Georg Arnold

Histopathology of Pleomorphic Adenoma in the Parotid Gland: A Prospective Unselected Series of 100 Cases

Objectives/Hypothesis Histopathological characteristics of pleomorphic adenomas, especially of capsular alterations such as thin capsule areas, capsule‐free regions, capsule penetration, satellite nodules, and pseudopodia in the different subtypes, are described.

Recurrent pleomorphic adenoma of the parotid gland: Analysis of 108 consecutive patients

Surgery for recurrent parotid pleomorphic adenoma is a challenging problem.

Histopathology of episcleral fibrosis after trabeculectomy with and without mitomycin C

Abstract• Background: The aim of the study was to investigate the histopathologic features of scar tissue which have proliferated at the site of trabeculectomy of surgical failures after procedures with and without the use of the antimetabolite mitomycin C (MMC).• Methods: We obtained seven surgical specimens after trabeculectomy without MMC and five specimens after trabeculectomy with MMC, which were compared with 23 controls. Sections were stained with hematoxylin and eosin, Verhoeff-van Gieson, Grocott methenamine silver, and alcian blue. An immunohistochemical stain was performed for α-smooth muscle actin.• Results: Specimens from eyes operated without MMC showed dense scar tissue with many fibroblasts, much ground substance, parallel-oriented collagen fibers, and contractile intracellular proteins within the fibroblasts. Specimens from eyes operated with MMC consisted of tissue with only few fibroblasts which did not exhibit contractile proteins. Collagen fibers were arranged randomly with less ground substance.• Conclusion: Even after 1–10 months, the scar tissue was distinctly different in the two groups. These results suggest that the use of MMC has long-term effects in vivo. Surgical failures related to scar formation are possible and not reduced to zero.

Successful Treatment of an Invasive Aspergillosis of the Skull Base and Paranasal Sinuses with Liposomal Amphotericin B and Itraconazole

Invasive aspergillosis and fulminant aspergillosis are rarities with a high mortality. In the literature there is no patient surviving an extended invasive aspergillosis of the paranasal sinuses and skull base after failure of operative intervention and of postoperative amphotericin B therapy. We report a complete remission of an invasive, partially fulminant aspergillosis. After an incomplete removal of the mycotic mass, we started postoperative drug therapy with amphotericin B. Under this treatment, the mycosis progressed. Additionally, the patient developed severe side effects, so that the treatment was interrupted. At this moment, we started a combined antimycotic drug therapy with liposomal amphotericin B and itraconazole. Within 10 weeks, clinically and radiologically, there was complete remission. The patient died 63 weeks after this treatment, due to a fulminant bacterial pneumonia. Postmortem histologic examination showed no aspergillosis in the skull base, paranasal sinuses, or lung.

Analysis of sequence and pathogenic properties of two variants of encephalomyocarditis virus differing in a single amino acid in VP1.

The encephalomyocarditis (EMC) virus-induced diabetes-like syndrome in mouse inbred strains was used as a model to study the insulin-dependent diabetes mellitus (IDDM). Our investigations were performed with two EMC virus variants, PV2 and PV7. After infection of SJL mice with 10(5) PFU of PV2 about 70% of the animals developed a diabetes-like syndrome, whereas the PV7 infected mice appeared healthy. Histological examination and in situ experiments revealed that the islets of Langerhans are a main target of PV2, whereas PV7 infection leads to only modest changes of the islets. Sequence analysis of both variants revealed one amino acid exchange within the capsid protein VP1. Hence, we describe the first diabetogenic and non-diabetogenic EMCV variants differing in only one single amino acid.

Myofibrillar Degeneration — A Common Type of Myocardial Lesion and its Selective Identification by a Modified Luxol Fast Blue Stain

Myofibrillar degeneration is a very common form of myocardial damage. It occurs as a disseminated lesion after various forms of injury (e.g. association with cardiovascular surgery, raised intracranial pressure). As a localized alteration it surrounds the coagulation necrosis of infarcts. The present study introduces a modification of the Luxol Fast Blue (LFB) stain as a specific marker of myofibrillar degeneration. In formalin-fixed and paraffin-embedded myocardium of human autopsies and biopsies two LFB-reaction types are demonstrable: A) irregular blue transverse bands and B) a diffuse blue staining of the entire myocyte. The first type corresponds to the cross band lesion typical of myofibrillar degeneration. By electron microscopy it consists of dense aggregations of disorganized myofilaments. The second form exhibits diffusely LFB-coloured cells and ultrastructurally an irregular felt-like splitting of myofibrils. The latter represents another, until now unrecognized type of myofibrillar degeneration which is not clearly detectable when using other staining methods. Since a coagulation necrosis is only faintly LFB-positive, this method is not suitable for the detection of early stages of infarcts. The obvious advantages of the LFB-method are: detection of type, amount and distribution pattern of myofibrillar degeneration in low-power-views, even if myocytes are cut transversely, high sensitivity, easy handling and reliability. The affinity of damaged cells for the LFB-stain seems to be related to the pathogenesis of myofibrillar degeneration, in which abundant Ca++-influx plays a primary role.

