Biomedical subjects
Publications and source records attributed to P Hermanek.
We report on a 52-year-old man who was admitted to hospital for peranal bleeding due to a rectal tumor with the endoscopic aspect of an angioma. The histological work-up revealed a Non-Hodgkin lymphoma of low malignancy (centroblastic-centrocytic lymphoma in the Kiel classification). The lymphoma was staged IE. A short review of the literature is given.
During the last 15 years in our department, the overall 5-year survival rate in patients with gastric cancer has increased from 20% to 30%. This improvement in prognosis is explained by three factors: (1) the reduction in surgical mortality, (2) an increase in the resectability rate, (3) the introduction of a histology-oriented surgical approach that takes account of the differences in growth behaviour between the intestinal and diffuse types of carcinoma as defined by Laurén. A further new aspect in gastric cancer surgery is the concept of extended lymph node dissection.
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A serially transplantable human prostatic carcinoma line, PC EW, has been developed through heterotransplantation of tumor tissue from a lymph node metastasis. PC EW is androgen dependent and is similar to the original tumor in terms of histological pattern, amounts of prostatic acid phosphatase secreted, and absence of a hormonally independent subline. This line is thus similar to PC 82, and we herein report the first results of comparative treatment trials conducted on PC EW.
Nonsteroid antiinflammatory drugs such as indomethacin may play an important role in preventing the development of chemically induced experimental carcinomas of various organs including the large bowel in rats and mice. This effect might correlate with an inhibition of prostaglandin (PG) synthesis by these drugs. Sprague-Dawley rats were given three intrarectal doses of 4 mg N-nitrosomethyl-urea (MNU) within week 1 to induce large-bowel carcinomas. The experimental groups of rats received a 0.001% aqueous solution of indomethacin ad libitum as drinking water for days 1-8 and/or a subcutaneous injection of 500 micrograms/kg body weight of PGE2 immediately before and 2 h after each MNU dose. They were then maintained on basal diet and plain tap water without further treatment. At autopsy at week 31, the tumor incidence and the mean number of tumors per rat were 90% and 1.7 in untreated rats, 67% and 0.8 in indomethacin-treated rats, and 79% and 1.2 in indomethacin + PGE2-treated rats, respectively. The data indicate that indomethacin reduced the number of large-bowel tumors, while pharmacologic doses of PGE2 failed to reestablish the anticarcinogenic activity of indomethacin. It was concluded that a tolerable therapeutic dose of indomethacin can reduce the carcinogenic activity of MNU in the large bowel.
The nonsteroid anti-inflammatory drug indomethacin, a potent prostaglandin synthesis inhibitor, may play a role in preventing chemically-induced large bowel cancer development in rats. 250 male Sprague-Dawley rats were given weekly intrarectal doses of 2 mg/kg body weight of acetoxymethyl-methylnitrosamine (AMMN) in the first 10 weeks of the experiment to induce large bowel tumors. Experimental groups received a 0.001% aqueous solution of indomethacin ad libitum as drinking water for different time intervals. At autopsy in week 21, the indomethacin treatment in the first and second 10-week periods, or only in the second 10-week period significantly reduced the number of large bowel tumors compared to non-treatment control groups, while the treatment in the first 10-week period alone did not affect the tumor development. It was observed at autopsy in week 31 that the 10-week cessation of treatment after the effective treatments permitted the growth of tumors, but the treatment in the first and second 10-week periods was effective enough to suppress tumor appearance compared to other groups. It can be concluded that indomethacin has an antiproliferative activity on large bowel carcinogenesis.
Fifteen patients with colorectal tumours, 15 patients with Crohn's disease (CD) and two groups of normal controls were investigated for the presence of spontaneous suppressor cell activity (SSCA) in peripheral blood mononuclear cells (PBMC). In comparison to the age and sex matched controls patients with colorectal carcinoma exhibited a significant increase in SSCA (P less than 0.01). No evidence could be obtained that the suppressive effect was due to a soluble factor such as prostaglandins. In contrast, patients suffering from CD presented a decreased SSCA. No correlation was obtained between the enhanced SSCA in tumour patients and the clinical stage of the disease, levels of oncofetal antigens or serum immune complexes. Likewise in patients with CD no correlation was found between decreased SSCA and CD index or different serum parameters. When PBMC of the different test groups were incubated with histamine or cimetidine before they were added to the indicator system the suppressive activity remained unchanged. Also pre-incubation of normal PBMC with alpha-fetoprotein or carcinoembryonic antigen did not change the spontaneous suppressor cell activity. Whether the significantly enhanced in vivo activity of spontaneous suppressor cells in patients with colorectal carcinoma is one of the multifactorial mechanisms leading to the establishment of cancer or whether it rather represents a reflection of the immune system on colorectal tumour antigens remains unsolved.
