The death of the Empress Elisabeth of Austria and Queen of Hungary-retold and reassessed with reconstruction of her autopsy

In this publication 125 years after the violent death of the famous Empress Elisabeth (1837-1898) of Austria, known as Sisi, a modern evaluation as well as valuation will be presented. The day after her assassination by the young anarchist Luigi Lucheni using a file, a partial autopsy was performed to find out the exact cause of death-a pericardial tamponade. The complete translation of the autopsy report is part of this article, the intention being to avoid unclear wording and translation errors, which have often caused some confusion in the past. A pictorial illustration of the puncture canal will provide clarity through medical facts as to how Empress Elisabeth's death came about by correct pathological and anatomical description and, thus, counteract former interpretations.

Multifactorial White Matter Damage in the Acute Phase and Pre-Existing Conditions May Drive Cognitive Dysfunction after SARS-CoV-2 Infection: Neuropathology-Based Evidence

BACKGROUND

There is an urgent need to better understand the mechanisms underlying acute and long-term neurological symptoms after COVID-19. Neuropathological studies can contribute to a better understanding of some of these mechanisms.

METHODS

We conducted a detailed postmortem neuropathological analysis of 32 patients who died due to COVID-19 during 2020 and 2021 in Austria.

RESULTS

All cases showed diffuse white matter damage with a diffuse microglial activation of a variable severity, including one case of hemorrhagic leukoencephalopathy. Some cases revealed mild inflammatory changes, including olfactory neuritis (25%), nodular brainstem encephalitis (31%), and cranial nerve neuritis (6%), which were similar to those observed in non-COVID-19 severely ill patients. One previously immunosuppressed patient developed acute herpes simplex encephalitis. Acute vascular pathologies (acute infarcts 22%, vascular thrombosis 12%, diffuse hypoxic-ischemic brain damage 40%) and pre-existing small vessel diseases (34%) were frequent findings. Moreover, silent neurodegenerative pathologies in elderly persons were common (AD neuropathologic changes 32%, age-related neuronal and glial tau pathologies 22%, Lewy bodies 9%, argyrophilic grain disease 12.5%, TDP43 pathology 6%).

CONCLUSIONS

Our results support some previous neuropathological findings of apparently multifactorial and most likely indirect brain damage in the context of SARS-CoV-2 infection rather than virus-specific damage, and they are in line with the recent experimental data on SARS-CoV-2-related diffuse white matter damage, microglial activation, and cytokine release.

An 18th century description of endometriosis : The autopsy of the Countess von Reitzenstein

Descriptions of endometriosis in 18th century monographs and manuscripts are rare and the recorded macroscopic features of endometriosis seldom support this attribution to the described cases. Recently, we became aware of an anonymous German autopsy report from the 18th century. After transcription, the manuscript was assessed by pathologists with historical expertise. This revealed that the patient died because of a malignant tumor, most probably of a gynecological origin. Furthermore, the described ovarian pathologic findings strongly support the diagnosis endometriotic ovarian cyst. Like Giovanni Battista Morgagni (1668-1772) in his landmark publication De Sedibus et Causis Morborum per Anatomen Indagatis (1761), the author correlated the pathological findings at autopsy with the symptoms of the patient. The identity of the patient could, with high probability, be established as being the Countess of Reitzenstein, the wife of a Prussian general major in the army of Friedrich the Great: Karl Erdmann von Reitzenstein (1722-1789).

Learning discriminative classification models for grading anal intraepithelial neoplasia

Grading intraepithelial neoplasia is crucial to derive an accurate estimate of pre-cancerous stages and is currently performed by pathologists assessing histopathological images. Inter- and intra-observer variability can significantly be reduced, when reliable, quantitative image analysis is introduced into diagnostic processes. On a challenging dataset, we evaluated the potential of learning a classifier to grade anal intraepitelial neoplasia. Support vector machines were trained on images represented by fractal and statistical features. We show that pursuing a learning-based grading strategy yields highly reliable results. Compared to existing methods, the proposed method outperformed them by a significant margin.

Acute dyspnea caused by a giant spindle cell lipoma of the larynx

BACKGROUND

The spindle cell lipoma (SCL) is a special type of lipoma and this is very rare in the head and neck regions. There are only five reported cases exist, which describes the occurrence of a SCL in the hypopharynx.

