Significance of the Galectin-8 Immunohistochemical Profile in Ovarian Cancer

Ovarian cancer (OC) still registers a high prevalence in female gynecological pathology. Given the aggressiveness of the tumor and the lack of response to conventional therapies, a current research interest is the identification of new prognostic markers. Gal-8, a member of the galectin family of molecules, involved in tumorigenesis, disease progression, and metastasis, has been assigned as a valuable tumor prognostic factor, and its inhibition may open new perspectives in cancer therapeutic management. Few studies have been carried out so far to evaluate OCs' galectin profiles. Our study aimed to characterize the Gal-8 profile in different types of ovarian neoplasia and to demonstrate its prognostic value. Our study group comprised 46 cases of OCs that were histologically and immunohistochemically investigated, introduced to Gal-8 immunoreactivity, qualitatively and semi-quantitatively evaluated, and correlated with clinicopathological characteristics. Gal-8 immunoexpression was identified in tumor epithelial cells, showing a dominant nuclear labeling, followed by cytoplasmic and mixed, nuclear, and cytoplasmic labeling. Significant differences between tumor histotypes were found in the statistical analysis between low and high Gal-8 immunoscore levels and clinicopathological features: HGSC (eng.= high-grade serous carcinoma) vs. LGSC (eng. = low-grade serous carcinoma), pathogenic types (type I vs. type II), and tumor grades. Our results reflect Gal-8 expression variability depending on the histological type and subtype, the progression stages, and the degree of differentiation of ovarian tumors, supporting its value as a prognostic factor. Our findings open perspectives for larger studies to validate our results, along with a potential Gal-8 transformation into a future therapeutic target.

Symptomatic pericardial cysts and dilemmas in their diagnosis

Pericardial cysts (PCs) or pleuropericardial cysts are rare congenital mediastinal lesions with an approximate incidence of one in 100 000 persons. Usually, they are asymptomatic, being incidentally discovered during a routine chest imaging examination or an autopsy exam. The study involved a retrospective evaluation of clinicopathological findings in a 6-year series of PCs, treated in the Clinic of Pulmonary Diseases, Iaşi, Romania. A group of five cases of PCs, four females and one male, were evaluated. All patients displayed different symptoms, such as dyspnea, chest pain, chronic cough, fatigue, palpitation, and epigastric pain. The cystic lesions were located in the right and left cardiophrenic angle, in four cases, and in the central mediastinum in a single case. The lesions had a fluid content and a maximum diameter that ranged between 35 and 95 mm. The microscopic examination of the surgical resection tissues revealed a thin connective tissue wall without any associated smooth muscle cells. The loose connective tissue band was lined by a layer of mesothelial cells with no cellular atypia, which displayed discrete papillary projections, in one case. Although PCs are rare incidental findings, they should be considered in differential diagnoses of mediastinal cysts, especially as they are associated with non-specific symptoms. Furthermore, considering the possibility of development of severe complications, PCs should be thoroughly explored for suitable patients' management.

The Interplay between Tumour Microenvironment Components in Malignant Melanoma

Malignant melanoma has shown an increasing incidence during the last two decades, exhibiting a large spectrum of locations and clinicopathological characteristics. Although current histopathological, biochemical, immunohistochemical, and molecular methods provide a deep insight into its biological behaviour and outcome, melanoma is still an unpredictable disease, with poor outcome. This review of the literature is aimed at updating the knowledge regarding melanoma’s clinicopathological and molecular hallmarks, including its heterogeneity and plasticity, involving cancer stem cells population. A special focus is given on the interplay between different cellular components and their secretion products in melanoma, considering its contribution to tumour progression, invasion, metastasis, recurrences, and resistance to classical therapy. Furthermore, the influences of the specific tumour microenvironment or “inflammasome”, its association with adipose tissue products, including the release of “extracellular vesicles”, and distinct microbiota are currently studied, considering their influences on diagnosis and prognosis. An insight into melanoma’s particular features may reveal new molecular pathways which may be exploited in order to develop innovative therapeutic approaches or tailored therapy.

Cephalic undifferentiated carcinoma with osteoclast-like giant cells arising from the main pancreatic duct: case report and literature review

Undifferentiated carcinoma with osteoclast-like giant cell (UCOGC) is a ductal carcinoma variant with a recently reported more protracted survival and pathognomonic histology comprising two cell populations: the mononuclear tumoral cells and nontumoral multinucleated giant cells. It usually presents as a large heterogenic tumor with mixed solid-cystic components. The tumor develops from the ductal epithelium but the sequence of epithelial changes is often not identified due to the rapid tumoral growth and associated necrotic changes. We report a case of a 76-year-old patient diagnosed with cephalic UCOGC originating in the epithelium of the main pancreatic duct with endoluminal growth and foci of other ductal neoplasms (high-grade pancreatic intraepithelial neoplasia (PanIN) and conventional ductal carcinoma). The particularity of our case consists in the identification of the columnar epithelium conversion, through high-grade PanIN, into UCOGC specific malignant features, in a large size tumor - aspect usually reported in small tumors. Alongside our case we also present a brief literature review of cephalic UCOGC case reports and case series.

A Rare Cause of Massive Hematuria: Placenta Percreta With Bladder Invasion

BACKGROUND/AIM

Placenta percreta is a rare event, but it poses serious problems due to potential hemorrhagic events. We report a particular case of placenta percreta with massive hematuria due to maternal bladder invasion, and describe the surgical protocol performed that resulted in an excellent outcome.

CASE REPORT

A 33-year-old patient, at 27^th weeks gestational age, presented in the emergency room of the Urology Department with urinary blood clot acute retention, because of massive hematuria from a placenta percreta with bladder invasion. After extracting the clots from the bladder, and coagulation of an area of venous ectasies of the posterior wall, hematuria ceased, but appeared after two days, necessitating again the bladder clots removal and coagulation. A surgical team with gynecologists, urologists, anesthesiologists and a neonatologist was composed, and after bilateral ureteral double J insertion, cesarean section was performed followed by hemostatic hysterectomy and partial cystectomy, bilateral internal iliac artery ligature and repair of the bladder wall. The postoperative evolution was without incidents; the Foley catheter was removed in the 14^th postoperative day.

CONCLUSION

In the context of a massive hematuria of a pregnant woman, the urologist must always consider a diagnosis of complicated placenta percreta.

Thymolipoma - the frontier between hamartoma and neoplasia?

Thymolipoma is an uncommon benign thymus lesion, with a partially deciphered etiopathogeny, being most frequently diagnosed in young patients, regardless of gender. Incidentally diagnosed in asymptomatic patients, larger thymolipomas lead to symptoms related to neighboring mediastinal structures compression, with an intensity which is correlated with the mass size. Our review presents the main epidemiological, pathogenic, clinicopathological and morphological characteristics of this rare pathology. Sometimes, thymolipomas may be associated with paraneoplastic syndromes, which are alleviated by the mass complete surgical resection. Imagistics may orientate the diagnosis, which is certified by the microscopic examination of the resection specimens. Extensive thymectomy remains the current therapeutic option and new tools have been developed to increase the accuracy of the surgical procedure to avoid incidental lesions of the important elements of the anterior mediastinum. Although rare, thymolipomas should be considered in the differential diagnosis of mediastinal masses and of paraneoplastic syndromes.

Epidemiology of biopsy-proven glomerulonephritis in the past 25 years in the North-Eastern area of Romania

PURPOSE

The aim of this retrospective study was: to analyze the epidemiological patterns of the kidney disease based on clinical and histological features in a single-center in the N-E region of Romania, between 2011 and 2019 and to compare the biopsy results with the others periods, as well as the results from other countries.

