Type II pleuropulmonary blastoma in a fetus: case report of a rare mesenchymal mediastinal tumor and literature review.

Mediastinal tumors are exceedingly rare during fetal development, presenting significant diagnostic challenges and potentially leading to severe outcomes such as stillbirth or metastatic disease if not promptly identified and managed. Pleuropulmonary blastomas are primitive mesenchymal tumors often linked to mutations in the DICER1 gene, indicating a hereditary pattern associated with other common adult neoplasms with dominant inheritance. This report describes a case involving a 20-year-old Caucasian woman whose pregnancy was complicated by a stillbirth in the second trimester. Initial suspicions of a mediastinal tumor arose from blood tests and ultrasound examinations during pregnancy surveillance. However, the definitive diagnosis of a type II pleuropulmonary blastoma was established through a pathological examination at autopsy. This case underscores the complexities of diagnosing fetal mediastinal tumors and contributes to the sparse literature on neonatal pleuropulmonary blastomas. Our comprehensive review of the differential diagnoses and literature emphasizes the unique characteristics of pleuropulmonary blastoma and its similarities to other soft tissue sarcomas, enhancing understanding of their clinical and genetic profiles.

Can SARS-CoV-2 Induce Uterine Vascular Anomalies and Poor Contractile Response?-A Case Report.

We are reporting a case of a 36 year-old Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) positive hypertensive primigravida with postpartum uterine atony that required emergency subtotal hysterectomy at Saint John Hospital Bucur Maternity Bucharest. The maternity was designated as the Coronavirus Disease 2019 (COVID-19) Maternity for Bucharest and Ilfov County since March 2020. The patient was mildly symptomatic for SARS-CoV-2, infection confirmed with reverse transcription polymerase chain reaction (RT-PCR). The caesarean section was performed and a live male fetus was born, 2630 g and Apgar Score of 9 (the male fetus was negative for SARS-CoV-2). Postpartum hysterectomy with adnexal preservation was performed because of uterine atony. The postoperative evolution was favorable. The patient was discharged with her baby 10 days after birth. Given the limited resources, the placenta, the umbilical cord and the uterus were not tested for SARS-CoV-2. The pathology exam revealed that on the maternal side there were specific uterine atony lesions as well as endometrial and miometrial ischaemia. The placenta had nonspecific findings: chronic ischemic lesions with small villi, fibrin deposits in the materno-fetal interface. The peculiarity of the case is that we report the morphological findings of the placenta and uterus resulted from intrapartum uterine atonia in a patient with gestational arterial hypertension, premature birth and COVID-19. Further studies are required to characterize the pattern of such intricate conditions.

Morphological and immunohistochemical diagnostic of extragastrointestinal stromal tumors - a 51 case series analysis.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract, originating from structures differentiating towards Cajal cells. Due to their morphology and localization, the extragastrointestinal stromal tumors (EGISTs) can be a diagnostic challenge. We investigated a series of 51 EGISTs diagnosed in our institutions, aiming to explore the immunophenotypes and to analyze the process and the utility of the antibodies required for a positive diagnosis. Immunohistochemical examinations were done for pan-cytokeratin (pan-CK), Ki67, discovered on GIST1 (DOG1) protein and platelet-derived growth factor receptor alpha (PDGFRA), as necessary. The main tumor site was abdominal wall in 43 (84%) cases, most of the tumors showed spindle cell cellularity, followed by mixed and epithelioid type. Twenty-six cases revealed a full conventional immunohistochemical profile with DOG1 positivity. In 10 cases, c-KIT expression was absent but with the preservation of cluster of differentiation (CD)34 positivity, and eight cases were positive for PDGFRA. In our study, we found a subgroup of eight cases presenting in extra-abdominal settings (including one in lung and two in the head-and-neck area). We concluded EGISTs represent a histopathological and immunohistochemically challenging subgroup testing more often negative for c-KIT mutations and positive for PDGFRA compared to GIST. DOG1 remains the marker of choice regardless of tumor site, while CD34 and CD117 should be considered as adjuvants.

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.

The role of glomerular morphometric features in pediatric podocytopathies - a single center study.

Podocytopathies represent a well-studied subgroup of glomerulopathies, being characterized by proteinuria due to damage or dysfunction of podocytes. Glomerular size in podocytopathies has been studied in different population, but only a few studies take in consideration the pediatric population. There are different methods to assess the glomerular size, but most of the studies report the maximal profile area as being the most accurate one. The aim of this study is to determine the range values of glomeruli in pediatric population with glomerulopathies and to establish a correlation between the measured size and several laboratory features. The patients that undergo renal biopsy in the Department of Nephrology, "Maria Sklodowska Curie" Clinical Emergency Hospital for Children, Bucharest, Romania, were divided into two groups: control vs. affected∕patient group. The control group included children that require renal biopsy for renal impairments other than high-range proteinuria (most of them recurrent microscopic asymptomatic hematuria), while the affected group had nephrotic-range proteinuria. Thirty patients were selected to be part of the control group and 30 patients in the affected group. In control group, the mean value diameter was 166.23±13.04 µm, and the area of the glomerulus had a mean value of 19 126.86±3070.83 µm². In the affected group, we obtained the following results: the mean value diameter was 192.42±28.15 µm, while the glomerular cross-sectional area had a mean value of 23 535.55±6456.57 µm². Using the linear regression, we concluded that all the cases with increased-size glomeruli had more urinary protein loss compared with the ones that had small-size glomeruli and low-range proteinuria.