Pathology of lung malignancies
- Henry D Tazelaar, MD
Henry D Tazelaar, MD
- Mayo Clinic Arizona
- Professor of Pathology
- Mayo Clinic College of Medicine
- Chair of the Department of Laboratory Medicine and Pathology
- Mayo Clinic Arizona
- Section Editors
- Andrew Nicholson, MD
Andrew Nicholson, MD
- Section Editor — Pulmonary Pathology
- Professor of Respiratory Pathology
- Imperial College School of Medicine, London
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
Lung cancer is the most common cancer worldwide, with about 1.8 million new cases and 1.6 million deaths in 2012 . (See "Overview of the risk factors, pathology, and clinical manifestations of lung cancer".)
The pathologic features of the major lung malignancies will be reviewed here. Clinical features, diagnosis, and management of patients with the different lung malignancies are discussed in the appropriate topic reviews. (See "Overview of the risk factors, pathology, and clinical manifestations of lung cancer" and "Overview of the initial evaluation, treatment and prognosis of lung cancer".)
Classification of lung carcinomas by histopathologic subtype provides important information about prognosis and is necessary for optimal treatment. (See "Overview of the treatment of advanced non-small cell lung cancer".)
Rationale for 2015 WHO classification — The 2015 World Health Organization (WHO) classification of lung tumors should be the foundation for lung cancer classification (table 1) [1,2]. In contrast to previous classification systems, the 2015 WHO classification relies to a greater extent on immunohistochemical characterization in addition to light microscopy, allowing for subtyping that more judiciously guides treatment strategy and predicts clinical course. In addition, it provides standardized criteria and terminology for lung cancer diagnosis on small biopsies and cytology, which is critical, given that the majority of patients with lung cancer present with high-stage disease and are not surgical candidates. Finally, it provides guidance for doing molecular testing on many carcinoma types, particularly adenocarcinomas, recognizing the therapeutic importance of targetable genetic alterations. (See "Personalized, genotype-directed therapy for advanced non-small cell lung cancer".)
Changes from the 2004 WHO classification for adenocarcinomas and biopsies are based on the 2011 multidisciplinary expert panel recommendations, representing the International Association for the Study of Lung Cancer (IASLC), the American Thoracic Society (ATS), and the European Respiratory Society (ERS) [3,4]. The rationale for the changes introduced by the 2015 WHO classification is based upon several observations:
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- CLASSIFICATION SCHEMES
- Rationale for 2015 WHO classification
- Comparison of the 2015 and 2004 WHO classification of adenocarcinoma
- ADENOSQUAMOUS CARCINOMA
- SQUAMOUS CELL CARCINOMA
- LARGE CELL CARCINOMA
- SARCOMATOID CARCINOMA
- Pleomorphic carcinoma
- Spindle cell carcinoma
- Giant cell carcinoma
- Pulmonary blastoma
- NEUROENDOCRINE TUMORS
- Small cell carcinoma
- Large cell neuroendocrine carcinoma
- Carcinoid tumors
- - Typical carcinoid tumors
- - Atypical carcinoid tumors
- DIFFERENTIAL DIAGNOSIS