True papillary carcinoma of the lung: a distinct clinicopathologic entity

• Published in: The American journal of surgical pathology Vol. 21; no. 1; p. 43
• Main Authors: Silver, S A, Askin, F B
• Format: Journal Article
• Language: English
• Published: United States 01.01.1997
• Subjects: Adenocarcinoma, Papillary - pathology; Adult; Aged; Carcinoma, Papillary - pathology; Female; Humans; Lung Neoplasms - pathology; Male; Middle Aged; Retrospective Studies
• ISSN: 0147-5185
• DOI: 10.1097/00000478-199701000-00005

There continues to be confusion as to whether papillary adenocarcinoma (PA) of the lung is a specific histologic entity or simply a variant of bronchioloalveolar carcinoma (BAC). We reviewed our files from 1981 through 1993 for all cases (n = 155) of resected primary lung adenocarcinoma specifically diagnosed as having papillary or bronchioloalveolar features. In addition, a random 10% (n = 67) of all remaining lung adenocarcinomas were reviewed. True PA was diagnosed when > or = 75% of the neoplasm contained papillary structures supported by fibrovascular cores with complicated secondary and tertiary branches. Marked nuclear atypia was present in 100%, and psammoma bodies were seen in 42% of cases. In contrast to BAC, true PA filled and distorted or replaced air spaces in the lung. Thirty-one cases of true PA were found, including 19 men and 12 women (mean age, 64.5 years). The lesions were solitary (n = 27) or multifocal (n = 4) with a mean diameter of 4.1 cm. Forty-five percent of patients had bronchopulmonary lymph node involvement at diagnosis; another 10% had extensive intrapulmonary lymphatic permeation by tumor. Disease-free survival for stage I and II PA was 40% (n = 15) and 25% (n = 8), respectively, at a mean of 3.4 and 3.5 years. Papillary adenocarcinoma of the lung is a distinct clinicopathologic entity with considerably worse morbidity and mortality than BAC.