Histological Types Of Lung Carcinoma Research Articles

Clinical characteristics, proteins, and genes related to interstitial pneumonia-associated squamous cell carcinoma of the lungs

Squamous cell carcinoma (SCC) is a common histological type of lung carcinoma that is associated with interstitial pneumonia (IP). We hypothesized that identifying specific genetic alterations or molecular markers of SCC with IP may aid the development of novel therapeutic strategies for the same. Therefore, in the present study, we aimed to identify tumorigenic genetic alterations and molecular markers in cases of SCC with IP. We included 28 lung SCC cases (14 cases with IP and 14 cases without IP). We performed immunohistochemistry for STAT3, STAT5, and TLE1, and next-generation sequencing was performed using an iSeq 100 system. The panel used in this study targeted 50 cancer-associated genes. Immunohistochemically, the rate of TLE1 positivity was higher in the SCC without IP group (93 %) than in the SCC with IP group (29 %), while that of STAT5 was higher in the SCC with IP group (79 %) than in the SCC without IP group (14 %). STAT3 expression was high in both the groups (SCC with IP, 64 %; SCC without IP, 71 %). Eighteen genes were mutated in more than six samples, and FBXW7 mutation was mainly observed in the SCC with IP group (p < 0.01). Mechanisms underlying tumorigenesis in SCC with IP included STAT5 activation via inflammation, while that in SCC without IP included squamous TLE1-mediated metaplasia. These findings are based on smoking-induced STAT3 activation; therefore, patients with IP who smoke are more likely to have progressive SCC. We also found that FBXW7 mutations may be associated with SCC with IP and keratinization. ERBB4 and KDR mutations were observed in both with or without IP, and these genes may be tumor-related genes in SCC. These molecular markers may help determine the prognoses of patients with SCC with IP and direct the development of treatment approaches.

Role of histopathological and immunohistochemical technique in diagnosis of lung carcinoma

Background: Lung cancer is currently the most frequently diagnosed major cancer and the most common cause of cancer mortality worldwide. Most lung cancers are associated with a well-known Carcinogen i.e., Cigarette Smoking. Immunohistochemistry helps in the sub typing of the lung neoplasm into different categories which have a therapeutic and prognostic importance. Materials and Methods: The present study is both retrospective and prospective study done at Pathology Department over a period of 1 year (October 2021 to September 2022). The present study was carried out on 50 patients presented with lung mass in radiological examination and undergone biopsy procedure and samples of the same were received at Histopathological section of Pathology Department, Shri M.P. Shah Govt. medical college, Jamnagar. Cases were diagnosed by histopathological examination and subtyping were done by Immunohistochemistry.Aims and ObjectivesTo determine the incidence of lung carcinoma with respect to age and sex of patients.To correlate between incidence and associated risk factors for lung carcinoma like smoking.To use Immunohistochemistry for subtyping of lung carcinoma.Results: In present study, out of 50 cases, most common histological type of lung carcinoma was Adenocarcinoma (n=23 cases,46%) followed by Squamous cell Carcinoma (n=20 cases,40%) and Small Cell Carcinoma (n=7 cases, 14%). There was male preponderance (96%) and male to female ratio was 25:1. Right sided Lung was most commonly involved (60%) than Left sided Lung (40%).Conclusion: As subtyping is important for different treatment modalities, the present study highlights the importance of histopathological and immunohistochemical study in diagnosis and subtyping of lung carcinoma. In this study we found that adenocarcinoma was most common subtype of lung carcinoma in Saurashtra region than other subtypes and majority of them were smokers.

Transthoracic ultrasound shear wave elastography for the study of subpleural lung lesions.

