Histopathological, immunophenotypic and clinical particularities and evolution of a case of hepatosplenic T-cell lymphoma in transformation to leukemia.

We present the possibilities of diagnosis correlating the pathological, immunophenotyping and clinical aspects of a rare case of T-cell lymphoma in a 23-year-old patient with leukemic transformation. In our consideration, it is very important to describe this case because in the literature there are very few cases presented and the treatment of this type of lymphoma does not present optimal results, the evolution of the patients being from three months to two years. The treatment modality that gives the possibility to prolong survival and cure is hematopoietic stem cell transplantation.

Current data in clinicopathological characteristics of primary hepatic tumors.

AIM: The present study aimed to investigate the status of primary liver tumors diagnosed in the Emergency Hospital of Mures County, Romania. MATERIALS AND METHODS: We performed a retrospective study based on data collected from histopathological bulletins stored in the archives of the Pathology Laboratories of Mures County. We selected those patients' data that were diagnosed with liver tumors during January 2004-August 2011. The acquired data were collected and processed statistically using the GraphPad InStat Demo 3 statistical software. RESULTS: We identified 748 liver tumors out of which 264 were primary liver tumors (35.29%), whereof 108 were malignant primary liver tumors and 156 benign liver tumors. The male:female ratio in case of malignant tumors was 1.7:1 and for benign tumors it was 1:2.62. In case of malignant tumors, the mean age of male patients was 63.98±11.67 as for female patients it was 60.14±11.65 years. In case of benign tumors, the mean age of male patients was 59.29±9.58 as for female patients it was 55.55±12.86. 81.48% of the malignant tumors were hepatocellular carcinoma (HCC), followed by cholangiocarcinoma (14.81%). 40% of HCC presented associated cirrhosis, in the other 60% signs of chronic alcoholism being observed. CONCLUSIONS: Hepatocellular carcinoma remains the first on the list of malignant primary liver tumors in Romanian patients, probably due to a high rate of alcohol consumption.

Microvascular density in non-Hodgkin B-cell lymphomas measured using digital morphometry.

INTRODUCTION: The growth of solid tumors requires the development of microvessels, therefore tumor expansion depends on angiogenesis. Microvessels provide nutrients and oxygen and remove catabolytic substances, while endothelial cells produce growth factors for tumor cells in a paracrine fashion. The microvascular component of a tumor also plays a role in the metastatic capacity of the tumor, enabling the tumor cells to spread to distant locations by providing a large endothelial surface. AIM: The purpose of this study was to review the literature about angiogenesis regarding malignant lymphomas and to perform basic measurements by means of digital morphometric methods in large B-cell lymphomas and follicular lymphomas. MATERIALS AND METHODS: After thorough analyzing currently available assessment methods, we performed angiogenesis assessment on 19 randomly selected cases, from paraffin-embedded specimens using digital morphometry. We used immunohistochemistry and the CD34 antigen to mark microvessels. We measured average vascular diameter and a previously successfully applied digital morphometric method to quantify the extent of endothelial area. RESULTS: According to literature data, our knowledge and understanding of angiogenesis grew rapidly from early studies such as Folkman's classic paper. Many studies showed that angiogenesis plays a key role in the biology of tumors and therefore the study of angiogenesis might open new therapeutic possibilities. There have been many studies of angiogenesis in malignant lymphomas, however not as many articles as in other tumor types. Our morphometric studies showed there are statistically significant differences between diffuse large cell lymphoma (DLBCL) and follicular lymphoma (FL) regarding average vascular diameter and that high grade lymphomas tend to have a greater CD34+ endothelial area.

Secondary involvement of lymph nodes in Kaposi sarcoma.

