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Histopathologie des Plattenepithelkarzinoms und des Adenokarzinoms der Cervix uteri

Histopathology of squamous cell carcinoma and adenocarcinoma of the uterine cervix

Zusammenfassung

Die Einführung eines Screeningprogramms hat auch in Deutschland zu einem Rückgang der Inzidenz des invasiven Zervixkarzinoms und zu einer relativen Zunahme der Karzinomvorstufen geführt. Das häufigste invasive Zervixkarzinom ist das Plattenepithelkarzinom. Adenokarzinome sind demgegenüber deutlich seltener. Besondere Formen des Plattenepithelkarzinoms sind das verruköse Karzinom, das papilläre (transitionalzellige) Karzinom und das lymphoepitheliomartige Karzinom.

Unter den verschiedenen Subtypen des Adenokarzinoms ist das muzinöse Karzinom am häufigsten, entweder als endozervikaler oder als intestinaler Subtyp. Wesentlich seltener sind der endometrioide, der seröse und der klarzellige Subtyp. Besondere Schwierigkeiten bereitet in der Diagnostik das Adenoma malignum („Minimal-deviation-Adenokarzinom“), weil nur geringe Atypien vorhanden sind und die atypischen Drüsen kaum von solchen einer endozervikalen glandulären Hyperplasie zu unterscheiden sind.

Zu einer vollständigen Diagnose eines Zervixkarzinoms gehört neben einer Angabe des Tumortyps immer auch eine Bestimmung des Malignitätsgrades. Immunhistochemische Untersuchungen sind oft hilfreich, um die verschiedenen Formen des Zervixkarzinoms voneinander und von metastatischen Läsionen abgrenzen zu können.

Abstract

The introduction of a screening programme for carcinoma of the cervix uteri has lead to a reduction in the number of invasive carcinomas and to a relative increase in the frequency of preinvasive cervical lesions. The most frequent type of invasive cancer of the cervix is squamous cell carcinoma. Adenocarcinomas are much more infrequent. Special subtypes of squamous cell carcinomas are the papillary (squamotransitional) subtype, the verrrucous subtype and the lymphoepithelioma-like subtype.

Among the various forms of adenocarcinoma, the mucinous subtype is the most frequent, either as endocervical or interstinal subtype. Much more rare are the serous and clear cell carcinomas. Great concern in daily diagnosis causes the adenoma malignum (minimal deviation adenocarcinoma), since this type of adenocarcinoma demonstrates only minor cytological atypia and greatly resembles the different types of endocervical glandular hyperplasia.

A report on a cervical carcinoma should always include the typing and grading of the tumor. Immunohistochemical stains are often useful to distinguish the various types of primary cervical cancer and to distinguish these from metastatic lesions.

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Literatur

  1. 1.

    Alfsen GC, Kristensen GB, Skovlund E et al. (2001) Histologic subtype has minor importance for overall survival in patients with adenocarcinoma of the uterine cervix: a population-based study of prognostic factors in 505 patients with nonsquamous cell carcinomas of the cervix. Cancer 92:2471–2483

    Article  CAS  PubMed  Google Scholar 

  2. 2.

    Benedet JL, Odicino F, Maisonneuve P et al. (2001) Carcinoma of the cervix uteri. J Epidemiol Biostat 6:7–43

    CAS  PubMed  Google Scholar 

  3. 3.

    Bouman A, Oosterhuis GJ, Naudin ten Cate L, van Doorn GA (1999) Villoglandular papillary adenocarcinoma of the cervix. Beware of a wolf in sheep’s clothing. Eur J Obstet Gynecol Reprod Biol 87:183–189

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Clement PB, Young RH, Keh P et al. (1995) Malignant mesonephric neoplasms of the uterine cervix. A report of eight cases, including four with a malignant spindle cell component. Am J Surg Pathol 19:1158–1171

    CAS  PubMed  Google Scholar 

  5. 5.

    Delaloye JF, Pampallona S, Coucke PA, De Grandi P (1996) Younger age as a bad prognostic factor in patients with carcinoma of the cervix. Eur J Obstet Gynecol Reprod Biol 64:201–205

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Hart WR (2002) Symposium part II: special types of adenocarcinoma of the uterine cervix. Int J Gynecol Pathol 21:327–346

    Article  PubMed  Google Scholar 

  7. 7.

    Horn LC, Fischer U, Bilek K (2001) Pathologic-anatomic description and basic morphological information for management of dysplasias and carcinomas of the cervix uteri. Zentralbl Gynakol 123:255–265

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Koenig C, Turnicky RP, Kankam CF, Tavassoli FA (1997) Papillary squamotransitional cell carcinoma of the cervix: a report of 32 cases. Am J Surg Pathol 21:915–921

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Mills SE, Austin MB, Randall ME (1985) Lymphoepithelioma-like carcinoma of the uterine cervix. A distinctive, undifferentiated carcinoma with inflammatory stroma. Am J Surg Pathol 9:883–889

    CAS  PubMed  Google Scholar 

  10. 10.

    Moritani S, Ioffe OB, Sagae S et al. (2002) Mitotic activity and apoptosis in endocervical glandular lesions. Int J Gynecol Pathol 21:125–133

    Article  PubMed  Google Scholar 

  11. 11.

    Olesen F (1988) A case-control study of cervical cytology before diagnosis of cervical cancer in Denmark. Int J Epidemiol 17:501–508

    CAS  PubMed  Google Scholar 

  12. 12.

    Ordi J, Nogales FF, Palacin A et al. (2001) Mesonephric adenocarcinoma of the uterine corpus: CD10 expression as evidence of mesonephric differentiation. Am J Surg Pathol 25:1540–1545

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Stewart CJ, Taggart CR, Brett F, Mutch AF (1993) Mesonephric adenocarcinoma of the uterine cervix with focal endocrine cell differentiation. Int J Gynecol Pathol 12:264–269

    CAS  PubMed  Google Scholar 

  14. 14.

    Utsugi K, Hirai Y, Takeshima N et al. (1999) Utility of the monoclonal antibody HIK1083 in the diagnosis of adenoma malignum of the uterine cervix. Gynecol Oncol 75:345–348

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Young RH, Clement PB (2002) Endocervical adenocarcinoma and its variants: their morphology and differential diagnosis. Histopathology 41:185–207

    Article  CAS  PubMed  Google Scholar 

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Schmidt, D., Horn, LC. & Kommoss, F. Histopathologie des Plattenepithelkarzinoms und des Adenokarzinoms der Cervix uteri. Pathologe 26, 255–261 (2005). https://doi.org/10.1007/s00292-005-0765-2

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Schlüsselwörter

  • Zervixkarzinom
  • Tumorregression
  • Adenoma malignum
  • Adenocarcinoma in situ
  • p16INK4a

Keywords

  • Carcinoma of cervix
  • Tumor regression
  • Adenoma malignum
  • Adenocarcinoma in situ
  • p16INK4a