ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Vol. 67 No. 2, April-June 2026

1. Postoperative abdominal wall actinomycosis mimicking malignancy: a case report and literature review

Daniel Ioan Mihalache, Laurentiu Augustus Barbu, Tiberiu Stefanita Tenea-Cojan, Nicolae Dragos Margaritescu, Stelian Stefanita Mogoanta, Liviu Vasile, Niculae Iordache

Background/Objectives: Actinomycosis is an uncommon chronic bacterial infection that may present as an infiltrative mass mimicking malignancy. Abdominal wall involvement, particularly after abdominal surgery, is rare and may pose a considerable diagnostic challenge. Study selection: A focused narrative review of PubMed was conducted to identify reports of abdominal and abdominal wall actinomycosis, focusing on clinical presentation, predisposing factors, diagnosis, treatment, and outcomes. Eleven relevant case reports were included in the comparative analysis. Case presentation: We report a 72-year-old woman with a history of left hemicolectomy for colorectal carcinoma who developed a progressively enlarging painful mass of the left abdominal wall. Computed tomography revealed an infiltrative soft tissue lesion extending toward adjacent retroperitoneal structures, raising suspicion for recurrent malignancy or soft tissue sarcoma. Surgical excision was performed. Histopathological (HP) examination revealed sulfur granules with radiating filamentous structures and surrounding Splendore-Hoeppli material within a dense suppurative inflammatory reaction, associated with granulation tissue and reactive fibrosis. These findings supported the diagnosis of abdominal wall actinomycosis. The patient received prolonged Penicillin-based antibiotic therapy, with a favorable outcome. Conclusions: Abdominal wall actinomycosis should be considered in the differential diagnosis of infiltrative masses, particularly after abdominal surgery. HP examination and appropriate special stains are essential for distinguishing this rare infection from malignancy and other mimics.

Corresponding author: Laurentiu Augustus Barbu, Assistant Lecturer, MD, PhD; e-mail: laurentiu.barbu@umfcv.ro; Liviu Vasile, Lecturer, MD, PhD; e-mail: vliviu777@yahoo.com

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2. SARS-CoV-2-related immune dysregulation and biologically plausible pathways to lymphomagenesis: a PRISMA-ScR-based scoping review

Paul-Catalin Toboltoc, Adela Vekony, Ioana Gagiu

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related immune dysregulation has generated interest in diagnostic pathology because infection-related inflammation, long coronavirus disease (COVID)-related immune disturbance, and post-vaccination lymphoid reactions may overlap with lymphoid-biological mechanisms and complicate the distinction between reactive lymphoid proliferations and lymphoid neoplasia. Aim: This scoping review aimed to map biologically plausible pathways through which SARS-CoV-2-associated immune perturbation may intersect with lymphomagenesis-related mechanisms, emphasizing diagnostic implications rather than causality. Materials and Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed/MEDLINE, Scopus, and Web of Science were searched from January 2020 to March 2026, with selected pre-2020 sources retained for mechanistic or diagnostic relevance. Sources were charted across mechanistic, immunological, virological, clinicopathological, and diagnostic domains. Results: After screening and eligibility assessment, 63 sources were retained for thematic synthesis. Evidence clustered around lymphoma-relevant but non-specific mechanisms, including inflammatory signaling, impaired immune surveillance, latent oncogenic viral reactivation, prolonged germinal-center activity with activation-induced cytidine deaminase (AID)-related genomic vulnerability, and lymphoid microenvironment remodeling. These mechanisms appear most relevant in predisposed hosts with chronic immune dysregulation, latent viral infection, defective deoxyribonucleic acid (DNA) repair, or occult abnormal lymphoid clones. Infection and vaccination are distinct contexts, because infection may produce broader immune disruption, whereas most post-vaccination nodal events are reactive and self-limited. Conclusions: Current evidence supports biological plausibility rather than a direct or generalizable causal relationship. The main diagnostic implication is careful clinicopathological correlation and distinction between reactive lymphoid proliferations and lymphoid neoplasia in post-COVID-19 and post-vaccination settings.

