Emergency and Elective Colorectal Cancer-Relationship between Clinical Factors, Tumor Topography and Surgical Strategies: A Cohort Study.

Background and Objectives: The purpose of the study was to analyze the relationships among several clinical factors and also the tumor topography and surgical strategies used in patients with colorectal cancer. Materials and Methods: We designed an analytical, observational, retrospective study that included patients admitted to our emergency surgical department and diagnosed with colorectal cancer. The study group inclusion criteria were: patients admitted during 2020-2022; patients diagnosed with colorectal cancer (including the ileocecal valve); patients who benefited from a surgical procedure, either emergency or elective. Results: In our study group, consisting of 153 patients, we accounted for 56.9% male patients and 43.1% female patients. The most common clinical manifestations were pain (73.2% of the study group), followed by abdominal distension (69.3% of the study group) and absence of intestinal transit (38.6% of the study group). A total of 69 patients had emergency surgery (45.1%), while 84 patients (54.9%) benefited from elective surgery. The most frequent topography of the tumor was the sigmoid colon, with 19.60% of the patients, followed by the colorectal junction, with 15.68% of the patients, and superior rectum and inferior rectum, with 11.11% of the patients in each subcategory. The most frequent type of procedure was right hemicolectomy (21.6% of the study group), followed by rectosigmoid resection (20.9% of the study group). The surgical procedure was finished by performing an anastomosis in 49% of the patients, and an ostomy in 43.1% of the patients, while for 7.8% of the patients, a tumoral biopsy was performed. Conclusions: Colorectal cancer remains one of the most frequent cancers in the world, with a heavy burden that involves high mortality, alterations in the quality of life of patients and their families, and also the financial costs of the medical systems.

Reinitiating Chemotherapy beyond Progression after Maintenance Immunotherapy in Extensive-Stage Small-Cell Lung Cancer.

Introduction: Small-cell lung cancer (SCLC) is an aggressive form of cancer with a poor prognosis. The two-year survival rate is 8% of all cases. Case presentation: We present the case of a male patient who was 50 years old at the time of diagnosis in May 2022. He was diagnosed with extensive-stage small-cell lung cancer, treated with immunotherapy in combination with chemotherapy (Durvalumab in combination with Etoposide plus Carboplatin) as a first-line treatment, followed by maintenance immunotherapy. In December 2023, a PET-CT scan revealed progressive disease with multiple metastases. Chemotherapy was reinitiated with Etoposide plus Cisplatin in January 2024. After two cycles of chemotherapy, the patient developed post-chemotherapy anemia, for which treatment with Epoetinum alpha was initiated. Chemotherapy was continued for another five cycles, until May 2024, with the maintenance of hemoglobin at a level within 9.9 mg/dL-11 mg/dL. Upon assessment at the end of May 2024, the patient presented an ECOG = 2 performance status, with a moderate general state, moderate-intensity fatigue, no pain, no anxiety or depression and no dyspnea. Discussions, Literature Review and Conclusions: Reinitiating chemotherapy after the failure of maintenance immunotherapy may be an option in patients with SCLC. Epoetinum allows oncological treatment by preventing chemotherapy-induced anemia.

Spindle Cell Rhabdomyosarcoma of the Inguinal Region Mimicking a Complicated Hernia in the Adult-An Unexpected Finding.

Rhabdomyosarcoma is a rare tumor that is diagnosed mostly in children and adolescents, rarely in adults, representing 2-5% of all soft tissue sarcomas. It has four subtypes that are recognized: embryonal (50%), alveolar (20%), pleomorphic (20%), and spindle cell/sclerosing (10%). The diagnosis of rhabdomyosarcoma is based on the histological detection of rhabdomyoblasts and the expression of muscle-related biomarkers. Spindle cell/sclerosing rhabdomyosarcoma consists morphologically of fusiform cells with vesicular chromatin arranged in a storiform pattern or long fascicles, with occasional rhabdomyoblasts. Also, dense, collagenous, sclerotic stroma may be seen more commonly in adults. We present a rare case of an adult who presented to the hospital with a tumor in the left inguinal area, was first diagnosed with a left strangulated inguinal hernia and was operated on as an emergency, although the diagnosis was ultimately a spindle cell rhabdomyosarcoma of the inguinal region.

Abrasion and dental pulp morphological changes in occlusal dysfunction.

