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Our study is the first to look at STAS as a prognostic parameter in mucinous adenocarcinomas only. Copy link. 2015). (Travis et al. The largest diameter of the tumor was divided into < 2, 2–5, and > 5 cm size categories. The model consists of the following: grade 1, lepidic predominant tumor; grade 2, acinar or papillary predominant tumor, both with no or less than 20% of high-grade patterns; and grade 3, any tumor with 20% or more of high-grade patterns (solid, micropapillary, or complex gland). They are connected to the outside of the body by hollow tubes called airways. The WHO classification currently views invasive mucinous adenocarcinoma as a “variant” and therefore not subject to pattern subclassification. Tumour Biol 37(1):887–96. In the 2015 WHO classification of lung tumors, minimally-invasive adenocarcinoma of the lung is defined as a small solitary adenocarcinoma measuring less than or equal to 3 cm with an invasive component less than or equal to 0.5 cm in greatest dimension. 2011; Travis et al. Acinar Adenocarcinoma of Lung is a histological subtype of pulmonary adenocarcinoma. PubMed  Am J Surg Pathol 28:442–452, Russell PA, Wainer Z, Wright GM, Daniels M, Conron M, Williams RA (2011) Does lung adenocarcinoma subtype predict patient survival? (Rossi et al. focused on “large” islands that were at least “several alveoli” separated from the edge of the tumor. 8600 Rockville Pike 2013) A pure mucinous histologic pattern without non-mucinous elements is associated with lower stage and better prognosis than mixed tumors. J Thorac Oncol, Rossi G, Murer B, Cavazza A, Losi L, Natali P, Marchioni A, Migaldi M, Capitanio G, Brambilla E (2004) Primary mucinous (so-called colloid) carcinomas of the lung: a clinicopathologic and immunohistochemical study with special reference to CDX-2 homeobox gene and MUC2 expression. Lung cancer is the leading cause of cancer-related death in the world, and the prevalence and mortality of lung cancer are still increasing dramatically.1 The survival of lung cancer is still poor, with a 5-year survival rate below 20%.2 Approximately 80% to 85% of lung cancers are non–small cell lung cancers (NSCLCs), and the most common subtype is adenocarcinoma. J Thorac Oncol 10:1243–1260, Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, Ishikawa Y, Wistuba I, Flieder DB, Franklin W, Gazdar A, Hasleton PS, Henderson DW, Kerr KM, Nakatani Y, Petersen I, Roggli V, Thunnissen E, Tsao M (2013) Diagnosis of lung adenocarcinoma in resected specimens: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. (Qu et al. Types of lung adenocarcinoma include lepidic, acinar, micropapillary, papillary, and solid. P30 CA016087/CA/NCI NIH HHS/United States. 2013), however, a recent study has shown that there is no survival difference if adjusted for stage. Papillary adenocarcinoma of the lung is a more advanced adenocarcinoma than bronchioloalveolar carcinoma that is composed of two distinct histological subtypes. Epub 2015 Oct 17. All tumors were treated and diagnosed in a single institution and were discussed in multi-disciplinary conference, with radiological and clinical evaluation and assumption of a lung primary tumor. Surgical and Experimental Pathology Tumor size ranged from 0.6 to 8.2 cm. We found no correlation with distant recurrence. 561. post-template-default,single,single-post,postid-561,single-format-standard,qode-quick-links-1.0,ajax_fade,page_not_loaded,,qode_grid_1300,footer_responsive_adv,qode-content-sidebar-responsive,qode-child-theme-ver-1.0.0,qode-theme-ver-12.0.1,qode-theme-bridge,wpb-js-composer js-comp-ver-5.4.2,vc_responsive. Mäkinen JM, Laitakari K, Johnson S, Mäkitaro R, Bloigu R, Lappi-Blanco E, Kaarteenaho R. Lung Cancer. Cribriform and signet ring cell patterns correlated with colloid areas (p = 0.002 and p = 0.003, respectively). Please enable it to take advantage of the complete set of features! Share. The nests are floating inside airspaces and are distinguished from lepidic implants. There was a significant association between distant metastasis and solid invasive growth (Fig. A cohort of 284 stage I pulmonary adenocarcinomas was used as a training set to identify histologic features associated with patient outcomes (recurrence-free survival [RFS] and overall survival [OS]). 