Fibrosis assessment in chronic hepatitis C--is the liver biopsy still necessary? The pathologist point of view.

AIM: The aim of this study was to compare the histological stage of fibrosis determined by liver biopsy with the stage of fibrosis assessed by Fibroscan, to analyze the correspondences and inconsistencies between obtained values and to discuss the role of the microscopic exam, from the pathologist point of view. MATERIAL AND METHODS: The study group consisted of 185 patients diagnosed with chronic hepatitis. Serological tests diagnosed chronic hepatitis C in 183 patients, and chronic hepatitis B and C for 2 patients. The patients were evaluated to determine the stage of fibrosis using two methods: liver biopsy and elastography (Fibroscan). RESULTS: Based on the pathologic evaluation, 124 cases were diagnosed as moderate chronic hepatitis (score 6-8), and the remaining 60 cases as severe hepatitis (score 9-12). Comparison of data from examination of liver biopsy with that obtained by Fibroscan examination revealed overlapping and divergent aspects. The fibrosis stage established through liver biopsy did not always coincide with the one assigned by liver stiffness measurement, particularly for intermediate stages F2 and F3. The best overlap was noted for F0-F1 and F4 stages, which indicates the evident ability of transient elastography to separate patients with minimal or no fibrosis from patients with extensive fibrosis. CONCLUSIONS: Our data concurs with the literature, which confirms presence of differences between Fibroscan and biopsy. From the point of view of the pathologist, liver biopsy still remains a valuable instrument, offering a relevant image of liver changes--as it is regarded more rather a selective than routine technique.

Hepatic steatosis background in chronic hepatitis B and C - significance of similarities and differences.

The aim of our study was to investigate comparatively the steatotic background in viral chronic hepatitis B, C and mixed types, in correlation with the severity degree of specific liver lesions. The study group consisted of 1206 liver biopsy specimens, etiologically diagnosed as hepatitis C - 1021 (84.66%) cases, hepatitis B - 100 (8.29%) cases, hepatitis B and C - 39 (3.23%) cases, hepatitis B and D - 39 (3.23%) cases, hepatitis C and toxicity - six (0.49%) cases, hepatitis B, C and D - one case (0.08%). The histopathological assessment focused on the steatotic lesions associated with inflammation and fibrosis. The cases were classified according to necrosis and inflammatory activity (score between 0-12) and fibrosis (score between 0-4). Our data indicates significant association of steatotic lesions in hepatitis C (76.59%) as opposed to other types of viral hepatitis. In mixed hepatitis B and C, steatotic lesions are more frequent (66.66%) than in chronic hepatitis B (47%) and in mixed chronic B and D hepatitis (48.72%). Steatosis was present in all cases with chronic hepatitis C and associated toxicity. These observations confirm the important aggressiveness of hepatitis C virus as opposed to hepatitis B and D virus. The analysis of the pattern of steatosis in correlation with necrosis and inflammatory activity and fibrosis, respectively, lead to the identification of certain specific elements. Thus, for all types of hepatitis, steatosis is associated predominantly with moderate severity (score 6-8) and progressive expansion of fibrosis (score 2-3). The presence of steatosis does not define hepatic lesions with severe inflammation (score 9-12) nor those with extended fibrosis (score 4). The type of steatosis present is mostly macrovesicular, the transformation into lipid cysts being uncommon. Based on the scoring systems applied in the evaluation of the entire investigated study group, we believe that a possible inclusion of a quantifiable criterion for steatosis could be beneficial in order to complete the characterization of the severity of the lesions, from the point of view of the potential for future evolution, reversible or irreversible.

[Serous and mucinous epithelial ovarian tumors--a clinicopathologic study of 116 cases]. / Tumori ovariene seroase si mucinoase. Studiu clinicopatologic a 116 cazuri.

