Siegfried Oberndorfer: a tribute to his work and life between Munich, Kiel, Geneva, and Istanbul

Oberndorfer’s article in which he described seven cases of carcinoid immediately received recognition, although in retrospect it is clear that he was not the first to describe carcinoids. Reports of similar tumors had been published before 1907 (cf. [7, 8]), in some of which the tumors can be clearly identified on the basis of the illustrations [3, 4, 14]. However, the authors of these case reports either did not give any interpretation of the described tumor [3] or regarded it as a primary carcinoma of the ileum [4, 14]. Oberndorfer’s conclusion that the described tumors in the ileum form a special group of neoplasms because of their similarity and also dissimilarity to usual carcinomas and their special growth features were therefore novel. Moreover, and most importantly, he coined a term to unmistakably designate the new tumor group.

The history of his life and particularly his so far unpublished autobiography characterize Siegfried Oberndorfer by four features: He had a general and deep interest in life and nature. He was diligent and highly disciplined. He had an analytical mind and he was an excellent writer.

He satisfied his interest in life and nature through excursions, tours and long journeys, and of course by studying medicine. He was not only a pathologist, but he worked temporarily as a general practitioner, as a ship’s doctor, and also as a military doctor. He was interested in all kinds of diseases from both the clinical and the pathological view. The subjects he studied were therefore also manifold. Apart from the carcinoids, he contributed in numerous articles to the study of the pathogenesis of appendicitis, tuberculosis, and many different tumors. But it was not only this wide spanned interest; it was also his will to record what he observed and what he encountered. Thus, he wrote reports, articles, and descriptions of almost everything he experienced and studied during his life. Everything he saw and studied he also analyzed with regard to its nature, causes, and significance. In the last two years of his life, he wrote an autobiography, in which he not only gave a report of his life but also commented and reflected on what he had experienced and what he had done.

He started medical school in 1895 in Munich and spent one term in Kiel in northern Germany, which for a Bavarian was a foreign country. Though only a student, the professor and head of the department of pathology in Kiel, Arnold Ludwig Heller (1840–1913), recognized his great interest in morbid anatomy and taught him his meticulous and “holoptic” autopsy technique which allowed the assessment of the organs in the context of their functional relationship to the surrounding organs. He quickly adopted Heller’s technique and also his cleanliness, for which he himself became famous in later years when he was director of a pathology department. It is very likely that he profited very much in his professional and scientific life from his capacity to perform accurate postmortem examinations. At least his first observations of carcinoids, which he made in Geneva [9], are probably because of the fact that he was in the possession of a technique that allowed him to recognize even pea-sized tumorlets in the ileum, which could be easily overlooked.

Since he was never merely a morphologist who focused only on the appearance of lesions, he also considered the clinical history of the patients in whom he detected the carcinoids. As none of his patients had any symptoms related to the tumorlets in the ileum, he regarded these lesions as extremely slowly growing and apparently harmless in nature.

Oberndorfer observed the first two cases of carcinoids in Geneva (1900–1901) while working as an assistant to Professor Friedrich Wilhelm Zahn (1845–1904). He reported on these two tumors in the Beiträge zur pathologischen Anatomie und allgemeinen Pathologie in 1901. In Munich, where he started to work as assistant to Professor Otto Bollinger (1843–1909) in 1904, he added four other carcinoid cases and presented his results at the annual meeting of the Deutsche Gesellschaft für Pathologie in Dresden in 1907 [10] (Fig. 4). His lecture was heavily debated and its essence was published in December 1907 in the Frankfurter Zeitschrift für Pathologie. In this report, he summarized his observations and interpretations of the lesions in five statements. The main characteristics of these tumorlets are:

1. 1.

   They are usually small and often multiple.

2. 2.

   Their cells form undifferentiated formations, at most with slight indications of glands.

3. 3.

   They are well defined and show no tendency to penetrate infiltratively into the surroundings.

4. 4.

   They do not metastasize.

5. 5.

   They appear to grow extremely slowly, do not reach any great size, and are thus apparently harmless in nature.

