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Formation of amyloid within peripheral nerves, resulting in amyloid-related neuropathies, may occur when myeloma-associated amyloid (AL) is deposited in an immune-related neuropathy or in familial amyloid polyneuropathy where prealbumin/transthyretin variants are marked by AF amyloid deposition. Refined histochemical and recent immunohistochemical techniques identify the correct type of amyloid and thus the nosologically precise form of amyloid-related neuropathy. Neuropathy is an inherent thought not obligate clinical and morphological component in two of the three systemic amyloidoses. Multiple causative factors in adult forms of neuropathy render a search for amyloid mandatory whenever respective biopsied nerve specimens are examined.

Twelve renal cell carcinomas composed of "chromophobe" cells are described. This is the first report of renal chromophobe cell tumors in humans neoplasms of this cell type having been described previously only in experimentally induced adenomas in animals. By light microscopy chromophobe cells have slightly opaque or finely reticular cytoplasm when stained with haematoxylin and eosin. They may be distinguished from the clear cells of hypernephroid renal cell carcinomas by the strongly positive reaction of their cytoplasm with Hale's (1946) colloidal iron method and the weaker positive reaction with alcian blue. Vesicular structures, often containing internal vesicles, and possibly derived from the endoplasmic reticulum or from mitochondria are visible electronmicroscopically. Glycogen is present to a variable but slight extent so that it is usually detected only by electron microscopy. The twelve renal cell carcinomas described were composed entirely of chromophobe cells. They were derived from a series of more than 500 adult renal cell carcinomas giving a frequency of approximately 2%. To avoid confusion the descriptive term "light cell" should be discarded and replaced by either "clear cell" or "chromophobe cell" as appropriate, since it is assumed that chromophobe cell tumors have a different derivation from clear cell and other renal cell carcinomas. They may also have a different prognosis although this has not yet been established.

Two phenotypically different permanent cell lines (A and B) were established from a single human chromophilic renal cell carcinoma. The cells of cell line A were large and spindle-shaped, exhibiting a mean doubling time of 32 hours and a saturation density of 85,000 cells/sqcm. The cells of cell line B were smaller and polygonal, exhibiting a mean doubling time of 19 hours and a saturation density of 370,000 cells/sqcm. Cell line A proved to be non-tumorigenic after heterotransplantation into nude mice, whereas cell line B produced rapidly growing carcinomas. These transplant tumors were non-metastatic after subcutaneous implantation, but highly metastatic after renal implantation indicating that the biological behaviour of malignant tumors may be affected by the host tissue.

Renal oncocytoma is a distinct type of epithelial tumor said to arise from the collecting duct system. Here we show that in nine of ten oncocytomas the tumor cells expressed an analog of the erythrocyte anion exchanger band 3. In the normal kidney band 3 is confined to the basolateral surface of the majority of intercalated cells which comprise up to 50% of the cortical collecting duct epithelium. Carbonic anhydrase c is another protein abundant in intercalated cells, and this was also expressed in six of the ten oncocytomas investigated. Immunoreactivity specific for band 3 and carbonic anhydrase c was not detected in any of the 20 renal cell carcinomas examined. At favourable section planes direct transitions between normal collecting ducts and oncocytic tubules were observed. These findings suggest that oncocytomas may develop from intercalated cells of the collecting duct epithelium.

Fibro-osteo-cemental lesions of the jaw bones are a heterogeneous group of diseases which present problems in classification. Psammous desmo-osteoblastoma is one of four newly proposed entities (Makek 1983) and has until now been characterized by its light microscopic, clinical and radiological features. On electron microscopy this tumour exhibits fibroblastic (preosteoblastic), osteoblastic and osteocytic cells and a globular mineralization unlike the mineralization of the psammoma bodies. Immunohistological investigations with anti-osteonectin, a bone specific protein linking mineral to collagen, showed positive intracellular staining in all tumour cells and extracellular staining in the osteoid. The psammoma bodies were, however, not stained. These results confirm the view of the osteogenic histogenesis of psammous desmo-osteoblastoma, with an osteogenic differentiation of the tumour cells, bone formation and association of psammoma bodies which are not of bone origin. This combination of findings supports the view that psammous desmo-osteoblastoma represents a new and distinct entity occurring in desmal preformed cranio-facial bones which should be incorporated in a revised WHO-classification.

