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Squamous cell carcinoma (SCC) is the most frequent cancer in oral cavity and its prognosis has exhibited little improvement in the last decades. Although much less common palate SCCs manifests a higher local aggression invading very quickly the adjacent muscles and jawbones, thus being able frequently to lead to dysfunctions in chewing, swallowing, and speech. To elucidate what underlies such local aggression, we investigated the immunohistochemical expression in palate SCCs of Podoplanin (D2-40), Galectin-3 (Gal-3), mammary serine protease inhibitor (Maspin) and minichromosome maintenance complex component 7 (MCM7), markers that are known to be involved in tumor invasiveness. We found a progressive increase in reactivity for D2-40 and MCM7 from the normal epithelium toward dysplastic epithelium and respectively to SCC, which suggests the intervention of these markers in the early stages of squamous cell carcinogenesis in the palate. The highest D2-40, Gal-3 and MCM7 reactivity was observed in basaloid and in poorly differentiated (G3) palate SCCs, while for Maspin the well-differentiated (G1) palate SCCs were the most reactive. The first three markers mentioned above were most intensely expressed at the invasion front, while the Maspin reactivity was low or absent at this level. Statistically, we found significant stratification on localization, grading, muscle invasion, and survival for all investigated markers, but with very high direct correlations between D2-40, Gal-3, and MCM7 immunoreactive score (IRS) values, while between the Maspin and each of the previous markers there were very high inverse correlations. Overall, all these investigate markers proved to be responsible for the local invasiveness and regional lymph node metastasis, thus allowing a prognostic and therapeutic stratification of patients with palate SCCs.

Cystic fibrosis (CF) is a genetic disease, with autosomal recessive transmission, multisystemic, characterized by a remarkable clinical polymorphism and significant lethal prospective. Respiratory manifestations dominate the clinical picture, being present in all patients. The aim of the paper was to analyze the incidence of clinical manifestations, especially respiratory ones, as well as the contribution of interdisciplinary consultations to the positive diagnosis of CF, in a group of 16 patients who were hospitalized and treated in the IInd Pediatric Clinic and IInd Medical Clinic of the Emergency County Hospital, Craiova, Romania, in a period of 20 years. The 16 patients diagnosed with and treated of CF had all shown increased values of sweat chloride concentration of over 60 mmol∕L. The main symptoms and clinical signs encountered in these patients were cough (75%), sputum (62.5%), dyspnea (50%), wheezing (50%), stature hypotrophy (100%), pallor (37.5%), cyanosis (25%). All 16 patients had an acute exacerbation of chronic pulmonary disease. Of the total hospitalizations, the death was recorded only in the case of one female patient. The association of some clinical aspects specific with a positive result of the sweat test or the presence of the two pathological alleles made room for determining a positive diagnosis. The multisystemic nature of this disease requires a multidisciplinary approach to these patients. Histopathologically, there was a correspondence between lung morphological lesions and the results of imaging investigations.

Dirofilariasis is a zoonotic worldwide-distributed disease, especially in regions with warm to temperate climate, where it recently recorded a significant increase of prevalence. A 61-year-old female, a dog owner, residing in the Southwest of Romania, near a swamp, developed a painless nodule in the left temporal region. The contrast-enhanced computed tomography (CT) scan revealed a temporal intramuscular cystic lesion. The surgical exploration confirmed the lesion as with intramuscular localization. The histopathology and biochemistry investigations established as a cause of the lesion an infestation with Dirofilaria repens species. The patient underwent an anthelmintic treatment with Diethylcarbamazine and the clinical and radiological follow-up did not revealed any recurrences within a period of 15 months after surgery. This is the second case reported in Craiova (Romania), the seventh worldwide reported case with localization in the temporal region, and the second one with intramuscular development in this region. The existence of such cases should alert the clinician to include parasitosis in the differential diagnosis of atypical space-occupying lesions of the head regions.

