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IntroductionSkin metastases arise in 10% of cancer patients, but standardized dermoscopy diagnostic criteria for skin metastases remain poor. This study's objective was to analyze the dermoscopy features of skin metastases from advanced systemic and cutaneous cancers.MethodsA retrospective study on 715 dermoscopy images of skin metastases from 33 patients with various primary cancers (breast, ovary, melanoma, non-melanoma skin cancer, and chronic leukemia) attending two academic centers between 2013 and 2023 was performed. Four independent observers blindly analyzed patterns, colors, vessels, and elementary lesions for each metastasis (30 parameters in total).ResultsThe structureless white pattern was the most prominent indicator of cutaneous metastasis (81.26%, p < 0.001). Regardless of the primary tumor, colors pink, red, white, and tan were identified. Elementary lesions were infrequent, except for melanoma metastases that displayed dots (13.23%) and globules (11.11%). Breast cancer metastases presented: blue (41.48%) and red (34.32%) colors, irregular vessels (13.58%), and a blue-naevus pattern (22.22%). Melanoma metastases displayed: a blue-naevus pattern (61.38%), a blue color (85.71%), and a structureless-blue combination pattern (79.37%). Non-melanoma skin cancer metastases were characterized by vascular (42.11%) and angioma-like (31.58%) patterns, pink (57.89%) and red (57.89%) colors, irregular (57.89%), thin hairpin (47.37%), comma (47, 37%), and thick hairpin (26, 32%) vessels and a red, white and irregular vessels combination pattern (52, 63%). A pink structureless combination pattern was frequent (61.05%) in chronic leukemia metastases. Ovarian cancer metastases displayed a white and tan structureless combination pattern (100%) and frequently had dotted vessels (42.85%).ConclusionPapules and nodules with a white structureless pattern suggest skin metastases, regardless of the primary tumor. A blue structureless lesion is indicative of melanoma metastasis and a vascular pattern with irregular vessels indicates a non-melanoma skin cancer metastasis. Dermoscopy stands as a reliable non-invasive diagnostic method for suspected cutaneous metastases in patients with a known cancer history.

IntroductionAlthough the incidence and mortality rates of colorectal cancer exhibit significant variability, it remains one of the most prevalent cancers worldwide. Endeavors to prevent colorectal cancer development focus on detecting precursor lesions during colonoscopy. The diagnosis of endoscopically resected polyps relies on hematoxylin and eosin staining examination. For challenging cases like adenomatous polyps with epithelial misplacement, additional diagnostic methods could prove beneficial.MethodsThis paper aims to underscore stromal changes observed in malignant polyps and polyps with pseudoinvasion, leveraging two-photon excitation microscopy (TPEM), a technique extensively employed in the medical field in recent years. Results and discussionsBoth the subjective and quantitative analysis of TPEM images revealed distinct distributions and densities of collagen at the invasion front in malignant polyps compared to areas of pseudoinvasion. TPEM holds potential in discerning true invasion in malignant polyps from pseudoinvasion, offering enhanced visualization of local stromal changes.

Intermediate-thickness melanomas display highly variable outcomes influenced by both clinical and histopathological characteristics. This study investigates several clinicopathological prognostic factors for pT3 cutaneous melanomas, focusing on a novel parameter, the width of invasion. This is a retrospective study of 49 patients diagnosed with cutaneous melanoma between 2012 and 2018 who were followed up for at least five years. We evaluated the age, gender, tumor location, Breslow depth of invasion, width of invasion, mitotic index, the presence/absence of ulceration, regression, microsatellites, lymphovascular invasion, and perineural invasion for their association with disease progression and survival. Cox univariate analysis revealed that progression-free survival (PFS) was significantly associated with age, depth of invasion, width of invasion, lymphovascular invasion, microsatellites, and perineural invasion. Overall survival (OS) was significantly associated with age, depth of invasion, width of invasion, microsatellites, and perineural invasion. Through multivariate Cox proportional hazards regression, the only factor associated with both PFS and OS was the width of the invasion. This is one of the few studies to assess the width of invasion and we have demonstrated that this parameter could become an important prognostic factor for cutaneous melanomas.

