[Late pulmonary manifestation of ovarian and breast cancer - which contribution provide immunohistochemical techniques?].
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Journal Article↗
Biomedical subjects
K M Müller
Publications and source records attributed to K M Müller.
[Inflammatory pseudopapilloma after recurring aspiration of fruit stones as rare differential diagnosis of bronchogenic cancer].
We present the case of a 51-year old man with drug-resistant pneumonia in the upper right lobe, weight loss and a 50-pack year history of cigarette smoking who underwent bronchoscopy. By clinical and radiological findings bronchogenic cancer was assumed. Fiberbronchoscopy showed an exophytic tumor-like mass obliterating the right upper lobe. Biopsies revealed an epithelial pseudopapillomatous tumor with multiple mucosal dysplasia and metaplasia. A second bronchoscopy in order to remove the lesion revealed a foreign body embedded in the tissue which could be removed easily. The foreign body proved to be a cherry stone, after its removal pneumonia resolved completely. In the same patient this lesion was recurrent one year later after aspiration of a grape seed. We present this case to emphasize the relationship between foreign body aspiration and inflammatory pseudopapilloma as a sequela of the inflammatory insult provoked by foreign bodies. Bronchoscopy is mandatory and may obviate misdiagnosis and thoracotomy. The use of inhaled and systemic steroids can be used to facilitate successful endoscopic extraction.
Carcinoma, Bronchogenic↗
Fibre-years, pulmonary asbestos burden and asbestosis.
The relations between cumulative asbestos fibre doses at the work-places and asbestos burden of the lung evaluated by lung dust analyses have been tested on 3 different groups of patients of the German Mesothelioma Register: 1. total collective (n = 366), 2. collective without elevated asbestos burden of the lungs (n = 193), 3. collective with asbestoses/minimal asbestoses (n = 64). The relations between the above mentioned parameters are in general only weak. The limit value of > 25 fibre-years is found in 19.6% of persons without increased pulmonary asbestos burden. In spite of reaching or exceeding the cumulative doses of 25 fibre-years, 24% of the whole collective also show no elevated asbestos-concentrations in their lung tissues. By contrast, 42% of patients with asbestos-associated lung fibroses do not attain 25 fibre-years at their work-places. Considering our data it is doubtful that the postulated limit value of 25 fibre-years can be an adequate parameter for the evaluation of asbestos-associated lung fibroses.
Adult↗
[Plaque morphology of the carotid bifurcation and incidence of embolisms in relation clinical stage of cerebrovascular insufficiency].
Vascular morphology and determination of plaque surface structure are getting more and more matter of interest before revascularisation procedures are performed. One reason may be the increase of interventional treatment (PTA). For that we investigated the value of ultrasound duplex scanning to predict preoperatively the vascular surface and plaque structure. 368 patients operated on obstructing stenosis of the carotid artery could be enrolled in this investigation. In all patients duplex ultrasound scanning was performed preoperatively. In 127 patient an analysis of TC-Doppler curve was possible. During some operations (eversion endarteriectomie) we performed experimental stent implantation. The evaluation was performed with statistical methods.
Aged↗
[Recurrent tumor--pathologic-anatomic findings].
Based on pathological-anatomical findings, early (2 months) and late (2 years) local and distant recurrencies are presented, considering topographic aspects following surgery of primary pulmonary tumours, metastatic pathways and time intervals. Morphological criteria for differentiating two tumours from metastases, systemic recurrencies of the basic disease following early micrometastatic spread, as well as the grading of tumour regression in surgical samples following radio chemotherapy are shown.
Diagnosis, Differential↗
[Pleural mesothelioma. I: History, epidemiology, clinical aspects (symptoms, diagnosis)].
EPIDEMIOLOGY: Although production and processing of asbestos have been prohibited for years, the incidence of mesothelioma of the pleura will rise in Western Europe. The incidence of mesothelioma will peak between the years 2010 and 2020. It will cause an estimated 250,000 deaths within the next 35 years. PATHOGENESIS: The fact that exposure to asbestos fibers may result in mesothelioma was first described in 1960. The risk of developing mesothelioma depends mainly on the type of asbestos fibers and the way asbestos is manufactured. Environmental eronite fibers in Central Turkey are the cause of endemic mesothelioma. The pathogenetic role of infection with simian virus 40 is still not determined. Thoracic radiation is of minor importance in the etiology of pleural mesothelioma. DIAGNOSIS: Between first symptoms of disease and diagnosis of mesothelioma often more than 6 months pass as clinical symptoms are rarely typical. Detection of early stages by invasive procedures and imaging is often very difficult. Histopathological distinction between adenocarcinoma and mesothelioma requires experienced pathologists. This implies that management of mesothelioma should only be performed in multidisciplinary cooperation in specialized centers.
