Neurological Surgery 脳神経外科51巻5号

2023年09月発行

特集 臨床脳神経外科医にとってのWHO脳腫瘍分類第5版 Ⅰ WHO脳腫瘍分類第5版の概要

トルコ鞍部腫瘍の分類・診断

著者： 西岡宏¹

所属機関： ¹虎の門病院間脳下垂体外科

ページ範囲：P.789 - P.798

Point
・臨床病理学的見地から，下垂体腺腫は下垂体神経内分泌腫瘍（PitNET）へ名称が変更された．
・PitNETの組織分類の基本は，下垂体転写因子（PIT1, TPIT, SF1）の免疫組織化学になった．
・腫瘍増殖能の指標（Ki67指数）の有用性や，特定の組織型の腫瘍がaggressiveな臨床経過を呈しやすいことは示されたが，PitNETのgrade分類は提示されなかった．
・エナメル上皮腫型と乳頭型の頭蓋咽頭腫は，おのおのCTNNB1変異とBRAF変異を呈する独立した個別の組織型になった．
・下垂体細胞腫，顆粒細胞腫などTTF1陽性の4型の後葉（神経下垂体）腫瘍は，下垂体細胞（pituicyte）由来腫瘍として統一された．

参考文献

1）Asa SL, et al；attendees of 14th Meeting of the International Pituitary Pathology Club, Annecy, France, November 2016：From pituitary adenoma to pituitary neuroendocrine tumor（PitNET）：an International Pituitary Pathology Club proposal. Endocr Relat Cancer 24：C5-C8, 2017　doi:10.1530/ERC-17-0004

2）Asa SL, et al：Pituitary neuroendocrine tumors（PitNETs）：nomenclature evolution, not clinical revolution. Pituitary 23：322-325, 2020

3）Ho K, et al：Pituitary neoplasm nomenclature workshop：does adenoma stand the test of time? J Endocr Soc 5：bvaa205, 2021　doi:10.1210/jendso/bvaa205

4）Rindi G, Inzani F：Neuroendocrine neoplasm update：toward universal nomenclature. Endocr Relat Cancer 27：R211-R218, 2020　doi:10.1530/ERC-20-0036

5）Nishioka H, Inoshita N：New WHO classification of pituitary adenomas（4th edition）：assessment of pituitary transcription factors and the prognostic histological factors. Brain Tumor Pathol 35：57-61, 2018

6）Nishioka H, et al：The complementary role of transcription factors in the accurate diagnosis of clinically nonfunctioning pituitary adenomas. Endocr Pathol 26：349-355, 2015

7）Inoshita N, et al：Immunohistochemical and ultrastructural review of six cases previously diagnosed as null cell PitNETs. Brain Tumor Pathol 40：158-162, 2023

8）Asa SL, et al：Overview of the 2022 WHO classification of pituitary tumors. Endocr Pathol 33：6-26, 2022

9）Lopes MBS, et al：Pituitary adenoma/pituitary neuroendocrine tumour. WHO Classification of Tumours. Central Nervous System Tumours（5th edition）. IARC, Lyon, 2021, pp. 406-414

10）Mete O, Asa SL：Structure, function, and morphology in the classification of pituitary neuroendocrine tumors：the importance of routine analysis of pituitary transcription factors. Endocr Pathol 31：330-336, 2020

11）Nishioka H：Aggressive pituitary tumors（PitNETs）. Endocr J 70：241-248, 2023

12）Trouillas J, et al：A new prognostic clinicopathological classification of pituitary adenomas：a multicentric case-control study of 410 patients with 8 years post-operative follow-up. Acta Neuropathol 126：123-135, 2013

13）Dai C, et al：Refractory pituitary adenoma：a novel classification for pituitary tumors. Oncotarget 7：83657-83668, 2016

14）Raverot G, et al：Aggressive pituitary tumours and pituitary carcinomas. Nat Rev Endocrinol 17：671-684, 2021

15）Trouillas J, et al：Aggressive pituitary tumours and carcinomas：two sides of the same coin? Eur J Endocrinol 178：C7-C9, 2018　doi:10.1530/EJE-18-0250

16）Goschzik T, et al：Genomic alterations of adamantinomatous and papillary craniopharyngioma. J Neuropathol Exp Neurol 76：126-134, 2017

17）Fukuhara N, et al：Immunohistochemistry or molecular analysis：which method is better for subtyping craniopharyngioma? Endocr Pathol 32：262-268, 2021

18）Santagata S, et al：Adamantinomatous craniopharyngioma. WHO Classification of Tumours. Central Nervous System tumours（5th edition）. IARC, Lyon, 2021, pp. 393-396

19）Santagata S, et al：Papillary craniopharyngioma. WHO Classification of Tumours. Central Nervous System tumours（5th edition）. IARC, Lyon, 2021, pp. 397-400

mutations. Acta Neuropathol 128：111-122, 2014

21）Lopes MBS, et al：Pituicytoma, granular cell tumor of the sellar region, and spindle cell oncocytoma. WHO Classification of Tumours. Central Nervous System Tumours（5th edition）. IARC, Lyon, 2021, pp. 401-405

22）Asa SL, et al：Hypothalamic vasopressin-producing tumors：often inappropriate diuresis but occasionally Cushing disease. Am J Surg Pathol 43：251-260, 2019