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Foreword Recently, the 16th Pediatric Oncology Symposium co-sponsored by the Pediatric Oncology Committee of the Guangdong Anti-Cancer Association and the Pediatric Oncology Committee of the Chinese Anti-Cancer Association and undertaken by the Department of Pediatric Oncology of Sun Yat-sen University Cancer Center was held online in Guangzhou.
Convened by a combination of offline
.
At the meeting, Professor Zhang Yu from the Cancer Center of Sun Yat-sen University shared the key points of pathological diagnosis of solid tumors in children, and vividly introduced the importance of immunohistochemistry and molecular detection in pathological diagnosis and identification through cases
.
After the meeting, Yimaitong invited Professor Zhang Yu to interpret the progress and development direction of pathological diagnosis of solid tumors in children
.
Expert Profile Zhang YuDeputy Chief Physician, Sun Yat-sen University Cancer Prevention Center, Department of Pathology, Child Cancer Pathology Subspecialty Director, Visiting Scholar, Los Angeles Children's Hospital of the University of Southern California, United States Visiting Scholar, Guangdong Anticancer Association, Oncology Pathology Youth Committee Standing Committee, Guangdong Anticancer Association, Oncology Pathology Major Committee member, Pediatric Oncology Professional Committee of Guangdong Anti-Cancer Association, member of Youth Committee of Guangdong Medical Association Pathology Branch, Yi Maitong: Pathological examination is the main diagnostic method for solid tumors in children.
Could you please talk about the pathological characteristics of solid tumors in children What? Professor Zhang Yu: Compared with adult tumors, the peculiarities of solid tumors in children are mainly manifested in the following four aspects: First, the specific disease types
.
Adult tumors are more common in epithelial origin, that is, cancers that people often say, such as nasopharyngeal carcinoma, colon adenocarcinoma, esophageal squamous cell carcinoma, etc.
; while solid tumors in children are more common in blastoma and sarcoma, such as neuroblastoma Tumor, Wilms’ tumor, Ewing’s sarcoma, etc.
, some diseases only occur in children
.
Secondly, because of the special disease, the morphology under the microscope is special, and most of the original tumors are differentiated, which increases the difficulty of pathological diagnosis
.
Therefore, the vast majority of solid tumors in children need to be assisted by auxiliary methods such as immunohistochemistry and molecular testing.
.
Third, the diagnostic criteria for benign and malignant solid tumors in children are different from those in adults
.
For example, juvenile xanthogranuloma is a benign self-limiting disease, but the cell proliferation index can occasionally be seen under the microscope, and the disease can also involve internal organs or bone, and even cause bone destruction
.
Fourth, solid tumors in children are mostly related to genetic changes
.
Therefore, necessary genetic testing can help pathological diagnosis and find therapeutic targets
.
Yimaitong: Recently, what progress has been made in the pathological diagnosis of solid tumors in children? What value does this have to improve the survival outcome of domestic children with solid tumors? Professor Zhang Yu: Due to morbidity, there is a higher degree of clinical attention to adult tumors.
The progress of clinical research, diagnostic classification, and therapeutic drugs in the field of adult tumors is also updated more quickly than children's tumors
.
However, in recent years, childhood tumors have gradually attracted clinical attention
.
When measuring the treatment and prognosis of childhood tumors, we should focus on the 20-year and 50-year survival rates, not just the 5-year and 10-year survival rates for adult tumors
.
A good prognosis is closely related to precise treatment, and the basis of precise treatment is precise pathological diagnosis and classification
.
The progress of pathological diagnosis of childhood tumors in recent years is mainly reflected in the following two aspects: First, refined and updated pathological diagnostic criteria and classification
.
For example, for neuroblastoma and Wilms tumor that occur in children, risk grading based on new diagnosis and classification criteria can be a good guide for clinical treatment, which not only avoids overtreatment of low-risk patients, It can also identify high-risk patients and actively treat them
.