METHODS

Our case report presents a case of a very large SCL in the larynx. We want to describe that how we treated the patients and compared the situation with other reported cases.

RESULTS

Intraoperatively, we found a tumor mass of 7 × 5 cm. It was successfully removed with the carbon dioxide laser. No postoperative complications occurred.

CONCLUSIONS

Although SCL is a very rare diagnosis in the larynx/hypopharynx, it should be included in the differential diagnosis of larynx/hypopharynx tumors. Our case is the first report of such a large SCL in the larynx. The clinical symptoms occurred relatively late and ended up in an acute situation of stridor and dyspnea.

[The Malady of Emperor Frederick III. and Virchow's diagnostic role]

Crownprince Frederick Wilhelm of Prussia was once the hope of the liberal movement in Germany. He embodied and lived a humanistic ideal based on the spirit of the enlightenment. Starting in January 1887 the passionate pipe smoker suffered on an unusual long hoarseness. A polyp of the vocal cord was diagnosed. Although this diagnosis seemed harmless, an odyssee was launched that made history. Rudolf Virchow-the foremost pathologist of that time-was involved in the following histological diagnosis. His role and that of the sprouting histopathology will be presented in this essay.

Frequency of primary cutaneous lymphoma variants in Austria: retrospective data from a dermatology referral centre between 2006 and 2013

BACKGROUND

Primary cutaneous lymphomas (PCL) are a heterogenous group of rare lymphoid neoplasms with incomplete information on global and regional prevalence. The recently introduced lymphoma classifications define distinctive clinicopathological disease entities that should allow for more accurate epidemiological assessment.

OBJECTIVE

The aim of this study was to evaluate the prevalence and clinical spectrum of PCL diagnosed and treated at the Department of Dermatology and Venereology in St. Pölten, Lower Austria, a dermatology referral centre providing secondary and tertiary care for a population of about 600 000.

METHODS

In this retrospective study pathology reports, electronically archived between 2006 and 2013, were screened for the terms lymphoma, mycosis fungoides (MF) and lymphomatoid papulosis (LyP). Patients were diagnosed according to the current WHO-EORTC classification for cutaneous lymphomas and results were compared with data from European, US and Asian centres.

RESULTS

Among 86 patients with PCL (age 58.3 ± 17.35 years, mean ± SD; women 38%, n = 33; men 62%, n = 53) 83% (n = 71) were classified as cutaneous T-cell lymphomas (CTCL) and 17% (n = 15) as cutaneous B-cell lymphomas (CBCL). Nine patients with CTCL showed associated haematological disorders and malignomas. Among 47 MF patients following variants were observed: pilotropic MF (n = 2), follicular mucinosis (n = 1), unilesional MF (n = 1), large-cell transformation (n = 3), erythrodermic MF (n = 1), poikilodermatous MF (n = 2) and posttransplant lymphoproliferative disorder (CD8(+) MF with gamma/delta phenotype after renal transplantation) (n = 1). One patient had MF concurrent with lymphomatoid papulosis. The group of CBCL comprised six cases (40%) of PCMZL and PCFCL each, 20% (n = 3) were classified as PCLBCL, LT.

CONCLUSION

This study for the first time provides data on the distribution of PCL clinicopathologic variants and stages according to the latest classification and staging systems in an Austrian referral centre.

Relative survival of patients with non-malignant central nervous system tumours: a descriptive study by the Austrian Brain Tumour Registry

BACKGROUND

Unlike malignant primary central nervous system (CNS) tumours outcome data on non-malignant CNS tumours are scarce. For patients diagnosed from 1996 to 2002 5-year relative survival of only 85.0% has been reported. We investigated this rate in a contemporary patient cohort to update information on survival.

METHODS

We followed a cohort of 3983 cases within the Austrian Brain Tumour Registry. All patients were newly diagnosed from 2005 to 2010 with a histologically confirmed non-malignant CNS tumour. Vital status, cause of death, and population life tables were obtained by 31 December 2011 to calculate relative survival.

