ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Vol. 64 No. 4, October-December 2023

1. Obliterative foam-cell arteriopathy. A unifying concept embracing several entities previously described as radiation, decidual, transplant, and intratumoral-associated arteriopathy

Jose-Fernando Val-Bernal, Marta-Maria Mayorga, Carlos Bercebal, Maria-Luisa Cagigal

This review article aimed to postulate the existence of a specific arterial injury having as its histological hallmark a collection of macrophages loaded with lipids in the intima of small-sized and medium-sized arteries causing narrowing or complete obstruction. The proposal is made that a series of previously described entities, such as ionizing radiation arteriopathy, acute atherosis (foam-cell decidual arteriopathy), transplant chronic arteriopathy of solid organ allografts, and intratumoral-associated foam-cell arteriopathy constitute different manifestations of the same basic morphological process identified as obliterative foam-cell arteriopathy (OFCA). OFCA is a local (single-organ) lesion in the aforementioned diverse processes with variable etiopathogenesis but converges in a single morphological marker. This arteriopathy is essentially an intimal disease. The processes in which the OFCA appears are known under a variety of names partly dependent on the location of the lesion. The basic unifying mechanism of the different entities is endothelial activation and dysfunction (local arterial endotheliopathy), preferably in small-sized or medium-sized arteries (100 to 500 micrometers in external diameter).

Corresponding author: Jose-Fernando Val-Bernal, Professor, MD, PhD; e-mail: fernando.val@unican.es

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2. Humps and bumps of head: review of meningiomas of the scalp

Elena Porumb-Andrese, Claudia Florida Costea, Georgiana Macovei, Gabriela Florenta Dumitrescu, Laurentiu Andrei Blaj, Iulian Prutianu, Andrei Ionut Cucu

Meningiomas are a type of tumor that arises from meningothelial cells and primarily develops in intracranial space, being some of the most common benign tumors of the central nervous system. However, meningiomas can rarely occur on the scalp and are called primary cutaneous meningiomas. Since the pathogenesis of these lesions is still uncertain, these tumors still pose challenges in terms of histopathological diagnosis. In this review, we will discuss the main cases of scalp meningiomas in the literature, their classification, pathological and immunohistochemical diagnosis, differential diagnosis with other scalp lesions and the most effective treatment. This study highlights the importance of immunohistochemistry in the differential diagnosis of skin lesions located on the scalp.

Corresponding author: Claudia Florida Costea, Professor, MD, PhD; e-mail: costea10@yahoo.com; Georgiana Macovei, Associate Professor, MD, PhD; e-mail: georgiana.macovei@umfiasi.ro

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3. Autoimmune encephalitis and paraneoplastic encephalitis: difficulties in diagnosis and management in the ICU

Mihaela Livia Agapie, Florin Tudor Borjog, Clementina Oana Dumitrascu, Rares Prajescu, Mihai Popescu, Carmen Orban

Autoimmune encephalitis (AIE) represents a category of relatively newly described neurological disorders associated with an increasing prevalence, a significant impact on the healthcare system, and a high rate of intensive care unit (ICU) admission. This category of diseases often requires prompt treatment, even before a definitive diagnosis is established. In the ICU, patients present with nonspecific signs and symptoms for AIE, which pose challenges in both management and diagnosis. Patients frequently exhibit dysautonomia, severe physical and psychic agitation, as well as tremors and dyskinesia, all of which complicate the diagnosis. They are prone to developing infections, including ventilator-associated pneumonia, and issues related to difficult venous access and pressure ulcers. Early initiation of immunosuppressive treatment is necessary to improve patients outcome. Through this article, we aimed to summarize current knowledge in terms of the difficulties in diagnosing and management of this pathology in the ICU, as well as the implications for the healthcare system in terms of human and financial resources.

