Vol. 55 No. 2, April-June 2014

1. Histopathology of the nail unit

Angel Fernandez-Flores, Marcela Saeb-Lima, Alfonso Martinez-Nova

In this report, we review several inflammatory infectious and tumoral conditions of the nail unit. We emphasize the anatomic peculiarities of such pathologies of the nail unit and provide some required diagnostic criteria.

Corresponding author: Angel Fernandez-Flores, MD, PhD; e-mail:

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2. Ocular cells and light: harmony or conflict?

Sanda Jurja, Mihaela Hincu, Mihaela Amelia Dobrescu, Andreea Elena Golu, Andrei Theodor Balasoiu, Malina Coman

Vision is based on the sensitivity of the eye to visible rays of the solar spectrum, which allows the recording and transfer of visual information by photoelectric reaction. Any electromagnetic radiation, if sufficiently intense, may cause damages in living tissues. In a changing environment, the aim of this paper is to point out the impact of light radiation on ocular cells, with its phototoxicity potential on eye tissues. In fact, faced with light and oxygen, the eye behaves like an ephemeral aggregate of unstable molecules, like a temporary crystallization threatened with entropia.

Corresponding author: Sanda Jurja, MD; e-mail:

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3. Expression of p53, D2-40 and alpha-smooth muscle actin in different histological subtypes of facial basal cell carcinoma

Razvan Mercut, Marius Eugen Ciurea, Claudiu Margaritescu, Sanda Mihaela Popescu, Monica Mihaela Craitoiu, Ovidiu Simion Cotoi, Doina Carina Voinescu

Although, generally BCC growths slowly and is minimally invasive, tumors developed in the head and neck region behave more aggressively with deep tissue invasion, recurrence and even local or distant metastases, causing significant morbidity or mortality. Recently, numerous studies have been conducted in order to identify new prognostic markers of BCC aggressiveness, but the results are not consistent. Thus, we were interested here in the immunohistochemical investigation of p53, D2-40 and alpha-SMA expression in the aggressive forms (eight infiltrative-morpheaform, six micronodular and six metatypical cases) versus superficial facial BCCs (five cases). As results, we first noticed that p53, D2-40 and alpha-SMA expression varied between different types of investigated BCCs. The highest reactivity was observed in metatypical subtype for the D2-40. p53 was mainly expressed in the micronodular BCC subtype and on overall, the tumor reactivity to this marker correlated directly with the reactivity for the other two used biomarkers. The infiltrative-morpheaform facial BCCs were peculiar more reactive to alpha-SMA. For all three investigated markers, regardless the histological subtype, the tumor reactivity was higher at the advancing edge, and in addition, at this level we noticed a D2-40 and alpha-SMA stromal reactivity for some cases of the more aggressive BCC subtype (peculiar in metatypical subtype). Thus, we concluded that in order to identify the most aggressive forms of facial BCCs it is useful to investigate these three markers, and this is even more important as they can all constitute therapeutic targets.

Corresponding author: Claudiu Margaritescu, Associate Professor, MD, PhD; e-mail:

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4. A morphometric approach in breast cytology - geometrical descriptors in the differentiation between benign and malignant lesions

Daniela Mihalache, Simona Eliza Giusca, Raluca Balan, Cornelia Amalinei, Adriana Grigoras, Irina-Draga Caruntu

This study focuses on the analysis of geometric descriptors that can be applied in breast cytology, and their correlation with the qualitative features, with the aim to underline the differences between the benign and malignant cell profile. The morphometric investigation was performed on smears obtained by fine needle aspiration, 10 cases (group 1) diagnosed as benign and 10 cases (group 2) as malignant. For group 2, the malignancy was histopathologically confirmed on the surgical resection specimen. The sequence of automated operation, previously reported by us, permitted the extraction of the following geometrical descriptors: cytoplasmic area, nuclear area, nucleo-cytoplasmic ratio, equivalent diameter and form factor. We analyzed the differences between the benign and malignant morphometric features, and the correlation between the malignant morphometric features and cytological, respectively histological grading. Statistically significant difference in cytoplasmic areas, nuclear areas, value of nucleo-cytoplasmic ratio and equivalent diameter was noted between group I and II. For the form factor, we did not register statistically significant differences. For group 2, the correlation between the morphometric features and cytological grading revealed that the nuclear area is the most valuable descriptor, due to the significant differences between the three successive grades of cytological severity, followed by the cytoplasmic area and equivalent diameter, their numerical values presenting significant differences between cytological grade 1 and 3, and 2 and 3, respectively. The statistical analysis between the morphometric features and histological grading showed that nuclear area and equivalent diameter are the most viable indicators, due to the significant differences present between the three successive grades of pathologic severity, followed by cytoplasmic area (significant differences only for grade 2 versus 3) and for nucleo-cytoplasmic ratio (significant differences only for grade 1 versus 2). The form factor does not provide information that could be correlated with the cytological or histological grading. The defined morphometric features enable the characterization of benign and malignant cells and provide objective criteria that could support a differentiation of benign from the malignant pathology in the cytological diagnosis.

Corresponding author: Irina-Draga Caruntu, Professor, MD, PhD; e-mail:

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5. Acantholytic squamous cell carcinoma: pathological study of nine cases with review of literature

Maria Sajin, Alina Hodorogea Prisacaru, Mihaela Cristina Luchian, Oana Maria Patrascu, Adrian Dumitru, Diana Costache, Doina Dumitrescu, Daniela Vrinceanu, Liliana Mary Voinea, Olga Simionescu, Mariana Costache

Squamous cell carcinoma (SCC) is classified in many subtypes or forms; one of them is the acantholytic squamous cell carcinoma, also called pseudoglandular, adenoid, epithelioma dyskeratoticum segregans, or adenoacanthoma. Researching and analyzing nine cases of acantholytic squamous cell carcinoma, we intend to verify if the data provided by the cases studied can be validated by the scientific literature. All the cases presented lesions found on the head and neck skin, with two exceptions - one on the larynx and the other one on the tonsil, all of them ulcerated lesions. In two cases, the tumors developed on the skin, in preneoplasic lesions (actinic keratosis). The tumors had dimensions between 4/3/4 mm and 100/90/36 mm. During one year, two of the cases studied presented multiple recurrences. We also found two cases of metatypical carcinoma accompanied the acantholytic variant of squamous cell carcinoma. None of the analyzed cases presented distant metastasis. The histopathological criteria for selection were: keratinised squamous tumor cell type, adenoid structures with round spaces with a defined wall of at least one cell width, spaces with isolated or grouped dyskeratotic acantholytic cells.