First page of Siegfried Oberndorfer’s famous publication on carcinoids in the Frankfurter Zeitschrift für Pathologie (1907)

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The first three statements are still valid, except for the descriptive term “undifferentiated formations”, which from today’s vantage point does not reflect the differentiation of this particular tumor tissue. The last two statements, however, did not stand the test of time. As more and more carcinoids with lymph node and liver metastases were observed, Oberndorfer already admitted that some carcinoids may also be malignant. In his contribution to Henke and Lubarsch’s textbook on special pathological anatomy and histology in 1929 [12], where he discussed his collection of 36 carcinoids of the ileum and appendix, he therefore distinguished carcinoids with benign behavior from “malignant carcinoids”.

The carcinoids’ endocrine nature was established by Masson [1, 5, 6], who suggested on the basis of his argentaffin staining results that the Kultchitzky cells in the crypts of Lieberkühn and the cells of the carcinoids have an endocrine function. Siegfried Oberndorfer himself abstained from speculating about the histogenesis of the carcinoids. Later, however, he discussed intensively, but also skeptically, the proposed neural-endocrine pathway that Masson proposed for the development of carcinoids in the appendix and their origin from the so-called enterochromaffin cells of the intestinal mucosa [11].

Siegfried Oberndorfer was appointed full professor and director of the Institute of General and Experimental Pathology at the University of Istanbul shortly after he was forced to retire as director of the Department of Pathology at the München Schwabing Hospital and Associate Professor at the Medical Faculty of the University of Munich. Together with his colleague, Professor Philipp Schwartz (1894–1978) [13], who was also driven out of Germany because of his Jewish background and headed the Institute of Pathological Anatomy in Istanbul, he contributed very much to the development of pathology in Turkey in the fields of diagnostic pathology, cancer research, and training in pathology. Later (1938), he founded and headed the Turkish Institute of Cancer Research (Fig. 5). Conceivably, these duties and his efforts to live in a foreign country and master its language consumed a great deal of his time. However, with his collaborators from Turkey (Drs. Uveis Maskar, Osman Saka, and Sati Eser) and from Germany (Dr. Peter Ladewig) he again produced approximately 100 contributions to many aspects of the pathology of neoplastic and nonneoplastic diseases and, finally, published textbooks in Turkish on general pathology (1937) and the histological diagnosis of some selected neoplasms (1941). An explanation for the fact that he never returned to the carcinoids may be that in his department he dealt only with surgical specimens, implying that at this time he had very little access to material to increase his experience with these tumors. But his interest in the carcinoids remained. Towards the end of his life he noted in his autobiography:

“Meine wesentlichen Arbeiten, so besonders die Wesentlichste, die fortleben wird, die Entdeckung der Bedeutung der “Carcinoide”, habe ich nur in ganz kurzen Seiten veroeffentlicht; all das andere, was andere noch hinzugefuegt haben, habe ich zum grossen Teil auch gewusst, aber nicht verwertet. Zum Teil hinderte mich auch eine gewisse Scheu vor der Publizierung, der Verwertung der Arbeit in den grossen wissenschaftlichen Zeitungsschriften, so besonders in Virchows Archiv, eine gewisse Scheu vor dem Urteil der Autoritaeten, das ich retrospektiv nicht zu fuerchten gehabt haette. Aber “tempi passati”; im Ganzen war mein Leben doch nicht ganz sinnlos und ohne Ergebnisse, aber es haette wissenschaftlich noch glaenzender sein koennen.” (from Oberndorfer’s unpublished autobiography, 1942–1943).

“My important works, especially the most significant work, which will survive, is the recognition of the significance of the carcinoids. It fills only a few pages. All the rest, which others added to it, I also knew, but made no use of it. In part, a certain hesitancy prevented me from publishing, from utilizing the work in the major scientific journals, particularly in Virchows Archiv, a certain dread of the verdict of the authorities that, retrospectively, I need not have feared. But “tempi passati”, on the whole my life was not entirely futile and without results; but scientifically it could have been even more distinguished.”

Siegfried Oberndorfer in Istanbul in 1936

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