Primary Pulmonary Adenocarcinoma Research Articles

Metastasis to an odontogenic cyst: case report and review of literature

Metastatic disease to the jawbone is relatively uncommon. However, its occurrence within a pre-existing odontogenic cyst or tumor is extremely rare. We present a case of a 61-year-old woman experiencing fatigue and nocturnal diaphoresis with an otherwise asymptomatic radiolucent lesion of the mandible. Radiographic features were suggestive of a benign odontogenic cyst. A biopsy revealed a metastatic nidus within the wall of a benign odontogenic cyst. Further investigations confirmed the presence of a primary pulmonary adenocarcinoma. Diagnosis of metastases to the orofacial region may be challenging because of their various clinical and radiographic features. Thorough histopathological analysis of any routine cystic tissue from the maxillofacial structures, even seemingly benign, is necessary to rule out more aggressive disease.

MA09.12 The Role of Different Lepidic Patterns for Determining Whether it is a Multiple Primary Pulmonary Adenocarcinoma

MA09.12 The Role of Different Lepidic Patterns for Determining Whether it is a Multiple Primary Pulmonary Adenocarcinoma

TTF-1 is a highly sensitive but not fully specific marker for pulmonary and thyroidal cancer: a tissue microarray study evaluating more than 17,000 tumors from 152 different tumor entities

Thyroid transcription factor 1 (TTF-1) immunohistochemistry (IHC) is routinely used for the distinction of primary pulmonary adenocarcinomas. However, TTF-1 can also occur in other malignancies. A tissue microarray containing 17,772 samples from 152 different tumor types was analyzed. Napsin-A, CK20, SATB2, FABP1, and Villin-1 IHC data were available from previous studies. TTF-1 staining was seen in 82 of 152 tumor categories including thyroidal cancers (19–100%), adenocarcinomas (94%), neuroendocrine tumors (67%) of the lung, small cell neuroendocrine carcinomas (71–80%), mesenchymal tumors (up to 42%), and thymomas (39%). Comparative analysis of TTF-1 and Napsin-A revealed a sensitivity/specificity of 94%/86% (TTF-1), 87%/98% (Napsin-A), and 85%/99.1% (TTF-1 and Napsin-A) for the distinction of pulmonary adenocarcinomas. Combined analysis of TTF-1 and enteric markers revealed a positivity for TTF-1 and at least one enteric marker in 22% of pulmonary adenocarcinomas but also a TTF-1 positivity in 6% of colorectal, 2% of pancreatic, and 3% of gastric adenocarcinomas. TTF-1 is a marker of high sensitivity but insufficient specificity for pulmonary adenocarcinomas. A small fraction of TTF-1-positive gastrointestinal adenocarcinomas represents a pitfall mimicking enteric-type pulmonary adenocarcinoma. Combined analysis of TTF-1 and Napsin-A improves the specificity of pulmonary adenocarcinoma diagnosis.

Aberrant Expression of Pneumocytic Markers (TTF-1 and Napsin-A) in Biliary Duct and Gallbladder Adenocarcinomas; A Potential Diagnostic Pitfall.

Cholangiocarcinomas and gallbladder carcinomas are epithelial tumours with biliary differentiation. On histology and immunohistochemistry, they resemble adenocarcinomas and possess overlapping immunohistochemical profiles. Diagnosing these tumours is best done using appropriate imaging and clinical features with compatible immunohistochemistry. Immuno-staining for thyroid transcription factor-1 (TTF-1) and novel aspartic proteinase of pepsin A (Napsin-A) is believed to be specific for primary pulmonary adenocarcinomas. We herein report uncommon instances of strong and diffuse expression of these markers in two examples of adenocarcinomas arising from the bile duct and gallbladder. A review of the literature and a summary of similar studies relating to aberrant TTF-1 and Napsin-A expression in biliary tract adenocarcinomas are presented.

