ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Vol. 57 No. 2 Suppl., 2016
This supplement was not sponsored by Outside Organizations.

1. Narrow band imaging with near-focus mode for colorectal polyps characterization

Adriana-Mihaela Ciocalteu, Elena Tatiana Cartana, Dan Nicolae Florescu, Ioana-Andreea Gheonea, Ionut Madalin Troponete, Tudorel Ciurea, Dan Ionut Gheonea

Conventional white light endoscopy is far from being an ideal tool to detect, characterize, and confirm the nature of colorectal lesions in order to indicate targeted biopsies or polyp resections only when necessary. Minimally invasive imaging techniques have gradually emerged to reveal previously unseen abnormalities to the operator during endoscopic examination. In this respect, technology and applications of narrow band imaging (NBI) are rapidly evolving. Magnification using NBI with near-focus mode has been introduced recently to enable closer examination under the control of a single button. The aim of this article is to offer an in-depth overview of this topic with emphasis on colorectal polyps through a literature review by using PubMed search tools including full-text articles, up-to-date guidelines and recent abstracts with obvious conclusions.

Corresponding author: Ioana-Andreea Gheonea, Associate Professor, MD, PhD; e-mail: iagheonea@gmail.com

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2. In vitro fertilization represents a risk factor for vasa praevia

Laurentiu Cornel Pirtea, Dorin Grigoras, Ioan Sas, Adrian Cosmin Ilie, Loredana Gabriela Stana, Andrei Gheorghe Marius Motoc, Adelina Maria Jianu, Octavian Mazilu

Vasa praevia is a rare but very dangerous obstetrical condition. The purpose of our article is to evaluate data available in literature that indicate in vitro fertilization as a risk factor for vasa praevia. PubMed Library and Cochrane Database were searched using the keywords vasa praevia, in vitro fertilization, velamentous cord insertion, placenta praevia. The conditions related to in vitro fertilization that increase the risk of vasa praevia formation were identified and discussed. Also, the diagnosis and management options were reviewed. In vitro fertilization represents a risk factor for vasa praevia and all such pregnancies should be screened by transvaginal ultrasound for vasa praevia.

Corresponding author: Adelina Maria Jianu, Associate Professor, MD, PhD; e-mail: adelina.jianu@gmail.com

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3. The role of autoantibodies in health and disease

Isabela Silosi, Cristian Adrian Silosi, Mihail Virgil Boldeanu, Manole Cojocaru, Viorel Biciusca, Carmen Silvia Avramescu, Inimioara Mihaela Cojocaru, Maria Bogdan, Roxana Mihaela Folcuti

Serum of healthy individuals contains antibodies that react with self and non-self antigens, generated in absence of external antigen stimulation. These antibodies, called natural antibodies, are particularly IgM isotype, are considered natural autoantibodies (NAA), displaying a moderate affinity for self-antigens. Although incidence of NAA in healthy individuals is not reported, it is established that autoreactive antibodies and B-cells, as well as autoreactive T-cells, are present in healthy persons. The functional abilities of NAA are not clear but is well accepted that they may participate in a variety of activities, such as maintenance of immune homeostasis, regulation of the immune response, resistance to infections, transport and functional modulation of biologically active molecules. On the other hand, specific adaptive immune responses through high-affinity, class-switched IgG autoantibodies, which bind self-proteins, can cause tissue damage or malfunctions, inducing autoimmune diseases. The new technology that allows for more autoantibody screening may further enhance the clinical utility of autoantibody tests, making it possible to diagnose autoimmune disease in its early stages and to intervene before installing injuries. The aim of this review paper is to succinctly analyze the progress in the physiological role and regulatory significance of natural autoantibodies in health and disease.

Corresponding author: Cristian Adrian Silosi, Lecturer, MD, PhD; e-mail: cristian_silosi@yahoo.fr

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4. Neuro-neoplastic interrelationships in colorectal level - immunohistochemical aspect in three cases and review of the literature

Cristina Florescu, Octavian Istratoaie, Georgica-Costinel Tartea, Daniel Pirici, Costin Teodor Streba, Bogdan Catalin, Ileana Puiu, Elena-Anca Tartea, Daniel-Cosmin Caragea, Mirela-Corina Ghilusi, Maria Victoria Comanescu, Ion Rogoveanu, Cristin Constantin Vere

Colorectal cancer represents a severe public health issue. Recent studies have shown the essential role played by nerves and their neurotransmitters in tumor initiation and progression. The aim of this study is to asses the expression of beta 2-adrenergic receptors (beta2A) for adrenaline and noradrenaline, and the expression of M3 muscarinic receptors (M3R) for acetylcholine (neurotransmitters produced and released by sympathetic and parasympathetic afferents of the digestive tract and also by the enteric nervous system) in different tumor gradings of colorectal adenocarcinoma, and also the tropomyosin receptor kinase A (TrkA) for the nerve growth factor produced by the cells of colorectal adenocarcinoma. Beta 2-adrenergic receptors were expressed both in normal colic tissue and in the tumor tissues, from the three patients included in the study. It was observed that both area and integrated optical density (IOD) are more elevated for this type of receptor in tumor tissues than in normal colic tissue. For the M3 muscarinic receptors, similarly to beta 2-adrenergic receptors, it was observed a growth both of the area and of the IOD with the tumor grading. The presence of TrkA receptors was also observed both in the normal colic mucosa and in the tumor tissues examined, but with a significant reduction of the signal in the poorly differentiated tumor tissue. Understanding the neurobiology of cancer in this context becomes necessary for establishing much more complex and targeted molecular targeted therapies.

Corresponding author: Georgica-Costinel Tartea, PhD Student; e-mail: georgetartea@gmail.com

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5. Diagnostic reevaluation of 17 cases of pheochromocytoma - a retrospective study

Nora Lupsan, Liliana Resiga, Adina Bianca Bosca, Carmen Georgiu, Doinita Crisan, Claudiu Mirescu, Anne-Marie Constantin, Ioan Simon, Alina Simona Sovrea

A rare neuroendocrine tumor, the pheochromocytoma (PCC) raises problems due both the limited experience of the researchers in this field and its pathogenic mechanisms, still not fully elucidated. The malignant potential of this tumor cannot be predicted based on its macro- or microscopic aspects, but on the presence of metastases. The aims of this study were: (1) the reevaluation of data for a pertinent and complete tumor diagnostic and prognostic pattern; (2) the statistical correlation of all investigated parameters with the malignant form and the survival rate in order to obtain a possible predictor of malignancy; (3) the potential identification of initially diagnosed benign tumors that become malignant in time. The retrospective study was conducted on 17 patients diagnosed with pheochromocytoma. We investigated: the personal data, the associated neuroendocrine syndromes, the clinical, the laboratory, the macro- and microscopic data [location, size, Hematoxylin-Eosin (HE) pheochromocytoma of the adrenal gland scaled score (PASS score), and immunohistochemical aspects] and the survival rate (analyzed by Kaplan-Meier method and Log-Rank test). The influence of diagnostic parameters on malignancy was calculated taking into consideration the survival rate. By reevaluation of the 17 cases, we tried to emphasize the value of a complex diagnosis pattern for PCCs, based on the correlation between clinical data, laboratory findings and microscopic features. A significant statistical difference between benign and malignant forms was not registered, but there were parameters as age, association with neuroendocrine syndromes, PASS score and specifically Ki-67 mitotic index that had a powerful impact on the survival rate and could be consider as possible predictors of malignancy. The potential of PCC malignant transformation was revealed in our study, by two cases that have metastasized in time.

