Morphological and clinical picture of the morphea in the oral cavity.

There are several types of morphea with different levels of connective tissue involvement and morphological manifestations. In this mini review, it was pointed out the most important morphological and clinical aspects of localised scleroderma in the oral cavity. The case presented in this article supports the scientific information and is described with details. The morphea of mucous membrane which was clinically suspected, was proved by histopathological examination of the sample. The unusual location of the local findings posed a diagnostic challenge. The case history should be significant due to the low number of studies. The special attention should be taken to match the clinical with pathomorphological picture in localised scleroderma diagnosis and treatment when the involvement of skin and oral mucosa is.

Adjuvant Radiochemotherapy with a 23-Month Overall Survival Time in a Patient after a Surgery due to Splenic Hemangiosarcoma Rupture: A Case Report with the Literature Review.

Spleen sarcoma is one of the most rare soft tissue malignancies. The annual incidence is 0.14-0.25/1,000,000 and the average age of diagnosis is 50 to 73 years. The incidence of this cancer has been increasing. Treatment of choice is surgical splenectomy, which rarely gives good results due to the aggressive course of the disease as well as the high potential for metastasis. Overall survival in primary spleen sarcomas as described by various authors is between 4 and 14 months. 80% of patients after spleen rupture do not survive 6 months. We report the case of a 42-year-old male diagnosed with spleen angiosarcoma. The patient underwent surgery in an emergency mode because of rapid rupture of the organ. Due to positive surgical margins, he underwent adjuvant radiochemotherapy followed by chemotherapy. Overall survival time was relatively long (23 months). The international guidelines provide information based on limited data. The role of postoperative radiotherapy in angiosarcomas remains controversial. Postoperative radiotherapy may increase local disease control, especially after nonradical operation, but this does not translate into improvement in overall survival time of these patients. The case shows that adjuvant radiotherapy as part of cancer treatment strategy may prolong the overall survival.

Early postnatal development of the lumbar vertebrae in male Wistar rats: double staining and digital radiological studies.

The aim of the study was to evaluate the physiological developmental changes of male rats' lumbar vertebrae during the first 22 days after birth. Morphology and mineralisation of lumbar vertebrae were evaluated using double-staining and digital radiography system, which allowed vertebral width and optical density to be determined. Pup weight, crown-rump length, body mass index and vertebral width increased during postnatal period and significantly correlated with their age. Bone mineralisation, as measured by optical density, did not show any significant differences. The complete fusion of the primary ossification centres had a cranio- -caudal direction and started on day 19 after parturition but was incomplete by day 22. It could be concluded that, unlike significant age-related increase of vertebral size, mineralisation was only slightly elevated during evaluated postnatal period. The method described is supplementary to alizarin red S staining as it provides both qualitative and quantitative data on mineralisation in a similar manner to micro computed tomography but does not allow 3 dimensional and microarchitecture examination.

Morphology of the foramen magnum in young Eastern European adults.

BACKGROUND: The foramen magnum is an important anatomical opening in the base of the skull through which the posterior cranial fossa communicates with the vertebral canal. It is also related to a number of pathological conditions including Chiari malformations, various tumours, and occipital dysplasias. The aim of the study was to evaluate the morphology of the foramen magnum in adult individuals in relation to sex. MATERIAL AND METHODS: The morphology of the foramen magnum was evaluated using 3D computer tomography images in 313 individuals (142 male, 171 female) aged 20-30 years. RESULTS: The mean values of the foramen length (37.06 ± 3.07 vs. 35.47 ± 2.60 mm), breadth (32.98 ± 2.78 vs. 30.95 ± 2.71 mm) and area (877.40 ± 131.64 vs. 781.57 ± 93.74 mm2) were significantly higher in males than in females. A significant, positive correlation was found between foramen length and breadth. Significant correlations were reported for breadth and area of the foramen magnum and corresponding external cranial diameters in females. Round as well as longitudinal and horizontal oval-like types of the foramen shape were established according to the breadth/length index of the structure. All the cranial and foramen measurements were significantly higher in individuals with round-like type of the foramen magnum. CONCLUSIONS: There was a sexual dimorphism of the foramen magnum among the examined individuals. It was related mainly to its linear diameters and area, not to the shape. Unlike males, female skulls had higher correlation between the examined parameters of the foramen and proper external cranial measurements, which indicates more homogeneous growth in girls.

Anatomical classification of the shape and topography of the operated stomach.

