: Ultrasound-guided fine-needle aspiration biopsies were performed in 37 patients (23 women, 14 men; mean age 58 [47-81] years) out of 310 patients in whom an adrenal tumour had been diagnosed by ultrasound between 1985 and 1991. In 21 the tumour diameter was 2-4 cm, in 16 over 4 cm. In 36 patients (97%) the material was suitable for histological analysis. There were 15 metastases, 4 primary adrenal carcinomas and 17 adenomas. 20 of 27 with an underlying malignant tumour had a malignant adrenal tumour (one of the aspiration biopsies in these cases was false-negative), while in 7 the space-occupying lesion was found to be benign. There were no false-positive findings. Ultrasound-guided fine-needle biopsy thus proved to be a reliable and informative method in the diagnosis of adrenal tumours. It should be undertaken under appropriate indication to ascertain the benign or malignant nature of a suspected adrenal lesion.

History and clinical findings. A 72 year old woman presented with signs of decompensated heart insufficiency 4 months after an operation due to perforated diverticulitis and retroperitoneal abscess. She had no fever leucocytosis, increase of CRP or signs of embolism but the erythrocyte sedimentation rare was 81 mm in the first and 115 mm in the second hour.Investigations. As the cause of the left heart incompetence, we found an aortic insufficiency 111 degrees due to a paravalvular leakage. Furthermore, there was an abscess in the aortic wall.Diagnostic procedure, treatment and courser Because of the endocarditis with an accompanying abscess of the aortic wall the patient was treated with an aortic valve replacement Post-operatively clostridium sordelli, an anaerobic germ of wound infection was cultured from the removed valve. Probably: it has been in the bloodstream since the operation of the perforated diverticulitis and retroperitoneal abscess. The patient had a complete recovery under a therapy with metronidazol for three weeks. In the observation for one year she got no relapse of endocarditis.Conclusions. Due to the increase of invasive diagnostic and therapeutic procedures exceptional germs of endocarditis were found more often. Therefore, atypical courses are also increasing.

In many cases blunt chest trauma involves cardiac lesions, such as pericardial effusion, aneurysma dissecans, or valvular rupture. Early diagnosis with routine transthoracic and/or transesophageal echocardiography is essential to prevent a fatal outcome. In the case reported, a previously healthy 68-year-old woman fell 7 meters from the roof of a barn and sustained blunt injury to the chest as well as fractures of the face. Physical examination revealed a systolic murmur at the cardiac apex, and chest x-ray film showed a severe pulmonary edema. Transesophageal echocardiography demonstrated a ruptured anterolateral papillary muscle with fourth degree mitral insufficiency. An immediate mitral valve replacement was necessary.

History and clinical findings: A 73-year-old woman was hospitalised because of increasing dyspnoea and hoarseness after a bout of acute tracheobronchitis. She had been receiving levothyroxine for a growing grade III nodular goitre. At the ages of 26 and 29 she had been treated for cervical lymph node tuberculosis with local excision and percutaneous radiotherapy of 8 Gy each time. On examination she was found to have a bulging neck profile and a hard, practically immobile node in the left lobe of the thyroid.Investigations: Laboratory tests showed a euthyroid metabolic state, while ultrasound demonstrated a mass, 40 mm in diameter, scintigraphically a cold nodule. A fine-needle biopsy was cytologically highly suspicious of neoplasm.Treatment and course: Surgical exploration of the neck and mediastinum revealed an insular follicular carcinoma (10 cm in diameter), involving the right recurrent laryngeal nerve and surrounding the brachiocephalic trunk. The latter had to be removed and a Gore-Tex graft was interposed. Postoperative radiotherapy was given (150 mCurie I-131).Conclusion: An enlarging nodular goitre, occurring after a latent period of years following radiotherapy to the neck region for benign and (or) malignant disease, especially when it had been administered in childhood or young adulthood, should raise the suspicion of a radiogenic thyroid carcinoma. Definitive diagnosis by fine-needle biopsy is essential.

