Clinical, Epidemiological, Morphological, and Immunohistochemical Aspects of Nasopharyngeal Carcinoma-4-Year Retrospective Study in the Western Part of Romania.

Nasopharyngeal carcinoma is one of the most common malignant tumors in the head and neck region. The carcinogenesis is a complex process stimulated by many factors. Although the etiological factors and pathogenic mechanisms are not elucidated, the genetic susceptibility, environmental factors, and association with latent infection with Epstein-Barr Virus play an important role. The aim of this study was to present the main clinical and epidemiological data, as well as the morphological aspects and the immunohistochemical profile, of patients with nasopharyngeal carcinoma diagnosed in western Romania. The study was retrospective and included 36 nasopharyngeal carcinomas. The histopathological diagnosis was completed using immunohistochemical reactions for the following antibodies: p63, p53 and p16 protein, cytokeratins (CK) AE1/AE3, CK5, CK7, CK20 and 34ßE12, epithelial membrane antigen (EMA), Epstein-Barr virus (EBV), leukocyte common antigen (LCA), CD20, CD4, CD8, CD68, CD117, and CD1a. The squamous malignant component of nasopharyngeal carcinoma presented with positivity for cytokeratins AE1/AE3, CK5, 34ßE12, and p63. Undifferentiated nasopharyngeal carcinoma was positive for EMA in 67% of cases, and 28% of cases showed an immunoreaction for CD117 in the malignant epithelial component. Also, the p53 protein was positive in all the cases. One case of undifferentiated nasopharyngeal carcinoma was p16-positive, and two cases were positive for EBV. A peri- and intratumor cellular infiltrate rich in lymphocytes, with a predominance of CD20-positive B lymphocytes, interspersed with T lymphocytes, was observed. The T cells were CD4- and CD8-positive, predominantly intratumoral, and the CD4:CD8 ratio was 1:1 for 75% of the undifferentiated subtype and 89% for differentiated non-keratinized squamous cell carcinoma. All subtypes of nasopharyngeal carcinoma presented with an inflammatory infiltrate with numerous plasma cells, eosinophils, and dendritic cells, presenting as antigen CD1a- and CD68-positive, as well as in CD117-positive mast cells.

Challenges of Pharyngeal Cancer Screening in Lower-Income Countries during Economic and Social Transitions: A Population-Based Analysis.

Background and Objectives: The rate of head and neck cancer (HNC) is expected to increase by 30% by 2030. However, there are many similarities between the symptomatology of a benign and a malign diagnosis; thus, a protocol for conducting a full head and neck examination is of high importance since the absence of adenopathy does not exclude a malignant diagnosis and also a favorable prognosis. Material and methods: The current study presents a retrospective study on 515 adult patients who underwent a biopsy for possible head and neck tumor pathology. Results: The patients identified with cancer were older than the rest of the group, with a higher developing trend in men than in women. However, the top 10 symptomatology patterns were identical in the malign and benign groups, meaning that new HNC may be missed due to the common symptomatology between benign and malign outcomes. Conclusions: The importance of a full ear, nose, and throat (ENT) examination may be of significant relevance for a proper diagnosis that can improve the overall prognosis of a patient with cancer. The absence of routine screening tests and screening guidelines for oral and pharyngeal cancers represents a significant barrier to secondary HNC prevention.

Otosclerosis under the magnifying glass.