Introduction: The "silent sinus syndrome" is a rare entity that was first described in 1964 and given this name 30 years later. Although it is well described both from clinically and radiologically point of view we consider that its rarity still makes it a subject for report., Case Presentation: A 46-year-old patient was admitted for facial asymmetry, diplopia, unilateral left enophthalmos, and inferior displacement of the eye globe, and decreased occlusal pressure in left dentate region. CT scan revealed interior bulging of all left maxillary sinus walls with osteolysis and intense opacification, enlargement of the left middle meatus especially in the posterior part and lateralization of the uncinate process. Nasal endoscopy with 00 rigid scope visualized mild deviation to the right of the nasal septum, enlargement of the left middle meatus by the lateral deviation of the left intersinusal septum and uncinate process. Surgery was scheduled and performed a left maxillary sinus antrostomy. Histopathological examination on the biopsies revealed inflammation. A complete study was performed to assess the elements of inflammation. Postoperative course was simple. Follow-up visit at three and six months, showed significant regression of diplopia and improved facial aspect., Conclusions: Silent sinus syndrome is a well-defined clinical entity with characteristic imagistic findings. Surgical intervention that restores sinus drainage will interrupt the pathogenesis of the disease and lead to its progressive regression. Topographic associations and density of inflammatory elements analyzed in relation with neoforming vessels suggest their implication in reparatory angiogenesis characteristic to chronic inflammation. Modulating activity in the frame of inflammatory process, of the T-lymphocytes and especially of T-lymphocytes may represent a target for the therapeutic management. Surgery can and should be performed by an endoscopic approach.

Introduction: Metabolic syndrome was defined by IDF (International Federation for Diabetes, 2007) by abdominal obesity plus at least two of the following: high triglycerides, low HDL-cholesterol, hypertension, high levels of glucose or type II diabetes diagnosed. Obesity is associated with a high cardiovascular risk, abdominal obesity being the most aggressive form, because it secretes cytokines and hormones in comparison to subcutaneous adipose tissue. Adipocytokines secreted by adipose tissue are mediators of atherosclerosis and endothelial damage., Materials and Methods: We studied a total of 80 subjects aged between 40 and 60 years with metabolic syndrome, in which the following adipocytokines values were determined: hs-CRP (turbidimetric method), IL-6, TNF-alpha, leptin (ELISA method), in comparison to a control group., Results: The values of these adipocytokines were significantly higher in the studied group compared with the control group and correlated with increased levels of glucose (patients with type II diabetes or increased tolerance test) and with hyper-triglyceridemia., Conclusions: Patients with metabolic syndrome had increased levels of proatherogenic adipocytokines, particularly leptin, leptin-resistance representing the pathogenic link of obesity. The identification as early as possible of the metabolic syndrome patients allows effective monitoring and correction of cardiovascular risk factors, with the opportunity to reduce morbidity and mortality in young ages. In men, proatherogenic cytokines values presented higher values than in women, which prove the role of abdominal obesity in proatherogenic cytokines production. Although women have a higher percentage of adipose tissue, this is not primarily abdominal adipose tissue.

Oral cavity cancer is a public health problem as the sixth leading cause of cancer worldwide. Most tumor lesions are detected in stage III and IV, leading to a poor prognosis, five-year survival rate ranging between 10% and 40%. Oral cancer etiology is multifactorial, known still incomplete. The main etiopathogenic factors are exposure to cigarette smoke and alcohol consumption. We conducted a retrospective study of oral cavity tumors hospitalized in 2008-2012 in Oral and Maxillofacial Surgery Clinic of the Emergency County Hospital of Craiova, Romania. Of 143 tumors of the oral cavity, 125 were malignant, and of these, 115 (92%) were represented by squamous cell carcinoma. Tumor lesions were more common in males (69%), patients from rural areas (64%) and those over 50-year-old (87.71%).

In this study, we analyzed the microvessel density (MVD) for CD105+ and α-SMA+ vessels and the VEGF immunoexpression in 38 gastric carcinomas. CD105+ MVD had superior values at the advancing edge compared with the intratumoral area, no matter of the analyzed clinico-pathological parameters, the difference being significant only in intestinal type, moderate differentiated carcinomas as well as in T2-T3 carcinomas, without lymph node metastases (p<0.05). Intratumoral expression of CD105+ MVD indicated significant differences related to histological type (p=0.006), depth of invasion (p=0.027) and lymph node metastases (p=0.009), but without statistical association in case of the advancing edge or metastases. The assesses of α-SMA+ MVD indicated no differences between intratumoral and advancing edge areas, no matter of the analyzed parameters, excepting intestinal type carcinomas, which presented significant high values (p=0.003) at the advancing edge. VEGF score revealed significant differences related to histological type (p=0.020), differentiation degree of the intestinal type carcinomas (p=0.036) and depth of invasion (p=0.049). In case of metastases, the levels of VEGF expression were higher in the primary tumor, without statistically significant differences (p>0.05). It were significant differences of intratumoral VEGF expression depending on CD105+ MVD values (p=0.019), but not with α-SMA+ MVD (p>0.05). Angiogenesis evaluated through the VEGF and MVD (CD105+ and α-SMA+) expression is correlated with the progression and metastasis of gastric cancer and could be considered a prognostic marker of these tumors.

