Incidental imaging findings of congenital rib abnormalities - a case series and review of developmental concepts.

BACKGROUND: Congenital rib abnormalities are found in approximately 2% of the general population. Usually, they occur in isolation and are rarely symptomatic, but they can also be associated with other malformations. MATERIALS AND METHODS: We reviewed imaging examinations performed over a period of 2 years (2014-2015), enabling us to identify isolated rib abnormalities in 6 adult patients. RESULTS: The case series consisted in 3 cases with bilateral cervical ribs and 1 case each with bifid rib, costal fusion and rib pseudarthrosis. In all patients, the costal anomalies were discovered incidentally. All rib malformations were detected at thoracic radiography, except for the rib pseudarthrosis, which was identified at computed tomography (CT) scan. Differential diagnosis was made between cer-vical ribs and abnormalities of the C7 transverse process and of the first rib, while the other costal malformations were distinguished from tumoural, traumatic or inflammatory lesions of the chest wall, lung and pleura. Considering the existing knowledge on rib development, we suggest a classification of the most common types of rib malformations in three categories: (I) results of homeotic transforma-tion, referring to numerical aberrations; (II) segmentation errors, including costal fusion and bridging; (III) anomalies of resegmentation, resulting in bifid ribs. CONCLUSIONS: It is important that radiologists are familiarised with the imaging features of rib abnormalities, since these anomalies can be misinterpreted as lesions with different implications. We are convinced that the developmental classification proposed in this paper can contribute to a better understanding of this pathology. (Folia Morphol 2018; 77, 2: 386-392).

Ovarian cancer: insights into genetics and pathogeny.

Starting from the information on ovarian cancer provided by the mainstream publications, we construct a review focusing on the following issues: (i) the genetic profile, (ii) the role of the epithelial-mesenchymal transition in the acquirement of malignant features, (iii) the controversial hypothesis regarding the origin, and (iv) the involvement of the immune system in the tumoral microenvironment. Advances in the decipherment at the genetic level in the pathogenic mechanisms progressively lead to the idea of a genetic signature for the ovarian cancer. Moreover, the complementary approaches oriented towards the decryption of the intrinsic structure of the expressed molecules and, implicitly, the development of proteomics open new perspectives for an early diagnosis and an appropriate treatment. The research on the epithelial-mesenchymal transition (mainly those exploring the signaling pathways responsible for the switch between the loss of the epithelial characteristics and the gain of a mesenchymal cell phenotype, with results in the amplification of differentiation, motility and tumoral invasion) allow a deeper understanding of the complex pathogenic mechanism which governs ovarian carcinogenesis. The classic conception of ovarian cancer pathogeny, based on the role of the ovarian surface epithelium, is currently reconsidered, and a novel hypothesis is formulated, which supports direct involvement of the Fallopian tubes for the serous type. Although recent research suggests the implication of immune/inflammatory cells by specific mechanisms in ovarian cancer pathogenesis, there is yet reliable evidence concerning their modality of direct action and/or modulation of tumoral growth. Thus, ovarian carcinogenesis remains a research challenge, due to still numerous unknown factors involved in the malignant transformation sequences, originating from the genetic-molecular alterations and reflected by cellular and tissue expression patterns.

Actinic keratosis--a histoenzymological study.

Actinic keratosis or senile keratosis is the most frequent premalign epithelial lesion that occurs in the elderly with a history of prolonged and intense exposure to the UV radiation and with an inborn susceptibility. Although the genetics and risk factors are clear nowadays, the histogenesis of this lesion is still under study. The histoenzymologic tests (such as those that demonstrate the ATP-ase and SDH-ase activity) are very useful for early detection of the structural and biochemical changes within the actinic keratosis lesion.

Morphological features in the embryological development of the anterior arch of the mandible.

OBJECTIVES: Our study is focused on the typical morphological features of the development of the mandible. There were investigated both specific elements for the ossification process as well as aspects of the developing tooth germs. METHODS: We performed transmission electron microscopy analyses on sections obtained from 15 human embryos aged between 6 and 20 weeks. The sections were acquired from specific areas of the anterior arch of the mandible, corresponding to the sites of development of the tooth germs, namely the incisors and the canines. RESULTS: There were observed some characteristic elements for the intramembranous ossification process (mesenchymal cells, collagen fibers, osteoblasts, bony spicules), and for the different stages of odontogenesis (bud, cap). CONCLUSIONS: The results confirm the important role of this territory and highlight the primary elements of the intramembranous ossification and of the odontogenesis, as essential steps in the development of the head and the face.

Histology teachware for the Web site of the University of Medicine and Pharmacy "Gr. T. Popa" Iasi.

Design and implementation of Web educational materials for medical sciences are discussed starting from a brief presentation of the current trends in using Internet facilities and placing emphasis on the specific case of the www page constructed for the Department of Histology. The paper focuses on the development of teaching-aids for the morphological study of organs and systems, illustrated by the creation of Histology Album, including photographs and explanatory texts, which is accessible via this www departmental page. Relevant aspects for the construction of the Histology Album are detailed in terms of both logical structure and physical implementation, based on HTML techniques. Outcomes are expected in achieving a noticeable progress in students' instruction, as a result of diversifying the documentation possibilities and increasing the role of the individual work (by avoiding the permanent supervision of an instructor). Further improvements of this www page are commented in the light of the recently proposed frameworks for distance learning, relying on specialized software tools that allow student's interactive work.

