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Fifteen transplanted human kidneys with clinical and histological signs of chronic rejection were examined microscopically for cellular infiltration. Three normal kidneys were used as a reference. All infiltrating cells were classified and counted. The average number of cells per 10 microscopic fields was called the relative density of cellular infiltrates. Differences in the densities of different cell classes and changes in the cellular infiltration of the grafts were regarded as cellular expressions of the immune response.

Twenty-three lymphomas of the eye, eyelid, and orbit were chosen for study from biopsy material of the Department of Pathology, University of Kiel, and the Lymph Node Registry in Kiel. There were 12 malignant non-Hodgkin's lymphomas and 11 benign lymphomas. Catamnestic examination confirmed the histologic diagnosis in all 11 cases of benign lymphoma. Eleven of the malignant lymphomas represented immunocytomas and were therefore of low-grade malignancy. In contrast, there was only one case of malignant lymphoma of high-grade malignancy, which was diagnosed as centroblastic lymphoma. The immunocytoma was retrobulbar in one third of our cases and conjunctival in only 2 cases, whereas benign lymphoma had developed in the conjunctiva in 7 of 11 cases. Immunocytoma represents a tumor composed of lymphocytes and plasma cells or plasmacytoid cells. PAS-positive globular inclusions are usually found in the nucleus and/or cytoplasm of the plasma cells or plasmacytoid cells. In der vorliegenden Studie wurden 23 Lymphome der Augen-, Lid- und Orbitalregion ausgewertet. Sie stammten aus einem nicht ausgewählten bioptischen Untersuchungsgut des Pathologischen Instituts der Universität Kiel und des Lymphknotenregisters bei der Deutschen Gesellschaft für Pathologie. Es handelte sich dabei um 12 maligne und 11 benigne Lymphome. Die malignen Lymphome stellten jeweils Non-Hodgkin-Lymphome dar. Unter den letzteren fanden wir elfmal ein Immunocytom, ein malignes Lymphom mit niedrigem Malignitätsgrad — dagegen nur einen Fall eines malignen Lymphoms mit hohem Malignitätsgrad, ein centroblastisches Lymphom. Die Diagnose eines benignen Lymphoms wurde jeweils durch die von uns erhobenen katamnestischen Angaben bestätigt. Während sich das benigne Lymphom in 7 von 11 Fällen in der Conjunctiva entwickelt hatte, war dies bei nur 2 von 11 Fällen mit Immunocytom zu beobachten. Das Immunocytom stellt einen Tumor dar, der aus Lymphocyten und Plasmazellen oder plasmocytoiden Zellen besteht und meist PAS-positive globuläre Einschlüsse in Kern und/oder Cytoplasma der Plasma- oder plasmocytoiden Zellen aufweist.

Nine lymph nodes with so-called benign nevus cell nevi were studied by light microscopy. In three cages the lymph nodes were also examined by electron microscopy. The solitary or multiple cell clusters were 35–645 µ in diameter and were usually found in the lymph node capsule or cortex. They were more frequent in the older patients. There was no predisposition for either sex. Specific morphologic features allowing clear cytologic identification of the cells were not evident. In particular, there was no indication that they represented nevus cells. However, they showed a great morphologic similarity to glomus cells. In addition, they were usually found near blood vessels. We assume that the cell clusters were hamartias related to glomangiomas. We call them glomus cell clusters.

The amount and distribution of tissue mast cells in the three subtypes of immunocytoma (IC) were studied in lymph nodes of 58 cases and compared with the findings on 34 cases of chronic lymphocytic leukemia (CLL). There were significantly more mast cells in the lymphoplasmacytic and lymphoplasmacytoid subtypes of IC than in CLL. The median mast cell count for the polymorphic subtype of IC was also greater than that for CLL; however, this difference was not statistically significant. Tissue mast cells were diffusely distributed in the lymph nodes in IC, whereas they were chiefly located in the sinus in CLL. Moreover, the cells themselves and their granules were generally larger in IC. Increase in the number and altered distribution of the tissue mast cells in histological sections are therefore diagnostic aids for distinguishing IC from CLL.

