Intradiploic epidermoid cysts - a series of three cases and our experience with literature data.

Intracranial epidermoid cysts are rare, representing almost 1% of all primary tumors and when are located in the diploe result from entrapped ectodermal embryonic remnants. Because of frequent complications, imaging studies are mandatory for highlighting erosions of both outer and inner table of the calvaria and treatment preparation. We enlisted three female patients within our study, comparing imaging with histopathology aspects. Even though the bone destruction was evident, no atypia or malignant signs were highlighted in serial sections. The interesting fact that we present is that our patients are all females, opposed to what is written in literature. Although the positive diagnosis can be made by imaging, histopathological examination of these cysts is mandatory for identifying malignant behavior.

The importance of the histopathological examination in establishing the diagnosis of delayed splenic rupture. Report of a case and literature review.

In forensic activity, splenic ruptures occur frequently in cases involving abdominal trauma due to road traffic collision, strokes, falls and work accidents. Splenic lesions can occur either immediately after the trauma or within variable timeframes after it, the last scenario being the case of a delayed splenic rupture. Delayed splenic rupture is ranked third in abdominal traumatology frequency, after liver and intestine rupture. Delayed splenic rupture is more frequently the result of abdominal contusions or compressions, rather than the result of direct wounds located in the left flank. In the first stage, an intraparenchymatous hematoma is formed. The second stage occurs within a variable timeframe (between two days and one month), either spontaneously or following a second trauma, when the capsule ruptures leading to secondary peritoneal hemorrhage. In order to correctly determine the chronology of splenic lesions, histopathological (HP) investigations have an important role to play. The presence of hemosiderin highlighted by Hematoxylin-Eosin (HE) staining or special stainings, confirms the diagnosis of delayed splenic rupture. This study will present the case of a 55-year-old male from the countryside, a chronic alcohol consumer, animal care provider, who suffered multiple traumatic injuries four days prior to his death. He was found lying on the ground, presenting an open craniocerebral trauma (CCT) with a bleeding wound on the scalp. The autopsy showed CCT with meningeal hemorrhage and subdural hematoma, along with a splenic rupture presumably produced in two stages. The HP investigations did not reveal the presence of hemosiderin in the tested specimen samples. Using this scientific diagnostic criterion, it was thus confirmed that the splenic rupture occurred after the aggression, in another traumatic stage, the same one where the other thanatogenerator lesions occurred, as a result of the victim's collapse from the same level and hitting the planes with irregular surfaces.

Unusual occurrence of avascular necrosis with bilateral involvement and ankylosing spondylitis, meningioma and Hodgkin lymphoma.

This case report aimed to reveal the multidisciplinary aspect and discuss an association of disorders in a complex case with Hodgkin disease, meningioma, avascular necrosis with bilateral involvement and ankylosing spondylitis. We report the case of a 47-year-old patient, diagnosed with Hodgkin lymphoma at the age of 14. Two decades later, she was diagnosed with frontal chordoid meningioma, which was surgically removed, without radiotherapy. She was re-operated 10 years later for recurrence of meningioma. At the age of 39, she was diagnosed with bilateral avascular necrosis of the humeral head, femoral head and scaphoid bones. In the same year, she was also diagnosed with ankylosing spondylitis. We considered that the occurrence of rare chordoid meningioma, avascular necrosis with multiple locations and bilateral involvement in a patient with a malignancy during childhood and an autoimmune disease was unusual and there may be some common pathways.

Morphological study of upper wisdom tooth.

The article presents aspects of crown and root morphology of the superior wisdom teeth, aiming to several parameters: size, shape crown and occlusal surface, number, topography and orientation of the roots in order to determine which the most common morphological types are. For this purpose, the upper wisdom teeth were collected. According to studies, the dominant form of the dental crown is parallelepipedic, the rectangular or parallelogram shape of the occlusal surface has large mesial and distal-oriented sides. The positive occlusal forms are generally poorly demarcated; cusps are less tall and rarely individualized. In half of the cases, the root is unique, voluminous, straight or with a curved distal tip.

The importance of the histopathological examination in lethal acute intoxication with ethylene glycol. Case report.

