Papers accepted for publication
1. Brain histopathological changes caused by SARS-CoV-2 infection
Roberta Andreea Cercel, Florin Ionut Buibas, Mircea-Sebastian Serbanescu, Daniel Pirici, George Popescu, Nina Ionovici, Marian Valentin Zorila, Ionut Tanase, Laurentiu Mogoanta, Maria Magdalena Manolea
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), affected over 775 million people in 232 countries and regions between 2020 and 2024, causing over seven million deaths and becoming the largest pandemic of the 21st century. Initially considered a respiratory virus with various clinical forms (from asymptomatic to severe clinical forms with severe respiratory failure), it was later shown that the disease also affects other organs and systems, including the nervous system. Therefore, in this study, we aimed at highlighting the histopathological lesions present in the central nervous system (CNS) in patients who died from SARS-CoV-2 infection. For microscopic study, 65 brain fragments were collected from 36 patients infected with SARS-CoV-2, clinically, imaging, and biologically diagnosed with COVID-19 [by real-time reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2]. The patients died under suspicious circumstances from a forensic medicine perspective during 2020 and required autopsy at the Institute of Forensic Medicine, Craiova or the Mina Minovici National Institute of Forensic Medicine, Bucharest, Romania to determine the main causes of death. The most common brain lesions were ischemic, with the aspect of neurons with intensely eosinophilic cytoplasm (red neurons), condensed, pyknotic, hyperchromic nuclei, perineuronal edema, giving the cerebral cortex a spongy appearance, fragmentation of unmyelinated extensions in the neuropil, collapse of blood vessels, and perivascular edema. Multiple vascular thromboses were identified, predominantly in small vessels (capillaries, arterioles, venules) or destruction of endothelial cells (ECs) with increased blood-brain barrier (BBB) permeability, perivascular edema, and collapse of blood vessels or areas of intracranial hemorrhage. The anti-spike antibody showed that the SARS-CoV-2 infected large neurons (pyramidal cells in the cerebral cortex and Purkinje cells in the cerebellar hemispheres), ECs, pericytes, and even smooth muscle cells in the structure of arterioles, metarterioles, and venules.
Corresponding author: George Popescu, MD, PhD; e-mail: george_popescu39@yahoo.com; Maria Magdalena Manolea, Associate Professor, MD, PhD; e-mail: magdalena.manolea@umfcv.ro
Abstract - Download PDF PDF
2. Renal clear cell carcinoma with bilateral parotid and orbital metastases - case report
Marius Octavian Pricop, Horatiu Constantin Urechescu, Flavia Zara, Adrian Camen, Serban Talpos-Niculescu, Cristiana Cuzic, Alisia Pricop, Raluca Maria Closca
Metastatic involvement of the oral and maxillofacial region is an uncommon clinical event. These secondary lesions may develop in several anatomical locations, most frequently within the parotid glands or orbital structures. While many primary tumors that spread to these regions arise from neighboring sites such as the scalp, face, oral cavity, or pharynx, distant subclavicular malignancies can also give rise to metastases in these areas. Among such tumors, renal cell carcinoma (RCC) is the third most frequent source of metastasis to the oral and maxillofacial region. Nevertheless, reports of RCC spreading to the parotid or orbital regions remain exceptionally rare. We present a distinctive clinical case of a 54-year-old man with clear cell RCC that, during its progression, produced simultaneous metastases to both parotid glands and to the orbital region - a combination that, to our knowledge, has not been previously documented in the medical literature.