Summary Sixteen cases of so-called reticulum cell sarcoma (RCS) of the lymph node were systematically studied using histological, cytochemical, electron microscopic, and immunochemical methods. In 8 cases some of the tumor cells showed PAS-positive globular cytoplasmic inclusions. The reactions for non-specific esterase or other marker enzymes were not positive in any case. Electron microscopically the cytoplasm contained many free polyribosomes. There was little ergastoplasm in most cases, but a moderately to strongly increased amount in 3 cases. The tumor tissue homogenate contained significantly increased amounts of IgM in 12 cases and of IgA in one case. Of the 12 IgM-positive RCS 5 showed serum IgM-levels within, 3 below, and only 2 above the normal range. This indicates that most of the RCS produced but did not secrete IgM. 2 cases labeled for surface-IgM revealed a positive reaction on a large number of tumor cells. We conclude that at least most of the RCS in our study were not derived from reticulum cells or histiocytes, but instead from lymphatic cells of the B-cell series. The morphologic similarity of the RCS-cells to “antigen-induced blasts” (called immunoblasts) suggests that RCS are derived from such blasts. This interpretation is especially supported by one case whose cells resembled immunoblasts not only morphologically but also with respect to the site of Ig-production: the perinuclear space. In general we therefore call RCS immunoblastic sarcoma of B-cell type and specify the tumor as plasmoblastic sarcoma if a significant amount of ergastoplasm is electron microscopically detectable.

Summary The histopathological diagnosis ofYersinia enterocolitica infections in mesenteric lymph nodes is described on the basis of biopsy material from 14 cases collected at the Lymph Node Registry in Kiel. In all cases, the aetiological diagnosis was verified by demonstrating significant antibody titres in serological tests and, in two cases, by isolatingYersinia enterocolitica from faeces. The mesenteric lymph nodes showed a rather specific histological picture. In all cases, the capsule was thickened by oedema and stained metachromatically. The cortical and paracortical pulp was always hyperplastic owing to an increase in the number of immunoblasts, plasmablasts, and plasma cells. The sinuses were dilatated and filled with intensely basophilic cells that varied in size from small to large (plasmacytoid cells and precursors). Small, or relatively large accumulations of “immature histiocytes” (transformed lymphocytes) were seen in the sinuses in about two thirds of the cases. Occasionally, there were small foci of small histiocytes (emigrated monocytes) in the cortical pulp. An abscess similar to the abscesses found in abscess-forming reticulocytic lymphadenitis due toYersinia pseudotuberculosis was evident in only one case.

Four ophthalmic lymphoplasmacytic/lymphoplasmacytoid (LP) immunocytomas with germinal centres were reviewed histologically and studied immunologically by means of the peroxidase-antiperoxidase (PAP) method. In two cases a histological diagnosis of LP immunocytoma was made, while in the other two cases a non-Hodgkin's lymphoma could not be histologically differentiated with certainty from a pseudolymphoma or reactive process. Immunological analysis confirmed the diagnosis in the former two cases and led in one of the latter also to a diagnosis of LP immunocytoma. In the fourth case the development of LP immunocytoma out of a pseudolymphoma could be demonstrated. In the four LP immunocytomas the germinal centres showed a monoclonal pattern of immunoglobulin in one case, a polyclonal pattern in one case and a negative reaction in two cases. The role of germinal centres in relation to the development of LP immunocytoma is discussed.

A case of a patient presenting with supraclavicular and cervical lymph node enlargement with demonstration of amyloid is presented. Histologic features are described. Amyloid deposition was not found in any other organ. Immunohistochemical typing with antisera raised against protein AA, A?, and A? showed a reaction only against A?. Thus, this case belongs to the immunoglobulin ? light chain-derived types that occur in many other parts of the body, particularly the respiratory tract.

