nach oben

Die Pathologie

Erschienen in:

01.11.2011 | Hauptreferate

Präkanzerosen der Cervix uteri

Morphologie und Molekularpathologie

verfasst von: Prof. Dr. L.-C. Horn, K. Klostermann

Erschienen in: Die Pathologie | Sonderheft 2/2011

Einloggen, um Zugang zu erhalten

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.

Andersen ES, Arffmann E (1989) Adenocarcinoma in situ of the uterine cervix: a clinico-pathologic study of 36 cases. Gynecol Oncol 35(1):1–7PubMedCrossRef

Arbeitsgemeinschaft Zervixpathologie und Kolposkopie. http://www.dysplasiezentren.de/2011

Baseman JG, Koutsky LA (2005) The epidemiology of human papillomavirus infections. J Clin Virol 32(Suppl 1):S16–S24PubMedCrossRef

Bertrand M, Lickrish GM, Colgan TJ (1987) The anatomic distribution of cervical adenocarcinoma in situ: implications for treatment. Am J Obstet Gynecol 157(1):21–25PubMed

Boddington MM, Spriggs AI, Cowdell RH (1976) Adenocarcinoma of the uterine cervix: cytological evidence of a long preclinical evolution. Br J Obstet Gynaecol 83(11):900–903PubMedCrossRef

Boon ME, Baak JP, Kurver PJ et al (1981) Adenocarcinoma in situ of the cervix: an underdiagnosed lesion. Cancer 48(3):768–773PubMedCrossRef

Bulten J, Horvat R, Jordan J et al (2011) European guidelines for quality assurance in cervical histopathology. Acta Oncol 50(5):611–620 Epub 2011 Feb 11PubMedCrossRef

Cameron RI, Maxwell P, Jenkins D, McCluggage WG (2002) Immunohistochemical staining with MIB1, bcl2 and p16 assists in the distinction of cervical glandular intraepithelial neoplasia from tubo-endometrial metaplasia, endometriosis and microglandular hyperplasia. Histopathology 41(4):313–321PubMedCrossRef

Carreon JD, Sherman ME, Guillén D et al (2007) CIN2 is a much less reproducible and less valid diagnosis than CIN3: results from a histological review of population-based cervical samples. Int J Gynecol Pathol 26(4):441–446PubMedCrossRef

10.

Carter JJ, Koutsky LA, Hughes JP et al (2000) Comparison of human papillomavirus types 16, 18, and 6 capsid antibody responses following incident infection. J Infect Dis 181(6):1911–1919PubMedCrossRef

11.

Casper GR, Östör AG, Qiunn MA (1997) A clinicopathologic study of glandular dysplasia of the cervix. Gynecol Oncol 64:166–170PubMedCrossRef

12.

Ceballos KM, Chapman W, Daya D et al (2008) Reproducibility of the histological diagnosis of cervical dysplasia among pathologists from 4 continents. Int J Gynecol Pathol 27(1):101–107PubMedCrossRef

13.

Cina SJ, Richardson MS, Austin RM, Kurman RJ (1997) Immunohistochemical staining for Ki-67 antigen, carcinoembryonic antigen, and p53 in the differential diagnosis of glandular lesions of the cervix. Mod Pathol 10(3):176–180PubMed

14.

Clifford GM, Rana RK, Franceschi S et al (2005) Human papillomavirus genotype distribution in low-grade cervical lesions: comparison by geographic region and with cervical cancer. Cancer Epidemiol Biomarkers Prev 14(5):1157–1164PubMedCrossRef

15.

Colgan TJ, Lickrish GM (1990) The topography and invasive potential of cervical adenocarcinoma in situ, with and without associated squamous dysplasia. Gynecol Oncol 36(2):246–249PubMedCrossRef

16.

Day PM, Thompson CD, Buck CB et al (2007) Neutralization of human papillomavirus with monoclonal antibodies reveals different mechanisms of inhibition. J Virol 81(16):8784–8792 Epub Jun 6PubMedCrossRef

17.

Datta SD, Koutsky LA, Ratelle S et al (2008) Human papillomavirus infection and cervical cytology in women screened for cervical cancer in the United States, 2003–2005. Ann Intern Med 148(7):493–500PubMed

18.

Denehy TR, Gregori CA, Breen JL (1997) Endocervical curettage, cone margins, and residual adenocarcinoma in situ of the cervix. Obstet Gynecol 90(1):1–6PubMedCrossRef

19.

