Immunohistochemical reclassification of anaplastic carcinoma reveals small and giant cell lymphoma

Thirty-one cases of thyroid malignancies which were originally classified as anaplastic carcinoma were reexamined immunohistochemically using PAP methods (peroxidase:antiperoxidase) for IgM, IgG, IgA, cytoceratin, calcitonin, lysozyme and alpha-1-antitrypsin. The reclassification results were compared with patient data such as clinical symptoms, treatment modalities, and clinical outcome. Postoperative radiotherapy was carried out in more than 80% of cases, chemotherapy in none. Seven of 31 tumors showed a positive staining for IgM (n=4), IgG (n=2), and IgA (n=1) antibodies. All of these cases were negative for epithelial markers. Surprisingly, not only all small cell tumors (n=3) but also 4 tissues with predominantly giant cell areas were among those reclassified as primary malignant lymphoma.

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Resumen Treinta y un casos de neoplasias malignas de la glándula tiroides originalmente clasificadas como carcinoma anaplásico fueron reexaminados por inmunohistoquímica utilizando métodos de peroxidosa:antiperoxidasa (PAP) para IgM, IgG, IgA, citoceratina, calcitonina, lisocina, y alfa-1-antitripsina. Los resultados de la reclasificación fueron comparados con la información clínica, incluyendo sintomatología, modalidades de tratamiento, y evolución final. Se realizó radioterapia postoperatoria en más de 80% de los casos, quimioterapia en ninguno. Siete de 31 tumores exhibieron tinción positiva para anticuerpos IgM (n=4), IgG (n=2), e IgA (n=1). Todos estos casos fueron negativos para marcadores epiteliales. Sorprendentemente, no sólo la totalidad de los tumores de células pequeñas (n=3) sino también 4 tejidos con áreas predominantes de células gigantes, estuvieron en el grupo de aquellos reclasificados como linfoma maligno.

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Résumé Trente et un cas de tumeurs malignes de la thyroïde, classifiés à l'origine comme des carcinomes anaplasiques, ont été réexaminés en immunohistochimie pour la présence d'anticorps IgM, IgG, IgA, de cytocératine, calcitonine, lysocyme, et alpha1-antitrypsine en utilisant la méthode péroxydase/antipéroxydase. Les résultats de cette reclassification ont été comparés avec des données cliniques: symptômes cliniques, modalités thérapeutiques, et évolution clinique. On a employé la radiothérapie postopératoire dans 80% des cas et la chimiothérapie dans aucun cas. Sept des 31 tumeurs étaient positives pour les anticorps IgM (n=4), IgG (n=2), et IgA (n=1). Dans tous ces cas, les marqueurs épithéliaux étaient négatifs. De cette manière, on a pu reclasser comme lymphomes malins primitifs non seulement 3 tumeurs à petites cellules mais aussi 4 tumeurs avec des zones de cellules géantes.

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Presented at the International Association of Endocrine Surgeons in Toronto, Ontario, Canada, September, 1989.     

Duodenocavale Fistel: Eine seltene Ursache einer oberen gastrointestinalen Blutung

Zusammenfassung. Nichttraumatische duodenocavale Fisteln sind eine sehr seltene Ursache gastrointestinaler Blutungen und werden deshalb h?ufig verkannt, obwohl die Kombination aus Blutung und Fieber dafür charakteristisch ist. Die duodenocavalen Verbindungen entstehen aus atypischen peptischen Geschwüren oder radiogenen Ulcera. Prognostisch entscheidend ist die rasche Planung der Operation, noch vor einer letal endenden Massivblutung. Nur die Aufhebung der duodenocavalen Verbindung und übern?hung des Cavadefekts kann den Patienten retten. Wir stellen den siebten Fall der Literatur mit duodenocavaler Fistel als Sp?tnebenwirkung nach percutaner Strahlentherapie vor. Der Patient entwickelte 10 Jahre nach Nephrektomie rechts und Nachbestrahlung mit 60 Gy rezidivierende obere gastrointestinale Blutungen und Fieber. Er überlebte durch partielle Duodenopankreatektomie nach Kausch-Whipple im Blutungsintervall.      

