Predominant intraepithelial localization of primed T cells and immunoglobulin-producing lymphocytes in Graves' disease.

It has been proposed that intrathyroid lymphocytes, localized in specific anatomical sites might have distinct, pathophysiologically relevant functions in Graves' disease. However, most studies of intrathyroidal lymphocytes were restricted to two lymphocyte locations and used semiquantitative methods. Therefore we used seven anatomically different lymphoid compartments to classify and evaluate by quantitative representative methods the total intrathyroidal lymphocytic infiltration and the staining indexes for immunoglobulin-producing plasmocytes and primed T cells (CD45RO), which provide maximum help to pokeweed mitogen-stimulated immunoglobulin synthesis in 36 thyroid glands from patients with Graves' disease. We found only 3.4% of all intrathyroidal lymphocytes intraepithelially. However, only intraepithelial lymphocytes showed a significantly higher staining index for primed T cells compared with several other compartments. There was also a high staining index for immunoglobulin-producing lymphocytes in this compartment. Kappa- and lambda-positive plasmocytes were found in a polyclonal distribution (kappa:lambda = 64.1: 35.9) in all compartments. This increased incidence of CD45RO-positive T lymphocytes and of immunoglobulin-producing lymphocytes among the intraepithelial lymphocytes suggests a distinct pathophysiological function of lymphocytes in peripolesis in Graves' disease. Furthermore, there is a polyclonal intrathyroidal immunoglobulin synthesis.

[An unusual differential diagnosis of cancer of the base of the tongue: malacoplakia]. / Eine ungewöhnliche Differentialdiagnose zum Zungengrundkarzinom: Malakoplakie.

A rare case is presented of a 68-year-old patient, suffering from malacoplakia of the base of the tongue. Up to now, only seven patients with manifestations of this chronic inflammatory disease in head and neck have been reported. Histologic features and therapeutic approaches are discussed, followed by a short review of the literature.

[Kala-azar originating in Ischia]. / Kala-Azar aus Ischia.

Four weeks after returning from a holiday on Ischia, a 53-year-old man fell ill with nocturnal sweating, fever, severe general malaise and hepatosplenomegaly. Sternal marrow and liver punctures revealed an infection with Leishmania donovani, i.e. Kala-Azar. Characteristic features were hyperplasia of the plasma cells in the bone marrow and liver, together with lymphoplasmocytoid cell wash-out and polyclonal IgG proteinaemia. Treatment with pentamidine (Lomidine) was unsatisfactory, while all manifestations of the disease regressed after two courses of sodium stibogluconate (Pentostam), although the hypergammaglobulinaemia and hyperproteinaemia disappeared only slowly. The plasma-cell hyperplasia in conjunction with the hypergammaglobulinaemia, which suggest multiple myeloma, is interpreted as a result of antibody formation by the chronic parasitic infection. Together with storage-cell hyperplasia it is also taken to be the cause of the peripheral leukopenia and thrombocytopenia.

[Hypercalcemias in chronic lymphatic leukemias and other non-Hodgkin's lymphomas]. / Hypercalcämien bei chronisch lymphatischen Leukämien und anderen Non-Hodgkin-Lymphomen.

Three years after diagnosis of chronic lymphocytic leukaemia in a 57 year old man developed a hypercalcaemia with multiple bone fractures, concomitant an increase of activity of the leukaemia. There was no hyperparathyroidism, nor in serum, nor inside the lymphocytes. The osteopenia was caused by leukaemic infiltrations. An additional activation of osteoclasts was caused by an osteoclasts activating factor (OAF), produced by the leukaemic cells. 2 (= 2.25%) of 89 Non-Hodgkin-Lymphomas except chronic lymphatic leukaemia had a moderate hypercalcaemia with concomitant activation of the underlying disease. 9 (= 7.7%) of 116 chronic lymphocytic leukaemias had hypercalcaemia, 2 thereof with increased activity of the leukaemia. Hypercalcaemia is thus very rarely found in other Non-Hodgkin-Lymphomas, in chronic lymphocytic leukaemia some what more often, and only here a concomitant increase in the activity of the underlying disease could be observed in some cases.

[Invasive meningioma of the anterior cranial fossa. Report of 2 cases]. / Das invasive Meningiom der vorderen Schädelgrube. Bericht über zwei Fälle.

Two cases of falx-meningiomas are reported. In both cases there was tumor infiltration of the skull base, orbital caves and paranasal sinus at the time of diagnosis. The histological diagnoses were hemangiopericytic meningioma and atypical meningotheliomatous meningioma. Prognosis and therapy are briefly discussed.