Primary signet-ring cell carcinoma of the prostate.

The occurrence of signet-ring cells within a mucinous prostatic carcinoma is an extremely rare finding. This cancer is characterized by both intracellular retention and extracellular secretion of mucinous material. We report a case of primary signet-ring cell carcinoma of the prostate that was confirmed by autopsy. The results of gross, microscopic, and immunohistochemical examinations are described.

Serous papillary cystic tumor of borderline malignancy with focal carcinoma arising in testis: case report with immunohistochemical and ultrastructural observations.

A 59-year-old white man presented with painless scrotal swelling, a symptom he stated he had had for "several decades." Pathologic examination (conventional stainings, immunohistochemistry, and electron microscopy) revealed a cystic papillary tumor that was classified as a serous papillary cystadenoma, ovarian type, of borderline malignancy, with focal transition into invasive cancer. This appears to be the ninth reported case of testicular tumors of the serous or mucinous ovarian type and the first reported case with development of a circumscribed carcinoma from serous cystadenoma of borderline malignancy.

Estimation of the proliferative activity of human breast cancer tissue by means of the Ki-67 and MIB-1 antibodies--comparative studies on frozen and paraffin sections.

The estimation of the Ki-67 index in human breast cancer tissue has been proven to be a useful prognostic tool. The examination can be performed, however, only on frozen sections (FS). The development of an antibody directed against parts of the Ki-67 antigen (MIB-1) has opened a new route to determine the proliferative activity on paraffin sections (PS). MIB-1 immunohistochemistry is used instead of Ki-67 immunohistochemistry if a tumour is delivered to the pathologist after formalin fixation or if that part of the tissue suspicious for breast cancer must be totally embedded in order to confirm the diagnosis. The present study compares the findings of Ki-67 (FS) and MIB-1 (FS and PS) immunohistochemistry in a total of 544 cases of human breast cancer. The findings confirm a good statistical correlation between the Ki-67 and the MIB-1 findings. The MIB-1 results are 2-2.5 times higher in FS than in PS. Good agreement exists between the Ki-67 indices determined on FS and the MIB-1 indices determined on PS. If the cut-off value for the separation of Ki-67 negative and positive cases is defined as 10%-20%, a MIB-1 index in PS of 10% permits the correct prediction of a negative Ki-67 index in 97% of the cases, and a MIB-1 index of 30% or more correctly predicts a positive Ki-67 index in 90% or more of the cases. Hence, the determination of the MIB-1 index on PS may replace the determination of the Ki-67 index on FS with a high degree of probability.

Multiple lipid islands of the colonic mucosa. A light and electron microscopic study.

Light and electron microscopic findings in a case of multiple lipid islands of the sigmoid mucosa are described. The patient apparently represents the second case with these lesions published in the medical literature. Lipid droplets were found in histiocytes, pericytes, smooth muscle cells, and Schwann cells. Pathological alterations of the nervous system in lipid islands have not been described before. The accumulation of lipids in different cell types of the colonic mucosa and the alterations of nervous elements are probably due to toxic factors reaching the cells either from the intestinal lumen or from the blood stream. The term "lipid proctitis (colitis)" does not appear to be useful because the lipid islands are obviously no disease sui generis but an epiphenomenon of other pathological processes. Pathological differential diagnosis and clinico-pathological correlation of colorectal lipid islands are briefly discussed.

Immunohistochemical determination of estrogen and progesterone receptor content in human breast cancer. Computer-assisted image analysis (QIC score) vs. subjective grading (IRS).

Immunohistochemistry of Estrogen Receptor (ER) and Progesterone Receptor (PR) has been performed in 687 cases of human breast cancer. The staining results have been compared by (1) computer-assisted image analysis (QIC Score) and (2) subjective grading of the cryostat sections ("German" IRS). Tumors without or with only weak ER or PR content may be distinguished by both methods from tumors with a high receptor content. The QIC Score values belonging to the intermediate IRS grades are distributed over a wide range, but no negative cases were found in these categories. It is concluded from our results that subjective grading of the slides is a simple, rapid and useful method for the determination of the tissue receptor content and must not be replaced by the expensive and time-consuming computer-assisted image analysis in daily practice.

Primary mesenteritis, mesenteric fibrosis and mesenteric fibromatosis. Report of four cases, pathology, and classification.

