Symptomatic pericardial cysts and dilemmas in their diagnosis.

Pericardial cysts (PCs) or pleuropericardial cysts are rare congenital mediastinal lesions with an approximate incidence of one in 100 000 persons. Usually, they are asymptomatic, being incidentally discovered during a routine chest imaging examination or an autopsy exam. The study involved a retrospective evaluation of clinicopathological findings in a 6-year series of PCs, treated in the Clinic of Pulmonary Diseases, Iasi, Romania. A group of five cases of PCs, four females and one male, were evaluated. All patients displayed different symptoms, such as dyspnea, chest pain, chronic cough, fatigue, palpitation, and epigastric pain. The cystic lesions were located in the right and left cardiophrenic angle, in four cases, and in the central mediastinum in a single case. The lesions had a fluid content and a maximum diameter that ranged between 35 and 95 mm. The microscopic examination of the surgical resection tissues revealed a thin connective tissue wall without any associated smooth muscle cells. The loose connective tissue band was lined by a layer of mesothelial cells with no cellular atypia, which displayed discrete papillary projections, in one case. Although PCs are rare incidental findings, they should be considered in differential diagnoses of mediastinal cysts, especially as they are associated with non-specific symptoms. Furthermore, considering the possibility of development of severe complications, PCs should be thoroughly explored for suitable patients' management.

The clinicopathological challenges of symptomatic and incidental pulmonary hamartomas diagnosis.

Pulmonary hamartomas (PHs) are the most common benign lung tumors. Usually, they are asymptomatic and incidentally discovered during assessment for other diseases or during the autopsy exam. In this context, we have performed a retrospective analysis of surgical resections in a 5-year series of patients diagnosed with PHs in the Clinic of Pulmonary Diseases, Iasi, Romania, aiming to evaluate their clinicopathological features. A total of 27 patients with PH (40.74% males and 59.26% females) were evaluated. 33.33% of patients were asymptomatic, while the others exhibited variable symptoms, such as chronic cough, dyspnea, chest pain or weight loss. In most cases, PHs presented as solitary nodules, predominantly disposed in the right upper lobe (40.74% of cases), followed by the right lower lobe (33.34%), and left lower lobe (18.51%). The microscopic examination revealed a mixture of mature mesenchymal tissue, such as hyaline cartilage, adipose tissue, fibromyxoid tissue, and smooth muscle bundles, in variable proportions, associated with clefts of entrapped benign epithelium. A dominant adipose tissue component was observed in one case. PH was associated with a history of extrapulmonary cancer diagnosis, in one patient. Although considered benign lung tumors, PHs diagnosis and therapy may be challenging. Having in mind the possibility of recurrence or their occurrence as a part of specific syndromes, PHs should be thoroughly investigated for an appropriate patients' management. Their complex significance and the correlation with other types of lesions, including malignancies, may be further studied, by more extensive studies of surgical and necroptic cases.

Remodeling of basement membrane in patients with asthma.

The "bronchial remodeling" specific for the asthmatic disease consists in irreversible changes of the bronchial wall, including glandular and smooth muscle fibers hyperplasia and÷or hypertrophy, goblet cells hyperplasia, and thickening of basement membrane (BM). We aimed to analyze the BM thickness in asthma patients, in order to validate the relationship between its changes and the disease severity defined in agreement with the Global Initiative for Asthma (GINA) criteria. The study group has been formed of 38 patients with different degrees of severity of asthma established by spirometry using Forced Expiratory Volume in one second (FEV1), and two patients without asthma symptoms as controls. The specimens harvested by fibrobronchoscopy have been processed by paraffin embedding followed by Hematoxylin-Eosin (HE) and Periodic Acid-Schiff (PAS) staining. For each case, the BM measurement has been realized by a "point-by-point" method. Statistical analysis has been performed using SPSS 17 software, by applying non-parametric correlation tests. The quantitative assessment revealed a progressive increase in BM thickness during the course of the disease, from a mean value of 11.2 µm in stage 1 to that of 15.6 µm in stage 4. Even if this process has been noticed starting with the first stage of asthma, the differences in the BM size were statistically significant only for stages 1 and 3 (p=0.047), stages 1 and 4 (p=0.000), stages 2 and 3 (p=0.000), and stages 3 and 4 (p=0.000). Spearman's test has shown an opposite correlation between the BM thickness and asthma severity defined by FEV1 values (r=-0.86, p<<0.01, 95% CI). Our study demonstrates that the collagen deposition at the epithelium-connective interface is initiated in early stages of asthma and continues in a progressive modality, the BM thickening being correlated with the disease severity. Thus, we support the concept of biological consequences of BM thickening in asthma pathogenesis, a mechanism still incompletely deciphered.

[Neutrophilic inflammation--indicative of asthma severity]. / Inflamatia neutrofilica ca indicator al severitatii astmului.

UNLABELLED: Our main aim in this study was to investigate the number of neutrophils at the bronchial mucosae level in patients diagnosed with bronchial asthma. MATERIAL AND METHODS: We examined a number of 21 patients with different level of severity of asthma (according to GINA). Fragments of bronchial mucosae were obtained through fiberbronchoscopy, prepared for histological examination for performing the immune staining with anti-elastase antibodies. RESULTS: We found significantly higher number of neutrophils at microscopic examination in the patients with severe asthma than in healthy subjects or mild asthma subjects (r = 0.79, p < 0.01). CONCLUSION: The results of this study suggest that neutrophils can be considered a specific lesion in patients with severe bronchial asthma.

[Expression of the Bax proapoptotic factor in asthmatic patients]. / Expresia factorului proapoptotic Bax la pacientii cu astm bronsic.

The alteration in the expression of the factors involved in the apoptotic mechanism of the respiratory cell epithelium of asthma patients remains an unsolved issue. The mitochondria holds a very important place in the apoptotic chain, making therefore the study of the proteins belonging to the Bcl-2 family that "controls" permeability of mitochondria's membrane extremely interesting, both for asthma as for other diseases. Our main concern in this study was to reveal the changes in expression of Bax factor at the level of the respiratory epithelium in asthma patients. We examined a number of 21 patients with different degrees of asthma. The tissue samples were accordingly processed for immunotyping with anti-Bax antibodies. Following microscopic examination we have found, even in mild cases of asthma, a decreased expression of Bax factor at the epithelial level, compared with the witness. The discovery of all these factors involved in cell apoptosis as well as their alteration in Asthma will be the future of therapeutic approach in these patients.