[Takotsubo syndrome (stress-induced cardiomyopathy)]. / Sindrom Takotsubo (stress-indutsirovannaya kardiomiopatiya).

The article presents published and own data about Takotsubo syndrome, a relatively rare heart disease that is similar to acute coronary syndrome, but without significant damage of coronary arteries. The leading pathogenetic factor is the catecholamine-induced stress damage of myocardium with involvement of microvessels. There is a certain underestimation of Takotsubo syndrome by both clinicians and pathologists, so some cases of Takotsubo syndrome are misdiagnosed as acute coronary syndrome. Morphological manifestations of Takotsubo syndrome are characterized by mucoid edema of interstitial myocardial tissue, round-cell infiltration of stroma and focal damage of cardiomyocytes.

[Clinical and morphological diagnosis of secondary hemophagocytic lymphohistiocytosis]. / Kliniko-morfologicheskaya diagnostika vtorichnogo gemofagotsitarnogo limfogistiotsitoza.

Secondary hemophagocytic lymphohistiocytosis (hemophagocytic syndrome, massive macrophage activation syndrome) is a rare, aggressive, severe syndrome with a frequent fatal outcome. The pathogenesis of the syndrome, the role of viral infection, and the development of an excessive, aberrant, and inflammatory response leading to multiple organ dysfunction and sepsis remain unclear so far. The paper presents the data available in the literature and describes the authors' own observation of secondary hemophagocytic lymphohistiocytosis in a 14-year-old girl who had Epstein-Barr virus infection and died of severe multiple organ dysfunction. The in vivo diagnosis was based on the typical clinical presentations of the disease, the detection of the virus by a polymerase chain reaction assay, and the determination of blood ferritin levels. Contemporary morphological diagnostic criteria (immunohistochemical reactions with anti-EBV and anti-CD68 monoclonal antibodies; Epstein-Barr virus encoded RNA (EBER) in situ hybridization) are shown; and clinical and pathological comparisons have been made.

[Actual problems of the pathology of sepsis: 25 years in search of a consensus]. / Aktual'nye problemy patologii sepsisa: 25 let v poiskakh konsensusa.

In search of a consensus the authors give current materials on the pathobiology of sepsis, which concerns the definitions, classification, etiology, pathogenesis, and diagnosis of the disease on the basis of their own experience and the data available in the literature. The sepsis problem that is one of the most controversial and complex ones in pathobiology and medical practice has undergone a great very important 25-year stage of development to culminate in the adoption of clinical Sepsis-3 Consensus. International experts have proposed a new definition of sepsis, with an emphasis on the life-threatening condition and the presence of organ dysfunction that can be regarded as an analogous to organ damage. Systemic inflammatory response remains an essential sign of sepsis, but is not strictly specific. Instead of its previous four forms of sepsis, two forms of the disease (sepsis proper and septic shock) have been identified. The Consensus-proposed Sepsis-3 criteria for diagnosing sepsis continue to remain predominantly clinical laboratory ones, confirming the need for further clinicopathological and experimental morphological comparisons in order to achieve a complete understanding of the problem of sepsis between clinicians and pathologists.

[Myocardial infarction and acute coronary syndrome: definitions, classification, and diagnostic criteria].

The review gives the definitions and classification of and diagnostic criteria for myocardial infarction and acute coronary syndrome in accordance with the "The third universal definition of myocardial infarction" adopted in 2012 (Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, 2012). It also discusses the clinical and morphological comparisons of and the problems in the differential diagnosis of myocardial infarction as a nosological entity within coronary heart disease with other coronarogenic and non-coronarogenic necroses of the myocardium.

[Development of targeted indicators of quality in postmortem examination].

The indicators of quality for impartial quantitative assessment of postmortem examination have been suggested. These indicators were based on ratio of achievement and target indexes of pathologicoanatomic activity. The indicators are necessary for decision making for enhancement of pathologicoanatomic service quality in the health-care agencies.

[The morphofunctional diagnostics principles of pancreatic cystic tumors differentiation].