Ethylene glycol is a toxic alcohol that is mainly introduced into an organism through the digestive pathway. Its priority toxic metabolites are glycolic acid and oxalic acid. We present the case of a young person, of the male persuasion, without any personal pathological history, found unconscious and presenting signs of violence. The patient is emergency hospitalized presenting coma, convulsive syndrome, severe metabolic acidosis and a positive result for alcoholism. Anamnestic data is extremely poor. The results of the clinical and paraclinical examinations suggest a possible poisoning with toxic alcohols. Despite the drug treatment and the hemodialysis, the evolution is unfavorable, resulting in death one week after admission. Through the forensic examination, the followings were found: cerebral and leptomeningeal edema, focal cerebral microhemorrhages, bronchopneumonia, septic spleen, shock kidney, hepatic fatty dystrophy, excoriated plaques in the head area. The histopathological (HP) examination confirms the macroscopic diagnosis and identifies the presence of calcium oxalate crystals in the kidney tubules. Subsequently, the toxicological examination of the biological samples taken from the corpse at the forensic examination, confirms the presence of the glycolic acid. Postmortem, the investigation conducted by the criminal investigation authorities confirms the oral ingestion of antifreeze. The absence of a positive history, along with alcohol consumption, nonspecific clinical symptomatology and the absence of calcium oxalate in urine are trap elements in the diagnosis of acute ethylene glycol poisoning. The presence of calcium oxalate in tissues, identified through the HP examination, is an extremely important factor when establishing the cause of death.

Acinic cell carcinoma of minor salivary glands - case report.

Salivary gland tumors have a high incidence (90%) within the parotid gland. The acinic cell carcinoma (ACC) represents only 1-3% of the salivary gland tumors, most frequently affecting the parotid. The minor salivary glands rarely develop ACC and when the ACC is localized in these glands, generally, it has a less aggressive evolution. The main criterion in the diagnostic of ACC is the histological examination with the regular Hematoxylin-Eosin (HE) staining and additionally Periodic Acid-Schiff (PAS) special staining. Immunohistochemical (IHC) examination confirms the origin of the tumor cells and the cellular proliferation index. Therapeutic management consists of surgical excision and radiotherapy. Left jugular tumor was the clinical diagnosis in the case we presented. The computed tomography (CT) examination revealed a voluminous expansive process of the left cheek. Surgery was performed with tumor resection and the skin defect was threatened. The histopathological (HP) and IHC exams have established the diagnosis of minor salivary glands adenocarcinoma with increased tumor proliferation index. The evolution was unfavorable to tumor recurrence in a short time of one year.

Anatomic variants in Dandy-Walker complex.

Dandy-Walker complex (DWC) is a malformative association of the central nervous system. DWC includes four different types: Dandy-Walker malformation (vermis agenesis or hypoplasia, cystic dilatation of the fourth ventricle and a large posterior fossa); Dandy-Walker variant (vermis hypoplasia, cystic dilatation of the fourth ventricle, normal posterior fossa); mega cysterna magna (large posterior fossa, normal vermis and fourth ventricle) and posterior fossa arachnoid cyst. We present and discuss four cases with different morphological and clinical forms of the Dandy-Walker complex. In all four cases, diagnosis was reached by incorporation of clinical (macrocephaly, seizures) and imaging [X-ray, computed tomography (CT), magnetic resonance imaging (MRI)] data. Two patients were diagnosed with Dandy-Walker complex, one patient was diagnosed with Dandy-Walker variant in a rare association with neurofibromatosis and one patient was diagnosed with a posterior fossa arachnoid cyst associated with left-sided Claude Bernard-Horner syndrome, congenital heart disease (coarctation of the aorta, mitral stenosis) and gastroesophageal reflux. In all forms of DWC, the clinical, radiological and functional manifestations are variable and require adequate diagnostic and therapeutic measures.

Study concerning the histopathological changes in chronic hepatopathies.

Chronic liver diseases represent a public health problem both at global level and in our country. Their significance is due not only to the large number of cases but also to their severe complications and associated diseases, which increase the gravity of prognosis. Hepatopathies generally develop by formation and accumulation of fibrous tissue, which leads to architectural distortions in the structure of the liver. Hepatic fibrosis is the result of chronic injury and plays a direct role in the pathogenesis of the hepatocellular dysfunction and portal hypertension. Histopathological changes depend on the stage of the disease and are an essential factor in the therapeutic options and prognosis of the disease. The analysis of histopathological changes at the level of the liver, in the patients with chronic liver disease evaluated by this study, shows that mesenchymal lesions and dystrophy have been present in more than 90% of the subjects, parenchymal lesions in 85% of the cases and fibrosis in 50% of the patients. In relation to the types of disorders, in chronic hepatitis the most frequent lesions described have been portal inflammation, portal fibrosis, and inflammatory infiltrate. In liver cirrhosis portal inflammation, porto-portal fibrosis and biliary neocanaliculi are also prevalent. The results of this study demonstrate the fact that, with the evolution of the disease, histopathological changes are more numerous and more pronounced.

