Lung Carcinoma



Lung cancer is considered the most common source of new cancer worldwide and contributes the highest number of deaths from cancer. In the United States, more than 222,000 new cases and approximately 157,300 deaths were expected in 2010. The Surveillance Epidemiology and End Results (SEER) group, who studied the incidence of lung cancer in 17 geographic areas, reported the incidence rate for all races to be 76.2 per 100,000 men and 52.4 per 100,000 women. However, the incidence rate varied among races – 41.4 men and 25.4 females per 100,000 Hispanics, compared to 101.2 men and 54.8 females per 100,000 blacks. It is estimated that 1 in 14 men and women will develop lung cancer during their lifetime. There are, however, different trends based on gender, according to the SEER report, with a −0.8 annual percentage change (APC) between 1991 and 2007 for men vs. a +1.0 APC in women over the same period.1,2


Small Cell Carcinoma Malignant Mesothelioma Malignant Pleural Effusion Annual Percentage Change Malignant Effusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Altekruse SF. SEER Cancer Statistics Review, 1975–2007: National Cancer Institute, Bethesda MD; 2010 (cited 2010). Available from:
  2. 2.
    American Cancer Society: Cancer facts and figures 2010. Available from:
  3. 3.
    Parkin DM, Muir CS. Cancer incidence in five continents. Comparability and quality of data. IARC Sci Publ. 1992;120:45-173.PubMedGoogle Scholar
  4. 4.
    Travis WD, Brambilla E, Muller-Hermelink KH, Harris CC, eds. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. Lyon: IARC Press; 2004.Google Scholar
  5. 5.
    Johnston WW. The malignant pleural effusion. A review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients. Cancer. 1985;56:905-909.PubMedCrossRefGoogle Scholar
  6. 6.
    DiBonito L, Falconieri G, Colautti I, Bonifacio D, Dudine S. The positive pleural effusion. A retrospective study of cytopathologic diagnoses with autopsy confirmation. Acta Cytol. 1992;36:329-332.PubMedGoogle Scholar
  7. 7.
    Renshaw AA, Madge R, Sugarbaker DJ, Swanson S. Malignant pleural effusions after resection of pulmonary adenocarcinoma. Acta Cytol. 1998;42:1111-1115.PubMedCrossRefGoogle Scholar
  8. 8.
    Lombardi G, Zustovich F, Nicoletto MO, Donach M, Artioli G, Pastorelli D. Diagnosis and treatment of malignant pleural effusion: a systematic literature review and new approaches. Am J Clin Oncol. 2010;33:420-423.PubMedCrossRefGoogle Scholar
  9. 9.
    Leung AN, Muller NL, Miller RR. CT in differential diagnosis of diffuse pleural disease. AJR Am J Roentgenol. 1990;154:487-492.PubMedGoogle Scholar
  10. 10.
    Ozcakar B, Martinez CH, Morice RC, et al. Does pleural fluid appearance really matter? The relationship between fluid appearance and cytology, cell counts, and chemical laboratory measurements in pleural effusions of patients with cancer. J Cardiothorac Surg. 2010;5:63.PubMedCrossRefGoogle Scholar
  11. 11.
    Heffner JE, Klein JS. Recent advances in the diagnosis and management of malignant pleural effusions. Mayo Clin Proc. 2008;83:235-250.PubMedGoogle Scholar
  12. 12.
    Kimura M, Tojo T, Naito H, Nagata Y, Kawai N, Taniguchi S. Effects of a simple intraoperative intrathoracic hyperthermotherapy for lung cancer with malignant pleural effusion or dissemination. Interact Cardiovasc Thorac Surg. 2010;10:568-571.PubMedCrossRefGoogle Scholar
  13. 13.
    Sahn SA. Pleural effusion in lung cancer. Clin Chest Med. 1982;3:443-452.PubMedGoogle Scholar
  14. 14.
    Bedrossian CWM, ed. Malignant Effusions: A Multimodal Approach to Cytologic Diagnosis. New York: Igaku-Shoin; 1994.Google Scholar
  15. 15.
    Tao LC, ed. Cytopathology of Malignant Effusions. Chicago: ASCP Press; 1996.Google Scholar
  16. 16.
    Tang P, Vatsia SK, Teichberg S, Kahn E. Pulmonary adenocarcinoma simulating malignant mesothelioma. Arch Pathol Lab Med. 2001;125:1598-1600.PubMedGoogle Scholar
  17. 17.
