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
- Glandular differentiation (single layer of cuboidal to columnar cells, mucin production, luminal spaces)
- With or without mucin production
- Irregular glands if differentiated
- Papillary or micropapillary pattern
- Irregular nests, cords of atypical cells
- More aggressive if solid or micropapillary pattern
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
- Surgery
- Radiation
- Chemotherapy
- Angiogenesis inhibitor
- Immunotherapy
- Therapy targeted molecular abnormalities
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