Von der Morphologie zur Molekularbiologie: Entwicklungen der Dermatohistopathologie am Beispiel des kutanen T-Zell-Lymphoms

Zusammenfassung

Zu Beginn des 19. Jahrhunderts stand die klinische Beschreibung einzelner Patienten mit kutanen Lymphomen im Vordergrund. Basierend auf diesen klinischen Beschreibungen und der morphologischen histopathologischen Untersuchung der „2. Dimension” der Haut konnten in der Folgezeit verschiedene Unterformen der kutanen Lymphome herausgearbeitet werden. Im Rahmen von Konsensuskonferenzen wurden dann Ende der 70er-Jahre des 20. Jahrhunderts basierend auf der morphologischen Beschreibung klinische und histologische Kriterien für die Diagnose erarbeitet und der übergeordnete Begriff des kutanen T-Zell-Lymphoms (CTCL) definiert. Schließlich konnte am Ende des 20. Jahrhunderts mit Hilfe der immunhistologischen Marker eine genaue Klassifikation der CTCL im Rahmen der EORTC und WHO vorgenommen werden. Die neuen Erkenntnisse der Molekularbiologie (TCR-Rearrangement) des ausgehenden 20.Jahrhunderts erhöhen die diagnostische Sicherheit bei dieser Erkrankung. Mit Hilfe neuer Erkenntnisse zur „genetischen Morphologie” der CTCL (Molekulare Genetik, Mikroarray-Technologie) wird es in naher Zukunft möglich sein, die Diagnostik, Prognostik und Therapie dieser Hauterkrankung weiter zu verbessern.

Abstract

In the beginning of the 19. century the first case reports of patients with cutaneous lymphomas were dominated by a detailed description of the clinical picture. Based on these clinical descriptions and the morphological dermatohistopathological examination of the „2. dimension” of the skin different subgroups of cutaneous lymphomas could be identified. In the late 70s of the 20. century diagnostic criteria were defined based on the morphological description of the clinical and histological features and the general term „cutaneous T-cell lymphoma” (CTCL) was established. Finally, with the help of newly introduced immunohistochemical markers a classification of CTCL was worked out by the EORTC and the WHO at the end of the 20. century. Molecular biology (TCR-Rearrangement) offers new insights into CTCL and increases the diagnostic safety especially of early-stage CTCL cases. In the future it will be possible to further improve the diagnosis, prognosis and therapy of CTCL by new discoveries regarding the „genetic morphology” (molecular genetics, microarray-technology) of this skin disease.

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