Ontology-Based Search Procedure to Identify Tissue Samples in an Autopsy Archive: A Pilot Study

This study aimed to obtain a detailed record of all autopsy specimens analyzed in the Pathology Department of the Emergency Clinical Hospital for Children, Cluj-Napoca from 1974 to 2018, by using an ontology-based search procedure (OSP) intended to identify the paraffin-embedded stored specimens in pathology reports. Two thousand nine hundred and fifty-six autopsy reports were analyzed using a list of histology terms and expressions commonly found in the microscopic descriptions of the autopsy reports, in Romanian. One pathologist was asked to evaluate the microscopic descriptive part of the autopsy reports for 300 cases and to classify the identified histology specimens according to the ICD-topography codes. The results were then compared with the OSP results. The validation assay returned a 97.32% sensitivity and a 99.48% specificity of the applied ontology-based search procedure when taking as a reference the assessment performed by a pathologist. The most common specimens identified were in the categories of the lower respiratory system (lung, trachea), liver, biliary tract, pancreas and urinary system. The proposed ontology can link valuable information to a highly reliable pathology-based autopsy registry allowing researchers to gain access to specimens stored in the pathology archives, and to facilitate disease registration, data extraction and reporting. This procedure represents a good starting point for developing suitable solutions to be implemented in registries, data banks and for the development of ontology-based registration tools

BOALA KIKUCHI-FUJIMOTO – PROBLEME DIAGNOSTICE

Boala Kikuchi este o afecţiune rară, benignă şi autolimitată, de etiologie necunoscută, care ar trebui inclusă în algoritmul diagnostic al adenopatiei cervicale. Diagnosticul de certitudine este histopatologic, modifi cările specifi ce fi ind necroza paracorticală ganglionară, histiocitele cu nuclei în formă de semilună şi numeroşii corpi apoptotici. Se prezintă cazul unui pacient de 13 ani cu diagnosticul de boală Kikuchi, afecţiune rar descrisă la vârsta pediatrică

Cutaneous Sarcoid-Like Granulomas in a Child Known with Nijmegen Breakage Syndrome

Background: Nijmegen Breakage Syndrome(NBS) is a rare autosomal recessive disorder with specific clinical features, characteristic chromosomal breakage and combined imunodeficiency. Patients with this condition also associate growth retardation with microcephaly, predisposition to malignancy and specific skin manifestations. Case Presentation: Here we report a 3-year old girl known with NBS associated with cutaneous sarcoid-like lesions. She presented with one year history of squamous lesions on the face and upper and lower limbs. The lesions were biopsied and histopatological examination revealed nonnecrotizing epitheloid granulomas and raised the suspicion of a sarcoid-like entity. Conclusion: The interest of this case will serve to better understand clinical manifestations in a rare genetic entity. Close follow-up is advised as cutaneous granulomas may be the first manifestation of systemic granulomas

ATPIC ASPECT OF EWING SARCOMA - poster.pdf

Introduction: Bone sarcoma is a rare disease, with an incidence of approximately 8 cases per million/year. It occurs in all ages but has a characteristic bimodal distribution, with peak incidences for adolescents and elderly. Ewing Sarcoma (EWS) is a mesenchymal-derived tumor that generally arises in bone and soft tissue. Intensive research regarding the pathogenesis of EWS has been insufficient to pinpoint the early events of Ewing sarcomagenesis. Case presentation: An 11 year old male child was admitted to Children Hospital Cluj for evaluation. At the physical examination a poorly delimitated tumor in the anterolateral muscle lodge of the shin was found. Tumor was adherent to the fibular periosteum. Biopsy was taken from the lesion. Results: At macroscopic examination the tumor of 6/3/2cm had yellow color and strong elastic consistency. Histopathological examination reveals a malignant structure of the tumor with small and blue cells infiltrating the muscle and periosteum. Tumor cells are arranged in islands separated by a well-represented conjunctive vascular tissue. In patches islands have a compact aspect but there are also islands with intercellular spaces giving it an alveolar aspect .Cells that have a syncytial aspect. Focal ischemic necrosis and capillary vascular permeation images are seen. Margins of the tumor piece are positives. PAS stain was focally positive. Immunohistochemistry showed an intense and diffuse positive reaction for CD99, while DES and SMA remained negative on tumor cells. Also ACL was negative, while S100 stain showed some focal stains to isolated tumor cells. Conclusion: The histological aspect of the tumor using HE resembles with alveolar rhabdomyosarcoma but immunohistochemistry clearly proves that it is a neuroectodermal tumor type, like Ewing Sarcoma. For a better differential diagnosis between the two entities, Actin staining for nonspecific muscle staining and / or Myogenin would be required

