Cavernous liver hemangioma complicated with spontaneous intratumoral hemorrhage: a case report and literature review.

Hemangiomas, the most common benign tumors of the liver, have a prevalence of approximately 20% and are more frequent in women. According to previous studies, the size and location of the tumor are correlated with the appearance of symptoms and complications. Cases of hemangiomas complicated by spontaneous intratumoral hemorrhage have been rarely reported in the literature. Here, we report the case of a 70-year-old woman admitted for persistent upper abdominal pain. The patient showed signs of anemia, inflammatory markers and a transient increase in creatinine levels, which were corrected by conservative treatment. Our patient denied the previous use of estrogen derivatives, smoking or alcohol consumption. Native computed tomography identified a liver mass measuring 73×63 mm, located in segment IV and bulging out of the anterior contour of the liver. The mass was surgically removed by hepatic segmentectomy, and histopathological examination identified a cavernous hemangioma complicated by intratumoral hemorrhage. The postoperative outcome was favorable. After a literature review, we identified 19 other cases of hepatic cavernous hemangioma complicated by intratumoral hemorrhage reported worldwide.

The evaluation of the sentinel lymph nodes status in breast carcinoma using microscopic, immunohistochemical and cytomorphometric methods in order to establish new stadializations and therapeutic schemes.

The state of axillary lymph nodes represents the most important prognostic parameter in patients with breast carcinoma. The biopsy and examination of sentinel lymph nodes, the former one containing metastases originating in mammary carcinoma, allows a better stadialization of the tumor but also the avoiding of the extirpation of the axilla, associated with a series of complications and high costs of hospitalization. In establishing the tumoral prognosis, not only the diameter but also the localization of the metastasis in the lymph nodes is utterly important. The evaluation of the metastases was carried out through the serial examination of the sentinel lymph node correlated to immunohistochemical examinations with AE1/AE3. Of the 570 patients with breast carcinoma evaluated in this research, 250 had macrometastases, 93 micrometastases, only 23 had isolated tumor cells, and in the case of 204 no metastases were found. The technique of computerized cytomorphometry allowed a better evaluation of the diameter and localization of the metastases in the lymph nodes than the examination through optical microscope. The tumoral prognosis in the case of patients with macrometastases is poorer than that of patients with micrometastases. The patients in whom only the presence of isolated tumoral cells was demonstrated have a similar prognosis with those who do not have metastases. As far as the localization of micrometastases in the sentinel lymph nodes is concerned, those with a subcapsular localization are associated with a poorer prognosis than those with an intraparenchymatous localization. As well as this, the subcapsular localization of micrometastases was also associated with the diameter of the primary tumor extending between 2-5 centimeters, a high microscopic grade, the presence of lymph vascular emboli and microscopic type of the primary tumor associated with poor prognosis. On the other hand, the presence of isolated tumoral cells was associated with tumors of a small diameter lacking the presence of lymph vascular emboli and with a low microscopic grade. All these data are essential in establishing the therapeutic management of the patients with breast carcinoma; consequently, we recommend their inclusion in future stadializations of this lesion and the evaluation of tumoral prognosis.

The endovaginal ultrasound finding of a thin and regular endometrium is uncommon in endometrial cancer.

AIM: To present the clinical and ultrasound features in patients with endometrial cancer in whom the endometrial thickness was less that 5 mm. METHOD: Retrospective study on 263 patients with endometrial carcinoma in whom the ultrasound evaluation of the endometrium was performed. The features noticed in the patients with endometrial thickness below 5 mm are presented. RESULTS: In 249 (94.68%) of our patients with endometrial carcinoma the mean endometrial thickness was 15 mm. In 14 patients (5.32%), in whom biopsy was performed prior to ultrasound examination, endometrial thickness was less than 5 mm. CONCLUSIONS: A thin and regular endometrium (below 5 mm) rules out an endometrial carcinoma provided that no biopsy has been performed within 3 months before ultrasound examination.

[Study of nucleolar organizer regions in prostate cancer]. / Studiul regiunilor organizatoare nucleolare în tumorile prostatice.

