Case Of Large Cell Carcinoma Research Articles

Global variations in lung cancer incidence by histological subtype in 2020: a population-based study

Lung cancer is the second most common cancer worldwide, yet the distribution by histological subtype remains unknown. We aimed to quantify the global, regional, and national burden of lung cancer incidence for the four main subtypes in 185 countries and territories. In this population-based study, we used data from Cancer Incidence in Five Continents Volume XI and the African Cancer Registry Network to assess the proportions of adenocarcinoma, squamous cell carcinoma, small-cell carcinoma, and large-cell carcinoma among all lung cancers by country, sex, and age group and subsequently applied these data to corresponding national (GLOBOCAN) estimates of lung cancer incidence in 2020. Unspecified morphologies were reallocated to specified subtypes. Age-standardised incidence rates were calculated using the world standard population to compare subtype risks worldwide, adjusted for differences in age composition between populations by country. In 2020, there were an estimated 2 206 771 new cases of lung cancer, with 1 435 943 in males and 770 828 in females worldwide. In males, 560 108 (39%) of all lung cancer cases were adenocarcinoma, 351 807 (25%) were squamous cell carcinoma, 163 862 (11%) were small-cell carcinoma, and 115 322 (8%) were large-cell carcinoma cases. In females, 440 510 (57%) of all lung cancer cases were adenocarcinoma, 91 070 (12%) were squamous cell carcinoma, 68 224 (9%) were small-cell carcinoma, and 49 246 (6%) were large-cell carcinoma cases. Age-standardised incidence rates for adenocarcinoma, squamous cell carcinoma, small-cell carcinoma, and large-cell carcinoma, respectively, were estimated to be 12·4, 7·7, 3·6, and 2·6 per 100 000 person-years in males and 8·3, 1·6, 1·3, and 0·9 per 100 000 person-years in females worldwide. The incidence rates of adenocarcinoma exceeded those of squamous cell carcinoma in 150 of 185 countries in males and in all 185 countries in females. The highest age-standardised incidence rates per 100 000 person-years for adenocarcinoma, squamous cell carcinoma, small-cell carcinoma, and large-cell carcinoma, respectively, for males occurred in eastern Asia (23·5), central and eastern Europe (17·5), western Asia (7·2), and south-eastern Asia (11·0); and for females occurred in eastern Asia (16·0), northern America (5·4), northern America (4·7), and south-eastern Asia (3·4). The incidence of each subtype showed a clear gradient according to the Human Development Index for male and female individuals, with increased rates in high and very high Human Development Index countries. Adenocarcinoma has become the most common subtype of lung cancer globally in 2020, with incidence rates in males exceeding those of squamous cell carcinoma in most countries, and in females in all countries. Our findings provide new insights into the nature of the global lung cancer burden and facilitates tailored national preventive actions within each world region. None.

Correlation between the Treg/Thl7 Index and the Efficacy of PD-1 Monoclonal Antibody in Patients with Advanced Non-Small-Cell Lung Cancer Complicated with Chronic Obstructive Pulmonary Disease

