squamous cell carcinoma lung pathology outlines
; Nasopharyngeal carcinoma can be considered a variant SCC. Fibroblast growth factor receptor 1 (FGFR1) is a transmembrane tyrosine kinase receptor that plays a role in normal physiologic functions, and evidence exists for deregulated signals in the pathogenesis of many different cancer types. The skin lesions may appear as crusted ulcer, plaques, and nodules It may ulcerate and bleed. The E17K mutation found in SCC does not alter the sensitivity of AKT to ATP competitive inhibitors, but it does alter the sensitivity to allosteric kinase inhibitors (85). Squamous cell carcinoma (SCC) accounts for about 20% of all lung cancers. ; Teruya-Feldstein, J.; Westra, WH. ; Banham, SW. (May 1991). Small cell carcinoma of the lung. In combination with erlotinib, MetMAb (an antibody to the MET receptor) showed clinical benefit in a phase II trial in pretreated patients with NSCLC and overexpression of MET (79). In the short term, the molecular characterization of patients with SCC in modern profiling platforms will therefore be as important as deciphering the molecular genetics of adenocarcinoma. The papillary variant shows endobronchial obstructive growth, sometimes with limited intraepithelial spread, and invasion may be difficult to assess. We classify these molecular alterations according to their therapeutic targets: membrane receptor alterations, signaling pathway alterations, and transcription factor alterations. Comprehensive pathological analyses in lung squamous cell carcinoma: single cell invasion, nuclear diameter, and tumour budding are … Despite the recognition of histologic subtypes, the concept of “one size fits all” governed decisions for many years (5). Depending on the patients’ medical status and stage of disease, treatment options include surgery, radiation therapy and chemotherapy. Targeting DDR2 mutations is auspicious. ; Pelosi, G.; Travis, WD. The acquisition of somatic genetic alterations is a main process in cancer. However, many genomic abnormalities are present in SCC, and there is growing evidence of their biologic significance. Non small cell lung cancer (NSCLC) Around 80 to 85 out of 100 lung cancers (around 80 - 85%) in the UK are non small cell lung cancer (NSCLC). Amplification of MET or FGFR1, both of which are found frequently in SCC of the lung, makes the amplified cells become dependent on that pathway, and clinical data concerning MET and FGFR1 inhibition are encouraging. Lung mass - usually centrally located, i.e. This may be because there is a low-level copy-number gain of MET in a much higher percentage of the tumors, but the biologic implications are unclear. • Data element: followed by its answer (response), outline format without the paired "Data element: Response" format is NOT considered synoptic. 0.0.0 . Thus, SCC represents an important field in which new therapeutic options are awaited. The demonstration of cells with genetic abnormalities that become addicted to oncogenes is a rational basis for the development of molecular targeted therapies, because normal cells in their vicinity do not bear the respective alteration. The purpose of this article is to review the genetic alterations that seem actionable (from a therapeutic perspective) and could potentially define different molecular subtypes of SCC, rendering them eligible for personalized treatment strategies. The latter 2 have a specific clinicopathologic significance and deserve to remain in the forthcoming classifications. Mutations are seen in ∼2% to 3% of SCCs; however, the precise frequency remains to be determined in sufficiently powered studies that are currently ongoing (36, 50–52). Squamous cell carcinoma is a type of non-small cell carcinoma. Carcinomas are named based on how the cells look under the microscope. Small cell lung cancer (SCLC) comprises 14% of all lung cancers, and >30 000 new cases are diagnosed per year in the United States. Marked nuclear size variation. Moreover, in a phase II trial of TKI258, a 25% disease control rate was achieved at 24 weeks in heavily pretreated patients with breast cancer with FGFR1 amplification (74). Sorafenib, a multikinase BRAF inhibitor, failed to show a survival advantage when added to first-line chemotherapy in advanced NSCLC (87). Sex-determining region Y-Box 2 (SOX2) is a transcription factor that plays a role in squamous differentiation of the esophagus and lung. The pink cytoplasm with distinct cell borders and keratin pearls characteristic for a squamous cell carcinoma are seen here at high magnification. Such features are seen in well-differentiated tumors (those that more closely mimic the cell of origin). Furthermore, although this study involved molecularly unselected patients, there was a trend toward better outcomes in patients with MET amplification. Lung SCC cell lines harboring DDR2 mutations were selectively killed by RNA interference or dasatinib. Squamous cell carcinoma of the lung is a type of lung cancer. ; O'Neill, M.; DeMuth, WE. The expression of p63 and its N-terminal truncated P40 lacking TTF1 expression is a quite constant phenotypical trait that allows NSCLC subtypes to be distinguished from adenocarcinoma (10–12). Squamous cell carcinoma (SCC) of the lung is the second most frequent histology in non–small cell lung cancer (NSCLC). Eosinophilia. Non-small cell lung carcinoma - diagnosis should be avoided if possible. Clinical Cancer Research How much of