Pulmonary intestinal-type adenocarcinoma does not show enteric differentiation by immunohistochemical study

Yousem, Samuel A.

doi:10.1038/modpathol.3800358

Cited by 64 publications

(59 citation statements)

References 30 publications

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“…Some of the cases in our study showed some of the features described by Yousem 30 and Inamura 31 resembling colorectal carcinoma, but our series further expands the morphologic spectrum that these tumors can display. This is of importance for differential diagnosis as tumors other than colorectal adenocarcinomas demonstrating a prominent cribriform growth pattern are capable of metastasizing to the lung and can arise from diverse sites such as the gallbladder, 33 paranasal sinuses, 34 urinary bladder, 35 breast, 11 prostate, 10 pancreas, 36 salivary glands, 37 thyroid, 38 sweat glands, stomach, ovary, 39 uterus, and endocervix.…”

Section: Discussionmentioning

confidence: 71%

“…29 The tumors were characterized by a predominant component of neoplastic tall columnar cells admixed with goblet cells and Paneth cells, with occasional features of neuroendocrine differentiation. More recently, pulmonary intestinal-type adenocarcinomas have also been described by Yousem 30 and by Inamura. 31 The tumors described by Yousem were characterized by a garland-like architecture, central 'dirty' necrosis, and stratified tall columnar cells lacking significant goblet cell or signet-ring features lining the glands.…”

Section: Discussionmentioning

confidence: 95%

“…A cribriform arrangement of the neoplastic cells in which luminal spaces were filled with mucinous material and necrotic debris was a feature of those tumors. Based on the patterns of immunoreactivity, pulmonary adenocarcinomas with enteric features can be divided into those showing positivity for TTF-1/CK7 and negativity for CDX2/CK20 (ie, lung adenocarcinoma with enteric morphology), 30 and those showing CD20/CDX2 positivity and negative CK7/TTF1 (ie, lung adenocarcinoma with enteric differentiation). 31,32 The majority of the enteric-type tumors, however, appear to exhibit a primary lung phenotype and, thus, display only enteric morphology.…”

Section: Discussionmentioning

confidence: 99%

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Cribriform adenocarcinoma of the lung: clinicopathologic, immunohistochemical, and molecular analysis of 15 cases of a distinctive morphologic subtype of lung adenocarcinoma

et al. 2014

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Lung adenocarcinoma is characterized by marked heterogeneity and may be composed of an admixture of histologic growth patterns, including acinar, papillary, solid, and lepidic (bronchioloalveolar). Tumors displaying a prominent or predominant cribriform architecture are rare and most often confused for metastases from other organs. We report the clinical, histologic, immunohistochemical, and molecular features in 15 primary lung adenocarcinomas with a predominant cribriform histology. All patients were adults between 30 and 80 years of age (median: 64), and all but one reported a history of heavy cigarette smoking. All cases showed a predominant (470%) cribriform architecture that resembled a variety of tumors arising in other organs, including breast, prostate, ovary, pancreas, uterus, colon, and thyroid. Immunohistochemical stains showed a phenotype consistent with a primary lung tumor (ie, TTF1 þ /CK7 þ ), with negative results for other markers. Molecular analysis in six cases showed that none harbored an EGFR-activating mutation. KRAS mutation was detected in one case, and an ALK1 and ROS1 gene rearrangement were each detected in an additional two cases. Cribriform adenocarcinomas of the lung represent a distinctive histologic subtype of lung cancer that may be morphologically difficult to differentiate from metastases with a predominant cribriform architecture.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Cribriform adenocarcinoma of the lung: clinicopathologic, immunohistochemical, and molecular analysis of 15 cases of a distinctive morphologic subtype of lung adenocarcinoma

et al. 2014

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“…CDX2 is expressed in a high proportion of colorectal carcinomas (61-100%) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] whereas the reported range of expression in primary ovarian mucinous tumors (the majority reported being carcinomas) is broad (0-100%). 3,4,[7][8][9][11][12][13][14][15][16]19,22,23 Most studies have evaluated CDX2 and CK20 in ovarian mucinous tumors as independent markers; 7,9,12,14,16 very few studies have addressed coordinate expression with CK7 22,23 and none has performed an analysis of coordinate expression profiles directly comparing the performance of CDX2 and CK20, when combined with CK7, in the same group of tumors.…”

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confidence: 99%

Immunohistochemical expression of CDX2 in primary ovarian mucinous tumors and metastatic mucinous carcinomas involving the ovary: comparison with CK20 and correlation with coordinate expression of CK7

