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ABSTRACT: Die Leber stellt das größte unpaarige parenchymatöse Organ des menschlichen Körpers dar und ist wesentlich an den zentralen
Stoffwechselvorgängen beteiligt. Einerseits weisen viele Patienten Veränderungen der gesamten Leber aufgrund vaskulärer/kardialer
Erkrankungen, Stoffwechselerkrankungen oder Infektionen auf (Stauung, Fettleber, Leberfibrose und Zirrhose). Andererseits
ist die Leber einer der häufigsten Manifestationsorte von Metastasen maligner Tumoren. Auch gutartige umschriebene Leberläsionen
wie Hämangiome oder die FNH sind relativ häufig. Um diese Läsionen hinsichtlich ihrer Dignität beurteilen zu können, ist die
Kenntnis der makroskopischen Struktur der Leber sowie ihre Lagebeziehungen zu anderen Organen wichtig, entscheidend ist letztlich
ihr feingeweblicher Aufbau. Die Feinstruktur der Leber und auch das vaskuläre und biliäre System sind durch die Embryonalentwicklung
bedingt und erklären sich aus der zentralen Stoffwechselfunktion der Leber.
The liver is the largest unpaired parenchymatous organ in the human body and takes part in almost all important metabolic
processes. Many patients show alterations of the whole organ due to vascular/cardiac disorders, metabolic or infectious diseases
(congestion, fatty liver disease, fibrosis and cirrhosis). However the liver is also a common site for metastatic lesions
of malignant tumors. Additionally, benign focal lesions, such as hemangioma or focal nodular hyperplasia (FNH) occur quite
frequently. To describe and diagnose these lesions in terms of dignity and location, knowledge of the macroscopic structure
and the relative position of the organ in relation to neighbouring organs are important as well as the histology. The microstructure
of the liver and its vascular and biliary vessels are determined by the embryonic development and its function as a central
metabolic organ.
SchlüsselwörterLeberanatomie–Histologie–Leitstrukturen–Segmente–Embryonalentwicklung
KeywordsAnatomy of the liver–Histology–Control structure–Segments–Embryonic development
Der Radiologe 05/2012; 51(8):655-660. · 0.61 Impact Factor
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ABSTRACT: Bereits vor 20Jahren wurde die Adenom-Karzinom-Sequenz zur Entstehung kolorektaler Karzinome beschrieben. Heute geht man
davon aus, dass es verschiedene Wege gibt, die zur Entwicklung eines Adenokarzinoms des Kolons oder Rektums führen. Diese
Entstehungswege bzw. Karzinomsubtypen können durch bestimmte Veränderungen und Eigenschaften genau charakterisiert werden
und erlangen in Zukunft sicher eine zunehmende Bedeutung für Prävention, Therapie und Prognose. Der Tumorigenese hereditärer
kolorektaler Karzinome liegen bestimmte familiäre genetische Veränderungen zugrunde, beispielsweise Mutationen des APC-Gens bei der familiären Adenomatosis polyposis coli oder bei einem HNPCC-Syndrom, Mutationen von Genen, die für DNA-Reparaturproteine
kodieren. Diese Heterogenität spiegelt sich auch in der Entstehung sporadischer Karzinome wider. Sie hat zu der Hypothese
geführt, dass es verschiedene Subgruppen kolorektaler Karzinome gibt, die sich in ihrer Pathogenese unterscheiden. So wird
mittlerweile von der klassischen Adenom-Karzinom-Sequenz, die die Entstehung eines Karzinoms auf dem Boden eines tubulären
Adenoms mit intraepithelialen Neoplasien beschreibt, eine Entwicklung von Karzinomen aus serratierten Läsionen abgegrenzt.
Des Weiteren lassen sich auch den verschiedenen Entstehungsmechanismen bzw. Karzinomsubtypen jeweils charakteristische Genveränderungen
zuordnen.
