Department of Pathology and Molecular Pathology, University Hospital Zuerich and University of Zuerich, Zuerich, Switzerland.
Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Urology, USC Keck School of Medicine, Los Angeles, CA, USA.
Eur Urol. 2022 Nov;82(5):458-468. doi: 10.1016/j.eururo.2022.06.016. Epub 2022 Jul 16.
The fifth edition of the World Health Organization (WHO) classification of urogenital tumours (WHO "Blue Book"), published in 2022, contains significant revisions. This review summarises the most relevant changes for renal, penile, and testicular tumours. In keeping with other volumes in the fifth edition series, the WHO classification of urogenital tumours follows a hierarchical classification and lists tumours by site, category, family, and type. The section "essential and desirable diagnostic criteria" included in the WHO fifth edition represents morphologic diagnostic criteria, combined with immunohistochemistry and relevant molecular tests. The global introduction of massive parallel sequencing will result in a diagnostic shift from morphology to molecular analyses. Therefore, a molecular-driven renal tumour classification has been introduced, taking recent discoveries in renal tumour genomics into account. Such novel molecularly defined epithelial renal tumours include SMARCB1-deficient medullary renal cell carcinoma (RCC), TFEB-altered RCC, Alk-rearranged RCC, and ELOC-mutated RCC. Eosinophilic solid and cystic RCC is a novel morphologically defined RCC entity. The diverse morphologic patterns of penile squamous cell carcinomas are grouped as human papillomavirus (HPV) associated and HPV independent, and there is an attempt to simplify the morphologic classification. A new chapter with tumours of the scrotum has been introduced. The main nomenclature of testicular tumours is retained, including the use of the term "germ cell neoplasia in situ" (GCNIS) for the preneoplastic lesion of most germ cell tumours and division from those not derived from GCNIS. Nomenclature changes include replacement of the term "primitive neuroectodermal tumour" by "embryonic neuroectodermal tumour" to separate these tumours clearly from Ewing sarcoma. The term "carcinoid" has been changed to "neuroendocrine tumour", with most examples in the testis now classified as "prepubertal type testicular neuroendocrine tumour".
第五版世界卫生组织（WHO）泌尿生殖系统肿瘤分类（WHO“蓝皮书”）于 2022 年发布，其中包含了重大修订。本文总结了肾脏、阴茎和睾丸肿瘤中最相关的变化。与第五版系列中的其他卷册一样，WHO 泌尿生殖系统肿瘤分类采用了分级分类法，按部位、类别、家族和类型列出肿瘤。第五版中包含的“基本和理想的诊断标准”部分代表了形态学诊断标准，结合免疫组织化学和相关分子检测。全球引入大规模平行测序将导致从形态学向分子分析的诊断转变。因此，引入了一种基于分子的肾肿瘤分类，考虑到肾肿瘤基因组学的最新发现。这种新型的分子定义的肾上皮性肿瘤包括 SMARCB1 缺失性肾髓质癌（RCC）、TFEB 改变的 RCC、ALK 重排的 RCC 和 ELOC 突变的 RCC。嗜酸性实性和囊性 RCC 是一种新的形态学定义的 RCC 实体。阴茎鳞状细胞癌的多种形态模式被归类为人乳头瘤病毒（HPV）相关和 HPV 不相关，并试图简化形态学分类。引入了一个包含阴囊肿瘤的新章节。保留了睾丸肿瘤的主要命名法，包括将“大多数生殖细胞肿瘤的癌前病变”术语“生殖细胞原位肿瘤”（GCNIS）用于大多数生殖细胞肿瘤，并将其与不源于 GCNIS 的肿瘤分开。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”，以将这些肿瘤与尤文肉瘤清楚地区分开来。术语“类癌”已更改为“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”。
