Uncommon Metastasis of Ovarian Dysgerminoma: A Case Report and Review of the Literature.

Ovarian malignant germ cell tumors (OMGCT) represent less than 10% of all ovarian tumors. Dysgerminoma is the most common malignant primitive germ cell tumor in young women, known for its curability and low propensity to invade and metastasize when diagnosed early. Herein, we report an unusual type of ovarian dysgerminoma (OD) metastasis with a brief review of the literature, lacking similar reported cases. To our knowledge, although there are several case reports of dysgerminoma metastases with variable anatomic location and presentation, vaginal metastasis has not been previously described. The local or systemic relapse together with local and distant metastasis is considered as an independent predictor of poor survival in patients with OD. In light of the absence of mutations status, our patient successfully responded to therapy. Currently, the patient remains in clinical remission. A specific follow-up plan is ongoing knowing that ovarian dysgerminomas tend to recur most often in the first 2-3 years after treatment.

Hypolipemiant Actions and Possible Cardioprotective Effects of Valine and Leucine: An Experimental Study.

Background and Objectives: Considering atherosclerosis as one of the more challenging threats to healthcare worldwide, any novel therapy that counteracts the risks for developing it, provides new opportunities for the management of this process. Material and methods: We performed an experimental research in which we induced a hypercholesterolemia via a cholesterol-rich diet. Our aim was to demonstrate the antiatherogenic potential of two essential amino acids (valine and leucine). The experimental study was carried out over a period of 60 days. Male Wistar rats weighing between 250-280 g were used and divided into 4 groups, each group including 8 animals. Group I-control was fed with a standard diet. Group II received cholesterol, group III cholesterol and valine and group IV cholesterol and leucine. Blood samples were collected from the retro-orbital plexus, under anesthesia with 75 mg/kg of intraperitoneal ketamine, in three different moments (R0-1st day, R1-the 30th day, R2-the 60th day) in order to measure the levels of triglycerides. Results: In R0, there were no significant differences between the average levels of triglycerides across all the groups (p < 0.05). Compared to the group I, in R1 and R2, the average levels of triglycerides were significantly higher in all groups (p < 0.001). Also, in R1 and R2, the average triglycerides in group II receiving cholesterol (C) were significantly higher than those in group III receiving valine (C + V) as well as in group IV receiving leucine (C + L) (p < 0.001; p < 0.05). In R2, the average triglycerides in group III were significantly lower than in group IV (p < 0.001). Conclusions: Our data provides evidence that valine and leucine have a direct impact on the lipid metabolism parameters by lowering the level of triglycerides. The comparison of the two essential amino acids indicates that valine acts more promptly and rapidly than leucine.

Methylenetetrahydrofolate reductase (MTHFR) polymorphisms and promoter methylation in cervical oncogenic lesions and cancer.

The aim of this study was to investigate the role of methylenetetrahydrofolate reductase (MTHFR) polymorphisms and MTHFR methylation pattern in cervical lesions development among women from Romania, a country with high prevalence of human papillomavirus (HPV) cervical infections. To achieve this goal, blood samples and cervical cytology specimens (n = 77)/tumour tissue specimens (n = 23) were investigated. As control, blood and negative cytological smears (n = 50) were used. A statistically significant association was found between T allele of C677T polymorphism and cervical lesions, heterozygote women presenting a threefold increased risk (normal/cervical lesions and tumours: wild homozygote 34/41 (0.68/0.41), heterozygote 14/51 (0.28/0.51), mutant homozygote 2/8 (0.04/0.08); OR = 3.081, P = 0.0035). Using χ square test for the control group, the HPV-negative and HPV-positive patients with cervix lesions, a significant correlation between viral infection and T allele of C677T polymorphism (P = 0.0287) was found. The MTHFR promoter was methylated in all HGSIL and tumour samples, significant differences being noted between HPV-positive samples, control group and cases of cervical dysplastic lesions without HPV DNA (P < 0. 0001) and between samples from patients with high-risk (hr)HPV versus low-risk (lr)HPV (P = 0.0026). No correlations between polymorphisms and methylation were observed. In Romania, individuals carrying T allele are susceptible for cervical lesions. MTHFR promoter methylation is associated with cervical severity lesions and with hrHPV.

