The 2015 World Health Organization Classification of Lung Tumors

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The 2015 World Health Organization Classification of Lung Tumors William D. Travis, MD, Elisabeth Brambilla, MD, Andrew G. Nicholson, MD, Yasushi Yatabe, MD, John H.M. Austin, MD, Mary Beth Beasley, MD, Lucian. R. Chirieac, MD, Sanja Dacic, MD, Edwina Duhig, MD, Douglas B. Flieder, MD, Kim Geisinger, MD, Fred R. Hirsch, MD, Yuichi Ishikawa, MD, Keith M. Kerr, MD, Masayuki Noguchi, MD, Giuseppe Pelosi, MD, Charles A. Powell, MD, Ming Sound Tsao, MD, Ignacio Wistuba, MD Journal of Thoracic Oncology Volume 10, Issue 9, Pages 1243-1260 (September 2015) DOI: 10.1097/JTO.0000000000000630 Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 A, Core biopsy shows an “adenocarcinoma with a lepidic pattern.” B, Correlation with the computed tomography (CT) scan shows a 2.5-cm pure ground glass nodule with no solid component, favoring a diagnosis of adenocarcinoma in situ (AIS), although a small invasive component or minimally invasive adenocarcinoma (MIA) cannot be excluded. C, This part solid nodule is from a resected lepidic predominant adenocarcinoma. If a core biopsy came from the ground glass area highlighted by the arrow, it could show the same pathologic findings as in A. It would be misleading to make a pathologic diagnosis of AIS in such a case as the entire lesion has not been sampled and the invasive component is not represented in the biopsy specimen. Journal of Thoracic Oncology 2015 10, 1243-1260DOI: (10.1097/JTO.0000000000000630) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Adenocarcinoma with micropapillary pattern. When an airspace contains a micropapillary pattern (arrowheads), even if it is surrounded by lepidic or acinar structures, it should be classified as a micropapillary pattern. Journal of Thoracic Oncology 2015 10, 1243-1260DOI: (10.1097/JTO.0000000000000630) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Invasion of adenocarcinoma in the pattern of spread through air spaces (STAS). A, Tumor cells are present within airspaces in the lung parenchyma beyond the edge of the tumor (arrows). B, These consists of micropapillary clusters and single cells (arrows). Journal of Thoracic Oncology 2015 10, 1243-1260DOI: (10.1097/JTO.0000000000000630) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 Nuclear protein in testis (NUT) carcinoma. A, This poorly differentiated carcinoma consists of large cells with moderate eosinophilic cytoplasm and prominent nucleoli. No clear glandular or squamous differentiation is seen. B, Immunohistochemistry with NUT antibody shows diffuse strong staining with a granular nuclear pattern. Journal of Thoracic Oncology 2015 10, 1243-1260DOI: (10.1097/JTO.0000000000000630) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 5 Primary pulmonary myxoid sarcoma. A, Spindle and rounded cells with typically bland nuclei show a lacelike or reticular architecture within sparsely cellular myxoid stroma, with a mixed chronic inflammatory infiltrate. B, Fluorescent in situ hybridization shows split red and green signals (thin arrows) with EWSR1 break-apart probes in tumor nuclei, consistent with the presence of rearrangements of this gene, contrasting with the fusion signal in a non-rearranged gene (thick arrow). C, Direct sequencing confirms the presence of EWSR1-CREB1 fusions, which predominantly involve exon 7 of each gene (lower diagram), or more rarely occur between exon 7 of EWSR1 and exon 8 of CREB1 (upper diagram). B and C, Reprinted from Thway et al.143 Journal of Thoracic Oncology 2015 10, 1243-1260DOI: (10.1097/JTO.0000000000000630) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 6 Myoepithelioma. The tumor shows clusters of small round cells with focal hyaline stroma. Journal of Thoracic Oncology 2015 10, 1243-1260DOI: (10.1097/JTO.0000000000000630) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 7 Erdheim–Chester disease. A, Low power shows diffuse interstitial infiltrates along lymphatic routes: the pleura (arrows) and bronchovascular bundles (arrowheads mark a few of the many affected bronchovascular bundles). B, High power shows thickening of the interstitium by sheets of histiocytic cells (arrowheads) adjacent to areas of fibrosis. Journal of Thoracic Oncology 2015 10, 1243-1260DOI: (10.1097/JTO.0000000000000630) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions