Arkhiv patologii最新文献

The literature review presents an analysis of the pathogenesis and pathological anatomy of liver damage in COVID-19. Liver damage with the steatosis, vascular disorders, mild portal and lobular inflammatory infiltration, cholestasis and clinically - liver failure is observed in majority of the patients with COVID-19. Chronic liver diseases with infection SARS-CoV-2 tend to decompensate, which significantly worsens the prognosis of the disease. Pathogenesis of liver damage in COVID19 is unclear. There was no convincing evidence for the hypothesis of cytotoxicity for hepatocytes or cholangiocytes by SARS-CoV-2. Similar liver morphological changes described by different authors suggest their nonspecific nature and multifactorial pathogenesis related to hypoxia, cytokin storm, systemic inflammatory response syndrome, sepsis and shock, Covid-associated angio- and coagulopathy, as well as drug-induced hepatotoxicity. Further research is needed to clarify the pathogenesis and pathological anatomy of the liver pathology in COVID-19.

Objective: To study the pathomorphological changes in eyes that underwent secondary enucleation following various types of organ-preserving treatments for choroidal melanoma (CM).

Material and methods: The study included 22 enucleated eyes with CM. Secondary enucleation was performed between 2 and 120 months after isolated and combined brachytherapy with Ru-106 and Rh-106 radioisotopes, proton therapy, and Gamma Knife treatment. The reasons for enucleation included progressive tumor growth in 12 patients and complications in 10 patients. Pathomorphological examinations were conducted at the National Center for Clinical Morphological Diagnostics, Saint Petersburg.

Results: The majority of the enucleated eyes showed spindle-cell tumors with varying degrees of pigmentation, scleral invasion (95.5%), Bruch's membrane rupture (90.5%), peri- and intratumoral lymphocytic infiltration (85.7%), signs of perineural invasion (22.7%), and involvement of the optic nerve in the tumor process (28.6%). In the study group, signs of vascular invasion in the tumor parenchyma were observed in only 4.8% of the enucleated eyes. Therapeutic pathomorphosis was evaluated according to Mandard et al. (1994), where TRG4 (60.0%) was frequently diagnosed, and Becker et al. (2003), where TRG3 (65.0%) predominated. The mitotic activity ranged from 1.0 to 5.0 mitoses per 1 mm², with an average of 1.6±1.5.

Conclusions: The presence of viable tumor cells and their mitotic activity, regardless of the organ-preserving treatment, reflects the absence of the so-called "devitalization" of the tumor and determines the high risk of continued tumor growth and its possible metastasis.

There is no consolidated opinion on the pathogenesis of neurological manifestations of COVID-19, especially after infection. A significant contribution to understanding the mechanisms of neuropathology in COVID-19 can be made by detailed morphologic studies of the brain with assessment of changes in different brain regions during different periods of the infection process.

Objective: Clarification of the nature of brain morphologic changes and intracerebral virus invasion in COVID-19 and postinfection.

Material and methods: The study included 15 patients who died during the acute phase of COVID-19 (11 people) or after an infection (4 people) without a history of acute focal changes in the brain or neurological diseases. In each case, 9 brain areas were assessed, including the cortex, hippocampus, brainstem (pons and medulla oblongata), cerebellum, basal ganglia, and central parts of the olfactory system. In addition to the histological study, an immunohistochemical study was performed using antibodies against CD8, Iba1, as well as SARS-CoV-2 proteins (S1 and N) and a semi-quantitative assessment of circulatory disorders, microglial reaction and expression of the SARS-CoV-2 S1 protein in the brain.

Results: The neuropathological picture was similar in the acute and post-infectious phases of COVID-19: microcirculatory disorders, diffuse cerebral edema, ischemic-hypoxic neuronal changes, accumulations of corpora amylacea, gliosis, small mainly perivascular lymphocytic infiltrates with a predominance of CD8⁺ T cells, moderate microglial reaction, accumulation of SARS-CoV-2 S1 protein in the brain. The N protein of the virus was not detected in the brain. The most pronounced changes were observed in the brainstem, especially in the medulla oblongata, and the cerebellum. The severity of structural changes did not correlate with disease duration. S1 protein expression in the brain did not correlate with the severity of the microglial response or disease duration.

Conclusion: The identified neuropathological changes in COVID-19 in the acute and post-infectious phases are nonspecific with a predominance of vascular disorders and microglial reaction and are most pronounced in the brain stem and cerebellum. The SARS-CoV-2 S1 protein can accumulate in neurons and be detected in the brain a year or more after infection.

Lymphangioleiomyomatosis (LAM) is a mesenchymal tumor included in PEComa family. Lung is the most frequent localization of LAM where it has bilateral spread and leads to respiratory failure. Development of LAM can be provided by tuberous sclerosis or it can be of sporadic nature. Extrapulmonary LAM usually develops in posterior mediastinal, retroperitoneal and pelvic lymph nodes. It is intriguing that primary nodal LAM, developed in the absence of pulmonary LAM, encounters relatively rare and discovers incidentally. Despite the well-known relationship of pulmonary LAM with tuberous sclerosis and occurrence of the tumor in young female patients, clinically occult LAM lesions can be encountered in wide age range and usually these aren't associated with tuberous sclerosis. Prognostic significance of incidentally found nodal LAM is still under debate as well as probability of metachronous lung involvement. Here we present small case series of accidentally discovered LAM in retroperitoneal and pelvic lymph nodes of four female patients.

Lung cancer occupies a leading position among malignant neoplasms throughout the world, and the issue of carcinogenesis of this disease today still remains relevant. This review examines in detail the issue of the participation of cancer stem cells in the development of lung cancer, the concept of the stem cell niche, and options for their detection using molecular and immunohistochemical studies. A separate section examines the impact of the new coronavirus infection COVID-19 on CSC and lung cancer carcinogenesis in general, as well as the successful results of the use of photodynamic therapy in the treatment of both diseases.

Donat Semenovich Sarkisov was born in Moscow on September 5, 1924. In the summer of 1942 D.S. Sarkisov was drafted into the army and sent to the Naval Medical Academy (VMMA), from which he graduated in 1947. Thus began his path in medicine, which lasted about 60 years.

New coronavirus infection is registered less frequently in children than in adults. Among all patients with COVID-19, the share of children is 8.6%. Clinical practice shows that in children, COVID-19 can be severe and even fatal. Articles have been published reflecting the clinical manifestations of Long Covid in children, while data on pathomorphological examination of the lungs during long-term COVID-19 in children are not available in the literature. On the basis of the Department of Pathological Anatomy with a course of Forensic Medicine and the Pathological-Anatomical Department of the Clinic of St. Petersburg State Pediatric Medical University, an analysis of medical documentation was carried out, autopsy materials were selected from 3 observations of the death of children from COVID-19. The selection criterion was the duration of the disease. A histological examination using standard methods and IHC analysis using antibodies to the nucleocapsid of SARS-Cov-2, CD95, CD31 were carried out on the lung tissue of 3 children aged 2 months to 2 years who died from a new coronavirus infection. Microscopically, all three patients showed microvessels damage, their thrombosis, angiogenesis, as well as signs of diffuse alveolar damage The combination of expression of the SARS-CoV-2 nucleocapsid and the apoptosis marker on the vascular endothelium of the MCR is of interest.

Conclusion: The data obtained indicate infection with coronavirus and death of endothelial cells due to apoptosis. Endothelial damage in the microvessels of the lungs is the initiating factor in the development of capillary-alveolar block, tissue hypoxia, and disseminated intravascular coagulation syndrome, leading in some cases to respiratory/multiple organ failure and death.

Vasoproliferative retinal tumor (VPT) is a term proposed by ophthalmologists in relation to the totality of manifestations of an intraocular volumetric process with involvement of the inner lining of the eye, an integral part of which is the active growth of blood vessels. The available literature data on the morphology of this process are very contradictory and ambiguous. The article presents two clinical cases of vasoproliferative retinal tumor with own illustration of morphological studies.

Ippolit Vasilyevich Davydovsky was born in 1887 in Danilov, Yaroslavl province, into the family of a clergyman. He received his primary education in a parochial church school. After I.V. Davydovsky's family moved to Yaroslavl, he continued his education in a men's gymnasium. Having successfully graduated from the gymnasium, I.V. Davydovsky in 1905 entered the medical faculty of Moscow State University, where he studied and was influenced by Acad. A.I. Abrikosov formed his first scientific interests. After graduating from the university in 1910, I.V. Davydovsky worked as a sanitary doctor and then as a zemstvo doctor. In 1912. I.V. Davydovsky received the title of Doctor of Medicine and a year later became a prozektor of the Yauza Hospital, which today bears his name. At this time, under the influence of Prof. M.N. Nikiforov, I.V. Davydovsky began to be interested in infectious pathology, which was later reflected in a number of his scientific works on typhus, paratyphus, dysentery and other infectious diseases.

Cardiac myxoma in its morphology is a typical benign tumor, meanwhile, the fact of its localization in the heart chamber, directly in the constant blood flow, largely determines the clinical behavior of this neoplasm, which is often manifested by the development of characteristics that formally determine the aggressive and even malignant nature of the course. Accordingly, the malignancy of cardiac myxoma is determined more by its clinical behavior (recurrence, multifocality of the lesion, the presence of mechanisms of spread similar to metastasis) rather than by its histological picture. In the structure of primary benign tumors of the heart, myxoma occupies a dominant position and its incidence is up to 85%. According to some authors, the tumor develops from multipotent mesenchymal stem cells of the endocardium, mainly in the area of the fossa ovale, while according to others the histogenesis of the tumor remains unclear. The obligate morphology element is the myxoma cell. The presence of so-called "ring" structures is special, regular and highly specific, and Gamna - Gandy bodies, foci of calcification and superficial thrombosis are considered characteristic secondary destructive morphological signs. The review describes the morphology features, specific clinical manifestations, immunohistochemical parameters of cardiac myxoma, and presents information available in the literature on the mechanisms of tumor spread (metastasis).