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Background: Ulcers of the hard palate are mostly caused by malignancies. In addition, rare diseases should be included in the differential diagnosis. Beside specific inflammations (lues, tuberculosis) necrotizing sialometaplasia belongs to these uncommon medical conditions., Patients: A 51-year-old male was admitted to the hospital with an algetic ulcer of the hard palate. Malignancy was ruled out by pathohistological examination. Inflammation or infection was excluded by serological examination. A second biopsy was investigated by the pathologist suspecting necrotizing sialometaplasia and confirmed the suspicion. By applying local treatment and systemic antibiosis against bacterial superinfection the ulcer finally healed., Conclusions: Necrotizing sialometaplasia is a rare medical condition generated by local circulatory disorder. 128 cases were published so far. Typical patients are males aged 50 and above. Characteristics of this ulcer are a high rate of spontaneous healing and lacking malignancy. After excluding a malignant tumor this rare disease has to be considered when diagnosing an ulcer of the hard palate.

History and Admission Findings: A 75-year-old woman, without a history of severe illness, developed an erythematosquamous skin disease on hands and forearms. After continued spreading of these cutaneous lesions, she was admitted to hospital, presenting with a generalised desquamating erythrodermia and marked pruritus., Investigations: Skin biopsy showed cornocutaneous signs with alternating ortho- and parakeratosis, typical for pityriasis rubra pilaris. Laboratory findings showed a chronic to acute inflammation with leukocytosis, granulocytosis in the differential blood count, raised C-reactive protein in a range from 54.7 to a maximum of 157.2 mg/l and a protein electrophoresis with elevated alpha1- and alpha2-fraction., Treatment and Course: The erythrodermia only temporarily receded under systemic therapy with acitretin and prednisolone. The patient developed intermittent septic fever accompanied by reduction or loss of consciousness. The general condition of the patient worsened considerably. Out of a rapidly progressing pleural effusion malignant cells similar to adenocarcinoma were isolated. Because CA15-3 was elevated we conducted an extended search especially for a breast carcinoma, but found only pathologically enlarged axillary, mediastinal and abdominal lymph nodes in conventional X-ray, CT, ultrasound and endoscopic procedures. The patient died from paraneoplastic pulmonary embolism. At autopsy, the widespread metastatic dissemination from poorly differentiated adenocarcinoma was confirmed. A necrosis in the right breast containing tumour cell remnants could probably be regarded as the primary neoplasm. Immunohistochemically no definite proof of breast nor gastro-intestinal carcinoma could be found., Conclusions: This case presents a rare paraneoplastic cutaneous manifestation as pityriasis rubra pilaris triggered by a poorly differentiated adenocarcinoma. The primary neoplasm could not definitely be identified, neither pre nor post mortem.

Unlabelled: Tubulovillous adenoma of the duodenum have a high potential for malignant transformation. An exact preoperative staging and an accurate histological examination are essential in order to choose a proper therapeutic strategy. We report on difficulties in the diagnostic and therapeutic process of a patient with a tubulovillous, juxtapapillary, duodenal adenoma. The adenoma had been resected by means of submucosal excision after infiltrative growth had been excluded endosonographically and malignancy had been ruled out by the histological examination of a taken biopsy. Furthermore no malignant changes had been found in the resected material. However an early recurrence of the tumor questioned the correctness of the first diagnosis. In fact, a retrospective histological examination of the resected specimen revealed an adenocarcinoma, which had been overlooked primarily. Finally the patient underwent duodenopancreatectomy and remains without signs of tumor recurrence so far., Conclusions: 1. Microinvasion of the submucosa can not be excluded endosonographically. Therefore endosonography can not specify the dignity of an unknown tumor with a sufficient safety, especially if there is only an intramural growth of the tumor without transmural spread. 2. Because of high recurrence rates and a distinct frequency of malignant transformation of duodenal adenomas, a submucosal resection should only be performed in high-risk patient. 3. In that patients the resected material has to be examined as accurately and subtly as possible to rule out a submucosal microinvasion. 4. Based on the above mentioned radical surgery (duodenopancreatectomy) should be performed in all normal risk patients with juxtapapillary adenomas.

The diagnosis of diffuse type gastric carcinoma is very difficult. The delay of diagnosis is often due to false-negative endoscopic and histologic evaluation. The architecture of the stomach can be clearly visualized by endosonography. Therefore, already minor destructions of the gastric layers can be found. The endosonographic picture includes the presence of the layers, which are larger and of irregular contour. In infiltrating gastric cancer typically the submucosal layer and the muscularis are concentrically enlarged and appear folded. Based on the endosonographic picture diffuse type gastric carcinoma has been diagnosed in 32 patients. When compared to the histologic diagnosis after gastrectomy or autopsy the accuracy of the endosonographic diagnosis was 87.5%, (28 out of 32 patients). From the remaining four patients diagnosed to have diffuse type gastric cancer by endosonography three patients turned out to have malignant infiltrating tumors of different histologies. Therefore, the positive predictive value of endosonography in detection of infiltrating malignant tumors was 96.8% in our group. In contrast the accuracy of preoperative histologic diagnosis by biopsies was only 58%. Suspicious results of gastroscopy, especially in combination with a negative biopsy, should lead to further evaluation by endosonography to detect diffuse type gastric cancer earlier.

