A Kaiser

Klinikum Nürnberg, Nuremberg, Bavaria, Germany

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Publications (15)14.99 Total impact

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    ABSTRACT: Die Tumorinfiltration der V. portae bei duktalen Adenocarcinomen des Pankreaskopfes gilt klassischerweise als Inoperabilitätskriterium. Trotz operationstechnischer Fortschritte auf dem Gebiet der Pfortaderresektion im Rahmen von Whipple-Operationen mit akzeptaler Letalität und Morbidität kann eine Gefäßresektion bei Infiltration nicht prinzipiell empfohlen werden. Problematisch ist vor allem die präoperative Sicherung einer eventuell vorliegenden Gefäßinfiltration, häufig sieht sich der Chirurg erst intraoperativ mit der Situation einer makroskopischen Pfortaderinfiltration bzw. Tumoradhärenz konfrontiert. Im Zeitraum von 1986 bis 1995 wurde an unserer Klinik bei 105 Patienten mit duktalem Adenocarcinom des Pankreaskopfes eine Whipple-Operation vorgenommen. In 8 Fällen erfolgte bei makroskopischer Tumorinfiltration bzw. Tumoradhärenz und unauffälliger präoperativer Diagnostik mittels indirekter Portographie und CT eine partielle Pfortaderresektion. In 4 der 8 Fälle fand sich eine tatsächliche, histologisch nachweisbare Infiltration der V. portae bis in die inneren Gefäßwandschichten, während die übrigen Fälle keine bzw. lediglich eine Adventitiainfiltration zeigten. Die Patienten ohne histologischen Nachweis einer tatsächlichen Gefäßinfiltration wiesen eine deutlich längere Überlebenszeit (27,75 Monate) gegenüber den Patienten mit histologischer Tumorinvasion in die V. portae (6,67 Monate) auf. Neuere Untersuchungen haben gezeigt, daß der endovasculäre, intraportale Ultraschall (IPEUS) einen deutlichen Informationsgewinn bezüglich der Frage einer vorliegenden Pfortaderinfiltration bieten kann. Auch wenn diese Untersuchung derzeit nicht als Standarddiagnostik gelten kann, so besteht die Möglichkeit, bei entsprechender Indikation hierdurch mit hoher Sensitivität und Spezifität eine tatsächliche Gefäßinfiltration zu erkennen. Kann mittels endovasculärem Ultraschall eine Tumorinfiltration in die V. portae ausgeschlossen werden, so zeigen unsere Ergebnisse, daß Patienten mit makroskopischer Tumoradhärenz tatsächlich von einer partiellen Pfortaderresektion profitieren. Tumor invasion of the portal vein by ductal adenocarcinoma of the pancreatic head is classically known as a criterion for inoperability. Despite improvement in operation techniques for portal vein resection during Whipple's procedure and acceptable mortality and morbidity, in the case of uncertain tumor infiltration vascular resection cannot be recommended in general. The problem is the preoperative detection of tumor infiltration of the portal vein. Often the surgeon is confronted with unsuspected macroscopic portal vein infiltration or tumor adhesion during the operation. Between 1986 and 1995 105 patients underwent Whipple's procedure for ductal adenocarcinoma of the pancreatic head in our department. In eight of these cases partial portal vein resection was performed because of macroscopic tumor infiltration or tumor adhesion. In all eight cases the preoperative diagnostic procedures with CT and portography did not show any suspicion of tumor infiltration. In four of the eight cases histological tumor infiltration of all vascular layers was found. In the others we found no or only adventitial tumor invasion. The patients without tumor infiltration of the portal vein showed a survival time after surgery of 27.78 months in contrast to 6.67 months in the group with histologically proven tumor infiltration. Endovascular, intraportal ultrasound (IPEUS), a new diagnostic procedure, can give helpful information regarding portal vein involvement. Although the IPEUS is not a standard diagnostic procedure it was shown to detect portal vein infiltration with high sensitivity and specificity. Our results indicate that in such cases where portal vein infiltration has been excluded by IPEUS, patients with macroscopic tumor adhesion do benefit from partial portal vein resection.
