Zusammenfassung
Fragestellung: Der menschliche Uterus setzt sich aus dem phylo- und ontogenetisch älteren Endometrium
mit der anschließenden Junktionalzone des Myometriums und dem rezenten äußeren Myometrium
zusammen. Vor diesem Hintergrund soll diese Studie die Frage beantworten, warum das
Risiko einer lymphogenen Aussaat beim endometrialen Adenokarzinom abrupt und nicht
kontinuierlich ansteigt, wenn mehr als die Hälfte des Myometriums durch die Tumorzellen
infiltriert werden. Material und Methodik: Mithilfe einer hochauflösenden vaginalen Ultraschallsonde wurde die zonale Anatomie
des Uterus von 100 gesunden postmenopausalen Frauen untersucht und dokumentiert. Zudem
wurde durch eine Metaanalyse der Zusammenhang zwischen einer myometrialen Infiltration
durch das Adenokarzinom und dem Risiko einer pelvinen und paraaortalen Lymphknotenmetastasierung
analysiert. Ergebnisse: Die Junktionalzone des Myometriums repräsentiert die Schicht des Uterus, die weitgehend
exakt die innere Hälfte des Myometriums umfasst. Die Metaanalyse wiederum untermauerte
die These, dass am Übergang von der inneren zur äußeren Hälfte des Myometriums eine
Schwelle existiert, jenseits derer das Risiko der lymphogenen Metastasierung abrupt
ansteigt. Schlussfolgerung: Solange sich das endometriale Adenokarzinom nicht über die Junktionalzone des Uterus
ausgebreitet hat, ist eine lymphogene Metastasierung selten. Die Sicht des humanen
Uterus als ein Organ, dass sich aus 2 onto- und phylogenetisch unterschiedlichen Einzelorganen
aufbaut, bietet eine Erklärung für das Metastasierungsverhalten des Adenokarzinoms
in Abhängigkeit von der myometrialen Eindringtiefe und könnte für weitere Forschungen
von Interesse sein.
Abstract
Purpose: The human uterus consists of the ontogenetically and phylogenetically older endometrium,
the adjacent junctional zone and the more recent outer myometrium. This understanding
of uterine zonal anatomy could provide an answer to the question why the risk of lymph
node metastasis increases abruptly when an endometrial adenocarcinoma invades more
than 50 % of the myometrial wall. Material and Methods: High resolution vaginal ultrasound was performed in 100 healthy postmenopausal women
and their zonal anatomy was documented. In a meta-analysis the relationship between
the depth of myometrial invasion by endometrial cancer and the rate of regional lymph
node metastases was analyzed. Results: In postmenopausal women the mean diameter of the junctional zone of the myometrium
was found to be almost exactly half the inner diameter of the myometrium. Our meta-analysis
confirmed the existence of a threshold whereby, if an endometrial adenocarcinoma invaded
more than 50 % of the myometrial wall, this resulted in a more than 5-fold higher
prevalence of lymph node metastasis. Conclusion: Endometrial cancer rarely results in lymph node metastasis as long as the disease
is confined to the junctional zone of the myometrium. The dissimilarity between the
inner and outer myometrial layers, based on their very different phylogenetic and
ontogenetic origins, might be of interest for further research.
Schlüsselwörter
Endometriumkarzinom - Junktionalzone des Myometriums - Lymphknotenmetastasen
Key words
endometrial cancer - junctional zone of the myometrium - lymph node metastasis
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Privatdozent Dr. med. Georg Kunz
St. Johannes Hospital Dortmund
Johannesstraße 9–17
44137 Dortmund
Email: georg.kunz@joho-dortmund.de