2015) In fact, these entities were not represented in the current study despite several cases showing entirely lepidic architecture, either because of size criterion (> 3 cm) or presence of STAS. showed a significantly increased 5-year recurrence-free survival for patients without STAS (“tumor islands”), in a series also of predominantly non-mucinous tumors. Epub 2012 Mar 5. Careers. Article  Pulmonary adenocarcinomas resected from 2003 to 2014 were retrospectively reclassified as non-mucinous invasive adenocarcinoma, colloid carcinoma, mucinous adenocarcinoma-in-situ, minimally invasive mucinous adenocarcinoma, or invasive mucinous adenocarcinoma (WHO 2015 reference). Reactivity to TTF-1 immunohistochemical stain was classified as absent (0), limited to scattered cells with no areas of > 10 contiguous cells staining (1), and areas of diffuse staining > 10 cells contiguously). The growth patterns of mucinous adenocarcinomas should be reported similar to reporting of non-mucinous adenocarcinomas. who studied a series of mucinous and nonmucinous lepidic predominant tumors, the percentage of the invasive component was significant, and showed an inverse correlation with time to distant metastasis. In 16 cases the predominant mucin-producing cell was cuboidal type; in 14 cases, columnar cells predominated. a. Columnar cells with cytoplasmic clearing. Carcinoma of the pancreas exhibiting exocrine differentiation and lacking significant (<25%) ductal or endocrine differentiation not applicable. Info. Lung adenocarcinoma is primarily categorized on the basis of histopathologic evaluation, although testing for genetic mutations (e.g. 2004) Although historically the term “colloid” has been used interchangeably with “mucinous”, the most recent WHO classification considers colloid carcinomas as a separate variant of adenocarcinoma, specifically defined by inconspicuous lepidic growth and airspaces distended with mucus containing tumor nests. We retrospectively studied time to lung recurrence and time to distant metastasis in 30 mucinous lung tumors, in relationship to histologic parameters, including spread through alveolar spaces, tumor size, invasive size, % invasive size, growth pattern (solid or cribriform, acinar, papillary, micropapillary, and lepidic), type of mucin-producing cell, and TTF-1 positivity. J Thorac Oncol 10:1444–1450, Zhao RY, Zhang J, Zhu L, Shao JC, Zhang Q, Teng HH, Qin G, Zhao LX, Ye M, Zhao JK, Ding WJ (2016) Expression of ALK protein in 7 371 pulmonary adenocarcinoma samples, with analysis of clinicopathologic features. Previous published reports have shown STAS to be an indicator of poor prognosis. 2013). 3). Patterns of tumor growth. COVID-19 is an emerging, rapidly evolving situation. 2011 Sep;8(5):381-5. doi: 10.1513/pats.201107-042ST. Some partners do not ask for your consent to process your data, instead, they rely on their legitimate business interest. 2014; Qu et al. Cancers (Basel). Tumors were also classified similarly to non-mucinous adenocarcinomas into lepidic (in situ), acinar, papillary, micropapillary and solid types (Fig. Mucinous adenocarcinomas have a variety of histologic patterns, and may coexist with non-mucinous areas in combined tumors. California Privacy Statement, Although tumors with a predominant solid growth pattern of mucin-producing cells are now classified as non-mucinous poorly differentiated adenocarcinoma, tumors with a solid component comprising < 50% of the overall tumor architecture were included provided > 50% of the tumor growth consisted of acinar or lepidic growth of mucin-producing (intracytoplasmic) mucin. Electronic medical records were utilized to track overall survival, disease specific survival, subsequent lymph node metastases, distant metastases, and tumor recurrence (defined as any subsequent tumor involvement outside of the initial lobe). 