Otosclerosis is a bone condition affecting the stapes bone within the otic capsule, and its exact cause is still unknown. It is characterized by a lack of proper remodeling of newly formed vascular and woven bone, leading to the development of abnormal osteons and the formation of sclerotic bone. Bilateral otosclerosis is seen in 80% of patients and 60% of otosclerosis patients have a family history of the condition. The etiology of this disease is still unknown, there are lots of theories to explain it. The histopathological (HP) studies of otosclerosis showed that osteoblasts, osteoclasts, vascular proliferation, fibroblasts, and histiocytes were observed in the stapes footplate. The onset of the symptoms occurs by the early third decade of life, usually it doesn't start later. In otosclerosis, the energy exerted by sound at the level of the tympanic membrane is reduced in the inner ear due to the fixation and rigidity of the ossicular chain, leading to hearing loss, especially for low frequencies. The primary clinical symptom of otosclerosis is conductive hearing loss but it is important to note that sensorineural hearing loss and mixed hearing loss can also occur as secondary symptoms of the condition. Another symptom present in patients with otosclerosis is tinnitus. The paper carried out a retrospective study of 70 patients diagnosed with otosclerosis in the Department of Otorhinolaryngology of Emergency City Hospital, Timisoara, Romania, between January 2021 to December 2022. Tissue fragments were processed at Service of Pathology by standard Hematoxylin-Eosin staining. The HP diagnosis was completed using Masson's trichrome staining, Giemsa histochemical staining, and immunohistochemical (IHC) reactions with anti-cluster of differentiation (CD)20, anti-CD3, anti-CD4, anti-CD8, anti-CD34, and anti-CD31 antibodies. The microscopic examination showed a chronic diffuse inflammatory infiltrate that consisted predominantly of mature T-lymphocytes, immunohistochemically positive for CD3, CD4 and CD8. There were also present rare CD20-positive B-lymphocytes. Among the lymphocytes, relatively numerous mast cells were identified, highlighted histochemically by the Giemsa staining. They had numerous purple-violet intracytoplasmic granules. In the connective tissue support, a relatively rich vascular network was identified, consisting of hyperemic capillaries, highlighted immunohistochemically with anti-CD31 and anti-CD34 antibodies. Bone tissues trabeculae showed extensive areas of fibrosis. The collagen fibers were highlighted by Masson's trichrome staining, being stained in green, blue, or bluish green.

Efficacy of Bilateral Cochlear Implantation in Pediatric and Adult Patients with Profound Sensorineural Hearing Loss: A Retrospective Analysis in a Developing European Country.

This retrospective study aimed to evaluate the outcomes of bilateral cochlear implantation in patients with severe-to-profound sensorineural hearing loss at the Timisoara Municipal Emergency Clinical Hospital ENT Clinic. The study involved 77 participants, divided into four groups based on their hearing loss characteristics and implantation history. Assessments were conducted pre- and post-implantation, focusing on speech perception, speech production, and reading achievement. Standard surgical procedures were performed, and participants were provided with a comprehensive rehabilitation program involving auditory training and communication therapy. The variables considered for analysis included demographic factors, implantation period, and quality of life assessment, with no statistically significant differences pre-implantation between the four study groups. Results revealed significant improvements in speech perception, speech production, and reading achievement after cochlear implantation. In adult patients, speech perception scores increased from 21.3% to 73.4% for WIPI and from 22.7% to 68.4% for HINT after 12 months of rehabilitation. Speech production scores improved from 33.5% to 76.8% and reading achievement scores increased from 76.2 to 106.3. Moreover, there was a significant improvement in patients' quality of life following cochlear implantation, with mean scores increasing from 2.0 to 4.2. Although it is known that bilateral cochlear implantation significantly improves speech perception, speech production, reading achievement, and quality of life in patients with severe-to-profound sensorineural hearing loss, this is the first study of its kind from Romania. Further research is warranted to optimize patient selection and rehabilitation strategies to maximize outcomes and determine better policies towards funding and access of cochlear implants for a wider range of patients in need.

Granulomatosis with Polyangiitis (GPA)-A Multidisciplinary Approach of a Case Report.