Background and Objectives: Squamous cell carcinoma (SQCC) represents a significant proportion of human malignancies affecting various anatomical sites, including the lung. Understanding the prognostic factors is crucial for establishing effective risk stratification in these patients, as multiple critical aspects significantly impact overall survival. Materials and Methods: A retrospective study was conducted on 99 patients with operable lung SQCC treated at a tertiary center. The exclusion criteria included patients under 18, those with in situ or metastatic SQCC, and those who received neoadjuvant therapy. The surgical specimens were re-analyzed, and data were collected on multiple variables, including pTNM staging, tumor characteristics, and overall survival (OS). The Kaplan–Meier survival analysis and Cox regression models were used to identify significant prognostic factors. Results: The Kaplan–Meier analysis showed a median survival of 36 months with a 65.65% mortality rate. Significant factors influencing survival included keratinization, histological grading, tumor size and stage, pleural invasion, tumor cell arrangement, tumor budding, spread through air space (STAS), and mitotic index. A multiple Cox regression highlighted the nonkeratinizing tumors, advanced pT stages, single-cell invasion, and high mitotic index as key predictors of poorer outcomes. The nonkeratinizing tumors showed higher mortality and shorter median survival rates compared to keratinizing tumors. The tumor staging, cell arrangement, and tumor budding significantly impacted the survival curves. Conclusions: The study underscores the importance of detailed histopathological evaluations in lung SQCC. The nonkeratinizing tumors, advanced pT stage, single-cell invasion, and high mitotic index were associated with higher hazard rates, emphasizing the need for a comprehensive grading system incorporating these factors to improve prognostic accuracy and guide treatment strategies.

Diagnosing cutaneous melanomas relies mainly on histopathological analysis, which, in selected cases, can be aided by immunohistochemical evaluation of conventional melanocytic markers. Nevertheless, these malignancies, particularly in metastatic settings, may display divergent differentiation with unusual histological and immunohistochemical features. In this context, we present the case of a 65-year-old male diagnosed with typical superficial spreading melanoma who developed recurrence and metastatic lesions featuring angiosarcomatous differentiation. The diagnosis of the initial tumour and the subsequently dedifferentiated lesions was confirmed by ample immunohistochemical analysis, which included several melanocytic markers, as well as mesenchymal and vascular markers. The recurrent tumour and lymph nodes metastases were completely negative for Melan-A and PRAME, and focally positive for SOX10. Additionally, they also displayed diffuse, intense positivity for CD10 and WT1 and focal positivity for CD99, ERB, and CD31. Thus, the diagnosis of primary cutaneous melanoma with recurrent and metastatic divergent angiosarcomatous differentiation was established. This occurrence is particularly rare and can pose important diagnostic challenges. Therefore, in addition to presenting this highly unusual case, we also performed a comprehensive review of the literature on divergent differentiation in melanomas.

Proliferative activity in cutaneous melanomas can be appreciated both histopathologically by counting mitotic figures and immunohistochemically through the Ki67 index, but the prognostic value of each method is still a matter of debate. In this context, we performed a retrospective study on 33 patients diagnosed with cutaneous melanomas between 2013 and 2018 in order to evaluate progression-free survival and overall survival. Multivariate Cox proportional hazards regression was performed by considering both clinical histopathological and immunohistochemical features. The mitotic rate was significantly independently associated with both outcomes, while the Ki67 index was not an independent prognostic factor. However, the Ki67 predictive accuracy could be improved by establishing both a cut-off value and a standardized protocol for evaluating its expression. Until these desiderata are met, the mitotic rate remains superior to the Ki67 index for predicting prognosis in cutaneous melanomas, as also has the advantage of being easily interpreted in a standard histopathological examination regardless of the pathologist’s experience and with no further financial expenses. Importantly, this is one of very few articles that has shown perineural invasion to be an independent prognostic factor for both progression-free survival and overall survival in cutaneous melanomas. As a consequence, this parameter should become a mandatory feature in the histopathological evaluation of cutaneous melanomas as it can improve the identification of patients who are at high risk for disease progression.

Liposarcomas are some of the most challenging soft tissue tumors and are subclassified into multiple subtypes with special histologic and molecular features. The peculiarities of each histopathological subtype influence the clinical behavior, management, and treatment of these neoplasms. For instance, well-differentiated liposarcomas are common soft tissue malignancies and usually display a favorable outcome. On the other hand, pleomorphic liposarcoma is the rarest, yet the most aggressive subtype of liposarcoma. This histopathological diagnosis may be challenging due to the scarce available data and because pleomorphic liposarcomas can mimic other pleomorphic sarcomas or other neoplasms of dissimilar differentiation. Nevertheless, the correct diagnosis of pleomorphic liposarcoma is of utmost importance as such patients are prone to develop local recurrences and metastases. Treatment usually consists of surgical excision along with radiotherapy and follow-up of the patients. Therefore, this review aims to assess the complex clinical, histological, and immunohistochemical features of liposarcomas in order to establish how these characteristics influence the management and prognosis of the patients, emphasizing the particularities of pleomorphic liposarcoma.