PURPOSE:Pelvic lymphadenectomy remains the most reliable method to prove lymph node metastases in prostate cancer. However, evaluation of lymphadenectomy to be complete and sufficient as judged by the number of removed lymph nodes in hampered by the fact that, in contrast to other malignancies (for example breast or gastric cancer), anatomical studies investigating the regular and average number of pelvic lymph nodes are missing. We established an anatomically based standard for pelvic lymphadenectomy. MATERIALS AND METHODS:Standard pelvic lymphadenectomy was performed on 30 human cadavers and 59 consecutive patients with clinically organ confined prostate cancer during radical retropubic prostatectomy. Number, size and topography of the lymph nodes were noted separately for each anatomical region of both iliac fossas. RESULTS:The mean number of lymph nodes removed in the autopsy series plus or minus standard deviation (22.7 +/- 10.2, range 8 to 56) was nearly identical to that from patients with prostate cancer (20.5 +/- 6.6, range 10 to 37) but striking interindividual differences were observed. Patients with prostate cancer demonstrated enlarged nodes regardless of whether they did or did not contain tumor. Interestingly, pelvic lymph node metastases were more common on the left side regardless of the primary tumor site. CONCLUSIONS:Approximately 20 pelvic lymph nodes may serve as a guideline for a sufficient standard pelvic lymph node dissection. Lymphadenopathy in prostate cancer patients is not always a result of metastases but, rather, hyperplastic or regressive alterations. A preferential distribution of lymph node metastases along the left iliac vessels regardless of the primary tumor site in the prostate warrants further investigation.

Prostatic carcinoma obtained from 41 patients (pT2N0, 5; pT2N+, 2; pT3N0, 16; pT3N+, 16; pT4N0, 1; and pT4N+, 1) ranging from 45 to 79 years of age were investigated in the present study. A total of 410 tumor areas of different grades were analyzed (G1, n = 116; G2, n = 98; and G3, n = 196). Vascular structures were labeled immunohistochemically using factor-VIII-associated antigen. The vascular surface density (VSD), the microvessel number (NVES), and the maximum microvessel number (NVES-MAX) were assessed by means of stereology, and the results were related to tumor stage, nodal status, and grade of differentiation. NVES and NVES-MAX showed a significant increase with rising pT stage ranging from 25.5 +/- 1.48 in controls to 135.0 +/- 5.5 microvessels/mm2 in pT4 tumors. Discrimination of different pT stages was more accurate with NVES-MAX. The VSD was significantly higher in pT2 tumors compared with controls, whereas there were no significant differences between pT3 tumors, pT4 tumors, and controls, although the values in pT3 and pT4 tumors were distinctly lower than in pT2 tumors (P < .05). The VSD and the NVES were not able to discriminate between the pN0 and the pN+ group. Both parameters were slightly higher in patients with metastatic disease. Only NVES-MAX values differed between the two groups with an average of additional 21 microvessels/mm2 in the pN+ group (P < .05). Concerning the grade of tumor differentiation the VSD continuously decreased from G1 (14.58 +/- 2.24 mm(-1) to G3 tumor areas (5.41 +/- 1.46 mm(-1). Only G1 tumors showed significant differences compared with controls (6.65 +/- 0.38 mm(-1). The NVES increased with rising tumor grade with significant differences between all four groups ranging from 25.5 +/- 1.5 in controls to 136.9 +/- 37.2 microvessels/mm2 in pT4 tumors.