    Cibas ES, Corson JM, Pinkus GS. The distinction of adenocarcinoma from malignant mesothelioma in cell blocks of effusions: the role of routine mucin histochemistry and immunohistochemical assessment of carcinoembryonic antigen, keratin proteins, epithelial membrane antigen, and milk fat globule-derived antigen. Hum Pathol. 1987;18:67-74.PubMedCrossRefGoogle Scholar
  18. 18.
    Shield PW, Callan JJ, Devine PL. Markers for metastatic adenocarcinoma in serous effusion specimens. Diagn Cytopathol. 1994;11:237-245.PubMedCrossRefGoogle Scholar
  19. 19.
    Fetsch PA, Abati A. Immunocytochemistry in effusion cytology: a contemporary review. Cancer. 2001;93:293-308.PubMedCrossRefGoogle Scholar
  20. 20.
    Westfall DE, Fan X, Marchevsky AM. Evidence-based guidelines to optimize the selection of antibody panels in cytopathology: pleural effusions with malignant epithelioid cells. Diagn Cytopathol. 2010;38:9-14.PubMedGoogle Scholar
  21. 21.
    Lozano MD, Panizo A, Toledo GR, Sola JJ, Pardo-Mindan J. Immunocytochemistry in the differential diagnosis of serous effusions: a comparative evaluation of eight monoclonal antibodies in Papanicolaou stained smears. Cancer. 2001;93:68-72.PubMedCrossRefGoogle Scholar
  22. 22.
    Ordonez NG. Role of immunohistochemistry in differentiating epithelial mesothelioma from adenocarcinoma. Review and update. Am J Clin Pathol. 1999;112:75-89.PubMedGoogle Scholar
  23. 23.
    Maguire B, Whitaker D, Carrello S, Spagnolo D. Monoclonal antibody Ber-EP4: its use in the differential diagnosis of malignant mesothelioma and carcinoma in cell blocks of malignant effusions and FNA specimens. Diagn Cytopathol. 1994;10:130-134.PubMedCrossRefGoogle Scholar
  24. 24.
    Comin CE, Novelli L, Boddi V, Paglierani M, Dini S. Calretinin, thrombomodulin, CEA, and CD15: a useful combination of immunohistochemical markers for differentiating pleural epithelial mesothelioma from peripheral pulmonary adenocarcinoma. Hum Pathol. 2001;32:529-536.PubMedCrossRefGoogle Scholar
  25. 25.
    Riera JR, Astengo-Osuna C, Longmate JA, Battifora H. The immunohistochemical diagnostic panel for epithelial mesothelioma: a reevaluation after heat-induced epitope retrieval. Am J Surg Pathol. 1997;21:1409-1419.PubMedCrossRefGoogle Scholar
  26. 26.
    Noguchi M, Nakajima T, Hirohashi S, Akiba T, Shimosato Y. Immunohistochemical distinction of malignant mesothelioma from pulmonary adenocarcinoma with anti-surfactant apoprotein, anti-Lewisa, and anti-Tn antibodies. Hum Pathol. 1989;20:53-57.PubMedCrossRefGoogle Scholar
  27. 27.
    Fetsch PA, Abati A, Hijazi YM. Utility of the antibodies CA 19–9, HBME-1, and thrombomodulin in the diagnosis of malignant mesothelioma and adenocarcinoma in cytology. Cancer. 1998;84:101-108.PubMedCrossRefGoogle Scholar
  28. 28.
    Simsir A, Fetsch P, Mehta D, Zakowski M, Abati A. E-cadherin, N-cadherin, and calretinin in pleural effusions: the good, the bad, the worthless. Diagn Cytopathol. 1999;20:125-130.PubMedCrossRefGoogle Scholar
  29. 29.
    Han AC, Filstein MR, Hunt JV, Soler AP, Knudsen KA, Salazar H. N-cadherin distinguishes pleural mesotheliomas from lung adenocarcinomas: a ThinPrep immunocytochemical study. Cancer. 1999;87:83-86.PubMedCrossRefGoogle Scholar
  30. 30.
    Schofield K, D’Aquila T, Rimm DL. The cell adhesion molecule, E-cadherin, distinguishes mesothelial cells from carcinoma cells in fluids. Cancer. 1997;81:293-298.PubMedCrossRefGoogle Scholar
  31. 31.
    Saqi A, Yun SS, Yu GH, et al. Utility of CD138 (syndecan-1) in distinguishing carcinomas from mesotheliomas. Diagn Cytopathol. 2005;33:65-70.PubMedCrossRefGoogle Scholar
  32. 32.