Corresponding author: Alina Simona Sovrea, Associate Professor, MD, PhD; e-mail: a_sovrea@yahoo.com

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6. Influence of hyperforin on the morphology of internal organs and biochemical parameters, in experimental model in mice

Simona Negres, Corina Scutari, Floriana Elvira Ionica, Veaceslav Gonciar, Bruno Stefan Velescu, Oana Cristina Seremet, Anca Zanfirescu, Cristina Elena Zbarcea, Emil Stefanescu, Emilia Ciobotaru, Cornel Chirita

Background and Aims: Hyperforin (HY) is used to treat depression and skin irritation and has been shown a number of pharmacological activities. The literature does no cite data on changes that may occur in the body after HY intake (ethylene diammonium salt - EDS) in long-term administration. From this point of view, the present work is a key to determining the pharmacotoxicological profile of the HY-EDS, in long-term administration. Materials and Methods: In present research, the influence of toxic doses of HY-EDS was investigated on the biochemical serum parameters and the histopathological changes in internal organs on the experimental mice model. For acute toxicity determination, the HY-EDS was tested in doses of 2000-5000 mg/kg, administered once per day orally. For subacute toxicity, the HY-EDS was tested in three groups of mice, in doses of 50, 75 and 100 mg/kg/day, administered once daily, for 28 consecutive days. Results and Conclusions: As concern acute toxicity, a lethal effect has not occurred at any of the two tested doses and HY-EDS was classified as Class V toxic: median lethal dose (LD50) >5000 mg/kg, p.o. After 14 days of follow-up in acute toxicity, the experimental results showed a statistically significant increase of aspartate transaminase (AST) and alanine transaminase (ALT), compared to the control group. There were no changes in creatinine and serum glucose compared to the control group. After the administration of repeated doses, it was observed an increase of serum transaminases and alkaline phosphatase. Histological examination revealed that the liver injuries were in an initial stage, making them reversible in case of HY-EDS treatment discontinuation. There was no evidence of kidney damage to any of the doses of HY-EDS.

Corresponding author: Floriana Elvira Ionica, Lecturer, Pharm, PhD; e-mail: floriana_umf@yahoo.com

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7. Clinical importance of pharmacogenetics in the treatment of hepatitis C virus infection

Adina Maria Kamal, Paul Mitrut, Kamal Constantin Kamal, Oana-Sorina Tica, Mihaela Niculescu, Dragos Ovidiu Alexandru, Andrei-Adrian Tica

Globally, over 4% of the world population is affected by hepatitis C virus (HCV) infection. The current standard of care for hepatitis C infection is combination therapy with pegylated interferon and ribavirin for 48 weeks, which yield a sustained virological response in only a little over half of the patients with genotype 1 HCV. We investigated the clinical importance of pharmacogenetics in treatment efficacy and prediction of hematotoxicity. A total of 148 patients infected with HCV were enrolled. All patients were treated for a period of 48 weeks or less with pegylated interferon and ribavirin. Four genotypes were investigated: inosine triphosphatase (ITPA) rs1127354, C20orf194 rs6051702, interferon lambda (IFNL)3 rs8099917, IFNL3/4 rs12979860 in the population from southwestern Romania. Genetic variants for rs129798660 and rs6051702 proved once more to represent an indisputable clinical tool for predicting sustained virological response (SVR) (69.23%, chi-square p=0.007846, p<0.05 and 63.29%, chi-square p=0.007846, p<0.05, respectively). ITPA genetic variants protect against ribavirin-induced hemolytic anemia and C20orf194 also proved to be protective against thrombocytopenia. These clinical findings strengthen the belief that pharmacogenetics should play a constant role in treatment decisions for patients infected with hepatitis C virus.

Corresponding author: Kamal Constantin Kamal, MD; e-mail: kamalconstantin@gmail.com

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8. Ultrastructure and histomorphometric analysis of human umbilical cord vessels in preeclampsia: a potential role of VEGF, VEGFR-1 and VEGFR-2

Shaima M. Almasry, Amr K. Elfayomy, Hala E. Hashem

Aim: This study aimed to analyze the ultrastructure and histomorphometric changes of the human umbilical cord vessels of preeclampsia compared to healthy pregnancies and the possible role of vascular endothelial growth factor (VEGF) and its receptors. Materials and Methods: Umbilical cord (UC) specimens were collected between August, 2014 and July, 2015. Histomorphometric analysis of UC vessels was performed utilizing an image analysis system. Cellular localization of VEGF, VEGFR-1 (VEGF receptor-1) and VEGFR-2 (VEGF receptor-2) were examined in immunohistochemically-stained sections of UC from 45 pregnancies with preeclampsia (PE) and 40 healthy pregnancies. Results: Compared with healthy pregnancies, UC venous measurements were significantly higher in PE; total venous area (p<0.001), luminal venous area (p<0.001) and luminal venous index (p=0.005). Arterial measurements except for the total arterial area were significantly lower in the PE compared to healthy pregnancies, luminal arterial area (p=0.32) and luminal arterial index (p=0.004). Histological and ultrastructural examination of UC from PE revealed discontinuity of vascular endothelium and disorganized edematous widely spaced smooth muscle cells. We demonstrated a significant increase in tissue expression of VEGF in PE (16.6+/-0.1) compared to healthy pregnancies (12+/-0.8) (p=0.001). Also, significant higher VEGFR-1 expression in PE (20.5+/-2.5) compared to healthy pregnancies (9.5+/-1.2) (p<0.001) has been observed. However, tissue expression of VEGFR-2 was decreased significantly in PE (10.5+/-0.7) compared to healthy pregnancies (13.8+/-1.6) (p=0.043). Conclusions: Altered tissue expression of VEGF and its receptors in the UC vessels could play a crucial role in disturbing the UC vascular endothelium, smooth muscles and measurements and this may underlie the existence of preeclampsia.

Corresponding author: Shaima Mohamad Almasry; e-mail: almasry.shaima@gmail.com

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9. P53, p16 and Ki67 immunoexpression in cutaneous squamous cell carcinoma and its precursor lesions

Alexandru Marinescu, Alex Emilian Stepan, Claudiu Margaritescu, Alis Magdalena Marinescu, Roxana Eugenia Zavoi, Cristiana Eugenia Simionescu, Mihaela Niculescu

The incidence of cutaneous squamous cell carcinoma (CSCC) and its precursor lesions argues the research for validating markers that would define the biomolecular mechanisms behind the potential progression and aggressiveness of these lesions. In this study, we analyzed the expression of p53, p16 and Ki67 in 91 cases of CSCC and its precursors in relation with the histological prognostic parameters. The quantification of the immunohistochemical reactions indicated superior significant differences for the studied markers in squamous cell carcinomas compared to keratinocytic intraepithelial neoplasia (KIN). P16 and Ki67 immunostaining for Bowens disease were similar to those from poorly differentiated carcinomas. In this study, we found significant differences in p53 expression in relation to tumor grading and p16 expression in relation to tumor staging. Ki67 showed higher values in high-grade and advanced stage carcinomas. Positive reactions in preinvasive lesions as well as in CSCC support the sequential development and p53 and p16 involvement from the early stages of skin carcinogenesis.

Corresponding author: Alex Emilian Stepan, Lecturer, MD, PhD; e-mail: astepan76@yahoo.com

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10. Predictive model of synovial membrane degradation using semi-automated morphometry and artificial neural networks

Otilia-Constantina Rogoveanu, Diana Kamal, Magdalena-Rodica Traistaru, Costin Teodor Streba

Gonarthrosis is a degenerative disease that affects mainly older people, but whose incidence has increased significantly in the last decade in population under the age of 65. The main objective of this study was developing a predictive model of synovial membrane degradation in relation to local nerve structures in patients with knee osteoarthritis, based on advanced morphometry and artificial neural networks (ANNs). We present here a pilot test of the method, describing preliminary findings in analyzing a pre-set number of images. We tested the system on a pre-defined set of 50 images from patients suffering of gonarthrosis in different stages. Biological material used for the histological study was synovial membrane fragments. We included 50 anonymized images from 25 consecutive patients. We found significant differences between mean fractal dimensions (FDs) of histological elements of normal and pathological tissues. In the case of immunohistochemistry, we found statistically relevant differences for mean FDs of all antibodies. We fed the data to the ANN system designed to recognize pathological regions of the examined tissue. We believe that further study will have an important contribution to the development and will bring new local targeted therapies. These could slow or reverse joint damage and pain relief in patients with osteoarthritis.

