Vol. 61 No. 2, April-June 2020

1. Latest advances in chronic rhinosinusitis with nasal polyps endotyping and biomarkers, and their significance for daily practice

Alma Aurelia Maniu, Maria Ida Perde-Schrepler, Corina-Bianca Tatomir, Mihai Ionut Tanase, Maximilian George Dindelegan, Vlad Andrei Budu, Gheorghe Doinel Radeanu, Marcel Cosgarea, Carmen Aurelia Mogoanta

The term chronic rhinosinusitis (CRS) comprises of an assortment of diseases that share a common feature: inflammation of the sinonasal mucosa. The phenotype classification of CRS, based on the presence of polyps, has failed to offer a curative treatment for the disease, particularly in refractory cases. Chronic rhinosinusitis with nasal polyps (CRSwNP) remains a challenging entity. Researchers have made efforts trying to characterize subtypes of the disease according to the endotypes, which are delineated by different immunological pathways, using biomarkers. Even if the inflammatory processes controlling CRSwNP are not fully understood, data suggested that the disease associated with a type 2 inflammatory mechanisms can be also linked to the type 1 or type 3 pathomechanism, being highly heterogeneous. Biomarkers for CRSwNP are proposed, such as: eosinophil count, cytokines, metalloproteinases, bitter and sweet taste receptors, and the nasal microbiome. For endotyping to be clinically applicable and simply determined, biomarkers referring to the intrinsic biomolecular mechanism still need to be found. Precision medicine is becoming the new standard of care, but innovative therapies such as biologics may be rather challenging for the clinicians in their daily practice. This new approach to CRSwNP implies patient selection and a simple algorithm for deciding the right treatment, easy to implement and adjust. Our review points out the ongoing new research on the pathophysiology of CRSwNP, biomarkers and treatment opportunities. It allows clinicians to keep abreast of current evidence-based knowledge and to individualize the management of CRSwNP, especially in refractory cases.

Corresponding author: Vlad Andrei Budu, Senior Lecturer, MD, PhD; e-mail:; Mihai Ionut Tanase, MD, PhD Student; e-mail:

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2. Natural and semisynthetic candidate molecules for COVID-19 prophylaxis and treatment

Andrei Bita, Ion Romulus Scorei, Laurentiu Mogoanta, Cornelia Bejenaru, George Dan Mogosanu, Ludovic Everard Bejenaru

Coronaviruses (CoVs) represent a family of viruses that have numerous animal hosts, and they cause severe respiratory, as well as systemic and enteric infections, in humans. Currently, there are limited antiviral strategies for treating patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The lack of specific antiviral medicines and SARS-CoV-2 vaccines continues to aggravate the situation. Natural product-based antiviral drugs have been used in the two previous CoV outbreaks: Middle East respiratory syndrome coronavirus (MERS-CoV) and the first SARS-CoV. This review emphasizes the role of natural and semisynthetic candidate molecules for coronavirus disease 2019 (COVID-19) prophylaxis and treatment. The experimental evidence suggests that nature could offer huge possibilities for treatment of the COVID-19 pandemic.

Corresponding author: Ion Romulus Scorei, Professor, Biochem, PhD; e-mail:

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3. The etiopathogenic and morphological spectrum of anencephaly: a comprehensive review of literature

Octavian Munteanu, Monica Mihaela Cirstoiu, Florin Mihail Filipoiu, Maria Narcisa Neamtu, Irina Stavarache, Tiberiu Augustin Georgescu, Ovidiu Gabriel Bratu, Gabriela Iorgulescu, Roxana Elena Bohiltea

Anencephaly is a severe malformation of the central nervous system (CNS), being one of the most common types of neural tube defects. It is defined as total or partial absence of the calvarium, with absence of the brain. Anencephaly has an incidence of 1 to 5 in every 1000 births, and the mortality rate is 100% during intrauterine life or within hours or days after birth. The etiology of anencephaly remains unclear, but various maternal-related environmental and genetic risk factors have been reported, which include diabetes, obesity, exposure to different drugs or toxins, genetic polymorphisms and mutations, as well as positive family history for neural tube defects. One of the most important nutritional factors in the development of anencephaly is folate deficiency. Methylenetetrahydrofolate reductase (MTHFR) gene codes the enzyme involved in the intracellular metabolism of folic acid; the 677C-T polymorphism of this gene causes the thermolability of the enzyme and decreased enzymatic activity, which is also dependent of folate plasmatic level. Etiopathogenesis of anencephaly includes several mutations in various other genes, such as: platelet-derived growth factor receptor alpha (PDGFRA), cadherin epidermal growth factor (EGF) laminin G (LAG) seven-pass G-type receptor 1 (CELSR1), Vang-like 1 (VANGL1) and Vang-like 2 (VANGL2), the last two being involved in the process of neurulation. Screening tests include maternal serum alpha-fetoprotein level and ultrasound (US) examination. During the first trimester US screening, anencephaly is now detected in all cases, but in order to decrease the complication rate of pregnancy termination, the diagnosis should be established as soon as possible, during the pregnancy confirmation US. We conclude that given that anencephaly is a severe malformation of the CNS, morphological characterization could improve the screening by US that is mandatory in the first trimester in order to plan the best, safe and early management.

Corresponding author: Tiberiu Augustin Georgescu, Assistant Professor, MD, PhD; e-mail:; Gabriela Iorgulescu, Senior Lecturer, MDD, MA, BA, PhD; e-mail:

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4. Morphopathological approaches in alcoholism

Ana Miruna Dragoi, Tiana Voicu, Ana Maria Chipesiu, Radu Virgil Costea

Alcohol morphopathology has been studied over time, being a central interest of specialists, due to the negative consequences it has on the brain and the entire central nervous system (CNS). This paper is a review of the literature that emphasizes one of the problems of the modern world, that of the compulsive consume of alcohol, having a great global spread. The studies analyzed are topical, being carried out in recent years and consider the harmful effects of alcohol on brain formations, such as corpus callosum, gray and white matter, hippocampus, and hypothalamus. At the same time, alcohol is a risk factor for cardiovascular diseases, and in combination with other harmful substances, increases the risk of various diseases, such as neurodegeneration. Abusive alcohol consumption can bring epigenetic changes and alter the typical functioning of cognitive functions. This paper focuses on alcohol consumption on adolescents and young people, which is a serious problem nowadays. Alcohol also influences the way of behavioral expression, becoming a risk for the development of mental disorders. However, alcohol withdrawal is another problem with different effects and must be in the attention of specialists.

