Lung cancer classification: Difference between revisions

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==Overview==
==Overview==
Primary lung cancers may be classified into [[small cell lung cancer]] (~15%) and [[non small cell lung cancer]] (~85%).  [[Non small cell lung cancer]] are a heterogenous group of lung cancers that are often grouped together because they share similar clinical features (e.g. [[prognosis]] and management). The 2004 WHO histological classification of [[tumors]] of the [[lung]] categorized [[lung]] [[tumors]] into [[malignant]] [[epithelial]] [[tumors]], [[benign]] [[epithelial]] [[tumors]], [[Lymphoproliferative disorders|lymphoproliferative tumors]], miscellaneous [[tumors]], and [[metastatic]] [[tumors]].
Primary lung cancers may be [[Classification|classified]] into [[small cell lung cancer]] (~15%) and [[non small cell lung cancer]] (~85%).  [[Non small cell lung cancer]] are a [[heterogeneous]] group of lung cancers that are often grouped together because they share similar clinical features (e.g. [[prognosis]] and management). The 2015 [[World Health Organization|WHO]] [[Histology|histological]] [[classification]] of [[tumors]] of the [[lung]] categorized [[lung]] [[tumors]] into [[malignant]] [[epithelial]] [[tumors]], [[benign]] [[epithelial]] [[tumors]], [[Lymphoproliferative disorders|lymphoproliferative tumors]], miscellaneous [[tumors]], and [[metastatic]] [[tumors]].


==Classification==
==Classification==
Primary lung cancers may be classified into two main categories:<ref name="WHO">{{cite book | last = Travis | first = William | title = Pathology and genetics of tumours of the lung, pleura, thymus, and heart | publisher = IARC Press | location = Lyon | year = 2004 | isbn = 9283224183 }}</ref>  
Primary lung cancers may be [[Classification|classified]] into two main categories:<ref name="WHO">{{cite book | last = Travis | first = William | title = Pathology and genetics of tumours of the lung, pleura, thymus, and heart | publisher = IARC Press | location = Lyon | year = 2004 | isbn = 9283224183 }}</ref>  
*[[Small cell lung cancer]] (~15%)   
*[[Small cell lung cancer]] (~15%)   
*[[Non small cell lung cancer]] (~85%).
*[[Non small cell lung cancer]] (~85%).
Line 20: Line 20:
*[[Squamous cell carcinoma of the lung|Squamous cell carcinoma]] (25% of lung cancers) <br>
*[[Squamous cell carcinoma of the lung|Squamous cell carcinoma]] (25% of lung cancers) <br>
*[[Adenocarcinoma of the lung|Adenocarcinoma]] (40% of lung cancers).  
*[[Adenocarcinoma of the lung|Adenocarcinoma]] (40% of lung cancers).  
:*[[Bronchioloalveolar carcinoma]] is a subtype of adenocarcinoma, is more common among female never-smokers, and may have different responses to treatment.<br><ref name="Raz">{{cite journal | last =Raz | first =DJ | coauthors =He B, Rosell R, Jablons DM | title =Bronchioloalveolar carcinoma: a review | journal =Clinical Lung Cancer | volume =7 | issue =5 | pages =313–322 | publisher =Cancer Information Group | date =Mar 2006 | pmid =16640802 }}</ref>
*[[Large cell carcinoma of the lung|Large cell carcinoma]] (10% of lung cancers)
*[[Large cell carcinoma of the lung|Large cell carcinoma]] (10% of lung cancers)
*Other non-small cell lung carcinomas:
*Other non-small cell lung carcinomas:
Line 31: Line 30:


