Clinicopathological, radiographic, and oncogenic features of primary pulmonary enteric adenocarcinoma in comparison with invasive adenocarcinoma in resection specimens

Abstract

Primary pulmonary enteric adenocarcinoma (PEAC) is a rare subtype of primary lung adenocarcinoma. However, it is not known whether there are any distinctive clinical or molecular features.PEACs were retrospectively identified in 28 patients from July 2014 to June 2016. We compared the clinicopathological, radiographic, and oncogenic characteristics of PEAC and primary pulmonary invasive adenocarcinoma (IAC).A total of 28 PEAC patients and 92 IAC patients were compared. PEAC occurred more frequently in males (P = .008), in older patients (P = .041), in those with larger lesions (P = .001), and in those in a more advanced stage (P = .011). Radiologically, PEAC patients had larger lesions (P = .025) and more solid (P = .006); however, there were no statistically significant differences in lobulation, spiculation, pleural indentation, pleural effusion, and lymphadenopathy between PEAC and IAC. PEAC had higher values of carcinoembryonic antigen (P = .008) and carbohydrate antigen 19-9 (P < .001) than IAC. PEAC had a higher incidence (40% vs 63%, P < .001) of Kristen rat sarcoma viral oncogene homolog (KRAS) mutations and a lower incidence (10.71% vs 3.3%, P < .001) of epidermal growth factor receptor (EGFR) mutations. Villin may be a useful marker in the differential diagnosis of PEAC. KRAS mutations occurred more frequently in PEACs, which are cytokeratin 7-negative (P = .032). EGFR mutation rates were higher in PEACs, which are cytokeratin 20- and caudal type homeobox transcription factor 2-negative (P = .041).PEAC is a rare and heterogeneous nonsmall-cell lung cancer subgroup with distinctive clinicopathological, radiographic, and molecular features. These results need to be further confirmed in future studies.

Pulmonary enteric adenocarcinoma: an overview

“…IHC features of PAED have been described by several authors, but data are often conflicting and inconclusive ( Refs 13,19,20,23,24,31,34). However, scientific societies agree in considering, as major pathological characteristics of PAED, the IHC positivity for at least one marker of colonic differentiation, among CDX2, CK20 and MUC2, as well as the presence of an entero-like tumour cell morphology in more than half sample (Travis 2013, Truini 2015).…”

“…spiculation, pleural effusion or indentation) can be similarly detected in PAED and primary pulmonary IAC samples (Ref. 19). Moreover, Bian et al found no significant differences when comparing CT scans from 13 PAED cases with 27 patients with metastatic colorectal cancer (MCC) (Ref.…”

“…There seem to be no significant differences between PAED and conventional lung adenocarcinoma in terms of correlation with smoking status ( Refs 11,19). Moreover, PAED incidence in both sexes varies according to different studies (Refs 20, 24), although it is apparently higher in males.…”

“…On the other hand, Zhao et al analysed 28 cases of PEAC and showed Villin as the most frequently expressed markers (89.2%), followed by CK7 (66.6%), CDX2 (57.1%), CK20 (36.0%), TTF1 (35.7%) and Napsin A (23.0%) (Ref. 19). Moreover, Lin et al confirmed the frequent expression of Villin (80.0%), but found discrepant data for the other markers (CDX2: 90.0% of expression rate, CK20: 70.0%; CK7: 30.0%; TTF1: 30.0%; Napsin A: 25%) over a series of 11 cases (Ref.…”

Cutaneous metastasis as a primary presentation of a pulmonary enteric adenocarcinoma

“…Also, considering the small number of cases observed, no differences in onset, lung location type, clinical course, and radiographic features between PEAC and conventional lung adenocarcinoma are reported. 3 In contrast to lung cancer, in several cases PEAC shows an increase in circulating tumor markers CA19-9 and carcinoembryonic antigen (CEA) with an absence of CYFRA 21.1 or Neuron Specific Enolase (NSE). 3 With the advance of nucleic acid sequencing technologies over the recent years, new perspectives are emerging in the field of cancer characterization, but the rarity of PEAC hindered the identification of specific molecular signatures to apply in differential diagnosis, prognostic stratification, and prediction of response to therapy.…”