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Open access

Chinezu Laura, Trouillas Jacqueline, Loghin Andrada and Borda Angela

Abstract

Introduction: The morphologic diagnosis of pituitary adenomas (PA) is based on immunohistochemistry (IHC). In Romania, IHC diagnosis of PA is restricted, all of the specific antibodies being very expensive. A histochemical staining, Herlant’s tetrachrome (HTCS), was described several years ago, but it was not widely used for diagnostic purposes because of technical difficulties. The aim of this paper is to bring into discussion this staining, to highlight its benefits, to improve the technical procedures and to establish a protocol, which combining both HTCS and IHC, facilitates the diagnosis of PA and, especially, substantially reduces the costs. Methods: HTCS was performed using normal pituitary glands. The optimal time of staining and the optimal concentration of different solutions were established for each step of the staining. Results: The improved technical procedure of HTCS is described. The staining features of all cellular types of the pituitary gland are depicted and illustrated: the chromophore cells, GH-secreting cells stained in orange, PRL-secreting cells in red-violet and ACTH-cells in dark blue, while cromophobe cells stained light blue. These staining features can be extrapolated to the diagnosis of PAs, as they consist of a proliferation of such cells. Conclusion: HTCS’s benefit is in functional PAs: it can identify GH, PRL, ACTH and TSH-adenomas, according to the cell type staining. A two-step diagnostic protocol is proposed, allowing the use of two, maximum three antibodies, instead of six: first step HTCS, and second step IHC

Open access

Călin Molnar, Octavian-Sabin Tătaru, Lucian Mărginean and Angela Borda

Abstract

Introduction: Renal cell carcinoma has a propensity to propagate into the renal vein and inferior vena cava. A small percentage has distant metastasis at presentation. Pulmonary, hepatic, cerebral and bone metastases are common, but skeletal muscle involvement is rare.

Case presentation: We present the case of a 51-year-old patient complaining of right flank pain, gross hematuria and a painful left laterothoracic mass. Preoperative examination revealed a tumor in the inferior pole of the right kidney, thrombosis of the right renal vein that extended into the inferior vena cava and a left laterothoracic tumor. We decided on a preoperative digital subtraction angiography and selected embolization of the laterothoracic mass. We performed right radical nephrectomy with vena cava thrombus excision and excision of the left laterothoracic tumor. The pathological examination revealed a clear cell renal carcinoma with sarcomatoid differentiation of the right kidney. Metastases with the above features were noticed in the right adrenal gland and in the skeletal muscle of the chest wall.

Conclusions: The surgical resection of large renal tumors with associated thrombus within the inferior vena cava is challenging to any surgeon. The preoperative embolization of the metastatic tumor is helpful in the reduction of pain and intraoperative blood loss.

Open access

Edith Dee, Andrada Loghin, Tamas Toth, Adrian Năznean and Angela Borda

Abstract

Introduction: Glomus tumors are rare benign mesenchymal neoplasms accounting for only 2% of all types of soft tissue tumors. Commonly located in the peripheral soft tissues, they are most frequently encountered in the subungual areas of fingers and toes, and very rarely in visceral organs due to the absence of glomus bodies. To date, 22 cases of primary renal glomus tumors have been described in the literature, of which 17 benign, with no evidence of recurrence or metastasis, three cases of malignant glomus tumor, and two cases with uncertain malignant potential. Case report: We report the 18th case of a benign glomus tumor of the kidney in a 49-year-old female patient, presenting the microscopic appearance (round, uniform cells with indistinct borders, scant finely granular eosinophilic cytoplasm, round nuclei lacking prominent nucleoli, arranged in solid sheets, accompanied by slit-like vascular spaces), the immunohistochemical profile (tumor cells showed immunoreactivity for smooth muscle actin, vimentin, as well as for CD34; they were negative for AE1/AE3, desmin, HMB-45, S-100 protein, renin, and chromogranin), and the differential diagnosis of this rare entity (juxtaglomerular tumor, angiomyolipoma, hemangioma, epithelioid leyomioma, solitary fibrous tumor, carcinoid tumor, and paraganglioma). Conclusion: Primary renal glomus tumors are rare tumors that radiologically can mimic other mesenchymal renal neoplasm. Accurate diagnosis is based on the microscopic appearance and especially the characteristic immunophenotype.

Open access

K.-Ivácson A. Csinszka, Monea Monica, Pop Mihai, Albu-Stan Aurita and Borda Angela

Abstract

The purpose of this study was to determine the prevalence of rubber dam usage among endodontists, other specialized practitioners, general practitioners and undergraduate final year students in Tirgu-Mures, Romania.

Material and method: A questionnaire was distributed among 250 subjects. Final year students and dentists were surveyed in relation to their prevalence of rubber dam usage.

Results: Overall response rate was 72,4. While 84,07% of the subjects knew about the advantages, only 49,72% used it during their practice, mostly endodontist (90%) and other specialized practitioners (53,84%). The use of this system on pediatric patients was lower compared to adult patients. The frequency of the rubber dam usage during endodontic treatment was higher (71,11 %) compared to dental restorations (35,55%), and 84,49% of the subjects were are willing to gain further knowledge about this system.

Conclusions: The results were similar to other reports originally from Eastern-European countries. The low percentage of the rubber dam usage presents quality issues, safety and medico-legal concerns for both the patient and the dentist. Greater emphasis should be placed on the advantages of rubber dam. Perception of final year dental students needs to be improved and continuing dental education for practitioners should be necessary to update their knowledge.

Open access

I.A. Nechifor-Boilă, Angela Borda, Andrada Loghin, Adela Nechifor-Boilă and C. Chibelean

Abstract

Objective: Diffusion Weighted Imaging (DWI) is the main sequence in the multiparametric prostate MRI protocol together with T2 and dynamic contrast-enhanced T1, leading to detection rates up to 60% in prostate cancer diagnosis. However, the use of intravenous contrast can have severe side-effects, making the use of unenhanced MRI sequences essential. The aim of our study was to assess the feasibility and efficiency of DWI as a standalone MRI technique for prostate cancer diagnosis. Methods: We performed a prospective cohort study at our department (09.2014-05.2015) and formed a study lot consisting in five prostate cancer patients that were scheduled for radical prostatectomy. Multiparametric MRI was performed (with DWI and T2 sequences) and the images were interpreted according to the PI-RADS system. The final histopathological result after prostatectomy served as gold standard. Results: A series of 9 lesions were detected and analyzed on DWI. At qualitative interpretation, DWI had a sensitivity of 85.7% and a specificity of 50%. The corresponding positive and negative likelihood ratios were 1.71 and 0.286, respectively (p=0.417). ADC analysis revealed a mean value of 1.2*10-3mm2/s for the benign lesions while the corresponding value was 0.8*10-3 for the malignant ones, regardless of tumor size and Gleason scoring. Conclusion: DWI is a feasible technique in the current clinical environment, with a good sensitivity and a medium specificity. Furthermore, an association to the anatomical T2 sequence could enhance the diagnostic efficiency of DWI and should be assessed in larger studies.

Open access

K.-Ivácson A.- Csinszka, Monea Adriana Maria, Monea Monica, Pop Mihai and Borda Angela

Abstract

Crown or root perforation, ledge formation, fractured instruments and perforation of the roots are the most important accidents which appear during endodontic therapy. Our objective was to evaluate the value of digital intraoral periapical radiographs compared to cone beam computed tomography images (CBCT) used to diagnose some procedural accidents. Material and methods: Eleven extracted molars were used in this study. A total of 18 perforations and 13 ledges were created artifically and 10 instruments were fractured in the root canals. Digital intraoral periapical radiographs from two angles and CBCT scans were made with the teeth fixed in position. The images were evaluated and the number of detected accidents were stated in percentages. Statistical analysis was performed using the chi square-test. Results: On digital periapical radiographs the evaluators identified 12 (66.66%) perforations, 10 (100 %) separated instruments and 10 (76.9%) created ledges. The CBCT scans made possible the recognition of 17 (94.66 %) perforations, 9 (90 %) separated instruments and 13 (100%) ledges. The totally recognized accidental procedures showed significant differences between the two groups. (p<0.05) Conclusion: Digital periapical radiographs are the most common imaging modalities used during endodontic treatments. Though, the CBCT allows a better identification of the procedural accidents.

Open access

Adela Nechifor-Boilă, Edit Dee and Angela Borda

Abstract

Introduction. The encapsulated, non-invasive subtype of follicular variant of papillary thyroid carcinoma (FVPTC) represents approximately 10% to 20% of all thyroid cancers. Many studies over the past decade have shown that these tumors carry an indolent clinical course, with no recurrence, even in patients treated by lobectomy. Their reclassification as neoplasms with “very low malignant potential” has recently been suggested by an international group of experts and a new terminology was proposed: “non-invasive follicular thyroid neoplasm with papillary-like nuclear features” (NIFTP). However, a diagnosis of NIFTP is still challenging for many pathologists in daily practice. Presentation of case series. By presenting six illustrative cases of NIFTP, this article aims to highlight the diagnostic criteria and the burden difficulties when dealing with NIFTP cases. Characteristic histological features, inclusion and exclusion criteria for NIFTP, as well as sampling guidelines and differential diagnosis challenges are all discussed. Conclusions. The diagnosis of NIFTP is not straightforward and requires meeting strict inclusion and exclusion criteria. Total sampling of the tumor capsule in these cases is mandatory in order to exclude invasion (capsular and/or vascular). A diagnosis of NIFTP promotes a less-aggressive patient management that is, no need for completion thyroidectomy or radioactive iodine therapy.

