEGATIVE FOR MALIGNANCY.
- THREE LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/3).
- PLEASE SEE TUMOUR SUMMARY.
</pre>

<pre>
LUNG, RIGHT UPPER LOBE, LOBECTOMY:
- MULTIPLE ADENOCARCINOMAS (x2) WITH AN ACINAR PATTERN, SOLID PATTERN, MICROPAPILLARY PATTERN
AND LEPIDIC PATTERN -- PATTERNS IN ORDER OF PREVALENCE.
- MARGINS NEGATIVE FOR MALIGNANCY.
- FOUR LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/4).
- LYMPHOVASCULAR INVASION PRESENT.
- PLEASE SEE TUMOUR SUMMARY AND COMMENT.

COMMENT:
The histology of the two adenocarcinomas resemble one another and lymphovascular
invasion is present. These findings favour that the smaller tumor is a metastasis, rather
than a synchronous primary.
</pre>

===Micro===
<pre>
Size (tissue): scant tissue (<0.5 cm).
Gland formation: focal, poorly formed.
Cell size: large.
Cytoplasm: moderate-to-abundant, grey-eosinophilic.
Nucleus location: eccentric.
Nuclear pleomorphism: moderate.
Nuclear moulding: absent.
Nucleoli: present, prominent.
Nuclear pseudoinclusions: present.
</pre>

<pre>
Number of cores: 3.
Length of cores (total): 2.0 cm.

Gland formation: present.
Cell size: large.
Cytoplasm: moderate, grey-eosinophilic.
Necrosis: none apparent.
Mucin: none.

Nucleus location: eccentric.
Nuclear pleomorphism: moderate.
Nuclear moulding: absent.
Nuclear pseudoinclusions: absent.
Nuclear shape/arrangment: cigar-like/pseudostratified.
Nucleoli: present.
</pre>

====Mucinous====
The sections show cores with well-formed glands composed of foveolar-like columnar cells with a relatively bland cytomorphology. Mitotic activity is not readily apparent. A small amount of non-lesional lung parenchyma is present.

===Lung cancer staging===
{{Main|Lung cancer staging}}

==See also==
*[[Lung tumours]].
*[[Adenocarcinoma]].
*[[Metastasis]].
*[[Lung carcinoma with ALK rearrangement]].

==References==
{{Reflist|2}}

==External links==
*[http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-staging Lung cancer staging (cancer.org)].
*[http://www.nucmedresource.com/thoracic-nodal-stations.html Thoracic lymph node stations (nucmedresource.com)].

[[Category:Diagnosis]]
[[Category:Lung tumours]]

Adenocarcinoma of the lung

2018-07-11T11:39:07Z

Abraham: /* www */

{{ Infobox diagnosis
| Name = {{PAGENAME}}
| Image = Acinar pattern adenocarcinoma of lung -- low mag.jpg
| Width =
| Caption = Invasive adenocarcinoma, acinar pattern (right of image) and benign lung (left of image). [[H&E stain]].
| Synonyms =
| Micro = +/-nuclear atypia (may be absent in mucinous tumours), eccentrically placed nuclei, usu. abundant cytoplasm (classically with mucin vacuoles), often conspicuous [[nucleoli]], +/-[[nuclear pseudoinclusions]]
| Subtypes =
| LMDDx = [[atypical adenomatous hyperplasia of the lung]], adenocarcinoma in situ, [[squamous cell carcinoma of the lung]], [[small cell carcinoma of the lung]], [[non-small cell lung carcinoma]], [[malignant mesothelioma]], [[Metastasis|metastatic]] [[adenocarcinoma]] (esp. [[colorectal adenocarcinoma]], breast adenocarcinoma ([[invasive ductal carcinoma of the breast]], [[invasive lobular carcinoma]]))
| Stains =
| IHC = [[CK7]] +ve, [[TTF-1]] +ve, CK20 -ve, [[p40]] -ve, p63 -ve (usually)
| EM =
| Molecular = +/-KRAS mutations, +/-EGFR mutations, +/-ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion), +/-ROS1 rearrangements, +/-RET rearrangements
| IF =
| Gross =
| Grossing =
| Staging = [[lung cancer staging]]
| Site = [[lung]] - see ''[[lung tumours]]''
| Assdx =
| Syndromes =
| Clinicalhx =
| Signs =
| Symptoms =
| Prevalence = most common primary lung tumour
| Bloodwork =
| Rads = lung mass - typically peripheral lesion (distant from large airways), may be multifocal
| Endoscopy =
| Prognosis = dependent on stage (minimally invasive and noninvasive: very good; invasive: moderate)
| Other =
| ClinDDx = other [[lung tumours]] - primary and metastatic
| Tx = surgical resection if feasible
}}
'''Adenocarcinoma of the lung''', also '''lung adenocarcinoma''', is common malignant [[lung tumour]].

==General==
*Adenocarcinoma is the most common (primary lung cancer).<ref name=pmid19118313>{{cite journal |author=Lutschg JH |title=Lung cancer |journal=N. Engl. J. Med. |volume=360 |issue=1 |pages=87-8; author reply 88 |year=2009 |month=January |pmid=19118313 |doi=10.1056/NEJMc082208 |url=}}</ref>
*Adenocarcinoma is the non-smoker tumour - [[small cell carcinoma of the lung|SCLC]] and [[squamous cell carcinoma of the lung|squamous]] are more strongly associated with [[smoking]].
*Lung adenocarcinoma is the most common brain metastasis.<ref name=pmid22012633>{{Cite journal | last1 = Nayak | first1 = L. | last2 = Lee | first2 = EQ. | last3 = Wen | first3 = PY. | title = Epidemiology of brain metastases. | journal = Curr Oncol Rep | volume = 14 | issue = 1 | pages = 48-54 | month = Feb | year = 2012 | doi = 10.1007/s11912-011-0203-y | PMID = 22012633 }}</ref>

Treatment:
*Lung adenocarcinoma may be treated with [[EGFR inhibitors]] (e.g. gefitinib (Iressa), erlotinib (Tarceva)).<ref name=pmid20855837>{{cite journal |author=Sun Y, Ren Y, Fang Z, ''et al.'' |title=Lung adenocarcinoma from East Asian never-smokers is a disease largely defined by targetable oncogenic mutant kinases |journal=J. Clin. Oncol. |volume=28 |issue=30 |pages=4616–20 |year=2010 |month=October |pmid=20855837 |doi=10.1200/JCO.2010.29.6038 |url=}}</ref>

Patients that receive EGFR inhibitors classically are:<ref name=pmid21151896>{{cite journal |author=Job B, Bernheim A, Beau-Faller M, ''et al.'' |title=Genomic Aberrations in Lung Adenocarcinoma in Never Smokers |journal=PLoS One |volume=5 |issue=12 |pages=e15145 |year=2010 |pmid=21151896 |pmc=2997777 |doi=10.1371/journal.pone.0015145 |url=}}</ref>
*Non-smokers.
*Female.
*Asian.
**Caucasians also benefit.<ref name=pmid20973798>{{Cite journal | last1 = Rosell | first1 = R. | last2 = Moran | first2 = T. | last3 = Cardenal | first3 = F. | last4 = Porta | first4 = R. | last5 = Viteri | first5 = S. | last6 = Molina | first6 = MA. | last7 = Benlloch | first7 = S. | last8 = Taron | first8 = M. | title = Predictive biomarkers in the management of EGFR mutant lung cancer. | journal = Ann N Y Acad Sci | volume = 1210 | issue = | pages = 45-52 | month = Oct | year = 2010 | doi = 10.1111/j.1749-6632.2010.05775.x | PMID = 20973798 }}</ref>

==Gross==
*Classically peripheral lesions.
*May be multifocal.

===Image===
<gallery>
Image:Adenocarcinoma (3950819000).jpg | Lung adenocarcinoma. (WC/Rosen)
</gallery>

==Microscopic==
Features:
*+/-Nuclear atypia - '''important'''.
**May be absent in mucinous tumours - may look similar to foveolar epithelium.
*Eccentrically placed nuclei.
*Abundant cytoplasm - classically with mucin vacuoles.
*Often conspicuous [[nucleoli]].
*+/-[[Nuclear pseudoinclusions]].

