Urothelkarzinom des oberen Harntrakts – lokalisiert: Histopathologie, Molekulargenetik und klinische Besonderheiten

Zusammenfassung

Das lokalisierte Urothelkarzinom des oberen Harntrakts (UTUC) stellt aufgrund seiner biologischen Heterogenität und anatomischen Komplexität eine diagnostische Herausforderung dar. Eine frühzeitige Erkennung und präzise Risikostratifizierung sind entscheidend für eine verbesserte Prognose. Die Kombination von Histologie, Urinzytologie und Biopsie spielt dabei eine zentrale Rolle. Die histopathologische Analyse soll eine Bestimmung des Tumorgrades ermöglichen, wobei die Unterscheidung zwischen Low- und High-Grade-Tumoren von Bedeutung ist. Die Urinzytologie hat eine hohe Sensitivität für High-Grade-Tumoren, aber eine eingeschränkte bei low grade. Molekulare Marker wie FGFR3- und TP53-Mutationen sowie eine Mikrosatelliteninstabilität (MSI) bei Lynch-Syndrom können zur Risikostratifizierung und Einschätzung des Tumorverhaltens beitragen. Die endoskopische Resektion stellt eine potenziell effektive, organerhaltende Therapie dar, insbesondere bei nicht-invasiven und Low-Grade-Tumoren. Trotz höherer Rezidivraten im Vergleich zur radikalen Nephroureterektomie (RNU) kann sie eine wertvolle Option durch ihren organerhaltenden Ansatz für Patienten mit chronischer Niereninsuffizienz sein, erfordert jedoch eine engmaschige Nachsorge.

Abstract

Localised upper tract urothelial carcinoma (UTUC) presents a diagnostic challenge due to its biological heterogeneity and anatomical complexity. Early detection and precise risk stratification are crucial for improved prognosis. The combination of histology, urine cytology, and biopsy plays a central role in preoperative diagnosis. Histopathological analysis allows for the determination of tumour grade, with the distinction between low-grade and high-grade tumours being particularly important. Urine cytology demonstrates high specificity for high-grade tumours, but limited sensitivity for low-grade lesions. Molecular markers such as FGFR3 and TP53 mutations, as well as microsatellite instability (MSI) in Lynch syndrome, can contribute to risk stratification and assessment of tumour behaviour. Endoscopic resection represents an effective organ-preserving therapy, particularly for non-invasive tumours. Despite higher recurrence rates compared with radical nephroureterectomy (RNU), it can be a valuable option for patients with chronic renal insufficiency given its organ-sparing approach. However, close follow-up is essential to detect recurrences early.

Schlüsselwörter

Lokalisiertes UTUC - Histologie, - Biopsie - Urinzytologie

Keywords

localised UTUC - histology - biopsy - urine cytology

Publikationsverlauf

Eingereicht: 01. September 2025

Angenommen nach Revision: 01. Dezember 2025

Artikel online veröffentlicht:
26. Januar 2026

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