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CME: Fusobacterium nucleatum/naviforme - a Rare but Serious Cause for Pyogenic Liver Abscesses Abstract. Pyogenic liver abscesses belong to the most common abdominal infections. Beside the most common pathogens, also rare forms like Fusobacteria, which can also be part of the natural oropharyngeal and enteral microbiome, may be considered to cause severe forms of abscesses of the liver. Since they may be more difficult to detect, they could become a challenge during diagnosis and therapy.Zusammenfassung. Pyogene Leberabszesse gehören zu den häufigsten abdominellen Infektionen. Als Ursache können neben den häufigsten Erregern auch seltenere Keime wie Fusobakterien, die auch in der natürlichen oropharyngealen und enteralen Flora vorkommen können, eine Rolle spielen. Weil sich dieser Keim diagnostisch schwieriger isolieren lässt, kann eine Infektion mit diesen selteneren Erregern und deren Therapie eine Herausforderung darstellen.

During the preoperative diagnostics of an 80-year-old male patient prior to a planned endarterectomy, an unclear space-occupying lesion was detected in the right nasopharyngeal cavity. It proved to be a dense soft tissue space-occupying lesion of the right maxillary sinus. The histological investigations revealed a partially necrotically decomposed malignant tumor below normal respiratory mucosa free from dysplasia. This case demonstrates the difficulties in differential diagnostics, particularly involving (aberrant) expression of cytokeratin.

Die Unterfütterung mit Rippenknorpel zum Auffüllen der Orbita ist eine Alternative zur Patientenbehandlung bei PESS (nach primären oder sekundären Plombenimplantationen). Von 2007 bis 2013 operierten wir 13 Patienten im Alter zwischen 33 und 69 Jahren mit dieser Methode an unserer[for full text, please go to the a.m. URL], 177. Versammlung des Vereins Rheinisch-Westfälischer Augenärzte

Daltonization is a procedure for adapting colors in an image or a sequence of images for improving the color perception by a color-deficient viewer. In this paper an intelligent/enhanced daltonization method for individuals suffering from protanopia is proposed. The algorithm implements logical image masking in order to modify the colors that are confused and to preserve those colors that are perceived correctly. The proposed method modifies iteratively the parameters for image daltonization after the provision of the initial conditions. The distinctive characteristic of the proposed approach is that when it is combined with a color-checking module, optimum daltonization parameters are effectively identified. Examples are provided in details, as well as screenshots from the algorithm when it is applied in digitized paintings/artworks., International Conference on Computer Vision Systems : Proceedings, The 5th International Conference on Computer Vision Systems (ICVS)

Epstein-Barr virus (EBV) is a lymphotropic herpesvirus infecting 95 % of the worldwide population. In case of an immunodeficiency of various causes, the virus may lead to the development of a wide spectrum of lymphoproliferations and lymphomas. This encompasses mononucleosis-like lymphoproliferations, hyperplasias of various B-cell subsets as well as aggressive non-Hodgkin lymphomas and classical Hodgkin lymphoma. These lesions occur frequently extranodal and present with a polymorphous histology with angioinvasion and necrosis. Clinical data combined with the immunohistological detection of CD30 expression in the activated infected cells and the demonstration of EBV-encoded proteins and RNA transcripts are helpful for achieving precise classification of these lesions.

Tumor necrosis factor (TNF)-alpha antagonists have considerably improved the therapeutic approach to chronic inflammatory disorders including psoriasis vulgaris. Recently, some cases of highly aggressive hepatosplenic T-cell lymphoma (HSTCL) have developed in patients with inflammatory bowel diseases (IBD) being treated with infliximab or adalimumab. Analysis of the published data suggests that the emergence of HSTCL is favored by the combination of purine analogues and infliximab or adalimumab in the therapy of a granulomatous inflammation involving Vdelta1(+)gammadelta T cells. Because psoriasis vulgaris is different from IBD in regard to the type of inflammation, the concomitant therapies used and the tissue-specific subsets of gammadelta T cells, the use of infliximab or adalimumab in psoriasis may not necessarily be associated with an increase in the risk of HSTCL.

