The clinical-morphological profile of bone and joints tuberculosis - our experience in relation to literature data.

AIM: The authors made a morphological assessment of musculoskeletal tissue samples from patients admitted in Surgical Departments of the Emergency County Hospital of Craiova, Romania, between 1990 and 2015, proved as presenting tuberculous lesions in the Department of Pathology of the same Hospital. MATERIALS AND METHODS: The studied material consisted of bone, joint and sometimes muscle tissue fragments resulted from biopsies or surgical excisions from 54 cases coming out of 841 patients investigated in the above-mentioned period of time, where the established histological diagnosis was tuberculosis (TB). For diagnostic confirmation, Ziehl-Neelsen staining has been used as a rule but, in some cases, immunohistochemistry was also used. RESULTS: TB lesions have prevailed in men and around the age of 50 despite the tissue involved (either bones or joints or both structures). Bone tissue, lower limb and right side of the body have been more frequently touched by the TB lesions. Axial bones (spine, ribs and hip bone) and knee joint have been the favorite sites. From morphological point of view, the inflammatory cellular population has been dominated by the epithelioid and giant Langhans cells that surrounded areas less or more extended of classical acidophilic fine granular necrosis. The fibrosis was observed more frequently around bone lesions, usually in an incipient phase. Overall, the granulomatous reaction was of reactive type but one should notice hyporeactive or areactive, disorganized reaction encountered quite often in bone or associated bone and joints lesions. CONCLUSIONS: Osteoarticular tuberculosis (OATB) has a complex and dynamic clinical morphological picture, which is still partly known, described and understood especially in the field of morphological changes. Further detailed and integrative analysis of both clinical and morphological aspects is required so the suspicion of diagnosis at the admission becomes as soon as possible certitude.

Histopathological aspects of some rare forms of facial basal cell carcinoma.

AIM: The main objective of the study was to highlight the histopathological aspects of some rare forms of facial basal cell carcinomas. PATIENTS, MATERIALS AND METHODS: The 65 selected patients were diagnosed with head basal cell carcinoma (BCC), during 2011-2013, and they underwent surgery. The excised tumor tissue fragments were processed for paraffin embedding and stained with Hematoxylin-Eosin (HE), Masson's trichrome with Aniline Blue, and Alcian Blue-Periodic Acid Schiff (AB-PAS). RESULTS: The youngest patient was 23 years old, while the oldest was 91 years. The facial BCC there was slightly higher prevalence in males of 34 out of 65 cases. Histopathologically, great varieties of morphological types have been identified in the 65 cases investigated. According to our data, by far the most common are nodular BCCs type, which represented 44.6% from the investigated cases, followed at some distance by morpheiform and superficial subtypes with 13.8% and 10.7%, respectively. The most rare cases of facial BCCs were: cystic, adenoid, fibroepithelial and basal with adnexal differentiation with in one single case each. Relatively rare were the following varieties: pigmented (four cases), combinations of several forms (four cases), metatypical (three cases), keratotic (three cases), and micronodular (two cases). CONCLUSIONS: Within the limits of this study, the data reported here shown that such a lesional pleomorphism very often requires to make a careful differential diagnosis with a number of other tumor or non-tumor entities.

Optical coherence tomography applications in tooth wear diagnosis.

Dental wear represents an irreversible loss of dental hard tissue under the action of physical, chemical and mechanical factors, excluding dental caries and acute trauma. Four clinical forms of dental wear are described: erosion, attrition, abfraction, and abrasion. Most experts agree that in each clinical form multiple etiological factors are involved, one being predominant. Optical coherence tomography (OCT) is a non-invasive optical method characterized by a micronic resolution. The applications of this type of investigation are multiple in the medical field in recent years, and OCT is gaining a growing importance in dentistry. The study pointed out through OCT imaging for the erosive tooth wear lesion the existence of chemical aggression, with strong demineralization of enamel and dentin. For attrition lesion, OCT images showed the contribution of excessive force and friction movements specific to bruxism. In abfraction, OCT image revealed the importance of the mechanic factor in producing this form of tooth wear and abrasion damage studied may be considered physiological, according to patient age. OCT examination may reveal existing lesions in hard dental tissues for each clinical form and could bring evidence on the mechanisms involved.

Neurobiological arguments for a pathogenic multifactorial disconnective model of cognitive disorders from Alzheimer's disease in elderly people.

Incidence of Alzheimer's disease (AD) in people over 75 years is much higher, and the progression of cognitive deficit become faster, leading to a decrease of quality of life for patients and their families. In this context, it is proposed a multifactorial pathogenic model of disconnected cognitive circuits, which is combined with genetic and vascular-cerebral vulnerability elements, allowing an aggressive progression of neurodegenerative factors, favoring onset of dementia. Data from research studies on animal model (rat) highlighted central role of cerebral cholinergic deficit (which is amplified by cerebral ischemia) on the background of apolipoprotein E4 (ApoE4) genotype, favoring multifactorial disconnected mechanisms, by excess of beta-amyloid (ß-A) or increase of vascular dysfunction. Depressive disorder, social stress and traumatic brain injury are favoring the excess in production of ß-A. Hippocampal structure disconnects the cognitive circuits, and from a neuropsychological point of view can be many patterns, which are correlated with neuroimaging (hippocampal atrophy, cerebral siderosis, white matter hyperintensity, ventriculomegaly) or biological (hyperhomocysteinemia) factors. Identifying the pathogenic model of multifactorial disconnectivity in the rapid evolution of cognitive deficit in patients with AD may create the premises for an early diagnosis and treatment, based on the biological, neuropsychological and clinical elements.

The morphological profile of small bowel tumors - our experience.

AIM: The authors assessed the morphological profile of tumor masses belonging to the small bowel discovered in their daily practice. MATERIALS AND METHODS: 31 tumor masses located in different segments of small intestine operated between 2002 and 2013 in the 1st Surgical Department, Emergency County Hospital of Craiova, Romania, were analyzed. The investigated parameters were: tumor location and number, tumor dimensions, gross assessment, tumor extension and histological assessment. RESULTS: Tumor masses belonging to small intestine were rare. They usually expressed by their complications. In many cases, they were placed at the extremities of the small intestine. They were usually small but sometimes large and developing outwards intestinal wall. Commonly they had a fungating and ulcerated appearance. They were rather of mesenchymal origin than epithelial. However, some of them were inflammatory pseudotumors. Almost all neoplastic proliferations had a malignant phenotype, most often with regional extension. CONCLUSIONS: Our series of tumors had a morphological profile somehow similar with the profile described in the literature but with some particularities: the polarization to the extremities of the intestinal segment, a significant number of large tumors, clinical expression through different complications, the balance inclined in favor of mesenchymal origin of tumors and the clear predominance of malignant aggressive phenotype.

Severe upper gastrointestinal bleeding from gastrointestinal stromal tumor of the stomach.

Gastrointestinal stromal tumor (GIST) is a mesenchymal tumor originating from the Cajal interstitial cells, immunologically characterized by the c-kit gene. The evolution may be asymptomatic, discovered by chance during a necropsy, upper gastrointestinal endoscopy or due to complications of type-algic, occlusive or hemorrhage. We present the case of a voluminous gastric GIST complicated with serious upper gastrointestinal bleeding in a patient with multiple hard associated diseases, undergoing an emergency surgery in hemorrhagic shock. The surgery consisted in the resection of the upper polar esogastric, the pathological and immunohistochemistry tests confirming the diagnosis of GIST. The evolution was unfavorable at discharge after 45 days after surgery by an anastomotic fistula.