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Präkanzerosen der Cervix uteri

Morphologie und Molekularpathologie

Precancerous lesions of the uterine cervix

Morphology and molecular pathology

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Zusammenfassung

Präkanzerosen des Plattenepithels der Cervix uteri entstehen im Bereich der Transformationszone auf dem Boden einer HPV-“high-risk“-Infektion und werden in Abhängigkeit von der Ausdehnung der Läsion im Epithel in die zervikalen intraepithelialen Neoplasien (CIN) I bis III unterteilt. CIN I und CIN II weisen in 60–90% bzw. 50% eine Regression, die CIN III in 20–50% eine Progression auf. Zur Graduierung der CIN und zur Abgrenzung gegenüber einer nichtpräkanzerösen Veränderung ist die p16-Immunhistochemie hilfreich. Das Konzept der glandulären Dysplasien hat sich nicht bestätigt und dieser Terminus sollte in der histologischen Diagnostik nicht benutzt werden. Die Vorläuferläsion des Adenokarzinoms der Cervix uteri ist das Adenocarcinoma in situ (AIS oder ACIS) mit einer Assoziation zur HPV-high-risk-Infektion. Im Vergleich zur CIN III ist es mit 1:50–100 seltener, aber in 25–75% mit einer solchen assoziiert. Andere glanduläre Läsionen können unter Einsatz der Immunhistochemie (z. B. p16, Ki-67, Bcl-2, Vimentin) in der Regel abgegrenzt werden. Alle Proben mit Verdacht auf eine zervikale Präkanzerose müssen in Stufenschnitten aufgearbeitet werden. Wichtige Angaben für die Klinik sind die Qualität des Präparats, die genaue Einordnung der Präkanzerose, die Angabe sonstiger Veränderungen, welche den auffälligen zytologischen/kolposkopischen Befund erklären und bei Konisaten die Beziehung der CIN bzw. des ACIS zu den Resektionsrändern.

Abstract

HPV-induced alterations of the uterine cervix are frequently biopsied because of suspicious findings on a Pap smear and/or colposcopy. Precancerous lesions occur at the so called transformation zone. For those representing squamous differentiation, the traditional three-tier grading system in CIN 1 to 3 is used. CIN 1 and CIN 2 represent (spontaneous) regression in 60–90% and 50%, respectively. In CIN 3 lesions progression is seen in 20–50%. For appropriate grading, improvement of inter- and intraobserver correlation as well as the exclusion of non-precancerous lesions, p16 immunohistochemistry might be helpful. The terms endocervical glandular dysplasia and low-grade glandular intraepithelial neoplasia have been suggested for glandular lesions less than adenocarcinoma in situ (AIS). Until now reproducible histological criteria have not been established. Additional studies using HPV analysis, p16 and Ki-67 immunohistochemistry have not been proved for these lesions. In accordance with international consensus meetings, these diagnostic terms are not recommended for use in practice. AIS, characterised by the replacement of glandular epithelium by cytologically malignant cells, has been established as the precancerous lesion of the endocervix. AIS is much less common than CIN 3 with a reported range of 1:50–100. But, AIS is found in association with CIN 3 with 25–75%. The differential diagnosis between AIS and non-neoplastic glandular lesion may be aided by immunohistochemistry (e.g. p16, Ki-67, bcl-2, vimentin). All specimens obtained after the clinical diagnosis of cervical precancerous lesions should be examined using step sectioning to rule out microinvasive growth. Important information for clinicians includes the quality of the specimen (cautery artefacts, transformation zone enclosed within the probe), exact grading of CIN lesions, identification of other lesions responsible for suspicious findings of a Pap smear or at colposcopy, and in the case of conisation the distance of the lesion from the resection margins (endo- and ectocervical and circumferential margin).

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

    L.-C. Horn

  2. Dysplasiezentrum, Universitätsfrauenklinik Leipzig (Triersches Institut), Zentrum für Frauen- und Kindermedizin, Universitätsklinikum Leipzig, Leipzig, Deutschland

    K. Klostermann

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  1. L.-C. Horn
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  2. K. Klostermann
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Correspondence to L.-C. Horn.

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Horn, LC., Klostermann, K. Präkanzerosen der Cervix uteri. Pathologe 32 (Suppl 2), 242 (2011). https://doi.org/10.1007/s00292-011-1517-0

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  • DOI: https://doi.org/10.1007/s00292-011-1517-0

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