Negatives:
*Lack of intercellular bridges.

Patterns:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
*Lepidic - tumour grows long the alveolar wall; means ''scaly covering''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/lepidic http://medical-dictionary.thefreedictionary.com/lepidic]. Accessed on: 8 August 2013.</ref> At lower power, the shapes should still resemble lung acini.
*Acinar - berry-shaped glands, smaller than lung acini.
*Papillary - fibrovascular cores.
*Micropapillary - nipple shaped projections without fibrovascular cores.
*Solid - sheet of cells.

Notes:
*[[Lymphovascular invasion]] is common.
*Micropapillary predominant pattern and tumours with any amount of the lepidic pattern are associated with EGFR mutations.<ref name=pmid21970488>{{Cite journal | last1 = Shim | first1 = HS. | last2 = Lee | first2 = da H. | last3 = Park | first3 = EJ. | last4 = Kim | first4 = SH. | title = Histopathologic characteristics of lung adenocarcinomas with epidermal growth factor receptor mutations in the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification. | journal = Arch Pathol Lab Med | volume = 135 | issue = 10 | pages = 1329-34 | month = Oct | year = 2011 | doi = 10.5858/arpa.2010-0493-OA | PMID = 21970488 }}</ref>

DDx:
*[[Atypical adenomatous hyperplasia of the lung]] - spaced [[hobnail]] cells, mild-to-moderate nuclear atypia, small lesion (< 5 mm).
*Adenocarcinoma in situ.
*[[Papillary thyroid carcinoma|Papillary carcinoma of thyroid]].
*[[Squamous cell carcinoma of the lung]].
*[[Small cell carcinoma of the lung]].
*[[Non-small cell lung carcinoma]] - diagnosis should be avoided if possible.
*[[Malignant mesothelioma]].
*[[Metastasis|Metastatic]] adenocarcinoma.
**[[Colorectal adenocarcinoma]].
**Breast adenocarcinoma.
***[[Invasive ductal carcinoma of the breast]].
***[[Invasive lobular carcinoma]].
**Other carcinomas.
*Carcinomas of the bronchial glands, e.g. [[adenoid cystic carcinoma]].

===Images===
=====Acinar adenocarcinoma=====
<gallery>
Image: Acinar pattern adenocarcinoma of lung -- low mag.jpg | Acinar LA - low mag.
Image: Acinar pattern adenocarcinoma of lung -- intermed mag.jpg | Acinar LA - intermed. mag.
Image: Acinar pattern adenocarcinoma of lung -- high mag.jpg | Acinar LA - high mag.
Image: Acinar pattern adenocarcinoma of lung -- very high mag.jpg | Acinar LA - very high mag.
Image: Acinar pattern adenocarcinoma of lung - alt -- very high mag.jpg | Acinar LA - very high mag.
</gallery>
<gallery>
Image:Adenocarcinoma, acinar subtype (3923397562).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
Image:Adenocarcinoma,_acinar_subtype_(4420421886).jpg | Acinar adenocarcinoma. (WC/Yale Rosen)
</gallery>
=====Mucinous adenocarcinoma=====
<gallery>
Image: Mucinous adenocarcinoma of the lung -- low mag.jpg | MAL - low mag.
Image: Mucinous adenocarcinoma of the lung -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous adenocarcinoma of the lung -- high mag.jpg | MAL - high mag.
Image: Mucinous adenocarcinoma of the lung -- very high mag.jpg | MAL - very high mag.
</gallery>
<gallery>
Image: Mucinous lung adenocarcinoma -- low mag.jpg | MAL - low mag.
Image: Mucinous lung adenocarcinoma -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous lung adenocarcinoma -- high mag.jpg | MAL - high mag.
Image: Mucinous lung adenocarcinoma and airway -- intermed mag.jpg | MAL - intermed. mag.
Image: Mucinous lung adenocarcinoma and airway -- high mag.jpg | MAL - high mag.
Image: Mucinous lung adenocarcinoma and airway - alt -- high mag.jpg | MAL - high mag.
</gallery>
<gallery>
Image:Bronchioloalveolar carcinoma, mucinous type 2.jpg |BAC - mucinous type - low mag. (WC/Yale Rosen)
Image:Bronchioloalveolar carcinoma, mucinous type.jpg | BAC - mucinous type - high mag. (WC/Yale Rosen)
</gallery>

=====Papillary adenocarcinoma=====
<gallery>
Image: Papillary adenocarcinoma of the lung -- very low mag.jpg | PAL - very low mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- low mag.jpg | PAL - low mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- intermed mag.jpg | PAL - intermed. mag. (WC/Nephron)
Image: Papillary adenocarcinoma of the lung -- high mag.jpg | PAL - high mag. (WC/Nephron)
</gallery>

====Fetal adenocarcinoma====
<gallery>
Image: Fetal adenocarcinoma of the lung -- very low mag.jpg | FAL - very low mag. (WC)
Image: Fetal adenocarcinoma of the lung - alt2 -- very low mag.jpg | FAL - very low mag. (WC)
Image: Fetal adenocarcinoma of the lung -- low mag.jpg | FAL - low mag. (WC)
Image: Fetal adenocarcinoma of the lung -- intermed mag.jpg | FAL - intermed. mag. (WC)
Image: Fetal adenocarcinoma of the lung -- high mag.jpg | FAL - high mag. (WC)
</gallery>

====www====
*[http://www.pathpedia.com/education/eatlas/histopathology/lung_and_bronchi/bronchioloalveolar_carcinoma_mucinous.aspx BAC mucinous type adjacent to benign (pathpedia.com)].
*[http://cancergrace.org/wp-content/uploads/2007/05/mucinous-vs-nonmucinous-bac-histology.jpg BAC mucinous and nonmucinous (cancergrace.org)].<ref>URL: [http://cancergrace.org/lung/2007/05/14/bac-mucinous-and-non-mucinous/ http://cancergrace.org/lung/2007/05/14/bac-mucinous-and-non-mucinous/]. Accessed on: 8 August 2013.</ref>
*[https://www.flickr.com/photos/pulmonary_pathology/7589291672/ Lepidic adenocarcinoma with invasive (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292214/in/photostream/ Lepidic adenocarcinoma (flickr.com/Yale Rosen)].
*[http://rosai.secondslide.com/sem910/sem910-case8.svs/view.apml/ Lepidic adenocarcinoma (rosaicollection.org/index.cfm)].
*[http://pathlabmed.typepad.com/surgical_pathology_and_la/2010/09/digital-case-challenge-non-mucinous-bronchioloalveolar-adenocarcinoma.html Mucinous adenocarcinoma (pathlabmed.typepad.com)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292780/in/photostream/ Non-mucinous adenocarcinoma in situ (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589292496/in/photostream/ Non-mucinous adenocarcinoma in situ (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589290010/in/photostream/ Acinar adenocarcinoma (flickr.com/Yale Rosen)].
*[https://www.flickr.com/photos/pulmonary_pathology/7589289274/in/photostream/ Acinar adenocarcinoma (flickr.com/Yale Rosen)].

===Classification===
Classification based on extent:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
#Adenocarcinoma in situ (AIS) - previously known as [[BAC]].
#*Subtypes: nonmucinous, mucinous, mixed mucinous/nonmucinous.
#*Definition: lack of invasion into the stroma, vascular spaces and pleura.
#*Must have a lepidic growth pattern.<ref name=pmid22214965>{{Cite journal | last1 = Borczuk | first1 = AC. | title = Assessment of invasion in lung adenocarcinoma classification, including adenocarcinoma in situ and minimally invasive adenocarcinoma. | journal = Mod Pathol | volume = 25 Suppl 1 | issue = | pages = S1-10 | month = Jan | year = 2012 | doi = 10.1038/modpathol.2011.151 | PMID = 22214965 }}</ref>
#Minimally invasive adenocarcinoma (MIA).
#*Lepidic growth with up to 5 mm of invasion.
#*Subtypes: nonmucinous (most common), mucinous (uncommon), mixed (mucinous/nonmucinous).
#*Should not have [[lymphovascular invasion]].{{fact}}
#Invasive adenocarcinoma:
#*Subtypes: micropapillary, mucinous (previously ''mucinous BAC''), colloid, fetal, enteric.