Unexpected Dramatic Evolution of Placenta Increta: Case Report and Literature Review.

Placental morbid adherence is a known risk factor for postpartum hemorrhage. The incidence of abnormal placental attachment has been increasing over the past few decades, mainly due to rising rates of cesarean deliveries, advanced maternal age, and the use of assisted reproductive technologies. Cesarean section is a significant risk factor for placenta increta, as it disrupts the normal architecture of the uterine wall, making it more difficult for the placenta to detach after delivery. We present the case of a woman who underwent a cesarean section at 28 weeks due to anterior placenta previa, accompanied by hemorrhage and rupture of membranes. Following the delivery, she experienced normal postoperative bleeding and was discharged home after five days. However, six weeks later, she presented with heavy bleeding, leading to the decision to perform a total hysterectomy. The levels of HCG were found to be low. The pathological examination of the specimens confirmed a diagnosis of placenta increta, as it revealed notable placental proliferation, necrotic villi, and placental invasion near the uterine serosa. Notably, we did not find any similar cases documented in the literature. Patients experiencing prolonged vaginal bleeding after childbirth and diagnosed with placenta accreta should be closely monitored through ultrasound examinations; abnormal proliferation of the placenta can occur, and prompt detection is crucial for appropriate management.

Uterine Fibroids and Pregnancy: A Review of the Challenges from a Romanian Tertiary Level Institution.

BACKGROUND AND OBJECTIVES: Uterine fibroids are relatively common in reproductive-age women and are directly linked to pregnancy. There are many debates about performing a myomectomy at the same time as a caesarian section (CS) in such cases due to the risk of a hemorrhage. Our study aims to investigate fibroid features and their evolution in pregnancy, complications of a myomectomy during CS and maternal and fetal obstetric outcomes of pregnancies with fibroids. MATERIALS AND METHODS: We realize a prospective study that includes 57 patients with fibroids in pregnancy diagnosed in January 2017-June 2019. We analyze the number, the location and the growth of fibroids during pregnancy and the maternal and fetal outcome. We appreciate the bleeding in patients with a myomectomy and without a myomectomy during CS, using hemoglobin values before and after birth. RESULTS: Most of the patients present single fibroids that are 30-160 mm in size, located on the anterior uterine wall. Vaginal delivery is used in 7% of women, whereas 85.96% deliver by CS. In addition, 68% of fibroids are diagnosed in the first trimester. In most cases, the fibroid has maximum growth in the second trimester of pregnancy. The myomectomy rate for fibroids during CS is 24.48. Hemoglobin values showed no statistically significant difference between the two groups with and without myomectomy. The operating time is double for the group with a myomectomy associated with a CS. The results of the obstetric outcomes are abortion in 7% of all patients, whereas premature delivery and births at term are 9.43% and 90.57%, respectively. CONCLUSIONS: The decision of performing a myomectomy during pregnancy can be a challenge and must be performed for selected cases. This procedure may have several benefits, such as avoiding another operation to remove fibroids.

Thromboembolic Disease in Haemophilic Patients Undergoing Major Orthopaedic Surgery: Is Thromboprophylaxis Mandatory?

Haemophilia is a rare genetic disorder, that results from various degrees of deficiency of coagulation factor VIII (haemophilia A), or factor IX (haemophilia B), with an X-linked transmission. The patients affected are in the majority of cases males (who inherit the affected X-chromosome from the maternal side), with rare cases of females with haemophilia (FVIII or FIX < 40 IU/dL), situations in which both X-chromosomes are affected, or one is affected, and the other one is inactive (known as carrier). The hypocoagulable state due to the deficiency of clotting factors, manifests as an excessive, recurrent tendency to bleeding, which positively correlates with plasmatic levels. Severe haemophilia results in hemarthrosis, although recent data have shown that moderate or even mild disease can lead to joint bleeding. Recurrent episodes of haemorrhages, usually affecting large joints such as knees, elbows, or ankles, lead to joint remodelling and subsequent haemophilic arthropathy, which may require arthroplasty as a last therapeutic option. Orthopaedic patients have the highest risk among all for deep vein thrombosis (DVT) and venous thromboembolism (VTE) with morbid and potentially fatal consequences. While for the rest of the population thromboprophylaxis in orthopaedic surgery is efficient, relatively safe, and widely used, for patients with haemophilia who are considered to have a low thromboembolic risk, there is great controversy. The great heterogeneity of this particular population, and the lack of clinical trials, with only case reports or observational studies, makes thromboprophylaxis in major orthopaedic surgery a tool to be used by every clinician based on experience and case particularities. This review aims to briefly summarise the latest clinical data and to offer an insight into the current recommendations that readers would find useful in daily practice.

