H Kronsbein

Fulda Clinic, Fulda, Hesse, Germany

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Publications (25)19.92 Total impact

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    ABSTRACT: CASE REPORT: Granulomatous infectious processes have a wide differential diagnosis. This report describes the case of a 73-year-old woman who had gone through an 8-year ordeal involving several paranasal sinus operations, development of chronic facial pain, orbital exenteration of the left eye, and now threatening loss of the remaining right eye on account of progression of the chronic inflammation. Despite repeated histologic examination of ENT material by various pathologic institutes, neither the histology nor laboratory parameters were able to point us in the right direction. In the end, it was the clinical course which led to the diagnosis of Wegener's granulomatosis. CONCLUSION: In chronic necrotizing granulomatous inflammatory processes in the region of the paranasal sinuses with involvement of the surrounding anatomic structures (orbit, skull base), Wegener's granulomatosis should be included in the differential diagnosis at an early stage, even if the typical signs of vasculitis and the typical antibodies are absent. The clinical course calls for an interdisciplinary treatment approach in conjunction with internists experienced in immunosuppressant therapy.
    Medizinische Klinik 09/2003; 98(8):453-7. · 0.34 Impact Factor
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    ABSTRACT: We report on three cases of amyloidosis of the breast, two of which coincided with breast cancer. Patient no. 1, a 60-year-old woman, presented with two mass lesions measuring 2 cm in diameter, one in each breast. Histologically, a tubulo-lobular carcinoma was found in the left breast accompanied by vascular, interstitial, and periductal amyloid deposits; the lesion in the right breast consisted of amyloid deposits only. Patient no. 2, an 86-year-old woman, presented with an ulcerated breast tumor measuring 5 cm in diameter on the left side. A poorly differentiated invasive ductal carcinoma was found in the mastectomy specimen, and it coincided with interstitial and vascular amyloid deposits. In both patients, tumor cells had invaded the amyloid deposits. Patient no. 3, a 73-year-old woman, presented with a mass measuring 5 x 3 x 3 cm in her left breast. Fibrocystic changes, as well as interstitial and periductal amyloid deposits, were found histologically. In each case electron microscopy showed rigid, non-branching fibrils of indefinite length and measuring 10-12 nm in diameter; these were consistent with amyloid fibrils. Clinical data, immunohistochemistry, and/or amino acid sequencing of the fibril proteins extracted from formalin-fixed and paraffin-embedded tissue specimens provided evidence that the amyloid deposits were of immunoglobulin light chain origin in all three cases. A review of the literature revealed that kappa-light chain has been described more frequently than lambda-light chain in the breast and that there are no specific clinical or radiological symptoms of amyloidosis affecting the breast; a diagnosis can be achieved only by histology.
    Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 06/2002; 440(5):527-35. · 2.68 Impact Factor
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    B Schick, H Kronsbein, G Kahle, A Prescher, W Draf
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    ABSTRACT: Papillary tumors of the middle and inner ear have been interpreted histogenetically in many ways. In 1989 Heffner proposed the endolymphatic sac epithelium as a possible origin. These rare tumors are clinically aggressive and can cause extensive temporal bone destruction. Because of this behavior, endolymphatic sac tumors (ELST) were classified as low-grade adenocarcinomas, although metastasis has not yet been documented. Two papillary neoplasms of the temporal bone are presented, which we believe are examples of adenomatous tumors arising from the epithelium of the endolymphatic sac. One was associated with a pituitary adenoma. A third case of a papillary middle ear neoplasm is described that shows histologic features similar to the other two, but it was located in the tympanum and had no connection to the endolymphatic sac. This report focuses on clinical, radiologic, and histologic findings of papillary tumors of the temporal bone with additional emphasis on modern concepts of histogenesis and aspects of differential diagnosis.