====Grading====
Graded G1-G4 - as per CAP protocol (version 3.4.0.0):<ref name=cap_protocol>CAP Lung protocol. Version: 3.4.0.0. URL: [http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf]. Accessed on: March 23, 2016.</ref>
*G1 = lepidic.
*G2 = acinar, papillary, cribriform.
*G3 = micropapillary, solid, mucinous, colloid.
*G4 = undifferentiated - '''not''' used for lung adenocarcinoma; it used for small cell carcinoma and large cell carcinoma.

Note:
*There is no consensus currently on grading - as per the international consensus guidelines of 2011.<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>

==Special stains==
*[[Mucicarmine]] +ve, cytoplasmic.
*[[PAS-diastase]] +ve, cytoplasmic.

==IHC==
Primary versus metastatic:
*TTF-1 +ve.
*CK7 +ve.
*CK20 -ve.

Panel for adenocarcinoma versus SCC:
*TTF-1 +ve.
*[[Napsin]] A +ve.
*[[p40]] -ve.<ref name=pmid22056955>{{Cite journal | last1 = Bishop | first1 = JA. | last2 = Teruya-Feldstein | first2 = J. | last3 = Westra | first3 = WH. | last4 = Pelosi | first4 = G. | last5 = Travis | first5 = WD. | last6 = Rekhtman | first6 = N. | title = p40 (ΔNp63) is superior to p63 for the diagnosis of pulmonary squamous cell carcinoma. | journal = Mod Pathol | volume = 25 | issue = 3 | pages = 405-15 | month = Mar | year = 2012 | doi = 10.1038/modpathol.2011.173 | PMID = 22056955 }}</ref>
*CK5/6 -ve.

Others:
*p63 -ve -- occasionally +ve.
*Vimentin -ve/+ve (+ve relatively common).
**Poor prognosticator.<ref>{{Cite journal | last1 = Dauphin | first1 = M. | last2 = Barbe | first2 = C. | last3 = Lemaire | first3 = S. | last4 = Nawrocki-Raby | first4 = B. | last5 = Lagonotte | first5 = E. | last6 = Delepine | first6 = G. | last7 = Birembaut | first7 = P. | last8 = Gilles | first8 = C. | last9 = Polette | first9 = M. | title = Vimentin expression predicts the occurrence of metastases in non small cell lung carcinomas. | journal = Lung Cancer | volume = 81 | issue = 1 | pages = 117-22 | month = Jul | year = 2013 | doi = 10.1016/j.lungcan.2013.03.011 | PMID = 23562674 }}</ref>

Note:
*In mucinous adenocarcinoma of the lung TTF-1 is usu. -ve (46% +ve) and napsin is usu. -ve (36% +ve).
**Positive staining is unusual but useful if present, as metastatic disease is uniformily negative for both.<ref name=pmid24651909>{{Cite journal | last1 = Rossi | first1 = G. | last2 = Cavazza | first2 = A. | last3 = Righi | first3 = L. | last4 = Sartori | first4 = G. | last5 = Bisagni | first5 = A. | last6 = Longo | first6 = L. | last7 = Pelosi | first7 = G. | last8 = Papotti | first8 = M. | title = Napsin-A, TTF-1, EGFR, and ALK Status Determination in Lung Primary and Metastatic Mucin-Producing Adenocarcinomas. | journal = Int J Surg Pathol | volume = 22 | issue = 5 | pages = 401-7 | month = Aug | year = 2014 | doi = 10.1177/1066896914527609 | PMID = 24651909 }}
</ref>

==Molecular==
*EGFR mutations (typically assessed by PCR) - respond to [[TKI]]s (e.g. [[gefitinib]], [[erlotinib]]) if:<ref name=pmid19680292>{{Cite journal | last1 = John | first1 = T. | last2 = Liu | first2 = G. | last3 = Tsao | first3 = MS. | title = Overview of molecular testing in non-small-cell lung cancer: mutational analysis, gene copy number, protein expression and other biomarkers of EGFR for the prediction of response to tyrosine kinase inhibitors. | journal = Oncogene | volume = 28 Suppl 1 | issue = | pages = S14-23 | month = Aug | year = 2009 | doi = 10.1038/onc.2009.197 | PMID = 19680292 }}</ref>
**Exon 19 deletion.
**Exon 21 L858R.
***Natural history of mutation is suspected to have a better prognosis vs. wild-type.<ref>URL: [http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r http://www.mycancergenome.org/mutation.php?dz=nsclc&gene=egfr&code=l858r]. Accessed on: 27 April 2012.</ref>
**[[KRAS mutations]] are absent, i.e. ''wild-type KRAS''.<ref>{{Cite journal | last1 = Pao | first1 = W. | last2 = Wang | first2 = TY. | last3 = Riely | first3 = GJ. | last4 = Miller | first4 = VA. | last5 = Pan | first5 = Q. | last6 = Ladanyi | first6 = M. | last7 = Zakowski | first7 = MF. | last8 = Heelan | first8 = RT. | last9 = Kris | first9 = MG. | title = KRAS mutations and primary resistance of lung adenocarcinomas to gefitinib or erlotinib. | journal = PLoS Med | volume = 2 | issue = 1 | pages = e17 | month = Jan | year = 2005 | doi = 10.1371/journal.pmed.0020017 | PMID = 15696205 }}</ref>

*ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion).<ref name=pmid21245935>{{Cite journal | last1 = Li | first1 = Y. | last2 = Ye | first2 = X. | last3 = Liu | first3 = J. | last4 = Zha | first4 = J. | last5 = Pei | first5 = L. | title = Evaluation of EML4-ALK fusion proteins in non-small cell lung cancer using small molecule inhibitors. | journal = Neoplasia | volume = 13 | issue = 1 | pages = 1-11 | month = Jan | year = 2011 | doi = | PMID = 21245935 }}</ref>
**Associated with a poor prognosis.<ref name=pmid22134072>{{Cite journal | last1 = Yang | first1 = P. | last2 = Kulig | first2 = K. | last3 = Boland | first3 = JM. | last4 = Erickson-Johnson | first4 = MR. | last5 = Oliveira | first5 = AM. | last6 = Wampfler | first6 = J. | last7 = Jatoi | first7 = A. | last8 = Deschamps | first8 = C. | last9 = Marks | first9 = R. | title = Worse disease-free survival in never-smokers with ALK+ lung adenocarcinoma. | journal = J Thorac Oncol | volume = 7 | issue = 1 | pages = 90-7 | month = Jan | year = 2012 | doi = 10.1097/JTO.0b013e31823c5c32 | PMID = 22134072 }}</ref>
**Amenable to treatment with TKI.
**See ''[[lung carcinoma with ALK rearrangement]].
**Do ''not'' occur with EGRF mutations ''or'' KRAS mutations.<ref name=pmid23729361>{{Cite journal | last1 = Gainor | first1 = JF. | last2 = Varghese | first2 = AM. | last3 = Ou | first3 = SH. | last4 = Kabraji | first4 = S. | last5 = Awad | first5 = MM. | last6 = Katayama | first6 = R. | last7 = Pawlak | first7 = A. | last8 = Mino-Kenudson | first8 = M. | last9 = Yeap | first9 = BY. | title = ALK rearrangements are mutually exclusive with mutations in EGFR or KRAS: an analysis of 1,683 patients with non-small cell lung cancer. | journal = Clin Cancer Res | volume = 19 | issue = 15 | pages = 4273-81 | month = Aug | year = 2013 | doi = 10.1158/1078-0432.CCR-13-0318 | PMID = 23729361 }}</ref>

*ROS1 - good response to crizotinib.<ref name=pmid25264305>{{Cite journal | last1 = Shaw | first1 = AT. | last2 = Ou | first2 = SH. | last3 = Bang | first3 = YJ. | last4 = Camidge | first4 = DR. | last5 = Solomon | first5 = BJ. | last6 = Salgia | first6 = R. | last7 = Riely | first7 = GJ. | last8 = Varella-Garcia | first8 = M. | last9 = Shapiro | first9 = GI. | title = Crizotinib in ROS1-rearranged non-small-cell lung cancer. | journal = N Engl J Med | volume = 371 | issue = 21 | pages = 1963-71 | month = Nov | year = 2014 | doi = 10.1056/NEJMoa1406766 | PMID = 25264305 }}</ref>
**Approximately 1% of NSCLC.<ref name=pmid25409376>{{Cite journal | last1 = Gold | first1 = KA. | title = ROS1--targeting the one percent in lung cancer. | journal = N Engl J Med | volume = 371 | issue = 21 | pages = 2030-1 | month = Nov | year = 2014 | doi = 10.1056/NEJMe1411319 | PMID = 25409376 }}</ref>

==Sign out==
===Biopsy===
Consensus recommendations:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=6 |issue=2 |pages=244–85 |year=2011 |month=February |pmid=21252716 |doi=10.1097/JTO.0b013e318206a221 |url=}}</ref>
*''Adenocarcinoma in situ'' (AIS) and ''minimally invasive adenocarcinoma'' should '''not''' be used in the reporting of small biopsies and cytology.
**Tumours with a non-invasive pattern are referred to by their pattern, e.g. ''lepidic growth'', '''not''' as AIS.

