Pleurisies - the experience of "Tudor Vladimirescu" Hospital of Pneumology II: morphological study.

UNLABELLED: Pleural effusions are still representing a challenge in daily practice. MATERIALS AND METHODS: This retrospective study on 221 patients with pleurisies hospitalized in our unit is focused on the contribution of different types of pleural fluid morphological evaluation in setting a correct etiological diagnosis. The algorithm of investigation included: gross aspects assessment on X-ray records and by direct observation of pleural liquid obtained by thoracentesis and microscopic assessment on cytology slides of pleural fluid and on histopathological samples obtained by pleural needle biopsies. RESULTS: Mycobacterial etiology was the most frequent, with 72% of all cases, followed by tumoral etiology. Cytologic examination of pleural fluid was useful in establishing the final diagnosis in 66.1% of cases, histopathological assessment being imposed for the rest of cases. DISCUSSION: Imagistic investigation offered appropriate information concerning the site and extention of pleural effusions and guided, in certain cases, the needle biopsy. Gross aspect of pleural fluid oriented quite well the suspicion diagnosis. The use of a set of cytological "formulas" was useful in filtering subsequently the suspicion diagnosis. Histopatholgical examination of pleural tissue samples established the final diagnosis in cases where etiology was still uncertain after laboratory and cytological examination and subtyped further the pathologic processes within each main category of etiology. CONCLUSIONS: A correct diagnosis of pleural effusions could be achieved only by going through a precise algorithm of investigation where, besides thorough clinical examination and laboratory tests especially of pleural liquid, morphological assessment and in particular cytologic examination of pleural liquid and histopatological examination of pleural tissue samples are essential.

Immunohistochemical nuclear staining for p53, PCNA, Ki-67 and bcl-2 in different histologic variants of basal cell carcinoma.

BACKGROUND: Basal cell carcinoma is the most common form of human cancer. Increased expression of p53 has been found in the majority of basal cell carcinomas (BCCs); however, UV-light-induced signature mutations are present in only about 50% of cases. Increased nuclear staining with an immunohistochemical marker of proliferation and apoptosis has been correlated with aggressive behavior in BCC. OBJECTIVE: Our purpose was to correlate markers expression of apoptosis (p53 and bcl-2) and cell proliferation (Ki-67 and PCNA) with histological indicators of tumor severity. METHODS: We used immunohistochemical stains for p53, PCNA, and Ki-67, in superficial, nodular and sclerosing BCC, to determine whether the staining patterns differ in these different histologic variants of BCC. RESULTS: Bcl-2 expression was significant in basal cell carcinomas said to be aggressive (morpheaform and nodular types). Of the studied tumors, 66.7% (n=14) strongly expressed p53. Our results show a greater expression of Ki-67 in nodular and superficial basal cell carcinoma. PCNA showed a strong expression in all types of tumors. CONCLUSION: Studies employing molecular and genetic biology techniques, associated with histomorphology, lead to the identification of risk factors in the development of more recurring and aggressive lesions.

The histopathological study of osteoporosis.

The osteoporosis is characterized by the imbalance between the activity of the osteoblasts, the bone forming cells, and the osteoclasts, the cells that resorb the bone tissue, imbalance that favors the osteoclasts. As a conclusion, in the case of osteoporosis, for the same volume, the bone is less compact and more fragile. The objective of our study is to make a histological evaluation of the different elements of the bone tissue in many 47 bone samples: 27 bone fragments were collected from the head and the femoral head of patients who required hip arthroplasty and 20 bone fragments were collected from the vertebral body of dead patients. The results of our study emphasized the thinned trabeculae of the bone that lost continuity, the preferential resorption of the horizontal trabeculae, the consecutive trabecular anisotropy and the reduction of the trabecular connectivity with enlarged areolae and the adipose degeneration of the marrow. One notices in the osteoporosis a reduction of the trabecular network connectivity directly proportional with the stage of the illness; thus, we determined a strong reduction of the trabecular connectivity in advanced osteoporosis stages. The growth aspects of the medular adiposity, associated with the intratrabecular connectivity concurs to highlight the functional connection between bone and marrow. The diminution of the medullar cellularity together with its enrichment in fat cells has negative outcomes on the bone.

The study of synovities with articular inflammatory liquid, through clinical-statistical, histological and immunohistochemical methods.