this molecular deciphering will translate to actionable targets and therapeutic success remains to be established. Gruver, AM. 1 summarize the genetic abnormalities observed in SCC. Encouraging new treatments (i.e., bevacizumab, EGFR tyrosine kinase inhibitors, and ALK inhibitors) have afforded benefits to patients with adenocarcinoma, but unfortunately the same is not true for SCC. Ongoing clinical trials are recruiting patients with NSCLC using dasatinib. Campbell, JH. Bleeding and cavitation are also induced by VEGFR TKIs, but this is probably not the only explanation for the increased toxicity in the SCC subtype. Patients with SCC of the lung should not be denied molecular testing, because such an approach may provide new therapeutic opportunities for such patients. In lung adenocarcinoma, significant improvements in outcomes can be achieved when targeted therapies are used in populations of patients who have been selected based on the molecular profile of their tumor. Moreover, figitumumab, an antibody targeting insulin-like growth factor I receptor, combined with chemotherapy, showed nonsignificantly worse survival when compared with chemotherapy alone in a phase III trial (8). SCC shows strong and diffuse expression of p63, which is a particular transcriptional factor of this histologic type (13). The incidence of SCC of lung has been decreasing in the last few decades reflecting a declining trend in smoking. This study was performed to screen potential biomarkers related to the occurrence, development and prognosis of LUSC to reveal unknown physiological and pathological processes. BRAF mutations are associated with increased kinase activity that leads to constitutional activation of MAPK2 and MAPK3, and they are mutually exclusive to EGFR and KRAS mutations. The BRAF protein is a cytoplasmatic serine/threonine kinase that plays an important role in the RAS–mitogen-activated protein kinase (MAPK) signaling pathway (63). All FNA specimens were reviewed independently by a panel of cytopathologists to differentiate between SQCC and ADC. Preclinical data for some of these alterations are promising, and it has been shown that many such aberrations can make a cancer cell become addicted to a specific pathway. p63, cytokeratin (CK) 5/6, and CK1, CK5, CK10, and CK14 (15) recognized by the antibody CK34β E12 are the hallmarks of this very aggressive variant with a high mitotic index. Trials testing trastuzumab in Her2-protein–overexpressing NSCLC failed to show clear benefit (81, 82). The mutational status of PI3KCA is not mutually exclusive to EGFR or KRAS (53). et al. SCCs are tumors that arise from bronchial epithelial cells through squamous metaplasia/dysplasia and are therefore characterized by keratinization and/or intercellular bridges, their most common features. The three main types are adenocarcinoma, squamous cell carcinoma and large cell carcinoma. The term bronchoalveolar carcinoma (BAC) has been extinct and, invasive mucinous adenocarcinoma of the lung now replaces the tumors previously known as mucinous bronchoalveolar carcinoma (BAC). The case cohort included 53 FNA cases of nonsmall cell lung carcinoma with surgical pathology follow-up. histological and immunohistochemical findings of resected colon cancer under immunotherapy for lung cancer. The somatic mutation E17K in the AKT1 gene was found in 1% of lung SCCs but not in adenocarcinoma (56). FGFR1 FISH-amplified SCC cells. Dasatinib, imatinib, nilotinib, and ponatinib target BCR/ABL, SRC, c-Kit, and multiple Eph kinases, and also inhibit DDR1 and DDR2 (75). Focus on Eastern Cooperative Oncology Group study 2598, PIK3CA mutations in patients with advanced cancers treated with PI3K/AKT/mTOR axis inhibitors, A phase I dose-escalation study of XL147 (SAR245408), a PI3K inhibitor administered orally to patients (pts) with advanced malignancies, A transforming mutation in the pleckstrin homology domain of AKT1 in cancer, Neoadjuvant MDM2 antagonist RG7112 for well-differentiated and dedifferentiated liposarcomas (WD/DD LPS): a pharmacodynamic (PD) biomarker study, Phase III study of carboplatin and paclitaxel alone or with sorafenib in advanced non-small-cell lung cancer, Phase I/II study of GSK2118436, a selective inhibitor of oncogenic mutant BRAF kinase, in patients with metastatic melanoma and other solid tumors, Facts and hopes in multiple myeloma immunotherapy, Biomarker Technologies in Immuno-oncology, Cancer Epidemiology, Biomarkers & Prevention, Disclosure of Potential Conflicts of Interest. Next to adenocarcinoma, squamous cell carcinoma (SCC) of the lung is the most frequent histologic subtype in non–small cell lung cancer. PTEN inactivation occurs more frequently at the protein level than at the genomic level, and promoter methylation is found in 35% of PTEN-negative NSCLC (59, 60). Discomfort when swallowing 7. By contrast, xenografts with nonmutant tumors were insensitive to treatment. There is no agreed upon measure of tumour extent (tumour thickness/depth of invasion) - proposed measures: Serine/threonine kinase 11 (STK11/LKB1) is a tumor-suppressor gene that phosphorylates AMPK. Suppression of SOX2 in amplified SOX2 cells has greater antiproliferative effects compared with other genes on 3q26.33, and SOX2 amplification and overexpression are involved in maintaining stem cell properties in SCC (24, 72). Lung cancer is the leading cause of cancer-related deaths worldwide. The recognition of molecular subtypes may identify tumors with different biologic behaviors, and molecular profiling together with an appropriate histologic diagnosis potentially can be used to select the right targeted therapy. Encouraging new treatments [i.e., bevacizumab, EGFR tyrosine kinase inhibitors (TKI), and ALK inhibitors] have afforded benefits to patients with adenocarcinoma, but unfortunately the same is not true for SCC. 3p deletion, p53 mutations). Squamous cell carcinoma (SCC) of the lung is the second most frequent histology in non–small cell lung cancer (NSCLC). Breast adenocarcinoma. May be associated with elevated serum calcium. 