The characteristics of peripheral lung tumours that suggest their bronchiolo-alveolar origin

Abstract

TUMOURS of the lower respiratory tract have generally been regarded as bronchial tumours. However, some authors (Garland, Beier, Coulson, Heald and Stein, 1962;Lisa, Trinidad and Rosenblatt, 1965) have pointed out recently that many pulmonary tumours have a peripheral origin. A similar conclusion was reached by Mottura and Campobasso (1966) who described the histological features of 557 tumours of the lung, studied on postmortem specimens and surgical resections. They concluded that these tumours could be classified histologically under four headings: anaplastic small cell carcinoma; squamous cell carcinoma; anaplastic large cell carcinoma and adenocarcinoma. This classification is not new and is very similar to that used by other workers (Fischer, 1949;McDonald, McBurney, Carlisle and Patton, 1951;Walter and Pryce, 1955; Whitwell, 1961;Delarue, Abelanet and Paillas, 1964), but the recent work has provided a new histogenetic basis for the classification, which suggests that among the tumours of the lower respiratory tract, a distinction should be made between the true bronchogenic carcinomas, which include anaplastic small cell carcinoma and squamous cell carcinoma, and the bronchiolo-alveolar carcinomas which include anaplastic large cell carcinoma and adenocarcinoma, the latter being tumours of the lung parenchyma.On the other hand, bronchial epithelium is, in the main, a lining epithelium and its histological and ultrastructural appearances are different from bronchiolar and alveolar epithelium (Krahl, 1963;Collet, 1965). The latter are directly concerned with respiratory function and are responsible for the growth and regeneration of pulmonary tissue, both in foetal and post-natal life (Willson, 1928;Amprino, 1937;Dunnill, 1962). Consequently, it seems logical to assume that if two kinds of epithelium exist, two kinds of tumour also exist, each related to the respective type of epithelium of origin.The purpose of this present paper is to illustrate the significance of the relationship between the location of the tumour and its histological type, and to describe and to discuss some histological aspects of peripheral lung tumours. This has provided more evidence to show that tumours of the lower respiratory tract may well be of two histogenetic patterns. MATERIALS AND METHODSFive hundred and thirty-one tumours were obtained by surgical resection at the Thoracic Surgery Centre of the University of Turin. The tumours were sub-divided into hilar-parahilar and peripheral tumours, according to whether or not they were in obvious connection with the bronchial tree. To establish whether or not this connection existed, all the bronchial branches were cut and opened 57

Survival Rates of Lung Cancer According to Histological Type

“…Such favourable behaviour could not be confirmed in the present or in other series (Hukill and Stern, 1962;Bennet and Sasser, 1969). On the other hand, the validity of alveolar cell cancer as a clinicopathological entity has been denied by Bennet and Sasser (1969) and recent ultrastructural observations in this Institute (Mollo, Canese and Campobasso, 1973) (Campobasso, 1968).…”

Comparison of clinical characteristics between patients with ALK-positive and EGFR-positive lung adenocarcinoma

“…This finding is the most clinically important finding in this study. Positive bronchoscopy findings (visible tumour or extrinsic compression) in ALKpositive patients indicated that the origin of the ALKpositive tumours was more centralized than that of EGFRpositive tumours, even though both groups consisted of adenocarcinomas that are traditionally known as peripheral tumours rather than squamous cell or small cell carcinomas [23,24]. The reasoning as to why ALK-positive patients present with more positive findings in bronchoscopy should be determined through a future study with radiologic and pathologic examinations and we are planning the separate study to confirm the central nature of ALK fusion-positive tumours by examining the radiographic features of these lung cancers.…”

Human Peripheral Lung Tumours: Light and Electron Microscopic Correlation

“…The fact that this ultrastructural feature is common to adenocarcinoma and large cell carcinoma so designated at light microscopy level is much in keeping with the concept of other authors (Friedberg, 1965;Herman, Bullock and Waken, 1966) that large cell carcinomata, including giant cell cancer, are iundifferentiated adenocarcinomata. This suggestion might well account for the difficulties in sharply separating adenocarcinoma and large cell carcinoma by light microscopy (Kreyberg, 1967;Campobasso, 1968;Melamed, 1968). It can be concluded that, irrespective of the light microscopical architecture, all peripheral lung tumours which fail to show squamous differentiation are in fact adenocarcinomata.…”

“…In previous papers (Mottura and Campobasso, 1966;Campobasso, 1968) human lung tumours have been defined as peripheral when showing no obvious connection with bronchi larger than 2 mm in diameter. It has also been pointed out that the majority of these tumours have the histological appearance of either adenocarcinoma or anaplastic large cell carcinoma.…”