Micromolecular multiple myeloma with chronic kidney failure in a young female patient on continuous hemodialysis.

The maximum incidence of multiple myeloma appears in the 6th-7th decade of life and although the number of patients aged les than 60 years is increasing in recent years, the diagnosis of a monoclonal gammopathy in a young patient, under the age of 40 years remains a rarity. Literature data cite an incidence of approximately 2.2% in patients less than 40-year-old and an incidence of 0.3% in patients less than 30-year-old of all cases diagnosed with multiple myeloma. We present the case of a 32-year-old patient, being on continuous hemodialysis for chronic kidney failure for about a year, at the Hematology Clinic of Craiova, Romania. We investigate the origin of a serum monoclonal component revealed when performing serum protein electrophoresis. Bone marrow examination revealed the presence of a plasma cell infiltrate of 18%, which associated with the presence of a serum monoclonal component and in the conditions of renal failure as a complication of the disease, has allowed the diagnosis of multiple myeloma.

Pseudorheumatoid disability man with chronic tophaceous gout: a case report.

Gout is a type of inflammatory arthropathy that affects the peripheral joints and results from the accumulation of monosodium urate (MSU) crystals in the synovial fluid and other tissues. This disease is the most common form of inflammatory arthritis in men over 40 years of age. The fundamental biochemical abnormality in gout is an increase in serum urate (SU) concentration. These needle-like crystals induce not only acute episodes of inflammatory process into the surrounding area, but also, in the long-term history of the disease, chronic inflammation that is associated with changes in articular and periarticular structures. The next step caused by deposited MSU crystals is represented by the tophus formation and chronic gouty synovitis. The presence of tophi has been associated with greater physical functional disability in gout patients. We presented a case of severe chronic tophaceous gout in a 48-year-old man with chronic hand arthritis and urolithiasis, to point the significance of complex assessment (clinical, functional, imagistic and histological exams) in the diagnosis of a soft tissue lesion, especially in hands.

The diagnostic characteristics of a group of patients with primary gastric lymphoma: macroscopic, histopathological and immunohistochemical aspects.

UNLABELLED: Primary gastric lymphoma is defined as the malignant lymphoproliferative disease with initial symptoms located in the stomach, or tumor mass located in the stomach. This paper aims to present the macroscopic, histopathological and immunohistochemical aspects encountered in a group of patients with primary gastric lymphoma, diagnosed between 2005 and 2010 in the Hematology Clinic of Craiova and the Hematology Clinic of "Fundeni" Institute in Bucharest. MATERIALS AND METHODS: This study was performed on a group of 65 patients diagnosed with primary gastric lymphoma. The positive diagnosis in primary gastric lymphoma is established by the histopathological and immunohistochemical analysis of gastric biopsies, taken during the upper gastrointestinal endoscopy, or of gastric resection samples. We used the monoclonal antibodies CD20, CD10, CD5, k light chain, PCNA (proliferating cell nuclear antigen) and Ki67. RESULTS: The average age of the patients enrolled in the study was 52.55 years. The most common macroscopic feature encountered was the mixed ulcerative-vegetative one. We found two histological types, represented by diffuse large B-cell lymphoma (with or without MALT component), and marginal zone lymphoma (MALT type). Both the MALT type lymphoma and the diffuse large B-cell lymphoma revealed B-cell phenotype. CONCLUSIONS: A correct diagnosis is very important in terms of therapeutic approach. The characteristics of the group of patients were: a higher number of the aggressive histological type; an excessive use of gastric resection; none of the cases was a T-lymphoproliferation.

Secondary plasma cell leukemia.