The algorithm of morphological diagnostics of pancreatic cystic formation including true cystic tumors, solid neoplasm with secondary cystic formation, nonneoplastic true cysts and pseudocysts are submitted. The determination of epithelial lining type specific for different neoplasms is a crucial factor. Tumors with border-line metastatic potential and carcinomas has been diagnosing in the detection of dysplasia and cell atopy features. On a number of occasions it's necessary to carry out an immunohistochemical investigation facilitating the differential diagnostics of neoplasms and determined the type of epithelium in intraductal papillary-mucinous tumors.

[Endometrial implantation window in infertility].

The paper presents the results of biopsy and curettage specimens from 92 patients with infertility. Histological and immunohistological (steroid receptors, Ki67, P27, and cyclin E) methods and scanning electron microscopy have been used. The substantial immunohistochemical (IHC) changes found in the endometrial implantation window in infertility are associated with the spectrum of the detected pathology. No clear correlations between the expression of IHC markers and the concentrations of serum hormones, which are characteristic of the normal menstrual cycle, may suggest that there is an imbalance of steroid reception at the endometrial tissue level. The detection of proteins P27 and cyclin E in the cytoplasm of glandular and stromal cells reflects the deficient block of a cell cycle essential for an adequate implantation window. The detected features of the superficial endometrial ultrastructure may be an additional indicator of the adequacy of endometrial secretory maturation. The essential histological, immunohistochemical, and ultrastructural features of the endometrium in infertility give valuable information that complements the traditional clinical classifications. Evaluation of the endometrial morphofunctional state opens up fresh opportunities to ensure an individual approach when using the regimens of assisted reproductive technologies.

[Mediator interactions in vasculogenesis and angiogenesis].

The article contains a review of the literature dedicated to the problems concerning mediator interactions in vasculogenesis and angiogenesis. Also presented herein is the role of the key angiogenic mediators and growth factors in the processes concerned, as well as certain variants of vasculo- and angiogenesis impairments associated with mediators dysfunction discussed.

[Angiodysplasias: role of mediators and growth factors].

The review of the literature deals with the findings concerning the role of impaired interaction between the basic angiogenic mediators and growth factors in vascular malformations. Presented herein are the contemporaneous views opinions on the aetiology and pathogenesis of angiodysplasias.

[Clinical and morphological characteristics of solid pseudopapillary tumors of the pancreas].

The paper presents the results of a comprehensive morphological study of the surgical material from 9 patients (females aged 19 to 67 years) with solid pseudopapillary tumors of the pancreas. Microscopically, the tumor appears predominantly as solid structure areas and pseudopapillae. The characteristic immunohistochemical signs are the positive expression of vimentin, alpha1-antitrypsin, and alpha1-antichemotrypsin, receptors of progesterone, as well as the low proliferation index by Ki67.

[Mesenchymal chondrosarcoma of the lung].

The authors present the data available in the literature and their observation of mesenchymal chondrosarcoma of the lung a 68-year-old female patient. Histologically, the tumor is exhibited by the fields of monomorphic round and oval cells with hyperchromic muclei and a scanty cytoplasm, with the hemangiopericytoma-like structures being formed here and there. There are foci of chondroid cells, portions of necrosis, and an ample quantity of mitoses. Immunohistochemical study has revealed that the tumor cells show the expression of vimentin, S-100 protein, neuron-specific enolase and the cytoplasmic expression of CD 99. The tests using CD 31, CD 34, factor VIII, desmin, total cytokeratin, or synaptophysin are negative.

[Solid pseudopapillary tumor of the pancreas].

