ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Vol. 46 No. 3, 2005

1. Paraganglioma of the cerebellopontine angle. Case presentation and pathological considerations

Carmen Ardeleanu, L. Danaila, D. Arsene

Paragangliomas (glomus tumors) arise from the extra-adrenal neuroendocrine system. They are benign but locally aggressive tumors, causing bone destruction and compression related symptoms. We present a case of paraganglioma of the cerebellopontine angle. Emphasis on possible difficulties in clinical, imaging or pathological identification, and surgical removal is done. To the best of our knowledge, only one more case was reported arising in the cerebellopontine angle.

Corresponding author: Carmen Ardeleanu, MD, PhD, e-mail: carmena@vbabes.ro

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2. The follow-up of the efficacy of antiviral therapy at patients with chronic hepatitis C

C. C. Vere, Carmen Avramescu, L. Mogoanta, I. Rogoveanu, S. Cazacu, T. Ciurea

Hepatitis C virus infection can cause progressive liver injury and lead to fibrosis and eventually cirrhosis. Peginterferon alfa-2a represents a significant advance in the treatment of patients with chronic hepatitis C. The aim of the study was to investigate the efficacy, safety and tolerability of the therapy with Peginterferon alfa-2a plus Ribavirin in patients with chronic hepatitis C. The study was made on a number of 37 patients with chronic hepatitis C, admitted in Medical Clinic no. 1, Emergency County Hospital Craiova. The diagnosis of chronic hepatitis was established by means of clinical, biological and morphological investigations. Patients received 180 micro-g subcutaneously of Pegasys, once weekly, along with either 1000 or 1200 mg/day of Copegus, depending on their weight, for 48 weeks, with 24 weeks of treatment - free follow-up. We evaluated: sustained virological response, histological response and adverse events. All patients were monitorized using blood tests, control of viremia and liver functional tests. Analysis viral response revealed that 11 patients (29.72%) achieved sustained virological response. Histological response was obtained in 20 cases (54.05%) with chronic hepatitis C. The adverse events for Pegasys and Copegus combination therapy were reported in 21 cases (56.72%). Antiviral therapy had positive effect on subjective symptoms in almost half of patients included in our study. An improvement of liver functional tests was noted in the most cases. A third of patients who received Peginterferon alfa-2a plus Ribavirin had sustained virological response. Histological response was noted both at patients with sustained virological response and with unsustained virological response. The side effects of the antiviral treatment are frequent and the severe ones, which require dose reduction, are present at a low number of patients.

Corresponding author: Cristin Constantin Vere, MD, PhD, e-mail: vere_cristin@yahoo.com

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3. Cytokines levels in prostate adenocarcinomas

Maria Balasoiu, Adriana Turculeanu, Carmen Avramescu, Violeta Comanescu, Cristiana Simionescu, L. Mogoanta

In this research, we determined the levels of IL-2, IL-6 and TNF-alpha at 60 patients with prostate adenocarcinomas situated in II, III and IV stages. The method used was ELISA quantitative. We observed that the IL-2 levels were normal in II stage, and the levels of IL-6 and TNF-alpha were lightly increased. In III and IV stages of prostate cancer, the levels of IL-2 were very low and the levels of IL-6 and TNF-alpha were very increased. The high levels of pro-inflammatory cytokines are correlated with diseases evolution. The decrease of IL-2 levels in advanced prostate cancer goes to the decrease of immune response in prostate cancer.

Corresponding author: Maria Balasoiu, MD, PhD, e-mail: turculeanu_balasoiu@yahoo.com

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4. Histiocytic sarcoma associated with Hodgkin's disease

Elena Doina Murarescu, Rodica Lighezan, D. Negru, Irina Rodica Chiselita, P. Plamadeala, Maria Sultana Mihailovici

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.

