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Here, we performed detailed clinicopathologic, genomic, and transcriptomic profiling of an atypical subset of SCLC that lacked RB1 and TP53 co-inactivation and arose in never\/light smokers. We found that most cases were associated with chromothripsis\u2014massive, localized chromosome shattering\u2014recurrently involving chromosome 11 or 12 and resulting in extrachromosomal amplification of CCND1 or co-amplification of CCND2\/CDK4\/MDM2, respectively. Uniquely, these clinically aggressive tumors exhibited genomic and pathologic links to pulmonary carcinoids, suggesting a previously uncharacterized mode of SCLC pathogenesis via transformation from lower-grade neuroendocrine tumors or their progenitors. Conversely, SCLC in never-smokers harboring inactivated RB1 and TP53 exhibited hallmarks of adenocarcinoma-to-SCLC derivation, supporting two distinct pathways of plasticity-mediated pathogenesis of SCLC in never-smokers.<\/jats:p>\n                  <jats:p>Significance: Here, we provide the first detailed description of a unique SCLC subset lacking RB1\/TP53 alterations and identify extensive chromothripsis and pathogenetic links to pulmonary carcinoids as its hallmark features. This work defines atypical SCLC as a novel entity among lung cancers, highlighting its exceptional histogenesis, clinicopathologic characteristics, and therapeutic vulnerabilities.<\/jats:p>\n                  <jats:p>See related commentary by Nadeem and Drapkin, p. 8<\/jats:p>","DOI":"10.1158\/2159-8290.cd-24-0286","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T10:02:01Z","timestamp":1724666521000},"page":"83-104","update-policy":"https:\/\/doi.org\/10.1158\/crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Chromothripsis-Mediated Small Cell Lung Carcinoma"],"prefix":"10.1158","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5801-3144","authenticated-orcid":false,"given":"Natasha","family":"Rekhtman","sequence":"first","affiliation":[{"name":"1Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5717-3856","authenticated-orcid":false,"given":"Sam E.","family":"Tischfield","sequence":"additional","affiliation":[{"name":"2Marie-Jos\u00e9e and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4754-1344","authenticated-orcid":false,"given":"Christopher A.","family":"Febres-Aldana","sequence":"additional","affiliation":[{"name":"1Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York."},{"name":"3Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1348-4094","authenticated-orcid":false,"given":"Jake June-Koo","family":"Lee","sequence":"additional","affiliation":[{"name":"4Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1705-1870","authenticated-orcid":false,"given":"Jason C.","family":"Chang","sequence":"additional","affiliation":[{"name":"1Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3253-3106","authenticated-orcid":false,"given":"Benjamin O.","family":"Herzberg","sequence":"additional","affiliation":[{"name":"4Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York."},{"name":"5Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center and the Herbert Irving Comprehensive Cancer Center, New York, New York."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0086-0513","authenticated-orcid":false,"given":"Pier","family":"Selenica","sequence":"additional","affiliation":[{"name":"1Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3220-2064","authenticated-orcid":false,"given":"Hyung Jun","family":"Woo","sequence":"additional","affiliation":[{"name":"2Marie-Jos\u00e9e and Henry R. 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