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H. Kim
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P1.02 - Biology/Pathology (ID 614)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.02-027 - Minute Pulmonary Meningothelial-Like Nodules Presenting as Multiple Ground-Glass Density Nodules (GGNs): A Case Report (ID 8960)
09:30 - 09:30 | Author(s): H. Kim
- Abstract
Background:
Minute pulmonary meningothelial-like nodules (MPMNs) are generally detected incidentally in resected lung specimens. Recently, with increased use of high-resolution computer tomography (HRCT), MPMNs have occasionally been detected before surgery. They may appear as mild restrictive lung disease or randomly distributed micronodules of ground-glass attenuation on HRCT.
Method:
In this study, we retrospectively evaluated a case in which multiple ground glass density nodules (GGNs) were detected incidentally and operated for diagnosis in our hospital with the final diagnosis of MPMNs.
Result:
A 58-year-old non-smoking woman was referred to our hospital for multiple GGNs in bilateral lower lobes detected on a chest CT scan. HRCT was obtained for further evaluation. Numerous tiny GGNs were seen in the both lower lungs with centrilobular, subpleural and gravitational distribution. Many of them showed cystic or cavitary changes. Three differential diagnoses were presented by HRCT findings. The first was multifocal adenocarcinoma in situ or adenocarcinoma, the second was multifocal micronodular pneumocyte hyperplasia, and the third was atypical manifestation of langerhans cell histiocytosis or respiratory bronchiolitis interstitial lung disease. A follow up HRCT was reobtained after 2 months to determine diagnostic strategy and there was no significant change or mild prominence. For pathologic confirmation, video-assisted thoracoscopic surgery (VATS) right lower lobe wedge resection was performed. Microscopically, the surgical lung biopsy specimen showed multifocal ovoid cell proliferation along alveolar interstitium. The cells were bland, and no mitotic activity was identified. Immunohistochemical analysis was performed, and the sample was positive for epithelial membrane antigen (EMA), progesterone (PR) and CD56. Cytokerain, thyroid transcription factor-1, and S100 were negative. Finally the diagnosis of MPMNs was established, and there was no evidence of malignancy. On the second postoperative day, the patient was discharged without any complications.
Conclusion:
MPMNs are not uncommon incidental pathologic findings but the HRCT findings are nonspecific. They can occasionally manifest as multiple GGNs on HRCT, mimicking multifocal adenocarcinoma in situ or interstitial lung disease. Although most cases do not require special treatment, when there is no confident clinical diagnosis, such as in our case, a pathological correlation could be performed. An awareness of MPMNs presenting as GGNs is important because it may simulate neoplastic or other nonneoplastic diseases.
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P3.02 - Biology/Pathology (ID 620)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.02-016 - Correlation of Programmed Cell Death Ligand-1 Messenger RNA and Protein Expression in Non-Small Cell Lung Cancer (ID 9472)
09:30 - 09:30 | Author(s): H. Kim
- Abstract
Background:
Monoclonal antibodies targeting the programmed cell death 1 (PD-1) receptor and its ligand (PD-L1) have been showing promising results in advanced non-small cell lung cancer (NSCLC). Here, we investigated PD-L1 messenger RNA (mRNA) expression by a novel RNA in situ hybridization technique and compared it with PD-L1 protein expression in NSCLC.
Method:
Primary NSCLC specimens of 687 patients (476 adenocarcinoma and 211 squamous cell carcinoma) were constructed into tissue microarrays. PD-L1 mRNA in situ hybridization was performed with RNAscope[®] assay and classified using two independent scoring systems (RNA scope score and RNA proportion score). We also performed immunohistochmisty (IHC) using the Dako 22C3 pharmDx assay for evaluating PD-L1 protein expression.
Result:
PD-L1 mRNA expression was detected in 11.9% by RNA scope score and 8.3% by RNA proportion score. PD-L1 protein expression showed a positivity of 25.2% for the 1% cut-off, and 9.9% for the 50% cut-off. The two RNA scoring systems showed a linear correlation to each other (r = 0.83, p < 0.01), as well as to PD-L1 IHC repectively (p < 0.0001). The cut-off value that best correlated with PD-L1 protein expression was “1” for both RNA scope score (κ = 0.43 for the 1% and 0.58 for the 50% IHC cut-off) and RNA proportion score(κ = 0.36 for the 1% and 0.60 for the 50% IHC cut-off). Applying this criteria, discordant cases were found in 20% and 9% with 1% and 50% IHC cut-offs, respectively.
Conclusion:
PD-L1 mRNA expression, evaluated either as RNA scope score or as RNA proportion score, showed promising statistical results in predicting PD-L1 protein levels. We could thereby set out the RNA scoring system for PD-L1 in NSCLC. Discordant cases with positive mRNA levels and negative immunohistochemical results may indicate that PD-L1 mRNA in situ hybridization could be a more sensitive marker than immunohistochemistry. To verify the predictive role of PD-L1 mRNA expression in immunotherapy, however, therapeutic response to anti-PD-1/PD-L1 inhibitors should be investigated in future studies.
