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Ovarialkarzinom und Präkanzerosen

Ovarian cancer and precancerous lesions

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Die klassische Begriffsbestimmung der Präkanzerose hat für das Ovarialkarzinom (OC) nach heutigem Kenntnisstand noch keine Bedeutung. Die in den letzten Jahren etablierte dualistische Theorie zur Entstehung des OC entdeckt aber neue Aspekte für die Frage nach Risikoläsionen und Präkanzerosen. Dazu gehört der Nachweis von tubaren intraepithelialen Läsionen im Fimbrientrichter, von „serous tubal intraepithelial carcinoma“ (STIC), bei Patientinnen mit OC und auch bei nicht erkrankten BRCA-Mutationsträgerinnen. Sie werden als wichtiges Element der Pathogenese des high-grade OC angesehen, dessen genaue klinische Einordnung, insbesondere die als Präkanzerose, aber noch nicht gänzlich geklärt ist.

Diskussion

Auch die Risikoassoziation einer Endometrioseerkrankung mit klarzelligen, endometrioiden und low-grade serösen OC unterstützt die Annahme einer unterschiedlichen Pathogenese der tumorbiologisch verschiedenen histologischen Subtypen des OC. Gleiches gilt für die Borderline-Tumoren des Ovars (BOT), die insgesamt eine gute Prognose haben, aber doch im unteren einstelligen Prozentbereich als invasive, vor allem low-grade seröse OC rezidivieren können.

Fazit

Sowohl die Endometriose als auch eine BOT-Erkrankung können nicht als Präkanzerose im klassischen Sinn bezeichnet werden: zu gering das Risiko, zu lang die zeitlichen Abstände. Dennoch gibt es wichtige klinische Aspekte im Umgang mit diesen Erkrankungen, die auch vor dem Hintergrund einer Risikoreduktion für das OC betrachtet werden sollten.

Abstract

Background

According to the current state of knowledge the classical definition of precancerous lesions still has no relevance for ovarian cancer. The recently established dualistic model for the pathogenesis of ovarian cancer has, however, revealed new aspects on the question of risk lesions and precancerous lesions. This includes the detection of tubal intraepithelial lesions in the fimbriae of the uterine tube and serous tubal intraepithelial carcinoma (STIC) in patients with ovarian cancer and also in disease-free BRCA mutation carriers. These are thought to be an important element in the pathogenesis of high-grade ovarian cancer but the exact clinical classification, particularly as being precancerous lesions, is not yet completely clarified.

Discussion

The association of endometriosis with an increased risk for the development of clear cell, endometrioid and low-grade serous ovarian cancer, supports the assumption of a different pathogenesis of the biologically different histological subtypes of ovarian cancer. The same is true for borderline ovarian tumors (BOT), which generally have a good prognosis but in a very small percentage of cases (<10 %) can also be recurrent as invasive and predominantly low-grade serous ovarian cancer.

Conclusion

Endometriosis and BOT cannot be regarded as precancerous lesions in the classical sense as the risks are too low and the time intervals are too long; however, there are important clinical aspects when dealing with these diseases that should also be considered with respect to a potential risk reduction for ovarian cancer.

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Authors and Affiliations

  1. Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3 Haus 24, 24105, Kiel, Deutschland

    M. Mackelenbergh, N. Maass, W. Jonat &  F. Hilpert

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  1. M. Mackelenbergh
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  2. N. Maass
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  3. W. Jonat
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  4. F. Hilpert
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Correspondence to F. Hilpert.

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M. van Mackelenbergh, N. Maass, W. Jonat und F. Hilpert geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Mackelenbergh, M., Maass, N., Jonat, W. et al. Ovarialkarzinom und Präkanzerosen. Gynäkologe 48, 415–421 (2015). https://doi.org/10.1007/s00129-015-3720-1

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  • DOI: https://doi.org/10.1007/s00129-015-3720-1

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