神经母细胞瘤的术语和形态学标准：国际神经母细胞瘤病理委员会的建议

Terminology and morphologic criteria of neuroblastic tumors: recommendations by the International Neuroblastoma Pathology Committee.

作者信息

Shimada H, Ambros I M, Dehner L P, Hata J, Joshi V V, Roald B

机构信息

Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, California 90027, USA.

出版信息

Cancer. 1999 Jul 15;86(2):349-63.

PMID:10421272

Abstract

BACKGROUND

As part of the international cooperative effort to develop a complete set of International Neuroblastoma Risk Groups, the International Neuroblastoma Pathology Committee (INPC) initiated activities in 1994 to devise a morphologic classification of neuroblastic tumors (NTs; neuroblastoma, ganglioneuroblastoma, and ganglioneuroma).

METHODS

Six member pathologists (H.S., I.M.A., L.P.D., J.H., V.V.J., and B.R.) discussed and defined morphologically based classifications (Shimada classification; risk group and modified risk group proposed by Joshi et al.) on the basis of a review of 227 cases, using various pathologic characteristics of the NTs. The classification-grading system was evaluated for prognostic significance and biologic relevance.

RESULTS

The INPC has adopted a prognostic system modeled on one proposed by Shimada et al. It is an age-linked classification dependent on the differentiation grade of the neuroblasts, their cellular turnover index, and the presence or absence of Schwannian stromal development. Based on morphologic criteria defined in this article, NTs were classified into four categories and their subtypes: 1) neuroblastoma (Schwannian stroma-poor), undifferentiated, poorly differentiated, and differentiating; 2) ganglioneuroblastoma, intermixed (Schwannian stroma-rich); 3) ganglioneuroma (Schwannian stroma-dominant), maturing and mature; and 4) ganglioneuroblastoma, nodular (composite Schwannian stroma-richlstroma-dominant and stroma-poor). Specific features, such as the mitosis-karyorrhexis index, the mitotic rate, and calcification, were also included to allow the prognostic significance of the classification to be tested. Recommendations are made regarding the surgical materials to use for an optimal pathobiologic assessment and the practical handling of samples.

CONCLUSIONS

The current article covers the essentials and important points regarding the histopathologic evaluation of NTs. Using the morphologic criteria described herein, the INPC is proposing the International Neuroblastoma Pathology Classification. It is reported in a companion article in this issue (Cancer 1999;86:363-71).

摘要

背景

作为制定一套完整的国际神经母细胞瘤风险组的国际合作努力的一部分，国际神经母细胞瘤病理委员会（INPC）于1994年启动了相关活动，以设计一种神经母细胞瘤性肿瘤（NTs；神经母细胞瘤、神经节神经母细胞瘤和神经节瘤）的形态学分类。

方法

六位病理学家成员（H.S.、I.M.A.、L.P.D.、J.H.、V.V.J.和B.R.）在回顾227例病例的基础上，利用NTs的各种病理特征，讨论并定义了基于形态学的分类（岛田分类；乔希等人提出的风险组和改良风险组）。对该分类分级系统的预后意义和生物学相关性进行了评估。

结果

INPC采用了一种以岛田等人提出的系统为模型的预后系统。它是一种与年龄相关的分类，取决于神经母细胞的分化程度、其细胞更新指数以及雪旺氏基质发育的有无。根据本文定义的形态学标准，NTs被分为四类及其亚型：1）神经母细胞瘤（雪旺氏基质少），未分化、低分化和分化型；2）神经节神经母细胞瘤，混合型（雪旺氏基质丰富）；3）神经节瘤（雪旺氏基质占主导），成熟型和成熟型；4）神经节神经母细胞瘤，结节型（复合性雪旺氏基质丰富/基质占主导和基质少）。还包括有丝分裂-核溶解指数、有丝分裂率和钙化等特定特征，以便检验该分类的预后意义。就用于最佳病理生物学评估的手术材料以及样本的实际处理提出了建议。