Biomedical subjects
Publications and source records attributed to R Warzok.
Leprosy is a widely distributed infectious disease in countries with tropic or subtropic climate and the most frequent treatable polyneuropathy. Because the import into countries with temperature climate should be considered a review is given on different stages and forms of course. Special attention is paid to structural changes and to the significance of morphological studies in establishing the diagnosis.
Under consideration of the ventrolateral approach, the Regio intervertebralis lateralis was demonstrated for 25 isolated cervical vertebral columns under clinical-topographical and morphometrical aspects. For obtaining mean values and as a comparison of the sides, the M. longus colli, the bony structures under special consideration of the Foramen intervertebrale in the craniocaudal and medio-lateral extension, the Arteria vertebralis with its Rami spinales, the system of the venous blood pathways, the Ganglion spinalis and the spinal nerve root were examined.
The activity of the enzyme gamma-glutamyltranspeptidase (GGT, E.C. 2.3.2.1) was studied in brains of Wistar rats at different stages of pre- and postnatal development. In brain homogenates the activity was lowest at day 20 of pregnancy. After birth it increased slightly up to day 10 of postnatal life, than a drastic increase could be observed until day 30, where the enzyme activity reaches a plateau, which was constant over the whole lifetime. At day 15 of pregnancy histochemical examination revealed enzyme activities in brain capillaries and the leptomeninx. No or very low activities were found in the choroid plexus and in the ependyma. The GGT activity continuously increased over the following time of pregnancy and postnatal development. At day 5 of postnatal development additionally to activities in the leptomeninx, brain capillaries, choroid plexus and ependyma the enzyme could also be observed in undifferentiated cells of the subependymal periventricular layer of the telencephalon. Microdiscelectrophoretical separation of Triton X-100 homogenate extracts of microdissected cells from the subependymal layer and the ependyma or the choroid plexus, resp., revealed only one enzyme band of GGT.
A short survey is given about the application of microelectrophoresis in clinical and experimental pathology. There are several fields in which microelectrophoresis in combination with enzyme histochemistry offers new possibilities in diagnosis, especially in cytology, liver biopsy and tumor pathology. Some difficulties and own experiences with the application of microelectrophoresis are shortly discussed.
A report is given on a 25-year-old man who was admitted to the hospital because of severe headache (CSF: 280 cells per mm3, 90% lymphocytes, later normal). Headache persisted for one year when acute deterioration occurred. The CSF showed 140 cells per mm3 (100% lymphocytes), 1 g% protein. Improvement of the patient's state after corticosteroid therapy. 9 months later he interrupted the intake of prednisolon and provoked exacerbation of the disease with motor and sensor disturbances. 21/2 years after the beginning of the symptomatology he suddenly developed cerebral coma and died. The autopsy revealed ischemic necrosis of both the left and the right thalamus, hemorrhage with destruction of the left-sided thalamus, nucleus caudatus, internal capsula and rupture into the lateral ventricle. Histologically, preparations from all parts of the brain revealed granulomatous angiitis of arteries, capillaries and veins with fibrinoid necrosis, infiltration of lymphocytes, histiocytes, epitheloid and plasma cells as well as numerous giant cells. Microaneurysms were found frequently. The inflammatory process showed various stages of the development indicating that more and more vessels had been involved at different times. Contrasting to giant cell arteritis of A. temporalis, in giant cell angiitis of the brain the blood sedimentation rate is frequently normal. In all reported cases, vessels of the leptomeninges were involved. Therefore, leptomeningeal biopsy is regarded as diagnostic procedure. The own observation as well as data of the literature demonstrate that giant cell angiitis of the brain is distinct from temporal arteritis (Horton's disease), not only because of differences in location, but also because of differences in age incidence and prognosis. It is supposed that giant cell angiitis is not a nosological entity, but the expression of different etiologic and pathogenetic mechanisms.
On the basis of own material and data of the literature problems of the classification of pituitary adenomas are discussed. Special emphasis is laid on typical light and electron microscopical as well as immune histochemical criteria of prolactinomas. Clinical and morphological aspecte of microadenomas and adenomatous hyperplasias are briefly described.
On the basis of light and electron microscopic findings problems of the morphology of gonads in testicular feminization syndrome (TF) are discussed. Within the tubules 3 cell types (light, dark, intermediate) can be distinguished which are regarded as different functional forms of Sertoli cells. Germ cells were not observed definitely. There are, however, remarkable difficulties in morphological distinction between undifferentiated Sertoli and germ cells. It is underlined that fine structure of gonads and cellular composition of tubules as well as the amount of interstitial cells depend on the age of the individuum and on the form of TF (complete and incomplete).
