Kuhn E, Morbini P, Cancellieri A, Damiani S, Cavazza A, Comin C E
Pathology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy; Department of Morphology, Surgery and Experimental Medicine and Laboratory of Technology for Advanced Therapies (LTTA), University of Ferrara, Italy.
Pathology Unit, Policlinico S. Matteo, Pavia, Italy.
Pathologica. 2018 Mar;110(1):5-11.
Lung cancer is the most frequent human malignancy and the principal cause of cancer-related death worldwide. Adenocarcinoma is now the main histologic type, accounting for almost half of all the cases. The 2015 World Health Organization has adopted the classification recently developed by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification has incorporated up-to-date advances in radiological, molecular and oncological knowledge, providing univocal diagnostic criteria and terminology. For resection specimens, new entities have been defined such as adenocarcinoma in situ and minimally invasive adenocarcinoma to designate adenocarcinomas, mostly nonmucinous and ≤ 3 cm in size, with either pure lepidic growth or predominant lepidic growth with ≤ 5 mm invasion, respectively. For invasive adenocarcinoma, the new classification has introduced histological subtyping according to the predominant pattern of growth of the neoplastic cells: lepidic (formerly non mucinous brochioloalveolar adenocarcinoma), acinar, papillary, micropapillary, and solid. Of note, micropapillary pattern is a brand new histologic subtype. In addition, four variants of invasive adenocarcinoma are recognized, namely invasive mucinous (formerly mucinous brochioloalveolar adenocarcinoma), colloid, fetal, and enteric. Importantly, three variants that were considered in the previous classification have been eliminated, specifically mucinous cystadenocarcinoma, signet ring cell, and clear cell adenocarcinoma. This review presents the changes introduced by the current histological classification of lung adenocarcinoma and its prognostic implications.
肺癌是最常见的人类恶性肿瘤，也是全球癌症相关死亡的主要原因。腺癌是目前主要的组织学类型，几乎占所有病例的一半。2015年世界卫生组织采用了国际肺癌研究协会、美国胸科学会和欧洲呼吸学会最近制定的分类方法。这种新的腺癌分类纳入了放射学、分子学和肿瘤学知识的最新进展，提供了明确的诊断标准和术语。对于切除标本，定义了新的实体，如原位腺癌和微浸润腺癌，分别用于指定主要为非黏液性且大小≤3 cm、具有纯鳞屑样生长或主要为鳞屑样生长且浸润≤5 mm的腺癌。对于浸润性腺癌，新分类根据肿瘤细胞的主要生长模式引入了组织学亚型：鳞屑样（以前的非黏液性细支气管肺泡腺癌）、腺泡状、乳头状、微乳头状和实性。值得注意的是，微乳头状模式是一种全新的组织学亚型。此外，还识别出浸润性腺癌的四种变体，即浸润性黏液性（以前的黏液性细支气管肺泡腺癌）、胶样、胎儿型和肠型。重要的是，先前分类中考虑的三种变体已被剔除，具体为黏液性囊腺癌、印戒细胞癌和透明细胞腺癌。本综述介绍了当前肺腺癌组织学分类所带来的变化及其预后意义。
