Morphological and functional features of the colonic mucus barrier in patients with symptomatic uncomplicated diverticular disease and acute uncomplicated diverticulitis.

OBJECTIVE: Aim: The purpose was to identify the morphological and functional features of the colonic mucus barrier in patients with symptomatic uncomplicated diverticular disease and acute uncomplicated diverticulitis. PATIENTS AND METHODS: Materials and Methods: In the research, three groups were formed. Group 1 included fragments of the mucous membrane of the large intestine, which were collected from 12 people during autopsies. The results of autopsies and histological examination of the material did not reveal any gastrointestinal pathology. Group 2 included biopsies of the mucous membrane of the large intestine from the area of the diverticulum of 34 patients with symptomatic uncomplicated diverticular disease. Group 3 included biopsies of the mucous membrane of the large intestine of 26 patients with acute uncomplicated diverticulitis. Histological (hematoxylin and eosin staining), histochemical (PAS reaction) and immunohistochemical (mouse monoclonal antibodies to Mucin 2 (MUC2) and Mucin 4 (MUC4)) staining methods were used. A morphometric study was also carried out. RESULTS: Results: In patients with diverticular disease, the authors identified disturbances in the morphofunctional state of the mucus barrier of the colon, the structure and function of goblet cells contained in its mucous membrane, characterized by a decrease in the thickness of the mucus layer covering the surface of the mucous membrane; a decrease in the size and number of goblet cells with a decrease in their mucus-producing ability; a change in the mucin profile, characterized by a violation of the content of MUC2 and MUC4. These changes were greatest in patients with acute uncomplicated diverticulitis compared with patients with symptomatic uncomplicated diverticular disease. CONCLUSION: Conclusions: The identified disturbances in the morphofunctional state of the mucus barrier of the colon, structural and functional changes in goblet cells may be one of the mechanisms for the development of acute uncomplicated diverticulitis and symptomatic uncomplicated diverticular disease.

Management of granulomatosis with polyangiitis complicated by intestinal perforation and pancytopenia: a case report and literature review.

Granulomatosis with polyangiitis is a systemic vasculitis. While the classic triad typically comprises otorhinolaryngologic, pulmonary, and renal manifestations, it is essential to recognize that granulomatosis with polyangiitis can affect any organ. Furthermore, reports have documented less common sites of involvement, such as the gastrointestinal tract. In this case-based review, we focus on a case of granulomatosis with polyangiitis presenting with intestinal perforation and the added challenge of concurrent pancytopenia.A 25-year-old female was diagnosed with granulomatosis with polyangiitis, with her clinical course progressing from joint pain to severe multi-organ involvement, including gastrointestinal complications. Treatment challenges emerged with the development of pancytopenia. While this may not directly result from granulomatosis with polyangiitis, it introduced an additional layer of complexity and delayed the induction of remission with immunosuppressants. Despite initial stabilization, an unexpected jejunal perforation occurred, requiring surgical intervention and subsequent postoperative care. The case underscores the complex nature of granulomatosis with polyangiitis and its potential complications. A literature search yielded discrete relevant cases in the context of our patient's intricate presentation, which has been summarized.We highlight the complexities in diagnosing and managing granulomatosis with polyangiitis-related complications, especially in uncommon presentations, and emphasize the importance of a personalized approach to patient care in these circumstances.

MORPHOLOGICAL FEATURES OF MAXILLARY SINUS CYSTS BASED ON THE STUDY OF PARTICULAR HISTOCHEMICAL AND IMMUNOHISTOCHEMICAL FACTORS OF INFLAMMATION.

OBJECTIVE: The aim: To study the morphological structure and immunohistochemical markers of inflammatory cells in the maxillary sinus cyst wall. PATIENTS AND METHODS: Materials and methods: Biopsy samples of maxillary sinus cysts of 92 operated patients aged 18 to 74 years were studied. We used standard staining with hematoxylin and eosin, PAS reaction, and immunohistochemical analysis with monoclonal antibodies to CD68 (macrophages) and CD3 (T- lymphocytes) to determine morphological features and severity of inflammation and PanCK AE1/AE2 antibodies to identify epithelium state. RESULTS: Results: All patients were divided into 2 groups: 29 patients with retention cysts and 63 with lymphagiotatic cysts (pseudocysts), depending on the unilateral or bilateral epithelial lining of the cyst wall. Retention cysts had the bilateral epithelial lining with a saving its function and structure. The thinned connective tissue layer was filled with separate clusters of lymphocytes and macrophages. Lymphagiotatic cysts were characterized by the unilateral epithelium lining of the wall with signs of degeneration, desquamation, and loss of the mucus-forming function. Dense infiltration of the connective tissue layer by inflammatory cells with pronounced expression is observed. CONCLUSION: Conclusions: Immunohistochemical analysis with monoclonal antibodies to CD3 and CD68 demonstrated that the inflammatory infiltrate of pseudocysts is represented by T-lymphocytes and different sizes of macrophages. The inflammatory infiltration of the pseudocyst wall was significantly severe compared to retention cysts.

