[Mesothelial proliferation of the tunica vaginalis testis]. / Mesotheliale Proliferate der Tunica vaginalis testis.

Proliferative changes seen in reactive mesothelial hyperplasia of a hydrocele sac may mimic malignant mesothelioma. There is no immunohistochemical staining that reliably separates benign from malignant mesothelial proliferations. However, the combined analysis of BAP1 by immunohistochemistry and CDKN2A by FISH has been reported to yield both a high specificity and sensitivity in this differential diagnosis. In addition, the evaluation of risk factors such as asbestos exposure or prior traumata may be helpful for the correct diagnosis. Exclusion of stromal invasion, which is diagnostic for malign mesothelioma, is of utmost importance. Therefore, extended histological workup is essential.

[Thoracic lymphatic system-principles, characteristics and advice for the practice]. / Das thorakale Lymphsystem ­ Grundlagen, Besonderheiten und Hinweise für die Praxis.

The lymphatic system of the lungs is complex. To maintain an effective gas exchange there is a need for a dense lymphatic network. The alveolae have no lymphatic vessels. There is no segment-specific lymph drainage. For both lungs there are fixed bronchopulmonary lymph nodes but the number and size of the lymph nodes are variable. There are seven mediastinal lymph node chains that vary in extent, each of which acts as an independent functional unit. The accurate assessment of the nodal status needs a simple reproducible nodal map. The division into compartments or zones makes this easier. Mediastinal lymph node metastases without involvement of bronchopulmonary lymph nodes are possible. The development mechanism of this skip metastasizing is multifactorial.

[GIP-like findings with a special spectrum of causes]. / GIP-ähnliche Befunde mit besonderem Ursachenspektrum.

Giant cell interstitial pneumonia (GIP)-like pulmonary alterations as a special form of condensate pneumopathy may result following inhalation of certain types of tobacco smoke which can cause a pitfall diagnosis of sideropneumoconiosis or hard metal lung disease. Exact information regarding the patient occupation and smoking history and especially regarding the origin of the cigarettes helps to clarify the findings.

[Morphological diagnostics of malignant pleural mesothelioma]. / Morphologische Diagnostik maligner Pleuramesotheliome.

The World Health Organization (WHO) classification differentiates between pleural tumors of mesothelial and mesenchymal origin as well as lymphoproliferative disorders, with malignant mesotheliomas forming the most common pleural primary tumor. Histologically, epithelioid (40-60 %), sarcomatoid (20-40 %), and biphasic mesotheliomas (20-40 %) are distinguished. The certain morphological diagnosis of a malignant pleural mesothelioma requires the establishment of mesothelial differentiation by means of an appropriate panel of antibodies to exclude pleural dissemination of a pulmonary or extrapulmonary epithelial malignancy and also requires the establishment of at least focal invasive growth to distinguish from reactive mesothelial proliferation. The exclusion of a malignant pleural mesothelioma may induce further differential diagnostic considerations, e. g. concerning the assignment to a certain primary tumor after the establishment of carcinomatous pleuritis.

[Atypical tumor regression]. / Atypische Tumorregression.

A 67-year-old man presented with a poorly differentiated squamous cell carcinoma of the esophagus diagnosed by biopsy. After neoadjuvant radiochemotherapy the gastroesophagectomy specimen showed diffuse polymorphic and anuclear cell residues ranging from 35 µm to 46 µm in size. Immunohistochemically, PanCK and AE1-3 revealed a positive staining while CD68 and MIB1 showed a negative staining. The retrospective anamnesis revealed that the patient had chronic polyarthritis as underlying illness, for which reason he had been taking humira and methotrexate, a cytostatic drug, for many years. Therefore, the development of the tumor might have been enhanced by these drugs. Electron microscopic analysis confirmed that the avital akaryote cell residues represented a special type of tumor regression. Complete tumor regression level IV without vital rest tumor tissue based on Baldus et al. was diagnosed.

