ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Vol. 49 No. 4, 2008

1. Proper detection of the nuclear shape: ways and significance

G. Bussolati

Shape and size of the nucleus, coupled with changes in chromatin amount and distribution, still remain the basic microscopic criteria for cytological diagnoses. Diagnostic recognition of the nuclear shape in pathological histology and cytology has been always based on the assumption that it is the content in nucleic acids, which determines the nuclear shape. The present review challenges this opinion, focuses on the structure, and functions of the nuclear envelope and on how these features can be exploited in diagnostic pathology. In particular, we will present the contribution of three-dimensional modeling to the understanding of nuclear irregularities in breast cancer and papillary thyroid carcinomas. Specifically, it will be shown how tagging the nuclear membrane with anti-Emerin antibodies can represent an additional and valuable tool in the differential diagnosis of thyroid lesions. Finally, the prognostic importance of detecting irregularities of the nuclear shape in breast carcinomas by immunofluorescence staining for nuclear proteins will be discussed.

Corresponding author: Gianni Bussolati, MD, PhD, e-mail: gianni.bussolati@unito.it

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2. Isolation and characterization of stem cells from the placenta and the umbilical cord

Carmen Mihaela Mihu, D. Mihu, N. Costin, D. Rus Ciucă, S. Şusman, R. Ciortea

In addition to its essential role in the development, nutrition and immunological tolerance of the product of conception, human placenta is an important source of stem cells. Over the past years, scientific research has been aimed at isolating and characterizing mesenchymal cells and amniocytes, which show a high plasticity and are found in the chorionic villi and the membranes. At the level of the umbilical cord, two types of stem cells can be found: hematopoietic and mesenchymal. The blood of the umbilical cord is already in the focus of attention of researchers, as an important source of hematopoietic stem cells that can be used for transplantation.

Corresponding author: Carmen Mihaela Mihu, MD, PhD, e-mail: carmenmihu2004@yahoo.com

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3. Immunohistochemical characterization of tumoral vessels in oral squamous cell carcinoma

Cl. Mărgăritescu, Cristiana Simionescu, D. Pirici, L. Mogoantă, Raluca Ciurea, A. Stepan

Tumors require a blood supply for growth and hematogenous dissemination. Angiogenesis is one of the mechanism by which tumors acquire their microcirculation. Structurally and functionally, these newborn vessels are abnormal, showing increased permeability, delayed maturation, and potential for rapid proliferation. Such vascular defects could be an explanation for the aggressivity of oral squamous cell carcinoma (OSCC). For these reason we studied the morphology of tumoral vessels in such tumors by using immunohistochemistry and immunofluorescence. Forty formalin-fixed, paraffin-embedded tissue blocks of OSCC were processed for double enzymatic and fluorescence immunohistochemistry. We were interested in analyzing the tumor vessel architecture, and their maturity and activity in such tumors. The tumor vessel architecture had a chaotic pattern, mostly of different sizes, aberrant morphology, tortuous, without clear lumen, and irregularly branches. Regarding pericytes recruitment, the immature and intermediate vessel types (both negative to smooth muscle actin-SMA) were the most numerous type of tumoral vessels. The mature ones (positive to SMA) were readily more numerous at the invasive front of OSCC (85.4 vessels/4 square-mm +/- 38.3), especially in poor differentiated tumoral type. Investigation of the tumor vessel basal membrane, as reactivity for collagen IV, revealed variability in thickness (2.59 micro-m +/- 0.48), small surface projections, discontinuities and loose associations with endothelial cells; these abnormalities being more obviously at the tumor-host interface and in poor differentiated OSCC. The most active angiogenesis was noticed in poor differentiated OSCC (0.23 +/- 0.04), at the tumor-host interface with the immature and intermediated vessel as the most active tumor vessel types. In conclusion, our study revealed some peculiar structurally and functionally defects of tumor vessels in OSCC, changes that could be selective targets for the new developing antiangiogenic drugs.

