Search

A 60 year old man consults the dermatologist because of a bean sized centrally ulcerated painless tumor in the skin of his left axilla. The axillary lymph nodes proximal to the skin tumor are firm and enlarged. The skin biopsy reveals a dense mixed infiltrate composed of lymphocytes, histiocytes, plasma cells and granulocytes and there are multiple neoplastic mononuclear and some multinuclear giant cells, resembling Hodgkin- and Reed-Sternberg-cells. Thus the diagnosis of Hodgkin's disease was considered on the grounds of the skin biopsy. Immunohistologically the atypical giant cells express the CD-30 (Ki-1)-antigen. Histology of the subsequently excised lymph nodes resembled the changes in the skin and showed classical Hodgkin's disease of mixed cellularity.

24 days after starting treatment of psoriasis with fumaric acid derivatives (0.8-1.0 g orally, plus unknown quantities locally) a 21-year-old woman developed acute oliguric renal failure with a rise of serum creatinine levels to 1094 mumol/l (12.4 mg/dl). Deterioration of renal function had been preceded by severe abdominal symptoms with nausea, vomiting and colicky pain. On admission to hospital she was dehydrated with hyponatraemia and hypokalaemia. There was glomerular microhaematuria, increased excretion of renal epithelia, and tubular proteinuria. Renal biopsy demonstrated acute tubular damage with vacuolization of proximal epithelia, dilated tubules and scattered necroses. After intermittent haemodialysis (13 courses over two weeks) renal function gradually recovered, as demonstrated at a follow-up examination four months after discharge.

The authors report on a triploid pregnancy with foetal malformations and a sonographically diagnosed partial hydatit mole. The course of this pregnancy was characterised by pre-eclampsia. The fact that in this case, for example, HCG serum levels were very high and persisted post abortum, similar to the concentrations seen in complete hydatit mole, underlines the difficulties in assessing and diagnosing a partial hydatit mole.

Primary carcinoma of the urethra is a rare lesion, and there are no standard therapeutical modalities suggested in the literature. We report the case of a 65-year-old woman with transitional cell carcinoma of the distal urethra and metastasis to the inguinal lymph nodes (T2 N1 MO G2). Locally, the lesion was treated by Nd:YAG laser coagulation in four sessions. Ileoinguinal and pelvic lymph-node dissection was performed as a diagnostic and therapeutic procedure. Twenty-eight months after the initial treatment, no evidence of tumor recurrence has been found, although extensive biopsy specimens have been taken. Clinical staging showed no evidence of metastases.

The identification of carcinoma cells in ascitic and pleural effusions by the detection of tumor markers was studied using an indirect immunoperoxidase method. Punctates from 56 patients with carcinomas, 18 with other malignant diseases and 10 with benign diseases were examined. In 35% of carcinomatous punctates tumor cells were stained by a CEA antiserum. No positive cells were found, however, in non-carcinomatous benign or malignant effusions. The immunocytochemical staining of CEA could detect tumor cells in 36% of carcinoma cases classified suspicious or negative using conventional cytology only. A TPA antiserum as well as the monoclonal antibody OC 125 stained cells in carcinomatous as well as in non-carcinomatous malignant and in benign punctates.

During a twin pregnancy of a 41-year old woman, a selective sectio parva was performed, without removing the placenta, in the 23rd week of gestation. An amniotic fluid examination after routine amniocentesis showed a free trisomy 21 in only one of the twins. The twin with normal caryotype was delivered in the 28th week. His placenta was well developed, whereas the placenta of the other child showed severe obliterations of the stem arteries with partial avascularity of the villi. The histological aspect was that of a so-called "endarteritis obliterans". Since the twin delivered via sectio parva showed no signs of dystrophy, we presume that at the time of delivery his placenta had developed regularly. The changes of the placenta, demonstrated by histological examinations, seemed to be caused by the stopping of the foetal blood circulation. We suggest that the intrauterine death is not caused by "endarteritis obliterans" only as often described previously. Obviously, the morphological picture of endarteritis obliterans can be the result of cessation of foetal blood circulation. Obliteration of stem arteries might be the main reason for the stillbirth with significant signs of dystrophy. The similar histological picture in placentae of normally developed stillbirths is obviously caused by discontinuation of foetal blood circulation.