Biomedical subjects
Publications and source records attributed to F Nödl.
Exanthematous skin eruptions in an acute attack of polyarthritis histologically showed Aschoff's nodules or rheumatic granulomas, which are usually found in the myocardium but not in the skin.
Clinically, the skin changes observed in a 34-year-old woman were suggestive of the reticular erythematosis mucinosis (REM) syndrome. On palpation, however, the changes suggested the plaque-type REM syndrome. Histologically, broad, well-delineated cell-rich bundles were found with abundant alcian-blue-positive material, together with a lymphocytic infiltrate. In such areas showing close contact with the lymphocytic infiltrate, stellate cells with delicate blue processes and protoplasmic granula predominated. Areas preferentially affected with deposits of mucopolysaccharides in the REM syndrome and its variants were not affected in the case presented. The histogenesis of this hitherto undescribed cutaneous mucinosis is discussed.
We report on epitheloid cell reactions, forming small and large nodules within the primarily affected regional lymph nodes in malignant melanoma. The importance of such granulomas for the interpretation of lymphoscintigraphic findings is pointed out. We discuss the histogenesis and different patterns of these tumor-specific reactions. In addition, the question whether these granulomas are the result of an enhanced immunologic tumor surveillance will be under discussion.
A 21-year-old Caucasian woman with congenital nevus of Ota developed a subcutaneous tumor below the lacrimal sack within the area of discoloration. The tumor, located subcutaneously, has been present for 4 years. Histologically, parts of the tumor showed neuroid structures as well as those like cellular blue nevus. In one part, however, malignant transformation features could be found.
A case of an unusual development of Wegener's granulomatosis is described. A long-term immunosuppressive therapy led to intermittent involution of the process, but finally a transformation to a new disease, for present qualified as "malignant histiocytosis" was the result. The cause of the transformation and the differentiation from other necrotising granulomas are discussed.
An unusual case of circumscribed mucinosis without thyroid dysfunction or paraproteinemia is reported. The lesions were localized symmetrically on the upper lip sparing the philtrum. Histopathologie findings suggest that the mucinous deposits are caused by a disturbance of the vascular circulation.
The case of 83 year old man with multiple nodules and tumors in the right forearm is demonstrated. Postmortem examination revealed visceral metastases. Histologically the tumor consists of poorly differentiated cells of mesenchymal origin. However, neither the polymorphous tumor cells nor the structures they form, comparable to primitive mesenchyma, permit a definite classification of this peculiar tumor.
Data of 378 melanoma patients treated surgically between 1969 and 1979 were evaluated in a retrospective analytic study. Histological criteria such as level of invasion (according to Clark) and tumour thickness (according to Breslow) were related to tendency for lymphogenic metastases and to life expectancy of patients. The level of invasion proved a better prognostic criterium than tumour thickness. In 202 lymphadenectomised patients it could be shown that the probablity of lymphogenic metastases is directly proportional to the level of invasion of the primary tumour. Histologically demonstrable lymphnode metastases were found in 47% of males and 38% of females with melanomas of invasion level III. Figures for melanomas with invasion level IV were 64% of males and 41% of females, and 100% of males but only 16% of females in melanomas of invasion level V. With negative lymphnode involvement the 5 year survival rate is significantly higher in females with invasion level IV and V or for melanomas with a vertical diameter of more than 2.25 mm than in males. Histologically established lymphnode metastases lead to a definitely worse prognosis for both sexes. A higher survival rate for females can then no longer be demonstrated.
We report on two cases of multiple so called granuloma telangiectaticum. Multiple and solitary granuloma telangiectaticum show similar histopathological changes. Mostly they prove to be real capillary angiomas and only very rarely pyogenic granulomas. Because of the variable clinical course we suggest a new classification of multiple so called granuloma telangiectaticum. The histopathogenesis of these angiomas is explained by considering the special structure of skin vessels.
"Metastases" in lymph nodes are not only found from cellular blue naevi but also from their spindle-shaped cell fascicular type. These "metastases" are mostly situated in the fibrous capsule, very rarely in the parenchyma of the lymph nodes. Individually the cells resembled those of the cutaneous tumour. Their occurence in the peripheral sinuses should be verified. Epitheloid vessel-wall cells (glomus-type cells), sometimes pigmented and occasionally found in large cell aggregates, can be noted in the capsule of the lymph nodes. By several authors, these cells are considered to be benign naevus cells. The histopathogenesis and the clinical importance of the "metastases" from blue naevus are discussed.
A 9 year old boy sought medical attention because of a cutaneous infiltrate of the nape that could not be diagnosed macroscopically. Microscopic examination showed it to be a fascicular fibroma of a special structure. The striking feature of the stroma was the distinct proliferation and degeneration of the elastic fibers. The alteraions of the elastic tissue are similar to those seen in elastofibroma dorsi. It is discussed if the lesion results from a hyperplasia of true elastic or/and pseudo-elastic fibers.
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Epitheliotropia of malignant skin lymphomas is an unexplained phenomenon which equally affects epidermis and ectodermal appendages. This phenomenon is found especially in tumours of probable T-cell origin. However it can also be observed in B-cell lymphomas (immunocytomas) and is therefore not an exact criterium for the biological origin of a lymphoma. In the case of germinal center tumors we could not find evidence of epitheliotropia. An active invasion of neoplastic cellular infiltrate into the epithelium must be differentiated from the phenomenons caused by passive pressure, resulting from the expansion of the tumor. However, one has to remember that epitheliotropic malignant lymphomas invade the epidermis in all stages of development. It is shown, that Pautrier microabscesses are only a special non specific aspect of epidermotropia.
We are reporting on a 71 years old woman suffering from a plaque-like raised nodular neoplasia that existed for two years. The histological changes, though local variable, are characterized by similar structures. The tumor cells are grouped in variably shaped, loose syncytial cords, just by loosing their cytoplasma in vascular-like cavities. Because of their morphological relations to mesenchym Bolck called these tissue-formations "spongiosynchymal" structures. They are considered by this author to characterize the common tissue-attribute of all endotheliomas and similar neoplasias. Additionally the histological pattern of these tumors can show, as in the present case, solid and epitheloid cell formations.
A report is given on age-related changes found in special morphological areas of the hilus vessels. These vessels, together with the physiological involution of lymph node parenchyma, are of importance for the deposition of melanoma cells. The hyperplasia of epitheloid cells of the vessel walls in the lymph node capsule as well as their possible misidentification as micro-metastases of melanoma cells is discussed.
Even without previous ray-treatment the mechanical effectivenes of the filtration ability of lymph-nodes may be reinforced by connective tissue growth around metastatic melanoma cells. On the other hand melanoma cells can pass this filter just because of the possibility to get into the lymph stream by means of wide lymphatics even within the first series of regional lymphatic ganglia. This is true also for passing the marginal lymphatic sinus and subsequent entering the vas efferens of the lymph-node. The therapeutical inferences of these observations are discussed.