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(Chest. 2005;127:1889.)
© 2005 American College of Chest Physicians

Unique Solitary Small Cell Lung Cancer

Need for Histologic Examination

Scott Faulkner, MD

Montgomery, AL

Correspondence to: Scott Faulkner, Suite 501, 1722 Pine St, Montgomery, AL 36106; e-mail: scottfaulkner{at}birch.net

In this issue of CHEST (see page 2273), Kamigaki and colleagues describe a small cell lung cancer (SCLC) that presented as an intraluminal lesion in the left descending pulmonary artery. The diagnosis was based on histologic descriptions of transbronchial aspirates that were supported by immunohistochemical data (+thyroid transcription factor-1, +cytokeratin, and –leukocyte common antigen). The results of staining with both chromogranin and synaptophysin were negative, and this indeed may be the case in a small number of SCLCs. Supporting the diagnosis were elevated levels of Pro-gastrin-releasing peptide, neuron-specific enolase, and carcinoembryonic antigens. The weight of evidence suggests that the tumor is an SCLC.

The diagnosis of SCLC should rest primarily with the histologic examination.1 SCLC can be confused with basaloid squamous cell cancers2 and other poorly differentiated tumors with some neuroendocrine differentiation. The limited amount of material available for analysis complicated the diagnosis.

The authors correctly point out that no conclusion can be reached regarding the origin of the SCLC. A surgical resection would have offered a better analysis of this cancer, but the patient’s outcome to date suggests that appropriate treatment was applied. The value of this presentation should be the potential for localized SCLC to be aggressively treated. There is a strong likelihood that the SCLC will recur. At that time, all efforts should be made to obtain sufficient tissue for clarification of the pathology.

References

  1. Ritter, JH (2003) To stain or distain, that is the question. Am J Clin Pathol 65,630-631[CrossRef]
  2. Cerilli, LA, Ritter, JH, Mills, SE, et al Neuroendocrine neoplasms of the lung. Am J Clin Pathol 2001;11(suppl),S65-S96




This Article
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