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In the last decade, the incidence and mortality associated with laryngeal malignancies has experienced an unfavorable evolution in Romania, in terms of this pathology the country that has become the leader, among the European Union (EU)-27 countries. The aim of the present retrospective study was to analyze the epidemiological data regarding laryngeal cancer and histopathological (HP) particularities in patients diagnosed in Western Romania. Within three years and 10 months (during October 2016-July 2020) in Ear, Nose and Throat (ENT) Clinic of Timişoara Municipal Emergency Clinical Hospital, 194 patients with laryngeal neoplasms (LN) were diagnosed. Most of the patients were male (93.8%), from Timiş County, mainly and the neighboring Counties of Caraş-Severin, Hunedoara, Mehedinţi and Arad. Patient's average age (both sexes) was 62.6 years, with a range from 38 to 84 years and the highest percentages in the 60+ age group (48%). Regarding smoker status, the main cause of the development of the LN, 93.9% of patients were active ones. Regarding localization [International Classification of Diseases 11th Revision (ICD-11)], about 69% were malignant neoplasm of glottis (C32.0), followed by supraglottis (C32.1), larynx-unspecified (C32.9), and subglottis (C32.2). From the HP point of view, several types of tumors were identified, most of which were non-keratinized and keratinized squamous cell carcinomas (about 90%). In addition, there were identified types of verrucous carcinoma, acantholytic carcinoma, squamous papilloma, a possible pleomorphic sarcoma, and pyogenic granuloma. The data presented in this study highlight the growing incidence of LN, which mainly affect men, at an increasingly young age. It is imperative to involve specialists from nutrition, general medicine, ENT, dentistry to start awareness programs and to develop prevention protocols.

The melanoma, having its origin in the melanocyte cells, is one of the most aggressive forms of skin cancer in the world with one of the highest rates of brain metastasis. The incidence of cutaneous melanoma in the Mediterranean countries varies from three to five cases∕100 000 people∕year. Its prognosis is based on an early diagnosis. Sinonasal mucosal melanoma (SNMM) is an extremely rare tumor, accounting for 0.3-2% of all melanomas. The non-specific symptomatology is often delaying the presentation of the patient at the hospital and therefore the diagnosis. The SNMM is a highly aggressive tumor, and the presence of metastasis at the diagnosis usually implies a poor prognosis. The management of the melanomas requires a precise pre-therapeutic assessment and a multidisciplinary approach for the diagnosis, with surgical treatment or radiotherapy required in order to ensure a better a quality of life. In this paper, we retrospectively analyzed two cases of mucosal melanoma and one case of cutaneous melanoma of the nose.

Chronic post-thoracotomy pain (PTPS) is a frequent complication of thoracic operations. Sometimes the pain is excruciating enough to impair activities of daily living (ADL). All thoracic procedures have the potential to cause trauma to the intercostal nerves due to retractor use, chest closure techniques, and or wound healing. In our study, we analyzed the microscopic aspects of the nerves involved in the healing process, to better understand the histopathology of chronic pain.29 patients with PTPS underwent intercostal neurectomy to alleviate the symptoms. Microscopic specimens harvested during the surgeries were sent to our pathology unit for evaluation. The following data regarding the surgical procedures was collected: surgical approach, chest closure type, number of excised nerves, and time interval from previous surgery to neurectomy.A mean of 2.34±1.11 nerves were excised. Microscopy of the specimens revealed: fibrosis, hyalinization of the epineurium and perineurium, intense hyperemia of the blood capillaries, and interstitial edema. 7 cases presented with myxoid degeneration of epineurium and perineurium. In all the cases, endoneurium, myelin sheaths, and axons were interrupted. The endoneurium showed the presence of hyperemic dilated capillaries. The segmental cytoplasmic vacuolization of Schwann's cells with the total disappearance of axons was also noted. 60% of the examined specimens had intraneural myxoid degeneration, with highly dense irregular connective tissue around nerve fibers.The pathologic findings in the structure of the intercostal nerves obtained from the patients are indicative of the involvement of the wound healing mechanisms in PTPS. The negative impact of wound healing could be considered a key component in the development of intense chronic pain.

Females require at a certain period of life the administration or supplementation of specific hormones (estrogen, progesterone), for various needs, such as: prevention of unwanted pregnancies, decreased menstrual bleeding, dysmenorrhea and pelvic pain in endometriosis, alleviation of symptoms associated with menopause, regulation of certain skin processes related to acne or aging and others. Also, hormones could act as oncogenes being known eloquent examples of estrogens labeled both as promoters of cell specific alteration or as mutagenic agents. The use of hormones and exposure to solar radiation is expected to cause a number of adverse changes to the body, especially due to their association with malignant processes. The current study was purported as a basis for understanding certain processes that occur with the administration of hormones and exposure to ultraviolet B (UVB) radiation. The animal model was made on healthy adult female BALB/c mice, which were separated into groups and treated with Ethinylestradiol (EES), Levonorgestrel (LNG) and their combination in the presence of UVB radiation. Changes in skin physiological parameters were analyzed by non-invasive methods, biochemical parameters related to changes in blood circulating system were evaluated by standard methods and histopathological analysis was conducted to point out the changes at the level of the internal body. Measurement of skin parameters such as erythema, melanin, skin hydration, has highlighted some changes in hormone-treated and exposed to UVB radiation groups which were significant only in the case of erythema. Biochemical parameters showed variations in terms of liver enzymes in groups treated with active substances. Histologically, aspects of internal organs revealed significant changes in the group treated with EES and LNG and exposed to UVB radiation.

