Correlations between intratumoral vascular network and tumoral architecture in prostatic adenocarcinoma.

The authors made a preliminary assessment of possible correlations between the intratumoral vascular density (IVD) and the architectural tumoral patterns described by Gleason. The studied material consisted of samples obtained by transurethral resection from 34 patients diagnosed with prostatic adenocarcinoma. Ten fields, five for dominant and five for secondary identified patterns of each case, with no necrosis were selected randomly from CD34 immunomarked sections using ×20 objective. IVD increased with Gleason pattern both for the entire group, but also for "solid" phenotype group of subtypes up to pattern 4, respectively subtype 4B. In "necrotizing" phenotype group of subtypes, IVD had a decreasing trend from the better-differentiated subtypes to the poorest one. These preliminary data showed that the intratumoral vascular network reacts differently to the loss of tumoral differentiation in the two groups of Gleason subtypes suggesting the existence of two different populations of malignant cells.

A profile of lung carcinomas: study on 364 cases.

The authors have proposed to analyze retrospectively the clinical-morphological profile of a consistent group of lung carcinomas treated surgically. The studied material consisted of clinical and pathological medical records from 364 patients confirmed histopathologically with lung carcinoma after surgical intervention. Five main groups were defined based on the histopathological criteria and then compared. The assessment of clinical data, in spite of a wide range of clinical expressions, revealed some particular features for each of the defined groups. The morphological data outlined also different behavioral profiles for each of the histopathological types of lung carcinoma. These results showed that malignant epithelial tumors of the lung are still a major challenge from the detection until the therapeutic intervention and, therefore, the preoperative clinical-morphological investigation is crucial for a better adjustment of the therapeutic act according to the individual profile of each type of tumor.

Effect of intraperitoneal administration of sterile human cerebrospinal fluid in rats.

INTRODUCTION: Distal ventriculoperitoneal shunt failure can be attributed to unabsorbed cerebrospinal fluid (CSF) from peritoneum. The objective of the experiment was to determine peritoneal reaction in rats after intraperitoneal administration of human CSF and evolution of local inflammatory response. MATERIALS AND METHODS: Wistar rats were used divided into four groups: three groups in which intraperitoneal injection of 3 mL, 2 mL and 0.5 mL of sterile human CSF was done and a control group. After sacrificing the animals, at 24, 48 or 72 hours, macro- and microscopic examination of the peritoneal cavity and peritoneal fluid analysis were performed. The experiment was done in compliance with legislation regarding animal research. RESULTS: Administration of high dose CSF (3 mL) led to death of all specimens. The dose of 0.5 mL of sterile CSF intraperitoneally administered was compatible with survival. Peritoneal response varied from necrotic-purulent reaction, with maximum intensity in group 1, and milder in group 2, to minimum inflammation in small foci and polymorphic cells in group 3. Inflammation only partially resolved in some specimens from group 3 after 72 hours, which incriminates the role of unabsorbed peritoneal CSF in pathogenesis of abdominal complications of ventriculoperitoneal shunts. CONCLUSIONS: Intraperitoneal administration of sterile human CSF caused inflammatory response of varying degrees and with multiple locations. High doses of CSF led to death of specimens. At 24 hours, the peritoneal response ranging from congestion to purulent reaction was acute, intense and diffuse but after 72 hours, the inflammatory response was mild, focal and limited.

Histological aspects of post-TACE hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the fifth most common type of cancer in men and the seventh in women and is the third most common cause of death from cancer worldwide [http://globocan.iarc.fr]. The overall incidence of HCC remains high in developing countries and is steadily rising in most industrialized countries [Shariff MI et al., 2009]. A variety of therapeutic modalities is available for treating hepatocellular carcinoma, but orthotopic liver transplantation (OLT) represents a curative option. Due to the shortage of donor organs and the increasing need for liver transplantation in the last decade, local ablation therapy (LAT) has been increasingly used in many centers as a bridge to transplant [Majno PE et al., 1997; Decaens T et al., 2005; Herber S et al., 2005; Bharat A et al., 2006; Obed A et al., 2007; Otto G et al., 2007]. We retrieved from the archive in the Histopathology Laboratory, Institute of Liver Studies, King's College Hospital, London, UK, 28 cases of HCC, which underwent treatment with TACE (Doxorubicin 40 mg/m²) as a bridge to transplantation, between 2008 and 2010. We also analyzed 14 additional post-TACE tumors, classified according to the architectural patterns published by Morisco F et al. (2008), for quantification of necrosis. Extensive tumor necrosis was observed in 12 (42.85%) of the patients. Viable hepatocellular carcinoma showed a wide range of differentiation, from well to poorly differentiated. The phenotype of the tumors was mostly hepatocelluar, but 14% showed a mixed phenotype, including glandular/pseudoglandular formation and cholangiocellular components. The percentage of necrosis ranged between 0% and 100%, with an average of 50.6%. There was no statistical correlation between the total size of the nodules and the surface of necrosis in our series (p=0.125). In conclusion, the systematic pathological assessment of post-TACE resected HCC can help in investigating the biology of treated tumors but needs to incorporate sampling protocols, digital image analysis, phenotypic classification by immunohistochemistry and enzymatic function.

