WHO Classification of Tumours 5th Edition Digestive System Tumours by WHO Classification of Tumours Editorial Board (z-lib.org).1

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WHO classification of tumours of the oesophagusBenign epithelial tumours and precursors8052/0 Squamous cell papilloma NOS8060/0 Squamous papillomatosis8148/0 Oesophageal glandular dysplasia (intraepithelialneoplasia), low grade8148/2 Oesophageal glandular dysplasia (intraepithelialneoplasia), high grade8077/0 Oesophageal squamous intraepithelial neoplasia(dysplasia), low grade8077/2 Oesophageal squamous intraepithelial neoplasia(dysplasia), high gradeMalignant epithelial tumours8140/3 Adenocarcinoma NOS8200/3 Adenoid cystic carcinoma8430/3 Mucoepidermoid carcinoma8560/3 Adenosquamous carcinoma8070/3 Squamous cell carcinoma NOS8051/3 Verrucous squamous cell carcinoma8074/3 Squamous cell carcinoma, spindle cell8083/3 Basaloid squamous cell carcinoma8020/3 Carcinoma, undifferentiated. NOS8082/3 Lymphoepithelioma-like carcinoma8240/3 Neuroendocrine tumour NOS8240/3 Neuroendocrine tumour, grade 18249/3 Neuroendocrine tumour, grade 28249/3 Neuroendocrine tumour, grade 38246/3 Neuroendocrine carcinoma NOS8013/3 Large cell neuroendocrine carcinoma8041/3 Small cell neuroendocrine carcinoma8154/3 Mixed neuroendocrine-non-neuroendocrine neoplasm(MiNEN)8045/3 Combined small cell-adenocarcinoma8045/3 Combined small cell-squamous cell carcinomaThese morphology codes are from the International Classification of Diseases for Oncology, third edition, second revision (ICD-O-3.2){1378A} Behaviour is coded /0 for benign tumours; /1 for unspecified, borderline, or uncertain behaviour; /2 for carcinoma in situ andgrade III intraepithelial neoplasia, /3 for malignant tumours, primary site; and /6 for malignant tumours, metastatic site Behaviour code /6 isnot generally used by cancer registries.This classification is modified from the previous WHO classification, taking into account changes in our understanding of these lesions24 Tumours of the oesophagushttps://t.me/afkebooks
TNM staging of tumours of the oesophagusOesophagus(ICD-0-3 C15) Including Oesophagogastric Junction (C16.0)Rules for ClassificationThe classification applies only to carcinomas and includesadenocarcinomas of the oesophagogastric/gastroesophagealjunction. There should be histological confirmation of thedisease and division of cases by topographic localization andhistological type. A tumour the epicentre of which is within 2 cmof the oesophagogastric junction and also extends into theoesophagus is classified and staged using the oesophagealscheme. Cancers involving the oesophagogastric junction (OGJ)whose epicentre is within the proximal 2 cm of the cardia (Siewerttypes l/ll) are to be staged as oesophageal cancers.The following are the procedures for assessing T, N, and Mcategories.T categoriesN categoriesM categoriesPhysical examination, imaging, endoscopy(including bronchoscopy), and/or surgicalexplorationPhysical examination, imaging, and/or surgicalexplorationPhysical examination, imaging, and/or surgicalexplorationAnatomical Subsites1. Cervical oesophagus (C15.0): this commences at the lowerborder of the cricoid cartilage and ends at the thoracic inlet(suprasternal notch), approximately 18 cm from the upperincisor teeth.2. Intrathoracic oesophagusa) The upper thoracic portion (C15.3) extending from thethoracic inlet to the level of the tracheal bifurcation,approximately 24 cm from the upper incisor teethb) The mid-thoracic portion (C15.4) is the proximal half ofthe oesophagus between the tracheal bifurcation and theoesophagogastric junction. The lower level is approximately32 cm from the upper incisor teethc) The lower thoracic portion (C15.5), approximately 8 cm inlength (includes abdominal oesophagus), is the distal halfof the oesophagus between the tracheal bifurcation and theoesophagogastric junction. The lower level is approximately40 cm from the upper incisor teeth3. Oesophagogastric junction (C16.0). Cancers involving theoesophagogastric junction (OGJ) whose epicentre is withinthe proximal 2 cm of the cardia (Siewert types l/ll) are to bestaged as oesophageal cancers. Cancers whose epicentre ismore than 2 cm distal from