[The impact of methodology on the reported prevalence of thyroid pathology: comparison of two autopsy series from Switzerland performed with different methods]

To investigate the impact of methodology on the detection and hence reported prevalence of pathological findings in thyroids, in the geographic area of Kt. Thurgau in Switzerland, we used two different methods in two consecutive autopsy series of 420 patients. In series A, the thyroids were sliced unfixed and only suspect lesions were examined histologically. In series B, the thyroids were fixed in formalin and sectioned in a standardized manner. At least one specimen per lobe was taken for histological examination. Series A revealed that five patients had adenomas, four malignant primary tumors, two metastases and four inflammatory changes in the thyroid. Series B detected ten patients with adenomas, eight with primary malignant tumors, eleven with metastases and twenty-eight with inflammatory changes in the thyroid. These differences were significant (p < 0.001). In conclusion, the methodology has an important impact on the detected prevalence of pathological findings in the thyroid.

Microarrays of bladder cancer tissue are highly representative of proliferation index and histological grade

The number of genes suggested to play a role in cancer biology is rapidly increasing. To be able to test a large number of molecular parameters in sufficiently large series of primary tumours, a tissue microarray (TMA) approach has been developed where samples from up to 1000 tumours can be simultaneously analysed on one glass slide. Because of the small size of the individual arrayed tissue samples (diameter 0.6 mm), the question arises of whether these specimens are representative of their donor tumours. To investigate how representative are the results obtained on TMAs, a set of 2317 bladder tumours that had been previously analysed for histological grade and Ki67 labelling index (LI) was used to construct four replica TMAs from different areas of each tumour. Clinical follow-up information was available from 1092 patients. The histological grade and the Ki67 LI were determined for every arrayed tumour sample (4x2317 analyses each). Despite discrepancies in individual cases, the grade and Ki67 information obtained on minute arrayed samples were highly similar to the data obtained on large sections (p<0.0001). Most importantly, every individual association between grade or Ki67 LI and tumour stage or prognosis (recurrence, progression, tumour-specific survival) that was observed in large section analysis could be fully reproduced on all four replica TMAs. These results show that intra-tumour heterogeneity does not significantly affect the ability to detect clinico-pathological correlations on TMAs, probably because of the large number of tumours that can be included in TMA studies. TMAs are a powerful tool for rapid identification of the biological or clinical significance of molecular alterations in bladder cancer and other tumour types.

Microarrays of bladder cancer tissue are highly representative of proliferation index and histological grade

The number of genes suggested to play a role in cancer biology is rapidly increasing. To be able to test a large number of molecular parameters in sufficiently large series of primary tumours, a tissue microarray (TMA) approach has been developed where samples from up to 1000 tumours can be simultaneously analysed on one glass slide. Because of the small size of the individual arrayed tissue samples (diameter 0.6 mm), the question arises of whether these specimens are representative of their donor tumours. To investigate how representative are the results obtained on TMAs, a set of 2317 bladder tumours that had been previously analysed for histological grade and Ki67 labelling index (LI) was used to construct four replica TMAs from different areas of each tumour. Clinical follow-up information was available from 1092 patients. The histological grade and the Ki67 LI were determined for every arrayed tumour sample (4x2317 analyses each). Despite discrepancies in individual cases, the grade and Ki67 information obtained on minute arrayed samples were highly similar to the data obtained on large sections (p<0.0001). Most importantly, every individual association between grade or Ki67 LI and tumour stage or prognosis (recurrence, progression, tumour-specific survival) that was observed in large section analysis could be fully reproduced on all four replica TMAs. These results show that intra-tumour heterogeneity does not significantly affect the ability to detect clinico-pathological correlations on TMAs, probably because of the large number of tumours that can be included in TMA studies. TMAs are a powerful tool for rapid identification of the biological or clinical significance of molecular alterations in bladder cancer and other tumour types.

