small cell lung cancer histology

small cell lung cancer histology

Mutagenesis. National Comprehensive Cancer Network. Small cell carcinoma (also known as small cell lung cancer) is a special type of lung cancer that tends to grow and spread quickly. Whereas squamous, large and small cell carcinoma rates have been decreasing since the mid-80s, adenocarcinoma rates remain stable in males and continue to increase in females, with large racial disparities. The neuroendocrine nature of the neoplasm is suggested by its frequent association with neurologic and endocrine paraneoplastic syndromes. About 10% to 15% of people with lung cancer have a type called small cell lung cancer. Staging small cell lung cancer: Veterans Administration Lung Study Group versus International Association for the Study of Lung Cancer--what limits limited disease?. Approximately 5% of SCLCs exhibit features of mixed small cell and non–small cell components, suggesting phenotypic plasticity and lending support to the cancer stem cell hypothesis. Parsons A, Daley A, Begh R, Aveyard P. Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. J Clin Oncol. 2(8664):640-3. Lung Cancer, 17 (1997), pp. American Cancer Society. [Full Text]. Small cell lung cancer (SCLC) comprises 14% of all lung cancers, and >30 000 new cases are diagnosed per year in the United States. 2008;26 (suppl):400s. [Medline]. Hanna NH, Einhorn LH. Lung Histology Rules C340-C343, C348, C349 (Excludes lymphoma and leukemia M9590 – M9992 and Kaposi sarcoma M9140) Available at [Full Text]. [Medline]. [Medline]. 2017 Dec 1. 2002 Sep. 4(2):87-94. Lung carcinomas may be broadly grouped into two categories, small cell and non-small cell carcinoma. 2006 May 1. Chest. Methods: Eligible patients (aged ≥20 years) had untreated stage IIIB/IV adenocarcinoma. not available. [Guideline] Früh M, De Ruysscher D, Popat S, Crinò L, Peters S, Felip E, et al. Surgery for small-cell lung cancer. 2012 Dec. 42(12):1297-309. American Joint Committee on Cancer. 24(13):2038-43. A randomized phase III trial comparing irinotecan/cisplatin (IP) with etoposide/cisplatin (EP) in patients (pts) with previously untreated extensive stage small cell lung cancer (E-SCLC). 2013 Mar-Apr. Small cell lung cancer (SCLC) extensive disease in patients unsuitable for intravenous or combination chemotherapy. ON THIS PAGE: You will find a drawing of the main body parts affected by SCLC. Small cell lung cancer: have we made any progress over the last 25 years?. N Engl J Med. They are thus separated, as small cell carcinoma of the lung has distinctive management implications. [Medline]. Approximately 5% of SCLCs exhibit features of mixed small cell and non–small cell components, suggesting phenotypic plasticity and lending support to … no pathology/cytology specimen . NSCLC accounts for about 85% of all lung cancers. Publication no. [Medline]. National Cancer Institute. May 14, 2018; Accessed: May 22, 2018. 123-134. The non-small cell lung cancer (NSCLC) specific GPA index was a 4-titered prognostic index. Slotman B, Faivre-Finn C, Kramer G, Rankin E, Snee M, Hatton M, et al. Code the histology to 8000 (cancer/malignant neoplasm, NOS) or as stated by the physician when nothing more specific is documented. Small cell lung cancer is most often located at the hilum and grows along the bronchi. 29(16):2215-22. Third-Line Nivolumab Monotherapy in Recurrent SCLC: CheckMate 032. Pathology of small cell carcinoma of the lung. The distinction between non-small-cell lung cancer and small-cell lung cancer is of major clinical import, as it significantly alters treatment options. 70(23):9721-9. Genome-wide interrogation identifies YAP1 variants associated with survival of small-cell lung cancer patients. Immunohistochemical stains for chromogranin, neuron-specific enolase, CD56, and synaptophysin are usually positive, but these are not an absolute requirement for the diagnosis. Mazzone PJ, Silvestri GA, Patel S, Kanne JP, Kinsinger LS, Wiener RS, et al. Amarasena IU, Walters JA, Wood-Baker R, Fong K. Platinum versus non-platinum chemotherapy regimens for small cell lung cancer. Most cancers that start in the lung, known as primary lung cancers, are carcinomas. Approved by the Cancer.Net Editorial Board, 07/2019. 