METHODS

We studied 442 renal biopsies. The indications for renal biopsy were represented by the clinical features: nephrotic syndrome, nephritic syndrome, asymptomatic urinary abnormalities, acute kidney injury, and chronic kidney disease of unknown etiology.

RESULTS

During the past 8 years, the annual incidence of renal biopsies was constant, albeit this incidence remained lower than in other countries. Nephrotic syndrome was the most common indication for renal biopsy (47.6%). Primary glomerulonephritis (GN) was the most common diagnosis in each of the three periods, followed by secondary GN. Vascular nephropathy and TIN were constant as a proportion from the overall biopsies in each of the three periods. The membranoproliferative GN (24.4%) and membranous nephropathy (MN) (21.9%) were the most prevalent primary GN, while lupus nephritis (LN) was the most common secondary glomerular disease in young female patients (7.5%). Compared to 1994-2004 period, we observed a significant decrease of incidence of focal segmental glomerulosclerosis (FSGS) and mesangial proliferative GN, and a significant increases in the frequency of MN.

CONCLUSION

The results of this study show that the GN distribution model was constant in N-E Romania and became similar to that observed in many countries with high socio-economic status.

Perirenal Adipose Tissue-Current Knowledge and Future Opportunities

The perirenal adipose tissue (PRAT), a component of visceral adipose tissue, has been recently recognized as an important factor that contributes to the maintenance of the cardiovascular system and kidney homeostasis. PRAT is a complex microenvironment consisting of a mixture of white adipocytes and dormant and active brown adipocytes, associated with predipocytes, sympathetic nerve endings, vascular structures, and different types of inflammatory cells. In this review, we summarize the current knowledge about PRAT and discuss its role as a major contributing factor in the pathogenesis of hypertension, obesity, chronic renal diseases, and involvement in tumor progression. The new perspectives of PRAT as an endocrine organ and recent knowledge regarding the possible activation of dormant brown adipocytes are nowadays considered as new areas of research in obesity, in close correlation with renal and cardiovascular pathology. Supplementary PRAT complex intervention in tumor progression may reveal new pathways involved in carcinogenesis and, implicitly, may identify additional targets for tailored cancer therapy.

Endometriosis - insights into a multifaceted entity

Firstly described at the end of nineteenth century, endometriosis remains an enigmatic disease, from etio-pathogenesis to specific markers of diagnosis and its ability to associate with malignancies. Our review has been designed from a historical perspective and steps up to an updated understanding of the disease, facilitated by relatively recent molecular and genetic progresses. Although the histopathological diagnosis is relatively simple, the therapy is difficult or ineffective. Experimental models have been extremely useful as they reproduce the human disease and allow the testing of different potential modulators or treatment options. Due to molecular resemblance to carcinogenesis, applications of anti-cancer agents are currently under scrutiny. The desired goal of an efficient therapy against symptomatic disease, along with associated infertility and malignancies, needs a deeper insight into the complex mechanisms involved in endometriosis initiation, development, and progres-sion. Current trends in genomic and proteomic approaches are useful for a more accurate classification and for the identification of new therapeutic targets.

Adipocytes spectrum - From homeostasia to obesity and its associated pathology

Firstly identified by anatomists, the fat tissue is nowadays an area of intense research due to increased global prevalence of obesity and its associated diseases. Histologically, there are four types of fat tissue cells which are currently recognized (white, brown, beige, and perivascular adipocytes). Therefore, in this study we are reviewing the most recent data regarding the origin, structure, and molecular mechanisms involved in the development of adipocytes. White adipocytes can store triglycerides as a consequence of lipogenesis, under the regulation of growth hormone or leptin and adiponectin, and release fatty acids resulted from lipolysis, under the regulation of the sympathetic nervous system, glucocorticoids, TNF-α, insulin, and natriuretic peptides. Brown adipocytes possess a mitochondrial transmembrane protein thermogenin or UCP1 which allows heat generation. Recently, thermogenic, UCP positive adipocytes have been identified in the subcutaneous white adipose tissue and have been named beige adipocytes. The nature of these cells is still controversial, as current theories are suggesting their origin either by transdifferentiation of white adipocytes, or by differentiation from an own precursor cell. Perivascular adipocytes surround most of the arteries, exhibiting a supportive role and being involved in the maintenance of intravascular temperature. Thoracic perivascular adipocytes resemble brown adipocytes, while abdominal ones are more similar to white adipocytes and, consequently, are involved in obesity-induced inflammatory reactions. The factors involved in the regulation of adipose stem cells differentiation may represent potential pathways to inhibit or to divert adipogenesis. Several molecules, such as pro-adipogenic factors (FGF21, BMP7, BMP8b, and Cox-2), cell surface proteins or receptors (Asc-1, PAT2, P2RX5), and hypothalamic receptors (MC4R) have been identified as the most promising targets for the development of future therapies. Further investigations are necessary to complete the knowledge about adipose tissue and the development of a new generation of therapeutic tools based on molecular targets.

Relationships between clinicopathological prognostic factors in papillary thyroid microcarcinoma: a refined analysis based on 428 cases

A clear definition of the prognostic factors for papillary thyroid microcarcinoma (PTMC) is still debatable, as the tumor characteristics which indicate a high risk of metastasis are little known. We investigated the clinicopathological profile of a large group of PTMC, aiming to ascertain possible relationships between a set of clinicopathological characteristics and four parameters expressing tumor extension and aggressiveness (namely lympho-vascular invasion, thyroid capsule invasion, extrathyroidal extension and lymph node metastasis). For 428 patients, the following data were retrospectively documented: sex, age, tumor size, histological variant, associated thyroid pathology, location (subcapsular, intraparenchymal), unilateral or bilateral involvement, number of foci, lympho-vascular invasion, thyroid capsule invasion, extrathyroidal extension and lymph node metastasis. Data were analyzed using univariate and multivariate logistic regression analysis. Multivariate analysis confirmed that the tumor size is a negative prognostic factor for lympho-vascular invasion, thyroid capsule invasion, extrathyroidal extension and lymph node metastasis. We also demonstrated a strong relationship between the subcapsular location and lympho-vascular and capsule invasion, and extrathyroidal extension. The multifocality was correlated only with thyroid capsule invasion and extrathyroidal extension. Regarding the histological variants, the only validated correlation was between the oncocytic variant and extrathyroidal extension. Our work contributes to the validation of PTMC prognostic factors, useful in stratification of PTMC in high or low risk classes, and able to explain the behavioral differences in the tumor development.

Comparative analysis of CD4 and CD8 lymphocytes - evidences for different distribution in primary and secondary liver tumors

INTRODUCTION

The impact of tumor cells on tumor-infiltrating lymphocytes (TILs) in cancer development is not yet clarified. Our study analyzed the distribution and prognostic value of CD4+ and CD8+ T lymphocytes in hepatocellular carcinoma (HCC) and liver metastases (LM).

MATERIAL AND METHODS

Archival tissue specimens of 35 HCC and 39 LM patients were immunohistochemically processed. The number of intratumoral (IT) and peritumoral (PT) CD4+ and CD8+ T cells was quantitatively analyzed.

RESULTS

We noted large variances of T lymphocyte subpopulations. Similar number of CD4+ and CD8+ lym-phocytes was present in HCC, whereas in LM the number of CD8+ cells was approximately two times higher than CD4+ lymphocytes. A significant prevalence of T cells in PT over IT areas was observed. The prognostic value was demonstrated only for PT CD8+ lymphocytes in LM, their reduced number being associated with shorter survival.

