Malignant mesothelioma of the pleura. A prospective therapeutic study of 132 patients from 1981-1985.

Between March 1981 and February 1985, 93 out of 132 patients with a histologically confirmed diagnosis of malignant pleural mesothelioma were eligible for therapy and were prospectively assigned to receive either combined therapy or best supportive care, according to their personal preferences. Fifty-seven patients underwent multimodal therapy including surgical resection where possible, polychemotherapy, and radiation therapy in case of partial remission. Thirty-six patients received maximal supportive care only, as did 39 patients who were not eligible for treatment. The median survival was 13 months for treated patients compared to 7 for those receiving best supportive care and 5 for patients not amenable to treatment. Median progress-free survival was 6, 2, and 1 month respectively. Surgical resection did not prolong life expectancy within the treated group. In view of significant differences in the distribution of various cofactors over the two study groups, stepwise Cox model analyses were performed. Prognostic nontreatment variables related to prolonged survival were: good performance status, stage I and II, absence of chest pain, age below 50 years, and epithelial histology. Although in the Cox model analyses the survival improvement of patients being treated could be greatly attributed to other cofactors, multimodal treatment showed some prolongation of life expectancy.

[Computed tomographic findings in diffuse malignant pleural mesothelioma]. / Computertomographische Befunde bei diffusem malignen Pleuramesotheliom.

Malignant pleural mesothelioma is a rare tumour and often difficult to diagnose. In this report, the CT findings of 50 patients with proven malignant pleural mesothelioma are described and tabulated. In 31 cases the CT findings could be compared with the results of thoracotomy and thoracoscopy. CT proved reliable in evaluating the exact extent of the disease. Additionally, a combination of findings can be detected by CT, suggesting the diagnosis of malignant pleural mesothelioma. The limitations of CT in malignant pleural mesothelioma are discussed.

Lipid-rich cell adenoma of the thyroid gland. Report of a peculiar thyroid tumour.

A thyroid adenoma consisting of lipid-rich follicle cells is presented which has not previously been described in this organ. The discussion focuses on the possibility of its metaplastic origin and on its histological analogy to lipid-rich carcinoma of the breast.

Adenolipoma (thyrolipoma) of the thyroid gland report of two cases and review of literature.

Rare fat cell-containing adenomas (adenolipomas) found in the thyroid gland of two patients are presented. Previously documented cases are reviewed. An origin from embryonic rests for these tumours as for diffuse lipomatosis of the thyroid is discussed.

[The incidence of regional lymph node metastases in operable prostatic carcinoma (author's transl)]. / Hüfigkeit regionärer Lymphknotenmetastasen beim operablen Prostatakarzinom. Analyse von 165 radikalen Prostatektomien.

Operation specimens of 165 radical prostatectomies were examined systematically for their pathological anatomy. In 22 cases (13.3%) there were metastases in the obturator and (or) iliac lymph nodes, in 12 cases these were micro-metastases with a maximal diameter of 2 mm. Ten were classified as N1, 7 ad N2 and 5 as N4. Lymph node involvement increased with increasing tumour staging: from 10% in T2 to 26.3% in T3. All metastasizing tumours had invaded the capsule (P3), 77% had additional infiltration of the seminal vesicles and in 73% the tumour volume was at least 50% that of the prostate. Thus prostate carcinoma must reach a certain size and penetrate the capsule before lymph node seeding occurs. The rate of metastases increases ninefold when the seminal vesicles are infiltrated. All metastasizing prostate cancers were polymorphic and in 73% the tumour differentiation in the metastases was identical. The findings as regards localisation of the tumour in the prostate and the metastases correlated in 91%. This result leads one to suspect a regular course of laterally localised spread in which the group of obturator lymph nodes appears to lie in the primary lymph drainage area of the prostate. The prognostic significance of regional lymph node metastases cannot yet be evaluated.

Immunohistochemical analysis of thyroglobulin synthesis in thyroid carcinomas.

This immuno-histochemical description of thyroglobulin synthesis in human thyroid carcinomas is based on the analysis of 72 malignant thyroid neoplasms and about 100 cases of thyroid adenomas and other diseases of the thyroid gland. In our experience immuno-histochemistry has been an invaluable diagnostic adjunct to light microscopy for three reasons: 1) as an approach to a functional classification of thyroid carcinomas, 2) as an aid in the differential diagnosis of thyroid carcinomas of follicle cell type from tumors of other origins, 3) as an aid in the functional classification of non-cancerous thyroid tissue. In the field of metastasizing thyroid carcinoma this immuno-histochemical approach combined with a morphometrical method may enable accurate identification of patients for whom radioiodine therapy is appropriate.

[A comparative clinical and pathological study on the classification and prognostic features of 57 thymomas. I. Microscopy and ultrastructural pathology (author's transl)]. / Klinisch-pathologische Studie zur Klassifikation und Prognose von Thymustumoren. I. Histologische und ultrastrukturpathologsiche Untersuchungen.