Granulomatosis with polyangiitis is an atypical, multisystem disease with unknown etiology that generally affects both genders equally, with a predominance in the Caucasian racial group for individuals in their fourth decade. The disease affects the small vessels of the respiratory system, lungs, and kidneys. ENT manifestations are common, but ocular involvement is also frequent and can occur as an initial harbinger of the disease. The signs and symptoms of the disease are non-pathognomonic and sometimes localized, but it carries a poor prognosis if left untreated. Early diagnosis of granulomatosis with polyangiitis can be difficult and is established by a clinical examination along with laboratory tests for anti-neutrophil cytoplasmic antibodies (ANCA) and anatomopathological exam results that showcase necrosis, granulomatous inflammation, and vasculitis. Although the ocular involvement is not life threatening, it can cause blindness and may also be a sign of the active form of this systemic fatal disease. Treatment strategies involving immunosuppression and adjuvant therapies improve the prognosis. In this article we present a rare case of a patient diagnosed with granulomatosis with polyangiitis in our ENT department in 2003, with a follow-up for19 years in our clinic.

Laryngeal malignancies - epidemiological data and particularities of the cases diagnosed in Western Romania (October 2016-July 2020).

In the last decade, the incidence and mortality associated with laryngeal malignancies has experienced an unfavorable evolution in Romania, in terms of this pathology the country that has become the leader, among the European Union (EU)-27 countries. The aim of the present retrospective study was to analyze the epidemiological data regarding laryngeal cancer and histopathological (HP) particularities in patients diagnosed in Western Romania. Within three years and 10 months (during October 2016-July 2020) in Ear, Nose and Throat (ENT) Clinic of Timisoara Municipal Emergency Clinical Hospital, 194 patients with laryngeal neoplasms (LN) were diagnosed. Most of the patients were male (93.8%), from Timis County, mainly and the neighboring Counties of Caras-Severin, Hunedoara, Mehedinti and Arad. Patient's average age (both sexes) was 62.6 years, with a range from 38 to 84 years and the highest percentages in the 60+ age group (48%). Regarding smoker status, the main cause of the development of the LN, 93.9% of patients were active ones. Regarding localization [International Classification of Diseases 11th Revision (ICD-11)], about 69% were malignant neoplasm of glottis (C32.0), followed by supraglottis (C32.1), larynx-unspecified (C32.9), and subglottis (C32.2). From the HP point of view, several types of tumors were identified, most of which were non-keratinized and keratinized squamous cell carcinomas (about 90%). In addition, there were identified types of verrucous carcinoma, acantholytic carcinoma, squamous papilloma, a possible pleomorphic sarcoma, and pyogenic granuloma. The data presented in this study highlight the growing incidence of LN, which mainly affect men, at an increasingly young age. It is imperative to involve specialists from nutrition, general medicine, ENT, dentistry to start awareness programs and to develop prevention protocols.

Assessment of the In Vitro Cytotoxic Profile of Two Broad-Spectrum Antibiotics-Tetracycline and Ampicillin-On Pharyngeal Carcinoma Cells.

Background and Objectives: In spite of the fact that antibiotics are considered to be the cornerstone of modern medicine, their use in the treatment of cancer remains controversial. In the present study, the main objective was to examine the effects of two antibiotics-tetracycline and ampicillin-on the viability, morphology, migration, and organization and structure of the nuclei and the actin fiber network of pharyngeal carcinoma cells-Detroit-562. Materials and Methods: In order to determine the viability of the cells, the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) method was applied after the cells were stimulated with five concentrations of tetracycline and ampicillin (10, 25, 50, 75, and 100 µM) for 72 h. A scratch assay was used to assess the migration ability of the cells. For the visualization of the nuclei and actin fibers, 4,6-diamidino-2-phenylindole (Dapi) and Rhodamine-Phalloidin were used. Results: There are different effects of tetracycline and ampicillin. Thus, tetracycline: (i) exhibited a concentration-dependent cytotoxic effect, decreasing cell viability to approximately 46%; (ii) inhibits cellular migration up to 16% compared to 60% for control cells; and (iii) induces changes in cell morphology as well as apoptotic changes in the nucleus and F-actin fibers. In contrast, in the case of ampicillin, an increase in viability up to 113% was observed at 10 µM, while a decrease in viability up to approximately 94% was observed at the highest concentration tested (100 µM). Conclusions: The results indicated a different effect regarding the impact on pharyngeal carcinoma cells. Thus, tetracycline has a concentration-dependent cytotoxic effect, while in the case of ampicillin a slight stimulation of cell viability was observed.