Open access

Radu-Alexandru Prișcă, Andrada Loghin, Horea-Gheorghe Gozar, Cosmin Moldovan, Tekla Mosó, Zoltán Derzsi and Angela Borda

Abstract

Objective: The mechanism by which the ureter propels urine towards the bladder has a myogenic origin, through peristaltic contractions. This pyeloureteral autorhythmicity is generated by specialized, electrically active cells, the interstitial cells of Cajal, located in the proximal regions of the upper urinary tract. The aim of this study was to describe the exact location and the distribution of interstitial Cajal cells in the human upper urinary tract and to analyze their normal number and morphology. This is a preliminary study, which will allow the study of these cells in different urinary tract pathologies.

Material and Method: Urinary tract fragments were sampled at different levels, from 13 autopsy cases. Cases with clinical evidence of renal disease, and with histological changes in the kidney or in the urinary tract tissue samples, visible in hematoxylin-eosin staining, were excluded. The interstitial Cajal cells were highlighted with anti-CD117 antibody, immunohistochemically.

Results: Cajal cells were indirectly highlighted by the presence of a finely granulated cytoplasm indicating immunoreactivity. These cells were spindle-shaped or stellate, with cytoplasmic extensions at one or both poles of the cell and large oval nucleus. We found that interstitial Cajal cells were located at all upper urinary tract levels, with a higher predominance in the calyces and pyelon. Interstitial Cajal cells were observed mostly between the two layers of the muscularis, but also between the muscle bundles. Most often, these cells were parallel to the muscle fibers.

Conclusion: Our study describes the method of detection of interstitial Cajal cells in normal human urinary tract. These results can be used to analyze the number, morphology and the location of these cells in different congenital pathologies, such as vesicoureteral reflux, pyeloureteral junction obstruction or primary obstructive megaureter.

Open access

IA Nechifor-Boila, H Suciu, Loghin Andrada, Borda Angela, A Maier, Martha Orsolya and C Chibelean

Abstract

Surgery for renal cell carcinomas with tumor thrombus extending in the Inferior Vena Cava (IVC) can be particularly challenging, especially in the retrohepatic and intraatrial situations (T3b and T3c). Classically, these tumors require the intraoperative use of cardio-pulmonary by-pass (CPB) and deep hypothermic circulatory arrest (DHCA), that can result in specific complications (stroke, platelet dysfunction), with increased postoperative morbidity rates.

In urological practice, a particular IVC preparation method is currently in use, allowing full control both upon the IVC and its tributaries. It is derived from the “piggy-back” liver transplantation technique and implies the resection of all hepatic ligaments, leaving the hepatic vascular connections intact. This procedure is joined by a form of veno-venous bypass (between the right atrium and the infrarenal IVC) that allows a constant central venous pressure (by assuring blood return), with less bleeding and without the need for CPB and DHCA (avoiding, in this way, their inherent complications). All in all, these recently-introduced procedures can offer better thrombus control, improved oncologic outcomes and smaller complication rates. We aim to present a case of borderline T3b/T3c renal tumor that was successfully treated in our university center using these techniques.

Open access

Fülöp Emöke, Marcu Simona Tünde, Borda Angela, Voidăzan Septimiu, EF Fülöp, M Ciorba and Mocan Simona

Abstract

Background and Aims. Gastric cancer, because of its aggressive evolution and the high mortality associated with it, remains one of the most debated subjects in medical literature with Helicobacter pylori (HP) as a major risk factor. Chronic inflammation caused by HP infection represents the initial site of the predisposing and afterwards premalignant lesions for gastric carcinoma. The purpose of this study was to evaluate the prevalence of HP infection, of predisposing and premalignant lesions on gastric biopsies, as well as to identify the correlations between them.

Material and method. A retrospective cross-sectional study was performed on gastric biopsies collected endoscopically from a single region, antrum or corpus, and from different regions, between January 2012 and July 2014. Incidence of HP infection, of predisposing and premalignant gastric lesions, the correlation of HP infection and these lesions, were evaluated.

Results. HP infection was diagnosed in 32.81%. Predisposing and premalignant lesions were present in 53.64% of biopsies with most of them in the antrum. HP infection stands out for the under 50 yo group (p=0.001). No correlation between frequency of HP infection and predisposing and premalignant lesions was observed.

Conclusions. Prevalence of HP infection in our study suggests that besides HP infection, other factors are also involved in gastric cancer development. Biopsies from different regions of the gastric mucosa do not offer extra information regarding HP infection prevalence but may be helpful in evaluating incidence and extension of predisposing and premalignant lesions.