Papers by Fridolin Bannwart
Praxis, Jan 11, 1994
We report the case of a 77-year-old man who presented with a polypoid tumor in the distal urethra... more We report the case of a 77-year-old man who presented with a polypoid tumor in the distal urethra. It was excised, and a histological diagnosis of malignant melanoma was made. The patient had no history of previous cutaneous biopsies or suspicious pigmented lesions; therefore, the melanoma was considered to be primary in the urethra. The patient declined therapy and died 28 months later with local tumor progression. The autopsy revealed a widespread metastatic disease. The male urethra is rarely the primary site of a malignant melanoma. This event has so far been described in about 45 patients. The case is discussed in view of the pertinent literature.
Schweizerische Rundschau für Medizin Praxis = Revue suisse de médecine Praxis, Jan 18, 1992
Myelolipomas are rare, benign, usually asymptomatic tumors of the adrenals consisting of fatty an... more Myelolipomas are rare, benign, usually asymptomatic tumors of the adrenals consisting of fatty and hemopoietic tissue. New imaging techniques lead increasingly to incidental findings. Diagnosis of a myelolipoma is confirmed by fine needle aspiration yielding mature adipose tissue together with hematopoietic cells, in particular megakaryocytes. Pathophysiology is unclear, correlations to hormonal disturbances are discussed and increased incidence of hypertension associated with myelolipoma has been reported. We describe a female patient who was found at evaluation of hypertension to have a myelolipoma of more than 1 kg of weight. Liposarcoma was suspected and the tumor excised. After excision blood pressure returned to normal.
BJU International, 2000
Objective To assess the reliability of the histological diagnosis of bladder cancer by assessing ... more Objective To assess the reliability of the histological diagnosis of bladder cancer by assessing the interobserver variability of staging and grading in pTa/pT1 tumours and evaluating the clinical signi®cance of discrepancies. Materials and methods All sections from 301 super®cial bladder carcinomas were reviewed by one pathologist. The prognostic relevance of grade and stage from both the initial and review diagnosis were determined in 128 patients for whom there was long-term follow-up information. Results There were signi®cant interobserver differences in both the grading and staging of tumours. From a total of 235 tumours that were initially considered pT1, the reviewer classi®ed 35% as pTa, 56% as pT1, 6% as pT1-(at least pT1), and 3% as pT2±4. In 39% of all biopsies there were interobserver differences in tumour grade. The prognostic signi®cance of grade and stage differed between the initial pathology report and the reviewer's diagnosis. The reviewer's staging allowed a better estimate of the risk of subsequent tumour progression than the initial staging. Progression was signi®cantly more common in 49 tumours in which the reviewer agreed with stage pT1 than in 29 tumours that were down-staged from pT1 to pTa (P = 0.0116). However, the initial tumour grade (P = 0.0386) but not the reviewer's grade (P = 0.2645) was signi®cantly linked to progression. Conclusions These results show that grading and staging by different pathologists have varying prognostic implications. If possible, biopsies from bladder tumours should be independently evaluated by two different pathologists before radical therapy is administered.
Annals of Diagnostic Pathology
BACKGROUND The protozoan Giardia lamblia (GL) and the bacterium Helicobacter pylori (HP) are comm... more BACKGROUND The protozoan Giardia lamblia (GL) and the bacterium Helicobacter pylori (HP) are common causes of gastrointestinal disease. Coinfection is common and has been reported in studies from Africa, Europe, North America and Asia, but data for Switzerland are scarce. AIM To investigate GL and HP prevalence and coinfection rate in gastrointestinal biopsies from the Zurich area of Switzerland. METHODS Cases were retrieved from the laboratory information system (Medica Institute of Clinical Pathology, Zurich, Switzerland). Histological slides of cases with GL were reviewed, as were the concurrent gastric biopsies, where available. RESULTS Between January 1, 2013 and December 31, 2020, GL was found in 88 (0.14%) of 62,402 patients with a small intestine biopsy and HP in 10,668 (15.5%) of 68,961 patients with a gastric biopsy. 74/88 (84.1%) of patients with GL had unremarkable small intestine biopsies, 13/88 (14.8%) had increased intraepithelial lymphocytes, 5/88 (5.7%) showed villous atrophy and 2/88 (2.3%) acute inflammation. 71/88 patients (80.7%) with GL had an available gastric biopsy, of which 12/71 (16.9%) were unremarkable, 28/71 (39.4%) had HP-associated gastritis, 11/71 (15.5%) showed reactive gastropathy and 1/71 (1.4%) had autoimmune gastritis. CONCLUSION Coinfection with HP is common in patients with GL in gastrointestinal biopsies from the Zurich area of Switzerland. Therefore, gastroenterologists should consider sampling the stomach when GL is suspected for evaluation of possible concurrent HP-associated gastritis. Likewise, pathologists should scrutinize any small intestine biopsy for the presence of GL when HP-associated gastritis is seen, and vice versa.
