Current Concepts in Pulmonary Pathology, An Issue of Surgical Pathology Clinics - E-Book

Sanja Dacic

Description

Pathology of lung cancers is presented, along with targeted therapies current in 2010. Additionally, asbestosis, mesothelioma, and malignant lymphomas are presented with reference to their features, differential diagnoses, and prognosis. Topics include: Bronchioloalveolar carcinoma and minimally invasive adenocarcinoma; Neuroendocrine tumors; Lung carcinoma staging problems; Targeted therapies in lung cancer; Benign and malignant mesothelial proliferations; Asbestos related lung disease; Primary Lymphoproliferative diseases of the lung; Vasculitis; and Small airway disease.

Sujets

• Medical
• Médecine
• Pathology

Informations

• Publié par: Saunders
• Date de parution: 02 août 2010
• Nombre de lectures: 0
• EAN13: 9781455700714
• Langue: English
• Poids de l'ouvrage: 26 Mo

Extrait

Current Concepts in Pulmonary Pathology , Vol. 3, No. 1, March 2010
ISSN: 1875-9181
doi: 10.1016/S1875-9181(10)00037-1

Contributors List
Surgical Pathology Clinics
Current Concepts in Pulmonary Pathology
GUEST EDITOR: Sanja Dacic, MD, PhD,
FISH Laboratory, Department of Pathology-PUH C608, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
CONSULTING EDITOR: John R. Goldblum, MD
ISSN  1875-9181
Volume 3 • Number 1 • March 2010

Current Concepts in Pulmonary Pathology , Vol. 3, No. 1, March 2010
ISSN: 1875-9181
doi: 10.1016/S1875-9181(10)00038-3

Contents
Cover
Contributors List
Forthcoming Issues
Pulmonary Pathology Integral to Clinical Decision Making
Bronchioloalveolar Carcinoma and Minimally Invasive Adenocarcinoma
Pulmonary Neuroendocrine Tumors
Lung Carcinoma Staging Problems
Targeted Therapies in Lung Cancer
Benign and Malignant Mesothelial Proliferation
Asbestos-Related Lung Disease
A Practical Approach to the Evaluation of Lymphoid and Plasma Cell Infiltrates in the Lung
Vasculitis
Small Airways Disease
Hypersensitivity Pneumonitis: Essential Radiologic and Pathologic Findings
Erratum
Index
Current Concepts in Pulmonary Pathology , Vol. 3, No. 1, March 2010
ISSN: 1875-9181
doi: 10.1016/S1875-9181(10)00039-5

Forthcoming Issues
Current Concepts in Pulmonary Pathology , Vol. 3, No. 1, March 2010
ISSN: 1875-9181
doi: 10.1016/j.path.2010.05.011

Pulmonary Pathology Integral to Clinical Decision Making

Sanja Dacic, MD, PhD,
FISH Laboratory, Department of Pathology-PUH C608, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
E-mail address: [e-mail]


Sanja Dacic, MD, PhD, Guest editor
Diseases of the lung and pleura may be challenging for practicing general surgical pathologists. This has became more obvious in recent years as we all witness the transformation of medicine into many highly specialized areas targeting different organ systems and even a single disease.
Lung and pleural pathology falls into a category of a highly specialized area of surgical pathology because of many unique diseases that are not encountered in other organ systems. Pulmonary pathology is more than ever an integral part of clinical decision making and patient management. Clinicopathologic-radiographic correlations are necessary for classification of interstitial lung diseases. Lung cancer is still the most common cancer in the world, and histologic diagnosis is frequently straightforward; however, its treatment is currently undergoing unseen revolutionary changes that place new demands on practicing pathologists who should be aware of advances in molecular diagnostics of lung tumors that play a major role in triaging lung cancer patients for adequate therapies.
The topics selected for “Current Concepts in Pulmonary Pathology” are a reflection of the most common questions and diagnostic dilemmas in pulmonary pathology today. Significance of radiographic correlation in diagnosis of interstitial lung diseases is emphasized in the article, “Hypersensitivity Pneumonitis” and contains comprehensive radiographic and histologic illustrations. Many articles are focused on neoplasia, which is undergoing significant changes in histologic classification, in particular upcoming classification of adenocarcinoma. The article, “Lung Carcinoma Staging Problems” provides the update, as 7th American Joint Committee on Cancer staging manual (AJCC) tumor staging is being implemented into clinical practice this year. Molecular diagnostics of lung tumors constitutes an integral part of any lung adenocarcinoma or nonsquamous cell carcinoma diagnostic work-up. Currently available targeted therapies, diagnostic assays used in clinical laboratories for molecular profiling of lung carcinomas, and morphologic-molecular correlations are discussed in detail. New discoveries continue to change our practice daily and their implementation into clinical practice is much faster than any of us expected.
This publication is intended to provide a quick reference for experienced, practicing pathologists and pathologists-in-training with key gross and microscopic features, differential diagnosis, and prognosis of common entities in lung pathology. Surgical pathology requires visual recognition of variety of patterns, and, therefore, numerous representative illustrations are provided. Key features, differential diagnosis, and the pitfalls inherent in each entity are summarized in boxes; this condensed text should be useful for busy pathologists.
I would like to thank all authors who shared their expertise in pulmonary pathology and provided reviews of the spectrum of neoplastic and non-neoplastic lung diseases that represent the current diagnostic standard in pulmonary pathology.
I would also like to thank the Editor of the Surgical Pathology Clinics series, Joanne Husovski, for her tremendous patience and excellent guidance.
Current Concepts in Pulmonary Pathology , Vol. 3, No. 1, March 2010
ISSN: 1875-9181
doi: 10.1016/j.path.2010.03.006

