Myositis ossificans - A case report and review of literature

Associated with abnormal bone formation with various localizations, myositis ossificans is both a diagnostic and a therapeutic challenge due to its rare occurrence and clinical presentation. We examined a case of a 14 year old male patient who was diagnosed with the clinical suspicion of myositis ossficans. Contrast substance MRI revealed the presence of a strictly intramuscular mass located in the 1/3 proximal area of the left thigh, at the level of the vastus lateralis muscle. Macroscopic examination of the specimens revealed multiple, irregular tissue fragments, forming a mass of about 5,5/6/1,2 cm. Additional immunohistochemical analysis was made using the following panel of markers: SMA, Vimentin, Desmin, protein S100, NSE and GFAP. Vimentin was intensely positive in osteoblasts, partially in osteocytes, in the stromal fibroblasts/ fibrocytes, in adipocytes and in the vascular wall, in endothelial and smooth muscle cells. GFAP and NSE were negative

HETEROGENEITY OF C ERB B FAMILY MEMBERS EXPRESSION IS RELATED TO CELL MORPHOLOGY AND IMMUNOPROFILE IN PITUITARY ADENOMAS

Purpose. Epidermal growth factor receptor (EGFR, HER1) and human epidermal receptor 2 (HER2) assessement in pituitary adenomas related to hormone profile. Design and methods. For 60 retrospective cases of pituitary adenomas, we established the histopathologic diagnosis by using morphological stains, followed by case selection for immunoprofile and EGFR and HER 2 assessement. Results. More than one third of the studied pituitary adenomas (33,33%) were positive for HER2, with membranar pattern in basophilic cells and with predominantly cytoplasmic, granular pattern for acidophils cells. HER2 immuno-expression characterized PRL secreting adenomas (p=0.005) and associations between FSH-LH (p< 0.001) TSH-FSH (p=0,024) and TSH-LH (p=0.028). In situ hybridization confirmed HER2 gene amplification in 33,34% out of all positive cases for HER2 by immunohistochemistry. EGFR positivity was found significantly for GH-prolactin (p=0.000) and prolactin-ACTH (p=0.045) co-expressing pituitary adenomas, peritumoral macrophages and folliculostellate cells. Conclusions. Differential HER2 and EGFR expression related to hormone profile heterogeneity can define different subclasses of pituitary adenomas and could explain clinical, prognostic and therapeutic heterogeneity which are observed in clinical practice. Our results support re-classification of pituitary adenomas based on molecular approach which should include markers with well certified prognostic and therapeutic impact

Morphologic changes in the injured anterior cruciate ligament (ACL) correlated with the expressions of protein S100 and NFAP: major therapeutic implications or a false gateway towards improving ACL reconstruction?

OBJECTIVES AND BACKGROUND To examine the morphological features of the anterior cruciate ligament (ACL) stumps following injury and to assess their correlation with protein S100 and neurofilament associated protein (NFAP). MATERIALS AND METHODS We selected a total number of 102 cases of ruptured ACLs. 56 cases out of the total number of cases were immunohiatochemically assessed for protein S100 and 46 cases out of the total number of cases were immunohiatochememically assessed for NFAP. RESULTS Both markers were identified in the synovial tissue, in the quasi-normal ligament and in the disrupted ligament. Protein S100 was positive in the nervous structures of the synovial and ligament tissues. NFAP expression was predominantly found in the free nerve endings and small nervous fibers of the synovial tissue and ligament tissue. A greater number of NFAP positive free nerve endings were detected in the quasi-normal ligament. CONCLUSIONS Ruptured ACL specimens do not present an arbitrary persistence of nervous fibers in the remnant stumps and may not ensure a successful recovery of the patient following ACL reconstruction procedures in all clinical cases. Figure 1. NFAP expression in the synovial tissue, in the quasi-normal ligament and the disrupted ligament. Note the presence of small positive nervous structures (a) and the presence of large nervous fibers showing a midlow, focal reaction, restricted to the cytoplasm of a few Schwann cells (b). REFERENCES 1. Anderson MJ, Browining WM 3rd, Urband CE, Kluczynski MA, Bisson LJ. A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament. Orthop J Sports Med. 2016;4:2325967116634074, doi: 10. 1177. 2. Sanders JO, Brown GA, Murray J, Pezold R, Savarino KS. Treatment of anterior cruciate ligament injuries. J Am Acad Orthop Surg. 2016; Epub ahead of print. 3. Hsia AW, Anderson MJ, Heffner MA, Lagmay EP, Zavodovskaya R, Christiansen BA. Osteophyte formation after ACL rupture in mice is associated with joint restabilization and loss of range motion. J Orthop Res. 2016;doi: 10. 1002

