ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Vol. 47 No. 4, 2006

1. Immunohistochemical expression of VEGF in normal human renal parenchyma

Flavia Baderca, Rodica Lighezan, Alis Dema, Aurora Alexa, M. Raica

In the normal kidney, VEGF is constitutively expressed in podocytes and tubular epithelial cells of the renal cortex and medulla. The aim of this study was to determine distribution of VEGF in normal renal parenchyma using immunohistochemical methods. The study was retrospective, using normal kidneys samples taken from 28 patients with nephroureterectomy for different types of renal cell carcinomas. Sections were stained with routine Hematoxylin-Eosin method and immunohistochemically with anti-VEGF polyclonal antibody. All cases presented an intense immunoreaction in the cells lining the nephron tubular system, the higher immunoreaction intensity in the collecting and distal tubules, but weak or moderate in the proximal tubules. The Henle loop cells showed a negative immunoreaction. The immunoreaction was absent in most cells of the renal corpuscle. The cells lining the same tubule presented some variation of intensity, with large polygonal epithelial cells, bulging in the tubular lumen showing an intense cytoplasmic immunoreaction for VEGF. In the renal parenchyma adjacent to the tumor, we observed the same pattern of positive reaction distribution as in the nephron's epithelial tubular cells situated far from the tumor. Adjacent to the tumor proliferation front and in those cases with massive invasive features, we observed a partial depletion of VEGF in distal tubules, while the majority of collecting ducts remained intense positive. The VEGF immunostaining was significantly higher in the renal cortex than in the outer and respectively the inner medulla.

Corresponding author: Flavia Baderca, MD, PhD, e-mail: flaviabaderca@yahoo.com

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2. Morphometric parameters and silver stain used in diagnosis of thyroid follicular diseases

Delia Ciobanu, Irina-Draga Căruntu, Carmen Vulpoi, Niculina Florea, Simona-Elisa Giuşcă

Fine-needle aspiration biopsy (FNAB) of the thyroid is limited in distinguishing hyperplastic nodular goiter from true follicular neoplasm and in separating follicular adenoma from follicular carcinoma. The present study was done to evaluate if the morphologic and morphometric investigations and silver staining of nucleolar organizer regions (NORs), either alone or in association would help to differentiate the thyroid follicular diseases. Forty FNAB smears of thyroid follicular diseases, histopathologically diagnosed as nodular goiter, lymphocytic thyroiditis, follicular adenoma and follicular carcinoma, were analyzed using the standard cytological exam, quantitative analysis and NORs assessment. The qualitative evaluation, correlated with the numerical results obtained from the quantitative analysis, revealed that the cellular pattern, mean nuclear diameter and NORs area are valuable criteria in the diagnosis of the benign and malign follicular lesions, respectively. The results attained through morphometry increase the sensibility and the specificity of FNAB in the diagnosis of thyroid follicular carcinomas.

Corresponding author: Delia Ciobanu, MD, PhD, e-mail: deliaku@yahoo.com

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3. Prognostic significance and detection of the Internal Tandem Duplication of the FLT3 gene in acute myeloid leukemia

Eva Gagyi, Emoke Horváth, C. Bödör, B. Timár, A. Matolcsy, Z. Pávai

The FMS-like tyrosine kinase-3 (FLT3), which belongs to the class III receptor tyrosine kinase family, expressed by immature hematopoietic cells, plays an important role in the proliferation, differentiation and survival of stem cells. The activating mutations of FLT3 gene have been reported to be of prognostic significance. The most common somatic alteration of the FLT3 gene is the Internal Tandem Duplication (FLT3/ITD), which is caused by the elongation of the juxtamembrane (JM) domain of FLT3. The duplicated fragment size varies from three to more than 400 base pair, always occurs in multiples of three while the reading frame is preserved. The elongated segment of DNA can be amplified by polymerase chain reaction (PCR), and the products are separated by gel electrophoresis. The FLT3/ITD is found in 20-40% of adult AML patients and is the most frequent mutation in leukemia. Using native peripheral blood and bone marrow from AML and non-AML patients (total of 19 samples), and samples from the RNA bank (total of eight samples), the authors purpose was to work out a method for FLT3/ITD detection, which can be used in routine diagnostics. All samples produced detectable PCR products, which proofs that this procedure can be used for the detection of FLT3/ITD mutations in daily clinical practice.

Corresponding author: Emoke Horváth, MD, PhD, e-mail: horvath_emoke@yahoo.com

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4. The virtual model of the prosthetic tibial components

Daniela Tarniță, D. Popa, D. N. Tarniță, D. Grecu, M. Negru

The paper presents a method of study and the steps to obtain the virtual tibial component of the human knee joint prosthesis. For that purpose, CAD parametric software was used which allows the construction of a high definition model. The obtained 3D model was studied using the finite element method and the stress and displacements distribution was obtained for different solicitations of the prosthetic and non-prosthetic tibial component of the virtual knee joint.