Corresponding author: Mariana Costache, Associate Professor, MD, PhD; e-mail:

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6. Role of transforming growth factor beta-connective tissue growth factor pathway in dihydropyridine calcium channel blockers-induced gingival overgrowth

Catalina Gabriela Pisoschi, Camelia Elena Stanciulescu, Ana Marina Andrei, Anca Berbecaru-Iovan, Cristina Munteanu, Florica Popescu, Ileana Monica Banita

Background: Gingival overgrowth was reported as a side effect after chronic administration of several drugs, which, despite their different pharmacological effect, seem to have the gingival mucosa as a secondary target. The thickness of the gingival epithelium and fibrosis in the lamina propria are unspecific changes that together determine the enlargement of the gingival mucosa, but the molecular mechanisms responsible for the imbalance of collagen synthesis/breakdown are still uncertain. The aim of our study was to assess the role of TGF-beta1-CTGF pathway in the activation of cells with a fibrilogenetic phenotype responsible for the gingival fibrosis developed after chronic administration of dihydropyridine calcium channel blockers. Materials and Methods: Fragments of gingival tissue collected from patients clinically diagnosed with gingival overgrowth after chronic administration of nifedipine and amlodipine were processed for paraffin embedding. Serial sections were used for routine staining Masson and Gomori silver impregnation in order to reveal collagen accumulation and for immunohistochemical reactions to label TGF-beta1, CTGF, Ki67 and alpha-SMA. Results: Routine histological staining for collagen revealed the presence of gingival fibrosis and a change between type I collagen/type III collagen ratio. Regardless of the drug involved, many slides showed extended TGF-beta1 positive areas, mainly in the profound - spinous and basal - layers, but also in some cells from the subjacent connective tissue. CTGF exposed intense positive reaction in the basal and parabasal layers, but also in resident cells from the connective tissue. Ki67 immunolabeling did not reveal an increased fibroblast proliferation in the lamina propria. We noticed the presence of a small number of myofibroblasts in the lamina propria. Conclusions: These findings suggest that TGF-beta1-CTGF axis is activated in dihydropyridine calcium channel blockers-induced gingival overgrowth and exerts a different control on the activation of fibroblasts with a synthetic phenotype. These results also have implications for better understanding mechanisms of fibrosis and the future use of this pathogenic pathway as a therapeutic target in order to limit gingival fibrosis.

Corresponding author: Camelia Elena Stanciulescu, Lecturer, Pharm, PhD; e-mail:

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7. Precursor and interstitial Cajal cells in the human embryo liver

Mugurel Constantin Rusu, Irina Duta, Andreea Cristiana Didilescu, Alexandra Diana Vrapciu, Sorin Hostiuc, Emil Anton

Interstitial Cajal Cells (ICCs) were only proven in human adult hepatic tissue. The immune phenotypes of various cell types in the human embryonic liver (HEL) are scarcely described. It was hypothesized that in HEL ICCs are present and distinctive to the precursor/progenitor cells populations. It was aimed and performed a qualitative study of HEL by use of antibodies against CD117/c-kit, CD31, CD34, CD90, CD105, DOG1, Ki67, and adiponectin. Five human embryos of 23-29 mm were used. Blasts and hematopoietic cells were comprising the two major cell populations in late stage embryos. The general population of blasts in the HEL was CD34-/CD105, although scarce CD117/c-kit+ and CD90+ such cells were found. Hematopoietic precursors were Ki67+. Adiponectin-positive plasmalemmas were found mostly in blasts. Endothelia were CD31+/CD34+. Interstitial cells with moniliform prolongations were found; such cells were scarcely CD117/c-kit+ but consistently DOG1+. They were diagnosed as ICCs but based on the morphology of their prolongations they can be equally viewed as being telocytes (TCs). Further studies should better correlate the precursor cell-types and immune phenotypes during human liver organogenesis. Liver ICCs and/or TCs should be also investigated in the human fetal liver.

Corresponding author: Mugurel Constantin Rusu, Associate Professor, MD, PhD, Dr. Hab.; e-mail:

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8. Delayed BMP4 exposure increases germ cell differentiation in mouse embryonic stem cells

Tahereh Talaei-Khozani, Nehleh Zarei Fard, Soghra Bahmanpour, Mansoureh Jaberipour, Ahmah Hosseini, Tahereh Esmaeilpour

Fate mapping studies have revealed that bone morphogenetic protein 4 (BMP4) signaling has a key role in segregation of primordial germ cells from proximal epiblast. Adding BMP4 to the culture media of embryonic stem (ES) cells could induce expression of germ cell markers; however, to provide a desired number of germ cells has remained a challenge. In the current study, we intended to establish an in vitro system to obtain reliable germ cells derived from ES cells. Differentiation was induced in ES cells via embryoid body (EB) and monolayer culture system. Cells were cultured with BMP4 from the beginning (++BMP4) or after 48 hours (+BMP4) of culturing for five days. The cultures were assessed for alkaline phosphatase (ALP) activity, expression of Oct4, Mvh and c-kit. In EB culture protocol, the expression of Mvh, Oct4 and ALP activity significantly increased in +BMP4 culture condition, but a significant down-regulation in the expression of germ cell markers was shown in ++BMP4 condition compared with the control group. Parallel differentiation experiments using monolayer culture system indicated the number of putative germ cells did not change. In the current study, we compared two differentiation methods (EB and monolayer) to achieve an optimal germ cell production. The EBs with a short exposure time period to BMP4, showing typical characteristics of germ cells. Therefore, our approach provides a strategy for the production of germline cells from ES cells.

Corresponding author: Soghra Bahmanpour; e-mail:

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9. Short-reactivation of Neurogenin-3 and mesenchymal microenvironment is require for beta-cells differentiation during fetal pancreas development and islet regeneration

Kaiming Yang, Yong Wang, Zhaokang Du, Xiujun Zhang

Purpose: To investigate influencing factors of beta-cells differentiation and microenvironment in embryonic development and regeneration, in order to conduct therapeutic efforts to broaden beta-cells mass in diabetes. Materials and Methods: The expression of Ngn3 (Neurogenin-3) and microenvironment of beta-cells differentiation during embryonic pancreas development at 4-12 weeks of gestation and regeneration after pancreatic islet injure observed by immunohistochemical staining. Results: The results showed that the expression of Ngn3 not only in pancreas development but also in beta-cells regeneration in rat diabetic model (DM) by streptozotocin (STZ) treatment. Pancreatic mesenchymal tissue always accompanied by islet cells differentiation and there is a short expression of Ngn3 occurrence before all islet cell types differentiated from pancreatic epithelium. The expression of Ngn3 including ectopic expression also appearance in beta-cells injured rat pancreas. In addition, there are some Nestin-positive cells where located in pancreatic duct, islets and mesenchyme were detected in DM. Double immunostaining witness Brdu/Ngn3-positive cells was only in pancreatic mesenchyme after beta-cells injure. Conclusions: Our data demonstrated the expression of transcription factor Ngn3 and pancreatic mesenchymal microenvironment are important and necessary to promote pancreatic progenitors differentiated to islet cells regardless of pancreatic development or islets regeneration.

