Symptoms and clinical course of EHEC O104 infection in hospitalized patients: a prospective single center study.

OBJECTIVES: Shiga-toxin producing O157:H7 Entero Haemorrhagic E. coli (STEC/EHEC) is one of the most common causes of Haemolytic Uraemic Syndrome (HUS) related to infectious haemorrhagic colitis. Nearly all recommendations on clinical management of EHEC infections refer to this strain. The 2011 outbreak in Northern Europe was the first to be caused by the serotype O104:H4. This EHEC strain was found to carry genetic features of Entero Aggregative E. coli (EAEC) and extended spectrum ß lactamase (ESBL). We report symptoms and complications in patients at one of the most affected centres of the 2011 EHEC O104 outbreak in Northern Germany. METHODS: The courses of patients admitted to our hospital due to bloody diarrhoea with suspected EHEC O104 infection were recorded prospectively. These data include the patients' histories, clinical findings, and complications. RESULTS: EHEC O104 infection was confirmed in 61 patients (female = 37; mean age: 44±2 years). The frequency of HUS was 59% (36/61) in our cohort. An enteric colonisation with co-pathogens was found in 57%. Thirty-one (51%) patients were treated with plasma-separation/plasmapheresis, 16 (26%) with haemodialysis, and 7 (11%) with Eculizumab. Patients receiving antibiotic treatment (n = 37; 61%) experienced no apparent change in their clinical course. Twenty-six (43%) patients suffered from neurological symptoms. One 83-year-old patient died due to comorbidities after HUS was successfully treated. CONCLUSIONS: EHEC O104:H4 infections differ markedly from earlier reports on O157:H7 induced enterocolitis in regard to epidemiology, symptomatology, and frequency of complications. We recommend a standard of practice for clinical monitoring and support the renaming of EHEC O104:H4 syndrome as "EAHEC disease".

Ligneous cervicitis in a woman with plasminogen deficiency associated with an atypical form of microglandular hyperplasia: a case report and review of literature.

A 19-yr-old woman with previously diagnosed clear cell adenocarcinoma was referred to the Charité for further treatment. Biopsies were taken from the cervix, the endometrium, pseudomembranes in the peritoneum, and sentinel lymph nodes. The morphologic picture of pseudomembranes and inflammation together with the provided information about plasminogen deficiency of the patients led to the hypothesis of ligneous cervicitis. The previously taken biopsies of the adenocarcinoma were reevaluated and showed a clear cell lesion. Further immunohistochemical examination with antibodies against p16, Ki67, CEA, and p53 could not prove its malignant character. As a result we diagnosed an atypical form of microglandular hyperplasia in a patient with ligneous cervicitis. Ligneous cervicitis is a rare inflammatory condition that might affect all mucus membranes in patients with plasminogen deficiency. This case shows the importance of correlating pathologic and clinical findings in the diagnosis of ligneous cervicitis because of the rarity of the disease and the heterogeneity at presentation.

[Mesenterial lymphangiolipoma - a rare finding in an asymptomatic patient]. / Mesenteriales Lymphangiolipom - eine Rarität als Zufallsbefund.

BACKGROUND: Lymphangioma is an uncommon tumor, an intraperitoneal lymphangiolipoma is exceedingly rare. These tumors are principally benign, but lead to complications due to their size and localization. CASE REPORT: A 46 year old male patient presented for a regular medical check up. Apart from a hearing loss 2006 and 2008 he reported no previous or chronic diseases. An extensive health examination had been performed two years ago and had been without pathological results. Abdominal ultrasound revealed a large polycystic lesion in the right middle and lower abdomen, approximately 12x10x7 cm in size. There was no vascularisation in the septae. In MRI, the tumor appeared cystic as well without communication to the intestinal wall. Laboratory values including echinococcus serology was without pathological results. An explorative laparotomy was done with right hemicolectomy and subsequent ileotransversostomy. Histologically, a lymphangiolipoma was diagnosed, as well as a chronic appendicitis and chronic lymphangitis of the ileocolic lymph nodes. Postoperatively, the patient recovered without any complications. CONCLUSION: Lymphangiomas, especially lymphangiolipomas, are an extremely rare differential diagnosis of intraabdominal cystic tumors. Potential complications included ileus, intussusception or an immuring growth. Abdominal ultrasound can reveal important pathological findings even in symptom- free patients.

Mucoepidermoid carcinoma of palatinal glands with exuberant foreign-body giant cell reaction.

A 69-year-old man with a 0.6 cm yellowish polypoid lesion in the lateral soft palate for 2 years is presented. Histological examination of the tumor revealed a small, well-differentiated, mucoepidermoid carcinoma dominated by densely packed cholesterol clefts in association with an exuberant foreign-body reaction with several giant cells. The tumor entity 'mucoepidermoid carcinoma with foreign-body giant cells' might be differentiated from 'mucoepidermoid carcinoma with an osteoclast-like giant cell stromal reaction' because differences in pathogenesis and tumor behavior are assumed.

Primary extranodal marginal zone B-cell lymphoma of the fallopian tube.