Dray M, Russell P, Dalrymple C et al (2005) p16(INK4a) as a complementary marker of high-grade intraepithelial lesions of the uterine cervix. I: Experience with squamous lesions in 189 consecutive cervical biopsies. Pathology 37(2):112–124PubMedCrossRef

20.

Fadare O, Rodriguez R (2007) Squamous dysplasia of the uterine cervix: tissue sampling-related diagnostic considerations in 600 consecutive biopsies. Int J Gynecol Pathol 26(4):469–474PubMedCrossRef

21.

Fadare O, Yi X, Liang SX et al (2007) Variations of mitotic index in normal and dysplastic squamous epithelium of the uterine cervix as a function of endometrial maturation. Mod Pathol 20(9):1000–1008 Epub Jul 20PubMedCrossRef

22.

Friedell GH, Tucker TC, McManmon E et al (1992) Incidence of dysplasia and carcinoma of the uterine cervix in an Appalachian population. J Natl Cancer Inst 84:1030–1032PubMedCrossRef

23.

Gloor E, Hurlimann J (1986) Cervical intraepithelial glandular neoplasia (adenocarcinoma in situ and glandular dysplasia). A correlative study of 23 cases with histologic grading, histochemical analysis of mucins and immunohistochemical determination of the affinity for four lectins. Cancer 58:1272–1280PubMedCrossRef

24.

Goldstein NS, Ahmad E, Hussain M et al (1998) Endocervical glandular atypia does preneoplastic lesion of adenocarcinoma in situ exist? Am J Clin Pathol 110:200–209PubMed

25.

Goldstein NS, Ahmad E, Hussain M et al (1998) Endocervical glandular atypia does preneoplastic lesion of adenocarcinoma in situ exist? Am J Clin Pathol 110:200–209PubMed

26.

Harnden P, Kennedy W, Andrew AC, Southgate J (1999) Immunophenotype of transitional metaplasia of the uterine cervix. Int J Gynecol Pathol 18(2):125–129PubMedCrossRef

27.

Hilfrich R, Hariri J (2008) Prognostic relevance of human papillomavirus L1 capsid protein detection within mild and moderate dysplastic lesions of the cervix uteri in combination with p16 biomarker. Anal Quant Cytol Histol 30(2):78–82PubMed

28.

Holowaty P, Miller AB, Rohan T, To T (1999) Natural history of dysplasia of the uterine cervix. J Natl Cancer Inst 91(3):252–258PubMedCrossRef

29.

Horn LC, Einenkel J, Höckel M et al (2007) Pathoanatomical preparation and reporting for dysplasias and cancers of the cervix uteri: cervical biopsy, conization, radical hysterectomy and exenteration. Pathologe 28(4):249–260PubMedCrossRef

30.

Horn LC, Reichert A, Oster A et al (2008) Immunostaining for p16^INK4a used as a conjunctive tool improves interobserver agreement of the histologic diagnosis of cervical intraepithelial neoplasia. Am J Surg Pathol 32(4):502–512PubMedCrossRef

31.

Ioffe OB, Sagae S, Moritani S et al (2003) Symposium part 3: Should pathologists diagnose endocervical preneoplastic lesions „less than“ adenocarcinoma in situ?: Point. Int J Gynecol Pathol 22(1):18–21PubMedCrossRef

32.

Jaworski RC, Pacey NF, Greenberg ML, Osborn RA (1988) The histologic diagnosis of adenocarcinoma in situ and related lesions of the cervix uteri. Adenocarcinoma in situ. Cancer 61(6):1171–1181PubMedCrossRef

33.

Jones MA (1998) Transitional cell metaplasia and neoplasia in the female genital tract: an update. Adv Anat Pathol 5(2):106–113PubMedCrossRef

34.

Kataja V, Syrjänen S, Mäntyjärvi R et al (1992) Prognostic factors in cervical human papillomavirus infections. Sex Transm Dis 19(3):154–160PubMedCrossRef

35.

Khleif SN, DeGregori J, Yee CL et al (1996) Inhibition of cyclin D-CDK4/CDK6 activity is associated with an E2F-mediated induction of cyclin kinase inhibitor activity. Proc Natl Acad Sci U S A 93(9):4350–4354PubMedCrossRef

36.

Klaes R, Benner A, Friedrich T et al (2002) p16^INK4a immunohistochemistry improves interobserver agreement in the diagnosis of cervical intraepithelial neoplasia. Am J Surg Pathol 26(11):1389–1399PubMedCrossRef

37.