Using an extended indirect immunoperoxidase method and the lectin I of Ulex europaeus (UEA-I), whose binding sites in lymph nodes are restricted to endothelial cells and erythrocytes, the angioarchitecture of 31 lymph nodes affected by Hodgkin's disease (HD) was demonstrated and analyzed. Compared with the normal state, the lymphocytic predominance type has a low relative vascular density, and venular endothelium is epithelioid throughout. Mixed cellularity types, especially those rich in epithelioid cells, have the lowest relative vascular density; the venular endothelium is often flat. In the sclerosing areas of the nodular sclerosis type structurel differences between capillaries, arterioles and venules vanish. Due to parenchymal atrophy and cellular depletion, relative vascular density is markedly increased in such areas, as is the case in lymphocytic depletion types. Despite all the histomorphological changes occurring in HD, the vascular system of the lymph node, surprisingly, does not undergo profound alteration. There is a positive correlation between the degree of epithelioid transformation of venular endothelium and trans-venular lymphocytic traffic. The conditions are described under which the otherwise non-reactive sinus endothelium expresses the UEA-I receptor.

The clinical and morphological findings are described in 27 children with nephronophthisis. Seventeen children were considered as sporadic cases. In 10 familial cases the presumed mode of inheritance was autosomal recessive. The clinical picture was rather uniform: polyuria-polydipsia, hyposthenuria, anemia, growth retardation, and azotemia with progressive renal failure. Six patients presented with tapeto-retinal degeneration. In a further seven children other ocular changes were detected. Two female siblings showed additional non-renal manifestations: mental retardation, pulmonary emphysema, skeletal anomalies, and congenital hepatic fibrosis.

Forty-five cases of myoepithelial sialadenitis (MESA) were investigated histologically, immunologically, and clinically. Two patients with clinical evidence of Sjögren's syndrome were also included in the study, though salivary gland biopsies showing MESA were not available. A total of 16 patients had Sjögren's syndrome or another type of autoimmune disease. In 42 cases of MESA, so-called proliferation areas composed of immunoblasts and lymphoplasmacytoid cells were found. The proliferation areas were small and circumscribed in 16 cases, and extensive and confluent in 26 cases. All the confluent proliferation areas analyzed with the immunoperoxidase (PAP) method showed a monotypic immunoglobulin pattern (predominantly IgM/?). Extrasalivary malignant lymphoma with the same histologic and immunohistologic features as the confluent proliferation areas was found in 14 patients. Thus, this type of MESA is called “manifest malignant lymphoma”. The tumor was classified as LP immunocytoma in 23 patients, and as LP immunocytoma transforming into immunoblastic lymphoma in three patients. One patient developed nodal B-immunoblastic lymphoma. The term “early lymphoma” is suggested for MESA with circumscribed proliferation areas showing a monotypic immunoglobulin pattern (usually IgM/?), because extrasalivary malignant lymphoma developed later in four of the patients with this type of MESA. The two patients with only clinical evidence of Sjögren's syndrome also showed extrasalivary malignant lymphoma (LP immunocytoma in one case and immunoblastic lymphoma in the other).

Twenty-seven cases of an unusual necrotizing lymphadenitis previously described only in Japan are reported as occurring in West Germany (23 cases), Iran (1 case), Italy (1 case), Korea (1 case) and Spain (1 case). The lesion frequently develops in the cervical lymph nodes of young women. It is characterized by infiltration of the cortex and/or paracortex by large collections of proliferating histiocytes and is devoid of granulocytes. Complete or, more often, incomplete necrosis of lymphoid tissue is seen in all cases. In cases with incomplete necrosis, the histiocytes are interspersed with pyknotic cells and nuclear debris. Based on the histological findings, the term “histiocytic necrotizing lymphadenitis without granulocytic infiltration” is proposed. Lesions to be considered in a differential diagnosis are malignant histiocytic neoplasms and necrotizing lymphadenitis with granulocytic infiltration, which is seen in lupus erythematosus and bacterial infections. The aetiology of histiocytic necrotizing lymphadenitis without granulocytic infiltration is still unclear. Some clinical and histological features indicate the possibility of an underlying viral infection.