    Der Chirurg 04/2012; 71(7):803-807. · 0.52 Impact Factor
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    ABSTRACT: Acinar cell carcinoma of pancreatic type rarely occurs at extra-pancreatic sites. We report four primary liver tumors with features of pancreatic acinar cell carcinoma. The patients were two males and two females with a mean age of 65 years (range, 49-72 years). They had upper abdominal pain, weight loss and/or an incidentally discovered liver mass. None had evidence of a primary pancreatic tumor. Grossly, the tumors were large (mean size, 12 cm), well circumscribed and showed a lobulated cut surface. Histologically, they showed a predominantly microacinar pattern, with occasional trabecular, solid and microcystic areas. Cellular atypia and mitotic activity varied within the same tumor and from tumor to tumor. Immunohistochemically, the tumor cells were positive for cytokeratin 18 and at least one acinar cell marker (ie, trypsin, amylase or lipase), but were negative for cytokeratins 7, 19 and 20, HepPar-1, AFP, CD10, carcinoembryonic antigen, CD56, Islet-1 and CDX2. Two tumors stained focally for synaptophysin and chromogranin A. Adjacent liver parenchyma displayed no evidence of cirrhosis. During a mean follow-up of 22 months (range, 3-38 months) no metastases occurred, but one patient developed local recurrence. Our study demonstrates that acinar cell carcinoma of pancreatic type may also originate from the liver and can be readily distinguished from other primary liver neoplasms by its distinct histological and immunohistochemical features. Because our cases were observed within a rather short period, it is likely that this tumor type is so far underrecognized and has been mistaken as a variant of hepatocellular carcinoma, cholangiocarcinoma or any other liver tumor.
    Modern Pathology 08/2011; 24(12):1620-6. · 5.25 Impact Factor
  • Abbas Agaimy, Annette Kaiser, Peter H Wuensch
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    ABSTRACT: Focal nodular hyperplasia (FNH) is a benign hepatocellular lesion composed of hyperplastic appearing hepatocytes arranged in nodules separated by fibrous septa that usually form a central stellate scar. Rare lesions that show unusual cytological or architectural features were reported as variants of focal nodular hyperplasia. We present the morphological features of a case of FNH with severe cytological atypia (so-called large cell change) in a 73-year-old man. In addition to diffuse cytological atypia, Mallory hyaline bodies were found in almost all lesional cells. This rare variant of FNH should be differentiated from other neoplastic lesions, in particular from the fibrolamellar variant of hepatocellular carcinoma.
    Pathology - Research and Practice 02/2003; 199(7):509-11. · 1.21 Impact Factor
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    ABSTRACT: Adenomas of the papilla of Vater are relatively rare tumours. They are of particular interest, not only because of their particular topography, but also because the adenoma-carcinoma sequence - accepted in the colorectum - has also been postulated to apply to the papilla of Vater. In fact, ampullary adenoma is often considered to be a precancerous lesion. To investigate this hypothesis, we reviewed the surgical specimens obtained during Whipple's procedures carried out to treat histologically confirmed carcinoma of the ampulla. A total of 37 surgical specimens obtained since January 1991 were reexamined for the presence of coexisting adenomatous structures. Such adenomatous residues were confirmed in 24/37 (65 %) cases. In 13/37 (35 %) cases, no residual adenoma was found. A comparison of the two groups revealed that detection of coexisting adenomatous structures decreased with increasing tumour progression. In similar manner, this also applied to the degree of malignancy: with increasing grade of malignancy the rate of detectable adenomatous structures decreased significantly. It may be assumed that these observations are due to the 'overgrowth' of preexisting adenomas by carcinomatous tissue. Further evidence is provided by the histological observation of transitional stages from adenoma with mild, moderate and severe cellular atypia to invasive carcinoma. These findings support the hypothesis of an adenoma-carcinoma sequence.