UNLABELLED: Surface epithelial tumors are the most important group of neoplasm of the ovary. These tumors are classified according to the following parameters: cell type, pattern of growth, amount of fibrous stroma, atypia and invasiveness. AIM: This study aimed to identify ovarian tumours, especially borderline type, by applying last parameters of criteria for histologic diagnostic of ovarian neoplasms. MATERIAL AND METHODS: The retrospective study included 116 patients with ovarian tumors diagnosed, investigated, surgically treated at the Obstetrical and Gynecological Hospital Botosani in the past 9 years (2002-2010). In this interval were recorded 116 cases of epithelial ovarian tumors. In sample processing, we used formalin for fixation, paraffin for specimen embedding and hematoxilin-eosin for staining. The age of the patients ranged between 19-86 years. RESULTS: From 116 cases, 57 (49,1%) were benign, 40 (34,5%) malignant and 19 (16,4%) borderline. In our study of benign neoplasms, we included 37 cases of serous tumours (64,9%) and 20 cases of mucinous types (35%). In the group of borderline tumours, the serous type was the most frequent (13 cases), followed by mucinous types (6), including 5 cases of intestinal type and 1 of endocervical pattern. The malignant tumors, according with decreasing order of frequency, were the following: 19 serous (47,5%), 8 mucinous (20%), 11 endometroid type (27,5%) and one of each cases of clear cell and small cell tumors (2,5%). CONCLUSIONS: Of great interest in our research was to identify ovarian borderline tumours, still representing a controversial group, in the same time corresponding with a scientiphic progress. Because the spectrum of epithelial tumors is very large, extensive sampling is essential to carry out all these important determinations, because benign, borderline and malignant patterns can be found in the same tumor.

The immunohistochemical expression of p53 and Ki67 in ovarian epithelial borderline tumors. Correlation with clinicopathological factors.

BACKGROUND: Borderline tumor of the ovary is an epithelial tumor with a low rate of growth and a low malignant potential to invade or metastasize. This tumor often is associated with a significantly better prognosis than epithelial ovarian cancer. Most of these tumors are either serous or mucinous in histology. AIM: Assessment of p53 and Ki67 immunohistochemical expression in 52 epithelial ovarian tumors, correlation with clinicopathological factors, and comparison between results in benign, borderline, and malignant tumors. MATERIALS AND METHODS: From the total number of 125 patients diagnosed with epithelial ovarian neoplasms in the period 2002-2010, 52 operated patients were selected, with serous and mucinous tumors. There were 26 (50%) malignant cases, 15 (28.8%) borderline and 11 (21.15%) benign. We used the monoclonal antibody DO7 and Ki67-MM1. RESULTS: P53 immunoreactions were positive in 41.66% of malignant serous tumors, most of them (90%) high-grade carcinomas; 6.66% of borderline and none benign tumors were positive. Ki67 was positive in 61.53% of malignant cases, with higher percents in advanced clinical stages. Ki67 immunoreactions were also positive in borderline and benign tumors, with lower percents, 13.3% respectively 9.09%. CONCLUSIONS: We found almost similar frequency of immunostaining in borderline tumors and low-grade invasive serous carcinomas in contrast to the significantly higher frequency of p53 mutations in high-grade serous carcinomas. Proliferative activity as assessed by Ki67 staining does not explain any possible relationship of serous borderline tumors to epithelial ovarian cancer.

[Expression of hormonal receptors (alpha-estrogen, beta-estrogen, progesteron), Ki-67 and P53 in endometrium of tamoxifen treated breast cancer patients]. / Expresia receptorilor hormonali (alpha-estrogen, beta-estrogen si progesteron), Ki-67 si P53 în endometrul pacientelor cu carcinom mamar tratat cu tamoxifen.

UNLABELLED: Tamoxifen is the most commonly prescribed adjuvant therapy for women with breast carcinoma ER+. It has agonist activity on the endometrium and is associated with an increased risk of endometrial carcinoma. The aim of this study was to evaluate the immunohistochemical changes on the histological endometrial modification from the patients treated with tamoxifen. MATERIAL AND METHOD: A group of 20 women selected from 125 patients with breast carcinoma, with adjuvant therapy. The criteria of selection were the histopathological proliferative changes of endometrium from these symptomatic patients. The 20 specimens of endometrium were evaluate immunohistochemycal by estrogen receptor alpha, beta, progesterone receptor, Ki-67 and P53. RESULTS AND CONCLUSIONS: The 20 endometrium specimen showed histological proliferative endometrial lessions, including polyps, hyperplasia and carcinoma. Immunohistochemical, benign lessions showned expression of estrogen alpha and beta receptor, low expression Ki-67 and absent expression of P53. These tests were negative in clear cell carcinoma, but were intens positive for Ki-67 and P53. In general, tamoxifen associated endometrial adenocarcinoma were characterized by a lower expression of estrogen receptor alpha, higher expression of progesterone receptor, and more frequent expression of estrogen receptor beta than endometrial spontaneous tumors.