Objective It was to explore the correlation between regulatory T cells (Treg)/T helper cell 17 (Thl7) and the efficacy of receiving a programmed death protein-1 (PD-1) monoclonal antibody (mAb) in patients with advanced non-small-cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD). Methods The research subjects were 82 patients who were clinically evaluated and treated in the Respiratory Department of Suqian Hospital connected with Xuzhou Medical University from January to December 2021. All of the patients were given PD-1 immunotherapy, and 50 healthy people were chosen as the control group. Classification was carried out according to tumor type and tumor stage. The levels of Th17 and Treg/Th17 in the peripheral blood of patients with different tumor-node-metastasis (TNM) stages and different types were compared, and the immune function, lung function (forced expiratory volume in one second/forced vital capacity (FEV1%/FVC), FEV1%, and FVC), and changes in inflammatory factors were compared before and after treatment. The levels of interleukin (IL)-17, IL-6, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β were compared between the two groups. The correlation between Th17 cells and Treg cells in the peripheral blood of patients with NSCLC complicated with COPD was analyzed. Results After treatment, the levels of IL-17, IL-6, TNF-α, and TGF-β in patients with NSCLC combined with COPD were notably superior to those in the control group (P < 0.05). The immune function and lung function of the patients were improved after treatment. There were 43 cases of squamous cell carcinoma, 30 cases of adenocarcinoma, and 9 cases of large cell carcinoma. The proportion of Th17 cells to CD4+ T cells in the blood of the three types of patients and the proportion of CD4+CD25HiCD127Lo regulatory T cells to CD4+ lymphocyte cells in Treg cells showed no considerable difference among the different case types (P > 0.05). No considerable difference was indicated in Treg/Th17 in peripheral blood between stage IIIB and stage IV lung cancer patients (P > 0.05). A positive linear correlation was revealed between Th17 cells and Treg cells in the peripheral blood of patients with NSCLC combined with COPD, R = 0.26, P = 0.039. Conclusion Treg and Th17 cells were shown to be much higher in lung cancer patients with COPD, which could lead to immunosuppression and tumor growth. PD-1 therapy for NSCLC has demonstrated efficacy and can improve patients' immunological state while being extremely safe.

Diagnostic Value of Napsin A in Small Biopsy of Non-Small Cell Lung Carcinoma

Background: Accurate sub-classification of non-small cell lung carcinoma (NSCLC) is crucial for the targeted therapy. In lung cancer most of tumors are un-respectable at diagnosis and small biopsy or cytological specimen is commonly the only available material for histopathology diagnosis. Although most of NSCLC can be diagnosed by routine stains, however diagnosis of poorly differentiated or undifferentiated tumors in small biopsy is challenging. Objective: To evaluate the diagnostic value of Napsin A immunohistochemical (IHC) marker in NSCLC small biopsy. Materials and Methods: Forty-six cases of primary NSCLC diagnosed by biopsy with subsequent resection were enrolled in this study. Subtyping of tumors was done according to 2015 World Health Organization criteria. IHC expression of Napsin A was assessed for all the cases. For large cell carcinoma (LCC) cases, Thyroid Transcription Factor 1 (TTF-1) and P63 expression were also tested. Markers expression was correlated with the histological diagnosis of the tumor. Sensitivity, specificity, positive, negative predictive values, and total accuracy of the markers were calculated. Result: In NSCLC cases, the diagnostic sensitivity and specificity of Napsin A were 85.2% and 75% (respectively) with a PPV of 85.2%, NPV of 75.0% and 81.4% accuracy. In LCC cases TTF1 sensitivity was 57.1% and specificity 100%, PPV 100%, NPV 14.3%, accuracy 60.0%. In LCC P63 marker had a diagnostic sensitivity, specificity, PPV, NPV and accuracy of 100%, 85.7%, and 33.3%, 100.0% and 86.7% respectively. Expression of both Napsin A and TTF 1 in LCC cases raised the accuracy to 86.7%. Conclusions: In small biopsy specimens Napsin A can subtype NSCLC with high sensitivity and moderate specificity. Additions of TTF-1/p63 IHC markers can further enhance the accuracy.

Clinical and Imaging Features of Acute Cerebral Infarction in Non-small Cell Lung Cancer Patients with Trousseau Syndrome

背景与目的急性脑梗死是Trousseau综合征（Trousseau syndrome, TS）的一种表现形式，但相对少见，往往容易被临床医师忽视。本研究探讨非小细胞肺癌（non-small cell lung cancer, NSCLC）合并TS以急性脑梗死为表现的临床、实验室检查及影像学特点。方法回顾性收集25例以急性脑梗死为表现的NSCLC合并TS患者的临床资料、实验室检查和影像学资料，进行分析总结。结果25例患者中男性18例，女性7例，年龄39岁-78岁，其中腺癌22例、鳞癌2例和大细胞癌1例；所有患者均有急性脑梗死的临床症状和体征；血浆D-二聚体明显升高，凝血酶原时间及活化部分凝血活酶时间均有不同程度的缩短；所有患者在头部磁共振成像（magnetic resonance imaging, MRI）[扩散加权成像（diffusion-weighted imaging, DWI）序列]平扫上均表现为累及多个颅内动脉供血区的急性多发性脑梗死灶，头磁共振血管成像（MR angiography, MRA）上梗死灶对应的供血血管管腔未见中重度狭窄。结论NSCLC合并急性多发性脑梗死是TS的少见表现类型，其特点是累及多个动脉供血区的急性多发性脑梗死灶伴有明显高凝状态；提高对该病的早期认识可以为临床诊疗提供一定的帮助。