The classification of malignant lymphomas according to the WHO scheme of 2001 is based on modern knowledge of B- and T-cell differentiation, the immunophenotype and genetic alterations of the neoplastic cells, as well as on clinical features. Conventional histology does not suffice for a reliable diagnosis of lymphoma diseases and the application of additional methods is required. Immunophenotyping by means of immunohistochemistry is indicated in practically all instances. In a number of cases, the analysis of clonality by PCR and cytogenetic alterations by FISH also need to be applied. A high risk cause of B-cell lymphomagenesis involves rearrangements at the immunoglobulin locus and events occurring during the germinal centre reaction (somatic mutations and immunoglobulin heavy chain class switch) which may result in molecular accidents in the form of chromosomal translocations and/or gain or loss of functional mutations. This may disrupt B-cell homeostasis resulting in increased proliferation, inhibition of apoptosis or both. Clinical behaviour may be influenced by the microenvironment, e.g. T-cells, cytokines and pathogenic microorganisms.

KSHV/HHV 8 infection is associated with primary effusion lymphoma, multicentric Castleman disease (MCD) and MCD-associated plasmablastic lymphoma. We report the case of an HIV-infected male with Kaposi sarcoma, MCD in the lymph node and development of a KSHV/HHV 8-associated plasmablastic lymphoma in the liver. Immunohistochemistry revealed an HHV 8 infection of plasmablasts showing cytoplasmic IgM/lambda expression. To the best of our knowledge, liver infiltration by a MCD-associated HHV 8 positive plasmablastic lymphoma has not been documented previously. The differential diagnosis is discussed.

The standard for the pathological identification of B-cell lymphomas is the World Health Organization (WHO) classification, which integrates tumor morphology, immunophenotype, recurrent genetic abnormalities and clinical features. The lymphoma entities defined in this classification are derived from virtually every stage of normal B-cell differentiation. This classification which has gained wide acceptance has proven useful in patient management and treatment. Novel findings based on gene expression profiling have however started to reveal that not all described entities are entirely molecularly homogeneous. This report describes distinct examples of the more common B-cell lymphomas along with the pathogenetic models and gives some information on the novel gene expression profiling data.

Diffuse large B-cell lymphomas (DLBCL) are non-Hodgkin's lymphomas (NHL) and with a prevalence of 30-40% they comprise the most frequent NHL in adults. Although their etiology is still unknown, a virus induction, especially by the Epstein-Barr-virus (EBV), is the subject of discussion. Patients with congenital or acquired immunodeficiency are primarily afflicted. PATIENT 1: A 39-year-old female patient developed an EBV-associated DLBCL of the plasmablastic subtype in the maxillary alveolar ridge in the region of teeth 11 and 21 after 24 years of immunosuppressive therapy with azathioprine due to myasthenia gravis. Clinically the lesion presented as a localized acute necrotizing periodontitis that was resistant to symptomatic therapy. After polychemotherapy the disease is in complete remission until today. PATIENT 2: A 56-year-old male patient developed an EBV-associated DLBCL of immunoblastic variant of the right maxillary edentulous alveolar ridge in the posterior region 7 weeks after heart transplantation and immunosuppressive therapy with azathioprine and cyclosporine A. Clinically, a soft, nonpainful, swelling measuring 1.5x0.5x0.5 cm with a central ulceration was evident. The tumor was excised followed by local radiation therapy. No recurrence was noted during a 15-year-follow-up.The presented clinical cases demonstrate the increased risk of occurrence of oral malignant B-cell lymphomas as adverse effects of immunosuppressive therapy. The demonstration of EBV in the tumor cells in both cases underlines the involvement of this virus in the pathogenesis of oral DLBCL arising in the setting of an immunodeficiency as has been shown previously in patients with HIV.Due to the varying and often nonspecific clinical appearance of oral DLBCL, an early biopsy and work-up by an institute specialized in hematopathology is essential for diagnosis, because these tumors may disseminate in early stages.

