Large-cell lung cancer is one of the histological types of non-small-cell carcinomas of the lung.
It is thought to account for approximately 10% of bronchogenic carcinoma 1.
Patients present with dyspnea, chronic cough and hemoptysis.
Microscopically large cell carcinoma is characterized by large nuclei/nucleoli with a moderate amount of cytoplasm, hence the name large cell carcinoma. This undifferentiated tumor lacks distinctive features of small cell carcinoma, glandular or squamous differentiation.
According to the last international consensus, the diagnosis of large cell carcinoma should not be achieved based on small biopsy or cytology samples and is, therefore, restricted to resection specimens where the tumor is completely sampled to exclude a differentiated component 4.
On immunophenotyping, characteristic features include 2:
- loss of staining with CK5/6
- CK14 positive in most squamous cell carcinoma (SCC)
- lack of MOC 31 positive in most adenocarcinomas
- positive immunoreactivity to EGFR, PDGFR-alpha and c-kit.
A histological subtype is of a large cell neuroendocrine carcinoma 3.
Large-cell lung cancer of the lung typically presents as a large peripheral mass of solid attenuation and irregular margin. Focal necrosis can be present. Other characteristics include rapid growth and early metastasis.
Treatment and prognosis
The histologic subtype of large cell neuroendocrine tumor has a more aggressive pattern and is associated with poorer prognosis.
- 1. Downey RS, Sewell CW, Mansour KA. Large cell carcinoma of the lung: a highly aggressive tumor with dismal prognosis. Ann. Thorac. Surg. 1989;47 (6): 806-8. Pubmed citation
- 2. Pardo J, Martinez-PeñUela AM, Sola JJ et-al. Large cell carcinoma of the lung: an endangered species?. Appl. Immunohistochem. Mol. Morphol. 2009;17 (5): 383-92. doi:10.1097/PAI.0b013e31819bfd59 - Pubmed citation
- 3. Oshiro Y, Kusumoto M, Matsuno Y et-al. CT findings of surgically resected large cell neuroendocrine carcinoma of the lung in 38 patients. AJR Am J Roentgenol. 2004;182 (1): 87-91. doi:10.2214/ajr.182.1.1820087 - Pubmed citation
- 4. Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JH, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D, Franklin W, Gazdar A, Gould M, Hasleton P, Henderson D, Johnson B, Johnson D, Kerr K, Kuriyama K, Lee JS, Miller VA, Petersen I, Roggli V, Rosell R, Saijo N, Thunnissen E, Tsao M, Yankelewitz D. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. (2011) Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 6 (2): 244-85. doi:10.1097/JTO.0b013e318206a221 - Pubmed