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

Chondrosarcoma (CHS) is a malignant tumor of soft tissue with cartilaginous differentiation that represent one tenth of all malignant proliferations developed from bone tissues. Even if CHS represents the third malignancy with bone localization, after myeloma and osteosarcoma, it is far less diagnosed in the head and neck region. The current paper presented two cases of conventional CHSs, which were diagnosed in Department of Thoracic Surgery and Department of Otorhinolaryngology of Emergency City Hospital, Timişoara, Romania, between February and June 2021. The malignant cases were of peripheral CHSs, one of scapula, and the other one had an extremely rare tracheal location with microscopic features of conventional low-grade tumors (grade 1). In all cases, conservative surgical curative treatment was performed, with a favorable postoperative evolution.

Aim of research was to evaluate and compare the clinical and microbiological effects of two different regimens of amoxicillin (AMX) and metronidazole (MTZ) combined with non-surgical periodontal therapy in patients with chronic periodontitis (CP), and identify antibiotic-resistant bacteria and changes in oxidative stress (OS). Forty-six patients with generalized CP were randomly assigned to group A [scaling and root planing within 24 h (SRP) + placebo for 7 days), group B [SRP + AMX + MTZ, both 500 mg three times daily (TID), 3 days), and group C [SRP + AMX + MTZ, both 500 mg TID, 7 days). Periodontal pocket depth (PPD-primary outcome), clinical attachment level (CAL), full-mouth bleeding scores (FMBS), plaque scores (FMPS), blood and subgingival plaque were assessed at baseline and after three months. OS was evaluated via derivatives of reactive oxygen metabolites (d-ROMs) and assessments of biological antioxidant potential (BAP). Bacterial profiling was performed by PCR. Antibiotic resistance was evaluated in cultures. PPD, CAL, number of sites with PPD ≥6 mm, their PPD, CAL and FMBS decreased (P

The current study was purported to assess the: (i) in vitro toxicity of betulin silver nanoparticles (AgNPs-B), bare and capped with polyethylene glycol (PEG), on two murine melanoma cell lines (B164A5 and B16Ova) and on healthy cell lines (keratinocytes and melanocytes), and (ii) in vivo antitumor efficacy of PEGylated AgNPs-B in an experimental melanoma model. Bare and PEG-capped AgNPs-B were synthesized by a chemical reduction method resulting in stable and non-aggregated spherical AgNPs-B and PEG-AgNPs-B, of narrow size distributions and mean hydrodynamic diameters of 25 nm and 75 nm, respectively. In vitro assessments were achieved by MTT and Annexin V-FITC assays and in vivo evaluation involved non-invasive techniques for the surveillance of the physiological skin parameters changes and histopathological examination of the harvested organs. The in vitro results revealed selective cytotoxicity against melanoma cells, at low doses that are nontoxic to normal cells; higher doses were associated with the loss of selectivity and toxicity for healthy cells. PEGylated formulation of betulin exerted a dose-dependent pro-apoptotic effect, more obvious in the case of B164A5 cells. Histopathological analysis suggested that PEGylated AgNPs-B developed relevant in vivo effects as antimelanoma agents by decreasing the tumor volume and inhibiting the development of secondary tumors.

Background and Objectives: Breast cancer (BC) remains one of the major causes of cancer death in women worldwide. The difficulties in assessing the deep molecular mechanisms involved in this pathology arise from its high complexity and diverse tissue subtypes. Long non-coding RNAs (lncRNAs) were shown to have great tissue specificity, being differentially expressed within the BC tissue subtypes. Materials and Methods: Herein, we performed lncRNA profiling by PCR array in triple negative breast cancer (TNBC) and luminal A tissue samples from 18 BC patients (nine TNBC and nine luminal A), followed by individual validation in BC tissue and cell lines. Tissue samples were previously archived in formalin-fixed paraffin-embedded (FFPE) samples, and the areas of interest were dissected using laser capture microdissection (LCM) technology. Results: Two lncRNAs (OTX2-AS1 and SOX2OT) were differentially expressed in the profiling analysis (fold change of 205.22 and 0.02, respectively, p &lt, 0.05 in both cases), however, they did not reach statistical significance in the individual validation measurement (p &gt, 0.05) when analyzed with specific individual assays. In addition, GAS5 and NEAT1 lncRNAs were individually assessed as they were previously described in the literature as being associated with BC. GAS5 was significantly downregulated in both TNBC tissues and cell lines compared to luminal A samples, while NEAT1 was significantly downregulated only in TNBC cells vs. luminal A. Conclusions: Therefore, we identified GAS5 lncRNA as having a differential expression in TNBC tissues and cells compared to luminal A, with possible implications in the molecular mechanisms of the TNBC subtype. This proof of principle study also suggests that LCM could be a useful technique for limiting the sample heterogeneity for lncRNA gene expression analysis in BC FFPE tissues. Future studies of larger cohort sizes are needed in order to assess the biomarker potential of lncRNA GAS5 in BC.

