Гемангиома печени в пренатальной диагностики: эхографические и патоморфологические особености

Secţia de Ultrasonografie în Obstetrică şi Perinatologie, Secţia Anatomie Patologică de profil, IMSP ICŞDOSMşiC, Centrul de Asistenţă Policlinico-Ambulatorie, or. BenderBackground. Hepatic hemangioma is a benign vascular neoplasm, reported in 2-4% [5] of adult population with a frequency range from necropsies within 1 to 7% cases [8, 11]. It is diagnosed incidentally in most pediatric cases. This fact served as an argument to publish this case report of primary diagnosis in prenatal period. Material and methods. In this article we present a pregnant 34 years woman with preterm delivery at 36 weeks of gestation. The ultrasound investigation was performed at 34-35 weeks of gestation and was found the presence of massive hepatic hemangioma in right lobe. The newborn died in the fi rst 5 hours of life. The postmortem morphopathological examine elucidated macro - and microscopic features of the tumor. Case report. The peculiarity of this case is the early diagnosis of intrauterine fetal hepatic cavernous hemangioma within 34-35 weeks of gestation. We present the ultrasonographic aspects of hemangioma in the perinatal period. Are very interesting the correlation data of ultrasound and histological features of hemangioma localized in the right hepatic lobe, emphasizing structural aspects and differentiation of tumors, vascular systems and of umbilical vein vessels in the fetus and new-born. Macroscopic and microscopic features are refl ected in giant hepatic hemangioma that occupies 95% of the right hepatic lobe. The peculiarities of placental circulation and the principles of diagnosis are elucidated. We give principles of evolution and treatment and some advises in case of congenital infections associations in patients with this pathology. The international studies results in diagnosis and treatment of patients with hepatic hemangioma are described in this work. Conclusion. Giant liver hemangioma in the fetus and neonate is a malformative benign vascular-tumor with intrauterine evolution of cardiovascular failure of diverse degree. The association of intrauterine or postnatal infection can lead to intratumoral hemodynamic, relatively frequent thrombosis, calcinosis or diverse bleeding that will worsen the postnatal newborn condition, with a possible death.Актуальность. Гемангиома печени это доброкачественная сосудистая неоплазия встречающиеся у 2-4% взрослого населения [5], частота по данным аутопсии составляет до 1% - 7% случаев [8, 11]. У детей чаще всего диагностируются случайно, а пренатальная диагностика еще реже, насчитывая единичные опублико- ванные случаи, что явилось объективным аргументом публикации данного случая с первичной диагностикой в пренатальном периоде. Материалы и методы. Материалом послужила медицинская документация случая с прижизненной прена- тальной диагностикой у беременной женщины в возрасте 34 лет при сроке гестации 34-35 недель гигантской гемангиомы печени у плода родившегося в 36 недель и умершего в течении первых 5 часов после рождения и результаты морфопатологического проведенного исследования Клинический случаи. Особенностью данного случая состоит в первичной диагностике гемангиомы печени внутриутробно у плода при беременности 34-35 недель. В статье приведены эхографические характеристики гемангиомы печени у плода. Приведены данные эхографического и патоморфологического сопоставления, акцен- тируя внимание на структурные особенности строения, дтференциальной диагностики, состояние сердечно- сосудистой системы и сосудов пупочной вены у плода и новорожденного. Приведены патоморфологические ма- кроскопические и микроскопические особенности гигантской гемангиомы печени с локализации в правой доли печени, занимающая 95% соответствующей доли. Освещены морфологические особенности плацентарного кро- вообращения и основные вопросы диагностики, течения, тактики ведения и лечения пациентов с данной патоло- гией. Приведены литературные данные освещающие результаты диагностики и лечения гемангиомы печени. Заключение. Гигантская кавернозная гемангиома печени у плодов и новорожденых является врожденной доброкачественной опухолевидной сосудистой аномалией развития, протекавшая в утробе с различной сте- пенью нарушения сердечно-сосудистого кровообращения При сочетании с инфекционной внутриутробной агрессией возможны гемодинамические нарушения в тканях самой опухоли, чаще всего с тромбоз аномальных сосудов, кальцинозом и кровоизлиянияниями различной степени осложняющие постнатальное состояние ново- рожденного и способствующие к летальному исходу