Corresponding author: Kaiming Yang, Professor, MD, PhD; e-mail:,

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10. Fluorescence analysis of apoptosis induced by Pseudomonas aeruginosa in endothelial cells

Carmen Curutiu, Mariana Carmen Chifiriuc, Florin Iordache, Coralia Bleotu, Veronica Lazar, Carmen Aurelia Mogoanta, Cristian Radu Popescu, Raluca Grigore, Serban Vifor Gabriel Bertesteanu

Intracellular invasion of professional phagocytic cells like monocytes and macrophages by a pathogen usually triggers the apoptosis of the host cells. The aim of this study was to evaluate if Pseudomonas aeruginosa, although not considered a classic intracellular pathogen, could adhere to endothelial cell surface, invade the intracellular compartment and subsequently induce apoptosis of the cells. The adherence and invasion capacity of P. aeruginosa to endothelial cells was monitored using Cravioto adapted method. The apoptotic cells were evidenced by staining with Acridine orange/Ethidium bromide. The qualitative assay of bacterial adherence to the cellular substrate revealed that all tested strains adhered to endothelial cells surface, exhibiting a diffuse, aggregative or mixed (diffuse-aggregative or localized-aggregative) pattern and 20-70% adherence rates. The adherence of P. aeruginosa induced the reorganization of cytoskeleton filaments and formation of endocytic membrane expansions. Cell free P. aeruginosa culture supernatants did not induce any cell death response, as noticed in case of whole bacterial culture, showing the capacity to induce apoptosis of endothelial cells. The fluorescence microscopy examination revealed chromatin condensation, fragmented nuclei, and membrane blebbing and apoptotic bodies in pathogen invaded cells.

Corresponding author: Raluca Grigore, MD; e-mail:

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11. Nuclear morphometry and proliferative activity evaluation in the gastrointestinal stromal tumors

Valeriu Ardeleanu, Aurel Nechita, Laurian Lucian Francu, Costinela Georgescu

Twenty-two cases with gastrointestinal stromal tumors (GISTs) have been studied, sized from 2 cm to invasive gigantic tumors and also from low to high degree of malignancy. The altering of the form and the size of the nucleus is a reference point of malignancy, being used in the histological grading of many types of tumors and also as an appreciating parameter of the tumoral prognosis, with a high degree of accuracy in the colorectal, uterine, prostatic or ovarian cancers, as it was pointed in the previous researches. The aim of this study is to evaluate the dimensional characteristic of the nuclei and the mitosis in GIST with a cholic and gastric localization, attempting a quantitative differentiation of the two tumors, by studying the following aspects: nuclear dimensions, mitotic activity index and the mitotic density. The results of the proliferative activity quantification (mitotic activity index and mitotic density) have shown that this can be a decisive criterion for the precocious appreciation of the evolution. The most important morphological criterion with a predictive role is the mitotic activity index, but is recommended to be applied correlated with the size and the localization of the tumor. Although various nuclear morphometry studies in different types of malignant tumors have been performed, the data in gastrointestinal stromal tumors is scarce and only few similar studies have been reported in the specialty literature; from this point of view, the present study is new and original and is also trying to point out that even with GIST, such analysis and prognosis is as valuable as in any other malignant diseases.

Corresponding author: Laurian Lucian Francu, Assistant, MD, PhD; e-mail:

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12. Histological study on effect of Nigella sativa on aged olfactory system of female albino rat

Sohair A. M. Eltony, Sanaa A. M. Elgayar

Nigella sativa (NS) has wide-ranging healing properties, neuroprotective and antioxidant effects. Aging process is commonly associated with a decline in the chemical senses including smell. To detect a possible improvement effect of NS on the aging of the olfactory system we used 15 female albino rats that equally divided into three groups: group I (control adult), group II (control aged), group III (treated aged) received 40 mg/kg/day NS orally for two months. Specimens from the olfactory epithelium (OE), main olfactory bulb (MOB) and piriform cortex (PC) were processed for light and electron microscopy. Aging in OE revealed reduction in thickness, vacuolations, an increase in PAS reaction and lipofuscin autofluorescence. Aged MOB and PC exhibited a reduction in basophilia and accumulation of neurofibrillary tangles (NFTs) in mitral and pyramidal cells respectively. NS treatment improved the structure and the thickness of the OE and reduced the lipofuscin autofluorescence. It also attenuated the reduction in cytoplasmic basophilia and the accumulation of lipofuscin pigment and the NFTs in both mitral and pyramidal cells and the lipofuscin autofluorescence. These observations indicate that use of NS, could be of value in improving the structural changes of the peripheral and central main olfactory organs, which occurred in association with aging.

Corresponding author: Sanaa A. M. Elgayar, Professor, MD, PhD; e-mail:

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13. Correlations between cyto-histopathological tissue changes at the dental implant interface and the degree of surface processing

Raluca Monica Comaneanu, Horia Mihail Barbu, Costin Coman, Florin Miculescu, Luminita Chiutu

The bone tissue is a specialized connective tissue adapted for support and protection. The bone physiology is balanced by the interaction between mechanical and metabolic factors. Current research focuses on the bone remodeling process after the insertion of dental implants, because, after the primary healing of the wound caused by the creation of the new alveolus, the proliferation and differentiation of the osteoblasts and fibroblasts will tip the balance of the healing pattern toward bone regeneration or fibrous encapsulation. Knowing and identifying the components of the connective and bone tissue prior to implant placement, researchers are investigating the quality and quantity of the bone matrix and the physiological stages of bone generation and resorption to improve the bone-implant interface. Our research included nine dental implant failures, without prosthetic supra-structures, immediately loaded or loaded after osseointegration. The analyzed samples were from the BIOMAT Research Center, Politehnica University of Bucharest, Romania, and experienced different modalities of surface preparation. Comparative analysis of the tissue at the bone-implant interface was investigated by scanning electron microscopy.