PurposeThe aim of this study was to assess whether new-generation shear wave elastography (SWE) is suitable for the characterization of lung subpleural lesions.MethodsIn total, 190 consecutive patients with subpleural lung lesions received ultrasonography and SWE. Patients with suspected malignancy underwent ultrasound-guided transthoracic needle biopsy. Final diagnoses were made on the basis of patients’ clinical course, microbiological studies, and histological results. SWE was also performed in 25 healthy volunteers.ResultsWe found no statistically significant differences in stiffness between lung carcinomas, lung metastases, and pneumonia (P=0.296) or between different histological types of lung cancer (P=0.393). Necrosis was associated with reduced stiffness in pneumonia. Excluding necrotic lesions, pneumonia showed higher stiffness than lung carcinomas (2.95±0.68 m/s vs. 2.60±0.54 m/s, P=0.006). Chronic pneumonia showed increased stiffness (3.03±0.63 m/s), probably due to the presence of fibrotic tissue on histology. Pleural effusion was associated with a statistically significant reduction in stiffness, both in lung carcinomas (P=0.004) and lung metastases (P=0.002). The presence of air in healthy lung tissue may lead to incorrect speed estimates due to shear wave reflection (very high values, 14.64±2.19 m/s).ConclusionTransthoracic SWE could not distinguish lung malignancy from pneumonia, or between different histological types of lung carcinomas. In particular, SWE seems unable to resolve the clinical dilemma of chronic subpleural consolidations.

Association of Tooth Loss and Risk of Lung Cancer in a Greek Adult Population: A Case Control Study

Aim: The purpose of the current case-control study was to assess the possible relationships between the number of missing teeth and the risk of lung carcinoma in out-patients Greek individuals of three private practices. Materials and Methods: The study sample consisted of 155 cases diagnosed with various histological types of lung carcinoma and 450 age, gender and socio-economic status matched controls. Data on oral health and the number of missing teeth were obtained through dental examination and questionnaire including aspects of their medical and dental history. Odds ratios (OR’s) and 95% Confidence Intervals (95%CI’s) were assessed using a logistic regression model adjusted for possible confounders. Results: The multivariate regressionanalysis model application showed that smoking (p=0.000, OR= 3.192, 95%CI= 2.065-4.933), deepperiodontalpockets(p= 0.048, OR= 1.89,95%CI=1.221-2.927) and a number of missing teeth more than four (p=0.032, OR=1.67, 95% CI= 0.489-1.953 and p= 0.047, OR=1.884, 95%CI= 0.495-1.209) were statistically significantly associated with risk for LC development. Conclusion: Individuals with deep periodontal pockets and a number of missing teeth more than four were at significantly higher risk for lung carcinoma.

Increased expression of REV7 in small cell lung carcinomas and its association with tumor cell survival and proliferation.

REV7 is involved in multiple biological processes including DNA damage tolerance, cell cycle regulation and gene expression, and is an accessory subunit of the mutation-prone DNA polymerase ζ. It has been reported that REV7 expression is associated with poor prognosis in several human cancers. The aim of this study is to investigate the significance of REV7 in lung carcinogenesis. Immunohistochemical analyses of surgically resected lung cancer specimens revealed that REV7 shows an increased expression in small cell lung carcinomas (SCLCs) when compared with other histological types of lung carcinoma. Association between REV7 expression levels and clinicopathological factors was investigated using SCLC cases with or without surgical resection. Our analyses revealed that high REV7 expression significantly correlated with tumor cell proliferation, assessed by Ki-67 labeling indices, and was negatively associated with distant metastasis and extensive-stage disease. No significant association was detected between REV7 expression and other factors, including prognosis or response to chemoradiotherapy in SCLC. Increase in REV7 expression in SCLC was confirmed using SCLC cell lines. In addition, siRNA-mediated depletion of REV7 activated the apoptotic pathway and suppressed cell growth in SCLC cells. These results suggest that REV7 plays an important role in tumor cell survival and proliferation in SCLC.

