Romanian Journal of Morphology and Embryology最新文献

Although inflammatory bowel disease (IBD) and colorectal polyps are considered as significant risk factors of colorectal cancer (CRC), the molecular mechanism associated with colorectal carcinogenesis is still explored. Unlike sporadic CRC, local persistent inflammation in IBD induces genetic and epigenetic alterations, leading to tumor development. Moreover, cumulative data indicate that colorectal polyps display a significant malignant potential. In this context, our study aimed to investigate the clinicopathological features of CRC associated with IBD and/or colorectal neoplastic polyps in a retrospective group of CRC cases. The clinical data and histopathological features of CRC cases have been collected from our files. Immunohistochemical examination of mismatch repair (MMR) proteins has been performed in a selected case. The study group comprised 40 patients, 72.5% men and 27.5% women, with a median age of 64.73±9.09 years. Out of the cases with double association, 62.5% of CRC cases displayed colorectal polyps, while 32.5% of patients were diagnosed with both CRC and IBD, which encompassed both ulcerative colitis (UC) and Crohn's disease (CD). Two patients included in our study group exhibited a triple association of IBD, colorectal polyps, and CRC, one of them showing defective MMR (dMMR) phenotype. Although our results provide significant data on the relationship between IBD, colorectal polyps, and colorectal carcinogenesis, future cohort studies are needed to improve our understanding on the complex mechanism of colorectal carcinogenesis, ultimately guiding improved prevention, diagnosis, and treatment strategies for these patients.

Cholesteatoma is an otologic pathology that can occur at any age and can lead to a variety of complications including facial palsy, intracranial abscess, hearing loss, venous thrombosis. Cholesteatoma, even if considered a benign condition, associates high risks of recurrency due to its invasiveness. We describe a case of recurrent cholesteatoma in a young boy who presented chronic ear discharge and hearing loss for which had undergone three surgical interventions between the ages of 16 and 19 years old, from 2019 to 2022. Pediatric cholesteatoma is more prone to recurrency. Considering surgical excision as the only treatment at the current moment, it is highly important to understand the biology of cholesteatoma lesional extension for further treatment management improvement. Good research of angiogenesis, chronic inflammation and immune infiltration correlated with surgical approach may be the future for preventing cholesteatoma recurrency.

The discovery of a cervical mass in children is a situation quite frequently encountered and often represents a diagnostic or therapeutic challenge for the practicing physician. Although approximately 12% to 15% of all neck masses (NMs) in children may be malignant, most commonly these masses are benign. This study included 137 patients aged between 14 months and 18 years old, with the majority (54.01%) of patients being less than five years old. A total of 83 (60.58%) patients were presented with a single NM, with 64 (59.12%) patients having mass located on the midline of the neck. Preoperatively, in addition to laboratory tests, imaging examinations played an important role in diagnostic orientation and determining the therapeutic plan. Among the imaging examinations, ultrasound was the most commonly used, performed in 87 (63.5%) of the patients. The definitive diagnosis was established based on the histopathological examination of the excised specimens. Midline NMs were most frequently thyroglossal duct cysts or dermoid cysts, while lateral NMs were often lymphadenitis or branchial cysts. The aim of this study was to present the experience of 10 years in evaluating cervical masses in the neck area that appeared in children, their possible causes, the methods of investigation (considering the contribution and limitations of each diagnostic method), and the therapeutic approach (since there is no clear standardization of treatment in the literature).