Klaes R, Woerner SM, Ridder R et al (1999) Detection of high-risk cervical intraepithelial neoplasia and cervical cancer by amplification of transcripts derived from integrated papillomavirus oncogenes. Cancer Res 59(24):6132–6136PubMed

38.

Kolstad P, Klem V (1976) Long-term followup of 1121 cases of carcinoma in situ. Obstet Gynecol 48(2):125–129PubMed

39.

Koutsky L (1997) Epidemiology of genital human papillomavirus infection. Am J Med 102(5A):3–8PubMedCrossRef

40.

Kurian K, al-Nafussi A (1999) Relation of cervical glandular intraepithelial neoplasia to microinvasive and invasive adenocarcinoma of the uterine cervix: a study of 121 cases. J Clin Pathol 52(2):112–117PubMedCrossRef

41.

Lee KR, Flynn CE (2000) Early invasive adenocarcinoma of the cervix. Cancer 89(5):1048–1055PubMedCrossRef

42.

Lee KR, Sun D, Crum CP (2000) Endocervical intraepithelial glandular atypia (dysplasia): A histopathologic, human papillomavirus, and MIB-1 analysis of 25 cases. Hum Pathol 31(6):656–664PubMedCrossRef

43.

Löning T, Riethdorf l (2011) Die Differenzialdiagnose des Adenokarzinoms der Zervix. Im Druck

44.

Lu X, Shiozawa T, Nakayama K et al (1999) Abnormal expression of sex steroid receptors and cell cycle-related molecules in adenocarcinoma in situ of the uterine cervix. Int J Gynecol Pathol 18(2):109–114PubMedCrossRef

45.

Macedo FC de, Nicol AF, Scudeler D, Nuovo GJ (2009) The utility of HPV in situ hybridization and the PAS test in improving the specificity of the diagnosis of CIN 1. Int J Gynecol Pathol 28(1):83–89PubMedCrossRef

46.

Maier RC, Norris HJ (1980) Coexistence of cervical intraepithelial neoplasia with primary adenocarcinoma of the endocervix. Obstet Gynecol 56(3):361–364PubMed

47.

Malpica A, Matisic JP, Niekirk DV et al (2005) Kappa statistics to measure interrater and intrarater agreement for 1790 cervical biopsy specimens among twelve pathologists: qualitative histopathologic analysis and methodologic issues. Gynecol Oncol 99(3 Suppl 1):S38–S52PubMedCrossRef

48.

McCluggage G, McBride H, Maxwell P, Bharucha H (1997) Immunohistochemical detection of p53 and bcl-2 proteins in neoplastic and non-neoplastic endocervical glandular lesions. Int J Gynecol Pathol 16(1):22–27PubMedCrossRef

49.

McCluggage WG, Shah R, Connolly LE, McBride HA (2008) Intestinal-type cervical adenocarcinoma in situ and adenocarcinoma exhibit a partial enteric immunophenotype with consistent expression of CDX2. Int J Gynecol Pathol 27(1):92–100PubMedCrossRef

50.

McCredie MR, Paul C, Sharples KJ et al (2010) Consequences in women of participating in a study of the natural history of cervical intraepithelial neoplasia 3. Aust N Z J Obstet Gynaecol 50(4):363–370PubMedCrossRef

51.

McCredie MR, Sharples KJ, Paul C et al (2008) Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study. Lancet Oncol 9(5):425–434PubMedCrossRef

52.

McIndoe WA, McLean MR, Jones RW, Mullins PR (1984) The invasive potential of carcinoma in situ of the cervix. Obstet Gynecol 64(4):451–458PubMed

53.

Medeiros F, Bell DA (2010) Pseudoneoplastic lesions of the female genital tract. Arch Pathol Lab Med 34(3):393–403

54.

Miroshnichenko GG, Parva M, Holtz DO et al (2009) Interpretability of excisional biopsies of the cervix: cone biopsy and loop excision. J Low Genit Tract Dis 13(1):10–12PubMedCrossRef

55.

Molden T, Kraus I, Karlsen F et al (2006) Human papillomavirus E6/E7 mRNA expression in women younger than 30 years of age. Gynecol Oncol 100(1):95–100PubMedCrossRef

56.

Moreira MA, Longato-Filho A, Taromaru E et al (2006) Investigation of human papillomavirus by hybrid capture II in cervical carcinomas including 113 adenocarcinomas and related lesions. Int J Gynecol Cancer 16(2):586–590PubMedCrossRef

57.

