Hintergrund: Die Diagnostik von interstitiellen Lungenkrankheiten ist schwierig. Die einfache und relativ risikoarme transbronchiale Zangenbiopsie liefert wegen der kleinen, durch Quetschartefakte veränderten Biopsate nur in ca. 30% eine eindeutige Histologie. Die chirurgische Lungenbiopsie (meist videoassistierte Thorakoskopie, VATS) ermöglicht bei allerdings wesentlich höherem Aufwand eine Diagnosestellung je nach Definition in >90%. Die transbronchiale Kryobiopsie wurde erstmals 2005 beschrieben, Berichte über den Einsatz in der klinischen Routine fehlen bisher.

The effect of incongruous medial meniscal grafts on the articular surface was studied. We compared the cartilage degeneration in 4 Groups of 25 sheep knees. The histological changes were graded according to the score of Mankin, the morphological alterations by the score of Jackson. In Group 1 no surgery was performed. In group 2, the meniscus was totally detached from its base at the capsule and refixed without changes in the congruity or isometry. This group provided the basic data. In group 3, the contralateral medial meniscus was used as a transplant by reversing it. The reattachment was done according to isometric conditions. With this technique only the congruity of the tibial and femoral surface was modified. In group 4, the medial meniscus was completely removed. The results of group 1 (Mankin grade 0.58; Jackson grade 0.00) and group 2 (grade 0.50 and 0.47) showed no difference. The highest degree of degenerative changes occurred in the meniscectomized knees (group 4, grade 4.47 and 1.73), however considerable changes were also found in the knees with an incongruous meniscal graft (group 3, grade 3.37 and 1.27). The results suggest that incongruous grafts will lead to degeneration of the articular surface but still have a chondroprotective effect.

Lymphangiomyomatosis (LAM) is a benign tumor-like lesion of lymphatic vessels with unknown etiology. 80 cases of LAM are presently described. So far, it appears that only women in their reproductive years seem to be affected. Here, we describe the first LAM in an 11-months-old infant with a presumably local form of LAM. This leads us to consider the possibility that this tumor-like lesion may originate from a hamartomateous malformation. The diagnosis is based on pre-operative sonography and CT, as well as on histological and immunohistochemical examination of the tumor.

The effect of incongruous medial meniscal grafts on the articular surface was studied. We compared the cartilage degeneration in 4 Groups of 25 sheep knees. The histological changes were graded according to the score of Mankin, the morphological alterations by the score of Jackson. In Group 1 no surgery was performed. In group 2, the meniscus was totally detached from its base at the capsule and refixed without changes in the congruity or isometry. This group provided the basic data. In group 3, the contralateral medial meniscus was used as a transplant by reversing it. The reattachment was done according to isometric conditions. With this technique only the congruity of the tibial and femoral surface was modified. In group 4, the medial meniscus was completely removed. The results of group 1 (Mankin grade 0.58; Jackson grade 0.00) and group 2 (grade 0.50 and 0.47) showed no difference. The highest degree of degenerative changes occurred in the meniscectomized knees (group 4, grade 4.47 and 1.73), however considerable changes were also found in the knees with an incongruous meniscal graft (group 3, grade 3.37 and 1.27). The results suggest that incongruous grafts will lead to degeneration of the articular surface but still have a chondroprotective effect.

Auxiliary liver transplantation (LT) is a special procedure of LT which could be proposed to patients with fulminant hepatic failure (FHF) and has for aim that complete regeneration of the native liver (NL) left in place will allow the graft recipient to resume normal liver function after allograft withdrawal.We report 30 cases of auxiliary LT performed for FHF in 12 European centers, Twenty-five of 30 patients were younger than 50 years. The cause of FHF was hepatitis A virus (HAV) in 4 patients, hepatitis B virus (HBV) in 7, paracetamol overdose in 5, ecstasy in 2, hepatotoxic drugs in 4, autoimmune hepatitis in 2, liver lesions of preeclampsia in 1 and unknown in 5, A postoperative, both clinical and histological follow-up of more than 3 weeks was obtained in 22 patients, enabling us to look for indicators predictive of NL regeneration and outcome. Histological changes observed in the NL included complete regeneration in 68%, incomplete regeneration with obvious fibrous sequelae in 14% and severe liver fibrosis or cirrhosis in 18%, of the 22 patients studied.The percentage and distribution of necrosis observed in tissue samples of the NL at the time of transplantation was not related to the final outcome. Complete NL regeneration was observed in 15 patients, out of whom 14 were younger than 40 years. Patients with complete regeneration were mainly affected by FHF due to HAV, HBV, or paracetamol overdose. After a follow-up of 18/11 (mean/median) months (range, 3 to 67 months), 19 of the 30 patients (63%) survived and 13 of them (68%), i.e., 43% of the 30 patients, had resumed normal NL function, with interrupted immunosuppression, the ultimate goal of emergency auxiliary LT,We conclude that, in patients with FHF, auxiliary LT is a procedure feasible in a number of centers and is associated with a complete regeneration capability of the NL in a majority of survivors, especially in those younger than 40 years. Confirmation of these encouraging preliminary results by large-scale prospective studies is required.