Asbestos↗
Evolution of IESs and scrambling in the actin I gene in hypotrichous ciliates.
Germ-line (micronuclear) genes in hypotrichous ciliates are interrupted by numerous, short, noncoding, AT-rich segments called internal eliminated segments, or IESs. IESs divide a gene into macronuclear destined segments, or MDSs. IESs are excised from micronuclear genes, and the MDSs are spliced when a micronuclear genome is processed into a macronuclear genome after cell mating. In the micronuclear version of the actin I gene intramolecular recombination between IESs during evolution has put MDSs into a scrambled disorder in some but not all hypotrichs. Studies using rDNA sequences to define phylogenetic relationships among eight hypotrichs suggests that evolution of the micronuclear actin I gene proceeds by successive addition of IESs in earlier diverging species, without MDS scrambling. Continued addition of IESs and recombination among IESs in later diverging species produced actin I genes with scrambled MDSs. Subsequent to MDS scrambling, additional IESs were inserted into the more recently evolved species. Thus, IES insertions and gene scrambling occur in a progressive manner during species evolution to produce micronuclear actin I genes of increasing structural complexity.
Actins↗
[Association of primary sclerosing cholangitis and sarcoidosis].
BACKGROUND: Primary sclerosing cholangitis and sarcoidosis are rarely associated diseases. CASE REPORT: We report the case of an 42-year-old woman with primary sclerosing cholangitis confirmed by endoscopic cholangiography, biopsy of the liver and serum neutrophil cytoplasmatic antibodies. Furthermore radiological and histological signs of pulmonary and hepatic manifestation of sarcoidosis were observed, besides there were alopecia areata and choledocholithiasis. CONCLUSION: The present case report gives a brief survey of the literature, reflects the theories to unknown etiology and reports actual aspects of diagnosis and therapy of both diseases.
Adult↗
Helix-stabilized Fv (hsFv) antibody fragments: substituting the constant domains of a Fab fragment for a heterodimeric coiled-coil domain.
Antibody Fv fragments would in principle be useful for a variety of biotechnological applications because of their small size and the possibility to produce them in relatively large amounts in recombinant form; however, their limited stability is a drawback. To solve this problem, both domains are usually fused via a peptide linker to form a single-chain Fv (scFv) fragment, but in some cases this leads to a dimerization. We present an alternative format for stabilizing antibody Fv fragments. The C(H)1 and C(L) domain of the Fab fragment were replaced with a heterodimeric coiled coil (WinZip-A2B1), which had previously been selected using a protein-fragment complementation assay in Escherichia coli. This new antibody format was termed helix-stabilized Fv fragment (hsFv), and was compared to the corresponding Fv, Fab and single-chain Fv format. Bacterial growth and expression of the hsFv was significantly improved compared to the Fab fragment. The hsFv fragment formed a heterodimer of heavy and light chain with the expected molecular mass, also under conditions where the scFv fragment was predominantly dimeric. The hsFv fragment was significantly more stable than the Fv fragment, and nearly as stable as the scFv fragment under the conditions used (80 nM protein concentration). Thus, the format of a helix-stabilized Fv (hsFv) fragment can be a useful alternative to existing recombinant antibody formats, especially in cases where poor expression of Fab fragments or multimerization of scFv fragments is a problem.
Amino Acid Sequence↗
[Congenital pulmonary fibrosarcoma. Differential diagnosis of infantile pulmonary spindle cell tumors].
Primary pulmonary mesenchymal tumors are rare causes of intrathoracic lesions in newborns. We describe a case of pulmonary spindle-cell tumor with features of infantile fibrosarcoma and discuss the differential diagnosis of spindle-cell lesions in this location. In view of further case reports of the literature, this neoplasia can best be categorized in a spectrum of fibroblastic/myofibroblastic differentiated spindle-cell tumors, with excellent prognosis. Especially in congenital lesions a favorable clinical course is to be expected after complete surgical resection. Additional radio- and/or chemotherapy is not recommended.
Diagnosis, Differential↗
[Histopathological aspects of Langerhans cell histiocytosis. With emphasis on the pulmonary form].
Langerhans cell histiocytosis (LCH) occurs principally but not exclusively in younger age groups. It can present as a single lesion or as multiple lesions and can affect one or several organ systems. Diagnosis of LCH requires the identification of CD1a and S-100 positive histiocytes. The range of synonyms used for LCH reflects both the variable clinical presentation and the variations in the histological "development stage" of the individual lesions from one case to another. The term LCH has now been accepted for all manifestations of the disease. The extent of the disease in a given case is specified by determining the number and location of foci and by ascertaining whether one or several organ systems are affected, and whether organ dysfunction exists. Among cases of LCH in adults, pulmonary LCH has a special status, as this usually results from cigarette smoking and is generally limited to the lungs. The lungs may also be affected in "conventional" LCH, and organ dysfunction may also exist in this form of the disease. In general, the morphology of LCH is sufficiently characteristic that the differential diagnosis versus other types of histiocytosis should not be difficult, provided an adequate specimen is available for examination.
