pulmonary tumors
2004 WHO histological classification of tumours of the lung
A. Malignant epithelial tumours
pulmonary squamous cell carcinoma 8070/3
- Papillary 8052/3
- Clear cell 8084/3
- Small cell 8073/3
- Basaloid 8083/3
pulmonary small cell carcinoma 8041/3
- Combined small cell carcinoma 8045/3
pulmonary adenocarcinoma 8140/3
- Adenocarcinoma, mixed subtype 8255/3
- Acinar adenocarcinoma 8550/3
- Papillary adenocarcinoma 8260/3
- Bronchioloalveolar carcinoma 8250/3
- Nonmucinous 8252/3
- Mucinous 8253/3
- Mixed nonmucinous and mucinous or indeterminate 8254/3
- Solid adenocarcinoma with mucin production 8230/3
- Fetal adenocarcinoma 8333/3
- Mucinous (“colloid”) carcinoma 8480/3
- Mucinous cystadenocarcinoma 8470/3
- Signet ring adenocarcinoma 8490/3
- Clear cell adenocarcinoma 8310/3
pulmonary Large cell carcinoma 8012/3
- Large cell neuroendocrine carcinoma 8013/3
- Combined large cell neuroendocrine carcinoma 8013/3
- Basaloid carcinoma 8123/3
- Lymphoepithelioma-like carcinoma 8082/3
- Clear cell carcinoma 8310/3
- Large cell carcinoma with rhabdoid phenotype 8014/3
pulmonary Adenosquamous carcinoma 8560/3
pulmonary Sarcomatoid carcinoma 8033/3
- Pleomorphic carcinoma 8022/3
- Spindle cell carcinoma 8032/3
- Giant cell carcinoma 8031/3
- Carcinosarcoma 8980/3
- Pulmonary blastoma 8972/3
pulmonary Carcinoid tumour 8240/3
- Typical carcinoid 8240/3
- Atypical carcinoid 8249/3
pulmonary Salivary gland tumours
- pulmonary Mucoepidermoid carcinoma 8430/3
- pulmonary Adenoid cystic carcinoma 8200/3
- Epithelial-myoepithelial carcinoma 8562/3
Preinvasive lesions
- Squamous carcinoma in situ 8070/2
- Atypical adenomatous hyperplasia
- Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
B. Mesenchymal tumours
Epithelioid haemangioendothelioma 9133/1
Angiosarcoma 9120/3
Pleuropulmonary blastoma 8973/3
Chondroma 9220/0
Congenial peribronchial myofibroblastic tumour 8827/1
Diffuse pulmonary lymphangiomatosis
Inflammatory myofibroblastic tumour 8825/1
Lymphangioleiomyomatosis 9174/1
Synovial sarcoma 9040/3
- Monophasic 9041/3
- Biphasic 9043/3
Pulmonary artery sarcoma 8800/3
Pulmonary vein sarcoma 8800/3
C. Benign epithelial tumours
Papillomas
- Squamous cell papilloma 8052/0
- Exophytic 8052/0
- Inverted 8053/0
- Glandular papilloma 8260/0
- Mixed squamous cell and glandular papilloma 8560/0
Adenomas
- Alveolar adenoma 8251/0
- Papillary adenoma 8260/0
- Adenomas of the salivary gland type
- Mucous gland adenoma 8140/0
- Pleomorphic adenoma 8940/0
- Others
- Mucinous cystadenoma 8470/0
D. Lymphoproliferative tumours
Marginal zone B-cell lymphoma of the MALT type 9699/3
Diffuse large B-cell lymphoma 9680/3
Lymphomatoid granulomatosis 9766/1
Langerhans cell histiocytosis 9751/1
E. Miscellaneous tumours
Harmatoma
Sclerosing hemangioma 8832/0
Clear cell tumour 8005/0
Germ cell tumours
Teratoma, mature 9080/0
- Immature 9080/3
- Other germ cell tumours
Intrapulmonary thymoma 8580/1
Melanoma 8720/3
F. Metastatic tumours
TNM classification of the lung
T – Primary Tumour
TX Primary tumour cannot be assessed, or tumour proven by the pres ence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy
T0 No evidence of primary tumour
Tis Carcinoma in situ
T1 Tumour 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus, i.e., not in the main bronchus (1)
T2 Tumour with any of the following features of size or extent: • More than 3 cm in greatest dimension • Involves main bronchus, 2 cm or more distal to the carina • Invades visceral pleura • Associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung
T3 Tumour of any size that directly invades any of the following: chest wall (including superior sulcus tumours), diaphragm, mediastinal pleura, parietal pericardium; or tumour in the main bronchus less than 2 cm distal to the carina1 but without involvement of the carina; or associated atelectasis or obstructive pneumonitis of the entire lung
T4 Tumour of any size that invades any of the following: mediastinum, heart, great vessels, trachea, oesophagus, vertebral body, carina; separate tumour nodule(s) in the same lobe; tumour with malignant pleural effusion (2)
Notes:
1. The uncommon superficial spreading tumour of any size with its invasive component limited to the bronchial wall, which may extend proximal to the main bronchus, is also classified as T1.
2. Most pleural effusions with lung cancer are due to tumour. In a few patients, however, multiple cytopathological examinations of pleural fluid are negative for tumour, and the fluid is non-bloody and is not an exudate. Where these elements and clinical judgment dictate that the effusion is not related to the tumour, the effusion should be excluded as a staging element and the patient should be classified as T1, T2, or T3.
N – Regional Lymph Nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension
N2 Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)
N3 Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)
M – Distant Metastasis
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis, includes separate tumour nodule(s) in a different lobe (ipsilateral or contralateral)
Stage Grouping
Occult carcinoma TX N0 M0 Stage 0 Tis N0 M0 Stage IA T1 N0 M0 Stage IB T2 N0 M0 Stage IIA T1 N1 M0 Stage IIB T2 N1 M0 T3 N0 M0 Stage IIIA T1, T2 N2 M0 T3 N1, N2 M0 Stage IIIB Any T N3 M0 T4 Any N M0 Stage IV Any T Any N M1
See also
pulmonary epithelial tumors
- pulmonary benign epithelial tumors
- pulmonary epithelial tumors (pulmonary carcinomas)
pulmonary mesenchymal tumors
- pulmonary benign mesenchymal tumors
- pulmonary sarcomas
pulmonary lymphoid tumors
- pulmonary lymphomas
pulmonary teratoma
pulmonary melanoma
pulmonary malignant tumors
- pulmonary carcinomas
- pulmonary sarcomas
- pulmonary lymphomas
- pulmonary melanoma
References
IARC - 2004 WHO histological classification of tumours of the lung