Der Pathologe

, Volume 34, Issue 1, pp 25–33

Gynäkopathologie-Update

Schwerpunkt
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Zusammenfassung

Die Gynäkopathologie verzeichnet in den letzten Jahren signifikante Fortschritte in der konventionellen lichtmikroskopischen, immunhistochemischen und molekularen Diagnostik. Exemplarisch werden 4 Themenfelder diskutiert. Die plattenepithelialen präkanzerösen und karzinomatösen Veränderungen im weiblichen Anogenitalbereich und in der Zervix werden durch eine transformierende „High-risk“-HPV (humanes Papillomavirus)-Infektion verursacht. Morphologische Unterschiede zwischen den verschiedenen Lokalisationen finden sich nicht. Im Gegensatz zur derzeit gültigen WHO-Klassifikation wird in Zukunft eine Unterteilung der Präkanzerosen in niedrig- und hochgradige Veränderungen vorgeschlagen. Nur ein Teil der Adenokarzinome der Zervix ist „High-risk“-HPV-assoziiert. Gleichwohl ist bei einigen dieser Karzinomtypen eine p16-Überexpression nachweisbar, die allerdings nicht HPV-vermittelt ist. Uterine Leiomyosarkome sind unabhängig vom Differenzierungsgrad klinisch aggressive Tumoren, bei denen nach wie vor in vielen Fällen keine kurative Therapie möglich ist. Am wichtigsten ist hier die Abgrenzung von den Leiomyomvarianten, die ein Leiomyosarkom imitieren können. Die serösen pelvinen und ovariellen Karzinome werden in niedrig- und hochmaligne Formen unterteilt. Sie unterscheiden sich signifikant hinsichtlich ihrer formalen und molekularen Genese sowie in ihren pathomorphologischen Eigenschaften. Deutliche Unterschiede finden sich auch im klinischen Verhalten und im Ansprechen auf eine Chemotherapie.

Schlüsselwörter

Humane Papillomaviren p16 Leiomyosarkom Borderline-Tumor Seröses Karzinom 

Update on gynecopathology

Abstract

Recent years have witnessed significant achievements in light microscopic, immunohistochemical and molecular diagnostics in gynecopathology. In this article four topics will be discussed as examples. The squamous precancerous and carcinomatous lesions of the female anogenital tract and the cervix are caused by a transforming high risk human papillomavirus (HPV) infection. No differences in morphological findings can be found between the different locations. In contrast to the current WHO classification a new categorization into low grade and high grade precancerous lesions is suggested. Only some cervical adenocarcinomas are related to high risk HPV infection. Nevertheless, some of these unusual variants demonstrate p16 overexpression. Uterine leiomyosarcomas are clinically aggressive neoplasms independent of the histological grade and in most cases curative treatment is not feasible. It is most important to distinguish leiomyosarcoma from those leiomyoma variants which mimic uterine leiomyosarcoma. Pelvic and ovarian serous carcinomas can be separated into low grade and high grade types which differ significantly in formal pathogenesis, molecular features and pathomorphological findings. Significant differences are also obvious in clinical behavior and response to chemotherapy regimens.

Keywords

Human papillomavirus p16 Leiomyosarcoma Borderline tumor Serous carcinoma 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Referenzzentrum für GynäkopathologieInstitut für PathologieMannheimDeutschland

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