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22. Kongenitaler Zwerchfelldefekt bei Geschwistern : Zwei Fallberichte

Author

Wolff, G., Böhm, N., Pringsheim, W., Bachmann, K. D., editor, Berger, H., editor, Bierich, J., editor, Boda, D., editor, Bremer, H.-J., editor, Brodehl, J., editor, Burgio, G. R., editor, Fischer, K., editor, Gladtke, E., editor, Hadorn, B., editor, Hagberg, B., editor, Hallman, N., editor, Hansen, H. G., editor, Harbauer, H., editor, von Harnack, G.-A., editor, Hecker, W. C., editor, Helge, H., editor, Hitzig, W. H., editor, Huth, E., editor, Kleihauer, E., editor, Künzer, W., editor, Lassrich, M. A., editor, Leiber, B., editor, Lindquist, B., editor, Marget, W., editor, Oehme, J., editor, Olbing, H., editor, Pfeiffer, R. A., editor, Prader, A., editor, Riegel, K., editor, Rossi, E., editor, Schärer, K., editor, Schmidt, E., editor, Schulte, F.-J., editor, Spiess, H., editor, Spranger, J., editor, Stalder, G., editor, Stephan, U., editor, Stoermer, J., editor, Ströder, J., editor, Teller, W., editor, Zetterström, R., editor, and Zweymüller, E., editor

Published
1980
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46. Results after surgery in undifferentiated large cell carcinoma of the lung: the role of neuroendocrine expression

Author

Böhm N, Grahmann Pr, Bansbach S, J. Hasse, W Lange, and Wertzel H

Subjects
Pulmonary and Respiratory Medicine, Pathology, medicine.medical_specialty, Lung Neoplasms, medicine.medical_treatment, Enolase, Synaptophysin, Neuroendocrine differentiation, Pneumonectomy, Postoperative Complications, Carcinoma, Non-Small-Cell Lung, medicine, Biomarkers, Tumor, Chromogranins, Humans, Survival rate, Observer Variation, biology, business.industry, Chromogranin A, General Medicine, Immunohistochemistry, Surgery, Survival Rate, Chemotherapy, Adjuvant, Phosphopyruvate Hydratase, biology.protein, Radiotherapy, Adjuvant, Segmental resection, Cardiology and Cardiovascular Medicine, business, Wedge resection (lung)
Abstract

Objective: The objective of this study was to define the incidence of light microscopically undifferentiated large cell carcinomas, to analyze tumor stages, types of resections necessary and postsurgical survival. Additionally we tried to evaluate whether or not neuroendocrine expression influences the biological behavior of these tumors. Methods: Light microscopic specimens of 105 patients having undergone surgery for undifferentiated large cell carcinoma were reviewed following the 1981 WHO criteria. Fifty eight cases were excluded because elements of adeno- or squamous cell carcinoma, neuroendocrine or combined patterns of histological differentiation were observed. The remaining 47 cases of pure undifferentiated large cell carcinoma were evaluated immunohistochemically for neuroendocrine differentiation using a combination of the markers neuron specific enolase, synaptophysin and chromogranin A. The hospital charts of the patients were analyzed retrospectively recording tumor stage, operative procedure, postoperative complications, postoperative adjuvant treatment procedures, actual tumor state and survival time. Results: Thirteen patients (27.7%) had postsurgical tumor stage I, 5 (10.6%) stage II, 15 (31.9%) stage IIIA, 9 (19.1%) stage IIIB, and 5 (10.6%) stage IV. In 46 of 47 patients resections of lung parenchyma were performed (wedge resection n 5, segmental resection n1, lobectomy n27, bilobectomy n3, pneumonectomy n 10), in 6 patients combined with broncho- and:or angioplastic procedures. At the time of chart review 20 (42.5%) patients were still alive. The cause of death in the remaining patients was recurrent lung cancer in the majority of cases (24 or 92.3%). The overall mean survival of the 46 patients undergoing parenchymal resections was 19 months, the 3-year survival rate 31.7%. The immunohistochemical examination demonstrated expression of neuron specific enolase in 15 cases. Synaptophysin and chromogranin A were not detected in any case. For these 15 patients the mean survival was 25.6 months (94.3) and the 1-year survival rate 67% (confidence interval 43‐91%) compared to 13.8 (92.1) months and 33.5% (confidence interval 15.3‐51.7%) in the remainder. The difference was not significant (P 0.06). Conclusions: The light microscopic diagnosis of undifferentiated large cell carcinoma revealed to be subject to considerable interobserver variability. Undifferentiated large cell carcinoma takes a more unfavorable clinical course than other non-small cell carcinomas. Despite lack of statistical significance, expression of neuron specific enolase appeared to be associated with less aggressive biological behavior of the respective neoplasms. Immunohistochemical evaluation of undifferentiated large cell carcinomas using a combination of neuron specific enolase, chromogranin A, and synaptophysin did not provide more therapeutically relevant information than that obtained by light microscopic assessment. © 1997 Elsevier Science B.V.

