国际口腔医学杂志

国际口腔医学杂志 ›› 2023, Vol. 50 ›› Issue (3): 263-271.doi: 10.7518/gjkq.2023024

• 指南解读 • 上一篇    下一篇

2022年世界卫生组织指南头颈部肿瘤分类的解读：牙源性和颌面部骨肿瘤

张超颖1(),李怡宁2,龚佳幸3,王慧明3,4()   

  1. 1.浙江大学医学院附属口腔医院;浙江大学口腔医学院 浙江省口腔疾病临床医学研究中心;浙江省口腔生物医学研究重点实验室 浙江大学癌症研究院 杭州 310006
    2.浙江大学医学院附属口腔医院病理科;浙江大学口腔医学院 浙江省口腔疾病临床医学研究中心;浙江省口腔生物医学研究重点实验室 浙江大学癌症研究院 杭州 310006
    3.浙江大学医学院附属口腔医院种植科;浙江大学口腔医学院 浙江省口腔疾病临床医学研究中心;浙江省口腔生物医学研究重点实验室 浙江大学癌症研究院 杭州 310006
    4.浙江大学医学院附属口腔医院口腔颌面外科 浙江大学口腔医学院 浙江省口腔疾病临床医学研究中心浙江省口腔生物医学研究重点实验室 浙江大学癌症研究院 杭州 310006
  • 收稿日期:2022-06-09 修回日期:2022-12-02 出版日期:2023-05-01 发布日期:2023-05-16
  • 通讯作者: 王慧明
  • 作者简介:张超颖，住院医师，硕士，Email：chaoying_zhang@zju.edu.cn
  • 基金资助:
    国家自然科学基金面上项目(31872752);中国博士后科学基金(2020TQ0257);浙江省医药卫生科技计划项目(2017KY448)

Interpretation of the 2022 classification of head and neck tumors by the World Health Organization: odontogenic and maxillofacial bone tumors

Zhang Chaoying1(),Li Yining2,Gong Jiaxing3,Wang Huiming3,4()   

  1. 1.Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, China
    2.Dept. of Pathology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, China
    3.Dept. of Implantology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, China
    4.Dept. of Oral and Maxillofacial Surgery, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, China
  • Received:2022-06-09 Revised:2022-12-02 Online:2023-05-01 Published:2023-05-16
  • Contact: Huiming Wang
  • Supported by:
    National Natural Science Foundation of China(31872752);the China Postdoctoral Science Foundation(2020TQ0257);the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission(2017KY448)

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摘要：

世界卫生组织出版的《头颈部肿瘤分类》是口腔颌面外科、口腔病理科医生权威的参考资料。随着近年来分子生物学的飞速发展和诊疗技术的不断提升，作为头颈部肿瘤中一类重要疾病——牙源性和颌面骨肿瘤，它在已经出版的2022年第5版中出现了许多新变化。本文主要与2017年第4版的指南比较，重点阐述了第5版在新分类、新病种和新遗传分子学改变这三方面的内容，以期辅助临床诊疗。

关键词: 牙源性肿瘤, 颌面骨肿瘤, 肿瘤分类, 世界卫生组织

Abstract:

The classification of head and neck tumors published by the World Health Organization is an autho-ritative reference for oral and maxillofacial surgeons and oral pathologists. With the rapid development of molecular biology and the corresponding advancements in diagnosis and treatment technologies in recent years, new changes have emerged in the significant odontogenic and maxillofacial bone tumors of the 5th edition published in 2022. This article mainly illustrates three aspects of new tumor classification, new disease types, and new genetic and molecular changes in the latest edition compared with the 2017 4th edition for assisting in clinical diagnosis and treatment.

Key words: odontogenic tumors, maxillofacial bone tumors, classification of tumors, World Health Organization

中图分类号: 

  • R 739.8

表 1

WHO头颈部肿瘤分类2022和2017版牙源性肿瘤和颌面骨肿瘤的新分类变化"