Corresponding author: Mihaela Livia Agapie, MD, PhD Student; e-mail: agapiemili@yahoo.com

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4. Improvement of carotid atherosclerosis and peripheral artery disease after hepatitis C virus eradication by direct-acting antivirals

Tudor Cuciureanu, Carol Stanciu, Robert Radu Nastasa, Larisa Ermina Stratina, Horia Octav Minea, Ioan Sebastian Zenovia, Catalin Sfarti, Cristina Maria Muzica, Laura Huiban, Remus Theodor Stafie, Ana-Maria Singeap, Stefan Chiriac, Eliza Camelia Cojocariu, Irina Girleanu, Oana Cristina Petrea, Sergiu Timofeiov, Iulian Dan Cuciureanu, Adrian Rotaru, Anca Trifan

Introduction: Recent research points to a link between chronic hepatitis C virus (HCV) infection and cardiovascular disease, especially carotid atherosclerosis, and suggests that HCV clearance may impact cardiovascular outcomes. Aim: To determine if viral eradication by the new oral direct-acting antiviral (DAA) agents has benefit regarding carotid atherosclerosis, peripheral artery disease (PAD), steatosis, and liver fibrosis. Patients, Materials and Methods: We conducted a prospective study on 168 patients diagnosed with chronic HCV infection or HCV-related cirrhosis. They were all treated with DAAs, with sustained virological response (SVR). Laboratory data, vibration-controlled transient elastography (VCTE), carotid intima-media thickness (IMT) measurement, and ankle-brachial index (ABI) were recorded in all patients. Results: We found an average IMT of 1.22+/-0.2 mm, with a variance range from 1.14+/-0.19 mm in the mild and moderate fibrosis (<=F2) group to 1.29+/-0.25 mm in the severe fibrosis (>=F3) group. Also, patients with severe fibrosis (>=F3) present a more critical decrease of IMT values, with the carotid thickness affecting only 18.2% of individuals in the follow-up period. At the baseline, the best values of ABI were recorded in patients having F1-F2 fibrosis stage (mean value 1.02+/-0.19). Instead, in the group with severe fibrosis, the average value of ABI was lower (0.91+/-0.16) at the baseline, with a significant increase at SVR evaluation (p<0.001). Conclusions: Our research highlights the beneficial effect of viral eradication on both carotid atherosclerosis and PAD, especially in those with advanced fibrosis and cirrhosis.

Corresponding author: Ana-Maria Singeap, Associate Professor, MD, PhD; e-mail: anamaria.singeap@yahoo.com; Robert Radu Nastasa, Assistant Professor, MD; e-mail: robertnastasa948@gmail.com

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5. In vitro effects of heparin-binding epidermal growth factor on adhesion stage of implantation

Burcu Biltekin, Ayhan Bilir, Ismail Seckin, Gozde Erkanli Senturk

A member of the epidermal growth factor (EGF) family, the heparin-binding EGF (HB-EGF) is expressed in the uteri of both humans and mice during the implantation process. To study the effects of HB-EGF on adhesion stage, we developed an in vitro implantation model employing Ishikawa cell line and JAR cell line, which may attach to Ishikawa cells. For 1, 6, 12, and 24 hours, co-cultures of JAR spheroids grown on Ishikawa monolayers were treated with 1, 10, and 100 ng/mL doses of HB-EGF. Using immunocytochemistry and Western blot analysis, the effects of HB-EGF on the protein expressions of E-cadherin, Erb-B2 receptor tyrosine kinase 4 (ErbB4), and integrin alphavbeta3 in Ishikawa and JAR cells were examined semi-quantitatively and quantitatively. Ultrastructural changes of in vitro implantation model were investigated by transmission electron microscopy. We revealed that HB-EGF influenced trophoblast cell adhesion to endometrial cells by upregulating the expression of the proteins ErbB4 and trophoblastic integrin alphavbeta3. Decrease in trophoblastic E-cadherin expression and increase in endometrial E-cadherin expression were demonstrated accompanying morphological variations in cells required for the invasion. We discovered ultrastructurally that Ishikawa cells acquired uterodome-like appearance, including the organelles, when 10 and 100 ng/mL dosages of HB-EGF were administered for 12 and 24 hours. However, following additional hours of adhesion and invasion, their intercellular spaces enlarged. The trafficking of vesicular transport was enhanced by JAR spheroids. We therefore discovered that in this implantation paradigm, HB-EGF may enhance the receptivity of Ishikawa cells and the adherence of JAR cells.