The angiographic findings in ten patients with renal oncocytoma are described. Characteristic features include: absence of encasement, vascular occlusions, arterio-venous shunts and contrast lakes (8/10). Spoke-wheel arrangement of tumor vessels (8/10). Homogeneous tumour contrast during the capillary phase (7/10). Sharp demarcation from the kidney and surroundings (9/10) and a peritumoral halo (4/10). If the suspicion of an oncocytoma is raised by CT examination of a space-occupying lesion (part I), angiography should be performed to confirm the diagnosis and help in planning surgical treatment.

140 biopsies from 108 patients afflicted with the carpal tunnel syndrome were studied, 27 of whom showed deposition of amyloid, in 6 of them to such an extent that the amyloid was considered significant in the pathogenesis of the carpal tunnel syndrome. Morphologically, vessels and ligaments were affected and especially the peritendinous structures. As it was always part of generalized amyloidosis, the amyloid in the carpal tunnel consisted immunohistologically of amyloid A in three cases (including one case with simultaneous amyloid deposition of the AA- and the AB-type), of amyloid A kappa in one case, of amyloid of prealbumin origin in seventeen cases and of AB-amyloid in eight cases. We also described for the first time the manifestation of generalized senile amyloidosis (ASs) in the carpal tunnel. Deposition of amyloid of beta-2-microglobulin type (AB) in the carpal tunnel was particularly frequent and massive.

In the chromophobe cell type of renal carcinoma, cytoplasmic microvesicles (frequently with "inner vesicles") demonstrable by transmission electron microscopy are one of the most important diagnostic features. The present paper reports on these microvesicles in freeze fracture replicas. Their diameter is mainly between 140 and 300 micron, but smaller and very much larger vesicles may also occur. The vesicle membrane is devoid of, or contains only scanty intramembranous particles. Cytoplasmic invaginations, probably the precursors of "inner vesicles" can also be detected. Connections with the agranular endoplasmic reticulum, mitochondria or other cell components could not be documented. Larger vacuoles limited by a membrane and containing large numbers of microvesicles have been interpreted as autophagic vacuoles. In freeze fracture replicas, there are marked differences between the chromophobe cell and the clear cell type of renal carcinoma, providing further evidence that the chromophobe cell type is a distinct entity.

In order to identify amyloid deposits in patients over 60 years of age (so-called senile amyloid), the following five tissues were investigated under the light and electron microscope: 1. pituitary gland, 2. pancreatic islets of Langerhans, 3. heart, 4. aorta, and 5. brain. In all an increasing incidence of amyloid deposits was found with increasing age, and in the brain a significant quantitative increase in amyloid deposits with increasing age was observed. Despite the biochemical heterogeneity of amyloid found in old age, all the deposits seen in tissues examined were morphologically similar. Typical amyloid fibrils were always found (diameter 60-100 A), and these were invariably deposited extracellularly and primarily on basement membranes. The amyloid-binding basement membranes were in most cases those of myocytic, but were also those of endothelial or epithelial cells. The almost invariable involvement of blood vessels, indicates the importance of these structures in the genesis of the various forms of senile amyloid.

The CT findings in a case of xanthogranulomatous cholecystitis are reported. Irregular thickening of the gallbladder wall and poorly defined borders of the underlying liver and the adjacent duodenum suggested a tumorous lesion.

A new cava filter has been tried in 23 dogs weighing between 16 and 23 kg. The filter consists of a stainless steel basket which can be introduced either antegrade or retrograde through a 10F teflon catheter and which can be removed again within the first four days. The filter was effective in holding back embolising thrombus. In the early stages, even without artificial embolisation, two out of five animals showed clot formation in the basket. After three or four months, all the filters were permeable and on only two occasions was a small amount of thrombus found.