2017年第4版分类[5]2022年第5版分类[4]解读
牙源性炎症性囊肿（odontogenic cysts of inflammatory origin）颌骨囊肿（cysts of the jaws）2022版取消牙源性炎症性、发育性囊肿的分类
根尖囊肿（radicular cyst）根尖囊肿（radicular cyst）
炎症性根侧囊肿（inflammatory collateral cysts）炎症性根侧囊肿（inflammatory collateral cysts）
牙源性和非牙源性发育性囊肿（odontogenic and non-odontogenic developmental cysts）外科纤毛囊肿（surgical ciliated cyst）2022版新增外科纤毛囊肿
含牙囊肿（dentigerous cyst）鼻腭管囊肿（nasopalatine duct cyst）
牙源性角化囊肿（odontogenic keratocyst）龈囊肿（gingival cysts）
根侧牙周囊肿和葡萄状牙源性囊肿（lateral perio-dontal cyst and botryoid odontogenic cyst）含牙囊肿（dentigerous cyst）
龈囊肿（gingival cysts）牙源性正角化囊肿（orthokeratinized odontogenic cyst）
腺牙源性囊肿（glandular odontogenic cyst）根侧牙周囊肿和葡萄状牙源性囊肿（lateral perio-dontal cyst and botryoid odontogenic cyst）
牙源性钙化囊肿（calcifying odontogenic cyst）牙源性钙化囊肿（calcifying odontogenic cyst）
牙源性正角化囊肿（orthokeratinized odontogenic cyst）腺牙源性囊肿（glandular odontogenic cyst）
鼻腭管囊肿（nasopalatine duct cyst）牙源性角化囊肿（odontogenic keratocyst）
牙源性肿瘤（odontogenic tumours）
良性牙源性上皮性肿瘤（benign epithelial odontogenic tumours）良性牙源性上皮性肿瘤（benign epithelial odontogenic tumours）

成釉细胞瘤（ameloblastoma）

单囊型成釉细胞瘤（ameloblastoma，unicystic type）

骨外或外周型成釉细胞瘤（ameloblastoma，extraosseous/peripheral type）

转移性成釉细胞瘤（metastasizing ameloblastoma）

单囊型成釉细胞瘤（ameloblastoma, unicystic）

骨外或外周型成釉细胞瘤（ameloblastoma，extraosseous/peripheral）

传统的实性或多囊型成釉细胞瘤（ameloblastoma, conventional）

腺样成釉细胞瘤（adenoid ameloblastoma）

转移性成釉细胞瘤（metastasizing ameloblasto-ma）

2022版将单囊型成釉细胞瘤、骨外或外周型成釉细胞瘤、传统的实性或多囊型成釉细胞瘤、转移性成釉细胞瘤单独分类；

2022版新增腺样成釉细胞瘤且单独分类

牙源性鳞状细胞瘤（squamous odontogenic tumour）牙源性鳞状细胞瘤（squamous odontogenic tumour）
牙源性钙化上皮瘤（calcifying epithelial odontogenic tumour）牙源性钙化上皮瘤（calcifying epithelial odontogenic tumour）
牙源性腺样瘤（adenomatoid odontogenic tumour）牙源性腺样瘤（adenomatoid odontogenic tumour）
良性牙源性上皮和牙源性间叶肿瘤（benign mixed epithelial and mesenchymal odontogenic tumours）

