外科理论与实践

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2025 , Vol. 30 >Issue 01: 27 - 33

DOI: https://doi.org/10.16139/j.1007-9610.2025.01.06

指南与共识

第5版WHO内分泌和神经内分泌肿瘤分类解读：甲状腺滤泡细胞起源肿瘤的更新及进展

  • 鲁姗姗 ,
  • 纪元
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  • 复旦大学附属中山医院病理科，上海 200032
纪元，E-mail:ji.yuan@zs-hospital.sh.cn

收稿日期: 2024-12-10

  网络出版日期: 2025-04-25

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Interpretation of the 5th edition of WHO classification of endocrine and neuroendocrine tumors: update and progress on follicular cell-derived thyroid tumors

  • LU Shanshan ,
  • JI Yuan
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  • Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

Received date: 2024-12-10

  Online published: 2025-04-25

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摘要

2022年WHO内分泌和神经内分泌肿瘤分类（第5版）将甲状腺滤泡细胞起源的肿瘤分为良性、低风险和恶性肿瘤。良性肿瘤新增了甲状腺滤泡结节性病变。旧称的“交界性肿瘤”修订为低风险滤泡细胞起源的肿瘤，包括具有乳头样核特征的非浸润性甲状腺滤泡性肿瘤、恶性潜能未定的甲状腺肿瘤以及透明变梁状肿瘤。新版WHO根据分子特征和侵袭性对恶性滤泡细胞起源的肿瘤进行分层。其中具有多种组织亚型的甲状腺乳头状癌（PTC）代表BRAF样恶性肿瘤，而浸润性包裹性滤泡亚型PTC和甲状腺滤泡癌代表RAS样恶性肿瘤。嗜酸细胞癌作为独立类型，特指嗜酸细胞成分≥75%的嗜酸性滤泡细胞起源并缺乏PTC核特征和高级别特征（坏死和核分裂象≥3/2 mm2）的肿瘤。新增的“高级别滤泡细胞起源的甲状腺癌”包括传统甲状腺低分化癌和高级别分化型甲状腺癌。间变性甲状腺癌(ATC)仍是分化最差的类型，甲状腺鳞状细胞癌目前归为ATC的亚型。不再推荐将“甲状腺微小乳头状癌”作为独立亚型；筛状-桑葚型甲状腺癌不再归类为PTC亚型，而被列为组织来源未定的甲状腺肿瘤。

关键词： 甲状腺肿瘤; 甲状腺滤泡细胞; 内分泌和神经内分泌肿瘤; 肿瘤分类; 病理诊断

本文引用格式

鲁姗姗 , 纪元 . 第5版WHO内分泌和神经内分泌肿瘤分类解读：甲状腺滤泡细胞起源肿瘤的更新及进展[J]. 外科理论与实践, 2025 , 30(01) : 27 -33 . DOI: 10.16139/j.1007-9610.2025.01.06

Abstract

The 2022 WHO classification of endocrine and neuroendocrine tumors (5th edition) categorizes thyroid follicular cell-derived tumors into benign, low-risk, and malignant types. Benign tumors now include thyroid follicular nodular lesions. A newly added category previously termed "borderline tumors" have been revised to low-risk follicular cell-derived tumors, which encompass non-invasive follicular thyroid neoplasm with papillary-like nuclear features, thyroid tumors of uncertain malignant potential, and hyalinizing trabecular tumors. The new WHO classification stratifies malignant follicular cell-derived tumors based on molecular characteristics and invasiveness: papillary thyroid carcinoma (PTC) with various histological subtypes represents BRAF-like malignancies; invasive encapsulated follicular variant PTC and follicular thyroid carcinoma represent RAS-like malignancies. Oncocytic carcinoma is now recognized as a distinct entity, specifically referring to tumors composed of ≥75% oncocytic follicular cells lacking PTC nuclear features and high-grade characteristics (necrosis and mitotic figures ≥3/2 mm²). A new category termed "high-grade follicular cell-derived thyroid carcinoma" has been added, encompassing traditional poorly differentiated thyroid carcinoma and differentiated high-grade thyroid carcinoma. Anaplastic thyroid carcinoma(ATC) remains the most undifferentiated type, with thyroid squamous cell carcinoma now classified as a subtype of ATC. The term "papillary thyroid microcarcinoma" is no longer recommended as a distinct subtype. Cribriform-morular thyroid carcinoma is no longer classified as a subtype of PTC, but is instead categorized as a tumor of uncertain histogenesis.

Key words： Thyroid tumor; Thyroid follicular cell; Endocrine and neuroendocrine tumor; Tumor classification; Pathological diagnosis

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