Acute pancreatitis: the onset digestive manifestation, in a patient with adult T-cell leukemia/lymphoma.

UNLABELLED: Acute pancreatitis is a common complication, which occurs with patients suffering from vesicular biliary lithiasis or chronic alcoholism. Hypercalcemia may determine acute pancreatitis, its causes being multiple: primary or secondary hyperparathyroidism, metabolic diseases of the bone, metastatic bone neoplasm, as well as lymphoproliferative syndromes caused by the HTLV-1 virus-adult T-cell leukemia/lymphoma (ATLL). ATLL is a malignant and aggressive lymphoproliferation with the T-cell, associated with the infection caused by the HTLV-1 retrovirus. Organomegaly, cutaneous conditions, and hypercalcemia represent the main characteristics of the disease. From a hematologic point of view, we can notice the atypical lymphocytes (also known as flower cells, due to the shape of their nucleus), with a distinct CD4+ CD25+ phenotype. There have been reported few cases of patients who showed acute pancreatitis in the onset of the disease. We will describe the case of a patient whose diagnosis has not been an easy one, as it showed multiple complications from a very early stage. CONCLUSIONS: The atypical onset of ATLL with acute pancreatitis is rarely reported. Its etiology seems to be hypercalcemia but pancreatic infiltration with ATLL cells cannot be ruled out. An attentive investigation of the peripheral blood sample and flow-cytometric tests of peripheral and medullar blood smear are very important for diagnosis. The patient showed from the very beginning severe neurological manifestations which developed to a coma. Causes could have been metabolic as well as CNS infiltration (as shown by the CT examination).

Arterial aging: a brief review.

Aging is associated with changes in arterial wall structure and function that exceed physiological adaptation, with an increased risk of cardiovascular events. The most consistent structural changes are luminal enlargement (dilatation), wall thickening (remodeling), and a reduction of elastic properties. Endothelial dysfunction plays an important role in the functional changes that occur with age. New target therapies to prevent or reverse this process are under evaluation.

Histopathological considerations of placenta in pregnancy with diabetes.

The authors present the results of a study on 19 cases of pregnant women with diabetes who delivered in No. 1 Clinic of Obstetrics and Gynecology, Emergency County Hospital of Craiova, between October 1st, 2009 and September 1st, 2011. After delivery, placentas were harvested for the pathology study. The results of this study reveal: villous immaturity, villous edema, presence of basement membrane thickening, congestion of capillaries called "chorangiosis", intra- and extravillous fibrinoid and a deposit of glycogen. The authors state that although these lesions are not pathognomonic for pregnancy with diabetes, they are very suggestive and specific for this association: diabetes-pregnancy.

Prognosis of colorectal cancer: clinical, pathological and therapeutic correlation.

INTRODUCTION: Significant progress in the knowledge of carcinogenesis and natural history of colorectal carcinoma (CRC), especially in polyp-cancer sequention and time for transition, are important prerequisites for a new approach to diagnosis. Surgical resection is the mainstay therapy for colorectal cancer, and pathologic assessment of the resected specimen provides data for assessment of outcome and rationale for adjuvant therapy. A pathology report includes TNM stage, tumor type, histologic grade, status of resection margins, and vascular invasion. AIM: The purpose of this paper was to highlight the pathological features and their correlations with postoperative evolution and prognosis of this cancer. PATIENTS AND METHODS: Data was collected using the database system of the Emergency County Hospital of Craiova, Romania. A total of 302 patients from January 2003 to December 2005 were included. RESULTS: The average survival for the entire group was 44.35 ± 28.94 months, and the D'Agostino-Pearson test for batch distribution showed abnormal distribution with two peaks, separated by a group of five patients who survived between 37 and 8 months. Fifty-one (38.05%) patients presented a median survival of 73.54 ± 10.47 months. CONCLUSIONS: Factors that contribute to a favorable prognosis in CRC are vegetant gross tumors and papillary microscopic forms, G1 and G2 degree of differentiation and disease diagnosed in stages I and II.

Whole-genome DASL gene expression profiling of hepatocellular carcinoma sub-populations isolated by laser microdissection on formalin-fixed and paraffin-embedded liver tissue samples.

