The Histopathology of Breast Adenocarcinoma and Lung Squamous Cell Carcinoma - Essay Example

mраrе and Соntrаst the Histораthоlоgy of Brеаst Аdеnосаrсinоmа and Lung Squamous Сеll Саrсinоmа Name Course Instructor Date Abstract The adenocarcinoma of the breast and squamous cell carcinoma (SCC) of the lung are the leading causes of cancer-related mortalities in women and men respectively. An investigation of peer reviewed articles with content on adenocarcinoma of the breast and SCC of the lung was conducted. The aim was to compare and contrast the histopathology of the two cancer types. Findings show that adenocarcinoma of the breast relates to cancer cells originating from the epithelium lining of either the ducts, or lobules of the mammary gland. On the other hand, SCC of the lung entails cancer cells originating centrally in larger airways, specifically the bronchi. Microscopic and histological features, as well as immunomarkers, assist to diagnose and differentiate the various cancer types. For both the adenocarcinoma of the breast and the squamous cell of the lung, detection, diagnosis and risk factors, are explained, laboratory specimens described, and the treatment options given. Introduction Adenocarcinoma of the breast and squamous cell carcinoma of the lung are significant in regards to their high prevalence, mortality rates, and disease burden relative to other cancer diseases (Dara et al. 2012; Makki 2015). Despite both being cancers, breast adenocarcinoma and SCC of the lung have varying histopathological and immunochemical features that determine their diagnosis and treatment. Case study of adenocarcinoma of the breast a. Significance of adenocarcinoma of the breast Adenocarcinoma of the breast presents one of the highest cancer incidences, and mortality rates worldwide (Makki 2015). Also, it is the commonest type of invasive carcinoma among the female population (Makki 2015). b. Detection, diagnosis and risk factors for adenocarcinoma of the breast Adenocarcinoma of the breast is detected by mammography, genetic screening, ultrasound, magnetic resonance imaging, ductogram, and, clinical and self breast examination that check for lumps, uncharacteristic breast appearance, and abnormal ductal discharges, (Sarica et al. 2013). A biopsy is done by taking a sample of tissue from an area of abnormality. The sample biopsied can be fluid with very tiny cells, removed through fine needle aspiration (Radhakrishna et al. 2013). Sections of the tumor are removed by core biopsy, while an entire tumor is removed by excisional biopsy (Radhakrishna et al. 2013). Primary risk factors for breast cancer are being female, old, and having a family history of breast cancer (Yoshimoto et al. 2011). Other risks include exposure to radiation, sensitivity to estrogen and progesterone, and modifiable behaviors like smoking, drinking, unhealthy foods, and sedentary lifestyle, increases breast adenocarcinoma likelihood (Yoshimoto et al. 2011). c. Types of specimens received in the laboratory for diagnosing adenocarcinoma of the breast Laboratory specimens are sampled from palpable mass, nipple discharge and lesions; hence they include lobule excisions, nipple duct excision, total mastectomy, and lymph node specimens, including sentinel node and axillary dissections (Sarica et al. 2013). d. Laboratory treatment of different specimen types For excision specimens, a gross examination is done, where size, shape and arrangement of cells are noted. The tumor is bisected into thin slices and fixated on sufficient amount of 10% neutral buffered formalin (NBF) for processing (Howat & Wilson 2014). For fluid specimens, the aspirates are spread on cassettes, fixed in a paraffin block. A microtome is used to thinly dissect the embedded tissue, and slices are placed on glass slides, and stained for microscopic examination (Radhakrishna et al. 2013). e. Microscopic appearance, cellular histology/features of adenocarcinoma of the breast The cellular features breast adenocarcinoma show whether the tumor originated from the inner lining of the epithelium of the ducts (infiltrating ductal carcinoma/IDC), or lobules (infiltrating lobular carcinoma/ICL) (Makki 2015). The microscopic appearance in low-grade IDC reveals mildly nuclear pleomorphism, well-differentiated cells, with tubule formation and slow mitotic activity (Makki 2015). On the other hand, high-grade tumor shows highly pleomorphic, poorly differentiated cells arranged in solid sheets, with rapid mitotic activity and necrosis (Makki 2015). In ICL, the tumor cells are small, subtle, with irregular edges, small amounts of cytoplasm, and arranged in single files within a fibrotic stroma (Makki 2015). f. Immunohistochemistry used for diagnosing and differentiating breast cancer type Invasive breast carcinomas usually test negative for