DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20151392

Shifting trends of lung tumours and its diagnosis by lung biopsy: a study of 78 cases

Kinnari S. Naik, Mayur Jarag, Pinal Shah, Mubin Patel, Amita Patel, Anand Shah

Abstract


Background: The objective of the study was to study the spectrum of pathological lesions in patients with lung mass and to study correlation between clinical findings, histopathological pattern and immunohistochemical stains in various biopsy specimen for differentiation and typing of tumors.

Methods: This retrospective study was done for the period of three years at Department of Pathology, New Civil Hospital, Surat, India, which is a tertiary health care Centre. Here we studied 78 cases of lung biopsy received in formalin, which were subjected to histopathological examination. Immunohistochemistry was performed as and when required.

Results: Total 78 lung biopsy specimens were examined. Out of which, 59 cases (75.6%) were neoplastic, 12 cases(15.4%) were non-neoplastic and 7 cases (9%) were inconclusive. The commonest histological type of malignancy was adenocarcinoma which is associated with peripheral mass lesion, female gender and in non-smokers. Commonest non-neoplastic lesion was tuberculosis.  Malignancy was seen quite common in patients presented with lung masses in our institute.

Conclusions: Lung tumours are quite common in patients presented with mass lesion. Similar to global trend, adenocarcinoma is the commonest histological type now and associated with change in incidence among women, in non-smokers, molecular alteration and prognosis which need further investigation. Immunohistochemistry is helpful in cases which are not accurately subtyped by histomorphology alone.

 


Keywords


Lung biopsy, Lung tumours, Histological types

Full Text:

PDF

References


Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008 Int J Cancer. 2010;127:2893-917.

Ganesh B, Sushama S, Monika S, Suvarna P. A Case-control Study of Risk Factors for Lung Cancer in Mumbai, India. Asian Pac J Cancer Prev .2011;12:357-62.

Shields TW. Pathology of Carcinoma of the Lung. In: Shields, editor. General Thoracic Surgery. Philadelphia. Lipponcott Williams and Wilkins. 2000:1249-68.

Shah S, Shukla K, Patel P. Role of needle aspiration cytology in diagnosis of lung tumors. A study of 100 cases. Indian J PatholMicrobiol . 2007;50:56-8.

Saha A, Kumar K, Choudhuri MK. Computed tomography-guided fine needle aspiration cytology of thoracic mass lesions: A study of 57 cases. J Cytol . 2009;26:55-9.

Mondal SK, Nag D, Das R, Mandal PK, Biswas PK, Osta M. Computed tomogram guided fine-needle aspiration cytology of lung mass with histological correlation: A study in Eastern India. South Asian J Cancer. 2013;2:14-8.

Tan KB, Thamboo TP, Wang SC, Nilsson B, Rajwanshi A, Salto-Tellez M. Audit of transthoracic fine needle aspiration of the lung:Cytological sub classification of bronchogenic carcinomas anddiagnosis of tuberculosis. Singapore Med J. 2002;43:570-5.

Bandyopadhyay A, Laha R, Das TK, Sen S, Mangal S, Mitra PK. CT guided fine needle aspiration cytology of thoracic mass lesions: A prospective study of immediate cytological evaluation. Indian J PatholMicrobiol. 2007;50:51-5.

Manickam TG, Rajasekaran S, Vasanthan PJ, Mahilmaran A, Bhanumathi V, Vijayalakshmi CS et al. Detection of Bronchogenic Carcinoma: Value of Blind Bronchial Biopsies in Endoscopically invisible Pulmonary Lesions. Lung India1994;2:73-6.

Noronha V, Dikshit R, Raut N, Joshi A, Pramesh CS, George K, et al. Epidemiology of lung cancer in India: Focus on the differences between non-smokers and smokers: A single-centre experience. Indian J Cancer. 2012;49:74-81.

Devesa SS, Bray F, Vizcaino AP, Parkin DM. International lung cancer trends by histologic type: Male: Female differences diminishing and adenocarcinoma rates rising. Int J Cancer. 2005;117:294-9.

Behera D,Balamugesh T.Lung cancer in India. Indian J Chest Dis Allied Sci .2004;46:269-81.

Madan M, Bannur. Evaluation of FNAC in lung diseases. Turk J Pathol. 2010;26:1-6.

Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y et al. International association for the study of lung cancer/American thoracic society/European respiratory society international multidisciplinary classification of lung adenocarcinoma. J ThoracOncol. 2011;6:244-85.

Tyczynski JE, Bray F, Parkin DM. Lung cancer in Europe in 2000: epidemiology, prevention, and early detection. Lancet Oncol 2003;4(1):45-55.

Janssen-Heijnen ML, Schipper RM, Klinkhamer PJ, Crommelin MA, MooiWJ,Coebergh JW. Divergent changes in survival for histological types of non small-cell lung cancer in the southeastern area of The Netherlands since 1975. Br J Cancer. 1998;77(11):2053-7.

Rawat J, Sindhwani G, Gaur D, Dua R, Saini S, et al. Clinico-pathological profile of lung cancer. Lung India.2009;26:74-6.

