Adenocarcinoma of the lung


A malignant epithelial tumour with glandular differentiation or mucin production.


Adenocarcinoma accounts for about 28% of primary lung carcinomas in men, 42% in women, and represents an increasing proportion of lung cancers2. Although most cases occur in smokers, with a relative risk of 4.1 for heavy smokers12, adenocarcinoma is the most common primary pulmonary malignancy in non-smokers.


Tumours tend to be peripheral and under 4 cm in size. There is a relatively high frequency of pleural involvement. Cavitation is rare. None-solid or part-solid nodules are more likely to be malignant and are more often bronchoalveolar carcinomas or adenocarcinomas with bronchoalveolar features11. For radiological prognostic factors, see below. Pure bronchoalveolar carcinomas can be differentiated as pure ground glass opacities devoid of lymphangitis23; the contrast index may help to identify BAC25.

Macroscopic appearances

Bronchoalveolar carcinoma often shows aerogenous spread within the same or other lobes.


Most adenocarcinomas show a mix of subtypes and degrees of differentiation.

Subtypes: acinar, papillary (including micropapillary) , bronchoalveolar, solid with mucin production. The solid variant requires mucin to be present in at least five tumour cells in each of two high power fields on mucin staining. Papillary tumours may be predominantly endobronchial15. Papillary carcinomas fill distort or replace alveolar spaces, show marked nuclear atypia, commonly contain psammoma bodies, in contrast to bronchoalveolar carcinoma29.




See immunohistochemistry of malignant epithelial tumours of lung.



positive in 75% of cases






usually positive


usually negative







Transcription factor E2F1





Mucinous BAC is often negative for TTF-1 and positive for CK20. See mucinous adenocarcinoma of lung.

Differential diagnosis


Surgical resection, if possible.




Tumours of the Lung, Pleura, Thymus and Heart. WHO Classification of Tumours. IARC Press 2004.

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This page last revised 29.4.2005.

©SMUHT/PW Bishop