Swiss Medical Weekly
A phenotype characterised by widespread instability of microsatellite sequences in DNA has been r... more A phenotype characterised by widespread instability of microsatellite sequences in DNA has been reported to occur in 10-15% of human colon cancers [1, 2]. Microsatellites are stretches of repeated DNA sequences consisting of mono-, di-or tri-nucleotide repeats. Mono-and di-nucleotide microsatellites are either shorter or longer by a few repeat units in this subset of colon cancers, when compared to those in the DNA of normal tissues. Microsatellite instability (MSI) is caused by a defect of the Mismatch Repair (MMR) system, which has evolved to correct errors of DNA polymerases [3, 4]. These enzymes are error-prone and, during DNA replication, they can cause strand misalignments with the formation of loops of extrahelical bases in the newly synthesised or in the template
Purpose: A retrospective analysis to assess the prognostic and predictive clinical value of breas... more Purpose: A retrospective analysis to assess the prognostic and predictive clinical value of breast tumor ErbB-2 receptor expression quantified by enzyme immunoassay (EIA), to compare levels measured by EIA with ErbB-2 status determined by immunohistochemistry (IHC), and to correlate receptor content with levels of phosphorylated (Y1248-P) ErbB-2, a measure of functional tyrosine kinase activity. Materials and Methods: EIA quantification of ErbB-2 was performed on membrane extracts from 3,208 well-characterized primary breast cancers. Overall, relapse-free, distant disease-free, and local/regionalfree patient survival data were available on 1,123 of these tumors. IHC scoring for ErbB-2 status (HercepTest; DAKO, Glostrup, Denmark) was performed on adjacent sections of 151 cases, and receptor functionality was measured in 230 tumors by an antibody specific for phosphorylated (Y1248-P) ErbB-2. Results: Unlike nonmalignant breast tissues, breast tumors showed increased ErbB-2 levels in a...
Gastroenterology, Hepatology and Endoscopy, 2020
For years efforts have been made to improve the quality of colonoscopy. Cap assisted colonoscopy ... more For years efforts have been made to improve the quality of colonoscopy. Cap assisted colonoscopy has shown in some studies to increase the adenoma detection rate (ADR) as did full-spectrum colonoscopies (FUSE®) with 330° angle, showing by initial studies a significantly lower adenoma miss rate and higher ADR. Subsequent FUSE® studies were unable to confirm these results. Our practice-based, randomized study compares the efficiency, i.e. ADR, of the relatively inexpensive cap assisted, the FUSE® and standard forward-viewing (SFV) colonoscopy. From March 2015 through February 2017 (phase A) patients referred for ambulant colonoscopy were randomly allocated to either colonoscopy with high definition SFV Pentax i10 (n=934) or FUSE® instruments (n=1044). From March 2017 through September 2019 (phase B) patients were systematically allocated to the colonoscopies, and the additional Endocuff® was used for the Pentax i10 instruments (n Pentax =750, n FUSE =1,386). All procedures were performed by one experienced endoscopist. Baseline characteristics of the 1,978 (phase A) and 2,136 (phase B) patients were similar between the respective groups; remaining deviations were controlled for by regression models. Mean age was 62.9 years (SD=11.6), half were male (50.5%), BBPS (Boston Bowel Preparation Scale) score was 7.29 (SD=0.86). 38.2% were screening, 59.5% surveillance, the remaining diagnostic colonoscopies. Ileum intubation rate was 98%. Patients were sedated with Propofol (mean dose overall 189 mg; SD=107 mg), significantly less with Endocuff® (166 mg; SD=67 mg, CI=161-171 mg). Average time to ileum was 5.6 minutes with no significant (n.s.) difference between different devices. Withdrawal time was significantly faster with FUSE® than with Pentax® in phase A (t F =16.5 min., t P =18.1 min, p<0.001) and significantly faster with Endocuff® than with FUSE® in phase B (t E =14.4 min., t F =15.8 min, p<0.001). Multivariate analysis showed male sex, diabetes and age to be significant risk factors for more adenomas. ADR was 52%/49% for FUSE® (phase A/B), and 54%/50% for Pentax (differences are not statistically significant on α=5% level, n.s.). Adenoma identified per colonoscopy (APC) were 1.1/1.0 with FUSE® and 1.2/1.1 with Pentax (n.s.). The overall number of all polyps per colonoscopy (PPC) were 1.8/1.9 (FUSE®) and 1.9/1.7 (Pentax, n.s.). 81% of the polyps were below 5 mm of size and only 5% were 10 mm or larger. 49% were tubular adenomas, 20% were serrated adenomas. In 0.61% a carcinoma was diagnosed. Conclusion: In a collective of 4114 patients randomly or systematically assigned to 3 different types of colonoscopies neither FUSE® nor Endocuff® significantly increases the adenoma detection rate (ADR). At present, no further benefit can be expected from new technology. Key factor for a high ADR seems to be long withdrawal times (e.g. 14 up to 18 min in SFV). With FUSE® and Endocuff® endoscopy times (withdrawal) decreased significantly.
