Cytoplasmic c-erbB2 and survival in Dukes' B colorectal carcinoma.
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Biomarkers, Tumor↗
Biomedical subjects
C Wittekind
Publications and source records attributed to C Wittekind.
Cholestasis induced hyperthyroidism after liver transplantation.
We report the case of a 68-year-old woman who underwent liver transplantation because of hepatitis-C-induced cirrhosis. She developed iodine-reduced hyperthyroidism postoperatively in temporal relation with cholestatic jaundice. Hepatic biopsies revealed moderate intrahepatic cholestasis and mild lobular inflammatory infiltration with some eosinophils. No histological evidence of acute graft rejection or reactivated hepatitis was found. Treatment with methimazole markedly reduced the serum parameters of cholestasis which, after subtotal thyroidectomy, returned to normal. Liver function recovered, as confirmed by repeated aminopyrine breath tests.
Aged↗
Carcinoembryonic antigen family members as diagnostic tools in immunohistopathology.
Following an analysis of the literature, the review concludes that the recent huge increase in our theoretical knowledge of the molecular biology of the CEA family has been accompanied by an adequate practical immunohistological implementation. However, a broader use of CEA as a diagnostic tool has been hampered by variable and conflicting results using polyclonal anti-CEA antibodies and by lack of standardization of immunohistochemical methods and tissue preparation. CEA immunoreactivity has been demonstrated in a variety of normal and neoplastic tissues, but in all sites with positive staining, at least one other author has failed to identify CEA reactivity. CEA can be used as a marker to identify epithelial differentiation; however, this will be helpful in only 1% of cases. The introduction of well-defined monoclonal antibodies against clearly defined epitopes of the CEA family will make the differential diagnosis of tumors easier.
Biomarkers, Tumor↗
[Classification and documentation of liver metastases of colorectal carcinomas].
Today, there is a variety of therapy modalities for patients with liver metastases. This therapeutic spectrum has made a more accurate classification of liver metastasis necessary. Data concerning therapy have to be documented as well as pretherapeutic data and data concerning results of pathologic examination. Without a careful documentation a reliable comparison between different therapy modalities will be impossible and thus a generally accepted concept of liver metastasis therapy cannot be expected. A classification of liver metastasis thus required should aid in the planning of treatment, yield an indication of prognosis, and assist in the evaluation of the results of treatment.
Clinical Trials as Topic↗
[An unusual incidence of carcinoid tumors and secondary malignancies].
A secondary malignancy is a common finding in carcinoid tumor patients. Several authors saw 7 to 36% of their carcinoid tumor patients developing an other malignancy. From 1965 to 1990 we treated 144 patients with a carcinoid tumor. During the follow-up time 24 (17%) developed a secondary tumor commonly sited in the gastrointestinal tract (8 colon carcinomas, 3 rectal carcinomas, 2 gastric carcinomas, 1 small bowel carcinoma, 1 esophageal cancer). The incidence is elevated 8 times in comparison to the normal population. One may speculate that a carcinoid patient possesses an increased susceptibility to all forms of malignancy. As a consequence all the carcinoid tumor patients should be thoroughly investigated and should be followed up in short terms. Central point of interest should be the gastrointestinal tract.
Adenocarcinoma↗
[Prognostic factors in liver tumors].
The prognosis of patients with hepatocellular carcinoma is dismal. Long-term survival and cure of patients with hepatocellular carcinoma (HCC) can be expected only after resection or hepatectomy followed by transplantation. Thus, prognosis primarily depends on the possibility of resective surgery, which is determined predominantly by anatomic extent of disease. This survey deals with factors that become effective after resection or transplantation and that have prognostic significance in univariate or multivariate analyses. Several studies have shown that resection for cure (R classification) and anatomical extent of the tumors (TNM) were the most important prognostic factors. Prognostic factors other than TNM and R can be grouped into clinical findings and pathological features. As to clinical findings, performance status is an important prognostic factor in one multivariate analysis. The effects of other factors as age, sex, tumor site, and hepatomegaly on prognosis were discussed controversially. As might be expected, studies on pathological factors yielded different results. Histological grade had an influence in one study, but not in another. Histological type and coexisting cirrhosis were important in multivariate analysis only in resected patients. The majority of factors (capsule formation, dysplasia of adjacent liver tissue, mitotic activity, bile production) were only investigated in univariate analyses. There are only few studies evaluating the prognostic importance of molecular pathology factors. None of them has shown convincing evidence that these parameters may give information more important than TNM and R classification. The prognostic importance of TNM for patients not treated by resective surgery is emphasized in many studies. Ascites, toxic syndrome, and laboratory variables as bilirubin, blood urea nitrogen, and serum albumin were independent predictors of survival. The prognosis of patients with cholangiocarcinoma is even worse than that of HCC-patients and only 25% patients resected with stage-II-tumors can be expected to survive for five years.