Corresponding author: Ana Miruna Dragoi; e-mail:

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5. Somatostatin receptors in normal and acromegalic somatotroph cells: the U-turn of the clinician to immunohistochemistry report - a review

Nina Ionovici, Mara Carsote, Dana Cristina Terzea, Anca Mihaela Predescu, Anne-Marie Rauten, Mihaela Popescu

This is a narrative review of literature introducing somatostatin receptors (SSTRs) as part of understanding the somatotroph cells since they are positive in normal cells but also in tumoral cells as seen in somatotropinoma, a growth hormone (GH)-producing neoplasia, which causes acromegaly. They are five subtypes of SSTRs (1 to 5), which are immunohistochemically positive in different proportions in somatotropinomas. SSTR types 2 and 5 are most frequent in GH-secreting adenomas and they are both targeted by medical therapy with somatostatin analogues (SSTAs) like first generation Octreotide and Lanreotide (mainly targeting SSTR2) and second generation Pasireotide (with highest affinity for SSTR5), thus heterogeneous SSTRs configuration into the tumor explains different pattern of response to treatment and it might predict it once the SSTRs immunostaining is performed. Monoclonal antibodies are used for immunohistochemical detection of SSTRs; currently, a lack of standardization is presented, and scoring systems, such as Volante, H-score or human epidermal growth factor receptor 2 (HER2)-score, are applied. Immunoreactive markers like SSTRs are the U-turn in clinical practice regarding somatotropinomas since the configuration of subtypes 2 and 5 explains the responsiveness to medical therapy like SSTA. Further achievement of disease control is imperiously necessary because acromegaly has an increased rate of morbidity and mortality.

Corresponding author: Mara Carsote, Lecturer, MD, PhD; e-mail:

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6. Brain changes in depression

Simona Corina Trifu, Arina Cipriana Trifu, Ecaterina Aluas, Mihai Alexandru Tataru, Radu Virgil Costea

The present review addresses major depressive disorder (MDD) and the implications of antidepressant treatment in the field of brain neuroplasticity, an effect initially considered adjacent but currently passed as central in the process of remission of MDD. Both in experimental animal studies and in human studies in subjects with mood disorders, neuroplasticity is considered the fundamental mechanism of neural defense against stress. Stress is the mediator between neurofunctional, neuroendocrine, neurobiological and neuroimmune disorders and depressive pathology of various intensities. Neurons have a high potential to adapt to the influences of internal and external factors. We are talking about neuroplasticity at different levels: structural neuroplasticity involving adult neurogenesis (such as plastic changes, dendritic reconstruction, when the morphology of the spine is affected); synaptic functional neuroplasticity and molecular and cellular mechanisms involved. These two major dimensions explain the pathophysiology of depression, as well as the convergence of the mechanisms involved in stress, major depressive decompensations, and the concept of neuroplasticity as the present target for new effective and potent antidepressant treatments.

Corresponding author: Arina Cipriana Trifu, MD; e-mail:

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7. The influence of gestational diabetes mellitus (GDM) and gestational hypertension (GH) on placental morphological changes

Anca-Maria Istrate-Ofiteru, Costin Berceanu, Sabina Berceanu, Cristina Jana Busuioc, Gabriela-Camelia Rosu, Damian Ditescu, Florin Grosu, Nicoleta-Loredana Voicu

Gestational diabetes mellitus (GDM) and gestational hypertension (GH) are some of the most common medical conditions associated with pregnancy. These can be correlated with placental morphopathological changes and implicitly can influence good fetal development. The age and weight of the mother can be correlated directly proportionally with those of the fetus but also with histoarchitecture and placental vascularization. The placental appearance associated with GDM and GH reveals macroscopic features, such as calcifications, fibrin deposits and placental infarcts, but the most relevant pathological features are the microscopic ones, highlighted by the classical staining techniques: Hematoxylin-Eosin (HE), Periodic Acid-Schiff (PAS)-Hematoxylin and Masson s trichrome (MT), but also by immunohistochemical technique with the help of the anti-cluster of differentiation 34 (CD34) antibody that labeled the capital endothelium in the structure of the placental terminal villi and thus we were able to quantify the vascular density according to the associated medical pathology. The microscopic changes identified were represented by intravillous and extravillous fibrin depositions, massive placental infarctions caused by vascular suppression due to various causes, such as thrombosis, but also placental calcifications. All these macroscopic and microscopic morphopathological changes, together with the clinical data of the mother and the newborn, we have demonstrated that they are interconnected and that they can vary depending on the pathology, GH or GDM.

Corresponding author: Gabriela-Camelia Rosu, Junior Assistant, MD; e-mail:; Florin Grosu, MD, PhD; e-mail:

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8. Tumor recurrence in parasagittal and falcine atypical meningiomas invading the superior sagittal sinus

Andrei Ionut Cucu, Mihaela Dana Turliuc, Claudia Florida Costea, Cristina Gena Dascalu, Gabriela Florenta Dumitrescu, Anca Sava, Serban Turliuc, Dragos Viorel Scripcariu, Ion Poeata

Objective: Parasagittal and falcine meningiomas are still a challenge in terms of surgical resection. Although maximal safe resection is the main therapeutic approach, numerous postoperative complications can still occur depending on the locations of these tumors. Moreover, previous studies have reported that parasagittal meningiomas have a higher recurrence rate than meningiomas with other locations. Patients, Materials and Methods: We retrospectively reviewed 21 patients with parasagittal and falcine atypical meningiomas [World Health Organization (WHO) grade II], nine of whom had their superior sagittal sinus (SSS) invaded by the tumor. We reviewed the demographic information, operative notes, pathological reports, and clinical and imagistic follow-up reports of each patient over a 5-year time span. Results: All the patients were surgically treated, and the tumor removal was grade II according to Simpson s grading system in 47.6% and grade III in 19% of the cases. The SSS was invaded in 42.9% of the patients. No immediate mortality or morbidity was revealed by our study. Tumor recurrence/progression documented on postoperative imaging amounted to 14.3% and 19%, 12 and 24 months after surgery, respectively. Furthermore, 36, 48 and 60 months after the surgery, the recurrence rate remained the same, namely in 9.5% of the cases. The recurrence was higher in patients with SSS invasion than in patients with no SSS invasion. The tumor recurrence was slightly more predominant in women, i.e., 6% higher than in the male group. Conclusions: In our group of patients with parasagittal and falcine meningiomas, we report a 47.6% Simpson II resection rate and 19% Simpson III resection rate associated with a very low complication rate and no immediately postoperative morbidity and mortality, compared to more aggressive techniques. The recurrence of parasagittal meningiomas predominated after grade III and IV Simpson resection and dural sinus invasion was a negative predictive factor for recurrence. Therefore, the surgery of parasagittal and falcine meningiomas is beneficial, both for tumor control, but also for improving neurological outcome. Aggressive meningioma resection should be balanced with the increased neurosurgical risk.

