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Die WHO-Klassifikation von 2014 nimmt eine Unterteilung in verschiedene Subtypen des muzinosen Adenokarzinoms vor. Kurzlich beschrieben wurde der gastrische Subtyp, der keine Assoziation zu einer High-risk-HPV-Infektion (humane Papillomviren) zeigt, prognostisch ungunstig ist sowie bevorzugt bei Asiatinnen auftritt und beim Peutz-Jeghers-Syndrom vorkommen kann. Mittelfristig ist zu erwarten, dass sich beim Adenokarzinom der Cervix uteri ein auf verschiedenen Invasionsmustern beruhendes Grading etabliert. Die tiefe Stromainfiltration makroinvasiver Karzinome ist definiert als eine Infiltration von >66 % des zervikalen Stromas. Zukunftig konnte eine maximale Tumorgrose von 2 cm ein Parameter zur Planung einer eingeschrankt-radikalen Operation sein. Parameter des histopathologischen Befundberichts, die relevant fur die Prognoseabschatzung und Auswahl der adjuvanten Therapie sind und als Qualitatsindikatoren im Rahmen von Zertifizierungen dienen, werden beschrieben. Der histologische Typ Adenokarzinom hat fur sich allein genommen keine pradiktive bzw. prognostische Bedeutung bei Patientinnen mit primar operativer Therapie, einer neoadjuvanten Chemotherapie, einer kombinierten Radiochemotherapie bzw. dem Einsatz von Angiogeneseinhibitoren. Molekulare Parameter und Biomarker besitzen derzeit keine Relevanz.

Histopathological assessment of the tumor grade and cell type is central to the management and prognosis of various gynecological malignancies. Conventional grading systems for squamous carcinomas and adenocarcinomas of the vulva, vagina and cervix are poorly defined. For endometrioid tumors of the female genital tract as well as for mucinous endometrial, ovarian and seromucinous ovarian carcinomas, the 3-tiered FIGO grading system is recommended. For uterine neuroendocrine tumors the grading system of the gastrointestinal counterparts has been adopted. Uterine leiomyosarcomas are not graded. Endometrial stromal sarcomas are divided into low and high grades, based on cellular morphology, immunohistochemical and molecular findings. A chemotherapy response score was established for chemotherapeutically treated high-grade serous pelvic cancer. For non-epithelial ovarian malignancies, only Sertoli-Leydig cell tumors and immature teratomas are graded. At this time molecular profiling has no impact on the grading of tumors of the female genital tract.

New insights gained in the field of molecular medicine have led to fundamental progress in the diagnosis and treatment of tumour patients. Individualised treatment has been essentially facilitated by molecular diagnostics, which, by identifying and interpreting characteristic genetic alterations (biomarkers) in single cells and tissues, provide specific information to confirm the diagnosis and support the treatment of numerous diseases. Particularly with regard to the use of new targeted drugs, which often require the presence or absence of specific target structures or genetic alterations to induce response, the molecular pathological determination of predictive biomarkers plays an increasing role and helps clinicians to decide on optimal therapies for individual patients. The aim of this review is to highlight general aspects of molecular tumour pathology for relevant tumour entities and to present available targeted therapies.

Molekulare Analysen gewinnen kontinuierlich an Bedeutung fur individualisierte Therapien, insbesondere in der Onkologie. Der vorliegende Beitrag gibt einen Uberblick uber molekulargenetische und molekularpathologische Analysen, die im Bereich der Tumordiagnostik zum Einsatz kommen. Damit erhalten v. a. Kliniker einen Einblick in das methodische Spektrum der molekularen Diagnostik. Zugleich werden die Einsatzmoglichkeiten und Grenzen dieser Methoden aufgezeigt.

The World Health Organization (WHO) classification from 2014 differentiates between different subtypes of mucinous adenocarcinoma of the uterine cervix. A gastric subtype was recently described that showed no association with high-risk human papillomavirus (HPV) infections, has a poor prognosis, is mainly diagnosed in women of Asian origin and can occur in patients with Peutz-Jeghers syndrome. Although no clear grading system has been recommended in the WHO classification, it is likely that grading of adenocarcinomas of the uterine cervix will partly be based on the different patterns of invasion. Deep stromal infiltration of macroinvasive carcinomas is defined as an infiltration of66 % of the cervical stroma. In the near future a maximum tumor size of 2 cm could act as a discriminator for planning of less radical surgery. Parameters of the histopathological report that are relevant for the prognostic assessment as well as the choice of adjuvant treatment and function as quality indicators during certification are described. The histological type of an adenocarcinoma alone is of no predictive or prognostic relevance for patients undergoing primary surgical treatment, neoadjuvant chemotherapy, combined chemo-radiotherapy or treatment with angiogenesis inhibitors. Currently, molecular parameters and biomarkers are of no relevance.

Histopathological assessment of the tumor grade and cell type is central to the management and prognosis of various gynecological malignancies. Conventional grading systems for squamous carcinomas and adenocarcinomas of the vulva, vagina and cervix are poorly defined. For endometrioid tumors of the female genital tract as well as for mucinous endometrial, ovarian and seromucinous ovarian carcinomas, the 3‑tiered FIGO grading system is recommended. For uterine neuroendocrine tumors the grading system of the gastrointestinal counterparts has been adopted. Uterine leiomyosarcomas are not graded. Endometrial stromal sarcomas are divided into low and high grades, based on cellular morphology, immunohistochemical and molecular findings. A chemotherapy response score was established for chemotherapeutically treated high-grade serous pelvic cancer. For non-epithelial ovarian malignancies, only Sertoli-Leydig cell tumors and immature teratomas are graded. At this time molecular profiling has no impact on the grading of tumors of the female genital tract.

New insights gained in the field of molecular medicine have led to fundamental progress in the diagnosis and treatment of tumour patients. Individualised treatment has been essentially facilitated by molecular diagnostics, which, by identifying and interpreting characteristic genetic alterations (biomarkers) in single cells and tissues, provide specific information to confirm the diagnosis and support the treatment of numerous diseases. Particularly with regard to the use of new targeted drugs, which often require the presence or absence of specific target structures or genetic alterations to induce response, the molecular pathological determination of predictive biomarkers plays an increasing role and helps clinicians to decide on optimal therapies for individual patients. The aim of this review is to highlight general aspects of molecular tumour pathology for relevant tumour entities and to present available targeted therapies.