Zusammenfassung
Endometrioide Karzinome (Typ-1-Karzinome) sind östrogenabhängig und oft mit endometrialen
Hyperplasien assoziiert. Die Nomenklatur dieser Hyperplasien ist derzeit im Fluss.
Die schwere adenomatöse Hyperplasie (atypische Hyperplasie) ist eine obligate Präkanzerose
und bedarf in der Postmenopause der Hysterektomie. Die anderen histologischen Typen
des Endometriumkarzinoms, das serös-papilläre und das klarzellige (sog. Typ-2-Karzinome)
Karzinom zeigen keine gleichartige Assoziation zu Vorläuferläsionen und sind nicht
östrogenabhängig. Bei endometrialen Veränderungen unter Tamoxifen-Therapie stehen
die Atrophie und der Nachweis fibrös-zystischer Polypen, mit und ohne zelluläre Metaplasien,
im Vordergrund. Bei denen mit der Therapie assoziierten Karzinomen stellt sich die
Frage, ob sie nicht auf einem bereits zuvor östrogenstimulierten Endometrium entstanden
sind.
Summary
The endometrioid type of endometrial adenocarcinoma „(type 1-carcinoma) is estrogen-dependend
and frequently associated with endometrial hyperplasia. The nomenclature of these
hyperplasias is currently under discussion. The highest risk for metachronous carcinoma
is associated with atypical hyperplasia of the endometrium as detected in fractional
curettings. In postmenopausal patients treatment should consist of abdominal hysterectomy.
The so-called type 2-carcinomas, serous-papillary and clear-cell type, do not demonstrate
a similar association with precursor lesions. Pathological findings in patients treated
with Tamoxifen include endometrial atrophy and fibro-cystic endometrial polyps, sometimes
with cellular metaplasias. Patients with breast cancer and tamoxifen treatment have
an increased risk of endometrial carcinoma. In some of these patients it could be
argued whether the carcinoma has developed in a preceeding endometrial hyperplasia.
Schlüsselwörter
Endometrium - Hyperplasie - Karzinom - Pathogenese - Tamoxifen
Key words
Endometrium - Hyperplasia - Carcinoma - Pathogenesis - Tamoxifen
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Prof. Dr. Dr. h. c. Dietmar Schmidt
Institut für Pathologie
Referenzzentrum für Gynäkopathologie
A 2,2
D-68159 Mannheim
Phone: 0621-2 27 79
Fax: 0621-15 32 88
Email: dietmar.schmidt@dgn.de