myoepithelial cell markers (MECs) such as p63 (protein 63), SMMHC (smooth muscle myosin heavy chain), calponin, SMA (smooth muscle actin) hence, can be differentiated from in situ breast cancers (Zhao et al. 2014). IDC is differentiated from ILC for its positive staining on E-cadherin, p120 Catenin and CK8 (Makki 2015). Usually, ductal carcinomas exhibit membranous staining patterns and lobular carcinomas show cytoplasmic staining (Makki 2015). In special breast carcinomas, a triple negative result for ER (estrogen receptor), PR (Progesterone receptor), and HER2 (human epidermal growth factor receptor) can identify basal-like carcinomas, while CK7 (cytokeratins) is consistently positive in Paget disease of the nipple (Makki 2015). Positive immunostain for GATA-binding protein 3 is indicative of metastatic breast cancer (Zhao et al. 2014). g. Treatment options The treatment options include chemotherapy - the administration of cytotoxic drugs to kill cancer cells especially where it has metastasized, the risk of recurrence is high, or the tumor is large and needs to be shrunk before surgery (Sahoo & Lester 2009). Surgery can be a lumpectomy, where a tumor and a small margin of surrounding healthy tissue are removed; mastectomy, involving removal of the entire breast tissues; removal of one lymph node or several lymph nodes in the armpit (Lin & Tripuraneni 2011). Radiotherapy may be administered on breast and lymph node areas, after surgery or chemotherapy, to destroy any remaining cancer cells (Lin & Tripuraneni 2011). Hormone therapy is administered to ER and PR positive breast cancers, by blocking estrogen and progesterone, promoting the growth of the carcinoma. Also, targeted drug therapy can be used, for example, monoclonal antibody Herceptin and Tykerb, which target HER2 cancers (Sahoo & Lester 2009). Case study of squamous cell carcinoma of the lung a. Significance of squamous cell carcinoma of the lung Squamous cell carcinoma (SCC) of the lung is one of the histological subtypes of non-small cell lung cancer (NSCLC), others being lung adenocarcinoma, and large-cell lung carcinoma (LCLC) (Davidson et al. 2013). NSCLCs accounts for the largest percentage of lung cancer cases relative to small cell lung cancer (SCLC) (Dara et al. 2012). SCC of the lung is more common among men than women, and is also the type of lung cancer that is mostly associated with smoking (Davidson et al. 2013). Also, it has the highest cancer-related morbidity and mortality rates worldwide, and presents a heavy disease burden to those affected (Lindeman et al. 2013). b. Detection, diagnosis and risk factors for squamous cell carcinoma of the lung Imaging technologies including Chest X-ray, computed tomography (CT), positron emission tomography (PET) scan, bronchoscopy and endobronchial ultrasound can be used to detect lung cell abnormalities (Dara et al. 2012). A mediastinocopy helps to determine whether cancerous cells have spread to the lymph nodes (Dara et al. 2012). A diagnosis of SCC of the lung is confirmed by biopsying the abnormal lung tissue. Also, sputum cytology can be done where sputum is checked for cancer cells (Davidson et al. 2013). Risk factors of SCC of the lung include smoking, secondhand smoke, asbestos, and exposure to radon gas, in addition to air pollutants such as diesel exhausts and coal products (Davidson et al. 2013). c. Types of specimens received in the laboratory for diagnosing squamous cell carcinoma of the lung The specimens received by the laboratory include bronchial excisions, bronchial washes, transbronchial fine-needle aspirates, mediastinal and lymph nodes excisions (Dara et al. 2012). d. Laboratory treatment of different specimen types Excised specimens are gross-examined by the pathologist, dissected into thin sections, which are fixed in 10% NBF or 70% ethanol, and processed in paraffin blocks (Howat & Wilson 2014). Bronchial washes (sputum), and fine needle aspirates are processed in paraffin blocks and smeared on glass slides for microscopic examination (Dara et al. 2012). e. Microscopic appearance, cellular histology/features squamous cell carcinoma Morphologic squaomous cell patterns are seen. The histology shows intercellular bridging and keratinisation of individual cells, known as squamous pearls (Kadota et al. 2014). Poorly differentiated cells in late stage SCC show greater mitotic activity than early stage cancer cells. Depending on cancer stage, cells can be papilliary, clear cell, small cell or basaloid (Kadota et al. 2014). f. Immunohistochemistry used for diagnosing and differentiating squamous cell carcinoma SCC of the lung is consistently positive for P63 and always negative for TTF1, which identifies lung adenocarcinoma (Terry et al. 2010). Other common SCC immunomarkers include CK5/6 and 34BE12 (Rekhtman et al. 2011). g. Treatment