AIM: To compare the qualitative and quantitative AgNOR scores per nucleus of histological grades. MATERIAL AND METHODS: Thirty-five needle biopsies from patients with prostate cancer (PC) aged 60 to 75 years were investigated. The morphologic parameters examined on histological specimens were: microscopic patterns, Gleason's histological grades (GLG), and AgNOR scores by automated image analyzer and quantitative AgNOR counts according to the classification, fine granules, large granules, and total granule counts. RESULTS: Our data suggest a significant correlation between GLG, AgNOR scores, and the percentage of both AgNOR fine and large granules. In HPIN, AgNOR count was evidently higher (5.56) as compared to normal acinar epithelium, slightly exceeding the level found in well-differentiated carcinoma (5.3). In our cases, the highest AgNOR counts were found in poorly differentiated carcinomas (9.81). AgNOR density in ductal carcinomas (7.61) was close to that in moderately differentiated carcinomas (7.35). CONCLUSION: This simple method may aid diagnostic judgement when interpreting needle biopsies of malignancy and act as a prognostic marker useful for identifying PC of low and high malignancy.

Metastasis from papillary renal cell carcinoma masquerading as primary ovarian clear cell tumor.

A 73-year-old female presented with a left ovarian tumor mass. Microscopic examination disclosed cystic spaces lined by abundant clear and eosinophilic tumor cells with pleomorphic nuclei. Differential diagnosis included primary ovarian oxyphilic-type clear cell carcinoma and sex-cord tumor with extensive luteinization. However, analysis of the patient's past history revealed that in 2003, she had undergone nephrectomy for a papillary renal cell carcinoma, and a histological comparison between the primary and the present tumor exhibited in the latter a substantially larger number of clear cells and loss of papillary architecture. Immunohistochemistry demonstrated a characteristic renal immunophenotype for a type II tubulopapillary tumor metastatic to ovary. The tumor cells were strongly positive for CD10 and AMACR, and negative for cytokeratin 7. This confirmed the renal origin of the ovarian tumor despite its divergent morphology of the renal primary. This is the first reported case of ovarian metastases of type II tubulopapillary carcinoma of the kidney.

T-cell primary cutaneous lymphomas. A clinicopathological and immunohistochemical study.

Within the large framework of the lymphoproliferative diseases, the primary cutaneous lymphomas are distinct pathologic conditions, defined by particular morphologic, immunologic, genetic, and clinic criteria. The study aimed to create the first clinicopathological and immunohistochemical profile of primary cutaneous lymphoma for a Romanian region. We investigated a series of 16 cases (diagnosed during a 5-year period) in accordance with the general principles of primary cutaneous lymphoma management. The methods included the clinic and morphologic exams, the latter relying on standard and immunohistochemical staining. The results revealed that all studied cases were T-type lymphomas, in terms of the WHO-EORTC classification. Most of these cases were diagnosed as mycosis fungoides; the group also included cases of Sezary syndrome, as well as rare entities such as: mycosis fungoides associated with follicular mucinosis and subcutaneous panniculitis-like T-cell lymphoma. Our discussions focused on the role of the clinicopathological assessment for the primary cutaneous lymphoma diagnosis and emphasized the importance of the immunohistochemical investigation. Compared with the previous Romanian researches on this topic, presenting only isolated cases, the current study develops a new level of analysis, based on the rigorous monitoring of a relatively large geographical area, for a long time horizon.

The value of intraoperative diagnosis in breast lesions.

