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Osteoidbildende Knochentumoren

Morphologie und aktuelle translationale Zellbiologie

Osteoid-forming bone tumors

Morphology and current translational cell biology

  • Schwerpunkt: Tumoren des Knochens und der Gelenke
  • Published:
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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.

Abstract

Osteoid osteoma and osteoblastoma are the most important benign osteoid-forming tumors. They grow slowly and are well differentiated. Histologically, the tumor cells show no atypia and no increased mitoses. In typical cases, they can be clearly diagnosed. However, the rare cases on the dividing line between osteoblastoma and osteosarcoma are extremely problematic. In these cases, molecular genetic investigations should contribute to finding the correct diagnosis in the future.

Juvenile highly malignant osteosarcoma is the most important malignant osteoid-forming tumor. About 40 years ago, neoadjuvant chemotherapy was introduced for the mostly young patients. This therapy highly significantly improved prognosis. However, a plateau phase was quickly reached and the last several decades have seen no further progress in conventional therapeutic approaches. There is no doubt that further progress can only be achieved on the basis of new molecular genetic and cell biological findings. The target-therapeutic strategies derived from these findings will be discussed in this review.

The rare parosteal osteosarcoma and the even rarer periosteal osteosarcoma are mostly not highly malignant tumors that are located on the surface of bone. The parosteal osteosarcoma is usually G1 and the periosteal osteosarcoma G2. Occasionally, the differential diagnosis between a parosteal osteosarcoma and a fibrous dysplasia is difficult. In such rare cases, the detection of GNAS mutations in fibrous dysplasia can prove useful. In contrast to chondromas and chondrosarcomas, periosteal osteosarcomas do not contain IDH1 and IDH2 mutations.

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  1. Institut für Pathologie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland

    Albert Roessner, Viktor Schoeder & Johannes Haybäck

  2. Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Graz, Österreich

    Maria Smolle

  3. Institut für Pathologie, Neuropathologie und Molekularpathologie, Medizinische Universität Innsbruck, Innsbruck, Österreich

    Johannes Haybäck

  4. Diagnostik & Forschungszentrum für Molekulare BioMedizin, Institut für Pathologie, Medizinische Universität Graz, Graz, Österreich

    Johannes Haybäck

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  1. Albert Roessner
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  2. Viktor Schoeder
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  3. Maria Smolle
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  4. Johannes Haybäck
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Correspondence to Albert Roessner.

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Interessenkonflikt

A. Roessner, V. Schoeder, M. Smolle und J. Haybäck geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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A. Roessner, Magdeburg

J. Haybäck, Magdeburg

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Roessner, A., Schoeder, V., Smolle, M. et al. Osteoidbildende Knochentumoren. Pathologe 41, 123–133 (2020). https://doi.org/10.1007/s00292-020-00763-2

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  • DOI: https://doi.org/10.1007/s00292-020-00763-2

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