Khuder SA. Effect of cigarette smoking on major histological types of lung cancer: a meta-analysis. Lung Cancer .2001;31:139–48.

Toh CK, Gao F, Lim WT, Leong SS, Fong KW, Yap SP, et al. Never- Smokers With Lung Cancer: Epidemiologic Evidence of a Distinct Disease Entity. J ClinOncol. 2006;24:2245-51.

Lim WT, Leong SS, Fong KW, Yap SP, et al. Non- smokers With Lung Cancer: Evidence of a Distinct Disease. J ClinOncol .2006;24:2245-51.

Gao YT, Blot WJ, Zheng W, Ershow AG, Hsu CW, Levin LI, et al. Lung cancer among Chinese women. Int J Cancer .1987;40:604-9.

Jindal SK, Malik SK, Dhand R, Gujral JS, Malik AK, Datta BN. Bronchogenic carcinoma in northern India. Thorax .1982;37:343-7.

Janssen-Heijnen ML, Coebergh JW, Klinkhamer PJ, Schipper RM, Splinter TA, Mooi WJ. Is there a common etiology for the rising incidence of and decreasing survival with adenocarcinoma of the lung? Epidemiology .2001;12:256-8.

Wynder EL, Hoffmann D. Re: cigarette smoking and the histopathology of lung cancer. J Natl Cancer Inst. 1998;90:1486–8.

Djordjevic MV, Hoffmann D, Hoffmann I. Nicotine regulates smoking patterns. Prev Med .1997;26:435–40.

Wu YL, Thongprasert S, Yang CH, Chu DT, Saijo N, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med .2009;36:947-57.

Rekhtman N, Ang DC, Sima CS, Travis WD, Moreira al. Immunohistochemical algorithm for differentiation of lung adenocarcinoma and squamous cell carcinoma based on large series of whole-tissue sections with validation in small specimens. Mod pathol. 2011;24(10):1348-59.

Nicholson AG, Gonzalez D, Shah P, et al. Refining the diagnosis and EGFR status of non-small cell lung carcinoma in biopsy and cytologic material, using a panel of mucinstaining, TTF-1, cytokeratin 5/6, and P63, and EGFR mutation analysis. J ThoracOncol. 2010;5:436–41.

Mukhopadhyay S, Katzenstein AL. Subclassification of non-small cell lung carcinomas lacking morphologic differentiation on biopsy specimens: utility of an immunohistochemical panel containing TTF-1, Napsin A, p63, and CK5/6. Am J SurgPathol 2011;35:15–25.

Zhang H, Liu J, Cagle PT, et al. Distinction of pulmonary small cell carcinoma from poorly differentiated squamous cell carcinoma: an immunohistochemical approach. Mod Pathol.2005;18:111-8.

Jerome MV, Mazieres J, Groussard O, Garcia O, Berjaud J, Dahan M, Carles P, Daste G. Expression of TTF-1 and cytokeratins in primary and secondary epithelial lung tumours: correlation with histological type and grade. Histopathology. 2004;45(2):125-34.

Viberti L, Bongiovanni M, Croce S, Bussolati G., 34betaE12 Cytokeratin Immunodetection in the Differential Diagnosis of Small Cell Tumors of Lung.Int J SurgPathol. 2000;8(4):317-22.

Johansson L: Histopathologic classification of lung cancer: relevance of cytokeratin and TTF-1 immunophenotyping. AnnDiagnPathol.2004;8:259–67.

Chu P, Wu E, Weiss LM. Cytokeratin 7 and cytokeratin 20 expression in epithelial neoplasms: A survey of 435 cases cases. Mod Pathol.2000;13:962–72.

Satoshi Ikeda, Masahiko Fujimori, Satoshi Shibata, MasazumiOkajima, YasuyoIshizaki, Takeshi Kurihara. Combined immunohistochemistry of β-catenin, cytokeratin 7, and cytokeratin 20 is useful in discriminating primary lung adenocarcinomas from metastatic colorectal cancer. BMC cancer,2006.

Kaufmann O, Georgi T, Dietel M. Utility of 123C3 monoclonal antibody against CD56 (NCAM) for the diagnosis of small cell carcinomas on paraffin sections.Hum Pathol. 1997;28(12):1373-8.

Lantuejoul S, Moro D, Michalides RJ et al. Neural cell adhesion molecule (NCAM) and NCAM-PSA expression in neuroendocrine lung tumors. Am J Surg Pathol.1998;22:1267–76.

Kontogianni, A G Nicholson, D Butcher, M N Sheppard. CD56: a useful tool for the diagnosis of small cell lung carcinomas on biopsies with extensive crush artefact. JClinPathol. 2005;58(9):978–80.

Ordonez NG. Value of thyroid transcription factor-1 immunostaining in distinguishing small cell lung carcinomas from other small cell carcinomas. Am J SurgPathol. 2000;24:1217–23.

Folpe AL, Gown AM, Lamps LW et al. Thyroid transcription factor-1: immunohistochemical evaluation in pulmonary neuroendocrine tumors. Mod Pathol.1999;12:5–8.