ORIGINAL ARTICLES  THORACIC SECTION 

The Journal of Cardiovascular Surgery 2003 October;44(5):661-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Study of the diagnostic difference between the clinical diagnostic criteria and results of immunohistochemical staining of multiple primary lung cancers

Nonami Y. ¹, Ohtuki Y. ², Sasaguri S. ¹

¹ Department of Surgery II, Kochi Medical School, Kochi, Japan 2 Department of Pathology II, Kochi Medical School, Kochi, Japan

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Aim. ­When mul­tiple syn­chro­nous or met­a­chro­nous ­lung ­cancer ­lesions are iden­ti­fied, dis­crim­i­na­tion of mul­ti­cen­tric ­lung can­cers ­from intra­pul­mo­nary metas­tases by clin­ical find­ings is ­often dif­fi­cult. ­When ­tissue ­types ­have the ­same path­o­log­ical fea­tures, ­such as com­bi­na­tions of squa­mous ­cell car­ci­noma (SCC), aden­o­car­cinoma (AD) or bron­chiolo-­alveolar ­cell car­ci­noma (BAC), it is espe­cially dif­fi­cult to dis­tin­guish a ­2nd pri­mary ­lung ­cancer ­from a met­a­static ­lesion. A new ­strategy for accu­rate diag­nosis of mul­tiple syn­chro­nous or met­a­chro­nous ­lung ­cancer is ­needed ­because of the dif­fi­culty of his­to­log­ical dis­crim­i­na­tion.
­Methods. Of 363 ­patients ­with pri­mary ­lung ­cancer for ­which sur­geries ­were con­ducted at our hos­pital, 7 ­cases ­were diag­nosed as syn­chro­nous mul­tiple ­lung ­cancer (BAC-BAC in 4 ­cases and SCC-BAC in 3 ­cases) and 8 ­cases (BAC-BAC in 2 ­cases, AD-BAC in 1 ­case, AD-AD in 1 ­case, SCC-AD in 1 ­case and SCC-SCC in 3 ­cases) ­were diag­nosed as met­a­chro­nous mul­tiple ­lung ­cancer ­according to the clin­ical diag­nostic cri­teria. ­This ­study ­focused on 8 ­cases ­with the com­bi­na­tions AD-AD, AD-BAC, or BAC-BAC. For immu­no­his­to­chem­ical ­staining, we ­used the anti­bodies to 6 anti­gens as fol­lows: CK-19, p53, CEA, Hup-1, PE-10, and Ki-67.
­Results. Of 4 ­cases diag­nosed as syn­chro­nous ­lung ­cancer ­according to the clin­ical diag­nostic cri­teria, dif­fering immu­no­his­to­chem­ical ­stained ­images of the ­lesions ­were ­observed in 3 ­cases, ­while in the 4th ­case ­almost iden­tical immu­no­his­to­chem­ical ­stained ­images ­were ­obtained, ­which indi­cated the 2 ­lesions ­were the pri­mary and met­a­static ­focuses. Of 4 ­cases diag­nosed as met­a­chro­nous ­lung ­cancer ­according to the clin­ical diag­nostic cri­teria, ­almost iden­tical ­stained ­images ­were ­seen in 3 ­cases, ­which indi­cated the 2 ­lesions ­were the pri­mary and met­a­static ­focuses.
Con­clu­sion. In gen­eral, ­Type A and ­Type B in ­Noguchi’s BAC clas­sifi­ca­tion, ­tended to be mul­tiple syn­chro­nous or met­a­chro­nous ­lung ­cancer ­lesions, ­while AD and ­Type C in ­Noguchi’s BAC clas­sifi­ca­tion ­tended to be the met­a­static ­focus. For the ­focuses ­with ­tissue ­type of BAC-BAC, the ­staining ­using CK-19, PE-10, and Ki-67 was ­useful in dis­tin­guishing mul­tiple pri­mary ­lung ­cancer ­from pul­mo­nary metas­tasis in ­cases ­with a com­bi­na­tion of AD and BAC.