Human chromophobe cell renal carcinoma

Twelve renal cell carcinomas composed of "chromophobe" cells are described. This is the first report of renal chromophobe cell tumors in humans neoplasms of this cell type having been described previously only in experimentally induced adenomas in animals. By light microscopy chromophobe cells have slightly opaque or finely reticular cytoplasm when stained with haematoxylin and eosin. They may be distinguished from the clear cells of hypernephroid renal cell carcinomas by the strongly positive reaction of their cytoplasm with Hale's (1946) colloidal iron method and the weaker positive reaction with alcian blue. Vesicular structures, often containing internal vesicles, and possibly derived from the endoplasmic reticulum or from mitochondria are visible electronmicroscopically. Glycogen is present to a variable but slight extent so that it is usually detected only by electron microscopy. The twelve renal cell carcinomas described were composed entirely of chromophobe cells. They were derived from a series of more than 500 adult renal cell carcinomas giving a frequency of approximately 2%. To avoid confusion the descriptive term "light cell" should be discarded and replaced by either "clear cell" or "chromophobe cell" as appropriate, since it is assumed that chromophobe cell tumors have a different derivation from clear cell and other renal cell carcinomas. They may also have a different prognosis although this has not yet been established.

Xanthogranulomatous cholecystitis mimicking carcinoma of the gallbladder: CT findings

The CT findings in a case of xanthogranulomatous cholecystitis are reported. Irregular thickening of the gallbladder wall and poorly defined borders of the underlying liver and the adjacent duodenum suggested a tumorous lesion.

Percutaneous antegrade electropapillotomy. Study in dogs

Antegrade electropapillotomy using the percutaneous transcystic approach was successfully performed in 11 of 16 dogs. When the intervention was effective, the pressure gradient between common bile duct and duodenum decreased from 6 to 1.3 mm Hg on average and returned to gradients slightly below the initial values after 4 weeks, owing to reactivation of the sphincter mechanism. Ineffective cutting, however, resulted in a temporary pressure rise. In one dog a papillary stenosis developed and was relieved by antegrade electrocutting. Irrespective of the success of the papillotomy, rises in levels of serum glutamine oxaloacetic and pyruvic transaminase, alkaline phosphatase, serum amylase and leukocytes were seen. Although the method is technically feasible, its clinical significance is not so much for antegrade papillotomy but rather for transhepatic incision of stenoses after hepaticojejunostomy.

[Echinococcus cysticus of the pancreas in the clinical picture of acute pancreatitis]

A 30-year-old Italian male was admitted to the hospital showing all clinical signs of acute pancreatitis. With the help of computerized tomography, ultrasonic and angiographic methods multiple cysts in pancreatic body and tail as well as close to the hilus of the spleen could be shown. Positive serological tests made the diagnosis "echinococcus granulosus" likely. Resection of the left part of the pancreas as well as resection of the spleen eliminated the parasite. Histologically hydatid cyst was traceable in the pancreatic duct.

[Sonography of the thyroid gland. Volume determination and morphologic correlation of echo and tissue structures]

The volume of 15 autopsied thyroid glands was determined by fluid displacement and compared with their sonographically obtained stereometric volumes. Maximum variation was 8.6%. Thyroid volumes were measured by ultrasound in 100 volunteers between ages 15 and 36. Total mean value was 19.8 ml. with a mean value of 22.1 ml. in the male group and 17.8 ml. in the female group. 20 volunteers had an additional scintigraphic examination. The thyroid volumes estimated by scintiscanning differed up to 85% with the volume measurements from sonography. Sonography scans were obtained from 6 autopsied thyroid glands and compared with the corresponding tissue slices. Tissue structures were reproduced with great accuracy by ultrasound.

Immunohistological differential diagnosis of inflammatory colonic diseases

Immunohistological investigations were carried out on human colonic tissue from, I healthy mucosa, 2 slightly inflamed mucosa, 3 mucosa with ulcerative colitis, 4 mucosa with Crohn's colitis, using antibodies against immunoglobulins and complement components. All our antibodies, including F(ab')2 fragments, demonstrated a progressive increase of labelled cells from healthy mucosa through slightly inflamed mucosa to mucosa with ulcerative colitis, in contrast to a complete absence of labelled cells in cases of Crohn's disease. The results are discussed with regard to their pathogenesis and their clinical significance for the differentiation of ulcerative colitis and Crohn's colitis.

