Zusammenfassung
Die Differenzialdiagnose von Raumforderungen im Weichteil umfasst neben tumorartigen reaktiven Läsionen eine Fülle benigner, intermediärer, niedrig- und hochmaligner neoplastischer Veränderungen. Da sich die Therapie dieser heterogenen Läsionen von einer reinen zurückhaltenden Beobachtung über schonende lokale Exzisionen bis hin zu ausgedehnten radikalen Resektionen erstreckt, hängt die Therapieentscheidung/Planung wesentlich von einer präzisen präoperativen histologischen Diagnose ab. Auch für klinisch eindeutig maligne Erkrankungen hat die präoperative histologische Diagnostik zunehmend an Bedeutung gewonnen, da unterschiedliche Therapieprotokolle für die unterschiedlichen Entitäten appliziert werden. Dank der Verfügbarkeit modernster hochauflösender bildgebender Verfahren wurde die bildgesteuerte Stanzbiopsietechnik zunehmend populär und hat sich auch vor anderen chirurgischen (offenen) Biopsiemethoden zunehmend durchgesetzt. Während sich die perkutane Stanzbiopsie für oberflächlich gelegene große Tumoren als eine einfache, schnelle und sichere ambulant durchführbare Methode eignet, ermöglicht die Bildsteuerung eine gleichzeitige Mitbeurteilung des Tumors und dessen Nachbarstrukturen, womit auch eine unbeabsichtigte Verletzung vitaler Strukturen vermieden werden kann. In dieser Übersicht wird gezeigt, dass eine gezielte, an die typischen topographischen, demographischen und morphologischen Befunde orientierte Aufarbeitung von Stanzbiopsien, im Einzelfall unterstützt durch moderne immunhistochemische und/oder molekulare Marker, in den meisten Fällen eine präzise präoperative Diagnose von Sarkomen ermöglicht. Dies setzt allerdings umfassendes Wissen und Erfahrung bzgl. der topographischen bzw. demographischen Aspekte und auch insbesondere der sehr heterogenen morphologischen Erscheinungsbilder der häufigen, der seltenen und sehr seltenen Sarkom-Entitäten und Subvarianten voraus, um ein limitiertes aber ausreichendes Markerpanel am limitierten Stanzbiopsiematerial hoch selektiv anzuwenden.
Abstract
The differential diagnosis of soft tissue swellings encompasses a variety of benign, intermediate, low-grade malignant and high-grade neoplastic lesions in addition to tumor-like reactive processes. As treatment of these heterogeneous conditions varies greatly from conservative observation and simple local excision up to extensive radical surgical resection, treatment decisions are based mainly on a precise preoperative histological diagnosis on limited biopsy material. Even for clinically unequivocal sarcomas, the importance of the preoperative histological diagnosis has been increasingly emphasized as different therapeutic regimens have been established for different sarcoma types and the indications for preoperative treatment is influenced by the tumor grade and by the entity itself. Other factors positively influencing the increasing use of core needle biopsy for preoperative tumor diagnosis in soft tissue pathology are the availability of modern high-resolution imaging modalities as well as the establishment of several new second generation immunohistochemical markers and the discovery of entity-specific translocations detected by fluorescence in situ hybridization (FISH) in several sarcoma subtypes. In this review it will be shown that a targeted approach for processing core needle biopsies oriented towards the characteristic topographical, demographic, cytomorphological and architectural features of soft tissue lesions facilitates a precise diagnosis of soft tissue neoplasms in most cases. However, profound knowledge of the different aspects of soft tissue tumor diagnostics and familiarity with the frequent as well as the less common and rare tumor entities and variants is a prerequisite for appropriate interpretation of core needle biopsy findings and for selecting a limited but well-suited marker panel. The utilization of modern immunohistochemistry and/or FISH methods is highly useful for establishing the diagnosis of rare and unusual neoplasms in core needle biopsies.
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Interessenkonflikt. A. Agaimy gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Agaimy, A. Stellenwert der Stanzbiopsie in der präoperativen Diagnostik von Weichteiltumoren. Pathologe 35 (Suppl 2), 189–197 (2014). https://doi.org/10.1007/s00292-014-2010-3
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DOI: https://doi.org/10.1007/s00292-014-2010-3