Der Pathologe

, Volume 37, Issue 6, pp 512–520 | Cite as

Fallstricke bei der histopathologischen Diagnostik des Endometriumkarzinoms und seiner Vorstufen

Klinisch wichtige Differenzialdiagnosen, Vermeidung falsch-positiver Diagnosen
Schwerpunkt: Uteruspathologie
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Zusammenfassung

Histopathologische Fehldiagnosen können bei Läsionen des Endometriums unnötigerweise zu unerwünschtem Verlust der Fertilität und therapieassoziierter Morbidität führen. Es ist daher wesentlich, Endometriumkarzinome sicher zu typisieren sowie von Vorstufen, benignen Läsionen und Artefakten abzugrenzen. In dieser Arbeit werden typische diagnostische „pitfalls“ abgehandelt. Eine sorgfältige Beachtung makroskopischer und histopathologischer Merkmale kann behilflich sein, klinische Fehlentscheidungen durch Berücksichtigung entscheidender Differenzialdiagnosen zu vermeiden. Hierzu gehören die Differenzialdiagnose hoch differenzierter endometrioider Adenokarzinome und der atypischen Endometriumhyperplasie, des myoinvasiven endometrioiden Adenokarzinoms und des atypischen polypoiden Adenomyoms sowie endometrioider und glandulär strukturierter seröser Adenokarzinome des Endometriums. Zudem gilt es, an die Möglichkeit falsch-positiver Hyperplasie- oder Karzinomdiagnosen infolge biopsiebedingter Artefakte zu denken.

Schlüsselwörter

Endometriumhyperplasie Endometrioides Adenokarzinom Adenomyom Hyperplasie Fehldiagnosen 

Pitfalls in the histopathological diagnostics of endometrial carcinoma and its precursors

Clinically relevant differential diagnoses, avoidance of false positive diagnoses

Abstract

Making an incorrect histopathological diagnosis of an endometrial lesion may lead to unwanted loss of fertility and therapy-associated morbidity; therefore, endometrial carcinomas need to be correctly typed and differentiated from hyperplastic precursors, benign lesions and artifacts. Typical diagnostic pitfalls are described in this article. Misdiagnosing endometrial lesions can be avoided by paying thorough attention to gross as well as microscopic features and by taking crucial differential diagnoses into consideration. These are, in particular, well-differentiated endometrioid adenocarcinoma of the endometrium versus atypical endometrial hyperplasia, myoinvasive endometrioid adenocarcinoma versus atypical polypoid adenomyoma and endometrioid carcinoma versus serous carcinoma of the endometrium with a predominantly glandular pattern. It is also important to consider the possibility of a false positive diagnosis of atypical endometrial hyperplasia or carcinoma in cases of biopsy-induced artifacts.

Keywords

Endometrial hyperplasia Endometrioid adenocarcinoma Adenomyoma Hyperplasia Diagnostic errors 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

F. Kommoss und S. F. Lax geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of PathologyVancouver General HospitalVancouverCanada
  2. 2.Institut für PathologieLKH Graz Süd-WestGrazÖsterreich

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