The history of the Laboratory of Pathology of the Cluj-Napoca Oncological Institute.

The Laboratory of Pathology of the actual "Professor Ion Chiricuta" Oncological Institute of Cluj-Napoca, former "Iuliu Maniu" Institute for Cancer Study and Prophylaxis, had the privilege that in its framework carry on an important part of their activity professors Titu Vasiliu and Rubin Popa, who are forming, beside Victor Babes, the golden trinity of the Romanian pathology. The Cancer Institute of Cluj, one of the first in the World, was founded in 1929, especially by the clear-sightedness and the efforts of Professor Iuliu Moldovan, the master of the modern Romanian school of hygiene. The clinic division was assisted by a Laboratory of Pathology, whose chief was appointed the young pathologist of high competence, Rubin Popa, associate Professor of this department of the Cluj School of Medicine. In 1942' he became director of the Institute, function accomplished until his premature disappearance in 1958. Titu Vasiliu worked in the Oncological Institute from 1949, a year after his forced retreat from the chair of pathology, up to 1958. Fortunately, his premature disappearance did not interrupt the activity of the laboratory, because the management of the Oncological Institute was committed to Ion Chiricuta, an experimented and modern surgeon of Bucharest. From 1960, the Laboratory of Pathology has been led by Professor Augustin Muresan, an experimented, rigorous and prudent pathologist, who has imprinted these indispensable qualities to his disciples learning under his leadership. The activity of the laboratory has been very favorably influenced by the presence of Professor Gheorghe Badenski from the Department of Microbiology. The collaboration with Professor Eugen Pora from Babes-Bolyai Department of Animal Physiology and his disciples, Virgil Toma, Draga Nestor, Sena Rosculet, Carmen Stugren and Georgette Buga has carried on the performance of interesting works concerning the thymus involution in tumor-bearing hosts and its signification for the depressed immunity in the advanced stages of cancer. In the same direction, the behavior of mast cells has been studied in collaboration with Professor George Csaba from the Budapest Medical University, Department of Biology. The observations brought about were remarked by the Canadian scientist Hans Selye. Most of these works have been included in the book "Immunity and cancer", distinguished with "Victor Babes" Prize of the Romanian Academy. The arrival in the Institute of Professor Ion Macavei, disciple of Iuliu Hatieganu and founder of the Clinical Hematology in Cluj, expert in blood and bone marrow cytology, has given a strong impulse to the studies of malignant hemopoietic diseases. The current use of cytologic and histopathologic examinations in this field of pathology and, especially, the introduction by him, for the first time in Romania, of the osteomedullary biopsy has permitted the elaboration of an appreciated work about the cytologic and histologic diagnosis of lymphadenopathies. In the histochemical-histoenzymatic period of the microscopic diagnosis, between the years 1960-1990, the laboratory has enjoyed by the advices and the material help of Professor Raymond Wegmann from the Paris University, Institute of Histochemistry, the founder-editor of the International Review of Histochemistry, from 1976, of Cellular and Molecular Biology, who visited our laboratory in 1992. From 1965, in an adjacent Laboratory of Cytogenetics, Corneliu D. Olinici has performed the first karyotypes in Cluj and has teached the method to several other specialists. Despite the technical difficulties, the works performed in the Laboratory of Pathology have succeeded sometimes to reach the quality required by Professor Chiricuta to a valuable scientific work in cancerology. This performance has been obtained by a study concerning Crabtree effect variations in tumoral metastases or about lactic-dehydrogenase behavior in breast carcinomas.

[Massive bilateral orbito-palpebral hematoma complicating acute myeloblastic leukemia]. / Hématome massif orbito-palpébral bi-latéral au cours d'une leucémie aiguë myéloblastique.

The authors present a case of acute mieloblastic leucemia, having as an unique symptom a massive bilateral orbito-palpebral hematoma, but having not other symptoms of the hemoragipar syndroms common in acute leucemiae. After a short period of retreat of the disease, the goeson, leading to death.

