Stellmacher Florian, Perner Sven
Pathologie, Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 1-40, 23845, Borstel, Deutschland.
Institut für Pathologie, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, 23538, Lübeck, Deutschland.
Pathologe. 2021 Feb;42(1):71-77. doi: 10.1007/s00292-021-00910-3. Epub 2021 Jan 21.
Although typical histological findings of tuberculosis are well known, the diagnosis of nonmicrobiologically proven tuberculosis with the instruments available to pathology is challenging. Indeed, necrotizing epithelioid cell granulomatosis is typical for tuberculosis, but it is also seen in a number of different infectious or noninfectious lung diseases. The tools of microscopy and molecular pathology are suitable for confirming the diagnosis or paving the way to a differential diagnosis, but molecular pathology applied to formalin-fixated and paraffin-embedded material is limited. This should be openly communicated to the referring clinician. After interdisciplinary re-evaluation of the findings, an alternative solution to confirm the diagnosis must therefore be found if the additional examinations are negative.
尽管结核病典型的组织学表现广为人知，但利用病理学现有的手段诊断非微生物学确诊的结核病具有挑战性。的确，坏死性上皮样细胞肉芽肿是结核病的典型表现，但在许多不同的感染性或非感染性肺部疾病中也可见到。显微镜检查和分子病理学工具适用于确诊或为鉴别诊断提供思路，但应用于福尔马林固定石蜡包埋材料的分子病理学存在局限性。这一点应坦率地告知转诊的临床医生。因此，在对检查结果进行多学科重新评估后，如果进一步检查结果为阴性，就必须找到其他确诊的办法。
