Anatomia Patologica, Facultat de Medicina, Hospital Clinic, Universitat de Barcelona, Institut D'Investigacions Biomediques August Pi i Sunyer, Villarroel 170, Barcelona, Spain.
Virchows Arch. 2011 Jun;458(6):649-57. doi: 10.1007/s00428-011-1075-0. Epub 2011 Apr 15.
On 15 June 1888, the German Emperor, Kaiser Friedrich III, died of laryngeal cancer. Three biopsies of his laryngeal lesion had been taken by the British laryngologist, Morel Mackenzie, in 1887 and diagnosed by Rudolf Virchow as "pachydermia verrucosa laryngis", confirming Mackenzie's assessment that the Kaiser's disease was benign. A fourth specimen coughed up by the patient was considered by Virchow to be nondiagnostic. A further specimen expectorated by the patient 3 months before his death was diagnosed as carcinoma by Wilhelm Waldeyer. The autopsy revealed squamous carcinoma in the larynx with a cervical lymph node metastasis. The discrepancies between the initial diagnoses and the final outcome of the Kaiser's disease gave rise to a never-ending medical controversy. Our investigations on this historical case were limited to the official German documents and publications and their English translations and to subsequent literature sources of the time, after having received confirmation that the histological slides and Virchow's original reports had been lost. Based on current surgical pathology knowledge, we propose that the tumour that challenged the diagnostic skills of the founder of pathology was hybrid verrucous carcinoma (HVC), an extremely rare, metastasizing variant of verrucous carcinoma (VC) composed of pure VC mixed with clusters of conventional squamous cell carcinoma. As we see it now, Virchow was therefore not totally wrong. Our retrospective evaluation suggests that Virchow's detailed description of the Kaiser's cancer preceded the paper that contributed to the full understanding of HVC of the larynx by 110 years.
1888 年 6 月 15 日，德国皇帝弗里德里希三世（Kaiser Friedrich III）因喉癌去世。1887 年，英国喉科医生莫雷尔·麦肯齐（Morel Mackenzie）对他的喉部病变进行了三次活检，并由鲁道夫·菲尔绍（Rudolf Virchow）诊断为“喉疣状厚皮病”，证实了麦肯齐的评估，即皇帝的疾病是良性的。患者咳出的第四份标本被菲尔绍认为无诊断价值。患者去世前 3 个月咳出的另一份标本被威廉·瓦尔德耶尔（Wilhelm Waldeyer）诊断为癌。尸检显示喉部鳞状细胞癌伴颈部淋巴结转移。最初诊断与皇帝疾病的最终结果之间的差异引发了一场无休止的医学争议。我们对这个历史病例的调查仅限于官方德国文件和出版物及其英文翻译，以及当时的后续文献来源，在收到组织学切片和菲尔绍原始报告丢失的确认后。基于当前的外科病理学知识，我们提出，这个挑战了病理学奠基人诊断技能的肿瘤是混合疣状癌（HVC），这是一种非常罕见的、转移性疣状癌（VC）变体，由纯 VC 与簇状常规鳞状细胞癌混合组成。在我们现在看来，菲尔绍并不是完全错的。我们的回顾性评估表明，菲尔绍对皇帝癌症的详细描述先于那篇论文，该论文对 HVC 的理解做出了贡献，比喉癌的理解早了 110 年。