    Skull Base Surgery 03/2001; 11(1):25-33. · 0.72 Impact Factor
  • H Kronsbein, H Arps, R Bässler
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    ABSTRACT: The Mamma-Registry Fulda, founded in 1976 by the senior co-author, is a personal service for pathologists having problems with histological diagnosis of breast diseases. From nearly 7000 cases filed up to now we selected 1112 consecutive consultations from 1996 to 1999 for this study. The aims were a critical analysis of a "submission-profile" and for each case a comparison of submitters' diagnoses with that of the register to crystallize special fields of problems in histopathological diagnosis and to make a statement about quality standards which was shown in a raster of results. The submitted cases came from pathologists in university institutes (13.9%), city hospitals (49.0%), group practices (24.2%), and single practices (11.6%). The material consisted of selected paraffin-blocs in about two thirds and of slides only in less than one third. The sendings were accompanied by letters with sufficient information on history, clinical background, and gross findings in 72%, and in an additional rate of 17.1% by copies of the histological reports already given by the submitters to their clinicians. The main reasons for consultations were a primarily uncertain diagnosis (45.8%) or the request to affirm a more or less definite diagnosis (40.7%) in cases of rare lesions or differing judgements in the submitting institution. Each diagnosis of the registry was coded in a special diagnostic key. In a raster of results the diagnosis of each case was listed as identical (55.0%) when there was complete agreement between submitter's and register's result, as included (23.9%) when one of the differential diagnoses named by the submitter fitted the register's diagnosis, and as different (6.7%) when there was only agreement about the dignity of differently classified lesions. False positive (2.3%) and false negative (4.5%) diagnoses of submitters were subclassified as clinically irrelevant (2.6%) and relevant (4.2%). The most often missed diagnostic entity in the latter group was tubular carcinoma. Overall the results of the study justify awarding a high standard of quality to histopathological diagnostics.
    Verhandlungen der Deutschen Gesellschaft für Pathologie 02/2001; 85:193-9.
  • R. Bässler, H. Kronsbein, H. Arps
    Gynakologe. 01/2001; 34(2):142-150.
  • R. Bässler, H. Kronsbein, H. Arps
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    ABSTRACT: Im Rahmen des Qualitätssicherungsprogramms in Hessen zur histopathologischen Diagnostik des Mammakarzinoms wird zu 3 Fragen Stellung genommen, die Aufgaben und Ziele der Pathologie betreffen: Die histopathologische Diagnostik ist keine statische, sondern eine am Fortschritt orientierte Methode mit einer morphologischen Basis. Klassifikationen unterliegen Veränderungen und Ergänzungen, die von Zeit zu Zeit in die praktische Diagnostik einfließen. Demnach sollte stets geprüft werden, ob die angewendete oder gewohnte histopathologische Diagnostik dem aktuellen Standard entspricht. Konsiliarische Untersuchungen von Problemfällen der Mamma (Mamma-Register Fulda) wurden seit 1976 an 6700 Fällen vorgenommen. 620 Fälle der Jahre 1998 und 1999 wurden im Hinblick auf die diagnostische Qualität der einsendenden Pathologen analysiert. In 6,6% lagen Fehldiagnosen vor, die in 3,6% zu therapeutischen und prognostischen Konsequenzen geführt hätten. Das Ergebnis dieser Studie rechtfertigt, der histopathologischen Diagnostik ein hohes Qualitätsniveau zuzuerkennen. Die hohen Qualitätsanforderungen an die histopathologische Diagnostik sind neben fachspezifischen Kenntnissen und Erfahrungen nur durch eine wesentlich bessere Zusammenarbeit von Gynäkologen, Radiologen und Pathologen zu erfüllen. In prä- und postoperativen Konsilen sollten die diagnostischen und therapeutischen Maßnahmen unter allen Beteiligten diskutiert werden. Within the framework of the Hessian quality control program for histopathological diagnosis of breast cancer, views are expressed on three questions that pertain to the responsibilities and goals of pathology. Histopathological diagnostic is not a static method, but rather one with a morphological basis oriented towards progress. Classifications are subject to changes and additions that occasionally influence practical diagnostics. Therefore, the applied or conventional histopathological diagnostics should always be checked to ensure they meet current standards. Histopathological consultations to investigate problematic cases of breast cancer (Fulda register) have been held since 1976 to scrutinize 6700 cases. Of these, 620 cases dating from the years 1998 and 1999 were analyzed with regard to the diagnostic quality of the contributing pathologists. In 6.6% of the cases, the diagnosis was incorrect, which could have had therapeutic and prognostic consequences for 3.6% of the cases. The result of this study justifies awarding a high standard of quality to histopathological diagnostics. The high quality demands imposed on histopathological diagnostics can only be fulfilled by considerable improvement of collaboration between gynecologists, radiologists, and pathologists, in addition to specialized knowledge. The diagnostic and therapeutic measures should be discussed among all participants at pre- and postoperative interdisciplinary consultations.
    Der Gynäkologe 01/2001; 34(2):142-150.