A nodular neuroblastoma was partially removed from the cerebellar vermis of a 15-month-old boy. Postoperative irradiation and chemotherapy were performed. More than 5 years later, re-operation revealed a mature ganglioglioma. Problems relating to the maturation of ganglionic tumors are discussed. The present case emphasizes that it is not justified to regard all neuroblastomas of the central nervous system as highly malignant neoplasms (grade IV).
In 1,491 autopsy cases with CNS tumors observed at the Pathological Institute of the Medical Academy of Erfurt in the period from 1953 to 1976 (54,946 autopsies) 72 cases (4.8%) with neurinomas were found. They comprise 67 solitary neurinomas, 1 bilateral acoustic neurinoma without other signs of neurofibromatosis, and 4 cases of neurofibromatosis with neurinomas of the CNS. Among the 68 cases with CNS neurinomas (neurofibromatoses excluded) 87% were acoustic neurinomas, 12% spinal tumors, and 1 case was located in the trigeminal nerve. In 60 (88%) of these 68 cases, the neurinoma was operated upon or clinically diagnosed, resp. The diameter of 18 (26%) neurinomas of the autopsy material was larger than 5 cm. Patients in the 6th decennium predominated in this series. The sex distribution revealed a preponderance of females over males (3:1). In 3 cases further CNS tumors (ependymoma, glioblastoma, meningioma) were found. Additionally, 3 cases had carcinomas of different localization (Table 5). Following tumors were seen in 9 cases of Morbus Recklinghausen with CNS involvement: 4 cases with multiple neurinomas, 3 meningiomas, 1 astrocytoma, 2 glioses and 1 angiomatous malformation (Table 6). Among 1,670 CNS tumors in biopsy material, 144 (8.6%) were neurinomas. 60% of them were located in the nervus acusticus, 40% spinally, mainly in the thoracic region. The 6th decennium was most affected, and females were more frequent than males (2:1) in our material. Nearly all CNS neurinomas were benign. Only 1 spinal tumors was classified as a malignant neurinoma. 2 of the 9 cases with Morbus Recklinghausen had malignant neurogenic tumors (neurofibrosarcomas).
In long-term experiments with Hooded rats the carcinogenic potential of 1-methyl-3(p-bromophenyl)-1-nitrosourea (Br-MPNU) could be demonstrated for the first time. Br-MPNU is formed also endogenously after combined administration of 1-methyl-3(p-bromophenyl)-urea (Br-MPU) and sodium nitrite. After repeated intragastric administration of 0.33 mmol Br-MPU and 0.73 mmol NaNO2 per kg b.w. papillomas and carcinomas of the forestomach developed in 83%. After repeated administration of 0.28 mmol Br-MPNU per kg b.w. these neoplasms were observed in 88%. The comparison of results obtained in similar experiments with 1-methyl-3-phenyl-1-nitrosourea shows that bromine substitution led to a reduction of the carcinogenic activity. The present paper is part of a complex program studying the interrelationships between structure, physico-chemical properties, mutagenicity and carcinogenicity of nitrosoureas.
A report is given demonstrating the maturation of a neuroblastoma of the cerebellum and its transformation into a ganglioglioma. In a male infant statomotor retardation was diagnosed at the age of 6 months. 9 months later, he developed symptoms indicating a cerebellar neoplasm. Craniotomy showed a vermian tumor which was classified histologically as a neuroblastoma. 51/2 years after the first operation, a control CT scan revealed a recurrence which showed light and electron microscopically the structure of a ganglioglioma. The child is now 8 years old and develops relatively well. On the basis of this observation and of the limited data published in the literature, it is suggested that, with the aid of light microscopy, it is possible to distinguish neuroblastomas from common medulloblastomas what is of practical importance because neuroblastomas seem to have a better prognosis. However, differential diagnostic criteria need further precision. Problems of the nosological placement of neuroblastomas and their histogenetic relationship to medulloblastomas are discussed. The statement of the WHO Classification of Tumors of the CNS that neuroblastomas correspond to grade IV cannot be accepted generally.
