Biomedical subjects

K-M Müller

Publications and source records attributed to K-M Müller.

At least 37 records · Page 2Linked to original sources

PubMed2004

[Differential diagnosis of saccular aneurysms of the isthmus aortae: example of a penetrating atherosclerotic ulcer. Case-report and review of the literature].

Most aneurysms of the isthmus aortae, particularly those following thoracic trauma, are most likely to be diagnosed as acute dissecting or post-traumatic pseudoaneurysms. Furthermore, penetrating atherosclerotic ulcers in patients with atherosclerosis, congenital aneurysms such as ductus diverticulum and Kommerell's diverticulum, luetic aneurysms, and saccular aneurysms associated with Marfan's syndrome have to be included in the list of differential diagnoses. In view of the severe effect of any open thoracic surgical intervention, exact preoperative diagnosis is crucial. We report the case of a 73-year-old male patient who was accidentally diagnosed with an aneurysm of the atherosclerotic isthmus aortae. The aneurysm extended from the aorta to the dorsal site. The sacciform aneurysm (4.5 cm) was resected electively. Based upon localisation and pathomorphological findings, a penetrating ulcer was diagnosed. We also present a review of the current literature and give a survey of the differential diagnoses of aneurysms of the aortic isthmus: penetrating atherosclerotic ulcus, acute (traumatic) dissecting aneurysm, post-traumatic pseudoaneurysm, ductus diverticulum, Kommerell's diverticulum, syphilitic aneurysm, and sacciform aneurysm due to Marfan's syndrome.

Aged↗

PubMed2004

[liposarcoma. Aspects of pathomorphology--an analysis of 209 tumos].

BACKGROUND: Among the heterogeneous group of adult soft tissue sarcomas, liposarcomas represent the largest entity along with malignant fibrous histiocytomas (MFH). PATIENTS AND METHODS: This article summarizes the results of pathomorphological data on 209 liposarcomas resected over a 10-year period. RESULTS: The most common tumor site was the thigh, and the peak age incidence was in the 5th and 6th decades. In general, three major subtypes of liposarcoma can be distinguished in terms of pathomorphology: well-differentiated/dedifferentiated liposarcoma, myxoid/round cell liposarcoma, and pleomorphic liposarcoma. Well-differentiated liposarcomas represent malignancy grade 1 tumors without biological potential to metastasize, but which are able to relapse locally in cases of incomplete resection. When a local relapse has occurred, the liposarcoma may show dedifferentiation and may metastasize. CONCLUSIONS: In the pathologic-anatomical diagnosis of liposarcomas, conventional light-microscopic findings are decisive. Additional methods of molecular pathology may help in single cases to gain further insights.

Adult↗

PubMed2004

[Pathology, classification, and staging of malignant lung tumors].

The histopathogical, immunohistochemical, and genetic characterization of specimens of, mostly advanced, lung tumors that show variable phenotypes in biopsies of just 1-2 mm does not allow conclusions regarding causal factors (e.g., smoking, radon, asbestos etc.) or further progress of the disease. Therapeutical approach and the still unfavorable prognosis remain essentially, as in the last thirty years, to be characterized by TNM and performance status of the individual patient and, to a lesser extent, by the main histological type of tumor. In recent years, our knowledge of the quite variable biology of tumors has been significantly increased by the use of immunohistochemical methods and molecular biology. These methods facilitated an improved qualitative and quantitative characterization of heterogeneously differentiated lung tumors (e.g., neuroendocrine/blastomatoid portions etc.). The detection of genetic alterations of tumor suppressor genes and oncogenes is, at the moment, only of scientific interest. The heterogeneity of tumors is emphasized by results obtained by molecular genetic techniques. A connection between the detected genetic anomalies and histomorphological growth patterns can not be seen. At the present time, the validity of individual findings for a correlation between operability, tumor progress, chemotherapy and prognosis is not sufficiently elucidated by investigations nor secured.

Gene Expression Profiling↗

PubMed2004

[Cellular changes in non-small cell lung cancer after neoadjuvant therapy].

