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Grading gynäkologischer Tumoren

Aktuelle Aspekte

Grading of gynecological tumors

Current aspects

  • Schwerpunkt: Grading-Systeme
  • Published:
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Zusammenfassung

Das Grading bei Tumoren des weiblichen Genitaltrakts hat eine sehr unterschiedliche Bedeutung. Für Plattenepithel- und Adenokarzinome der Vulva, Vagina und der Cervix uteri gibt es kein verbindliches Gradingsystem. Bei den endometrioiden Endometriumkarzinomen (Typ-1-Karzinomen) ist das Grading therapeutisch und prognostisch relevant. Das von der FIGO vorgeschlagene 3‑stufige Grading in Abhängigkeit vom Prozentsatz des soliden Tumoranteils hat nach wie vor seine Gültigkeit. Bei den neuroendokrinen Tumoren des Uterus erfolgt ein Grading in Analogie zu den gastrointestinalen Tumoren. Bei Leiomyosarkomen wird kein Grading durchgeführt. Bei den endometrialen Stromasarkomen werden in Abhängigkeit von der Morphologie, der Immunhistologie, ergänzt durch die Molekularpathologie Low- und High-grade-Tumoren unterschieden. Unter Berücksichtigung der Tubulusformation der Sertoli-Zellen und der Menge intratumoralen primitiven gonadalen Stromas erfolgt das Grading bei Sertoli-Leydig-Zell-Tumoren des Ovars und beim unreifen Teratom in Abhängigkeit von der Ausdehnung primitiver Neurotubuli. Für endometrioide, seromuzinöse und muzinöse Ovarialkarzinome wird das FIGO-Grading für endometrioide Endometriumkarzinome empfohlen. Für chemotherapierte seröse High-grade-Karzinome wurde ein Regressionsgrading etabliert. Molekularbiologische Daten spielen derzeit bei gynäkologischen Tumoren für das Grading (noch) keine Rolle.

Abstract

Histopathological assessment of the tumor grade and cell type is central to the management and prognosis of various gynecological malignancies. Conventional grading systems for squamous carcinomas and adenocarcinomas of the vulva, vagina and cervix are poorly defined. For endometrioid tumors of the female genital tract as well as for mucinous endometrial, ovarian and seromucinous ovarian carcinomas, the 3‑tiered FIGO grading system is recommended. For uterine neuroendocrine tumors the grading system of the gastrointestinal counterparts has been adopted. Uterine leiomyosarcomas are not graded. Endometrial stromal sarcomas are divided into low and high grades, based on cellular morphology, immunohistochemical and molecular findings. A chemotherapy response score was established for chemotherapeutically treated high-grade serous pelvic cancer. For non-epithelial ovarian malignancies, only Sertoli-Leydig cell tumors and immature teratomas are graded. At this time molecular profiling has no impact on the grading of tumors of the female genital tract.

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Authors and Affiliations

  1. Institut für Pathologie, Abteilung Mamma-, Gynäko- & Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland

    L.-C. Horn, I. Sändig & K. Schierle

  2. Pathologisches Institut, Ludwig-Maximilins-Universität, München, Deutschland

    D. Mayr

  3. Frauenklinik des Klinikums rechts der Isar, Technischen Universität München, München, Deutschland

    C. E. Brambs

  4. Universitätsfrauenklinik Leipzig (Triersches Institut) im Zentrum für Frauen- und Kindermedizin, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland

    J. Einenkel

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Horn, LC., Mayr, D., Brambs, C.E. et al. Grading gynäkologischer Tumoren. Pathologe 37, 337–351 (2016). https://doi.org/10.1007/s00292-016-0183-7

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