Primary mesenteritis is a rare disease. Two cases and two additional patients with mesenteric fibrosis/fibromatosis are reported. A classification of primary and secondary mesenteritis is suggested in order to replace the confusing variety of terms used for the same disease process. Differential diagnosis of mesenteric fibrosis versus mesenteric fibromatosis may be difficult, and some criteria for the separation of these two entities are discussed. Among the clinical symptoms, transmission of aortic pulsations to the anterior abdominal wall is a rare but important aid for diagnosis. Associated diseases are malignant lymphoma, colonic adenomatosis (Gardner's syndrome) and retroperitoneal fibrosis. Microscopically, mesenteric lipomatosis and Whipple's disease must be ruled out. Usually, surgical treatment is not necessary. Prednisone and azathioprine may be helpful in severe cases. Fatal outcome of primary mesenteritis is extremely rare.

Pyloric gland type adenoma of the gallbladder with squamoid spindle cell metaplasia.

This study documents a pyloric gland type adenoma of the gallbladder with prominent spindle cell metaplasia arising in a 61 year-old woman. A pedunculated polyp, 1.5 x 1.0 x 1.0 cm, was histologically diagnosed as a tubular adenoma. Most glandular structures showed positivity for a monoclonal antibody M2 (2B5) which indicates a differentiation to pylotic gland type. The spindle cell component displayed no apparent epithelial structures but stained mostly positive for pancytokeratin and cytokeratin (CK) 18, and focally for CK 5 + 6, CKs 7 and 19, whereas CKs 8, 13, 20, and non-epithelial markers could not be demonstrated. This suggests that the spindle cells were immature epithelial cells differentiating towards squamous and/or glandular cells. Even in spindle cell areas, the nuclear atypia was mild, and proliferating cells positive for MIB-1 (Ki-67) antigen were infrequently seen. This unique phenomenon, of which only three cases have been previously reported, is considered to represent benign squamoid spindle cell metaplasia.

[Colorectal polyps. Pathologico-anatomical and statistical studies on 3037 polyps]. / Colorectale Polypen. Pathologisch-anatomische und statistische Untersuchungen an 3037 Polypen.

Report on 3037 colorectal polyps from the Deutsche Klinik für Diagnostik Wiesbaden that were observed within about 6 years and submitted to microscopic examination. The polyps were classified according to the WHO nomenclature, 1976. Adenomas and metaplastic (hyperplastic) polyps were the most frequenty types. The terms 'carcinoma in situ,' 'focal carcinoma,' 'adenoma with severe cellular atypia,' and 'malignant polyp' are explained and discussed in view of possible false interpretations by the surgeon. It is stressed that only the term 'adenoma with severe cellular atypia' (WHO classification) should be retained. In 286 cases, primary multiplicity of polyps was observed. There were recurrent polyp(s) in 154 cases (7%). Most frequently the recurrent polyp(s) corresponded to the type that had been found during the first examination. Finally, some remarks are made concerning the techniques of biopsy and of pathological examination.

[Colonic histiocytosis (author's transl)]. / PAS-positive Makrophagen in der Kolonschleimhaut -- Kritische Anmerkungen zum Begriff der "Kolonhistiozytose"

Macrophages accumulating various substances can be detected in the mucosa of the small and large bowel under physiological and various pathological conditions. Among these the so-called PAS-positive macrophages have attracted much attention in recent times. Abundant occurrence of such cells in the intestinal mucosa has been termed "colonic histiocytosis". The occurrence of PAS-positive macrophages was investigated in 200 unselected and otherwise normal biopsy specimens of rectal mucosa; no correlation was found between the occurrence of these cells on the one hand and any intestinal or extraintestinal disease on the other. PAS-positive macrophages were mostly found close to the surface of the mucosa or to the cryptal epithelium as well as between the crypts. It is suggested to abandon the term "colonic histiocytosis" since it induces a false impression of a disease entity in the clinician (and may be related falsely e.g. to "histiocytosis X", and since the clinician may tend to attribute unnecessary importance to this harmless finding.

[Effectiveness and efficiency of ambulatory diabetes education programs. A comparison of specialty practice and general practice]. / Effektivität und Effizienz ambulanter Diabetikerschulungen. Ein Vergleich von Schwerpunktpraxis und Allgemeinpraxis.

