Fig. 1(A) Computed tomography horizontal view reveals a pulmonary mass with usual interstitial pneumonia (UIP). (B) The surgical specimen shows a poorly-circumscribed gray and white soft mass with UIP.
Fig. 2(A) On the low-power field, usual interstitial pneumonia (UIP) shows non-uniform interstitial fibrosis with a patchwork pattern, honeycomb changes, fibroblastic foci (inset) and mild inflammation (inset). (B) There are many dysplastic foci of the epithelium in the peripheral portion of this squamous cell carcinoma with UIP. (C) Adenocarcinomas also show many foci of transformation from normal bronchiolar epithelium to dysplastic cells at the periphery of the tumor. (D) Dysplastic cells show more hyperchromatic and larger nuclei than normal reactive bronchiolar epithelial cells. Adenocarcinomas have variable patterns described as micropapillary (E) and cleft-like acinar (F). (G) Most adenocarcinomas contain variable areas of clear cell change. (H) Several tumors show variable area of mucin production.
Table 1.Clinicohistological information of 43 usual interstitial pneumonia patients with lung cancer
Parameter |
n (%) |
Sex (male) |
41 (95) |
Smoking history |
34 (79) |
Mean age (yr) |
68 |
TNM stage |
|
I |
19 (44) |
II |
12 (28) |
III |
11 (26) |
N/A |
1 (2) |
Surgical procedure |
|
Lobectomy |
37 (86) |
Pneumonectomy |
3 (7) |
Wedge resection |
2 (5) |
Sleeve lobectomy |
1 (2) |
Histologic type |
|
Squamous cell carcinoma |
18 (42) |
Adenocarcinoma |
17 (40) |
LCNE |
2 (5) |
Combined carcinoma |
2 (5) |
Others |
4 (9) |
Location (lobe) |
|
Right lower |
18 (42) |
Left lower |
15 (35) |
Right upper |
6 (14) |
Left upper |
3 (7) |
Right middle |
1 (2) |
Less than 1 month of cancer-free period |
20 (47) |
1-Year survival rate |
26 (60) |
Table 2.Clinicohistological information of 43 usual interstitial pneumonia patients with lung cancer
Case No. |
Age (yr) |
Sex |
Histologic type |
Size (cm) |
Lobe |
Segment |
T |
N |
M |
Stage |
Smoking |
SI (py) |
PFT FEV1/FVC (%) |
Procedure |
CFP (mo) |
SP (mo) |
1 |
60 |
M |
SQ |
3.5 |
LLL |
Superior |
2a |
1 |
0 |
IIA |
S |
N/A |
89/81 |
P |
0 |
0 |
2 |
70 |
M |
SQ |
5.5 |
LLL |
Bronchus |
2b |
1 |
0 |
IIB |
E |
35 |
108/101 |
S |
58 |
0 |
3 |
66 |
M |
LCNE |
2.5 |
RLL |
Posterior basal |
1b |
2 |
0 |
IIIA |
N |
0 |
93/84 |
L |
8 |
0 |
4 |
69 |
M |
SQ |
7.5 |
LLL |
Basal |
3 |
1 |
0 |
IIIA |
S |
N/A |
65/84 |
L |
0 |
1 |
5 |
71 |
M |
SQ |
5 |
LUL |
Apicoposterior |
2a |
0 |
0 |
IB |
N |
0 |
94/87 |
L |
44 |
1 |
6 |
73 |
M |
SQ |
6.8 |
LUL |
Anterior |
2b |
2 |
0 |
IIIA |
E |
40 |
90/68 |
L |
0 |
1 |
