ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Vol. 66 No. 2, April-June 2025

1. Neuroendocrine tumors of the appendix: a comprehensive review of the literature and case presentation

Liviu Vasile, Laurentiu Augustus Barbu, Gabriel Florin Razvan Mogos, Valeriu Surlin, Ionica Daniel Vilcea, Liliana Cercelaru, Stelian Stefanita Mogoanta, Nicolae-Dragos Margaritescu, Victor Nimigean, Vanda Roxana Nimigean, Tiberiu Stefanita Tenea-Cojan

Background/Objectives: Appendiceal neuroendocrine tumors (aNETs), though rare and often incidentally discovered, have shown a rising incidence, particularly among younger individuals, due to improved diagnostic practices, and are generally associated with favorable prognosis, with current evidence supporting conservative, individualized management and tailored surveillance strategies based on tumor size, grade, histopathological features, and imaging findings. Study selection for review: A PubMed search was performed to explore the current understanding of aNETs, with emphasis on their etiopathogenesis, diagnostic criteria, and therapeutic strategies. Case presentation: A 42-year-old man underwent an uneventful laparoscopic appendectomy for acute appendicitis, during which a 5 cm appendix with a pale, nodular tip suggestive of a lesion was resected, leading to the incidental discovery of an aNET. Conclusions: aNETs, though rare, are increasingly detected incidentally and have a favorable prognosis, with individualized management and follow-up guided by tumor features and supported by multidisciplinary care.

Corresponding author: Laurentiu Augustus Barbu, Assistant Lecturer, MD, PhD; e-mail: laurentiu.barbu@umfcv.ro; Gabriel Florin Razvan Mogos, Lecturer, MD, PhD; e-mail: gabriel.mogos@umfcv.ro

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2. Wild-type transthyretin cardiac amyloidosis: a case of multisystemic involvement and review of literature

Cristiana Gianina Moise, Cristina Elena Negroiu, Oana Mirea, Robertina Iulia Tudorascu, Emilia Georgiana Vinturis, Suzana Danoiu, Ionut Donoiu, Andreea Stefan, Victor Cornel Raicea

Introduction: Cardiac amyloidosis (CA) represents a progressively evolving infiltrative pathology, defined by the myocardial accumulation of amyloid fibrils. The condition predominantly originates from transthyretin-derived (ATTR) or immunoglobulin light chain-related (AL) amyloidosis. ATTR cardiomyopathy (ATTR-CM), particularly the wild-type (wt) form (wtATTR-CM), is becoming more widely acknowledged as a contributor to cardiac dysfunction in the elderly population. However, diagnosing ATTR-CM remains challenging due to its clinical similarity to other cardiac conditions and a history of frequent misdiagnoses. Recent advancements in nuclear imaging using bone-avid radiotracers have greatly improved the ability to diagnose ATTR-CM non-invasively. Case presentation: This case involves an 86-year-old male with documented peripheral joint disease, supraspinatus tendon rupture affecting both limbs, referred for exertional dyspnea. Echocardiography indicated left ventricular hypertrophy, diastolic dysfunction, reduced global longitudinal strain, accompanied by severe mitral regurgitation (MR) secondary to prolapse of the posterior mitral leaflet. Cardiac magnetic resonance (CMR) imaging revealed concentric hypertrophy, elevated T1 mapping, and increased extracellular volume, highly suggestive of amyloid deposition. Bone scintigraphy confirmed the diagnosis of ATTR-CM with a Perugini score of 3. A biopsy of the abdominal fat pad revealed amyloid deposits. Conclusions: Such presentations of ATTR-CM emphasize its systemic nature and the need for early recognition and treatment. An important aspect of this case is the uncommon association between CA and posterior mitral valve prolapse, which leads to significant MR.