High-throughput tissue microarray analysis of 3p25 (RAF1) and 8p12 (FGFR1) copy number alterations in urinary bladder cancer

Studies by comparative genomic hybridization revealed that the chromosomal regions 3p25 and 8p11-p12 are recurrently amplified in bladder cancer. To investigate the prevalence of DNA copy number alterations in these chromosomal regions and study their clinical significance, we used probes for the RAF1 (3p25) and FGFR1 (8p12) genes for fluorescence in situ hybridization. A tissue microarray containing 2317 tumors was analyzed. The analysis revealed RAF1 amplification in 4.0% and FGFR1 amplification in 3.4% of interpretable tumors. In addition, deletions were found at the 3p25 locus in 2.2% and at the 8p11-12 locus in 9.9% of interpretable tumors. Both amplifications and deletions of RAF1 and FGFR1 were significantly associated with high tumor grade (P < 0.0001), advanced stage (P < 0.0001), and poor survival (P < 0.05) if tumors of all of the stages where analyzed together. RAF1 amplifications were associated with subsequent tumor progression in pT1 carcinomas (P < 0.05). The marked differences in the frequency of all of the analyzed changes between pTa grade 1/grade 2 and pT1-4 carcinomas support the concept of these tumor groups representing different tumor entities.

[A normal thyroid gland upon autopsy: a relatively uncommon finding]

In a series of 420 autopsies the thyroid glands have been weighed, serial sections made and examined histologically with at least one specimen per lobe. There is an age-dependent increase in mean thyroid weight. In the 7th decade the mean weight exceeds 29 g and weights above this are regarded as goitre. Between the 4th and 8th decade the incidence of goitre is 20-30%, after which the incidence rises steadily to 64% in the 10th decade. The commonest thyroid pathology is hyperplastic nodules, which are found in 39% of patients (49.4% of males and 33.4% of females). 2.4% of all patients have adenomas, 1.9% primary carcinomas and 2.8% thyroid metastases. Inflammatory infiltrates are observed in 6.6% of cases (9.4% of females and 4.4 of males). To establish the incidence of normal thyroid glands we have studied 840 serial autopsies. Only 25% of thyroids are normal (19% of females and 30% of males). The incidence of normal thyroid glands tends to decrease with age and in no decade does it reach 50%.

[From epidemiology of melanoma to prevention--facts and references]

Melanoma incidence rates in Switzerland are very high for European standards. Incidence is increasing like in other white populations; melanoma mortality has stopped its secular increase and is decreasing in people under the age of 65. The reasons for the high melanoma rates in Switzerland can only be guessed: Switzerland is a rich country (melanoma is more prevalent among the rich); the Swiss are known to spend their vacations in Southern countries, exposing themselves to the sun. The paradox of increasing incidence and decreasing mortality rates is discussed, also from the view of the histopathologist. Melanoma patients are at increased risk for subsequent skin carcinoma (basalioma/spinalioma) and vice versa. This may be explained by the common risk factor: sun exposure. The importance of primary prevention is stressed; the Swiss Cancer League is organising annual education campaigns among youngsters. Secondary prevention should focus on high risk groups: families prone to melanoma; older men.

[Histopathological and clinical aspects of benign cutaneous fibrous histiocytoma: increased rate of recurrent histiocytomas with a proliferative tendency]

An investigation of 2486 benign cutaneous fibrous histiocytomas (BFH) at the institute of Pathology of Münsterlingen, Switzerland, revealed a special group of histiocytomas, proliferative benign cutaneous fibrous histiocytomas (PBFH). These tumors recur 17 times more frequently than the so-called normal benign cutaneous fibrous histocytoma (NBFH). A quantitative analysis of six histopathological parameters showed that PBFH can be differentiated from NBFH with a sensitivity of 95%.

[Spitz nevus and Reed nevus: simulating melanoma in adults]

One hundred and three cases of Spitz nevi were reviewed, 36% of these patients were adults. The lesions in children occurred primarily on the face and secondarily on the trunk followed by the extremities. In adults, they affect the legs in women, and the trunk in men as does malignant melanoma. Clinically they were diagnosed more frequently as Spitz nevi in children and adolescents than in adults. Spitz nevi were most commonly mistaken clinically for "common" melanocytic nevus, hemangioma, verruca, fibrous histiocytoma, molluscum contagiosum, granuloma pyogenicum, keloid, and melanoma. Histologically, there are various expressions of Spitz nevi, but they are usually compound melanocytic nevi with little pigmentation and typically large spindle- and/or epithelioid melanocytes. There are only small histopathological differences between Spitz nevi in childhood and adulthood: one important feature rarely seen in Spitz nevi of adults is multiple mitotic figures at the dermo-epidermal junction but rarely at the base of the melanocytic nevus. Nevus Reed is considered to possibly be a distinctly pigmented variant of Spitz nevus.