RESULTS

Overall 5-year relative survival was 96.1% (95% CI 95.1-97.1%), being significantly lower in tumours of borderline (90.2%, 87.2-92.7%) than benign behaviour (97.4%, 96.3-98.3%). Benign tumour survival ranged from 86.8 for neurofibroma to 99.7% for Schwannoma; for borderline tumours survival rates varied from 83.2 for haemangiopericytoma to 98.4% for myxopapillary ependymoma. Cause of death was directly attributed to the CNS tumour in 39.6%, followed by other cancer (20.4%) and cardiovascular disease (15.8%).

CONCLUSION

The overall excess mortality in patients with non-malignant CNS tumours is 5.5%, indicating a significant improvement in survival over the last decade. Still, the remaining adverse impact on survival underpins the importance of systematic registration of these tumours.

The EndoPredict score provides prognostic information on late distant metastases in ER+/HER2- breast cancer patients

Background:

ER+/HER2− breast cancers have a proclivity for late recurrence. A personalised estimate of relapse risk after 5 years of endocrine treatment can improve patient selection for extended hormonal therapy.

Methods:

A total of 1702 postmenopausal ER+/HER2− breast cancer patients from two adjuvant phase III trials (ABCSG6, ABCSG8) treated with 5 years of endocrine therapy participated in this study. The multigene test EndoPredict (EP) and the EPclin score (which combines EP with tumour size and nodal status) were predefined in independent training cohorts. All patients were retrospectively assigned to risk categories based on gene expression and on clinical parameters. The primary end point was distant metastasis (DM). Kaplan–Meier method and Cox regression analysis were used in an early (0–5 years) and late time interval (>5 years post diagnosis).

Results:

EP is a significant, independent, prognostic parameter in the early and late time interval. The expression levels of proliferative and ER signalling genes contribute differentially to the underlying biology of early and late DM. The EPclin stratified 64% of patients at risk after 5 years into a low-risk subgroup with an absolute 1.8% of late DM at 10 years of follow-up.

Conclusion:

The EP test provides additional prognostic information for the identification of early and late DM beyond what can be achieved by combining the commonly used clinical parameters. The EPclin reliably identified a subgroup of patients who have an excellent long-term prognosis after 5 years of endocrine therapy. The side effects of extended therapy should be weighed against this projected outcome.

[Vienna's Department of Pathology at the Medical University--a chronology of the past 200 years]

In December 2012 we celebrated the reconstruction of the Department of Pathology at the Vienna Medical School. This short report presents the evolution of this institute by its directors and their main achievements. From Rokitansky to Kerjaschki we follow the path from the work at the morgue to the modern diagnostic methods für personalised medicine.

Type A dissection and chronic dilatation: tenascin-C as a key factor in destabilization of the aortic wall

OBJECTIVES

Tenascin-C plays an important role in myocardial and vascular remodelling. We hypothesized that tenascin-C is a key factor in the development of degenerative disease of the ascending aorta, leading to chronic dilatation and acute aortic dissection.

METHODS

Ascending aortic wall specimens were obtained during surgery for chronic dilatation (n=52) and acute Type A dissection (n=30). Patients (n=12) undergoing aortic valve replacement served as controls. Tenascin-C expression was evaluated by immunostaining and semi-quantitatively assessed using the ImageJ software. TN-C levels in peripheral blood were determined by enzyme-linked immunosorbent assay.

RESULTS

Histological examination showed a clear difference between chronic dilatation and acute dissection. In chronic dilatation, tenascin-C staining was homogenously distributed throughout the media parallel to vascular smooth muscle cells. In acute dissection, a strong staining with a heterogenous and spotty distribution was detected. Control aortas showed no tenascin-C staining. Tenascin-C expression was significantly higher in Type-A dissection compared with chronic dilatation. This was accompanied by a significant elevation of tenascin-C levels in peripheral blood in acute dissection. There was no statistical correlation between the tenascin-C level in peripheral blood and the aortic diameter either in dissection or in dilatation.

CONCLUSIONS

Tenascin-C is a marker of progressive destabilization of the aortic wall independent of size in chronic dilatation and acute dissection. Therefore, it might be a valuable tool in guiding intervention strategies in patients with disease of the ascending aorta.

EndoPredict improves the prognostic classification derived from common clinical guidelines in ER-positive, HER2-negative early breast cancer

BACKGROUND

In early estrogen receptor (ER)-positive/HER2-negative breast cancer, the decision to administer chemotherapy is largely based on prognostic criteria. The combined molecular/clinical EndoPredict test (EPclin) has been validated to accurately assess prognosis in this population. In this study, the clinical relevance of EPclin in relation to well-established clinical guidelines is assessed.

