Metastatic malignant acrospiroma of the hand.

We present the case of a 37-year-old man with multiple pulmonary metastases of a primarily unknown primary tumour. Thorough revision of the medical history yielded that he had already passed three resections of a right palmar mass, which had been described as a benign tumour. Clinical examination showed a thickened scar with a suspicious palpable mass in the right hand. Excision of this scar and the tumour mass with histopathological examination now revealed a malignant acrospiroma. Resection of the pulmonary metastases histologically also confirmed a malignant acrospiroma. The following radical resection of the metacarpals II and III with the index and middle finger under the assumption of a wide compartment resection achieved tumour free margins and proved to be efficient with the patient being relapse free for 4 years from this operation. Although the prognosis of this tumour is generally unfavourable this particular case demonstrates the value of a radical surgical resection as the mainstay of treating such highly malignant sweat gland tumours of the hand.

[Recurrent, primary multifocal malignant melanoma of the mucous membrane of the upper respiratory tract. Peculiarities of the in-situ components]. / Rezidivierte, primär multifokale maligne Melanome der Schleimhäute des oberen Respirationstraktes. Besonderheiten der in situ-Komponente.

We report on a patient who at 61 years of age presented with two nodular melanomas in the right nasal cavity. These tumors were limited to the mucosal membrane and were accompanied by a large amount of atypical hyperplasia of the melanocytes within the glandular and surface epithelium of various other samples of the mucous membrane, a finding also verified immunohistochemically. These tumors were treated surgically. In the clinical course, after a prolonged tumor-free interval, a malignant melanoma of the contralateral nasal cavity occurred, in addition to recurrences in the area of the primary tumor. It seems likely that the large, diffuse proliferation of atypical melanocytes observed could have been the starting point of both the tumor recurrences and the second primary. Thus, in a histologically proven melanoma in the mucous membranes of the upper respiratory system, a more intense preoperative histological diagnostic procedure, in given cases with the assistance of immunohistochemical methods, could be useful to demonstrate intraepithelial atypical melanocytes. It is possible that by doing this the present poor prognosis for mucosal melanomas of the upper respiratory tract might be improved.

[Weil's disease and necrotizing herpes pneumonia as the cause of death of a 39-year-old sewage drain worker]. / Weil'sche Erkrankung und nekrotisierende Herpespneumonie als Todesursache bei einem 39 Jahre alt gewordenen Kanalarbeiter.

Acute leptospirosis in Europe (Weil's disease) is a rare and in more than 90% of the cases undiagnosed febrile, self-limited disease. We report the case of a 39-year-old sewerage worker, who was admitted to our hospital with fever, jaundice, pain in his calves and acute renal failure. Serology revealed elevated antibody titers against Leptospira canicola, L. icterhaemorrhagica and L. sejroe. The patient developed disseminated intravascular coagulation (DIC) with diffuse gastrointestinal bleeding due to thrombocytopenia. The ECG showed atrial fibrillation with irregularly irregular rhythm. Cardiac arrest developed, most likely due to hypoxia, with a drop in the blood pressure. Despite immediate resuscitation efforts the patient developed severe hypoxic brain damage and died a few days later. Autopsy disclosed histologic signs of a generalized leptospiral infection, signs of shock and within the lungs a necrotizing herpes simplex virus pneumonia causing the death of the patient. The virus pneumonia most probably was caused by retrograde canalicular dissemination of oral secretions since herpetic tracheitis and esophagitis were found and herpetic lesions were readily identified on the lips and tongue. A medical opinion asked for by the professional association having liability for occupational safety and insurance was given, the disease being recognized as an occupational disease.

[Alveolar adenoma of the lung. Immunohistochemical characterization of type II pneumocytes]. / Alveoläres Adenom der Lunge. Immunhistochemische Charakterisierung von Pneumozyten Typ II.

The alveolar adenoma of the lung is a rare benign tumor in which the normal parenchymal architecture is imitated by a proliferation of both the alveolar epithelial cells and the mesenchymal septal cells. The first description, based on six cases, was published in 1986 by Yousem and Hochholzer. From their ultrastructural findings they presumed a type II pneumocytes differentiation of the epithelial cells. We investigated an alveolar adenoma of the lung immunohistochemical by means of antibodies against apoprotein B and C of human surfactant. Both the lining cells and the macrophages in the alveolar-like spaces were stained. The septal connection tissue cells did not react. These findings confirm the expression of surfactant constituents and, hence, the differentiation into type II pneumocytes of the epithelial cells of the alveolar adenoma.

[Extensive pulmonary tumor embolisms of anaplastic thyroid gland carcinoma as a rare cause of hemorrhagic pleural effusion in an 88-year-old patient]. / Ausgedehnte pulmonale Tumorembolien eines anaplastischen Schilddrüsenkarzinoms als seltene Ursache von hämorrhagischen Pleuraergüssen bei einer 88jährigen Patientin.

An 88 year old woman without substantial previous illness was admitted to hospital because of a rapidly developing dyspnea and thoracic pains. X-Ray, CT scan and ultra sound showed a subdivided pleural effusion of the left side. After a short time a pulmonary infiltrate as well as a contralateral pleural effusion developed. Neither tumor cells nor mycobacteria could be detected in repeated pleural punctions. The general condition of the patient was deteriorating continuously while an antibiotic therapy given in the meantime only led to a temporary recovery. Three weeks later the patient died under the picture of a cardio-respiratory failure. At autopsy the lungs showed parenchymal haemorrhages and multiple infarctions as well as pleural effusions. The above mentioned changes could be explained histologically by tumor embolism of small pulmonary arteries from an anaplastic thyroid carcinoma. The discussion gives a short survey about already published cases of tumor embolism in the lung. PMVC as the diagnostic method of choice is discussed.

[Hereditary angioneurotic edema. Clinical syndrome and therapy]. / Hereditäres angioneurotisches Odem. Klinisches Syndrom und Therapie.

Hereditary angioneurotic edema is transmitted as an autosomal dominant disease. It is characterized by a deficiency of the C1 esterase inhibitor. Clinical manifestations are periodic swelling of the extremities, face, upper airways and abdominal viscera. We described one patient to demonstrate the clinical features and current treatment. Danazol therapy is discussed.

[Burn injuries during surgery (author's transl)]. / Zur Problematik intraoperativer Verbrennungsschäden.

The simultaneous use of high frequency apparatuses and a heated water bed may, in certain unfavourable circumstances result in burn injuries.