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01.01.2009 | Leitthema

Pathologie der Präkanzerosen und der Karzinome von Vulva und Vagina sowie morphologische Prognosefaktoren

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

Erschienen in: Die Onkologie | Ausgabe 1/2009

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Zusammenfassung

Das Vaginal- und das Vulvakarzinom sind mit jeweils ca. 1% aller malignen Tumoren des weiblichen Genitales selten. In Analogie zum Dysplasiekonzept bei der Cervix uteri werden die Präkanzerosen der Vagina als vaginale intraepitheliale Neoplasien (VAIN) und die der Vulva als vulväre intraepitheliale Neoplasien (VIN) bezeichnet. Aufgrund einer differenten Pathogenese und Morphologie werden prinzipiell zwei Arten der VIN definiert: Die klassische VIN ist durch eine Assoziation zu High-Risk-HPV charakterisiert, einem Auftreten bei jungen Frauen und einer Multifokalität. Die differenzierte VIN („simplex“ bzw. „differentiated type“) ist deutlich seltener, wird in der Regel bei postmenopausalen Patientinnen diagnostiziert, weist keine Assoziation zu einer HPV-Infektion auf, jedoch eine Alteration von p53. Die meisten der invasiven Vaginal- bzw. Vulvakarzinome sind Plattenepithelkarzinome, gefolgt von den Adenokarzinomen. Die Datenlage zu prognostisch relevanten Faktoren beim Vaginalkarzinom ist eingeschränkt. Gut etabliert ist das Tumorstadium und bei radiotherapierten Karzinomen die Tumorgröße. Das Ausmaß des Befalls der Scheide durch den Tumor (befallene Drittel) wird ebenso kontrovers diskutiert wie die Bedeutung einer proximalen bzw. distalen vaginalen Lokalisation des Karzinoms. Relevante Prognosefaktoren beim Vulvakarzinom sind das Tumorstadium, der Nachweis (inguinaler) Lymphknotenmetastasen (LKM), die Größe der LKM sowie der Nachweis eines Kapseldurchbruchs, die Invasionstiefe des Karzinoms und der Abstand zum Resektionsrand. Kontrovers werden das Grading und der Nachweis von Lymphgefäßeinbrüchen diskutiert. Voraussetzung für die adäquate Erhebung prognostisch und therapeutisch relevanter Faktoren ist eine sorgfältige pathologisch-anatomische Befundung.
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Metadaten
Titel
Pathologie der Präkanzerosen und der Karzinome von Vulva und Vagina sowie morphologische Prognosefaktoren
verfasst von
Prof. Dr. L.-C. Horn
K. Schierle
Publikationsdatum
01.01.2009
Verlag
Springer-Verlag
Erschienen in
Die Onkologie / Ausgabe 1/2009
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-008-1537-4

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