Bernd Roetman

Ekkrines Spiradenokarzinom mit ungewöhnlicher histiozytärer Riesenzellkomponente Fallbericht und Literaturübersicht eines seltenen malignen Schweißdrüsentumors

ZusammenfassungWir berichten über ein Spiradenokarzinom (malignes ekkrines Spiradenom), einen seltenen Schweißdrüsentumor. Der Tumor war am behaarten Kopf einer 63-jährigen Frau aufgetreten. Nach einem mehrjährigen stationären Befund bei Zustand nach viele Jahre zuvor entferntem Tumor, der nicht histologisch untersucht worden war, kam es innerhalb von wenigen Wochen zu einem sehr schnellen Tumorwachstum mit ausgedehnter Ulzeration. Das maligne ekkrine Spiradenom ist charakterisiert durch das Nebeneinander der benignen Vorstufe und des malignen Anteils in einem Präparat, wobei auch das zeitliche Nacheinanderauftreten an derselben Lokalisation bekannt ist. Es handelt sich um den 47. beschriebenen Fall. Die Besonderheit des vorgestellten Falls ist die erhebliche Tumorheterogenität mit herdförmigen atypischen Histiozyten wie bei einem atypischen Fibroxanthom sowie eine ausgedehnte Fremdkörperreaktion bei Cholesterinnadeln wie bei einem Xanthogranulom. Die statische DNA-Zytophotometrie zeigt in den 3 verschiedenen Tumoranteilen wechselnd ausgeprägte Aneuploidie. Der bisherige Verlauf nach vollständiger Exzision über 23 Monate ist ohne Tumorrezidiv. Eine Literaturübersicht wird gegeben.AbstractWe report the case of a spiradenocarcinoma (malignant eccrine spiradenoma), a rare variant of a malignant sweat gland tumor, which occurred in the scalp of a 63-year-old woman. Some years before the current tumor occurred, a tumour of unknown histology had been excised from the same localization. The new tumor presented with rapid growth and exulceration. Malignant eccrine spiradenoma is characterized by the coincidence of a benign and a malignant portion within one specimen. We report case example 47 of this entity. The peculiarity of this case is the enormous heterogeneity with foci of atypical histiocytes like an atypical fibroxanthoma and an extensive foreign body reaction with cholesterol needles as in a xanthogranuloma. Static DNA cytophotometric analysis revealed different degrees of aneuploidy in the three tumor portions. The follow-up of 23 months is without recurrent tumor. A review of the literature is given.

Elevated Systemic Interleukin-18 in Multiple Injured Patients Is Not Related to Clinical Outcome

Interleukin-18 (IL-18) is a pleiotropic proinflammatory cytokine with the ability to induce interferon-gamma production in T-helper cells type 1 and natural killer cells. To investigate the role of IL-18 after severe trauma we measured plasma levels of IL-18 in 229 multiple injured patients [mean age of 39 +/- 16 (range 11-81) years, injury severity score (ISS) of 31 +/- 10 (range 16-66) points; 55 women and 174 men] and correlated these with demographics, clinical course, and routine laboratory parameters. IL-18 plasma levels were significantly increased in polytraumatized patients compared to healthy donors (p < 0.001). Survivors presented significantly (p < 0.05) higher IL-18 plasma median values (n = 193, median 98 pg/mL) compared to nonsurvivors (n = 36, median 63 pg/mL). Patients >60 years old (n = 35) had significantly lower plasma levels of IL-18 (median 45 pg/mL) compared to younger ones (n = 194, median 92 pg/mL). In the subgroup of nonsurvivors (n = 12) elderly patients had the lowest plasma levels of IL-18 (median 45 pg/mL). Patients with an ISS >25 had significant higher IL-18 plasma levels compared to the group with an ISS <or=25 (p < 0.001). Our data demonstrate elevated plasma levels of IL-18 after severe trauma.

[Arm wrestling injuries--report on 11 cases with different injuries].

INTRODUCTION Arm wrestling may cause severe injuries. Various injuries after arm wrestling have been reported in the literature, whereas the most common injury is the humeral shaft fracture. In this context we report on eleven cases with different injuries during arm wrestling. MATERIAL AND METHODS All patients were analyzed using a standardized questionnaire. The effect of drugs, pre-existing conditions and injuries as well as sport activities were examined. Furthermore we report about a 24 year old patient who sustained a radial shaft fracture which has not been reported in the literature yet. RESULTS 8 patients suffered from a fracture. The humerus was the most affected bone in 7 cases. 3 patients had a muscle strain, whereas in all 3 cases the patients were regularly sportive active and warmed-up be for the injury. Ten patients were reintegrated into the previous job after an average time period of 6 weeks. One patient was out of work. CONCLUSIONS Regular sport activity and the muscle strength are important factors for the injury intensity. Further studies are necessary to confirm this theory.