Immunocytochemical expression of p16INK4a and HPV L1 capsid proteins as predictive markers of the cervical lesions progression risk.

UNLABELLED: Genital HPV infections are extremely common but most of them are spontaneously cleared by the host immune response. The main problem is how to identify the HPV-HR positive patients who are at risk of progressive disease. AIM: The purpose of this study was to investigate the uterine cervix lesions concerning the HPV status appreciated through the immunocytochemical expression of the L1 HPV and p16INK4a proteins. MATERIAL AND METHODS: 76 women who tested positive for HPV were selected from a cohort of 374 patients. In this study were detected the immunochemical expression of HPV L1 capsid protein and p16INK4a in LBC samples. RESULTS: The p16INK4a positive rate was expressed in 56.57% of all the cases. The percentage grew from 0% in NILM cases to 100% in SCCs cases (p-value <0.00001). The HPV L1 capsid protein positive was expressed in 12.50% of NILM cases, 33.33% of ASC-US, 50% of LSIL, 18.51% of HSILs cases, but 0% in the SCC group (p-value = 0.01). The L1-/p16+ pattern was found in 21.87% of LSIL, 81.48% of HSIL, and 100% of SCC cases (p-value <0.00001). The association of these two markers (L1 and p16INK4a) raises the accuracy of the diagnostic from 64% for HPV L1 capsid protein and respectively 87% for p16INK4a to 91% when they are associated. CONCLUSIONS: The combination of L1 capsid protein and p16 appears to be useful for an early diagnosis and may be able to identify the patients with risk of lesion progression.

[Endo-histological correlation in chronic Helicobacter pylori gastritis]. / Corelatii endo-histologice în gastrita cronica determinata de Helicobacter pylori.

UNLABELLED: In this study, we analysed the correlations between endoscopic aspects and histopathological changes at the patients with dispeptic simptoms and anti-Helicobacter pylori antibodies, investigated with upper endoscopy. MATERIAL AND METHODS: Our study comprised of 418 patients from Bacau Hospital, in period October 2005 - October 2008. Histopathological diagnosis was correlated with endoscopic aspects. RESULTS: Average age was 55 years, with predominance of woman and rural people, without statistical significance. Histopathological diagnosis of nonatrophic gastritis was found at 211 (50%) patients, atrophic gastritis at 192 (46%) patients, intestinal metaplasia at 108 (26%), low grad intraepithelial neoplasia at 70 (17%), high grad intraepithelial neoplasia, at 4 (1%) patients, neoplasia at 28 (7%). The most severe diagnostic was atrophic gastritis with intraepithelial neoplasia. Our analysis has found nonatrophic gastritis in 211 patients (50%), atrophic gastritis in 192 (46%), intestinal metaplasia in 108 (26%), low grade intraepithelial neoplasia in 70 (17%), high grade intraepithelial neoplasia in 4 (1%), superficial gastric carcinoma in 27 (7%) and one MALT lymphoma. CONCLUSION: There was no correlation between the endoscopical aspects and the histological diagnosis. All histological changes were strongly related to Helicobacter pylori infection. Prospective studies are needed to evaluate whether the eradication of Helicobacter pylori will indeed reduce the risk of gastric cancer.

[Histopathologic and immunohistochemic changes in Helicobacter pylori colonised gastric mucosa]. / Modificarile histopatologice si imunohistochimice din mucoasa gastrica colonizata de Helicobacter pylori.

