International Journal of Clinical Oncology

, Volume 24, Issue 4, pp 375–384 | Cite as

Histologic transformation of non-small-cell lung cancer in brain metastases

  • Meng Jiang
  • Xiaolong Zhu
  • Xiao Han
  • Haiyan Jing
  • Tao Han
  • Qiang Li
  • Xiao DingEmail author
Original Article



Treatment strategies differ substantially for small-cell lung cancer (SCLC), adenocarcinoma and squamous-cell cancer (SCC). Therefore, it is of important significance to identify histologic transformation. There are no reports on histologic transformation in brain metastases (BM) to date. The aim of this study was to analyze the histologic transformation in BM for the first time.


Medical records were reviewed and patients with both resected BM and primary tumors were examined retrospectively. The histologic diagnosis was confirmed by H&E staining, and additional diagnostic immunohistochemical stains were performed at the discretion of the pathologists. Characteristics of histologic transformation in BM were analyzed.


3 of 24 patients (12.5%) with both resected BM and primary non-small-cell lung cancers (NSCLCs) had evidence of histologic transformation in BM. One case with SCC transformed to adenocarcinoma in brain, one case with adenocarcinoma transformed to SCLC, and another case with adenocarcinoma transformed to SCC. The three cases of histologic transformation were all spontaneous and had not tested gene status.


We disclosed the histologic transformation of NSCLC in BM at a frequency not as low as expected, and speculated it as an evolution promoted by intratumor heterogeneity, though it warrants further prospective multi-institution investigations with comprehensive molecular analysis. Our findings provided further impetus for surgery when the metastatic or recurrent lesion is resectable, and repeated pathologic evaluation to help tailor individualized treatment.


Histologic transformation Non-small-cell lung cancer Brain metastases Small-cell lung cancer Surgery 



This work was supported by the Research Award Fund for outstanding Young-Middle aged Scientists of Shandong Province, China [BS2014YY004]; and Shandong Provincial Natural Science Foundation, China [ZR2014HQ064, ZR2014HP042]. The funders had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Japan Society of Clinical Oncology 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryShandong Provincial Hospital Affiliated to Shandong UniversityJinanChina
  2. 2.Department of Cardiovascular SurgeryShandong Provincial Hospital Affiliated to Shandong UniversityJinanChina
  3. 3.Experimental DepartmentAffiliated Tumor Hospital of Guangxi Medical UniversityNanningChina
  4. 4.Department of PathologyShandong Provincial Hospital Affiliated to Shandong UniversityJinanChina
  5. 5.Cancer CenterShandong Provincial Hospital Affiliated to Shandong UniversityJinanChina

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