Digital 3D image reconstruction of ventriculocapillary communication as revealed in one case after transmyocardial laser revascularization

TMR (Transmyocardial Laserrevascularization) was performed on the partially dyskinetic left ventricular anterior wall with stenotic coronary blood supply in a 61 year old woman with a history of angina and myocardial infarction. As an ischemic aneurysm developed in the anteroapical region of the TMR treated area, it became clear that TMR did not provide a substitute for coronary blood supply in this very heart region. The aneurysm was removed surgically 7 months after TMR and showed histopathologic features of an acute aneurysm. Three-dimensional image analysis helped prove the presence of linear tracks through several serial sections which were not easily visible in routine histology sections. Also, three-dimensional vessel reconstruction showed a connection between a small endocardial pit on one serial section with the capillary network in the adjacent serial sections. The results should not be generalized, as currently aneurysmectomy is an end point not reached by the majority of TMR-treated patients.

Epithelioid sarcoma

Epithelioid sarcoma is a malignant soft tissue tumor characterized by its propensity to occur in the distal extremities as a nodular lesion and its slow and asymptomatic growth. Microscopically, the diagnosis is difficult. Therefore the interval between onset of symptoms and diagnosis averages one to three years. 10 years survival after onset are not uncommon whatever the treatment chosen. Having to treat such a tumor of a hand, 8 years after onset, we decided a local radical excision by micro-surgery instead of amputation or mutilating excision. Long standing clinical follow-up will add valuable information as to the cure of the upper extremity.

[Transmyocardial laser revascularization. Histopathology of laser channels in 10 postoperatively deceased patients 1 to 18 days after treatment with a CO2 laser]

TMLR (Transmyocardial laser revascularization) is a disputed cardiosurgical technique available in Europe since 1994 that aims to deliver additional blood flow to ischemic myocardium from the left heart chamber. Goal of our study is morphological examination of laser channels in human hearts to answer the questions: Are there patent laser channels with communication to the left chamber and to intramural vessels? We examined hearts of 10 patients who died during the first 18 days after TMLR. Channels were examined in histological serial sections under the light microscope. Laser channels in the first days postoperatively have a lumen diameter of about 1 mm and are surrounded by coagulation necrosis about 500 microns thick. Despite phagocytic removal of necrotic tissue the lumen diameter decreases during the following two weeks. Open intramyocardial channels can be shown in all patients. These channels communicate with intramural vessels, but in no instance with chamber lumen. Our results suggest that clinical benefits are based on improved distribution of coronary blood. Additional blood is not delivered from left chamber lumen to the myocardium. However, our patients represent the small subgroup of the decreased. If similar observations can be made in the majority of patients living symptom free after TMLR remains open.

Melanoma in childhood: an EORTC-MCG multicenter study on the clinico-pathological aspects

Melanoma in children is rare. Nevertheless, it is imperative that clinicians be aware that melanoma does occur in childhood. Yet there is very little information available on the clinico-pathologic variations, and the prognostic parameters of melanoma in children. This report presents the results of a multicenter study of 102 lesions originally diagnosed as cutaneous melanoma, conducted among 5 Western European countries and collected during the period 1961-1994. Criteria for inclusion in the study included: (1) diagnosis of cutaneous melanoma; (2) age up to 16 years at diagnosis; and (3) availability of representative microscopic slides. On the basis of the histologic review only, 60 lesions were confirmed as melanoma, and 42 lesions initially diagnosed as melanoma were reclassified as nevi; 31 of the latter contained a predominance of spindle cells. The only significant parameter associated with the development of metatases or fatal outcome was thickness of more than 2.00 mm. The 5-year survival rate observed in this study was 84%. Based on these findings we conclude that considerable over-diagnosis of melanomas in children occurs. In order, therefore, to give consistent epidemiological data on melanomas in children and to improve proper recognition of their diagnostic features, both by clinicians and by pathologists, we propose to set up a central registry of melanomas in children in Europe, under the auspices of the European Organization for Research and Treatment of Cancer.

