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<meta name="description" content="腫瘍病理鑑別診断シリーズ「腎盂・尿管・膀胱癌」，待望の第2版．2022年にはWHO分類第5版が発行されたほか，初版刊行から10年が過ぎ，分子生物学的な知見の集積が進み，免疫チェックポイント阻害薬及び抗体-薬物複合体薬が登場するなど，泌尿器系腫瘍病理を取り巻く状況は様々な変化を続けている．そのような状況を踏まえ，本改訂では，最新の知見を盛り込み，尿路上皮癌を中心に，尿路に生じるその他の癌腫及び間葉系">

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		<h1 class="catchCopy">尿路腫瘍診断の要となる形態学的特徴と鑑別診断を押さえた必携の書！</h1>
		

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					編集：宮居弘輔（防衛医科大学校病院講師）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">腫瘍病理鑑別診断シリーズ「腎盂・尿管・膀胱癌」，待望の第2版．2022年にはWHO分類第5版が発行されたほか，初版刊行から10年が過ぎ，分子生物学的な知見の集積が進み，免疫チェックポイント阻害薬及び抗体-薬物複合体薬が登場するなど，泌尿器系腫瘍病理を取り巻く状況は様々な変化を続けている．そのような状況を踏まえ，本改訂では，最新の知見を盛り込み，尿路上皮癌を中心に，尿路に生じるその他の癌腫及び間葉系腫瘍の定義や概念，病理診断の要点や鑑別ポイントを，精選した病理写真とともに解説した．さらに臨床と病理の連携を目的に，病理診断に求められる情報や治療効果の判定についても解説した．</section><section class="preface">第2版の序<br><br>　尿路腫瘍のほとんどは尿路上皮系腫瘍に分類され，他臓器と比較して病理学的な特徴が少ない，単一病変と捉えられがちであった．しかしながらその臨床経過は様々で，再発を繰り返すも病期の進展を認めない病態から早期診断・治療を行ったにもかかわらず腫瘍死に至る病態まで存在する．この複雑な臨床経過を説明する病理学的機序の解明が進まなかった現状がある．しかしながら近年の尿路上皮系腫瘍の分子生物学的な知見の集積，特にThe Cancer Genome Atlas（TCGA）projectに代表される網羅的遺伝子解析が進められ，その病態は複雑であることが判明してきた．長らく有効な治療法の発展が乏しかった尿路上皮系腫瘍であるが，分子生物学的アプローチによる白金製剤の治療効果予測が可能となる状況が到来してきており，同アプローチによる尿路上皮癌分類の提唱もされつつある．また，免疫チェックポイント阻害薬及び抗体-薬物複合体薬の登場による予後改善が期待される状況になりつつある．2022年に刊行された『WHO Classification of Tumours, Urinaryand Male Genital Tumours（以下，WHO blue book） 第5版』ではこれらの分子生物学的な研究成果を取りあげているものの，その実行可能性や有用性の検証は未知数であるとして，分類の基準は引き続き形態診断が中心である．2021年に刊行された『腎盂・尿管・膀胱癌取扱い規約　第2版』でも形態所見が重要な立ち位置を占めている．診断に携わる病理医には現在の尿路上皮癌の分子生物学的な理解を意識しつつも，従来の形態像を重視した病理診断を行うことが求められている．<br>　2012年11月に本書の初版が刊行され，病理診断並びに臨床現場に重要な役割を果たしてきた．