The histological modifications in uterus during its post-partum involution

Laboratorul Morfologie USMF „Nicolae Testemitanu”The histological modifications in uterus during its post-partum involution The histological modifications in uterus during its post-partum involution were investigated. It was determined that the process of post-partum involution of the uterus is manifested histologically by atrophy and dystrophy processes in muscle elements, by the 80 decreasing of the connective tissue’s volume and its degradation. The involution of muscle tissue anticipates the reduction of extracellular matrix of connective tissue. S-au studiat modificările histologice ale uterului în procesul involuţiei sale post-partum. S-a determinat, că procesul de involuţie post-partum a uterului în aspect histologic se manifestă prin procese de atrofie şi distrofie a elementelor musculare, micşorarea volumului şi degradarea ţesutului conjunctiv. Involuţia ţesutului muscular anticipează reducerea matricei extracelulare a ţesutului conjunctiv

Studiul histologic și imunohistochimic a 2 cazuri de leiomiom al țesuturilor moi profunde

Background. The low incidence of deep soft tissue leiomyoma, the absence of signs and symptoms of onset in most cases are important problems in attempts to detect the disease early. Objective of the study. The aim of our study is to help elucidate aspects related to tumor pathogenesis and immunohistochemical profile underlying the tumor. Material and Methods. The studied material was represented by the operating parts from the Department of Pathology of the SCR Timofei Moșneaga. The methods used were paraffin inclusion technique and immunohistochemical techniques for assessing the origin and exclusion of a malignant process and its confirmation by the following markers Ki67, EMA, PCK, CD34, SMA, Desmin, Vimentina, S100, Melanosome HMB45, ER, PR. Results. The expression of all these markers on smooth muscle cells in both the normal myometrium and leiomyomas suggests their involvement in uterine functions through autocrine/paracrine mechanisms, directly stimulating tumor growth and progression. Conclusion. The evaluation of the tumor immunoprofile, in correlation with the data from the literature on the significance of tumor markers could be an indicator of the mixed origin of deep leiomyomas. Introducere. Incidența scăzută a leiomiomului țesuturilor moi profunde, absența semnelor și simptomelor de debut, în cele mai multe cazuri, constituie probleme importante în încercările de depistare precoce a bolii. Scopul lucrării. Scopul studiului nostru este de a contribui la elucidarea unor aspecte legate de patogenia tumorii și profilul imunohistochimic ce stau la baza tumorii. Material și Metode. Materialul studiat a fost reprezentat de piesele operatorii din secția Anatomie Patologică a SCR „Timofei Moșneaga”. Metodele utilizate au fost: tehnica de includere la parafină, tehnicile imunohistochimice pentru aprecierea originii și excluderea unui proces malign și confirmarea acestuia prin următorii markeri: Ki67, EMA, PCK, CD34, SMA, Desmin, Vimentina, S100, Melanosome HMB45, ER, PR. Rezultate: Expresia tuturor acestor markeri asupra celulelor musculare netede atât din miometrul normal, cât și din leiomioame sugerează implicarea lor în funcțiile uterine prin mecanisme autocrine/paracrine, stimulând direct creșterea și progresia tumorală. Concluzii. Evaluarea imunoprofilului tumoral, în corelație cu datele din literatură privind semnificația marcherilor tumorii, ar putea fi un indicator al originii mixte a leiomioamelor profunde

Epithelio-mesenchymal transition process in the pathogenesis of extragenital endometriosis

