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IF 2.6 2区医学 Q2 PATHOLOGY

Human pathology

Pub Date : 2026-03-01 Epub Date: 2026-03-05 DOI: 10.1016/S0046-8177(26)00051-1

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What's new in upper gastrointestinal pathology: Key updates and evolving challenges in 2026 上消化道病理学的新进展：2026年的关键更新和不断变化的挑战。

IF 2.6 2区医学 Q2 PATHOLOGY

Human pathology

Pub Date : 2026-03-01 Epub Date: 2025-12-25 DOI: 10.1016/j.humpath.2025.106025

Domenika Ortiz Requena MD, Elizabeth A. Montgomery MD.

Diagnostic pathology of the upper gastrointestinal tract continues to evolve as molecular insights, clinical practices, and updated international standards improve our understanding of disease. The World Health Organization (WHO) classification of digestive system tumors, now in its 6th edition, includes several important changes, including incorporating esophageal epidermoid metaplasia as a separate section, and modifying the approach to metaplastic and dysplastic gastric lesions. These updates reflect a broader trend toward simplified terminology, clearer definitions of precursor lesions, and more consistent grading systems across the digestive tract.

At the same time, increased use of immunotherapy has introduced new patterns of injury. Beyond immune checkpoint inhibitors, several agents, including rituximab and chimeric antigen receptor T-cell therapy have been associated with distinctive upper-GI mucosal alterations that can resemble infectious or immunologic diseases. Failure to recognize these patterns of injury can carry significant clinical implications, including treatment delay or discontinuation, and require careful histologic evaluation to avoid misclassification.

This review summarizes select upper-GI updates from the 6th edition of the WHO classification and outlines emerging therapy-related injuries with a focus on rituximab- and CAR-T–associated changes. The aim is to provide a practical and contemporary guide for pathologists navigating these evolving diagnostic challenges.

随着对分子的认识、临床实践和更新的国际标准提高了我们对疾病的理解，上胃肠道的诊断病理学不断发展。世界卫生组织（WHO）的消化系统肿瘤分类，现在是第6版，包括几个重要的变化，包括将食管表皮样化生作为一个单独的部分，并修改了胃化生和发育不良病变的方法。这些更新反映了一种更广泛的趋势，即简化术语，更清晰的前体病变定义，以及更一致的消化道分级系统。与此同时，免疫疗法的使用增加，引入了新的损伤模式。除了免疫检查点抑制剂，包括利妥昔单抗和嵌合抗原受体t细胞治疗在内的一些药物与独特的上消化道粘膜改变有关，这些改变可能类似于感染性或免疫性疾病。未能识别这些损伤模式可能具有重要的临床意义，包括治疗延迟或停止，并且需要仔细的组织学评估以避免错误分类。本综述总结了世卫组织第6版分类中精选的上消化道最新信息，并概述了新出现的治疗相关损伤，重点是利妥昔单抗和car - t相关的变化。目的是为病理学家导航这些不断发展的诊断挑战提供实用和现代的指南。

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引用次数: 0

Select updates in the pathology of kidney, testis, and penile cancer for 2026: Including FLCN-mutated (kidney) tumors, paratesticular mesothelial tumors, and TP53/HPV status in penile squamous cell carcinoma 选择2026年肾脏、睾丸和阴茎癌病理的最新进展：包括flcn突变的（肾脏）肿瘤、睾丸旁间皮肿瘤和阴茎鳞状细胞癌的TP53/HPV状态。

IF 2.6 2区医学 Q2 PATHOLOGY

Human pathology

Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.humpath.2026.106032

Burak Tekin , Rumeal D. Whaley , Katrina Collins , Lori A. Erickson , Liang Cheng , Sounak Gupta

Herein, we have provided select updates targeted towards practicing pathologists pertaining to the pathology of kidney, testis, and penile cancer. This includes discussion of diagnostic criteria, evolution of nomenclature, emerging immunohistochemistry markers, diagnostic pitfalls, and improved understanding of prognostic significance of biomarkers and/or staging parameters. For kidney tumors, specific topics of discussion include a summary of the recent literature pertaining to the biology and diagnostic criteria for conventional and non-conventional FLCN-mutated tumors, utility of GPNMB immunohistochemistry, and diagnostic pitfalls relevant to eosinophilic solid and cystic renal cell carcinoma. Testicular/paratesticular updates address diagnostic criteria for mesothelium-derived lesions of the tunica vaginalis, recommended immunohistochemical panels for testicular sex cord-stromal tumors, and recommended nomenclature, specifically the use of “embryonic-type neuroectodermal tumor” rather than primitive neuroectodermal tumor (PNET) in the context of somatic transformation of testicular germ cell tumors. For penile squamous cell carcinoma, the summary emphasizes prognostic biomarkers, notably TP53 alterations and high risk HPV status, and nuances pertaining to pathologic staging.

