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Morphologie und Prognose des folliculären Schilddrüsencarcinoms — Eine klinisch-pathologische und DNS-cytometrische Untersuchung an 95 Tumoren

Morphology and prognosis of follicular thyroid carcinoma

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Summary

A retrospective study of 95 follicular thyroid carcinomas was conducted to evaluate the prognostic value of different morphological and clinical features. The biological behaviour of these tumours was primarily influenced by presence or absence of a capsule type of confinement: the frequency of lethal outcome among widely invasive carcinomas was six times higher than among encapsulated neoplasms. Furthermore, dismal prognosis could be demonstrated for tumours occurring in older patients (with a sharp break in the prognosis at the age of 52 years) and for those lesions which displayed oxyphilic metaplasia. The same effect was shown for presence of lymph node metastasis, tumour invasion of the cervical soft tissue and, for the case of encapsulated carcinomas, distant haematogenous spread. Conversely, the degree of differentiation and the patients' sex proved to have no significant influence on prognosis. In 22 carcinomas, cytophotometric and flow-cytometric determinations of DNA values were performed. These procedures revealed to have only limited diagnostic value, since for the majority of the tumours, benignancy or malignancy could not be judged from the DNA histograms. However, DNA measurements proved to contribute valuable information for the prognosis in individual cases of widely invasive follicular carcinomas. The discussion focuses on the diagnostic, therapeutic and prognostic relevance of these findings and on their impact on subclassification of follicular thyroid carcinomas.

Zusammenfassung

In einer retrospektiven Studie an 95 folliculären Schilddrüsencarcinomen wurden verschiedene morphologische und klinisch-biologische Parameter auf ihre prognostische Bedeutung geprüft. Das klinische Verhalten der Tumoren wurde vorrangig durch Vorhandensein oder Fehlen einer Kapselbegrenzung bestimmt: Grob invasive Carcinome zeigten sechsfach häufiger einen letalen Verlauf als gekapselte Neoplasien. Ein ungünstigeres Verhalten ergab sich ferner bei Manifestation des Tumors im höheren Lebensalter (Schwellenalter: 52 Jahre) und bei Nachweis einer oxyphilen Differenzierung, weiterhin bei Vorliegen von Lymphknotenmetastasen, einer Halsweichteilinfiltration und - im Fall gekapselter Carcinome - von Fernmetastasen. Dagegen hatten die Faktoren Differenzierungsgrad und Geschlecht keinen signifikanten Einfluß auf die Prognose. Bei 22 Tumoren erfolgten cytophotometrische und flußcytometrische DNS-Bestimmungen. Der diagnostische Nutzen dieser Verfahren war dadurch limitiert, daß an Hand der DNSHistogramme in der Mehrzahl der Carcinome keine eindeutige Dignitätsbeurteilung getroffen werden konnte. Dagegen erwiesen sie sich als brauchbares Instrument für die Prognosebeurteilung individueller grob invasiver Tumoren. Die diagnostische, differentialtherapeutische und prognostische Bedeutung der Befunde sowie deren Relevanz für die Subklassifikation folliculärer Schilddrüsencarcinome wird diskutiert.

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Authors and Affiliations

  1. Institut für Pathologie, Universität Hamburg, Martinistraße 52, D-2000, Hamburg 20

    S. Schröder & B. Sablotny

  2. Institut für Biophysik und Strahlenbiologie, Universität Hamburg, Hamburg

    H. Baischz & I. Meiners

  3. Institut für Mathematik und Datenverarbeitung in der Medizin, Universität Hamburg, Hamburg

    W. Rehpenning

  4. Abteilung Nuklearmedizin, Radiologische Universitätsklinik Hamburg, Hamburg

    H. -W. Müller-Gärtner

  5. Abteilung Allgemeinchirurgie, Chirurgische Universitätsklinik Hamburg, Hamburg

    K. Schulz-Bischof & H. W. Schreiber

  6. Institut für Pathologie, Allgemeines Krankenhaus Hamburg-Altona, Hamburg

    W. Böcker

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  1. S. Schröder
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Prof. Dr. G. Seifert aus Anlaß seines 65. Geburtstags gewidmet

Mit dankenswerter Unterstützung durch die Deutsche Forschungsgemeinschaft (Sehr 274/ 2-1) und die Hamburger Stiftung zur Förderung der Krebsbekämpfung

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Schröder, S., Baischz, H., Rehpenning, W. et al. Morphologie und Prognose des folliculären Schilddrüsencarcinoms — Eine klinisch-pathologische und DNS-cytometrische Untersuchung an 95 Tumoren. Langenbecks Arch Chiv 370, 3–24 (1987). https://doi.org/10.1007/BF01259423

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