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Neue morphologische und molekulare Aspekte des Lungenkarzinoms

Novel morphological and molecular aspects of lung cancer

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Zusammenfassung

Für die pulmonalen Karzinome haben sich in den letzten Jahren erhebliche Neuerungen sowohl in der morphologischen Einordnung als auch hinsichtlich neuer molekularer, therapierelevanter Stratifikatoren ergeben. Dies betrifft im morphologischen Bereich insbesondere die Entitätszuordnung nichtkleinzelliger Karzinome am Biopsiematerial unter Berücksichtigung morphologischer und immunhistochemischer Kriterien sowie die neu eingeführte IASLC/ATS/ERS-Klassifikation pulmonaler Adenokarzinome auf der Basis des vorherrschenden Wachstums. Letztere führt neben einigen neuen Subtypen u. a. nun auch das Adenokarzinom in situ der Lunge und das minimal-invasive pulmonale Adenokarzinom ein. Die Neuausrichtung im morphologischen Bereich wird durch rasante Entwicklungen im Bereich der molekularen Diagnostik komplementiert, die vornehmlich die pulmonalen Adenokarzinome betreffen und es heute ermöglichen, aufgrund etablierter genetischer Biomarker wie EGF-Rezeptor-Mutationen und EML4-ALK-Translokationen einem Teil der Patienten zielgerichtete Therapien anzubieten. Über die beiden genannten etablierten molekularen Marker hinaus befindet sich eine große Anzahl molekularer Prädiktoren für zielgerichtete Therapien in der klinischen Entwicklung.

Abstract

In recent years the classification of pulmonary cancer has seen a paradigm shift with respect to both morphological as well as molecular aspects. On the morphological side this includes novel criteria for tumor classification from biopsy material based on morphological and immunohistochemical aspects as well as a novel classification based on morphological patterns for pulmonary adenocarcinomas. In addition, this new classification now includes adenocarcinoma in situ as well as minimally invasive adenocarcinoma as novel entities and a variety of novel adenocarcinoma subtypes. This reclassification was accompanied and complemented by tremendous developments in the field of lung cancer genomics which paved the way for now widely established predictive molecular markers, e.g. epidermal growth factor receptor (EGFR) mutations and EML4-ALK translocations and will certainly lead to a variety of novel predictive markers not only for pulmonary adenocarcinoma but also for other pulmonary neoplasms.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. A. Warth, A. Stenzinger, W. Weichert geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Institut für Pathologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland

    A. Warth, A. Stenzinger &  W. Weichert

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Warth, A., Stenzinger, A. & Weichert, W. Neue morphologische und molekulare Aspekte des Lungenkarzinoms. Pathologe 34, 419–428 (2013). https://doi.org/10.1007/s00292-013-1787-9

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