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Pathology of Large Cell Carcinoma of Lung

Dr Sampurna Roy MD                         May 2015         


Syn: Poorly differentiated Anaplastic Carcinoma ; Undifferentiated Large Cell Carcinoma.

According to some authors the existence of Large Cell Carcinoma as a definite entity has been challenged. Some consider it to be a "wastebin" category.

Large cell carcinoma is a merely descriptive term indicating a subtype of lung cancer with no specific features of small-cell lung cancer, adenocarcinoma  or squamous cell carcinoma. This diagnosis is allowed on surgical specimens only, whereas its counterpart in biopsy/cytology samples is non-small-cell lung carcinoma, not otherwise specified.

The tumour is composed of sheets of poorly differentiated large tumour cells. 

The cells contain round to oval nuclei and prominent nucleoli.

There is marked cellular atypia and an increased mitotic activity.

The tumour shows no definite evidence of either squamous or glandular differentation.

Unlike pleomorphic carcinoma there is no evidence of any spindle cell component, atypical multinucleated and giant tumour cells.

Some of these tumours  showed a solid growth pattern of polygonal cells with eosinophilic intracytoplasmic inclusion bodies.

Histochemically, these cells were periodic acid-Schiff-negative.

Immunohistochemically, vimentin and neuron-specific enolase were positive. Epithelial membrane antigen was focally and weakly positive and p53 was positive in 60% of tumoral cells.

Electron microscopy revealed intracytoplasmic inclusion bodies consisting of whorled intermediate filaments.

Based on histological and immunohistochemical findings, the patient was diagnosed as having pulmonary large cell carcinoma with rhabdoid phenotype.

Because of its aggressive clinical course, early diagnosis and decision on therapy is very important for this disease.

Large cell carcinomas of the lung showing evidence of neuroendocrine differentiation is a distinctive clinicopathologic disease and should not be classified with unspecified large cell anaplastic carcinomas of the lung.

Applying specialized techniques, most cases of large cell carcinoma can be further reclassified into more informative categories that may guide molecular testing for predictive biomarkers and enable selection of more appropriate therapies.

                                                   
Further reading:

Large cell carcinoma of lung: On the verge of extinction?

Large cell carcinoma of the lung: a tumor in search of an author. A clinically oriented critical reappraisal.

Large-cell carcinoma of the lung: a diagnostic category redefined by immunohistochemistry and genomics.

Global analysis of chromosome 1 genes among patients with lung adenocarcinoma, squamous carcinoma, large-cell carcinoma, small-cell carcinoma, or non-cancer.

Close Relation of Large Cell Carcinoma to Adenocarcinoma by Hierarchical Cluster Analysis: Implications for Histologic Typing of Lung Cancer on Biopsies.

Large-cell carcinoma of the lung with a remarkable preoperative elevation of serum carcinoembryonic antigen level.

Large cell carcinoma of the lung. Ultrastructural and immunohistochemical features.

Large cell carcinoma of the lung with neuroendocrine differentiation. A comparison with large cell "undifferentiated" pulmonary tumors.

A case of large cell carcinoma of the lung with rhabdoid phenotype

Pulmonary large cell carcinoma with rhabdoid phenotype.

Large cell carcinoma of the lung with a rhabdoid phenotype. 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

 

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