Crissman J D, Visscher D W, Sakr W
Department of Pathology, Harper Hospital, Detroit, MI.
J Cell Biochem Suppl. 1993;17F:49-56. doi: 10.1002/jcb.240531008.
Intraepithelial neoplasia of the upper aerodigestive tract (UADT), including both histologically defined dysplasia and carcinoma in situ (CIS), appears to fall into two broad groups similar to intraepithelial neoplasia of other squamous mucosae, keratinizing and non-keratinizing. Keratinizing dysplasia/CIS is common in the UADT and uncommon in other sites such as the cervix. In general, keratinizing epithelial proliferation results in thick epithelium, usually with prominent superficial keratin expression with a whitish or "leukoplakic" clinical appearance. Although most clinical leukoplakic changes in the UADT mucosa do not represent neoplastic transformation and do not progress to invasive carcinoma, keratinizing dysplasia, defined by nuclear atypism and maturation alterations, has an appreciable progression to invasive carcinoma. Non-keratinizing dysplasia/CIS, common in the cervix, is less common in the UADT mucosa. In general, non-keratinizing epithelial alterations consist of a proliferation of incompletely differentiated cells as measured by a spectrum of maturation markers. These changes result in a thin epithelium which commonly has a red, or clinically "erythroplakic," appearance. Non-keratinizing dysplasias are less common, but are more likely to harbor high grade dysplasia or early invasive carcinoma.
上消化道呼吸道上皮内瘤变（UADT），包括组织学定义的发育异常和原位癌（CIS），似乎可分为两大类，类似于其他鳞状黏膜的上皮内瘤变，即角化型和非角化型。角化型发育异常/原位癌在UADT中常见，而在其他部位如宫颈则不常见。一般来说，角化上皮增生导致上皮增厚，通常伴有明显的表层角蛋白表达，临床表现为白色或“白斑样”外观。尽管UADT黏膜的大多数临床白斑样改变并不代表肿瘤转化，也不会进展为浸润性癌，但由核异型性和成熟改变定义的角化型发育异常有相当比例会进展为浸润性癌。非角化型发育异常/原位癌在宫颈常见，在UADT黏膜中较少见。一般来说，非角化上皮改变表现为一系列成熟标志物检测显示的不完全分化细胞的增殖。这些改变导致上皮变薄，通常表现为红色，即临床上的“红斑样”外观。非角化型发育异常较少见，但更可能伴有高级别发育异常或早期浸润性癌。