Forum Médical Suisse ‒ Swiss Medical Forum, 2017
A l'heure actuelle, une personne sur cinq souffre de reflux gastro-oesophagien (RGO), avec une te... more A l'heure actuelle, une personne sur cinq souffre de reflux gastro-oesophagien (RGO), avec une tendance à la hausse. Le développement d'un oesophage de Barrett en est une complication possible et potentiellement maligne. Chez quels patients atteints de RGO un diagnostic endoscopique est-il indiqué? Quand un traitement empirique est-il suffisant?
Swiss Medical Forum ‒ Schweizerisches Medizin-Forum, 2017
Mittlerweile jeder Fünfte leidet an einer gastroösophagealen Refluxerkrankung (GERD), Tendenz ste... more Mittlerweile jeder Fünfte leidet an einer gastroösophagealen Refluxerkrankung (GERD), Tendenz steigend. Die Entwicklung eines Barrett-Ösophagus ist eine mögliche und potentiell maligne Komplikation. Bei welchen GERD-Patienten ist eine endoskopische Diagnostik angezeigt, wann eine empirische Therapie ausreichend? Einleitung Die gastroösophageale Refluxerkrankung (GERD) zeigt eine Prävalenz von ca. 20% mit zunehmender Inzidenz. Eine benigne Komplikation von GERD ist die Refluxösophagitis mit ihren möglichen Folgen wie Ulkus oder peptische Striktur. Eine potentiell maligne Komplikation von GERD ist die Entwicklung eines Barrett-Ösophagus, der als Präkanzerose für die Entwicklung eines Adenokarzinoms des distalen Ösophagus (Barrett-Karzinom) anzusehen ist. In der westlichen Welt findet sich einerseits eine siebenfache Zunahme der Inzidenz des Adenokarzinoms des distalen Ösophagus, andererseits belegen neuere Studien ein relativ geringes individuelles Entartungsrisiko eines Barrett-Ösophagus ohne Dysplasie von lediglich 0,12-0,33% pro Jahr [1-4]. Vor diesem Hintergrund stellt sich die Frage nach sinnvoller evidenzbasierter Diagnostik und Therapie. Es gilt, Risikofaktoren für die Entwicklung eines Barrett-Ösophagus aus der Masse der Patienten mit GERD zu erkennen und diese gezielt einer Endoskopie zuzuführen. Nach bioptisch gesicherter Diagnose eines Barrett-Ösophagus erfolgt ein Abschätzen des individuellen Risikos einer malignen Transformation. Dabei kristallisieren sich zunehmend Faktoren für effiziente, endoskopische Überwachungsstrategien heraus. Frühzeitig entdeckt können dysplastische und mukosale frühkarzinomatöse Veränderungen effektiv und sicher kurativ mittels endoskopischer Resektions-und Ablationsverfahren behandelt werden, die mittlerweile als Therapie der ersten Wahl gelten. Gastroösophageale Refluxerkrankung Definition, Diagnostik und empirische Therapie GERD sollte anhand der Montreal-Klassifikation definiert werden, die den pathophysiologischen Prozess des gastroösophagealen Refluxes und die klinische Symptomatik unabhängig voneinander berücksichtigt. Die Diagnose von GERD kann somit einerseits allein anhand von Symptomen, Folgen oder Komplikationen von Reflux und andererseits durch apparativ gemessenen Reflux ohne Symptome gestellt werden. Sodbrennen ist neben Aufstossen und Regurgitationen das sensitivste Symptom von GERD [5, 6]. Vor dem Hintergrund explodierender Gesundheitskosten stellt sich die klinische Frage, bei welchen Patienten mit GERD eine endoskopische Diagnostik indiziert ist. Nach den aktuellen Studien können Patienten mit behandlungsbedürftigen, klassischen Refluxbeschwerden ohne Alarmzeichen oder Risikofaktoren
Plastic and Reconstructive Surgery - Global Open, 2019