Corresponding author: Daniela Tarniță, Eng, PhD, e-mail: dtarnita@yahoo.com

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5. Cerebellar atrophy - a comparative microscopic study

Emma Gheorghe, S. Vameşu, V. Tomuta, Mihaela Hîncu, T. Mehedinți, G. Nicola

The cerebellum is required for the coordination of fine movement. In health, it provides corrections during motion, which are the basis for precision and accuracy, and it is critically involved in motor learning and reflex modification. Disease of the cerebellum or its connections leads to incoordination. The study puts forth the morphometric study of cerebellum cortex and of the modifications that occur at this level during cerebellar atrophy. Our research used routine histological methods, but also special methods, adequate to the studied cerebellar cortex (silver impregnation), in order to observe the characteristic structures of the organ. We used comparative morphometric methods in order to gather data about the structural changes that occur in the cerebellar cortex during cerebellar atrophy. In order to analyze the histological modifications we determined the following parameters: thickness of the cerebellar cortex - is a derived feature appropriate for elongated or thin structures, area fraction of the molecular layer in the cerebellar cortex, number of Purkinje neurons per microscopic field and area fraction of the blood vessels per microscopic field. The reference microscopic field has an area of 280.000 µm2. Observations and conclusions that arose from this study may represent a contribution to the theoretical knowledge on which the medical practice is based.

Corresponding author: Emma Gheorghe, MD, PhD, e-mail: gheorghe_emma@yahoo.com

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6. Value of antimesothelioma HBME-1 in the diagnosis of inflammatory and malignant pleural effusions

Liliana Mocanu, Anca Maria Cîmpean, M. Raica

Pleural effusions occur in many benign and malignant conditions. The differentiation of mesothelial hyperplasia, malignant epithelial mesothelioma and metastatic adenocarcinoma in cytologic specimens is often difficult. Because many immunohistochemical studies had suggested that HBME-1 has a high sensibility but a low specificity for mesothelial differentiation, the authors investigate its utility in cytological specimens. In this study, immunostaining was performed on 30 smears from seven patients with inflammatory pleural effusions, 21 patients with metastatic pleural effusions and two patiens with malignant epithelial mesothelioma. Two independent observers evaluated the immunoreactivity. Benign mesothelial cells expressed HBME-1 in 13 (46.43%) cases with thick and thin membrane pattern and with thin membrane and cytoplasmic pattern in 11 (39.29%) cases. One of the malignant mesothelioma was positive for HBME-1 with thick and thin membrane pattern. Metastatic tumor cells were positive for HBME-1 in seven (33.33%) cases; the staining pattern in metastatic adenocarcinoma cells was thin membrane and focal cytoplasmic. HBME-1 has a moderate sensibility and specificity for mesothelial cells and can be used as part of a panel for differentiation of malignant and reactive mesothelial cells from adenocarcinoma in pleural effusions.

Corresponding author: Liliana Mocanu, MD, PhD candidate, e-mail: lcmocanu@yahoo.co.uk

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7. Non-Hodgkin Malignant Lymphoma study - admitted cases during 1990-2005 in Ophthalmologic Clinical Department, Oradea

Mihaela Coroi, Elena Roşca, Gabriela Muțiu, Ligia Burtă, Viorica Todor, T. Coroi, D. Roşca

Non-Hodgkin Malignant Lymphomas are rare tumors, difficult to be diagnosed. We have made a clinical and paraclinical retrospective study, along 15 years (1990-2005), estimating the moment of onset, clinical and anatomo-pathological features, in each of the 11 cases.

Corresponding author: Mihaela Coroi, MD, PhD, e-mail: opticlar@gmail.com, opticlar@rdslink.ro

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8. Former and present aspects in upper level of viscero-skull architecture

M. C. Niculescu, V. Niculescu, Adelina Jianu, Iulia-Camelia Ciobanu, A. Motoc

The classical reference material describes two resistance arcs, the maxillary arc and the mandibulary arc, from which the masticatory forces direct themselves towards the functional resistance structures of the viscero-skull. From the maxillary arc, three pairs of vertical pillars ascend (that is fronto-nasal, zygomatic and pterygoid). Certain authors add to these a median arc - the bony part of the nasal septum. From the mandibulary arc, the lines of force make for the cordyle and the coronoid process of the mandible. In terms of the new outlook, at the upper level of the viscero-skull, there are five vertical blades described: one median, two medial and two lateral, those last including the pillars from the classical descriptions. These vertical blades are joined by three horizontal laminae: the upper one, the middle one - interrupted by the median line and the lower one - included in the concavity of the maxillary arc. These structures of laminae induce the formation of some resistance cylinders and cones. Within the lower level of the viscero-skull there are three mandibulary arcs described: the upper one (the classic mandibulary arc), the middle one (with an oblique direction) and the lower one.

