Nishioka Hiroshi
Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital.
No Shinkei Geka. 2023 Jul;51(4):642-653. doi: 10.11477/mf.1436204797.
The major changes in the upcoming 5 edition of the "2022 WHO Classification of Endocrine and Neuroendocrine Tumors" include:(1)evolution of the nomenclature: from pituitary adenoma to pituitary neuroendocrine tumour(PitNET),(2)detailed subtyping of a PitNET based on the tumor lineage, cell type, and related characteristics,(3)endorsement of the routine use of immunohistochemistry for pituitary transcription factors(PIT1, TPIT, SF1, GATA3, and ER-alpha),(4)introduction of some additional clinicopathologically distinct PitNET subtypes,(5)introduction of the term "metastatic PitNET" to replace the previous terminology "pituitary carcinoma," and(6)unifying posterior lobe tumors, the family of pituicyte tumors that invariably express TTF1, et al. Currently, no widely agreed grading or staging systems for PitNETs exist. Prognosis varies by tumor subtype and certain tumor subtypes are recognized as more aggressive(high-risk PitNETs)than others. Potentially aggressive PitNETs should be identified on an individual basis upon considering the tumor subtype, proliferative potential, and tumor invasion assessment.
即将出版的第5版《2022年世界卫生组织内分泌和神经内分泌肿瘤分类》中的主要变化包括:(1)命名法的演变:从垂体腺瘤到垂体神经内分泌肿瘤(PitNET);(2)根据肿瘤谱系、细胞类型和相关特征对PitNET进行详细的亚型分类;(3)认可垂体转录因子(PIT1、TPIT、SF1、GATA3和雌激素受体α)免疫组化的常规应用;(4)引入一些其他临床病理特征明显的PitNET亚型;(5)引入“转移性PitNET”一词以取代先前的术语“垂体癌”;(6)统一后叶肿瘤,即总是表达甲状腺转录因子1等的垂体细胞瘤家族。目前,尚无广泛认可的PitNET分级或分期系统。预后因肿瘤亚型而异,某些肿瘤亚型被认为比其他亚型更具侵袭性(高风险PitNET)。应在考虑肿瘤亚型、增殖潜能和肿瘤侵袭评估的基础上,对潜在侵袭性PitNET进行个体化识别。