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Zentralbl Chir 2013; 138(S 02): e55-e62
DOI: 10.1055/s-0031-1271555
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Histologische Klassifikation: Beurteilung von Resektaten nach EMR / ESD – Regressionsstadien nach präoperativer Vorbehandlung

Histological Classification: Evaluation of Resection Specimens of EMR/ESD – Response Evaluation after Neoadjuvant Therapy
J. Munding
1   Universitätsklinikum Bochum, Institut für Pathologie, Bochum, Deutschland
,
W. Ziebarth
1   Universitätsklinikum Bochum, Institut für Pathologie, Bochum, Deutschland
,
O. Belyaev
2   Klinik für Chirurgie, St. Josef Hospital, Chirurgie, Bochum, Deutschland
,
W. Uhl
2   Klinik für Chirurgie, St. Josef Hospital, Chirurgie, Bochum, Deutschland
,
A. Tannapfel
1   Universitätsklinikum Bochum, Institut für Pathologie, Bochum, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
24 October 2011 (online)

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Zusammenfassung

Die zunehmende Überwachung von Patienten mit Barrettschleimhaut führt zu einer zuneh­menden Diagnostik früher Karzinomformen mit nur geringer Invasionstiefe. Vergleichbar zu asiatischen Ländern, in denen aufgrund der höheren Inzidenz von Magenkarzinomen eine engmaschige Überwachung von Risikopatienten durchgeführt wird, werden auch zunehmend in europäischen Ländern endoskopische Resektionen von sogenannten Frühkarzinomen des Magens oder frühen Karzinomen des Ösophagus vorgenommen. Neben der Kenntnis der endoskopischen Techniken müssen auch bestimmte Anforderungen an das zu gewinnende Resektat gestellt werden, die eine gute pathohistologische Aufarbeitung ermöglichen. Nur so kann die genaue Tie­feninfiltration ermittelt und die Entfernung im Gesunden korrekt bestimmt werden, was für den weiteren Therapieverlauf und die Prognose entscheidend ist. Fortgeschrittene Karzinome des Ösophagus und des Magens werden multi­modal behandelt, sodass vor der endgültigen Therapie zumeist eine neoadjuvante Radio- und / oder Chemotherapie durchgeführt wird. Dies führt zu bestimmten, pathohistologisch nachweisbaren Veränderungen im Karzinomgewebe, denen mit einem Regressionsgrading Rechnung getragen wird. 

Abstract

The surveillance of patients with Barrett mucosa in the distal oesophagus leads to an increase of patients diagnosed with early cancer of the oesoph­agogastric junction and stomach with only superficial infiltration. Comparable to Asian countries where screening of patients at risk is recommended due to the high incidence of gastric cancer, endoscopic resection of early cancer in the stomach and distal oesophagus is inreasing. In spite of the special endoscopic techniques ­there are several requirements for the resected specimen which ensure its exact pathohistological evaluation. This is necessary to detect the exact depth of infiltration and the resection margins. To provide an exact pathohistological diagnosis is important for further therapeutic im­plications and prognosis. Advanced carcinomas of the oesophagus and stomach need multimodal treatment with radiation and chemotherapy. This has a special impact on the tumour which leads to pathohistological detectable changes as esti­mated in the so-called regression grading. 

