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Syringocystadenocarcinoma papilliferum (SCACP), the malignant counterpart of syringocystadenoma papilliferum (SCAP), is an extremely rare malignant adnexal neoplasm. It is described by the World Health Organization as a malignant transformation of SCAP occurring in middle-aged to elderly individuals with a predilection for the head and neck. SCACP seems to arise from a long-standing syringocystadenoma probably on a background of nevus sebaceous (NS) through a multistep progression. A 75-year-old man was referred to our department with a long-standing NS with a recent newly developing nodule on his scalp. The tumor was excised. On histology, the overall architecture of the tumor still resembled an unusual SCAP within NS but simultaneously showed transition to syringocystadenocarcinoma papilliferum in situ and invasive SCACP as recognizable by the presence of areas of nuclear atypia, increased proliferative activity, and infiltrative growth. In summary, we report an extremely rare case of an invasive SCACP of the scalp that demonstrates histological evidence for all transitive steps in the hypothetical multistep progression from NS to invasive SCACP in one single lesion. The implications of these findings are discussed in the light of the relevant literature.

To shed more light on the pathogenesis of sebaceous carcinoma, we analysed the expression of proteins related to angiogenesis in 18 ocular and 22 extraocular sebaceous carcinomas using a broad panel of immunohistochemical markers. To quantify the expression of D2-40, vascular endothelial growth factor, vascular endothelial growth factor receptor-2 and -3, we calculated a quantification score by considering the percentage of positive tumour cells (0=0%, 1=up to 1%, 2=2-10%, 3=11-50%, and 4=>50%) in relation to the staining intensity (0=negative, 1=low, 2=medium, and 3=strong). Additionally, lymphatic microvessel density in the D2-40 stained sections was counted. Vascular endothelial growth factor receptor-3 (quantification score 9.42 ± 2.94) was significantly more strongly expressed than vascular endothelial growth factor receptor-2 (quantification score 2.15 ± 2.42, p < 0.001). Furthermore, epidermal vascular endothelial growth factor expression was negatively correlated with the intratumoural lymphatic vessel density, and the ratio of small lymphatics to large lymphatics was much higher in intratumoural tissue than in paratumoural tissue and in intraindividual control tissue, suggesting a lymphangiogenetic potential of sebaceous carcinoma.

Zylindrome gehoren zur Gruppe der seltenen Adnextumoren des Erwachsenenalters. Pradilektionsstellen sind der behaarte Kopf und das Gesicht. Eindrucksvoller als der zufallige Befund eines solitaren Zylindroms ist das massenhafte, syndromale Auftreten im Rahmen eines Brooke-Spiegler-Syndroms. An der Kopfhaut konnen multiple Zylindrome dann auf ganz charakteristische Weise als sog. Turbantumor imponieren. Insbesondere bei plotzlicher Wachstumstendenz oder Ulzeration muss der mogliche Ubergang in ein Zylindrokarzinom bedacht werden.

Despite new horizons opened by recent advances in molecular pathology, histological evaluation still remains the diagnostic gold standard regarding cutaneous melanocytic neoplasms. Several histological variants of melanoma have been described, and their knowledge is crucial for accurate diagnosis and classification of cases with unusual clinico-pathological features. Uncommon histological variants of melanoma have been described based on a broad constellation of features, including architectural pattern, stromal alterations, cytological attributes, and other morphological properties. This review is aimed at providing an extensive discussion of unusual but distinctive histopathological variants of melanoma.

Zusammenfassung Hintergrund 2016 wurden erstmals „Nationale Empfehlungen für Bewegung und Bewegungsförderung“ für Deutschland veröffentlicht. Der folgende Beitrag stellt das assoziierte Forschungsprojekt kurz vor und fasst die Empfehlungen für ältere Erwachsene sowie für Erwachsene mit einer chronischen Erkrankung zusammen. Methodisches Vorgehen Für die Empfehlungen für Bewegung wurden systematische Literaturrecherchen, kriteriengeleitete Qualitätsbewertungen sowie Inhaltsanalysen und -synthesen von international vorhandenen Bewegungsempfehlungen angewandt. Für die Empfehlungen für Bewegungsförderung wurden 3 systematische Literaturrecherchen zu den Themenfeldern Wirksamkeit, Kostenwirksamkeit und Qualitätssicherung von Intervention zur Bewegungsförderung durchgeführt. Ergebnisse Ältere Erwachsene und Erwachsene mit einer chronischen Erkrankung erzielen durch regelmäßige körperliche Aktivität bedeutsame Gesundheitswirkungen. Eine zentrale Bewegungsempfehlung für beide Zielgruppen ist es, möglichst 150 Minuten moderate oder 75 Minuten intensive Ausdaueraktivitäten, bzw. eine entsprechende Kombination, verteilt über die Woche zu erzielen. Weiterhin sollten muskelkräftigende Aktivitäten an mindestens 2 Tagen pro Woche durchgeführt werden. Bewegungsförderung gelingt für beide Zielgruppen dann, wenn sie in den Lebenswelten dieser Zielgruppen stattfindet und ihnen passgenaue Maßnahmen zur Bewegungsförderung anbietet. Dies können z. B. Bewegungsberatungen sein. Schlussfolgerungen Mit der Entwicklung evidenzbasierter „Nationaler Empfehlungen für Bewegung und Bewegungsförderung“ liegt ein wichtiger Baustein für die Initiierung und Umsetzung von Maßnahmen der bewegungsbezogenen Gesundheitsförderung in Deutschland vor. Die spezielle Formulierung dieser Empfehlungen für die Zielgruppen älterer Erwachsener und Erwachsener mit einer chronischen Erkrankung ist international einmalig.