    Chu PG, Arber DA, Weiss LM. Expression of T/NK-cell and plasma cell antigens in nonhematopoietic epithelioid neoplasms. An immunohistochemical study of 447 cases. Am J Clin Pathol. 2003;120:64-70.PubMedCrossRefGoogle Scholar
  33. 33.
    O’Connell FP, Pinkus JL, Pinkus GS. CD138 (syndecan-1), a plasma cell marker immunohistochemical profile in hematopoietic and nonhematopoietic neoplasms. Am J Clin Pathol. 2004;121:254-263.PubMedCrossRefGoogle Scholar
  34. 34.
    Llinares K, Escande F, Aubert S, et al. Diagnostic value of MUC4 immunostaining in distinguishing epithelial mesothelioma and lung adenocarcinoma. Mod Pathol. 2004;17:150-157.PubMedCrossRefGoogle Scholar
  35. 35.
    Takezawa C, Takahashi H, Fujishima T, et al. Assessment of differentiation in adenocarcinoma cells from pleural effusion by peripheral airway cell markers and their diagnostic values. Lung Cancer. 2002;38:273-281.PubMedCrossRefGoogle Scholar
  36. 36.
    Mimura T, Ito A, Sakuma T, et al. Novel marker D2-40, combined with calretinin, CEA, and TTF-1: an optimal set of immunodiagnostic markers for pleural mesothelioma. Cancer. 2007;109:933-938.PubMedCrossRefGoogle Scholar
  37. 37.
    Gomez-Fernandez C, Jorda M, Delgado PI, Ganjei-Azar P. Thyroid transcription factor 1: a marker for lung adenoarinoma in body cavity fluids. Cancer. 2002;96:289-293.PubMedCrossRefGoogle Scholar
  38. 38.
    Zhu W, Michael CW. WT1, monoclonal CEA, TTF1, and CA125 antibodies in the differential diagnosis of lung, breast, and ovarian adenocarcinomas in serous effusions. Diagn Cytopathol. 2007;35:370-375.PubMedCrossRefGoogle Scholar
  39. 39.
    Tan D, Zander DS. Immunohistochemistry for assessment of pulmonary and pleural neoplasms: a review and update. Int J Clin Exp Pathol. 2008;1:19-31.PubMedGoogle Scholar
  40. 40.
    Agoff SN, Lamps LW, Philip AT, et al. Thyroid transcription factor-1 is expressed in extrapulmonary small cell carcinomas but not in other extrapulmonary neuroendocrine tumors. Mod Pathol. 2000;13:238-242.PubMedCrossRefGoogle Scholar
  41. 41.
    Pomplun S, Wotherspoon AC, Shah G, Goldstraw P, Ladas G, Nicholson AG. Immunohistochemical markers in the differentiation of thymic and pulmonary neoplasms. Histopathology. 2002;40:152-158.PubMedCrossRefGoogle Scholar
  42. 42.
    Suzuki A, Shijubo N, Yamada G, et al. Napsin A is useful to distinguish primary lung adenocarcinoma from adenocarcinomas of other organs. Pathol Res Pract. 2005;201:579-586.PubMedCrossRefGoogle Scholar
  43. 43.
    Dejmek A, Naucler P, Smedjeback A, et al. Napsin A (TA02) is a useful alternative to thyroid transcription factor-1 (TTF-1) for the identification of pulmonary adenocarcinoma cells in pleural effusions. Diagn Cytopathol. 2007;35:493-497.PubMedCrossRefGoogle Scholar
  44. 44.
    Chu P, Wu E, Weiss LM. Cytokeratin 7 and cytokeratin 20 expression in epithelial neoplasms: a survey of 435 cases. Mod Pathol. 2000;13:962-972.PubMedCrossRefGoogle Scholar
  45. 45.
    Li HC, Schmidt L, Greenson JK, Chang AC, Myers JL. Primary pulmonary adenocarcinoma with intestinal differentiation mimicking metastatic colorectal carcinoma: case report and review of literature. Am J Clin Pathol. 2009;131:129-133.PubMedCrossRefGoogle Scholar
  46. 46.
    Spriggs AI, Boddington MM. Oat-cell bronchial carcinoma. Identification of cells in pleural fluid. Acta Cytol. 1976;20:525-529.PubMedGoogle Scholar
  47. 47.
