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Erschienen in: Der Pathologe 2/2020

19.02.2020 | Knochentumoren | Schwerpunkt: Tumoren des Knochens und der Gelenke

Osteoidbildende Knochentumoren

Morphologie und aktuelle translationale Zellbiologie

verfasst von: Albert Roessner, Viktor Schoeder, Maria Smolle, Johannes Haybäck

Erschienen in: Die Pathologie | Ausgabe 2/2020

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Zusammenfassung

Die wichtigsten gutartigen osteoidbildenden Tumoren sind das Osteoidosteom und das Osteoblastom. Sie wachsen langsam und sind scharf begrenzt. Histologisch zeigen die Tumorzellen keine Atypien und keine vermehrten Mitosen. In typischen Fällen ist die Diagnose eindeutig. Äußerst problematisch sind aber die seltenen Fälle auf der Grenze zwischen Osteoblastom und Osteosarkom. Molekulargenetische Untersuchungen sollten hier in Zukunft zur korrekten Diagnosefindung beitragen.
Der wichtigste maligne osteoidbildende Tumor ist das juvenile hochmaligne Osteosarkom. Vor etwa 40 Jahren wurde für die meist jungen Patienten eine neoadjuvante Chemotherapie eingeführt, welche die Prognose hoch signifikant verbessert hat. Es wurde aber schnell eine Plateauphase erreicht, und seit Jahrzehnten gibt es mit den konventionellen Therapieansätzen keinen weiteren Fortschritt mehr. Realistischerweise muss angenommen werden, dass eine weitere Effizienzsteigerung der Therapie nur auf Basis der neuen molekulargenetischen und zellbiologischen Erkenntnisse erzielt werden kann. Die sich aus diesen Erkenntnissen ableitenden targettherapeutischen Strategien werden in diesem Beitrag diskutiert.
Die sehr viel selteneren nicht hoch malignen Osteosarkome sind an der Knochenoberfläche lokalisiert. Es handelt sich um die parossalen Osteosarkome, die meist G1-Tumoren sind und die periostealen Osteosarkome, meist G2. Wenn in seltenen Fällen die Differenzialdiagnose zwischen einem parossalen Osteosarkom und einer fibrösen Dysplasie schwierig ist, kann der Nachweis von GNAS-Mutationen in der fibrösen Dysplasie hilfreich sein. Periosteale Osteosarkome enthalten im Gegensatz zu Chondromen und Chondrosarkomen keine IDH1- und IDH2-Mutationen.
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Metadaten
Titel
Osteoidbildende Knochentumoren
Morphologie und aktuelle translationale Zellbiologie
verfasst von
Albert Roessner
Viktor Schoeder
Maria Smolle
Johannes Haybäck
Publikationsdatum
19.02.2020
Verlag
Springer Medizin
Erschienen in
Die Pathologie / Ausgabe 2/2020
Print ISSN: 2731-7188
Elektronische ISSN: 2731-7196
DOI
https://doi.org/10.1007/s00292-020-00763-2

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