[Bilateral large conjunctival tumours as primary manifestation of sarcoidosis--successful treatment with steroid-depot-injections]. / Beidseitige ausgeprägte konjunktivale Tumoren als Primärmanifestation einer Sarkoidose -- erfolgreiche Therapie mit Steroid-Depot-Injektionen.

INTRODUCTION: Ocular manifestations of sarcoidosis vary enormously. They include the conjunctiva, lacrimal gland, orbita, intraocular structures and eye-lid, either isolated or combined. We describe a female patient who presented with unusually large, bilateral conjunctival tumours as a primary manifestation of sarcoidosis. PATIENT: A 79-year-old white woman was referred to us for further management of a persisting "conjunctivitis", which had been refractory to treatment with multiple medications. Initial examination disclosed swollen eye-lids and bilateral large hard tumours of the inferior fornix. The obtained brush smear, which was cytopathologically evaluated, revealed epitheloid cells and multinucleate giant cells. After 4 weeks she developed three reddish-brown maculopapular lesions on her face. The subsequent biopsy from the left inferior fornix and the skin showed histopathologically a granulomatous epitheloid cell inflammation without central necrosis and without acid-proof bacilli. Therefore a sarcoidosis was included into the differential diagnosis. The systemic evaluation revealed no other manifestation. At first we tried to reduce the chronically inflammatory tumours with different immunomodulating local treatment forms. Only the repeated intralesional injection of a steroid depot showed a complete disappearance of all conjunctival and skin tumours. CONCLUSION: An isolated bilateral primary manifestation of sarcoidosis with large massive conjunctival tumours is very rare and clinically not typical. The non-invasive, cytopathological examination by means of brush smears offers a new perspective in the fast diagnosis of conjunctival manifestation of sarcoidosis. The tumours respond excellently to the intralesional injection of steroid depots.

[Percutaneous CT-controlled cutting-needle biopsy of diffuse interstitial and alveolar lung diseases--the technic and results]. / Perkutane CT-kontrollierte Schneidbiopsie diffuser interstitieller und alveolärer Lungenerkrankungen--Technik und Ergebnisse.

Twenty-three patients underwent CT-guided large-bore biopsy of diffuse lung disease of clinically and radiologically indeterminate etiology. The procedure was preceded by negative transbronchial biopsy in 20 cases. CT-guided biopsies were performed with a 14-gauge Trucut-needle. Obtaining at least 3 specimens of different parts of the diseased area, a correct histologic diagnosis was achieved in all cases. The size of the histologic specimens (mean: 5-6 mm) exceeded that of the specimens obtained by transbronchial biopsy as reported in the literature. Two major complications occurred and included a rapidly developing tension pneumothorax treated by a small-bore catheter and one self-limited hemoptysis. Major advantages of percutaneous CT-guided biopsy are the nonsuperimposed and very sensitive imaging of lung alterations in diffuse lung diseases that allows evidence of adjacent less and more involved areas accessible by one biopsy approach. CT-guided large-bore biopsy with a cutting needle seems to be a very promising, accurate method in the pathomorphologic work-up of diffuse lung diseases rendering open biopsy unnecessary in many cases.

[CT-guided Tru Cut biopsy of solid pelvic space-occupying lesions. The indications, technic and results]. / CT-gesteuerte Tru-Cut-Biopsie soldier pelviner Raumforderungen. Indikationen, Technik und Ergebnisse.

Solid lesions in different localisations of the pelvis were biopsied with a large-bore Tru-Cut cannula (G 14) in 88 patients under computed tomographic guidance. Special techniques for safe access to pelvic lesions are described. Indications for biopsy were suspected extraluminal tumour recurrence (n = 49), masses outside the pelvic organs in the absence of a known pelvic primary (n = 21) and in the presence of a known pelvic primary (n = 10). In 8 cases, lesions situated within pelvic organs were punctured. Without any repeat biopsy, accuracy reached 96.6%, sensitivity was 95.2% and specificity was 100%. In comparison to the results of FNA reported in the literature diagnostic accuracy can be improved upon by using large-bore biopsy. No complications occurred.

Histological effects of local microwave hyperthermia in prostatic cancer.

Recent investigations have shown that hyperthermia can reduce the volume of the prostate and improve local symptoms in patients with carcinoma of the prostate. Histological examinations of the effect of hyperthermia on prostatic cancer tissue, however, have not been performed systematically until now. Thus, we initiated a study to investigate the effects of heat on prostatic cancer as a prerequisite for further clinical trials on hyperthermia as treatment for prostatic cancer. Twenty patients with untreated prostatic cancer underwent local hyperthermia (915 MHz), each receiving four sessions of 60 min each. The intraprostatic temperature was 42-43 degrees C. Histological specimens of the prostate were taken before the treatment and 1-2 weeks after the last hyperthermia session. Hyperthermia produced hyperaemic alterations of the prostatic stroma and a diffuse oedema with interstitial lymphoplasmacellular infiltration. Definite signs of tumour cell necrosis, however, could not be seen in any of the patients. Hence the shrinkage of prostatic tumours described earlier cannot be explained by histologically proven tumour cell destruction. Thus hyperthermia is not adequate as a single treatment for prostatic cancer. Hyperthermia may, however, be useful as part of integrated therapy regimens together with cytostatic or hormonal agents and radiotherapy because of hyperaemic, chemo- and radiosensitizing effects.