Prognostic value of MMP-2, -9 and TIMP-1,-2 immunoreactive protein at the invasive front in advanced head and neck squamous cell carcinomas

In head and neck cancer as well as in other carcinomas, tumor expansion and spread to distant sites require the secretion of destructive enzymes that degrade the extracellular matrix. A variety of proteases contribute to matrix destruction. Characteristics of the invasive tumor front may reflect tumor prognosis better than do other parts of the tumor. Therefore, it was the aim of the present study to (i) compare central and peripheral tumor zones for differences in the expression of matrix-metalloproteinases (MMP) -2 and -9 and their naturally occurring inhibitors (tissue inhibitor of matrix-metalloproteinases (TIMP) -1 and -2), (ii) examine the morphological potential of malignancy, and (iii) correlate these findings with clinicopathological parameters. The study population consisted of 106 surgical specimens of advanced head and neck squamous cell carcinomas. The invasive front was graded for malignancy, and immunohistochemical staining with MMP-2, MMP-9, TIMP-1 and TIMP-2 antibodies was performed. Both MMP-2 and MMP-9 were found to be significantly overexpressed at the tumor front. The MMP-2-positive invasive front exhibited diminished overall survival times. In multivariate analysis, MMP-2 expression retained its correlation with overall survival in addition to nodal status and total malignancy score. Expression of TIMP-2 correlated with local tumor invasion. We conclude that the expression of MMP-2 at the invasive front is a marker of poor survival and appears to be associated with early recurrence in initially lymph node-negative patients.     

Primary sarcoma of the inferior vena cava: review of diagnosis, treatment, and outcomes in a case series

Leiomyosarcoma of the inferior vena cava is a rare mesenchymal tumor. The diagnostic approach, based on general guidelines of oncologic surgery, seems to be relatively routine; specific aspects of treatment, including vascular reconstruction, depend on tumor stage, grade, and location. In this report, the management of this disease in 5 patients is summarized and the literature is reviewed. A thorough diagnostic assessment includes sonography, computed tomography, angiography or duplex ultrasonography, perioperative pathohistologic examination, and appropriate differential diagnosis. Radical resection is associated with the best outcome and long-term survival. In this series, 4 of 5 patients underwent tumor resection. In 2 patients, the disease was classified as R0. Another patient had R1 status found at resection and underwent postoperative radiation after the tumor bed was marked intraoperatively. She has remained stable since treatment. One patient died of pulmonary metastases 32 months after primary R1 tumor resection. The 5th patient has been stable since diagnosis; resection was not possible because of severe accompanying diseases and because consent for surgical intervention could not be obtained from the patient. There is reasonable hope that leiomyosarcoma of the inferior vena cava can be treated successfully, even in advanced stages, with novel antineoplastic drugs and radiotherapeutic protocols. However, general treatment recommendations have not yet been compiled.     

Lipoma-like liposarcoma of the tongue

BACKGROUND: Liposarcomas of the tongue are rare. To date only 7 cases have been reported. PATIENT: We report a new case of a well differentiated lipoma-like liposarcoma of the body of the tongue in a 71-year old woman. Complete uneventful resection was performed. Histologically the tumor consisted of fat cells with occasional lipoblasts and spindle cell areas. There is no sign of recurrence of the tumor 2 years later. RESULTS AND CONCLUSIONS: Liposarcomas of the tongue are rare neoplasms. All cases reported were histologically well differentiated. Liposarcomas have to be considered in the differential diagnosis of solid masses of the tongue.     

Gerichtliche Psychologie und Psychiatrie

International Journal of Legal Medicine -     

Spurennachweis. Leichenerscheinungen. Technik

Ohne Zusammenfassung     

Gesetzgebung. Kriminologie. Gefängniswesen. Strafvollzug

Ohne Zusammenfassung     

Manifestation eines Cushing-Syndroms und osteoporotischer Frakturen in der Schwangerschaft einer Patientin mit Carney-Komplex

Zusammenfassung Anamnese und klinischer Befund: Aufgrund von therapierefraktären Lendenwirbelsäulenbeschwerden wurde bein einer 31-jährigen Patientin nach einer Sectio caesarea eine Röntgenuntersuchung veranlasst, die Frakturen von L2 und L3 bei stark erhöhter Strahlentransparenz zeigte. Neben den klinischen Zeichen des Hypercortisolismus waren bei der Untersuchung auch zahlreiche Hyperpigmentationen im Gesichtsbereich unter Einbeziehung des Lippenrots und der rechten Konjunktiva auffällig, so dass ein Carney-Komplex vermutet wurde. Untersuchungen: Ein nicht supprimierbares Cortisol bestätigte in der endokrinologischen Diagnostik einen Hypercortisolismus. Die selektive Venenkatheteruntersuchung ergab den Verdacht auf eine bilaterale Cortisolmehrproduktion. Auch in der CT-Untersuchung der Nebennieren fanden sich knotige Veränderungen rechts und eine Hyperplasie links. Therapie und Verlauf: Bei der bilateralen Adrenalektomie konnte histologisch die Verdachtsdiagnose einer primär pigmentierten nodulären Hyperplasie bestätigt werden. Die Zeichen des Hypercortisolismus bildeten sich rasch zurück. Schlussfolgerung: Die Diagnose eines Cushing-Syndroms bei Carney-Komplex wurde bei unserer Patientin erst nach Beendigung der Schwangerschaft gestellt, obgleich die Zeichen des Hypercortisolismus schon lange vor Beginn der Schwangerschaft bestanden. An die seltene Diagnose eines Carney-Komplexes sollte bei klinischen Symptomen des Hypercortisolismus und charakteristischen phänotypischen Veränderungen (Hyperpigmentationen) gedacht werden. Abstract History and Clinical Findings: In a 31-year-old patient a conventional X-ray was performed due to persistend pain at the lumbar spine level after a cesarean section. It revealed compression fractures of L2 and L3. Besides very clear clinical signs of hypercortisolism, multiple hyperpigmentations and naevi in the patient's face including the lips and the conjunctiva of the right eye were visible, suggesting a Carney complex. Investigations: Insuppressible cortisol levels confirmed an adrenal origin of hypercortisolism. A selective catheterization of adrenal veins supported the presence of bilateral adrenal cortisol production. The computed tomography showed nodular lesions in the right and a hyperplasia of the left adrenal gland. Treatment and Course: A bilateral adrenalectomy was performed and a primary pigmented nodular adrenal hyperplasia was confirmed histologically. Clinical signs of hypercortisolism rapidly resolved after adrenalectomy. Conclusions: The diagnosis of Cushing's syndrome as a part of Carney complex was diagnosed at the end of a pregnancy although signs of hypercortisolism were present a long time before. The rare diagnosis of Carney complex should be considered in patients exhibiting symptoms of hypercortisolism and the typical clinical signs (hyperpigmentations).