the OGJ will be staged using theStomach Cancer TNM and Stage even if the OGJ is involved.TNM Clinical ClassificationT - Primary TumourTX Primary tumour cannot be assessedTO No evidence of primary tumourTis Carcinoma in situ/high-grade dysplasiaT1 Tumour invades lamina propria, muscularis mucosae, orsubmucosaT1a Tumour invades lamina propria or muscularismucosaeT1b Tumour invades submucosaT2 Tumour invades muscularis propriaT3 Tumour invades adventitiaT4 Tumour invades adjacent structuresT4a Tumour invades pleura, pericardium, azygos vein,diaphragm, or peritoneumT4b Tumour invades other adjacent structures such asaorta, vertebral body, or tracheaN - Regional Lymph NodesNX Regional lymph nodes cannot be assessedNO No regional lymph node metastasisN1 Metastasis in 1 to 2 regional lymph nodesN2 Metastasis in 3 to 6 regional lymph nodesN3 Metastasis in 7 or more regional lymph nodesM - Distant MetastasisMO No distant metastasisM1 Distant metastasispTNM Pathological ClassificationThe pT and pN categories correspond to the T and N categories.pNO Histological examination of a regional lymphadenectomyspecimen will ordinarily include 7 or more lymph nodes. Ifthe lymph nodes are negative, but the number ordinarilyexamined is not met, classify as pNO.pM - Distant Metastasis*pM1 Distant metastasis microscopically confirmedNote* pMO and pMX are not valid categories.Regional Lymph NodesThe regional lymph nodes, irrespective of the site of the primarytumour, are those in the oesophageal drainage area includingcoeliac axis nodes and paraesophageal nodes in the neck butnot the supraclavicular nodes.The information presented here has been excerpted from the 2017 TNM classification of malignant tumours, eighth edition |408,3385A|. © 2017 UICC.A help desk for specific questions about the TNM classification is available at https://www.uicc.org/tnm-help-desk.https://afkebooks.comTumours of the oesophagus 25
Page 1 and 2: WHO Classification of Tumours • 5
Page 3 and 4: 9 Tumours of the gallbladder and ex
Page 5 and 6: List of abbreviations3D three-dimen
Page 7 and 8: Introduction to tumours of the dige
Page 9 and 10: One particularly important change i
Page 11 and 12: both low-grade and high-grade compo
Page 13 and 14: Box 1.01 Specific subtypes of mixed
Page 15 and 16: TNM Clinical ClassificationJejunum/
Page 17: Tumours of the oesophagusEdited by:
Page 21 and 22: https://afkebooks.comTumours of the
Page 23 and 24: understanding of their pathogenesis
Page 25 and 26: Squamous papilloma should be differ
Page 27 and 28: Macroscopic appearanceNot clinicall
Page 29 and 30: 3% to 23% (2752,2976}, undoubtedly
Page 31 and 32: The grading of squamous dysplasia i
Page 33 and 34: Box 2.02 Risk factors for oesophage
Page 35 and 36: cell patterns {3669,613,3767}. The
Page 37 and 38: Table 2.02 The Mandard and Becker s
Page 39 and 40: Fig. 2.16 Oesophageal adenoid cysti
Page 41 and 42: Fig. 2.18 Oesophageal mucoepidermoi
Page 43 and 44: Box 2.04 Summary of key genetic abn
Page 45 and 46: Superficialand protrudingtypeType 0
Page 47 and 48: by local resection if submucosal in
Page 49 and 50: similar tumours located in the head
Page 51 and 52: Fig. 2.28 Serotonin-producing oesop
Page 53 and 54: Tumours of the stomachEdited by: Fu
Page 55 and 56: TNM staging of carcinomas of the st
Page 57 and 58: https://afkebooks.comTumours of the
Page 59 and 60: Gastritis and metaplasia: precursor
Page 61 and 62: Fundic gland polypsGenta RMGDefinit
Page 63 and 64: Gastric hyperplastic polypsGenta RM
Page 65 and 66: Gastric dysplasiaKushima RLauwers G
Page 67 and 68: Fig. 3.06 Foveolar-type gastric dys
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Chapter 3Fig. 3.10 Intramucosal inv
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Fig.3.13 Intestinal-type adenoma. T
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Foveolar-type adenomaSekine SMontgo
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Gastric pyloric gland adenomaSekine
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Oxyntic gland adenomaYaoTVieth MDef
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Gastric adenocarcinomaCarneiro FFuk
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Fig. 3.27 Early gastric carcinoma.