    Zeitschrift für Gastroenterologie 12/2002; 40(11):913-20. · 1.41 Impact Factor
  • A Agaimy, A Kaiser, P H Wünsch
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    ABSTRACT: The case of a primary cardiac epithelioid hemangioendothelioma (EHE) arising multifocally in the papillary muscle of the tricuspid valve and the deeper trabecular muscle in a 68-year-old male with myelodysplastic syndrome is presented. The tumor was an incidental autopsy finding. Histologically the tumor is characterized by proliferation of plump epithelial-like endothelial cells with the vascular differentiation being mostly expressed at a cellular level in the form of cytoplasmic vacuoles. In the differential diagnosis, metastatic carcinoma, cardiac myxoma as well as other epithelioid vascular neoplasms should be considered. EHEs are indolent tumors of intermediate malignancy with the potential to metastasize, even after a long time. Primary cardiac EHE is extremely rare. To our knowledge, only four EHEs of the heart have been reported in the literature. We believe, this is the first report of a cardiac EHE in this localization and the first one in association with myelodysplastic syndrome.
    Zeitschrift für Kardiologie 05/2002; 91(4):352-6. · 0.97 Impact Factor
  • A. Agaimy, Annette Kaiser, P. H. Wünsch
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    ABSTRACT: Anhand einer eigenen Beobachtung an einem 68-jährigen Patienten soll das sehr seltene epitheloide Hämangioendotheliom (EHE) des Herzens vorgestellt werden. Das histologische Bild ist durch eine Proliferation epitheloider Endothelzellen mit primitiver Gefäßdifferenzierung gekennzeichnet. Das biologische Verhalten des EHE wird als intermediär zwischen den benignen Hämangiomen und den konventionellen Angiosarkomen eingeschätzt mit meist indolentem Verlauf und späterem Metastasierungspotential in manchen Fällen. Differentialdiagnostisch kommen Karzinommetastasen, Herzmyxome und andere epitheloide Gefäßtumoren in Betracht. Bisher sind nur vier EHEs des Herzens publiziert worden. Wir berichten über ein kardiales EHE, das im Papillarmuskel der Trikuspidalklappe und in den tieferen Trabekelmuskeln multifokal entstanden ist. Der Tumor wurde bei der Autopsie eines Patienten mit vordiagnostiziertem myelodysplastischen Syndrom festgestellt. Unseres Wissens ist eine solche Lokalisation und die Assoziation mit einem myelodysplastischen Syndrom bisher noch nicht beschrieben worden. The case of a primary cardiac epithelioid hemangioendothelioma (EHE) arising multifocally in the papillary muscle of the tricuspid valve and the deeper trabecular muscle in a 68-year-old male with myelodysplastic syndrome is presented. The tumor was an incidental autopsy finding. Histologically the tumor is characterized by proliferation of plump epithelial-like endothelial cells with the vascular differentiation being mostly expressed at a cellular level in the form of cytoplasmic vacuoles. In the differential diagnosis, metastatic carcinoma, cardiac myxoma as well as other epithelioid vascular neoplasms should be considered. EHEs are indolent tumors of intermediate malignancy with the potential to metastasize, even after a long time. Primary cardiac EHE is extremely rare. To our knowledge, only four EHEs of the heart have been reported in the literature. We believe, this is the first report of a cardiac EHE in this localization and the first one in association with myelodysplastic syndrome.