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

The present study was purported to assess the toxicological profile of bare and polyethylene glycol (PEG) coated spherical silver nanoparticles (AgNPs) by means of in vitro (on human keratinocytes - HaCat cells) and in vivo non-invasive tests (after intraperitoneal - i.p. administration to mice). Bare and PEG-coated AgNPs were synthesized by applying Turkevich's method slightly modified. The physico-chemical characterization revealed the formation of stable, spherical AgNPs and PEG-AgNPs, with narrow size distributions and mean hydrodynamic sizes in the range of 19 nm and 50 nm, respectively. Toxicity data revealed a dose-dependent safe profile for low concentrations of test compounds (

MicroRNAs (miRNAs) have been proven to regulate the development and progression of cancer through various mechanisms. The aim of the present study was to compare miRNA expression between primary melanomas from different sites. We analyzed the expression of 84 miRNAs in 27 primary melanoma and 5 nevus formalin-fixed paraffin-embedded (FFPE) samples using the Human Cancer PathwayFinder miScript miRNA PCR Array. The FFPE samples were obtained from the archives of the Municipal Clinical Emergency Hospital of Timisoara and included 10 cutaneous melanomas, 10 uveal melanomas, 7 mucosal melanomas, and 5 cutaneous nevi. Out of 84 miRNAs, 11 miRNAs showed altered expression in all types of melanoma compared with the nevi. Among these, miR-155-5p, miR-9-5p, miR-142-5p, miR-19a-3p, miR-134-5p, and miR-301a-3p were upregulated, while miR-205-5p, miR-203a-3p, miR-27b-3p, miR-218-5p, and miR-23b-3p were downregulated. The highest similarity in miRNA expression pattern was found between uveal and mucosal melanoma groups, i.e., 15 miRNAs had altered expression in both groups. Overall, we identified several miRNAs with significantly altered expression in primary melanomas, including those reported for the first time in this type of cancer. Among them, mir-9-5p, mir-203a-3p, mir-19a-3p, mir-27b-3p, and mir-218-5p showed altered expression in all melanoma groups vs. nevus group. Further research should explore the potential of these miRNAs in melanoma.

Maslinic acid is a pentacyclic triterpene with a plethora of biological activities, including anti-inflammatory, antioxidant, antimicrobial, cardioprotective, and antitumor effects. New derivatives with improved properties and broad-spectrum activity can be obtained following structural changes of the compound. The present study was aimed to characterize a benzylamide derivative of maslinic acid&mdash, benzyl (2&alpha, 3&beta, ) 2,3-diacetoxy-olean&minus, 12-en-28-amide (EM2)&mdash, with respect to the anti-angiogenic and anti-inflammatory effects in two in vivo experimental models. Consequently, the compound showed good tolerability and lack of irritation in the chorioallantoic membrane assay with no impairment of the normal angiogenic process during the tested stages of development. In the acute ear inflammation murine model, application of EM2 induced a mild anti-inflammatory effect that was potentiated by the association with zinc chloride (ZnCl2). A decrease in dermal thickness of mice ears was observed when EM2 and ZnCl2 were applied separately or in combination. Moreover, hyalinization of the dermis appeared only when EM2 was associated with ZnCl2, strongly suggesting the role of their combination in wound healing.

We report a case of rare benign tumor of the larynx - amyloidosis of larynx - in a 52-year-old female who presented to the Department of Ear, Nose and Throat (ENT), Timişoara Municipal Hospital, Romania, with dysphonia. The patient's first presentation was in June 2012, with a polypoid formation localized on left vocal cord. The patient underwent a suspended microlaryngoscopy (SM) with tumor removal followed by histopathological examination, which revealed a laryngeal amyloidosis. The tumor recurred in 2013, 2014, 2016, 2017 and 2018. The patient underwent tracheotomy, followed by SM with endoscopic CO2 laser procedures, in order to remove the tumor and to ensure the airway. The follow-up was for six years. In May 2018, amyloid was located in subglottis, glottis and left false vocal fold. The patient needed five revision surgical procedures. The patient did not developed systemic amyloidosis during the follow-up period.

