Biomechanical analysis and clinical treatment of blunt renal trauma

Moesin, one of the ERM (ezrin; radixin; moesin) family members, is directly associated with the cytoplasmic domain of CD44, which is now thought to be related to the metastatic potential of tumor cells. Using immunohistochemistry we investigated the expression of moesin in normal epidermis and various kinds of epithelial skin tumors: squamous cell carcinoma, verrucous carcinoma, Bowen's disease, solar keratosis, keratoacanthoma, basal cell carcinoma, and extramammary Paget's disease. Normal skin showed positive epidermal staining for moesin with the exception of the stratum corneum. The expression of moesin varied with the type of skin tumor. In basal cell carcinoma, Bowen's disease, and extramammary Paget's disease, moesin expression was either faint or negative. In contrast to Bowen's disease, invasive squamous cell carcinoma showed more intense and heterogeneous staining of the cytoplasm and the cell membrane. Verrucous carcinoma was weakly positive, with a tendency for the moesin to be distributed in the cell membrane. The staining pattern of moesin varied among the different kinds of epithelial skin tumors, and its expression was generally similar to that of the standard form of CD44. These results suggest that moesin is closely inter-related with CD44 in epithelial skin cells as seen in other cellular systems, and that the variable pattern of moesin staining among the skin tumor cells could reflect expression disorders associated with the transformation.     

Multicentric giant cell tumor of bone

Giant cell tumor of bone accounts for 4% to 5% of primary bone tumors in the United States. Multicentric giant cell tumors occur in < 1% of all patients with giant cell tumors, and only 43 patients with multicentric giant cell tumor have been reported on in the literature. This series presents 3 additional cases of multicentric giant cell tumor, includes updated data for 2 patients previously reported on in the literature, and reviews 24 cases previously reported on in detail in the literature. The mechanism by which giant cell tumor involves multiple locations is not known. Multicentric giant cell tumor, in contrast to unifocal giant cell tumor, has a tendency to involve the hands, feet, and metaphysis/diaphysis of long bones and to occur in a slightly younger population. In 15 of the 29 patients reviewed, a second lesion did not develop for > 2 years after their initial presentation. Eighteen of those 29 patients had > 2 sites of tumor involvement, 1 of whom had 11 lesions. Two of the 5 patients in the authors' series presented with a spectrum of disease activity, with latent, active, and aggressive lesions present throughout the observation period.     

TC findings in a case of Castleman''s disease with subclavian localization

An 85-year-old Japanese woman had noticed erythema on her vulvar region 3 years before. The erythema gradually increased in size and followed erosion and ulceration with pigmentation on the edge of the erythema. A skin biopsy from the pigmented area showed large round cells with ample cytoplasm, which formed nests or glandular structures. In the dermis there was mass formation of basophilic cells and peripheral cells in a palisade arrangement. The tumor cells in the epidermis showed positive immunoreactivity for carcinoembryonic antigen; on the other hand, the dermal tumor was negative. We diagnosed that the tumor in the epidermis was vulvar Paget's disease, and the dermal tumor was a solid type of basal cell carcinoma. We speculate that the vulvar Paget's disease preceded and then the basal cell carcinoma developed in the area of Paget's disease. This is the first report in which basal cell carcinoma in the area of Paget's disease was documented.     

Dose-related vestibular and cochlear effects of transtympanic gentamicin

Perianal Paget's disease is rare, and its relationship to an associated internal regional cancer has been ill defined. We analyzed the histologic and immunohistochemical features of perianal Paget's disease in 11 patients to determine the frequency and relationship of associated regional internal carcinoma and to gain insight into its histogenesis. Of five patients with documented rectal adenocarcinoma, it was discovered synchronously with the Paget's disease in four and, subsequently, in one. Paget's cells of signet ring type predominated in four cases. Intraepithelial glands with intraluminal dirty necrosis were present in four cases. The immunophenotype in four cases studied was cytokeratin (CK)7+/CK20+/gross cystic disease fluid protein- (GCDFP) in both the intraepithelial Paget's cells and the invasive rectal adenocarcinoma. Six patients did not have documented rectal carcinoma. The Paget's cells in four were CK7+/CK20-/GCDFP15+. Three of these had purely intraepithelial Paget's disease, and invasive or metastatic disease developed in none after wide local excision. Bilateral inguinal lymph node metastases developed in the fourth patient, and the patient died 8 months after diagnosis of Paget's disease. In two patients, the Paget's cells were CK7+/CK20+/GCDFP15-. Recurrent intraepithelial perianal Paget's disease developed in one patient at 7 months; the patient was alive without disease at 24 months, and the other patient had several intraepithelial recurrences of perianal Paget's disease, and, subsequently, a large perianal tumor of uncertain cell type developed at 108 months, which led to the patient's death. We conclude that there are two types of perianal Paget's disease. One type has endodermal differentiation with gastrointestinal-type glands containing intraluminal dirty necrosis, numerous signet ring cells, CK20 positivity, and GCDFP15 negativity. Such cases are especially likely to be associated with synchronous or metachronous rectal adenocarcinoma. The other type is a primary cutaneous intraepithelial neoplasm in which the Paget's cells display sweat gland differentiation, including GCDFP15 positivity; it generally lacks gastrointestinal-type glands, intraluminal dirty necrosis, and CK20 positivity. The CK7 is a sensitive, albeit nonspecific, marker for Paget's cells.     

