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A 50-year-old male complains of episodic flushing and tachycardia over the past few months. X-rays revealed a pulmonary mass. Shown is an H&E from the lung. Click here to see the whole slide image.
Click here for the comparative pathology.
D. Atypical carcinoid tumor
Primary pulmonary neuroendocrine tumors represent about 20% of all lung cancers. They are classified into four categories:
1. Typical carcinoid tumor
2. Atypical carcinoid tumor
3. Large-cell neuroendocrine tumor
4. Small-cell neuroendocrine tumor
The atypical carcinoids, such as the current example, have been the most difficult to classify. The presence of Chromogranin A or Synaptophysin identifies the tumor as neuroendocrine. Current recommendations suggest that mitotic rate (Ki-67) and p53 and ras mutations are useful prognostic indicators.
This Image IQ has been provided by the Center for Genomic Pathology
1. Gustafsson BI, Kidd M, Chan A, et al. Bronchopulmonary neuroendocrine tumors. Cancer. 2008;113:5-21. PubMed PMID: 18473355.
2. Przygodzki RM, Finkelstein SD, Langer JC, et al. Analysis of p53, K-ras-2, and C-raf-1 in pulmonary neuroendocrine tumors. Correlation with histological subtype and clinical outcome. Am J Pathol. 1996;148:1531-1541. PubMed PMID: 8623922.
3. Kobayashi Y, Tokuchi Y, Hashimoto T, et al. Molecular markers for reinforcement of histological subclassification of neuroendocrine lung tumors. Cancer Sci. 2004;95:334-341. PubMed PMID: 15072592.
4. Rekhtman N. Neuroendocrine tumors of the lung: an update. Arch Pathol Lab Med. 2010;134:1628-1638. Review. PubMed PMID: 21043816.