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SOCIETATEA ROMÂNĂ DE MORFOLOGIE (S.R.M.
)
UNIVERSITATEA DE MEDICINĂ ŞI FARMACIE DIN CRAIOVA
COLEGIUL MEDICILOR DOLJ
https://www. rjme.ro/
The ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY

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Al XVIII-lea Simpozion Național

de Morfologie Microscopică,
cu participare internațională
VOLUM DE REZUMATE
Editura Medicală Universitară Craiova

ISBN 978-973-106-160-3 12–15 octombrie 2022
SOCIETATEA ROMÂNĂ de MORFOLOGIE (SRM)
UNIVERSITATEA DE MEDICINĂ ŞI FARMACIE DIN CRAIOVA
Centrul pentru Studii de Morfologie Microscopică şi Imunologie
COLEGIUL MEDICILOR DOLJ
Al XVIII – lea
Simpozion Naţional
de
Morfologie Microscopică
cu participare internaţională
VOLUM DE REZUMATE
Acreditat de Colegiul Medicilor din România
12 - 15 OCTOMBRIE 2022
CRAIOVA
Descrierea CIP a Bibliotecii Naţionale a României
Simpozion National de Morfologie Microscopica (2022;
Craiova)
Al XVIII-lea Simpozion National de Morfologie
Microscopica cu participare Internationala / Laurentiu
Mogoanta, Claudiu Mărgăritescu, Nicolae Daniel Pirici
(ed.). Craiova : Editura Medicală Universitară, 2022
ISBN 978-973-106-160-3
I. Mogoantă, Laurenţiu (ed.)
II. Mărgăritescu, Claudiu (ed.)
III. Pirici Nicolae Daniel (ed)
61(063)
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Tiparul REPROGRAFIA UNIVERSITĂŢII DE MEDICINĂ ŞI FARMACIE CRAIOVA
Comanda 525/2022
Tiraj 200 + 40 ex
Preşedinte: Prof. univ. dr. Claudiu MĂRGĂRITESCU
Vicepreședinte: Prof. univ. dr. Laurențiu MOGOANTĂ
COMITETUL ŞTIINŢIFIC
Claudiu MĂRGĂRITESCU Andrada LOGHIN
Laurenţiu MOGOANTĂ Mihaela Cezarina MEHEDINTI
Cornelia AMĂLINEI Eugen MELNIC
Mariana AȘCHIE Carmen Mihaela MIHU
Flavia BADERCA Andrei Gheorghe Marius MOTOC
Angela BORDA Gabriela MUȚIU
Irina Draga CĂRUNTU Iancu-Emil PLEȘEA
Raluca-Niculina CIUREA Ovidiu Laurean POP
Mariana COSTACHE Aurel POPA-WAGNER
Ovidiu Simion COTOI Marius RAICA
Doinița CRIȘAN Maria SAJIN
Alis Liliana Carmen DEMA Cristiana Eugenia SIMIONESCU
COMITETUL DE ORGANIZARE
Laurenţiu MOGOANTĂ Marius MATEI
Claudiu MĂRGĂRITESCU Nina IONOVICI
Nicolae Daniel PIRICI Mirela Marinela FLORESCU
Mircea Sebastian ȘERBĂNESCU Anca-Mihaela PREDESCU
Alex Emilian STEPAN Ionica PIRICI
Costin Teodor STREBA Gabriela Camelia ROȘU
George Dan MOGOŞANU Anca Maria ISTRATE-OFIŢERU
Horia Octavian MANOLEA Ilona Mihaela LILIAC
Tudor-Adrian BĂLȘEANU Bogdan OPREA
Bogdan CĂTĂLIN Liliana STREBA
Garofiţa Olivia MATEESCU Larisa IOVAN
Cristina Jana BUSUIOC Valentin Octavian MATEESCU
SECRETARIAT
Laurenţiu MOGOANTĂ George Dan MOGOŞANU
Claudiu MĂRGĂRITESCU Horia Octavian MANOLEA
Nicolae Daniel PIRICI Ilona Mihaela LILIAC
Mircea-Sebastian ȘERBĂNESCU Cristiana-Emilia DAVID
Digestive Pathology
Digestive Pathology
Salivary gland tumors: classification of the morphological phenotypes based on

architectural patterns
Ludmila Lozneanu1, Delia-Gabriela Ciobanu-Apostol2, Irina-Draga Căruntu1, Simona-Eliza Giușcă2

1) Department of Morpho-Functional sciences I - Histology, "Grigore T. Popa" University of Medicine and Pharmacy, Iași , Romania
2) Department of Morpho-Functional sciences I - Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, Iași , Romania
Salivary gland tumors (SGT) are among the most difficult areas to diagnose. Although SGTs have a low incidence, representing only
3%-5% of head and neck tumors, the diagnostic problems are reflected by the high number of different tumors that occur in a small
anatomicalarea,surgicallydifficulttoaccess.SGTsariseeitherfrommajorsalivaryglandsorfromseveralminorsalivaryglands,being
variably associated with cyto-architectural features and morphological diversity, and can have similar features in different clinical
presentations.Small-sizedorearlySGTshavearchitecturalandmorphologicalfeaturessimilartobenignSGTs,whichcomplicatesthe
therapeutic approach and the practical algorithm of histopathological diagnosis. The rarity and morphological variations make them
difficult to diagnose. In rare cases high-grade transformation of SGTs is associated with aggressive clinical evolution. New subtypes
and phenotypes introduced in 2022 World Health Organization classification increase the complexity of diagnosis. Although
diagnosis based on classic Hematoxylin and Eosin procedures remain the gold standard of salivary gland pathology,
immunohistochemistry and molecular biology techniques are an adjunctive tool for the identification of cellular differentiation and
the correct assessment of tumor staging. Recognize SGTs entities is important to avoid over- or under-diagnosis and to benefit from
proper clinical management.
Keywords: salivary glands, tumor, morphological diversity, histopathological diagnosis
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Digestive Pathology
Proliferating Lymphatic Endothelial Cells as a Prognostic Marker in Head and Neck

Squamous Cell Carcinoma
Cristina-Stefania Dumitru1, Amalia Raluca Ceausu1, Pusa Nela Gaje1, Cristian Silviu Suciu1, Marius Raica1
1) Department of Microscopic Morphology/Histology, Angiogenesis Research Center, “Victor Babes” University of Medicine and
Pharmacy, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
Introduction
Podoplanin and Ki-67 are two important markers of cancer progression. The aim of this study is to evaluate double immunostaining
for Ki-67 and podoplanin in head and neck squamous cell carcinoma (HNSCC), and to observe the involvement of lymphagiogenesis
in tumoral and peritumoral areas, as well as the density of tumor proliferation correlated with histopathological grading.
Material and methods
Atotalof50patientswithHNSCCwereincludedinthisstudy.Wecarriedoutamorphologicalevaluationoftissuesamples,afterthat,
cases were selected for double Ki-67 and podoplanin immunostaining.
Results
Podoplanin expression was significantly correlated with histopathological grade (p < 0.05; p = 0.037) and expression of Ki-67 (p <
0.05;p=0.050).Ahighexpressionofpodoplanin,aswellasoftheproliferationfactorKi-67,wasobservedinhistopathologicalgrade
G3andthecorrelationbetweenthese(p<0.05;p=0.028),andimplicationofLMVDandLVIwasnotsignificant(LMVDp=0.577;LVI
p = 0.976).
Conclusion
This study demonstrated the importance of double immunolabeling in assessing lymphagiogenesis and tumor proliferation in
correlation with histopathological grades in HNSCC.
Keywords: lymphatic vessels, podoplanin, Ki-67, head and neck squamous cell carcinoma
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Digestive Pathology
Analysis of clinicopathological prognostic factors in gastric cancer
Aura Jurescu1, Octavia Vița1, Vlad Lupu1, Bianca Nătărâș1,2, Andrei Plopeanu1,2, Anca Mureșan1,2, Mărioara Cornianu1,2, Sorina
Tăban1,2, Alis Dema1,2
1) Department of Microscopic Morphology - Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine
and Pharmacy, Timișoara, Romania
2) Department of Pathology , “Pius Brînzeu” Emergency County Clinical Hospital, Timişoara, Romania
Introduction
Globally,gastriccancer(GC)isthefourthmostcommoncancerandthesecondleadingcauseofcancerdeath.Accordingtotheeighth
TNM classification, the prognosis of GC is largely related to disease extension. However, the risk of recurrence varies significantly
within the same stage, and the patient’s outcome may depend on additional prognostic factors. Lauren’s classification system
recognizes two main histological types of GC: intestinal-type and diffuse-type, although there is no difference in the clinical
management of these subtypes. The aim of this study is to assess the relationship between the intestinal-type and diffuse-type GC
with the clinicopathological parameters in patients with surgically resected GC.
Weperformedaretrospective-observationalstudyincludingallpatientsdiagnosedwithGConresectionspecimensattheEmergency
CountyClinicalHospitalinTimișoara,betweenJanuary2019andDecember2020.Clinicopathologicalcharacteristicswereexamined,
and descriptive statistics were used (Fisher’s exact test and Chi-squared test) to analyze two groups of GC patients based on Lauren
classification: intestinal-type and diffuse-type GC. Next, for the multivariable analysis of the pT parameter (the depth of tumor
invasion in the gastric wall) we grouped the cases into two categories: early invasive (pT1+pT2), and deeply invasive (pT3+pT4)
tumors.
Results
The study included 62 (67%) men, with a ratio of 2:1 between men and women. The average age at diagnosis was 65.7 years (range
31 to 93). Most patients had diffuse-type GC (54/92, 59% of cases). As compared with intestinal-type GC, patients with diffuse-type
GC presented more frequently with metastases in regional lymph nodes (47/54 cases, p=0.011), lympho-vascular invasion (LVI+)
(49/54, p=0.0236), and perineural invasion (PnI+) (43/54, p=0.0205). Regarding the pT parameter, 11/92 cases (12%) were
categorized as pT1+pT2, and 81/92 cases (88%) belonged to the pT3+pT4 category. We noted that among the pT3+pT4 cases, the
majority presented with lymphnodal metastases (69/81 cases, p<0.0001) and LVI+ (79/81 cases, p=0.0003). Furthermore, 63/81
pT3+pT4 cases had PnI+, as opposed to only one case with PnI+ in the pT1+pT2 group, p<0.0001.
Conclusion
In addition to the disease stage, histology could be a useful prognostic marker for both early and advanced GC patients. For the
purpose of risk stratification, further clinical trials investigation is clearly needed.
Keywords: Gastric cancer (GC), prognostic factor, adenocarcinoma, histology
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Digestive Pathology
Immunoexpression of claudins in gastric adenocarcinomas
Oana Iulia Crețu1, Cristiana Eugenia Simionescu1, Alex Emilian Stepan1, Claudiu Mărgăritescu1, Raluca-Niculina Ciurea1, Mirela
Marinela Florescu1, Bianca Cătălina Andreiana1, Anne Marie Badiu1
1) Pathology Department, University of Medicine and Pharmacy Craiova, Romania
Introduction
Gastric adenocarcinomas are malignant tumors with an agressive behavior and a high mortality rate. The disturbance of intercellular
adhesion systems participates in gastric carcinogenesis, claudins being identified as involved molecules.
The study was retrospective and included 58 cases of primitive gastric adenocarcinomas, diagnosed on total gastrectomy specimens
after classical histopathological processing and in accordance with the latest classifications. Subsequently, we analyzed descriptively
and statistically the membranous immunoexpression of Claudin 1, 4 and 7, in relation to the main aggressiveness parameters of the
tumorlesions.Fortheimmunohistochemicalanalysis,therewereusedscoresthattookintoaccountthenumberoflabelledcellsand
the intesity of reactions.
Results
The immunoexpression of Claudin 1 and 7 was identified in tumor cells membrane and indicated the association of high scores with
tubular tumor architecture, with low grade tumors and in initial and intermediate tumor stages. In the case of Claudin 1, poorly
cohesive, hepatoid and mucinous adenocarcinomas were negative. For Claudin 4, the high scores observed at the membranne level
were associated with poorly cohesive with signet-ring cell, hepatoid and tubular type, with low grade tumors and in initial and
intermediate tumor stages. In the cases of poorly cohesive non-signet-ring cell, hepatoid and high grade tubular type tumors, it was
detected the cytoplasmic and membranous immunoreaction of Claudin 4.
Conclusion
The investigated claudins are useful for identifying aggressive adenocarcinomas, the loss of expression being frequently associated
with high grade and advanced tumors. The cytoplasmic and membranous translocation of Claudin 4 suggests a possible role as a
transcription cofactor involved in tumor proliferation.
Keywords: Claudin 1, Claudin 4, Claudin 7, gastric adenocarcinomas
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Digestive Pathology
Pseudomembranous colitis – etiopathogenic mechanisms, histopathologic

