Immunosialadenitis (Sjögren's syndrome) and lymphoproliferation.

The association of primary salivary gland non-Hodgkin's lymphoma (NHL) and immunosialadenitis (myoepithelial sialadenitis, MESA) is well recognized. Within MESA the whole spectrum of lymphoproliferation starting with a prelymphoma transforming into an early lymphoma and later on into a manifest lymphoma can be observed. These lymphomas represent so-called low grade B-cell lymphomas of mucosa associated lymphoid tissue (MALT), an entity also including lymphoplasmocytoid immunocytoma according to the Kiel classification of NHL. In a few patients a transition into a high grade B-cell lymphoma may occur. The recognition of early stages of lymphomas and their distinction from reactive MESA is only possible by application of immunohistological methods.

Immunostaining in atypical fibroxanthoma of the skin.

We have studied 12 cases of cutaneous atypical fibroxanthoma using immunohistochemistry to demonstrate lysozyme, alpha-1-antitrypsin, S-100-protein, receptors for peanut agglutinin, and intermediate filaments. Results were compared with immunostaining in 24 cases of other so-called fibrohistiocytic tumours. In addition 2 cases of atypical fibroxanthoma and 6 cases of fibrohistiocytic tumours were stained by monoclonal antibodies specific for the monocyte cell lineage (Ki-M1, Ki-M2, Ki-M6, Ki-M7, Ki-M8, OKM-1 and Leu-M1) and double-stained by monocyte-markers and Ki-67. The immunophenotype of atypical fibroxanthoma was rather similar to the marker profile found in malignant fibrous histiocytoma. All atypical fibroxanthomas were positive for vimentin and negative for epithelial markers. Monocyte lineage-specific determinants could be demonstrated in varying amounts in cells suggestive of being reactive. In contrast proliferating--Ki-67 positive--cells did not express monocyte/macrophage related antigens in atypical fibroxanthoma and malignant fibrous histiocytoma both. As to the histogenesis of these tumours our findings speak in favour of a derivation from primitive mesenchymal cells rather than from histiocytes.

[Difficulties in the differential diagnosis of a non-traumatic, active myositis ossificans during pregnancy (author's transl)]. / Differentialdiagnostische Schwierigkeiten bei einem fall von aktiver Myositis ossificans non traumatica in der Gravidität

A 28 year old patient complained of sensory disturbances and pain in the right upper arm during pregnancy. During the 32nd week of her pregnancy, a large painful mass developed in the flexor muscles which, radiographically, showed some calcification. A diagnosis of a parosseous sarcoma was made; biopsy, however, indicated a diagnosis of non-traumatic myositis ossificans. Since the histological appearances of active myositis may be vary difficult to distinguish from a juxtacortical sarcoma, a right brachial angiogram and scintiscan were obtained. The angiographic and scintigraphic findings were erroneously considered to suggest malignancy. Following delivery, the tumour was removed. Futher histology confirmed the diagnosis of localised, non-traumatic myositis ossificans. The value of radiology, biopsy, angiography and scintigraphy are discussed with reference to our experience.

Identification of types and primary sites of malignant tumors by examination of exfoliated tumor cells in serous fluids. Comparison with the diagnostic accuracy on small histologic biopsies.