Corresponding author: Elena Doina Murarescu, MD, PhD, e-mail: doinamurarescu@yahoo.com

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5. Analysis of stress and displacements of phalanx bone with the finite element method

D. N. Tarnita, Daniela Tarnita, D. Popa, Roxana Tarnita

In this paper analyze of phalanx bone supposed at compression, torsion and bending is made. We know that the bones are one of the most important natural composite materials. The finite element method offers the possibility for the study of the stress and the displacements, which appears in different solicitations cases. We realized that the most solicited parts of the bone which will be the next broken parts, so the fracture are the once from the meeting of the bone's body with its hand. The observations made by studying 74 cases of fractures caused by torsion and compression and also made by the testing of 23 phalanx bones confirm these conclusions.

Corresponding author: Danut Nicolae Tarnita, MD, PhD, e-mail: dtarnita@yahoo.com

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6. Correlations between the colic branches of the mesenteric arteries and the vascular territories of the colon

M. C. Niculescu, V. Niculescu, Iulia-Camelia Ciobanu, Ecaterina Daescu, Adelina Jianu, Alina-Maria Sisu, Codruta-Ileana Petrescu, A. Motoc

The study, done on 100 corpses from the dissection rooms of anatomy laboratory, hinted the morphological variability of the colic arteries and their territories. Morphological variability of the colic branches derived from the mesenteric arteries (superior right colic artery - 98%; middle right colic artery - 88%; inferior right colic artery - 100%; middle colic artery - 36%; superior left colic artery - 100%; middle left colic artery - 50%; inferior left colic artery - 100%) allows us to give out a morphogenetic supposition related their ramification and number. Analyze of the results guide us to a tentative of setting down the vascular territories of the colon. In the beginning were established the territories of the mesenteric arteries (superior and inferior) and after that, were marked the subterritories for each colic artery. Establishing the vascular territories of the colic arteries have not only anatomical importance but also a surgical one, been known the difficult postoperatory colon's revitalization.

Corresponding author: Marius Corneliu Niculescu, MD, PhD, e-mail: niculescu@umft.ro

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7. Morphoclinical study of intracerebral haemorrhage with intraventricular extension

B. Zaharia, I. E. Plesea, C. C. Georgescu, A. Camenita, Claudia Valentina Georgescu, S. D. Enache, Mihaela Tenovici

Aims. The study is an integrated assessment of clinical, imagistic and morphological parameters in severe intracerebral haemorrhages (ICH) complicated with intraventricular extension (IVE). Material and methods. The studied group had 93 cases of patients with ICH and IVE who were hospitalized in the Emergency County Hospital of Craiova and died during hospitalization. The parameters evaluated were clinical (relation with the seasons, age, sex, arterial blood pressure, the motor deficit, degree of coma, Glasgow score at admission and medical care) and morphological (the sites of the intraparenchymal haematoma and IVE, the size of the intraparenchymal haematoma, the presence of the mass effect, perilesional oedema and subarachnoid effusion). The latter were assessed on CT films and during autopsy. Results. The presence of IVE as a complication of ICH showed a predilection for cold seasons, especially autumn. From the 93 studied cases 51 were men and 42, women. 52.6% of the patients were in the fifth and sixth life decade. Almost 80% of the patients had IIIrd stage arterial hypertension at admission, over 80% motor deficits and almost 60% Glasgow scores lower than 6. The ventricular effusion involved at least one of the lateral ventricles. The hematomas had huge dimensions as compared to hosting encephalic structures, in lobar sites involving more than one lobe. Other risk factors as mass effect and perilesional oedema were constantly present. Conclusions. The association of IVE with other independent risk factors such as hypertension, low Glasgow scores volume of intraventricular bleeding, dimensions of haemorrhagic foci, presence of mass effect and perilesional oedema results in the death of patient despite any sustained therapeutic intervention.

