Cord Langner

Medical University of Graz, Gratz, Styria, Austria

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Publications (318)1091.69 Total impact

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    ABSTRACT: Tuberous sclerosis complex (TSC) is a genetic disorder with multisystem involvement that is due to autosomal-dominantly inherited or sporadic mutations in TSC1 and TSC2 genes. Involvement of the gastrointestinal tract is rare. We report the case of a 51-year-old woman with diagnosis of TSC established by genetic testing, who presented with colorectal hamartomatous polyposis. Multiple small polyps were found scattered through the left colon and rectum. Histology revealed a distinct spindle cell proliferation in the lamina propria, originating from the muscularis mucosae. The cells lacked atypia or mitotic activity and were diffusely positive for smooth muscle actin and negative for S100 protein. Genetic testing proved a disease causing frameshift mutation in the TSC1 gene. Although gastrointestinal involvement is rare in TSC, hamartomatous polyps can be the initial manifestation of this syndrome. Genetic testing should be considered in every case for which TSC is clinically suspected.
    Pathology - Research and Practice 10/2015; DOI:10.1016/j.prp.2015.09.016 · 1.40 Impact Factor
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    ABSTRACT: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system 1 2 was adopted to define the strength of recommendations and the quality of evidence. Main recommendations 1 ESGE recommends endoscopic en bloc resection for superficial esophageal squamous cell cancers (SCCs), excluding those with obvious submucosal involvement (strong recommendation, moderate quality evidence). Endoscopic mucosal resection (EMR) may be considered in such lesions when they are smaller than 10 mm if en bloc resection can be assured. However, ESGE recommends endoscopic submucosal dissection (ESD) as the first option, mainly to provide an en bloc resection with accurate pathology staging and to avoid missing important histological features (strong recommendation, moderate quality evidence). 2 ESGE recommends endoscopic resection with a curative intent for visible lesions in Barrett's esophagus (strong recommendation, moderate quality evidence). ESD has not been shown to be superior to EMR for excision of mucosal cancer, and for that reason EMR should be preferred. ESD may be considered in selected cases, such as lesions larger than 15 mm, poorly lifting tumors, and lesions at risk for submucosal invasion (strong recommendation, moderate quality evidence). 3 ESGE recommends endoscopic resection for the treatment of gastric superficial neoplastic lesions that possess a very low risk of lymph node metastasis (strong recommendation, high quality evidence). EMR is an acceptable option for lesions smaller than 10 - 15 mm with a very low probability of advanced histology (Paris 0-IIa). However, ESGE recommends ESD as treatment of choice for most gastric superficial neoplastic lesions (strong recommendation, moderate quality evidence). 4 ESGE states that the majority of colonic and rectal superficial lesions can be effectively removed in a curative way by standard polypectomy and/or by EMR (strong recommendation, moderate quality evidence). ESD can be considered for removal of colonic and rectal lesions with high suspicion of limited submucosal invasion that is based on two main criteria of depressed morphology and irregular or nongranular surface pattern, particularly if the lesions are larger than 20 mm; or ESD can be considered for colorectal lesions that otherwise cannot be optimally and radically removed by snare-based techniques (strong recommendation, moderate quality evidence). © Georg Thieme Verlag KG Stuttgart · New York.
    Endoscopy 09/2015; 47(9):829-854. DOI:10.1055/s-0034-1392882 · 5.05 Impact Factor
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    ABSTRACT: This study aimed to assess the clinicopathological significance of tumour differentiation of metastatic lymph node tissue in patients with American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) stage III colorectal cancer. In a cohort of 145 patients, lymph node grades were G1 in 77 (53.1%), G2 in 41 (28.3%) and G3 in 27 (18.6%) cases, respectively. Despite differences in 77 (53.1%) cases, primary tumour and lymph node grade correlated significantly (Somer's D=0.639; p<0.001). Lymph node grade was significantly associated with N classification (p=0.009), tumour size (p=0.024) and lymphovascular invasion (p=0.004). Patients with lymph node grade G1 had better progression-free survival (p=0.031) and cancer-specific survival (p=0.008). Multivariable analysis identified lymph node grade as independent predictor of cancer-specific survival in this cohort. In conclusion, lymph node grade emerged as a promising novel prognostic variable for patients with AJCC/UICC stage III disease. Additional studies are warranted to validate this new finding.