The aim of the study was to present the classification of anatomical variants of the operated stomach, based on radiological and historical data. Different anatomical variants of the operated organ were found in 431 out of 2034 patients examined in the years 2006-2010. Four main groups were established: abnormal position along longitudinal (I) and horizontal axis (II), as well as abnormal shape (III) and stomach connections (IV). An additional group (V) encloses mixed forms that combine features of two or more of the main groups. The first group contains the partial and total translocation of the stomach into the thoracic cavity after the partial or total oesophagectomy. Depending on the applied surgical techniques used during the total oesophagectomy, the stomach could be located anteriorly or posteriorly to the pericardial sac. An elongated and gastrectatic form often with signs of pylorostenosis is visible in patients treated by vagotomy. The consequences of fundoplication included: lack of or narrow cardiac angle, and often a mild form of stomach cascade. The most common abnormal shape of the stomach was secondary to gastrectomy and gastric bending. The final organ shape depends on the type of applied surgical procedure that maintains physiological connection with the duodenum or an un-anatomical one, mostly with the jejunal loop. In banding, the body of the stomach forms an hourglass at the level of the artificial adjustable band, typically applied in surgical treatment of obesity (slim surgery).

Intrapancreatic accessory spleen.

A case of accessory spleen located in the tail of the pancreas in a stillbirth male foetus is reported. The congenital anomaly was revealed at autopsy. The intrapancreatic spleen was well demarcated and was composed of red and white pulp; however, same pancreatic ducts were intermingled with the splenic parenchyma. As well as the intrapancreatic lesion another minute accessory spleen was also found at the hilum of the proper organ. Since a lack of morphological features of trisomy 13 syndrome were found in the foetus, the ectopic spleens were regarded as incidental findings.

Anatomical variances and dimensions of the superior orbital fissure and foramen ovale in adults.

The aim of the study was the retrospective morphological analysis of selected structures of the middle cranial fossa, i.e. foramen ovale and superior orbital fissure, in relation to the external head and cranial diameters in adults from the Lublin region (Poland). The study was performed on data collected during computed tomography examinations of 60 individuals (age 20-30 years), without any cranial or brain abnormalities. Based on the post-processing reconstructions, 3-dimensional views of the skull and head were obtained. The length and width of both structures, as well as thickness of the frontal, temporal, and occipital squamae, were measured. The morphology of the ovale foramina and superior orbital fissures were checked. The length and width of the skull and head were the only parameters that significantly differed between males and females. The thickness of the frontal and temporal squama was insignificantly lower in males than in females. Almond and oval shapes were the most typical for the foramen ovale. The superior orbital fissure was found as a wide form - with or without accessory spine originating from its lower margin or as a laterally narrowed form. The length and width of the foramen ovale were insignificantly higher in males than in females. The same results were found for the area of the right superior orbital fissure. The thickness of the frontal and occipital squamae influenced the thickness of the temporal squama. The analysed individuals had asymmetrical, oval, or almond-shape ovale foramina. Unlike the seldom visible laterally narrowed form of the superior orbital fissure, a wide form with or without accessory spine was the most commonly observed. The diameters of both superior orbital fissures and ovale foramina indicated the asymmetry of the neurocranium.

Blue nevus of the endocervix.

The mucosa of the uterine cervix is normally devoid of melanocytes; therefore, melanin-containing lesions are very rare in this site. A new case of a common blue nevus in the cervix of a 57-year-old woman is reported. The lesion was an incidental finding in a total hysterectomy specimen performed for atypical endometrial hyperplasia. Gross and histological examination revealed minute dark macula on the mucosa of the posterior aspect of the endocervical canal, composed of loose conglomerates of spindle-shaped and dendritic cells located superficially within the stroma, containing multiple brownish granules, which exhibited positive immunostaining for HMB45 and melan A. Although the blue nevi seem to be lesions of low clinical significance, they require careful differential diagnosis with malignant melanoma, especially in scanty endocervical curettage or cervical biopsy specimens.

Sebaceous glands - unusual histological finding in the uterine cervix.

Sebaceous glands have been extremely rare findings in the female genital system. Excluding the vulva and recent findings, very few cases have been described. The origin of the lesions remains a topic of speculation. However, it appears that prolonged irritation induces a metaplastic response in the ectocervical epithelium. A new case of sebaceous glands in the ectocervix of a 46-year-old woman is reported. The lesions were unexpectedly found in a hysterectomy specimen. The procedure was carried out for multiple leiomyomas of the uterine corpus. Histological examination revealed three mature sebaceous glands located distally to the transformation zone, which opened directly onto the surface epithelium. It could be concluded that sebaceous glands in the ectocervix are rare lesions of unclear origin and low clinical significance. However, the glands could potentially be associated with sebaceous carcinoma of that anatomical site.