Large cell carcinoma of the lung presenting as diffuse pulmonary infiltrates with haemoptysis

AbstractDue to rapid advances in our understanding of the molecular pathogenesis of non‐small cell lung cancer (NSCLC), the 2015 World Health Organization (WHO) classification has defined large cell carcinoma (LCC) as a subtype that is lacking glandular or squamous cells, and any neuroendocrine differentiation. Accordingly, LCC is one of the rarest subtypes of NSCLC. LCC usually presents as a large peripheral tumour with prominent necrosis and its specific characteristics are not well known. Here, we report a case of LCC identified during differential diagnosis of diffuse alveolar haemorrhage in a patient with haemoptysis.

Adjuvant chemotherapy improves the prognosis of early stage resectable pulmonary large cell carcinoma: analysis of SEER data.

Pulmonary large cell carcinoma (LCC) is a poorly differentiated and rare tumor with dismal outcome, and there are no recommended treatments for LCC. Little is known about the efficacy of postoperative chemotherapy in patients with early stage LCC. The patients with early stage I/II LCC in the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2015 were retrospectively reviewed. The overall survival (OS) of patients with LCC at different stages and treatments were evaluated by Kaplan-Meier analysis with log-rank test. Univariate and multivariate Cox proportional risk regression analysis were employed to determine the independent risk factors of OS. Finally, a nomogram was constructed to predict the 1 -, 3- and 5-year OS of early stage LCC patients. A total of 1,099 pulmonary LCC cases were included in this study. 71.8% of patients were over 60 years old, and 66.7% of the tumor lesions located in the upper lobe, followed by the lower lobe (25.7%). Meanwhile, the majority of tumors showed poor differentiation (96.1%). The median OS of surgical patients with or without post-operative adjuvant chemotherapy was 61 and 47 months, respectively. Post-operative chemotherapy was associated with better OS (HR: 0.805; 95% CI: 0.676-0.959, P=0.020). For patients with tumor size >3 cm or IB stage tumor, the prognosis of postoperative chemotherapy was better than that of patients without chemotherapy. Multivariate Cox analysis revealed the age, stage and treatments were independent risk factors of OS for early stage LCC. The nomogram had a calibration index of 0.581. The incidence of LCC was high in the elderly, and it generally had poor differentiation. Post-operative chemotherapy is strongly recommended for patients with LCC at stage IB or higher.

Insulinoma-associated protein 1 is a sensitive and specific marker for lung neuroendocrine tumors in cytologic and surgical specimens