Moritani S, Ioffe OB, Sagae S et al (2002) Mitotic activity and apoptosis in endocervical glandular lesions. Int J Gynecol Pathol 21(2):125–133PubMedCrossRef

58.

Münger K (2002) The role of human papillomaviruses in human cancers. Front Biosci 7:d641–d649PubMedCrossRef

59.

Nasiell K, Nasiell M, Vaćlavinková V (1983) Behavior of moderate cervical dysplasia during long-term follow-up. Obstet Gynecol 61(5):609–614PubMed

60.

Nasiell K, Roger V, Nasiell M (1986) Behavior of mild cervical dysplasia during long-term follow-up. Obstet Gynecol 67(5):665–669PubMedCrossRef

61.

Negri G, Bellisano G, Carico E et al (2011) Usefulness of p16^ink4a, ProEX C, and Ki-67 for the diagnosis of glandular dysplasia and adenocarcinoma of the cervix uteri. Int J Gynecol Pathol 30(4):407–413PubMedCrossRef

62.

Negri G, Bellisano G, Zannoni GF et al (2008) p16 ink4a and HPV L1 immunohistochemistry is helpful for estimating the behavior of low-grade dysplastic lesions of the cervix uteri. Am J Surg Pathol 32(11):1715–1720PubMedCrossRef

63.

Negri G, Moretto G, Menia E et al (2006) Immunocytochemistry of p16^INK4a in liquid-based cervicovaginal specimens with modified Papanicolaou counterstaining. J Clin Pathol 59(8):827–830PubMedCrossRef

64.

Nucci MR, Clement PB, Young RE (1999) Lobular endocervical glandular hyperplasia, not otherwise specified. Am J Surg Pathol 23:886–891PubMedCrossRef

65.

O’Neill CJ, McCluggage WG (2006) p16 expression in the female genital tract and its value in diagnosis. Adv Anat Pathol 13(1):8–15CrossRef

66.

Östör AG (1993) Natural history of cervical intraepithelial neoplasia – a critical review. Int J Gynecol Pathol 12:186–192PubMedCrossRef

67.

Östör AG, Mulvany N (1996) The pathology of cervical neoplasia. Curr Opin Obstet Gynecol 8:69–73PubMed

68.

Papanicolaou GN, Traut HF (1943) Diagnosis of uterine cancer by the vaginal smear. Commonwealth Fund, New York

69.

Parker MF, Zahn CM, Vogel KM et al (2002) Discrepancy in the interpretation of cervical histology by gynecologic pathologists. Obstet Gynecol 100(2):277–280PubMedCrossRef

70.

Pavlakis K, Messini I, Yiannou P et al (2010) A pre-tailored panel of antibodies in the study of cervical mesonephric remnants. Gynecol Oncol 116(3):468–472PubMedCrossRef

71.

Plaxe SC, Saltzstein SL (1999) Estimation of the duration of the preclinical phase of cervical adenocarcinoma suggests that there is ample opportunity for screening. Gynecol Oncol 75(1):55–61PubMedCrossRef

72.

Quint KD, Koning MN de, Doorn LJ van et al (2010) HPV genotyping and HPV16 variant analysis in glandular and squamous neoplastic lesions of the uterine cervix. Gynecol Oncol 117(2):297–301PubMedCrossRef

73.

Rabban JT, McAlhany S, Lerwill MF et al (2010) PAX2 distinguishes benign mesonephric and mullerian glandular lesions of the cervix from endocervical adenocarcinoma, including minimal deviation adenocarcinoma. Am J Surg Pathol 34(2):137–146PubMedCrossRef

74.

Reagan JW, Harmonic MJ (1956) The cellular pathology in carcinoma in situ: a cytohistopathological correlation. Cancer 9:385PubMedCrossRef

75.

Reagan JW, Patten SF Jr (1962) Dysplasia: a basic reaction to injury in the uterine cervix. Ann N Y Acad Sci 97:662–682PubMedCrossRef

76.

Regauer S, Reich O (2007) CK17 and p16 expression patterns distinguish (atypical) immature squamous metaplasia from high-grade cervical intraepithelial neoplasia (CIN III). Histopathology 50(5):629–635PubMedCrossRef

77.

Ribeiro AA, Figueiredo Alves RR, Costa MC et al (2011) Association between HPV types and species groups and cervical neoplasia from a high-risk area for cervical cancer, Goiânia, Brazil. Int J Gynecol Pathol 30(3):288–294PubMedCrossRef

78.