Kaposi sarcoma is a low-grade neoplasm first described by Moricz Kaposi in 1872. Although many attempts have been made to explain its pathogenesis, its etiology still remains obscure. In this regard, many aspects of the disease's genetic, epidemiological and histopathological backgrounds are even today unclear. We present the case of a 57-year-old male patient, constant HIV negative, with a history of plaque-like lesions on his right foot approximately two years ago. Following surgical removal, a diagnosis of Kaposi sarcoma, plaque stage was settled. One year after, the patient was admitted to the hospital for pain in the right ankle and foot, associated to paresthesis and trophic lesions at this level. Similar lesions developed in the popliteal fossa. Biopsy and subsequent histological and immunohistochemical examination revealed a KS at that level. The most recent hospital admission revealed the appearance of an indolent lymphadenopathy in the groin. Our case represents a rare occurrence of Kaposi sarcoma at a HIV-negative patient, which, after several local recurrences and progressive behavior, produced a lymph node involvement at the groin level. The immunohistochemical assessments have confirmed the diagnosis.

Practical value of the complex analysis of sentinel lymph nodes in colorectal carcinomas.

BACKGROUND: Despite modern factors, which seem to predict outcome, lymph node (LN) status remain the main prognostic factor, which also shows the need for complex oncotherapy in colorectal carcinomas (CRC). Sentinel lymph nodes (SLNs) mapping is a very controversial method, which can increase the number of identified LN. MATERIALS AND METHODS: In 28 patients who underwent surgical intervention between December 2009 and December 2010, we performed in vivo SLNs mapping followed by ex vivo examination at 1, 10, and 48 hours. All blue nodes were separately included. In cases without LN metastases (pN0) five multilevel sections and immunohistochemical stain with cytokeratin 20 were performed in SLNs. RESULTS: Two cases were excluded because they were in pT4 stage. In one case the diameter of lymph nodes was about 10 mm and we obtained a false negative result (negative SLNs with positivity in the non-SLNs). From the other 25 cases, 13 do not presented LN metastases or micrometastases, nine had metastases only in the SLNs and the other three in both SLNs and non-SLNs. Mean identified number of LNs was 15. The blue dye intensity increased after formalin fixation and some nodes with metastases were blue stained only after 10 hours. CONCLUSIONS: SLNs mapping is a simple and inexpensive technique, which can improve the management of CRC. All in vivo and ex vivo blue LNs should be considered SLNs. Ultrastaging of SLNs is an expensive method, with uncertain results. High diameter of LNs seems to be an exclusion criterion for SLNs mapping.

Cardiac allograft vasculopathy in adult human recipients: a case series of seven patients and review of literature.

BACKGROUND: Chronic rejection (CR) also called cardiac allograft vasculopathy (CAV) is, besides infections and malignant tumors, the leading cause of death during the late period of post-heart transplant. PATIENTS AND METHODS: In this paper, we present a series of seven cases with chronic post-transplant cardiac rejection in the light of our experience related to histopathological aspects, difficulties in diagnosing and survival time. RESULTS: Our study comprises patients whose ages ranked at the time of transplant between 33 and 58 years, with a mean age of 47.71 years, the ratio between men and women being 6:1. Chronic rejection - cardiac allograft vasculopathy occurred in all seven patients comprised in this study, the earliest in the second year post-transplant (three patients), followed by the third year (one patient), the seventh and eighth year (one patient) and the latest survival period being over 11 years (one patient). Four out of the seven patients with chronic rejection events were preceded by episodes of acute cellular rejection. The most convincing indirect evidence of chronic rejection in endomyocardial biopsies were: ischemic events of the myocardiocytes and impaired microvascular network because of perivascular and interstitial fibrosis. CONCLUSIONS: Our study shows that the most important morphological factors correlated with the manifestation of chronic rejection were the episodes of acute cellular rejection or perivascular and interstitial fibrosis, these injuries also being indirect signs mainly detectable at the level of endomyocardial biopsies.

A case of a giant sacrococcygeal teratoma.

Sacrococygeal teratomas are congenital tumors of newborns, originate from one or more of the three germinal layers. Most sacrococygeal teratomas are found in newborns, infants and children youger than 4 years. The prenatal ultrasound exams have increased the number of sacrococygeal teratomas presenting in fetuses. Radical resection, including the coccyx must be performed even if the primary lesion is benign in up to 70% of cases. We report a 16 days old baby girl presented with a large, type 111 sacrococygeal teratoma. The tumor was diagnosed only at 36 weeks of pregnancy. The teratoma was disected from the surrounding structures and excised en bloc with the coccyx. The postoperative recovery was uneventful. There are good functional and cosmetic results at six months follow-up.

