Foveolar gastric metaplasia of the duodenum: a frequent, so far neglected type of duodenal polyp.

Foveolar gastric metaplasia of the duodenum (FGM) is considered as imperfect mucosal healing in the context of H. pylori gastritis and intake of NSAIDs or ASS.  Typical endoscopic findings are redness of the mucosa, erosion/ulcer and loss of mucosal folds. During diagnostic histological examinations we observed a frequent so far not described association of FGM with endoscopically observed duodenal polyps. The archives of two institutes of pathology with high gastroenterological workload (approximately 100 000 patients per year) were investigated for an association between "duodenal polyp" and "foveolar gastric metaplasia". In Institute 1, of 481 duodenal polyps 41 % were classified as FGM, 9 % as adenoma and 2 % as heterotopic gastric mucosa. In 48 % no histological correlate was present. In Institute 2, 217 cases of FGM were diagnosed. Of these, in 69 cases the endoscopic finding was "polyp" (32 %). In the other cases, the endoscopic findings were mucosal defect (18 %), redness/inflammation (16 %), suspicion for gastric heterotopia (5 %) and scar (3 %). In 26 % of cases no pathologic endoscopic finding was reported. Both groups of patients with FGM showed a similar distribution of age ranges (24 - 83 years and 16 - 88 years), median age (62 years and 61 years, respectively) and a dominance of male sex (both 1.5:1). In conclusion, foveolar gastric metaplasia is a frequent, so far neglected correlate of endoscopically detected duodenal polyps.

[Serrated polyps of the duodenum. Three cases with immunohistological and molecular pathological findings]. / Serratierte Polypen des Duodenums. Drei Fälle mit immunhistologischen und molekularpathologischen Befunden.

We report on three cases of serrated polyps of the duodenum which were incidental endoscopic findings in three male patients with a median age of 70 years (range 63-84 years). Architecturally the histological findings in cases 1 and 2 were similar to hyperplastic polyps of the colon. In case 3 there was a low grade intraepithelial neoplasia which covered the whole polyp. This polyp relapsed after 2 years with similar histological findings. Immunohistochemically an increased proliferative activity was found in case 3 as well as associated overexpression of p16 (INK4a) and p53. No abnormal expression of MLH1 and ß-catenin was found in any of the polyps. Molecular pathological analysis showed a BRAF mutation (V600E) in case 3. A wild type sequence in the KRAS gene was found in all polyps. In conclusion, serrated polyps should be included in the diagnostic spectrum of benign duodenal polyps.

[Quality of hygiene in endoscope reprocessing--the fundamentals of indicator-assisted quality management in gastroenterology]. / Qualität der Hygiene bei der Endoskop-Aufbereitung--die Grundlage eines indikatorengestützten Qualitätsmanagements in der Gastroenterologie.

High level disinfection and infection control in reprocessing gastrointestinal endoscopes is a critical security factor for patients in gastrointestinal health care. National and international guidelines for an adequate high quality disinfection of gastrointestinal endoscopes have been developed aiming to obtain infection control. The German Medical Association has recently published recommendations on quality assurance in gastrointestinal endoscopy including standardised procedures for disinfection and infection control. A prospective study was carried out in a large urban area in both private practices and hospitals to identify and characterise flaws and limitations in disinfection of gastrointestinal endoscopes by measuring a set of indicators of the quality of structures, processes and outcomes. Moreover, the influence of information and continuous medical education on the quality of disinfection and infection control were to be evaluated. The bacterial contamination of endoscopes after reprocessing was measured as a relevant outcome quality indicator. The results revealed substantial flaws in cleaning and disinfection procedures in gastrointestinal endoscopy under routine clinical conditions. Overall, 49 and 39 percent of all (pre- and post-interventionally, resp.) checked endoscopes were contaminated by one or more bacteria. More often failures were discovered in the optic rinse system than in the cleaning/disinfection and the final rinse and drying process. A substantial failure rate was detected in gastrointestinal endoscope reprocessing under routine conditions according to the reprocessing procedure. Compared to manual and semi-automatic cleaning and disinfection, the full automatic cleaning and disinfection machines (RDG-E) showed the best results. Though their cleaning process remains improveable, it seems advisable to prefer RDG-E-machines for disinfection and infection control in gastrointestinal endoscopy. Continuous quality control of disinfection should be obtained by introducing regular microbiological examinations of the reprocessed endoscopes. Negative microbiological controls of the contamination of endoscopes are suitable quality indicators of a quality management system aiming to improve the quality of structures, processes and outcomes in gastroenterological health care.

