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Pathologie der benignen und malignen Schilddrüsenveränderungen – was der endokrine Chirurg wissen sollte

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Viszeral- und Allgemeinchirurgie

Part of the book series: Springer Reference Medizin ((SRM))

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Zusammenfassung

Gutartige Erkrankungen der Schilddrüse betreffen Entzündungen, Hyperplasien, benigne Neoplasien sowie Funktionsstörungen; mit ca.15 Millionen Betroffenen gehören sie zu den häufigsten Erkrankungen in Deutschland. Im Gegensatz zu Entzündungen, Hyperplasien und benignen Neoplasien, die histologisch gut darstellbar sind, zeigen klinische Funktionsstörungen der Schilddrüse in der Regel sowohl qualitativ und quantitativ nur ein eingeschränktes morphologisches Korrelat. Die Ursache von Funktionsstörungen können Entzündungen, Hyperplasien und (ganz überwiegend benigne) Tumoren sein; Funktionsstörungen sind aber auch selbst die Ursache von Hyperplasien und Tumoren der Schilddrüse. Benigne Schilddrüsenerkrankungen manifestieren sich klinisch durch die von ihnen verursachten Funktionsstörungen (Hypothyreose, Hyperthyreose) und/oder durch die Folgen einer hyperplastisch und/oder neoplastisch vergrößerten Schilddrüse, wie z. B. Kompression umliegender Strukturen mit Schluckstörungen, Heiserkeit etc., aber auch kosmetische Auswirkungen.

Fast alle Tumoren der Schilddrüse sind epithelialer Natur; dementsprechend selten sind nichtepitheliale Tumoren (gutartige und bösartige mesenchymale Tumoren, maligne Lymphome u. a.). Die 4. Ausgabe der WHO-Klassifikation der Tumoren der Schilddrüse (WHO 2017) beinhaltet grundlegende Änderungen mit weitreichenden diagnostischen Konsequenzen, sowohl für die präoperative Feinnadelbiopsie, die intraoperative Gefrierschnittdiagnostik als auch die endgültige Paraffinhistologie. In die aktuelle Klassifikation (siehe Tab. 2) wurde eine Gruppe von gekapselten Tumoren („other encapsulated follicular-patterned thyroid tumours“) mit unsicherem Malignitätspotenzial aufgenommen, wobei insbesondere durch die Etablierung der „Nicht-invasive follikuläre Neoplasie mit PTC-äquivalenten Kernmerkmalen (NIFTP)“ ein entscheidender Schritt zur Verringerung der Diagnose „Schilddrüsenkrebs“ bei Tumoren mit offensichtlich biologisch indolentem Verlauf gemacht wurde. Des Weiteren erfolgte die insbesondere für eine korrekte Diagnose von gering differenzierten Schilddrüsenkarzinomen (PDTC, Volente et al. 2007) entscheidende Neubewertung der diagnostischen Kriterien „Tumornekrose“ und „Mitosezahl“ (Rosai 2017; WHO 2017). Der Einsatz der Immunhistochemie ist bei der Diagnose von Schilddrüsentumoren seit Jahrzehnten Standard; dazu erlangte aber auch die Molekularpathologie bei der Schilddrüsendiagnostik einen immer höheren Stellenwert.

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Authors and Affiliations

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

    Kurt Werner Schmid

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  1. Kurt Werner Schmid
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Correspondence to Kurt Werner Schmid .

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Editors and Affiliations

  1. Allgemein- Viszeral- u. Gefäßchirurgie, Charité Universitätsmedizin Berlin, Berlin, Berlin, Deutschland

    Martin Kreis

  2. Klinik für Visceral-, Thorax- und G, Universitätsklinikum Marburg, Marburg, Hessen, Deutschland

    Detlef K. Bartsch

  3. Klinik & Poliklinik Allgemein & Abdomin, Universitätsklinikum Mainz, Mainz, Rheinland-Pfalz, Deutschland

    Hauke Lang

Section Editor information

  1. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Philipps-Universität Marburg, Marburg, Deutschland

    Detlef K. Bartsch

  2. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Philipps-Universität Marburg, Marburg, Deutschland

    Katharina Holzer

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Schmid, K.W. (2021). Pathologie der benignen und malignen Schilddrüsenveränderungen – was der endokrine Chirurg wissen sollte. In: Kreis, M., Bartsch, D.K., Lang, H. (eds) Viszeral- und Allgemeinchirurgie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61724-3_2-1

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  • Print ISBN: 978-3-662-61724-3

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