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29.08.2016 | Zervixkarzinom | Leitthema

Zervixkarzinom und seine Vorstufen

verfasst von: Prof. Dr. Hans-Peter Sinn, Birgit Helmchen, Sarah Schott, Thomas Löning

Erschienen in: Die Onkologie | Ausgabe 10/2016

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Zusammenfassung

Hintergrund

Die Nomenklatur plattenepithelialer und glandulärer Vorläuferläsionen des Zervixkarzinoms wurde in der WHO-Klassifikation und in nationalen und internationalen Leitlinien in den letzten Jahren reformiert.

Methoden

Die Arbeit basiert auf einer PubMed-Literaturrecherche sowie nationalen und internationalen Leitlinien zum Thema.

Ergebnisse

Bei den HPV-assoziierten zervikalen intraepithelialen Neoplasien wurde eine scharfe Abgrenzung der plattenepithelialen Läsionen geringen und hohen Risikos (LSIL bzw. HSIL) in den Vordergrund gestellt. Morphologische Veränderungen, die mit der produktiven Phase der HPV-Infektion assoziiert sind, werden als LSIL bezeichnet und Veränderungen, die mit einer Deregulation der HPV-Expression und des Zellzyklus einhergehen, als HSIL. Für das klinische Management ist jedoch weiterhin die Angabe der dreistufigen CIN-Klassifikation unverzichtbar. Zur Differenzialdiagnose HPV-assoziierter Vorläufer und insbesondere der Abgrenzung metaplastischer squamöser und glandulärer Läsionen ist die p16-Immunhistochemie (ggf. in Kombination mit Ki67) in der Diagnosestellung von Relevanz. Das Staging des Zervixkarzinoms wurde durch Unterteilung von Stadium IIA in IIA1 und IIA2 ergänzt und die Bedeutung einer standardisierten Bestimmung morphologischer Prognosefaktoren hervorgehoben. Die Differenzierung spezieller Typen des Plattenepithelkarzinoms und seltener, nicht HPV-assoziierter Adenokarzinome erfordert besondere Aufmerksamkeit.

