TUMORS OF THE LOWER RESPIRATORY TRACT

by

THOMAS V. COLBY, M.D.
Laboratory of Medicine and Pathology
Mayo Clinic Scottsdale
Scottsdale, Arizona 85259

MICHAEL N. KOSS, M.D.
Co-Chairman
Department of Pulmonary
and Mediastinal Pathology
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000
and
Department of Pathology
University of Southern California
Los Angeles, California 90033

WILLIAM D. TRAVIS, M.D.
Co-Chairman
Department of Pulmonary
and Mediastinal Pathology
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000


Table of Contents

1 Introduction and Classification
  1.1 WHO Histologic Typing of Lung Tumors
2 Embryology, Anatomy, and Congenital, Developmental, and Related Lesions
  2.1 Embryology
  2.2 Anatomy and Histology
  2.3 Congenital Anomalies and Related Lesions
    2.3.1 Bronchial Atresia (Regional or Segmental Pulmonary
          Overinflation)
    2.3.2 Pulmonary Sequestration (Intralobar Sequestration, Extralobar
          Sequestration)
    2.3.3 Congenital Bronchopulmonary Foregut Malformations
    2.3.4 Bronchogenic Cysts (Bronchial Cysts)
    2.3.5 Congenital Cystic Adenomatoid Malformation
    2.3.6 Infantile Lobar Emphysema/Polyalveolar Lobe
    2.3.7 Pulmonary Interstitial Emphysema
    2.3.8 Diffuse Pulmonary Lymphangiectasia
    2.3.9 Ectopic Tissues in the Lung
3 Specimen Handling and Special Techniques
  3.1 Routine Handling of Lung Specimens
    3.1.1 The Surgical Pathology Report
  3.2 Special Techniques
    3.2.1 Immunohistochemistry
    3.2.2 Flow Cytometry
    3.2.3 Molecular Biology
4 Papillary Tumors of the Bronchial Tree
  4.1 Squamous Papilloma and Papillomatosis
  4.2 Other Bronchial Papillomas
    4.2.1 Columnar Papillomas
    4.2.2 Inverted Papillomas or Polyps
    4.2.3 Transitional Cell Papillomas
    4.2.4 Fibroepithelial Polyps
5 Miscellaneous Benign Epithelial Tumors
  5.1 Papillary Adenoma of Type 2 Cells
  5.2 Alveolar Adenoma
  5.3 Mucinous Cystadenoma and Pulmonary Mucinous Tumors of Borderline
      Malignancy
    5.3.1 Mucinous Cystadenoma
    5.3.2 Mucinous Cystic Tumor of Borderline Malignancy
6 Tumors of Salivary Gland Type
  6.1 Mucoepidermoid Carcinoma of the Bronchus
  6.2 Adenoid Cystic Carcinoma
  6.3 Mucous Gland Adenoma
  6.4 Pleomorphic Adenoma
  6.5 Acinic Cell Carcinoma
  6.6 Other Rare Salivary Gland Tumors
    6.6.1 Carcinoma ex Pleomorphic Adenoma (Malignant Mixed Tumor)
    6.6.2 Pulmonary Oncocytoma
    6.6.3 Myoepithelioma
    6.6.4 Adenosquamous Carcinoma with Amyloid-like Stroma
7 Carcinoma of the Lung: Overview, Incidence, Etiology, and Screening
  7.1 Overview
  7.2 Incidence
  7.3 Etiology and Pathogenesis
  7.4 Screening for Carcinoma of the Lung
8 Carcinoma of the Lung: Clinical and Radiographic Aspects, Spread,
  Staging, Management, and Prognosis
  8.1 Demographics
  8.2 Signs and Symptoms
  8.3 Radiographic Features
  8.4 Patterns of Spread
  8.5 Staging, Management, and Prognosis
9 Morphologic Diagnosis and Heterogeneity of Carcinoma of the Lung
  9.1 Diagnosis
  9.2 Histologic Heterogeneity