Autopsies were performed on 3 patients 30 min after they had died of bacillary dysentery (Shigella flexneri 4a). The results of detailed histological examinations of the intestinal tract were compared with the experimental data from recent years. Shigella organisms were found in several epithelial cells at the tips of the colonic folds, where they multiplied in the cytoplasm. From these cells the bacteria infected adjacent epithelial cells, so that foci of infected cells were formed. The cells originally infected were at the centers of these foci, and their cytoplasms therefore contained the most bacteria. This eventually led to the death of these cells, causing superficial ulceration with less markedly infected epithelial cells at the edges. Continued spreading from cell to cell also enabled the bacteria to reach the epithelium of the crypt gland.

114 cases of malignant lymphoma consisting chiefly of lymphocytes were classified by histology as chronic lymphocytic leukemia of the B-cell type (B-CLL) or lymphoplasmacytic/lymphoplasmacytoid lymphoma (LP immunocytoma) and investigated with the immunoperoxidase-bridge (PAP) method for the presence of heavy and light immunoglobulin chains. Fifteen cases were excluded because they showed a completely negative reaction, which might have been an artifact. Of the remaining 99 cases, 46 revealed polyclonal immunoglobulin-positive plasma cells only and could be clearly classified as B-CLL. In 33 cases there were a moderate or large number of plasma cells or plasmacytoid cells with monoclonal intracytoplasmic positivity. Two heavy chain classes were demonstrated in three other cases, and both light chain types were detected in one case. These 37 cases were finally classified as LP immunocytoma. Ten cases contained only a few monoclonal plasmacytoid cells and were interpreted as borderline cases between B-CLL and LP immunocytoma. Six cases have not yet been clarified — there was an inexplicable discrepancy between their histology and immunostaining.

Two cases of malignant non-Hodgkin's lymphoma arising in an yAlbrecht-Arzt-tumour are reported. In the first case a centroblastic-centrocytic lymphoma in a palatinal cystadenolymphoma of a 64-year-old female is described. In the other case a centroblastic lymphoma developed in an Albrecht-Arzt-tumor of the submandibular region in an 82-year-old man. The occurence of a high-grade malignant lymphoma in cystadenolymphoma has not been reported in the literature so far.

A case of follicular centroblastic-centrocytic lymphoma with an unusually pronounced plasmacytic component occurring in the gingiva and cervical lymph nodes of a 74-year-old male patient is described. Immunohistological analysis revealed a monotypic intracytoplasmic immunoglobulin pattern (IgM/?). The relation between follicular malignant non-Hodgkin's lymphomas and extramedullary plasmacytome is discussed. In the present case the tumour may represent the development of an autonomous plasma cell clone within a follicular centroblastic-centrocytic lymphoma.

The microvasculature of lymph nodes of 55 cases of T-cell lymphoma was studied by light microscopy, immunohistochemistry and electron microscopy. A modified peroxidase-antiperoxidase (PAP) method was used for staining paraffin sections with lectin I of Ulex europaeus (UEA-I), which is a specific marker for vascular endothelial cells. The T-cell nature of each case was proven by immunohistochemistry, including immunoperoxidase staining of frozen sections with monoclonal T-cell antibodies. The cases were subclassified according to previously established criteria, but with the addition of a separate group showing a high content of clear cells. For the purpose of the present study, the small blood vessels were separated into two main variants, viz.: high endothelial venules (HEV) and all other types of vessels with flat endothelium (SVFE). The development of each of these variants and the extent of lymphocyte migration through the vascular wall were assessed semiquantitatively.