7 |
58 |
M |
Ad, SQ |
2.8, 1.1 |
RUL |
Anterior |
1b |
0 |
0 |
IA |
E |
25 |
77/85 |
L |
60 |
1a
|
8 |
68 |
M |
Ad |
4.5 |
LLL |
Posterior basal |
2a |
0 |
0 |
IB |
E |
40 |
123/104 |
L |
18 |
1 |
9 |
57 |
M |
Ad |
2.2 |
LLL |
Anterior basal |
2a |
2 |
0 |
IIIA |
S |
40 |
79/67 |
L |
11 |
2 |
10 |
63 |
M |
SQ |
4 |
RLL |
Lateral basal |
2a |
0 |
0 |
IB |
E |
40 |
87/90 |
L |
0 |
4a
|
11 |
59 |
M |
SQ |
4.8 |
RLL |
Superior |
2a |
0 |
0 |
IB |
E |
40 |
71/73 |
L |
2 |
4a
|
12 |
72 |
M |
Ad |
2 |
LLL |
Anterior basal |
1a |
0 |
0 |
IA |
N |
0 |
110/89 |
L |
2 |
4 |
13 |
67 |
M |
LCC |
6 |
LLL |
Superior |
2b |
1 |
0 |
IIB |
S |
60 |
93/90 |
P |
0 |
6 |
14 |
75 |
M |
Ad |
3.5 |
RLL |
Basal |
2a |
2 |
0 |
IIIA |
N |
0 |
103/88 |
L |
0 |
8 |
15 |
72 |
M |
LCNE |
2.6 |
RLL |
Superior |
2a |
0 |
0 |
IB |
N |
0 |
94/96 |
L |
13 |
9 |
16 |
69 |
M |
LCNE+SQ |
4 |
RML |
Bronchus |
2a |
2 |
0 |
IIIA |
E |
30 |
107/110 |
L |
48 |
10a
|
17 |
50 |
M |
Ad |
3.5 |
LLL |
Posterior basal |
2a |
2 |
0 |
IIIA |
E |
N/A |
75/70 |
L |
48 |
10a
|
18 |
71 |
M |
SQ |
1.8 |
RUL |
Anterior |
1a |
0 |
0 |
IA |
E |
25 |
76/61 |
W |
13 |
12a
|
19 |
73 |
M |
SQ |
4.5 |
RLL |
Lateral basal |
2a |
2 |
0 |
IIIA |
E |
N/A |
90/87 |
L |
24 |
13a
|
20 |
66 |
M |
Ad |
2.5 |
LLL |
Superior |
2a |
1 |
0 |
IIA |
E |
44 |
108/94 |
L |
20 |
13 |
21 |
74 |
M |
Ad |
0.4 |
LLL |
Superior |
1a |
1 |
0 |
IIA |
S |
60 |
118/105 |
L |
1 |
15 |
22 |
71 |
M |
Ad |
3 |
LLL |
Medial basal |
3 |
2 |
0 |
IIIA |
S |
49 |
80/89 |
L |
20 |
15 |
23 |
76 |
M |
SQ |
2.3 |
RUL |
Anterior |
1b |
0 |
0 |
IA |
E |
50 |
83/77 |
L |
0 |
16a
|
24 |
63 |
M |
SCC+NSCC |
2.2 |
RUL |
Anterior |
N/A |
N/A |
N/A |
N/A |
S |
20 |
88/77 |
W |
1 |
17 |
25 |
70 |
M |
ASQ |
4.5 |
RLL |
Lateral basal |
1b |
1 |
0 |
IIA |
E |
47 |
96/82 |
L |
84 |
17a
|
26 |
84 |
M |
Ad |
1.7 |
RUL |
Posterior |
1b |
0 |
0 |
IA |
S |
58 |
105/91 |
L |
31 |
19 |
27 |
71 |
M |
Ad |
4.8 |
RLL |
Lateral basal |
2a |
1 |
0 |
IIA |
S |
45 |
122/113 |
L |
0 |
20 |
28 |
76 |
M |
SQ |
1.5 |
RLL |
Superior |
1a |
0 |
0 |
IA |
S |
50 |
76/83 |
L |
0 |
21 |
29 |
76 |
M |
Ad |
2.2 |
LLL |
Superior |
1b |
2 |
0 |
IIIA |
S |
20 |
100/91 |
L |
0 |
22 |
30 |
79 |
M |
SQ × 2 |
1.9, 0.4 |
RLL |
Superior |
2b |
0 |
0 |
IIA |
E |
N/A |
96/75 |
L |
65 |
26a
|
31 |
65 |
M |
SQ |
2 |
RLL |
Lateral basal |
2a |
0 |
0 |
IB |
E |
38 |
90/85 |
L |
0 |
29a
|
32 |
73 |
M |
SQ |
3.1 |
LLL |
Posterior basal |
2a |
0 |
0 |
IB |
E |
50 |
92/86 |
L |
0 |
29a
|
33 |
70 |
M |
Pl |
3.3 |
RLL |
Superior |
2a |
0 |
0 |
IB |
S |
N/A |
104/85 |
L |
0 |
30 |
34 |
70 |
M |
Ad |
4.5 |
