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Presented by George Netto, M.D. and prepared by Carla Ellis, M.D.
Case 1: A 45 year old male presented with shortness of breath and chronic cough.
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1. Question
Week 441: Case 1
A 45 year old male presented with shortness of breath and chronic cough. He was found to have a 5 cm central pulmonary mass on chest CT scan. A right upper lobectomy was performed.images/1Alex/07042010case1image1.jpg
images/1Alex/07042010case1image2.jpgCorrect
Answer: Large cell undifferentiated pulmonary carcinoma, basaloid type
Histology: This tumor displays features of basaloid carcinoma with a nesting pattern of growth, indistinct cell boundaries, abrupt keratinization, and central comedonecrosis
Discussion: Pulmonary carcinoma with a basaloid pattern (LBC) are classified either as basaloid variant of squamous cell carcinoma (SCC) or as variant of large cell carcinoma (LCC) based on the presence of a squamous component.
Basaloid pattern confers a poor prognosis in non-small cell lung carcinoma, especially in stage I-II patients. In a recent large European series, 90 LBC’s, including 46 basaloid variants of LCC and 44 basaloid variants of SCC, were compared with 1,328 other non-small cell lung carcinoma (NSCLC) with regard to clinical features and survival.
The survival of basaloid variants of LCC and SCC was comparable. Median and overall survival were significantly lower for LBC than for NSCLC in stage I-II patients, with a median survival of 29 and 49 months, respectively, and 5-yr survival rates of 27 and 44% for LBC and NSCLC. Similarly, disease-specific survival was shorter in LBC.
Currently, the use of immunohistochemical markers, such as TTF-1, CK7, CK19, p63, 34betaE12 and thrombomodulin can help in accurately classifying pulmonary tumors with non small cell morphology by further teasing out cases of poorly differentiated SCCs, adenosquamous carcinoma and adenocarcinomas.
In a study by Pardo et al., 27 of 82 initially diagnosed pulmonary LCC (32.9%) were re-classified as adenocarcinomas, because they coexpressed TTF-1, CK7, and CK19, and were negative for p63. 31 (37.8%) of 82 LCC were reclassified as poorly differentiated SCC, based on their immunoreactivity with 34betaE12, p63, thrombomodulin, and CD44v6. 16 (19.5%) of 82 classic LCC correspond to undifferentiated adenosquamous carcinomas, since they displayed conflicting immunostaining for markers of both SCC and adenocarcinomas.
Reference(s):
– Appl Immunohistochem Mol Morphol. 2009 Oct;17(5):383-92.
Large cell carcinoma of the lung: an endangered species?
Pardo J, Martinez-Peñuela AM, Sola JJ, Panizo A, Gúrpide A, Martinez-Peñuela JM, Lozano MD.
– Eur Respir J. 2008 Apr;31(4):854-9. Epub 2007 Dec 19.
Lung carcinomas with a basaloid pattern: a study of 90 cases focusing on their poor prognosis. Moro-Sibilot D, Lantuejoul S, Diab S, Moulai N, Aubert A, Timsit JF, Brambilla C, Brichon PY, BrambillaIncorrect
Answer: Large cell undifferentiated pulmonary carcinoma, basaloid type
Histology: This tumor displays features of basaloid carcinoma with a nesting pattern of growth, indistinct cell boundaries, abrupt keratinization, and central comedonecrosis
Discussion: Pulmonary carcinoma with a basaloid pattern (LBC) are classified either as basaloid variant of squamous cell carcinoma (SCC) or as variant of large cell carcinoma (LCC) based on the presence of a squamous component.
Basaloid pattern confers a poor prognosis in non-small cell lung carcinoma, especially in stage I-II patients. In a recent large European series, 90 LBC’s, including 46 basaloid variants of LCC and 44 basaloid variants of SCC, were compared with 1,328 other non-small cell lung carcinoma (NSCLC) with regard to clinical features and survival.
The survival of basaloid variants of LCC and SCC was comparable. Median and overall survival were significantly lower for LBC than for NSCLC in stage I-II patients, with a median survival of 29 and 49 months, respectively, and 5-yr survival rates of 27 and 44% for LBC and NSCLC. Similarly, disease-specific survival was shorter in LBC.
Currently, the use of immunohistochemical markers, such as TTF-1, CK7, CK19, p63, 34betaE12 and thrombomodulin can help in accurately classifying pulmonary tumors with non small cell morphology by further teasing out cases of poorly differentiated SCCs, adenosquamous carcinoma and adenocarcinomas.
In a study by Pardo et al., 27 of 82 initially diagnosed pulmonary LCC (32.9%) were re-classified as adenocarcinomas, because they coexpressed TTF-1, CK7, and CK19, and were negative for p63. 31 (37.8%) of 82 LCC were reclassified as poorly differentiated SCC, based on their immunoreactivity with 34betaE12, p63, thrombomodulin, and CD44v6. 16 (19.5%) of 82 classic LCC correspond to undifferentiated adenosquamous carcinomas, since they displayed conflicting immunostaining for markers of both SCC and adenocarcinomas.
Reference(s):
– Appl Immunohistochem Mol Morphol. 2009 Oct;17(5):383-92.
Large cell carcinoma of the lung: an endangered species?
Pardo J, Martinez-Peñuela AM, Sola JJ, Panizo A, Gúrpide A, Martinez-Peñuela JM, Lozano MD.
– Eur Respir J. 2008 Apr;31(4):854-9. Epub 2007 Dec 19.
Lung carcinomas with a basaloid pattern: a study of 90 cases focusing on their poor prognosis. Moro-Sibilot D, Lantuejoul S, Diab S, Moulai N, Aubert A, Timsit JF, Brambilla C, Brichon PY, Brambilla