    Zeitschrift für Kardiologie 01/2002; 91(4):352-356. · 0.97 Impact Factor
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    ABSTRACT: The prognostic value of microinvasion of lymph vessels and lymph nodes has become increasingly important; there is a wide range in prognosis of patients with nodal-negative tumor stages after curative resection for colorectal cancer. Detection of the prognostic importance of isolated lymph-vessel invasion as a possible precursor of lymph-node metastasis in patients with nodal-negative tumor stages. Retrospective analysis of 894 patients with R0-resected colorectal cancer, uni- and multivariate analysis of tumorbiologic prognostic factors, immunohistochemical proof of tumor cells in negative lymph nodes (pN0) using the epithelial marker HEA-125 (human epithelial antigen). The incidence of lymph-vessel invasion (L) was 37.7% in total. A pN0,L1 status was found in 144 patients (16.1% of all analyzed patients). Comparing patients with pN0,L1 status to those with pN+,L0 status showed that both groups have similar rates of overall survival and tumor relapse. Lymph-node status, lymph-vessel invasion, depth of tumor infiltration (pT) stage, and age were detected as independent prognostic factors by multivariate analysis. After reanalysis of 54 cases primarily classified as 18.5% pN0,L1, microinvasion in lymph nodes was detected by immunohistochemistry. We found a higher rate of tumor relapse (approximately 20%) for those patients. In regard to the overall survival rate, however, there was no difference when compared to patients without immunohistochemical proof of microinvasion. Isolated lymph-vessel invasion in nodal-negative tumor stages and a lymph-node-positive tumor status have equivalent prognostic importance in colorectal cancer.
    Langenbeck s Archives of Surgery 04/2001; 386(2):124-31. · 1.89 Impact Factor
  • Viszeralchirurgie 01/2001; 36(1):29-33. · 0.06 Impact Factor
  • Geburtshilfe und Frauenheilkunde 01/2001; 61(10):804-808. · 0.85 Impact Factor
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    ABSTRACT: Of all patients who died of HIV infection within 10 years (1. 1. 1988 to 31. 12. 1997) at the Klinikum Nürnberg 58 autopsy cases were reviewed at the Institute of Pathology of the above mentioned hospital. The male:female ratio was 2.1:1, the mean age being 40.5 years. Most of the patients showed an advanced stage of lymphadenopathy at the moment of death. Non-Hodgkin's lymphoma and Kaposi's sarcoma, both HIV-related malignant diseases, were diagnosed in 6/58 cases, 10.3% each. HIV-related myelodysplastic changes existed in 28/58 patients (48.3%). Twelve patients showed an HIV-associated encephalopathy (20.7%). Opportunistic infections (pneumocystis carinii, cytomegaly, toxoplasmosis, atypical mycobacteriosis) were found in 28/58 patients (48.3%). A mycosis was diagnosed in 9/58 cases (15.5%). Tuberculosis was identified in 4/58 patients (6.9%). Cirrhosis of the liver was ascertained in 8/58 patients (13.8%). 24/58 patients (41.4%) died of respiratory disorder. In the acquired immunodeficiency syndrome numerous morphological findings will be helpful in diagnosis and therapy.
    Medizinische Klinik 10/2000; 95(9):482-6. · 0.34 Impact Factor
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    ABSTRACT: Patienten und Methoden: 58 Sektionsfälle der in einem Zeitraum von zehn Jahren (1.1.1988 bis 31.12.1997) verstorbenen und am Institut für Pathologie des Klinikums Nürnberg obduzierten HIV-infizierten Patienten wurden ausgewertet. Ergebnisse: Das Geschlechtsverhältnis Männer : Frauen belief sich auf 2,1 : 1. Der Altersdurchschnitt lag bei 40,5 Jahren. Zum Zeitpunkt des Todes gehörte die Mehrzahl der Patienten einem fortgeschrittenen Lymphadenopathiestadium an. An HIV-assoziierten malignen Erkrankungen ließen sich in gleicher Häufigkeit (jeweils 6/58; 10,3%) ein Non-Hodgkin-Lymphom und ein Kaposi-Sarkom diagnostizieren. Eine HIV-Enzephalopathie bestand bei 12/58 Patienten (20,7%). HIV-assoziierte myelodysplastische Veränderungen fanden sich in 28/58 Fällen (48,3%). Opportunistische Infektionen (Pheumocystis carinii, Zytomegalie, Toxoplasmose, atypische Mykobakteriose) wiesen insgesamt 28/58 (48,3%) Patienten auf. Eine Mykose war in 9/58 Fällen (15,5%) gegeben. In 4/58 (6,9%) bestand eine Tuberkulose. Eine Leberzirrhose ließ sich bei 8/58 Patienten (13,8%) diagnostizieren. 24/58 Patienten (41,1%) starben in der respiratorischen Insuffizienz. Schlußfolgerung: Beim erworbenen Immundefektsyndrom sind zahlreiche morphologische Befunde zu erheben, die hohe diagnostische und somit therapeutische Relevanz besitzen.