Corresponding author: Paul-Catalin Toboltoc, MD, PhD Student; e-mail: paul.toboltoc@gmail.com

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3. Subglottic stenosis in granulomatosis with polyangiitis: clinical, histopathological and therapeutic considerations with presentation of two cases

Bianca Rusu, Gabriela Cornelia Musat, Carmen Aurelia Mogoanta, Alex Iulian Milea, Caius Codrut Sarafoleanu

Granulomatosis with polyangiitis (GPA), once known as Wegener s granulomatosis (WG), is an uncommon systemic vasculitic disorder characterized by inflammation of the vascular walls, particularly affecting the respiratory tract. One serious complication is subglottic stenosis (SGS), a narrowing of the airway just below the vocal cords. While uncommon, it can be life-threatening and may show up as stridor, dyspnea, or voice changes. Sometimes, it is the first or only sign that someone has GPA. Diagnosing this condition takes a combination of clinical evaluation, imaging, endoscopy, and blood tests for specific antibodies [anti-neutrophil cytoplasmic antibodies (ANCA)]. Tissue biopsy is especially valuable, it can confirm the diagnosis by showing the characteristic inflammation patterns, particularly when the disease presents in unusual ways. Treatment typically involves both systemic immunosuppressive medications and, when necessary, procedures to open up the narrowed airway. We present two cases of GPA-associated SGS that highlight how differently this condition can present, the challenges of managing a compromised airway, and the need for tailored treatment plans. These cases reinforce why early detection of airway involvement matters, why patients need careful long-term monitoring to watch for re-narrowing, and why a team-based approach across specialties leads to the best outcomes.

Corresponding author: Carmen Aurelia Mogoanta, Associate Professor, MD, PhD; e-mail: carmen_mogo@yahoo.com; Gabriela Cornelia Musat, Associate Professor, MD, PhD; e-mail: gabimusat@yahoo.com

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4. Beyond H&E: CDX2 immunohistochemistry in tumor budding assessment of colorectal carcinoma

Aminia Diana Ciobanoiu, Gheorghe Gindrovel Dumitra, Iancu Emil Plesea, Anwar Erchid, Valentin Titus Grigorean

Background and Objectives: Tumor budding (TB) phenomenon is recognized as one of the important adverse prognostic factors of colorectal carcinoma (CRC) and is currently assessed following to the International Tumor Budding Consensus Conference (ITBCC) recommendations on routine Hematoxylin and Eosin (H&E)-stained slides. However, TB evaluation may become difficult in cases showing inflammatory infiltrates, stromal desmoplasia, or glandular fragmentation. Immunohistochemical (IHC) markers, including caudal type homeobox 2 (CDX2), may improve the identification of isolated tumor buds in such situations. Patients, Materials and Methods: The retrospective study included 170 CRC cases selected from the archives of a single regional pathology center. TB was evaluated on both H&E-stained and CDX2-immunostained slides according to a modified ITBCC-based grading system including an additional Bd0 category for cases lacking identifiable tumor buds. Tumor buds were counted within a standardized field area. TB distribution was evaluated in the proximal, middle, and distal tumor regions. Results: Low-grade budding lesions predominated in all evaluated tumor regions on both H&E and CDX2 assessment. Regional variation in TB distribution was observed along the invasive tumor front, supporting the presence of spatial heterogeneity in CRC. Comparative analysis of TB evaluation on H&E-stained preparations and on CDX2 immunolabeled preparations revealed the existence of differences between the two methods, especially in cases with low or intermediate budding activity. CDX2 immunostaining facilitated the identification of additional tumor buds, leading to the reclassification of a number of cases to higher budding categories (intermediary and high-grade budding lesions), especially in difficult cases, characterized by intense stromal reaction, inflammation or glandular fragmentation. Conclusions: The present study demonstrated that IHC labeling should be considered primarily as a detection tool for accurate TB assessment, but other antibodies should be tested to increase the accuracy of tumor bud identification.