Despite new horizons opened by recent advances in molecular pathology, histological evaluation still remains the diagnostic gold standard regarding cutaneous melanocytic neoplasms. Several histological variants of melanoma have been described, and their knowledge is crucial for accurate diagnosis and classification of cases with unusual clinicopathological features. Uncommon histological variants of melanoma have been described based on a broad constellation of features, including architectural pattern, stromal alterations, cytological attributes, and other morphological properties. This review is aimed at providing an extensive discussion of unusual but distinctive histopathological variants of melanoma.

After a review of the physiology in the formation and degradation of cutaneous elastic tissue, we describe the clinicopathologic disorders characterized by increased and decreased cutaneous elastic tissue. Cutaneous disorders characterized by increased and/or abnormal elastic tissue in the dermis include elastoma, also named nevus elasticus, dermatosis lenticularis disseminata, pseudoxanthoma elasticum, late-onset focal dermal elastosis, linear focal elastosis, elastoderma, elastofibroma dorsi, and elastosis perforans serpiginosa. In some of these conditions, the specific histopathologic diagnosis may be rendered with hematoxylin-eosin stain, whereas in other ones special elastic tissue stains are necessary to demonstrate the anomalies. Cutaneous disorders characterized by decreased dermal elastic tissue include nevus anelasticus, papular elastorrhexis, perifollicular elastolysis, anetoderma cutis laxa, postinflammatory elastolysis and cutis laxa, white fibrous papulosis of the neck, pseudoxanthoma elasticum-like papillary dermal elastolysis, and mid dermal elastolysis. In most of these conditions, the histopathologic anomalies are only seen with elastic tissue stains, and cutaneous biopsies of these processes stained with hematoxylin-eosin show appearance of normal skin. The diagnosis of some of these disorders characterized by increased or decreased elastic dermal tissue should be followed by general exploration of the patient to rule out associated severe systemic anomalies, and in some cases, a genetic counseling should be offered to the family.

Sebaceous neoplasms with an organoid pattern (rippled, labyrinthine/sinusoidal, carcinoid-like, and petaloid) are rare. Previous studies suggested that the above patterns likely represent variations along a morphological continuum. The objectives of this study were to (1) validate this proposition by studying a large number of cases, (2) determine whether there are specific associations with clinical features, (3) establish their frequency, and (4) determine whether they have any association with Muir-Torre syndrome. Fifty-seven sebaceous neoplasms (54 sebaceomas and 3 sebaceous carcinomas) with organoid growth patterns were studied. These occurred in 36 men and 18 women (sex unknown in 3), with ages at diagnosis ranging from 22 to 89 years (mean, 63 years). All patients presented with a solitary nodule (mean size, 11 mm) on the head and neck area. Of the 57 tumors, 24 manifested a single growth pattern, 23 had a combination of 2 patterns, and 10 a combination of 3 patterns, indicating that these patterns are part of a morphological continuum of changes. The carcinoid-like pattern was the most frequent in the "monopatterned" neoplasms (13 cases), whereas the labyrinthine/sinusoidal pattern comprised most of the "polypatterned" lesions, in which various combinations occurred. Immunohistochemically, mismatch repair protein deficiency was detected in 3 of the 22 cases studied, whereas 5 of the 33 patients with available follow-up had an internal malignancy/premalignancy. In conclusion, sebaceous neoplasms with organoid growth patterns are predominantly sebaceomas having a predilection for the scalp, occurring as solitary lesions in elderly patients (male to female ratio of 2:1). Such patterns are expected to be found in a quarter of sebaceomas. In most cases, more than one of the organoid patterns is present. These lesions do not appear to be associated with internal malignancy or mismatch repair deficiency in most cases. However, confirmation of the absence of any significant association with Muir-Torre syndrome syndrome will require genetic studies.

BACKGROUND Primary cutaneous apocrine cribriform carcinoma (PCACC) is a rare tumor, clinically appearing as a solitary nodule, mostly involving extremities of females and this lesion usually raises a differential diagnosis with metastatic cribriform carcinomas, especially breast cancer. OBJECTIVE To study GATA3 expression in a series of 14 primary cutaneous cribriform carcinomas and to test its usefulness to differentiate this tumor from metastatic breast cancer. METHODS We retrieved 14 cases with PCACC (each from a different patient) from the files of the authors. Cases were dated from 1994 to 2014. We also evaluated 6 cases of cutaneous breast cancer metastasis RESULTS: No PCACCs expressed GATA3. Breast cancer metastases expressed GATA3 in 100% of our studied cases. CONCLUSION Even though GATA3 expression has been reported in many benign and malignant adnexal tumors (mostly of sebaceous, follicular, and apocrine differentiation), as well as in many other neoplasms, GATA3 staining to differentiate PCACC from skin breast cancer metastasis has a high negative predictive value. A positive GATA3 staining in this context should permit one to rule out PCACC with a high level of confidence.