Stereologic consequences of iatrogenic collapse: The morphology of adenocarcinoma in situ overlaps with invasive patterns. Proposal for a necessary modified classification of pulmonary adenocarcinomas

Recognizing non-invasive growth patterns is necessary for correct diagnosis, invasive size determination and pT-stage in resected non-small cell lung carcinoma. Due to iatrogenic collapse after resection, the distinction between adenocarcinoma in-situ (AIS) and invasive adenocarcinoma may be difficult. The aim of this study is to investigate the complex morphology of non-mucinous non-invasive patterns of AIS in resection specimen with iatrogenic collapse, and to relate this to follow-up.The effects of iatrogenic collapse on the morphology of collapsed AIS were simulated in a mathematical model. Three dimensional related criteria applied in a modified classification, using also cytokeratin 7 and elastin as additional stains, in two independent retrospective cohorts of primary pulmonary adenocarcinomas ≤3 cm resection specimen with available follow-up information.The model demonstrated that infolding of alveolar walls occurs during iatrogenic collapse and lead to a significant increase in tumor cell heights in maximal collapse areas, compared to less collapsed areas. The morphology of infolded AIS overlaps with patterns described as papillary and acinar adenocarcinoma according to the WHO classification, necessitating an adaptation.The modified classification incorporates recognition of iatrogenic and biologic collapse, tangential cutting effect true invasion and surrogate markers of invasion i.e. grey zone, covering a multilayering falling short of micropapillary, cribriform and solid alveolar filling growth. The use of elastin and CK7 staining aids in the morphologic recognition of iatrogenic collapsed AIS and the distinction from invasive adenocarcinoma. Out of a total of 70 resection specimens 1 case was originally classified as AIS and 9 were reclassified as iatrogenic collapsed AIS. Patients with collapsed AIS showed a 100 % recurrence-free survival after a mean follow-up time of 69.5 months.With the current WHO classification, AIS is overdiagnosed as invasive adenocarcinoma due to infolding. The modified classification facilitates the diagnosis of AIS.

S2879 A Rare Presentation of Synchronous Primary Pulmonary and Cecal Adenocarcinoma

S2879 A Rare Presentation of Synchronous Primary Pulmonary and Cecal Adenocarcinoma

Primary pulmonary mucinous adenocarcinoma in a young adult with MELAS syndrome

Primary pulmonary mucinous adenocarcinoma in a young adult with MELAS syndrome

Protein Expression, Amplification, and Mutation of HER2 Gene in Canine Primary Pulmonary Adenocarcinomas: Preliminary Results.

Recently, human epidermal growth factor receptor 2 (HER2) has emerged as a therapeutic target of interest for non-small-cell lung cancer in humans. The role of HER2 in canine pulmonary adenocarcinomas is poorly documented. To address this gap, this study employed three methodologies: immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and next-generation sequencing (NGS) to investigate the protein expression, gene amplification, and mutation of HER2 in 19 canine primary pulmonary adenocarcinomas. By IHC, 3 out of 19 cases were overexpressed 3+, 6 were 2+, and 10 were negative. With FISH, 2 cases were amplified (12.5%), 3 were inadequate for the analyses, and the others were non-amplified. With NGS, seven cases were inadequate. All other cases were wild-type, except for one IHC 3+ case, which was amplified with FISH and with a specific mutation already described in human pulmonary adenocarcinoma, V659E. This mutation is probably sensitive to tyrosine kinase inhibitory drugs. These results are similar to those in human medicine and to the few data in the literature on canine lung carcinomas; the presence of 12.5% of amplified cases in dogs lays the foundation for future targeted drugs against HER2 alterations.

Radiological Features of Primary Pulmonary Invasive Mucinous Adenocarcinoma Based on 312 Consecutive Patients.

