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  • 1
    ISSN: 1433-0385
    Keywords: Key words: Staging ; Esophageal cancer ; Gastric cancer ; Colon cancer ; Rectum cancer ; Diagnostic imaging ; Endoscopy ; Endoscopic ultrasound ; Surgical resection ; Multimodal therapy. ; Schlüsselwörter: Staging ; Oesophaguscarcinom ; Kardiacarcinom ; Magencarcinom ; Coloncarcinom ; Rectumcarcinom ; bildgebende Diagnostik ; Endoskopie ; endoskopischer Ultraschall ; chirurgische Therapie ; multimodale Therapie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. In Anbetracht der sich erweiternden therapeutischen Möglichkeiten bei gastrointestinalen Tumoren ist es auch zu einer Verfeinerung der prätherapeutischen Diagnostik gekommen. Allerdings ist die Diagnostik in Kliniken, in denen nicht das gesamte Spektrum der verfügbaren therapeutischen Möglichkeiten ausgeschöpft wird, eine sehr viel straffere und allein auf die chirurgische Therapie konzentrierte. Grundsätzlich ist die Erfassung der Wandinfiltrationstiefe, d. h. der T-Kategorie wichtig, weil alleine aufgrund der Festlegung dieser Kategorie wichtige weitere diagnostische und therapeutische Konsequenzen abzuleiten sind. Dies ist heute mittels Endoskopie und endoskopischem Ultraschall mit hoher Genauigkeit möglich. Wenig fortgeschrittene Tumoren (T1/2) stellen in aller Regel eine primär chirurgische Indikation dar. Lokal fortgeschrittene Tumoren (T3/4) müssen in Hinblick auf die Indikation zur multimodalen Therapie überprüft werden. Der direkte Nachweis von Lymphknotenmetastasen ist immer noch unbefriedigend. Aus dem angenommenen nodulären Status sollten deswegen keine wesentlichen therapeutischen Konsequenzen gezogen werden. Immer ist jedoch die Suche nach Fernmetastasen erforderlich, da beim Nachweis von Fernmetastasen nur eine palliative Therapie in Frage kommt. Neben der Erfassung des Tumorstadiums tritt mehr und mehr die bioptisch-histologische Detailbeurteilung des Tumors in den Vordergrund. Dadurch werden nicht nur wichtige und therapeutisch relevante Informationen zum Grading möglich, wir stehen darüber hinaus am Beginn einer modernen molekularen Diagnostik. Es steht zu erwarten, daß in absehbarer Zeit eine Fülle weiterer Informationen mit prognostischer Relevanz aus endoskopisch gewonnenen Biopsien erhalten werden können, die im Hinblick auf therapeutische Konsequenzen überprüft werden müssen.
    Notes: Summary. The increasing spectrum of therapeutic options for tumors of the gastrointestinal tract has resulted in a refinement of the pretherapeutic diagnostic strategies. The diagnostic approach in surgical institutions that are focused on primary surgical resection will therefore be much less sophisticated than in institutions who propose a selective therapeutic approach based on the pretherapeutic tumor stage and prognostic parameters. Pretherapeutic assessment of the depth of tumor infiltration, i. e. the T-category, is essential because most further diagnostic and therapeutic decisions are based on this information. This can today be achieved with a high degree of accuracy by endoscopy and endoscopic ultrasonography. Early T-stages (T1–2) are usually an indication for primary surgical resection and, after exclusion of distant metastases, no further diagnostic studies are required. In patients with locally advanced esophageal, gastric or rectum tumors (T3–4) multimodal therapeutic concepts should be considered. This usually requires additional diagnostic studies. None of the available diagnostic imaging modalities today allows satisfactory pretherapeutic assessment of lymph node metastases. The assumed nodular status should therefore currently not influence therapeutic decisions. Essential is, however, the assessment of distant metastases, since the documentation of distant tumor spread will change the therapeutic approach to a palliative situation. Detailed histologic and molecular-biologic assessment of tumor characteristics is growing in importance. This not only provides therapeutically relevant information regarding tumor grading, but opens the door towards a modern molecular diagnostic approach. It can be expected that in the near future a vast amount of relevant prognostic information can be obtained from endoscopic tumor biopsies, which may soon alter our therapeutic concepts.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-069X