Corresponding author: Claudiu Mărgăritescu, MD, PhD, e-mail: c_margaritescu2000@yahoo.com

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4. The immunohistochemical expression of E-cadherin in gastric cancer; correlations with clinicopathological factors and patients' survival

Daniela Lazăr, Sorina Tăban, Carmen Ardeleanu, Alis Dema, I. Sporea, Marioara Cornianu, Elena Lazăr, Corina Vernic

Background: The aim of our study is to investigate the immunohistochemical expression of E-cadherin in gastric carcinomas and in surrounding mucosa (normal or with lesions of chronic atrophic gastritis, intestinal metaplasia or dysplasia). Material and Methods: We included 61 patients with gastric cancers operated in Emergency County Hospital Timisoara. We analyzed the E-cadherin immunohistochemical expression, the correlation with clinical and pathological factors and the outcome of the patients. The positive homogeneous pattern of staining for the cellular membranes is considered normal. The negative homogeneous or the heterogeneous pattern (of the cytoplasm and membrane) represented aberrant E-cadherin expression. Results: Areas of chronic atrophic gastritis and intestinal metaplasia presented a normal pattern of immunostaining for the membranes. Aberrant E-cadherin expression was noticed in 30 cases of gastric carcinomas (49.2%) and in 11 cases (35.5%) of epithelial dysplasia in the surrounding tissue. Our results showed no correlation between E-cadherin expression and gender, age, tumor location, pT, pN, pTNM and lympho-vascular invasion. Aberrant E-cadherin immunostainings were significantly more frequent in diffuse-type carcinomas in comparison with the intestinal-type carcinomas (82.4% vs. 31.6%) (p = 0.000491 ES). Signet-ring carcinomas and anaplastic carcinomas presented a high-proportion of aberrant immunostainings (82.4% and 100%), as well as poor differentiated carcinomas (61.5%). Carcinomas with distant metastasis presented significantly more aberrant immunostainings than those without metastasis (71.4% vs. 42.6%). Five-year survival rate was significantly lower in patients with aberrant E-cadherin expression in comparison with the patients presenting normal staining (10% vs. 22.6%). Conclusions: In gastric carcinomas and areas of epithelial dysplasia, aberrant E-cadherin expression was significantly more frequent in comparison with the surrounding normal mucosa (p<0.001 ES). Our data suggest a strong correlation between Lauren's classification of gastric carcinomas and E-cadherin immunohistochemical expression. Assessment of the survival curve of the patients highlighted the role of prognostic factor for the aberrant immunohistochemical E-cadherin expression.

Corresponding author: Daniela Lazăr, MD, PhD, e-mail: lazar_daniela@yahoo.com

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5. Angiogenesis and co-expressed of ER and c-erbB-2 (HER2/neu) protein in primary breast cancer patients: an analysis of 158 needle core biopsies

S. Vamesu

Formation of new blood vessels from a preexisting vascular bed (angiogenesis) is a complex multistep process, which may also permit metastasis. High c-erbB-2 (HER2/neu) expression has also been shown to correlate with tamoxifen resistance in patients in some studies. To investigate how tumor angiogenesis correlates with co-expression ER/c-erbB-2 (HER2/neu) in breast carcinoma diagnosed on core biopsy, microvessels were counted (and graded the density of microvessels) within the initial invasive carcinomas of 158 patients. Using light microscopy, the number of microvessels was counted manually in a subjectively selected hot spot (in the most active areas of neovascularization per 400x field), and their values were separated as above or below median (low and high), without knowledge of the outcome in the patient or any other pertinent variable. When tumors were classified as high or low MVD, based on a cut-off value (30.70175 microvessels/square-mm), cases with high MVD were significantly more numerous. When the mean values of MVD of the various groups defined by co-expression ER/c-erbB-2 (HER2/neu) were compared, significant difference was noted (P = 1.82E-05). MVD did show a relationship with groups defined by co-expression ER/c-erbB-2 (HER2/neu) (P = 0.000422). Combining endocrine treatment with these new-targeted therapies (using antiangiogenic molecules) is a promising approach to improve present treatment strategies and overcome endocrine resistance and should be investigated in future preclinical and clinical studies.