Сочетание синдрома амниотических тяжей с пентадой Кантрелла

IMSP, Institutul Mamei şi Copilului – Departamentul de Morfopatologie, USMF Nicolae Testemiţanu – Laboratorul MorfopatologicObjective of the study. A rare case of morphopathologic diagnosis associated with malformations - amniotic bands syndrome with Cantrell’s pentad, diagnosed in fetus after the abortion at 21 weeks of gestation - is presented. Material and methods. As material for morphopathologic examinations served as follows: pathological bulletin (No. 92), fetus and placental complex. Morphological examination was performed by morphometric, histologic examination of tissue samples from organs of fetus and placenta in accordance with accepted histological standards using methods of hematoxylin-eosin staining and by Van - Gieson. Results. As a result of the study performed there were identifi ed and described morfopatologicheskie signs in fetus of 2 combined rare congenital malformations, such as the syndrome of amniotic bands with classic Cantrell’s pentad and placental complex, which were regarded as blastopatiya with delayed clinical effect due to violation of morphogenesis of fetoplacental complex at pro-embryonic and embryonic periods in combination with the infl ammatory-infectious lesions of placenta and fetus. Conclusion. The presented case promotes awareness in obstetricians, in functional diagnostics physicians, morphopatologists with morfopatological changes of rarest congenital malformations of development and the possibility of their combination for early prenatal diagnosis, deciding on termination of early pregnancy and careful examination, both for genetic and persistent infection of parents to forecast the future pregnancies.Цель. Представляется редкий случай морфологической диагностики сочетанной врожденной аномалии развития – синдром амниотических тяжей с пентадой Кантрелла, диагностированный у плода после прерывания беременности в сроке 21 недели. Материал и методы. Материалом для морфологической диагностики послужило: направление (№ 92), плод и плацентарный комплекс. Морфологическое исследование проводилось методами морфометрии, гистологического исследования тканевых проб из органов плода и плаценты согласно принятых гистологических стандартов с использованием методов окраски гематоксилин-эозином и по Ван – Гизону. Результаты. В результате проведенного исследования были выявлены и описаны у плода морфопатологические признаки сочетающихся двух врожденных редких аномалий развития, такие как синдром амниотических тяжей с классической пентадой Кантрелла и плацентарного комплекса, которые были расценены как бластопатия с отсроченным киническим эффектом вследствие нарушения морфогенеза фето-плацентарного комплекса на проэмбриональном и эмбриональном периодах в сочетании с воспалительно-инфекционными поражениями плаценты и плода. Заключение. Представленный случай способствует повышению осведомленности врачей акушеров, функциональной диагностики и морфопатологов с морфопатологическими изменениями редчайших врожденных аномалий развития и возможности их сочетания для ранней пренатальной диагностики, решения вопроса o прерывании беременности на ранних сроках и тщательной как генетической, так и в плане персистирующих инфекций исследовании родителей для прогнозирования последующих беременностей

Nivelul divergenţelor dintre diagnosticul clinic şi morfopatologic conform datelor cerviciului de morfopatologie a IMSP IMşiC