Corresponding author: Cristina Elena Negroiu, Assistant Professor, MD, PhD; e-mail: cristina.negroiu@yahoo.ro

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3. Short histological kaleidoscope - recent findings in histology. Part V. About tendons, ligaments, and cartilages

Elena Mihaela Jianu, Carmen Mihaela Mihu, Rada Teodora Sufletel, Carmen Bianca Crivii, Anne-Marie Constantin, Lavinia Patricia Mocan, Ioana Maria Orlea, Roxana Adelina Stefan, Paul-Andrei Stefan, Andrei Coneac, Madalin Mihai Onofrei, Tudor Cristian Pascalau, Andreea Crintea, Alina Simona Sovrea

Tendons, ligaments, and various types of cartilage, including elastic, hyaline, growth, articular, and meniscal cartilage, share important structural and functional properties. As connective tissues, they are characterized by a dense extracellular matrix composed of collagen fibers and proteoglycans, which provide mechanical strength and flexibility. Their limited vascularity affects healing potential and metabolic activity. These tissues are crucial for maintaining joint integrity, distributing mechanical loads, and supporting skeletal development. This overview highlights the common features that define these connective tissues, providing a foundation for further understanding of their roles in musculoskeletal physiology and pathology, their capacity for regeneration, and possible treatment options.

Corresponding author: Rada Teodora Sufletel, Assistant, MD, PhD; e-mail: sufletel.rada@umfcluj.ro

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4. Appendiceal malakoplakia: a review of the literature and case presentation

Laurentiu Augustus Barbu, Liviu Vasile, Gabriel Florin Razvan Mogos, Valeriu Surlin, Ionica Daniel Vilcea, Liliana Cercelaru, Stelian Stefanita Mogoanta, Nicolae-Dragos Margaritescu, Tiberiu Stefanita Tenea-Cojan

Background/Objectives: Malakoplakia is an uncommon clinicopathological entity defined by the accumulation of dysfunctional macrophages containing undigested bacterial remnants and pathognomonic Michaelis-Gutmann bodies. Although it most frequently involves the gastrointestinal tract, particularly the colon, rectum, and rectosigmoid junction, appendiceal involvement remains rare. This case represents only the fourth reported occurrence of appendiceal malakoplakia in a young, immunocompetent adult without notable comorbidities, underscoring its exceptional clinical presentation. Study selection for review: A PubMed search was performed to explore the current understanding of malakoplakia, with emphasis on its etiopathogenesis, diagnostic criteria, and therapeutic strategies. Case presentation: A 25-year-old immunocompetent male presented with a periappendicular abscess mimicking a tumor, ultimately requiring right hemicolectomy. Histopathological (HP) evaluation confirmed intestinal-appendicular malakoplakia and granulomatous lymphadenitis, with no evidence of tuberculosis, underscoring the diagnostic challenge and the need for further investigation into its etiopathogenesis in young, otherwise healthy individuals. Conclusions: This case illustrates a rare instance of appendicular malakoplakia in a young adult, emphasizing the importance of HP evaluation for accurate diagnosis and the need to consider this entity in the differential diagnosis of appendiceal masses to avoid mismanagement.

Corresponding author: Liviu Vasile, Lecturer, MD, PhD; e-mail: vliviu777@yahoo.com; Ionica Daniel Vilcea, Professor, MD, PhD; e-mail: ionica.valcea@umfcv.ro

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5. Physical exercise and irisin: managing obesity and related comorbidities

Cristina Elena Negroiu, Robertina Iulia Tudorascu, Suzana Danoiu, Vlad Padureanu, Sanziana Godeanu, Raluca Danoiu, Adrian Ionut Ungureanu, Maria Cristina Bezna, Cristiana Gianina Moise

We live in an obesity pandemic characterized by sedentary lifestyles and unhealthy eating habits among more and more people. Therefore, it is crucial to understand the pathophysiology of obesity. A myokine secreted during exercise, irisin, has been the subject of many studies in recent years. It is well-known that physical exercise is one of the key therapeutic pillars in the fight against obesity. Irisin is a polypeptide hormone released during physical activity, and once it enters the bloodstream, it has numerous effects on the human body. This review aimed to highlight the latest studies on irisin, focusing on its structure, the mechanisms behind its release into the bloodstream, its effects on various organs, and, last but not least, how its serum levels change in different pathologies and its therapeutic effects.