2004) Our study found a great deal of morphologic overlap between invasive mucinous adenocarcinomas and colloid carcinomas, therefore we included two cases of pure colloid carcinoma in this study. Virchows Arch 467:675–686, CAS  There was a positive correlation between the proportion of micropapillary features and STAS (P = .05) and the degree of cribriform growth and STAS (p = 0.03). Copyright © 2020 International Association for the Study of Lung Cancer. Privacy, Help Terms and Conditions, Of these, 14 (47% of all tumors) showed STAS limited to within 0,5 mm of the border of the tumor (27% of all tumors, grade 1) and the remainder showed STAS present beyond this distance (> 0.5 mm) (Fig. Cite this article. The presence of signet ring cells as a type of solid growth was also noted. The current study demonstrates that STAS is a frequent finding in mucinous adenocarcinomas of the lung, rendering the newly created categories of “mucinous adenocarcinoma in situ” and “minimally invasive adenocarcinoma” very rare. Similar to published reports, we found STAS to be associated with poorer prognosis, but only in the sense of local recurrence. Interobserver reproducibility revealed good agreement (k = 0.617). 2015; Masai et al. 2009), and higher rates of recurrence (Onozato et al. Adenocarcinoma in situ, either serous or mucinous . Definition / general | Case reports | Treatment | Microscopic (histologic) description. FOIA Keywords: describe the spreading of tissue fragments and individual cells through a knife surface as one of the possible artifacts in lung specimens. Watch later. a, lepidic; b, acinar; c, papillary and acinar; d, focally solid. b. PAS (with diastase pretreatment) demonstrates diffuse cytoplasmic staining with basal nuclei. The relative prevalence of the neoplasm in the various salivary gland reflects the abundance of acinic cells: parotid gland (~80%) > minor salivary glands (~17%) > submandibular glands (~3%). 2016) Although it is well known that the tumor cells may resemble either goblet cells or cuboidal cells, in the current study the latter showed some intra-cytoplasmic mucin, at the very least along the brush border; these cuboidal cells were more likely to express TTF-1. spreading of tissue fragments and individual cells through a knife surface. Histopathology Lung-- Adenocarcinoma. 2004) Geles et al. Adenocarcinoma is the non-smoker tumour - SCLC and squamous are more strongly associated with smoking. Mucinous adenocarcinomas of the lung account for approximately 10–15% of lung adenocarcinomas and have been reported to portend a poorer prognosis than non-mucinous adenocarcinoma (Cai et al. Histopathology 68:356–366, Article  Some glands appear as solid clusters of tumor cells and lack a recognizable lumen. Mucinous adenocarcinoma is often considered a relatively poor prognostic group among adenocarcinomas of the lung and has a high rate of pulmonary recurrence. The medical term “acinar adenocarcinoma” is derived from both Latin and Greek languages: the word “acinar” originates from a Latin word acinus that means “berry,” while “adenocarcinoma” is a combination of the words adeno and carcinoma, both of which mean “gland” and “cancer,” respectively. Pathology and Genetics of Tumors of the lung, Pleura, Thymus and heart. The histopathology of lung cancer appears to be changing: The incidence of squamous cell carcinoma in the United States is declining, accompanied by the increase in the incidence of adenocarcinoma. The definition of STATS, while accepted in the current WHO Classification, is not consensual. The International Association for the Study of Lung cancer … Mucinous adenocarcinoma is often considered a relatively poor prognostic group among adenocarcinomas of the lung and has a high rate of pulmonary recurrence. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society: international multidisciplinary classification of lung adenocarcinoma: executive summary. A grading system for pulmonary adenocarcinoma has not been established. Mucinous adenocarcinomas are generally recognized to show a low rate of reactivity for TTF1, as goblet cells are negative for TTF-1 in contrast to pneumocytes and Clara cells. Fabio Tavora. Columnar / goblet cell type was inversely correlated with TTF-1 expression (p = 0.01). Privacy The authors declare that they have no competing interests. 2013; Kamata et al. This proposal has not yet been tested in clinical datasets to determine whether it defines prognostically significant subgroups of lung adenocarcinoma. The largest invasive component was divided in < 1, 1–2, and > 2 cm size categories. Am J Surg Pathol 37:1100–1108, Zhang Y, Wang R, Li Y, Pan Y, Hu H, Zhang Y, Li H, Shen L, Yu Y, Sun Y, Chen H (2015) Negative thyroid transcription factor 1 expression defines an unfavorable subgroup of lung adenocarcinomas. Adenocarcinoma; Lung; Model; Prognosis; Tumor grading. The International Association for the Study of Lung Cancer pathology panel evaluated a set of histologic criteria associated with prognosis aimed at establishing a grading system for invasive pulmonary adenocarcinoma. https://doi.org/10.1007/s13277-015-3869-1. Censors were set for two times points with statistics run independently: time to distant recurrence; and time to lung recurrence. The growth patterns of mucinous adenocarcinomas should be reported like reporting of non-mucinous adenocarcinomas. Qu et al. Predictive value of the international association for the study of lung cancer/American Thoracic Society/European Respiratory Society classification of lung adenocarcinoma in tumor recurrence and patient survival. Conclusions: Manage cookies/Do not sell my data we use in the preference centre. 2015) Jessurun et al. Tumor size included the entire lesion, invasive and non-invasive were recorded used a conventional ocular micrometer. {Diaz, 1999 #45}. (Onozato et al. 2015) It has been appreciated that “mucinous adenocarcinomas” can show predominantly extracellular mucin, as opposed to both intra- and extracellular mucin, and that these so-called “mucus out of cell” tumors are less likely to harbor KRAS mutations. The novel histologic International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification system of lung adenocarcinoma is a stage-independent predictor of survival. Acinar adenocarcinoma is a histological subtype of gland-forming cancer that is diagnosed when cuboidal and/or columnar shaped malignant cells in the neoplastic tissue form acini and tubules. Tumors classified as “colloid carcinoma”, now considered a variant of invasive adenocarcinoma, were included in the study due to significant histologic overlap with “mucinous adenocarcinoma”. It is unclear how variations in architectural patterns typically described for non-mucinous adenocarcinomas affect the prognosis of mucinous adenocarcinomas. 4). 2015) Onozato et al. volume 1, Article number: 3 (2018) Pathologic parameters predicting poor outcome have not been extensively studied, including the presence of spread through alveolar spaces (STAS). Clipboard, Search History, and several other advanced features are temporarily unavailable. 3Department of Pathology, Hachioji Medical Center of Tokyo Medical University, Japan Abstract Background and objective: The 4th edition of the WHO Classification of Tumors of the Lung, Pleura, Thymus and Heart states that adenocarcinomas should be classified according to the predominant pattern. (Strand et al. Diagn Pathol 10:94, Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JH, Beasley MB, Chirieac LR, Dacic S, Duhig E, Flieder DB, Geisinger K, Hirsch FR, Ishikawa Y, Kerr KM, Noguchi M, Pelosi G, Powell CA, Tsao MS, Wistuba I, Panel WHO (2015) The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. PathologyOutlines.com website. adenocarcinoma lung pathology outlines. slide 34 of 128: Tweets by @WebPathology . (Kamata et al. (Geles et al. Although considered to be more common in mucinous adenocarcinomas than in non-mucinous tumors, the frequency and significance of its presence specifically in the mucinous subset has not been investigated. Prevention and treatment information (HHS). 