[Pathologic-anatomic examination of prostatovesiculectomy samples in prostate carcinoma]

The incidence of the prostatic carcinoma as well as the cases treatable by radical prostatovesiculectomy with curative intention is increasing. The exact pathological examination of the specimens defines the stage of disease and subsequently the prognosis and therapeutic consequences. The compatibility of different scientific studies is made difficult by the lack of a standard in the pathological examination of the specimens. Our exactly defined rational method helps eliminate these troubles and ameliorate the interdisciplinary dialogue.

[Analysis and epidemiology of gallstones in deceased and autopsied patients of the Thurgau canton]

In our postmortem examinations of patients in the canton of Thurgau from May 1989 through December 1991 we found a cholelithiasis or a condition after a cholecystectomy of gallstones in 44% of the women and 23% of the men. While gallstones were found in only 11% of the women and 7% of the men up to age 50, half of all women and every third man in the age group over 90 had gallstones. Among the gallstone carriers, 8% of the women and 2.5% of the men had developed a gall bladder--gall duct carcinoma. Where a liver cirrhosis was present, gallstones occurred at nearly the same rate in both sexes (45%/44%). 33% of the persons with gallstones had a solitary stone, and 31% had more than 10 stones. More than a third of all stones had a cholesterol content of more than 80%, and every seventh stone had a bilirubin content higher than 80%. The calcium content of more than 40% of the stones exceeded 5%. The examination for bilirubin can be easily performed with some exercise by means of the bilirubin test field on the urine sticks supplied by the Boehringer Mannheim company.

Cytokeratin expression in mucinous sweat gland carcinomas: an immunohistochemical analysis of four cases

Four mucinous sweat gland carcinomas were examined for the distribution of cytokeratin (CK) polypeptides using immunohistochemical techniques on paraffin-embedded sections. All the tumour specimens reacted with monoclonal antibodies to CK 7, CK 8, CK 18 and CK 19. Antibodies to CK 1, CK 1/2/10/14, CK 1/5/10/11, CK 13, CK 14 and CK 20 did not stain any of the carcinomas. The results add additional support to the notion that mucinous sweat gland carcinoma represents a tumour histogenetically related to the eccrine secretory coil. Furthermore, the absence of CK 20 might significantly contribute to the differentiation of this tumour from cutaneous metastases from gastrointestinal carcinomas.

[Multiple primary melanomas of the hair follicles--a special form of malignant melanoma of the skin]

Within 5 years, a 79-year-old male patient developed multiple primary melanomas, all which originated from the hair follicles. The fact that this patient was elderly, the high number of primary tumors, their follicular origin, and the lack of a history of such disorders in the patient's family caused us to postulate that multiple primary follicular melanomas represent a special form of malignant melanoma of the skin.

[Cancer mortality in the Thurgau canton 1970 and 1980 with a comparison between urban and rural areas]

As an addition to the recently published data by the Swiss Statistics Office in cooperation with the Swiss Cancer Registry, this report presents a microanalysis of trends in Canton Thurgau (185 000 inhabitants) based on the corresponding data. In the course of only 10 years the number of deaths due to cancer in rural areas has come to equal to that in city areas. This trend is particularly obvious for bronchial carcinoma in men. The decrease in mortality due to carcinoma of the stomach is more obvious in the urban population than in rural areas, a trend in which it can be assumed that environmental factors play a role. Further developments must be observed carefully, and corresponding analyses should also be performed in other cantons.

Kaposi's sarcoma and malignant lymphoma in AIDS

A 48-year-old homosexual with contacts in different countries, including Haiti, presented with multiple pigmented or bluish nodules on both lower legs and upper arms. He had a history of secondary syphilis, hepatitis B and herpes zoster ophthalmicus. Biopsies of the skin tumors revealed a typical Kaposi's sarcoma of low grade malignancy. The endothelial origin of the tumor was indicated by the presence of specific endothelial organelles (Weibel-Palade bodies) in the cytoplasma of the tumor cells. Erythrocyte phagocytosis was found in tumor cells within and without the vascular channels. Laboratory tests were compatible with the clinical diagnosis of an acquired immune deficiency syndrome (AIDS) with a helper: suppressor T-lymphocyte ratio of 0.28 and a cutaneous anergy. In the course of the illness tumors of the stomach and duodenum were detected. Histology showed a malignant non-Hodgkin lymphoma of high grade malignancy. Within weeks the patient died in a cachectic state. Autopsy revealed a Kaposi's sarcoma of the skin with metastases in the stomach and a wide-spread malignant lymphoma in the gastrointestinal tract, in several visceral organs and in many lymph nodes.