<pre>
Lung, Right Upper Lobe, Core Biopsy:
- INVASIVE ADENOCARCINOMA, NON-MUCINOUS.

Comment:
The adenocarcinoma is positive for TTF-1 and napsin. EGFR/ALK testing was ordered.
</pre>

=====Mucinous adenocarcinoma with noncontributory stains=====
<pre>
Lung, Right Upper Lobe, Core Biopsy:
- ADENOCARCINOMA, MUCINOUS, see comment.

Comment:
The adenocarcinoma is negative for both napsin and TTF-1. EGFR/ALK testing was ordered.

The findings are compatible with a primary or secondary adenocarcinoma; clinical and
radiologic correlation is required.
</pre>

====Block letters====
<pre>
LUNG, LEFT, BIOPSY:
- ADENOCARCINOMA, LEPIDIC GROWTH; INVASION CANNOT BE EXCLUDED IN THIS SMALL SPECIMEN.
</pre>

<pre>
LUNG, RIGHT UPPER LOBE, NEEDLE BIOPSY:
- INVASIVE ADENOCARCINOMA, NON-MUCINOUS.

COMMENT:
The tumour stains as follows:
POSITIVE: TTF-1.
NEGATIVE: p40.

The immunoprofile is compatible with lung adenocarcinoma.
</pre>

<pre>
MASS, LEFT LOWER LOBE OF LUNG, BIOPSY:
- INVASIVE ADENOCARCINOMA.

COMMENT:
The tumour is positive for TTF-1.

Tissue will be sent for molecular testing and the results reported as an addendum.
</pre>

===Resection===
<pre>
LUNG, LEFT UPPER LOBE, LOBECTOMY:
- ADENOCARCINOMA WITH AN ACINAR PATTERN, SOLID PATTERN, MICROPAPILLARY PATTERN
AND LEPIDIC PATTERN -- PATTERNS IN ORDER OF PREVALENCE.
- MARGINS NEGATIVE FOR MALIGNANCY.
- THREE LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/3).
- PLEASE SEE TUMOUR SUMMARY.
</pre>

<pre>
LUNG, RIGHT UPPER LOBE, LOBECTOMY:
- MULTIPLE ADENOCARCINOMAS (x2) WITH AN ACINAR PATTERN, SOLID PATTERN, MICROPAPILLARY PATTERN
AND LEPIDIC PATTERN -- PATTERNS IN ORDER OF PREVALENCE.
- MARGINS NEGATIVE FOR MALIGNANCY.
- FOUR LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/4).
- LYMPHOVASCULAR INVASION PRESENT.
- PLEASE SEE TUMOUR SUMMARY AND COMMENT.

COMMENT:
The histology of the two adenocarcinomas resemble one another and lymphovascular
invasion is present. These findings favour that the smaller tumor is a metastasis, rather
than a synchronous primary.
</pre>

===Micro===
<pre>
Size (tissue): scant tissue (<0.5 cm).
Gland formation: focal, poorly formed.
Cell size: large.
Cytoplasm: moderate-to-abundant, grey-eosinophilic.
Nucleus location: eccentric.
Nuclear pleomorphism: moderate.
Nuclear moulding: absent.
Nucleoli: present, prominent.
Nuclear pseudoinclusions: present.
</pre>

<pre>
Number of cores: 3.
Length of cores (total): 2.0 cm.

Gland formation: present.
Cell size: large.
Cytoplasm: moderate, grey-eosinophilic.
Necrosis: none apparent.
Mucin: none.

Nucleus location: eccentric.
Nuclear pleomorphism: moderate.
Nuclear moulding: absent.
Nuclear pseudoinclusions: absent.
Nuclear shape/arrangment: cigar-like/pseudostratified.
Nucleoli: present.
</pre>

====Mucinous====
The sections show cores with well-formed glands composed of foveolar-like columnar cells with a relatively bland cytomorphology. Mitotic activity is not readily apparent. A small amount of non-lesional lung parenchyma is present.

===Lung cancer staging===
{{Main|Lung cancer staging}}

==See also==
*[[Lung tumours]].
*[[Adenocarcinoma]].
*[[Metastasis]].
*[[Lung carcinoma with ALK rearrangement]].

==References==
{{Reflist|2}}

==External links==
*[http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-staging Lung cancer staging (cancer.org)].
*[http://www.nucmedresource.com/thoracic-nodal-stations.html Thoracic lymph node stations (nucmedresource.com)].

[[Category:Diagnosis]]
[[Category:Lung tumours]]

Giant cells

2018-07-05T11:57:06Z

Abraham: /* Table */

[[Image:Giant cell in bronchial wash -- very high mag.jpg|thumb|right|Giant cell from a [[pulmonary cytopathology|bronchial wash]]. [[Pap stain]].]]
'''Giant cells''' are "big" cells with multiple nuclei. They come in different flavours, which are suggestive of causality.

This article deals with the classic types of giant cells. A more general differential diagnosis of giant cells is in ''[[giant cell lesions]]''.

==Giant cell types==
List:
*Touton giant cell.
*Osteoclast-like giant cell.
*Foreign body type giant cell.

===Table===
{| class="wikitable"
| Type
| Histology
| DDx
| Other
| Image
|-
| Touton giant cell
| nuclei form a ring around the cell periphery
| [[juvenile xanthogranuloma]], [[Erdheim-Chester disease]]
| high lipid content lesions<ref>URL: [http://granuloma.homestead.com/giant_cells.html http://granuloma.homestead.com/giant_cells.html]. Accessed on: 7 February 2011.</ref>
| [[Image:Juvenile_xanthogranuloma_-_very_high_mag.jpg|thumb|200px|JXG (WC)]]
|-
| Epithelioid type
| scattered nuclei<ref name=Ref_InstantPath7>{{Ref InstantPath|7}}</ref>
| drug reaction, neoplasm, foreign body, infection, idiopathic, autoimmune, allergic
| [[granuloma|granulomatous inflammation]]
| [[Image:Crohn%27s_disease_-_colon_-_very_high_mag.jpg|thumb|150px|center|Granuloma (WC)]]
|-
| Langhans giant cell
| peripheral eccentric nuclei<ref name=Ref_InstantPath7>{{Ref InstantPath|7}}</ref>
| tuberculosis, sarcoidosis.
| '''not''' to be confused with ''Langerhans cells''
| [[Image:Granulation_tissue_containg_a_poorly_formed_granuloma_with_a_Langhan%27s_giant_cell.jpg|thumb|200px|LGC (WC)]]
|-
| Osteoclast-like giant cells
| round nuclei
| osteoclasts, others
| [[AKA]] osteoclast-type giant cells
|
|}

==See also==
*[[Basics]].
*[[Giant cell lesions]] - includes a DDx of lesions with giant cells.
*[[Histiocytoses]].

==References==
{{Reflist|1}}

[[Category:Basics]]

Giant cells

2018-07-05T11:56:54Z

Abraham: /* Table */

[[Image:Giant cell in bronchial wash -- very high mag.jpg|thumb|right|Giant cell from a [[pulmonary cytopathology|bronchial wash]]. [[Pap stain]].]]
'''Giant cells''' are "big" cells with multiple nuclei. They come in different flavours, which are suggestive of causality.