Background and Objectives: Lichen planus of the lip (LPL) is a chronic inflammatory condition that resembles actinic cheilitis, discoid lupus erythematosus, graft-versus-host disease, and lichenoid reaction to dental materials or drugs. The purpose of this study was to conduct a literature review on lichen planus lip involvement and to report a retrospective observational study that characterises and explores the clinical, histopathological, and evolution of the lesions in a group of patients with unique involvement of LPL. Materials and Methods: Clinical data of patients diagnosed with LPL was retrieved from the medical charts of the patients referred to the Oral Pathology Department of the “Carol Davila” University of Medicine and Pharmacy. A concurrent electronic literature research was carried out using PubMed and Web of Science from 2003 to 2023. Results: Eleven patients diagnosed with unique LPL were analysed (male/female ratio was 1.75, mean age 63.64 years ± 12.52). All patients presented lesions of the lower lip; the clinical forms were atrophic (six cases) and erosive (five cases), and the histopathological exam confirmed the diagnosis. After topical treatment with corticosteroids, most of the patients had complete remission. The literature review revealed 24 studies (sixteen case reports and eight case series) which comprised 84 patients. Isolated lip involvement was reported in 17 studies, and five articles with concomitant oral lichen planus, while two articles did not mention this criterion. Conclusions: Our study brings new data on isolated lichen planus of the lip that primarily affects the lower lip with predominance in male patients. It was reported worldwide in patients between 22 and 75 years old. Topical corticosteroids were the main treatment prescribed and they usually brought remission of the lesions. Lichen planus of the lip is a challenging diagnosis for oral health practitioner providers as well as for dermatologists.

Background and Objectives: The mainstay treatment of non-small-cell lung carcinoma is still surgery, but its impact on survival beyond nine years has never been reported/analysed in Romania. Therefore, we studied the clinical characteristics and the short- and long-term survival of a population of 1369 patients diagnosed and treated in a single institution, with the variables included in the database being collected retrospectively. Materials and Methods: In this paper, we aimed to study a number of factors that might influence prognosis and survival in non-small bronchopulmonary carcinoma. Consequently, we analysed a series of parameters such as the age of patients, their sex, the histopathological type, the tumour stage, the presence of bronchial invasion, and the completeness of surgical resection. Results: All patients underwent major lung resection for curative purposes (pneumonectomy, lobectomy, or bilobectomy) between January 2015 and January 2023. The vital status of patients included in the study was obtained by checking the DGEP (General Directorate for Persons Record) database and verifying the reporting of “non-deceased” by the hospital administrative database, as well as by telephone interviews (with patients or their relatives). On univariate analysis, predictors of worse survival were the following: male sex (the hazard of death was 1.54 times higher in men); pT (compared to pT1 tumours, pT2 tumours have a 1.60 times higher hazard of death, pT3 tumours have a 2.16 times higher hazard, and pT4 tumours have a 2.97 times higher hazard); maximum tumour size (a 10 mm increase in tumour size is associated with a 10% increase in the hazard of death); the degree of differentiation (compared to patients with G1 tumours, those with G3 tumours have a 2.16 times higher hazard of death); resectability (compared to R0, R1 B+ has a 1.84 times higher hazard of death, R1 V+ has a 1.82 times higher hazard of death, and R1 B+&V+ has a 2.40 times higher hazard of death). Conclusions: As a result, long-term survival can be achieved after complete surgery for NSCLC, and factors that classically predict overall survival suggest that both the initial tumour aggressiveness and host characteristics act beyond the period usually considered in oncology.