Corresponding author: Marius Corneliu Niculescu, MD, PhD, e-mail: niculescu.virgil@gmail.com

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9. Ellis-van Creveld syndrome

Corina Lichiardopol, C. Militaru

Ellis-van Creveld syndrome is a rare autosomal recessive disorder caused by mutations in the EVC and EVC2 gene (4p16), characterized by chondrodystrophy, postaxial polydactyly, ectodermal dysplasia and cardiac anomalies. We present the case of a 24-year-old female patient with unaffected parents and an affected sister, with a personal history of surgically corrected postaxial polydactyly of both hands and atriventricular canal. Clinical features were: a marked acromesomelic short stature (135 cm height), narrow thorax, genu valgum, club feet, brachydactyly, malposed toes, hypoplastic nails and teeth, diffuse alopecia, atrioventricular canal, hypoplastic mammary glands and a small goiter. Radiologic evaluation revealed short metacarpals and phalanges, capitat and hamat fusion on the left, left ulnar epiphysis with areas of osteolysis and osteocondensation, genu valgum, short fibulae, narrow thorax, cardiac enlargement with hilar congestion. Echocardiogram showed absence of the atrial sept and the basal portion of the ventricular sept and electrocardiogram - right bundle branch block, left anterior fascicular block and left ventricular hypertrophy. Free thyroxin, TSH and usual laboratory parameters were in the normal range with exception of ionic calcium which was low (3.8 mg/dL).

Corresponding author: Corina Lichiardopol, MD, PhD, e-mail: corinalich@gmail.com

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10. Skull base tumor invading both cavernous sinuses. Adenoid cystic carcinoma mimicking a meningioma

D. Arsene, Carmen Ardeleanu, L. Dănăilă

We present a case of an anterior skull base tumor invading both cavernous sinuses and extending into the right orbit in a 55-year-old female. The radiological aspect was confusing, being highly suggestive for an extensively invasive meningioma. However, the orbital portion of the tumor, which was surgically removed, proved to be an adenoid cystic carcinoma. Some peculiar immunohistochemical findings were obvious, as well as a lack of continuity of the tumor with the local lachrymal gland. This is an unusual situation, when a lachrymal gland tumor spread along the cavernous sinus, cross the midline and approaches the contralateral orbit. Such local extension should be considered in the differential diagnosis of anterior skull base tumors.

Corresponding author: Dorel Arsene, MD, PhD, e-mail: dorelarsene@yahoo.com, dorelarsene890@hotmail.com

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11. Lymphangioma of the oral cavity

Ligia Stănescu, E. F. Georgescu, Cristiana Simionescu, Iuliana Georgescu

Lymphangiomas are uncommon congenital hamartomas of the lymphatic system, usually diagnosed in infancy and early childhood. Commonly located at head and neck, they are rarely situated in the oral cavity. Preferred site of oral involvement is the tongue. In the absence of proper therapy, lymphangiomas of the tongue are extremely recurrent, leading to serious complications such as hemorrhage or obstruction of the upper respiratory airways. The authors present the case of eleven years old boy with pseudo-vesicles, and smooth, glossy lesions on the tongue, and a red prominent pulsative sublingual mass located at the base of the tongue. Both the macroscopic structure and the histological aspect sustain the diagnosis of lymphangioma. CT established that is a profound lymphangioma with a narrow communication with the superficial planes. Conclusions. Though rarely met in the oral cavity, lymphangiomas are an eventuality to take into consideration by the clinician. Early recognition is of utmost importance to initiation of proper treatment, and avoiding serious complication.

Corresponding author: Ligia Stănescu, MD, PhD, e-mail: ligstanescu@yahoo.com

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12. Classical testicular seminoma in young man

F. Voinea, S. Vameşu, Mariana Deacu, Mariana Aşchie, I. Poinăreanu

A 29-year-old man was admitted in Urology Department of County Hospital of Constanta for left testicular increased size in last six months, without other symptoms. Testicular tumor was palpated and visualized by ultrasound. Computed tomography did not revealed metastatic lymph nodes. Beta-human chorionic gonadotropin and alpha-fetoprotein were within the normal range. We diagnosed the case as a left testicular tumor and performed high orchiectomy. Histological examination revealed typical seminoma. Subsequently, the patient was given two courses of systemic chemotherapy (bleomycin, etoposide, cisplatin) as an adjuvant therapy. The patient has remained free of disease six months after discharge.

Corresponding author: Felix Voinea, MD, PhD, e-mail: felix.voinea@yahoo.com

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