Homage to Dimitar Kadanoff - The Grand Teacher in Bulgarian Anatomy

Academician Dimitar Dimitrov Kadanoff is the first academician of the Bulgarian Academy of Sciences (BAS) in the field of Anatomy and founder of the Antropologic section of the Morphologic institute of BAS. Kadanoff is widely considered the most influential figure in Bulgarian Anatomy and the `Grand Teacher`. He remains one of the most highly respected Bulgarian scientists on an international level, with a total of 91 articles referenced in PubMed to his name, which are still highly cited

Demographic, clinical and morphological profile of malignant cutaneous melanoma in a Northeastern region of Bulgaria

IntroductionMelanoma is a malignant tumor with an unfavorable prognosis and an increasing incidence worldwide, with the most significant and the most common type being cutaneous melanoma. The epidemiological characteristics of cutaneous melanoma in Bulgaria are presented with low morbidity, moderate growth rate, and relatively low mortality, but with a rapid rate of increase in both sexes.AimThe aim of this study was to establish the clinical and morphological features of cutaneous melanoma in the Dobrich district and compare them to the European trends.Materials and MethodsA retrospective non-clinical approach was used in the selection of patients. The study included patients with histologically proven skin melanoma in the period 2016–2019. Data on patient sex, age at diagnosis, tumor location, and clinical stage of the disease were collected according to Clark and Breslow criteria.ResultsThe collected data show that the cutaneous melanoma in Dobrich district has a profile different from the average European one—all age groups are affected, except for 11- to 20-year-olds, and most cases occur in the age group of 61- to 70-year-olds, with an average age of diagnosis 59.82 years. In regard to sex distribution, men are more common, and the most common localization is the lower limbs. Morphological features show an advanced nature of the disease with a diagnosis in the late clinical stages.ConclusionOur data show that the gender distribution of cases corresponds to the European average, but the age and clinical stage of the disease are significantly more advanced, indicating a delayed diagnosis and emphasizing the need to develop a campaign for the prevention and early diagnosis

Wearable video documentation devices in anatomic pathology autopsies

IntroductionIn the past decade, many wearable devices for video documentation have been released on the free market. However, they have seldom been implemented into autopsy practice.AimThis research aimed to compare several different types of video recording devices and compare their feasibility, both in regards to their form factor and video quality, in everyday autopsy practice.Materials and MethodsFive separate wearable devices for video documentation devices were used in the standard autopsy practice of a single pathologist – two box-style sports cameras - Kitvision Escape KVESCAPE4KW (Kondor, Hapton, Lancashire, England) and GoPro Hero 7 Silver (San Mateo, California, USA), a pair of camera glasses – NCS0002 (Spardar Smart Technology Co., Ltd., Shenzhen, China), a pair of smart glasses – Cloud-I II (Topsky Digital Technology Co., Ltd., Shenzhen, China), and Google Glass – XE V2 (Google LLC, Mountain View, California, USA). The five devices were compared both for their pros and cons and for their feasibility in autopsy and educational practice.ResultsOnly the box-style sports cameras and Google Glass provided sufficient video resolution on the initial test to be considered efficient aids. A total of sixty-five full autopsies were documented, using the box-style sports cameras and Google Glass, with ten autopsies being recorded simultaneously with the two devices. Flaws present in both types of recording devices were in their relatively short battery life and the limitation of data that could be stored.ConclusionVideo documentation of autopsies using new generation wearable devices is a feasible option for both individual autopsy cases and educational purposes of both students and young pathologists. The different designs are susceptible to individual preferences, however, box-style sports cameras seem to be best suited for autopsy practices

