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K A Metz

Publications and source records attributed to K A Metz.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Surgery of primary unilateral adrenal gland tumors--results of 154 patients].

Surgical resection of adrenal neoplasias with endocrine activity is principally indicated. In adrenal neoplasias without endocrine activity, surgical removal is indicated in relation to tumor size. Surgical access and extent of resection are the major problems related to adrenal surgery. From 1980 to 1996, in 154 patients (62 m, 92 f) primary and unilateral adrenal tumors (139 benign, 15 malign) were resected. 93 resections were performed transperitoneally, 13 extraperitoneally, and 48 retroperitoneoscopically. Subtotal adrenal resections were performed in 23 benign tumors smaller than 4 cm. Perioperative lethality was 0%, morbidity was 31.8%. Malignancy was correlated to tumor size: In 114 tumors smaller than 5 cm, no malign neoplasia was found, whereas in 40 tumors larger than 5 cm, 15 specimen were malign. Operating time of the retroperitoneoscopic method was significantly longer than of open procedures (p < 0.05). Postoperative analgotic medication was significantly reduced after endoscopic surgery compared to transperitoneal or extraperitoneal surgery (p < 0.0001). No tumor recurrences occurred after subtotal adrenal resections (mean follow up: 5.7 [1.3 years]). In patients with adrenal carcinomas, 5-year-survival was approximately 15%. In adrenal neoplasias smaller than 5 cm, malignancy is extremely rare. Therefore, less aggressive surgery with a lower morbidity (extraperitoneal approach) and reduced postoperative pain (retroperitoneoscopic approach) including function preserving resection is indicated in these lesions. Due to the high incidence of malignancy, adrenal tumors larger than 5 cm should principally be treated by conventional transperitoneal surgery.

Adolescent↗
PubMed1996

How to differentiate between T-cell-rich B-cell lymphoma and lymphocyte-predominant Hodgkin's disease. Evidence for the value of MB1 and 4KB5 immunostaining.

Striking morphological similarities exist between T-cell-rich B-cell lymphoma and lymphocyte-predominant Hodgkin's disease (Hodgkin's paragranuloma), making the distinction between them extremely difficult. Immunohistochemistry provides a means of overcoming this difficulty. Immunostaining with UCHL1, L26, MB1, and 4KB5 was performed on five T-cell-rich B-cell lymphomas and 11 Hodgkin's paragranulomas (7/11 nodular, 4/11 diffuse). L26 stained the tumour cells not only of T-cell-rich B-cell lymphomas, but also of L+H Hodgkin's disease. In contrast, MB1 as well as 4KB5 identified all of the neoplastic cells in 3/5 T-cell-rich B-cell lymphomas, but did not react with the L+H cells in 8/11 Hodgkin's paragranulomas. Some overlap of staining patterns became apparent in the remaining cases, with 2/5 T-cell-rich B-cell lymphomas showing the MB1+/4KB5+ phenotype in a tumor cell subset only. Similarly, in 3/11 Hodgkin's paragranulomas, some MB1/4KB5-positive L+H cells occurred in addition to MB1/4KB5-negative L+H cells. These cases, nevertheless, could be distinguished from one another by the numbers of MB1/4KB5-positive background lymphocytes, which were scanty or absent in T-cell-rich B-cell lymphomas and more numerous in Hodgkin's paragranulomas.

Adolescent↗
PubMed1995

T-cell-rich B-cell lymphoma and lymphocyte-predominant Hodgkin's disease: two closely related entities?

