Pulmonary giant cell carcinoma: pathological entity or morphological phenotype?

Attanoos, Richard; Papagiannis, A.; Suttinont, Panthep; Goddard, H.; Papotti, M; Gibbs, A R

doi:10.1046/j.1365-2559.1998.00378.x

Cited by 52 publications

(49 citation statements)

References 24 publications

(26 reference statements)

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“…8,71,72 We were able to find only three GCC, confirming the rarity of this entity. 3,8,14,19,21,30,71,73 CS, of which we found three examples, is defined as "a malignant tumor having a mixture of carcinoma and sarcoma containing heterologous elements such as malignant cartilage, bone or skeletal muscle." 8,71,72 Finally, we found a unique example of PB, a rare "biphasic tumor containing a primitive epithelial component that may resemble well-differentiated fetal adenocarcinoma and a primitive mesenchymal stroma."…”

Section: Discussionmentioning

confidence: 99%

“…From a morphologic viewpoint, choriocarcinoma typically displays a dimorphic neoplastic population consisting of cytotrophoblastic and syncytiotrophoblastic elements, whereas, as in our case, a continuum spectrum of cellular size from medium to giant and multinucleated cells characterizes pulmonary PCs in general and GCCs in particular. 3 Considering the above finding, the well-known "burnt-out" phenomenon occurring in germinal tumors, and the possible expression of ectopic placental hormones in many nontrophoblastic malignancies, including conventional lung carcinomas, a diagnosis of primary pulmonary choriocarcinoma should be accepted only after a meticulous clinicopathologic and immunohistochemical analysis has been performed. In this setting TTF-1 seems to represent a helpful marker because we have tested five bona fide choriocarcinomas of the testis and 10 normal placentas, but staining was observed neither in cytotrophoblasts nor in syncytiotrophoblasts (unpublished observation).…”

Section: 76mentioning

confidence: 99%

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Pulmonary Carcinomas With Pleomorphic, Sarcomatoid, or Sarcomatous Elements

Rossi

Cavazza

Stürm

et al. 2003

The American Journal of Surgical Pathology

342

207

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We collected 75 primary pulmonary carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements to better define their clinical, histologic, and immunohistochemical profile. The patient's age ranged from 42 to 81 years (mean 65 years), and the male-to-female ratio was 9.7:1. Sixty-nine patients (92%) were smokers. Cough and hemoptysis were the most frequent presenting symptoms. Fifty-nine patients (65%) died of disease: only stage significantly predicts overall survival (p ‫ס‬ 0.0273). Microscopically, based on the WHO criteria, 58 cases were classified as pleomorphic carcinoma (51 with an epithelial component, 7 composed exclusively of spindle and giant cells), 10 as spindle cell carcinoma, 3 as giant cell carcinoma, 3 as carcinosarcoma, and 1 as pulmonary blastoma. Immunohistochemically, in the tumors composed exclusively of spindle and/or giant cells, thyroid transcription factor-1 (TTF-1) and cytokeratin 7 were positive in 55% and 70% of the cases, respectively, whereas surfactant protein-A was always negative. In pleomorphic carcinomas with an epithelial component, cytokeratin 7, TTF-1, and surfactant protein-A were positive in the sarcomatoid component in 62.7%, 43.1%, and 5.9% of the cases, respectively, whereas they were always negative in the sarcomatous part of carcinosarcomas and blastoma. In the epithelial component of pleomorphic carcinomas, cytokeratin 7, TTF-1, and surfactant protein-A were positive in 76.4%, 58.8%, and 39.2% of the cases, respectively, whereas the same antibodies did not react with the epithelial component of carcinosarcomas; in the case of blastoma, the epithelial part of the tumor was positive for cytokeratin 7 and TTF-1, whereas it was negative for surfactant protein-A. Cytokeratin 20 was always negative. In our opinion, this study: 1) supports the metaplastic histogenetic theory for this group of tumors; 2) shows that cytokeratin 7 and TTF-1, but not surfactant protein-A, are useful immunohistochemical markers in this setting; 3) confirms that stage is at the moment the only significant prognostic parameter, as in conventional non-small cell lung carcinomas; and 4) shows that this group of tumors has a worse prognosis than conventional non-small cell lung carcinoma at surgically curable stages I, justifying their segregation as an independent histologic type in the WHO classification.

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Section: Discussionmentioning

confidence: 99%

Section: 76mentioning

confidence: 99%

Pulmonary Carcinomas With Pleomorphic, Sarcomatoid, or Sarcomatous Elements

Rossi

Cavazza

Stürm

et al. 2003

The American Journal of Surgical Pathology

342

207

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“…Gels, containing a 1 Â TBE buffer were run with a discontinuous buffer system (25 mM tris and 192 mM glycine). Electrophoresis was performed at 90 V for 17-18 h on a PROTEAN II XI cell (BIORAD) at room temperature, and the gels were stained with 0.1% AgNO 3 . Results of SSCP analysis were confirmed performing two independent experiments, and the DNA samples of all cases exhibiting aberrant bands were sequenced as described.…”