1.1. However, the detection of new genetic alterations constitutes a window of opportunity to test both new and already approved molecules (Table 2). BYL 719, an oral PI3K inhibitor, is under phase I study in patients harboring PI3KCA mutations. In lung cancer, the estimated frequency of mutations is low (1% for SCC and 2% for adenocarcinoma), and MET-mutated cells reveal enhanced ligand-mediated proliferation and significant in vivo tumor growth (36, 37). Adenoid Cystic Carcinoma. Approximately 90% of mutations found in lung cancer do not involve the mutation commonly seen in melanoma (V600E), and this may have biologic and therapeutic implications (64, 65). Adenocarcinoma and squamous cell carcinoma (SCC) are the most frequent histologic subtypes, accounting for 50% and 30% of NSCLC cases, respectively. This fusion is uncommon, occurring in ∼2% to 7% of cases of NSCLC, and is more prevalent in people who never smoked or in light smokers and in patients with adenocarcinoma. Common signs and symptoms of squamous cell carcinoma are not unlike those of other lung causes and typically include:2 1. ; Ralston, S.; Boyle, IT. The 2004 World Health Organization classification recognizes 4 variants of SCC: clear cell, small cell, papillary, and basaloid. The other 2 variants have no clinical relevance. Many MET inhibitors are under investigation. GDC-0068 is an oral, selective, ATP-competitive AKT inhibitor that is currently in a phase I trial. No other potential conflicts of interest were disclosed. Variable keratinisation (keratin pearls etc) is present (figure 2). Smoking thus causes a field effect on the lun… E-3810, a dual VEGF/FGFR1 inhibitor, was well tolerated in a phase I trial (73). Lung 4. Until now, targeting of p53 has proved to be highly disappointing; however, a new era may emerge with the use of hdm2 inhibitors such as RG7112 and MK-8242, which are currently in the phase I setting. Somatic mutations of LKB1 are present in 5% of lung SCCs and 23% of adenocarcinomas, and their roles are not clear (70). Loss of p53 pathway function can also be related to HDM2 amplification/overexpression when p53 is wild type. Inflammation (lymphocytes, plasma cells). 2. An adenocarcinoma component was found in 34 cases, a squamous cell carcinoma component in 13, and a large cell carcinoma component in 40. ; Henrique, R. (Dec 2013). ; Luthringer, DJ. The loss of PTEN activity leads to hyperactivation of the PI3K–AKT pathway. BKM120 is a potent and highly specific oral pan-class I PI3K inhibitor that is currently being evaluated combined with chemotherapy in patients with NSCLC and evidence of an activated PI3K pathway. Dasatinib and imatinib inhibit cells carrying DDR2 mutations, which are detected more often in SCC than in adenocarcinoma. Clear cell is considered to be more of a cellular change than a pattern, and can occur in all histological categories. Small cell lung cancer is an aggressive neoplasm, which is reflected in its high-grade morphology, evident in both cytologic and histologic preparations. The overall survival rate and disease-free survival rate were 36.6% and 40.7%, respectively, and both rates were significantly lower than for other nonsmall cell lung … Squamous cell carcinoma of the lung. Encouraging new treatments have afforded a benefit to patients with adenocarcinoma, but unfortunately the same is not true for SCC. ©2012 AACR. Lung cancers are traditionally divided into non–small cell carcinoma (NSCC) and small cell carcinoma (small cell lung carcinoma, SCLC), with the former accounting for 80% of the cases and the latter accounting for the remaining 20%. http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf, https://librepathology.org/w/index.php?title=Squamous_cell_carcinoma_of_the_lung&oldid=46525, Attribution-NonCommercial-ShareAlike 4.0 International, typically a mass assoc. Squamous cell lung cancer, also called squamous cell carcinoma of the lung, accounts for about 30% of all lung cancers. Several FGFR1 TKIs (BGJ398, AZD4547, TKI258, and E-3810, all of which are orally available) are in the early phase of clinical development. Although the incidence of adenocarcinoma is on the rise, lung SCC is currently the second most frequent histologic subtype and the leading one in developing countries. In lung SCC, the frequency of FGFR1 amplification by FISH (Fig. Nuclear moulding - most useful for distinguishing from NSCLC - key feature. Bishop, JA. Patients with head and neck squamous cell carcinoma (HNSCC) may also develop squamous cell carcinomas (SCCs) in their lungs For example, 5% of patients with HNSCC clinically develop lung metastases ( 1).In these patients, the presence of even a single lung nodule is an ominous finding that may herald the onset of widespread tumor dissemination.
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