Lung cancer classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA; Cafer Zorkun, M.D., Ph.D. [2]; Rim Halaby, M.D. [3]

Overview

Primary lung cancer can be classified into two main categories: small cell lung cancer (~15%) and non small cell lung cancer (~85%). Non small cell lung cancer includes several subtypes grouped together because their prognosis and management are similar. The 2004 WHO histological classification of tumors of the lung categorized lung tumors into malignant epithelial tumors, benign epithelial tumors, lymphoproliferative tumors, miscellaneous tumors, and metastatic tumors.

Classification

Lung cancer

Small cell lung cancer (~15%)

Non small cell lung cancer (~85%) Squamous cell carcinoma (25% of lung cancers) Adenocarcinoma (40% of lung cancers) Large cell carcinoma (10% of lung cancers) Adenosquamous carcinoma Carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements Carcinoid tumor Lung carcinoma of salivary gland type Unclassified carcinoma

• Primary lung cancer can be classified into two main categories: small cell lung cancer (~15%) and non small cell lung cancer (~85%).
• There are three main sub-types of non small cell lung cancer , which are grouped together because their prognosis and management are similar:
  • Squamous cell carcinoma (25% of lung cancers)
  • Adenocarcinoma (40% of lung cancers) and large cell lung carcinoma (10% of lung cancers)
  • Large cell carcinoma (10% of lung cancers)
• A subtype of adenocarcinoma, the bronchioloalveolar carcinoma, is more common in female never-smokers, and may have different responses to treatment.

WHO Histological Classification of Tumors of the Lung

Malignant Epithelial Tumors

• Squamous cell carcinoma

• Papillary
• Clear cell
• Small cell
• Basaloid

• Small cell carcinoma

• Combined small cell carcinoma

• Adenocarcinoma

• Adenocarcinoma, mixed subtype
• Acinar adenocarcinoma
• Papillary adenocarcinoma
• Bronchioloalveolar carcinoma

• Nonmucinous
• Mucinous
• Mixed nonmucinous and mucinous or indeterminate

• Solid adenocarcinoma with mucin production

• Fetal adenocarcinoma
• Mucinous (“colloid”) carcinoma
• 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

• Adenosquamous carcinoma

• Sarcomatoid carcinoma

• Pleomorphic carcinoma
• Spindle cell carcinoma
• Giant cell carcinoma
• Carcinosarcoma
• Pulmonary blastoma

• Carcinoid tumor

• Typical carcinoid
• Atypical carcinoid

• Salivary gland tumors

• Mucoepidermoid carcinoma
• Adenoid cystic carcinoma
• Epithelial-myoepithelial carcinoma

• Preinvasive lesions

• Squamous carcinoma in situ
• Atypical adenomatous hyperplasia
• Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

• Mesenchymal tumors

• Epithelioid haemangioendothelioma
• Angiosarcoma
• Pleuropulmonary blastoma
• Chondroma
• Congenial peribronchial myofibroblastic tumor
• Diffuse pulmonary lymphangiomatosis
• Inflammatory myofibroblastic tumor
• Lymphangioleiomyomatosis
• Synovial sarcoma

• Monophasic
• Biphasic

• Pulmonary artery sarcoma
• Pulmonary vein sarcoma

Benign Epithelial Tumors

• Papillomas

• Squamous cell papilloma

• Exophytic
• Inverted

• Glandular papilloma
• Mixed squamous cell and glandular papilloma

• Adenomas

• Alveolar adenoma
• Papillary adenoma
• Adenomas of the salivary gland type

• Mucous gland adenoma
• Pleomorphic adenoma
• Others

• Mucinous cystadenoma

Lymphoproliferative Tumors

• Marginal zone B-cell lymphoma of the MALT type
• Diffuse large B-cell lymphoma
• Lymphomatoid granulomatosis
• Langerhans cell histiocytosis

Miscellaneous Tumors

• Hamartoma
• Sclerosing hemangioma
• Clear cell tumor
• Germ cell tumors

• Teratoma, mature
• Immature
• Other germ cell tumors

• Intrapulmonary thymoma

• Melanoma

References

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