Osteonecrosis of the jaw (ONJ) is a multifactorial condition associated with bisphosphonates (BPs) treatment, head and neck irradiation, malignancy, chemotherapy, periodontal disease or trauma. The first cases of BPs-related ONJ (BRONJ) were reported over a decade ago.The study was retrospective and analyzed archived material. The study included 38 patients diagnosed and treated in the Clinic of Oral and Maxillofacial Surgery, Emergency City Hospital, Timişoara, Romania, for BRONJ, between 2013 and 2016. For all the cases were noted gender, age, localization of osteonecrosis, therapeutic indications for BPs (osteoporosis or malignancy), history of radiotherapy or chemotherapy, presence of bone metastases. If the treatment consisted in surgical removal of necrotic bone, the surgically removed specimens were sent to Service of Pathology of the same Hospital. The excised specimens were prepared with routine histological technique.All the patients included in the current study were diagnosed with BRONJ. The patient history and clinical characteristics were the most useful diagnostic methods. Radiographic changes are not significant in early stages of osteonecrosis. The prevalence of BPs-associated ONJ is higher between 55-74 years old.ONJ is an important complication of BPs medication. The majority of affected patients develop this complication after dentoalveorar surgery, especially after dental extraction. Therefore, a good state of dental health is one of the most important directives when dealing with potential candidates for BPs therapy.

Basal cell carcinoma (BCC) is the most common locally invasive malignant epidermal neoplasm. It is generally a tumor that runs a slow progressive course and can usually be cured by surgery. Basosquamous carcinoma is considered by some authors a rare subtype of BCC, while others describe it as independent tumor with different evolution from BCC. The aim of the study was to present a very interesting case of initially otherwise ordinary BCC that during its repeated and extensive relapses changed its histopathology in a basosquamous carcinoma, despite the free surgical margins and leading to major surgeries with loss of right eye. We present a case of 75-year-old male diagnosed in 2008 with a tumor located in the right naso-orbital region. The patient underwent surgical treatment, the histopathology being consistent with BCC. He presented recurrences of the tumor in 2009 and 2010 that were excised at approximately 9 and 16 months, respectively, from the first intervention. In 2010, the surgical procedure was radical, with removal of the tumor and the entire right superior eyelid. This approach proved to have negative side effects over the right eye in time. Therefore, after two months, a complete exenteration of the right orbit was necessary. The tumor recurred again for three times, after 20, 30 and 42 months from the first intervention and every time surgical treatment was applied. The microscopic inspection of the biopsies showed similarities between recurrences and initial tumor. In 2013, after 57 months from the first intervention, the patient was readmitted with a lesion in the same region that was excised but that time the histopathology differed from the previous, the tumor being composed of sheets of achromic epithelioid cells, with vesicular nuclei and prominent, eosinophilic nucleoli. The tumor cells were positive for pan-cytokeratin AE1∕AE3 and negative for S100 protein, human melanoma black 45 (HMB45) and vimentin that sustained the diagnosis of basosquamous carcinoma. The paper presented an interesting case with different histopathological features from a recurrence to other, with important implication in diagnosis and prognosis. The transformation of BCC into basosquamous carcinoma sustain that the basosquamous carcinoma is better a rare, aggressive variant of BCC, than an individual lesion.

Cervical lipomas are tumors that may present as painless masses with slow growth. This type of tumors is usually asymptomatic until they reach a large size. They can be solitary or multiple. When multiple and symmetrical distributed around neck area, the lesions can be classified as Madelung's disease, a rare condition that affects mostly Mediterranean men. Our objective was to describe the symptoms, cytological and histological aspects, diagnostic problems and treatment strategies of the large size lipomas and to highlights that the differential diagnosis between common lipoma of cervical area and Madelung's disease can be established only on clinical grounds, with major implications in the treatment options.The study was retrospective and analyzed archived material. We selected four cases of cervical lipomas, each with its particularities, treated in the Clinic of Oral and Maxillofacial Surgery, Timişoara City Hospital, Romania. For all the cases, we performed a fine-needle aspiration with consequent cytological exam. The microscopic evaluation of Papanicolaou-stained slides established the diagnosis of lipomas. The surgically removed specimens were sent to the Department of Pathology. The excised specimens were prepared with routine histological technique.The cases presented one or more lateral cervical swelling of the neck, inserted among major vascular-nervous elements, becoming life-threatening conditions. All the cases studied had the same cytological and histopathological features consistent with lipoma, fibrolipoma or angiolipoma, but, instead of this, clinical aspects differed from case to case. On clinical grounds, two patients were considered as Madelung's diseases.Despite of the same histopathological aspects, lateral cervical lipomas can be classified in varies categories with different treatment strategies and prognostic factors. The correct diagnosis of Madelung's disease is important in order to add other treatment options to the surgery or liposuction as avoiding alcohol or medication for metabolic disorders.

