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Introduction. Tumour microenvironment and the expression of check-point molecules on tumour cells was proven to have prognostic and therapeutic implications in various types of cancer. Evaluation of immune infiltrate and Programmed Death-1 (PD-L1) expression in gastrointestinal stromal tumours (GISTs) could bring valuable information for development of targeted immune therapy for a subset of cases. The objective of this study was to determine the PD-L1 expression and to analyse the intratumoural inflammatory infiltrate in different categories of GISTs. Material and methods. Twenty four cases of immunohistochemically confirmed GISTs were microscopically reviewed and tested for PD-L1, CD3 and CD20. Their expression was quantified and statistical analysis was performed to search for differences between subgroups. Results. The expression of PD-L1 on tumour cells was identified in fourteen cases, with variable intensity and extent, ten cases being negative. The immune infiltrate was invariably present, lymphocytic predominant, with intertumoural and intratumoural quantitative differences, from sparse to abundant and with focal aggregation around blood vessels, fibrous septa, in the periphery of the tumour and under ulcerated areas. T cells were the dominant lymphocytic subtype. Causality connections could not be determined between PD-L1 expression, the pattern of inflammation and other clinical and pathological variables, limitation determined in part by the reduced extent of the study. Conclusions. GISTs express PD-L1 in a significant percentage of cases and have a great variability in the number and distribution of intratumoural immune cells, aspects that can be further exploited for therapeutic purposes.

Bednar tumor is a rare cutaneous neoplasm, regarded as a variant of dermatofibrosarcoma protuberans with melanotic colonization and it usually affects young and middle-aged adults or children. This lesion is considered a low-grade malignant tumor, which can be associated with multiple local recurrences after surgical excision. Although a rare phenomenon, these lesions may undergo fibrosarcomatous transformation, which implies a poorer prognosis of the disease, as the tumor has a more locally aggressive behavior and patients might also develop distant metastases. We present the case of a 53-year-old female patient, with no significant medical history, who presented with a subcutaneous nodule on her upper back, for which a wide surgical excision was performed. The gross examination of the specimen showed a solitary protuberant grey-white nodule with a bluish shade and flecked with pigment. The microscopic examination revealed a malignant proliferation with a predominantly fascicular growth pattern, composed of spindle cells with highly pleomorphic nuclei and high mitotic rate, as well as the presence of dendritic cells with abundant melanin. Upon immunohistochemical analysis, the proliferation showed negative staining for CD 34 and AE 1/3, whereas the scattered dendritic cells stained positive with S100 protein. Ki 67 was positive in 15% of the tumor cells and the absence of p53 expression was noted. Thus, the diagnosis of Bednar tumor with fibrosarcomatous transformation was established. The aim of this paper was to gain further knowledge about the histopathological and immunohistochemical features, as well as about the treatment of Bednar tumor, especially considering its rarity.

Introduction: Granuloma gravidarum represents a rare lesion, defined as a reactive vascular hyperplasia of pregnancy, that affects mainly the oral mucosa. Very few cases were reported on non-mucous sites. Case presentation: We present the case of a 32-year-old, 18 weeks pregnant patient, that developed a granuloma gravidarum on the excision scar of a volar atypical melanocytic lesion. She presented to the dermatology department with a recently developed melanocytic lesion on her left heel. Dermoscopy showed asymmetry and brown globules in a ring pattern. The lesion was excised with 5 mm margins, under local anesthesia and sedation. The path report and immunohistology revealed a dysplastic melanocytic acral nevus. The excision site closed nicely, but after 5 days a red friable 0,5 cm vascular bleeding tumor developed in one extremity of the scar. Patient refused biopsy. The new tumor raised diagnostic difficulties between a vascular lesion and an amelanotic recurrence of the melanocytic lesion. Due to the path report which showed a benign pigmented lesion and because the lesion was excised completely, granuloma gravidarum was suspected. Patient received local antibiotic treatment and the vascular lesion involuted completely after 3.5 weeks. Conclusion: Pregnant women are at high risk of developing vascular tumors at trauma sites, due to hormonal changes. It’s important to be aware of this surgery complication in pregnant patients, as evolution is usually benign and complete spontaneous resolution is possible.

