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{{Lung cancer}}
{{Lung cancer}}


{{CMG}}; '''Associate Editor(s)-In-Chief:''' Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, {{CZ}}
{{CMG}}; {{AE}} {{KSH}} {{CZ}} {{Rim}} {{SH}}


==Overview==
==Overview==
Primary lung cancer can be classified into two main categories: '''small cell lung cancer''' (~15%) and '''non small cell lung cancer''' (~85%).  Non small cell lung cancer includes several subtypes classified by their histopathological findings, and they are grouped together because their prognosis and management are similar. The 2004 WHO histological classification of tumors of the lung categorized lung tumors into malignant epithelial tumors, benign epithelial tumors, lymphoproliferative tumors, miscellaneous tumors, and metastatic tumors.<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>
Primary lung cancers may be [[Classification|classified]] into [[small cell lung cancer]] (~15%) and [[non small cell lung cancer]] (~85%).  [[Non small cell lung cancer]] are a [[heterogeneous]] group of lung cancers that are often grouped together because they share similar clinical features (e.g. [[prognosis]] and management). The 2015 [[World Health Organization|WHO]] [[Histology|histological]] [[classification]] of [[tumors]] of the [[lung]] categorized [[lung]] [[tumors]] into [[malignant]] [[epithelial]] [[tumors]], [[benign]] [[epithelial]] [[tumors]], [[Lymphoproliferative disorders|lymphoproliferative tumors]], miscellaneous [[tumors]], and [[metastatic]] [[tumors]].


==Classification==
==Classification==
* Primary lung cancer can be classified into two main categories: '''small cell lung cancer''' (~15%) and '''non small cell lung cancer''' (~85%).
Primary lung cancers may be [[Classification|classified]] into two main categories:<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>  
* There are three main sub-types of non small cell lung cancer , which are grouped together because their prognosis and management are similar:
*[[Small cell lung cancer]] (~15%) 
** [[Squamous cell carcinoma of the lung|Squamous cell carcinoma]] (25% of lung cancers)
*[[Non small cell lung cancer]] (~85%).
** [[Adenocarcinoma of the lung|Adenocarcinoma]] (40% of lung cancers) and large cell lung carcinoma (10% of lung cancers)
** [[Large cell carcinoma of the lung|Large cell carcinoma]] (10% of lung cancers)
* A subtype of adenocarcinoma, the [[bronchioloalveolar carcinoma]], is more common in female never-smokers, and may have different responses to treatment.<ref name="Raz">{{cite journal | last =Raz | first =DJ | coauthors =He B, Rosell R, Jablons DM | title =Bronchioloalveolar carcinoma: a review | journal =Clinical Lung Cancer | volume =7 | issue =5 | pages =313–322 | publisher =Cancer Information Group | date =Mar 2006 | pmid =16640802 }}</ref>


==WHO Histological Classification of Tumors of the Lung <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>==
{{Family tree/start}}
{{familytree | | | A01 | | | A01= '''Lung Cancer'''}}
{{familytree | |,|-|^|-|.| | }}
{{familytree | B01 | | |!| | B01= <div style="float: left; text-align: left; width: 30em; padding:1em;">'''[[Small cell lung cancer]] (~15%) '''</div>}}


===Malignant Epithelial Tumors===
{{familytree | | | | | B02 | B02= <div style="float: left; text-align: left; width: 30em; padding:1em;">'''[[Non small cell lung cancer]] (~85%)'''<br>
*[[Squamous cell carcinoma of the lung|Squamous cell carcinoma]] (25% of lung cancers) <br>
*[[Adenocarcinoma of the lung|Adenocarcinoma]] (40% of lung cancers).
*[[Large cell carcinoma of the lung|Large cell carcinoma]] (10% of lung cancers)
*Other non-small cell lung carcinomas:
:*[[Adenosquamous carcinoma of the lung|Adenosquamous carcinoma]] <br>
:*[[Carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements]] <br>
:*[[Carcinoid tumor of the lung|Carcinoid tumor]] <br>
:*[[Lung carcinoma of salivary gland type|Lung carcinoma of salivary gland type]]<br>
:*[[Unclassified carcinoma of the lung|Unclassified carcinoma]] </div>}}
{{Family tree/end}}


* Squamous cell carcinoma
==WHO Histological Classification of Tumors of the Lung ==
:* Papillary
The [[World Health Organization]] ([[World Health Organization|WHO]]) [[Classification|classifies]] [[tumors]] of the [[lungs]] as follows:<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>
:* Clear cell
:* Small cell
:* Basaloid


