[Type II bile duct cyst or accessory gall bladder?]

Choledochal and bile duct's cysts are well known, their morphological classification and also operative management had been described in detail. The most frequent are cysts' types I. and IV., in which the operation consists of cyst's resection and biliary tract reconstruction. Authors summarize nowadays knowledge and present case of 21-months old girl, who was diagnosed of choledochal cyst accidentally. She was operated on electively; the operative finding verified 2 cystic lesions with own bile ducts joined to choledochal duct. The proximal cyst had 3 diverticles and thus mimicked a choledochal cyst type IV. on the preoperative examinations. The resection of both cystic lesions was done. This is a unique case of biliary tract malformations.

[Extrauterine choriocarcinoma--a rare form of gestational trophoblastic disease]

Choriocarcinoma represents the most serious form of trophoblast gestation disease. In the majority of cases the carcinomatous tissues fill out the uterine cavity, or they grow in a form of nodes deep in the uterine wall. The primary extrauterine localization of this tumour is very rare. The authors describe two cases of choriocarcinomas with tubal or ovarian localization. (Fig. 4, Ref. 19.)

[Technical problems in the preparation of biopsy samples of the spleen]

Spleen tissue sampling for bioptical examination should be performed after mutual consultation of clinician and pathologist. Clinician should know what is expected from the pathologist. This can influence preparation and sampling method considerably. In a great amount of cases the whole organ is removed. A lab technician is sampling on her own and her contribution to a good result can be either positive or negative. Imprint preparations from the tissue sections can be useful. Specialized examination should be performed in the presence of a pathologist or his co-workers. The active approach of a lab technician can significantly contribute to the value of examined sample of the spleen, of the organ until recently considered to be not important or full of mysteries.

[Traumatic rupture of the spleen. Histopathologic findings]

The most common causes of splenic rupture are blunt injury and surgical intervention in abdominal cavity. Morphological investigation of the spleen often shows but a small capsular laceration as well as haemorrhage and granulocytic infiltration in microscopy of its margins. The laceration may be sometimes difficult to find. There are two types of microscopical haemorrhage. One in sinus-lacking subcapsular tissue zone, the other in deeper layers. In this case the tissue haemorrhage is diffuse, sometimes within or around the marginal zone. The sinuses are neither collapsed nor obturated by any material even close to margins of the wound.

[The spleen in hereditary spherocytosis]

Hereditary spherocytosis is the most common inherent, autosomal dominant hemolytic anemia. Mild splenomegaly, venostasis and common decrease of while pulp is characteristic for hereditary spherocytosis. Cords are filled with spherocytes, sinuses can be empty or squeezed. Both sinuses and veins include ghost erythrocytes that lost haemoglobin. They are seen light-microscopically in differential interferent contrast. Macrophages are numerous, sinus lining cells are hypertrophic. Erythrophagocytosis is hardly seen by electron microscope. Not all red blood cells are spherocytes. Spherocytes are seen well in electronmicroscopy. We did not observed transition of erythrocytes through sinus walls. In certain circumstances lots of ferritin is seen both intra and extracytoplasmically. Iron accumulation in cords can result in their fibrosis.

[Fibronectin and the human spleen]

Fibronectins are glycoproteins with a function of molecular glue. The aim of the study is to encourage interest in processes in extracellular matrix of the spleen. Undigested cryostat or formol-paraffin sections and commercially available antibodies were used. We were mostly successful in extracellular localization of fibronectin in trabeculae, vessel walls and lamellae of circumferent reticulum of periarterial lymphatic sheaths and in the ring fibres of the sinuses. Changes in the amount of fibronectin occurred, for example, in circulation disturbances. In hereditary spherocytosis the ring fibres were reduced. Increase of fibronectin can suggest the development of fibrosis.

[Reactivity of antibodies to collagen types I to IV and antibodies to chondroitin sulfate in the spleen]

Antibodies to collagen type I and III reacted negatively, antibodies to collagen type IV positively with reticulin, trabeculae and circumferent reticulum of lymphatic sheaths, poorly positively with capsula, strongly positively with subcapsular zone. Antibodies to collagen type II reacted positively with capsula, poorly with subcapsular zone, strongly with sinus wall and poorly with trabeculae. They did not react with circumferent reticulum of periarterial lymphoid sheaths. Antibodies to collagen type II and IV reacted positively with central arteries. Antibodies to chondroitinsulphate C reacted poorly and antibodies to chondroitinsulphate B strongly positively with sinus walls and oval cells spread in the white and red pulpa. Antibodies to chondroitin sulphate A reacted similarly as antibodies to chondroitinsulphate B.