INTRODUCTION: The examination of the synovial is very useful in the positive and differential diagnostic of many articular diseases and especially in the conditions of acute monoarthritis. MATERIALS AND METHODS: The study focused on the establishment of clinical-statistical, histopathological and immunohistochemical correlations on a group of cases anatomo-pathologic diagnosed with synovity with articular inflammatory liquid. The group was divided in five subgroups: rheumatoid polyarthritis, uric arthropathy (gout), TBC arthritis, sarcoidosis and villo-nodular synovity. RESULTS AND DISCUSSION: During the clinical-statistical study the number of arthritis with articular inflammatory infiltration was pursued, the specific location of them and the correlation of the clinical dates with paraclinical ones. In the histopatological and immunohistochemical analysis was pursued the presence of the inflammatory infiltration through the implication of both types of B- and T-lymphocytes in different proportions taking into consideration the cause of the synovity. CONCLUSIONS: The synovial biopsy is indicated at patients at whom the diagnostic is not established after the clinical evaluation. The examination of the synovial tissue can be the only way of establishing a definitive diagnostic in inflammatory arthropathies.

Study of malignant fibrous histiocytoma: clinical, statistic and histopatological interrelation.

INTRODUCTION: Malignant fibrous histiocytoma (MFH) is a malignant tumor of soft parts observed at approximately 70% of cases situated at the level of the outsides. PATIENTS AND METHODS: Our study is formed of 14 cases of patients in a period of three years (2007-2010), diagnosed anatomo-pathological with malignant fibrous histiocytoma at the County Hospital of Oradea. The histopathological examination together with the immunohistochemical one is of vital importance in the establishment of the positive diagnostic and furthermore in the establishment of the differential diagnostic with carcinomas, plasmacytomas, osteosarcomas, fibrosarcomas and lymphosarcomas, fact that arouse the doctors to administrate the correct treatment to a specific patient. DISCUSSION: MFH is a tumor of late adulthood that occurs in men more commonly than women. Computer tomography and MRI have been widely used in the diagnosis and staging of MFH. MFH is secondary to another process such as radiation, surgery, fracture, osteonecrosis, Paget's disease, non-ossifying fibroma or fibrous dysplasia 20% of the time. MFH arising from a previous abnormality is usually more aggressive and has a poorer prognosis than primary MFH. Primary osseous MFH is a central lesion found in the diaphysis or metaphysis of the bone that causes aggressive bone destruction and a soft tissue mass. The most common sites in order are the distal femur, proximal tibia, proximal femur and proximal humerus. Primary osseous MFH is less common. MFH is found in the extremities 70-75% of the time and 50% of all cases are in the lower extremity. Other less common sites include the retroperitoneum, and the head and neck. In our study, of 14 patients with malignant fibrous histiocytoma, the highest incidence is during the sixth decade of life and there is a male to female ratio of 8 to 6. In the specialty literature, malignant fibrous histiocytoma tend to occur in children and teenagers but can also occur in older adults as secondary lesions in bone infarcts and radiation fields. This tumor is clinically similar to osteosarcoma and fibrosarcoma, although malignant fibrous histiocytomas have been classified as different from the osteosarcoma group because of a different histology (no tumor bone production). Treatment is similar to that of osteosarcoma. CONCLUSIONS: During our study, the average age was of 61 years in comparison with the specialty literature where the average age was of 50 years. The same as in the specialty literature the cases of fibrous malignant histiocytoma studied are more frequently present at men. Regarding the situation, our study shows the affectation of the long bones especially the femur followed by the radius. The histopathological examination together with the immunohistochemical one is of vital importance in the establishment of the positive diagnostic and furthermore in the establishment of the differential diagnostic with carcinomas, plasmacytomas and lymphosarcomas.

Study of clinical-morphological correlations in carcinoid tumors of the colon.

INTRODUCTION: The incidence of carcinoid tumors of the digestive tract increased in the last 30 years. The aim of the study is to find clinical and morphologic correlations in cases with digestive carcinoid tumors. MATERIALS AND METHODS: A retrospective study on 76 cases with digestive carcinoid tumors divided in five groups according to their location on the segments of the digestive tract. RESULTS: The subgroup of colon carcinoid is analyzed and clinical-morphological correlations are obtained between the demographic data of the patients (age, gender and environment), tumor location, clinical expression and morphologic features. CONCLUSIONS: Due to the newly discovered techniques of investigation, the incidence of digestive carcinoid tumors has risen in association with other pathologies for which we make these investigations.

Evidence for the involvement of TGF-ß1-CTGF axis in liver fibrogenesis secondary to hepatic viral infection.

