Warranting investigation of primary lung adenocarcinoma in patients with an extrapulmonary malignancy and lung nodules due to high frequency.

Abstract

OBJECTIVES:

To distinguish primary lung adenocarcinoma (PLA) from metastatic adenocarcinoma/malignancy to optimize therapy.

METHODS:

We investigated the utility of thyroid transcription factor 1 (TTF-1) and napsin A in distinguishing PLA from metastatic adenocarcinoma/malignancy and assessed the frequency of PLA in patients with extrapulmonary malignancy/adenocarcinoma (PLA-EPM/EPA).

RESULTS:

TTF-1 and napsin A identified PLA in PLA-EPM/ EPA with a sensitivity of 89.4% and 93.3% and a specificity of 93.9% and 94.7%, respectively. PLA was confirmedin 47.4% of PLA-EPM and 40.2% of PLA-EPA. Overall, 38.5% of patients with PLA had EPM. The common organs for PLA-EPA were breast (35.8%), colon (13.2%), and others, whereas the common organs resulting in pulmonary metastasis were the colon (32.8%), breast (28.1%), and others. A patient with a smoking history and without EPM had a higher chance of having PLA. Multiple nodules are not a reliable indication of metastatic adenocarcinoma.

CONCLUSIONS:

Our results firmly support the role of TTF-1 and napsin A in identifying PLA-EPM/EPA. We reason that all new lung nodules in patients with a history of EPM should be screened using these techniques due to the high frequency of PLA-EPM, which will affect treatment and prognosis of patients with EPM/EPA.

• Authors: Bing Zhu, Shavari Dalal, David W Kamp, Xiaoqi Lin
• Journal: American journal of clinical pathology (Am J Clin Pathol) Vol. 141 Issue 3 Pg. 429-36 (Mar 2014) ISSN: 1943-7722 [Electronic] England
• PMID: 24515772 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers, Tumor
• NKX2-1 protein, human
• Nuclear Proteins
• Thyroid Nuclear Factor 1
• Transcription Factors
• Aspartic Acid Endopeptidases
• NAPSA protein, human

Topics

• Adenocarcinoma (diagnosis, pathology, secondary)
• Adult
• Aged
• Aged, 80 and over
• Aspartic Acid Endopeptidases (metabolism)
• Biomarkers, Tumor (metabolism)
• Diagnosis, Differential
• Female
• Humans
• Lung Neoplasms (diagnosis, pathology, secondary)
• Male
• Middle Aged
• Nuclear Proteins (metabolism)
• Sensitivity and Specificity
• Thyroid Nuclear Factor 1
• Transcription Factors (metabolism)