Differential diagnosis difficulties related to infantile hemangioma - case report and literature review

Infantile hemangioma is a benign vascular tumor that is often present in the cephalic region and can grow rapidly in size, causing serious complications. The hemangioma with oro-maxillofacial sphere localization may often pose differential diagnosis problems, requiring additional investigations. We present the case of a 3-month-old baby who was brought to the Emergency Room for acute respiratory failure and dysphagia caused by the rapid increase in size of a soft palate and lateral pharyngeal wall tumor. The clinical examination revealed a "wine stain" hemangioma in the inter-eyebrow and frontal areas, a hemangioma in the right genial area, 1∕1.5 cm in diameter, growing rather in depth than on the surface, and a purplish-blue tumoral mass with irregular edges, grown in the soft palate and in the right lateral wall of the pharynx, which impaired both eating and breathing. Obstructive phenomena have been aggravated by an acute respiratory infection. Due to the inconsistencies between different medical specialties about the nature of the tumor and the suspicion of malignancy, in order to establish the correct diagnosis and therapeutic management, urgent tumor biopsy was required. After starting oral treatment with Propranolol, the evolution was favorable. Infantile hemangiomas may sometimes be hard to diagnose, requiring additional imaging examinations, and sometimes-pathological examination. Since it may affect a vital function, or the patient's esthetic appearance, or if the tumor has ulcerated, bleeds or got infected, the certain diagnosis and the onset of treatment should be done as soon as possible.

Clinical, imaging and histopathological correlations of gingival overgrowth: a retrospective analysis in northeastern Romanian population

BACKGROUND

Gingival overgrowth refers to an increase in the size of the gingival tissue. The etiology varies, and is often a multi-factor issue; what may contribute to gingival enlargement are aspects, such as disease, local and systemic conditions and idiopathic factors. The aim of the present study is to analyze and to correlate the clinical, epidemiological, imaging and histopathological (HP) features of gingival overgrowth in northeastern Romanian population.

PATIENTS, MATERIALS AND METHODS

We conducted a clinical, imaging, and pathological study on 98 patients with gingival overgrowth, who underwent a surgical intervention for a gingival biopsy in the Office of Oral and Maxillofacial Surgery, "Prof. Dr. Nicolae Oblu" Emergency Clinical Hospital, Iaşi, Romania, during a 14-month period (January 1, 2018 to February 28, 2019). All patients with localized gingival overgrowth had clinical and imaging investigations done and then were referred to an oral and maxillofacial facility. A surgeon performed the excision of the gingival overgrowth and then sent the surgical specimens to the Laboratory of Pathology for HP examination.

RESULTS

Local inflammation was found responsible for the gingival overgrowth in most of the cases, with the number of females outnumbering that of the males. A very good correlation was found between clinical and HP diagnosis when epithelial hyperplasia, peripheral giant cell granuloma and pyogenic granuloma were involved and a moderate one when fibrous hyperplasia was involved.

CONCLUSIONS

These findings suggest that the occurrence of gingival overgrowth can have many causes, which highlights the importance of clinical pathology in assisting practitioners with making a better diagnosis.

Borderline ovarian cyst treated by laparoscopic surgery: clinical case report and literature review

Borderline ovarian serous tumors are a rare distinct category of epithelial ovarian tumors, distinguished from both benign and invasive ovarian tumors. As borderline ovarian cysts are only a small part of the gynecological conditions of children, the therapeutic approach to this special type of tumor has not been standardized yet. Despite the technological breakthroughs that we have witnessed lately, the positive diagnosis of ovarian tumors is possible only by surgery and histopathological examination, and laparoscopic surgery has become the golden standard in the management of this condition. The aim of this case report is to demonstrate a very good long-term evolution after minimal invasive treatment and minimal damage to the reproductive apparatus in children with borderline ovarian tumors. The case reported in this paper is that of a 17-year-old adolescent with borderline serous papilliferous cystadenoma diagnosed by ultrasound and computed tomography (CT) scanning, whose CA-125 biomarker had normal values. As the purpose was to preserve the patient's reproductive function, we chose to remove and excise the cyst by laparoscopic surgery, without removing the ovaries. The patient's subsequent evolution was positive and at 19-year-old, she gave natural birth to a healthy baby girl. Nevertheless, as relapses are possible after many years, the patient's long-term monitoring is necessary.

Influence of montelukast on cisplatin-induced experimental acute renal failure

AIM

To investigate the influence of Montelukast (MK) in acute renal failure (ARF) experimentally induced by cisplatin (CIS).

