Evaluation of the incidence of inflammatory and tumor pathology of nose and nasal sinus region.

Inflammatory and nasal-sinus tumor pathology is a field of great interest in rhinology worldwide. The aim of the paper is to determine the prevalence of nasal and nasal-sinus inflammatory diseases, as well as nasal and nasosinusal rhinosinusitis tumors, in association or not with inflammatory diseases, using histopathological (HP) examination. It is also desired to identify the association of chronic inflammatory pathology with the tumor one, considering inflammation and immunodeficiency as local susceptibility factors. A retrospective study was performed on a group of 254 patients hospitalized between 2018-2019 in Department of Otorhinolaryngology, Emergency County Hospital, Târgu Mures, Romania. Based on the clinical and HP examination, the distribution by inflammatory pathologies was made as follows: 175 nasal polyposis, 108 chronic rhinitis, 39 sinusitis - strictly affecting the sinus and 28 chronic polyposis rhinosinusitis - nasal and sinus association. Considering the evaluation of the incidence of benign tumor pathology, the following were found: out of the total examined cases, 4% squamous papilloma, 4% exophytic papilloma, 44% Schneiderian papilloma, 4% benign fibrous histiocytoma, 18% hemangioma, 4% hamartoma, and 4% osteoma were identified. The incidence of malignant tumors is 26% squamous cell carcinoma, 12% intestinal adenocarcinoma, 2% nonintestinal type adenocarcinoma, 2% large B-cell lymphoma, 2% plasma cell, 2% olfactory neuroblastoma, 7% malignant melanoma, 16% basal cell carcinoma. The paper draws attention to the increased incidence of tumor and inflammatory pathology both individually and in combination, considering the involvement of the clinical correlation with the HP result completed, if necessary, with immunohistochemical examinations, for a precise diagnosis.

Optical biopsy strategy for the assessment of atrophic gastritis, intestinal metaplasia, and dysplasia.

BACKGROUND AND AIMS: The pathogenesis of gastric cancer involves premalignant changes of the gastric mucosa. An accurate estimation of the topography and severity of these lesions represents an important step in detecting premalignant lesions, thereby classifying patients into low or high risk of developing gastric cancer. We prospectively analyzed the diagnostic performance of narrow-band imaging with magnification endoscopy (NBI-ME) for assessing premalignant gastric lesions during real-time examination. PATIENTS, MATERIALS AND METHODS: A total number of 59 patients were examined by NBI-ME and target biopsies of the antrum, corporeal, and incisura angularis levels. Modified endoscopic patterns were classified into three groups: type A [tubulo-villous mucosal pattern with regular microvessels, or the light blue crest (LBC) sign], type B [disappearance of normal subepithelial capillary network (SECN) pattern], and type C [irregular mucosal pattern (IMP) and∕or irregular vascular pattern (IVP)]. The endoscopic diagnosis was compared to histological findings (the gold standard). The NBI-ME results were assessed for accuracy, sensitivity, specificity, and negative and positive predictive values in detecting intestinal metaplasia, atrophic gastritis and dysplasia. RESULTS: Analysis of endoscopic patterns showed a good correlation with premalignant lesions (p<0.05). Type A pattern showed 80.2% accuracy, 80.43% sensitivity and 80% specificity [area under receiver operating characteristic (AUROC) of 0.8] in detecting intestinal metaplasia. Diagnostic performance for assessment of atrophic gastritis was not ideal (69.5% accuracy, 83.72% sensitivity, 56.04% specificity, AUROC 0.69). Pattern C represents a reliable endoscopic marker for the diagnosis of dysplasia (91.1% accuracy, 83.3% sensitivity, 91.81% specificity, AUROC 0.87). The extension of precancerous lesions was estimated during endoscopic examination. CONCLUSIONS: NBI-ME represents a valuable tool in the assessment of premalignant gastric lesions, thereby categorizing patients into low and high risks of developing gastric cancer. The applicability of the method in routine practice is promising, as it helps shape the follow up protocol of patients with premalignant lesions of the stomach. It is worth mentioning that, this method requires standardization, additional training, and expertise.

Vanek's tumor: a rare cause of gastric outlet obstruction. Case report and literature review.

