Hussein K, Panning B
Institut für Pathologie, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover (MHH), Hannover, Deutschland.
Pathologe. 2018 Mar;39(2):172-177. doi: 10.1007/s00292-017-0392-8.
Rudolf Virchow is one of the founders of modern pathology, and many of his ideas on inflammatory and neoplastic diseases are still valid today. Even for Virchow, determination of malignancy was not always easy. As an example, the laryngeal disease of Crown Prince Frederick William, the later Emperor Frederick III, is presented.The clinical findings at the beginning of the disease were suggestive of a carcinoma, though an inflammatory lesion was also discussed. Several attempts were made to remove the lesion bioptically, but local recurrences occurred and the first tissue samples were not examined histopathologically. Since laryngeal tumour operations had a high mortality at that time, histopathologic examinations were made in order to decide for or against an operation. The samples taken after pre-treatment did not meet Virchow's criteria for determining a carcinoma. Contrary to the present concept of a carcinoma in situ-carcinoma sequence, Virchow's concept was based on the assumption that carcinomas are not derived from the epithelium, but arise from a mesenchymal-epithelial transformation from the connective tissue. The clinical suspicion of a laryngeal carcinoma was confirmed only shortly before the patient's death and later by a post-mortem examination.The question repeatedly asked is whether Virchow should have diagnosed a carcinoma at the beginning of the disease. The answer has been the same for more than a hundred years: the clinician is dissatisfied with the histopathological diagnosis, so the pathologist is to blame.
鲁道夫·魏尔啸是现代病理学的奠基人之一，他关于炎症性和肿瘤性疾病的许多观点至今仍然有效。即使对于魏尔啸来说，确定恶性肿瘤也并非总是容易的。例如，文中介绍了后来的腓特烈三世皇帝——王储腓特烈·威廉的喉部疾病。疾病初期的临床症状提示为癌，但也有人讨论是炎症性病变。曾多次尝试通过活检切除病变，但出现了局部复发，且最初的组织样本未进行组织病理学检查。由于当时喉部肿瘤手术的死亡率很高，因此进行了组织病理学检查以决定是否进行手术。预处理后采集的样本不符合魏尔啸确定癌的标准。与目前原位癌 - 癌序列的概念相反，魏尔啸的概念基于这样一种假设，即癌并非起源于上皮细胞，而是由结缔组织的间充质 - 上皮转化产生。直到患者死亡前不久，临床对喉癌的怀疑才得到证实，后来通过尸检得以确认。人们反复提出的问题是，魏尔啸在疾病初期是否应该诊断为癌。一百多年来答案一直相同：临床医生对组织病理学诊断不满意，所以病理学家应受责备。