Role of ProEx C immunocytochemistry in cervical high-grade squamous intraepithelial lesions detection.

BACKGROUND: Screening programs using Papanicolaou smear along with human papillomavirus (HPV) testing led to a significantly decrease of cervical cancer rates. Nevertheless, both assessments have limited specificity for revealing cervical high-grade lesions. The main problem is how to identify the real precursor of cervical squamous cell carcinomas (SCC), namely high-grade squamous intraepithelial lesions (HSIL). AIM: The aim of our study was to conclude if ProEx C might be used as a marker for high-grade cervical intraepithelial neoplasia (CIN). MATERIALS AND METHODS: In this study, we detected the immunochemical expression of anti-ProEx C antibody in liquid-based cytology (LBC) samples. We analyzed a total number of 125 cervical cytology specimens. RESULTS: In 48% of all cases, ProEx C was found to be positive. The percentage increased from 0% in negative for intraepithelial lesion or malignancy (NILM) cases to 100% in SCC cases. CONCLUSIONS: ProEx C may be utilized to improve the accuracy of cytological diagnosis on cervical smears, according to the findings of this study. This marker is also useful in detecting unrevealed high-grade lesions on atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesions (LSIL) smears, being very useful in establishing the conduct of these cases.

Orthopedic surgery in hemophilic patients with musculoskeletal disorders: A systematic review.

Hemophilia is a hereditary coagulopathy caused by factor VIII (hemophilia type A) or by coagulation factor IX (hemophilia type B) dysfunction, characterized by an increased bleeding predisposition, which is either spontaneous or secondary to minimal trauma. Currently, hemophilia may also be considered an 'orthopedic' condition, due to the fact that it affects the musculoskeletal system of most hemophilic patients. In recent years, constant prophylaxis using coagulation factors has led to a significant improvement in the hemophilic patient's quality of life, by reducing both life-threatening hemorrhagic phenomena, as well as the occurrence of chronic complications. Nevertheless, progressive joint bleeding remains unavoidable in this category of patients, and the onset of chronic arthropathy with secondary motor deficiency remains the main complication with an invalidating character. In such cases, orthopedic management is imperative; osteoarticular complications being managed most often with the help of conservative or surgical techniques. The purpose of this review is to provide an overview of modern orthopedic practices which are useful in the management of hemophilic patients suffering from osteoarticular disorders.

Rib Exostoses Presenting as Mediastinal Masses: A Rare Presentation and Minireview of the Literature.

Costal osteocartilaginous exostoses, also known as osteochondromas, are the most common neoplasms of the long bones but are rare tumors of the ribs. Osteochondroma is often asymptomatic and incidentally observed. Tumors typically begin to grow before puberty and continue until bone maturation is reached. Our paper presents the case of a 16-year-old young male who was admitted to the hospital with nonspecific symptoms and having a family history of exostosis. Chest X-ray and computed tomography imaging revealed multiple costosternal exostoses, manifested as mediastinal masses, with protrusion into the thoracic cavity, exerting compressive effects on the ascending aorta and pulmonary parenchyma. Surgery is required in childhood if lesions are painful. But if tumor formation occurs in adulthood, such pathological bony outgrowths should always be resected for avoiding further complications. In this patient, surgical intervention removed the tumoral masses and improved the symptoms. Subsequently, histological exam confirmed the diagnosis of osteocartilaginous exostoses and showed the lack of dysplastic changes.

The relationship between HPV16 and HPV18 viral load and cervical lesions progression.