UNLABELLED: Helicobacter pylori (H. pylori) colonize gastric mucosa causing both inflammatory changes, premalignant lesions and malignant tumors, including gastric lymphoma and carcinoma. In this study, our propose was to evaluate the histopathological changes corellated with immunohistochemical results demonstrating the types of cellular infiltration and proliferative activity of gastric mucosa infected with H. pylori. MATERIAL AND METHOD: Gastric endoscopic examinations was performed in 468 patients with anti-H. pylori antibodies and dispeptic phenomena. Snippets harvested endobiopsic stomach were fixed in formalin and processed by paraffine inclusion. Histological sections were stained with hematoxylin-eosine and Giemsa. In 65 cases of endobiopsic fragments (36 deep chronic gastritis with intestinal metaplasia, glandular atrophy and intraepithelial neoplasia and 29 carcinomas) immunohistochemical reactions were performed by applying reagents for evidence of H. pylori colonies, of T lymphocytes (CD3) and macrophages (CD68) and Ki-67 reagent for proliferating nuclear antigen labelling. RESULTS: Endobiopsic specimen found in all H. pylori or by Giemsa staining or by anti-H. pylori antibodies when they were in small numbers. Histologically, were diagnosed : 463 superficial and deep chronic gastritis associated with premalignant lesions, 29 carcinomas, 2 non-Hodgkin's lymphoma and an adematous polyp. Immunohistochemically, inflammatory infiltrate consisted of numerous T lymphocytes, macrophages and lymphoid follicles. Foveolar cell nuclei, in areas of intraepithelial neoplasia and carcinomatous cells were intensely stained with Ki-67, demonstrating increased proliferation. CONCLUSIONS: In gastric infection with H. pylori, inflammatory infiltrat is composed of abundant macrophages and T lymphocytes. Ki-67 was absent or minimal in chronic gastritis, while in areas of intraepithelial neoplasia was positive in both foveolar and coating epithelium. Anti-H. pylori antibodies in human serum remains one of the simplest methods to detect H. pylori, therefore it plays an important role in practice. Medical eradication of bacteria may cancel inflammatory changes, metaplasia and proliferation of gastric mucosa and thus it prevents the cascade of carcinogenesis.

[Evaluation of p16INK4a and Ki-67 proteins expression in cervical intraepithelial neoplasia and their correlation with HPV-HR infection]. / Evaluarea expresiei proteinelor p16nk4a si ki-67 în neoplazia intraepiteliala cervicala si corelarea acestora cu infectia HPV-HR.

OBJECTIVE: The aim of our study was to evaluate the expression of p16INK4A and Ki-67 in cervical intraepithelial neoplasia (CIN) and to correlate the high-risk human papillomavirus (HPV) infection with these two biomarkers. MATERIAL AND METHOD: Sixty patients were included in our study. All of the patient underwent colposcopy-guided biopsy to asses the grade of CIN. For the immunohistochemistry exam we used p161NK4A and Ki-67 antibody and their expression was semiquantitatively classified in 4 classes: 0, 1, 2 and 3. HPV genotyping was used to detect high-risk HPV. RESULTS: 7 of our cases were benign (11.66%); 18 cases presented CIN1 (30%), 14 cases CIN2 (23.33%), 16 cases CIN3 (26.66%) and 5 cases invasive squamous cell carcinoma (8.33%). We observed that the expression of p16INK4A and Ki-67 were positively associated with CIN grade, p161NK4A expressions increased significantly with high-risk HPV infection. We observed a positive correlation between the expression of the p16INK4A and Ki-67. CONCLUSION: In our study, the expression of p16 and Ki-67 were positively related to the CIN grade. p16INK4A expressions of high-risk HPV specimens significantly increased more than Ki-67. Therefore, in the diagnosis of CIN and high-risk HPV infection, p16INK4A can be a useful biomarker.

[Immunohistochemic staining for CK5/6 and P63 significance in prostate premalignant lesions and adenocarcinoma]. / Semnificatia imunohistochimica a CK5/6 si P63 în leziunile premaligne si î adenocarcinomul de prostata.

UNLABELLED: The morphologic information from usual hematoxiline-eosine staining are sometimes insufficient in certifying or excluding the adenocarcinoma of the prostate, cases who must be study by immunohistochemistry. AIM: The investigation of staining for CK5/6 and P63 in cases diagnosed with prostate adenocarcinoma associated with high grade prostatic intraepithelial neoplasia. MATERIAL AND METHODS: The study was realized on 56 cases analyzed in Pathology Laboratory of Focsani Emergency Hospital. RESULTS: We registered a positive correct diagnosis for atypical adenomatous hyperplasia in 86% of cases and for prostate adenocarcinoma grade 1 in 14% of cases. CONCLUSIONS: CK5/6 and P63 are useful markers for elucidating a positive false diagnosis for prostate adenocarcinoma grade 1.

[Tamoxifen and endometrial pathology]. / Tamoxifenul si modificarile endometriale.