Corresponding author: Bogdan Zaharia, MD, PhD, e-mail: zb@umfcv.ro, pathology@umfcv.ro

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8. Electronic microscopic evaluation of the beta insular cells in type 2 diabetes

Olivia Mateescu, Adriana Bold, Daniela Cernea, H. Manolea, Cristina Busuioc, L. Mogoanta

In this work, it has been done an electronic microscopic evaluation of the intra-cytoplasmic organelle devices of the pancreatic beta insular cells in the type 2 diabetes mellitus (insulin independent). The motivation of this study is the lesions noticed within another study, photonic microscopic, reason why we have considered it important to show up as well the interest modifications of the constitutive organelles of the beta insular cells.

Corresponding author: Garofita Olivia Mateescu, MD, PhD, e-mail: garo2963@yahoo.com

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9. Tumoral stroma of salivary pleomorphic adenoma - histopathological, histochemical and immunohistochemical study

Cl. Margaritescu, M. Raica, Cristiana Simionescu, L. Mogoanta, M. Surpateanu, F. Jaubert, Fl. Bogdan

The aims of our paper were to establish the main histopathological, histochemical and immunohistochemical aspects of tumoral stroma from salivary pleomorphic adenomas. For this purpose, we investigated 103 cases by the classical histopathological technique with paraffin embedding and staining with Hematoxylin-Eosin (HE), Hematoxylin-Eosin-Safranin (HES), trichromic Masson, trichromic Goldner Szeckelly, orcein and Periodic Acid Schiff-Blue Alcian (PAS-AA). Immunohistochemically, they were investigated for AE1-AE3, MNF116, CK8, EMA, vimentin, alpha-actin calponin, S-100, GFAP, collagen IV, and PCNA. The results of our study suggest the key role of neoplastic myoepithelial cell in the achievement of diverse morphological aspects of stroma in such neoplasms.

Corresponding author: Claudiu Margaritescu, MD, PhD, e-mail: mclaudiu@umfcv.ro, c_margaritescu@hotmail.com

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10. The role of histological examination for prognostic evaluation and therapeutic algorithm in urinary bladder tumors

Em. Trasca, R. Buzulica, C. Plesan, Iuliana Nicolescu

Pathological examination plays a major role in order to determine the prognostic and therapy of patients with urinary bladder tumors after a prior transurethral resection (TUR). The prognostic factors are studied to identify the risk of recurrence and tumoral progression of patients with superficial urothelial tumors and for appreciate the metastatic potential and response to therapy for patients with invasive carcinoma.

Corresponding author: Emil Trasca, MD, PhD, e-mail: lucianbuzulica@yahoo.com

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11. Uncommon pattern in soft tissues epithelioid sarcoma

Carmen Ardeleanu, Maria Comanescu, Violeta Comanescu, F. Andrei

Epithelioid sarcoma (ES) is a rare tumor, but extremely versatile, simulating easily both clinically and morphologically multiple benign lesions as granulomas and malignant tumors as achromic melanomas or carcinomas. Especially the histological aspects are suggesting for an epithelial tumor. The atypical biological behavior of tumor is conferred by: a propensity for lymph nodes metastases, large dimensions of tumor, unusual localizations. Aim: to report some peculiar histological and immunophenotypic aspects in soft parts epithelioid sarcoma. Materials and methods. We analyzed retrospectively three cases of epithelioid sarcomas with unusual clinico-morphological (large dimensions), histopathological (absence of necrosis) and immunohistochemical (IHC) patterns selected from 200 consecutive soft parts malignant tumors of "Victor Babes" National Institute Bucharest files. For the immunohistochemical (IHC) staining, the following antibodies were used: vimentin, EMA, cytokeratins (KL1, CK19), S-100 protein, CD68, p53 protein, vascular markers (CD31, CD34, FVIII-related antigen), HMB45, MELAN A. Results. The tumors had unusually large dimensions, the absence of necrosis, a vaguely alveolar pattern; the IHC staining showed a strong positivity of S-100 protein, a variable expression of cytokeratins KL1 and CK19, in association to a scarce positivity for EMA, zonal positivity for CD34 and diffuse reaction for vimentin. Conclusion. The immunophenotype of ES may have a large variability and the correlation to clinico-morphological aspects is necessary for a good diagnostic assessment.