Lung cancer is among the most common oncological diseases regarding incidence and mortality, with most of these having epithelial origins. Pathological reporting of these tumors is conducted according to the 5th edition of the World Health Organisation (WHO) classification of thoracic tumours. This study aims to draw the pathologist’s attention to four rare, atypical microscopic aspects that some of the most common types of lung malignancies reveal upon standard evaluation (hematoxylin-eosin stain) that make histopathological diagnosis challenging: acantholytic, pseudoangiosarcomatous, signet ring cell, and clear cell features. Each of these aspects was exemplified by a case diagnosed in the pathology department of the “Marius Nasta” Institute. Furthermore, we analyzed the classification dynamics of different WHO editions and used PubMed to review articles written in English and published in the last eleven years on this subject. Pathologists should be familiar with these unusual aspects to avoid misdiagnoses and to ensure the correct classification of tumors, which is extremely important because these tumor phenotypes have been associated with specific molecular alterations and a worse clinical evolution. There is a need to clarify the histogenesis and associated genetic mutations, given the fact that the rarity of these tumor phenotypes makes their study difficult. Some authors consider these to be overlapping entities; however, we do not encourage this, as they may exhibit different prognoses and various molecular alterations with important therapeutic implications. The signet ring cell feature was associated with ALK rearrangement in lung adenocarcinoma; thus, these patients can benefit from tailored therapy with ALK-tyrosine kinase inhibitors (ALK-TKI). Recent studies associated clear cell morphology with FGFR3-TACC3 fusion, suggesting that patients with this diagnosis may be potentially eligible for FGFR inhibitors. We described, for the first time, the pseudoangiosarcomatous pattern in a case of lung adenocarcinoma; to our knowledge this aspect has only been described until now in the context of squamous cell carcinomas.

Measurement(s) Type I Collagen Technology Type(s) multi-photon laser scanning microscopy Factor Type(s) second order susceptibility tensor elements Sample Characteristic - Organism Homo sapiens Sample Characteristic - Environment laboratory environment Sample Characteristic - Location Romania

Introduction. Cutaneous metastases are usually observed in end-stage cancers. In some cases, the diagnosis of skin metastases is not clinically evident. New studies have found that serological markers, such as fibrinogen and lactate dehydrogenase (LDH), represent predictive factors of cutaneous metastases and could be used in the follow-up. The objective of our study was to evaluate these two markers (fibrinogen and LDH) and to find if there are any correlation between different parameters such as patients’ age, dimensions, and type of the tumour, as well as local complications. Materials and methods. We conducted a retrospective study on 56 patients with cutaneous metastases. We analysed different parameters of patients who underwent skin biopsies or surgical excision, such as age, number, diameter, localization or complications, type of primary neoplasia, other internal organ malignancies, as well as serological levels of LDH and fibrinogen. Results. The study included patients with various types of malignant tumours, most of them with melanoma, followed by different types of adenocarcinomas and leiomyosarcoma. Our cohort also included some rare cases of uterine cervix adenocarcinoma metastases, renal cell metastases and pancreatic metastases. Regarding the serological markers, we identified that fibrinogen correlates with the diameter of the skin nodules, LDH correlates with the age of the patients diagnosed with melanoma, and the two serological parameters correlate with one another. Conclusions. Fibrinogen and LDH can be considered poor prognostic factors for patients with melanoma metastases. As the two markers correlate with one another and with some of the analysed parameters, they could, in the future, be useful to better estimate the malignant disease outcome.

Thick cutaneous melanomas (Breslow depth > 4 mm) are locally advanced tumors, generally associated with poor prognosis. Nevertheless, these tumors sometimes display unpredictable behavior. This study aims to analyze clinical and histopathological features that can influence the prognosis of thick melanomas. This is a retrospective study on 94 thick primary cutaneous melanomas diagnosed between 2012 and 2018 that were followed-up for at least five years to assess disease progression and survival. We evaluated the age, gender, tumor location, histological subtype, Breslow depth, Clark level, resection margins, mitotic index, the presence/absence of ulceration, necrosis, regression, microsatellites, neurotropism, lymphovascular invasion, and the pattern of tumor-infiltrating lymphocytes, and their association with disease progression and survival. By conducting univariate analysis, we found that progression-free survival (PFS) was significantly associated with female gender, the superficial spreading melanoma (SSM) subtype, mitotic index, necrosis, microsatellites, and perineural invasion. Overall survival (OS) was significantly associated with female gender, Breslow depth, SSM subtype, necrosis, microsatellites, and perineural invasion. Through multivariate Cox proportional hazards regression, we found that the only factors associated with PFS were Breslow depth, necrosis, microsatellites, and perineural invasion, while the factors associated with OS were Breslow depth, necrosis, microsatellites, and perineural invasion. Certain histopathological features such as Breslow depth, necrosis, microsatellites, and perineural invasion could explain differences in disease evolution. This is one of the first studies to demonstrate an association between necrosis and perineural invasion and outcomes in patients with thick melanomas. By identifying high-risk patients, personalized therapy can be provided for improved prognosis.