Corresponding author: Magdalena-Rodica Traistaru, Associate Professor, MD, PhD; e-mail: rodicatraistru@hotmail.com

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11. Changes in rat ovary with experimentally induced diabetes and the effects of lycopene on those changes

Mustafa Yildiz, Mustafa Sandikci

Free radicals increase in the presence of diabetes. Lycopene is a powerful antioxidant. The goal of the present study was to determine the effect of diabetes on rat ovaries and the protective role of lycopene in that context. Experimental diabetes was induced with 50 mg/kg streptozotocin. Rats were randomly separated into four groups, as follows: control + corn oil, control + lycopene, diabetes + corn oil and diabetes + lycopene. The histological and histometric evaluations were performed using Crossmans triple staining method. The immuno-histochemical connexin-43 expression was identified and the apoptotic cell density was determined using the terminal deoxynucleotidyl transferase dUTP nick-end labeling method, while the malondialdehyde levels were measured using the enzyme-linked immunosorbent assay technique in the ovaries. Vacuolization of the corpus luteum, hydropic degeneration in the interstitial regions, and the number of corpora lutea increased in the ovary as effects of diabetes while the diameter of the corpora lutea decreased. The intensity of connexin-43 expression decreased in the primordial and atretic follicles, interstitial cells and luteal cells of the corpora lutea in the diabetes + corn oil group. The ovarian malondialdehyde levels and the number of apoptotic cells in the granulose layers of the large antral follicles increased in the presence of diabetes. Lycopene increased the expression of connexin-43 in the primordial, secondary and large antral follicles in the ovaries of diabetic animals. The changes caused by diabetes in the ovaries and the protective role of lycopene in some but not all parameters was revealed.

Corresponding author: Mustafa Yildiz; e-mail: mustafayildiz17@yahoo.com

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12. Anterior commissure laryngeal neoplasm endoscopic management

Nicolae Constantin Balica, Marioara Poenaru, Eugen Horatiu Stefanescu, Eugen Radu Boia, Caius Ion Doros, Flavia Baderca, Octavian Mazilu

The CO2 laser surgery represents a treatment method of laryngeal bicordal and anterior commissure glottic cancer T1b, T2, N0. In Department of ENT, Timisoara, Romania, during 1.01.2001-31.12.2011 were analyzed 781 files from patients with laryngeal neoplasm. One hundred twenty-seven patients presented the tumor that involved both vocal cords and anterior commissure, stages T1b, T2 and T3. Therapeutic options included CO2 laser microsurgical excision for 55 (43.30%) patients, frontolateral hemilaryngectomy for 16 (12.59%) patients, total laryngectomy for 42 (33.07%) patients, radiotherapy for 10 (7.87%) patients, and four (3.14%) patients, initially, refused any treatment modality. Endoscopic laser CO2 microsurgery was the primary and solitary management for curative resection of the glottic cancer. All operations were performed under general anesthesia with orotracheal intubations. The mean follow-up was 58 months, with the range between 36 to 84 months. Suspended microlaryngoscopy with CO2 laser surgery has been performed in 43 (33.85%) patients staged T1bN0Mx and 12 (9.44%) patients staged T2N0Mx. In five (9.09%) patients, we encountered local recurrences. The endoscopic CO2 laser surgery is in our view the elective and preferable surgical method in laryngeal glottic cancer stage T1b and T2 for cure, with oncological and functional results superior to those of conventional surgical procedures.

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

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13. Clinical, imagistic and histopathological study of chronic apical periodontitis

Ileana Cristiana Croitoru, Stefania Craitoiu, Cristian Marian Petcu, Oana Andreea Mihailescu, Roxana Maria Pascu, Adelina Gabriela Bobic, Doriana Agop Forna, Monica Mihaela Craitoiu

Periapical lesions are among the most frequent periodontal pathologies in human teeth, generally called apical periodontitis. Apical periodontitis is a continuation of the endodontic space infection and it is manifested as a response of the host defense against the microbial action. It may determine local inflammation, hard tissue resorption, destruction of other periapical tissues. The preliminary diagnosis of chronic periapical lesions is based on the clinical symptoms and imagistic investigation, which represent a reliable diagnosis instrument, but the histological investigation remains essential for a certain diagnosis. We performed a clinical and histological study of the periapical lesions, evaluating the various clinical and imagistic aspects and we compared them with the results of the histological examination, in order to establish the correspondence between the clinical-imagistic aspects and the morphological ones. The relation between the histological aspects, the clinical signs and imagistic aspects may provide valuable data both for establishing an accurate diagnosis and for adopting the most efficient treatment.

Corresponding author: Stefania Craitoiu, Professor, MD, PhD; e-mail: scraitoiu@yahoo.com

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14. The prevalence of crown injuries to frontal teeth at schoolchildren aged 6 to 14 and their effects on the periodontal tissue

Ionela Teodora Dascalu, Horia Octavian Manolea, Evantia Coles, Constantin Daguci, Marilena Bataiosu, Cristina Maria Andrei, Mihaela Jana Tuculina, Oana Andreea Diaconu, Luminita Daguci

The research aims at emphasizing the interrelation between the social impact and the self-esteem of schoolchildren with dental crown fractures in the frontal group. Dental traumatic injuries are frequently met to schoolchildren, therefore, the prevention and interception of traumatic pathology within parents, teachers and children is more than necessary. Our statistical study intends to determine the prevalence of dental trauma to southwestern Romanian schoolchildren aged 6 to 14. The survey included a number of 1684 schoolchildren attending public schools, randomly chosen. Data were collected from October 2012 to December 2013. Clinical examination was conducted to assess the dental traumatic injuries. Age and gender distribution, etiological factors, risk factors and the cause of injuries were the parameters taken into consideration. The data collected was processed and analyzed using the SPSS (Statistical Package for the Social Sciences) statistical software. The overall prevalence of dental trauma was 4.63% amongst the subjects examined. The maxillary central incisor was the most commonly affected tooth (85.19% in boys and 97.87% in girls). We observed a significant statistical difference in the number of children with one, two or three fractured teeth from the urban and rural areas. The percentage of schoolchildren with crown fractures that we examined was of 3.09% in the urban area and 1.54% in the rural area. The traumatic injuries of the maxillary upper teeth were most prevalent. Since the dental trauma of incisors has a strong impact on the quality of life of children and their families, health preventive policies are needed in order to avoid psychological implications on the lifelong existence of children affected.

Corresponding author: Constantin Daguci, DMD, PhD; e-mail: dagucicristi@yahoo.com

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15. Analysis of bronchoalveolar lavage fluid in a first Romanian pulmonary alveolar proteinosis cohort

Oana Claudia Deleanu, Ana-Maria Zaharie, Aneta Serbescu, Floarea Mimi Nitu, Florin Dumitru Mihaltan, Oana-Cristina Arghir

The features of bronchoalveolar lavage fluid (BALF) components and the severity of pulmonary alveolar proteinosis (PAP) were analyzed in the first Romanian cohort of patients admitted to Marius Nasta Institute of Pneumophtisiology, Bucharest, Romania. A six-year follow-up study based on bronchoalveolar lavage (BAL) data was performed between January 2007 to December 2012. Study cohort consisted in 20 inpatients diagnosed with PAP, based on BALF cytological findings and/or on histopathological findings. Demographic, medical history, tobacco use, clinical and radiological features, disease progression with or without whole lung lavage (WLL) therapy were collected. Disease severity was evaluated by pulmonary function testing including spirometry, blood gas analysis, plethysmography, and diffusing capacity of the lung for carbon monoxide (DLCO), also known as transfer factor (TLCO). The cellular profile of all BALF specimens was analyzed. Statistical analysis made by SPSS version 17.0 included Student s t-test, chi-square test and ANOVA. Mean age of the subjects was 43+/-16.59 years, with male predominance (n=12; 60%). Diagnosis of PAP was facilitated by fiberbronchoscopy (FBS) with BAL in 90% of cases. Cytological findings of BALF revealed lower macrophages (57.26+/-18.19%), with a preponderance of neutrophils (17.75+/-19.44%) and lymphocytes (21.8+/-16.12%). Lower oxygen partial pressure was identified in elders, comparing to younger patients (p=0.038). Patients treated by WLL had a lower total lung capacity (TLC) and DLCO versus those who did not required WLL (p=0.009, respectively p=0.056). The severity of pulmonary abnormalities provided WLL indication was not influenced by BALF cellularity.