Lung Expression of Macrophage Markers CD68 and CD163, Angiotensin Converting Enzyme 2 (ACE2), and Caspase-3 in COVID-19.

Background and Objectives: The coronavirus (SARS-CoV-2) damages all systems and organs. Yet, to a greater extent, the lungs are particularly involved, due to the formation of diffuse exudative inflammation in the form of acute respiratory distress syndrome (ARDS) with next progression to pulmonary fibrosis. SARS-associated lung damage is accompanied by the pronounced activation of mononuclear cells, damage of the alveoli and microvessels, and the development of organized pneumonia. To study the expression of macrophage markers (CD68 and CD163), angiotensin-converting enzyme-2 (ACE2), and caspase-3 on the results of two fatal clinical observations of COVID-19. Materials and Methods: In both clinical cases, the female patients died from complications of confirmed COVID-19. Conventional morphological and immunohistochemical methods were used. Results: There was an acute exudative hemorrhagic pneumonia with the formation of hyaline membranes, focal organization of fibrin, stromal sclerosis, stasis, and thrombus formation in the lung vessels. Signs such as the formation of hyaline membranes, organization, and fibrosis were more pronounced in severe disease activity. The activation of CD68+/CD163+ macrophages could cause cell damage at an early stage of pneumonia development, and subsequently cause fibrotic changes in lung tissue. ACE2 expression in lung tissue was not detected in severe pneumonia, while in moderate pneumonia, weak expression was noted in individual cells of the alveolar epithelium and vascular endothelium. Conclusions: This finding could show the dependence of ACE2 expression on the severity of the inflammatory process in the lungs. The expression of caspase-3 was more pronounced in severe pneumonia.

Surgical View of Morphological and Pathogenetic Identity of Pilonidal Cysts and Acne Inversa.

<b>Introduction:</b> As a rule, the treatment of pilonidal cysts is based on a surgical approach. Surgical treatment depends on the form of the disease and surgeon's preferences regarding the method. The treatment process does not consider preoperative treatment that would affect the structural components of the skin involved in the pathological process. The results of surgical treatment remain unsatisfactory, leading to a significant number of recurrences and long-term healing of the postoperative wound. </br></br> <b> Materials and methods:</b> Morphological examination of the pieces of skin with altered sacrococcygeal tissues after radical surgical treatment of 46 patients with pilonidal cyst of the sacrococcygeal region was performed, and 46 patients with acne inversa of the intergluteal cleft, groin and scalp were selected. The sex distribution of patients with pilonidal cysts was as follows: 43 (91.3%) male patients, 3 (6.5%) female patients. Among 46 patients with acne inversa and dissecting cellulitis, the distribution was as follows: 32 (69.6%) male patients and 14 (30.4%) female patients. Patients with pilonidal cysts of the sacrococcygeal region underwent surgical treatment according to the developed method of economical median resection using sutures with internal fixation. </br> </br> <b> Results:</b> Considering and comparing the morphological picture observed in the pathomorphological examination of histological specimens in patients with pilonidal cysts, acne inversa, dissecting cellulitis, the similarity of changes in most patients is noteworthy. "Acne inversa" was first described in 1839 by Velpeau, who originally called the disease "hydradenitis suppurativa", believing that inflammatory changes occur in the sweat glands [1-3]. In 1854, surgeon Verneuil described this disease, and later it was named after him. We observed chronic proliferative inflammation in different layers of the dermis and subcutaneous tissue (the main focus is in the subcutaneous tissue, but closely related to the dermis and epidermis). </br></br> <b>Discussions:</b> Pilonidal cyst of the sacrococcygeal region, especially without hair in the cavity of the cyst, can be considered as a type of acne inversa with appropriate location. We believe that the use of local and systemic retinoids, namely isotretinoin, in the treatment of patients with this disease other than surgery, together with other groups of drugs traditionally used in the treatment of pilonidal cysts, may be promising in the treatment of pilonidal cysts.

AN INTEGRATED APPROACH TO THE MORPHOLOGICAL DIAGNOSIS OF DIFFERENT TYPES OF PLEOMORPHIC ADENOMAS OF THE SALIVARY GLAND: LONG-TERM RESEARCH RESULTS.

