Tumoral volume and prognosis in limited small-cell lung carcinoma (S.C.L.C.)
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Abstract Context.—The cytologic features of small cell carcinoma of the lung are well described. Nevertheless, some small cell carcinomas may be difficult to reproducibly distinguish from non–small cell carcinomas, and this distinction carries significant clinical importance. Objective.—To correlate the cytologic features of individual cases of small cell carcinoma of the lung in fine-needle aspiration specimens from the College of American Pathologists Non-Gynecologic Peer Comparison Cytology Program with the frequency of misclassification as non– small cell carcinoma. Design.—We reviewed 1185 interpretations of 23 different cases of small cell carcinoma in lung fine-needle aspiration specimens and correlated the cytologic features noted in these cases with performance in the program. Results.—Cases were divided into those that were frequently misclassified as non–small cell carcinoma (at least 10% of the responses, 11 cases) and those that were infrequently misclassified as non–small cell carcinoma (<5% of all responses, 12 cases). All cases had areas on the slides with classic features of small cell carcinoma. However, 10 of 11 cases that were frequently misclassified as non–small cell carcinoma had cells with either increased cytoplasm (4 cases), cytoplasmic globules (so-called paranuclear blue bodies) (3 cases), or apparent intracytoplasmic lumina (3 cases). These features were not identified in cases that were infrequently misclassified (P = .005). In addition, cases more frequently misclassified as non–small cell carcinoma tended to show better overall cellular and group preservation. Conclusions.—Frequent misclassification of small cell carcinoma as non–small cell carcinoma in lung fine-needle aspiration specimens in this program correlates strongly with the presence of cytoplasmic features that may suggest non–small cell carcinoma or with the presence of paranuclear blue bodies. Misclassification in this program may reflect a variety of factors, including the variation in the cytologic features of individual cases, but also the lack of wide recognition that some features of non–small cell carcinoma may also be noted in well-preserved cases of small cell carcinoma.
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Abnormalities of the p53 oncogene in lung cancer have recently been reported to be more frequent in small cell lung cancer (SCLC) than in non-small cell lung cancer (non-SCLC), but their status in combined type SCLC is as yet unknown. In this study, immunohistochemical analysis using a polyclonal antibody against p53 protein was performed in 12 surgically resected specimens of combined type SCLC. Immunoreactivity of the p53 protein was found in 5 (42%) of the 12 cases, and the immunostaining pattern of the p53 protein in areas of the non-small cell carcinoma type was the same as in those of the small cell carcinoma type. Thus, it seems that the incidence of p53 abnormalities in combined type SCLC is slightly lower than in ordinary type SCLC. It is also suggested that abnormalities of the p53 oncogene in this histological type may not be a specific event related to the morphological difference between small cell carcinoma and non-small cell carcinoma.
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e23281 Background: SCCBis a rare, aggressive form of breast cancer that is associated with extremely poor outcomes (Hare 2015). In an effort to identify new treatment options, we utilized comprehensive genomic profiling to assess the potential for novel therapies in SCCB. Methods: Under an IRB approved protocol, we identified patients (pts) with SCCB and SCLC profiled by Caris Life Sciences between 2007-2015. Tumors were assessed with up to 21 IHC stains, in situ hybridization (ISH) of cMET, EGFR, HER2 and TOP2A, and next generation sequencing (NGS) as well as Sanger sequencing of 47 genes. Results: 19 patients with SCCB were identified, median age was 58 years (range 37-79) and 42% had metastatic disease at presentation; for comparison 58 pts with SCLC were identified (66 [36-86], 65% metastatic). By IHC 30% SCCB pts expressed ER, 15% expressed PR and 18% expressed androgen receptor; SCLC pts expressed ER 0%, PR 2%, AR 6%. SCCB and SCLC pts had similar patterns of other IHC expression (0% v 0% PDL1, 50% v 42% PD1, 80% v 95% TOP2A, respectively). All SCCB and SCLC pts were negative for HER2 and cMET amplification by ISH. NGS revealed TP53 mutations in 75% of patients both with SCCB and SCLC and PIK3CA mutations in 38% of SCCB pts but no SCLC pts (Fisher’s exact test p = 0.005, OR 0.02 [0.00-0.52]). No other mutations were found in SCCB pts and no other mutation occurred in over 10% of SCLC pts except RB1 in 20% (p = 0.31). Conclusions: SCCB is an aggressive tumor with few therapeutic options. Molecular profiling suggests many similarities between SCCB and SCLC with the exception an increased incidence of PIK3CA mutations in SCCB, which may have therapeutic implications.
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Abstract Context.—The cytologic features of small cell carcinoma of the lung are well described. Nevertheless, some small cell carcinomas may be difficult to reproducibly distinguish from non–small cell carcinomas, and this distinction carries significant clinical importance. Objective.—To correlate the cytologic features of individual cases of small cell carcinoma of the lung in fine-needle aspiration specimens from the College of American Pathologists Non-Gynecologic Peer Comparison Cytology Program with the frequency of misclassification as non– small cell carcinoma. Design.—We reviewed 1185 interpretations of 23 different cases of small cell carcinoma in lung fine-needle aspiration specimens and correlated the cytologic features noted in these cases with performance in the program. Results.—Cases were divided into those that were frequently misclassified as non–small cell carcinoma (at least 10% of the responses, 11 cases) and those that were infrequently misclassified as non–small cell carcinoma (<5%...
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