[Surgical therapy of giant tubulovillous adenoma of the duodenum and incidental serous cystadenoma of the head of the pancreas]. / Chirurgische Therapie bei tubulovillösem Riesenadenom des Duodenums und inzidentellem serösem Zystadenom des Pankreaskopfes.

A villous giant adenoma of the duodenum was diagnosed in a 56-year-old female patient with uncharacteristic upper abdominal discomfort after multiple previous laparotomies for various indications. A partial pancreaticoduodenectomy was performed as radical oncological procedure since the dignity of the neoplasm was uncertain. Histopathologic examination revealed medium-grade cell dysplasia of the villous adenoma but an incidental serous cystadenoma of the pancreatic head as well. The postoperative course was uneventful. The coincidence of these both rare neoplastic entities has yet not been described in the literature. The surgical options for treatment of both neoplasms are discussed.

Breast tumors with myofibroblastic differentiation: clinico-pathological observations in myofibroblastoma and myofibrosarcoma.

This report describes the clinico-pathological features of myofibroblastic tumors of the breast in six patients. Four women and one man presented with a benign myofibroblastoma. The sixth patient was a woman with myofibrosarcoma. All myofibroblastomas were composed of a fascicular arrangement of spindle cells embedded in dense bundles of collagen. Tumors differed with respect to their proportion of neoplastic cells and collagenous stroma as well as cellular pleomorphism. Based on this variation, the tumors could be subclassified as classic, collagenized, epithelioid and cellular myofibroblastoma. Immunohistological staining confirmed myofibroblastic differentiation by strong expression of either desmin or smooth muscle actin with coexpression of vimentin. In addition, numerous cells reacted with antibodies to CD68. Proliferative activity was rather low in the myofibroblastoma with an average of 0-2 mitotic figures per 10 HPF. DNA cytometric analysis was performed in two cases and showed diploid stem lines with minor S-phase fractions (1% and 3%). In the myofibrosarcoma, cells contained pleomorphic nuclei with some giant cells and numerous mitotic figures (6-7/10 HPF) and had infiltrating margins that were apparent even grossly. Immunohistochemically, tumor cells strongly expressed vimentin, smooth muscle actin and fibronectin. Ultrastructurally, neoplastic cells met the criteria of myofibroblasts, i.e. contained abundant intermediate filaments and myofilament bundles with focal densities as well as fibronexus junctions. DNA cytometric analysis exhibited again a diploid stemline but marked proliferative activity was present as indicated by an S-phase fraction of 20%. In conclusion, in benign myofibroblastoma there may be some cellular pleomorphism but mitotic activity is always low. The malignant counterpart, myofibrosarcoma, is characterized by marked cellular pleomorphism, infiltrating margins and high mitotic rate.

[Unusual finding of rhabdomyosarcoma of the heart]. / Ungewöhnlicher Befund eines Rhabdomyosarkoms des Herzens.

A report is given on a 67-year-old man with a monstrous rhabdomyosarcoma of the heart which was found at autopsy. This is a very rare finding, especially the size of the tumour is impressive. The differential diagnosis and difficulties of clinical diagnosis are discussed.

[Uhl's anomaly of the heart]. / Beitrag zur Uhlschen Anomalie des Herzens.

Partial aplasia of the myocardium of the anterior wall of the right ventricle (Uhl's disease) of a 63-year old male is reported. The pathogenesis of Uhl's disease is discussed.