Welcome to the July 2015 edition of Pulmonary Pathology Reviews, a multi-institutional journal club brought to you this month by Kelly Butnor at the University of Vermont. Her OVERVIEW follows highlighting what's hot and what's not in articles that appeared in print in June 2015. Click here if you want her PDF article summary, abstracting essential information from the articles reviewed encapsulating take home messages in a sentence or two for time-crunched readers. Her OVERVIEW is followed by an ARTICLE INDEX that includes links to PubMed abstracts and full text articles for those whose institutions are appropriately licensed. And if you want to hear the unedited teleconference exactly as it went down at 09:15 EDT on Monday, July 27th, click here to download an MP3 audiofile (be patient - depending on bandwidth it can take awhile but is almost always worth the wait!).
Carefully curated from the medical literature published in June 2015 are 19 articles with at least tangential relevance to the practice of diagnostic pulmonary pathology, 4 of which have been selected for discussion.
On the heels of a study by Kadota et al that Dr. Myers presented last month, Warth et al take their turn at elucidating the prognostic significance of STAS (spread through air spaces) in resected pulmonary adenocarcinoma. STAS is a frequent finding in micropapillary adenocarcinoma. The diagnostic value of reporting this morphologic parameter remains unresolved. While STAS is associated with shortened disease-free and overall survival, it is not independent of stage.
Histologic subtype is proving to be an important factor in lung adenocarcinoma outcome. It would be ideal if histologic subtype could be reliably predicted intraoperatively on wedge resections, particularly from patients with marginal lung function, in whom sublobar resection may be desirable for lesions with a low risk of recurrence (e.g. MIA). Alas, Yeh et al show frozen section does not adequately predict predominant histologic subtype, a problem they attribute largely to tumor heterogeneity and sampling error. Frozen section also overestimates the degree of invasion in pulmonary adenocarcinoma, which the authors suggest might be improved by inflating lung tissue with diluted embedding medium prior to sectioning.
Kamata et al call attention to a rare lung tumor for which they offer the descriptive moniker “cilated muconodular papillary tumor.” These small, peripheral tumors, which are characterized by glandular and/or papillary arrangements of bland ciliated columnar cells, mucous cells, and basal cells ensconced in copious mucin, are associated with a benign outcome even when managed by sublobar resection.
Adding to the lexicon of non-neoplastic lung disease, Feinstein et al discuss the features of GOP (granulomatous organizing pneumonia), which is more likely to present as masses/nodules than COP or AFOP. AFOP mortality in this study did not differ significantly from that of COP or GOP and was notably less than in the initial study of this entity by Beasley et al. However, the study population consisted of patients being followed at a cancer center, half of whom were asymptomatic at the time of diagnosis.
Perhaps the biggest news to break in June came in the form of a media release announcing FDA approval of the Ventana D5F3 clone to detect ALK rearrangements immunohistochemically. According to the crizotinib package insert, by virtue of it being a an FDA-approved companion diagnostic test, patients with a positive ALK IHC result do not need confirmatory testing by another methodology to start targeted therapy.
Other good beach reads this summer include a study by Sholl et al on primary pulmonary NUT carcinoma and studies on the suitability of specimens other than lung tumor tissue, including serum, plasma, and malignant effusions, for EGFR and ALK molecular testing by Wu et al and Zhou et al.
ARTICLE INDEX (with PubMed links)
Articles (and Media Release) for Discussion
Warth et al. Prognostic impact of intra-alveolar tumor spread in pulmonary adenocarcinoma. Am J Surg Pathol 2015;39:793–801
Yeh et al. Using frozen section to identify histological patterns in stage I lung adenocarcinoma of ≤3 cm: accuracy and interobserver agreement. Histopathology 2015;66:922–938
Kamata et al. Ciliated muconodular papillary tumors of the lung: a clinicopathologic analysis of 10 cases. Am J Surg Pathol 2015;39:753–760
Feinstein et al. A comparison of the pathological, clinical and radiographical, features of cryptogenic organizing pneumonia, acute fibrinous and organizing pneumonia and granulomatous organizing pneumonia. J Clin Pathol 2015;68:441–447
Ventana Medical Systems. Media Release: Ventana receives FDA approval for the first fully automated IHC companion diagnostic to identify lung cancer patients eligible for XALKORI® (crizotinib)
Articles for Notation
Chang et al. PD-L1 is highly expressed in lung lymphoepithelioma-like carcinoma: a potential rationale for immunotherapy. Lung Cancer 2015;88:254–259
Hattori et al. Evaluation of androgen receptor and GATA binding protein 3 as immunohistochemical markers in the diagnosis of metastatic breast carcinoma to the lung. Pathol Int 2015;65:286–292
Marquez-Medina et al. Little things make big things happen: angiolymphatic invasion and tumor necrosis prognosticate the outcome of locally advanced non–small cell lung cancer treated with a prior induction therapy. Am J Clin Pathol 2015;143:889-894
Sholl et al. Primary pulmonary NUT midline carcinoma: clinical, radiographic, and pathologic characterizations. J Thorac Oncol 2015;10:951–959
Watanabe et al. Biomarker expression and druggable gene alterations for development of an appropriate therapeutic protocol for pulmonary adenosquamous carcinoma. Histopathology 2015,66:939–948
Wu et al. Can EGFR mutations in plasma or serum be predictive markers of non-small-cell lung cancer? A meta-analysis. Lung Cancer 2015;88:246–253
Zenali et al. An update on clinicopathological, immunohistochemical, and molecular profiles of colloid carcinoma of the lung. Hum Pathol 2015;46:836–842
Zhan et al. High expression of transcriptional factor HoxB9 predicts poor prognosis in patients with lung adenocarcinoma. Histopathology 2015;66:955–965
Zhou et al. Cell block samples from malignant pleural effusion might be valid alternative samples for anaplastic lymphoma kinase detection in patients with advanced non-small-cell lung cancer. Histopathology 2015;66:949–954
Davidson. Prognostic factors in malignant pleural mesothelioma. Hum Pathol 2015;46:789–804
Kropski et al. The genetic basis of idiopathic pulmonary fibrosis. Eur Respir J 2015;45:1717–1727
Yazawa. Recent advances in histogenesis research of lung neuroendocrine cancers: Evidence obtained from functional analyses of primitive neural/neuroendocrine cell-specific transcription factors. Pathol Int 2015;65:277–285
Hida et al. Diffuse intrapulmonary malignant mesothelioma presenting with miliary pulmonary nodules: a case report. Pathol Int 2015;65:318–323
Kimura et al. Aspergillus fungal ball in central cavity of a pulmonary cryptococcal nodal lesion Pathol Int 2015;65:329–331
Shan et al. BIRC6-ALK, a novel fusion gene in ALK break-apart FISH-negative lung adenocarcinoma, responds to crizotinib. J Thorac Oncol 2015;106:e37-39