Corresponding author: Horia Mihail Barbu, Lecturer, DDS, PhD; e-mail:

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14. Histopathological changes of renal tissue following sodium fluoride administration in two consecutive generations of mice. Correlation with the urinary elimination of fluoride

Nicoleta Dimcevici Poesina, Cristian Balalau, Vanda Roxana Nimigean, Victor Nimigean, Ion Ion, Daniela Baconi, Maria Barca, Violeta Baran Poesina

The present study was designed to investigate the toxic effects (evaluated as histopathological changes) of sodium fluoride on the kidney in two consecutive generations of NMRI mice. An attempt to correlate the toxicity with the urinary elimination of fluoride has been made, as urinary fluoride excretion has been widely used as an indicator of fluoride intake and exposure. Six mixed (males and females) animal groups have been constituted by dividing the populations of mice derived from pregnant females (named mothers 0.5 mg sodium fluoride) treated with 0.5 mg sodium fluoride by daily gavage and pregnant females (named mothers 0.25 mg sodium fluoride) treated with 0.25 mg sodium fluoride by daily gavage; three types of sodium fluoride treatments were administrated: homeopathic, allopathic-homeopathic and allopathic. When the animals reached the adulthood, by randomization, they were selected in pairs for giving birth to the second generation of mice. No treatments were administrated to the second generation of mice; thus, the urinary elimination of fluoride in the second generation is attributed to exposure at sodium fluoride before birth. The administration of sodium fluoride to the first generation (F1) is realized until the mice reached the adulthood. For the first generation, the urine was collected at three times, every three weeks: at the age of four weeks, seven weeks and 11 weeks; single sampling urine, at the age of four weeks, has been conducted for the second generation. The urine samples have been analyzed using the ion selective electrode method for fluoride. For the histopathological examination, the animals were killed by cervical dislocation; the kidneys were collected in a 10% formalin solution. The preparation of samples for optical microscopy was realized with Hematoxylin-Eosin staining. The results indicate that the elimination of fluoride was similar (at the second evaluation, at 7-week-old of the first generation) for the both generations of mice. Histopathological observation of the kidney has revealed granular dystrophy of the renal tubules, necrosis of the endothelial cells and of the mesangial cells of renal glomerulus. The study indicates that different sodium fluoride treatments produce some pathological aspects of the kidneys and influence the urinary elimination of fluoride in two consecutive generations of mice. For the higher doses, the pathological changes of the kidney are more important, and the urinary elimination of fluoride is higher, especially for the allopathic doses.

Corresponding author: Camelia Elena Stanciulescu, Lecturer, Pharm, PhD; e-mail:

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15. Liver steatosis associated with chronic hepatitis C

Eugenia Irimia, Laurentiu Mogoanta, Ion Octavian Predescu, Ion-Cristian Efrem, Casiana Stanescu, Letitia Adela Maria Streba, Anca Meda Georgescu

Hepatic steatosis is a common histological finding in chronic liver diseases. One of the pathological entities in which hepatic steatosis has been found is chronic hepatitis C. The prevalence of steatosis in these patients ranges from 40% to 86%, with an average of 55%, which is two times higher than the steatosis seen in adults uninfected with hepatitis C. Many studies have shown that hepatic steatosis is a medical condition that may progress to steatohepatitis, progressive hepatic failure, hepatic cirrhosis, and is a risk factor for development of hepatocellular carcinoma. We have proposed to evaluate the severity of steatosis in patients with chronic hepatitis C and to correlate it with necroinflammatory processes and fibrosis. We included 259 patients diagnosed with chronic hepatitis C and proven histological steatosis. Age of patients with hepatic steatosis varied from 20 to 69 years. Most cases of steatosis associated with chronic hepatitis C (47.87%) were diagnosed in the age group 50-59 years. Of 259 patients, 141 (54.44%) were female and 118 (45.56%) male. Slight steatosis was identified in 130 cases (50.19%), moderate fatty changes were present in 54 (20.85%) patients and severe steatosis in 75 (28.96%) patients. The appearance of steatosis was macrovesicular and predominantly affected the third zone of the hepatic lobe. Most cases of hepatic steatosis were associated with necroinflammatory activity and low and moderate fibrosis. Cases of marked steatosis associated with intense activity accounted for about 10%, while marked steatosis was associated with severe fibrosis in less than 5% of cases.

Corresponding author: Letitia Adela Maria Streba, Associate Professor, MD, PhD; e-mail:

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16. Magnetite nanostructures functionalized with cytostatic drugs exhibit great anti-tumoral properties without application of high amplitude alternating magnetic fields

Georgeta Voicu, Livia Elena Crica, Oana Fufa, Lavinia Iuliana Moraru, Roxana Cristina Popescu, Gabriela Purcel, Miruna Codruta Stoilescu, Alexandru Mihai Grumezescu, Coralia Bleotu, Alina Maria Holban, Ecaterina Andronescu

Here, we report the synthesis, characterization and the impact of magnetite nanoparticles functionalized with cytostatic drugs, epirubicin (Epi) and fludarabine (Flu) (Fe3O4@Epi, Fe3O4@Flu) prepared by chemical co-precipitation method on tumoral cells in vitro. The average diameter of the resulted particles was about 4 nm for both Fe3O4@Epi and for Fe3O4@Flu. These bioactive nanostructured materials proved to significantly enhance the antitumor effect of tested cytostatic drugs in vitro. The most significant result was obtained in the case of Epi, where the tested magnetite nanostructured material enhanced the cytotoxic effect of this drug with more than 50%.

Corresponding author: Alexandru Mihai Grumezescu, Chem. Eng., PhD; e-mail:

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17. The evaluation of p16 and Ki67 immunoexpression in ameloblastomas

Daniel Alin Olimid, Alma Maria Florescu, Daniela Cernea, Corneliu Cristian Georgescu, Claudiu Margaritescu, Cristiana Eugenia Simionescu, Alex Emilian Stepan

In this study, we investigated the p16 and Ki67 immunoexpression in 19 ameloblastomas in order to highlight some correlations of these markers with the aggressive variants of tumors. The p16 immunoreaction was present in 90.9% of cases; the highest scores are present in the typical follicular and in the intraluminal unicystic variant, at the opposite pole being the granular cells variant. In these cases, the maximum reaction was observed at the level of the stellated reticulum cells while the lowest reaction was present at the level of cubico-cylindrical peripheral cells of the neoplastic islands. The Ki67 immunoreaction was present in all cases, the highest scores being present in the typical follicular variant, opposite being the ameloblastoma with granular cells cases and that with acanthomatous differentiation type. The immunostained cells were located predominantly at the periphery of the tumoral islands but also in the stellated reticulum cells in the central area. The p16 and Ki67 markers may be useful for distinguishing different types of ameloblastomas in terms of aggressiveness.

