Bubendorf L
Institut für Pathologie, Universitätsspital Basel, Schönbeinstr. 40, 4031, Basel, Schweiz.
Pathologe. 2011 Nov;32 Suppl 2:218-23. doi: 10.1007/s00292-011-1527-y.
The World Health Organization (WHO) 2004 classification includes 3 categories of pulmonary preneoplastic lesions, including squamous dysplasia and carcinoma in situ (CIS) for squamous cell carcinoma, atypical adenomatous hyperplasia (AAH) for the majority of adenocarcinomas and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) for carcinoids. The distinction of the 3 grades of squamous dysplasia and CIS is mainly based on the degree by which the basal cell zone is expanded, the degree of cellular atypia and the level of mitoses. The category AAH consists of a proliferation of atypical epithelial cells with Clara cells or type 2 pneumocyte features. They grow along the alveolar septae in a lepidic fashion, sometimes reaching into the terminal bronchioles. In contrast to the newly described adenocarcinoma in situ (AIS), AAH is smaller (≤ 5 mm), has a lower cell density and a lower degree of cellular atypia. The putative cancer stem cells of peripheral adenocarcinomas reside in the bronchioloalveolar duct junction, while those of central squamous cell carcinomas are located in the basal cell compartment of the bronchi. This review provides an overview of the current knowledge on preneoplastic lesions of the lungs and their clinical impact.
世界卫生组织（WHO）2004年的分类包括3类肺肿瘤前病变，其中鳞状细胞癌的鳞状发育异常和原位癌（CIS）、大多数腺癌的非典型腺瘤样增生（AAH）以及类癌的弥漫性特发性肺神经内分泌细胞增生（DIPNECH）。鳞状发育异常的3个等级与原位癌的区分主要基于基底细胞层扩展的程度、细胞异型性程度以及有丝分裂水平。AAH类别由具有克拉拉细胞或Ⅱ型肺泡上皮细胞特征的非典型上皮细胞增殖组成。它们以鳞屑样方式沿肺泡间隔生长，有时可延伸至终末细支气管。与新描述的原位腺癌（AIS）相比，AAH体积较小（≤5 mm），细胞密度较低，细胞异型性程度也较低。周围型腺癌的假定癌症干细胞位于细支气管肺泡导管连接处，而中央型鳞状细胞癌的癌症干细胞则位于支气管的基底细胞区。本综述概述了目前关于肺肿瘤前病变及其临床影响的知识。