AIM: The authors set out to assess if the presence and the degree of severity of the abrasion, as a consequence of the occlusal dysfunction, determine further morphological changes in the dental pulp. MATERIALS AND METHODS: Study group included teeth dental pulp from 45 cases with occlusal dysfunction, subsequently divided into two subgroups: 24 cases with abrasion (AB) and 21 cases without abrasion (NONAB). The set of morphological parameters of dental pulp were thicknesses of the outer layer, inner layer and entire peripheral pulp zone, the presence of pulpal calcifications and their extent within the dental pulp, the presence of interstitial fibrosis and its extent within the dental pulp and the vascular density (VD) of pulpal capillary network. Tissue samples were fixed in 10% buffered formalin, embedded in paraffin, and sectioned off at 4 µm. Serial slides were stained with Hematoxylin-Eosin (HE), Masson's trichrome (MT) and anti-cluster of differentiation 34 (CD34) antibodies labeled with 3,3'-Diaminobenzidine (DAB) and transformed into virtual slides on which the above-mentioned parameters were studied comparatively with the help of a dedicated in-house software, realized in MATLAB (MathWorks, USA). The numerical values of the assessed parameters were also stratified in classes, thus obtaining score scales for each parameter. Statistical tools used were Lilliefors test, t-test (two-sample assuming equal variances), Mann-Whitney test, Pearson's correlation test, one-way analysis of variance (ANOVA) test and χ² (chi-squared) test. RESULTS AND DISCUSSIONS: Both peripheral zone (PZ) and its layers individually tended to be thicker in the teeth with abrasion than in those without abrasion. Also, teeth with abrasion tended to develop larger amounts of calcium deposits in their dental pulp than teeth without abrasion. On the other hand, fibrotic tissue in dental pulp had no relationship with the presence or absence of abrasion. PZ as a whole and its layers evolved together in the same way, with a stronger correlation in the group of teeth without abrasion. Deposits of calcium evolved in the opposite direction to both the amount of fibrous tissue and the capillaries density of the dental pulp. Consequently, the amount of fibrous tissue and VD evolved together in the same way, more pronounced in the teeth without abrasion. CONCLUSIONS: Our preliminary study pointed out that different components of the dental pulp showed slight to moderate changes depending on the degree of abrasion in teeth with occlusal dysfunction.

Long-Term Survival in Metastatic Pancreatic Adenocarcinoma of Intestinal Type.

Introduction and Literature Review: Pancreatic cancer is often diagnosed in an advanced/metastatic stage, as it is a very aggressive type of cancer. The prognosis of pancreatic cancer is extremely unfavorable. The mean survival rate for patients with metastatic pancreatic adenocarcinoma is 3-6 months. Stage IV pancreatic cancer has a five-year survival rate of 1.3% to 13%. This article presents recent data regarding the oncologic management of metastatic pancreatic cancer. Case presentation: We present the case of a female patient who was 49 years old at the time of diagnosis, in June 2021. The patient was diagnosed with stage IV pancreatic neoplasm (due to liver metastases). The diagnosis was made by histopathological and immunohistochemical examination, which corroborated imaging investigations. The patient underwent four lines of chemotherapy between July 2021 and July 2024, undergoing partial response to the disease. The patient is a long-term survivor of metastatic pancreatic cancer (3 years in July 2024). Discussions: the peculiarity of this case is long-term survival (3 years and a month at the date when this article is being written) in a patient with pancreatic cancer and liver metastases. Conclusions: histopathological type, good performance status, CEA, and CA tumor markers 19.9 within normal limits may be favorable prognostic factors for long-term survival in metastatic pancreatic carcinoma.

Influence of tumor topography on clinical-morphological profile of laryngeal malignancies.

