Gould V E, Lee I, Warren W H
Rush-Presbyterian-St. Luke's Medical Center, Department of Pathology, Chicago.
Pathol Res Pract. 1988 Apr;183(2):200-13. doi: 10.1016/S0344-0338(88)80047-5.
The dispersed neuroendocrine (NE) system is represented in the bronchopulmonary tract by submucosal nerves and ganglion cells and, in the mucosal lining by solitary NE cells and neuroepithalial bodies (NEB's). The latter two components variably express pan-NE markers including NSE, chromogranin (s) and, notably, synaptophysin. The expression of serotonin, bombesin, calcitonin and leu-enkephalin has been well established; additional eutopic materials include somatostatin and calcitonin gene-related peptide. Solitary NE cells and NEB's are epithelial structures as defined by their consistent cytokeratin expression. Hyperplasia and dysplasia of NE cells may be found in association with various forms of chronic injury; they have been noted in chronic bronchiectasis and in the vicinity of neoplasms of various types. Hyperplastic and dysplastic pulmonary NE cells frequently express ectopic materials particularly ACTH. NE neoplasms of the bronchopulmonary tract comprice a spectrum that includes a) carcinoids, b) well differentiated NE carcinomas, c) intermediate cell NE carcinomas and d) small cell NE carcinomas. The precise pathologic criteria defining these entities are discussed in detail as are their clinical implications. The entire spectrum of lung NE neoplasms express NE markers demonstrable by immunocytochemistry; these include pan-NE markers, serotonin and numerous neuropeptides. The expression of multiple hormonal materials is frequent. Within any given tumor, some variation in expression may be noted in different sites and in different periods of the "normal" or therapeutically modified lifespan of the tumor. The entire spectrum of lung NE neoplasms is epithelial for they express cytokeratin polypeptides and desmoplakin; subsets of the tumors coexpress cytokeratins and neurofilament proteins. Also, subsets of these NE neoplasms may be immunostained with monoclonal antibodies to antigens related to exocrine phenotype suggesting focal amphicrine features.
弥散神经内分泌（NE）系统在支气管肺组织中，由黏膜下神经和神经节细胞代表，在黏膜层则由单个NE细胞和神经上皮小体（NEB）代表。后两种成分可变地表达泛NE标志物，包括神经元特异性烯醇化酶（NSE）、嗜铬粒蛋白和特别突出的突触素。5-羟色胺、蛙皮素、降钙素和亮脑啡肽的表达已得到充分证实；其他原位物质包括生长抑素和降钙素基因相关肽。单个NE细胞和NEB是上皮结构，这由它们持续的细胞角蛋白表达所定义。NE细胞的增生和发育异常可能与各种形式的慢性损伤相关；在慢性支气管扩张以及各种类型肿瘤附近均有发现。增生性和发育异常性肺NE细胞常表达异位物质，尤其是促肾上腺皮质激素（ACTH）。支气管肺组织的NE肿瘤包括以下几种类型：a）类癌，b）高分化NE癌，c）中间细胞NE癌和d）小细胞NE癌。详细讨论了定义这些实体的精确病理标准及其临床意义。肺NE肿瘤全谱均表达可通过免疫细胞化学证实的NE标志物；这些标志物包括泛NE标志物、5-羟色胺和众多神经肽。多种激素物质的表达很常见。在任何给定肿瘤内，在肿瘤“正常”或经治疗改变的生存期的不同部位和不同时期，可能会注意到表达的一些差异。肺NE肿瘤全谱均为上皮性肿瘤，因为它们表达细胞角蛋白多肽和桥粒斑蛋白；部分肿瘤同时表达细胞角蛋白和神经丝蛋白。此外，这些NE肿瘤的部分亚群可用针对与外分泌表型相关抗原的单克隆抗体进行免疫染色，提示具有局灶性双相分泌特征。