  • B Schick, H Kronsbein, B Loewenhardt
    HNO 11/2000; 48(10):784-5. · 0.42 Impact Factor
  • B. Schick, H. Kronsbein, B. Loewenhardt
    HNO 09/2000; 48(10):784-785. · 0.42 Impact Factor
  • T Vogtmann, J Volmar, H Kronsbein, T Bonzel
    The Journal of invasive cardiology 11/1999; 11(10):649. · 1.57 Impact Factor
  • A Relic, B Schick, H Kronsbein, G Kahle, W Draf
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    ABSTRACT: Hemangiomas of the skull base are rare neoplasms and are easily misdiagnosed as acoustic neuromas when occurring in the internal auditory canal. Among these tumors, ossifying hemangiomas are characterized histologically be newly formed bone tissue within their substance. We describe a 26-year old female patient who presented with left-sided sensorineural hearing loss and tinnitus. T2-weighted magnetic resonance imaging demonstrated a bright space-occupying lesion of the internal auditory canal with extension to the geniculate ganglion. Bony erosions of the internal auditory canal were proved by high-resolution computed tomography. A hemangioma was suspected preoperatively and was resected via a middle cranial fossa approach. Histologically, new bone formations were found in a cavernous hemangioma. In general, radiologic findings can suggest a hemangioma of the internal auditory canal and help to differentiate it from acoustic neuroma. Based on the histological findings of intratumoral bone formation, the hemangioma in our patient was classified as an ossifying hemangioma. However, reactive bone formation at the borders of a tumor in the internal auditory canal can also be mistaken as new intratumoral bone formation.
    HNO 07/1999; 47(6):563-8. · 0.42 Impact Factor
  • T Vogtmann, J Volmar, H Kronsbein, T Bonzel
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    ABSTRACT: We report a case of LAD-stent deformation by extracorporeal cardiopulmonary resuscitation (CPR) shortly after stent implantation. To our knowledge, this is the first reported case. During an emergency PTCA, stents were implanted into the RCA and LAD. Patency was proven by angiography before the patient left the cardiac laboratory. Thirty minutes later the patient underwent CPR because of ventricular fibrillation. The patient died in cardiogenic shock. Postmortem examination showed a distinctly deformed LAD-stent. The case proves the possibility of a deformation of a coronary stent by resuscitation.
    Zeitschrift für Kardiologie 05/1999; 88(4):296-9. · 0.97 Impact Factor
  • C Davies, B Schick, H Kronsbein, J Hendus
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    ABSTRACT: Hemangiopericytomas are mesenchymal tumors and account for about 1% of all CNS tumors. Aggressive growth, tendency to local recurrence and relatively frequent metastases are the clinical features of these tumors. Histological characteristics are marked cellularity, vascularity and a dense net of reticular fibers. This case presents a patient with a local recurrence of a right temporal, atypical meningioma that had been operated on and irradiated elsewhere. After embolization large parts of the tumor were removed palliatively. Histological aspects of the resected tumor were consistent with a diagnosis of an atypical meningioma. Not until hepatic metastases from this tumor were found was the diagnosis re-examined and corrected to a malignant meningeal hemangiopericytoma. Surgical resection of primary tumor with frequent controls and, if needed, postoperative radiation therapy is the treatment of choice. Furthermore metastasizing atypical meningiomas should be examined critically to determine if a hemangiopericytoma is present.
    HNO 04/1999; 47(3):183-7. · 0.42 Impact Factor
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    ABSTRACT: Hämangioperizytome sind mesenchymale Tumoren, die ca. 1% aller ZNS-Tumoren ausmachen. Sie zeichnen sich klinisch durch ihr aggressives Wachstum, die Neigung zu Rezidiven und eine relative Häufigkeit von Metastasen sowie histologisch bei Zell- und Gefäßreichtum durch ein dichtes Netz retikulärer Fasern aus. Der hier vorgestellte Patient wurde an unserer Klinik mit einem rechts temporalen Rezidiv eines auswärts voroperierten und bestrahlten atypischen Meningeoms aufgenommen. Nach Embolisation wurden unter palliativem Aspekt große Teile des Tumors entfernt. Das histologische Bild des Resektats gab keinen Anlaß, an der Diagnose eines atypischen Meningeoms zu zweifeln. Erst als im weiteren Verlauf Lebermetastasen des Meningealtumors nachgewiesen wurden, mußte die Diagnose überprüft werden und in die eines malignen meningealen Haemangioperizytoms geändert werden. Die chirurgische Resektion mit engmaschigen Kontrollen und gegebenfalls mit postoperativer Bestrahlung ist die Therapie der Wahl bei meningealen Hämangioperizytomen. Zudem sollten metastasierende atypische Meningeome dahingehend kritisch überprüft werden, ob ein meningeales Hämangioperizytom vorliegt. Hemangiopericytomas are mesenchymal tumors and account for about 1% of all CNS tumors. Aggressive growth, tendency to local recurrence and relatively frequent metastases are the clinical features of these tumors. Histological characteristics are marked cellularity, vascularity and a dense net of reticular fibers. This case presents a patient with a local recurrence of a right temporal, atypical meningioma that had been operated on and irradiated elsewhere. After embolization large parts of the tumor were removed palliatively. Histological aspects of the resected tumor were consistent with a diagnosis of an atypical meningioma. Not until hepatic metastases from this tumor were found was the diagnosis re-examined and corrected to a malignant meningeal hemangopericytoma. Surgical resection of primary tumor with frequent controls and, if needed, postoperative radiation therapy is the treatment of choice. Furthermore metastasizing atypical meningiomas should be examined critically to determine if a hemangiopericytoma is present.