Corresponding author: Claudia Florida Costea, Associate Professor, MD, PhD; e-mail:; Serban Turliuc, Associate Professor, MD, PhD; e-mail:

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9. Multidisciplinary approach to patients with manifestations and pulmonary complications of cystic fibrosis

Viorel Biciusca, Ileana Octavia Petrescu, Cristina Elena Singer, Anca Gabriela Oancea, Ana-Maria Petrescu, Ionelia-Sorina Stan, Patricia Durand, Citto Iulian Taisescu, Daniela Dumitrescu, Mihaela Amelia Dobrescu, Ion Udristoiu, Diana Rodica Tudorascu, Florin Petrescu

Cystic fibrosis (CF) is a genetic disease, with autosomal recessive transmission, multisystemic, characterized by a remarkable clinical polymorphism and significant lethal prospective. Respiratory manifestations dominate the clinical picture, being present in all patients. The aim of the paper was to analyze the incidence of clinical manifestations, especially respiratory ones, as well as the contribution of interdisciplinary consultations to the positive diagnosis of CF, in a group of 16 patients who were hospitalized and treated in the IInd Pediatric Clinic and IInd Medical Clinic of the Emergency County Hospital, Craiova, Romania, in a period of 20 years. The 16 patients diagnosed with and treated of CF had all shown increased values of sweat chloride concentration of over 60 mmol/L. The main symptoms and clinical signs encountered in these patients were cough (75%), sputum (62.5%), dyspnea (50%), wheezing (50%), stature hypotrophy (100%), pallor (37.5%), cyanosis (25%). All 16 patients had an acute exacerbation of chronic pulmonary disease. Of the total hospitalizations, the death was recorded only in the case of one female patient. The association of some clinical aspects specific with a positive result of the sweat test or the presence of the two pathological alleles made room for determining a positive diagnosis. The multisystemic nature of this disease requires a multidisciplinary approach to these patients. Histopathologically, there was a correspondence between lung morphological lesions and the results of imaging investigations.

Corresponding author: Citto Iulian Taisescu, Associate Professor, MD, PhD; e-mail:; Mihaela Amelia Dobrescu, Lecturer, MD, PhD; e-mail:

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10. Clinical-morphological profiles of esophageal carcinoma s main types

Dan Camenita, Alin Dragos Demetrian, Razvan Mihail Plesea, Manuela Ioana Tanasie-Vasile, Victor Dan Eugen Strambu, Valentin Titus Grigorean, Elena Ionita, Iancu Emil Plesea, Augustin Marian Marincas

Aim: The purpose of the study was to define and then to compare particularly the morphological profiles of the main morphological types of esophageal carcinoma (EC). Patients, Materials and Methods: The studied group included 46 operated EC patients. Few parameters were clinical (gender and age). The rest of them described both gross and histological features of the entire group and of the two main histological types of carcinoma (lesion site, lateral extension, lesion dimensions, gross aspect, and histological type, and tumor grade, and stage). Stratification scales of cases were defined according to each parameter in order to compare the data and a statistical apparatus [Student s t-test and chi2 (chi-squared) test] was used. Results: The studied tumors were encountered mostly in mature adult and elderly men, usually in the lower segments of the esophagus. Many of them had between five and ten cm in the long diameter and produced stenosis. Most of them had infiltrating appearance combined often with protruding or/and ulcerated aspects. Usually, the tumors were poorly differentiated and in stage III. The two main histological types of EC showed different morphological profiles. Data from the literature revealed sometimes wide ranges of variation for the studied morphological parameters. Our results were within these ranges of variation. Conclusions: ECs proved to be aggressive and late diagnosed tumors in general, with distinct morphological and behavioral profiles for the two main histological types. Comparisons with literature data confirmed many of our observations regarding the clinical and morphological aspects of both ECs as a whole and its histological types.

Corresponding author: Iancu Emil Plesea, Professor, MD, PhD; e-mail:

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11. Histopathological features of low-dose organophosphate exposure

Cristian Cobilinschi, Radu Ciprian Tincu, Claudia Oana Cobilinschi, Tiberiu Paul Neagu, Gabriel Becheanu, Ruxandra-Diana Sinescu, Ionel Alexandru Checherita, Ioana Marina Grintescu, Ioan Lascar

Organophosphate (OP) use remains largely available worldwide despite more strict regulatory measures, in agriculture, parks or households, leading to a daily low-dose exposure. The systemic dysfunction appears partly due to acetylcholinesterase inhibition, exhibiting a primary toxic effect on the endocrine system but also on the liver and kidneys, which are responsible for products metabolization and elimination. Prolonged OP exposure can be responsible for histopathological (HP) changes that can either evolve or worsen pre-existing conditions. We conducted an experimental study including six male Wistar rats divided into two groups (four rats in the study group and two in the control group). The subjects in the first group were administered 100 mg/kg Chlorpyrifos half median lethal dose (LD50) at baseline and at 48 hours, under general anesthesia. Organ harvesting was achieved after one week. HP modifications were discovered in all kidney samples, with dystrophic changes and vacuolization of mesangial cells, dilation of renal tubules and epithelial atrophy. Congestion of vascular structures also occurred. The liver samples showed severe alteration in both vessels and hepatocytes. Adrenal gland impairment was confirmed through an increase in vacuole number in all areas, while a decrease in colloid content was noted in the thyroid gland simultaneously with a modified foamy aspect. This study is the first to certify the extent of organ injury induced by OP exposure, describing both glomerular and tubular involvement in the kidneys, liver necrosis and endocrine disturbances.

Corresponding author: Tiberiu Paul Neagu, Assistant Professor, MD, PhD; e-mail:; Ionel Alexandru Checherita, Professor, MD, PhD; e-mail:

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12. Clinical, ultrasound and histopathological correlation of clinically N0 neck nodes in patients with cancers of the pharynx and larynx

Gheorghe Iovanescu, Florin Birsasteanu, Veronica Madalina Boruga, Adrian Apostol, Eugen Horatiu Stefanescu, Vlad Andrei Budu, Flavia Baderca, Simona Corina Trifu, Carmen Aurelia Mogoanta, Diana Camelia Bonte, Mihaela Viviana Ivan

Background: The presence of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymphadenopathy (N0) remains controversial. Neck palpation, as the method used in tumor, node, metastasis (TNM) staging, has limitations and can provide false negative results in some cases. Lymph node metastases are associated with a reduced survival rate but at the same time, neck dissection for the patient with N0 neck is not without risks or complications. Objectives: In prospective study, we compared palpation, ultrasonography (US) examination of the neck and histopathological examination in patients with cancers of the pharynx and larynx. Patients, Materials and Methods: Forty-six patients with cancers of the pharynx and larynx that presented with a N0 neck were prospectively analyzed. They were divided in two groups: 23 patients operated with an external approach including the control of the lymph node areas, and a second group of 23 patients operated using endoscopy and carbon dioxide (CO2) laser, no neck dissection - watchful waiting policy. All patients have had a flexible endoscopy of the pharynx and larynx, US of the neck and all received surgical treatment for their primary tumor. Imaging was performed in selected cases. All the removed lymph nodes were sent for histopathology. US was also used as a follow-up method. The US features of the examined lymph nodes were: diameters [longitudinal (L) and transverse (T)]; the ratio of the two diameters (L/T); shape; lymph node area; central hypodensity; regular/irregular margins; aspect (homogeneous or not). Results: US has detected 25 lymph nodes in the open surgery group and intraoperatively, we excised 31 (sensitivity of 80.6%). Ten lymph nodes showed metastases, with 100% accuracy of US, which have been confirmed both pathologically and immunohistochemically. US in the second group - patients treated with CO2 laser - detected at four patients 10 cervical lymph nodes that did not presented any malignant features. At recurrence alone, the US confirmed 100% presence of nodes metastases. Conclusions: US was superior to palpation and this method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis (N0).