[Local recurrence after the sphincter-saving operations and abdominal perineal resection in rectal cancer]. / Recidiva tumorala locala dupa chirurgia conservatoare si rezectia abdominoperineala în cancerul rectal.

By local recurrence we define the appearance of the same anatomopathological type of cancer like the one initially described in the primary tumor, limited at the rectum or pelvis.The study is based on the analysis of all the cases with rectal cancer who undergone surgical procedures in Surgical Clinic No.2 Tg. Mures in the last 5 years. Using the most important parameters for each patient we identified some risk factors for the recurrence of the rectal cancer: surgical procedures--there were no major variations in the local recurrence between the sphincter-saving operations and abdominal perineal resections. The most frequent recurrence tumors appeared after Hartmann I operation; the moderate aggressive adenocarcinomas at the old patients and high aggressive adenocarcinomas in young patients, T3, T4 stages. The recurrent rectal cancer is more frequent in aged patients with high aggressive adenocarcinomas. There were no major differences in recurrence rate between the sphincter-saving operations and abdominal perineal procedures.

Diagnostic and differential diagnostic criteria of lymphoid neoplasms in bone marrow trephine biopsies: a study of 87 cases.

The aim of this study is to present the diagnostic and differential diagnostic criteria of the bone marrow specimen involved by lymphomas based on the histomorphological immunophenotype features and clonality of the tumor cells, patterns of lymphoproliferation and diagnostic pitfalls. BMB material obtained from the right posterior iliac crest was represented from 87 untreated and treated patients with BM involving malignant lymphoma, stained with Hematoxylin-Eosin, Giemsa, Periodic Acid Schiff and Gömöri's Silver. In order to perform immunohistochemistry examination we used a large antibody panel. B-cell clonality was determined in six cases. We found eight reactive lymphoproliferative responses and 79 lymphoid neoplasms of which 45 were diagnosed as de novo lymphoma, the rest of 34 samples being examined for staging. The predominant lymphoma was CLL (30 cases), over followed by DLBCL (18 cases). The most frequent patterns of involvement were the interstitial (29%) and mixed (15%) ones. In eight cases, we found reactive lymphoid aggregates. The B-cell clonality test showed four monoclonal, one oligoclonal and one polyclonal diseases form. Diagnosis of lymphoma versus reactive aggregate has been based on the combination of a lot of antibodies and involvement pattern. Although investigation of gene rearrangement was necessary for the establishment of the correct diagnosis in only 6.9% of cases, it should be emphasized that it is of great importance in disease monitoring.

Comparison of methods for the estimation of measurement uncertainty for an analytical method for sulphonamides.

A simple and inexpensive liquid chromatographic method for the determination of seven sulphonamides in animal tissues was validated. The measurement uncertainty of the method was estimated using two approaches: a 'top-down' approach based on in-house validation data, which used either repeatability data or intra-laboratory reproducibility; and a 'bottom-up' approach, which included repeatability data from spiking experiments. The decision limits (CCalpha) applied in the European Union were calculated for comparison. The bottom-up approach was used to identify critical steps in the analytical procedure, which comprised extraction, concentration, hexane-wash and HPLC-UV analysis. Six replicates of porcine kidney were fortified at the maximum residue limit (100 microg kg(-1)) at three different stages of the analytical procedure, extraction, evaporation, and final wash/HPLC analysis, to provide repeatability data for each step. The uncertainties of the gravimetric and volumetric measurements were estimated and integrated in the calculation of the total combined uncertainties by the bottom-up approach. Estimates for systematic error components were included in both approaches. Combined uncertainty estimates for the seven compounds using the 'top-down' approach ranged from 7.9 to 12.5% (using reproducibility) and from 5.4 to 9.5% (using repeatability data) and from 5.1 to 9.0% using the bottom-up approach. CCalpha values ranged from 105.6 to 108.5 microg kg(-1). The major contributor to the combined uncertainty for each analyte was identified as the extraction step. Since there was no statistical difference between the uncertainty values obtained by either approach, the analyst would be justified in applying the 'top-down' estimation using method validation data, rather than performing additional experiments to obtain uncertainty data.