Epidermoid bone inclusion cysts are pathological structures bordered by a layer of stratified squamous epithelium containing keratin debris. They are also called epidermal bone cysts. Intraosseous epidermoid cysts are rare entities; these lesions may occur as a result of trauma (puncture wound or pressure erosion). They appear to be well defined, translucent lytic lesions with sclerotic margins on imaging studies. The most frequent sites affected are: the distal phalanx and the calvaria - intradiploic, but a few cases of larger bone involvement have been reported. The imagistic differential diagnosis of this lesion includes intraosseous extension of a glomus tumor, enchondroma, osteoid osteoma, acral metastases, some primary vascular bone tumors, giant cell reparative granuloma, subungual nodular melanoma or other lytic non-neoplastic lesions such as osteomyelitis. We present the case of a 70-year-old man experiencing anxiety and pain due to distal phalanx expansion of the IV digit, following hand trauma. An X-ray was performed, showing a radiotransparent lesion located in the distal phalanx. An intramedullary inclusion cyst must be taken into account as a clinical differential diagnosis. Due to the extensive destruction of the distal phalanx, amputation was necessary. Gross examination of the surgical specimen revealed a cystic lesion that contained whitish, creamy material with extensive necrotic areas. Microscopic examination revealed a ruptured intraosseous epidermoid inclusion cyst, which was successfully excised.

Introduction. The identification of the type and site of origin in undifferentiated tumours of unknown primary site using immunohistochemistry is a frequent requirement in pathology practice. There are many histologic lesions that display similar morphologic aspects, with misdiagnosis potentially resulting in over- or undertreatment. This makes the diagnostic accuracy extremely important in the era of targeted therapies. The objective of the study was to evaluate the process of diagnosis in 50 melanoma cases presenting as poorly differentiated or undifferentiated tumours with unknown primary origin, with emphasis on the immunohistochemical algorithm. Methods. 50 cases were selected to analyse the utility of IHC testing in diagnosing poorly differentiated malignancies. The immunohistochemical evaluation was based on the staining percentage of cells: focal positive 50%, negative (-) 0%. Results. After applying the Fan Lin algorithm, for most of the cases (45), the cytokeratin and CD45 proved negative, while S100 and vimentin were positive in diffuse or zonal patterns. For the 3 cases analysed by applying the Turin algorithm, the first antibody panel consisted in testing CK7/CK20, that showed no expression for all 3 cases. Conclusions. In this study, we demonstrated that the immunohistochemical examination of poorly differentiated malignant tumours is a reliable and valuable test and is recommended as a standard method in diagnosis along with the correlations with clinical and histological data.

Introduction. Skin metastases are rare metastases of internal or cutaneous tumors, commonly diagnosed after the primary cancer. Sometimes, they can be the first manifestation of a malignancy. Cutaneous metastases associate a poor prognosis for the patient and the survival rate decreases considerably. The objective of the study was to analyze the clinico-epidemiological and histological characteristics of skin metastases, in order to better understand different types of malignancies and their prognosis, as well as to highlight the particularities of this rare localization of the metastases. Material and methods. We conducted a retrospective study, in which we included 50 cases of skin metastases diagnosed in the Pathology Department of the University Emergency Hospital Bucharest, Romania, over a period of three years. We analyzed the cases from all epidemiological, clinical, gross and histological data, based on the records of the hospital. Results. The patients’ ages ranged from 16 to 92 years old, with a mean age of 60.1 years. Almost half of the patients were females (26 cases). Most of the patients were diagnosed with primary melanoma (17 cases), followed by primary tumors of the gastrointestinal tract (9 cases) and breast carcinomas (8 cases). 29 cases presented with complications, such as ulceration, infection or necrosis. Conclusions. Most of the skin metastases were of malignant melanoma, but any kind of primary tumor can, eventually, disseminate to the skin, conferring a poor prognosis on the patient. Also, any site can be involved, but some malignancies do have preferred areas for dissemination.

