褐色細胞腫の良悪判定スコア(Thompson)
4点以上では生物学的にaggressive behaviorをとる可能性あり
Feature | Score if present (no. of points assigned) |
Large nests or diffuse growth (>10% of tumor volume) | 2 |
Central (middle of large nests) or confluent tumor necrosis (not degenerative change) | 2 |
High cellularity | 2 |
Cellular monotomy | 2 |
Tumor cell spindling (even if focal) | 2 |
Mitotic figures >3/10HPF | 2 |
Atypical mitotic figure(s) | 2 |
Extension into adipose tissue | 2 |
Vascular invasion | 1 |
Capsular invasion | 1 |
Profound nuclear pleomorphism | 1 |
Nuclear hyperchromasia | 1 |
Total | 20 |
HPF = high-power field |
注1:Cellular monotomyが特に分かりにくいが、WHO blue bookで、Cellular monotomy (usually with smaller cells having high nuclear to cytoplasmic ration)と書かれている。
注2:あくまで一つの考え方であり、世界的に賛同を得られているものとは言い難い。副腎褐色細胞腫の良悪判定に関しては、他にも研究がなされており、WHO blue bookでそのことについて言及されている。
(左:Extension into adipose tissue、右:Vascular invasion)
(Vascular invasion)
(Large nestとCentral comedonecrosis)
(Large nestとCentral comedonecrosis)
(Tumor cell spindling を伴うLarge nest)
(左上:Profound nuclear pleomorphism、左下:Atypical mitotic figure、右:Tumor cell spindling)
(High cellularityとCellular monotomy??)
出典:
1. Thompson LDR. Pheochromocytoma of the adrenal gland scaled score (PASS) to separate benign from malignant neoplasms. A clinicopathologic and immunophenotypic study of 100 cases. Am J Surg Pathol 2002;26:551-66.
2. Thompson LDR, et al. Malignant adrenal phaeochromacytoma. In: DeLellis RA, Lloyd RV, Heitz PU, Eng C, eds. World Organization Classification of Tumours. Pathology& Genetics. Tumours of Endocrine Organs.Lyon: IARC Press; 2004. pp.147-50.
執筆日:2013/06/26
執筆者:神戸大学医学部附属病院病理診断科 酒井康裕