    Journal of Clinical Pathology 06/2015; 68(9):742-745. DOI:10.1136/jclinpath-2014-202772 · 2.92 Impact Factor
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    ABSTRACT: Postoperative chemotherapy is recommended for all patients with lymph node positive colon cancer. In colon cancer, mutations in the TP53 gene are present in more than 30% of tumors. We found that the most commonly used postoperative chemotherapy resulted in a marked survival benefit for patients with normal TP53 status while it was associated with significant survival disadvantage in TP53 mutant patients. Overall the survival disadvantage of the mutated patients almost balanced the survival benefit of the TP53 normal patients. This might be an explanation why chemotherapy resulted in less progress in survival of colon cancer than we would have expected.
    06/2015; 10(8). DOI:10.1016/j.ebiom.2015.06.003
  • Annika Resch · Lars Harbaum · Marion J Pollheimer · Peter Kornprat · RA Lindtner · Cord Langner ·
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    ABSTRACT: This study aimed to assess the clinicopathological significance of tumour differentiation of metastatic lymph node tissue in patients with American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) stage III colorectal cancer. In a cohort of 145 patients, lymph node grades were G1 in 77 (53.1%), G2 in 41 (28.3%) and G3 in 27 (18.6%) cases, respectively. Despite differences in 77 (53.1%) cases, primary tumour and lymph node grade correlated significantly (Somer's D=0.639; p<0.001). Lymph node grade was significantly associated with N classification (p=0.009), tumour size (p=0.024) and lymphovascular invasion (p=0.004). Patients with lymph node grade G1 had better progression-free survival (p=0.031) and cancer-specific survival (p=0.008). Multivariable analysis identified lymph node grade as independent predictor of cancer-specific survival in this cohort. In conclusion, lymph node grade emerged as a promising novel prognostic variable for patients with AJCC/UICC stage III disease. Additional studies are warranted to validate this new finding. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Zeitschrift für Gastroenterologie; 05/2015
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    Vincenzo Villanacci · Gabrio Bassotti · Cord Langner ·

    Journal of Crohn s and Colitis 03/2015; 9(5). DOI:10.1093/ecco-jcc/jjv043 · 6.23 Impact Factor
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    ABSTRACT: HintergrundDas Management von „kleinen Polypen“ im distalen Kolon und Rektum ist in den Fokus der Kosten-Nutzen-Analyse der Vorsorgekoloskopie geraten. So wird insbesondere im angloamerikanischen Sprachraum aktuell diskutiert, winzige (Die Amerikanische Gesellschaft für Gastroenterologische Endoskopie (ASGE) hat im Rahmen ihrer sog. Innovationsdiskussion („Preservation and Incorporation of Valuable Endoscopic Innovations [PIVI]“) diskutiert, Polypen unter 0,5 cm Durchmesser zwar zu entfernen, nicht jedoch histopathologisch zu untersuchen - um angeblich Kosten zu sparen (www. In Computermodellrechnungen wurde ermittelt, dass durch das „Entfernen und Verwerfen“ pro Vorsorgekoloskopie 25 US-Dollar gespart werden könnten [1, 2].Nicht nur aus berufspolitischen Gründen wird die Diskussion auch in Deutschland geführt - und von einigen be ...
    Der Pathologe 03/2015; 36(2). DOI:10.1007/s00292-015-0003-5 · 0.39 Impact Factor
  • Annika Resch · Nora I Schneider · Cord Langner ·
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    ABSTRACT: Surgical resection is the treatment of choice for patients with locally confined disease, but early cancers may be adequately treated by endoscopic resection alone. In advanced colorectal cancers, accurate staging including pathological lymph node assessment is crucial for patient counselling and decision making. In addition to the extent of surgical lymph node removal and the thoroughness of the pathologist in dissecting the cancer specimen lymph node recovery is related to the actual number of regional lymph nodes that is related to patient demographics, tumor location and biology. Current guidelines recommend a minimum of twelve nodes harvested as the standard of care. In patients with node-negative tumors a variety of histological features may be used for adjusted risk assessment, including histological subtyping, lymphatic and venous invasion, tumor budding and tumor necrosis as well as the anti-tumor host inflammatory response which has been identified as favorable feature in several studies. In rectal cancer, involvement of the circumferential resection margin and the plane of surgery are important prognostic factors. Early or superficial colorectal cancer is defined as invasive adenocarcinoma invading into, but not beyond the submucosa. A number of features require special attention because they are used to determine the necessity for radical surgery. In addition to the assessment of completeness of excision, these include the recording of parameters that predict the presence of lymph node metastasis, namely the depth of invasion into the submucosa, tumor grade, and the presence of additional risk factors, such as angioinvasion and tumor budding. The combination of these parameters allows the stratification of affected individuals into low-risk and high-risk categories.Keywords: colorectal cancer - early colorectal cancer - lymph node metastasis - pathological features - risk factors - prognosis.
