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M Wehrmann

Publications and source records attributed to M Wehrmann.

At least 19 recordsLinked to original sources
PubMed2006

Unusual distribution of red marrow mimicking chloroma in a patient with acute myelogenous leukemia.

We present a case of unusual distribution of red marrow in a patient with extramedullary acute myelogenous leukemia (AML). In adults, hematopoietic marrow is usually located in the axial skeleton and the proximal aspects of the limbs, except for the epiphyses. Nodular islets of red marrow located in the epiphyseal and distal parts of the limbs may mimic tumoral infiltration and be mistaken for chloroma in a patient with AML.

Aged↗
PubMed2005

Adrenocortical carcinoma producing 11-deoxycorticosterone: a rare cause of mineralocorticoid hypertension.

A 37-yr-old man presented with the classic signs of mineralocorticoid excess hypertension and hypokalemia. The cause was not aldosterone excess, but elevation of plasma 11-deoxycorticosterone (DOC). Computed tomography (CT) scans showed a large right adrenal mass without signs of metastatic disease. The tumor was removed by open laparotomy, and histology revealed an adrenocortical carcinoma. Two yr after diagnosis, the patient is in good general condition and there is no sign of recurrence or metastatic disease, despite the large tumor size. DOC producing adrenocortical carcinomas causing mineralocorticoid hypertension are very rare, so far only 10 cases have been described in the literature.

Adrenal Cortex Hormones↗
PubMed2005

Steroid profile in an adrenocortical carcinoma producing aldosterone.

We report a rare case of primary aldosteronism due to an adrenocortical carcinoma. A 61-year-old woman with a history of hypertension and hypokalemia was referred for evaluation of a 4.2 cm measuring adrenal mass without secondary signs of malignancy. Endocrinological testing was consistent with primary aldosteronism. The patient underwent surgical resection of the adrenal mass; histology revealed an adrenocortical carcinoma. Postoperatively blood pressure, serum potassium, and aldosterone returned to normal. Four months after adrenalectomy, the patient presented again with hypokalemic hypertension and was found to have metastatic disease. Endocrinological investigation revealed primary aldosteronism and subclinical autonomous glucocorticoid hypersecretion. Careful hormonal investigation should be obtained in patients with adrenal masses causing excessive aldosterone secretion. In uncertain cases of primary aldosteronism, we would suggest to measure 18-hydroxycortisol levels, as excessive amounts may indicate adrenocortical carcinoma.

Adrenal Cortex Hormones↗
PubMed2005

Invasive pulmonary aspergillosis: frequency and meaning of the "hypodense sign" on unenhanced CT.

The purpose of this study was to establish the diagnostic value of central hypointensity ("hypodense sign") in lung consolidations or nodules, in severely immunocompromised or neutropenic patients, suspected of having invasive pulmonary aspergillosis (IPA), and to assess its recognition on unenhanced CT scans. Serial CT scans of the lung were retrospectively reviewed in 43 consecutive immunosuppressed patients with IPA, and assessed for the presence of the hypodense sign using standard mediastinal and lung windowing settings, as well as a special, narrower window setting (width 110-140 HU; level 15-40 HU). The temporal relationship between the occurrence of the first CT-finding suspicious of IPA and the appearance of the hypodense sign, as well as between this and the occurrence of the crescent sign, cavitation or reduction in lesion size, was evaluated. Additionally, CT-scans from 89 immunocompromised patients with viral (n=45) or bacterial (n=44) pneumonia, investigated in the same time period at our institution were reviewed, with respect to the presence of the "hypodense" sign. Unenhanced CT scans revealed the hypodense sign in 11 neutropenic patients and 2 severely immunocompromised patients, out of a total of 43 patients with IPA evaluated in this study (30.2%). The mean time between the appearance of the first CT-findings of IPA (large nodule or consolidation +/- positive halo sign) and the hypodense sign was 7.8 days, while the time interval between the hypodense sign and the occurrence of crescent sign, cavitation, or decrease of the lesion's size was 8.3 days. The hypodense sign did not occur in any of the patients with viral or bacterial pneumonia, in the control series. We consider the hypodense sign to be a supplementary tool in the diagnosis of IPA. Its sensitivity was low in our series, but the high specificity makes it valuable in predicting IPA, anticipating the occurrence of cavitation or crescent sign, which are considered specific, but late findings of IPA. The hypodense sign is recognizable also on unenhanced CT, when a narrower lung window setting is used.