* Small cell carcinoma
{| class="wikitable"
:* Combined small cell carcinoma
|+
 
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" ! | WHO Classification of Lung Tumors
* Adenocarcinoma
|-
:* Adenocarcinoma, mixed subtype
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histological type
:* Acinar adenocarcinoma
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Subtype
:* Papillary adenocarcinoma
|-
:* Bronchioloalveolar carcinoma
! colspan="2" style="background: #707070; color: #FFFFFF; text-align: center;" |Epithelial tumors
::* Nonmucinous
|-
::* Mucinous
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenocarcinoma of the lung|'''Adenocarcinoma''']]
::* Mixed nonmucinous and mucinous or indeterminate
|
:* Solid adenocarcinoma with mucin production
*[[Lepidic adenocarcinoma of the lung|Lepidic adenocarcinoma]]
::* Fetal adenocarcinoma
*[[Acinar adenocarcinoma of the lung|Acinar adenocarcinoma]]
::* Mucinous (“colloid”) carcinoma
*[[Papillary adenocarcinoma of the lung|Papillary adenocarcinoma]]
::* Mucinous cystadenocarcinoma
*[[Micropapillary adenocarcinoma of the lung|Micropapillary adenocarcinoma]]
::* Signet ring adenocarcinoma
*[[Solid adenocarcinoma of the lung|Solid adenocarcinoma]]
::* Clear cell adenocarcinoma
*[[Invasive mucinous adenocarcinoma of the lung|Invasive mucinous adenocarcinoma]]
 
** Mixed invasive mucinous
* Large cell carcinoma
** Nonmucinous adenocarcinoma
:* Large cell neuroendocrine carcinoma
*[[Colloid adenocarcinoma of the lung|Colloid adenocarcinoma]]
::* Combined large cell neuroendocrine carcinoma
*[[Fetal adenocarcinoma of the lung|Fetal adenocarcinoma]]
:* Basaloid carcinoma
*[[Enteric adenocarcinoma of the lung|Enteric adenocarcinoma]]
:* Lymphoepithelioma-like carcinoma
*[[Minimally invasive adenocarcinoma of the lung|Minimally invasive adenocarcinoma]]
:* Clear cell carcinoma
** Nonmucinous
:* Large cell carcinoma with rhabdoid phenotype
** Mucinous
 
* Pre-[[Invasive (medical)|invasive]] [[Lesion|lesions]]
* Adenosquamous carcinoma
**[[Atypical adenomatous hyperplasia of the lung|Atypical adenomatous hyperplasia]]
 
**[[Adenocarcinoma of the lung|Adenocarcinoma]] in situ
* Sarcomatoid carcinoma
*** Nonmucinous
:* Pleomorphic carcinoma
*** Mucinous
:* Spindle cell carcinoma
|-
:* Giant cell carcinoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Squamous cell carcinoma of the lung|Squamous cell carcinoma]]'''
:* Carcinosarcoma
|
:* Pulmonary blastoma
* Keratinizing squamous cell carcinoma
 
* Nonkeratinizing squamous cell carcinoma
* Carcinoid tumor
* Basaloid squamous cell carcinoma
:* Typical carcinoid
* Pre-[[Invasive (medical)|invasive]] [[lesion]]
:* Atypical carcinoid
** Squamous cell carcinoma in situ
 
|-
* Salivary gland tumors
! colspan="2" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Neuroendocrine tumors'''
:* Mucoepidermoid carcinoma
|-
:* Adenoid cystic carcinoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Small cell carcinoma of the lung|Small cell carcinoma]]'''
:* Epithelial-myoepithelial carcinoma
|
 
* Combined [[Small cell carcinoma of lung|small cell carcinoma]]
* Preinvasive lesions
|-
:* Squamous carcinoma in situ
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Large cell neuroendocrine carcinoma of the lung|Large cell neuroendocrine carcinoma]]'''
:* Atypical adenomatous hyperplasia
|
:* Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
* Combined [[Large cell neuroendocrine carcinoma of the lung|large cell neuroendocrine carcinoma]]
 
|-
* Mesenchymal tumors
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Carcinoid syndrome|Carcinoid tumors]]'''
:* Epithelioid haemangioendothelioma
|
:* Angiosarcoma
*[[Carcinoid tumor|Typical carcinoid tumor]]
:* Pleuropulmonary blastoma
*[[Carcinoid tumor|Atypical carcinoid tumor]]
:* Chondroma
|-
:* Congenial peribronchial myofibroblastic tumor
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Pre-[[Invasive (medical)|invasive]] [[lesion]]'''
:* Diffuse pulmonary lymphangiomatosis
|
:* Inflammatory myofibroblastic tumor
*[[Diffuse]] [[idiopathic]] [[Lung|pulmonary]] [[neuroendocrine cell]] [[hyperplasia]]
:* Lymphangioleiomyomatosis
|-
:* Synovial sarcoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Large cell carcinoma of the lung|Large cell carcinoma]]'''
::* Monophasic
|
::* Biphasic
* N/A
:* Pulmonary artery sarcoma
|-
:* Pulmonary vein sarcoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Adenosquamous carcinoma]]'''
 
|
===Benign Epithelial Tumors===
* N/A
 
|-
* Papillomas
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Sarcomatoid carcinoma of the lung|Sarcomatoid carcinomas]]'''
:* Squamous cell papilloma
|
::* Exophytic
*[[Pleomorphic carcinoma of the lung|Pleomorphic carcinoma]]
::* Inverted
*[[Spindle cell carcinoma of the lung|Spindle cell carcinoma]]
:* Glandular papilloma
*[[Giant cell carcinoma of the lung|Giant cell carcinoma]]
:* Mixed squamous cell and glandular papilloma
*[[Carcinosarcoma of the lung|Carcinosarcoma]]
 
