Role of liver transplantation in hepatobiliary malignancy.
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Aged↗
Biomedical subjects
A Beham
Publications and source records attributed to A Beham.
Lipoma of the liver: computed tomographic, ultrasonographic, and cytologic findings.
A hepatic lesion, manifest for several years in a 59-year-old female patient, was diagnosed as lipoma in the pre-contrast scan because of its attenuation value (-87 Hounsfield units (HU)); in addition, diagnosis was confirmed by aspiration cytology. In this case report the great merit of transmission computed tomography (TCT) is demonstrated, and ultrasound patterns and possible histogenetic origin of this neoplasm are discussed. The lipomatous liver tumors described in the literature with attenuation values of less than -60 HU are merely mixed tumors with lipomatous amounts of various sizes, whereas in true lipomas attenuation values from -80 to -120 HU have been measured.
Biopsy↗
Thyroid infiltrating dendritic cells, epitheloid cells and giant cells in iodine deficiency.
This study describes dendritic cells in thyroid sections of iodine deficient goiters. Cells were characterized by monoclonal markers and detected by immunohistochemistry and double labelling immunofluorescence. We observed dendritic cells located in focal aggregates in the interstitium and epitheloid cells as well as multinucleated giant cells filling thyroid follicles. All these cells showed strong positivity for the MHC class II molecules HLA-DR, -DQ, -DP and RFD1, a monoclonal marker for active antigen presenting cells.
Antigen-Presenting Cells↗
[Clinical significance of Tl-201/Tc-99m subtraction scintigraphy as a parameter for surgical indication of cold struma nodules].
In a retrospective study Tl-201/Tc-99m subtraction scintigraphy (method acco. to Ferlin et al.) was performed in addition to Tc-99m scintigraphy, sonography and fine needle puncture in 400 patients. Postoperative histological evidence was available of all patients (carcinomas [n = 31], follicular and oncocytic adenomas [n = 235], nodular hyperplasia, Hashimoto's thyroiditis, Riedel's struma and de Quervain's thyroiditis [n = 134]). With regard to possible malignancy the sensitivity, in case of positive Tl-201 uptake was 85%. As however, adenomas also have a high tendency towards isolated Tl-201 uptake, the specificity for malignant growth was 62%. Thus Tl-201/Tc-99m subtraction scintigraphy is well suited as a criterion to exclude thyroid carcinomas; on the other hand, a positive Tl-201 uptake is not a fail-safe indication of malignant processes. At best it suggests the occurrence of autonomous growth and can thus, in addition to sonography and fine needle biopsy, serve as an aid in the decision as to whether surgical intervention is indicated.
Adenocarcinoma↗
TA-stapler resection of congenital splenic cyst. Case report.
Splenic cysts are uncommon. Primary (true, epithelial) and secondary (false, non-epithelial) forms may be distinguished, the latter being more usual. Organ-preserving resection of a primary mesothelial splenic cyst, using a TA-stapler, is described and alternative techniques of splenic preservation are discussed.
Cysts↗
[Isolated thyroid gland sarcoidosis and hyperthyroidism].
A case of isolated sarcoidosis of the thyroid gland, associated with hyperthyroidism, is reported in a 28-year-old male patient whose thyroid was removed for hyperthyroid multinodular goitre. Histology revealed a regressive adenoma and sarcoidosis in non-adenomatous thyroid residue. Further diagnosis, therapeutic management and a 3-year follow-up did not disclose any specific changes or involvement of other tissues. Isolated thyroidal sarcoidosis with hyperthyroid alterations are extremely rare and mostly chance findings; simultaneous occurrence of thyroid sarcoidosis and hyperthyroidism may be a symptom of gland infiltration for which an adequate explanation is still lacking.
Adult↗
[Metastatic thyroid cancer: sudden death following aclarubicin therapy].
