pulmonary tumors

Types

 epithelial pulmonary tumors
 mesenchymal pulmonary tumors / conjunctive pulmonary tumors

Archive : 2004 WHO histological classification of tumours of the lung

A. Malignant epithelial tumours

 pulmonary squamous cell carcinoma 8070/3

• Papillary 8052/3
• Clear cell 8084/3
• Small cell 8073/3
• Basaloid 8083/3

 pulmonary small cell carcinoma 8041/3

• Combined small cell carcinoma 8045/3

 pulmonary adenocarcinoma 8140/3

• Adenocarcinoma, mixed subtype 8255/3
• Acinar adenocarcinoma 8550/3
• Papillary adenocarcinoma 8260/3
• Bronchioloalveolar carcinoma 8250/3
  • Nonmucinous 8252/3
  • Mucinous 8253/3
  • Mixed nonmucinous and mucinous or indeterminate 8254/3

• Solid adenocarcinoma with mucin production 8230/3
  • Fetal adenocarcinoma 8333/3
  • Mucinous (“colloid”) carcinoma 8480/3
  • Mucinous cystadenocarcinoma 8470/3
  • Signet ring adenocarcinoma 8490/3
  • Clear cell adenocarcinoma 8310/3

 pulmonary Large cell carcinoma 8012/3

• Large cell neuroendocrine carcinoma 8013/3
  • Combined large cell neuroendocrine carcinoma 8013/3
• Basaloid carcinoma 8123/3
• Lymphoepithelioma-like carcinoma 8082/3
• Clear cell carcinoma 8310/3
• Large cell carcinoma with rhabdoid phenotype 8014/3

 pulmonary Adenosquamous carcinoma 8560/3
 pulmonary Sarcomatoid carcinoma 8033/3

• Pleomorphic carcinoma 8022/3
• Spindle cell carcinoma 8032/3
• Giant cell carcinoma 8031/3
• Carcinosarcoma 8980/3
• Pulmonary blastoma 8972/3

 pulmonary Carcinoid tumour 8240/3

• Typical carcinoid 8240/3
• Atypical carcinoid 8249/3

 pulmonary Salivary gland tumours

• pulmonary Mucoepidermoid carcinoma 8430/3
• pulmonary Adenoid cystic carcinoma 8200/3
• Epithelial-myoepithelial carcinoma 8562/3

 Preinvasive lesions

• Squamous carcinoma in situ 8070/2
• Atypical adenomatous hyperplasia
• Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

B. Mesenchymal tumours

 pulmonary Epithelioid haemangioendothelioma 9133/1
 pulmonary Angiosarcoma 9120/3
 pulmonary Pleuropulmonary blastoma 8973/3
 pulmonary Chondroma 9220/0
 Congenial peribronchial myofibroblastic tumour 8827/1
 Diffuse pulmonary lymphangiomatosis
 pulmonary Inflammatory myofibroblastic tumour 8825/1
 pulmonary Lymphangioleiomyomatosis 9174/1
 pulmonary Synovial sarcoma 9040/3

• Monophasic 9041/3
• Biphasic 9043/3

 Pulmonary artery sarcoma 8800/3
 Pulmonary vein sarcoma 8800/3

C. Benign epithelial tumours

 bronchial papillomas

• bronchial squamous cell papilloma 8052/0
  • Exophytic 8052/0
  • Inverted 8053/0

• bronchial Glandular papilloma 8260/0
• bronchial Mixed squamous cell and glandular papilloma 8560/0

 pulmonary Adenomas

• pulmonary Alveolar adenoma 8251/0
• pulmonary Papillary adenoma 8260/0
• pulmonary Adenomas of the salivary gland type
  • pulmonary Mucous gland adenoma 8140/0
  • pulmonary Pleomorphic adenoma 8940/0
  • Others

• pulmonary Mucinous cystadenoma 8470/0

D. Lymphoproliferative tumours

 pulmonary Marginal zone B-cell lymphoma of the MALT type 9699/3
 pulmonary Diffuse large B-cell lymphoma 9680/3
 pulmonary Lymphomatoid granulomatosis 9766/1
 pulmonary Langerhans cell histiocytosis 9751/1

E. Miscellaneous tumours

 pulmonary Harmatoma
 pulmonary Sclerosing hemangioma 8832/0
 pulmonary Clear cell tumour 8005/0
 pulmonary Germ cell tumours
 pulmonary Teratoma, mature 9080/0

• Immature 9080/3
• Other germ cell tumours

 Intrapulmonary thymoma 8580/1
 pulmonary Melanoma 8720/3

F. Metastatic tumours

Links

 Benign lung neoplasms at the Yale Rosen Collection

2015 WHO classification of tumours of the lung

The 2015 World Health Organization (WHO) lung adenocarcinoma classification divides tumours into categories of indolent pre-invasive, minimally invasive and predominantly lepidic and, by examining predominant patterns of invasion, allows for further stratification into intermediate and high-grade tumours.