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Table 3.03 Comparison of the Lauren
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Fig. 3.35 Mixed carcinoma. A Poorly
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Fig. 3.38 Adenocarcinoma with enter
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Established predictive biomarkersER
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component is mandatory, as is exclu
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immunohistochemistry may help deter
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PathogenesisThe frequent presence o
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Fig. 3.46 Gastroblastoma. A The epi
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Table 3.06 Key clinicopathological
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rs>nofofidieoro-inrs»r-T.isJ1.•n
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synaptophysin, whereas chromogranin
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Tumours of the small intestine and
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TNM staging of carcinomas of the sm
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Chapter 4https://afkebooks.comTumou
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neoplasm-associated carcinoma (carc
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Fig.4.02 Duodenal intestinal-type a
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Ampullary adenomaSekine SShia JDefi
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eesart/vn>hsoess-asle-ng'1)2).leire
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adenocarcinomas are slightly differ
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Ampullary adenocarcinomaAdsay NVRei
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pancreatobiliary-type or gastric-ty
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Small intestinal and ampullaryneuro
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Gangliocytic paraganglioma demonstr
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https://afkebooks.com
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TNM staging of adenocarcinomas of t
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https://afkebooks.comTumours of the
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Appendiceal serrated lesions and po
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has also been described in traditio
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notmay 'oursW, ¡ceal■adeid inKH,
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withosisrog-□ursliumomithenealiti
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Appendiceal goblet cell adenocarcin
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Staging (TNM)The staging of appendi
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Clinical featuresThere are no speci
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indication to perform an extended r
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WHO classification of tumours of th
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M - Distant MetastasisMO No distant
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Colorectal serrated lesions and pol
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the development of serrated polyps
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Fig. 6.06 Sessile serrated lesion (
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CytologyNot clinically relevantDiag
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their hierarchy are evident as comp
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cytological features of HGD, includ
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coliears,and/asedaneery ofhisskoff
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Colorectal adenocarcinomaNagtegaal
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Fig. 6.26 Mucinous adenocarcinoma.
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Fig. 6.32 Adenosquamous carcinoma o
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Table 6.03 Overview of the most com
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Qenomic classificationThis approach
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Table6.06 Overview of hereditary ca
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IFig.6.37 Neuroendocrine tumour (NE
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or GLPs (GLP-1 and GLP-2), but ofte
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WHO classification of tumours of th
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Tumours of the anal canal:Introduct
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Inflammatory cloacogenic polypLam A
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Anal condylomaLam AKDefinitionAnal
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Anal squamous dysplasia(intraepithe
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Fig. 7.10 Low-grade squamous intrae
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Fig. 7.13 Anal squamous cell carcin
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Anal adenocarcinomaShia JDefinition
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Fig. 7.19 Fistula-associated anal c
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Anal neuroendocrine neoplasmsLam AK
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>><7’'- W //‘Ax A- X# < 1 V r r
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TNM staging of tumours of the liver
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umours of the liver and intrahepati
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Focal nodular hyperplasia of the li
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Fig, 8.03 Focal nodular hyperplasia
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The presence of thick cell plates,
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Fig. 8.06 p-catenin-activated hepat
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Hepatocellular carcinomaTorbenson M
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invasion into the major bile ducts
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Fig. 8.10 Hepatocellular carcinoma.
