Adenocarcinoma

from Wikipedia, the free encyclopedia
Classification according to ICD-10
C80 Malignant neoplasm without specifying the location
ICD-10 online (WHO version 2019)
Classification according to ICD-O-3
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

Microscopic image of a conventional adenocarcinoma of the rectum in HE staining
Signet ring cell carcinoma, HE.
Mucinous adenocarcinoma. HE.
TTF1 expression (brown) in a brain metastasis of a pulmonary adenocarcinoma (lung cancer). Immunohistochemistry.

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)
  • 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).
  • 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 .:

literature

  • Ursus-Nikolaus Riede, Hans-Eckart Schaefer: General and special pathology. Thieme, Stuttgart 1999. ISBN 3-13-683304-X .

Web links

Individual evidence