Corresponding author: Horatiu Constantin Urechescu, Lecturer, DMD, PhD; e-mail: urechescu.horatiu@umft.ro
Abstract - Download PDF PDF
3. Assessment of the clinical and morphological characteristics of visceral melanoma metastases and primary extracutaneous melanomas
Bianca Roxana Nataras, Alis Liliana Carmen Dema, Aura Jurescu, Octavia Cornelia Vita, Sorina Maria Taban, Ioana Hurmuz, Diana Nadina Szilagyi, Daciana Grujic, Valentin Tudor Popa, Sorin Dema
Aim: This study aimed to assess the clinical and morphological characteristics of patients with visceral melanoma metastases and primary extracutaneous melanomas. Patients, Materials and Methods: We performed a retrospective study on patients with visceral melanoma metastases and primary extracutaneous melanomas, diagnosed in two pathology departments. Results: We identified 50 cases of visceral metastases and eight cases of primary extracutaneous melanomas. A percentage of 56% of the distant metastases involved the brain, 28% were localized in the digestive tract (stomach, small bowel, colon, liver, cystic duct), 16% involved the lung, spleen, adrenal gland, peritoneum, urinary bladder and bone. In 34% of the cases, the metastases were diagnosed prior to the primary melanoma. A percentage of 62.5% of primary extracutaneous melanomas were ocular melanomas, 25% were anal mucosa melanomas and one case (12.5%) involved the penile glans. Statistical analysis showed that distant melanoma metastases were more frequently diagnosed in the seventh decade (p<0.0001), and a higher percentage of patients lived in urban areas (p=0.001). The majority of the primary cutaneous melanomas associated with brain metastases were located on the trunk (p=0.0565). The brain metastases were more frequently diagnosed in males (64%; p=0.0604). Conclusions: The brain is the most frequent organ involved by distant melanoma metastases, followed by the digestive tract. It is important to be aware of the least common metastatic locations such as cystic duct, urinary bladder, adrenal gland, spleen and peritoneum, in order to avoid misdiagnosis.
Corresponding author: Valentin Tudor Popa, MD, PhD Student; e-mail: popa.valentin@umft.ro
Abstract - Download PDF PDF
4. The influence of diabetes mellitus on blood vessels amounts and immune status in case of breast cancer
Ecaterina Foca, Dumitru Brinza, Ecaterina Carpenco, Valeriu David, Lilian Saptefrati, Veaceslav Fulga
Background: Breast cancer (BC) remains one of the most prevalent malignancies worldwide, and its progression can be influenced by systemic conditions such as type 2 diabetes mellitus (T2DM). Both diseases share common mechanisms of metabolic dysregulation, chronic inflammation, and vascular dysfunction that may reshape the tumor microenvironment (TME). Aim: To conduct a comparative evaluation of the vascular and immune components of the BC microenvironment in patients with and without T2DM, as well as in normal mammary tissue, with particular emphasis on cluster of differentiation (CD)34+ microvessel density (MVD), T-cell subsets (CD3+, CD4+, CD8+), and their association with hormonal receptor status and proliferative index (Ki67). Materials and Methods: Immunohistochemical analysis was performed on 58 invasive ductal carcinomas (29 T2DM-associated, 29 non-diabetic) and 10 normal breast samples. Quantification of immune and vascular markers was correlated with clinical and morphological parameters using Spearman s test and Welch statistics (p<=0.05). Results: T2DM-associated BCs demonstrated significantly increased intratumoral MVD (p=0.03) and decreased intratumoral CD3+, CD4+, and CD8+ lymphocytes compared with non-diabetic tumors, indicating an immune-excluded phenotype. Blood glucose correlated positively with CD34+ vessel content and inversely with Ki67 expression (rs=-0.29, p=0.05). Peritumoral CD8+ cells were positively associated with estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status, suggesting hormonal modulation of immune infiltration. Conclusions: T2DM promotes vascular proliferation and suppresses intratumoral immune activity in BC, creating an angiogenic yet immunosuppressed microenvironment. These findings highlight the impact of metabolic imbalance on tumor biology and underscore the need for integrating metabolic control and immunomodulatory strategies in the management of diabetic BC patients.
Corresponding author: Ecaterina Carpenco, Assistant Professor, PhD; e-mail: ecaterina.carpenco@usmf.md
Abstract - Download PDF PDF
5. Traumatic thoracic extradural cyst - surgical management and literature review
George Popescu, Marius-Cristian Zaharia, Denisa Soci, Carla-Maria Andrasi, Angela Neacsu, Radu-Mircea Gorgan, Ana Catalina Tantu, Georgeta Ionescu
Extradural arachnoid cysts (EACs) are rare, fluid-filled lesions located outside the dura mater, predominantly found in the thoracic spine. While many remain asymptomatic, their progressive enlargement may lead to significant neurological deficits due to spinal cord compression. This case report describes a 43-year-old patient presenting with incomplete paraplegia (Frankel grade C) due to a thoracic EAC at the T5-T6 level. Surgical management involved laminectomy, complete cyst excision, and dural defect repair, leading to neurological improvement. The discussion reviews current diagnostic and therapeutic approaches, emphasizing the importance of early intervention to optimize patient outcomes.