Vanek's tumor or inflammatory fibroid polyp (IFP) is a rare submucosal, mesenchymal tumor of the digestive tract, of unknown etiology. We present an unusual case of a 62-year-old female patient, investigated for intermittent nausea, vomiting, abdominal pain and anemia. Narrow-band imaging (NBI) endoscopy showed a polypoid tumor with normal coverage mucosa prolapsing through the pylorus. The tumor was surgically removed. Histopathological (HP) examination revealed the presence of spindle cells with uniform nuclei exhibiting no mitotic activity. The inflammatory cells were predominantly represented by eosinophils. The vascular component was prominent suggesting a vascular lesion. We put emphasis on the presentation of this particular case because of its scarcity among the other types of gastric polyps, suspicion for features of malignancy, and the particularities of the clinical presentation, consisting of intermittent gastric outlet obstruction ("ball valve syndrome") accompanied by weight loss and anemia. The differential diagnosis of other benign or malignant gastric lesions was based on endoscopic, computed tomography and HP aspects.

The evaluation of Ki67, p53, MCM3 and PCNA immunoexpressions at the level of the dental follicle of impacted teeth, dentigerous cysts and keratocystic odontogenic tumors.

UNLABELLED: The aim of this study is to analyze the immunoexpression of Ki67, p53, MCM3 and PCNA markers in epithelial remnants of dental follicles of impacted teeth and to identify a possible correlation between the immunoexpression of these markers in dentigerous cysts and keratocystic odontogenic tumors in order to evaluate their evolutionary behavior. MATERIALS AND METHODS: A total of 102 cases were included in the study and divided into three subgroups: the first subgroup consisted of 62 cases with dental follicles of impacted teeth, the second included 20 cases of dentigerous cysts and the third subgroup comprised a number of 20 cases with keratocystic odontogenic tumors. Immunomarking with the four antibodies was performed. RESULTS: A positive marking was obtained in over 60% of the dental follicles for all markers. Statistically significant differences were also obtained in dentigerous cysts and keratocystic odontogenic tumors for Ki67, p53 and MCM3. Assessment of the four antibodies in the two layers of keratocystic odontogenic tumors shows a positive correlation between Ki67 and MCM3 both for the basal and parabasal layer, with slightly increased values in the latter. CONCLUSIONS: In order to determine the proliferative capacity of epithelial remnants in the dental follicles, Ki67 and PCNA, Ki67 and MCM3 are the most useful markers in practice; they have similar behavior and are more likely to help in distinguishing between dentigerous cysts and keratocystic odontogenic tumors.

Necrotizing fasciitis in oro-maxillo-facial area after radiotherapy for squamous cell carcinoma of the soft palate.

The fascia's and subcutaneous adipose tissue's impairment by mono or polymicrobial infection, which also can involve the skin and the muscles, is rarely seen in oro-maxillo-facial area. The present case report is presenting a case of necrotizing fasciitis in a patient who had a history of an invasive squamous cell carcinoma of the soft palate, with surgical treatment and with radiotherapy. He was admitted in our Clinic with malaise and subsequently developed a toxico-septic shock. Clinical symptoms, serological and bacteriological analysis and histopathological examination confirmed the diagnosis of necrotizing fasciitis (NF). The patient subsequently underwent a series of surgical reconstruction and aesthetic treatments because of the complications that had arised in the meantime. Postoperative evolution was favorable towards complete closure of the defect. The prognosis of this disease is generally reserved, the favorable evolution depending on the possibility of wound sterilization and the surgery is required despite its mutilating effect.

Ultrasonography-histopathology correlation in major salivary glands lesions.

Major salivary glands display a various and complex pathology, showing different evolution and prognosis, depending on the histopathological form. The choice of an appropriate treatment plan for the best outcome, therefore the proper surgical approach, would imply preoperative knowledge of the histopathological diagnosis. However, any core-biopsy performed prior to surgery presents the risk of a false result and increases the difficulty of latter surgery. Therefore, some complementary examinations are used, among these, ultrasonography. The retrospective study (April 2010-March 2013) conducted in the Clinic of Oral and Maxillofacial Surgery, Emergency County Hospital, Tirgu Mures, Romania, aims to evaluate the relevance of the ultrasonography by itself in leading towards a proper preoperative assessment and diagnosis, and thus, in choosing the proper treatment plan. The study included 33 lesions of the major salivary glands, undergoing first ultrasonography, then curative surgery. Different characteristics (shape, dimension, consistency, vascularization, homogeneity, delimitation) were assessed on ultrasonography as well as on histopathology; finally, the correlation between those two examinations was evaluated, by comparing diagnoses. The results of our study are similar to others, showing that ultrasonography can diagnose preoperatively the majority lesions of major salivary glands. The conclusions of the study sustain the importance of ultrasonography as a routine examination in major salivary glands lesions.