UNLABELLED: Tamoxifen is a non-steroid antiestrogen, used as adjuvant therapy for breast carcinoma in women with positive estrogen receptor (ER+). In this report we evaluated endometrial histological changes in women treated with Tamoxifen for ER+ breast carcinoma. MATERIAL AND METHOD: We performed transvaginal ultrasonography for the endometrial thickness and biopsy of endometrium on a group of 125 symptomatic women with Tamoxifen therapy for ER+ breast carcinoma. The endometrial specimens were histologically processed for histological diagnosis. RESULTS: Of all patients, 49.6% had endometrial pathology (women with functional hemorrhage), and 32% had atrophic endometrium. Endometrial pathology was represented by endometrial simple hyperplasia 17.6%, and endometrial complex hyperplasia 8.8%. Endometrial complex hyperplasia with atypia was found in 5.6%, endometrial polyps in 11.2%, endometrial carcinoma in 4.8% and müllerian mixt tumor in 1.6%. CONCLUSIONS: Endometrial pathology was more likely to be diagnosed in gynecological symptomatic postmenopausal and premenopausal women with breast carcinoma treated with Tamoxifen. Therefore, it is necessary that these patients to be supervise, first, with transvaginal ultrasonography for endometrium, and after, with biopsy of endometrium. All patients on long-term Tamoxifen therapy should be annually screened by endometrial biopsy for endometrial pathology.

Experimental COPD induced by solid combustible burn smoke in rats: a study of the emphysematous changes of the pulmonary parenchyma.

According to the GOLD 2006 definition, COPD is a preventable and treatable pathological situation characterized by the partially reversible airflow limitation determined by a variable proportion mixture of small airways disease (obliterative bronchiolitis) and parenchyma destruction (emphysema). A major impediment in the study of the COPD is represented by the fact the fundamental morphological changes that determine the major pulmonary dysfunction take place in the small, peripheral, airways, at the bronchiolo-alveolar attachments. That is why the experimental model of COPD developed progressively to the transgenic mouse. There are many experimental studies on the animal models that have obtained emphysema rapidly through intratraheal instillation of elastasis or bronchitis/bronchiolitis through intratraheal instillation of particles. It is accepted that the unnatural character of aggression, that does not permit the natural evolution of the inflammatory phenomenon, limits these models and tissue remodeling that take place in COPD patients. It is well known that cigarette smoking is a major cause of COPD. There have been reported some cases of COPD in never smoking patients exposed to air pollutants. We aimed to create an experimental model of COPD in rat through exposure to smoke resulted from solid combustibles burn for the same period and in the same conditions of cigarette smoke exposure and to compare the pulmonary morphological changes. Thirty Wistar rats were divided into three groups (n = 10): (1) the control group (C), (2) the cigarette smoke group (CS), and (3) the solid combustible smoke group (SCS). Apart from the control group, these were treated with solid combustibles smoke (SCS group) or cigarette smoke (CS group) for six months. Morphological and morphometry studies have been assessed. We have established a rat COPD model based on natural cigarette smoke exposure versus solid combustible burn resulted smoke, usable for a further approach in human non-smoker COPD investigation. Out procedures resulted in clear pulmonary morphological lesions that are characteristic for COPD. The achieved data support the idea that solid combustible burn resulted smoke determines emphysematous parenchyma lesions that are similar, but with an attenuated morphological appearance when comparing to the cigarette smoke exposure.

[Gastric lymphoma. Morphological and immunohistochemical study]. / Limfomul gastric. Studiu morfologic si imunohistochimic.

UNLABELLED: Most of extranodal lymphomas are localized in gastrointestinal tract, gastric lymphoma representing more than 50% of them. The role that Helicobacter pylori (H. pylori) plays in pathogenesis of gastric lymphoma has changed the therapeutic approach. AIMS: Description of morphological features and immunohistochemical pattern of gastric lymphomas from patients admitted in University Hospital "Sf. Spiridon" Iasi. MATERIAL AND METHODS: Thirty four gastric lymphomas were investigated using routine histopathological technics and immunohistochemical staining based on a large panel of antibodies: CD3, CD5, CD20, CD79á, CD23, CD30, cyclin-D1, BCL2, BCL6, ALK1, Ki67, CK-cocktail, anti-H. pylori. RESULTS: All gastric lymphomas were localized in the antrum, most of them being solitary and large-sized tumors. Ninety-seven percent were B-cell lymphomas, 41.17% were mucosa-associated lymphatic tissue lymphomas (MALT lymphomas), and the remaining were high grade lymphomas. Only one case was classified as peripheral T-cell lymphoma. Cytokeratin cocktail immunostaining improved the detection of typical lymphoepithelial lesions, which characterized exclusively the MALT lymphomas. The sensibility for H. pylori detection in gastric lymphoma cases was increased by 22% using anti-H. pylori antibodies. CONCLUSIONS: Immunohistochemistry is a diagnostic method for gastric lymphomas, being useful in identification of lymphoepithelial lesions, detection of H. pylori infection, and is mandatory for lymphomas classification according to WHO criteria.

