pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLCpulmo-2476Research ArticleКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИCLINICAL GUIDELINESНовая классификация легочных опухолей всемирной организации здравоохраненияThe new world health organization classification of lung tumoursБрамбийяЕ.BrambillaE.

Отделение клеточной патологии центрального госпиталя.

Гренобль

ТрависВ. Д.TravisW. D.

Отделение пульмонологии и медиастинальной патологии

Вашингтон

КолбиТ. В.ColbyT. V.

Отделение патологии

Скоттсдейл

КорринБ.CorrinB.

Лондон

ШимосатоЙ.ShimosatoY.

Токио

Университет ГренобляFranceИнститут патологии Вооруженных СилUnited StatesКлиника МейоUnited StatesНациональный госпиталь сердца и легкихUnited KingdomНациональный центральный госпиталь ракаJapan200417082021061121Copyright © Брамбийя Е., Травис В.Д., Колби Т.В., Коррин Б., Шимосато Й., 20212021Брамбийя Е., Травис В.Д., Колби Т.В., Коррин Б., Шимосато Й.Brambilla E., Travis W.D., Colby T.V., Corrin B., Shimosato Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/2476

Классификации опухолей являются основой диагностики, выбора лечебной тактики, а также эпидемиологических и клинических исследований. Новая классификация разработана на принципах воспроизводимости, клинической значимости и простоты в использовании с целью свести к минимуму количество неклассифицируемых опухолей.

Главные изменения в классификации нового пересмотра, по сравнению с предшествующей (ВОЗ, 1981), заключаются в выделении двух новых преинвазивных состояний, помимо плоскоклеточной дисплазии и карциномы in situ, — атипичной аденоматозной гиперплазии и диффузной идиопатической легочной нейроэндокринноклеточной гиперплазии. Другие изменения касаются классификации аденокарциномы: к бронхоальвеолярной карциноме отнесены только неинвазивные опухоли. Произошел значительный прогресс в подходе к классификации нейроэндокринных легочных опухолей. Крупноклеточный нейроэндокринный рак теперь определяется как гистологически высокодифференцированная немелкоклеточная карцинома, характеризующаяся гистопатологическими чертами нейроэндокринной дифференциации и наличием иммуногистохимических нейроэндокринных маркеров. Класс крупноклеточного рака обогатился различными вариантами, включая крупноклеточный нейроэндокринный рак и базальноклеточный рак. Наконец, выделен новый класс, названный карциномой с плеоморфными, саркоматоидными или саркоматозными элементами, который характеризуется пролиферацией разнообразных клеточных элементов от эпителия до мезенхимальных структур.

Иммуногистохимия и электронная микроскопия — весьма ценные технологии для диагностики и классификации, но нашей целью было создание простой в практическом отношении классификации, применимой в любом хирургическом подразделении, поэтому большинство легочных опухолей классифицировано на основании данных световой микроскопии.

Tumour classification systems provide the foundation for tumour diagnosis and patient therapy and a critical basis for epidemiological and clinical studies. This updated classification was developed with the aim to adhere to the principles of reproducibility, clinical significance, and simplicity in order to minimize the number of unclassifiable lesions.

Major changes in the revised classification as compared to the previous one (WHO 1981) include the addition of two pre-invasive lesions to squamous dysplasia and carcinoma in situ; atypical adenomatous hyperplasia and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. Another change is the subclassification of adeno-carcinoma: the definition of bronchioalveolar carcinoma has been restricted to noninvasive tumours. There has been substantial evolution of concepts in neuroendocrine lung tumour classification. Large cell neuroendocrine carcinoma (LCNEC) is now recognized as a histologically high grade non small cell carcinoma showing histopathoiogical features of neuroendocrine differentiation as well as immunohisto-chemical neuroendocrine markers. The large cell carcinoma class has been enriched with several variants, including the LCNEC and the basaloid carcinoma, both with a dismal prognosis. Finally, a new class was defined called carcinoma with pleomorphic, sarcomatoid, or sarcomatous elements, which brings together a number of proliferations characterized by a spectrum of epithelial to mesenchymal differentiation.

Immunohistochemistry and electron microscopy are invaluable techniques for diagnosis and subclassification, but our intention was to render the classification simple and practical to every surgical laboratory, so that most lung tumours could be classified by light microscopis criteria.

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The authors declare that there are no conflicts of interest present.