Experimental and clinical evidence exists showing that tumor growth, local recurrence and metastasis in progressive disease are dependent upon tumor angiogenesis. Quantification of microvessels as a measure of angiogenesis might be one of the most powerful prognostic tools available based on the assumption that metastatic potential increases with enhanced vascularization. Vascular surface density (VSD: dimension mu m(-1)) expressing the amount of surface area of blood vessels contained in a unit of tissue volume was calculated in 79 renal cell carcinomas of different nuclear grades (G1: n = 16; G2: n = 42; G3: n = 21). Vessel walls were highlighted by immunostaining endothelial cells for Ulex-Europaeus-Antigen (UEA). VSD was calculated using an ocular test grid evaluating 10 randomly selected areas for each tumor at x400 magnification. In contrast to findings in other tumors we observed a significant reduction of vascular density with decreasing differentiation of tumor tissue, poorly differentiated RCC (G3) disclosing to lowest value of vessel surface per volume. As the mean values of Vascular surface density in normal renal tissue overlap with those obtained from moderately differentiated tumors, the degree of vascularization is not qualified to serve as a prognostic factor in renal cell carcinomas. The comparison and interpretation of existing studies, however, is rendered more difficult as a result of the lack of standardized methods for the quantitative assessment of neoangiogenesis.

Three cases of malignant clear cell carcinoma of the gallbladder were studied immunohistochemically with a broad panel of antibodies, especially cytokeratins, in order to better characterize their histogenesis. The advantage of immunohistochemistry in the differential diagnosis between clear cell carcinoma of the gallbladder and other clear cell carcinomas metastatic to the gallbladder such as renal cell carcinoma is discussed.

Primary carcinoma of the adrenal cortex is an extremely rare neoplasm, accounting for an estimated 0.05-0.2% of all malignancies. Hormonally functioning tumors occur in about 50% of patients with Cushing's syndrome (50%), virilism (30%) and feminization (12%) being the most common clinical manifestations. Isolated aldosteronism caused by adrenocortical carcinoma is found in about 1-3% in patients with the clinical signs of Conn's syndrome. The only preoperative feature suggesting malignancy is a size of more than 5 cm in computed tomography. We report a rare case of a 29-year-old man with biochemically proven primary aldosteronism as the unique manifestation of a carcinoma of the right adrenal cortex.

The expression of two specific nucleolar antigens, p120 and B23, has been investigated in the prostatic carcinoma cell line LNCaP as well as in 40 frozen and 40 formalin-fixed tissue samples of benign and malignant prostatic lesions (15 benign hyperplasias, 5 grade 1, 15 grade 2, and 5 grade 3 carcinomas). In vitro, immunoreactivity of p120 was confined to nucleoli of proliferating cells, with virtually no negative staining during S and G2/M phases. Unlike p120, B23 was expressed in the nucleoli of all LNCaP cells independently of growth and cell cycle phases. Hence, B23 was detectable in all stromal as well as in normal and malignant epithelial prostatic cells, both in fresh and in formalin-fixed tissue sections after microwave treatment. In contrast, the immunoreactivity of p120 was almost completely restricted to the nucleoli of prostate carcinoma cells: frozen sections of benign prostatic hyperplasia (n = 15) were either totally negative for p120 (n = 13) or had a low percentage of positively stained cells (labeling index = 3.3% in 3 cases). In the carcinoma group 76% (19/25) of the specimens were p120 positive, and there was a significant rise of labeling index from 18.1% in grade 1 to 82.2% in grade 3 carcinomas (P < 0.001). In contrast to B23, p120 could not be reliably demonstrated in formalin-fixed and paraffin-embedded tissue. We therefore conclude that anti-B23 is a general marker of nucleoli, whereas expression of p120 appears to correlate with "hyperactivity" of the nucleolus and provides a new tool for flow cytometrical and immunohistochemical assessment of nucleolar activity in tumor pathology.