Background: We suggest that the degree of scar improvement with a beveled incision technique with... more Background: We suggest that the degree of scar improvement with a beveled incision technique with an angle of about 20 degrees to the skin can be translated for various reconstructions on the face and can be verified by a validated clinical assessment scale and histology. Methods: A total of 5 patients (2 men and 3 women) with a mean age of 68 years (range 54–84 years) undergoing elective surgeries on the face for tumor excision or cosmetic procedures were included. The beveled incision technique was compared with the conventional vertical incision (control group). Outcome measures were major and minor complications, pain and scar quality using the Patient and Observer Scar Assessment Scale, and histomorphologic scar assessment. Results: After a mean follow-up of 7.6 months (range 6–13 months), all patients healed uneventfully without pain, hypertrophic scars, or infection. We found a better overall Patient and Observer Scar Assessment Scale score in the beveled incision technique g...
Digestive diseases and sciences, Jan 23, 2018
Barrett's esophagus with high-grade dysplasia and early-stage adenocarcinoma is amenable to c... more Barrett's esophagus with high-grade dysplasia and early-stage adenocarcinoma is amenable to curative treatment by endoscopic resection. Histopathological correlation has established that mucosal cancer has minimal risk of nodal metastases and that long-term complete remission can be achieved. Although surgery is the gold-standard treatment once there is submucosal involvement, even T1sm1 (submucosal invasion ≤ 500 μm) cases without additional risk factors for nodal metastases might also be cured with endoscopic resection. Endoscopic resection is foremost an initial diagnostic procedure, and once histopathological assessment confirms that curative criteria are met, it will be considered curative. Endoscopic resection may be achieved by endoscopic mucosal resection, which, although easy to perform with relatively low risk, is limited by an inability to achieve en bloc resection for lesions of size more than 1.5 cm. Conversely, the technique of endoscopic submucosal dissection is m...
Gastrointestinal Endoscopy, 2015
Geburtshilfe und Frauenheilkunde, 1988
Zusam men fassu ng 13 von 188 Pati entinnen mit eine m Zervixa bstrich Klasse IV nach Pap an icol... more Zusam men fassu ng 13 von 188 Pati entinnen mit eine m Zervixa bstrich Klasse IV nach Pap an icolaou wiesen in Koni sat und Kür ettage led iglich abnor mes Epithe l resp. leicht ode r mittelschwe r dysplasti sch es Epit he l auf. Aus versc hiede ne n Gründen wurd en 5 dieser Fraue n anschließe nd hyst er ektomi ert. Ledi glich bei eine r dieser Pati entinnen fand sich im Ope ra tionsprä parat ein pathologisch er Befund in Form eines Endo me trium karz ino ms Stadium O. Bei 8 Proband innen wurde unter regelmäßiger kolposkopisch-zytologischer Kont ro lle exsp ekt ati v vorgeg ange n. Aufgru nd des weiteren Verlau fs mit eine r dur chs chnittliche n Beobac ht un gszeit von üb er 52 Mon at en zeigte sich, daß ein exspektativ es Vorgehen un ter kolposkopisch-zytologischer Kontro lle resp. mit Kontrollkür ettage gere chtfertigt ist , sofe rn die Pa ttentin noc h Kinder wünscht. Pat ho logtcal Papanicolaou Sm earTypc IV with ou t lIi s tological Ce r r ela tion-\Vhat s hould be do ne ? 13 of 188 pat ien ts with a Papanicolaou s mear Type IV of th e cervix s howed histologically only abnor ma l epithelium, CIN I or 11, a result whi ch does not expla in th e cytologic result. For several reasons a hyst er ectom y was pe rformed in 5 cases. In only one of these pa tients a pathological findin g, an endometria l carci noma stage 0, was detected .ln the othe r 8 cases a rout ine pr oced ure unde r regular colposcopic and cytologic control bad been performed. Accordin g to the results during a med ian follow-up ove r 52 mo nt hs , such routine proce dure is ju stified , if th e patlent wan ts children and if respectively a regu lar colposco pic/cytologic control or a cont rol eurenage afte r 3-6 months is unde rta ken. Ober die Inzid en z von pathologisch en Portioabs tric he n und von Dyspl asien der Portio ut eri existie re n un zähli ge Unte rs uchungen. Dabei wird mehrheitlich eine Übe re instimmung der Befunde von Zytologie und Hist ologie in etwa 80-90% ge funde n.