Corresponding author: Robertina Iulia Tudorascu, Lecturer, MD, PhD; e-mail: irtudorascu@gmail.com; Cristina Elena Negroiu, Assistant Professor, MD, PhD; e-mail: cristina.negroiu@yahoo.ro

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6. Acute pulmonary inflammatory reaction in COVID-19 - histological and immunohistochemical study

Florin Ionut Buibas, Roberta Andreea Cercel, Mircea-Sebastian Serbanescu, Adina Andreea Mirea, Florentina Dumitrescu, Daniel Pirici, Denisa Floriana Vasilica Pirscoveanu, Anca-Maria Istrate Ofiteru, Marian Valentin Zorila, Laurentiu Mogoanta

Coronavirus disease 2029 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which enters the human body via the respiratory route and can infect nasal and bronchial epithelial cells, goblet cells, hair cells, pneumocytes, etc. COVID-19 caused the worst pandemic in centuries. SARS-CoV-2, once in the airway tree, penetrates the host cells and causes a strong inflammatory reaction by a rapid response of the innate immune system, in particular by activation of macrophages and dendritic cells that recognize the virus component proteins as non-self. Cells of the immune system secrete type I interferon and proinflammatory cytokines, initiating an antiviral state in neighboring cells and in the intercellular connective matrix, recruiting new immune mediators and new cells to the site of infection. This rapid response is crucial for limiting the spread of SARS-CoV-2. In the present study, we aimed at highlighting some microscopic aspects of the acute inflammatory reaction in the lung for SARS-CoV-2 infection. The analysis of the histological pieces suggested that the pulmonary inflammatory reaction begins with the accumulation of immune cells in the interalveolar septa in response to viral insult, congestion of pulmonary vessels with increased blood volume in pulmonary vessels, followed by the presence of alveolar exudate, which reduces the area of hematosis and triggers respiratory symptoms. The inflammatory reaction was totally inhomogeneous, varying widely from patient to patient and even within the same patient, probably depending on the immune status, age or comorbidities. It presented two phases, a predominantly exudative phase (EP) and a predominantly proliferative phase (PP), intricately intertwined; sometimes, on the same histopathological piece, we identified both areas of incipient inflammatory reaction (EP) and a very intense reaction in the PP, suggesting that the pulmonary inflammatory reaction developed rapidly. The inflammatory infiltrate had a complex composition: neutrophilic leukocytes, macrophages, mast cells, lymphocytes and plasma cells. The most abundant inflammatory cells were macrophages, both in the EP and PP. The use of anti-interleukin (IL) antibodies showed that ILs are mainly produced by cells of the monocyte-macrophage system, but also by conjunctival cells (fibroblasts).

Corresponding author: Denisa Floriana Vasilica Pirscoveanu, Lecturer, MD, PhD; e-mail: pirscoveanudenisa@gmail.com

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7. Clinicopathological spectrum of adrenal tumors: a retrospective study from a Romanian tertiary referral center

Ramona Teodora Catana, Adela Corina Nechifor-Boila, Sorina Moica, Laura Chinezu, Angela Borda

Adrenal tumors represent an uncommon and heterogeneous group of lesions with diverse clinical and histopathological features. Their detection has increased in recent years due to the widespread use of advanced imaging techniques. However, epidemiological data regarding the various types of adrenal tumors in Eastern Europe remain scarce and show considerable variability. In this study, we aimed to analyze the clinicopathological characteristics, distribution, and temporal trends of adrenal tumors diagnosed in a Romanian tertiary referral center between 2001 and 2022. We conducted a retrospective review of 116 adrenalectomy specimens documented in the Pathology Database of our institution. Demographic characteristics, tumor laterality, histological subtypes, and temporal distribution patterns were analyzed. Adrenal adenomas were the most common tumors (31.9%), followed by pheochromocytomas (24.1%), and adrenal cortical carcinomas (11.2%); other lesions (e.g., cysts, myelolipoma, etc.) were rare. The number of adrenal surgeries increased by 36% in the period 2012-2022 compared to 2001-2011. The prevalence of adrenal adenomas almost doubled in the second study period (38.8% vs. 22.4%, p=0.014). Pheochromocytomas remained constant, revealing a similar prevalence (around 24%) in both time periods. Carcinomas prevalence was lower in both intervals (7.4% in 2012-2022 vs. 16.3% in 2001-2011, p=0.405). Our findings highlight temporal changes in the histological spectrum of adrenal tumors, with an increasing trend in cortical adenomas and persistently low rates of adrenocortical carcinoma. These results offer insight into local patterns of adrenal pathology and underscore the need for ongoing clinicopathological monitoring.

