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Precursors to pulmonary neoplasia
T V Colby1, I I Wistuba, A Gazdar
1Department of Laboratory Medicine and Pathology, Mayo Clinic Scottsdale, Arizona 85259, USA.
Advances in Anatomic Pathology
|December 22, 1998
Summary
Precancerous lung lesions like squamous dysplasia and atypical adenomatous hyperplasia (AAH) are precursors to lung cancers. These hyperplastic changes in the bronchi and airways are key to understanding lung carcinoma and carcinoid tumor development.
Area of Science:
- Pulmonary Pathology
- Oncology
- Cellular Biology
Background:
- Squamous dysplasia is a known precursor to squamous cell lung carcinoma.
- Atypical adenomatous hyperplasia (AAH) is increasingly recognized as a precursor to lung adenocarcinoma.
- Bronchiolar neuroendocrine cell hyperplasia is implicated in the development of pulmonary carcinoid tumors.
Purpose of the Study:
- To review the role of precancerous lesions in lung carcinoma development.
- To highlight the atypical adenomatous hyperplasia-adenocarcinoma sequence.
- To discuss bronchiolar neuroendocrine cell hyperplasia in relation to carcinoid tumors.
Main Methods:
- Review of existing literature on lung dysplasia and hyperplasia.
- Comparison of AAH with adenocarcinoma characteristics.
- Analysis of bronchiolar neuroendocrine cell hyperplasia in various airway conditions.
Main Results:
- AAH shares immunohistochemical, morphometric, flow cytometric, and genetic abnormalities with adenocarcinoma.
- AAH can be multifocal, potentially explaining multicentric lung adenocarcinomas.
- Bronchiolar neuroendocrine cell hyperplasia can be multifocal and bilateral, sometimes meeting criteria for carcinoid tumors.
Conclusions:
- Understanding precancerous lesions is crucial for early detection and prevention of lung cancers.
- The AAH-adenocarcinoma sequence provides a model for multistep carcinogenesis in the lung.
- Bronchiolar neuroendocrine cell hyperplasia, especially when multifocal, warrants attention as a potential precursor to carcinoid tumors.