Corresponding author: Burcu Biltekin, PhD; e-mail: burcubiltekin@gmail.com

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6. Incidental carcinoma of the prostate in cystoprostatectomy specimens - is it always a toothless lion?

Vlad Dema, Alexei Croitor, Andreea Floruncut, Sorin Dema, Tiberiu Razvan Bardan, Sorina Maria Taban, Robert Alexandru Barna, Bianca Roxana Nataras, Alin Adrian Cumpanas

Incidental prostate carcinoma (iPC) is a subject of debate concerning its definition, incidence, biology, diagnosis, staging, and treatment. The present study aimed to assess the incidence and main clinical-morphological characteristics of iPC identified in radical cystoprostatectomy (RCP) specimens over a 5-year period. Using the database of the Urology and Pathology Departments, we identified all patients with bladder carcinomas (BCs) who underwent RCP within a 5-year frame time. We selected only those patients with synchronous BC and prostate carcinoma (PC). The following parameters were analyzed for these patients: age, type of bladder and prostate tumor, degree of differentiation, pathological stage, and other prognostic parameters. We identified 91 men with bladder tumors treated by RCP among whom 43, aged between 53 and 84 years (mean age: 69.2 years), presented synchronous PC. iPC was more prevalent in older individuals (>65 years: 30 patients, 69.8%), with only six out of the 43 (12.8%) patients with iPC being aged <=60 years. All iPC cases were conventional adenocarcinoma. Well-differentiated prostate adenocarcinomas (grade group 1) predominated (65.1%). Among the 43 iPCs, 16 (37.2%) were clinically significant PCs. iPC is frequently identified in patients with BC when inclusion and evaluation of all or most of the prostate tissue are performed. Although more than half of iPCs were well-differentiated tumors confined to the prostate, a significant number of cases met the criteria of clinically significant PC. All men over the age of 50 who are candidates for RCP, should undergo evaluation through serum prostate specific antigen determination.

Corresponding author: Alexei Croitor, Assistant Professor, MD, PhD Student; e-mail: alexei.croitor@umft.ro

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7. Clinicopathological characteristics and prognostic factors of atypical meningiomas with bone invasion: a retrospective analysis of nine cases and literature review

Andrei Ionut Cucu, Claudia Florida Costea, Georgiana Macovei, Gabriela Florenta Dumitrescu, Anca Sava, Laurentiu Andrei Blaj, Iulian Prutianu, Elena Porumb-Andrese, Cristina Gena Dascalu, Mihaela Cosman, Ion Poeata, Serban Turliuc