Anterior wall of the oropharynx or the base of the tongue is the site of different types of cancers, most of them usually diagnosed in advanced stages. The most common histological type of cancer diagnosed in these patients is squamous cell carcinoma (SCC). The treatment methods are multiple, but the optimal therapeutic option with best results on outcome and on the patients' quality life has not been established. The objectives of our study were to evaluate the tongue base SCCs treated by transhyoid approach and the oncological outcomes of the surgery combined with radiotherapy.The retrospective study was performed over a period of 10 years (2001-2010) on 37 previously untreated patients. All the tumors were biopsied and after histopathological (HP) diagnosis, the tumors were excised. All the specimens were fixed in 4% (v/v) buffered formalin and sent for the HP evaluation.In the study were included only the patient diagnosed on biopsy with different types of SCC. The mean age was 61 years old, most of the patients (94.59%) being males. We performed a tongue base transhyoid tumor resection in 23 (62.17%) cases followed by epiglottectomy in five (13.51%) cases or horizontal supraglottic laryngectomy in nine (24.32%) cases, respectively. Bilateral neck dissections and postoperative radiotherapy were performed in all cases. The postoperative and post-therapeutic evolution was favorable at three years (81.1%) and five years (75.67%). There were no signs of local or regional recurrences. The tumor specific three-year and five-year survival rates were: pT2 100%, pT3 87.5%, pT4a 71.42% and 57.14%, and pT4b 50% and 25%, respectively. The stage specific three-year and five-year survival rates were: stage II 100%, stage III 85.71%, stage IVA 83.33% and 79.16%, and stage IVB 50% and 25%, respectively.The prognosis for the SCC of the tongue base is poor. Cancer resection by transhyoid approach is a feasible procedure, which permits a good tumor control with limited postoperative morbidity, with an important benefit on the life quality of the patients.

Rare naso-sinonasal lesions represent a diagnostic challenge for clinicians because of the paucity of the cases and similarities with other more frequently sinonasal pathologies. The aim of the study was to present five rare sinonasal lesions in order to emphasize their symptomatology, imaging aspects, histopathological features, algorithms of diagnosis, and strategies of treatment and importance of teamwork between clinicians, pathologists and radiologists for a correct and prompt diagnosis.The cases were represented by patients with nasal sarcoidosis, nasal primitive neuroectodermal tumors, sinonasal mucosal melanoma, sinonasal plasmacytomas and nasal-type extranodal natural killer (NK) T-cell lymphoma. All the patients were biopsied in the Department of ENT (Ear, Nose and Throat), "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania, and the diagnosis was made using routine and immunohistochemical (IHC) stainings. The patients with sinonasal melanoma and the patient with extranodal NK T-cell lymphoma died in few months after diagnosis, despite treatment. Rare sinonasal lesions share similar symptomatology and imaging aspects with other, more frequently diagnosed entities. The cases reported in this paper showed the same pattern as those presented in other studies; the symptomatology, diagnosis, treatment and prognosis were the same. Clinical examination, imaging studies and routine and IHC markers guides us to the right diagnosis that should be prompt because of the prognosis of some tumors. The treatment has a few characteristics: surgery excision within safe margins, working with other specialties (oncology, radiotherapy, hematology, nephrology, pneumology), follow-up and correctly informing the patient being mandatory.In this paper, there were presented five interesting cases of rare sinonasal lesions, in order to highlight the importance of teamwork for a quick and correct diagnosis.

Extranodal natural killer (NK)÷T-cell lymphomas, nasal type are rare and aggressive non-Hodgkin's lymphomas (NHLs), with unknown etiology, rapid evolution and poor prognosis, due to midline tissue destruction and rapid spreading of the tumor. These lymphomas occur commonly in the nasal cavity and upper aerodigestive tract, but can also present involvement of the skin, salivary gland, and testis. We describe a case of nasal type T-cell NHL involving the nasal cavity and determining right thigh cutaneous metastases in a 47-year-old female associated with liver comorbidities and occupational dust exposure. The patient was suffering from chronic type C hepatitis and cirrhosis and she has been occupationally exposed to metal dust for 10 years. Clinical and laboratory investigations were performed. Essential for diagnosis and treatment protocol was nasal endoscopy and biopsy of nasal and cutaneous lesions. The histopathological exam was consistent with NK÷T-cell lymphoma. Patient was diagnosed in Ann Arbor stage IVA. Chemotherapy was initiated with Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine and Prednisone, but it was stopped after two cycles because of the liver condition. The treatment plan also included radiotherapy, but soon after initiation, the patient died because of a liver complication. We present a rare case of extranodal NK÷T-cell lymphoma, nasal type, with cutaneous involvement to which the treatment could not be properly applied because of the late diagnosis and liver comorbidities.

Cutaneous lymphomas (CLs) represent a group of lymphoproliferative disorders that can be difficult to diagnose in the early stage because they could mimic many benign inflammatory dermatoses (chronic eczema, bullous dermatosis, idiopathic erythroderma, psoriasis, lymphadenitis). Primary cutaneous B-cell lymphomas are a unique and controversial group of skin lymphomas characterised by the absence of extracutaneous manifestations at diagnosis. We present the case of a 60-year-old man with 7-month history of a growing inguinal mass/tumour, which was misdiagnosed as inguinal chronic lymphadenitis. Recognition of the correct entity, primary cutaneous diffuse large B-cell lymphoma leg type, led to an appropriate therapeutic strategy, knowing that these types of tumours behave more aggressively than other types of primary cutaneous B-cell lymphomas. The patient was discharged with rituximab + chemotherapy indication and favourable outcome. The aim of the presentation is to describe these common skin manifestations, however seen in a primary cutaneous B-cell lymphoma, which underlines the necessity of rigorous monitoring/long-term follow-up as well as exhaustive histopathological analysis for the diagnosis.