Adult↗
[Morphological findings and medical insurance aspects in 371 exhumations].
OBJECTIVES: The morphological findings in organ systems following exhumation, form the basis for answering a number of medical insurance issues. The aim of this study was to analyse the development of the number of exhumations performed and the medical insurance relevance over a 31-year-period. METHODS: A total of 371 exhumations, performed between 1967-1998 at the Institute of Pathology, Occupational Associations Hospital, Bochum, for medical insurance reasons were evaluated. RESULTS: The average number of days after burial was 74, ranging from 9 to 47.8. For the first third of the period investigated, the proportion of exhumations was 3.5% of all autopsy cases, for the second third this fell to about 0.4% and rose to 1.5% for the last third. In the first two-thirds, the main reasons for the exhumations were related to the grading and effects of pneumoconioses in connection with the cause of death. In the last third, asbestos-associated diseases were mainly involved. In 99.2% of all cases, the autopsy results revealed important evidence for clarification of the medical insurance issues. The current catalogue of expectations listing the pathomorphological findings which can be expected after certain periods of internment, could be extended by our own results.
Academies and Institutes↗
[Arachnoid cyst with consecutive brain stem atrophy, hypoglossal nerve paresis and tongue atrophy].
We report the pathological anatomy of a patient aged 77 years at the time of death, who suffered from an arachnoid cyst situated near the right lower olive nucleus. This led to palsy of the hypoglossal nerve and partial gliosis of the brainstem with consecutive hemiatrophy of the tongue. This lesion did not seem to have any further effects onto clinical presentation. The patient died of a fulminant lung embolism and also presented an adenocarcinoma of the lung.
Aged↗
[Pulmonary lymphangioleiomyomatosis. Morphologic and immunohistochemical findings].
Pulmonary lymphangioleiomyomatosis (LAM) is a rare disease affecting only women which is characterised by cystic parenchymal changes and smooth muscle proliferation and has to be considered in the differential diagnosis of interstitial lung disease. The LAM cell is classified as a so-called perivascular epithelioid cell (PEC) showing immunohistochemical co-expression of smooth muscle and melanocytic markers (melanomyopericyte). A total of 18 cases of LAM and 56 cases of various other pulmonary diseases were analysed by immunohistochemistry. For the diagnosis of LAM in transbronchial or open lung biopsies, immunohistochemistry using the antibody HMB 45 is decisive because it shows a highly specific and sensitive, but often only faint reaction for pulmonary LAM. The immunohistochemical detection of nuclear localised microphthalmia transcription factor (MiTF) in LAM as an additional melanocytic marker further emphasises the melanocytic (as well as smooth muscle) line of differentiation within the cells of LAM. Using the concept of a melanomyopericyte, pulmonary LAM could be classified as a hamartomatous interstitial lung disease showing perivascular smooth muscle and partial melanocytic differentiation.
Actins↗
[Complex pulmonary vessel alterations in an aorto-pulmonary window in adulthood].
An aorto-pulmonary window (aorto-pulmonary septal defect) is considered to be a rare congenital cardiac malformation. We report the case of a patient with an unrepaired congenital aorto-pulmonary window 1.4 cm in size which is the largest aorto-pulmonary septal defect yet reported. This patient died at the age of 58 not from the congenital cardiac malformation but from the after-effects of a pulmonary adenocarcinoma diagnosed 2 years previously. Interestingly, the long standing, persistent pulmonary hypertension correlated well with the varying pathomorphological changes seen in the pulmonary vessels. In addition to the complex morphological signs due to the pulmonary hypertension such as the extensive aneurysms found in the left and right main pulmonary arteries (first report of this size), pulmonary vessels with relatively few pathomorphological changes were also found. Hence this first report of such a long survival of a patient with a comparatively large aorto-pulmonary septal defect demonstrates a surprising variety of pathomorphological alterations seen in the pulmonary arteries in the face of excessive pulmonary hypertension. These alterations could be the result of peripheral aneurysmatic formations and thrombembolic stenoses of the lobular or segmental arteries and might provide an explanation for the long survival of this particular congenital cardiac malformation. All these varying findings in the pulmonary arteries emphasise the fact that the pathomorphological findings in lung biopsies might not be representative of the whole lung.
Adenocarcinoma↗
Ossification in atherosclerotic carotid arteries.
