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Mutation of epidermal growth factor receptor gene in adenosquamous
carcinoma of the lung.Lung
Cancer. 2007 Jan;55(1):129-30. Epub 2006 Dec 6.
We have
investigated 26 adenosquamous lung cancer tissues and found that four
EGFR mutations were mainly in female and non-smoker lung cancer.
However, EGFR mutation at kinase domain was exclusive with K-ras
mutation. However, smoking and gender status could affect the
occurrence of EGFR mutation. There was no difference in EGFR mutation
status if analysis was performed in never smoker female subgroup.
Identical
epidermal growth factor receptor mutations in adenocarcinomatous and
squamous cell carcinomatous components of adenosquamous carcinoma of
the lung.Cancer.
2007 Feb 1;109(3):581-7.
BACKGROUND: Adenosquamous carcinoma of the lung is composed of
adenocarcinomatous and squamous cell carcinomatous components. The
epidermal growth factor receptor (EGFR) mutations occur mostly in
adenocarcinomas and rarely in squamous cell carcinoma of lung.
Attempts to investigate the EGFR mutation status in each component of
adenosquamous carcinoma and to characterize the patients according to
mutation status may help to understand the histogenesis of
adenosquamous carcinoma. METHODS: The mutation status of EGFR kinase
domain from exon 18 to 21 was investigated in 25 Korean patients with
adenosquamous carcinoma by polymerase chain reaction-single strand
conformation polymorphism using the tissues of each component from the
adenosquamous carcinoma tumor. Clinicopathologic characteristics of
the patients according to the status of EGFR mutations were compared.
RESULTS: EGFR mutations were identified in 11 (44%) patients: 9
mutations were in exon 19, 1 in exon 20, and 1 in exon 21. EGFR
mutations were significantly more frequent (P = .005) in women (n = 8,
80%) than men (n = 3, 20%). Never-smokers (n = 8, 62%) had EGFR
mutations more commonly than smokers (n = 3, 25%; P = .111). Identical
EGFR mutations in both components of adenosquamous carcinoma were
confirmed by nucleotide sequencing. CONCLUSIONS: The frequency of EGFR
mutation and clinicopathologic characteristics of the EGFR mutants in
adenosquamous carcinoma are similar to those of Asian patients with
adenocarcinomas. Identical EGFR mutations in both components suggest
the possibility of monoclonality in the histogenesis of adenosquamous
carcinoma.
Adenosquamous
carcinoma of the lung (an analysis of 13 cases).Tuberk
Toraks. 2005;53(2):161-6.
Adenosquamous
carcinoma of the lung is a rare disease. The biological behavior and
clinicopathologic characteristics of this tumor have not been well
described. In this study, we retrospectively evaluated 13 patients
with adenosquamous carcinoma of the lung diagnosed at our center
between January 2001 and May 2004. There were 12 males and 1 female
whose ages ranged from 45 to 69 years, with a mean age of 55.9 years.
Ten patients were smoker. The most frequent symptoms were chest pain
and cough. Bronchoscopic examination detected that tumor was centrally
located in four cases and was peripherally located in nine cases.
Preoperative pathological diagnosis was squamous cell carcinoma in
eight patients, non-small cell lung carcinoma in four patients and
adenocarcinoma in one patient. One patient was in pathological stage
IA, three patients in stage IB, one patient in stage IIA, two patients
in stage IIB, five patients in stage IIIA, and one patient in stage
IIIB. Twelve patients underwent resection (six, lobectomy; five,
pneumonectomy; one, bilobectomy). Five of 12 patients received
adjuvant therapy. Five patients died of disease within 3 and 21
months. Seven patients have had survival time between 9 and 31 months.
A case of
pulmonary adenosquamous cell carcinoma with thin-wall cavities.Nihon
Kokyuki Gakkai Zasshi. 2005
Jan;43(1):59-62.
