《2017 年世界卫生组织垂体肿瘤分类概述》。
Overview of the 2017 WHO Classification of Pituitary Tumors.
机构信息
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
Department of Pathology, University Health Network, 200 Elizabeth Street, 11th Floor, Toronto, ON, M5G 2C4, Canada.
出版信息
Endocr Pathol. 2017 Sep;28(3):228-243. doi: 10.1007/s12022-017-9498-z.
This review focuses on discussing the main changes on the upcoming fourth edition of the WHO Classification of Tumors of the Pituitary Gland emphasizing histopathological and molecular genetics aspects of pituitary neuroendocrine (i.e., pituitary adenomas) and some of the non-neuroendocrine tumors involving the pituitary gland. Instead of a formal review, we introduced the highlights of the new WHO classification by answering select questions relevant to practising pathologists. The revised classification of pituitary adenomas, in addition to hormone immunohistochemistry, recognizes the role of other immunohistochemical markers including but not limited to pituitary transcription factors. Recognizing this novel approach, the fourth edition of the WHO classification has abandoned the concept of "a hormone-producing pituitary adenoma" and adopted a pituitary adenohypophyseal cell lineage designation of the adenomas with subsequent categorization of histological variants according to hormone content and specific histological and immunohistochemical features. This new classification does not require a routine ultrastructural examination of these tumors. The new definition of the Null cell adenoma requires the demonstration of immunonegativity for pituitary transcription factors and adenohypophyseal hormones Moreover, the term of atypical pituitary adenoma is no longer recommended. In addition to the accurate tumor subtyping, assessment of the tumor proliferative potential by mitotic count and Ki-67 index, and other clinical parameters such as tumor invasion, is strongly recommended in individual cases for consideration of clinically aggressive adenomas. This classification also recognizes some subtypes of pituitary neuroendocrine tumors as "high-risk pituitary adenomas" due to the clinical aggressive behavior; these include the sparsely granulated somatotroph adenoma, the lactotroph adenoma in men, the Crooke's cell adenoma, the silent corticotroph adenoma, and the newly introduced plurihormonal Pit-1-positive adenoma (previously known as silent subtype III pituitary adenoma). An additional novel aspect of the new WHO classification was also the definition of the spectrum of thyroid transcription factor-1 expressing pituitary tumors of the posterior lobe as representing a morphological spectrum of a single nosological entity. These tumors include the pituicytoma, the spindle cell oncocytoma, the granular cell tumor of the neurohypophysis, and the sellar ependymoma.
这篇综述重点讨论了即将发布的第四版《世界卫生组织垂体肿瘤分类》的主要变化,强调了垂体神经内分泌(即垂体腺瘤)和一些涉及垂体的非神经内分泌肿瘤的组织病理学和分子遗传学方面。我们没有采用正式的综述形式,而是通过回答与病理医生相关的精选问题来介绍新的世界卫生组织分类的要点。除了激素免疫组织化学,修订后的垂体腺瘤分类还认识到其他免疫组织化学标志物的作用,包括但不限于垂体转录因子。第四版世界卫生组织分类采用了这种新方法,摒弃了“产生激素的垂体腺瘤”的概念,采用了腺垂体细胞谱系命名法,根据激素含量和特定的组织学和免疫组织化学特征对组织学变异进行分类。这种新分类不需要对这些肿瘤进行常规的超微结构检查。对于无功能性腺瘤,需要证明免疫组织化学对垂体转录因子和腺垂体激素均为阴性。此外,不再推荐使用不典型垂体腺瘤这一术语。除了准确的肿瘤亚型分类外,强烈建议在个别病例中评估肿瘤的增殖潜能,包括有丝分裂计数和 Ki-67 指数,以及肿瘤侵袭等其他临床参数,以考虑具有侵袭性的腺瘤。由于其侵袭性行为,该分类还将一些垂体神经内分泌肿瘤亚型定义为“高风险垂体腺瘤”;这些包括稀疏颗粒状生长激素腺瘤、男性催乳素腺瘤、柯罗氏细胞腺瘤、静默促肾上腺皮质激素腺瘤,以及新引入的多激素阳性 Pit-1 腺瘤(以前称为静默亚型 III 垂体腺瘤)。新的世界卫生组织分类的另一个新方面是,将后叶表达甲状腺转录因子-1 的垂体肿瘤定义为单一疾病实体的形态学谱。这些肿瘤包括垂体细胞瘤、梭形细胞嗜酸性细胞瘤、神经垂体颗粒细胞瘤和鞍内室管膜瘤。