Anticancer research
We analysed 39 prostatic carcinomas for loss of heterozygosity on chromosomal arms 8p, 10q, 16q, ... more We analysed 39 prostatic carcinomas for loss of heterozygosity on chromosomal arms 8p, 10q, 16q, 17p and 18q and for mutations in the p53 anti-oncogene. Loss of heterozygosity (LOH) on 8p was detected in one out of 5 informative tumors, LOH on 16q in 3 out of 21 tumors, LOH on 17p in 2 out of 18 tumors, and LOH on 18q in 2 out of 17 tumors. No deletions were observed on 10q in 14 informative tumors. p53 alterations occurred in 3 out of 38 examined tumors, comprising two point mutations and a small deletion. Chromosomal deletions and p53 mutations were confined to locally invasive prostatic carcinomas, suggesting that they are associated with the progression of some prostate cancers rather than with tumor initiation.
Laboratory investigation; a journal of technical methods and pathology, 1989
The so-called atypical germ cells or cells of carcinoma in situ morphologically resemble neoplast... more The so-called atypical germ cells or cells of carcinoma in situ morphologically resemble neoplastic cells in seminoma. Since seminomas show numerical aberrations of chromosome 1 we have used a DNA probe specific for chromosome region 1q12 to determine whether such aberrations can be detected in atypical germ cell nuclei in paraffin-embedded seminiferous tubules as well. One-third of intratubular nuclei, containing atypical germ cells, consistently showed three hybridization signals in contrast to two signals regularly observed in normal intestine and in spermatogonia. We thus show that cytogenetic studies of precancerous cells can be performed directly on the tissue where these cells originate.
International Journal of Oncology, 1995
We analyzed endometrial adenocarcinomas for mutations of the p53 anti-oncogene, expression of the... more We analyzed endometrial adenocarcinomas for mutations of the p53 anti-oncogene, expression of the HERllneu oncogene and for loss of heterozygosity on chromosome 16q. p53 mutations were found in 3 of 25 tumors. Elevated expression of HEKllneu found in 7 of 24 tumors involves a mechanism other than gene amplification. LOH on chromosome 16q22-24 was observed in 4 of 13 informative tumors. Four of 25 endometrial tumors exhibited two or more alterations. Tumors with the highest HERllneu protein level exhibited a negative progesterone receptor status. Accumulation of these changes may determine the biological behaviour of a subset of endometrial tumors.
Praxis, 2009
Das massive Ödem des Ovars (massive ovarian edema, MOE) ist eine seltene, benigne Erkrankung jung... more Das massive Ödem des Ovars (massive ovarian edema, MOE) ist eine seltene, benigne Erkrankung junger Frauen. Weil präoperativ differentialdiagnostisch meist ein maligner Tumor im Vordergrund steht, besteht das Risiko, dass diese Patientinnen überbehandelt werden. Bei der beschriebenen 18-jährigen Patientin wurde aufgrund präoperativer Daten die klinische Verdachtsdiagnose PCO-Syndrom (Syndrom der polyzystischen Ovarien) gestellt. Im MRI wurde das vergrösserte Ovar als muzinöser Tumor interpretiert. Bei der Laparotomie zeigte sich ein glattwandiger, opalfarbener Ovarialtumor mit Adnextorsion. Die histopathologische Untersuchung des Adnexektomiepräparates ergab die Diagnose eines MOE. Keilexzision, Schnellschnitthistologie, Derotation und Suspension des Ovars wären therapeutisch ausreichend gewesen. Die Übertherapie lässt sich vermeiden, wenn bei jungen Frauen mit vergrössertem Ovar das MOE in die Differentialdiagnose miteinbezogen wird und die charakteristischen Sonographie-, MRI- und...
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Papers by Fridolin Bannwart