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K Dirschmid

Publications and source records attributed to K Dirschmid.

At least 19 recordsLinked to original sources
PubMed1996

[Tubular differentiated stomach carcinoma of the (Ming) infiltrating type].

Gastric carcinoma of the infiltrative type (according to Ming) occasionally shows adenomatous differentiation only. Over the past 18 years, we have observed 23 cases of this tumour type, accounting for 3.6% of all surgically treated gastric carcinomas. Macroscopically they were classified as Borrmann IV or III, while histologically most of them were well differentiated. Histologically, these tumours retained the pre-existing structures of the stomach, most readily observable at the tunica muscularis propria; a pronounced desmoplasia was also characteristic, particularly in the submucosal and subserosal layers. In all cases the tumour tissue spread inside lymphatic vessels. All but 2 cases with metastatically involved lymph nodes, often small, showed infiltration of the lymph node sinus; in three quarters of cases the serosa was infiltrated by the tumour. Significant findings among the patients under observation for extended periods included bilateral ovarian metastases in 4 of 5 women examined and tumour recurrence at the anastomosis in 6 of 9 patients in whom Billroth II operation had been performed. The mean survival time of 16 patients was 14.9 months. Owing to the diffuse type of tumour growth, extensive surgery is recommended as in cases of signet ring cell cancer. The high incidence of small lymph node metastases from this type of tumour should also be taken in account preoperative staging. Preoperative diagnosis of this tumour subtype is difficult, because histological criteria alone do not allow clear identification. Close cooperation with clinical investigators is necessary, and intraoperative assessment of the tumour--including frozen section of necessary--in particular is of the utmost importance.

Adenocarcinoma↗
PubMed1996

Incidence of extramural venous invasion in colorectal carcinoma: findings with a new technique.

In reported studies of extramural venous invasion (EVI) by colorectal carcinoma (CRC) in which conventional preparations involving a sectioning plane perpendicular to the tumor were used, an incidence as high as 36% has been found for unselected surgical material from patients operated on for cure. However, with this preparation technique, not all of the veins that exit the bowel wall roughly at right angles can be examined adequately. We investigated whether preparation of the adjacent vascular connective tissue with tangential sectioning might not result in different EVI rates. A total of 100 unselected surgical specimens of the bowel bearing 103 CRCs were prepared using a previously undescribed method, and EVI was found in 54.1% of the cases considered to have been treated curatively. To assess EVI fully, a complete study of all the vessels draining the tumor would be required yet the conventional preparation technique is associated with the distinct possibility of sampling error, because only a few vessels in each block are sectioned in the longitudinal axis. This sampling error might well be the explanation for the considerably higher incidence of EVI in our cases than in the reports in the literature. In all patients with EVI, the possibility of hematogenous metastases exists, and this has a significant bearing on the question of selecting patients for adjuvant chemotherapy.

Carcinoma↗
PubMed1993

Pulmonary infarction: sonographic appearance with pathologic correlation.

OBJECTIVE: Peripheral pulmonary lesions are detectable by ultrasound, the aim of this study was to compare sonograms of pulmonary infarctions with their pathological reports. SUBJECTIVE: A total of 26 lung infarcts in 15 non-fixed autopsy lungs of patients showing necroscopically pulmonary embolism were examined sonographically in a water-bath no later than 5 h after autopsy with a 5- or 7.5-MHz sector scanner. Five of these patients were suspected of pulmonary embolism and underwent sonographic examinations shortly before their death. RESULTS: Ultrasound showed mainly wedge-shaped (n = 18), hypoechoic areas. Their location, form and size corresponded exactly with pathological findings. Fresh infarcts were homogeneous and more hypoechoic. Older infarcts were well demarcated and showed a hyperechoic reflex in the center corresponding to the bronchiole; this was a sign of segmental involvement. In two cases it was possible to differentiate thromboembolically congested afferent blood vessel directed to the hilus. Ultrasound images from five living patients were similar to the image of the autopsy lung. CONCLUSION: In accordance with clinical studies these observations suggest that transthoracic sonography can be an efficient technique in the detection of pulmonary infarction, as well in an early reperfusionable stage as in distinguished infarct formation.

Humans↗
PubMed1993

Epithelial misplacement after biopsy of colorectal adenomas.

The question has been raised as to whether the removal of biopsy material from colorectal adenomas can lead to misplacement of tumour fragments into the deeper layers of the bowel wall. We carried out an analysis of histological sections obtained from 21 patients in whom, between 2 and 21 days before removal of their adenoma, forceps biopsy (n = 18), or polypectomy (n = 3) had been performed. The initial histological picture a few days after biopsy is of an ulcer covered by a suppurative exudate and abundant mucus-containing small, free-lying groups of tumour cells. After an average of 7 days, we found misplacement of these groups of cells into the submucosa where, during the course of reparative processes, they became embedded within a capillary-rich granulation tissue. Subsequently, fibrosis of the submucosa develops with persistent mucus pools. Our results thus show that removal of biopsy material from adenomas can result in misplacement of tumour particles into the submucosa. These changes were observed in flat or broad-based tumours, and epithelial misplacement appears to be detectable within only a short period after biopsy. For the differential diagnosis, it is important to distinguish these changes from invasive carcinoma.

Adenoma↗
PubMed1990

[Incidence and distribution of tumor disease in relatives. 1. Degrees of stomach carcinoma patients].

The incidence and distribution of malignancies have been analyzed in 435 first degree relatives of 56 patients with histologically proven stomach cancer following the collection of detailed family histories. Eleven stomach cancers were found whereas only three could be expected from age and sex matched incidence data of the local tumour registry. The incidence of all other cancer entities corresponded to that of the whole population. In general, more attention should be paid to the family history, since, among other criteria, it may help to identify individuals at risk and therefore allow the early detection of stomach cancer.