Für die Durchführung der konformalen 192Ir HDR Brachytherapie ist eine genaue Dosisberechnung im Patientenkörper unerlässlich. Die Brachytherapieplanungssysteme (BPS) berücksichtigen in ihren Dosisberechnungen gegenwärtig die inhomogene Körperanatomie und die endlichen Körperdimensionen nicht. Diese Arbeit beschäftigt sich mit der Untersuchung des Einflusses der vom als Dosisreferenzmaterial Wasser abweichenden Körperinhomogenitäten und der endlichen Körperdimensionen auf die Dosisberechnung und mit der Entwicklung eines schnellen analytischen Dosisberechnungsmodells für die Korrektur der Dosisverteilung in der Umgebung von 192Ir Strahlern. Hierzu wird anhand der Unterscheidung der Primär- von der Streuphotonendosis und der Sievert Integrationsmethode ein neues Dosisberechnungsmodell entwickelt und in einer Reihe von homogenen, inhomogenen und endlichen Testphantomgeometrien auf seine Rechengenauigkeit verglichen sowie mit Monte Carlo (MC) Simulationsberechnungen überprüft. Die Einsatzgrenzen des Modells werden in zwei klinischen Fallbeispielen durch den Vergleich mit BPS- und MC- Dosisberechnungen jeweils in homogenen und inhomogenen Patientenphantomgeometrien untersucht. Die für die Brachytherapieplanung erwünschte Rechengeschwindigkeit wird von der Fähigkeit des Modells zur Korrektur der Dosisverteilung in inhomogenen patientäquivalenten Phantomgeometrien nicht begrenzt. Zusätzlich wird die BPS-Rechengenauigkeit verglichen, mit den MC-Simulationsberechnungen im dritten klinischen Fallbeispiel mit endlichen Körperdimensionen untersucht und der potentielle Einsatz des vorgestellten Modells diskutiert.

édité par Magistrat der stadt Wien. Referat kulturelles erbe. Stadtsarchäologie Wien, info:eu-repo/semantics/published

Monocytoid B-cells appear as a distinct B-cell population in a number of lymphadenopathies but above all in Piringer's lymphadenopathy. Up until now, their assignment to a recognised B-cell subpopulation has not been conclusively achieved. Immunohistological studies have shown characteristics in common with the tumour cells of hairy cell leukemia and also with so-called splenic marginal zone cells. In order to unequivocally clarify their B-cell differentiation stage we have isolated single monocytoid B-cells from immunostained frozen sections and have analysed their immunoglobulin chain gene rearrangements. In addition we have studied the Ig-expression of monocytoid B-cells at both the RNA and protein levels.

Large B-cell neoplasms represent one of the most frequent groups of non-Hodgkin-lymphomas (30-40%). They are characterized by an aggressive clinical course. These lymphomas may evolve either de novo or secondary during the course of a less aggressive lymphoma. In addition to primary nodal, a primary extranodal manifestation is rather common. The neoplastic cells, even within one given case, show a broad morphological spectrum. Several findings of the last two decades have revealed that the large B-cell lymphomas represent an inhomogeneous group. This fact has been taken into account by the new WHO classification of malignant lymphomas. There are two groups identified, that of the variants and that of the subtypes. The various variants (centroblastic, immunoblastic, anaplastic, T-cell/histiocyte-rich) correspond to lymphomas without reproducible discriminating criteria lacking characteristic clinical, immuno-phenotypical and genetic findings. In contrast, the primary mediastinal, the intravascular, the primary effusion and primary central nervous system lymphomas represent distinct disease entities. A number of recently described large cell lymphoma types, i.e. plasma-blastic, ALK-positive and primary gastric, are included in the classification, their designation as distinct entities is still under discussion.

A case of precursor B-cell lymphoma of unusual location in the mandible is presented. Clinical features as well as technical examinations led to the misdiagnosis of chronic osteomyelitis. Only immunohistological examination of intraoperatively taken biopsies was able to reveal the true diagnosis. High-dose chemotherapy was started and full remission could be achieved.

