Lung injury patterns in newborns, infants and young children - morphological and immunohistochemical approaches.

Lower respiratory infections are an important cause of morbidity and mortality in children, especially in newborns, infants and young children. We conducted a retrospective study and we analyzed the causes of death in newborns, infants and young children, in the necropsy protocols from two Departments of Pathology (Mures County Hospital and Emergency County Hospital of Târgu Mures, Romania), between 2016-2018. We performed descriptive statistics: number of necropsies per year, distribution by gender (male∕female), by place of origin (rural∕urban), by age and leading causes of death in our study. To establish the pattern of lung injuries, we performed a morphological, histopathological and immunohistochemical study [cluster of differentiation (CD) 3, CD14, CD20, CD31, CD34, CD68]. Our study is showing the most frequent and typical aspects of pulmonary pathologies in fetuses, newborns, infants and young children. In this way, we are highlighting the microscopic aspects of the immature lung, amniotic fluid and meconium aspiration, pulmonary distress syndrome in children, pneumonia, bronchopneumonia and vascular pulmonary disease developed in patients with congenital cardiac defects. Most deaths were recorded in the first 30 days or in the first year of life. Primary respiratory diseases were the leading causes of death in these patients. Secondary respiratory diseases were associated with the major causes of death in these patients as an aggravating or precipitating factor.

Gastric Burkitt lymphoma: A case report and literature review.

RATIONALE: Burkitt lymphoma (BL) is an endemic tumor in Africa but rare sporadic cases are diagnosed in Europe. PATIENT CONCERNS: A 60-year-old woman was hospitalized with fulminant hematemesis and a history of recurring melena. DIAGNOSES: The upper gastrointestinal endoscopy revealed a tumor of the antrum. INTERVENTIONS: Emergency gastrectomy was performed. OUTCOMES: Gross findings revealed an ulcerated tumor with elevated margins and several perigastric and extragastric lymph nodes. Histological examination showed proliferation of atypical lymphocytes with a Ki67 index of 100%; they were marked by CD20, CD79a, bcl-6, and CD10 and were negative for CD3, CD5, CD23, TdT, bcl-2, and Cyclin D1. The tumor cells crossed the serosa and presented invasion of the lymph nodes. The patient died 10 days after surgery due to bronchopneumonia and acute renal failure. LESSONS: In our department, only one gastric BL was diagnosed in a 61 consecutive lymphomas of the gastrointestinal tract (1.64%). Less than 200 reports about gastric-BL have been published to date. This case highlights the difficulty of diagnosis of rare variants of aggressive gastric lymphomas in medium-income countries without screening programmes.

Immunohistochemical expression of Ki-67 and p53 along with their digitalized evaluation in the discriminatory analysis of reactive atypia and dysplastic lesions in gastrointestinal biopsies of the stomach.

The differential diagnosis between reactive atypia and non-invasive neoplasia (or dysplasia) can be challenging in the case of small conventional forceps biopsy specimens of the stomach. Despite the existence of several classifications for neoplastic epithelial lesions of the stomach, there are few auxiliary tools for aiding in this decision besides standard stains. We studied the utility of Ki-67 and p53 immunohistochemistry in this setting and their clinico-pathological correlations, based on a set of 99 cases with cytological or architectural atypia reviewed by three pathologists. We also tested a digitalized method based on the ImageJ software for the evaluation of Ki-67 expression to determine whether this could be of an additional help. CONCLUSIONS: Ki-67 and p53 expression correlates well with microscopic and morphological modifications in biopsies and can be a useful tool in confirming or dismissing an impression of dysplasia in routine pathological work-up. Digital processing is cumbersome and of limited value and it could only be of additional help if more automated methods are developed.

Histopathological evaluation and expression of the pluripotent mesenchymal stem cell-like markers CD105 and CD44 in the synovial membrane of patients with primary versus secondary hip osteoarthritis.

To present the morphological changes of classic primary versus rapidly progressive and secondary hip osteoarthritis (HO) and to examine the expression of two pluripotent mesenchymal stem cell-like markers in the synovial membrane. A prospective observational study was conducted in 57 consecutive cases of radiologically confirmed HO in which total hip arthroplasty was performed. Based on the radiological and clinicopathological features, the cases were divided into three categories: classic primary HO (group A; n=16), rapidly destructive HO (group B; n=24), and HO secondary to avascular osteonecrosis of the femoral head (group C; n=17). Immunostains were performed using the markers CD44 and CD105. The cases from group A were mainly characterized by a marked perivascular inflammatory infiltrate and simple synovial hyperplasia. In group B, the papillary type of synovial hyperplasia was found and presence of chondromatosis, ossification, and ectopic follicles with germinal centers in the subsynovial layer was characteristic, whereas marked calcification and/or ossification were seen in group C. Focal expression of the CD105 and CD44 was noted in the hyperplastic synovial cells and subsynovial layer in cases from group A, whereas synovial cells from group B were diffusely positive for both CD44 and CD105. In secondary HO, CD44 marked the inflammatory cells. Mobilization of the CD44/CD105 positive synovial cells seems to play a role in the genesis of HO. The number of the pluripotent mesenchymal stem cell-like cells derived from the hyperplastic synovial cells might be related to the severity of possible immune-mediated rapidly destructive HO.

