Risk-adapted treatment choice in stage I nonseminomatous testicular germ cell cancer by regarding vascular invasion in the primary tumor: a prospective trial.

Based on the results of a retrospective study, which found blood vessel invasion to be the most important prognostic factor in clinical stage I nonseminomatous testicular germ cell cancer (NSTGCC I), a prospective study was started in 1985 which assigned NSTGCC I patients without evidence of vascular invasion to surveillance and patients with vascular invasion to two cycles of adjuvant chemotherapy with cisplatin, etoposide, and bleomycin. Twenty-two patients entered the surveillance group and 18 patients received adjuvant chemotherapy. Median follow-up is 30 months (3 to 50 months). Relapses occurred in three patients (7.5%), one in the surveillance group (4.5%), two in the chemotherapy group (11%). Thirty-eight patients (95%) are alive and without evidence of disease. Two patients of the adjuvant-treated group died, one of progressive germ cell cancer and one of lung cancer. We conclude that low- and high-risk NSTGCC I patients can be identified by considering blood vessel invasion. The presence of embryonal carcinoma and vascular invasion seem to be interrelated prognostic factors, because in 94% of vessel invasion the invading element was embryonal carcinoma. The exclusion of patients with vascular invasion from surveillance decreases relapse rates remarkably. Adjuvant chemotherapy diminishes relapse rates in high-risk patients but does not entirely prevent relapse.

Syndrome of continuous muscle fiber activity and plasmacytoma with IgM paraproteinemia.

A patient with IgM-lambda plasmacytoma presented with continuous muscle fiber activity syndrome (CMFAS), which responded to carbamazepine therapy. This is the first report of CMFAS in association with plasmacytoma and IgM paraproteinemia.

Expression of cathepsin D in head and neck cancer.

To determine overexpression of cathepsin D in head and neck tumours we examined cytosols from 53 primary tumours, nine cytosols of lymph node metastases and 12 cytosols from adjacent normal tissue. We found a significantly lower concentration in normal tissue compared with tumour cytosol as well as with metastases, even when we compared tumours and corresponding metastases pairwise. In addition, we found a significantly higher concentration of cathepsin D in five lymph node metastases than in the corresponding tumours. We conclude that the reported role of cathepsin D is not restricted to breast cancer but could also be important in head and neck cancer.

Intravascular lymphomatosis: a clinicopathological study of three cases.

In patients with intravascular lymphomatosis (IL) a broad spectrum of neuro-psychiatric disorders including dementia, focal neurological signs and seizures has been reported. Clinical diagnosis is difficult since neuroimaging findings are nonspecific. The clinical histories, biopsy and autopsy findings of three patients with IL, one with brain biopsy, are described. Two of them presented with rapidly progressive, fluctuating dementia. The third patient suffered from seizures followed by aphasia. Histology revealed large-cell lymphoma of the B cell type. The prognosis of IL, in general, is poor.

Bacterial contamination of pulmonary artery catheters.

The catheter tips of 152 patients, who were haemodynamically supervised by pulmonary artery monitoring or continuous cardiac output determination, were bacteriologically examined. 106 cultures remained sterile, 21 cultures revealed a growth of non pathogenic organisms. Staphylococcus aureus was cultured 15 times, pseudomonas aeruginosa 4 times, Citrobacter as well as Escherichia coli twice, and Klebsiella and Enterobacter once each. There was no statistically significant connection between dwelling period and contamination. Also diabetes mellitus or corticoid medication in high dosage had no significant influence on contamination rate.

Spindle cell variant of pulmonary adenocarcinoma.

A 45-year-old male developed a transverse lesion of the spinal cord two years after resection of a pulmonary adenocarcinoma. Laminectomy revealed a spindle cell tumor, immunohistochemically considered as leiomyosarcoma. Autopsy disclosed a spindle cell variant of an adenocarcinoma of the lung. The present report demonstrates that spindle cell formations can be found not only in squamous cell carcinomas but also in adenocarcinomas of the lung, and that metastases may be composed of this spindle cell component only.