    Ceskoslovenska patologie 02/2015; 51(1):12-22.

  • Zeitschrift für Gastroenterologie 01/2015; 53(01). DOI:10.1055/s-0034-1397143 · 1.05 Impact Factor
  • Cord Langner · Michael Vieth ·
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    ABSTRACT: This chapter explains the terminology and classification of colorectal neoplastic precursor lesions, with focus on serrated lesions: hyperplastic polyp, sessile serrated adenoma/polyp (or lesion), mixed polyp and traditional serrated adenoma. We refer to practical issues, such as the measurement of polyp size and the grading of intraepithelial neoplasia/dysplasia (low grade vs. high grade). The definition of invasion is driven by the World Health Organization and defined as invasion into the submucosal layer. Risk assessment of pT1 colorectal cancers is the prerequisite of clinical decision making ranging from follow-up only to additional endoscopic and surgical procedures. The evaluation is based upon the following parameters: depth of invasion (for sessile lesions reported according to Kikuchi levels sm1–sm3; for polypoid/pedunculated lesions reported according to Haggitt levels I–IV), tumour grade, vascular invasion, margin involvement, budding (tumour cell dissociation at the invasion front) and (possibly) perineural invasion.
    Multidisciplinary Treatment of Colorectal Cancer, 01/2015: pages 211-225; , ISBN: 978-3-319-06141-2
  • Cord Langner ·
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    ABSTRACT: Although often viewed as a single disease, colorectal cancer more accurately represents a family of diseases with different precursor lesions. Conventional (tubular, tubulovillous and villous) adenomas are the most common neoplastic lesions occurring in the large intestine. They have adenomatous polyposis coli (APC) mutations and arise from dysplastic aberrant crypt foci, initially as polyclonal lesions. In sporadic tumours, neoplastic progression follows the traditional pathway (chromosomal instability pathway), resulting in CpG island methylator phenotype (CIMP)-negative, microsatellite-stable (MSS), BRAF and KRAS wild-type cancers. Germline mutations in the APC gene lead to familial adenomatous polyposis. Conventional adenomas are also the precursors of Lynch syndrome-associated microsatellite-instable (MSI-high) cancers. Sessile serrated adenoma/polyp (SSA/P) is the principal precursor lesion of the serrated pathway, in which BRAF mutation can lead to colorectal cancer with MSI-high CIMP-high or MSS CIMP-high phenotype. SSA/Ps have been associated with synchronous and metachronous invasive adenocarcinomas as well as so-called interval carcinomas. Serrated polyposis is rare but most likely underdiagnosed. Affected individuals bear an increased but unspecified risk for the development of colorectal cancer; close endoscopic surveillance is warranted. Traditional serrated adenomas (TSAs) are much less common than the other serrated lesions. Cancers originating from TSAs may show KRAS mutation with a CIMP-high MSS phenotype. © 2014 S. Karger AG, Basel.