A 68-year-old
man was admitted to our hospital because of continuous cough of three
months duration and for investigation of a thin-wall cavitary lesion
(> 3 cm) in the right upper lung field. Thin-wall cavity (40 x 35 mm)
with notch and spiculation was observed in the right S2 on chest CT. A
histological diagnosis of pulmonary adenocarcinoma was obtained by
bronchoscopic examination, and he was transferred to the Department of
Thoracic Surgery where a right upper lobectomy was performed.
Subsequently, cavity formation (45 x 40 x 35 mm) was disclosed in the
right S2. Most of the surrounding cavity consisted of the components
of a well differentiated squamous cell carcinoma with keratinization
and slightly different components of a poorly differentiated
adenocarcinoma with mucous production. The final diagnosis was
pulmonary adenosquamous cell carcinoma and the postoperative
histological classification was T2N2M0 (Stage 3A) because of
metastasis to the lymph nodes (#4 and #11). A communicating bronchus
was histologically identified and we presumed that the thin-wall
cavity developed by a check valve mechanism. Although squamous cell
carcinoma has been reported to be the histological type, tending to
form thin-wall cavities among patients with lung cancer reported to be
squamous cell carcinoma, recently an increasing number of such
cavities have been reported among patients with pulmonary
adenocarcinoma. Herein, we have reported a rare case of histological
diagnosis of pulmonary adenosquamous cell carcinoma with cavity
formation.
Adenosquamous
carcinoma of the lung: CT-pathological correlation.Clin
Radiol. 2005 Mar;60(3):364-9.
AIM: To
correlate CT morphological features and histopathological findings of
adenosquamous carcinoma of the lung. MATERIALS AND METHODS: In all, 29
patients underwent contrast-enhanced CT of an adenosquamous carcinoma
of the lung, followed by resection of the cancer. Correlations between
CT morphological and histopathological features were evaluated,
including location, characteristics of margins, attenuation and the
presence of necrosis. RESULTS: The tumour was peripheral in 21 (72%)
and central in 8 (28%) cases. The tumours varied in size from 1.1cm to
11.0cm (mean 3.8cm); 20 (69%) appeared as heterogeneous masses and 9
(31%) as homogeneous masses. The most common CT features were
lobulation in 27 (93%), pleural tail in 22 (76%), spiculation in 17
(59%), necrosis in 15 (52%) and vessel convergence in 13 (45%). Among
the 21 peripheral tumours, 14 (67%) showed intratumoural necrosis and
17 (81%) were heterogeneous. Among the 8 central tumours, only 1
(12.5%) showed intratumoural necrosis and 5 (62.5%) were homogeneous.
These CT features corresponded mainly to solid tumour growth, which
was composed of both squamous cell carcinomatous and
adenocarcinomatous tissue. CONCLUSION: Adenosquamous carcinoma of the
lung is shown to be characteristically a solid, lobulated nodule or
mass, more commonly peripheral than central. After intravenous
injection of positive contrast medium, CT shows that the peripheral
lesions are usually of heterogeneous soft-tissue attenuation.
Prognosis and
survival after radical resection of primary adenosquamous lung
carcinoma.Eur
J Cardiothorac Surg. 2005
Apr;27(4):686-92.
OBJECTIVE: In
order to evaluate the follow-up study of surgical treatment for
primary adenosquamous lung carcinoma (ASC) we specified prognostic
criteria, also in comparison with primary adenocarcinoma (AC).
METHODS: The study group consisted of 96 patients discharged between
1990 and 1999 after radical surgical treatment for ASC-80 (83%) men
and 16 (17%) women aged 34-73, mean 56 years. Consequently, we
evaluated 252 patients operated during the same time period for
primary AC. RESULTS: Apart from grading, we did not find any
significant differences between both ASC and AC groups of patients.