We report on a 62-year-old patient with a metastasising, only poorly differentiated follicular thyroid carcinoma, who was subjected postoperatively to chemotherapy with Aclarubicin. Aclarubicin (Aclaplastin) is a new cytostatic agent, from the group of anthracyclines, with fewer side effects and clearly diminished cardiotoxicity. The patient died suddenly after two treatment cycles with clinical symptoms of cardiac insufficiency; the post-mortem examination, however, revealed that two metastases in the myocardium might have been the cause of death; toxic myocardial damage could be excluded histologically. Upon occurrence of cardial symptoms and signs during therapy with cytostatic agents of thyroid carcinoma with Aclarubicin, whose cardiotoxic side effects are known, the possibility of metastatic spread in the myocardium should, nevertheless, also always be considered in the differential diagnosis.
Aclarubicin↗
[Abdominal fibromatosis in a 58-year-old male patient].
We report on a 58 year-old male patient, in whom abdominal fibromatosis occurred 3 years after laparotomy and irradiation on account of rectal cancer. Abdominal fibromatosis are very rare tumour-like fibrous lesions of the anterior muscular abdominal wall, mainly affecting fertile females. Men, however, are only rarely affected and without age preponderance. A hereditary or mutant generalized defect of growth regulation of fibrous tissue is considered to be the cause of this disease; moreover, trauma, hormonal effects and pregnancies often play a role as cofactors. Interestingly, there is a high correlation between abdominal fibromatoses and osseous lesions of the femur, mandible and thoracic, as well as lumbar spine. In our case thoraco-lumbar Scheuermann's disease was detected.
Abdominal Muscles↗
Spindle cell and pleomorphic lipoma: an immunohistochemical study and histogenetic analysis.
Twenty-two spindle cell lipomas and seven pleomorphic lipomas were investigated immunohistochemically in order to study the differentiation of the non-adipocytic elements. In all cases, neither spindle cells nor pleomorphic cells reacted with antibodies to a monocyte/macrophage antigen (MAC-387), fibronectin, laminin or type IV collagen. The absence of demonstrable basement membrane material argues against the possible prelipoblastic nature of these cells. With the antibody to S-100 protein, spindle cells were immunonegative, whereas pleomorphic cells sometimes revealed an intracytoplasmic weak to moderate staining reaction. In the light of what is known about the development of adipose tissue, our results would support the hypothesis of Bolen and Thorning (Am J Surg Pathol 1981; 5: 435-441) that spindle cell lipoma is composed of adipocytes and non-fat storing immature mesenchymal cells. It would appear that pleomorphic lipoma is similarly derived but that in some cases adipocytic differentiation is also abnormal. The characteristic clinical distribution of these two types of tumour may be of relevance in determining the cause of these unusual benign patterns of differentiation.
Adult↗
Hamartoma of the spleen with haematological symptoms.
We report the case of a 29 year old male patient with a splenic hamartoma suffering from infections, anaemia and thrombocytopenia. Shortly after surgical removal of the tumour the blood cell count was within normal range. Hamartomas of the spleen are rare benign tumour-like lesions composed mainly of vascular elements. Most of them remain small in size and asymptomatic and are therefore incidental findings at laparotomy or autopsy. However, occasionally they present with symptoms, among which haematological disturbances appear in very few cases; only 16 cases of splenic hamartomas with haematological symptoms are described in the literature. The major symptoms were anaemia and/or thrombocytopenia as well as frequent infections. After removal of these lesions the symptoms disappeared.
Adult↗
Extramedullary haematopoiesis in the thyroid gland.
The case of an 82-year-old female patient with extramedullary haematopoiesis in the thyroid gland due to agnogenic myeloid metaplasia is reported.
Adenoma↗
Diagnosis of hepatic hemangioma with 99mTc-labeled red cells: single photon emission computed tomography (SPECT) versus planar imaging.