Microcystic adnexal carcinoma (MAC) is a low-grade malignant tumor of the skin. Histologically, this tumor shows a biphasic pattern, with cords and nests of basaloid cells, as well as keratin horn cysts. This biphasic histological appearance has been interpreted by some authors as a sign of double eccrine and folliculosebaceous-apocrine differentiation, whereas some other authors defend a solely eccrine differentiation. In this context, sebaceous differentiation in MAC would support the first option. However, there are only 3 cases of MAC with sebaceous differentiation in the literature, and all of them were reported before adipophilin was available, which in the appropriate context (eg, testing clear cells for sebaceous vs eccrine differentiation) is very useful. In this study, we present 3 cases of MAC with focal sebaceous differentiation confirmed by immunoexpression of adipophilin in the sebaceous foci.

INTRODUCTION Twelve cases of primary cutaneous secretory carcinoma (PCSC) have been published, 9 showing ETV6-NTRK3 translocation, a characteristic finding shared with secretory breast carcinoma and mammary analogue secretory carcinoma. CASE REPORT A 34-year-old female presented a solitary nodule on the right groin. Biopsy revealed a secretory carcinoma staining positive with CK7, CAM5.2, mammaglobulin and S100 and negative with GATA3, CK20, podoplanin, calponin and CDX2. ETV6-NTRK3 was demonstrated by Fluorescence in situ hybridization (FISH). DISCUSSION PCSC is a rare neoplasm, described in the skin in 2009, that affects more frequently females with a mean age of 42.3 years and it is most commonly located in axilla. Histopathologically, these tumor cells are characterized by bubbly eosinophilic secretions diastase-resistant and bland nuclei and they are arranged in various growth patterns, including microcystic, tubular, solid and papillary. S100, mammoglobin and CK7 are usually positive. We review the main histopathological features to rule out histopathologic mimics such as breast metastasis, salivary tumors, cribriform carcinoma and primary cutaneous adenoid cystic carcinoma. GATA3 negative staining, as in our case, can help to rule out breast metastasis. Moreover, long-term benign follow up (144 months) in this case as well as follow-up data on outcomes from literature review support that PCSC is a low-grade sweat gland carcinoma.

We present the case of a 35-year-old man who developed a follicular differentiated cutaneous carcinoma with an eosinophil-rich infiltrate and an aggressive clinical behavior. After an in-depth histopathological investigation the diagnosis of trichoblastic carcinoma was made. Over the course of the disease the patient developed a cutaneous in-transit metastasis as well as an axillary lymph node metastasis 18 months after the excision of the primary tumor on his back. Based on a literature review we discuss the different concepts behind the term "trichoblastic carcinoma" and we summarize the clinical and histological details of previously reported cases. Furthermore, we focus on the phenomenon of tumor-associated eosinophilia.

Blue nevi are melanocytic tumors originating in the cutaneous dermis. Malignant tumors may arise in association with or resembling blue nevi, so called ‘blue nevus-like melanoma’, which can metastasize and result in patient death. Identifying which tumors will behave in a clinically aggressive manner can be challenging. Identifying genetic alterations in such tumors may assist in their diagnosis and prognostication. Blue nevi are known to be genetically related to uveal melanomas (eg, both harboring GNAQ and GNA11 mutations). In this study, we analyzed a large cohort (n=301) of various morphologic variants of blue nevi and related tumors including tumors diagnosed as atypical blue nevi (n=21), and blue nevus-like melanoma (n=12), screening for all gene mutations known to occur in uveal melanoma. Similar to published reports, we found the majority of blue nevi harbored activating mutations in GNAQ (53%) or GNA11 (15%). In addition, rare CYSLTR2 (1%) and PLCB4 (1%) mutations were identified. EIF1AX, SF3B1, and BAP1 mutations were also detected, with BAP1 and SF3B1 R625 mutations being present only in clearly malignant tumors (17% (n=2) and 25% (n =3) of blue nevus-like melanoma, respectively). In sequencing data from a larger cohort of cutaneous melanomas, this genetic profile was also identified in tumors not originally diagnosed as blue nevus-like melanoma. Our findings suggest that the genetic profile of coexistent GNAQ or GNA11 mutations with BAP1 or SF3B1 mutations can aid the histopathological diagnosis of blue nevus-like melanoma and distinguish blue nevus-like melanoma from conventional epidermal-derived melanomas. Future studies will need to further elucidate the prognostic implications and appropriate clinical management for patients with tumors harboring these mutation profiles.

This is the first study to determine the cytomegalovirus (CMV) seronegativity rate for women of childbearing age in Saxony-Anhalt and to determine the prevalence of clinically relevant congenital CMV (cCMV) infection in Central Germany, because there are no valid data available. The retrospective study was undertaken between January 2005 and December 2015. For the first time in Germany, the following seven data sources were used to analyze the prevalence of clinically relevant cCMV infection and the rate of CMV seronegative women of childbearing age: CMV Screening in maternity unit, University Women’s Hospital, Social Paediatrics Centre (SPC), Malformation Monitoring Centre (MMC), Newborn Hearing Screening (NHS), Neonatal Intensive Care Unit (NICU), and In-house Doctor Department. Key parameters were anti-CMV IgG and IgM, CMV PCR of urine, and clinically relevant symptoms caused by CMV. Between 46 and 52% of women of childbearing age were CMV seronegative. The prevalence of clinically relevant cCMV infection was between 0.008 and 0.04%. The CMV seronegativity rate of women of childbearing age was confirmed to be in the middle range of estimated data from other sources in Germany. Data from the NICU, SPC, NHS, and MMC show the prevalence of clinically relevant cCMV infection. The risk of all cCMV infections is underestimated. Thus, the true prevalence of clinically relevant and subclinical cCMV infections is >0.04%.