Carcinogenic uterine risk of repeated abortions: hormone receptors tumoral expression.

The main objective of this study is to draw the attention that repeated induced abortions in the women's physiological history are very dangerous and could lead to developing uterine cancer. The legislation regarding this practice is variable in different countries. Relevant information in the field concerning the numerous risk factors that appear with abortions must be taught in schools before girls start their sexual life and can help avoiding the complications that may follow. Also, the abortion should be an extreme measure that must be used only in extreme cases that threaten the mother's life or imply the health of the future child. The study comprised 258 women diagnosed with endometrial carcinoma, without any risks factors for this type of cancer, which were questioned regarding the abortions in previous history. The results show that the age when the uterine carcinoma appears is even lower as the number of abortions is higher and the number of this type of cancer cases is directly proportional with the number of abortions suffered. In order to avoid this fact we have to pay more attention to the legislation and education of the patients. Also, we followed the expression of both estrogen and progesterone hormone receptors, in the case of uterine cancer that occurred in women who had abortions in history compared to the expression of hormone receptors in the case of patients who did not have abortions.

Atypical case of Sjögren's syndrome with psychiatric and peripheral neurological disorder.

Sjögren's syndrome is a rare disorder of the immune system characterized by the chronic lymphocytic infiltration of the organs with exocrine secretion (lachrymal, salivary glands), but also of other tissues of the body, that can be primary or secondary and can appear alone or in association with other systemic diseases: rheumatic arthritis, systemic erythematous lupus, scleroderma or polymyositis÷dermatomyositis. The case that we are presenting is that of a 40-year-old man, who came to the Department of Rheumatology with articular, muscular, ocular, psychological and neurological symptoms. After multiple biological, immunological, histological, neurological, psychiatric, ophthalmological, digestive investigations, it was reached the conclusion that the patient presents a rare autoimmune disease (primary Sjögren's syndrome) involving mainly peripheral neuromuscular and psychological (small frequency) and the patient was given specific immunomodulatory, anti-inflammatory and anti-depressive treatment, to which he responded well. Thus, after 18 months of investigation, severe depressive episodes and difficult collaboration of the patient with the medical team, it was possible to reach the definitive diagnosis and to perform the appropriate treatment.

Monitoring the effects of treatment in colon cancer cells using immunohistochemical and histoenzymatic techniques.

BACKGROUND: Monitoring the effects of treatment in malignant diseases is very important in study of the influence on the cell metabolism. Energy production in cancer cells is abnormally dependent on aerobic glycolysis. In addition to the dependency on glycolysis, cancer cells have other atypical metabolic characteristics. The purpose of the present study is to evaluation and analysis of the colon cancer cells under anti-angiogenic treatment, to establish the changes in the cellular energy metabolism and apoptotic potential. Anti-angiogenic drugs block the vascular endothelial growth factors, preventing the formation of new vessels. MATERIALS AND METHODS: We use immunohistochemical analysis of cytochrome c release and histoenzymatic analysis of adenosine triphosphatase (ATP-ase), succinate dehydrogenase (SDH), lactate dehydrogenase (LDH) enzymes. Colorectal tumor tissue samples were obtained by biopsy following the surgical procedures at the County Clinical Hospital of Oradea (Romania). RESULTS: The obtained results show that the apoptotic potential of malignant cells increases during the anti-angiogenic treatment, in the same time the rate of glycolysis increases, due to installed hypoxia and reduced ATP synthesis. Our results have been confirmed by international studies too. CONCLUSIONS: It was been demonstrated that the apoptotic potential of malignant cells increases significantly during anti-angiogenic treatment. There is growing evidence that cancer's "Achilles' heel" is tumor cell metabolism.

A nonfunctional neuroendocrine tumor of the pancreas - a case report.

Pancreatic neuroendocrine tumors (pNETs) represent about 1-5% of the pancreatic tumors, having an annual incidence of about 1/100 000, with difficult positive and differential diagnostic, especially in nonfunctioning tumors. We present a case of large dimensions (10/8 cm) pancreatic tail NET developed in a 65-year-old woman, incidentally discovered while she was examined for a strangled inguinal hernia. The patient had no specific tumor signs and the imagistic examination did not reveal any metastases. The histopathological and especially the immunohistochemical examinations were decisive for the diagnosis, treatment and prognostic establishment. The tumor showed intense positivity for chromogranin, synaptophysin, CD56, CD117, CK19, MNF-116 and negative for CK5/6 and CK7. The proliferative index established through the Ki-67 assessment was around 3%, while p53 was positive in 25-30% of tumor cells nuclei.