10 In Situ and Early Invasive (Occult) Squamous Cell Carcinoma
11 Squamous Cell Carcinoma and Variants
12 Adenocarcinoma of the Lung (Excluding Bronchioloalveolar Carcinoma)
13 Bronchioloalveolar Carcinoma
14 Small Cell Carcinoma and Large Cell Neuroendocrine Carcinoma
  14.1 Small Cell Carcinoma
  14.2 Large Cell Neuroendocrine Carcinoma
15 Large Cell Carcinoma
16 Adenosquamous Carcinoma, Carcinomas Associated with Cysts, and Paget
   Disease of the Bronchus
  16.1 Adenosquamous Carcinoma
  16.2 Carcinomas Associated with Lung Cysts
  16.3 Pagetoid Spread of Adenocarcinoma in the Bronchus
17 Carcinoid and Other Neuroendocrine Tumors
  17.1 Unifying Concept of Pulmonary Neuroendocrine Tumors
     17.1.1 Neuroendocrine Cells
     17.1.2 Classification
     17.1.3 Neuroendocrine Body
  17.2 Carcinoid Tumorlet
  17.3 Typical and Atypical Carcinoid Tumors
  17.4 Unusual Lung Tumors with Neuroendocrine Differentiation
     17.4.1 Paraganglioma
     17.4.2 Primitive Neuroectodermal Tumor (Malignant Small Round Cell
            Tumor of the Thoracopulmonary Region)
     17.4.3 Neuroendocrine Carcinoma with Rhabdoid Phenotype
     17.4.4 Amphicrine Neoplasms
     17.4.5 Neuroendocrine Carcinoma with Anemone Features
     17.4.6 Pulmonary Blastoma with Neuroendocrine Differentiation
18 Hamartoma
19 Fibrous and Fibrohistiocytic Tumors and Tumor-Like Conditions
  19.1 Inflammatory Pseudotumor (Plasma Cell Granuloma-Histiocytoma
       Complex)
  19.2 Intrapulmonary Localized Fibrous Tumor
  19.3 Malignant Fibrous Histiocytoma
  19.4 Miscellaneous Fibrous and Fibrohistiocytic Tumors
     19.4.1 Fibrosarcomas
     19.4.2 Mesenchymal Cystic Hamartoma
     19.4.3 Cystic Fibrohistiocytic Tumor
20 Miscellaneous Mesenchymal Tumors
  20.1 Smooth Muscle Tumors
     20.1.1 Leiomyoma and Leiomyosarcoma
     20.1.2 Lymphangioleiomyomatosis
     20.1.3 Glomus Tumors
  20.2 Skeletal Muscle Tumors
     20.2.1 Rhabdomyoma
     20.2.2 Rhabdomyosarcoma
  20.3 Vascular Tumors and Related Conditions
     20.3.1 Vascular Malformations
     20.3.2 Hemangioma/Hemangiomatosis
     20.3.3 Lymphatic Lesions
     20.3.4 Epithelioid Hemangioendothelioma
     20.3.5 Kaposi Sarcoma
     20.3.6 Pulmonary Angiosarcoma
     20.3.7 Pulmonary Artery and Vein Sarcomas
     20.3.8 Hemangiopericytoma
  20.4 Neurogenic Tumors
     20.4.1 Neurilemmoma and Neurofibroma
     20.4.2 Neuroma and Ganglioneuroma
     20.4.3 Malignant Nerve Sheath Tumors
     20.4.4 Malignant Psammomatous Melanotic Schwannoma
     20.4.5 Neuroblastoma and Ganglioneuroblastoma
     20.4.6 Meningioma
  20.5 Cartilaginous Tumors of the Lung
     20.5.1 Chondroma
     20.5.2 Chondroblastoma
     20.5.3 Chondrosarcoma
  20.6 Osteogenic Tumors
     20.6.1 Metaplastic Bone
     20.6.2 Osteosarcoma
  20.7 Fatty Tumors
     20.7.1 Lipomas
     20.7.2 Liposarcomas
  20.8 Aveolar Soft Part Sarcoma
21 Mixed Epithelial and Mesenchymal Tumors
  21.1 Pulmonary Blastoma
     21.1.1 Well-Differentiated Fetal Adenocarcinoma (Pulmonary