UNLABELLED: Cervical cancer remains one of the most important mortality causes worldwide. It is already known that high risk HPV (HR-HPV) has the main role in the development of pre- or cancerous lesions. Despite the fact that many studies focused on the HR-HPV viral loads as possible biomarkers, the viral load quantification utility for all HR-HPV genotypes is still a controversy. The purpose of our study was to determine if HPV16 and 18 viral load values might be a potential marker for HPV infection clearance versus of pre- and cancerous lesions development. MATERIALS AND METHODS: 80 women who tested positive for HPV16 and 18 were selected from a cohort of 250 patients. The samples, consisting in cervical smears, were collected in transport media ESwab (Copan). The patient's average age was 36.26 years. HPV DNA detection, genotyping and viral load determination were performed twice for each patient (within one year follow-up). RESULTS: HPV 16 viral load was significantly higher in normal cytology samples and in HGSIL patients than in ASCUS/LGSIL (p value < 0.0312). HPV 18 viral load was also significantly higher in HGSIL cases than in ASCUS/LGSIL (p = 0,038). Independently of cervical cytology, HPV 18 viral load was lower (7.93 x 10(4) copies/microL) than HPV 16 viral load (5 x 10(13)) copies/microL). CONCLUSIONS: For HPV types 16 or 18 positive patients with LGSIL cytology the viral load might have predictive value. Our study suggested that patients with elevated viral loads are at disease risk progression and should be carefully evaluated.

The role of echocardiography and 99mTc-HDP scintigraphy in non-invasive diagnosis of cardiac amyloidosis: A case series and literature review.

RATIONALE: Cardiac amyloidosis, considered for the last years to be a rare disease, is one of the determinants of HFpEF. The non-specific clinical presentation and the difficulties related to endomyocardial biopsy have made cardiac amyloidosis an underdiagnosed clinical entity. Improvement of non-invasive diagnostic techniques and the development of new therapies increased clinical awareness for this form of restrictive cardiomyopathy. We here summarize echocardiography and Tc-HDP scintigraphy findings in 6 cases of cardiac amyloidosis and review the literature data of this progressive and fatal cardiomyopathy. PATIENTS CONCERNS: The main clinical manifestations were fatigue, low exercise tolerance and edemas. The right heart failure symptoms usually dominated the clinical picture. DIAGNOSES: All cases were evaluated by echocardiography; 3 cases were further examined by bone scintigraphy and 4 cases a peripheral biopsy was performed. Electrocardiography showed low-voltage QRS complexes and "pseudo-infarct" pattern in the precordial leads, contrary to the echocardiographic aspect, which revealed thickening of ventricle walls. Biatrial dilation and diastolic disfunction were observed. Impaired systolic function was detected in advanced stages of the disease. Tc-HDP scintigraphy revealed cardiac uptake of radiopharmaceutical and managed to confirm the diagnosis in 1 case of cardiac amyloidosis in which salivary gland biopsy was negative. INTERVENTIONS: The treatment was based on managing fluid balance, with the mainstream therapy represented by diuretics. Neurohormonal agents, usually used in heart failure treatment were avoided, due to poor tolerance and worsening of disease course. The management of these 6 cases was challenging due to the refractory manifestation of congestive heart failure. OUTCOMES: During follow-up, 4 of the 6 patients from the current study died in the first year after the final diagnosis was established. LESSONS: Nuclear imaging of cardiac amyloidosis has a revolutionary development nowadays. Bone scintigraphy presents promising results for identifying patients at early stages of disease and to differentiate between cardiac amyloidosis types. Further studies are necessary for the standardization of imaging protocol and development of non-invasive diagnostic tools, especially in assessing the response to treatment and disease progression, for which little is known.

High-risk human papillomaviruses distribution in Romanian women with negative cytology.

INTRODUCTION: Romania has the highest incidence and mortality rate of cervical cancer in Europe. The objective was to estimate the prevalence of high-risk human papillomavirus (hrHPV) genotypes and to evaluate the role of certain socio-behavioral factors in acquiring viral infection, in a cohort of Romanian women with negative Pap. METHODOLOGY: In a prevalence study 611 women (aged 17-58 years) with negative Pap, with no known history of atypical cytology and valid HPV test were included. Each participant completed a questionnaire containing data on socio-behavioral factors. From 344 women aged between 30-58 years, 63 were randomly selected for a second examination (conventional cytology and HPV detection and genotyping) after twelve months. RESULTS: Of the 611 women, 19.80% were HPV positive, 14.73% infected with hrHPV. Differences in the prevalence of hrHPV (17.60% versus 12.50%) as single (13.01% vs 9.01%) and multiple infections (9.71% vs 3.49%) were noted between women under the age of 30 and above. Among socio-behavioral factors, marital status and multiple sexual partners correlate with HPV and hrHPV infection. At follow-up, from 34 HPV negative cases, 10 changed to positive (5 hrHPV), while 2 developed abnormal cytology. Out of the 29 HPV positive cases, 12 cleared the HPV infection and 17 retested positive of which 4 worsened their cytology. CONCLUSIONS: In Romania, HPV infection is common in women with negative cytology. HPV genotyping is of epidemiological importance because the distribution of hrHPV types can determine the impact of prophylactic vaccines and the necessity of HPV testing as screening method.

