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Case Series
 
Pulmonary adenocarcinoma with enteric differentiation: A distinctive histologic subtype
Tiago Biachi de Castria1, Manoel Carlos Leonardi de Azevedo Souza1
1Instituto do Câncer do Estado de São Paulo, Brazil.

Article ID: 100015Z10TC2016
doi:10.5348/Z10-2016-15-CS-6

Address correspondence to:
Tiago Biachi de Castria
Instituto do Câncer do Estado de São Paulo 215 Doutor Arnaldo Ave
Fifth floor, Clinical Oncology Department
São Paulo/SP
Brazil

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How to cite this article:
de Castria TB, de Azevedo Souza MCL. Pulmonary adenocarcinoma with enteric differentiation: A distinctive histologic subtype. J Case Rep Images Oncology 2016;2:23–27.


Abstract
Introduction: Lung adenocarcinoma has a complex variety of different hystopathologic subtypes with distinct epidemiology, pathology and prognosis. Pulmonary adenocarcinoma with enteric differentiation is a rare variant defined as a tumor with more than 50% of colorrectal-like components, immunohistochemistry (IHC) positive for at least one marker of enteric differentiation (CK20, CDX-2 or MUC2) and no evidence of other malignancies.
Case Series: Patients were identified in a review of a set of adenocarcinomas, apparently originated in colon, but posteriorly accessed as lung adenocarcinomas. Median age was 57.6 years, were all Caucasian subjects and presented with metastatic disease. The median size were 6.3 cm at the time of diagnosis and all had spiculated shape forms at CT scans. Microscopic description revealed a lepidic (mucinous) adenocarcinoma in all five cases. Immunohistochemistry were positive for CK20 or CDX-2 in all these cases and was negative for CK7 in one patient.
Conclusion: The use of immunohistochemistry analysis can distinguish between metastatic colorectal carcinoma and primary pulmonary adenocarcinoma with enteric differentiation. This differentiation on the basis of morphological and immunohistochemical findings may be difficult in the case of CK7-negative and physical examination and image evaluation are essentials in this characterization.

Keywords: Adenocarcinoma, Enteric differentiation, Lung cancer, Pulmonary cancer


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Author Contributions
Tiago Biachi de Castria – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Manoel Carlos Leonardi de Azevedo Souza – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Tiago Biachi de Castria et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.