Imunoterapie - nová naděje i pro pacienty s prognosticky nepříznivým histologickým typem karcinomu plic

Clanek pojednava o nových možnostech lecby nemalobuněcneho karcinomu plic v pokrocilem, tedy metastazujicim stadiu. Kazuistika popisuje připad pacientky s pokrocilým metastazujicim pleomorfnim karcinomem plic, ktera byla lecena pembrolizumabem. Výsledky terapie timto tzv. blokatorem kontrolnich bodů imunitni reakce jsou zřetelne na přiložených CT scanech hrudniku. Nasledně jsou rozebrana indikacni kriteria teto terapie a naznacena možna budoucnost a sirsi použiti imunoterapie v onkologicke lecbě.

Air bronchogram in pleomorphic carcinoma of the lung is associated with favorable prognosis.

BackgroundPleomorphic carcinoma (PC) of the lung is a rare histological type of lung carcinoma. The association between computed tomography (CT) findings and histology with outcome remains unclear. We examined the relationships between CT features and histopathologic findings, and evaluated the impact of CT features and other clinicopathologic factors on survival.MethodsThirty‐five consecutive patients with PC of the lung who underwent surgery between October 2010 and December 2015 were enrolled in this study. The 35 tumors were classified with or without air bronchogram in the tumors, and with or without intratumoral ground glass opacity (GGO) on CT.ResultsAir bronchogram and GGO were detected in 12 (34.3%) and 5 (14.3%) tumors, respectively. Multivariate analysis revealed that air bronchogram was significantly associated with the presence of adenocarcinoma components with lepidic growth patterns (P = 0.005), and predominance of adenocarcinomas (P = 0.026). GGO was significantly associated with the presence of adenocarcinoma component with lepidic growth pattern (P = 0.010). Air bronchogram was an independent favorable prognostic factor for overall survival, whereas GGO did not have a significant effect on survival.ConclusionAir bronchogram observed in PCs of the lung is strongly related with histological components of the tumor and favorable outcome.

Role of Baseline Bone Scintigraphy in the Evaluation of Skeletal Metastases of Newly Diagnosed Lung Carcinoma Patients

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Lung carcinoma is the most common cancer worldwide with high potentiality of being metastasized to bone. Technetium-99m methylene diphosphonate (99mTc MDP) bone scintigraphy is a sensitive nuclear medicine imaging study to detect the skeletal metastases. The utilization of bone scan upon diagnosis of lung cancer appears to help in accurate staging of patients and planning treatment. The aim of the present study was to see the role of baseline bone scintigraphy in the newly diagnosed lung carcinoma patients and also to see the number, pattern and sites of involvement of bone as well as to evaluate the skeletal metastases according to the different histological types of lung carcinoma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and Methods:&lt;/strong&gt; This observational study was carried out at the Institute of Nuclear Medicine &amp;amp; Allied Sciences (INMAS), Sylhet during the period of July 2014 to June 2015. A total number of 59 lung carcinoma patients who attended at the scintigraphy division of INMAS, Sylhet within three months of their histopathological diagnosis were included in this study. Clinical staging was done from clinical evaluation (history and physical examination) and also form available investigation reports. Skeletal scintigraphy was performed by dual-head gamma camera using low-energy all purpose collimator, 2-3 hours after IV administration of 20-30 mCi of 99mTc MDP. Interpretation was done by recording the distribution of radiotracer within the skeleton along with correlation of history, physical examination, FNAC or biopsy reports and other relevant investigation findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 59 patients, 43 (72.9%) were male and 16 (27.1%) were female. The age range of the patients was from 37 to 85 years with a mean (± SD) of 59.10 ± 10.43 years. The rate of lung carcinoma was highest in the age group of 55-64 years (45.7%), followed by 45-54 years (27.1%) and 65-74 years (11.9%). Incidence was lowest in patients below 45 years (6.8%) and above 75 years (8.5%). Skeletal metastases were detected in 52.54% of lung carcinoma patients where multiple lesions were seen in 87.1% of cases and solitary lesion in 12.9%. Among the metastatic lesions, 82.9% lesions were distributed in axial skeleton and 17.1% lesions were distributed in appendicular skeleton. Spine was the most frequent site of metastatic involvement in the present study which was 37.8% followed by ribs 28.0%, sternum 9.7% and pelvic bones 7.3%. Thoracic spine was found to be involved more (58.1%). Regarding patterns of metastatic lesions, 23 patients (74.1%) showed hot lesions, two patients (6.5%) showed cold lesions, four patients (12.9%) showed superscan and two patients (6.5%) showed pattern of hypertrophic osteoarthropathy. Bone metastasis was found in 75% cases of small cell lung carcinoma (SCLC) and 49.2% cases of non-small cell lung carcinoma (NSCLC). Among NSCLC, adenocarcinoma showed 62.9% metastases followed by 36.8% squamous cell carcinomas and 20.0% large cell carcinomas. In this series, clinical staging was done and 11 patients ( 18.6% ) were found in stage I, 21 patients ( 35.6% ) in stage II, 23 patients ( 39.0% ) in stage III and 04 patients ( 6.8 % ) in stage IV. Skeletal scintigraphy detected metastatic lesions in six of 11 cases (54.5 %) in clinical stage I, five of 21 cases (23.8 %) in clinical stage II, 16 of 23 cases (69.6 %) in clinical stage III and in all patients (100%) with clinical stages IV showing higher rate of bone metastases with advanced clinical stages.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: In this study, skeletal scintigraphy changed clinical staging of 27 patients. Early diagnosis of lung carcinoma, followed by bone scanning without delay helps to diagnose skeletal metastases, the presence of which is a major determinant in subsequent pathological staging and treatment planning.&lt;/p&gt;&lt;p&gt;Bangladesh J. Nuclear Med. 19(2): 111-115, July 2016&lt;/p&gt;

