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Spezifische Typen des Harnblasenkarzinoms

Specific types of bladder cancer

  • Schwerpunkt: Uropathologie
  • Published:
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Zusammenfassung

Das Harnblasenkarzinom zeigt seltene Varianten und Sonderformen, welche unterschiedliche prognostische Bedeutung haben und dadurch möglicherweise unterschiedliche Therapieansätze bedingen. Solche Varianten müssen daher histologisch diagnostiziert und benannt werden. Einen aggressiveren Verlauf weisen dabei Urothelkarzinome der „nested“-Variante auf, welche teils ein sehr blandes zytologisches Bild präsentieren. Auch die morphologisch an Plasmazellen erinnernde plasmazytoide Variante des Urothelkarzinoms geht mit einer verkürzten Überlebenszeit und einer hohen Tendenz zur peritonealen Metastasierung einher. Die mikropapilläre Variante mit kleinen papillären, in artefiziellen Spalträumen liegenden Tumorkomplexen und häufiger lymphovaskulärer Infiltration zeigt ebenfalls eine schlechte Prognose. Weitere in der aktuellen WHO-Klassifikaton gelistete Varianten sind das mikrozystische, Lymphoepitheliom-ähnliche,  sarkomatoide, riesenzellige sowie das undifferenzierte Urothelkarzinom. Neben diesen Varianten existieren 3 Sonderformen: das Plattenepithelkarzinom, das Adenokarzinom und das kleinzellige (neuroendokrine) Karzinom. Diese Karzinome sind durch eine vollständige plattenepitheliale oder drüsige Differenzierung gekennzeichnet und zeigen ein teils schlechteres Ansprechen auf adjuvante Therapien. Das kleinzellige Karzinom der Harnblase weist analog zum kleinzelligen Karzinom der Lunge einen neuroendokrinen Phänotyp auf, hat einen aggressiven Verlauf, reagiert aber entsprechend sensibel auf (neo-)adjuvante Chemotherapie. Morphologie und Histologie der bedeutendsten Varianten und Sonderformen werden in diesem Übersichtsartikel vorgestellt.

Abstract

Bladder cancer shows rare variants and special subtypes with diverse prognostic importance and therefore may necessitate different therapeutic approaches. For pathologists it is important to histologically diagnose and specify such variants. Nested variants of urothelial carcinoma with inconspicuous, well-formed tumor cell nests present with an aggressive course. The plasmacytoid variant, which morphologically resembles plasma cells is associated with a shorter survival time and a high frequency of peritoneal metastasis. Micropapillary urothelial carcinoma with small papillary tumor cell islands within artificial tissue retraction spaces and frequent lymphovascular invasion also has a poor prognosis. Other important rare differential variants listed in the World Health Organization (WHO) classification are microcystic, lymphoepithelioma-like, sarcomatoid, giant cell and undifferentiated urothelial carcinomas. Additionally, there are three special types of bladder cancer: squamous cell carcinoma, adenocarcinoma and small cell neuroendocrine carcinoma of the bladder. These tumors are characterized by pure squamous cell or glandular differentiation and are sometimes less responsive to adjuvant (chemo)therapy. Small cell carcinoma of the bladder mimics the neuroendocrine features of its pulmonary counterpart, shows an aggressive course but is sensitive to (neo–)adjuvant chemotherapy. The morphology and histology of the most important variants and special types are discussed in this review.

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Authors and Affiliations

  1. Institut für Pathologie, Universitätsklinikum Erlangen, Krankenhausstrasse 8–10, 91054, Erlangen, Deutschland

    S. Bertz & A. Hartmann

  2. Institut für Pathologie, Uniklinikum RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Deutschland

    R. Knüchel-Clarke &  N. T. Gaisa

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  1. S. Bertz
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  2. A. Hartmann
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  3. R. Knüchel-Clarke
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  4. N. T. Gaisa
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Correspondence to S. Bertz or N. T. Gaisa.

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S. Bertz, A. Hartmann, R. Knüchel-Clarke, N.T. Gaisa geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Schwerpunktherausgeber

A. Hartmann, Erlangen

R. Knüchel-Clarke, Aachen

G. Kristiansen, Bonn

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Bertz, S., Hartmann, A., Knüchel-Clarke, R. et al. Spezifische Typen des Harnblasenkarzinoms. Pathologe 37, 40–51 (2016). https://doi.org/10.1007/s00292-015-0129-5

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