MATERIAL AND METHODS

The experiment was carried out in male Wistar rats (280-320g), divided into 4 groups of 12 animals each, treated as follows: Group I (Control); Group II (CIS): CIS, 5 mg/kbw, single dose, i.p.; Group III (CISMK): CIS, 5 mg/kbw, single dose, i.p and MK 2 mg/kbw, p.o., 10 days; Group IV (MK): MK 2 mg/kbw, p.o., 10 days. Blood and urine (24 h) samples were taken before the start of experiment (Io) and at 3, 7, 10 and 14 days after CIS administration. The following were determined: urea, creatinine, Ca, Mg serum levels and creatinine, proteins, Ca and Mg urinary levels. For histological evaluation, 3 rats of each group were sacrificed at 3, 7, 10 and 14 days. The severity of histopathological changes was evaluated using scores on a 1-4 point scale.

RESULTS

Both in CIS and CISMK group, serum levels of urea and creatinine and urinary protein levels were significantly higher compared with Io values and control group at 3 and 7 days, (p < 0.01 and p < 0.05, respectively). Urinary creatinine levels were significantly decreased at 3 and 7 days, (p < 0.01) and (p < 0.05) in CIS and CISMK group compared to Io and control group. The degree of severity of histopathological changes was similar in CIS and CISMK group.

CONCLUSIONS

The obtained results showed that MK at a dose of 2 mg/kbw had no protective effect in CIS-induced experimental acute renal failure.

Plurimalformative syndrome associating trisomy 18 and omphalocele. Case report and review of the literature

Trisomy 18 or Edwards syndrome is a rare chromosomal anomaly, associated with mild to severe intellectual disabilities and multiple congenital anomalies. Trisomies 18 and 13 are lethal, only 5-10% of patients surviving the first year of life. Although prenatal biological and ultrasound investigations are mandatory and free and the detection rate of chromosomal abnormalities is high, the birth of children with no real chance at a normal life being thus avoided by therapeutic abortion, the parents of the here presented child did not benefit from medical examination or prenatal tests, unfortunately the case of many families in Romania. The policy of limiting medical intervention in newborns with Edwards syndrome due to the broad spectrum of severe congenital malformations, severe mental retard and reduced life expectancy is unanimously accepted, but yet difficult to apply from an ethical point of view. That is why very important for both healthcare providers and families to have accurate and detailed knowledge of survival, disease course, and quality of life so that they can make fully informed decisions regarding care of these babies. The particularity of this case is the association of multiple congenital anomalies in a male newborn with trisomy 18, almost all apparata and systems being affected, with the presence of an omphalocele and complete right labiopalatine cleft, which are less frequent at children with trisomy 18.

Vascular endothelial growth factor (VEGF) expression in the lung in toxic septic shock

INTRODUCTION

The need for reasoning with medical evidence the different types of shock, especially when there are medical and legal implications, has determined the search of biological markers of the shock. In the case of toxic septic shock, the most important markers to be used are: the cytokines, the tumor necrosis factor-alpha (TNF-alpha) and interleukin 6 (IL-6), procalcitonin, lactoferin and the vascular endothelial growth factor (VEGF). VEGF has an essential role in angiogenesis and vascular permeability.

MATERIALS AND METHODS

In our study group, we included 30 cases of different types of shock in which we studied the VEGF expression in the lungs. We added also 10 fragments of lung as control group. According to the etiology, the 30 cases of shock were: 15 with a toxic septic shock and 15 with a hemorrhagic shock. In all these cases we used the classical Hematoxylin and Eosin staining method and the immunohistochemical reactions for VEGF-A. Statistical analysis was performed using SPSS 13.0.

RESULTS

The VEGF expression was decreased in all the cases of toxic septic shock, in the endothelium and also in the alveolar epithelium, compared to a high level of expression in other cases of shock and in the control lung.

CONCLUSIONS

These data allow us to appreciate that VEGF has a different expression in different types of shock and in the normal lung. We observed a statistically significant difference between VEGF expression in toxic septic shock and hemorrhagic shock (p=0.000001). There is a similarity of VEGF expression between hemorrhagic shock and the control lungs (p=0.00001). An obviously low VEGF expression in the toxic septic shock represents a useful biological marker in the forensic medical cases.

[Epidemiological data on shock in forensic medicine]

The shock is a relative frequent diagnostic in forensic medicine.

MATERIAL AND METHOD

We realized a statistical study, using 323 deaths through diverse shock typology, registered within the Forensic Medicine Institute of Iaşi in 2000-2009. The concerned variables were: the spread of cases on years, the clinical forms, age, sex, provenience environment, volemic feature, the survival time from the shock to the death, the spread of complications on the form of the shock and survival, the juridical way of death. Our data were introduced in the EXCEL database and statisticaly analyzed by SPSS program.

RESULTS

We obtained statistic data on shock typology, based on the survival time and based on the complications of shock types.