diagnosis, and significance in Legal Medicine
Cornelia Amalinei1,2
1) Department of Morphofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
2) Department of Histopathology, Institute of Legal Medicine Iasi, Romania
Introduction
Pseudomembranous colitis represents a particular entity, included in non-IBD (intestinal bowel disease) category. Positive and
differential diagnosis are based on histopathological examination, added to clinical, laboratory, and endoscopic findings, along with
microbiological certification of the microorganism or its antigens, in Clostridium difficile colonisation, with detection of its two
bacterial toxins.
This work, based on literature analysis is an update regarding this entity, in correlation with personal professional experience.
Results
Pseudomembranous colitis may show three histopathological types, in correlation with temporal evolution of the disease, according
to the depth and degree of inflammatory changes (type 1, 2, and 3). Pseudomembranous colitis etiology is variable, added to
Clostridium difficile infection, such as different bacteria, viruses, parasites, toxins, and drugs. Regarding the etiopathogeny, the first
step is considered to be an imbalanced colonic microbiota, followed by Clostridium difficile colonisation, usually precipitated by the
therapywithantibiotics,immunosuppressives,orchemotherapeutics.Aftertheinitialcolonisation,theinfectionismediatedbytoxins
AandBproduction,leadingtocellularlesions,inflammationresultinginmicroabscessesandpseudomembranes,withfataloutcome
in fulminant type of the disease. Laboratory findings are useful for disease monitoring and recurrences detection, in the presence of
recognized risk factors.
Conclusion
In conclusion, pseudomembranous colitis represents an entity with great significances in Legal Medicine and its early and adequate
diagnosis may prevent patients’ fatal outcome.
Keywords: pseudomembranous colitis, pseudomembranes, Clostridium difficile, microabscesses
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Digestive Pathology
Post-transplant lymphoproliferative disorder with intestinal injury associated with

Epstein-Barr virus infection.
Ludmila Lozneanu1,3, Delia-Gabriela Ciobanu-Apostol2,3, Andreea Rusu1, Carmen Ungureanu2,3

1) Department of Morpho-Functional sciences I - Histology, "Grigore T. Popa" University of Medicine and Pharmacy, Iași , Romania
2) Department of Morpho-Functional sciences I - Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, Iași , Romania
3) "Sf. Spiridon" County Emergency Clinical Hospital, Pathology, Iasi, Romania
Introduction
Post-transplant lymphoproliferative disorders (PTLDs), described and standardized according to 2017 WHO classification, are the
most well-studied immunosuppression-related lymphoproliferations. PTLDs include a broad spectrum of diseases, ranging from
benign proliferation of lymphoid tissues, manifested either as a localized lesion or systemic disease, to malignant proliferation with
aggressive behavior.
We presented the case of a 43 years old man with history of renal transplant, who underwent surgical intervention and double
immunosuppressive treatment, presented at the 3rd Surgical Clinic, Iasi, with lower digestive hemorrhage. He suffered numerous
hospitalizations and surgical intervation due to complications caused by EBV infection. Numerous immunohistochemical (IHC) tests
were performed for the phenotyping of the intestinal lymphoproliferative process.
Results
In our case the pathological and IHC examination revealed features that were consistent with polymorphic PTLD: effacement of
normal intestine architecture by a proliferation of small to intermediate sized lymphocytes, some immunoblasts and plasma cells,
associated with EBV.
Conclusion
The oncogenic impact of EBV allows overlapping morpho-clinical features at different lymphoproliferativ diagnostic stages.
Recognizing PTLD is important because it influences treatment decisions.
Keywords: Post-transplant disorder, EBV, lymphoproliferative disorder
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Digestive Pathology
Updates in GIST. A pathologist’s perspective
Irene Alexandra Spiridon1, Delia-Gabriela Ciobanu-Apostol1,2, Irina-Draga Căruntu3,4

1) Department of Pathology , "Grigore T. Popa"University of Medicine and Pharmacy, Iasi, Romania
2) Department of Pathology , “Sf. Spiridon” University Emergency Clinical Hospital, Iasi, Romania
3) Department of Histology, "Grigore T. Popa"University of Medicine and Pharmacy, Iasi, Romania
4) Department of Pathology , "Dr. C. I. Parhon" Clinical Hospital, Iasi, Romania
Introduction
Gastrointestinalstromaltumors(GISTs)arethemostfrequentsarcomasofthegastrointestinaltract,beingrelativelynewlydefined–
no older than 40 years. The approach to GISTs in the era of molecular diagnosis is continuously improving, making use of a detailed
characterization of these tumors in order to tailor therapy and refine the prognosis of patients with this disease.
The presentation focuses on the latest updates in GIST research available in the mainstream, while critically evaluating the
applicability of these novel concepts into the daily practice of a pathologist.
Results
The current systems employed in estimating the risk of progression take into account specific parameters such as tumor size, mitotic
activity and tumor location. However, these internationally recommended classifications are less accurate in estimating the clinical
outcome of patients with high risk tumors and lack consensus regarding the management of tumors with small size. The re-
evaluation of classical clinico-pathological factors can further uncover the biological features of these tumors, while the detailed
investigation of the mutational profile is far more superior in outlining tumor subtypes with specific behavioral patterns.
Conclusion
Located at the intersection between genotype and phenotype, the pathological diagnosis carries an essential role in identification of
these tumors, but also in guiding therapy, a task which is continuously changing.
Keywords: GIST, prognosis, malignancy, update, molecular pathology, immunohistochemistry
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Digestive Pathology
Diagnostic challenges in GIST
Irene Alexandra Spiridon1, Delia-Gabriela Ciobanu-Apostol1,2, Andreea Rusu3, Irina-Draga Căruntu3,4

