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| LMDDx = [[atypical adenomatous hyperplasia of the lung]], adenocarcinoma in situ, [[squamous cell carcinoma of the lung]], [[small cell carcinoma of the lung]], [[non-small cell lung carcinoma]], [[malignant mesothelioma]], [[Metastasis|metastatic]] [[adenocarcinoma]] (esp. [[colorectal adenocarcinoma]], breast ...
| Stains =
| IHC = [[CK7]] +ve, [[TTF-1]] +ve, CK20 -ve, [[p40]] -ve, p63 -ve (usually)
| EM =
| Molecular = +/-KRAS mutations, +/-EGFR mutations, +/-ALK [[chromosomal translocation]] (inv(2)(p21p23) -- EML4-ALK fusion), +/-ROS1 rearrangements, +/-RET rearrangements
| IF =
| Gross =
| Grossing =
| Staging = [[lung cancer staging]]
| Site = [[lung]] - see ''[[lung tumours]]''
| Assdx =
| Syndromes =
| Clinicalhx =
| Signs =
| Symptoms =
| Prevalence = most common primary lung tumour
| Bloodwork =
| Rads = lung mass - typically peripheral lesion (distant from large airways), may be multifocal
| Endoscopy =
| Prognosis = dependent on stage (minimally invasive and noninvasive: very good; invasive: moderate)
| Other =
| ClinDDx = other [[lung tumours]] - primary and metastatic
| Tx = surgical resection if feasible
}}
'''Adenocarcinoma of the lung''', also '''lung adenocarcinoma''', is common malignant [[lung tumour]].
==General==
*Adenocarcinoma is the most common (primary lung cancer).<ref name=pmid19118313>{{cite journal |author=Lutschg JH |title=Lung cancer |journal=N. Engl. J. Med. |volume=360 |issue=1 |pages=87-8; author reply 88 |year=2009 |month=January |pmid=19118313 |doi=10.1056/NEJMc082208 |url=}}</ref>
*Adenocarcinoma is the non-smoker tumour - [[small cell carcinoma of the lung|SCLC]] and [[squamous cell carcinoma of the lung|squamous]] are more strongly associated with [[smoking]].
*Lung adenocarcinoma is the most common brain metastasis.<ref name=pmid22012633>{{Cite journal | last1 = Nayak | first1 = L. | last2 = Lee | first2 = EQ. | last3 = Wen | first3 = PY. | title = Epidemiology of brain metastases. | journal = Curr Oncol Rep | volume = 14 | issue = 1 | pages = 48-54 | month = Feb | year = ...
Treatment:
*Lung adenocarcinoma may be treated with [[EGFR inhibitors]] (e.g. gefitinib (Iressa), erlotinib (Tarceva)).<ref name=pmid20855837>{{cite journal |author=Sun Y, Ren Y, Fang Z, ''et al.'' |title=Lung adenocarcinoma from East Asian never-smokers is a disease largely defined by targetable oncogenic mutant kinases |journal...
Patients that receive EGFR inhibitors classically are:<ref name=pmid21151896>{{cite journal |author=Job B, Bernheim A, Beau-Faller M, ''et al.'' |title=Genomic Aberrations in Lung Adenocarcinoma in Never Smokers |journal=PLoS One |volume=5 |issue=12 |pages=e15145 |year=2010 |pmid=21151896 |pmc=2997777 |doi=10.1371/jour...
*Non-smokers.
*Female.
*Asian.
**Caucasians also benefit.<ref name=pmid20973798>{{Cite journal | last1 = Rosell | first1 = R. | last2 = Moran | first2 = T. | last3 = Cardenal | first3 = F. | last4 = Porta | first4 = R. | last5 = Viteri | first5 = S. | last6 = Molina | first6 = MA. | last7 = Benlloch | first7 = S. | last8 = Taron | first8 = M. | tit...
==Gross==
*Classically peripheral lesions.
*May be multifocal.
===Image===
<gallery>
Image:Adenocarcinoma (3950819000).jpg | Lung adenocarcinoma. (WC/Rosen)
</gallery>
==Microscopic==
Features:
*+/-Nuclear atypia - '''important'''.
**May be absent in mucinous tumours - may look similar to foveolar epithelium.
*Eccentrically placed nuclei.
*Abundant cytoplasm - classically with mucin vacuoles.
*Often conspicuous [[nucleoli]].
*+/-[[Nuclear pseudoinclusions]].
Negatives:
*Lack of intercellular bridges.
Patterns:<ref name=pmid21252716>{{cite journal |author=Travis WD, Brambilla E, Noguchi M, ''et al.'' |title=International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma |journal=J Thorac Oncol |volume=...
*Lepidic - tumour grows long the alveolar wall; means ''scaly covering''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/lepidic http://medical-dictionary.thefreedictionary.com/lepidic]. Accessed on: 8 August 2013.</ref> At lower power, the shapes should still resemble lung acini.
*Acinar - berry-shaped glands, smaller than lung acini.
*Papillary - fibrovascular cores.
*Micropapillary - nipple shaped projections without fibrovascular cores.
*Solid - sheet of cells.
Notes:
*[[Lymphovascular invasion]] is common.
*Micropapillary predominant pattern and tumours with any amount of the lepidic pattern are associated with EGFR mutations.<ref name=pmid21970488>{{Cite journal | last1 = Shim | first1 = HS. | last2 = Lee | first2 = da H. | last3 = Park | first3 = EJ. | last4 = Kim | first4 = SH. | title = Histopathologic characteristi...
DDx:
*[[Atypical adenomatous hyperplasia of the lung]] - spaced [[hobnail]] cells, mild-to-moderate nuclear atypia, small lesion (must be <5 mm).
*Adenocarcinoma in situ.
*[[Papillary thyroid carcinoma|Papillary carcinoma of thyroid]].
*[[Squamous cell carcinoma of the lung]].
*[[Small cell carcinoma of the lung]].
*[[Adenoid cystic carcinoma]].
*[[Non-small cell lung carcinoma]] - diagnosis should be avoided if possible.
*[[Malignant mesothelioma]].
*[[Metastasis|Metastatic]] adenocarcinoma.
**[[Colorectal adenocarcinoma]].
**Breast adenocarcinoma.
***[[Invasive ductal carcinoma of the breast]].
***[[Invasive lobular carcinoma]].
***[[Bronchiolar metaplasia]].
**Other carcinomas.
*Carcinomas of the bronchial glands, e.g. [[adenoid cystic carcinoma]].
===Images===
=====Acinar adenocarcinoma=====
<gallery>
Image: Acinar pattern adenocarcinoma of lung -- low mag.jpg | Acinar LA - low mag.
Image: Acinar pattern adenocarcinoma of lung -- intermed mag.jpg | Acinar LA - intermed. mag.
Image: Acinar pattern adenocarcinoma of lung -- high mag.jpg | Acinar LA - high mag.
Image: Acinar pattern adenocarcinoma of lung -- very high mag.jpg | Acinar LA - very high mag.
Image: Acinar pattern adenocarcinoma of lung - alt -- very high mag.jpg | Acinar LA - very high mag.
</gallery>
<gallery>