第5版WHO消化系统肿瘤分类解读:胆道系统肿瘤的更新及进展

The fifth edition of WHO classification of digestive system tumors:update and progress on biliary system tumors

第5版WHO消化系统肿瘤分类中,胆道系统肿瘤更新后总体改变不多。在良性肿瘤及癌前病变部分,将胆管上皮内瘤变的3级分类系统改为高级别与低级别两个级别。同时新增胆囊与胆管导管乳头状肿瘤伴相关浸润性癌。肝内胆管肿瘤分类中,新增胆管腺瘤和胆管腺纤维瘤。这两类疾病在以往版本,常在与胆管癌鉴别诊断中提到。第5版WHO消化系统肿瘤分类的肝内胆管癌分为小胆管亚型和大胆管亚型,并不再推荐使用胆管细胞癌和细胆管细胞癌的名称。肝外胆管癌首次列为单独部分,除常见的组织学类型外,还包括鳞状细胞癌、腺鳞癌和未分化癌。另外,新版分类中增加了不少分子病理学相关的内容,为肿瘤的精准分类及诊断提供了依据。

Overall,there was little change in biliary system tumors of the 5th edition of WHO classification of digestive system tumors after update.The three-tiered classification of biliary intraepithelial neoplasia changed to two-tiered system:high-grade and low-grade,in the section of benign tumors and precancerous lesions.And both intracholecystic and intraductal papillary tumors associated with invasive carcinoma were added.The classification of intrahepatic bile duct tumors introduced parts of bile duct adenoma and bile duct adenofibroma,which were mentioned previously in the differential diagnosis with bile duct carcinoma.Intrahepatic cholangiocarcinoma was divided into small bile duct subtype and large bile duct subtype in the 5th edition of WHO classification,and the names of cholangiocellular carcinoma and cholangiole cell carcinoma were no longer recommended to use.Extrahepatic cholangiocarcinoma was listed as a separate part for the first time,including squamous cell carcinoma,adenosquamous carcinoma and undifferentiated carcinoma in addition to common histological types.Some new contents of molecular pathology in the 5th edition of WHO classification were added,which provided the basis for precise classification and diagnosis of tumors in biliary system.