Corresponding author: Ana-Maria Zaharie, MD, PhD Student; e-mail: ana_neb@yahoo.com

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16. Diagnosing HIV-associated cerebral diseases - the importance of Neuropathology in understanding HIV

Ioan-Alexandru Diaconu, Laurentiu Mihaita Stratan, Luciana Nichita, Victoria Arama, Valentina Ruxandra Moroti Constantinescu, Alexandra-Ioana Diaconu, Daniela Adriana Ion

The study aims to compare two aspects concerning the diagnosis of acquired immune deficiency syndrome (AIDS)-associated central nervous system (CNS) pathology (neuroAIDS): clinical diagnoses issued ante mortem with pathology results issued post mortem. The group of 39 human immunodeficiency virus (HIV)-positive patients was created over 23 years and is limited by marked heterogeneity. The enrolled cases were treated at the Prof. Dr. Matei Bals National Institute for Infectious Diseases, Bucharest, Romania, deceased due to AIDS-related complications and underwent brain necropsies performed in the Pathology Laboratory at the Colentina Clinical Hospital, Bucharest. The level of superposition between clinical and the necroptic diagnoses of neurological AIDS-associated diseases was: 60% for progressive multifocal leukoencephalopathy (PML), 50% for cerebral cryptococcosis, 33% for cerebral toxoplasmosis, 20% for cerebral lymphoma, null for cerebral tuberculosis, HIV encephalopathy (HIVE), neurosyphilis and cytomegalovirus cerebral infection. Half of the cases without an AIDS-associated CNS lesion were previously clinically overdiagnosed. We observed that the rate of overdiagnosis concerning an AIDS-associated cerebral illness has risen from 36% in 1993 to 124% in 2015, an elevation with statistical relevance [p=0.037, confidence interval (CI) 95%]. The rate of underdiagnosis has slowly risen from 24% in 1993 to 40% in 2015, however, with no statistical relevance. The rate of clinical confirmation has been stagnant in linear regression from 1993 to 2015. The results of our study reveal a gap between ante mortem and post mortem diagnoses, with many instances of overdiagnosis and underdiagnosis of several major AIDS-associated CNS illnesses, highlighting the need for a more detailed, multidisciplinary approach of neuroAIDS.

Corresponding author: Ioan-Alexandru Diaconu, MD, PhD Candidate; e-mail: diaconuia@yahoo.com

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17. Posterior vitreous detachment and macular anatomical changes - a tomographic-electroretinographic study

Alin-Stefan Stefanescu-Dima, Cornelia Andreea Corici, Maria-Rodica Manescu, Teodor-Nicusor Sas, Maria Iancau, Carmen-Luminita Mocanu

Aim: Posterior vitreous detachment (PVD) is a physiological phenomenon due to aging characterized by separation of the vitreous cortex from the retina and may induce a variety of pathological events at the vitreoretinal junction. The aim of this study is to highlight in vivo anatomical and functional changes in early stages of PVD allowing the correct treatment. Material and Methods: Non-consecutive case series; optical coherence tomography (OCT) relies on analyzing the reflectivity of coherent light from different anatomical interfaces within posterior vitreous and retinal histological layers, thus acquiring transverse sections through vitreoretinal interface, sensory retina, retinal pigment epithelium and choroid. Modern techniques using Fourier spectral analysis of the reflected light enhance axial resolution to 5-10 micro-m, almost matching classic histological sections. Integrating these sections, OCT can reconstruct three-dimensional tissue anatomy. Full-field electroretinogram (ERG) evaluates the function of the entire retina evoked by a flash light. Results: Imaging of the vitreoretinal interface with OCT allowed staging PVD and correctly diagnosing its secondary pathologies: cystoid macular edema, vitreomacular traction syndrome, epiretinal membrane, macular pucker, macular hole, macular pseudohole, lamellar macular hole. The cone response of full-field ERG is a marker of retinal damage in macular pathology due to PVD. Conclusions: Correct understanding of vitreoretinal anatomic and functional changes due to posterior vitreous detachment is essential for a proper diagnosis and treatment.

Corresponding author: Cornelia Andreea Corici, MD, PhD Student; e-mail: corici.andreea@gmail.com

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18. Histological factors that predict the liver fibrosis in patients with chronic hepatitis C

Ileana Octavia Petrescu, Viorel Biciusca, Citto Iulian Taisescu, Dragos Ovidiu Alexandru, Oana Taisescu, Maria Victoria Comanescu, Florin Petrescu, Iulian Alin Silviu Popescu, Diana-Maria Trasca, Mircea Catalin Fortofoiu, Cristian Adrian Silosi, Maria Fortofoiu

In chronic hepatitis, pathologies reveal a prominent inflammatory infiltrate portal consisting mostly of lymphocytes and plasma cells invading the portal spaces, although one can also identify macrophages, neutrophils or eosinophils. In all the forms of chronic hepatitis, fibrosis starts in the portal area, namely periportally, subsequently extends towards the lobules to the central veins, causing septa, followed by fibrosis. We studied 52 patients with chronic hepatitis C, who underwent a hematological, biochemical, virological and histopathological investigation. We found that the severity degree of the portal inflammation was in direct relation to the hepatitis activity index (HAI) and to the degree of fibrosis. The portal inflammation is dependent to the degree of fibrosis. The degree of inflammation significantly changes the distribution of cases with different degrees of fibrosis (chi-square p=0.00011 <0.001). Periportal inflammation, periportal necrosis and focal necrosis are the morphological aspects of the necroinflammatory process best correlated to the occurrence and development of fibrosis.

Corresponding author: Citto Iulian Taisescu, Associate Professor, MD, PhD; e-mail: taisescu@yahoo.com

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19. Subsets of telocytes: the progenitor cells in the human endocardial niche

Florentina Grigoriu, Sorin Hostiuc, Alexandra Diana Vrapciu, Mugurel Constantin Rusu

Telocytes (TCs) are cells defined by their long and moniliform processes termed telopodes. They were previously identified in the endocardium and express neural markers, such as nestin and neuron-specific enolase (NSE). Previous studies found a positive expression of neuro-filaments in endocardial endothelial cells, and a positive expression of nestin in cardiac side population (CSP) progenitor cells, which allowed us to hypothesize that TCs in the endocardial stem niche could be in fact progenitors that express nestin. Materials and Methods: We used cardiac samples from 10 human adult donor cadavers. Endocardial endothelial cells expressed CD146, alpha-smooth muscle actin (alpha-SMA), smooth muscle myosin (SMM), nestin and, scarcely, neurofilaments. Within atrial and ventricular samples, we found an endocardial discontinuous smooth muscle layer expressing, similar to pericytes and vascular smooth muscle cells, alpha-SMA, nestin, SMM, and CD146. We assessed a similar phenotype in the subendocardial muscle layer, which also expressed neuron-specific enolase. The expression of nestin and CD146 strongly indicates a progenitor phenotype, which, in turn, supports the hypothesis that, in humans, an endocardial stem niche supplied by an endothelial-mesenchymal transition should be considered, although it mimics a primitive supply from the cardiac neural crest with dormant cardiac side population progenitor cells. Nevertheless, the endocardial niche could indeed harbor precursor cells that are morphologically similar to TCs.

