The arthroscopy-histological criterion link in the result's estimation of the endoscopic treatment by resection of the knee's meniscus lesions.

The authors present the results of a statistical, clinical, imaging X-ray and optical microscopic studies of some lesions of knee's meniscus, the arthroscopy allowing this structure's biopsy during the endoscopic procedures of resection. These histological criterions are very important estimation factors of long-term results of these techniques, often the microstructure looking different to the appearing normal macroscopic aspect.

Histological and ultrastructural analysis of the seminiferous tubule wall in ageing testis.

The authors evaluated possible morphological changes of basement membrane (BM) and lamina propria (LP) of seminiferous tubule wall (ST) related to ageing. Surgical samples of testicular tissue from 28 cases with orchiectomy for prostate adenocarcinoma were processed for light microscopy and transmission electron microscopy (TEM) examination. Seven age groups (AgGr) between 50 and 80 years were designed. Tissue samples were immunomarked for collagen IV and smooth muscle actin. Images were acquired and measured with a specialized software. Thirty ST were randomly selected, with ×40-objective, for each case. Five random determinations for each ST and each parameter were performed. Mean values/tubule, case and AgGr were calculated for each parameter. Regression line (RL), slope and significance test for slope were determined for each parameter correlation with ageing. BM mean value was around 0.5 µm, with narrow limits of ranging in AgGr but more extended individual limits. RL showed discrete decreasing trend with ageing but without an obvious statistical correlation. LP mean value was around 6 µm, also with narrow limits of ranging in AgGr and more extended individual limits. RL decreased discretely with ageing but without an obvious statistical correlation. TEM showed more prominent BM material and more collagen fibers and less fibroblasts in LP of older AgGr and higher fibroblasts density in LP of younger AgGr. Our results showed that BM thickness is apparently decreasing with ageing whereas LP presents extremely variable degenerative changes, with a "mosaic", focal distribution and no tendency to advance with ageing.

Morphoclinical study of intracerebral hemorrhage with subarachnoid effusion.

AIM: The study is an integrated assessment of clinical, imagistic and morphological parameters in severe intracerebral hemorrhages (ICH) complicated with subarachnoid effusion (SAE). MATERIALS AND METHODS: The studied group had 37 cases of patients with ICH and SAE who were hospitalized in the Emergency County Hospital of Craiova and died during hospitalization. The parameters evaluated were clinical (relation with the seasons, age, sex, arterial blood pressure, the motor deficit, degree of coma and Glasgow score at admission) and morphological (the sites of the intraparenchymal hematoma and SAE, the size of the intraparenchymal hematoma, the presence of the mass effect, and the association of intraventricular effusion). The latter were assessed on CT films and during autopsy. RESULTS: The presence of SAE as a complication of ICH showed a predilection for cold seasons, especially winter. From the 37 studied cases, 18 were men and 19 women. 51.3% of the patients were in the fourth and fifth life decade. Almost 73% of the patients had third stage arterial hypertension at admission, over 56% motor deficits and almost 49% Glasgow scores lower than 6. The hematomas had huge dimensions as compared to hosting encephalic structures, in lobar sites involving more than one lobe. Other risk factors as mass effect, perilesional edema and intraventricular extension (IVE) were constantly present. CONCLUSIONS: The association of SAE with other independent risk factors such as hypertension, low Glasgow scores, dimensions of hemorrhagic foci, presence of mass effect, perilesional edema and intraventricular extension (IVE) results in the death of patient despite any sustained therapeutical intervention.

Correlations between intralobular interstitial morphological changes and epithelial changes in ageing testis.

