Gale N, Kambic V, Michaels L, Cardesa A, Hellquist H, Zidar N, Poljak M
Institute of Pathology, Faculty of Medicine, University of Ljubljana, Slovenia.
Adv Anat Pathol. 2000 Jul;7(4):240-51. doi: 10.1097/00125480-200007040-00006.
There is no internationally accepted classification of epithelial hyperplastic laryngeal lesions (EHLL). The majority of current classifications follow criteria similar to those commonly used for cervical epithelial lesions. However, the different etiology of laryngeal cancer and its particular clinical and histologic features necessitate a grading system more appropriate to this region. The Ljubljana classification of EHLL was devised in 1971 to cater to this requirement. Detailed criteria for histologic grading in this classification were formulated by a working group on EHLL of the European Society of Pathology in 1999. The system recognizes four grades: simple and abnormal hyperplasia are benign categories; atypical hyperplasia ("risky" epithelium) is potentially malignant, and carcinoma in situ actually malignant. The main features by which the proposed grading system differs from other classifications are: 1. the distinction between benign and potentially malignant lesions; 2. the positive separation of carcinoma in situ from atypical hyperplasia; 3. the lack of prognostic significance for any surface keratin layer. The eventual outcome of EHLL patients so graded justifies the proposal for separating the lesions into a benign group, showing malignant transformation in only 0.9% of cases, from a potentially malignant group showing malignant transformation in 11% of cases. For diagnostically difficult cases, supplementary techniques such as those using morphometry, immunohistochemical and molecular biology are advised to improve the accuracy of diagnosis and predictions of their biological behavior.
目前尚无国际公认的上皮增生性喉病变（EHLL）分类。当前大多数分类遵循的标准与常用于宫颈上皮病变的标准相似。然而，喉癌的病因不同及其特殊的临床和组织学特征需要一个更适合该区域的分级系统。1971年设计了卢布尔雅那EHLL分类以满足这一要求。1999年欧洲病理学会EHLL工作组制定了该分类中组织学分级的详细标准。该系统认可四个级别：单纯增生和异常增生为良性类别；非典型增生（“危险”上皮）有潜在恶性，原位癌为实际恶性。所提议的分级系统与其他分类不同的主要特征为：1. 良性与潜在恶性病变的区分；2. 原位癌与非典型增生的明确区分；3. 任何表面角质层缺乏预后意义。如此分级的EHLL患者的最终结果证明了将病变分为良性组（仅0.9%的病例发生恶性转化）和潜在恶性组（11%的病例发生恶性转化）的提议是合理的。对于诊断困难的病例，建议采用诸如形态计量学、免疫组织化学和分子生物学等辅助技术，以提高诊断准确性及其生物学行为的预测能力。
