Adenocarcinoma of the lung classification: Difference between revisions

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{{Adenocarcinoma of the lung}}
{{Adenocarcinoma of the lung}}
{{CMG}}; {{AE}} {{SC}}
{{CMG}}; {{AE}} {{Trusha}}{{SC}} {{Cherry}}
==Overview==
==Overview==
== Classification ==
Adenocarcinoma of the lung may be [[Classification|classified]] according to [[World Health Organization|WHO]] into many sub-types. Adenocarcinoma of the lung may be [[Classification|classified]] according to IASLC/ATS/ERS into pre-invasive [[Lesion|lesions]], [[Atypical adenomatous hyperplasia of the lung|atypical adenomatous hyperplasia]], adenocarcinoma in situ, minimally invasive adenocarcinoma, invasive adenocarcinoma, and variants of invasive adenocarcinoma.
[[File:Adenocarcinoma of the lung.jpg|thumb|right|A gross pathological specimen of a pulmonary adenocarcinoma, removed in a [[lobectomy]].]]
Adenocarcinomas are highly heterogeneous tumors. Several major histological subtypes are currently recognized by the WHO <ref name="who2004"/> and  IASLC/ATS/ERS<ref name="pmid21828029">{{Cite journal | pmid = 21828029| year = 2012| author1 = Van Schil| first1 = P. E.| title = Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification| journal = European Respiratory Journal| volume = 39| issue = 2| pages = 478-86| last2 = Asamura| first2 = H| last3 = Rusch| first3 = V. W.| last4 = Mitsudomi| first4 = T| last5 = Tsuboi| first5 = M| last6 = Brambilla| first6 = E| last7 = Travis| first7 = W. D.| doi = 10.1183/09031936.00027511}}</ref><ref>{{Cite journal | pmid = 21804158| year = 2011| author1 = Travis| first1 = W. D.| title = Paradigm shifts in lung cancer as defined in the new IASLC/ATS/ERS lung adenocarcinoma classification| journal = European Respiratory Journal| volume = 38| issue = 2| pages = 239-43| last2 = Brambilla| first2 = E| last3 = Van Schil| first3 = P| last4 = Scagliotti| first4 = G. V.| last5 = Huber| first5 = R. M.| last6 = Sculier| first6 = J. P.| last7 = Vansteenkiste| first7 = J| last8 = Nicholson| first8 = A. G.| doi = 10.1183/09031936.00026711}}</ref><ref>{{Cite journal | pmid = 18951650| year = 2009| author1 = Vazquez| first1 = M| title = Solitary and multiple resected adenocarcinomas after CT screening for lung cancer: Histopathologic features and their prognostic implications| journal = Lung Cancer| volume = 64| issue = 2| pages = 148-54| last2 = Carter| first2 = D| last3 = Brambilla| first3 = E| last4 = Gazdar| first4 = A| last5 = Noguchi| first5 = M| last6 = Travis| first6 = W. D.| last7 = Huang| first7 = Y| last8 = Zhang| first8 = L| last9 = Yip| first9 = R| last10 = Yankelevitz| first10 = D. F.| last11 = Henschke| first11 = C. I.| author12 = International Early Lung Cancer Action Program Investigators| doi = 10.1016/j.lungcan.2008.08.009| pmc = 2849638}}</ref>


