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Resumo
Os conhecimentos actuais da patologia molecular do cancro do pulmão requerem outra caracterização histológica, para além de carcinoma de células pequenas e carcinoma não pequenas células para suporte da terapia personalizada e entendimento do valor real dos fármacos actualmente disponíveis.
Como o diagnóstico e seguimento clínico da maioria dos casos de cancro do pulmão se baseia em produtos de biópsia e citologia, a classificação imunoistoquímica do carcinoma broncopulmonar (IBPCC) é necessária para suporte morfológico da classificação da WHO 1999/2004, clarificando as características celulares das neoplasias e o entendimento da carcinogénese.
O painel imunoistoquímico reforça os tipos histológicos principais do carcinoma bronco – pulmonar: carcinoma epidermóide (queratinas de alto peso molecular – HWMC), carcinoma adenoscamoso (CK/ /TTF1, MWMC), carcinoma neuroendócrino (Chrg, Syn, CD56, TTF1, Ki67) e adenocarcinoma (CK7, Ck20, TTF1); as variantes do carcinoma de células grandes e do carcinoma sarcomatóide são englobados num único grupo de carcinomas pleomórficos (CK7, TTF1, HWMC, VMT, desmina, actina), onde cabe o polimorfismo e o pleomorfismo celular.
A quimioterapia do carcinoma broncopulmonar continuará baseada no platino e na gemcitabina no futuro próximo e a IBPCC será uma ferramenta simples e eficiente para o registo das características e tipos histológicos do carcinoma do pulmão presentes nas biópsias e amostras citológicas para suporte da evidência clínica e dos ensaios farmacêuticos.
Rev Port Pneumol 2009; XV (6): 1101-1119
Palavras-chave:
Carcinoma broncopulmonar
imunoistoquímica
Abstract
The current state of molecular knowledge on lung cancer demands a histological classification which goes beyond small-cell and non-small-cell carcinoma to provide support for tailored therapy in aiding in understanding of the drugs currently available.
As diagnosis and follow-up in the vast majority of lung cancer cases is based on biopsies and cytology samples, Immunohistochemical Bronchial Pulmonary Carcinoma Classification (IBPCC) is necessary to reveal the raft of characteristics available. This provides morphological support for the WHO’s 1999/2004 classification, in addition to an understanding of carcinogenesis.
The immunohistochemical panel clarifies the main morphology and cytology characteristics to maintain the leading histological types as squamous cell carcinoma (high weight molecular cytokeratins/HWMC), adenosquamous carcinoma (CK7, TTF1, HWMA), neuroendocrine carcinoma (Chrg, Syn, CD56, TTF1, Ki67), adenocarcinoma (CK7, CK20, TTF1) and bring the polymorphic and pleomorphic carcinomas under a single banner of pleomorphic carcinoma (Ck7, TTF1, HWMC, VMT, Desmin, Actin) which shelters large cell carcinomas and sarcomatoid carcinomas.
Lung cancer chemotherapy will still be based on platinum and gemcitabine for the near future and the IBPCC is a simple and efficient tool for streamlining the registration of lung cancer histological characteristics in biopsies and other reduced samples to support clinical evidence and trials.
Rev Port Pneumol 2009; XV (6): 1101-1119
Key-words:
Bronchial-pulmonary carcinoma
immunohistochemistry
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