Neurological Surgery 脳神経外科36巻6号

2008年06月発行

総説

脳腫瘍の新WHO分類

著者： 中里洋一¹

所属機関： ¹群馬大学大学院医学系研究科病態病理学分野

ページ範囲：P.473 - P.491

Ⅰ．は じ め に

　脳腫瘍の治療や研究を行う上で正しい診断が必須なことは論を俟たないが，その診断の基礎ともいうべき脳腫瘍分類が改訂された．脳腫瘍分類の世界標準はWorld Health Organization（WHO）により編纂されているWHO分類である．これは1979年に“Histological Typing of Tumours of the Central Nervous System”として出版された分類が最初のものである¹⁰⁹⁾．それ以来，病理学的方法論の進歩や，新しい腫瘍型の出現に合わせて改訂を重ねており，1993年に第2版⁵⁴⁾，2000年に第3版⁵⁵⁾が出版されてきた．そしてこのたび7年ぶりに，脳腫瘍WHO分類が改訂され，2007年6月に第4版（WHO2007）として出版された⁶⁸⁾．第3版（WHO2000）以後の学問的成果を盛り込んで，新しい組織型の追加，分類枠の変更，診断基準の明確化，個々の腫瘍型の記述の改訂など，大幅な変更が加えられている．分類を掲載した書籍（WHO blue book）の形態は第3版とほぼ同様であり，各腫瘍型の定義，疫学，臨床症状，画像所見，病理組織像，分子遺伝学的所見，予後などが詳細かつ簡潔にまとめられ，それに最新文献が多数引用されている．コンパクトな書籍として日常の臨床や病理診断の現場で利用しやすいように工夫されている．

　脳腫瘍のWHO分類の改訂は，脳腫瘍の診断，治療をはじめ，病理学的あるいは分子遺伝学的研究にまで広範な影響を及ぼすものと考えられる．脳腫瘍の新WHO分類の解説はすでにいくつか刊行されており^35,67)，筆者もBrain and Nerve誌に総説を発表した⁷⁷⁾．本稿では前述の総説と重複する部分もあるが，図表を多用して可及的にわかりやすい解説を試みたい．

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