Cardiac fibroblasts play a main role in the physiological turnover of the extracellular matrix, as well as its pathological remodeling. A study was performed on a batch of 23 cases who died of various cardiac complications secondary to scarring myocardial infarctions. The aim of the study was to assess the fibroblast involvement in cardiac repair under ischemic conditions after myocardial infarction. Tissue myocardial samples from the left ventricle were taken from these cases for microscopy examination, in order to investigate the type and degree of fibrosis as well as the presence of cardiac interstitial fibroblasts. Multiple series of histological sections were also performed and examined, along with immunohistochemical analysis. The fibroblasts were diffusely distributed in the interstitium among the residual cardiomyocytes, showing variable expression of vimentin and smooth muscle actin. During cardiac remodeling, there was a successive interstitial deposition, first of reticulin fibers and then of collagen fibers, leading to interstitial fibrosis and myocardial replacement. There was a correlation between vimentin and smooth muscle actin expression and collagen deposition. Fibrosis with cardiac remodeling is based on maintaining proliferation capacity of the fibroblast and its capacity of protein synthesis in the extracellular matrix. Under hypoxic ischemic conditions, followed by myocardial infarction, the fibroblast switches phenotype and transdifferentiate into myofibroblast, contributing to the healing by secreting extracellular matrix proteins and collagen deposition, with subsequent cardiac remodeling and regulation of the micro-environment metabolism.

Stem cells represent an old niche with various new potential therapeutics. Besides drug treatment, reperfusion procedures and surgical revascularization, stem cell therapy could be a good option in ischemic cardiac diseases. A study was performed on a small group of cases who died of cardiac arrhythmia secondary to scarring myocardial infarctions. Tissue cardiac samples were taken from these cases (from the anterior and lateral wall of the left ventricle), for microscopy examination, in order to investigate the presence of cardiac stem cells (CSC). Multiple series of histological sections were also performed and examined, along with immunohistochemical analysis (IHC). The cells were identified in close contact with the residual ischemic cardiomyocytes, in the proximity of the myocardial collagenous scar, in old myocardial infarctions. They were activated by hypoxic ischemia and were influenced by the capillary microvascular density and the interstitial micro-environment conditions. In chronic intermittent ischemia they seem to turn themselves from dormant quiescent cells into activated progenitor committed cells.

A 51-year old patient suffering from long-standing type 2 diabetes mellitus presented with a dark lesion on his forehead that had been growing for several weeks (Fig. 8.1). He had had a similar lesion several years before that had been diagnosed and treated topically as a seborrheic keratosis. Clinical examination showed a brown-grey lesion with clear but irregular margins and a smooth surface covered by a few pits. The clinical diagnosis of seborrheic keratosis was confirmed by dermoscopy.

Introduction. High‑grade serous carcinoma of the ovary is an aggressive form of cancer, with unknown precursor lesions and often delayed diagnosis because of non‑specific, mild symptoms. Objective. We performed a clinical‑pathological study of ovarian high‑grade serous carcinomas, in order to evaluate morphological and new immunohistochemistry characteristics of this malignancy. Methods. This is a retrospective study of 10 cases of ovarian high‑grade serous carcinoma. We evaluated patients’ age, symptoms at presentation, macroscopic aspects, bilateral involvement, microscopic features: papillary/solid areas, mitotic index, psammoma bodies, tumoral extension, lymph node metastasis, immunohistochemistry markers: CD44, ER, AR, Ki67 index. Results. Mean age was 56.9 years old. Tumors were bilateral in 50% of cases. Only 30% were limited to the ovary. Maximum tumor diameter was 16 cm. Solid component in a proportion of 50‑95% was more characteristic. Most tumors had a mitotic index of 30‑50 mitosis/10HPF (70% of cases). 20% of cases contained psammoma bodies. 2 cases out of 7 had lymph node metastasis. We noticed one case with pleural metastasis (M1). We observed AR80% was noticed in 30% of cases. CD44 was positive in 50% of cases and one case had diffuse positivity of CD44 in corpus luteum cells near the tumoral bed. Conclusions. The majority of patients with ovarian high‑grade serous carcinomas presented with extraovarian extension and were characterized by high mitotic index, rare presence of psammoma bodies, AR expression