2014 Aug 1;32(22):2357-64. doi: 10.1200/JCO.2013.50.1049. Invasive adenocarcinoma of lung, acinar type. We and our partners process personal data such as IP Address, Unique ID, browsing data for: Use precise geolocation data | Actively scan device characteristics for identification.. Cite this page: Pernick N. Acinar (pending). Weng CF, Huang CJ, Huang SH, Wu MH, Tseng AH, Sung YC, Lee HH, Ling TY. Acinar-predominant adenocarcinoma of the lung is a histological subtype of non-mucinous invasive adenocarcinoma of the lung. Pulmonary mucinous adenocarcinomas: a clinicopathologic series with emphasis on the prognostic significance of spread through alveolar spaces, and presence of solid growth component. Air travels from our mouth and nose down the airways into the lungs. (Fig. (Rossi et al. In keeping with findings by Strand et al. Mucinous adenocarcinomas of the lung are similar to non-mucinous prognostically, in that STAS and solid growth are poor prognosticators, for local and distant recurrence, respectively. statement and As no standardized definition for mucinous adenocarcinoma of the lung has been established, “mucinous” was defined in this study as a mucin-producing adenocarcinoma (presence of airspace mucin pools) with intracellular mucin in at least 50% of the tumor cells. There was no correlation between STAS and other histopathologic parameters. However, variations and mixed patterns are frequent in adenocarcinoma, and a strong correlation between mucinous and nonmucinous cells and TTF1 staining patterns has not been established in mucinous adenocarcinomas. 2006; Wu et al. Introduction: This site needs JavaScript to work properly. 2015 Dec;90(3):568-74. doi: 10.1016/j.lungcan.2015.10.014. (Tsuta et al. Tumors were classified as either showing predominantly cuboidal mucin-producing cells with eosinophilic cytoplasm, with no or a minor component of interspersed goblet cells and sometimes showing a fine brush border, or alternately showing a predominance of columnar mucin-producing cells with clear cytoplasm (goblet cells). FT and AB participated in the design of the study and performed the statistical analysis. In contrast to areas of lepidic growth where the elastic framework of the lung is intact, acinar adenocarcinoma has stromal invasion, as evidenced by disruption of the elastic framework with bundles of broken elastic fibers seen on VVG stains accompanied by desmoplastic tumor stroma 10 … Google Scholar, Geles A, Gruber-Moesenbacher U, Quehenberger F, Manzl C, Al Effah M, Grygar E, Juettner-Smolle F, Popper HH (2015) Pulmonary mucinous adenocarcinomas: architectural patterns in correlation with genetic changes, prognosis and survival. Recently, STAS has been included as a type of invasion in the 2015 WHO classification of lung tumors. 2012) are important parameters in the mucinous subset as well. ≤ 3 cm, with ≤ 5 mm area of stromal invasion or growth pattern(s) other than lepidic: Minimally Invasive Adenocarcinoma (MIA) 3. Pathology international , 55 (10), 619-625. Time-adjusted Kaplan Meier curves relating STAS to local recurrence (top) and proportion of solid growth to distant recurrence (bottom). STAS of any type was present in 22 (73%) of cases. 2. There was no significant association between any pathologic variable and death outcome. University of Maryland Medical Center, 22 S. Greene St., Baltimore, MD, 21201, USA, Messejana Heart and Lung Hospital, Rua Frei Cirilo, 3460, Fortaleza, CE, 60160150, Brazil, You can also search for this author in Lung Cancer 80:230–233, Wu J, Chu PG, Jiang Z, Lau SK (2013) Napsin A expression in primary mucin-producing adenocarcinomas of the lung: an immunohistochemical study. https://doi.org/10.1186/s42047-018-0013-8, DOI: https://doi.org/10.1186/s42047-018-0013-8. Metastasis was determined by imaging in 5 patients, biopsy in 1 patient, and cerebrospinal fluid cytology in one