    Keywords: Hodgkin's disease ; Lymphoma ; Lymphomatoid papulosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Skin biopsy specimens from normal skin and from 115 patients with benign dermatoses, pre- or pseudo-malignant disorders or malignant cutaneous lymphomas have been examined immunohistologically for expression of the Reed-Sternberg cell associated antigen CD30 detected by monoclonal antibodies Ki-1 and Ber-H2. The antibodies stained the atypical cells in lymphomatoid papulosis, a proportion of the neoplastic cells in some cases of mycosis fungoides and most of the neoplastic cells in six large cell anaplastic/pleomorphic non-Hodgkin's lymphomas. The lymphoid cells in all other specimens were Ki-1- and Ber-H2-negative. In all cases, expression of the Ki-1/Ber-H2 antigen was accompanied by expression of activation and proliferation associated markers (i. e., HLA-DR, IL-2 receptor, transferrin receptor and the Ki-67 nuclear antigen). These data indicate the value of antibodies Ki-1 and Ber-H2 in distinguishing between lymphomatoid papulosis and other types of pre- or pseudo-malignant disorders and support the view that lymphomatoid papulosis, Hodgkin's disease and some types of non-Hodgkin's lymphoma constitute a spectrum of related disorders, originated from activated lymphoid cells.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-0584
    Keywords: C3 receptors ; Germinal center cells ; Non-Hodgkin's lymphoma ; Hodgkin's disease ; C3-Rezeptoren ; Keimzentrumszellen ; Non-Hodgkin-Lymphome ; Morbus Hodgkin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The occurrence and distribution of complement receptors (C3R) were investigated on frozen sections from normal lymphoid tissue and from 185 cases of malignant lymphoma. Various EAC complexes were used: vital EA or glutaraldehyde-fixed EA coated with mouse complement (EAC mouse and Glu-EAC mouse, respectively), human complement (EAC human and Glu-EAC human), or complement from C6-deficient rabbits (EACra-C6-def, Glu-EACra-C6-def). The different EAC complexes showed varying affinity for C3R: Glu-EAC human 〉 EAC mouse = EACra-C6-def 〉 Glu-EAC mouse = Glu-EACra-C6-def 〉 EAC human. The EAC complexes differed not only in their receptor affinity but also in their pattern of binding. On frozen sections of tonsils, EAC mouse, EAC human and EACra-C6-def adhered exclusively to germinal centers and the follicular mantle, whereas Glu-EAC mouse, Glu-EAC human and Glu-EACra-C6-def adhered not only to germinal centers and the follicular mantle but also to parafollicular areas and sometimes to interfollicular regions. The various EAC complexes were also assayed for reactivity to C3b receptors of human erythrocytes and C3R of human tonsil cells. Human erythrocytes (C3b receptor+ and C3d receptor− did not react with EAC mouse, EAC human or EACra-C6-def whereas tonsil cells (C3b and C3d receptor+) showed positive reactions with these complexes. In contrast, Glu-EAC mouse, Glu-EAC human and Glu-EACra-C6-def displayed marked affinity for both the C3b receptors of human erythrocytes and the C3Rof tonsil cells. In connection with previously reported data, these findings indicate that (a) EAC mouse, EAC human and EACra-C6-def react only with receptors for C3d, whereas Glu-EAC human, Glu-EAC mouse and Glu-EACra-C6-def are bound by C3b receptors and probably by C3d receptors as well, and (b) germinal center cells and follicular mantle lymphocytes express C3b and C3d receptors whereas cells in parafollicular areas and those in the interfollicular zone bear only C3b receptors. On frozen sections from a fetal thymus C3R could be clearly demonstrated with Glu-EAC human. The demonstration of C3R on frozen sections from malignant lymphomas with the Glu-EAC human complex revealed C3R on cells from all types of lymphoma except mycosis fungoides, although there were variations in the number of positive cells and in the density of the reaction. C3R were most common and were expressed most densely in two types of germinal center cell tumors, viz. centroblastic/centrocytic lymphoma and centrocytic lymphoma. Combined with the investigation of acid phosphatase activity and the sheep erythrocyte rosette test, analysis of C3R in lymphoblastic lymphomas of the T type led to the distinction of three subtypes, viz. a prethymocytic, a prothymocytic, and a mature thymocytic subtype. In none of the cases of Hodgkin's disease tested could C3R be demonstrated unequivocally on Hodgkin or Sternberg-Reed cells.