Age-Related Changes of the Pineal Gland in Humans: A Digital Anatomo-Histological Morphometric Study on Autopsy Cases with Comparison to Predigital-Era Studies

Background and objectives: The pineal gland is a photoneuroendocrine organ in the midline of the brain, responsible primarily for melatonin synthesis. It is composed mainly of pinealocytes and glial tissue. This study examined human postmortem pineal glands to microscopically assess age-related changes using digital techniques, and offers a perspective on evolutionary tendencies compared to the past. Materials and Methods: A retrospective autopsy study has been performed on 72 pediatric and adult autopsy cases. The glands have been processed for histological analysis and immunohistochemical staining with glial fibrillary acidic protein (GFAP). Slides were assessed under polarized light and digitally scanned. Morphometric data were obtained using CaseViewer and ImageJ. Results: Thirty-three females and 39 males were included in the study, grouped under three age groups: 0–25, 46–65, and 66–96 years of age. The peak gland volume was found within the 46–65 age group, the overall mean volume was 519 mm3, the main architectural types were lobular and insular, and the mean percentage of pineal calcification was 15% of the gland, peaking within the 66–96 age group, with a predominantly globular shape. Glial cysts were found in 20.8% of cases. The intensity of GFAP stain was maximal in the pediatric age group, but the extent of glial tissue was much larger in elderly patients. Discussion: The degenerative process of the pineal gland can be quantified by measuring normal parenchyma, calcifications, glial tissue, and glial cysts. Morphometric differences have been observed and compared to a similar studies performed in the published literature. The current study, unfortunately, lacks a 26–45 age group. Digital techniques seemed to offer a more exact analysis, but returned similar results to studies performed over 40 years ago, therefore offering important information on evolutionary tendencies. Conclusions: Increase in glial tissue, calcifications, and glial cysts have a defining role as age-related changes in the pineal gland

Particular Morphological Features in the Diagnosis of Pediatric Helicobacter pylori Gastritis: A Morphometry-Based Study

Background: Current pediatric guidelines recommend the use of the Updated Sydney Classification for gastritis to assess histological changes caused by Helicobacter pylori (H. pylori) infection. The purpose of this study was to investigate the morphometric alterations of the antral mucosa in relation to pediatric H. pylori infection. Methods: A total of 65 cases were considered eligible. Apart from scoring the biopsies according to the recommendations, foveolar hyperplasia (FH) was assessed. The following measurements were performed on digital slides: total mucosal thickness, foveolar and glandular length, number of glandular cross sections per 40X field, glandular diameter, and distance between glands. Results: The thickness of the antral mucosa increased along with the bacterial density and the intensity of inflammation in H. pylori-infected children (p < 0.05). FH was significantly associated with the presence of H. pylori (p < 0.001) and also exhibited a greater length of the foveolar and glandular structures and an increased glandular diameter (p < 0.05), but without influencing the thickness of the mucosa. Conclusions: Our results reinforce the fact that FH is not only an important histologic characteristic of gastropathy, but is also a significant change observed in H. pylori infection in children and may be considered for reporting when evaluating pediatric gastric biopsies

Helicobacter pylori Gastritis in Children—The Link between Endoscopy and Histology

Background: The management of Helicobacter pylori (H. pylori) infection raises important challenges, still being the most common chronic infection worldwide in all age groups. In high-prevalence regions, paediatric patients need a specific focus, as the acquisition of the infection takes place in childhood. The objective of this study was to analyze the endoscopic and histopathologic changes of the gastric mucosa in H. pylori infected children. Material and Methods: A retrospective study was performed on consecutive paediatric patients, ranging from 0 to 18 years of age, who underwent an upper gastrointestinal endoscopy (UGE) for a period of 5 years, regardless of their symptomatology. Endoscopy reports and histological slides were reviewed and clinical, endoscopic, and histologic data were recorded. Results: A total of 248 patients were included in the study, 82 (33.06%) of them being H. pylori infected. There was no difference in age and symptoms between the infected and noninfected group. A significant association was found between the H. pylori infection and histopathological parameters such as acute and chronic inflammatory infiltrate. The bacterial load influences the intensity of inflammation (p < 0.001). The chronic inflammation was predominant, only 23.2% of the patients displayed acute inflammation (p < 0.0001). The topographic distribution of inflammation was dominated by pangastritis (p = 0.04) with 58.6% of the patients presenting similar degrees of inflammation both in the antrum and corpus. Conclusion: Endoscopic features such as nodularity of the antral mucosa (p < 0.05) along with histological findings as lymphoid follicles (p < 0.05) are suggestive of H. pylori infection. However, the concordance between the endoscopic and histological diagnosis is still far from perfect (Cohen’s k coefficient = 0.42), maintaining the need for an invasive approach in children