Corresponding author: Adela Nechifor-Boila, Associate Professor, MD, PhD; e-mail: adela.nechifor-boila@umfst.ro

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8. A zebrafish colorectal xenograft model for chemotherapy response

Andrei-Nicolae Ceobanu, Mihail-Gabriel Dimofte, Dragos Pieptu, Lucian Hritcu, Florin Zugun-Eloae, Gabriel Luta, Alexandru-Florin Braniste

Colorectal cancer (CRC) is the third most diagnosed cancer globally and the third leading cause of cancer-related deaths. Early-stage CRC treatment consists of a combination of surgery, radiotherapy, and chemotherapy, while advanced CRC remains difficult to manage, most patients will experience disease progression and require multiple lines of systemic therapy. Choosing the right therapy is often a challenge since most chemotherapeutics lack distinctive biomarkers, thus functional testing has emerged as a promising strategy to personalize therapy and minimize unnecessary toxicity. In this study, we present our zebrafish (Danio rerio) xenograft model to evaluate the response to first-line chemotherapeutic protocols commonly used in clinical practice. We demonstrate that after a short course of chemotherapy there is an evident reduction in primary tumor size, circulating tumor cells, and metastasis area during the follow-up period. These changes were more pronounced in subgroups treated with Irinotecan, indicating the xenografts sensitivity to these protocols. We believe this model has significant potential for both fundamental cancer research and translational applications.

Corresponding author: Alexandru-Florin Braniste, MD, PhD Student; e-mail: braniste.florin@gmail.com

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9. Dynamic TyG-inflammation-endothelial trajectories and placental histopathology synergistically define a maternal-fetal vascular risk phenotype

Biliana Alexandra Belovan, Adrian Claudiu Ratiu, Ioan Sas, Loredana Gabriela Stana

Background: Maternal dysmetabolism and low-grade inflammation accelerate fetal aortic wall thickening. Whether concomitant placental vascular or inflammatory lesions amplify this risk is unknown. Participants, Materials and Methods: 88 women with singleton, anatomically normal pregnancies were phenotyped at 24-26 weeks (visit 1, V1) and 32-34 weeks (visit 2, V2). Dynamic maternal markers [(Delta triglyceride-glucose (TyG) index, Delta interleukin-6 (IL-6), Delta high-sensitivity C-reactive protein (hsCRP), Delta flow-mediated dilation (FMD)] again generated three metabolic inflammatory response phenotypes (MIRP-1/-2/-3). Placentas were examined by pathologists. A placental malperfusion-inflammation composite (PMIC) score (0-10) summed semiquantitative grades of maternal vascular malperfusion (MVM), distal villous immaturity, chronic villitis of unknown etiology (CVUE) and acute chorioamnionitis. Results: Adequate placental tissue was obtained from 84 (95%) dyads. Median PMIC rose step wise from MIRP-1 = 2 [interquartile range (IQR) 1-3] to MIRP-2 = 5 [IQR 3-6] and MIRP-3 = 7 [IQR 6-9] (p<0.001). In mixed effects modelling, PMIC independently predicted fetal abdominal aorta intima-media thickness (IMT) progression [beta=+0.012 mm per PMIC point; 95% confidence interval (CI): 0.007-0.017; p<0.001] alongside Delta TyG and Delta IL-6 (R(2) conditional = 0.61). Mothers in the high risk combined phenotype (MIRP-3 + PMIC >=7; n=25) exhibited a mean IMT increment of +0.21+/-0.05 mm vs. +0.06+/-0.03 mm in the double low reference group (MIRP-1 + PMIC <=3; n=22; p<0.001). A five variable XGBoost model [Delta TyG, Delta IL-6, Delta FMD, PMIC, baseline body mass index (BMI)] identified fetuses with late gestation high IMT (>=90th percentile) with area under the receiver operating characteristic (AUROC) 0.91, outperforming the parent model lacking PMIC (AUROC 0.88). Conclusions: Placental vascular and inflammatory lesions potentiate the impact of adverse maternal metabolic inflammatory trajectories on fetal arterial remodeling. Integrating rapid placental histology with dynamic TyG inflammation endothelial indices could refine perinatal risk stratification and guide both ante and postpartum surveillance.

