Small cell carcinoma of lungs

Small cell carcinoma of lungs 

Updated: 10/15/2020

© Jun Wang, MD, PhD

General features
  • Also called oat cell carcinoma
  • Poorly differentiated neuroendocrine tumor
  • Derived from primitive cells of basal bronchial epithelium
  • More common in men, median age 60
  • Strong association with tobacco smoking
  • Most common lung cancer associated with uranium mining, probably associated with radon
  • Smoking cessation associated with improved survival
Key clinical features
  • Nonspecific presentations similar to other lung cancer: cough, dyspnea, etc
  • Associated paraneoplastic syndromes due to production of ACTH, ADH, calcitonin, etc
  • Lambert-Eaton myasthenic syndrome
Presynaptic disorder of neuromuscular transmission
Autoimmune process against voltage-gated calcium channels (VGCCs)
Occasionally antibodies against acetylcholine receptor, but usually low titers (High titer seen in myasthenia gravis)
Impaired release of acetylcholine
Presentations: Proximal muscle weakness, depressed tendon reflexes, posttetanic potentiation, and autonomic changes
  • Acanthosis nigricans: Brown, velvety and verrucous plaques in axillae, back of neck and other skin folds, associated with visceral malignancies, endocrine diseases and congenital disorders
  • Leukemoidreactions: Reactive leukocytosis due to tumor produced bioactive factors
  • Trousseau syndrome: Acquired blood clotting disorder that results in migratory thrombophlebitis, commonly associated with internal malignancy, probably due to cancer caused imbalance of coagulative system
  • Hypertrophic pulmonary osteoarthropathy: Syndrome of clubbing of the digits, periostitis of the long (tubular) bones, and arthritis, probably associated with tumor released cytokine, growth factor, etc
Key morphological features
Markers
  • Positive: Cytokeratin, TTF1
  • Positive for neuroendocrine markers: CD56, neuron specific enolase, chromogranin, synaptophysin
  • Negative: CD45 and other lymphocytic markers
Treatment
  • Chemotherapy
  • Radiation therapy
Indicators for poor prognosis
  • Elevated serum LDH/alkaline phosphatase
  • Relapsed disease
  • Weight loss of greater than 10% of baseline body weight
  • Poor performance status
  • Hyponatremia



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