Abstract
Non-sarcomatous spindle cell foci (N-SSCF) without aggressive invasiveness, also called morule-like lesions, occur occasionally in conventional lung adenocarcinoma, but their characteristics remain poorly understood. We identified N-SSCF in 7 (4.0 %) of 173 lung adenocarcinomas and examined their clinicopathological features. The patients were six men and one woman with a mean age of 57.0 years (range, 43–76 years). All tumors were papillary-predominant adenocarcinomas, ranging in size from 1 to 4.5 cm (mean, 2.7 cm). N-SSCF occupied 10–30 % of the tumors, and in all cases, there were focal or multifocal transitions between the two morphotypes. Most N-SSCF were plug-like nodules filling the spaces of cancerous alveoli/tubules or patchy insular nests. N-SSCF frequently contained mucin + lumina and were positive for cytokeratin 7, thyroid transcription factor 1, and Napsin A, but negative for cytokeratin 5/6 and vimentin, similar to the adenocarcinoma cells of the same tumor. Five cases (71 %) were at stage I or II, suggesting that N-SSCF can occur in an early phase of lung cancer. In an age-, sex-, and stage-matched control study, N-SSCF were not associated with prognosis (P = 0.471). We consider tumors with N-SSCF a distinct structural variant of adenocarcinoma without prognostic significance. They should be distinguished from true sarcomatous spindle cells and micropapillary components, which are associated with aggressive behavior.
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The authors thank Kenji Okada for excellent technical assistance and Daniel Mrozek for editing the manuscript.
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Matsukuma, S., Obara, K., Kato, K. et al. Non-sarcomatous spindle cell morphology in conventional lung adenocarcinoma: a clinicopathological study. Virchows Arch 465, 165–172 (2014). https://doi.org/10.1007/s00428-014-1598-2
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DOI: https://doi.org/10.1007/s00428-014-1598-2