Anhand von international publizierten Ubersichtsarbeiten soll im Rahmen dieses systematischen Reviews die gesundheitsokonomische Wirksamkeit von Praventionsmasnahmen der Bewegungsforderung analysiert werden. Der Review von Ubersichtsarbeiten basiert auf einer systematischen Literaturrecherche in 10 Datenbanken (u. a. PubMed, Scopus, SPORTDiscus), erganzt um eine Handrecherche. Fur den Zeitraum von Januar 2000–Oktober 2015 wurden Publikationen in englischer und deutscher Sprache gesucht. Ergebnisse der identifizierten Reviews wurden abgeleitet. Insgesamt wurden 18 Reviews identifiziert, die der Pravention durch Bewegungsforderung zugeordnet werden konnten (2 Reviews fokussieren auf bevolkerungsbezogene Ansatze, 10 auf individuumsbezogene Ansatze, 6 betrachten bevolkerungs- und individuumsbezogene Ansatze). Ein hohes gesundheitsokonomisches Potenzial zeigt sich besonders fur bevolkerungsbezogene Masnahmen, die eine breite Bevolkerungsschicht zu vergleichsweise gunstigen Kosten erreichen. Bedeutend sind hier politik- und umweltbezogene Strategien sowie Masnahmen zur Unterstutzung von Verhaltensanderungen durch Information. Am umfangreichsten untersucht wurden bisher individuumsbezogene Ansatze (z. B. Bewegungsberatungen, Bewegungsprogramme). Diese weisen aufgrund geringerer Breitenwirkung und eines haufig hoheren Ressourceneinsatzes eine vergleichsweise geringere Kosteneffektivitat auf. Die vorliegende Studie legt eine umfassende Sichtung und Analyse des gegenwartigen internationalen Forschungstandes zur gesundheitsokonomischen Wirksamkeit von Praventionsmasnahmen der Bewegungsforderung vor. Es zeigt sich, dass viele Masnahmen der Bewegungsforderung als „kosteneffektiv“ gelten. Allerdings bestehen deutliche Unterschiede in der Kostenwirksamkeit zwischen den Ansatzen. Bevolkerungsbezogenen Ansatzen wird das groste gesundheitsokonomische Potenzial zugesprochen. Gleichzeitig muss auf Grenzen der existierenden okonomischen Evidenz gerade in diesem Feld aufgrund von methodologischen Herausforderungen und noch bestehenden Forschungsdefiziten hingewiesen werden.

The success of an intervention for physical activity promotion depends not only on the use of an evidence-based approach, but also on the quality of its implementation in practice. Based on current recommendations from scientists and public health institutions, this state-of-the-art review summarizes the quality criteria for the conception, implementation and evaluation of interventions.A systematic literature search was conducted in the electronic databases PubMed and Scopus. Additionally, guidelines from relevant public health institutions were identified via search engines and websites from governmental and nongovernmental organizations. Based on the analysis of selected documents, quality criteria were listed, grouped and categorized.24 documents, published between 2005 and 2015, provided quality criteria for interventions for physical activity promotion. From the selected documents, 18 quality criteria were defined (conception: 7, implementation: 7, evaluation: 4).This review provides evidence on the relevance of quality criteria within certain stages of an intervention. Future studies could compare the effect of quality criteria on the success of an intervention, or approach the topic from a health-economic perspective.

Im Rahmen der Entwicklung von Empfehlungen fur Bewegungsforderung wurde ein Review von Ubersichtsarbeiten durchgefuhrt, um die Wirksamkeit verschiedener Interventionen im Hinblick auf die Forderung von Bewegung zu untersuchen. Der Beitrag berichtet uber das methodische Vorgehen und erste Ergebnisse. Es wurde eine systematische Literatursuche in PubMed, Scopus, Sport Discus, PsycInfo und weiteren elektronischen Datenbanken durchgefuhrt. Es wurden englisch- und deutschsprachige Ubersichtsarbeiten berucksichtigt. Durch die Suche wurden 213 Ubersichtsarbeiten identifiziert, die fur eine weitere Analyse verwendet werden konnten. Den grosten Anteil machten Reviews zu den Zielgruppen Kindern und Jugendlichen (74) und Erwachsenen (66) aus. Demgegenuber konnten nur wenige Reviews fur die Zielgruppe der alteren Menschen (14) identifiziert werden. Uber den Review von Ubersichtsarbeiten lassen sich die Wirkungen verschiedener Interventionen zur Bewegungsforderung beurteilen. Es zeigen sich jedoch deutliche Unterschiede in der Evidenzlage fur verschiedene Zielgruppen und Interventionsformen.

An otherwise healthy 50-year-old woman was evaluated for the presence of 2 erythematous, and slightly pruritic plaques, involving both cheeks for 30 years. Left-side skin biopsy showed a diffuse proliferation of ductal structures horizontally arranged and involving the reticular dermis that resembled tubular adenoma embedded in a sclerotic stroma and surrounded by a peculiar periductal desmoplasia. Nuclear atypia or mitosis was not found. Contralateral biopsy showed identical findings. Differential diagnosis included microcystic adnexal carcinoma (MAC) and plaque-like syringoma and a peculiarly horizontally arranged tubular adenoma. We ruled out MAC as the lesions were long-standing, without infundibular cysts, solid strands, or perineural infiltration. Our case closely resembled those previously described as sweat duct proliferation associated with aggregates of elastic tissue and atrophoderma vermiculatum, although striking differences were observed, as our case did not present aggregates of elastic tissue, did not involve the papillary and superficial reticular dermis, and presented evidences of decapitation secretion as a sign of apocrine differentiation. We consider our case as a MAC simulator and we propose the descriptive name of bilateral facial apocrine fibrosing hamartoma.