The accuracy of identification of tumor type and primary site of malignant tumors by examination of exfoliated tumor cells was cytologically studied in 448 malignant effusions from 366 patients for whom the primary tumor site had been confirmed by histology. Ninety-seven corresponding small biopsies from metastases were separately reviewed histopathologically. In four fluids, the cells were too scanty or too poorly preserved for tumor typing. The cytologic tumor typing was performed with nearly 100% accuracy in the remaining 444 fluids, except for those of intermediate-cell anaplastic carcinomas (0 of 3) and poorly differentiated squamous (epidermoid) carcinomas (1 of 5). Adenocarcinoma was correctly identified in 98% of 285 fluids, large-cell carcinoma in 97% of 108 fluids, oat-cell carcinoma in 94% of 16 fluids, well-differentiated (keratinizing) squamous carcinoma in 100% of 3 fluids, malignant lymphoma in 100% of 22 fluids and sarcoma in 100% of 2 fluids. The criteria and the failures are discussed at length. In the investigation of the accuracy of cytologic and histologic diagnoses with respect to the primary tumor site, tumors with variable sites of origin (sarcomas and lymphomas) and those with usually singular sites of origin (e.g., small-cell anaplastic carcinoma of the lung) were excluded, leaving 387 cytologic and 83 histologic specimens available for review. The breast as a primary site was correctly identified in 70% of both the cytologic and histologic specimens; the primary cytodiagnostic criteria included a uniform cell pattern, finely granular chromatin, dense cytoplasm and cell balls with smooth borders. Ovarian primaries were correctly identified in 70% of the fluids and 83% of the biopsy samples on the basis of very irregular clusters of large pleomorphic tumor cells, large nucleoli and psammoma bodies. Lung primaries, identified in 50% of the fluids and 29% of the biopsy samples, showed quite variable cell patterns, most often including large pleomorphic cells with or without mucus formation and prominent multinucleation. Gastric cancers of the diffuse type were accurately identified in 52% of the corresponding fluids, which showed mainly isolated cells with dense cytoplasmic rims, occasional signet-ring cells, "embryo-shaped" nuclei, marked hyperchromasia and densely granular chromatin.(ABSTRACT TRUNCATED AT 400 WORDS)

[Bone scans in the diagnosis of renal osteopathy]. / La scintigrafia ossea nella diagnostica dell'osteopatia renale.

Biochemical tests (serum calcium, inorganic phosphate and alkaline phosphatase), as well as clinical, radiological, scanning and histological investigations were undertaken in 24 patients in chronic renal failure. The frequency with which the diagnosis of renal osteopathy could be made depended in the method of investigation, the biochemical findings proving to be completely unreliable. There were positive radiological signs in ten patients and clinical signs in 12, predominantly in the progressive stages of osteopathy. A positive scan was obtained in 23 patients, typical histological bone changes in an equal number. Since it correlates so well with the histological findings, bone scan is suitable particularly in the early diagnosis of osteopathy. Since this test is easily performed and hardly stresses the patient, it should routinely be the initial one for the diagnosis of renal osteopathy.

The adenoma-carcinoma sequence of the colon and rectum.

Morphological and epidemiological arguments in favour of an adenoma-carcinoma concept of evolution in the development of colorectal cancers are presented. It is highly probable that most colorectal cancers arise in adenomas. Therefore detection and endoscopic removal of adenomas is a means of reducing the incidence of colorectal carcinomas.

Colorectal cancer: the relationship of staging to survival. A cancer registry study of 800 cases in St. Gallen-Appenzell.

Proper classification of colorectal cancer has been critical in determining prognosis. Dukes' staging and its modifications have created considerable confusion. The TNM system has never been widely accepted because of its complexity. The Australian clinico-pathological staging (ACPS) system corresponds closely to Dukes' A, B, C-classification, but it differs from Dukes' in separating a stage D for incurable metastatic disease. Evaluating the compatibility of these 3 different staging systems, a survival analysis is presented of a group of 800 non-selected patients, resected in curative or palliative intention and compiled from the cancer registry of St. Gall-Appenzell. The prognostic importance of accurate staging for colorectal cancer is confirmed. No matter which system is used, in order to give realistic statements it must be based on tumor penetration, lymph node involvement and distant metastasis.

[The gastric surface carcinoma (early carcinoma)]. / Das Oberflächenkarzinom (Frühkarzinom) des Magens

Gastric surface carcinoma or early cancer is defined as carcinoma limited to the mucosa or submucosa of the gastric wall. It has an excellent prognosis. Enormous progress in detection and histological diagnosis of early gastric carcinoma has been made with fibre-optic gastroscopy and guided biopsy. Macroscopic types and histological pattern of 18 cases of early cancer are described (16 mucosal and 2 submucosal carcinomas). The endoscopic biopsy allows the diagnosis "carcinoma" in most cases, if 5-6 biopsies are taken for examination. Definite diagnosis warrants throughout histological examination of the resected specimen showing the carcinoma limited to the superficial layers of the stomach wall. In 11 of our 18 cases the surface carcinoma was localised to the antrum and the angulus. The size of the carcinoma was less than 2 cm2 in 7 of 18 cases. 6 of 18 cases showed a multicentric origin. The good prognosis of early gastric cancer as compared to deeper infiltrating carcinomas justifies a more aggressive diagnostic approach. Problems concerned with diagnosis, surgical procedures and tissue preparation for histology are discussed.