BACKGROUND. Excision of facial cutaneous carcinomas requires further reconstruction in a combined team with plastic surgeons. Among the traditional risk factors, the unprotected occupational exposure to sunlight can be identified. Giant masses at the level of the nose are frequently squamous carcinomas in origin. Moreover, repeated tumor trauma favours local-regional and remote extension. MATERIAL AND METHODS. We present step by step the surgical management of an old woman with a nasal mass of 58/36/20 mm. Also, the patient presented right genian tumefaction of approximately 6 months in evolution. RESULTS. The patient was submitted to surgical resection with free margins, leaving a considerable nasal and genian groove defect. Teaming up with the plastic surgeon, we applied complex reconstruction techniques with a satisfactory aesthetic and functional result. The histopathologic diagnosis confirmed our suspicion of an acantholytic squamous cell carcinoma with lymph nodes metastasis. CONCLUSION. Our case exhibited traditional risk factors, living in a rural environment. The tumor degree of aggressiveness was increased by repeated self-inflicted trauma. Late presentation to healthcare services implied complex facial reconstruction for the combined resection of the nasal tip and genian lymph node.

BACKGROUND Eye and skin share the embryological origin. Both are established risk factors in epidermal skin cancer. There are few reports using iris colour classification scales, most of them analyse colour in general or are too complex to use in daily practice. OBJECTIVES To investigate which iris colour pattern is associated with epidermal skin cancer in a S-E European Caucasian population. METHODS A case-control study was conducted on 480 patients: 229 skin cancers patients and 251 controls (dermatological patients free of skin cancers) admitted in two medical clinics of Dermatology in Bucharest, between October 2011 and May 2014. High-resolution iris photographs were taken for each patient. Three parameters of the iris were analysed individually and in association patterns for each patient: periphery, collaret and freckles. RESULTS The most frequent iris colour pattern associated with epidermal skin cancer was blue periphery with light brown collaret and freckles present. In terms of individual parameters, the strongest indicators for skin cancer patients were blue periphery and blue collaret. CONCLUSIONS The results of this study sustain the hypothesis that blue periphery with light brown collaret and freckles iris pattern is a reliable phenotypic marker for epidermal skin cancer. The results of this study differ from previous reports in which skin cancer risk was associated with a homogeneous blue iris. We account these differences in the characteristics of the recruited patients (S-E European, skin type II and III). The assessment of iris colour patterns is an easy and inexpensive detection tool in skin cancer risk assessment.

Histopathological image analysis performed by a trained expert is currently regarded as the gold-standard for the diagnostics of many pathologies, including cancers. However, such approaches are laborious, time consuming and contain a risk for bias or human error. There is thus a clear need for faster, less intrusive and more accurate diagnostic solutions, requiring also minimal human intervention. Multiphoton microscopy (MPM) can alleviate some of the drawbacks specific to traditional histopathology by exploiting various endogenous optical signals to provide virtual biopsies that reflect the architecture and composition of tissues, both in-vivo or ex-vivo. Here we show that MPM imaging of the dermoepidermal junction (DEJ) in unstained fixed tissues provides useful cues for a histopathologist to identify the onset of non-melanoma skin cancers. Furthermore, we show that MPM images collected on the DEJ, besides being easy to interpret by a trained specialist, can be automatically classified into healthy and dysplastic classes with high precision using a Deep Learning method and existing pre-trained convolutional neural networks. Our results suggest that deep learning enhanced MPM for in-vivo skin cancer screening could facilitate timely diagnosis and intervention, enabling thus more optimal therapeutic approaches.

Histopathological image analysis performed by a trained expert is currently regarded as the gold-standard in the case of many pathologies, including cancers. However, such approaches are laborious, time consuming and contain a risk for bias or human error. There is thus a clear need for faster, less intrusive and more accurate diagnostic solutions, requiring also minimal human intervention. Multiphoton Microscopy (MPM) can alleviate some of the drawbacks specific to traditional histopathology by exploiting various endogenous optical signals to provide virtual biopsies that reflect the architecture and composition of tissues, both in-vivo or ex-vivo. Here we show that MPM imaging of the dermoepidermal junction (DEJ) in unstained tissues provides useful cues for a histopathologist to identify the onset of non-melanoma skin cancers. Furthermore, we show that MPM images collected on the DEJ, besides being easy to interpret by a trained specialist, can be automatically classified into healthy and dysplastic classes with high precision using a Deep Learning method and existing pre-trained Convolutional Neural Networks. Our results suggest that Deep Learning enhanced MPM for in-vivo skin cancer screening could facilitate timely diagnosis and intervention, enabling thus more optimal therapeutic approaches.

