[Ultrasound investigation of cervical lymph node metastases: conception and results of a histopathological exploration]. / Ultraschalluntersuchung zervikaler Lymphknotenmetastasen: Konzept und Ergebnis einer histopathologischen Aufarbeitung.

BACKGROUND: Ultrasound (US) is one of the most important methods for detection of cervical lymph node metastases in malignancies of the head and neck. In our study, the specificity of ultrasound was explored by a special, histopathological exploration considering the anatomical regions of the neck. METHODS: Thirty-eight patients were studied (5 female, 33 male, age: 38-86 years) with different histology and incidence of metastatic spread of head and neck cancers. Forty-six neck dissections were performed (30 radical and 16 selective). Histological exploration was performed after pinning the neck soft tissue with needles to anatomical live drawings of the lymph node regions, a modification of the Medina procedure. This procedure allowed a correct topographical assignment of lymph node metastases and comparison of preoperative sonographical findings with histopathological results. RESULTS: We isolated 1333 lymph nodes, 137 of them infiltrated by metastases. These lymph node metastases were found in 28 of 46 neck dissections. The number of lymph nodes in radical neck dissections ranged from 21 to 60 (mean: 36), in selective neck dissection from 1 to 43 (mean: 16). Sensitivity, specificity, and accuracy of ultrasound reached 96%, 69%, and 78%, respectively. Seventy-two lymph node metastases (52%) of 12 neck dissections could not be evaluated by ultrasound. CONCLUSIONS: Our results confirm the reliability of ultrasound regarding sensitivity, specificity and accuracy of US-detectable cervical lymph nodes as reported in world literature. However, we were able to demonstrate in special histopathological explorations, that ultrasound did not detect more than 50% of present lymph node metastases in our series. We consider it essential to perform histopathological explorations of the soft tissue of the neck as described in our study to evaluate the efficacy and reliability of US, CT, and MRI in detecting lymph node metastases of head and neck malignancies.

Analysis and purification of phorbol esters using normal phase HPLC and photodiode-array detection.

For the first time a normal-phase HPLC method using photodiode-array detection is described for the analysis and purification of phorbol esters. The use of the method is demonstrated with examples of 10 different tigliane and daphnane esters (TPA, DOPP, DOPPA, Sap A, Sap B, Sap C, Sap D, Thy A, Ro and Rx). Both analytical and semipreparative techniques were developed. The method has been used in the final purification of DOPP and Rx from plant extracts. The method can be employed in the areas of phytochemistry, biochemistry and pharmacology/toxicology, where small samples of the toxic materials are required for research.

Bilateral ventricular neurofibroma of the larynx.

Laryngeal neurofibroma (LNF) is an unusual tumour and only approximately two dozen cases have been reported previously. Isolated LNF not associated with von Recklinghausen's disease is even more unusual. According to a review of the available literature, the case presented is the first bilateral one and the first originating from the ventricles. The tumour was removed completely by microlaryngoscopy without tracheostomy. The macroscopic and light macroscopic findings are presented and a review of the literature on neurogenic tumours in the larynx is presented.

Retro- and para-pharyngeal ganglioneuroma.

A patient with slight dysphagia and dyspnoea on exertion was referred to us. We diagnosed a large retro- and para-pharyngeal ganglioneuroma. The mass was surgically removed in toto. The case is presented and the features are discussed.

[Synovial sarcoma, a rare tumor of the larynx. Case report and differential diagnostic considerations]. / Das Synovialsarkom, ein seltener Tumor des Larynx. Falldarstellung und differentialdiagnostische Uberlegungen.

The synovial sarcoma of the larynx is a very rare tumour. Only six cases have been published so far in international literature. We describe a synovial sarcoma of the larynx in a 53-year old patient. Laryngectomy and neck-dissection were performed, followed by adjuvant radiotherapy. 16 months after therapy neither locoregional recurrence nor lung metastases have occurred. Clinically, an attempt can be made to differentiate a synovial sarcoma from a squamous cell carcinoma based on the appearance of the surface epithelium. It is still a problem to safely establish the diagnosis of a synovial sarcoma on the basis of a biopsy. The poor prognosis of this tumour requires radical surgical removal. The effects of radiation are discussed controversially.

Nasopharyngeal angiofibroma: an immunohistochemical study of 32 cases.

Thirty-two cases of nasopharyngeal angiofibroma, including 2 recurrences, all of which had been excised from males between 7 and 25 years, were subjected to systematic immunohistochemical study. Most of the tumour vessels, which lacked elastic laminae, were characterized by vascular walls of irregular thickness and variable muscle content. In places endothelial cells were only separated from the stroma by a single attenuated layer of contractile cells, whereas elsewhere the same vessel walls showed pad-like thickenings of their muscle coat. All cells of the vessel walls showed immunoreactivity for vimentin and smooth muscle actin, whereas desmin-positive cells were present only in small numbers in some vessels, generally those with thicker muscle coats. The stromal cells were decorated by vimentin antibodies only; however, in some more fibrotic hyaline areas the stromal cells displayed also reactivity for smooth muscle actin. In most cases S-100 protein-staining disclosed many nerves, and this accentuated their parital distortion by tumour tissue. Our findings provide an extended insight to the morphology of angiofibromas at this site, particularly highlighting the irregularity of their vascular walls, which, taken together with the lack of elastic laminae and elastic stromal fibres, can be held responsible for the typical pronounced tendency for haemorrhage in these lesions.

Synovial metaplasia of the skin.

We present two female patients, aged 15 and 45 years, with synovial metaplasia of the skin. Both lesions, localized in the knee and hand respectively, arose after preceding local trauma. Case 1 had intradermal irregular cystic spaces in the adjacent myxoid stroma of which large polygonal eosinophilic cells were found. In contrast, case 2 was characterized by a longitudinal space within the lower dermis and subcutis which was lined by a membrane similar to hyperplastic synovium. The cells of the membrane showed an eosinophilic spindle shaped cytoplasm with processes towards the lumen. In both cases the eosinophilic cells, strongly suggestive of fibroblasts, showed staining for vimentin only, whereas no reactivity could be obtained with antibodies to actin, desmin, S-100 protein, Factor VIII related antigen, cytokeratin, epithelial membrane antigen, carcinoembryonic antigen and CD 68. The absence of CD 68 positivity differs from that seen in normal and hyperplastic synovium. Delayed wound healing around a nidus seems the most likely cause of the change.