Department of Morphopathology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Epithelial – mesenchymal transition (EMT) endows cells with migratory and invasive proprieties, a prerequisite for the establishment of endometriotic lesions. The role EMT might play in the pathophysiology of endometriosis is still unknow. Therefore, we examined four markers for EMT in endometrium and endometriosis: E – cadherin + Vimentin, double reactions and simple reactions Twist and N – cadherin. Aim of the study. Immunohistochemical assessment of the invasiveness potential of extragenital endometriosis lesions by investigating some of the specific markers (β-catenin / vimentin panel) of the epithelio-mesenchymal transition process (EMT), a process by which epithelial cells lose their polarity and contact with the polarity and contact invasive. Materials and methods. During a period of five years (2012 – 2017) we analyzed 41 cases of extragenital endometriosis: appendix 5, colon 7, intestine 8, anterior abdominal wall after caesarean operation- 10, inguinal hernia – 6, umbilical hernia- 4, perineal region- 1. The material was processed according to the classic histological technique by inclusion in paraffin. The 3 μm sections obtained were stained with Hematoxylin – Eosin and Masson's trichrome stains. Another sections were dewaxed, rehydrated and processed for immunohistochemistry using as primary antibodies monoclonal antibodies Vimentin and mouse monoclonal antibody N – cadtherin, E – cadherin, Twist. Results. Immunohistochemically, we aimed to change the immunophenotype from epithelial to mesenchyme in extragenital endometriosis by analyzing the most important markers of the transition process. In endometriosis and endometrium E – cadherin, Vimentin, N – cadherin and Twist were expressed on protein level. Investigation of E – cadherin / Vimentin coexpression revealed a decrease in E – cadherin reactivity at the site of invasion of gastrointestinal endometriosis with an increase in reactivity to Vimentin together with the increase of the invasion pattern and the increase of the stage of the disease respectively. Twist transcription factor immunoexpression revealed a highly positive expression on the mesenchymal lineage, proving involvement of this transcriptional factor in the invasion process of endometriosis. N – cadherin was positive in the endometrial glands, showing their differentiation into a mesenchymal phenotype and their migratory potential. Conclusions. The results of our study confirm involvement of the epithelial – mesenchymal transition process in the pathogenesis of extragenital endometriosis lesions, on the one hand, and they certify their invasive potential in these localizations, on the other hand

The role of the collagenase in collagen biodegradation in normal and cirrhotic liver

Laboratorul Morfologie USMF “N. Testemiţanu”The biodegradation of collagen is a process of a vital importance both in norm and in pathological conditions. The initial stage in the collagen degradation is an extracellular proteolytical process, started up by the collagenases – Zn-dependent metalloenzymes, that break up the collagen specifically. In normal liver the collagenase activity was determined in Kuppfer cells. In experimental fibrosis an evident increase of its activity was observed in fibroblasts, Ito cells and hepatocytes. In advanced or irreversible liver cirrhosis the activity of the colagenase decreased. During the recovery from hepatic fibrosis an increase of collagenolytical activity and a decrease of collagen quantity were determined. Biodegradarea colagenului reprezintă un proces de importanţă vitală atît în normă, cît şi în diverse stări patologice. Etapa iniţială în degradarea colagenului este un proces proteolitic extracelular, declanşat sub acţiunea colagenazelor – metaloenzimelor Zn-dependente, care clivează în mod specific molecula de colagen. În ficatul normal activitatea colagenazei a fost depistată în celulele Kupffer, s-a determinat majorarea ei evidentă în fibroza experimentală (sursele celulare fiind fibroblastele, celulele Ito, hepatocitele) şi scăderea ei în caz de ciroză avansată sau ireversibilă. În involuţia fibrozei hepatice s-a observat o creştere a activităţii colagenolitice şi o micşorare concomitentă a cantităţii de colagen în ficat

Histological and immunohistochemical study of 2 cases of deep soft tissue leiomyoma

Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Department of morphopathologyIntroduction Deep leiomyomas are benign neoplasms, which are rarely encountered, with location other than the gynecological tract. These neoplasms exhibit smooth muscle differentiation and can be located in the deep soft tissue, retroperitoneum, mesentery, omentum, within the abdominal cavity and have an increased prevalence in women. Purpose The aim of our study is to provide useful information on some aspects of the immunohistochemical profile underlying this specific type of tumor. Material and methods Our study involved 2 cases of postmenopausal women with clinical diagnosis of retroperitoneal tumor. We examined paraffin-embedded tissue sections cut at 3µm and stained with hematoxylin-eosin. A large panel of immunohistochemical markers were used including the following: Anti-PCK, EMA, S100, Vim, ER, PR, Melanosome, HMB45, Ki67, Desmin, SMA, CD34, Caldesmon. Results Histologically, they are classic leiomyomas, similar to those encountered in the gynecological tract. LM are composed of spindle cells with smooth muscle morphology: oval nuclei, frequently with blunt ends (cigar-shaped), perinuclear clear vacuoles and fibrillary eosinophilic cytoplasm. Conclusions Deep leiomyomas occur preferentially in women during the perimenopausal period, and most commonly have a retroperitoneal location. These tumors are commonly positive for estrogen and progesterone