Nitrogen dioxide (NO2), the oxidation product of nitric oxide (NO), is a reactive free radical forming gas, the inhalation of which has been reported to induce severe damage to distal airways. In order to quantify dose and time course of parenchymal and vascular damage, rats were exposed to 5, 10 and 20 ppm NO2 for 3 and 25 days, followed by quantitative histology and morphometry of the lung. Histological investigations of the short-term exposed animals showed structural alterations extending from slight interstitial oedema after exposure to 5 ppm, to epithelial necrosis and interstitial inflammatory infiltration after exposure to 10 ppm, and an additional intra-alveolar oedema after 20 ppm. The pulmonary arteries disclosed no qualitative changes, such as muscularization of intra-acinar vessels. Long-term exposure to 10 ppm and 20 ppm NO2 resulted in emphysema and slight centrilobular interstitial fibrosis. Morphometric analysis revealed the alveolar surface density to be significantly diminished after short-term exposure to 20 ppm NO2 and long-term exposure to 10 and 20 ppm NO2. The medial thickness of pulmonary arteries was significantly increased after short- and long-term exposure to 20 ppm NO2 and long-term exposure to 10 ppm NO2. In the 5 ppm short- and long-term exposure groups the pulmonary arterial medial thickness was significantly decreased compared to controls. Correlation analysis revealed a negative correlation between average medial thickness and alveolar surface density (coefficient of correlation: -0.56). We conclude that the extent of NO2-induced pulmonary parenchymal and vascular alterations are closely related and concentration- and time-dependent.

In this study we investigated the diagnostic significance of a set of different morphometric nuclear parameters in the differential diagnosis of soft tissue tumors. Nuclear area, the standard deviation of the nuclear area, the shape factor and other parameters such as Feret's Diameter and Martin's Radii were assessed using a computer assisted image analyzer system. A statistically significant difference (p < 0.01) between benign and malignant tumors and tumor-like lesions could be confirmed for the nuclear area and the standard deviation of the nuclear area, with the significance level being lower (p = 0.5) for the latter parameter. The shape factor also discriminated between the examined groups. Reclassification of the assessed histological diagnosis was performed by linear discriminant analysis using all possible combinations of the different nuclear parameters. This procedure disclosed an increasing rate of correctly reclassified cases with rising number of parameters applied. We conclude that the assessment of nuclear parameters may be helpful in the correct diagnosis and differential diagnosis of soft tissue tumors and tumor-like lesions of fibrous origin.

Amongst males, the prevalence of prostate cancer is third in frequency with a rising incidence. As the population grows older, the number of latent cancer of the prostate increases. Therefore, diagnostic tools for an early detection of this malignancy are necessary. Silver staining of nucleolus organizer regions (AgNOR) is a new technique in tumour analysis. It is especially valuable as an addition to classical prostate cytology. A report on 90 cases of transrectal prostate aspiration biopsies is presented. 81 of these had a histological evaluation (biopsy gun) at the same time. The air-dried slides were stained according to Ploton et al. [10]. The AgNORs were counted and measured by means of an interactive image analysis system. Patients without malignancy were reliably classified as negative both by routine cytology as well as by AgNOR analysis. The sensitivity in routine tumor diagnosis was ca. 87%. In contrast, the AgNOR index revealed a sensitivity of 96% and a specificity of 97%. Thus, AgNOR staining improves differential diagnosis in inconclusive cases. Our data suggests that the inexpensive AgNOR analysis improves differentiation between carcinomatous and benign prostatic cells. It is a useful tool, in addition to routine prostatic cytology.

We report on the case of a 31-year-old male patient with focal testicular vasculitis as the only clinical manifestation of endangiitis obliterans (Winiwarter-Buerger disease), who presented with acute scrotal pain and swelling suggestive of a testicular tumor. Doppler sonography revealed significantly increased vascularization at the borders of the lesion, which rather indicated a vascular process; however, the presence of solid areas meant that the possibility of testicular cancer could not be excluded. Left inguinal orchiectomy was performed. The surgical specimen revealed histological patterns compatible with endangiitis obliterans; Raynaud phenomenon was the only sign of systemic disease, and no other organs were found to be affected. Despite the high sensitivity and specificity of ultrasound/Doppler sonography, in the differential diagnosis of an unexplained testicular mass surgical exploration is still mandatory. The different types of focal vasculitis are described and discussed with reference to the literature.