==WHO Histological Classification of Tumors of the Lung ==
==WHO Histological Classification of Tumors of the Lung ==
The [[World Health Organization]] ([[World Health Organization|WHO]]) classifies [[tumors]] of the [[lungs]] as follows:<ref name="WHO">{{cite book | last = Travis | first = William | title = Pathology and genetics of tumours of the lung, pleura, thymus, and heart | publisher = IARC Press | location = Lyon | year = 2004 | isbn = 9283224183 }}</ref>
The [[World Health Organization]] ([[World Health Organization|WHO]]) [[Classification|classifies]] [[tumors]] of the [[lungs]] as follows:<ref name="WHO">{{cite book | last = Travis | first = William | title = Pathology and genetics of tumours of the lung, pleura, thymus, and heart | publisher = IARC Press | location = Lyon | year = 2004 | isbn = 9283224183 }}</ref><ref name="urlwww.jto.org">{{cite web |url=https://www.jto.org/article/S1556-0864(15)33571-1/pdf |title=www.jto.org |format= |work= |accessdate=}}</ref>
===Malignant epithelial tumors===
====Squamous cell carcinoma====
* [[Papillary]] carcinoma
* [[Clear cell carcinoma of the lung|Clear cell carcinoma]]
* [[Small cell carcinoma]]
* [[Basal cell carcinoma|Basaloid carcinoma]]


====[[Small cell carcinoma]]====
{| class="wikitable"
* Combined small cell carcinoma
|+
 
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" ! | WHO Classification of Lung Tumors
====[[Adenocarcinoma of lung|Adenocarcinoma]]====
|-
* [[Adenocarcinoma of lung|Adenocarcinoma]], mixed subtype
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histological type
* [[Acinic cell carcinoma|Acinar]] [[adenocarcinoma]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Subtype
* [[Papillary]] [[adenocarcinoma]]
|-
* [[Bronchioloalveolar carcinoma]]
! colspan="2" style="background: #707070; color: #FFFFFF; text-align: center;" |Epithelial tumors
:* Nonmucinous
|-
:* [[Mucinous carcinoma|Mucinous]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenocarcinoma of the lung|'''Adenocarcinoma''']]
:* Mixed nonmucinous and [[mucinous]] or indeterminate
|
* Solid [[adenocarcinoma]] with [[mucin]] production
*[[Lepidic adenocarcinoma of the lung|Lepidic adenocarcinoma]]
:* Fetal [[adenocarcinoma]]
*[[Acinar adenocarcinoma of the lung|Acinar adenocarcinoma]]
:* Mucinous (“colloid”) carcinoma
*[[Papillary adenocarcinoma of the lung|Papillary adenocarcinoma]]
:* [[Mucinous cystadenocarcinoma]]
*[[Micropapillary adenocarcinoma of the lung|Micropapillary adenocarcinoma]]
:* [[Signet ring cell carcinoma|Signet ring adenocarcinoma]]
*[[Solid adenocarcinoma of the lung|Solid adenocarcinoma]]
:* [[Clear cell carcinoma of the lung|Clear cell]] [[adenocarcinoma]]
*[[Invasive mucinous adenocarcinoma of the lung|Invasive mucinous adenocarcinoma]]
 
** Mixed invasive mucinous
====[[Large cell carcinoma of the lung|Large cell carcinoma]]====
** Nonmucinous adenocarcinoma
* [[Large cell neuroendocrine carcinoma of the lung|Large cell neuroendocrine carcinoma]]
*[[Colloid adenocarcinoma of the lung|Colloid adenocarcinoma]]
:* Combined large cell [[neuroendocrine]] carcinoma
*[[Fetal adenocarcinoma of the lung|Fetal adenocarcinoma]]
* [[Basaloid large cell carcinoma of the lung|Basaloid carcinoma]]
*[[Enteric adenocarcinoma of the lung|Enteric adenocarcinoma]]
* [[Lymphoepithelioma-like carcinoma of the lung|Lymphoepithelioma-like carcinoma]]
*[[Minimally invasive adenocarcinoma of the lung|Minimally invasive adenocarcinoma]]
* [[Clear cell tumor|Clear cell carcinoma]]
** Nonmucinous
* [[Large cell carcinoma of the lung|Large cell carcinoma]] with [[Malignant rhabdoid tumor|rhabdoid]] [[phenotype]]
** Mucinous
 