CONCLUSIONS

The differences between proportions of T lymphocytes within tumor and its environment might be explained by proapoptotic effect of cancer cells on TILs.

Computational and Immunohistochemical Analyses Highlight AXL as a Potential Prognostic Marker for Ovarian Cancer Patients

BACKGROUND/AIM

The activation of the membrane tyrosine kinase AXL is implicated in the migration and invasion in several carcinomas, including ovarian cancer. Herein, we investigated the association of the expression of AXL transcript and protein to the aggressiveness of ovarian cancer, as well as to patient outcome.

MATERIALS AND METHODS

Overall and relapse-free survival were determined with respect to AXL transcript levels by computational analysis on two publicly available datasets containing data of gene expression from high-grade ovarian cancers (n=776). Immunohistochemical evaluation of AXL protein expression was then performed using a proprietary tissue microarray consisting of 62 ovarian cancers of different histology, grading and staging. Expression was analyzed for association with clinicopathological parameters, including survival.

RESULTS

In both analyzed datasets, AXL transcript expression was significantly associated to both overall and relapse-free survival in high-grade ovarian cancers. Membrane expression of AXL protein was observed in 89% of the analyzed ovarian cancers. A significant correlation was found between AXL expression and serous histologic subtype, higher tumor grade and type II tumors. No significant association between AXL protein expression and patient survival was found in our cohort. AXL is frequently expressed in high-grade serous ovarian cancers and its expression is significantly associated to tumors displaying poor prognosis.

CONCLUSION

AXL is a potential prognostic marker for the most aggressive ovarian carcinomas.

Macrophage profile in primary versus secondary liver tumors

Macrophages are important components of the tumor-associated infiltrate and are qualified as one of the major players of the cancer-related inflammation. It was shown that tumor cells can either stimulate or mediate apoptosis of tumor-associated macrophages (TAMs). To date, there is no general agreement regarding the influence of TAMs and their numbers on the progression of hepatocellular carcinoma (HCC) and hepatic metastases (HM). To analyze the presence of TAMs and compare their numbers in intratumoral (IT) and peritumoral (PT) areas with the clinical outcome of HCC and HM patients. Biopsies from 35 HCC and 39 HM cases were analyzed. Clinical and follow-up data was enrolled for each case; the colorectal cancer was the origin of 26 HM patients. TAMs were identified by immunohistochemistry using anti-CD68 monoclonal antibody. The quantitative assessment was performed by determining the mean number of CD68-positive cells in IT and PT areas in HCC and HM. Two threshold methods were applied: threshold 1 (T1) was calculated with the use of (-log) Cox method; threshold 2 (T2) was considered as 1/3 TAMs number of group's mean. For statistical analyses Mann-Whitney U-test, Spearman's correlation, Cox proportional hazard and Kaplan-Meier tests were applied. To date, 36.12% HCC and 27.78% HM patients were alive, median survival was 5 and 17 months for HCC and HM, respectively (P = 0.05). We found significant two-fold decrease of TAMs numbers between IT vs. PT territories in both HCC and HM. A positive correlation between numbers of PT and IT TAMs was observed in HM group (rs = 0.48, P < 0.05) but not in HCC. The number of TAMs was not associated with any studied clinical factor. Univariate Cox regression analysis showed that tumor stage ≤ II (P = 0.01) and increased number of PT TAMs (P = 0.06, only when T2 value was applied) were associated with favorable prognosis in HCC (HR = 2.614 and 2.457, respectively). Univariate and multivariate Cox analyses in HM revealed favorable prognosis for histological grade ≤ G2 and one lobe tumors (P = 0.021 and 0.045; HR = 0.395 and 0.438, respectively). Survival analysis retained the impact of increased TAMs numbers in peritumoral areas (P = 0.03), tumor stages in HCC (P = 0.007), lobes' number (P = 0.007) and histological grade (P = 0.005) on HM patients' outcome. In HCC and HM the low number of TAMs in intratumoral areas was related to the tumor cell microenvironment. The increased peritumoral TAMs number in primary liver tumors was associated with better prognosis.

Morphological changes in membranoproliferative glomerulonephritis - a quantitative approach

Our study aimed to investigate the quantitative profile of the renal corpuscle components in membranoproliferative glomerulinephritis (MPGN). We have analyzed digital color images corresponding to relevant microscopic fields from renal biopsies (10 cases type I MPGN and 10 cases type II MPGN). A computerized morphometric algorithm was designed and applied in both red-green-blue (RGB) and hue-lightness-saturation (HLS) color spaces, allowing the automated measurement of areas for the following morphological characteristics of the renal corpuscles (RCs): glomerulus, Bowman space, cells, mesangial matrix and glomerular basement membranes, and capillaries. Student's t-test comparatively applied between the numerical data obtained for the measured morphological characteristics, for each individual color space, showed significant differences between type I MPGN and type II MPGN for Bowman space area (p=0.006) and for mesangial matrix and glomerular basement membranes area - exclusively in RGB color space (p=0.013). We have also demonstrated larger RCs and glomerular size in type II MPGN, comparative to those in type I MPGN. Consequently, we assume that the morphometrical characterization of RCs histological components could be used as an additional criterion not only in the diagnosis of MPGNs, but also in the stratification of evolution and prognosis of patients diagnosed with type I and II MNGN, respectively.

Relationship between Kuppfer cells, inflammation, and fibrosis in chronic hepatitis B and C

Kupffer cells are liver parenchymal components of the immune system able of intervention in pathogenic mechanisms involved in viral hepatitis and tumoral lesions. Our study aimed to evaluate the Kupfferian hyperplasia in chronic hepatitis B and C, and to correlate with the severity of liver lesions, focusing on the modality in which Kupffer cells modulate the necroinflammatory events and fibrosis specific for chronic hepatitis morphologic substrate. We investigated 33 cases with chronic hepatitis B and 38 cases with chronic hepatitis C, diagnosed according to Ishak score (in chronic hepatitis B and C) and METAVIR score (in chronic hepatitis C). Kuppfer cells were immunohistochemical labeled, by using an anti-CD68 antibody and heat-induced epitope retrieval (HIER) technique. The sinusoidal reaction expressed by CD68 (+) cells hyperplasia progressively increases along with the intensity of necroinflammatory activity and with the amplitude of fibrosis lesions. Statistically significant differences between Kupffer cells number and the degree of necroinflammatory activitiy and fibrosis, respectively (Ishak score) have been identified in both types of chronic hepatitis. However, no significant differences have been registered when comparing the Kupffer cells number corresponding to each degree of necroinflammatory activity and of fibrosis, in chronic hepatitis B versus C, respectively. Our results demonstrate the relationship between Kupffer cells and the severity degree of the disease, without differences between chronic hepatitis B and C. Consequently, we may appreciate that the chronic hepatitis C specific lesions progression, different from that of chronic hepatitis B, is influenced by a different behavior of Kupffer cells, and not by their effective

The immunohistochemical assessment of HPV related adenocarcinoma: pathologic and clinical prognostic significance

Although several epidemiologic studies have confirmed the association between high-risk human papillomavirus (hr-HPV) and adenocarcinoma of the cervix, there are few papers focusing on the molecular immunophenotype of the HPV related cervical adenocarcinoma and its precursor lesions. The present study is aimed to assess the immunohistochemical expression of p16, p53, cyclin D1, EGFR, and COX-2 in benign and malignant lesions of cervical glandular components, and consequently the identification of the relationship between these markers and the HPV L1 capsid protein. We investigated 7 cases of endocervical adenocarcinoma in situ (AIS), 8 cases of adenosquamous carcinoma, 15 cases of invasive adenocarcinoma of endocervical type, and 5 cases without malignant lesions (normal and/or benign endocervical epithelium). The tissue fragments underwent standard laboratory procedures for the histopathological and immunohistochemical exams. For each marker, the semi-quantitative assessment was performed using appropriate scoring systems. Our results showed that: (i) the combination of L1 capsid protein and p16 can predict the progression risk of precursor lesion of endocervical adenocarcinomas; (ii) p53 - COX2 - p16 co-assessment is useful as a panel of relevant biomarkers for L1 - p16 association; (iii) EGFR increases according to the progression in lesions severity; (iv) cyclin D1 is a reliable marker for the invasive capacity. Further studies are necessary to quantify the value of these markers, as prognostic factors in HPV related cervical adenocarcinoma.