Corresponding author: Mugurel Constantin Rusu, Professor, MD, PhD, Dr. Hab; e-mail: mugurel.rusu@umf.ro

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20. Study of some invasiveness markers as pathogenic factors in oral pseudoepitheliomatous hyperplasia

Roxana Maria Pascu, Claudiu Margaritescu, Monica Mihaela Craitoiu, Alma Maria Florescu, Ileana Cristiana Croitoru, Adelina Gabriela Bobic, Ciprian Laurentiu Patru, Gheorghe Dan Malaescu, Stefania Craitoiu

Pseudoepitheliomatous hyperplasia is a benign reactivated epithelial lesion secondary to another pathology, whose incidence is difficult to establish. There still exist controversies regarding the origin and pathogenesis of these lesions. For this purpose, we performed an immunohistochemical study upon 20 cases of oral pseudoepitheliomatous hyperplasia associated with inflammatory and neoplastic conditions, investigating a series of markers with a possible pathogenic potential in developing this type of lesions. Thus, the immunoreactivity study for beta-catenin showed the presence of a membrane reactivity in all the stratum spinosum and a predominantly cytoplasmatic reactivity, more rarely a nuclear one, in the cells of the basal stratum cells, especially in the epithelial apices that descend deeply in the chorion. Instead, in the case of vimentin, the reactivity was present only in the epithelial apices, especially in the peripheral cells, in comparison to the central ones, and especially in the cases where the epithelial apices descended deeply in the sublesional chorion. Moreover, we observed that the MMP9 reactivity in pseudoepitheliomatous hyperplasia lesions was present in the cells at the epithelium-chorion interface and especially in the epithelial apices that descend deeply into the chorion, and also in the epithelial chorion and networks. The study for CXCR4 immunoreactivity showed a good reactivity in almost all layers of this hyperplastic lesion, with a maximum reactivity especially inside the epithelial apices that descend deeply in the sublesional chorion. Such an immunoprofile suggests the ability of the oral epithelial cells to undergo an epithelial mesenchymal transition process, thus acquiring mesenchymal characteristics through which it deeply migrates in the subadjacent chorion and contributes to the formation of epithelial apices in pseudoepitheliomatous hyperplasia. Moreover, the invasive ability of these lesions is also given by the average quantity of matrix metalloproteinases present in the epithelium-chorion interface determined by the activation of CXCR4 receptors at this level.

Corresponding author: Claudiu Margaritescu, Professor, MD, PhD; e-mail: c_margaritescu2000@yahoo.com

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21. Evaluation of normal and pathological Achilles tendon by real-time shear wave elastography

Pompiliu Horatiu Petrescu, Dragos Andrei Izvernariu, Catalina Iancu, Gabriel Ovidiu Dinu, Dan Crisan, Simona Alina Popescu, Roxana Lucia Denisa Sirli, Bogdan Mihai Nistor, Ion Calin Rautia, Dorela Codruta Lazureanu, Sorin Dema, Ion Radu Prejbeanu, Ioan Sporea

Tendinopathy covers a range of several tendon conditions, mostly caused by overuse but at least in Achilles tendon pathology, favored by obesity, diabetes, inflammatory and autoimmune conditions. Subclinical tendon pathology is difficult to diagnose, as magnetic resonance imaging (MRI) examinations are sometimes inconclusive and not cost-effective. Elastography is an ultrasound examination method that uses mechanical impulses to produce shear waves in the tissue of interest, then measures the tissue displacement and calculates the shear wave speed or the elastic modulus of the examined tissue. We have used B-mode ultrasonography and shear wave elastography on 80 Achilles tendons from healthy volunteers with or without tendon pathology history, and correlated the data obtained with the clinical parameters of the volunteers, such as age, body mass index (BMI) and sports practice. We have shown that there is no significant correlation between the elastic modulus of the Achilles tendon and age, sports practice and body mass index with the exception of the correlation between the elastic modulus of the right Achilles tendon in men and age. Shear wave elastography has proved to be cost-effective for the evaluation of the Achilles tendon in healthy volunteers and was able to monitor the evolution of one patient with old tendon rupture treated by surgery. It can complete MRI investigation and it can replace B-mode ultrasonography particularly in monitoring the post-surgery evolution.

Corresponding author: Pompiliu Horatiu Petrescu, Assistant Professor, MD, PhD; e-mail: lalusha87@yahoo.com

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22. Characterization of the tumor cells from human head and neck cancer

Georgiana Gabriela Petrica-Matei, Florin Iordache, Razvan Hainarosie, Marinela Bostan

Although it is very difficult to establish a correlation between the behavior of tumor cells in vitro and in vivo tumors, in this study we tried to analyze some functions of the tumor cells isolated from head and neck tumor fragments, comparatively with the tumor cell cultures, hoping that the results could help the clinician to choose optimal treatment for head and neck cancer patients. The aim of the present study was to evaluate the expression of p53 protein, the apoptosis process and the cell cycle parameters in the cell cultures of head and neck carcinoma obtained from fragments of tumor excised from patients. Using ELISA assay and flow cytometry methods we analyzed the p53 protein expression, distribution of the cell cycle phases and the level of apoptosis in the tumor cells which were immediately isolated from the tumor fragments, as well as in the ones that were subsequently passed in culture several times. Our results showed that p53 protein expression was weak in four (33.3%) patients, moderate in three (25%) patients and intense in five (41.6%) patients. Our data showed that both tumor cells isolated from the tumor fragments (passage 0), as well as cell cultures at passage 5 had the percentage of S-phase of the cellular cycle higher than 20%, suggesting that tumors have high proliferative activity. The tumor cells cultures have a small percentage of apoptosis that may reflect a biological aggressive tumor character. In conclusion, these data may improve the diagnostic protocols and help to an efficient monitoring of therapy.

Corresponding author: Marinela Bostan, Research Scientist III, PhD; e-mail: marinela.bostan@yahoo.com

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23. Papillary thyroid cancer stroma - histological and immunohistochemical study

Tatiana Georgiana Radu, Marius Eugen Ciurea, Stelian Stefanita Mogoanta, Cristina Jana Busuioc, Florin Grosu, Mihaela Tenovici, Ileana Octavia Petrescu, Ionela Mihaela Vladu

Thyroid cancer is the most frequent endocrine neoplasia. The incidence of the disease has been increasing in the past few decades in many regions, especially where the population was subject to some forms of accidental exposure. Among all the histopathological forms, papillary thyroid cancer (PTC) is the most common histological subtype of malignant thyroid tumor, representing about 80-90% of all malignant thyroid tumors. Although it is generally accepted that tumor stroma plays an essential role in the development and metastasis of tumor cells, histopathological studies focused on tumor cells characteristics. In this study, we evaluated the characteristics of tumor stroma histopathologically and immunohistochemically examining a total of 18 cases of papillary thyroid carcinomas, of which 18 cases were classic papillary carcinomas, 11 cases papillary carcinomas, follicular forms, five cases were papillary carcinomas - formed with tall-cells, three cases of papillary carcinomas, solid variants and one case was interpreted as an oncocytic variant. Most papillary carcinomas have been typically characterized by the presence of neoplastic papillae, composed of a central axis of fibro-vascular, branched, and coated by one or more layers of cubic or prismatic epithelial cells. In three typical papillary carcinomas, the stroma was composed of coarse connective axes rich in collagen fibers. The predominantly fibrous stroma, consisting of connective septum was observed in four cases, while in one case of papillary carcinoma, solid variant, we have identified a hyaline stroma; in one case was revealed a myxoid stroma. Diffuse stromal calcifications have been identified in two cases only. In the tumoral stroma, there were identified inflammatory infiltrates in nine cases, formed mostly of lymphocytes, and in one case, there was observed the presence of aggregated lymphoid nodules. The immunostaining with anti-CD34 antibody showed that in papillary thyroid carcinomas there is a well-represented vascularity, mostly made of small vessels (arterioles, venules, capillaries) with diameters between 7 and 50 micro-m, and immunostaining with anti-vimentin and anti-alpha-SMA antibody showed an increased number of fibroblasts, respectively myofibroblasts in the tumoral stroma. We believe that in the same thyroid tumor there are several clones of neoplastic cells that reshape the stroma, giving it certain histopathological characteristics.