Histopathological image analysis of stained tissue slides is routinely performed by a pathologist to diagnose diseases, such as cancers. Although the approach is effective, it is labor-intensive, time-consuming and risks being biased. Therefore, it would be beneficial to develop faster and more cost-effective approaches. Multiphoton microscopy can alleviate these problems by allowing label-free imaging with high contrast. When label-free multiphoton microscopy is combined with deep learning based image analysis, a wide variety of possibilities arise for the real-time characterization and diagnosis of tissues. Here, we overview our recent work on this topic focusing on automated classification of tissue images taken from human skin near the dermoepidermal junction.

Label-free tissue imaging with Multiphoton Microscopy (MPM) techniques such as Two-Photon Excitation Fluorescence Microscopy (TPEF) or Second Harmonic Generation Microscopy (SHG) can provide cues of similar pathologic relevance to the information collected for characterization / confirmation purposes with traditional histopathology protocols based on fixation and staining. To date, various approaches for the automated characterization of MPM datasets have been proposed, but usually these address the outputs of a single technique, while MPM imaging sessions can simultaneously yield multiple information categories associated to distinct modalities. We discuss here the main concepts of the Bag-of-Features (BoF) paradigm used for automated image classification and retrieval, and a series of past experiments that dealt with BoF based tissue characterization. Further on, we present some of our connected efforts placed on the problem of human epithelial tissue characterization with TPEF & SHG and introduce a concept for MPM data classification based on multiple BoF experts that utilize in a parallel manner complementary information categories.

Background The tracking and identification of errors in the detection and follow-up of melanoma are important because there is huge potential to increase awareness about the most vulnerable aspects of diagnosis and treatment, and to improve both from the perspective of healthcare economics. The present study was designed to identify where errors occur and to propose a minimum set of rules for the routine guidance of any specialist in melanoma management. Methods This report describes the evaluation of a unique series of 33 cases in which errors applying to many steps in the diagnosis and treatment of melanoma were detected. Cases were collected at two centers in Romania, one public and one private, as part of a process of obtaining patient-requested second opinions. Results A total of 166 errors were identified across the 33 patients, most of which were treatment errors. The errors fell into six categories: clinical diagnostic errors (36 errors among 30 patients); primary surgical errors (31 errors among 16 patients); pathology errors (24 errors among 17 patients); sentinel lymph node biopsy errors (13 errors among 13 patients); staging errors (17 errors among 13 patients); and treatment or management errors (45 errors among 33 patients). Conclusions Based on the present results, we propose that in countries lacking national guidelines, clinicians should adhere to international evidence-based guidelines for the diagnosis and treatment of melanoma.

We report the case of a 33 weeks pregnant woman who was admitted in our hospital for recent jaundice. The controversial results of medical investigations and the patient’s clinical outcome indicated the necessity for immediate caesarian-section along with exploratory laparotomy. The surgeons extracted gelatinous membranes from the main biliary duct. At the Department of Pathology from University Emergency Hospital from Bucharest, we received the placental components, were we noted the presence of one true umbilical cord knot and meconium impregnation, a non-slatted gallbladder of 18 cm long and the numerous, heterogeneous membranes. On histopathological examination we found uteroplacental hypoxia-related features in the placenta together with retroplacental hematoma, umbilical cord edema, and inflammatory content of the gallbladder and hydatid cyst fragments on the common bile duct samples. The premature new-born survived and both the mother and the infant were discharged in good health condition after 2 weeks.

Skin cancers can be classified in three major classes: squamous cell carcinoma (SCC), basal cell carcinoma and melanoma. While the first two are effectively treatable even when discovered in more advanced stages, the 5-year survival rate drops dramatically with melanoma progression as this variant can rapidly spread to other sites of the body (the lungs or the brain via the circulatory system). Regardless of their type, the early detection and accurate analysis of skin cancers is of utmost importance in clinical practice, having deep implications over the efficiency of administered therapies, survival probability, sustainability of healthcare systems and emotional comfort of the patients and their relatives. Since skin cancer development modifies tissue morphology and alters its biochemical characteristics, a variety of optical and chemical imaging techniques have been proposed so far as suitable tools to investigate genesis and progression aspects. Among these, multiphoton microscopy (MPM) has emerged as a powerful clinical tool which can non-invasively image and obtain complementary information from human skin [1]. In this work we propose to extend a previously reported polarimetric method [2] to MPM imaging, in order to improve the quality of images collected on human epithelial tissues.