[Dermoid cyst of the spleen]

The case report of a 14-year old girl is given. In her spleen of the weight of 1580 g an irregular cyst of glossy inner surface and with striking trabeculation developed. It was filled with clear greenish liquid. The wall was formed by hyalinised collagen tissue which was covered by epidermoid and cuboidal epithelium on the inner surface. Vessel conglomerates were frequent, some bleeding or mononuclear infiltrates, foci of giant cell granulation tissue, lymphoid or fatty tissue were present.

[The effect of age and risk factors on postoperative complications and mortality in patients with surgery for colorectal carcinoma]

The authors analyzed the risk factors and their impact on perioperative complications and mortality in aged patients electively operated due to colorectal cancer at the II. Surgical Clinic LFUK in Bratislava during the period from January 1, 1986 to October 31, 1994. The patients were divided into three groups according to WHO criteria, those younger than 65, from 65 to 75, and older than 75 years of age. The results are in correlation with the data published in literature. According to the accomplished results the age per se does not represent contraindication to surgical intervention. However, the lethality in the aged patients with two or more risk factors significantly increases. In regard to the latter the authors recommend a strictly individual consideration as to whether these patients would benefit more from palliative therapy procedures as to life prolongation and its quality improvement. (Tab. 5, Ref. 25.)

[Functional morphology of the spleen]

The spleen was till the first half of the twentieth century considered to represent an organ of no special significance. Nowadays its clearance function and position in the immunity system is thoroughly investigated. Informations on its cellular composition and compartments are sufficient. The problems coinciding with circulation in the spleen are solved. The study of interactions of T and B lymphocytes regarding the development of humoral immunity do not provide clear results. Unclear remain also the relations of extracellular and cellular structures. The localisation of the spleen in blood circulation and large amount of migrating lymphocytes justify its significant position in the protection of host against infections spreading haematogenously. It is not inevitable for survival, but its removal increases the risk of unmanageable infections carried by bacteria with polysaccharide capsules. The microenvironment in the spleen enables intercellular relations and determines the development of immune reactions. Microcirculation enables it to function as a biological filter without the necessity of specialized filtrating structures being present. In consequence of blood filtration everything leaks into the extravasal space. Subsequently all components normally constituting the blood return back into the blood within vessels. That is why no special structures are formed in order to filter individual components from the blood. All components that should not be present in the blood are excluded extravasally. The substances which are not let through the wall of sinuses into the blood, remain in the marginal zone and in the red pulp. The macrophages of the marginal zone and red pulp destroy and degrade the unrequired substances. (Ref. 26).

[Morphologic analysis of synovial effusion in rheumatoid arthritis. I. Light microscopy--cytology, histochemistry and semi-thin sections]

Inflammatory synovial fluid in patients with rheumatoid arthritis contained IgG, IgM and C3 component of complement, unspecific esterase and acid phosphatase and affinity to Pisum sativum agglutinin (PSA). Various forms of a degeneration of polymorphs, giant non-lymphoid mononuclear cells with cerebriphorm nuclei in different stages of phagocytosis and lymphocytes, sometimes with numerous nuclear invaginations, were found. All the cells of synovial fluid contained IgG, not the IgM. C3 component of complement was limited to non-lymphoid non-lymphoid mononuclear cells. Both the enzymatic activities were especially stressed in polymorphs. PSA was bound to all cells.

Immunohistochemical markers in uterine tumour diagnostics

The recent fast growth of data on new markers and their identification in different cellular structures results in the need of narrow selection with regard to their applicability. The aim of the review is description of application possibilities of immunohistochemical methods in the diagnostics of pathological processes in the cervix and body of uterus. (Fig. 5, Ref. 43.)

