Epithelial misplacement after biopsy of colorectal adenomas.

The question has been raised as to whether the removal of biopsy material from colorectal adenomas can lead to misplacement of tumour fragments into the deeper layers of the bowel wall. We carried out an analysis of histological sections obtained from 21 patients in whom, between 2 and 21 days before removal of their adenoma, forceps biopsy (n = 18), or polypectomy (n = 3) had been performed. The initial histological picture a few days after biopsy is of an ulcer covered by a suppurative exudate and abundant mucus-containing small, free-lying groups of tumour cells. After an average of 7 days, we found misplacement of these groups of cells into the submucosa where, during the course of reparative processes, they became embedded within a capillary-rich granulation tissue. Subsequently, fibrosis of the submucosa develops with persistent mucus pools. Our results thus show that removal of biopsy material from adenomas can result in misplacement of tumour particles into the submucosa. These changes were observed in flat or broad-based tumours, and epithelial misplacement appears to be detectable within only a short period after biopsy. For the differential diagnosis, it is important to distinguish these changes from invasive carcinoma.

[Elastolysis of the eyelids. A rare cause of ptosis]. / Elastolyse der Lider. Seltene Ursache einer Ptosis.

BACKGROUND: Mid-dermal elastolysis is a rare disorder of elastic tissue which is characterized clinically by wrinkling of the skin and histologically by the selective absence of elastic fibers in the mid dermis. Two patients with severe ptosis and a loss of the lateral tarsal suspension are reported. PATIENTS AND METHODS: A 36-year-old male patient presented with bilateral ptosis, skin atrophy of the eyelids and a loss of lateral tarsal suspension. With normal clinical and routine laboratory investigations, punch biopsy revealed clear signs of mid-dermal elastolysis. Plastic surgery of both eyelids (levator advancement) was performed with good success after a 1-year interval without progression of ptosis. Another 37 year old patient suffered from mild ptosis, skin atrophy of the eyelids and a loss of lateral tarsal suspension. As the patient chose not to have surgical treatment, he was treated with oral corticosteroids. To differentiate between an acute and a chronic type of elastolysis a punch biopsy is required. In addition, we want to highlight the surgical option in chronic and non-progressive cases. CONCLUSIONS: In contrast to formerly reported localized forms of acute acquired cutis laxa with complete loss of elastic fibres in the reticular and papillary dermis, we report a chronic type of elastolysis in these patients. In our experience in cases without any apparent progression of symptoms a surgical repair can provide long-term success.

[Inverted urothelial papilloma (author's transl)]. / Das invertierte Papillom des Urothels

Casuistic report dealing with the observation of an inverted papilloma arising from the pars prostatica urethrae. By means of the literature, clinical and pathologic problems of this scarcely known neoplasm, which was not delimitated in the German literature before 1963, are discussed.

[Sentinel lymph node biopsy in breast cancer patients--results and experience after 500 sentinel lymph node biopsies]. / Die Sentinellymphknotenbiopsie beim Mammakarzinom. Ergebnisse und Erfahrungen nach 500 Sentinellymphknotenbiopsien.

INTRODUCTION: Sentinel lymph node biopsy (SLNB) is a widely used technique for axillary staging in breast cancer patients. The principle to evaluate the axillary status of a breast cancer patient with a less invasive surgery than axillary lymph node dissection (ALND) meets the new minimally invasive concept in breast cancer surgery. Some breast cancer centers proceed to SLNB without ALND in SLN-negative patients. PATIENTS AND METHODS: Between March 1998 and March 2002, 500 SLNBs were performed. After a learning period with SLNB and ALND in 75 patients with a sensitivity of 96.2% and a false-negative rate of 3.8%, SLNB alone without further ALND was performed in a group of patients. In addition, the feasibility of SLNBin patients with locally advanced breast cancer, in patients after neoadjuvant chemotherapy and in patients with multicentricity was evaluated. The combined method with blue dye and technetium-99m-labeled human albumin for identification of SLNs was applied. RESULTS: 500 SLNBs were performed. The identification rate was 86.2%. After exclusion of patients with neoadjuvant chemotherapy and patients with multicentricity, the identification rate was 94.5%. SLNs were positive in 41.3% of patients and negative in 58.7% of patients. DISCUSSION: SLNB is an excellent method for axillary stag-ing and an alternative for ALND in a certain group of breast cancer patients.

[Sudden death following foreign body entrapment in the esophagus]. / Plötzlicher Tod durch Fremdkörpereinspiessung im Oesophagus

Case report about a 53 year old man, suffering from sudden suffocation, caused by inflammatory laryngeal edema following a foreign body traping in the esophagus with consecutive abscess and phlegmona of the esophageal wall.