Insulinoma-associated protein 1 (INSM1) is an immunohistochemical marker for neuroendocrine differentiation with potentially superior sensitivity and specificity. INSM1 performance in pulmonary cytology cell block material (CB) has not been well established, and large series demonstrating its performance have been few. Typical and atypical carcinoid, small cell lung carcinoma, and large cell neuroendocrine carcinoma, squamous cell carcinoma, and adenocarcinoma CBs and 563 surgical specimens comprising 17 typical carcinoid, 14 atypical carcinoid, 8 small cell lung carcinoma, 10 large cell neuroendocrine carcinoma, 58 squamous cell carcinoma, 415 adenocarcinoma, and 17 large cell carcinoma cases and 24 other tumor types were immunostained with INSM1, CD56, synaptophysin, and chromogranin A. The INSM1 sensitivity, specificity, positive predictive value, and negative predictive value were 92.3%, 100%, 78.9%, and 99% in the CBs and 89.8%, 98.1%, 81.5%, and 99% in the surgical specimens, respectively, with 86.2% concordance. The sensitivity, specificity, positive predictive value, and negative predictive value for the other neuroendocrine markers were 97.4%, 93.3%, 97.4%, and 93.3% in the CBs and 93.9%, 93.6%, 58.2%, and 99.4% in the surgical specimens for CD56; 89.7%, 100%, 100%, and 75% in the CBs and 93.4%, 91.2%, 50.5%, and 99.4% in the surgical specimens for synaptophysin; 66.7%, 100%, 100%, and 53.6% in the CBs and 75.5%, 98.6%, 84.1%, and 97.7% in the surgical specimens for chromogranin A, respectively. Finally, INSM1, together with CD56, maximized the sensitivity to 100% with 93.3% specificity in the CBs. The results from our study have further established the high sensitivity and specificity of INSM1 in the largest pulmonary cytologic and surgical cohorts to date. INSM1 either matched or outperformed the performance of existing neuroendocrine markers, and its combination with CD56 appeared to maximize test performance.

The expression level of CSDAP1 in lung cancer and its clinical significance.

Expression level of messenger RNA (mRNA) of cold shock domain protein A intronless pseudogene (CSDAP1) in lung cancer tissues was studied. Fresh pathological specimens collected from 317 patients with primary lung cancer through surgical resection from January 2007 to January 2012 were selected. Reverse transcription-polymerase chain reaction (RT-PCR) and western blot analysis were used to detect the transcription and translation of CSDAP1 in lung cancer tissues and cancer-adjacent normal tissues, and the results were analyzed in combination with clinicopathological features and prognosis of lung cancer. Among 317 lung cancer specimens, 105 cases (33.1%) had high expression of CSDAP1. Among 138 cases of pulmonary adenocarcinoma, 59 cases had high expression of CSDAP1, and the high expression rate was 42.8%. Among 170 cases of lung squamous cell carcinoma, 46 cases had high expression of CSDAP1, and the high expression rate was 27.5% (P<0.05). Three cases of large cell carcinoma and 9 cases of small cell carcinoma had extremely low expression or had no expression of CSDAP1. Among the 127 lung cancer patients with regional lymph node metastasis, 53 cases (41.7%) had high expression of CSDAP1, while among the 190 lung cancer patients without regional lymph node metastasis, 52 cases (27.4%) had high expression of CSDAP1 (P<0.05). The results also revealed that the expression of CSDAP1 was also related to tumor-node-metastasis (TNM) staging of lung cancer. One-year, three-year and five-year survival rates of lung cancer patients who had no expression of CSDAP1 were relatively high (P<0.05). The results suggested that CSDAP1 may play an important role in the occurrence, development and judgement of prognosis of lung cancer.

Advanced Stage Lung Cancer: Persisting Challenges in the Era of Molecular Targeted Therapy-Our Experience