Corresponding author: Marius-Cristian Zaharia, MD; e-mail: zahariamarius16@gmail.com; Ana Catalina Tantu, MD; e-mail: catalina.tantu8@gmail.com
Abstract - Download PDF PDF
6. Multimodal spectrum of approach in poorly differentiated thyroid carcinoma (an updated analysis)
Mihai Costachescu, Nina Ionovici, Dana Cristina Terzea, Florina Vasilescu, Lucian-George Eftimie, Alexandra-Ioana Trandafir, Ana-Maria Gheorghe, Oana-Claudia Sima, Claudiu Nistor, Mara Carsote
Thyroid malignancy represents the most common type of endocrine cancer, with an increasing incidence all over the world, including an increasing rate of detection among younger adults, 90% to 95% of all cases being non-medullary types. Poorly differentiated thyroid cancer, accounting 1% to 5% of all thyroid malignancies, is a less understood neoplasm compared to the other more frequent and better described thyroid cancers, associating various histological patterns that might bring pitfalls of diagnosis in everyday practice. We aimed to provide an updated analysis in the field of poorly differentiated thyroid carcinoma, based on a multimodal approach, including emergent biomarkers. The current data offers a robust framework for elucidating the biology of poorly differenced thyroid malignancy and further on, it provides the basis for a multilayered therapeutic approach. Emergent biomarkers might be detected from cytological analysis based on fine-needle aspiration or blood assays as cell-free deoxyribonucleic acid (cfDNA), but the most important remains the identification of the molecular and genetic constellation in terms of analyzing RAS, telomerase reverse transcriptase (TERT), B-Raf proto-oncogene, serine/threonine kinase (BRAF), tumor protein p53 (TP53), phosphatase and tensin homolog (PTEN), copy number alterations (CNA) and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) profile, which serve as prognostic markers and pointers of anti-cancer medical therapy. Overall, despite recent advances in multimodal management, the prognostic remains severe. The issue is ongoing, and we expect a massive expansion within the following years, across a guideline-based, as well as a personalized decision.
Corresponding author: Nina Ionovici, Associate Professor, MD, PhD; e-mail: nina.ionovici@umfcv.ro
Abstract - Download PDF PDF
7. Testicular cancer in adolescents: clinicopathological and immunohistochemical aspects
Cristina Elena Singer, Razvan Cosmin Pana, Mihaela Popescu, Jaqueline Abdul-Razzak, Iulian Alin Silviu Popescu, Alex Emilian Stepan, Ileana Octavia Petrescu, Elena Savu, Simina Gaman, Liviu Vasile, Cristina Popescu, Ana Maria Petrescu
Testicular germ cell malignancies have a low prevalence among pediatric neoplasia, presenting a bimodal distribution, the two peaks being around the age of five years and postpuberty. Early identification of these types of solid tumors is extremely important, since the prognosis has improved significantly in recent decades through the multimodal diagnostic and therapeutic approach. Our study refers to two cases of testicular neoplasm diagnosed in the postpubertal period. The two adolescents were diagnosed in the Department of Oncopediatrics, in a short interval (February and March 2023). The diagnostic process was based on biological dosing, histopathological (HP) and immunohistochemical examination of orchiectomy specimens and imaging evaluations (computed tomography and magnetic resonance imaging). Following the investigations described, non-seminomatous germ cell tumors were identified in both cases. In the first patient, the tumor was classified in stage IB, while the second patient presented with advanced stage disease, presenting pulmonary, hepatic and ganglia metastases, being classified in stage IIIC. In both patients, chemotherapy was initiated according to current therapeutic protocols. Testicular tumors are a rare pathology with a specific clinical-biological and HP picture that require a multimodal approach (pediatric oncologist, pediatric surgeon, pathologist, radiologist), and for which the prognosis differs depending on the diagnosis stage and the detected histological type.