CONCLUSION

Relevant statistic data were obtained on the relations between the factors that generated the shock, the complications induced and the shock types, related also to the juridical way of death.

[Posterior fossa meningiomas--topographic and anatomopathologic aspects]

Meningiomas are the most frequent met intracranial tumors. Many authors tried to order them according to location, origin and histopathologic type.

MATERIAL AND METHOD

Our study is focused on posterior fosa meningiomas, initially classified according to their origin based on IRM and surgical findings in order to identify correlations between demographic data, topographic tumor origin and anatomopathologic characteristics for each subgroup. 35 posterior fosa meningioma patients that have been subject to neurosurgery in Iaşi "Prof.Dr. N. Oblu" Hospital Neurosurgery Clinic between January 1st 2005 and December 1st 2009 were assessed.

RESULTS

In our study group the majority of patients were females, with an average age in their early 60's. Benign meningiomas (1st degree) represented the unique subtype in tumors located in cerebellum convexity and foramen magnum. Other locations have different characteristic subtypes (fibrous vs. angiomatous meningioma).

[Children's Langerhans cell histiocytosis, diagnostic problems]

Langerhans cell histiocytosis is a group of idiopathic disorders characterized by the proliferation of cells of the mononuclear phagocyte system and the dendritic cell system. From the clinical point of view there are 3 forms of histiocytosis encountered in child pathology: acute, disseminated called Abt-Letterer-Siwe (it usually affects children under 2 years of age), eosinophilic granuloma and the intermediate clinical form called Hand-Schuller-Christian disease. We present the case of a premature born child that had, even from the day she was born, a rash disseminated on the entire surface of the body associated with enlarged lymph nodes, hepatosplenomegaly and thrombocytopenia. The diagnosis of Langerhans cell Histiocytosis is difficult to establish and this case is an example that confirms it. Therefore, we present the difficulties in diagnosing this case and its particular evolution.

Immunoproliferative small intestinal disease versus colonic monoblastic sarcoma in a 2-year-old boy

The authors present a case of colonic monoblastic sarcoma, previously treated for other digestive abnormalities (malabsorbtion, Hirschprung's disease). Important similitudes with immunoproliferative small intestinal disease (IPSID) lymphoma were demonstrated for this patient (male, 2-year-old). His main admission complaints were failure to thrive, recurrent episodes of enterocolitis and malabsorbtion syndrome. Some particularities of this case are the young age and the extremely rapid development of the malignant disease in a patient with no previous signs of acute non-lymphoblastic leukemia. The initial diagnosis was of malabsorbtion syndrome, based on the clinical exam at presentation, and then the patient was thought to have a form of Hirschprung's disease, due to a functional intestinal disorder (slow transit). After the necropsy, pathologists diagnosed an immunoproliferative small intestinal disease, and four years later, they performed a more appropriate pathological exam, which explained better clinical symptoms associated to this complex case.

[New methods in cancer research--tissue microarray]

Cancer research advances imperiously requested for a new reliable method for biomarker tissue localization study, with standardized experimental conditions, reproducible, fast and at low-prices. Tissue Microarrays technique is the most important discovery in histopathology techniques in the last decade. It mainly consists in bringing and precisely organizing in a single paraffin block of hundreds of micro-cylinders from different blocks. Sections from this new block may be processed using almost all analyses (immunohistochemistry, in situ hybridization). The clear sightedness of those who developed this technique is proved by its rapid acceptance and integration in basic research, prognostic factors oncology and drugs discovery, reflected in hundreds of publications.

Histiocytic sarcoma associated with Hodgkin's disease

Histiocytic sarcoma is a rare malignant neoplasm. It is well-known the association of Langerhans' cell histiocytosis with Hodgkin's disease but only few cases of histiocytic sarcoma associated with Hodgkin's disease was reported. We present the case of 20-years-old female patient with Hodgkin's disease with a sternal tumor mass which was diagnosed as histiocytic sarcoma. The diagnostic was established immunohistochemically, using a large battery of antibodies (S-100, CD 68, CD 34, CD 15, CD 30, Vim, NFAP) and by electron microscopy which revealed the lack of the Birbeck granules in the malignant proliferated histiocytes.

[Prognostic markers in gastric neuro-endocrine carcinoma]

Gastric endocrine tumors show a wide spectrum of clinical pathologic features. Behaviour prognostic evaluation of these tumors is difficult. The aim of this report is to present a rare case of a neuroendocrine carcinoma with multiple locations in stomach.

METHODS

A 62 years female patient underwent a resection of stomach for a tumor. The paraffin-embedded sections of 12 blocks were studied by histological and immunohistochemical methods including HE, van Gieson, Grimelius, chromogranin A, cytokeratin, neuron-specific enolase, vimentin, desmin, smooth muscle actin, Ki-67 antigen, protein S-100.

