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Funktionelle Pathologie der Milz

Grundlagen und differenzialdiagnostische Erwägungen am Milzpräparat

Functional splenic pathology and differential diagnosis in splenectomy

  • Schwerpunkt: Pathologie der Milz
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Zusammenfassung

Pathologisch-anatomisch gliedert sich die Milz in rote und weiße Pulpa, die z. T. unabhängig voneinander im Rahmen von systemischen und lokalen Prozessen reagieren. Während die rote Pulpa im Wesentlichen der Filtrierung des Blutes dient, ist die weiße Pulpa gemeinsam mit der sie umgebenden perifollikulären Marginalzone dafür verantwortlich, den organisierten Ablauf von Immunreaktionen zu gestalten, wobei Mechanismen der „natürlichen“ Immunität und des adaptiven Immunsystems integriert werden. Die Milz wird in der überwiegenden Mehrzahl der Fälle aus therapeutischen Gründen oder aufgrund extralienaler Erkrankungen entnommen. Lediglich etwa 10% der Splenektomien stellen diagnostische Probleme dar. Das differenzialdiagnostische Spektrum für den Pathologen unterscheidet sich in Abhängigkeit davon, ob eine hämatologische Systemerkrankung, Splenomegalie oder ein Milztumor abzuklären ist.

Abstract

From a pathologic-anatomic perspective, the splenic parenchyma is divided into red and white pulp, which react to a certain extent independently from one another in the context of systemic and local processes. While the red pulp serves to filter blood, the white pulp, together with the perifollicular marginal zone, organizes immune reactions. In the marginal zone, innate and acquired immune responses are integrated. The vast majority of splenectomies serve therapeutic purposes in the context of already known disease. Therefore, only about 10% of splenectomy specimens are diagnostic challenges, including the diagnosis of haematological diseases, splenomegaly or splenic tumors. Differential diagnosis considerations are discussed based on the clinical presentation.

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Authors and Affiliations

  1. Institut für Pathologie, Universitätsklinikum Mannheim, Mannheim, Deutschland

    A. Marx

  2. Institut für Pathologie, Universität Würzburg, Würzburg, Deutschland

    A. Zettl & H.K. Müller-Hermelink

  3. Institut für Pathologie, Städtisches Klinikum Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Deutschland

    M. Hartmann &  T. Rüdiger

Authors
  1. A. Marx
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  2. M. Hartmann
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  3. A. Zettl
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  4. H.K. Müller-Hermelink
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  5. T. Rüdiger
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Correspondence to T. Rüdiger.

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Marx, A., Hartmann, M., Zettl, A. et al. Funktionelle Pathologie der Milz. Pathologe 29, 109–114 (2008). https://doi.org/10.1007/s00292-008-0967-5

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  • DOI: https://doi.org/10.1007/s00292-008-0967-5

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