The list of human amyloidoses contains at least ten different types that might be differentiated on account of their pattern of distribution (localized or generalized), on the basis of their underlying diseases and above all on account of their different amyloidogenic proteins. According to WRIGHT it was already possible to differentiate two types of amyloid by pretreating the histologic tissue sections with KMnO4 before staining them with Congored. But now nearly all different types of amyloid can be determined immunohistologically by means of specific antibodies. In the human brain and in its coverings we found as well localized as generalized amyloidoses. The most frequent localized amyloidosis is the cerebral amyloidosis in Alzheimer's disease, in senile dementia of the Alzheimer type and in "normal" aging (type ASb). The endocrine type of amyloid could be detected in the anterior pituitary lobe of old people and sometimes in adenomas of the pituitary gland (type AE). In cases of generalized amyloidosis (e.g. amyloid type AA, type AF or type AL) the intracranial amyloid deposits or precipitations are only found in those regions where the blood brain barrier is insufficient. These regions are --choroid plexus --infundibulum (hypothalamus) --pineal gland (epiphysis) --area postrema --circumventricular organs --ganglion Gasseri and --dura mater. The other parts of the CNS (the leptomeninges, cortical grey matter, subcortical white matter and basal ganglia) are always free of amyloid in these cases of generalized amyloidosis. In cases of cerebral amyloidosis (type ASb) the typical berefringent Congored deposits are found in the leptomeninges and in cortical and subcortical grey matter; white matter and all other regions are always free of amyloid. We observed several cases with more than one type of amyloidosis: e.g. a generalized form and a second local amyloidosis, two generalized forms (AA and A beta 2M) or even several localized types (ASb, AE). By paying attention to the typical distribution pattern of the amyloid deposits in the CNS and its coverings and by using specific antibodies it is now possible to distinguish between two different amyloidoses even in the same body region, e.g. in the human brain.

The haemangiopericytoma is a rare type of vascular tumour. The article reports on a case of unusual location in the liver.

An 8-year follow-up of Ceravital middle ear prostheses showed an extremely good tolerance in the middle ear space. Incompatibility phenomena were not observed. Inflammatory reactions were neither caused nor supported by the implants. The implantation was always performed without interposition of cartilage. Extrusions were not observed. Long-lasting inflammatory processes destroy implants in the same way as they affect ossicles. Transient inflammatory periods (e.g. in the early postoperative period, POM) do not lead to any remarkable changes of the implant surface. In healthy middle ears, the hearing results are stable.

A 30-year-old Italian male was admitted to the hospital showing all clinical signs of acute pancreatitis. With the help of computerized tomography, ultrasonic and angiographic methods multiple cysts in pancreatic body and tail as well as close to the hilus of the spleen could be shown. Positive serological tests made the diagnosis "echinococcus granulosus" likely. Resection of the left part of the pancreas as well as resection of the spleen eliminated the parasite. Histologically hydatid cyst was traceable in the pancreatic duct.

Human and experimental amyloidosis can occur either as a generalized widespread deposit of various proteins or a localized deposit. We looked for local amyloidosis caused iatrogenically under clinical and experimental conditions. Subcutaneous tissue from one diabetic patient and six Wistar rats, which had received a continuous local infusion of 1.2 iu of insulin daily for 6 weeks, was examined histologically. In all cases the development of granulation tissue around the tip of the catheter was observed. In addition, inhomogenous extracellular deposits showing green birefringence under polarized light when stained Congo red were seen. Immunohistologically, they displayed binding of anti-insulin antibody. Electron microscopy demonstrated a typical spear-like fibrillar structure with a fibril diameter of 60 to 80 A. These findings confirmed that the deposited substance was amyloid. Iatrogenically administered protein produced in vivo amyloidosis at the site of its entry. Insulin can lead to the formation of amyloid fibrils not only in vitro but also in vivo.

535 human renal cell carcinomas were classified using a classification system based on defined tumor cell types. The following tumor cell types were distinguished: clear cells (with variants: clear cell-eosinophilic, plasma-rich), chromophobe cells (with variants: eosinophilic, relatively light), chromophilic cells (basophilic, eosinophilic), spindleshaped/-pleomorphic cells. A group "still unclassified" is added. This classification largely rejects the term "granular" (which as a rule was combined with "eosinophilic"), because in our view this term referred to a heterogenic group of variants of different cell types. A cytological grading--based on nuclear morphology--is conducted using 3 grades (GI - III). Preliminary results from follow up studies (survival rates, metastases) suggest that this classification may also have clinical importance for tumor prognosis.