Corresponding author: Adrian Apostol, MD, PhD; e-mail:; Vlad Andrei Budu, Lecturer, MD, PhD; e-mail:

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13. Analysis of TP53 gene and particular infrastructural alterations in invasive ductal mammary carcinoma

Corina Elena Mihalcea, Ana-Maria Morosanu, Daniela Murarasu, Liliana Puiu, Sabin-Aurel Cinca, Silviu Cristian Voinea, Nicolae Mirancea

This study was conducted in order to determine the mutational status of TP53 gene and to determine some particular aspects from ultrastructural level in invasive mammary ductal carcinoma. The cellular signaling pathway involving the TP53 gene acts in biological deoxyribonucleic acid (DNA) repair processes and cell cycle arrest following a signal transmitted to the p53 protein when posttranslational changes occur in the cell due to stress induced in the cell by both intrinsic and extrinsic factors. Cellular stress activates the transcription factor function of the protein that initiates, as the case may be, either DNA repair or programmed cell death (apoptosis). The TP53 gene is commonly mutated in many human cancers and also has a highly polymorphic grade. To determine the mutational status of the exons 4-9 of the TP53 gene, we used extracted DNA from fresh breast tissue, and we analyzed it through direct sequencing. In mammary carcinoma, the mutation frequency of TP53 is running between 20-40% and, in regards the polymorphism, at least 14 different forms were identified, that are associated with cancer risk. The mutation type distribution showed a predominance of deletions and a reduced frequency of substitutions comparing with International Agency for Research on Cancer (IARC) database. Taken in consideration the importance of the tumor associated stroma in tumor development, we have also investigated some particular aspects at the infrastructural level of invasive mammary ductal carcinoma, notably concerning telocytes as tumor stroma interstitial cells by transmission electron microscopy analysis.

Corresponding author: Nicolae Mirancea, PhD, Senior Scientist grade I; e-mail:

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14. Periodontal clinico-morphological changes in patients wearing old nickel-chromium and copper alloys bridges

Luminita Daguci, Constantin Daguci, Cristiana Iulia Dumitrescu, Catalina Farcasiu, Daniela Ioana Tarlungeanu, Marilena Bataiosu, Magdalena Natalia Dina, Claudiu Margaritescu, Mihaela Jana Tuculina, Oana-Cella Andrei

Elderly population frequently presents more than one prosthetic restoration realized from different types of dental alloys which, in time, suffer various alterations in the oral environment. Metallic ions are released in saliva due to its electrolytic qualities, interacting with the contact tissues. Studies regarding cytotoxicity of dental alloys are providing contradictory results. Besides biocompatibility, the microbial factor is also greatly influencing the long-term success of the prosthetic rehabilitation. This study s aim was to assess the response of the gingival tissue to nickel-chromium (Ni-Cr) and copper (Cu)-based dental casting alloys from fixed dentures present in many patients from Romania. Gingival samples were taken from 124 patients wearing fixed dental restorations made from these two types of alloys from injured areas surrounding the abutment teeth; histological specimens were prepared, fixed in 10% neutral buffered formalin, paraffin-embedded and stained with Hematoxylin-Eosin (HE). Histological analysis showed the existence of a chronic inflammatory infiltrate in the gingival chorion, necrosis areas, and vascular congestion. Various morphological alterations appeared, depending on the intensity of the inflammation and the immune response. The surface epithelium suffered a hyperplasic reaction, either limited to acanthosis or involving the whole epithelium, the release of the Cu2+ and Ni2+ ions from the dental alloys used in bridges and crowns being responsible for inducing gingival hyperplasia and a chronic inflammation in the areas situated around the abutment teeth. The immunohistochemical study allowed us to observe an increased number of positive cluster of differentiation 3 (CD3) T-lymphocytes in periodontium, proving that the cellular immune response is rapid and intense.

Corresponding author: Marilena Bataiosu, Associate Professor, DMD, PhD; e-mail:; Cristiana Iulia Dumitrescu, Lecturer, MD, PhD; e-mail:

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15. Idiopathic tenosynovitis with rice bodies

Mihaela Pertea, Bogdan Veliceasa, Natalia Velenciuc, Cristina Terinte, Mihaela Mitrea, Petru Ciobanu, Ovidiu Alexa, Sorinel Lunca

Purpose: Idiopathic tenosynovitis with rice bodies is a rare disease and its non-association with rheumatic diseases, tuberculosis infection or trauma is reported only in few cases in literature. Patients, Materials and Methods: Our study presents a series of five patients diagnosed with tenosynovitis with rice bodies at the flexor tendons of the upper limb. Medical history revealed no associated disease or trauma. Disease duration ranged between two months and four years, two patients presenting symptoms of acute carpal tunnel and three patients tumor mass. In one case, the tumor measured 210 mm in length and a tendon rupture was suspected. Laboratory and imaging investigations could not establish a specific associated pathology and a preoperative diagnosis. Surgical treatment consisting of synovectomy was performed in all patients. Results: In all five cases, intraoperative appearance could easily determine the presence of rice bodies. Histopathological examination revealed typical aspect for rice bodies and make the diagnosis possible without the need for other more laborious processing (immunohistochemistry). The amount of rice bodies was directly proportional to disease duration. In all cases, the recovery was complete. After a median 30.4-month follow-up, no recurrence was detected. Subsequently performed laboratory investigations and specific tests did not reveal tuberculosis infection, rheumatic disease, or other diseases. Conclusions: This is the largest series of patients with idiopathic tenosynovitis with rice bodies and the bigger tumor mass reported to date. Synovectomy with removal of all rice bodies represents the optimal treatment. A longer disease course may be associated with a larger number of rice bodies, which may be associated with tendon rupture. The etiopathogenesis remains unclear, further studies being necessary to establish it.

Corresponding author: Bogdan Veliceasa, MD, PhD; e-mail:; Mihaela Mitrea, MD, PhD; e-mail:

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16. Evaluation of placental vascularization in thrombophilia and intrauterine growth restriction (IUGR)

Nicoleta-Loredana Voicu, Roxana Elena Bohiltea, Sabina Berceanu, Cristina Jana Busuioc, Gabriela-Camelia Rosu, Stefan Paitici, Anca-Maria Istrate-Ofiteru, Costin Berceanu, Damian Ditescu

The placenta is an essential organ in the proper development of pregnancy, and it can present a lot of structural and vascular lesions that can affect fetal development. One of the pathologies associated with pregnancy, which can change the placental structure is thrombophilia (TPh), and this can be correlated with an intrauterine growth restriction (IUGR) of the fetus. Maternal clinical aspects (age, weight) can be correlated with fetal ones (weight, gender), but also with the structural and vascular aspect of the placenta. The placental structure associated with TPh and IUGR shows macroscopic changes, such as fibrin deposition, calcifications and placental infarctions, but microscopic lesions are best highlighted by classical staining techniques: Hematoxylin-Eosin (HE), Masson s trichrome (MT) and Periodic Acid-Schiff (PAS)-Hematoxylin, but also by immunohistochemistry technique with the help of anti-cluster of differentiation 34 (CD34) antibody that could make it possible to quantify vascular density depending on the pathology. Microscopic changes were massive infarcts caused by vascular ischemia, intravenous and extravillous fibrin deposits, calcifications, and vascular thrombosis. All these clinical, morphological and morphopathological data are interconnected and may vary in the presence of TPh and IUGR.