306. Martin Kirschner zum 100. Geburtstag

Zusammenfassung Vergleichende licht-, elektronenmikroskopische und funktionelle in vitro-Untersuchungen an Normal-, Colitis ulcerosa- und Divertikel-Därmen zeigen, daß der Längsmuskulatur (Taenien) des Divertikeldarms pathogenetisch eine zentrale Rolle zukommt. Die Ergebnisse legen nahe, der Längsmuskulatur im chirurgischen Therapiekonzept bei der Divertikelerkrankung eine erhöhte Aufmerksamkeit zu widmen -mit der Konsequenz, die Taenien quer zu spalten. Der Wert der Taeniomyotomie wird in einer prospektiven Studie belegt. Hierin eingeschlossen sind klinische Daten, Röntgen- sowie funktionelle in vivo-Untersuchungen.     

Ergebnisse einer langdauernden und hochdosierten ACTH-Behandlung der rheumatischen Karditis im Kindesalter

Ohne Zusammenfassung     

Rhesus monkey alpha7 nicotinic acetylcholine receptors: comparisons to human alpha7 receptors expressed in Xenopus oocytes

An alpha7 nicotinic acetylcholine receptor sequence was cloned from Rhesus monkey (Macaca mulatta). This clone differs from the mature human alpha7 nicotinic acetylcholine receptor in only four amino acids, two of which are in the extracellular domain. The monkey alpha7 nicotinic receptor was characterized in regard to its functional responses to acetylcholine, choline, cytisine, and the experimental alpha7-selective agonists 4OH-GTS-21, TC-1698, and AR-R17779. For all of these agonists, the EC(50) for activation of monkey receptors was uniformly higher than for human receptors. In contrast, the potencies of mecamylamine and MLA for inhibiting monkey and human alpha7 were comparable. Acetylcholine and 4OH-GTS-21 were used to probe the significance of the single point differences in the extracellular domain. Mutants with the two different amino acids in the extracellular domain of the monkey receptor changed to the corresponding sequence of the human receptor had responses to these agonists that were not significantly different in EC(50) from wild-type human alpha7 nicotinic receptors. Monkey alpha7 nicotinic receptors have a serine at residue 171, while the human receptors have an asparagine at this site. Monkey S171N mutants were more like human alpha7 nicotinic receptors, while mutations at the other site (K186R) had relatively little effect. These experiments point toward the basic utility of the monkey receptor as a model for the human alpha7 nicotinic receptor, albeit with the caveat that these receptors will vary in their agonist concentration dependency. They also point to the potential importance of a newly identified sequence element for modeling the specific amino acids involved with receptor activation.     

Inflamed pouch mucosa possesses altered tight junctions indicating recurrence of inflammatory bowel disease

Background and aims  

The etiology of pouchitis after coloproctomucosectomy with ileal pouch-anal anastomosis in patients with ulcerative colitis is still unknown. Beside changes in luminal antigens, the immunological predisposition is assumed to be responsible. In previous electrophysiological studies, we showed that mucosal barrier and transport function in pouchitis is markedly reduced. Thus, the aim of the present study was to analyze barrier function on the molecular level.     

Mentoring: A Key Strategy to Prepare the Next Generation of Physicians to Care for an Aging America

Mentoring is an important instructional strategy that should be maximally used to develop the next generation of physicians who will care for a growing population of frail older adults. Mentoring can fulfill three specific purposes: (1) help learners choose an area of specialty, (2) help fellows and new faculty navigate advancement in the academic environment, and (3) help new physicians enter a local medical community and develop a high-quality, professionally rewarding, financially viable practice that meets the needs of older adults. The components and process of mentoring are reviewed. Current and potential mechanisms to promote mentoring for the specific purpose of increasing the quality and quantity of physicians available to care for the older adult population are discussed.