Introduction: Lung cancer is the pioneer among all the cancers and also the leading cause of cancer related mortality worldwide. In India unlike in western countries most patients are diagnosed at advanced stage (Stage III/Stage IV) which in turn adversely affects the patient prognosis and survival. Studying the proportion of the total lung cancer cases which will present in advanced stage and their clinical, pathological and radiological profile will give us an insight into the problem. Aim: To know the percentage incidence of patients presenting with advanced stage lung cancer (Stage IIIB/Stage IV) and to study the clinical, pathological and radiological profile of these patients along with treatment details and follow-up. Materials and Methods: This was a descriptive retrospective study spanning 4 years from January 2013 to December 2016. All patients with a histopathological diagnosis of Stage IIIB and Stage IV lung cancer, treated during this period were included. Clinical features, radiological (X-ray and CT) findings, histopathological findings including immunohistochemistry if done, treatment modality and survival were analysed based on the information collected from the medical records. R esults: Out of 82 cases diagnosed as advanced stage disease, complete clinical data was available for 67 cases which formed the material for the study. Of 67 patients, 47 were male and 20 were female forming a Male: Female ratio of 2.35:1. The mean age of the patients was 61.3 years. Patients presented with cough (59.7%), chest pain (34.3%) dyspnoea (29.8%), weight loss (17.9%), fever (16.4%), haemoptysis (11.9%). Histologically majority were Adenocarcinoma (ADC) (35.8%) followed by Squamous Cell Carcinoma (SCC) (29.8%) small cell carcinoma (14.92%) and just one case of large cell carcinoma. Forty three cases (64.17%) presented with metastases. The most common site for metastasis was bone followed by brain. Three patients who tested positive for Epidermal Growth Factor Receptor (EGFR) mutation were treated with Erlotinib/Gefitinib. The remaining 64 cases were treated with regimens including combinations of premetrexed, platinum based compounds and etoposide. On follow-up 17 patients died during the course of the treatment. C onclusion: High proportion of lung cancer patients present at advanced stage. This demand for public awareness programs about the smoking hazards, early symptoms and importance of early treatment.

Combined Off-Pump Coronary Artery Bypass Grafting and Lung Resection in Patients with Lung Cancer Accompanied by Coronary Artery Disease.

IntroductionOptimal surgical approach for the treatment of resectable lung cancer accompanied by coronary artery disease (CAD) remains a contentious issue. In this study, we present our cases that were operated simultaneously for concurrent lung cancer and CAD.MethodsSimultaneous off-pump coronary artery bypass surgery (OPCABG) and lung resection were performed on 10 patients in our clinic due to lung cancer accompanied by CAD. Demographic features of patients, operation data and postoperative results were evaluated retrospectively.ResultsMean patient age was 63.3 years (range 55-74). All patients were male. Six cases of squamous cell carcinoma, three of adenocarcinoma and one case of large cell carcinoma were diagnosed. Six patients had single-vessel CAD and 4 had two-vessel CAD. Three patients underwent OPCABG at first and then lung resection. The types of resections were one right pneumonectomy, three right upper lobectomies, one right lower lobectomy, three left upper lobectomies, and two left lower lobectomies. Reoperation was performed in one patient due to hemorrhage. One patient developed intraoperative contralateral tension pneumothorax. One patient died due to acute respiratory distress syndrome at the early postoperative period.ConclusionSimultaneous surgery is a safe and reliable option in the treatment of selected patients with concurrent CAD and operable lung cancer.

Efficacy and tolerability of nanoparticle albumin-bound paclitaxel in combination with carboplatin as a late-phase chemotherapy for recurrent and advanced non-small-cell lung cancer: A multi-center study of the Fukushima lung cancer association group of surgeons.

The present retrospective multi-center study aimed to evaluate the efficacy and feasibility of nanoparticle albumin-bound (nab)-paclitaxel plus carboplatin as a second or late-phase chemotherapy in patients with non-small cell lung cancer (NSCLC). A total of 25 patients with recurrent or advanced NSCLC who had received previous chemotherapy were treated with nab-paclitaxel (70-100 mg/m2, intravenously) on days 1, 8 and 15 every 28 days with a carboplatin area under the concentration-time curve of 4-6 on day 1. The overall response rate, disease control rate, progression-free survival (PFS), overall survival (OS) and toxicities were statistically evaluated. Of the 25 patients, there were 9 cases of recurrent disease following surgery, 16 cases of advanced disease, 13 cases of adenocarcinoma, 11 cases of squamous cell carcinoma and 1 case of large cell carcinoma. A total of 13 patients received second-line chemotherapy and 12 received fourth-line or later chemotherapy. One patient exhibited a complete response, 7 had a partial response, 10 exhibited stable disease and 7 had progressive disease. The overall response rate was 32.0% and the disease control rate was 72.0%. The median PFS and median OS following nab-paclitaxel treatment were 4.0 and 14.0 months, respectively. Frequent treatment-associated adverse events were myelosuppression, peripheral neuropathy, gastrointestinal symptoms and baldness, the majority of which were grade 1-2. Grade 3-4 neutropenia, thrombocytopenia and anemia occurred in 7 (28.0%), 3 (12.0%) and 2 (8.0%) patients, respectively. No patients experienced grade 3-4 sensory neuropathy and no grade 5 adverse effects were observed. Nab-paclitaxel plus carboplatin as second-phase or later chemotherapy provided a small but significant survival benefit for patients with recurrent or advanced NSCLC, with tolerable adverse effects. To the best of our knowledge, the results of the present study demonstrated for the first time that nab-paclitaxel plus carboplatin is a promising and feasible late-phase chemotherapeutic agent for NSCLC.