BACKGROUND: Only 2% of all extranodal primary lymphomas affect the female genital tract. Involvement of the fallopian tubes by primary lymphoma is extremely rare. CASE: A 34-year-old patient presented with the symptoms of salpingitis. Laparoscopy with salpingectomy was performed. Salpingitis caused by Acinetobacter species was diagnosed and antibiotic treatment was administered. Histologic examination of the fallopian tube revealed primary extranodal marginal zone B-cell lymphoma (MALT-type lymphoma) of the fallopian tube. After 12 months no tumoral recurrence occurred. CONCLUSION: Although the female genital tract is rich in mucosa and the existence of mucosa-associated lymphoid tissue (MALT) has been demonstrated previously, extranodal marginal zone B-cell lymphoma of the fallopian tube is exceptional. To our knowledge only two cases with extranodal marginal zone B-cell lymphoma of the fallopian tube have been previously reported. Existence of inflammation close to the tumor is interesting to emphasize.

Ultrastructural morphometry of the rat pituitary intermediate zone after stimulation and suppression.

The intermediate zone of the rat pituitary was studied after stimulation for 3 weeks with the adrenostatic drugs metyrapone and aminogfutethimide and after suppression for 3 weeks with the glucocorticoid 6α-methylprednisolone using morphometry by the point-counting method on electron micrographs. After metyrapone, intermediate cells showed a significant (P <.05) increase in volume percentages of the smooth endoplasmic reticulum, the Golgi apparatus, and the lucent immature secretory granules, as well as a significant decrease in the lucent secretory granules, the vacuoles, the lysosomes, and the cell membranes in comparison with the untreated controls. After aminoglutethimide, the volume percentages of the nuclei, the smooth endoplasmic reticulum, and the dense and lucent immature secretory granules were significantly increased in comparison with the controls, whereas the unorganized cytoplasm, the lucent secretory granules, the vacuoles, and the lysosomes were significantly decreased. The morphological changes after both adrenostatic drugs clearly indicate the pathophysiologically expected increase of secretory activity. After 6α-methyfprednisolone, the rough endoplasmic reticulum, the vacuoles, and the lysosomes significantly decreased in comparison with the controls, and the smooth endoplasmic reticulum, the Golgi fields, and the immature secretory granules were increased. These changes cannot be interpreted without certain reservations as the first alterations indicate decreased activity, whereas the increased Golgi fields and immature secretory granules are usually signs of increased secretory activity, which cannot be expected after glucocorticoid treatment. The possible causes are discussed.

Ultrastructural morphometry of normal adrenal cortex and of hyperplastic adrenals in gushing's disease.

Surgical specimens of 4 normal adrenal glands and of 5 hyperplastic ones in Cushing's disease were studied ultrastructurally. The ultrastructure of the three zones of each adrenal gland was morphometrically and statistically analyzed. Comparing the statistical data of the three zones of the normal gland, the development of smooth endoplasmic reticuium and rough endoplasmic reticuium showed an increase from the outer zona glomerulosa to the inner zona fasciculata and reticularis. Also, the mitochondria were more numerous in the inner zona reticularis than in the outer zones. In Cushing's disease, the smooth endoplasmic reticuium, the rough endoplasmic reticuium, and the mitochondria were developed to a significantly higher degree than in normal human adrenal glands. The distribution of the cell organelles in the zona fasciculata and zona reticularis is almost alike in normal adrenal glands and in the adrenal cortex in Cushing's disease, except that the smooth endoplasmic reticuium in the zona reticularis was less extensive than in the zona fasciculata. The volume percentages of lipid vacuoies in the hyperplastic zona fasciculata in Cushing's disease was strongly and significantly decreased in comparison to normal adrenal glands. Our ultrastructural findings and the statistical data were in accordance with the results from animal experiments with adrenocorticotropic hormone (ACTH) stimulation and confirmed former qualitative ultrastructural findings concerning human adrenal gland changes in ACTH-dependent Cushing's disease.

Ultrastructural morphometry of different adrenal adenoma types.

Twelve surgical specimens of adrenal tumors (3 mainly compact cell adenomas and 2 mainly spongiocytic adenomas of Cushing's syndrome, 4 adenomas of Conn's syndrome, 1 androgen-secreting adenoma, and 2 hormonally inactive tumors) were studied by ultrastructural morphometry, using the point-counting method. All groups were compared with regard to the statistical differences among the different cell organelles. Compact cell adenomas and spongiocytic adenomas in Cushing's syndrome revealed differences in the volume fraction of the following cell organefles: nuclei, smooth endoplasmic reticulum, mitochondria, Golgi zones, and unorganized cytoplasm, as well as in the fraction of lipid vacuoles. Compact cell adenomas in Cushing's syndrome were different from Conn's adenomas with respect to nuclei, smooth endoplasmic reticulum, rough endoplasmic reticulum, lysosomes, Golgi zones, and unorganized cytoplasm. Spongiocytic adenomas in Cushing's syndrome were different from adenomas in Conn's syndrome with respect to organized cytoplasm and lysosomes. Further data are given concerning the differences between Cushing's syndrome, adenomas in androgen-producing tumors, and inactive tumors. The statistically significant data were correlated with the functional expression of the different tumors. The morphometric studies confirmed the visually established ultrastructural features of adrenal tumors and provided further significant differences. Finally, these examinations obviously yielded specific patterns of the different adrenal adenoma types.