Microscopic analysis of resection specimens of non-small cell lung cancer after neoadjuvant therapy evokes the subjective impression of cytologic changes, especially enlargement of the individual tumor cells and their nuclei. Therefore, objectivization of these changes was tested morphometrically. Corresponding investigations could be carried out in 24 patients who had each received identical neoadjuvant therapy. The diameters and areas of the tumor cells and their nuclei as well as the nucleocytoplasmic ratio were assessed. The adenocarcinomas investigated revealed a significant cellular enlargement after treatment. Moreover, in 18 resection specimens (75%), cytomorphological changes could be shown in comparison to untreated tumor tissue. The cellular and nuclear parameters analysed as well as the cytomorphological changes assessed showed no significant correlation to the grade of therapy-induced tumor regression and thus do not allow an assessment of therapy success. Based on these results, grading of non-small cell lung cancer is not recommended after neoadjuvant therapy and the diagnosis of "large cell anaplastic" carcinoma should be made with reservation.

Adenocarcinoma↗

PubMed2004

[Obligation to report occupational diseases. Importance of external post-mortem examinations before cremation].

The practical use of the legally required documentation of occupational diseases is demonstrated by a case of asbestos-related pleural mesothelioma. During the mandatory inquest before cremation, information of manifest pleural mesothelioma had been relayed to the widow of the patient, and an investigation for a possible occupational disease was performed. Reconstruction of the case showed that in the course of 3 months at least 13 physicians had been involved in in-hospital as well as ambulatory therapeutic measures. Until death, none of them informed the trade association about a suspected occupational disease in accordance with BK 4105 of the codex of occupational diseases, although the diagnosis of manifest pleural mesothelioma had been histologically confirmed already 10 weeks prior to the death of the patient. This case demonstrates obvious and evident deficiencies in applying the Code of Social Law VII, which requires physicians to report occupational diseases. In addition, it shows the importance of the post-mortem examination as a control function before cremation.

Germany↗

PubMed2004

[A rare case of a neuroendocrine carcinoma of the esophagus. Intermediate between a well-differentiated neuroendocrine carcinoma and a low-differentiated neuroendocrine carcinoma].

We report a rare case of a neuroendocrine carcinoma located in the esophagus of a 62-year-old male patient. The initial diagnosis of a "small-cell tumor" was based on biopsy. Our diagnosis was based on the histomorphological examination of the resected material. Diagnostic criteria were the characteristic solid or clustered growth patterns, monomorphic cell nuclei, lack of necrosis, immunohistochemical detection of neuroendocrine markers like chromogranin, synaptophysin and neuron-specific enolase (NSE) as well as detection of cytoplasmic neuroendocrine granules by electron microscopy. In addition, we found an increased prolific activity by staining with Ki67 antigen. 30% of the cell nuclei displayed a positive reaction. Focal invasion of blood vessels was also detected. With 17 different chromosomal imbalances, comparative genomic hybridization (CGH) revealed a malignant tumor stage that was not visible at the microscopic level. According to the new WHO classification of neuroendocrine tumors the described tumor was identified as an intermediate between a well-differentiated neuroendocrine carcinoma and a low-differentiated neuroendocrine carcinoma.

Biomarkers↗

PubMed2004

[Morphological findings after stent implantation in the carotid artery].

This report describes the pathological-anatomical and immunohistochemical findings of carotid arteries after incorporation of self-expanding metal stents. Ten stent specimens were examined. All specimens displayed variable expression patterns of chronic low-grade foreign body reactions in the vicinity of the incorporated stent struts as characterized by the appearance of CD68-positive macrophages and mainly CD3- and CD45-R0-positive T lymphocytes. Overwhelming proliferations in relation to intimal hyperplasia can be regarded as the main cause of stent-associated vascular restenosis. After a period of 6 months the expression of factor VIII-positive neoendothelial cells on the luminal surface can be detected in individual cases. Reactions of the vascular wall depend on the state of the underlying atherosclerotic lesions prior to stenting. In cases of predominantly atheromatous soft plaques, the typical reaction pattern triggered by the metallic foreign body pressed into vessel tissue can be absent. In summary, the morphological findings show a chronic tissue reaction in response to stent incorporation. In addition, individually differing reaction patterns ranging from discrete inflammatory changes to massive stenoses were identified and documented.

