Histologic Features of ALK-Expressing Adenocarciomas of the Lung

Hye-Jong Song; Ji Yun Jeong; Yoonla Choi; Joungho Han

doi:10.6058/jlc.2011.10.1.32

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Song, Jeong, Choi, and Han: Histologic Features of ALK-Expressing Adenocarciomas of the Lung

Original Article

J Lung Cancer 2011;10(1):32-36.

Published online: 11 January 2011

DOI: https://doi.org/10.6058/jlc.2011.10.1.32

Histologic Features of ALK-Expressing Adenocarciomas of the Lung

Hye-Jong Song, M.D., Ji Yun Jeong, M.D., Yoonla Choi, M.D., Ph.D., Joungho Han, M.D., Ph.D.

Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address for correspondence Joungho Han, M.D., Ph.D. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon- dong, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-2800 Fax: 82-2-3410-0025 E-mail: hanjho@skku.edu

Revised 18 April 201116 June 2011 Accepted 17 June 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

This study was designed to define the specific histologic features of anaplastic lymphoma kinase (ALK)-expressing pulmonary adenocarcinoma. Materials and Methods: Of the 580 pulmonary adenocarcinomas diagnosed between March 2010 and February 2011, immunohistochemical staining for ALK was performed in 269 cases showing any suspicious histologic features in previous reports. The subtype according to the World Health Organization classification and the characteristic histologic features were re-evaluated in ALK-expressing cases.

Results:

A total of 46 cases (7.9% of the 580 adenocarcinomas, 17.1% of the 269 studied cases) were positive for ALK. Among the 46 cases showing ALK positivity, 35 cases (76%) showed intra- and/or extracytoplasmic mucin. The most well-known characteristic finding asso-ciated with ALK, signet ring cells, was found in 18 cases (39.1%). Cribriform pattern with extracytoplasmic mucin was identified in five cases. In six cases, all three features were found. On the other hand, there were three other cases that did not show any of the aforementioned histologic features. In 12 lobectomy specimens, the most common histologic pattern was a solid pattern (five cases, 41.6%).

Conclusion: Intra- and/or extracytoplasmic mucin, including signet ring cell appearance and a cribriform pattern with extracytoplasmic mucin, are characteristic features of ALK-expressing non-small cell lung cancer.

Keywords: Non-small cell lung carcinoma, Anaplastic lymphoma kinase, Immunohistochemistry, Adenocarcinoma

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Fig. 1.

Representative example of ALK-expressing pulmonary adenocarcinoma. (A) The cut surface in the lobectomy specimen shows a well-demarcated pale yellow solid mass. (B∼ D) The specimen is consisted of mixed histologic patterns including solid, acinar, and papillary pattern. Intra- and/or extracytoplasmic mucin with signet ring cells were frequently identified (hematoxylin-eosin stain, ×16, ×100, and ×200 respectively). (E, F) ALK antibody stains cytoplasm of tumor cells diffusely with slightly granular pattern (ABC method, ×100 and ×400 respectively).

Table 1.

Characteristics of Patients and Specimens

Age (median), yr	25∼77 (52)
Sex	Male	20 (43.5)
	Female	26 (56.5)
Procedure	Lung biopsy	22 (47.8)
	Lobectomy	12 (26.1)
	LN biopsy	10 (21.7)
	Wedge resection	1 (2.2)
	Metastasectomy	1 (2.2)

Values are presented as number (%) unless otherwise indi-cated.

Table 2.

Pathologic Features in Immunohistochemically ALK- positive NSCLC

Dominant pattern (lobectomy cases)
Solid		5 (41.7)
Papillary		3 (25.0)
Acinar		4 (33.3)
Characteristic features
Intra- and/or extracytoplasmic mucin	(＋)	35 (76.1)
	(−)	11 (23.9)
Cribriform with extracytoplasmic mucin	(＋)	7 (15.2)
	(−)	39 (84.8)
Signet ring cells	(＋)	18 (39.1)
	(−)	28 (60.9)

Values are presented as number (%).

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