Corresponding author: Gheorghe Gindrovel Dumitra, Associate Professor, MD, PhD; e-mail: gindrovel.dumitra@umfcv.ro; Iancu Emil Plesea, Professor, MD, PhD; e-mail: emil.plesea@umfcd.ro

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5. Mast cells - key players of digestive tumors associated angiogenesis

Raluca Stefana Ioana Mos, Amalia-Raluca Ceausu, Nela-Pusa Gaje, Valeria Nicoleta Nastase, Alexandru Ciolofan, Adelina Tudor, Iulian Alexandru Ciprian Blidisel, Diana Carmen Matcau, Adina Octavia Duse, Amalia Nicolescu, Maria Daniela Mot, Adina Ligia Pop-Moldovan, Liana Mioara Mos, Octavian Marius Cretu, Flavia Zara, Ovidiu Alexandru Mederle, Marius Raica

Introduction: Mast cells (MCs) are immune cells derived from hematopoietic cluster of differentiation (CD)34+ and CD117+ precursors that complete their maturation in peripheral tissues such as the connective and mucosal layers, perivascular and perineural regions, and secondary lymphoid organs, where they play essential roles in regulating immune responses. The MC s dual role as both an effector and regulator of angiogenesis makes it a valuable indicator of tumor aggressiveness and a potential therapeutic target in digestive malignancies. Materials and Methods: 41 cases of digestive tumors with gastric, pancreatic and colorectal origins and their corresponding liver metastasis were evaluated by morphological and immunohistochemical techniques. The effects of Sodium Cromoglycate (Cromolyn) applied to a xenograft of cells derived from a liver metastasis of colorectal origin with a desmoplastic histological growth pattern, applied to chorioallantoic membrane (CAM) were analyzed. CD34 and mast cell tryptase (MCT) were used as primary antibodies. Results: A statistically significant correlation was noticed between mast cell density (MCD) outside the metastasis area and microvascular density (MVD) in the metastasis area with pancreatic origin (p=0.023). A statistically significant correlation was noted with a p-value of 0.046 for the desmoplastic histological growth pattern, between MCD in the metastatic area and the degree of differentiation. After therapy with Cromolyn, increased MVD and the absence of positive MCT were noticed in the xenograft. Conclusions: The analysis of MCD demonstrated marked variability depending on tumor type, differentiation, and histological growth pattern. Targeting MC activation could represent an adjuvant of anti-angiogenic therapy in metastatic digestive cancers.

Corresponding author: Amalia-Raluca Ceausu, Habil. Associate Professor, MD, PhD; e-mail: ra.ceausu@umft.ro

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6. Remodeling of intramyocardial tissue capillaries density depending on age, sex and cause of death

Laura Elena Camenita, Razvan Mihail Plesea, Cristina Florescu, Mircea-Sebastian Serbanescu, Iancu Emil Plesea, Valentin Titus Grigorean, Tiberiu Tataru

Aim: Aging together with the wide range of diseases causing death are ones of the influential factors of cardiac wall remodeling regarding both their structural and functional features. The authors compared the changes of myocardial interstitial capillary network density (vascular density - VD) between the main regions of the cardiac wall during patients ageing and depending on patients cause of death. Patients, Materials and Methods: Five cross-sections from epicardium to endocardium [left ventricle wall (LVW): anterior segment (LV_AW), lateral segment (LV_LW), and posterior segment (LV_PW); interventricular septum (IVS); and right ventricle wall (RVW)] were collected during necropsies from 95 patients died with different ages (AP_01, 0-24 years; AP_02, 25-44 years; AP_03, 45-64 years; and AP_04, >64 years) and with different types of causes of death (V_P - vascular diseases, NV_P - non-vascular diseases, and S/V_Dth - suspect/violent cause of death, considered also control group - CG) in the hospital. Tissue samples were processed classically and immunomarked with anti-cluster of differentiation 34 (CD34) antibody. Glass slides were transformed into virtual slides. The VD was determined with a dedicated built program. Mean values (AVs) were compared with Pearson s correlation test. Results: On one hand, VD increased slowly from youth to elderly in LV_Ws and decreased with age in the IVS and RVW. It had the lowest values in LV_Ws till AP_03 and in RVW in elderly. The highest values were in RVW till 44 years and then in IVS. VD had higher values in women than in men along the main regions of the cardiac wall and a divergent behavior, with age, in the two sexes. Thus, in men, VD had an increasing trend with age from LV_AW to RVW [correlation matrix (CM) positive, p-value >0.05] whereas in women, the trend was decreasing with age from LV_AW to RVW (CM negative, p-value >0.05), excepting IVS where it increases (CM positive). On the other hand, the VD had lowest values in V_P group and highest values in CG in general and in both sexes. Its values increased from LVW to RVW in V_P group and CG and decreased in NV_P group in general and in both sexes. They also increased from LV_AW toward LV_PW in all groups of COD and in both sexes. The VD AVs were higher in females than in males in CG and NV_P group and higher in males than in females in V_P group. Its values were lowest in both sexes in V_P group but highest in men in NV_P group and in women in CG. Conclusions: VD and is remodeling with aging in different ways both along the cardiac wall s regions and in the two sexes, being generally higher in females than in males. The causing death diseases determine different pathways of interstitial capillary network remodeling both along the different regions of the cardiac wall and in the two sexes, the most important being the capillary density decrease in vascular diseases as compared with all other causes of death.

