[Epithelioid hemangioma--a rare tumor of the hand]. / Das epitheloide Hämangiom--ein seltener Tumor der Hand.

Epithelioid hemangioma is a rare disorder in Europe, affecting the skin and subcutaneous tissue in young adults. The presented cases all involve the hand, and, in one case, the intrinsic muscles and periosteum.

[Primary malignant melanoma of the distal urogenital tract. Case report and review of the literature]. / Das primäre maligne Melanom des distalen Urogenitaltraktes. Fallbericht und Literaturübersicht.

The primary manifestation of a malignant melanoma is rarely found in the female urethra and considerably less in urinary bladder. This article is based on a case report of a female patient who had to undergo numerous transurethral resections and died of such an escalating tumor. Malignant melanoma in the form of metastases are relevant to the urologist, because they are discovered frequently in the genitourinary tract. The symptoms and diagnostic procedures correspond to those of other urological carcinomas. Radical surgery is of major importance as therapy.

Primary testicular manifestation of systemic lupus erythematosus.

The case of a patient with a hitherto unknown primary testicular manifestation of systemic lupus erythematosus (SLE) is reported. Findings on scrotal palpation and sonography suggested the presence of a testicular tumor. Histological examination of the testicular biopsy and immune status did not confirm the clinical diagnosis but demonstrated SLE.

[Complications following cell therapy]. / Komplikationen nach Zelltherapie.

So far, the law in the Federal Republic of Germany still allows the injection of fresh-cell preparations from animals as a roborant to increase the vitality of the organism and to strengthen the body's immune defense system. The use of "sicca-cell" preparations was provisionally forbidden in 1987 by the Federal Health Organization (Bundesgesundheitsamt; BGA). Prohibition of fresh-cell injections would have exceeded the authority of this office, although the same serious reservations also applied in the case of this treatment method. Several publications that have appeared since 1955 have reported serious complications of this therapy, some life-threatening and some even lethal. Two further cases are now added: (1) A woman aged 69 had been receiving treatment with cell injections for 9 years. Immediately after an injection of sicca cells she collapsed and was hospitalized; 7 days thereafter she developed an ascending paralysis with increasing inability to swallow or breathe. She died 25 days after the injection as a consequence of central and peripheral respiratory failure. Autopsy revealed the alterations typical for acute Landry-Guillain-Barré-Strohl syndrome. (2) A 76-year-old healthy woman had been receiving treatment with fresh-cell preparations for several years. After an injection of cell suspensions a painful local swelling was observed. The symptoms were interpreted as the consequence of an iatrogenic local hematoma, and repeated punctures were performed to obtain blood. The patient was transferred to a surgical department for further therapy. Two days after the injection she suddenly died with signs of acute cardiovascular failure. Autopsy revealed the signs of a fulminating clostridial infection and also the characteristic signs of Landry-Guillain-Barré syndrome with involvement of the autonomic nervous system. In both cases the development of an inflammatory process in the peripheral nervous system could be interpreted as an immune-mediated allergic disease, related to the repeated injection of heterologous antigenic material containing nervous tissues. This hypothesis would also explain the two other cases already published and would be consistent with the observed perivenous leukoencephalopathy of the central nervous system. The human disease pictures correspond to the well-established animal models of EAEM (experimental allergic encephalomyelitis) and EAN (experimental allergic neuritis). The pathogenesis is discussed; the major role of the central and peripheral nervous system is stressed, with special reference to the risk of acute autonomic failure. The need for specific autopsy techniques for the investigation of the entire nervous system, including spinal cord, roots, spinal ganglia and peripheral nerves with sympathetic chains, is raised.

Epithelioid haemangioma--angiolymphoid hyperplasia with eosinophilia. Case report and review of literature.

Epithelioid haemangioma (angiolymphoid hyperplasia with eosinophilia: ALH) is a rare tumour most often affecting the skin and subcutaneous tissue in young adults. Unusual findings in the present case included deep location oft the lesion with involvement of striated muscle and periosteum which complicated clinical diagnosis. These tumours are generally composed of proliferating small vessels with prominent endothelial cells and heavy inflammatory infiltrate made up of lymphocytes, lymphoid follicles, plasma cells, mast cells, and especially eosinophils. The lesion is benign, and local excision is curative. Clinical manifestation and morphological characteristics of this rare lesion are described in this paper and are compared with other cases reported in the literature.

[2 cases of death following cell therapy]. / Zwei Todesfälle nach Zelltherapie.

Fresh-cell therapy is a paramedical procedure whose claimed therapeutic success has not been proven by customary clinical tests (randomized, double-blind trials). In addition, the qualitatively and quantitatively non-standardized parenteral application of heterologous antigens presents considerable danger for the recipient in the form of fatal immune reactions. Two cases are reported in which history, clinical findings and autopsy provided evidence of a causal relationship between cell therapy and death. In one instance, a 75-year-old woman died 30 days after an intramuscular injection of quick-frozen fresh cells from the effects of an immune-complex vasculitis; in the other, a 60-year-old woman died 14 days after "original fresh-cell treatment after Prof. Niehans" from perivenous leucoencephalitis.

Diagnosis of urothelial tumor by ureterorenoscopy.

In the past, radiologically detected filling defects in the upper urinary tract were correctly interpretable only by means of cytological techniques. The introduction of ureterorenoscopy has provided a reliable method for the detection of tumors in the ureter and renal pelvis. In contrast to transurethral ureterolithotripsy, diagnostic ureterorenoscopy entails few complications. It thus fills a diagnostic gap and facilitates therapeutic planning. A report is presented on 15 patients with obscure hematuria, or unclear filling defects in the upper urinary tract. In 10 patients, the unequivocal diagnosis of urothelial carcinoma was endoscopically and bioptically established by ureterorenoscopy. Small nonradiopaque concrements were found in 3 cases. The origin of hemorrhage could not be determined in 2 patients.

Primary non-Hodgkin's lymphomas of the central nervous system.

Thirty-five primary non-Hodgkin's lymphomas (NHL) of the central nervous system (CNS) were examined in a retrospective study and classified according to the Kiel classification. Diagnosis was made on surgical biopsies in 28 cases and on autopsy specimens in seven cases. The tumors were predominantly located in the frontal lobe and were unifocal in all but two cases. Patients ranged in age from seven to 74 years, with a male-female ratio of 1.3:1. The lymphomas were probably all of B cell type. In contrast to NHLs of the lymph nodes, the NHLs of the CNS we encountered were more often high grade (immunoblastic, lymphoblastic) than low grade malignant. All but one low grade malignant NHL found in our study were lymphoplasmacytoid (LP) immunocytomas.

The immunoperoxidase method for rapid diagnosis of Herpes simplex encephalitis (HSE) using touch preparations.

Ten rats were inoculated intracerebrally with Herpes simplex virus type I to study the possibility of establishing a rapid diagnosis of Herpes simplex encephalitis through examination of touch preparations of brain tissue stained by the immunoperoxidase method. All except one of the animals died within four days of the developing encephalitis. The surviving animal was killed on the fourth day. Touch preparations were shortly fixed in 4% buffered formalin, cold acetone, or alcohol. The indirect immunoperoxidase method was used to identify viral antigen. The authors found that formalin serves as a good fixative and sensitivity as well as specificity is high. The diagnosis could be made within 4 hours. The cellular morphology is retained. The reaction product is stable and background staining no problem. The results of this study imply to use this method also for rapid diagnosis of brain biopsy tissue in human infections.

Insertion tendopathy in athletes. A light microscopic, histochemical and electron microscopic examination.

Tendon tissue of eleven athletes suffering from insertion tendopathy and of two controls was examined. Part of the tissue was prepared for routine light microscopy, a part for enzyme histochemical staining of Nicotinamide-adenine-dinudeotide-diaphorase (NADP-diaphorase), lactate dehydrogenase (LDH), beta-glucuronidase and alkaline phosphatase. Small pieces of tissue were also prepared for electron microscopic examination. The removed tissue was edematous and mushy. The normally densely packed parallel or interwoven collagen bundles were loosened by edema, focal necrosis or hemorrhage. Infiltration of fatty tissue and granulation tissue was also present. The amount of acid mucopolysaccharides was markedly increased. The histochemical studies showed strong enzyme activity of NADP-diaphorase and LDH in normal tendon tissue as well as around areas of degeneration and in granulation tissue. beta-Glucuronidase and alkaline phosphatase was present, but in general with lesser activity than the above enzymes. The electron microscopic examination revealed marked degeneration of the fiber systems, focal necrosis, deposit of amorphous masses and mucopolysaccharides and focal mineralisation. The reparative zones showed proliferating capillaries, often with a collapsed lumen and prominent endothelial cells and basement membranes.

Complications after combination of chemotherapy and radiation for malignant brain tumours.

The combination of chemotherapy and irradiation for the treatment of malignant intracerebral tumours is increasing, and survival times longer than those after monotherapy are reported. The suitability of simultaneous radio-chemotherapy using BCNU-Bleomycin, a regimen in which has been followed 38 patients of this hospital (up to 31 December 1981) is critically discussed. Statistics of 30 patients with treatment ended by 31 December 1980 and case histories of two patients with fatal complications, aspergillosis in the one and necrotizing colitis in the other, are presented. The value of the various agents used for chemotherapy is discussed with respect to the survival rates and observed side effects in all the patients. The use of Bleomycin is questioned.

Herpes simplex encephalitis. A modified indirect immunoperoxidase technique for rapid diagnosis in paraffin-embedded tissue.

A modification of a reliable and simple method of the indirect immunoperoxidase technique was used to identify herpesvirus antigen in paraffin-embedded tissue of patients with herpes simplex encephalitis (HSE), as well as in rats and mice. So far we have studied five cases in humans and six in mice and rats. With preincubation, we increased antigenicity and accomplished high specificity. Brown reaction product was found mainly at the periphery of the areas of necrotizing encephalitis. Here it was present in different types of glial cells, as well as in neurons. In the animals, it was found in the leptomeninx in cells of the basal cortex and in the ependymal cells of the third ventricle and the cells around it. This method should be of great value for the study of human pathology because new drugs are available for treatment of HSE and a tissue diagnosis is necessary. It is also a useful technique for studying viral CNS infections in experimental animals.

[Multiple systemic neuromas of the skin and mucous membranes]. / Multiple systematisierte Neurome der Haut und der Schleimhaut.

A 58-year-old man is described with fibrillar neuroma of the lips, tongue, mucous membranes of the mouth, and larynx. Also tumors of the capillitium, the neck the trunk, and the arms were found. There were no clinical or blood chemical signs of pheochromocytoma, medullary carcinoma of the thyroid or medullated corneal nerve fibers. It is considered that there is no association with the multiple endocrine adenomatosis type IIb, or with the neurofibromatosis von Recklinghausen.