Hepatic pathological features in naïve patients with chronic hepatitis C who have developed thyroid disorder.

Knowing the hepatic pathological features encountered in patients with chronic hepatitis C (CHC) and the fact that extrahepatic manifestations occur only in people with certain characteristics of the immune system, we tried to evaluate, qualitatively and semi-quantitatively, the liver pathological aspects encountered in 96 patients with CHC, previously untreated with Interferon (naïve), who showed or did not show signs of thyroid disorder (TD), hospitalized in the 2nd Medical Clinic of the Emergency County Hospital, Craiova, Romania, within a period of five years (2007-2012). Following hormonal, immunological, and thyroid ultrasound investigations, 14 (14.58%) of the 96 patients showed signs of TD. The main clinical forms of TD in the studied patients with CHC were autoimmune thyroiditis and subclinical hypothyroidism. In the patients with CHC with TD, we found mild chronic hepatitis in 14.28% of cases, the appearance of moderate chronic hepatitis was found in 71.42% patients, and the appearance of severe chronic hepatitis was found in 14.28% patients, while in the patients with CHC without TD we found chronic mild hepatitis in 62.19% of cases, the appearance of moderate chronic hepatitis was met in 32.92% patients, and the appearance of severe chronic hepatitis was found in 4.87% of patients. Mild and moderate fibrosis were found only in CHC patients without TD in a percentage of 25.6% and 65.85%, respectively, while severe fibrosis was found at 12.19% among CHC patients without TD and 92.85% among CHC patients with TD. The pathological aspect of liver cirrhosis was found only in those with TD (7.14%). In conclusion, the pathological features which define the liver necroinflammatory process, as encountered at the pathological examination in CHC patients with TD are the same as in any active chronic hepatitis, the differences being represented by the higher percentage of the periportal and the preseptal necrosis (piecemeal necrosis), as well as by the higher score of portal inflammation. In addition, the severe hepatic fibrosis and the histopathological appearance of the liver cirrhosis have only defined the cases of CHC with TD.

Uteroplacental apoplexy associated with invasive cervical neoplasm.

The cervical cancer is the worldwide second neoplasia in women, after the breast cancer. The incidence of invasive carcinoma in pregnancy is 1÷2000 to 1÷10 000 pregnancies. In most of the studies, almost all the patients had microinvasive carcinoma or limited cervical carcinoma at the cervix level. In the uteroplacental apoplexy, pathologically, retroplacental hematoma is formed while the fetus is still in the uterus. When speaking about the uteroplacental apoplexy, the fetal mortality is 100% and the maternal mortality can reach 5%. The particularity of the presented case is the association of the invasive cervical neoplasm, pathology unknown to the patient, with uteroplacental apoplexy, diagnosis for which she was hospitalized as an emergency. After the extraction of the dead fetus by segmental-transversal cesarean section, we continued to perform the total hysterectomy with adnexectomy. The fetus, the placenta, the uterus and the ovaries were sent for histopathological examination. Subsequently, the histopathological bulletin revealed cervical lesions in the neck of type cervical intraepithelial neoplasia (CIN) I, CIN II, CIN III, metaplastic squamous epithelium and moderately differentiated squamous cell carcinoma.