Positron emission tomography (PET) methodology for small animals and its application in radiopharmaceutical preclinical investigation

Among the more uncommon tumors that may sometimes be encountered in the laryngeal region is the recently described giant cell tumor of the larynx. This lesion is a true neoplasm, presumably of the fibrohistiocytic series. Histologically, it closely resembles the more familiar true giant cell tumor of long bone. The laryngeal giant cell tumors appear, to date, to be nonmetastasizing lesions; it is possible that they may recur locally if incompletely excised (although this remains to be demonstrated). In view of the rarity of these tumors, a tentative diagnosis of such a neoplasm should always prompt consideration of other (more frequently encountered) differential diagnostic possibilities, including cytologically malignant giant cell-rich tumors such as malignant fibrous histiocytoma and sarcomatoid carcinoma.     

Genital Paget's disease with clear cells in the epidermis of the axilla

We report an 84-year-old man with extramammary Paget's disease (EMPD) involving the genital region. Microscopic examination revealed very few clear cells appearing pagetoid in the lower portion of prickle cell layer of the right axilla epidermis, with no clinically detectable eruption. Their histochemical, immunohistochemical and lectin-binding reactions were almost identical to those in the genital lesion. However, although the axillary lesion was diagnosed as subclinical Paget's condition, the clinical course showed no aggressive or destructive nature. Our case suggests that not all subclinical Paget's conditions become malignant, and that in some cases the clear cells may be precursors of Paget's cells developing multifocally.     

Morphometric investigations on bone giant cell tumors

The authors have studied 12 cases of bone giant cell tumors and have shown that the increase in aggressiveness is accompanied by higher values of mitotic activity and nuclear features (area, perimeter, long and short axes), which might be useful for grading the bone giant cell tumors.     

The Paget's disease--a gerontological study (author's transl)

Authors found Paget's disease in cases among 1500 patients who considered themselves as healthy. They established their diagnosis on the basis of radiological and laboratory examinations. The incidence rate of Paget's disease was 0,7%, however it must be more frequent in the old groups. The familiar incidence of this illness is not frequent, thus it is rather intriguing that three persons i.e., 2 sisters and 1 brother is one family were found to have Paget's disease showing similar clinical and radiological symptoms. After three years the comparative examinations of two returning aged women showed a progress of Paget's disease. This manifested in exacerbation of osteopathy and increased the activity of the serum-alkaline-phosphatase. The cases of Paget's disease were reported by the authors because of the radiological interest, familiar incidence and the gerontological-geriatrical aspects.     

Giant-cell tumor in soft parts in a patient with osseous Paget's disease: diagnosis by fine-needle aspiration

In this report, the cytological features and differential diagnosis of a case of giant-cell tumor (GCT) in soft tissues in a patient with osseous Paget's disease (PD) are described, with histological confirmation. Characteristic cytological findings include a diffuse cellular population of neoplastic cells composed of two types: one group of polygonal or round mononuclear small cells, exhibiting a thin-rim, dense cytoplasm and single hyperchromatic nuclei; and the second group of multinucleated, osteoclast-type giant cells with dozens of round nuclei, showing occasional micronucleoli. A prominent feature is the presence of numerous capillary structures surrounded by tumor cells. The differential diagnosis includes a number of other neoplastic and reactive processes in which giant cells may be abundant. The cytological features of GCT appear to be characteristic enough to allow a suggestive diagnosis. However, the final diagnosis should be made only after the lesion has been studied histologically.     

Osteolytic form of Paget's disease. Differential diagnosis and pathogenesis

Of fourteen patients with Paget's disease for whom adequate roentgenograms and pathological material were available, six had lesions showing significant or predominant osteolysis. Based on a study of these six patients and a review of the literature, the following mechanisms were identified as causes of the so-called osteolytic type of the disease: (1) an "early" destructive Paget's lesion; (2) "advanced" Paget's disease with secondary degenerative changes; (3) "seeding" of an independent osteolytic lesion, particularly tumor in pre-existing Paget's disease; (4) sarcomatous transformation; and (5) immobilization after fracture. An osteolytic lesion in a patient without other bone disease may be due to Paget's disease, while an associated lytic lesion may be the result of a variety of conditions. Accurate pathological diagnosis is essential.     