Corresponding author: Cristiana Eugenia Simionescu, Professor, MD, PhD; e-mail:

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18. Ultrasonographic and histopathological features of cervical lymph node metastases

Ionela Genes, Carmen Aurelia Mogoanta, Gabriel Lostun, Alexandra Lostun, Huba Mozes, Gheorghe Muhlfay

Objectives: Different approaches have been made to differentiate benignant from malignant cervical lymphadenopathy using ultrasound examination. Assessment of nodal status is essential in patients with head and neck carcinomas as it predicts prognosis and helps in the selection of treatment options. The present study was designed to evaluate the role of ultrasound in the assessment of malignant cervical lymph nodes using the histological gold standard results. Gray-scale ultrasound assesses the nodal size, shape, border, internal architecture and color Doppler ultrasound evaluate the vascular pattern of lymph nodes. Materials and Methods: 158 cervical lymphadenopathies evaluated by ultrasound in 100 patients over a period of 36 months (between January 2010 and December 2012) were evaluated for the presence of intranodal vascular pattern, which was considered benignant when it traversed through the node without disruption. Results: Of the 158 cervical tumors evaluated, 114 (72.2%) were found to be malignant on pathologic review. Malignant vascular markings were present in 133/158 lymph nodes evaluated. The presence of malignant vascular pattern had a sensitivity of 97.37% and a positive predictive value of 82.84%. Malignant gray-scale ultrasound markings had a sensitivity of 23.3% and a positive predictive value of 100%. Conclusions: The presence of normal intranodal blood flow was associated with a benignant diagnosis in 87.5% of the masses evaluated. The addition of this color Doppler ultrasound finding improves the ability of ultrasound exam to predict the likelihood of malignant involvement.

Corresponding author: Ionela Genes, University Assistant, MD, PhD; e-mail:

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19. The chick chorioallantoic membrane: a model of short-term study of Dupuytren s disease

Ion Mindrila, Horia Parvanescu, Daniel Pirici, Mihaela Niculescu, Sandra Alice Buteica, Oana Taisescu, Danut Nicolae Tarnita

Dupuytren s disease is a progressive fibroproliferative disorder that impairs hand function by altering the normal structures of the palmar fascial bands. Nodules composed almost entirely of myofibroblasts and cords are pathognomonic of Dupuytren s disease. The myofibroblasts express alpha-smooth muscle actin that is especially involved in development of the disease. We aimed to evaluate whether the xenograft of Dupuytren s fibromatosis taken from operating room and transplanted on chick chorioallantoic membrane (CAM) survives with its histological and immunohistological features. Fresh samples obtained from eight patients with Dupuytren s disease were minced and immediately inoculated onto 24 CAMs of 8-day-old chick embryos. The implanted CAMs were examined daily by stereomicroscopy and finally the xenografts were examined and characterized in histological sections using a panel of antibodies. The xenografts were incorporated into the CAMs 6-7 days after transplantation, continued to grow and stimulated angiogenesis in the chick embryo CAMs. The CAMs vessels entered the xenografts and anastomosed with the newly formed xenografts vessels (CD34+ and CD105+) those containing nucleated chick erythrocytes. Myofibroblasts (alpha-SMA+) and macrophages (CD68+) were readily recognized in the xenograft thickness. We concluded that the xenografts of Dupuytren s fibromatosis transplanted onto chick embryo CAMs continued to develop and preserved the histological and immunohistological features.

Corresponding author: Ion Mindrila, Professor, MD, PhD; e-mail:

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20. Cutaneous verrucous carcinoma - report of three cases with review of literature

Mariana Costache, Laura Tatiana Desa, Luminita Elena Mitrache, Oana Maria Patrascu, Adrian Dumitru, Diana Costache, Emanuel Albu, Maria Sajin, Olga Simionescu

Verrucous carcinoma is a rare variant of squamous cell carcinoma. It is well differentiated and rarely metastases but can sometimes be very aggressive locally in depth. The paper presents three cases of cutaneous verrucous carcinoma with different localizations. The first patient shows a lesion in the sacrogluteal region, the second one presented a tumor localized on the auricle (external ear), and the third patient showed a tumor on the sole of the foot. All patients underwent tumor excision and the histopathological diagnosis was verrucous carcinoma. In the first two cases, the surgery was completely curative by excision of the tumors. In the last case, the patient had relapsed and due to the aggressive nature of the tumor, which infiltrated the deeper plans, the tumor had reached the bone. None of the patients showed any metastases.

Corresponding author: Mariana Costache, Associate Professor, MD, PhD; e-mail:

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21. Diagnostic correlation between RET proto-oncogene mutation, imaging techniques, biochemical markers and morphological examination in MEN2A syndrome: case report and literature review

Alina Simona Sovrea, Eleonora Dronca, Mihaela Galatar, Serban Radian, Corina Vornicescu, Carmen Georgescu

Multiple endocrine neoplasia type 2 (MEN2) is a rare autosomal dominant monogenic disorder caused mostly by missense mutations in the RET (REarranged during Transfection) proto-oncogene on chromosome 10q11.2. MEN2A represents more than 50% of all MEN2 cases, having a regular pattern with medullary thyroid carcinoma (MTC) incidence of 90-100%, bilateral pheochromocytoma (PCC) incidence of 40-50% and primary hyperparathyroidism (HPT) incidence of 10-25%. Until recently, the diagnosis of MTC was most frequently based on fine-needle aspiration of thyroid nodules, after an ultrasound examination and endocrine evaluation of serum calcitonin levels. Nowadays, RET gene screening (starting with exons 10 and 11) is a mandatory test used for identification of both symptomatic and non-symptomatic MTC carriers or for exclusion of healthy individuals from subsequent periodical clinical/biochemical screening. In this context, and in the idea of PCC preceding MTC, the early detection of germline RET mutations are highly suggestive for hereditary disease. PCC diagnosis is established in classical manner by abdominal ultrasound imaging or computed tomography confirming the presence of adrenal gland masses, elevated plasma metanephrines and normetanephrines values and histopathological examination. Additional HPT diagnosis is acknowledged by serum ionized calcium and parathormone levels. Here we report a hereditary case of MEN2A in a two-generation Romanian family, along with data presenting the importance of correlative plurifactorial diagnostic scheme in this syndrome and a short literature review.