In the last ten years, a multitude of studies focusing on gene expression profiling have attempted to shed light on the molecular and genomic mechanisms leading to hepatocarcinogenesis. One of the downsides of the technology available until recently was that it was limited to RNA extracted from fresh/frozen tissue or cell cultures. Recent advances have made it possible to obtain good quality RNA from formalin-fixed paraffin-embedded (FFPE) tissue, allowing access to a virtually limitless archival resource to be available for retrospective and long-term prospective clinico-pathological studies. Laser-capture microdissection allows the isolation of specific cell populations or of specific microscopic areas of interest from tissue samples. This allows the selective evaluation of gene expression of targeted cell clusters, especially in a very heterogeneous environment as the malignant tissue. In our study, we demonstrated that by laser microdissecting the areas of interest from FFPE tissue we could obtain gene expression signals by running the purified RNA through the Whole Genome DASL assay. A large number of genes were expressed in both subpopulations of hepatocellular carcinoma (classical HCC and cholangiocellular differentiation) as well as in the cirrhotic and non-cirrhotic liver background.

Correlations between intratumoral interstitial fibrillary network and tumoral architecture in prostatic adenocarcinoma.

The authors made a preliminary assessment of possible correlations between the amount of intratumoral stromal fibrillary components (ISFC) and the architectural tumoral patterns described by Gleason. The studied material consisted of samples obtained by transurethral resection from 34 patients diagnosed with prostatic adenocarcinoma. Ten fields, five for dominant and five for secondary identified patterns of each case, with no necrosis were selected randomly from Gömöri stained sections using ×20 objective. ISFC-ratio increased with Gleason pattern both for the entire group but also for "Necrotizing" phenotype patterns and "Solid" phenotype patterns, excepting the subtype "4A" where the stromal compartment was reduced by the expansion of tumoral ducts enlarged by growing tumoral intraductal cribriform masses. These preliminary data showed that stromal microenvironment try to adapt to the loss of tumoral differentiation by increasing the amount of fibrillary components of intratumoral stromal compartment.

Importance of early complex evaluation in high-risk pregnancy associated to diabetes mellitus. Case presentation and review of the literature.

We report and analyze a case of pregnancy associated with pre-existent diabetes mellitus and fetal congenital anomalies involving neural tube defect (NTD) and congenital heart defect (CHD). We discuss the early antenatal management of such high-risk pregnancies. The clinical course, maternal paraclinic profile and morpho-sonographic investigation of the fetus are described. A 28-year-old pregnant woman with pre-existing diabetes and a pre-pregnancy BMI 31 kg/m², without preconception counseling for optimization of glycemic control was evaluated in our center for first trimester genetic screening at 12 weeks of gestation. Considering a high-risk pregnancy, careful fetal morphological assessment by ultrasound was performed; the extensive examination using high-resolution probes, both by transabdominal and transvaginal approach, found hypoplastic left heart syndrome (HLHS) and open spina bifida (OSB). Both anomalies present important difficulties regarding first trimester diagnostic. The couple was informed and chose termination of pregnancy (TOP). We consider that an anomaly scan at 12-13 + 6 gestational weeks by expert operators should be offered to high-risk pregnancies, because it provides the chance to detect the majority of fetal anomalies. This offer for couples the option of an early decision about the management of pregnancy in cases of severe fetal anomalies; postnatal treatment could be discussed as well as TOP and if the latter is chosen, the maternal risk and the potential psychological burden are lowered, as compared with TOP performed in the mid-second trimester.

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.

Photodynamic diagnosis of non-muscle invasive bladder cancer using hexaminolevulinic acid.

UNLABELLED: Bladder cancer (BC) is the most common tumor of the urinary tract. White light cystoscopy (WLC) is currently considered the standard investigation for diagnosis of bladder tumors. Recent studies suggest that using exogenous fluorescence (photodynamic diagnosis, PDD) can improve its diagnostic sensitivity and specificity. OBJECTIVE: Our study aims to analyze the value of using fluorescent cystoscopy (PDD) in the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC). PATIENTS AND METHODS: The study designed as a prospective randomized clinical trial was conducted over a 12 months period and included 44 patients with primitive NMIBC diagnosed and treated in our department in 2009. Twenty-two patients were included in the study group (PDD), while 22 patients were diagnosed and treated by conventional methods (WLC). RESULTS: There were no statistically significant differences between the two groups regarding age, sex, place of origin, smoking history, clinical symptoms or presence of urological history as well as tumor size, location or number. Fluorescence cystoscopy examination identified 25.8% more tumors than the conventional examination (p=0.004). We demonstrated a significant reduction of tumor recurrence rates at 3, 6, 9 and 12 months by using PDD (HR=0.3271, 95% CI 0.1091-0.9809; p=0.0461). CONCLUSIONS: The use of PDD in patients with NMIBC results in significant improvement of the efficiency of their initial diagnosis cystoscopy (by over 25%). We demonstrated improved patient prognosis and quality of life following conservative TUR treatment of these tumors by significantly reducing the tumor recurrence rate (by 9-27%) in the first year of follow-up.