Corresponding author: Adrian Claudiu Ratiu, Lecturer, MD, PhD; e-mail: ratiu.adrian@umft.ro

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10. Morphology of facial aging: a shape-based quantification

Corina Jula Cazacu, Ciprian Radu Jula, Elena Sapte, Raluca Ozana Chistol, Cristina Furnica, Efstathios Grammatikis, Andra Irina Bulgaru-Iliescu

Facial aging is a natural reflection of the passage of time, shaped by genetics, environment, and lifestyle. Before attempting to adjust the aging face, the plastic surgeon needs to understand normal facial aging in terms of shape. The aim of our study was to analyze the facial profile of the Romanian population and to characterize facial shape age-related changes using geometric morphometrics. The study group comprised 140 participants (70 males, 70 females) aged 10-51 years, categorized into five age groups: 10-14, 15-20, 21-30, 31-40, and >40 years. Frontal photographs of all participants were taken using a digital camera. Twenty-four paired and unpaired landmarks were marked on the face of each individual using tpsDIG2w64 program. Digitized landmarks were superimposed, aligned and averaged based on least-squares Procrustes analysis. For each age group, a consensus configuration of landmarks was generated for shape comparison. Thin-plate splines (TPSs) and relative warps (RWs) were used to explore and quantify facial aging from one age group to another. In case of the male face, maximum variability was registered for tragus, gonion, gnathion, and moderate variability for trichion, glabella, nasion, subnasale, orbitale superius, and alare. The first RW explained 51.97% of total shape variation and primarily represented vertical transformations, while the second RW (horizontal changes) was responsible for 12.07% of shape variation. While males showed initial growth of the lower face, females demonstrate earlier development in the upper facial region. Pair landmarks were more prone to changes in female and, contrary to men, facial aging was almost equally distributed on the vertical and horizontal axes, the first RW being responsible for 38.07% and the second RW for 27.16% of total shape change. In conclusion, the aging adult human face undergoes a gender-specific transformation in shape and form.

Corresponding author: Elena Sapte, Professor, MD, PhD; e-mail: esapte@ymail.com

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11. Influence of root morphology on the customized technique for adaptation of glass fiber posts and orthodontic extrusion for achieving the ferrule effect

Gheorghe Sorin Mihali, Dan Lolos, Mihai Ioan Mitariu, Dana Cristina Bratu

This study evaluated the clinical outcomes of a customized technique for restoring large-diameter root canals using prefabricated glass fiber posts (GFPs). The approach involved strategic modifications to accommodate increased root diameters and improve restoration longevity. A total of 104 crowns [45 e.max lithium disilicate (LidiSi) monolithic, 17 e.max LidiSi layered, 27 zirconia monolithic, and 15 zirconia layered] were cemented on endodontically treated teeth (ETT) with GFPs adapted using this technique. The restorations demonstrated a 97.1% survival rate over 24 months, confirming the method s effectiveness, minimal invasiveness, and suitability for rehabilitating ETT. The high success rate underscores the durability of this personalized restoration approach. While these findings suggest promising long-term potential, further research is needed to fully assess the biomechanical impact of all involved components.

