Clinicopathological studies on adenocarcinoma of the lung--relationship between subclassification based on cell origin and prognosis of surgical patients
Takaoka, K.
Hokkaido Journal of Medical Science 62(1): 41-53
1987
ISSN/ISBN: 0367-6102 PMID: 3817741 Document Number: 294514
The relationship between the light- and electron-microscopic subclassification of a tumor based on the morphological similarity to the cell origin and the prognosis of 67 surgical patients with adenocarcinoma of the lung was studied. The prognosis of patients with each subtype was different due to the frequency of metastasis into the lymph nodes. The bronchial gland cell type and the nonciliated bronchiolar cell type consisting of cuboidal cells showed a poorer prognosis than the bronchial surface epithelial cell type (both with and without mucus) and the nonciliated bronchiolar cell type composed of columnar cells. The more unfavorable type as far as prognosis was concerned frequently metastasized into the lymph nodes. In particular, the bronchial gland cell type metastasized into the mediastinal lymph nodes even if the tumors were small in size, and it included more fibrotic focus of the tumors. The cells of the bronchial gland cell type and the nonciliated bronchiolar cell type consisting of cuboidal cells were smaller in cellular size and were connected loosely, but they were arranged in a larger cluster. These findings might explain the reason why these cells frequently metastasized into the lymph nodes. The X-ray films revealed a characteristic appearance corresponding to the subtype. The radiographic findings of the patients with poorer prognosis tended to show three patterns of tumor shadows: more than 5 cm in diameter, dense with spicular radiation, ill-marginated, faint and pseudomorphic with pleural indentation. Subclassification based on cell origin was considered to reflect the degree of malignancy of adenocarcinoma of the lung, and it seemed possible to assess the prognosis of the patients by chest radiographic manifestations.