[Development of carcinoma of Vater's ampulla in an adenoma. Analysis of a personal case load and review of the literature]. / Zur Entstehung der Karzinome der Papilla Vateri über eine Adenom-Karzinom-Sequenz. Eine Analyse des eigenen Krankengutes und eine Literaturübersicht.

A retrospective analysis was undertaken of our case material of 40 histological preparations of carcinoma of the ampulla of Vater, as well as a survey of the literature of 103 adenomas of the ampulla of Vater. Signs of malignant transformation were detected in 25% of the adenomas, whilst adenomatous residues were identified in 72% of the examined carcinomas of the ampulla of Vater. Thus, an adenoma-carcinoma sequence seems to be as significant in the case of Vater's papilla as in the colo-rectal region. An epidemiological investigation confirms this hypothesis since 1. adenomas of the papilla Vateri develop 4 years prior to a carcinoma and 2. the relative sex distribution of the two diseases is approximately equal.

[Giant prepyloric aberrant pancreas with acute gastric haemorrhage (authors transl)]. / Grosses präpylorisches Nebenpankreas mit akuter Magenblutung

A description is given of the clinical symptoms, radiological features and pathological findings in this report of a large, pseudotumorous aberrant pancreas located in the stomach of a 52-year-old male patient. The presenting complication was a gastro-intestinal haemorrhage necessitating gastric resection. Questions pertaining to the clinical diagnosis are extensively discussed.

[Eosinophilic gastroenteritis]. / Die eosinophile Gastroenteritis.

Eosinophilic gastroenteritis represents a very rare inflammatory disease of the stomach and bowel. Aetiologically an allergic diathesis must be assumed, but it is only very seldom that a particular allergen can be identified as being responsible for any case. Characterized by peripheral blood eosinophilia and eosinophilic infiltration of various parts of the gastro-intestinal tract, together with disturbed gastro-intestinal function, complications can arise in this disease requiring surgical intervention. In general, however, conservative therapy is adequate. The clinical features are discussed on the basis of an own case report.

[The high autopsy rate in Vienna]. / Zur hohen Autopsierate in Wien.

In 1983 34% of all persons who died in the Republic of Austria were autopsied. We examined the frequency of postmortem examinations in the capital city, Vienna, between 1983 and 1987 in view of this high overall autopsy rate. The annual autopsy rate in all 9 pathology institutes and the department of legal medicine of the University of Vienna was on average 51 to 53%. There was a slight statistically verifiable decline in 1987. The reason for this high necropsy rate is that Austrian law permits the autopsies without the consent of next of kin if it appears indicated for medical, scientific or educational reasons; further more the fact, that the chairman of the department is at the same time the coroner for the hospital. A high autopsy rate is necessary to maintain a high standard of diagnostic accuracy even in modern medicine. The diagnoses were inaccurate or incomplete in 15% of all cases. The high autopsy rate is the basis for extremely accurate mortality and morbidity statistics and provides the basis for long range public health planning. Medical students develop an insight in disease patterns, which cannot be gained in any other way. The pathology departments of Vienna introduce a new city-wide computer-supported diagnostic file system, which will provide a baseline for comparative scientific studies.

[Extreme kidney displacement caused by an adrenal pseudocyst]. / Extreme Nierenverlagerung durch eine Nebennieren-Pseudozyste.

Renal displacement is very infrequently associated with a space occupying adrenal disease and sometimes imposes major diagnostic problems. The diagnosis of monstrous, retroperitoneal cysts is of particular difficulty. In a 51-year-old female patient the diagnosis and the association of a cystic formation to the adrenal gland could only be made at surgery, despite the steadily increasing renal displacement. The etiology of adrenal cysts, the diagnostic procedures and the possible concurrence of hypertension are discussed.