On the basis of an own observation and 38 cases found in the literature problems of histogenesis, classification and biological behavior of myogenic brain tumors and mixed neoplasms with myogenic elements are discussed. In a 2-year-old boy, 2 months after first clinical symptoms, a tumor of the walls of the 4th ventricle had been removed. The growth showed a large variety of histological structures. Irregularly arranged bundles of long muscle fibers with centrally located nuclei and cross striation were the most striking feature. Large cells with prominent nucleoli resembling ganglion cells were identified electronmicroscopically as rhabdomyblasts. Other areas were composed of astrocytic elements or of honeycomb-like structures usually observed in oligodendrogliomas. In serial sections small cells with dark nuclei typical for medulloblastomas were found in small areas. The body died 15 months after the onset of symptoms. The autopsy revealed a relapse in midline structures of the cerebellum. The histological picture differed substantially from that of the primary neoplasm. It was composed only of small cells, showed a large number of collagenous fibers and corresponded to a demoblastic medulloblastoma. The histological variety is regarded as an expression of the pluripotency of neoplastic elements, which are evidently capable to form neuroectodermal as well as mesenchymal structures. It is emphasized that an overgrowth more anaplastic cells led to the described morphological changes. Gliomedullomyoblastoma is regarded as a special variant of medulloblastoma with an unfavourable prognosis.
5,100 formalin-fixed pituitaries of an unselected autopsy material of the Institute of Pathology of the Ernst-Moritz-Arndt-University of Greifswald were analysed with regard to the occurrence of adenomas and adenomatous hyperplasias. Beside the histological classification the size was determined. For some adenomas of the pituitary gland (ACTH-cell-adenomas, TSH-cell-adenomas and evidently also prolactinomas) the development from a hyperplasia which is a consequence of a central regulation disorder is supposed. The pathogenesis of the other types of adenomas remains still unclear. Difficulties in differential diagnosis between adenomatous hyperplasias and small adenomas are discussed.
A short history of the Greifswald chair of pathology is given, beginning with the establishment in 1856, just 400 years after the foundation of the university. The work of directors of the institute is outlined at the background of scientific and social preconditions and developments. Special emphasis is paid to the scientific heritage of such outstanding researchers as Grohé, Grawitz, Gross, Domagk, Ceelen, Leupold, Loeschcke, Bienengräber, Holle, Patzelt and Stiller. From this review it becomes evident, that in many fields of pathology (especially in the field of inflammation) the development has been influenced by the scientific work of this chair.
On the basis of an own observation of polyposis coli combined with lipomatous hamartoma of the corpus callosum problems of the genesis of lipomas of the central nervous system and its coverings are discussed. Colectomy was performed in a 37-year-old man because of polyposis coli. His sister suffers from the same disease. The patient died 25 d after the operation as a result of diffuse peritonitis. As an incidental finding, the autopsy revealed a lipomatous hamartoma with a diameter of approximately 1 cm. Histologically the growth showed the typical structure of a lipoma and contained a remarkably high number of blood vessels with proliferations of the intima and fibrosis of the walls. At the periphery small calcifications were demonstrated. In the adjacent brain tissue angiomatous proliferations of blood vessels were observed. Furthermore, disturbances of the gross structure of the gyri cinguli and other gyri of the median surface of the brain were found. The histological examination discovered marked irregularities of the single layers of the cerebral cortex. It is suggested that developmental and genetic factors might play a significant role in the genesis of lipomatous tumors of the CNS.
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Agyria is an extremely rare malformation of the brain caused by an arrest of neuronal migration towards the cortex. A case of nearly complete agyria is presented in a 2 8/12 year-old boy. The autopsy revealed complete absence of cerebral convolutions in the frontal, parietal and occipital lobes of both hemispheres and discrete convolutions in the temporal lobes. The cortex reached up to 22 mm and the central white matter was very thin, occipitally up to 2 mm. Additionally, hydrocephalus internus was observed. Clinical and pathoanatomical findings are presented and compared with other data published in the literature. The results are discussed in relation to a possible pathogenetic mechanism leading to this cerebral malformation.
The Lesch-Nyhan syndrome is commonly regarded as a metabolic disorder of the purine metabolism without specific morphological changes. In the present paper a report is given on a 13-year-old boy. The neuropathological investigation revealed PAS positive deposits in the ganglion cells of the nucleus olivaris. In HE preparations, the storage material appears as light foamy accumulations displacing nuclei to the cell border. The deposits are sudan-III-negative and there is no UV fluorescence. Electron microscopically the primarily formol fixed tissue of the nucleus olivaris shows circumscribed accumulations of a relatively homogeneous substance with medium density in the dilated smooth endoplasmic reticulum. The diameter ranges from 476 to 850 nm. In this connection, it seems to be possible that the lack of cGMP might lead to disturbances of the protein metabolism of postsynaptic structures, the significance of which is discussed. It is suggested that further investigations of the CNS in Lesch-Nyhan patients should be focussed on the nucleus olivaris.