[Immunohistochemical evaluation of topoisomerase IIalpha as proliferation factor in gastric lymphoma]. / Evaluarea imunohistochimica a topoizomerazei IIalpha ca factor de proliferare in limfoamele gastrice.

UNLABELLED: Topoisomerase IIalpha is a nuclear enzyme essential for DNA replication, with presumed prognostic value in various tumors. MATERIAL AND METHODS: Study group included 34 gastric lymphomas. Tissue samples, formalin-fixed, paraffin-embedded, were investigated by immunhistochemistry using monoclonal antibodies anti Ki67 and anti topoisomerase IIalpha. RESULTS: The 34 gastric lymphomas were previously diagnosed as follows: 14 MALT lymphoma and 20 aggressive lymphoma (17 diffuse large B-cell lymphoma, 2 diffuse large B-cell lymphoma with minor MALT component and 1 peripheral T-cell lymphoma). Both markers (Ki67 and topoisomerase IIalpha) were positive in 2-31% of tumor cells in MALT lymphoma, while in aggressive lymphoma up to 46-98% of tumor cells showed a positive expression. CONCLUSION: Similar expression of Ki67 and topoisomerase IIalpha recommends the utilization of topoisomerase IIalpha in determining the proliferation fraction in gastric lymphomas. In addition, we suggest that it might be possible to use topoisomerase II inhibitor agents in high grade gastric lymphomas.

[Liver hemosiderosis study in chronic viral hepatitis]. / Studiul hemosiderozei hepatice in hepatopatiile cronice virale.

UNLABELLED: In chronic viral hepatitis the histopathological exam can reveal the presence of liver iron deposits in 10 to 73% of patients. Iron deposits are usually found in Kupffer cells, in endothelial cells and portal macrophages, and extremely rarely in hepatocytes. AIM: To evaluate the incidence of hepatic hemosiderosis in chronic viral hepatitis. METHODS: 549 morphopathological features of liver biopsy specimens performed in the Gastroenterology and Hepatology Institute IaSi, between January 1 2003 and December 31 2007 have been analyzed. Semiquantitative assessment of the degree of hepatic iron overload was performed and the localization of haemosiderin deposits: at the level of hepatocytes, the reticuloendothelial system or mixedly. The same anatomopathologist examined the blades and interpreted the results. RESULTS: The medium age of patients who underwent liver biopsy was 45.08 years +/- 10.045. Positive iron staining was found in 22.8% of cases, more frequently in males (31%), and in 91.82% of cases iron deposits were grade 1-2. The association of alcoholic etiology did not influence the incidence of hemosiderosis: 23% in patients with hepatitis and no ethanol exposure vs 25% in cases of strictly viral etiology. Deposits of haemosiderin were more frequent in viral hepatitis B (38.6%) than in viral hepatitis C (26.9%). In 34% of cases stainable iron was found only in reticuloendothelial system and in 46% of cases both in Kupffer cells and hepatocytes. CONCLUSION: Almost a quarter of chronic viral hepatitis cases are associated with liver deposits of haemosiderin, with features of secondary iron overload (deposits localized in the mesenchymal areas or mixedly). There is a higher risk of hemosiderosis in men, especially for those between 30 and 50. Liver iron overload levels in chronic viral hepatitis are, in most cases, low or medium, and the association with an alcoholic etiology does not influence the incidence of hemosiderosis in chronic viral hepatitis.

Chronic obstructive pulmonary disease in a new concept.

Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. Although COPD is a nonspecific term referring to a set of conditions that develops progressively because of a number of different disease processes, it most commonly refers to patients with chronic bronchitis and emphysema and to a subset of patients with asthma. Several different definitions were proposed for COPD in time. COPD is not asthma but can coexist with asthma, the other major airways obstructive disease caused by airway inflammation. Inflammation underlying in asthma has characteristic features, distinct of that from COPD. Longitudinal studies revealed the heterogeneous character of COPD. The pathological hallmarks of chronic obstructive pulmonary disease (COPD) are inflammation of the small airways (bronchiolitis) and destruction of lung parenchyma (emphysema). International guidelines stress the importance of accurately discriminating between asthma and chronic obstructive pulmonary disease. Although characteristic pathological features have been described for both conditions, their discriminatory power has never been systematically assessed. This might be rectified by improving pathological definitions.