OBJECTIVE: The aim: To describe an integrated approach to the morphological diagnosis of different types of pleomorphic adenomas of the salivary gland. PATIENTS AND METHODS: Materials and methods: Surgical and biopsy material from 30 patients with pleomorphic adenomas of epithelial, mixed and mesenchymal variants was studied using histological, immunohistochemical, genetic, morphometric and statistical methods. RESULTS: Results: The results of research allowed us to identify methods for determination the pleomorphic adenomas types. The first method requires an immunohistochemical reaction with a monoclonal antibody to human papillomavirus type 16, followed by counting the percentage of positively stained cells in the tumor. Thus, the mesenchymal variant of the tumor is diagnosed when the percentage of positively stained cells is < 40%. In the mixed variant, this indicator is ≥ 40%, but ≤ 70%, and in epithelial variant - > 70%. The second method was based on the multivariate discriminant analysis. Three formulae were derived to determine the tumor types (Fmesenchymal = - 41.03 + 4.96Ð¥1 + 1.11Ð¥2, Fepithelial = - 22.27 + 3.46Ð¥1 + 0.85Ð¥2, Fmixed = - 122.25 + 5.63Ð¥1 + 3.2Ð¥2, here Ð¥1 - number of vessels, Ð¥2 - specific volume of parenchyma). CONCLUSION: Conclusions: The authors identified several methods for determining the histological variants of pleomorphic adenomas. These methods will improve the morphological diagnosis of pleomorphic adenomas variants in the preoperative and postoperative periods.

Pulmonary pattern in systemic vasculitis: granulomatosis, lung cancer or both?

As clinical manifestations of systemic vasculitides share many common features with other conditions, the rate of diagnostic errors and delayed diagnoses is high. Hence we performed an analysis of the available data regarding misdiagnosis of vasculitis as lung cancer and vice versa, as well as coexistence of vasculitis and lung cancer. The present case-based review highlights the diagnostic challenges encountered when granulomatosis with polyangiitis (GPA) mimics lung cancer. The importance of a multidisciplinary team approach to patients with pulmonary involvement and multisystem manifestations is essential for appropriate planning of further diagnostic steps and for minimizing the delay in correct diagnosis and treatment. In the present case, although computed tomography raised suspicion for lung cancer, further biopsies and laboratory screening for systemic vasculitides rejected malignancy and confirmed the diagnosis of GPA.

MORPHOLOGICAL JUSTIFICATION OF THE SIGNIFICANCE OF LUMBAR ARTERIES IN THE PREVENTION OF SPINAL CORD ISCHEMIA IN ATHEROSCLEROTIC LESIONS OF ABDOMINAL AORTA.

OBJECTIVE: The aim: To investigate atherosclerosis of the abdominal part of the aorta and atherosclerosis of the lumbar arteries, aimed at improving surgical tactics during reconstructive interventions on the abdominal part of the aorta in patients with multifocal atherosclerosis. PATIENTS AND METHODS: Materials and methods: 20 autopsies were performed. The macro preparation consisted of the part of the abdominal aorta 1х1 sm taken along with a separated lumbar artery for 1-1,5 sm. Histological cuts were coloured with hematoxylin and eosin. The histochemical research was conducted in order to establish changes in all layers of blood vessels. The immunohistochemical research was carried out along with generally accepted histological methods in 10 cases to determine the morphological vessel wall functional state, connective tissue and smooth muscle components. RESULTS: Results: In all cases there were morphological signs of aortic atherosclerosis with different degrees of damage to the lumen. In none of the analyzed cases did we establish pathomorphological signs of atherosclerosis of the lumbar artery distal to the mouth. In the walls of the lumbar arteries, we noted the preservation of the layered structure, the integrity of the endothelial cells, the normal arrangement of smooth muscle cells. CONCLUSION: Conclusions: It was established that there cannot be the atherosclerotic occlusion of the lumbar artery, since there are no signs of atheromatous lesions in its walls, the structure of all layers is preserved, the endothelial damage is absent, the location and structure of the lining cells is normal.

MORPHOLOGICAL JUSTIFICATION OF THE SALIVARY GLAND TISSUE RESECTION BOUNDARIES DURING SURGICAL TREATMENT OF PATIENTS WITH PLEOMORPHIC ADENOMAS.

OBJECTIVE: The aim is to substantiate morphologically the resection boundaries of the salivary gland tissue in the surgical treatment of patients with pleomorphic adenoma of different histological variants. PATIENTS AND METHODS: Materials and methods: The study used autopsy, surgical and biopsy material, divided into 2 groups. Group 1 included autopsy material (n=6), represented by tissue fragments of the parotid salivary gland, in which macroscopic and microscopic examination did not reveal any general pathological processes. Group 2 included surgical and biopsy material from 30 patients, represented by pleomorphic adenomas with adjacent tissue of the salivary gland at a distance of 0.5 cm and 1.0 cm. Histological, morphometric and statistical research methods were used. RESULTS: Results: The morphological features of the salivary gland tissue which was adjacent to the pleomorphic adenoma at a distance of 1.0 cm, practically corresponded to thephysiological norm. However, the tissue of the salivary gland, bordering the tumor at a distance of 0.5 cm, was characterized by pronounced changes. These changes were: violation of the ratio of the specific volumes of the parenchyma and stroma; atrophy of the terminal sections and ducts with cystic expansion of some ducts; thickening of the secretion and formation of calculi in the lumen of some ducts; atrophic and alterative changes in the epithelial lining the terminal sections and ducts; sclerosis and lipomatosis, areas with hyalinosis and dystrophic calcification in the stroma; hemodynamic disturbances in the stroma with a decrease in the number of vessels; pronounced focal or diffuse immune infiltration in the stroma in some areas with the lymphoid follicles formation. CONCLUSION: Conclusion: The comprehensive study has confirmed that removal of the tumor with the adjacent tissue of the salivary gland at a distance of 1.0 cm in patients with pleomorphic adenoma of various histological variants is the most justified from the morphological point of view.

