Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan.
J Thorac Oncol. 2015 Sep;10(9):1337-1340. doi: 10.1097/JTO.0000000000000616.
During surgical resection of a peripherally located high-grade neuroendocrine carcinoma (HGNEC), we unexpectedly discovered prominent bronchial intraepithelial tumor spread up to the surgical end of the bronchus. Because bronchial intraepithelial tumor spread of peripherally located HGNEC has been rarely reported, we conducted a retrospective analysis at our hospital.
We histologically reviewed surgically resected HGNEC cases to assess bronchial intraepithelial spread of tumor cells. HGNECs with bronchial intraepithelial tumor spread were further studied by immunohistochemistry for neuroendocrine markers, and their clinicopathological characteristics were evaluated.
Of 1778 cases of surgically resected lung cancer in our hospital, 47 cases of HGNEC were evaluated. Bronchial intraepithelial tumor spread was observed in nine cases (19.1%); eight of these cases were large-cell neuroendocrine carcinoma (LCNEC) or small-cell lung carcinoma with an LCNEC component. Moreover, bronchial intraepithelial tumor spread was continuous from the primary tumor to the resected end of the bronchus in four cases, and all these cases had an LCNEC component. Furthermore, HGNEC with bronchial intraepithelial tumor spread was associated with a higher recurrence rate than no bronchial intraepithelial tumor spread.
The results of this study suggest that bronchial intraepithelial tumor spread is commonly observed in cases of peripherally located HGNEC and may be a unique form of tumor invasion, especially tumors with LCNEC morphology. Therefore, surgeons and pathologists should be cognizant of bronchial intraepithelial tumor spread in peripherally located HGNEC, as well as its potential role as an indicator of HGNEC aggressiveness.
在切除位于周围的高级别神经内分泌癌（HGNEC）时，我们意外地发现支气管上皮内肿瘤明显扩散至支气管的手术端。由于周围 HGNEC 的支气管上皮内肿瘤扩散很少有报道，我们在我院进行了回顾性分析。
我们对手术切除的 HGNEC 病例进行组织学复习，以评估肿瘤细胞的支气管上皮内扩散。对有支气管上皮内肿瘤扩散的 HGNEC 进一步进行神经内分泌标志物的免疫组织化学研究，并评估其临床病理特征。
在我院 1778 例手术切除的肺癌病例中，评估了 47 例 HGNEC。9 例（19.1%）观察到支气管上皮内肿瘤扩散；其中 8 例为大细胞神经内分泌癌（LCNEC）或小细胞肺癌伴 LCNEC 成分。此外，4 例病例的支气管上皮内肿瘤扩散从原发性肿瘤连续至支气管的切除端，且所有这些病例均有 LCNEC 成分。此外，有支气管上皮内肿瘤扩散的 HGNEC 复发率高于无支气管上皮内肿瘤扩散的 HGNEC。
本研究结果表明，支气管上皮内肿瘤扩散在周围 HGNEC 中常见，可能是一种独特的肿瘤侵袭形式，尤其是具有 LCNEC 形态的肿瘤。因此，外科医生和病理学家应意识到周围 HGNEC 中的支气管上皮内肿瘤扩散及其作为 HGNEC 侵袭性指标的潜在作用。