Cerebellum developmental challenges: From morphology to molecular issues

Introduction: It is known that, throughout the development of the nervous system, the cellular migratory routes are an important part of its expansion; therefore, the cerebellum is ‘sprinkled’ with cellular changes during its growth. The aim of this study was to analyse the morphological features of the cerebellum cells in all the layers, during its development. Material and methods: We examined 14 cases of human cerebellum, ranging between 1 to 12 months by histopathology and immunohistochemistry. Results: Haematoxylin and eosin staining method confirmed the age-linked migration of the cells from the external granular layer into the internal granular layer. Moreover, immunohistochemical evaluation using PROX1 and NFAP showed positivity for the Purkinje cells. However, these cells exposed negativity on NSE stained specimens. On the other hand, the transience of the EGL was analyzed using OCT3/4, which showed the migration of the EGL cells through the molecular layer to the IGL. Also, GFAP and NFAP proved to be a useful tool for the identification of the climbing fibres and the variation of their density connected the age of the patient. Conclusions: The human cerebellum undergoes different morphological and molecular changes throughout its evolution during embryogenesis. The markers used in our study have proved to present a differential, stage-dependant reactivity and appeared as useful tools for the identification of different cerebellar structures. Our study is a challenging attempt to understand the basics of cerebellar development at a morphological and molecular level and may bring new perspectives for a better approach of cerebellar associated pathologies

Morphologic changes in the injured anterior cruciate ligament (ACL) correlated with the expressions of protein S100 AND NFAP: Major therapeutic implications or a wrong gateway towards improving ACL reconstruction ?

Objectives: We examined the histoarchitecture of the anterior cruciate ligament [ACL] stumps in different stages of evolution after injury and we analyzed the correlation with the expressions of protein S100 and neurofilament associated protein [NFAP]. Materials and Methods: A total number of 102 cases of ruptured ACL was included in our study. Immunohistochemistry was performed for protein S100 [56 cases] and NFAP [46 cases] in order to evaluate the nervous structures located in the ligament and in the synovial tissue. Results: Protein S100 and NFAP were identified in the quasi-normal ligament, in the disrupted ligament and in the synovial tissue. Protein S100 was positive in the nervous structures of the synovial tissue. The nervous fibers from the ligament also reacted to protein S100. The synovial tissue reacted to NFAP at the level of the small nervous fibers and free nerve endings. In the ligament, NFAP expression was predominantly found in the small nervous fibers and in the free nerve endings. The quasi-normal ligament showed a greater number of NFAP positive free nerve endings. Conclusions: We found significant differences between the quasi-normal and the disrupted ligament regarding the expressions of protein S100 and NFAP. The low number of nervous structures identified using the two markers may suggest a time- and injury-dependent loss of nervous fibers following post-rupture ligament remodeling. The persistence of nervous fibers in the remnant stumps of the ruptured ACL is not ‘absolute’ and may not always ensure a successful recovery of the patient after ACL reconstructio

Heterogeneity of Blood Vessels and Assessment of Microvessel Density-MVD in Gingivitis

Gingivitis is a very common oral disease highly prevalent in adults that, if left untreated, can progress to periodontitis. It involves a complex and slow interaction between the host response and the oral microbiome represented by the dental plaque. The inflammation of the gingiva is associated with the activation of pathological angiogenesis and the existence of a high number of newly formed blood vessels quantified as microvessel density (MVD). The present study includes a number of 51 gingival biopsies from patients with different gingival indexes (GI): GI = 0, n = 12; GI = 1, n = 15; GI = 2, n = 16; and GI = 3, n = 8, processed and stained with the routine hematoxylin–eosin method. The inflammatory infiltrate was scored, the blood vessels were detected with anti-CD34 antibody, and MVD was determined. Inflammatory changes were observed in 39 of the 51 cases included in our study. CD34 + vessels with normal morphological appearance were observed in all 12 cases of health gingiva. In cases of inflammatory lesions, the morphology of the blood vessels showed changes with the evolution of gingival lesions. In severe inflammation, a particular aspect was observed in the vessels, such as the presence of the phenomenon of intussusception. MVD increases with the severity of gingival lesions, with the highest density being observed in severe inflammation