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Biopsieindikationen

Histopathologische Diagnostik in der Rheumatologie

Indications for tissue biopsy

Diagnostic histopathology in rheumatological diseases

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Zusammenfassung

In diesem Artikel wird die Bedeutung der standardisierten histopathologischen Diagnostik von Gewebeproben unterschiedlicher Kompartimente (Synovialis, Gefäße, Knochenstanzen) für die Stratifizierung der Therapie der Arthritiden und anderer Erkrankungen des rheumatischen Formenkreises sowie von Osteopathien erläutert. Als diagnostisches Hilfsmittel wird der Synovialitis-Score zur Unterscheidung von Low-grade- (assoziiert mit degenerativen und posttraumatischen Arthropathien) und High-grade-Synovialitiden (assoziiert mit entzündlichen Erkrankungen des rheumatischen Formenkreises) vorgestellt. Als eines der offiziellen Klassifikationskriterien werden die Lippendrüsenbiopsie im Rahmen der Diagnostik eines Morbus Sjögren (Sjögren-Syndrom) sowie Biopsieindikationen im Rahmen der erweiterten Vaskulitisdiagnostik (Chapel-Hill-Klassifikation) näher beleuchtet. Zuletzt werden die Wertigkeit der Knochenbiopsie/Beckenkammstanze für die Diagnostik der metabolischen Knochenerkrankungen und hämatophathologische Fragestellungen im Rahmen rheumatologischer Erkrankungen hervorgehoben.

Abstract

The role of a standardized histopathological examination of tissue biopsies and of different tissue compartments (synovia, vascular tissue, bone) is discussed in order to stratify the therapy of different forms of arthritis and other rheumatological diseases. Furthermore the diagnostic steps for the histopathological diagnosis of metabolic osteopathic diseases are highlighted. The synovitis-score is described as a diagnostic device leading to the diagnosis of a low-grade synovitis, which is associated with degenerative and posttraumatic arthropathies, or of a high-grade synovitis which is associated with rheumatic diseases.

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  1. Medizinisches Versorgungszentrum für Histologie, Zytologie und Molekulare Diagnostik, Max-Planck-Str. 18-20, 54296, Trier, Deutschland

    V. Krenn,  C. Poremba &  C. Dierkes

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  1. V. Krenn
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  2. C. Poremba
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  3. C. Dierkes
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Correspondence to V. Krenn.

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Krenn, V., Poremba, C. & Dierkes, C. Biopsieindikationen. Z. Rheumatol. 71, 297–313 (2012). https://doi.org/10.1007/s00393-012-0979-7

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