High variability in MMP2/TIMP2 and MMP9/TIMP1 expression in secondary liver tumors

The assessment of MMPs/TIMPs expression in various primary tumors has potential prognostic values. Considering the paucity of studies in secondary liver tumors, our aim was to study the expression of MMP2, MMP9, TIMP1, and TIMP2 in secondary hepatic cancer, focusing on their variability in the malignant cells. The study group included 25 cases of liver metastases of colorectal cancer, diagnosed and surgically treated at "Sf. Spiridon" University Hospital of Iassy, Romania. Immunohistochemistry for MMP2, MMP9, TIMP1, and TIMP2 has been performed, followed by the semi-quantitative assessment of the markers using a scoring system based on the positive tumoral cells percentage and the staining intensity. The expression of investigated markers revealed an increased staining variability. The scores showed that MMP2/TIMP2 and MMP9/TIMP1 immunoreactivity was extremely heterogeneous within the analyzed group, with a dominant weak expression for MMP2 and MMP9, in contrast to strong TIMP2 and TIMP1 expression. Ten different patterns of expression of the investigated markers have been identified. No major differences between the expression of MMP2 (14 positive cases) and MMP9 (16 positive cases) could be detected. Our results sustain the inverse correlation between MMP and the correspondent TIMP expression, supporting the hypothesis that MMPs/TIMPs balance has mainly an inhibitory effect on invasiveness. Our study demonstrated that tumoral cells are adapted to MMPs:TIMPs production in the liver microenvironment. The lack of significant differences between MMP2 and MMP9 expression shows that the activity of both MMPs is independent, without reciprocal influences.

Immunohistochemical study of colorectal cancer liver metastases: the immune/inflammatory infiltrate

Our study is focused on the investigation of the immune/inflammatory infiltrate in liver metastases secondary to colorectal cancer. Twenty cases of colorectal liver metastases have been studied, including eight with recurrent metastases occurred after a previous treatment by thermonecrosis (group 1) and 12 with primary metastases treated exclusively by surgery (group 2). The cases were investigated by routine histopathological exam and by immunohistochemistry, using CD3, CD20 and CD68 antibodies. The design of the study envisages a comparative qualitative and quantitative evaluation of the B- and T-lymphocytes and macrophages inside the tumor and at the interface between liver parenchyma and tumor. Student's t-test was used for all statistical comparisons. The qualitative exam revealed, for both groups, the presence of an important T-lymphocyte, and respectively B-lymphocyte cell population at the interface between the tumor and the liver parenchyma, the number of intratumoral cells being extremely reduced. The statistical analysis showed significant differences (p<0.05 for groups 1 and 2, T- and B-lymphocytes, intratumoral vs. peritumoral). However, the comparison of group 1 with group 2 revealed no statistically significant differences between the mean value of intratumoral and peritumoral T- and B-lymphocytes, respectively. The qualitative exam revealed the presence of a well represented macrophage cell population, with a heterogenous distribution from case to case. This finding was confirmed by numerical information, with a lack of a statistically significant difference between the mean number of macrophages quantified intra and peritumoral, for both study groups. However, statistically significant differences were noticed between intratumoral and peritumoral mean value, respectively, for group 1 vs. group 2 (p<0.05). T-lymphocytes are the most numerous, their peritumoral location being the landmark for the histoarchitecture of the immune/inflammatory infiltrate and conducting the immune response developed at the interface between the tumor and liver parenchyma. The quantitative assessment of the immune infiltrate shows similar features in surgically resected metastases and recurrent metastatic disease after thermonecrosis. On the contrary, the quantitative evaluation of the macrophage population indicates a functional association rather with the primary metastasis process than with the recurrent metastatic disorder.

The protective effect of montelukast sodium on carbon tetrachloride induced hepatopathy in rat

AIM

This study investigates the effects of montelukast sodium (MK) (CysLTLT1 receptor antagonist) on CCl(4)induced hepatopathy on rat.

MATERIAL AND METHODS

We worked on 4 groups of 10 Wistar male rats each. The groups received as follows: group I (control group) - saline, group II - MK 5mg/kg/day i.p. for 5 days, group III - MK 5mg/kg/day i.p., 1 day prior to and 4 days concomitantly with CCl(4) p.o., 0.3ml/Kg/day and group IV - CCl(4), p.o., 0.3ml/Kg/day for 4 days. One day after the last administration, samples of blood were taken and alanine aminotransferase (ALT), total bilirubin (TB), direct bilirubin (DB), malondialdehyde (MDA), catalase (CAT) as well as total antioxidant capacity (TAC) were determined. The histopathological exam was performed. We also determined superoxide dismutase (SOD), MDA, CAT and GSH in liver homogenate.

RESULTS

Compared to group IV, group III exhibited statistically significant lower levels of ALT (318+/-15.75 versus 203.14+/-10.28 UI, p<0.0001), TB (3.16+/-0.30 versus 1.99+/-0.08mg/dl, p<0.0001), MDA in blood and in liver homogenate (4.98+/-1.71 versus 2.15+/-1.18nmol/ml, p=0.0004) and higher levels of SOD and CAT. Histopathologically, group IV presented important macro- and micro-vesicular hepatic steatosis and group III preserved lobular histoarchitecture and had less severe cellular lesions.

CONCLUSION

MK exhibits a partial hepatoprotective effect on rats treated with CCl(4).

Idiopathic gingival hypertrophy--a morphological study and a review of literature

Gingival overgrowth occurs as a response to several drugs, in some systemic diseases, as a consequence of a genetic predisposition or could be idiopathic, the last being less studied. Independently of the etiological factor involved, histological changes are maintained and intensified by the presence of the bacterial plaque.

MATERIAL AND METHODS

Fibrotic mucosa clinically diagnosed with idiopathic hypertrophy was included in paraffin and studied using usual histological stains and immunohistochemical techniques for vimentin, MMP-3 and TIMP-2.

RESULTS

Evaluation of histological changes revealed an unspecific pattern like the thickening of the epithelium, with acanthosis and acantholysis and massive deposition of connective tissue in the lamina propria. Keratinocytes from the areas with acantholysis express MMP-3. In the fibrous areas we noted few fibroblasts and a discrete expression of MMP-3. Extended areas of inflammatory tissue with numerous de novo capillaries were observed among the collagen bundles. Proinflammatory and endothelial cells expressed both MMP-3 and TIMP-2. The last antibody had an intense expression deeper in the epithelium. Our results were discussed in accordance with reference data.

CONCLUSIONS

We conclude that the histological changes observed were not specific for the idiopathic gingival hypertrophy and the imbalance of tissue homeostasis was due to the interaction between keratinocytes and connective cells in the milieu of specific changes induced by the inflammatory conditions.