The aim of this study is to investigate the radiological features of primary pulmonary invasive mucinous adenocarcinoma (IMA) in a relatively large population to help improve its further understanding and its accuracy of initial diagnosis. This retrospective study included consecutive patients with pathologically confirmed primary pulmonary IMA from January 2019 to December 2021. According to tumor morphology, IMAs were divided into regular nodule/mass, irregular, and large consolidative types. According to tumor density, IMAs were divided into solid, halo, part-solid, pure ground-glass, and cystic types. ANOVA, chi-square, or Fisher exact tests were used to analyze the differences in radiological and clinicopathological characteristics of IMA according to morphological and density subtypes. We analyzed 312 patients. Pulmonary IMA tended to occur in the elderly, with a slightly higher number of women than men. IMA showed a predominance in the lower lobe and adjacent to pleura. IMA of regular nodule/mass, irregular, and large consolidative types accounted for 80.8% (252/312), 13.8% (43/312), and 5.4% (17/312), respectively. Solid, halo, part-solid, pure ground-glass, and cystic IMAs accounted for 55.8% (174/312), 28.2% (88/312), 11.2% (35/312), 1.3% (4/312), and 3.5% (11/312), respectively. The lobulated (76.9%), spiculated (63.5%), and air bronchogram (56.7%) signs were common in IMA. Dead branch sign (88.2%), angiogram sign (88.2%), and satellite nodules/skipping lesions (47.1%) were common in large-consolidative-type IMA. Kirsten rat sarcoma viral oncogene mutations were common (56.1%), whereas epidermal growth factor receptor mutations were relatively rare (2.3%). Pulmonary IMA of regular nodule/mass type and solid type were the most common at the initial diagnosis. Detailed radiological features can aid in the differential diagnosis of IMA.

Primary pulmonary enteric adenocarcinoma: A case report and review of literature

Primary pulmonary enteric adenocarcinoma (P-PEAC) is an unusual subtype of invasive lung adenocarcinoma. The significance of such tumor lies in its similar histopathological and immunohistochemical characteristics to colorectal adenocarcinoma. Therefore, a detailed investigation is crucial to establish a definitive diagnosis. This paper reports a case of a 51-year-old Saudi female, diagnosed with a rare variant of lung carcinoma, P-PEAC.

Solitary Pulmonary Nodule Under the Anonymity of COVID-19 Infection

Abstract We report the case of a 32-year-old male patient, a former smoker, with a known history of SARS-COV-2 infection, mild clinical form, condition that required follow-up evaluation. Despite being oligosymptomatic, the patient reports discreet respiratory symptoms, manifested by dry cough and a sensation of chest tightness. CT thoracic scan revealed a pseudo-nodular, diffusely contoured infiltrate of approximately 10 mm, in the apical left upper lobe segment (LUL), sequelae appearance, thought to represent SARS-COV-2 residual changes, with follow-up recommendation. Three months later, reassessment highlighted a slight progression of the lesion, with a spiculated appearance and umbilicated pleura, a context that mandated further respiratory-specific medical investigations, including bronchoscopic examination and positron emission tomography (PET CT). Given the diagnostic suspicion that included a pathology with neoplastic potential, the firm recommendation was to perform a nodular pulmonary biopsy through video-assisted thoracoscopy (VATS). Both the histopathological (HP) and immunohistochemical (IHC) examinations supported the diagnosis of primary pulmonary adenocarcinoma. The therapeutic course was completed by performing a left upper lobectomy with lymphadenectomy. The case is instructive, confirming that SARS-COV-2 infection is a perfect mimic (1), capable of imitating various other conditions. In this context, the optimal scenario is distinguished, where monitoring after infection contributes to the early and incidental identification of neoplasia, thus suggesting that SARS-COV-2 infection may also offer certain benefits.

EGFR 19 deletion and FGFR2-FILIP1 rearrangement in lung adenocarcinoma with cervix and endometrium metastases: A case report and literature reviewcase report and literature review

Distant metastases of pulmonary adenocarcinoma are regularly observed in the bones, brain, and liver, rarely in the cervix or endometrium. We report a case of 53-year-old Chinese female with primary pulmonary adenocarcinoma which metastasized to the uterine cervix and endometrium

Can tumour budding change the future of pulmonary adenocarcinoma?