PATIENTS AND METHODS

We assigned risk groups to 1702 ER-positive/HER2-negative postmenopausal women from two large phase III trials treated only with endocrine therapy. Prognosis was assigned according to National Comprehensive Cancer Center Network-, German S3-, St Gallen guidelines and the EPclin. Prognostic groups were compared using the Kaplan-Meier survival analysis.

RESULTS

After 10 years, absolute risk reductions (ARR) between the high- and low-risk groups ranged from 6.9% to 11.2% if assigned according to guidelines. It was at 18.7% for EPclin. EPclin reassigned 58%-61% of women classified as high-/intermediate-risk (according to clinical guidelines) to low risk. Women reclassified to low risk showed a 5% rate of distant metastasis at 10 years.

CONCLUSION

The EPclin score is able to predict favorable prognosis in a majority of patients that clinical guidelines would assign to intermediate or high risk. EPclin may reduce the indications for chemotherapy in ER-positive postmenopausal women with a limited number of clinical risk factors.

[Limits and benefits of non-controlled therapy-related observations]

In the age of evidence-based medicine, results from prospective controlled interventional studies are awarded the highest priority for determining the efficacy of a therapeutic measure. In contract, the role of non-controlled therapy-related observations is very low. This conception is due to the fact that in the absence of a control group it is impossible to assess a causal relationship between an administered therapy and the subsequent clinical outcome.Nevertheless, non-controlled therapeutic observations may be clinically relevant. Four domains may be distinguished : besides their importance for learning and teaching, such observations can contribute to evaluate which benefits results gained in controlled studies have in daily practice. On the other hand, they may point to hitherto unknown phenomena, such as the detection of new indications or unexpected therapeutic side effects. Finally, they may act as an important source for the generation of hypotheses about therapeutic measures, thus fostering further research.

Rokitansky's diseases and cause of death : A short pathological and historical discourse

Carl Rokitansky was one of the foremost experts and pioneers in pathological anatomy of the 19th century. Virchow and Rokitansky paved the way for the modern specialty of pathology, as we know it today. Whilst Virchow was the doyen of histopathology, Rokitansky's merit was his excellent gross pathology establishing thereby a nosological classification of disease. For this achievement, Virchow called Rokitansky the Lineè of pathology. In spite of his importance little is reported on Rokitansky. If the cause of death is mentioned, it is always stated incorrectly. This error may be due to a misleading certificate of death, which was issued without autopsy. This essay aims to describe Rokitansky's illnesses, particularly in his last months, and to deduce from available evidence the most probable cause of his death - with short explanations for non-medical readers. Briefly, Rokitansky suffered from arteriosclerosis leading to stenocardial attacks (angina pectoris). Rokitansky tried to relieve himself from pain by using chloroform. His personal description of the symptoms in his autobiography and the circumstances of his death clearly indicate a heart attack as the cause of death.

The Austrian Brain Tumour Registry: a cooperative way to establish a population-based brain tumour registry

In Austria, registration of malignant brain tumours is legally mandatory, whereas benign and borderline tumours are not reported. The Austrian Brain Tumour Registry (ABTR) was initiated under the auspices of the Austrian Society of Neuropathology for the registration of malignant and non-malignant brain tumours. All Austrian neuropathology units involved in brain tumour diagnostics contribute data on primary brain tumours. Non-microscopically verified cases are added by the Austrian National Cancer Registry to ensure a population-based dataset. In 2005, we registered a total of 1,688 newly diagnosed primary brain tumours in a population of 8.2 million inhabitants with an overall age-adjusted incidence rate of 18.1/100,000 person-years. Non-malignant cases constituted 866 cases (51.3%). The incidence rate was higher in females (18.6/100,000) as compared to males (17.8/100,000), while 95/1,688 (5.6%) cases were diagnosed in children (<18 years). The most common histology was meningioma (n = 504, 29.9%) followed by glioblastoma (n = 340, 20.1%) and pituitary adenoma (n = 151, 8.9%). Comparison with the Central Brain Tumor Registry of the United States (CBTRUS) database showed high congruency of findings. The ABTR model led by neuropathologists in collaboration with epidemiologists and the Austrian National Cancer Registry presents a cooperative way to establish a population-based brain tumour registry with high quality data. This setting links cancer registration to the mission of medical practice and research as defined by the World Medical Association in the Declaration of Helsinki. The continued operation of ABTR will aid in monitoring changes in incidence and in identifying regional disease clusters or geographic variations in brain tumour morbidity/mortality.