Plasma cell leukemia (PCL) is a rare disease and is the least common variant of multiple myeloma accounting for 2-3% of all plasma cell dyscrasias. We report a patient who was diagnosed with multiple myeloma, 12 months earlier; he was treated with VBCMP, VCMP regime, and after 12 months he presented of high grade fever, weakness, palpitations, loss of appetite, bone pains, dyspnea. Initial evaluation revealed plasmacytosis with blood plasma cell count of 13 860/mm³. His hemoglobin (Hb) was 8.4 mg/dL, platelets were 45 000/mm³ and total leukocyte count (TLC) was 23 100/mm³ (60% plasma cells). Bone marrow examination revealed 90% plasmablastic cells. Serum LDH was high at 3117 U/L and serum calcium was also elevated at 9.1 mg/dL. A diagnosis of PCL was made and the patient was started on treatment with VAD regime along with supportive care. Patient condition deteriorated very quickly, despite treatment and he died on the third day. A detailed report of this case and a review of PCL is presented here.

Synchronous carcinoma of the ascending colon and caecum.

The caecum and the ascending colon are the colon segments most frequently affected by tumoral synchronism. Synchronous colorectal carcinoma etiopathogenesis is complex and most likely by malignancy of preexisting adenomas (adenoma-adenocarcinoma sequence). The following tumoral synchronism clinical case's particularity is represented by the simultaneous diagnosis of a flat-type adenocarcinoma of the caecum (less common histopathological type) and of a mucinous adenocarcinoma on the ascending colon. Tumor profiles of both carcinomas were examined histologically and immunohistochemically, emphasizing: (1) tumor proliferation different histological type; (2) residual adenomas in the periphery of the flat-type adenocarcinoma; (3) hardly microscopic detectable invasive character of the flat-type carcinoma; (4) mucinous carcinoma's infiltrating character and its immunohistochemical phenotype; (5) both tumor aggressiveness.

Thyroid regional metastasis from a giant cell malignant fibrous histiocytoma of the larynx in a patient with history of trichinellosis and tuberculosis.

Sarcomas represent less than 1% of malignant laryngeal tumors and giant cell malignant fibrous histiocytoma is exceptionally rare. Diagnosis is histologically based and immunohistochemistry allows differentiation from other fibro-histiocytic neoplasms. We present the case of a 53-year-old male patient with positive medical history for trichinellosis and tuberculosis, and a laryngeal tumor invading the thyroid and causing respiratory distress by airway obstruction. Total laryngectomy and thyroidectomy were performed followed by thyroxine replacement therapy and radiotherapy. Histologically, the tumor consisted of spindle shaped cells with prominent mitoses, and abundant, osteoclast-like, multinucleated giant cells. Similar lesions were identified in the thyroid, adipose and muscular tissues. Parasitic elements were present in muscles. Tumoral cells showed positive immunostaining for Ki67 (40-50%) and vimentin and negative for AE1/AE3, CD31, S100 and myoglobin; the giant multinucleated cells were CD68-positive. Chronic infection might have had a pathogenic significance.

Videocapsule endoscopy and single balloon enteroscopy: novel diagnostic techniques in small bowel pathology.

Videocapsule endoscopic (VCE) exploration represents a major breakthrough in non-invasive imagistic, especially of the small bowel. Our study group consisted of 29 initial subjects admitted in the 1st Internal Medicine and Gastroenterology Clinic at the Emergency County Hospital of Craiova between June 2008 and March 2009. We have excluded a number of eight subjects from the VCE-group, as their pathology represented an absolute contraindication for capsule ingestion. The remaining 21 patients (11 men - 52.38% vs. 10 women - 47.61%) underwent videocapsule diagnostic investigation followed by single balloon enteroscopy with biopsy or surgical removal, where case. Large resection cups were histologically prepared in the Pathology Department of the Emergency County Hospital of Craiova. We performed a statistical analysis of the data using Fisher's Exact Test, which is applicable to small numbered lots. In five cases (23.80%) VCE investigation did not reveal any abnormalities. Five (23.80%) cases had non-tumoral pathology, all of them being inflammatory lesions. We found tumoral lesions in 11 (52.38%) cases: five (23.80%) benign and six (28.57%) malign. We found that inflammatory lesions predominantly affected subjects in the 15-30 and 30-45 years intervals (p=0.00103), whereas tumoral lesions are positively correlated with old age, predominantly affecting the 45-60 and above 60-year-old groups (p=0.00216). VCE combined with SBE open new frontiers for small bowel exploration. Histology remains the single most accurate test for establishing the nature of a lesion.