[The relationship between the degree of dissemination of pharyngolaryngeal tumours and immunological changes (author's transl)]. / Le rapport entre le degré de dissémination des tumeurs pharyngolaryngées et les modifications immunologiques.

An investigation was carried out on 34 patients with malignant pharyngolaryngeal tumours which had been operated on, microscopic changes in the regional ganglia (sinusal histocytosis, hypertrophy of the germinal centres, the paracortical area, the number of pyroninophilic plasmocytes, the behaviour of the mastocytes) and into certain cell immunity tests (the cytological formula of the inflammatory reaction in the cutaneous window, intracutaneous reaction to tuberculin, the time taken to reject normal skin homografts). The results were correlated with the presence or absence of ganglionic metastases. A relative correlation was found between the absence of metastasis, and manifest sinusal histiocytosis, the hypertrophied paracortical zone, the considerable number of young mastocytes, early mobilisation of macrophages, a normal amount of time taken to reject the cutaneous homograft. These tests enable certain prognostic conclusions to be drawn and draw attention to the need, in some cases, to build up the low level of immunity.

[Retrospective studies on the relation between fibrocystic disease and cancer of the breast with therapeutic conclusions]. / Cercetari retrospective asupra raportului dintre boala fibrochistica si cancerul de sîn, cu concluzii terapeutice.

On the basis of 597 cases of benign and malignant tumoral, respectively dysplastic diseases of the breast, operated at the IInd Surgical Clinic of Tirgu-Mures during the period 1977-1983, the authors consider the fibrocystic disease (FCD) of the II and III degree as a facultative precancerous lesion. The extremely high frequency of FCD associated to the mammary cancer in young women, as well as of intense epithelial proliferations and intermediate forms, of transition from typical epithelial hyperplasias to the atypical forms observed in some of these cases, is pointed out. The 4 cases (1.94%) of mammary neoplasms which occurred late after a mammary sectorectomy performed for FCD illustrate that the risk of mammary neoplasm in FCD is 7.4 times higher than the mammary cancer rate in women without FCD. In the extensive forms of FCD with marked epithelial proliferations, especially if additional risk factors are also present, the authors recommend a uni- or bilateral subcutaneous mastectomy, a uni- or bilateral simple mastectomy respectively. They deem necessary the setting up, in all departments of general surgery, of an adequate organizational framework for the dispensary care, the hormonal therapy and the control of women with FCD.

Case of biliary lithiasis in an infant.

The case of a 3-month-old premature infant deceased by massive hemorrhage from a giant hemangioma of the right thigh, exhibiting also biliary lithiasis, is discussed. The six dark-green-blackish faceted calculi contained by the gall bladder appear to be formed of biliary pigment and the consequence of repeated inflammatory hemolytic episodes in an immunodeficient infant.

Malignant lymphomatoid granulomatosis infiltrating myocardium and producing sudden death.

The case of a 70 year old man suddenly deceased by myocardial lesions produced by a malignant pulmonary lymphomatoid granulomatosis is reported. The light microscopic pattern of the pulmonary, lymph node and myocardial lesions showed a polymorphous immunoblastic lymphoma.

The histopathological and immunohistochemical diagnosis in small cell lung carcinoma.

The small cells lung carcinoma (SCLC) represents 10-25% of the bronchogenical carcinomas, prevails at middle ages and is closely associated with tobacco smoke. It belongs to the group of carcinomas with neuroendocrine differentiation, the patients presenting various paraneoplastic syndromes. The study was performed on 491 patients with a clinical and radiological suspicion of bronchopulmonary cancer. In this study, the histopathological examination gives results similar to those mentioned in the medical literature for the small cells lung carcinoma, prevailing in the case of young patients. The immunohistochemical examinations are particularly precious in confirming the diagnosis, especially in the diagnosis of the lymphonodular micrometastases.

Microscopic patterns in surgically removed spleens.