Histopathology of columnar-lined esophagus in patients with gastroesophageal reflux disease

BACKGROUND AND AIMS

The question of whether an endoscopically normal-appearing esophagogastric junction should be biopsied in patients with gastroesophageal reflux disease is controversial. We have addressed this issue using endoscopy and histopathology.

METHODS

A total of 114 consecutive patients (58 males) with symptoms of gastroesophageal reflux disease prospectively underwent endoscopy, including biopsy sampling from the esophagogastric junction. Endoscopically visible columnar-lined esophagus was defined by the presence of gastric-type mucosa above the level of the rise of the gastric folds. Histopathology was conducted using the Paull-Chandrasoma classification.

RESULTS

Of the 114 patients, 85 (74.6%) had endoscopically visible columnar-lined esophagus of length < or =0.5 cm (n = 82), 1 cm (n = 2) and 7 cm (n = 1); 29 patients (25.4%) had a normal endoscopic junction. All patients had histopathologic columnar-lined esophagus. Intestinal metaplasia and low-grade dysplasia was identified in 26 (22.8%) and 5 (4.4%) individuals, respectively, and was not statistically different in endoscopically normal vs. abnormal junction (P = 0.408 for intestinal metaplasia, P = 0.775 for low grade dysplasia). Intestinal metaplasia was independent from endoscopic esophagitis (P = 0.398) and hiatal hernia (P = 0.405).

CONCLUSIONS

Columnar-lined esophagus cannot be excluded by endoscopy. In patients with gastroesophageal reflux disease, biopsy sampling of normal-appearing junction is recommended for histopathologic exclusion of intestinal metaplasia and low-grade dysplasia.

Progressive up-regulation of genes encoding DNA methyltransferases in the colorectal adenoma-carcinoma sequence

Epigenetic silencing is a prominent feature of cancer. Here, we investigated the expression of DNA demethylase and three DNA methyltransferases during colorectal tumorigenesis comparing the genes encoding DNA methyltransferases 1 (DNMT1), 3A, and 3B (DNMT3A and DNMT3B) with methyl-CpG binding domain protein 2 (MBD2), recently described as the only active DNA demethylase. Total RNA isolated from normal colonic mucosa (n = 24), benign adenomas (n = 18), and malignant colorectal carcinomas (n = 32) was analyzed by reverse transcriptase-PCR with subsequent quantification by capillary gel electrophoresis. In contrast to MBD2, expression of DNMT1 and DNMT3A increased in parallel to the degree of dysplasia, with significant overexpression in the malignant lesion when compared with mucosa or with benign lesions (DNMT1). Pairwise comparisons between tumors and matched, adjacent healthy mucosa tissue (n = 13) revealed that expression of all three genes encoding DNA methyltransferases increased by two- to three-fold. Our data suggest a relevant role of the DNA methyltransferases during colorectal tumorigenesis. This increase is not counterbalanced by enhanced expression of the demethylating component MBD2. As a consequence, epigenetic regulation in the adenoma-carcinoma sequence may be driven by increased methylating activity rather than suppressed demethylation.

[Man on display--corpses and organs in public]

The public presentation of organs and of corpses makes critical and ethical reflexion necessary. On the basis of the current pluralism of individual moral positions the relativity of ethics is indicated. Morality may be interpreted as an adaptive-complex system with a dynamic evolution. Along this line of thought, the change in legal philosophy becomes stabilized by the constantly acting theology.

Videoendoscopy and histopathology of the esophagogastric junction in patients with gastroesophageal reflux disease

BACKGROUND AND AIMS

During endoscopy the stomach is considered to rise at the level of the 'gastric' folds; however, anatomical studies have demonstrated that the proximal gastric folds may in fact be esophageal. This prospective study was designed to assess the histopathology of endoscopically visible proximal gastric folds in patients with gastroesophageal reflux disease.