Amplification of FGFR1 gene and expression of FGFR1 protein is found in different histological types of lung carcinoma

Although lung cancer continues to be the leading cause of cancer-related death, accurate diagnosis followed by personalized treatment is expected to raise the 5-year survival rate. Targeted therapies are now in routine clinical use, in particular for lung adenocarcinoma (ADC). Fibroblast growth factor receptor 1 (FGFR1) has recently emerged as a molecular target, especially in squamous cell/epidermoid carcinoma (SQC) of the lung. This paper evaluates FGFR1 expression and gene copy number in adenocarcinomas, squamous cell carcinomas, pleomorphic carcinomas (PLEOMC) and adenosquamous carcinomas (ADSQC) of the lung and also explores the epithelial-mesenchymal transition (EMT) pathway. We studied 76 lung carcinomas: 34 ADC, 24 SQC, 10 PLEOMC and 8 ADSQC. FGFR1 expression was evaluated by immunohistochemistry and gene amplification by fluorescence in situ hybridization (FISH). Higher FGFR1 protein expression was observed in all tumour types compared to non-tumour tissue. FGFR1 expression was higher in ADC and PLEOMC than in SQC. We found a tendency to higher expression in ADC than in SQC and significantly higher expression in PLEOMC than in other histological subtypes. FISH-based amplification of FGFR1 was identified in 15 (20%) lung carcinomas: 5 (15%) ADC, 5 (21%) SQC, 3 (30%) PLEOMC and 2 (25%) ADSQC. Amplification was more frequent in SQC without significant differences. FGFR1 protein is expressed in the majority of lung carcinomas, though it is higher in ADC and PLEOMC (the latter may reflect the importance of FGFR1 control of the EMT pathway). FGFR1 amplification was identified in all types of lung carcinoma. Although FGFR1 is most frequently amplified in SQC, other histological types merit assessment of FGFR1 amplification, in order to select patients that might benefit from targeted therapy.

Primary adenocarcinoma of the lung--histological subtypes and outcome after surgery, using the IASLC/ATS/ERS classification of lung adenocarcinoma.