Atypical Hepatocellular Neoplasm With Peliosis in Cirrhotic Liver Versus Hepatocellular Carcinoma: A Diagnostic Trap.

Atypical hepatocellular neoplasm (AHN) is an adenoma-like hepatic tumor that even occurs in noncirrhotic liver of males (any age) or females ≥ 50 years old, or associates focal atypical features. In this article, 2 unusual cases diagnosed in elderly cirrhotic patients, unrelated to steroids, are presented. The first case was incidentally diagnosed in an 83-year-old female. During laparoscopic surgery for cholecystectomy, hemoperitoneum was installed and laparotomy was necessary to remove a 70-mm nodular encapsulated hepatic tumor that was microscopically composed by hepatocyte-like cells with clear cytoplasm, arranged in 1- to 2-cell-thick plates and intermingled with areas of peliosis, negative for alpha fetoprotein (αFP), p53, and keratin 7, with low Ki67 index and intact reticulin framework. The second case was incidentally diagnosed at ultrasound examination in a 66-year-old male. The surgical specimen was a 50-mm solid multinodular tumor that microscopically consisted of 3-cell-thick plates of hepatocyte-like cells with acinar, pseudoglandular, and trabecular architecture, intermingled with peliotic areas, without nuclear atypia and disintegrated reticulin framework. Both of the cases occurred in cirrhotic liver. The tumor cells were marked by AE1/AE3 keratin, displayed a Ki67 index < 5% and were negative for αFP, p53, and keratin 7. No recurrences or any other disorder occurred 6 months after surgery. In cirrhotic liver, adenomas with peliosis that do not satisfy all the diagnosis criteria synthesized in the article should be considered AHNs and differential diagnosis includes hepatocellular carcinoma but also focal nodular hyperplasia, regenerative nodules, and dysplastic nodules. This histological entity is not yet included in the WHO Classification list.

High-risk follicular dendritic cell sarcoma of the tonsil mimicking nasopharyngeal carcinoma.

Follicular dendritic cell sarcoma (FDCS) is often misdiagnosed as a carcinoma or malignant lymphoma due to morphological variability. In FDCS application of routine antibody panels without CD21 and CD23 increases the misdiagnosis rate, because the tumor cells often show focal positivity for usual immunohistochemical markers. Our new case showed a distinct picture due to the uncommon tumor architecture, with extensive areas of necrosis and hemorrhage, the presence of nuclear atypia, and an increased mitotic count and Ki-67 index. These features suggest the classification of this tumor in the category of high-risk malignancies, with uncommon features of FDCSs.

Pagetoid reticulosis Woringer-Kolopp type, a particular variant of mycosis fungoides: a case report.

According to the definition of WHO, pagetoid reticulosis (PR) is characterized by the presence of unique skin lesion in the shape of patches or plaques caused by the proliferation of atypical T-cells in epidermis. We report the case of a 50-year-old female, presenting a 50×65 mm erythematous scaly patch, well-defined, slightly infiltrated, discrete polycyclic, on the right buttock, which appeared and developed in about 6-8 months. The clinical and dermatoscopic aspects suggested a Bowen's disease. A skin biopsy was performed. The histological examination of the pieces confirmed the presence of monoclonal lymphoid infiltrate with obvious phenomena of epidermotropism. Immuno-phenotypically the tumoral cells express intensively CD3 and CD8 and focally CD4. Surgical excision was performed without radiotherapy and chemotherapy. The patient was followed-up for 42 months without local relapses, distant lymph nodes or visceral metastases. Microscopic aspect of the lesion corresponds to stage I-II of mycosis fungoides (MF) (patches or plaques); the diagnosis was PR Woringer-Kolopp type. The most recent classification of skin lymphomas (WHO, 2008) confirms that the immunohistochemical profile of T-cells can be CD4+ and CD8- or CD4- and CD8+, and frequently CD30+, in contrast to the classical versions of MF. Pagetoid reticulosis type Woringer-Kolopp, a rare particular variant of mycosis fungoides, is suspected in cases with unique, distinctive lesion and confirmed only by histological immunohistochemistry. Treatment consists of surgical excision of the lesion with long follow-up.

Non-Epstein-Barr virus associated lymphoepithelioma-like carcinoma of the esophagogastric junction with microsatellite instability, K-ras wild type.

A 60-year-old male was admitted to our hospital for gastric cancer. Considering his general condition, total gastrectomy and dissection of regional lymph nodes were performed. Macroscopically, a 45 mm × 20 mm × 10 mm-sized, ulcero-infiltrative tumor located in the esophagogastric junction was described. Microscopically, the tumor consisted of a poorly differentiated adenocarcinoma intermingled with dense lymphoid infiltration predominantly composed of T-cell lymphocytes. The tumor cells infiltrated the submucosa, muscularis and subserosal layers of the stomach, respectively the esophageal adventitia. No metastases were noticed in the 58 regional lymph nodes. Based on the histopathological features, the diagnosis was lymphoepithelioma-like carcinoma, pT3N0 stage. In situ hybridization for Epstein-Barr virus showed no nuclear signal in tumor cells. The p53 expression was observed in fewer than 10% of the tumor cells. Real-time PCR analysis showed microsatellite instability without K-ras mutation in codon 12. No recurrences or metastases were reported 6 months after surgical intervention. No adjuvant therapy was performed.