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. Cafer Zorkun, M.D., Ph.D. [2] Rim Halaby, M.D. [3] Dildar Hussain, MBBS [4]

Overview

Primary lung cancers may be classified into 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

Primary lung cancers may be classified into two main categories:

• Small cell lung cancer (~15%)
• Non small cell lung cancer (~85%).

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:

Epithelial tumors

• Adenocarcinoma
  • Lepidic adenocarcinoma
  • Acinar adenocarcinoma
  • Papillary adenocarcinoma
  • Micropapillary adenocarcinoma
  • Solid adenocarcinoma
  • Invasive mucinous adenocarcinoma
    • Mixed invasive mucinous
    • Nonmucinous adenocarcinoma
  • Colloid adenocarcinoma
  • Fetal adenocarcinoma
  • Enteric adenocarcinoma
  • Minimally invasive adenocarcinoma
  • Nonmucinous
    • Mucinous
  • Preinvasive lesions
    • Atypical adenomatous hyperplasia
    • Adenocarcinoma in situ
      • Nonmucinous
      • Mucinous

• Squamous cell carcinoma
  • Keratinizing squamous cell carcinoma
  • Nonkeratinizing squamous cell carcinoma
  • Basaloid squamous cell carcinoma
  • Preinvasive lesion
    • Squamous cell carcinoma in situ

Neuroendocrine tumors

• Small cell carcinoma
  • Combined small cell carcinoma
• Large cell neuroendocrine carcinoma
  • Combined large cell neuroendocrine carcinoma
• Carcinoid tumors
  • Typical carcinoid tumor
  • Atypical carcinoid tumor
• Preinvasive lesion
  • Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
• Large cell carcinoma
• Adenosquamous carcinoma
• Sarcomatoid carcinomas
  • Pleomorphic carcinoma
  • Spindle cell carcinoma
  • Giant cell carcinoma
  • Carcinosarcoma
  • Pulmonary blastoma
• Other and Unclassified carcinomas
  • Lymphoepithelioma-like carcinoma
  • NUT carcinoma
• Salivary gland-type tumors
  • Mucoepidermoid carcinoma
  • Adenoid cystic carcinoma
  • Epithelial-myoepithelial carcinoma
  • Pleomorphic adenoma

• Papillomas
  • Squamous cell papilloma
    • Exophytic
    • Inverted
  • Glandular papilloma
  • Mixed squamous and glandular papilloma
• Adenomas
  • Sclerosing pneumocytoma
  • Alveolar adenoma
  • Papillary adenoma
  • Mucinous cystadenoma
  • Mucous gland adenoma

Mesenchymal tumors

• Pulmonary hamartoma
• Chondroma
• PEComatous tumors
  • Lymphangioleiomyomatosis
  • PEComa, benigne
    • Clear cell tumor
  • PEComa, malignant
• Congenital peribronchial myofibroblastic tumor
• Diffuse pulmonary lymphangiomatosis
• Inflammatory myofibroblastic tumor
• Epithelioid hemangioendothelioma
• Pleuropulmonary blastoma
• Synovial sarcoma
• Pulmonary artery intimal sarcoma
• Pulmonary myxoid sarcoma with EWSR1–CREB1 translocation
• Myoepithelial tumors
  • Myoepithelioma
  • Myoepithelial carcinoma

Lymphohistiocytic tumors

• Extranodal marginal zone lymphomas of mucosa-associated Lymphoid tissue (MALT lymphoma)
• Diffuse large cell lymphoma
• Lymphomatoid granulomatosis
• Intravascular large B cell lymphoma
• Pulmonary Langerhans cell histiocytosis
• Erdheim–Chester disease

Tumors of ectopic origin

• Germ cell tumors
  • Teratoma, mature
  • Teratoma, immature
• Intrapulmonary thymoma
• Melanoma
• Meningioma, NOS

References

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