Słodkowska J, Langfort R, Rudziński P, Kupis W
Zakładu Patomorfologii, Instytutu Gruźlicy i Chorób Płuc w. Warszawie.
Pneumonol Alergol Pol. 1998;66(5-6):297-303.
Neuroendocrine tumors of the lung represent a group of controversial pulmonary neoplasms regarding their classification, criteria for diagnosis, predictors of future behavior, and therapy. The histologic criteria for their classification rest heavily on the proposed by Arrigoni et al. in 1972, for atypical carcinoid (AC). According to these authors AC has mitoses between 5 and 10 per 10 high power fields (HPF), necrosis, hypercellularity and disorganized architecture. The survival analysis performed by Flieder et al. (1997) for a variety of clinical and histologic features revised the histologic criteria for separating AC from typical carcinoid (TC) and proposed a range of mitotic counts between 2 and 20 per HPF for AC. From 1978 until 1997, 77 resected pulmonary carcinoids were reclassified for TCs and ACs according to Flieder's et al. histologic criteria. The clinical and pathological various features were studied for the group of 62 TCs and 15 ACs. 77 patients (pts) entered the study: 29(38%) males and 48(62%)females; mean age 43 years, range 18-75 years, 46 pts underwent lobectomies, 16 bilobectomies, 12 pneumonectomies and 3 wedge resections. The patients with TC were younger than those with AC (males: 40 vs 50 years and females 42 vs 49 years). TCs were significantly smaller than ACs (mean diameter respectively: 24 mm vs 33 mm). Fifty four (87%) of TCs and all ACs had central localization. The time of patients observation ranged from 2 months to 18 and half years; 2 patients with TC died due to tumours progression; 3 due to other diseases. Regional lymph node metastases occurred in 10% TCs and 33% ACs (p = 0.032). The heterotopic bone formation appeared in 11(18%) TCs and 2(13%) ACs. The mitotic counts for AC range between 2 and 6 per 10 HPF, accompanied by small foci of necrosis in 2 cases. Peripheral carcinoids showed a spindle-cell morphology. The performed study has highlighted the new concept of the carcinoids classification and the importance of the mitotic counts as histologic criteria for AC diagnosis. The data based on the largest in Polish literature lung carcinoids collection.
肺神经内分泌肿瘤在分类、诊断标准、未来行为预测指标及治疗方面是一组存在争议的肺部肿瘤。其分类的组织学标准很大程度上依据1972年阿里戈尼等人提出的非典型类癌（AC）标准。根据这些作者的观点，AC每10个高倍视野（HPF）中有5至10个核分裂象、坏死、细胞增多及结构紊乱。弗里德等人（1997年）针对多种临床和组织学特征进行的生存分析修订了区分AC与典型类癌（TC）的组织学标准，并提出AC每HPF的核分裂象计数范围为2至20个。从1978年至1997年，根据弗里德等人的组织学标准，对77例切除的肺类癌重新分类为TC和AC。对62例TC和15例AC患者的临床和病理特征进行了研究。77例患者纳入研究：男性29例（38%），女性48例（62%）；平均年龄43岁，范围18至75岁，46例患者接受肺叶切除术，16例接受双肺叶切除术，12例接受全肺切除术，3例接受楔形切除术。TC患者比AC患者年轻（男性：40岁对50岁，女性：42岁对49岁）。TC明显小于AC（平均直径分别为：24毫米对33毫米）。54例（87%）TC和所有AC均位于中央。患者观察时间为2个月至18年半；2例TC患者因肿瘤进展死亡；3例因其他疾病死亡。10%的TC和33%的AC发生区域淋巴结转移（p = 0.032）。11例（18%）TC和2例（13%）AC出现异位骨形成。AC的核分裂象计数为每10个HPF 2至6个，2例伴有小灶性坏死。周围型类癌呈梭形细胞形态。本研究突出了类癌分类的新概念以及核分裂象计数作为AC诊断组织学标准的重要性。这些数据基于波兰文献中最大的肺类癌病例收集。