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Fig. 8.14 Hepatocellular carcinoma.
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Table 8.09 Histological features an
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Staging (TNM)Staging of HCC follows
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fable 8.10 Molecular findings in he
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Box8.04 The 2017 PRETEXT (PRE-Treat
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Bile duct adenomaTsui WMNakanuma YD
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Cases reported to represent maligna
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Fig, 8.26 Biliary adenofibroma with
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fig. 8.29 Mucinous cystic neoplasm
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Fig. 8.32 Fine-needle aspirate of m
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9Fig. 8.34 Intrahepatic cholangioca
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Fig. 8.37 Intrahepatic cholangiocar
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Staging (TNM)Staging of ¡CCA follo
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Fig. 8.42 Combined hepatocellular-c
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9Tumours of the gallbladder andextr
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TNM staging of tumours of the gallb
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TNM staging of tumours of the dista
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Pyloric gland adenoma of the gallbl
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Biliary intraepithelial neoplasiaBa
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of the epithelium and typically dis
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rFig. 9.06 Intracholecystic papilla
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Intraductal papillary neoplasm of t
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Mutations of RNF43, a tumour suppre
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Carcinoma of the gallbladderRoa JCA
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Fig. 9.18 Mucinous gallbladder carc
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adenocarcinoma component in a seemi
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Carcinoma of the extrahepatic bile
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apSC cohort meta-analysis, the sens
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genome-wide copy-number variations
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>•<sr,¡Iirs1/njaSf5aJITumours of
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TNM staging of carcinomas of the pa
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into two tiers of dysplasia, on the
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Fig. 10.03 Acinar cystic transforma
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Serous neoplasms of the pancreasSin
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Fig. 10.06 Serous cystadenoma. Micr
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pancreatic intraepithelial neoplasi
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surgically resected PDACs, can some
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Serum tumour markers such as CEA an
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Fig. 10.14 Intestinal-type intraduc
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Pancreatic intraductal oncocytic pa
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pancreatic intraductal tubulopapill
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pancreatic mucinous cystic neoplasm
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CytologyAspirates contain varying a
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Fig. 10.20 Pancreatic cancer. A Cor
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peripancreatic and retroperitoneal
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Histological subtypesadenosquamous
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Fig. 10.25 Pancreatic ductal adenoc
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mutations) are more frequently asso
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pancreatic acinar cell carcinomaLa
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Fig. 10.29 Acinar cell carcinoma. A
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PancreatoblastomaOhike NLa Rosa SDe
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Fig. 10.35 Pancreatoblastoma. A Squ
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neoplasm (NEN), and have demonstrat
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pancreatic neuroendocrine neoplasms
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adenocarcinomas, because PanNECs fr
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Non-functioning pancreaticneuroendo
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Fig. 10.46 Non-functioning neuroend
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Fig. 10.49 Non-functioning neuroend
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InsulinomaPerren ACouvelard ASinghi
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GastrinomaKasajima ACouvelard ADefi
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VIPomaShi CKasajima ALa Rosa SDefin
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GlucagonomaCouvelard AKlóppel GShi
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SomatostatinomaSinghi ADAdsay NVSas
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ACTH-producing neuroendocrine tumou
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Serotonin-producing neuroendocrinet
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Pancreatic neuroendocrine carcinoma
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further investigation. Similarly, i
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Fig. 10.66 Mixed acinar-neuroendocr
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Haematolymphoid tumoursof the diges
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Haematolymphoid tumours of thediges
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Extranodal marginal zone lymphoma o
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PathogenesisFour translocations are
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TFig. 11.09 Immunoproliferative sma
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EtiologyUnknownPathogenesisDTFL har
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Enteropathy-associated T-cell lymph
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Fig. 11.14 Refractory coeliac disea
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Monomorphic epitheliotropic intesti
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Fig. 11.19 Monomorphic epitheliotro
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enteropathy) (206,2028,638). If the
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Fig. 11.22 Indolent T-cell lymphopr
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PathogenesisHSTL shows clonally rea
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Fig. 11.25 EBV+ inflammatory follic
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Diffuse large B-cell lymphomaChan W
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.V.'Vrf •>‘i'i; BB~ b» - M íF
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Follicular lymphomaOttGYoshino TDef
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Mantle cell lymphomaCampo ESeto MDe
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Desirable: morphological features s
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rFig. 11.38 Burkitt lymphoma. A Dif
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of BL: FISH analysis for MYC, BCL2,
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Fig. 11.45 Plasmablastic lymphoma.