Ultrastructural study of human herpesvirus-7 replication in tissue culture

Abstract Human herpesvirus 7 (HHV-7) was grown in a CD4+ lymphoblastic cell line (SupT1) and in cord blood mononuclear cells (CBMC). Virus infection was demonstrated by immunohistology with positive control sera, with monoclonal antibodies and by in situ hybridization for viral DNA. Cytopathic effects following HHV-7 infection generally resemble those after HHV-6 infection but are less pronounced. The ultrastructural appearance of HHV-7 and the replicative stages were similar to those described by Kramarsky and Sander for HHV-6. There were some minor discrepancies, including quite an extensive and space-filling tegument, a slightly different structure of the nucleoid, the frequent finding of nucleocapsids without any visible core and apparently scarce or delicate spikes on the envelope. These differences may suggest HHV-7 rather than HHV-6, but this finding needs confirmation. Mature HHV-7 particles measured 170 nm in diameter, with nucleocapsids of 90–95 nm and a tegument of about 30 nm.

Epithelioid hemangioendothelioma. Report of a case with immuno-lectinhistochemical and ultrastructural demonstration of its vascular nature.

The epithelioid hemangioendothelioma (EHE) is a rare vascular tumour of borderline malignancy, first described as a separate entity in 1982 by Weiss and Enzinger. The abundant cytoplasm of endothelial cells mimiking epithelioid appearances, prominent cytoplasmic vacuolization and barely perceptible lumina even in reticulin stains may result in EHE being mistaken for a signet ring cell carcinoma. In our case, difficulties in differential diagnosis were enhanced by the location of the tumour within an inguinal lymph node. The usefulness of FVIIIR:Ag- and UEA I- histochemistry in ascertaining the endothelial nature of this tumour is demonstrated, in correlation with electron microscopic data. The different reaction sites of these markers are striking and typical: FVIIIR: Ag displays a granular or diffuse cytoplasmic reaction, whereas UEA I provides a linear staining of vacuoles and luminal surfaces.

CO2 laser surgery for verrucous carcinoma of the larynx

The verrucous carcinoma (VC) is a low grade malignant tumor. Treatment strategies of VC of the larynx are topics of the ongoing discussion, and the role of the carbon dioxide laser therapy in the management remains unclear to date.

Temporary vitreous gas tamponade by perfluoromethylcyclopentane

Abstract Using perfluoromethylcyclopentane (FMCP; US patent no. 5,441,989, granted 1995) we have developed a new vitreous gas tamponade in a rabbit model that allows complete filling of the vitreous cavity without vitrectomy and without a significant increase in intraocular pressure. In humans this procedure would allow the blockage of inferior and posterior retinal holes without special positioning of the patient. Perfluoromethylcyclopentane (FMCP), a liquid perfluorocarbon with a boiling point slightly above body temperature, is injected in minute volumes into the vitreous cavity, where it vaporizes, thereby filling a gas volume approximately 500 times its liquid volume. FMCP was injected into the midvitreous in six rabbits (six eyes). After 2–3 days a complete gas tamponade was achieved in three eyes. Two eyes showed 75–90% filling, and one eye was filled only 50% with gas. Intraocular pressure was highest in the completely filled eyes, ranging from 26.6 to 38.8 mmHg. In all eyes the maximum expansion of the gas bubble lasted 2 weeks. One eye developed a retinal detachment. All eyes showed transient subcapsular cataracts. The results of this study showed that intravitreal injection of FMCP, a new perfluorocarbon liquid, results in a complete gas tamponade of the vitreous cavity which lasts 2 weeks without severe intraocular pressure rise and without vitrectomy. This procedure will be especially useful for eyes that have retinal detachment from inferior or posterior retinal holes. Injection of a conventional gas such as SF6 or C3F8 usually does not block retinal holes in inferior or posterior locations without tedious positioning and risk of (transient) glaucoma. Since the mechanism of transition of FMCP from liquid to gas in the vitreous is poorly understood, we are currently studying FMCP vaporization in an in vitro eye model.