Immunoexpression of constitutive and inducible cyclooxygenase isoforms in distinguishing and accessory structures of synovial joints in rat foetuses.

Joint formation is a developmental process regulated by various factors including bone morphogenetic proteins, transforming and growth factors, etc. Recently, a high expression of cyclooxygenase (COX) isoforms in the foetal cartilaginous elements was also revealed. On the other hand, various joint and skeletal abnormalities were seen in laboratory animal and human offspring, exposed in utero to several COX inhibitors. Immunoexpression of constitutive (COX-1) and inducible (COX-2) cyclooxygenase isoforms was evaluated in various articular structures of untreated and unfamiliar 21-day-old male rat foetuses. Both COX isoforms were detected in the articular cartilage and joint capsule, as well as in the intra-articular disc of the temporomandibular joint and meniscus of the knee joint. COX-1 immunostaining was revealed in the anterior and posterior cruciate ligament of the knee joint and the labrum of the hip and shoulder, whereas COX-2 immunoreactivity in those structures was not found. It could be concluded that both constitutive and inducible COX isoforms are physiologically expressed in various structures of synovial joints in rat foetuses at the end of prenatal development.

Immunoexpression of constitutive and inducible cyclo-oxygenase isoforms in the rat foetal and maternal digestive tract.

Cyclo-oxygenase (COX), which catalyses the conversion of arachidonic acid to prostaglandin endoperoxide and prostanoids, is widely expressed in mammalian organs. The aim of the study was to evaluate the immunoexpression of the constitutive and inducible cyclo-oxygenase isoforms (COX-1 and COX-2 respectively) in the oesophagus, stomach and the small and large bowels of untreated rat dams and foetuses on gestational day 21. The localisation of the COX isoforms was similar in the maternal and foetal organs, although the intensity of the reaction for COX-2 was stronger in the foetuses. Cytoplasmic COX-1 immunostaining was found in myocytes of the muscularis propria, muscularis mucosae and the blood vessels. It was also positive in the endothelial cells, scattered stromal cells of the lamina propria and the ganglion cells of the nerve plexus in the bowels. Apart from the keratinised layer, a strong reaction was revealed in the stratified squamous epithelium of the oesophagus and forestomach. Negative or weakly positive staining was found in the mucus-secreting cells covering the surface, gastric pits and pyloric glands, as well as in the parietal cells and the chief cells. Weakly positive COX-1 immunostaining was observed in epithelial cells of the small intestine crypts, but in some cases enterocytes and goblet cells covering villi were also positive. In the colonic mucosa weak COX-1 staining was typical of the absorptive, and goblet cells. The COX-2 immunostaining was nuclear and/or cytoplasmic. An inconsistent positive reaction was seen in the muscle of the muscularis mucosae, muscularis propria and the blood vessels. Positive staining was also found in scattered stromal cells of the lamina propria and adventitia and the ganglion cells. Weak nuclear staining was found in the stratified squamous epithelium of the oesophagus and forestomach. Unlike the strong foetal reactivity in the epithelial cells of the glandular stomach, a negative or weakly positive reaction was seen in the maternal parietal and/or mucous-secreting surface stomach cells. Some epithelial cells of the crypts both in the small and large bowel were also COX-2 positive. In conclusion, constitutive and inducible COX isoforms were detected in the digestive tract of pregnant female and in foetuses. COX-1 was the predominant isoform in both the adult and foetal organs.

Association of maternal pancreatic function and foetal growth in rats treated with DFU, a selective cyclooxygenase-2 inhibitor.