Corresponding author: Anca-Maria Istrate-Ofiteru, Assistant, MD, PhD; e-mail:; Costin Berceanu, Associate Professor, MD, PhD; e-mail:

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17. Morphological and histopathological changes in placentas of pregnancies with intrauterine growth restriction

Valeria Visan, Raluca Anca Balan, Claudia Florida Costea, Alexandru Carauleanu, Raluca Maria Haba, Mihai Stefan Cristian Haba, Demetra Gabriela Socolov, Raluca Anamaria Mogos, Camelia Margareta Bogdanici, Dragos Nemescu, Daniela Maria Tanase, Mihaela Dana Turliuc, Andrei Ionut Cucu, Dragos Viorel Scripcariu, Bogdan Florin Toma, Razvan Mihai Popovici, Manuela Ciocoiu, Florin Dumitru Petrariu

Aim: The definition of fetal growth restriction (FGR) refers to the incapability of a fetus to achieve the appropriate estimated growth, with expected fetal weight below the 10th percentile calculated for its gestational age. Placental factors and hypoxemia are considered to be essential elements with influence on intrauterine growth restriction (IUGR) and fetal death. The purpose of the present study was to investigate the macroscopic and microscopic pathological findings regarding the placentas in pregnancies complicated by influence on IUGR. Patients, Materials and Methods: Our study included 42 third-trimester pregnant patients admitted to the Cuza Voda Hospital of Obstetrics and Gynecology, Iasi, Romania, in the last three years. Soon after delivery, the 42 placentas were collected and analyzed; 32 placentas came from cases previously diagnosed with influence on IUGR and were included in our study group. Ten other placentas included in the control group were selected from uncomplicated pregnancies. Standard Hematoxylin-Eosin (HE) staining method, as well as Periodic Acid-Schiff (PAS) staining, and immunohistochemical techniques for cluster of differentiation 31 (CD31) and collagen IV were used in order to highlight the morphological features of the studied placentas. Results: Our study revealed that reduced placental dimensions and eccentric umbilical cord insertion are correlated with the birthweight of the fetuses with IUGR (p<0.05). The most common histological finding in our study group was placental infarction later correlated with IUGR, but a certain causality could not be demonstrated, as this finding was also present in normal pregnancies. Other histopathological findings were also present in the influence on IUGR group, such as fibrin deposits, diffuse calcification, chronic villitis, avascular chronical villi, with no significant statistical correlations. CD31 was strongly immunoexpressed in the villous endothelial cells. Collagen IV presented a strong immunoreaction in the basement membrane and mesenchyme of the placental villi. Conclusions: Our study revealed a correlation between the dimensions of the diameters and volume of the maternal placenta and the presence of influence on IUGR. Moreover, it confirms the available data suggesting that the place of insertion of the umbilical cord is correlated with the weight of the fetus. Further studies with extended panel antibodies are needed in order to determine and complete the role of these morphological changes in the development of influence on IUGR.

Corresponding author: Claudia Florida Costea, Associate Professor, MD, PhD; e-mail:; Raluca Anca Balan, Associate Professor, MD, PhD; e-mail:

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18. Gross-total versus near-total resection of large vestibular schwannomas. An institutional experience

Adrian Florian Balasa, Corina Ionela Hurghis, Flaviu Tamas, Georgiana Mihaela Serban, Attila Kovecsi, Ioan Alexandru Florian, Rares Chinezu

Objective: We will report our experience of the surgical treatment of large vestibular schwannomas (VSs). Patients, Materials and Methods: We conducted a retrospective study of patients operated on for Koos grade IV VS between 2007 and 2015 at the Department of Neurosurgery, Emergency County Hospital, Targu Mures, Romania. We studied the general preoperatory clinical data, the preoperative and postoperative facial nerve status, preoperative hearing on the affected side, and any postoperative complications, including death. Results: Sixty-six cases were included in our study. The mean age was 52.95 years and 66.7% (n=44) of the sample were female. All patients had suffered from tinnitus and this had been followed by loss of serviceable hearing on the affected side in 89.4% (n=59) of cases. Preoperative facial palsy was found in 53% (n=35) of patients. The mean tumor size was 40.35 mm. Gross-total resection (GTR) was achieved in 24 (36.36%) cases, while near-total resection (NTR) was obtained in 42 (63.64%) cases. New-onset facial palsy or degradation of the preoperative facial deficit occurred in 12 (18.18%) cases, most of whom were patients with a GTR (n=9, 37.5%). This was statistically significant. There were no significant postoperative differences between the GTR and NTR groups. There was one death in the GTR group. Conclusions: We conclude that near-total tumor removal provides good surgical results and better postsurgical quality of life for patients when compared to gross-total tumor resection. Therefore, this should be the end goal of the resection of large VSs.

Corresponding author: Adrian Florian Balasa, Lecturer, MD, PhD; e-mail:

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19. New 2-(4-(4-bromophenylsulfonyl)phenyl)-4-arylidene-oxazol-5(4H)-ones: analgesic activity and histopathological assessment

Florica Barbuceanu, Elena-Valentina Rosca, Theodora-Venera Apostol, Oana-Cristina Seremet, Constantin Draghici, Dragos Paul Mihai, Simona Negres, George Mihai Nitulescu, Stefania-Felicia Barbuceanu

This paper reports the synthesis, analgesic activity, acute toxicity and histopathological (HP) assessment of four new compounds from oxazol-5(4H)-ones class that contain in their molecule a diarylsulfone moiety. The new 2-(4-(4-bromophenylsulfonyl)phenyl)-4-arylidene-oxazol-5(4H)-ones were obtained by reaction of 2-(4-(4-bromophenyl-sulfonyl)benzamido)acetic acid intermediate with aromatic aldehydes (benzaldehyde, 4-methoxy, 4-nitro or 4-bromobenzaldehyde), in acetic anhydride and in the presence of anhydrous sodium acetate. The new compounds have been characterized by spectral techniques, such as: Fourier-transform infrared spectroscopy (FT-IR), mass spectrometry (MS), proton nuclear magnetic resonance (1H-NMR) and by elemental analysis. The acute toxicity of the new oxazol-5(4H)-ones in mice was assessed through acute toxic class method, according to Organization for Economic Co-operation and Development (OECD) Guidelines. The HP assessment of some preserved organs collected from mice has been performed. The analgesic activity of all new synthesized compounds was carried out with two pharmacological tests: the writhing test and the hot plate test. In order to predict the binding affinities of the synthesized oxazol-5(4H)-ones derivatives against molecular targets involved in pain and inflammation, molecular docking simulations were performed. The results of the writhing test indicated that the most active compound was the oxazolone that contains in the molecule a methoxy group. The acute oral toxicity study revealed no lethal effect of new compounds. The HP assessment of the preserved organs collected from mice did not indicate any cytohistopathological aspects that can be linked to any inflammatory, neoplastic or cytotoxic process, demonstrating the low toxicity of new compounds.

