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05.07.2016 | Neuroendokrine Tumoren | Schwerpunkt: Grading-Systeme

Grading neuroendokriner Tumoren

verfasst von: Prof. Dr. W. Saeger, P. A. Schnabel, P. Komminoth

Erschienen in: Die Pathologie | Ausgabe 4/2016

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Zusammenfassung

Die aktuelle WHO-Klassifikation der neuroendokrinen Tumoren (NET) der Lunge unterscheidet gemäß ihrer Prognose zwischen typischen Karzinoiden (Low-grade-NET), atypischen Karzinoiden (Intermediate-NET), klein- und großzelligen NET bzw. Karzinomen als High-grade-NET. Den neuroendokrinen Neoplasien (NEN) des Gastrointestinaltrakts und des Pankreas wurde ein einheitliches Gradingsystem, das ENETS-/WHO-Grading, zugeschrieben. Es ermöglicht zusammen mit dem TNM-System präoperativ, an Biopsien oder Feinnadelpunktionen (FNP) eine Risikoabschätzung vorzunehmen. Die gut differenzierten Tumoren werden nach ihrer Mitosezahl und dem Ki-67-Index in G1- (<2 Mitosen/10 HPF [„high power field“], Ki-67 < 3 %) und G2- (2–20 Mitosen/10 HPF, Ki-67 3–20 %) Tumoren eingeteilt. Bei den nicht seltenen Diskrepanzen zwischen Mitosezahl und Ki-67-Index sollte der jeweils höhere Wert berücksichtigt werden. Von den neuroendokrinen Karzinomen des G3-Typs sind undifferenzierte Karzinome des klein- wie des großzelligen Typs mit noch schlechterer Prognose zu unterscheiden. Ein Grading der Schilddrüsenkarzinome mit Prognoserelevanz ergibt sich aus der speziellen Subtypisierung, sodass ein G1- bis G3-System entfällt. Für die sehr seltenen Nebenschilddrüsen- und Hypophysenkarzinome ist sinnvollerweise kein Grading etabliert. Die Nebennierentumoren besitzen ebenfalls kein Grading. Die Prognose richtet sich dort nach dem Ki-67-Index und in sehr eingeschränktem Maße nach den etablierten Scoringsystemen.

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Titel: Grading neuroendokriner Tumoren
verfasst von: Prof. Dr. W. Saeger
P. A. Schnabel
P. Komminoth
Publikationsdatum: 05.07.2016
Verlag: Springer Berlin Heidelberg
Schlagwörter: Neuroendokrine Tumoren
Karzinoide
Erschienen in: Die Pathologie / Ausgabe 4/2016
Print ISSN: 2731-7188
Elektronische ISSN: 2731-7196
DOI: https://doi.org/10.1007/s00292-016-0186-4

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