泌尿器 TNM Stage

        2022年04月08日最終更新

Kidney

T1a ≤4 cm
T1b >4 cm ≤7 cm
T2a >7 to 10 cm
T2b >10 cm
T3a Renal vein, perinephric fat
T3b Vena cava below diaphragm
T3c Vena cava above diaphragm or wall of IVC
T4 Beyond Gerota fascia, ipsilateral adrenal
N1 single

Stage Grouping
I     T1N0M0
II    T2N0M0
III T3 or N1
IV T4 or M1


Urinary bladder

Ta    Non-invasive papillary
Tis   In situ: "flat tumor"
T1    Lamina propria (subepithelial connective tissue)
Nested variant では retraction artifact など浸潤の所見がなくとも浸潤とする
pT1 以上は 必ず LVI を記載しよう(寺本先生より)
T2a  Superficial muscular invasion (inner half)
深部 TURBT では筋層か採取されているかどうか明記しよう(寺本先生より)
T2b  Deep muscular invasion (outer half)
T3a   microscopic perivesical
T3b   extravesical mass (macroscopically)
T4a   prostatic stroma, seminal vesicle, uterus, or vagina
T4b   pelvic wall or abdominal wall

N1 Single pelvic
N2 Multiple pelvic
N3 Common iliac

M1a beyond common iliac LN
M1b non-lymph-node

Stage Grouping
0a
0is
I
II
III T3, T4a
IV T4b or N1-3 or M1

Urothelial tumors
Infiltrating urothelial carcinoma
8120/3
with squamous differentiation (記載しよう)
with glandular differentiation  (記載しよう)
with trophoblastic differentiation
Nested
Microcystic
Micropapillary 8131/3
Lymphoepithelioma-like 8082/3
Lymphoma-like
Plasmacytoid
Sarcomatoid 8122/3
Giant cell 8031/3
Undifferentiated 8020/3
Non-invasive urothelial neoplasias
Urothelial carcinoma in situ 8120/2
Non-invasive papillary urothelial carcinoma, high grade 8130/23
Non-invasive papillary urothelial carcinoma, low grade 8130/21
Non-invasive papillary urothelial neoplasm of low malignant potential 8130/1
Urothelial papilloma 8120/2
Inverted urothelial papilloma 8121/0

Grading:
Low grade (低異型度):核は均一に腫大,基底層に分裂,コーヒー豆様 (elongated, grooved), 微細クロマチンを持つ核, 配列も大きさもそろっている。核小体は不明瞭, 2倍体が多い。

High grade (高異型度):極性,大きさ,形状,クロマチンパターンに多様性がある。核小体は明瞭,分裂像はしばしば認められる。CK20, p53, p63は陽性のことが多く,aneuploidy が通常認められる。2q-, 5q-, 6q-, 9p-, 9q-, 17q+, 18q-, 20q+はpTa G3でそれぞれ3割以上に認められる。

Adenocarcinoma, NOS 8140/3
Enteric (colonic type)
Mucinous 8480/3
Signet-ring cell 8490/3
Clear cell 8310/3
Hepatoid
Mixed

Urachal carcinoma 8010/3
Villous adenoma 8261/0

TURBT の標本作製個数
CAP によれば,腫瘍径 1 cm につき1カセット作製(10カセットまで)。これらがすべて非浸潤性であった場合,あるいは粘膜下層までの浸潤にとどまる場合,追加の標本(可能ならすべて)を作製しさらに確認する。
[10カセット以上作ることに,ほぼ意味がないように思うのが,引用できる論文がない...]
別の論文によれば,最低6 g (3カセット),できればさらに10 g 毎に1カセットとある (Lopez-Beltran et al. Pathologica 2001)

Renal pelvis, Ureter

pTa Non-invasive papillary
pTis In situ
pT1 Subepithelial connective tissue
pT2 Muscularis
pT3 Beyond muscularis (直近の脂肪織)
pT4 Adjacent organ, perinephric fat

N1    single, ≤ 2 cm ; N2 Single >2 cm or multiple

Stage Grouping
0a
0is
I
II
III
IV T4 or N1-2 or M1


Urethra

Male Penile Urethra and Female Urethra
pT0: No evidence of primary tumor
pTa: Non-invasive papillary carcinoma
 pTis: Carcinoma *in situ*
pT1: Tumor invades subepithelial connective tissue
pT2: Tumor invades any of the following: corpus spongiosum, periurethral muscle
pT3: Tumor invades any of the following: corpus cavernosum, anterior vagina
pT4: Tumor invades other adjacent organs (invasion of the bladder)

Prostatic Urethra
pTa: Non-invasive papillary carcinoma
pTis: Carcinoma *in situ* involving the prostatic urethra or periurethral or prostatic ducts without stromal invasion
pT1: Tumor invades urethral subepithelial connective tissue immediately underlying the urothelium
pT2: Tumor invades the prostatic stroma surrounding ducts either by direct extension from the urothelial surface or by invasion from prostatic ducts
pT3: Tumor invades the periprostatic fat
pT4: Tumor invades other adjacent organs (e.g., extraprostatic invasion of the bladder wall, rectal wall)

pN1: Single
    inguinal, true pelvis (perivesical, obturator, internal and external iliac), or presacral 総腸骨は pM1?
pN2: Multiple

Stage Grouping (AJCC prognostic stage groups)
0a
0is
I
II
III T3 or N1
IV T4 or N2 or M1

Penis

pTis PeIN
pTa Noninvasive localized SCC
pT1a LVI0, Pn0, G1-2
pT1b LVI1 or Pn1 or G3-4
pT2 Corpus spongiosum invasion
pT3 Corpora cavernosum invasion
pT4 Scrotal/prostate/bone invasion

pN1 ≤ 2 inguinal
pN2 ≥3 inguinal or bilateral
pN3 Extranodal extension or pelvic

Stage I     pT1a
Stage IIA pT1b pT2
Stage IIB    pT3
Stage IIIA    N1
Stage IIIB    N2
Stage IV    T4 or N3 or M1