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.

Pancreatic heterotopy is a rare entity defined as the presence of abnormally located pancreatic tissue without any anatomical or vascular connection to the normal pancreas. Heterotopic pancreatic tissue can be found in various regions of the digestive system, such as the stomach, duodenum, and upper jejunum, with the less commonly reported location being the gallbladder. Gallbladder pancreatic heterotopia can be either an incidental finding or diagnosed in association with cholecystitis. Pancreatitis of the ectopic tissue has also been described. In this context, we report three cases of heterotopic pancreatic tissue in the gallbladder with different types of pancreatic tissue according to the Heinrich classification. One patient was a 24-year-old male who presented with acute pancreatitis symptoms and an ultrasonographical detected mass in the gallbladder, which proved to be heterotopic pancreatic tissue. The other two cases were female patients aged 24 and 32, respectively, incidentally diagnosed on histopathological examination after cholecystectomy for symptomatic cholelithiasis. Both cases displayed chronic cholecystitis lesions; one of them was also associated with low grade dysplasia of the gallbladder. Although a rare occurrence in general, pancreatic heterotopia should be acknowledged as a possible incidental finding in asymptomatic patients as well as a cause for acute cholecystitis or pancreatitis.

Dedifferentiated liposarcoma of the deep soft tissue of the lower extremities is an infrequent finding. Myxoid liposarcoma is considered the most common soft tissue neoplasia arising in this anatomic region. Divergent differentiation usually occurs within well-differentiated liposarcoma and is exceedingly rare in a myxoid liposarcoma. We report a 32-year-old man who developed a dedifferentiated liposarcoma of the thigh on the background of a pre-existing myxoid liposarcoma. The gross examination of the surgical specimen showed a 11/7/2 cm tumour mass with solid tan-grey areas and focal myxoid degeneration. The microscopic examination revealed a malignant lipogenic proliferation, containing round cells with hyperchromatic nuclei and atypical lipoblasts, confined to the basophilic stroma with a myxoid aspect. Abrupt transition towards a hypercellular, non-lipogenic area consisting of highly pleomorphic spindle cells with atypical mitotic figures was also noted. Immunohistochemical staining was performed. Tumour cells in the lipogenic area were intensely positive for S100 and p16, and CD34 staining highlighted an arborizing capillary network. The dedifferentiated tumour areas showed positive MDM2 and CDK4 staining within neoplastic cells, with the Ki 67 proliferation marker expressed in approximately 10% of the cells. Wild-type TP53 protein expression pattern was documented. Thus, the diagnosis of a dedifferentiated liposarcoma was established. This paper aims to provide further knowledge about liposarcomas with divergent differentiation at peculiar locations, emphasizing the importance of histopathologic examination and immunohistochemical analysis for establishing the diagnosis and assessing the therapeutic response and prognosis of this condition.

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.

Introduction. The most important histologic prognostic factors for melanoma remain depth of invasion and mitotic rate. In a digital era, precision (in terms of reproducibility and inter laboratories repeatability), as well as image evidence, are new qualitative parameters. The objective of the study was to evaluate in a retrospective analysis any significant difference among the Breslow digital assessments performed using two different immunohistochemical stains and the gold standard, hematoxylin eosin stain. Material and methods. We evaluated 130 primary cutaneous melanomas diagnosed in a two-year period (2016-2017) with known Breslow scale. Immunohistochemistry staining (SOX10 and Melan A) was perform followed by slide scanning. Aperio Imagescope and StataCorp software were used for data acquisition and statics. Results. No significantly statistic differences were recorded between groups in terms of Breslow values (p=0.98, Kruskal-Wallis test). Conclusions. All three stains perform similar in evaluating depth of invasion regardless of the method used to quantify it. The pathologist should consider using an accurate and precise method like a digital measurement technique for daily reports.

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.