Schlussfolgerung

Die kürzlich aktualisierten Empfehlungen zur Diagnostik und Klassifikation des Zervixkarzinoms berücksichtigen das verbessertes Verständnis der Biologie und des Verlaufs der Erkrankung.
Literatur
3.
Zurück zum Zitat Bean SM, Kurtycz DF, Colgan TJ (2011) Recent developments in defining microinvasive and early invasive carcinoma of the uterine cervix. J Low Genit Tract Dis 15:146–157CrossRefPubMed Bean SM, Kurtycz DF, Colgan TJ (2011) Recent developments in defining microinvasive and early invasive carcinoma of the uterine cervix. J Low Genit Tract Dis 15:146–157CrossRefPubMed
4.
Zurück zum Zitat Carreon JD, Sherman ME, Guillen 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 26:441–446CrossRefPubMed Carreon JD, Sherman ME, Guillen 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 26:441–446CrossRefPubMed
5.
Zurück zum Zitat Castle PE, Schiffman M, Wheeler CM et al (2009) Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2. Obstet Gynecol 113:18–25CrossRefPubMedPubMedCentral Castle PE, Schiffman M, Wheeler CM et al (2009) Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2. Obstet Gynecol 113:18–25CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Clinton LK, Miyazaki K, Ayabe A et al (2015) The LAST guidelines in clinical practice: implementing recommendations for p16 use. Am J Clin Pathol 144:844–849CrossRefPubMed Clinton LK, Miyazaki K, Ayabe A et al (2015) The LAST guidelines in clinical practice: implementing recommendations for p16 use. Am J Clin Pathol 144:844–849CrossRefPubMed
7.
Zurück zum Zitat Darragh TM, Colgan TJ, Cox JT et al (2012) The lower Anogenital squamous terminology standardization project for HPV-associated lesions: background and consensus recommendations from the college of american pathologists and the american society for Colposcopy and cervical pathology. Arch Pathol Lab Med 136:1266–1297CrossRefPubMed Darragh TM, Colgan TJ, Cox JT et al (2012) The lower Anogenital squamous terminology standardization project for HPV-associated lesions: background and consensus recommendations from the college of american pathologists and the american society for Colposcopy and cervical pathology. Arch Pathol Lab Med 136:1266–1297CrossRefPubMed
8.
Zurück zum Zitat Diaz De Vivar A, Roma AA, Park KJ et al (2013) Invasive endocervical adenocarcinoma: proposal for a new pattern-based classification system with significant clinical implications: a multi-institutional study. Int J Gynecol Pathol 32:592–601CrossRefPubMed Diaz De Vivar A, Roma AA, Park KJ et al (2013) Invasive endocervical adenocarcinoma: proposal for a new pattern-based classification system with significant clinical implications: a multi-institutional study. Int J Gynecol Pathol 32:592–601CrossRefPubMed
9.
Zurück zum Zitat Elfgren K, Kalantari M, Moberger B et al (2000) A population-based five-year follow-up study of cervical human papillomavirus infection. Am J Obstet Gynecol 183:561–567CrossRefPubMed Elfgren K, Kalantari M, Moberger B et al (2000) A population-based five-year follow-up study of cervical human papillomavirus infection. Am J Obstet Gynecol 183:561–567CrossRefPubMed
10.
Zurück zum Zitat Hammer A, Rositch A, Qeadan F et al (2016) Age-specific prevalence of HPV16/18 genotypes in cervical cancer: A systematic review and meta-analysis. Int J Cancer 138:2795–2803CrossRefPubMed Hammer A, Rositch A, Qeadan F et al (2016) Age-specific prevalence of HPV16/18 genotypes in cervical cancer: A systematic review and meta-analysis. Int J Cancer 138:2795–2803CrossRefPubMed
11.
Zurück zum Zitat Hanselaar A, Van Loosbroek M, Schuurbiers O et al (1997) Clear cell adenocarcinoma of the vagina and cervix. An update of the central Netherlands registry showing twin age incidence peaks. Cancer 79:2229–2236CrossRefPubMed Hanselaar A, Van Loosbroek M, Schuurbiers O et al (1997) Clear cell adenocarcinoma of the vagina and cervix. An update of the central Netherlands registry showing twin age incidence peaks. Cancer 79:2229–2236CrossRefPubMed
12.
Zurück zum Zitat Husain RS, Ramakrishnan V (2015) Global variation of human Papillomavirus genotypes and selected genes involved in cervical malignancies. Ann Glob Health 81:675–683CrossRefPubMed Husain RS, Ramakrishnan V (2015) Global variation of human Papillomavirus genotypes and selected genes involved in cervical malignancies. Ann Glob Health 81:675–683CrossRefPubMed
13.
Zurück zum Zitat International Collaboration of Epidemiological Studies of Cervical C (2007) Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies. Int J Cancer 120:885–891CrossRef International Collaboration of Epidemiological Studies of Cervical C (2007) Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies. Int J Cancer 120:885–891CrossRef
14.