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection spread rapidly from China around the world, causing the worst pandemic since the beginning of the 21st century. Although the disease named coronavirus disease 2019 (COVID-19) has multiple organ symptoms, the main pathological lesions occur in the lung, causing respiratory failure, pulmonary embolism, secondary bacterial pneumonia and pulmonary fibrosis. Despite the best efforts of researchers, the pathogenesis of SARS-CoV-2-induced cellular and tissue damage in organs and systems is poorly understood. Therefore, in our study, we aimed to highlight the pulmonary lesions and their extent, which could explain the complex symptomatology presented by patients who died with acute respiratory distress syndrome (ARDS). The study was performed on a number of 36 patients diagnosed with COVID-19 who died under legally suspicious conditions, requiring autopsy within the Romanian Forensic Medicine Institutes. All patients presented a local inflammatory reaction of pneumonic type, with exudative and proliferative phenomena, with intra-alveolar and interstitial inflammatory infiltrates formed by lymphocytes, macrophages and neutrophilic granulocytes, with congested or ruptured blood vessels with intra-alveolar or interstitial hemorrhages, with multiple thrombosis, with proliferation of local fibroblasts transformed into myofibroblasts and presence of granulation tissue that remodeled the entire lung parenchyma.

Non-alcoholic fatty liver disease (NAFLD) has emerged as a silent global epidemic, frequently contributing to systemic inflammation. As the primary immune cells of the central nervous system (CNS), microglia undergo morphological changes that serve as critical indicators of CNS health. In this study, we aimed to quantify alterations in microglial morphology within the cortex of young and aged mice with liver damage. Our results demonstrated that hepatic dysfunction leads to a significant increase in total branch length in both young (285.79±68.23 μm) and aged animals (268.67±69.06 μm), compared to their respective controls (164.07±33.05 μm and 140.96±27.18 μm) (p<0.0001). Additionally, aged animals with liver damage exhibited a mean branch length of 5.84±0.66 μm, higher than 2.63±0.19 μm observed in those without liver injury. The number of primary branches in aged mice with liver damage decreased from 6.6±1.2 branches to 3.1±1.5 (p<0.0001). In addition, we have shown a decrease in the number of secondary branches in aged animals with liver damage. This suggests that microglia not only respond to CNS-specific injuries but also to chronic systemic pathologies like NAFLD. These findings highlight the importance of better understanding the liver-brain axis in order to better understand the neuroimmune consequences of systemic diseases.

Osteosarcoma (OS) is the most prevalent primary bone malignancy, predominantly affecting adolescents and young adults, and presents significant clinical challenges due to its aggressive nature and high potential for metastasis. This retrospective study analyzed 34 cases of primary OS, aged 10 to 65 years, to identify clinicopathological correlations that could inform future research and treatment strategies. The findings aim to guide larger cohort studies, essential for validating these correlations and developing tailored approaches that enhance patient outcomes. The analysis focused on demographic factors, sex, tumor grade, stage, size, and histological subtype, utilizing criteria established by the American Joint Committee on Cancer (AJCC) and the World Health Organization (WHO). The results revealed a predominance of the disease in males under 25 years of age, with the femur being the most common site of occurrence. Conventional osteoblastic OS emerged as the most frequent subtype, accounting for 50% of the cases, predominantly presenting as high-grade (G3) tumors. Over 70% of the tumors were T1 in extension (≤8 cm) and classified as stage IIA, indicating a locally advanced disease state. Correlations were observed between histological type, grade, and stage, underscoring the importance of detailed histopathological (HP) assessments in determining prognosis and guiding treatment. The findings highlight correlations between histological subtype, grade, and stage, reaffirming the critical role of detailed HP assessments in prognosis and treatment planning. While the limited sample size necessitates cautious interpretation, this study provides valuable regional and age-specific insights that could inform clinical decision-making. Future research should prioritize multi-center studies and delve into the genetic and molecular underpinnings of OS subtypes to enhance understanding and develop targeted therapies.

Castleman disease (CD) is a group of lymphoproliferative disorders characterized by abnormal enlargement of lymph nodes (LNs) and a wide range of symptoms. Only a few cases are found in the head and neck. Based on clinical presentation and evolution, the disease can be classified into two main subtypes: unicentric CD (UCD), characterized by the enlargement of a single LN or a single LN chain, and multicentric CD (MCD), characterized by the involvement of multiple LNs and regions, with more important systemic symptoms and a poor prognosis. CD is also known as "the great mimicker" and can be easily misdiagnosed, sharing similar clinical and imaging characteristics with other pathologies, mainly when it is found in the neck. A histopathological (HP) and immunohistochemical (IHC) correlation is essential in these cases to accurately diagnose and establish the proper treatment plan. In light of this, we present a rare case of a 15-year-old young female with a slowly expanding, isolated supraclavicular mass. An excisional biopsy was performed, and the results confirmed the presence of CD, hyaline-vascular type. As of this writing, there was no evidence of recurrence or new enlarged LNs. We also review CD's clinical and HP features and the diagnostic and treatment challenges it poses.