Quantitative second harmonic generation microscopy methods that provide an estimate for the molecular structure of collagen in tissues by fitting theoretical models with experimental data at pixel-level are gaining increasing momentum. Such methods offer reliable diagnostic-relevant information that complement traditional histology procedures. We provide guidelines on selecting the optimal experimental data acquisition parameters (frame or pixel averaging, pixel dwell time, pixel size, zoom factor) and the most suited pre-processing steps (thresholding, averaging of pixels) for ensuring experimental data fitting with very high performance. Under controlled image acquisition conditions, we also propose pixel fitting efficiency calculation which varies across distinct tissue types and has potential to be used to differentiate tissues exhibiting distinct collagen architectures.

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

The conversion of histology slides into electronic format represents a key element in modern histopathology workflows. The most common way of converting physical histology slides into digital versions consists of tile-based scanning. In such approaches, the entire image of the slide is generated by consecutively scanning adjacent sample regions with a degree of overlap and then stitching these together to constitute an image mosaic. To achieve a high-quality result, the image acquisition protocol for collecting the mosaic tiles requires a recalibration of the microscope when moving from one sample region to another. This recalibration procedure typically involves focus and illumination adjustments, aimed at rendering a homogeneous image mosaic in terms of brightness, contrast, and other important image properties. The accurate evaluation of the digital slide's quality factor is, therefore, an important matter, as it can lead to designing efficient (and automated) mosaic generation protocols. We introduce here a new methodology for the evaluation of image mosaics collected with brightfield microscopy on histology slides, coined Objective Quantifiable Scoring System (OQSS). It relies on objective scoring criteria that take into consideration fundamental characteristics of image mosaics, and on histology specific aspects. We present the theoretical principles of this methodology and discuss the potential utility of this framework as a quality ground-truth tagging mechanism of histology slide image mosaics applicable for the reliable benchmarking of image quality assessment algorithms.

Introducere. Achiziţia de masă osoasă continuă şi după atingerea taliei finale în perioada de tranziţie. Deficitul de hormon de creştere (GHD) pare să aibă un efect semnificativ asupra turnover-ului colagenului în timpul copilăriei şi mai puţin în timpul maturităţii. Propeptidul amino terminal al colagenului tip I (P1NP) este un marker de formare osoasă cu variabilitate intraindividuală scăzută faţă de IGF1. Subiecţi şi metodă. 17 pacienţi de sex masculin diagnosticaţi în timpul copilăriei cu GHD, retestaţi în perioada de tranziţie, au fost evaluaţi la minimum 3 luni de la întreruperea tratamentului cu GH. Am evaluat corelaţia P1NP cu IGF1. Am determinat puterea predictivă a P1NP în identificarea pacienţilor cu deficit de GH persistent. Rezultate. Am găsit o corelaţie pozitivă puternică între P1NP şi IGF-1 în grupul de pacienţi care au menţinut deficitul de GH în perioada de adult tânăr (r = 0,72, CI [0,02 la 0,94], p = 0,046). O valoare prag pentru P1NP de - 0,66 SDS prezice persistenţa deficitului de GH cu o sensibilitate de 62,5% CI [24,5 la 91,5], specificitate de 75% CI [47,6 la 92,7] şi AUC = 0,719 CI [0,5 la 0,881], p

Introduction. Bone mineral accretion continues beyond the attainment of final height during the transition period. Growth hormone deficiency (GHD) appears to have a significant effect on collagen turnover during childhood and less during adulthood. Amino-terminal propeptide of type I collagen (P1NP) is a marker of bone formation with low intra-individual when comparing to IGF1. Material and method. We evaluated 17 male patients diagnosed with GHD during childhood, after retesting GH axis in their transition period after at least 3 months from GH withdrawal. We correlate concentrations of P1NP and IGF1. We determined the predictive value for P1NP in identifying persistent GHD. Results. We found a strong positive correlation between IGF-1 and P1NP in the group of patients who maintained GH deficiency as young adults (r = 0.72, CI [0.02 to 0.94], p = 0.046). A threshold value for the P1NP of - 0.66 SDS predicts persistence of GHD with a sensitivity of 62.5% CI [24.5 to 91.5], specificity 75% CI [47.6 to 92.7] and AUC = 0.719 CI [0.5 0881]. We did not find a significant difference when we compared the AUC for the two parameters (p = 0.29). Conclusion. During the transition period, when the growth velocity is not available anymore, the dynamics of P1NP may be useful in quantifying the effectiveness of GH replacement therapy.