Background: Meningiomas are the most common primary neoplasms of the central nervous system in adults, arising from the arachnoid cap cells. Thus, grade 2 meningiomas are situated on the border between benignity and malignancy. Among the many prognostic factors that have been investigated in these tumors, bone invasion is one of them. Objective: The aim of our study was to identify whether bone invasion influences tumor recurrence and progression-free survival (PFS) in patients with atypical meningiomas (AMs). Patients, Materials and Methods: Out of 81 patients with AMs followed over a period of five years, we identified nine patients with bone invasion. We analyzed their demographic, clinical, imaging, and pathological characteristics, such as age, gender, radiological aspects, morphological features, extent of resection, recurrence rate, and PFS over a follow-up period of 60 months. Bone invasion was determined based on preoperative, surgical, and pathological reports. Results: Out of the nine patients with bone invasion, four had convexity meningiomas, four had parasagittal meningiomas and one had a falcine meningioma. Regarding tumor recurrence/progression, most patients (n=6) recurred within the first 24 months after surgery. Our study showed that the early recurrence/progression of tumor (at 12 months) correlated with extensive presence of malignancy criteria, especially with the presence of 15-18 mitoses/10 high-power fields, as well as with large foci of spontaneous necrosis, but also with tumor bone infiltration, extensive bone lamellae destruction, and tumor infiltration of adjacent muscle with its atrophy due to tumor compression. Patients with bone invasion had a PFS of 29.3 months, compared to patients without invasion who had a higher PFS (49.3 months). Significant statistical associations were observed between bone invasion and tumor recurrence (p=0.002) and PFS (p=0.004). Conclusions: Our study emphasizes the importance of a thorough histopathological examination of the surgical specimen, which can provide significant data for the assessment of the progression of an AM [World Health Organization (WHO) grade 2] with bone invasion. AM infiltration in adjacent bone and muscle increases the rate of tumor recurrence and decreases PFS over a follow-up period of 60 months.

Corresponding author: Claudia Florida Costea, Professor, MD, PhD; e-mail: costea10@yahoo.com; Georgiana Macovei, Associate Professor, MD, PhD; e-mail: georgiana.macovei@umfiasi.ro

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8. Symptomatic pericardial cysts and dilemmas in their diagnosis

Adriana Grigoras, Cornelia Amalinei, Irina-Draga Caruntu, Constantin Cristian Grigoras, Irina Rodica Chiselita, Radu Adrian Crisan-Dabija

Pericardial cysts (PCs) or pleuropericardial cysts are rare congenital mediastinal lesions with an approximate incidence of one in 100 000 persons. Usually, they are asymptomatic, being incidentally discovered during a routine chest imaging examination or an autopsy exam. The study involved a retrospective evaluation of clinicopathological findings in a 6-year series of PCs, treated in the Clinic of Pulmonary Diseases, Iasi, Romania. A group of five cases of PCs, four females and one male, were evaluated. All patients displayed different symptoms, such as dyspnea, chest pain, chronic cough, fatigue, palpitation, and epigastric pain. The cystic lesions were located in the right and left cardiophrenic angle, in four cases, and in the central mediastinum in a single case. The lesions had a fluid content and a maximum diameter that ranged between 35 and 95 mm. The microscopic examination of the surgical resection tissues revealed a thin connective tissue wall without any associated smooth muscle cells. The loose connective tissue band was lined by a layer of mesothelial cells with no cellular atypia, which displayed discrete papillary projections, in one case. Although PCs are rare incidental findings, they should be considered in differential diagnoses of mediastinal cysts, especially as they are associated with non-specific symptoms. Furthermore, considering the possibility of development of severe complications, PCs should be thoroughly explored for suitable patients management.

Corresponding author: Cornelia Amalinei, Professor, MD, PhD; e-mail: cornelia.amalinei@umfiasi.ro; Adriana Grigoras, Associate Professor, MD, PhD; e-mail: adriana.grigoras@umfiasi.ro, a_grigoras6600@yahoo.com

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9. Post-COVID-19 enterocolitis - a cause of rebellious diarrhea, acute abdomen and liver failure

Cosmin Vasile Obleaga, Rukie Ana Maria Ahmet, Dan Nicolae Florescu, Dragos Marian Popescu, Cristian Mesina, Liliana Streba, Cristin Constantin Vere, Cristian Constantin

Currently, worldwide, the coronavirus disease 2019 (COVID-19) pandemic, which first appeared in Wuhan, China, in December 2019, is capsizing the medical system and turning the attention of the entire healthcare system through the many aspects it presents, both from a pathophysiological and from a semiological view, insufficiently studied aspects. With a high rate of morbidity and mortality, the COVID-19 pandemic was initially observed as a pathology leading to a severe acute respiratory syndrome, but over time gastrointestinal and hepatic manifestations have been reported. The study includes an analysis of 21 patients in the stage of the clinical disease of COVID-19 or in the stage of recovery, hospitalized in the Departments of General Surgery II or Gastroenterology, Emergency Clinical County Hospital of Craiova, Romania, with predominantly digestive symptoms, with the clinical expression of infectious enterocolitis, although stool culture was negative for pathogenic bacteria. The evolution of patients was influenced by the appearance of peritonitis through colonic necrosis or remission of clinical symptoms under empirical therapy.