Corresponding author: Valentin Titus Grigorean, Professor, MD, PhD; e-mail: grigorean.valentin@yahoo.com, valentin.grigorean@umfcd.ro; Iancu Emil Plesea, Professor, MD, PhD; e-mail: pie1956@yahoo.com, emil.plesea@umfcd.ro

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7. Morphological comparative study between a fifth-generation adhesive system and a universal system in total-etch mode applied at the cervical region

Claudia-Ioana Cojocaru, Horia Octavian Manolea, Claudiu Calin, Petre Costin Marasescu, Bogdan Mihai Galbinasu

For both direct and indirect restorations at the cervical level, the preparation aims to ensure only enamel bonding, due to its proven performance over time. This study sought to evaluate the adhesion to the cervical tooth structure. The aim of the study was to morpho-structurally compare a two-step adhesive system with a universal system in total-etch mode, starting from the hypothesis of the presence of only enamel as the bonding substrate at the level of cavities prepared to the standard depth of 0.4 mm, located 2 mm coronal to the cementoenamel junction. Each adhesive system was assigned a batch of three tooth samples with standard prepared and filled cavities. From each tooth sample, three sections were cut in bucco-lingual direction at the level of the fillings. The sections were prepared for examination by scanning electron microscopy (SEM), using a specific protocol for demineralization and deproteinization. The fifth generation system presented well-represented enamel micro-retentions. Hiatuses were observed at the level of the dentin hybrid layer, despite the formation of intra-tubular resin plugs. The universal system presented less evident micro-retentions on enamel. The thickness of the adhesive layer of the universal system presented higher values compared to the fifth generation system, for both hard dental tissues. Minimal preparations may present dentin exposure, depending on the location of the cervical termination. Acid etching before applying the universal system increased its performance. In the case of enamel, the fifth generation system shows a more favorable adhesion, due to micro-mechanical retention.

Corresponding author: Claudiu Calin, Lecturer, DMD, PhD; e-mail: claudiu.calin@umfcd.ro; Petre Costin Marasescu, Lecturer, DMD, PhD; e-mail: petre.marasescu@umfcv.ro

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8. Clinicopathological and ultrasound assessment of endometrial hyperplasia in perimenopausal women

Valentin Teodor Motateanu, Razvan Grigoras Capitanescu, Stefan Paitici, Maria Victoria Olinca, Razvan Cosmin Pana, Alexandru Cristian Comanescu, Adrian Victor Tetileanu, Roxana Elena Bohiltea, Costin Berceanu