[Prognosis and treatment of membranous glomerulonephritis-a 5-year prospective study]. / Prognosticul si tratamentul glomerulonefritei membranoase: studiu prospectiv pe 5 ani.

UNLABELLED: The aims of the study were to describe the clinical, pathological and biological features of membranous GN and to prospectively evaluate the relationships between individual negative prognostic factors--type of therapy and outcome. Between 1993-1998, 13/150 (8.7%) consecutive patients with renal biopsy had membranous GN (M = 62%, age = 42.5 +/- 14.5 years). Main (major) findings in these patients were: asymptomatic proteinuria--23.1%, heavy proteinuria (> 10 g/day)--33.3%, microscopic hematuria--53.8%, increased plasma creatinine levels--33.3%, hypertension--23.1% cases. 60% of the patients with nephrotic proteinuria had an underlying cause (infection, malignancy, immune-mediated systemic diseases). 40% of the patients with nephrotic proteinuria had 0 or less than 2 negative prognostic factors (without any of the recognized severe morphological changes). The following differentiated treatment protocols were applied: no treatment for asymptomatic proteinuria (group A), i.v. methyl-prednisolone boluses + prednisone 1 mg/kgc/day 3 months for those patients with few negative prognostic factors (group B), and steroids (as above) + cyclophosphamide (2 mg/kgc/day 3 months) or the Ponticelli regime in patients with important risk factors (group C). Outcome after a median follow-up period of 24 months was: complete remission in all cases from groups A + B (with only one exception were the underlying cause was breast malignancy); in group C in 75% of the subjects a complete or partial remission (proteinuria < 1 g/day) was obtained. Only one case progressed to chronic renal failure. There were no secondary effects from corticoids or immunosuppressive therapy. CONCLUSIONS: In membranous GN treatment should be tailored to the presence and type of negative prognostic factors. Even in high-risk patients combined steroids and immunosuppressive therapy determines a favorable outcome in 75% of the cases, without severe adverse effects.

[Operational models in the histopathological examination of liver puncture biopsies]. / Modele operationale în examenul histopatologic al punctiei biopsie hepatice.

The main goal of this paper is to give an overview of the personal experience in the investigation of the hepatic biopsy. There were analyzed liver specimens from 26 children hospitalized in Clinical Hospital "Sf. Maria" Iasi. The first clinic diagnosis was post-viral chronic hepatitis and most of the cases provided the serologic markers. Histopathological exam revealed 2 cases of active chronic hepatitis and 24 cases of persistent chronic hepatitis. The interpretation of the lesions relied on Ludwig and Metavir scoring systems. The significance of these scores is very important because they allow one to identify the grading of the necro-inflammatory/histological activity and the staging of fibrosis. Thus, the result of these scoring systems make it possible to classify the cases into aggressivity based forms, indicate the therapy approach and estimate the prognosis as well as the clinical course.

Morphologic evaluation of radiotherapy in cervical carcinoma--a computerized morphometric approach.

Our work analyses the effects of radiotherapy in cervical carcinoma by computerized morphometry techniques that evaluate the morphologic changes in the specimens taken from pre and post-irradiation biopsies of 8 cases. These cases were diagnosed as squamous cell carcinoma, undifferentiated (1 case), moderately (5 cases) and well differentiated (2 cases). For each case, 40 relevant microscopic fields were chosen, reflecting the morphologic aspects before (20 fields) and after irradiation (20 fields). The digitised images of these fields were used for measuring the tumoral and stromal areas by a program we implemented in the Zeiss KS400 environment. The program provides a mean tumoral/stromal area for each case, computed by averaging the results of the 20 measurements performed on the pre and post-irradiation images. In terms of a stereological interpretation, each mean tumoral area expresses the percentage of the tumoral volume and can be used as an index for quantifying the efficiency of the radiotherapy. Such an index allows developing comparative discussions on cases that belong either to the same diagnosis entity, or to different diagnosis entities. These discussions yield the idea that the morphologic classification of a case is not sufficient to accurately predict the efficiency of irradiation, and a systematic approach to the morphometric features, before and after irradiation, may contribute to the refinement of the prediction.

[The importance of immunohistochemical examination in the diagnosis of malignant lymphoproliferative diseases--the author's personal experience]. / Semnificatia examenului imunohistochimic în diagnosticul limfoproliferarilor maligne--experienta proprie.