1) Department of Pathology , "Grigore T. Popa"University of Medicine and Pharmacy, Iasi, Romania
2) Department of Pathology , “Sf. Spiridon” University Emergency Clinical Hospital, Iasi, Romania
3) Department of Histology, "Grigore T. Popa"University of Medicine and Pharmacy, Iasi, Romania
4) Department of Pathology , "Dr. C. I. Parhon" Clinical Hospital, Iasi, Romania
Introduction
The gastrointestinal tract harbors some of the most frequent epithelial tumors, with one of the highest rates of cancer-related
morbidity and mortality in the general population. However, it is also home to mesenchymal proliferations, among which
gastrointestinal stromal tumors (GISTs) are the most frequent.
The presentation is built on a case-report format and focuses on the differential diagnosis of GIST, which includes both benign and
malignant tumors.
Results
The differences identified in the hematoxilin-eosin stain, but also during the immunohistochemical examination can often lead the
diagnosis astray. Therefore, the goal is to efficiently triage between the epithelial and non-epithelial tumors of the gut, while being
aware of the potential pitfalls that can arise even with the use of ancillary testing.
Conclusion
In spite of their histogenesis, the morphology of these entities is variable and incites to a broad differential diagnosis including
epithelial, mesenchymal, but also secondary tumors located in the gut. The identification of the mutation that drives the malignant
process and the characteristic immunohistochemical profile has significantly impacted the diagnosis of GIST. However, they still
represent a challenge for the pathologist.
Keywords: GIST, immunohistochemistry, differential diagnosis, prognosis, CD117, DOG1
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Digestive Pathology
Right vs. left colorectal carcinomas: an overview of clinico-pathological features
Aura Jurescu1, Adrian Văduva1,2, Remus Cornea1,2, Robert Barna1,2, Codruța Lăzureanu1,2, Anca Mureșan1,2, Mărioara Cornianu1,2,
Sorina Tăban1,2, Alis Dema1,2
1) Department of Microscopic Morphology - Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine
and Pharmacy, Timișoara, Romania
2) Department of Pathology , “Pius Brînzeu” Emergency County Clinical Hospital, Timişoara, Romania
Introduction
Colorectal cancer (CRC) exhibits different molecular and pathological characteristics depending on tumor location. Differences
betweenproximalanddistalcoloncancersareprobablyduetodifferentembryonicorigins,geneticmutations,lifestyleand/ordietary
habits. The aim of our study was to evaluate the clinicopathological features of CRC based on the tumor location.
From the database of our Pathology Department of the "Pius Brînzeu" Timișoara Emergency County Clinical Hospital we selected all
cases with CRC diagnosis on surgical resection specimens, between 2009 and 2018, extracting the cases of conventional colorectal
adenocarcinomas.Theclinicopathologicalparameterswerestatisticallyinterpretedandcomparedbetweenthreegroups:right-sided
colon carcinomas, left-sided colon carcinomas, and rectal carcinomas.
Results
The median age of the patients was 65.5 years (range 24–93 years), and 938 patients (58.19%) were male. We identified 680
patients (42.18%) with left-sided colon carcinomas, 494 (30.65%) with right-sided colon carcinomas, and 438 (27.17%) with rectal
carcinomas. Patients diagnosed with right-sided colon carcinomas had almost equal gender distribution, while patients with left-
sided colon carcinomas and rectal tumors were more frequently male (405/680 cases - 59.56% and 287/438 cases - 65.53%,
respectively), with statistically significant differences (p<0.0001). The right colon was the most likely location for high grade (G3-G4)
tumors (104/225, 46.22%), while low grade (G1-G2) tumors were more frequently located in the left colon and rectum (997/1387 -
71.88%), p<0.0001. Patients with right-sided colon carcinomas had mostly advanced stage tumor pT3-pT4, 65% of them presenting
regionallymph-nodesmetastases(pN+)andlymphovascularinvasion(LVI+)atthetimeofdiagnosis.ThepT1-pT2stagetumorswere
morefrequentlyidentifiedinpatientswithrectalcarcinomas(105/438cases-23.97%),comparedtotheleft-sidedcoloncarcinomas
(81/680 cases - 11.91%) and the right-sided colon carcinomas (54/494 cases - 10.93%), p<0.0001.
Conclusion
We identified different clinicopathotogical features of CRC according to the site of involvement. These should be considered in
patients with CRC for screening program and treatment strategies. Tumor location can be used as stratification risk factor, but the
prognostic significance needs further investigation.
Keywords: colorectal cancer (CRC), location, right-sided, left-sided, rectum, clinicopathotogical features
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Digestive Pathology
Prognostic value of pattern-based morphology classifications in pancreatic ductal

adenocarcinoma
Andreea Rusu1, Simona-Eliza Giușcă2, Delia-Gabriela Ciobanu-Apostol2, Ludmila Lozneanu1, Andrei Daniel Timofte1, Irina-Draga
Căruntu1
1) Histology , University of Medicine and Phamacy „Grigore T. Popa”, Romania
2) Pathology, University of Medicine and Phamacy „Grigore T. Popa”, Romania
Introduction
Pancreatic tumoral proliferations with ductal origin represents more than 90% of pancreatic malignancies. Although ductal
carcinogenesis requires decades and the process involves an intraductal stage followed by an invasive and a metastatic phase, most
ofpancreaticductaladenocarcinomas(PDAC)arediagnosedinalateunresectablestage.Besidethis,theheterogeneityofthetumors
remains one major reason that prevents the molecular classification to be translated into a morphology-based one. Recent data
indicates that tumoral patterns can be useful to establish prognosis in PDAC.
The study included paraffin embedded tissues from 81 cases diagnosed with PDAC between 2009-2016 in "St. Spiridon" University
Hospital. Survival and clinico-pathological data were noted. The histopathology aspects were reappraised and all cases were
classified in correspondence with Digestive system tumors classification, 5th edition. From each patient we selected 1-3 slides
representativefortumormorphologypatterns.Ourstudyaimedtoidentifythepatternsofpancreato-biliaryphenotypeproliferations
and to correlate it with clinico-pathological features.
Results
Following cases reevaluation, 67.90% were classified as conventional PDAC and 32.09% as non-conventional, respectively 58.02%
type A glandular and 41.97% type B non-glandular. The patterns identified were: common/classic (49.12%), foamy cell (17.54%),
cribriform (11.40%), large duct (10.52%), basal (6.14%) and micropapillary (5.26%). The presence of conventional common/classic
pattern was correlated with a homogeneous tumoral process whilst non-conventional patterns were identified more frequently on
heterogeneous proliferations (p=0.001) and associated with a higher number of positive lymph nodes (p=0.005). There were no
differencesbetweenoverallsurvivalofconventionalandnon-conventionaltumors.Conversely,usingglandularversusnon-glandular
classification we observed significant differences between the two groups (p=0.004).
Conclusion
Morphological patterns evaluation in pancreato-biliary phenotype proliferations can be useful to prognostic PDAC stratification, but
studies on higher number of cases are needed. Comparative, both morphology classifications that use tumoral patterns reveal
different elements.
Keywords: pancreatic ductal adenocarcinoma, prognosis, morphology, heterogeneity, patterns
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Female Genital Pathology
Abnormal uterine bleeding due to ovulatory dysfunction (AUB-O). Pathology and

etiopathogenic correlations
Cristiana Eugenia Simionescu1, Claudiu Mărgăritescu1, Alex Emilian Stepan1, Raluca-Niculina Ciurea1, Mirela Marinela Florescu1,
Bianca Cătălina Andreiana1, Anne Marie Badiu1, Oana Iulia Crețu1
AUB (abnormal uterine bleeding) is a common and often debilitating condition for women worldwide. AUB due to ovulatory
dysfunction (AUB-O) is one of the major causes of AUB and a clinical and pathological diagnosis of exclusion. Approximately 90% of
cases are related to changes in the level of endogenous estrogens and refer to episodes of bleeding due to lack of ovulation,
respectively anovulatory AUB-O. Histopathological varieties of anovulatory AUB-O include: proliferative phase glands and stromal
collapse pattern, disordered and persistent proliferative phase pattern, and atrophy. Only around 10% of AUB-O cases are related to
changes in progesterone levels and appear associated with the abnormal pattern of the secretory phase and nonmenstrual collapse,
respectively ovulatory AUB-O. Histopathological varieties of ovulatory AUB-O include: luteal phase defect, inadequate secretory
phase pattern and mixed phase pattern. The lack of uniform interpretation of the changes associated with the various described
patterns limits the usefulness of these terms in reporting AUB-O. Hence the need to develop a system of biomarkers that allows the
phenotyping of women with AUB-O, so that personalized therapy can be applied and the best treatment strategies can be ensured.
Keywords: abnormal uterine bleeding, dysfunction, patterns
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Endometrial Stem Cells Population. Modern Concepts
Raluca Anca Balan1, Teodora Ana Balan1, Cornelia Amalinei1

1) Department of Morphofunctional Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy, Romania
Introduction
Theendometriumrepresentsaremarkableuniquetissuecharacterizedbyaregenerationactivitycomparabletothatofbonemarrow,
epidermis, or intestinal epithelium. In humans, the cyclic endometrial activity has been scientifically hypothesized regarding its
mechanism, regulatory factors, and their impact on fertility and endometrial pathology. Relatively recent scientific progresses have
changed the knowledge in respect with endometrial regeneration and uterine-derived diseases. We highlight the recent advances in
classification of endometrial stem cells, addressing the current paradigm regarding endometrial regeneration, based on endometrial
stem cells (ESCs) and endometrial regenerative cells (ERCs).
The presentation is based on English language publications indexed in the principal medical databases, using as key words:
“endometrium”, “stem cells”, “regeneration”.
Results
The distinct remodeling potential of the endometrium lead to the hypothesis of the existence of adult stem cells in the uterine
mucosa,withcorrespondingcyclicactivity,theiralterationsbeinglinkedwithvariousendometrialpathologicconditions.Conforming
totheirorigin,ESCscanbeclassifiedasendogenousandexogenous.TheexogenousESCscomprisebonemarrow-derivedstemcells,
umbilical cord-derived mesenchymal stem cells, human amnion-derived mesenchymal stem cells, and adipose tissue-derived
mesenchymal stem cells. Specific identification techniques define several types of endogenous endometrial cells, represented by
epithelialstem/progenitorcells,mesenchymalstemcells,sidepopulationcells,andmenstrualstemcells.ERCsrepresentmultipotent
mesenchymal stem cells from menstrual blood, which have an elevated proliferative potential.
Conclusion
Recent progresses in endometrial stem cells research may generate new hypotheses regarding regeneration and implantation. The
facility in obtaining stem cells from endometrium and their high proliferative ability make them ideal candidates for cell-based
therapies. Identification of new endometrial stem cell markers is needed to facilitate their isolation, with promising applications.
Keywords: Endometrium, stem cells, regeneration
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Intravenous uterine leiomyomatosis: case report
Mihaela-Maria Pasca-Fenesan1, Andrei-Alexandru Cosma1, Alina-Cristina Barb1, Anca Maria Cimpean1, Serban-Mircea Negru2
1) Department of Microscopic Morphology/Histology, Angiogenesis Research Center, Victor Babes University of Medicine and
Pharmacy, Timisoara, Romania
2) Oncology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Introduction
Intravenous uterine leiomyomatosis (IVL) is a rare condition consisting of a histologically benign smooth muscle cells proliferation
related to uterine wall but sometime having a clinical aggressive behavior by the development of intracardiac extension which may
induce congestive heart failure.
Wedescribehereacaseofapostmenopausalwomenwithgiantuterineleiomyomatreatedwithsurgicalresection.Patientpresented
with nonspecific symptoms localized in the pelvic area. At thoracic scan solitary pulmonary nodule is present.
Results
Immunohistochemical studies consist of both smooth muscle component and vascular components and results were correlated with
clinical data
Conclusion
IVL is a rare disease which is treated mostly by surgery. Hormone receptors (HRs) expression may be present and anti HRs targeted
therapies could be a therapeutic option. Recurrences may appear but causes inducing them are not well understood. Despite of its
dissemination through vascular pathway, tumor vascularization is mostly neglected related to the expression of specific markers
favoring intravascular tumor cells presence. MRI of the pelvis and CT of the thorax should be prescribed as follow-up.
Keywords: intravenous uterine leiomyomatosis, smooth muscle, vascular
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Expression and role of the SDF-1 factor and the CXCR4 receptor in the process of
invasion from extragenital endometriosis
Eugeniu Cazacu1, Eremei Zota1, Mihai Parnov1, Claudiu Margaritescu2