Background: Endometrial hyperplasia (EH) is a heterogeneous proliferative endometrial disorder frequently encountered during perimenopause, characterized by variable architectural complexity, cytological atypia and biological behavior. Aim: This study aimed to evaluate the clinical, ultrasonographic (US), histopathological (HP) and immunohistochemical (IHC) features of EH in perimenopausal women and to assess the associations between these parameters. Patients, Materials and Methods: This multicenter observational study included 103 perimenopausal women with histopathologically confirmed EH, evaluated between 2020 and 2025. Patients were stratified into two age-defined subgroups: Group A (40-45 years, n=49) and Group B (46-51 years, n=54). All patients underwent standardized US evaluation according to International Endometrial Tumor Analysis (IETA) terminology, followed by HP examination. IHC analysis was performed in selected representative cases. Results: Abnormal uterine bleeding (AUB) was the predominant clinical presentation in both groups. Significant differences between subgroups were observed for previous endometrial biopsy, uterine dimensions, adenomyosis prevalence and endometrial thickness. Group B showed significantly greater uterine dimensions, higher prevalence of adenomyosis and increased mean endometrial thickness. HP evaluation demonstrated a heterogeneous spectrum of architectural, cytological, stromal and vascular alterations. Significant age-related differences were identified for atypical EH/endometrial intraepithelial neoplasia (EIN), nuclear atypia, increased mitotic activity, vascular proliferation and abnormal vascular morphology, all being more frequent in Group B. IHC assessment further demonstrated substantial biological heterogeneity across EH lesions. Conclusions: Perimenopausal EH represents a heterogeneous spectrum of proliferative endometrial lesions with progressive clinicopathological complexity during the perimenopausal transition. Integrated US, HP and IHC assessment provides a comprehensive framework for lesion characterization, particularly in morphologically complex cases.

Corresponding author: Razvan Grigoras Capitanescu, Lecturer, MD, PhD; e-mail: razvan.capitanescu@gmail.com; Stefan Paitici, Lecturer, MD, PhD; e-mail: stefanppaitici@gmail.com

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9. Analysis of circulating bone-glucose profile and exerkine irisin across parathormone quartiles in patients with primary hyperparathyroidism

Ana-Maria Gheorghe, Nina Ionovici, Oana-Claudia Sima, Mihai Costachescu, Adrian Ciuche, Dana Manda, Mara Carsote

Background: Parathyroid tumors, mostly single or multiple adenomas, cause a hormonal imbalance via parathormone (PTH) excess, that further increases serum calcium (primary hyperparathyroidism) with both PTH- and calcium-related multi-organ consequences. Testing the bone turnover markers (BTM) profile might capture the essence of associated bone turnover anomalies with practical applications in the clinical setting. Objective: Our objective was to compare the BTM across mineral metabolism panel, glucose profile, as well as circulating irisin levels in patients with primary hyperparathyroidism vs. (tumor-free) controls by refining the analysis based on PTH values quartiles. Patients, Materials and Methods: A prospective study with a single-center design in menopausal adults, who were enrolled between December 2024 and May 2026. Results: 148 enrolled across four PTH quartiles (mean age 63.39 years and menopause length 16.55 years): 27.09+/-5.56 pg/mL (Q1), 38.33+/-2.58 pg/mL (Q2), 46.34+/-2.93 pg/mL (Q3) and 65.78+/-16.51 pg/mL in Q4 (p<0.001 for each). Glycated hemoglobin (HbA1c) was lower (statistically significantly): Q4 of 5.74+/-0.32% compared to non-Q4 of 5.98+/-0.67% (p=0.006), as well as triglycerides of 103.39+/-36.34 vs. 124.41+/-66.26 mg/dL (p=0.017). Fasting insulin was also different among PTH quartiles, with the highest median value in Q4 of 8.35 (6.47, 11.49) micro-IU/mL (p=0.027). Median homeostatic model assessment for insulin resistance (HOMA-IR) was higher in Q2 vs. Q1 (p=0.034), Q3 vs. Q1 (p=0.016) and Q4 vs. Q1 (p=0.005). Osteocalcin was statistically significantly different among quartiles (p=0.036). Receiver operating characteristic (ROC) curve analysis of osteocalcin to predict primary hyperparathyroidism revealed area under the curve (AUC) 0.645 (p=0.006). The cut-off osteocalcin with the highest Youden index was for the value of 21.26 ng/mL (sensitivity 63.90%; specificity 63.10%). In Q4, irisin associated a statistically significant and positive correlation with the value of calculated body mass index (BMI) (r=0.361, p=0.042). Conclusions: In this PTH-based quartiles analysis of menopausal females with/without primary hyperparathyroidism, we found a distinct interpretation of the glucose profile and BTM depending on quartiles, while irisin positive corelated with BMI in cased with parathyroid tumors.