Squamous cell carcinomas are malignant epithelial tumors frequently found in patients over 60-65 years old, with only 1-6% [2] of the cases being diagnosed in patients younger than 40 years. Rarely, it appears as a sign or complication of a genetic condition such as Rothmund-Thomson syndrome or poikiloderma congenitale, an autosomal recessive disorder due to mutations of RECQL4 helicase gene on 8q24 [2]. Furthermore, there are only 300 cases reported in the literature so far [3]. Beside skin tumors, this condition is characterized by redness and atrophy of the skin, small stature, sparse hair, teeth and nails abnormalities, osteopenia, osteoporosis or osteosarcomas [4, 5]. We report an interesting case of a 32 year old patient known with Rothmund-Thomas syndrome and multiple skin tumors excised over the past few years, which presented with two skin tumors on the cheek and on the nasal region, measuring 1 cm and 0,7 cm in diameter (Figure 1). Histologically, both tumors were composed of malignant and pleomorphic keratinocytes, with enlarged nuclei, evident nucleoli and numerous atypical mitosis (Figure 2,3) infiltrating the deeper portions of the dermis. One tumor also presented keratin formation, thus diagnosed as keratinized squamous cell carcinoma, while the other was non-keratinized squamous cell carcinoma (Figure 4,5).

Renal cell carcinoma (RCC) is the most common kidney tumor in adults, accounting for 2% of all cancers worldwide. It is two times more frequent in men than in women and it can metastasize to the lungs, liver, bones and brain. Skin metastases are unusual. A 79-year-old male with no personal history of malignancy, presents to the Department of Plastic Surgery for excision of a 36/32/14 mm ulcerated tumoral mass located in the right parietal area. Microscopic examination revealed a well-defined multinodular tumor located in the deep dermis, composed of a mostly solid and partially discohesive proliferation of cells featuring clear or granular-eosinophilic cytoplasm and vesicular nuclei with prominent nucleoli, lacking marked atypia. Mitotic rate varied from 2-3 to 12 mitoses per 10HPF. Focal areas of haemorrhage and necrotic debris as well as brisk lymphocytic infiltration were easily identifiable. The expansive and non-infiltrative pattern of growth supported the hypothesis of a metastatic tumor. The scarcity of clinical data and absence of a highly suggestive histopathological aspect, led to multiple differential diagnoses, including: large cell lymphoma, metastatic melanoma and metastatic carcinoma. Immunohistochemical stainings eventually confirmed the diagnosis of cutaneous metastasis of clear cell renal cell carcinoma (CD10+, PAX8+, Vimentin+) and excluded all other differentials (LCA-, Melan A-, AE1/AE3-, CK5/6-). Cutaneous metastases of RCC in the head and neck area are extremely unusual, given the distance from the anatomical site of the primary tumor. This case highlights the importance of careful clinical inspection of the skin in patients with internal organ malignancy.

Autosomal recessive polycystic kidney disease (ARPKD) is an important inherited cause of chronic kidney disease with an estimated incidence of 1 in 20,000 live births [1-3]. Mutations of the PKHD1 (polycystic kidney and hepatic disease 1) gene located on chromosome 6p12, are responsible for the entire spectrum of ARPKD [2]. Almost 40% of all affected cases are either stillborn or will die in the neonatal period, due to respiratory insufficiency or kidney failure. In most cases, this disease is accompanied by congenital hepatic fibrocystic lesions (specifically malformation of the liver plate -Meyenburg complex) or by Caroli syndrome [3]. We report a case of a newborns with ARPKD who died within 2 days after birth. Autopsy was performed in the Department of Pathology of the University Emergency Hospital in Bucharest. After a thorough, we established the diagnosis of ARPKD based on specific histological features of this disease, which, as in our case, may establish the final diagnosis without further need for genetic testing. Gross examination revealed hugely enlarged kidneys with cystically dilated collecting ducts that replaced the renal parenchyma almost completely (Figure1). The lungs were mildly hypoplastic. Microscopic examination confirmed the suspicion and showed typical features of ARPKD: numerous radially elongated cysts lined by cuboidal epithelium, decreased renal parenchyma and few restant rudimentary glomeruli (Figure2). The liver showed dilated portal spaces, with multiple irregularly branching bile ducts and extensive fibrosis consistent with Meyenburg complex (Figure3), classically associated with polycystic liver disease.