[Morphology of the liver in anthracosilicosis (author's transl)]. / Die Morphologie der Leber bei der Anthrakosilikose.

Histological sections of the liver taken at the autopsy of 26 patients with anthracosilicosis of different degrees of severity were investigated retrospectively. Single macrophages containing dust were found in the portal fields, as well as dust storing Kupfer cells proliferating centroacinarity. Granuloma of the walls of central and sublobular veins could be observed, containing infiltrates of lymphocytes and plasma cells, proliferating fibroblasts including histiocytes, and fibrosis and hyalinisation in later stages. It may be assumed, that dust pigments are being transported by blood and taken up by Kupler cells in the first line, to be transmitted directly to the central vein and to a lesser degree by way of lymph drainage into the portal mesenchyma in a later stage. These morphological changes of the liver apparently did not cause any clinical symptoms; they could be found in a high percentage of all patients, which did not have cirrhosis of the liver, and they could be found in all degrees of severity of anthracosilicosis. Thus liver biopsy will yield valuable diagnostic results in this granulomatous disease of the liver as well.

[Lipoma and pseudolipoma of the liver (author's transl)]. / Lipom und Pseudolipom der Leber.

Tumors and tumorlike lesions of fatty tissue arise only rarely in the liver. Those solitary nodules usually do not extend 2 cm in size and therefore remain clinically asymptomatic. Their gross appearance demands differential diagnosis from other tumorous or granulomatous lesions by means of biopsy and histological examination. Two characteristic cases with review of the literature are presented.

[Diagnosis of (intra)-cystic breast cancer]. / Zur Diagnose des (intra)-zystischen Mammakarzinoms.

Besides the known intracystic carcinoma of the breast there are also other cystic tumour types such as, for example, the cystically necrotized carcinoma of the mamma. Preoperative diagnosis of these tumours is effected via pneumocystography and aspiration cytology if mammography alone does not yet permit a definitive assessment of the tumour status. If sonography is used as the only additional examination, diagnostic errors are likely to happen. The well-known recommendation according to which sonographically identified ("simple") cysts can be left as they are, deserves further discussion under this aspect. The problems associated with histological classification and preoperative diagnosis are discussed taking five cystic carcinomas of the breast as basis.

Morphology and incidence of testicular tumors in western Austria (1945-1980).

During the years 1945-1980 260 testicular tumors were registered in the two western provinces of Austria ( Tyrol and Vorarlberg ). The histological slices of these tumors were revised and classified according to the revised "British Classification" ( Pugh 1976). 91.9% of investigated testicular tumors were of germinal cell origin: 43.8% of them were seminomas and 38.1% teratomas. Combined tumors first appeared regularly when the surgical material was completely processed. The right side was more common affected than the left, in the ratio 7:5. The age of orchidectomy showed the typical peaks for seminomas, teratomas and combined tumors. 60% of germinal cell tumors were operated in stage pT3 (UICC). The average incidence of all testicular tumors in the years 1945-1980 was 1.9/100,000 males, but in the last decennium (1971-1980) the average incidence was 4.0, with a maximum of 6.9 in 1978. Districts with a high percentage of employed in agriculture and forestry showed lower incidences than industrialized areas.

[Tubular differentiated stomach carcinoma of the (Ming) infiltrating type]. / Tubulär differenziertes Magenkarzinom vom infiltrativen Typ (nach Ming).

Gastric carcinoma of the infiltrative type (according to Ming) occasionally shows adenomatous differentiation only. Over the past 18 years, we have observed 23 cases of this tumour type, accounting for 3.6% of all surgically treated gastric carcinomas. Macroscopically they were classified as Borrmann IV or III, while histologically most of them were well differentiated. Histologically, these tumours retained the pre-existing structures of the stomach, most readily observable at the tunica muscularis propria; a pronounced desmoplasia was also characteristic, particularly in the submucosal and subserosal layers. In all cases the tumour tissue spread inside lymphatic vessels. All but 2 cases with metastatically involved lymph nodes, often small, showed infiltration of the lymph node sinus; in three quarters of cases the serosa was infiltrated by the tumour. Significant findings among the patients under observation for extended periods included bilateral ovarian metastases in 4 of 5 women examined and tumour recurrence at the anastomosis in 6 of 9 patients in whom Billroth II operation had been performed. The mean survival time of 16 patients was 14.9 months. Owing to the diffuse type of tumour growth, extensive surgery is recommended as in cases of signet ring cell cancer. The high incidence of small lymph node metastases from this type of tumour should also be taken in account preoperative staging. Preoperative diagnosis of this tumour subtype is difficult, because histological criteria alone do not allow clear identification. Close cooperation with clinical investigators is necessary, and intraoperative assessment of the tumour--including frozen section of necessary--in particular is of the utmost importance.