PUB133 The Investigation on Shanghai Local Lung Cancer Patients’ Prognosis at Shanghai Chest Hospital: 2004-2014

This research investigates the prognosis of Shanghai local lung cancer patients who were treated at Shanghai Chest Hospital from 2004 to 2014. This research first identifies Shanghai local lung cancer patients with their address and resident ID information recorded in hospital’s information system, and then categorizes patients into various pathology / cancer stage groups, based on their diagnosis codes. With collected data, this study calculates patients’ survival rates with Kaplan-Meier method and draws their survival curves. Cox risk regression model is also employed to identify factors with significant impact on patients’ overall survival period. From January 1, 2004 to December 31, 2014, 21,918 Shanghai local lung cancer patients were treated at Shanghai Chest Hospital. Among all these patients, 10,646 were investigated, including 2,019 cases of squamous cell carcinoma; 5,949 cases of adenocarcinoma cancer; 437cases of adenosquamous carcinoma; 599 cases of small cell lung cancer; 125 cases of large cell carcinoma; and 583cases of poorly differentiated carcinoma. According to the stage of their cancers, 3.4% patients were at stage I; 2.6% were at stage II; 29.3% were at stage III; and 64.7% at were stage IV. Among these investigated cases, 7,617 patients died and 3,029 cases were censored. This study finds that small cell lung cancer, squamous cell carcinoma, and poorly differentiated carcinoma have the poorest prognosis. Stage IV adenocarcinoma patients have better prognosis than stage IIIB patients of aforementioned cancers. Female patients have better prognosis than male patients in the cases of adenocarcinoma, small cell lung cancer, and poorly differentiated carcinoma (p<.05). In this investigation patients are also categorized into 2004-2006, 2007-2010, and 2011-2014 groups. This research finds that after 2011 adenocarcinoma cancer patients had significantly improved prognosis (p<.05). However, there is no significant improvement among other cancer types. This study also finds that among patients surviving for more than five years, stage IV patients have the highest percentage (adenocarcinoma 37.58%; squamous cell carcinoma 8.15%; poorly differentiated carcinoma 5.61%; and small cell lung cancer 4.42%). The five year survival rates of these patients are, respectively, 7.0%, 6.1%, 2.5%, and 5%. Adenocarcinoma patients have better prognosis than the patients of other types of cancers.

8cm におよぶポリープ状発育を示した肺大細胞癌の 1 例

8cm におよぶポリープ状発育を示した肺大細胞癌の 1 例

Napsin A/p40 antibody cocktail for subtyping non-small cell lung carcinoma on cytology and small biopsy specimens.