[Granulocytic sarcoma of the breast in chronic granulocytic leukemia (author's transl)]. / Myelosarkom der Mamma bei chronischer myeloischer Leukämie

A 46 year old women with long lasting menstruation disturbances and amenorrhea developed a chronic granulocytic leukemia and bilateral mammary tumors after pregnancy. The histologic examination revealed a myelosarcoma of the breast. The diagnostic features and the pathogenesis of these tumors are discussed. The severe hormonal disturbances could be accepted as localizing factors.

[Para-articular osteoporosis in chronic polyarthritis]. / Die gelenksnahe Osteoporose bei chronischer Polyarthritis.

In patients with rheumatoid arthritis according to the criteria of the American Rheumatism Association (ARA) (4) the head of the femur was resected during reconstructive hip joint operation. The area of increased radiological translucence near to the joint space was histologically investigated. The rarefication of the trabecula was found distal of the articular cartilage. In this radiologically translucent area numerous osteoclasts and inflammatory cells could be found.

[Bacterial aortic aneurysm due to pseudomonas aeruginosa after pneumonectomy (author's transl)]. / Bakterielles Aortenaneurysma durch Pseudomonas aeruginosa nach Lungenresektion

After transpericardial extrapleural pneumonectomy because of bronchial carcinoma in a 56-year old woman an infection of the thoracic cavity develops, caused by pseudomonas aeruginosa. The patient dies from this infection. At autopsy an aneurysm of the thoracic aorta is discovered close to the previous site of operation. In the wall of the aneurysm pseudomonas aeruginosa is found. Pathogenetic problems concerning the development of bacterial aortic aneurysms are discussed, and in the case presented an infection of the aortic wall from outside via the lymphatics of the adventitia and vasa vasorum is regarded as the most probably way of infection.

The importance of tumour volume in the prognosis of radically treated periampullary carcinomas.

OBJECTIVE: To assess the influence of tumour volume on clinicopathological findings and survival time after radical operation for periampullary carcinoma. DESIGN: Retrospective study. SETTING: Kaiser-Franz-Josef-Hospital, Vienna, Austria. SUBJECTS: 72 of 75 consecutive patients who underwent pancreaticoduodenectomy for periampullary carcinoma between 1 January 1979 and 31 December 1991. OUTCOME MEASURES: Cancers were divided into four groups according to volume (mm3) and the incidence of lymph node involvement, infiltration of surrounding tissues and of visceral vessels, and histologically non-radical resections were calculated, as was the length of survival after resection. RESULTS: There were 22 tumours with a volume of 0-2500 mm3 (group 1), 12 with a volume of 2,501-5,000 mm3 (group 2), and 19 each in groups 3 (5,0001-10,000 mm3) and 4 (more than 10,000 mm3). All carcinomas of the common bile duct (n = 5) and the papilla of Vater (n = 18) were in groups 1 and 2, whereas 38 of the 49 carcinomas of the head of pancreas were in groups 3 and 4. Lymph nodes were involved in 3 (14%), 6 (50%), 13 (68%) and 14 (74%); the surrounding tissues were infiltrated in 6 (27%), 8 (67%), 11 (58%) and 12 (63%); the main visceral vessels were involved in 0, 3 (25%), 5 (26%) and 8 (42%); and the resections were histologically not radical in 0, 2 (17%), 7 (37%) and 9 (47%), respectively. There was significant negative correlation (p < 0.0001) between tumour mass and survival. CONCLUSIONS: These results explain at least in part the poorer prognosis after radical resection of carcinoma of the head of the pancreas.

[Clear cell carcinoma with unusual skin involvement]. / Klarzellensarkom mit ungewöhnlichem Hautbefall.

Clear-cell sarcoma of tendons and aponeuroses represents a rare, malignant tumor. Its knowledge and differential diagnosis is of importance in order to initiate early treatment. A typical case and in particular the histological differential diagnosis will be discussed.

[Correlation of tumor site and tumor volume in radical surgery of cancer of the peripapillary area]. / Untersuchungen zur Wechselwirkung von Tumorlokalisation und Tumorvolumen bei radikal operierten Karzinomen der peripapillären Region.