The study focuses on the possible influences of intra (I) lobular (L) stromal compounds [intertubular spaces and seminiferous (S) tubule (T) wall (W)] morphologic changes on S epithelium (E) during ageing process. The material consisted of surgical samples of testicular tissue from 192 patients with orchidectomy for prostate carcinoma. Seven age groups were designed, from 50 to 80 years. Tissue samples were fixed in neutral buffered formalin, embedded in paraffin stained with HE, Goldner and Gömöri and immunomarked (in a subgroup of 28 cases) for smooth muscle actin, collagen IV, and CD34. SE had an uneven involution, both individually and inter-individually, but with normal spermatogenesis in many of ST. E degenerative changes were seen mainly in L periphery. Different stages of maturation arresting were more frequent in older patients. IL septae had changes with extremely variable intensity, dispersed mainly in L periphery, without significant spread and without extensive trend with ageing. Leydig cells showed focal hyperplasia without extensive trend related with ageing. STW presented strictly in the internal layer of lamina propria (apposed to basement membrane of ES) a focal sclerosis, with variable extension concerning its presence, thickness and T circumference (T without sclerosis, with focal sclerosis and with fibro-hyaline "collar" - FHyC) but not related with ageing. IL arteriolae showed focal areas of degeneration with a wide individual and inter-individual range of intensity and extension, but not related with age. Capillary network (CN), with both its peri-T and intramural segments, was present in all age groups, with no quantitative endothelial changes and decreasing only in very old cases. FHyC was often associated with E atrophy. STW focal sclerosis could explain focal degeneration of SE in senescence, although CN undergoes no significant changes.

Sentinel lymph node study in colorectal cancer using serial sectioning and Hematoxylin-Eosin staining: importance and limitations.

The lymph node involvement represents an important predictor for survival in colorectal cancer; consequently, the best pathologic evaluation is necessary in order to adequately assess the lymph node status. This study aims to evaluate the impact of sentinel lymph node technique in colorectal cancer in lymphatic basin staging. The study included 43 consecutive operated cases, in which the identification of sentinel lymph node was performed during surgery (in vivo procedure - colon cancer) or immediately after the removal of the resection specimen (ex vivo procedure - rectal cancer). These cases were matched with 45 control cases. The identified sentinel lymph node was separately examined using multiple sections and Hematoxylin-Eosin staining method. The detection rate, accuracy, sensitivity and false negative rate were better for colon cancer (86.36%; 84.21%; 66.66%; 23.07%) vs. rectal cancer (61.9%; 84.61%; 50%; 18.18%), but there are no arguments for the feasibility of the technique in every day practice. Further studies and methods are mandatory in order to improve the staging of the pN status in colon and rectal cancer.

Thyroid regional metastasis from a giant cell malignant fibrous histiocytoma of the larynx in a patient with history of trichinellosis and tuberculosis.

Sarcomas represent less than 1% of malignant laryngeal tumors and giant cell malignant fibrous histiocytoma is exceptionally rare. Diagnosis is histologically based and immunohistochemistry allows differentiation from other fibro-histiocytic neoplasms. We present the case of a 53-year-old male patient with positive medical history for trichinellosis and tuberculosis, and a laryngeal tumor invading the thyroid and causing respiratory distress by airway obstruction. Total laryngectomy and thyroidectomy were performed followed by thyroxine replacement therapy and radiotherapy. Histologically, the tumor consisted of spindle shaped cells with prominent mitoses, and abundant, osteoclast-like, multinucleated giant cells. Similar lesions were identified in the thyroid, adipose and muscular tissues. Parasitic elements were present in muscles. Tumoral cells showed positive immunostaining for Ki67 (40-50%) and vimentin and negative for AE1/AE3, CD31, S100 and myoglobin; the giant multinucleated cells were CD68-positive. Chronic infection might have had a pathogenic significance.

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%).

Crohn disease or intestinal fistulising tuberculosis? Diagnosis difficulties in a case treated with infliximab and corticosteroids.

UNLABELLED: Crohn disease represents an idiopathic inflammatory bowel disorder with possibility of local and extra intestinal complications. Infliximab therapy is one of major therapeutic alternatives but this treatment may by followed by several possible infections, especially the reactivation of a latent tuberculosis. We present a case of a 28-year-old patient who was admitted in our hospital with clinical signs of bowel obstruction. Colonoscopy revealed close stenosis al the level of splenic flexure. Surgery was soon performed for the imminence of occlusion and pathology has revealed chronic inflammatory infiltrate with lymphocytes and plasma cells, interpreted as Crohn disease complicated with stenosis. A treatment with prednisone 30 mg/day, ciprofloxacin 1000 mg/day administrated intermittently and sulphasalasine 3 g/day for one year was indicated but the patient develop external abdominal fistula. Infliximab therapy 5 mg/kg/dose was administered at two weeks interval, with initial good results after two doses. At two weeks after the second dose, the patient has presented fever and weight loss; abdominal CT-scan has revealed inflammatory adherences of right flexure of the colon with external fistula, resolved by surgery. The evolution was later complicated by right tibio-tarsian involvement, which imposed orthopedic intervention. Pathology has revealed bone tuberculosis and antibacillary therapy was initiated with good results. CONCLUSIONS: Bone tuberculosis may represent a rare evolutive modality at a patient with Crohn disease treated by Infliximab and corticoids. Infliximab therapy in a patient with immunosuppressant (previous corticotherapy, splenectomy) may activate a latent center of tuberculosis. Ciprofloxacin therapy may explain insidious modality of evolution by minor antibacillary effect.

