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Praktische Probleme im Mammographie-Screening: Kolumnarzellläsionen einschließlich flache Epithelatypie und lobuläre Neoplasien

Der Pathologe (Impact Factor: 0.62). 01/2008; 29. DOI: 10.1007/s00292-008-1037-8

ABSTRACT Kolumnarzellläsionen (CCL) und lobuläre Neoplasien (LN) werden in Mammographie-Screening-Biopsien immer häufiger diagnostiziert. Der mammographische Leitbefund der CCL ist Mikrokalk (MK), LN sind meist Zufallsbefunde. Beide Läsionen – und speziell die flache Epithelatypie (FEA) als atypische Variante der CCL – sind häufig miteinander und auch mit einer atypischen duktalen Hyperplasie (ADH) assoziiert. Molekularpathologische Befunde von CCL zeigen chromosomale Veränderungen, die auch im duktalen Carcinoma in situ (DCIS) und in invasiven gut differenzierten Karzinomen gefunden werden. Dies unterstützt die Hypothese, dass CCL neoplastische Proliferationen sind. Klinische Befunde deuten darauf hin, dass CCL Indikatorläsionen und nichtobligate Präkanzerosen sind. Es gibt derzeit keine international einheitliche Klassifikation der CCL. Kennzeichnendes Merkmal der LN sind Mutationen im CDH1-(E-Cadherin-)Gen. Alternative genetische Veränderungen im CDH1-Pathway können in immunhistochemisch CDH1-positiven LN zu einem Funktionsverlust von CDH1 führen. Wir stellen die Hypothese auf, dass ein Teil der morphologischen und immunhistochemischen Hybridläsionen (WHO 2003) den LN mit alternativen CDH1-Funktionsverlusten entsprechen könnten. Neuere Verlaufsdaten weisen auf eine höhere Rate ipsilateraler Karzinome bei Patienten mit vorbekannter LN hin. Es ist eine offene Frage, ob die FEA und die LN eine gemeinsame Familie intralobulärer Neoplasien sind, die gemeinsame nichtobligate Vorläufer einer ,,low nuclear grade breast neoplasia family“ sind.

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