Antegrade electropapillotomy using the percutaneous transcystic approach was successfully performed in 11 of 16 dogs. When the intervention was effective, the pressure gradient between common bile duct and duodenum decreased from 6 to 1.3 mm Hg on average and returned to gradients slightly below the initial values after 4 weeks, owing to reactivation of the sphincter mechanism. Ineffective cutting, however, resulted in a temporary pressure rise. In one dog a papillary stenosis developed and was relieved by antegrade electrocutting. Irrespective of the success of the papillotomy, rises in levels of serum glutamine oxaloacetic and pyruvic transaminase, alkaline phosphatase, serum amylase and leukocytes were seen. Although the method is technically feasible, its clinical significance is not so much for antegrade papillotomy but rather for transhepatic incision of stenoses after hepaticojejunostomy.

This paper reports on 32 chromophobe cell renal carcinomas observed in 697 renal cell cancers (RCC) of adults (peak in the sixth decade of life). The chromophobe cell-type differs from other types of RCC macroscopically, the cut-surface being predominantly of grey-beige colour. Histologically, there are two variants: one is the typical (light) variant (n = 22) and the other is eosinophilic (n = 10). Both variants have in common (a) reaction of the cytoplasm with Hale's acid iron colloid; (b) electron microscopic detection of cytoplasmic microvesicles (150-300 nm), frequently with 'inner vesicles', and (c) low glycogen content in comparison with the clear cell carcinoma. Immunocytochemical investigations on the intermediate filaments show a positive reaction for cytokeratins No. 18 (uniformly) and Nos. 7 and 19 (to varying extents) for both variants, whereas vimentin was not found in any of these carcinomas, in contrast to the clear-cell type. The cytomorphological grading revealed predominantly G II tumours. A lymph node metastasis was found in one patient. On the basis of the mortality curves determined, the prognosis for patients with chromophobe cell carcinomas is more favourable than that of the clear-cell type. In terms of differential diagnosis, on the one hand, the typical (light) variant of the chromophobe cell RCC must be delimited from the clear-cell RCC, and on the other hand, the eosinophilic variant must be distinguished from the chromophilic or 'granular' RCC. Microscopic, histological, histochemical, electron microscopic, and intermediate filament analysis results document that the chromophobe cell type of RCC is a distinct entity. The implications for the nomenclature of RCC, especially with regard to the 'granular' type, are discussed.

Typing of renal cell tumours according to cytomorphological criteria results in different basic cell types, i.e. the clear cell type, the chromophilic cell type, the chromophobic cell type, the oncocytic cell type and the cell type of Duct-Bellini-Carcinoma. Each basic cell type exhibits a typical spectrum of cytological variability including eosinophilic (granular) variants. Antigenic properties of the proximal tubule can mainly be detected in clear cell and chromophilic renal cell carcinomas, whereas antigenic properties of the connecting tubule and collecting duct can be found especially in the chromophobic renal cell carcinoma and oncocytoma as far as in Duct-Bellini-Carcinoma. These different phenotypes of epithelial renal cell tumours are possibly due to various histogenetic pathways. Prognostic factors in renal cell carcinoma include staging, grading and to a less extent cytological and histological parameters which are summarized in a new prognostic score. From this score, three significantly distinct prognostic groups evolved with a correct prognosis of over 80% on the average for an individual case, which suggests a great prognostic potential.

Recanalisation of arteriosclerotic occlusions by means of laser angioplasty, Kensey catheter and the "hot tip" catheter is undergoing early, successful clinical trials. The thermo-cautery catheter described in this paper uses the well known technique of cutting with high frequency electric currents in order to achieve vascular recanalisation. Seven attempts were made to recanalise occlusions at post mortem; four were successful, but perforation occurred in three. Histologically we found a narrow rim of carbonisation of tissues surrounded by a zone of homogenisation and a transitional zone.

The possibility of percutaneous antegrade papillotomy under image intensifier control was investigated in eight dogs. It was successful in five animals. Successful papillotomy can be recognised radiologically and also by the feel of the catheter. The effect of papillotomy can be demonstrated by a fall of the pressure gradient existing between common bile duct and duodenum. The use of this method in patients is discussed.

A 82 year old woman developed wide spread hemorrhagic skin gangrene in the face and on the extremities as cutaneous manifestation of IgG-IgM cryoglobulinemia, in this case a concomitant phenomenon of lymphocytic malignant lymphoma.

