Advances In Clinical Pathology Of Giant Cell Carcinoma Of Lung

Giant cell carcinoma of the lung(GCCL)is one of the rare malignant tumors in primary pulmonary tumors,It is composed of multinucleated and / or mononuclear tumor giant cells.It is one of the morphological lines of pulmonary sarcomatoid carcinoma(PSC)in non-small cell lung cancer(NSCLC).In the 1950 s,GCCL have attracted the attention of pathologists,it was named a variety of naming because.of different views about GCCL's pathological classification and tissue sourcesnd In the WHO(2004)lung tumor tissue classification,PSC was divided into five subtypes:pleomorphic carcinoma,spindle cell carcinoma,giant cell carcinoma,carcinosarcoma and pulmonary blastoma.In the WHO(2015)lung tumor tissue classification,the pleomorphic carcinoma,spindle cell carcinoma and giant cell carcinoma was attributed to a chapter.With the application of immunohistochemistry and electron microscopy and other pathological techniques,GCCL has been gradually confirmed that it's sarcomatoid component(tumor giant cell)is from epithelial tissue rather than mesenchymal tissue,which is transformed by stable(epithelial-mesenchymal transition,EMT)becomes a characteristic of transformational carcinoma,that is,GCCL is a sarcomatoid-like epithelial carcinoma.The etiology and pathogenesis of GCCLis not yet fully defined,but most of the literature suggests that GCCL is associated with smoking.The study found that c-myc gene recombination,CYP1A1 allele mutation,TGFR2 mutation may be specific to participate in GCCL.GCCL is rare in clinical practice,accounting for the proportion in primary lung cancer 0.1~0.4%.Clinical manifestations are some nonspecific lung cancer symptoms,such as cough,sputum,bloody,chest pain and so on.Diagnosis still depends on pathology.The tumour is essentially undifferentiated,with bulky necrotic masses,having no distinct or distinguishing architectural pattern.Histologically,the main element ofthe tumour is a polygonal,spindle or strap giant cell with one or several nuclei and prominent nucleoli.The cytoplasm is uniformly eosinophilic or finely vacuolated,and prominent acidophilic nuclear inclusions are frequently seen.A complement of smaller undifferentiated cells is present with little desmoplastic response..Immunohistochemical results showed that the giant cells in addition to the expression of epithelial markers,especially low molecular weight keratin,but also a high proportion of expression Vim.?-HCG positive rates were 91% and 26%,respectively.? CEA and Mucin and EMA staining were negative,Lung giant cell carcinoma is rare and have short duration in clinical practice,prone to lymph node and distant metastasis.Clinical treatment of the tumor is still the main operation,postoperative radiotherapy and chemotherapy,combined with chemotherapy and other comprehensive treatment,but the treatment of this disease is poor,adjuvant chemotherapy and radiotherapy does not seem to help.In view of the current domestic and foreign only GCCL related case reports and clinical case analysis,clinical data less,the lack of effective understanding of the diagnosis and treatment of such lung cancer experience.So it is necessary to fully understand the clinical pathology of GCCL and other characteristics,so the early diagnosis and treatment of the tumor is of great significance.