Published
1998

47. Konzept für eine klinisch orientierte Autopsie von Feten unter Nutzung informationstechnischer Methoden

Author

Kayser, K., Böhm, N., Tennstedt, Cornelia, Kayser, K., Böhm, N., and Tennstedt, Cornelia

Abstract

Aufgrund der rasanten technischen Entwicklung im Bereich der pränatalen Diagnostik in den letzten Jahren werden mehr angeborene Fehlbildungen zu einem früheren Zeitpunkt der Schwangerschaft und detaillierter erkannt. Das führt dazu, dass die zur Autopsie gelangenden Feten zunehmend kleiner sind und komplexere Befunde aufweisen. Gleichzeitig werden die genetischen Ursachen von mehr Erkrankungen, Fehlbildungen und Syndromen aufgedeckt, so dass die DNA-Diagnostik, Chromosomenanlyse u.a. molekulargenetische und biochemische Erkenntnisse die klinisch-genetische Diagnostik zunehmend ergänzen. Durch Festlegung einer gezielten Autopsiestrategie und Nutzung moderner Kommunikationsmittel kann der Pathologe die in den letzten Jahren gestiegenen klinischen Anforderungen erfüllen. Ein Problem ist es jedoch, dass nicht genügend Pathologen auf dem Gebiet der Fetalpathologie spezialisiert sind. Das trifft nicht nur für Deutschland zu, sondern das ist mehr oder weniger eine weltweite Situation. Ein möglicher Lösungsansatz dieses Problems wäre die Nutzung von Softwareprogrammen, die dazu dienen, unerfahrene Pathologen moderne Anleitungen während der Autopsie von Feten zu geben. Das kann mit einer telepathologischen Betreung durch einen Experten auf diesem Gebiet kombiniert werden. Darüberhinaus erlaubt die derzeitige digitalisierte Befunddokumentation den Vergleich aktueller mit gespeicherten Fällen sowie Recherchen und stellt eine gute Basis zur Erstellung von Lehrmaterial dar., Due to the enormous technical developments in recent years in the area of prenatal ultrasound more malformations are detected in greater detail and at an earlier point in time during pregnancy than in the past. As a result, fetuses of increasingly smaller size and with complex diagnoses are presented for autopsy. At the same time, the genetic causes of ever more diseases, malformations and syndromes are being discovered, so that DNA diagnostics, chromosome analysis and, among others, molecular-genetic and biochemical investigations have come increasingly to complement clinical-genetic diagnostics. Through establishment of a clinically oriented autopsy strategy and the use of modern communication media, pathologists can satisfy the increased clinical demands of recent years. The remaining problem is that we do not have enough pathologists experienced in fetal pathology. This is not only true for Germany, it is more less the situation worldwide. One means of dealing with this problem may be the use of software programs to guide inexperienced pathologists through the modern autopsy procedure. This can be combined with the use of telepathological advise given by an expert in the field. Over and above this, digitized documentation of findings can be used in research, which allows the comparison of current with previously saved cases and presents a good basis for the development of education material.

Published
2002

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