Corresponding author: Liliana Streba, Lecturer, MD, PhD; e-mail: liliana.streba@umfcv.ro; Dragos Marian Popescu, Associate Professor, MD, PhD; e-mail: dragos.popescu@umfcv.ro

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10. Histological findings for the absorption of small and large liposomes - the basis of future drug delivery and contrast media systems

Roxana Florentina Sufaru, Cristinel Ionel Stan, Catalina Anisoara Peptu, Liviu Ciprian Gavril, Dragos Andrei Chiran, Dragos Valentin Crauciuc, Eduard Gabriel Crauciuc, Mihaela Adela Iancu, Ruxandra Vatavu, Codrin Gabriel Lucasievici, Ana Maria Dumitrescu, Anca Sava

Background and Objectives: The purpose of our study was to obtain and characterize carrier systems in different sizes that can affect oral absorption, since the mechanisms of liposome absorption are not yet fully understood. From stomach to the small intestine, liposomes can be gradually destroyed. Understanding the factors that affect oral absorption leads to developing safe and effective nanosystems to improve the oral delivery of therapeutics. Materials and Methods: We determined the efficiency of the absorption of small and large liposomes at the level of gingival mucosa, heart, liver, testicles, kidneys, and lungs, using frozen-section fluorescence microscopy, on rat tissues after liposomes administration. A number of 36 male rats were divided in four groups: control groups, A and C, consisted of six rats each and did not receive liposomes; two other groups, B and D, were the experimental ones, and consisted of 12 male rats each. The animals received small liposomes (75-76 nm) and large liposomes (80-87 nm), respectively, administered either by endogastric tube or intraperitoneal injection. After 24 hours, the animals were sacrificed, and we harvested the organs. We performed frozen sections and analyzed them with fluorescence microscopy. Results: The frozen sections obtained from all organs revealed a higher absorption level of small liposomes in the testicles, liver, and gum, while the large liposomes had a greater affinity for the liver, with variations dependent on the route of administration. Conclusions: Frozen-section fluorescence microscopy is a reliable technique for visualization of liposome absorption. Based on the size of these nanosystems, we revealed significant absorption for small liposomes in testicles, liver, heart, and gum, and for large liposomes mainly in the liver, compared with the control groups. The study advocates for the usage of liposomes for medical purposes, based on their absorption proprieties.

Corresponding author: Liviu Ciprian Gavril, Senior Assistant Professor, MD, PhD; e-mail: liviu.gavril@umfiasi.ro; Dragos Andrei Chiran, Senior Assistant Professor, MD, PhD; e-mail: dragos-andrei.chiran@umfiasi.ro

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11. Time to redefine hyperuricemia? The serum uric acid cut-off level for precipitation might be lower: a pilot study

Ananu Florentin Vreju, Cristina Dorina Parvanescu, Adina Turcu-Stiolica, Stefan Cristian Dinescu, Sineta Cristina Firulescu, Andreea Lili Barbulescu, Andreea Beatrice Chisalau, Razvan Adrian Ionescu, Horatiu Valeriu Popoviciu, Cristina Elena Gofita, Roxana Mihaela Dumitrascu, Cristina Gabriela Ene, Florin Liviu Gherghina, Paulina Lucia Ciurea, Claudiu Avram