Among the 96 patients operated radically for ASC median overall
survival (OS) was 20 months. The cumulative postoperative survival
rates at 5 and 10 years were 25.4 and 19.2%, respectively. By
comparison, median OS for 252 patients with AC, discharged after
surgical treatment in the same period, was 28.5 months and the
cumulative postoperative survival rates at 5 and 10 years were 42.5
and 39.1%, respectively (P=0.006). At pathologic stages IA, the
cumulative survival rate at 5 years was 63.3% for patients with ASC as
compared with 72.1% for patients with AC (P=0.330). However, out of IB
stage patients treated surgically for ASC 31.8% survived 5 years in
comparison with 56.3% operated for AC (P=0.017). Study of survival
rates did not differ significantly between ASC and AC patients at
stage IIA (P=0.824) and stage IIB (P=0.217), respectively. Univariate
analysis revealed that six factors of tumor size, T status, N status,
as well visceral pleura involvement, tumor localization (central vs.
peripheral) and tumor structure were significantly associated with the
survival rate according to these variables. Multivariate analysis
using Cox's proportional hazards model indicated that T factor, nodal
involvement and one of the tumor components predominating were
significant factors associated with the postoperative survival of
patients with ASC. CONCLUSIONS: Our findings indicate that in patients
after radical operation for ASC, predominance for one of the
histopathological components (adenous or squamous) within primary
tumor is attended by worst prognosis. Our study confirmed also that
the prognosis of ASC of the lung was poorer than that of primary AC.
Lack of generally accepted diagnostic criteria and unclear prognosis,
even in the pathologic stage I suggest that there is a need for
prospective studies in this respect.
Colliding
primary lung cancers of adenosquamous carcinoma and large cell
neuroendocrine carcinoma.Pathol
Int. 2003 Jan;53(1):58-65.
We report an
extremely rare case of primary lung cancer showing various
histological elements diagnosed as the collision of an adenosquamous
carcinoma and a large cell neuroendocrine carcinoma by loss of
heterozygosity (LOH) analysis of the human androgen receptor (AR) and
phosphoglycerate kinase (PGK-1) genes. The tumor exhibited a tiny
ground-glass opaque shadow suggesting atypical adenomatous hyperplasia
18 months prior to surgery. However, the tumor grew rapidly, and the
resected tumor consisted of two closely located nodules. The larger
nodule was composed of well-differentiated adenocarcinomatous and
moderately to poorly differentiated squamous cell carcinomatous
elements, while the smaller nodule consisted of a large cell
neuroendocrine carcinomatous element with partial squamoid
differentiation having focal continuity with the adenocarcinomatous
element. Both the adenocarcinomatous and squamous cell carcinomatous
elements revealed transitional features and LOH of AR and PGK-1 genes,
while the large cell neuroendocrine carcinomatous element showed a
monoclonal pattern but possessed both alleles of AR and PGK-1 genes.
From these clinical and pathological results, the parental cell of the
large cell neuroendocrine carcinomatous element was considered to be
different from that of the adenosquamous carcinomatous element.
Poor prognosis
after lung resection for patients with adenosquamous carcinoma of the
lung.Ann
Thorac Surg. 2003 Jun;75(6):1740-4.
BACKGROUND: We
evaluated the prognosis of adenosquamous carcinoma of the lung after
lung resection in comparison with other types of carcinoma. METHODS:
We retrospectively reviewed charts of patients who underwent lung
resection for lung cancer. RESULTS: Surgical outcomes for 30 patients
with adenosquamous carcinoma of the lung, who were treated between
1976 and 1998, were compared with the surgical results for 1,219
patients similarly treated for adenocarcinoma or squamous cell
carcinoma during the same period. Adenosquamous carcinoma comprised
only 2.1% of 1,408 lung cancer cases treated by resection. The overall
cumulative 5-year survival rate was only 6.2% for the patients with
adenosquamous carcinoma, indicating a significantly poorer prognosis
than for adenocarcinoma or squamous cell carcinoma. CONCLUSIONS: The
cumulative survival rate for patients with adenosquamous carcinoma in
pathologic stages IA to IIB was similar to that of patients with stage
IIIA adenocarcinoma or squamous cell carcinoma.
