首页|第5版WHO肾上腺皮质肿瘤分类解读

第5版WHO肾上腺皮质肿瘤分类解读

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第5版WHO肾上腺皮质肿瘤分类(简称第5版分类)根据近几年研究进展,新增了非肿瘤性病变,包括肾上腺残基、肾上腺囊肿、肾上腺皮质增生和结节性肾上腺皮质病.根据肿瘤细胞起源、组织病理、生物标志物和分子特征,对一系列肿瘤概念进行更新或重新命名.最重要的变化为结节性肾上腺皮质病及其细化分类,包括散发性结节性肾上腺皮质病、双侧小结节性肾上腺皮质病、双侧大结节性肾上腺皮质病.第5版分类引入HISTALDO分类法,结合组织形态和CYP11B2免疫表型识别醛固酮分泌部位,并对醛固酮分泌性肾上腺皮质腺瘤进一步分类.第5版分类保留肾上腺皮质癌组织亚型、Weiss与Lin-Weiss-Bisceglia诊断标准,强调血管侵犯对肿瘤诊断与评估预后的影响.新增网状蛋白标准与Helsinki评分系统用于肾上腺皮质肿瘤的鉴别诊断,采用Wieneke系统评估儿童肾上腺皮质肿瘤.第5版分类强调使用核分裂象计数(核分裂象/10 mm2)和Ki-67阳性指数准确评估肿瘤增殖率,在肾上腺皮质癌患者动态风险分层中发挥重要作用.本文主要针对第5版分类中主要变化进行解读,强调了肾上腺皮质病理组织学特征、辅助研究和相关基因特征的知识进展,以增加对第5版分类的理解.
Interpretation of the 5th edition WHO classification of adrenal cortical tumors
Non-neoplastic lesions were added in the 5th edition WHO classification of adrenal cortical tumor based on the recent update,including adrenal rests,adrenal cysts,congenital adrenal hyperplasia and adrenocortical nodular disease.A range of tumor concepts were updated or refined based on tumor cell origin,histopathology,oncology and molecular biology.The most significant nomenclature change in the field of adrenal cortical pathology involves the refined classification of adrenal cortical nodular disease,which now includes sporadic nodular adrenocortical disease,bilateral micronodular adrenal cortical disease,and bilateral macronodular adrenal cortical disease.The 5th edition WHO classification endorses the nomenclature of the HISTALDO classification to help the classification of aldosterone producing adrenal cortical lesions,which uses CYP11B2 immunohistochemistry to identify functional sites of aldosterone production.The 5th edition WHO classification does not change the Weiss and Lin-Weiss-Bisceglia histopathologic criteria for diagnosing adrenal cortical carcinomas,and underscores the diagnostic and prognostic impact of angioinvasion in these tumors.Reticulin algorithm and Helsinki scoring system were added to assist the differential diagnosis of adrenal cortical neoplasms in adults.Pediatric adrenal cortical neoplasms are assessed using the Wieneke system.The 5th edition WHO classification places an emphasis on an accurate assessment of tumor proliferation rate using both the mitotic count(mitoses per 10 mm2)and Ki-67 labeling index which play an essential role in the dynamic risk stratification of affected patients.This review highlights advances in knowledge of histological features,ancillary studies,and associated genetic findings that increase the understanding of the adrenal cortex pathologies in the 5th edition WHO classification.

Adrenal cortex neoplasmsInternational classification of diseasesWorld Health Organization

张立坤、刘志艳

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上海交通大学医学院附属第六人民医院病理科,上海 200233

肾上腺皮质肿瘤 国际疾病分类法 世界卫生组织

国家自然科学基金上海市"科技创新行动计划"自然科学基金(2023)上海市"科技创新行动计划"医学创新研究专项(2020)上海市第六人民医院引进人才科研启动基金

8197250023ZR144820020Z1190030420200701

2024

10.3760/cma.j.cn112151-20230809-00058

中华病理学杂志
中华医学会

中华病理学杂志

CSTPCD北大核心
影响因子：1
ISSN：0529-5807
年,卷(期)：2024.53(1)
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