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Primäre Speicheldrüsentumoren aus Sicht der Pathologie

Morphomolekulare Besonderheiten und diagnostisch-therapeutische Herausforderungen

Primary salivary gland tumors from a pathology perspective

Morphomolecular peculiarities and diagnostic and therapeutic challenges

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Zusammenfassung

Neoplasien der Speicheldrüsen wurden historisch als eine Entität angesehen, die keine weitere prognostische und therapeutische Subklassifikation erlaubte. Prognostisch entscheidend war demnach nur das Tumorstadium. Im Laufe der Jahre wurden dann auf morphologischer Basis einige Subentitäten wie adenoidzystische Karzinome, Mukoepidermoidkarzinome, Azinuszellkarzinome und Speichelgangkarzinome auf morphologischer Basis definiert. In den letzten 2 Jahrzehnten unterlagen die Speicheldrüsenkarzinome dann einer dynamischen, auf morphologischen, immunphänotypischen und molekulargenetischen Charakteristika beruhenden nosologischen „Spaltung“, sodass nun 21 eigenständige Karzinomtypen in der aktuellen Klassifikation der Weltgesundheitsorganisation (WHO) erfasst sind. Eine exakte Subtypisierung der einzelnen Tumoren stellt heutzutage kein „Pathologen-Hobby“ mehr, sondern einen signifikant mitentscheidenden Faktor für eine optimierte onkologisch-chirurgische und ggf. systemische Therapie dar. Im vorliegenden Beitrag werden die wichtigsten neuen Entwicklungen der Klassifikation von Speicheldrüsenkarzinomen erörtert.

Abstract

Similar to tumors of other organs, salivary gland neoplasms were historically viewed as a single neoplastic entity and mostly treated as such. Accordingly, only the clinical tumor stage, and not the histological subtype, was considered to be of significant prognostic impact. However, over the years, several distinct sub-entities have been characterized based on morphological features, such as adenoid cystic carcinoma, mucoepidermoid carcinoma, acinic cell carcinoma, and salivary duct carcinoma. Most importantly, the nosology of salivary gland carcinomas has undergone a dynamic “splitting” on the basis of morphological, immunophenotypic, and molecular characteristics, so that 21 independent carcinomas are now listed in the current World Health Organization (WHO) classification. Moreover, it has become evident that splitting of these carcinoma subtypes no longer represents a “pathologist’s hobby,” but carries significant prognostic and therapeutic relevance for optimized cancer surgery and potentially systemic therapy. The current review summarizes the major features of salivary gland tumors, both benign and malignant, and gives an account of their classification systems and genetic profiles.

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  1. Pathologisches Institut, Universitätsklinikum Erlangen, Krankenhausstr. 8–10, 91054, Erlangen, Deutschland

    Abbas Agaimy

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Correspondence to Abbas Agaimy.

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A. Agaimy gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Agaimy, A. Primäre Speicheldrüsentumoren aus Sicht der Pathologie. HNO 71, 207–214 (2023). https://doi.org/10.1007/s00106-023-01281-2

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