Corresponding author: Elena-Valentina Rosca, Pharm, PhD Student; e-mail:

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20. The role of non-invasive scores in determining the liver fibrosis in NAFLD and psoriatic patients

Carmen-Daniela Neagoe, Anca-Smaranda Farmazon, Anca-Maria Amzolini, Cristina-Elena Singer, Simona-Laura Ianosi, Cristina-Violeta Tutunaru, Amelia-Valentina Genunche-Dumitrescu, Nicolae-Gabriel Ianosi, Ion Paun, Polliana-Mihaela Leru, Oana-Sorina Tica, Mihaela Popescu

According to recent data, psoriatic patients have an increased prevalence of non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome, compared with the general population. In some published studies, the severity and presence of psoriasis disease were correlated with the severity of NAFLD. In the current study, we aimed to compare the sensibility and specificity of the non-invasive scores and liver biopsy in determining fibrosis in patients with NAFLD and moderate to severe psoriasis. We performed the scientific research from June 2014-December 2017 and we included 71 patients: 40 patients with NAFLD and 31 patients with moderate to severe psoriasis according to Psoriasis Area and Severity Index (PASI) score and NAFLD, who received Etanercept treatment for at least one year. Based on the clinical and laboratory data, we calculated the following scores for fibrosis: body mass index (BMI), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, diabetes (BARD) score, Fibrosis-4 (FIB-4) score, and NAFLD fibrosis score (NFS). For liver biopsy, we used the Menghini technique. By calculating Kendall s test, we also observed a strong direct correlation between the degree of fibrosis and FIB-4 (tau=0.558) and NFS (tau=0.490) scores, with a critical statistical impact, and the lack of a correlation with the BARD score (tau=0.095; p=0.332). The hepatic biopsy allowed the more accurate establishment of the role of the non-invasive tests in the diagnosis of the lesions of steatosis, steatohepatitis, and hepatic fibrosis. The non-invasive tests are most useful for the exclusion of the evolution lesions and for the confirmation of the advanced stages of the disease. Among these, the NFS score proved a high statistically significant correlation (p<0.0001) with the fibrosis histological lesions.

Corresponding author: Simona-Laura Ianosi, Associate Professor, MD, PhD; e-mail:; Ion Paun, Associate Professor, MD, PhD; e-mail:

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21. Agreement of two pre-trained deep-learning neural networks built with transfer learning with six pathologists on 6000 patches of prostate cancer from Gleason2019 Challenge

Mircea-Sebastian Serbanescu, Carmen-Nicoleta Oancea, Costin Teodor Streba, Iancu Emil Plesea, Daniel Pirici, Liliana Streba, Razvan Mihail Plesea

Introduction: While the visual inspection of histopathology images by expert pathologists remains the golden standard method for grading of prostate cancer the quest for developing automated algorithms for the job is set and deep-learning techniques have emerged on top of other approaches. Methods: Two pre-trained deep-learning networks, obtained with transfer learning from two general purpose classification networks - AlexNet and GoogleNet, originally trained on a proprietary dataset of prostate cancer were used to classify 6000 cropped images from Gleason2019 Challenge. Results: The average agreement between the two networks and the six pathologists was found to be substantial for AlexNet and moderate for GoogleNet. When tested against the majority vote of the six pathologists the agreement was perfect and moderate for AlexNet, and GoogleNet, respectively. Despite our expectations, the average inter-pathologist agreement was moderate, while between the two networks it was substantial. Resulted accuracy for AlexNet and GoogleNet when tested against the majority vote as ground truth was of 85.51% and 74.75%, respectively. This result was higher than the score obtained on the dataset that they were trained on, showing their generalization capabilities. Conclusions: Both the agreement and the accuracy indicate a better performance of AlexNet over GoogleNet, making it suitable for clinical deployment thus could potentially contribute to faster, more accurate and with higher reproducibility prostate cancer diagnosis.

Corresponding author: Costin Teodor Streba, Associate Professor, MD, PhD; e-mail:

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22. Alpha-lipoic acid and vitamin B complex slow down the changes in mice diabetic cardiomyopathy

Georgica Costinel Tartea, Diana Ruxandra Florescu, Alexandru Radu Mihailovici, Ionut Donoiu, Octavian Istratoaie

Aim: The aim of our study was to assess histologically and by cardiac ultrasound the effects of alpha-lipoic acid (ALA) and vitamin B complex, as pathogenic therapies, in diabetic cardiomyopathy (DCM) in mice. Materials and Methods: We performed an experimental animal study, in which we analyzed from a structural and functional point of view the changes produced in DCM. To produce DCM, we induced diabetes mellitus (DM) in C57BL/6 mice by intraperitoneal injection of a single 150 mg/kg body weight dose of streptozotocin (STZ). We formed a sham group (animals without DM), a control group (animals with DM but without treatment, DM_Control) and a group of animals with DM that were treated with ALA and vitamin B complex (DM_Treated). Results: At six weeks after STZ administration, there was no decrease in left ventricular ejection fraction (LVEF) in the sham group, while in the control group there was a significant decrease in LVEF, about 43.75+/-3.37%, compared to the group that received treatment with ALA and vitamin B complex, in which LVEF decreased to 49.6+/-5.02% (p=0.0432). Also, the degree of interstitial myocardial fibrosis was higher in animals with DM compared to animals without DM, but the applied therapeutic protocol considerably improved the accumulation of interstitial collagen. The same observation was maintained regarding the evaluation of polysaccharide deposits. Conclusions: We can say that the administration of ALA and vitamin B complex in mice with STZ-induced DM, improves the degree of myocardial fibrosis, the accumulation of polysaccharides, and prevents severe deterioration of systolic and diastolic function of the heart.

Corresponding author: Ionut Donoiu, Associate Professor, MD, PhD; e-mail:

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23. Morpho-functional and radiological approach of poststroke seizures

Iulian Dan Cuciureanu, Delia Hinganu, Cristian Statescu, Anca Sava, Marius Valeriu Hinganu, Mihaela Dana Turliuc, Tudor Cuciureanu, Radu Andy Sascau

Epilepsy is characterized by recurrent seizures that cannot be associated with other specific causes. The presence of a single convulsive or tonic seizure after a stroke does not necessarily mean that a person develops a form of epilepsy unless the convulsions become chronic and recurrent poststroke epilepsy. The purpose of our study is to highlight the existence of a connection between the type and the topography of a vascular stroke on the one hand, and on the other hand, the type of seizures that have occurred and how long they have occurred after the stroke. The study was conducted in a total of 165 patients at the Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iasi, Romania, diagnosed with stroke and spastic seizures after stroke and who survived for at least one year. In this study, the ideal patient should be the patient diagnosed for the first time with temporal lobe epilepsy, followed longitudinally by high-resolution imaging techniques. Studying topography and morphopathology of poststroke sequelae can lead to an increase in accuracy prediction of epilepsy after it.

