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Endometriale Karzinome und Vorstufen – Neue Aspekte

Endometrial carcinomas and precursor lesions – new aspects

Der Pathologe volume 30, pages 261–267 (2009)Cite this article

Zusammenfassung

Endometriale Adenokarzinome lassen sich grob in 2 Gruppen trennen, die heute allgemein als Typ-I- und Typ-II-Karzinome bezeichnet werden. Zwischen den beiden Gruppen gibt es signifikante Unterschiede hinsichtlich konventionell-morphologischer, immunhistochemischer, molekularpathologischer und klinischer Merkmale. Lediglich die Typ-I-Karzinome sind Östrogen-assoziiert. Zu den Typ-I-Karzinomen gehören das endometrioide Adenokarzinom mit seinen Varianten und das muzinöse Karzinom, zu den Typ-II-Karzinomen das seröse und das klarzellige Karzinom. Nicht alle Karzinome lassen sich jedoch ohne Weiteres einer der beiden Kategorien zuordnen, sondern es gibt Hybridtumoren und Mischtypen, z. B. endometrioide Karzinome mit einer serösen Komponente. Mit der atypischen Hyperplasie beim endometrioiden Karzinom und dem endometrialen intraepithelialen Karzinom (EIC) beim serösen Karzinom sind die Vorläuferläsionen bekannt und morphologisch und molekularpathologisch klar definiert. Noch nicht definiert ist demgegenüber die Vorstufe des klarzelligen Karzinoms. Immunhistochemische Marker für das endometrioide Adenokarzinom sind CK7 und Vimentin, für das seröse Karzinom p53 und p16. Die korrekte Typisierung des Karzinoms ist von essenzieller prognostischer Bedeutung. Insbesondere der Nachweis einer serösen Komponente ist entscheidend, da seröse Karzinome aufgrund ihrer schon frühzeitigen Metastasierung eines ausgedehnten operativen Eingriffs mit anschließender Chemo- und Strahlentherapie bedürfen.

Abstract

Endometrial carcinomas can be separated into two groups which are designated as type I and type II carcinomas today. Both groups of tumors are clearly different with regard to conventional light microscopy, immunohistochemistry, molecular pathology and clinical features. Only type I carcinomas are associated with hyperestrogenism. The group of type I carcinomas consists of endometrioid carcinoma and its variants, and mucinous carcinoma. The prototypes of type II carcinomas are serous and clear cell carcinoma. Not all carcinomas, however, can be assigned to one of the two groups, because there are hybrid tumors and mixed carcinomas, e.g. endometrioid carcinoma with a serous component. The precursor lesions of the endometrioid carcinoma and the serous carcinoma are well characterized morphologically and by molecular pathology. Atypical hyperplasia is the precursor lesion of endometrioid carcinoma, whereas endometrial intraepithelial carcinoma (EIC) is the precursor lesion of serous carcinoma. No precursor lesion has as yet been identified for clear cell carcinoma. Immunohistochemical markers for endometrial carcinoma are CK7 and vimentin, for serous carcinoma markers are p53 and p16. Correct typing is of essential prognostic necessity in endometrial carcinoma. Of utmost importance is the detection of a serous component, because serous carcinoma leads to early tumor spread with the necessity of radical surgery, chemotherapy and radiotherapy.

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  1. Institut für Pathologie, Gemeinschaftspraxis, A2,2, 68159 , Mannheim, Deutschland

    D. Schmidt

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Schmidt, D. Endometriale Karzinome und Vorstufen – Neue Aspekte. Pathologe 30, 261–267 (2009). https://doi.org/10.1007/s00292-009-1154-z

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