Age Factors↗
Organ-sparing treatment of advanced bladder cancer: a 10-year experience.
PURPOSE: Radical cystectomy is considered as standard therapy for muscle-invasive bladder cancer. We present 10-year results of bladder-sparing treatment by conservative surgery and radiotherapy +/- chemotherapy. METHODS AND MATERIALS: From 1982 through 1991, 245 consecutive patients, mean age 66 years, with invasive bladder cancer (T2-3 or poor prognostic T1, no distant metastases) entered a prospective protocol with the objective of bladder preservation. Treatment consisted of transurethral resection (complete, if possible) and definitive radiotherapy with 56 Gy maximum dose (50.4 Gy minimum target dose) in 28 fractions. Since 1985, 139 patients received a simultaneous chemotherapy on 5 days in the first and fifth treatment week with either 25 mg/m2 cisplatin daily (79 patients) or 65 mg/m2 carboplatin (60 patients). Cystectomy was performed as salvage treatment for residual or recurrent invasive disease. The median follow-up at the date of analysis (12-31-92) was 5.9 years. RESULTS: The overall survival was 47% after 5 years and 26% after 10 years. The 5-year survival according to the initial T-category was 60% for T1 (44 patients), 64% for T2 (47 patients), 43% for T3 (127 patients), and 16% for T4 (23 patients). The most important single prognostic factor was the amount of residual tumor after TUR (5-year survival 80% after R0, 53% after R1, and 31% after R2 resection, p < 0.01). Chemotherapy increased the rate of complete remission, but had no impact on 5-year survival (52% vs. 50%). Fifty-three salvage cystectomies were performed, all without severe complications, and 192 patients (79%) maintained a normal functioning bladder. The bladder preservation rate in 5-year survivors was 83%. CONCLUSIONS: Organ-sparing treatment of advanced bladder cancer by transurethral surgery and definitive radiotherapy or radiochemotherapy is feasible and effective. The survival in this series is as good as in any comparable cystectomy series. Eighty-three percent of long-term survivors maintained their functioning bladders.
Aged↗
Effect of hepatocyte growth factor on the expression of E- and P-cadherin in gastric carcinoma cell lines.
Hepatocyte growth factor (HGF), identical to scatter factor, (SF) is a secretory glycoprotein from fibroblasts which dissociates and increases the motility of various types of epithelial cells. After treatment of three gastric carcinoma cell lines (MKN-28, MKN-45 and TMK-1) with HGF (10 ng/ml), TMK-1 cells lost their tight cell to cell contact and showed marked scattering, while the two other cell lines remained unaffected. To learn about the underlying mechanism of the HGF induced scattering, we examined the expression of adhesion molecules and growth factor/receptor systems at the mRNA and protein level. The observed scattering of treated TMK-1 cells was associated with a reduction in the expression of E- and P-cadherin protein. The respective mRNA levels remained unchanged after HGF/SF treatment. In the two other cell lines, which showed no scattering, there were no changes in the expression of E- and P-cadherin. All other growth factors and their receptors examined (TGF-alpha, EGFR, c-met and c-erbB2) remained constant and were not affected by HGF treatment. The results suggest that HGF/SF may regulate cell adhesion in gastric carcinomas via E- and P-cadherin expression at the protein level.
Adenocarcinoma↗
Clinico-pathological criteria with prognostic relevance in hepatoblastoma.
We investigated clinical data and histological specimens of 46 patients with a hepatoblastoma (HB) for prognostic criteria. Disease-free survival (DFS) of 23 patients treated in the German Cooperative Study HB-89 (1988-1990) was 83%, in contrast to 40% in 10 children with other chemotherapy regimes (1977-1987) and 38% in 13 with only a tumour resection (P = 0.005). Tumour residence after resection (R category) correlated significantly with probability of DFS (P = 0.0001). This was also the case for pT status, according to the pTNM classification for liver carcinoma (P = 0.0007), involvement of one or both liver lobes (P = 0.004), multiplicity of tumour nodes (P = 0.001), vascular invasion (P = 0.0006) and expression of nucleolar organiser regions as an indicator for proliferation activity of tumour cells (P = 0.05). Patients' age and histopathological subtypes could only indicate outcome, while tumour size and serum alpha-fetoprotein values were not significantly related to prognosis. In multivariate analysis, pT status and R categories remained significant. These should be applied in all cooperative trials on HB.
Child↗
The pathologist and the residual tumor (R) classification.
