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Prostatakarzinom

Teil 1: Rückblick über Zellkinetik der Jahre 1966–2015 und Zukunftsperspektiven des neuen Gradings der International Society of Urological Pathology (ISUP)

Prostate cancer

Part 1: Review of cell kinetics over the years 1966–2015 and future perspectives of the new grading of the International Society of Urological Pathology (ISUP)

  • Schwerpunkt: Uropathologie
  • Published:
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Zusammenfassung

Die Tritium-markierte Thymidin-Histoautoradiographie, die versilberbare Nukleolen organisierenden Regionen (AgNOR-Technik) und die Ki67-MIB-1-Immunhistochemie haben zellkinetisch die Prostatakarzinomentwicklung in gering, mäßig und stark proliferierende Tumoren unterteilt, sich neben der klassischen Histologie und Zytologie als wichtige Zusatzmethoden gezeigt und Vorlagen für das Grading mit „low“, „intermediate“ und „high grade“ geliefert. Die DNA-Zytometrie kann durch den Nachweis mehrheitlich diploider oder aneuploider Zellkerne die Zellkinetik des Prostatakarzinoms (PCa) stützen, sollte aber nur zusammen mit der Histologie bewertet werden. Alle auf der Histologie basierenden zellkinetischen Analysen schließen die klassischen sowohl hoch als auch niedrig differenzierten glandulären und kribriformen sowie soliden undifferenzierten Strukturen und ihre Unterformen ein, sodass der Malignitätsgrad ein Summationsgrad sein kann, sofern die genannten Untersuchungen in das Grading mit einbezogen werden. Die Zukunftsperspektiven einer individualisierten Therapieoption, z. B. bei der „active surveillance“ für das Low-grade-PCa, aber auch für die höhergradigen PCa, liegen in den molekularen Zusatzmethoden einschließlich gesamtgenomischen Untersuchungen mithilfe des „next generation sequencing“.

Abstract

Using tritium-labeled thymidine histoautoradiography, the AgNOR staining technique and Ki67-MIB-1 immunohistochemistry to study cell kinetics, prostate cancer can be subdivided into slowly, moderately and rapidly proliferating tumors. These are important supplementary methods and prerequisites for a grading as low, intermediate and high-grade in addition to classical histology and cytology. Cytometry of DNA can confirm the cell kinetics of prostate cancer by detection of a predominance of diploid or aneuploid cell nuclei but should only be evaluated together with histological investigations. All histology-based analyses of cell kinetics encompass the classical highly and poorly differentiated glandular and cribriform patterns as well as solid undifferentiated structures and the various subcategories. The malignancy grading of prostate cancer can result from the summation of histological grading and cell kinetic analyses, as long as the named investigations are included. The future perspectives of individualized therapy options, including active surveillance in early low-grade and also for high-grade prostate cancer and new antihormonal treatment in advanced disease, may increasingly rely on tissue biomarkers and advanced technologies for whole genome analysis including next generation sequencing.

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Authors and Affiliations

  1. Institut für Pathologie, Hegau-Bodensee-Kliniken, Akademisches Lehrkrankenhaus, Universität Freiburg, 78207, Postfach 720, Singen, Deutschland

    B. Helpap

  2. Abteilung Zytopathologie, Institut für Pathologie, Universität Basel, Basel, Schweiz

    L. Bubendorf

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Correspondence to B. Helpap.

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Interessenkonflikt

B. Helpap und L. Bubendorf geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Schwerpunktherausgeber

A. Hartmann, Erlangen

R. Knüchel-Clarke, Aachen

G. Kristiansen, Bonn

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Helpap, B., Bubendorf, L. Prostatakarzinom. Pathologe 37, 3–10 (2016). https://doi.org/10.1007/s00292-015-0123-y

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