[Pronounced bilateral mammary hypertrophy as a rare manifestation of acute lymphatic leukemia]. / Ausgeprägte bilaterale Mammahypertrophie als ungewöhnliche Manifestation einer akuten lymphatischen Leukämie.

A 33-year-old patient, hitherto healthy, has been admitted for clarification of bilateral mammary hypertrophy. In the course of the usual routine examination a lump of the size of a cherry was identified in the right breast. Within 6 weeks both breasts had become tight and grown symmetrically to three times their original size. A provisionary diagnosis of high malignant non-hodgkin lymphoma was made by multiple high speed needle biopsies and was later confirmed by a surgical tissue specimen of the right breast. For further classification a bone-marrow biopsy was taken from the pelvic bone and an immature acute lymphoblastic leukemia (ALL), known as preB1-ALL, diagnosed. Sonographic examination, computer tomography of the thorax and mammographical findings, as well as symptoms, outcome and differential diagnosis of a proliferative lymphatic disease with first manifestation in both breasts are presented and discussed.

[Primary squamous cell carcinoma of female mammary gland]. / Primäres Plattenepithelkarzinom der weiblichen Brustdrüse.

Squamous metaplasia can be demonstrated in about 4% of all invasive carcinomas of the breast. Primary squamous cell carcinomas of the breast are rare, since they occur in less than 1% of all primary invasive breast carcinomas. In order to classify a breast tumor as a primary squamous cell carcinoma one must exclude an epidermal origin, especially from the nipple region and the possibility of metastatic infiltration of the breast by a squamous cell carcinoma from a different location. Causative and formal pathogenesis of primary squamous cell carcinoma of the breast is not clear. A pluripotent embryonal stem cell origin is discussed, considering the phylogenetic descent of the mammary gland from skin appendages. Squamous metaplasia is also suggested to be a precursor of squamous cell carcinoma. Here endocrine stimulation and chronic inflammation may both play an inductive role. The number of published cases of squamous cell carcinomas developing years and decades after implantation of silicon prostheses has increased in recent years. These tumors probably develop on top of squamous metaplasia induced by the inflammatory pseudocapsule. Estimating the prognosis and therapeutic management in patients with squamous cell carcinoma of the breast should follow the same guidelines as for other squamous cell cancers.

[Adult giant cell hepatitis with fatal outcome. Clinicopathologic case report and reflections on pathogenesis]. / Adulte Riesenzellhepatitis mit tödlichem Verlauf. Klinisch-pathologischer Fallbericht und Uberlegungen zur Pathogenese.

The occurrence of plasmodial giant cells in the liver is probably a morphological reaction pattern with the most diverse causes. In babies and infants, these changes occur in particular in neonatal hepatitis and intrahepatic and extrahepatic bile duct atresia. Viral infections and/or autoimmune reactions are discussed etiologically in giant cell hepatitis in adults (adult gaint cell hepatitis, AGCH), which is much rarer. In some of the cases, there were conspicuously high titers against paramyxoviruses. Giant cell hepatitis can occur in the course of HIV infection. These both indicate an infectious cause. However, the disease cannot be transmitted to chimpanzees. Apart from our case, only one further case is described in the literature in which a completed hepatitis A infection could be demonstrated serologically. In addition, the titer of antinuclear antibodies was raised in our patient. This autoimmune phenomenon is probably of crucial pathogenetic significance in our patient, especially since a hepatitis A infection on its own does not afford an adequate etiological explanation for the form of chronic and active hepatitis with consecutive cirrhotic transformation observed here.

[Inflammatory pseudotumor of the liver. Morphologic and cytophotometry studies and differential diagnosis]. / Inflammatorischer Pseudotumor der Leber. Morphologische und zytophotometrische Untersuchungen sowie Differentialdiagnose.

