Trisomy 8 as sole karyotypic aberration in an ovarian metastasizing Sertoli-Leydig cell tumor.

Sertoli-Leydig cell tumors (SLCTs) represent a rare group of sex-cord stromal tumors of the ovary of unknown pathogenesis. We report a SLCT of intermediate differentiation with peritoneal recurrence and lymph node metastasis 12 months after removal, including cytogenetic analysis by comparative genomic hybridization and fluorescence in situ hybridization, which showed trisomy 8 as sole unbalanced karyotypic aberration. Our results provide evidence that a simple numeric chromosomal abnormality in SLCT may be associated with a malignant phenotype and suggest that the molecular pathogenesis of SLCT may be different from ovarian granulosa-stromal cell tumors.

[Intra-abdominal lymphangioma]. / Das intraabdominelle Lymphangiom.

Mesenteric cystic tumors are very rare. The incidence of the cystic lymphangioma, which belongs to this group, is even lower. Often it is mistakenly classified together with the chylous mesenteric cysts. The term "mesenteric cyst" is of a descriptive topographical nature, whereas the lymphangioma can be classified clearly by the histopathological findings. The lymphangioma typically appears in the first decade and when it is intra-abdominal it shows acute abdominal symptoms. Ultrasonography and computed tomography are very sensitive but not very specific examinations. The differential diagnosis of intra-abdominal lymphangioma includes many benign and malignant tumors. Therefore, a diagnosis is often first made during operation because of the macroscopic aspect and then definitely because of the histological examination. Differentiation between a mesenteric cyst and a cystic lymphangioma is important for the prognosis, because when there is a cystic lymphangioma with an incomplete resection, one has the danger of a recurrence with tendency to invasive growth. The therapy of choice is a complete radical resection. We report the case of an intra-abdominal lymphangioma and have studied the reports published about these tumors. We point out the clinical presentations, diagnosis, differential diagnosis and therapy of the lymphangioma.

Case report. Pathohistological findings in a clinical case of disseminated infection with Fusarium oxysporum.

Despite appropriate antimicrobial and antifungal therapy (amphotericin B), a disseminated infection with Fusarium oxysporum in a 75-year-old immunocompromised patient (acute myeloid leukaemia, minimal leucocyte count of 0.5 giga l-1) led rapidly to death. A similarly fatal course of an F. oxysporum infection has been reported in several cases. Fusarium oxysporum could be isolated shortly before death from blood cultures and from a swab taken from skin efflorescences. An autopsy revealed histopathologically typical fungal infiltrates in the mucosa of the pharynx, epiglottis, trachea, and oesophagus and in the parenchyma of the spleen, the lung and both kidneys. Because of the high risk of a fatal outcome of this infection, the clinician should aim at maximum diagnostic enforcement. We propose both analysis of blood cultures and immediate skin biopsy--with PAS-staining--of suspicious dermal efflorescences for microscopic examination. The treatment of choice is discussed controversially but a beneficial effect has been reported from granulocyte transfusion, subcutaneous administration of GM-CSF and concomitant treatment with amphotericin B.

Cytochrome P450 isoenzyme mRNA expression pattern in human urinary bladder malignancies and normal urothelium.

This study was designed to analyze the cytochrome P450 isoenzyme mRNA expression pattern of transitional cell carcinomas of the bladder (N = 19) and normal urothelium (N = 10). In addition, biopsies from normal urothelium (N = 32) taken at the time of transurethral resection of bladder cancer in eight patients from surrounding histologically normal urothelium also were characterized concerning their specific cytochrome P450 mRNA expression pattern. A total of 13 of 19 of the analyzed tumor specimens (68%) revealed expression of cytochrome P450 1B1. Cytochrome P450 4B1 and 1A1 mRNA expression were detected in 79% (15 of 19) and 53% (10 of 19) of the tumor specimens, with no correlation between tumor stage and grade of the neoplasm. Biopsies from macroscopically and histologically normal urothelium from tumor-invaded bladders also showed expression of cytochrome P450 1B1 in 75% (24 of 32), 4B1 in 62.5% (20 of 32), and 1A1 in 50% (16 of 32). Furthermore, a 75% homology concerning cytochrome P450 1B1 and 4B1 mRNA expression was observed between the bladder tumor and the biopsies from this bladder. The polymerase chain reaction analysis of normal urothelium from normal bladders that do not harbor a neoplasm revealed CYP450 mRNA expression for CYP450 1A1 in 6 of 10; 1B1 in 5 of 10; 4B1 in 6 of 10; 2D6 in 2 of 10; and 2E1 in 2 of 10. According to our data, CYP450 1B1 mRNA expression is not tumor-specific. The present findings are the first to compare CYP450 expression in bladder cancer with biopsies from the same tumor-bearing bladder, and they indicate that, from the enzymatic point of view, bladder cancer also is a panurothelial field disease present in even normal urothelium.

[Expanded, radical perineal prostatectomy]. / Die erweiterte, radikale perineale Prostatektomie.

