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Primäre und sekundäre Knochengeschwülste

  • Chapter
Skeletterkrankungen

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Zusammenfassung

Knochentumoren sind seltene Neoplasien und stellen daher eine erhebliche Herausforderung für den nichtspezialisierten Radiologen, Pathologen und Orthopäden dar. Die nicht seltene Isomorphie von Knochentumoren mit nichtneoplastischen tumorähnlichen Läsionen sowie stress- und entzündungsinduzierten Knochenveränderungen einerseits und die Polymorphie einzelner Entitäten erfordern eine sehr differenzierte radiologische Untersuchungsstrategie und Befundinterpretation, um einerseits unnötige Biopsien zu vermeiden und andererseits die Notwendigkeit einer Biopsie aufzuzeigen. Pathologe und Orthopäde brauchen vom Radiologen einen Befund mit Informationen über die exakte Lokalisation und Ausdehnung einer tumorsuspekten Läsion, deren Aggressivität sowie anhand spezifischer Merkmale wie z. B. eine bestimmte vom Tumor gebildete Matrix eine Verdachtsdiagnose. Ist die Diagnose mit Hilfe der Radiologie sicher zu stellen, dann muss sie vom Radiologen ggf. auch dem Pathologen gegenüber verteidigt werden.

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Notes

  1. 1.

    2Auf der Basis eines sorgfältig ausgewerteten Krankenguts von 2161 Mammakarzinompatientinnen empfiehlt Langhammer (Langhammer 1991) folgende Indikationen für die Skelettszintigrafie: Bei Patientinnen mit »low risk« für eine Skelettmetastasierung (pT1pN0) keine routinemäßige Szintigrafie, bei »medium risk« (pT1pN1, pT2pN0) empfehlenswert, bei »high risk« (pN1 und größerem Primärtumor, pN2/3) regelmäßige Szintigrafie in halb- bis mindestens einjährigen Abstände.

  2. 2.

    2Auf der Basis eines sorgfältig ausgewerteten Krankenguts von 2161 Mammakarzinompatientinnen empfiehlt Langhammer (Langhammer 1991) folgende Indikationen für die Skelettszintigrafie: Bei Patientinnen mit »low risk« für eine Skelettmetastasierung (pT1pN0) keine routinemäßige Szintigrafie, bei »medium risk« (pT1pN1, pT2pN0) empfehlenswert, bei »high risk« (pN1 und größerem Primärtumor, pN2/3) regelmäßige Szintigrafie in halb- bis mindestens einjährigen Abstände.

  3. 3.

    3Unter einer Bisphosphonattherapie nehmen sowohl osteolytische als auch osteoplastische Metastasen an Dichte zu (Quattrocchi 2007).

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Freyschmidt, J. (2016). Primäre und sekundäre Knochengeschwülste. In: Skeletterkrankungen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48137-0_16

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  • Online ISBN: 978-3-662-48137-0

  • eBook Packages: Medicine (German Language)

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