Clin Transl Oncol (2009) 11:825-827 DOI 10.1007/s12094-009-0450-7
S U P L E M E N TA R Y I N F O R M AT I O N
Lung Cancer OncoGuia: surgical pathology report guidelines Josep Ramírez · M. Ángeles Montero · María Alejo · Josep Lloreta on behalf of the Lung Cancer OncoGuia Group*
Received: 8 July 2009 / Accepted: 14 August 2009
The guidelines below have been developed in the framework of the Lung Cancer OncoGuia [1] and are aimed at standardising descriptions of diagnoses in lung and pleural cancer pathology reports so these are fully comparable regardless of the pathologist who issues the diagnosis. Bearing in mind that biopsy is limited, an example description of radical pulmonary resection is provided, with annotations for smaller biopsies. Given the general consensus regarding the heterogeneity of lung carcinomas, definitive diagnosis of histological type and grade should be based on the resection specimen. Small cell carcinoma is a special case, as treatment and prognosis are determined by the type itself, regardless of any other associated component.
Cytology is not discussed, as the diagnosis referred to here only covers tumour type. Cytology should confirm whether a tumour is epithelial or it is a small-cell or nonsmall-cell carcinoma, although confirmation may depend on the technique used: sputum cytology, bronchial aspiration, transbronchial/transtumoral aspiration, transbronchial/ nodular aspiration or percutaneous aspiration.
Identifying data Date obtained: Biopsy no.:
Date registered: Name: Age:
Health history no.: Sex:
Reporting the resection specimen [2] J. Ramírez Pathology Department Hospital Clínic i Provincial de Barcelona Barcelona, Spain A. Montero Pathology Department Hospital Universitari de la Vall d’Hebrón Barcelona, Spain M. Alejo Pathology Department Hospital de Vic Vic, Barcelona, Spain J. Lloreta Pathology Department Hospital del Mar Barcelona, Spain *Coordinating clinical guideline team of the Catalan Cancer Strategy: P. Manchon Walsh (쾷) · J.M. Borràs · T. Ferro · J. Alfons Espinàs Av. Gran Vía, s/n, km 2,7 ES-08907 L’hospitalet de Llobregat, Barcelona, Spain e-mail:
[email protected]
• Resection site (lung, lobe or segment, right or left) • Resection type (pneumonectomy, lobectomy, segmentectomy, tumorectomy) — Histological type (according to the WHO staging table, reproduced below) — Histological differentiation (well/moderately/ poorly differentiated) — Tumour size (maximum diameter) — Tumour site (lobe) — Infiltration: bronchial surgical margin (distance to the tumour) pleura (distance to the tumour). if chest wall tissue is included, indicate the presence of tumour and its margins. — Specimen lymph nodes (N1): hilar other (interbronchial, subpleural, intrapulmonary) — Other lymph nodes: specify the site for surgery (see N staging) — Disorders secondary to the tumour: obstructive pneumonitis (indicate extension/size) other (bronchial dilatation, airway inflammation, acute parenchymatous inflammation)
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— Tumour-associated disorders (bronchial metaplasia, dysplasia, or extension in situ) • Conditions not associated with the neoplasm*: • Chronic obstructive pulmonary disease, residual lesions, granulomatous lesions, pneumoconiosis, etc. *All postoperative lung resection patients continue to function with the remainder of the lung. Any information on preexisting, diffuse or bilateral diseases may be useful for the patient’s prognosis. Example: lung, right pneumonectomy Well differentiated adenocarcinoma — Tumour size: 3.5 cm — Location: upper lobe — Infiltration of lymphatic vessels — Metastasis in 1 of the 4 identified hilar nodes Distal bronchial dilatation with organising areas
Bronchial/pulmonary biopsy cancer diagnosis [3] • Biopsy site (side and/or lobe) • Specimen type (bronchial, transbronchial or pulmonary) — Histological type (according to the WHO staging table, reproduced below) — Vascular infiltration — Tumour-associated disorders (bronchial metaplasia, dysplasia, or extension in situ) Example: right upper lobar bronchus, bronchial biopsy Well differentiated adenocarcinoma • Infiltration of lymphatic vessels
Lung and pleural cancer classification and coding WHO 2004: Malignant pulmonary and pleural epithelial tumours [4] MALIGNANT EPITHELIAL PULMONARY TUMOURS Squamous cell carcinoma Papillary squamous cell carcinoma Clear cell squamous cell carcinoma Small cell squamous cell carcinoma Basaloid squamous cell carcinoma Small cell carcinoma Combined small cell carcinoma (with another type of carcinoma)
M80703 M80523 M80843 M80733 M80833
bronchioloalveolar carcinoma or indeterminate Solid adenocarcinoma with mucin production Adenocarcinoma, mixed subtype Adenocarcinoma variants Foetal adenocarcinoma, well differentiated Mucinous (colloid) adenocarcinoma Mucinous cystadenocarcinoma Signet ring adenocarcinoma Clear cell adenocarcinoma Large cell carcinoma Large cell neuroendocrine carcinoma Combined large cell neuroendocrine carcinoma Basaloid carcinoma Lymphoepithelioma-like carcinoma Clear cell carcinoma Large cell carcinoma with rhabdoid phenotype
M82543 M82303 M82553 M83333 M84803 M84703 M84903 M83103 M80123 M80133 M80133 M81233 M80223 M83103 M80143
Adenosquamous carcinoma
M85603
Sarcomatoid carcinoma Pleomorphic carcinoma Spindle cell carcinoma Giant cell carcinoma Carcinosarcoma Pulmonary blastoma Other
M80333 M80223 M80323 M80313 M89803 M89723
Carcinoid tumour Typical carcinoid tumour Atypical carcinoid tumour
M82403 M82493
Salivary gland carcinoma Mucoepidermoid carcinoma Adenoid cystic carcinoma Epithelial-myoepithelial carcinoma
M84303 M82003 M85623
MALIGNANT PLEURAL MESOTHELIOMAS Diffuse malignant mesothelioma Epithelioid mesothelioma Sarcomatoid mesothelioma Desmoplastic mesothelioma Biphasic mesothelioma
M90503 M90523 M90513 M90513 M90533
M80413 Localised malignant mesothelioma
M90503
Other mesothelial tumours Papillary mesothelioma, well differentiated Adenomatoid tumour
M90521 M90540
M80453
Adenocarcinoma M81403 Acinar adenocarcinoma M85503 Papillary adenocarcinoma M82603 Bronchioloalveolar carcinoma M82503 Nonmucinous bronchioloalveolar carcinoma M82523 Mucinous bronchioloalveolar carcinoma M82533 Mixed nonmucinous and mucinous
Comments on the classification The classification codes are those of theWHO Book [4].
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Staging of pulmonary carcinoma
Pleural mesothelioma diagnosis
WHO staging is used, based on the initial TNM and, following initial surgery, on pTNM. At the present time, the WHO is updating a few changes in the guidelines [5]. T: important details to be provided by the pathologist after surgical resection: Tis: carcinoma in situ T1: tumour of 3 cm or less surrounded by non-infiltrated pleura and without main bronchus involvement (>2 cm distal to the carina) T2: tumour of more than 3 cm and/or invasion of visceral pleura and/or main bronchus involvement (