Corresponding author: Eleonora Dronca, MD, PhD; e-mail:

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22. Restoration of molar morphology with a split cast post and core

Constantin Daguci, Luminita Daguci, Marilena Bataiosu, Veronica Mercut, Petra Surlin, Adina Magdalena Bunget, Mihaela Jana Tuculina, Mihaela Raescu

The teeth with extensive coronal destructions due to carious process can be saved by using split cast post and core. This technique has been used for a long time and with positive results recognized by many authors. The clinical case presented here describes indirectly the reconstitution technique with split cast post and core with latch of a maxillary molar with divergent roots and extensive coronal destruction both in area and depth.

Corresponding author: Constantin Daguci, Lecturer, MD, PhD; e-mail:

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23. Pulmonary inflammatory myofibroblastic tumor in an AIDS patient

Simona Claudia Cambrea, Ghiulendan Resul, Ion Bulbuc, Marius Cambrea, Florina Vasilescu

Background: Pulmonary inflammatory myofibroblastic tumor (PIMT) is a rare disease that occurs more frequently in younger patients. Its etiopathogeny remains debated whether this is an inflammatory lesion characterized by uncontrolled cell growth or a true neoplasm. Aim: To present a case of PIMT in a young men, HIV-positive since childhood. Patient, Methods and Results: We report the case of an HIV-positive patient, aged 21 years, with collapsed immunity (CD4=23 cells/mm3), which in the second half of 2009 was clinically and radiologically diagnosed with recurrent right pneumonia. Serological tests were negative for Mycoplasma, Epstein-Barr and HHV-8 and positive for cytomegalovirus (CMV). Further monitoring of this episode raises imaging suspicion of the tumor in right upper pulmonary lobe. A lung wedge biopsy by thoracotomy was performed. The result of histopathological examination was suggestive for Kaposi sarcoma but required an immunohistochemical examination (vimentin, smooth muscle actin, CD34, anaplastic lymphoma kinase, CK7, L26/CD20, CD38, CD68), which established diagnosis of PIMT. In our case, we noticed a favorable evolution under antiretroviral treatment (by increasing CD4 count - immunity slowly improved), broad-spectrum antibiotics, and steroidal anti-inflammatory treatment, with regression of PIMT over eight months. Conclusions: Although inflammatory myofibroblastic tumor (IMT) is rare, it should be considered in the differential diagnosis of pulmonary tumoral lesions in young adults. This is the first PIMT case in an HIV-positive patient described in Romania. Even good response in such cases was noticed after surgical treatment, in our case we achieved complete remission of the disease with anti-inflammatory steroidal therapy and combined antiretroviral therapy (cART). As other infectious etiologies, CMV also could represent a trigger for developing a pulmonary inflammatory myofibroblastic tumor.

Corresponding author: Simona Claudia Cambrea, University Lecturer, MD, PhD; e-mail:

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24. Atypical Bourneville sclerosis without epilepsy and mental retardation: case report and literature review

Adela Magdalena Ciobanu, Mihai Gheorghe Lisievici, Teodora Camelia Coman, Jean Ciurea, Mihaela Camelia Popa

Twenty-four-year-old woman without familiar detected signs of Bourneville s disease or tuberous sclerosis complex (TSC) was diagnosed with this disease by casual discovery on cerebral magnetic resonance imaging (MRI) of an intraventricular tumor, after symptoms consist in headache, equilibrium disturbances, and progressive loss of vision. MRI shows an intracranial mass, 33/24/30 mm in size, localized at the level of third ventricle and lateral ventricles, with irregular shape, interesting the foramen of Monroe. There are also nodular areas of calcification and a supratentorial hydrocephalus involving the lateral ventricles and the posterior part of the third ventricle. The patients present facial angiofibromas, but from the classical triad of the disease, the epilepsy and mental retardation were absent, the patient never presented seizures. The total removal of the tumor (peace to peace) was performed surgically, the macroscopic features of resected tumor (20/10/10 mm) was of white-gray color, elastic consistency, localized in the both lateral ventricles (left>right) and into the third ventricle, traversing the foramen Monroe. The histopatological examination associated with specific localization of tumor and the facial angiofibromas are very suggestive for subependimar giant cell astrocytoma (SEGA). We have a rare case of atypical or incomplete TSC in which the epileptic seizures and the mental retardation are absent, the intelligence is normal, but occur some psychical symptoms: anxiety, sleeplessness, and autism or behavior disturbances. The evolution of this case was marked by complications because of postoperative hydrocephalus and multiple shunt insertions and revisions were performed after the tumor resection.

Corresponding author: Adela Magdalena Ciobanu, Lecturer, MD, PhD; e-mail:

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25. Inflammatory pseudotumors of the kidney due to IgG4-related tubulointerstitial nephritis

Mihai Harza, Gener Ismail, George Mitroi, Mihaela Gherghiceanu, Adrian Preda, Ioanel Sinescu

The paper presents the case of a female patient who was admitted to our department because of prolonged febrile syndrome, altered general status and renal tumoral masses revealed by thoracic and abdominal CT. After thorough histological examination, including immunohisto-chemistry and in situ hybridization studies, we reached the diagnosis of renal pseudotumoral masses due to IgG4-related tubulointerstitial nephritis. The kidney is a distinct target organ affected by IgG4-related sclerosing disease, and the most frequent manifestation is tubulo-interstitial nephritis. We described the clinical, imagistic and histopathological features of kidney and urological involvement in IgG4-related sclerosing disease, especially focusing on IgG4-related tubulointerstitial nephritis. This is a rare case of IgG4-related sclerosing disease without extrarenal features, excepting lumboaortic lymphadenopathy.

Corresponding author: Gener Ismail, MD, PhD; e-mail:

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26. Coexistence of renal cell carcinoma of clear cell type with sarcomatoid cell type component and adrenal mature ganglioneuroma with myelolipoma - a case of 69-year-old female patient

Piotr Lewitowicz, Andrzej Wincewicz, Agata Horecka-Lewitowicz, Jaroslaw Matykiewicz, Dorota Koziel, Stanislaw Gluszek, Stanislaw Sulkowski

This report presents a case of 69-year-old woman, who was operated due to renal tumor. Apart from renal neoplasm, the adjacent adrenal gland contained another one tumor in medulla of the organ. The renal lesion was diagnosed renal cell carcinoma, clear cell type with undifferentiated cell sarcomatoid component. The adrenal neoplasm was composed of wavy S100-positive, Schwann-like cells and dispersed chromogranin A-reactive ganglion cells to be consistent with mature ganglioneuroma. It was accompanied by coexistent myelolipoma that contained hematopoietic cells including clearly visible megakaryocytes and foci of fat. To our knowledge, our paper is the first to report sporadic clear cell renal cell carcinoma with sarcomatoid cell type component and mature adrenal ganglioneuroma with myelolipoma in the same patient.

