<B>Adenocarcinoma of Lung </B>

[©]

Adenocarcinoma of Lung

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 Correlations:

• 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. W.B. Saunders. Philadelphia 1994. pp.720-25.