Corresponding author: Jaqueline Abdul-Razzak, MD, PhD Student; e-mail: jaquelineabdulrazzak90@gmail.com; Simina Gaman, DMD, PhD; e-mail: simina.gaman@umfcv.ro
Abstract - Download PDF PDF
8. Leveraging artificial intelligence for cardiovascular risk: a primary care perspective
Christiana Raluca Danciulescu, Mircea Sorin Ciolofan, Constantin Renato Ivanescu, Dragos Ovidiu Alexandru
Background/Objectives: Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide. Primary care physicians, particularly family doctors, play a pivotal role in early detection and prevention. This study investigates the potential of artificial intelligence (AI)-based temporal deep learning (DL) models to support cardiovascular risk (CVR) stratification in primary care. Materials and Methods: We implemented temporal DL architectures, namely Long Short-Term Memory (LSTM) network and Gated Recurrent Unit (GRU), on a clinically realistic synthetic patient cohort. The dataset included demographic and clinical variables such as age, sex, body mass index (BMI), blood pressure (BP), and established risk factors (smoking, diabetes, and hypertension). Models were trained on sequential data to predict CVR categories (low, moderate, and very high) along with their corresponding probabilities. Model outputs were statistically benchmarked and subsequently aligned with actionable clinical recommendations. Results: Both LSTM and GRU models demonstrated the ability to forecast CVR across multiple time horizons. Predictions were successfully translated into clinically interpretable recommendations supporting tailored follow-up intervals and targeted interventions. Conclusions: Integration of AI-driven CVR forecasting into routine family medicine practice can enhance early intervention strategies, optimize patient management, and improve resource allocation. This approach highlights the potential of temporal DL to strengthen preventive care outcomes in primary care settings.
Corresponding author: Mircea Sorin Ciolofan, Associate Professor, MD, PhD; e-mail: sorin.ciolofan@yahoo.com
Abstract - Download PDF PDF
9. Localized gingival enlargements: clinical, histopathological and surgical evaluation in five cases
Bilge Cansu Uzun Saylan, Ayca Muhterem, Sulen Sarioglu
Background: Localized gingival enlargements (GEs) are frequently encountered reactive lesions with various etiologies, including chronic irritation, trauma, systemic conditions, hormonal influences, and medication use. Despite their benign nature, these lesions can significantly affect oral function and aesthetics and may occasionally mimic neoplastic processes. This case series aims to present the clinical and histopathological (HP) features of five patients with localized GEs, describe different surgical approaches including scalpel and diode laser excision, and report short-term clinical outcomes. Case presentations: Five patients with gingival overgrowths of varying etiology were evaluated. All underwent thorough periodontal debridement and oral hygiene instruction prior to surgical intervention. HP evaluation followed surgical excision. Patients were monitored for recurrence for at least three months. Lesions included inflammatory epithelial hyperplasia, cavernous hemangioma, and squamous cell papilloma. One case revealed immunoglobulin G4 (IgG4)-positive plasma cells and was referred to Rheumatology Department. A suspected vascular lesion was successfully managed with laser excision to minimize bleeding. One patient exhibited recurrence of a papillomatous lesion, prompting referral to infectious disease. No major complications occurred during the follow-up period. Conclusions: Localized GEs can present diverse HP profiles. Biopsy remains essential for definitive diagnosis, especially when clinical features are ambiguous. Laser surgery proved beneficial in vascular lesions by reducing intraoperative bleeding and enhancing patient comfort. Identifying and managing underlying systemic or local factors is crucial to prevent recurrence.
Corresponding author: Ayca Muhterem, DDS; e-mail: ayca.muhterem@deu.edu.tr
Abstract - Download PDF PDF
10. Columnar cell variant of papillary thyroid carcinoma in an adolescent: a comprehensive histopathological, immunohistochemical, and molecular analysis
Gizem Issin, Fatih Demir, Diren Vuslat Cagatay, Ismail Yilmaz
The columnar cell variant (CCV) of papillary thyroid carcinoma (PTC) is a rare histological subtype with distinct morphological and immunohistochemical (IHC) features, which can present diagnostic challenges. We report a case of a 13-year-old girl diagnosed with CCV of PTC (CCV-PTC) following a total thyroidectomy for a solitary thyroid nodule. Histopathological (HP) examination revealed aggressive features, including vascular invasion and extrathyroidal extension. However, no metastases or recurrences were observed during six years of follow-up. This case report provides a comprehensive analysis of a rare CCV-PTC in an adolescent, focusing on its HP, IHC, and molecular characteristics. It also discusses diagnostic pitfalls and differential diagnoses that should be considered.