et al. 2006

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Recent studies have demonstrated conflicting results regarding the value of CDX2 for distinguishing primary ovarian mucinous tumors from metastatic mucinous carcinomas in the ovary. Utility of coordinate expression of cytokeratins 7 and 20 is restricted to distinction of ovarian mucinous tumors from lower gastrointestinal tract metastases and data comparing coordinate expression of all three markers is limited. Immunohistochemical studies were performed to compare expression of CDX2 and cytokeratin 20, both markers of intestinal differentiation, in conjunction with coordinate expression of cytokeratin 7, in 90 mucinous tumors involving the ovary: 42 primary ovarian mucinous tumors (31 atypical proliferative (borderline) mucinous tumors (gastrointestinal type), 11 mucinous carcinomas) and 48 metastatic mucinous carcinomas of upper (pancreaticobiliary tract: 14; stomach: five) and lower (colon and rectum: 25; appendix: four) gastrointestinal tract origin. Primary ovarian tumors expressed CDX2 (40%) less frequently than cytokeratin 20 (83%) (Po0.0001). CDX2 expression in primary ovarian tumors (40%) was lower than CDX2 expression in metastatic carcinomas of both upper (74%; P ¼ 0.016) and lower gastrointestinal tract origin (90%; Po0.0001). Cytokeratin 20 expression was similar in primary ovarian tumors (83%) and metastases of upper (89%; P ¼ 0.071) and lower gastrointestinal tract origin (93%; P ¼ 0.29). Thus, as a single marker CDX2 offers some advantage over cytokeratin 20 because it is less frequently positive in primary ovarian tumors. In the almost universally cytokeratin 7-positive primary ovarian tumors and metastases of upper gastrointestinal tract origin, CDX2 coordinate expression was less common in primary ovarian tumors (36%) than in metastases of upper gastrointestinal tract origin (63%) (P ¼ 0.022) whereas cytokeratin 20 coordinate expression was identical in both tumor types (79%). In the almost universally cytokeratin 7-negative metastases of lower gastrointestinal tract origin, coordinate expression of CDX2 (83%) and cytokeratin 20 (86%) were equivalent (P ¼ 1.00). CDX2 was comparable to cytokeratin 20 in distinguishing metastases of lower gastrointestinal tract origin (usually cytokeratin 7-negative and CDX2/cytokeratin 20 positive) from primary ovarian tumors and metastases of upper gastrointestinal tract origin (usually cytokeratin 7-positive and CDX2/cytokeratin 20 variable). CDX2 provided some advantage over cytokeratin 20 for distinguishing primary ovarian mucinous tumors from metastases of upper but not lower gastrointestinal tract origin; however, the advantage in the former was limited due to the occurrence of shared coordinate expression profiles in both tumor types. Cytokeratin 7 provides the predominant discriminatory value among these markers yet is limited to distinction of primary ovarian tumors from metastases of lower gastrointestinal tract origin.

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“…Immunohistochemical markers can reliably differentiate between primary lesions at both sites, as lung adenocarcinomas express thyroid transcription factor-1 (TTF-1) and cytokeratin 7 (CK7) but not cytokeratin 20 (CK20) or CDX-2, whereas primary colon adenocarcinomas express CK20 and CDX-2 but not TTF-1 or CK7. [8] One study demonstrates that a combination of TTF-1+, CK7+, CK20-is highly specific for lung adenocarcinoma (p < .001), and TTF-1-, CK7-, CK20+ is extremely specific for gastrointestinal adenocarcinoma (p < .001). [9] This case occurred prior to the development of these markers.…”

Section: Discussionmentioning

confidence: 99%

Metastatic lung carcinoma presenting as intussusception of the ascending colon

Halleran

Onderdonk

2016

CRCP

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Introduction: Lung cancer remains a leading cause of cancer deaths worldwide, and an estimated 50% of cases are associated with metastasis at the time of diagnosis. We present the case of a 45-year-old female smoker with a history of right upper lobectomy with radiation for lung adenocarcinoma who, nine months later, presented with abdominal pain and was found to have an isolated metastatic lesion to the cecum causing intussusception. Case description: A 45-year-old woman presented with a two-day history of abdominal pain, melena, fever, and chills. A diagnostic workup revealed a mass in the cecum and a colocolic intussusception. The patient underwent right hemicolectomy and was discharged following a slow recovery. Microscopic examination of the lesion revealed an adenocarcinoma histologically identical to the primary lung tumor. Further workup failed to uncover any further evidence of disease. The patient continues to be well after 23 years of clinical follow-up. Discussion: Metastasis to the colon is a rare event but represents advanced disease and the prognosis is poor. Symptomatic involvement of the colon has only been reported in fourteen previous cases. Conclusions: Although uncommon, metastatic disease from lung to colon should be considered in patients with lung and large bowel masses diagnosed within a relatively short time course. More likely are synchronous primaries or colon metastasis to the lung, but an accurate diagnosis is critical. Lung metastasis to the bowel portends a poor prognosis, but isolated metastatic disease can be surgically resected for cure as demonstrated in our case.

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Pulmonary intestinal-type adenocarcinoma does not show enteric differentiation by immunohistochemical study

Cited by 64 publications

References 30 publications

Cribriform adenocarcinoma of the lung: clinicopathologic, immunohistochemical, and molecular analysis of 15 cases of a distinctive morphologic subtype of lung adenocarcinoma

Cribriform adenocarcinoma of the lung: clinicopathologic, immunohistochemical, and molecular analysis of 15 cases of a distinctive morphologic subtype of lung adenocarcinoma

Immunohistochemical expression of CDX2 in primary ovarian mucinous tumors and metastatic mucinous carcinomas involving the ovary: comparison with CK20 and correlation with coordinate expression of CK7

Metastatic lung carcinoma presenting as intussusception of the ascending colon

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