Lung

Adenocarcinoma

Adenocarcinoma overview


Editorial Board Member: Andrey Bychkov, M.D., Ph.D.
Editor-in-Chief: Debra L. Zynger, M.D.
Caroline I.M. Underwood, M.D.
Carolyn Glass, M.D., Ph.D.

Last staff update: 19 July 2022

Copyright: 2019-2022, PathologyOutlines.com, Inc.

PubMed Search: Lung adenocarcinoma

Caroline I.M. Underwood, M.D.
Carolyn Glass, M.D., Ph.D.
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Cite this page: Underwood C, Musick A, Glass C. Adenocarcinoma overview. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lungtumoradenocarcinoma.html. Accessed August 14th, 2022.
Definition / general
  • Non-small cell lung carcinoma with glandular differentiation, mucin production or pneumocyte marker expression
Essential features
  • Most prevalent non-small cell lung carcinoma
  • 5 main histologic patterns (acinar, papillary, micropapillary, lepidic, solid); mucinous and nonmucinous subtypes
  • Positive for TTF1
Terminology
  • Terminology of lung adenocarcinoma was significantly revised in the 2015 WHO classification (J Thorac Oncol 2015;10:1243)
    • Discontinuation of the terms bronchioloalveolar carcinoma (BAC) and mixed subtype adenocarcinoma
    • Addition of adenocarcinoma in situ (AIS) as a preinvasive lesion to join atypical adenomatous hyperplasia
    • Addition of minimally invasive adenocarcinoma
    • Use of the term lepidic for a noninvasive component (previously classified as BAC) of an invasive adenocarcinoma
    • Introduction of the term invasive mucinous adenocarcinoma for adenocarcinomas formerly classified as mucinous BAC, excluding tumors that meet criteria for AIS or minimally invasive adenocarcinoma (MIA)
    • Discontinuation of the subtypes of clear cell and signet ring adenocarcinoma
    • Discontinuation of the term mucinous cystadenocarcinoma and inclusion of these under the category of colloid adenocarcinoma
ICD coding
  • ICD-O: 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
Diagrams / tables

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Histologic subtyping for surgeon

Histologic subtyping for surgeon

Histologic pattern and prognosis

Histologic pattern and prognosis

Treatment

Treatment

Grading of invasive nonmucinous adenocarcinomas

Grading of invasive nonmucinous adenocarcinomas

Clinical features
  • Cough (productive if mucinous adenocarcinoma), hemoptysis, dyspnea, weight loss, chest pain (Chest 2012;142:1338)
  • Paraneoplastic / endocrine syndromes are much less common than in small cell lung carcinoma
    • Hypertrophic pulmonary osteoarthropathy with clubbing of the fingers, symmetric polyarthritis, periostitis of the long bones (World J Clin Oncol 2014;5:197)
Diagnosis
  • Histological, based on morphology and staining pattern
Radiology description
Radiology images

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Mucinous adenocarcinoma

Mucinous adenocarcinoma

Adenocarcinoma on axial CT Adenocarcinoma on axial CT

Adenocarcinoma on axial CT

Prognostic factors
Case reports
Treatment
Gross description
Gross images

Contributed by Yale Rosen, M.D.
Peripheral adenocarcinoma

Peripheral adenocarcinoma



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Peripheral adenocarcinoma

Peripheral adenocarcinoma

Frozen section description
Frozen section images

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

Mucinous lung adenocarcinoma

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Caroline I.M. Underwood, M.D., Andrey Bychkov, M.D., Ph.D., Fulvio Lonardo, M.D. and Negar Rassaei, M.D.
Adenocarcinoma in situ

Adenocarcinoma in situ

Acinar pattern

Acinar pattern

Lepidic pattern, architecture

Lepidic pattern, architecture

Lepidic pattern, cytologic features

Lepidic pattern, cytologic features

Micropapillary pattern

Micropapillary pattern


Papillary pattern Papillary pattern

Papillary pattern

Papillary pattern

Papillary pattern

Solid pattern, architecture

Solid pattern, architecture

Solid pattern, cytologic features

Solid pattern, cytologic features


Mucinous subtype, architecture

Mucinous subtype, architecture

Mucinous subtype, cytologic features

Mucinous subtype, cytologic features

Positive PDL1

Negative PDL1

Negative PDL1

ADC cocktail

Virtual slides

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Resection specimen

Resection specimen

Core needle biopsy

Core needle biopsy

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

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Large malignant cells

Large malignant cells

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

Contributed by Ankur R. Sangoi, M.D. (Case #425)
<i>ALK</i> break apart FISH images (<i>ALK</i> gene in RED) <i>ALK</i> break apart FISH images (<i>ALK</i> gene in RED)

ALK break apart FISH images

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 style question #1

A 59 year old man presents with cough, hemoptysis and shortness of breath. A mass in his left lung was biopsied. 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 style answer #1
C. The growth pattern indicated in the patient's biopsy above is a poor prognostic factor. 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 overview
Board review style question #2
A 63 year old woman presented with 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 style answer #2
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 overview
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