THE TUMORI POREKLA BUBREŽNOG PARENHIMA- NOVA KLASIFIKACIJA PREMA SVETSKOJ ZDRAVSTVENOJ ORGANIZACIJI (2022)
Sažetak
Peto izdanje klasifikacije urogenitalnih tumora Svetske zdravstvene organizacije (SZO), objavljeno 2022. godine, sadrži značajne revizije u pogledu klasifikacije karcinoma bubrega. Pored osnovnih pododeljaka za svaki karcinom bubrega, kao što su epidemiologija, etiologija, markoskopski i mikroskopski opis, genetska istraživanja, uvršten je i pododeljak „Osnovni i poželjni dijagnostički kriterijumi“ koji je uključen u peto izdanje SZO i koji predstavlja morfološke dijagnostičke kriterijume, kombinovane sa imunohistohemijom i relevantnim molekularnim testovima. Globalno uvođenje masovnog paralelnog sekvenciranja će rezultirati dijagnostičkim pomakom sa morfologije na molekularne analize. Stoga je uvedena molekularno vođena klasifikacija tumora bubrega, uzimajući u obzir nedavna otkrića u genomici tumora bubrega. Takvi novi molekularno definisani epitelni tumori bubrega uključuju SMARCB1-deficijentni medularni karcinom bubrežnih ćelija (RCC), TFEB-izmenjen RCC, ALK-preuređen RCC i ELOC-mutiran RCC. Eozinofilni solidni i cistični RCC je nov morfološki definisan RCC entitet koga na prvom mestu karakteriše imunohemijska pozitivnost na CD20. S obzirom da su karcinomi bubrega rezistentni na hemio i radioterapiju, uvedena je imunoterapija kod RCC-ova koji imaju detektovane mutacije i koja je pokazala rezultate i dobar terapijski odgovor. Iz tog razloga je neophodno da se uvedu molekularna testirana prilikom standardne rutinske dijagnostike, kako bi se pacijentima uvodila imunoterapija i time poboljšao kvalitet i produžio životni vek.
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