This paper reports the results of a prospective study carried out to demonstrate the most important advantages of 99mTc-blood pool single emission computed tomography (SPECT) versus the established method of planar scintigraphy (PS) in the non-invasive diagnosis of liver hemangiomas. The study group comprised 40 patients in whom positive evidence of 56 hemangiomas, detected incidentally in the course of screening examinations, was established via SPECT and PS. The sensitivity of SPECT was 51/56 (91%), of PS 22/56 (39.3%); for lesions smaller than 30 mm in diameter, the sensitivity of SPECT was 31/38 (81.6%), of PS 6/38 (15.8%). All lesions with diameters of more than 30 mm were detected by both PS and SPECT. However, the SPECT method proved to be clearly superior in the identification of lesions which were smaller than 30 mm and located in unfavourable topographical sites (dorsal or subphrenic). The study proves that SPECT with 99mTc-labeled erythrocytes is the ideal complement to ultrasonography in the detection of liver hemangionas; its major advantage over TCT (transmission computed tomography) is its safe application in cases with contrast agent intolerance and hyperthyroid patients. Moreover, liver biopsies are dangerous and ill-suited for the verification of diagnosis.
Adult↗
99mTc-labeled monoclonal anti-carcinoembryonic antigen antibody (BW 431/26). Clinical results in the detection of colorectal carcinomas and recurrences.
With the introduction of 99mTc-labeled monoclonal antibodies against carcinoembryonic antigen (CEA) a clinically relevant extension can be expected in the diagnosis of colorectal tumors by immunoscintigraphy (IS). This study comprises a total of 49 patients (primary colorectal tumors, occult neoplasms, and suspicious recurrences), in whom IS with 99mTc monoclonal antibody (MAb) BW 431/26 was performed. After injection of 1100 MBq 99mTc MAb BW 431/26 a whole-body scan was performed in anterior and posterior projection 5 1/2 h later, and SPECT of the abdominal region was done after 6 and 24 h. In the course of primary tumor identification (n = 20) all coloscopically diagnosed and operatively verified carcinomas were confirmed and correctly localized by IS (n = 11). In three patients with positive IS and suspicious coloscopic findings surgery was refused by patients and relatives. In five cases IS was true negative and in 1 case false positive. In the diagnosis of recurrences (n = 29) IS showed an uptake in computer-tomographically and coloscopically suspicious areas in 17 cases. In 12 cases IS was rated negative (11 true-negative findings in scar and granulation tissue, 1 false-negative finding in para-aortal lymph nodes). Elevated serum CEA levels were found only in 17 of 31 patients with true-positive IS. In postoperative cancer care IS with 99mTc-labeled anti-CEA antibody plays a preeminent role in the exclusion or identification of colorectal recurrences.
Adult↗
[Immunohistochemical analysis of 42 renal cell carcinomas and one oncocytoma with mono- and polyclonal antibodies against vimentin and cytokeratin].
42 renal cell carcinomas and 1 oncocytoma were investigated by means of immunofluorescence (including double immunofluorescence) using a panel of mono- and polyclonal antibodies to vimentin and cytokeratins. In all tumors except chromophobe cell renal carcinoma (CCRC) and oncocytoma generally a coexpression of vimentin and cytokeratins could be demonstrated; however, the intermediate filament expression was often very heterogeneous with regard to the distribution of vimentin and cytokeratins in general, depending on the mono- and polyclonality of the antibodies and on the areas of a tumor investigated. In CCRC and oncocytoma all tumor cells contained cytokeratin filaments. In addition, as revealed by double immunofluorescence, in only occasional tumor cells we could demonstrate vimentin.
Adenocarcinoma↗
Intrathyroidal dendritic cells, epitheloid cells, and giant cells in iodine deficient goiter.