AIM: Laryngeal cancers are redoubtable because they are still diagnosed in advanced stages which results in poor survival and the decline of life quality. The authors intend to identify if the tumor topography influences clinical behavior, the morphological profile and therapeutic strategy. PATIENTS, MATERIALS AND METHODS: The study group included 188 patients with laryngeal malignancies diagnosed and treated in an Ear, Nose and Throat (ENT) Department. The patients have been divided into four groups according to the tumor topography and extension. Three categories of parameters were defined (epidemiological, clinical, and morphological) and analyzed comparatively between the four groups using filter scales and the χ² (chi-squared) correlation test. RESULTS: Epidemiological parameters (sex, age, socio-economic status) showed no significant differences between the four groups. Clinical parameters (symptoms, lymphadenopathies, surgical procedures, and hospitalization) instead registered significant differences between the four groups. Morphological parameters (longitudinal diameter, transverse diameter, shape, gross aspect, histopathological aspect, grade, local invasion - pT, lymph node invasion - pN, metastases - pM and tumor stage), excepting shape, registered too significant differences between the four groups. The analysis of the whole set of parameters in each group revealed different, distinct profiles for each of the topographic groups, especially for glottic and large tumors. Our results concerning the entire series of tumors ranged in the limits of variation of each of the parameters observed in the literature. CONCLUSIONS: Our study revealed that tumors placed in different regions of the larynx have distinct profiles from epidemiological, clinical, and morphological points of view. However, the profile of our entire group of tumors proved to be comparable with the literature data.

Right Transcephalic Ventriculo-Subclavian Shunt in the Surgical Treatment of Hydrocephalus-An Original Procedure for Drainage of Cerebrospinal Fluid into the Venous System.

The objectives of this article are to present an original surgical procedure for the temporary or definitive resolution of hydrocephalus, in the case of repeated failure of standard treatment techniques, and to present a case that was resolved using this surgical technique. MATERIALS AND METHODS: We present the case of a 20-year-old male patient with congenital hydrocephalus who underwent a number of 39 shunt revisions, given the repetitive dysfunctions of various techniques (ventriculo-peritoneal shunt, ventriculo-cardiac shunt). The patient was evaluated with the ventricular catheter externalized at the distal end and it was necessary to find an emergency surgical solution, considering the imminent risk of meningitis. The patient was also associated with the diagnosis of acute lithiasic cholecystitis. RESULTS AND DISCUSSIONS: The final chosen solution, right ventriculo-venous drainage using the cephalic vein, was a temporary surgical solution, but there are signs that this procedure can provide long-term ventricular drainage. CONCLUSIONS: Transcephalic ventriculo-subclavian drainage represents an alternative technical option, which can be used when established options become ineffective.

Preliminary study of some of the main intratumor stroma components in gastric carcinomas.

AIM: The relationship between stromal compartment and tumor behavior in gastric carcinomas is still poorly understood and defined. Therefore, the authors started, with this preliminary study, an analysis of stromal compartment morphology and behavior in tumors arising from gastric mucosa epithelium. MATERIALS AND METHODS: The study group included 75 patients operated for gastric carcinoma. Five parameters describing tumor morphology and behavior and eight parameters describing tumor stroma (TS) morphology were assessed. Histopathological examination included six serial sections of formalin-fixed, paraffin-embedded tumor tissue samples, stained with three classical stains and three antibodies to reveal the different parameters. For data comparison, Pearson's correlation test and the chi-squared (χ²) correlation test were used. RESULTS: Studied tumors were, usually, infiltrating, undifferentiated∕diffuse type, invasive in subserous spaces and with a Ki67 index higher than 20%. Collagen fibers dominated the stromal components, with a predominance of mature type and an average fibrillary index of 2.7. The whole amount of stromal components accounted for around one quarter of the tumor area. Mature collagen fibers were in opposite correlation with their immature counterpart, and both were in opposite correlation with smooth muscle fibers and expressed an opposite trend of correlation with components of vascular compartment. The whole amount of stromal components had divergent behavior with the components of vascular compartment. The latter expressed generally an opposite trend of correlation with individual fibrillary stromal components. We found only isolated relationships statistically significant between stromal components and tumor characteristics. CONCLUSIONS: TS is in a continuous remodeling process in relation to the evolution of tumor parenchyma, tumors less differentiated proving to have an immature stroma, with newly formed collagen fibers and higher vascular density. Further studies are required.

Epithelioid hemangioendothelioma - an unexpected diagnosis of a mediastinal tumor with extensive local thrombosis.