Comparative assessment of bone regeneration by histometry and a histological scoring system / Evaluarea comparativă a regenerării osoase utilizând histometria și un scor de vindecare histologică

Obiective: Scopul studiului de față a constat în evaluarea valorii scorului de vindecare histologică, comparativ cu histometria în monitorizarea vindecării osose la nivelul calotei. Material și metodă: Am realizat un studiu cazcontrol cu un lot control și unul de studiu. La un număr de 60 de șoareci CD1 incluși în lotul de studiu am indus chirurgical un defect osos la nivelul calotei și am realizat reconstrucția defectului utilizând grefe obținute prin inginerie tisulară. Ingineria tisulară a grefonului osos s-a realizat utilizând celule stem embrionare poziționate pe suport matriceal -corn caduc de cerb, iar ca inductor al diferențierii am utilizat mediu osteogenetic bazal și complex. La cei 30 de șoareci CD1 incluși în lotul control am indus chirurgical același defect osos la nivelul calotei, dar nu am realizat reconstrucția osoasă a acestuia. Procesul de regenerare osoasă a fost evaluat la 2 și respectiv la 4 luni utilizând scorul de vindecare și histometria. Rezultate: Scorul de vindecare histologică s-a corelat statistic semnificativ cu dimeniunea defectului obtinută la histometrie (p<0.001). Evaluarea parametrilor în baza cărora s-a stabilit scorul de vindecare histologică indică regenerarea cea mai avansată la subiecții din lotul de studiu sacrificați la 4 luni, la care s-a utilizat pentru ingineria grefonului osos celule stem embrionare, suport matriceal corn caduc de cerb și mediu osteogenetic complex ca inductor. Concluzii: scorul de vindecare histologică este o metoda valoroasă de cuantificare a procesului de regenerare osoasă. Relevanță clinică: Acest studiu demonstrează că scorul de vindecare histologică prezentat este un instrument util pentru clinician în procesul de evaluare a regenerării osoase

Atelo-collagen type I bovine bone substitute and membrane in guided bone regeneration: a series of clinical cases and histopathological assessments

Absorbable atelo-collagen type 1 represents a new approach for guided bone regeneration with several reported advantages such as: osteoblast attachment, proliferation, mineralization potential, absorption of growth factors and inhibition of bacterial pathogen colonization. The aim of this study was to assess the clinical, radiological (preoperative width, re-entry width, gain), Periotest measurements and histologic benefits of atelo-collagen-derived bovine bone grafts (ImploBone) in combination with an atelo-collagen type I barrier membrane (ImploSorb) for guided bone regeneration (GBR) of atrophic alveolar crest in thirteen patients. Eleven patients underwent simultaneous GBR with implant insertion, two had initial GBR procedure followed by implant placement after 6 months of healing. Ridge augmentation was performed using an atelo-collagen membrane (ImploSorb, Bioimplon, Germany) and a combination of 50% ABBM (ImploBone, granule size 0.5-1mm, BioImplon Germany) mixed with 50% autologous bone. It was found that simultaneous GBR with implant placement resulted in a 35% gain at bone defect level (preoperative width 5.03±1.25 mm, re-entry width 6.81±0.98 mm, gain 1.78±1.71 mm). Implant placement performed in a 2 stage surgery 6 months following GBR was linked with a 63.9% gain at bone defect level (preoperative width 3.79±1.10 mm, re-entry width 6.22±1.41 mm, gain 2.43±1.43 mm). The total gain in both groups was 41.9% utilizing these novel biomaterials (preoperative width 4.68±1.32 mm, re-entry width 6.65±1.12 mm, gain 1.96±1.64 mm). This case series study presents a protocol where GBR can be performed either simultaneously to implant placement or delayed with this innovative biomaterial to favor bone regrowth. Future randomized controlled clinical trials are needed to further validate the bonepromoting potential of atelo-collagen-based biomaterials for bone regeneration