Corresponding author: Stelian Stefanita Mogoanta, Lecturer, MD, PhD; e-mail: ssmogo@yahoo.com

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24. A rare case of ovarian splenosis

Ioana-Andreea Gheonea, Sarmis-Marian Sandulescu, Sineta Cristina Firulescu, Diana Rodica Tudorascu, Mircea Ovidiu Ciobanu, Oana Badea, Dan Ionut Gheonea, Daniela Larisa Sandulescu

Splenosis is a very rare entity that often appears following a traumatic rupture of the spleen or after splenectomy and represents heterotopic transplantation of splenic tissue. The ovary is reported as an atypical and rare localization. We report a case of a middle-aged woman, which presented with a left adnexal mass. Transvaginal ultrasonography, computed tomography (CT) and high-field 3T magnetic resonance imaging (MRI) revealed the left adnexal mass. Laparoscopy was performed, and histological and immunohistochemical examination revealed that resected mass was splenic tissue.

Corresponding author: Dan Ionut Gheonea, Associate Professor, MD, PhD, MSc; e-mail: digheonea@gmail.com

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25. Histopathological and clinical traps in lichen sclerosus: a case report

Daciana Elena Branisteanu, Daniel Constantin Branisteanu, Gabriela Stoleriu, Dan Ferariu, Catalina Maria Voicu, Loredana Elena Stoica, Constantin Caruntu, Daniel Boda, Florina Mihaela Filip-Ciubotaru, Andreea Dimitriu, Cezar-Doru Radu

Lichen sclerosus et atrophicus and limited systemic scleroderma (acrosclerosis) are inflammatory skin diseases that ultimately evolve into two distinct modes of atrophic scar formation, but which can easily be confused clinically. They are very rarely associated. The literature has reported cases in which lichen sclerosus was associated with various forms of scleroderma, but often with localized morphea. The characteristic histopathological picture of lichen sclerosus includes a thin epidermis, with orthohyperkeratosis and vascular degeneration in the basal layer, loss of elastic fibers, and band-like inflammatory infiltrate in the papillary dermis, while systemic sclerosis is characterized by excessive deposition of collagen in the dermis, accompanied by reduction in adnexal structures and their entrapment in collagen, and the presence of perivascular lymphocytic inflammatory infiltrate. We present the case of a 40-year-old female patient clinically diagnosed with systemic scleroderma and lichen sclerosus involving the genital mucosa. Physical examination in conjunction with laboratory findings (elevated antinuclear, anti-Scl-70, anti-SSA antibodies and immunogram) induced the supposition of the coexistence of lichen sclerosus and systemic scleroderma, fact confirmed by pathological examination. Systemic therapy with corticosteroids, immunosuppressive and phlebotropic drugs, peripheral vasodilators and other tropic adjuvants and topically potent topical corticosteroids was initiated. The course was favorable under therapy, the hardened skin slightly regaining elasticity, relief of itching and disappearance of lichen sclerosus lesions. Our case reaffirms the uncommon association of these two disorders. The importance of history, physical and laboratory examinations in making a diagnosis of certainty in emphasized.

Corresponding author: Daniel Constantin Branisteanu, Lecturer, MD, PhD; e-mail: dbranisteanu@yahoo.com

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26. Umbilical hernia masking primary umbilical endometriosis - a case report

Elvira Bratila, Oana-Maria Ionescu, Dumitru-Cristinel Badiu, Costin Berceanu, Simona Vladareanu, Doina Mihaela Pop, Claudia Mehedintu

Endometriosis is a gynecologic condition affecting mainly the pelvic organs. However, extrapelvic endometriosis has been reported in almost all parts of the body. Umbilical endometriosis, either primary or secondary, is uncommon and has a documented neoplastic risk. We present the case of a 46-year-old woman with a large umbilical hernia associating primary umbilical endometriosis discovered during surgery and confirmed later by pathological and immunohistochemical exams. The patient underwent omphalectomy and partial omentum resection, alongside with mesh abdominal wall repair. The patient was informed about the recurrence risk and was asymptomatic at follow-up consults.

Corresponding author: Costin Berceanu, University Lecturer, MD, PhD; e-mail: dr_berceanu@yahoo.com

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27. Primary squamous cell carcinoma of the thyroid: a case report

Corina Lichiardopol, Valeriu Surlin, Maria-Camelia Foarfa, Mirela-Corina Ghilusi, Simona Bondari

Primary squamous cell carcinoma of the thyroid is a very rare thyroid malignancy (less than 1% of thyroid cancers) with unfavorable clinical evolution and median survival less than one year, due to highly local tumor invasiveness with airway obstruction, metastases and treatment complications. We present a 62-year-old female patient with a fixed, rapidly increasing 5 cm right thyroid nodule, generating compressive signs and significant weight loss, resembling anaplastic thyroid carcinoma. Thyroid hormones, antithyroid antibodies and calcitonin were normal. Computed tomography (CT) scan revealed mediastinal extension of the tumor and excluded the presence of lymph nodes or other tumors (T3N0M0). Total thyroidectomy was performed and histopathological evaluation revealed squamous cell carcinoma, which was confirmed by immunohistochemistry, showing diffuse positivity for CK7, CK19, CK34betaE12, galectin-3, EGFR, focal positivity for p63 and negativity for TTF-1 and CD5. Subsequently, the patient underwent chemotherapy (Paclitaxel, Cisplatin, Epirubicin) and radiotherapy (40 Gy), but tumor recurrence was noticed one month after surgical resection and continued to grow despite treatment. Nodal and metastases status remained negative at regular follow-up. The patient died within one year after diagnosis. External radiotherapy and chemotherapy were not efficient in our case. New treatment options are needed to improve outcome in primary squamous cell carcinoma of the thyroid.

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

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28. Multiple myeloma and secondary plasma cell leukemia

Vitorino Modesto dos Santos, Sandro Pinheiro Melim, Priscilla Souza de Faria, Viviane Vieira Passini, Mayza Lemes Duarte, Renata Athayde Casasanta

Plasma cell leukemia is very rare condition characterized by malignant proliferation of plasma cells in blood and bone marrow, which is aggressive and has a short survival even with conventional treatment. This ominous entity may be primary, or develops secondarily during the course of multiple myeloma. A 53-year-old Brazilian woman with multiple myeloma is described with bone marrow evaluation revealing 25% plasma cells. The quantification of plasma cell infiltration in bone marrow aspirate and immunohistochemistry study revealed consistent features of myeloma and plasma cell leukemia, and lambda light chain expression. Worthy of note was the absence of CD56 expression and the expression of CD20; moreover, 23% of circulating plasma cells were detected in peripheral blood smears. Therefore, the diagnosis of plasma cell leukemia was characterized and therapeutic schedules with dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide were utilized. With significant clinical improvement, the patient is currently waiting for bone marrow transplant.

