影像诊断与介入放射学

自上次世界卫生组织(world health organization,WHO)公布前列腺和膀胱肿瘤分类,已有12年。在此期间,关于这些肿瘤的病理和遗传学出现了大量知识更新。2016年WHO分类指南中新增了前列腺导管内癌的内容。在大多数情况下,前列腺导管内癌是一种在导管内扩散且具有侵袭性的前列腺癌,需与高级别前列腺上皮内瘤进行区分。前列腺腺泡腺癌新增了两种类型,包括微囊腺癌和多形性巨细胞腺癌。修改后的Gleason分级系统也增补至新分类的前列腺癌分级中;对于评分为Gleason 7分的腺癌,建议诊断报告列出结构类型为4级(pattern 4)的比例。新分类进一步推荐近来提出的前列腺癌5级分类。对于膀胱癌,2016年WHO分类继续沿用国际泌尿病理协会(International Society of Urological Pathology,ISUP)1997年的分类指南。本次修订中更好地定义了非侵袭性的尿路上皮病变,包括尿路上皮异型增生和未知恶性潜能的尿路上皮增生,常见于有尿路上皮癌病史的患者,侵袭性尿路上皮癌的异向分化,指一定比例的"常见型"尿路上皮癌和其他形态变化同时存在。病理医生在病理报告中需注明不同组织的比例。

It has been 12 years since the publication of the last World Health Organization(WHO) classification of tumours of the prostate and bladder. During this time, significant new knowledge has been generated about the pathology and genetics of these tumours. Intraductal carcinoma of the prostate is a newly recognized entity in the 2016 WHO classification. In most cases, it represents intraductal spread of aggressive prostatic carcinoma and should be separated from high-grade prostatic intraepithelial neoplasia. New acinar adenocarcinoma variants are microcystic adenocarcinoma and pleomorphic giant cell adenocarcinoma.Modifications to the Gleason grading system are incorporated into the 2016 WHO section on grading of prostate cancer, and it is recommended that the percentage of pattern 4 should be reported for Gleason score 7. The new WHO classification further recommends the recently developed prostate cancer grade grouping with five grade groups. For bladder cancer, the 2016 WHO classification continues to recommend the 1997 International Society of Urological Pathology grading classification. Newly described or better defined noninvasive urothelial lesions include urothelial dysplasia and urothelial proliferation of uncertain malignant potential, which is frequently identified in patients with a prior history of urothelial carcinoma. Invasive urothelial carcinoma with divergent differentiation refers to tumours with some percentage of "usual type " urothelial carcinoma combined with other morphologies. Pathologists should mention the percentage of divergent histologies in the pathology report.