Phyllodes tumor: diagnostic imaging and histopathology findings.

Phyllodes tumors are rare breast tumors, accounting for less than 1% of all primary tumors of the breast. Histologically, phyllodes tumors can be divided into benign (60%), borderline (20%) and malignant (20%). The mammography examination was performed by means of a digital mammography system Giotto 3D Images; the ultrasound examination was performed through a GE Logiq P6 device and histological confirmation was possible after surgery or following the histological biopsy. We grouped the nine patients who presented clinically palpable nodules into two groups, namely: the six patients presenting histological benign results into Group I, and Group II where we included those with borderline and malignant histological results. Mammography performed in 77.7% revealed a well-circumscribed round or oval opacity or with contour lobules. Ultrasound examination was performed in all patients. Mammography and ultrasound have limitation in differentiating between benign lesion and phyllodes tumor. In the nine analyzed cases, mammographic and ultrasound examinations did not allow the differentiation into the three groups of phyllodes tumor. Histopathological examination is considered the golden standard for their diagnosis. Correlations between mammographic and microscopic aspects were inconclusive for determining the degree of differentiation, ultrasound changes could be correlated with the histopathological aspects.

Accessory spleen.

An accessory spleen (AS), or splenunculus, is a small nodule of splenic tissue found outside of the spleen. Post-mortem examinations, also known as autopsies, are carried out to identify a cause of death, and to assess the state of the organs of the deceased. We present two incidental cases of splenunculi, one localized in greater omentum and a second one localized in the hilum of the spleen, diagnosed during a histopathological examination. An immunohistochemical profile of the normal and accessory spleen was followed where the expression of the CD20, CD3, CD23, α-SMA were analyzed.

The process of ageing reflected by histological changes in the skin.

Structural and functional alterations, as well as changes occurring in the aspect of the skin during the ageing process, are due to some complex mechanisms, determined by intrinsic and extrinsic factors, which act synergistically. This study aims to analyze the histological changes of collagen and elastic fibers and of skin vasculature that occur in time, during the process of ageing. Fragments of skin have been collected from subjects of both sexes and of different ages, totaling 121 samples from different body regions. The following stains were used: Modified Goldner's Masson trichrome, Ferric Orcein-Hematoxylin and the combined stains Orcein-Goldner's trichrome. As the process of ageing advances, collagen fibers become thinner and change their aspect; at advanced age, the lysis of collagen fibers and their thickening in the deep dermis is present, as they become more fibrous. Elastic fibers show the tendency of fragmentation at more advanced age, gradually change their tinctorial affinity and reduce in amount; in the deep dermis, they tend to thicken progressively, in the presence of discrete elastolysis processes that evolve steadily and irreversibly. Thus, processes of elastic fibers degeneration and lysis run faster by comparison with those of collagen fibers degeneration. With ageing, a progressive reduction of dermis vasculature is present, due to a reduction in the number and size of vascular vessels, which is in its turn associated with the progressive alterations of vascular walls components, changes that advance until the function of the vessel ceases.

Difficulties of diagnosis in retroperitoneal tumors.

Retroperitoneum is a large space where the primary and metastatic tumors grow silently before clinical signs appear. Retroperitoneal sarcomas represent 10% to 15% of all soft tissue sarcomas. This group, retroperitoneal soft tissue sarcomas is associated with a very poor long-term survival rate, difficulty in diagnosis and complete surgical removal with a rim of normal tissue around the tumors. Liposarcoma is the most frequent retroperitoneal sarcoma. MFH is the second most common retroperitoneal sarcoma. The diagnosis in retroperitoneal sarcomas is clinical, radiological and histological. Our case presents a MFH with the difficulties of clinical, radiological and histological diagnosis. The initial diagnosis is based on the imaging findings, which offer information on the composition, density, extend and relation to the adjacent organs and structures, with the identification of displacement of the kidney. The definitive diagnosis is established by the pathology findings. The proportion of local recurrence rates of MFH after initial local excision ranges between 16% to 52%.

Evaluation of microvascular density in inflammatory lesions and carcinoma of palatine tonsil.