    HNO 03/1999; 47(3):183-187. · 0.42 Impact Factor
  • T. Vogtmann, J. Volmar, H. Kronsbein, T. Bonzel
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    ABSTRACT: Wir berichten über die Deformation eines koronaren Stents als Folge einer extrakorporalen Herzdruckmassage. Es handelt sich um den ersten publizierten Fall. Im Rahmen einer Akut-PTCA war je ein RCA- und ein LAD-Stent implantiert und deren Durchgängigkeit vor Verlassen des Katheterlabors angiographisch überprüft worden. Nach einer 30 Minuten später einsetzenden, erfolglosen Reanimation verstarb die Patientin im kardiogenen Schock. Die Obduktion zeigte einen stark deformierten LAD-Stent. Diese Beobachtung beweist die Möglichkeit der Deformation eines koronaren Stents durch Reanimationsmaßnahmen. We report a case of LAD-stent deformation by extracorporeal cardiopulmonary resuscitation (CPR) shortly after stent implantation. To our knowledge, this is the first reported case. During an emergency PTCA, stents were implanted into the RCA and LAD. Patency was proven by angiography before the patient left the cardiac laboratory. Thirty minutes later the patient underwent CPR because of ventricular fibrillation. The patient died in cardiogenic shock. Postmortem examination showed a distinctly deformed LAD-stent. The case proves the possibility of a deformation of a coronary stent by resuscitation. Schlüsselwörter PTCA – Stent – ReanimationKey words PTCA – stent – resuscitation
    Zeitschrift für Kardiologie 01/1999; 88(4):296-299. · 0.97 Impact Factor
  • A. Relic, B. Schick, H. Kronsbein, G. Kahle, W. Draf
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    ABSTRACT: Hämangiome der Schädelbasis sind insgesamt seltene Tumoren, die im Bereich des inneren Gehörgangs insbesondere mit dem wesentlich häufigeren Akustikusneurinom verwechselt werden können. Das ossifizierende Hämangiom repräsentiert eine Sonderform in der Gruppe der Hämangiome und ist histopathologisch durch intratumorale Knochenneubildungen gekennzeichnet. Es wird von einem kavernösen Hämangiom des linken inneren Gehörgangs bei einer 26jährigen Patientin berichtet, welches zu einer progredienten sensorineuralen Hörminderung und Tinnitus geführt hatte. Bei T2-gewichteter kernspintomographischer Darstellung einer signalreichen Neubildung im inneren Gehörgang mit computertomographisch evidenten Knochendestruktionen am Gehörgangsboden war präoperativ die Abgrenzung von einem Akustikusneurinom möglich. Über einen transtemporalen Zugang konnte die vaskuläre Neubildung reseziert werden. Histopathologisch waren Knochenneubildungen in einem kavernösen Hämangiom zu erkennen. Die radiologischen Befunde ermöglichen präoperativ die Abgrenzung eines Hämangioms vom Akustikusneurinom. Aufgrund des Nachweises von Knochenneubildungen in den histologischen Schnittpräparaten des Tumors ist die Einordnung des kavernösen Hämangioms als ossifizierendes Hämangiom naheliegend. Neben der Wertung der histologisch nachgewiesenen Knochenneubildungen als intratumorale Ereignisse muß auch an die Möglichkeit einer in den Schnittpräparaten vorgetäuschten intratumoralen Knochenneubildung durch den Anschnitt reaktiver Knochenneubildungen am destruierten Gehörgangboden gedacht werden. Hemangiomas of the skull base are rare neoplasms and are easily misdiagnosed as acoustic neuromas when occurring in the internal auditory canal. Among these tumors, ossifying hemangiomas are characterized histologically be newly formed bone tissue within their substance. We describe a 26-year old female patient who presented with left-sided sensorineural hearing loss and tinnitus. T2-weighted magnetic resonance imaging demonstrated a bright space-occupying lesion of the internal auditory canal with extension to the geniculate ganglion. Bony erosions of the internal auditory canal were proved by high-resolution computed tomography. A hemangioma was suspected preoperatively and was resected via a middle cranial fossa approach. Histologically, new bone formations were found in a cavernous hemangioma. In general, radiologic findings can suggest a hemangioma of the internal auditory canal and help to differentiate it from acoustic neuroma. Based on the histological findings of intratumoral bone formation, the hemangioma in our patient was classified as an ossifying hemangioma. However, reactive bone formation at the borders of a tumor in the internal auditory canal can also be mistaken as new intratumoral bone formation.
