Our June 2014 Pulmonary Pathology Reviews comes to us courtesy of Kelly Butnor from the spectacularly beautiful University of Vermont. In it she reviews articlesfrom the May 2014 peer-reviewed print literature of potential value to those with interest in diagnostic pulmonary pathology. Check out her OVERVIEW for a quick synopsis of what's hot and what's not, followed by an ARTICLE INDEX with links to PubMed abstracts and full text versions if your institution is appropriately licensed. Click here if you want her text summary in PDF format, information-dense crib notes for those who want the facts without having to read the full article. And if you want to listen to the teleconference as it went down at 09:15 EDT on Monday, June 30th, click here for the MP3 audiofile (and be patient - depending on your bandwidth it make take awhile to load!).
From the published annals of May 2014, thirty-one articles were selected for review and as has been the trend, pulmonary neoplasia and, in particular, the molecular aspects thereof, reigned supreme. Up for discussion are 5 articles on a diversity of topics within the realm of thoracic pathology.
Gulati et al address the very real-world issue of what happens to patients with ground glass nodules on CT whose biopsy findings are suspicious for lung adenocarcinoma but elect to be observed. The answer, apparently, is nothing too detrimental, in that no lung cancer deaths or distant metastasis occurred during the follow-up period. Although about one-third of patients did have interval growth or partial nodule solidification, prompting most to ultimately decide to undergo definitive therapy, delayed resection did not appear to have an adverse effect on outcome.
It seems more often than not, biopsies of mesothelial proliferations are too superficial to confidently assess invasion. Although homozygous p16 deletion by FISH has been used to facilitate the diagnosis of malignant mesothelioma, the p16 status of surface mesothelial proliferations that are separate from invasive tumor has not been characterized until now. Hwang et al show that the p16 status of surface mesothelial proliferations corresponds to the invasive component. The authors conclude that in the appropriate clinicoradiographic setting, a positive p16 deletion result can permit a diagnosis of mesothelioma in samples containing only a superficial mesothelial proliferation.
A different author by the same name attempts to further shrink the wastebasket that is large cell carcinoma. Hwang et al provide a host of evidence that aside from not meeting the WHO criterion for intracellular mucin, large cell carcinoma lacking squamous or neuroendocrine differentiation is indistinguishable from solid-subtype adenocarcinoma and should be reclassified as such.
Not all stage I acinar-subtype lung adenocarcinomas are created equal. Kadota et al show that a cribriform pattern, which under the IASLC/ATS/ERS system, is classified as acinar adenocarcinoma, is associated with a high risk of recurrence even if it comprises only 10% of the tumor.
Shekhel et al report on the clinicopathologic characteristic of pleural coccidioidomycosis, which is far rarer and pulmonary parenchymal disease, emphasizing the need for liberal sampling, as the concentration of spherules in infected pleural tissue is often low.
Other highlights include articles by King et al and Richelidi et al, in which 2 different pharmacologic agents appear to actually slow the progression of IPF and yet another study showing ALK immunohistochemistry is ready for prime time when it comes to accurately detecting rearranged carcinomas that may respond to crizotinib by Wynes et al.