Richart RM (1966) Colpomicroscopic studies of cervical intraepithelial neoplasia. Cancer 19:395CrossRef

79.

Richart RM (1973) Cervical intraepithelial neoplasia. Pathol Annu 8:301–328PubMed

80.

Roberts JN, Buck CB, Thompson CD et al (2007) Genital transmission of HPV in a mouse model is potentiated by nonoxynol-9 and inhibited by carrageenan. Nat Med 13(7):857–861PubMedCrossRef

81.

Rouzier R (2008) Management of CIN1. J Gynecol Obstet Biol Reprod (Paris) 37(Suppl 1):S114–S120

82.

Sano T, Oyama T, Kashiwabara K et al (1998) Expression status of p16 protein is associated with human papillomavirus oncogenic potential in cervical and genital lesions. Am J Pathol 153(6):1741–1748PubMedCrossRef

83.

Schlesinger C, Silverberg SG (1999) Endocervical adenocarcinoma in situ of tubal type and its relation to atypical tubal metaplasia. Int J Gynecol Pathol 18(1):1–4PubMedCrossRef

84.

Schmidt D (2011) Der Einsatz von Biomarkern in der zytologischen Diagnostik der präkanzerösen Veränderungen der Zervix. Im Druck

85.

Schoolland M, Segal A, Allpress S et al (2002) Adenocarcinoma in situ of the cervix. Cancer 96(6):330–337PubMedCrossRef

86.

Schottländer J, Kermauner F (1912) Zur Kenntnis des Uteruskarzinoms; monographische Studie über Morphologie, Entwicklung, Wachstum, nebst Beiträgen zur Klinik der Erkrankung. Karger, Berlin

87.

Shin JW, Rho HS, Park CY (2009) Factors influencing the choice between cold knife conization and loop electrosurgical excisional procedure for the treatment of cervical intraepithelial neoplasia. J Obstet Gynaecol Res 35(1):126–130PubMedCrossRef

88.

Smedts F, Ramaekers FC, Hopman AH (2010) The two faces of cervical adenocarcinoma in situ. Int J Gynecol Pathol 29(4):378–385PubMedCrossRef

89.

Smith JS, Lindsay L, Hoots B et al (2007) Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: a meta-analysis update. Int J Cancer 121(3):621–632PubMedCrossRef

90.

Solomon D, Schiffman M, Tarone R, ALTS Study group (2001) Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: Baseline results from a randomized trial. J Natl Cancer Inst 93(4):293–299PubMedCrossRef

91.

Soutter WP, Sasieni P, Panoskaltsis T (2006) Long-term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia. Int J Cancer 118(8):2048–2055PubMedCrossRef

92.

Stanley M (2010) Pathology and epidemiology of HPV infection in females. Gynecol Oncol 117(Suppl 2):5–10CrossRef

93.

Stewart CJ, Little L (2010) Diagnostic value and implications of vimentin expression in normal, reactive and neoplastic endocervical epithelium. Pathology 42(3):217–223PubMedCrossRef

94.

Teshima H, Beaudenon S, Koi S et al (1997) Human papillomavirus type 18 sequences in adenocarcinoma and adenosquamous carcinoma of the uterine cervix. Arch Gynecol Obstet 259:169–177PubMedCrossRef

95.

Trunk MJ, Wentzensen N, Knebel Doeberitz M von (2005) Molekulare Pathogenese des Zervixkarzinoms und seiner Vorstufen. Pathologe 26(4):283–290PubMedCrossRef

96.

Tsoumpou I, Arbyn M, Kyrgiou M et al (2009) p16(INK4a) immunostaining in cytological and histological specimens from the uterine cervix: a systematic review and meta-analysis. Cancer Treat Rev 35(3):210–220PubMedCrossRef

97.

Aspert-van Erp AJ van, Smedts FM, Vooijs GP (2004) Severe cervical glandular cell lesions with coexisting squamous cell lesions. Cancer 102(4):218–227CrossRef

98.

Hoeven KH van, Ramondetta L, Kovatich AJ et al (1997) Quantitative image analysis of MIB-1 reactivity in inflammatory, hyperplastic, and neoplastic endocervical lesions. Int J Gynecol Pathol 16(1):15–21PubMedCrossRef

99.