RESULTS

Histological pattern was similar in primary tumor (mucosa and submucosa) and sessile lesion at distance, where it affected only mucosa. Histopathologically, these tumors show a sheet of round to spindle and polyhedral neoplastic cells with hyperchromatic nuclei, considerable mitotic activity. Immunohistochemically, the neoplastic cells were positive for cytokeratin and neuron-specific enolase and a high Ki-67 labelling index. The three lymph nodes from five had metastasis.

CONCLUSION

The IHC reactions were needed for diagnosis of multiple neuroendocrine carcinomas with lymph node metastasis. These histological and immunohistochemical criteria were very important for the identification of tumors with the aggressive evolution.

[Urokinase-type plasminogen activator (uPA) and its inhibitor--new prognostic factors in oral squamous cell carcinoma]

Several cell biological studies have shown that the invasiveness of different malignant tumors (breast, renal, prostate, gastric, ovarian cancers) depends at least in part on the urokinase type plasminogen activator (uPA) and its inhibitor PAI1. uPA converts plasminogen into plasmin. Plasmin degrades tumor matrix components and starts invasion and metastasis. Our target was to see the possible prognostic relevance of the tumor-associated proteolytic factors and to compare with tumor size, nodal status and grading. Our results suggest that the invasive and metastatic potential of squamous cell carcinoma is correlated with overexpression of uPA and PAI1.

[Limitations in the histopathologic diagnosis and prognosis of neuroblastoma]

Neuroblastoma is the most common nonhematopoietic solid tumor of childhood and has been intensively studied for at least 4 decades. Despite this, few predictive histopathologic clues to its behavior exist. Ages, anatomic sites of occurrence, histopathology of the tumor and clinical stage have traditionally been the only reliable prognostic factors in this disease. In the present study we analyzed these prognostic factors in 72 neuroblastic tumors and our histopathological possibilities of diagnosis.

[Relevance of histopathologic diagnosis in amelogenesis imperfecta]

The aim of the study was the determination of the correlation between the morphostructural aspects of the enamel defects and the clinical diagnostic and the nosologic kinds of these diseases. The research was made on 600 children from Iassy between 7-11 years old, who were examined in natural light. The index used for the systematization of the data was EDS. We used 21 temporary teeth and we examined these teeth on an optic microscope. The study show that there is no absolute correlation between the morphostructural aspects of the enamel defects and the clinical aspects of the lesions, and the clinical defect may not be always associate to the dysplasia from the imperfect amelogenesis.

[Endometrial carcinoma in situ. Morphological and immunohistochemical aspects]

A possible precursor for invasive endometrial carcinoma is an in situ stage, but this notion is very much debated. We present a case of endometrial carcinoma diagnosed in a patient with post-menopausal bleeding. The morphological examination of the hysterectomy specimen, processed by routine technique, put in evidence focal atypias of the glandular epithelium in a group of few endometrial glands, on a background of atrophy without a desmoplastic stromal reaction. The immunohistochemical investigation of the steroid receptors and p53 protein, using monoclonal antibodies in the ABC technique, revealed the p53 positivity and the absence of the receptors in the focal malignant areas. The surface epithelium had the same immunohistochemical aspect. These aspects were decisive in precising that the malignant change was primarily in the surface epithelium with secondary extension in some glands, the final diagnosis being in situ serous papillary carcinoma.

[Morphological study of osteosarcomas in children]

Osteosarcoma is the most frequent primary osteal tumor in children. Our study evaluates morphological aspects of osteosarcomas during last 20 years. We present the results of study that includes 32 cases of classical osteosarcomas that had been diagnosed and treated at the "Sf. Maria" Hospital from Iasi (Romania). The diagnosis is based on usually histopathological methods applied to bioptic and surgical exeresis pieces. Male sex is most involved (56%). Patients' age is between 12-15 years in 68% of total cases. In 50% cases the tumour was localized in distal femoral metaphysis. Histological forms were: osteoblastic (66%), chondroblastic (18%), fibroblastic (16%). Enneking's staging was: II A (6.25%), II B (81.25%), and III (12.5%). Metastasis appeared in 75% cases' evolution. Concluding, 25% of studied patients had a favourable evolution during a 5 years period. Survival rate at 2 years was 39%.

[The causes of gingival overgrowth]

Gingival overgrowth includes a series of diseases with many clinical appearances. The pathological mechanisms being obscure there were used many terms for defining it. Thus, "gingival hyperplasia" and "gingival hypertrophy" were the definitions used to define this pathology. Therefore, the term of "gingival overgrowth" replaced in last decades the above two terms. This article have the goal of trying a classification of the entities forming the large family of gingival overgrowth.