在这里，我们提供了选择更新针对执业病理学家有关病理肾，睾丸，和阴茎癌。这包括对诊断标准的讨论，命名法的演变，新出现的免疫组织化学标记物，诊断陷阱，以及对生物标记物和/或分期参数的预后意义的改进理解。对于肾肿瘤，具体的讨论主题包括总结有关常规和非常规flcn突变肿瘤的生物学和诊断标准的最新文献，GPNMB免疫组织化学的应用，以及与嗜酸性实体肾细胞癌和囊性肾细胞癌相关的诊断陷阱。睾丸/睾丸旁更新了阴道膜间皮源性病变的诊断标准，推荐了睾丸性索间质肿瘤的免疫组化检查，推荐了命名法，特别是在睾丸生殖细胞肿瘤体细胞转化的背景下使用“胚胎型神经外胚层肿瘤”而不是原始神经外胚层肿瘤（PNET）。对于阴茎鳞状细胞癌，总结强调预后生物标志物，特别是TP53改变和高危HPV状态，以及与病理分期有关的细微差别。

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引用次数: 0

Navigating diagnostic shifts: A comparative review of the WHO 5th edition and ICC 2022 classifications of myeloid neoplasms 导航诊断转变：WHO第5版和ICC 2022骨髓性肿瘤分类的比较回顾。

IF 2.6 2区医学 Q2 PATHOLOGY

Human pathology

Pub Date : 2026-03-01 Epub Date: 2026-02-18 DOI: 10.1016/j.humpath.2026.106077

Sharon Koorse Germans, Olga K. Weinberg

The near-simultaneous publication of the World Health Organization (WHO) 5th Edition classification of hematolymphoid tumors (WHO-HAEM5) and the International Consensus Classification (ICC) in 2022 represents a pivotal moment in the taxonomy of myeloid neoplasms. Both systems emphasize integration of morphology, cytogenetics, and molecular genetics, yet they diverge in several clinically meaningful areas, including blast thresholds for acute myeloid leukemia (AML), definition of the myelodysplastic syndrome (MDS)–AML interface, and categorization of TP53-mutated disease [TP53mut MN] [1–3]. These differences extend beyond nomenclature, influencing prognostic stratification, therapeutic decision-making, and eligibility for clinical trials [4–7]. Recent comparative cohort studies demonstrate substantial reclassification rates, particularly among MDS with excess blasts, AML with myelodysplasia-related features, and TP53-mutated neoplasms, with prognosis driven largely by underlying molecular features rather than blast percentage alone [8–11]. This review provides a comprehensive comparison of WHO-HAEM5 and ICC 2022, synthesizes emerging real-world outcome data, and discusses implications for diagnostic practice, harmonization efforts, and future refinement of myeloid neoplasm classification [12–14].

世界卫生组织（WHO）第5版血淋巴肿瘤分类（WHO- haem5）和国际共识分类（ICC）将于2022年几乎同时出版，这是髓系肿瘤分类的关键时刻。这两个系统都强调形态学、细胞遗传学和分子遗传学的整合，但它们在几个有临床意义的领域存在分歧，包括急性髓性白血病（AML）的爆炸阈值、骨髓增生异常综合征(MDS)-AML界面的定义以及tp53突变疾病TP53mut MN的分类[1-3]。这些差异超出了命名范畴，影响了预后分层、治疗决策和临床试验资格[4-7]。最近的比较队列研究显示了大量的重分类率，特别是在具有过量原细胞的MDS、具有骨髓增生异常相关特征的AML和tp53突变的肿瘤中，其预后主要由潜在的分子特征驱动，而不仅仅是原细胞百分比[8-11]。本综述提供了WHO-HAEM5和ICC 2022的全面比较，综合了新兴的现实世界结果数据，并讨论了对诊断实践、协调工作和未来髓系肿瘤分类改进的影响[12-14]。