    Medizinische Klinik 09/2000; 95(9). · 0.34 Impact Factor
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    ABSTRACT: Tumor invasion of the portal vein by ductal adenocarcinoma of the pancreatic head is classically known as a criterion for inoperability. Despite improvement in operation techniques for portal vein resection during Whipple's procedure and acceptable mortality and morbidity, in the case of uncertain tumor infiltration vascular resection cannot be recommended in general. The problem is the preoperative detection of tumor infiltration of the portal vein. Often the surgeon is confronted with unsuspected macroscopic portal vein infiltration or tumor adhesion during the operation. Between 1986 and 1995 105 patients underwent Whipple's procedure for ductal adenocarcinoma of the pancreatic head in our department. In eight of these cases partial portal vein resection was performed because of macroscopic tumor infiltration or tumor adhesion. In all eight cases the preoperative diagnostic procedures with CT and portography did not show any suspicion of tumor infiltration. In four of the eight cases histological tumor infiltration of all vascular layers was found. In the others we found no or only adventitial tumor invasion. The patients without tumor infiltration of the portal vein showed a survival time after surgery of 27.78 months in contrast to 6.67 months in the group with histologically proven tumor infiltration. Endovascular, intraportal ultrasound (IPEUS), a new diagnostic procedure, can give helpful information regarding portal vein involvement. Although the IPEUS is not a standard diagnostic procedure it was shown to detect portal vein infiltration with high sensitivity and specificity. Our results indicate that in such cases where portal vein infiltration has been excluded by IPEUS, patients with macroscopic tumor adhesion do benefit from partial portal vein resection.
    Der Chirurg 08/2000; 71(7):803-7. · 0.52 Impact Factor
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    ABSTRACT: HISTORY AND CLINICAL FINDINGS: A 86-year-old woman was hospitalized two days before death. Her past history included essential hypertension and joint pain. Electrocardiography and laboratory findings revealed an acute myocardial infarction. Chemical laboratory examination demonstrated hyperthyroidism. The x-ray of the chest showed a tumor-like mass in the right lung and a nodular goiter with focal changes. Sonographically a tumor in the left colon was diagnosed. Inspite of intensive care the patient died two days later of cardiogenic shock. AUTOPTIC DIAGNOSIS: The autopsy revealed a transmural myocardial infarction with rupture of the heart wall. An adenocarcinoma of the rectum infiltrating the perirectal fatty tissue was diagnosed. Metastases were absent. Additional to an eutopic nodular goiter there was ectopic thyroid tissue in the lung, as a tumour mass under the visceral pleura, in the pelvic cavity and in the skeleton. The histologic findings revealed a close resemblance to the thyroid gland in normal anatomical position. In small foci in the eutopic and ectopic thyroid tissues there were signs of hyperthyroidism. There was no evidence of malignancy. CONCLUSION: One should always keep in mind that manifest hyperthyroidism, not explicable on the grounds of the thyroid findings in normal anatomical position can point to ectopic (multilocular) thyroid tissue, especially when there are "tumours" of uncertain origin.
    DMW - Deutsche Medizinische Wochenschrift 05/2000; 125(14):421-4. · 0.65 Impact Factor
  • Deutsche Medizinische Wochenschrift - DEUT MED WOCHENSCHR. 01/2000; 125(14):421-424.
  • Chirurg. 01/2000; 71(7):803-807.