[Histopathological diagnosis of Barrett's mucosa and associated neoplasias. Results of a consensus conference of the Working Group for "Gastroenterological Pathology of the German Society for Pathology" on 22 September 2001]. / Histopathologische Diagnostik der Barrett-Schleimhaut und ihrer Neoplasien. Ergebnisse einer Konsensus-Konferenz der Arbeitsgemeinschaft "Gastroenterologische Pathologie der Deutschen Gesellschaft für Pathologie" am 22. September 2001 in Erlangen.

There are a number of difficulties regarding the diagnosis of Barrett's mucosa and the varying grades of neoplasia that may be associated with it. It was therefore the aim of a consensus conference of the "Working Group for Gastroenterological Pathology within the German Society of Pathology" to achieve standardization regarding the following issues: definition and diagnostic criteria for Barrett's mucosa and its discrimination from intestinal metaplasia of the cardia, diagnostic criteria for intraepithelial neoplasia, number of biopsies necessary to establish the diagnosis, significance of additional immunohistochemical and/or molecular biological methods as well as importance of a second opinion in the diagnosis of intraepithelial neoplasia.

[Diagnosis of pulmonary diseases with transthoracic ultrasound]. / Diagnostik pulmonaler Erkrankungen mit transthorakaler Sonographie.

The indications or ultrasound in the evaluation of pulmonary disorders are described. Clinical applications are several lung diseases in adults and especially in children. In specific, well-defined applications, the feasibilities of ultrasound are promising. Sonography provides important additional information to chest X-ray and is even superior to CT under special circumstances. Pulmonary sonography is a useful link between conventional X-ray and more expensive cross-sectional imaging. In the evaluation of pulmonary diseases at present the potential of ultrasound is not optimally used.

Endometrioid adenoma (polypoid endometriosis) of the omentum maius.

Endometrioid adenoma (polypoid endometriosis) of the omentum maius in an 89-year old female is reported. The tumor measured 1 cm in diameter and consisted of resting or weakly proliferating, partially macrocystic endometrial glands, encapsulated by delicate fibrous connective tissue. Immunohistochemically, glandular and stromal cells expressed estrogen receptor strongly, progesterone receptor weakly and CA 125 only weakly in a few glands. This is another, but rare example of the capacity of the omentum maius to develop tumors of the Müllerian variety.

[Comparison of computerized tomography and B-image ultrasound in imaging diagnosis of the mediastinum]. / Vergleich von Computertomographie und B-Bild-Sonographie in der bildgebenden Diagnostik des Mediastinums.

40 patients with suspected mediastinal tumors were independently examined with computed tomography (CT) and sonography. The findings were confirmed by bronchoscopy, mediastinoscopy or surgery. In the assessment of the upper and middle mediastinum, sonography reaches a high sensitivity. On the contrary, in the evaluation of the anterior and posterior mediastinum, sonography is clearly inferior to CT. 90% of the tumors demonstrated by CT could be assessed with sonography. The most frequent tumors can be diagnosed with ultrasound. The evaluation of tumors in the paravertebral and retrosternal space is limited. Sonography of the mediastinum is a noninvasive, well-reproducible and cost-effective imaging modality that provides important information in cases of unclear X-ray and CT findings. The preliminary results encourage to a more frequent use of mediastinal sonography.

Differential basement membrane composition in multiple epithelioid haemangioendotheliomas of liver and lung.

