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Large Cell Carcinoma of the Lung

InBrief



carcinoma of the lungs

Large-cell carcinomas are a diagnosis of exclusion when a lung malignancy does not meet the criteria of small-cell lung cancer (SCLC), adenocarcinoma, or squamous-cell carcinoma based on light microscopy and immunohistochemical-marker expression.


Large-cell carcinomas are aggressive and represent about 5%-10% of lung cancers. Histologically, they are malignant epithelial neoplasms (poorly differentiated) without glandular or squamous differentiation or small-cell features.


Causes and Risk Factors

Smoking is the primary risk factor for all lung cancers, including large-cell carcinoma. The median age of presentation is 61 years; men are three times more likely than women to develop these cancers.


Signs and Symptoms

Large-cell carcinoma can present with signs and symptoms similar to those of other types of lung cancer, including cough, chest pain, dyspnea, and hemoptysis.


Diagnostic Evaluation and Differential Diagnosis

On imaging, large-cell carcinoma typically presents as a peripheral mass with or without necrosis. Diagnosis requires a biopsy with histologic confirmation that rules out glandular, squamous, and neuroendocrine differentiation. Electron microscopy plus immunohistochemistry can sometimes better classify tumors and may be required before a diagnosis of large-cell carcinoma can be made.


Differential diagnoses include other types of lung carcinoma, including small-cell, adenocarcinoma, and neuroendocrine carcinomas; metastatic lesions of the lung; and benign lesions (eg, hamartomas, fibromas).


Treatment Options

Treatment of large-cell carcinoma varies based on the patient’s comorbidities and tumor stage. It may be treated with combinations of surgery, chemotherapy, immunotherapy, and radiation therapy.


Summary of Lung Cancer Classification

Small-cell lung cancers (SCLCs) include small-cell carcinoma (oat-cell cancer), combined small-cell carcinoma, and neuroendocrine lung cancer (NET).

Adenocarcinoma of lung
Adenocarcinoma of lung

Nonsmall-cell lung cancers (NSCLCs) include adenocarcinoma, squamous-cell carcinoma, and large-cell carcinoma.

Squamous Cell Carcinoma of Lung
Squamous Cell Carcinoma of Lung

Other large-cell carcinomas include neuroendocrine large-cell lung cancers, which tend to be more aggressive than other neuroendocrine tumors.

Large cell neuroendocrine tumor of the lung
Large cell neuroendocrine tumor of the lung

Summary of Lung Cancer Classification

  • Pulmonary Neuroendocrine Tumors (NET)

  • Pulmonary Carcinoid Tumors

    • Typical Carcinoid Tumors

    • Atypical Carcinoid Tumors

  • Large Cell Neuroendocrine Carcinomas

  • Small Cell Lung Carcinomas


Carcinoid tumors is also a type of neuroendocrine lung cancer NET's) but represents only a small percentage of primary lung cancer (less than 1%). Carcinoid lung tumors typically present as a low grade, well-differentiated, slow-growing tumor. Less commonly they may present as atypical high-grade, poorly differentiated carcinomas. All NETs may produce circulating neuropeptides.


 

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References:


Travis WD, Brambilla EW, Burke AP, Marx A, Nicholson AG, eds. WHO Classification of Tumours of the Lung, Pleura, Thymus, and Heart. Lyon, France: IARC Press; 2015.


Clinical Lung Cancer Genome Project; Network Genomic Medicine. A genomics-based classification of human lung tumors. Sci Transl Med. 2013;5(209):209ra153.


Rajdev K, Hasan Siddiqui A, Ibrahim U, Patibandla P, Khan T, El-Sayegh D. An unusually aggressive large cell carcinoma of the lung: undiagnosed until autopsy. Cureus. 2018;10:e2202.


Derks J, Hendriks L, Buikhuisen W, Groen H, Thunnissen E, Van Suylen RJ, Houben R, Damhuis R, Speel E, Dingemans AM. Clinical features of large cell neuroendocrine carcinoma: a population-based overview. European Respiratory Journal 2016 47: 615-624; DOI: 10.1183/13993003.00618-2015.


Limaiem F, Tariq M, Wallen J. Lung Carcinoid Tumors. StatPearls. Last Update: October 16, 2020.


Pulmonary Neuroendocrine Tumors. Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/types/lung/types/pulmonary-neuroendocrine-tumors.





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