如何领会：未成熟畸胎瘤的Norris分级系统？

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如何领会：未成熟畸胎瘤的Norris分级系统？

姓名：	×××	性别：	年龄：
标本名称：
简要病史：
肉眼检查：

如何领会：未成熟畸胎瘤的Norris分级系统？

一、回允中主译《阿克曼外科病理学》第八版下卷：高子芬、潘增刚、裴斐译第19章女性生殖系统第1499页：Norris等提出的分级系统如下：

Ⅰ级成熟组织丰富，其间混有疏松的间叶组织，偶见核分裂象；未成熟的软骨；牙齿原基。

Ⅱ级成熟组织较少；神经上皮灶少见，核分裂象常见，任何一张切片中未成熟神经组织不超过3个低倍（x 40）视野。

Ⅲ级几乎没有成熟组织；大量的神经上皮成份，同时有富于细胞的间质，占4个或4个以上的低倍视野。

二、回允中主译Stephen S.Sternberg主编《诊断外科病理学》第3版下卷：沈丹华译，回允中校：卵巢第2365页：

不成熟畸胎瘤根据不成熟组织的含量，这其中几乎总是神经组织，分成1~3级。1级肿瘤有稀少的胚胎性神经组织灶，在任何一张切片中占据一个低倍视野（x 40）以下，2级肿瘤含有中等量的胚胎性神经组织，在任何一张切片中占据1个以上但4个以下的低倍视野，3级肿瘤含有大量的胚胎性神经组织，在任何一张切片中占据4个或更多的低倍视野。

三、张建民著《卵巢病理学》第441页：由2003年卵巢肿瘤分类推荐Norris（1976）3级分类：

1级肿瘤罕见灶状不成熟神经外胚层组织，每张切片＜1(40x )。

2级肿瘤内不成熟神经外胚层组织或类似成份每张切片1~3（40x ）。

3级肿瘤内大量不成熟神经外胚层组织每张切片＞3（40x ）。

上述叙述中，前二者的“任何一张切片”与后者之“每张切片”字面上理解似乎不同。“任何一张”，意味着只要有一张达到标准即可；而后者“每张”则标准陡然上升，意味着一张都不能少。
那么，大家觉得标准应该是如何界定？？？

如何领会：未成熟畸胎瘤的Norris分级系统？

姓名：	×××	性别：	年龄：
标本名称：
简要病史：
肉眼检查：

如何领会：未成熟畸胎瘤的Norris分级系统？

一、回允中主译《阿克曼外科病理学》第八版下卷：高子芬、潘增刚、裴斐译第19章女性生殖系统第1499页：Norris等提出的分级系统如下：

Ⅰ级成熟组织丰富，其间混有疏松的间叶组织，偶见核分裂象；未成熟的软骨；牙齿原基。

Ⅱ级成熟组织较少；神经上皮灶少见，核分裂象常见，任何一张切片中未成熟神经组织不超过3个低倍（x 40）视野。

Ⅲ级几乎没有成熟组织；大量的神经上皮成份，同时有富于细胞的间质，占4个或4个以上的低倍视野。

二、回允中主译Stephen S.Sternberg主编《诊断外科病理学》第3版下卷：沈丹华译，回允中校：卵巢第2365页：

不成熟畸胎瘤根据不成熟组织的含量，这其中几乎总是神经组织，分成1~3级。1级肿瘤有稀少的胚胎性神经组织灶，在任何一张切片中占据一个低倍视野（x 40）以下，2级肿瘤含有中等量的胚胎性神经组织，在任何一张切片中占据1个以上但4个以下的低倍视野，3级肿瘤含有大量的胚胎性神经组织，在任何一张切片中占据4个或更多的低倍视野。

三、张建民著《卵巢病理学》第441页：由2003年卵巢肿瘤分类推荐Norris（1976）3级分类：

1级肿瘤罕见灶状不成熟神经外胚层组织，每张切片＜1(40x )。

2级肿瘤内不成熟神经外胚层组织或类似成份每张切片1~3（40x ）。

3级肿瘤内大量不成熟神经外胚层组织每张切片＞3（40x ）。

上述叙述中，前二者的“任何一张切片”与后者之“每张切片”字面上理解似乎不同。“任何一张”，意味着只要有一张达到标准即可；而后者“每张”则标准陡然上升，意味着一张都不能少。
那么，大家觉得标准应该是如何界定？？？