The tonsil carcinoma with squamous cells seems to be one of the neoplastic lesions with a growing incidence worldwide, even in those geographical areas where the smoking incidence has been reduced. In the disease etiopathogenesis, more factors are incriminated. Among these, the most frequently mentioned are smoking, alcohol consumption and the infection with the Human Papilloma Virus. Among the morphological modifications incriminated for the tumoral appearance and development, there is also included the angiogenesis process that involves the apparition of new blood vessels out from the pre-existent ones, vessels that bring a plus of oxygen and nutritive substances for the tumoral cells. Taking into consideration the fact that the tumoral process is most often accompanied by an inflammatory reaction, in our study we also determined the microvascular density in the carcinoma with squamous cells in the palatine tonsil and in chronic tonsillitis, compared to the vascular density in normal tonsil stroma. We quantified the reaction of the mast cells in the stroma of the two types of lesions, too. The microvascular density in the carcinoma with squamous cells in the palatine tonsil was a lot greater than the microvascular density in chronic tonsillitis. The maximum number of blood vessels in tumoral lesions as well as their area, quantified through the "hot spot" technique on the surface unit, was around two times greater than in chronic tonsillitis. The number of mast cells was significantly larger in chronic tonsillitis and in tonsil carcinoma, too, but the reaction of these cells in the inflammatory affections was more intense than in the neoplastic lesions.

Bony metaplasia in a caecum adenocarcinoma.

Ectopic bone formation in the digestive tract is a very rare phenomenon in pathology. Most cases of bone metaplasia were found in distal colon tumors, rectum and sigmoid respectively. We present a case of well-differentiated adenocarcinoma of the caecum (the second case of literature) associated with bone metaplasia, which debuted atypical, with symptoms of infectious enterocolitis, in a 72-year-old female patient, with no history of digestive pathology. Highlighting bone metaplasia was achieved by current histological techniques. Patient's evolution was favorable with surgical treatment and chemotherapy.

Pterygium: histological and immunohistochemical aspects.

INTRODUCTION: Pterygium represents a triangular conjunctivo-epithelial overgrowth, proliferating from the bulbar conjunctiva and covering the cornea, causing severe vision loss. It is an abnormal growth and differentiation of the conjunctive epithelial structures of the corneal limbus. Chronic exposures to solar ultraviolet radiation, heat and dust, as well as viral agents, are the most common pathogenic entities involved in its evolution. Recent studies linked pterygium with neoplastic proliferation, as ocular limbic stem cells and p53-protein expression are altered. MATERIALS AND METHODS: Our study was conducted on 84 fragments of pterygium, collected after surgery from patients admitted between 2008 and 2009 in the Departments of Ophthalmology of the Emergency County Hospital of Craiova and Hospital of Rovinari. Histological studies were performed by staining with Hematoxylin-Eosin, light green trichromic (Goldner-Szekely technique) and PAS-Hematoxylin. Immunohistochemistry highlighted the T-lymphocytes by using the CD3 antibody, B-lymphocytes by using the CD20 antibody and cells of the macrophage system using the CD68 antibody. The slides were analyzed under a 55I Nikon microscope, resulting pictures being captured with a 5 MP digital camera and digitally retrieved and enhanced using the dedicated NIS-Elements software. RESULTS: Histology showed the presence of a conjunctivo-epithelial structure, significantly different from the structure from which it developed. In 20% of the cases, the covering epithelium was similar to that of the bulbar conjunctival mucosa. In some cases, when pathogens were more active in the environment, the appearance of the covering epithelium of the membrane appeared pleomorphic, with dysplastic aspects, suggesting significant alteration of cell proliferation and differentiation. In approximately 75% of patients, we identified goblet cells in the surface epithelium. They appeared either isolated or associated in variable numbers, structures resembling intraepithelial glands. These particular cells synthesize and accumulate PAS-positive mucines rich in glycosaminoglycans, and are usually found in conjunctival epithelium. We observed a number of invaginations in the connective tissue underlying the epithelium, mostly formed by goblet cells, this giving the aspect of mucous glands, similar to the "glands of Henle". A highly developed vascular neoformation network, consisting of arterioles, venules and a very large number of capillaries can also be found in the connective tissue. Immunohistochemistry suggested that B-lymphocytes marginally take part in the immune response in pterygium. T-lymphocytes formed the majority of the mass of immune system cell present in connective tissue of the pterygium. Macrophage-type cells were distributed unevenly in the pterygium tissue, as the intensity of the inflammatory process varies depending on antigen levels. CONCLUSIONS: Pterygium shows significant changes both in the epithelium and in the underlying connective tissue. Immune cell infiltrate was diffuse, more abundant in areas with erosion of the covering epithelium.