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2017 ; 6
(5
): 513-529
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gab.com Text
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English Wikipedia
Classification of pulmonary neuroendocrine tumors: new insights
#MMPMID29114468
Pelosi G
; Sonzogni A
; Harari S
; Albini A
; Bresaola E
; Marchiò C
; Massa F
; Righi L
; Gatti G
; Papanikolaou N
; Vijayvergia N
; Calabrese F
; Papotti M
Transl Lung Cancer Res
2017[Oct]; 6
(5
): 513-529
PMID29114468
show ga
Neuroendocrine tumors of the lung (Lu-NETs) embrace a heterogeneous family of
neoplasms classified into four histological variants, namely typical carcinoid
(TC), atypical carcinoid (AC), large cell neuroendocrine carcinoma (LCNEC) and
small cell lung carcinoma (SCLC). Defining criteria on resection specimens
include mitotic count in 2 mm(2) and the presence or absence of necrosis,
alongside a constellation of cytological and histological traits including cell
size and shape, nuclear features and overall architecture. Clinically, TC are
low-grade malignant tumors, AC intermediate-grade malignant tumors and SCLC/LCNEC
high-grade malignant full-blown carcinomas with no significant differences in
survival between them. Homologous tumors arise in the thymus that occasionally
have some difficulties in differentiating from the lung counterparts when
presented with large unresectable or metastatic lesions. Immunohistochemistry
(IHC) helps refine NE diagnosis at various anatomical sites, particularly on
small-sized tissue material, in which only TC and small cell carcinoma categories
can be recognized easily on hematoxylin & eosin stain, while AC and LCNEC can
only be suggested on such material. The Ki-67 labeling index effectively
separates carcinoids from small cell carcinoma and may prove useful for the
clinical management of a metastatic disease to help the therapeutic
decision-making process. Although carcinoids and high-grade neuroendocrine
carcinomas in the lung and elsewhere make up separate tumor categories on
molecular grounds, emerging data supports the concept of secondary high-grade
NETs arising in the preexisting carcinoids, whose clinical and biological
relevance will have to be placed into the proper context for the optimal
management of these patients. In this review, we will discuss the selected,
recent literature with a focus on current issues regarding Lu-NET nosology, i.e.,
classification, derivation and tumor evolution.
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