METHODS

35 consecutive patients (20 males) with gastroesophageal reflux disease underwent video endoscopy, including biopsy sampling from the endoscopically visible esophagogastric junction (0 cm, 0.5 cm and 1.0 cm distal to the rise of gastric folds and 0.5 cm and 1.0 cm proximal to it). Endoscopy was digitally recorded and reviewed for assignment of biopsy level. Columnar-lined esophagus and esophagitis were cataloged according to the Paull-Chandrasoma histopathologic classification and the Los Angeles endoscopic classification.

RESULTS

Endoscopy: Normal endoscopic esophagogastric junction was seen in 11 (31%) patients and visible columnar-lined esophagus < or = 0.5 cm in 24 (69%).

HISTOLOGY

Columnar-lined esophagus extended 1.0 cm in 22.8% of patients and 0.5 cm in 51.4%, distal to the rise of the gastric folds. In all patients columnar-lined esophagus was interposed between squamous epithelium and gastric oxyntic mucosa. Thus, so-called gastric folds contained mucosa of esophageal origin in all patients. Intestinal metaplasia (Barrett esophagus) was detected in eight (22.9%) patients.

CONCLUSIONS

Endoscopy cannot exclude histopathologic columnar-lined esophagus within gastric rugae. Thus, visible 'gastric' folds should not be used for definition of the esophagogastric junction but as a reference landmark for biopsy sampling during endoscopy.

Atherosclerosis research from past to present--on the track of two pathologists with opposing views, Carl von Rokitansky and Rudolf Virchow

It is now clear that inflammation plays a key role in atherogenesis. As a matter of fact, signs of inflammation of atherosclerotic plaques have been observed for centuries and also constituted the basis for a fierce controversy in the 19th century between the prominent Austrian pathologist Carl von Rokitansky and his German counterpart, Rudolf Virchow. While the former attributed a secondary role to these inflammatory arterial changes, Virchow considered them to be of primary importance. We had the unique opportunity to address this controversy by investigating atherosclerotic specimens from autopsies performed by Carl von Rokitansky up to 178 years ago. Twelve atherosclerotic arteries originally collected between the years 1827 to 1885 were selected from the Collection Rokitansky of the Federal Museum of Pathological Anatomy, Vienna Medical University. Using modern sophisticated immunohistochemical and immunofluorescence techniques, it was shown that various cellular intralesional components, as well as extracellular matrix proteins, were preserved in the historic atherosclerotic specimens. Most importantly, CD3 positive cells were abundant in early lesions, thus, rather supporting Virchows's view, that inflammation is an initiating factor in atherogenesis. Furthermore, we hope to have opened a new and intriguing possibility to study various pathological conditions using valuable historical specimens.

200 Jahre Josef Ŝkoda (1805–1881): Neuerer der physikalischen Untersuchung

The bicentenary of Josef Skoda's birth (December 10(th) 2005) was seen as an excellent opportunity to review his accomplishments for internal medicine. He extended the physical examination, namely percussion and auscultation, and established the scientific basis for these techniques. While Skoda's predecessors interpreted sounds and murmurs by natural philosophy and phenomenologically, Skoda established diagnoses based on empirical and experimental investigations. He compared diagnostic findings with post mortem results at Rokitansky's morgue. Thus, Skoda's work led to the modern capabilities of the physical examination.

[Rokitansky and the Vienna Medical School--from the philosophy of nature to natural science]

On February 19th 2004 we celebrated the 200th anniversary of Carl Rokitansky's birth. Together with Morgagni and Virchow, Rokitansky paved the way for the development of modern pathology. In addition, he was the co-founder of the so-called Second Vienna Medical School. Rokitansky represents a personality on the threshold of the change in medicine from a phenomenological-dominated philosophy to an evidence-based science. This jubilee essay aims at outlining this development particularly with regard to the Vienna Medical School before and after Rokitansky.

