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Analysis of Histologic Features Suspecting Anaplastic Lymphoma Kinase (ALK)-Expressing Pulmonary Adenocarcinoma.

Choi IH, Kim DW, Ha SY, Choi YL, Lee HJ, Han J - J Pathol Transl Med (2015)

Bottom Line: However, using ALK-fluorescence in situ hybridization (FISH) as the standard method has demerits such as high cost, a time-consuming process, dependency on interpretation skill, and tissue preparation.Acinar, cribriform, and solid growth patterns, extracellular and intracellular mucin production, and presence of signet-ring-cell element, and psammoma body were significantly more often present in ALK-positive cancer.In addition, the presence of goblet cell-like cells and presence of nuclear inclusion and groove resembling papillary thyroid carcinoma were common in the ALK-positive group.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Since 2007 when anaplastic lymphoma kinase (ALK) rearrangements were discovered in non-small cell lung cancer, the ALK gene has received attention due to ALK-targeted therapy, and a notable treatment advantage has been observed in patients harboring the EML4/ALK translocation. However, using ALK-fluorescence in situ hybridization (FISH) as the standard method has demerits such as high cost, a time-consuming process, dependency on interpretation skill, and tissue preparation. We analyzed the histologic findings which could complement the limitation of ALK-FISH test for pulmonary adenocarcinoma.

Methods: Two hundred five cases of ALK-positive and 101 of ALK-negative pulmonary adenocarcinoma from January 2007 to May 2013 were enrolled in this study. The histologic findings and ALK immunohistochemistry results were reviewed and compared with the results of ALK-FISH and EGFR/KRAS mutation status.

Results: Acinar, cribriform, and solid growth patterns, extracellular and intracellular mucin production, and presence of signet-ring-cell element, and psammoma body were significantly more often present in ALK-positive cancer. In addition, the presence of goblet cell-like cells and presence of nuclear inclusion and groove resembling papillary thyroid carcinoma were common in the ALK-positive group.

Conclusions: The above histologic parameters can be helpful in predicting ALK rearranged pulmonary adenocarcinoma, leading to rapid FISH analysis and timely treatment.

No MeSH data available.


Related in: MedlinePlus

Histologic features of anaplastic lymphoma kinase (ALK)-rearranged pulmonary adenocarcinoma. (A) ALK-rearranged tumors show variable growth patterns. At low magnification, the tumor shows solid, acinar, and papillary growth patterns. (B) Cribriform and micropapillary patterns are more frequent in ALK-positive pulmonary adenocarcinoma. (C) Tumors have frequent extracellular and intracellular mucin production. (D) Solid growth is frequently found to contain signet-ring-cells. (E) A few psammoma bodies are noted in the background of mixed tumor and extracellular mucin. (F) Some tumors contain goblet cell-like cells. (G) Intranuclear inclusion and nuclear groove resembling papillary thyroid carcinoma are frequently found. (H) On the biopsied specimen from the patient showing dramatic response to ALK-targeted therapy before ALK-fluorescence in situ hybridization, many signet-ring-cells are found. (I) Tumor cells in Fig. 2H show 3+ ALK-immunohistochemistry score.
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f2-jptm-49-4-310: Histologic features of anaplastic lymphoma kinase (ALK)-rearranged pulmonary adenocarcinoma. (A) ALK-rearranged tumors show variable growth patterns. At low magnification, the tumor shows solid, acinar, and papillary growth patterns. (B) Cribriform and micropapillary patterns are more frequent in ALK-positive pulmonary adenocarcinoma. (C) Tumors have frequent extracellular and intracellular mucin production. (D) Solid growth is frequently found to contain signet-ring-cells. (E) A few psammoma bodies are noted in the background of mixed tumor and extracellular mucin. (F) Some tumors contain goblet cell-like cells. (G) Intranuclear inclusion and nuclear groove resembling papillary thyroid carcinoma are frequently found. (H) On the biopsied specimen from the patient showing dramatic response to ALK-targeted therapy before ALK-fluorescence in situ hybridization, many signet-ring-cells are found. (I) Tumor cells in Fig. 2H show 3+ ALK-immunohistochemistry score.

Mentions: Histologic subtypes based on predominant growth pattern were investigated in the ALK-positive and -negative resection groups, but there was no statistically significant histologic subtype of ALK-positive pulmonary adenocarcinoma (Table 3). However, acinar, solid, micropapillary, and cribriform growth patterns were more frequent in ALK-positive lung cancer based on the examination of growth patterns (p=.035, p=.002, p=.004, and p<.001 respectively) (Table 3, Fig. 2A, B). The ALK-positive group showed more variable growth patterns at a statistically significant level; 77.7% of cases in the ALK-positive group showed more than 3 types of growth patterns (mean, 3.3). However, cases in the ALK-negative group usually contained 2 or 3 types of growth patterns (75.2%; mean, 2.4) (p<.001) (Table 3, Fig. 2A).