The second is the application of molecular testing.
Among children's solid tumors, soft tissue tumors account for a relatively high proportion, and most of the differentiated primitive tumors, many of which rely on genetic testing
.
At present, most domestic units have carried out molecular testing, which is of great significance for the diagnosis and molecular typing of solid tumors in children and the search for therapeutic targets
.
For example, molecular testing of small round cell rhabdomyosarcoma can distinguish acinar rhabdomyosarcoma from embryonic rhabdomyosarcoma, both of which have different malignancy and treatment options
.
Furthermore, the prognosis of fusiform/sclerosing rhabdomyosarcoma is quite different, and molecular typing based on second-generation sequencing can be used to guide subsequent clinical treatment
.
The application of molecular target detection has enabled more patients to benefit from targeted therapy
.
For example, if NTRK rearrangement is detected, the targeted drug larotinib can be used
.
Yimaitong: For the pathological diagnosis of solid tumors in children, what do you think need to be improved in clinical practice? What are the future directions? Professor Zhang Yu: As mentioned earlier, childhood tumors have their particularities compared with adult tumors
.
The establishment of the child tumor pathology subspecialty will help us keep up with the latest developments at home and abroad, update diagnostic specifications in time, maintain good clinical and pathological communication, so that pathological diagnosis can better serve the clinic and children, and form pathological diagnosis and clinical treatment.
The virtuous circle of mutual promotion and mutual improvement realizes high-precision pathological diagnosis
.
Therefore, it is recommended that qualified hospitals separate childhood tumor pathology from major pathology
.
In addition, clinical diagnosis and treatment has entered the molecular age, and more and more tumors are named after molecular changes
.
For example, sarcoma with CIC rearrangement, sarcoma with BCOR gene translocation, and spindle cell tumor with NTRK rearrangement
.
In the future, more genetic changes will be identified and named in tumors, and more targeted drugs will be used in clinics to benefit more children
.
October Breast Cancer Prevention Month Free Clinic Lecture Scan the QR code below, add the assistant WeChat, you can participate in the breast cancer lecture on-site interaction, and you will have the opportunity to receive a copy of the exquisite boutique!
Convened by a combination of offline
.
At the meeting, Professor Zhang Yu from the Cancer Center of Sun Yat-sen University shared the key points of pathological diagnosis of solid tumors in children, and vividly introduced the importance of immunohistochemistry and molecular detection in pathological diagnosis and identification through cases
.
After the meeting, Yimaitong invited Professor Zhang Yu to interpret the progress and development direction of pathological diagnosis of solid tumors in children
.
Expert Profile Zhang YuDeputy Chief Physician, Sun Yat-sen University Cancer Prevention Center, Department of Pathology, Child Cancer Pathology Subspecialty Director, Visiting Scholar, Los Angeles Children's Hospital of the University of Southern California, United States Visiting Scholar, Guangdong Anticancer Association, Oncology Pathology Youth Committee Standing Committee, Guangdong Anticancer Association, Oncology Pathology Major Committee member, Pediatric Oncology Professional Committee of Guangdong Anti-Cancer Association, member of Youth Committee of Guangdong Medical Association Pathology Branch, Yi Maitong: Pathological examination is the main diagnostic method for solid tumors in children.
Could you please talk about the pathological characteristics of solid tumors in children What? Professor Zhang Yu: Compared with adult tumors, the peculiarities of solid tumors in children are mainly manifested in the following four aspects: First, the specific disease types
.
Adult tumors are more common in epithelial origin, that is, cancers that people often say, such as nasopharyngeal carcinoma, colon adenocarcinoma, esophageal squamous cell carcinoma, etc.
; while solid tumors in children are more common in blastoma and sarcoma, such as neuroblastoma Tumor, Wilms’ tumor, Ewing’s sarcoma, etc.
, some diseases only occur in children
.
Secondly, because of the special disease, the morphology under the microscope is special, and most of the original tumors are differentiated, which increases the difficulty of pathological diagnosis
.