Subtyping non-small cell lung carcinomas (NSCLC) into adenocarcinoma (ACA) or squamous cell carcinoma (SQCC) is important for treatment and specimen triage for molecular studies. To preserve tissue for molecular studies in cytology/small biopsy specimens, a 2-antibody cocktail for NSCLC subtyping was developed. Markers for lung ACA (thyroid transcription factor 1 and napsin A) and SQCC (cytokeratin 5/6 and p40) were evaluated on tissue microarrays (TMAs) with 143 ACA and 98 SQCC specimens. The napsin A/p40 combination was selected for NSCLC subtyping and validated on the TMA as well as on a cohort of cell block/small biopsy specimens from 80 poorly differentiated NSCLCs. Using TMA analysis, the napsin A-positive (+)/p40± immunophenotype identified ACA with 94% sensitivity and 100% specificity, whereas the napsin A (negative)-/p40+ immunophenotype identified SQCC with 100% sensitivity and specificity. On the validation cohort of 80 cell block and small biopsy specimens, the napsin A/p40 cocktail accurately subtyped 63 of 70 NSCLC (90%) as ACA or SQCC using the subsequent surgical resection as reference histology. Of the remaining 17 cases, 15 were classified as NSCLC-not otherwise specified based on a napsin A-/p40- immunophenotype; their corresponding resections were diagnosed as ACA (7 cases), large cell carcinoma (7 cases), or pleomorphic carcinoma (1 case). Two additional large cell carcinoma cases showed a napsin A-/p40+ or napsin A+/p40+ profile in the preoperative cell block/small biopsy sample. A napsin A/p40 cocktail can accurately subtype NSCLC into ACA and SQCC in most cell block/small biopsy specimens of poorly differentiated NSCLC. In the minority of cases in which the napsin A/p40 immunophenotype is indeterminate, additional stains may be necessary for precise classification. Cancer Cytopathol 2016;124:472-84. © 2016 American Cancer Society.

Bronchial neuroendocrine neoplasms: A Surveillance Epidemiology and End Results (SEER) database review of treatment outcomes.

4098 Background: Bronchial neuroendocrine tumors (NENs) are a biologically heterogeneous group of malignancies with varied approaches to treatment. We queried the SEER database about outcomes of surgery and radiation. Methods: We identified 945331 cases in the SEER database with malignancies of the lung and extracted 187991 bronchial NENs – 130092 cases of small cell carcinoma, 44520 cases of large cell carcinoma, 3349 cases of neuroendocrine carcinoma (grades 3/4 [G3/4]), 9135 cases of typical bronchial carcinoid (grade 1 [G1]), and 895 cases of atypical bronchial carcinoid (grade 2 [G2]) – to examine clinical outcomes by treatment modality, including radiation in 82157 cases and surgery in 21352. Results: Surgical intervention on the primary NEN became less frequent as SEER stage become more extensive; operations were performed in 56.0% of cases of localized disease, 19.9% of regional disease, and 4.5% of distant disease. Proportionately more surgery was performed on lower-grade histologies (e.g. 84% of...

Bronchial neuroendocrine neoplasms: A Surveillance Epidemiology and End Results (SEER) database review of demographics and survival in 187,991 cases.

4097 Background: Bronchial neuroendocrine neoplasms (NENs) are a biologically heterogeneous group of malignancies whose differences are incompletely understood. We aimed to study the demographics and survival of patients with these neoplasms by reviewing the SEER database. Methods: We identified 945,331 cases in the SEER database with malignancies of the lung and extracted 187,991 bronchial NENs to examine patient characteristics & clinical outcomes by histology and stage. Results: By histology and grade, there were 130,092 cases of small cell carcinoma, 44,520 cases of large cell carcinoma, 3,349 cases of neuroendocrine carcinoma (grade 3/4), 9,135 cases of typical bronchial carcinoid (grade 1), and 895 cases of atypical bronchial carcinoid (grade 2). The ethnic predilection was Caucasian (87%, with 9% black and 4% other). Overall there were more cases in men (55% of the entire cohort), but women accounted for 66% of the carcinoid cases. Mean age at diagnosis for all NENs was 66, with typical carcinoids ...

Radiofrequency ablation (RFA) for palliative treatment of painful non-small cell lung cancer (NSCLC) rib metastasis: Experience in 12 patients.

