RESUMO
The World Health Organization (WHO) classification from 2014 differentiates between different subtypes of mucinous adenocarcinoma of the uterine cervix. A gastric subtype was recently described that showed no association with high-risk human papillomavirus (HPV) infections, has a poor prognosis, is mainly diagnosed in women of Asian origin and can occur in patients with Peutz-Jeghers syndrome. Although no clear grading system has been recommended in the WHO classification, it is likely that grading of adenocarcinomas of the uterine cervix will partly be based on the different patterns of invasion. Deep stromal infiltration of macroinvasive carcinomas is defined as an infiltration of >66 % of the cervical stroma. In the near future a maximum tumor size of 2 cm could act as a discriminator for planning of less radical surgery. Parameters of the histopathological report that are relevant for the prognostic assessment as well as the choice of adjuvant treatment and function as quality indicators during certification are described. The histological type of an adenocarcinoma alone is of no predictive or prognostic relevance for patients undergoing primary surgical treatment, neoadjuvant chemotherapy, combined chemo-radiotherapy or treatment with angiogenesis inhibitors. Currently, molecular parameters and biomarkers are of no relevance.
Assuntos
Adenocarcinoma Mucinoso/classificação , Adenocarcinoma Mucinoso/patologia , Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia , Neoplasias Uterinas/classificação , Neoplasias Uterinas/patologia , Organização Mundial da Saúde , Adenocarcinoma Mucinoso/terapia , Biomarcadores Tumorais/análise , Terapia Combinada , Feminino , Papillomavirus Humano 16/patogenicidade , Humanos , Gradação de Tumores , Invasividade Neoplásica , Infecções por Papillomavirus/classificação , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/terapia , Patologia Molecular , Prognóstico , Indicadores de Qualidade em Assistência à Saúde , Neoplasias do Colo do Útero/classificação , Neoplasias do Colo do Útero/terapia , Útero/patologiaRESUMO
Histopathological assessment of the tumor grade and cell type is central to the management and prognosis of various gynecological malignancies. Conventional grading systems for squamous carcinomas and adenocarcinomas of the vulva, vagina and cervix are poorly defined. For endometrioid tumors of the female genital tract as well as for mucinous endometrial, ovarian and seromucinous ovarian carcinomas, the 3tiered FIGO grading system is recommended. For uterine neuroendocrine tumors the grading system of the gastrointestinal counterparts has been adopted. Uterine leiomyosarcomas are not graded. Endometrial stromal sarcomas are divided into low and high grades, based on cellular morphology, immunohistochemical and molecular findings. A chemotherapy response score was established for chemotherapeutically treated high-grade serous pelvic cancer. For non-epithelial ovarian malignancies, only Sertoli-Leydig cell tumors and immature teratomas are graded. At this time molecular profiling has no impact on the grading of tumors of the female genital tract.
Assuntos
Neoplasias dos Genitais Femininos/patologia , Adenocarcinoma/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias do Endométrio/patologia , Feminino , Neoplasias dos Genitais Femininos/classificação , Genitália Feminina/patologia , Humanos , Gradação de Tumores , Estadiamento de Neoplasias , Tumores Neuroendócrinos/patologia , Neoplasias Ovarianas/patologia , Prognóstico , Tumor de Células de Sertoli-Leydig/patologia , Neoplasias do Colo do Útero/patologia , Neoplasias Vaginais/patologia , Neoplasias Vulvares/patologiaRESUMO
New insights gained in the field of molecular medicine have led to fundamental progress in the diagnosis and treatment of tumour patients. Individualised treatment has been essentially facilitated by molecular diagnostics, which, by identifying and interpreting characteristic genetic alterations (biomarkers) in single cells and tissues, provide specific information to confirm the diagnosis and support the treatment of numerous diseases. Particularly with regard to the use of new targeted drugs, which often require the presence or absence of specific target structures or genetic alterations to induce response, the molecular pathological determination of predictive biomarkers plays an increasing role and helps clinicians to decide on optimal therapies for individual patients. The aim of this review is to highlight general aspects of molecular tumour pathology for relevant tumour entities and to present available targeted therapies.