Corresponding author: Sorin Vamesu, MD, PhD, e-mail: sorinvamesu@yahoo.com

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6. Relevance of the immunohistochemical expression of cytokeratin 8/18 for the diagnosis and classification of breast cancer

Anca Maria Cimpean, C. Suciu, Raluca Ceausu, Diana Tatucu, Anca Maria Muresan, M. Raica

Purpose: The aim of our study was to characterize and describe the different immunohistochemical expression patterns of cytokeratin 8/18 (CK8/18) in breast tumors and to make a correlation between histopathology, immunohistochemistry for CK8/18 and its possible diagnostic value of this pair of keratins for molecular classification of breast cancers. Material and Methods: Forty cases of breast tumors immunostained with monoclonal antibodies against CK8/18 using a polymer based detection system and diaminobenzidine as chromogen were microscopically evaluated in normal and tumor breast tissue concerning the intensity, distribution and density of positive cells. Association with histopathology and nuclear grade were also studied. Results: Three different models of positive reaction were found: (1) normal cytoplasmic with intense and diffuse pattern, (2) aberrant membrane pattern and (3) aberrant cytoplasmic granular pattern associated with membranous positive reaction. Normal expression of CK8/18 was found in 23 cases of breast cancer, aberrant membranous in nine cases and aberrant with granular pattern in four cases. Further studies will be needed to elucidate these differences and possible correlation with other molecular markers.

Corresponding author: Marius Raica, MD, PhD, e-mail: raica@umft.ro

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7. The maxillary sinus floor in the oral implantology

V. Nimigean, Vanda Roxana Nimigean, Nicoleta Măru, D. I. Sălăvăstru, Daniela Bădită, Mihaela Jana Ţuculină

The aim of this study was to establish the mean distances between the maxillary sinus floor and the roots of the lateral maxillary teeth in dentate subjects, respectively the mean height of the available bone for oral implant placement in the corresponding area, in edentulous ones. Material and Methods: We determined the maxillary sinus floor position in relation to morphoclinical alveolodental benchmarks on 50 dry skulls, dentate 30 and edentulous 20, and correlations were performed by use of 40 CT-scans of the targeted area. In addition, 20 human adult cadavers were bilaterally dissected in order to bring topographical evidence at that level. Results: The data we obtained lead us to define three dentosinusal relations: tangent (close) relation 60.8%; distanced relation 25.6%; penetrating relation: 13.6%; three subantral classes in edentulous patients, emphasizing the direct relation of the age of the edentulism and the degree of bone resorption. We discuss the results we obtained from the viewpoint of their application in the field of oral implantology. Conclusions: The maxillary sinus floor represents the danger zone for the oral implantology.

Corresponding author: Victor Nimigean, MD, PhD, e-mail: vandanimigean@yahoo.com

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8. The adult coeliac ganglion: a morphologic study

Alina Maria Şisu, Codruta Ileana Petrescu, C. C. Cebzan, A. Motoc, S. Bolintineanu, Adriana Monica Vaida, M. C. Niculescu, M. C. Rusu

The coeliac plexus is located on the sides of the coeliac trunk and nearby the origins of the superior mesenteric and renal arteries. Afferent branches get to this plexus from the vagus nerve, splanchnic nerves and the right phrenic nerve; efferents leave for viscera through periarterial plexuses and the retroportal nerves. The coeliac plexus ganglia - coeliac, superior mesenteric, aorticorenal - are prevertebral ganglia that receive the preganglionic sympathetic fibers brought by the splanchnic nerves from the thoracic spinal cord. For studying the adult coeliac ganglia dissections were performed then pieces were drawn for silver staining by the method of Bielschowsky on blocks and HE stains. The adult coeliac ganglia consist of well-defined ganglionic subunits, of a varying number of neurons with somata ranging from 14 to 48 microns and characteristically involved in extensive dendritic fields. Individual degrees of coalescence may justify the macroscopic appearance of the coeliac ganglion but its structure keeps distinctive subunits.