The arthroscopy-histological criterion link in endoscopic "repair" treatment of chondral and chondralbone lesions of the knee.

The authors present the results of optical microscopic studies of some lesions of cartilage and subchondral bone of the knee, the arthroscopy allowing this structure's biopsy during the endoscopic procedures. These histological criteria are very important estimation factors of long term results of these "repair" techniques, the microstructure showing the real biological status of these specific tissues.

[Pseudo-Meigs syndrome, a rare variant]. / Varianta rara de sindrom pseudo-Meigs.

The pseudo- Meigs syndrome is defined as a pelvic tumour, other than the ovarian fibroma complicated with ascites and hydrothorax that can be recovered after the tumour is surgically extirpated. The uterine leiomyoma is an extremely rare cause of this syndrome, only 24 cases have been recorded so far, most of them presenting hydropic degeneration or necrosis. The case exposed by us, a 50- year old obese,with nanism woman, presented clinical, biological and imaging characteristics of the syndrome; moreover, she had arterial high blood pressure for more than five years, fact that didn't need postoperative treatment. She was sent to the ER because she had severe respiratory insufficiency, arterial high blood pressure, tachycardia and, at the clinical examination, she presented massive right hydrothorax, ascites, and pelvic tumour. The biologic explorations (the benign cytology in the pleural liquid and ascites, CA-125 with ten times the normal value) and the imagery completed the picture of a Meigs/ pseudo-Meigs syndrome that implied the laparotomy. The H-P examination and the postoperative evolution confirmed the diagnosis. We presented this case in order to emphasize both its rarity and its real positive and differential diagnosis problems.

Osteoarticular tuberculosis--a ten years case review.

Extrapulmonary sites of tuberculosis must not be neglected as they are not so rarely fortuitous discovering. The morphological diagnosis of tuberculosis is generally easy to do. However, there are the atypical lesions rising diagnostic difficulties. The authors reviewed the histopathological diagnostic in 19 cases of osteoarticular tuberculosis lesions selected from 390 cases of surgical extrapulmonary granulomatous lesions, using for difficult cases, with atypical lesions, new diagnostic tools as immunohistochemistry and DNA amplification technique by the polymerase chain reaction.

Morphoclinical study of intracerebral haemorrhage with intraventricular extension.

AIMS: The study is an integrated assessment of clinical, image and morphological parameters in severe intracerebral haemorrhages (ICH) complicated with intraventricular extension (IVE). MATERIAL AND METHODS: The studied group had 93 cases of patients with ICH and IVE who were hospitalized in the Emergency County Hospital of Craiova and died during hospitalization. The parameters evaluated were clinical (relation with the seasons, age, sex, arterial blood pressure, the motor deficit, degree of coma, Glasgow score at admission and medical care) and morphological (the sites of the intraparenchymal haematoma and IVE, the size of the intraparenchymal haematoma, the presence of the mass effect, perilesional oedema and subarachnoid effusion). The latter were assessed on CT films and during autopsy. RESULTS: The presence of IVE as a complication of ICH showed a predilection for cold seasons, especially autumn. From the 93 studied cases 51 were men and 42, women. 52.6% of the patients were in the fifth and sixth life decade. Almost 80% of the patients had IIIrd stage arterial hypertension at admission, over 80% motor deficits and almost 60% Glasgow scores lower than 6. The ventricular effusion involved at least one of the lateral ventricles. The hematomas had huge dimensions as compared to hosting encephalic structures, in lobar sites involving more than one lobe. Other risk factors as mass effect and perilesional oedema were constantly present. CONCLUSIONS: The association of IVE with other independent risk factors such as hypertension, low Glasgow scores volume of intraventricular bleeding, dimensions of haemorrhagic foci, presence of mass effect and perilesional oedema results in the death of patient despite any sustained therapeutic intervention.