Assessment of the Biological Activity of Thyme Essential Oil in the Presence of the Classic Antibiotic Tetracycline.

The present study was purported to assess the activities: (i) antibacterial and synergistic against three types of both Gram-positive and Gram-negative bacteria that are susceptible to drug resistance and (ii) cytotoxic and synergistic on colorectal adenocarcinoma cells, of thyme essential oil (TEo) in combination with tetracycline (Tcyc). Chemical composition of thyme essential oil was evaluated by gas chromatography-mass spectrometry (GC-MS) method, antioxidant capacity by 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) assay, antibacterial and synergistic properties were determined by disk diffusion method and cytotoxic activity by quantifying viable cells by using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. Thyme essential oil has an elevated antioxidant activity, antibacterial potential against both Gram-positive and Gram-negative bacteria, especially on S. aureus and K. pneumoniae at the highest concentration tested (50µL/mL), also having a synergistic effect when combined with tetracycline (50µL/mL TEo with 10µg/mL Tcyc). Essential oil-treated cells showed a dose-dependent reduction in colorectal adenocarcinoma cell viability, while combination with tetracycline leads to a significantly attenuated decrease in viability.

Nicotine Exerts Cytotoxic Effects in a Panel of Healthy Cell Lines and Strong Irritating Potential on Blood Vessels.

The use of tobacco products is a major global public health issue, as it is the leading cause of preventable death worldwide. In addition, nicotine (NIC) is a key component of electronic and conventional cigarettes. Although nicotine's addictive potential is well known, its health effects are not entirely understood. Thus, the main objective of the present study was to evaluate its toxicological profile both in vitro, at the level of three healthy cell lines, and in ovo, at the level of the chorioallantoic membrane. Five different concentrations of nicotine were used in keratinocytes, cardiomyocytes, and hepatocytes for the purpose of evaluating cell viability, cell morphology, and its impact on nuclei. Additionally, the hen's egg test on the chorioallantoic membrane (HET-CAM) method was used to assess the biocompatibility and irritant potential of the chorioallantoic membrane. Across all cell lines studied, nicotine was proven to be significantly damaging to cell viability, with the highest concentration tested resulting in less than 2% viable cells. Moreover, the morphology of cells changed dramatically, with alterations in their shape and confluence. Nicotine-induced cell death appears to be apoptotic, based on its impact on the nucleus. In addition, nicotine was also found to have a very strong irritating effect on the chorioallantoic membrane. In conclusion, nicotine has an extremely strong toxicological profile, as demonstrated by the drastic reduction of cell viability and the induction of morphological changes and nuclear alterations associated with cellular apoptosis. Additionally, the HET-CAM method led to the observation of a strong irritating effect associated with nicotine.

Methotrexate and Cetuximab-Biological Impact on Non-Tumorigenic Models: In Vitro and In Ovo Assessments.

Background Objectives: The neoplastic process remains a major health problem facing humanity. Although there are currently different therapeutic options, they raise a multitude of shortcomings related to the toxic effects associated with their administration. Methotrexate (Met) and Cetuximab (Cet) are two basic chemotherapeutics used in cancer practice, but notwithstanding despite many years of use, the mechanisms by which the multitude of side-effects occur are not yet fully understood. Thus, the present study focused on the in vitro and in ovo evaluation of the associated toxic mechanisms on keratinocytes, keys cells in the wound healing process. Materials and Methods: The two chemotherapeutics were tested in eight different concentrations to evaluate keratinocytes viability, the anti-migratory effect, and the influence on the expression of markers involved in the production of cell apoptosis. In addition, the potential irritating effect on the vascular plexus were highlighted by applying the in ovo method, chick chorioallantoic membrane (HET-CAM). Results: The results revealed that Met induced decreased cell viability as well as increased expression of pro-apoptotic genes. In the vascular plexus of the chorioallantoic membrane, Met caused vascular irritation accompanied by capillary hemorrhage and vascular stasis. Conclusions: Summarizing, Cet presents a safer toxicological profile, compared to Met, based on the results obtained from both in vitro (cell viability, wound healing, RT-PCR assays), and in ovo (HET-CAM assay) techniques.