Fatal human metapneumovirus infection following allogeneic hematopoietic stem cell transplantation.

Respiratory viruses are an important yet underestimated cause of infectious morbidity and mortality in immunocompromised children and adolescents. Here, we report the occurrence of fatal lower respiratory tract disease associated with human metapneumovirus (HMPV) infection in a 10-year-old girl with chronic graft-versus-host disease following allogeneic hematopoietic stem cell transplantation (HSCT) for secondary chronic myeloid leukemia. Symptoms occurred 8 months after HSCT while on immunosuppression with 0.2 mg/kg/day of prednisone, and presented as dry cough, bilateral pneumonitis, and progressive respiratory distress. Non-invasive and invasive microbiological investigations revealed HMPV type B as the sole pathogen. Histopathological findings showed interstitial and intra-alveolar pneumonitis with profound alveolar cell damage. The patient was treated with intravenous and oral ribavirin and polyvalent immunoglobulins, but ultimately died from respiratory failure. The case reflects the potentially fatal impact of infections by respiratory viruses in immunocompromised patients and the need for effective approaches to their prevention and treatment.

[Glandular papilloma of the right main bronchus. Detection of an exon 2 mutation of the KRAS gene (c.35G>A)]. / Glanduläres Papillom des rechten Hauptbronchus. Nachweis einer Exon-2-Mutation des KRAS-Gens (c.35G>A).

Benign epithelial tumors of the tracheobronchial system and the lungs are exceedingly rare. These entities encompass squamous and glandular papillomas (as well as their mixed forms) and adenomas (alveolar adenoma, papillary adenoma, salivary gland-like pleomorphic and mucinous adenomas and mucinous cystadenomas). These tumors are considered to be biologically benign neoplasms; however, they can pose considerable diagnostic difficulties, especially during frozen section evaluation, as they can mimic malignant tumors and in particular they can resemble well differentiated papillary adenocarcinomas. As a result of the extreme rarity of these tumors only a few descriptive diagnostic series exist and a systematic investigation including molecular data does not exist. This article presents the case of a 64-year-old patient with a glandular papilloma of the right main bronchus including the immunohistochemical and molecular work-up as well as a review of the current literature.

[Pleuritis in yellow nail syndrome]. / Pleurabefunde beim Yellow-Nail-Syndrom.

A 76-year-old man presented clinically with coughing and shortness of breath and was diagnosed radiologically to have massive pleural effusion as a combined feature of yellow nail syndrome. A lung biopsy was taken and revealed histologically: chronic non-specific inflammation in the pleuropulmonary border, intrapleural edema with eightfold pleural thickening in comparison to normal, angiogenesis in both the nutritive and functional intrapleural blood vessels, no abnormalities of lymphatic vessels with normal topographical distribution as detected by immunohistochemistry for antibody D2-40, granulomatous chronic foreign body reaction as a consequence of pleural effusion therapy by talcum pleurodesis.The histopathological findings of chronic non-specific pleuritis with angiogenesis and increased permeability of blood vessels led to massive intrapleural edema with pleural effusion. Abnormalities of lymphatic vessels could not be confirmed. Considering the features of this disease, they are probably secondary to chronic r infectious or immunological inflammation or paraneoplastic complications with angiogenesis (in about 19%).

[Histopathological evaluation of the meniscus]. / Histopathologische Begutachtung des Meniskus.

Menisci fulfill many functions within the complex biomechanics of the knee joint. In the case of meniscus lesions, sparing arthroscopic resection and surgical refixation are the treatments of choice. In terms of diagnosis, this means in general that histopathologic diagnostics are carried out on detached meniscus fragments of between 5 mm and 2 cm in size. A good knowledge of physiologically possible cellular and fibrous histological meniscus damage, as opposed to nonphysiological change regarded as normal with respect to age, is essential for diagnostic meniscus evaluation. The clinician expects clear statements from the pathologist regarding the severity of previous or secondary degenerative meniscus damage, the age and type of traumatic tears, and an appraisal of the relationship between trauma and meniscus damage from an insurance point of view. Close cooperation between the clinician and the pathologist allows for a fast and unambiguous correlation of anamnesis, the clinical picture, and morphological reporting such that problematic insurance cases can be clarified quickly.