Adult↗
PubMed1989

[Atrophy of the corpus mucosa of the stomach simulating polyposis].

We report on five cases of mucosal atrophy of the gastric body, under the aspect of a polyposis: These polyps showed intact mucosa with abundant fundic glands and were situated in the diffuse atrophic mucosa of the gastric body. Four of these cases were manifestations of type A gastritis, in one case the lesion surrounded a peptic ulcer. Laboratory findings of serologically analysed cases with type A gastritis showed elevated parietal cell antibodies in all cases, two of three cases showed a high level of gastrin, the values for vitamin B12 showed different levels; no patients revealed antibodies against the intrinsic factor, and no patient had pernicious anemia. The family history revealed three cases with cancer of the stomach on one side of the parents. It is important to biopsy polyps and the flat mucosa separately in order to verify this form of atrophy of the gastric mucosa and to also exclude small polypous tumors of the mucosa. Observation of the number of polyps allows a control of the extent of the atrophy of the mucosa.

Adult↗
PubMed1987

Tuberculous gastric ulcer.

This is a case report on tuberculosis of the stomach in a 70-year-old woman who, submitted to an endoscopic examination for uncharacteristic upper abdominal complaints, revealed multiple ulcers in the aboral part of the stomach, together with a thickening of the gastric wall. Histologically, caseating epithelioid cell granulomas were found, and only a single acid-fast tubercle (TB rod). As a further specific manifestation, tuberculous spondylitis developed, which was treated surgically. Under anti-tuberculous treatment, the gastric ulcers healed. The clinical-endoscopic picture, the pathogenesis, complications and differential diagnosis are discussed on the basis of current literature.

Aged↗
PubMed1986

[Intraoperative rapid biopsy of thyroid neoplasms and surgical procedures in atypical adenoma].

For a differential diagnosis of atypical adenoma and highly differentiated follicular carcinoma cryosections are of value only if findings are positive. Between 1977 and 1982 we observed 85 thyroid carcinomas and 47 atypical adenomas. In 5 cases the diagnosis on the basis of a cryosection had failed to detect a carcinoma. In patients with atypical adenoma we performed a subtotal resection; a primary lobectomy was not carried out as it would have meant exposing an unnecessarily high percentage of patients to an increased risk of complications. 3-8 years postoperatively the patients show no pathological findings.

Adenoma↗
PubMed1986

[A so-called atypical adenoma of the thyroid in an endemic struma area].

In view of the benign clinical course of the atypical adenoma and the high diagnostic accuracy of our frozen sections we feel that subtotal strumectomy with in toto removal of the adenoma and closely spaced follow-ups constitutes an adequate treatment of this thyroid neoplasm. In our opinion primary lobectomy means unnecessarily exposing a disproportionately high percentage of patients to the higher complication risk of this more radical surgery. From 1977 to 1982 there were 47 cases of atypical adenoma among our patients. The ratio men: women was 1:3.7, the mean age of the patients was 44 years. The patients underwent subtotal strumectomy. In the period under review "atypical adenoma" diagnosed on the basis of frozen sections turned out to be carcinoma in 5 instances. The follow-up period of the 47 patients that underwent surgery ranges from 1 1/2 to 7 years. None of the patients has had tumor regrowth so far.

Adenoma↗
PubMed1985

[Sonographic findings in autonomous adenoma of the thyroid gland in a goiter-endemic region].

Ultrasound scanning was carried out in 84 patients with autonomous nodules and 67 patients with inactive nodules. The echo pattern was correlated to the macro- and microscopic findings as well as to the function of the nodules. The autonomous nodules showed a low echogenicity in 57%, a normal parenchyma-identical echogenicity in 10% and a high echogenicity in 33%. In comparison the echo pattern of the inactive nodules showed low level echoes in 31%, normal in 36% and a high level echoes in 31%. Only one third of the nodules showed a homogeneous echo pattern, one third showed liquid degeneration and one third a mixed echo pattern. There is no correlation between the echo pattern of the autonomous nodules and the metabolic function of the nodules. 65 patients have been operated (37 autonomous and 28 inactive nodules). The macroscopic findings showed bleeding and cysts in most of the echo-poor nodules, also those with homogeneous structures. In the histological findings microfollicular structures were found in both high- and low-echogenicity nodules (18/16%). Macrofollicular changes and mixed forms were found mainly in nodules with parenchyma-identical and high echogenicity (58/48%). Ultrasound is very helpful in the morphological diagnosis of thyroid nodules, but there is no significant correlation to metabolic activity or to microscopic structures of the nodules in the thyroid gland.

Adenoma↗
PubMed1984

Pseudomalignant erosion in hyperplastic gastric polyps.

Six cases of hyperplastic gastric polyps are described that, in the region of the eroded head, revealed strikingly atypical mesenchymal cells. These disseminated cells with marked nuclear pleomorphism and also atypical mitotic figures, undergoing direct transition to typical granulation tissue, are considered to be particularly activated mesenchymal cells. In a single case in which only excisional biopsy was performed, these cells were found to persist over a lengthy period, while in endoscopic-biopsy follow-ups of the polypectomized cases, these cells were subsequently no longer detectable. In four of the cases, the polyp was located in the region of the cardia, so that a traumatic factor may possibly be considered as having some causal relevance. In particular when biopsy excisions are performed, the differential diagnosis of this polyp with its endoscopic and histologic appearance of a tumor-like lesion, from epithelial and mesenchymal malignancies, as also from neural tumors, can be difficult.

Adult↗