    HNO 01/1999; 47(6):563-568. · 0.42 Impact Factor
  • B Schick, H Kronsbein, M Heil, W Draf
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    ABSTRACT: BACKGROUND: Spontaneous malignant transformation of laryngeal papillomatosis was in the past mostly negated, or the discussion in literature was rather toned down and reserved. Therefore, from a biological and prognostic point of view, HPV infection of the larynx seems to carry a different weight than a viral infection in genital region. According to general consensus, secondary, malignant transformation in juvenile papillomatosis occurs in irradiated patients and leads to the conclusion that radiation therapy of this disease is presently contraindicated. Because there is as yet no causal and curative treatment, repeated and frequent removal of papillomatous tissue by microlaryngoscopy may often be necessary to keep the airway patent. PATIENT, METHOD AND RESULTS: We diagnosed and treated an advanced laryngeal squamous cell carcinoma with lymphatic metastasis in a 50-year old male. Juvenile papillomatosis had been diagnosed already at the age of five, and at the patient's last presentation 5 years ago (age 45), typical clinical and histological features of laryngeal papillomatosis had been observed. Furthermore, virus infection of the papillomatous tissue (HPV-6/11) was proved by using the technique of in-situ hybridisation. Risk factors for malignant transformation, such as smoking, alcohol or radiation, were denied by the patient. CONCLUSIONS: From these aspects, a spontaneous, malignant transformation of laryngeal papillomatosis must be considered with regard to six similar observations in the German and English literature. In the reported case, a tumoural origin in the flat laryngeal mucosa in close neighbourhood to the former site of papillomas, is less probable, albeit not ruled out completely, since continuous changes from benign squamous papilloma to atypical, invasive tumour and a HPV-infection in the carcinomatous tissue could not be proved by in-situ hybridisation.
    Laryngo-Rhino-Otologie 04/1997; 76(3):150-4. · 0.82 Impact Factor
  • K P Hunfeld, R Bässler, H Kronsbein
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    ABSTRACT: Focal B-lymphocytic mastitis and focal fibrosis of the breast in young women have rarely been reported as a complication of longstanding insulin-dependent diabetes mellitus type I. We present two cases of "diabetic mastopathy" in male diabetics suffering from gynecomastia. Furthermore, these two cases were examined in comparison to a selected group of 6 patients showing gynecomastia with a marked inflammatory reaction, as well as to 24 non-selected cases of common gynecomastia. The lesion is interpreted as a diabetes-induced autoimmune reaction of the breast and may be regarded as a lympho-epithelial lesion. Its histopathological characteristics are a marked chronic periductal and perivascular mastitis with a predominance of B-lymphocytes, a focal homogenous fibrosis and so called "epithelioid stromal fibroblasts" within the fibrotic matrix. Our findings support the existance of "diabetic mastopathy" in the male and point out to the potentially misleading pattern of this benign tumor-like lesion simulating gynecomastia.
    Pathology - Research and Practice 02/1997; 193(3):197-205. · 1.21 Impact Factor
  • B. Schick, H. Kronsbein, M. Heil, W. Draf
    Laryngo-rhino-otologie - LARYNGO RHINO OTOL. 01/1997; 76(03):150-154.
  • Der Radiologe 07/1996; 36(6):515-9. · 0.47 Impact Factor
  • B Schick, G Kahle, H Kronsbein, W Draf
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    ABSTRACT: A papillary neoplasm that was presumed to originate from the endolymphatic sac was described by Heffner in 1989. This tumor was considered to be a "low-grade adenocarcinoma" because of its behavior: slow growth, local destruction and failure to metastasize. The clinical manifestations are hearing loss, vertigo, facial nerve paralysis and/or cerebellar disorders. Endolymphatic sac tumors have previously been mistaken for such neoplasms as paraganglioma, choroid plexus papilloma and carcinoma, adenomatous tumor of the middle ear and secondary metastases. The diagnosis of this neoplasm is facilitated by CT and MRI. The treatment of choice is total removal of tumor as soon as possible and requires clinical awareness of this rare but important pathologic entity.
    HNO 07/1996; 44(6):329-32. · 0.42 Impact Factor