1) Morphopathology, Nicolae Testemitanu State University of Medicine and Pharmacy, Republic of Moldova
2) Pathology, University of Medicine and Pharmacy of Craiova, Romania
Introduction
The role of the SDF-1 (stromal cell-derived factor 1)/CXCR4 (chemokinin receptor CXCR4) axis should be mentioned given its clear
involvement in the processes of invasion and metastasis of many human malignant neoplasms. We were interested in studying the
involvement of this axis in the pathogenesis of extragenital endometriosis.
SDF-1 and CXCR-4 protein expression levels were detected by immunohistochemical staining in 42 cases of endometriosis and 8
cases on normal endometrium tissues.
Results
SDF-1andCXCR-4wereexpressedinbothendometriosislesionsandtheglandularepithelialcellsandmesenchymalcellsofnormal
endometrialtissue.Positivestainingsiteswerelocatedinthecytoplasm.Avaluewasusedtocalculateandanalyzetheexpressionof
immune staining. The expressions of these two in endometriosis lesions were significantly higher than that in normal endometrial
tissues, and the differences were statistically significant (P<0.05).
Conclusion
Bothmarkersweremuchmoreintenselyexpressedintheendometriosislesions.TheSDF-1factorthroughitsreceptorCXCR-4plays
a major role in the pathogenesis of endometriosis by promoting the proliferation of endometrial stromal cells.
Keywords: SDF-1, Endometriosis, CXCR-4
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Angiogenic therapy based on nanostructured silica/ Calendula officinalis extract

nanomaterial in heterotopic ovarian autotransplantation
Ion Mîndrilă1, Onabi Marjan1, Laura Andreea Mîndrilă1, Dan Eduard Mihaiescu2, Sandra Alice Buteică3
1) Department of Anatomy, University of Medicine and Pharmacy of Craiova, Romania
2) Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Romania
3) Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, Romania
Introduction
The angiogenesis process, which allows the development of an efficient microperfusion, is a determining factor for the survival and
maintenanceofthetransplantedovariesfunction.Topreventhypoxicischemiainjury,angiogenesis-stimulatingagentsmustbeused
to rapidly induce revascularization after transplantation. In this study we used a nanostructured silica/ Calendula officinalis extract
nanomaterial applied in the transplant bed to stimulate angiogenesis in the heterotopic autotransplanted ovaries.
TwelvefemaleWistarratswereusedfortheleftovaryautotransplantationinthecervical-dorsalsubcutaneousregion.Theharvested
ovaries were reimplanted after washing with saline solution (n=6), and after applying nanomaterial in the transplant bed (n=6). Two
weeks later, the ovaries (transplanted or non-transplanted) were harvested, processed by usual histological techniques, sectioned,
and stained with HE and trichrome azan for the morphological and morphometric assessment of the ovarian structure, follicles
counting, and the vascular density in the transplant bed.
Results
The results of this study showed a greater follicular reserve and an increased vascular density in rats with nanostructured bioactive
materials applied in the transplant bed
Conclusion
This study highlighted the beneficial potential of the nanostructured silica/ Calendula officinalis extract nanomaterial in the rapid
revascularization process of the autotransplanted ovary.
Keywords: ovary, heterotopic transplantation, angiogenesis, nanomaterial, Calendula officinalis
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Diagnostic Challenges in Placental Accretion
Raluca Anca Balan1, Teodora Ana Balan1, Simona-Eliza Giușcă1, Irina-Draga Căruntu1
1) Department of Morphofunctional Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy Iași, Romania
Introduction
Placenta percreta represents the most severe form of the placenta accreta spectrum, sometimes causing premature labor, heavy
peripartumbleeding,orgreatercomplicationswhendiagnosedintraoperativelyorwhentrophoblasticinvasioninvolvesneighboring
organs. Although the ultrasonography or magnetic resonance imaging contribute to the clinical diagnosis, they can sometimes lead
to diagnostic dilemma.
We present two particular cases of placenta percreta, one complicated with massive hematuria due to maternal bladder invasion,
with the surgical protocol performed and an excellent outcome, and a second case of retained placenta percreta associated with
acquired uterine arteriovenous malformation (AVM) mimicking a gestational trophoblastic disease, surgically treated, with a very
good outcome.
Results
A challenge of the first case was the ultrasound differential diagnosis between a solid bladder tumor and a giant blood clot. Uterine
ruptureandplacentalabruptionrepresentthedifferentialdiagnosisforbladderbleedinginducedbyplacentapercreta.Inthesecond
presented case, ultrasonography highlighted the specific features of acquired AVM, but the magnetic resonance raised the suspicion
of a gestational trophoblastic disease, due to the vascular abnormalities and increased beta-human chorionic gonadotrophin values.
The differential diagnosis of the preoperative imaging examination may take into account uterine fibroids, adenomyosis, isthmocele,
or leiomyosarcoma. In both cases, the placenta percreta, as well as urinary bladder involvement and uterine AVM were
histopathological documented on the surgical specimens.
Conclusion
Both presented particular cases of placenta percreta represent rare but sometimes life-threatening conditions, which should be
diagnosedearlyduringpregnancy,becauseoftheseriousfetalandmaternalimplications.Thegold-standardcertificationofplacenta
percreta, bladder involvement, or uterine arteriovenous malformation comes only after the histopathological examination.
Keywords: Placenta percreta, urinary bladder invasion, uterine arteriovenous malformation
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SOX2, E-cadherin, and P-cadherin interplay in breast cancer molecular subtypes
Alina-Cristina Barb1, Andrei Alexandru Cosma1, Mihaela-Maria Pasca-Fenesan1, Anca Maria Cîmpean1, Marius Raica1
1) Department of Microscopic Morphology/ Histology, Angiogenesis Research Center, "Victor Babes" University of Medicine and
Pharmacy Timisoara, Romania
Introduction
SOX2 or SRY (sex determining region Y)-box 2, E- and P-cadherin (Ecad, Pcad) are aggressiveness variables associated with
metastasis and anticancer drug resistance.
Fifty women with breast cancer provided tissue samples. The expression of SOX2, E-, and P-cadherin was assessed by
immunohistochemistry and linked with the breast cancer molecular subtypes. Membrane (M) and cytoplasmic (C) expression of E-
cadh and P-cadh were evaluated in this research.
Results
E-cadherin cytoplasmic / membranous expression was substantially linked with SOX2 expression in Luminal type A patients (p =
0.003).ForLuminaltypeBpatients,weidentifiedtheEcadM-/C+/SOX2+phenotypeanddiscoveredastrongconnectionbetween
E- cadherin and SOX2 (p = 0.001). The EcadM + / EcadC + / SOX2 + phenotype was seen in a comparable proportion of Luminal A,
HER2, and TNBC tumors. There was a statistically significant correlation (p = 0.037) between cytoplasmic/membrane P-cadherin
expression and SOX2 in HER2 patients. The greatest incidence of the Ecad.C+/Pcad+/SOX2+ phenotype has been seen in TNBC and
HER2 patients.
Conclusion
The E-cadC + / P-Cadh + / SOX2 + phenotype is predominantly observed in HER2 and TNBC cases, and it characterizes subgroups of
tumorswithanintenseepithelial-mesenchymaltransition,aspectsthatinducethedevelopmentofresistancetotherapy.Additionally,
the inclusion of SOX 2 in the molecular evaluation of breast cancer is required, due to its predictive role regarding the response to
therapy especially related to its involvement as marker of cancer stem cells.
Keywords: Breast cancer, SOX2, E-cadherin, P-cadherin, molecular subtypes
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Special cases in breast and intestinal pathology
Daniela Mihalache1, Oana Maria Balan1