In this study, we aimed to determine EGF, c-erbB-2 and EGFR expression in 25 specimens of intestinal gastric adenocarcinomas by standardized immunohistochemistry and to establish correlations with the major clinico-morphological parameters of these patients. We observed EGF reactivity in 22 (88%) cases, a c-erbB-2 protein expression in eight (32%) cases and an EGFR reactivity in 13 (46.42%) cases. The EGF expression was significantly correlated with the tumor degree of differentiation, but not with other investigated clinico-morphological parameters and nor with c-erbB-2 and EGFR1 expression. However, we noticed the existence of a dependence between c-erbB-2 and EGFR1 expression in the main tumor mass. Such immunoprofile suggests the possible intervention of autocrine and paracrine loops in the developing of intestinal variant of gastric adenocarcinomas.

Invasive lobular carcinoma (ILC) is the second most common type of invasive breast cancer, having distinct morphologically but also prognostic and therapeutic features. This type of breast cancer shows a higher rate of multiple metastases with a more frequent axillary-lymph-node involvement. Related to these dissemination and metastatic features, we aimed to study the immunohistochemical expression of D2-40, VEGF-C and VEGFR-3 in 25 cases of ILCs stratified according to the histopathological and molecular classification. Regardless of histopathological or molecular subtype, the statistical tests proved that for ILC, the highest D2-40 lymphatic microvessels density (LMVD) was in the peritumoral areas. In classical subtype, the LMVD values were positively correlated with the degree of tumor differentiation and pTNM clinical stages and when these cases were classified based on the molecular criteria the highest recorded values were found in the luminal B subtype. In addition, regardless of the histopathological and molecular subtypes, the D2-40 LMVD varied in the same direction for both VEGF-C and VEGFR-3 categories, with the highest LMVD values recorded in those cases with the highest VEGF-C and VEGFR-3 reactivity, especially in the peritumoral areas. Considering only the molecular luminal A and B subtypes, we have noted that VEGF-C and VEGFR-3 expression was significantly higher in luminal A subtype compared to luminal B. This immunoprofile suggests the existence of a tumor type-specific lymphangiogenesis that may have certain prognostic and therapeutic implications.

Plasma cell leukemia (PCL) is a rare disease and is the least common variant of multiple myeloma accounting for 2-3% of all plasma cell dyscrasias. We report a patient who was diagnosed with multiple myeloma, 12 months earlier; he was treated with VBCMP, VCMP regime, and after 12 months he presented of high grade fever, weakness, palpitations, loss of appetite, bone pains, dyspnea. Initial evaluation revealed plasmacytosis with blood plasma cell count of 13 860/mm³. His hemoglobin (Hb) was 8.4 mg/dL, platelets were 45 000/mm³ and total leukocyte count (TLC) was 23 100/mm³ (60% plasma cells). Bone marrow examination revealed 90% plasmablastic cells. Serum LDH was high at 3117 U/L and serum calcium was also elevated at 9.1 mg/dL. A diagnosis of PCL was made and the patient was started on treatment with VAD regime along with supportive care. Patient condition deteriorated very quickly, despite treatment and he died on the third day. A detailed report of this case and a review of PCL is presented here.

Besides lesions considered to be premalignant (such as erythroplasia, Bowen disease), a number of other potentially malignant lesions with higher or lower degree of epithelial dysplasia depending on the keratinization degree or determined by the action of carcinogens and irritants substances are described in the oral mucosa. Although they are practically considered the most harmless formations located on the oral mucosa, papillomas and condylomas are also the most frequent. In this study (conducted on a total of 38 cases with benign neoplasia) we planned a histopathological evaluation of surgical excision samples obtained from interventions on lingual neoplasias and harvested from the areas most exposed to chronic trauma or the areas in direct contact with mechanical irritants, in order to determine the histopathological pattern of the different types of histopathological lesions, the possible presence of keratosis-type changes or even possible dysplasias.