Hybridoma technology enabled the production of tumor-specific monoclonal antibodies reactive exclusively with human renal cell carcinoma. Intracellular localization of the antigen was undertaken in order to gain understanding of its possible physiological role in cellular metabolism and to investigate its future clinical applicability for immunoscintigraphy in tumor localization. For immunoelectron microscopy a special paraformaldehyde-periodate fixation process (PLP fixation) had to be employed, in order to preserve the cell's ultrastructure without destruction of the antibody-binding epitope. The antigen was found to be strictly intracytoplasmic in close correlation to the glycogen particles characteristic for human renal cell carcinoma. These findings suggest that this antigen may be involved in the pathological glycogen synthesis, explaining the specific staining pattern of these monoclonal antibodies.

The computer tomograms of 22 patients with renal oncocytomas were analysed retrospectively. Characteristic findings were: 1. solid round space-occupying lesions (22/22), 2. sharp demarcation from the kidney (20/22), 3. smooth margin (20/22), 4. hypodensity after intravenous contrast (20/20), 5. enhancement (19/19), 6. central hypodense nidus (16/22), 7. homogeneous beyond the nidus (11/22). In the presence of these criteria, the diagnosis of an oncocytoma may be suspected. Safe differentiation from a renal cell carcinoma may not always be possible.

In 95 patients with acute necrotising pancreatitis the clinical severity of the disease was compared with morphological criteria of operative specimens. In addition, various morphological phenomena, typical in acute and chronic pancreatitis, were investigated in 3 aetiologically different groups. In these groups pathohistologic alterations, associated with aetiological factors, were seen frequently. Furthermore, there was a good correlation between classifications according to gravity criteria in the assessment of the underlying disease. About 90% of cases clinically classified as acute pancreatitis proved, on the basis of the morphology, to be chronic recurrent pancreatitis. It thus follows that "genuine" acute pancreatitis is a rather rare syndrome.

One hundred and five carotid stenoses were examined by B-scan sonography (10 MHz) and the results compared with the macroscopic and histological appearances. The most important sonographic findings depended on surface structure, echo amplitude and the presence of acoustic shadows. From the therapeutic point of view, B-scan sonography is complementary to angiography by evaluating the morphology of the plaques, particularly if the indications for surgery are ill-defined.

The term renal cell tumors (adenomas and carcinomas) subsumes the tumors deriving from the uriniferous tubule epithelium of the kidney. Precise analysis shows that the renal cell tumors display different cell types which build up the individual tumor alone or in combination with each other. Three categories of basic elements are distinguished in the characterization of renal cell tumors: Cytological elements = tumor cell types: Clear, chromophobe, chromophilic (basophilic, eosinophilic), oncocytic, spindle-shaped/pleomorphic. Histological elements = growth patterns: Compact, acinar (nest-like), tubulopapillary (tubular, papillary), cystic. Cytological grading of malignancy: G I, G II, G III; mainly based on the degrees of nuclear atypia. The cytological features are given priority compared to the histological growth forms for classification of renal cell tumors. However, the latter are not to be neglected in the overall evaluation of a tumor. A classification of renal cell tumors is suggested and the result of its application in 510 renal cell carcinomas and oncocytomas is presented. On this basis and in connection with the cytological grading, a more precise prognostic evaluation of the renal cell carcinomas is expected.