Angioplasty, Balloon, Coronary↗

PubMed2004

[Angiotensin converting enzyme (ACE, CD143) in the regular pulmonary vasculature].

Angiotensin I converting enzyme (ACE, CD143) is an endothelial transmembrane Zn2+-dipeptidylpeptidase. By formation of angiotensin II and degrading bradykinin it acts as a vasoconstrictor. We examined endothelial ACE expression in human pulmonary vessels in specimens from 20 female and 19 male patients (age: 34-76 years) by immunohistochemistry. In all specimens, capillary endothelial cells showed the strongest expression, followed by those in arterioles and arteries. Venules and veins showed next to no staining. The differences in staining intensities were significant ( P<0.001). Sex affected neither the expression intensity nor the expression pattern. Summarizing, we demonstrate the existence of a vessel-type specific ACE expression pattern for pulmonary vessels. The nearly exclusive endothelial ACE expression in capillaries and arterial vessels points to ACE as an immunohistochemical marker for these vessels in normal lung tissue.

Adult↗

PubMed2004

[Mesotheliomas with leucocytic infiltration].

Malignant mesotheliomas are rare tumors which can affect pleura, peritoneum, pericardium, or tunica vaginalis testis. Histomorphologically, predominant epitheloid, sarcomatoid and biphasic types can be distinguished. In some cases, leucocytic infiltrations can be observed adjacent to the tumor. Here, mesotheliomas presenting inflammatory reactions to tumor growth have to be differentiated from occasional cases with parasynchronic development of neoplastic lymphatic diseases. Moreover, so called lymphohistiocytoid mesotheliomas, a sporadically observed variant of malignant mesotheliomas, have been reported to imitate inflammatory patterns. These different forms of malignant mesotheliomas are difficult to distinguish and may lead to diagnostic misinterpretations and consequently therapeutic mismanagement. The purpose of this study was to differentiate morphological and immunohistochemical characteristics of the above mentioned diagnoses. We therefore studied two rare cases, a mesothelioma with parallel lymphoma and a lymphohistiocytoid mesothelioma, and compared them to a third more common case of mesothelioma with inflammatory tissue-reaction.

Aged↗

PubMed2004

[Classification of pulmonary alveolar proteinosis in newborns, infants, and children].

Pulmonary alveolar proteinoses are rare pulmonary diseases characterised by an intraalveolar accumulation of surfactant protein A. Subtyping of alveolar proteinoses: Type I alveolar proteinoses: severe respiratory insufficiency in newborns, which will take a lethal course without lung transplant; hereditary SP-B deficiency and an intraalveolar accumulation of N-terminal incompletely processed SP-C. Type II alveolar proteinoses: occur in newborns and infants; often take a lethal course; show intraalveolar accumulation of precursors of SP-B and mature SP-B as well as an accompanying interstitial lung disease of variable severity. Type III alveolar proteinoses: in infants and children; do not generally take a lethal course; they are characterised by an intraalveolar accumulation of precursors of SP-B and mature SP-B without accompanying interstitial lung disease. "Cryptogenic" congenital, acquired (idiopathic), and secondary type III alveolar proteinoses can be distinguished. In newborns, infants, and children with pulmonary alveolar proteinosis, a detailed pathological-anatomical examination including immunohistochemical and molecular genetic analyses, should be performed in order to optimise the therapeutical management.

Child↗

PubMed2004

[Therapy-induced tumor regression in adult soft tissue sarcomas-morphological findings].