Immunohistochemistry and immunofluorescence were performed on thyroid sections of 44 consecutive patients undergoing thyroid surgery for goiter due to iodine deficiency. Sections were compared with specimens from ten individuals without goiters from the same endemic area, with specimens from ten sporadic nontoxic goiter patients, and with specimens from an area with sufficient iodine supply from nine healthy subjects. Cells were characterized using monoclonal antibodies to the CR3 receptor (CD11b) and the p150/95 antigen (CD11c) present on macrophages, to HLA-DR, to antigen presenting cells (RFD1), to T helper (CD4) and to T suppressor/cytotoxic cells (CD8), and with a polyclonal antibody to human cytokeratin. In iodine deficient goiters, focal aggregates were found of RFD1-positive dendritic cells. Furthermore, RFD1-positive epitheloid cells were seen. In 27% of cases, these epitheloid cells completely filled the thyroid follicles. Within the epitheloid cell clusters, multinucleated giant cells could be detected that carried the macrophage markers. Dendritic cells, epitheloid cells, and giant cells were strongly HLA-DR positive. In nongoitrous thyroids from the endemic area such aggregates could also be seen but they were more sparse and were RFD1 negative. Giant cells were absent there. In normal thyroids with sufficient iodine supply, only a few isolated dendritic cells were seen. All except RFD1, which was negative, showed the same marker pattern. In sporadic nontoxic goiters from an area with sufficient iodine supply, dendritic cells occurred in much higher numbers than in the normal thyroids from that area, and they were RFD1 positive. They never aggregated as in iodine deficiency, and giant cells were not observed. These observations on iodine deficient goiter strongly suggest involvement of active antigen-presenting cells in this disorder. However, the immunohistologic difference between this disease and sporadic goiter suggests different underlying mechanisms.
Adult↗
[Classification of colorectal cancers: current results from the catchment area of the Graz Institute of Pathology].
In comparison with the results of Dukes the percentage of stage Dukes A of colorectal carcinomas could be increased from 15% to about 27%, whereas the percentage of stage Dukes C decreased from 51 to 40% in some international medical centers during the seventies of this century. Our results in Styria are comparable. However, there was no further progress in the early diagnosis of colorectal carcinomas in Styria from 1984 to 1986 (42% of Dukes C stage cases) as compared with 1974 to 1979 (41% of Dukes C stage cases). The percentage of endoscopically removed tumors increased from 3% (1974 bis 1979) to 9% (1984 to 1986) of all curatively treated carcinomas. Because of the fact that the endoscopically removed tumors (stage pT1pNx) could not be classified according to Dukes, the percentage of Dukes stage A decreased from 30% (1974 to 1979) to 24% (1984 to 1986). But the small numbers of endoscopically removed tumors did not significantly influence the percentage of Dukes C stages. There was only partial success in the predominantly rural areas in which the percentage of Dukes C stages decreased from 47% (1974 to 1979) to 39% (1984 to 1986). 39% Dukes stage C in rural areas correspond to the percentage of the predominantly municipal areas (40%). This progress can be explained by the availability of colonoscopy to all hospitals in 1984 to 1986, which was not the case previously.(ABSTRACT TRUNCATED AT 250 WORDS)
Austria↗
[Chronic invasive fibrous thyroiditis (Riedel struma). Case report with special reference to preoperative diagnosis].
Chronic invasive fibrous thyroiditis (Riedel's struma) is a very rare disease of unknown aetiology mainly affecting middle-aged or old female patients. An aggressive fibrosis partly or totally replaces normal thyroid gland tissue. The gland becomes stony hard, is not displaceable and, characteristically, the fibrous tissue penetrates the capsule and infiltrates into surrounding structures such as muscles, vessels, nerves and even the trachea. Riedel's struma is often associated with fibrotic processes in other parts of the body. The preoperative differential diagnosis includes malignant tumours and fibrosing stages of Hashimoto's disease, as well as subacute thyroiditis de Quervain. This paper reports the case of a 60-year-old woman suffering from Riedel's struma and discusses differential diagnostic aspects with regard to preoperative investigation and pathohistology.
Biopsy, Needle↗
[Presence of islands of fatty tissue in struma].
We examined 929 surgically obtained thyroid glands derived from 791 female and 138 male patients and found intrathyroidal adipose tissue in 18 cases (1.94%). Only the thyroid glands of middle aged and older women (mean age 51 years) were affected, as well as in the case of follicular adenomas and nodular and diffuse hyperplasia. With respect to localization in the interstitial connective tissue, as well as between thyroid follicles, interstitial, parenchymatous and mixed types are proposed. In addition to sex and age there is a high correlation with obesity, which is suggestive of hormonal influences. Knowledge of the presence of intrathyroidal fat tissue is of interest to the pathologist since it may lead to erroneous interpretations of histological and cytological specimens of the thyroid gland. In conclusion, not one case of hypothyroidism was detected amongst the 18 cases investigated in this study.
Adenoma↗