Zusammenfassung
Hintergrund
Das Hodgkin-Lymphom stellt eine besondere diagnostische Herausforderung für Pathologen dar. Diese Herausforderung besteht in der Paucizellularität des Tumors, in dem Lymphomzellen unter 1 % aller Zellen ausmachen. Der überwiegende Anteil aller Zellen in dem Gewebe entspricht nichtneoplastischen, inflammatorischen Zellen, dem sog. Microenvironment. Die Zusammensetzung dieses Microenvironments wird für die Einteilung der klassischen Hodgkin-Lymphome in die Subtypen in der Histologie erfasst.
Ziel
Das Ziel dieser Übersichtsarbeit ist die Darstellung von Entwicklungen in der Diagnose, Klassifikation und Prognosevorhersage von Hodgkin-Lymphomen in der Pathologie der letzten Jahre.
Material und Methoden
Es erfolgte eine selektive Literaturrecherche unter Berücksichtigung eigener Erfahrungen als Referenzpathologe im Rahmen des Kompetenznetz Malige Lymphome e. V.
Ergebnisse und Diskussion
Aus dem Microenvironment lassen sich aber auch prognostische Informationen ablesen, wie Genexpressionsanalysen gezeigt haben. Die Lymphomzellen selbst, die Hodgkin- und Reed-Sternberg Zellen, können vom Pathologen innerhalb des Microenvironments durch lange bekannte Marker wie CD30 immunhistochemisch detektiert werden. In den letzten Jahren sind allerdings neue diagnostische Marker hinzugekommen, die die Diagnostik erleichtern. Hierzu gehören v. a. Transkriptionsfaktoren wie PAX5, BOB1 und OCT2, deren Nachweis in der Immunhistologie wichtige Kriterien für die Definition des Hodgkin-Lymphoms liefern. Diese Fortschritte in der molekularen und auch histologischen Analyse haben im Zusammenspiel mit der Beschreibung klinischer Krankheitsbilder, die ein Hodgkin-Lymphom imitieren können, wie dem Epstein-Barr-Virus-assoziierten mukokutanen Ulkus, diagnostische Grenzzonen des Lymphoms neu definiert.
Abstract
Background
Hodgkin’s lymphoma is a diagnostic challenge for pathologists. This challenge is primarily due to the paucicellularity of the tumor, in which the lymphoma cells make up less than 1 % of all cells. The vast majority of cells in the tissue are non-neoplastic inflammatory cells and constitute the microenvironment. The composition of this microenvironment is used for the histological classification of classical Hodgkin’s lymphoma subtypes.
Aim
The aim of the review article is the presentation of recent developments in the diagnosis, classification and prediction of prognosis of Hodgkin’s lymphomas by pathology.
Material and methods
A selective search of the literature was carried out with reference to personal experience as a reference pathologist within the framework of the Competence Network Malignant Lymphoma (registered) Society.
Results and discussion
Prognostic information can be derived from the microenvironment as has been shown by gene expression analyses. The lymphoma cells, consisting of Hodgkin and Reed-Sternberg cells, can be immunohistochemically detected by pathologists within the microenvironment using well-known markers, such as CD30, However, in recent years new diagnostic markers have been developed which facilitate the diagnostics. These include transcription factors, such as PAX5, BOB1 and OCT2 and their detection by immunohistology produces important criteria for the definition of Hodgkin’s lymphoma. These advances in molecular and histological analyses have redefined the diagnostic boundary zones of lymphoma in combination with the description of clinical symptoms which can imitate Hodgkin’s lymphoma, such as mucocutaneous ulcers associated with Epstein-Barr virus.
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Interessenkonflikt. W. Klapper, H. Stein und A. Rosenwald geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen und Tieren.
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Klapper, W., Stein, H. & Rosenwald, A. Neues von der Histopathologie des Hodgkin-Lymphoms. Onkologe 20, 421–428 (2014). https://doi.org/10.1007/s00761-013-2633-7
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DOI: https://doi.org/10.1007/s00761-013-2633-7