Overview of the 2022 WHO Classification of Pituitary Adenomas/Pituitary Neuroendocrine Tumors: Clinical Practices, Controversies, and Perspectives.

The latest edition of the WHO classification of the central nervous system was published in 2021. This review summarizes the major revisions to the classification of anterior pituitary tumors. The most important revision involves preferring the terminology of pituitary neuroendocrine tumor (PitNET), even though the terminology of pituitary adenoma (PA) still can be used according to this WHO classification compared to the previous one. Moreover, immunohistochemistry (IHC) examination of pituitary-specific transcription factors (TFs), including PIT1, TPIT, SF-1, GATA2/3, and ERα, is endorsed to determine the tumor cell lineage and to facilitate the classification of PitNET/PA subgroups. However, TF-negative IHC staining indicates PitNET/PA with no distinct cell lineages, which includes unclassified plurihormonal (PH) tumors and null cell (NC) tumors in this edition. The new WHO classification of PitNET/PA has incorporated tremendous advances in the understanding of the cytogenesis and pathogenesis of pituitary tumors. However, due to the shortcomings of the technology used in the diagnosis of PitNET/PA and the limited understanding of the tumorigenesis of PitNET/PA, the application of this new classification system in practice should be further evaluated and validated. Besides providing information for deciding the follow-up plans and adjunctive treatment after surgery, this classification system offers no additional help for neurosurgeons in clinical practice, especially in determining the treatment strategies. Therefore, it is necessary for neurosurgeons to establish a comprehensive pituitary classification system for PitNET/PA that incorporates neuroimaging grading data or direct observation of invasiveness during operation or the predictor of prognosis, as well as pathological diagnosis, thereby distinguishing the invasiveness of the tumor and facilitating neurosurgeons to decide on the treatment strategies and follow-up plans as well as adjunctive treatment after surgery.

Clinical pathological characteristics and prognosis of 468 thymoma patients / 中国胸心血管外科临床杂志

@#Objective    To assess the correlation of WHO pathological classification and Masaoka stage of thymomas with its prognosis. Methods    A total of 468 patients with thymomas who received surgeries during 2009-2019 in Huashan Hospital, Fudan University, were collected. There were 234 males and 234 females with an average age of 21-83 (49.6±18.7) years. A total of 132 patients underwent video-assisted thoracic surgery (VATS) and 336 patients underwent thymectomy with median sternal incision. The follow-up time was 5.7±2.8 years. The clinical data of the patients were analyzed. Results    The amount of intraoperative bleeding was 178.3±133.5 mL in the median sternal incision group, and 164.8±184.1 mL in the VATS group (P=0.537). The operative time was 3.3±0.7 h in the median sternal incision group and 3.4±1.2 h in the VATS group (P=0.376). Postoperative active bleeding, phrenic nerve injury and chylothorax complications occurred in 8 patients, 9 patients and 1 patient in the VATS group, respectively, and 37 patients, 31 patients and 7 patients in the median sternal incision group, respectively. There was no statistical difference between the two groups (P=0.102, 0.402, 0.320). The 5-year cumulative progression free survival (PFS) rates of patients with WHO type A, AB, B1, B2, B3 and C thymomas were 100.0%, 100.0%, 95.7%, 81.4%, 67.5% and 50.0%, respectively (P<0.001). The 5-year PFS rates of patients with Masaoka stageⅠ-Ⅳ thymomas were 96.1%, 89.2%, 68.6% and 19.3%,  respectively (P<0.001). The 5-year PFS rate was 87.3% in patients with myasthenia gravis (MG) and 78.2% in patients without MG (P<0.001). The 5-year PFS rates of patients with different surgeries were 82.4% and 83.8%, respectively (P=0.904). Conclusion    WHO pathological classification and Masaoka stage have significant clinical prognosis suggestive effect. Thymoma patients combined with MG have better prognosis, which suggests early diagnosis and treatment of thymoma are important.

The Clinical and Pathological Analysis of 1,012 Cases of Non-Hodgkins Lymphoma / 中国肿瘤临床

Objective: To explore the clinicopathologic features of non-Hodgkin' s lymphoma (NHL) patients seen in our hospital in the recent ten years and to discuss the relationship between clinical data and the prognostic factors. Methods: The clinical and pathological features of 1,012 NHL cases were retrospectively analyzed. Results: The main pathological subtypes included 346 (34.1%) cases of diffuse large B-cell lymphoma (DLBCL), 185 (18.3%) cases of peripheral T-cell lymphoma (PTCL), 97 (9.6%) cases of follicular lymphoma (FL), 94 (9.3%) cases of extranodal mucosa-associated lymphoid tissue (MALT), 62 (6.1%) cases of nasal NK/T-cell lymphoma and 47 (4.6%) cases of T-lymphoblastic lymphoma. There were 619 (61.2%) cases classified as nodal lymphoma and 393 (38.8%) cases classified as extranodal lymphoma. For the whole group, the 5-year overall survival (OS) rate was 45.8%. The univariate analysis showed that the clinical stage, performance status (PS), B-symptom, age, tumor size, the serum lactate dehydrogenase (LDH) level, the number of extranodal involvement and IPI were correlated with prognosis of NHL(P＜0.05). The multivariate analysis showed that the source of T cells, Ⅲ/Ⅳ clinical stage, IPI (3～5) and increased LDH were correlated with poor prognosis (P＜0.05). Conclusion: The incidence of NHL in middle-aged people is relatively higher. Extranodal lymphoma and B-cell lymphoma are more frequent in Xinjiang. Immunophenotypes, clinical stages, IPI and the level of LDH expression are closely correlated with prognosis of NHL.