options Treatment options include surgery, radiotherapy, and chemotherapy. Angiogenesis inhibitors such as Ramucirumab are given in metastatic SCC (Lindeman et al. 2013). SCC patients that over-express EGFR (epidermal growth factor receptor) benefit from immunotherapy on cetuximab - a monoclonal antibody against EFGR (Lindeman et al. 2013). Conclusion The comparative analysis of the adenocarcinoma of the breast and SCC of the lung cases shows that breast adecarcinoma develops from the epithelial lining of the ducts or lobule, while, SCC of the lung develops centrally in the major airways. Both cancers are significant basing on their high incidences and mortality rates. The primary risk factors for breast adenocarcinoma include old age, female, family history of breast cancer, and exposure to progesterone and estrogen and chest radiation. Similarly, people increase their likelihood for SCC of the lung if they are smokers, passive smokers, exposed to radon gas, and asbestos. Histological features help to identify the cancer cells and disease stage. Basic immunohistochemical breast adenocarcinoma diagnostic markers include ER, HER2, PR, and p53, while for SCC of the lung are P63, CK5/6, and 34BE1.Common treatment options sought for both breast and lung cancer types include surgery, chemotherapy, radiation, drug-targeted and immunotherapy. List of References Dara. L, Aisner, M, & Carrie, B, & Marshall, M 2012, ‘Molecular pathology of non-small cell lung cancer: A practical guide’, American Journal of Clinical Pathology, vol. 138, no. 3, pp. 332-346. Davidson, M, Gazdar, A, & Clarke, B 2013, ‘The pivotal role of pathology in the management of lung cancer’, Journal of Thoracic Disease, vol. 5, Is. 5, doi:10.3978/j.issn.2072-439.2013.08.43. Howat, WJ & Wilson, BA 2014, ‘Tissue fixation and the effect of molecular fixatives on downstream staining procedures. Methods, vol. 70, no. 1, pp. 12–19. doi.org/10.1016/j.ymeth.2014.01.022 Kadota, K, Nitadori, J, Woo, KM, Sima, C, Finley, D…2014, ‘Comprehensive pathological analyses in lung squamous cell carcinoma: Single cell invasion, nuclear diameter and tumor budding are independent prognostic factors for worse outcomes. Journal of Thoracic Oncology, vol. 9, no. 8, pp.1126-1139. doi:10.1097/JTO.0000000000000253. Lin, R, & Tripuraneni, P 2011, ‘Radiation therapy in early-stage invasive breast cancer. Indian Journal of Surgical Oncology, vol. 2, no. 2, pp. 101–111. doi.org/10.1007/s13193-011-0048-8. Lindeman, NI, Cagle, PT, Beasley, MB, Chitale, DA, Dacic, S, Giaccone, G…Ladanyi, M 2013, ‘Molecular testing guideline for selection of lung cancer patients for egfr and alk tyrosine kinase inhibitors. Journal of Thoracic Oncology , vol. 8, no. 7, pp. 823–859. doi.org/10.1097/JTO.0b013e318290868f. Makki, J 2015, ‘Diversity of breast carcinoma: Histological subtypes and clinical relevance,’ Clinical Medicine Insights. Pathology, vol. 8, pp. 23-31.doi: 10.4137/CPath.S31563. Radhakrishna, S, Gayathri, A, & Chegu, D 2013, ‘Needle core biopsy for breast lesions: An audit of 467 needle core biopsies. Indian Journal of Medical and Paediatric Oncology, vol. 34, no. 4, pp. 252–256. doi.org/10.4103/0971-5851.125237. Rekhtman, N, Ang, DC, Sima, CS, Travis, WD, & Moreira, AL 2011, ‘Immunohistochemical algorithm for differentiation of lung adenocarcinoma and squamous cell carcinoma based on large series of whole-tissue sections with validation in small specimens’, Modern Pathology, vol. 24, no. 10, pp. 1348-59. Sarica, O, Ozturk, E, Demirkurek, HC., & Uluc, F 2013, ‘Comparison of ductoscopy, galactography, and imaging modalities for the evaluation of intraductal lesions: A critical review. Breast Care, vol.8, no. 5, pp. 348–354. doi.org/10.1159/000355833. Sahoo, S & Lester, S 2009, ‘Pathology of breast carcinomas after neoadjuvant chemotherapy: An overview with recommendations on specimen processing and reporting. Archives of Pathology & Laboratory Medicine, vol. 133, no. 4, pp. 633-642. Terry, J, Leung, S, Laskin, J, Leslie, K, Gown, A, & Ionescu, D 2010, ‘Optimal immunohistochemical markers for distinguishing lung adenocarcinomas from squamous cell carcinomas in small tumor samples’, American Journal of Surgical Pathology, vol. 34, no. 12, pp. 1805-11.  doi: 10.1097/PAS.0b013e3181f7dae3. Yoshimoto, N, Nishiyama, T, Toyama, T, Takahashi, S, Shiraki, N…2011, ‘Genetic and environmental predcictors, endogenous hormones and growth factors, and risk of estrogen receptor-positive breast cancer in Japanese women’, Cancer Science, vol. 102, no. 11, pp. 2065-72. doi: 10.1111/j.1349-7006.2011. Zhao, L, Yang, X, Khan, A, & Kandil, D 2014, ‘Diagnostic role of immunohistochemistry in the evaluation of breast pathology specimens. Archives of Pathology & Laboratory Medicine, vol. 138, no. 1, pp. 16-24. http://dx.doi.org/10.5858/arpa.2012-0440-RA. Read More