EXPRESSION FEATURES OF HUMAN PAPILLOMA VIRUS TYPE 16 AND ANTI-EPSTEIN-BARR VIRUS IN PLEOMORPHIC ADENOMA, SURROUNDING AND INTACT SALIVARY GLAND.

OBJECTIVE: The aim is to reveal the expression features of MCA to human papilloma virus type 16 and anti-Epstein-Barr virus in the pleomorphic adenoma, surrounding and intact salivary gland. PATIENTS AND METHODS: Materials and methods: It was used surgical and biopsy material from 30 patients, represented by pleomorphic adenomas with surrounding to tumor tissue of the salivary gland and intact tissue of the salivary gland (the distance between the tumor and the intact salivary gland - 10 mm). Immunohistochemical study was performed using mouse monoclonal antibody (MCA) to human papilloma virus type 16 (clone CAMVIR-1, «Diagnostic BioSystems¼, USA) and anti-Epstein-Barr virus (LMP, clone CS. 1-4, «Dako¼, Denmark). Visualization was performed, using an EnVisionTM FLEX detection system (Dako, Denmark). Antigen unmasking was carried out in citrate buf f er pH 6.0 at 95°C. Primary antibodies were incubated at room temperature for 30 minutes, secondary antibodies - 20 minutes. Sections were counterstained with Gill hematoxylin. We assessed the immunohistochemical reaction by a semi-quantitative method by counting the percentage of positively stained cells in the fi eld of view of a microscope × 400. Microspecimens were studied and photoarchived on an Olympus BX-41 microscope (Japan). RESULTS: Results: In this study it was detected a positive immunohistochemical reaction with MCA to human papilloma virus type 16 and anti-Epstein-Barr virus, respectively, in 26 (86.7%) and 8 (26.7%) cases. Epithelial, mixed and mesenchymal variants of pleomorphic adenoma of the salivary glands are characterized, respectively, by the severely expressed, moderately expressed and minimally expressed of MCA to human papilloma virus type 16 and anti-Epstein-Barr virus. The parenchymal component of pleomorphic adenoma is characterized by more marked expression of these markers as compared to the stromal component. The epithelial cells of the salivary glands, surrounding the pleomorphic adenoma, as well as intact salivary glands, express MCA to human papilloma virus type 16 and anti-Epstein-Barr virus. The severity of the expression of these markers in the salivary gland is determined by the histological variant of the tumor (severely expressed in the epithelial variant, moderately expressed in the mixed variant, and minimally expressed in the mesenchymal variant). CONCLUSION: Conclusions: The immunohistochemical study has shown that the Epstein-Barr virus and, especially, human papilloma virus type 16 can act as exogenous trigger factors involved in the development of pleomorphic adenoma of the salivary glands. The revealed immunohistochemical features of MCA expression to human papilloma virus type 16 and anti-Epstein-Barr virus in the salivary gland surrounding the pleomorphic adenoma and in the intact tissue of the salivary gland make it possible to recommend the extracapsular dissection of the tumor with resection of the adjacent intact tissue of the salivary gland at a distance of 10 mm in patients with pleomorphic adenoma.

PATHOMORPHOLOGICAL CHARACTERISTICS OF IMMUNOCOMPLEX RENAL DISEASE IN PATIENTS WITH IMMUNODEFICIENCY VIRUS AND HEPATITIS C VIRUS, RECEIVING ANTIRETROVIRAL THERAPY.

OBJECTIVE: The aim is to verify and describe the morphological substrate of renal impairment in HIV/HCV co-infection among patients receiving ART to assess and predict the morphogenesis of immunocomplex lesions. PATIENTS AND METHODS: Materials and methods: To assess and predict the morphogenesis of immunocomplex renal disease, we examined retrospectively the kidney tissue samples of 15 patients, who died with HIV/HCV co-infection and received ART. Histological, histochemical and immunohistochemical research methods were used. RESULTS: Results: Segmental and diffuse mesangial proliferation with extracellular matrix expansion with glomerular damage ≥50% in 9 (60%) cases, and involving <50% of glomeruli in 5 (33%), with CD68 expression as single cells were detected. In 12 (80%) cases, there was uneven swelling and focal proliferation of endothelial cells with the involvement of 20-50% of the glomeruli, as well as the presence of cellular infiltrates in the lumen of capillary loops in 3 (20%) cases with monomorphic intensity in "+". Sclerotic changes were present in various degrees of severity - from cases of complete glomerulosclerosis with obliteration of the Bowman's lumen to focal and microfocal depressions 8 (55%), sclerosis 10 (66%), hyalinosis 1 (6%), uneven thickening, focal cleft 8 (55%) and perihilar focal sclerosis. These areas were positive for IgG and C1q complement fractions within the "+", "++" intensity. Among the study group, no case of HIV-associated nephropathy was found that coincided with the predicted spectrum of kidney damage for patients in this sample. The described morphological changes were mainly verified as immuno-mediated by HCV. CONCLUSION: Conclusions: A comprehensive morphological study revealed the morphological substrate of kidney damage and its morphogenesis in patients with HIV/HCV co-infection, receiving ART.