In 731 hyperplasiogenic polyps which have been removed by endoscopical polypectomy there were ten polyps with an early cancer and eight polyps with severe dysplasias (borderline lesions) as well as one polyp, in which an advanced carcinoma had developed. This is to date the greatest series of hyperplasiogenic polyps with malignant transformation. In addition, in nine patients with hyperplasiogenic polyps carcinomas could be discovered, i.e. a rate for malignancy of 3.8%. It seems that stomachs with multiple polyps are particularly endangered. The recurrence rate on follow-up examinations covering a period of up to eight years was 36.1%.

Formalin-fixed (F) and glutaraldehyde-pretreated (G) umbilical veins (n = 24) were interposed in the infra-renal aorta of dogs. The follow-up period was 1 year. Early complications with significant differences included 2 occlusions and 3 deaths (41.6%) in group F, 1 occlusion and 1 death (16.6%) in group G. Ten animals of group G and 7 of group F were alive at 1 year, 7 transplants of each of both groups were angiographically and macroscopically patent (25%). Four aneurysms (33.3%) existed angiographically and showed good collateral circulation angiographically (25%). Four aneurysms (33.3%) existed angiographically and macroscopically in group F (statistically significant). Histologically, group G was found to have a delayed resorption and an earlier beginning of connective-tissue proliferation as compared to group F. Considering early and late findings, G-pretreatment is preferable to F-treatment of umbilical veins.

By the aid of fractional estimation of N-acetylneuraminic acid (NAN) from gastric juice it is possible to investigate quantitative changes of NAN-proteins on the gastric juice. Patients with active chronic atrophic gastritis of the type B have an increase of orosomucoid, which is precipitated by phosphorwolfram acid, in the gastric juice.

From 1969 to 1980 the authors examined 587 histological specimens of oral leukoplakia obtained from 424 patients. The histological findings were assessed in classification numbers qualitatively and quantitatively characterizing the subepithelial inflammation, epithelial hyperplasia, keratosis, the grade of epithelial dysplasia an the degree of infiltration when carcinoma had already developed. From this histological classification a classification number resulted which allows conclusions on the prognosis of the leukoplakia under study. Besides the grade of dysplasia also the features of the subepithelial inflammation are important for the prognostic assessment of leukoplakia. The classification numbers are suitable for data processing. In the grading system reported, the most important morphological findings are represented with qualitative and quantitative objectiveness. The classification number leads to more reliable comparison and evaluation of the results obtained by different research groups.

In 731 hyperplasiogenic polyps which have been removed by endoscopical polypectomy there were 9 polyps with an early cancer and 8 polyps with severe dysplasias (borderline lesions) as well as 1 polyp, in which an advanced carcinoma has been developed. This is the outstanding greatest number of hyperplasiogenic polyps with a malignant transformation. In addition in 9 patients with hyperplasiogenic polyps carcinomas could be discovered, i.e. a rate for malignant developments of 3.7%. It seems that stomachs with multiple polyps are endangered in particular. The recurrence rate of follow-up examinations covering a period of up to 8 years was 36.1%.

From August 1976 till the end of February 1979 158 polyp in 83 patients (48 male and 35 female) were removed by means of the rectocoloscopic polypectomy with the high frequency diathermy loop. 66% of the polypi had a diameter of less than 1 cm. Most the polypi were with about 70% in the sigma and in the rectum. With 60.7% the adenomas appeared most frequently, followed by the hyperplastic polypi in 20% and by the inflammatory ones in 13.3% of the cases. With the increase of size of the polypi the proportion of the adenomas clearly increased in comparison to the other kinds of polypi. Severe epithelial atypias (altogether 23.1%) were more frequently in adenomas larger than 2 cm than in smaller ones. An invasive carcinoma was found in no polypus. Thus the endoscopic polypectomy in every case meant a curative therapy with great economic use. In patients a haemorrhage appeared as a complication of the coloscopic polypectomy. Only the removal of the polypi in toto allows an exact histological classification and the answer of the decisive question, whether in one adenoma only severe epithelial atypias are present and thus the polypectomy is therapeutically sufficient or whether there exists an adenocarcinoma, for the removal of which an operation according to the principles of the carcinoma surgery must be carried out. The endoscopic ablation of the adenomas thus means a genuine prophylaxis of cancer.

By single intraarticular injection of lectin from Lens culinaris in nosenitized rabbits acute and chronic arthritis was produced. By use of fluoresceinisothiocyanate-labelled lectin binding of lectin could be demonstrated in the connective tissue of joint capsule for 4 weeks. The morphological features of lectin-arthritis were described. The results are discussed with respect to the pathogenesis of the arthritis.

The commonest type of polyps in the large intestine in our series of 506 polypectomies in 262 patients were adenomas (64%) especially tubular adenomas. Severe epithelial atypia being present in 11% of all adenomas and it was three times more discovered in villous adenomas than in tubular forms and with increasing adenomas size. Because severe epithelial atypia could be observed in polyps with diameters less than 5 mm it should be demanded to remove each polyp for an exact histological examination independent of his size. Single forceps biopsies of polyps do not allow the estimation of their further development in view of malignancy.