Lipoprotein (a) [Lp(a)] is a recognized independent cardiovascular (CV) risk factor with significant implications in the morphopathology of atherosclerotic plaques, particularly in the context of myocardial infarction (MI). Structurally, Lp(a) consists of a low-density lipoprotein (LDL) particle covalently bound to apolipoprotein A (ApoA), and its resemblance to plasminogen (PLG) underpins its dual proatherogenic and prothrombotic effects. Elevated Lp(a) levels disrupt endothelial repair mechanisms, enhance the deposition of oxidized LDL, and promote foam cell formation, which are critical for the initiation and progression of atherosclerosis. Pathologically, atherosclerotic plaques associated with Lp(a) display hallmark features of instability, including thin fibrous caps, increased macrophage infiltration, calcification, and fragile neovascularization. These features contribute to plaque ruptures and thrombotic complications. Additionally, the structural similarity of Lp(a) to PLG interferes with fibrinolysis, creating a prothrombotic environment that exacerbates the risk of acute ischemic events. Genetic and non-genetic factors influence plasma Lp(a) concentrations, with significant inter-individual and ethnic variability contributing to varying CV risk profiles. Despite advancements in the understanding of the pathophysiological role of Lp(a), effective therapeutic options remain limited. Current management focuses on mitigating traditional CV risk factors, while emerging therapies, such as antisense oligonucleotides and short interfering ribonucleic acid (siRNA) targeting hepatic ApoA production, offer promising avenues for reducing Lp(a) levels. Further clinical validation of these therapies is warranted. This review underscores the importance of incorporating Lp(a) measurement into routine CV risk assessment and emphasizes the need for continued research on its morphopathological impacts and therapeutic modulation, with the aim of reducing the burden of atherosclerosis and MI.

Toxic epidermal necrolysis (TEN) is a serious dermatological condition often triggered by different drugs or medications or, less commonly, by infections, leading to extensive epidermal detachment and multisystemic complications, resembling the severity and systemic impact of burn injuries. This case report portrays a 26-year-old female patient with a history of psychiatric treatment and recreational drug use, presenting with typical prodromal symptoms and characteristic manifestations on the integument and mucosae. Clinical management involved an interdisciplinary team in a burn center, administering immunoglobulins, systemic steroids, and supportive therapies to prevent complications including infection and to support skin re-epithelization. Histopathological findings confirmed the diagnosis. Despite the extensive lesions, prompt treatment facilitated a positive outcome. The report emphasizes the necessity of referral to specialized centers and the complex, multidisciplinary management required for TEN patients to optimize survival and minimize long-term sequelae.

Nasal polyps develop as a result of inflammation of the nasal and sinus mucosa. Allergies and nasal infections cause inflammation, and these are the main reasons why these symptoms appear in the first place. This study highlights the involvement of macrophages, as well as T- and B-lymphocytes, in the pathophysiology of nasal polyps. For the evaluation of lymphocyte activity, we analyzed the immunoexpression of cluster of differentiation 45RO [CD45RO; common leukocyte antigen (CLA)] and for macrophages we analyzed the immunoexpression of cluster of differentiation 68 (CD68). Our research, conducted on 110 sinonasal polyps harvested from chronic rhinosinusitis patients with nasal polyps, focused on analyzing both the epithelial and stromal compartments in relation to pre-established composite scores. Additionally, specific histopathological parameters were included in the study. We concluded that the inflammatory cells were more prevalent in the stromal compartment compared to the epithelial compartment. The statistical evaluation of CD45RO (CLA) and CD68 scores in the stromal compartment were also associated with high histological composite scores.