The consequences of chronic arsenic poisoning among Moselle wine growers. Pathoanatomical investigations of post-mortem examinations performed between 1960 and 1977.

From post-mortem examinations performed at the Pathology Institute at Koblenz, 163 cases of wine growers affected by chronic arsenic poisoning were analyzed. While a reduction could be seen in the number of cases of liver cirrhosis, the carcinoma rate was still high and even increased when compared to earlier reports. Lung cancers were identified in 66% of all wine growers affected and are thus the leading form of the skin were observed. A particular characteristic of amount of carcinomas or precarcinogenic alterations of arsenic carcinoma. However, nearly the same amount of carcinomas or precarcinogenic alterations of the skin were observed. A particular characteristic of cases. Among the multiple tumors, up to six different carcinomas were found. As arsenic is no longer detectable by toxicologic-chemical means the deposits of arsenic have been depleted and excreted long ago and so the diagnosis of chronic poisoning today depends on morphological changes of the skin (arsenic hyperkeratosis, melanosis and M. Bowen) which have been shown to be reliable. A comparison of our analysis with much more extensive material collected by the trade association supports our experience and the determined case rates. Furthermore modern theories on the carcinogenic action of arsenic, the question of the tumor latency and the relation of specific cancers to the poison are presented. In addition medical opinions on chronic arsenic poisoning are discussed.

A case of fulminant herpes simplex hepatitis in an adult.

The case presented documents HSV hepatitis in a 41 year old caucasian male with a history of prolonged steroid treatment and recent irradiation for brain tumor recurrence. The fulminant nature of the hepatitis, accompanied by gastric ulcer hemorrhage, lead to his death within 24 hours of symptomatic manifestation. The diagnosis of HSV hepatitis was made postmortem. The etiology of the hepatitis was established by light microscopic identification of Cowdry type A intranuclear inclusion bodies, electron microscopic identification of virus particles, and the immunohistochemical detection of herpes simplex virus antigens.

[Malignant melanoma of the penile fossa navicularis]. / Malignes Melanom der Fossa navicularis penis.

A case of a malignant melanoma of the orificium externum urethrae in a 53-year-old man is reported. This is a very rare localisation of such a tumor. Already at the beginning of therapy the tumor was ulcerated. Histological investigation showed a very cellular faintly pigmented tumor. The prognosis is poor. Modern therapy is discussed.

[On the pathology of acute heart failure in bronchial asthma (author's transl)]. / Zur Pathologie des akuten Herztodes beim Asthma bronchiale.

In cases dying with asthma, heart muscle stained by the Haematoxylin-basic-Fuchsin-Pikric acid-method showed multiple areas of focal ischaemic injury of single or small groups of muscle fibres. The localisation of these changes in the inner layers of the wall and septum of the ventricle and the pattern of the changes produced, suggest poor coronary perfusion. The changes are explained as the result of combined damage due to hypoxic circulatory disturbances of the heart muscle and the effects of catecholamines. The appearances may provide the morphological basis for accurate diagnosis.

Lipogranulomatosis circumscripta (panniculitis non suppurativa).

Four cases of nodular lipogranulomas in the breast, the arms and in the omentum are discussed. Nodular lipogranulomas develop from single fat cells, the fat of which is enclosed and phagocytized by lipophages. The small areas grow and become confluent into larger granulomas, which become scars by the formation of reticulin fibers. The rosette-like pattern, the primary degenerative alteration of the fat cells and the progression of the lesion all suggest insufficient blood supply. Inflammation is secondary and appears only occasionally.

Dissecting aneurysm of the pulmonary artery.

Dissecting aneurysm of the aorta is often seen; similar changes in the pulmonary artery are rare. In the German literature they are unknown. 11 previously described cases have been compiled with their clinical and pathological records, and a new added. The patient, a 45 year old woman, suffered from pulmonary hypertension which resulted in medionecrosis and a large aneurysm of the trunk of the pulmonary artery. She died of haemopericardium after rupture of the artery in two stages, with a tear of 8 cm in the trunk which reached to the bifurcation of the vessel.

[Aspergillosis of the maxillary sinus (author's transl)]. / Aspergillose der Kieferhöhle.

Aspergillosis of the paranasal sinuses becomes more and more important. 5 special cases and their histological findings are described. All of them showed unilateral chronic sinusites of long duration. Surgically there were found crumbly cheese-like substances in the sinuses, which corresponded to old fungal masses. The diagnosis was only possible by histological examination, usual staining methods were sufficient. Contrary to the opinion that consumptive basic illness or defects of the immunity system - also caused by therapy - would be a disposing factor for the fungal infection it has now been demonstrated that such cases are to be expected also spontaneous. Anatomical abnormities of the nasal space can favour the affection. Radical operation was the successful therapy.

[Congenital pilocytic astrocytoma of the brain]. / Angeborenes pilozytisches Astrozytom des Grosshirns.

Case report about a 9 months old female infant, that died of an exorbitant large astrocytoma of the base of both hemispheres. The tumor was apparent 10 weeks after birth and considered to be connatal. It has been classified as a pilocytic form, which is very rare in this age. The origin has been discussed as dysontogenic.

Mucoepidermoid mammary carcinoma. Immunohistochemical and biochemical analyses of intermediate filaments.

