Seethala Raja R, Stenman Göran
Department of Pathology and Laboratory Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Pathology and Genetics, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden.
Head Neck Pathol. 2017 Mar;11(1):55-67. doi: 10.1007/s12105-017-0795-0. Epub 2017 Feb 28.
The salivary gland section in the 4th edition of the World Health Organization classification of head and neck tumors features the description and inclusion of several entities, the most significant of which is represented by (mammary analogue) secretory carcinoma. This entity was extracted mainly from acinic cell carcinoma based on recapitulation of breast secretory carcinoma and a shared ETV6-NTRK3 gene fusion. Also new is the subsection of "Other epithelial lesions," for which key entities include sclerosing polycystic adenosis and intercalated duct hyperplasia. Many entities have been compressed into their broader categories given clinical and morphologic similarities, or transitioned to a different grouping as was the case with low-grade cribriform cystadenocarcinoma reclassified as intraductal carcinoma (with the applied qualifier of low-grade). Specific grade has been removed from the names of the salivary gland entities such as polymorphous adenocarcinoma, providing pathologists flexibility in assigning grade and allowing for recognition of a broader spectrum within an entity. Cribriform adenocarcinoma of (minor) salivary gland origin continues to be divisive in terms of whether it should be recognized as a distinct category. This chapter also features new key concepts such as high-grade transformation. The new paradigm of translocations and gene fusions being common in salivary gland tumors is featured heavily in this chapter.
《世界卫生组织头颈部肿瘤分类》第4版中的唾液腺部分对多个实体进行了描述并将其纳入其中，其中最重要的是（乳腺样）分泌性癌。该实体主要是基于乳腺分泌性癌的重现以及共享的ETV6-NTRK3基因融合而从腺泡细胞癌中分离出来的。“其他上皮性病变”小节也是新增内容，其关键实体包括硬化性多囊性腺病和闰管增生。鉴于临床和形态学上的相似性，许多实体已被归入更广泛的类别，或者像低度筛状囊腺癌重新分类为导管内癌（加上低度的限定词）那样，转变为不同的分组。唾液腺实体如多形性腺瘤的名称中已去掉了特定分级，这为病理学家在分级时提供了灵活性，并允许在一个实体内识别更广泛的谱系。（小）唾液腺来源的筛状腺癌在是否应被视为一个独特类别方面仍存在分歧。本章还介绍了高级别转化等新的关键概念。唾液腺肿瘤中常见的易位和基因融合这一新模式在本章中得到了重点阐述。