Introduction: Imagistic examinations have an essential role in the assessment of gastric cancer both in earlier and advanced stages. Among these, endoscopic ultrasound (EUS) especially contributes to the diagnosis by direct visualization of the tumor and to the staging and prognosis assessment through the evaluation of the gastric wall and regional lymph nodes. Computer tomography (CT) examination also has an important role, especially in advanced stages, in the assessment of the prognosis, contributing to TNM staging. The aim of this study is a comparative assessment of tumor invasion degree by these two imagistic methods and the correlation of the imagistic diagnosis with histopathologic assessment results on surgical specimens., Materials and Methods: The basis of the study was represented by a group of 38 patients with gastric carcinoma investigated both by endoscopic ultrasound and computer tomography from which 15 cases with surgical excision of the tumor followed by microscopic examination were selected. Studied material was represented by: patients' medical charts, registers for ultrasound endoscopy and CT investigation, endoscopic and CT images, surgical excision samples and pathology reports. Tumor fragments were processed by classical histological techniques (fixation and paraffin wax embedding) and staining (HE)., Results: Comparing the CT examination with ultrasound endoscopy results showed that CT examination overestimated the invasion grade of the gastric wall (T) but accurately defined the grade of lymph node invasion (N) and metastases (M). Comparing the results of ultrasound endoscopic examination with those from histopathological examination showed that the first method underestimated the grade of invasion of the gastric wall (T) while the latter correctly defined the grade of lymph node invasion (N) and metastases (M). Comparing CT examination results with histopathological ones showed that CT overestimated both the grade of invasion of the gastric wall (T), lymph node invasion (N) and metastases (M)., Conclusions: In the preoperative assessment of the invasion stage of gastric carcinoma (TNM), ultrasound endoscopy is the elective imagistic investigation for predicting the grade of invasion of the gastric wall while CT examination is a more accurate assessment of lymph node extension and metastases, the precise definition of invasion stage being only the result of histopathological examination on surgical specimens.

Intraductal papillary mucinous tumors (IPMTs) are benign and malignant lesions that arise from the epithelial lining of main pancreatic duct and/or branch pancreatic ducts, with excessive mucin production (especially hyperplastic/adenomatous variety). Based on the degree of cytoarchitectural atypia on microscopic examination, IPMTs are classified as benign, borderline, carcinoma in situ and invasive tumors. Imaging examinations are very important to establish the diagnosis. Two or more tests are usually required. Transabdominal ultrasound, endoscopic ultrasound, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangio-pancreatography have been used for the diagnosis of IPMTs. The correct diagnosis, achieved until recently only with endoscopic retrograde cholangiopancreatography, can be currently obtained with non-invasive imaging modalities, particularly computed tomography and magnetic resonance imaging. Confirmation of the diagnosis requires, however, endoscopic-ultrasound fine-needle aspiration biopsy, followed by cytological or microhistological exams. The natural evolution of IPMTs is still not clear and the management is consequently still evolving.

Although a series of premalignant or potentially malignant lesions are described in the tongue, there are many other lesions whose potential of degeneration can be determined by a prolonged action of irritant or carcinogenic factors. Even if they are practically considered to be harmless, benign formations of mesenchymal origin with lingual location represent in the same time a neoplastic lesion under the influence of local and general factors, for a variable period of time. When these structures are located in major risk areas from the oral cavity and in particular, those directly related to the tongue, special attention should be paid to their development. In this study (conducted on a total of 16 cases of benign mesenchymal malignancies), we planned a histopathological evaluation of surgical excision samples obtained from interventions on lingual neoplasias, and harvested from areas with the highest risk for lingual cancer development (pelvilingual groove, the base of the tongue and the insertion of the anterior pillar) in order to assess the histopathological aspects in different types of lesions and the possible presence of degenerative changes.

The subungual exostosis is a benign bone tumor on the distal phalanx of a digit, beneath or adjacent to the nail, often bringing in discussion many differential diagnosis. We present a 14-year-old boy with a cutaneous nodular lesion, painful to the easy touch on the latero-internal half of the nail of right big toe with extension in the cutaneous part of this. He suffered many treatments, especially cauterization, but with recurrence. In the present, the radiological findings of the affected finger and the histopathological ones from the fragment excised confirmed the diagnosis of subungual exostosis. The local excision of the entire region with the removal of the cartilaginous cap has been followed by a silent period without recurrences of almost two years when he as revised.

Tuberous sclerosis complex (TSC) is a multisystem syndrome characterized by neurological symptoms and tumors in multiple organs including kidney, brain, skin, eyes, heart and lung. Kidney and brain are the two most frequently affected organs in TSC. TSC is an autosomal disorder with extensive clinical variability. We described TSC in a family at a mother and her daughter. We emphasized the importance of Computed Tomography in the discovery of some asymptomatic organic involvement as bilateral renal angiolipoma in the mother.