ARTICLE INDEX (with PubMed links)
Articles for Discussion
Gulati et al. Outcomes of unresected ground-glass nodules with cytology suspicious for adenocarcinoma. J Thorac Onc 2014;9:685-691
Hwang et al. p16 FISH deletion in surface epithelial mesothelial proliferations is predictive of underlying invasive mesothelioma. Am J Surg Pathol 2014;38:681-688
Hwang et al. Pulmonary large cell carcinoma lacking squamous differentiation is clinicopathologically indistinguishable from solid-subtype adenocarcinoma. Arch Pathol Lab Med 2014;138:626-635
Kadota et al. The cribriform pattern identifies a subset of acinar predominant tumors with poor
prognosis in patients with stage I lung adenocarcinoma: a conceptual proposal to classify cribriform predominant tumors as a distinct histologic subtype. Mod Pathol 2014;27:690-700
Shekhel et al. Surgical pathology of pleural coccidioidomycosis: a clinicopathological study of 36 cases. Hum Pathol 2014;45:961-969
Articles for Notation
Allo et al. Epidermal growth factor receptor mutation-specific immunohistochemical antibodies in lung adenocarcinoma. Histopathology 2014;64:826–839
An et al. Unusual expression of thyroid transcription factor 1 and napsin A in metastatic adenoid cystic carcinoma of extrapulmonary origin in the lung. Am J Clin Pathol 2014;141:712-717
Ao et al. The utility of a novel triple marker (combination of TTF1, napsin A, and p40) in the subclassification of non–small cell lung cancer. Hum Pathol 2014;45:926-934
Calio et al. ALK/EML4 fusion gene may be found in pure squamous carcinoma of the lung. J Thorac Onc 2014;9:729-732
Campos-Parra et al. Relevance of the novel IASLC/ATS/ERS classification of lung adenocarcinoma in advanced disease. Eur Respir J 2014;43:1439-1447
Clay et al. The clinical relevance of pathologic subtypes in metastatic lung adenocarcinoma. J Thorac Onc 2014;9:654-663
De Cos Escuin et al. Tumor, node and metastasis classification of lung cancer – M1a versus
M1b – Analysis of M descriptors and other prognostic factors. Lung Cancer 2014;84:182-189
Hamanaka et al. A subset of small cell lung cancer with low neuroendocrine expression and good prognosis: a comparison study of surgical and inoperable cases with biopsy. Hum Pathol 2014;45:1045–1056
Kim et al. Impact of cigarette smoking on response to epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors in lung adenocarcinoma with activating EGFR mutations. Lung Cancer 2014;84:196-202
King et al. A Phase 3 trial of Pirfenidone in patients with idiopathic pulmonary fibrosis. N Engl J Med 2014;370: 2083-92
Mizukami et al. Molecular mechanisms underlying oncogenic RET fusion in lung adenocarcinoma. J Thorac Onc 2014;9:622-630
Pan et al. ALK, ROS1 and RET fusions in 1139 lung adenocarcinomas: a comprehensive study of common and fusion pattern-specific clinicopathologic, histologic and cytologic features. Lung Cancer 2014;84:121-126
Richeldi et al. Efficacy and safety of Nintedanib in idiopathic pulmonary fibrosis. N Engl J Med 2014;370: 1079-87
Wagner et al. Chromogenic in situ hybridisation (CISH) is a powerful method to detect ALK-positive non-small cell lung carcinomas. J Clin Pathol 2014;67:403-407
Wang et al. Classification of thymic epithelial neoplasms is still a challenge to thoracic pathologists - a reproducibility study using digital microscopy. Arch Pathol Lab Med 2014;138:658-663
Wynes et al. An international interpretation study using the ALK IHC antibody D5F3 and a sensitive detection kit demonstrates high concordance between ALK IHC and ALK FISH and between evaluators. J Thorac Onc 2014;9:631-638
Yoshida et al. Immunohistochemical detection of ROS1 is useful for identifying ROS1 rearrangements in lung cancers. Mod Pathol 2014;27:711-720
Review Articles, Consensus Statements, and Editorials
Barker et al. Obliterative bronchiolitis. N Engl J Med 2014;370:1820-1828
Hunninghake. A new hope of idiopathic pulmonary fibrosis. N Engl J Med 2014;370:2142-2143
Kerr et al. ALK testing in non-small cell lung carcinoma: what now? J Thorac Onc 2014;9:593-595
Marx et al. ITMIG consensus statement on the use of the WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Onc 2014;9:596-611
Selman et al. Revealing the pathogenic and aging-related mechanisms of the enigmatic idiopathic pulmonary fibrosis an integral model. Am J Respir Crit Care Med 2014;189:1161-1172
Case Reports and Letters to the Editor
Dziadziuszko et al. Miliary brain metastases in a patient with ROS1-rearranged lung adenocarcinoma – a case report. J Thorac Onc 2014;9:e34-e69
Hirai et al. Experience with erlotinib in lung adenocarcinoma harboring a coexisting KIF5B-RET fusion gene and EGFR mutation - report of a rare case. J Thorac Onc 2014;9:e37-e39
Hsieh et al. Pulmonary tuberculosis presenting as organizing pneumonia. Am J Respir Cirt Care Med 2014;189:e63
Raghu et al. Pulmonary Fibrosis Associated with Aluminum Trihydrate (Corian) Dust. N Engl J Med 2014;370:2154-2156