This article deals with the classic types of giant cells. A more general differential diagnosis of giant cells is in ''[[giant cell lesions]]''.

==Giant cell types==
List:
*Touton giant cell.
*Osteoclast-like giant cell.
*Foreign body type giant cell.

===Table===
{| class="wikitable"
| Type
| Histology
| DDx
| Other
| Image
|-
| Touton giant cell
| nuclei form a ring around the cell periphery
| [[juvenile xanthogranuloma]], [[Erdheim-Chester disease]]
| high lipid content lesions<ref>URL: [http://granuloma.homestead.com/giant_cells.html http://granuloma.homestead.com/giant_cells.html]. Accessed on: 7 February 2011.</ref>
| [[Image:Juvenile_xanthogranuloma_-_very_high_mag.jpg|thumb|200px|JXG (WC)]]
|-
| Epithelioid type
| scattered nuclei<ref name=Ref_InstantPath7>{{Ref InstantPath|7}}</ref>
| drug reaction, neoplasm, foreign body, infection, idiopathic, autoimmune, allergic
| [[granuloma|granulomatous inflammation]]
| [[Image:Crohn%27s_disease_-_colon_-_very_high_mag.jpg|thumb|150px|center|Granuloma (WC)]]
|-
| Langhans giant cell
| peripheral eccentric nuclei<ref name=Ref_InstantPath7>{{Ref InstantPath|7}}</ref>
| suberculosis, sarcoidosis.
| '''not''' to be confused with ''Langerhans cells''
| [[Image:Granulation_tissue_containg_a_poorly_formed_granuloma_with_a_Langhan%27s_giant_cell.jpg|thumb|200px|LGC (WC)]]
|-
| Osteoclast-like giant cells
| round nuclei
| osteoclasts, others
| [[AKA]] osteoclast-type giant cells
|
|}

==See also==
*[[Basics]].
*[[Giant cell lesions]] - includes a DDx of lesions with giant cells.
*[[Histiocytoses]].

==References==
{{Reflist|1}}

[[Category:Basics]]

Microorganisms

2018-07-05T10:21:49Z

Abraham: /* Microscopic */

'''Microorganisms''' show-up every once in a while. It is essential to know 'em.

=Microorganisms=
==Fungi==
{| class="wikitable sortable"
|-
! Name (disease)
! Kingdom
! Size
! Shape
! Stains
! Other (microscopic)
! Clinical
! References
! Image
|-
| Aspergillus ([[aspergillosis]])
| Fungi
| ?
| '''Hyphae that branching with 45 degrees angle'''
| PAS-D
| Fruiting heads when aerobic
| ? Immunosuppression
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| [[Image:Pulmonary_aspergillosis.jpg|thumb|center|150px| Aspergillus. (WC)]]
|-
| Zygomycota ([[zygomycosis]]); ''more specific'' Mucorales (mucormycosis)
| Fungi
| ?
| '''Branching hyphae with variable width'''
| ?
| [[Granulomata]] assoc.
| Diabetes, immunodeficient
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| [[Image:Zygomycosis.jpg |thumb|center|150px| Zygomycosis. (WC)]]
|-
| Coccidioides, usually C. immitis (coccidioidomycosis)
| Fungi
| '''Large''' - 20-60 micrometers, endospores 1-5 micrometers
| Spherules
| Stains?
| Other?
| Immunodeficient
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| [http://pathmicro.med.sc.edu/mycology/cocc3.jpg Coccidioidomycosis (med.sc.edu)] [[Image:Coccidioides_immitis_on_Sabouraud%27s_medium.jpg |thumb|center|150px|C. immitis (WC)]]
|-
| Histoplasma ([[histoplasmosis]])
| Fungi
| 2-5 micrometers
| Spherical
| [[GMS]]
| '''Intracellular (unlike candida), granulomata'''
| Source: soil with bird droppings
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| [[Image:Histoplasma_pas-d.jpg|thumb|center|150px| Histoplasmosis. (WC)]]
|-
| Blastomyces ([[blastomycosis]])
| Fungi
| 5-15 micrometres
| Spherical (yeast)
| Stains?
| Granulomas, '''broad-based budding yeast'''
| Habitat: Northeast America, Africa
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref><ref>[http://pathmicro.med.sc.edu/mycology/mycology-6.htm http://pathmicro.med.sc.edu/mycology/mycology-6.htm]</ref>
| [[Image:Blastomycosis_cropped.JPG | thumb|center|150px|Blastomyces. (WC)]]
|-
| Paracoccidioides ([[paracoccidioidomycosis]])
| Fungi
| 6-60 micrometres
| Spherical (yeast)
| Stains?
| '''Multiple budding "steering wheel" appearance'''
| Clinical???
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| [[Image:Paracoccidioides_brasiliensis_01.jpg |thumb|center|150px|P. brasiliensis (WC)]]
|-
| Pneumocystis jirovecii ([[pneumocystis carinii pneumonia]]; abbrev. PCP)
| Fungi (previously thought to be a protozoan)
| 7-8 micrometres
| '''"Dented ping-pong ball"'''
| GMS
| Usually in clusters of '''alveolar casts with a honeycomb appearance'''
| [[HIV]]/AIDS associated
| <ref name=Ref_APBR684>{{Ref APBR|684}}</ref>
| [[Image:Pneumocystosis_carinii_of_lung_in_AIDS_959_lores.jpg|thumb|center|150px| PCP. (WC)]]
|-
| Cryptococcus ([[cryptococcosis]])
| Fungi
| 5-15 micrometres
| Yeast
| GMS
| '''Prominent (i.e. thick polysaccharide) capsule'''
| HIV/AIDS associated, most common CNS fungus
| <ref name=Ref_APBR682>{{Ref APBR|682}}</ref>
| [[Image:Cryptococcosis_of_lung_in_patient_with_AIDS._Mucicarmine_stain_962_lores.jpg |thumb|center|150px| Crytococcosis - mucicarmine (WC)]]
|}
Notes:
*'''Bold''' text = key features.

=Fungi=
{{Main|Fungi}}
*There are lots of 'em. Below are a few of 'em.

Terminology:<ref>[http://www.fungionline.org.uk/1intro/3growth_forms.html http://www.fungionline.org.uk/1intro/3growth_forms.html]</ref>
*Hyphae = microscopic filamentous growth (of fungi) -- single cell.
*Mycelial = filamentous network of hyphae.
*Septae/septation = hyphae may be subdivided by septae -- if they aren't they are one mass of protoplasm. (?)
*Dimorphism = exist in two forms; e.g. single cell (yeast) and mycelial growth.
*Pseudohyphae = looks like hyphae --but branching pattern is created by separate cells.<ref>[http://pathmicro.med.sc.edu/mycology/mycology-3.htm http://pathmicro.med.sc.edu/mycology/mycology-3.htm]</ref>

===Tissue invasive fungi===
Typically:<ref>CM 17 Apr 2009.</ref>
*Mucor.
*Aspergillus.

===List===
*[[Histoplasmosis]].
*[[Coccidioidomycosis]].
*[[Pneumocystis pneumonia]].
*[[Cryptococcus]].
*[[Cryptosporidiosis]].
*[[Candidiasis]].
*[[Blastomycosis]].
*[[Mucormycosis]].

=Worms & stuff=

==Schistosomiasis==
:''See [[Urine cytopathology]]''.
===General===
*Trematode, i.e. type of worm.

*Due to:
**''Schistosoma mansoni''.
**''Schistosoma haematobium''.
**''Schistosoma japonicum''
*''S. haematobium'' infection associated with [[squamous cell carcinoma of the urinary bladder]].
**Classically presents with hematuria.

===Microscopic===
Features of ova (''S. haematobium''):<ref>URL: [http://path.upmc.edu/cases/case622/dx.html http://path.upmc.edu/cases/case622/dx.html]. Accessed on: 26 January 2012.</ref>
* Elliptical ~140 micrometres max dimension.
* "Spike" approx. the size of a [[PMN]].