As recently discussed in the public health literature, many questions concerning 'structural' approaches in health promotion seem to remain unanswered. We argue that, before attempting to provide answers, it is essential to clarify the underlying theoretical assumptions in order to arrive at the right questions one should ask. To this end, we introduce into the current debate an existing theoretical framework that helps conceptualize structural and individual aspects of health promotion interventions at different levels of action. Using an example from the field of physical activity promotion, we illustrate how an integrated framework can help researchers and health promoters rethink important issues and design better interventions. In particular, such an approach may help overcome perceived distinctions between different types of approaches, re-conceptualize ideas about the effectiveness of interventions, and appropriately address issues of health disparities.

The authors describe 10 cases of sebaceoma that manifested prominent infundibulocystic structures in all cases and, additionally, conspicuous squamous metaplasia in 6 neoplasms. All tumors occurred on the scalp or the face (2 cases lacked clinical information) and presented as a solitary lesion, measuring from 5 to 20 mm. The patients' age ranged from 22 to 89 years. The main component of all tumors was small, uniform basaloid cells (immature sebocytes) intermixed with mature sebocytes clearly arranged in nodules, classifying the lesions as a sebaceoma. In all neoplasms, the tumor cells showed organoid growth patterns of sebaceoma, including rippled, sinusoidal/labyrinthine, and carcinoid-like, occurring alone or in combination. Additionally, numerous infundibulocystic structures were readily noticed and were either distributed multifocally or unilocular within the tumors. In some cases, they were segregated from the main tumor bulk. The authors posit that these structures, which are different from both sebaceous ductal differentiation and squamous metaplasia, represent an authentic follicular differentiation. The infundibulocystic features (combined with squamous metaplasia), when prominent and in a limited biopsy specimen, may cause a confusion with trichoadenoma or even microcystic adnexal carcinoma.

Digital papillary adenocarcinoma is a rare but well characterized carcinoma of the sweat glands, which apart from very few exceptions is localized in acral skin. This type of sweat gland carcinoma tends to recur locally and may cause delayed metastases in a few cases. We describe the clinical findings and the broad histopathologic spectrum of four cases of this rare adnexal carcinoma and give a short summary of the literature.

Der Artikel fasst die Ergebnisse der Umsetzung eines evidenzbasierten Bewegungsprogramms zur Pravention von Demenz – GESTALT – in der Praxis in Bezug auf die Gewinnung schwer erreichbarer Zielgruppen, wie korperlich inaktive und sozial benachteiligte Altere, zusammen. Erfolgreich eingesetzte Strategien und Ergebnisse der Teilnehmergewinnung werden dargelegt und Empfehlungen an die Praxis abgeleitet. Recruitment of physically inactive and socially disadvantaged people (60 +) for participation in an evidence-based exercise program for the prevention of dementia

Ziele: Der vorliegende Beitrag dient der empirischen Veranschaulichung eines Konzepts des interaktiven Wissenstransfers zur nachhaltigen Implementierung von evidenzbasierten Bewegungsprogrammen in der Praxis. Hierzu werden der Ansatz, das Vorgehen und die ersten Ergebnisse eines Modellprojekts zur Demenzpravention „GESTALT“ vorgestellt sowie das Zusammenspiel von Wissenschaft, Politik und Praventionspraxis in dieser Studie erlautert. Methodik: Das Konzept des interaktiven Wissenstransfers wird im GESTALT-Projekt durch den Ansatz der kooperativen Planung, der Stakeholder aus Wissenschaft, Politik und Praxis systematisch beteiligt und befahigt, umgesetzt. Bei der Evaluation der nachhaltigen Implementation des GESTALT-Projekts (2011–2014) wurden die 3 Dimensionen Zielgruppe, Organisationen und Umwelt berucksichtigt. Zur Erfassung der Effekte bei der Zielgruppe (n=75) wurde u. a. deren Bindung an korperliche Aktivitat erhoben. In Bezug auf die Dimensionen Organisationen und Umwelt wurden die kooperativen Planungssitzungen, die Durchfuhrung des GESTALT-Programms, der Schriftverkehr sowie die Gesprache und Veranstaltungen dokumentiert und ausgewertet. Ergebnisse: In Bezug auf die Zielgruppe konnte die Mehrheit der Teilnehmenden (60%) durch das GESTALT-Programm an einen aktiven Lebensstil gebunden werden. In Bezug auf die Organisationen wurden 14 Kooperationspartner fur die kooperative Planung gewonnen. 5 Organisationen haben das GESTALT-Programm nach Adaptationen mehrfach durchgefuhrt und bieten Folgeangebote fur ehemalige Teilnehmende an. Uber in der Planungsgruppe entwickelte Partnerschaften sowie durch verstarkte Offentlichkeitsarbeit und die Gewinnung von politischen Entscheidungstragern konnten Ressourcen fur die nachhaltige Weiterfuhrung des Projekts erschlossen werden. Schlussfolgerung: Die Pilotstudie GESTALT zeigt, dass das Konzept des interaktiven Wissenstransfers wesentlich zur Sicherung der Nachhaltigkeit des GESTALT-Programms im Bereich der Demenzpravention beitrug. Dabei mussten zum einen Masnahmen zur Veranderung von lokalen Strukturen umgesetzt werden, zum anderen das Programm an die vorhandenen Strukturen der Praventionspraxis angepasst werden. Die kooperative Planung erwies sich als geeignete Grundlage zur Wissensgenerierung im Sinne einer praxisbasierten Evidenz und begunstigte die wechselseitige Adaptation von Programm und Implementationskontext.