[Trophoblastic disease. I. Use of immunohistochemistry in the diagnosis of complete hydatidiform moles]

Immunohistochemical study of 15 complete moles detected expression of human chorion-gonadotropin (hCG), human placental lactogen (hPL) and placental alkaline phosphatase (PLAP). Syncytiotrophoblast showed the most conspicuous expression of hCG, hPL positivity was mild, PLAP positivity poor. Intermediate trophoblast had stronger hPL positivity There was not any positivity in cytotrophoblastic cells.

[Trophoblastic disease. II. Immunohistochemical and cytogenetic parameters of partial hydatidiform moles]

A group of 30 cases of partial hydatid mole were studied by cytogenetics and immunohistochemistry. Trophoblastic cells were always triploid. Syncytiotrophoblastic cells and intermediate trophoblast showed the strongest expression of PLAP, hPL positivity was mild. Expression of hCG was only focal. There was not found any detectable immunopositivity in trophoblastic cells.

[Monoclonal antibodies in the biopsy diagnosis of tumors]

Immunohistochemistry has made rapid advances over the last decades. The 80s have been the era of monoclonal and polyclonal antibodies which have made identification of different antigens more exact and more simple. Demonstration of individual markers of tumor cells has greatly contributed to the determination of histogenesis and to classification of tumors. The initial euphoria, however, has been on the wane as facts have accumulated demonstrating that the expression of many markers is disappearing particularly in less differentiated tumors or that new markers appear which were considered to be specific for a different type of tissue. Some of the problems involved are being dealt with in the short overview presented.

[Immunohistochemical analysis of the liver using monoclonal antibodies against intermediate filaments]

The expression of some types of cytokeratin and vimentin in the liver was studied by using monoclonal antibodies to these types of intermediary filaments. Necrotic samples from livers without pathological finding were examined. A panel of 5 monoclonal antibodies, prepared in Czechoslovakia, to cytokeratins Nos. 7,8,18, and 19, as well as to vimentin was used. The findings confirmed the characteristic expression of cytokeratins 8 and 18 in hepatocytes and of cytokeratins 7, 8, 18, and 19 in epithelial cells of intrahepatic bile canaliculi, that monoclonal antibodies prepared in Czechoslovakia (LAMO, Brno and VUKEO, Brno) can be successfully used in immunochemical studies of intermediary filaments in the liver.

[Enzymes of the female prostate during the fertile age and after menopause. Comparative histochemical study]

Using histochemical methods, the authors compared the enzymes in the prostate of 19 women of fertile age (15-45 years) and in 9 women after the menopause (53-79 years). In women after the menopause they observed a reduced naphthylesterase activity and also of some other enzymes in the prostatic glands which indicates a possible reduced secretory activity of the prostate in women past reproductive age. Conversely in women after the menopause, with age a marked increase of the activity of lysosomal acid phosphatase in the epithelium of the prostatic ducts was found. "Prostatic" acid phosphatase persisted as regards its activity also in women after the menopause. A drop of activity of dehydrogenases occurs only in women in the most advanced age groups, during the early menopause the findings were similar as during fertile age. The demonstrated differences in enzymes of the prostate in fertile women and after the menopause indicate their different function in the woman's life. These data are the first basis for the possible inclusion of the female prostate among hormone-dependent organs of female reproduction.

[Development of adrenergic innervation of the heart in man]

The presence of postganglionic adrenergic nerve fibres in the myocardium of human fetuses ranging in gestational age from 9 weeks to 8 months was studied by the method of glyoxilic acid induced fluorescence (GIF). Heart samples were obtained after legal induced interruption of pregnancy, indicated in part of the cases for genetic defects. Identification of adrenergic nerve fibers in the human heart proved possible only in the second half of gestation. This finding supports the assumption of humoral rather than nervous regulation of heart activity in the first half of intrauterine development of the fetus.

[Cardiac complication of mucoviscidosis]

Over the years 1971 to 1988 autopsies of 33 children with the clinical diagnosis of mucoviscidosis were performed at the Institute of Pathology, Medical Faculty, Comenius University, Bratislava. In three cases pronounced changes were observed on the myocardium, predominantly on the left ventricle. Multifocal necrosis and fibrosis of the myocardium represent rare but severe changes occurring as a complication of mucoviscidosis in infancy.