    Digestive Diseases 01/2015; 33(1):28-37. DOI:10.1159/000366032 · 2.18 Impact Factor
  • Annika Resch · Cord Langner ·
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    ABSTRACT: The pathological examination of early colorectal cancer specimens, in particular 'malignant polyps', provides important prognostic information. The depth of invasion into the submucosal layer assessed according to the Haggitt (for pedunculated lesions) or Kikuchi (for nonpolypoid lesions) classification systems or by direct measurement has been associated with the risk of lymph node metastasis. Angioinvasion, in particular lymphatic invasion, budding, tumor differentiation or grade, and resection margin status have been identified as further risk factors. The combination of these parameters allows the stratification of affected individuals into low- and high-risk categories, which is pivotal for clinical management. For low-risk cancers, defined as a completely excised Haggitt level 1-3/Kikuchi sm1 tumor with no evidence of poor differentiation or angioinvasion, local excision is generally regarded as adequate treatment. Oncological surgical resection is, however, indicated for high-risk cancers, which show at least one of the following features: Haggitt level 4/Kikuchi sm3 invasion, the presence of lymphatic (or vascular) invasion, poor differentiation, or positive resection margin. The inclusion of molecular markers such as tumor suppressor genes and their products, markers involved in tumor vascularization, and markers related to tumor cell adhesion and invasion may help to refine risk stratification, but data on molecular markers are still limited in this regard. © 2014 S. Karger AG, Basel.
    Digestive Diseases 01/2015; 33(1):77-85. DOI:10.1159/000366036 · 2.18 Impact Factor
  • L. Setaffy · C. Langner ·
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    ABSTRACT: Although often viewed as a single disease, colorectal cancer more accurately represents a constellation of heterogeneous subtypes that result from different combinations of genetic events and epigenetic alterations. Chromosomal instability (CIN), microsatellite instability (MSI) and CpG island methylator phenotype (CIMP) have been identified as the three major molecular characteristics, which interact with other significant mutations, such as mutations in the KRAS and BRAF genes. High-level MSI (MSI-H) is of eminent clinical importance. It is the seminal molecular feature for the identification of individuals with Lynch syndrome, but it may also occur in sporadic cancers with CIMP phenotype, which arise from serrated precursor lesions. MSI-H status is a marker of favorable prognosis and may be used for outcome prediction, that is, molecular grading. Among others, mucinous and medullary histology, signet-ring cell differentiation, and a marked anti-tumoral immune response are histological features suggesting MSI. Universal tumor testing is recommended and may be performed using immunohistochemistry (mismatch repair protein expression) or molecular analysis, as has recently been recommended by an international task force. In this review, we consider in detail the molecular pathogenesis of colorectal cancer, focusing on the diagnosis of MSI in both hereditary and sporadic tumors. © 2015, Versalius University Medical Publisher. All rights reserved.
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    ABSTRACT: Intrahepatic granuloma formation and fibrosis characterize the pathological features of Schistosoma mansoni (S.m.) infection. Based on previously observed substantial anti-fibrotic effects of 24-nor-ursodeoxycholic acid (norUDCA) in Abcb4/Mdr2(-/-)mice with cholestatic liver injury and biliary fibrosis, we hypothesized that norUDCA improves inflammation-driven liver fibrosis in S.m. infection. Adult NMRI mice were infected with 50 S.m. cercariae and after 12 weeks received either norUDCA- or ursodeoxycholic acid (UDCA)-enriched diet (0.5% wt/wt) for 4 weeks. Bile acid effects on liver histology, serum biochemistry, key regulatory cytokines, hepatic hydroxyproline content as well as granuloma formation were compared to naive mice and infected controls. In addition, effects of norUDCA on, primary T-cell activation/proliferation and maturation of the antigen-presenting-cells (dendritic cells, macrophages) were determined in vitro. UDCA as well as norUDCA attenuated the inflammatory response in livers of S.m. infected mice but exclusively norUDCA changed cellular composition and reduced size and of hepatic granulomas as well as TH2-mediated hepatic fibrosis in vivo. Moreover norUDCA affected surface expression level of major histocompatibility complex (MHC) class II of macrophages and dendritic cells as well as activation/proliferation of T-lymphocytes in vitro, whereas UDCA had no effect. This study demonstrates pronounced anti-inflammatory and anti-fibrotic effects of norUDCA compared to UDCA in S.m. induced liver injury and indicates that norUDCA directly represses antigen presentation of antigen presenting cells and subsequent T-cell activation in vitro. Therefore norUDCA represents a promising drug for the treatment of this important cause of liver fibrosis. Copyright © 2014. Published by Elsevier B.V.