Zurück zum Zitat International Collaboration of Epidemiological Studies of Cervical C, Appleby P, Beral V et al (2006) Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer 118:1481–1495CrossRef International Collaboration of Epidemiological Studies of Cervical C, Appleby P, Beral V et al (2006) Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer 118:1481–1495CrossRef
15.
Zurück zum Zitat Kalof AN, Dadmanesh F, Longacre TA et al (2013) Protocol for the examination of specimens from patients with carcinoma of the uterine cervix. In: Cancer reporting protocols. College of American Pathologists (CAP), Northfield Kalof AN, Dadmanesh F, Longacre TA et al (2013) Protocol for the examination of specimens from patients with carcinoma of the uterine cervix. In: Cancer reporting protocols. College of American Pathologists (CAP), Northfield
16.
Zurück zum Zitat Karamurzin YS, Kiyokawa T, Parkash V et al (2015) Gastric-type Endocervical Adenocarcinoma: an aggressive tumor with unusual metastatic patterns and poor prognosis. Am J Surg Pathol 39:1449–1457CrossRefPubMed Karamurzin YS, Kiyokawa T, Parkash V et al (2015) Gastric-type Endocervical Adenocarcinoma: an aggressive tumor with unusual metastatic patterns and poor prognosis. Am J Surg Pathol 39:1449–1457CrossRefPubMed
17.
Zurück zum Zitat Kenny SL, Mcbride HA, Jamison J et al (2012) Mesonephric adenocarcinomas of the uterine cervix and corpus: HPV-negative neoplasms that are commonly PAX8, CA125, and HMGA2 positive and that may be immunoreactive with TTF1 and hepatocyte nuclear factor 1‑beta. Am J Surg Pathol 36:799–807CrossRefPubMed Kenny SL, Mcbride HA, Jamison J et al (2012) Mesonephric adenocarcinomas of the uterine cervix and corpus: HPV-negative neoplasms that are commonly PAX8, CA125, and HMGA2 positive and that may be immunoreactive with TTF1 and hepatocyte nuclear factor 1‑beta. Am J Surg Pathol 36:799–807CrossRefPubMed
18.
Zurück zum Zitat Koenig C, Turnicky RP, Kankam CF et al (1997) Papillary squamotransitional cell carcinoma of the cervix: a report of 32 cases. Am J Surg Pathol 21:915–921CrossRefPubMed Koenig C, Turnicky RP, Kankam CF et al (1997) Papillary squamotransitional cell carcinoma of the cervix: a report of 32 cases. Am J Surg Pathol 21:915–921CrossRefPubMed
19.
Zurück zum Zitat Kojima A, Mikami Y, Sudo T et al (2007) Gastric morphology and immunophenotype predict poor outcome in mucinous adenocarcinoma of the uterine cervix. Am J Surg Pathol 31:664–672CrossRefPubMed Kojima A, Mikami Y, Sudo T et al (2007) Gastric morphology and immunophenotype predict poor outcome in mucinous adenocarcinoma of the uterine cervix. Am J Surg Pathol 31:664–672CrossRefPubMed
20.
Zurück zum Zitat Kuragaki C, Enomoto T, Ueno Y et al (2003) Mutations in the STK11 gene characterize minimal deviation adenocarcinoma of the uterine cervix. Lab Invest 83:35–45CrossRefPubMed Kuragaki C, Enomoto T, Ueno Y et al (2003) Mutations in the STK11 gene characterize minimal deviation adenocarcinoma of the uterine cervix. Lab Invest 83:35–45CrossRefPubMed
21.
Zurück zum Zitat Kurman RJ, International Agency for Research on Cancer, World Health Organization (2014) WHO classification of tumours of female reproductive organs. International Agency for Research on Cancer, Lyon Kurman RJ, International Agency for Research on Cancer, World Health Organization (2014) WHO classification of tumours of female reproductive organs. International Agency for Research on Cancer, Lyon
23.
Zurück zum Zitat McCluggage WG (2013) Premalignant lesions of the lower female genital tract: cervix, vagina and vulva. Pathology 45:214–228CrossRefPubMed McCluggage WG (2013) Premalignant lesions of the lower female genital tract: cervix, vagina and vulva. Pathology 45:214–228CrossRefPubMed
24.
Zurück zum Zitat McCluggage WG (2016) Recent developments in non-HPV-related Adenocarcinomas of the lower female genital tract and their precursors. Adv Anat Pathol 23:58–69CrossRefPubMed McCluggage WG (2016) Recent developments in non-HPV-related Adenocarcinomas of the lower female genital tract and their precursors. Adv Anat Pathol 23:58–69CrossRefPubMed
25.
Zurück zum Zitat 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 9:425–434CrossRefPubMed 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 9:425–434CrossRefPubMed
26.
Zurück zum Zitat Ostor AG, Duncan A, Quinn M et al (2000) Adenocarcinoma in situ of the uterine cervix: an experience with 100 cases. Gynecol Oncol 79:207–210CrossRefPubMed Ostor AG, Duncan A, Quinn M et al (2000) Adenocarcinoma in situ of the uterine cervix: an experience with 100 cases. Gynecol Oncol 79:207–210CrossRefPubMed
27.