* Pre-[[Invasive (medical)|invasive]] [[Lesion|lesions]]
====[[Adenosquamous carcinoma]]====
**[[Atypical adenomatous hyperplasia of the lung|Atypical adenomatous hyperplasia]]
 
**[[Adenocarcinoma of the lung|Adenocarcinoma]] in situ
====[[Sarcomatoid carcinoma of the lung|Sarcomatoid carcinoma]]====
*** Nonmucinous
* Pleomorphic carcinoma
*** Mucinous
* Spindle cell carcinoma
|-
* Giant cell carcinoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Squamous cell carcinoma of the lung|Squamous cell carcinoma]]'''
* Carcinosarcoma
|
* [[Pleuropulmonary blastoma|Pulmonary blastoma]]
* Keratinizing squamous cell carcinoma
 
* Nonkeratinizing squamous cell carcinoma
====Carcinoid tumor====
* Basaloid squamous cell carcinoma
* Typical carcinoid
* Pre-[[Invasive (medical)|invasive]] [[lesion]]  
* Atypical carcinoid
** Squamous cell carcinoma in situ
 
|-
====Other tumors that may affect the lungs====
! colspan="2" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Neuroendocrine tumors'''
=====Salivary gland tumors=====
|-
* [[Mucoepidermoid carcinoma]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Small cell carcinoma of the lung|Small cell carcinoma]]'''
|
* Combined [[Small cell carcinoma of lung|small cell carcinoma]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Large cell neuroendocrine carcinoma of the lung|Large cell neuroendocrine carcinoma]]'''
|
* Combined [[Large cell neuroendocrine carcinoma of the lung|large cell neuroendocrine carcinoma]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Carcinoid syndrome|Carcinoid tumors]]'''
|
*[[Carcinoid tumor|Typical carcinoid tumor]]
*[[Carcinoid tumor|Atypical carcinoid tumor]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Pre-[[Invasive (medical)|invasive]] [[lesion]]'''
|
*[[Diffuse]] [[idiopathic]] [[Lung|pulmonary]] [[neuroendocrine cell]] [[hyperplasia]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Large cell carcinoma of the lung|Large cell carcinoma]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Adenosquamous carcinoma]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Sarcomatoid carcinoma of the lung|Sarcomatoid carcinomas]]'''
|
*[[Pleomorphic carcinoma of the lung|Pleomorphic carcinoma]]
*[[Spindle cell carcinoma of the lung|Spindle cell carcinoma]]
*[[Giant cell carcinoma of the lung|Giant cell carcinoma]]
*[[Carcinosarcoma of the lung|Carcinosarcoma]]
*[[Pulmonary blastoma of the lung|Pulmonary blastoma]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Other and [[Classification|Unclassified]] [[Carcinoma|carcinomas]]'''
|
*[[Lymphoepithelioma-like carcinoma of the lung|Lymphoepithelioma-like carcinoma]]
* NUT carcinoma
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Salivary gland]]-type [[Tumor|tumors]]'''
|
*[[Mucoepidermoid carcinoma]]
* Adenoid cystic carcinoma
* Adenoid cystic carcinoma
* Epithelial-myoepithelial carcinoma
*[[Epithelium|Epithelial]]-[[myoepithelial]] [[carcinoma]]
* Preinvasive lesions
*[[Pleomorphic adenoma]]
:* [[Squamous]] [[carcinoma in situ]]
|-
:* Atypical [[adenomatous]] [[hyperplasia]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Papilloma|Papillomas]]'''
:* Diffuse idiopathic [[pulmonary]] [[neuroendocrine]] cell [[hyperplasia]]
|
 
