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Neuroendokrine Tumoren der Lunge

Vom kleinzelligen Lungenkarzinom bis zur diffusen idiopathischen pulmonalen neuroendokrinen Zellhyperplasie

Neuroendocrine tumors of the lungs

From small cell lung carcinoma to diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

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Zusammenfassung

Die für 2015 angekündigte neue WHO-Klassifikation wird erstmalig die neuroendokrinen Tumoren (NET) der Lunge in einem Abschnitt gemeinsam abhandeln. Dabei wird zwischen High-grade-Tumoren, den kleinzelligen Lungenkarzinomen („small cell lung cancer“, SCLC) und großzelligen neuroendokrinen Karzinomen („large cell neuroendocrine carcinoma“, LCNEC), Intermediate-grade-Tumoren, den atypischen Karzinoiden (AC), und Low-grade-Tumoren, den typischen Karzinoiden (TC) sowie Vorläuferläsionen (diffuse idiopathische pulmonale neuroendokrine Zellhyperplasie, DIPNECH) unterschieden. Bisher waren die LCNEC im Kapitel der großzelligen Karzinome zu finden.

LCNEC konnten bisher nach der gültigen WHO-Klassifikation von 2004 diagnostiziert werden, die für Operationspräparate konzipiert ist. Danach sind wesentliche Kriterien ein neuroendokrines Wachstumsmuster, das am Biopsiematerial nicht oder schwer erkennbar sein kann, nichtkleinzellige zytologische Merkmale, eine Mitoserate von über 10/2 mm2 (im Mittel etwa 70–80/2 mm2), Tumorzellnekrosen und die immunhistochemische Positivität von mindestens einem anderen neuroendokrinen Marker als der neuronenspezifischen Enolase (NSE).

Die Gegenüberstellung aller neuroendokrinen Tumore der Lunge erlaubt einen direkteren Vergleich und eine bessere differenzialdiagnostische Abgrenzung der einzelnen Entitäten.

Abstract

The new World Health Organization (WHO) classification announced for 2015 will for the first time present all neuroendocrine tumors (NET) of the lungs in one single section. In this classification high grade small cell lung carcinoma (SCLC) and large cell neuroendocrine carcinoma (LCNEC) will be discriminated from intermediate grade atypical carcinoid (AC) and low grade typical carcinoid as well as from the preinvasive lesion diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH). The LCNEC was previously listed under the section of large cell carcinomas. The LCNEC could previously be diagnosed according to the current WHO classification from 2004 which is designed for resection specimens. According to this the main diagnostic criteria are a neuroendocrine growth pattern which can be difficult or impossible to detect in biopsy material, non-small cell cytological features, more than 10 mitoses per 2 mm2 (mean 70–80 per 2 mm2), tumor cell necrosis, and an immunohistochemical positivity for at least one neuroendocrine marker other than neuron-specific enolase (NSE). The presentation of all neuroendocrine tumors of the lungs in one section allows a more direct comparison and a better differential diagnostic discrimination of the different entities.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. P.A. Schnabel und K. Junker weisen auf folgende Beziehung hin: sie haben 2013 an einem Advisory Board der Firma Novartis zur Diagnostik großzelliger neuroendokriner Karzinome teilgenommen. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Institut für Allgemeine und Spezielle Pathologie, Universitätsklinikum des Saarlandes, Gebäude 26, 66421, Homburg/Saar, Deutschland

    P.A. Schnabel

  2. Zentrum für Pathologie, Klinikum Bremen Mitte, Bremen, Deutschland

    K. Junker

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Correspondence to P.A. Schnabel.

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Schnabel, P., Junker, K. Neuroendokrine Tumoren der Lunge. Pathologe 35, 557–564 (2014). https://doi.org/10.1007/s00292-014-1917-z

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