Update on small cell carcinoma and its differentiation from squamous cell carcinoma and other non-small cell carcinomas
Update on small cell carcinoma and its differentiation from squamous cell carcinoma and other non-small cell carcinomas
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DOI：
10.1038/modpathol.2011.150
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发表时间：
2012-01-01
期刊：
影响因子：
7.5
通讯作者：
Travis, William D.
中科院分区：
文献类型：
--
作者：
Travis, William D.
小细胞肺癌（SCLC）占所有肺癌的14%，在美国每年新诊断的病例为30万例。SCLC是整个肿瘤学领域中最独特的恶性肿瘤之一，具有独特的临床特征，对特定化疗的反应性，遗传特征和高度可靠的病理诊断。SCLC是通过光学显微镜来定义的，最重要的染色是高质量的苏木精和伊红（H&E）染色切片。绝大多数病例可以单独通过H&E诊断；然而，在问题病例中，免疫组织化学可以非常有助于与其他肿瘤区分。细胞学也是一个强大的工具，通常比肿瘤细胞少、挤压伪影和/或坏死的小活检更明确。由于几乎所有的小细胞肺癌都出现在晚期，大多数患者的诊断是基于小活检和细胞学标本。从历史上看，从1962年Kreyberg提出燕麦细胞和多角形细胞类型开始，SCLC的组织学亚分类发生了重大变化。目前的亚分类只识别两种亚型：纯SCLC和合并SCLC。病理学家需要尽最大努力对SCLC或其他组织学类型的肺癌做出诊断，这在大多数情况下是可以实现的。本综述将讨论在少数病例中出现的一些诊断问题，并概述解决这些问题的实用方法。简要介绍其他神经内分泌肺肿瘤，概述这类肿瘤的分子发病机制。现代病理学杂志（2012）25,S18-S30；doi: 10.1038 / modpathol.2011.150
Small cell lung cancer (SCLC) comprises 14% of all lung cancers, and >30 000 new cases are diagnosed per year in the United States. SCLC is one of the most distinctive malignancies in the entire field of oncology with characteristic clinical properties, responsiveness to specific chemotherapy, genetic features and a highly reliable pathological diagnosis. SCLC is defined by light microscopy, and the most important stain is a good-quality hematoxylin and eosin (H&E)-stained section. The vast majority of cases can be diagnosed on H&E alone; however, in problem cases, immunohistochemistry can be very helpful in making the distinction from other tumors. Cytology is also a powerful tool, often being more definitive than small biopsies with scant tumor cells, crush artifact and/or necrosis. As virtually all SCLCs present in advanced stages, most patients are diagnosed based on small biopsy and cytology specimens. Historically, there has been significant evolution in the histological subclassification of SCLC dating from 1962 when Kreyberg proposed the oat cell and polygonal cell types. The current subclassification recognizes only two subtypes: pure SCLC and combined SCLC. Pathologists need to do their best to make a diagnosis of SCLC or other histological types of lung cancer and this can be achieved in most cases. This review will address some of the diagnostic problems that occur in the minority of cases and outline practical ways to address them. Brief reference will be made to other neuroendocrine lung tumors with an overview of the molecular pathogenesis of this spectrum of tumors. Modern Pathology (2012) 25, S18-S30; doi:10.1038/modpathol.2011.150