The classical adenoma-carcinoma sequence for colorectal cancer was first described 20 years ago. Today it is assumed that
there are several different pathways for the carcinogenesis of colorectal cancer. These pathways and colorectal cancer subtypes
show characteristic genetic alterations and qualities and will become of increasing relevance for prevention, therapy and
prognosis in the future. The tumorigenesis of hereditary colorectal carcinoma is based on different genetic alterations in
germlines, for example mutations of the APC gene in adenomatosis polyposis coli or of genes coding for DNA mismatch repair
enzymes in the HNPCC syndrome. This heterogeneity is reflected in the development of sporadic colorectal adenocarcinoma and
led to the hypothesis of different subtypes of colorectal carcinoma. Nowadays different pathways for the development of colorectal
carcinoma can be distinguished in addition to the first described adenoma-carcinoma sequence, for example the so-called serrated
lesions pathway. In addition characteristic genetic alterations can be attributed to the different pathways of tumorigenesis
or carcinoma subtype.
Der Onkologe 04/2012; 15(12):1182-1192. · 0.17 Impact Factor
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ABSTRACT: Klatskin tumors are a distinct subgroup of cholangiocarcinomas which are a surgical challenge due to their special localization. Different localizations do not show great differences concerning histomorphology and precursor lesions. With respect to molecular alterations there are only small differences. Accurate clinical and histomorphological diagnosis is important for therapy and especially the prediction of prognosis as well as standardized processing of the resection specimen if the carcinoma is resectable. Additionally, accurate lymph node dissection is necessary. Concerning molecular markers further investigations are needed to develop individualized therapy regimes.
Der Chirurg 02/2012; 83(3):208-14. · 0.70 Impact Factor
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ABSTRACT: The surveillance of patients with Barrett mucosa in the distal oesophagus leads to an increase of patients diagnosed with early cancer of the oesoph-agogastric junction and stomach with only superficial infiltration. Comparable to Asian countries where screening of patients at risk is recommended due to the high incidence of gastric cancer, endoscopic resection of early cancer in the stomach and distal oesophagus is inreasing. In spite of the special endoscopic techniques -there are several requirements for the resected specimen which ensure its exact pathohistological evaluation. This is necessary to detect the exact depth of infiltration and the resection margins. To provide an exact pathohistological diagnosis is important for further therapeutic im-plications and prognosis. Advanced carcinomas of the oesophagus and stomach need multimodal treatment with radiation and chemotherapy. This has a special impact on the tumour which leads to pathohistological detectable changes as esti-mated in the so-called regression grading.
Zentralblatt für Chirurgie 10/2011; · 1.02 Impact Factor
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ABSTRACT: Tumour angiogenesis via vascular endothelial growth factor (VEGF) is essential for promoting tumour progression and is overexpressed in colorectal cancer. The humanised monoclonal anti-VEGF antibody bevacizumab (Avastin®, Genentech Inc., South San Francisco, CA) has shown activity in metastatic colorectal cancer (mCRC) combined with conventional chemotherapy. The search for biomarkers to predict response to anti-angiogenic therapy in mCRC is of great interest. We investigated several potential predictive anti-angiogenic markers including circulating endothelial progenitor cells (EPC) in patients with mCRC receiving bevacizumab containing treatment within a randomised multicenter phase 2 study of the German AIO GI tumour study group.
We collected sequential blood samples and tumour tissues from patients participating in a clinical trial for patients with mCRC. We performed flow cytometry of mononuclear cells isolated from peripheral blood to assess CD 133 + or CD 34 + /KDR + EPC before the first bevacizumab containing chemotherapy and after 21 days. Circulating VEGF blood levels before a bevacizumab containing chemotherapy regimen and after 21 days and VEGF expression in tumour tissue were examined.
Patients with mCRC and a partial remission after six months of immuno-chemotherapy containing bevacizumab showed a reduction of CD 34 negative KDR positive cells as early as 3 weeks after start of therapy. In contrast, no remarkable change in the number of CD 34 /KDR positive or CD 34 /CD133 positive cells was seen. Furthermore, there was no correlation between treatment response and VEGF expression within the tumour tissue. The mAb bevacizumab reduced serum-VEGF levels in patients independent of their treatment response to bevacizumab.