UNLABELLED: Frozen section examination is aimed at making a preoperative diagnosis, determining the benign or malignant nature of a breast lesion, but also the most suitable surgical procedure. The sensitivity and specificity of this method and the causes of discrepancies were analyzed in a retrospective study of 2 177 breast lesions. METHOD: 1,150 frozen sections from 2,177 breast lesions were performed in the interval 1999-2005. The sections made at the open door cryostat and measuring 5 microm were stained with rapid Hematoxylin-Eosin. The following terms were used for describing the intraoperative diagnosis: negative, positive, and await paraffin section. After the frozen section diagnosis was made, the frozen tissue was thawed to room temperature and fixed in formalin overnight for further paraffin processing. The remaining unfrozen tissue was processed into a paraffin section. RESULTS: The number of cases and the number of frozen sections increased from 1999 (341 cases, 87 frozen sections) to 2005 (441 cases, 220 frozen sections). Mean sensitivity (a/a+c) was 94%, and mean specificity (d/b+d) was 99%. The false positive cases accounted for 0.08%, while the false negative ones for 2.26%. In 7% of the cases the diagnosis could not be made on frozen section. CONCLUSIONS: Despite the raging popularity of aspiration cytology, frozen section still stands out as the method of choice for rapid diagnosis. Frozen section is not indicated to be performed on mammographically detected lesions, small lesions, papillary lesions, proliferating fibrocystic disease, or tubular carcinoma.

[Evaluation of peritoneal extensions for the diagnosis and management of serous ovarian borderline tumors]. / Importanta evaluarii implantelor peritoneale în diagnosticul si managementul tumorilor ovariene seroase borderline.

Serous borderline tumours of the ovary represent a heterogeneous group of epithelial ovarian neoplasm. They are usually associated with a favourable outcome. Some of them have a worse prognosis. The most important prognostic factor is represented by the association with peritoneal implants (non-invasive and invasive). Tumours associated with noninvasive implants have an excellent prognosis and tumours associated with invasive implants have a fatal outcome. This article presents 15 serous borderline ovarian tumours, 12 associated with peritoneal implants, 2 of them with invasive implants and 10 with non-invasive implants. The authors present the main microscopic criteria for the diagnosis of peritoneal implants, their histogenesis and the importance for the management of these tumours.

[Endosalpingiosis of the axillary lymph nodes--primary or metastatic tumour?]. / Endosalpingioza limfonodulilor axilari--leziune primara sau metastastica?

The involvement of extra-abdominal sites by serous ovarian tumours of low malignant potential is extremely rare. In this paper we present the case of a 33 years old woman, diagnosed with atypical endosalpingiosis in the axillary lymph nodes before the diagnosis of a bilaterally ovarian serous tumour of low malignant potential. The occurrence of axillary lymph nodes involvement associated with serous tumours of the ovary could be explained by the presence of circulating serous cells that remained dormant for a period of time or by the development of an independent primary tumour from glandular inclusions in axillary lymph nodes. The recognition of the occurrence of axillary atypical endosalpingiosis in association with serous tumours of the ovary is important to avoid misdiagnosis. It is better to define these lesions as secondary serous papillary involvement.

[The significance of intestinal metaplasia related to gastric ulcer]. / Semnificatia metaplaziei intestinale in contextul ulcerului gastric.

PURPOSE: Intestinal metaplasia is considered an intermediary stage of gastric carcinogenesis. Thus, we aim to investigate lesions of intestinal metaplasia diagnosed at patients with peptic ulcer. MATERIAL AND METHODS: Our study was achieved on a group of 212 patients, clinically diagnosed with gastric ulcer and having partial gastrectomy. The fragments obtained from the circumference, the basis and from around the ulcer were formalin-fixed (10%) and paraffin included. The specimens were stained routinely (HE) and with special methods (van Gieson, Masson, Gomori, PAS and Alcian Blue). RESULTS: Intestinal metaplasia was present in 36 cases (16.9%). It was noted as a unique lesion (in 10 cases), in association with chronic gastritis (23 cases) and with dysplasia (3 cases). Most of the cases (70%) displayed type I (complete) metaplasia characterized by the presence of enterocytes, goblet and Paneth cells. The glandular architecture was regular, with straight crypts, lined by mature, absorbtion cells and goblet cells producing sialomucins. 20% of the cases displayed type II (incomplete) metaplasia, with distort crypts, lined by a few absorptive and goblet cells and sparse Paneth cells. 10% of the cases presented type III (incomplete, colonic type) metaplasia with twisted crypts, increased cell density and stratification. The goblet cells in the adjacent mucosa of the malignant ulcers contained mainly sulphomucins, together with a few neutral mucins and sialomucins. The signification and the involvement of the intestinal metaplasia in the malignant transformation of the gastric ulcer are discussed. CONCLUSION: Since it represents a risk factor for carcinogenesis the identification of intestinal metaplasia in the context of the gastric ulcer is extremely important.