Corresponding author: Nina Ionovici, Associate Professor, MD, PhD; e-mail: nina.ionovici@umfcv.ro; Adrian Ciuche, Senior Lecturer, MD, PhD, Dr. Habil.; e-mail: adrian.ciuche@umfcd.ro

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10. Alternative cutoffs for cortisol post-Dexamethasone suppression testing: is there a practical point for the bone health evaluation?

Nina Ionovici, Alexandra-Ioana Trandafir, Dana Manda, Ana-Maria Gheorghe, Dana Cristina Terzea, Mara Carsote, Adrian Ciuche

Background: Current guideline-based stratification in the non-secretory adrenal tumors (ADTs) involves the second-day (post-Dexamethasone testing) plasma cortisol (D-C) threshold of <1.8 micro-g/dL to determine a non-functional profile and another one for a mild cortisol secretion (cortisol between 1.8 and 5 micro-g/dL). Objective: To analyze the bone status in terms of mineral metabolism, circulating biomarkers of bone turnover and bone mineral density in menopausal women with ADTs by comparing two population subgroups, according to distinct thresholds for D-C, which are out of the current guidelines (1.4 micro-g/dL and 0.9 micro-g/dL, respectively). Patients, Materials and Methods: A retrospective analysis was conducted in ADT-positive menopausal women. Results: Final analysis included 109 adults: ADT-1 group (52.3%; D-C: <=1.4 micro-g/dL) vs. ADT-2 group (47.7%; D-C: 1.4-5 micro-g/dL) and ADT-3 group (20.2%; D-C: <=0.9 micro-g/dL) vs. ADT-4 group (79.8%; D-C: 0.9-5 micro-g/dL), respectively. ADT-1 group vs. ADT-2 group was at similar age (60.14+/-8.56 vs. 60.08+/-11.85 years), menopause duration (13.85+/-7.41 vs. 14.19+/-8.54 years), body mass index (30.78+/-6.20 vs. 29.23+/-6.73 kg/m(2)), and obesity rate (56% vs. 35.9%). Mineral metabolism assays showed no between-group difference. Both groups experienced a vitamin D deficiency according to 25-hydroxyvitamin D (23.69+/-10.42 vs. 25.35+/-9.98 ng/mL, p=0.481). Except for femoral neck T-score within ADT-1 group (-1.22+/-1.11), all the other dual energy X-ray absorptiometry (DXA) categories were normal. The prevalence of osteoporosis diagnosis was similar: 24.5% vs. 35.4%, with lower fracture rate (3.5% compared to 21.2%, p=0.005). ADT-3 group compared to ADT-4 group showed a similar bone health status. Half of patients suffered from obesity (50% vs. 46.4%, p=0.775). A borderline significance was attributed to a higher total hip T-score in ADT-3 group vs. ADT-4 group (-0.23 vs. -0.87, p=0.06), both with intra-normal values, and a lower fracture rate (0% vs. 14.9%, p=0.053). Osteoporosis diagnosis displayed a statistically significant decrease in the prevalence in ADT-3 group vs. ADT-4 group: 5.6% vs. 35.4% (p=0.042). Conclusions: Menopausal adults with D-C >0.9 micro-g/dL should be mandatory tested for osteoporosis, and those with D-C >1.4 micro-g/dL should be additionally screened for osteoporotic fractures, while age is not different among the subgroups with different cutoffs.