MALIGNANT TUMORS OF THE APPENDIX: CLINICAL AND MORPHOLOGICAL ANALYSIS OF CASES FROM THE PRACTICE.

The authors have analyzed medical histories of two patients, treated in health care facilities of Kharkiv region from 2008 to 2020. These patients underwent urgent appendectomy, given the existing clinic of acute appendicitis. Morphological examination of the surgical material allowed us to diagnose adenocarcinoma in one case, and neuroendocrine tumor in combination with endometriosis in the other case. Morphological examination of the surgical material in the first case revealed a moderately differentiated adenocarcinoma and diffuse neutrophilic infiltration in all layers of the appendix, and in the second case - a well-differentiated neuroendocrine tumor (G3), combined with the signs of phlegmonous-ulcerative appendicitis and loci of endometriosis. In both cases, there were no specific for the oncological process anamnestic and clinical-instrumental data, and these tumors were manifested by the clinic of acute appendicitis. Only morphological examination of the surgical material allowed identifying the pathological process. Clinical and morphological analysis of cases from the practice of malignant tumors of the appendix (neuroendocrine tumor and adenocarcinoma) will be useful and interesting for the medical community and should stimulate cancer vigilance in physicians.

TUMORS AND TUMOR-LIKE LESIONS OF THE SALIVARY GLANDS: MORPHOLOGICAL CHARACTERISTICS OF THE SURGICAL MATERIAL.

OBJECTIVE: The aim is to give a morphological characteristic of tumors and tumor-like lesions of the salivary glands in the course of a comprehensive analysis of the surgical material. PATIENTS AND METHODS: Materials and methods: The study used surgical material from 67 patients with various pathologies of the salivary glands. The patients were treated at Kyiv City Clinical Hospital No. 12 (Ukraine, Kiev) from 2014 to 2018. The resulting material was fixed in a 10% solution of neutral formalin (pH 7.4) for 24-48 hours, carried out according to the generally accepted technique and embedded in paraffin. Serial sections 2 µm thick were made from paraffin blocks and stained with hematoxylin and eosin. Microspecimens were studied, using Olympus BX-41 microscope (Japan). RESULTS: Results: A comprehensive morphological study of the surgical material of patients with salivary gland pathology undergoing treatment at Kyiv City Clinical Hospital No. 12 (Ukraine, Kiev) for the period from 2014 to 2018 revealed benign tumors and tumor-like lesions of these glands. Pleomorphic adenomas and adenolymphomas represented benign tumors of the salivary glands, while cysts represented tumor-like lesions. Different ratios of parenchymal and stromal components characterized pleomorphic adenomas of the salivary glands. On this basis, we identified three tumor variants (mesenchymal (15 cases, 50.0 %); mixed or classic (10 cases, 33.3 %); epithelial (5 cases, 16.7 %)). A characteristic microscopic feature of salivary gland adenolymphomas was a pronounced predominance of the parenchyma over the stroma. A well-defined wall, represented by connective tissue fibers and epithelial lining, characterized the cysts of the salivary glands. The connective tissue capsule separating the tumor tissue from the intact tissue of the salivary gland was clearly pronounced in adenolymphomas, and in pleomorphic adenomas it could be clearly expressed, intact, with tumor invasion or absent. In mesenchymal and mixed variants of pleomorphic adenomas, in comparison with the epithelial variant, there was a frequent tumor invasion of the capsule, thinning of the capsule or its absence. CONCLUSION: Conclusions: Morphological examination of the surgical material allows us to diagnose tumors (pleomorphic adenomas and adenolymphomas) and non-tumor lesions (cysts) of the salivary glands. This, of course, is of great therapeutic, diagnostic and prognostic value. Among the identified pathology of the salivary glands, pleomorphic adenomas cause certain difficulties in morphological diagnosis due to their structural diversity and heterogeneity, sometimes requiring morphometric, immunohistochemical or genetic research.

CLINICAL AND MORPHOLOGICAL CORRELATION DEPENDENCIES AND THEIR SIGNIFICANCE IN PATIENTS WITH COMPLICATIONS OF LABORED ERUPTION OF THE LOWER THIRD MOLARS.