T-cell-rich B-cell lymphoma (TCRBCL) is a recently described variant of non-Hodgkin's lymphoma. It may arise de novo or secondary to follicular lymphoma and large B-cell lymphoma. We present here seven cases of TCRBCL to emphasize a peculiar relationship to lymphocyte-predominant Hodgkin's disease. Morphologically, the neoplastic populations of all TCRBCLs, in addition to centroblast-like and immunoblast-like cells, comprised a few L+H-like elements. These neoplastic cells were all regularly scattered in a majority of reactive small T-lymphocytes as well as histiocytes. Moreover, tumour cells of TCRBCL, including the L+H-like elements of TCRBCL, expressed LCA and L26 but did not stain for Leu-M1 and BerH2, as is the case with the Reed-Sternberg cell L+H variant of lymphocyte-predominant Hodgkin's disease. Furthermore, the L26 immunoreaction in one of the cases, which otherwise presented as typical TCRBCL, disclosed a small subcapsular area resembling nodular paragranuloma because some few foci consisting of mature B lymphocytes with occasional L+H-like elements were seen. This also holds true for a second of the TCRBCLs presented that obviously coexisted with recurrent Hodgkin's paragranuloma 10 years after the primary manifestation. These findings indicate a close connection between TCRBCL and lymphocyte-rich Hodgkin's disease, and it may even be speculated as to whether TCRBCL represents merely a phenotypically different manifestation of this Hodgkin's subtype. Although the data presented here will not provide sufficient proof of this hypothesis, it seems clear that the nosology of TCRBCL in the context of current lymphoma classifications requires further elucidation.

Adult↗
PubMed1995

Immunohistological findings in patients with superficial bladder carcinoma after intravesical instillation of keyhole limpet haemocyanin.

OBJECTIVE: To determine whether keyhole limpet haemocyanin (KLH) instilled intravesically improves the local cellular response within the bladder wall of patients suffering from superficial bladder carcinoma. PATIENTS AND METHODS: Twelve patients (10 men and two women, mean age 67 years, range 42-85) with superficial carcinomas of the bladder were treated for 6 consecutive weeks and then monthly for 1 year with 20 mg KLH in 20 mL saline instilled intravesically after complete resection of the tumours. Biopsies were taken for immunohistochemical examination before treatment and again 6 weeks, 3, 6 and 9 months after treatment. Six patients with no evidence of cystitis or malignant bladder disease acted as a control group. Immunofluorescent staining of the biopsies was performed using monoclonal antibodies to the T-cell markers CD4 and CD8, and to CD14 (monocytes), CDw15 (granulocytes), CD19 B-cells (Pan-B), CD68 (macrophages) and HLA-DR. Anti-KLH antibody-producing plasma cells were detected using a standard technique. A semiquantitative analysis of locally infiltrating cell types was performed. RESULTS: After treatment with KLH the increase of CD8+ suppressor cells was less pronounced than that of CD4+ helper cells. The T-helper/inducer to T-suppressor/cytotoxic cell ratio thus altered from 0.8:2.0 before treatment to 1.6:2.3 afterwards. Hence, the number of T-helper cells had increased considerably, whereas there was only a moderate increase in the number of T-suppressor cells. This cellular ratio could be detected for 9 months after KLH therapy. The numbers of activated HLA-DR+ immune cells in the submucosa and among urothelial cells also increased after KLH instillation. The degree of mononuclear cell infiltration of the submucosa increased considerably, but granulocyte infiltration was only moderate. Lymph follicles with enhanced B-lymphocyte counts were also detected. CONCLUSION: Immune-cell infiltration into the urothelium and enhanced activation (expression of class II antigens) suggests distinct processes of cellular antigen recognition, which could be detected for up to 9 months after the beginning of KLH therapy. This may represent a basic functional mechanism of KLH therapy.

Administration, Intravesical↗
PubMed1995

Deep venous thrombosis and pulmonary artery embolism in high-grade non Hodgkin's lymphoma: incidence, causes and prognostic relevance.

To analyse incidence, risk factors, causes and prognostic significance of venous thromboembolism (VTE) in high-grade non-Hodgkin's lymphoma (HG-NHL) a prospective clinical trial (N = 593), also undertaken to analyse other aspects of HG-NHL, a study of haemostasis (N = 25) and a post-mortem analysis (N = 70) were performed. Clinical analysis documented a 6.6% incidence of VTE, and 77% of all cases occurred before or within the first 3 months of chemotherapy. Ann Arbor stage IV and B-mediastinal clear cell histology were risk factors for VTE, while rapid changes in tumour load or application of consolidation chemotherapy were not. Vessel compression by HG-NHL was the leading cause of VTE, whereas a significant (paraneoplastic or chemotherapy-induced) thrombophilic state was not disclosed by haemostatic tests. While VTE-related fatality was found to be low in the clinical trial (1.7%) and at necropsy (8.5%), the occurrence of VTE was associated with an unsatisfactory response of HG-NHL to chemotherapy and a high incidence of treatment-related mortality due to diffuse alveolitis. Thus, fatal VTE in HG-NHL is rare, but VTE is associated with an unfavourable clinical course of HG-NHL.