IMSP Institutul Mamei şi CopiluluiScopul studiului vizează caracteristica diagnosticului, nivelul şi cauzele divergenţei în mortalitatea survenită intrauterin şi postnatal. Material şi metode. Material de studiu au servit dările de seamă pe ultimii 5 ani (2011-2015) şi 372 fişe morfopatologice ale autopsiilor în mortalitatea survenită in utero – 190 cazuri şi postnatal la vârsta de 0-18 ani – 182 cazuri, din anul 2015. Rezultate. În plan cronologic, dinamismul divergenţei generale a înregistrat o creştere de la 14,3% (2011) până la 27,4% (2015), cu un maximum de 27,9% în 2014. Analiza mortalităţii investigate morfopatologic în Serviciul de Morfopatologie clinică a IMSP IMşiC în perioada anului 2015 a stabilit în mortalitatea copiilor ponderea majoră a diagnosticului bicauzal – 68,0% şi a polipatiei în 12,1% din cazuri. În 52,4% cazuri examinarea morfopatologică post-mortem a completat nozologia şi etiologia afecţiunilor ce au cauzat mortalitatea, stabilind după principiul nozologic un nivel de divergenţă de 27,4% din cazuri, cu predilecţie în mortalitatea intrauterină – 15,3%. Evaluarea divergenţelor în funcţie de cauze a relevat frecvenţa cauzelor obiective în 65,3%. În funcţie de categorii, a predominat divergenţa de categoria I cu 54,5%, iar cele de categoria II şi III au constituit 43,9% şi 1,5%, respectiv. Coraportul cauzelor subiective la obiective a înregistrat un indice a calităţii de 0,53, fi ind < 1, ceea ce reflectă o calitate satisfăcătoare a managementului clinico-diagnostic. Conform datelor de literatură, Зайратьянц О.В (2005), J Roulson, et. al. (2005), E Gleizer (2008), divergenţa în perioada copilului oscilează între 15% şi 65% din cazurile examinate post-mortem, media mondială constituie circa 30-35%. Concluzii. Nivelul de divergenţă în IMSP IMşiC este un indice numerar constituind 27,4%, care reflectă eficienţa măsurilor organizatorice şi nivelul tehnologic al procesului clinico-diagnostic înregistrând în perioada anului 2015 un indice de 0,53, ceea ce relevă o calitate satisfăcătoare a procesului clinico-diagnostic

Traumatismul renal la copil

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Catedra de chirurgie, ortopedie şi anesteziologie pediatrică, Centrul Naţional Ştiinţifico-Practic de Chirurgie Pediatrică acad. „Natalia Gheorghiu”, IMSP Institutul Mamei şi CopiluluiThe objective of the study. Renal traumas are a permanent challenge for physicians, obliging them to find new diagnostic and therapeutic solutions, that lead to continuous improvement of life quality. This challenge led to an application of advanced technics of imaging investigation for an accurate determination of renal trauma, before exploring it clinically. In some patients, a nonspecific and variable clinical picture of renal trauma impedes its diagnostics. A case of renal trauma diagnosed and treated surgically with a positive outcome in our clinic is described below. Materials and methods: Here is a case history of a 14-year-old patient without any previous history, who had not been treated medicinally until he suffered a renal trauma. The patient with risk factor - hemorrhage was transferred from the Regional Hospital to Academician Natalia Gheorghiu National Scientific and Practical Centre of Pediatric Surgery, PHI Institute of Mother and Child’s, for the treatment. The patient underwent surgical intervention. As the kidney was crushed with an affected renal pedicle, a nephrectomy was performed. The patient’s decapsulated kidney, removed during the surgery, was sampled for macroscopic morpho-pathological study using the method of morphometry (organometry and macrometry). The morphometry data were compared with the average norm for adolescents aged 14. Tissue samples taken from lesions of the renal parenchyma and adjacent tissues were examined histo-morphologically and later processed using automated histological processing and hematoxylin staining method. Results: The results of the study revealed that the kidney lesioned severely revealed that the trauma developed in the kidney that was anatomically and morphologically compliant with the patients' age, and in the absence of any previous pathology. The lesion was attested to be of a severe degree. It was revealed that in children in lesions produced by closed injuries the kidney undergoes not only severe lesions due to combined ruptures with involvement of the caliceal system but also of a renal parenchyma major contusion supplemented with diverse intensity and spread of hemorrhagic changes localized both at the level of rupture and in adjacent tissues. These lesions are commonly associated with aseptic ischemic and necrotic changes that within 52 hours cause the evolution of both necrotic and thrombotic changes and the development of inflammatory process attested by a discreet focal lymphocytic and leucocytic infiltration