348 spleens surgically removed have been examined microscopically and classified into 3 groups: (I) 154 emergency splenectomies (86 traumatic ruptures, 44 enlarged supramesocolic exeresis, 44 cirrhosis), (II) 143 therapeutic splenectomies (135 cases of hypersplenism among which 10 apparently primitive, 7 myeloproliferative syndromes, 1 hairy cell leukemia), and (III) 51 diagnostic splenectomies (7 non specific inflammations, 2 tuberculosis, 1 mycosis, 6 echinococcosis, 12 leukemias, 9 non-Hodgkin's lymphomas, 13 Hodgkin's lymphomas, 1 primary splenic hemangioma). The study of the first group material, obtained especially of traumatic rupture, has been very valuable to follow the spleen microscopic structure in normal humans of different age. The latter two group cases have raised interesting problems of microscopic diagnosis, permitting at the same time a better understanding of the pathology of this organ.

Lymphoid changes suggesting escalation of immune response into malignant lymphoma.

The conditions in which the microscopic changes of the lymphoid organs, especially lymph nodes, render difficult the histologic decision of immune response or malignant lymphoma, are reviewed. The possibility that in certain circumstances, prolonged, pathologic immune response escalate to malignant lymphomas, as well as the new classifications of these diseases, in terms of this conception are discussed.

Angio-immunoblastic lymphadenitis: remarks about two cases.

Two patients with clinical and pathological symptoms of so-called angioimmunoblastic lymphadenitis are presented. Both patients were over 50, with multiple lymphadenopathies, fever, pruritus and hyperglobulinemia. The lymph node changes exhibited a characteristic histological triad consisting of diffuse lymphoid proliferation, small arborizing vessels proliferation and paraamyloid-like amorphous material deposition. As previous authors suggested, the disease seems to be the expression of a prolonged hyperimmune response induced by the hypersensitivity to certain factors.

Lesions of the female genital tract in leukemia and lymphoma.

A pathological study was carried out on the female genital tract on specimens from 14 patients with leukemia or lymphoma. Marked lesions with microscopic alterations were found in chronic granulocytic leukemia and in histiocytic and mixed lymphomas, accompanied by clinical manifestations. The origin of the blastic elements is discussed.

Clinico-morphological correlative aspects in progressive muscular dystrophy.

The author's 15-year experience in the investigation of progressive muscular dystrophy (PMD) is presented. Clinical and paraclinical (biochemical, electromyographical and morphohistochemical) parameters were estimated and correlated in patients with facioscapulohumeral (FSH), Duchenne (D) and limb-girdle (LG) types of muscular dystrophy. The value of each kind of investigation was also estimated in the establishment of the anatomoclinical diagnosis of a degenerative muscular affection.

Different behaviour of thymus in hosts bearing skin homografts or ehrlich ascites carcinoma.

Thymus behaviour in A2G male mice transplanted with skin homografts or Ehrlich ascites carcinoma was followed for a period of 28 days. In comparison with control mice of the same strain in which only a slowly physiological involution of the thymus was observed, a marked, irreversible involution was seen in the tumour-bearing mice in contrast with the transient, completely recovered involution in animals transplanted with skin homografts. Thymus behaviour appears as the major structural difference between a host developping a strongly efficient or an inefficient immune response.

Effect of cortisol on the release and retention of labelled DNA in the thymus and spleen of mice.

The lymphocytolytic effect of different doses of cortisol was studied in the thymus and spleen of mice previously injected with 3H-thymidine. The results indicate that in thymus the fraction of labelled cells was more resistant to cortisol than the unlabelled cell population. The release of DNA into the fraction of DNA soluble in 0.14 M NaC1 was delayed suggesting that cortisol controls indirectly the lymphocytolytic process. Up to 24 hours after administration of cortisol the loss of labelled spleen cells significantly exceeded the loss of unlabelled cells. The time course of the release of labelled DNA into the fraction of DNA soluble in 0.14 M NaC1 indicates that a fraction of labelled DNA was rapidly removed from the spleen after injection of cortisol.