Aim: To document the spectrum of histological changes of cutaneous lesions found in patients with gout. Material and methods: Thirteen cutaneous biopsies were studied. The biopsies were fixed in formalin solution and stained with hematoxyline and eosin. Results: A common feature in all 13 cases was the presence of deposits of basophilic material with needle-like clefts. The main histological reaction pattern was palisading granuloma. In 7 cases the deposits were subcutaneously located and in 6 cases intradermal and subcutaneously. The inflammatory infiltrate contained mainly epithelioid histiocytes and multinucleate giant cells. In 5 cases it also contained neutrophils and in one case foam cells. Secondary changes were found in 6 cases. Conclusion: When the clinical findings are atypical, cutaneous biopsy remains an important tool to establish the diagnosis of tophi, even in those cases with no possibility to exam alcohol fixed specimens under polarized light. In our study the preliminary clinical diagnosis was consistent with the histological findings in only 3 cases. The key feature that allowed the correct diagnosis was the presence of basophilic material with needle-like clefts surrounded by a palisading histiocytic infiltrate.

We report mucosal melanoma of the upper lip in a patient affected by the Laugier-Hunziker disease. Using dermatoscopy, two distinct parts were identified in the same mucosal area: nodular (malignant) and macular (benign). A complete surgical excision was performed and the patient has been free of disease for 16 months.

Tuberculosis (TB) is a chronic granulomatous disease that affects various systems of the body. Although the pulmonary form is most common, TB can also occur in the lymph nodes, kidneys, bones, and oral cavity. Oral TB is often a consequence of active pulmonary TB and is relatively rare. Here, we report a series of cases that emphasize the importance of considering oral TB in the differential diagnosis of mucosal lesions. In addition, although primary oral TB was previously considered a disease of the young, these cases demonstrate that it may occur in subjects of all ages.

Objective: In this retrospective study, patients’ medical records were reviewed to investigate the profiles of 633 OLP cases in a group of Romania. Material and Methods: In this retrospective study, the following clinical data were obtained from the medical charts of patients: gender, age, clinical presentation of OLP, site affected, presence of symptoms, extraoral manifestations of lichen planus, presence of systemic diseases, and history of medications. Results: Most (78.67%) OLP patients were female and the mean age at presentation was 52 years. The white type of the disease (reticular/papular/plaque lesions) was the main form encountered in this sample (48.97%). Among patients with available hepatitis C virus test results, 9.6% were serum-positive. OLP was associated with gallbladder disease (i.e. cholecystitis, cholelithiasis) in 19% of patients. Six patients (0.95%) developed squamous cell carcinoma at a site with confirmed OLP lesions. Conclusions: To the best of our knowledge, no similar study has been conducted in a Romanian population. The present investigation revealed the predominance of OLP among middle-aged white women and the prevalence of bilateral involvement of the buccal mucosa with reticular white lesions. Anti-HCV circulating antibodies were more common in patients with OLP than in the general population and, notably, OLP was associated with gallbladder disease (cholecystitis, cholelithiasis) in 19% of patients. Key words:Oral lichen planus, oral mucosal diseases, retrospective study.

Cutaneous melanoma is a “perfid”, aggressive and hard to be treated malignant tumor in case of delayed diagnosis. However, patients still have a chance to escape progressive disease if the lesion is recognized early, when the surgical approach is curative. Dermoscopy has the important advantage of rapidity and non-invasivity in a field with (still) contradictory algorithms of diagnosis and treatment. The recognition of the elementary dermoscopic lesions enables accurate diagnosis for cutaneous melanoma. In our opinion, dermoscopy appears compulsory in the routine derma-tologic examination. In vivo microscopy (dermoscopy) together with histopathology (plus or minus immunohisto-chemistry) seem, at present, to provide the most reliable diagnosis of melanoma.