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Aktuelle TNM/FIGO-Stadieneinteilung für das Zervix- und Endometriumkarzinom sowie maligne Müller-Mischtumoren

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Current TNM/FIGO classification for cervical and endometrial cancer as well as malignant mixed Müllerian tumors

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Zusammenfassung

Zahlreiche Studien der letzten Jahre zum Zervix- und Endometriumkarzinom sowie zu den malignen Müller-Mischtumoren (MMMT) des Uterus haben eine Überarbeitung der FIGO/TNM-Klassifikation erforderlich gemacht. Die wesentlichste Änderung beim Zervixkarzinom betrifft das Stadium FIGO IIA/T2a. In Analogie zum Stadium FIGO IB/T1b wird es anhand der Tumorgröße mit einem Grenzwert von ≤4 cm vs. >4 cm unterteilt in FIGO IIA1/T2a1 und FIGO IIA2/T2a2. Beim Endometriumkarzinom werden die Kategorien FIGO IA/pT1a und FIGO IB/pT1b zu FIGO IA/pT1a zusammengefasst, und die bisherige Kategorie FIGO IC/pT1c wird zu FIGO IB/T1b. Die Kategorie FIGO IC/pT1c entfällt. Die frühere Kategorie FIGO IIA/T2a mit einer Infiltration der endozervikalen Drüsen, nicht jedoch des zervikalen Stromas, entfällt. Sie wird in der Kategorie FIGO I/T1 subsumiert. Die bisherige Kategorie FIGO IIB/T2b mit Nachweis der Infiltration des Stromas der Cervix uteri wird zu FIGO II/T2. Neu ist die Kategorie T3c/IIIC, die nunmehr die Metastasierung in die regionären Lymphknoten mit berücksichtigt. T3c1/IIIC1 beinhaltet die Metastasierung in pelvine und T3c2/IIIC2 die Beteiligung der paraaortalen Lymphknoten mit oder ohne gleichzeitige pelvine Lymphknotenmetastasierung. Alternativ kann der Nachweis einer Metastasierung in die regionären Lymphknoten im TNM als N1 verschlüsselt werden. Die MMMT werden in Analogie zum Endmetriumkarzinom klassifiziert.

Abstract

Numerous recent studies of endometrial and cervical carcinomas as well as malignant mixed Müllerian tumors (MMMT) of the uterus have made a revision of the FIGO/TNM classification necessary, effective as of January 1st, 2010. There will be a new subclassification of carcinoma of the uterine cervix with proximal vaginal infiltration, using the same cut-off for the tumor extension as used for stage FIGOIB/T1b (≤/>4 cm), resulting in stage FIGO IIA1/T2a1 and FIGO IIA2/T2a2. In endometrial carcinoma, the previous FIGO IA/pT1a and FIGO IB/pT1b will be merged to FIGO IA/pT1a. The former category FIGO IC/T1c will be changed into FIGO IB/T1b. The category FIGO IC/pT1c will not longer been used. Additionally, there will be no separate classification for the involvement of the endocervical glands by endometrial carcinoma. This feature will be incorporated in stage FIGO I/T1 disease. The new category FIGO II/T2 will be defined as endocervical stromal involvement. There will be a new category, termed T3c/IIIC, which includes regional lymph node involvement. Stage T3c1/IIIC1 will be defined as pelvic lymph node involvement and stage T3c2/IIIC2 para-aortal lymph node involvement with or without pelvic lymph node disease. In the TNM system, regional lymph node involvement can alternatively be classified as N1. The MMMT will be staged like endometrial carcinoma.

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Authors and Affiliations

  1. Abteilung Mamma-, Gynäko- & Perinatalpathologie, Institut für Pathologie, Universität Leipzig, Liebigstr. 26, 04103, Leipzig, Deutschland

    L.-C. Horn, K. Schierle & C. Wittekind

  2. Allgemeine Histologie und Zytologie, Referenzzentrum für Gynäkopathologie, Institut für Pathologie, Mannheim, Mannheim, Deutschland

    D. Schmidt

  3. Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin, Berlin, Deutschland

    U. Ulrich

  4. Department für Bildgebung und Strahlenmedizin, Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    A. Liebmann

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  1. L.-C. Horn
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  2. K. Schierle
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  3. D. Schmidt
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  4. U. Ulrich
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  6. C. Wittekind
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Correspondence to L.-C. Horn.

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Horn, LC., Schierle, K., Schmidt, D. et al. Aktuelle TNM/FIGO-Stadieneinteilung für das Zervix- und Endometriumkarzinom sowie maligne Müller-Mischtumoren. Pathologe 32, 239–243 (2011). https://doi.org/10.1007/s00292-010-1273-6

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