    Journal of Hepatology 11/2014; DOI:10.1016/j.jhep.2014.11.020 · 11.34 Impact Factor
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    ABSTRACT: The International Consultations on Urological Diseases are international consensus meetings, supported by the World Health Organization and the Union Internationale Contre le Cancer, which have occurred since 1981. Each consultation has the goal of convening experts to review data and provide evidence-based recommendations to improve practice. In 2012, the selected subject was bladder cancer, a disease which remains a major public health problem with little improvement in many years. The proceedings of the 2nd International Consultation on Bladder Cancer, which included a 'Pathology of Bladder Cancer Work Group,' have recently been published; herein, we provide a summary of developments and consensus relevant to the practicing pathologist. Although the published proceedings have tackled a comprehensive set of issues regarding the pathology of bladder cancer, this update summarizes the recommendations regarding selected issues for the practicing pathologist. These include guidelines for classification and grading of urothelial neoplasia, with particular emphasis on the approach to inverted lesions, the handling of incipient papillary lesions frequently seen during surveillance of bladder cancer patients, descriptions of newer variants, and terminology for urine cytology reporting.Modern Pathology advance online publication, 21 November 2014; doi:10.1038/modpathol.2014.158.
    Modern Pathology 11/2014; 28(5). DOI:10.1038/modpathol.2014.158 · 6.19 Impact Factor
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    ABSTRACT: Multifocal stenosing enteritis, not related to Crohn's disease or drug intake, has been described under two different terms: "cryptogenic multifocal ulcerous stenosing enteritis" (CMUSE) and "neuromuscular and vascular hamartoma" (NMVH). We present three new cases of this condition and argue that the two terms reflect the same disease entity. Although etiology and pathogenesis of the disease remain largely unclear, obliterative vascular changes may play an important role. © Georg Thieme Verlag KG Stuttgart · New York.
    Endoscopy 11/2014; 47(04). DOI:10.1055/s-0034-1390798 · 5.05 Impact Factor
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    ABSTRACT: Microscopic colitis has emerged as a major cause of chronic watery non-bloody diarrhoea, particularly in elderly females. The term is used as an umbrella term to categorize a subgroup of colitides with distinct clinicopathologic phenotypes and no significant endoscopic abnormalities: Lymphocytic colitis is defined by an increased number of surface intraepithelial lymphocytes, collagenous colitis by a thickened collagen band underneath the surface epithelium. There is increased inflammation in the lamina propria, but only little or no crypt architectural distortion. Incomplete and variant forms showing less characteristic features have been reported under different names. Differential diagnosis mainly includes resolving infectious colitis and changes related to the intake of drugs such as non-steroidal anti-inflammatory drugs. Substantial clinical and histological overlap between lymphocytic and collagenous colitis has been described, raising the suspicion that the conditions are two histological manifestations of the same entity, possibly representing different manifestations during the disease course or different stages of disease development. In this review we provide a practical approach for pathologists with focus on diagnostic criteria and differential diagnosis, discuss recent insights into the pathogenesis of disease and the relation to classical chronic inflammatory bowel disease, i.e. Crohn's disease and ulcerative colitis.This article is protected by copyright. All rights reserved.
    Histopathology 11/2014; 66(5). DOI:10.1111/his.12592 · 3.45 Impact Factor
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    ABSTRACT: Objective Histopathology is potentially an important outcome measure in UC. Multiple histological disease activity (HA) indices, including the Geboes score (GS) and modified Riley score (MRS), have been developed; however, the operating properties of these instruments are not clearly defined. We assessed the reproducibility of existing measures of HA. Design Five experienced pathologists with GI pathology fellowship training and expertise in IBD evaluated, on three separate occasions at least two weeks apart, 49 UC colon biopsies and scored the GS, MRS and a global rating of histological severity using a 100 mm visual analogue scale (VAS). The reproducibility of each grading system and for individual instrument items was quantified by estimates of intraclass correlation coefficients (ICCs) based on two-way random effects models. Uncertainty of estimates was quantified by 95% two-sided CIs obtained using the non-parametric cluster bootstrap method. Biopsies responsible for the greatest disagreement based on the ICC estimates were identified. A consensus process was used to determine the most common sources of measurement disagreement. Recommendations for minimising disagreement were subsequently generated. Results Intrarater ICCs (95% CIs) for the total GS, MRS and VAS scores were 0.82 (0.73 to 0.88), 0.71 (0.63 to 0.80) and 0.79 (0.72 to 0.85), respectively. Corresponding inter-rater ICCs were substantially lower: 0.56 (0.39 to 0.67), 0.48 (0.35 to 0.66) and 0.61 (0.47 to 0.72). Correlation between the GS and VAS was 0.62 and between the MRS and VAS was 0.61. Conclusions Although ‘substantial’ to ‘almost perfect’ ICCs for intrarater agreement were found in the assessment of HA in UC, ICCs for inter-rater agreement were considerably lower. According to the consensus process results, standardisation of item definitions and modification of the existing indices is required to create an optimal UC histological instrument.