Cutaneous melanoma is a metastatic disease characterized by high resistance to treatment, the incidence of which has alarmingly increased worldwide over the past years. A thorough characterization of tumor onset, progression and metastasis is compulsory to overcome the gaps existent in melanoma biology. The present study suggests a well‑established protocol and a detailed histological description of human melanoma models in ovo and in vivo obtained by the inoculation of A375 cells to chick embryo chorioallantoic membrane (CAM) and Balb/c nude mice. The inoculation of A375 cells on CAM led to the formation of compact primary and secondary tumors on day 4 post‑inoculation, with mean surface area values of 2.2±0.4 mm2 and 1.5±0.3 mm2, respectively. Moreover, the vessels around the tumors presented a spike wheel pattern, indicating a strong angiogenic reaction. All the injected mice, apart from one, developed solid polypoid primary tumors with lobulated surfaces and intense vascularization, and achromic epithelioid malignant melanocytes with vesiculous nuclei and necrosis area were detected. Metastasis was histologically confirmed in only 30% of the mice with the tumor xenografts. These data indicate that the standardization protocols proposed are complex and reproducible, and can be further employed for the therapeutic surveillance of antiangiogenic and anticancer agents.

The CO2 laser surgery represents a treatment method of laryngeal bicordal and anterior commissure glottic cancer T1b, T2, N0. In Department of ENT, Timisoara, Romania, during 1.01.2001-31.12.2011 were analyzed 781 files from patients with laryngeal neoplasm. One hundred twenty-seven patients presented the tumor that involved both vocal cords and anterior commissure, stages T1b, T2 and T3. Therapeutic options included CO2 laser microsurgical excision for 55 (43.30%) patients, frontolateral hemilaryngectomy for 16 (12.59%) patients, total laryngectomy for 42 (33.07%) patients, radiotherapy for 10 (7.87%) patients, and four (3.14%) patients, initially, refused any treatment modality. Endoscopic laser CO2 microsurgery was the primary and solitary management for curative resection of the glottic cancer. All operations were performed under general anesthesia with orotracheal intubations. The mean follow-up was 58 months, with the range between 36 to 84 months. Suspended microlaryngoscopy with CO2 laser surgery has been performed in 43 (33.85%) patients staged T1bN0Mx and 12 (9.44%) patients staged T2N0Mx. In five (9.09%) patients, we encountered local recurrences. The endoscopic CO2 laser surgery is in our view the elective and preferable surgical method in laryngeal glottic cancer stage T1b and T2 for cure, with oncological and functional results superior to those of conventional surgical procedures.

Simona Popescu,1,2 Bogdan Timar,2,3 Flavia Baderca,4,5 Mihaela Simu,6,7 Laura Diaconu,1,2 Iulian Velea,8,9 Romulus Timar1,2 12nd Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 2Clinic of Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital, 3Department of Functional Sciences, 4Department of Microscopic Morphology, “Victor Babes” University of Medicine and Pharmacy, 5Service of Pathology, Emergency City Hospital, 6Department of Neurosciences, “Victor Babes” University of Medicine and Pharmacy, 7Clinic of Neurology, Emergency Clinical County Hospital, 8Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy, 9Clinic of Pediatrics, Emergency Clinical County Hospital, Timisoara, Romania Abstract: Population aging is unprecedented, without parallel in the history of humanity. As type 2 diabetes mellitus is predominantly more prevalent in aging populations, this creates a major public health burden. Older adults with diabetes have the highest rates of major lower-extremity amputation, myocardial infarction, visual impairment, and end-stage renal disease of any age group. The aims of our study were to assess whether age is an independent factor for the occurrence of diabetic neuropathy (DN), and to evaluate the relationship between the presence and the severity of DN and the diabetes duration and blood glucose level. In this study, we enrolled 198 patients, previously diagnosed with type 2 diabetes mellitus. For all patients, we measured hemoglobin A1c (HbA1c), lipid profile, and body mass index and we assessed the presence and severity of DN using the evaluation of clinical signs and symptoms. Patients had a median age of 62 years, with a median of diabetes duration of 7 years; 55.1% of the patients were men and the average HbA1c in the cohort was 8.2%. The prevalence of DN according to Michigan Neuropathy Screening Instrument was 28.8%, being significantly and positively correlated with higher age (65 vs 59 years; P=0.001) and HbA1c (8.6% vs 8.0%; P=0.027). No significant correlations were observed between the severity of DN and diabetes duration, body mass index (31.9 vs 29.9 kg/m2), or the number of centimeters exceeding the normal waist circumference (25.2 vs 17.3 cm; P=0.003). In conclusion, age influences the presence of DN, independent on other risk factors. This influence persists even after adjusting for other, very important risk factors, like blood glucose level or diabetes duration. Keywords: peripheral neuropathy, elderly patients, type 2 diabetes mellitus, body mass index, hemoglobin A1c, diabetic neuropathy