良性牙源性上皮和牙源性间叶肿瘤（benign mixed

epithelial & mesenchymal odontogenic tumours）

成釉细胞纤维瘤（ameloblastic fibroma）牙瘤（odontoma）
牙源性始基瘤（primordial odontogenic tumour）牙源性始基瘤（primordial odontogenic tumour）
牙瘤（odontoma）成釉细胞纤维瘤（ameloblastic fibroma）
牙本质生成性影细胞瘤（dentinogenic ghost cell tumour）牙本质生成性影细胞瘤（dentinogenic ghost cell tumour）
良性间叶性牙源性肿瘤（benign mesenchymal odontogenic tumours）良性间叶性牙源性肿瘤（benign mesenchymal odo-ntogenic tumours）
牙源性纤维瘤（odontogenic fibroma）牙源性纤维瘤（odontogenic fibroma）
牙源性黏液瘤/黏液纤维瘤（odontogenic myxoma/myxofibroma）成牙骨质细胞瘤（cementoblastoma
成牙骨质细胞瘤（cementoblastoma）牙骨质-骨化纤维瘤（cemento-ossifying fibroma）
牙骨质-骨化纤维瘤（cemento-ossifying fibroma）牙源性黏液瘤（odontogenic myxoma）
牙源性癌（odontogenic carcinomas）恶性牙源性肿瘤（malignant odontogenic tumours）2022版将牙源性癌分类名改为恶性牙源性肿瘤
成釉细胞癌（ameloblastic carcinoma）牙源性硬化性癌（sclerosing odontogenic carcinoma）
原发性骨内癌，NOS（primary intraosseous carcinoma，NOS）成釉细胞癌（ameloblastic carcinoma）
牙源性硬化性癌（sclerosing odontogenic carcinoma）牙源性透明细胞癌（clear cell odontogenic carcinoma）
牙源性透明细胞癌（clear cell odontogenic carcinoma）牙源性影细胞癌（ghost cell odontogenic carcinoma）
牙源性影细胞癌（ghost cell odontogenic carcinoma）原发性骨内癌，NOS（primary intraosseous carcinoma，NOS）
牙源性癌肉瘤（odontogenic carcinosarcoma）牙源性癌肉瘤（odontogenic carcinosarcoma）
牙源性肉瘤（odontogenic sarcomas）牙源性肉瘤（odontogenic sarcomas）2022版牙源性肉瘤归为恶性牙源性肿瘤，包括成釉细胞纤维肉瘤、成釉细胞纤维牙本质肉瘤、成釉细胞纤维牙肉瘤
巨细胞病变和单纯性骨囊肿（giant cell lesions and simple bone cyst）巨细胞病变和单纯性骨囊肿（giant cell lesions and simple bone cyst）
中央性巨细胞肉芽肿（central giant cell granuloma）中央性巨细胞肉芽肿（central giant cell granuloma）
外周性巨细胞肉芽肿（peripheral giant cell granuloma）外周性巨细胞肉芽肿（peripheral giant cell granuloma）
巨颌症（cherubism）巨颌症（cherubism）
动脉瘤样骨囊肿（aneurysmal bone cyst）动脉瘤样骨囊肿（aneurysmal bone cyst）
单纯性骨囊肿（simple bone cyst）单纯性骨囊肿（simple bone cyst）
骨和软骨肿瘤（Bone and cartilage tumours）2022版新分出骨和软骨肿瘤大类，涵盖了之前的纤维骨和骨软骨瘤病变、良性颌面骨和软骨肿瘤、恶性颌面骨和软骨肿瘤类别
纤维骨和骨软骨瘤病变（fibro-osseous and osteochondromatous lesions）纤维骨肿瘤和结构不良（fibro-osseous tumours and dysplasias）2022版更名为纤维骨肿瘤和结构不良，突出了结构不良
骨化性纤维瘤（ossifying fibroma）牙骨质-骨结构不良（cemento-osseous dysplasia）
家族性巨大牙骨质瘤（familial gigantiform cementoma）节段性牙上颌骨发育异常（segmental odontomaxillary dysplasia）2022版新增节段性牙上颌骨发育异常
纤维结构不良（fibrous dysplasia）纤维结构不良（fibrous dysplasia）
牙骨质-骨结构不良（cemento-osseous dysplasia）青少年小梁状骨化纤维瘤（juvenile trabecular ossifying fibroma）2022版青少年小梁状骨化纤维瘤从骨化性纤维瘤中分出，定位至亚型
骨软骨瘤（osteochondroma）沙瘤样骨化纤维瘤（psammomatoid ossifying fibroma）2022版沙瘤样骨化纤维瘤从青少年骨化性纤维瘤亚型（青少年沙瘤样骨化纤维瘤）中分出，并删去“青少年”的前称
家族性巨大牙骨质瘤（familial gigantiform cementoma）
良性颌面骨和软骨肿瘤（benign maxillofacial bone and cartilage tumours）良性颌面骨和软骨肿瘤（benign maxillofacial bone and cartilage tumours）
软骨瘤（chondroma）骨瘤（osteoma）
骨瘤（osteoma）骨软骨瘤（osteochondroma）
婴儿色素性神经外胚层肿瘤（melanotic neuroectodermal tumour of infancy）骨母细胞瘤（osteoblastoma）2022版删除婴儿色素性神经外胚层肿瘤
软骨母细胞瘤（chondroblastoma）软骨母细胞瘤（chondroblastoma）
软骨黏液样纤维瘤（chondromyxoid fibroma）软骨黏液样纤维瘤（chondromyxoid fibroma）
骨样骨瘤（osteoid osteoma）骨的促结缔组织增生性纤维瘤（desmoplastic fibroma of bone）
骨母细胞瘤（osteoblastoma）
促结缔组织性纤维瘤（desmoplastic fibroma）
恶性颌面骨和软骨肿瘤（malignant maxillofacial bone and cartilage tumours）恶性颌面骨和软骨肿瘤（malignant maxillofacial bone and cartilage tumours）2022版恶性颌面骨和软骨肿瘤分类重组
软骨肉瘤（chondrosarcoma）颌骨骨肉瘤（osteosarcoma of the jaw）
间叶软骨肉瘤（mesenchymal chondrosarcoma）软骨肉瘤家族（chondrosarcoma family）2022版软骨肉瘤家族包括Ⅰ、Ⅱ、Ⅲ级
骨肉瘤（osteosarcoma）间叶软骨肉瘤（mesenchymal chondrosarcoma）
血淋巴肿瘤（haematolymphoid tumours）横纹肌肉瘤伴转录因子CP2重排[rhabdomyosarcoma with transcription factor CP2 (TFCP2) rearrangement]2022版新增横纹肌肉瘤伴转录因子CP2重排
骨孤立性浆细胞瘤（solitary plasmacytoma of bone）2022版删除骨孤立性浆细胞瘤
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