Corresponding author: Gizem Issin, Associate Professor, MD, PhD; e-mail: gizemissin@gmail.com
Abstract - Download PDF PDF
1. Brain histopathological changes caused by SARS-CoV-2 infection
Roberta Andreea Cercel, Florin Ionut Buibas, Mircea-Sebastian Serbanescu, Daniel Pirici, George Popescu, Nina Ionovici, Marian Valentin Zorila, Ionut Tanase, Laurentiu Mogoanta, Maria Magdalena Manolea
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), affected over 775 million people in 232 countries and regions between 2020 and 2024, causing over seven million deaths and becoming the largest pandemic of the 21st century. Initially considered a respiratory virus with various clinical forms (from asymptomatic to severe clinical forms with severe respiratory failure), it was later shown that the disease also affects other organs and systems, including the nervous system. Therefore, in this study, we aimed at highlighting the histopathological lesions present in the central nervous system (CNS) in patients who died from SARS-CoV-2 infection. For microscopic study, 65 brain fragments were collected from 36 patients infected with SARS-CoV-2, clinically, imaging, and biologically diagnosed with COVID-19 [by real-time reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2]. The patients died under suspicious circumstances from a forensic medicine perspective during 2020 and required autopsy at the Institute of Forensic Medicine, Craiova or the Mina Minovici National Institute of Forensic Medicine, Bucharest, Romania to determine the main causes of death. The most common brain lesions were ischemic, with the aspect of neurons with intensely eosinophilic cytoplasm (red neurons), condensed, pyknotic, hyperchromic nuclei, perineuronal edema, giving the cerebral cortex a spongy appearance, fragmentation of unmyelinated extensions in the neuropil, collapse of blood vessels, and perivascular edema. Multiple vascular thromboses were identified, predominantly in small vessels (capillaries, arterioles, venules) or destruction of endothelial cells (ECs) with increased blood-brain barrier (BBB) permeability, perivascular edema, and collapse of blood vessels or areas of intracranial hemorrhage. The anti-spike antibody showed that the SARS-CoV-2 infected large neurons (pyramidal cells in the cerebral cortex and Purkinje cells in the cerebellar hemispheres), ECs, pericytes, and even smooth muscle cells in the structure of arterioles, metarterioles, and venules.
Corresponding author: George Popescu, MD, PhD; e-mail: george_popescu39@yahoo.com; Maria Magdalena Manolea, Associate Professor, MD, PhD; e-mail: magdalena.manolea@umfcv.ro
Abstract - Download PDF PDF2. Renal clear cell carcinoma with bilateral parotid and orbital metastases - case report
Marius Octavian Pricop, Horatiu Constantin Urechescu, Flavia Zara, Adrian Camen, Serban Talpos-Niculescu, Cristiana Cuzic, Alisia Pricop, Raluca Maria Closca
Metastatic involvement of the oral and maxillofacial region is an uncommon clinical event. These secondary lesions may develop in several anatomical locations, most frequently within the parotid glands or orbital structures. While many primary tumors that spread to these regions arise from neighboring sites such as the scalp, face, oral cavity, or pharynx, distant subclavicular malignancies can also give rise to metastases in these areas. Among such tumors, renal cell carcinoma (RCC) is the third most frequent source of metastasis to the oral and maxillofacial region. Nevertheless, reports of RCC spreading to the parotid or orbital regions remain exceptionally rare. We present a distinctive clinical case of a 54-year-old man with clear cell RCC that, during its progression, produced simultaneous metastases to both parotid glands and to the orbital region - a combination that, to our knowledge, has not been previously documented in the medical literature.
