Abstract
Zusammenfassung. Die neusten Erkenntnisse zu der Pathogenese des Zervixkarzinoms führten zu Anpassungen in der zytologischen und histologischen Nomenklatur seiner Vorstufen. Die aktuelle, 2014 eingeführte histologische WHO-Terminologie unterscheidet, analog zum zytologischen Bethesda-System, zwischen zwei histologischen Stufen der HPV-bedingten Veränderungen: LSIL und HSIL, die mit unterschiedlichen Risiken der Progredienz zum invasiven Karzinom einhergehen und klinisch entsprechend unterschiedlich gehandhabt werden sollen. Die immunhistochemische Detektion des p16-Proteins als Surrogat der neoplastischen Transformation der HPV-infizierten Zellen hilft, die rein mikroskopische Diagnose zu objektivieren und zu sichern, und ist ein wichtiges Hilfsmittel in der Histopathologie. Die Verfügbarkeit der HPV-Impfung und die HPV-Detektion werden in den kommenden Jahren die Abläufe in der Frühentdeckung und die Epidemiologie der Zervixkarzinom-Vorstufen beeinflussen.
Abstract. The histological and cytological nomenclature of the precursors of the invasive cervical carcinoma has recently been adjusted according to our modern understanding of the pathogenesis of the disease. The currrent histological WHO classification from year 2014 differentiates in the analogy to the cytological Bethesda system between two grades of HPV-related precursor forms: LSIL and HSIL, which are associated with a different risk of the progression to the invasive cancer and need different clinical management. Immunohistochemical detection of p16 protein as a marker of the neoplastic transformation of the HPV infected cells helps to ensure the microscopic diagnosis and constitutes an important additional study. HPV vaccination and availability of the HPV detection tests will influence the future epidemiology and the strategies of the early detection of the precursors of the cervical cancer.
Résumé. Des adaptations de la nomenclature cytologique et histologique pour les lésions précurseurs du carcinome cervical ont été effectuées, suite aux nouvelles connaissances concernant la pathogénèse de ce carcinome. La version actuelle de la terminologie de l’OMS de 2014 distingue, en analogie au système cytologique de Bethesda, deux étapes histologiques d’altérations morphologiques induites par le HPV: Le LSIL et le HSIL, qui associent des risques différents quant à la transformation en carcinome invasif et qui devront être suivis de manière différente. La détection immunohistiochimique de la protéine p16 en tant que marqueur de substitution pour la transformation néoplasique des cellules atteintes d’HPV aide à objectiver et assurer le diagnostic posé uniquement au microscope et constitue un atout important de l’histopathologie. La disponibilité de la vaccination HPV et la détection HPV vont influencer les processus de la détection précoce et de l’épidémiologie des lésions précurseurs du carcinome cervical.
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