Mixed malignant germ cell tumour of the liver

Germ cell tumours of the liver are rare neoplasms, with fewer than 20 cases reported in the literature following presentation as teratomas, choriocarcinomas or yolk sac tumours. We report a 52-year-old patient who complained of upper abdominal pain and anorexia. Ultrasonography and computed tomography of the abdomen revealed a large hepatic mass. Among the laboratory values we found elevated levels of alpha-fetoprotein and beta-chorionic gonadotropin. Repeated biopsies via CT scan, laparoscopy and laparotomy disclosed a poorly differentiated adenocarcinoma. Subsequently liver function deteriorated and, on the basis of clinical data highly suggestive of a malignant germ cell tumour, a modified chemotherapeutic protocol (PEI) was initiated. The elevated levels of alpha-fetoprotein and beta-chorionic gonadotropin declined rapidly, but the patient died 10 days later of liver dysfunction and bronchopneumonia. Subsequent autopsy confirmed the initial clinical diagnosis of a multilocular extragonadal malignant germ cell tumour of the liver with components of choriocarcinoma and embryonal carcinoma.

Proliferative activity, p53 accumulation and neoangiogenesis in pulmonary carcinosarcomas and pulmonary blastomas

Carcinosarcoma and pulmonary blastomas are rare biphasic tumors. Lung cancer pathogenesis is a multistep process. Proliferative activity, p53 accumulation and angiogenesis are of well-known relevance and ought to be evaluated in the epithelial and mesenchymal components of these tumors. Using antibodies against Ki-67 epitope MIB1 and proliferating cell nuclear antigen (PC 10) in 10 carcinosarcomas, tumors revealed a significantly higher proliferative activity in the epithelial component compared with the mesenchymal component in the MIB1 reaction (p = 0.013). In three pulmonary blastomas of the biphasic subtype, proliferative activity was similar in both parts. In five of 10 carcinosarcomas and in one of three pulmonary blastomas, accumulation of the p53 epitopes Pab 1801 and/or DO-1 was found. At the tumor front, a significantly higher vessel density was found compared with the central parts (p < or = 0.015) using a monoclonal antibody against human endothelium (CD 31). No differences were found between carcinosarcomas and pulmoblastomas. Higher proliferative activity in carcinosarcomas revealed a better prognosis regarding metastasis behavior (p = 0.05) and tumor-associated death in the follow-up (p < or = 0.017). p53 accumulation and microvessel density were of no prognostic value. This is in contrast to results in non-small cell lung cancer, pointing to a different biologic behavior.

[Expression of proliferation markers PCNA and MIB 1 in verrucous squamous epithelial carcinoma of the oral cavity]

Expression of proliferation markers PCNA and MIB 1 was evaluated in 17 verrucous carcinomas and in five cases of normal squamous epithelium of the oral cavity. Immunohistochemistry revealed no significant differences in the proliferative activities. Highest expression was seen in the basal zones. Proliferative activity in more than 26% of cells is no longer compatible with verrucous carcinoma, but favours the diagnosis of squamous cell carcinoma.

[Primary germ cell tumors of the mediastinum]

This is a report on 5 cases of mediastinal germ cell tumours. Of three mature teratomas seen in a 48-year old male and a 21-year old and 19-year old female, one was asymptomatic, another one associated with streptococcal pneumonia and the third associated with progressive cough irritation. In addition, a seminoma was seen in a male of 58 years of age and a yolk sac tumour (mesonephroma type 2) in a male of 23 years. Whereas in mature teratomas surgical resection can be considered sufficient, resection combined with chemotherapy should be performed in patients suffering from malignant germ cell tumours, and in addition also radiotherapy in case of seminoma. This approach may result in a significant improvement of the prognosis in malignant mediastinal germ cell tumours.

[Malignant fibrous histiocytoma in the area of a total endoprosthesis of the hip joint]

Up to now 8 cases of malignant fibrous histiocytoma are reported in whom the tumor had developed after total hip replacement. Direct contact between tumor and prosthesis was proved in 7 cases. We report on a female patient of 74 years of age in whom a malignant fibrous histiocytoma of the gluteal region had formed 15 years after total hip replacement. Tumor was located in the old operation scar. Not only a direct effect of the foreign material, but also the scar has to be regarded as an etiological factor in pathogenesis of malignant fibrous histiocytoma in these cases.