One hundred and twenty-five consecutive patients with prostate cancer underwent an extended, radical perineal prostatectomy according to the technique described by VE Weldon. This technique was modified by an initial complete mobilization of the posterior aspect of the prostate and seminal vesicles from the rectum and pelvic wall, incision of the endopelvic fascia, and partial resection of the dorsal vein complex after suture ligature. The perioperative morbidity was low. An operative revision was necessary in four (3.2%) patients because of arterial bleeding from a drainage channel (n = 1), wound infection (n = 2), and rectocutaneous fistula (n = 1). The in-dwelling catheter was removed on day 4-8 in 104 (83%) patients. Positive surgical margins were diagnosed in 22 (17.6%) patients only. These patients had pT3 (n = 17) and pT4 (n = 5) tumors with a Gleason score > or = 7 (n = 17) mostly; extensive, multifocal capsular penetration (n = 18); seminal vesicle invasion (n = 11); and lymph node metastases (n = 4). The unifocal positive margins were localized at the apex (n = 3), dorsolateral (n = 6) aspect, and bladder neck (n = 4). In nine patients, multifocal positive surgical margins were noted. The risk for a positive surgical margin depends on the serum PSA level, Gleason score, and tumor volume. In case potency preservation is not considered, the extended, radical perineal prostatectomy with the above mentioned modifications should be considered to guarantee a low rate of surgical margins.

Expression of heat shock proteins 72/73 in human peritoneal mesothelial cells in vivo and in vitro.

Leukocyte accumulation during peritonitis leads to an injurious microenvironment which is involved in the host defense reaction but is also thought to cause peritoneal damage. We tested the hypothesis that mesothelial cells (MC) respond to the injurious microenvironment during peritonitis by an increased expression of heat shock proteins (HSP 72/73), a basic way by which cells are protected against injury. Comparison of resting MC and activated MC during peritonitis in vivo by means of immunohistochemistry revealed an increased expression of HSP 72/73. As assessed by Western immunoblotting, incubation of MC in vitro with tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) caused a time-dependent induction of HSP 72/73 expression, which was maximal 6 h after stimulation. We suggest that the increased HSP 72/73 expression of MC during peritonitis is in part induced by TNF-alpha and IL-1beta and may exert a cell-protective function, lessening MC damage during peritonitis.

[Primary liposarcoma of the stomach wall--a rare mesenchymal tumor]. / Primäres Liposarkom der Magenwand--ein seltener mesenchymaler Tumor.

INTRODUCTION: Primary liposarcoma of the stomach wall is rare. Only eight cases have been described so far. MATERIAL AND METHOD: Here we report the ninth case, occurring in a 74-year-old woman who presented with weight loss and a therapy-resistant ulcer of the stomach wall. RESULTS: Pre- and perioperative findings suggested a benign lipoma of the stomach wall. The patient was treated with subtotal gastrectomy. On microscopic examination the tumor showed features of a benign lipoma but for a distinctive capillary net. Immunohistochemically the S-100 reaction was positive. Less than 1% of Ki67-positive cells could be found, thus suggesting a highly differentiated primary liposarcoma of the stomach wall. CONCLUSION: In situations where the benign or malignant nature of a submucosal lesion cannot be diagnosed with certainty a mesenchymal tumor of the stomach wall has to be included in the differential diagnosis. Here the indication for complete surgical excision and histological workup has to be set widely.

[In vitro analysis and animal experiment study of surface modified biodegradable polylactide ureteral stents]. / In-vitro-Analytik und tierexperimentelle Untersuchung oberflächenmodifizierter biodegradierbarer Polylactidureterstents.

With the objective of developing a biodegradable ureteric stent, various polylactides were analyzed and grafted with a clinically adapted surface. Stent moulding was performed by CESP technology (Controlled Expansion of Saturated Polymers), which is not based on high temperature but gas-loading under high pressure which induces a foamy bulk structure. The hydrolytically biodegradable, synthetic homo- and copolymers poly(D,L-lactide) (PDLLA), poly(D,L-lactide-co-trimethylene-carbonate) (PDLLA-co-TMC), poly(D,L-lactide-co-glycolide) (PDLLA-co-Gly) as derivatives of lactic acid or glycolic acid and surface modifications with hydroxyethylene-methacrylate (HEMA) and oligoethyleneoxidemonomethacrylate (OEOMA) were analyzed with regard to cytotoxicity and cell adhesion. Methacrylates have minimized protein and cell adhesion and degradation of non-toxic products. All polymers exhibited a high degree of biocompatibility and cell adhesion was markedly reduced following HEMA grafting. A 3 cm and 7 Charrière prototype of the stent was moulded from PDLLA-co-TMC by CESP-technology, and grafted with HEMA by means of plasma-induced polymerization. Finally, the stents were implanted into female sheep, following unilateral ureterotomy. Regular blood and urine analysis as well as ultrasound and the final autopsy revealed no pathological findings. Histopathological analysis exhibited a regular epithelium without any changes being determined by contact to the stent, and a good regeneration of all layers in the area of anastomosis.