Cutaneous lymphomas (CLs) represent a group of lymphoproliferative disorders that can be difficult to diagnose in the early stage because they could mimic many benign inflammatory dermatoses (chronic eczema, bullous dermatosis, idiopathic erythroderma, psoriasis, lymphadenitis). Primary cutaneous B‐cell lymphomas are a unique and controversial group of skin lymphomas characterised by the absence of extracutaneous manifestations at diagnosis. We present the case of a 60‐year‐old man with 7‐month history of a growing inguinal mass/tumour, which was misdiagnosed as inguinal chronic lymphadenitis. Recognition of the correct entity, primary cutaneous diffuse large B‐cell lymphoma leg type, led to an appropriate therapeutic strategy, knowing that these types of tumours behave more aggressively than other types of primary cutaneous B‐cell lymphomas. The patient was discharged with rituximab + chemotherapy indication and favourable outcome. The aim of the presentation is to describe these common skin manifestations, however seen in a primary cutaneous B‐cell lymphoma, which underlines the necessity of rigorous monitoring/long‐term follow‐up as well as exhaustive histopathological analysis for the diagnosis.

Psoriasis is an inflammatory skin disease, with a polymorphic clinical appearance. Modern techniques for in vivo imaging of skin structure, such as reflectance confocal microscopy (RCM) and dermoscopy, could be very useful tools for diagnosis and monitoring of psoriatic lesions. We report a case of psoriasis vulgaris in which we identified certain dermoscopic features suggestive for psoriasis and RCM enabled us to identify in vivo most of the histological features of psoriatic lesions.

The metal alloys used in dental practice are the subject of numerous discussions referring to the effect they have on oral cavity tissues. Numerous scientists established that the organic molecules did not exert a significant influence on the degradation of metallic implants. The aim of this study was to test the cytotoxic potential of the most used dental alloys, the Ni-Cr alloy and the Co-Cr alloy. The tests were made on cell culture of pure cell line dermal fibroblasts and of those obtained from skin biopsies, for both, dental alloys and their eluates. The results were compared with control samples. At seven days after inoculation, we observed the relative similarity between the Ni-Cr alloy and the Co-Cr alloy, where the cells did not detach from the plate and they grow to the edge of the material. In case of the eluates, there were no fragments detached, the cells having a relatively high confluence. Therefore, the cytotoxic effects of the two alloys are similar, even if there are speculations in the literature according to which Ni-Cr alloys would have a more pronounced effect. In conclusion, our study revealed non-cytotoxicity of these two dental alloys, and we believe so they can be used successfully in dental practice.

Typically, the right testicular vein drains blood into the inferior vena cava, while the left testicular veins drains into the left renal vein. However, variations in the paths of the testicular veins do occur. Such variations can influence testicular drainage and even lead to varicocele, one of the causes of male infertility. During a routine dissection conducted within the Department of Anatomy and Embryology’s laboratory, an anomalous path of the right testicular vein was observed on the cadaver of a 60-year old. The person’s death had been the result of an unrelated cause. The anomaly discovered was that both the left and right testicular veins drained into the left renal vein. The right testicular vein ascended diagonally, crossed in front of the inferior vena cava and joined the lower side of the left renal vein, at an almost 90 degree angle and at a distance of 0.3cm from the inferior vena cava. The left testicular vein joined the left renal vein on the same side, but 4cm further away from the vena...

Nasopharyngeal carcinoma is the predominant tumor type arising in the nasopharynx with cervical lymph nodes present in 60-90% of all cases at the time of presentation. The most frequent pathological varieties include squamous cell carcinoma well-differentiated keratinizing, moderately differentiated non-keratinizing and an undifferentiated type. We present a case of non-keratinizing undifferentiated carcinoma of the nasopharynx with parapharyngeal and middle cranial fossa space involvement in an 18-year-old male who has been admitted in our hospital for recurrent right ear otitis media. Symptoms consisted in mild conductive hearing loss, trigeminal V2 nerve anesthesia, right ear tinnitus, mild dysphagia, mild dysphonia, right hypoglossal nerve paralysis and right Claude Bernard-Horner's syndrome. Clinical examination revealed no lymph node masses, chest X-ray corresponding to a normal thoracic image. Cranial contrast enhanced CT scan showed a non-homogenous mass of 5.4/4.5/5.5 cm from the level of the right rhinopharyngeal wall, extending in the right parapharyngeal space, invading the right middle cranial fossa. Cranial MRI with contrast enhancement revealed a rhino- and parapharyngeal mass of 5.5/4.6/5.3 cm with intracerebral extension in the right cavernous sinus, right internal carotid artery being engulfed by the tumor mass with partial compression. Several lymph node masses of 1.7/1.2 cm were also revealed. We performed rhinopharyngeal biopsy, right tympanotomy and grommet tube insertion. The tissue specimens were processed with routine histological technique. Subsequent immunohistochemical reactions for pan-cytokeratin AE1/AE3 and leukocytes common antigen were performed. The histological examination of routine stained slides showed that malignant tumor cells had a syncytial pattern of growth in a background of small lymphocytes. The positivity of tumor cells for pan-cytokeratin established the final diagnosis of non-keratinizing undifferentiated carcinoma. The age of onset, the clinical signs and symptoms and minimum involvement of lymph nodes represents the particular aspects of the case.

