Lung

Other carcinomas

Large cell



Topic Completed: 1 December 2017

Minor changes: 11 May 2021

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PubMed Search: Large cell undifferentiated carcinoma of the lung[TI]

Roseann Wu, M.D., M.P.H.
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Cite this page: Wu R. Large cell. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lungtumorlargecell.html. Accessed October 25th, 2021.
Definition / general
Essential features
  • Malignant, poorly differentiated epithelial neoplasm of lung composed of large atypical cells
  • Tumors lack morphologic and immunohistochemical evidence of glandular, squamous or neuroendocrine differentiation
  • Diagnosis of exclusion, which may overlap or be synonymous with pleomorphic carcinoma
Terminology
  • Large cell undifferentiated carcinoma and large cell carcinoma are synonymous
  • Previously, large cell carcinoma included variants such as basaloid carcinoma, large cell neuroendocrine carcinoma, lymphoepithelioma-like carcinoma, clear cell carcinoma, large cell carcinoma with rhabdoid phenotype
  • As of 2015 WHO classification, large cell carcinoma is a diagnosis of exclusion, with reclassification of the former large cell carcinoma subtypes into different categories (J Thorac Oncol 2015;10:1243)
  • May overlap or be synonymous with pleomorphic carcinoma; diagnostic terminology still evolving
ICD coding
  • Use code specific for location of tumor
  • C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung
Epidemiology
  • 80% men, adults aged 50 - 70
  • Associated with smoking
Sites
  • 50% with connection to large airway
  • Periphery of lungs
Pathophysiology
  • Behavior similar to other poorly differentiated lung carcinoma
Clinical features
  • Similar to other poorly differentiated non small cell carcinoma, i.e. cough, chest pain, shortness of breath
  • Typically larger than 5 cm
Diagnosis
  • Diagnosis of exclusion, therefore cannot definitively diagnose on small biopsies or in lymph node metastases
  • NSCC NOS (non small cell carcinoma, not otherwise specified) can be used on small biopsy / cytology specimens
  • Diagnosis of entity began to decline when TTF1 immunohistochemical staining was introduced
Radiology images

Images hosted on other servers:
2.7 cm lobulated mass

2.7 cm lobulated mass

Prognostic factors
  • Generally poor prognosis
Case reports
Treatment
  • Dependent on stage: surgical excision, chemotherapy / radiation
Gross description
  • Usually peripheral lung and unifocal; spherical tumor with well defined borders and bulging, lobulated, homogeneous gray white "fish flesh" cut surface
  • Internal necrosis and hemorrhage common
  • No anthracosis
  • Frequently involves thoracic wall
Gross images

Contributed by Debra Zynger, M.D.
Right lung mass

Right lung mass

Microscopic (histologic) description
  • Large, polygonal and anaplastic cells growing in sheets or solid nests
  • No clear adenocarcinoma, squamous or neuroendocrine morphology
  • Moderately abundant cytoplasm, well defined cell borders, vesicular nuclei, prominent nucleoli
  • Foci of central necrosis and hemorrhage may be present
Microscopic (histologic) images

Contributed by Roseann Wu, M.D., M.P.H.
Large cell carcinoma Large cell carcinoma

Large cell carcinoma



Images hosted on other servers:
Rhabdoid cells

Rhabdoid cells

Various images Various images

Various images

Tumors reclassified and unable to be reclassified with extended IHC panel Tumors reclassified and unable to be reclassified with extended IHC panel

Tumors reclassified and unable to be reclassified with extended IHC panel

Virtual slides

Images hosted on other servers:
Various images Various images Various images Various images

Various images

Cytology description
  • Large pleomorphic cells with a moderate to abundant amount of cytoplasm, vesicular nuclei, prominent nucleoli
Positive stains
Differential diagnosis
Board review style question #1
Large cell carcinoma of lung will generally stain for which of the following immunohistochemical markers?

  1. CAM5.2
  2. Chromogranin
  3. p40
  4. SOX10
  5. TTF1
Board review style answer #1
A. CAM5.2

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