Adolescent↗
PubMed2004

Extensive peritoneal and omental lymphomatosis with raised CA 125 mimicking carcinomatosis: CT and intraoperative findings.

Diffuse peritoneal and omental seeding are well-known forms of dissemination of metastatic carcinoma. A wide variety of primary neoplasms may cause peritoneal and omental carcinomatosis, most commonly carcinomas of the ovary, gastrointestinal tract and breast. Extensive involvement of the peritoneal cavity with lymphoma is, however, rare. The association of peritoneal lymphoma with a raised CA 125, a tumour marker which is commonly raised in ovarian carcinoma, is a highly challenging clinical situation, which to our knowledge has not been published before in the medical literature. Not being aware of the possibility of this unusual combination of clinical, laboratory and imaging findings can lead to an erroneous diagnosis, as in our case.

Adult↗
PubMed2002

Value of positron emission tomography for lung cancer staging.

OBJECTIVE: The therapeutic strategy in non-small-cell lung cancer (NSCLC) requires exact staging of tumour invasion (T) as well as differentiation between ipsi- and contralateral lymph node invasion (N1/2 vs N3). [18F]FDG-positron emission tomography (FDG-PET) has been shown to detect invaded N with high accuracy while correct determination of T appears to be unclear. The purpose of this prospective study was to evaluate benefit and necessity of 18FDG-PET as an additive to conventional staging modalities. METHODS: Forty patients with suspected non-small-cell lung cancer (NSCLC) were staged by means of computed tomography (CT), bronchoscopy, mediastinoscopy and bone scintigraphy. Additionally, attenuation corrected FDG-PET of the thorax was performed pre-operatively for analysis of T and N topography. After surgical resection with radical lymphadenectomy T and N staging results of CT and PET were compared with the pathological diagnoses. Specificity, sensitivity, positive predictive value and accuracy of CT and PET were calculated. RESULTS: Twenty three squamous cell carcinomas, 14 adenocarcinomas, and three non-malignant tumours were found. Accuracy of CT-T was 0.75 and of PET-T 0.78; accuracy of CT-N was 0.78 and of PET-N 0.80. By combination of CT-T and PET-T accuracy was 0.88. Combination of CT-N and PET-N yielded an accuracy of 0.90. In two out of three cases, PET correctly determined T0. In two cases non-malignant inflammatory lymph nodes were falsely staged as malignant by PET. CONCLUSIONS: Adequate pre-operative T- and N-staging is possible with both CT and FDG-PET. Accuracy can be improved by combination of CT and FDG-PET. FDG-PET is superior to CT in order to differentiate between malignant and benign tumours. However, acute inflammation can mimic malignant lymph node invasion. FDG-PET is justified as a supporting staging measure in cases presenting unclear differentiation between N2 and N3 after conventional staging and is helpful in cases with unclear cell type of the primary tumour.

Carcinoma, Non-Small-Cell Lung↗
PubMed2001

[Invagination caused by angiolipoma of the small intestine--a rare cause of occult gastrointestinal hemorrhage].

We present the case of a 71-year-old woman who was hospitalized because of a severe hip contusion. She had no symptoms or clinical signs of abdominal disease. Routine blood testing showed anemia, presumably owing to occult bleeding. Ultrasonographic abdominal screening revealed ileo-ileal intussusception with a central hyperechoic tumor suggestive of a lipoma as lead point. This diagnosis was confirmed at surgery, where a small bowel resection was performed. Histologic examination disclosed a benign angiolipoma of the ileum with a superficial shallow ulceration which obviously was the source of the occult blood loss. Diagnostic and therapeutic procedures and a literature review are discussed.

