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Praktisch-diagnostische Aspekte uteriner Leiomyosarkome im Kontext der WHO-Klassifikation 2020

Practical diagnostic aspects of uterine leiomyosarcoma in the context of the 2020 WHO classification

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Zusammenfassung

Die WHO-Klassifikation 2020 unterscheidet das spindelzellige, epitheloide und myxoide Leiomyosarkom (LMS) als morphologische Varianten. Diagnostische Parameter zur Unterscheidung zum Leiomyom sind nach wie vor nukleäre Atypien (Kerngrößenschwankungen > 2–3: 1), die Mitosezahl (meist ≥ 10 Mitosen/10 HPF bei 0,55 mm Gesichtsfelddurchmesser bzw. 0,24 mm2 Fläche) und Tumorzellnekrosen. Diese morphologischen Kriterien haben in Abhängigkeit vom histologischen Subtyp unterschiedliche Bedeutung. Bei der Ermittlung der Mitosezahl sind präanalytische, färbetechnische und tumorgeografische Aspekte zu beachten. Der STUMP ist nach wie vor die histopathologisch am schlechtesten charakterisierte Entität. Immunhistochemische Färbungen mit p53, p16, Ki-67 und WT‑1 können zur Abgrenzung von Leiomyomata zum Teil hilfreich sein. Molekularpathologische Untersuchungen spielen in der Differenzialdiagnostik derzeit (noch) eine untergeordnete Rolle.

Abstract

The 2020 WHO Classification defines the spindle cell, epithelioid, and myxoid variants as subtypes of uterine leiomyosarcomas (LMS). Presence of cellular atypia (size variation of polymorphic nuclei > 2–3:1), tumor cell necroses, and mitotic count (usually ≥ 10 MF/10 HPF) are still the key features for diagnostic separation from uterine leiomyomas. Preanalytic variables, staining quality, as well as intralesional geographic distribution may affect the mitotic count. Smooth muscle tumors of uncertain malignant potential (STUMP) still exist as a not yet well-characterized diagnostic entity. Immunohistochemical stains against p16, p53, Ki-67, and WT‑1 may aid differential diagnosis in selected cases. Diagnostic molecular pathology is not yet relevant for diagnosis.

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Authors and Affiliations

  1. Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Institut für Pathologie, Universitätsklinikum Leipzig AöR, Liebigstr. 26, 04103, Leipzig, Deutschland

    Lars-Christian Horn & Anne Kathrin Höhn

  2. Pathologisches Institut, der Ludwig-Maximilians-Universität München, München, Deutschland

    Grit Gesine Ruth Hiller, Doris Mayr & Elisa Schmoeckel

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  1. Lars-Christian Horn
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  2. Grit Gesine Ruth Hiller
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  4. Elisa Schmoeckel
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  5. Anne Kathrin Höhn
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Correspondence to Lars-Christian Horn.

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L.-C. Horn, G.G.R. Hiller, D. Mayr, E. Schmoeckel und A.K. Höhn geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Horn, LC., Hiller, G.G.R., Mayr, D. et al. Praktisch-diagnostische Aspekte uteriner Leiomyosarkome im Kontext der WHO-Klassifikation 2020. Pathologe 43, 196–201 (2022). https://doi.org/10.1007/s00292-022-01064-6

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