Epidemiology and pathology of parotid tumors five-year retrospective study.

AIM: To retrospectively analyze the epidemiological, clinical and pathological data of parotid tumors. MATERIAL AND METHODS: Reassessment of the histologic diagnosis of parotid tumor in the patients admitted to the Oral and Maxillofacial Surgery Unit of the Iasi "Sf. Spiridon" University Emergency Hospital during 2009-2013. Data on gender, age, place of residence, location, size, surgical procedure type and histopatological type were recorded. RESULTS: The risk of developing pleomorphic adenonma is 7.40 times higher in women and 4.08 times higher before the age of 50 years. The risk of Warthin tumor is 16.47 times higher in male patients and 3.58 times higher in urban patients. People older than 50 years have a 7.14 times higher risk of developing malignancy and rural people have a 2.41 times higher risk of developing cancer. Diabetes, obesity and systemic hypertension were not important risk factors in our study. CONCLUSIONS: According to this study age and the place of residence could be important predictors for parotid gland tumors. Since in Romania there are few epidemiological data regarding the parotid gland pathology, further cohort studies are needed for a better understanding of their clinical and pathological behavior.

The immunohistochemical expression of p53 and Ki67 in ovarian epithelial borderline tumors. Correlation with clinicopathological factors.

BACKGROUND: Borderline tumor of the ovary is an epithelial tumor with a low rate of growth and a low malignant potential to invade or metastasize. This tumor often is associated with a significantly better prognosis than epithelial ovarian cancer. Most of these tumors are either serous or mucinous in histology. AIM: Assessment of p53 and Ki67 immunohistochemical expression in 52 epithelial ovarian tumors, correlation with clinicopathological factors, and comparison between results in benign, borderline, and malignant tumors. MATERIALS AND METHODS: From the total number of 125 patients diagnosed with epithelial ovarian neoplasms in the period 2002-2010, 52 operated patients were selected, with serous and mucinous tumors. There were 26 (50%) malignant cases, 15 (28.8%) borderline and 11 (21.15%) benign. We used the monoclonal antibody DO7 and Ki67-MM1. RESULTS: P53 immunoreactions were positive in 41.66% of malignant serous tumors, most of them (90%) high-grade carcinomas; 6.66% of borderline and none benign tumors were positive. Ki67 was positive in 61.53% of malignant cases, with higher percents in advanced clinical stages. Ki67 immunoreactions were also positive in borderline and benign tumors, with lower percents, 13.3% respectively 9.09%. CONCLUSIONS: We found almost similar frequency of immunostaining in borderline tumors and low-grade invasive serous carcinomas in contrast to the significantly higher frequency of p53 mutations in high-grade serous carcinomas. Proliferative activity as assessed by Ki67 staining does not explain any possible relationship of serous borderline tumors to epithelial ovarian cancer.

Quantitative analysis of the relationship between microRNA­124a, -34b and -203 gene methylation and cervical oncogenesis.

