The importance of rapid, intraoperative histological diagnosis in the radical surgical treatment of the malignant tumours of the limbs.

During a period from 1971 to 1978 13 cases of limb tumours with suspected malignancy had a biopsy and depending on the result of histological examination of frozen sections a subsequent amputation in the same session. Material included 5 cases of osteogenic sarcoma, 3 cases of mesenchymal chondrosarcoma, 2 cases of synovial sarcoma and 3 tumours of other origin. In 11 cases the radical operation was performed in the same session and in 2 cases surgical intervention was delayed until after examination of the definitive sections.

The pathologic new bone formation of an osteogenic sarcoma.

The authors describe the structure of bone and tumorous new bone formation of an amputated femur affected by osteogenic sarcoma. They studied a slide of the invaded bone using stereomicroscopic and comparative histologic techniques. The bone destruction induced by the tumor produces characteristic morphologic changes both in the cortical and in the cancellous bone. Investigation of the extraosseal tumorous bone formation is described together with its relation to the cortical bone. In the development of tumorous bone plates primary and secondary formations could be distinguished. The intraosseal, tumor-induced new bone/osteoid formation appears characteristically in the invaded marrow-spaces as a so-called "miniature spongiosa". In the zone adjacent to the tumor, reactive bony spines grow out from the surface of the normal spongy plates. These findings are also analyzed from the view of the roentgenologic findings.

[The routes of local spread of the giant cell tumour (author's transl)]. / Die lokalen Ausbreitungsarten des Riesenzelltumors.

Based on the follow-up of two cases the authors state that the recurrence and local metastases of the giant cell tumours develop as a result of direct cellular activity and by the bloodstream.

[Fibrous dysplasia, "inverse" intravascular form of ossification (author's transl)]. / Die fibröse Dysplasie, eine "invers", intravasculäre Form der Ossifikation.

Histologic analysis of 22 cases of fibrous dysplasia was performed. 1. In each case separately 100 immature bony trabeculae were counted, giving a total of 2200 counts. It was concluded, that on a given section, 75,7 per cent of the trabeculae were in contact with vascular cavities. The remaining 24,3 per cent seemingly "metaplastic" bony trabeculae were examined further by serial section. In different layers of the block material the obvious connection with vascular spaces could be shows. 2. The vascular (not metaplastic) origin of immature bony trabeculae was demonstrated too. The development of this pattern of bone starts and continues in contrast to normal ossification within the capillaries and sinusoids in an "inverted" manner. Later the trabeculae "grow out" from the vascular cavities but keep their contact with them.

[The role of glomi (arteriovenous anastomoses) in the pathomechanisms of solitary enchondromas (author's transl)]. / Die Rolle der Glomi (arterio-venöse Anastomosen) im Pathomechanismus solitärer Enchondrome.

The author performed the histlologic examination of 62 solitary enchondromas located in the short tubular bones of the hand and the feet. In 25 cases the thinned cortical bone and its periosteum covering the lesion could be examined, too. Comparison with the controls revealed that the glomi (arteriovenous anastomoses) in the periosteum, or close to it were open in 1 case, strongly contracted in 9 cases, and closed in 15 cases. It is shown throughout the whole material that the pathologic tissue of the enchondromas has a poor vascular supply. In 14 out of 62 cases the septa amoung the cartilaginous lobes were filled with blood. In the vicinity of these, however, a regular osteoblastic ossification sets in. The above results lead to the conclusion that in the pathomechanism of the enchondromas the local hypoxaemia induced by functional disturbance of the glomi plays an important role in the proliferation of the bradytrophic cartilaginous tissue.

Benign osteoblastoma: quantitative histological distinction from osteoid osteoma.

The author performed on 10 cases of benign osteoblastoma and osteoid osteoma a comparative quantitative histological analysis using an optical line-mesh grid for sampling. Tissue components under the line crossing were counted five hundred times in every case making a total of five thousand counts for each group. It was demonstrated that 1. in osteoblastoma the amount of stroma is roughly by 10 per cent elevated and the amount of osteoid about 10 per cent less in comparison with osteoid osteoma. 2. As far as the osteoblast lining, capillaries and giant cells are concerned, there is no basic numerical difference between the two lesions. Experiences gained by qualitative histological comparison are also described. His results are favouring the concept of benign osteoblastoma as an entity with true tumour nature.

[Data on the pathogenesis of solitary juvenile bone cysts (author's transl)]. / Uber die Pathogenese der solitären, juvenilen Knochencysten

On the basis of the histologic analysis of 45 solitary (juvenile) bone-cysts the author reveals new aspects of the pathogenesis. I. Data on sex-age-localisation are referred to. II. Due to the hemosiderosis regularly manifesting itself in the loose connective tissue layer lining the cyst and owing to the similarity to the liquified hematomas to be found elsewhere in the organism, as well as on the basis of the specific blood-supply conditions of the spongiosa of the increasing metaphysis the author presumes the intramedullary hemorrhage--possibly occurring also without fracture--to be the primary change. III. In the lining layer of the cyst, as well as in the adjacent bony tissue the author frequently observed capillary stase and to a considerable degree lymphedemas (resorption insufficiency). On the basis of these data the author presumes that the following mechanism might be hold responsible for the persisting of the cyst: The congestive (anoxic) wall of the capillary gets permeable for the proteins. Hence the fluid of high protein content, filling the cyst is constantly replaced. It is emphasized that solely the lymphatic vessels are apt to convey proteins. On the basis, however, of the histologic phenomena (lymphedema) observed, the pericystic lymphatic system is in the stage of relative insufficiency.

[Aneurysmal bone cysts (author's transl)]. / Aneurysmatische Knochencysten. Histologische Analyse von 15 Fällen

Authors describe histological observations of 15 cases of aneurysmal bone cysts. Frequent occurrence of areas similar to giant cell tumor or solitary bone cyst was found together with fields producing chondroid intercellular substance. Attention is called to the differentiation of the two lesions described above and occasionally tumors and tumor-like conditions of chondroblastic origin. The vascular changes observed in the surroundings (arteriologsclerosis) support the earlier hypotheses attaching importance to local hemodynamic disturbance in the pathogenesis of the lesion. In certain cases penetration of aneurysmal bone cyst into the epiphyseal cartilage was found. Previous infraction or recurrence does not alter the histological picture fundamentally.

Vascular changes in the surrounding of osteoid osteomas.

Authors observed in 11 instances of osteoid osteoma out of 20 revised cases the characteristic features of arteriolosclerosis in the small arteries supplying the nidus. With these, earlier hypothesis of Jaffe about an increased intravascular pressure in the nidus and supplying vessels in supported.

Bone changes in young mice with impaired lymphoid system.

Disturbances of osseal growth were observed in young mice with their lymphoid system affected by antihymocyte serum or mitolactol (dibromodulcitol) treatment. These bone changes were similar to those observed in germ-free and neonatally thymectomized mice as well as in mice suffering from a graft vs. host reaction. Their severity was in direct correlation with the disturbance of the thymus dependent lymphoid system. Not only immunological adaptation but also normal bone growth appears to require an intact thymus and thymus dependent lymphoid system.