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Zytopathologische Ergussdiagnostik In Der Berufsgenossenschaftlichen Begutachtung Von Asbest-assoziierten Malignen Mesotheliomen Und Lungenkarzinomen Pleural Effusion Cytology Of Asbestos-Associated Malignant Mesothelioma And Lung Carcinoma In The Diagnosis Of Occupational Diseases By The Statutory

S. Biesterfeld, M. Schramm, A. Schad, N. Pomjanski
Published 2014 ·

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Bei Lungenkarzinomen und malignen Mesotheliomen ist die Bildung von Pleuraergüssen oft der erste Hinweis auf eine Tumorerkrankung. Da die Ergüsse relativ früh im diagnostischen Ablauf punktiert werden, steht Material zur zytopathologischen Tumordiagnostik häufig bereits zur Verfügung, bevor histologische Probenentnahmen erfolgt sind. In der hier präsentierten Studie wird über Erfahrungen mit der zytopathologischen Ergussdiagnostik in der berufsgenossenschaftlichen (BG) Begutachtung von sieben Patienten berichtet, bei denen keine histologischen Gewebeproben aus Lungenoder Pleurabiopsien vorlagen. Untersucht wurden im Mittel acht Sedimentausstriche von auswärts vorbefundeten Pleuraergüssen bei siebenMännern (mittleres Alter: 81,7 Jahre) mit jeweils langjähriger Asbestexposition und in einigen Fällen BG-anerkannter Asbestose. Nach der üblichen konventionellen zytopathologischen Untersuchung wurden fallbezogen die Methoden der Immunzytochemie, der DNA-Bildzytometrie, der AgNOR-Analyse sowie der Fluoreszenz in situ-Hybridisierung angewandt. Sechs der sieben Fälle ließen sich gutachterlich abschließend lösen. In drei Fällen lag ein malignes Mesotheliom im Vollbeweis vor, in zwei Fällen eine Pleurakarzinose eines Lungenkarzinoms. Bei einem mit Mesotheliom-Verdacht punktierten Patienten wurden Zellen eines hochmalignen Non-Hodgkin-Lymphoms (NHL) nachgewiesen und ein Mesotheliom ausgeschlossen. Nur ein Fall blieb diagnostisch offen; hier wurde später auswärts nach dem Tod des Patienten ein malignes Mesotheliom durch Autopsie gesichert. In allen sieben Fällen ist die jeweilige BG unserer Beurteilung gefolgt und hat die fünf Fälle von Mesotheliomen und Lungenkarzinomen als Berufskrankheiten anerkannt sowie den NHL-Fall abgelehnt. Der diagnostisch ungeklärte Fall wurde zunächst nicht anerkannt, sondern erst nach dem Abstract !
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