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Table 11.04 Clinicopathological fea
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Extranodal NK/T-cell lymphomaKo YHL
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4VFig. 11.51 Lymphomatoid gastropat
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Fig. 11.53 Systemic mastocytosis in
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Langerhans cell histiocytosisChan J
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IFollicular dendritic cell sarcomaC
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Histiocytic sarcomaChan JKCPileri S
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Mesenchymal tumours ofthe digestive
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TNM staging of gastrointestinal str
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(familial GIST), NF1 mutations (neu
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Gastrointestinal stromal tumourDei
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Fig. 12.03 Succinate dehydrogenase-
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paediatric GISTs are SDH-deficient
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Fig. 12.09 Epithelioid inflammatory
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events in the vast majority of spor
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The vast majority of SFTs are posit
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for the stomach and colon {2308,693
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Fig. 12.18 Inflammatory fibroid pol
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Fig. 12.22 Plexiform fibromyxoma. A
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CytologyLarge mass-forming leiomyom
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HistopathologyLeiomyosarcomas consi
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Fig. 12.26 Embryonal rhabdomyosarco
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of the skin or other sites (2940).
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Essential and desirable diagnostic
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Fig. 12.31 Epithelioid haemangioend
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Fig. 12.33 Gastric lymphangioma-lik
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AngiosarcomaThway KDoyle LAFukayama
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Glomus tumourThway KDoyle LAFukayam
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Lymphangioma and lymphangiomatosisT
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SchwannomaAntonescu CRHornick JLDef
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Granular cell tumourAntonescu CRHor
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PerineuriomaAntonescu CRHornick JLD
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Ganglioneuroma and ganglioneuromato
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PEComa, including angiomyolipomaHor
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blood vessel walls. Some tumours co
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diagnosed after the age of 5 years
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Macroscopic appearanceCNSET is well
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Fig. 12.56 Synovial sarcoma. A The
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Fig. 12.58 Gastrointestinal clear c
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Embryonal sarcoma of the liverHorni
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Other tumours of the digestive syst
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https://afkebooks.comOther tumours
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Fig. 13.02 Anorectal melanoma. A An
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instances. Intraparenchymal lesions
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diffuse multiorgan manifestation, d
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routine and special staining, immun
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■V.-.ri/ CP ML■'***/. .Genetic
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Table 14.01 The heritable syndromes
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Lynch syndromeFrankel WLArends MJFr
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Genomics and Health as the sole def
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Fig. 14.02 Colon adenocarcinoma fro
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arearrangement and is therefore tra
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Fig. 14.06 Familial adenomatous pol
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deficiency syndrome, and multiple p
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Fig. 14.11 Gastric adenocarcinoma a
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Other adenomatous polyposesArends M
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mutations that give rise to Lynch s
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EtiologyGenetic studies are current
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Hereditary diffuse gastric cancerCa
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Fig. 14.21 Signet-ring cell carcino
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Familial pancreatic cancerHruban RH
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Essential and desirable diagnostic
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Fig. 14.27 Colonic juvenile polyp.
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Peutz-Jeghers syndromeBrosens LAAJa
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Cowden syndromeBrosens LAAJansen MD
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have gastric polyps {671,1869}, whi
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ContributorsADSAY, N. VolkanIstanbu
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