Zusammenfassung
Die Einführung eines Screeningprogramms hat auch in Deutschland zu einem Rückgang der Inzidenz des invasiven Zervixkarzinoms und zu einer relativen Zunahme der Karzinomvorstufen geführt. Das häufigste invasive Zervixkarzinom ist das Plattenepithelkarzinom. Adenokarzinome sind demgegenüber deutlich seltener. Besondere Formen des Plattenepithelkarzinoms sind das verruköse Karzinom, das papilläre (transitionalzellige) Karzinom und das lymphoepitheliomartige Karzinom.
Unter den verschiedenen Subtypen des Adenokarzinoms ist das muzinöse Karzinom am häufigsten, entweder als endozervikaler oder als intestinaler Subtyp. Wesentlich seltener sind der endometrioide, der seröse und der klarzellige Subtyp. Besondere Schwierigkeiten bereitet in der Diagnostik das Adenoma malignum („Minimal-deviation-Adenokarzinom“), weil nur geringe Atypien vorhanden sind und die atypischen Drüsen kaum von solchen einer endozervikalen glandulären Hyperplasie zu unterscheiden sind.
Zu einer vollständigen Diagnose eines Zervixkarzinoms gehört neben einer Angabe des Tumortyps immer auch eine Bestimmung des Malignitätsgrades. Immunhistochemische Untersuchungen sind oft hilfreich, um die verschiedenen Formen des Zervixkarzinoms voneinander und von metastatischen Läsionen abgrenzen zu können.
Abstract
The introduction of a screening programme for carcinoma of the cervix uteri has lead to a reduction in the number of invasive carcinomas and to a relative increase in the frequency of preinvasive cervical lesions. The most frequent type of invasive cancer of the cervix is squamous cell carcinoma. Adenocarcinomas are much more infrequent. Special subtypes of squamous cell carcinomas are the papillary (squamotransitional) subtype, the verrrucous subtype and the lymphoepithelioma-like subtype.
Among the various forms of adenocarcinoma, the mucinous subtype is the most frequent, either as endocervical or interstinal subtype. Much more rare are the serous and clear cell carcinomas. Great concern in daily diagnosis causes the adenoma malignum (minimal deviation adenocarcinoma), since this type of adenocarcinoma demonstrates only minor cytological atypia and greatly resembles the different types of endocervical glandular hyperplasia.
A report on a cervical carcinoma should always include the typing and grading of the tumor. Immunohistochemical stains are often useful to distinguish the various types of primary cervical cancer and to distinguish these from metastatic lesions.
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Schmidt, D., Horn, LC. & Kommoss, F. Histopathologie des Plattenepithelkarzinoms und des Adenokarzinoms der Cervix uteri. Pathologe 26, 255–261 (2005). https://doi.org/10.1007/s00292-005-0765-2
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DOI: https://doi.org/10.1007/s00292-005-0765-2