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Molekulare Klassifikation beim Endometriumkarzinom

Molecular classification of endometrial cancer

  • Leitthema
  • Published:
Die Gynäkologie Aims and scope

Zusammenfassung

Die von Bokhman et al. propagierte dualistische Subtypisierung stellte über mehrere Jahrzehnte das Fundament zur Prädiktion von Endometriumkarzinomen dar, das jedoch über die Jahre eine gewisse Unschärfe in Bezug auf Graduierung und Gesamtüberleben der Patientinnen aufwies. Molekulare Analysen identifizierten die Subgruppen POLE-ultramutiert, MMRd („mismatch repair deficient“), p53-mutiert und Endometriumkarzinome mit einem unspezifischen molekularen Profil. Die prädiktive Evidenz der molekularen Subgruppen und ihre Überlegenheit gegenüber dem von Bokhman et al. publizierten Modell, konnte durch mehrere Studien bestätigt werden. Im vorliegenden Übersichtsartikel werden anhand von 5 Fallbeispielen aus der Routinediagnostik die Typisierung von endometrioiden Adenokarzinomen und der zugehörige molekularpathologische Hintergrund beschrieben. Weiterhin wird im letzten Fallbeispiel eine sich aktuell noch nicht in der WHO(World Health Organization)-Klassifikation weiblicher Genitaltumoren genannte Subgruppe beschrieben.

Abstract

The dualistic subtyping propagated by Bokhman et al. provided the foundation for the prediction of endometrial cancer for several decades; however, over the years it has exhibited uncertainties in terms of tumor cell graduation and overall survival of patients. Molecular analyses identified the new subgroups POLE ultramutated, mismatch repair deficient (MMRd), p53 mutated, and endometrial cancer with an unspecific molecular profile. The predictive evidence of the molecular subgroups was confirmed by several studies and is significantly superior to the model published by Bokhman et al. In the present review article, the typing of endometrioid adenocarcinomas and the associated molecular pathological background are described based on five histopathological case examples from routine diagnostics. Furthermore, the last case report describes a subtype not yet included in the World Health Organization (WHO) classification of female genital tumors.

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  1. Institut für Klinische Pathologie, Universitätsklinikum Freiburg, Breisacher Str. 115a, 79106, Freiburg, Deutschland

    Peter Bronsert, Konrad Kurowski,  Martin Werner &  Sylvia Timme

  2. Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland

    Clara Unger

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P. Bronsert, K. Kurowski, M. Werner, C. Unger und S. Timme geben an, dass kein Interessenkonflikt besteht.

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Bronsert, P., Kurowski, K., Werner, M. et al. Molekulare Klassifikation beim Endometriumkarzinom. Gynäkologie 56, 164–175 (2023). https://doi.org/10.1007/s00129-023-05056-2

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