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引用次数: 0

Inside front cover - Masthead 内前盖-报头

IF 2.6 2区医学 Q2 PATHOLOGY

Human pathology

Pub Date : 2026-03-01 Epub Date: 2026-03-05 DOI: 10.1016/S0046-8177(26)00048-1

引用次数: 0

Practical and challenging issue in thyroid cytopathology 甲状腺细胞病理学中的实际和具有挑战性的问题。

IF 2.6 2区医学 Q2 PATHOLOGY

Human pathology

Pub Date : 2026-03-01 Epub Date: 2025-12-16 DOI: 10.1016/j.humpath.2025.106019

Qianqian Zhang, Belen Padial Urtueta, Elisabetta Merenda, Gabriele Rotondaro, Noemi Morelli, Alessia Piermattei, Patrizia Straccia, Federica Cianfrini, Angela Feraco, Alessia Granitto, Antonino Mule, Esther Diana Rossi

The detection of thyroid lesions is a frequently encountered especially in the adult population. Data from literature emphasize that they are found in more than 65 % of individuals. Most of these lesions are benign (90–92 %), even though the incidence of malignancy has been increasing due to frequent ultrasonographic head and neck evaluation, which can now identify small subcentimeter suspicious nodules. However, a 20 % of them, falling into the category of indeterminate lesions can lead to some pitfalls and tricky evaluations. Globally Fine needle aspiration (FNA) has been established as a safe, useful, first-line diagnostic tool, with a high positive predictive value for identifying malignancy. The development of classification system originated in order to obtain a practical classification system, able to combine each entity with a category and then with a specific risk of malignancy (ROM) and management. It is well-known that, among the others, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) represent the most worldwide used system. The 3r edition of TBSRTC, published in July 2023, subclassified indeterminate lesions into: a) atypia of undetermined significance (AUS) with nuclear atypia or other atypia, b) follicular neoplasm (FN) and c) suspicious for malignancy (SFM). However, despite the high positive predictive value (97 %–99 %), sensitivity (65 %–99 %) and specificity (72 %–100 %) of thyroid FNAC, diagnostic pitfalls exist that can lead to false positive (FP) and/or false negative (FN) results. This inconvenience is mostly due to the overlapping of morphological features in terms of cells and even background. This review discusses the most important practical issue also related to the application of TBSRTC and the evaluation of morphological challenges that can lead to pitfalls and diagnostic errors.

甲状腺病变的检测是一个经常遇到的问题，特别是在成人人群中。文献资料强调，65%以上的人都有这种症状。这些病变大多是良性的（90-92%），尽管由于频繁的头颈部超声检查，恶性肿瘤的发生率也在增加，现在可以识别亚厘米级的可疑小结节。然而，其中20%属于不确定病变类别，可能会导致一些陷阱和棘手的评估。在全球范围内，细针穿刺（FNA）已被确立为一种安全、有用的一线诊断工具，在识别恶性肿瘤方面具有很高的阳性预测价值。分类系统的发展源于为了获得一种实用的分类系统，能够将每个实体与一个类别结合起来，然后具有特定的恶性肿瘤风险（ROM）和管理。众所周知，其中Bethesda甲状腺细胞病理学报告系统（TBSRTC）是全球使用最多的系统。2023年7月出版的第3r版TBSRTC将不确定病变分为：a)具有核异型或其他异型的不确定意义异型（AUS）， b)滤泡性肿瘤（FN）和c)可疑恶性肿瘤（SFM）。然而，尽管甲状腺FNAC具有较高的阳性预测值（97%-99%）、敏感性（65%-99%）和特异性（72%-100%），但存在可导致假阳性（FP）和/或假阴性（FN）结果的诊断陷阱。这种不方便主要是由于在细胞和甚至背景方面的形态学特征重叠。这篇综述讨论了最重要的实际问题，也与TBSRTC的应用和形态学挑战的评估有关，这些挑战可能导致陷阱和诊断错误。

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引用次数: 0

Practice updates: Emerging entities in bone and soft tissue pathology 实践更新：骨和软组织病理学中的新兴实体。