Merkel cell carcinoma (MCC) has been reported in association with other types of cutaneous neoplasms within the same lesion, including squamous cell carcinoma, Bowen's disease, actinic keratosis, follicular cysts, trichoblastoma and lentigo maligna, among others. However, the association of MCC and sweat gland tumors has never been described in the literature. We report two unique cases of MCC that developed within cutaneous poromas. A 56-year-old male (Patient 1) and an 81-year-old female (Patient 2) presented with nodules on the upper arm and lower back, respectively. Histopathologic study of both cases revealed a tumor in the dermis composed of poroid and cuticular cells intermingled with a proliferation of small round cells that showed characteristic histopathological and immunohistochemical features of MCC. In both cases, the two neoplasms were tightly admixed and distinct, suggesting that the MCC could have developed within a previously existing poroma. No morphological features of transition between the two tumors were seen. Neoplastic cells of MCC expressed immunoreactivity for chromogranin, synaptophysin, neuron-specific enolase, CAM 5.2 and cytokeratin 20, the last two markers showing the characteristic paranuclear dot-like pattern. In contrast, the poroma cells only expressed cytokeratin MNF116. Metastatic deposits were not identified in the regional lymph nodes or distantly.

Objectives This paper presents a typology of available evidence to inform physical activity policy. It aims to refine the distinction between three types of evidence relating to physical activity and to compare these types for the purpose of clarifying potential research gaps. Methods A scoping review explored the extent, range and nature of three types of physical activity-related evidence available in reviews: (I) health outcomes/risk factors, (II) interventions and (III) policy-making. A six-step qualitative, iterative process with expert consultation guided data coding and analysis in EPPI Reviewer 4. Results 856 Type I reviews, 350 Type II reviews and 40 Type III reviews were identified. Type I reviews heavily focused on obesity issues (18 %). Reviews of a systematic nature were more prominent in the Type II (>50 %). Type III reviews tended to conflate research about policy intervention effectiveness and research about policymaking processes. The majority of reviews came from the United States, United Kingdom, Australia and Canada. Conclusions Although evidence gaps exist regarding evidence Types I and II, the most prominent gap regards Type III, i.e. research pertaining to physical activity policymaking. The findings presented herein will be used to inform physical activity policy development and future research. Electronic supplementary material The online version of this article (doi:10.1007/s00038-016-0807-y) contains supplementary material, which is available to authorized users.

Das primar kutane kribriforme apokrine Karzinom stellt eine distinkte, jedoch wenig bekannte Variante der kutanen apokrinen Karzinome mit biologisch indolentem Verlauf dar. Es sollte nicht mit einer kutanen Metastase eines viszeralen Karzinoms, mit einem adenoid-zystischen Basalzellkarzinom oder einem primar kutanen adenoid-zystischen Karzinom verwechselt werden.

BACKGROUND Solid carcinoma is a poorly characterized malignant apocrine neoplasm as only 16 cases have been published. OBJECTIVE To characterize its clinical, histopathological, and immunohistochemical features. METHODS We compiled 14 cases of solid carcinoma and clinical information were updated. Hematoxylin and eosin slides were reviewed and we stained all the cases for CEA, EMA, SMA, PHLDA-1, BerP4, nestin, p53, p63, p75, CK5/6, CK7 and some with remaining material for CK14, 15, CK10, CK19, S100, CD117, and CAM5. RESULTS All the lesions were located on the scalp. Histopathologically, all the cases were characterized by solid aggregates of neoplastic epithelial cells without nuclear atypia or mitotic figures involving all the dermis. All the cases presented perineural infiltration and most of them had cornified cystic structures. CK5/6 and p63 were positive. CEA and EMA underlined the scarce ducts. Ki67 was lower than 1%. BerEP4 and PHLDA-1 were negative. CONCLUSION Solid carcinoma is a solid variant of MAC affecting the scalp more frequently than classic MAC, mostly in old males and showing variable-sized nests involving the entire dermis and composed by poroid, clear-cells, or a mixture of both. It is positive for p63 and CK5/6 and negative for BerEP4 and PHLDA-1. Staining features with CK19 and PHLDA1 differ from classic MAC.