BackgroundPulmonary adenocarcinoma shows different prognosis even in the same pathological subtype and stage. In this study, it is aimed to investigate the relationship between tumour budding and known prognostic values and clinicopathological features in pulmonary adenocarcinoma. MethodsIn this study, there have been 77 patients diagnosed with primary pulmonary adenocarcinoma. In the evaluation process, the number of budding between 0 and 4 is accepted as low budding (Bd1), the number of budding between 5 and 9 is considered as medium budding (Bd2), and the number of budding above 10 is considered as high budding (Bd3). ResultsAccording to the findings of the study, it can be seen that there is a statistical difference between tumour budding and stromal fibrosis (p < 0.001). The presence of pleural invasion, lymph vascular invasion and perineural invasion in patients with Bd3 is found to be statistically higher than the patients with Bd1 (p = 0.048) (p = 0.041) (p = 0.029). ConclusionsTumour budding has been associated with pleural invasion, lymph vascular invasion, perineural invasion, and stromal fibrosis. This study is the first to show the relationship between tumour budding and stromal fibrosis in pulmonary adenocarcinomas. The role of tumour budding in lung cancers remains to be clarified.

Prognosis of primary pulmonary adenocarcinoma after surgical resection in small-breed dogs: 52 cases (2005-2021).

Tumor size is an important prognostic factor in lung cancer in dogs, and the canine lung carcinoma stage classification (CLCSC) recently has been proposed to subdivide tumor sizes. It is unclear if the same classification scheme can be used for small-breed dogs. To investigate whether the tumor size classification of CLCS is prognostic for survival and progression outcomes in small-breed dogs with surgically resected pulmonary adenocarcinomas (PACs). Fifty-two client-owned small-breed dogs with PAC. Single-center retrospective cohort study conducted between 2005 and 2021. Medical records of dogs weighing <15 kg with surgically resected lung masses histologically diagnosed as PAC were examined. The numbers of dogs with tumor size ≤3 cm, >3 cm to ≤5 cm, >5 cm to ≤7 cm, or >7 cm were 15, 18, 14, and 5, respectively. The median progression-free interval (PFI) and overall survival time (OST) were 754 and 716 days, respectively. In univariable analysis, clinical signs, lymph node metastasis, margin, and histologic grade were associated with PFI, and age, clinical signs, margin, and lymph node metastasis were associated with OST. Tumor size classification of CLCS was associated with PFI in all categories, and tumor size >7 cm was associated with OST. In multivariable analysis, tumor size >5 cm to ≤7 cm and margin were associated with PFI, and age was associated with OST. The tumor size classification of CLCS would be an important prognostic factor in small-breed dogs with surgically resected PACs.

Correlation between ALK, ROS1 Biomarkers and EGFR Oncogene Mutations in Lung Tumours: Our Observations in an Apex Oncopathology Laboratory