            Endodermal Tumor)
     21.1.2 Biphasic Pulmonary Blastoma
     21.1.3 Cystic and Pleuropulmonary Blastomas of Childhood
  21.2 Carcinosarcomas of the Lung
22 Lymphoreticular Disorders
  22.1 Histologic Diagnosis of Lymphoreticular Infiltrates in the Lung
  22.2 Lymphatics and Lymphoid Tissue of the Lung
  22.3 Benign/Hyperplastic Disorders
     22.3.1 Pseudolymphoma (Nodular Lymphoid Hyperplasia)
     22.3.2 Lymphocytic Interstitial Pneumonia and Diffuse Lymphoid
            Hyperplasia
     22.3.3 Giant Lymph Node Hyperplasia (Castleman Disease)
     22.3.4 Angioimmunoblastic Lymphadenopathy
  22.4 Lymphomas Presenting in Lung
     22.4.1 Small Lymphocytic and Lymphoplasmacytoid Lymphomas (Including
            Low-Grade Lymphomas of BALT)
     22.4.2 Angiocentric Immunproliferative Lesions/Angiocentric
            Lymphomas (Lymphomatoid Granulomatosis/Polymorphic
            Reticulosis)
     22.4.3 Large Cell Lymphoma of Lung
     22.4.4 Intravascular Lymphomatosis (Angiotropic Lymphoma)
     22.4.5 Other Non-Hodgkin Lymphomas of the Lung
     22.4.6 Primary Pulmonary Hodgkin Disease
     22.4.7 Plasmacytoma
     22.4.8 Mast Cell Tumor
  22.5 Systemic Lymphoproliferative Disorders Secondarily Involving the
       Lung
     22.5.1 Hodgkin Disease and Non-Hodgkin Lymphoma
     22.5.2 Cutaneous T-Cell Lymphomas (Mycosis Fungoides and Sézary
            Syndrome)
     22.5.3 Malignant Histiocytosis
     22.5.4 Multiple Myeloma
     22.5.5 Systemic Light Chain Disease
     22.5.6 Waldenström Macroglobulinemia
  22.6 Post-Transplant Lymphoproliferative Disorders and Related
       Conditions
  22.7 Leukemic Infiltrates Involving the Lung
     22.7.1 Myelofibrosis
 22.8 Pleural Involvement in Lymphoreticular Disorders
 22.9 Pulmonary Histiocytosis X
23 Miscellaneous Tumors and Tumors of Uncertain Histogenesis
  23.1 Sclerosing Hemangioma of the Lung
  23.2 Clear Cell Tumor
  23.3 Minute Pulmonary Meningothelial-Like Nodules ("Minute Pulmonary
       Chemodectomas")
  23.4 Granular Cell Tumor
  23.5 Thymoma
  23.6 Malignant Melanoma
  23.7 Germ Cell Tumors
     23.7.1 Teratoma
     23.7.2 Choriocarcinoma
  23.8 Ependymoma
24 Tumor-Like Conditions
  24.1 Nodular Pulmonary Amyloidosis
  24.2 Pulmonary Hyalinizing Granuloma
  24.3 Pulmonary Malakoplakia
  24.4 Rounded Atelectasis
  24.5 Focal Organizing Pneumonia
25 Tumors Metastatic to the Lung
  25.1 Patterns of Metastasis
     25.1.1 Multiple Nodules
     25.1.2 Lymphangitic Metastasis
     25.1.3 Endobronchial Metastasis
     25.1.4 Metastatic Tumor Embolization
     25.1.5 The Solitary Pulmonary Metastasis
     25.1.6 Pleural Metastases
  25.2 Distinctive Histologic Growth Patterns
     25.2.1 Lepidic Growth Pattern
     25.2.2 Interstitial Spread
     25.2.3 Cavitation
  25.3 Special Techniques and Their Application in the Diagnosis of
       Pulmonary Metastases
     25.3.1 Immunohistochemistry
     25.3.2 Electron Microscopy
     25.3.3 Oncogenes
26 Index

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