Adenocarcinoma of lungs

Adenocarcinoma of lungs 

Updated: 10/15/2020

© Jun Wang, MD, PhD

General features
  • Arising from bronchi, bronchioles and alveolar cells
  • More common in female
  • Most common type of lung cancer in nonsmokers males
Clinical presentations
  • Bronchial obstruction (pneumonitis, atelectasis)
  • Associated paraneoplastic syndrome
Clubbing
Hypertrophic pulmonary osteoarthropathy 
  • Clubbing
  • Spoon-shaped nails
  • Inflammation, swelling and pain in the hand, fingers, knees or ankles
Trousseau syndrome of hypercoagulability
Commonly seen molecular abnormalities
  • p53
  • Amplification: MET, Her2
  • Mutation: EGFR, KRAS, PTEN, LKB
  • Fusion: EML4-ALK
  • KRAS mutation and MET amplification associated with poor prognosis and acquired EGFR inhibitor resistance
Key morphological features
Adenocarcinoma in situ
  • 3 cm or less
  • Pure lepidic pattern (proliferate along the framework of alveolar septae) but no features of invasion
  • Term “bronchioloalveolar carcinoma” no longer used
  • Nearly 100% disease free survival following complete resection
Markers
  • Positive: CK7, TTF1
  • Negative: CK20, p63
Molecular testing
  • EGFR and ALK
  • If EGFR negative: KRAS
  • If ALKnegative: ROS1
Treatment
  • Surgery
  • Radiation
  • Chemotherapy
  • Angiogenesis inhibitor
  • Immunotherapy
  • Therapy targeted molecular abnormalities



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