====Images====
<gallery>
Image:Schistosomiasis_haematobia.jpg | Schistosomiasis haematobia. (WC)
Image:Schistosoma japonicum (1) histopathology.JPG | Schistosoma japonicum. (WC/KGH)
Image:Schistosoma japonicum (2) histopathology.JPG | Schistosoma japonicum. (WC/KGH)
Image:Schistosoma japonicum (3) histopathology.JPG | Schistosoma japonicum. (WC/KGH)
Image:Schistosoma_-_intermed_mag.jpg | Schistosoma eggs - intermed. mag. (WC/Nephron)
Image:Schistosoma_-_very_high_mag.jpg | Schistosoma eggs - very high mag. (WC/Nephron)
</gallery>
www:
*[http://path.upmc.edu/cases/case622.html Schistosomiasis - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case622/images/fig08.jpg Comparison of Schistosome eggs (upmc.edu/Lancet)].

==Toxoplasma==
===General===
*Common CNS infection.
**''Toxoplasma gondii'' - pathogenic; causes ''toxoplasmosis''.
*Protozoa.
*A [[TORCH infection]].

===Microscopic===
General:
*Tachyzoites (Invasive form):
**Crescent-shaped organisms that are 2-3μm wide by 4-8μm long.
*Bradyzoites:
**Are founded within the tissue cysts and are shorter than tachyzoites.
*Oocysst:
**Ovoid shape that measures 10μm to 12μm and contains four sporozoites.

*Histopathological features depend on location in body.

====Lymph node====
LN features:<ref name=Ref_ILNP113>{{Ref ILNP|113}}</ref>
*Reactive germinal centers (pale areas - larger than usual).
**Often poorly demarcated - due to loose epithelioid cell clusters at germinal center edge - '''key feature'''.
*Epithelioid cells - perifollicular & intrafollicular.
**Loose aggregates of histiocytes (do not form round granulomas):
***Abundant pale cytoplasm.
***Nucleoli.
*Monocytoid cells (monocyte-like cells) - in cortex & paracortex.
**Large cells in islands/sheets '''key feature''' with:
***Abundant pale cytoplasm - '''important'''.
***Well-defined cell border - '''important'''.
***Singular nucleus.
**Cell clusters usually have interspersed neutrophils.

Images (lymph node):
*[http://commons.wikimedia.org/wiki/File:Toxoplasmosis_lymphadenopathy_-_low_mag.jpg Toxoplasmosis - low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Toxoplasmosis_lymphadenopathy_-_high_mag.jpg Toxoplasmosis - high mag. (WC)].

====CNS====
CNS features:<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/N0I001-PQ01-M.htm http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/N0I001-PQ01-M.htm]. Accessed on: 19 October 2010.</ref>
*Granular appearing ball ~ 2x the size of resting lymphocyte.

=====Images (CNS)=====
<gallery>
Image:Toxoplasmosis_-_cropped_-_very_high_mag.jpg | CNS toxoplasmosis - very high mag. (WC)
Image:Toxoplasmosis_-_ihc_-_very_high_mag.jpg | CNS toxoplasmosis - IHC - very high mag. (WC)
</gallery>
www:
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/N0I001-PQ01-M.htm CNS toxoplasmosis (ouhsc.edu)].
*[http://moon.ouhsc.edu/kfung/jty1/Composites/FND5IE01-Toxoplasmosis-Micro.htm CNS toxoplasmosis (ouhsc.edu)].
*[http://path.upmc.edu/cases/case350.html Toxoplasmosis - several images (upmc.edu)].

====Heart====
Features:
*Intramuscular organisms.

DDx:
*[[Chagas disease]]. (???)

Images (heart):
*[http://path.upmc.edu/cases/case160.html Toxoplasmosis (upmc.edu)].

===IHC===
*IHC for toxoplasma.<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/N0I001-PQ01-M.htm http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/N0I001-PQ01-M.htm]. Accessed on: 19 October 2010.</ref>

==Strongyloidiasis==
===General===
*Causes by worm ''Strongyloides stercoralis''.
*High case mortality rate ~ 70%.<ref name=pmid15337730>{{Cite journal | last1 = Lim | first1 = S. | last2 = Katz | first2 = K. | last3 = Krajden | first3 = S. | last4 = Fuksa | first4 = M. | last5 = Keystone | first5 = JS. | last6 = Kain | first6 = KC. | title = Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management. | journal = CMAJ | volume = 171 | issue = 5 | pages = 479-84 | month = Aug | year = 2004 | doi = 10.1503/cmaj.1031698 | PMID = 15337730 }}</ref>
*May present after years of latency due to immune suppression.<ref name=pmid11528578>{{Cite journal | last1 = Siddiqui | first1 = AA. | last2 = Berk | first2 = SL. | title = Diagnosis of Strongyloides stercoralis infection. | journal = Clin Infect Dis | volume = 33 | issue = 7 | pages = 1040-7 | month = Oct | year = 2001 | doi = 10.1086/322707 | PMID = 11528578 }}</ref>

Location:
*Lung. (???)

===Microscopic===
Features:
*Long worms.
*~10-15 micrometers wide.

====Images====
<gallery>
Image:Strongyloides_stercoralis_larva.jpg | Strongyloides. (WC)
</gallery>
www:
*[http://www.totallyfreeimages.com/121316/This-micrograph-reveals-adult-strongyloides-nematodes-located-am Strongyloides (CDC/totallyfreeimages.com)].
*[http://www.sciencephoto.com/media/116331/enlarge Strongyloides (sciencephoto.com)].

==Echinococcus==
*Several species - most common: ''Echinococcus granulosus''.
*Causes ''[[hydatid disease]]'' in the [[liver]].

===Microscopic===
Features:
*Laminated wall +/- calcification.<ref name=Ref_PBPoD8_448>{{Ref PCPBoD8|448}}</ref>
*Organisms:
**Hooklets.
**Scoleces - knoblike anterior end of a tapeworm.<ref>[http://www.thefreedictionary.com/scoleces http://www.thefreedictionary.com/scoleces]. Accessed on: 10 January 2010.</ref>

==Enterobius vermicularis==
*AKA ''pinworm''.
===General===
*Classically found in a [[vermiform appendix]] removed for appendicitis that does not have [[acute appendicitis]].<ref name=pmid7945067>{{Cite journal | last1 = Dahlstrom | first1 = JE. | last2 = Macarthur | first2 = EB. | title = Enterobius vermicularis: a possible cause of symptoms resembling appendicitis. | journal = Aust N Z J Surg | volume = 64 | issue = 10 | pages = 692-4 | month = Oct | year = 1994 | doi = | PMID = 7945067 }}</ref>
**See: ''[[Vermiform appendix#Enterobius vermicularis]]''.

===Gross===
*Peri-anal white squiggly thing ~ 2-13 mm in length.

Image:
*[http://www.dijitalimaj.com/alamyDetail.aspx?img={14157DA6-DBE8-4E03-BE4A-69591588E153} Pinworm (dijitalimaj.com)].

===Microscopic===
Features - organism:
*0.2-0.5 mm width x 2-13 mm length.
*Characteristic triangular "spikes" seen on cross section - base x height ~ 30 x 30 μm.
**''Spikes'' is in quotations, as these are really a longitudinal blade-like ridges, that run the length of the worm.

Features - eggs:<ref name=Ref_APBR685>{{Ref APBR|685}}</ref>
*Ovoid - double walled shells, one side flat.

====Images====
www:
*[http://www.brown.edu/Courses/Digital_Path/systemic_path/GI/enterobius.html Enterobius (brown.edu)].
<gallery>
Image:Enterobius_-_very_low_mag.jpg | Enterobius - very low mag. (WC)
Image:Enterobius_-_high_mag.jpg | Enterobius - high mag. (WC)
Image:Pinworms_in_the_Appendix_%281%29.jpg | Pinworm (WC)
</gallery>
==Trichinella==
===General===
*Causes ''Trichinosis''.
**Classically associated with uncooked pork.<ref name=pmid17072975>{{cite journal |author=Kaewpitoon N, Kaewpitoon SJ, Philasri C, ''et al.'' |title=Trichinosis: epidemiology in Thailand |journal=World J. Gastroenterol. |volume=12 |issue=40 |pages=6440–5 |year=2006 |month=October |pmid=17072975 |doi= |url=http://www.wjgnet.com/1007-9327/12/6440.asp}}</ref>
*Several types; most due to ''T. spiralis''.<ref name=pmid17072975/>

===Microscopic===
Features:
*Worm.

