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Immunhistochemie in der Mammapathologie

Zur Differenzialdiagnose epithelialer Mammaläsionen

Immunohistochemistry in breast pathology

Differential diagnosis of epithelial breast lesions

Zusammenfassung

Die proliferativen epithelialen Mammaläsionen umfassen ein faszinierend vielfältiges Spektrum von den benignen hyperplastischen über die nichtinvasiven neoplastischen Läsionen bis zu invasiven Karzinomen. Radiologisch werden diese Läsionen durch Mikrokalzifikationen, Architekturstörungen oder Herdbefunde detektiert. Bei der dann notwendig werdenden präoperativen Abklärung durch minimal-invasive Biopsien ist der Pathologe bereits in die Diagnostik eingebunden. Eine verlässliche morphologische Diagnose des bioptischen Präparats ist die Basis nicht nur der pathologisch-radiologischen Korrelationsdiagnostik sondern auch des weiteren Managements von benignen proliferativen Mammaläsionen und der therapeutischen Entscheidungen beim Mammakarzinom.

In der täglichen Praxis ist die Immunhistochemie in schwierigen Fällen die entscheidende Methode zur Beurteilung der Läsion. Schwerpunkt dieser Arbeit ist es, die wichtigsten Marker zu beschrieben und ihren Einsatz beispielhaft anhand charakteristischer Differenzialdiagnosen darzustellen.

Abstract

Proliferative epithelial breast lesions include a wide variety of benign hyperplastic and noninvasive neoplastic lesions, as well as invasive carcinomas. Mammographically these lesions may show microcalcifications, architectural distortions or mass lesions. The task of the pathologist begins with a preoperative diagnosis by means of minimally invasive biopsy. His diagnosis forms the basis for not only the radiological-pathological correlation diagnosis, but also for the management of benign proliferative breast disease lesions, as well as therapeutic decisions in the case of malignant lesions.

In daily practice, immunohistochemistry is the method of choice for clarifying difficult cases. The aim of this chapter is to describe the relevant markers in breast pathology and to provide an algorithmic approach to different proliferative breast disease lesions.

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Correspondence to W. Böcker.

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Böcker, W., Hungermann, D., Weigel, S. et al. Immunhistochemie in der Mammapathologie. Pathologe 30, 13–19 (2009). https://doi.org/10.1007/s00292-008-1103-2

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Schlüsselwörter

  • Immunhistochemie
  • Proliferative Mammaläsionen
  • Basale Zytokeratine
  • Luminale Zytokeratine
  • Myoepitheliale Marker

Keywords

  • Immunohistochemistry
  • Proliferative breast lesions
  • Basal cytokeratins
  • Luminal cytokeratins
  • Myoepithelial marker