CA: A Cancer Journal for Clinicians, Vol 28, 331-342, Copyright
© 1978 by American Cancer Society
The Pathology of Tumors Part I: Precancerous and Pseudomalignant Lesions
Juan Rosai M.D.1 and
Lauren V. Ackerman M.D.2
1 Professor, Laboratory Medicine and Pathology and Director of Anatomic Pathology, Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota.
2 Professor of Pathology, State University of New York, Stonybrook, New York.
The biological behavior of a tumor is the clinician's, patient's, and must be the pathologist's main concern. Predicting this behavior accurately requires clinical as well as microscopic information since the morphology of a tumor may be inconsistant with its true nature.
The pathologist's final decision should be communicated in terms most useful to the surgeon, avoiding emphasis on subclassifications, except where they are clinically significant, and adapting the terminology so that, in those situations where typing or subtyping may influence the choice of therapy, the recommendations are clear to the surgeon.
Evaluating precancerous conditions and benign tumors that resemble cancer creates special problems for the pathologist. Many conditions previously designated as "precancerous" have, in fact, a very low potential for malignant development and only extreme care in assessing these lesions will prevent unnecessary surgery for a truly benign condition or conservative management of a condition which will inevitably become cancer.
There are a number of lesions, many of which are not even neoplastic, that microscopically resemble cancer. Here again the pathologist must exercise great care that drastic surgery is not performed for a perfectly benign lesion with an ominous appearance, or that treatment of cancer is not delayed.