Adenosquamous cervical carcinoma morphological characteristics.

Adenosquamous carcinomas range between 5-25% of cervical cancers and are composed by an admixture of malignant squamous and glandular elements. The aim of our study was to identify some common characteristics and to evaluate the correlation between the degrees of differentiation of the two components. We analyzed 15 cases diagnosed in a 6 years period. The age ranged between 26 years and 67 years (mean age 46.5 years). Paraffin embedding, followed by HE staining were performed. Differential diagnosis with endometrioid adenocarcinoma of the cervix with squamous metaplasia was made. Four cases (26.66%) were subtyped as clear cell adenosquamous carcinomas and 2 cases (13.33%) were subtyped as glassy cell carcinomas, exhibiting finely granular ground glass type cytoplasm. 93.33% of cases exhibited a poorly differentiated squamous component and 66.66% of cases exhibited a well differentiated glandular component. 20% (3 cases) presented prominent lymphoplasmacytic and eosinophilic inflammatory tumoral infiltrate. Squamous intraepithelial lesions in overlying epithelium was observed in 4 cases (26.66%). One case presented extension to the uterine body. One case, diagnosed as glassy cell subtype, presented regional lymph node metastases. Our study concluded the occurrence of adenosquamous cervical carcinomas at a similar age with squamous cervical carcinomas in the investigated group of patients. As adenosquamous cervical carcinomas are considered expressions of a biphasic differentiation of a single pluripotential sub-columnar reserve cell, a similar degree of differentiation of the two components would be expected. Although, we registered a degree of variability in grading of the two components, with a tendency of squamous component toward poorly differentiated aspect and a slightly dominant aspect of well differentiated glandular pattern.

The morphologic changes induced by hormone and radiation therapy on prostate carcinoma.

The morphologic changes induced by hormone and radiation therapy were evaluated in prostate biopsy and prostatectomy specimens from patients with residual prostate carcinoma. The two therapeutic methods induce changes both in the nonmalignant and malignant residual prostatic tissue. Following hormone therapy, the nonmalignant prostatic tissue showed atrophy of prostatic acini associated with fibrosis, basal cell hyperplasia, degenerative changes of the secretory epithelial cells, and a marked decrease of high-grade intraepithelial neoplasia (HGPIN). In the fragments of residual carcinoma, squamous cell metaplasia, necrosis, and necrobiosis in the foci, vacuolization of the cell cytoplasm, smaller, rare nucleoli, intraluminal crystalloids, higher Gleason score associated with a lower capsular penetration, areas of necrosis and mitoses were found. Following radiation therapy, the nontumoral prostatic tissue showed an increased number of atrophic acini, squamous cell metaplasia, and presence of atypical glands. The morphologic changes induced by radiation therapy in the residual prostatic carcinoma were characterized by an abnormal architectural structure of the glands and presence of cell atypias correlated with the biochemical lowering of serum PSA.

[Acinic cell adenocarcinoma of the lip]. / Adenocarcinom cu celule acinare cu localizare la nivelul buzei. Prezentare de caz.

The variable histological appearance of acinic cell carcinoma coupled with its uncommon occurrence account for considerable diagnostic difficulties. We present the case of a 68 years old women, with a salivary cyst localised in the upper lip. The tumour mass was excised, fixed in formaline, embedded in paraffin and the sections were stained with Haematoxylin-Eosin, PAS-Haematoxylin, PAS-Alcian blue and Perls. The tumour was nodular, well circumscribed, with a cystic appearance on the cut surface. Microscopically, the tumour had a papillary-cystic growth, with one large cystic space lined by epithelium of variable thickness and branching projections of epithelium occupying a large portion of the cyst's lumen. Different cellular features were recognised in the tumour, with the presence of both serous and mucous acinar differentiation. Also, vacuolated cells were present in a large number. Acinic cell adenocarcinoma is a malignant epithelial neoplasm in which the neoplastic cells demonstrate not only serous acinar differentiation. The clinical and histopathological findings are discussed in the light of the literature.

