Biomedical subjects
Publications and source records attributed to C Willgeroth.
A case of locally extensive perigenital Paget's disease in an 84-year-old man is presented. Topical application of 5-fluorouracil emerged as the safest and most effective treatment because of the patient's poor general condition and the extensive involvement of the pubic and genital skin.
The influence of pathomorphological parameters (keratinization, grading, nucleolar organizer region (NOR) counts, automatic analysis of micrographs) on prognosis was determined for 284 patients with carcinomas of the oropharynx or hypopharynx. Keratinization was found to have no influence on prognosis. Histopathological grading and automatic analysis of micrographs with mark 22 were seen to be of major relevance. Patients with grading 3 were noted to have a poorer prognosis than those with gradings of 1 or 2. This latter finding was statistically significant. Although the absolute NOR counts had no influence on prognosis, they did show a statistically significant effect on the extent of lymphogenic formation of metastases. Cox regression analysis of clinical and pathomorphological parameters revealed that combination therapy, tumor grading, and mark 22 of automatic analysis of micrographs were important factors relevant to prognosis.
It is supposed that the nucleolar organizer regions (NORs), genes on which ribosomal RNA is coded, may contain information on the structure of the nucleolus and on nucleolar activity which permits discrimination between normal and neoplastic cells and their proliferation activity. In the present study, the histological sections of 144 patients with carcinomas of the oropharynx and hypopharynx were studied in a retrospective approach to determine the absolute NOR counts per 100 nuclei and investigate their influence on the prognosis and extent of lymphogenic formation of metastases. An absolute NOR count of 681 per 100 nuclei was found to give reliable discrimination between stage N0 or N1 carcinomas and stage N2 or N3 disease.
In a period of 10 years (1981-90) papillary thyroid carcinomas were found in 124 cases. In 95 cases we were able to perform immunohistochemical studies for Leu-M1 antigen and S-100 protein. The examination of these cases has revealed that the presence of S-100 positive Langerhans cells yields no additional information for the prognosis of the papillary thyroid carcinoma. But we observed that the existence of Leu-M1 positive tumour cells is connected with a poor postoperative course of disease in comparison to Leu-M1 negative tumours.
Differentiated thyroid carcinomas (follicular and papillary) were found to differ, for several biological behaviours, from carcinomas of other organs and even from anaplastic carcinomas of the thyroid. These peculiarities are quite often morphologically characterised by mature, organ-like histological appearances, long-time encapsulation from adjacent thyroid tissue, and delayed metastasation. Proper judgement of need for surgery and operability, consequently, can be quite difficult. Any tumour, therefore, should be individually assessed, and caution may be appropriate when it comes to therapeutic decision-making. These tumours are briefly typed in this paper by their histological patterns. The unique nature is mentioned of follicular and papillary carcinomas. Reference is made to factors of relevance to prognosis.
Perirectal spreading of rectal carcinoma is significant for their therapy. Moreover, possible metastasis of the regional lymph nodes and/or of the liver must be detected before therapy. For preoperative staging CT-investigations in 52 patients were performed. For the tumour stages pT1 and pT2 correct CT-staging was achieved in 60% of the cases. CT-information on lymphogenic metastases is not satisfactory, liver metastases were detected with a sensitivity of 72%. 56 patients were investigated after abdominosacral rectum ablation. In 34 cases no local recidivation was detected, but 3 cases of liver metastases were found, also one metastasis of the kidney. Of 22 patients with regional recurrences 5 had liver metastases. 3 cases of lymphogenic metastasis were found.
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In spite of the great decrease in morbidity and mortality, tuberculosis still is important in autopsies. In our postmortem investigations on 65,002 unselected adults, from 1961 to 1985 we found 2,633 (4.1%) cases of tuberculosis, among them 1,471 (2.3%) inactive and 1,162 (1.9%) active forms. The frequency of active tuberculosis fell continuously to about 1% of all autopsies performed. The average age of death of tuberculosis increased strongly, the peak being at present between 71 and 80 years. The number of tuberculosis death below 50 years decreased from about 22% (1962) to 7% in recent years. Severe exudative-cavernous tuberculosis receded, as compared to more uncharacteristic forms. Nevertheless, real pathomorphosis of tuberculosis has not occurred.
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A 23 years old women was affected with oxyuriasis with development of peritoneal ascites. The problems of differential diagnosis are discussed.
The case of a 50-year-old woman with a ruptured liver caused by peliosis hepatis is presented. Death occurred three days after laparotomy for an acute abdomen with a clinical diagnosis of intra-abdominal hemorrhage. Autopsy findings including histology are presented and the possible pathogenetic mechanisms are discussed. There was neither evidence of a tumor nor of drug or toxin exposure. Known etiologic factors for this disorder are discussed on the basis of the medical literature. These include consumptive primary disorders, anabolic agents and oral contraceptives. The pathogenetic sequence involves damage to the endothelial cells of the hepatic sinuses and to the reticular fiber network. This case should make physicians aware of this infrequent iatrogenic disorder which is apparently increasing in its occurrence.