172 cases of lymphogranulomatosis X (LgX) were studied by light microscopy. In 53 cases immunohistological techniques for detecting intracytoplasmic immunoglobulins were applied. In the lymph nodes of all cases the nodal architecture was found to be effaced. Active germinal centres were absent, and there was a generalized, markedly increased proliferation of epithelioid venules. A polymorphic infiltrate was present in all cases. It was dominated by immunoblasts in 14%, by plasma cells in 16%, by epithelioid cells in 23% and by lymphocytes in 6% of the cases. In the remaining 41% of the cases no special type of cell predominated (mixed cell type of LgX). The clusters of clear cells present in some cases with immunoblastic predominance did not stain for intracytoplasmic immunoglobulins; in contrast, the basophilic immunoblasts exhibited a polyclonal Ig pattern. In some of the cases with lymphocytic predominance most of the lymphocytes showed abundant cytoplasm with azurophil granules.

The incidence of malignant lymphomas in the nasal cavity and paranasal sinuses was found tobe 0.17% of all malignant lymphomas and 0.44% of all extranodal malignant lymphomas registered in the Kiel Lymph Node Registry from 1972 to 1987. Fifty-nine cases of malignant lymphoma presenting in the nasal cavity and paranasal sinuses were investigated with morphological and immunological methods. The median age of the patients was 64.5 years, with a female predominance (m:f=0.87:1). In the 59 cases a marked preponderance of B-cell lymphomas was found (centroblasticn=15, immunoblasticn=8, Burkitt's lymphoman=6, Immunocytoman=3, centrocyticn=1, centroblastic/centrocyticn=1, plasmacyticn=11); only a small number (n=5) was of T-cell lineage (pleomorphic types). Nine further cases could not be assigned with certainty to either the T or B cell system. Angiocentricity with infiltration and destruction of vessel walls by tumour cells was demonstrated only in the T-cell lymphomas; the B-cell lymphomas, in contrast, of ten surrounded and compressed blood vessels with intact endothelium. No similarity to malignant lymphomas of mucosa associated lymphoid tissue, such as those in the gastrointestinal tract, was detected.

Fifteen cases of generalized peripheral T-cell non-Hodgkin's lymphoma in baboons were phenotyped immunologically and morphologically. Using the updated Kiel classification the cases included low-grade and high-grade lymphomas and low-grade lymphomas that had transformed into high-grade lymphomas. In the low-grade group there were seven cases of lymphocytic type, partly corresponding to chronic lymphocytic leukaemia of T type and to T-zone lymphoma in man. In addition there were four cases of prolymphocytic-lymphocytic type, which show large nodules (“proliferation centres”) and which have no equivalent in the Kiel classification. In four cases there was a progression to an immunoblastic lymphoma and in one case to a large cell anaplastic lymphoma. In addition, three cases of large cell anaplastic lymphoma without a low-grade component were found. Both the immunoblastic lymphomas and the large cell anaplastic lymphomas corresponded well with the same types in the Kiel classification. The cases of large cell anaplastic lymphoma were also CD30 positive. Most of these lymphomas were CD4 positive, but there were rare cases that were either CD8 positive, showed both CD4 and CD8 positivity or had lost both antigens. Antigens associated with cell activation were often revealed. All but one baboon had antibodies in the blood against the retrovirus STLV-1 (simian T-cell leukaemia virus 1), which is very similar to human T-cell leukaemia virus 1 (HTLV-1) in man. Despite this virological resemblance, the morphology of these T-cell lymphomas does not resemble that of the HTLV-1-positive Japanese T-cell lymphomas but is like that of the HTLV-1-negative European cases.