Corresponding author: Horatiu Constantin Urechescu, Lecturer, DMD, PhD; e-mail: urechescu.horatiu@umft.ro
Abstract - Download PDF PDF3. Assessment of the clinical and morphological characteristics of visceral melanoma metastases and primary extracutaneous melanomas
Bianca Roxana Nataras, Alis Liliana Carmen Dema, Aura Jurescu, Octavia Cornelia Vita, Sorina Maria Taban, Ioana Hurmuz, Diana Nadina Szilagyi, Daciana Grujic, Valentin Tudor Popa, Sorin Dema
Aim: This study aimed to assess the clinical and morphological characteristics of patients with visceral melanoma metastases and primary extracutaneous melanomas. Patients, Materials and Methods: We performed a retrospective study on patients with visceral melanoma metastases and primary extracutaneous melanomas, diagnosed in two pathology departments. Results: We identified 50 cases of visceral metastases and eight cases of primary extracutaneous melanomas. A percentage of 56% of the distant metastases involved the brain, 28% were localized in the digestive tract (stomach, small bowel, colon, liver, cystic duct), 16% involved the lung, spleen, adrenal gland, peritoneum, urinary bladder and bone. In 34% of the cases, the metastases were diagnosed prior to the primary melanoma. A percentage of 62.5% of primary extracutaneous melanomas were ocular melanomas, 25% were anal mucosa melanomas and one case (12.5%) involved the penile glans. Statistical analysis showed that distant melanoma metastases were more frequently diagnosed in the seventh decade (p<0.0001), and a higher percentage of patients lived in urban areas (p=0.001). The majority of the primary cutaneous melanomas associated with brain metastases were located on the trunk (p=0.0565). The brain metastases were more frequently diagnosed in males (64%; p=0.0604). Conclusions: The brain is the most frequent organ involved by distant melanoma metastases, followed by the digestive tract. It is important to be aware of the least common metastatic locations such as cystic duct, urinary bladder, adrenal gland, spleen and peritoneum, in order to avoid misdiagnosis.
Corresponding author: Valentin Tudor Popa, MD, PhD Student; e-mail: popa.valentin@umft.ro
Abstract - Download PDF PDF4. The influence of diabetes mellitus on blood vessels amounts and immune status in case of breast cancer
Ecaterina Foca, Dumitru Brinza, Ecaterina Carpenco, Valeriu David, Lilian Saptefrati, Veaceslav Fulga
Background: Breast cancer (BC) remains one of the most prevalent malignancies worldwide, and its progression can be influenced by systemic conditions such as type 2 diabetes mellitus (T2DM). Both diseases share common mechanisms of metabolic dysregulation, chronic inflammation, and vascular dysfunction that may reshape the tumor microenvironment (TME). Aim: To conduct a comparative evaluation of the vascular and immune components of the BC microenvironment in patients with and without T2DM, as well as in normal mammary tissue, with particular emphasis on cluster of differentiation (CD)34+ microvessel density (MVD), T-cell subsets (CD3+, CD4+, CD8+), and their association with hormonal receptor status and proliferative index (Ki67). Materials and Methods: Immunohistochemical analysis was performed on 58 invasive ductal carcinomas (29 T2DM-associated, 29 non-diabetic) and 10 normal breast samples. Quantification of immune and vascular markers was correlated with clinical and morphological parameters using Spearman s test and Welch statistics (p<=0.05). Results: T2DM-associated BCs demonstrated significantly increased intratumoral MVD (p=0.03) and decreased intratumoral CD3+, CD4+, and CD8+ lymphocytes compared with non-diabetic tumors, indicating an immune-excluded phenotype. Blood glucose correlated positively with CD34+ vessel content and inversely with Ki67 expression (rs=-0.29, p=0.05). Peritumoral CD8+ cells were positively associated with estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status, suggesting hormonal modulation of immune infiltration. Conclusions: T2DM promotes vascular proliferation and suppresses intratumoral immune activity in BC, creating an angiogenic yet immunosuppressed microenvironment. These findings highlight the impact of metabolic imbalance on tumor biology and underscore the need for integrating metabolic control and immunomodulatory strategies in the management of diabetic BC patients.
Corresponding author: Ecaterina Carpenco, Assistant Professor, PhD; e-mail: ecaterina.carpenco@usmf.md
Abstract - Download PDF PDF5. Traumatic thoracic extradural cyst - surgical management and literature review
George Popescu, Marius-Cristian Zaharia, Denisa Soci, Carla-Maria Andrasi, Angela Neacsu, Radu-Mircea Gorgan, Ana Catalina Tantu, Georgeta Ionescu
Extradural arachnoid cysts (EACs) are rare, fluid-filled lesions located outside the dura mater, predominantly found in the thoracic spine. While many remain asymptomatic, their progressive enlargement may lead to significant neurological deficits due to spinal cord compression. This case report describes a 43-year-old patient presenting with incomplete paraplegia (Frankel grade C) due to a thoracic EAC at the T5-T6 level. Surgical management involved laminectomy, complete cyst excision, and dural defect repair, leading to neurological improvement. The discussion reviews current diagnostic and therapeutic approaches, emphasizing the importance of early intervention to optimize patient outcomes.