[Chronic pyelonephritis and its differential diagnosis. A disease changing with time]. / Die chronische Pyelonephritis und ihre Differentialdiagnose. Ein Krankheitsbild im Wandel der Zeit.

Chronic pyelonephritis (c.p.) is by definition an infectious tubulo-interstitial nephritis. It has to be differentiated from other etiologic forms of tubulo-interstitial nephritis. Therefore strict morphological criteria are needed for diagnosis. The characteristic lesion is a large cortico-medullary scar overlying a dilated chronically inflammed calyx. The macroscopic aspect and the histologic survey picture are more important than histologic details. A diagnosis on renal biopsies is therefore not warranted. Vesico-renal reflux and papillary morphology play an important pathogenetic role. Beside the more common focal scar a diffuse form of scarring can be observed. A limited number of conditions only have to be considered in differential diagnosis. The Ask-Upmark kidney seems to be a special form of c.p. related to urinary tract infection and reflux in early infancy. Pelvi-calyceal lithiasis without superimposed infection causes a picture very similar to a pyelonephritic scar. A reliable differentiation between c.p. and analgesic nephropathy may cause problems in endstage kidneys with sloughed off papillae. Various mechanisms of renal damage such as bacterial infection, immunological mediated inflammation, leakage of urinary constituents into the interstitium especially Tamm-Horsfall-protein and ischemia have to be considered. Despite the frequency of urinary tract infections chronic progressive pyelonephritis is rare. Predisposing factors are needed for progression of the disease. These include congenital or acquired urinary tract obstruction, vesico-renal reflux and papillary damage with intrarenal obstruction to the urinary flow. Other important factors are focal and segmental glomerulosclerosis and hypertension.

[Locally and regionally limited breast cancer from the pathologist's view point]. / Das lokal und regional begrenzte Mammakarzinom aus der Sicht des Pathologen.

The role of the pathologist in breast cancer is discussed from the practical viewpoint. For primary diagnosis surgical biopsy is preferred. Of prognostic significance are the size of the tumor and the number of regional lymph nodes affected. The different histological patterns have little prognostic bearing, with the exception of some rare special types such as medullary or mucinous carcinomas. Histological and/or cytological "grading" is too time-consuming for practical purposes. The pathologist is confronted with new problems by non-palpable "minimal breast cancer" detected by mass screening methods. The solution to these problems requires close interdisiplinary cooperation. In In the broad field of cystic diseases of the breast there is a need for a better histological definition of what constitutes a true premalignant lesion. Finally, the problems of multicentric and bilateral breast cancers are mentioned.

[The significance of the clinical autopsy from the viewpoint of the pathologist]. / Die Bedeutung der klinischen Autopsie aus der Sicht des Pathologen.

Selected examples are cited to show that, even today, autopsy can provide the clinician with essential information. The most important task of clinical autopsy is analysis of the individual case and correlation between clinical and autopsy findings. The discrepancies that may arise here are illustrated by cases of endocarditis. Spontaneous or therapeutic alterations of disease forms can only be established by autopsy, as is exemplified by indigenous systemic mycoses. The part autopsy can play in the analysis of new disease entities is illustrated in the case of analgesic nephropathy. From this it emerges that autopsy serves not only to establich terminal states but also the early stages. The example of malignant tumors which eluded clinical diagnosis is cited to demonstrate the value of autopsy statistics. In conclusion, an appeal is made for more intensive cooperation between clinician and pathologist and wider use of modern methods in the evaluation of autopsies.