Corresponding author: Dan Lolos, DMD, PhD Student; e-mail: lolosdan@umft.ro

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12. Morphological and clinical aspects of acute postmyocardial remodeling in patients with pre-existing hypertrophy

Camelia Nicolae, Nicolae Paun, Madalina Andreea Munteanu, Cristina Florescu, Gabriela Uscoiu, Alice Elena Munteanu, Mihaela Paula Bolohan, Ioan Tiberiu Nanea

Introduction: Cardiac remodeling is a relevant and unfavorable evolution of myocardial infarction, which is associated with an increased risk of progression to overt heart failure (HF). It is currently acknowledged as a fundamental therapeutic objective that clinicians must address from the acute event to the comprehensive clinical follow-up. Aim: The aim of the study was to assess the importance of left ventricular hypertrophy (LVH) in acute myocardial infarction (AMI) extension. Patients, Materials and Methods: Inclusion criteria: anterior V1-V4 ST-segment elevation myocardial infarction (STEMI) and left ventricular ejection fraction (LVEF) >50%. Exclusion criteria: other STEMI locations, heart disorders, systemic diseases. Patients underwent pharmacological or percutaneous revascularization. Echocardiography was performed until day 3 of AMI and after 14 days. To measure the length of the expansion segment (LES), an original mathematical formula was obtained using the parasternal short-axis view at the papillary muscle level, myocardial mass (MM), and interventricular septum thickness (IST). Statistical studies have used the Student s t-test, the linear regression equations and the Pearson s correlation coefficient. Results: 172 AMI patients were analyzed and divided into two groups. Patients with LVH showed a strong reverse Pearson s correlation coefficient between LES and IST. For group II, a significant strongly reverse correlation for the LES and IST. Conclusions: Pre-existing LVH in AMI is associated with the limitation of the expansion. In the group without LVH, a 1 cm increase in LES corresponds to a 0.0622 cm decrease in IST.

Corresponding author: Madalina Andreea Munteanu, MD, PhD; e-mail: dr.amunteanu@gmail.com

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13. External root resorptions: cone-beam computed tomography assessment and histopathological characterization

Roxana-Maria Talpos-Niculescu, Luminita Maria Nica, Laura Cristina Rusu, Raluca Maria Closca, Flavia Zara, Malina Popa, Serban Talpos-Niculescu

Background: External root resorption (ERR) represents a pathological condition of uncertain etiology and variable clinical presentation that can jeopardize the long-term prognosis of affected teeth. Aim: This study aimed to correlate radiological (cone-beam computed tomography - CBCT) and histological findings in three teeth affected by ERR with different localization (apical, middle or cervical), with a focus on the structural changes of the dental hard and soft tissues. Materials and Methods: Two monoradicular and one pluriradicular teeth diagnosed with ERR and external cervical resorption (ECR) based on initial periapical radiography were analyzed using CBCT and lesions were measured in all three planes and described after Patel s classification; after extraction/root amputation, samples were decalcified and processed using standard histological techniques (Hematoxylin-Eosin, van Gieson, Masson s trichrome). Results: Several key features were noticed at the site of resorptive areas: osteoclasts, large multinucleated cells responsible for the resorption of mineralized tissues positioned along the root surface, resulting in the formation of resorption lacunae. Adjacent to the resorptive areas, granulation tissue, with a dense network of capillaries and inflammatory cells, including fibroblasts. Extensive destruction of dentin, cementum, and enamel, presence of fibrous repair, osteoid formation, and dystrophic calcifications were noticed. Conclusions: The combined radiological-histological evaluation enhances diagnostic accuracy and may guide therapeutic strategies.

Corresponding author: Luminita Maria Nica, Associate Professor, DMD, PhD; e-mail: nica.luminita@umft.ro; Malina Popa, Associate Professor, DMD, PhD; e-mail: popa.malina@umft.ro

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14. Details of rare and novel anatomical variations in a case with bilateral long styloid processes

Mugurel Constantin Rusu, Razvan Costin Tudose, Alexandra Diana Vrapciu, Mihai Butucescu

Anatomical vascular variants are frequently reported; however, their broader anatomical context and potential associations with additional variations are often overlooked. This case report presents a unique combination of multiple rare and novel cervical vascular anatomical variants identified in a single patient, thereby highlighting the importance of comprehensive anatomical assessment. A 64-year-old female patient underwent a computed tomography angiography, during which several unexpected anatomical variants were identified: bilaterally elongated styloid processes, with differing ossified segments; bilateral internal jugular vein (IJV) compression at the atlas transverse processes, consistent with jugular nutcracker syndrome; and bilateral Launay s external carotid veins, which drained into the IJVs and communicated via the prevertebral venous plexus. Additionally, a bilateral overlap of the mastoid and transverse processes of the atlas was observed. The right lingual artery exhibited an unusual sinuous course, perforating the hyoglossus muscle. The left IJV displayed a 2.78 cm longitudinal fenestration, with distinct anterior and posterior arms. Complex venous communications were also noted, including a left anterior jugular vein (AJV)-superior thyroid vein connection, a bilateral AJV prelaryngeal anastomosis, and evidence of a drainage pathway from the left IJV to the right AJV. Furthermore, a left posterior external jugular vein (EJV) was observed, continuing the left occipital vein and draining into the left EJV. This case illustrates that the presence of a specific anatomical variant should prompt careful evaluation for additional, potentially unexpected variations. A thorough anatomical assessment can reveal complex interrelationships among vascular structures, which may have significant clinical and surgical implications.

Corresponding author: Mugurel Constantin Rusu, Professor, Dr.Med., Dr.Biol., Dr.Habil.; e-mail: mugurel.rusu@umfcd.ro

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15. Histopathological insights of a rare tubal adenomatoid tumor - case report and literature review

Nicoleta Alina Mares, Alexandru Iordache, Cristian Viorel Poalelungi, Diana Alexandra Costache, Dragos Adrian Georgescu, Niculae Iordache

Background: Adenomatoid tumors (ATs) of the Fallopian tube are rare benign neoplasms, accounting for approximately 0.5-1% of all ATs of the female genital tract. They are often asymptomatic and discovered incidentally. Due to their mesothelial origin, histopathological (HP) diagnosis may be uncertain, requiring immunohistochemical (IHC) tests for definitive confirmation. Case presentation: We present a case of an incidentally discovered tubal AT following a total hysterectomy with prophylactic salpingectomy in a 42-year-old patient with known uterine leiomyomatosis. IHC tests showed positive expression for calretinin and Wilms tumor 1 (WT1) and negative expression for Ki67 and p53, confirming the histological diagnosis of a tubal AT and ruling out malignancy. Conclusions: This study highlights the asymptomatic nature of tubal ATs and emphasizes that they do not require specific treatment, and surgical excision is sufficient. Their HP appearance, combined with IHC findings, remains the key to diagnosis.

Corresponding author: Alexandru Iordache, MD, PhD Student; e-mail: a_iordache@yahoo.com; Cristian Viorel Poalelungi, Senior Lecturer, MD, PhD; e-mail: cristian.poalelungi@umfcd.ro

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16. Adenomatoid hyperplasia of minor salivary glands: report of three cases with immunohistochemical findings and literature review

Carmelo Urso

Adenomatoid hyperplasia (AH) is an infrequent intraoral lesion, composed of lobular aggregates of hyperplastic normal-appearing salivary glands (SG). Three cases of adenomatoid hyperplasia of minor salivary glands (AHMSG) are reported: two were located on the hard palate, in a female patient aged 41 and in a male aged 85 years, and one in the lower lip, in a male patient aged 37. Histopathologically, lesions showed enlarged lobules of mucous or mixed acini with dilated salivary ducts and fibrous stroma. Immunohistochemically, acinar cells were positive for CAM 5.2 and cytokeratin 7 (CK7) and negative for epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA); myoepithelial cells were positive for p63 and smooth muscle actin (SMA); luminal cells of intercalated, striated and excretory/interlobular ducts were positive for CK7, CAM 5.2, EMA and sex-determining region Y (SRY)-box transcription factor 10 (SOX10); basal ductal cells, positive for CK7 and CAM 5.2, also stained with p63; Ki67 labeling index ranged between 1% and 5%. AHMSG is a lesion to be recognized to avoid clinical overdiagnosis, since it can simulate a benign or malignant SG tumor, and to prevent histological underdiagnosis, since hyperplastic SG, showing a normal cyto-architectural structure, may suggest the absence of pathology.

Corresponding author: Carmelo Urso, MD, PhD; e-mail: carmelo.urso@istitutofanfani.it

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