[Lung transplantation and rejection. Basic principles, clinical aspects and histomorphology]. / Lungentransplantation und Abstoßung. Grundlagen, klinische Aspekte und Histomorphologie.

Lung transplantation is the ultimate therapeutical approach for the treatment of both children and adults with terminal congenital or acquired lung disease. In contrast to survival rates during the first year following transplantation, the long-term survival for patients after lung transplantation has not significantly improved in the past. In addition to other complications, acute cellular rejection constitutes a major cause for diminished function of pulmonary grafts, and can, among other factors, be causative for chronic rejection (bronchiolitis obliterans syndrome, BOS). In 2006, the International Society for Heart and Lung Transplantation (ISHLT) provided a revised version of the grading system for acute and chronic rejection of pulmonary grafts.

Neuropsychiatric symptoms and brain structural alterations in Fabry disease.

BACKGROUND: Neuropsychiatric symptoms (NPS), mainly cognitive deficits up to dementia and depressive syndromes have been described repeatedly in Fabry disease (FD). However, examinations regarding the pattern, extent, and frequency of the NPS in FD are still lacking. Moreover, the relationship between NPS and brain structural alterations in FD is unknown. The aim of this study was 1) to characterize NPS in a relatively large cohort of adult subjects with FD, and 2) to explore the association of cognitive performance and depressive syndromes with the FD-typical brain structural findings. METHODS: Twenty-five Fabry patients (age 36.5 ± 11.0) with mild to moderate disease involvement and 20 age, gender-, and education-matched healthy controls were extensively studied by neuropsychiatric assessment, structural magnetic resonance imaging, magnetic resonance angiography, and diffusion-tensor imaging. RESULTS: Patients with FD showed deficits only in the attention domain. Clinically relevant depressive syndromes were noted in 60% of the patients. The subgroup of patients with markedly elevated volumes of white matter lesions (not associated with actual stroke; n=7) showed slightly more learning and memory deficits, but no higher depression rate compared to less affected patients. CONCLUSIONS: Against the prevailing assumption, Fabry patients, even those with marked brain structural alterations, showed only mild cognitive deficits. The high frequency of depression in FD is likely to be related to the burden of this chronic multiorganic hereditary disease, but not to the FD-typical brain structural alterations. Longitudinal studies are necessary to clear, if the mild cognitive deficits in FD might precede clinically relevant cognitive decline.

[Histopathological meniscus diagnostic]. / Histopathologische Meniskusdiagnostik.

Menisci fulfill many functions within the complex biomechanics of the knee joint. In the case of meniscus lesions, sparing arthroscopic resections and operative refixation are the treatments of choice. With regard to diagnostics, this means that in general terms, the histopathologic diagnostics are carried out on detached meniscus fragments of between 5 mm and 2 cm in size. An experienced pathologist's knowledge of physiologically possible cellular and fibrous histological meniscus damage, as opposed to nonphysiological change regarded as normal with respect to age, is essential during a diagnostic meniscus evaluation. The clinician expects clear statements from the pathologist regarding the severity of previous or secondary degenerative meniscus damage, the age and type of traumatic tears, and appraisal of the relationship between trauma and meniscus damage from an insurance point of view. Close cooperation between the clinician and the pathologist allows for fast and unambiguous correlation of anamnesis, the clinical picture, and morphological reporting so that cases involving insurance problems - which are numerous, often long-term, and often unsatisfactory - can be clarified quickly.