Inflammatory pseudotumors of the liver are extremely rare. Worldwide only 50 cases have been described so far. In lung tissue, their incidence is higher, with 119 cases being published. Etiological factors are still a matter of debate; reactive inflammatory processes have recently been proved by immunohistological and cytophotometric studies. This seems to be true for both liver and lung locations of inflammatory pseudotumors. Considerable morphological heterogeneities, conspicuously varying from one case to another, reflect the numerous synonyms that have been created for this condition, i.e., plasma cell granuloma, xanthoma, fibroxanthoma, histiocytoma, plasmacytoma, solitary "mast cell tumor" and pseudoneoplastic pneumonia, just to number a few of them. This multicolored morphology explains the difficulties in histologic diagnosis, especially if needle biopsies or frozen sections are submitted to pathology. Differential diagnosis of an inflammatory pseudotumor of the liver needs to include fibrohistiocytic neoplasia if spindle-cell-shaped areas are included or, on the other hand, parenchymal infiltrates of the nodular sclerosing type of Hodgkin's granuloma. Immunohistological investigations do not allow final decisions since spindle-shaped cells within pseudotumours can express vimentin and/or desmin as well. Such histological cases should always include the excision of a piece of liver tissue of sufficient size to comfortably allow for the recognition of the multicellular composition and morphological heterogeneity of this process.

[Chorioangiomatosis of the placenta--diagnosis and obstetrical management]. / Chorangiomatose der Plazenta--Diagnostik und geburtshilfliches Management.

Chorioangiomas are the most common benign tumors of the placenta. The pathologist is able to recognize these tumors in 1% of all examined specimens, but 80% of them are small and of no clinical significance. The larger chorioangiomas are very rare and often associated with complications such as placental abruption, fetal anemia, premature labor and preterm delivery. Early diagnosis of such a large placental tumor is necessary for the obstetrician to adjust the management of pregnancy to reduce fetal and maternal mortality and morbidity. We present a case of multiple placental chorioangiomas, in which the largest was 8 cm in diameter, detected in the 33rd week of pregnancy and associated with polyhydramnion and fetal anemia because of fetomaternal transfusion. Early diagnosis and well-timed delivery avoided severe complications for mother and neonate.

[Comparison of flow cytometric, static cytometry and tumor cytogenetic investigation results human renal cell carcinomas]. / Vergleich durchflusszytophotometrischer, einzelzellzytophotometrischer und tumorzytogenetischer Untersuchungsergebnisse an Nierenzellkarzinomen des Menschen.

Published data about the frequency of DNA-aneuploidy of renal cell tumours show a great variation. The own study was performed to clarify whether this fact is due to methodological discrepancies or to intratumoural heterogeneity of DNA ploidy. The comparison of DNA ploidy assessed by flow cytometry (fresh and paraffin-embedded tissue) and static cytometry (paraffin-embedded tissue) in equivalent tumour regions showed identical results. 71% of clear cell renal carcinomas showed intratumoural heterogeneity of DNA ploidy. In 55% there was either a combination of diploid and aneuploid stem lines and/or a combination of different aneuploid stem lines ("heterogenous aneuploidy"). The rate of aneuploidy was found to be higher with increasing cytoplasmic eosinophilia of the clear cell renal carcinoma cells. Studies which address the prognostic significance of DNA ploidy of renal carcinomas should specifically investigate on the significance of heterogenous aneuploidy for prognosis.

Leiomyosarcoma of the kidney. Immunohistological and ultrastructural findings with special emphasis on the growth fraction.

This report deals with a case of renal smooth muscle tumour. Considering the low mitotic rate, this neoplasm would have been classified as leiomyoma. However, it displayed a relatively large growth fraction by immunostaining with the monoclonal antibody Ki-67. This led us to the diagnosis "leiomyosarcoma", which is in line with the unfavourable clinical course. We suggest that assessment of the growth fraction with Ki-67 seems to be more objective than the conventional criteria for determining the malignant potential of smooth muscle tumours.

[Morphology and growth characteristics of human renal cell carcinoma in correlation to cytogenetic data]. / Morphologie und Wachstumsfraktion von Nierenzellkarzinomen des Menschen in Korrelation zu zytogenetischen Daten.

Previous cytogenetical studies of renal cell carcinomas reported non-uniform results, but some chromosomes or chromosomal segments seemed to be affected more frequently by chromosomal aberration. This study was undertaken to determine a possible association between morphology, growth fraction (Ki-67, APAAP-method), and cytogenetical data of renal cell carcinomas. Our results show a variety of chromosomal aberrations, which do not correlate with morphological typing of the tumors. A single characteristic anomaly could not be found. There is an inverse correlation between complexity of chromosomal aberrations and size of growth fraction. For further interpretation of our results detailed molecular-genetic studies are necessary, which should investigate whether growth factors, oncogenes, or other genes are influenced by the reported chromosomal aberrations.