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor and the mediastinal localization is amongst the most infrequent. We present the case of a 37-year-old woman with a history of resected left thyroid tumor that presented to our department for evaluation of a left supraclavicular palpable mass in close contact with local vascular structures, and with heterogeneous contrast enhancement as described by computed tomography (CT) and magnetic resonance imaging (MRI). Considering the history of the patient, the presumptive diagnosis of thyroid tumor recurrence was established, and the patient was referred to surgical department. During procedure, we encountered important bleeding from a ruptured jugular vein branch, which we assumed to be a newly formed tumor blood vessel. After surgery (48 hours postoperatively), the patient developed important local thrombosis that encompassed the left internal jugular vein, left subclavian vein and the left brachiocephalic trunk that partially subsided after anticoagulant therapy. The histological examination revealed the presence of a vascular tumor proliferation of epithelioid endothelial cells that was characteristic of an EHE confirmed later on the immunohistochemical studies as Yes-associated protein 1-transcription factor E3 (YAP1-TFE3) subtype. In addition to the case report, some relevant information from the scarce literature data about mediastinal EHE were reviewed here.

Meropenem antibiotic therapy in acute secondary peritonitis, therapeutic effects superior to other therapies - experimental clinical and histopathological study in the laboratory animal.

AIM: A perforated peptic ulcer is the most common cause of peritonitis through the perforation of the digestive tube, which occurs in a percentage between 2% and 14% of patients diagnosed with peptic ulcer and being associated with a 10% to 30% mortality rate. MATERIALS AND METHODS: Considering the above, we imagined a study, using laboratory animals, in which we produced gastric perforations, then followed their evolution without antibiotic treatment and under antibiotic therapy with Cefuroxime 25 mg∕kg∕24 hours intravenously or Meropenem 40 mg∕kg∕24 hours intravenously, following the tissue changes both macroscopically and microscopically. RESULTS: The study revealed a mortality of 36.6%, most deaths (81.82%) occurred in the first 24 hours after the perforation, all subjects belonging to the group that did not receive antibiotic treatment and the group treated with Cefuroxime. From a clinical point of view (evaluation of the general condition), macroscopically and microscopically, a better evolution of the subjects who received antibiotic therapy can be observed, compared to those who did not receive antibiotic therapy, thus in the case of subjects who received antibiotic therapy, the absence or the presence of a small amount of intraperitoneal fluid, which has a serocitrine appearance, as well as the absence of macroscopic changes at the level of unaffected intraperitoneal organs, can be observed. Microscopically, it can be seen that in the subjects treated with Meropenem, changes in the parietal peritoneum were minimal. CONCLUSIONS: Antibiotic therapy with Meropenem in acute peritonitis has a survival rate comparable to peritoneal lavage and source control.

Remodeling of the aortic wall layers with ageing.

AIM: The authors aimed to evaluate the correlations between the variation of two of the main morphological parameters of the aortic wall (intima and media thicknesses) and ageing. MATERIALS AND METHODS: Aortic cross sections (base region, cross region, thoracic region, and abdominal region) were collected from 90 cases of all ages died and autopsied in the hospital. Tissue samples were processed using the classical histopathological technique (formalin fixation and paraffin embedding) and stained with Orcein and Goldner's trichrome. The obtained histological slides were transformed into virtual slides. Intima and media thicknesses were determined on virtual slides using a custom-made software, developed in MATLAB (MathWorks, USA). RESULTS AND DISCUSSIONS: The intima layer underwent an obvious and continuous process of thickening both from the aortic base region to its terminal (abdominal) region and from young ages to old age. The processes were similar in men and women but almost always more pronounced in men than in women. The media layer underwent a thickness reduction process from the aortic base to the terminal (abdominal) region whereas with age, the thickness of the layer increased. This divergent profile of evolution was similar in both men and women but with some variations depending on either topography or ageing. CONCLUSIONS: Each of the main layers of the aortic wall revealed dynamic individual evolutionary profiles related to age, gender and topography along the aortic path. Studies must be continued in a more detailed, standardized and integrated way.

Anatomical remodeling of the aortic wall in relation with the cause of death.