We examined the expression of the diverse cytokeratin (CK) polypeptides as well as vimentin in human renal cell carcinomas of various subtypes and in renal oncocytomas by applying both two-dimensional gel electrophoresis and immunocytochemistry by using polypeptide-specific monoclonal antibodies. The tumors were classified according to the guidelines of the World Health Organization, with some modifications based primarily on recently proposed cytomorphological criteria. All clear cell carcinomas (G I, G II; N = 20) co-expressed CKs nos. 8 and 18, and vimentin, with CK no. 19 being present in 13 of the 20 cases and exhibiting a heterogeneous distribution. Dedifferentiated carcinomas (G III; N = 8) also co-expressed CKs nos. 8 and 18 as well as vimentin, but in addition, exhibited CK no. 19 and, in many cases, CK no. 7; in 1 case, only vimentin was expressed. Both eosinophilic-granular (N = 3) and basophilic (small cell cuboidal; N = 6) carcinomas contained CKs nos. 8 and 18, and the co-expression of vimentin was a consistent feature of these tumors; CK no. 19 was found in all of these cases, while CK no. 7 was present in the majority. In chromophobe cell carcinomas (N = 8), in contrast to all of the other carcinoma types, no vimentin was detected in the tumor cells, with only CKs nos. 8, 18, and to a variable extent 7, being present. Similarly, oncocytomas (N = 8) lacked vimentin and exhibited only CKs nos. 8 and 18. Conspicuous scattered CK no. 19-positive cells were found in these two last tumor types. No CK polypeptides other than simple-epithelium-type CKs (nos. 7, 8, 18, and 19) were detected in any of the tumors studied. These results indicate that, in renal cell tumors, the expression of intermediate-filament proteins is strikingly correlated with the specific morphologic appearance. While the co-expression of CKs nos. 8 and 18 and vimentin was a surprisingly consistent feature of the most common subtypes of renal cell carcinomas, CK no. 19 exhibited remarkable heterogeneity of expression both within individual tumors and between different tumors, the expression patterns of this CK being correlated to the tumor subtypes. The consistent absence of vimentin in chromophobe cell carcinomas and oncocytomas makes it possible to define these as a separate class of renal cell tumors. This finding supports the view that chromophobe cell carcinomas represent a distinct tumor entity and points to their close phenotypic relationship to benign oncocytomas as well as to normal renal tubules.

A case report of a dorsal defect of patella is presented and discussed in comparison with the Osteochondrosis dissecans of the patella.

After grading into 4 groups of severity the extent of amyloidosis of the islets of Langerhans was investigated in 60 patients with diabetes and in 60 without. Distinction of 3 stages of diabetes according to clinical parameters showed clear connections between the stage of diabetes and the extent of amyloidosis. Development of amyloid locally may be evidence for progressive B cell insufficiency in diabetes of adults.

Using light and electron microscopy, 65 cases of amyloid deposits in the heart were examined. Five different groups were distinguished: I. isolated atrial amyloidosis, II. senile cardiac amyloidosis, III. cardiac amyloid accompanying chronic infections and tumors, IV. cardiac amyloid accompanying plasma cell dyscrasia, V. idiopathic cardiac amyloidosis. Seen structurally, no principal differences in the precise localization of the amyloid deposits were found in any of the groups investigated. Amyloid is always deposited in the vicinity of cells with myocytic cell differentiation (i.e. the heart muscle cells, non-striated muscle cells of the vessels), whereby the relevant basement membranes serve as conductors. A systematic relationship between amyloid and the collagenous fibers of the interstitium or the tunica adventitia of the vessels could not be demonstrated, which shows the concept "pericollagen" to be inadequate for the morphological characterization of amyloid deposits in the heart. Whereas for group I a localized mechanism for the production of amyloid must be considered, in the case of groups II-V a vascular principle expression of a generalized amyloidosis seems to be the major factor. The question of the differing concentration of amyloid deposits in the heart suggests that localized factors (e.g. changes in the myocytic basement membranes) and quantitative changes of the amyloid-building proteins may also be important.

In the present study we have examined ten cases of the chromophobe type renal cell carcinoma. This type of tumor is distinguished from the other carcinomas of the kidney with light cytoplasm (formerly called "hypernephroid") by (a) a positive Hale's iron colloid stain of the cytoplasm, (b) the occurrence of numerous invaginated vesicles within the cytoplasm that resemble the invaginated vesicles of intercalated cells of the collecting duct system, and (c) a positive immunoreaction of both the plasma membrane and the cytoplasm with antibodies to the epithelial membrane antigen (EMA) and carbonic anhydrase C (CAC), respectively. Unlike oncocytomas, which also express CAC and EMA, the chromophobe renal cell carcinoma does not express the erythrocyte anion exchanger band 3. These findings strongly indicate that chromophobe renal cell carcinomas as well as oncocytomas of the kidney are histogenetically related to the two populations of intercalated cells of the collecting duct system. Thus, both tumors represent examples of renal tumors which disprove the broadly accepted hypothesis that all epithelial tumors of the kidney are histogenetically related to the proximal tubule.