Cervical cancer is a leading cause of mortality in women. Molecular and epidemiological data have unequivocally confirmed that high-risk human papillomaviruses (HPVs) are a major etiological agent of this malignancy, as host epigenetic alterations are induced in response to viral infection. The present study evaluated the methylation status of CpG islands surrounding miR-124a, miR-34b and miR-203 in 29 cervical cancer precursor lesions, 31 cervical tumors and 30 normal control samples, with the aim of identifying potential markers of cervical cancer. Direct quantitative methylation-specific PCR (qMSP) was used to evaluate the degree of methylation in the samples. HPV DNA was detected and genotyped using the Linear Array HPV Genotyping Test. Data were statistically analyzed using the Kruskal-Wallis test. Differences in miRNA hypermethylation between the tumor and control samples were highly significant for all the genes tested (p<0.0001). Significant results were also obtained regarding the hypermethylation of miR-124a and miR-203 in the precursor lesions compared to the control samples. Among the 29 patients with precursor lesions, 68.97% (20/29) presented high risk (hr)-HPV genotypes and 31.03% (9/29) were diagnosed with low risk (lr)-HPV. Significant results (p=0.0266) were obtained for miR-124a (hr-HPV group, mean 41.32; lr-HPV group, mean 6.74), revealing a strong association between the methylation process and the hr-HPV genotype. Borderline results (p=0.058) were obtained for miR-203 (hr-HPV group, mean 44.05; lr-HPV group, mean 3.33). These results confirm the involvement of epigenetic alterations in cervical oncogenesis. The lr-HPV precursor lesions had a methylation percent pattern similar to that of the normal samples, while the results for the hr-HPV precursor lesions and tumors indicate a possible involvement of the hr-HPV genotype in the miRNA methylation process.

[Histopathologic and immunohistochemic changes in Helicobacter pylori colonised gastric mucosa]. / Modificarile histopatologice si imunohistochimice din mucoasa gastrica colonizata de Helicobacter pylori.

UNLABELLED: Helicobacter pylori (H. pylori) colonize gastric mucosa causing both inflammatory changes, premalignant lesions and malignant tumors, including gastric lymphoma and carcinoma. In this study, our propose was to evaluate the histopathological changes corellated with immunohistochemical results demonstrating the types of cellular infiltration and proliferative activity of gastric mucosa infected with H. pylori. MATERIAL AND METHOD: Gastric endoscopic examinations was performed in 468 patients with anti-H. pylori antibodies and dispeptic phenomena. Snippets harvested endobiopsic stomach were fixed in formalin and processed by paraffine inclusion. Histological sections were stained with hematoxylin-eosine and Giemsa. In 65 cases of endobiopsic fragments (36 deep chronic gastritis with intestinal metaplasia, glandular atrophy and intraepithelial neoplasia and 29 carcinomas) immunohistochemical reactions were performed by applying reagents for evidence of H. pylori colonies, of T lymphocytes (CD3) and macrophages (CD68) and Ki-67 reagent for proliferating nuclear antigen labelling. RESULTS: Endobiopsic specimen found in all H. pylori or by Giemsa staining or by anti-H. pylori antibodies when they were in small numbers. Histologically, were diagnosed : 463 superficial and deep chronic gastritis associated with premalignant lesions, 29 carcinomas, 2 non-Hodgkin's lymphoma and an adematous polyp. Immunohistochemically, inflammatory infiltrate consisted of numerous T lymphocytes, macrophages and lymphoid follicles. Foveolar cell nuclei, in areas of intraepithelial neoplasia and carcinomatous cells were intensely stained with Ki-67, demonstrating increased proliferation. CONCLUSIONS: In gastric infection with H. pylori, inflammatory infiltrat is composed of abundant macrophages and T lymphocytes. Ki-67 was absent or minimal in chronic gastritis, while in areas of intraepithelial neoplasia was positive in both foveolar and coating epithelium. Anti-H. pylori antibodies in human serum remains one of the simplest methods to detect H. pylori, therefore it plays an important role in practice. Medical eradication of bacteria may cancel inflammatory changes, metaplasia and proliferation of gastric mucosa and thus it prevents the cascade of carcinogenesis.

[Evaluation of p16INK4a and Ki-67 proteins expression in cervical intraepithelial neoplasia and their correlation with HPV-HR infection]. / Evaluarea expresiei proteinelor p16nk4a si ki-67 în neoplazia intraepiteliala cervicala si corelarea acestora cu infectia HPV-HR.