*[[Squamous cell papilloma]]
=====Mesenchymal tumors=====
** Exophytic
* [[Epithelioid]] [[Hemangioendothelioma|haemangioendothelioma]]
** Inverted
* [[Angiosarcoma]]
*[[Gland|Glandular]] [[papilloma]]
* Pleuropulmonary [[blastoma]]
* Mixed [[squamous]] and [[Gland|glandular]] [[papilloma]]
* [[Chondroma]]
|-
* Congenial peribronchial myofibroblastic [[tumor]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Adenoma|Adenomas]]'''
* Diffuse [[pulmonary]] [[lymphangiomatosis]]
|
* Inflammatory myofibroblastic [[tumor]]
* Sclerosing pneumocytoma
*[[Alveolar]] [[adenoma]]
*[[Papilla|Papillary]] [[adenoma]]
*[[Mucinous cystadenoma]]
*[[Mucous gland]] [[adenoma]]
|-
! colspan="2" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Mesenchymal tumors'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hamartoma|'''Pulmonary hamartoma''']]
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Chondroma]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[PEComa|PEComatous tumors]]'''
|
* [[Lymphangiomyomatosis|Lymphangioleiomyomatosis]]
* [[Lymphangiomyomatosis|Lymphangioleiomyomatosis]]
* [[Synovial sarcoma]]
* [[PEComa]] (benign)
* [[Pulmonary artery sarcoma]]
**[[Clear cell tumor]]
* [[Pulmonary]] [[vein]] [[sarcoma]]
*[[PEComa]] ([[malignant]])
 
|-
=====Benign Epithelial Tumors=====
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Congenital peribronchial myofibroblastic tumor'''
* [[Papilloma|Papillomas]]
|
:* [[Squamous cell]] [[papilloma]] (either exophytic or inverted)
* N/A
:* Glandular [[papilloma]]
|-
:* Mixed [[squamous cell]] and [[glandular]] [[papilloma]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Diffuse [[Lung|pulmonary]] [[lymphangiomatosis]]'''
* [[Adenoma|Adenomas]]
|
:* [[Alveolar]] [[adenoma]]
* N/A
:* [[Papillary]] [[adenoma]]
|-
:* [[Adenomas]] of the [[salivary gland]] type
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Inflammation|Inflammatory]] [[Myofibroblast|myofibroblastic]] [[tumor]]'''
::* [[Mucous]] [[gland]] [[adenoma]]
|
::* [[Pleomorphic adenoma]]
* N/A
::* Others
|-
:* Mucinous cystadenoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Vascular tumor|'''Epithelioid hemangioendothelioma''']]
 
|
=====Lymphoproliferative Tumors=====
* N/A
* [[Marginal zone lymphoma|Marginal zone B-cell lymphoma]] of the [[MALT lymphoma|MALT]] type
|-
* [[Diffuse large B cell lymphoma|Diffuse large B-cell lymphoma]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pleuropulmonary blastoma|'''Pleuropulmonary blastoma''']]
* [[Lymphomatoid granulomatosis]]
|
* [[Langerhans cell histiocytosis]]
* N/A
 
|-
=====Miscellaneous Tumors=====
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Synovial sarcoma]]'''
* [[Hamartoma]]
|
* Sclerosing [[hemangioma]]
* N/A
* [[Clear cell tumor]]
|-
* [[Germ cell tumor|Germ cell tumors]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Pulmonary artery]] [[Tunica intima|intimal]] [[sarcoma]]'''
:* Mature [[Teratoma]]  
|
:* Immature Teratoma
* N/A
:* Other [[germ cell]] [[tumors]]
|-
* Intrapulmonary [[thymoma]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Pulmonary myxoid sarcoma with EWSR1–CREB1 [[translocation]]'''
* [[Melanoma]]
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''[[Myoepithelial]] [[Tumor|tumors]]'''
|
*[[Myoepithelial cells|Myoepithelioma]]
*[[Myoepithelial]] [[carcinoma]]
|-
! colspan="2" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Lymphohistiocytic tumors'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Extranodal marginal zone lymphomas of [[MALT lymphoma|mucosa-associated Lymphoid tissue (MALT lymphoma)]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Diffuse large cell [[lymphoma]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lymphomatoid granulomatosis|'''Lymphomatoid granulomatosis''']]
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Intravascular large [[B cell]] [[lymphoma]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Lung|Pulmonary]] [[Langerhans cell histiocytosis]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Erdheim-Chester disease'''
|
* N/A
|-
! colspan="2" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Tumors of ectopic origin'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Germ cell tumor|Germ cell tumors]]'''
|
* Mature [[teratoma]]
* Immature [[teratoma]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Pulmonary|Intrapulmonary]] [[thymoma]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Melanoma]]'''
|
* N/A
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Meningioma]], [[NOS]]'''
|
* N/A
|}


