[Costal osteoid osteoma]. / Kostales Osteoidosteom.

We report about a rare case of osteoid osteoma of the 9th rib in a 32 year old woman. A search of medical literature yielded only 16 reports about costal osteoid osteoma. This tumor should be considered in cases of painful rib without anamnestic trauma.

[Isolated ovarian metastasis of primary gallbladder carcinoma with estrogen and androgen production]. / Isolierte Ovarialmetastase eines primären Gallenblasenkarzinoms mit Ostrogen- und Androgenproduktion.

The rare case of an isolated ovarian metastasis of a primary adenocarcinoma of the gallbladder is reported: the ovarian metastasis was associated with androgen and estrogen production. The differential diagnoses are discussed.

Growth of Hodgkin cell lines in severely combined immunodeficient mice.

No animal model exists for the in vivo growth of Hodgkin's-lymphoma-derived cells. Neither unmanipulated Hodgkin's-disease(HD)-derived cell lines nor primary biopsy tissue could be grown in nude mice. Since the severe combined immunodeficient (SCID) mouse has been reported to be a better recipient for transplanted human lymphatic tissue than the nude mouse, we tested whether SCID mice provide suitable conditions for the in vivo growth of HD cell lines. Tumorigenicity of HD cells was tested in untreated and pre-treated SCID mice and in another combined immunodeficient mouse strain, beige/nude/X-linked immunodeficient (BNX) mouse. SCID mice supported in vivo growth of the 6 HD cell lines tested (L428, L540, L591, DEV, HD-LM2, KM-H2). Only one of the 6 lines (DEV) was tumorigenic in BNX mice. No HD cell line proliferated in T-cell-deficient nude mice. Thus, in vivo growth of HD cell lines appeared to be related to the degree of host immunodeficiency. Additional growth supportive treatments such as fibrosarcoma co-transplantation, intraperitoneal mineral oil injection or immunosuppressive pre-treatment (anti-asialo-GMI-antibody injection) permitted growth of 3 additional HD cell lines in BNX mice. The immunophenotype and karyotype of explanted graft cells were identical to the original cell lines. Our experiments describe an effective and reproducible xenograft model for growth of Hodgkin's-disease-derived cell lines. This may be of value for elucidating the growth characteristics of Hodgkin's-lymphoma-derived cells as well as for testing new therapeutic regimens.

Histological investigation for comparison of cartilaginous tumors of unknown biological course with unequivocal chondrosarcomas.

Morphological findings recorded from chondromatous tumors of unknown biological behaviour (n = 40) were compared with those obtained from unequivocal chondrosarcomas (n = 27), and the histological results were evaluated by clinical outcome. The morphological details were analysed by histological set up and summarized by Mirra et al. (1985): Two benign patterns, the enchondroma encasement pattern and the island of cartilage patterns, were the most common findings in cartilaginous tumors of unknown biological behaviour. Malignant patterns, such as chondrosarcoma permeation, invasion of the Haversian system, soft tissue mass and bands of fibrosis patterns were detected only in unequivocal chondrosarcomas. However, the enchondroma encasement pattern could be focally demonstrated also in central chondrosarcomas (n = 3), a phenomenon, which in our opinion could not be interpreted as being indicative of a preexisting benign lesion. Morphological classification of chondromatous tumors of unknown biological behaviour, as a group of benign cartilaginous tumors, enables their discrimination from unequivocal chondrosarcomas. This was also confirmed by the significant difference (p = 0.0065; Mantel-Cox) among survival curves after Kaplan and Meier (1958). We conclude that the above criteria, when applied with due caution, are helpful in classifying chondromatous tumors.

[Necrotizing fasciitis. Case report and review of the literature]. / Nekrotisierende Fasciitis. Fallbeschreibung und Literaturübersicht.

The necrotizing fasciitis is an infection with no or only a small trauma. It is a rapidly progressing process especially with necrosis and edema of subcutaneous fat and adjacent fascia underlined by systemic toxicity but spearing of skin and muscle by the initial process. Late recognition and lack of immediate aggressive surgical treatment contribute to the distressingly high mortality. Early and complete debridement offers the best chance for cure.

Right-ventricular hemangioma causing serious outflow-tract obstruction.

A 28-year-old woman had a partially nonexertional dyspnea and a murmur of pulmonary stenosis. Echocardiography and magnetic resonance imaging revealed a mass causing a nearly completely pulmonary outflow-tract obstruction. The mass was successfully resected and the pathological diagnosis of a mixed capillary and cavernous polypoid hemangioma was made. This case represents one of the very rare cases of a right-ventricular hemangioma in adults in which obstruction of the outflow-tract was initially evident. Non-invasive diagnosis and an exploratory operation with resection is the procedure of choice.

[Pulmonary lymphangiomyomatosis]. / Pulmonale Lymphangiomyomatose.

The case of a woman of 48 years of age suffering from pulmonary lymphangiomyomatosis is presented. Chest radiographs showed the reticular infiltrate of diffuse interstitial lung disease, whereas high resolution CT illustrated multiple, well-defined cystic lesions distributed diffusely through the lungs without fibrotic changes or nodular densities. The patient underwent open lung biopsy and pleurodesis because of recurrent pneumothorax. Treatment with medroxyprogesterone was initiated.

[Assessment of the grading of cartilaginous tumors of the long tubular bones from the radiologic and pathologic viewpoint]. / Zur Problematik der Dignitätsbeurteilung von Knorpeltumoren langer Röhrenknochen aus radiologischer und pathologischer Sicht.