Paget's disease and sensori-neural deafness: temporal bone histopathology of Paget's disease

Four cases with Paget's disease of the temporal bone are presented to illustrate the pathogenesis of the associated deafness. One case illustrates the combination of severe deafness due to bilateral otosclerosis with probably asymptomatic bilateral Paget's disease. One case with advanced Paget's disease presents features to explain early stages of sensori-neural deafness before actual cellular invasion of the inner ear. One case of profound deafness due to Paget's disease presents a different stage of cellular invasion of the inner ear by the disease on each side. One case illustrates invasion of the internal auditory meatus by Paget's disease with infiltration of the acoustic division of the nerve and profound deafness.     

New studies and considerations on the pathology of the primate skull. A contribution to the "Gundu" problem

The problem of 'Gundu' in primates is discussed. Cases of so-called 'Gundu' in the literature, two cases in Gorilla and one in Lagothrix, are dealt with. Histological and X-ray techniques are used. One case (Lagothrix) represents the so-called simian bone disease, which is metabolic disorder and is due to a secondary nutritional hyperparathyroidism. The other two cases (Gorilla) show symmetrical bony tumors of the maxilla. The origin is uncertain. Gundu, Paget's disease and primary hyperparathyroidism Recklinghausen have not been observed in primates so far.     

Osteitis deformans (Paget's disease) and calcific disease of the heart valves

The prevalence of calcific aortic valve stenosis in Paget's disease (osteitis deformans) was investigated by reviewing autopsy data of severe cases (> or = 75% involvement of > or = 3 major bones, the femur, tibia, skull, and pelvis) and moderate cases (> or = 75% involvement of only 1 or 2 major bones) of Paget's disease. Comparisons were made with normal age-matched controls. Aortic stenosis (AS) was present in 24% of 27 autopsies of severe Paget's disease compared with 3.5% in 201 controls (p <0.01). Clinical signs of AS were present in 39% of 102 patients with severe Paget's disease compared with 4% in 417 controls (p <0.101). The prevalence of AS in 18 cases of moderate Paget's disease was similar to that of controls. Electrocardiograms were reviewed in 45 cases of Paget's disease and compared with 80 controls of similar age. Complete atrioventricular (AV) block, incomplete AV block, bundle branch block, and left ventricular hypertrophy were present in 11%, 11%, 20%, and 13% of the Paget's cases and in only 2.5%, 1.3%, 2.5%, and 3.8% in the control cases (p <0.05, <0.05, <0.01, and <0.05, respectively). It is concluded that in severe Paget's disease there is a high prevalence of AS, heart block, and bundle branch block, but these are not present in moderate degrees of bone involvement.     

多中心骨巨细胞瘤9例报道与文献分析

Objective: The aim of this study was to investigate the clinical, radiographic and histiopathologic features of multicentric giant cell tumor of bone. Methods: All the clinical data of twenty tumors in nine patients of multicentric giant cell tumor that underwent surgical treatment in our department from 1990 to 2010 were retrospectively reviewed, which included three males and six females. The patients ranged from 15 to 45 years at diagnosis, with an average age of 22.3 years. Three of the patients were younger than twenty years of age. Most tumors arose in long bones, especially around the knee. Radiographically, the tumors in long bones usually manifested as expansive lytic lesions involving the metaphysis and extending into the epiphysis. Three tumors in three patients were confined to the metaphysis, and one tumor exhibited bone-forming lesions. All tumors were treated with curettage or resection. Results: The typical "giant cell" could be found in the oncologic examination in all cases. In some areas, such as the fibrohistiocytic regions, reactive bone forming and aneurysmal bone cyst-like changes could be found. Follow-up averaged 3.5 years, ranging from 6 months to 12 years. There was a recurrence of three tumors, and one patient died of pulmonary metastasis. Conclusion: Multicentric giant cell tumor occur often in younger patients than do solitary giant cell tumor. They are frequently present around the knee, and confined to the metaphysis. Each tumor arose independently, rather than being in multiple sites of metastatic lesion that develop from a single tumor. The risk of recurrence depends on the type of surgery that is performed.     