Corresponding author: Alina Maria Şisu, MD, PhD, e-mail: alinasisu@gmail.com, alinasisu@umft.ro

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9. Experimental COPD induced by solid combustible burn smoke in rats: a study of the emphysematous changes of the pulmonary parenchyma

Elena Doina Murărescu, Fl. Eloae-Zugun, Maria Sultana Mihailovici

According to the GOLD 2006 definition, COPD is a preventable and treatable pathological situation characterized by the partially reversible airflow limitation determined by a variable proportion mixture of small airways disease (obliterative bronchiolitis) and parenchyma destruction (emphysema). A major impediment in the study of the COPD is represented by the fact the fundamental morphological changes that determine the major pulmonary dysfunction take place in the small, peripheral, airways, at the bronchiolo-alveolar attachments. That is why the experimental model of COPD developed progressively to the transgenic mouse. There are many experimental studies on the animal models that have obtained emphysema rapidly through intratraheal instillation of elastasis or bronchitis/bronchiolitis through intratraheal instillation of particles. It is accepted that the unnatural character of aggression, that does not permit the natural evolution of the inflammatory phenomenon, limits these models and tissue remodeling that take place in COPD patients. It is well known that cigarette smoking is a major cause of COPD. There have been reported some cases of COPD in never smoking patients exposed to air pollutants. We aimed to create an experimental model of COPD in rat through exposure to smoke resulted from solid combustibles burn for the same period and in the same conditions of cigarette smoke exposure and to compare the pulmonary morphological changes. Thirty Wistar rats were divided into three groups (n = 10): (1) the control group (C), (2) the cigarette smoke group (CS), and (3) the solid combustible smoke group (SCS). Apart from the control group, these were treated with solid combustibles smoke (SCS group) or cigarette smoke (CS group) for six months. Morphological and morphometry studies have been assessed. We have established a rat COPD model based on natural cigarette smoke exposure versus solid combustible burn resulted smoke, usable for a further approach in human non-smoker COPD investigation. Out procedures resulted in clear pulmonary morphological lesions that are characteristic for COPD. The achieved data support the idea that solid combustible burn resulted smoke determines emphysematous parenchyma lesions that are similar, but with an attenuated morphological appearance when comparing to the cigarette smoke exposure.

Corresponding author: Elena Doina Murărescu, MD, e-mail: dmurarescu@hotmail.com

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10. Modular adaptive implant based on smart materials

N. Bizdoacă, Daniela Tarnită, D. N. Tarnită

Applications of biological methods and systems found in nature to the study and design of engineering systems and modern technology are defined as Bionics. The present paper describes a bionics application of shape memory alloy in construction of orthopedic implant. The main idea of this paper is related to design modular adaptive implants for fractured bones. In order to target the efficiency of medical treatment, the implant has to protect the fractured bone, for the healing period, undertaking much as is possible from the daily usual load of the healthy bones. After a particular stage of healing period is passed, using implant modularity, the load is gradually transferred to bone, assuring in this manner a gradually recover of bone function. The adaptability of this design is related to medical possibility of the physician to made the implant to correspond to patient specifically anatomy. Using a CT realistic numerical bone models, the mechanical simulation of different types of loading of the fractured bones treated with conventional method are presented. The results are commented and conclusions are formulated.

Corresponding author: Nicu G. Bizdoacă, Eng, PhD, e-mail: nicu@robotics.ucv.ro

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11. Transitional cell tumors of the ovary: a compact group with a heterogeneous histological and immunophenotypical pattern

M. Ceausu, Dana Terzea, Alina Georgescu, Camelia Dobrea, Mihaela Mihai, Cristina Iosif, Florina Vasilescu, Carmen Ardeleanu

A small percentage of ovarian neoplasms are transitional cell tumors, which proves to be a distinct group with various histological and immunohistochemical patterns. In this study, 13 archived formalin-fixed paraffin-embedded samples of transitional cell tumors of the ovary have been assessed using standard HE stain and the indirect tristadial ABC peroxidase IHC method for 11 antibodies (CA125, CK7, CEA, EMA, MNF116, CK20, Vim, ER, PgR, PCNA, Ki-67). More than 50% were malignant Brenner tumors. CA125 was positive in all malignant tumors (of Brenner type and transitional cell carcinomas), but not in benign and borderline tumors, while CK7 was positive in ~70% of all cases. These two antibodies have shown a high sensitivity and low specificity, but do not correlate to each other. PCNA was positive in the study batch with a mean value of 40% and Ki-67 with a mean value under 25%. A direct correlation statistically significant has been noted between the aforementioned proliferation factors and the tumor grade (r = 0.4, p = 0.05). The other markers were unspecific, with low sensitivity and independently of the histopathological type.

