Adenocarcinoma of the lung biopsy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2]

Overview

Biopsy is helpful in the diagnosis of adenocarcinoma of the lung.

Biopsy

• Biopsy is helpful in the diagnosis of adenocarcinoma of the lung.
  • Fine needle aspiration (FNA):
    • CT guided FNA uses a small amount of tissue from a suspected lung tumour or from a lymph node in the chest.
    • FNA may also be obtained during bronchoscopy, along with endobronchial ultrasound, to take samples of lymph nodes around the trachea and bronchi.

• Thoracentesis
  • Thoracentesis may be done to remove fluid from around the lungs to see if it contains cancer cells.
• On microscopic histopathological analysis, nuclear atypia, eccentrically placed nuclei, abundant cytoplasm, and conspicuous nucleoli are characteristic findings of adenocarcinoma of the lung.
• Atypical adenomatous hyperplasia (AAH): is the precursor of peripheral adenocarcinomas. It consists of well demarcated columnar or cuboidal cells with the following features:
  • Varying degrees of cytologic atypia
  • Hyperchromasia
  • Pleomorphism
  • Prominent nucleoli
• As adenocarcinoma is a derivative of mucus producing glands in the lungs, it tends to stain mucin positive.
• Based on differentiation, the tumor may be:
  • Well differentiated (low grade): Normal appearance
  • Poorly differentiated (high grade): Abnormal glandular appearance with a positive mucin stain
• Subtypes
  • Lepidic predominant:

  • Tumor grows long the alveolar wall

  • Acinar predominant:

  • Berry-shaped glands, smaller than lung acini

  • Papillary predominant:

  • Fibrovascular cores

  • Micropapillary predominant:

  • Nipple shaped projections without fibrovascular cores

  • Solid predominant:

  • Sheet of cells

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