Die Endstadien der myeloischen Leukämie rufen im Leberschnittbild vielfach Veränderungen hervor, die von dem typischen Befund einer myeloischen Leukämie (starke intracapilläre Blutbildung) wesentlich abweichen. Durch Beachtung dieser Veränderungen sind wir in der Lage, Rückschlüsse auf die Entwicklungsphase der Leukose und das Blutbild im Zeitpunkt des Todes zu ziehen. Dabei sind 2 charakteristische histologische Befunde herauszustellen:1.Können dieCapillaren der Leberacini sehr leukocytenarm sein, wobei aber das Lebergewicht noch ziemlich hoch ist und auch die vergrößerte Milz in der Regel histologisch eine deutliche Blutbildung aufweist. Aus diesem histologischen Leberbefund dürfen wir eine sekundär aleukämische oder sogar leukopenische Myelose (im Rahmen einer terminalen „Panhämophthise“) oder eventuell auch eine primär aleukämische Myelose annehmen. Letzteremuß jedoch nicht mit zellarmen Lebercapillaren einhergehen, sondern es ist nur ein Rückschluß von dem Leberschnitt auf das Blutbild, nicht aber umgekehrt möglich. Auch nach „erfolgreicher“ Urethanbehandlung myeloischer Leukämien fehlt eine intracapilläre Myelopoese, wobei allerdings die Blutleukocytenzahl noch nicht ganz normalisiert zu sein braucht.2.Kann einesehr starke periportale Infiltration der Leber mit nur teilweise oxydasepositiven Rundzellen bestehen, so daß mehr das Bild einer lymphatischen als das einer myeloischen Leukämie hervorgerufen wird. In diesem Fall ist man berechtigt, eine Myeloblastose des Blutes (auch Mikro- und Paramyeloblastose!), also das terminale Entdifferenzierungsstadium einer myeloischen Leukämie anzunehmen. Kommt es dann noch zu einem Absinken der ehemals gesteigerten Leukocytenwerte (Bildungsinsuffizienz, gesteigerter Zerfall), so finden sich zellarme Capillaren bei starker periportaler Infiltration.

Der Leukocytenabbau des Kaninchens erfolgt vor allem in der Milz und läßt sich hier morphologisch gut verfolgen. Er spielt sich teils in den sog. Trümmerfeldern der Pulpastränge, teils innerhalb von Makrophagen ab. Die Einzelheiten dieses Leukocytenabbaus werden auf Grund eigener Untersuchungen zusammen mit den Befunden der Literatur eingehend besprochen. Der Grad des Leukocytenuntergangs in der Kaninchenmilz wechselt, doch ist oft schon physiologischerweise ein starker Leukocytenzerfall zu beobachten, der bei Septicämie, nach intravenöser Peptoninjektion, eventuell auch bei Milzvenenunterbindung und chronischen Entblutungsversuchen gesteigert sein soll.

Die Gitterfasermenge des Knochenmarkes ist bei chronischer lymphatischer Leukämie mehr als doppelt so hoch wie im Normalmark (104,8±4,7 mm/mm2) und etwa ebenso hoch wie in den sog. Lymphfollikeln des Normalmarkes. Bei kurzer Krankheitsdauer dürfte die Fasermenge geringer sein als bei längerem Bestehen der Leukämie. Bin statistisch signifikanter Zusammenhang mit einer vorangegangenen Behandlung läßt sich nicht nachweisen. Auch gehen Fasermenge und Reticulumzellenzahl nicht parallel. Faserreiche Lymphadenosen sind nicht etwa als assoziierte Retikulosen anzusehen.

Among fifty cases of lymphogranulomatosis (Hodgkin's disease) having a constantly high content of epithelioid cells, it was possible to separate a particular form characterized by massive infiltrations of focally aggregated epithelioid cells. This form showed peculiar features concerning morphology, incidence and clinical manifestations. Typical Hodgkin cells and Sternberg giant cells were often absent, although it was always possible to find some atypical variants of these cells. Plasmocytes were often abundant. Fibrosis, even after treatment, did not appear. Transition into sarcoma was seen only once.

The presence of alkaline phosphatase was investigated in slide preparations and smears of lymph nodes with the azo dye method.