[Connective tissue growth factors, CTGF and Cyr61 in drug-induced gingival overgrowth--an animal model]

Human gingival overgrowth may occur as a side effect of chronic administration of some therapeutic agents. The mechanisms responsible for the gingival tissues lesions, fibrosis and inflamation, involve an impaired balance between the production and the degradation of type I collagen. It has been demonstrated that CCN2/CTGF, a connective tissue growth factor, is highly expressed in the gingival tissues and positively correlated with the degree of fibrosis in the drug-induced gingival overgrowth. The aim of this study was to identify the presence and localization of CCN2/CTGF and CCN1/Cyr61, members of the same molecular family, in gingival tissues of cyclosporin A- and nifedipine-treated rats, by immunohistochemistry. Staining was evaluated with light microscope and the results show cellular and extracellular CTGF in nifedipin gingival overgrowth tissues with intensity of labeling higher compared to the CsA gingival overgrowth tissues or the controls. The staining for Cyr61 shows its intracellular localization with no diference of labeling intensity between drug-induced gingival overgrowth and normal tissues. Also, we were interested in the gingival TGF-â expression in those animals. We didn't find any commercial anti-rat TGF antibody and our anti-human antibody shows no cross-reactivity with rat tissues. The data from our study sustain the involvement of CTGF and Cyr61 as growth factors in the gingival tissues and the CTGF association with drug-induced gingival overgrowth.

The influence of leukotriene receptors' antagonists on experimentally induced ulcer in rats

AIM

Gastric mucosal cells synthesize a large number of eicosanoids (including leukotrienes) which are distinctively involved in ulcerogenesis. This experimental study investigated the effect of 4 leukotriene receptors' antagonists on indomethacin(IND)-induced ulcer in rats.

MATERIAL AND METHODS

Animals were divided into six groups (of 8 rats each) which received as follows: group I (control)--saline; group II--IND 20 mg/kg p.o.; group III--montelukast sodium 10 mg/kg p.o. and IND 20 mg/kg p.o.; group IV-- a quinolinic derivative (19363) 20 rM/kg p.o. and IND 20 mg/kg p.o.; group V--a phenethylamido derivative (20599) 20 microM/kg p.o. and IND 20 mg/ kg p.o.; group VI--a resatophenone derivative (19072) 20 microM/kg p.o. and IND 20 mg/kg p.o. Animals were sacrificed eight hours after the last administration. The gastric index (UI), gastric pH and histopathological exam were performed on the removed stomachs.

RESULTS

UI was 25.8 +/- 6.3 in group II, 10.20 +/- 2.3 in group III (p < 0.05), 21.60 +/- 2.8 in group IV, 13.40 +/- 2.4 in group V (p < 0.05) and 20.80 +/- 3.9 in group VI. pH values were 2.2 +/- 0.3 in group II, 3.4 +/- 0.9 in group III (p < 0.05), 2.6 +/- 0.8 in group IV, 2.9 +/- 0.7 in group V and 2.5 +/- 0.6 in group VI. The histopathological exam revealed: (i) typical lesions for ulcer in groups II, IV and VI, the most severe being in group II; (ii) only superficial non-hemorrhagic erosions in group V; (iii) small erosion areas alternating with large zones of normal mucosa in group III. The obtained data demonstrated different degrees of gastro-protective activity for the studied leukotriene receptor antagonists.

CONCLUSION

Especially montelukast but also phenethylamido derivative (20599) exhibited a partial gastro-protective effect on IND-induced ulcer in rats.

[Contribution of immunohistochemistry and flow-cytometry in the study of endometrial pathology]

Endometrioid endometrial carcinoma is characterized by hyperestrogenism and high sensitivity to progestogens. Our study was designed in order to demonstrate the hormonal influences in neoplastic endometrium, by investigating steroid receptors expression and their correlation with proliferation activity, with matrix enzymes expression, and with susceptibility to apoptosis inducers, from hyperplasia to carcinoma. 13 cases were included in our study, 7 endometrial hyperplasias, and 6 endometrial carcinomas. Immunohistochemistry technique was performed, using antibodies against ER-á, PR, PCNA, MMP-2, MMP-9, Fas, and FasL molecules. Flow-cytometry was complementary used, for steroid receptors, PCNA and MMPs. Endometrial hyperplasias were positive for both hormonal receptors, in epithelial and stromal cells. An evident decrease of the percent of positive cells and of the staining intensity of both ER and PR was observed in poorly differentiated endometrial carcinomas. Endometrial hyperplasias presented a similar proliferative index with differentiated endometrioid endometrial carcinomas. Poorly differentiated endometrial carcinomas showed the highest PCNA index. Both types of investigated MMPs were evident, with similar aspect of localisation for both MMP-2 and MMP-9. The staining intensity for MMP-9 was higher than that of MMP-2, and was identified both in epithelial and in stromal cells. Fas and FasL expressions were identified in glandular epithelium of endometrial hyperplasias and carcinomas, although the staining intensity was reduced. Flow-cytometry showed a correlation between qualitative and quantitative data concerning hormonal receptors, PCNA and MMPs. Our study emphasises that neoplastic endometrial cells express several molecules correlated with malignant transformation and tumoral progression, by coordinated intervention of steroids, proliferating factors, gelatinases, in opposition with systems involved in apoptosis initiation.

Ki-67, p53 and bcl-2 analysis in colonic versus rectal adenocarcinoma

This paper develops a comparative study between similar subtypes of colonic and rectal adenocarcinoma, based on their immunohistochemical profiles for Ki-67, p53 and bcl-2 markers, in order to evaluate the prediction value for the investigated markers, according to the histologic subtype and location. Thirty cases of adenocarcinoma were investigated, 15 with colonic and 15 with rectal location. For both locations, the cases included five well-differentiated, five moderately differentiated and five low differentiated subtypes. The immunohistochemical investigation was performed using Ki-67, p53 and bcl-2 antibodies (DAKO) and streptavidin-biotin method (LSAB Kit, DAKO). The semiquantitative analysis of the immunohistochemical reactions was based on the Ki-67 and p53 index, respectively, counted as number of positive cells from 100 positive and negative cells. For bcl-2, the reaction was considered positive, respectively negative, for a percentage of positive cells higher, respectively smaller, than 5%. All 30 cases (100%) were positive for Ki-67. The mean value of Ki-67 index for colonic, respectively rectal adenocarcinoma was 55.8%, respectively 59.6%. No statistical correlation was found between the proliferative activity and location (p=0.502). Ten cases (66%) of colonic adenocarcinoma were positive for p53, with a mean value of 42.5% for p53 index. Eight cases (53%) of rectal adenocarcinoma were positive for p53, with a mean value of 21.1% for p53 index. There was a statistic correlation between the apoptotic activity and location (p=0.005). The positive reaction for bcl-2 was present in seven (46.6%) and nine (60%) from the 15 cases of colonic and, respectively, rectal adenocarcinoma. The statistic analysis revealed that bcl-2 cannot be significantly associated with any of the two locations (p=0.48144, 95% CI). The use of the Wald tests permitted the assessment of the predictive power for the investigated markers according to the pathologic subtype and location. Thus, p53 is on the first position (W=16.56, p=0.00004, 95% CI), followed by Ki-67 (W=4.49, p=0.034, 95% CI), whereas bcl-2 cannot be considered a predictive factor (W=2.5, p=0.107, 95% CI). The immunohistochemical evaluation of Ki-67, p53 and bcl-2 yields refined information on colorectal tumor biology. Our study confirms, from the statistic point of view, the role of p53, followed by Ki-67, as predictive factors.