Image:
*[http://www.microbiologybytes.com/introduction/Paraquiz/QUIZ06A.html Muscle bx with trichinella (microbiologybytes.com)].
*[http://library.med.utah.edu/WebPath/jpeg2/MUSC010.jpg Trichinella (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html]. Accessed on: 5 December 2010.</ref>

==Cysticercosis==
===General===
*Caused by ''Taenia solium''; pork tapeworm.
*May cause [[epilepsy]]; most common parasitic CNS infection.<ref name=pmid19208982>{{cite journal |author=Prasad KN, Prasad A, Verma A, Singh AK |title=Human cysticercosis and Indian scenario: a review |journal=J. Biosci. |volume=33 |issue=4 |pages=571–82 |year=2008 |month=November |pmid=19208982 |doi= |url=}}</ref>

===Gross===
*Multiple cystic spaces.

Image:
*[http://reference.medscape.com/features/slideshow/neurocysticercosis Neurocysticercosis (medscape.com)].

===Microscopic===
Features:
*Large ovoid body with complex structures (cross-section of worm) - size: millimetres.
**+/-External eosinophilic microvilli.
**+/-Gastrointestinal tract - ovoid structure within the worm.

Notes:
*Histomorphology is not distinctive for the type... microbiology usually figures it out.

Images:
*[http://www.dpd.cdc.gov/dpdx/html/imagelibrary/A-F/Cysticercosis/body_Cysticercosis_il1.htm Cysticercosis (cdc.gov)].
*[http://www.sciencephoto.com/media/116340/enlarge Cysticercosis (sciencephoto.com)].
*[http://path.upmc.edu/cases/case154.html Neurocysticercosis - case 1 (upmc.edu)].
*[http://path.upmc.edu/cases/case376.html Neurocysticercosis - case 2 (upmc.edu)].

==Rhinosporidiosis==
:'''''Not''' to be confused with [[rhinoscleroma]]''.
===General===
*Caused by parasite ''Rinosporidium seeberi''.
**India, Sri Lanka.
*Nasal mass.
**May present with obstruction.<ref name=pmid16945122/>

===Microscopic===
Features:<ref>URL: [http://www.histopathology-india.net/Rhino.htm http://www.histopathology-india.net/Rhino.htm]. Accessed on: 4 January 2012.</ref><ref name=pmid16945122/>
*Globular cysts ~ 100 micrometers with endospores:
**Hyperchromatic (blue) spherical 10-100 micrometer.

Images:
*[http://www.arquivosdeorl.org.br/conteudo/imagesFORL/11-02-19-fig01-ing.gif Rhinosporidiosis (arquivosdeorl.org.br)].<ref>URL: [http://www.arquivosdeorl.org.br/conteudo/acervo_eng.asp?id=428 http://www.arquivosdeorl.org.br/conteudo/acervo_eng.asp?id=428]. 4 January 2012.</ref>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1560165/figure/F1/ Rhinosporidiosis (nih.gov)].<ref name=pmid16945122>{{Cite journal | last1 = Morelli | first1 = L. | last2 = Polce | first2 = M. | last3 = Piscioli | first3 = F. | last4 = Del Nonno | first4 = F. | last5 = Covello | first5 = R. | last6 = Brenna | first6 = A. | last7 = Cione | first7 = A. | last8 = Licci | first8 = S. | title = Human nasal rhinosporidiosis: an Italian case report. | journal = Diagn Pathol | volume = 1 | issue = | pages = 25 | month = | year = 2006 | doi = 10.1186/1746-1596-1-25 | PMID = 16945122 |PMC = 1560165 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1560165/?tool=pubmed}}</ref>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1560165/figure/F2/ Rhinosporidiosis (nih.gov)].

===Stains===
*[[GMS stain]] +ve organisms.

==Leishmaniasis==
===General===
*Caused by protozoa in the group ''Leishmania'' group.
*Transmitted to humans by the ''sand fly''.

May be:
*Cutaneous.<ref name=pmid20377337>{{Cite journal | last1 = Goto | first1 = H. | last2 = Lindoso | first2 = JA. | title = Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis. | journal = Expert Rev Anti Infect Ther | volume = 8 | issue = 4 | pages = 419-33 | month = Apr | year = 2010 | doi = 10.1586/eri.10.19 | PMID = 20377337 }}</ref>
*Mucocutaneous.<ref name=pmid20377337/>
*Visceral.<ref name=pmid19708817>{{Cite journal | last1 = den Boer | first1 = ML. | last2 = Alvar | first2 = J. | last3 = Davidson | first3 = RN. | last4 = Ritmeijer | first4 = K. | last5 = Balasegaram | first5 = M. | title = Developments in the treatment of visceral leishmaniasis. | journal = Expert Opin Emerg Drugs | volume = 14 | issue = 3 | pages = 395-410 | month = Sep | year = 2009 | doi = 10.1517/14728210903153862 | PMID = 19708817 }}</ref>

===Microscopic===
Features:
*Small ~1-2 micrometers.

====Images====
<gallery>
Image:Leishmania_donovani_01.png | Leishmania - smear. (WC)
Image:Leishmania_2009-04-14_smear.JPG | Leishmania - bone marrow. (WC)
Image:Cutaneous_Leishmaniasis_x100 | Leishmania - cutaneous. (WC)
</gallery>
www:
*[http://www.cdc.gov/parasites/leishmaniasis/index.html Leishmania and sand fly (cdc.gov)].

===Stains===
*[[Giemsa stain]] - highlights organisms.

=Viruses=
{{Main|Viruses}}
This is a fairly big topic. There are about half a dozen viral inclusions (e.g. [[CMV]], [[HSV]], [[VZV]], [[adenovirus]]) a decent pathologist ought to be able to identify. The ''virus'' article covers 'em.

=Bacteria=
{{Main|Bacteria}}
This is a small topic when considered from the perspective of an anatomical pathologist. Most stuff is sorted-out by microbiology.

=Microorganisms and cancer=
==Viruses and cancer==
A number of microorganisms are associated with the development of cancer:<ref>{{Ref PCPBoD8|168}}</ref>
*[[Human papillomavirus]] (HPV) - cancer of cervix, vulva, vagina, penis, anus, head & neck.
*[[Epstein-Barr virus]] - [[Burkitt lymphoma]], [[Post-transplant lymphoproliferative disorder]], classical [[Hodgkin lymphoma]] (all but ''[[Nodular sclerosis Hodgkin lymphoma|nodular sclerosis HL]]''), [[nasopharyngeal carcinoma]].
*[[Hepatitis B]] - [[HCC]].
*[[Hepatitis C]] - [[HCC]].
*[[Lymphoma#Adult_T-cell_leukemia.2Flymphoma|Human T-cell lymphotropic virus type I]] (HTLV-1) - [[Adult T-cell leukemia/lymphoma]].
*[[Human herpesvirus-8]] (HHV-8) - [[Kaposi sarcoma]], [[primary effusion lymphoma]], body cavity lymphoma.
*[[Merkel cell carcinoma|Merkel cell polyomavirus]] - [[Merkel cell carcinoma]].

==Bacteria and cancer==
*[[Helicobacter pylori]] - [[MALT lymphoma]], [[gastric carcinoma]].

==Parasites and cancer==
*[[Schistosoma haematobium]] - [[squamous cell carcinoma of the urinary bladder]].
*Clonorchis sinensis (AKA Opisthorchis sinensis) - [[cholangiocarcinoma]].
*Opisthorchis viverrini - [[cholangiocarcinoma]].

=See also=
*[[Staining]].
*[[Immunohistochemistry]].
*[[Viruses]].

=References=
{{reflist|2}}

=External links=
*[http://www.fujita-hu.ac.jp/~tsutsumi/index.html Pathology of Infectious Diseases (fujita-hu.ac.jp)].