We examined circulating endothelial progenitor cells (EPC), serum-VEGF levels and the tumour tissue VEGF expression of patients with mCRC under a bevacizumab containing chemotherapy. The patients with a partial remission after six months of immuno-chemotherapy showed a reduction of CD 34 negative KDR positive cells as early as 3 weeks after start of therapy. Neither serum nor tissue markers were of significant predictive value in our pilot study. Furthermore, we review the current data on biomarkers for anti-angiogenic therapy of mCRC.
Zeitschrift für Gastroenterologie 10/2011; 49(10):1398-406. · 0.90 Impact Factor
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ABSTRACT: Solid pseudopapillary neoplasms (SPNs) are rare pancreatic tumors. They occur most frequently in young females and are often diagnosed accidentally. SPNs are characterized by an excellent clinical outcome. In our case series the clinical course, pathohistological data and clinical outcome of eight patients (7 female patients, 1 male patient) with SPN are described. Histological examination as well as immunohistochemical analysis shows similar results in all eight cases. Although in the literature a few cases of SPNs with bad prognosis have been reported, up to now none of our patients shows any signs of recurrence or metastasis. Moreover, we give in this case series a summary of SPNs in the literature, important clinical and pathological differential diagnosis, and additionally discuss relevant differential diagnosis occurring in daily routine work.
Zeitschrift für Gastroenterologie 10/2011; 49(10):1417-22. · 0.90 Impact Factor
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ABSTRACT: The ductal adenocarcinoma of the pancreas is characterised by a very poor prognosis due to an early inoperability of the tumours. Even if operated under curative aspects, local recurrence of the disease is quite frequent with corresponding poorer prognosis. For a better assessment, standardised protocols for the pathohistological processing of resection specimens of the pancreas are needed urgently as well as a strict adherence to the R classification. In order to establish a reliable marker for the risk of recurrence, the smallest distance to the circumferential resection margin should be indicated in comparison to the circumferential resection margin (CRM) concept in colorectal carcinoma.
Zeitschrift für Gastroenterologie 10/2011; 49(10):1423-7. · 0.90 Impact Factor
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ABSTRACT: The liver is the largest unpaired parenchymatous organ in the human body and takes part in almost all important metabolic processes. Many patients show alterations of the whole organ due to vascular/cardiac disorders, metabolic or infectious diseases (congestion, fatty liver disease, fibrosis and cirrhosis). However the liver is also a common site for metastatic lesions of malignant tumors. Additionally, benign focal lesions, such as hemangioma or focal nodular hyperplasia (FNH) occur quite frequently. To describe and diagnose these lesions in terms of dignity and location, knowledge of the macroscopic structure and the relative position of the organ in relation to neighbouring organs are important as well as the histology. The microstructure of the liver and its vascular and biliary vessels are determined by the embryonic development and its function as a central metabolic organ.
Der Radiologe 08/2011; 51(8):655-60. · 0.61 Impact Factor
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ABSTRACT: Background: The concept of total mesorectal excision has revolutionised rectal cancer surgery. TME reduces the rate of local recurrence and tumour associated mortality. However, in clinical trials only 50% of the removed rectal tumours have an optimal TME quality. - Patients: During a period of 36 months we performed 103 rectal resections. The majority of patients (76%; 78/103) received an anterior resection. The remaining patients underwent either abdominoperineal resection (16%; 17/103), Hartmann;s procedure (6%; 6/103) or colectomy (2%; 2/103). - Results: In 90% (93/103) TME quality control could be performed. 99% (92/93) of resected tumours had optimal TME quality. In 1% (1/93) the mesorectum was nearly complete. None of the removed tumours had an incomplete mesorectum. In 98% (91/93) the circumferential resection margin was negative. Major surgical complications occurred in 17% (18/103). 5% (4/78) of patients with anterior resection had anastomotic leakage. 17% (17/103) developed wound infections. Mortality after elective surgery was 4% (4/95). - Conclusion: Optimal TME quality results can be achieved in all stages of rectal cancer with a rate of morbidity and mortality comparable to the results from the literature. Future studies should evaluate outcome and local recurrence in accordance to the degree of TME quality.
European journal of medical research. 07/2010; 15(7):292-6.