1) Department of Pathology, Braila County Hospital, Romania
Introduction
Primary squamous cell carcinoma of the breast is a rare type of breast cacer with unique biological behaviour. This is a very
aggressive, hormone receptor negative and treatment refractory tumor with poor prognostic.
Small bowel adenocarcinoma is a rare tumor incidentally detected during laparotomy for intestinal obstruction or perforation. In
some cases , they are diagnosed during evaluation of obscure gastrointestinal bleeding.
We report tow special cases .
First case: primary squamous cell carcinoma of the breast in a 59-years-old postmenopausal lady who presented with a lump in the
left breast. Left mastectomy was performed and specimen send to histopathology analysis which suggested the diagnosis of
squamous cell carcinoma of the breast.
The second case: small bowel adenocarcinoma in a 74-years-old lady who presented with intestinal obstruction. Partial intestinal
resection was performed and specimen send to histopathology analysis which confirmed the diagnosis of small bowel
adenocarcinoma.
Results
Squamous cell carcinoma of the breast is the tumor of elderly age group and tumors frequently reach large volumes with lymph
nodes infiltration at the time of surgery in 10-30% of cases.
Becausetheincidenceofsmallboweladenocarcinomaislow,thereisaneedtofurtherstudiestoevaluatethepossibleapplicationof
strategies to obtain a better outcome.
Conclusion
Primary squamous cell carcinoma of the breast is very rare and aggressive tumour having poor prognostic. Clinical trials including
large series of these rare tumors are needed to improve patient's outcome.
Small bowel adenocarcinoma are difficult to diagnose because of nonspecific signs and symptoms, delayed presentation and
diagnosed during emergency for acute abdomen.
Keywords: breast, squamous cell, carcinoma, small bowel, adenocarcinoma
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Urinary System and Male Genital Pathology
Histopathological criteria in the renal transplant biopsy assessment
Irina-Draga Caruntu1,2, Andrei Daniel Timofte1, Andreea Simona Covic3,4, Simona-Eliza Giusca1,2
1) Department of Morphofunctional Sciences I, University of Medicine and Pharmacy , Romania
2) Department of Pathology, "Dr. C. I. Parhon" Clinical Hospital Iasi, Romania
3) Department of Internal Medicine - Nephrology, University of Medicine and Pharmacy , Romania
4) Department of Nephrology, "Dr. C. I. Parhon" Clinical Hospital Iasi, Romania
KidneytransplantpathologyisdirectlyassociatedwiththeBanffclassificationschemedevelopedsince1991throughtheinitiativeof
Professor Kim Solez from the University of Alberta in Edmonton, Canada. In parallel with the clinical and therapeutic approach, the
assessment principles of histopathological changes present in transplant pathology were progressively developed, through
conferences organized every two years. This initiative was conducted by a group of specialists in histopathology, immunology,
genetics, nephrology, surgery, biostatistics - thus defining the "Banff community" which, although apparently diverse, ensures an
integrated vision in renal transplant pathology. The original Banff classification scheme has registered updates that reflect the in-
depth understanding of the relationship between the immune mechanism involved in transplantation and the allograft microscopic
lesions. Each new classification scheme resulting from a Banff Conference has been introduced by a reference article published in
prestigious journals in the field, highlighting the changes made in classification and discussing the pathophysiological substrate of
microscopic lesions. In recent years, research directions focus of the Banff working groups are shown, underlining the effort to
standardize the diagnosis of renal transplant pathology through the evaluation of the molecular substrate and digital pathology,
machinelearning,andartificialintelligenceadvances.Thelecturecoversthemajormilestonesapplicableintheclassificationofrenal
transplant pathology, between 1991 and 2019. Starting from the classification schemes, the two major diagnostic classes are
reviewed:antibody-mediatedrejectionandTcell-mediatedrejection,withdetailsonactive,chronicactiveandchronicforms,andthe
semi-quantitativehistologicalscoresforspecificlesionsforthetwotypesofrejection,aswellasfornon-immunologicallesions.Each
score is illustrated with relevant images, which can be a starting point for training in kidney transplant pathology.
Keywords: kidney transplant, pathology, Banff classification
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Renal tumours – 2022 WHO classification
Simona-Eliza Giusca1,2, Bianca Mariana Chifu1, Andrei Daniel Timofte1, Irina-Draga Caruntu1,2
1) Department of Morphofunctional Sciences , "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
2) Department of Pathology, "Dr. C. I. Parhon" Clinical Hospital, Iasi, Romania
Renaltumorpathologyincludesseveraltumortypesdevelopedfromdifferentprecursorsthat,throughdistinctmolecularpathogenic
mechanisms, frequently associated with a particular genetic background, determine complex phenotypes.
Important amendments in terminology and concepts, the deciphering of elements of pathogenesis, and the identification of new
tumor types sustain the need for periodic updating of tumor classifications.
Forthespecialistsinrenaltumorpathology-histopathologists,oncologists,andurologists,2022isareferenceyearbyreportingona
highly expected publication - namely the latest, fifth edition of the WHO Classification of Tumours; Urinary and Male Genital
Tumours. The book is published 6 years apart from the previous edition.
The lecture aims to review the new elements in renal tumor pathology, namely: changes in the nomenclature, by introducing new
names and renal tumor entities; introduction of the molecularly defined renal carcinomas category; differentiation between the
classical papillary renal cell carcinoma and the "emerging entities" with papillary features; introduction of the "other oncocytic
tumors" category.
Keywords: renal tumours, emerging entities, WHO Classification
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Immunoexpression of E-caderin, Vimentin, and Beta-catenin in clear cell renal cell

carcinomas
Bianca Cătălina Andreiana1, Alex Emilian Stepan1, Raluca-Niculina Ciurea1, Claudiu Margaritescu1, Mirela Marinela Florescu1,
Anne-Marie Badiu1, Cristiana Eugenia Simionescu1
1) Pathology Department, University of Medicine and Pharmacy Craiova, Craiova, Romania
Introduction
Clear cell renal cell carcinomas (CCRCC) are the most common renal tumors and despite current advances in diagnosis, continue to
have high rates of metastasis and mortality.
The study included 40 CCRCC diagnosed in the Clinical Emergency County Hospital Craiova, between 2020 and 2021, the biological
material being represented by nephrectomy specimens, which were classically processed by paraffin embedding, stained with
hematoxylin-eosin and classified according to the latest criteria. We analyzed the E-cadherin, Vimentin and Beta-catenin
immunoexpression in relation to histopathological prognostic parameters. The quantification of the reactions was done through a
final score, calculated on the basis of reaction intensity and percentage of labeled cells. For the statistical analysis we used the chi-
square test within the SPSS20 software.
Results
Inthisstudy,mostCCRCCwereidentifiedinmalepatients(67.5%),themeanageatdiagnosisbeing60.4±10.2years.Thetumorsizes
werebetween2-16cm,withanaveragevalueof6.88cm.MostofthecaseswereclassifiedastumorstageIII(62.5%)andpresented
a low grade (77.5%). E-cadherin immunoreaction was positive in 90% of cases, Vimentin immunoreaction was present in all cases,
andBeta-cateninimmunoreactionwasidentifiedin75%ofcases.HighscoresofE-cadherinwerestatisticallysignificantlyassociated
with low-grade CCRCC. Vimentin reactions indicated statistically significant high scores for high-grade CCRCC and tumors that
presented vascular invasion. In the case of Beta-catenin, we found that membranous immunoexpression was predominant in low-
grade carcinomas, while membranous/cytoplasmic immunoexpression was significantly associated with high-grade, advanced-stage
lesions, with necrosis and vascular invasion.
Conclusion
Our study indicated variable immunoreactivity of E-cadherin, Vimentin and Beta-catenin in relation to histopathological prognostic
factors of CCRCC, which supports their utility in evaluating the aggressiveness of lesions and also can be used to determine tumor
heterogeneity and better stratify patients for therapy
Keywords: clear cell renal carcinoma, E-cadherin, Vimentin, Beta-catenin
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The utility of programmed death ligand-1 (PD-L1) immunohistochemical

assessment in muscle-invasive urothelial carcinomas
Andrada Loghin1,2, Adela Corina Nechifor-Boilă1,2, Angela Borda1,3, Alin Nechifor-Boilă4, Septimiu Voidăzan5, Myriam Decaussin-
Petrucci6
1) Histology Department, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș,
Romania
2) Pathology Department, Târgu Mureș County Hospital, Romania
3) Pathology Department, Târgu Mureș Emergency County Hospital, Romania
4) Urology Department, Târgu Mureș County Hospital, Romania
5) Epidemiology Department, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș,
Romania
6) Pathology Department, Universite Claude Bernard Lyon 1, Hopital Lyon Sud, France
Introduction
Prevalence of bladder cancer (BC), the ninth most common cancer worldwide, is increasing each year. The majority of BCs are
urothelial carcinomas (UC). Immune checkpoint inhibitors have been shown to induce durable responses in a subset of UC patients
with progressive disease following chemotherapy and in those who are cisplatin ineligible.
The aim of our study is to present some of the approved PD-L1 tests and their accompanying scoring algorithms used for the
assessmentofthePD-L1statusofpotentialimmunotherapycandidates(pembrolizumab:CPS≥10,companiondiagnosticassay22C3,
Dako; atezolizumab: IC score≥5%, companion diagnostic assay SP142, Ventana; durvalumab: TC%/IC%≥25%, companion diagnostic
assaySP263,Ventana)andalsotocomparetheperformanceofthenovelQR1clone(Quartett,Diagomic,Germany)withthoseofthe
standardizedclonesfortheIHCdetectionofPD-L1,andtodeterminethebestscoringalgorithmforassessmentofPD-L1expression
when using the QR1 clone.
Results
The use of these immune checkpoint inhibitors is now restricted to patients with PD-L1-positive tumors.
Conclusion
Therefore, expression of PD-L1 by tumor tissue, assessed by IHC, has become an important, clinically validated predictive biomarker
in guiding therapeutic decisions in patients with locally advanced or metastatic UCs.
Keywords: Immune checkpoint inhibitors , PD-L1, urothelial carcinoma
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SPINK1 immunohistological profile and its prognostic value in relation to TFF3

status in prostate adenocarcinomas
Andrei Daniel Timofte1, Simona-Eliza Giusca1,2, Nona Girlescu1, Iulian Prutianu1, Irina-Draga Caruntu1,2
1) Department of Morpho-functional Sciences, University of Medicine and Pharmacy "Grigore T. Popa" Iasi , Romania
2) Department of Pathology, "Dr. C. I. Parhon" Clinical Hospital Iasi , Romania
Introduction
Establishingthemolecularportraitassociatedtoprostateadenocarcinoma(ADK)isapriorityresearchdirectioninmalegenito-urinary
pathology. From the wide panel of biomarkers involved in prostate carcinogenesis, SPINK1 and TFF3 are „candidate” biomarkers for
defining distinct subsets of patients, in terms of prognosis.
Our study aimed to investigate the immunohistochemical profile of SPINK1 and TFF3 in sporadic prostate ADK and to analyze the
correlations between immunoexpression, classical clinicopathological parameters and biochemical recurrence.
The study group included 105 cases of sporadic prostate ADK treated by radical prostatectomy. Tissue specimens were
immunohistochemically analyzed by using anti-TFF3 and anti-SPINK1 antibodies. The studied cases were dichotomized into ADK
withpositiveandnegativeSPINK1status,respectively,accordingtoathresholdof10%positivityintumorcells,regardlessofstaining
intensity. TFF3 status was semi-quantitatively assessed as low and high.
Based on SPINK1 and TFF3 immunohistochemical profile, cases were classified into four subsets. For each subset, correlation
between SPINK1 immunoexpression, age, Gleason score, prognostic grade group, tumor stage, capsular, perineural, lymphovascular
invasion, and biochemical recurrence were statistically analyzed.
Results
SPINK+ status was confirmed only in the subset with TFF3 overexpression (12.38% of cases). Statistical correlation analysis revealed
significant differences between SPINK1 immunoexpression and TFF3 immunoexpression (p=0.0001). In this distinct subset, positive
SPINK1 immunoexpression was significantly correlated with age at disease onset (76.92% of cases under 65 y.o. – p=0.002),
prognosticgradegroup(76.92%ofcasesclassifiedinprognosticgradegroups3–p=0.001)andlympho-vascularinvasion(presentin
53.84%ofcases–p=0.004).SPINK1overexpressioninTFF3+subsetindicatedadecreaseofthebiochemicalrecurrence-freeinterval
compared to the other subsets, with no statistically significant association.
Conclusion
Our results define a distinct molecular subtype of prostate ADK characterized by concomitant overexpression of SPINK1 and TFF3,
with an aggressive clinical behavior and a rapid course towards biochemical recurrence.
Keywords: prostate adenocarcinoma, SPINK1, TFF3
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Cerebrovascular Diseases
Wide Studies in Ischaemic Stroke: Are Genetics Only Useful for Finding Genes?
Israel Fernández Cadenasi1