Aged↗
PubMed1999

Improvement of non-small-cell lung cancer staging by means of positron emission tomography.

BACKGROUND: Exact staging of ipsi- and contralateral mediastinal lymph-node metastases (N 1/2 vs. N3) is essential for the therapeutic strategy in non-small-cell lung cancer (NSCLC). CT and mediastinoscopy are the standards of reference for N staging. However, even with these combined measures the extent of invasion of mediastinal lymph nodes can remain vague. 18FDG Positron Emission Tomography (18FDG-PET) has recently been shown to detect invaded nodes with high accuracy. The purpose of this study was to evaluate 18FDG-PET as an aid in N staging. METHODS: 27 patients with suspected NSCLC were clinically staged by means of CT, bronchoscopy, mediastinoscopy, and bone scintigraphy. Additionally, 18FDG-PET was performed preoperatively for analysis of topography of invaded lymph nodes. CT and 18FDG-PET were evaluated in a blinded fashion. Surgical therapy was performed with radical lymphadenectomy. CT N staging as well as PET N staging results were compared with the pathological diagnoses (pTN). Specificity, sensitivity, and accuracy of CT and PET in N staging were calculated. RESULTS: 14 squamous-cell carcinomas, 10 adenocarcinomas, and 3 non-malignant tumors were found. In 8 patients no invasion was found (N0), in 13 patients an ipsilateral invasion (N1/2), and in 3 patients a contralateral invasion (N3). In the correct detection of N1/2 the sensitivity of CT and of PET was 0.77, the specificity of CT and of PET was 0.79. The accuracy of CT was 0.74 and of PET 0.78. By combining CT and PET accuracy was 0.85. CONCLUSIONS: Adequate preoperative LN staging is possible with both CT and 18FDG-PET. The accuracy, however, can be improved by a combination of CT and 18FDG-PET.

Adenocarcinoma↗
PubMed1999

Disparate actions of mifepristone (RU 486) on glands and stroma in the primate endometrium.

Besides being an antiprogestin, mifepristone (RU 486) was recently shown to antagonize oestrogen-dependent growth in the endometrium. To explore the molecular mechanisms for this phenomenon, we investigated whether or not the morphological effects of mifepristone are mediated by the progesterone receptor (PR) and whether mifepristone has disparate effects on the glandular epithelium and stroma. Six groups of hypogonadal, oestrogen-primed cynomolgus monkeys were treated for 2 weeks with: vehicle only (group I); mifepristone (group II); mifepristone plus progesterone at 0.2 mg/kg (group III), 1.0 mg/kg (group IV) or 5.0 mg/kg (group V); and progesterone only (5.0 mg/kg) (group VI). Histomorphological evaluation showed strikingly compacted stroma in the mifepristone-exposed endometria (group II), which was partially reversible by additional progesterone treatment (groups III-V). Glandular proliferation (pseudostratification, glandular mitoses) in mifepristone-treated monkeys was not significantly different from that in vehicle (oestradiol)-treated monkeys, but was inhibited by progesterone-only treatment. Cells containing vacuoles were scarce in the mifepristone-exposed endometrium, but detected frequently in progesterone-exposed endometria, indicating the strong antisecretory effect of mifepristone on glands. We conclude that oestrogen-dependent oedema in the stroma is antagonized by mifepristone. The reversal of this effect by progesterone suggests a PR-mediated mechanism. In glands, mifepristone is antiprogestogenic, but not antioestrogenic. Thus, stromal cells may be the target of antiprogestin-induced inhibition of oedema and endometrial growth.

Animals↗
PubMed1999

Immunophenotyping of acute lymphoblastic leukaemia in routinely processed bone marrow biopsy specimens.