Morphological findings of 21 soft tissue sarcomas of adulthood following preoperative chemo- and/or radiotherapy including perfusion therapy and resection are presented. The therapy-induced changes included a spectrum ranging from total tumor regression up to still completely vital tumor (median of all cases: 30% vital tumor tissue). 7 of 21 sarcomas (33%) were evaluated as responders (grade I-III). So-called malignant fibrous histiocytoma (MFH) revealed a good tumor response to preoperatively administered therapy (regression grades I and II). Myxoid/round-cell liposarcoma exhibited regression grades of IV-V (i.e. 30% up to 95% vital tumor tissue, non-responders). Synovial sarcoma was characterized by regression grades III up to VI (i.e. up to 100% vital tumor tissue without any signs of regression, 83% non-responders). Completely vital tumor was evident in 2 synovial sarcomas despite preoperative tumor therapy. These findings hint towards differences in response of distinct sarcoma entities to preoperative chemo-/radiotherapy. A grading of therapy-induced tumor regression in adult soft tissue sarcomas may best refer to already established grading schemes (e.g. according to the grading scheme for osteosarcomas following chemotherapy of Salzer-Kuntschik). A report of sarcoma resection specimens should include the percentage of vital tumor tissue.

Adult↗

PubMed2004

Carotid artery calcium: accuracy of a calcium score by computed tomography-an in vitro study with comparison to sonography and histology.

OBJECTIVES: The aim of this study was to compare methods of quantifying calcification of the internal carotid artery. MATERIALS AND METHODS: We examined 92 internal carotid artery endarterectomy specimens. Grey scale median (GSM) values were calculated from optimized B-mode scans. The degree of calcification was assessed using radiographic calcification grading. Plaques were processed histologically, and classified into: (1) calcium-rich hard plaques, (2) lipid-rich soft plaques, and (3) combined plaques. The specimens were scanned in CT-scanner. The calcium score was determined as described by Agatston. RESULTS: Histopathology and GSM results concurred in 39 out of 92 cases (kappa=0.088). There was no significant correlation between the calcium score and the median GSM value (R=0.005; P=0.959). Histology and CT morphology showed a significant concordance (P<0.001). Also CT and radiomorphological classification showed close agreement (R=0.628, P<0.001). CONCLUSIONS: Calcium scores calculated using CT morphology enable precise in vitro evaluation of the calcium content of plaques in the internal carotid. In contrast, grey scale median values do not adequately reflect calcification of plaques.

Aged↗

PubMed2004

[Pleuromesothelioma -- psychology and pathogenesis].

Investigations into the anatomical pathology are of crucial importance for the diagnosis and therapy of pleural tumours. The main objective is to differentiate reactive hyperplastic proliferations of the mesothelium from already manifest primary or secondary malignant pleural tumours. Given the absence of distinct morphological features displayed by pleural mesotheliomas, specific additional immunohistochemical and cytometric tests can provide valuable clues for the differential diagnosis of primary and secondary pleural neoplasms. Confirmation of the diagnosis during the initial stages of tumour development i. e. mesothelioma in-situ and early mesothelioma necessitates invasive diagnostic procedure as early as possible. This holds particularly true if surgery is aimed at cure. However, in order to firmly establish the diagnosis considering the afore mentioned problems, the tissue specimens to be examined by a pathologist must be of adequate size. 90 % of all pleural mesotheliomas are asbestos associated due to occupational exposure. Therefore, all cases of a suspected pleural mesothelioma must be reported to the appropriate professional association as a potential occupational disease. The Bochum based German Mesothelioma Registry, which is supported by the head office of the German Professional Associations, conducts research and acts as an advisory institution in difficult cases, where problems concerning the classification of tumours by their anatomical pathology arise.

Humans↗

PubMed2004

Human coronary morphology after beta radiation brachytherapy of in-stent restenosis.

This case report discusses the human coronary morphological findings 18 hours after brachytherapy (beta radiation) of an in-stent restenosis. Brachytherapy produced aseptic inflammation of the periadventitial connective tissue integrating the vasa vasorum in the acute phase. The stent neointima eight months after stenting and acutely 18 hours after radiation consisted of the same cellular components as human stent neointima of specimen not additionally treated with radiation. No evidence of necrosis or excessive fibrotic alterations of the arterial vessel wall have been found.

