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WHO-Klassifikation 2010 für den unteren Gastrointestinaltrakt

Was ist neu?

WHO classification 2010 for the lower gastrointestinal tract

What is new?

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Zusammenfassung

Die neue WHO-Klassifikation der Tumoren des Gastrointestinaltrakts beinhaltet nicht nur eine neue Definition diagnostischer Termini wie „intraepitheliale Neoplasie“ und „Dysplasie“, sondern auch Änderungen der Nomenklatur und Diagnostik, die für die tägliche Routine hoch relevant sind. Serratierte Adenokarzinome, kribriforme Adenokarzinome vom Komedotyp und mikropapilläre Adenokarzinome werden als neue histologische Subtypen des kolorektalen Karzinoms eingeführt. Die Graduierung muzinöser und siegelringzelliger Adenokarzinome des Kolorektums, die bislang definitionsgemäß immer als G3 (schlecht differenziert) klassifiziert wurden, ist jetzt vom Mikrosatellitenstatus der Karzinome abhängig. Eine hohe Mikrosatelliteninstabilität (MSI-H) ist mit einer besseren Prognose assoziiert. Daher werden MSI-H-Karzinome als „low grade“ eingeordnet, während Karzinome ohne (Mikrosatellitenstabilität, MSS) oder mit nur geringer Mikrosatelliteninstabilität (MSI-L) aufgrund ihrer schlechteren Prognose als „high grade“ klassifiziert werden. Daher muss die Bestimmung der MSI mithilfe immunhistologischer Methoden bzw. der Fragmentlängenanalyse als integraler Bestandteil der pathomorphologischen Befundung dieser Karzinome angesehen werden. Serratierte Polypen/Adenome und ihr Progressionspotenzial zum kolorektalen Karzinom über den sog. alternativen, serratierten Signalweg sollen ebenso besprochen werden wie die Erkenntnisse hinsichtlich neuer prognostischer bzw. prädiktiver Marker. Damit liefert dieser Beitrag einen Überblick über die wichtigsten Veränderungen dieser neuen WHO-Klassifikation kolorektaler Karzinome.

Abstract

The new WHO classification of tumors of the digestive system not only redefines common diagnostic terms, such as intraepithelial neoplasia and dysplasia but also introduces changes in the nomenclature and diagnostics of colorectal tumors which will be important in daily practice. Changes in nomenclature and classification include the introduction of serrated adenocarcinoma, cribriform comedo type adenocarcinoma and micropapillary adenocarcinoma as new distinct histological subtypes of colorectal cancer. The grading of mucinous and signet ring carcinomas, which were previously invariably graded as G3/high grade, is now dependent on the microsatellite instability (MSI) status as a high MSI (MSI-H) indicates a better and low or no MSI (MSI-L/MSS) a worse prognosis. Thus, analysis of microsatellite instability via immunohistochemistry or fragment length analysis must be included in the pathological report of these tumors. Serrated polyps/adenomas and their potential of progression into colorectal cancer via the alternative pathway of colorectal carcinogenesis will be discussed as well as new insights into prognostic and predictive markers of colorectal cancer. This manuscript will give an overview of the most important changes within the new WHO classification of colorectal tumors.

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  1. Institut für Pathologie, Universitätsklinikum „Carl Gustav Carus“, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    D.E. Aust

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Aust, D. WHO-Klassifikation 2010 für den unteren Gastrointestinaltrakt. Pathologe 32 (Suppl 2), 326 (2011). https://doi.org/10.1007/s00292-011-1505-4

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  • DOI: https://doi.org/10.1007/s00292-011-1505-4

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