Therefore, the vast majority of solid tumors in children need to be assisted by auxiliary methods such as immunohistochemistry and molecular testing.
.
Third, the diagnostic criteria for benign and malignant solid tumors in children are different from those in adults
.
For example, juvenile xanthogranuloma is a benign self-limiting disease, but the cell proliferation index can occasionally be seen under the microscope, and the disease can also involve internal organs or bone, and even cause bone destruction
.
Fourth, solid tumors in children are mostly related to genetic changes
.
Therefore, necessary genetic testing can help pathological diagnosis and find therapeutic targets
.
Yimaitong: Recently, what progress has been made in the pathological diagnosis of solid tumors in children? What value does this have to improve the survival outcome of domestic children with solid tumors? Professor Zhang Yu: Due to morbidity, there is a higher degree of clinical attention to adult tumors.
The progress of clinical research, diagnostic classification, and therapeutic drugs in the field of adult tumors is also updated more quickly than children's tumors
.
However, in recent years, childhood tumors have gradually attracted clinical attention
.
When measuring the treatment and prognosis of childhood tumors, we should focus on the 20-year and 50-year survival rates, not just the 5-year and 10-year survival rates for adult tumors
.
A good prognosis is closely related to precise treatment, and the basis of precise treatment is precise pathological diagnosis and classification
.
The progress of pathological diagnosis of childhood tumors in recent years is mainly reflected in the following two aspects: First, refined and updated pathological diagnostic criteria and classification
.
For example, for neuroblastoma and Wilms tumor that occur in children, risk grading based on new diagnosis and classification criteria can be a good guide for clinical treatment, which not only avoids overtreatment of low-risk patients, It can also identify high-risk patients and actively treat them
.
The second is the application of molecular testing.
Among children's solid tumors, soft tissue tumors account for a relatively high proportion, and most of the differentiated primitive tumors, many of which rely on genetic testing
.
At present, most domestic units have carried out molecular testing, which is of great significance for the diagnosis and molecular typing of solid tumors in children and the search for therapeutic targets
.
For example, molecular testing of small round cell rhabdomyosarcoma can distinguish acinar rhabdomyosarcoma from embryonic rhabdomyosarcoma, both of which have different malignancy and treatment options
.
Furthermore, the prognosis of fusiform/sclerosing rhabdomyosarcoma is quite different, and molecular typing based on second-generation sequencing can be used to guide subsequent clinical treatment
.
The application of molecular target detection has enabled more patients to benefit from targeted therapy
.
For example, if NTRK rearrangement is detected, the targeted drug larotinib can be used
.
Yimaitong: For the pathological diagnosis of solid tumors in children, what do you think need to be improved in clinical practice? What are the future directions? Professor Zhang Yu: As mentioned earlier, childhood tumors have their particularities compared with adult tumors
.
The establishment of the child tumor pathology subspecialty will help us keep up with the latest developments at home and abroad, update diagnostic specifications in time, maintain good clinical and pathological communication, so that pathological diagnosis can better serve the clinic and children, and form pathological diagnosis and clinical treatment.
The virtuous circle of mutual promotion and mutual improvement realizes high-precision pathological diagnosis
.
Therefore, it is recommended that qualified hospitals separate childhood tumor pathology from major pathology
.
In addition, clinical diagnosis and treatment has entered the molecular age, and more and more tumors are named after molecular changes
.
For example, sarcoma with CIC rearrangement, sarcoma with BCOR gene translocation, and spindle cell tumor with NTRK rearrangement
.
In the future, more genetic changes will be identified and named in tumors, and more targeted drugs will be used in clinics to benefit more children
.
October Breast Cancer Prevention Month Free Clinic Lecture Scan the QR code below, add the assistant WeChat, you can participate in the breast cancer lecture on-site interaction, and you will have the opportunity to receive a copy of the exquisite boutique!