The cell lineage derivation and type of proliferation (monoclonal versus polyclonal) of the atypical cells in Hodgkin's Disease (HD) has remained in question up until now. Immunophenotypic studies favoured a lymphoid origin. Molecular biological studies using DNA extracted from whole biopsy material provided inconsistent results, probably due to the rarity of the atypical cells in the affected tissue. Hence the molecular biological studies were extended to the analysis of isolated atypical cells. However, even these single cells studies yielded conflicting results. We therefore have improved the technique of single cell isolation from tissue sections and applied it to 25 cases of classical HD and 11 cases of lymphocyte predominant HD (LPHD). We investigated a total of 1,465 single atypical cells for rearranged Ig variable-region chain (V) genes. In all instances in which the single cell DNA lead to a PCR amplification product, these were found to contain identical rearranged V region genes. All of these V region gene sequences proved to be highly mutated. The coding capacity of the rearranged Ig genes was frequently disrupted in classical HD but rarely in LPHD. The V sequences of the latter histotype showed in addition intra-clonal diversity in the majority of patients whereas this was not seen in all but one case of classical HD. Additionally, in 10 to 20% of classical HD cases T-cell antigens and/or cytotoxic molecules could be demonstrated in the atypical cells. These results indicate that, a) the atypical cells of LPHD are a clonal population of neoplastic germinal centre B cells; b) the atypical cells from 80-90% of classical HD cases represent a clonal expansion of B cells which are related to germinal centre B cells or their progeny; and c) the atypical cells of 10-20% of classical HD may originate from T cells.

In this study we present morphological, cytological, immunophenotypical, and molecular genetic features of ten cases of AIDS-related primary brain lymphomas obtained as sterotactic biopsies, autopsy specimens, or cerebrospinal fluid samples. Histologically, a very characteristic perivascular and diffuse lymphomatous spread in the brain parenchyma was observed. By applying a highly sensitive in situ hybridization technique (ISH) using digoxigenin-labeled antisense riboprobes, abundant Epstein-Barr virus (EBV)-encoded small nuclear RNAs (EBER) transcripts could be demonstrated in each case studied. A combination of ISH with immunohistochemical staining for latent membrane protein (LMP-1) and EBV nuclear antigen-2 (EBNA-2) showed different patterns of EBV latency with a predominance of the broad spectrum (EBER+/EBNA-2+/LMP-1+). Clonal rearrangements of immunoglobulin heavy chain (IgH) genes were demonstrated in four cases using a sensitive polymerase chain reaction. In one patient the rearrangement pattern suggested biclonal lymphoproliferation. Our observations confirm the implication of the EBV in the etiology of AIDS-related primary malignant lymphomas of the brain. The demonstration of EBV gene products and clonal IgH rearrangements even in small biopsy samples is a useful tool for distinguishing between reactive and neoplastic lymphocytic infiltrates, which are frequently observed in brain and cerebrospinal fluid specimens obtained from AIDS patients.

32 cases of T cell lymphoma of angioimmunoblastic lymphadenopathy type (AILD-TCL) were investigated for their association with Epstein-Barr virus (EBV). Polymerase chain reaction (PCR) for detection of EBV-DNA and in situ hybridization for EBV-encoded small nuclear RNAs (EBER) produced almost identical results, showing that all but one of AILD-TCL cases contained EBV genomes. Three distinctive patterns of EBV infection were observed after immunophenotypical characterization of EBER positive cells: 1. predominant infection of B-immunoblasts (26% of the cases), 2. predominant infection of neoplastic T cells (42% of the cases) and 3. infection of few small lymphocytes (32% of the cases). EBV-encoded latent membrane protein was frequently detectable in cases exhibiting patterns 1 and 2. These findings suggest that, in AILD-TCL patients B cells and especially T cells are highly susceptible to a persistent EBV infection which may lead to a growth advantage of infected cells.