标签：卵巢畸胎瘤成熟性非成熟性

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21 楼发表于2006-10-13 22:22:00举报|引用
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本帖最后由于 2006-10-13 23:22:00 编辑

Immature teratomas have been traditionally graded from 1 to 3 based on the amount of immature, almost always neural tissue (112). Grade 1 tumors have rare foci of embryonal neural tissue occupying less than 1 low-power (×40) field (lpf) in any slide, grade 2 tumors contain moderate quantities of embryonal neural tissue, occupying more than 1 but fewer than 4 lpfs in any slide, grade 3 tumors contain large quantities of embryonal neural tissue occupying 4 or more lpfs in
any slide.
Sternberg Diagnostic Surgical Pathology, 4th Edition
WHO引用的是这篇文章
1: Cancer. 1976 May;37(5):2359-72.
Immature (malignant) teratoma of the ovary: a clinical and pathologic study of 58 cases.
Norris HJ,
Zirkin HJ,
Benson WL.
Fifty-eight immature ovarian teratomas were studied. Neoplams with other germ cell elements (endodermal sinus tumor, choriocarcinoma, and dysgerminoma) were excluded so that the clinical and pathologic features of "pure" immature teratomas could be defined and correlated with the prognosis. The primary tumors and their metastatic growths were graded from 0 to 3. Forty were stage I; nine, stage II; and nine, stage III. The size and stage of teratomas were related to survival, but it was the grade of the primary tumor that best determined the likelihood of extraovarian spread, and it was the grade of the metastases that related best to the subsequent course. Actuarial survival was 63% at 5 years and also at 10 years. Regardless of the grade of the primary tumor, only one of six with grade 0 metastases progressed, and that neoplasms may not have been adequately sampled. Two of five neoplasms having grade 1 metastases did not progress, and two of six patients with grade 2 metastatic growths were living after relatively long intervals. All seven patients with grade 3 metastases died with tumor, none surviving more than 2.1 years. Survival of patients with grade 1, 2, and 3 neoplasms was 81, 60, and 30% respectively. The importance of adequate sampling of primary tumor and metastases for estimating prognosis and determining therapy is stressed.
PMID: 1260722 [PubMed - indexed for MEDLINE]

一片最新的综述中谈及了这个问题

Roth LM, Talerman A. Recent advances in the pathology and classification of ovarian germ cell tumors.Int J Gynecol Pathol. 2006 Oct;25(4):305-20.
PMID: 16990705 [PubMed - in process]
Traditionally, immature teratomas are graded using a 3-tiered system based on the amount of immature neuroepithelium present (34) and more recently, the criteria were modified (35). Tumors with an aggregate amount of immature tissue not exceeding 1 low-power field (×40, using a ×4 objective and a ×10 eyepiece) on any one slide are considered grade 1; those with more than 1 but not exceeding 3 high-power fields on any one slide are considered grade 2, and those with more than 3 low-power fields of immature tissue are grade 3 (35). In the same article, a 2-tiered system was proposed as an alternative, with grade 1 tumors classified as low grade and grades 2 and 3 tumors considered as high grade. The grading system has clinical significance in that grade 1 tumors confined to the ovary do not require combination chemotherapy, whereas higher-grade tumors are treated.
他所引用的文章

34. Norris HJ, Zirkin HJ, Benson WL. Immature (malignant) teratoma of the ovary: a clinical and pathologic study of 58 cases. Cancer 1976;37:2359-72. LinkSource Bibliographic Links [Context Link]

35. O’Connor DM, Norris HJ. The influence of grade on the outcome of stage I ovarian immature (malignant) teratomas and the reproducibility of grading. Int J Gynecol Pathol 1994;13:283-9. LinkSource Bibliographic Links [Context Link]

对照一下原文的出处，就不难理解究竟是哪一种翻译更为准确，这就提醒我们，在看参考书的时候，如果对于文章中的内容有疑问，还是需要去阅读原文，因为翻译的不准确，以讹传讹的事情实在是太多了