1) Institut de Recerca Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
Genetic factors are associated with the risk of stroke. Moreover, recent studies have found genetic variants associated with stroke
acute and long-term outcome. Genome-wide Association Studies (GWAS) are a powerful tool to find genetic risk factors in complex
diseases. However, the data generated by these studies may also be useful in other disciplines. This “big data” combined with other
“omic data” such as epigenetics, proteomics or transcriptomics and complex bioinformatic analysis can be used to understand the
biological mechanisms associated with stroke risk and stroke outcome. Moreover, the “big data” can be useful to find potential drug
targets and potential treatments using repurposing drug analysis.
Keywords: genetic factors, stoke, big data, omic data
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Genetic tools to convert astroglia to neurons after cerebral ischemia
Aurel Popa-Wagner1
1) Department of Biochemistry, University of Medicine and Pharmacy of Craiova, Romania
Ischemic stroke represents the 2nd leading cause of death worldwide and the leading cause for long-term disabilities, for which no
cure exists. After stroke, neurons are frequently lost in the infarct core. On the other hand, other cells such as astrocytes become
reactiveandproliferative,disruptingtheneurovascularunitinthelesionedarea,especiallyintheagedbrain.Therefore,restoringthe
balance between neurons and nonneuronal cells within the perilesional area is crucial for post stroke recovery. In addition, the aged
post stroke brain mounts a fulminant proliferative astroglial response leading to the buildup of gliotic scars that prevent neural
regeneration.Therefore,"melting"glialscarshasbeenattemptedfordecades,albeitwithlittlesuccess.Alternativestrategiesinclude
transforming inhibitory gliotic tissue into an environment conducive to neuronal regeneration and axonal growth by genetic
conversion of astrocytes into neurons. The latter idea has gained momentum following the discovery that in vivo direct lineage
reprogramming in the adult mammalian brain is a feasible strategy for reprogramming nonneuronal cells into neurons. This exciting
newtechnologyemergedasanewapproachtocircumventcelltransplantationforstroketherapy.However,thepotentialofthisnew
methodology has not been yet tested to improve restoration of structure and function in the hostile environment caused by the
fulminant inflammatory reaction in the brains of aged animals.
Keywords: adenoviral vectors, astroglia, genetic conversion, stroke, therapy
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Characterization of microglia behavior (morphology and phagocytosis) in healthy

and pathological conditions with image analysis tools
Valérie Petegnief1,2, Aleix Martinez3, Jean-Karim Hériché4, Maria Calvo5, Christian Tischer6, Amaia Otxoa de Amezaga7, Anna
Bosch5, Anna M. Planas1,2
1) Department of Neuroscience and Experimental Therapeutics, Institute for Biomedical Research of Barcelona (IIBB). Spanish
Research Council (CSIC), Spain
2) Institut d’Investigacions Biomèdiques Augustí Pi i Sunyer, Barcelona, Spain
3) Institute for Bioengineering of Catalonia, Barcelona, Spain
4) Cell Biology and Biophysics Unit, European Molecular Biology Laboratory, Heidelberg, Germany
5) Advanced Optical Microscopy Facility, University of Barcelona, Barcelona, Spain
6) Centre for BioImage Analysis, European Molecular Biology Laboratory, Heidelberg, Germany
7) Achucarro Basque Center for Neuroscience and Department of Neuroscience, University of the Basque Country UPV/EHU, Leioa,
Spain
Introduction
Microglia are very sensitive to changes in the environment and respond through morphological transformation, phagocytosis and
metabolism adaptations. In order to depict microglia behavior in healthy and pathological conditions, we developed image analysis
programs to quantify neuronal death, microglia morphologies and phagocytosis.
Primary mice neuronglia cultures, in which microglia express the tdTomato protein, were exposed to excitotoxic or
excitotoxic+inflammatory challenges and analyzed 8h later in time-lapse acquired in a confocal microscope. Neuronal death was
assessed by SYTOX staining of nucleic debris and phagocytosis through the engulfment of green SYTOX positive particles in red
microglia.
Results
We identified 7 morphologies (round, hypertrophic, fried- egg, bipolar and 3 “inflamed” morphologies) and found the morphometric
features able to describe them. Through machine learning, we generated a classifier able to separate them and assign one of the 7
classes to microglia in sample images. In control cultures, round and hypertrophic morphologies were the most abundant and
excitotoxicity did not promote changes in the distribution of the populations. In contrast, excitotoxicity+inflammation decreased the
round and hypertrophic populations and increased the proportion of inflamed morphologies.
Conclusion
Excitotoxicity and excitotoxicity+inflammation significantly increased the percentage of phagocytosing microglia to a similar extent.
Our data suggest that in vitro accumulation of dead cells is not sufficient at least in our model to significantly modify microglia
behavior at early time-points (up to 12h) and that inflammation is critical to promote phenotypical changes in microglia.
Keywords: microglia, phenotyping, apoptosis, inflammation
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Effects and mechanisms of mesenchymal stromal cell-derived small extracellular

vesicles in the ischemic brain
Dirk Hermann1
1) Department of Neurology, University Hospital Essen University of Duisburg-Essen, Germany
Obtained from the right cell-type, mesenchymal stromal cell (MSC)-derived small extracellular vesicles (sEVs) promote stroke
recovery. Within this process, microvascular remodeling plays a central role. Herein, we evaluated the effects of MSC-sEVs on the
proliferation, migration, and tube formation of human cerebral microvascular endothelial cells (hCMEC/D3) in vitro and on post-
ischemic angiogenesis, brain remodeling and neurological recovery after middle cerebral artery occlusion (MCAO) in mice. In vitro,
sEVs obtained from hypoxic (1% O2), but not 'normoxic' (21% O2) MSCs dose-dependently promoted endothelial proliferation,
migration, and tube formation and increased post-ischemic endothelial survival. sEVs from hypoxic MSCs regulated a distinct set of
miRNAs in hCMEC/D3 cells previously linked to angiogenesis, three being upregulated (miR-126-3p, miR-140-5p, let-7c-5p) and
three downregulated (miR-186-5p, miR-370-3p, miR-409-3p). LC/MS-MS revealed 52 proteins differentially abundant in sEVs from
hypoxic and 'normoxic' MSCs. 19 proteins were enriched (among them proteins involved in extracellular matrix-receptor interaction,
focal adhesion, leukocyte transendothelial migration, protein digestion, and absorption), and 33 proteins reduced (among them
proteins associated with metabolic pathways, extracellular matrix-receptor interaction, focal adhesion, and actin cytoskeleton) in
hypoxic MSC-sEVs. Post-MCAO, sEVs from hypoxic MSCs increased microvascular length and branching point density in previously
ischemictissueassessedby3Dlightsheetmicroscopyoverupto56days,reduceddelayedneuronaldegenerationandbrainatrophy,
andenhancedneurologicalrecovery.sEV-inducedangiogenesisinvivodependedonthepresenceofpolymorphonuclearneutrophils.
Inneutrophil-depletedmice,MSC-sEVsdidnotinfluencemicrovascularremodeling.sEVsfromhypoxicMSCshavedistinctangiogenic
properties. Hypoxic preconditioning enhances the restorative effects of MSC-sEVs.
Keywords: MSCs, EVs, hCMEC, MCAO, neutrophils, mice
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The circadian rhythm within the suprachiasmatic nucleus in aging and disease
Kilic Ertugrul1
1) Department of Physiology, Istanbul Medipol University, Istanbul, Turkey
Introduction
The circadian rhythm is driven by a master clock within the suprachiasmatic nucleus which regulates the rhythmic secretion of
melatonin. Bmal1 coordinates the rhythmic expression of transcriptome and regulates biological activities, involved in cell
metabolism and aging. However, the role of Bmal1 in cellular- survival, signaling, its interaction with intracellular proteins, and how
melatonin regulates its expression is largely unclear.
Here we observed that melatonin increases the expression of Bmal1 and both melatonin and Bmal1 increase cellular survival after
oxygen glucose deprivation (OGD) while the inhibition of Bmal1 resulted in the decreased cellular survival without affecting
neuroprotective effects of melatonin.
Results
By using a planar surface immunoassay for PI3K/AKT signaling pathway components, we revealed that both melatonin and Bmal1
increased phosphorylation of AKT, ERK-1/2, PDK1, mTOR, PTEN, GSK-3AlphaBeta, and p70S6K. In contrast, inhibition of Bmal1
resultedindecreasedphosphorylationoftheseproteins,whichtheeffectofmelatoninonthesesignalingmoleculeswasnotaffected
bytheabsenceofBmal1.Besides,theinhibitionofPI3K/AKTdecreasedBmal1expressionandtheeffectofmelatoninonBmal1after
both OGD in vitro and focal cerebral ischemia in vivo.
Conclusion
Our data demonstrate that melatonin controls the expression of Bmal1 via PI3K/AKT signaling, and Bmal1 plays critical roles in
cellular survival via activation of survival kinases.
Keywords: circadian rhythm, Bmal1, melatonin, transcriptome, PI3K/AKT pathway
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Monomeric C-reactive protein in aging and cerebrovascular diseases
Mark Slevin1
1) Metropolitan University of Manchester, Manchester, UK
Monomeric C-reactive protein (mCRP), the dissociated form of native C-reactive protein, is a critical molecule that causes and
perpetuates inflammation in serious diseases. It has 'adhesive'-like properties causing aggregation of blood cells and platelets, and
can stick permanently within arterial tissue where it can contribute to further complications including thrombosis, linking it
potentially to atherosclerosis and subsequent acute coronary events. In this mini review, we discuss briefly the implications and the
potential value of measuring and manipulating it for clinical diagnostics and therapeutic purposes.
Keywords: mCRP, inflammation, atherosclerosis, diagnostics, therapy
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Mesenchymal stem cell derived extracellular vesicles - a new approach for cell
therapies in stroke patients
Roxana Surugiu1, Aurel Popa-Wagner1, Dirk Hermann2