Osteoclast-like giant cell tumor in mucinous cystadenocarcinoma of the pancreas: an immunohistochemical and molecular analysis

Osteoclast-like giant cell tumors (OLGT) are rare neoplasms of the pancreas and mostly associated with ductal adenocarcinomas. In this report, we present the rare case of OLGT associated with mucinous cystadenocarcinoma (MCC). We investigated the expression profile of both tumors by methods of molecular biology and immunohistochemistry. The panel of markers included osteopontin, her2/neu, mismatch repair genes, K-ras, p53, E-cadherin, VEGF-C, and podoplanin. Osteopontin was expressed by the osteoclast-like giant cells but not by the mononuclear tumor cells of the OLGT. We detected an amplification and overexpression of her2/neu in the MCC but not in the OLGT. Although we observed an immunohistochemical expression of hMSH2 and hMLH1 in the OLGT, we were not able to confirm this result by western blot analysis. We also did not find any microsatellite instability (D2S123, BAT26). While mutation of K-ras codon 12 was found in both tumor components, there was wild-type DNA of p53. E-cadherin was expressed in MCC but not in OLGT. VEGF-C was only positive in osteoclast-like giant cells and some of the mononuclear cells of OLGT. The vessel-rich stroma of OLGT did not present any podoplanin-positive lymphatic vessel. The observation of our case and others in the published literature may indicate separating OLGT with undifferentiated carcinoma from OLGT with MCC for the better clinical outcome of the latter.

Myxoma valvulae arteriae pulmonalis described by Rokitansky: medicohistorical and clinicopathological aspects

The bicentenary of the birth of Rokitansky, the first true descriptive pathologist, was celebrated in February 2004. Rokitansky gathered many and important specimens that are now displayed in the Federal Museum of Pathological Anatomy in Vienna. On examining Rokitansky's collection we found a myxoma of the pulmonary valve of a 70-year-old woman who died in 1833. Cardiac myxomas are rare but are the most frequent primary heart tumors, appearing even less frequently on cardiac valves. Modern histology has confirmed Rokitansky's diagnosis on gross pathology. The good condition of this 171-year-old specimen was surprising. Thus, Rokitansky described the myxoma 75 years before Ribbert's first description of a myxoma in this rare localization.

Discovery of a letter from Rokitansky to Virchow about subependymal corpora amylacea

Until recently, Rokitansky and Virchow were thought to have never exchanged letters. Recently, however, a letter from Rokitansky to Virchow dated 1853 was discovered. In this letter, Rokitansky commented on Virchow's discovery of subependymal corpora amylacea. This report comprises an English translation of this letter together with a historical appraisal and a short comment on the importance of corpora amylacea in the brain.

Osteopontin expression in ductal adenocarcinomas and undifferentiated carcinomas of the pancreas

Osteopontin (OPN) is a non-collagenous extracellular matrix protein with pleiotropic functions, including mediation of cell adhesion and migration. Recently, high OPN serum levels were found in pancreatic ductal adenocarcinomas (PDACs) in which OPN mRNA was identified in macrophages. We investigated OPN expression at the protein level in 15 PDACs and 10 undifferentiated pancreatic carcinomas (UCs), 4 of them with osteoclast-like giant cells (OCGCs), to find out whether the degree of OPN expression is related to tumor infiltration by macrophages and the adhesive capacity of tumor cells. With regard to its potential adhesive function, we compared OPN expression in PDACs and UCs with that of E-cadherin and beta-catenin, two well-known adhesive molecules. OPN positivity was observed in two-thirds of PDACs (10/15) and in 7 UCs (7/10), including all 4 UCs with OCGCs. Apart from tumor cells, OPN was expressed in macrophages and OCGCs. When we assessed the relationship between the number of OPN-positive macrophages and tumor cells, we did not find any statistically significant correlation. There was also no correlation, either positive or negative, between OPN expression and E-cadherin and beta-catenin expression. The results demonstrated that, in PDACs and UCs, OPN is expressed in both tumor-associated macrophages and tumor cells. The biological significance of this dual expression pattern is not yet known. It is, however, unlikely that OPN has an adhesive function, since its expression pattern differs distinctly from that of E-cadherin or beta-catenin.

[Rokitansky's first description of a spondylocostal dysplasia, dysostosis]

The bicentenary of Carl Rokitansky's birth prompted us to evaluate his less well-known work related to osteopathology. Of various articles containing humoropathological interpretations of osseous diseases, one work should be highlighted. It is, to the best of our knowledge, the first description of a spondylocostal dysplasia, re-discovered many years later, precisely described and accompanied by an excellent illustration.