Immunohistochemical markers in the study of gallbladder premalignant lesions and cancer

AIM

The aim of the study was to perform a comparative analysis of proliferative and apoptotic activity as well as of microvascular density (MVD) in metaplasia, dysplasia and gallbladder carcinoma.

MATERIAL AND METHOD

There were investigated 10 cases of chronic cholecystitis associating premalignant lesions and 5 cases of gallbladder carcinoma developed on a chronic cholecystitis background. The immunohistochemical (IHC) staining was made using Ki-67, p53 and CD34 antibodies, and the streptavidin-biotin method. The semiquantitative analysis focused on the intensity of the IHC reaction for Ki-67 and p53 (on a scale from 0 to 4), the Ki-67 index and the percentage of p53 positive cell nuclei. The MVD was established on 5 representative fields as mean of the number of CD34 positive vessels.

RESULTS

Ki-67 was positive in all 10 chronic cholecystitis cases (100%) and in all 5 carcinoma cases (100%), which is explainable by the selection manner of chronic cholecystitis associating premalignant lesions and by the invasive pattern of the carcinomas. Ki-67 index rose from 10% in simple dysplastic lesions associated with chronic cholecystitis to 20% in severe dysplastic lesions associated with chronic cholecystitis up until 90% in carcinoma. In all chronic cholecystitis, p53 was negative for normal gallbladder epithelium, in metaplastic territories and in those with mild dysplasia. In the dysplastic areas present in chronic cholecystitis, the positive reaction of p53 rose from 20% (in moderate dysplasia) to 80% (in severe dysplasia). All carcinoma cases were p53 positive (100%), its expression varying from 30% in papillary areas and 30-50% in undifferentiated adenocarcinoma to 80-100% in well differentiated type. In chronic cholecystitis MVD was of 5-9 vessels / field in areas adjacent to pyloric metaplasia and 10-20 vessels / field in severe dysplastic areas. Gallbladder carcinoma cases presented a MVD of 15-30 vessels / field.

CONCLUSIONS

The investigation of Ki-67, p53 and MVD brings important data regarding the carcinogenesis process in the gallbladder, initiated on the background of a chronic cholecystitis. The dynamics in the values for Ki-67, p53 and MDV followed from premalignant lesions to carcinoma sustains the hypothesis of the metaplasia-dysplasia-carcinoma sequence.

[Lipomas of the oral cavity--a retrospective study]

Lipomas are the most common soft tissue mesenchymal neoplasms, with 15 to 20% of the cases involving the head and neck region and 1 to 4% affecting the oral cavity. They represent 0.1 to 5% of all benign tumours of the mouth and are usually found as long-standing soft nodular asymptomatic swellings covered by normal mucosa. Few large series of intraoral lipomas and its variants are seen in literature.

AIM

This study aimed to assess the clinical and histological features of intraoral lipomas.

MATERIALS AND METHODS

A retrospective review was undertaken of medical records and histological studies of 19 patients with histopathologically proven intraoral lipomas, over a 15-year period (from 1992 to 2006) at the Department of Oral and Maxillofacial Surgery, Iaşi.

RESULTS

Most of the cases affected adults (18 cases) without gender predilection and the main involved sites were: the floor of the mouth (6 cases), the buccal mucosa (5 cases), the lips (4 cases), the tongue (3 cases) and the buccal sulcus (1 case). The histological analysis revealed 14 cases of common lipomas (3 with infiltrating features), 4 cases of fibrolipomas, and 1 myxoid lipoma. All lesions were surgically removed and none showed recurrence, regardless of the various histological subtypes.

CONCLUSIONS

Lipomas should be considered in the differential diagnosis of soft-tissue head and neck masses. Even though several histological types are described, the clinical course and the surgical treatment are similar. Our study confirms the rare incidence of the oral lipomas development. Key words:

Immunohistochemical study of the morphological changes in placental villi from fetal membranes infectious disease

Many types of infection cause placental changes but sometimes the etiological cause may be difficult to prove. Infections may ascend from endocervical canal or they may reach placenta hematogenously through the maternal blood. Typically, placenta of "the amnionic sac infection syndrome" is an immature placenta. Complex cellular mechanisms are involved in all types of infection that often are associated with placental insufficiency.

OBJECTIVES

The aim of this study was to evaluate cellular changes induced by the hypoxic conditions due to infectious disease in the placental villous structures, especially in the trophoblast layer and vascular bed.

MATERIAL AND METHODS

In order to label the trophoblast layer we used anti-cytokeratin cocktail AE1/AE3. Antibodies anti-VEGF and anti-c-ErbB4 were used for the evaluation of tissue response under hypoxic conditions and its involvement in villous remodeling.

RESULTS

Chorion villi from placentas with histopathological features of insufficiency due to infectious etiology show an intense immunostaining for VEGF in the trophoblast, vessel walls and some stromal cells, namely Hofbauer cells. Villous trophoblast from the infected placenta expresses c-ErbB4 receptor.

CONCLUSIONS

Overexpression of VEGF and c-ErbB4 is needed for the involvement of trophoblast layer in villous remodeling processes in order to maintain placental functionality under the effects of the inflammatory cascade.

Computer-aided identification of renal corpuscle elements in RGB and HLS color images

The qualitative and quantitative changes in the structure of the renal corpuscle allow the assessment of the glomerular involvement degree, defining each type of glomerulonephritis. Recently, several works dedicated to glomerulonephritis focus on the quantitative investigation, achieved by digital (numerical) image processing, where the identification of the interest elements is a key stage.

OBJECTIVES

The aim of the study was the elaboration of a technique for constructing reliable color models in the RGB and HLS spaces for each element of the structure of the renal corpuscle.

MATERIAL AND METHODS

We analyzed images captured from trichrome stained fragments of renal biopsy. Each image contained a single renal corpuscle. The identification procedure used the software tools specialized in color image analysis provided by the Zeiss KS400 environment.

RESULTS

There were defined specific chromatic domains in the RGB and HLS space for the identification of the following elements: the Bowman space and the glomerular capillaries (white colored regions), the nuclei (brown colored regions), the mesangium (green colored regions).

DISCUSSIONS

In order to get a relevant picture of the role played by the decisions made in the definition of the chromatic domains, we performed two tests for the modification of the chromatic domain allocated to the mesangium in the RGB and HLS space, respectively.

CONCLUSION

The procedures proposed for the identification of the RGB and HLS color models can successfully replace the manual delineation of the renal corpuscle elements. Such models represent an important step in our research visualizing the future development of computer programs for automated measurements of renal corpuscle elements.

[Hepatic changes due to the administration of midazolam and ketamine--an experimental study]

The aim of the study was the investigation of the secondary effects at the hepatic level determined by anesthetics.

MATERIAL AND METHODS

There were used 4 groups of 10 mature white Wistar rats, males and females. Group I was the witness group. According to the experimental protocol, group II received midazolam and ketamine, group III--carbon tetrachloride and group IV--midazolam, ketamine and carbon tetrachloride. The hepatic fragments taken from the sacrificed animals after 4 weeks were processed for light microscopy (HE, van Gieson and Gömöri stains) and also for electronic microscopy.

RESULTS

Midazolam in association with ketamine determined at the hepatic level a series of morphologic changes, identified in light and electronic microscopy. The light microscopy analysis revealed a significant inflammatory syndrome, and many isolated cellular necroses (acidophile bodies--apoptotic cells). Moreover, the electronic microscopy study showed marked anomalies of the cellular components, even when light microscopy indicated only minor lesions. The predominant ultrastructural changes were the mitochondrial abnormalities.