Liver fibrosis is a nonspecific response to injuries, which implies the synthesis of an abnormal extracellular matrix (ECM). TGF-ß (transforming growth factor ß) is a cytokine involved in regulation of several important processes: cell development and differentiation, apoptosis, synthesis and degradation of ECM. CTGF (connective tissue growth factor) is a cysteine rich peptide that belongs to the CCN family of proteins and plays an essential role in the formation of blood vessels, bone and connective tissue. The purpose of this study was to assess TGF-ß1 and CTGF immunohistochemical expression in different stages of liver fibrosis secondary to chronic viral hepatitis. Liver biopsies from patients diagnosed with chronic viral hepatitis B and C were embedded in paraffin and further used for histological staining and immunohistochemical reactions to detect TGF-ß1 and CTGF. Liver sections stained with trichromic Masson for collagen staining and Gömöri's silver impregnation revealed various degrees of liver fibrosis, noted in the METAVIR scale from 1 to 4. Sections with discrete degrees of fibrosis revealed the positivity only in the endothelial cells of liver sinusoids and occasionally in proinflammatory cells from the portal tracts, the number of TGF-ß1-positive cells being directly proportional to the incidence of liver injury. Positive reaction for TGF-ß1 expanded to the cytoplasm of hepatocytes located nearby fibrosis bundles while increasing the parenchymal damage. The expression of CTGF was observed in the classical areas of the hepatic lobule, such as the perisinusoidal spaces around the portal tracts or central veins, but also in the hepatocytes surrounding the fibrotic areas. Regardless of the etiological factor of liver damage, activation of liver cells causes an increased synthesis of TGF-ß1 followed by a CTGF overproduction in various polymorphic hepatic structures, in accordance with the degree of fibrosis.

Contributions to the study of morphofunctional interrelations in the liver of the rats treated with certain antipsychotic drugs.

The issue of antipsychotics in psychiatry constituted a revolution at the time. The firsts, starting with chlorpromazine represent the conventional antipsychotics, in the last decades there was a new generation of antipsychotics, atypical, which improved the results in treating psychoses. Because, as any drug, it may have adverse effects we aimed an experimental study on rats to observe the toxic potential on liver of both generations of antipsychotics. From the first generation we used chlorpromazine, haloperidol and haloperidol decanoate and from the second, aripiprazole and risperidone. Results of the study show an increased toxicity of chlorpromazine and diminished among the others, without being the same for every drug.

Preliminary study regarding the utility of certain immunohistochemical markers in diagnosing neurofibromas and schwannomas.

The present study shows the histopathological and immunohistochemical aspects encountered in 49 benign tumors with neural origin diagnosed in the Pathology Department of the Emergency County Hospital of Craiova between 2000 and 2007. Histopathological criteria were used for the histopathological diagnosis, having been diagnosed 22 neurofibromas and 27 schwannomas. Histopathological examination was completed by the immunohistochemical examination using anti-S100 and anti-vimentin antibodies, anti-CD34, anti-CD57 and anti-neurofilament antibodies, as well as the Ki67 proliferation marker. Both tumors showed positive immunostaining for S100, CD34, CD57, but of varying intensity and distribution. Schwannomas and neurofibromas showed a low proliferation index (<5%).

Considerations on the ultrastructural particularities of the dental pulp cells.

We realized an ultrastructural study of the cells of the dental pulp, having in view their particularities relative to other types of conjunctive tissue. For this purpose, we selected five cases represented by teeth without subjective or objective symptomatology. Within the paper there are exposed the morphological aspects observed by means of electron microscopy. The results are then discussed in relation with a series of observations made by other researchers regarding the particularities of the pulp cells structures.

Histopathological and immunohistochemical aspects in both basaloid and spindle cell variant of cervical carcinoma.

The study was performed by using a number of eight cases of cervical carcinomas suiting to basaloid carcinomas and spindle cell carcinomas under the circumstances of usual histopathological staining. Immunohistochemically we used anticytokeratin monoclonal antibody (AE1/AE3) to confirm the epithelial differentiation and also PCNA to evaluate the cell proliferation rate. Tumor positiveness for AE1/AE3 cytokeratin cocktail confirmed its epithelial nature. Immunoexpression for PCNA indicated a high index of cell proliferation for all the cases with a more increased value for the basaloid carcinomas.

Tumoral stroma of salivary pleomorphic adenoma -- histopathological, histochemical and immunohistochemical study.

The aims of our paper were to establish the main histopathological, histochemical and immunohistochemical aspects of tumoral stroma from salivary pleomorphic adenomas. For this purpose we investigated 103 cases by the classical histopathological technique with paraffin embedding and staining with Hematoxylin-Eosin (HE), Hematoxylin-Eosin-Safranin (HES), trichromic Masson, trichromic Goldner Szeckelly, orcein and Periodic Acid Schiff-Blue Alcian (PAS-AA). Immunohistochemically, they were investigated for AE1-AE3, MNF116, CK8, EMA, vimentin, alpha-actin calponin, S-100, GFAP, collagen IV, and PCNA. The results of our study suggest the key role of neoplastic myoepithelial cell in the achievement of diverse morphological aspects of stroma in such neoplasms.