Zusammenfassung
Mittlerweile ist das Endometriumkarzinom das häufigste Malignom der weiblichen Genitalien. Pathogenetisch lassen sich 2 Typen unterscheiden: der klassische östrogeninduzierte endometriale und der nichtklassische hormonunabhängige seröse Typ. Die adenomatöse Hyperplasie als Präkanzerose zu identifizieren, ist bisher in hohem Maße an subjektive Kriterien gebunden und dementsprechend wenig reproduzierbar. Eine Verbesserung mittels morphometrischer und molekulargenetischer Methoden erscheint hilfreich. Für die Diagnose des Endometriumkarzinoms ist nach wie vor die fraktionierte Kürettage der Goldstandard. Die Differenzialdiagnose zwischen einem Adenokarzinom des Endometriums und der Endozervix lässt sich durch eine Kombination von Antikörpern immunhistochemisch abklären. Der Eckpfeiler der Therapie ist die Operation, wobei eine differenzierte individuelle Entscheidung je nach histologischem Befund bedeutsam ist. Zunehmend umstritten ist die postoperative adjuvante Radiatio, während die Brachytherapie der Vagina mittlerweile als etabliert gilt. Der vorliegende Artikel vermittelt einen Überblick über die aktuelle Situation der Pathogenese, Diagnose und Therapie des Endometriumkarzinoms.
Abstract
The endometrial carcinoma is meanwhile the most common malignant tumor of the female genital tract. 2 subtypes can be divided according the pathogenesis: the classical estrogen related endometroid type and the nonclassical estrogen unrelated serous type. The endometrial adenomatous hyperplasia as a precancerous lesion must be identified by subjective criteria. Therefore the histological diagnosis is worse reproducible. An improvement would be helpful by morphometric and moleculargenetic methods. The golden standard of diagnosis of the endometrial carcinoma is fractional dilatation and curettage. Immunohistochemical staining with a limited panel of antibodies can discriminate between an endometrial and an endocervical origin of an adenocarcinoma. The corner stone of the therapy is surgery. An individual decision about postoperative treatment is very important and depends on histological criteria. The adjuvant postoperative whole pelvic radiation is under discussion whereas the vaginal brachytherapy is established as standard therapy. This article outlines an overview of the actual situation for pathogenesis, diagnosis and treatment endometrial cancer.
Schlüsselwörter
Endometriumkarzinom - Pathogenese - Diagnose - Therapie
Keywords
Endometrial carcinoma - pathogenesis - diagnosis - therapy
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1 Auszugsweise vorgetragen am 23. 02. 2002 anlässlich „Gynäkologie und Geburtshilfe, Frankfurt, 2002”
Prof. Dr. med. Johannes Dietl
Universitäts-Frauenklinik
Josef-Schneider-Str. 4
97080 Würzburg
Telefon: 09 31/2 01/2 52 50
Fax: 09 31/2 01/2 54 06
eMail: j.dietl@mail.uni-wuerzburg.de
