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Allgemeiner Aufbau und histologische Pathophysiologie der Tunica synovialis

Standardisierung histologischer Synovialisdiagnostik

General structure and histological pathophysiology of the tunica synovialis

Standardization of histological synovialis diagnostics

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Arthroskopie Aims and scope

Zusammenfassung

Die Tunica synovialis besteht aus 3 Kompartimenten: der synovialen Deckzellschicht, dem synovialen Stroma und Lymphfollikeln, die je nach Krankheitsbild in unterschiedlicher Quantität vorliegen. Zur Standardisierung wurde ein einheitlich anwendbarer Synovitis-Score geschaffen, der eine Unterscheidung in Low-grade- und High-grade-Synovitis erlaubt. Dieses Scoringsystem wird international als Goldstandard der morphologischen Beschreibung krankhafter Veränderungen der Tunica synovialis angesehen. Im aktuellen Artikel wird insbesondere auf die Bedeutung synovialer Fibroblasten und auf nomenklatorische Probleme eingegangen. Daneben werden pathophysiologische Grundlagen diskutiert. Die moderne histopathologische Diagnostik inkludiert histochemische („periodic acid Schiff“ [PAS], Grocott, Goldner, Berliner-Blau-Reaktion, Kongorot-Reaktion nach Puchtler), immunhistochemische (zahlreiche Antikörper im Routinebetrieb) und molekulare Methoden (In-situ-Hybridisierung, Polymerase-Kettenreaktion [PCR], Next Generation Sequencing [NGS]), die in den vergangenen Jahren durch proteomische Methoden ergänzt wurden. Diese sog. „Omics“-Methoden werden dazu führen, dass zahlreiche neue Biomarker in die Diagnostik einbezogen werden.

Abstract

The tunica synovialis is composed of three compartments: the synovial covering cell layer, the synovial stroma and lymph follicles. These compartments may be present in varying quantities depending on the underlying disease. For standardization a uniformly applicable synovitis score has been established that enables a differentiation into low-grade and high-grade synovitis. This scoring system is internationally regarded as the current gold standard for the morphological description of pathological alterations of the tunica synovialis. This article focuses particularly on the importance of synovial fibroblasts and problems concerning the nomenclature. Furthermore, the pathophysiological principles are discussed. Modern histopathological diagnostics include histochemical (PAS, Grocott, Goldner, Prussian blue staining, Congo red staining of Puchtler), immunohistochemical (numerous antibodies in routine application) and molecular methods (in situ hybridization, polymerase chain reaction and next generation sequencing), which were supplemented by proteomic methods in recent years. These so-called omics methods will lead to the inclusion of many new biomarkers in the diagnostics.

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Author information

Authors and Affiliations

  1. MVZ für Histologie, Zytologie und Molekulare Diagnostik Trier, Trier, Deutschland

    Jörg Kriegsmann

  2. Proteopath GmbH, Trier, Deutschland

    Jörg Kriegsmann &  Rita Casadonte PhD

  3. Fakultät Medizin/Zahnmedizin, Danube Private University (DPU), Steiner Landstraße 124, 3500, Krems-Stein, Österreich

    Jörg Kriegsmann

  4. Innere Medizin V, Abteilung für Hämatologie, Onkologie und Rheumatologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    Katharina Kriegsmann MSc., MBA

Authors
  1. Jörg Kriegsmann
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  2. Rita Casadonte PhD
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  3. Katharina Kriegsmann MSc., MBA
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Correspondence to Jörg Kriegsmann.

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Interessenkonflikt

p. J. Kriegsmann, R. Casadonte und K. Kriegsmann 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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P. Lobenhoffer, Hannover

J. Kriegsmann, Trier

W. Hackl, Innsbruck

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Kriegsmann, J., Casadonte, R. & Kriegsmann, K. Allgemeiner Aufbau und histologische Pathophysiologie der Tunica synovialis. Arthroskopie 35, 160–165 (2022). https://doi.org/10.1007/s00142-022-00527-5

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  • DOI: https://doi.org/10.1007/s00142-022-00527-5

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