Cytokeratin AE1/AE3 mimicry in glioblastoma

INTRODUCTION: The diagnosis and treatment of intracranial tumors requires a multidisciplinary approach. A key moment in this process is the pathological verification of the tumor type. This process, although aided by immunohistochemistry (IHC), can often be difficult and misleading.MATERIALS AND METHODS: Ten histologically confirmed cases of glioblastoma multiforme (GBM) were reviewed for their IHC reaction with the anti-glial fibrillary acidic protein (GFAP) glial marker and the CK AE1/AE3 antibody cocktail, whose main use in neuropathology is to either prove or rule out metastatic cancer of epithelial origin, the primary location of which may not be known or even suspected.RESULTS: All ten pathologically verified cases of GBM were diagnostically positive for GFAP, with eight of them also revealing CK AE1/AE3 expression with variable intensity. Out of the CK AE1/AE3 positive cases, five (50% in total) gave a low to intermediate non-diagnostic positive reaction, while the other three cases (30% in total) gave a strong positive reaction with possible diagnostic value. Cells, across all GBM cases, that tested positive for CK AE1/AE3, regardless of the strength of the reaction, were also positive for GFAP on neighboring IHC serial slides.CONCLUSION: The presented results reveal CK AE1/AE3 expression in a great portion of GBM cases, which may be caused by three-dimensional mimicry between the CK AE1/AE3 and GFAP target molecules. This therefore necessitates the need for a careful interpretation of the results. CK AE1/AE3, however, remains a useful tool in neuropathology, regardless of the possibility of false positivity in GBM cells

Esophageal neoplasms - single institution report

Introduction:Esophageal malignancies are a diverse group of neoplastic processes. The different entries that contribute to the group have a very wide margin of incidence across different populations, attributed to the presence of different predisposing factors. The aim of this study was to establish the statistical prevalence of histologically verified esophageal neoplasms in a single medical institution.Materials and Methods:All histologically confirmed cases of malignancies isolated from the esophagus, for a period of three-and-a-half-years registered in the St. Marina University Hospital, Varna, Bulgaria, were retrieved from the pathological archive and their incidence compared in a descriptive statistical manner. The cases were further classified based on the age and gender of the patients.Results:For the set time period, 33 cases of esophageal malignancies were registered. From these cases 66.67% (n=22) were diagnosed as squamous cell carcinoma of the esophagus (SCCE), 30.30% (n=10) as adenocarcinoma of the esophagus (ACE) and 3.03% (n=1) as a non-Hodgkin`s B MALT lymphoma diagnoses in an 84-year-old male patient. The mean age of diagnosis of patients with SCCE (n=22) was 59.45 years of age, with a standard deviation of ±11.05 years, while the mean age of diagnosis of patients with ACE (n=10) was 70.40 years of age, with a standard deviation of ±14.83 years.Conclusion:The results show clear statistical difference in the mean age of diagnosis. The male-to-female ratio of all cases is comparable to that of the global population, while the statistical segregation between entries shows a tendency towards the developed countries

The great imitator - EMA positive glioblastoma multiforme

INTRODUCTION: Glioblastoma multiforme (GBM) has always been a diagnostic challenge for pathologists. As a rare oncological entry with astrocytic differentiation, it can manifest itself in a variety of histomorphological forms, mimic other tumors and it often has varying immunohistochemical (IHC) profiles, further challenging the process of its verification.MATERIALS AND METHODS: Four pathologically verified cases of GBM, registered at the St. Marina University Hospital, Varna, Bulgaria were retrieved from the central pathological archive. The cases were tested and reviewed based on their hematoxylin and eosin (H&E) profiles and IHC reactions with GFAP used as a glial differentiation marker, Vimentin - as a positive IHC control and EMA, an epithelial marker, non-reactive in healthy brain tissue.RESULTS: As expected all GBM cases had the histomorphological hallmarks of the tumor on the H&E stain. They were diagnostically positive for GFAP and had a strong positive IHC reaction with Vimentin. Three out of the four cases also revealed a varying in intensity reaction with EMA, with one case having a weak reaction in individual cells that could not be considered diagnostic and the other two cases having a diffuse positive reaction in most of the tumor cells.CONCLUSION: In the age of immunohistochemistry, GBM continues to expand the set of IHC markers that react with it, although several of them such as Cytokeratin AE1/AE3 and EMA, as demonstrated in this study, should be non-reacting as they react with proteins normally present only in epithelial cells and absent in healthy brain tissue. This can often be misleading and, in certain cases, lead to histopathological misdiagnosis

Clinical, morphological and differential diagnosis chartecteristics of atypical melanocytic nevi

