[Intracortical dedifferentiated chondrosarcoma]. / Intrakortikales dedifferenziertes Chondrosarkom.

Chondrosarcoma is the second most frequent mesenchymal malignant tumour of the bone. Classification of this kind of tumour is made by clinical, radiological und pathological means. A case of an intracortical chondrosarcoma was first reported by Babinet et al. 2003 [2]. During the staging examination of a 59-year-old patient referred to our clinic because of a squamous cell carcinoma of the oropharynx, we also found a highly malignant intracortical dedifferentiated chondrosarcoma of the distal femur shaft. Due to the primary assumption of bone metastasis of the oropharynx tumour, marginal extralesional tumour resection was performed followed by composite osteosynthesis. Considerations on differential diagnosis and their implications for further therapy are discussed.

[Cystic lymphangioma with endosalpingiosis as a rare cause of gastrointestinal bleeding]. / Zystisches Dünndarmlymphangiom mit Endosalpingiose als seltene Ursache einer gastrointestinalen Blutung.

We report on a 31-year-old woman with an iron-deficiency anemia and positive Guaiac test, existing for more than 2 years. Despite an extensive gastrointestinal examination a bleeding source could not be found. Also angiography of the abdominal arteries with injection of heparin as provocative protocol was normal. Enteroclysis showed a remarkable finding which led to laparotomy. A cystic lymphangioma with endolymphatic endosalpingiosis as the bleeding source was identified and removed. Lymphangioma is a rare benign soft tissue tumor which usually appears during the first 2 years of life. Only in some cases the lymphangioma is intraabdominal and there can be different, no specific symptoms. Endosalpingiosis is also a rare benign disease, it consists of scattered epithelium of the Fallopian tube. It is the first case to our knowledge, in which the appearance of the endosalpingiosis in a lymphangioma is described.

[Pulmonary microcalcification with miliary foreign-body granulomas. Residuals of cured Pneumocystis carinii pneumonia in AIDS]. / Pulmonale Mikrokalzifikationen mit miliaren Fremdkörpergranulomen. Residuen einer abgeheilten Pneumocystis-carinii-Pneumonie bei AIDS.

Pneumocystis carinii pneumonia (PCP) is one of the most frequent infectious lung diseases in immunocompromised patients, especially in AIDS cases. The present case report describes pulmonary miliary microcalcifications with and without foreign-body reaction in a patient with successfully treated PCP who was known to have AIDS. This form of residues of completely healed PCP tends to be rare. Other infectious granulomas, foreign-body granulomas and sarcoidosis must be differentially diagnosed. After cautious decalcification, pneumocysts can be demonstrated with methamine silver (Grocott). It is important to be aware that PCP can also undergo spontaneous cure, so that miliary microcalcifications may then be the sole pointer to the presence of AIDS.

Intermittent activity-induced hemobilia caused by liver hemangioma.

BACKGROUND: Intestinal bleeding of unknown origin can lead to a difficult workup. Abdominal colic, melena/hematemesis, and jaundice represent the pathognomonic triad for hemobilia, but clinical presentation and etiology of this entity are varying. Seldom all of these symptoms are present, and rarely does hemobilia cause melena or hematemesis. Often the correct diagnosis is missed. Patients frequently have a long history of complaints and inadequate therapy. CASE REPORT: We report on a patient who complained of repeated, severe epigastric pain and massive melena induced by exercise activity. After 2 years of complaints and an unnecessary operation, ultrasound detected a liver hemangioma. It was supposed that the hemangioma was causing hemobilia during strenuous physical activity. The patient underwent a partial liver resection to eliminate the hemangioma. All complaints resolved, and the patient remained asymptomatic postoperatively. CONCLUSIONS: Physicians should be aware of hemobilia as a rare cause of upper gastrointestinal bleeding, especially if esophagogastroduodenoscopy cannot demonstrate any bleeding source. Ultrasound is able to visualize many diseases leading to hemobilia and should be integrated into the early workup of unclear intestinal bleedings.

[Tumor simulating primary pulmonary cryptococcosis in an immunocompetent patient. A contribution to differential diagnosis]. / Als Tumor imponierende primäre pulmonale Kryptokokkose bei einer immunkompetenten Patientin. Ein Beitrag zur Differentialdiagnose.

Case report of a primary cryptococcosis of the lung in a 78-year old non-immunocompromised female. The patient presented with a mass in the right upper lobe, highly suspicious of lung cancer. Cryptococcus finally was detected on repeated biopsies from ulcerated and necrotic bronchial mucosa. A clinical work-up showed no evidence of dissemination and no signs of immunoinsufficiency. Mass reduction in the lung was achieved under therapy with fluconazol.