Rheumatoid myositis, myth or reality? A clinical, imaging and histological study

Vol. 55 No. 3 Suppl., 2014
This supplement was not sponsored by Outside Organizations.


Codrina Ancuta, Daniela Cristina Pomirleanu, Carmen-Rodica Anton, Eovelina Moraru, Emil Anton, Rodica Marieta Chirieac, Eugen Ancuta

Rheumatoid myositis (RM) is still poorly characterized, albeit the concept of muscle involvement in rheumatoid arthritis (RA) is well-recognized as being driven by a wide range of causes including inflammation, drugs, impaired joint flexibility, sedentarism. Objective: To describe clinical, serological, imaging and histological pattern of RM. Materials and Methods: This is a retrospective study on eight RM selected from a cohort of one hundred and three RA systematically assessed for skeletal muscle involvement. Data collected included clinical, serum muscle enzymes, muscle imaging and biopsy (Hematoxylin-Eosin, modified Gomori trichrome staining). Results: Routine muscle histology indicated both non-specific muscle fiber damage (changes in fiber size and internal structure: pleomorphic mitochondria, dilated sarcotubular system, multiple internal or subsarcommal nuclei; abnormal fiber types distribution: trend towards type II; atrophy; degenerative/regenerative modifications) and the presence of inflammatory deposits in all patients (mild to moderate, patchy B- and T-cells infiltrates, mainly perivascular and endomysial, but also in the perimysial region classified as polymyositis-like deposits). High levels of serum muscle enzymes, abnormal EMG (short duration, small amplitude, polyphasic motor unit action potentials) without insertional activity and fibrillations, active inflammation on both Doppler ultrasound and MRI were commonly reported. Conclusions: Traditional analysis of muscle biopsy specimens (Hematoxylin-Eosin, modified Gomori trichrome staining) is faraway unsatisfactory, only documenting changes in muscle fibers size, architecture, internal structure, and, possibly, detecting perivascular, perimysial or endomysial inflammatory deposits. Upcoming research should address the value of muscle imaging for the diagnosis and evaluation of treatment response and muscle function in rheumatoid myositis.

Corresponding author: Eugen Ancuta, MD, PhD, MsC; e-mail: eugen01ro@yahoo.com

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Mihai-Catalin Afrem, Claudiu Margaritescu, Monica Mihaela Craitoiu, Mirela Ciuca, Calin-Gabriel Sarla, Ovidiu Simion Cotoi

Oral cancer was ranked as the sixth worldwide most common cancer, but recent studies noticed an overall downward trend in its incidence. However, for tumors localized on the tongue, the incidence seems to increase. The malignant transformation of many carcinomas is associated with loss of epithelial differentiation and gain of a mesenchymal phenotype, a process known as epithelial-mesenchymal transition (EMT) which for oral squamous cell carcinomas (OSCC) could be a predictor and a prognostic factor. The aim of our study was to investigate immunohistochemically the E-cadherin/N-cadherin switch and vimentin expression as markers of EMT process in tongue OSCC. Thus, we analyzed 15 cases of tongue OSCC by enzymatic double immunohistochemistry using the following double pairs of antibodies: E-cadherin/vimentin and N-cadherin/E-cadherin. E-cadherin reactivity was recorded in all the investigated cases, the pattern of expression being both membranous and cytoplasmic, with the membrane pattern decreasing simultaneously with the decrease of the differentiation degree and with the increase of invasion phenotype, while the cytoplasmic pattern had an opposite behavior. Tumor parenchyma reactivity for vimentin was noticed in 73.3% and its expression was more obvious in tumor cells from the periphery of proliferative islands and in acantholytic carcinomatous cells. N-cadherin reactivity was restricted to only 33.33% of the investigated cases and its expression was prevalent in poorly differentiated forms. In conclusion, in tongue squamous cell carcinomas at the invasion front the E-cadherin reactivity decreases while vimentin expression increases, with a cytoplasmic N-cadherin reactivity in a few of the observed cases. This EMT phenotype was correlated with the decrease of differentiation degree, with the increase of the type of invasion pattern and with increasing disease stages and thus these EMT markers could be used for prognostic stratification of such patients.

Corresponding author: Claudiu Margaritescu, Professor, MD, PhD; e-mail: c_margaritescu2000@yahoo.com

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