Williams Jessica F, Vivero Marina
Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
Histopathology. 2022 Nov;81(5):556-568. doi: 10.1111/his.14714. Epub 2022 Aug 2.
Neuroendocrine carcinomas of the lung are currently classified into two categories: small-cell lung carcinoma and large-cell neuroendocrine carcinoma. Diagnostic criteria for small-cell and large-cell neuroendocrine carcinoma are based solely on tumour morphology; however, overlap in histologic and immunophenotypic features between the two types of carcinomas can potentially make their classification challenging. Accurate diagnosis of pulmonary neuroendocrine carcinomas is paramount for patient management, as clinical course and treatment differ between small-cell and large-cell neuroendocrine carcinoma. Molecular-genetic, transcriptomic, and proteomic data published over the past decade suggest that small-cell and large-cell neuroendocrine carcinomas are not homogeneous categories but rather comprise multiple groups of distinctive malignancies. Nuances in the susceptibility of small-cell lung carcinoma subtypes to different chemotherapeutic regimens and the discovery of targetable mutations in large-cell neuroendocrine carcinoma suggest that classification and treatment of neuroendocrine carcinomas may be informed by ancillary molecular and protein expression testing going forward. This review summarizes the current diagnostic criteria, prognostic and predictive correlates of classification, and evidence of previously unrecognised subtypes of small-cell and large-cell neuroendocrine carcinoma.
小细胞肺癌和大细胞神经内分泌癌。小细胞和大细胞神经内分泌癌的诊断标准仅基于肿瘤形态；然而，这两种类型的癌在组织学和免疫表型特征上的重叠可能使其分类具有挑战性。准确诊断肺神经内分泌癌对患者管理至关重要，因为小细胞和大细胞神经内分泌癌的临床病程和治疗方法有所不同。过去十年发表的分子遗传学、转录组学和蛋白质组学数据表明，小细胞和大细胞神经内分泌癌并非同质类别，而是由多组独特的恶性肿瘤组成。小细胞肺癌亚型对不同化疗方案的敏感性差异以及大细胞神经内分泌癌中可靶向突变的发现表明，未来神经内分泌癌的分类和治疗可能需要辅助分子和蛋白质表达检测。本综述总结了当前的诊断标准、分类的预后和预测相关性，以及小细胞和大细胞神经内分泌癌先前未被认识的亚型的证据。