*[[Pulmonary blastoma of the lung|Pulmonary blastoma]]
* Adenomas
|-
:* Alveolar adenoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Other and [[Classification|Unclassified]] [[Carcinoma|carcinomas]]'''
:* Papillary adenoma
|
:* Adenomas of the salivary gland type
*[[Lymphoepithelioma-like carcinoma of the lung|Lymphoepithelioma-like carcinoma]]
::* Mucous gland adenoma
* NUT carcinoma
::* Pleomorphic adenoma
|-
::* Others
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Salivary gland]]-type [[Tumor|tumors]]'''
:* Mucinous cystadenoma
|
 
*[[Mucoepidermoid carcinoma]]
===Lymphoproliferative Tumors===
* Adenoid cystic carcinoma
 
*[[Epithelium|Epithelial]]-[[myoepithelial]] [[carcinoma]]
* Marginal zone B-cell lymphoma of the MALT type
*[[Pleomorphic adenoma]]
* Diffuse large B-cell lymphoma
|-
* Lymphomatoid granulomatosis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Papilloma|Papillomas]]'''
* Langerhans cell histiocytosis
|
 
*[[Squamous cell papilloma]]
===Miscellaneous Tumors===
** Exophytic
 
** Inverted
* Harmatoma
*[[Gland|Glandular]] [[papilloma]]
* Sclerosing hemangioma
* Mixed [[squamous]] and [[Gland|glandular]] [[papilloma]]
* Clear cell tumor
|-
* Germ cell tumors
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Adenoma|Adenomas]]'''
:* Teratoma, mature
|
:* Immature
* Sclerosing pneumocytoma
:* Other germ cell tumors
*[[Alveolar]] [[adenoma]]
 
*[[Papilla|Papillary]] [[adenoma]]
* Intrapulmonary thymoma
*[[Mucinous cystadenoma]]
 
*[[Mucous gland]] [[adenoma]]
* Melanoma
|-
 
! colspan="2" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Mesenchymal tumors'''
===Metastatic Tumors===
|-
 
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hamartoma|'''Pulmonary hamartoma''']]
==TNM Classification of Carcinomas of the Lung==
|
===T: Primary Tumor===
* N/A
{|
|-
|TX || Primary tumor cannot be assessed.<br> OR <br>Tumor is demonstrated by the presence of malignant cells in bronchial washings or sputum, but is not visualized by imaging or bronchoscopy.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Chondroma]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[PEComa|PEComatous tumors]]'''
|
* [[Lymphangiomyomatosis|Lymphangioleiomyomatosis]]
* [[PEComa]] (benign)
**[[Clear cell tumor]]
*[[PEComa]] ([[malignant]])
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Congenital peribronchial myofibroblastic tumor'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Diffuse [[Lung|pulmonary]] [[lymphangiomatosis]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Inflammation|Inflammatory]] [[Myofibroblast|myofibroblastic]] [[tumor]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Vascular tumor|'''Epithelioid hemangioendothelioma''']]
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pleuropulmonary blastoma|'''Pleuropulmonary blastoma''']]
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Synovial sarcoma]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Pulmonary artery]] [[Tunica intima|intimal]] [[sarcoma]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Pulmonary myxoid sarcoma with EWSR1–CREB1 [[translocation]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''[[Myoepithelial]] [[Tumor|tumors]]'''
|
*[[Myoepithelial cells|Myoepithelioma]]
*[[Myoepithelial]] [[carcinoma]]
|-
! colspan="2" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Lymphohistiocytic tumors'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Extranodal marginal zone lymphomas of [[MALT lymphoma|mucosa-associated Lymphoid tissue (MALT lymphoma)]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Diffuse large cell [[lymphoma]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lymphomatoid granulomatosis|'''Lymphomatoid granulomatosis''']]
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Intravascular large [[B cell]] [[lymphoma]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Lung|Pulmonary]] [[Langerhans cell histiocytosis]]'''
|
* N/A
|-
|-
| T0 ||There is no evidence of primary tumor.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Erdheim-Chester disease'''
|
* N/A
|-
|-
|Tis ||Carcinoma in situ
! colspan="2" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Tumors of ectopic origin'''
|-
|-
|T1 ||The tumor has the following characteristics: <br> The greatest dimension is <3 cm <br> AND <br>The tumor is surrounded by lung or visceral pleura<br> AND <br>The tumor does not extend to the main bronchus as demonstrated by the absence of bronchoscopic evidence of invasion more proximal than the lobar bronchus .
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Germ cell tumor|Germ cell tumors]]'''
|
* Mature [[teratoma]]
* Immature [[teratoma]]
|-
|-
|T2 ||The tumor has the following characteristic<br>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Pulmonary|Intrapulmonary]] [[thymoma]]'''
The greatest dimension is >3cm
|
<br> OR <br>
* N/A
The tumor involves the main bronchus, 2 cm or more distal to the carina.
<br> OR <br>
The tumor invades the visceral pleura.
<br> OR <br>
There is evidence of atelectasis or obstructive pneumonitis that extends to the hilar region without the involvement of the entire lung.
|-
|-
|T3 ||The tumor is of any size AND it directly invades any of the following: chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Melanoma]]'''
<br> OR <br>The tumor is localized in the main bronchus at a distance less than 2 cm distal to the carina but without the involvement of the carina.
|
<br> OR <br>There is evidence of associated atelectasis or obstructive pneumonitis of the entire lung.
* N/A
|-
|-
|T4 ||The tumor is of any size that invades any of the following: mediastinum, heart, great vessels, trachea, oesophagus, vertebral body, carina<br> OR <br>There is/are separate tumor nodule(s) in the same lobe. <br> OR <br>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Meningioma]], [[NOS]]'''
The tumor is associated with malignant pleural effusion.
|
* N/A
|}
|}
===M: Distant Metastasis===