このような様々な進歩がみられる現状の中で，尿路上皮癌を中心にしつつも，初版に引き続き尿路に生じる尿路上皮癌以外の癌腫及び間葉系腫瘍の病理学的事項の解説並びにこれらの領域の最近の知見を反映させることを目的としてこの度の改訂を行った．<br>　本書の第1部では尿路上皮癌異型度分類の歴史的変遷，肉眼所見の解釈並びに検体の取扱い方を解説する．特に肉眼所見の解釈や切り出し方法に関しては知識や経験の不足が指摘されており，その改善を目的として本項目を立案した．第2部では『癌取扱い規約 第2版』並びに『WHO blue book 第5版』における分類を規範として，各組織型の典型像，組織学的バリエーションを豊富な写真で示して，診断，鑑別のポイントを解説する．第3部は術中迅速診断を含め，標本検鏡時に問題となる状況ごとに鑑別のポイント，ピットフォール，免疫染色などの追加検索の活用法を取りあげる．第4部は治療にあたる主治医と病理医の連携を深めることを目的に，最新の治療方法，治療方針を決定するうえで病理診断に求められる情報，治療効果の判定，病理診断報告書の記載法について触れる．併せて，近年急速に進展している分子生物学による検討及び分子生物学的分類について言及する．<br>　いずれの項目も執筆は最前線で診断・治療に携わっている先生方に依頼した．本書が病理医の診断の役に立つのみでなく，尿路に生じる腫瘍を多面的に捉え，診療に携わる者をつなぐ役割を果たすことを期待している．<br><br>　令和5年10月<br>　宮居弘輔<br>　都築豊徳<br><br><br>　この「腫瘍病理鑑別診断アトラスシリーズ」は日本病理学会の編集協力のもと，刊行委員会を設置し，本シリーズが日本の病理学の標準的なガイドラインとなるよう，各巻ごとの編集者選定をはじめ取りまとめを行っています．<br><br>　腫瘍病理鑑別診断アトラス刊行委員会<br>　小田義直，坂元亨宇，都築豊徳，深山正久，松野吉宏，森谷卓也</section><section class="indexes">第1部　検鏡前の確認事項	<br>　Ⅰ．尿路腫瘍分類の変遷		<br>　Ⅱ．尿路腫瘍の肉眼所見		<br>　Ⅲ．病理標本の取扱い方		<br>		<br>第2部　組織型と診断の実際		<br>　Ⅰ．尿路上皮系腫瘍		<br>　　1　尿路上皮内癌	<br>　　2　乳頭腫および非浸潤性乳頭状尿路上皮癌	<br>　　3　内反性増殖を示す腫瘍	<br>　　4　浸潤性尿路上皮癌	<br>　　（1）通常型および種々の分化を伴う浸潤性尿路上皮癌<br>　　（2）微小乳頭状亜型，形質細胞様亜型，肉腫様亜型<br>　　（3）その他の亜型<br>　Ⅱ．扁平上皮系腫瘍		<br>　Ⅲ．腺系腫瘍		<br>　Ⅳ．尿膜管に発生する腫瘍		<br>　Ⅴ．ミュラー管腫瘍		<br>　Ⅵ．神経内分泌腫瘍		<br>　Ⅶ．その他・間葉系腫瘍		<br>　Ⅷ．腫瘍様病変		<br>　Ⅸ．尿細胞診の実際とパリシステム<br><br>第3部　鑑別ポイント			<br>　Ⅰ．真の乳頭状腫瘍と低乳頭状増殖を示す良性・悪性病変の鑑別		<br>　Ⅱ．腫瘍深達度評価のポイント		<br>　Ⅲ．尿路腫瘍の診断に有用な免疫染色		<br>　Ⅳ．脈管侵襲の評価		<br>　Ⅴ．術中迅速診断での切除断端評価		<br>　Ⅵ．膀胱原発癌と他臓器癌の膀胱浸潤・転移との鑑別	<br><br>第4部　臨床との連携	<br>　Ⅰ．尿路腫瘍の膀胱鏡所見	<br>　Ⅱ．尿路腫瘍の画像診断～膀胱癌VI-RADS，上部尿路上皮癌の画像診断について～	<br>　Ⅲ．腎盂・尿管・膀胱癌の診断並びに治療方法		<br>　Ⅳ．病理診断報告書の記載	<br>　Ⅴ．尿路上皮癌における病理学的治療効果判定基準		<br>　Ⅵ．治療に伴う組織像・細胞像の変化		<br>　Ⅶ．尿路上皮腫瘍の分子生物学的異常と免疫表現型		<br>　Ⅷ．遺伝性腫瘍		<br>			<br>索引</section></article>
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