BACKGROUND: Heterotopic ossification as newly formed bone in extraosseous tissue is an uncommon finding in atherosclerotic lesions. The exact mechanisms and development of bone formation in regard to late stage calcified atherosclerosis still remains under debate. METHODS: We studied 400 autopsy carotid probes and 306 samples of atherosclerotic carotid endatherectomy. Radiographic analysis and classification of calcification was performed followed by light microscopy. In probes with detected ossifications further analysis using immunohistochemistry, scanning electron microscopy (SEM) and energy dispersive x-ray micro-analysis (EDX) including calcium mapping was performed. RESULTS: Ossification in atherosclerotic carotid arteries was a finding in only a minority of samples (5%) and occurred at sites of large calcific deposits. Histomorphology of bone formation equaled skeletal bone showing osteoblastic cells, osteocytes included in osteoid matrix, bone marrow and osteolytic giant multinucleated cells. Closely related to newly formed bone zones of neovascularization were found. Development of ossification seemed to occur in five stages (lipidous plaque, fibrous cellular plaque, fibrous acellular plaque, calcified plaque and osteogenesis). The environment of sites of ossification was characterized by a varying texture of extracellular fibrous matrix, foam cells, smooth muscle cells, fibroblasts and calcified deposits. CONCLUSIONS: Heterotopic ossifications of atherosclerotic plaques seem to be a specific differentiation of fibrous plaques. Components of atherosclerotic lesions like vascular wall cells, neovessels and matrix structures seem to be involved in the process of transformation to mature bone tissue.
Arteriosclerosis↗
[Minimally invasive percutaneous contrast-ultrasound guided thrombin occlusion of iatrogenic pseudoaneurysm].
BACKGROUND: Complicating femoral artery puncture aneurysms may occur resulting in the need for surgical or newer, non- or minimal-invasive therapy: A new minimal-invasive method is the percutaneous occlusion injecting bovine thrombin. The high thrombogenous potential of thrombin bears the risk of iatrogenic artery occlusion by artificial intravascular instillation. AIM: Is the contrast-ultrasound guided thrombin injection safe and effective in occluding femoral aneurysms? METHODS: During 1/99 to 12/00, 33 femoral artery aneurysms as a complication coronary catheterization were diagnosed. In 32 patients the aneurysm (mean dimensions 32 x 35 x 24 mm) was punctured during ultrasound guidance. By injecting ultrasound contrast medium, the flow pattern perfusing the aneurysm was documented. In the canula position where no contrast medium exited the aneurysm thrombin was injected. RESULTS: Complete occlusion of the aneurysm was achieved in 96.9% (31 out of 32) of the patients by contrast-ultrasound guided thrombin occlusion. Follow-up for up to 3 months after the procedure revealed complete occlusion and no clinical or sonographical complications. In one case, a large aneurysm (50 mm x 62 mm x 27 mm) had already led to skin alterations and was only partly occluded by thrombin injection. CONCLUSIONS: Contrast-ultrasound guided thrombin occlusion of femoral artery aneurysms is safe and highly effective.
Aneurysm, False↗
[Stent-induced changes of coronary morphology--pathologic-anatomic and experimental findings after balloon expansion].
BACKGROUND: Restenosis after coronary stenting still remains a major limitation of implanted endoluminal endoprostheses. To minimize-device related complications, a better understanding of the mechanisms leading to vessel wall alterations is needed. AIM: To study the morphological effects of coronary stenting in correlation to design changes of the endoprostheses after intraluminal dilation. METHODS: 1) Postmortem analysis of the changes in coronary artery morphology and venous bypass specimens of 35 stents inserted in 27 patients (24 hours up to 4 years after implantation). 2) Standardized postmortem stenting of 20 highly stenosed (> 90% in postmortem selective coronary angiography) and calcified coronary artery segments. Artifact-free microscopical analysis and measurements were performed on cross sections obtained by methylmethacrylate embedding and hard-cut grinding histological preparation. RESULTS: Light microscopy revealed inhomogeneous stent expansion in all artery cross sections resulting in twisted stent filaments. Calcified plaque areas were not deformed by the stent dilation. In eccentric stenoses only over-dilation of the fibrotic plaque segments led to enlargement of the vessel's cross section. Dissections were seen on the edges of atherosclerotic plaques reaching into the arterial medial lamina. Underlying vessel morphology and not implantation pressure determined stent symmetry. Ruptured stent filaments were a seldom but crucial complication of changes in stent design after balloon dilation. CONCLUSIONS: The expansion pattern of coronary stents is determined mostly by the underlying degree of atherosclerotic disease, which is the major factor influencing results of coronary stenting and leading to limiting thrombotic and myofibroblastic stent occlusions.
Angioplasty, Balloon, Coronary↗