Effect of mental and physical stress on intraocular pressure--a pilot study]

PURPOSE: Malignant tumors at the proximal humerus are an operative challenge. Radical removal is a principal of tumor surgery but as much functionality as possible should be retained. These conditions often conflict so a compromise has to be reached. This paper proposes a solution to this dilemma, introducing an operative approach, with a new modular prosthesis, to a secondary Paget's osteosarcoma in the proximal humerus. METHODS AND RESULTS: A recently developed humerus modular prosthesis is described, which has been implanted into a patient with Paget's osteosarcoma. In these, mostly elderly, patients, successful operative therapy should combine radical removal with early mobilization. Paget's osteosarcoma is a recognized complication of the disease, and its prognosis is poor. In our patient, the implanted humerus prosthesis allowed a limb-saving procedure to be combined with radical removal of the tumor and postoperative early mobilization. A 3-month follow-up yielded good results with no recurrence of the disease and the patient had satisfactory movement. She was able to resume normal daily life shortly after the operation. CONCLUSION: Implantation of a modular prosthesis of the humerus may allow radical removal of a malignant tumor in that area while achieving early motion. In the literature, amputation is often advocated, as radical treatment with chemotherapy is not a successful option in this elderly patient group. We think the alternative use of a modular prosthesis of the humerus is possible in selected cases. We have encountered no other case in the literature where a limb-saving procedure attempts to preserve as much functionality as possible in Paget's osteosarcoma.     

Multicentric giant cell tumor of bone--a case report and comprehensive review of literature

Multicentric giant cell tumor of bone is a very rare occurrence, forming less than 1% of all giant cell tumors. A new case report is presented, along with a comprehensive review of the literature.     

The osteoclast: review of ultrastructure, origin, and structure-function relationship

Multinucleated cells of the giant cell tumor and the genuine osteoclasts exhibit a number of common morphological characteristics and may or may not originate from similar progenitor cells. Judging from the present preliminary results, it is obvious that the differentiation of the plasma membrane into a specialized area, the ruffled border, is not as conspicuous in the giant cell as in the osteoclast. A series of interrelated investigations including histochemical methods at the ultrastructural level applied both in giant cell tissue and cultured giant tumor cells are in progress. These studies may further elucidate the possible relationship between the osteoclast and the multinucleated giant cell tumor as well as the possible relationships between giant cells and other cell types of tumors.     

Perianal Paget''s disease years after rectal adenocarcinoma removal

BACKGROUND: Perianal Paget's disease often coincides with anorectal carcinoma, which extends into the epidermis from a contiguous organ. OBJECTIVE: Our purpose was to present a patient with perianal Paget's disease who had a rectal adenocarcinoma excised 14 years previously in another hospital and to determine whether there is a relationship between the perianal Paget's disease and the rectal adenocarcinoma. METHODS: We examined the resected specimens of the rectal adenocarcinoma and the perianal Paget's disease histologically. RESULTS: In the resected specimen of the rectal adenocarcinoma, Paget cells were present within the anal epidermis adjacent to the rectal adenocarcinoma. The Paget cells showed the same histochemical and immunohistological findings as the adenocarcinoma cells. CONCLUSION: There was a close relationship between the perianal Paget's disease and the rectal adenocarcinoma. It is probable that the Paget cells were derived from direct spread from the rectal adenocarcinoma.     

Prospective study on the influence of gastroduodenal ulcer hemorrhage on the diagnostic methods in Helicobacter pylori infection]

Peripheral giant cell granuloma consists of mononuclear cells and osteoclast-like giant cells. The proliferative ability of peripheral giant cell granuloma is restricted to the mononuclear cell compartment, whereas multinucleated giant cells lack mitotic activity. Although the proliferative compartment of peripheral giant cell granuloma has been investigated in detail, the expression and distribution of proteins regulating apoptosis is unknown. The present study demonstrates strong expression of bak and bax in the majority of giant cells. In contrast, giant cells show only weak positivity for bcl-2 and moderate positivity for bcl-x. Mononuclear cells were negative to weakly positive for bcl-x. Only scattered mononuclear cells were positive for bak, bax and bcl-2. The frequency of apoptotic nuclei detected by TUNEL-staining compared to regular nuclei was 18 times higher in giant cells than in mononuclear cells. In summary, our findings support the presumption that giant cells of bone and soft tissue tumors are reactive cell forms and not of neoplastic origin.     

Primary tumors of the thoracic skeleton

From 1975 to 1990, eighty-nine primary tumors of the thoracic skeleton; ribs, sternum, scapula, clavicle, and thoracic spine, were treated. Forty-four tumors (49%) were benign lesions. Forty-five tumors were malignant and were proportionately distributed amongst the five sites. The most common malignancies were Ewing's sarcomas, chondrosarcomas, plasmacytomas, osteogenic sarcomas, and lymphomas. All patients with Ewing's sarcomas were treated with combination chemotherapy, surgical resection, and radiation therapy for those with residual disease after surgery. Only one patient has died of disease. Patients with primary chondrosarcomas were treated by surgery alone and all are free of disease or have died without disease. Patients with solitary plasmacytomas or primary lymphomas of bone were treated with radiation therapy initially. Half the patients developed systemic disease. The patients with osteogenic sarcomas included several with radiation induced lesions and Paget's osteosarcoma and all but one died of disease.