Zurück zum Zitat Paquette C, Jeffus SK, Quick CM et al (2015) Interobserver variability in the application of a proposed histologic subclassification of endocervical adenocarcinoma. Am J Surg Pathol 39:93–100CrossRefPubMed Paquette C, Jeffus SK, Quick CM et al (2015) Interobserver variability in the application of a proposed histologic subclassification of endocervical adenocarcinoma. Am J Surg Pathol 39:93–100CrossRefPubMed
28.
Zurück zum Zitat Quint KD, De Koning MN, Van Doorn LJ et al (2010) HPV genotyping and HPV16 variant analysis in glandular and squamous neoplastic lesions of the uterine cervix. Gynecol Oncol 117:297–301CrossRefPubMed Quint KD, De Koning MN, Van Doorn LJ et al (2010) HPV genotyping and HPV16 variant analysis in glandular and squamous neoplastic lesions of the uterine cervix. Gynecol Oncol 117:297–301CrossRefPubMed
30.
Zurück zum Zitat Roma AA, Diaz De Vivar A, Park KJ et al (2015) Invasive endocervical adenocarcinoma: a new pattern-based classification system with important clinical significance. Am J Surg Pathol 39:667–672CrossRefPubMed Roma AA, Diaz De Vivar A, Park KJ et al (2015) Invasive endocervical adenocarcinoma: a new pattern-based classification system with important clinical significance. Am J Surg Pathol 39:667–672CrossRefPubMed
31.
Zurück zum Zitat Singh GK, Miller BA, Hankey BF et al (2004) Persistent area socioeconomic disparities in U.S. incidence of cervical cancer, mortality, stage, and survival, 1975–2000. Cancer 101:1051–1057CrossRefPubMed Singh GK, Miller BA, Hankey BF et al (2004) Persistent area socioeconomic disparities in U.S. incidence of cervical cancer, mortality, stage, and survival, 1975–2000. Cancer 101:1051–1057CrossRefPubMed
32.
Zurück zum Zitat Singh N, Arif S (2004) Histopathologic parameters of prognosis in cervical cancer – a review. Int J Gynecol Cancer 14:741–750CrossRefPubMed Singh N, Arif S (2004) Histopathologic parameters of prognosis in cervical cancer – a review. Int J Gynecol Cancer 14:741–750CrossRefPubMed
33.
Zurück zum Zitat Torre LA, Bray F, Siegel RL et al (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108CrossRefPubMed Torre LA, Bray F, Siegel RL et al (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108CrossRefPubMed
34.
Zurück zum Zitat UICC (2010) TNM: Klassifikation maligner Tumoren (Hrsg. Ch Wittekind und H.-J. Meyer). Wiley-VCH, Weinheim UICC (2010) TNM: Klassifikation maligner Tumoren (Hrsg. Ch Wittekind und H.-J. Meyer). Wiley-VCH, Weinheim
35.
Zurück zum Zitat Walboomers JM, Jacobs MV, Manos MM et al (1999) Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 189:12–19CrossRefPubMed Walboomers JM, Jacobs MV, Manos MM et al (1999) Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 189:12–19CrossRefPubMed
36.
Zurück zum Zitat Waxman AG, Chelmow D, Darragh TM et al (2012) Revised terminology for cervical histopathology and its implications for management of high-grade squamous intraepithelial lesions of the cervix. Obstet Gynecol 120:1465–1471CrossRefPubMedPubMedCentral Waxman AG, Chelmow D, Darragh TM et al (2012) Revised terminology for cervical histopathology and its implications for management of high-grade squamous intraepithelial lesions of the cervix. Obstet Gynecol 120:1465–1471CrossRefPubMedPubMedCentral
37.
Zurück zum Zitat Wiebe E, Denny L, Thomas G (2012) Cancer of the cervix uteri. Int J Gynaecol Obstet 119(Suppl 2):S100–S109CrossRefPubMed Wiebe E, Denny L, Thomas G (2012) Cancer of the cervix uteri. Int J Gynaecol Obstet 119(Suppl 2):S100–S109CrossRefPubMed
38.
Zurück zum Zitat Yemelyanova A, Vang R, Seidman JD et al (2009) Endocervical adenocarcinomas with prominent endometrial or endomyometrial involvement simulating primary endometrial carcinomas: utility of HPV DNA detection and immunohistochemical expression of p16 and hormone receptors to confirm the cervical origin of the corpus tumor. Am J Surg Pathol 33:914–924CrossRefPubMed Yemelyanova A, Vang R, Seidman JD et al (2009) Endocervical adenocarcinomas with prominent endometrial or endomyometrial involvement simulating primary endometrial carcinomas: utility of HPV DNA detection and immunohistochemical expression of p16 and hormone receptors to confirm the cervical origin of the corpus tumor. Am J Surg Pathol 33:914–924CrossRefPubMed
39.
Zurück zum Zitat Young RH, Clement PB (2002) Endocervical adenocarcinoma and its variants: their morphology and differential diagnosis. Histopathology 41:185–207CrossRefPubMed Young RH, Clement PB (2002) Endocervical adenocarcinoma and its variants: their morphology and differential diagnosis. Histopathology 41:185–207CrossRefPubMed
Metadaten
Titel
Zervixkarzinom und seine Vorstufen
verfasst von
Prof. Dr. Hans-Peter Sinn
Birgit Helmchen
Sarah Schott
Thomas Löning
Publikationsdatum
29.08.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Onkologie / Ausgabe 10/2016
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-016-0094-5

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