Corneal endothelial dysfunction remains the most frequent indication for corneal transplantation, limited by donor material shortage, poor long-term graft survival, or allogeneic graft rejection. Therefore, tissue-engineered endothelial grafts (TEEG) represent a promising alternative to human donor tissue. In this study, we generated electro-spun scaffolds and tested these for their suitability for human corneal endothelial cell (hCEC) cultivation.The polymers poly(methyl-methacrylate) (PMMA), poly(lactic-co-glycolic acid) (PLGA), and polycaprolactone (PCL) were spun with equal parameters. HCEC-12 was cultured on the scaffolds for 3 to 7 days. Scaffolds were evaluated by light microscopy, porometry, light transmission, scanning electron microscopy (SEM), live/dead staining and cell viability assay.Electro-spun fibers from PMMA (2.99 ± 0.24 µm) showed significantly higher diameters than PCL (2.29 ± 0.11 µm; p = 0.003) and PLGA (1.84 ± 0.21 µm; p 0.001), while fibers from PCL also showed larger diameters than those from PLGA (p = 0.002). PMMA scaffolds (26.77 ± 17.48 µm) had significantly larger interstitial spaces than those from PCL (13.30 ± 5.47 µm; p = 0.04) and PLGA (10.42 ± 6.15 µm; p = 0.002), while PCL and PLGA did not differ significantly (p = 0.26). SEM analysis revealed that only PLGA fibers preserved a normal HCEC-12 morphology. PLGA and PCL did not differ in cell number, death, or viability after 7 days of HCEC-12 cultivation. PMMA showed significantly higher cytotoxicity (p 0.001; PLGA: 1626.2 ± 183.8 RLU; PMMA: 841.9 ± 92.7 RLU; PCL: 1580.2 ± 171.02 RLU).The biodegradable PLGA and PCL electro-spun scaffolds resulted in equal biocompatibility, while PMMA showed cytotoxicity. Only PLGA preserved hCEC morphology and consequently seems to be a promising candidate for TEEG construction.

Ductal carcinoma in situ (DCIS) in the mammary glands consists of a proliferation of ductal luminal cells with preserved polarity but lacking the marked intercellular cohesion of hyperplastic cells. We report two cases of DCIS arising in the apocrine glandular structures of a nevus sebaceus (NS). The first patient was a 44-year-old woman with a ductal neoplasm composed of multilayered ductal elements with a monomorphous cellularity and a polar orientation of nuclei. The neoplastic cells were positive for Cm5.2 and CK7. The second patient was a 67-year-old woman with phacomatosis pigmentokeratotica. A skin biopsy of an erythematous plaque within her NS showed an epithelioid monomorphous tumor with eosinophilic and slightly granular cytoplasm. Slight nuclear pleomorphism with some hyperchromatic nuclei was seen. The tumor cells were positive for CK7 and gross cystic disease fluid protein-15. Actin showed a preserved layer of myoepithelial cells in both cases. Our cases are noteworthy, as secondary malignancies or multiple tumors arising in NS are rare, and the presence of multiple neoplasms in phacomatosis pigmentokeratotica is even rarer. Moreover, these tumors expand the spectrum of secondary malignant neoplasms arising in NS, as they closely resemble mammary DCIS.

Aims Multiple cutaneous and uterine leiomyomatosis (MCUL) also named as hereditary leiomyomatosis and renal cancer syndrome (HLRCC) is an autosomal dominant disorder caused by heterozygotic germline mutations in fumarate hydratase (FH) with incomplete penetrance and clinically challenging to diagnose. To test immunohistochemistry for FH as a potential marker for the detection of FH-deficiency. Methods and results We have tested 42 smooth muscle neoplasms, 13 lesions of patients with suspicious or confirmed HLRCC, 20 sporadic piloleiomyomas, two angioleiomyomas and 7 leiomyosarcomas. FH staining grades from 1 to 3. Ten of the 13 lesions from the patients with HLRCC syndrome showed negative FH staining. Most sporadic piloleiomyomas presented grade 3 FH staining although five cases presented grade 1 FH staining. Sensitivity of FH staining in our series is 83.3% but specificity is 75%. Conclusions This staining could indicate a high risk of HLRCC in most of the confirmed cases but it could also suggest the presence of a syndrome in up to 25% of sporadic cases. HLRCC syndrome should be rule out in FH negative piloleiomyomas after complete anamnesis if multiple lesions or positive familiar history is found.

CHILD syndrome is an acronym signifying congenital hemidysplasia with ichthyosiform nevus and limb defects. A 27-year-old woman presented with chronic verrucous and hyperkeratotic skin lesions involving the left genital area, left hand and left foot since childhood. The histopathologic findings were consistent with verruciform xanthoma. In correlation with the clinical picture of a linear lesion, the diagnosis of CHILD nevus was made. Subsequent genetic analysis identified a germline c.324C>T (p.A105V) NSDHL mutation and confirmed a diagnosis of CHILD syndrome. This syndrome can be associated with only minimal clinical symptoms. The anatomical distribution of the lesions, a static clinical course and the typical histopathologic features of a CHILD nevus can serve as the clue to a diagnosis of CHILD syndrome in such cases.

Hautadnextumoren mit einer Haarfollikeldifferenzierung umfassen eine klinisch-pathologisch heterogene Gruppe, die entsprechend der verwirklichten zytologischen Differenzierung klassifiziert wird. Aufgrund des komplexen Aufbaus des nichtneoplastischen Haarfollikels konnen in einem gegebenen Neoplasma auch verschiedene Differenzierungen vorhanden sein und es gibt zweifelsohne klinisch-pathologische Uberlappungen zwischen den etablierten Entitaten. Der Einsatz immunhistologischer Verfahren hat bei der Diagnosefindung dieser Tumoren eine nur eingeschrankte Bedeutung.