[Acral-lentiginous melanoma: the newest subgroup of malignant melanomas of the skin]

A new subgroup of malignant melanoma, acral-lentiginous melanoma (ALM), is presented, which the authors have diagnosed in 8% of their melanoma patients. In a retrospective study the clinical and pathological findings in 44 patients with ALM are reviewed. A relationship was found between age, tumor diameter and thickness, pigmentation, ulceration, vasoinvasion and mitoses. The author's patients had a 5-year survival rate of 58%.

[Follow-up study of B-II-stomachs: clinical, endoscopic and histologic results]

Histological investigation leads to significantly more reliable evaluation of the B-2 stump than do clinical or endoscopic examinations. This is the result of our study, in which follow-up examinations in 58 patients were undertaken 25 to 30 years after B-2 resection for benign ulcer. Of these 58 patients 23 were examined endoscopically and histologically (22 patients). The histological results of interest are: early cancer, dysplasia and intestinal metaplasia. - Carcinoma of the gastric stump occurs only occasionally earlier than 15 years after resection. In order to detect more early cancers, we therefore suggest that a routine endoscopy and histological evaluation of the gastric mucosa should be undertaken 15 years after gastric resection for benign ulcer. Further follow-ups depend on the result of this "staging" of the gastric mucosa.

[Death caused by ill-fitting dentures]

Two deaths afford evidence of the fact that ill-fitting dental prostheses may have fatal consequences. These may arise from swallowing the wrong way, aspiration or distorsion of the pharyngeal mucosa, especially where the patient's consciousness is somehow impaired and above all under the influence of alcohol. Both of the deaths under consideration could have been avoided by adequate correction of a dental prosthesis. Patients with defective or ill-fitting prostheses should be made aware of the dangers and referred to a dentist.

[Does the intramammary carcinomatous lymphagiosis have prognostic significance in nodal-negative breast neoplasms?]

This study represents an attempt to analyse the prognostic significance of intramammary lymphangiosis carcinomatosa (ILC) in nodal-negative mammary carcinomas. It is based on 125 cases of nodal-negative mammary carcinomas covered by the prospective OSAKO study (reference number 06/74). Histological sections of the mastectomy preparations were examined for the presence of ILC. We found it difficult to diagnose the presence of lymphangiosis carcinomatosa in mammary gland tissue in cases of mammary carcinoma on the basis of histological findings. Applying strictest criteria, ILC was found in 11 of the 125 cases (8.8%). Due to the small number of carcinomas with ILC and to the average observation period of only 3 1/2 years it is as yet impossible to reach any statistically significant conclusions regarding rate of relapse, appearance of distant metastases and deaths. It is, however, striking that 2 of 11 patients with ILC died as a result of their carcinomas, whereas there were only 3 carcinoma deaths out of 107 cases in the group without ILC. It is at present too early to decide whether ILC is an appropriate criterion to use in selecting cases of nodal-negative mammary carcinoma with a poor prognosis, meriting the administration of adjuvant chemotherapy.

[Paraganglioma of the glomus caroticum]

Extra-adrenal paraganglioma (chemodectoma) is a rare tumor; the tumor of the carotid body is the most frequently observed chemodectoma. Histochemical analysis of the glomus cell shows catecholamine in all cases, but functional activity of those tumors is an exception. The diagnosis of carotid body tumor can be confirmed by carotid arteriography. Surgery is the treatment of choice. Malignant degeneration of chemodectoma has been observed in a few cases.

[Percutaneous transluminal recanalization in a patient with arterial occlusive disease and multiple injuries (author's transl)]

A case of a 66 year old patient with multiple injuries is reported. A combination of conventional trauma treatment and percutaneous transluminal angioplasty (PTR) of a segmented superficial femoral artery occlusion prevented leg amputation. When the patient died 8 weeks later from trauma sequelae the successful recanalization was demonstrated in histopathology investigation. It is concluded that PTR is an ideal accessory to the present therapeutic spectrum in vascular surgery.

[Xanthogranulomatous pyelonephritis]

Based on literature and own case the entity of xanthogranulomatous pyelonephritis is reviewed. In particular are discussed the difficulties of the preoperative diagnostic procedures and the differential diagnosis.