AIM: The authors set out to evaluate the correlations between three of the main morphological aortic parameters (aortic diameter, intima, and media thickness) and the cause of death. MATERIALS AND METHODS: Study group included 28 people died of a cardiovascular (CV) disease and 62 people died of a noncardiovascular (NCV) disease. Four aortic cross-sections (base, cross, thoracic, abdominal) were collected during autopsy from the selected cases, fixed in 10% buffered formalin and photographed together with a calibrating ruler. Then, they were processed using the classical histopathological (HP) technique (formalin fixation and paraffin embedding), stained with Hematoxylin-Eosin (HE) and Orcein, and the obtained histological slides were transformed into virtual slides. Aortic diameters were determined on calibrated photos using a custom-made software, developed in MATLAB (MathWorks, USA). Intima and media thicknesses were determined on virtual slides using a dedicated image analysis software. RESULTS AND DISCUSSIONS: The most frequent CV causes of death were the ischemic heart diseases and the most frequent NCV causes of death were the inflammatory diseases. Aortic diameter decreased from the aortic origin till the aortic end, with larger values in women than in men and in CV diseases than in NCV diseases. The difference in the remodeling of the aortic diameter between the two groups is smaller towards the abdominal region. Intima thickness increased from the aortic origin till the aortic end and was larger especially in women died of CV diseases, whereas in men there were some shifts at the extremities of the aorta. The difference in the remodeling of the intimal thickness between the two groups is extremely variable. Media was thicker in almost all of its segments in CV group than in NCV. It was a divergent evolution of the correlation degree trends in the two groups. CONCLUSIONS: The three morphological parameters of the aorta (diameter, intima, and media thicknesses) are more or less influenced by the pathological status that caused patient's death by the patient's sex and by the topographic region where the measurement was made.

Assessment of the aortic wall histological changes with ageing.

AIM: The authors aimed to quantitatively assess the variation with age of three of the main components of the aortic wall, namely elastic fibers (FE) and collagen fibers [FC(COL)], and smooth muscle cells (SMCs). MATERIALS AND METHODS: Four aortic cross sections (base, cross, thoracic, abdominal) were collected during autopsy from 90 cases of all ages, processed using the classical histopathological (HP) technique (formalin fixation and paraffin embedding) and stained with Orcein and Goldner's trichrome. The obtained histological slides were transformed into virtual slides. Quantitative measurements of the three components were made on identical regions of interest (ROIs) selected from two-paired slides stained with the above-mentioned techniques using custom-made software, developed in MATLAB (MathWorks, USA). RESULTS AND DISCUSSIONS: FE revealed an obvious decreasing general trend with age, present at all four levels of investigation. Smooth muscle fibers (FM) density showed almost no variation with age regardless of the level at which the measurement was made. FC(COL) density had an obvious increasing trend with age, expressed in all four aortic regions FE densities and FM densities were higher in men than in women, while FC(COL) densities were higher in women than in men in three of the aortic regions excepting, in all cases, the cross region. CONCLUSIONS: There were differences between men and women concerning the composition of aortic wall cellular and extracellular compartments. FE and FC(COL) dominated the age-related remodeling process of the aortic wall. The process evolved in the same way in all regions of the aorta. Studies need to be continued to define more clearly this complex process of vascular wall remodeling with aging.

Automated Gleason grading of prostate cancer using transfer learning from general-purpose deep-learning networks.

Two deep-learning algorithms designed to classify images according to the Gleason grading system that used transfer learning from two well-known general-purpose image classification networks (AlexNet and GoogleNet) were trained on Hematoxylin-Eosin histopathology stained microscopy images with prostate cancer. The dataset consisted of 439 images asymmetrically distributed in four Gleason grading groups. Mean and standard deviation accuracy for AlexNet derivate network was of 61.17±7 and for GoogleNet derivate network was of 60.9±7.4. The similar results obtained by the two networks with very different architecture, together with the normal distribution of classification error for both algorithms show that we have reached a maximum classification rate on this dataset. Taking into consideration all the constraints, we conclude that the resulted networks could assist pathologists in this field, providing first or second opinions on Gleason grading, thus presenting an objective opinion in a grading system which has showed in time a great deal of interobserver variability.

Agreement of two pre-trained deep-learning neural networks built with transfer learning with six pathologists on 6000 patches of prostate cancer from Gleason2019 Challenge.