Volante R, Giubilato P, Ronco G (2010) Quality of colposcopy and treatment: data from the national survey of Italian organised cervical screening programmes. 2008 activity. Epidemiol Prev 34(5–6 Suppl 4):73–80

100.

Knebel-Doeberitz M von (2011) Pathogenese HPV-assoziierter Neoplasien. Im Druck

101.

Walboomers JM, Jacobs MV, Manos MM et al (1999) Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 189(1):12–19PubMedCrossRef

102.

Wang SS, Sherman ME, Hildesheim A et al (2004) Cervical adenocarcinoma and squamous cell carcinoma incidence trends among white women and black women in the United States for 1976–2000. Cancer 100(5):1035–1044PubMedCrossRef

103.

Wang SS, Sherman ME, Silverberg SG et al (2006) Pathological characteristics of cervical adenocarcinoma in a multi-center US-based study. Gynecol Oncol 103(2):541–546PubMedCrossRef

104.

Weir MM, Bell DA, Young RH (1997) Transitional cell metaplasia of the uterine cervix and vagina: an underrecognized lesion that may be confused with high-grade dysplasia. A report of 59 cases. Am J Surg Pathol 21(5):510–517PubMedCrossRef

105.

Wells M, Östör AG, Crum CP et al (2003) Epithelial tumors of the aauterine cervix. In: Tavassoli FA, Devilee P (eds) Pathology and genetics of tumours of the breast and female genital organs. World Health Organization Classification of Tumours. IARC Press, Lyon, pp 259–279

106.

Witkiewicz A, Lee KR, Brodsky G et al (2005) Superficial (early) endocervical adenocarcinoma in situ: a study of 12 cases and comparison to conventional AIS. Am J Surg Pathol 29(12):1609–1614PubMedCrossRef

107.

Woodman CB, Collins S, Rollason TP et al (2003) Human papillomavirus type 18 and rapidly progressing cervical intraepithelial neoplasia. Lancet 361(9351):40–43PubMedCrossRef

108.

Zaino RJ (2002) Symposium part I: Adenocarcinoma in situ, glandular dysplasia, and early invasive adenocarcinoma of the uterine cervix. Int J Gynecol Pathol 21(4):314–326PubMedCrossRef

109.

Hausen H zur (2002) Papillomaviruses and cancer: from basic studies to clinical application. Nat Rev Cancer 2(5):342–350PubMedCrossRef

Titel: Präkanzerosen der Cervix uteri
Morphologie und Molekularpathologie
verfasst von: Prof. Dr. L.-C. Horn
K. Klostermann
Publikationsdatum: 01.11.2011
Verlag: Springer-Verlag
Erschienen in: Die Pathologie / Ausgabe Sonderheft 2/2011
Print ISSN: 2731-7188
Elektronische ISSN: 2731-7196
DOI: https://doi.org/10.1007/s00292-011-1517-0

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

„Jeder Fall von plötzlichem Tod muss obduziert werden!“

17.05.2024 Plötzlicher Herztod Nachrichten

Ein signifikanter Anteil der Fälle von plötzlichem Herztod ist genetisch bedingt. Um ihre Verwandten vor diesem Schicksal zu bewahren, sollten jüngere Personen, die plötzlich unerwartet versterben, ausnahmslos einer Autopsie unterzogen werden.

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Schlechtere Vorhofflimmern-Prognose bei kleinem linken Ventrikel

17.05.2024 Vorhofflimmern Nachrichten

Nicht nur ein vergrößerter, sondern auch ein kleiner linker Ventrikel ist bei Vorhofflimmern mit einer erhöhten Komplikationsrate assoziiert. Der Zusammenhang besteht nach Daten aus China unabhängig von anderen Risikofaktoren.

Semaglutid bei Herzinsuffizienz: Wie erklärt sich die Wirksamkeit?

17.05.2024 Herzinsuffizienz Nachrichten

Bei adipösen Patienten mit Herzinsuffizienz des HFpEF-Phänotyps ist Semaglutid von symptomatischem Nutzen. Resultiert dieser Benefit allein aus der Gewichtsreduktion oder auch aus spezifischen Effekten auf die Herzinsuffizienz-Pathogenese? Eine neue Analyse gibt Aufschluss.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Sonderheft 2/2011

Satzung der Deutschen Gesellschaft für Pathologie e. V.

Lieselotte Gerhard

Vorläuferläsionen pankreatobiliärer Karzinome

Vorläuferläsionen des Lungenkarzinoms

Speicheldrüsenkarzinome