Die Esteraseaktivität der Lymphknotenzellen wurde mit den Substraten a-Naphthylacetat und Naphthol-AS-Acetat im Schnitt- und Tupfpräparat geprüft. Die Reaktion mit a-Naphthylacetat ist stets stärker als diejenige mit Naphthol-AS-Acetat, außer bei den Gewebsmastzellen. Die stärkste positive Reaktion finden wir in den phagocytosefähigen Zellen, nämlich in Sinusretothelien, Reticulumzellen der Pulpa und Follikeln (hier besonders in Kerntrümmerphagen !), Epitheloidzellen und Langhansschen Riesenzellen. Die „saftigen“ Epitheloidzellen reagieren viel stärker als die „dürren“. Eine geringere Aktivität zeigen die Gewebsmastzellen, Hodgkinzellen und Sternbergschen Riesenzellen. Die regenerierenden Zellen des Lymphknotens — basophile Stammzellen und Germinoblasten — sind wie die Lymphocyten und Plasmazellen esterasenegativ. Im Tupfpräparat konnten kleine Reticulumzellen durch ihre positive Reaktion von Lymphocyten abgegrenzt werden. Auch gelang es, einen Teil der „mittleren retikulären Reizzellen“ den Histiocyten zuzuordnen.

Es wurden die Gitterfasern des „normalen“ Knochenmarkes von 55 Sektionsfällen sowohl quantitativ als auch qualitativ untersucht. Mit Hilfe einer einfachen Methodik gelingt es, den Fasergehalt zahlenmäßig zu erfassen und somit exakte, reproduzierbare Werte über die Fasermenge zu erzielen.

Bei Hyperplasien der Erythro-, Myelo- und Thrombopoese wurden Fasergehalt und -anordnung studiert. Der durchschnittliche Fasergehalt entspricht etwa dem des normalen Knochenmarkes. Er beträgt 47,5 ±2,4 mm/mm2. Auch die Faseranordnung zeigt keinen Unterschied. Dagegen kann man an dem Faserpräparat zwei Besonderheiten der kleinen Gefäße erkennen: Die Capillaren sind bei allen Formen der Hyperplasie mehr oder weniger vermehrt, die Sinus zeigen manchmal bei starker Hyperplasie der Erythropoese einen Einbruch roter Vorstufen in das Gefäßlumen.

Morphological examinations of the kidneys of 146 plasmocytoma patients revealed the typical pathological-anatomical picture of myeloma kidney in only a third. In 23%, histological changes characteristic of acute renal failure were present and in a further 17% only evidences of acute renal failure were detected. In 8% the picture was dominated by severe pyelonephritis; nearly a third of all cases showed no morphological peculiarities. When correlated with clinical data it was noted that in renal insufficiency there was pathological evidence in 48% of myeloma kidney, in 36% evidence of acute renal failure. In about a third of all kidneys of plasmocytoma patients with renal insufficiency were there signs of acute renal failure. In only two patients could contracted kidneys be implicated as the cause of renal dysfunction.

After BCG-vaccination of a newborn girl, some enlarged regional lymph-nodes were noticed at the age of ten months. Light-microscopically the lymph nodes showed the typical histological pictures of “BCG-granulomatosis”. The acid-fast bacilli, cultured from fresh lymph node tissue were shown by bacteriological tests to be indistinguishable from BCG. During the investigation period intradermal tuberculin reactions remained negative. Serum immunoglobulins showed deficiency of IgA level.

Among 42 cases of lymph node metastases of lymphoepithelial carcinoma (Schmincke-Régaud) there were 5 which also showed an epithelioid cell reaction with varying amounts of caseous necrosis. These tuberculoid changes occur only together with carcinomatous infiltration of the lymph nodes themselves; in neighboring lymph nodes which have not been infiltrated by carcinoma cells only epithelioid cell reactions without caseous necroses are seen. These are considered to be tuberculoid reactions to the tumor necroses, while the caseous necroses are to be considered, at least partly, as necrotic tumor complexes. The epithelioid cell reaction with caseous necroses appears almost exclusively as a consequence of Schmincke tumors, occasionally long before the primary tumor is discovered.