[[Category:Basics]]
[[Category:Microorganisms]]

Microorganisms

2018-07-05T10:21:39Z

Abraham: /* Microscopic */

2017-11-13T15:12:15Z

Abraham: /* Drugs */

'''Programmed death-ligand 1''', commonly abbreviated '''PD-L1''', is a protein with an important role in immune system regulation and [[cancer]].

Normally, PD-L1 on cells binds with [[programmed cell death 1]] on the T lymphocytes.<ref name=pmid22658126/>

PD-L1 is also known as '''CD274'''.<ref name=omim>{{OMIM|605402}}</ref>

==General==
*[[IHC]] testing using a PD-L1 antibody (demonstrating positive tumour cells) predicts response to anti-PD-L1 drugs.<ref name=pmid26970723/>

===Background===
Cytotoxic T cell function is regulated by receptor pairs found on the tumour and lymphocyte:<ref name=pmid22658126>{{Cite journal | last1 = Ribas | first1 = A. | title = Tumor immunotherapy directed at PD-1. | journal = N Engl J Med | volume = 366 | issue = 26 | pages = 2517-9 | month = Jun | year = 2012 | doi = 10.1056/NEJMe1205943 | PMID = 22658126 }}</ref>
{| class="wikitable sortable"
! Function
! Tumour cell
! T cell
|-
| Antigen presentation
| MHC
| TCR
|-
| Signal inhibition
| PD-1
| [[PD-L1]] (CD274), PD-L2 (CD273)
|}

==Prognosis==
*Good prognosis - in high-grade [[ovarian serous carcinoma]], associated with [[tumour-infiltrating lymphocytes]].<ref name=pmid26972336>{{Cite journal | last1 = Webb | first1 = JR. | last2 = Milne | first2 = K. | last3 = Kroeger | first3 = DR. | last4 = Nelson | first4 = BH. | title = PD-L1 expression is associated with tumor-infiltrating T cells and favorable prognosis in high-grade serous ovarian cancer. | journal = Gynecol Oncol | volume = 141 | issue = 2 | pages = 293-302 | month = May | year = 2016 | doi = 10.1016/j.ygyno.2016.03.008 | PMID = 26972336 }}</ref>

==Drugs==
*Atezolizumab.<ref name=pmid26970723>{{Cite journal | last1 = Fehrenbacher | first1 = L. | last2 = Spira | first2 = A. | last3 = Ballinger | first3 = M. | last4 = Kowanetz | first4 = M. | last5 = Vansteenkiste | first5 = J. | last6 = Mazieres | first6 = J. | last7 = Park | first7 = K. | last8 = Smith | first8 = D. | last9 = Artal-Cortes | first9 = A. | title = Atezolizumab versus docetaxel for patients with previously treated non-small-cell lung cancer (POPLAR): a multicentre, open-label, phase 2 randomised controlled trial. | journal = Lancet | volume = | issue = | pages = | month = Mar | year = 2016 | doi = 10.1016/S0140-6736(16)00587-0 | PMID = 26970723 }}</ref>
*Durvalumab.
*Pembrolizumab
*Avelumab

===Anti-PD-L1 drugs - use===
PD-L1 antibodies are being used to treat:<ref name=pmid26895815>{{Cite journal | last1 = Gandini | first1 = S. | last2 = Massi | first2 = D. | last3 = Mandalà | first3 = M. | title = PD-L1 expression in cancer patients receiving anti PD-1/PD-L1 antibodies: A systematic review and meta-analysis. | journal = Crit Rev Oncol Hematol | volume = 100 | issue = | pages = 88-98 | month = Apr | year = 2016 | doi = 10.1016/j.critrevonc.2016.02.001 | PMID = 26895815 }}</ref>
*[[Malignant melanoma]].
*[[Non-small cell lung cancer]].
**Associated with response predicted by [[tumour-infiltrating lymphocytes]] and ''PD-L1 IHC'' positivity of the tumour cells.<ref name=pmid26970723/>
*[[Renal cell carcinoma]].
*[[Urothelial carcinoma]].

==See also==
*[[Molecular pathology]].
*[[Cytotoxic T-lymphocyte-associate antigen 4]].

==References==
{{Reflist|1}}

[[Category:Immunohistochemistry]]
[[Category:Molecular pathology]]

Programmed death-ligand 1

2017-11-13T05:02:03Z

Abraham: /* Drugs */

'''Programmed death-ligand 1''', commonly abbreviated '''PD-L1''', is a protein with an important role in immune system regulation and [[cancer]].

Normally, PD-L1 on cells binds with [[programmed cell death 1]] on the T lymphocytes.<ref name=pmid22658126/>

PD-L1 is also known as '''CD274'''.<ref name=omim>{{OMIM|605402}}</ref>

==General==
*[[IHC]] testing using a PD-L1 antibody (demonstrating positive tumour cells) predicts response to anti-PD-L1 drugs.<ref name=pmid26970723/>

===Background===
Cytotoxic T cell function is regulated by receptor pairs found on the tumour and lymphocyte:<ref name=pmid22658126>{{Cite journal | last1 = Ribas | first1 = A. | title = Tumor immunotherapy directed at PD-1. | journal = N Engl J Med | volume = 366 | issue = 26 | pages = 2517-9 | month = Jun | year = 2012 | doi = 10.1056/NEJMe1205943 | PMID = 22658126 }}</ref>
{| class="wikitable sortable"
! Function
! Tumour cell
! T cell
|-
| Antigen presentation
| MHC
| TCR
|-
| Signal inhibition
| PD-1
| [[PD-L1]] (CD274), PD-L2 (CD273)
|}

==Prognosis==
*Good prognosis - in high-grade [[ovarian serous carcinoma]], associated with [[tumour-infiltrating lymphocytes]].<ref name=pmid26972336>{{Cite journal | last1 = Webb | first1 = JR. | last2 = Milne | first2 = K. | last3 = Kroeger | first3 = DR. | last4 = Nelson | first4 = BH. | title = PD-L1 expression is associated with tumor-infiltrating T cells and favorable prognosis in high-grade serous ovarian cancer. | journal = Gynecol Oncol | volume = 141 | issue = 2 | pages = 293-302 | month = May | year = 2016 | doi = 10.1016/j.ygyno.2016.03.008 | PMID = 26972336 }}</ref>

==Drugs==
*Atezolizumab.<ref name=pmid26970723>{{Cite journal | last1 = Fehrenbacher | first1 = L. | last2 = Spira | first2 = A. | last3 = Ballinger | first3 = M. | last4 = Kowanetz | first4 = M. | last5 = Vansteenkiste | first5 = J. | last6 = Mazieres | first6 = J. | last7 = Park | first7 = K. | last8 = Smith | first8 = D. | last9 = Artal-Cortes | first9 = A. | title = Atezolizumab versus docetaxel for patients with previously treated non-small-cell lung cancer (POPLAR): a multicentre, open-label, phase 2 randomised controlled trial. | journal = Lancet | volume = | issue = | pages = | month = Mar | year = 2016 | doi = 10.1016/S0140-6736(16)00587-0 | PMID = 26970723 }}</ref>
*Durvalumab.
*Pembrolizumab

===Anti-PD-L1 drugs - use===
PD-L1 antibodies are being used to treat:<ref name=pmid26895815>{{Cite journal | last1 = Gandini | first1 = S. | last2 = Massi | first2 = D. | last3 = Mandalà | first3 = M. | title = PD-L1 expression in cancer patients receiving anti PD-1/PD-L1 antibodies: A systematic review and meta-analysis. | journal = Crit Rev Oncol Hematol | volume = 100 | issue = | pages = 88-98 | month = Apr | year = 2016 | doi = 10.1016/j.critrevonc.2016.02.001 | PMID = 26895815 }}</ref>
*[[Malignant melanoma]].
*[[Non-small cell lung cancer]].
**Associated with response predicted by [[tumour-infiltrating lymphocytes]] and ''PD-L1 IHC'' positivity of the tumour cells.<ref name=pmid26970723/>
*[[Renal cell carcinoma]].
*[[Urothelial carcinoma]].

==See also==
*[[Molecular pathology]].
*[[Cytotoxic T-lymphocyte-associate antigen 4]].

==References==
{{Reflist|1}}

[[Category:Immunohistochemistry]]
[[Category:Molecular pathology]]