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There are numerous types of sinusitis caused by fungal strains, some of which already colonize the nasal cavity. Mild forms present fungus balls growing inside a preexisting sinus cavity. The invasive type ranges from chronic manifestations to acute aggravated episodes. The latter scenario is encountered in cases with reduced immune responses, such as patients with diabetes, individuals receiving any form of transplant, AIDS cases and chemotherapy patients. Without the control of immunosuppression, the infection is aggravated and extends to the orbit and inside the skull base, regardless of the prompt surgical and medical treatment. This is the most common pathogenic fungus on the nasal sinuses level. It can occasionally enter the sinus cavity during dental procedures. The pathogenesis is enhanced by anaerobic conditions in poorly ventilated sinus cavities. Rhinosinusal aspergilloma has a slow, insidious evolution over months and even years. Our experience revealed the presence of both a dental problem and previous self-administered antibiotic regimens in almost every case. The initial symptoms are common with sinusitis of dental origin, but aspergilloma should be considered when a patient with a competent immune system does not respond to standard antibiotic treatment. The final diagnosis of rhinosinusal aspergilloma is conducted on a pathology sample with silver staining. The bacteriology exam of the sinus secretion rarely reveals a fungus infection; however, as revealed in our clinical experience, there may be coinfection with other multidrug-resistant bacteria. Surgical treatment must establish a wide exposure of the sinus cavity and correct drainage regardless of the external, combined or endoscopic approach. Early diagnosis and emergency surgical debridement along with administering systemic antifungal compounds in some cases represent the key to the successful treatment of invasive aspergilloma.

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.

Horton's arteritis is found in the literature under various names, such as temporal arteritis, Horton's disease senile arteritis, granulomatous arteritis or giant cell arteritis (GCA). The pathogenic mechanism is the result of an inflammatory cascade triggered by a still unknown factor that causes dendritic cells in vessels to recruit T cells and macrophages, which form granulomatous infiltrates. The clinical picture consists of a daily headache with temporal localization, with moderate to severe intensity, unilateral or bilateral, with a history of months, years. Other changes may include pain in the cheek or tongue during chewing (claudication), weight loss, generalized fatigue, low-grade fever, and frequent pain in the limbs, in the context of coexisting rheumatic polymyalgia. Visual symptoms represent a special category, involving blurred vision, scotomas, and even sudden blindness. Histopathological examination of the temporal artery biopsy reveals focal thickening of the intima, with interruption of the lamina propria, with transmural inflammatory infiltrates, sometimes with multinucleated giant cells. In this article, we aim to review the role of temporal artery resection in the diagnosis of Horton's arteritis, but we also discuss the hypothesis of a potential therapeutic benefit of this procedure. However, there are also clinical situations in which there has been a considerable improvement in clinical symptoms and especially in vision deficit, with the improvement of the visual field after surgery performed for biopsy. It is difficult to estimate the influence of temporal artery resection alone, given that most patients also have concomitant cortisone treatment. However, in some cases, the rapid improvement of symptoms immediately after surgery, with the improvement of visual acuity and visual field, along with the disappearance of the headaches, can create the premises for future studies on a therapeutic contribution of temporal artery resection in GCA.

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.

From the first recognition of dysplastic nevi as a pathology per se, many debates have been raised and many histological and immunohistological studies have been conducted in order to establish the true significance of these lesions. Therefore, the aim of this study was to establish if there is a correlation between HMB-45, Melan A and Bcl-2 expression and the grade of dysplasia, as well as between the marker's staining patterns.Ten dysplastic nevi from six female patients were selected and their histological features (size, dysplasia), as well as the immunohistological staining patterns, were studied (HMB-45, Melan A, Bcl-2). The Pearson correlation coefficient and regression was calculated with Windows Excel Data Analysis.We demonstrated that there was a notable correlation between the dysplasia and the size of the lesions (r(8)= 0.62 with p-value= 0.052), and also between Melan A and Bcl-2 (a r(6)= 0.73, p0.05), but we did not obtain a statistically significant correlation between other features (p0.05).We can affirm, at least in our cases, there is a correlation between the grade of dysplasia and the size of the lesion, and also, that there is a correlation between Melan A and Bcl-2 staining, explained by MITF gene. These results were only partial concordant with those in other studies, therefore a larger number of cases is recommended to be further analyzed in order to clearly draw a conclusion.

Galactorrhoea has varied causes including physiological as in pregnancy, lactation, stress, or it can be pathological or drug induced. Its evaluation comprises of a thorough history, physical examination, laboratory tests and imaging studies. We report herewith two interesting cases of galactorrhoea. The first case was a rare adverse effect of a commonly used drug (domperidone and rabeprazole) and the second case was of mild hypothyroidism leading to galactorrhoea. Prolactin levels were normal in both the cases, emphasizing that not every case of galactorrhoea is associated with high serum levels of prolactin. Secondly, galactorrhoea may be present in patients who are clinically euthyroid, in such cases dynamic tests of thyroid function can identify the cause of galactorrhoea.

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).

Medicine is continually evolving; the new technologies of diagnosis and treatment continue to improve the life expectancy and lead to new information concerning various pathologies. The autopsy is viewed more and more as an ultimate branch of medicine and used only in extreme cases or for forensic purposes. Nevertheless, many studies, including this one, prove the utility and indispensability of the autopsies, without which a complete and accurate diagnosis cannot be made. Finally, the autopsy followed by histopathological examination of the tissues remains the ultimate and most important step for the apprehension of the diseases and for further evolution of medicine. This study reveals the correspondence rate between the clinical and the postmortem diagnosis, as well as between macroscopic and histopathological diagnosis.

In recent years, the autopsy was considered necessary only in medico-legal cases, or when the clinician requires it to better understand the pathology and cause of death (with the deceased family's consent). Although it has been shown in numerous studies that the autopsy and the postmortem histopathological examination are the only ones that can diagnose correctly and completely, the autopsy rate is declining. The primary motive of the family in consenting to a perinatal necropsy, may be to determine the cause of death of their child and to be aware of possible complications of their future pregnancy. This study shows the rate of concordance between clinical diagnosis and autopsy diagnosis, and the rate of concordance between macroscopic diagnosis and microscopic findings, pointing out once again the importance and the utility of the autopsy in medical practice.