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Plattenepithelkarzinome des oberen Aerodigestivtraktes

Prognostische Signifikanz der Kapselruptur und extrakapsulären Tumorausbreitung von Lymphknotenmetastasen

Squamous cell carcinomas of the upper aerodigestive tract

Prognostic significance of the capsular rupture and extranodal spread of lymph node metastases

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Zusammenfassung

Die Kapselruptur und konsekutive extrakapsuläre Ausbreitung von Lymphknotenmetastasen ist ein entscheidendes Prognostikum für Patienten mit Plattenepithelkarzinomen der oberen Luft- und Speisewege. Außer der Definition der Kapselruptur als Kontakt der Metastase zum perinodulären Fettgewebe besteht bezüglich des Ausmaßes des transkapsulären Wachstums keine eindeutige morphologische Festlegung. Daher wurde ein siebenstufiges histologisches Bewertungsschema entwickelt, welches den graduellen metastatischen Befall des Lymphknotens in Form des inselartigen, intranodalen Wachstums, der Kapselinfiltration, der Desmoplasie, der Kapselruptur und der konsekutiven extrakapsulären Tumorausbreitung erfasst. Die Angabe einer extrakapsulären Metastasierung stellt aufgrund der zuverlässigen Reproduzierbarkeit und der prognostischen Signifikanz eine sinnvolle Ergänzung zum gängigen TNM-System dar. Am besten ist dieses durch Ergänzung der N-Kategorie um den Index R+ (Lymphknotenmetastase mit Kapselruptur) oder R− (Lymphknotenmetastase ohne Kapselruptur) hinter dem N umzusetzen.

Abstract

The capsular rupture and subsequent extranodal spread of lymph node metastases is of crucial and well established prognostic value in patients with squamous cell carcinomas of the upper aerodigestive tract. Besides the basic histologic definition of the extranodal spread (i.e. contact of the metastasis with perinodal fatty tissue), there is no agreement on the morphologic extent of transcapsular spread. As a measure of improvement, a histologic evaluation differentiating between seven gradual types of metastatic nodal affection was applied. The histologic scheme considers intranodal growth, infiltration of the capsule, the presence of desmoplasia and especially the rupture of the capsule and the subsequent extranodal spread of the metastasis. As extranodal spread is an easily reproducible and reliably significant prognostic criterion, it should be included in the current TNM classification, e.g., by an addition of the index R+ (lymph node metastasis with capsular rupture) or R− (lymph node metastasis without capsular rupture) to the N category.

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  1. Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde des Universitätsklinikums Hamburg-Eppendorf

    S. Wenzel & U. Koch

  2. Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg

    S. Wenzel

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Wenzel, S., Koch, U. Plattenepithelkarzinome des oberen Aerodigestivtraktes. HNO 52, 783–789 (2004). https://doi.org/10.1007/s00106-004-1119-8

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