Microvascular response to calcium phosphate bone substitutes: an intravital microscopy analysis

ObjectivesThe purpose was to evaluate inflammatory and microcirculatory reactions after implantation of various calcium phosphate bone substitutes in an in vivo model.MethodsCalcium phosphate-based bone substitutes were implanted in dorsal skinfold chambers of mice. Intravital fluorescence microscopy was performed to measure inflammatory and microcirculatory reactions based on functional vessel density (FVD), capillary leakage, and relative white blood cell velocity (rWBCV).ResultsAn increase of FVD was observed in all groups and the capillary leakage grew with a level of significance (p < 0.001). The fraction of rolling and sticking leukocytes (rWBCV) was highest at the beginning of the trial and decreased during the course.ConclusionsThere are differences in microvascular soft tissue reactions between various calcium phosphate bone substitutes, but inflammatory reactions were moderate, and the results revealed no reasons which explain the sporadic failure of the tested substances under clinical conditions.

Polypoid pleomorphic sarcoma of the colon

In contrast to common colonic epithelial neoplasms, polypoid mesenchymal tumors of the colon are extremely rare. The majority of uncommon gastrointestinal mesenchymal tumors are associated with the so-called gastrointestinal stromal tumors (GIST). We present a case of a rare colonic pleomorphic sarcoma, macroscopically mimicking a common epithelial colonic polyp, which did not match the criteria of GIST. In this case report we discuss the clinical and pathological characteristics of a rare polypoid-shaped, pleomorphic colonic sarcoma and refer a mark-off to other rare mesenchymal neoplasms of the gut.

Die druckdolente Schwellung in der Kniekehle als Wegweiser einer monoklonalen Gammopathie unklarer Spezifität (MGUS)

AL amyloidosis (AL-A) is seen in about 6-15 % of patients with multiple myeloma. In contrast, the sporadic occurrence of AL-A is a rarity. The presence of amyloid is often found in the respiratory tract followed by the lung, the eyelids, the skin and the lower urinary tract, while the presence in soft tissues or bone is rather uncommon. We here describe a 71-year-old woman who presented with a pressure-sensitive swelling in the left knee at our hospital. The clinical examination on admission showed a tumourous alteration of the popliteal soft tissues without any signs of neurological deficits. However, the range of motion (ROM) of the left knee was restricted with 0-0-100 degrees for extension and flexion. A dialysis-dependent renal insufficiency, heart insufficiency with the necessity of permanent anticoagulation and glaucoma were noted as pre-existing illnesses. Further diagnostic examinations including ultrasound and magnetic resonance imaging (MRI) of the left knee revealed a solid tumourous structure with a radiological suspicion of pigmented villonodular synovitis. A complete surgical extirpation of the tumourous structure was performed. The further performed diagnostic examinations including histological and immunohistochemical analyses showed evidence of an AL-A tumour. A monocloncal gammopathy of unknown specificity (MGUS) was detected as an origin for the AL-A. This case underscores the necessity of complete extirpation and histological and immunohistochemical analyses of any soft tissue tumour. Possible previously existing rare malignant diseases can be detected only in this way.

Querschnittslähmung nach isolierter Rückenmarksruptur – eine seltene Verletzung

INTRODUCTION Complex vertebral fractures can lead to injury of the spinal cord with resulting paraplegia. High-speed accidents are common causes, especially in younger patients. Malignant or inflammatory processes play an important role in the elderly. Less common reasons for a spinal cord injury are congenital malformations. We here report about a 17-year-old patient who suffered from paraplegia after an isolated rupture of the spinal cord without an injury of the vertebral bodies, intervertebral disc or ligamentous structures. This type of injury has not been reported in the literature before. PATIENT AND METHOD We report about a 17-year-old patient, referred to our hospital, presenting with lumbal paraplegia after a high-speed accident 8 days prior to admission. After initial stabilisation of the polytraumatised patient, he was referred to our hospital for further treatment. RESULTS AND CONCLUSION The radiological examination showed a bilateral acetabular fracture, a right anterior pelvic ring fracture and shaft fractures of the left humerus and right femur. Furthermore, the spinal cord at thoracic level 10/11 was ruptured. Interestingly, there was no injury of the vertebral bodies, intervertebral disc or ligamentous structures. A tethered cord as a possible anatomic variation could be excluded in this case by MRI. However, anatomic variations could be the reason for this injury and should be kept in mind.