Corresponding author: Alexandra-Ioana Trandafir, MD, PhD Student; e-mail: alexandra-ioana.trandafir@drd.umfcd.ro

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11. Is routine terminal ileum intubation justified during screening colonoscopy? Evidence from a regional screening program

Victor-Mihai Sacerdotianu, Alexandra-Georgiana Bocioaga, Carmen-Nicoleta Oancea, Dumitru Radulescu, Mirela Marinela Florescu, Dan Nicolae Florescu, Dan Ionut Gheonea

Background/Aim: Although colonoscopy represents the cornerstone of colorectal cancer (CRC) screening, the incremental diagnostic yield of routine terminal ileum (TI) intubation remains insufficiently defined, particularly in fecal immunochemical test (FIT) positive patients. This study evaluated the feasibility, diagnostic performance, and clinical relevance of routine TI intubation in participants enrolled in a regional CRC screening program. Patients, Materials and Methods: We performed a retrospective analysis of individuals aged 50-74 years who underwent colonoscopy within a regional CRC screening program in South-West Romania between November 2020 and December 2023. Patients with successful TI intubation were compared with individuals in whom TI exploration was not performed. Demographic characteristics, bowel preparation quality, sedation parameters, comorbidities, procedural variables, and histopathological (HP) outcomes were assessed. Results: The analysis included 1512 complete colonoscopies, of which TI intubation was successfully achieved in 41.86% of procedures. Macroscopic TI abnormalities were identified in 1.74% of patients, including erosions, ulcerations, hyperemia, and nodular or atrophic changes. HP analysis showed findings suggestive of inflammatory bowel disease in 27.27%, celiac disease-related changes in 9.09%, and nonspecific inflammatory alterations in 63.64% of abnormal cases. Successful TI exploration was more commonly observed in patients receiving sedation and in those with better bowel preparation. No significant associations were observed regarding age, sex, or FIT values. Conclusions: Routine TI intubation demonstrated a relatively limited diagnostic yield in this screening population. Although clinically meaningful findings were uncommon, TI assessment may remain valuable in selected clinical settings. Further prospective studies are needed to establish its role in screening colonoscopy.

Corresponding author: Alexandra-Georgiana Bocioaga, Teaching Assistant, MD, PhD Student; e-mail: alexandra.bocioaga@umfcv.ro

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12. Embryological and morphological insights into diagnosing cardiac anatomy in heterotaxy syndrome

Lacramioara Eliza Chiperi, Daniela Toma, Amalia Fagarasan, Liliana Gozar, Alisa Ariana Tivadar

Aim: The aim of this study was to highlight the hypothesis that embryological development and morphological aspects necessitate a comprehensive analysis of all situses and a detailed description of each anomaly, rather than attempting to force the malformation into the rigid categories of heterotaxy syndrome (HS) - left or right isomerism. This hypothesis is supported by describing the anatomy of a complex patient with multiple laterality defects resulting in multiple cardiac and organ malformations. Case presentation: The unique aspect of the presented patient s morphological diagnosis lies in the presence of a leftward heart loop with an unusual shape and direction, with the right ventricle (RV) positioned posterosuperior to the left ventricle (LV). This configuration suggests congenitally corrected transposition of the great arteries, although it deviates from the typical presentation. Additionally, there is an arrest in the development of other embryonic structures, including an atrioventricular septal defect (AVSD) with asymmetric ventricles, hypoplasia of the left-sided morphological RV, and malposition of the great arteries, with the aorta positioned anteriorly and to the right of the stenotic pulmonary artery. There is also another important inconsistency: the atrial situs is solitus within the context of HS, accompanied by left bronchial isomerism, polysplenia, interrupted inferior vena cava, and bilateral superior vena cavae. Conclusions: In our patient s case, the segmental analysis revealed a rare morphological cardiac anatomy. Understanding both normal and pathological embryological cardiac development, and correlating it with the current morphological anatomy, was crucial in ensuring the correct diagnosis and treatment for our patient.

Corresponding author: Lacramioara Eliza Chiperi, MD, PhD; e-mail: lacramioara-eliza.pop@umfst.ro

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13. Letter to the Editor: Integrating histological, cytological and clinical assessment in CRSwNP: a complementary perspective on CHS and CCG

Matteo Gelardi, Rossana Giancaspro, Michele Cassano

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Corresponding author: Matteo Gelardi, MD; e-mail: matteo.gelardi@unifg.it

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