OBJECTIVE: The aim is to determine the clinical and morphological dependencies, which are important for diagnostics, treatment and prediction of outcomes of pathological processes in the region of the LTM with complicated eruption, as based on the study of histopathological changes of paradental tissue (mucous membrane, walls of retromolar pocket, alveolar bone tissue). PATIENTS AND METHODS: Materials and methods: The materials of the study were 34 biopsy specimens of pathologically altered soft tissue and parodontium obtained as a result of pericoronectomy, extraction of the LTM and other surgical interferences performed based on the relevant indications in 28 patients in the region of the LTM with complicated eruption. Morphological and statistical research methods were used. RESULTS: Results: The local pathological processes, which chronologically precede the destructive changes in the hard tissue of a tooth (caries), are developed in patients of both genders with complicated LTM eruption in soft tissue of parodontium and the adjacent bone tissue of the alveolar wall in the majority of cases. As per biopsy examinations, the frequency of the main pathological processes in paradental tissue in case of complicated LTM eruption varies from 25 to 60 % of the number of biopsy specimens and occurs in various combinations in patients with different values of clinical parameters. The correlation relationships between the patients' clinical data and the morphological parameters of damage to paradental tissue are weak, multidirectional and uncertain in the majority of combinations (considering the available number of biopsy specimens studied). The close certain positive dependence between the damage of the squamous epithelium and the inflammation activity in the lamina propria mucosae, covering the tooth: in the vast majority of cases, the presence of damaged epithelium (within the biopsy specimen) is associated with the inflammation of high activity, was established as based on correlation relationships between the morphological parameters of damage to paradental tissue. CONCLUSION: Conclusions: The found pathological changes and the correlations justify surgical tactics on paradental soft and osseous tissues that are directed on the LTM sparing.

IMMUNOHISTOCHEMICAL FEATURES OF THE EXPRESSION OF HUMAN PAPILLOMA VIRUS TYPE 16 IN PLEOMORPHIC ADENOMAS OF SALIVARY GLAND.

OBJECTIVE: The aim is to reveal the immunohistochemical features of human papilloma virus type 16 expression in various histological variants of pleomorphic adenomas of the salivary gland. PATIENTS AND METHODS: Materials and methods: The material of the study was surgical and biopsy material from 30 patients with pleomorphic adenomas of the salivary glands, among which in 15 cases mesenchymal was detected, in 10 - mixed, in 5 cases - epithelial histological variant, respectively. Immunohistochemical study was performed, using mouse monoclonal antibody to human papilloma virus type 16. Visualization was performed, using an EnVisionTM FLEX detection system. Histological sections of grade III cervical intraepithelial neoplasia (CIN III) were used as a positive control; for a negative control, the procedure was performed without primary antibodies. The immunohistochemical reaction was assessed by a semi-quantitative method by counting the percentage of positively stained cells in the field of view of a microscope × 400. Microspecimens were studied, photoarchived on an Olympus BX-41 microscope. RESULTS: Results: Expression of human papilloma virus type 16 of varying severity was determined in 26 cases of pleomorphic adenomas of the salivary glands, which was 86.7%. The epithelial component of the pleomorphic adenoma of the salivary gland was characterized by a more pronounced expression of the monoclonal antibody to human papilloma virus type 16 compared to the mesenchymal component of the tumor. The severity of the immunohistochemical reaction with a monoclonal antibody to human papilloma virus type 16 depended on the histological variant of the pleomorphic adenoma of the salivary gland. Epithelial, mixed and mesenchymal variants of pleomorphic adenoma of the salivary gland were characterized, respectively, by the most pronounced, pronounced and moderately pronounced expression of a monoclonal antibody to human papilloma virus type 16. CONCLUSION: Conclusions: A comprehensive immunohistochemical study with a monoclonal antibody to human papilloma virus type 16 revealed the presence of a causal relationship between the infection of a patient with human papilloma virus type 16 and development of pleomorphic adenoma of the salivary gland in him.

MORPHOLOGICAL FEATURES OF CELLULAR INFILTRATION IN THE MUCOSA OF LARGE INTESTINE IN ULCERATIVE COLITIS AND IRRITABLE BOWEL SYNDROME.