Genetic patterns of metalloproteinases and their tissular inhibitors - clinicopathologic and prognostic significance in colorectal cancer.

Colorectal cancer (CRC) is the third most common cancer in men and second in women. Progression and invasion of colorectal cancer is a multistep process involving multiple interactions between the tumor and the surrounding stroma mediated by many proteins, among them metalloproteinases (MMPs) and tissular inhibitors of metalloproteinases (TIMPs). We aimed to review the correlations between the expression of the MMPs and TIMPs genes and the clinicopathologic variables of the CRC. Levels of MMPs genes expression in colorectal cancer correlate with the depth of invasion, hematogenous and lymphatic metastasis, poor differentiation, Duke's stage and prognosis. Levels of TIMP's genes expression correlate with better prognosis and longer survival. There are also some controversial data explained by the fact that most of the studies addressed one or few MMPs and÷or TIMPs. The methods to assess the variance in gene expression were not always the same. The promoter regions of metalloproteinases present many polymorphisms and all have allele-specific effects on regulation of MMP gene transcription. Numerous studies on the association of these polymorphisms with cancer susceptibility have been carried out. Most of the studies addressed one or two polymorphisms and their implications. A meta-analysis is necessary to confirm significant correlations. The heterogenicity of the MMPs and TIMPs genetic patterns generated by different studies on colorectal cancer does not allow us to have an overall correlation with clinicopathologic variables and the prognosis of the disease. Studies that involve many MMPs, TIMPs polymorphisms and their tissular expression would be more valuable to better assess the role of those enzymes in the progression of the disease and may serve as a starting point for selective therapeutic approaches.

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.

The role of endoscopic examination accompanied by histological examination on biopsy samples in the diagnosis of gastric carcinoma.

INTRODUCTION: Endoscopic evaluation is one of the most important explorations in the diagnosis of gastric cancer, increasing its value by adding biopsy sampling and histopathologic examination, especially in early forms of gastric malignant proliferations. The aim of this study was to evaluate some descriptive parameters of macroscopic and microscopic aspects of gastric carcinomas defined with the help of endoscopic investigation and gastric biopsies sampled during endoscopic examination, and their correlation with patient survival. MATERIALS AND METHODS: The study was performed on a group of 119 patients diagnosed with gastric carcinoma. The study material was represented by: tissue fragments obtained by endoscopic biopsy, clinical observation charts, histopathologic diagnosis records, ledgers for records of endoscopic investigation, and endoscopic images recorded for each patient. Biopsies were taken preferentially from areas with the highest risk of malignancy. Tumor fragments were subjected to conventional histological processing techniques (fixation and inclusion in paraffin) and then were stained with HIM. The study included two chapters: the imagistic study and the pathologic study. The parameters assessed were: the site of the lesion within the stomach, the endoscope macroscopic appearance, the microscopic appearance of the endoscope biopsy sample, and the survival, followed up until 48 months. RESULTS: The most frequently observed macroscopic aspect was the fungating one, in more than two thirds of all cases, followed by the infiltrating one, but all with a poor survival - about 25-30% at 24 months. The most frequent location was the antro-pyloric region, with the highest survival rate of 25% at 24 months, followed by the gastric corpus and the lesser curvature. Most of the tumors were restricted to a single segment of the stomach. The most frequent microscopic aspect was the tubular one (75% of all cases) with its poorly differentiated variant (39 of the 91 cases). The 24 months survival was under 50% for all morphological types of carcinoma, with the lowest ones in the tubular and mucinous types (around 25%). The secretory pattern was identified on biopsy samples stained with HE in only 15% of the cases, and did not influence the survival of the patients. CONCLUSIONS: The combined histologic and endoscopic morphologic investigation allowed the shaping of an accurate morphologic and prognostic preoperative profile in gastric carcinomas.

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.

Preliminary study of bipolar hip prosthesis - influence of acetabular bone interactions on bone morphology.

Periprosthetic bone changes following hip arthroplasty are yet to be completely described. The material consisted of imagistic records (X-ray films, CT and MRI scans) and of acetabular bone tissue sampled from 14 cases with femoral head prosthesis and revision of the prosthesis fixed and decalcified in Duboscq-Brazil solution and stained with Hematoxylin and Eosin, trichrome van Gieson and trichrome Masson. Acetabular bone is home of a great variety of morphological changes that can be divided in degenerative and regenerative changes seen in both compact and trabecular components but only inside the maximal pressure area of the acetabular roof. Our preliminary morphological study revealed the existence of an adaptation effort to the mechanical stress materialized through a dynamic process of bone remodeling in the maximal pressure area.

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.

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.