BACKGROUND AND OBJECTIVE: The increasing incidence of NIDDM requires adequate proof of the effectiveness and efficiency of out-patient programmes for diabetics. This study aimed at examining which of the two methods may promise the better results under controlled expenses--modifications of the present standardized diabetes education program in the general practice or specifically developed diabetes education programme in specialist diabetes practice. PATIENTS AND METHODS: 75 diabetics took part in the different out-patient diabetes education programmes at one special practice for diabetology or one of seven general practitioner practices, respectively. The self-developed intensive diabetes education programme of the special practice led by two specialists in diabetology and a dietician was compared with the diabetes education programme of the general practices performed by a doctor's assistant. 38 diabetics in eight training groups at the specialist for diabetology and 37 patients in seven training groups at the general practices were instructed. 32 patients in total (18 patients at the specialist practice and 14 patients at the general practices) additionally received an evaluated support programme which addressed psychosocial impediments related to the topics of a structured diabetes therapy. All patients were asked to complete a questionnaire before, right after, 3 and 6 months after the programme. Weight and glycosylated haemoglobin (HbA1c) were measured before, 3 and 6 months after the programme. RESULTS: The mean weight and glycosylated hemoglobin of all groups decreased as expected. However, the patients of the general practices achieved more lasting reduction of these objective parameters. All patients stated impairments of their quality of life, but the patients of the specialist practice felt more impaired. The motivational support programme achieved only few positive results. CONCLUSION: The standardized diabetes education programme of the general practices and the more intensive and expensive diabetes education programme achieved equally valuable results. Regarding time and expenses, the standardized diabetes education programme may be the more efficient method of NIDDM out-patient education.

Karl Touton and his "xanthelasmatic giant cell." A selective review of multinucleated giant cells.

The position of the Touton giant cell in relation to the foreign body and Langhans type of giant cell is considered. (A short account of Karl Touton's life is also included.) After reviewing the historical development of the concept of giant cells and current interpretations of their nature, the unitarian view of polykaryons now favored by workers in the field is extended to include also the "xanthelasmatic giant cell" of Touton, whose characteristic appearance is determined merely by the presence of demonstrable lipid in the cytoplasm. It is proposed that Touton cells develop when the stimulus to cell fusion is accompanied also by a factor stimulating lipid uptake. This factor is missing in the development of the other two giant cell "types," but apart from that there are no other significant differences.

Comparative biochemical and immunohistochemical studies on the cathepsin D content of human breast cancer.

Cathepsin D (CD) has been introduced as a predictor of prognosis in patients with breast cancer due to its mitogenic effect and its role in tumour metastasis. Commonly, the CD content of tumours is examined by means of a biochemical method based upon the use of monoclonal antibodies, and immunohistochemical visualization of CD has not been used extensively. The present study compares the biochemical and immunohistochemical findings in 216 cases of human breast cancer. CD may occur in tumour cells and/or macrophages. Correlation of immunohistochemically determined CD content and biochemical CD content is better in tumour cells than in macrophages. The possible causes of this observation are briefly discussed. Although a statistical correlation between the biochemical and the immunohistochemical CD findings exists, the results in individual cases vary within a wide range. Hence, the results of biochemical and immunohistochemical CD assay in an individual tumour cannot be compared directly.

Malignant transformation of hyperplasiogenic polyps of the stomach--case report.

Case report of a 71 years old female with multiple hyperplasiogenic gastric polyps with malignant transformation of two polyps. So far, the hyperplasiogenic polyp was considered to be only an "indicator lesion" because the incidence of gastric cancer (apart from the polyps themselves) was found to be increased in these patients. This opinion has to be revised in view of the present case. The consequences for diagnosis, treatment and nosologic classification of hyperplasiogenic gastric polyps are discussed.

Bone formation by cancer metastases: case report and review of literature.

The formation of heterotopic bone tissue in malignant tumors or in their metastases is extremely rare. In a 60 years old male patient with bronchogenic carcinoma (adenocarcinoma) extensive bone formation was observed within multiple metastases in the skeletal muscles. On the basis of the microscopic findings, the mechanism of bone formation by malignant tumors is discussed. Obviously, proliferation of local mesenchymal tissue and differentiation of mesenchymal cells to osteoblasts is induced by the tumor cells.

Anorectal ergotism: another cause of solitary rectal ulcers.

Anorectal ulceration was observed in 6 patients who excessively used suppositories containing ergotamine tartrate. The mucosal lesions of the rectum resembled those observed in the "solitary rectal ulcer syndrome." However, characteristic features of ergotamine-induced ulcers are absence of a mucosal prolapse, lack of a history of constipation, and rapid healing after discontinuation of the drug. Furthermore, the rectal lesion may be associated with anal ulceration, which occasionally presents as the only clinical manifestation of "anorectal ergotism."