Section: Microdissection and K-ras Gene Analysismentioning

confidence: 99%

“…These tumors have been variously designated in the past as biphasic and monophasic sarcomatoid carcinoma, pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, pseudosarcoma, pulmonary blastoma and carcinosarcoma. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The latest recommendations of the World Health Organization have eliminated most of these terms, 1 confirming the designation of pleomorphic carcinomas to either pure neoplasms consisting of sarcomatoid spindle and giant tumor cells or biphasic neoplasms containing sarcomatoid spindle and/or giant cell components (accounting for at least 10% of the tumor mass) and conventional non-small-cell lung carcinoma, including squamous cell carcinoma, adenocarcinoma or large-cell carcinoma. These tumors may be differentiated from carcinosarcomas for the lack of a true malignant heterologous mesenchymal component, such as bone, cartilage, vessels or skeletal muscle, 10 and from pulmonary blastomas for the lack of primitive mesenchymal and epithelial tumor cells.…”

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confidence: 99%

“…1,20 Pleomorphic carcinomas are basically thought to be epithelial tumors in which neoplastic cells undergo an epithelial-mesenchymal transition 21 and express vimentin and other mesenchymal proteins. 3,7,[13][14][15]17,19,22 In different anatomical sites, most, but not all, of these tumors composed of carcinoma and sarcoma or sarcoma-like components are considered monoclonal growths (the so-called divergent hypothesis) rather than true collision tumors (convergent hypothesis). 20,[23][24][25][26][27][28][29][30][31] In turn, these monoclonal growths may originate from a single ancestor undergoing divergent epithelial and mesenchymal differentiation early during the neoplastic transformation (combination theory), or the full-blown carcinoma cells undergo sarcomatoid changes during tumor progression (conversion theory).…”

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K-ras gene mutational analysis supports a monoclonal origin of biphasic pleomorphic carcinoma of the lung

et al. 2004

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We investigated 27 pleomorphic carcinomas of the lung for exon 1 K-ras gene mutations using polymerase chain reaction-single-strand conformation polymophism analysis and direct sequencing. All pleomorphic carcinomas were biphasic, that is, composed of an adeno-, squamous-or large-cell-carcinomatous component associated with a spindle-and/or giant-cell component. Of 27 cases, six (22%) showed K-ras codon 12 mutations, which is a figure higher than that previously reported on in pure sarcoma-like pleomorphic carcinomas. Five tumors displayed the same mutation in both the epithelial and the sarcomatoid components, whereas in one tumor the mutation was restricted to the epithelial component. All mutations occurred in smokers, and were transversions, including GGT (glycine) to TGT (cysteine) change in two cases, to GCT (alanine) in two and to GTT (valine) in two. No significant relationships were found between the occurrence and type of mutations and patients' survival or any other clinicopathological variable, suggesting that K-ras mutations are early events in the development of these tumors. Our results indicate that most, though not all, biphasic pleomorphic carcinomas of the lung are monoclonal in origin, and that cigarette smoking may have a causative role in the development of K-ras alterations in these tumors, as all mutations are transversions.

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Sarcomatoid carcinoma of the lung

Nakajima

Kasai

Hashimoto

et al. 1999

Cancer

110

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BACKGROUND Spindle and giant cell carcinomas of the lung are rare subtypes and are regarded as one type of lung carcinoma, termed pleomorphic carcinoma in the Armed Forces Institute of Pathology classification. This classification is different from the World Health Organization classification. METHODS Thirty‐seven cases of sarcomatoid (spindle and/or giant cell) carcinoma of the lung were studied by light microscopy, conventional histochemistry, and immunohistochemistry to establish their clinical and histologic characteristics. RESULTS The patient population was comprised of 29 men and 8 women ages 33–81 years. Seventeen patients died of their disease and there was no statistically significant difference in patient prognosis between sarcomatoid carcinoma and nonsarcomatoid carcinoma of the lung. Using light microscopy, 5 cases (13.5%) comprised entirely of sarcomatoid components without carcinomatous elements were classified as Group A. In the remaining 32 cases (86.5%), classified as Group B, carcinomatous components were present (adenocarcinoma [18 cases; 48.7%], squamous cell carcinoma [8 cases; 21.6%], and large cell carcinoma [6 cases; 16.2%]). Sarcomatoid components were divided further into three categories: spindle cell type, giant cell type, and mixed spindle and giant cell type. Immunohistochemically, the sarcomatoid components of all 37 cases were positive for cytokeratins. Statistically, there was no significant prognostic difference between the 37 cases of sarcomatoid carcinoma and 647 cases of nonsarcomatoid, nonsmall cell carcinoma of the lung (P = 0.8537). CONCLUSIONS The sarcomatoid portions in all sarcomatoid carcinomas in the current study showed an epithelial differentiation, and there was no apparent difference in biologic behavior between sarcomatoid carcinoma and ordinary lung carcinoma. Cancer 1999;86:608–16. © 1999 American Cancer Society.

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Pulmonary giant cell carcinoma: pathological entity or morphological phenotype?

Cited by 52 publications

References 24 publications

Pulmonary Carcinomas With Pleomorphic, Sarcomatoid, or Sarcomatous Elements

Pulmonary Carcinomas With Pleomorphic, Sarcomatoid, or Sarcomatous Elements

K-ras gene mutational analysis supports a monoclonal origin of biphasic pleomorphic carcinoma of the lung

Sarcomatoid carcinoma of the lung

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