Corresponding author: Delia Hinganu, University Lecturer, MD, PhD; e-mail:; Cristian Statescu, University Lecturer, MD, PhD; e-mail:

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24. Mesangioproliferative glomerulonephritis with extracapillary crescents - unexpected fatal complication in a 17-year-old patient with implanted left ventricular assist device

Elena Carmen Opris, Horatiu Suciu, Ioan Jung, Catalin Bogdan Satala, Hussam Al Hussein, Marius Mihai Harpa, Cosmin Marian Banceu, Simona Gurzu

The continuous flow left ventricular assist device (cf-LVAD) is the life-saving solution for patients with end-stage global heart failure. We present the case of a young patient with biventricular dilated cardiomyopathy, who had a cf-LVAD implantation and died as result of progressive renal failure. In the first year after implantation, he suffered repeated strokes and episodes of pneumonia with Klebsiella pneumoniae and Escherichia coli. The patient had hypertension, which was kept under control with angiotensin-converting enzyme (ACE) inhibitors and beta-blockers. After multiple bleeding episodes, the patient died at 21 months after the LVAD implant. At autopsy, parenchymatous brain hemorrhage was found to be associated with pulmonary hemorrhages. The unexpected features related to mesangioproliferative and extracapillary glomerulonephritis, with focal glomerulosclerosis. The proliferated parietal cells of Bowman s capsule proved to express cluster of differentiation 44 (CD44), whereas remnant podocytes and mesangial cells showed Wilms tumor 1 (WT1) positivity. Since CD44 might be involved in fibrogenesis, but ACE inhibitors can exert a protective role against glomerular deterioration, we performed a synthesis of literature data which enabled us to propose a hypothesis with a potential clinical impact. We conclude that, in patients with LVAD implants, high blood pressure and high serum level of angiotensin II, the association between ACE inhibitors and anti-CD44 agents might exert glomerular protection and increase the survival time. Experimental studies are necessary to support our hypothesis and to explain the mechanism of possible glomerulopathy installed after LVAD implant.

Corresponding author: Simona Gurzu, Professor, MD, PhD; e-mail:

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25. Chameleonic appearance of caseous calcification of the mitral valve - still a problem for its appropriate management

Caius Glad Streian, Ana Lascu, Raluca Sosdean, Ciprian Nicusor Dima, Florin Grosu, Adrian Costache, Andrei Gheorghe Marius Motoc

According to the research literature, the caseous calcification of the mitral annulus (CCMA) is a rare variant of the mitral annulus calcification (MAC) entity, described mostly in elderly women. The aim of this study was to present the case of a 53-year-old female patient with caseous calcification of the mitral valve annulus and posterior cusp, which was diagnosed as papillary fibroelastoma. An echo-dense and quasi-homogeneous tumoral mass, measuring 1.6/1.4 cm, at the level of the posterior mitral ring was detected by echocardiographic examination, as well as by cardiac magnetic resonance imaging (MRI). Histopathological analysis revealed fibrous connective tissue with myxoid areas, hyaline degeneration with unstructured necrosis and dystrophic calcifications, which was consisting with the operative findings of a toothpaste tumor, or caseous calcification of the mitral valve. Differential diagnosis with other cardiac tumors, abscesses, thrombi or fibroelastomas is emphasized.

Corresponding author: Ana Lascu, MD, PhD; e-mail:

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26. Multiple and giant coronary artery aneurysm - case report and a review of the literature

Elena Emilia Babes, Victor Vlad Babes, Mihaela Mirela Zdrinca, Ilarie Brihan, Razvan Marius Vicas, Monica Adriana Motorca, Larisa Renata Pantea-Rosan, Alina Cristiana Venter

We report an unusual case of a 70-year-old female patient admitted in the Department of Cardiology, Emergency County Hospital, Oradea, Romania, for unstable angina and heart failure. Coronary angiography and computed tomography revealed multiple coronary artery aneurysms, some of them giant, associated with significant coronary artery disease. Coronary artery aneurysm is a rare disease, but the frequency of diagnostic increased with the development of coronary angiography. However, very rarely coronary artery aneurysm is very large and can be termed giant aneurysm, and a small number of reports have been described in literature. The management and the prognosis of the disease is still controversial.

Corresponding author: Elena Emilia Babes, Lecturer, MD, PhD; e-mail:; Victor Vlad Babes, Assistant Professor, MD, PhD; e-mail:

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27. Primary prostate cancer synchronous with renal cell carcinoma: clinical experience and literature review

Zhong-Yuan Li, Cheng-Cheng Ying, Zhi-Hua Wan, Zhi-Shun Wang, Guo-Hao Li, Lin Chen, Yong-Lian Guo

The objective of this study was to report the diagnosis and treatment results of primary prostate adenocarcinoma (PRAD) concurrent in a patient with renal cell carcinoma (RCC), and to review the relative literature. A 62-year-old man was admitted to our hospital with chief complaint of a painless, incidentally found renal mass for one year. RCC was initially found by computed tomography (CT) scan, but prostate cancer was incidentally found by abnormal prostate-specific antigen (PSA) level results. The post-nephrectomy pathology assay reported clear RCC with positive staining of vimentin, cluster of differentiation 10 (CD10), carbonic anhydrase IX (CA-IX), paired box 8 (Pax-8), epithelial membrane antigen (EMA), and Ki67 labeling index (Ki67 LI). Magnetic resonance imaging (MRI) revealed uneven signals in the right peripheral zone of the prostate. Both prostate biopsy and post-prostatectomy pathology examination revealed prostate acinar adenocarcinoma with positive staining of P504S and Ki67 LI. The patient has been in periodic follow-up and has remained in good general condition without any evidence of recurrence to date. To the best of our knowledge, the present report is the only case of systematically described pre- and post-therapy laboratory, pathology, and imaging examination results. Our report together with published studies suggest that increased awareness of synchronous PRAD risk will enable early detection and prompt therapies in patients with RCC.

Corresponding author: Yong-Lian Guo, MD, PhD; e-mail:

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28. Oral lichen planus - case report

Cristian Sebastian Vlad, Daliborca Cristina Vlad, Roxana Popescu, Veronica Madalina Boruga, Sinziana Luminita Istrate, Corina Flangea, Beatrice Giorgiana Barac, Ioana Maria Malita, Simona Ioana Sipos, Flavia Baderca

This paper presents the case of a 58-year-old heavy smoker female who came to our clinic with acute pain, as well as mastication and feeding difficulties. The macroscopic examination revealed oral erosive lesions and ulcerations. The polymorphic aspect of the lesions required the differential diagnosis of oral erythroplakia or carcinoma, which were excluded by biopsy. At the same time, we assessed the expression of S100 protein, Ki67 and the cluster of differentiation (CD) 4, CD8 (T-cell) and CD20 (B-cell) immune cell markers by immunohistochemical analysis. As a result, after the clinical and pathological assessment, the diagnosis of oral lichen planus was established, and a therapy plan was conducted. We observed a favorable clinical evolution after the administration of corticosteroids and immunomodulatory agents.

