96. Jahrestagung der Deutschen Gesellschaft für Pathologie e. V ...

Abstracts
logical examination of tumor tissue during surgery could demonstrate
Rhodococus Equi.
Conclusions. To our knowledge this case represents the first pleural malacoplakia
associated with a Rhodococus equi infection. Extravesikal malacoplakia
is an important differential diagnosis in immunosuppressed
patient especially in case of a proved Rhodococus equi infection.
FR-P-171
Testicular primitive neuroectodermal tumor – molecularpathological
analysis and discussion of developement
S . Brandt1 , B . Lohe2 , A . Vogetseder1 , T . Rüdiger2 , H . Moch1 , P . Bode1 1 2 Universitiy Hospital Zurich, Zürich, Switzerland, Städtisches Klinikum Karlsruhe,
Pathologisches Institut, Karlsruhe
Aims. The occurrence of a testicular primitive neuroectodermal tumor
(PNET) is a rare event in malignant transformation of a teratomatous
component in testicular germ cell tumors. Based on morphological, immunohistochemical
and molecularpathological findings these tumors
resemble central PNETs, as otherwise only seen in children and do not
show a rearrangement of the EWS gene on chromosome 22. We describe
a case of a PNET occurring in a testicular germ cell tumor.
Methods. Routine immunohistochemistry (AE1/AE3-Cytokeratin, S100,
Synaptophysin, CD99, GFAP, Oct-3/4 and CD30) was performed as well
as Fluorescence in situ Hybridization (FISH) and RT-PCR.
Results. Immunohistochemistry showed focal expression of AE1/AE3-
Zytokeratin, S100, Synaptophysin, GFAP and CD99 and no expression
of Oct-3/4 and CD30 in the tumor cells. No translocation of t(11;22)
(EWSR1/FLI1) and t(21;22) (EWSR1/ERG) could be shown by FISH and
RT-PCR.
Conclusions. The occurrence of testicular primitive neuroectodermal
tumor is a rare event. It is believed to originate from malignant transformation
of a teratomatous component in testicular germ cell tumors.
Identification of a PNET component in a testicular germ cell tumor is
of clinical relevance since studies have shown that these tumors do not
respond to conventional cisplatin based chemotherapy in comparison to
usual germ cell tumors. Some authors recommend PNET specific chemotherapy,
as well as retroperitoneal lymph node dissection.
FR-P-172
Complicated Malaria tropica – two typical disease patterns
I . Klempert1 , P . Lohneis1 , W .D . Schmitt1 , M . Dietel1 1Charité University hospital, Institute of Pathology, Berlin
Aims. Malaria – the second most common infectious disease of the world
is rare in Germany. Pathologists are seldom tasked with diagnostics, but
if demanded it is generally presented by fulminant development and
with impressive findings.
Methods. On the basis of two autopsies, which had a fulminant, following
the lethal course of the disease the typical histological pattern and
the correlative medical findings will be demonstrated. The microscopic
slides were prepared with the Hematoxylin-eosin-stain and additionally
examined by the polarizing microscope to differentiate between the
double refracting malaria pigment and stain dependent artefacts.
Results. Anamnestic: Case 1: The patient had a fever, diarrhea and vomiting,
with kidney failure as symptoms of Malaria (tropica) during a
residence in Sierra Leone. Due to the limited therapeutic possibilities
locally, the patient tried to return to his home. The flight back home was
interrupted by a forced landing, because the patient collapsed. He was
brought to the emergency room of the Charité Berlin. The plasmodiumdensity
was very high (>30%). The next day an emergency Splenectomie
by laparotomie was necessary, followed by a secondary haemorrhage.
The cardiovascular system was stable, the plasmodium-density came
down to >1%. Six days later the patient died, caused by a multi organ
failure with a leading liver insufficiency. Case 2: The patient came to his
138 | Der Pathologe · Supplement 1 · 2012
family doctor, because he felt ill and had slurred speech. A few days before,
he had returned from a journey to Cameroon. Within the next few
hours he drifted off more and more and showed increasing intracranial
pressure. He died the next day, caused by a central cardio-vascular system
failure. The density of the plasmodia was 10%. Histologic: Case 1: Expanded
intra- and pericapillary deposits of hemozoin (iron free malaria
pigment) inside the liver, myocardium, kidney and the alveolus of the
lung. Agglutinate erythrocytes were found inside the hepatic sinus and
some vital, adipose hepatocytes were present. Case 2 shows analogous
to case 1 extensive manifestation at the organs. Additionally a massive
edematous brain with plasmodia and hemozoin inside the erythrocytes
of the intracerebral capillaries was found.
Conclusions. The rare disease pattern of a malaria infection appears with
extensive histopathological findings that can be demonstrated by simple
histological methods in correlation with the clinical development.
FR-P-173
Orbital epithelioid sarcoma: a case report
T . Berg1 , J . Knolle1 , S . Knipping2 , C . Kneifel3 , K . Stock4 , I .F . Ciernik5 , T . Mentzel6 1 2 Dessau City Hospital, Institute of Pathology, Dessau, Dessau City Hospital,
Department of Otorhinolaryngology, Dessau, 3Dessau City Hospital, Department
of Ophthalmology, Dessau, 4Dessau City Hospital, Department of Radiology,
Dessau, 5Dessau City Hospital, Department of Radiation Oncology,
Dessau, 6Dermatopathologie Bodensee, Friedrichshafen
Aims. Epithelioid sarcoma (ES) is a rare and aggressive soft tissue neoplasm
most prevalent in the distal extremities of young male adults. The
proximal type of ES is thought to be the morphological progression with
predominance for somewhat older patients and a higher propensity for
metastasis than classic ES.
Methods. We report on a 30-year-old patient who presented with proptosis
of the right eye. He complained of metamorphopsy and visual impairment.
Diagnostic imaging was suspicious for sarcoma. Preoperative
biopsy was performed followed by histological and immunohistochemical
analysis. Antibodies against Cytokeratins (clone MNF116, CK 5/6, CK
8/18, CK 7, CK 20), Vimentin, S100-protein, CD34, CD31, CD10, Desmin,
Aktin, p63, PHH3 and TTF-1 were used. Wide local tumor excision with
curative intent followed.
Results. Histological examination of the biopsy revealed a nodular
growth pattern of atypical eosinophilic epitheloid and spindle cells with
25 mitoses per 10 high-power-fields. By immunohistochemistry, the tumor
was positive for vimentin, cytokeratins and EMA while there was
no reaction for CD34 and INI-1. The diagnosis of proximal-type ES was
established. The patient underwent orbital exenteration with negative
surgical margins. Largest tumor diameter was 27 mm. Eight months
after diagnosis metastatic progression with multiple metastases of the
vertebral column and the base of the skull was noted.
Conclusions. ES (proximal variant) develops predominantely in the pelvis,
perineal region, trunk, mediastinum and genital tract. It is exceedingly
rare in the orbital fossa. To our knowledge only three cases have
been reported. Differential diagnoses include carcinoma, amelanotic
malignant melanoma, epithelioid malignant peripheral nerve sheath tumor
(MPNST), epithelioid angiosarcoma and myoepithelioma. ES has
been associated with an unfavourable prognosis, early and frequent metastasis
and requires adequate surgical treatment at an early stage with
proper assessment of surgical margins. Postoperative radiation oncology
and/or adjuvant systematic treatment might be considered according to
the presentation.