We report a case of epithelioid haemangioendothelioma involving both lung and liver. The tumour cells were positive for factor-VIII-related antigen. Immunohistochemical analysis of various basement membrane components in tumour tissue of lung and liver showed striking differences. In the liver tumour there was selective expression of collagen IV, with minimal and focal amounts of laminin and basement membrane-associated heparan sulphate proteoglycan. In the lung tumour nodules, in contrast, all these basement membrane components were present. These patterns of basement membrane expression closely resemble those of normal liver and lung basement membrane respectively. We suggest that this provides evidence that epithelioid haemangioendothelioma arises from local endothelial cell proliferation and that it supports the assumption of a multicentric rather than metastatic origin when multiple tumour deposits are found.

Screening for lung cancer in the middle-aged.

A screening programme for lung diseases has been in operation in the German Democratic Republic for more than 3 decades. The programme is based on biennial chest X-rays (70 x 70 mm posterior-anterior) of the population 40 years of age or over. With respect to lung cancer the results show that, for the population under 60 years of age, the adjusted relative risk of dying from lung cancer among subjects who took part in the last screening round compared with subjects who did not but were screened at least once during the preceding 10-year period was 0.93 (95% confidence interval 0.65-1.33).

Ascomycete mycorrhizas from pot-grown silver-fir seedlings (Abies alba Mill.).

Four types of ascomycete mycorrhizas were found on seedlings of Abies alba grown in pot cultures on mineral soil. One type was formed by Cenococcum graniforme Ferd. & Winge; the fungal partners of the other three types could not be identified. The macroscopic and microscopic characteristics are described. One mycorrhiza appeared to be identical with Type 15 of Haug & Oberwinkler, found in natural spruce stands. Senescent stages of this type are also described. Ultrastructural investigations showed that the dolipore seemed to be the main distinguishing feature between ascomycete and basidiomycete mycorrhizas. Differences in the matrix of the interface and the fungal wall were not stable enough to be used as a distinguishing feature between asco- and basidiomycetes. Dead fungal cells were isolated from the living tissue by plugging of septa with Woronin bodies and walling-over of the plugged septa. Subsequently these isolated dead cells could be colonized by the fungus. The predominant mycorrhization of the fir seedlings by ascomycetes in pot culture with mineral soil is discussed.

Immunocytochemical analysis of Ewing's tumors. Patterns of expression of intermediate filaments and desmosomal proteins indicate cell type heterogeneity and pluripotential differentiation.

Examples of classical Ewing's tumors ("Ewing's sarcomas") of both skeletal and extraskeletal locations were analyzed for the expression of intermediate filament (IF) and cell junction proteins, with the use of immunofluorescence and immunoelectron microscopy as well as gel electrophoresis. In all 11 tumors examined vimentin filaments were abundant. A type of plaque-bearing small cell junction, which is common in these tumors but difficult to classify by morphologic criteria, was identified by antibodies to desmoplakins as true desmosomes. These were found in all cases, although in a very variable proportion of cells. Some of these junctions were associated with vimentin IFs. In addition, 9 of the cases examined showed scattered or clustered cells expressing the simple-epithelium type cytokeratins 8 and 18. Moreover, 3 cases displayed dispersed or clustered cells producing neurofilaments. The value of these observations, notably the cell type heterogeneity, for the diagnosis of tumors of this group is discussed. The results further indicate that Ewing's tumors are derived from a primitive, pluripotential cell that may differentiate, in variable proportions, into cells with mesenchymal, epithelial, and, more rarely, even neural features, suggesting that this tumor should be regarded as a blastoma, rather than as a true sarcoma.

[The cancer register and notification responsibility]. / Krebsregister und Meldepflicht.

Changes of the age-specific and age-standardized incidence of malignant neoplasms in the GDR between 1962 and 1980 are investigated. A series of cancer localisation has increased in which case improved diagnostics and increased risk are discussed as causes (cancer of colon and rectum, of the pancreas, the breast and the testicle). The epidemics of bronchial cancer has apparently reached its climax, the admission rates stagnate. Cancer of the stomach and recently also cancer of the gallbladder and the extrahepatic bile ducts decrease in their frequency.