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Robert Gomez
Robert Gomez

WHO Classification Of Tumours Of The Urinary Sy...


The fifth edition of the World Health Organization (WHO) classification of urogenital tumours (WHO "Blue Book"), published in 2022, contains significant revisions. This review summarises the most relevant changes for renal, penile, and testicular tumours. In keeping with other volumes in the fifth edition series, the WHO classification of urogenital tumours follows a hierarchical classification and lists tumours by site, category, family, and type. The section "essential and desirable diagnostic criteria" included in the WHO fifth edition represents morphologic diagnostic criteria, combined with immunohistochemistry and relevant molecular tests. The global introduction of massive parallel sequencing will result in a diagnostic shift from morphology to molecular analyses. Therefore, a molecular-driven renal tumour classification has been introduced, taking recent discoveries in renal tumour genomics into account. Such novel molecularly defined epithelial renal tumours include SMARCB1-deficient medullary renal cell carcinoma (RCC), TFEB-altered RCC, Alk-rearranged RCC, and ELOC-mutated RCC. Eosinophilic solid and cystic RCC is a novel morphologically defined RCC entity. The diverse morphologic patterns of penile squamous cell carcinomas are grouped as human papillomavirus (HPV) associated and HPV independent, and there is an attempt to simplify the morphologic classification. A new chapter with tumours of the scrotum has been introduced. The main nomenclature of testicular tumours is retained, including the use of the term "germ cell neoplasia in situ" (GCNIS) for the preneoplastic lesion of most germ cell tumours and division from those not derived from GCNIS. Nomenclature changes include replacement of the term "primitive neuroectodermal tumour" by "embryonic neuroectodermal tumour" to separate these tumours clearly from Ewing sarcoma. The term "carcinoid" has been changed to "neuroendocrine tumour", with most examples in the testis now classified as "prepubertal type testicular neuroendocrine tumour".




WHO Classification of Tumours of the Urinary Sy...


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Urinary and Male Genital Tumours is Volume 8 in the 5th edition of the World Health Organization (WHO) series on the classification of human tumours. This series (also known as the WHO Blue Books) is regarded as the gold standard for the diagnosis of tumours and comprises a unique synthesis of histopathological diagnosis with digital and molecular pathology.


It has been 12 yr 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.


Central Nervous System Tumours is the sixth volume in the 5th edition of the WHO series on the classification of human tumours. This series (also known as the WHO Blue Books) is regarded as the gold standard for the diagnosis of tumours and comprises a unique synthesis of histopathological diagnosis with digital and molecular pathology. These authoritative and concise reference books provide indispensable international standards for anyone involved in the care of patients with cancer or in cancer research, underpinning individual patient treatment as well as research into all aspects of cancer causation, prevention, therapy, and education.


NEW! The WHO Classification of Tumours Online website now also features the IAC-IARC-WHO Cytopathology Reporting Systems companion series, which focuses on the classification of tumours from the point of view of the cytopathologist.


The World Health Organization, in its seminal series on the classification of tumors, recently published, "WHO Classification of Tumours, 5th Edition, Volume 8: Urinary and Male Genital Tumours," with George Netto, M.D., Robert and Ruth Anderson Endowed Chair, as an expert member of the urinary and male genital tumors editorial board. It is now available in print and digital formats.


The 2002 AJCC staging system and 2004 WHO classification of tumors of the urinary system incorporate recent advances in our understanding of renal cell neoplasia. Although the current classification system is still primarily based on cytologic appearance and the putative cell of origin in combination with growth pattern, recently discovered genetic alterations played a decisive role in the recognition of new entities. In particular, the spectrum of renal neoplasia affecting younger adults has been expanding. The pathologic features of these new rarer entities are described here.


Some histological types of BC contain pathologically different properties with varying clinical courses. In 2004, the World Health Organization/ International Society of Urological Pathology consensus classification system for papillary urothelial neoplasms of the urinary bladder was published [4]. The system classifies urothelial cancer (UC) into two main types: low-grade UC (LGUC) and high-grade UC (HGUC) [5]. Clinically, although LGUC has a low malignant potential, HGUC has a risk of disease progression and metastases, followed by death [6, 7]. Therefore, HGUC cannot be ignored in patients with BC.


Small cell carcinomas are tumours of neuroendocrine origin that occur most commonly in the lungs. However, small cell carcinoma can occur in many other organs, including the urinary bladder. The best data for management of small cell carcinoma comes from experience with pulmonary small cell carcinomas. 041b061a72


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