Dissecting progressive stages of 5-fluorouracil resistance in vitro using RNA expression profiling

Resistance to anticancer drugs such as the widely used antimetabolite 5-fluorouracil (FU) is one of the most important obstacles to cancer chemotherapy. Using GeneChip arrays, we compared the expression profile of different stages of FU resistance in colon cancer cells after in vitro selection of low-, intermediate- and high-resistance phenotypes. Drug resistance was associated with significant changes in expression of 330 genes, mainly during early or intermediate stage. Functional annotation revealed a majority of genes involved in signal transduction, cell adhesion and cytoskeleton with subsequent alterations in apoptotic response, cell cycle control, drug transport, fluoropyrimidine metabolism and DNA repair. A set of 33 genes distinguished all resistant subclones from sensitive progenitor cells. In the early stage, downregulation of collagens and keratins, together with upregulation of profilin 2 and ICAM-2, suggested cytoskeletal changes and cell adhesion remodeling. Interestingly, 6 members of the S100 calcium-binding protein family were suppressed. Acquisition of the intermediate-resistance phenotype included upregulation of the well-known drug resistance gene ABCC6 (ATP-binding cassette subfamily C member 6). The very small number of genes affected during transition to high resistance included the primary FU target thymidylate synthase. Although limited to an in vitro model, our data suggest that resistance to FU cannot be explained by known mechanisms alone and substantially involves a wide molecular repertoire. This study emphasizes the understanding of resistance as a time-depending process: the cell is particularly challenged at the beginning of this process, while acquisition of the high-resistance phenotype seems to be less demanding.

Podocyte flattening and disorder of glomerular basement membrane are associated with splitting of dystroglycan-matrix interaction

The transmembrane component of the dystroglycan complex, a heterodimer of alpha- and beta-dystroglycan, was recently localized at the basal cell membrane domain of podocytes, and it was speculated that it serves as a device of the podocyte for maintaining the complex podocyte foot process architecture, and for regulating the exact position of its ligands, the matrix proteins laminin and agrin, in the glomerular basement membrane (GBM). The redistribution of dystroglycan in two experimental rat models of foot process flattening and proteinuria-i.e., podocyte damage induced by polycationic protamine sulfate perfusion, and reactive oxygen species (ROS)-associated puromycin aminonucleoside nephrosis-was examined. In both experimental diseases, aggregation and reduced density of alpha-dystroglycan by endocytosis by podocytes was observed. In in vitro solid-phase binding assays, protamine and ROS competed with the binding of alpha-dystroglycan with purified laminin and a recombinant C-terminal fragment of agrin that contains the dystroglycan-binding domain. These changes were associated with disorder of the fibrillar components of the lamina rara externa of the GBM, as confirmed quantitatively by fractal analysis. These results indicate that both polycation and ROS induce similar changes in the distribution of podocyte alpha-dystroglycan that involve competitive disruption of alpha-dystroglycan/matrix protein complexes, endocytosis of the liberated receptor by podocytes, and disorganization of the matrix protein arrangement in the lamina rara externa. This links functional damage of the dystroglycan complex with structural changes in the GBM.

Expression of heat shock proteins in human hepatocellular carcinoma after radiofrequency ablation in an animal model

Since tumor cells are known to express heat shock proteins (HSPs) as a response to cellular stress, such as heat, our goal was to determine the expression of HSPs in human hepatocellular carcinoma (HCC) before and after percutaneous radiofrequency (RF) ablation using a rat model. In 12 nude rats, human HCC cells (SK-HEP-1) were inoculated subcutaneously. A total of 21 tumors were grown in the bilateral flanks of the rats. Of those, 19 were treated with percutaneous RF ablation (diameter of RF electrode, 18 gauge; RF ablation energy, 60-600 W; duration, 20-100 sec). To determine the extent of necrosis, and the cellular expression of HSP 70 and HSP 90, the tumors were excised within 6, 12 and 24 h after RF ablation, respectively. The extent of the coagulation necrosis and the expression of HSP 70 and 90 were evaluated. Linear regression analysis showed a significant correlation between the volume of coagulation necrosis and the RF energy applied. Before RF ablation, expression of HSP 70 and 90 was 0% and 0-30%, respectively. Following RF ablation, the maximum level of HSP 70 expression was 60%, and the maximum level of HSP 90 expression was 100%. The expression of HSP 70 and 90 in HCC is significantly increased by RF ablation. These findings are of particular importance in the host-tumor immune response and might be useful in forthcoming immunotherapeutical strategies.