Fifty-seven thymomas, defined as neoplasms of the epithelial-reticular framework cells of the thymus, were assessed in respect to histologic type, inclusive of there ultrastructural aspects. The median age of the 57 patients was 40.4 years, with a range of 2 1/2--72 years. All neoplasms were located in the anterior mediastinum. The tumours in 40 cases were encapsulated and without invasion of adjacent tissue or implants (equal to non-invasive thymomas). The tumors in 17 cases were invasive of adjacent tissue, particularly mediastinal pleura, pericard and trachea. Six of 57 patients (equal to 10.5%) with thymomas have had a thoracic and supraclavicular lymph node metastasis, and osteolytic metastases in the vertebrae and sternum. Thirty-seven (equal to 64.9%) were so-called lympho-epithelial, 7 (equal to 12.3%) pure epithelial, 4 (equal to 7.0%) atypical (or anaplastic) with granulomatous focuses, 3 (equal to 5.3%) carcinoid and one (equal to 1.8%) seminomatous tumors. One patient have had a thymic cyst as a tumor-like conditions of the thymus, and four patients (equal to 7.0%) have had a thymo-lipoma. The histologic type of thymoma had no proof value in predicting prognosis with the exception of the so-called atypical or anaplastic thymoma. The fine structural aspects of thymomas and the fine structural differential diagnosis of anterior mediastinal tumors are discussed.

Carcinoma and dysplastic lesions of the prostate. A histomorphological analysis of 50 total prostatectomies by step-section technique.

50 prostate carcinomas which were totally prostatectomized together with removal of the seminal vesicles in all cases and pelvic lymphadenectomy in 38 cases were studied histologically. The material was cut by step-section technique in 5 mm thick slices and "large area slides" were made. 4 of the 50 carcinomas were morphologically circumscribed (stage I), 6 tumors were limited to the organ (stage II) and 40 prostate carcinomas had already penetrated the capsule, i.e. fascia of Denonvillier (stage III). In 12 cases the seminal vesicles were involved, regional lymph node metastases were seen 8 times. The carcinomas were mainly localized in the peripheral part of the organ (28 X in the periphery, 21 X both peripherally and centrally and only 1 X in the centre). Multifocal tumor growth was found in 30 cases (60%). The main mass of tumor was mostly situated in the middle (25 X) and caudal (15 X) zone of the prostate. During the course of tumor growth the expansion was directed centrally but then mainly longitudinal and parallel to the urethra. By progressing tumor volume there was a noticeable increase in capsular penetration as well as infiltration of the seminal vesicles and lymph node metastases. Histologically 10 carcinomas showed a uniform pattern, a unique solid and/or cribriform tumor architecture was never observed. 90% of the pluriform carcinomas consisted of the morphological stage III.

[Thymic carcinoid. Case report and review of the literature (author's transl)]. / Thymus-Carcinoid. Fallbericht und Literaturübersicht

A case of a primary thymic carcinoid tumour of a 32 year old male is reported, and the previously published 25 cases are reviewed. The neoplasms occur in adults, predominantly in males: they are located in the anterior or antero-superior mediastinum. The only sufficient treatment is the surgical excision; through radiotherapy may be indicated in some cases, too. The tumour is characterized by the formation of rosettes, ribbons and garlands; sheet-like or medullary areas, and large clusters with central necrosis. The tumour is positive for the Grimelius argyrophil silver stain. Ultrastructurally numerous dense-core "neurosecretory" granules are observed. The formal pathogenesis is similar to that of carcinoid tumours of other locations; particularly of those arriving from derivates of the foregut, respectively from the APUD cell system. At present it cannot be decided whether this particular tumour of the thymus represents an autochthonic thymic carcinoid or simply a teratoma with a differentiation in one direction in the sence of a simplified teratoma.

[Ultrastructure and formal pathogenesis of embryonal rhabdomyosarcoma (author's transl)]. / Zur Ultrastruktur und formalen Pathogenese des embryonalen Rhabdomyosarkoms

An embryonal rhabdomyosarcoma of the nasopharynx of a 10 year old boy is analysed with light and electron microscopy. With regard to cell shape and cytoplasmic features the following four tumour cell types could be distinguished: 1. Undifferentiated mesenchymal cells with a big loosely packed nucleus and a small cytoplasmic rim with only few cell organelles; 2. Undifferentiated tumour cells with a broad cytoplasmic body which contains a dense network of nonspecific intermediate filaments with a diameter of about 100 A; 3. Immature rhabdomyoblasts with randomly orientated specific myofilaments; 4. Fully differentiated rhabdomyoblasts with well developed myofibrils often showing a sarcomeric pattern. Glycogen deposits which were seen in great masses in many tumour cells were regarded to result from degenerative processes within the tumor. The cellular stages in the development of rhabdomyoblasts are basically identical to those known from the embryogenesis and regeneration of striated muscle. From these observations the two following developmental pathways are suggested: 1. Origin of the tumour from an undifferentiated mesenchymal cell; 2. Atypical regeneration of striated muscle which terminates in malignant progressive tumour growth. At present, the body of information about rhabdomyosarcomas supports the assumption of an origin from immature mesenchymal cells. Nevertheless, the second theory cannot be totally excluded.