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 cancers may be classified into two main categories: small cell lung cancer (~15%) and non small cell lung cancer (~85%). Non small cell lung cancer are a heterogenous group of lung cancers that are often grouped together because they share similar clinical features (e.g. prognosis and management). 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). Bronchioloalveolar carcinoma is a subtype of adenocarcinoma, is more common among female never-smokers, and may have different responses to treatment. Large cell carcinoma (10% of lung cancers) Other non-small cell lung carcinomas: Adenosquamous carcinoma Carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements Carcinoid tumor Lung carcinoma of salivary gland type Unclassified carcinoma

WHO Histological Classification of Tumors of the Lung

The World Health Organization (WHO) classifies tumors of the lungs as follows:

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

Sarcomatoid carcinoma

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

Carcinoid tumor

• Typical carcinoid
• Atypical carcinoid

Other tumors that may affect the lungs

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
• Pulmonary artery sarcoma
• Pulmonary vein sarcoma

Benign Epithelial Tumors

• Papillomas

• Squamous cell papilloma (either exophytic or 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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