Slide of the Week: Carcinoid in the Lung, July 25th, 2011

A 50 yo male complains of episodic flushing and tachycardia over the past few months.  X-rays revealed a pulmonary mass.  The following is an H&E from the lung.

Carcinoid in the lung

 

Referring to the above H&E stained section of a lung tumor, what is your diagnosis?

  1. Squamous cell carcinoma
  2. Small cell neuroendocrine tumor
  3. Typical Carcinoid tumor
  4. Atypical Carcinoid tumor

 

Which immunohistochemical tests should be used to establish diagnosis and prognosis?

  1. Ki67
  2. Chromogranin A
  3. P53
  4. All of the above

 

 

Click here to see the whole slide image.

Click here for the comparative pathology.

Scroll below for answers.


 

 

 

 

 

 

 

 

 

Answer 1: 4, Atypical Carcinoid tumor.

Answer 2: d, All of the above.

 

Comment:

Primary pulmonary neuroendocrine tumors represent about 20% of all lung cancers. They are classified into four categories:  1. Typical Carcinoid tumor, 2 Atypical carcinoid tumor, 3. Large cell neuroendocrine tumo,r and 3. Small cell neuroendocrine tumor. The  atypical carcinoids, such as the current example,  have been the most difficult to classify. The presence of Chromogranin A or Synaptophysin identifies the tumor as neuroendocrine. Current recommendations suggest that mitotic rate (Ki67) and p53 and Ras mutations are useful prognostic indicators.

 

References:

Gustafsson BI, Kidd M, Chan A, Malfertheiner MV, Modlin IM. Bronchopulmonary neuroendocrine tumors. Cancer. 2008 Jul 1;113(1):5-21. PubMed PMID:18473355

Przygodzki RM, Finkelstein SD, Langer JC, Swalsky PA, Fishback N, Bakker A, Guinee DG, Koss M, Travis WD. Analysis of p53, K-ras-2, and C-raf-1 in pulmonary neuroendocrine tumors. Correlation with histological subtype and clinical outcome. Am J Pathol. 1996 May;148(5):1531-41. PubMed PMID:8623922

Kobayashi Y, Tokuchi Y, Hashimoto T, Hayashi M, Nishimura H, Ishikawa Y, Nakagawa K, Sato Y, Takahashi A, Tsuchiya E. Molecular markers for reinforcement of histological subclassification of neuroendocrine lung tumors. Cancer Sci. 2004 Apr;95(4):334-41. PubMed PMID:15072592

Neuroendocrine tumors of the lung: an update. Rekhtman N. Arch Pathol Lab Med. 2010 Nov;134(11):1628-38. Review. PubMed PMID:21043816

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