The new world health organization classification of lung tumours
Abstract
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.
About the Authors
E. Brambilla
Университет Гренобля
France
France
W. D. Travis
Институт патологии Вооруженных Сил
United States
United States
T. V. Colby
Клиника Мейо
United States
United States
B. Corrin
Национальный госпиталь сердца и легких
United Kingdom
United Kingdom
Y. Shimosato
Национальный центральный госпиталь рака
Japan
Japan
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Brambilla E., Travis W.D., Colby T.V., Corrin B., Shimosato Y. The new world health organization classification of lung tumours. PULMONOLOGIYA. 2004;(6):11-21. (In Russ.)
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