    Notes: Zusammenfassung Das Vorkommen und die Verteilung von Komplement-Rezeptoren (C3R) wurde an Gefrierschnitten von normalem lymphatischem Gewebe und von 185 malignen Lymphomen mit verschiedenen EAC-Komplexen [vitale EA und glutaraldehydfixierte EA, beschichtet mit Komplement von der Maus (EAC-Maus, Glu-EAC-Maus), vom Menschen (EAC-Human, Glu-EAC-Human) und zum Teil von C6-defekten Kaninchen (EAC-KC6d, Glu-EAC-KC6 d)] untersucht. Die verschiedenen EAC-Komplexe zeigten eine unterschiedliche Affinität zu den C3-Rezeptoren: Glu-EAC-Human 〉 EAC-Maus = EAC-KC6d 〉 Glu-EAC-Maus = Glu-EAC-KC6d 〉 EAC-Human. Die EAC-Komplexe differierten nicht nur in ihrer Rezeptoraffinität, sondern auch im Haftungsmuster. Die EAC-Maus, EAC-KC6d und EAC-Human hafteten an Gefrierschnitten von Tonsillen ausschließlich im Bereich der Keimzentren und des Follikelwalls, während die Glu-EAC-Human, die Glu-EAC-Maus und die Glu-EAC-KC6d sowohl im Bereich der Keimzentren und des Follikelwalls als auch parafollikulär und bisweilen auch zwischen den Follikeln hafteten. Die Austestung der Reaktivität der verschiedenen EAC-Komplexe gegenüber C3bR von humanen Erythrozyten und C3R humaner Tonsillenzellen ergab, daß sich EAC-Maus, EAC-Human und EAC-KC6d konstant negativ gegenüber humanen Erythrozyten (C3bR+ und C3dR−), aber positiv gegenüber Tonsillenzellen (C3bR+ und C3dR+) verhielten, während die Glu-EAC-Human, Glu-EAC-Maus und Glu-EAC-KC6d eine starke Affinität zu den C3bR der Humanerythrozyten und zu den C3R der Tonsillenzellen zeigten. In Verbindung mit kürzlich mitgeteilten Daten geht aus diesen Befunden hervor, daß a) EAC-Maus, EAC-Human und EAC-KC6d nur mit Rezeptoren für C3d reagieren, während Glu-EAC-Human, Glu-EAC-Maus und Glu-EAC-KC6d eine Bindung mit CSbR- und wahrscheinlich auch mit C3dR eingehen und b) Keimzentrumszellen und Follikelwall-Lymphozyten C3bR und C3dR exprimieren und daß die Zellen der parafollikulären und zum Teil auch der interfollikulären Zone nur den C3bR besitzen. Am Gefrierschnitt eines fetalen Thymus ließen sich mit Glu-EAC-Human eindeutig C3R nachweisen. Der Nachweis von C3R an Gefrierschnitten maligner Lymphome ergab, daß mit dem Komplex Glu-EAC-Human bei allen Lymphomtypen, mit Ausnahme der Mycosis fungoides, C3R nachweisbar waren, allerdings in unterschiedlicher Häufigkeit und Dichte. Am häufigsten und in großer Dichte waren C3R bei den Keimzentrumszelltumoren, dem centroblastisch/centrocytischen Lymphom und dem centrocytischen Lymphom, zu demonstrieren. Die Analyse der C3R bei den lymphoblastischen Lymphomen vom T-Typ führte in Verbindung mit der Untersuchung der sauren Phosphatase und des Schafserythrozyten-Rosettentests zur Abgrenzung von drei Subtypen, nämlich einem Präthymozyten-, einem Prothymozyten- und einem reifen Thymozyten-Subtyp. An Hodgkin- und Sternberg-Reed-Zellen ließen sich in keinem der untersuchten Fälle eindeutig C3R nachweisen.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Journal of cancer research and clinical oncology 101 (1981), S. 111-124 
    ISSN: 1432-1335
    Keywords: Hodgkin's disease ; In vitro cultures
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Four in vitro cell lines (L 428, L 439, L 538, and L 540) were established from different materials of three patients with Hodgkin's disease: pleural effusions, peripheral blood, and bone marrow. The histological diagnosis was confirmed in all cases by several independent histologists. All four cell lines have been in culture for over 6 months up to over 3 years. The neoplastic nature of the culture cells is indicated by the demonstration of several structural and numeric chromosome abnormalities associated with a monoclonal pattern of marker chromosomes. EBV-specific antigens (EBNA, VCA) were not detected in either cell line. Ia-like antigens, receptors for human T cells, acid phosphatase, and acid esterase were shown to be present in the cultured cells. All cell lines lacked surface or cytoplasmic Ig, HTLA, receptors for C3b, C3d, IgG-Fc, mouse E or sheep E, and were devoid of lysozyme, peroxidase, and chloracetate esterase. The described features do not represent B cells, T cells, myeloid cells, monocytes, or macrophages. The morphology and the marker pattern of the culture cells, however, is identical with that of freshly obtained Hodgkin's (H)- and Sternberg-Reed (SR)-cells, except for the lack of CIg in the in vitro cells, which is explained by the culture conditions. Heterotransplantation in nude mice was achieved by intracranial inoculation and by s.c. transplantation of cultured cells embedded in a plasma clot. The described findings suggest that these cultured Hodgkin's cell lines are indeed derived from H and SR cells. The cellular origin of these cells is not clear, the loss of cellular differential markers during the process of possible dedifferentiation is discussed.
