[Heterogeneity of malignant bronchial tumors. Problems of histogenesis]. 1986

E Brambilla, and C Brambilla

The 1981 WHO classification of bronchial carcinoma, based on light microscopic analysis, proposed 4 principal classes: epidermoid carcinoma, adenocarcinoma, small cell carcinoma and large cell undifferentiated carcinoma. This apparently simple nosology underestimates the difficulties of classifying a good number of these tumors, due to a great diversity in appearance within the same histologic group. Experimental studies on the regeneration of bronchial epithelium, on lesions induced by irritants and carcinogens, suggest one undifferentiated cell line as the origin of all malignant proliferations, including neuro-endocrine tumours. To support this histogenetic hypothesis, an ultra-structural analysis of the carcinomas shows the existence and frequency of heterogenous forms, multi-differentiated, up to the level of individual cells. The same cell line may express several ways of differentiation simultaneously (bi or tri-partite differentiation). Equally immunohistochemical methods reveal antigenic differentiation (intermediary filaments, neuro-endocrine antigens) and establish a means of identifying different cellular constituents. These two methods have allowed real progress in the diagnosis of neuro-endocrine tumours, placing them firmly with bronchial tumours and seem particularly helpful in the analysis of undifferentiated small and large cell carcinomas. By another way, one finds in the majority of bronchial tumours the different antigens expressed, certainly following their histological type in variable degrees, yet with an antigenic (phenotypic) profile showing great similarity. This is a reflection of multi-differentiation in these tumours and appears as a direct consequence of their common histogenetic origin. Bronchial carcinomas are placed along a continuous spectrum of three parallel and/or simultaneous differentiations. They represent a single tumour having a tendency to express one or several ways of differentiation.

UI MeSH Term Description Entries
D008175 Lung Neoplasms Tumors or cancer of the LUNG. Cancer of Lung,Lung Cancer,Pulmonary Cancer,Pulmonary Neoplasms,Cancer of the Lung,Neoplasms, Lung,Neoplasms, Pulmonary,Cancer, Lung,Cancer, Pulmonary,Cancers, Lung,Cancers, Pulmonary,Lung Cancers,Lung Neoplasm,Neoplasm, Lung,Neoplasm, Pulmonary,Pulmonary Cancers,Pulmonary Neoplasm
D002283 Carcinoma, Bronchogenic Malignant neoplasm arising from the epithelium of the BRONCHI. It represents a large group of epithelial lung malignancies which can be divided into two clinical groups: SMALL CELL LUNG CANCER and NON-SMALL-CELL LUNG CARCINOMA. Carcinoma, Bronchial,Bronchial Carcinoma,Bronchial Carcinomas,Bronchogenic Carcinoma,Bronchogenic Carcinomas,Carcinomas, Bronchial,Carcinomas, Bronchogenic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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