AIMS: To assess the value of immunophenotyping of acute lymphoblastic leukaemia (ALL) in routinely processed bone marrow trephine biopsy specimens and to establish a minimum panel of antibodies to assess lymphoid lineage and enable differentiation from acute myeloid leukaemia. METHODS: 45 routinely processed bone marrow biopsy specimens (formalin fixed, paraffin embedded and mildly decalcified in EDTA) reported to contain leukaemic infiltrates on the basis of cytomorphological and enzyme-cytochemical analysis of bone marrow smears (22 c-ALL, 11 T-ALL, 2 B-ALL, 10 u-ALL (unclassified)) were immunostained by the ABC method with a broad panel of 26 antibodies against various haemopoietic antigens. RESULTS: Staining with antibodies directed against myeloperoxidase and lysozyme showed that seven cases were either biphenotypic or mixed leukaemias (2), or of myelogenous origin (acute myeloid leukaemia (AML)-M1 (2); AML-M4 (2); AML-M5a (1)). Five of these seven cases had been diagnosed initially as u-ALL. Three further cases with no compact leukaemic infiltrates were excluded. ALL was confirmed in the remaining 35 cases. Because of revised diagnoses, the total numbers of ALL subtypes changed (23 c-ALL, 8 T-ALL, 2 B-ALL, 2 u-ALL). Immunostaining of more than 10% of blast cells in at least one case was found with 19 of the 26 antibodies. The most sensitive lineage specific antibodies for diagnosis were found to be anti-CD10 for c-ALL (22/23) and beta F1 for T-ALL (6/8). Expression of aberrant antigens was fairly common--for example, 7/23 cases of c-ALL stained with antibodies against T cell associated antigens. CONCLUSIONS: Immunohistochemical investigation of routinely processed bone marrow biopsy specimens enables reliable detection of ALL subtypes c-ALL and T-ALL. A minimum panel of antibodies, against TdT, CD34, myeloperoxidase, lysozyme, CD10, CD79a, and CD20, and the antibody beta F1, is proposed for the immunophenotyping of acute leukaemia.

Antigens, Neoplasm↗
PubMed1999

Aortic plaque size and endometrial response in cholesterol-fed rabbits treated with estrogen plus continuous or sequential progestin.

ERT is associated with a reduced incidence of coronary risk and cardiac events in postmenopausal women, but increases the risk of endometrial hyperplasia and carcinoma. Combined estrogen and progestin therapy protects the endometrium; however, its effects on heart disease risk factors are not completely known. In our study, 56 ovariectomized New Zealand White rabbits in 7 groups received a 0.5% cholesterol diet for 12 weeks. Controls were not treated with hormones. All other animals received (per kilogram body weight per week) intramuscular injections of either 0.3 mg estrogen (estradiol valerate) alone, 8.3 mg progestin (hydroxyprogesterone caproate) alone, estrogen and progestin continuously in 3 different dosages (0.3 and 8.3 mg; 1 and 8.3 mg; or 1 and 2.8 mg; estrogen and progestin, respectively), or 1 mg estrogen with 25 mg progestin sequentially in 2-week cycles. Eight non-ovariectomized animals served as further controls for endometrial analysis. Morphometric analysis of plaque size in the aortic arch showed that estrogen monotherapy, and the 3 combined therapies with 1 mg estrogen, significantly reduced intimal thickening (P<0.05). The application of progestin alone had no effect on plaque size. The endometrium was enlarged by 3-fold after estrogen treatment, and was decreased by half after progestin treatment, compared with control uteri (P<0.05). In all groups with combined hormone regimens, endometrial size was not significantly different from control uteri. However, these uteri showed more inflammatory reactions, especially when higher doses of hormones were given. In this animal model, doses of progestin that are able to successfully reduce the proliferative effect of estrogen on endometrium do not diminish the desirable antiatherosclerotic properties of estrogen.