Introduction: Analysis of Anaplastic lymphoma receptor tyrosine kinase gene (ALK), Repressor of Silencing 1 (ROS1) gene are determined by immunohistochemistry (IHC) and it is an easily applicable, cost-effective assay for potential treatment with crizotinib. Mutations of Epidermal growth factor receptor (EGFR) genes are evaluated by IHC/Multiplex RT-PCR. The purpose of this study is to assess the frequencies of ALK, ROS1 and their association with EGFR fusion gene mutations in a spectrum of lung tumours. Materials and methods: A total of 202 cases of lung tumours reported at our Center for Oncopathology from September 1st 2020 to 31st August 2021, were retrospectively analyzed for ALK, ROS1 and EGFR fusion genes based on Immunohistochemistry (IHC) and Multiplex PCR findings. ALK was tested using D5F3 clone, and ROS1 was analyzed using Cell Signalling’s D4D6 clone on the Ventana immunohistochemistry platform. EGFR status was analyzed using EGFR mutation test V2 real-time multiplex PCR assay on Roche Cobas Z480. Results: 202 biopsy samples and cellblocks of fluid aspirates were analyzed. 175/202 were histologically and immunologically proved as Non-small cell lung carcinoma (Primary pulmonary adenocarcinoma) and its metastases. 09/199 (5.23%) were Positive for ALK IHC and 03/199 (1.74%) cases had equivocal results. 06/179 (3.85%) cases were Positive for ROS1 IHC and 03/179 (1.92%) cases had equivocal results. Other histo-morphological diagnoses i.e., adenosquamous, squamous, small cell, mucinous carcinoma etc (27 cases) were all ALK and ROS1 Negative. 188/202 tumours were analyzed for EGFR mutation status, which showed 70/188 (37.23%) had specific EGFR mutations. 118/188 (62.76%) cases were EGFR wildtype. Conclusion: We observed that age related incidence of EGFR mutations was highest in elderly females, of 61 to 70 years. ALK gene mutations occurred in 6.03% and ROS1 gene mutations occurred in 5.02% of lung tumours and their metastases. EGFR-mutations were associated with ROS1 mutated lung adenocarcinomas. There are no coexistent ALK-EGFR or ALK-ROS1 mutations. All ALK IHC positive pulmonary adenocarcinomas are ROS1 negative and are mutually exclusive.

First Analysis of Expression of Napsin-A in Ovine Pulmonary Adenomatosis of Sheep and Goat at Duhok Governorate

Ovine Pulmonary Adenomatosis is a chronic respiratory disease of sheep or contagious lung cancer of sheep, and less commonly of goats. A total of 4061 lung samples were selected randomly from slaughtered sheep and goats. All samples of lungs with typical lesions were fixed in 10% neutral buffered formalin and examination is performed by macrocsopical and microscopical observation. To perform IHC technique, we used TMA with a polymer system by application of specific markers Napsin A. Results showed 35 lungs suspected from natural cases are diagnosed as OPA. Histologically results showed that the presence of multiple proliferations foci of neoplastic cells in the epithelial cell of alveoli and bronchi, these proliferations appears either papillary or as impression of solid growths appearance or acinar shape which is classified as classical and atypical form. The current study found that the expression of Nnapsin A was observed in 85.71% of the OPA as a granular cytoplasmic staining but there was staining in the nucleus of tumor cells. In conclusion, these findings indicate for the first time that Napsin A is extremely specific for adenocarcinoma of lung in primary origin and use of this important biomarker is guaranteed to help disconnect primary pulmonary adenocarcinoma for diagnosis from other types of lung cancer.

Refined Diagnosis of Pleural Effusions by Immunocytochemistry of Cell Blocks.

The main objective of microscopic examination of pleural effusions is to ascertain the presence of malignant cells. Effusions prepared routinely using May-Grünwald-Giemsa (MGG)- and Papanicolaou (PAP)-staining can, in a number of cases, provide inconclusive cytological results regarding malignancy. This report describes the refined diagnosis of such cases based on immunocytochemical analysis of pleural effusion cell blocks. Of the 340 pleural effusions obtained during 2019 at the Department of Clinical Cytology, Gävle Hospital, Sweden, 63 (18.5%) contained atypical cells of undetermined significance or potentially malignant cells. This diagnosis could be refined using Epithelial Cell Adhesion Molecule/EPCAM (BEREP4) immunocytochemical analysis of effusion cell blocks, allowing previously inconclusive effusions to be classified as clearly benign 42/63 (66.7%) or malignant 21/63 (33.3%). Effusions initially diagnosed as clearly malignant (27/340; 7.9%) were all 27 (100%) BEREP4-immuno-stained. Most BEREP4-positive effusions (37/48; 77.1%) were also carcinoembryonic antigen (CEA) positive. The number of BEREP4-positive cells, however, tended to exceed that of CEA-positive cells. The BEREP4 positive effusions were further examined using different monoclonal antibodies, such as Thyroid transcription factor 1 (TTF-1) for primary pulmonary adenocarcinoma, to determine the original site of the primary tumour. Immunohistochemical staining of pleural effusion cell blocks significantly refines the diagnosis of serous pleural effusions, especially in cases where the preliminary diagnosis was atypical cells of undetermined significance or potentially malignant cells. Furthermore, in the cases of malignancy, the origin of the primary tumour could most often be determined.