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kim-Son H. Nguyen M.D. Cafer Zorkun, M.D., Ph.D. [2] Rim Halaby, M.D. [3] Dildar Hussain, MBBS [4]

Overview

Primary lung cancers may be classified into small cell lung cancer (~15%) and non small cell lung cancer (~85%). Non small cell lung cancer are a heterogeneous group of lung cancers that are often grouped together because they share similar clinical features (e.g. prognosis and management). The 2015 WHO histological classification of tumors of the lung categorized lung tumors into malignant epithelial tumors, benign epithelial tumors, lymphoproliferative tumors, miscellaneous tumors, and metastatic tumors.

Classification

Primary lung cancers may be classified into two main categories:[1]

 
 
Lung Cancer
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

WHO Histological Classification of Tumors of the Lung

The World Health Organization (WHO) classifies tumors of the lungs as follows:[1][2]

WHO Classification of Lung Tumors
Histological type Subtype
Epithelial tumors
Adenocarcinoma
Squamous cell carcinoma
  • Keratinizing squamous cell carcinoma
  • Nonkeratinizing squamous cell carcinoma
  • Basaloid squamous cell carcinoma
  • Pre-invasive lesion
    • Squamous cell carcinoma in situ
Neuroendocrine tumors
Small cell carcinoma
Large cell neuroendocrine carcinoma
Carcinoid tumors
Pre-invasive lesion
Large cell carcinoma
  • N/A
Adenosquamous carcinoma
  • N/A
Sarcomatoid carcinomas
Other and Unclassified carcinomas
Salivary gland-type tumors
Papillomas
Adenomas
Mesenchymal tumors
Pulmonary hamartoma
  • N/A
Chondroma
  • N/A
PEComatous tumors
Congenital peribronchial myofibroblastic tumor
  • N/A
Diffuse pulmonary lymphangiomatosis
  • N/A
Inflammatory myofibroblastic tumor
  • N/A
Epithelioid hemangioendothelioma
  • N/A
Pleuropulmonary blastoma
  • N/A
Synovial sarcoma
  • N/A
Pulmonary artery intimal sarcoma
  • N/A
Pulmonary myxoid sarcoma with EWSR1–CREB1 translocation
  • N/A
Myoepithelial tumors
Lymphohistiocytic tumors
Extranodal marginal zone lymphomas of mucosa-associated Lymphoid tissue (MALT lymphoma)
  • N/A
Diffuse large cell lymphoma
  • N/A
Lymphomatoid granulomatosis
  • N/A
Intravascular large B cell lymphoma
  • N/A
Pulmonary Langerhans cell histiocytosis
  • N/A
Erdheim-Chester disease
  • N/A
Tumors of ectopic origin
Germ cell tumors
Intrapulmonary thymoma
  • N/A
Melanoma
  • N/A
Meningioma, NOS
  • N/A

References

  1. ↑ 1.0 1.1 Travis, William (2004). Pathology and genetics of tumours of the lung, pleura, thymus, and heart. Lyon: IARC Press. ISBN 9283224183.
  2. ↑ "www.jto.org".

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