Kidney trauma to child

Materialele Conferinţei Ştiinţifice Anuale al Institutului Mamei și Copilului, Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Catedra de chirurgie, ortopedie şi anesteziologie pediatrică, Centrul Naţional Ştiinţifico-Practic de Chirurgie Pediatrică acad. „Natalia Gheorghiu”, IMSP Institutul Mamei şi CopiluluiSUMMARY Objective of the study. Renal traumas are a permanent challenge for physicians, obliging them to fi nd new diagnostic and therapeutic solutions, that lead to continuing improvement of life quality. This challenge led to an application of advanced technics of imaging investigation for an accurate detrmination of renal trauma, before exploring it clinically. In some patient a noncpecifi c and variable clinical picture of renal trauma impedes its diagnostics. A case of renal trauma diagnosed and treated surgically with a positive outcome in our clinic is described below. Materials and methods: Here is a case history of a 14 year-old patient without any previous history, who had not been treated medicinally until he suffered a renal trauma. The patient with risk factor - haemorrhage was transferred from the Regional Hospital to Academician Natalia Gheorghiu National Scientifi c and Practical Centre of Pediatric Surgery, PHI Institute of Mother and Child’s, for the treatment. The patient underwent surgical intervention. As the kidney was crushed with an affected renal pedicle, nephrectomy was performed. The patient’s decapsulated kidney, removed during the surgery, was sampled for macroscopic morphopathological study using the method of morphometry (organometry and macrometry). The morphometry data were compared with the average norm for adolescents aged 14. Tissue samples taken from lesions of the renal parenchyma and adjacent tissues were examined histomorphologically and later processed using automated histological processing and hematoxylin staining method. Results: The results of the study revealed that the kidney lesioned severely revealed that the trauma developed in the kidney that was anatomically and morphologically compliant with the patien’s age, and in the absence of any previous pathology. The lesion was attested to be of a severe degree. It was revealed that in children in lesions produced by closed injuries the kidney undergoes not only severe lesions due to combined ruptures with involvement of the caliceal system, but also of a renal parenchyma major contusion suplimented with diverse intensity and spread of hemorrhagic changes localized both at the level of rupture and in adjacent tissues. The se lesions are commonly associated with aseptic ischemic and necrotic changes that within 52 hous cause the evolution of both necrotic and thrombotic changes and the development of inflammatory process attested by a discreet focal lymphocytic and leucocytic infiltration

The morphology of human conceptus in deregulated pregnancies of early prenatal period

Serviciu de morfopatologie și citomorfologie, Laboratorul știinţific de morfopatologie, Secţia de ultrasonografie, Subdiviziunea obstetrică, Centrul Perinatal nivelul III, IMSP Institutul Mamei și Copilului, Chișinău, R. Moldova, Laboratorul de morfologie, Catedra de histologie, citologie și embriologie, Catedra de morfopatologie, IP Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, Chișinău, R. Moldova, Conferința Ştiinţifică Internaţională ”Probleme actuale ale morfologiei” dedicată celor 75 de ani de la fondarea Universităţii de Stat de Medicină și Farmacie Nicolae Testemiţanu, Chişinău, 30-31 octombrie 2020Abstract Background: Events that occur at the maternal-fetal interface define the success of pregnancy. Information on the maternal-fetal interface in the first trimester can be gained from clinical, morphological studies. An important issue, also for Moldova is risk assessment of maternal-fetal pathologies development. Material and methods: A retrospective cohort study carried out in 2712 selected cases with deregulated pregnancy in the first trimester. Results: The incidence of normal uterine site of pregnancies (79,8%) prevailed on ectopic (20,2%). In 54% of selected cases a stopped progressing pregnancy were diagnosed. The spontaneous abortion during 6-12 of gestational weeks constitute 21,3%. In 67,9% the reason were fetus abnormalities, in 20,9% were described endometrial pathologies and in 11,25% both reasons, fetus-uterine problems were diagnosed. By analyzing macro- and microscopic features of germinative components, human (or fetal) conceptus (CU/ CF) were subdivided in 6 groups: I) CF with normoform development – where embryonic and chorionic structures resemble normal morphology (CFDN); II) CF – with embryo-placental retardation (CFREP); III) CF with abnormalities (CFA) subdivided in: single (isolated) (CFAI) and combined abnormalities (CFAC); IV) CF – with anembryonic gestational sac (CFSCA); V) CF – hydatidiform mole (CFHM); VI) CF – growth-disorganized embryos (CFD). Conclusions: This study represents a first interdisciplinary research, which evaluated a complex of clinical, biochemical and pathological features of pregnancies disrupted in the first trimester. The preliminary results emphasize the existence of several groups of risk, whose structure and incidence should be evaluated by future studies

