A 63 YO male with a 50 pack year smoking history presents with shortness of breath, coughing and blood-streaked sputum. A chest radiograph shows a large mass in the middle lobe of the right lung that is biopsied and the H&E stained slide is seen below.
A. Your diagnosis is:
- Non-small cell lung cancer
- Small cell Lung cancer
- Neuroendocrine carcinoma
B. Your diagnosis is based on:
- Chromogranin granules
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Answer: A: 1 (Non-small cell lung cancer), B: 2 (Desmosomes)
Lung cancers are now classified as: Non-Small Cell Lung Cancer (which includes squamous cell carcinoma and adenocarcinoma) or small cell carcinoma with a miscellaneous category (including pleomorphic, carcinoid, salivary gland and unclassified). Within these morphological types, numerous genetic alterations have been found. The literature has numerous studies implicating genetic and epigenetic changes that lead to tumorigenesis as well as implications for prognosis and treatment.
Sy SM, Wong N, Lee TW, Tse G, Mok TS, Fan B, Pang E, Johnson PJ, Yim A. Distinct patterns of genetic alterations in adenocarcinoma and squamous cell carcinoma of the lung. Eur J Cancer. 2004 May;40(7):1082-94. PubMed PMID:15093586.
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