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Benigne Tumoren und tumorähnliche Läsionen des Knochens

Allgemeine Behandlungsprinzipien

Benign tumours and tumour-like lesions of the bone

General treatment principles

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Zusammenfassung

Hintergrund

Benigne Knochentumoren sind wesentlich häufiger als maligne Knochentumoren. Einige sind durch einen eindeutigen radiologischen Befund klar zu klassifizieren, bei anderen ist die Diagnostik vielfältiger. Weiterhin kann die Therapie unterschiedlicher benigner Läsionen stark differieren. Ein Großteil der Läsionen bedarf keiner weiteren operativen Therapie. Bei anderen Tumoren, wie z. B. der aneurysmatischen Knochenzyste oder dem Riesenzelltumor ist aufgrund des lokal aggressiven Verhaltens die operative Therapie indiziert.

Diagnostik

Die größte Herausforderung liegt in der Bildgebung und für den Pathologen in der Unterscheidung von benignen Läsionen und Low-grade-Sarkomen, sodass hier einmal mehr die histopathologische Diagnose und entitätsmäßige Zuordnung im Verbund mit allen klinischen und radiologischen Informationen gestellt werden kann. Aus einer gewissen diagnostischen Unsicherheit heraus wird häufiger als notwendig die operative Therapie gewählt.

Therapie

Zur Behandlung der fibrösen Dysplasie und des Riesenzelltumors sind systemische medikamentöse Therapieansätze hinzugekommen. Die fibröse Dysplasie kann in Abhängigkeit von der Aktivität mit Bisphosphonaten behandelt werden und für den Riesenzelltumor zeigt die Therapie mit Denosumab ein gutes Ansprechen. Das Osteoidosteom ist einer der dankbarsten gutartigen Knochentumoren, da es durch die klassische Klinik, eine relativ eindeutige Radiomorphologie und die einfache Therapie gut und effektiv zu behandeln ist. Die Wahl des jeweiligen Therapieverfahrens richtet sich v. a. nach der Lokalrezidivneigung der Läsion, der Komplikationsrate der jeweiligen Verfahren, den Möglichkeiten zur Defektrekonstruktion, den resultierenden Funktionsdefiziten und den patientengebundenen Besonderheiten.

Abstract

Background

Benign bone lesions are much more common than malignant lesions. Some benign bone tumors have a characteristic and typical radiographic appearance, while others are more challenging. Therapy of benign bone tumors differs greatly. While the majority of benign bone tumors do not require surgical therapy, other specific lesions, e. g. aneurysmal bone cysts or giant cell tumors (GCT) of the bone require surgery due to their locally aggressive behavior.

Diagnostics

The major challenge for the radiologist and/or pathologist is the differentiation between a benign and low-grade malignant lesion (e. g. enchondroma versus low-grade chondrosarcoma) for which all available clinical and radiographic information is mandatory. Therefore, surgical therapy is rather more often performed than necessary due to uncertainty in many cases.

Therapy

Novel systemic therapies are available for fibrous dysplasia and GCT of the bone: Fibrous dysplasia can be treated with bisphosphonates, and GCT responds to denosumab. In fact, denosumab has been approved for the treatment of irresectable GCT. Osteoid osteoma is fairly easy to recognize and also to treat given the characteristic clinical presentation and rapid and effective response to local therapy (possible as percutaneous thermo-/laser ablation). In summary, several therapeutic options exist for benign bone tumors, and the choice depends upon the tendency/risk of local recurrence, the rate of surgical complications, options for defect reconstruction, postoperative functional deficits, and specific patient characteristics.

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  1. UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum „Carl-Gustav-Carus“ der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    H. Fritzsche,  K.-D. Schaser &  C. Hofbauer

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  1. H. Fritzsche
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Correspondence to K.-D. Schaser.

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H. Fritzsche, K.-D. Schaser und C. Hofbauer geben an, dass kein Interessenkonflikt besteht.

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Fritzsche, H., Schaser, KD. & Hofbauer, C. Benigne Tumoren und tumorähnliche Läsionen des Knochens. Orthopäde 46, 484–497 (2017). https://doi.org/10.1007/s00132-017-3429-z

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