Adolescent↗
PubMed1994

Immunohistochemical detection of estrogen and progesterone receptors in endometriotic tissue. A comparative study of paraffin embedded and fresh frozen tissues.

30 formalin-fixed and paraffin embedded and 20 fresh frozen samples of endometriotic tissue were analysed immunohistochemically for the concentration of estrogen and progesterone receptors. In the formalin-fixed and paraffin embedded group only 37% of the samples were estrogen receptor positive whereas 63% were receptor negative. In contrast, we found that 67% of the samples had a positive progesterone receptor status. In the fresh frozen group 60% of endometriotic tissues were estrogen receptor positive and 75% of the tissues had a positive progesterone receptor status. We could not find any correlation between the site or severity of the endometriosis or the hormonal receptor status. We were able to demonstrate that the immunohistochemical detection of hormonal receptors in endometriotic tissues is possible and that better results were obtained if fresh frozen rather than formalin-fixed and paraffin embedded tissues were analyzed.

Endometriosis↗
PubMed1994

Well-differentiated (oncocytoid) neuroendocrine carcinoma of the larynx with multiple skin metastases: a brief report.

A 63-year-old woman presented with a history of increasing dysphagia of about two weeks duration. Laryngoscopy revealed a nonulcerated supraglottic epitheliomatous lesion that morphologically appeared well-differentiated and distinctly oncocytoid. Although the tumour lacked any criteria for malignancy such as cellular atypia, pleomorphism or necroses, it recurred twice after primary surgery and later gave rise to multiple painful skin metastases. The diagnosis of an oncocytoid differentiated neuroendocrine carcinoma of the larynx (laryngeal carcinoid) was made. Misinterpretation of laryngeal carcinoids is common, but can be avoided if one is familiar with this rare variant of laryngeal neoplasms.

Carcinoid Tumor↗
PubMed1994

[Endometriosis in retroperitoneal lymph nodes].

This is a case report on an endometriosis in retroperitoneally situated lymphatic nodes in a 29-year-old patient. The patient had a cervical carcinoma FIGO Ib and was treated surgically by radical hysterectomy after Wertheim-Meigs-Okabayashi with pelvic lymphonodectomy. Endometriosis was found in two lymphatic nodes of the retroperitoneum. The patient had no anamnesis or clinical symptoms of endometriosis. Endometriosis could also not be found in any other parts of the abdomen.

Adult↗
PubMed1994

Melanotic neuroectodermal tumor of infancy (MNTI) in the epididymis. A case report with immunohistological studies and special consideration of malignant features.

Melanotic neuroectodermal tumors of infancy (MNTI) are uncommon, usually benign neoplasms, most frequently found in the maxilla. These tumors are extremely rare in the epididymis. Only 18 cases with this site of origin are documented. We report on the third epididymal MNTI with some morphological characteristics of malignancy but favorable clinical outcome. The 2 cm large tumor of a 6-month-old male infant showed large epitheloid cells in the center and small neuroblastoma-like cells at the periphery. Despite invasion of lymphatics there is no evidence of relapse or metastases during 4 years of follow-up. Immunohistochemically, the large tumor cells were distinctly positive for cytokeratin, vimentin, GFAP, the melanoma marker NKI-C3, NSE, and S100. The small tumor cells were only slightly positive for GFAP, NKI-C3, NSE, and S100 but they were negative for cytokeratin and vimentin. Neurofilament and chromogranin could not be proved in the tumor.

Biomarkers, Tumor↗
PubMed1993

The association of pulmonary CMV infection with interstitial pneumonia after bone marrow transplantation. Histopathological and immunohistochemical findings in 104 autopsies.