Corresponding author: Roxana Popescu, Associate Professor, MD, PhD; e-mail:; Veronica Madalina Boruga, PhD Student; e-mail:

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29. Hereditary leiomyomatosis and renal cell cancer syndrome - case report and review of the literature

Liliana Gabriela Popa, Raluca Silvia Lutuc, Mara Madalina Mihai, Irina Ahmed Salem, Silvius Ioan Negoita, Calin Giurcaneanu, Simona Vasilica Fica

Hereditary leiomyomatosis and renal cell cancer syndrome (HLRCC) is an exceptionally rare autosomal dominant condition caused by a germline heterozygous mutation of the fumarate hydratase gene. It manifests as multiple piloleiomyomas, associated with numerous, early-onset uterine leiomyomas in female patients, as well as a highly increased risk of renal cell carcinoma (RCC), most often type 2 papillary RCC. HLRCC has been described in association with adrenal cortical hyperplasia, pheochromocytoma, adrenal cortical carcinoma, and other solid tumors, but the exact relationship between these disorders has not yet been clarified. We present a case of HLRCC associated with bilateral adrenal cortical hyperplasia and discuss the pathogenesis, clinical and paraclinical features of HLRCC, as well as the adequate management of these patients.

Corresponding author: Mara Madalina Mihai, Assistant Professor, MD, PhD; e-mail:

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30. Syphilis associated with abdominal trauma and splenic rupture in pregnancy

Liliana Steriu, Roxana-Cleopatra Penciu, Corina Madalina Nour, Silvia Izvoranu, Iulia-Diana Mocanu, Gabriela-Izabela Baltatescu, Oana Cojocaru, Vlad-Iustin Tica

We present a case of a pregnant woman in the third trimester who came to the Department of Emergency, Sf. Apostol Andrei Emergency County Hospital, Constanta, Romania, in September 2016, for abdominal pain and ascites. After admission, the patient was periodically tested (biochemically and by ultrasound). We also payed attention to the fetal well-being. During the hospitalization, the patient was also found positive for syphilis. Biochemical values have progressively altered, the fetus started to present acute fetal distress and the patient gave birth by Caesarean section after two days of hospitalization. The intraoperatory surprise was hemoperitoneum caused by posttraumatic splenic rupture. The relevance of this case consists in its rarity (we were not able to find in the literature a case with the association of pregnancy, syphilis, trauma, and splenic rupture), in the difficult histopathological clear assertion and in the clinical awareness of such a condition.

Corresponding author: Liliana Steriu, MD; e-mail:

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31. The bursa of Hieronymus Fabricius ab Aquapendente: from original iconography to most recent research

Domenico Ribatti, Andrea Porzionato, Aron Emmi, Raffaele De Caro

Hieronymus Fabricius ab Aquapendente (1533-1619) described the homonymous bursa in the De Formatione Ovi et Pulli, published posthumously in 1621. He also included a figure in which the bursa was depicted. We here present the figure of the bursa of Fabricius, along with corrections of some mislabeling still presents in some anastatic copies. The bursa of Fabricius is universally known as the origin of B-lymphocytes; morphogenetical and physiological issues are also considered.

Corresponding author: Domenico Ribatti, Professor, MD, PhD; e-mail:; Raffaele De Caro, Professor, MD, PhD; e-mail:

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32. Leopold Auerbach s heritage in the field of morphology and embryology with special emphasis on gametogenesis of invertebrates

Andrzej Wincewicz, Piotr Woltanowski

Plexus myentericus Auerbachi and Friedreich-Auerbach disease are widely used eponyms that are associated with eminent morphologist Leopold Auerbach (1828-1897), whose life is relatively little known due to limited access to his German-written XIX century biographies and lack of English biographical papers about him in world literature. Hereby we focused on hardly known achievements of Leopold Auerbach in the field of gametogenesis and embryology of invertebrates. Auerbach did not only confirm unicellularity of amoebas, which was previously discovered. He described cleavage of fertilized eggs of Ascaris nigrovenosa and Strongylus auricularis. Moreover, his accurate descriptions on germination of Paracentrotus lividus inspired a recognized German zoologist Oscar Hertwig (1849-1922). Auerbach also profoundly studied an encystation of Oxytricha pellionella on morphological grounds. His descriptions referred to karyokinesis as well as oogenesis and spermatogenesis to discover conjugations of spermatozoa in pairs in the epididymis of a beetle, Dytiscus marginalis. He also distinguished two types of spermatozoa of Paludina vivipara: the hairlike-shaped (German: haarformigen) and the worm-shaped (wurmformigen) ones of these fresh water (river) snails. His studies on germination (including cell division during cleavage of nematodes) inspired the others, e.g., Oscar Hertwig, and following generations to conclude that Auerbach deserves the credit for having provided the first scientific foundation for modern teaching on fertilization according to professor of anatomy Gustav Born (1851-1900) at Breslau University.

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

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33. 100 Years since the birth of Ladislau Steiner. Creativity of Neurosurgery

Mircea Vicentiu Saceleanu, Aurel George Mohan, Andrei Alexandru Marinescu, Alexandru Vlad Ciurea

Ladislau Steiner (1920-2013) was a Romanian neurosurgeon, born in the historic and picturesque region of Fagaras. He was educated by some of the best doctors and professors in Romania, during the communist regime. After his escape through the communist regime, in 1961, at 41 years old, he started his neurosurgical and radiosurgical career at Karolinska Institute, in Stockholm, under the renown Herbert Olivecrona and Lars Leksell. He worked here for 25 years, until he retired in 1987 as head of 1st and 2nd Departments of Neurosurgery in the institute s affiliated clinic Sophiahemmet Hospital. He is most known in Sweden as the first to introduce microsurgical techniques in neurosurgery, but internationally he is known as the unofficial emissary of Gamma Knife Surgery. After his retirement, he continued his practice at University of Virginia, USA, for another 23 years and another two years at International Neurosciences Institute, Hannover, Germany, being a Professor of Neurosurgery and Radiology of Gamma Knife Surgery. Thanks to his efforts, Romanian neurosurgery had an accelerated progress after the fall of communism, in 1989. Also, thanks to him, Romania was the first Southeast European country with a Gamma Knife unit. For his efforts, he was appointed Honorary President of the Romanian Society of Neurosurgery. We pay tribute to a great Romanian neurosurgeon who managed to touch the lives of thousands of patients and doctors from almost all countries in the world, in time when the world was divided between east and west, communism and freedom.

Corresponding author: Aurel George Mohan, Associate Professor, MD, PhD; e-mail:

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34. Letter to the Editor: Corrigendum to the paper The impact of imagistic evaluation of premalignant and malignant lesions of the breast confirmed in histopathological terms

Alina Oana Rusu-Moldovan


Corresponding author: Alina Oana Rusu-Moldovan, MD, PhD Student; e-mail:

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