Corresponding author: Mihai Ceausu, MD, PhD, e-mail: ceausu_mihai@yahoo.com

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12. E-cadherin expression in invasive breast cancer

C. Suciu, Anca Maria Cîmpean, Anca Maria Muresan, D. Izvernariu, M. Raica

There were investigated 22 cases with invasive breast carcinoma from the archive material, and the immunohistochemical expression of E-cadherin was correlated with clinical stage, pathological type, grade of the tumor, and lymph nodes status. The expression of E-cadherin was assessed by the pattern of the final product of reaction and number of positive cells. The reaction was appreciated as normal if over 70% of tumor cells showed membrane of membrane and cytoplasmic pattern, and aberrant, if less than 70% of tumor cells were positive. There were found 45.5% cases with normal expression and 54.5% with aberrant expression. Strong positive reaction was found mainly in tumor cells invading the adipose tissue, but the reaction was weak or negative in tumor cells within the vessels. Both normal and aberrant expression of E-cadherin correlates with grade and with clinical stage. In our study was found that the increase of the tumor grade is associated with decrease in the expression of E-cadherin. Tumors over 2 cm in their larger diameter showed a decreased expression of E-cadherin. Seventeen from 22 cases with lymph node metastasis had positive reaction in the primary, but there were not found significant differences between the normal and aberrant expression.

Corresponding author: Cristian Suciu, MD, PhD candidate, e-mail: cristian_suciu@yahoo.com

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13. The usefulness of immunohistochemistry in sporadic colorectal cancer

Camelia Doina Vrabie, M. Ceausu, Angela Petrescu, Maria Waller, I. Dina

Background: Colorectal cancer is an important disease with a large morbidity and mortality and also with increasing health care costs because of widespread of the multi-modal therapy and of the new drugs that continue to appear. There are 678.000 colorectal cancer cases and 400 000 deaths from the disease worldwide. It is the second commonest cause of cancer death in the European Union, but unlike the commonest cause of cancer related death that is lung cancer, the basis of the disease initiation is currently not understood. At the same time, the incidence increases with age, the carcinomas being rare before the age of 40 years, excepting individuals with genetic predisposition or predisposing conditions such as inflammatory bowel diseases. The early detection of colorectal cancer is potential associated with an important decrease of the cancer related mortality. Aim: Our study proposes to find out the significance of some immunohistochemical markers (VEGF, p53, CK20 and CEA) in sporadic colorectal carcinoma cases and to establish the statistical correlations between molecular markers and tumor grade and stage. Material and Methods: We investigated histopathological 40 inpatients (19 female and 21 males) who undergone surgery for colorectal carcinomas in "Sf. Ioan" Emergency Hospital, Bucharest, between September 2005-September 2006. We proceeded the histopathological examination to establish the grade, stage and the main features of the tumors, and then we analyzed using ABC method for immunohistochemistry the following markers for 20 selected cases: vascular endothelial growth factor (VEGF), carcinoembrionic antigen (CEA), cytokeratin 20 (CK20), and p53 oncoprotein. Finally, we analyzed statistical the results using t-Student test. Results: The distribution of colorectal cancer cases (n = 40) regarding the age has showed the preponderance of patients older than 70 years (22/55%) and a small percentage of younger adults (2/5%). The repartition of colorectal tumors of sex ratio outlines a small difference between males (21/52.5%), and females (19/47.5%). The histopathological analysis of tumor grade in the 40 cases has revealed a high percent of moderate grade tumors (23/57.5%), in comparison with the poor differentiated tumors (11/27.5%) and the well-differentiated cancers (6/15%). The neovascularity within the stroma, the main features of tumor growth, has been noticed in 15 cases (3.75%), and also an important inflammatory lymphocyte infiltrate in nine cases (22.5%). We have noticed positive correlation between VEGF1 and CK20 (r = 0.4, p = 0.05), and between VEGF1 and CEA (r = 0.88, p = 0.001). In addition, our results demonstrate a positive correlation between tumor grade and CEA (r = 0.43, p = 0.009), and no relation among the other markers. Conclusions: Our present study shows that CK20 and CEA are positive immunostaining markers no matter the stage (100%). The oncoprotein p53 has been negative in T1 and T2 stages, but in advanced stages has been positive in a half of cases (50%). Regarding the location, p53 and VEGF showed positively results whatever the topography. We have noticed a direct proportional relation in VEGF expression and CEA, and CEA and tumor grade (r = 0.88, p<0.001).