Acute myocardial infarction in sepsis

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“Sepsis is defined as “a systemic inflammatory response syndrome during an infection” and is generally considered a disease aggravated by inadequate immune response. The cardiovascular system is often compromised in sepsis and septic shock always affected. The presence of cardiovascular dysfunction in sepsis is associated with a significantly increased mortality rate compared with patients with sepsis with cardiovascular dysfunction. The paper presents a clinical case of acute myocardial infarction as a complication of embolic sepsis, which served as the direct cause of death

Studiul histologic și imunohistochimic a 2 cazuri de leiomiom a țesuturilor moi profunde

Department of Morphopathology, Nicolae Testemitanu SUMPhBackground. The low incidence of deep soft tissue leiomyoma, the absence of signs and symptoms of onset in most cases are important problems in attempts to detect the disease early. Objective of the study. The aim of our study is to help elucidate aspects related to tumor pathogenesis and immunohistochemical profile underlying the tumor. Material and Methods. The studied material was represented by the operating parts from the Department of Pathology of the SCR Timofei Moșneaga. The methods used were paraffin inclusion technique and immunohistochemical techniques for assessing the origin and exclusion of a malignant process and its confirmation by the following markers Ki67, EMA, PCK, CD34, SMA, Desmin, Vimentina, S100, Melanosome HMB45, ER, PR. Results. The expression of all these markers on smooth muscle cells in both the normal myometrium and leiomyomas suggests their involvement in uterine functions through autocrine / paracrine mechanisms, directly stimulating tumor growth and progression. Conclusion. The evaluation of the tumor immunoprofile, in correlation with the data from the literature on the significance of tumor markers could be an indicator of the mixed origin of deep leiomyomas.Introducere. Incidența scăzută a leiomiomului țesuturilor moi profunde, absența semnelor și simptomelor de debut, în cele mai multe cazuri, constituie probleme importante în încercările de depistare precoce a bolii. Scopul lucrării. Scopul studiului nostru este acela de a contribui la elucidarea unor aspecte legate de patogenia tumorii și a profilului imunohistochimic, ce stau la baza tumorii. Material și Metode. Materialul studiat a fost reprezentat de piesele operatorii din secția Anatomie Patologică a SCR „Timofei Moșneaga”. Metodele utilizate au fost tehnica de includere la parafină și tehnici imunohistochimice, pentru aprecierea originii și excluderea unui proces malign, și confirmarea acestuia prin urmatorii markeri Ki67, EMA, PCK, CD34, SMA, Desmin, Vimentina, S100, Melanoso Rezultate. Expresia tuturor acestor markeri asupra celulelor musculare netede atât din miometrul normal, cât și din leiomioame sugerează implicarea lor în funcțiile uterine prin mecanisme autocrine/paracrine, stimulând direct creșterea și progresia tumorală. Concluzii. Evaluarea imunoprofilului tumoral, în corelație cu datele din literatură privind semnificația marcherilor tumorii, ar putea fi un indicator despre originea mixtă a leiomioamelor profunde

Abdominal wall and cesarean scar endometriosis: report of a two case

Department of Morphopathology State Medical and Pharmaceutical University „Nicolae Testemitanu”Endometriosis is described as the presence of functioning endometrial tissue (glands and stroma) outside the uterine cavity. The most common location is within the pelvis. However, extra pelvic endometriosis is a fairly uncommon disorder and difficult to diagnose. It can sometimes occur in a surgical scar. Scar endometriosis is a rare condition and difficult to diagnose. It mostly follows obstetrical and gynecological surgeries. It presents as a painful, slowly growing mass in or near a surgical scar. We report two cases of abdominal wall scar endometriosis after cesarean section and strangulated umbelical hernia. Consequently the pathogenesis, diagnosis,morfology and compliation are discussed. Endometrioza este descris ca prezenţa de functionare tesutului endometrial (glande şi stroma), in afara cavitatii uterine. Cea mai frecventa localizare este la nivelul pelvisului. Cu toate acestea, endometrioza extra pelvian este o tulburare destul de neobişnuita şi dificil de diagnosticat. Ea poate aparea, uneori, într-o cicatrice chirurgicala. Endometrioza cicatrizanta este o afectiune rara si dificil de diagnosticat. Prin urmare, apare dupa interventiile chirurgicale obstetrice şi ginecologice. Se prezintă ca o masă dureroasă, cu o crestere treptata pe sau lângă o cicatrice chirurgicala. Am raportat două cazuri de endometrioza abdominala cicatrizanta de perete după cezariană şi hernia strangulata ombelicala. În consecinţă, patogeneza, diagnosticul, morfology şi compilatie sunt discutate

