Fillinger János
Daganatpatológiai Központ, Országos Onkológiai Intézet, Citopatológiai Osztály, Budapest, Hungary.
Magy Onkol. 2018 Jul 20;62(2):83-89. Epub 2018 Apr 10.
The heterogeneous group of lung neuroendocrine tumors are divided into four main types: typical carcinoid (TC), atypical carcinoid (AC), large cell neuroendocrine carcinoma (LCNEC), and small cell carcinoma (SCLC). Classification is based on the analysis of surgical resection specimens, which, in addition to basic morphological features, takes into account the mitotic count in 2 mm², the presence or absence of necrosis. According to prognosis, TC is low grade, AC is intermediate grade, while SCLC and LCNEC are high grade carcinomas with very poor prognosis. The morphological diagnosis can be refined by the use of neuroendocrine immunohistochemical markers. Based on the histological diagnosis, clinical prognosis is not always clear. Application of Ki-67 labeling can get closer to real biological behavior. Recently, more than 2/3 of the cases are small samples (core biopsy, bronchoscopic biopsy, cytological smears). Diagnostic algorithms developed for resection specimens has limited usage for these samples. In a single case, a wide range of histological techniques should be used in the processing of the sample, and still only an unsatisfactory result is obtained. Knowing the potential information content of the samples can help the clinician to set up a diagnostic and therapeutic plan.
典型类癌(TC)、非典型类癌(AC)、大细胞神经内分泌癌(LCNEC)和小细胞癌(SCLC)。分类基于对手术切除标本的分析,除了基本形态特征外,还考虑2mm²区域内的有丝分裂计数以及有无坏死。根据预后情况,TC为低级别,AC为中级别的,而SCLC和LCNEC是预后极差的高级别癌。形态学诊断可通过使用神经内分泌免疫组化标记物来细化。基于组织学诊断,临床预后并不总是明确的。应用Ki-67标记可以更接近真实的生物学行为。最近,超过2/3的病例是小样本(芯针活检、支气管镜活检、细胞学涂片)。为切除标本开发的诊断算法对这些样本的应用有限。在单个病例中,样本处理应使用多种组织学技术,但仍只能获得不理想的结果。了解样本的潜在信息含量有助于临床医生制定诊断和治疗方案。