Adenocarcinoma of the lung pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2], Shanshan Cen, M.D. [3], Sudarshana Datta, MD [4]

Overview

Adenocarcinoma is the most common type of lung cancer found in non-smokers and is usually seen as a peripheral lesion in the lungs. In past several years many genetic and environmental factors has been identified as a causative factor for lung cancer. Individual susceptibility, active smoking, radon exposure, exposure to high pollution levels, asbestos exposure, occupational or environmental exposure to particular agents or carcinogens contribute to the development of adenocarcinoma of the lung. Hydrocarbons cause damage to the DNA and form DNA adducts. Genes involved in the pathogenesis of adenocarcinoma of the lung include EGFR, HER2, KRAS, ALK, and BRAF. On gross pathology, peripheral multifocal single or multiple solid firm yellow-white nodule or mass which may invade into the pleura and cause pleural retraction/puckering. Adenocarcinoma usually does not form a cavitary lesion. It may present as a diffuse pleural thickening resembling malignant mesothelioma. On microscopic histopathological analysis, nuclear atypia, eccentrically placed nuclei, abundant cytoplasm, and conspicuous nucleoli are characteristic findings of adenocarcinoma of the lung.

Pathogenesis

Field of injury and field cancerization

Genetics

Molecular pathogenesis of adenocarcinoma of the lung

Mutations TP53, KRAS, EGFR, NF1, BRAF, MET, RIT
Fusions ALK, ROS1, RET
SCNAs Gains: NKX2-1, TERT, EGFR, MET, KRAS, ERBB2, MDM2

Losses: LRP1B, PTPRD, and CDKN2A

Pathway alterations RTK/RAS/RAF

mTOR, JAK-STAT, DNA repair, cell cycle regulation, epigenetic deregulation

Environment

Smoking

Radon gas

The association of radon gas exposure to lung cancer is described below.[23][24]

Asbestos

Viruses

Infection and Inflammation

Gross Pathology

Gray-tan tumor seen predominantly at the periphery.
(Source: Libre pathology

Microscopic Pathology

On microscopic histopathological analysis, nuclear atypia, eccentrically placed nuclei, abundant cytoplasm, and conspicuous nucleoli are characteristic findings of adenocarcinoma of the lung.

Histological Subtypes

References

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