In recent years, techniques, probes, and reagents became available to reliably visualize individual Epstein-Barr virus (EBV)-infected cells, to assess EBV gene expression, and to analyze the clonal composition of EBV genomes in human tissues. Application of these techniques to more than 1000 lymphoid tissue specimens revealed (1) characteristic cellular and compartmental distribution patterns of EBV-infected cells in normal lymph nodes, reflecting the interference of EBV with physiologic B cell differentiation pathways, (2) an association of EBV with various mono- and oligoclonal lymphoproliferations ranging from benign conditions to overtly malignant lymphomas, and (3) characteristic patterns of EBV gene expression among EBV-associated lymphoproliferations. In the context of the established immortalizing and transforming properties of EBV, the findings support the concept of an etiologic role of EBV for cases of certain lymphomas such as Burkitt's lymphoma, anaplastic large cell lymphoma, Hodgkin's disease, and lymphomas arising in immunocompromised individuals. In contrast, lymphomas harboring EBV in only proportions of the tumor cells (such as cases of peripheral T cell lymphoma and some B cell lymphoma types) argue against an etiologic role in the primary process of malignant transformation for the virus in these instances. Since in many of these cases a proportion of the EBV infected tumor cells express the EBV oncoprotein LMP (latent membrane protein) the virus may influence, however, the proliferative properties as well as the morphological and molecular phenotype of the neoplastic cells.

During the last two years oral contraceptives containing gestodene were suspected to cause cerebrovascular disorders. 52 cases with adverse neurological side effects were registered up to October 31, 1990. Anonymous protocols received from the Companies Schering AG and Wyeth Pharma were analyzed from a clinical point of view. There are different arterial and venous, thrombotic and embolic disorders caused by different pathogenetic principles. Only one third of the cases was documented by neuro-imaging to render possible actual diagnostic reliability. Suspected cases represent a great number of different cerebrovascular disorders usually observed in neurological and neurosurgical series, concerning both men and women, OC-users and non users.

The presence of Epstein-Barr virus (EBV) DNA and antigens was assessed by polymerase chain reaction and immunohistology, respectively, in a total of 92 cases of Hodgkin's disease, angioimmunoblastic lymphadenopathy, CD30-positive anaplastic large cell (ALC) lymphomas, and AIDS-associated atypical lymphoproliferations (ALP). Proportions of the EBV DNA-positive lesions showed latent membrane protein (LMP) expression; some of the LMP-positive ALC lymphomas and ALP cases also displayed EBNA2 immunostaining. BZLF1-protein and gp250/350 immunoreactivity were absent in all instances indicating latent EBV infection. Since the LMP gene has transforming potential, our findings support the concept of a pathoetiological role for EBV in these lymphoproliferative lesions.

Tissue specimens from 198 cases of Hodgkin's disease and 151 non-Hodgkin lymphomas as well as 34 non-malignant lymph node biopsies were examined for the presence of Epstein-Barr virus (EBV) DNA by polymerase chain reaction. EBV-specific DNA sequences were detected in DNA extracts of 58% of Hodgkin's disease biopsies. Non-Hodgkin lymphomas and benign lymph node lesions were associated with EBV in far smaller proportions. In Hodgkin's disease biopsies, subsequent in situ hybridization revealed an exclusive localization of EBV DNA in the tumour cells, suggesting an involvement of EBV in the pathogenesis of Hodgkin's disease in a substantial proportion of cases.

This report examines two cases of infection of the central nervous system by Listeria monocytogenes (L.m.). Both cases show that listeriosis is not only a differential diagnosis of purulent meningitis, but can also be the cause of an isolated brain stem syndrome with normal cerebrospinal fluid cell count. The prognosis depends crucially on the early antibiotic therapy (ampicillin). The first patient was a chronic alcoholic. He died of fulminant septic shock and meningitis with brain stem encephalitis (cell count of cerebrospinal fluid: 10500/microliters). L.m. was isolated from blood cultures and from cerebrospinal fluid. The second patient had no indications of preexisting immunological disorder. Two days after perianal injections for haemorrhoids, symptoms of a progredient brain stem syndrome developed. The cell count of cerebrospinal fluid was only 10/mu, but L.m. was isolated from blood cultures. The patient died of circulatory failure. At autopsy, a brain stem encephalitis and cerebellitis with inflammation of the surrounding leptomeninx was identified.