2771 cases of clinicopathological analysis of pulmonary neoplasm

Objective: To analyze clinicopathological features and observe the pathological type and distribution among pulmonary neoplasm in Affiliated Hospital of Academy of Military Medical Sciences, according to the World Health Organization criteria(2015). Methods: A retrospective analysis of 2 771 cases of pulmonary neoplasm from November 1st 2010 to March 31 th 2015 was made by authors. All the histopathological slides including HE slides and immunohistochemistry slides were re-examined and the medical records were reviewed. Results: Among the 2 771 cases, most patients were males(1 671 cases), which accounted for 60.30%, and rare cases were females(1 100 cases), which accounted for 39.70%; the left lung patients were 1 286 cases, which accounted for 46.41%, the right lung patients were 1 456 cases, which accounted for 52.54%, and the bilateral lung patients were 29 cases, which accounted for 1.05%; ages ranged from 16 to 91. A total of 1 622 cases were adenocarcinoma(58.53%), 424 cases were squamous carcinomas(15.30%), 32 cases were adenosquamous carcinoma(1.15%), 465 cases were neuroendocrine tumors(16.78%), 19 cases were large cell carcinoma(0.69%), 1 case was spindle cell carcinoma(0.04%), 1 case was giant cell carcinoma(0.04%), 17 cases were carcinosarcoma(0.61%), 1 case was lymphoepithelioma-like carcinoma(0.04%), 4 cases were salivary gland-type tumours(0.14%), 11 cases were adenomas(0.40%), 55 cases were mesenchymal tumours(1.98%), 7 cases were lymphoma(0.25%), 13 cases were tumours of ectopic origin(0.47%), 99 cases were metastatic tumours(3.57%). The positive rates of TTF-1 and Napsin A antibody were 92.60%(1 263/1 364) and 97.07%(1 324/1 364) in NSCLC-NOS, favor adenocarcinoma small biopsies; the positive rates of CK5/6, P40 and P63 antibody were 96.99%(290/299), 98.51%(66/67) and 93.72%(343/366) in NSCLC-NOS, favor squamous carcinomas small biopsies; among non-small cell lung cancer, 34.77%(378/1087) have EGFR gene mutations, 2.92%(24/823) have KRAS gene mutations, 0.87%(5/572) have BRAF gene mutations, 11.99%(41/342) have ALK fusion gene, 22.23%(66/296) have the positive of ALK-D5F3 antibody, 2.56%(7/273) have ROS1 fusion gene, 4.40%(12/273) have c-Met gene amplification, 6.67%(1/15) have c-Met gene mutation, 0.73%(2/273) have Her-2 gene mutations, 13.33%(2/15) have PIK3 CA gene mutations, 6.67%(1/15) have PTEN gene mutation, and none has RET or NTRK1 fusion gene in primary biopsy. The second biopsy rate was 4.76%(18/378) in EGFR gene mutations, and 2.44%(1/41) in ALK fusion genes. Conclusion: Male patients have high incidence of lung neoplasms, and the most common lesions were in the right lung. Adenocarcinoma has become the most common pathological type in lung cancer. The mutation rate of EGFR gene and ALK fusion gene are high, and other genes are low but they should not be ignored in primary biopsy. We should pay attention to the second biopsy rate which is relatively low.