Document Detail

High-grade lung adenocarcinoma with fetal lung-like morphology: clinicopathologic, immunohistochemical, and molecular analyses of 17 cases.
MedLine Citation:
PMID:  23629442     Owner:  NLM     Status:  MEDLINE    
Low-grade lung adenocarcinoma of fetal lung type, which is well characterized by its unique clinicopathologic and molecular features, is recognized as a distinct variant of lung cancer. In contrast, high-grade lung adenocarcinoma with fetal lung-like morphology (HG-LAFM) has not been studied widely. To characterize this subset better, we analyzed 17 high-grade adenocarcinomas with at least focal component resembling a developing epithelium in the pseudoglandular phase of the fetal lung. These rare (ca. 0.4%) carcinomas occurred predominantly in elderly men with a heavy smoking history, who showed elevated serum α-fetoprotein in 4 of 5 cases tested. Histologic examination revealed a fetal lung-like component as a focal finding accounting for 5% to 60% of the total tumor volume. It was invariably admixed with tissues having a morphology not resembling that of a fetal lung. A coexisting non-fetal lung-like element was quite heterogenous in appearance, showing various growth patterns. However, clear-cell (88%), hepatoid (29%), and large cell neuroendocrine carcinoma (24%) histology seemed overrepresented. HG-LAFM was characterized immunohistochemically by frequent expression of α-fetoprotein (41%), glypican-3 (88%), SALL-4 (59%), neuroendocrine markers (82%), CDX-2 (35%), and p53 (65%). HG-LAFM was molecularly heterogenous in that EGFR or KRAS mutation was observed in 22% of cases tested for both. Our data indicate that HG-LAFMs might form a coherent subgroup of lung adenocarcinomas. However, the uniformly focal nature of the fetal lung-like element, widely diverse coexisting non-fetal lung-like histology, and inhomogenous molecular profiles lead us to believe that HG-LAFM is best regarded as a morphologic pattern showing characteristic association with several clinicopathologic parameters rather than a specific tumor entity.
Shigeki Morita; Akihiko Yoshida; Akiteru Goto; Satoshi Ota; Koji Tsuta; Karin Yokozawa; Hisao Asamura; Jun Nakajima; Daiya Takai; Masaya Mori; Teruaki Oka; Junichi Tamaru; Shinji Itoyama; Koh Furuta; Masashi Fukayama; Hitoshi Tsuda
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of surgical pathology     Volume:  37     ISSN:  1532-0979     ISO Abbreviation:  Am. J. Surg. Pathol.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-13     Completed Date:  2013-07-18     Revised Date:  2014-01-29    
Medline Journal Info:
Nlm Unique ID:  7707904     Medline TA:  Am J Surg Pathol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  924-32     Citation Subset:  IM    
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MeSH Terms
Adenocarcinoma / genetics*,  mortality,  pathology*
DNA Mutational Analysis
Genes, erbB-1
Kaplan-Meier Estimate
Lung Neoplasms / genetics*,  mortality,  pathology*
Middle Aged
Neoplasm Staging
Polymerase Chain Reaction
Proto-Oncogene Proteins / genetics
Tumor Markers, Biological / analysis
alpha-Fetoproteins / analysis
ras Proteins / genetics
Reg. No./Substance:
0/KRAS protein, human; 0/Proto-Oncogene Proteins; 0/Tumor Markers, Biological; 0/alpha-Fetoproteins; EC Proteins
Comment In:
Histopathology. 2014 Jan;64(2):309-11   [PMID:  24117842 ]

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