Lung cancer classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Kim-Son H. Nguyen M.D. Cafer Zorkun, M.D., Ph.D. [2] Rim Halaby, M.D. [3] Dildar Hussain, MBBS [4]

## Overview

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Primary lung cancers may be classified into small cell lung cancer (~15%) and non small cell lung cancer (~85%). Non small cell lung cancer are a heterogeneous group of lung cancers that are often grouped together because they share similar clinical features (e.g. prognosis and management). The 2015 WHO histological classification of tumors of the lung categorized lung tumors into malignant epithelial tumors, benign epithelial tumors, lymphoproliferative tumors, miscellaneous tumors, and metastatic tumors.

## Classification

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Primary lung cancers may be classified into two main categories:[1]

* Small cell lung cancer (~15%)
* Non small cell lung cancer (~85%).

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Small cell lung cancer (~15%)

Non small cell lung cancer (~85%)

* Squamous cell carcinoma (25% of lung cancers)

* Adenocarcinoma (40% of lung cancers).
* Large cell carcinoma (10% of lung cancers)
* Other non-small cell lung carcinomas:

* Adenosquamous carcinoma

* Carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements

* Carcinoid tumor

* Lung carcinoma of salivary gland type

* Unclassified carcinoma

## WHO Histological Classification of Tumors of the Lung

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The World Health Organization (WHO) classifies tumors of the lungs as follows:[1][2]

WHO Classification of Lung Tumors

Histological type  | Subtype
Epithelial tumors
Adenocarcinoma |

* Lepidic adenocarcinoma
* Acinar adenocarcinoma
* Papillary adenocarcinoma
* Micropapillary adenocarcinoma
* Solid adenocarcinoma
* Invasive mucinous adenocarcinoma
* Mixed invasive mucinous
* Nonmucinous adenocarcinoma
* Colloid adenocarcinoma
* Fetal adenocarcinoma
* Enteric adenocarcinoma
* Minimally invasive adenocarcinoma
* Nonmucinous
* Mucinous
* Pre-invasive lesions
* Atypical adenomatous hyperplasia
* Adenocarcinoma in situ
* Nonmucinous
* Mucinous

Squamous cell carcinoma |

* Keratinizing squamous cell carcinoma
* Nonkeratinizing squamous cell carcinoma
* Basaloid squamous cell carcinoma
* Pre-invasive lesion
* Squamous cell carcinoma in situ

Neuroendocrine tumors
Small cell carcinoma |

* Combined small cell carcinoma

Large cell neuroendocrine carcinoma |

* Combined large cell neuroendocrine carcinoma

Carcinoid tumors |

* Typical carcinoid tumor
* Atypical carcinoid tumor

Pre-invasive lesion |

* Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

Large cell carcinoma |

* N/A

Adenosquamous carcinoma |

* N/A

Sarcomatoid carcinomas |

* Pleomorphic carcinoma
* Spindle cell carcinoma
* Giant cell carcinoma
* Carcinosarcoma
* Pulmonary blastoma

Other and Unclassified carcinomas |

* Lymphoepithelioma-like carcinoma
* NUT carcinoma

Salivary gland-type tumors |

* Mucoepidermoid carcinoma
* Adenoid cystic carcinoma
* Epithelial-myoepithelial carcinoma
* Pleomorphic adenoma

Papillomas |

* Squamous cell papilloma
* Exophytic
* Inverted
* Glandular papilloma
* Mixed squamous and glandular papilloma

Adenomas |

* Sclerosing pneumocytoma
* Alveolar adenoma
* Papillary adenoma
* Mucinous cystadenoma
* Mucous gland adenoma

Mesenchymal tumors
Pulmonary hamartoma |

* N/A

Chondroma |

* N/A

PEComatous tumors |

* Lymphangioleiomyomatosis
* PEComa (benign)
* Clear cell tumor
* PEComa (malignant)

Congenital peribronchial myofibroblastic tumor |

* N/A

Diffuse pulmonary lymphangiomatosis |

* N/A

Inflammatory myofibroblastic tumor |

* N/A

Epithelioid hemangioendothelioma |

* N/A

Pleuropulmonary blastoma |

* N/A

Synovial sarcoma |

* N/A

Pulmonary artery intimal sarcoma |

* N/A

Pulmonary myxoid sarcoma with EWSR1–CREB1 translocation |

* N/A

Myoepithelial tumors |

* Myoepithelioma
* Myoepithelial carcinoma

Lymphohistiocytic tumors
Extranodal marginal zone lymphomas of mucosa-associated Lymphoid tissue (MALT lymphoma) |

* N/A

Diffuse large cell lymphoma |

* N/A

Lymphomatoid granulomatosis |

* N/A

Intravascular large B cell lymphoma |

* N/A

Pulmonary Langerhans cell histiocytosis |

* N/A

Erdheim-Chester disease |

* N/A

Tumors of ectopic origin
Germ cell tumors |

* Mature teratoma
* Immature teratoma

Intrapulmonary thymoma |

* N/A

Melanoma |

* N/A

Meningioma, NOS |

* N/A

### Classification of Lung Cancer among Nonsmoking Individuals:

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* Adenocarcinoma is the most common histologic subtype in nonsmoking individuals, accounting for approximately 60%–80% of cases.
* Squamous cell carcinoma represents about 17% of lung cancers in nonsmokers.
* Small cell lung cancer is uncommon in nonsmoking individuals, comprising fewer than 10% of cases.
* Lung cancers in nonsmoking individuals more frequently contain actionable oncogenic alterations.

* EGFR mutations and ALK rearrangements are particularly enriched in tumors from nonsmoking individuals.

## References

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1. ↑ 1.0 1.1 Travis, William (2004). Pathology and genetics of tumours of the lung, pleura, thymus, and heart. Lyon: IARC Press. ISBN 9283224183.
2. ↑ "www.jto.org".

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