Tracheal carcinoma and mixed pneumoconiosis. A causal relationship?

We report on a 58-year-old man who had worked as a plumber and fitter for over 41 years and had been exposed to asbestos, man-made mineral fibers and welding fumes. Eighteen months before death, squamous cell carcinoma of the trachea occurred. Energy-dispersive X-ray analysis revealed intrapulmonal dust deposits in accordance with his exposure. A relationship between the tracheal carcinoma and the dust exposure causing a mixed pneumonoconiosis seems to be probable.

[Pneumocystis carinii pneumonia with recurrent pneumothorax and pleuritis]

A report on three HIV-positive patients with recurrent pneumothorax in pneumocystis carinii pneumonia on whom partial parietal pleurectomy and in two cases also a wedge-shaped pulmonary resection were performed. Histology revealed granulomatous necrotising pneumonia involving the visceral pleura, and a partly honeycomb-shaped metaplasia of the pulmonary tissue. A fibrinous and partly granulomatous necrotising pneumocystis carinii pleuritis of both pleural membranes was seen, being the morphological correlate of an in all cases prolonged exudation to the pleural cavity. Conservative treatment remained unsuccessful due to the marked lung and pleura involvement in the inflammatory process, necessitating surgical revision.

[Pneumatosis cystoides intestinalis: associated diseases, morphology and presumed pathogenesis]

Based on six cases, the clinical presentation, morphology and presumable pathogenesis of pneumatosis cystoides intestinalis (PCI) are discussed. As a rule PCI is not a disease in its own right, but a complication of very different, in part extraintestinal diseases. These can be subsumed in three groups. Group 1 includes patients with PCI as a complication of lung disease and initially normal intestinal status. The patients in group 2 develop pneumatosis on the grounds of intestinal disease secondary to primary extraintestinal or generalized disease. In group 3 pneumatosis develops as a complication of primary gastrointestinal disease.

[Malignant fibrous histiocytoma of the thoracic wall in the area of a tuberculous pleural callosity]

The authors report on a patient of 85 years of age in whom a malignant fibrous histiocytoma of the thoracic wall had formed 51 years after a healed pulmonary tuberculosis that had resulted in the development of a pleural callosity. The malignant fibrous histiocytoma is interpreted as a neoplastic transformation of cells of the primary repair process. Age assumes the role of a predisposing factor.

Scar carcinoma of the trachea after tracheotomy. Case report and review of the literature

We present another case of squamous cell carcinoma of the trachea developed in a tracheotomy scar. In the literature 6 cases of cancer found in tracheotomy scars or tracheostomies are reported. The patients' ages ranged from 6 to 66 years. The interval between tracheotomy and the occurrence of cancer ranged from 3 to 41 years. Local extirpation and radiotherapy were tried. The use of stents is emphasized.

[Esophago-thoracic fistula after pneumonectomy and long-term main bronchus stump fistula]

A woman patient admitted for treatment, who had reached the age of 65 years, had a previous history of an open pulmonary tuberculosis in 1946 that had been treated at that time by means of collapsotherapy and phrenico-exeresis. Pleuropneumonectomy was performed in 1976 because of a residual cavity of a thoracic empyema. Since 1978 the patient suffered from a fistula of the bronchus treated by postural therapy without achieving a cure. In 1989 a fistula formed between oesophagus and pneumonectomy cavity. Clinically this was associated with an increasing reduction of performance and a suddenly ineffective postural drainage, resulting in triphasic and eventually fatal aspiration. Histology revealed a suppurative inflammation in the fistular channel and a slight superficial Candida colonisation of the pneumonectomy cavity, of the fistular channel and of adjacent mucous glands of the oesophagus. Formation of the fistula was probably due to a small traction diverticulum followed by perforation because of obstructed oesophageal passage due to scarified distortions.