Antibiotics: Conventional Therapy and Natural Compounds with Antibacterial Activity-A Pharmaco-Toxicological Screening.

Antibiotics are considered as a cornerstone of modern medicine and their discovery offers the resolution to the infectious diseases problem. However, the excessive use of antibiotics worldwide has generated a critical public health issue and the bacterial resistance correlated with antibiotics inefficiency is still unsolved. Finding novel therapeutic approaches to overcome bacterial resistance is imperative, and natural compounds with antibacterial effects could be considered a promising option. The role played by antibiotics in tumorigenesis and their interrelation with the microbiota are still debatable and are far from being elucidated. Thus, the present manuscript offers a global perspective on antibiotics in terms of evolution from a historical perspective with an emphasis on the main classes of antibiotics and their adverse effects. It also highlights the connection between antibiotics and microbiota, focusing on the dual role played by antibiotics in tumorigenesis. In addition, using the natural compounds with antibacterial properties as potential alternatives for the classical antibiotic therapy is discussed.

Photoprotection role of melanin in the human retinal pigment epithelium. Imaging techniques for retinal melanin.

The human eye is made up of multiple layers of pigmented tissues that have in componence melanin. In the eye, one can separate melanosomes from various embryonic origins. The pigment-producing cells in the stroma of the iris, ciliary body and the choroid (uveal melanocytes) are neural crest derivatives. On the other hand, ciliary, iris and retinal pigment epithelial cells are developed from the neural ectoderm. One universally accepted role of melanin is to react as neutral-density filter in scattering light. Melanin acts as a free radical stabilizer and has the ability to absorb near-infrared, visible light and UV radiation. This paper reviews the current knowledge on ocular melanin, including ocular melanogenesis, roles of melanin in retinal metabolic processes and some imaging techniques that identify melanin in the retina.

Fortuitous discovery of melanomas in the ENT Department - a histopathological and immunohistochemical study.

The melanoma, having its origin in the melanocyte cells, is one of the most aggressive forms of skin cancer in the world with one of the highest rates of brain metastasis. The incidence of cutaneous melanoma in the Mediterranean countries varies from three to five cases∕100 000 people∕year. Its prognosis is based on an early diagnosis. Sinonasal mucosal melanoma (SNMM) is an extremely rare tumor, accounting for 0.3-2% of all melanomas. The non-specific symptomatology is often delaying the presentation of the patient at the hospital and therefore the diagnosis. The SNMM is a highly aggressive tumor, and the presence of metastasis at the diagnosis usually implies a poor prognosis. The management of the melanomas requires a precise pre-therapeutic assessment and a multidisciplinary approach for the diagnosis, with surgical treatment or radiotherapy required in order to ensure a better a quality of life. In this paper, we retrospectively analyzed two cases of mucosal melanoma and one case of cutaneous melanoma of the nose.

Primary tonsillar tuberculosis - case report.

We report the case of a 44-year-old male patient with tonsillar tuberculosis (TB) diagnosed in the Department of Ear, Nose & Throat (ENT), "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania. The patient addressed to our Clinic with intense odynophagia, referred otalgia, sore throat, fever periods and weight loss. During the ENT clinical exam, we identified an enlarged left tonsil, partially covered with yellowish-white plaque, with ulceration and bleeding spots localized on tonsillar inferior pole. A high suspicion of tonsillar malignancy was raised, and a biopsy was performed revealing extrapulmonary TB. Taking into consideration the normal chest X-ray, a primary tonsillar TB diagnosis was established. The patient was addressed to Department of Pneumophthisiology for anti-tuberculous therapy for six months. At the end of the treatment, the patient was symptoms-free.

Laryngotracheal foreign body: chicken neck bone.

