The Bases for the Histologic Grading of Carcinoma

It is just forty years since Hansemgnn, in his monograph ‘‘ Studien uber die Spezi-ficitat, den Altruismus und die Anaplasie der Zellen,” first presented the idea that a scale might be drawn up to represent the degree to which the morphology of a tumor departs from that of the mother cells from which it arises. Hansemann described and presented photomicrographs of three grades of anaplasia in squamons-cell carcinoma and in adenocarcinoma. At this time he suggested the possibility that the grade of anaplasia might be correlated with the degree of clinical malignancy of the tumor as evidenced by its tendency to metastasize, but lacking data bearing on this point he made no claim that such a relationship existed. He set to work, however, to discover the endresults for all the tumors which he graded histologically. Nine years later, in the second edition of his book, “Die mikroskopische Diagnose der bosartigen Qeschwulste, ” he concluded that a relationship did indeed exist between grade of anaplasia and grade of malignancy. Highly anaplastic tumors almost always recurred and metastasized. Those showing a lesser grade of anaplasia were sometimes cured. Hansemann ’s interesting observation received comparatively little attention in his own country, and it is only in recent years, and particularly in the United States, that histologic grading has been studied extensively. Good evidence has accumulated that for a few special types of carcinoma, such as that in the cervix and in the rectum, the grade of anaplasia is a useful gauge of the grade of malignancy. For tumors in general, however, the majority of pathologierts have shown a just reserve in making prognoses on the basis of grading. The relationship of grade of anaplasia to malignancy must be studied separately for each type of tumor, and the necessary follow-up data upon which to base such studies are, in general, not yet available in American clinics. For it should be remembered that the test of the value of grade *Read before the American Association for Cancer Research, May 8, 1933, at Washington, D. 0.