The change of the signification of the appearance of tuberculosis is explained (1) in a cognition-theoretical, (2) under a more medical practical aspect and (3) in the real prevalence of tuberculosis in autopsies nowadays. The pathology of the tuberculosis and of its different manifestations were known in the main before the detection of tubercle bacteria by Robert Koch. However, its nature and its cause and the connexions of the different forms of tuberculosis were wrongly interpreted in relations to the timely knowledge. Not till the detection of the tubercle bacteria and confirmation of tuberculosis as a bacterial infectious disease the pathology gained new possibilities to take part in further investigations in the disease with great success. The disease of tuberculosis goes back to earliest time of mankind. Since this time it existed until the middle of 20th century in nearly the same manner, not curable with a high morbidity and mortality and heavy courses. A change of its course to lower mortality and a decrease of the heavy exudative forms could be observed after getting a higher social standard of life in many countries, by the modern prophylaxis and therapy of the tuberculosis and related to a disease drifting into the older ages of men with a predominance of milder forms of tuberculosis in this age. We use our observations of 53,167 autopsies of adults with a total number of 2277 (4.3%) tuberculosis, (1249 = 2.4% inactive and 1028 = 1.9% active tuberculoses) to explain some facts about the present situation of tuberculosis. In this time the relative amount of tuberculosis among the whole number of autopsies decreased from 6.4% to 3.2%, the active tuberculosis from 3.8% to 0.8%. In 1961 we still found 39% exudative-cavernous tuberculosis of lungs, 1981 only 21%. But the amount of tuberculosis miliaryis pulmonum increased in this period from 3% to 26%, the generalised tuberculosis miliaris from 17% to 53%. 1981 only 1 tuberculosis deceased was younger than 50 years. But alarming is the fact that more than 50% of active tuberculosis and 63% of the miliar tuberculosis in the last 10 years were not diagnosed in lifetime but only by autopsy.
Besides a separation of reactive-hyperplastic nodules from true adenomas in the sense of autonomic tumours of the thyroid gland "follicular neoplasias" often make difficulties in the daily diagnostic work. This collective term integrates the follicular adenoma and the follicular carcinoma of the WHO-Classification of thyroid tumours (1974). The distinction between a benign "simple adenoma" and an even benign "atypical adenoma", between encapsulated well-differentiated follicular carcinoma and differentiated follicular carcinoma with wide infiltration of the capsule besides other less differentiated follicular carcinomas is very useful. In spite of the good prognosis of the atypical adenoma, clinicans should know the special problems of these tumours and provide a very careful post operationem control.
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It is reported on a 16-year-old patient with Goodpasture's syndrome in whom in a period of two years recurrent respiratory infection with haemoptyses appeared. Shortly after admission to hospital he died of respiratory insufficiency. Immunohistologically post mortem on pulmonary and renal tissue could be proved diffuse linear deposits of IgG and C3 on the basement membrane of the renal glomeruli and the alveoli. Histologically prevailed pulmonary haemorrhages and pulmonary haemosiderosis, whereas on the kidneys only a focal segmental mesangioproliferative glomerulonephritis was present. References are given to the possibility of early diagnosis by means of immunohistological examinations on the lungs and/or biopsies of the kidney and the determination of circulating glomerular antibodies of the basement membrane, since despite general knowledge also in adequate anamnesis with relapsing pulmonary haemorrhages at juvenile age it is not always thought of this fact and hopeful courses under early therapy with corticoids, immunosuppressive drugs and perhaps plasmapheresis are described in literature.
It is reported on renal biopsies in 67 patients with "slight proteinuria", 39 of whom were at an age of younger than 20 years. In 53 patients the cause of the "slight proteinuria" is a mesangio-proliferative glomerulonephritis, where in 2 cases severe changes with sclerosis were proved. Thus by way of addition the necessity of a renal biopsy is emphasized for the clarification of the cause also of a "slight proteinuria".
The lipofuscin contents in pyramidal cells of laminae III and V in area 10 (Brodmann) of the frontal brain from 6 men who recently died at different ages without any neurological or psychiatric symptoms were investigated by electronmicroscopic-morphometric methods. The results of this investigation actually do reveal an increase of the lipofuscin with age, but also demonstrate to what extent this process is subject to individual variability. Great differences in the accumulation of the lipofuscin exist among the cells within the same cytoarchitectonic layer. On the other hand wide correspondence between the mean values of both laminae can be stated.