IF 2.6 2区医学 Q2 PATHOLOGY

Human pathology

Pub Date : 2026-03-01 Epub Date: 2025-12-17 DOI: 10.1016/j.humpath.2025.106023

Nooshin K. Dashti , Scott E. Kilpatrick

In last few decades our understanding of bone and soft tissue tumors has evolved significantly, expanding and clarifying our current classification system. Due largely to increased utilization of ancillary testing, particularly molecular tools, new entities are continually emerging and/or being further refined. In addition to morphological and molecular differences, in many instances, the recognition of a new entity carries significant prognostic and potentially therapeutic relevance. In this review on practice updates, we endeavor to discuss five recently described tumors including pseudoendocrine sarcoma, NUT-rearranged sarcoma, VGLL3-rearranged spindle cell rhabdomyosarcoma of head and neck, superficial neurocristic FET::ETS fusion tumors, and NFATC1/2-rearranged epithelioid vascular tumors.

在过去的几十年里，我们对骨和软组织肿瘤的理解有了显著的发展，扩展和澄清了我们目前的分类系统。主要是由于辅助测试的使用增加，特别是分子工具，新的实体不断出现和/或进一步完善。除了形态学和分子差异外，在许多情况下，新实体的识别具有重要的预后和潜在的治疗相关性。在本文中，我们试图讨论最近报道的五种肿瘤，包括假内分泌肉瘤、nut重排肉瘤、vgll3重排的头颈部梭形细胞横纹肌肉瘤、浅表神经系统性FET::ETS融合肿瘤和nfatc1 /2重排的上皮样血管肿瘤。

引用次数: 0

Selected updates in thyroid, parathyroid, and adrenal gland pathology 甲状腺，甲状旁腺和肾上腺病理学的精选更新。

IF 2.6 2区医学 Q2 PATHOLOGY

Human pathology

Pub Date : 2026-03-01 Epub Date: 2026-01-03 DOI: 10.1016/j.humpath.2025.106029

Lori A. Erickson, Sounak Gupta, Rumeal D. Whaley, Burak Tekin, Jorge Torres-Mora

Endocrine pathology is continuously advancing with with new classification systems and an increased understanding the underlying pathogenesis and genetic alterations, whether somatic or germline, in endocrine diseases. Many changes have recently occurred in the classification of thyroid carcinoma, the most complex of which involve the new category of “high-grade follicular cell derived non anaplastic thyroid carcinoma” which encompasses both poorly differentiated thyroid carcinomas and differentiated high-grade thyroid carcinomas. The word “hyperplasia” is no longer used with primary multiglandular parathyroid disease due to increased understanding of its clonal nature. New terminology of “atypical parathyroid tumor” has been introduced for tumors highly worrisome for malignancy but without definitive invasion. “Parafibromin deficient parathyroid tumor” is now used for parathyroid neoplasms that show complete loss of nuclear parafibromin all tumor cells. Newer classification systems are increasingly used in the classification of adult and pediatric adrenal cortical neoplasms. The utility of CYP11B2 immunostain is being increasing reread recognized in the diagnosis of primary unilateral aldosteronism. This update focus on selected complex and significant areas in endocrine pathology that have undergone recent changes.

随着新的分类系统和对内分泌疾病的潜在发病机制和遗传改变（无论是体细胞还是种系）的了解的增加，内分泌病理学不断发展。近年来，甲状腺癌的分类发生了许多变化，其中最复杂的是“高级别滤泡细胞衍生的非间变性甲状腺癌”这一新类别，包括低分化甲状腺癌和分化的高级别甲状腺癌。由于对原发性多腺甲状旁腺疾病的克隆性认识的增加，“增生”一词不再用于原发性多腺甲状旁腺疾病。新术语“非典型甲状旁腺瘤”已引入肿瘤高度担心恶性，但没有明确的侵袭。“Parafibromin缺乏性甲状旁腺瘤”现在用于甲状旁腺肿瘤，显示所有肿瘤细胞的核旁纤蛋白完全丧失。更新的分类系统越来越多地用于成人和儿童肾上腺皮质肿瘤的分类。在原发性单侧醛固酮增多症的诊断中，CYP11B2免疫染色的应用越来越广泛。这次更新的重点是选定的复杂和重要的内分泌病理领域，已经经历了最近的变化。