Schlüsselwörter

Mukosektomie - Submukosektomie - Frühkarzinom - Regressionsgrading

Key words

mucosectomy - submucosectomy - early cancer - regression grading
 

  • Literatur

  • Bosman FT, Carneiro F, Hruban RH eds WHO Classification of Tumours of the Digestive System. 4. ed World Health Orgn; 2010
    PubMedGoogle Scholar
  • Moehler M, Al-Batran SE, Andus T et al. [German S3-Guideline “Diagnosis and Treatment of Esophagogastric Cancer”]. Z Gastroenterol 2011; 49: 461-531
    Article in Thieme ConnectPubMedGoogle Scholar
  • Wittekind C, Meyer HJ. TNM Klassifikation maligner Tumore. Weinheim: Wiley-Blackwell; 2010
    Google Scholar
  • Soetikno RM, Gotoda T, Nakanishi Y et al. Endoscopic mucosal resection. Gastrointest Endosc 2003; 57: 567-579
    CrossrefPubMedGoogle Scholar
  • Tischoff I, Tannapfel A. [Gastrointestinal tract – pathology of early cancers]. Zentralbl Chir 2010; 135: 385-388
    Article in Thieme ConnectPubMedGoogle Scholar
  • Vieth M, Stolte M. Pathology of early upper GI cancers. Best Pract Res Clin Gastroenterol 2005; 19: 857-869
    CrossrefPubMedGoogle Scholar
  • Holscher AH, Drebber U, Monig SP et al. Early gastric cancer: lymph node metastasis starts with deep mucosal infiltration. Ann Surg 2009; 250: 791-797
    CrossrefPubMedGoogle Scholar
  • Westerterp M, Koppert LB, Buskens CJ et al. Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction. Virchows Arch 2005; 446: 497-504
    CrossrefPubMedGoogle Scholar
  • Wang J, Yu JC, Kang WM et al. Treatment strategy for early gastric cancer. Surg Oncol 2011; [Epub ahead of print]
    PubMedGoogle Scholar
  • Soetikno R, Kaltenbach T, Yeh R et al. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 2005; 23: 4490-4498
    CrossrefPubMedGoogle Scholar
  • Bollschweiler E, Baldus SE, Schroder W et al. Staging of esophageal carcinoma: length of tumor and number of involved regional lymph nodes. Are these independent prognostic factors?. J Surg Oncol 2006; 94: 355-363
    CrossrefPubMedGoogle Scholar
  • Liu L, Hofstetter WL, Rashid A et al. Significance of the depth of tumor invasion and lymph node metastasis in superficially invasive (T1) esophageal adenocarcinoma. Am J Surg Pathol 2005; 29: 1079-1085
    PubMedGoogle Scholar
  • Holscher AH, Vallbohmer D, Bollschweiler E. Early Barrett‘s carcinoma of the esophagus. Ann Thorac Cardiovasc Surg 2008; 14: 347-354
    PubMedGoogle Scholar
  • Japanese Classification of Gastric Cancer in Gastric Cancer. 2nd. English Edition 2010: 10-24
    PubMedGoogle Scholar
  • Ono H, Kondo H, Gotoda T et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
    CrossrefPubMedGoogle Scholar
  • Pech O, May A, Gunter E et al. The impact of endoscopic ultrasound and computed tomography on the TNM staging of early cancer in Barrett‘s esophagus. Am J Gastroenterol 2006; 101: 2223-2229
    CrossrefPubMedGoogle Scholar
  • Rampado S, Bocus P, Battaglia G et al. Endoscopic ultrasound: accuracy in staging superficial carcinomas of the esophagus. Ann Thorac Surg 2008; 85: 251-256
    CrossrefPubMedGoogle Scholar
  • Waxman I, Raju GS, Critchlow J et al. High-frequency probe ultrasonography has limited accuracy for detecting invasive adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia or intramucosal carcinoma: a case series. Am J Gastroenterol 2006; 101: 1773-1779
    CrossrefPubMedGoogle Scholar
  • Zuccaro Jr G, Rice TW, Vargo JJ et al. Endoscopic ultrasound errors in esophageal cancer. Am J Gastroenterol 2005; 100: 601-606
    PubMedGoogle Scholar
  • Ell C, May A, Pech O et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett‘s cancer). Gastrointest Endosc 2007; 65: 3-10