BackgroundPainful rib metastasis is common in non-small cell lung cancer (NSCLC). Pain is often partially or totally refractory to analgesic medications or the side effects of medication are unacceptable. We report the safety and efficacy of a new method: radiofrequency ablation (RFA) in treating painful NSCLC rib metastasis.MethodsRFA procedures were completed in 12 patients with painful rib metastasis. Patient age ranged from 66–83 years (mean 74.8 years, standard deviation (SD) = 5.3). There were four cases of squamous-carcinoma, seven adenocarcinomas, and one case of large cell carcinoma. Pain caused by neoplasm size, pain levels pre-procedure and post-procedure (as assessed using the visual analog scale, VAS), time length, and target temperature of RFA treatments were documented.ResultsRFA procedures were performed with 100% technical success. The mean pre-procedure and post-procedure pain, as measured by the VAS, was 7.9 (SD = 0.90) and 3.4 (SD = 0.99), respectively. No symptomatic complications occurred. Non-symptomatic complications included one case of pneumothorax and one case of hemoptysis.ConclusionRFA appears to be a safe, practical, and effective method for the palliative treatment of painful NSCLC chest wall metastasis.

Large-cell carcinoma of the lung: a diagnostic category redefined by immunohistochemistry and genomics.

The current classification system defines large-cell carcinoma (LCC) morphologically as an undifferentiated lung carcinoma lacking features of adenocarcinoma (ADC), squamous cell, or small-cell carcinoma. As a result, LCC has evolved into a clinicopathologically heterogeneous entity. In the current era of histology-driven predictive molecular testing and oncologic management, ambiguous diagnostic categories frustrate attempts to provide more personalized cancer care, thus the pathology community has engaged in a concerted effort to revise the criteria for LCC. Most cases of LCC are immunophenotypically similar to ADC or squamous cell carcinoma. LCC lacking squamous and neuroendocrine features is clinically and genomically indistinguishable from solid ADC. Even cases of LCC lacking immunophenotypic differentiation may contain genomic alterations characteristic of other forms of lung carcinoma. Applying ancillary techniques, most cases of LCC can be reclassified into more informative categories that may guide molecular testing for predictive biomarkers and enable selection of more appropriate therapies.

ラブドイド形質を伴う肺大細胞癌の1手術例：本邦報告例の検討

ラブドイド形質を伴う肺大細胞癌の1手術例：本邦報告例の検討

Applications and Limitations of Immunohistochemical Expression of “Napsin-A” in Distinguishing Lung Adenocarcinoma From Adenocarcinomas of Other Organs

Distinguishing between primary lung adenocarcinoma and metastatic adenocarcinoma of lung before planning patient treatment is clinically important. Immunohistochemical markers play an important role in classification of primary lung tumors and are an effective method for separating metastatic tumors from primary pulmonary carcinoma. In this study, we evaluated the expression of Napsin-A in primary pulmonary carcinoma and some cases of nonpulmonary adenocarcinoma. The Napsin-A immunohistochemical evaluation was carried out using surgical specimens from 18 cases of adenocarcinoma, 19 cases of squamous cell carcinoma, 2 cases of large cell carcinoma, 1 case of bronchoalveolar carcinoma of lung, as well as 33 cases of renal cell carcinoma, 30 cases of thyroid neoplasm, 31 cases of colonic carcinoma, 31 cases of breast carcinoma, and 30 cases of endometrial adenocarcinoma. For the primary lung carcinoma cases, all 18 cases of adenocarcinoma, 2 of the large cell carcinomas, and the 1 bronchioloalveolar carcinoma case were positive for Napsin-A. For the thyroid tumors, Napsin-A was positive in 14 cases of papillary carcinoma. Napsin-A was positive for 87.5% of papillary renal cell carcinoma cases and in 29.4% of clear cell carcinoma cases and for 1 chromophobe renal cell carcinoma case. Three out of 30 endometrial adenocarcinomas showed Napsin-A reactivity. All squamous cell carcinoma cases and adenocarcinomas of colon and breast were negative for Napsin-A. Napsin-A is a useful marker for differentiating primary lung adenocarcinoma from squamous cell carcinoma. However, Napsin-A immunoreactivity has the potential to misguide a pathologist to conclude a metastasis from renal, thyroid, or endometrial carcinoma as a primary lung adenocarcinoma. Therefore, when there is a need to rule out lung metastasis from other organs, implementation of other biologically specific markers should be considered.