Corresponding author: Andrzej Wincewicz, FEBP, MD, PhD; e-mail:,

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27. Concurrence of bilateral kinking of the extracranial part of the internal carotid artery with coiling and tortuosity of the external carotid artery - a case report

Erika Cvetko

Anatomical variations of the carotid arterial system have a great impact on surgical approaches to the neck and radiological imaging interpretation. Although reports on internal carotid artery dolichoarteriopathy (kinking, tortuosity, coiling) have been reported, no report on dolichoarteriopathy of the external carotid artery has been described. Herein, we report a case with concurrent bilateral kinking of the extracranial part of the internal carotid artery associated with extensive calcifications in the relatively high-located carotid bifurcation and coiling with tortuosity of the external carotid artery in a male cadaver - an entity that has not yet been reported. The variation presented should be kept in mind during various surgical procedures in order to decrease possible iatrogenic or surgical complications.

Corresponding author: Erika Cvetko, DMD, PD, Professor; e-mail:

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28. Immunohistochemistry of a choroidal melanoma: nestin, CD34 and CD117/c-kit labeling

Alexandra Diana Vrapciu, Mugurel Constantin Rusu, Liliana Mary Voinea

In a case of choroidal melanoma (CM) in a 70-year-old male patient, was firstly aimed at studying the processes of angiogenesis by use of nestin and CD34 antibodies. Anti-CD117/c-kit antibodies were further considered for their progenitor cells specificity. Choroidal melanoma was histopathologically confirmed. Nestin-positive endothelia were found in the CM and the adjacent retina, but not in endothelia elsewhere in that eye. Nestin-positive non-pigmentary cells were found within the CM. Filopodia-projecting endothelial tip cells (ETCs), nestin- and CD34-positive were found in the CM. CD34-positive ETCs were also found in the iridial stroma. There were found two different immune patterns of the retinal Muller cells (MCs). They were nestin-positive in the retina adjacent to the tumor, but negative in any other part of retina. On the other hand, CD117/c-kit antibodies labeled MCs as follows: (a) discontinuously, or continuously, in the retina adjacent to the CM; (b) only the inner segments of the MCs were labeled in the retina unrelated to the CM. While nestin could be a reliable marker for retinal damage, the CD117/c-kit phenotype of MCs still needs further investigations. Antiangiogenic therapy appears as a good choice for tumor therapy.

Corresponding author: Mugurel Constantin Rusu, Associate Professor, MD, PhD, Dr. Hab.; e-mail:

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29. Craniofacial morphological changes of familial bilateral hypodontia of maxillary premolars

Georgeta Zegan, Radu Bogdan Mavru, Elena Braha

The hypodontia of a permanent tooth from a dental group represents a normal evolution in human dentition morphology. Nevertheless, the hypodontia of two teeth within a dental group is a rare developmental anomaly when not associated to a systemic syndrome. The aim of this study was to report two rare cases of four maxillary premolars hypodontia, not including the third molar, of two white women from the same family. There were presented clinical, radiological and genetic findings. These cases are of interest to practitioners for four aspects: the atypical phenotype of hypodontia, the complexity of craniofacial morphological changes, the autosomal dominant familial inheritance with variable expressivity and the difficult classification of diagnosis.

Corresponding author: Georgeta Zegan, Associate Professor, DMD, PhD; e-mail:

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30. Fertility preserving treatment in a nulliparous with a molar pregnancy: a case report

George Alexandru Filipescu, Andreea Gratiana Boiangiu, Nicoleta Clim, Florin Andrei

Hydatidiform mole represents an abnormal form of conception that occurs in about one in 500-1000 pregnancies. It is a subtype of gestational trophoblastic disease. Hydatidiform moles should be regarded as premalignant lesions because 15-20% of complete hydatidiform moles (CHMs) and 1% of partial hydatidiform moles (PHMs) undergo malignant transformation into invasive moles, choriocarcinomas, or, in rare cases, placental-site trophoblastic tumors (PSTTs). We will illustrate the case of a 26-year-old nulliparous with a seven weeks amenorrhea, positive immunological pregnancy test, a beta-HCG value of 136 000 mIU/mL and minor vaginal bleeding. The ultrasonographic examination showed an enlarged endometrium with adjacent hyperechoic material containing tiny anechoic spaces and an anembryonic pregnancy, distended endometrial cavity containing innumerable, variably sized anechoic cysts with intervening hyperechoic material (snowstorm appearance). The CT showed a uterine mass measuring 89/111/67 mm, inhomogeneous density, proliferative-infiltrative endocavitary tissue without exceeding the peritoneal serosa, and a few pulmonary micronodules with not certain origin on the left inferior lobe. In this case, due to the large infiltrative uterine mass, the risk of severe bleeding after curettage and the possibility of a necessity hysterectomy, we decided to apply first of all the Methotrexate protocol for molar pregnancy.

Corresponding author: George Alexandru Filipescu, MD, PhD; e-mail:

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31. Fatal paradoxical cryptic miliary tuberculosis and immune reconstitution disease in a young non-HIV immunocompromised male patient: case report with autopsy findings

Milena Adina Man, Oana Cristina Arghir, Sorin Man, Costin Teodor Streba, Mihai Olteanu, Mimi Nitu

Non-HIV immunocompromised patients may develop immune reconstitution inflammatory syndrome (IRIS) as an abnormal response to invading microorganisms, such as Mycobacterium tuberculosis (MTB). IRIS consists in a sudden change in the dominant T-helper responses to inflammation, which is not balanced by anti-inflammatory response, playing a critical role in microbial pathogenesis. A patient with restoration of host immunity during anti-tuberculosis treatment can become gravely ill with a paradoxical severe form of tuberculosis (TB) disease named TB immune reconstitution disease (IRD).The diagnosis of acute cryptic miliary TB is difficult and requires an accurate histopathology. We report a fatal association between a generalized lymphadenitis tuberculosis and IRD in a 34-year-old male patient, non-smoker, non-HIV immunocompromised, but with a previously co-morbid diabetes mellitus (DM) type I. The purpose of this report is to describe an unusual and rare case of a progressive extrapulmonary TB disease to a liver involvement, mimicking a hepatotoxicity secondary to anti-tuberculosis therapy. The diagnosis of disseminated miliary TB with cryptic pulmonary was confirmed later after performing necropsy. Formalin-fixed paraffin-embedded pulmonary and extrapulmonary miliary foci were processed for histology and stained with Hematoxylin and Eosin. This rare entity of cryptic miliary involvement of the lungs is described more in elderly than in young individuals. In the reported case, IRD induced a paradoxical progressive dissemination of TB lesions leading to death in a patient with an apparent uncomplicated form of lymphadenitis TB.

