Fushimi H, Kikui M, Morino H, Yamamoto S, Tateishi R, Wada A, Aozasa K, Kotoh K
Department of Pathology, Osaka Prefectural General Hospital, Japan.
Cancer. 1996 Jan 15;77(2):278-83. doi: 10.1002/(SICI)1097-0142(19960115)77:2<278::AID-CNCR9>3.0.CO;2-I.
Small cell lung carcinoma (SCLC) has been divided into three subtypes: pure SCLC, mixed small cell/large cell carcinoma (mixed SC/LC), and combined SCLC. Patients with mixed SC/LC show a worse prognosis than those with pure SCLC.
Persistence of histologic subtype in SCLC in the primary sites during the course of treatment or in the different organs at autopsy was examined. For this purpose, biopsy or cytologic specimens before chemotherapy, and autopsy specimens from 175 patients with SCLC were reviewed. They included 147 (84%) men and 28 (16%) women with an age range of 29-83 (median, 65) years.
The frequency of mixed SC/LC in the primary sites was statistically higher in autopsy (14.3%) than that in biopsy or cytology specimens (8.6%) (P < 0.05). At autopsy, involved organs were categorized into two groups according to frequency of appearance of mixed SC/LC, i.e., a higher frequency group, including the liver (31 of 85; 36.4%), adrenal gland (15 of 56; 26.8%), brain (6 of 9; 66.7%), and extrathoracic lymph nodes (17 of 59; 28.8%) and a lower frequency group, including the lung (metastatic sites) (12 of 102; 11.8%), pleura (8 of 74; 10.8%), and intrathoracic lymph nodes (12 of 94; 12.8%). The difference in frequency between these two groups was statistically significant (P < 0.05).
These findings suggest that primary pure SCLC can progress to mixed SC/LC with an increased potential for distant metastasis.
小细胞肺癌（SCLC）已被分为三种亚型：纯小细胞肺癌、小细胞/大细胞混合癌（混合性小细胞/大细胞癌）和复合型小细胞肺癌。混合性小细胞/大细胞癌患者的预后比纯小细胞肺癌患者更差。
研究了小细胞肺癌在治疗过程中原发部位或尸检时不同器官中组织学亚型的持续性。为此，回顾了化疗前的活检或细胞学标本以及175例小细胞肺癌患者的尸检标本。其中包括147例（84%）男性和28例（16%）女性，年龄范围为29 - 83岁（中位数为65岁）。
尸检中原发部位混合性小细胞/大细胞癌的发生率在统计学上高于活检或细胞学标本（14.3%比8.6%）（P < 0.05）。尸检时，受累器官根据混合性小细胞/大细胞癌出现的频率分为两组，即高频率组，包括肝脏（85例中的31例；36.4%）、肾上腺（56例中的15例；26.8%）、脑（9例中的6例；66.7%）和胸外淋巴结（59例中的17例；28.8%），以及低频率组，包括肺（转移部位）（102例中的12例；11.8%）、胸膜（74例中的8例；10.8%）和胸内淋巴结（94例中的12例；12.8%）。这两组之间的频率差异具有统计学意义（P < 0.05）。
这些发现表明，原发性纯小细胞肺癌可进展为混合性小细胞/大细胞癌，远处转移的可能性增加。