* Non-invasive or minimally invasive adenocarcinoma
==Classification==
**[[Adenocarcinoma in situ of the lung]] ([[Bronchioalveolar carcinoma]])
* Adenocarcinomas are highly [[heterogeneous]] [[Tumor|tumors]].
**[[Minimally invasive adenocarcinoma of the lung]]
* Several major [[Histology|histological]] sub-types are currently recognized by the [[World Health Organization|WHO]] and IASLC/ATS/ERS [[classification]] systems.<ref name="pmid21828029">{{Cite journal | pmid = 21828029| year = 2012| author1 = Van Schil| first1 = P. E.| title = Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification| journal = European Respiratory Journal| volume = 39| issue = 2| pages = 478-86| last2 = Asamura| first2 = H| last3 = Rusch| first3 = V. W.| last4 = Mitsudomi| first4 = T| last5 = Tsuboi| first5 = M| last6 = Brambilla| first6 = E| last7 = Travis| first7 = W. D.| doi = 10.1183/09031936.00027511}}</ref><ref>{{Cite journal | pmid = 21804158| year = 2011| author1 = Travis| first1 = W. D.| title = Paradigm shifts in lung cancer as defined in the new IASLC/ATS/ERS lung adenocarcinoma classification| journal = European Respiratory Journal| volume = 38| issue = 2| pages = 239-43| last2 = Brambilla| first2 = E| last3 = Van Schil| first3 = P| last4 = Scagliotti| first4 = G. V.| last5 = Huber| first5 = R. M.| last6 = Sculier| first6 = J. P.| last7 = Vansteenkiste| first7 = J| last8 = Nicholson| first8 = A. G.| doi = 10.1183/09031936.00026711}}</ref><ref>{{Cite journal | pmid = 18951650| year = 2009| author1 = Vazquez| first1 = M| title = Solitary and multiple resected adenocarcinomas after CT screening for lung cancer: Histopathologic features and their prognostic implications| journal = Lung Cancer| volume = 64| issue = 2| pages = 148-54| last2 = Carter| first2 = D| last3 = Brambilla| first3 = E| last4 = Gazdar| first4 = A| last5 = Noguchi| first5 = M| last6 = Travis| first6 = W. D.| last7 = Huang| first7 = Y| last8 = Zhang| first8 = L| last9 = Yip| first9 = R| last10 = Yankelevitz| first10 = D. F.| last11 = Henschke| first11 = C. I.| author12 = International Early Lung Cancer Action Program Investigators| doi = 10.1016/j.lungcan.2008.08.009| pmc = 2849638}}</ref>
* Invasive adenocarcinoma
*The IASLC/ATS/ERS lung adenocarcinoma [[Histology|histological]] [[classification]] system was proposed in 2011.<ref>{{cite journal|doi=10.3978/j.issn.2072-1439.2014.09.13}}</ref>
** Acinar predominant adenocarcinoma
*According to this new [[classification]], [[tumor]] size ≤ 3 cm with pure lepidic pattern, but without [[Lymph node metastases|lymphatic]], [[vascular]], and [[Pleura|pleural]] [[Invasive (medical)|invasion]] or tumor [[necrosis|necrosis,]] was defined as adenocarcinoma ''in situ'' (AIS).
** Papillary predominant adenocarcinoma
*If [[tumor]] size ≤ 3 cm with a lepidic predominant pattern and contained ≤ 5 mm [[stromal]] [[Invasive (medical)|invasion]], it was defined as minimally invasive adenocarcinoma (MIA).
** Micropapillary predominant adenocarcinoma
*If tumor had > 5 mm [[stromal]] [[Invasive (medical)|invasion]], it was defined as an invasive adenocarcinoma.
** Solid predominant adenocarcinoma
** Invasive mucinous adenocarcinoma


In as many as 80% of tumors that are extensively sampled, components of more than one of these subtypes will be recognized. In such cases, resected tumors should be classified by comprehensive histological subtyping.  Using increments of 5% to describe the amount of each subtype present, the predominant subtype is used to classify the whole tumor.<ref>{{Cite journal | pmid = 21252716| year = 2011| author1 = Travis| first1 = W. D.| title = International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma| journal = Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer| volume = 6| issue = 2| pages = 244–85| last2 = Brambilla| first2 = E| last3 = Noguchi| first3 = M| last4 = Nicholson| first4 = A. G.| last5 = Geisinger| first5 = K. R.| last6 = Yatabe| first6 = Y| last7 = Beer| first7 = D. G.| last8 = Powell| first8 = C. A.| last9 = Riely| first9 = G. J.| last10 = Van Schil| first10 = P. E.| last11 = Garg| first11 = K| last12 = Austin| first12 = J. H.| last13 = Asamura| first13 = H| last14 = Rusch| first14 = V. W.| last15 = Hirsch| first15 = F. R.| last16 = Scagliotti| first16 = G| last17 = Mitsudomi| first17 = T| last18 = Huber| first18 = R. M.| last19 = Ishikawa| first19 = Y| last20 = Jett| first20 = J| last21 = Sanchez-Cespedes| first21 = M| last22 = Sculier| first22 = J. P.| last23 = Takahashi| first23 = T| last24 = Tsuboi| first24 = M| last25 = Vansteenkiste| first25 = J| last26 = Wistuba| first26 = I| last27 = Yang| first27 = P. C.| last28 = Aberle| first28 = D| last29 = Brambilla| first29 = C| last30 = Flieder| first30 = D| display-authors = 29| doi = 10.1097/JTO.0b013e318206a221}}</ref> The predominant subtype is prognostic for survival after complete resection.<ref>{{Cite journal | pmid = 21642859| year = 2011| author1 = Russell| first1 = P. A.| title = Does lung adenocarcinoma subtype predict patient survival?: A clinicopathologic study based on the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary lung adenocarcinoma classification| journal = Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer| volume = 6| issue = 9| pages = 1496–504| last2 = Wainer| first2 = Z| last3 = Wright| first3 = G. M.| last4 = Daniels| first4 = M| last5 = Conron| first5 = M| last6 = Williams| first6 = R. A.| doi = 10.1097/JTO.0b013e318221f701}}</ref>
* The [[World Health Organization|WHO]] [[Histology|histological]] [[classification]] of adenocarcinoma is following:<ref name="WHO">{{cite book | last = Travis | first = William | title = Pathology and genetics of tumours of the lung, pleura, thymus, and heart | publisher = IARC Press | location = Lyon | year = 2004 | isbn = 9283224183 }}</ref><ref name="urlwww.jto.org">{{cite web |url=https://www.jto.org/article/S1556-0864(15)33571-1/pdf |title=www.jto.org |format= |work= |accessdate=}}</ref>
 