Corresponding author: Vitorino Modesto dos Santos, Professor, MD, PhD; e-mail: vitorinomodesto@gmail.com

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29. Mesenchymal hamartoma of the left liver lobe in an 18-month-old female patient

Emil Radu Iacob, Calin Marius Popoiu, Alexandra Nyiredi, Laurentiu Mogoanta, Oana Badea, Eugen Sorin Boia

Mesenchymal hamartoma of the liver (MHL) is a benign and rare hepatic lesion, with an uncertain etiology and a potential for developing into an undifferentiated distant embryonal sarcoma after an incomplete resection. It mainly presents as progressive abdominal distension with normal blood works. Most cases are diagnosed in the first two years of life, with a higher frequency in boys and on the right liver. We report the case of a mesenchymal hamartoma of the left liver in an 18-month-old girl, with a rough evolution and a literature review. There were performed an abdominal computed tomography (CT) scan and resection of the lesion. The macroscopic and histological examination described a 16.5x17.9x10.5 cm multicystic mass as a MHL lesion. MHLs may have a malignant potential and in the clinical presence of a neoplastic syndrome there requires a good diagnosis and drastic surgical treatment.

Corresponding author: Calin Marius Popoiu, Associate Professor, MD, PhD; e-mail: mcpopoiu@yahoo.com

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30. Mullerianosis of the urinary bladder: a rare case report and review of the literature

Marius Stanimir, Luminita Cristina Chiutu, Sebastien Wese, Amelia Milulescu, Raducu Nicolae Nemes, Ovidiu Gabriel Bratu

The aim of this paper is to report a very rare case of mullerianosis (endosalpinx, endometrium, and endocervix) in a post-menopausal woman. Mullerianosis of the bladder is a very rare disease, which affects mainly the women of the reproductive age group, but with a good prognosis if the transitional bladder carcinoma is resolved. We present the case of a 64-year-old woman complaining of left lower abdomen pain, repeated lower and upper tract urinary infections, emergency urinary incontinence and hematuria. The surgical history shows that she underwent a hysterectomy, caesarean section and appendectomy. The clinical examination emphasizes a normal abdomen, with a normal aspect of the post-operative scars and a second-degree cystocele. An abdominal computed tomography (CT) scan with contrast and a cystography were performed and showed a 16 mm lesion-like tumor on the left bladder wall respectively a third-degree vesicoureteral reflux. These investigations were followed by a cystoscopy and transurethral resection of the bladder tumor (TURBT). The histopathology report described three types of tissues: endometriosis, endocervicosis and endosalpingiosis. Sequent to these results, a partial cystectomy with the re-implantation of the left ureter was performed. Once again, the results of the specimen confirm the diagnosis of mullerianosis. The immediate post-operative outcomes were good, the patient having no pains and no more hematuria. Six month later, a tension-free vaginal tape obturator (TVT-O) operation was carried out for urinary incontinence and two years later, a correction for a post-surgical abdominal hernia was performed. Mullerianosis of the bladder is a very rare disease, which affects mainly the women at the procreation age, but with a good prognosis. The differential diagnosis with a malignant tumor is very important to be carefully made. Currently, there is no golden standard to treat this disease. The cystoscopy and the histopathological examination of the specimen are indispensable for the certainty diagnosis.

Corresponding author: Luminita Cristina Chiutu, Professor, MD, PhD; e-mail: luminita.chiutu@gmail.com

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31. An evaluation on multidisciplinary management of carotid body paragangliomas: a report of seven cases

Dragos Catalin Jianu, Silviana Nina Jianu, Andrei Gheorghe Marius Motoc, Traian Flavius Dan, Marioara Poenaru, Sorina Taban, Octavian Marius Cretu

Carotid body paragangliomas (CBPGLs) are a rare neoplasms of the neuroendocrine system that affect the carotid glomus. The aim of this study is to improve their management in our Departments. This retrospective analysis reports family history, clinical presentation, imaging diagnostics, Shamblin classification, surgical treatment, complications, and the outcome of seven patients with CBPGLs. All lesions were represented by a painless cervical mass, with no functional or bilateral neck tumors. One patient had two different localizations (the second one was a glomus tumor of the right prelachrymal sac), and a family history for CBPGL. All neck tumors were diagnosed during duplex ultrasound corroborated by magnetic resonance imaging (MRI), and by magnetic resonance angiography (MR-A). They presented a diameter between 3 and 5 cm (MRI). Complete subadventitial resection of the tumor was performed in all patients, with no preoperative embolization in any of the cases. The CBPGLs were confirmed on histopathology and immunohistochemistry. Lymph node metastasis was not found in any of the cases. Mortality and perioperative stroke rates were null. Transitory cranial nerve deficit occurred in one case without permanent palsy. After a follow-up of three years in each patient, there were no signs of tumor recurrence in any of the cases. Relatively early diagnosis of CBPGL was possible in our seven patients using multidisciplinary management. Preoperative planning of the surgical procedure by integrated diagnostic imaging was essential in our study to operate only Shamblin group II tumors, minimizing the known risk of complications associated with large CBPGL (group III).

Corresponding author: Andrei Gheorghe Marius Motoc, MD, PhD; e-mail: amotoc@umft.ro

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32. Prosthetic rehabilitation of complete edentulous patients with morphological changes induced by age and old ill fitted dentures

Oana Cella Andrei, Ruxandra Margarit, Livia-Alice Tanasescu, Luminita Daguci, Constantin Daguci

Extremely old, complete edentulous patients are very difficult to treat both because of their anatomical and psychological condition. Treatment challenges are increasing when this situation is associated with low socio-economic status, poor general health and unrealistic expectations. This article presents a prosthetic rehabilitation of a very old patient, presenting a serious bone atrophy associated with a maxillary flabby ridge, whose dentures accelerated the bone resorption because of their poor fitting, lack of retention and wrong occlusal contacts. Despite his old age and scarce social life, restoring esthetics in the trial phase had a major psychological impact for the patient, making him more optimistic about the result and helping him to accept and functionally integrate the new complete dentures.

Corresponding author: Livia-Alice Tanasescu, Assistant, MD, PhD; e-mail: tanasescualice@gmail.com

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33. A case of a generalized symptomatic calcinosis in systemic sclerosis

Cristian Radu Jecan, Stefan-Iulian Bedereag, Ruxandra-Diana Sinescu, Valentin-Titus Grigorean, Cristina-Nicoleta Cozma, Anca Bordianu, Ioan-Petre Florescu

Calcinosis consists of abnormal calcium deposition in soft tissues, which appears often in patients with limited systemic sclerosis, being one of the criteria of CREST (calcinosis cutis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. With a long evolution, the aim of the treatment is to control the symptoms and prevent complications. In this article, we present the challenging management of a profuse lesion of calcinosis in a patient with systemic sclerosis. We describe the case of a 52-year-old woman with systemic sclerosis and CREST syndrome who was admitted in our Department with multiple painful and disabling tumoral masses, situated in nearly all joints. The interscapular vertebral tumoral mass was excised and the defect was closed. Histopathological examination revealed cutaneous calcinosis, probably associated with CREST syndrome, a type of scleroderma. Postoperative results were favorable and no local complications were encountered. Six months follow-up revealed no evidence of recurrence. Despite the size and the invasion of the tumor in the muscle, complete resection was possible with an adequate reconstruction; the postoperative result being acceptable. With a lower response to medication, surgical treatment is considered the only option for treating symptomatic lesions of calcinosis in order to improve quality of life.

Corresponding author: Cristina-Nicoleta Cozma, MD; e-mail: cristina.cozma88@yahoo.com

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34. Common and unusual dental development abnormalities in a patient with bicuspid aortic valve

Anca Maria Raducanu, Ion-Victor Feraru, Ioana Suciu, Elina Teodorescu, Andreea Cristiana Didilescu, Ileana Ionescu, Ecaterina Ionescu

Bicuspid aortic valve (BAV) is the most common congenital abnormality of the heart. In this condition, instead of three cusps, the aortic valve has two cusps. Children with congenital heart diseases are at increased risk of developing oral diseases, such as: higher number of decayed teeth, developmental anomalies, periodontal disease, malocclusion, dental crowding, as well as susceptibility to develop infective endocarditis from bacteremia caused by chronic poor oral health. However, little information is available regarding oral manifestations and their management in patients with congenital heart defects, despite the importance of these diseases. This paper presents oral manifestations associated with BAV in a young patient, alongside the general features of the condition. The presented case with BAV brings together features of a complex pathology and multidisciplinary treatment, which was conducted over a long period of time and still continues nowadays.