Based on 46 enosteal cartilaginous tumours of the long tubular bones (43 patients) the established radiological and Mirra's histopathological criteria of tumour status are assessed independently and compared retrospectively. In lesions of Lodwick's type I B (37 cases) with mineralisation of the cartilaginous matrix and facultatively cortical arrosion, lack of periosteal reaction, destruction of the corticalis and parosseal tumour extension none of Mirra's histopathological criteria of malignancy was found. It may be expected that biopsy and histopathological examination will not give valuable additional information in this radiological constellation, because there are no known definite histopathological criteria of benignity. Suspicious radiological findings should prompt complete resection of the lesion. Biopsy and histopathological classification are always crucial when matrix mineralisation is lacking and therefore the diagnosis of a cartilaginous tumour cannot be established radiologically.

[Presacral malignant schwannoma]. / Präsakrales malignes Schwannom.

In a woman patient who was 69 years of age and who was free from complaints and symptoms we identified a cystic solid and partly calcified tumour of 11 X 9 X 7 cm size in the lower abdomen, as well as two circular pulmonary foci that were suspected of being malignant. Clinical, sonographical and radiological findings led to the suspected diagnosis of a pulmonary metastasizing ovarian carcinoma. However, laparotomy revealed that the tumour site was presacral and retroperitoneal. The tumour was extirpated, and the histological diagnosis was that of a malignant schwannoma. No radiotherapy or chemotherapy was initiated because of the slender changes of success and the considerable side effects. Clinical pattern, problems of diagnosis and the prognosis of these rare malignomas are discussed.

A mathematical model for metastatic growth illustrated by in vivo and in vitro growth of a transplantable mammary carcinoma in mice.

We analysed the growth pattern of metastases in C3H-mice produced by i.v. injection (tail vein) of tumor cell suspensions of mammary carcinoma HB. Although the ordinary Gompertz equation generally corresponds well to tumor growth in animals and men, we found it inadequate to describe the growth of lung metastases in our model. The morphometric analysis and growth kinetics (LI/GF) of the metastases show a biphasic pattern. The first phase is characterized by a strictly avascular growth and nutrition by diffusion, the second phase is initiated by tumor angiogenesis. To analyze these observations we developed a new mathematical equation which fits particularly well to the metastatic growth curve. We conclude that the present model is appropriate for the analysis of tumor angiogenesis, especially to study factors, which influence the development of a tumor specific vascular system.

[Initial experiences with nuclear spin tomography of bone diseases]. / Erste Erfahrungen mit der Kernspintomographie bei Knochenerkrankungen.

The results of MRT in 41 patients with bone diseases are reported. MRT proved to be a sensitive method in evaluating localised bone lesions. MR provided definite advantages in comparison with computed tomography and plain films in the determination of the intramedullary and extraosseous extent of circumscribed bone lesions. A better characterisation of the nature and histology of bone changes was not possible with MRT. Diffuse bone marrow disease are well demonstrable via MRT.

Magnetic resonance imaging of primary tumours and tumour-like lesions of bone.

The experience with magnetic resonance imaging (MRI) of 81 patients with primary bone tumours and tumour-like lesions is reported. MRI proved to be a sensitive method of detecting primary bone tumours. Intramedullary and extraosseous parts of bone tumours were delineated better than by plain films and computed tomography (CT). Surgical clips and Harrington rods did not appreciably limit the estimation of tumour recurrence. MRI provided definite advantages compared to CT in the surgical staging of bone tumours and tumour-like lesions. MRI was found to be an imaging method with low specificity. Differentiation of tissue components, such as haematoma, fat, necrosis, and cystic areas, led to a specific diagnosis only in rare cases. Plain films and CT were found to be superior to MRI in assessing the biological activity and the differential diagnosis of bone tumours and tumour-like lesions.

Comparative investigations on the effect of different dose schedules of the phase-specific drug vincristine (VCR) on the proliferation kinetics of a solid experimental tumour.

The aim of the present investigation was to study the effect of a high bolus injection (1 X 2.1 mg) of vincristine (VCR) during the phase of tumour growth retardation at the 14th day after transplantation and to compare the findings with the results of single (1 X 0.35 mg) and repeated (6 X 0.35 mg) applications of this cytostatic drug. Furthermore, an attempt was made to induce a synchronization of tumour cell proliferation. It was found that the effect on the volume growth was very pronounced after the high bolus injection and the repeated application of vincristine compared with the single low dose of the cytostatic drug. A synchronization of the tumour cell proliferation by flow out of the mitotic block could not be demonstrated. On the other hand a modest simultaneous recruitment of previously non-cycling tumour cells into the cell cycle occurred in the periphery of the tumour after the high bolus injection. The repeated application and the high bolus injection of VCR increased the cytostatic effect, especially in the tumour centre, related to the more slowly proliferating tumour cell compartment.

The influence of a solid tumor of the mouse on the proliferation kinetics of haemopoietic bone marrow cells.

It is generally accepted that cancer has strong effects on bone marrow cells (e.g. tumor-associated anaemia). The present investigation studies the proliferation kinetics of haemopoietic cells and the topographic differences in proliferation patterns in the bone marrow of tumor-bearing animals and controls. It was demonstrated that the differences in the cell cycle times, whether between peripheral and central parts of the bone marrow or between the experimental group and the control group, were slight or nonexistent. However, the growth fraction showed an increased proliferation rate in tumor-bearing as compared with normal animals (57% and 37%, respectively).