Branchial cleft anomalies are developmental disorders of the neck. The aim of this study was to evaluate the data of our patients, who have been diagnosed and treated for second branchial abnormalities in the last six years. We report our clinical experience in second branchial anomalies with a review of the literature. Our study is a retrospective one on a number of 23 patients hospitalized within 2001-2007 in ENT Clinic of Craiova for second branchial abnormalities in relation with age, gender, origin environment, clinical and paraclinical context in which the therapeutic decision was made, surgical procedures, post-surgical evolution. Among the anomalies of the second branchial arch, we encountered 10 (43.47%) patients with branchial cyst and 13 (56.52%) patients with branchial sinus. Twelve (52.17%) of the 23 patients were women and 11 (47.83%) were men; 9 (39.13%) patients were diagnosed and treated within the first age decade, seven (30.43%) within the second age decade, five (39.13%) within the third age decade and two (8.71%) in the fourth age decade. Histological examination of the lesions after excision established the diagnosis in all the cases. Second branchial arches anomalies are the most common branchial anomalies. Sinuses are more frequently than cysts and branchial fistulae are extremely rare. There is no gender predilection. The majority of patients (approximately 70%) were diagnosed and treated during their childhood. Treatment for these lesions is complete surgical excision for prevent recurrences.

Neurofibromatosis type 1 (NF1), also called von Recklinghausen disease or peripheral neurofibromatosis, is a common autosomal dominant disorder characterized by multiple neurofibromas, "café au lait" spots and Lisch nodules of the iris with a variable clinical expression. Osseous anomalies appeared in the patients with NF1 including dysplasia, scoliosis and pseudoarthrosis. We propose a research of the osseous involvement at 11 patients, seven female and four male with ages from 9 to 60 at which the cutaneous aspect has the complete form, hyperpigmented spots and cutaneous neurofibromas and only more than six "café au lait" spots. All the patients suffered radiological exams, CT- and MRI-scan. The results were different from case to case from the extreme severe deformations, especially at the children, to clinical unapparent osseous involvement, incidental found or with occasion of our investigation. CONCLUSIONS. The patients with NF1 has osseous abnormalities specific of the disease, like dysplasia, scoliosis, pseudoarthrosis, often gentle but sometimes extremely severe. The most severe osseous involvement are presented in the cases when these development early in the childhood. Other times the osseous abnormalities are clinical asymptomatic, their finding been clinical incidental. We want to have a separate mention for the maxillary and mandible involvement, which according to our information is not a rare form.

Unlabelled: Sturge-Weber syndrome is a rare disorder consisting of a port-wine nevus in the distribution of the ophthalmic branch of the trigeminal nerve and central nervous system malformations. Facial cutaneous vascular malformation, seizures, and glaucoma are among the most common symptoms and signs. The syndrome results from malformation of the cerebral vasculature located within the pia mater, most commonly over the occipital region. These malformations led to venous hypertension and subsequent hypoperfusion on the underlying cortex, causing chronic cerebral ischemia, atrophy, calcification and neurological deterioration. We describe 18-years-old young girl hospitalized for upper digestive hemorrhage that revealed a cavernomatous transformation of portal vein. At the same time, she presents extensive congenital, bilateral port wine stains on the face, epilepsy and glaucoma of the right eye. Computer tomography showed intracranial vascular abnormalities with calcifications, particularly in the right occipital lobe. The clinical presentation and imagistic assessment confirmed the diagnosis of Sturge-Weber syndrome associated with upper non-cirrhotic portal hypertension generated by a malformation of portal vein., Conclusions: Upper digestive hemorrhage is a quite rare eventuality in the Sturge-Webber syndrome. Moreover, portal tract malformations with cavernomatous transformation are exceptionally cited in the literature. Despite this rare association, abdominal investigation, as well as computed cranial tomography should be performed in all cases of children that present a facial cutaneous vascular malformation.

Sarcomas are relatively uncommon tumors, accounting for 1% of all malignancies. Sarcomas are commonly classified according to their site of origin: soft tissues or bone. The purpose of the clinic study was to focus the symptoms and the clinic signs. The radio-imaging study is essential in the evaluation of the maxilla tumors. The histopathologic study was done to determine the histological type, the differentiation level, the invasion level as well as the presence or absence of the metastases in drainage ganglia. The correlation of the findings of this study leads to a clear and correct clinic diagnosis, an adequate local or general therapy and a prognostic. The diagnostic role of imaging is essential and often permits the orientation to benignity or, on the contrary, requires biopsy if the image is an aggressive one or of uncertain nature. Advances in diagnostic imaging have contributed substantially to the management of tumors. The strong collaboration among the physician, imaging personnel and anatomo-pathologist serves the patient's benefit.