Peripheral blood mononuclear cells of patients with different tumors of the gastrointestinal tract (esophagus, stomach, colon, rectum), with Crohn's disease and healthy controls were analyzed for their capacity to produce mitogen induced interleukin-2 (I1-2). Tumor patients could be divided into two groups, one group exhibiting a nearly normal and a second group showing a significantly decreased production of I1-2. Most of the patients with a carcinoma of the colon were found in the low-producer group. Patients with Crohn's disease did not significantly differ from the relevant controls. Tumor patients with proven metastasis produced less I1-2 as compared to those with localized disease although the differences are not significant. When I1-2 containing supernatants of patients with tumors were additionally analyzed for the presence of prostaglandin E2, an inverse relationship could be demonstrated. Supernatants showing a suppressed activity of I1-2 exhibited increased amounts of PGE2, indicating a modulation of I1-2 production by prostaglandin E2.
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The "borderline lesion" of the stomach (severe dysplasia of the protruded type) is nowadays considered to be a true precancerous lesion. Histologically, this lesion is characterized by a proliferation in the area of the glandular neck, combined with severe cellular atypia. Investigation by means of transmission electron microscopy reveals the structure of these cells to be very similar to the structure of cells of an intestinal-cell-type carcinoma of the stomach. In addition to signs for a loss of differentiation of the cells, such as the absence of rough-surfaced endoplasmatic reticulum, mucin granules, and of the polarity of the cells, remarkably frequently luminal bulges and "blebs" developed to various extents can be detected. Morphometric analysis is delineating the tendency of structural features of the borderline lesion to develop toward the gastric cancer cell. These irregularities might be expressions of the beginning of expansive growth and signs pointing to differentiation into malignant neoplasia.
Between 1978 and 1981 634 frozen section examinations were performed during 185 operations on patients with pancreatic or periampullary carcinoma. The frozen section findings and the definite reports after paraffin embedding were identical in 97.2% of all examinations. 1.6% of frozen section findings were false negative, 0.2% false positive. The positive predictive value, especially important for the surgeon, was 100% for examinations of the pancreas and the primary tumor and 98.9% for metastases and structures suspicious of metastases. The negative predictive value was 94.3% and 99.6% respectively. Serious complications of pancreatic biopsies were not observed. On 438 pancreatic resection specimens after intraoperative frozen section examination a benign disease was diagnosed between 1971 and 1981. By further work-up after paraffin embedding at another institution a carcinoma was detected surprisingly only in two cases (0.5%). A pancreatic resection based on a false positive frozen section finding was never performed. The results prove that intraoperative frozen section examination is a useful and reliable diagnostic procedure. A review of the recent literature demonstrates as well that similar results cannot be achieved by other methods including intraoperative fine needle aspiration biopsy.
Local excision of rectal cancer can be a part of treatment of this tumor. The authors do not feel that this procedure is only palliative. Clinical staging I and II, tumor diameter less than 3 cm, malignancy grade 1 or 2, invasion no deeper than the submucosa, and no signet-cell carcinoma are all requisites for limited, local excision of rectal carcinoma. Patients operated upon under these criteria have a five-year survival rate of 89.6 +/- 21.7 per cent for those with invasion into the submucosa and 78 +/- 49.9 per cent for those with invasion into the muscularis propria. But to get such good results, strict self control must be exercised in selecting patients.
To investigate the factors influencing the malignant potential of adenomas, a logit analysis was carried out. The malignancy rate (frequency of malignant areas infiltrating into submucosa) in adenomas is influenced by 1. the size of the adenoma, 2. the interrelationship between size and histological type (tubular, tubulo-villous, villous) and 3. the macroscopic growth pattern (pedunculated, semipedunculated, sessile). No influence is exercised by the number of adenomas, their localization, or the sex of the patient.
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Of 426 operatively removed renal cell carcinomas, macroscopic vein invasion was proven in 197 cases, i.e. 46.2%. The inferior vena cava contained tumor in 4.0%, the trunk of the renal vein in 24.4%, and in 18.1% only the major branches of the renal vein were found invaded. In 132 patients (31.0%) with tumor-free major renal branches, vein invasion could be demonstrated histologically. Statistically significant correlations could be found comparing renal vein invasion and other pathological parameters as histological grade, tumor diameter, local spread and lymphatic metastases. Proof of renal vein invasion affects prognosis: age-corrected 5-year survival rates amounted to 33.6 +/- 8.5% in macroscopically determined vein invasion; 62.3 +/- 11.9% in histologically determined vein invasion, and 89.0 +/- 10.3% without vein invasion. Vein invasion should be subdivided into an only histological and a macroscopical group of evidence, because significantly different survival rates will result. Therefore, an exact definition of the UICC classification criteria and a standardized usage are necessary and should be kept in mind for the next issue of the UICC classifications.