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引用次数: 0

Clinical significance of the relative location of perineural cancer invasion on prostate biopsy: Detection within 1-mm of the core tip as an independent prognosticator 前列腺活检中神经周围癌浸润相对位置的临床意义：核心尖端1mm内检测可作为独立的预后指标

IF 2.6 2区医学 Q2 PATHOLOGY

Human pathology

Pub Date : 2026-02-01 Epub Date: 2025-12-11 DOI: 10.1016/j.humpath.2025.106015

Olalekan K. Lanipekun , Ying Wang , Hiroshi Miyamoto

Perineural invasion (PNI) detected on prostate biopsy is a recognized indicator of aggressive disease including extraprostatic extension. However, the clinical relevance of its relative location within the biopsy core remains poorly understood. We herein assessed corresponding radical prostatectomy findings and long-term oncologic outcomes in 180 prostate cancer patients exhibiting only a single focus of PNI on the entire systematic biopsy. PNI was located at <1-mm (n = 26; 14.4 %), ≥1 to <2-mm (n = 43; 23.9 %), ≥2 to <3-mm (n = 36; 20.0 %), ≥3 to <4-mm (n = 27; 15.0 %), ≥4 to <5-mm (n = 28; 15.6 %), or ≥5-mm (n = 20; 11.1 %) from the closest tip of the core. Univariate survival analysis in the dichotomized cohort based on the distance revealed significantly higher risks of biochemical recurrence (P < 0.001) and cancer-specific mortality (P = 0.042) in patients with PNI located <1-mm from the core tip than in those with PNI ≥1-mm. There were no significant differences in the clinicopathologic features examined, including total tumor length on biopsy or estimated tumor volume on prostatectomy, tumor grade on biopsy or prostatectomy, pT or pN category, and surgical margin status, between the <1-mm vs. ≥1-mm groups. In multivariable Cox regression analysis, PNI <1-mm from the tip (vs. ≥1-mm) showed significantly worse recurrence-free survival both before (hazard ratio 3.435, P < 0.001) and after (hazard ratio 3.228, P = 0.002) adjusting for prostatectomy factors. PNI detected within 1-mm of the biopsy core tip was thus found to independently predict a worse postoperative prognosis. This spatial detail of PNI on needle core biopsy may enhance the risk stratification of prostate cancer.

前列腺活检检测到的周围神经侵犯（PNI）是一种公认的侵袭性疾病的指标，包括前列腺外展。然而，其在活检核心内的相对位置的临床相关性仍然知之甚少。我们在此评估了180例前列腺癌患者的根治性前列腺切除术结果和长期肿瘤预后，这些患者在整个系统活检中只出现了单一的PNI病灶。句是位于& lt; 1毫米(n = 26。14.4%),≥1 & lt; 2毫米(n = 43。23.9%),≥2 & lt; 3毫米(n = 36。20.0%),≥3 & lt; 4毫米(n = 27。15.0%),≥4 & lt; 5毫米(n = 28; 15.6%),或≥5毫米(n = 20; 11.1%)最接近的核心。基于距离的二分类队列的单因素生存分析显示，PNI位于距核心尖端1毫米的患者的生化复发风险（P < 0.001）和癌症特异性死亡率（P = 0.042）显著高于PNI≥1毫米的患者。检查的临床病理特征，包括活检时的肿瘤总长度或前列腺切除术时的估计肿瘤体积，活检或前列腺切除术时的肿瘤分级，pT或pN类别以及手术切缘状态，在1毫米组和≥1毫米组之间没有显著差异。在多变量Cox回归分析中，在前列腺切除术因素校正前（风险比3.435,P < 0.001）和后（风险比3.228,P = 0.002）， PNI距根尖1 mm（与≥1 mm相比）的无复发生存率均显著降低。因此，在活检芯尖端1毫米内检测到的PNI可以独立预测较差的术后预后。针芯活检的PNI空间细节可能增加前列腺癌的风险分层。

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IF 2.6 2区医学 Q2 PATHOLOGY

Human pathology

Pub Date : 2026-02-01 Epub Date: 2026-02-03 DOI: 10.1016/S0046-8177(26)00037-7

引用次数: 0

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