This review of the literature on palmoplantar hypokeratosis, a process that was first indentified only 10 years ago, discusses the current state of our understanding, the therapeutic options available, and the debate about etiology. Forty-four publications reporting 69 cases were found. Palmar or plantar hypokeratosis occurs mainly in women (76.8%) and age at the time of a first visit to a physician ranges from 42 to 84 years. Most cases present between the ages of 51 and 70 years. The majority of patients have had solitary lesions usually located on the right palm, particularly in the regions of the thenar (in 44/79 lesions [55.7%]) or hypothenar eminences (in 11/79 lesions [13.9%]). In only 8 cases was there a history of prior trauma at the site. Studies using polymerase chain reaction techniques to identify human papillomavirus involvement were negative in most cases. These hypokeratotic lesions are localized epidermal depressions formed by an abrupt thinning of the stratum corneum, providing a singular histopathologic feature. This condition can currently be considered a localized keratinization disorder affecting zones where there is a thick stratum corneum. The precipitating cause is unknown and a definitive treatment remains to be found. The mechanism would be the localized failure of a clone of keratinocytes during differentiation toward normal palmoplantar hyperkeratinization.

Galli Galli disease (GGD) is the name given to a rare form of acantholytic Dowling-Degos disease. (DDD), the latter itself being a rare condition. We believe we are describing for the first time in Indian dermatologic literature a case of GGD in a family where 25 persons have DDD and have been able to document a KRT5 mutation in four members of the family. Whereas reticulate pigmentation is a hallmark of DDD there are rare reports of mottled pigmentation with multiple asymptomatic hypopigmented macules scattered diffusely along with the pigmentation. All the cases described here show a mottled pigmentation comprising hypo and hyperpigmented asymptomatic macules. After the clinical diagnosis was made by one of the authors (SV) in India, the German authors repeated histological examination and successfully demonstrated a heterozygous nonsense mutation, c.C10T (p.Gln4X), in exon 1 of the KRT5 gene, from various centers in Munich, Bonn, Dusseldorf and Friedrichschafen in Germany.

Demenzielle Erkrankungen stellen ein globales Gesundheitsproblem dar. Aktuelle Studien zeigen, dass korperliche Aktivitat den kognitiven Abbau verlangsamen und das Auftreten von Demenz verzogern kann. Derzeit mangelt es in Deutschland an speziell zur Pravention von Demenz konzipierten evidenzbasierten Bewegungsprogrammen. Die Interventionsstudie GESTALT untersuchte, ob und inwiefern ein evidenzbasiertes Bewegungsprogramm zur Pravention demenzieller Erkrankungen in die Praxis von Praventionsanbietern implementiert werden kann. Der Schwerpunkt dieses Beitrags liegt auf dem Aspekt der Wirksamkeit des Programms bzgl. der kognitiven und physischen Leistungsfahigkeit der Teilnehmer (65–75 Jahre) sowie der Steigerung und Aufrechterhaltung der korperlichen Aktivitat. GESTALT beinhaltete ein 6-monatiges multimodales Bewegungsprogramm und eine begleitende telefonische Beratung. GESTALT wurde von den Praventionsanbietern erfolgreich implementiert und sehr gut von den Teilnehmern angenommen. 60 % der Teilnehmer (n = 75) wurden durch die Intervention an zusatzliche Bewegung gebunden. Es zeigten sich Verbesserungen der kognitiven Leistungsfahigkeit bzgl. des Kurzzeit- und Arbeitsgedachtnisses. Zum Teil wurden Teilnehmer erreicht, die nur wenige Risikofaktoren fur Demenz aufwiesen. Die erfolgreiche Implementation und Wirksamkeit des Programms sprechen fur eine Verstetigung und Disseminierung von GESTALT. Um verstarkt Personen zu gewinnen, die inaktiv sind oder eine hohere Anzahl an Risikofaktoren aufweisen, sind weitergehende Anstrengungen bzgl. der Rekrutierungsstrategien erforderlich.

A 14-year-old Swiss Warmblood gelding was presented with chronic severe polyuria, polydipsia and weight loss. At the time of admission, water intake was 240 l/day. On rectal examination, a large mass was identified in the left dorsal abdominal quadrant, which was shown to originate from the left kidney by transabdominal ultrasonographic examination. Unilateral nephrectomy via flank incision was performed under general anaesthesia. Histopathological examination of the tumour revealed a papillary renal adenocarcinoma. Successful outcome and survival was documented 13 months after surgery. Severe polyuria and polydipsia should be considered as major clinical signs for renal carcinoma in horses, which can be successfully treated with unilateral nephrectomy if no signs of metastatic spread are evident.

Oncocytomas are benign tumors most often occurring in salivary or lacrimal glands and thyroid tissue. As cutaneous oncocytoma is exceptionally rare, this tumor is uncommonly encountered by dermatopathologists. Herein, we illustrate the case of an 80-year-old man who presented with a slowly growing papule of the lower eyelid. Histopathologically, the adenomatous tumor was composed of large monomorphic cells with eosinophilic granular cytoplasm. Electron microscopy revealed abundant, enlarged and abnormally shaped mitochondria. These findings were consistent with an oncocytoma of the skin. The presented case is unique in that the thorough work-up of the tumor tissue revealed not only hyperplastic mitochondria, representing the ultrastructural correlate of the observed granular cytoplasm, but additionally disclosed functional consequences with elevated levels of reactive oxygen specimen (ROS) within the tumor. Disrupted oxygen metabolism may result from cellular aging processes and may putatively represent the underlying pathogenesis of oncocytoma.