第5版WHO内分泌和神经内分泌肿瘤分类解读:甲状腺滤泡细胞起源肿瘤的更新及进展  

Interpretation of the 5th edition of WHO classification of endocrine and neuroendocrine tumors:update and progress on follicular cell⁃derived thyroid tumors

作　　者：鲁姗姗 纪元 LU Shanshan;JI Yuan(Department of Pathology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院病理科,上海200032

出　　处：《外科理论与实践》2025年第1期27-33,共7页Journal of Surgery Concepts & Practice

摘　　要：2022年WHO内分泌和神经内分泌肿瘤分类(第5版)将甲状腺滤泡细胞起源的肿瘤分为良性、低风险和恶性肿瘤。良性肿瘤新增了甲状腺滤泡结节性病变。旧称的“交界性肿瘤”修订为低风险滤泡细胞起源的肿瘤,包括具有乳头样核特征的非浸润性甲状腺滤泡性肿瘤、恶性潜能未定的甲状腺肿瘤以及透明变梁状肿瘤。新版WHO根据分子特征和侵袭性对恶性滤泡细胞起源的肿瘤进行分层。其中具有多种组织亚型的甲状腺乳头状癌(PTC)代表BRAF样恶性肿瘤,而浸润性包裹性滤泡亚型PTC和甲状腺滤泡癌代表RAS样恶性肿瘤。嗜酸细胞癌作为独立类型,特指嗜酸细胞成分≥75%的嗜酸性滤泡细胞起源并缺乏PTC核特征和高级别特征(坏死和核分裂象≥3/2 mm2)的肿瘤。新增的“高级别滤泡细胞起源的甲状腺癌”包括传统甲状腺低分化癌和高级别分化型甲状腺癌。间变性甲状腺癌(ATC)仍是分化最差的类型,甲状腺鳞状细胞癌目前归为ATC的亚型。不再推荐将“甲状腺微小乳头状癌”作为独立亚型;筛状-桑葚型甲状腺癌不再归类为PTC亚型,而被列为组织来源未定的甲状腺肿瘤。The 2022 WHO classification of endocrine and neuroendocrine tumors(5th edition)categorizes thyroid follicular cell-derived tumors into benign,low-risk,and malignant types.Benign tumors now include thyroid follicular nodular lesions.A newly added category previously termed"borderline tumors"have been revised to low-risk follicular cellderived tumors,which encompass non-invasive follicular thyroid neoplasm with papillary-like nuclear features,thyroid tumors of uncertain malignant potential,and hyalinizing trabecular tumors.The new WHO classification stratifies malignant follicular cell-derived tumors based on molecular characteristics and invasiveness:papillary thyroid carcinoma(PTC)with various histological subtypes represents BRAF-like malignancies;invasive encapsulated follicular variant PTC and follicular thyroid carcinoma represent RAS-like malignancies.Oncocytic carcinoma is now recognized as a distinct entity,specifically referring to tumors composed of≥75%oncocytic follicular cells lacking PTC nuclear features and high-grade characteristics(necrosis and mitotic figures≥3/2 mm²).A new category termed"high-grade follicular cell-derived thyroid carcinoma"has been added,encompassing traditional poorly differentiated thyroid carcinoma and differentiated high-grade thyroid carcinoma.Anaplastic thyroid carcinoma(ATC)remains the most undifferentiated type,with thyroid squamous cell carcinoma now classified as a subtype of ATC.The term"papillary thyroid microcarcinoma"is no longer recommended as a distinct subtype.Cribriform-morular thyroid carcinoma is no longer classified as a subtype of PTC,but is instead categorized as a tumor of uncertain histogenesis.

关 键 词：甲状腺肿瘤 甲状腺滤泡细胞 内分泌和神经内分泌肿瘤 肿瘤分类 病理诊断 

分 类 号：R736.1[医药卫生—肿瘤]