Constitutive (COX-1) and inducible (COX-2) cyclooxygenase isoforms have been detected in various mammalian tissues. Their activity is blocked by non-steroidal anti-inflammatory drugs that may induce various side reactions. The aim of the study was to evaluate the effects of DFU, a selective COX-2 inhibitor, on exocrine and endocrine pancreatic function and the immunoexpression of both COX isoforms in maternal and foetal rat pancreases. The compound was administered to pregnant Wistar rats once daily from the 8th to the 21st day of gestation. Glucose level and amylase activity were determined in the maternal sera. Maternal and foetal pancreases were examined histologically. Immunoexpression of COX-1 and COX-2 was also evaluated. Both biochemical parameters, as well as the histological structure of the pancreas were undisturbed in the dams and their foetuses. The maternal glucose level was found to be an important factor for foetal growth. Strong cytoplasmic COX-1 immunostaining was observed in acinar secretory cells, whereas in islets the immune reaction was weak. Endocrine cells also revealed strong cytoplasmic COX-2 staining in the maternal and foetal pancreases. Acinar cells exhibited nuclear reaction, which was strong in the foetal but weak in the maternal pancreases. No differences in COX immunoexpression were found between the DFU-exposed and the control groups in either mothers or foetuses. It should be stressed that DFU administered throughout mid and late pregnancy in rats did not change maternal or foetal pancreatic morphology or immunoexpression of either of the main COX isoforms in the organ.

Congenital ventricular septal defects and prenatal exposure to cyclooxygenase inhibitors.

Ventricular septal defects (VSDs) are common congenital abnormalities which have been reported to be associated with maternal fever and various environmental factors. The aim of the present study was to evaluate the effect of prenatal exposure to cyclooxygenase (COX) inhibitors on heart defects. A retrospective statistical analysis was performed using data collected in our laboratory during various teratological studies carried out on albino CRL:(WI)WUBR Wistar strain rats from 1997 to 2004. The observations were compared with concurrent and historic control data, as well as findings from other developmental toxicological studies with selective and nonselective COX-2 inhibitors. Despite the lack of significant differences in the frequency of VSDs between drug-exposed and control groups, statistical analysis by the two-sided Mantel-Haenszel test and historical control data showed a higher incidence of heart defects in offspring exposed to nonselective COX inhibitors (30.06/10,000). Unlike other specific inhibitors, aspirin (46.26/10,000) and ibuprofen (106.95/10,000) significantly increased the incidence of the VSD when compared with various control groups (5.38-19.72/10,000). No significant differences in length or weight were detected between fetuses exposed to COX inhibitors and born with VSD and non-malformed offsprings. However, a statistically significant increase of fetal body length and decrease of body mass index were found in fetuses exposed to COX inhibitors when compared with untreated control. We conclude that prenatal exposure to COX inhibitors, especially aspirin and ibuprofen, increased the incidence of VSDs in rat offspring but was not related to fetal growth retardation.

Congenital ventricular septal defects and prenatal exposure to cyclooxygenase inhibitors

Ventricular septal defects (VSDs) are common congenital abnormalities which have been reported to be associated with maternal fever and various environmental factors. The aim of the present study was to evaluate the effect of prenatal exposure to cyclooxygenase (COX) inhibitors on heart defects. A retrospective statistical analysis was performed using data collected in our laboratory during various teratological studies carried out on albino CRL:(WI)WUBR Wistar strain rats from 1997 to 2004. The observations were compared with concurrent and historic control data, as well as findings from other developmental toxicological studies with selective and nonselective COX-2 inhibitors. Despite the lack of significant differences in the frequency of VSDs between drug-exposed and control groups, statistical analysis by the two-sided Mantel-Haenszel test and historical control data showed a higher incidence of heart defects in offspring exposed to nonselective COX inhibitors (30.06/10,000). Unlike other specific inhibitors, aspirin (46.26/10,000) and ibuprofen (106.95/10,000) significantly increased the incidence of the VSD when compared with various control groups (5.38-19.72/10,000). No significant differences in length or weight were detected between fetuses exposed to COX inhibitors and born with VSD and non-malformed offsprings. However, a statistically significant increase of fetal body length and decrease of body mass index were found in fetuses exposed to COX inhibitors when compared with untreated control. We conclude that prenatal exposure to COX inhibitors, especially aspirin and ibuprofen, increased the incidence of VSDs in rat offspring but was not related to fetal growth retardation.

The activity and immunoexpression of cathepsin D in rat male reproductive organs.

Cathepsin D is a cysteine endopeptidase that belongs to the lysosomal enzyme family. The aim of the study was to evaluate the enzyme immunoexpression and activity in selected male genital organs in mature Wistar rats. The activity of cathepsin D was measured spectrophotometrically in homogenates of the testis, epididymis, seminal vesicle and prostate. Immunohistochemical staining was also performed in the ductus deferens. Enzyme activity was found in the following sequence: testis>epididymis>dorsal prostatic lobe>seminal vesicle>lateral prostatic lobe>ventral prostatic lobe. Although there were differences in enzyme activity between various organs of the male reproductive system, cathepsin D immunoreactivity was seen exclusively in the Sertoli and Leydig cells in the testis.