==References==
==References==

Latest revision as of 18:12, 2 July 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kim-Son H. Nguyen M.D. Cafer Zorkun, M.D., Ph.D. [2] Rim Halaby, M.D. [3] Dildar Hussain, MBBS [4]

Overview

Primary lung cancers may be classified into small cell lung cancer (~15%) and non small cell lung cancer (~85%). Non small cell lung cancer are a heterogeneous group of lung cancers that are often grouped together because they share similar clinical features (e.g. prognosis and management). The 2015 WHO histological classification of tumors of the lung categorized lung tumors into malignant epithelial tumors, benign epithelial tumors, lymphoproliferative tumors, miscellaneous tumors, and metastatic tumors.

Classification

Primary lung cancers may be classified into two main categories:[1]

 
 
Lung Cancer
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

WHO Histological Classification of Tumors of the Lung

The World Health Organization (WHO) classifies tumors of the lungs as follows:[1][2]

WHO Classification of Lung Tumors
Histological type Subtype
Epithelial tumors
Adenocarcinoma
Squamous cell carcinoma
  • Keratinizing squamous cell carcinoma
  • Nonkeratinizing squamous cell carcinoma
  • Basaloid squamous cell carcinoma
  • Pre-invasive lesion
    • Squamous cell carcinoma in situ
Neuroendocrine tumors
Small cell carcinoma
Large cell neuroendocrine carcinoma
Carcinoid tumors
Pre-invasive lesion
Large cell carcinoma
  • N/A
Adenosquamous carcinoma
  • N/A
Sarcomatoid carcinomas
Other and Unclassified carcinomas
Salivary gland-type tumors
Papillomas
Adenomas
Mesenchymal tumors
Pulmonary hamartoma
  • N/A
Chondroma
  • N/A
PEComatous tumors
Congenital peribronchial myofibroblastic tumor
  • N/A
Diffuse pulmonary lymphangiomatosis
  • N/A
Inflammatory myofibroblastic tumor
  • N/A
Epithelioid hemangioendothelioma
  • N/A
Pleuropulmonary blastoma
  • N/A
Synovial sarcoma
  • N/A
Pulmonary artery intimal sarcoma
  • N/A
Pulmonary myxoid sarcoma with EWSR1–CREB1 translocation
  • N/A
Myoepithelial tumors
Lymphohistiocytic tumors
Extranodal marginal zone lymphomas of mucosa-associated Lymphoid tissue (MALT lymphoma)
  • N/A
Diffuse large cell lymphoma
  • N/A
Lymphomatoid granulomatosis
  • N/A
Intravascular large B cell lymphoma
  • N/A
Pulmonary Langerhans cell histiocytosis
  • N/A
Erdheim-Chester disease
  • N/A
Tumors of ectopic origin
Germ cell tumors
Intrapulmonary thymoma
  • N/A
Melanoma
  • N/A
Meningioma, NOS
  • N/A

References

  1. ↑ 1.0 1.1 Travis, William (2004). Pathology and genetics of tumours of the lung, pleura, thymus, and heart. Lyon: IARC Press. ISBN 9283224183.
  2. ↑ "www.jto.org".

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