We herein present a case involving a 78-year-old patient who had aspirated a laryngotracheal foreign body 3 days prior to hospital admission. The patient had severe congenital intellectual disability; however, no agitation, suffocation, or death occurred despite almost complete laryngeal obstruction. The laryngotracheal foreign body was removed by tracheotomy and suspended microlaryngoscopy.

Head and neck metachronous tumors - clinical, histopathological and immunohistochemical study.

Multiple primary tumors (MPT) represent an important factor affecting the survival of some patients. They present an incidence of about 0.7-11% of all carcinomas developing in any region of the human body, being either synchronous or metachronous. These tumors raise problems of differential diagnosis, with tumoral relapses and distance metastases; also, they involve problems related to chemotherapy, radiotherapy and surgical treatment. In the present paper, we studied a group of 902 patients diagnosed with head and neck tumors admitted to the Ear, Nose & Throat (ENT) Clinic of the Emergency County Hospital of Timisoara, Romania, and we identified 12 patients with metachronous tumors, representing 1.33% of the hospitalized cases. Of the 12 patients with metachronous tumors, a single case was a woman, the other 11 cases being diagnosed in men. Regarding the age of the patients with metachronous tumors, only a single patient was aged less than 60 years old; most of them (nine patients) were aged between 60 and 69 years old, while two patients were aged over 70 years old. Nine patients were alcohol consumers, while 10 (83.33%) patients were smokers of about 20 cigarettes∕day. All the metachronous tumors localized in the head and neck were squamous cell carcinomas. The second primary tumor was identified in the prostate, kidneys, ureter, lungs, salivary gland, thyroid gland, meninges, colon, rectum or skin.

Bisphosphonates-induced osteonecrosis of the jaw - epidemiological, clinical and histopathological aspects.

INTRODUCTION: Osteonecrosis of the jaw (ONJ) is a multifactorial condition associated with bisphosphonates (BPs) treatment, head and neck irradiation, malignancy, chemotherapy, periodontal disease or trauma. The first cases of BPs-related ONJ (BRONJ) were reported over a decade ago. PATIENTS, MATERIALS AND METHODS: The study was retrospective and analyzed archived material. The study included 38 patients diagnosed and treated in the Clinic of Oral and Maxillofacial Surgery, Emergency City Hospital, Timisoara, Romania, for BRONJ, between 2013 and 2016. For all the cases were noted gender, age, localization of osteonecrosis, therapeutic indications for BPs (osteoporosis or malignancy), history of radiotherapy or chemotherapy, presence of bone metastases. If the treatment consisted in surgical removal of necrotic bone, the surgically removed specimens were sent to Service of Pathology of the same Hospital. The excised specimens were prepared with routine histological technique. RESULTS: All the patients included in the current study were diagnosed with BRONJ. The patient history and clinical characteristics were the most useful diagnostic methods. Radiographic changes are not significant in early stages of osteonecrosis. The prevalence of BPs-associated ONJ is higher between 55-74 years old. CONCLUSIONS: ONJ is an important complication of BPs medication. The majority of affected patients develop this complication after dentoalveorar surgery, especially after dental extraction. Therefore, a good state of dental health is one of the most important directives when dealing with potential candidates for BPs therapy.

Basal cell carcinoma and basosquamous carcinoma, two faces of the same condition?

