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High-grade Neuroendocrine Carcinoma of the Lung With Carcinoid Morphology: A Study of 12 Cases

发布日期:2017/2/24 23:49:04 文章来源: 作者: 点击次数:8050

 

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Am J Surg Pathol 2017;41:263–270

High-grade Neuroendocrine Carcinoma of the Lung With Carcinoid Morphology: A Study of 12 Cases

Anne Marie Quinn, PhD, FRCPath,* Anshuman Chaturvedi, MD, FRCPath,*

and Daisuke Nonaka, MD

From the *Department of Histopathology, The University Hospital of South Manchester NHS Foundation Trust; †Department of Histopathology, The Christie NHS Foundation Trust; and ‡Institute of Cancer Sciences, The University of Manchester, Manchester, UK.

Abstract: Twelve lung neuroendocrine tumors with morphologic features of carcinoid tumors but with mitotic count >10/2mm2 are reported. There were 7 males and 5 females, with age ranging from 56 to 78 years. Four cases were from never-smokers. All tumors showed architectural and cytomorphologic features of carcinoid tumor, including organoid nesting, insular, trabecular, or acinar growth, and tumor cells with low nucleocytoplasmic ratio, abundant cytoplasm, ovoid to round nuclei, and salt and pepper chromatin. Angulated or confluent nesting, insular or lobular growth pattern was also seen. Nuclear irregularities and anisonucleosis were focally present. Mitotic count ranged from 11 to 61/2mm2. Punctate-type necrosis was present in 8 tumors. Anaplastic cytology, large infarct-type necrosis, desmoplasia, or marked inflammatory infiltrate was not found in any of the tumors. One tumor occurred in the background of diffuse idiopathic pulmonary neuroendocrine hyperplasia. All tumors were treated by resection, and all but 1 patient subsequently developed metastasis, and 7 died of the tumor. For metastatic tumors, 4 patients were treated by platinum-based chemotherapy with no apparent response, whereas 3 other patients were treated by combined capecitabine and temozolomide—novel chemotherapy for well-differentiated neuroendocrine tumor/ carcinoid tumor—2 of them responded. This subset of tumor would be classified as large cell neuroendocrine carcinoma according to the current WHO classification scheme, but their clinical and pathologic features appear to have more in common with the carcinoid tumor group than large cell neuroendocrine carcinoma, therefore, identification of this subset may be relevant for further therapeutic management.

 

伴有类癌形态的高级别神经内分泌癌

摘要:十二例伴有类癌特征,但有丝分裂数> 10/2mm2的肺神经内分泌肿瘤的报告。有7例男性和5例女性,年龄范围从5678岁。4例患者从不吸烟。所有肿瘤都表现出类癌的结构和细胞形态学特点,包括器官样、岛屿状、小梁状或腺泡状生长,肿瘤细胞低核浆比,胞浆丰富,核为卵圆形、染色质呈胡椒盐样。成角或汇合结节状、小叶状生长模式也可以见到。局部可见核不规则及异型。有丝分裂计数范围从 1161/2mm2。点状坏死出现在8例肿瘤中。但所有的肿瘤均无间变细胞、大面积梗死型坏死、结缔组织增生,以及明显的炎性浸润。有1例发生在弥漫性特发性肺神经内分泌细胞增生的背景中。所有的肿瘤均经手术切除,除1例外均发生了转移,而7例死于肿瘤。转移的肿瘤有4例采用铂类化疗没有明显的反应,而其他3例通过联合卡培他滨和替莫唑胺治疗高分化神经内分泌肿瘤/类癌的新化疗。这类肿瘤根据目前的WHO分类方案将被归类为大细胞神经内分泌癌,但其临床和病理特征与大细胞神经内分泌癌相比,似乎与类癌有更多的共同点,因此,认识此类肿瘤对于进一步治疗有着更重要的意义。(翻译 付欣)

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