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1. Histopathology: In metastatic lung cancer, adenocarcinoma accounts for 30%, squamous cell carcinoma accounts for 30%, and other undifferentiated cancers include large cell undifferentiated carcinoma and small (oat) cell undifferentiated carcinoma. Bronchoalveolar mucoepithelial carcinoid and pulmonary sarcoma are rare. Tumor cells derived from squamous cell metastatic carcinoma of the lung, usually moderate or poorly differentiated, are epithelial-like islands of cells, with varying degrees of keratinization and intercellular bridges, usually only a small amount of squamous cell vortex (corner Beads). Keratinocytes are atypical, manifested as large and strange-shaped cells, spindle cells, clear cells, and a large number of mitotic figures. The center of the large tumor foci is a necrotic area.
Metastatic carcinoma derived from lung adenocarcinoma is usually moderately differentiated, with tubular and glandular structures. The tumor cells are pleomorphic, with deep nuclear staining and many mitotic figures.
Large-cell undifferentiated carcinoma metastatic carcinoma is composed of large, pleomorphic cells with abundant cytoplasm, obvious nucleoli, and many mitotic figures. The giant cell subtype has ghost cells, odd-shaped nuclei, and phagocytic cells with white blood cells. The clear cell subtype is composed of sheet clear cells and clear cell islands.
Small-cell undifferentiated lung metastatic carcinoma is composed of mildly pleomorphic cells slightly larger than lymphocytes. The tumor cells are arranged in islands, trabeculae and rosettes. Common mitotic phenomena.
2. Immunohistochemistry: derived from metastatic squamous cell carcinoma of the lung, like other squamous cell carcinomas, cytokeratin and epithelial membrane antigen are positive. 50% to 80% are derived from lung squamous cell metastatic carcinoma, which is positive for carcinoembryonic antigen. Derived from lung metastatic adenocarcinoma, PAS staining is positive and amylase resistant, and saliva mucin is positive. 70%～100% are positive for carcinoembryonic antigen (CEA). Large cell undifferentiated metastatic carcinoma derived from the lung is positive for cytokeratin and carcinoembryonic antigen, and negative for neuron-specific enolase, S-100 protein and white blood cell common antigen. When metastatic carcinoma derived from small (oat) cells of the lung, low-molecular-weight cytokeratin showed diffuse perinuclear granular positive reactions and positive reactions to nerve filaments to varying degrees. In addition, it is positive for nerve-specific enolase (NSE) and negative for S-100 protein.
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