Molecular mechanisms in hormone-resistant prostate cancer.

Prostate cancer is the most common malignancy in males. Despite the efforts for an early diagnosis, approximately one third of the cases are diagnosed in advanced clinical stages. Prostatic cancer, as the function of normal prostate is dependent upon androgens. So, androgenic deprivation represents an effective treatment especially in advanced cases. Although, the majority of patients will initially respond to androgen blockade, consequently the hormone-resistance will develop and the tumor will progress. The mechanism that determines tumoral progression during the endocrine treatment is driven by genomic instability, characterized by activating mutations of androgen receptor gene (AR), progression of some cellular clones possible of neuroendocrine origin that become adapted to low concentrations of residual adrenal androgens, suppression of apoptosis, by bcl-2 oncogene overexpression and p53 mutations, and growth factors (IGF-1--Insulin-like growth factor, KGF--keratinocyte growth factor, EGF--Epidermal growth factor, TGF a, b- Transforming growth factor a and b, bFGF--Fibroblastic growth factor type b) regulatory effect through either a paracrine or an autocrine mechanism. The identification of molecular alterations that appear during prostate carcinogenesis, may lead to the identification of new molecular targets to prevent hormone-resistance and to improve the prognosis in prostate cancers.

[The significance of morphologic and immunohistochemical patterns in the diagnosis of undifferentiated endometrial sarcoma]. / Importanta aspectului morfologic si imunohistochimic în diagnosticul sarcomului endometrial nediferentiat.

We present the case of a 56-year-old woman presenting an uterine tumor associated with pain and vaginal bleeding. The slides from the tumor were studied with monoclonal antibodies to Vimentin, CD 10, KL 1, Actin, Desmin, CD 34, S 100 protein, Ki 67, PCNA. The tumor cells were Vimentin and CD 10 diffuse positive, focal Actin positive, Desmin, KL 1, CD 34 and S 100 protein-negative. 85% of the tumor cells were PCNA positive and 25 % were Ki 67 positive. We conclude that undifferentiated endometrial sarcoma may express specific markers but also muscle-related antigens. These findings reflect a common relationship of the endometrial stromal cells to the myometrium. Knowledge of these immunoreactivity patterns is essential when evaluating poorly differentiated uterine endometrial sarcoma .It simulates morphological pattern of muscle uterine tumors.

[Hepatic changes due to the administration of midazolam and ketamine--an experimental study]. / Modificari hepatice secundare administrarii de midazolam si ketamina. Studiu experimental.

UNLABELLED: The aim of the study was the investigation of the secondary effects at the hepatic level determined by anesthetics. MATERIAL AND METHODS: There were used 4 groups of 10 mature white Wistar rats, males and females. Group I was the witness group. According to the experimental protocol, group II received midazolam and ketamine, group III--carbon tetrachloride and group IV--midazolam, ketamine and carbon tetrachloride. The hepatic fragments taken from the sacrificed animals after 4 weeks were processed for light microscopy (HE, van Gieson and Gömöri stains) and also for electronic microscopy. RESULTS: Midazolam in association with ketamine determined at the hepatic level a series of morphologic changes, identified in light and electronic microscopy. The light microscopy analysis revealed a significant inflammatory syndrome, and many isolated cellular necroses (acidophile bodies--apoptotic cells). Moreover, the electronic microscopy study showed marked anomalies of the cellular components, even when light microscopy indicated only minor lesions. The predominant ultrastructural changes were the mitochondrial abnormalities. DISCUSSIONS: The most numerous and diverse morphologic changes were observed at the group where carbon tetrachloride was administered in association with midazolam and ketamine. We can assert that carbon tetrachloride increased the aggressive potential of ketamine, manifested even in association with midazolam. CONCLUSIONS: Although each of the two anesthetics does not have an evident hepatotoxicity, when they are associated with each other or they are administered with a known hepatotoxic substance, they determine hepatic lesions of various sizes and degrees.