The paper reviews the data available in the literature and describes the authors' observation of solid pseudopapillary tumor of the pancreas in a 33-year-old woman. Microscopically, the tumor, 2.5 x 2.5 x 2 cm in size, appeared predominantly as solid areas and solitary pseudopapillae comprising monomorphic round and oval cells with a light cytoplasm and round nuclei. Immunohistochemical study revealed diffuse cytoplasmic tumor cell staining in response to vimentin, alpha-antitrypsin, neuronspecific enolase, and cytokeratin 18; focal expression of synaptophysin and CD117; a negative reaction with antibodies to epithelial membrane antigen, S-100 protein, cytokeratins 7, 8, and 19, and CD57. Progesterone receptors were detectable in the nuclei of solitary tumor cells and the reaction with estrogen receptor was negative. The proliferation index (by Ki67) is about 0.2%.

[The anatomical pathology of a vulnerable atherosclerotic plaque in ischemic heart disease].

Results of a morphological study of coronary arteries from 90 patients who died from ischemic heart disease and arterial hypertension are presented. Various types of fibrous plaques damage and their features in arterial hypertension were morphologically found.

[Postmortem service in the Russian Federation (state-of-the-art and trends)].

According to the order of the Ministry of Health and Social Development, Professor O. D. Mishnev is appointed principal pathologist of the Ministry. The principle pathologists of federal districts are Professor I. A. Kazantseva (Central Federal District); Prof. N. M. Anichkov, Corresponding Member of the Russian Academy of Medical Sciences (North-Western Federal District); Prof. I. S. Derizhanova (Southern Federal District), Prof. T. A. Fedorina (Volga Federal District), Prof. V. L. Kovalenko, Corresponding Member of the Russian Academy of Medical Sciences (Urals Federal District); Prof. L. M. Nepomnyashchikh (Siberian Federal District), and Prof. Yu. V. Kaminsky (Far-Eastern Federal District). The above specialists and the principal pathologists of the Health Departments of Moscow and St. Petersburg Prof. O. V. Zairatyants and Prof. M. G. Rybakova make up a working group whose objective is to develop standards of postmortem studies, to coordinate, and to analyze the activities of postmortem services of the country. The role of principal pathologists of the bodies (ministries, departments, committees) of health care of federal districts, republics, territories, and regions is essential. It is necessary to set up a federal organizational-and-methodical center for postmortem studies under the Ministry of Health and Social Development. The chief results of the activities of postmortem services of Russia and federal districts over 6 years (2000-2005) are presented. The shortcomings and trends of postmortem services of the country are outlined.

[Surgical sepsis: clinical, pathological, and anatomic aspects].

The principles of modern clinical diagnosis and treatment policy of surgical sepsis are presented. The concept of a systemic inflammatory reaction and sepsis is outlined and the possibilities of making their morphological diagnosis, by applying high-tech studies are shown. Emphasis is placed on the necessity of establishing the etiology of sepsis and making its clear nosological entities, by compulsorily indicating the codes of the International Classification of Diseases-10.

[Cystic teratoma of the pancreas].

A case of pancreatic cystic teratoma is described in a 52-year-old woman. The tumor is macroscopically presented by an 8 x 8 x 7-cm multifocal cyst. Histological, immunohistochemical, and electron microscopic studies have revealed the derivatives of three germinal layers (ecto-, endo, and mesoderma).

[Pseudoglandular adenoma of the adrenal gland].

Pseudoglandular adenoma of the adrenal is described in a 44-year-old female patient. Immunohistochemically tumor cells were positive to cytokeratins 8 and 18, vimentin, chromogranin A, Ki-67 (2-3%) and gave a negative reaction with cytokeratins 7, 10, 13, 17 and 20, synaptophysin, protein S-100, smooth-muscle actin alpha.

[Histochemical characteristics of adrenergic myocardial and adrenal fibers in experimental narrowing of the aorta and pulmonary artery].

Ligation of the aorta or the pulmonary trunk was the method of experimental overloading of heart ventricles. Histochemical studies indicated activation of mediator chain of the sympatho-adrenal system. Catecholamines content in the nervous plexus of the overloaded ventricle did not change but there was an increase of their content in the medullary layer of the adrenals. Thus, chromaffin cells activity increases and desympathization of the heart muscle may be an important step in pathogenesis of heart failure in acute arterial hypertension.