An In Vivo Observational Histological Study of Peripheral Arterial Damage in Patients with Acute Limb Ischemia in SARS-CoV-2 Infection.

Thromboembolic events, such as acute limb ischemia, were reported worldwide in patients with COVID-19, suggesting that SARS-CoV-2 infection acts like a redoubtable prothrombotic factor in these patients. The aim of the study was to summarize the histopathological changes found in the arterial wall, intraarterial thrombus, and adjacent skeletal muscles. Considering the lack of evidence from in vivo studies, we performed observational histological research of peripheral arterial damage in patients with acute limb ischemia and SARS-CoV-2 infection. We investigated 22 patients with acute limb ischemia and SARS and harvested histopathological samples from those who agreed to this procedure. We performed histologic tissue harvesting during the revascularization procedure from the thrombosed area of the common femoral artery. Morphologic analysis was made on the hematoxylin-eosin (HE) stain. Special stains were also used-Elastica van Gieson (EvG) and Alcian Blue-Periodic Acid-Schiff (AB-PAS) and primary antibodies-CD45 and CD61. Our patients had significant risk factors for thrombus formation, since all of them had arterial hypertension, 81% had dyslipidemia, 73% were obese, 63% suffered from diabetes mellitus, and 45% were active smokers. The histological findings using immunohistochemistry (CD45 and CD68 reactions) or special and usual stains underlined the mechanism for ischemia production in SARS-CoV-2 patients. The main histological findings in our study were endothelial destruction and inflammation that were found in all analyzed structures.

Three-Dimensional Virtual Pathology Specimens: Decrease in Student Performance upon Switching to Digital Models.

Several alternatives to formalin-stored physical specimens have been described in medical literature, but only a few studies have addressed the issue of learning outcomes when these materials were employed. The aim of this study was to conduct a prospective controlled study to assess student performance in learning anatomic pathology when adding three-dimensional (3D) virtual models as adjunct teaching materials in the study of macroscopic lesions. Third-year medical students (n = 501) enrolled at the Victor Babes University of Medicine and Pharmacy in Timisoara, Romania, were recruited to participate. Student performance was assessed through questionnaires. Students performed worse with new method, with poorer results in terms of overall (mean 77.6% ±SD 11.8% vs. 83.6% ±10.5) and individual question scores (percentage of questions with maximum score 34.6% ±25.6 vs. 47.7 ± 24.6). This decreased performance was generalizable, as it was observed across all language divisions and was independent of the teaching assistant involved in the process. In an open-ended feedback evaluation of the new 3D specimens, most students agreed that the new method was better, bringing arguments both for and against these models. Although subjectively the students found the novel teaching materials to be more helpful, their learning performance decreased. A wider implementation as well as exposure to the technique and use of virtual specimens in medical teaching could improve the students' performance outcome by accommodating the needs for novel teaching materials for digital natives.

Intestinal heterotopic pancreas involved by simultaneous PanIN-2 lesion and endocrine microadenoma: a unique case.

We hereby present the case of a 58-year-old male who underwent a total gastrectomy for gastric neoplasm. During the surgery, a tumor mass in the jejunum was identified, considered as metastasis, and resected. The histopathological examination of the jejunal lesion showed ectopic pancreas. In this area, two pathological distinct lesions were identified, one histologically compatible with pancreatic intraepithelial neoplasia (PanIN) type 2 lesion and the other with morphologic criteria for endocrine microadenoma. To our knowledge, this is the first case that evidences the presence of a concomitant premalignant exocrine lesion and benign endocrine lesion in a heterotopic pancreas.

Pseudobenign prostate carcinomas: causes of false-negative biopsy results.

Prostate carcinomas are continuously surprising the pathologists through their multitude of variants and histological subtypes, some of them being recently described and characterized. Among these are individualized: atrophic carcinoma, foamy gland, pseudohyperplastic, microcystic, certain subtypes of ductal adenocarcinoma and hormone-treated adenocarcinoma, which because of minimal architectural and/or cytological atypia are often under-diagnosed, especially in small tissue fragments. This paper presents the morphological criteria, including information provided by some immunohistochemical markers for positive and differential diagnosis of these variants/subtypes of prostate adenocarcinoma with which the pathologist should be familiar and avoid their confusion with a series of similar histological structures or benign/premalignant lesions.

Soft tissue epithelioid angiosarcoma.

We present a case of 48-year-old male with a nine months history of right inferior thoracic (T10-T12) paravertebral mass, which became painful after a back trauma; dyspnea and hemoptysis were associated. The preoperative native and with contrast substance CT revealed a tumor mass extended from the right paravertebral muscles to the diaphragmatic right pillar muscle, invading the postero-basal pleura and the posterior arches of the right XIth and 12th ribs with osteolysis. Fragments of 10 cm large tumor resection specimen (striated muscle, dense connective tissue, adipose tissue, lymph nodes and intercostals nerves) were routinely processed, further immunohistochemical investigations were needed, using Dako antibodies pan-CK clone MNF116, CD34, CD20, vimentin, synaptophysin, melanoma HMB45 clone, with LSAB 2Kits system and further CK AE1÷AE3, CK7, CK20, CEA, S-100 protein, CD31, von Willebrand factor, D2-40÷podoplanin, Ki-67 antigen, with EnVision system and DAB visualization in both systems. The histological and immunohistochemical aspects were indicative for soft tissue epithelioid angiosarcoma, which was misdiagnosed on frozen and HE sections as a carcinoma, because of the cohesiveness and nesting properties of the malignant cells, together with the presence of lymph node metastases. The proliferative activity of the malignant cells, highlighted by Ki-67 antibody, clone MIB 1 was high (30% of malignant cells were positive at HPF). The patient was discharged with adjuvant therapy indication: radiotherapy and chemotherapy. The tumor locally recurred 12 months afterwards, but the patient is still alive 22 months after surgery.