Structura şi caracteristica proceselor patologice în morbiditate conform diagnosticului histomorfologic intravital

IMSP Institutul Mamei şi CopiluluiScopul studiului vizează aportul diagnosticului morfopatologic şi frecvenţa proceselor patologice atestate în morbiditate conform datelor Serviciului de Morfopatologie şi Citopatologie clinică a IMSP IMşiC în perioada anului 2015. Material şi metode. Material de studiu au servit rezultatele examinărilor histo - şi citomorfologice ale 8995 pacienţi cu vârsta 0-58 ani în material biopsic, postoperatoriu, obstetrical – 8147 pacienţi şi citologic al colului uterin – 848 paciente prin aplicarea standardului minim de metode histologice (hematoxilină-eozină şi selectiv: van Gieson, orceina, alcian blu, Mason) şi citologice: coloraţia după Romanovski şi după Papa Nicolau( pap-test). Rezultate. În funcţie de complexitatea materialului examinat în 60,2% examinările au avut o importanţă de diagnostic primar al patologiilor, în 12,6% de precizare şi în 24,2% cazuri de confirmare. În structura diagnosticului histomorfologic frecvenţa majoră a înregistrat procesele tumorale cu 38,6% (3143), din care în 1,9% (157) tumori maligne. Cu o frecvenţă de 30,8% s-au înregistrat patologia inflamatore specifică şi nespecifică, urmate de ce-a vicio-displazică cu 8,9% cazuri şi în 21,7% cazuri alte patologii. În structura tumorilor maligne, conform perioadelor de vârstă, ponderea majoră – 64,3% (101) s-a înregistrat în perioada adultului, la vârsta 20 - 62 ani şi 35,7% (56) din cazuri în perioada copilului, la vârsta de 1 lună -18 ani. În perioada copilului a predominat limfomul – 25,0%, predilecţie non Hodjkin, urmat de neuroblastom – 14,3%, sarcom – 8,9% şi carcinom – 3,6%, alte tipuri tumorale constituind 48,2% din cazuri. În perioada adultă, în 61,3% cazuri au predominat carcinoamele, cu predilecţie adenocarcinomul endometrial şi intestinal, urmate de mola hidatiformă, varianta sinciţio-trofoblastică proliferativă – 9,7%, tumorile carcinomatoase – 6,5% şi alte tipuri de tumori – 22,5% din cazuri. În citopatologie a colului: opţional 41,3%, infl amaţii/organisme – 28,1%, anormalităţi epiteliale: AS-CUS, ASC-H, LSIL (HPV,CIN1), HSIL (CIS/CIN2,CIN3) – 9,8%, inclusiv un caz de carcinom pavimentos. Concluzie. Diagnosticul morfopatologic intravital este de o importanţă deosebită, cu aport major în diagnosticul primar privind originea, caracterul şi activitatea proceselor patologice celular-tisulare în morbiditate la vârsta copilului şi a adultului, în special în depistarea proceselor precanceroase şi canceroase