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Nomenklatur der plattenepithelialen Präkanzerosen des unteren weiblichen Genitales

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Nomenclature of squamous cell precursor lesions of the lower female genital tract

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  • Schwerpunkt: Uteruspathologie
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Zusammenfassung

Die Mehrzahl der Präkanzerosen (intraepitheliale Neoplasien, IN) des Plattenepithels des unteren weiblichen Genitaltrakts beruht auf einer HPV-Infektion (humane Papillomviren). Diese führt zum Auftreten zellulärer Atypien mit der Folge eines gestörten geweblichen Aufbaus. In Abhängigkeit von ihrer Pathogenese werden bei den vulvären intraepithelialen Neoplasien (VIN) die HPV-high-risk-assoziierte klassische VIN („usual“, u‑VIN) und die mit einem Lichen sclerosus assoziierte differenzierte VIN („differentiated“, d‑VIN) mit p53-Alteration unterschieden. In der aktuellen WHO-Klassifikation wird für die plattenepithelialen Präkanzerosen des unteren weiblichen Genitaltrakts ein neues System zur Graduierung vorgeschlagen mit Unterteilung in L‑SIL („low-grade squamous intraepithelial lesions“; Kondylome/HPV-assoziierte Veränderungen plus VIN 1, vaginale intraepitheliale Neoplasie 1 [VaIN 1] bzw. zervikale intraepitheliale Neoplasie 1 [CIN 1]) und H‑SIL („high-grade squamous intraepithelial lesions“; VIN 2 und 3, VAIN 2 und 3 bzw. CIN 2 und 3). Bei der Unterscheidung kann die p16-Immunhistochemie hilfreich sein. Diese binäre Einteilung läuft jedoch der zytologischen Nomenklatur in Deutschland (Münchner Nomenklatur III) zuwider, die zur Vermeidung einer Übertherapie von Patientinnen mit einer mäßiggradigen intraepithelialen Neoplasie eine Unterteilung in 3 Dysplasiegrade vornimmt. Die einzelnen Nomenklaturen werden einander gegenüber gestellt. Es wird empfohlen, zusätzlich zur SIL-Klassifikation der WHO den Grad der jeweiligen Präkanzerosen anzugeben.

Abstract

The majority of precancerous lesions of the lower female genital tract (intraepithelial neoplasia, IN) are caused by human papillomavirus (HPV) infections resulting in cellular atypia and in turn an altered tissue architecture. Depending on the pathogenesis, a distinction is made between vulvar intraepithelial neoplasia (VIN) classified as classical VIN associated with high-risk HPV infections (u-VIN) and differentiated VIN (d-VIN), which is associated with lichen sclerosus et atrophicus and p53 alterations. In the current World Health Organization (WHO) classification a novel grading system for squamous cell precancerous lesions of the lower female genital tract has been proposed, differentiating low grade squamous intraepithelial lesions (L-SIL) including condyloma and HPV-associated alterations plus VIN 1, vaginal intraepithelial neoplasia (VaIN 1) and cervical intraepithelial neoplasia (CIN 1) from high grade squamous intraepithelial lesions (H-SIL) with VIN 2 and 3, VaIN 2 and 3 as well as CIN 2 and 3. The use of p16 immunohistochemistry can assist the differentiation. The new binary classification, however, contradicts the German cytological nomenclature (Munich nomenclature III), which differentiated three grades of dysplasia in order to avoid overtreatment of patients with moderate IN. The individual nomenclatures are compared to each other. It is recommended to report the grade of precancerous lesions in addition to the SIL classification of the WHO.

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Authors and Affiliations

  1. Institut für Pathologie, Abteilung Mamma-, Gynäko- und Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland

    L.-C. Horn & K. Schierle

  2. Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München, Deutschland

    C. E. Brambs

  3. Universitätsfrauenklinik Leipzig (Triersches Institut) im Zentrum für Frauen- und Kindermedizin, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland

    R. Handzel

  4. Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland

    G. Mehlhorn

  5. Institut für Pathologie, Viersen, Deutschland

    D. Schmidt

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  1. L.-C. Horn
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  4. G. Mehlhorn
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L.-C. Horn, C.E. Brambs, R. Handzel, G. Mehlhorn, D. Schmidt und K. Schierle geben an, dass kein Interessenkonflikt besteht.

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S.F. Lax, Graz

Die Autoren L.-C. Horn und C. E. Brambs haben zu gleichen Teilen zu der Arbeit beigetragen.

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Horn, LC., Brambs, C.E., Handzel, R. et al. Nomenklatur der plattenepithelialen Präkanzerosen des unteren weiblichen Genitales. Pathologe 37, 526–533 (2016). https://doi.org/10.1007/s00292-016-0239-8

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