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Therapieinduzierte Tumorregression beim Mammakarzinom

Morphological response to therapy of breast carcinoma

  • Schwerpunkt: Tumorregression
  • Published:
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Zusammenfassung

Die primäre (neoadjuvante oder präoperative) Chemotherapie wird bei Mammakarzinomen eingesetzt, um die Tumormasse zu reduzieren und möglichst brusterhaltend operieren zu können. In bis zu 80% der Fälle ist zumindest ein klinisches Ansprechen des Tumors zu verzeichnen, die Chemosensitivität kann bei diesem Vorgehen in vivo überprüft werden. Zusätzlich ist das Ausmaß der Tumorregression nach Therapie als eigenständiger prognostischer Faktor inzwischen etabliert.

Neben der Reduktion der Zellzahl des Tumors sind Fibrose, Vakuolisierung des Zytoplasmas und erhöhte Kernpolymorphie typische Folgen der Chemotherapie. Das Grading kann sich in beide Richtungen ändern, während das Typing und Immunprofil des Karzinoms nur in einem geringeren Prozentsatz der Tumoren durch die Therapie wesentlich verändert werden. Prädiktiv für die Chemosensitivität des Tumors sind ein hohes Grading, die Östrogenrezeptornegativität, die Überexpression von Her2-neu und ein negativer Lymphknotenstatus.

Abstract

Neoadjuvant chemotherapy has been extended to earlier stages of breast carcinoma in order to increase the rate of breast conservation by downstaging. Tumour regression can be observed in up to 80% of the cases and the chemosensitivity of the individual tumour can be studied in vivo. Moreover therapy induced regression has been established as an independent prognostic parameter.

Characteristic effects of chemotherapy include reduction in cell number, fibrosis, vacuolization of cytoplasm and increased nuclear pleomorphism. Grading, typing and immunohistochemical properties of the carcinomas remain unchanged in the majority of cases. Predictive for the chemosensitivity of tumours are a high nuclear grade, overexpression of Her-2-neu, lack of estrogen receptor expression and lymph node metastases.

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Authors and Affiliations

  1. Institut für Pathologie, Medizinische Hochschule Hannover

    F. Länger & H. H. Kreipe

  2. Zentrum der Frauenheilkunde, Medizinische Hochschule Hannover

    H.-J. Lück

  3. Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover

    F. Länger

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  1. F. Länger
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  3. H. H. Kreipe
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Correspondence to F. Länger.

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Länger, F., Lück, HJ. & Kreipe, H.H. Therapieinduzierte Tumorregression beim Mammakarzinom. Pathologe 25, 455–460 (2004). https://doi.org/10.1007/s00292-004-0713-6

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  • DOI: https://doi.org/10.1007/s00292-004-0713-6

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