A high-quality approach to lymphoproliferative diseases needs mastering the basic principles of morphology, immunology and genetics. The diagnosis relies on both traditional methods (histopathological analysis) and modern procedures (supported by advanced techniques such as immunohistochemistry, flow cytometry, and molecular biology). This paper presents a personal point of view developed by the author as a consequence of experiencing the immunohistochemical reactions for the diagnosis of non-Hodgkin's malignant lymphomas. Immunohistochemistry, as an effective and currently practiced procedure, allows the identification of the cellular line of the proliferating cells. Full details are given for material and methods, providing a complete characterization of the used monoclonal antibodies (DAKO-CD20, L26, DAKO-CD3, DAKO-CD68, PG-M1, DAKO-E29, EMA), as well as an integral description of the sequenced working phases. Relevance, efficiency, performance, limits and perspectives of the employed procedure are discussed with direct references to the results of this personal study.

[Morphological diagnostic problems in a case of peritoneal blastomycosis]. / Probleme de diagnostic morfologic într-un caz de blastomicoza peritoneala.

Blastomycosis is a mycotic disease, caused by a fungal infection. It has a wide spectrum of clinical presentations, and, particularly, can mimic neoplastic disease. Correct diagnosis of the illness requires fungal culture and biopsy. In Romania, mycotic histopathology is insufficiently developed, and morphological tests are recommended to very few people who present this type of pathology. The paper discusses a case of peritoneal blastomycosis found at a patient with an abdominal pseudotumoral mass. The microscopic exam revealed the characteristic histologic features and budding yeast, in specific dyes, typical to the Blastomyces dermatidis (PAS, silver-methenamin). Authors of this paper hereby intend to draw pathologists' attention on the existence and diagnosis of mycotic lesions, whose number is continuously increasing nowadays.

[3 cases of malignant immunoblastic lymphomas]. / Trei cazuri de limfoame maligne imunoblastice.

Immunoblastic malignant lymphomas belong to the high-grade malignant lymphomas and can be classified into B and T types, according to the origin line of the proliferating cells. This paper presents three cases of immunoblastic malignant lymphomas, exhibiting fairly close morphological aspects. The morphological diagnosis based on standard methods using conventional dyes was supplemented by immunohistochemical diagnosis with monoclonal antibodies. Thus, the cellular line of the proliferating cells has been identified. A brief overview of the theoretical criteria requested for defining and differentiating the two types of immunoblastic lymphomas is also formulated.

[Computer-assisted instruction in the field of morphology]. / Instruire asistata de calculator în domeniul morfologic.

Visiting the image collections of normal and pathological morphology, available with free access on the World Wide Web (www), represents a vast source of extremely valuable material for both teaching and documentation in research activities. The aim of this paper is to provide a brief overview of the www facilities, which is gradually structured at the conceptual level. This overview ranges from the exploration of various topics in medical sciences/morphology, till the concrete aspects revealed by the construction and utilization of image libraries, designed for internal use, in accordance with certain systematic criteria. Examples from normal and pathological morphology illustrate the principles envisaged by the elaboration of such libraries.

[The morphopathological aspects at autopsy of HIV infection in children]. / Aspecte morfopatologice necropsice ale infectiei cu HIV la copii.

Aspects of HIV infection and AIDS in childhood have been reported since 1982. Pathological features are due to direct action of HIV, opportunistic infection and some tumoral processes. This report presents our own experience resulted from 27 cases of necropsy of patients diagnosed with AIDS or seropositive for HIV. Emphasize is placed on microscopic changes in different systems and organs (central nervous system, heart, lung, gastrointestinal tract, liver, lymphoid organs, kidney), by comparing our results with those described in literature.

[Carcinosarcoma of the corpus uteri--a case report]. / Carcinosarcomul corpului uterin--consideratii pe marginea unui caz.

Sarcomas account for fewer than 5% of all cancers of the uterine corpus. We present the last classification of The International Society of Gynecology Pathologists for pure sarcomas and also for mixed epithelial-nonepithelial tumors of the uterine corpus. The paper concerns with the study of a case of carcinosarcoma, treated in the III-rd Clinic of Gynecology from Iasi. This morphological diagnostic represents the most common epithelial-nonepithelial tumor affecting the uterus. Immunohistochemistry with EMA confirms the theory of the combined tumor with a unique origin.

[The anatomicopathological considerations in the clinical study of malignant non-Hodgkin's lymphomas in children]. / Consideratii anatomo-patologice pe marginea studiului clinic al limfoamelor maligne non-hodgkiniene la copil.

There have been studied 78 cases with abdominal LMNH diagnosis, treated at the "Sf. Maria" Hospital of Iasi, during the period 1970-1994. The microscopic exam has placed emphasis on the following two important aspects: (i) morphological diagnosis based on standard morphological methods, using conventional staining; (ii) immunohistochemical diagnosis, using monoclonal antibodies CD20, CD3; CD68, E29--for 18 cases. The cases investigated immunohistochemically permitted the identification of the lymphoid tumoral cells for the B/T line and tumoral macrophages, as well as the differential diagnosis with undifferentiated carcinomas. A direct correlation between a certain symptom and the disease could not be determined, although all the gastro-intestinal symptomatic elements have been taken into account. This fact reconfirmed the important role played by the anatomo-pathological exam in establishing the diagnosis and stage of the disease. Consequently the gastro-intestinal lymphomas are particular clinical entities, the investigation of which requires an interdisciplinary approach.