Corresponding author: Marius-Cristian Zaharia, MD; e-mail: zahariamarius16@gmail.com; Ana Catalina Tantu, MD; e-mail: catalina.tantu8@gmail.com
Abstract - Download PDF PDF6. Multimodal spectrum of approach in poorly differentiated thyroid carcinoma (an updated analysis)
Mihai Costachescu, Nina Ionovici, Dana Cristina Terzea, Florina Vasilescu, Lucian-George Eftimie, Alexandra-Ioana Trandafir, Ana-Maria Gheorghe, Oana-Claudia Sima, Claudiu Nistor, Mara Carsote
Thyroid malignancy represents the most common type of endocrine cancer, with an increasing incidence all over the world, including an increasing rate of detection among younger adults, 90% to 95% of all cases being non-medullary types. Poorly differentiated thyroid cancer, accounting 1% to 5% of all thyroid malignancies, is a less understood neoplasm compared to the other more frequent and better described thyroid cancers, associating various histological patterns that might bring pitfalls of diagnosis in everyday practice. We aimed to provide an updated analysis in the field of poorly differentiated thyroid carcinoma, based on a multimodal approach, including emergent biomarkers. The current data offers a robust framework for elucidating the biology of poorly differenced thyroid malignancy and further on, it provides the basis for a multilayered therapeutic approach. Emergent biomarkers might be detected from cytological analysis based on fine-needle aspiration or blood assays as cell-free deoxyribonucleic acid (cfDNA), but the most important remains the identification of the molecular and genetic constellation in terms of analyzing RAS, telomerase reverse transcriptase (TERT), B-Raf proto-oncogene, serine/threonine kinase (BRAF), tumor protein p53 (TP53), phosphatase and tensin homolog (PTEN), copy number alterations (CNA) and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) profile, which serve as prognostic markers and pointers of anti-cancer medical therapy. Overall, despite recent advances in multimodal management, the prognostic remains severe. The issue is ongoing, and we expect a massive expansion within the following years, across a guideline-based, as well as a personalized decision.
Corresponding author: Nina Ionovici, Associate Professor, MD, PhD; e-mail: nina.ionovici@umfcv.ro
Abstract - Download PDF PDF7. Testicular cancer in adolescents: clinicopathological and immunohistochemical aspects
Cristina Elena Singer, Razvan Cosmin Pana, Mihaela Popescu, Jaqueline Abdul-Razzak, Iulian Alin Silviu Popescu, Alex Emilian Stepan, Ileana Octavia Petrescu, Elena Savu, Simina Gaman, Liviu Vasile, Cristina Popescu, Ana Maria Petrescu
Testicular germ cell malignancies have a low prevalence among pediatric neoplasia, presenting a bimodal distribution, the two peaks being around the age of five years and postpuberty. Early identification of these types of solid tumors is extremely important, since the prognosis has improved significantly in recent decades through the multimodal diagnostic and therapeutic approach. Our study refers to two cases of testicular neoplasm diagnosed in the postpubertal period. The two adolescents were diagnosed in the Department of Oncopediatrics, in a short interval (February and March 2023). The diagnostic process was based on biological dosing, histopathological (HP) and immunohistochemical examination of orchiectomy specimens and imaging evaluations (computed tomography and magnetic resonance imaging). Following the investigations described, non-seminomatous germ cell tumors were identified in both cases. In the first patient, the tumor was classified in stage IB, while the second patient presented with advanced stage disease, presenting pulmonary, hepatic and ganglia metastases, being classified in stage IIIC. In both patients, chemotherapy was initiated according to current therapeutic protocols. Testicular tumors are a rare pathology with a specific clinical-biological and HP picture that require a multimodal approach (pediatric oncologist, pediatric surgeon, pathologist, radiologist), and for which the prognosis differs depending on the diagnosis stage and the detected histological type.
