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<meta name="description" content="腫瘍病理鑑別診断シリーズ「造血器腫瘍」，WHO分類第5版に対応した待望の第2版．初版刊行（2013）から13年．造血器系のWHO分類も第5版（2024）となり，分子分類がより重要視され，分類自体も細かく，複雑になった．また，2025年には造血器腫瘍の遺伝子パネル検査が保険収載されるなど，造血器腫瘍の診断を取り巻く環境は変化の只中にある．そうした状況を踏まえ，今改訂では，最新知見を盛り込み，精選した">

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		<h1 class="catchCopy">造血器腫瘍の病理診断における必携の一冊！WHO分類第5版対応の改訂版！</h1>
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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「造血器腫瘍」，WHO分類第5版に対応した待望の第2版．初版刊行（2013）から13年．造血器系のWHO分類も第5版（2024）となり，分子分類がより重要視され，分類自体も細かく，複雑になった．また，2025年には造血器腫瘍の遺伝子パネル検査が保険収載されるなど，造血器腫瘍の診断を取り巻く環境は変化の只中にある．そうした状況を踏まえ，今改訂では，最新知見を盛り込み，精選した病理写真とともに病理診断の要点，鑑別ポイントを解説した．</section><section class="preface">第2版の序<br><br>　造血器腫瘍は，リンパ球性腫瘍と骨髄性腫瘍に大別され，リンパ球性腫瘍は形態学的観察に基づいた免疫組織化学・フローサイトメトリー・遺伝子解析にて診断される．よって，形態学的な観察が非常に重要となることが多く，この大きな流れはWHO分類第5版（2024年）においても踏襲されている．一方，骨髄性腫瘍の診断は，これまでも塗抹標本などにおける芽球の占めるパーセンテージの測定など検査部や血液内科医によってなされることが多かったが，近年，融合遺伝子などの腫瘍化ドライバー遺伝子による分類がより重要視されており，将来的には，分類＝治療方針の決定に明瞭につながると思われる．<br>　WHO分類第5版では，骨髄性腫瘍の診断においては分子検査のスクリーニングのウエイトが大きくなってきており，形態像のみでは確定診断に至りにくくなっている．しかしながら，骨髄吸引クロットや骨髄生検標本は，病理に提出される検体の中でその占める割合は決して低くないのも事実である．症例の病態に関する情報が十分把握できない状況も想定されるが，他の検査所見と併せて統合的に診断書を作成することが理想的である．一方で病理診断のウエイトが大きい症例も存在する．例えば，dry tap症例・免疫組織化学を必要とする症例が挙げられる．いかなる状況においても，患者にとって何が有益なのかを意識しながら診断をする姿勢が必要であると考えられる．そこで本書では，病理医が知っておくと役立つような，造血器腫瘍に関する検体の取り扱い手技・遺伝子診断・治療方針に関して，血液内科医に解説を依頼した．そして，病理診断報告書に何を求めているか，言い換えれば病理医が何を病理診断報告書に記載しておかなければならないかを整理した．<br>　本書では，初版でWHO分類第4版（2008年）を柱とした分類が提示されていたことを受け，WHO分類第5版を主軸とした分類を提示・解説することとする．引き続き，重要な鑑別診断は「第2部 組織型と診断の実際」の各腫瘍の項で述べるが，病理組織診断で求められ，かつ，日常診療でよく遭遇する鑑別診断については，「第3部 鑑別ポイント」にまとめた．また，全体の構成も，「第1部 検鏡前の確認事項」「第2部 組織型と診断の実際」「第3部 鑑別ポイント」「第4部 臨床との連携」の4部に分ける．それに加え，分類や概説では表せない必要事項を「トピックス」として随所に盛り込むなど，初版の流れを踏襲した．一方で本書では新たに，WHO分類第5版に倣い，診断の要となるessential diagnostic criteriaを，第2部の各腫瘍の項で明示することとした.<br>　本書が，病理医や血液内科医にとって，造血器腫瘍の病理診断の羅針盤となれば望外の喜びである．<br><br>令和8年1月<br>加留部　謙之輔<br>倉田　盛人<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，前田大地，森谷卓也</section><section class="indexes">第1部　検鏡前の確認事項<br>　Ⅰ．骨髄評価のための基礎知識<br>　　1　骨髄の採取<br>　　2　塗抹標本の取り扱い方<br>　　3　病理標本の取り扱い方<br>　　4　免疫組織化学による造血器腫瘍の鑑別<br>　　5　フローサイトメトリー，染色体分析，FISH，遺伝子診断<br>　　6　遺伝子診断とパネル検査<br>　Ⅱ．成人の骨髄の評価<br>　Ⅲ．小児の骨髄と白血病の特徴<br><br>第2部　組織型と診断の実際<br>　Ⅰ．骨髄性前駆病変<br>　Ⅱ．骨髄増殖性腫瘍<br>　　1　慢性骨髄性白血病<br>　　2　真性赤血球増加症（真性多血症）<br>　　3　本態性血小板血症<br>　　4　原発性骨髄線維症<br>　　5　若年性骨髄単球性白血病<br>　Ⅲ．肥満細胞症<br>　Ⅳ．骨髄異形成腫瘍<br>　　1　遺伝子異常を伴う骨髄異形成腫瘍<br>　　2　形態学的特徴によって定める骨髄異形成腫瘍<br>　　3　小児骨髄異形成腫瘍<br>　Ⅴ．骨髄異形成/骨髄増殖性腫瘍<br>　Ⅵ．急性骨髄性白血病<br>　　1　遺伝子異常で定義される急性骨髄性白血病<br>　　2　分化段階で定義される急性骨髄性白血病<br>　　3　骨髄肉腫<br>　Ⅶ．二次性骨髄性腫瘍<br>　Ⅷ．混合表現型急性白血病<br>　Ⅸ．芽球性形質細胞様樹状細胞腫瘍<br>　Ⅹ．形質細胞への分化を示す腫瘍<br>　Ⅺ．急性リンパ芽球性白血病<br><br>第3部　鑑別ポイント<br>　Ⅰ．骨髄病変を伴うリンパ球性腫瘍<br>　Ⅱ．線維化をきたす骨髄病変の鑑別<br>　COLUMN　dry tap をきたす骨髄性腫瘍の鑑別<br>　Ⅲ．骨髄低形成をきたす骨髄性腫瘍の鑑別<br>　Ⅳ．巨核球の形態異常をきたす骨髄性腫瘍の鑑別<br>　Ⅴ．赤芽球系細胞の増加をきたす骨髄性腫瘍の鑑別<br>　Ⅵ．好酸球増多をきたす骨髄病変の鑑別<br><br>第4部　臨床との連携<br>　Ⅰ．MPN における疾患のリスク分類<br>　Ⅱ．リンパ腫骨髄浸潤の臨床的意義<br>　Ⅲ．造血細胞移植後の骨髄変化<br>　Ⅳ．分子標的薬を含む薬剤治療後の骨髄像<br>　Ⅴ．放射線障害と造血器腫瘍<br>　Ⅵ．病理診断報告書の記載法</section></article>
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