    Spieler P, Gloor F. Identification of types and primary sites of malignant tumors by examination of exfoliated tumor cells in serous fluids. Comparison with the diagnostic accuracy on small histologic biopsies. Acta Cytol. 1985;29:753-767.PubMedGoogle Scholar
  48. 48.
    Smith R, Nguyen GK. Unusual cytologic manifestation of small-cell lung cancer in associated pleural effusion. Diagn Cytopathol. 2004;30:266-267.PubMedCrossRefGoogle Scholar
  49. 49.
    Salhadin A, Nasiell M, Nasiell K, et al. The unique cytologic picture of oat cell carcinoma in effusions. Acta Cytol. 1976;20:298-302.PubMedGoogle Scholar
  50. 50.
    Khunamornpong S, Siriaunkgul S, Suprasert P. Cytology of small-cell carcinoma of the uterine cervix in serous effusion: a report on two cases. Diagn Cytopathol. 2001;24:253-255.PubMedCrossRefGoogle Scholar
  51. 51.
    Pereira TC, Saad RS, Liu Y, Silverman JF. The diagnosis of malignancy in effusion cytology: a pattern recognition approach. Adv Anat Pathol. 2006;13:174-184.PubMedCrossRefGoogle Scholar
  52. 52.
    DeLellis RA. The neuroendocrine system and its tumors: an overview. Am J Clin Pathol. 2001;115(Suppl):S5-S16.PubMedGoogle Scholar
  53. 53.
    Chhieng DC, Ko EC, Yee HT, Shultz JJ, Dorvault CC, Eltoum IA. Malignant pleural effusions due to small-cell lung carcinoma: a cytologic and immunocytochemical study. Diagn Cytopathol. 2001;25:356-360.PubMedCrossRefGoogle Scholar
  54. 54.
    Cerilli LA, Ritter JH, Mills SE, Wick MR. Neuroendocrine neoplasms of the lung. Am J Clin Pathol. 2001;116(Suppl):S65-S96.PubMedGoogle Scholar
  55. 55.
    Smith-Purslow MJ, Kini SR, Naylor B. Cells of squamous cell carcinoma in pleural, peritoneal and pericardial fluids. Origin and morphology. Acta Cytol. 1989;33:245-253.PubMedGoogle Scholar
  56. 56.
    Nieto-Llanos S, Vera-Roman JM. Squamous cell carcinoma of the bladder with metastasis diagnosed cytologically in a pleural effusion. Acta Cytol. 1999;43:1191-1192.PubMedGoogle Scholar
  57. 57.
    Hoda SA, Rosen PP. Cytologic diagnosis of metastatic penile carcinoma in pleural effusion. Arch Pathol Lab Med. 1992;116:198-199.PubMedGoogle Scholar
  58. 58.
    Gamez RG, Jessurun J, Berger MJ, Pambuccian SE. Cytology of metastatic cervical squamous cell carcinoma in pleural fluid: report of a case confirmed by human papillomavirus typing. Diagn Cytopathol. 2009;37:381-387.PubMedCrossRefGoogle Scholar
  59. 59.
    Pu RT, Pang Y, Michael CW. Utility of WT-1, p63, MOC31, mesothelin, and cytokeratin (K903 and CK5/6) immunostains in differentiating adenocarcinoma, squamous cell carcinoma, and malignant mesothelioma in effusions. Diagn Cytopathol. 2008;36:20-25.PubMedCrossRefGoogle Scholar
  60. 60.
    Ordonez NG. What are the current best immunohistochemical markers for the diagnosis of epithelioid mesothelioma? A review and update. Hum Pathol. 2007;38:1-16.PubMedCrossRefGoogle Scholar
  61. 61.
    Ordonez NG. The diagnostic utility of immunohistochemistry in distinguishing between epithelioid mesotheliomas and squamous carcinomas of the lung: a comparative study. Mod Pathol. 2006;19:417-428.PubMedCrossRefGoogle Scholar
  62. 62.
    Li Q, Bavikatty N, Michael CW. The role of immunohistochemistry in distinguishing squamous cell carcinoma from mesothelioma and adenocarcinoma in pleural effusion. Semin Diagn Pathol. 2006;23:15-19.PubMedCrossRefGoogle Scholar
  63. 63.
    Bassarova AV, Nesland JM, Davidson B. D2-40 is not a specific marker for cells of mesothelial origin in serous effusions. Am J Surg Pathol. 2006;30:878-882.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  1. 1.Department of PathologyThe University of MichiganAnn ArborUSA

Personalised recommendations