Brambilla E
Laboratoire d'Anatomie Pathologique, Hôpital A.-Michallon, Grenoble.
Rev Mal Respir. 1992;9 Suppl 4:R309-15.
The histopathology criteria which could be taken into account in devising the best strategy in tumor extension search in non small cell lung carcinoma (NSCLC), were examined. First, the differential diagnosis between primary and metastatic carcinoma is impossible on histological basis in squamous carcinomas, and in mucinous adenocarcinoma which share several features with tumors from digestive tract including mucus secretion, morphological pattern and ultrastructural signs. The recognition of cells which are unique in the lung (Clara cells, pneumonocytes II) guarantees the pulmonary origin of a non mucinous adenocarcinoma. In other cases such as large cell carcinomas, the diagnosis of metastasis can be achieved in some instances in using a large panel of immunohistochemical markers. Secondly, the expression of neuroendocrine markers in NSCLC could lead to an extension search procedure identical to that of SCLC, if it can be confirmed that they share their poor prognosis and chemosensibility. Finally, there is no statistical evidence of a difference in the extrathoracic extension between well and poorly differentiated forms of squamous carcinoma and adenocarcinoma. Only one exception should be made for the recently described basaloid carcinoma of the lung which extension and prognosis are more severe than in other NSCLC.
研究了在制定非小细胞肺癌（NSCLC）肿瘤扩展搜索的最佳策略时可考虑的组织病理学标准。首先，在鳞状细胞癌以及与消化道肿瘤具有包括黏液分泌、形态模式和超微结构特征等若干共同特征的黏液腺癌中，基于组织学基础无法鉴别原发性癌和转移性癌。识别肺中特有的细胞（克拉拉细胞、Ⅱ型肺细胞）可确保非黏液腺癌的肺源性。在其他情况下，如大细胞癌，使用大量免疫组化标志物在某些情况下可实现转移的诊断。其次，如果能证实非小细胞肺癌中神经内分泌标志物的表达与小细胞肺癌具有相同的不良预后和化学敏感性，那么其扩展搜索程序可与小细胞肺癌相同。最后，没有统计学证据表明高分化和低分化的鳞状细胞癌及腺癌在胸外扩展方面存在差异。对于最近描述的肺基底样癌是唯一的例外，其扩展和预后比其他非小细胞肺癌更严重。