[Postnatally acquired pulmonary cyst: differential diagnosis of pediatric cystic pulmonary lesions]. / Postnatal erworbene Lungenzyste. Differenzialdiagnosen zystischer Lungenläsionen im Kindesalter.

BACKGROUND: Differential diagnosis of infantile pulmonary cysts comprises congenital cystic lesions (including foregut cysts) and pneumatoceles (i.e., pulmonary cysts of acquired, inflammatory or traumatic origin). CASE: We report the resection of a subpleural air-filled lung cyst of 4 cm in a former preterm (33rd week of pregnancy) at the age of 8 months that was first diagnosed 7 days postnatally by chest X-ray. Pneumatocele was diagnosed pathomorphologically. CONCLUSION: In children, most pneumatoceles are caused by trauma or pneumonia. In the case described, disruption of subpleural alveolar walls due to high pressure ventilation is the likely cause. Differential diagnoses are discussed.

[Extraskeletal mesenchymal chondrosarcoma: rare differential diagnosis of pleural calcifications]. / Das extraskelettale mesenchymale Chondrosarkom: Seltene Differenzialdiagnose pleuraler Verkalkungen.

We report on a 78-year-old male patient with unilateral pleural effusion who underwent multiple diagnostic tests including thoracoscopy without establishing a final diagnosis. In the course of time, the patient developed multiple pleural tumors with calcifications. A CT-guided transthoracic biopsy was performed; the specimen revealed histopathological and immunohistochemical evidence for an extraosseous mesenchymal chondrosarcoma. Besides a short review of the literature, the case is discussed as an extremely rare differential diagnosis of pleural calcifications. To the best of our knowledge, this is the first patient in whom the diagnosis of an extraosseous chondrosarcoma, most likely of the pleura, could be established by CT-guided transthoracic biopsy.

[Sarcoidosis as a mimicry of haemangiotic carcinomatosis]. / Sarkoidose als Mimikri einer Hämangiosis carcinomatosa.

The radiologic work-up of a 67-year-old female patient for dyspnea revealed micronodular infiltrates in both lungs, which in combination with enlarged mediastinal and abdominal lymph-nodes were highly suspicious of sarcoidosis stage II. A bronchoscopic examination including transbronchial biopsy in another hospital was not diagnostic, so the patient was referred to us for surgical lung biopsy. A specimen from the right middle lobe showed massive haemangiotic carcinomatosis of a clear-cell carcinoma. The pathologist--without knowing the history of the patient--discussed a renal-cell carcinoma as potential primary malignancy, which could easily be confirmed as the patient had a tumor-nephrectomy two years ago.

[Diverticulum of the ductus arteriosus. Cause of traumatic aortic ruptures?]. / Ductus-arteriosus-Divertikel. Ursache traumatischer Aortenrupturen?

INTRODUCTION: According to angiographic studies 9-26% of all adult aortae show a ductus arteriosus diverticulum (DAD), i.e. an indention of the aortic wall at the insertion of the obliterated ductus arteriosus. This region is predisposed for traumatic aortic rupture. Up to now fixation at the transition from aorta transversa to fixed aorta descendens is regarded as cause. It is unclear whether ductus diverticulum favours traumatic aortic rupture. MATERIAL AND METHODS: A total of 143 thoracic aortas (female symbol:37; male symbol:106, 17-91 years) were scanned histomorphologically for DAD. Calcification was quantified by CT multislice volume scan. RESULTS: A DAD was detected in 44% of macroscopically non-calcified and slightly calcified aortic specimens. Histologically, autochthonal elastic and collagenous fibres of the media were disrupted. CT in macroscopically non-calcified aortas proved isolated calcification in 78%. DISCUSSION: The incidence of 44% DAD-higher than in angiographic studies-can be explained by the method (histopathology), allowing diagnosis of diverticula down to microm. These morphological alterations are to be seen, at least in part, as a causative factor for the predilection to traumatic aortic ruptures.