Upload
duongcong
View
217
Download
0
Embed Size (px)
Citation preview
ferentiated squamous caricnoma of the bron-
chus 18 examples of this tumour were
studied. On light microscopy i0 of the
tumours contained loci of keratinisation or
intercellular bridges and therefore ful-
filled the World Health Organisation's diag-
nostic criteria. In eight these features
were absent, but the overall appearance was
sufficiently squamoid to preclude their
placement in any other category. On electron
microscopy many cells showed the charac-
teristic desmosomes and tonofilaments of
s~mous carcinoma, but there were also
areas of adenodifferentiation. The
ultrastructure of both light microscopic
groups was identical. In conclusion, this
type of tumour is dimorphic with charac-
teristics of adenocarcinoma and squamous
carcinoma on electron microscopy.
Keratinisation and bridges are not essential
diagnostic criteria: the overall pattern and
cellular morphology are more important.
Subtypes of Small Cell Carcinoma of the
Lung: Morphometric, Ultrastructural, and Im-
munohistochemical Analyses.
Nomori, H., Shimosato, Y., Kodama, T. et al.
Pathology Division, National Cancer Center
Research Institute, Chuo-ku, Tokyo 104,
Japan. Hum. Pathol. 17: 604-613, 1986.
Fifty-three surgically resected small
cell carcinomas of the lung were studied
morphometrically, electron microscopically,
in~mlnohistochemically, and in terms of pos-
sible site of origin. Four subtypes of small
cell carcinomas were identified: oat cell
carcinoma (OAT), small cell carcinoma of the
intermediate cell type (INT), combined oat
cell carcinoma, and undifferentiated car-
cinoma of the small cell type (UCS). The
latter type is presumed to be nonneuroen-
docrine. Morphometric analysis showed con-
siderable overlap among OAT, INT, and UCS
with respect to nuclear area, cell area, and
nuclear/cytoplasmic ratio. Ultrastruc-
turally, significantly more carcinomas
categorized as OAT and INT contained
neurosecretory granules than did those in
the UCS category (P<O.01 and 0.05,
respectively). Cells with tonofibrils were
more frequent in UCSs than in OATs and INTs.
Inm~mohistochemically, fewer UCSs than OATs
contained cells with gastrin-releasing pep-
tide, neuron-specific enolase, and Leu-7 (P
= 0.5, P<0.05, P<0.05, respectively). UCSs
were located more frequently at the
periphery of the lung than were OATs
33
(P<O.OI)) and INTs (P = 0.06). These find-
ings suggest that UCS may be a pathologic
entity distinct from the typical
neuroendocrine-type small cell carcinoma and
that this subtype probably corresponds to
small cell carcinoma with a 'large cell com-
ponent,' and to very poorly differentiated
adenocarcinoma and sqlmmous cell carcinoma
of the small cell type.
Mixed Small Cell and Non-Small Cell Lung
Cancer.
Adelstein, D.J., Tomashefski, J.F. Jr.,
Snow, N.J. et al. Department of Medicine,
Cleveland Metropolitan General Hospital,
Cleveland, OH 44109, U.S.A. Chest 89: 699-
704, 1986.
Seventeen (i0 percent) of 176 patients
with small-cell carcinoma of the lung seen
at this hospital since 1976 proved to have
mixed small-cell and non-small-cell tumors.
The presence of a mixed lung cancer was es-
tablished prior to chemotherapy or irradia-
tion in nine patients. Eight were initially
diagnosed as pure small-ceil carcinoma but
proved to have a mixed tumor at either sur-
gery or autopsy. Of the 17 patients, eight
received chemotherapy, and four had a par-
tial response. Six of the 40 autopsies per-
formed on patients with small-cell lung can-
cer demonstrated intrathoracic tumor which
was histologically mixed. Extrathoracic
metastases in these patients were
heterogeneous and included pure small-cell,
pure non-small-ceil, and mixed histologic
type. We conclude that mixed small-cell and
non-small-cell lung cancers are relatively
frequent and carry important prognostic and
therapeutic implications. Clinical manage-
ment of patients with small-cell lung cancer
should therefore be flexible and tailored to
the potential for histologic diversity.
Mixed lung cancer in previously untreated
patients suggests a common endodermal origin
for small-cell and non-small-ceil pulmonary
tumors.
Scar Adenocarcinoma of the Lung: A Light and
Electron Microscopic Study.
Edwards, C., Carlile, A. Department of His-
topathology, East Birmingham Hospital, Bir-
mingham B9 5ST, U.K.J. Clin. Pathol. 39:
423-427, 1986.
Five well differentiated peripheral
adenocarcinomas of the lung were inves-
tigated, using light and electron micros-
copy. Each tumour contained a central nidus