Corresponding author: Mimi Nitu, Associate Professor, MD, PhD; e-mail:

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32. Desmosomes as markers for the proliferating parietal epithelial cells in collapsing glomerulosclerosis. A case report

Eugen Mandache, Simona Stancu, Gener Ismail, Mircea Penescu

Two variants of focal segmental glomerulosclerosis are known to present epithelial hypercellularity in the Bowman s space, namely the collapsing and the cellular types. This epithelial cell proliferation may get features of either pseudocrescent or tubular profiles. Our case of collapsing focal segmental glomerulosclerosis has been ultrastructurally investigated concerning the proliferating epithelial cell type: parietal versus visceral. Based on the cellular organelles, especially on the ubiquitous presence of desmosomes, the authors are endorsing, with ultrastructural arguments, the opinion favoring the parietal epithelial cells (PEC) as the proliferating cell type. It is also taken into consideration the eventual change of PECs phenotype in contact with the glomerular tuft components like the glomerular basement membrane.

Corresponding author: Eugen Mandache, MD, PhD; e-mail:

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33. Papillary fibroelastoma of the pulmonary valve: a case report

Adrian Molnar, Svetlana Encica, Emese Kovacs, Simona Manole, Diana Sacui, Ioan Muresan, Traian Scridon

Papillary fibroelastoma is a rare, benign cardiac tumor typically found on the heart valves, which is usually discovered incidentally on echocardiography. The clinical presentation of cardiac papillary fibroelastoma varies from no symptoms to severe embolic sequelae. We report the case of a 55-year-old female patient, with a suspicion of pulmonary embolism one year before, presently admitted to the hospital for mild respiratory symptoms; the trans-esophageal echocardiography (TEE) revealed a 10/10 mm tumoral mass attached on the pulmonary valve, confirmed also by the contrast-enhanced magnetic resonance imaging (MRI). Considering the embolization risk, we decided surgical removal, with favorable outcome. The pathologic exam of the removed tumor established the diagnosis of papillary fibroelastoma. The clinical and imaging assessment one month after surgery were within normal limits. The surgical removal of the papillary fibroelastoma of the pulmonary valve is mandatory for the elimination of embolization risk. The intervention is relatively secure, with low rates of morbidity and mortality.

Corresponding author: Adrian Molnar, Assistant Professor, MD; e-mail:

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34. Bilateral asymmetry of the highly bifurcated brachial artery variation

Eleni Panagouli, Sophia Anagnostopoulou, Dionysios Venieratos

High bifurcation of the brachial artery seems to be a common variation, which can occur in many different forms, and some of them might be rather rare. We report an unusual case of bilateral high bifurcation of the brachial artery in a male cadaver. On the right arm, high origin of the ulnar artery as superficial ulnar artery was observed. The brachial artery continued and divided at the level of the elbow into radial and common interosseous artery. On the left arm, a high bifurcation of the common interosseous artery occurred, while the rest of the brachial artery continued and at the level of the elbow bifurcated into radial and superficial ulnar artery. In both arms, the common interosseous artery followed the branching pattern of the normal ulnar artery. The so formed superficial ulnar arteries gave each four common palmar digital arteries. This case is being reported for the bilaterally different variational anatomy of the upper limb arteries.

Corresponding author: Eleni Panagouli, MD, PhD; e-mail:

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35. Therapeutic protocol using growth factors in electrocution wounds - case reports and review of the literature

Razvan Nicolae Teodoreanu, Serban Arghir Popescu, Ioan Lascar, Virginia Vulturescu, Alice Grigore

Injuries by high voltage electrocution represent rare and very complex accidents. In order to provide support to surgical therapy, to limit the extension of injuries or to support the natural process of tissue repair, we oriented towards the use of two growth factors, insulin and platelet-enriched plasma (PRP) administered locally, on the injury site. The therapeutic protocol was applied on three cases of electrocution with promising results in reducing the duration of surgical and pharmacological treatment and of time of hospitalization. The influence of growth factors on healing wounds, the mechanism of action and recent therapeutic applications are also discussed.

Corresponding author: Razvan Nicolae Teodoreanu, MD; e-mail:

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36. Giant benign mass of the lateral neck: a case report

Serban Rosu

We report the case of a woman aged 32 years with no medical history, who presented to the Department of Oral and Maxillofacial Surgery in Timisoara, Romania, accusing pain, right lateral cervical swelling and difficulty in head movements, due to the presence of a giant lateral cervical mass, which had a rapid growth during the last six months. During anamnesis, it was difficult to determine whether the initial location was anterior or posterior to the sternocleidomastoid muscle. CT images showed a homogeneous, well-defined cystic tumor, which compressed surrounding tissues. Pre-surgical image investigations received were digitally processed and showed the origin of the mass on the anterior margin of the sternocleidomastoidian muscle. Histopathological examination confirmed the clinical diagnosis of branchial cyst. The treatment was surgical, carried out under general anesthesia through oral intubation and consisted of cystic enucleation, followed by restoration of normal functions.

Corresponding author: Serban Rosu, University Assistant, MD; e-mail:

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37. Accessory slips of the extensor digiti minimi

Jing Li, Qing Hua Mao

During the educational dissection of a 69-year-old Chinese male cadaver, an extensor digiti minimi (EDM) with five slips on the right hand was discovered. Except for the two slips of the little finger, the two radial slips were inserted into the dorsal aponeurosis of the middle finger and the ring finger, respectively. The middle slip was connected to the junctura tendinum in the fourth intermetacarpal spaces. Variations in this region are of paramount importance for the reconstructive surgeons, who may utilize the accessory slips to restore functional capacity of the fingers.

Corresponding author: Jing Li, Lecturer; e-mail:

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