1) Department of Biochemistry, University of Medicine and Pharmacy of Craiova, Craiova, Romania
2) Department of Neurology, University of Duisburg-Essen, Germany
Introduction
Beingtheleadingcauseofdeathandlong-termdisabilitiesandwithonlyafewtreatmentoptions,stroketherapiesisaresearchfield
where urgent studies on animal models are required in order to start the human clinical trials. To improve brain remodelling and
plasticity, and to bypass limitations of endogenous neurogenesis following ischemic stroke, small extracellular vesicles (sEVs)
obtained from mesenchymal stromal cells (MSCs) can be used to promote neurological recovery after middle cerebral artery
occlusion (MCAO) in rodents. .
Male Sprague-Dawley rats divided into two groups: young (4-5 months) and old (19-20 months) were both subjected to permanent
distal MCAO (middle cerebral artery occlusion). Vehicle or MSC-sEVs (2x10^6 or 2x10^7 MSC equivalents/kg) were given
intravenously at 24 hours, 3 days, and 7 days after the stroke. Over the course of 28 days, we assessed neurological impairments
using behavioural tests, followed by immunohistochemistry to analyse brain inflammatory responses, angiogenesis, and
neurogenesis.
Results
Aged vehicle-treated rats displayed more severe motor-coordination deficits assessed by rotating pole and cylinder tests, as well as
greater brain infarcts, compared to young vehicle-treated rats. MSC-sEVs did not affect infarct volume, but they significantly
decreased motor-coordination deficits in both young and old rats. Age-related differences in vehicle-treated rats' levels of brain
macrophage infiltrates in the periinfarct tissue were observed. These infiltrates were considered a symptom of an inflammatory
environment that inhibits healing. sEVs reduced brain macrophage infiltrates in the old group. Also, periinfarct angiogenesis was
increased by sEVs at both doses in young and old rats as assessed by CD31/BrdU double staining, and low-dose sEVs increased
neurogenesis in the subventricular area as assessed by DCX/BrdU double staining.
Conclusion
Our study provides strong evidence that MSC-sEVs improve functional neurological recovery and brain tissue remodeling. This work
promotes additional proof-of-concept investigations in stroke scenarios relevant to clinics.
Keywords: MSCs, aging, EVs, exosomes, stroke
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Modulation of intracerebral Abeta amyloid deposition by controlling Aquaporin 4

water channel on a mouse model of Alzheimer’s disease
Marina-Daniela Manescu1, Bogdan Catalin2, Gabriela Camelia Rosu1, Anca-Maria Istrate-Ofiteru 1, Ionica Pirici3, Laurentiu
Mogoanta1, Daniel Pirici1
1) Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
2) Department of Physiology, University of Medicine and Pharmacy of Craiova, Romania
3) Department of Human Anatomy, University of Medicine and Pharmacy of Craiova, Romania
Introduction
The interstitial fluid of the brain parenchyma drains to the cervical lymph nodes through the paravascular spaces in the thickness of
the vascular basement membranes. Aquaporin 4 (AQP4) is the most important water channel in the CNS, at the interface between
astrocyteend-feetsandvascularbasementmembranes,andAQP4knock-outanimalmodelscarryingamyloidprecursorprotein(APP)
and presenilin 1 mutations (PS1) lead to Abeta amyloid deposition especially around blood vessels (cerebral amyloid angiopathy),
compared to predominantly intraparenchymal deposits in APP/PS1 animals.
Here,doubletransgenicmiceforAPPSwedish(KM670/671NL)mutationandforthePS1(L166P)mutationweretreatedfor1month
with an AQP4 inhibitor (TGN-020) and a facilitator (TGN-073), in doses of 200 mg/kg (N= 10/group). The animals started the
treatment at the age of 1 month, when amyloid deposits begin to appear in this model, and after a month of daily treatment they
were euthanized, and the brains processed for immunohistochemistry for Abeta, glial cells and blood vessels (CD31). A batch of
untreated PSAPP animals were included as a control group (N=10). The sections were scanned at high resolution (80×) using a slide
scanner, and the number of amyloid plaques, the distance to the nearest blood vessel, the density and the average area of the
deposits were counted.
Results
Our study showed a variability of amyloid deposits and glial cells’ densities in the brains of animals treated with the two AQP4
modulators, compared to untreated animals, illustrating for the first time that a modulator of the perivascular drainage of the
interstitial fluid can change the number and morphology of amyloid deposits, despite an overt Abeta overexpression in these animal
models.
Conclusion
TheseresultssupportsthehypothesisthatthefunctionaldeficiencyofAQP4thatoccurswithage-relatedvascularchanges,favorsthe
accumulation of Abeta in patients with Alzheimer's disease.
Keywords: Alzheimer's disease, Aquaporin 4, paravascular drainage
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Vascular and glial changes in the brain of COVID-19 patients
Gabriela Camelia Rosu1, Valentin Octavian Mateescu 1, Alexandra Simionescu 3, Anca-Maria Istrate-Ofiteru 1, George Cristian
Curcă 2,3, Ionica Pirici 4, Laurentiu Mogoanta 1, Ion Mindrila 4, Samir Kumar-Singh 5, Sorin Hostiuc 2,3, Daniel Pirici1
2) Department of Legal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
3) “Mina Minovici” , National Institute for Legal Medicine – Bucharest, Romania
4) Department of Human Anatomy, University of Medicine and Pharmacy of Craiova, Romania
5) Laboratory of Cell Biology & Histology, Molecular Pathology Group, Faculty of Medical & Health Sciences, University of Antwerp,
Belgium
Introduction
Lung damage caused by SARS-CoV-2 infection is the central element of the 2019-nCoV acute respiratory syndrome (COVID-19). At
the level of the CNS, a multitude of changes have been described, such as microglial activation, perivascular lymphocyte cuffing,
hypoxic-ischemic changes, microthrombosis, infarcts or hemorrhages.
We analyzed the light microscopy morphology of the vascular basement membranes and the perivascular astrocytes from brain
fragments taken from 14 patients with SARS-CoV-2 infection confirmed by RT-PCR, and compared it to 4 control patients. Brain
tissues were immunostained for basement membranes (collagen IV), astrocytes (GFAP), as well as for endothelia (CD31), Tight
Junction 1 (TJ1) adhesion protein and Aquaporin 4 (AQP4) water pore protein. On 3D rendered images from the cortex and white
matter, we calculated vessel densities and diameters, degree of gliosis, collagen IV/GFAP and GFAP/AQP4 colocalization ratios, as
well as the fractal dimension (FD) of astrocytes and vascular basement membranes viewed in tangential planes.
Results
Reactive gliosis did not exceed the levels found for control patients, however, the FD values of GFAP revealed lower branching
complexitiescomparedtocontrols,andGFAP-collagenIVcolocalizationalsodecreasedinCOVID-19patients.Bloodvesseldiameters
increased in COVID-19 cases, especially for the white matter, and TJ1 protein decreased its colocalization with the endothelia. Blood
vessel basement membranes showed significantly increased irregularities (FD values) compared to control cases.
Conclusion
The irregularity of the basement membranes and reduction of the astrocyte end-feet suggest important morphological changes of
the BBB in COVID-19 brains that could be causally linked with hypercoagulability stability and ischemia/hypoxia in these patients.
Keywords: COVID-19, brain vessels, vascular basement membranes, fractal dimension, astrocytes
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Medical Resident Experience
Antigen Presenting Cells in Oral Papillomatosis
Elena Cristina Andrei1, Cristina Maria Munteanu2, Ileana Monica Baniță1

1) Histology, University of Medicine and Pharmacy Craiova, Romania
2) Oro-Maxillo-Facial Surgery, Univeristy of Medicine and Pharmacy Craiova, Romania
Introduction
Antigen presenting cells are represented by macrophages and dendritic cells. These cells have a role in the activation of T
lymphocytes and effector cells of the acquired immune system. Macrophages are localized in the lamina propria of the oral cavity
mucosaandplayanessentialroleininnateandalsoinadaptativeimmuneresponse.FollowingthebindingoftheTollLikeReceptors
(TLRs) from keratinocytes to the HPV, the activation of dendritic cells (Langerhans cells in epithelium) and resident macrophages is
determined
We intend the assessment of macrophages and dendritic cells in HPV positive infection versus nonconfirmed HPV papilomatosis of
oral mucosa.
The samples of oral mucosa diagnosticated with papillomatosis were processed for paraffine imbedding; sections of 4µm were
incubated with CD68 for macrophages, langerin - marker for Langerhans cells and CD83, one of the best-known maturation markers
for human dendritic cells.
Results
TheincidenceofLangerinandCD83markedcellswasdifferentbetweenthetwogroupsofsubjects(HPVpositiveandHPVnegative
papillomatosis).Langerinewaspositiveincellsresidentinbasalinparabasallayeroftheepithelium,andsometimesthosecellswere
also positive for CD83.
Conclusion
In HPV infection, the viral oncoproteins intervenes in mobilisation and maturation of Langerhans cells, as we demonstrated in our
work.
Keywords: oral papillomatosis, HPV, antigen presenting cells, macrophages, Langerhans cells, langerine
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Keratinocytes Involvement in Oral Human Papilloma Virus infection
Elena Cristina Andrei1, Cristina Maria Munteanu2, Ileana Monica Baniță1

