Malignant peritoneal mesothelioma after Thorotrast exposure.

A case of a malignant peritoneal mesothelioma in a 63-year-old male patient with a history of exposure to Thorotrast in 1945 is presented. There was no history of exposure to asbestos. The clinical manifestation was a serosal effusion, which required weekly ascites puncture until therapy with intraperitoneal bleomycin was initiated. The latter treatment led to a significant reduction of ascites without any influence on tumor progression. Unfortunately, intraperitoneal bleomycin was accompanied by pulmonary toxicity, but at a higher total dose than known for intravenous administration. Three years after diagnosis the patient is still alive, without relapse of ascites production after bleomycin had to be stopped. Considering the risk of pulmonary fibrosis with high-dose intraperitoneal bleomycin and the lack of efficacy on tumor reduction, bleomycin seems to offer no advantage with respect to cisplatin.

[Diagnosis of pancreatic lesions: possibilities of cytology]. / Diagnose von Läsionen des Pankreas: Möglichkeiten der Zytologie.

The pancreas is relatively inaccessible to conventional methods of study and is difficult to investigate because of its anatomic location. Different imaging techniques have made it possible to detect tumors with diameters in the range of 1 cm. Endoscopic methods (lavage and cytologic brush methods) never proved successful enough to obtain diagnostic material. Combination among aspiration cytology, different X-ray methods, and ultrasound scanning have been reported to give astonishingly accurate results: many reports indicate its value. The following paper describes our experiences with this method for examination of pancreatic lesions and presents our own results.

[The value of fine-needle biopsy under ultrasonic control in the diagnosis of kidney tumors]. / Die Wertigkeit der ultraschallgeleiteten Feinnadelpunktion in der Diagnostik von Nierentumoren.

127 fine-needle aspiration biopsies obtained under ultrasonographic control from circumscribed kidney lesions of 102 patients (with histologically examined lesions) were selected from a total of 867 fine-needle aspiration biopsies performed in the years between 1978 and 1986. The result of the cytological examination was compared with the histological diagnosis of the lesion. A correct diagnosis of the nature of the lesion (concerning dignity) was achieved in 90.2% of the cases under optimal circumstances. No mistakenly positive diagnosis was made. A total of 88% of the histologically malignant tumors or 80.2% of the kidney cancers were correctly diagnosed already on the basis of the cytological examination. The fine-needle aspiration can be repeated when the obtained material is insufficient: A kidney cancer was diagnosed in this way 13 times among 22 patients. The cytological examination permitted a more precise tumor-type differentiation in the large majority of cases. These results demonstrate the value of this diagnostic tool that carries only an irrelevant risk.

Cytologic presentation of malignant mesothelioma in pleural effusions.

1,601 pleural effusions were found to be malignant between 1976 and 1987. Among these were 26 (1.6% of the malignant effusions) mesothelioma. Only 2 cases showed pronounced cytologic features that made a definite diagnosis possible on cytologic criteria alone. In 20 cases diagnosis of mesothelioma was strongly suggested by the patient's history and cytology of the effusion was compatible with mesothelioma. In the other 4 cases special examinations (histo- and immunohistochemistry, electron microscopy) led to the final diagnosis. The cytologic features of mesothelioma and other examination techniques, needed to resolve the differential diagnosis of mesothelioma versus other neoplasm in pleural effusions, are discussed.