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.
Referring to the above H&E stained section of a lung tumor, what is your diagnosis?
- Squamous cell carcinoma
- Small cell neuroendocrine tumor
- Typical Carcinoid tumor
- Atypical Carcinoid tumor
Which immunohistochemical tests should be used to establish diagnosis and prognosis?
- Chromogranin A
- All of the above
Scroll below for answers.
Answer 1: 4, Atypical Carcinoid tumor.
Answer 2: d, All of the above.
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.
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
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