Diethylnitrosamine may induce esophageal dysplasia after local intramural administration.

PURPOSE: To assess the possibility of promoting esophageal squamous cell carcinoma after direct administration of diethylnitrosamine (DEN) into the wall of the esophagus. MATERIAL AND METHODS: Adult male Wistar rats weighing 250-300 g were used in the studies. Via laparotomy, solution of DEN (at the volume of 0.1 ml) was injected directly into the esophageal wall. Animals were divided into 3 groups: CONTROL group--injected with saline, DEN1 group--injected with DEN 100 mg, DEN2 group--injected twice with DEN at the dose of 100 mg with 7 days interval (total dose of 200 mg). RESULTS: Microscopic evaluation after 180 days revealed signs of esophagitis in 20% and 30% subjects in DEN1 and DEN2 group respectively. In 30% of animals from DEN1 and 50% animals from DEN2 group, low-grade dysplasia was recognized. The difference between DEN2 and control animals was statistically significant with p < 0.03. Neither high-grade dysplasia nor invasive carcinoma were found in both experimental groups. None of the liver specimens showed the evidence of pathology. CONCLUSIONS: These initial results may indicate the possibility of development of premalignant lesions after local administration of carcinogen into esophageal wall. Observed changes were limited exclusively to esophagus which became the "target organ" in this model.

Coexistence of esophageal granular cell tumor and squamous cell carcinoma: a case report.

Granular cell tumors (GCTs) are relatively uncommon, usually benign and solitary neoplasms. Until now, about 200 cases of esophageal GCTs have been reported in the literature. We present a rare case of synchronous occurrence of esophageal GCT and moderately differentiated squamous cell carcinoma in a 40-year-old white woman. The GCT was detected incidentally during esophagoscopy undertaken for evaluation of a 4-month history of progressive solid food dysphagia. The gross and microscopic appearance of the GCT was typical. It was localized in the mucosa of the middle esophagus dystally and separately to the cancer. It revealed strong positive immunostaining for vimentin, S-100 protein and neuron-specific enolase, as well as weakly positive focal staining for Ki67 and p53 protein. Although, the coexistence of esophageal GCTs and cancers seems to be coincidental, the necessity of a careful clinical evaluation and a close follow-up of patients with GCT is suggested.

Intravascular B-cell lymphoma in a 38-year-old woman: a case report.

Intravascular lymphoma (IVL) is a rare aggressive disease characterised by the presence of lymphoma cells only in the lumina of small vessels, particularly capillaries. Only about 200 cases have been reported in the world (some of them retrospectively). IVL is predominantly of B-cell lineage origin but occasionally T-cell lineage occurs. Multiple organs may be involved and a variety of clinical presentations have been described. These include nephrotic syndrome, pyrexia and hypertension, breathlessness and haemolytic anaemia, leukopoenia, pancytopoenia and disseminated intravascular coagulation. We report a case of a 38-year-old woman with a highly aggressive clinical course of IVL. She was admitted to the Department of Neurosurgery because of spondylolisthesis of L5-S1 qualified to surgery. During hospitalisation haemolytic anaemia, thrombocytopoenia and splenomegaly were observed and she was admitted to the Department of Haematology for diagnosis. During her staying in the hospital, new symptoms, such as kidney and liver failure, occurred and the central nervous system was involved. The clinical course was very rapid and progressive. Corticosteroid therapy was started but the disease soon led to the fatal outcome. Diagnosis was established at post-mortem examination.

Multiple synchronous granular cell tumours of the esophagus: a case report.

Granular cell tumours (GCTs) are relatively uncommon, usually benign and solitary neoplasms. Approximately 5-11% of all tumours occur in the gastrointestinal tract and about one third of them appear in the esophagus. Till now, only 30 cases of multiple esophageal GCTs have been reported in the literature. We present the case of a 44-year-old man with three synchronous GCTs in the distal esophagus. The lesions were detected incidentally during esophagoscopy. Histopathologic examination of tissue samples revealed the nests of polygonal cells with small hyperchromatic nuclei and abundant granular cytoplasm located in the lamina propria of the mucosa. The cytoplasmic granules were positively stained with PAS and were diastase resistant. The positive immunostaining for S-100 protein was also noted.