Adenocarcinoma is the most common histological type of lung carcinoma. Recently the histologic classification of adenocarcinomas in the lung was modified to better reflect biologic properties and prognosis. We reviewed the histology of all primary lung adenocarcinomas operated on in Iceland during a 20-year period and assessed the impact of histology on survival. This nationwide study included 285 patients (mean age 67 years, 57% female), who underwent resection in Iceland from 1991 to 2010. Tumors were reclassified according to the current IASLC/ATS/ERS classification system. Overall survival was estimated by the Kaplan-Meier method and Cox regression analysis used to evaluate prognostic factors of overall mortality. Acinar predominant adenocarcinoma was the most common histological subtype (46%) followed by solid-predominant (SPA) with mucin production comprised (23%). Non-invasive carcinomas were rare. A difference in survival between the histological adenocarcinoma subtypes was not seen (p = 0.32) and multivariate analysis showed that advanced stage and age predicted worse outcome, but histologic subtyping of adenocarcinoma did not. In this nation-wide study there was not a statistical difference in survival according to adenocarcinoma subtypes and the histological subtype did not predict mortality. Preinvasive and minimally invasive adenocarcinomas were rare.

Assessement of angiogenesis reveals blood vessel heterogeneity in lung carcinoma

Despite advances in treatment, the prognosis for lung cancer patients remains poor. Angiogenesis appears to be a promising target for lung cancer therapy; however, the clinical significance of vascular changes are not completely understood. The aim of this study was to evaluate the types and morphology of blood vessels in various lung carcinomas. Using double immunostaining, we investigated 39 biopsies from patients admitted with various histological types of lung carcinoma. Tumor blood vessels were quantified separately for CD34/smooth muscle actin and described as either immature, intermediate or mature. Double immunostaining evaluation of the type of blood vessels in lung carcinomas revealed a marked heterogeneity. The immature and intermediate type of vessels were more common in adenocarcinomas (ADCs) and squamous cell carcinomas (SCCs) of the lung. Small cell lung carcinomas revealed a significant correlation between pathological and immature types of blood vessels. Therefore, quantifying the types of tumor vessels in lung carcinomas may be an important element to improve the results of anti-vascular therapy.

Identification of an HLA-A*0201-restricted cytotoxic T lymphocyte epitope from the lung carcinoma antigen, Lengsin

Lengsin is an eye lens protein with a glutamine synthetase domain. We previously identified this protein as a lung carcinoma antigen through cDNA microarray analysis. Lengsin protein is overexpressed irrespective of the histological type of lung carcinoma, but not in normal tissues other than the lens. Therefore, to significantly extend the use of Lengsin-based T-cell immunotherapies for the treatment of patients with lung carcinoma, we searched for HLA-A*0201-restricted epitopes from this protein by screening predicted Lengsin-derived candidate peptides for the induction of tumor-reactive CTLs. Four Lengsin-derived peptides were selected by computerized algorithm based on a permissive HLA-A*0201 binding motif, and were used to immunize HLA-A*0201 transgenic (HHD) mice. Two of the immunizing peptides, Lengsin(206-215)(FIYDFCIFGV) and Lengsin(270-279)(FLPEFGISSA), induced peptide-specific cytotoxic T lymphocytes (CTLs) in HHD mice, and thus were used to stimulate human peripheral blood lymphocytes invitro. Lengsin(206-215) and Lengsin (270-279) also induced human peptide-specific CTLs, and we were able to generate Lengsin(206-215)- and Lengsin(270-279)-specific CTL clones. The Lengsin(270-279)-specific CTL clone specifically recognized peptide-pulsed T2 cells, COS-7 cells expressing HLA-A*0201 and Lengsin, and HLA-A*0201+/Lengsin+ lung carcinoma cells in an HLA-A*0201-restricted manner. On the other hand, the Lengsin(206-215)-specific CTL clone failed to recognize HLA-A*0201+/Lengsin+ target cells in the absence of cognate peptide. These results suggest that Lengsin(270-279) is naturally processed and presented by HLA-A*0201 molecules on the surface of lung carcinoma cells and may be a new target for antigen-specific T-cell immunotherapy against lung cancer.

