Adenocarcinoma
Classification according to ICD-10 | |
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C80 | Malignant neoplasm without specifying the location |
ICD-10 online (WHO version 2019) |
Classification according to ICD-O-3 | |
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8140/3 | Adenocarcinoma NOS |
ICD-O-3 first revision online |
When adenocarcinoma is called a malignant ( malignant ) from the top layer of cells ( epithelium ) outgoing tumor composed of glandular tissue emerged. In contrast, the benign ( benign ) cell changes in glandular tissue are called adenomas .
Adenocarcinomas occur mainly in the digestive organs, lungs, kidneys and genital organs. The therapy depends on the origin of the tumor ( primary tumor ) and its spread ( TNM stage). Microscopically, the degree of differentiation (similarity to normal tissue) plays a major role, which flows into the TNM as “ grading ”.
Important differential diagnoses are e.g. B. in carcinoma the squamous cell carcinoma , furthermore the urothelial carcinoma and the mesothelioma . In the non-epithelial tumors z. B. Sarcomas , lymphomas and melanomas .
pathology
Adenocarcinomas can be typed in the course of the pathological work-up based on their shape (morphology), possibly mucus secretion ( mucin content ) and protein content, and in some cases also assigned to the original organ , which is particularly important in the case of metastases in order to track down the initial tumor ( primary tumor ) ( cf.CUP- Syndrome ). Summarized:
- Epithelial nature (immunohistochemically cytokeratin positive)
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Growth pattern :
- Morphologically better differentiated adenocarcinomas show a "glandular" growth, e.g. B. in tubes (tubular, acinar, ductal) or sieve-shaped (kribriform). Other growth forms are z. B. papillary (finger-shaped) and micropapillary (bud-like).
- Adenocarcinomas with poorer differentiation often grow “in one piece” (solid) or single-cell (diffuse) and can only be identified by additional examinations of other carcinomas such as B. a poorly differentiated squamous cell carcinoma . Mixed form: adenosquamous carcinoma.
- Mucus formation : Extra- or intracellular accumulation of mucus, can be visualized on the HE section or using PAS diastase staining. Extreme cases are mucinous adenocarcinoma (tumor cells swim in mucous pools) and signet ring cell carcinoma (the tumor cells are bulging with mucin).
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Immunohistochemistry (the protein content is shown in color by means of antibodies and color reactions):
- p40 and p63 mostly negative (if positive, squamous cell carcinoma would be more likely)
- Cytokeratins 7, 18, 20 variable positive, CK 5/6, 14 mostly negative
- Organ-specific immune marker constellations, e.g. B .:
- Lungs: CK7 +, CK20 -, TTF1 +
- Biliary tract, pancreas: CK7 +/-, CK20 +/-, CA19-9 +
- Colon: CK7 +/-, CK20 +, CDX2 +
- Prostate: PSA +, SPP +, AMACR +
- Mamma, female genitals: CK7 +, ER and PR often +
- Kidney: RCC +, PAX8 +, CD10 +, Vimentin +
Adenocarcinomas show organ-dependent etiopathogenetic, morphological and immunohistochemical differences and the nomenclature is sometimes inconsistent and subject to change over time. Frequent locations and subtypes are e.g. B .:
- Esophageal cancer - intestinal (tubular, cribriform) or diffuse (signet ring cell), risk factor: Barrett's esophagus
- Stomach cancer - ditto. Risk factor: Helicobacter pylori .
- Colon cancer - predominantly tubular and cribriform. Risk factor: adenomas , FAP , HNPCC
- Liver cancer - hepatocellular carcinoma (HCC) originating from the liver cells, cholangiocellular carcinoma (CCC) originating from the bile ducts. Risk factor: cirrhosis of the liver , chronic hepatitis
- Bile duct carcinoma - tubular, cribriform
- Pancreatic Cancer - Ductal
- Lung cancer - acinar, cribriform, papillary, micropapillary, solid ... Risk factor: smoking
- Breast cancer - ductal (new nomenclature: NST), lobular. Risk factor: BRCA
- Ovarian cancer - serous / papillary mucinous. Risk factor: BRCA
- Endometrial cancer - endometrioid, serous
- Prostate cancer - acinar, cribriform, solid, diffuse. Risk factor: age
- Renal cell carcinoma - clear cell, papillary, chromophobic
literature
- Ursus-Nikolaus Riede, Hans-Eckart Schaefer: General and special pathology. Thieme, Stuttgart 1999. ISBN 3-13-683304-X .
Web links
Individual evidence