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Envisioning the next WHO head and neck classification.
Margaret Brandwein-Gensler1, Shi Wei
1Departments of Pathology, University of Alabama at Birmingham, 3545 North Pavilion, 619 19th Street South, Birmingham, AL, 35249-7331, USA, MGensler@uab.edu.
Head and Neck Pathology
|March 6, 2014
Summary
The upcoming WHO classification needs updates for salivary gland tumors, proposing new terms for salivary duct carcinoma and cystadenocarcinoma. It also suggests adding hyalinizing clear cell carcinoma and sinonasal renal cell-like adenocarcinoma, and incorporating a risk model for oral squamous cell carcinoma prognosis.
Area of Science:
- Pathology
- Oncology
- Head and Neck Surgery
Background:
- Current World Health Organization (WHO) classifications for salivary gland neoplasms require revision to improve diagnostic accuracy and prognostic stratification.
- Existing terminology for certain salivary duct carcinomas and cystadenocarcinomas lacks precision and clarity.
- Emerging distinct entities like hyalinizing clear cell carcinoma (HCCC) and Sinonasal Renal Cell-like Adenocarcinoma (SNRCLA) warrant formal inclusion.
Purpose of the Study:
- To propose specific nomenclature changes for salivary gland tumors in the forthcoming WHO classification.
- To recommend the inclusion of HCCC and SNRCLA as distinct entities.
- To advocate for the integration of a prognostic risk model for oral squamous cell carcinoma (OSCC).
Main Methods:
- Review and analysis of current diagnostic criteria and nosology for salivary gland neoplasms.
- Evaluation of specific molecular markers (e.g., EWSR1-ATF1 fusion) for diagnostic specificity.
- Assessment of the prognostic value of histological features, including the "worst pattern of invasion" (WPOI) in OSCC.
Main Results:
- Conventional salivary duct carcinoma should be reclassified as "high-grade salivary duct carcinoma".
- Low-grade salivary duct carcinoma should replace "low-grade cribriform cystadenocarcinoma"; cystadenocarcinoma should be an "Exclusionary" category.
- EWSR1-ATF1 fusion is specific for HCCC; SNRCLA is a distinct clear cell neoplasm. WPOI-5 predicts locoregional recurrence and occult metastasis in OSCC.
Conclusions:
- The next WHO classification should adopt revised terminology for salivary duct carcinoma and cystadenocarcinoma.
- HCCC and SNRCLA should be formally recognized, with HCCC potentially retaining "hyalinizing" in its name.
- Integrating a risk model, particularly WPOI, into the OSCC section will enhance prognostic assessment and clinical decision-making for neck dissection.
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