Dysplastic nevi are a group that is histologically characterized by architectural and cytological atypia and are considered as an intermediate group of pigmented lesions between normal and malignant melanoma. Like all other pigmented neoplasms, they are the result of exposure to genetic and phenotypic factors, solar hypersensitivity and chronic ultraviolet exposure. Clinically, dysplastic nevi are larger than the common ones, larger than 6 mm, asymmetrical, with a slightly uneven surface and uneven borders, poorly demarcated from the surrounding skin and usually with bicolored areas. These are difficult to diagnose melanocyte lesions, and the histological criteria determining their belonging to this group include the presence of architectural disorders, cytological atypia and manifestations of an immune response by the macroorganism. Architecturally, they manifest with a lentiginous type of melanocyte proliferation in which melanocytes are distributed at the border with the basal layer of the elongated, rounded apical and hyperpigmented epidermal ridges. Cell proliferation at the tips of the epidermal ridges displaces basal keratinocytes and coalesces with the formation of bridge structures around the dermal papillae. Their cytological characteristics include different variations. In nevi with a dominant lentiginous architectural appearance, basal melanocytes with cytoplasmic retraction are often observed. Small, rounded nevus cells, elongated cells with varying pigmentation, and epithelioid cell types were observed in nest-dominated forms of the atypical nevus. Beyond these cell types, the appearance of cytological atypism in intraepidermal melanocytes is a major criterion for diagnosing nevi as atypical. The cells have a varying degree of nuclear atypism, involving no more than 5% of all cells. Based on the criteria, atypism is divided into three degrees - mild, moderate, and severe. The International Melanoma Pathology Group recommends dysplasia to be classified into two groups only – low- and high-grade

Pleomorphic adenoma of the palpebra: a histopathological case report

Pleomorphic adenoma (PA) is a benign glandular tumor, originating most commonly from the parotid gland. Other rare locations for PA are the breast, lung, lacrimal glands, etc. PA originating from other exocrine glands such as the glands of Moll in the palpebra are extremely rare. Herein we report a case report of a 66-year-old female patient with such PA, excised due to vision impediment, with a discussion on the histological aspects and diagnostic and management approaches of PA in this rare location

Video documentation in pathology autopsy practice - advantages and disadvantages

Autopsies are among the best-defined medical procedures with minimal institutional differences and personalization. Methodologies for a pathological anatomy autopsy are defined in well-established manuals that have not been re-published for decades in some countries, are sold out, and can hardly be found by trainees. Over the last decade, many portable video recorders have become widely available on the free market. The records allow for correct instructions for learning from the practice of novice pathologists, and the audio parameters can be an aid in the formation of the final protocol, especially the organ parameters and their macroscopic changes. Both medical students and young pathologists can study the technique of autopsy from videos, which proves them a good educational tool. While local laws are very different and in some cases do not recognize video documentation as evidence, in some regions such records can still be used in medical matters as evidence. In such cases, video evidence would be much more preferred than photographs that can easily be speculated upon. The contribution to the completion of the pathologist's report by the certifying officer is also beyond doubt because of the possibility of monitoring and documenting the overall macroscopic picture and recognizing changes unnoticed by the specialist during the autopsy. Video documentation of autopsies with new portable devices increases the diagnostic ability of the autopsy, serves the educational purposes both in the training of students and young pathologists and last but not least, can be used in the discussion of difficult cases of interdisciplinary forums with an increase in the confidence in the pathological conclusion

Autopsy practice in patients with morbid obesity

IntroductionObesity, as defined by the World Health Organization (WHO), is a body mass index (BMI) of 30 kg/m2 or more. Obesity itself is further categorized as class 1 - BMI of 30-34 kg/m2, class 2 - BMI of 35-40 kg/m2, and class 3 or extreme obesity is defined as a BMI greater than 40 kg/m2.Materials and MethodsFrom a total of 60 autopsies, 50 were adult autopsies and 10% (n=5) complied with the WHO criteria of extreme obesity, BMI above 40 kg/m2.ResultsThree of the patients were male and two - female. BMI varied from 45 to 97 kg/m2, with the most obese patient weighing 320 kg. Age varied from 38 to 53 years. Gross evaluation and histological changes revealed that all of the patients had hypertension and congestive heart failure with reverse type nutmeg liver and cyanosis of the spleen and kidneys, with one of the patients having pelvic and deep vein thrombosis.ConclusionAutopsies of patients with morbid obesity represent an extreme difficulty for the pathologist based on the inadequacy of the armamentarium for such patients, extreme physical workload, and the number of direct complications of obesity that need to be observed