The value of cytogenetics performed simultaneously with histopathology was evaluated in patients with myelodysplastic syndrome (MDS). Clonal karyotype changes of the bone marrow cells supporting the histological diagnosis were found in 38/69 cases (55%). The chromosome aberrations, especially complex changes, were significantly correlated to distinct histopathological findings such as atypias of the haematopoietic cell lines and myelosclerosis. Complex karyotype changes were further associated with short survival of the MDS patients. Our results demonstrate that cytogenetic analyses are helpful in supplementing the histopathological diagnoses. Recent developments in molecular cytogenetics even allow the detection of chromosomal aberrations in non-dividing cells from cytological preparations or tissue sections which may become available for routine diagnosis.

Chromosome analyses of bone marrow and peripheral blood cells were performed in a total of 51 patients with myelodysplastic syndromes (MDS) simultaneously with histopathological examination of resin-embedded bone marrow biopsies. Diagnosis of MDS was established by histopathology according to the French-American-British (FAB) classification, and reassessed by haematological data and clinical course. Clonal karyotypic changes were found in 30 of the 51 patients (59%): in 15 of 19 (79%) patients with refractory anaemia, 7 of 11 (64%) with refractory anaemia and excess of blasts (RAEB), 6 of 10 (60%) with RAEB in transformation, and 2 of 11 (18%) with chronic myelomonocytic leukaemia. The following three features of the histopathology revealed positive correlations with karyotype abnormalities: all cases of myelofibrosis in MDS (7/51) were accompanied by chromosome aberrations, microforms of megakaryocytes with reduced nuclear lobulation were observed in 18 of 30 cases with karyotype changes, and hypocellularity of haematopoiesis was associated with aberrations of chromosome 7 in 2 of 4 cases. No positive correlations were revealed between abnormal karyotypes and the transformation to acute leukaemia. The survival times were significantly decreased in patients with complex (3 and more) karyotype changes, when compared with patients with single (1-2) chromosome aberrations or normal karyotype, independently of the FAB classification.

Regression of pulmonary metastases from renal cell carcinoma (RCC) following nephrectomy is well known, although infrequent. Regression of metastases in other organs is extremely rare. However, only 44% of the reported cases in the literature have provided convincing histological proof of metastatic disease prior to the observed regression. Moreover, the majority of cases have occurred following nephrectomy, with or without other therapeutic measures. This paper gives an up-to-date review of 114 cases reported in the literature. The authors' own RCC patients with metastatic spread and showing this clinical phenomenon are also given.

A 43-year-old alcohol-dependent man had sustained three acute episodes of chronic pancreatitis. At the third hospital admission enlarged axillary and supraclavicular lymph nodes, widening of the mediastinum and bone metastases were noted. Cytological examination of a needle biopsy of the supraclavicular lymph node revealed a poorly differentiated adenocarcinoma. Because of the marked enlargement of the pancreas and the history, a rapidly and unusually metastasizing carcinoma of the pancreas was diagnosed. In view of the rapid deterioration of the patient no chemotherapy was begun and he died 4 weeks after admission. Autopsy confirmed the chronic pancreatitis but no carcinoma of the pancreas. Instead there was a peritoneal mesothelioma with extensive lymphogenous and haematogenous metastases. The incidence of this tumour is ever increasing. It should be included in the differential diagnosis, because survival time can be increased if the correct diagnosis is made very early.

The distribution of various types of necrosis was studied in rheumatoid synovial tissue of different joints. It was found that rheumatoid granulomas were present only in tissues of hand and elbow joints, whereas hemigranulomas occurred in hand, elbow and knee joints. Necrotising vasculitides were most frequently seen in those joints which also contained rheumatoid granulomas or hemigranulomas.