Particularities of lung tumour angiogenesis and stroma formation in inhabitants from radionuclide-contaminated territories at Semipalatinsk region, Kazakhstan

The aim of this study was to investigate particularities of angiogenesis and stroma formation in various histological types of lung carcinoma in inhabitants from radionuclide-contaminated territories at Semipalatinsk region, Kazakhstan. We used operational and biopsy material from 87 lung carcinoma patients. Of them, 33 patients (the 1st group) lived in the neighbourhood of Semipalatinsk testing area from their childhood to 2002 and were exposed to radiation for a long time (the mean year radiation dose exceeded 0.1 rem). Operational and biopsy material from 54 patients living at Kazakhstan territories with normal radiation level (14 patients) or in Moscow (40 patients) were as controls (the 2nd group). Immunohistochemical methods were used to detect ММР-1, ММР-2, ММР-9, TIMP-1, VEGF, CD34, chromogranin, and CD68. Expression of ММР-1, ММР-2, ММР-9 in tumour cells was enhanced in the 1st group compared to the controls. Angiogenesis in tumour stroma of Semipalatinsk patients was more significant compared to the controls with regard to VEGF expression and density of newly formed vessels. We proposed that the mentioned above factors could provide poor prognosis of lung carcinoma in inhabitants of radionuclide-contaminated territories.

Changing trends in the distribution of the histologic types of lung cancer: a review of 4,439 cases

Lung cancer is the second most common cancer and the leading cause of cancer death in both men and women. The purpose of the study is to explore the distribution of the 4 major histologic types of lung carcinoma and the incidence of lung cancer with reference to all other sites of cancer. The clinical and histopathologic data of 4,439 patients with lung carcinoma between January 1980 and December 2003 were reviewed. Adenocarcinoma has become the most frequent histologic type in men and women (36.8% and 46.5%, respectively), followed by squamous cell carcinoma (31.6% and 25.4%, respectively). The incidence of large cell (undifferentiated) carcinoma in men and women is 18.0% and 9.9%, respectively. The incidence of small cell carcinoma in men and women is 13.7% and 18.3%, respectively. In addition, analysis of our data indicates that lung cancer rate is decreasing, relative to all other primary cancer sites. The results of this study suggest that the incidence of lung cancer has decreased in comparison with other sources of cancer in southern Texas. This observation is consistent with the current national trends. In addition, there are significant changes in the distribution of the major histologic types of lung cancer. The results of this study may portend important changes in the selection of targeted therapy and patient management.

Telomerase expression in lung preneoplasia and neoplasia

Telomeres are specialized structures at eukaryotic chromosomes ends, which role is to prevent them from degradation, end to-end fusion and rearrangement. However, they shorten after each cellular division because of an incomplete DNA replication, acting in normal somatic cells as a mitotic clock for permanent proliferation arrest or senescence entry. Short telomeres are perceived as damaged DNA leading to p53/ATM pathway activation. In tumoral cells, a ribonucleoprotein complex termed telomerase enables telomere elongation. This complex, composed of 2 main components, the telomerase RNA component or hTR, the RNA template for telomere synthesis, and telomerase reverse transcriptase, the catalytic subunit, is reactivated in the majority of cancers, including those of the lung. In this review, we briefly present the main results on telomerase expression in various histological types of lung carcinoma and in bronchial carcinogenesis along with telomere attrition. Inhibition of one of the main components of the enzyme or limitation of telomere access by telomerase represent novel targets for cancer therapies and chemoprevention in high risk patients of lung cancer.