Beta Particles↗

PubMed2004

Severe pulmonary hypertension in chronic idiopathic myelofibrosis.

BACKGROUND: Chronic myeloproliferative disorders (CMPD) seem to be associated with an increased risk for pulmonary hypertension (PH). CASE REPORT: A patient with history of chronic idiopathic myelofibrosis (CIMF) presented with progressive dyspnea (New York Heart Association class III). Until this time he had not received specific treatment for CIMF. Echocardiography and rightheart catheterization confirmed PH. Further diagnostic procedures excluded a specific cause of PH. Therefore, primary PH was assumed. 2 years later he presented again with progressive dyspnea due to a progress of PH. A few days later the patient died from acute posterior myocardial infarction. Pathologic examination of the lung showed an obstruction of the small vessels by conglomerates of megakaryocytes. DISCUSSION: We conclude that PH developed secondarily due to CMPD. PH should be suspected in patients with CMPD and should influence the decision for treatment of CMPD.

Chronic Disease↗

PubMed2003

[Neuroendocrine tumors of the lung].

Neuroendocrine tumors of the lung can be seen as a separate entity, in accordance with the recommendations of the WHO classification of 1999, in terms of immunohistochemical findings in biopsy material as well as in more extensive resections. The characterization of carcinoid tumors and small cell lung cancer by the pathologist according to histomorphological and cytological criteria is commonly accepted, and is of decided importance with regard to clinical questions and therapeutic measures.However, it is still unclear whether the "new" group of large cell neuroendocrine carcinomata of the lung has to be regarded as a separate entity with clinical and therapeutic relevance, or whether this group remains within the non-small cell lung cancers as a special form of differentiation. These complex questions can only be answered by studies targeting the course of the disease and the results of therapy.

Carcinoid Tumor↗

PubMed2003

[CGH findings in neuroendocrine tumours of the lung].

According to the 1999 World Health Organisation classification of lung tumors, the classification of neuroendocrine (NE) tumors is solely based on light-microscopic features. Typical and atypical carcinoid tumors are distinguished from large cell (LCNEC) and small cell neuroendocrine carcinomas (SCLC). We used comparative genomic hybridization (CGH) on 50 samples to investigate the cytogenetic relationships between NE tumors. On average, carcinoid tumors showed markedly fewer chromosomal imbalances (1.8/case, 23 cases) than LCNEC (13.3/case, 17 cases) or SCLC (17/case, 10 cases). The frequency of amplicons increased accordingly. Typical carcinoid tumors exhibited significant defects on chromosomes 11 and 13 only. Interestingly, only the frequency of losses on chromosome arm 11q was very similar for all three tumor entities (about 30%). In conclusion, the CGH results support the classification of typical carcinoid tumors as a separate entity in clear distinction from the NE carcinomas.

Carcinoma, Large Cell↗

PubMed2003

[Apoptosis and tumor regression in locally advanced non-small cell lung cancer with neoadjuvant therapy].

Dysregulation of apoptosis is closely associated with malignant cell transformation. On the other hand, apoptosis is induced by chemotherapy or irradiation. Therefore, in 54 patients with locally advanced non-small cell lung cancer (NSCLC, 36 squamous cell carcinomas, 18 adenocarcinomas, stage IIIA/IIIB), apoptotic indices were comparatively analysed before onset and after termination of neoadjuvant therapy. The results were compared with the response to neoadjuvant therapy (extent of therapy-induced tumour regression) as well as the survival times. A statistically significant difference could not be established between pre-therapeutically and post-surgically established apoptotic indices (mean values: 0.93% vs. 1.1%). Neither before therapy nor after surgery did the apoptotic indices show a significant predictive value concerning different overall survival times. These results suggest that neoadjuvant therapy does not modify the extent of apoptosis in lung cancer in the long term. Only a few weeks after the completion of the neoadjuvant chemoradiotherapy this contributes to a net proliferation of the residual tumour tissue which is largely equivalent to that of the untreated tumour.

Adenocarcinoma↗