Corresponding author: Ion-Victor Feraru, Lecturer, DDS, PhD; e-mail: victor.feraru@gmail.com

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35. Dermal plexiform spindle cell lipoma

Jose-Fernando Val-Bernal, Sandra Hermana

Spindle cell lipoma located in the dermis is uncommon. The plexiform variant of this tumor is rare. In fact, only six cases of this variant have been described previously. We report herein a case of dermal plexiform spindle cell lipoma with prominent myxoid matrix. A 47-year-old male patient presented with a solitary, 2.2 cm-cutaneous mass in the right buttock region that had slowly increased in size for over one year. The dermal lesion was characterized by a mixture of mature adipocytes, spindle shaped cells and inconspicuous ropey collagen bundles in a mucinous background. This lesion showed a fascicular and plexiform pattern with adipocytes irregularly arranged, predominant in the depth of the lesion. Immunohistochemically, the spindle cells were positive for CD34, factor XIIIa, and vimentin, and negative for retinoblastoma protein, claudin-1, GLUT-1, epithelial membrane antigen, neurofilament protein, and Sox-10. S100 protein stained a thinned cytoplasmic rim of mature adipocytes and labeled about 25% of spindle cells in the most superficial areas. A review of the seven cases published, including the present report, revealed that there were five females and two males. Most cases located in the thigh-groin-buttock area. The age of the patients ranged from 32 to 58 years with a mean of 45.7 years. Clinical diagnosis suggested a lipomatous or neural tumor in six cases. The main differential diagnosis includes dermal intraneural plexiform neurofibroma and purely intradermal monophasic plexiform spindle cell nevus.

Corresponding author: Jose-Fernando Val-Bernal, MD, PhD; e-mail: apavbj@humv.es

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36. Pregnancy resulting from IMSI after testicular biopsy in a patient with obstructive azoospermia

Constantin-Cristian Vaduva, Carmen Constantinescu, Mihaela Mirela Radu, Alice Roxana Vaduva, Andrei Panus, Mihaela Tenovici, Damian Ditescu, Dinu Florin Albu

In this article, we report a case of pregnancy obtained in an infertile couple diagnosed with severe male factor infertility. The couple attended for fertility examination reporting a history of 10 years of infertility. The cause of infertility was obstructive azoospermia. The treatment consists of in vitro fertilization (IVF). The ovarian stimulation of female patient was done with antagonist protocol and after ovarian puncture was obtained nine oocytes. The urologist performed testicular sperm extraction (TESE). There were selected nine sperm cells by intra-cytoplasmic morphologically selected sperm injection (IMSI). For this purpose, we used an inverted microscope with high magnification equipped with x60 air objectives with modulation contrast illumination. After intracytoplasmic sperm injection (ICSI) of sperm into the oocytes there were obtained six normal embryos from which three embryos were transferred into the uterus. A singleton pregnancy was achieved which was completed with birth of a healthy baby in time. This successful outcome shows that use of IMSI and ICSI procedures are really useful in selection of best spermatozoa obtained by TESE in treatment of obstructive azoospermia.

Corresponding author: Constantin-Cristian Vaduva, Senior Lecturer, MD, PhD; e-mail: hitmed@gmail.com

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37. Tonsillar lymphoma masquerading as obstructive sleep apnea - pediatric case report

Corneliu Toader, Miorita Toader, Alina Stoica, Gabriel Pop, Alina Oprea, Anca Simona Constantin, Liviu Niculescu, Iolanda Cristina Vivisenco, Mircea Stelian Draghici, Andrei Osman, Carmen Aurelia Mogoanta

The commonest cause of head and neck malignancy in pediatric patients is lymphoma. A particular case is the tonsillar lymphoma. Even though unilateral tonsillar enlargement represents an ominous sign for neoplasia, clinical manifestations vary and are non-specific. Therefore, a delayed diagnosis is performed which compromises optimal therapy and hinders the prognosis. We present the case of a 5-year-old boy who was initially diagnosed with obstructive sleep apnea, without reported systemic complaints. Asymmetric tonsillar hypertrophy created the premises for performing a tonsillectomy to rule out malignancy. The pathological evaluation of the resected tonsils revealed a malignant non-Hodgkin s lymphoma, with immunophenotypic features consistent with sporadic type Burkitt lymphoma. The aim of this paper is to emphasize the importance of the histopathological examination and of the immunohistochemistry testing for the prompt and accurate diagnosis of all asymmetric tonsillar hypertrophy in children undergoing tonsillectomy. Furthermore, immunohistochemical diagnosis is vital for establishing a personalized multi-agent chemotherapy regimen, which dramatically improves the survival rate. We recommend histopathological evaluation in all children with asymmetric tonsillar hypertrophy undergoing tonsillectomy for various reasons. Needless to say, it is better to be cautious and exclude the presence of tonsillar lymphoma, than to confront with the severe consequences of misdiagnosis.

Corresponding author: Miorita Toader, MD, PhD; e-mail: toadermiorita@yahoo.com

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38. Borderline Brenner tumors associated with ovarian cyst - case presentation

Dinu Florin Albu, Cristina Crenguta Albu, Alexandru Marian Goganau, Stefan Dimitrie Albu, Laurentiu Mogoanta, Antoine Edu, Damian Ditescu, Constantin-Cristian Vaduva

Borderline Brenner tumors represent quite a rare entity of ovarian tumors (about 2%) that develop from the surface ovarian epithelium. They are formed from papillary structures made of fibrovascular conjunctive axes covered by a transition epithelium, similar to the urinary bladder epithelium. According to the WHO classification, Brenner tumors present the following forms: benign, borderline and malignant. The benign ones are the most frequent, representing about 95%, the borderline represent about 5%, and the malignant ones less than 1%. We present the case of a 64-year patient who was diagnosed with right ovary cyst. The histopathological examination highlighted the presence of a borderline Brenner tumor at the same time with the cystic lesion, on the same ovary. The surgical treatment led to a complete cure of the patient, so that the yearly ultrasound reexamination did not trace the presence of any tumoral relapse.

Corresponding author: Cristina Crenguta Albu, Lecturer, MD, PhD; e-mail: crenguta.albu@yahoo.com

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39. Pro Memoria. Professor Boleslaw Jalowy (1906-1943): Mortui viventes obligant - the livings are obligated to the dead

Andrzej Wincewicz

Professor Boleslaw Jalowy (1906-1943) was a chairman of Department of Histology and Embryology at Faculty of Medicine of King John Casimir University (Polish: Universytet Jana Kazimierza: UJK) in Lvov. He succeeded Professor Wladyslaw Szymonowicz (1869-1939) who held this position for decades. As the most skillful followers of his tutor, Boleslaw Jalowy was a great investigator of physiology of human tissue, embryogenesis, histological consequences of female sex hormones on blood clotting action as well as regeneration of nerves in addition to description of silver staining technique for reticulin fibers of skin. He was a hard working person with gentle attitude to such a subtle matter as microscopic structure of human body. However, he happened to live in brutal conditions of nationalistic struggles. His example shows how much a dedicated scientist could do in a very short time as his life was tragically ended with murdering him during World War Two. His story is a great lesson for generations of academic workers how to meet high moral standards with efficient and creative scientific work in evil and destructive, nationalistic climate that occurs usually in wartime.

Corresponding author: Andrzej Wincewicz, Professor, MD, PhD; e-mail: ruahpolin@yahoo.com, andwinc@gmail.com

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