Nadir and Finical-Minimally Invasive Adenocarcinoma Lung

Minimally invasive adenocarcinoma emerges as a miniature, solitary, localized, primary pulmonary adenocarcinoma ≤ 3.0 centimetre magnitude and ≤ 0.5 centimetre zone of stromal invasion or non-invasive (lepidic) pattern of neoplastic evolution. Minimally invasive adenocarcinoma lung is predominantly comprised of non-mucinous component and is confined within peripheral pulmonary parenchyma. Preponderantly asymptomatic, poorly defined areas appear concurrent with lepidic pattern of tumour growth whereas solid foci are concordant with focal tumour invasion. Cogent histopathological subtypes appear as non-mucinous variant, mucinous variant and mixed variant. Stromal invasion configures acinar, papillary, micropapillary, solid, colloid, foetal or invasive mucinous lesions. Neoplastic cells appear immune reactive to CK7, thyroid transcription factor1(TTF-1) or Napsin A and immune non-reactive to p40. Minimally invasive adenocarcinoma lung requires segregation from neoplasms such as invasive pulmonary adenocarcinoma, lepidic predominant pattern, adenocarcinoma in situ or atypical adenomatous hyperplasia lung. The gradually progressive neoplasm demonstrates ‘ground glass’ opacities. Appropriate neoplastic discernment necessitates comprehensive histological assessment of entire surgical resection specimens. Minimally invasive adenocarcinoma lung can be appropriately treated with surgical extermination of the neoplasm followed by extensive monitoring. Neoplasm is devoid of lymphatic invasion, vascular invasion, tumour necrosis or pleural invasion.

Primary Pulmonary Colloid Adenocarcinoma: A Case Report with Literature Review

Pulmonary colloid adenocarcinomas are uncommon tumors individualized as a distinct entity in the histological classification of World Health Organisation of lung tumors characterized by extensive pool of extracellular mucin distending and destroying alveolar walls.

Microwave ablation therapy assisted by artificial pneumothorax and artificial hydrothorax for lung cancer adjacent to the vital organs.

ObjectivesThis study aimed to investigate the technical methods and safety of artificial pneumothorax and artificial hydrothorax in the treatment of lung cancer adjacent to vital organs by CT-guided microwave ablation.Subjects and MethodsThree of the six patients were men and three were women, with a mean age of 66.0 years (range 47–78 years). There patients had primary pulmonary adenocarcinoma, one had lung metastasis from liver cancer, one had lung metastasis from colon cancer, and one had lung metastasis from bladder cancer. There were four patients with a single lesion, one with two lesions, and one with three lesions. The nine lesions had a mean diameter of 1.1 cm (range 0.4–1.9). In three patients, the lung cancer was adjacent to the heart, and in the remaining three, it was close to the superior mediastinum. Six patients were diagnosed with lung cancers or lung metastases and received radical treatment with microwave ablation (MWA) assisted by artificial pneumothorax and artificial hydrothorax in our hospital. Postoperative complications were observed and recorded; follow-up was followed to evaluate the therapeutic effect.ResultsThe artificial pneumothorax and artificial hydrothorax were successfully created in all six patients. A suitable path for ablation needle insertion was also successfully established, and microwave ablation therapy was carried out. 2 patients developed pneumothorax after operation; no serious complications such as operation-related death, hemothorax, air embolism and infection occurred.Moreover, 4–6 weeks later, an enhanced CT re-examination revealed no local recurrence or metastasis, and the rate of complete ablation was 100%.ConclusionsMicrowave ablation, assisted by artificial pneumothorax, artificial hydrothorax, is a safe and effective minimally invasive method for treating lung cancer adjacent to the vital organs, and optimizing the path of the ablation needle and broadening the indications of the ablation therapy