Lung tissue of 104 necropsies was studied by routine (HE) histology, by immunohistochemistry and partly by in situ hybridization in order to explore the association of pulmonary cytomegalovirus (CMV) infection and interstitial pneumonia (IP) after allogeneic bone marrow transplantation. IP was detected in 59 of 104 patients (56%). 12 of these (20% of the IP cases) presented as CMV-IP. No evidence of a CMV infection was obtained in the remaining 47 IP. Immunohistochemistry did not improve the CMV detection essentially over the results of routine (HE) analysis of viral inclusions. In situ hybridization performed on frozen sections of 21 cases turned out to be more sensitive than routine histology and immunohistochemistry, detecting active as well as latent CMV infections. However, the clinical relevance of latent infections, as disclosed by positive hybridization results in the absence of nuclear inclusions as well as immunohistochemical positivities, seems to be low, because latent infections typically were not found to be associated with IP.

Autopsy↗
PubMed1992

Pheochromocytoma of the urinary bladder.

A case of a pheochromocytoma of the urinary bladder is reported which was treated preoperatively with alpha-receptor-blocking agents. The tumor was operated transurethrally, followed by partial cystectomy.

Combined Modality Therapy↗
PubMed1992

[Morphological and immunohistochemical findings on the frequency of intranuclear immunoglobulin inclusions (Dutcher bodies) in malignant B-cell lymphomas].

318 cases of 682 malignant B-cell lymphomas reacted positive for cIg. 66 of them showed Dutcher bodies (DB). DB were found in about 22% of plasmacytomas, 17% of immunocytomas, and in 7.5% of follicular lymphomas and polymorphic centroblastomas, respectively. Regarding only the cIg-positive cases, DB occurred in about 27% of immunocytomas, 20% of follicular lymphomas and 18% of polymorphic centroblastomas. A single case of prolymphocytic leukaemia, centrocytoma, monomorphic centroblastoma, and immunoblastoma each showed also DB. Usually, DB-positive plasmacytomas showed kappa, alpha, and J-chains. The remaining lymphomas mostly expressed kappa, my, and J-chains. In conclusion Dutcher bodies can occur with any cIg-producing B-cell lymphoma. They are not limited to immunocytomas.

Cell Nucleus↗
PubMed1991

[Splenic cysts. Their morphology, diagnosis and therapy].

Over a 10-year period, nine patients (four men, five women, mean age 27 years) underwent surgery for splenic cysts (six epidermoid cysts, two mesothelial cysts and one pseudocyst). Six patients had had suggestive clinical symptoms, but, in the other three, the cysts were only discovered by chance on ultrasound scan. Three of the patients with epidermoid cysts had raised serum concentrations of the tumour markers carcinoembryonic antigen (CEA) or carbohydrate antigen (CA 19-9. All six benign epidermoid cysts contained immunohistochemically demonstrable CEA and/or CA 19-9 in the inner epithelial layer, implying a mesothelial origin for these cysts. In five cases the splenic cysts were completely extirpated (splenectomy in two, hemisplenectomy in one, enucleation in two); in four cases cyst resection was performed, leaving part of the cyst adherent to the spleen. In one of these four patients, a 4 cm cyst persisted postoperatively in the hilus of the spleen, but has remained unchanged over an 8-year period. Splenic cysts are usually benign, despite the presence of tumour markers in the cyst wall, and do not require removal. The only indications for surgical intervention are complications (e.g. rupture), symptomatic cysts or asymptomatic cysts with an increased risk of rupture (diameter greater than 5 cm). The very rare parasitic and infective forms must always be surgically sterilized.

Adolescent↗
PubMed1990

[Primary lymphatic dysplasia in a newborn infant].

We describe a case of primary lymphatic dysplasia in a newborn, presenting with lymphedema, chylothorax, and chylous ascites. Malfunction of the lymphatic system, which is supposed to cause this rare disorder, could also be responsible for a number of cases of non-immunologic hydrops fetalis.

Chylothorax↗
PubMed1989

[Spontaneous remission in disseminated histiocytosis X].

An 8 months old girl presented with biopsy-proven, disseminated histiocytosis X affecting at least two organ systems. Within one year there was spontaneous regression of the disease lasting for 10 years until today. Considering this case and others from literature the necessity of aggressive chemotherapy in selected cases is discussed.

Biopsy↗