Localized laryngeal amyloidosis - a case report.

Amyloidosis encompasses a variety of conditions, caused by extracellular, insoluble protein fibrils that disturb the normal functioning of cells and organs. The disease may be localized or systemic, hereditary or acquired (associated with chronic inflammatory or hematological diseases). We present the case of a 49-year-old woman, with symptoms including dysphagia, dysphonia and dyspnea. After taking the case history and performing clinical examination, we suspected a laryngeal tumor to be the cause of the symptoms. Microlaryngoscopy and biopsy were performed. The histopathological examination result of the biopsy specimen was amyloidosis. Surgical excision of the tumor was performed. Our case presentation describes this rare pathological finding, its clinical manifestations, the histopathological and surgical diagnostic problems, treatment, patient evolution and the difficulties we encountered along the way, through the scope of our personal experience.

A study on the type of lesions achieved by three electrosurgical methods and their way of healing.

The technical progress in the medical sector in the past decades has continuously driven the development of electrosurgical techniques. The controversies surrounding the superiority of a certain technique relative to another - electrocautery, laser and radiofrequency - have determined us to carry out a histopathological design with the aim of comparing the healing sort of the shallow wounds generated by the three types of electrosurgical devices. The experimental study has investigated the healing process inflicted by the electrosurgical devices mentioned beforehand on 12 Wistar albino rats. The wounds were inflicted under intravenous general anesthesia with Xylazine and Ketamine and were performed lateral to the spine region, using laser, radiofrequency and electric cautery. The histological samples harvested at one, three, five, and seven days were sent to pathological examination. We followed by comparison the evolution of the first two phases of the wound healing produced by the three electrosurgical methods analyzed. We described the histopathological changes occurred in the epidermis, dermis and hypodermis and also the subcutaneous soft tissues in all of the three types of lesions. Electrocautery remains the most frequently used electrosurgical device, even if it has unquestionable disadvantages as compared to other modern instruments. Laser-assisted surgery and radiofrequency are refine energy-based instrumentation, being utilized at a multidisciplinary surgical level.

Changes in immunoexpression of p53, Ki-67, Ets-1, APAF-1 and PTEN in serrated and conventional colon adenomas.

UNLABELLED: The balance between apoptosis and proliferation is tipped towards a decrease of apoptosis as the colonocyte progresses in the adenoma to carcinoma sequence of colon carcinogenesis. According to literature data, proteins like p53, Ki-67, APAF-1, Ets-1, PTEN contribute to inhibition of apoptosis and stimulation of proliferation. AIM: Considering the complex interference among colorectal carcinogenetic mechanisms, our aim was to study the markers Ets-1 and APAF-1 relative to p53, Ki-67 and PTEN expression in colon adenomas/polyps (A/P). MATERIALS AND METHODS: We performed immunohistochemistry on 99 colon A/P cases from the material of the Department of Pathology, Emergency County Hospital of Tirgu Mures, Romania. Secondary EnVision Flex/HRP (Horseradish peroxidase) (20 minutes) was used for signal amplification. RESULTS: The majority of A/P show increased Ki-67, p53, Ets-1 expression, decreased APAF-1 expression and preserved PTEN expression. p53, Ki-67, Ets-1 and APAF-1 demonstrated statistically significant correlations with histological type and grade of dysplasia. We also observed that expression of these proteins in the intestinal crypts has a typical distribution according to histological type and grade of dysplasia. CONCLUSIONS: In case of hyperplastic polyps APAF-1 expression decreases as p53 and Ki-67 expression increases, followed by a decrease in PTEN expression in serrated adenomas, and an increase of Ets-1 expression in conventional adenomas.