OBJECTIVE: The aim is to improve morphological diagnostics, including differential, of UC and IBS, identifying morphological features of cellular infiltration in the mucous membrane ofthe large intestine. PATIENTS AND METHODS: Material and methods: Autopsy and biopsy material - fragments of the mucous membrane of the large intestine was used in this study. All the material was divided into 5 groups. Group 1 included autopsy material from 6 cases, in which no general pathological processes in the gastrointestinal tract were detected during autopsy and microscopic examination. Group 2 included biopsy material from 34 patients with diagnosed UC of the 1st activity degree. Group 3 included the biopsy material of 27 patients with UC of the 2nd degree of activity. Group 4 included biopsy material from 19 patients, diagnosed with UC of the 3rd degree of activity. Group 5 included biopsy material from 82 patients with clinically diagnosed IBS. Histological, morphometrical, immunohistochemical and statistical methods of investigation were used. RESULTS: Results: The mucous membrane of the large intestine in patients with ulcerative colitis of varying degrees of activity, compared with the physiological norm, has pronounced infiltration by plasma cells, T-lymphocytes, B-lymphocytes, macrophages, mast cells, eosinophilic and neutrophilic leukocytes in the superficial parts of the epithelium, crypts,lamina propria. There is also an increase in the number and size of lymphoid follicles in the lamina propria. Predominant cellular elements in the infiltrate are plasma cells, T-lymphocytes, eosinophilic and neutrophilic leukocytes. The growth of ulcerative colitis activity leads to an increase the inflammatory cell infiltration in the mucous membrane of the colon, as evidenced an increase the density of cellular infiltrate; the severity of inflammatory changes in crypts and an increase in the number of crypt abscesses; a decrease the number of cases with focal infiltration in the lamina propria and an increase the number of cases with diffuse infiltration; the spread of inflammatory cell infiltration from the superficial parts of the lamina propria to its deep parts with the subsequent involvement of its entire thickness; an increase the central trends of the indexes of the severity of all cellular infiltration, infiltration by plasma cells, T-lymphocytes, macrophages, neutrophilic leukocytes. The mucous membrane of the large intestine in patients with irritable bowel syndrome has moderately pronounced cellular infiltration in the superficial epithelium andlamina propria, in comparison with the physiological norm. The number and size of lymphoid follicles increase. Inflammatory cell infiltration often spreads to the upper onethird or two thirds of the thickness of the lamina propria, characterized by the presence of plasma cells, T-lymphocytes, B-lymphocytes, macrophages, mast cells, eosinophilic and neutrophilic leukocytes. In this case, plasma cells, T-lymphocytes, mast cells and macrophages dominate. The indexes of the severity of all cellular infiltration, as well as infiltration by plasma cells, T-lymphocytes, B-lymphocytes, macrophages, mast cells, eosinophilic and neutrophilic leukocytes, increases in the mucous membrane of the large intestine in irritable bowel syndrome in comparison with the norm. In the mucous membrane of the large intestine in irritable bowel syndrome compared with ulcerative colitis of varying degrees of activity inflammatory cell infiltration is less pronounced. It often extends to one third or two thirds of the thickness of the lamina propria. There are fewer lymphoid follicles, cryptitis and crypt abscesses are not determined. The indexes of the severity of all cellular infiltration, as well as infiltration by plasma cells, T-lymphocytes, eosinophilic and neutrophilic leukocytes are lower. CONCLUSION: Conclusions: The revealed features of cellular infiltration in the mucous membrane of the large intestine make it possible to improve morphological diagnostics, including differential, of ulcerative colitis of varying degrees of activity and irritable bowel syndrome.

Evaluation of the endoscopic treatment with topical prednisolone administration for intestinal strictures in Crohn's disease.

<br><b>Introduction:</b> The prevalence of Crohn's disease amounts to 5.9 cases per 100,000 population. Complications such as intestinal strictures usually occur within a long course of Crohn's disease. Intestinal resection for stricture does not prevent a stricture recurrence and the need for repeated resections, which in turn leads to the formation of short intestine syndrome. The advantage of endoscopic balloon dilatation is organ preservation and a quick clinical therapeutic effiect. However, the frequency of recurrences after conventional endoscopic balloon dilatation of the intestinal stricture in Crohn's disease is still at a relatively high level and amounts to 59%, which justifies the need to improve the endoscopic dilatation technique.</br> <br><b>Aim:</b> The aim of this study to improve the treatment effectiveness for intestinal strictures in Crohn's disease using endoscopic balloon dilatation combined with prednisolone injection in the stricture area.</br> <br><b>Materials and methods:</b> Endoscopic treatment for intestinal strictures in Crohn's disease was performed in 64 patients. Depending on the endoscopic technique, patients were randomized into 2 groups. The first group consisted of 32 (50%) patients who underwent conventional endoscopic balloon dilatation of strictured areas. The second group consisted of 32 (50%) patients in whom an endoscopic balloon dilatation in combination with submucosal injection of prednisolone to the area of stricture after dilatation was performed. Patient groups were comparable in age, sex and length of stricture.</br> <br><b>Results and conclusions:</b> The results showed that endoscopic balloon dilatation with administration of 40 mg of prednisolone in group II patients was more effective compared to conventional balloon dilatation. The recurrence rate was reduced from 34.4% to 9.3%. The risk of recurrence of intestinal stricture in group I during the first year of observation was found to be 4.5 times higher - HR = 4.5 (1.6-12.9); P = 0.010. The effectiveness of advanced endoscopic balloon dilatation for intestinal strictures was confirmed by colonoscopy with patomorphological examination of the intestinal mucosa 6 months after dilation in patients of both groups.</br>.

