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Diagnose und Differenzialdiagnose des zervikalen Adenokarzinoms

Diagnosis and differential diagnosis of cervical adenocarcinoma

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Zusammenfassung

Diese Übersicht fasst pathogenetische und praktische Aspekte der (Sub-)Klassifikation zervikaler glandulärer (Prä-)Neoplasien zusammen und stellt dabei u. a. den Nutzen eines Gradings in Frage. Im Kontext der Differenzialdiagnose gutartiger „Imitate“ wird die phänotypische Variabilität der glandulären Präkanzerosen und Karzinome und deren Unterscheidung mittels Spezialuntersuchungen beschrieben. Hinsichtlich der Karzinome geht es um die Differenzialdiagnose der hochdifferenzierten Neoplasien, darunter das „Minimal-deviation“-Adenokarzinom (MDA, Adenoma malignum), Karzinome mit endometrioider oder villoglandulärer Morphologie sowie die mesonephrischen Hyper- und Neoplasien, ferner um die Kenntnis HPV-negativer glandulärer (Prä-)Neoplasien, darunter die „Gastric-type“-Adenokarzinome und diagnostische Algorithmen zur Unterscheidung primärer und sekundärer zervikaler Adenokarzinome. Schließlich werden die Schwierigkeiten bei der Erkennung frühinvasiver Adenokarzinome kommentiert, speziell auch immanente Fallstricke bei der Bestimmung der Eindringtiefe.

Abstract

This overview summarizes pathogenetic and practical aspects of (sub-)classification of cervical glandular (pre-)neoplasias and, inter alia, calls into question the usefulness of grading. In the context of the differential diagnosis of benign “imitations”, the phenotypic variability of glandular precancerous lesions and carcinomas is described as well as the use of special tests to distinguish them. With regard to carcinomas, the differential diagnosis of well-differentiated neoplasias is addressed including “minimal deviation” adenocarcinoma (MDA, malignant adenoma), carcinomas with endometrioid or villoglandular morphology, and mesonephric hyper- and neoplasias. Furthermore, knowledge of HPV-negative glandular (pre-)neoplasias is covered including “gastric-type” adenocarcinomas and diagnostic algorithms for discriminating between primary and secondary cervical adenocarcinomas. Finally, comments are offered on the difficulties in recognizing early invasive adenocarcinomas, especially also the pitfalls inherent in determining the depth of invasion.

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Notes

  1. Expression herunterreguliert bei HR-HPV-assoziierten, glandulären (Prä-)Neoplasien, sog. Null-Marker, Prof. W.G. McCluggage, Tagung der European Society of Pathology 2011, Helsinki.

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Authors and Affiliations

  1. Referenzzentrum für Gynäkopathologie und Zytologie, Albertinen Pathologie Hamburg, Hamburg, Deutschland

    T. Löning

  2. Gemeinschaftspraxis für Pathologie, Hamburg, Deutschland

    L. Riethdorf

  3. Department of Pathology and Laboratory Medicine, Calgary Laboratory Services and University of Calgary, #C1150c 1403 - 29th Street NW, AB T2N 2T9, Calgary, Canada

    M. Köbel

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  1. T. Löning
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  2. L. Riethdorf
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  3. M. Köbel
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Correspondence to M. Köbel.

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Löning, T., Riethdorf, L. & Köbel, M. Diagnose und Differenzialdiagnose des zervikalen Adenokarzinoms. Pathologe 32, 505–513 (2011). https://doi.org/10.1007/s00292-011-1481-8

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