Signet ring and clear cell adenocarcinoma are no longer histological subtypes, but rather cytological features that can occur in tumour cells of multiple histological subtypes, most often solid adenocarcinoma.<ref name="pmid21828029"/>
 
Some variants are not clearly recognized by the WHO and IASLC/ATS/ERS classification:
* Enteric adenocarcinoma of the lung<ref>{{Cite journal | pmid = 15605076| year = 2005| author1 = Yousem| first1 = S. A.| title = Pulmonary intestinal-type adenocarcinoma does not show enteric differentiation by immunohistochemical study| journal = Modern Pathology| volume = 18| issue = 6| pages = 816-21| doi = 10.1038/modpathol.3800358}}</ref><ref>{{Cite journal | pmid = 23372961| year = 2013| author1 = Lin| first1 = D| title = Pulmonary enteric adenocarcinoma with villin brush border immunoreactivity: A case report and literature review| journal = Journal of thoracic disease| volume = 5| issue = 1| pages = E17–20| last2 = Zhao| first2 = Y| last3 = Li| first3 = H| last4 = Xing| first4 = X| doi = 10.3978/j.issn.2072-1439.2012.06.06| pmc = 3547996}}</ref>
* [[Cribriform adenocarcinoma of the lung]]


{| class="wikitable"
|+
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" ! | WHO Classification of Lung Tumors
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histological type
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Subtype
|-
! colspan="2" style="background: #707070; color: #FFFFFF; text-align: center;" |Epithelial Tumors
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenocarcinoma of the lung|'''Adenocarcinoma''']]
|
* Lepidic adenocarcinoma
* Acinar adenocarcinoma
* Papillary adenocarcinoma
* Micropapillary adenocarcinoma
* Solid adenocarcinoma
* Invasive mucinous adenocarcinoma
** Mixed invasive mucinous
** Nonmucinous adenocarcinoma
* Colloid adenocarcinoma
* Fetal adenocarcinoma
* Enteric adenocarcinoma
* Minimally invasive adenocarcinoma
* Nonmucinous
** Mucinous
* Preinvasive lesions
** Atypical adenomatous hyperplasia
** Adenocarcinoma in situ
*** Nonmucinous
*** Mucinous
|}
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 19:34, 17 September 2019

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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 of the lung may be classified according to WHO into many sub-types. Adenocarcinoma of the lung may be classified according to IASLC/ATS/ERS into pre-invasive lesions, atypical adenomatous hyperplasia, adenocarcinoma in situ, minimally invasive adenocarcinoma, invasive adenocarcinoma, and variants of invasive adenocarcinoma.

Classification

WHO Classification of Lung Tumors
Histological type Subtype
Epithelial Tumors
Adenocarcinoma
  • Lepidic adenocarcinoma
  • Acinar adenocarcinoma
  • Papillary adenocarcinoma
  • Micropapillary adenocarcinoma
  • Solid adenocarcinoma
  • Invasive mucinous adenocarcinoma
    • Mixed invasive mucinous
    • Nonmucinous adenocarcinoma
  • Colloid adenocarcinoma
  • Fetal adenocarcinoma
  • Enteric adenocarcinoma
  • Minimally invasive adenocarcinoma
  • Nonmucinous
    • Mucinous
  • Preinvasive lesions
    • Atypical adenomatous hyperplasia
    • Adenocarcinoma in situ
      • Nonmucinous
      • Mucinous

References

  1. Van Schil, P. E.; Asamura, H; Rusch, V. W.; Mitsudomi, T; Tsuboi, M; Brambilla, E; Travis, W. D. (2012). "Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification". European Respiratory Journal. 39 (2): 478–86. doi:10.1183/09031936.00027511. PMID 21828029.
  2. Travis, W. D.; Brambilla, E; Van Schil, P; Scagliotti, G. V.; Huber, R. M.; Sculier, J. P.; Vansteenkiste, J; Nicholson, A. G. (2011). "Paradigm shifts in lung cancer as defined in the new IASLC/ATS/ERS lung adenocarcinoma classification". European Respiratory Journal. 38 (2): 239–43. doi:10.1183/09031936.00026711. PMID 21804158.
  3. Vazquez, M; Carter, D; Brambilla, E; Gazdar, A; Noguchi, M; Travis, W. D.; Huang, Y; Zhang, L; Yip, R; Yankelevitz, D. F.; Henschke, C. I.; International Early Lung Cancer Action Program Investigators (2009). "Solitary and multiple resected adenocarcinomas after CT screening for lung cancer: Histopathologic features and their prognostic implications". Lung Cancer. 64 (2): 148–54. doi:10.1016/j.lungcan.2008.08.009. PMC 2849638. PMID 18951650.
  4. . doi:10.3978/j.issn.2072-1439.2014.09.13. Missing or empty |title= (help)
  5. Travis, William (2004). Pathology and genetics of tumours of the lung, pleura, thymus, and heart. Lyon: IARC Press. ISBN 9283224183.
  6. "www.jto.org".


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