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  • 5
    ISSN: 1432-1335
    Keywords: Immunoperoxidase ; Hodgkin's disease ; Significance of polytypic cytoplasmic IgG ; Histiocytic, B and T markers ; Antiserum to Hodgkin's and Sternberg-Reed cells
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To help clarify the origin and nature of Hodgkin's (H) and Sternberg-Reed (SR) cells, three different sets of experiments were performed. First, it was shown that cytoplasmic γ, ϰ, and λ occur not only in H and SR cells, but also in polymorphic tumor cells of epithelial, neurogenic, and lymphoid origin. Furthermore, human IgG that was injected i.v. into rats penetrated many rat liver cells, whereas injected human α1-antitrypsin did not. Second, staining of frozen section revealed that H and SR cells lack surface immunoglobulin and peripheral T-cell antigen. Third, an antiserum raised against the L 428 cell line (derived from Hodgkin's disease) and absorbed with human serum and normal cells did not react with any cells of tonsil tissue (lymphoid cells, histiocytes, and interdigitating reticulum cells), whereas it reacted strongly with the L 428 cell line cells and with H and SR cells of 10 different cases. In all ten cases, the antiserum stained the surface of H and SR cells; in two cases, it also stained the nucleoli and some chromatin spots in H and SR cells. The results obtained in these experiments indicate that H and SR cells are not closely related to lymphoid cells, histiocytes, or interdigitating reticulum cells. The findings also suggest that H and SR cells express one or more antigens that have not yet been detected on or in normal cells.
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Der Chirurg 67 (1996), S. 877-888 
    ISSN: 1433-0385
    Keywords: Key words: Lymph node dissection ; Lymphadenectomy ; Esophageal cancer ; Cancer of the cardia ; Gastric cancer. ; Schlüsselwörter: Oesophaguscarcinom ; Kardiacarcinom ; Magencarcinom ; Lymphadenektomie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Bei den Tumoren des oberen Gastrointestinaltrakts ist wie auch bei allen anderen Tumoren das Erreichen der Residualtumorfreiheit wichtigstes Operationsziel. Dazu muß nicht nur der Primärtumor in allen 3 Dimensionen mit adäquatem Sicherheitsabstand entfernt werden, das gleiche Ziel muß auch im Bereich der Lymphabflußwege erreicht werden. Dazu müssen befallene Lymphknoten und Lymphknoten mit sog. „microinvolvement“ entfernt werden. Im Minimum ist hierfür eine Lymphadenektomie der zwei tumornahen Compartmente (D2-Lymphadenektomie) notwendig. Der notwendige Sicherheitsabstand der Lymphadenektomie kann über die sog. Lymphknoten-Ratio abgeschätzt werden. Dabei handelt es sich um das Verhältnis zwischen der Anzahl der chirurgisch entfernten Lymphknoten und der Anzahl der tumorbefallenen Lymphknoten. Die Prognose kann durch die Lymphadenektomie immer dann nachhaltig verbessert werden, wenn die Lymphknoten-Ratio kleiner als 0,2 ist. Diese Operationsziele sind zumindest bei beginnender Lymphknotenmetastasierung zu erreichen. Bei fortgeschrittener Lymphknotenmetastasierung kann die Lymphadenektomie nur zu einer Reduktion lokaler Rezidive beitragen. Beschränkt sich die Lymphadenektomie nur auf die operative Entfernung von Lymphknoten, geht sie mit keinem erhöhten Operationsrisiko einher. Diese grundsätzlichen therapeutischen Prinzipien gelten in gleicher Weise für das Oesophagus-, Kardia- und Magencarcinom.
    Notes: Summary. Similar to other tumor entities, complete tumor removal with an adequate safety margin in all three dimensions (the oral margin, the aboral margins and the tumor bed) must be the primary aim of any surgical approach to carcinoma of the upper gastrointestinal tract. The same goal has to be achieved in the area of the lymphatic drainage. All positive nodes and nodes with a so-called ’microinvolvement' have to be removed together with the primary tumor. The safety margin of lymphadenectomy can be estimated by the lymph node ratio, i. e. the ratio between the number of removed and positive nodes. Several studies have shown that for carcinoma of the upper gastrointestinal tract the prognosis can be improved markedly if the lymph node ratio is below 0.2. For tumors in the early phase of lymphatic metastasis this can be achieved by extensive lymph node dissection. In practice, this requires as a minimum a lymphadenectomy of compartments I and II of the tumor's lymphatic drainage (D2 lymphadenectomy). The individual compartments are determined by the embryogenesis of the affected organ and defined by the tumor location. In patients with advanced lymphatic metastases, lymphadenectomy does not improve the prognosis and can only result in a reduction of local recurrences. Lymphadenectomy does not increase the risk and morbidity of the surgical procedure, provided it is restricted to the removal of nodes. These basic principles of lymphadenectomy are valid for carcinomas of the esophagus, cardia and stomach.
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