OBJECTIVE: The aim of our study was to evaluate the expression of p16INK4A and Ki-67 in cervical intraepithelial neoplasia (CIN) and to correlate the high-risk human papillomavirus (HPV) infection with these two biomarkers. MATERIAL AND METHOD: Sixty patients were included in our study. All of the patient underwent colposcopy-guided biopsy to asses the grade of CIN. For the immunohistochemistry exam we used p161NK4A and Ki-67 antibody and their expression was semiquantitatively classified in 4 classes: 0, 1, 2 and 3. HPV genotyping was used to detect high-risk HPV. RESULTS: 7 of our cases were benign (11.66%); 18 cases presented CIN1 (30%), 14 cases CIN2 (23.33%), 16 cases CIN3 (26.66%) and 5 cases invasive squamous cell carcinoma (8.33%). We observed that the expression of p16INK4A and Ki-67 were positively associated with CIN grade, p161NK4A expressions increased significantly with high-risk HPV infection. We observed a positive correlation between the expression of the p16INK4A and Ki-67. CONCLUSION: In our study, the expression of p16 and Ki-67 were positively related to the CIN grade. p16INK4A expressions of high-risk HPV specimens significantly increased more than Ki-67. Therefore, in the diagnosis of CIN and high-risk HPV infection, p16INK4A can be a useful biomarker.

Immunocytochemical expression of p16INK4a and HPV L1 capsid proteins as predictive markers of the cervical lesions progression risk.

UNLABELLED: Genital HPV infections are extremely common but most of them are spontaneously cleared by the host immune response. The main problem is how to identify the HPV-HR positive patients who are at risk of progressive disease. AIM: The purpose of this study was to investigate the uterine cervix lesions concerning the HPV status appreciated through the immunocytochemical expression of the L1 HPV and p16INK4a proteins. MATERIAL AND METHODS: 76 women who tested positive for HPV were selected from a cohort of 374 patients. In this study were detected the immunochemical expression of HPV L1 capsid protein and p16INK4a in LBC samples. RESULTS: The p16INK4a positive rate was expressed in 56.57% of all the cases. The percentage grew from 0% in NILM cases to 100% in SCCs cases (p-value <0.00001). The HPV L1 capsid protein positive was expressed in 12.50% of NILM cases, 33.33% of ASC-US, 50% of LSIL, 18.51% of HSILs cases, but 0% in the SCC group (p-value = 0.01). The L1-/p16+ pattern was found in 21.87% of LSIL, 81.48% of HSIL, and 100% of SCC cases (p-value <0.00001). The association of these two markers (L1 and p16INK4a) raises the accuracy of the diagnostic from 64% for HPV L1 capsid protein and respectively 87% for p16INK4a to 91% when they are associated. CONCLUSIONS: The combination of L1 capsid protein and p16 appears to be useful for an early diagnosis and may be able to identify the patients with risk of lesion progression.

[The prognostic molecular factors in precancerous lesions and nonmelanotic skin carcinoma]. / Factori moleculari în leziunile precanceroase si carcinomul cutanat.

The most common cutaneous carcinoma, which includes basal cell carcinoma (BCC) and squamous cell carcinomas (SCC), accounts for approximately 90% or more of all skin malignancies. Actinic keratosis, bowenoid type of actinic keratosis, Bowen's disease or SCC in situ have been considered precursors of skin SCC. Authors present the histopathological criteria of precursors of skin SCC, variants invasive SCC and BCC. Also, one discusses about the roles of immunohistochemical staining of gene products in evidence of molecular changes in cell that might occur according to the transformation from precancerous lesions to SCC.

[ASCUS of metaplastic type. Cyto-histopathological correlations]. / ASCUS de tip metaplazic. Corelatii cito-histopatologice.

We evaluated the cytopathological changes and the prognostic significance of atypical squamous metaplastic cells in cervical smears. 50 ASCUS cases were divided in two groups: 25 cases in different settings and 25 of metaplastic type. All cases were re-evaluated after 6 months and when necessary, verified by biopsy. The second cytological diagnosis was: group I--13 normal, 2 LSIL, 40 ASCUS; group II--6 normal, 2 LSIL, 2 HSIL and 15 ASCUS. The HPV was positive in 5 cases in group I and in 9 cases in group II. In ASCUS persistent cases the biopsy revealed: in group I--3 CIN 1 and 1 CIN 2 cases; in group II--1 CIN 1, 2 CIN II, 2 CIN III and one case of microinvasive carcinoma. In conclusion, atypical metaplastic cells are more frequently involved in serious cervical lesions.