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We report on a woman presenting with fever and novel round lesion in the lung four months after heart transplantation. Microbiologic assessment of bronchial lavage and operative specimen revealed pulmonary nocardiosis. Furthermore, cerebral involvement has been observed. Antibiotic treatment according to the microbiological sensitivity test for eleven months resulted in complete remission of pulmonary and cerebral nocardiosis. Immunosuppressive treatment increases the risk for opportunistic infections early after transplantation as well as malignancies during the late course.

Chondrosarcomas of the larynx are rare malignant tumors usually diagnosed with significant delay due to their nonspecific symptoms. We report a 50-year-old male presenting with progressive dyspnea. Indirect laryngoscopy revealed a subglottic stenosis. The cricoid cartilage was shown on CT to be massively damaged. Histologic differentiation between chondroma and highly differentiated chondrosarcoma was very difficult. Therefore, an organ-preserving treatment concept using partial cricoid resection and staged endoscopic arytenoidectomy was chosen. Total laryngectomy and permanent tracheostomy could be avoided. Due to the risk of recurrence, early follow-up with endoscopy and CT is mandatory.

Background: Exact estimation of a tumor's size and the definition of adequate resection margins in carcinomas of the tongue are often difficult because of the tumor's extension and deep infiltration., Methods: We have developed a method that allows intraoperative visualisation and marking of tumor margins. Intra-operative endosonography was performed on nine patients with carcinomas of the tongue using a 8-12 MHz linear array transducer. The oral cavity was flooded with normal saline solution and the transducer was immersed therein. This allowed scanning in a non-contact mode. The tumor margins were marked with a surgical suture under endosonographic monitoring., Results: In the nine patients studied, the histological margins corresponded to the sonographic margins. The sonographic marking proved to be useful during the resection of the tumor and histological safety margins were respected in each case., Conclusions: This non-invasive procedure provides a quick and reliable orientation during the resection of tongue carcinoma, and a more precise and individual definition of resection margins is possible. Intraoperative non-contact use of endosonography is a promising method.

Anorectal melanomas represent a very small group of mucosal melanoma with unknown etiology and poor prognosis. In view of their location, a history of sun exposure is not likely to have had an impact on their development. Recent epidemiologic data indicate a bimodal age distribution. To date there is no information whether an infection with the human papilloma virus plays a role in the tumorigenesis of anorectal melanoma. The lesions can be misdiagnosed as hemorrhoids on clinical examination. On histological examination amelanotic types have been misdiagnosed as lymphoma, sarcoma,and undifferentiated carcinoma. Useful immunohistochemical markers are S 100 protein, HMB-45, Melan A, and MiTF (microphthalmia-transcription-factor). Therapy includes local excision or abdominoperineal resection followed by optional inguinal and parailiac lymph node dissection, and consecutive chemo- and immunotherapy. The poor long-term prognosis of anorectal melanomas correlates with their advanced tumor size and depth of infiltration at diagnosis. The overall 5-year survival rates range between <5 and 22% in different series.

The history of gallbladder involvement by a malignant melanoma in a 65-year-old woman is reported. The gallbladder, clinically resected for cholecystitis, harboured a polypoid dark pigmented tumour. The tumour was identified as a malignant melanoma immunohistochemically by positive reactions for gp100 (HMB45), melan A, and MiTF. Clinically, the patient was treated for cutaneous malignant melanoma by local excision 10 years earlier. The literature of pigmented lesions of the gallbladder is reviewed. In conclusion, the most important differential diagnosis of pigmented lesions of the gallbladder is the secondary gallbladder melanoma.