Background: Hyperuricemia is classically defined as serum uric acid (SUA) value higher than 6.8 mg/dL; between hyperuricemic patients, only 15-20% will develop gout. Our first goal was to find if there is a specificity of the snowstorm feature on ultrasound (US) for hyperuricemia. Moreover, we aimed to determine if there is a level of SUA from which the urates tend to appear in the synovial fluid, without generating a typical clinical gouty flare. Patients, Materials and Methods: We conducted a cross-sectional, transverse study, including 108 consecutive patients that displayed a set of clinical and imaging features, such as swollen knee and US proof for knee joint effusion. Results: Performing binary logistic regression, the relation between the explanatory variable (hyperechogenic spots) and the response variable (SUA) was demonstrated to be a significant one (p=0.005). The value of 0.397 for the statistical phi coefficient suggests a medium intensity association between the diagnosis of gout or asymptomatic hyperuricemia and whether the patients have hyperechogenic spots or not. We found the cut-off value for SUA equal to 4.815 mg/dL, regardless of gender, from which, the urate starts to precipitate. Values for men tend to be higher in comparison to the ones found for women (4.95 mg/dL vs. 3.9 mg/dL). Conclusions: The snowstorm aspect of the fluid might be the result of an increased level of SUA and more than this, the cut-off level for SUA to precipitate might be lower than the fore used values.

Corresponding author: Adina Turcu-Stiolica, Professor, PhD; e-mail: adina.turcu@gmail.com; Razvan Adrian Ionescu, Lecturer, MD, PhD; e-mail: tane67@gmail.com

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12. The influence of SARS-CoV-2 on the immune system elements and on the placental structure. Clinical, histological and immunohistochemical study

Cristina Jana Busuioc, Gabriela-Camelia Rosu, George-Lucian Zorila, Laurentiu Mogoanta, Anca-Maria Istrate-Ofiteru, Daniel Pirici, Ilona Mihaela Liliac, Larisa Iovan, Elena Iuliana Anamaria Berbecaru, Maria-Cristina Comanescu, Sergiu Marian Cazacu, Dominic-Gabriel Iliescu

Background: The effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy remain relatively unknown. Aim: We present this original paper where we analyzed 60 parturients, at term, 30 without associated infection (C-) and 30 with associated infection (C+), present at birth. Methods: We analyzed the blood count and placental microscopic structure through classical and immunohistochemical staining and observed the placental areas affected by the presence of SARS-CoV-2. Results: SARS-CoV-2 infection was accompanied by a decrease in the number of lymphocytes, the number of platelets and the presence of placental structural changes, identifying extensive areas of amyloid deposits, placental infarcts, vascular thrombosis, syncytial knots, with a decrease in placental vascular density and the presence of infection in the cells located at decidual level, at syncytiotrophoblast level and at the level of the cells of the chorionic plate, still without overcoming this barrier and without causing any fetal infection in the analyzed cases. Conclusions: This study shows that the invasion of SARS-CoV-2 in the placenta can produce significant structural changes, with a decrease in placental vascular density that can have significant implications on proper fetal perfusion. Also, the presence of immunoreactivity at the level of decidua, the placental villi, as well as the chorionic plate proves that the virus can overcome the maternal-fetal barrier. However, in the analyzed cases there were no fetal infections at birth, which may show that local placental factors can be a protective filter for the fetus.

Corresponding author: Anca-Maria Istrate-Ofiteru, MD, PhD; e-mail: ancaofiteru92@yahoo.com; Maria-Cristina Comanescu, MD, PhD; e-mail: cristinacomanescu85@gmail.com

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13. Kaposi s sarcoma of the larynx: case series

Mircea Sorin Ciolofan, Florin Anghelina, Carmen Aurelia Mogoanta, Alexandru Nicolae Vlaescu, Mihaela Roxana Mitroi, Alina Nicoleta Capitanescu, Charoula Florou, Anca-Maria Istrate-Ofiteru, Gheorghe Iovanescu

Kaposi s sarcoma (KS) represents a type of cancer that usually arises on the skin and very rarely in other organs. KS-associated herpesvirus (KSHV), also known as human herpesvirus-8 (HHV-8) commonly arises in patients with acquired immunodeficiency syndrome (AIDS). Laryngeal involvement of KS is very rare. Our study comprised of three cases with laryngeal KS. All cases were solved through surgical excision of the tumor. Histopathological and immunohistochemistry examinations revealed laryngeal KS. Laryngeal KS should be managed through surgical resection, followed by oncological treatment.