Immunoexpression of matrix metalloproteinases MMP-1, MMP-2, MMP-9 and MMP-14 in extragenital endometriosis and eutopic endometrium

Department of Morphopathology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, the Republic of Moldova, Department of Pathology, University of Medicine and Pharmacy, Craiova, Romania, The 75th anniversary of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova (1945-2020)Background: Matrix metalloproteinases are proteolytic enzymes responsible for the disorder of extracellular matrix modeling in endometriosis and their involvement in the invasion process. The aim of this study was to evaluate the immunohistochemical expression of matrix-metalloproteinases MMP-1, MMP-2, MMP-9 and MMP-14 in surgical excision specimens, collected from women with extragenital endometriosis compared to their expression in the normal endometrium. Material and methods: The study included 40 female patients diagnosed with extragenital endometriosis. The used methods consisted in processing the specimens by classical histological technique with paraffin inclusion and enzymatic immunohistochemical technique for the detection of metalloproteinases MMP-1, MMP-2, MMP-9 and MMP-14. Results: The expression of matrix metalloproteinases MMP-2, MMP-14 was significant in glandular cells from endometriotic lesions, while MMP-9 was evident in both stromal and glandular cells in these lesions. The expression MMP-1 was not present. Normal endometrial tissue showed high reactivity for MMP-14 and low reactivity for MMP-2 and MMP-9. Conclusions: This study reveals some aspects related to the morphological and clinical features of extragenital endometriosis with different locations and the correlation between the clinical evolution and some immunohistochemical markers with potential prognosis regarding the aggressiveness of such lesions

Immunoexpression of matrix metalloproteinases MMP-1, MMP-2, MMP-9 and MMP-14 in extragenital endometriosis and eutopic endometrium

Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Department of morphopathology, University of Medicine and Pharmacy, Craiova, Romania, Department of Pathology, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction: Endometriosis is a comon, benign, inflamatory, pathology, represented by the ectopic location of functional endometrial glands and stroma outside the uterine cavity [1, 2]. Matrix metalloproteinase (MMP) represents a large family zinc-dependent endopeptidases, involved in the degradation of the extracellular matrix in the process of endometrial cell implantation and are classified by their substrate specificity [7, 8]. Matrix metalloproteinases (MMPs) are essential in orchestrating proper physiological functioning of the endometrium; hence, alteration of MMP activities is considered as a critical factor for the development of endometriosis. MMPs are involved in the cellular event of epithelial-mesenchymal transition [10, 22]. Purpose: The aim of this study was to evaluate the immunohistochemical expression of matrixmetalloproteinases MMP1, MMP2, MMP9 and MMP14 in surgical excision specimens, collected from women with extragenital endometriosis compared to their expression in the normal endometrium. Material and methods: The patient group consist 42 women with endometriosis, age range of 21-63 years (median 40), diagnosed and surgically treated at Department of Surgery, Obstetrics and Gynecology from Gherghe Paladi Municipal Clinical Hospital, Sfantul Arhanghel Mihail Municipal Clinical Hospital, Chisinau, the Republic of Moldova and Emergency County Hospital, Craiova, Romania. Location included: the anterior abdominal wall after caesarean operation – 20, inguinal hernia – 7, umbilical hernia – 4, perineal region – 1, appendix – 4, colon – 5, and ileum – 1case. Results: The classical histopatological examination of the general expression of MMP-1, MMP-2, MMP-9 and MMP-14 revealed a diverse variability. For MMP-2, MMP-9, MMP-14 markers, the reaction positivity was variable not only from one case to another but also within each case, the latter being characterized by the identification of different areas within endometriosis. Immunohistochemical analysis has demonstrated the significant enhance of MMP-9 and MMP- 14 expressions in endometriosis and in endometrium. The distinctive feature of MMP-9 and MMP-14 expression in endometriosis was considerable increase of its activity precisely on the border of endometriotic lesion and the peritoneum. Conclusions: The MMP-9 and MMP-14 activity significant elevation, established on ectopic endometrium of women with endometriosis. Study of MMP-1, MMP-2, MMP-9 and MMP-14 activities in endometriotic lesions from women with endometriosis is perspective for further investigation in order to determine a possible role of matrix metalloproteinases in the development of invasiviness process in case of extragenital endometriosis