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| Adenocarcinoma |
| Etiology • Least closely associated with cigarette smoking of all lung cancers • Radiation, air pollution and genetic predisposition may also play a role |
| Pathogenesis • BPDE (catabolite of benzo[a]pyrene in cigarette smoke) binds p53 mutational hot spots in lung carcinoma • p53 mutation affects cell replication and centromere replication, |
| Epidemiology • Accounts for 25-40% of all lung cancers. |
| General Gross Description • Often peripheral location • May involve the pleura causing puckering and scarring. • May be associated with pleural effusion • Cut surfaces often glisten and are yellow if abundant mucin secretion within the tumor • May be unassociated with large bronchus |
| General Microscopic Description • Usual bronchial adenocarcinoma is gland forming • Mucus secretion may require special stains such as mucicarmine or PAS • Cells show large nuclei with prominent nucleoli • Variants include bronchoalveolar carcinoma which spreads along preexisting alveolar septae |
| Clinical Correlation • Peripheral location associated with pleuritic chest pain and effusion. • Weight loss and dyspnea • Staging dependent on extent of disease ranging from I (confined to the lung with >2 cm distance from hilum and pleura) to IV (metastatic disease) • Metastases to lymph nodes, brain, liver, and adrenals • Surgical treatment is preferred; many patients have insufficient pulmonary reserve for treatment • Overall five year survival 10% |
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th edition. Philadelphia, W.B. Saunders, 1994, pp. 720-25. |
| Adenocarcinoma |
| Synopsis by: Melinda Sanders M.D. (T28000M81403)[126] |
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