Corresponding author: Carmen Aurelia Mogoanta, Associate Professor, MD, PhD; e-mail: carmen_mogo@yahoo.com; Alexandru Nicolae Vlaescu, MD, PhD; e-mail: alex.vlaescu@gmail.com

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14. Zinc-Boron-PLGA biocomposite material: preparation, structural characterization, and in vitro assessment

Maria Viorica Ciocilteu, Ion Romulus Scorei, Gabriela Rau, Claudiu Nicolicescu, Andrei Bita, Vladimir Lucian Ene, Andreea Simionescu, Adina Turcu-Stiolica, Venera Cristina Dinescu, Johny Neamtu, Laurentiu Mogoanta, George Dan Mogosanu

Nowadays, the state-of-the-art discoveries in the field of delivery systems for therapeutic purposes have redefined the importance of biocompatible and biodegradable poly(lactic-co-glycolic acid (PLGA) nanocomposites. The study aimed to obtain a biocomposite material, with improved properties of its constituents [zinc-boron (Zn-B) complex and PLGA], by a simple, cost-effective method. The water/oil/water double emulsion technique allowed the adjustment of the synthesis parameters, to maximize the degree of Zn-B complex encapsulation. The morphological aspects of the samples were established by scanning electron microscopy (SEM). Particle size distribution was determined by dynamic light scattering (DLS). Morphology was typical for PLGA, spherical one. Depending on the synthesis conditions, the obtained particles have diameters between 10-450 nm. Zeta potential (ZP) showed that the particles have electronegative surface charge, offering a favorable perspective on aggregation, flocculation, and dispersion phenomena. It was observed, applying the design of experiments, that the particles size increased with increasing amounts of PLGA and polyvinyl alcohol (PVA), while ZP increased with higher PLGA and smaller PVA amounts in the formulation. The encapsulation efficiency was determined by ultra-high performance liquid chromatography/mass spectrometry (UHPLC/MS). The in vitro assessment was performed using Vero CCL-81 epithelial cell line and the 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test. Zn-B-PLGA biocomposite has promising characteristics and can be used for future biomedical applications.

Corresponding author: Ion Romulus Scorei, Professor, PhD; e-mail: romulus_ion@yahoo.com; Claudiu Nicolicescu, Associate Professor, PhD; e-mail: nicolicescu_claudiu@yahoo.com

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15. Intracardiac mass presenting as acute myocardial infarction

Diana Ruxandra Hadareanu, Mihaela Corina Berceanu, Roxana Daniela Stroescu, Sebastian Militaru, Constantin Militaru, Calin Dinu Hadareanu, Victor Cornel Raicea, Nelu Irinel Sosea, Elian Octavian Boldu, Oana Cristina Munteanu Mirea, Razvan Ilie Radu, Ioana Andreea Gheonea, Mihai Marius Botezat, Cristian Militaru

Cardiac tumors, although rare, present intricate diagnostic and therapeutic challenges, necessitating timely intervention for optimal patient outcomes. This case report focuses on a 65-year-old woman admitted with chest pain and loss of consciousness, ultimately diagnosed with a left ventricular cardiac myxoma. The patient s presentation mimicked acute coronary syndrome, highlighting the diagnostic complexity associated with cardiac tumors. Advanced imaging modalities, including transthoracic echocardiography, computed tomography, and invasive coronary angiography, played a pivotal role in characterizing the intracardiac mass. Histopathological (HP) examination, utilizing immunohistochemistry, confirmed the tumor as a cardiac myxoma. The patient management involved a multidisciplinary approach, leading to surgical resection of the mass and mitral valve replacement. The case underscores the importance of the HP confirmation in patients with cardiac masses, especially when multimodality cardiac imaging suggests various tumor types, simultaneously emphasizing the need for a comprehensive diagnostic approach that includes advanced imaging and histopathology to ensure an accurate diagnosis and tailored management of cardiac tumors.