Neuroendocrine Lung Tumors

Abstract: A case of large cell neuroendocrine carcinoma (LCNEC) of the lung is presented to introduce the topic of pulmonary neuroendocrine tumors. These encompass a spectrum of tumors including the low-grade typical carcinoid (TC), intermediate-grade atypical carcinoid (AC), and the high-grade LCNEC and small cell carcinoma (SCLC). These tumors have certain morphologic, ultrastructural, immunohistochemical, and molecular characteristics in common, but there are important differences in incidence, clinical, epidemiologic, histologic, survival, and molecular characteristics. Although these tumors are frequently discussed in a spectrum, the carcinoid tumors are only distantly related to the high-grade SCLC and LCNEC. In contrast to SCLC and LCNEC, both TC and AC can occur in patients with multiple endocrine neoplasia (MEN) type 1. In addition, neuroendocrine cell hyperplasia with or without tumourlets is relatively frequent in both TC and AC but not in LCNEC or SCLC. Histologic heterogeneity with other major histologic types of lung carcinoma occurs with both SCLC and LCNEC but not with TC or AC. In contrast to LCNEC, most TC and AC are readily diagnosed by light microscopy without the need for special tests. The percentage of genetic changes is usually low for TC, high for SCLC and LCNEC, and intermediate for AC.

Histological types and significance of bronchial epithelial dysplasia

Pulmonary epithelium is known to undergo a preneoplastic process prior to the development of lung carcinoma. Squamous dysplasia and atypical adenomatous hyperplasia have been identified and classified as preinvasive lesions of squamous cell carcinoma and peripheral pulmonary adenocarcinoma, respectively. However, these commonly recognized preinvasive lesions do not completely explain the development of all histological types of lung carcinoma. By examining 114 resection lung specimens, we concluded that there are four histological patterns of bronchial epithelial dysplasia based on morphological features (basal cell dysplasia, columnar cell dysplasia, bronchial epithelial dysplasia with transitional differentiation, and squamous dysplasia). The histological patterns were further characterized by immunohistochemistry. Basal cell dysplasia was focally positive for cytokeratin (CK) 17 and 10/13; columnar cell dysplasia was generally positive for CK7, 8, and 18; bronchial epithelial dysplasia with transitional differentiation had a heterogeneous immunoprofile, while squamous dysplasia was positive for CK10/13 and focally positive for CK17. Various degrees of abnormal expression of p53 and Ki-67 were found in the different types of bronchial epithelial dysplasia. The cases were divided into three groups based on degree and extent of bronchial epithelial dysplasia. By Crosstabs McNemar test, the Mann–Whitney U-test (for two independent groups), the Kruskal–Wallis one-way nonparametric ANOVA (for >2 independent groups) and Spearman correlation analysis, the degree and extent of bronchial epithelial dysplasia was shown to be positively correlated with the incidence of bronchogenic carcinoma and multifocal primary lung carcinoma (P<0.05). These findings indicated the following: (1) bronchial epithelium can develop various patterns of dysplasia with abnormal/ambiguous cell differentiation and abnormal expressions of p53 and Ki-67. Thus, these bronchial epithelial dysplastic lesions may represent a preneoplastic process. (2) The degree of bronchial epithelial dysplasia may significantly predispose individuals to bronchogenic carcinoma and multifocal primary lung carcinoma.

Napsin A is useful to distinguish primary lung adenocarcinoma from adenocarcinomas of other organs

The aim of the present study was to compare the usefulness of the peripheral airway cell markers, naspin A and surfactant protein A (SP-A), for distinguishing primary lung adenocarcinoma from adenocarcinomas of other organs in various clinical conditions. Immunohistochemical expression of napsin A and SP-A was analyzed at primary sites of 120 lung carcinomas and 40 adenocarcinomas of other organs, at lung metastatic sites of 32 adenocarcinomas of other organs, and in metastatic lymph nodes of 21 lung adenocarcinomas and 45 adenocarcinomas of other organs. Napsin A and SP-A expressions were compared between primary and recurrent sites in 8 lung adenocarcinomas. Napsin A and SP-A expressions were noted in 84.3% and 53.0% of primary sites of 83 lung adenocarcinomas, respectively, but neither napsin A nor SP-A was expressed at primary sites of other histological types of lung carcinomas or at primary or metastatic sites of adenocarcinomas of other organs. In lung adenocarcinomas, napsin A and SP-A were expressed in metastatic lymph nodes in 81.0% and 19.0%, respectively, and at recurrent sites in 87.5% and 37.5%, respectively. Napsin A is superior to SP-A for distinguishing primary lung adenocarcinoma from adenocarcinomas of other organs at primary, metastatic, and recurrent sites.

