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Typical and atypical carcinoid tumors of the lung: a clinicopathological correlation of 783 cases with emphasis on histological features

Cesar A Moran, Kaleigh E Lindholm, Hans Brunnström, Gerald Langman, Se Jin Jang, Dominic Spagnolo, Siaw Ming Chai, Andrew Laycock, Giovanni Falconieri, Stefano Pizzolitto, Alessandro de Pellegrin, Filomena Medeiros, Lilian Edmunds, Ana Catarino, Fernando Cunha, Jae Ro, Sergio Pina-Oviedo, Jose Torrealba, Domenico Coppola, Fredrik Petersson, Ming Lian Oon, Goran Elmberger, Santiago Ramon Y Cajal, Irene Sansano Valero, Liliana Dalurzo, Fernando Soares, Antonio H Campos, Semir Vranic, Faruk Skenderi, Arlene M Correa, Boris Sepesi, David Rice, Reza Mehran, Garrett Walsh
Human Pathology 2020, 98: 98-109
We present 783 surgical resections of typical and atypical carcinoid tumors of the lung identified in the pathology files of 20 different pathology departments. All cases were critically reviewed for clinical and pathological features and further correlated with clinical outcomes. Long-term follow-up was obtained in all the patients and statistically analyzed to determine significance of the different parameters evaluated. Of the histopathological features analyzed, the presence of mitotic activity of 4 mitoses or more per 2 mm2 , necrosis, lymphatic invasion, and lymph node metastasis were identified as statistically significant. Tumors measuring 3 cm or more were also identified as statistically significant and correlated with clinical outcomes. Based on our analysis, we consider that the separation of low- and intermediate-grade neuroendocrine neoplasms of the lung needs to be readjusted in terms of mitotic count as the risk of overgrading these neoplasms exceeds 10% under the current criteria. We also consider that tumor size is an important feature to be considered in the assessment of these neoplasms and together with the histological grade of the tumor offers important features that can be correlated with clinical outcomes.

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