Immature teratomas have been traditionally graded from 1 to 3 based on the amount of immature, almost always neural tissue (112). Grade 1 tumors have rare foci of embryonal neural tissue occupying less than 1 low-power (×40) field (lpf) in any slide, grade 2 tumors contain moderate quantities of embryonal neural tissue, occupying more than 1 but fewer than 4 lpfs in any slide, grade 3 tumors contain large quantities of embryonal neural tissue occupying 4 or more lpfs in
any slide.
Sternberg Diagnostic Surgical Pathology, 4th Edition
WHO引用的是这篇文章
1: Cancer. 1976 May;37(5):2359-72.
Immature (malignant) teratoma of the ovary: a clinical and pathologic study of 58 cases.
Norris HJ,
Zirkin HJ,
Benson WL.
Fifty-eight immature ovarian teratomas were studied. Neoplams with other germ cell elements (endodermal sinus tumor, choriocarcinoma, and dysgerminoma) were excluded so that the clinical and pathologic features of "pure" immature teratomas could be defined and correlated with the prognosis. The primary tumors and their metastatic growths were graded from 0 to 3. Forty were stage I; nine, stage II; and nine, stage III. The size and stage of teratomas were related to survival, but it was the grade of the primary tumor that best determined the likelihood of extraovarian spread, and it was the grade of the metastases that related best to the subsequent course. Actuarial survival was 63% at 5 years and also at 10 years. Regardless of the grade of the primary tumor, only one of six with grade 0 metastases progressed, and that neoplasms may not have been adequately sampled. Two of five neoplasms having grade 1 metastases did not progress, and two of six patients with grade 2 metastatic growths were living after relatively long intervals. All seven patients with grade 3 metastases died with tumor, none surviving more than 2.1 years. Survival of patients with grade 1, 2, and 3 neoplasms was 81, 60, and 30% respectively. The importance of adequate sampling of primary tumor and metastases for estimating prognosis and determining therapy is stressed.
PMID: 1260722 [PubMed - indexed for MEDLINE]

一片最新的综述中谈及了这个问题

Roth LM, Talerman A. Recent advances in the pathology and classification of ovarian germ cell tumors.Int J Gynecol Pathol. 2006 Oct;25(4):305-20.
PMID: 16990705 [PubMed - in process]
Traditionally, immature teratomas are graded using a 3-tiered system based on the amount of immature neuroepithelium present (34) and more recently, the criteria were modified (35). Tumors with an aggregate amount of immature tissue not exceeding 1 low-power field (×40, using a ×4 objective and a ×10 eyepiece) on any one slide are considered grade 1; those with more than 1 but not exceeding 3 high-power fields on any one slide are considered grade 2, and those with more than 3 low-power fields of immature tissue are grade 3 (35). In the same article, a 2-tiered system was proposed as an alternative, with grade 1 tumors classified as low grade and grades 2 and 3 tumors considered as high grade. The grading system has clinical significance in that grade 1 tumors confined to the ovary do not require combination chemotherapy, whereas higher-grade tumors are treated.
他所引用的文章

34. Norris HJ, Zirkin HJ, Benson WL. Immature (malignant) teratoma of the ovary: a clinical and pathologic study of 58 cases. Cancer 1976;37:2359-72. LinkSource Bibliographic Links [Context Link]

35. O’Connor DM, Norris HJ. The influence of grade on the outcome of stage I ovarian immature (malignant) teratomas and the reproducibility of grading. Int J Gynecol Pathol 1994;13:283-9. LinkSource Bibliographic Links [Context Link]

对照一下原文的出处，就不难理解究竟是哪一种翻译更为准确，这就提醒我们，在看参考书的时候，如果对于文章中的内容有疑问，还是需要去阅读原文，因为翻译的不准确，以讹传讹的事情实在是太多了

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22 楼发表于2006-10-13 23:51:00举报|引用
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首先，谢谢九等生网友!

他说的方法非常好!!

Immature teratomas have been traditionally graded from 1 to 3 based on the amount of immature, almost always neural tissue (112). Grade 1 tumors have rare foci of embryonal neural tissue occupying less than 1 low-power (×40) field (lpf) in any slide, grade 2 tumors contain moderate quantities of embryonal neural tissue, occupying more than 1 but fewer than 4 lpfs in any slide, grade 3 tumors contain large quantities of embryonal neural tissue occupying 4 or more lpfs in any slide.
Sternberg Diagnostic Surgical Pathology, 4th Edition

但是，“fewer than 4 lpfs in any slide”与“occupying 4 or more lpfs in any slide. ”似乎是矛盾的。前者是全否定，后者是全肯定，那么部分肯定与部分否定的情况如何呢？对了，那一定是归为Grade 2~3了。