The R classification, adopted in 1987 by the UICC, denotes absence or presence of residual tumor after treatment. Residual tumor may be localized in the area of the primary tumor and/or as distant metastases. R0 corresponds to resection for cure or complete remission. R1 to microscopic residual tumor, R2 to macroscopic residual tumor. The R classification takes into account clinical and pathological findings. A reliable classification requires the pathological examination of resection margins. The R classification has considerable clinical significance, particularly being a strong predictor of prognosis. General and specific procedures for performing pathological R classification on resection specimens of different organs will be described. New methods in R classification comprise imprint cytology, cytolocial examination of ascites, examination of bone marrow biopsy. The importance of these methods will have to be established in the future.
Humans↗
[Liver cancer: diagnostic possibilities and value of pathology].
The high differentiation of treatment options for patients with liver carcinoma resulted in more extensive questions to the pathologist. Resection rate for HCC is about 30%, thus the multitude of diagnoses has to be made on biopsies. An histological (rarely cytological) diagnosis has to be the section specimens with regard to typing, grading, R classification and results of studies on molecular pathology of this tumor. Essential statements on resection specimens include pTNM classification, R classification, typing, and grading. Based on these data, more parameters expected to be of prognostic value can be evaluated.
Biopsy↗
[To what extent are laparoscopic procedures defensible in oncologic surgery?].
Successful oncological standard procedures can only be replaced by new methods if their value has been proven by long-term results. Laparoscopic tumor resections with curative intention have to be considered experimental, especially because long-term results are not yet available. These operations require two preconditions: 1) the oncological quality of tumor resection must be assessed by special methods of pathohistological examinations; and 2) long-term follow-up care must be guaranteed. In most cases, these preconditions are only secured within clinical trials.
Abdominal Neoplasms↗
Effect of hepatocyte growth factor (HGF)/scatter factor (SF) on cell adhesion in gastric cancer.
Hepatocyte Growth Factor (HGF)/Scatter Factor (SF) is a secretory glycoprotein from stromal fibroblasts which binds to the transmembrane c-met receptor. This receptor is expressed from a variety of tumors, including gastric carcinomas. To look for a possible paracrine loop between gastric cancer cells and their surrounding fibroblasts in gastric carcinoma, the effect of HGF/SF treatment on the morphology and the expression of cell adhesion molecules was examined. The cell line TMK-1, established from poorly differentiated gastric carcinoma, responded with scattering after HGF/SF treatment. We found that the observed morphological changes were accompanied with a reduced expression of E- and P-cadherin protein in these cells. In a cell line established from well differentiated gastric carcinoma, named MKN-28, neither scattering nor changes in cadherin expression could be detected. This results suggested, that HGF/SF is a regulator of cell adhesion via affecting E- and P-cadherin. Taking into account, that only cells from poorly differentiated gastric carcinoma cell lines responded in scattering after HGF/SF treatment, paracrine secreted HGF/SF may play an important role in the pathogenesis of these type of gastric carcinoma in vivo.
Adenocarcinoma↗
Surgical removal of a lipoma of the heart.
In a 29-year-old woman echocardiography revealed a tumour originating from the anterior wall of the right ventricle. Noninvasive findings aroused suspicion of a lipoma. The tumour was removed under cardiopulmonary bypass, the resulting defect in the right ventricular wall being covered with a Goretex patch. Histological examination classified the tumour as a rhabdomyolipoma.
Adult↗
Osteoclastic giant cell tumor of the pancreas. An immunohistological study and review of the literature.
A case of an osteoclastic giant cell tumor of the pancreas is presented. The different surgical specimens during the forty months of observation suggest that the histological feature of the tumor has changed. Although immunohistological studies were performed, the histogenesis remains obscure. Additional 19 cases of the literature were briefly reviewed.
Adult↗
[Drug induced liver injuries].
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Chemical and Drug Induced Liver Injury↗
[Importance of tumor growth and spread for surgical radical excision].
Different organ tumours of the gastrointestinal tract show variations in invasion patterns which are partly dependent on the biological characteristics of the tumour and partly dependent on the anatomical situation of the involved organ. It is important for the surgeon to have knowledge of the local invasion behaviours in making a precise indication for surgery, in the planning and in the technical accomplishment of the operation. Residual tumour has been shown to be a particular important prognostic factor. This paper investigates a large series of patients with different organ tumours in order to find in which location a R1 situation must be expected and which surgical consequences should be thus derived. The percentage of R0 resections in all patients who underwent resection differed in the individually examined organs: oesophagus, 65%; stomach, 80%; pancreas, 77%; colon, 81%; rectum, 84%. R1 resections also showed differences in incidence: oesophagus, 17%; stomach, 7%; pancreas, 13%; colon, 3%; rectum, 4%. Residual tumour was most frequently found in the lateral (superficial or free) resection margins: oesophagus, 79%; stomach, 67%; pancreas, 86%; colon, 78%; rectum, 74%. The other resection margins were significantly less-frequently involved.
Digestive System↗
Acute liver allograft rejection and liver function: quantitative evaluation using the [14C]aminopyrine breath test.
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Acute Disease↗