Sikl's Department of Pathology, Faculty of Medicine in Plzen, Charles University, E. Benese 13, 305 99, Plzen, Czech Republic.
Department of Pathology and Molecular Genetics, Bioptical Laboratory Ltd, Plzen, Czech Republic.
Head Neck Pathol. 2022 Mar;16(1):40-53. doi: 10.1007/s12105-022-01420-1. Epub 2022 Mar 21.
The salivary gland section in the 5th edition of the World Health Organization Classification of Head and Neck Tumours features a description and inclusion of several new entities, including sclerosing polycystic adenoma, keratocystoma, intercalated duct adenoma, and striated duct adenoma among the benign neoplasms; and microsecretory adenocarcinoma and sclerosing microcystic adenocarcinoma as the new malignant entities. The new entry also includes mucinous adenocarcinoma subdivided into papillary, colloid, signet ring, and mixed subtypes with recurrent AKT1 E17K mutations across patterns suggesting that mucin-producing salivary adenocarcinomas represent a histologically diverse single entity that may be related to salivary intraductal papillary mucinous neoplasm (IPMN). Importantly, the number of entities in the salivary chapter has been reduced by omitting tumors or lesions if they do not occur exclusively or predominantly in salivary glands, including hemangioma, lipoma, nodular fasciitis and hematolymphoid tumors. They are now discussed in detail elsewhere in the book. Cribriform adenocarcinoma of salivary gland origin (CASG) now represents a distinctive subtype of polymorphous adenocarcinoma (PAC). PAC is defined as a clinically, histologically and molecularly heterogeneous disease group. Whether CASG is a different diagnostic category or a variant of PAC is still controversial. Poorly differentiated carcinomas and oncocytic carcinomas are discussed in the category "Salivary carcinoma not otherwise specified (NOS) and emerging entities". New defining genomic alterations have been characterized in many salivary gland tumors. In particular, they include gene fusions, which have shown to be tightly tumor-type specific, and thus valuable for use in diagnostically challenging cases. The recurrent molecular alterations were included in the definition of mucoepidermoid carcinoma, adenoid cystic carcinoma, secretory carcinoma, polymorphous adenocarcinoma, hyalinizing clear cell carcinoma, mucinous adenocarcinoma, and microsecretory adenocarcinoma.
第五版世界卫生组织头颈部肿瘤分类中的唾液腺部分，对一些新实体进行了描述和收录，包括良性肿瘤中的硬化性多囊性腺瘤、角化囊肿、中间导管腺瘤和纹状管腺瘤；以及新的恶性实体，包括微分泌性腺癌和硬化性微囊性腺癌。新条目还包括黏液性腺癌，分为乳头状、胶样、印戒细胞和混合亚型，在模式上有反复出现 AKT1 E17K 突变，表明产生黏液的唾液腺癌代表一种组织学上多样化的单一实体，可能与唾液内导管乳头状黏液性肿瘤（IPMN）有关。重要的是，如果肿瘤或病变不是仅或主要发生在唾液腺中，则省略了唾液腺章节中的实体，包括血管瘤、脂肪瘤、结节性筋膜炎和血液淋巴肿瘤。它们现在在书中的其他地方详细讨论。来源于唾液腺的筛状腺癌（CASG）现在代表多形性腺癌（PAC）的一个独特亚型。PAC 定义为一种临床上、组织学上和分子上具有异质性的疾病群体。CASG 是否是一种不同的诊断类别或 PAC 的变体仍存在争议。低分化癌和嗜酸细胞瘤在“唾液腺癌未特指（NOS）和新出现的实体”类别中讨论。许多唾液腺肿瘤的新定义基因组改变已经被描述。特别是，它们包括基因融合，这些融合已被证明与肿瘤类型具有紧密的特异性，因此在具有诊断挑战性的病例中具有很高的价值。反复出现的分子改变被纳入了黏液表皮样癌、腺样囊性癌、分泌癌、多形性腺癌、透明细胞癌、黏液腺癌和微分泌性腺癌的定义中。