17-alpha-Hydroxyprogesterone↗
PubMed1998

Expression of cell adhesion molecules by endothelium in the human lower uterine segment during parturition at term.

OBJECTIVE: Our purpose was to determine whether the expression of certain adhesion molecules by endothelium in the human lower uterine segment at term varies with the degree of cervical dilatation. STUDY DESIGN: Biopsy specimens of the lower uterine segment of 34 women undergoing cesarean section at term at various stages of cervical dilatation were immunostained for endothelial leukocyte adhesion molecule-1, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and platelet-endothelial cell adhesion molecule. RESULTS: The expression of endothelial leukocyte adhesion molecule-1 was significantly greater at more than 6 cm dilatation than at less than 2 cm (p = 0.00031) as was that of vascular cell adhesion molecule-1 (p = 0.033). Expression of intercellular adhesion molecule-1 and platelet-endothelial cell adhesion molecule did not vary with the degree of cervical dilatation. CONCLUSION: Cervical dilatation is associated with up-regulation of certain endothelial cell adhesion molecules. The findings support the hypothesis that certain processes associated with cervical dilatation at term resemble those involved in the acute inflammatory reaction.

Cervix Uteri↗
PubMed1998

Preeclamptic nephropathy -- an endothelial lesion. A morphological study with a review of the literature.

OBJECTIVE: We investigated wether an endothelial lesion, postulated in pathogenesis of preeclampsia (PE) in general, is also pathogenetically relevant in the characteristic renal lesions of PE, presenting as special glomerular alterations, designated as "preeclamptic nephropathy". STUDY DESIGN: Renal biopsies of 90 women with PE were analyzed by light microscopy (LM), immunohistology (IH) and electron microscopy (EM). Corresponding with clinical data clinicomorphological correlations were performed. RESULTS: In IH and EM the altered glomeruli demonstrate an endothelial lesion. Consecutive morphological reactions could be revealed by EM, allowing a subdivision in different stages of disease. The late stage indicates the reversibility of these renal lesions. Close correlations were found between clinical and morphological data. Focal glomerulosclerosis presents a hyperperfusion lesion, developing only facultatively in PE as a result of hyperfiltration. CONCLUSION: In preeclamptic nephropathy the first morphological substrate of renal changes with the key to pathogenesis presents itself as an endothelial lesion. This results in a disturbance of glomerular basement membrane permeability and in an imbalance of different mediator systems, with dominance of vasoconstrictive reactions but also coagulative-, reparation-, and proliferation-processes, leading to the characteristic glomerular alterations of preeclamptic nephropathy.

Adult↗
PubMed1998

The long-term prognosis of benign nephrosclerosis accompanied by focal glomerulosclerosis and renal cortical interstitial fibrosis, designated so-called decompensated benign nephrosclerosis by Fahr, Bohle and Ratscheck.

The long-term prognosis of decompensated benign nephrosclerosis (DBN) was investigated by a retrospective analysis of the fate of 170 patients with this disease, which yielded the following results: 1) DBN carries a particularly poor prognosis. The renal survival rate (RSR) was 35.9% at 5 years and 23.6% at 10 years. The prognosis is therefore worse than that of any other primary glomerulopathy, with the exception of rapidly progressive glomerulonephritis. 2) DBN mainly affects males (sex ratio 5:1) and differs in this respect, among others, from focal sclerosing glomerulonephritis, in which the male:female ratio is 1.2:1. 3) The prognosis for females is no better than for males. 4) The severity of proteinuria at the time of biopsy has no influence on the prognosis. 5) The prognosis is particularly poor in cases in which the serum creatinine concentration is already elevated to more than 2.0 mg% at the time of biopsy. We conclude from these findings that not only the blood pressure, but also the serum creatinine concentration, should be assessed at regular intervals in all hypertensive individuals, so that DBN can be treated at an early stage, when it is still amenable to treatment.

Adult↗