Lung tumors
with mixed histologic pattern. Clinico-pathologic characteristics and
prognostic significance.Eur
J Cardiothorac Surg. 2002
Nov;22(5):701-7.
OBJECTIVE: To
analyze and compare clinico-pathologic characteristics and survival
between lung tumors with mixed histologic pattern and our population
of resected lung tumors with single histology in the same period.
METHODS: From January 1993 to December 1999, 1158 patients received
resection for lung tumors. Of these, 59 (5.1%) presented a mixed
histologic pattern on the surgical specimen. There were 48 men and 11
women (mean age 64 years, range 43-79). Three groups of tumors were
identified: adenosquamous carcinoma, combined neuroendocrine + non-neuroendocrine
carcinoma (NNEC) and biphasic tumors (epithelial + mesenchymal
malignant components) represented by carcinosarcoma and blastoma. The
combined neuroendocrine tumors were further divided in small cell lung
carcinoma (SCLC) + large cell neuroendocrine carcinoma (LCNEC)/NNEC
and other neuroendocrine tumors/NNEC. Clinico-pathologic
characteristics, pTNM and survival were analyzed and compared to our
population of resected lung tumors with single histology. RESULTS:
There were 33 adenosquamous carcinomas, 19 combined SCLC+LCNEC/NNEC,
two other neuroendocrine tumors/NNEC and five biphasic tumors (three
carcinosarcomas and two blastomas). Among adenosquamous carcinomas,
high cell grading (G2 or G3), advanced stage (IIIa or higher) and
intratumoral perineural invasion were significantly more evident than
in the single histology population. Among combined neuroendocrine/NNEC,
high cell grading (G3) and intratumoral vascular invasion were
significantly more evident than in the single histology population.
Among biphasic tumors, all were at early stages and showed high cell
grading (G3). Three-year survival rates were 46% in the single
histology group, 28% in the adenosquamous group and 21% in the
combined SCLC + LCNEC/NNEC. The difference among the three groups was
significant (P = 0.013). Median survival of biphasic tumors was 19
months (range 8-37). CONCLUSIONS: Lung tumors with mixed histologic
pattern are rare tumors. Adenosquamous carcinoma and combined SCLC +
LCNEC/NNEC present a more aggressive clinico-pathologic behaviour and
reduced survival as compared to the single histology population of
resected lung tumors.
Adenosquamous
lung carcinoma: clinical characteristics, surgical treament and
prognosis.Chin
Med Sci J. 2000 Dec;15(4):238-40.
OBJECTIVE: The
effectiveness of surgical resection of adenosquamous carcinoma of the
lung remains poorly defined because of the histology's relatively low
frequency, the failure in most published series to separate
adenosquamous carcinoma from the other variants of non-small cell lung
carcinoma. To define the effectiveness of treatment of adenosquamous
carcinoma, we have retrospectively reviewed our hospital experience
over a 12-year period. METHODS: Retrospectively reviewed 22 cases of
adenosquamous carcinoma who were surgically treated, except one
patient, in the PUMCH from Jan. 1985 to Aug. 1997. This series
constitutes the 1.9% of a total of 1 245 patients with all types of
surgical treatment for the primary lung cancer during the same time.
RESULTS: The adenosquanous carcinoma was mostly presented in the old
patients with a mean age of 60 years and mostly located in the
peripheral of lung (n = 20). The overall 5-year survival was 23%.
Those with stage I tumors survival was only 18% (n = 13), stage II 5%.
The survival in stage III tumos was not longer than 25 months and in
stage IV survival was not longer than 12 months. CONCLUSION: Our
results suggest that adenosquamous carcinoma of lung was a virulent
tumor, which exhibited highly aggressive biological behavior with
early lymph nodes metastasis (46%) and its prognosis was worse than
that of both squamous cell carcinoma and adenocarcinoma.
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