Morphological features of pilonidal cysts of the sacrococcygeal region.

INTRODUCTION: Despite the fact that the pilonidal cyst of the sacrococcygeal region is a long-known disease, the mechanism of accumulation or absence of hair in the cyst remains unclear, which affects the accuracy of the name of the disease, as well as understanding of its pathogenesis. AIM: Aim to perform morphological examination of pilonidal cysts of the sacrococcygeal region, to determine the nature of the cysts, the frequency of hair in the cyst cavity and to determine the causes and mechanism of its accumulation in cysts. MATERIALS AND METHODS: A morphological study of skin areas with altered tissues of the sacrococcygeal region after radical surgical treatment of 235 patients with a coccygeal cyst of the sacrococcygeal region was carried out. The gender distribution of patients with pilonidal cysts was as follows: 220 (93.4%) male patients, 15 female patients (6.6%). RESULTS: Among 235 patients who underwent radical surgical treatment, the absence of hair shafts was recorded in 112 (46.8%) cases, hair in the cyst structure - in 123 male patients (53.2%), both visually and under a microscope, and in 4 of them (0.9%) only under a microscope. Among 15 patients, hair in the cyst cavity was found in 1 case (0.4%), in 14 patients they were not detected either visually or by microscopic examination. DISCUSSION: Having observed the formation of foreign body granuloma and the accumulation of polynuclear histiocytes of foreign bodies around the hair in the pilonidal cyst cavity, a proportional increase in histiocytes depending on the number of hairs, that is, the body's reaction to the foreign body was registered. However, multinucleated histiocytes in lower numbers were also observed in cases in which hair shafts were not found either microscopically or macroscopically, which may indicate both completed phagocytosis and formation of a cyst without a hair component, registering the reaction of histiocytes to inflammatory changes in the cyst cavity. The detection of atypically located pilonidal cysts (cheek, navel) provides additional confirmation of the formation of pilonidal cyst as a result of disturbance of hair growth through the hair funnel due to inflammatory changes in the hair follicle and their accumulation subcutaneously.

Clinical and morphological features of the ovarian brenner tumour: current state of the problem.

OBJECTIVE: Introduction: Ovarian tumours are an actual problem of present-day medicine, being one of the most difficult sections of modern oncology. The majority of ovarian tumours are of epithelial origin. The ovarian Brenner tumour represents a rare epithelial ovarian neoplasm and accounts for 1-2% of all ovarian neoplasms. The aim of the study is to identify clinical and morphological features of ovarian Brenner tumour. PATIENTS AND METHODS: Materials and methods: The material was 5 cases of Brenner ovarian tumour, diagnosed in the study of 4 cases of operational material and 1 case of autopsy observation for the period from 2007 to 2019. Histological and immunohistochemical staining methods were used. The microspecimens were examined on an Olympus BX-41 microscope (Japan). RESULTS: Results: Ovarian Brenner tumour is a rather rare pathology, the histogenesis of which is debatable. Morphological examination is the main method for its diagnosing. Ovarian Brenner tumours developed in women of middle and old age (the average age was 51.8 years). Women with a malignant ovarian Brenner tumour were older than women with a benign variant (the average age in women with a malignant variant was 55.8 years, with a benign variant - 49.3 years). Benign ovarian Brenner tumour occurred more frequently compared with a malignant one. Malignant and benign variants of ovarian Brenner tumour were characterized by a one-sided nature of the lesion with frequent involvement in the pathological process of the left ovary. Clinically, in patients with a benign variant of the Brenner tumour in all cases an abdominal pain syndrome was determined, combined in one case with metrorrhagia. A malignant ovarian Brenner tumour was clinically manifested by severe abdominal pain syndrome, combined in one case with complaints of an increase in the size of the abdomen, and in another case with intoxication syndrome and a clinic of small bowel obstruction. In all cases a malignant ovarian Brenner tumour metastasized to the omentum and in one case also to the small intestine wall. Macroscopically the ovarian Brenner tumour had the form of a node, the dimensions of which were significantly larger for the malignant variant compared with a benign, dense or soft consistency, on the cross section of a whitish-gray or brown color with cysts. A damaged ovary with a malignant variant of Brenner tumour significantly increased in size, while with a benign one, its size did not change or increased slightly. In all cases the malignant and benign variants of ovarian Brenner tumour were combined with various reproductive system organs pathologies (mucinous papillary cystadenoma of the ovary, serous ovarian cyst, ovarian endometriosis, endometrial hyperplasia, cervical nabothian cysts, uterine leiomyoma). CONCLUSION: Conclusions: A study conducted by the authors revealed clinical and morphological features of a rare ovarian tumour - Brenner tumour, which will contribute to a better understanding of this pathology by the doctors of various specialties, and improve the treatment and diagnostic process.