Cathepsin-D expression in breast lesion: an immunohistochemical study.

Cathepsin-D (CathD) is an aspartyl lysosomal protease expressed in all tissues that might play a role in antigen processing, cell proliferation and tissue renewal, and activation of different pro hormones. The aim of our study was to compare the expression of CathD in most common breast tumors and tumor-like breast lesions. The study includes 21 patients with histologically verified breast lesions (adenosis, ductal hyperplasia, fibroadenomas, and different types of invasive carcinoma). We investigated the cathepsin-D expression in these breast lesions using immunohistochemistry (IH; paraffin-embedded tissues). Cathepsin-D staining within each lesion was assessed by estimating the area of the objects and the medium pixel intensity per object, as the integrated optical density (IOD). The immunostaining was more obvious in breast invasive carcinomas and macrophages. The reaction in tumor tissue was heterogeneous with little variation of staining intensity in positive tumor cells. Adenosis had the maximum area/signal intensity from all studied breast benign lesions (p<0.001, Student t-test). The general tendency (all benign lesions, lobular carcinomas and G3 ductal invasive carcinoma) was a more prominent representation of the cellular compartment. In the G3 ductal invasive carcinoma-type, the group of patients with metastases had a stronger expression in the cellular compartment. These results suggest that CathD expression was strongest in malignant than in benign breast disease, the positivity being present in both epithelial neoplastic and stromal cells. We also conclude that our procedure in IOD measurement is prone to less subjective-related biases, and thus more accurate and constant than other methods employed by other authors.

Kaposi's sarcoma associated with AIDS.

In 1872, Moritz Kaposi, first described "Idiopathisches multiples Pigmentsarkom der Haut", which has become known as Kaposi sarcoma (KS). In the present KS is considerate an opportunistic neoplasm rather than a genuine cancer. It is a disease with clinical aspects extremely different, associate with some immunological deficits. The discovering in 1994 of a new type of human herpes virus called human herpes virus type 8 (HHV8) in the KS lesions sustains also a viral etiology. Four forms of Kaposi's sarcoma are recognized: classical, endemic (associated with AIDS), epidemic and iatrogenic (usually after transplant). All these forms have the same histopathologic aspects and are associated with HHV. However, these differ in prognosis and treatment. The authors present a KS case associated with AIDS occurring at a patient in the childhood. The particularities of the case are the presence of only two cutaneous lesions, from which one giant tumor, and the other nodular in aspect and the appearance of an infection HIV in the childhood with involvement of others risk factors except homosexuality. It is important, on one side the importance of the histopathologic exam of an angiomatous tumor for the establishing the diagnosis of KS even when is solitaire and appear in the child, and the other side the absolute necessity to search an eventual concomitant infection with HIV in the presence of a KS.

Giant keratoacanthoma of the hand.

Giant keratoacanthoma (KA) is a very rare tumor which benefits of surgical treatment. We present a case of 61-years-old man with a giant keratoacanthoma situated on the dorsum of the right hand. The diagnosis is established by routine histopathologic examination.

[Primary anastomosis in perforated Crohn disease]. / Restabilirea primara a continuitatii digestive în boala Crohn perforata, neglijata.

Inflammatory bowel disease (IBD) comprises a group of diseases of intestine characterized by chronic inflammation of the bowel with periods of exacerbation and remission. The evolution of the disease needs, in some therapeutic moments, surgeon's intervention. We described the case of a patient hospitalized through emergency service of Military Hospital of Craiova which presented multiple ileo-cecal perforations, histological examination proving clinical supposition of Crohn's disease. The authors achieved, on the other hand, some considerations about etiopathogenical, clinical and therapeutic aspects of this disease.