Basal cell carcinoma (BCC) is the most common locally invasive malignant epidermal neoplasm. It is generally a tumor that runs a slow progressive course and can usually be cured by surgery. Basosquamous carcinoma is considered by some authors a rare subtype of BCC, while others describe it as independent tumor with different evolution from BCC. The aim of the study was to present a very interesting case of initially otherwise ordinary BCC that during its repeated and extensive relapses changed its histopathology in a basosquamous carcinoma, despite the free surgical margins and leading to major surgeries with loss of right eye. We present a case of 75-year-old male diagnosed in 2008 with a tumor located in the right naso-orbital region. The patient underwent surgical treatment, the histopathology being consistent with BCC. He presented recurrences of the tumor in 2009 and 2010 that were excised at approximately 9 and 16 months, respectively, from the first intervention. In 2010, the surgical procedure was radical, with removal of the tumor and the entire right superior eyelid. This approach proved to have negative side effects over the right eye in time. Therefore, after two months, a complete exenteration of the right orbit was necessary. The tumor recurred again for three times, after 20, 30 and 42 months from the first intervention and every time surgical treatment was applied. The microscopic inspection of the biopsies showed similarities between recurrences and initial tumor. In 2013, after 57 months from the first intervention, the patient was readmitted with a lesion in the same region that was excised but that time the histopathology differed from the previous, the tumor being composed of sheets of achromic epithelioid cells, with vesicular nuclei and prominent, eosinophilic nucleoli. The tumor cells were positive for pan-cytokeratin AE1∕AE3 and negative for S100 protein, human melanoma black 45 (HMB45) and vimentin that sustained the diagnosis of basosquamous carcinoma. The paper presented an interesting case with different histopathological features from a recurrence to other, with important implication in diagnosis and prognosis. The transformation of BCC into basosquamous carcinoma sustain that the basosquamous carcinoma is better a rare, aggressive variant of BCC, than an individual lesion.

Lipomas of cervical area - clinical and pathological considerations.

INTRODUCTION: Cervical lipomas are tumors that may present as painless masses with slow growth. This type of tumors is usually asymptomatic until they reach a large size. They can be solitary or multiple. When multiple and symmetrical distributed around neck area, the lesions can be classified as Madelung's disease, a rare condition that affects mostly Mediterranean men. Our objective was to describe the symptoms, cytological and histological aspects, diagnostic problems and treatment strategies of the large size lipomas and to highlights that the differential diagnosis between common lipoma of cervical area and Madelung's disease can be established only on clinical grounds, with major implications in the treatment options. MATERIALS AND METHODS: The study was retrospective and analyzed archived material. We selected four cases of cervical lipomas, each with its particularities, treated in the Clinic of Oral and Maxillofacial Surgery, Timisoara City Hospital, Romania. For all the cases, we performed a fine-needle aspiration with consequent cytological exam. The microscopic evaluation of Papanicolaou-stained slides established the diagnosis of lipomas. The surgically removed specimens were sent to the Department of Pathology. The excised specimens were prepared with routine histological technique. RESULTS: The cases presented one or more lateral cervical swelling of the neck, inserted among major vascular-nervous elements, becoming life-threatening conditions. All the cases studied had the same cytological and histopathological features consistent with lipoma, fibrolipoma or angiolipoma, but, instead of this, clinical aspects differed from case to case. On clinical grounds, two patients were considered as Madelung's diseases. CONCLUSIONS: Despite of the same histopathological aspects, lateral cervical lipomas can be classified in varies categories with different treatment strategies and prognostic factors. The correct diagnosis of Madelung's disease is important in order to add other treatment options to the surgery or liposuction as avoiding alcohol or medication for metabolic disorders.

Tracheal enlargement or Mounier-Kuhn syndrome in giant cell arteritis: a possible causal association with therapeutic implications.

Giant cell arteritis (GCA) is a large-vessel vasculitis with rarely described respiratory initial manifestations. We report such a case presenting with hoarseness, stridor, cough and dyspnea, in which a tracheomegaly with tracheomalacia was found. No signs of relapsing polychondritis were present. The respiratory symptoms rapidly improved after glucocorticoids and Azathioprine. Tracheomegaly or Mounier-Kuhn syndrome is characterized by marked dilatation of trachea and central bronchi. The differential diagnosis and the possible relationship between tracheomegaly and GCA involving metalloproteinase-induced elastolysis are discussed. This is the first case, to our knowledge, of Mounier-Kuhn syndrome in vasculitis. The association of tracheomegaly with GCA may be underestimated, as the diagnosis is not always obvious on conventional radiographs. A tracheal enlargement finding in GCA requires monitoring to ensure early detection and prevention of spontaneous tracheal rupture. Adding a metalloproteinase inhibitor like Doxycycline to GCA therapy would be rational for the prophylaxis of complications.