[Spleno-renal distal and proximal shunts for hypersplenism due to hepatic cirrhosis]. / Suntul spleno-renal distal si proximal pentru hipersplenismul datorat cirozei hepatice.

The secondary hypersplenism appears from 30-50% in liver cirrhosis with portal hypertension. The mechanism of the complication is the splenic congestion as the result of the progress of the portal hypertension. Between 1997-2005, 16 patients with hypersplenism due to liver cirrhosis were operated in the service. The aim of the operation was to decompress the portal hypertension, by spleno-renal shunt (Warren), in 6 patients, truncular shunts in 2 patients, and splenectomy with spleno-renal shunts in 8 patients. No postoperative death was noted on the series. The platelets number and the white blood cells, destroyed by the reticuloendothelial system of the spleen, were counted in the first month and the first year, as well as the spleen volume. In patients with non-splenectomy operations the improvement of the blood elements number was remarked in the first week, but the volume of the spleen remained increased during 1-6 month. In patients with splenectomy the platelets and the white cells dramatically increased, with the risk of coagulation disfunction. The survival rate at five years was 12 patients.

[Cervical anastomotic fistula in surgery of the esophagus]. / Fistulele anastomozelor cervicale din chirurgia esofagului.

Cervical anastomotic fistula are reported in the surgical literature in 10-30% of the patients, providing a much longer hospitalisation, a higher morbidity and in some cases even mortality. Between 1997-2003, 91 patients underwent surgical treatment for esophageal cancers and 14 patients for chemical burns. In the cancer group the rate of resection was 67,03% (61 patients). In 8 patients with non-resection tumours a retrosternal esophageal by-pass with stomach was carried out. Cervical anastomosis were performed in 68 patients, by hand sutures. Anastomotic fistula were noted in 9 patients (13,24%). In 6 cases temporarily fistula occurred, with spontaneous healing by local treatment, in 8-28 days. 2 patients required reoperation and one patient a definitive feeding jejunostomy. Most common causes of fistula are technical problems, ischemic gastric or colonic tube, postoperative respiratory failure, with prolonged hypoxia. An anastomosis in the neck results in less postoperative complications than one of the lower level.

[Multivisceral operations for carcinoma of the upper stomach and cardia]. / Operatii multiviscerale pentru cancerul gastric al polului superior si al cardiei.

In this study are noted technical problems regarding "en bloc" multiple organ resections and the anatomic and functional reconstruction for carcinoma of the upper stomach and cardia. From 1997 to 2002, a total of 264 patients with cancers of the stomach were operated in the service. 75 patients presented cancers localized at the proximal stomach and cardia (97.33% adenocc.). The rate of resectability was 27.77% (27 pt.). Types of operations in this series were: standard esophagogastrectomy in 7 patients; total gastrectomy with regional lymphadenectomy in 9 patients; 11 patients underwent "en bloc" multiple organ resection, with the removal of the stomach, partial or total esophagectomy and, occasionally, ablation of the spleen, pancreas, left hepatectomy, resection of the diaphragm and an extensive lymphadenectomy. Surgical mortality for the complex multivisceral resections was noted in 3 patients (8.88%). The global 5 years survival in the service is poor: 15.9%.

The C-cells: current concepts on normal histology and hyperplasia.

We describe the current concepts on the embryology, normal morphology and immunohistochemistry of a minor cell population of the thyroid, the C-cells. We also try to make delineation between the normal number of the C-cells and C-cell hyperplasia. The two types of C-cell hyperplasia, physiologic and neoplastic are defined and characterized from morphologic and genetic point of view. Their relation with thyroid pathology, especially with medullary thyroid carcinoma is discussed.