Prostate lesions with cribriform / pseudocribriform pattern.

Prostate lesions with cribriform / pseudocribriform architecture range from normal histological structures to infiltrative carcinoma. In each group of lesions with cribriform architecture (benign, premalignant and malignant intraductal or infiltrating), there are situations in which histological classification of the lesion is difficult or impossible on routine stains. A more wide-scale application of the immunohistochemical investigation for clearing up the problematic prostate lesions led to the definition and reclassification of cribriform lesions in distinct categories and sometimes very different in terms of progression, prognosis and treatment. This paper proposes an overview of the prostate lesions with cribriform / pseudocribriform architecture, emphasizing the morpho-immunohistochemical criteria for positive and differential diagnosis.

Clinicopathologic features and five years survival analysis in molecular subtypes of breast cancer.

PURPOSE: In the last years, the incidence of breast cancer has been increasing; characteristic patterns of gene expression have emerged, reflecting molecular differences between previously known as well as newly defined subtypes of breast cancer. This study aimed to classify the molecular subtypes of breast cancers based on the expression profile of immunohistochemical markers and to evaluate their association with clinicopathological features. MATERIAL AND METHODS: A total of 173 cases of breast carcinoma were examined retrospectively using immunostains for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2). Because the triple-negative phenotype, when defined by IHC using only these three markers, is not the optimal method for defining basal-like breast cancer, we need to use an additional marker--CK 5/6. RESULTS: The luminal type was the most common subtype in breast cancer (71.6%), which was followed by the basal subtype (21.9%). HER2 subtype were 2.8% from the total of cases, being associated with the highest rate of high-graded cases. Basal type is presented largely in premenopausal women and displayed aggressive features, such as large tumor size and poorly differentiated cancers. Luminal A included the highest percentage of patients older than 60 years, the highest proportion of stage I-II tumors and well/moderately differentiated lesions. HER2-type was more frequent in premenopausal women and showed a high percentage of positive lymph nodes. CONCLUSIONS: These molecular differences have been shown to correlate very well with clinical features and survival, or even better than traditional histopathological parameters. The discovery of certain molecular characteristics of breast cancers has helped us to understand better the pathophysiology of disease and to develop more direct therapeutic strategies.

Primary malignant non-Hodgkin's lymphomas of salivary glands.

We evaluated the medical record of patients with salivary gland neoplasms diagnosed at Timisoara City Hospital from 2002 to 2009. A study has been carried out for seven years on 204 cases of salivary gland tumors and only two cases of salivary gland lymphomas were diagnosed. The two cases were females of 71- and 49-year-old, respectively. The formalin-fixed paraffin-embedded tissue samples were cut in 4 mum thick sections and stained with Hematoxylin and Eosin. The primary monoclonal antibodies for the immunohistochemical analysis were the followings: LCA (2B11, Dako), CD20 (L26, Dako), cytokeratin (MNF116, Dako), p53 (DQ-7, Dako), and PCNA (PC-10, Dako). The histopathology and immunohistochemistry suggested in the first case a low-grade diffuse large B-cell mucosa associated lymphoid tissue lymphoma and in the second case a high-grade extranodal marginal zone B-cell lymphoma.

Schwannoma of the lip: case report and review of the literature.

Schwannomas of the lip are rare, benign neoplasms which vary in size. The diagnosis is typically made at the time of surgery following biopsy and surgical resection is the mainstay of treatment. We present one case of lip schwannoma: the patient was 25-year-old and he has presented to otorhinolaryngologist for a non-dolorous tumor on the mucosal side of his inferior lip, which was increasing in size for the last six months. The tumor had a superficial ulceration and infection. Initially it was suspected to be a papilloma. The tumor was radically removed, and the sections were stained with Hematoxylin-Eosin. The tumor was encapsulated and showed two different pattern of growth. Antoni A areas displayed spindle cells closely packed together with palisading of nuclei. Verocay bodies, which were presented in Antoni A areas, are whorled formations of palisading tumor cells. The cells of neoplasm were monotone. Only few spindle cells were moderately pleomorphic, but mitotic figures were unusual. In addition, immunohistochemical labeling was performed for S-100 protein, vimentin, GFAP and NSE and confirmed the diagnosis. This report describes a case of lip schwannoma, which was correctly diagnosed by routine staining and confirmed by immunohistochemical staining for S-100 protein, vimentin, GFAP and NSE.

Amelanotic vulvar melanoma: case report and review of the literature.

A rare case of amelanotic vulvar melanoma is presented. The patient was a 71-year-old woman complaining of vulvar itching and yellowish vaginal discharge who underwent a complete gynecological evaluation during which a suspicious grey-whitish mass on her vulva was observed. The tumor presented superficial ulceration and was located in the upper half of the labia minora and clitoris. Initially it was suspected to be a vulvar carcinoma. A biopsy was taken and a histopathological suspicion of amelanotic melanoma was rendered. The mass was radically excised and the diagnosis was confirmed using HMB-45, Melan-A and anti-S-100 protein antibodies. Malignant melanoma is readily diagnosed by the presence of melanin granules. Although amelanotic melanoma contains a few melanin granules, it is often difficult to differentiate it from other non-epithelial malignant tumors. This report describes a case of amelanotic melanoma of the vulva, which was correctly diagnosed by immunohistochemical staining with the HMB-45, Melan-A antibody and for the S-100 protein.