Bronchioloalveolar Carcinoma and Minimally Invasive Adenocarcinoma

Andre L. Moreira, MD, PhD ,
Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
E-mail address: [e-mail]

Abstract
Abstract
The most recent WHO classification of lung cancer defines bronchioloalveolar carcinoma (BAC) as a noninvasive carcinoma or adenocarcinoma in situ. However, the use of this terminology is not uniform and does not reflect standardized criteria. As a result, the diagnosis of BAC has been used in association with small, solitary, and well-differentiated adenocarcinoma as well as tumors with advanced clinical stage. At present, there is a growing consensus among specialists in thoracic oncology that BAC or adenocarcinoma in situ is a rare tumor, and the term should be restricted to adenocarcinomas that show a pure lepidic pattern of growth. The amount of invasive component present in a tumor with a predominant lepidic growth pattern has also been under intense scrutiny. The concept of minimally invasive adenocarcinoma is developing in order to differentiate a pure BAC from an invasive adenocarcinoma that still carries an excellent prognosis.

Keywords
• Adenocarcinoma • Lung • Bronchioloalveolar carcinoma • Carcinoma in situ

Overview
Not long ago, all pulmonary adenocarcinomas were grouped together with squamous cell carcinoma and classified as non–small cell carcinomas. There was no attempt to differentiate among the histologic subtypes of adenocarcinoma, partially because all non–small cell carcinomas were regarded as having the same prognostic significance and treatment options. This concept has changed dramatically in the last decade.
The observation that pure bronchioloalveolar carcinoma (BAC) had a 5-year survival rate of 100% 1, 2 has revolutionized the field by demonstrating that not all pulmonary adenocarcinomas are the same. This observation has been confirmed by several investigators 3 - 6 and has resulted in the modification of the entire classification of pulmonary adenocarcinoma. 2 The current definition of BAC by the World Health Organization (WHO) classification of lung cancer is that of an adenocarcinoma that grows along preexisting alveolar structures (lepidic growth pattern) without stromal, vascular, or pleural invasion. Therefore, it is defined as a noninvasive adenocarcinoma or adenocarcinoma in situ. 2 There is intense investigation on the subtypes of adenocarcinomas and their histologic prognostic significance. In addition, targeted therapy toward specific mutations in adenocarcinomas subtypes has revolutionized the clinical management of patients with lung cancer.
The WHO recognizes 2 main types of bronchioloalveolar carcinoma, mucinous and nonmucinous. These 2 entities, though sharing the lepidic growth pattern, are very different regarding histologic and molecular features, as well as natural history. 7 This article discusses the diagnostic criteria, differential diagnosis, and diagnostic pitfalls for these entities. In addition, the emerging concept of minimally invasive adenocarcinoma is examined.

Nonmucinous bronchioloalveolar carcinoma


Key Features
Nonmucinous Bronchioloalveolar Carcinoma

Adenocarcinoma that grows along preexisting alveolar structures without parenchymal, vascular, or pleural invasion, therefore BAC is an adenocarcinoma in situ.
Tumor cells can be flat, columnar, or hobnail, and exhibit mild to significant cytologic atypia.
The presence of any invasive component excludes the diagnosis of BAC.
Rare tumor.
Very often described radiographically as ground-glass opacity (GGO).
Excellent prognosis when it presents as a solitary tumor.
Can be multifocal.
The diagnosis should be made only in complete excised tumors.

Gross and Radiographic Features
It is very difficult to identify a pure BAC grossly because of the intrinsic characteristic of growth with preservation of the pulmonary alveolar structures. The tumor does not form a defined nodule but rather a slight discoloration or firmness of the pulmonary parenchyma ( Fig. 1 ). The effect is more tactile than visual. The tumor is more frequently discovered by radiographic examination. Radiologists very often describe the computed tomography (CT) scan appearance of a pure BAC as that of ground-glass opacity (GGO) 8, 9 ; however, there is no consensus among radiologists on a defined radiographic appearance for BAC, mostly because not all pure GGO lesions, when excised, correspond to pure BAC histologically. Studies of radiographic-histologic correlations have showed that pure GGO can have a component of invasive adenocarcinoma admixed with a BAC growth pattern, 10 and invasive adenocarcinomas, such as pure papillary type, can present radiographically as a GGO. In addition, GGO is not a specific diagnosis for ca