Corresponding author: Camelia Doina Vrabie, MD, PhD, e-mail: camianapat@yahoo.com

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14. A review of literature along with a cadaveric study of the prevalence of the Giacomini vein (the thigh extension of the small saphenous vein) in the Indian population

Prakash, Jyoti Kumari, N. Nishanth Reddy, P. Kalyani Rao, T. Preethi Ramya, G. Singh

Short saphenous has most variable anatomy in the inferior extremity which become more relevant especially in varicose vein surgery. Present study on cadavers was undertaken to report the prevalence of the thigh extension of the short saphenous vein (Giacomini vein) in the Indian population and to discuss it with the prior studies reported in the literature on other populations. Dissection was performed on both the sides of 50 embalmed cadavers to study the prevalence of the Giacomini vein. Mode of termination of the proximal extension of the short saphenous vein in the thigh was studied for different criteria. Ninety-two percent of the lower extremities showed prevalence of the Giacomini vein. In 71% specimens the short saphenous vein terminated into the popliteal vein. Most common mode of extension in the thigh was anastomosis with the great saphenous vein. Prevalence of Giacomini vein in Indian population was highest (92%) compared to previous studies by various authors in other populations. Aforementioned anatomical facts including the mode of termination of the thigh extension of the short saphenous vein can be important for surgeons planning intervention in this area. The complex anatomy of this vein and different reports in the literature regarding its clinical significance suggest further studies in this direction.

Corresponding author: Prakash, MD, e-mail: prakashrinku@rediffmail.com

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15. Thyroid nodule with Hashimoto thyroiditis in childhood - a challenging experience

Ionela Pascanu, Angela Borda, Claudia Bănescu

Fine-needle aspiration biopsy (FNAB) of the thyroid, although not perfect, is considered currently the best preoperative method in establishing malignancy in a thyroid nodule. We report the case of an 8-year-old girl with a thyroid mass in the right thyroid lobe. Endocrine investigations revealed subclinical hypothyroidism and high titer of anti-thyroid peroxidase antibodies. Fine Needle Aspiration Biopsy (FNAB) of the right side of the thyroid gland, where on thyroid ultrasonography (US) a poorly defined iso-/hypoechoic nodule with irregular margins was detected, revealed a background of lymphocytes and plasma cells mixed with follicular cells with reactive changes. After four months of treatment with L-thyroxine, ultrasonographic follow up showed an increase in nodule size. FNAB was performed again but showed non-diagnostic cytology. Right lobectomy was performed and the pathology report shows papillary carcinoma, follicular variant predominantly with components of insular growth. We discuss the false-negative FNAB interpretation because of the concomitant autoimmune thyroiditis. Management strategy for this case and the prognosis is also discussed.

Corresponding author: Ionela Pascanu, MD, PhD, e-mail: iopascanu@gmail.com

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16. Type Ib indolent mastocytosis with systemic involvement: cutaneous mastocytosis and gastrointestinal involvement at young girl

E. F. Georgescu, Ligia Stanescu, Claudia Valentina Georgescu, Iuliana Georgescu

A 21-year-old young girl presents with intense abdominal pain, nausea, diarrhea in the context of a cutaneous eruption formed by erythematous and papulous elements with brown violet aspect, very pruriginous, occasioned by the preparation of some fishmeal. Similar eruption debuted from childhood from the age of 4 year became rare with age. Since 3 years, the patient presents more intense digestive manifestation. The therapy with H2 antagonist (loratadine) and a mast cell stabilizer is beneficial over the digestive symptoms and in the same time cancel the pruritus and the erythema of the cutaneous lesions that remain hyperpigmented. The histopathological examination of a cutaneous lesion confirms the diagnosis of mastocytosis and the endoscopic examination discovers a duodenal ulcer and an erosive gastritis. The systemic mastocytosis is a rare disease, often associated with an urticaria pigmentosa, with difficult diagnosis in his absence. That's why, in patients with macular or nodular pigmented cutaneous lesions appeared in infancy and early childhood and which urticate in a characteristic manner when the skin is firmly rubbed, a cutaneous biopsy is necessary.

