Nicholson S A, Ryan M R
Lauren V Ackerman Laboratory of Surgical Pathology, Washington University School of Medicine, St. Louis, Missouri, USA.
Cancer. 2000 Jun 25;90(3):148-61. doi: 10.1002/1097-0142(20000625)90:3<148::aid-cncr3>3.0.co;2-9.
The nosology of neuroendocrine neoplasia has evolved substantially in recent years. The aim of this study was to review the authors' institutional experience and diagnostic accuracy for cytologic specimens of neuroendocrine carcinoma (NEC) and to identify features most suggestive of neuroendocrine differentiation.
The cytologic and histologic findings of 29 archival NEC in which cytology preceded biopsy or resection were compared. The study was comprised of 6 carcinoid tumors, 3 atypical carcinoid tumors, 17 high grade NEC (5 small cell, 9 large cell, and 3 mixed small/large cell), and 3 combined NEC/nonneuroendocrine carcinomas. Cytologic material was derived from 21 fine-needle aspirates (FNA), 6 bronchial brushing/washings, and 2 gastrointestinal tract brushings.
Of the 29 cases, the correct cytologic diagnosis was rendered in 11. Two cases were identified as NEC but were graded incorrectly. The remaining 16 cases were interpreted as nonsmall cell carcinoma (8 cases); diagnostic or suspicious of carcinoma, not otherwise specified (7 cases); and atypical, indeterminate for malignancy (1 case). On review, neuroendocrine features were identified in 14 of the latter 16 cases.
The cytologic diagnosis of NEC, both high and low grade, can be difficult. Because of acinus-like formations and columnar cell shapes, low grade NEC may be mistaken for adenocarcinoma. Small cell carcinomas, especially in bronchial brush and wash preparations, may be difficult to classify beyond malignant. Large cell NEC may be confused with nonneuroendocrine carcinomas because of abundant cytoplasm and nucleoli. Attention to the presence of loose cell aggregates in a background of singly dispersed cells; feathery patterns created by tumor cells clinging to capillaries; rosette formations; delicate, granular cytoplasm; inconspicuous nucleoli; molding in high grade tumors; and, most important, speckled or dusty chromatin patterns are useful in identifying neuroendocrine differentiation in cytologic specimens.
近年来，神经内分泌肿瘤的分类学有了很大发展。本研究的目的是回顾作者所在机构对神经内分泌癌（NEC）细胞学标本的经验和诊断准确性，并确定最能提示神经内分泌分化的特征。
比较了29例存档的NEC的细胞学和组织学结果，这些病例的细胞学检查先于活检或切除。该研究包括6例类癌肿瘤、3例非典型类癌肿瘤、17例高级别NEC（5例小细胞型、9例大细胞型和3例小/大细胞混合型）以及3例NEC/非神经内分泌癌合并型。细胞学材料来自21例细针穿刺抽吸（FNA）、6例支气管刷检/冲洗以及2例胃肠道刷检。
29例病例中，11例做出了正确的细胞学诊断。2例被诊断为NEC但分级错误。其余16例被解释为非小细胞癌（8例）；诊断为癌或可疑癌，未另行分类（7例）；非典型，恶性不能确定（1例）。复查时，后16例中的14例发现了神经内分泌特征。
NEC的细胞学诊断，无论高低级别，都可能存在困难。由于腺泡样结构和柱状细胞形态，低级别NEC可能被误诊为腺癌。小细胞癌，尤其是支气管刷检和冲洗标本，可能难以明确分类为恶性肿瘤以外的类型。大细胞NEC可能因丰富的细胞质和核仁而与非神经内分泌癌混淆。注意在单个分散细胞背景中存在松散的细胞聚集体；肿瘤细胞附着于毛细血管形成的羽毛状模式；菊形团形成；细腻、颗粒状的细胞质；不明显的核仁；高级别肿瘤中的核膜内陷；以及最重要的，斑点状或尘状染色质模式，有助于在细胞学标本中识别神经内分泌分化。