INTRODUCTION: While the visual inspection of histopathology images by expert pathologists remains the golden standard method for grading of prostate cancer the quest for developing automated algorithms for the job is set and deep-learning techniques have emerged on top of other approaches. METHODS: Two pre-trained deep-learning networks, obtained with transfer learning from two general purpose classification networks - AlexNet and GoogleNet, originally trained on a proprietary dataset of prostate cancer were used to classify 6000 cropped images from Gleason2019 Challenge. RESULTS: The average agreement between the two networks and the six pathologists was found to be substantial for AlexNet and moderate for GoogleNet. When tested against the majority vote of the six pathologists the agreement was perfect and moderate for AlexNet, and GoogleNet, respectively. Despite our expectations, the average inter-pathologist agreement was moderate, while between the two networks it was substantial. Resulted accuracy for AlexNet and GoogleNet when tested against the majority vote as ground truth was of 85.51% and 74.75%, respectively. This result was higher than the score obtained on the dataset that they were trained on, showing their generalization capabilities. CONCLUSIONS: Both the agreement and the accuracy indicate a better performance of AlexNet over GoogleNet, making it suitable for clinical deployment thus could potentially contribute to faster, more accurate and with higher reproducibility prostate cancer diagnosis.

Clinical-morphological profiles of esophageal carcinoma's main types.

AIM: The purpose of the study was to define and then to compare particularly the morphological profiles of the main morphological types of esophageal carcinoma (EC). PATIENTS, MATERIALS AND METHODS: The studied group included 46 operated EC patients. Few parameters were clinical (gender and age). The rest of them described both gross and histological features of the entire group and of the two main histological types of carcinoma (lesion' site, lateral extension, lesion dimensions, gross aspect, and histological type, and tumor grade, and stage). Stratification scales of cases were defined according to each parameter in order to compare the data and a statistical apparatus [Student's t-test and χ² (chi-squared) test] was used. RESULTS: The studied tumors were encountered mostly in mature adult and elderly men, usually in the lower segments of the esophagus. Many of them had between five and ten cm in the long diameter and produced stenosis. Most of them had infiltrating appearance combined often with protruding or∕and ulcerated aspects. Usually, the tumors were poorly differentiated and in stage III. The two main histological types of EC showed different morphological profiles. Data from the literature revealed sometimes wide ranges of variation for the studied morphological parameters. Our results were within these ranges of variation. CONCLUSIONS: ECs proved to be aggressive and late diagnosed tumors in general, with distinct morphological and behavioral profiles for the two main histological types. Comparisons with literature data confirmed many of our observations regarding the clinical and morphological aspects of both ECs as a whole and its histological types.

Tissue microarrays - brief history, techniques and clinical future.

INTRODUCTION AND AIM: There is a growing need for better, cheaper and faster histopathological diagnostic. The authors reviewed the main steps of the efforts towards the improvement of the pre-analytical phase of tissue processing for histological examination. RESULTS: Since their introduction decades ago tissue microarrays (TMAs) proved their value by increasing efficiency, standardization and accuracy of many histological techniques, such as histochemistry, histoenzymology, immunohistochemistry, in situ hybridization, etc. By allowing the simultaneous analysis and comparison of multiple different tissues on a single histology slide (up to 1000 individual samples), TMAs are also having a significant economic advantage (consumables and labor). From its first description until recent years, the TMA techniques have evolved steadily but slowly despite many attempts to adapt it for clinical diagnostics. In this paper, we are reviewing the main techniques of obtaining TMA blocks from the beginning to the present day, as well as recent developments that are expanding their scope into high accuracy/efficiency clinical diagnostics. CONCLUSIONS: Considering recent developments, we believe that the prospect of high-throughput histology might be achievable in the not-so-distant future.

Peripheral adenopathies in children - an attempt of clinical morphological profile.

AIM: The authors have proposed to assess peripheral adenopathies in a series of hospitalized children in order to identify and define clinical and morphological profiles of different types of lymph node (LN) diseases. MATERIALS AND METHODS: The studied group consisted of 58 patients less than 18 years of age. The investigation algorithm included: gender, age, site, involvement, side, extension and histopathological (HP) type of LN lesions. Tissue fragments were processed using classical histological techniques (formalin fixation and paraffin embedment) and stained with Hematoxylin-Eosin (HE). In some cases (tuberculous lesions and lymphomas), special stainings (Ziehl-Neelsen) and immunohistochemistry were used. Stratification scales of cases were defined according to each parameter in order to compare the data. All obtained data were assessed individually, compared to each other and with similar data from the literature with the help of a statistical apparatus [χ² (chi-squared) test and analysis of variance (ANOVA) test] in some cases. RESULTS: The young patients were slightly more frequently boys, of all ages but with a mean age of 10 and half years. The affected LNs belonged most often to neck region, either on the left or on the right side but sometimes bilateral or even on the midline; usually, more than one LN was involved in the area. In most of the cases, the lesions were localized in only one LN area. HP picture was dominated by the inflammatory processes, firstly the nonspecific ones, followed by tuberculosis. DISCUSSIONS: Our observations fitted, for each parameter, with the wide ranges found in the literature. Comparisons between parameters' variations revealed differences, sometimes significant that we tried to organize in clinical and morphological profiles. CONCLUSIONS: The assessment of our data allowed us to define some clinical and morphological profiles of different types of adenopathy that, by improvement on studies including larger series, could be of real use in daily pediatric practice.