2007 Sep. 12(9):1096-104. [Full Text]. [Guideline] Lung Cancer: Screening. 2016 Aug. 17 (8):1147-1157. 18(3):211-6. 2002 Sep. 37(3):271-6. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. [Medline]. Design: Nine genes with the most complete published mutation coincidence data were evaluated. Halvorsen TO, Sundstrøm S, Fløtten Ø, Brustugun OT, Brunsvig P, Aasebø U, et al. [Medline]. [Guideline] Detterbeck FC, Lewis SZ, Diekemper R, Addrizzo-Harris D, Alberts WM. Gamma knife stereotactic radiosurgery as salvage therapy after failure of whole-brain radiotherapy in patients with small-cell lung cancer. 143(4):329-36. CD006849. The major histological types include: adenocarcinoma of lung; squamous cell carcinoma of the lung 385 (9962):36-42. 2012 Jul. Ann. Introduction: PIONEER (NCT01185314) was a prospective, multinational, epidemiological study of epidermal growth factor receptor (EGFR) mutations in patients from Asia with newly diagnosed advanced lung adenocarcinoma. N Engl J Med. Lung cancer describes many different types of cancer that start in the lung or related structures.. [Medline]. Siegel RL, Miller KD, Fuchs HE, Jemal A. Small cell cancers are usually central lesions (in … The major histological types include: adenocarcinoma of lung; squamous cell carcinoma of the lung 357(7):664-72. Treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with activating mutations of EGFR-TK. Since it has often spread outside the lung at the time it is diagnosed, it is rarely treated with surgery. Twenty-five years of clinical research for patients with limited-stage small cell lung carcinoma in North America. New York, NY: McGraw-Hill Education; 2016. J Clin Oncol. Objective: To analyze principal histological types of lung cancer, as well as the staging, treatment and survival of lung cancer patients. J Clin Oncol (Suppl). For LC, histologic subtype was identified as major independent prognostic factor (p = 0.033): while LC was 81% for squamous cell carcinoma patients, LC was significantly improved for high-risk and even more non-high-risk adenocarcinoma patients with 96% and 100%, respectively (p = 0.026). New York, NY: Oxford University Press; 2018. Mutational landscape determines sensitivity to PD-1 blockade in non-small cell lung cancer. A 65 year old man presents to the clinic with generalized fatigue for 6 months. Katki HA, Kovalchik SA, Petito LC, Cheung LC, Jacobs E, Jemal A, et al. Kalemkerian GP, Schneider BJ. Spigel DR, Townley PM, Waterhouse DM, Fang L, Adiguzel I, et al. Cigarette smoking and lung cancer--relative risk estimates for the major histological types from a pooled analysis of case-control studies. [Medline]. Small cell lung cancer (SCLC) is typically centrally located, arising in peribronchial locations. Gefitinib Monotherapy. 143 (5 Suppl):7S-37S. Higher Lung Cancer Incidence in Young Women Than Young Men in the United States. Int J Radiat Oncol Biol Phys. New York, NY: Springer; 2016. Oncol. [Full Text]. Ann Oncol. Randomized phase II study of bevacizumab in combination with chemotherapy in previously untreated extensive-stage small-cell lung cancer: results from the SALUTE trial. 95(7):1528-38. J Clin Oncol. Treatment of patients with lung cancer depends upon the tumor stage, histology (non-small cell lung cancer [NSCLC] versus small cell lung cancer, nonsquamous versus squamous NSCLC), molecular characteristics, and an assessment of the patient's overall medical condition. Non-small cell lung cancer (NSCLC) accounts for 80%–90% of lung cancers, while small cell lung cancer (SCLC) has been decreasing in frequency in many countries over the past two decades . Most cases presented advanced stages at the moment of diagnosis, and … 2003 Feb. 30(1):3-8. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. Jenkins K. Which Smokers Should Be Screened for Lung Cancer?. In accordance with ‘taking care’ of the cancer patient, the management of non-small cell lung cancer (NSCLC) is currently carried out by a multidisciplinary team in which the pathologist plays a pivotal role. [Guideline] National Collaborating Centre for Cancer. Non-small-cell lung carcinoma (NSCLC) is any type of epithelial lung cancer other than small-cell lung carcinoma (SCLC). 453-457. Small-cell lung cancer (SCLC) is a disease in which cells in your lung begin growing out of control. Small-cell lung cancer (SCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. American Cancer Society. Although cigarette smoking is the main cause of lung cancer, anyone can develop the disease. 2008. 153 (4):954-985. Small cell lung cancers include ICD-O morphology codes M-80413, M-80423, M-80433, M-80443, and M-80453. Cancer. 131(5):1210-9. Even with advanced treatment options, the small cell lung cancer (SCLC) survival rate is not as good as it is with other types of lung cancer.SCLC can grow and spread quickly. Schmittel A, Sebastian M, Fischer von Weikersthal L, et al. N Engl J Med. 340(4):265-71. DeVita VT Jr, Lawrence TS, Rosenberg SA, eds. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2021/cancer-facts-and-figures-2021.pdf, http://www.ncbi.nlm.nih.gov/books/NBK65909/#CDR0000062945__1, http://www.who.int/mediacentre/factsheets/fs297/en/, http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening, https://www.medscape.com/viewarticle/896582, http://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf, http://www.cancer.org/cancer/lungcancer-smallcell/detailedguide/small-cell-lung-cancer-staging, https://www.medscape.com/viewarticle/902700, https://www.fiercebiotech.com/biotech/press-release-gsk-receives-approval-for-hycamtin-capsules, International Association for the Study of Lung Cancer. Lancet Oncol. [Medline]. A 72 year old man was recently diagnosed with small cell lung cancer. Chemotherapy With or Without Maintenance Sunitinib for Untreated Extensive-Stage Small-Cell Lung Cancer: A Randomized, Double-Blind, Placebo-Controlled Phase II Study-CALGB 30504 (Alliance). Shepherd FA, Laskey J, Evans WK, Goss PE, Johansen E, Khamsi F. Cushing's syndrome associated with ectopic corticotropin production and small-cell lung cancer. Without further ado, here are the questions (in bold): Hi, i found this website is sooo helpful for me. These tumors are thought to develop from neuroendocrine Kulchitsky cells and are composed of sheets of small, round to spindled cells with dark nuclei, scant cytoplasm, and fine, granular (“salt and pepper”) nuclear chromatin with indistinct nucleoli. Jiang L, Yang KH, Guan QL, Mi DH, Wang J. Cisplatin plus etoposide versus other platin-based regimens for patients with extensive small-cell lung cancer: a systematic review and meta-analysis of randomised, controlled trials. Background Lung cancer (LC) incidence in the United States (US) continues to decrease but with significant differences by histology, gender and race. METHODS: Data were obtained during the KBP-2010-CPHG study, which included all new cases of primary lung cancer diagnosed in 2010 in 104 non-academic hospitals. Lung cancer. 1995 May 15. Micke P, Faldum A, Metz T, Beeh KM, Bittinger F, Hengstler JG, et al. Marabelle A, Le DT, Ascierto PA, Di Giacomo AM, De Jesus-Acosta A, Delord JP, et al. 10th ed. Acta Oncol. Available at https://www.medscape.com/viewarticle/902700. J Clin Oncol. All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. Ready N, Farago AF, de Braud F, Atmaca A, Hellmann MD, Schneider JG, et al. Non–small-cell lung cancer (NSCLC) comprises approximately 80% to 85% of all lung cancers, 1 and the majority of patients present with advanced or metastatic disease. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Thorac Cardiovasc Surg. ... Pancoast tumor: An anatomic designation (not a specific histology) for a lung cancer that starts in the upper lobe of the lung and extends outward to destroy the ribs and vertebrae. Despite significant recent achievements in the treatment of these patients, identification of all the clinically actionable alterations required for patient management remains challenging, particularly when dealing with cytological or small bioptic samples. Medscape Medical News. In small cell lung cancer, the tumour starts in the neuroendocrine cells of the lung. December 28, 2020; Accessed: February 2, 2021. [Medline]. Click. METHODS: Data were obtained during the KBP-2010-CPHG study, which included all new cases of primary lung cancer diagnosed in 2010 in 104 non-academic hospitals. [Medline]. [Full Text]. SCC, sometimes called epidermoid carcinoma, is more prevalent in men and arises in the lining of the large air passageways, or bronchi.Another common type of NSCLC is adenocarcinoma, which occurs at the … [Medline]. Available at http://www.who.int/mediacentre/factsheets/fs297/en/. It is advised to handle small diagnostic specimens prudently because they are often the only specimen available for molecular analysis. Respir Med. 9(3):499-508. Cochrane Database Syst Rev. N Engl J Med. Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. [Medline]. The histologic types of lung cancer defined by the World Health Organization are listed in Table 5. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. 121. It starts in nerve cells or cells that make hormones. Adami H, Hunter D, Laglou P, Mucci L, eds. Typical patients are men older than 70 years who are current or past heavy smokers and who have pulmonary and cardiovascular comorbidities. He is a 25 pack per year smoker and has hypertension previously well controlled with on his current regimen. Lancet. [Medline]. Rule H1. If you log out, you will be required to enter your username and password the next time you visit. Lancet. [Medline]. [Medline]. Physical exam reveals an adipose deposit on the dorsal upper thorax and abdominal striae. 2013 May. Lung cancer is the most common cause of cancer deaths worldwide. 2011 Jan 20. Patients with mixed SCLC/NSCLC histology are managed according to the same guidelines as those for patients with SCLC. According to the histological size of cancer cells under a microscope, lung cancer can be divided into small cell lung cancer (SCLC) and NSCLC. Specificity of calcium channel autoantibodies in Lambert-Eaton myasthenic syndrome. 2020 Jan 1. AJCC Cancer Staging Manual. The samples are checked under a microscope for cancer cells. The incidence and mortality of small-cell lung cancer worldwide make this disease a notable health-care issue. Non-small cell lung cancer represents a heterogeneous group of lung cancers that do not have "small cells" on histology. Author: Yale Rosen, M.D. Small cell lung cancer (SCLC) About 10% to 15% of all lung cancers are SCLC and it is sometimes called oat cell cancer. Combined chemotherapy with cisplatin, etoposide, and irinotecan versus topotecan alone as second-line treatment for patients with sensitive relapsed small-cell lung cancer (JCOG0605): a multicentre, open-label, randomised phase 3 trial. Hanna N, Bunn PA Jr, Langer C, Einhorn L, Guthrie T Jr, Beck T, et al. Goto K, Ohe Y, Shibata T, Seto T, Takahashi T, Nakagawa K, et al. Surgery for limited-stage small cell lung cancer, should the paradigm shift? She states that a month ago, she began experiencing shortness of breath during her morning 2 mile walk, which she had previously enjoyed without difficultly. 2017 May. [Medline]. 2016 Aug 23. The two broad histological subtypes of lung cancer are small-cell lung cancer (SCLC), which is the cause of 15% of cases, and non-small-cell lung cancer (NSCLC), which accounts for 85% of cases and includes adenocarcinoma, squamous-cell carcinoma, and large-cell carcinoma. Randomized phase II trial of single-agent amrubicin or topotecan as second-line treatment in patients with small-cell lung cancer sensitive to first-line platinum-based chemotherapy. Efficacy of Pembrolizumab in Patients With Noncolorectal High Microsatellite Instability/Mismatch Repair-Deficient Cancer: Results From the Phase II KEYNOTE-158 Study. Recent clinical trials, however, demonstrate that histology is an important factor for individualizing treatment, based on either safety or efficacy outcomes. Prophylactic cranial irradiation in small-cell lung cancer: findings from a North Central Cancer Treatment Group Pooled Analysis. 