DISCUSSIONS

The most numerous and diverse morphologic changes were observed at the group where carbon tetrachloride was administered in association with midazolam and ketamine. We can assert that carbon tetrachloride increased the aggressive potential of ketamine, manifested even in association with midazolam.

CONCLUSIONS

Although each of the two anesthetics does not have an evident hepatotoxicity, when they are associated with each other or they are administered with a known hepatotoxic substance, they determine hepatic lesions of various sizes and degrees.

[Perilesional changes in gastric ulcer]

Our work aims to provide a descriptive analysis of the perilesional changes associated with gastric ulcer, which were observed on a group of patients diagnosed by endobiopsy.

MATERIAL AND METHOD

The group comprised 90 persons with clinical diagnosis of gastric ulcer, who were investigated both endoscopically and pathologically. The gastric fragments were processed for light microscopy (HE, PAS, alcian blue stains).

RESULTS

Besides the typical gastric ulcer, the morphological exam identified gastric ulcer combined with chronic gastritis, complete and incomplete intestinal metaplasia, gastric atrophy, hyperplasia as well as dysplasia. A malignant gastric ulcer was confirmed in 6 cases. A number of 10 patients displayed malignant lesions (gastric carcinoma, intestinal and diffuse types) developed independently of the gastric ulcer.

CONCLUSIONS

The identification of various morphological changes in the gastric mucosa adjacent to the ulcer allows a correct evaluation, with respect to the diagnosis and the evolution. The presence of these lesions, correlated with the existence of Helicobacter pylori, means major risk factors for gastric carcinogenesis.

[Electron microscopy in oral squamous cell carcinoma of elderly patients]

OBJECTIVES

Squamous cell carcinoma is the most frequent tumor occurring in the oral cavity. The aim of the study is to point out the fine-structural characteristics of the tumor cells and of the adjacent stromal cells, trying to establish a correlation between these characteristics and the biological behavior of the tumor.

MATERIAL AND METHODS

We performed an electron microscopic investigation for tree elderly patients diagnosed with oral squamous cell carcinoma.

RESULTS

The tumoral cells presented nuclear abnormalities and the reduction of the intercellular cohesion, through an increase in the intercellular spaces, and desmosomal modifications. Through the abundance and the variety of the cellular types, the stromal component represented a positive response from the host.

CONCLUSIONS

In the diagnosis of the oral carcinoma, the electron microscopic exam supplements the light microscopic investigation, revealing important morphologic elements at a subcellular level (regarding the nucleus, cellular organelles, and junctions).

[Statistical and regression analysis in interpreting computerized morphometric results]

The aim of the study is to construct the statistical framework requested by the interpretation of the results obtained through computerized morphometry procedures. The study also includes the regression analysis of the investigated quantitative features.

MATERIAL AND METHODS

The automatic measurements performed under Zeiss KS400 environment were achieved on a microscopic specimen of dental pulp. The areas and the perimeters were determined for 139 fibroblasts, so as to define two statistical series able to characterize the size of the cells.

RESULTS AND DISCUSSIONS

The results are formulated in both analytic and numerical terms, the latter relying on the graphical support and computational resources of Zeiss KS400 environment. Also, the mathematical support is implemented. The research focuses on three key aspects: (i) the role of the class organization (clustering) in the correct evaluation of the measured cellular areas, (ii) the global characterization of these areas by the standard statistical indices, (iii) the linear and quadratic regression perimeter versus area.

CONCLUSIONS

The study is based on a concrete morphometric investigation of a dental pulp microscopic specimen, but the statistical and regression analysis can be applied to any other kind of specimen that undergoes a morphometric examination. The implementation under Zeiss KS400 is easy adaptable to other software environments providing similar facilities. For an exhaustive approach, in accordance with the sampling and selection laws, this type of study should be successively practiced on several fields of the microscopic specimens.

Microscopic morphometry--a modern approach

OBJECTIVES

The aim of this paper is to give a brief presentation of the recent trends in histologic and histopathologic computerized morphometry, based on the personal experience in exploiting modern software environments and illustrated by a relevant case study. Through its goal, overall conception and direct involvement in diagnosis, the work belongs to the currently emerging researches on analytical and quantitative histology.

MATERIAL AND METHODS

The proposed methodology for the automatic extraction of quantitative features is applied to an endometrial adenocarcinoma and is implemented as a procedure, called ADK, running on ZeissKS400 platform. The description of the ADK procedure, as a detailed flowchart, is preceded by an overview of the KS400 resources for biomedical domain, compared to the main characteristics of other three well-known software packages for digital image processing.

RESULTS AND DISCUSSIONS

The results are formulated in terms of the numerical information provided by the exploitation of ADK procedure, referring to the 2-D and 3-D (stereological) evaluation of tumorous versus stromal areas and volumes, respectively. Procedure ADK also performed measurements for the nuclei corresponding to the stromal and tumorous zones, respectively, in order to calculate the percentage of nuclei inside these zones. The discussions focus on the interpretation of the measurement results, as factors for the prognostic assessment.

CONCLUSIONS

The computer-aided morphometric investigations open perspectives for operating with more expressive criteria in pathology diagnosis, resulting from the possibility to quantify, at the pixel level, features of interest which in classical approaches are subject to rough approximations.

[ANCA's- approach, advantages, limits]

OBJECTIVES

The aim of this paper is to present the experience of the Laboratory of the Department of Histology in establishing the presence of ANCAs, in cases which cover an extremely large and diverse pathological area. The investigations were made following the request of some clinical medical services, ANCAs being a complementary exam, with an important role in the orientation and/or confirmation of the diagnosis.

METHODS

There were investigated 77 cases with clinical diagnoses ranging in the connective tissue diseases field, mainly SLE and vasculitides, and in the renal diseases field, mainly glomerulonephritis. There was performed an indirect immunofluorescence technique with a personal method, involving the usage of blood smear instead of neutrophils concentrate, human anti-IgG monospecific fluorescent conjugate and serum from the patients.

RESULTS AND DISCUSSIONS

There was obtained a comprehensive survey of the presence of ANCAs in the study group. The interpretation of the results was completed within the general clinical background and in association with the physician. There is discussed the significance of the data in comparison with the literature.

CONCLUSIONS

The ANCAs research may become a monitoring method of different cases, offering therapeutic and prognostic efficiency elements.

Morphological features in the embryological development of the anterior arch of the mandible

OBJECTIVES

Our study is focused on the typical morphological features of the development of the mandible. There were investigated both specific elements for the ossification process as well as aspects of the developing tooth germs.

METHODS

We performed transmission electron microscopy analyses on sections obtained from 15 human embryos aged between 6 and 20 weeks. The sections were acquired from specific areas of the anterior arch of the mandible, corresponding to the sites of development of the tooth germs, namely the incisors and the canines.

RESULTS

There were observed some characteristic elements for the intramembranous ossification process (mesenchymal cells, collagen fibers, osteoblasts, bony spicules), and for the different stages of odontogenesis (bud, cap).

CONCLUSIONS

The results confirm the important role of this territory and highlight the primary elements of the intramembranous ossification and of the odontogenesis, as essential steps in the development of the head and the face.

Actinic keratosis--a histoenzymological study

Actinic keratosis or senile keratosis is the most frequent premalign epithelial lesion that occurs in the elderly with a history of prolonged and intense exposure to the UV radiation and with an inborn susceptibility. Although the genetics and risk factors are clear nowadays, the histogenesis of this lesion is still under study. The histoenzymologic tests (such as those that demonstrate the ATP-ase and SDH-ase activity) are very useful for early detection of the structural and biochemical changes within the actinic keratosis lesion.