Corresponding author: Carmen Ardeleanu, MD, PhD, e-mail: carmena@vbabes.ro

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12. Giant keratoacanthoma of the hand

H. Parvanescu, L. Mogoanta, Camelia Foarfa, M. Ciurea, A. Georgescu, Corina Nicolae

Giant keratoacanthoma (KA) is a very rare tumor, which benefits of surgical treatment. We present a case of 61-year-old man with a giant keratoacanthoma situated on the dorsum of the right hand. The diagnosis is established by routine histopathologic examination.

Corresponding author: Horia Parvanescu, MD, PhD, e-mail: horia_parvanescu@yahoo.com

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13. Pseudo-tumoral lesions of the cervix

Cristiana Simionescu, Cl. Margaritescu, Claudia Valentina Georgescu, L. Mogoanta, Alis Magda Marinescu

Pseudo-tumoral lesions of the cervix implies some reactive, non-neoplastic changes (metaplasia, hyperplasia, inflammation) that, occasionally, are wrong interpreted as precancerous or malign lesions. Even some can present architectural or cytological abnormal aspects, these are different from the one noted in carcinomas or the precursor lesions of carcinomas. Them recognition is indispensable in order to avoid the diagnose errors and the super evaluation of these benign lesions.

Corresponding author: Cristiana Simionescu, MD, PhD, e-mail: csimionescu2004@yahoo.com

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14. Study of cerebral vascular structures in hypertensive intracerebral haemorrhage

I. E. Plesea, A. Camenita, C. C. Georgescu, S. D. Enache, B. Zaharia, Claudia Valentina Georgescu, Mihaela Tenovici

Aims. The study was performed in order to assess the alterations of extraparenchymal and intraparenchymal vascular structures in 82 hypertensive patients suspected of primary intraparenchymal hematoma, which died and were autopsied in order to confirm the diagnosis. Material and methods. The studied material consisted of nervous tissue situated near and distant from the haemorrhagic lesion. The specimens of nervous tissue were processed by the classical histological technique and stained with the usual stainings and with immunohistochemical stains for basement membranes and endothelial cells. Results. Extraparenchymal arteries showed classic lesions of atherosclerosis. Atheromatous lesions were of all types, even the extension towards the media being encountered a complication with thrombosis. At the level of the intraparenchymal blood vessels, the spectrum of the lesions due to arterial hypertension included all steps of vascular wall degeneration, from hypertrophy of smooth muscle layer to complete hyalinization of arterial wall, but with a focal irregular distribution, not related with the proximity of haemorrhagic focus. High arterial blood pressure also influenced the capillary walls, which showed focal or circumferential thickening due to the densification of the type IV collagen material from the basement membrane structure. The CD34 immunostaining showed that endothelial cells kept their structural integrity. Conclusions. The sequence of degenerative lesions of the cerebral vascular wall culminates with the hyalinization of excessive fibrillar material form arteriolar wall or from basement membranes. Hyalin material is weakening the wall resistance to the stress determined by the high values of blood pressure in hypertension, and, correlated with a minimal resistance of the surrounding cerebral parenchyma, can explain why the cerebral parenchyma is the only tissue in which blood pressure variations can determinate vascular rupture and cerebral haemorrhage. The more adequate term for describing the vascular wall changes seems to be sclerosis (arteriolar and even capillary) with hyalinosis.

Corresponding author: Iancu Emil Plesea, MD, PhD, e-mail: emp@umfcv.ro, pathology@umfcv.ro

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15. In memoriam of Professor A. G. E. Pearse (1916-2003)

I. Radu, Doina Onicescu

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Corresponding author: -

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