The most significant changes in the 2015 edition comparing to the 2014 one involve:
 (1) use of immunohistochemistry throughout the classification,
 (2) a new emphasis on genetic studies, in particular, integration of molecular testing to help personalize treatment strategies for advanced lung cancer patients,
 (3) a new classification for small biopsies and cytology similar to that proposed in the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification,
 (4) a completely different approach to lung adenocarcinoma as proposed by the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification,
 (5) restricting the diagnosis of large cell carcinoma only to resected tumors that lack any clear morphologic or immunohistochemical differentiation with reclassification of the remaining former large cell carcinoma subtypes into different categories,
 (6) reclassifying squamous cell carcinomas into keratinizing, non-keratinizing, and basaloid subtypes with the nonkeratinizing tumors requiring immunohistochemistry proof of squamous differentiation,
 (7) grouping of neuroendocrine tumors together in one category,
 (8) adding NUT carcinoma,
 (9) changing the term " sclerosing hemangioma " to " sclerosing pneumocytoma ",
 (10) changing the name " hamartoma " to " pulmonary hamartoma ,"
 (11) creating a group of pulmonary PEComatous tumors that include :

• (a) " pulmonary lymphangioleiomyomatosis ",
• (b) " pulmonary PEComa, benign (with clear cell tumor as a variant) and
• (c) PEComa, malignant,

TNM staging system of lung tumors

T – Primary Tumour

TX Primary tumour cannot be assessed, or tumour proven by the pres
ence of malignant cells in sputum or bronchial washings but not
visualized by imaging or bronchoscopy

T0 No evidence of primary tumour

Tis Carcinoma in situ

T1 Tumour 3 cm or less in greatest dimension, surrounded by lung
or visceral pleura, without bronchoscopic evidence of invasion
more proximal than the lobar bronchus, i.e., not in the main
bronchus (1)

T2 Tumour with any of the following features of size or extent:
• More than 3 cm in greatest dimension
• Involves main bronchus, 2 cm or more distal to the carina
• Invades visceral pleura
• Associated with atelectasis or obstructive pneumonitis that
extends to the hilar region but does not involve the entire lung

T3 Tumour of any size that directly invades any of the following:
chest wall (including superior sulcus tumours), diaphragm,
mediastinal pleura, parietal pericardium; or tumour in the main
bronchus less than 2 cm distal to the carina1 but without
involvement of the carina; or associated atelectasis or obstructive
pneumonitis of the entire lung

T4 Tumour of any size that invades any of the following:
mediastinum, heart, great vessels, trachea, oesophagus,
vertebral body, carina; separate tumour nodule(s) in the same
lobe; tumour with malignant pleural effusion (2)

Notes:

1. The uncommon superficial spreading tumour of any size with its
invasive component limited to the bronchial wall, which may
extend proximal to the main bronchus, is also classified as T1.

2. Most pleural effusions with lung cancer are due to tumour.
In a few patients, however, multiple cytopathological examinations
of pleural fluid are negative for tumour, and the fluid is non-bloody
and is not an exudate. Where these elements and clinical judgment
dictate that the effusion is not related to the tumour, the effusion
should be excluded as a staging element and the patient should be
classified as T1, T2, or T3.

N – Regional Lymph Nodes

NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph
nodes and intrapulmonary nodes, including involvement by direct
extension

N2 Metastasis in ipsilateral mediastinal and/or subcarinal
lymph node(s)

N3 Metastasis in contralateral mediastinal, contralateral hilar,
ipsilateral or contralateral scalene, or supraclavicular
lymph node(s)

M – Distant Metastasis

MX Distant metastasis cannot be assessed

M0 No distant metastasis

M1 Distant metastasis, includes separate tumour nodule(s) in a
different lobe (ipsilateral or contralateral)

Stage Grouping

Occult carcinoma TX N0 M0
Stage 0 Tis N0 M0
Stage IA T1 N0 M0
Stage IB T2 N0 M0
Stage IIA T1 N1 M0
Stage IIB T2 N1 M0
T3 N0 M0
Stage IIIA T1, T2 N2 M0
T3 N1, N2 M0
Stage IIIB Any T N3 M0
T4 Any N M0
Stage IV Any T Any N M1

See also

 pulmonary epithelial tumors

• pulmonary benign epithelial tumors
• pulmonary epithelial tumors (pulmonary carcinomas)

 pulmonary mesenchymal tumors

• pulmonary benign mesenchymal tumors
• pulmonary sarcomas

 pulmonary lymphoid tumors

• pulmonary lymphomas

 pulmonary teratoma
 pulmonary melanoma

 pulmonary malignant tumors

• pulmonary carcinomas
• pulmonary sarcomas
• pulmonary lymphomas
• pulmonary melanoma

IHC

 Immunohistochemistry for pulmonary & pleural neoplasms. 2017 http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2016-0550-RA0-RA

Open references

 Immunohistochemistry for pulmonary & pleural neoplasms. 2017 http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2016-0550-RA

 The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JH, Beasley MB, Chirieac LR, Dacic S, Duhig E, Flieder DB, Geisinger K, Hirsch FR, Ishikawa Y, Kerr KM, Noguchi M, Pelosi G, Powell CA, Tsao MS, Wistuba I; WHO Panel. J Thorac Oncol. 2015 Sep;10(9):1243-60. doi : 10.1097/JTO.0000000000000630 PMID: 26291008

 Introduction to The 2015 World Health Organization Classification of Tumors of the Lung, Pleura, Thymus, and Heart.
Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG.
J Thorac Oncol. 2015 Sep;10(9):1240-2. doi : 10.1097/JTO.0000000000000663. No abstract available
PMID: 26291007 Free

References

 IARC - 2004 WHO histological classification of tumours of the lung