Corresponding author: Sebastian Militaru, Assistant Professor, MD, PhD; e-mail: sebastian.militaru@umfcv.ro; Victor Cornel Raicea, Lecturer, MD, PhD; e-mail: dr.raicea.victor@gmail.com

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16. Solitary fibrous tumor developing in the right retroperitoneal space

Cristian Mesina, Cosmin Vasile Obleaga, Mihai Calin Ciorbagiu, Cristin Constantin Vere, Dragos Marian Popescu, Florina Carmen Popescu, Daniel Alin Cristian, Mihaela-Iustina Mesina-Botoran

Solitary fibrous tumor (SFT) is a rare mesenchymal tumor that is quite aggressive and prone to recurrence and metastasis. Most SFTs are benign, but the identification of the histological features that define the dedifferentiation of SFTs can predict the aggressiveness of the tumor and the presence of a reserved prognosis. We present a rare case of conventional SFTs with features of malignancy and highlight the diagnostic and therapeutic difficulties related to this case. Computed tomography aspect suggested a possible gastrointestinal stromal tumor. Surgical intervention was performed through median laparotomy and a tumor of approximately 15/12 cm was found, developed from the level of the right retroperitoneal space, and pushing anteriorly the ascending colon, cecum, and terminal ileum. The immunohistochemical aspect correlated with the histopathological one suggests a SFT most likely malignant. In conclusion, the early diagnosis of SFTs is essential in establishing an appropriate treatment. Immunohistochemistry is indispensable in establishing the diagnosis of SFTs.

Corresponding author: Mihai Calin Ciorbagiu, Assistant Professor, MD, PhD; e-mail: mihai.ciorbagiu@gmail.com; Cosmin Vasile Obleaga, Lecturer, MD, PhD; e-mail: cosmin.obleaga@gmail.com

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17. Giant exophytic gastrointestinal stromal tumor (GIST) causing gastric outlet obstruction: case report and review of literature

Victor-Mihai Sacerdotianu, Cecil Sorin Mirea, Petrica Popa, Dan Ionut Gheonea, Maria Camelia Foarfa, Marius Matei, Daniela Larisa Sandulescu, Cristian Virgil Lungulescu, Tudorel Ciurea, Bogdan Silviu Ungureanu

Background: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors, mostly located within the stomach. About 30% of GISTs are incidentally diagnosed and as they become symptomatic may be associated with bleeding, bowel obstruction or spontaneous rupture. Case presentation: We present the case of a middle-aged patient diagnosed with a giant gastric GIST, which presented for intermittent gastric outlet obstruction symptoms, and emphasize the major imagistic, histopathological, and therapeutic challenges that may be encountered. There are only several cases of gastric exophytic gastric GIST provoking intermittent gastric outlet obstruction. Tumor resection should be adapted to every patient s status, focused on en bloc extraction, with preservation of invaded organs as much as possible.

Corresponding author: Marius Matei, Lecturer, MD, PhD; e-mail: marius.matei@umfcv.ro; Cecil Sorin Mirea, Professor, MD, PhD; e-mail: mirea_cecil@yahoo.com, mirea_cecil@yahoo.com

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18. Conference Announcement: The XIXth National Symposium, with international participation, on Microscopic Morphology, Craiova, Romania, May 29-June 2, 2024

Laurentiu Mogoanta

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