Mark L. Kayton, MD, Mai He, MD, PhD, Maureen F. Zakowski, MD, Andre L

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Primary Lung Adenocarcinomas in Children and Adolescents Treated for Pediatric Malignancies Mark L. Kayton, MD, Mai He, MD, PhD, Maureen F. Zakowski, MD, Andre L. Moreira, MD, PhD, Christopher Lau, PhD, Alexander J. Chou, MD, Melinda Merchant, MD, PhD, Pamela R. Merola, MD, Leonard H. Wexler, MD, Michael P. La Quaglia, MD, William D. Travis, MD, Marc Ladanyi, MD Journal of Thoracic Oncology Volume 5, Issue 11, Pages 1764-1771 (November 2010) DOI: 10.1097/JTO.0b013e3181f69f08 Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Case 1. A, Computed tomographic (CT) image of new lung nodule (arrow) that prompted thoracotomy. B and C, Bronchioloalveolar carcinoma of 1 mm showing crowded cuboidal to columnar cells growing along alveolar walls in a lepidic fashion, with cellular stratification, overlapping of nuclei, and coarse nuclear chromatin (hematoxylin and eosin; original magnifications, 20× and 40×). Journal of Thoracic Oncology 2010 5, 1764-1771DOI: (10.1097/JTO.0b013e3181f69f08) Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Case 5. A, Suspicious density seen on CT scan in the right middle lobe of the lung at the time of diagnosis of osteosarcoma of the humerus. B and C, Invasive adenocarcinoma of the right middle lobe of the lung. Note the presence of invasive glands with fibrotic stroma and sharp demarcation between the tumor cells and the normal pulmonary parenchyma (hematoxylin and eosin; original magnifications, 10× and 40×). D, Immunohistochemical stain for TTF-1. This photomicrograph shows that the invasive glands are positive for TTF-1, thus confirming a pulmonary origin for this adenocarcinoma. E, Mass spectrometry-based genotyping for EGFR exon 21 L858R mutation on Sequenom platform confirming the presence of L858R mutation. The germline peak is indicated by an asterisk and the mutant peak by an arrow. CT, computed tomography; TTF, thyroid transcription factor-1. Journal of Thoracic Oncology 2010 5, 1764-1771DOI: (10.1097/JTO.0b013e3181f69f08) Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Case 7. A, Right lower lobe adenocarcinoma, mixed subtype with papillary and bronchioloalveolar patterns (hematoxylin and eosin; original magnification, 40×). B, Bronchioloalveolar carcinoma-like nodule in the right middle lobe not seen on preoperative CT scan (hematoxylin and eosin; original magnification, 40×). C, Sequenom genotyping assay showing the presence of G → T mutation at position 35 in KRAS codon 12 (G12V mutation) in the mixed-type adenocarcinoma of the right lower lobe. The germline peak is indicated by an asterisk and the mutant peak by an arrow. CT, computed tomography. Journal of Thoracic Oncology 2010 5, 1764-1771DOI: (10.1097/JTO.0b013e3181f69f08) Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 Case 8. Left lower lobe adenocarcinoma, mixed subtype with predominant acinar pattern (hematoxylin and eosin; original magnification, 40×). This tumor contained an EGFR mutation (exon 19 deletion) (see text). EGFR, epidermal growth factor receptor. Journal of Thoracic Oncology 2010 5, 1764-1771DOI: (10.1097/JTO.0b013e3181f69f08) Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions