[Thoracic pain, shock-inducing gastrointestinal bleeding]. / Thoraxschmerzen, schockierende obere Gastrointestinalblutung.

A 65-year-old patient was referred to hospital with suspected myocardial infarction because of left-sided thoracic pain. A paresis of the left recurrent nerve of unknown etiology has been known for three years. Because of shock with anemia, upper gastrointestinal endoscopy was performed. A diverticulum-like lesion in the proximal esophagus was found to be the source of the bleeding. A contrast X-ray examination showed a cavity of approximately 2 x 2 cm originating from the proximal esophagus. Computerized tomography revealed a large mediastinal mass reaching from the thyroid to the diaphragm. An ultrasound-guided fine-needle puncture of this tumor, together with the endoscopical snare biopsies of the esophageal lesion, allowed the diagnosis of an anaplastic thyroid carcinoma with erosion of the esophagus. The patient responded well to palliative radiotherapy. The defect in the proximal esophagus refilled quickly. Nine months after radiotherapy the patient is doing well.

[Quantitative determination of dose-response relations of taxol and cisplatin in ovarian cancer cells with a bioassay in comparison with cytomorphology]. / Quantitative Erfassung der Dosis-Wirkungs-Beziehungen der Zytostatika Taxol und Cisplatin an Ovarialkarzinomzellen mit einem Bioassay im Vergleich zur Zytomorphologie.

The dose-response relations of the cytotoxic drugs taxol and cisplatin and their combination were analyzed in an ovarian cancer cell line (BG-1). The chemosensitivity profiles were obtained with 5 concentrations using the ATP cell viability assay (ATP-CVA). Furthermore, the cytomorphologic changes were analyzed. Our findings demonstrate that the ATP-CVA is able to determine the fraction of surviving cells and has proved to be an effective tool to measure cytotoxicity. At the same time we were able to analyze the cytomorphologic changes. The implications of these results for the practice of gynecologic oncology are discussed.

Bronchogenic carcinoma mimicking metastatic thyroid carcinoma.

We present a case of a false-positive 131I scan in the follow-up of a patient with papillary thyroid carcinoma, which developed 24 yr after radiation therapy for Hodgkin's disease. In the primary evaluation of a neck mass, histology was typical for a papillary thyroid carcinoma and thyroglobulin staining was positive. After total thyroidectomy, 131I uptake was seen in the hilum and right lung. The initial interpretation of these foci as metastatic disease was not supported by the progressive clinical course despite radioiodine treatment. Hence, repeated bronchial brushings and cytology of the pleural effusion were obtained. These specimens were negative in thyroglobulin staining and positive for synoptophysin, a marker for small-cell bronchial carcinoma. Thereby a small to medium cell undifferentiated bronchial carcinoma was demonstrated, which apparently was actively taking up iodine. In conclusion, an atypical clinical course of a suspected metastatic thyroid carcinoma should lead to a reevaluation of the initial diagnosis to prevent an inappropriate therapeutic regimen.

[Proliferative myositis--a little-known pseudomalignant lesion]. / Proliferative Myositis--eine wenig bekannte pseudomaligne Läsion.

The leading symptom of proliferative myositis is a rapidly growing hard tumor in the muscle. The disease is rare and therefore widely unknown. We observed a case of proliferative myositis in a 54-year-old female. We initially interpreted the hard tumor in the left musculus sternocleidomastoideus and its rapid growth as a malignant disease. The histological findings finally led to the correct diagnosis. In the light of the literature of 78 reported cases, a presumptive diagnosis can already be suspected from the clinical examination. The addition of CT scan and fine needle aspiration is highly diagnostic.

[Retinal and vitreal metastasis of a small cell bronchus cancer]. / Retinale und vitreale Metastase eines kleinzelligen Bronchuskarizinoms.

The rare form of retinal metastasis with infiltration of the vitreous is presented in terms of a 47-year-old female patient suffering from an oat cell bronchogenic carcinoma with remote metastasis. Clinical appearance, differential diagnosis, diagnostic evaluation, histology and evolution are discussed.

[Diagnosis of pathologic changes in the liver caused by fine needle puncture]. / Diagnose von pathologischen Veränderungen der Leber durch die Feinnadelpunktion.

Needle aspiration biopsy for cytologic detection of tumors and tumor-like lesions of the liver is widely recognized as a safe and highly sensitive method, especially since the introduction of imaging techniques for guidance of the aspirators needle. In the following paper we discuss indications and contraindications of the method; in the context of the articles about cytologic diagnosis of gastrointestinal lesions we write about our own observations and experiences in using this method of guided fine needle aspirations and cytologic examinations of liver lesions.

[Possibilities of cytodiagnosis in ascites]. / Möglichkeiten der Zytodiagnostik im Aszites.

The examination of ascitic fluid is an important part in the diagnosis and control of gastrointestinal diseases. Different etiological conditions and pathological ways help develop different types of ascitic fluid. Variation of protein content (transudates/exsudates), variation of cells lead to different diagnosis. The following paper describes methods, diagnosis and differential diagnosis and limits of the cytological ascitic fluid examination.

[Image-guided thin needle puncture of tumors of the gastrointestinal system. Puncture technique and handling of materials]. / Die bildgesteuerte Feinnadelpunktion von Tumoren aus dem Magen-Darm-Trakt. Technik der Punktion und der Materialverarbeitung.

The image-guided fine-needle aspiration biopsy in the diagnosis of gastro-intestinal tumors has reached a very high value out of other diagnostic tools. The results of this method depend directly on the technical performance (aspirator, technicians, cytologist) of the punction and processing of the obtained cytological material. The following paper is a brief communication on technical methods and experience in performing the image-guided fine-needle aspiration biopsy at the university hospital of Zurich.

[Disseminated histoplasmosis as the first manifestation of HIV infection]. / Disseminierte Histoplasmose als erste Manifestation einer HIV-Infektion.

A 29-year-old man who had been abroad for several years (mainly Mexico) fell ill with fever (up to 39.8 degrees C), night sweats, weight loss of 10 kg in 6 months (height 181 cm, weight 50.5 kg) and abdominal pain. Computed tomography of the abdomen revealed many enlarged abdominal lymph nodes. Serological tests were positive for HIV antibodies. Fine-needle biopsy of one of the enlarged lymph nodes revealed numerous macrophages with round inclusions, typical for Histoplasma capsulatum. Disseminated histoplasmosis was confirmed by direct antigen demonstration in serum and urine. The patient's serious clinical condition clearly improved and lymph node enlargement regressed after starting specific i.v. treatment with amphotericin B (initially 20 mg/dl, then 50 mg/dl). Although complete cure of the histoplasmosis in connection with the HIV infection is not to be expected, the patient has remained without symptoms for four months on 50 mg weekly of amphotericin B i.v., later changed to imidazole derivatives (400 mg ketoconazole or 200 mg itraconazole, respectively.

[Ascites in metastatic neuroendocrine tumor of the intestine. Cytologic and immunocytochemistry diagnosis]. / Aszites bei metastasierenden neuroendokrinen Tumoren des Darms. Zytologische und immunzytochemische Diagnostik.

The presence of neuroendocrine tumor cells in ascites is extremely rare. Cytologic specimens of ascites of two patients suffering from this tumor disease were examined. The use of immunocytochemical staining allows to reach a correct diagnosis in cases in which the result of conventional diagnosis remains unsettled.

Pseudoepithelial pattern in smears prepared from fine needle aspirates of plasmacytomas.

A pseudoepithelial pattern was observed in smears prepared from fine needle aspirates (FNA) from three plasmacytomas. In one case cells displayed a markedly granular, 'oncocytic' cytoplasm. Granularity of the cytoplasm was due to a large number of mitochondria as shown by electron microscopy. B-lymphocytic origin of the neoplasms was confirmed by immunocytochemistry.

Fine needle aspiration of the liver. Significance of hepatocytic naked nuclei in the diagnosis of hepatocellular carcinoma.

Fine needle aspiration (FNA) smears from 60 cases of histologically (34) or clinically (26) confirmed hepatocellular carcinomas were reviewed. In about 90% of the cases, the cytologic preparations contained clusters of malignant cells with variable degrees of hepatocytic features and a distinctive type of naked nuclei. These naked nuclei had features similar to those of the malignant hepatocytes, but with more evident atypia. They were numerous in about 75% of the cases and less frequent in 15%; in three cases, they were practically absent. All three cases of well-differentiated hepatocellular carcinomas presented with numerous naked nuclei with slight atypia. Flowerlike-configured naked nuclei were especially found in poorly differentiated hepatocellular tumors. Hepatocytic naked nuclei were rarely found in FNA smears from normal liver, metastases, cysts or degenerative, regenerative and inflammatory liver processes; when seen in these cases, they showed no atypia. The presence of atypical hepatocytic naked nuclei appears to be a very useful criterion for the diagnosis of hepatocellular carcinoma.

[Cytological diagnosis of hepatocellular carcinoma based on ultrasonically guided fine needle biopsy]. / Die zytologische Diagnose des hepatozellulären Karzinoms anhand der ultraschallgesteuerten Feinnadelpunktion.

1902 ultrasonically guided fine needle aspirations of liver were examined in the Cytology Department of the Institute of Pathology, University Hospital of Zürich, in the period 1977 to March 1987. 75 of the patients had hepatocellular carcinoma which was confirmed by clinical follow-up, laboratory data and/or by histology. In 71 cases (94.6%) malignancy was diagnosed with certainty or was strongly suspected. There were no false positive diagnoses of malignancy. 2 cases of well differentiated hepatocellular carcinoma were interpreted as liver cell hyperplasia. Hepatocellular carcinoma was distinguished from metastatic tumors in 68 of 75 cases (= 83%). In 7 cases a metastatic process was misinterpreted as primary liver cell carcinoma. However, in 3 cases tumors diagnosed as metastases proved to be hepatocellular carcinomas. The efficacy and limits of the technique of ultrasonically guided fine needle aspiration in the diagnoses of liver pathology are discussed.