Corresponding author: Eugen Florin Georgescu, MD, PhD, e-mail: efg@usa.net

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17. Abdominal wall endometriosis: report of two cases

S. Gourgiotis, G. Veloudis, N. Pallas, P. Lagos, N. S. Salemis, C. Villias

Endometriosis is the abnormal existence of functional uterine mucosal tissue outside the uterus. It is a usual disorder of women in reproductive age, which is mainly located in the female genital tract. We report the cases of two women with endometriosis of the abdominal wall; the first one in the rectus abdominis muscle and the second one in the surgical scar of previous caesarian incision. The diagnosis was made by the histopathological analysis of the surgical specimens.

Corresponding author: Stavros Gourgiotis, MD, PhD, e-mail: drsgourgiotis@tiscali.co.uk

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18. Sjogren's syndrome associated with chronic hepatitis C - the benefit of the antiviral treatment

Cristina Prunoiu, E. F. Georgescu, M. Georgescu, Cristiana Simionescu

Chronic hepatitis C virus infection (CHCV) has high prevalence of immunological abnormalities. Extrahepatic manifestations (EHM) have been reported in association with CHCV infection, whose heterogeneity makes difficult any correlation between the two disorders. Among extrahepatic symptoms of C virus hepatitis, sicca syndrome is also registered. Sjogren's or sicca syndrome (SS) is a chronic, slowly progressive disease, with inflammatory-immune mediation characterized by lymphocytic infiltration of the lachrymal and salivary glands. A distinct primary form and a secondary one, occurring when presented in the context of an autoimmune or hepatic disease have been described. We present a case of SS in a patient with CHCV, commenting a possible link between primary SS and the CHCV, as well as the similarities and the distinctions among these conditions. Our conclusion is that CHCV can induce SS with some clinical particularities like presence of pericapillary and not pericanalicular lymphocytic infiltrate without destroying the salivary glands, in the absence of SS-A/SS-B antibodies. The favorable evolution of SS under IFN therapy is an argument for an authentic relation. Further studies are necessary to determine if CHCV is an etiological agent of SS or of it can induce a pseudo-sicca syndrome, characterized by a simple glandular inflammation consisting mainly in a simple lymphocytic adenitis.

Corresponding author: Eugen Florin Georgescu, MD, PhD, e-mail: efg@usa.net

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19. Pseudoxanthoma elasticum

Elena Buteică, Irina Stoicescu, Fl. Burada, M. Ioana, Eugenia Rosulescu, Aurelia Enescu, Elena Carmen Niculescu, Sandra Alice Buteică, B. Stănoiu

Pseudoxanthoma elasticum (PXE) is an autosomal recessive disorder of connective tissue, characterized by elastic fibers mineralization and fragmentation, and affects the skin, eyes, cardiovascular system, and gastrointestinal system. PXE is caused by mutations in the ABCC6 gene, located on chromosome 16p13.1. We investigated clinical and laboratory three patients with pseudoxanthoma elasticum. All the patients present on dermatological examination yellowish papules, located especially on the neck and axillary area. In case no. 2 the patient presents "cutis laxa" in the axillary area. In case no. 3 the patient presents hyperpigmented spot on right forearm and another maculo-pigmented oval spot located at the base of the left posterior hemithorax. In two cases, the ophthalmologic examination shows angioid streaks. The modifications of elastic fibers (thickened or fragmented) are present in all cases.