The histological features of mucoepidermoid mammary carcinomas (MMCs) are presented, and criteria for distinguishing these tumours from squamous epithelial metaplasia in other mammary carcinomas are considered. Immunohistochemical and gel-electrophoretic analyses of the intermediate-filament proteins in one MMC case revealed a complex pattern of cytokeratin polypeptide expression. The simple-epithelium-type cytokeratins 7, 8, 18, and 19 were detected mainly in nonsquamous (including mucinous) cells, while the stratified-epithelium-type cytokeratins 5, 6, 14, 16, and 17 were present in squamous cells. However, in both the nonsquamous and squamous regions of the tumour, cytokeratins of the "reverse" type were detected in individual cells. This pattern of single-cell heterogeneity with respect to cytokeratin polypeptide expression suggests that the mixed phenotype of this tumour is not caused by the clonal divergence of tumour cell types. Rather, histogenetically, a pluripotent stem cell with the ability to differentiate into squamous (epidermoid) or mucinous cells might be the starting-point of such a tumour and such differentiation processes may continue to occur during tumour growth. The present case also revealed that mucoepidermoid tumours are not necessarily of low malignancy; there are highly malignant forms with rapid metastasis.

[Solid cystic acinar cell tumor of the pancreas. Immunohistologic studies of histogenesis]. / Der solid-zystische Azinuszelltumor des Pankreas. Immunhistologische Untersuchungen zur Histogenese.

A case of a very rare solid and cystic tumor of the pancreas in a 25-year-old woman was examined by immunohistochemical methods, e.g. antiglucagon, antisomatostatin, antivip etc. The stainings by the PAP- or biotin-avidin-method were negative and also those with S-100 protein and especially with chromogranin. A tumor of the endocrine system was therefore excluded. Some areas of the tumor showed positive staining with alpha-1-antitrypsin as is known in acinar cell carcinoma. The classification of the neoplasm as an acinar adenoma of the pancreas seems to be well established, mainly because several authors electronmicroscopically demonstrated structures resembling acini and zymogen granules.

[Extracranial olfactory neuroblastoma (author's transl)]. / Das extrakranielle Olfaktoriusneuroblastom.

It is reported of an 59-year-old woman with an extracranial olfactory neuroblastoma (aesthesioneuroblastoma). Clinical symptoms were unilateral obstructed nasal respiration, bleeding and dysosmia. Important but difficult is the histological diagnosis. The best therapy is radical surgery; the origin of the tumor, the fila olfactoria and lamina cribrosa, have to be resected widely. A "superradical" intervention of the non-involved regio olfactoria of the opposite side is not necessary. Questions of radiation and prognosis are discussed.

[Acute hemorrhagic necrosis of the breast following treatment with Cumarin]. / Akute hämorrhagische Nekrose der Mamma nach Cumarintherapie.

A case of hemorrhagic necrosis of the breast is reported in a thirty-four year old woman who received Cumarin treatment for deep leg vein thrombosis and pulmonary embolism. It was necessary to remove the breast. The microscopic examination showed complete blockage of the vessels by fibrin thrombi in almost all veins. The cause of this venous thrombosis was explained as a Shwartzman-Sanarelli-Phenomenon.

[Differential diagnosis of a hemorrhagic-necrotizing epiploic appendix]. / Zur Differentialdiagnose einer hämorrhagisch-nekrotisierenden Appendix epiploica.

In a 52 year old pyknic patient in whom very violent pain had suddenly occurred in the left lower abdomen, an acute hemorrhagic infarction of an epiploic appendix of the sigmoid colon with adhesion to the anterior abdominal wall was found to be the cause of the symptoms. A hernia, above all a hernia of the semilunar line of Spigelius, an inflammatory process and a granuloma had to be considered in the differential diagnosis.

Inguinal nephroblastoma.

A case of an extrarenal nephroblastoma is reported which was located in the inguinal region. In the surrounding fat tissue normal ectopic glomerular and tubular structures and two more nephroblastomas were found. Therefore and because of negative clinical investigations in regarding of a renal malignant tumour the inguinal mass was thought to be the primary tumour and not a metastasis. This conclusion is important for the diagnosis and therapy.

Papillary carcinoma of the prostate, location, morphology, and immunohistochemistry: the histogenesis and entity of so-called endometrioid carcinoma.

Fifty carcinomas that were partially to completely papillary in nature were examined. According to urethroscopic and rectal palpation findings, six of the carcinomas were located centrally, 40 tumors were in the prostate proper, and four were clinical stage T0. The epithelium of the papillary portions of the tumors was dark in some instances, light in others. Immunohistochemistry revealed that 20 of 22 tumors were positive for prostatic acid phosphatase (PAP) and prostate-specific antigen (PSA). In no case was a topical relationship to the utriculus prostaticus demonstrable. The epithelium of the utriculus in seven additional patients who were not involved in this series also stained positively for PAP and PSA. Usual carcinomas of the prostate proper can develop endometrioid structures that do not differ immunohistochemically from ordinary portions of the carcinoma. Tumors located in central portions of the prostate are, in our opinion, morphologic variants of usual prostatic carcinomas, and apparently arise in prostatic ducts. We conclude that a distinction between endometrioid carcinomas and tumors of prostatic ducts does not seem justified and that papillary prostatic carcinomas should be treated like common prostatic cancer.