The clinical-morphological profile of tuberculous pleurisies - our experience in relation to literature data.

AIM: The authors made a morphological evaluation of pleural tissue fragments from patients hospitalized in Thoracic Surgery Department of the Emergency County Hospital of Craiova, Romania, over a period of 26 years, diagnosed with tuberculous lesions in the Pathology Department of the same Hospital. PATIENTS, MATERIALS AND METHODS: The studied material consisted of pleural tissue samples taken by biopsy or surgical excision from 39 cases coming out of 841 patients investigated in the above-mentioned period of time and diagnosed from histological point of view with tuberculosis (TB). Granuloma cell population was assessed using immunohistochemical method. For diagnostic confirmation, Ziehl-Neelsen staining has been used as a rule but, in some cases, immunohistochemistry was also used. RESULTS: TB lesions predominated in men usually around or over 50 years old. The diagnostic was suspected in almost half of the cases. Right cavity was more affected and the extended fibrosis was present in a significant number of cases. The inflammatory conflict was of reactive type, with giant Langhans cells granulomas and acidophilic necrosis but sometimes with superinfection or significant fibrous sequelae. CONCLUSIONS: Pleural effusions of TB origin are a reality more and more present due to the recrudescence of pulmonary TB in the last decades. Their presence should be suspected if faced to a unilateral pleural effusion with free-flowing fluid occurred almost often to a man of any age from youth to elderly.

The study of tumor architecture components in prostate adenocarcinoma using fractal dimension analysis.

AIM: The aim of the study is to evaluate the three main components of the tumor architecture in correlation with two different grading systems of prostate adenocarcinoma (PA) using the fractal dimension (FD) analysis. PATIENTS, MATERIALS AND METHODS: 433 fields with different patterns of PA selected from 83 patients with total prostatectomy according to Gleason and Srigley grading systems were selected. Four serial sections were cut and stained in order to assess the following parameters: tumor grading with Hematoxylin-Eosin (H-E), tumor cells architecture (GÖ) with Gömöri technique, tumor stroma architecture (TC) with Goldner's trichrome, and vascular network (VN) architecture with cluster of differentiation 34 (CD34) immunomarker. Images were binarized with variable user-defined empiric threshold for Goldner's trichrome staining and CD34 immunostaining and k-nearest neighbor approach for GÖ staining. The FD was computed for each binary image using a box-counting algorithm. The three computed values were used for clustering and classification, k-nearest neighbor proving to be a good choice with a classification rate, due to the irregular distribution of cases in different patterns. Values tending to "1" had the meaning of a more "Linear type" distribution and values tending to "2" had the meaning of a more "Area type" distribution. RESULTS: Tumor cells architecture had a more ordered smooth ascending trend towards "area-like" type of distribution (with FD>1.5) in Srigley system than in Gleason system. Tumor stroma architecture had almost the same type of distribution - between "linear-like" and "area-like" (FD~1.5) - in both grading systems. VN architecture had a more "linear-like" type of distribution (FD<1.5), with a descending trend towards high-grade patterns in both systems. Tumor cells architecture had a direct correlation with tumor stroma architecture and VN architecture (p-value of Pearson's test <0.001), while tumor stroma architecture and VN architecture proved no correlation (p-value of Pearson's test >0.05), irrespective of grading pattern. CONCLUSIONS: Tumor cell population is remodeling and adapting TC and VN in the same way its architectural disposal evolves. TC and VN develop independently of each other, the former towards "Area type" and the latter towards "Linear type" of architectural disposal as the degree of differentiation is decreasing. FD analysis proved that Srigley system is more accurate in grading PA than Gleason system.