    CrossrefPubMedGoogle Scholar
  • Tannapfel A, Schmelzer S, Benicke M et al. Expression of the p53 homologues p63 and p73 in multiple simultaneous gastric cancer. J Pathol 2001; 195: 163-170
    CrossrefPubMedGoogle Scholar
  • Chennat J, Waxman I. Endoscopic treatment of Barrett’s esophagus: From metaplasia to intramucosal carcinoma. World J Gastroenterol 2010; 16: 3780-3785
    CrossrefPubMedGoogle Scholar
  • Kang HJ, Kim DH, Jeon TY et al. Lymph node metastasis from intestinal-type early gastric cancer: experience in a single institution and re­assess­ment of the extended criteria for endoscopic submucosal dissection. Gastrointest Endosc 2010; 72: 508-515
    CrossrefPubMedGoogle Scholar
  • Ishikawa S, Togashi A, Inoue M et al. Indications for EMR/ESD in cases of early gastric cancer: relationship between histological type, depth of wall invasion, and lymph node metastasis. Gastric Cancer 2007; 10: 35-38
    CrossrefPubMedGoogle Scholar
  • Song KY, Park SM, Kim SN et al. The role of surgery in the treatment of recurrent gastric cancer. Am J Surg 2008; 196: 19-22
    CrossrefPubMedGoogle Scholar
  • Cunningham D, Allum WH, Stenning SP et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006; 355: 11-20
    CrossrefPubMedGoogle Scholar
  • Ajani JA, Moiseyenko VM, Tjulandin S et al. Quality of life with docetaxel plus cisplatin and fluorouracil compared with cisplatin and fluorouracil from a phase III trial for advanced gastric or gastroesophageal adenocarcinoma: the V-325 Study Group. J Clin Oncol 2007; 25: 3210-3216
    CrossrefPubMedGoogle Scholar
  • Baldus SE, Monig SP, Schroder W et al. [Regression of oesophageal carcinomas after neoadjuvant radiochemotherapy: criteria of the histopathological evaluation]. Pathologe 2004; 25: 421-427
    CrossrefPubMedGoogle Scholar
  • Becker K, Mueller JD, Schulmacher C et al. Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy. Cancer 2003; 98: 1521-1530
    CrossrefPubMedGoogle Scholar
  • Brucher BL, Becker K, Lordick F et al. The clinical impact of histopathologic response assessment by residual tumor cell quantification in esophageal squamous cell carcinomas. Cancer 2006; 106: 2119-2127
    CrossrefPubMedGoogle Scholar
  • Hermann RM, Horstmann O, Haller F et al. Histomorphological tumor regression grading of esophageal carcinoma after neoadjuvant radiochemotherapy: which score to use?. Dis Esophagus 2006; 19: 329-334
    CrossrefPubMedGoogle Scholar
  • Tong DK, Law S, Kwong DL et al. Histological regression of squamous esophageal carcinoma assessed by percentage of residual viable cells after neoadjuvant chemoradiation is an important prognostic factor. Ann Surg Oncol 2010; 17: 2184-2192
    CrossrefPubMedGoogle Scholar
  • Rohatgi PR, Correa AM, Swisher SG et al. Gender-based analysis of esophageal cancer patients undergoing preoperative chemoradiation: differences in presentation and therapy outcome. Dis Esophagus 2006; 19: 152-157
    CrossrefPubMedGoogle Scholar
  • Mandard AM, Dalibard F, Mandard JC et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 1994; 73: 2680-2686
    CrossrefPubMedGoogle Scholar
  • Urba SG, Orringer MB, Turrisi A et al. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 2001; 19: 305-313
    PubMedGoogle Scholar
  • Berger AC, Farma J, Scott WJ et al. Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol 2005; 23: 4330-4337
    CrossrefPubMedGoogle Scholar
  • D’Ugo D, Persiani R, Rausei S et al. Response to neoadjuvant chemotherapy and effects of tumor regression in gastric cancer. Eur J Surg Oncol 2006; 32: 1105-1109
    CrossrefPubMedGoogle Scholar