2012 Sep 1. Horn L, Mansfield AS, Szczęsna A, Havel L, Krzakowski M, Hochmair MJ, et al. This coronal positron emission tomogram shows a large, focal, hypermetabolic area on the right that is consistent with a large mass in the central portion of the right upper pulmonary lobe. [Medline]. His chest Xray shows a large hilar mass in the left thorax but is negative for pleural effusion. 1989 Sep 16. 143 (5 Suppl):e142S-65S. Jackman DM, Johnson BE. World Health Organization. 340:b5569. [Medline]. [Medline]. Xray of the chest shows a right sided lung mass at the hilum. Jotte R, Conkling P, Reynolds C, Galsky MD, Klein L, Fitzgibbons JF, et al. 2005 Oct 15-21. [Medline]. Advances in Small Cell Lung Cancer. N Engl J Med. Small-cell lung cancer: state of the art. Non small-cell lung cancer (NSCLC) accounts for ∼85% of primary lung cancers, the most common subtypes being adenocarcinoma (ADC) and squamous cell carcinoma (SCC) . Article Download PDF View Record in Scopus Google Scholar. Winston W Tan, MD, FACP is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, American Society of Hematology, Philippine Medical Association, Texas Medical AssociationDisclosure: Nothing to disclose. Hermes A, Waschki B, Reck M. Hyponatremia as prognostic factor in small cell lung cancer--a retrospective single institution analysis. Noda K, Nishiwaki Y, Kawahara M, Negoro S, Sugiura T, Yokoyama A, et al. SCLC is one of the two major types of lung cancer. Semin Thorac Cardiovasc Surg. 83(1):e53-9. [Medline]. 2006 Oct 1. pathology/cytology . [Medline]. Among these histologic types, adenocarcinoma and SCC are the most frequent and account for> 80% of resected lung cancers. The EGFR mutation status (primary end point: positive, negative, or undetermined) of … Use the menu to see other pages. J Clin Oncol. Lancet. Semin Oncol. 2005 Mar. Lung Solid Tumor Rules December 2020 Update 33. Ready NE, Pang HH, Gu L, Otterson GA, Thomas SP, Miller AA, et al. Wynder EL, Graham EA. [33]. Types of Lung Cancer Non-Small Cell Lung Cancer (NSCLC) Most lung cancers are classified as non-small cell lung cancer (NSCLC). [Medline]. 2011 Aug. 22(8):1798-804. … Which of the following tumors most commonly produces the paraneoplastic syndrome seen in this patient? Small Cell Carcinoma of the Lung. [Medline]. A total of 171 NSCLC patients with brain metastases treated by hypofractionated stereotactic radiotherapy with or without whole-brain radiotherapy between 2001 and … Arriagada R, Le Chevalier T, Pignon JP, Riviere A, Monnet I, Chomy P, et al. AJCC Cancer Staging Manual Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, et al, eds. Prognostic value of histology in patients with non-small cell lung cancer. Clin Lung Cancer. J Clin Oncol. Available at http://www.cancer.org/cancer/lungcancer-smallcell/detailedguide/small-cell-lung-cancer-staging. He is anxious about his prognosis and asks about treatment options. Background: Meta-analyses were conducted to characterize patterns of mutation incidence in non small-cell lung cancer (NSCLC). RESULTS: In all, 3199 patients had adenocarcinoma (ADC), 1852 squamous cell carcinoma (SCC), 754 large cell … 2010 Jan 21. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. Harris S, Chan MD, Lovato JF, Ellis TL, Tatter SB, Bourland JD, et al. 18-fluorodeoxyglucose positron emission tomography in the diagnosis and staging of lung cancer: a clinical practice guideline. [Guideline] Rudin CM, Ismaila N, Hann CL, Malhotra N, Movsas B, Norris K, et al. 20(14):3054-60. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly93d3cubWVkc2NhcGUuY29tL2Fuc3dlcnMvMjgwMTA0LTM3NzQzL3doYXQtYXJlLXRoZS1oaXN0b2xvZ2ljLWZpbmRpbmdzLW9mLXNtYWxsLWNlbGwtbHVuZy1jYW5jZXItc2NsYw==. Very high rates of cell division are observed, and necrosis, sometimes extensive, may be seen. SCLCs behave aggressively and are treated nonsurgically in most cases, whereas NSCCs are 33 (15):1660-5. Cancer Res. Recent clinical trials, however, demonstrate that histology is an important factor for individualizing treatment, based on either safety or efficacy outcomes. 2011 Sep. 26(5):657-66. Irfan Maghfoor, MD is a member of the following medical societies: American Society of HematologyDisclosure: Nothing to disclose. The three types are known as adenocarcinomas, squamous cell carcinomas, and large cell carcinomas. The doctor or nurse collects samples (biopsies) of cells or tissue from the lung or nearby lymph nodes. [Full Text]. Regimen. J Clin Oncol. Crush artifact of the relatively fragile tumor cells is a common finding in small biopsies, but this feature is not considered diagnostic in and of itself. However, we cannot answer medical or research questions or give advice. Sher E, Gotti C, Canal N, Scoppetta C, Piccolo G, Evoli A, et al. 1999 Jan 28. Toronto, Ontario: Cancer Care Ontario; 2007. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. 2002 Oct 1. © Copyright PathologyOutlines.com, Inc. Click, Small cell neuroendocrine carcinoma [title] lung, Basaloid variant of squamous cell carcinoma, Lung adenocarcinoma, poorly differentiated, Neuroendocrine tumor that arises in the hilum of smokers with a poor prognosis and no current targeted therapy, High grade, usually advanced at diagnosis, Almost exclusively associated with smoking / tobacco exposure, Positive for at least one neuroendocrine marker, 70% have metastasis at time of diagnosis (, Lung: central / bronchial / hilar; rarely a peripheral nodule, Metastasis to liver, adrenals, bone, bone marrow, brain; often widespread, Arises from neuroendocrine cells of basal bronchial epithelium, Adrenocorticotropic hormone (ACTH) production →, Antidiuretic hormone (ADH) → syndrome of inappropriate antidiuretic hormone secretion (SIADH) → hyponatremia, Limited: ipsilateral hemithorax and regional lymph nodes, Extensive: contralateral thorax and lymph nodes, metastasis or malignant effusions, Biopsy: based on hematoxylin and eosin morphology, No diagnostic labs but can have associated abnormalities (see, More useful as staging tool; often not visible on chest Xray due to central location (, Imaging for staging includes chest CT, brain MRI or CT, bone scans (technetium or PET) (, Continued smoking → chemotherapy resistance, Labs: elevated lactate dehydrogenase (LDH), alkaline phosphatase, albumin, Metastasis to the liver, bone marrow and brain, 53 year old man, smoker, presenting acutely with malignant tension hydrothorax (, 62 year old man with pituitary gland metastasis (, 64 year old man with inappropriate antidiuretic hormone paraneoplastic syndrome (, 76 year old man with two morphologically distinct patterns of small cell lung carcinoma (, Septuagenarian man with back spasms presenting with tumor lysis syndrome (, Combined chemotherapy (platinum based) and radiation (, 5 year survival rate: 10 - 13 % (limited), 1 - 2% (extensive), Peripheral nodules: circumscribed, with fleshy cut surface, Rarely seen at frozen section due to being diagnosed on cytology and usually treated nonoperatively, Round / oval blue cells with minimal cytoplasm; usually small to medium sized, Nuclear features: finely dispersed chromatin, no distinct nucleoli, molding, smudging, high mitotic rate, Stroma: thin, delicate, scant, fibrovascular, Necrosis and apoptosis of individual cells common, Patterns: sheets, clusters, ribbons, rosettes, peripheral palisading, Azzopardi phenomena: basophilic nuclear material lining blood vessel walls, Metastatic cells usually have more cytoplasm, Nuclei: oval / elongated, hyperchromatic, absent nucleoli, granular cytoplasm, smooth membrane, Pattern: molding, individual cells or loose clusters, crush artifact, Necrosis and apoptosis of individual cells and tumor background, Neurosecretory granules - dense in central cytoplasm with peripheral halo (.

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