Manifestation and ultrastructural typing of amyloid deposits in the heart

Using light and electron microscopy, 65 cases of amyloid deposits in the heart were examined. Five different groups were distinguished: I. isolated atrial amyloidosis, II. senile cardiac amyloidosis, III. cardiac amyloid accompanying chronic infections and tumors, IV. cardiac amyloid accompanying plasma cell dyscrasia, V. idiopathic cardiac amyloidosis. Seen structurally, no principal differences in the precise localization of the amyloid deposits were found in any of the groups investigated. Amyloid is always deposited in the vicinity of cells with myocytic cell differentiation (i.e. the heart muscle cells, non-striated muscle cells of the vessels), whereby the relevant basement membranes serve as conductors. A systematic relationship between amyloid and the collagenous fibers of the interstitium or the tunica adventitia of the vessels could not be demonstrated, which shows the concept "pericollagen" to be inadequate for the morphological characterization of amyloid deposits in the heart. Whereas for group I a localized mechanism for the production of amyloid must be considered, in the case of groups II-V a vascular principle expression of a generalized amyloidosis seems to be the major factor. The question of the differing concentration of amyloid deposits in the heart suggests that localized factors (e.g. changes in the myocytic basement membranes) and quantitative changes of the amyloid-building proteins may also be important.

Senile amyloidosis: principles of localization in a heterogeneous form of amyloidosis

In order to identify amyloid deposits in patients over 60 years of age (so-called senile amyloid), the following five tissues were investigated under the light and electron microscope: 1. pituitary gland, 2. pancreatic islets of Langerhans, 3. heart, 4. aorta, and 5. brain. In all an increasing incidence of amyloid deposits was found with increasing age, and in the brain a significant quantitative increase in amyloid deposits with increasing age was observed. Despite the biochemical heterogeneity of amyloid found in old age, all the deposits seen in tissues examined were morphologically similar. Typical amyloid fibrils were always found (diameter 60-100 A), and these were invariably deposited extracellularly and primarily on basement membranes. The amyloid-binding basement membranes were in most cases those of myocytic, but were also those of endothelial or epithelial cells. The almost invariable involvement of blood vessels, indicates the importance of these structures in the genesis of the various forms of senile amyloid.

Iatrogenic, insulin-dependent, local amyloidosis

Human and experimental amyloidosis can occur either as a generalized widespread deposit of various proteins or a localized deposit. We looked for local amyloidosis caused iatrogenically under clinical and experimental conditions. Subcutaneous tissue from one diabetic patient and six Wistar rats, which had received a continuous local infusion of 1.2 iu of insulin daily for 6 weeks, was examined histologically. In all cases the development of granulation tissue around the tip of the catheter was observed. In addition, inhomogenous extracellular deposits showing green birefringence under polarized light when stained Congo red were seen. Immunohistologically, they displayed binding of anti-insulin antibody. Electron microscopy demonstrated a typical spear-like fibrillar structure with a fibril diameter of 60 to 80 A. These findings confirmed that the deposited substance was amyloid. Iatrogenically administered protein produced in vivo amyloidosis at the site of its entry. Insulin can lead to the formation of amyloid fibrils not only in vitro but also in vivo.

[Hemorrhagic skin necrosis in intravascular precipitation of cryoglobulin by lymphocytic malignant lymphoma]

A 82 year old woman developed wide spread hemorrhagic skin gangrene in the face and on the extremities as cutaneous manifestation of IgG-IgM cryoglobulinemia, in this case a concomitant phenomenon of lymphocytic malignant lymphoma.

[Amyloid of islets of Langerhans and its relation to diabetes mellitus (author's transl)]

After grading into 4 groups of severity the extent of amyloidosis of the islets of Langerhans was investigated in 60 patients with diabetes and in 60 without. Distinction of 3 stages of diabetes according to clinical parameters showed clear connections between the stage of diabetes and the extent of amyloidosis. Development of amyloid locally may be evidence for progressive B cell insufficiency in diabetes of adults.

[Percutaneous antegrade papillotomy. Preliminary experimental results and potential clinical use (author's transl)]

The possibility of percutaneous antegrade papillotomy under image intensifier control was investigated in eight dogs. It was successful in five animals. Successful papillotomy can be recognised radiologically and also by the feel of the catheter. The effect of papillotomy can be demonstrated by a fall of the pressure gradient existing between common bile duct and duodenum. The use of this method in patients is discussed.