Lung tumor
Adenocarcinoma
General


Topic Completed: 6 June 2019

Revised: 11 June 2019

Copyright: 2019, PathologyOutlines.com, Inc.

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Cite this page: Underwood C, Musick A, Glass C. Adenocarcinoma-general. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lungtumoradenocarcinoma.html. Accessed June 17th, 2019.
Definition / general
  • Non small cell lung carcinoma with glandular differentiation
Essential features
  • Most prevalent non small cell carcinoma
  • Five histologic patterns; mucinous and non mucinous subtypes
  • Positive for TTF1
Terminology
  • Lepidic adenocarcinoma formerly called bronchioloalveolar carcinoma
ICD coding
    ICD-0:
  • 8046/3 - non small cell carcinoma of bronchus or lung (international code)

    ICD-10:
  • C34.90 - malignant neoplasm of unspecified part of unspecified bronchus or lung
Epidemiology
Sites
Pathophysiology
Etiology
Clinical features
  • Cough, (productive if mucinous adenocarcinoma [Chest 2012;142:1338]), hemoptysis, dyspnea, weight loss, chest pain
  • Hypertrophic pulmonary osteoarthropathy (World J Clin Oncol 2014;5:197)
    • Clubbing of the hands, symmetric polyarthritis, periostitis of the long bones
Diagnosis
  • Histological, based on morphology and staining pattern
Radiology description
Radiology images

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Mucinous adenocarcinoma (Fig 3a)

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Axel lung window (Case 4)

Prognostic factors
Case reports
Treatment
  • NCCN Guidelines 3.2018
  • For stages I, II, IIA: surgical resection (preferred) + adjuvant chemotherapy (platinum based) and radiation
  • Inoperable or metastatic: chemotherapy variable radiation
Gross description
Gross images

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Peripheral adenocarcinoma

Frozen section description
Frozen section images

Contributed by Caroline Mullins Underwood, M.D.
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Mucinous lung adenocarcinoma

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Caroline Mullins Underwood, M.D., Andrey Bychkov, M.D., Ph.D. and Fulvio Lonardo, M.D.
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Acinar pattern

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Lepidic pattern, architecture

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Lepidic pattern, cytologic features

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Micropapillary pattern

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Papillary pattern

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Solid pattern, architecture


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Solid pattern, cytologic features

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Mucinous subtype, architecture

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Mucinous subtype, cytologic features

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High grade cytological features

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Invasion

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Negative PDL1


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Adenocarcinoma in situ

Cytology description
  • 3 dimensional clusters of cohesive cells; foamy / vacuolated cytoplasm; fine chromatin; variable prominent nucleoli (J Thorac Oncol 2011;6:244)
  • Usually done on pleural effusions
Cytology images

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Large malignant cells

Negative stains
Electron microscopy description
Molecular / cytogenetics description
Molecular / cytogenetics images

Case of the Week #425

ALK break apart FISH images (ALK gene in RED)

Sample pathology report
  • Lung, left upper lobe, wedge resection:
    • Invasive adenocarcinoma, acinar predominant with secondary solid growth pattern (see synoptic report)
Differential diagnosis
Board review question #1

    A 59 year old man presents with cough, hemoptysis and shortness of breath. A mass in his left lung was biopsied (H&E shown above). Which of the following statements about this disease is true?

  1. Exposure to benzene is an important risk factor in the development of this disease
  2. Masses are most frequently found in central / hilar regions of both lungs
  3. The growth pattern indicated in the patient’s biopsy above is a poor prognostic factor
  4. The most common site of metastasis is the liver
  5. This disease has a higher incidence in men than in women
Board review answer #1
C. The H&E stain demonstrates a micropapillary pattern, which is a poor prognostic factor. Lung adenocarcinoma is associated with exposure to radon, not benzene, and is typically found in the peripheral regions or upper lobes of the lung. This cancer is also more common in women than in men and most frequently metastasizes to the brain, not the liver.

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Reference: Adenocarcinoma- General
Board review question #2
    A 63 year old African American woman presents to her primary care provider with a persistent cough, chest pain and an unintended weight loss of 10 lbs within the last four months. She smoked 1 pack per day for 31 years, but quit 15 years ago. A chest CT scan reveals a mass in the upper lobe of her left lung with enlargement of the mediastinal lymph nodes. Surgical biopsy shows columnar tumor cells with abundant intracytoplasmic mucin in an acinar growth pattern. The malignant cells are most likely to be positive for which of the following mutations?

  1. ALK rearrangement
  2. BRAF
  3. EGFR
  4. HER2 amplification
  5. KRAS
Board review answer #1
E. KRAS is the most common mutation associated with mucinous adenocarcinoma (76%). EGFR mutations are rare in the mucinous subtype. ALK, HER2 and BRAF are uncommon mutations overall.

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Reference: Adenocarcinoma- General
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