Study of cerebral vascular structures in hypertensive intracerebral haemorrhage.

AIMS: The study was performed in order to assess the alterations of extra-parenchymal and intraparenchymal vascular structures in 82 hypertensive patients suspected of primary intraparenchymal hematoma, which died and were autopsied in order to confirm the diagnosis. MATERIAL AND METHODS: The studied material consisted of nervous tissue situated near and distant from the haemorrhagic lesion. The specimens of nervous tissue were processed by the classical histological technique and stained with the usual stainings and with immunohistochemical stains for basement membranes and endothelial cells. RESULTS: Extra-parenchymal arteries showed classic lesions of atherosclerosis. Atheromatous lesions were of all types, even the extension towards the media being encountered a complication with thrombosis. At the level of the intraparenchymal blood vessels, the spectrum of the lesions due to arterial hypertension included all steps of vascular wall degeneration, from hypertrophy of smooth muscle layer to complete hyalinization of arterial wall, but with a focal irregular distribution, not related with the proximity of haemorrhagic focus. High arterial blood pressure also influenced the capillary walls which showed focal or circumferential thickening due to the densification of the type IV collagen material from the basement membrane structure. The CD34 immunostaining showed that endothelial cells kept their structural integrity. CONCLUSIONS: The sequence of degenerative lesions of the cerebral vascular wall culminates with the hyalinization of excessive fibrillar material form arteriolar wall or from basement membranes. Hyalin material is weakening the wall resistance to the stress determined by the high values of blood pressure in hypertension, and, correlated with a minimal resistance of the surrounding cerebral parenchyma, can explain why the cerebral parenchyma is the only tissue in which blood pressure variations can determinate vascular rupture and cerebral haemorrhage. The more adequate term for describing the vascular wall changes seems to be sclerosis (arteriolar and even capillary) with hyalinosis.

Assessment of Gleason system use on different types of prostatic tissue samples.

One of the well-known and accepted methods of prostatic adenocarcinoma grading is Gleason system. The authors made a retrospective analysis of 221 prostatic adenocarcinomas divided into three groups (transvesical prostatectomies, transurethral resections and needle biopsies) following the type of surgical procedure used for drawing the tissue. Gleason scores and comparison between odd and even Gleason scores were assessed in the entire group and in each subgroup. High scores prevailed, meaning a tendency towards a low grade of differentiation. Even scores also prevailed meaning, on one hand, that, often, the examined specimen reveals only one pattern and, on the other hand, that surgical procedures as transurethral resections and unique needle biopsies cannot offer a sufficient material for examination, the multicentricity of prostatic carcinoma being well known.

Histological study [correction of styudy] of the femural head and neck microscopic architecture in persons with senile osteoporosis.

For our study were available fragments of bony tissue from 24 patients (15 females and 9 males) aged between 55-82 which needed hip arthroplasty after they had undergone femural neck fractures. Biologic pieces have been fixed, then decalcified and processed by wax embedding. We noted that the spongious osseous tissue appeared as rarefied after the remoulding processes; osseous traveas grew unplainly thinner, with their large areolar cavities filled of bony yellow marrow. The osseous cortex presented deformed osteomas with large irregular Havers ducts. The osteocytes appeared rarefied, of small size with a picnotic and hyperchrome nucleus.

Comparative study between prostatic carcinoma G1-G3 and Gleason grading systems.

The need of an accurate and prognostically valuable method for grading the prostatic carcinoma resulted in, in the last decades, a large number of systems, none of them succeeding in being unanimously accepted by the pathologists family. The authors selected and reassessed using Gleason system a group of 221 cases with prostatic adenocarcinoma previously diagnosed using a combined G1-G3 system. The results were converted from Gleason system to G1-G3 system and then compared with the initial diagnostics. The group was divided, following the type of surgical procedure used for drawing the tissue, into three groups: transvesical prostatectomies (TVP), transurethral resections (TUR) and needle biopsies (B). The concordance between the two systems was good, even the number of TUR and B specimens was significant (85% of the studied group) showing that any of them can be successfully used in current practice, depending only on pathologist's experience.