The blue nevus is a variant of a melanocytic nevus that presents as blue-gray to blue or black papules or nodules measuring up to 1 cm in diameter; it has a predilection for females and can be congenital or acquired. The classification of blue nevi is complex, with biological behavior being benign, borderline, or malignant. The case we present is one of a 40-year-old woman with multiple dermatofibromas that appeared and increased gradually in size during pregnancy. Physical examination revealed three spherical, brownish to red-purple nodules localized on the left leg, right shoulder and right laterocervical area. In addition, on her right forearm, there was a 0.3 cm nodule with a discreet non-pigmented, elevated area and a blue perilesional border that appeared in her childhood, affirmative after stinging herself with a pencil. The patient's family history was negative for significant lesions. The laboratory and imagistic findings were normal. Four skin biopsies were performed. The histopathological examination revealed an uncommon blue nevus with two different populations of pigmented cells: spindle shaped or dendritic melanocytes diffuse distributed in the middle dermis and closely aggregated deeply pigmented melanocytes in the reticular dermis. The other three lesions were diagnosed as dermatofibromas: bland spindle shaped cells in a fibrous stroma, some cells with a storiform arrangement. The overlying epidermis was hyperplastic with acanthosis and hyperpigmentation of the basal cell layer. No mitoses were seen.

Ocular melanocytic lesions comprise a spectrum of lesions ranging from benign nevi to invasive melanoma. Clinical and histopathological appearance of conjunctival lesions ranges from freckle to lentigo and to nevi. Between these types, conjunctival nevi and conjunctival melanosis are the most frequent. Conjunctival and uveal melanocytes are derived from the neural crest, as their cutaneous counterparts, whereas the pigment epithelial melanocytes are derived from the neuroepithelium or the layers of the optic cup. Melanomas can develop in one of several places within the eye, and can be divided in uveal melanomas and conjunctival melanomas. The purpose of the study was to investigate the epidemiological and morphological data of ocular melanocytic lesions, especially intraocular melanoma, through analysis of the ocular biopsies received in the Department of Pathology, Emergency City Hospital, Timisoara, Romania, for the period of five years. We did not observed any gender predilection neither in benign nor in malignant tumors. In our study, whatever the tumor location was, the most common type of melanomas was mixed with both, epithelioid and spindle cells. In some cases, immunohistochemical investigations are useful to appreciate the benign or malignant character of the tumor.

Multiple glomuvenous malformations (GVMs), also known as glomangiomas, are uncommon entities with histological features of both glomus cells proliferation and venous malformation. A 14-year-old boy was admitted to our clinic with multiple dermal blue nodules, disseminated in different segments of the body. The patient's family history was positive for similar lesions; his mother and maternal grandmother had some asymptomatic blue nodules on their body. Histological examination showed a tumor composed of multiple caveronous vessels surrounded by glomus cells, positive for alpha smooth muscle actin, HHF35 (pan-actin), and h-caldesmon. This is a case of multiple GVMs, a rare disease caused by mutations in glomulin gene, with an autosomal dominant pattern of inheritance. The clinical and histopathological features are briefly discussed.

The segmental branches of the renal artery vary in number and origin. The 1998, Terminologia Anatomica homologates two branches of the renal artery (anterior, posterior) and five segmental arteries: four from the anterior branch and one from the posterior one. The purpose of this study is to evaluate the renal artery branching pattern, the number and origin of the segmental arteries, as well as to review data from similar studies. The study material consisted of 60 formalin-fixed adult kidneys. Dissections and microdissections were performed on the renal arteries and their branches. The branching of the renal artery was prehilar in 81.67% of cases, hilar in 10% and intra-sinusal in 8.33%. The number branches varied as follows: two branches in 42 cases (70%), three branches in 14 cases (23.33%) and four branches in four cases (6.67%). We subsequently analyzed the origin of the segmental arteries and found that in 53% of the cases the segmental arteries arose independently from the renal artery's branches, while in 47% of the cases they derived from common trunks of type I (85%) or II (15%). Type I trunks are those that originate directly from the main renal artery. They divide either into 2-3 segmental branches, or into just 1-2 branches and a smaller trunk (type II). The type II trunks further divide into 2-3 other segmental branches. These common trunks must be taken into account to avoid confusion with the segmental arteries. Knowledge of these variations is useful not only morphologically, but also clinically.