High-grade Lung Adenocarcinoma With Fetal Lung–like Morphology
| Autor: | Hitoshi Tsuda, Koji Tsuta, Teruaki Oka, Jun Nakajima, Masaya Mori, Shinji Itoyama, Akiteru Goto, Karin Yokozawa, Shigeki Morita, Satoshi Ota, Masashi Fukayama, Jun-ichi Tamaru, Akihiko Yoshida, Daiya Takai, Koh Furuta, Hisao Asamura |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Pathology medicine.medical_specialty Lung Neoplasms DNA Mutational Analysis Adenocarcinoma of Lung Kaplan-Meier Estimate Adenocarcinoma Biology Polymerase Chain Reaction Pathology and Forensic Medicine Proto-Oncogene Proteins p21(ras) Proto-Oncogene Proteins Biomarkers Tumor medicine Humans Lung cancer Aged Neoplasm Staging Fetus Lung Fetal adenocarcinoma Histology Genes erbB-1 Middle Aged respiratory system medicine.disease Immunohistochemistry Epithelium medicine.anatomical_structure Mutation ras Proteins Female Surgery alpha-Fetoproteins Anatomy |
| Zdroj: | American Journal of Surgical Pathology. 37:924-932 |
| ISSN: | 0147-5185 |
| Popis: | Low-grade lung adenocarcinoma of fetal lung type, which is well characterized by its unique clinicopathologic and molecular features, is recognized as a distinct variant of lung cancer. In contrast, high-grade lung adenocarcinoma with fetal lung-like morphology (HG-LAFM) has not been studied widely. To characterize this subset better, we analyzed 17 high-grade adenocarcinomas with at least focal component resembling a developing epithelium in the pseudoglandular phase of the fetal lung. These rare (ca. 0.4%) carcinomas occurred predominantly in elderly men with a heavy smoking history, who showed elevated serum α-fetoprotein in 4 of 5 cases tested. Histologic examination revealed a fetal lung-like component as a focal finding accounting for 5% to 60% of the total tumor volume. It was invariably admixed with tissues having a morphology not resembling that of a fetal lung. A coexisting non-fetal lung-like element was quite heterogenous in appearance, showing various growth patterns. However, clear-cell (88%), hepatoid (29%), and large cell neuroendocrine carcinoma (24%) histology seemed overrepresented. HG-LAFM was characterized immunohistochemically by frequent expression of α-fetoprotein (41%), glypican-3 (88%), SALL-4 (59%), neuroendocrine markers (82%), CDX-2 (35%), and p53 (65%). HG-LAFM was molecularly heterogenous in that EGFR or KRAS mutation was observed in 22% of cases tested for both. Our data indicate that HG-LAFMs might form a coherent subgroup of lung adenocarcinomas. However, the uniformly focal nature of the fetal lung-like element, widely diverse coexisting non-fetal lung-like histology, and inhomogenous molecular profiles lead us to believe that HG-LAFM is best regarded as a morphologic pattern showing characteristic association with several clinicopathologic parameters rather than a specific tumor entity. |
| Databáze: | OpenAIRE |
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