RLL |
Anterior basal |
2a |
0 |
0 |
IB |
N |
0 |
124/107 |
L |
0 |
33 |
35 |
68 |
M |
SQ |
3 |
RLL |
Superior |
4 |
2 |
0 |
IIIB |
N/A |
N/A |
102/88 |
P |
8 |
38 |
36 |
54 |
F |
Ad |
3.5 |
RLL |
Anterior basal |
2a |
1 |
0 |
IIA |
N |
0 |
82/75 |
L |
0 |
40 |
37 |
63 |
M |
SQ |
4 |
LLL |
Lateral basal |
2a |
0 |
0 |
IB |
S |
60 |
96/77 |
L |
17 |
43a
|
38 |
51 |
F |
Ad |
2.5 |
RLL |
Superior |
1b |
0 |
0 |
IA |
N |
0 |
87/71 |
L |
0 |
53a
|
39 |
64 |
M |
Ad |
1.8 |
RUL |
Anterior basal |
2a |
1 |
0 |
IIA |
E |
40 |
123/99 |
L |
6 |
56 |
40 |
73 |
M |
Ad |
1 |
RLL |
Superior |
1a |
0 |
0 |
IA |
E |
N/A |
79/81 |
L |
0 |
63 |
41 |
71 |
M |
Ad |
2.8 |
RLL |
Superior |
1b |
1 |
0 |
IIA |
S |
60 |
95/103 |
L |
0 |
82a
|
42 |
60 |
M |
SQ |
3.5 |
LUL |
Anterior |
2a |
1 |
0 |
IIA |
E |
40 |
106/97 |
L |
0 |
117 |
43 |
67 |
M |
SQ |
1.8 |
LLL |
Superior |
2a |
0 |
0 |
IB |
E |
40 |
N/A |
L |
0 |
160a
|
Table 3.Clinical information of 84 usual interstitial pneumonia patients as a reference group
Parameter |
Value |
No. of patients (surgical diagnosis:nonsurgical diagnosis) |
57:27 |
Mean age (yr) |
60 |
Sex (male:female) |
66:18 |
Smoking history (N:E:C) |
29:31:24 |
Mean survival period (mo)a
|
39.83 (2-117) |
Table 4.Comparison between the UIP with lung cancer group and the UIP-only group
|
Lung cancer with UIP (n = 43) |
UIP-only (n = 84) |
p-value |
Age (yr) |
67.9 ± 7.2 |
60.3 ± 7.7 |
< .001 |
Sex (male:female) |
41:2 (95.3) |
65:19 (77.4) |
.01 |
Smoking history |
34 (79.1) |
55 (65.5) |
.113 |
More than 30 py |
81.5% |
60.0% |
.052 |
Table 5.Multivariate Cox proportional analysis of the 43 usual interstitial pneumonia with lung cancer patients
|
OR (95% CI) |
p-value |
Smoking history (nonsmoking vs smoking) |
12.610 (1.293-123.016) |
.029 |
Smoking index (≤ 30 py vs > 30 py) |
0.528 (0.065-4.321) |
.552 |
FVC (> 86.5%a vs ≤ 86.5%) |
0.342 (0.090-1.308) |
.117 |
Age (≤ 70a yr vs > 70 yr) |
0.222 (0.070-0.709) |
.011 |
Stage (I vs II, III) |
0.310 (0.100-0.957) |
.042 |
Procedure (W vs L, P) |
0.026 (0.002-0.399) |
.009 |
CFP (≤ 2 mo vs > 2 mo) |
0.188 (0.062-0.567) |
.003 |
Table 6.Multivariate Cox proportional analysis of the total 127 patients, including the 43 UIP with lung cancer and 84 UIP-only patients
|
OR (95% CI) |
p-value |
Smoking history (nonsmoking vs smoking) |
1.557 (0.799-3.033) |
.193 |
Smoking index (≤ 30 py vs > 30 py) |
0.913 (0.464-1.797) |
.792 |
FVC (≤ 80.5%a vs > 80.5%) |
0.804 (0.480-1.347) |
.408 |
Age (≤ 63a yr vs > 63 yr) |
0.699 (0.423-1.154) |
.161 |
Cancer (UIP-only vs UIP with cancer) |
0.461 (0.262-0.810) |
.007 |