Corresponding author: Jaqueline Abdul-Razzak, MD, PhD Student; e-mail: jaquelineabdulrazzak90@gmail.com; Simina Gaman, DMD, PhD; e-mail: simina.gaman@umfcv.ro
Abstract - Download PDF PDF8. Leveraging artificial intelligence for cardiovascular risk: a primary care perspective
Christiana Raluca Danciulescu, Mircea Sorin Ciolofan, Constantin Renato Ivanescu, Dragos Ovidiu Alexandru
Background/Objectives: Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide. Primary care physicians, particularly family doctors, play a pivotal role in early detection and prevention. This study investigates the potential of artificial intelligence (AI)-based temporal deep learning (DL) models to support cardiovascular risk (CVR) stratification in primary care. Materials and Methods: We implemented temporal DL architectures, namely Long Short-Term Memory (LSTM) network and Gated Recurrent Unit (GRU), on a clinically realistic synthetic patient cohort. The dataset included demographic and clinical variables such as age, sex, body mass index (BMI), blood pressure (BP), and established risk factors (smoking, diabetes, and hypertension). Models were trained on sequential data to predict CVR categories (low, moderate, and very high) along with their corresponding probabilities. Model outputs were statistically benchmarked and subsequently aligned with actionable clinical recommendations. Results: Both LSTM and GRU models demonstrated the ability to forecast CVR across multiple time horizons. Predictions were successfully translated into clinically interpretable recommendations supporting tailored follow-up intervals and targeted interventions. Conclusions: Integration of AI-driven CVR forecasting into routine family medicine practice can enhance early intervention strategies, optimize patient management, and improve resource allocation. This approach highlights the potential of temporal DL to strengthen preventive care outcomes in primary care settings.
Corresponding author: Mircea Sorin Ciolofan, Associate Professor, MD, PhD; e-mail: sorin.ciolofan@yahoo.com
Abstract - Download PDF PDF9. Localized gingival enlargements: clinical, histopathological and surgical evaluation in five cases
Bilge Cansu Uzun Saylan, Ayca Muhterem, Sulen Sarioglu
Background: Localized gingival enlargements (GEs) are frequently encountered reactive lesions with various etiologies, including chronic irritation, trauma, systemic conditions, hormonal influences, and medication use. Despite their benign nature, these lesions can significantly affect oral function and aesthetics and may occasionally mimic neoplastic processes. This case series aims to present the clinical and histopathological (HP) features of five patients with localized GEs, describe different surgical approaches including scalpel and diode laser excision, and report short-term clinical outcomes. Case presentations: Five patients with gingival overgrowths of varying etiology were evaluated. All underwent thorough periodontal debridement and oral hygiene instruction prior to surgical intervention. HP evaluation followed surgical excision. Patients were monitored for recurrence for at least three months. Lesions included inflammatory epithelial hyperplasia, cavernous hemangioma, and squamous cell papilloma. One case revealed immunoglobulin G4 (IgG4)-positive plasma cells and was referred to Rheumatology Department. A suspected vascular lesion was successfully managed with laser excision to minimize bleeding. One patient exhibited recurrence of a papillomatous lesion, prompting referral to infectious disease. No major complications occurred during the follow-up period. Conclusions: Localized GEs can present diverse HP profiles. Biopsy remains essential for definitive diagnosis, especially when clinical features are ambiguous. Laser surgery proved beneficial in vascular lesions by reducing intraoperative bleeding and enhancing patient comfort. Identifying and managing underlying systemic or local factors is crucial to prevent recurrence.
Corresponding author: Ayca Muhterem, DDS; e-mail: ayca.muhterem@deu.edu.tr
Abstract - Download PDF PDF10. Columnar cell variant of papillary thyroid carcinoma in an adolescent: a comprehensive histopathological, immunohistochemical, and molecular analysis
Gizem Issin, Fatih Demir, Diren Vuslat Cagatay, Ismail Yilmaz
The columnar cell variant (CCV) of papillary thyroid carcinoma (PTC) is a rare histological subtype with distinct morphological and immunohistochemical (IHC) features, which can present diagnostic challenges. We report a case of a 13-year-old girl diagnosed with CCV of PTC (CCV-PTC) following a total thyroidectomy for a solitary thyroid nodule. Histopathological (HP) examination revealed aggressive features, including vascular invasion and extrathyroidal extension. However, no metastases or recurrences were observed during six years of follow-up. This case report provides a comprehensive analysis of a rare CCV-PTC in an adolescent, focusing on its HP, IHC, and molecular characteristics. It also discusses diagnostic pitfalls and differential diagnoses that should be considered.
Corresponding author: Gizem Issin, Associate Professor, MD, PhD; e-mail: gizemissin@gmail.com
Abstract - Download PDF PDF