In a group of 52 partial duodenopancreatectomies (34 cancers of the head of the pancreas, 14 cancers of the papilla and 4 cancers of the common bile duct) the dependence of tumour volume and tumour localisation on carcinomatous lymph node involvement, infiltration of surrounding tissues, infiltration of great visceral vessels and not radical resection was determined. The analysis demonstrates that there is significant difference in volume between radically treated carcinomas of the common bile duct, the papilla of Vater and the head of the pancreas with mean volumes of 463:1,851:11,835 mm3 or 1:4:26! Furthermore the investigation shows that for every analysed parameter median volume is larger for positive observations than for negative ones: lymph node involvement 10,606:6,459 mm3, infiltration of surrounding tissues 10,444:6,703 mm3, infiltration of great visceral vessels 14,923:7,144 mm3, not radical resection 18,130:5,343 mm3. From these results it is concluded, that early stages of periampullary carcinomas with a good chance for cure are only present in radically treated cancers of the papilla and the common bile duct. In cancers of the head of the pancreas the significant larger primary cancers and the more advanced staging results in a dismal prognosis.

[Beta-HCG-producing choriocarcinoma of the pineal area as a cause of precocious puberty]. / Beta-HCG-produzierendes Choriokarzinom der Pinealisregion als Ursache einer Pubertas praecox.

We report the case of an eight-year-old boy with precocious puberty due to a beta-HCG producing choriocarcinoma of the pineal region. beta-HCG-levels were elevated initially (9659 mU/ml) and did not normalize completely after surgical removal of the brain tumor. A relapse of the tumor in the hypothalamic region led to a new increase of beta-HCG-level up to 41258 mU/ml. Histopathology of a subsequently removed metastasis in the right lung showed immunohistological evidence of beta-HCG production. Introduction of chemotherapy was followed by a normalization of the beta-HCG-level and of the previously elevated hormone values.

[CRST syndrome and primary biliary cirrhosis]. / CRST-Syndrom und primäre biliäre Zirrhose.

The case of a female patient with the history of amanita poisoning, CRST syndrome and primary biliary cirrhosis (PBC) is reported. Immunological features (IgM-rheumatoid factor, antinuclear-, anticentromere- and antimitochondrial antibodies) and HLA-antigens are studied. Immunological abnormalities occurring in CRST and PBC suggest a common autoimmune base, which also makes concomitance of these two disease states more than coincidental.

Implications of histological grade of tumour for the prognosis of radically resected periampullary adenocarcinoma.

OBJECTIVE: To study the influence of histological grade of tumour on the prognosis of radically resected periampullary cancers. DESIGN: Retrospective study. SETTING: Teaching hospital, Austria. SUBJECTS: 156 patients (papilla of Vater, n = 34, head of the pancreas, n = 105, and distal common bile duct, n = 17) who underwent partial pancreaticoduodenectomy for periampullary adenocarcinoma between 1 January, 1967 and 31 December, 1996. OUTCOME MEASURES: The relation between grade of tumour and site, T and N classification, extramural growth, invasion of vessels and resection margins, tumour volume, and survival time. RESULTS: Well differentiated lesions were significantly more common in the papilla of Vater (n = 15, 44%, p = 0.01) than in the pancreatic head or the common bile duct (n = 20, 19%, and n = 5, 29%, respectively). Only in ampullary lesions did the grade of tumour significantly affect the incidence of other histopathological risk factors (T p = 0.003; nodal status p = 0.01; extramural growth p = 0.0001; tumour volume p = 0.02) and survival time (p = 0.02); no significant correlations were found in cancers of the head of the pancreas or common bile duct. CONCLUSIONS: There was a significant difference in the distribution of grade of tumour between the different sites of origin of resected periampullary cancers. Grade of tumour correlated with T and N classification, tumour volume, extramural growth, and survival only in ampullary lesions.