Analysis of Histologic Features Suspecting Anaplastic Lymphoma Kinase (ALK)-Expressing Pulmonary Adenocarcinoma.

Choi IH, Kim DW, Ha SY, Choi YL, Lee HJ, Han J - J Pathol Transl Med (2015)

Histologic features of anaplastic lymphoma kinase (ALK)-rearranged pulmonary adenocarcinoma. (A) ALK-rearranged tumors show variable growth patterns. At low magnification, the tumor shows solid, acinar, and papillary growth patterns. (B) Cribriform and micropapillary patterns are more frequent in ALK-positive pulmonary adenocarcinoma. (C) Tumors have frequent extracellular and intracellular mucin production. (D) Solid growth is frequently found to contain signet-ring-cells. (E) A few psammoma bodies are noted in the background of mixed tumor and extracellular mucin. (F) Some tumors contain goblet cell-like cells. (G) Intranuclear inclusion and nuclear groove resembling papillary thyroid carcinoma are frequently found. (H) On the biopsied specimen from the patient showing dramatic response to ALK-targeted therapy before ALK-fluorescence in situ hybridization, many signet-ring-cells are found. (I) Tumor cells in Fig. 2H show 3+ ALK-immunohistochemistry score.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508568&req=5

f2-jptm-49-4-310: Histologic features of anaplastic lymphoma kinase (ALK)-rearranged pulmonary adenocarcinoma. (A) ALK-rearranged tumors show variable growth patterns. At low magnification, the tumor shows solid, acinar, and papillary growth patterns. (B) Cribriform and micropapillary patterns are more frequent in ALK-positive pulmonary adenocarcinoma. (C) Tumors have frequent extracellular and intracellular mucin production. (D) Solid growth is frequently found to contain signet-ring-cells. (E) A few psammoma bodies are noted in the background of mixed tumor and extracellular mucin. (F) Some tumors contain goblet cell-like cells. (G) Intranuclear inclusion and nuclear groove resembling papillary thyroid carcinoma are frequently found. (H) On the biopsied specimen from the patient showing dramatic response to ALK-targeted therapy before ALK-fluorescence in situ hybridization, many signet-ring-cells are found. (I) Tumor cells in Fig. 2H show 3+ ALK-immunohistochemistry score.
Mentions: Histologic subtypes based on predominant growth pattern were investigated in the ALK-positive and -negative resection groups, but there was no statistically significant histologic subtype of ALK-positive pulmonary adenocarcinoma (Table 3). However, acinar, solid, micropapillary, and cribriform growth patterns were more frequent in ALK-positive lung cancer based on the examination of growth patterns (p=.035, p=.002, p=.004, and p<.001 respectively) (Table 3, Fig. 2A, B). The ALK-positive group showed more variable growth patterns at a statistically significant level; 77.7% of cases in the ALK-positive group showed more than 3 types of growth patterns (mean, 3.3). However, cases in the ALK-negative group usually contained 2 or 3 types of growth patterns (75.2%; mean, 2.4) (p<.001) (Table 3, Fig. 2A).

Bottom Line: However, using ALK-fluorescence in situ hybridization (FISH) as the standard method has demerits such as high cost, a time-consuming process, dependency on interpretation skill, and tissue preparation.Acinar, cribriform, and solid growth patterns, extracellular and intracellular mucin production, and presence of signet-ring-cell element, and psammoma body were significantly more often present in ALK-positive cancer.In addition, the presence of goblet cell-like cells and presence of nuclear inclusion and groove resembling papillary thyroid carcinoma were common in the ALK-positive group.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Since 2007 when anaplastic lymphoma kinase (ALK) rearrangements were discovered in non-small cell lung cancer, the ALK gene has received attention due to ALK-targeted therapy, and a notable treatment advantage has been observed in patients harboring the EML4/ALK translocation. However, using ALK-fluorescence in situ hybridization (FISH) as the standard method has demerits such as high cost, a time-consuming process, dependency on interpretation skill, and tissue preparation. We analyzed the histologic findings which could complement the limitation of ALK-FISH test for pulmonary adenocarcinoma.

Methods: Two hundred five cases of ALK-positive and 101 of ALK-negative pulmonary adenocarcinoma from January 2007 to May 2013 were enrolled in this study. The histologic findings and ALK immunohistochemistry results were reviewed and compared with the results of ALK-FISH and EGFR/KRAS mutation status.

Results: Acinar, cribriform, and solid growth patterns, extracellular and intracellular mucin production, and presence of signet-ring-cell element, and psammoma body were significantly more often present in ALK-positive cancer. In addition, the presence of goblet cell-like cells and presence of nuclear inclusion and groove resembling papillary thyroid carcinoma were common in the ALK-positive group.

Conclusions: The above histologic parameters can be helpful in predicting ALK rearranged pulmonary adenocarcinoma, leading to rapid FISH analysis and timely treatment.

No MeSH data available.


Related in: MedlinePlus