Impact of the endoscopic ultrasound on the management of the lung carcinoma: A single center experience

7187 Background: Recent studies have shown that EUS-FNA is an accurate test for the cytological diagnosis & staging (D&S) of the lung carcinoma (LC). In our center, EUS was introduced for a prospective study on LC. The purpose of this study was to determine the impact of EUS-FNA on management of the lung cancer. Method: Data were collected from Jan. 2002 to Nov. 2004 on subjects with suspected LC. CT-guided FNA, bronchoscopy, mediastinoscopy/surgery and PET scan were commonly used tests for the D&S. EUS-FNA was introduced as an alternative test for the D&S in Nov. 2003. The three years (2002, 2003, 2004) were compared for the total number of patients with LC, the test that established the tissue diagnosis, complication rate due to diagnostic procedures, proportion of patients that required the invasive procedures (mediastinoscopy) for the staging of the NSCLC. ANOVA & Chi-square test were used to compare the three years for continuous & dichotomous variables, respectively. Result: There was positive trend in the use of EUS for establishing the cytological diagnosis and histological type of LC. In 2004, EUS was the commonest procedure to establish the tissue diagnosis of the LC. Overall complication rate due to diagnostic procedures for suspected LC were significantly low in 2004 as compared to that in 2002 and 2003. EUS-FNA detected metastases to mediastinum in 40% of cases in 2004. There was significant reduction in the proportion of patients undergoing mediastinoscopy for the staging of Non-small cell lung carcinoma (NSCLC) in 2004 as compared to 2002 and 2003. Conclusion: There is a positive trend in the usage of the EUS for the diagnosis & staging of the lung cancer, which is associated with significant lowering of the overall complication rate due to other diagnostic procedures and negative trend in use of invasive procedure (mediastinoscopy) for staging of the NSCLC. We recommend that EUS should be incorporated in the routine diagnostic work up of the lung carcinoma. No significant financial relationships to disclose.

Histopathologic classification of lung cancer: Relevance of cytokeratin and TTF-1 immunophenotyping

Histopathologic classification of lung carcinoma is important, as a prognostic factor and in the evaluation of treatment modalities. Although the World Health Organization classification of lung cancer is based on routine microscopy, immunohistochemistry is an important additional aspect in modern pathologic practice. This study examines whether the main histologic types of lung carcinomas are more reliably diagnosed with immunohistochemical technique using antibodies for the lung tissue-specific antigen thyroid transcription factor-1 (TTF-1) and a panel of cytokeratin (CK) antibodies. Forty-five cases of lung cancer (12 squamous cell carcinoma, 13 small cell carcinoma, 11 adenocarcinoma, 9 large cell carcinoma [LCC]/pleomorphic carcinoma) were stained with antibodies to CK CAM5.2, CK5, CK7, CK20, and TTF-1. All 45 cases were positive with CAM5.2, 16 of 45 cases with CK5, 34 of 45 cases with CK7, 4 of 45 cases with CK20, and 29 of 45 with TTF-1. Squamous cell carcinoma (epidermoid carcinoma) had the immunophenotype CK5+/TTF-1-, and at least 20% were also positive with CK7. Most nonepidermoid tumors had the "lung-specific" phenotype CK5-/TTF-1+; all small cell carcinomas had the phenotype CK5-/CK8+/TTF-1+, all adenocarcinomas CK5-/CK7+/TTF-1+ and (more than 50%) of LCC CK5-/CK7+/TTF-1+. Thus, more than 50% of LCCs were of the same phenotype as adenocarcinomas. The immunophenotypes of the main histologic types of lung carcinoma are stable and highly reproducible. However, because of considerable overlapping, immunophenotyping should not be used alone for histopathologic classification of lung cancer, but only as an adjunct to light microscopy. It is also suggested that CK5+ lung carcinomas with basaloid features should be regarded as variants of squamous cell carcinoma and not as LCC.