Histology teachware for the Web site of the University of Medicine and Pharmacy "Gr. T. Popa" Iaşi

Design and implementation of Web educational materials for medical sciences are discussed starting from a brief presentation of the current trends in using Internet facilities and placing emphasis on the specific case of the www page constructed for the Department of Histology. The paper focuses on the development of teaching-aids for the morphological study of organs and systems, illustrated by the creation of Histology Album, including photographs and explanatory texts, which is accessible via this www departmental page. Relevant aspects for the construction of the Histology Album are detailed in terms of both logical structure and physical implementation, based on HTML techniques. Outcomes are expected in achieving a noticeable progress in students' instruction, as a result of diversifying the documentation possibilities and increasing the role of the individual work (by avoiding the permanent supervision of an instructor). Further improvements of this www page are commented in the light of the recently proposed frameworks for distance learning, relying on specialized software tools that allow student's interactive work.

[Prognosis and treatment of membranous glomerulonephritis-a 5-year prospective study]

The aims of the study were to describe the clinical, pathological and biological features of membranous GN and to prospectively evaluate the relationships between individual negative prognostic factors--type of therapy and outcome. Between 1993-1998, 13/150 (8.7%) consecutive patients with renal biopsy had membranous GN (M = 62%, age = 42.5 +/- 14.5 years). Main (major) findings in these patients were: asymptomatic proteinuria--23.1%, heavy proteinuria (> 10 g/day)--33.3%, microscopic hematuria--53.8%, increased plasma creatinine levels--33.3%, hypertension--23.1% cases. 60% of the patients with nephrotic proteinuria had an underlying cause (infection, malignancy, immune-mediated systemic diseases). 40% of the patients with nephrotic proteinuria had 0 or less than 2 negative prognostic factors (without any of the recognized severe morphological changes). The following differentiated treatment protocols were applied: no treatment for asymptomatic proteinuria (group A), i.v. methyl-prednisolone boluses + prednisone 1 mg/kgc/day 3 months for those patients with few negative prognostic factors (group B), and steroids (as above) + cyclophosphamide (2 mg/kgc/day 3 months) or the Ponticelli regime in patients with important risk factors (group C). Outcome after a median follow-up period of 24 months was: complete remission in all cases from groups A + B (with only one exception were the underlying cause was breast malignancy); in group C in 75% of the subjects a complete or partial remission (proteinuria < 1 g/day) was obtained. Only one case progressed to chronic renal failure. There were no secondary effects from corticoids or immunosuppressive therapy.

CONCLUSIONS

In membranous GN treatment should be tailored to the presence and type of negative prognostic factors. Even in high-risk patients combined steroids and immunosuppressive therapy determines a favorable outcome in 75% of the cases, without severe adverse effects.

[Operational models in the histopathological examination of liver puncture biopsies]

The main goal of this paper is to give an overview of the personal experience in the investigation of the hepatic biopsy. There were analyzed liver specimens from 26 children hospitalized in Clinical Hospital "Sf. Maria" Iaşi. The first clinic diagnosis was post-viral chronic hepatitis and most of the cases provided the serologic markers. Histopathological exam revealed 2 cases of active chronic hepatitis and 24 cases of persistent chronic hepatitis. The interpretation of the lesions relied on Ludwig and Metavir scoring systems. The significance of these scores is very important because they allow one to identify the grading of the necro-inflammatory/histological activity and the staging of fibrosis. Thus, the result of these scoring systems make it possible to classify the cases into aggressivity based forms, indicate the therapy approach and estimate the prognosis as well as the clinical course.

[Computer-assisted instruction in the field of morphology]

Visiting the image collections of normal and pathological morphology, available with free access on the World Wide Web (www), represents a vast source of extremely valuable material for both teaching and documentation in research activities. The aim of this paper is to provide a brief overview of the www facilities, which is gradually structured at the conceptual level. This overview ranges from the exploration of various topics in medical sciences/morphology, till the concrete aspects revealed by the construction and utilization of image libraries, designed for internal use, in accordance with certain systematic criteria. Examples from normal and pathological morphology illustrate the principles envisaged by the elaboration of such libraries.

[3 cases of malignant immunoblastic lymphomas]

Immunoblastic malignant lymphomas belong to the high-grade malignant lymphomas and can be classified into B and T types, according to the origin line of the proliferating cells. This paper presents three cases of immunoblastic malignant lymphomas, exhibiting fairly close morphological aspects. The morphological diagnosis based on standard methods using conventional dyes was supplemented by immunohistochemical diagnosis with monoclonal antibodies. Thus, the cellular line of the proliferating cells has been identified. A brief overview of the theoretical criteria requested for defining and differentiating the two types of immunoblastic lymphomas is also formulated.

[The importance of immunohistochemical examination in the diagnosis of malignant lymphoproliferative diseases--the author's personal experience]

A high-quality approach to lymphoproliferative diseases needs mastering the basic principles of morphology, immunology and genetics. The diagnosis relies on both traditional methods (histopathological analysis) and modern procedures (supported by advanced techniques such as immunohistochemistry, flow cytometry, and molecular biology). This paper presents a personal point of view developed by the author as a consequence of experiencing the immunohistochemical reactions for the diagnosis of non-Hodgkin's malignant lymphomas. Immunohistochemistry, as an effective and currently practiced procedure, allows the identification of the cellular line of the proliferating cells. Full details are given for material and methods, providing a complete characterization of the used monoclonal antibodies (DAKO-CD20, L26, DAKO-CD3, DAKO-CD68, PG-M1, DAKO-E29, EMA), as well as an integral description of the sequenced working phases. Relevance, efficiency, performance, limits and perspectives of the employed procedure are discussed with direct references to the results of this personal study.

[Morphological diagnostic problems in a case of peritoneal blastomycosis]

Blastomycosis is a mycotic disease, caused by a fungal infection. It has a wide spectrum of clinical presentations, and, particularly, can mimic neoplastic disease. Correct diagnosis of the illness requires fungal culture and biopsy. In Romania, mycotic histopathology is insufficiently developed, and morphological tests are recommended to very few people who present this type of pathology. The paper discusses a case of peritoneal blastomycosis found at a patient with an abdominal pseudotumoral mass. The microscopic exam revealed the characteristic histologic features and budding yeast, in specific dyes, typical to the Blastomyces dermatidis (PAS, silver-methenamin). Authors of this paper hereby intend to draw pathologists' attention on the existence and diagnosis of mycotic lesions, whose number is continuously increasing nowadays.

[The morphopathological aspects at autopsy of HIV infection in children]

Aspects of HIV infection and AIDS in childhood have been reported since 1982. Pathological features are due to direct action of HIV, opportunistic infection and some tumoral processes. This report presents our own experience resulted from 27 cases of necropsy of patients diagnosed with AIDS or seropositive for HIV. Emphasize is placed on microscopic changes in different systems and organs (central nervous system, heart, lung, gastrointestinal tract, liver, lymphoid organs, kidney), by comparing our results with those described in literature.

[Carcinosarcoma of the corpus uteri--a case report]

Sarcomas account for fewer than 5% of all cancers of the uterine corpus. We present the last classification of The International Society of Gynecology Pathologists for pure sarcomas and also for mixed epithelial-nonepithelial tumors of the uterine corpus. The paper concerns with the study of a case of carcinosarcoma, treated in the III-rd Clinic of Gynecology from Iaşi. This morphological diagnostic represents the most common epithelial-nonepithelial tumor affecting the uterus. Immunohistochemistry with EMA confirms the theory of the combined tumor with a unique origin.