patient. PubMed Central  2a-d ). Another variant of adenocarcinoma is “colloid” carcinoma, which is associated with a high rate of STAS and not infrequent expression of enteric antigens such as CDX-2. (Rossi et al. Am J Surg Pathol 37:287–294. For columnar cell predominant cases 2/14 (14%) cases showed focal TTF 1 reactivity; in none of these tumors was TTF1 diffusely positive. Lung adenocarcinoma is the most common brain metastasis. Cai D, Li H, Wang R, Li Y, Pan Y, Hu H, Zhang Y, Gong R, Pan B, Sun Y, Chen H (2014) Comparison of clinical features, molecular alterations, and prognosis in morphological subgroups of lung invasive mucinous adenocarcinoma. It is defined by the presence of “abundant” intracytoplasmic mucin and has a predilection for multicentricity, large areas of in-situ growth, and by KRAS(Kirsten rat sarcoma viral oncogene) mutations. Compared to nonmucinous adenocarcinomas, mucinous carcinomas have a high rate of local recurrence in the lungs. Distinguishing hepatoid adenocarcinoma of lung from hepatocellular carcinoma metastatic to lu … Care was made to distinguish pre-existing pneumocytes in areas of lepidic growth. Receiver operating characteristic curve analysis was used to select the best model, which was validated (n = 212) and tested (n = 300, including stage I-III) in independent cohorts. Histopathology Lung-- Adenocarcinoma - YouTube. Reproducibility of the model was assessed using kappa statistics. Tumors with acinar predominant histologic pattern are classified as grade 2 tumors 2012 May 1;30(13):1438-46. doi: 10.1200/JCO.2011.37.2185. Zhonghua Bing Li Xue Za Zhi 45:601–605, CAS  Warth A, Muley T, Meister M, Stenzinger A, Thomas M, Schirmacher P, Schnabel PA, Budczies J, Hoffmann H, Weichert W. J Clin Oncol. Clusters within 0.5 mm of the tumor edge was graded as type 1 STAS, whereas clusters beyond 0.5 mm of the tumor edge and present in ≥2 low magnification (2.5 mm diameter) fields were designated as grade 2. 2016; Watanabe et al. Part of Acinar Adenocarcinoma Acinar adenocarcinoma is a common type of adenocarcinoma with tumor cells ar-ranged in classic glandular structure on a fibroelastic stroma. Solid growth in the tumor was significantly associated with distant metastases, suggesting that architectural patterns- particularly micropapillary patterns and solid growth- that are known to portend poorer prognoses in non-mucinous adenocarcinomas (Warth et al. No external funding was used. The subtype is denoted based on the predominant histologic pattern observed. Correspondence to Pathologic parameters predicting poor outcome have not been extensively studied, including the presence of spread through alveolar spaces (STAS). (Righi et al. The tumor is diagnosed under a microscope, on examination of the cancer cells by a pathologist. Proc Am Thorac Soc. 2013 Spring;25(1):14-21. doi: 10.1053/j.semtcvs.2013.01.003. Google Scholar. PubMed Google Scholar. 5). Onco Targets Ther 7:2127–2132, PubMed  Arch Pathol Lab Med 137:685–705, Tsuta K, Ishii G, Nitadori J, Murata Y, Kodama T, Nagai K, Ochiai A (2006) Comparison of the immunophenotypes of signet-ring cell carcinoma, solid adenocarcinoma with mucin production, and mucinous bronchioloalveolar carcinoma of the lung characterized by the presence of cytoplasmic mucin. J Clin Oncol. The impact of the 2015 classification on prognosis was reviewed by a PubMed search … 2016) However, the relationship of histologic pattern of mucinous adenocarcinoma and outcome has not been studied in detail. There was no significant correlation between mucin type and growth pattern or presence of STAS. Median follow-up was 40 months. There was no association between other pathologic parameters and distant metastasis (p > 0.1). Cookies policy. Tumor spread through alveolar spaces (“STAS”, alternately “aerogenous metastases” or “small cluster invasion”) has been linked to poorer clinical outcomes, including higher rates of lymphatic involvement and lymph node metastases (Kawakami et al.

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