[A primary undifferentiated pleomorph cardiac sarcoma. Case report]. / Sarcomul cardiac primar pleomorf nediferentiat. Prezentare de caz.

The aim of the study was to characterize the clinical and histological picture of a malignant cardiac tumor, to assess the prognosis and to develop a management strategy. We described a primary cardiac sarcoma, located in the right ventricle. Minimal invasive right thoracotomy was used and a partial surgical excision of the malignant cardiac tumor was made as a palliative procedure. The malignant cardiac tumour continues to have a poor prognosis despite of the individualization of the approach.

Morphological changes positive correlates with oxidative stress in COPD. Preliminary data of an experimental rat model--study and literature review.

It is well known that nicotine that is a major toxic component of cigarette smoke induces oxidative stress which is responsible for the lung damages in COPD and cancer. There have been reported some cases of COPD in never smoking patients exposed to air pollutants. The aim of our study is to evaluate the morphological pulmonary changes in rats exposed to cigarette smoke respectively to solid combustible smoke and to establish the relationship between the exposure and the level of oxidative stress measured through serum (s) and pulmonary tissue (l) MDA in rats (TBARS method). Thirty Wistar rats were divided into three groups (n = 10): (1) the control group (C), (2) the cigarette smoke group (CS), and (3) the solid combustible smoke group (SC). Apart from the control group, these were treated with solid combustibles smoke or cigarette smoke for six months. We collected blood for serum determination of MDA and the lungs were removed for histopathological analysis and to determine the levels of malondialdehyde (MDA). The levels of serum and lung MDA were significantly higher in CS and SC groups compared with C group, but not significantly differences between CS and SC group were detected. These findings are positively correlated with histopathological changes (squamous metaplasia and clear cell hyperplasia in the bronchium epithelium, emphysema) found in pulmonary tissue. Preliminary data of our study confirms that not only the cigarette smoke but also the environmental pollutants are involved in the major pathways of COPD.

Early gastric carcinoma diagnosed on endobiopsic and surgical specimens.

UNLABELLED: Early gastric carcinoma (EGC) is difficult to diagnose without a screening program. AIMS: In this study, we reveal the importance of endobiopsy in EGC diagnosis. MATERIAL AND METHODS: We examined multiple gastric endobiopsies from 1,201 patients with or without symptoms and endoscopical aspect for gastric carcinoma. All specimens were fixed in 15% buffered neutral pH formaldehyde and paraffin embedded. Histological sections were stained using current techniques: Hematoxylin-Eosin, trichromic van Gieson, Giemsa (for Helicobacter pylori) and Alcian blue, pH 1 and 2.5 (for acid and sulfated mucins). We used Laurén histological classification with two main types of gastric carcinoma: intestinal and diffuse. RESULTS: From 1,201 gastric endobiopsies, we diagnosed gastric carcinoma in 257 patients (21.3%) and only four of them were EGCs, although their endoscopical examination was negative for gastric tumor. Among these malignant proliferations, three cases showed intestinal type EGC and one case was diffuse type EGC. The additional endobiopsies fragments presented chronic atrophic gastritis with H. pylori infection, intestinal metaplasia and dysplasia. CONCLUSIONS: EGC had an incidence of 0.34%, which is very low because the lack of an endoscopical screening program favors the diagnosis of gastric cancer in advanced stages. Both histological types--intestinal and diffuse, were present in EGC, associated with H. pylori chronic gastritis, intestinal metaplasia and dysplasia. The presence of dysplasia recommends the endoscopical surveillance of these patients.

Neurofibroma, schwannoma or a hybrid tumor of the peripheral nerve sheath?

Classically, the different subtypes of the peripheral nerve sheets tumors display typical morphological features which differentiate them from the other nervous tumors. Either schwannoma or neurofibroma have characteristic histological and immunohistochemical features. We present a case of peripheral nerve sheets hybrid tumor which have had histological and immunohistochemical features of neurofibroma and schwannoma.