Corresponding author: Elena Buteică, PhD, e-mail: buteicaelena@yahoo.com

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20. The accuracy of combined physical examination and ultrasonography for the detection of abdominal aorta aneurysm

Doina Cârstea, Letitia Adela Maria Streba, Adina Glodeanu, A. P. Cârstea, Mihaela Vancu, Ana-Maria Ninulescu

Atherosclerosis is the most frequent cause in the appearance of an abdominal aorta aneurysm (AAA) and plays an important role in his development. Most AAA does not cause any symptoms, especially when talking about elderly patients, however, many of those aneurysms can be detected during physical examination. Their detection is very important because the natural evolution and the major reason in treating AAA is their tendency to rupture. We present the case of an adult man with a complex clinical pathology, but not related to the AAA. The diagnosis of the AAA has been suspicion through palpation, and the abdominal ultrasound exam confirmed it. This case is particular interesting, as the AAA requires surgical intervention, while patient's health status was poor. An essential issue is establishing the importance of the AAA screening, when there are no symptoms present. For now, there are not satisfactory studies to be used as a guide.

Corresponding author: Doina Cârstea, MD, PhD, e-mail: dag_carstea@yahoo.com

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21. High origin of ulnar artery in South Indian male cadaver: a case report

K. M. R. Bhat, B. K. Potu, S. Gowda

Superficial ulnar artery, a rare variation may arise from axillary or brachial artery. Here we report a case of high origin of superficial ulnar artery from the axillary artery. Superficial ulnar artery, after running under the bicipital aponeurosis in the cubital fossa, it terminated as superficial palmar arch in the hand. We also discuss its clinical and embryological relevance.

Corresponding author: Kumar M. R. Bhat, MD, PhD, e-mail: kummigames@yahoo.com

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22. Accessory lateral pectoral nerves supplying the pectoralis major

Rajalakshmi Rai, Anu V. Ranade, Latha V. Prabhu, Mangala M. Pai, S. R. Nayak

Certain surgical treatment failures of the brachial plexus lesions are due to the presence of anatomical variations. Anatomical knowledge of the pectoral nerves is of clinical importance during mastectomy, neurotization or other surgical procedures in the axilla. The present case describes three nerves arising from the lateral cord of brachial plexus supplying the pectoralis major muscle one below the other which was observed during routine dissection for undergraduate students. Knowledge of certain variations as in the present case may be advantageous for cosmetic augmentations during radical mastectomy where pectoralis major can be preserved because of its additional nerve supply in the lower part.

Corresponding author: Rajalakshmi Rai, e-mail: rajalakshmirai@yahoo.co.in

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23. A case report on accessory brachialis muscle

Rajanigandha Vadgaonkar, Rajalakshmi Rai, Anu V. Ranade, S. R. Nayak, Mangala M. Pai, R. Lakshmi

Supernumerary heads or slips of brachialis (anticus) muscle is one among the most striking variations, described and encountered in the dissection routine. Very few studies are quoted in the list of its anomalies. We present a unique occurrence of an accessory brachialis muscle (acBr) that formed a fibro-muscular tunnel after blending with the medial intermuscular septum in the lower part of the arm. This tunnel contained the median nerve, the brachial artery and few additional twigs that innervated the neighboring muscles. Because of its intimate topographical relation with the neurovascular bundle, there is no doubt about its role, in the etiogenesis of various compression syndromes. Also, the brachial flexors received innervation from the median nerve, due to the absence of the musculo-cutaneous nerve. We discuss in this report the possible embryogenesis and the clinical application of this variation that can aid the physicians in their approach and required treatment.

Corresponding author: Rajalakshmi Rai, e-mail: rajalakshmirai@yahoo.co.in

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24. Rare anatomical variant: arterial circle in palm and at the base of the thumb

Venkata Ramana Vollala, Somayaji Nagabhooshana, S. M. Bhat, V. Rodrigues, Mohandas Rao, N. Pamidi, S. Surendran

In this article, we describe anomalous formation, distribution of superficial palmar arch and an arterial circle at the base of the thumb found during routine dissection classes in the right hand of a 45-year-old male cadaver. These variations are unique and provide significant information to surgeons dissecting the hand region.

Corresponding author: Venkata Ramana Vollala, e-mail: ramana.anat@gmail.com

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