    Gut 10/2014; DOI:10.1136/gutjnl-2014-307536 · 14.66 Impact Factor
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    ABSTRACT: In colorectal cancer, the presence and extent of eosinophil granulocyte infiltration may render important prognostic information. However, it remains unclear whether an increasing number of eosinophils might simply be linked to the overall inflammatory cell reaction or represent a self-contained, antitumoral mechanism that needs to be documented and promoted therapeutically. Peri- and intratumoral eosinophil counts were retrospectively assessed in 381 primary colorectal cancers from randomly selected patients. Tumors were diagnosed in American Joint Committee on Cancer (AJCC)/Union Internationale Contre le Cancer (UICC) stage I in 21%, stage II in 32%, stage III in 33%, and stage IV in 14%. Presence and extent of eosinophils was related to various histopathological parameters as well as patients' outcome. Overall, peri- and intratumoral eosinophils were observed in 86 and 75% cancer specimens. The peritumoral eosinophil count correlated strongly with the intratumoral eosinophil count (R=0.69; P<0.001) and with the intensity of the overall inflammatory cell reaction (R=0.318; P<0.001). Both increasing peri- and intratumoral eosinophil counts were significantly associated with lower T and N classification, better tumor differentiation, absence of vascular invasion, as well as improved progression-free and cancer-specific survival. However, only peritumoral eosinophils, but not intratumoral, were an independent prognosticator of favorable progression-free (hazard ratio 0.75; 95% confidence interval 0.58-0.98; P=0.04) and cancer-specific survival (hazard ratio 0.7; 95% confidence interval 0.52-0.93; P=0.01)-independent of the intensity of overall inflammatory cell reaction. This was also found for patients with AJCC/UICC stage II disease, wherein the presence of peritumoral eosinophils was significantly associated with favorable outcome. In conclusion, the number of peritumoral eosinophils had a significant favorable impact on prognosis of colorectal cancer patients independent of the overall tumor-associated inflammatory response. Evaluation of peritumoral eosinophils represents a promising readily assessable tool and should therefore routinely be commented on in the pathology report.Modern Pathology advance online publication, 12 September 2014; doi:10.1038/modpathol.2014.104.
    Modern Pathology 09/2014; DOI:10.1038/modpathol.2014.104 · 6.19 Impact Factor

  • Human pathology 08/2014; 45(12). DOI:10.1016/j.humpath.2014.06.028 · 2.77 Impact Factor

Publication Stats

4k Citations
1,091.69 Total Impact Points


  • 2004-2015
    • Medical University of Graz
      • Institute of Pathology
      Gratz, Styria, Austria
  • 2013
    • Klinikum Bayreuth GmbH
      Bayreuth, Bavaria, Germany
  • 2010-2012
    • University of Bayreuth
      Bayreuth, Bavaria, Germany
    • University of Texas Southwestern Medical Center
      • Department of Urology
      Dallas, TX, United States
    • Ruhr-Universität Bochum
      • Institut für Pathologie
      Bochum, North Rhine-Westphalia, Germany
  • 2001-2012
    • Karl-Franzens-Universität Graz
      • Institute of Psychology
      Gratz, Styria, Austria
  • 2009
    • Universität Heidelberg
      • Department of Urology
      Heidelburg, Baden-Württemberg, Germany
    • University of Rostock
      • Institut für Pathologie
      Rostock, Mecklenburg-Vorpommern, Germany
  • 2008
    • Keio University
      Edo, Tōkyō, Japan
  • 2006
    • IST Austria
      Klosterneuberg, Lower Austria, Austria
  • 2000-2001
    • Klinikum Kassel
      Cassel, Hesse, Germany
  • 1999
    • Philipps University of Marburg
      • Institut für Physiologie und Pathophysiologie
      Marburg, Hesse, Germany