Department of Molecular Oncology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, QMUL and Barts Health NHS Trust, London, UK.
WHO Classification of Tumours Group, International Agency for Research on Cancer, World Health Organization, Lyon, France.
Histopathology. 2022 Oct;81(4):459-466. doi: 10.1111/his.14675. Epub 2022 Jul 1.
The 5th edition of the World Health Organisation Blue Book was published recently and includes a comprehensive update on testicular tumours. This builds upon the work of the 4th edition, retaining its structure and main nomenclature, including the use of the term 'germ cell neoplasia in situ' (GCNIS) for the pre-invasive lesion of most germ cell tumours and division from those not derived from GCNIS. While there have been important developments in understanding the molecular underpinnings of testicular cancer, this updated classification paradigm and approach remains rooted in morphology. Nomenclature changes include replacement of the term 'primitive neuroectodermal tumour' by 'embryonic neuroectodermal tumour' based on the non-specificity of the former term and to separate these tumours clearly from Ewing sarcoma. Seminoma is placed in a germinoma family of tumours emphasising relation to those tumours at other sites. Criteria for the diagnosis of 'teratoma with somatic transformation' have been modified to not include variable field size assessments. The word 'carcinoid' has been changed to 'neuroendocrine tumour', with most examples in the testis now classified as 'prepubertal type testicular neuroendocrine tumour'. For sex cord-stromal tumours, the use of mitotic counts per high-power field has been changed to per mm2 for malignancy assessments, and the new entities, 'signet ring stromal tumour' and 'myoid gonadal stromal tumour', are defined. Well-differentiated papillary mesothelial tumour has now been defined as tumour type with a favourable prognosis. Sertoliform cystadenoma has been removed as an entity from testicular adnexal tumours and placed with Sertoli cell tumours.
最近出版了第五版世界卫生组织蓝皮书，其中包括对睾丸肿瘤的全面更新。这是在第四版的基础上进行的，保留了其结构和主要命名法，包括使用术语“原位生殖细胞肿瘤”（GCNIS）来表示大多数生殖细胞肿瘤的侵袭前病变，并将其与非 GCNIS 来源的肿瘤区分开来。尽管在理解睾丸癌的分子基础方面取得了重要进展，但这种更新的分类范式和方法仍然植根于形态学。命名法的变化包括用“胚胎性神经外胚层肿瘤”取代“原始神经外胚层肿瘤”，这是基于前者术语的非特异性，并将这些肿瘤与尤文肉瘤清楚地区分开来。精原细胞瘤被置于生殖细胞瘤家族的肿瘤中，强调与其他部位的肿瘤的关系。“具有体细胞转化的畸胎瘤”的诊断标准已修改，不再包括可变场大小评估。“类癌”一词已改为“神经内分泌肿瘤”，睾丸中的大多数肿瘤现在被归类为“青春期前型睾丸神经内分泌肿瘤”。对于性索-间质肿瘤，使用高倍视野中的有丝分裂计数来评估恶性肿瘤的方法已更改为每平方毫米，并且定义了新实体，“印戒状基质肿瘤”和“肌源性性腺基质肿瘤”。分化良好的乳头状间皮瘤现在被定义为预后良好的肿瘤类型。鞘状囊腺瘤已从睾丸附件肿瘤中作为实体删除，并与支持细胞肿瘤一起放置。