1) Histology, University of Medicine and Pharmacy Craiova, Romania
2) Oro-Maxillo-Facial Surgery, Univeristy of Medicine and Pharmacy Craiova, Romania
Introduction
The life cycle of the Human Papilloma Virus (HPV) is entirely intraepithelial, and the infection does not produce local inflammation,
cellular apoptosis or cytolysis. Keratinocytes are known as non-professional presenting antigens cells, defined as ‚immune sentinels’
with role in initiating the local immune response.
The evolution of the papillary lesions caused by HPV infection in the oral cavity is drive by Toll Like Receptors (TLR) guiding the
innate immune system to neutralize the virus. Through the activation process of TLR at the level of keratinocytes, the production of
typeIinterferontakesplace,butanimprovementinthecytotoxicresponseofTh1lymphocytesisalsopresent.Areducedexpression
of TLRs is suggestive of the progression of the pathology, while their increased expression indicates the regression infection and the
virus clearing. From the TLRs present on the keratinocytes, TLR9 seems to be the more important in recognizing HPV.
Detection of TLR9 was performed by immunohistochemistry on gingiva samples from lesions diagnosticated with papillomatosis,
confirmed or not HPV positive by PCR method. Paraffin embedded samples were processed through the usual sequence of the
immunohistochemical technique using as antibody TLR 9 in dilution 1:100.
Results
The incidence and the intensity of the immunohistochemical reaction was different in the HPV positive versus HPV negative lesions.
We noted the immunoreaction manly in the keratinocytes of all the layers of the epithelium, but also in some nonkeraticytar cells in
epithelium.Afaintimmunopositivereactionwasnoticedinproinflammatorycellsandsometimesinendothelialcellsfromthelamina
propria. In HPV positive papillomatosis the immunopositivity was generally less present or even absent.
Conclusion
Our results suggest that the innate immune response may be compromised, depending on the type of HPV, from its first step – the
TLR9 activation.
Keywords: keratinocytes, HPV, immune system, Toll Like Receptors
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Paget's vulvar disease - Case Report
Maria Cătălina Popelea1, Andreea-Raluca Szőke1,2, Ovidiu Simion Cotoi1,2

1) Department of Pathology, Mureș Clinical County Hospital, Târgu Mureş, Romania
2) Department of Pathophysiology, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu
Mureș, Romania
Introduction
Extramammary Paget's disease (EMPD) is a rare dermatological condition, with only a few hundred cases reported in the literature,
that occurs in areas where apocrine sweat glands are abundant, most commonly affecting the vulva (65%). There is an important
association between EMPD and another underlying malignancy in 10% - 30% of cases, so a thorough investigation is mandatory.
A 78-year-old patient presents a vulvar tumor, from which an incisional biopsy was performed for histopathological diagnosis.
Results
Two tissue fragments with dimensions of 3x3x1 mm and 3x2x1 mm, respectively, were examined. On microscopic examination, a
squamous epithelium with marked architectural disorder was observed, containing in the basal layer clusters of large, vacuolated,
atypical cells with pale, eosinophilic cytoplasm and enlarged nuclei. Tumor cells migrate isolated or in nests towards the surface,
being present including in the stratum corneum. Vulvar intraepithelial neoplasia (VIN), vulvar melanoma and extramammary Paget's
diseasewithvulvarlocalizationwereconsideredforthedifferentialdiagnosis,forwhichvariousimmunohistochemicalreactionswere
performed. Immunohistochemically, the tumor cells were positive for CK7, CEA and negative for CK20 and SOX10. CK7 highlights
the involvement of the adnexal epithelium (hair follicles, sweat glands). The nuclear proliferation index Ki-67 marks tumor cells and
is more expressed in the basal and intermediate layer of the epithelium. No dermal invasion was observed on the fragments
examined.
Conclusion
The particularity of this case is represented by the fact that an incisional biopsy was performed for the diagnosis, the treatment of
choice for this condition being the complete excision of the tumor, at the same time establishing the real extent of the disease
following the surgical intervention. A multidisciplinary team is required for the management of this condition, the risk of an
associated malignancy together with the high recurrence rate make the prognosis of these patients reserved.
Keywords: Paget's Disease, immunohistochemistry, vulvar, CK7
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Immature ovarian teratoma first detected after pregnancy: a case report
Andreea-Raluca Szőke1,2, Mihaela Covaciuc1, Maria-Cătălina Popelea1, Andrada Raicea1, Jenő Róbert Bartha1, Ovidiu S. Cotoi1,2,
Marius-Florin Coroș3, Sabin Gligore Turdean1,4
1) Pathology Department, Mureș County Clinical Hospital, Romania
2) Department of Pathophysiology, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu
Mureș, Romania
3) General surgery Department, Mureș County Clinical Hospital, Romania
4) Morphopathology Department, George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș,
Romania
Introduction
Ovarian teratoma is a tumor composed of cells from the three germ layers, with a variable content of mature and immature tissue.
The tumor generally occurs in young women and the classification is carried out according to the amount of neuroectoderm.
A 23-year-old patient presents with a lack of bowel movements for about 48 hours. The patient had a full-term pregnancy with
natural childbirth six months ago. The CT scan revealed an abdominopelvic mass of 260x230x160 mm. Following surgery, a right
ovarian tumor with a heterogeneous appearance (cystic spaces with serous content and solid areas with hemorrhage and hair
follicles) was found. Microscopically, the tumor consisted of a proliferation of mature tissues derived from all three embryonic layers:
keratinized squamous epithelium, intestinal glandular epithelium, respiratory epithelium, choroid plexus, glial tissue, bone and
cartilaginous tissue, muscle, and connective tissue. Multiple foci of immature tissue (25%) represented by tubules and
neuroectodermalrosetteswithhyperchromaticcellsandfrequentmitosiswereseen.Theseareaswereidentifiedintwo"lowpower"
fields.Theimmunohistochemistrystudyrevealedapositivecalretinininhyperplasticmesothelialcellsandfocal-positivereactionsof
S100 and NSE in tumor cells.
Results
Histopathological diagnosis was mature teratoma and immature teratoma histological grade 2, stage pT1C2NxM0, FIGO IC. The
patient received oncological treatment with specific chemotherapy. The pet-CT control examination performed after six months did
not reveal recurrences or tumor metastases.
Conclusion
Immatureovarianteratomasduringpregnancyarerare,accountingforlessthan1%ofovariantumors.Inthiscase,ovarianteratoma
was first detected after pregnancy because of compression of the abdominal organs and intestinal occlusion. Acceleration of tumor
growth may be due to hormonal changes associated with pregnancy and the postpartum period. Early histopathological diagnosis,
surgical intervention, and oncological treatment play an important role in the prognosis of this type of tumor.
Keywords: immature ovarian teratoma, postpartum, immunohistochemistry
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Aspects of CD8 and endoglin immunoexpression in myocytic neoplasms of the

uterine body
Madalina Bosoteanu1,3, Mariana Deacu1,3, Mariana Așchie1,2, Raluca Ioana Voda1,2,4, Cristian Ionut Orasanu1,2,4, Roxana Cleopatra
Penciu5, Sergiu Ioachim Chirila6
1) Clinical Service of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Romania
2) Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology -CEDMOG, “Ovidius”
University of Constanţa, Romania
3) Department of Pathology, Faculty of Medicine, “Ovidius” University of Constanţa, Romania
4) Institute of Doctoral Studies, Doctoral School of Medicine, “Ovidius” University of Constanţa, Romania
5) Department of Obstetrics and Gynecology, Faculty of Medicine, “Ovidius” University of Constanţa, Romania
6) Medical Informatics and Biostatistics, Faculty of Medicine, "Ovidius" University of Constanta, Romania
Introduction
Thetumorallymphocyticinfiltratepresupposesthepresenceofspecifickillerlymphocytesinthetumormicroclimate.Foraneffective
anti-tumor immune response, the activation and co-stimulation of all the lymphoid components of the immune system is necessary.
CD105 is a type I transmembrane endothelial glycoprotein indispensable and with a key role in the treatment of tumor angiogenesis.
We performed a 5 years retrospective study that included: active mitotic leiomyoma, symplastic leiomyoma, leiomyosarcoma and
tumors with uncertain malignant potential originating in the uterine body. The immunohistochemical evaluation was performed
using CD8 and CD105 antibodies. The statistical analysis was performed with the SPSS Statistics Version 26 program.
Results
Weidentifiedthefollowingcases:4mitoticallyactiveleiomyomas,7symplasticleiomyomas,3smoothmuscletumorswithuncertain
malignant potential and 9 leiomyosarcomas. The average number of positive CD8 cells was statistically significantly associated with
age(p=0.038),diagnosis(p=0.011),hormonalstatus(p=0.009)andthepresenceofdiabetes(p=0.012),andCD8markerpositivitywas
significantly associated with the severity of atypia (p=0.024). The number of CD105+ capillaries was significantly associated with
lympho-vascular invasion, the number of positive capillaries being higher in patients with tumor emboli present (p=0.034).
Conclusion
After performing the statistical analysis, we observed numerous correlations with the data from the literature, but also new
associations that indicate the possibility of using other categories of immunological and angiogenic therapeutic agents, with the aim
of increasing the response rates to oncological treatment, but also the survival of patients.
Keywords: CD8, Endoglin, Uterus
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Colorectal adenocarcinoma and precursors
Daniela Mihalache1
Introduction
Colorectal carcinoma is one of the most common cancers and one of the leading causes of cancer-related death.Pathologic
examination of biopsy, polypectomy and resection specimens is crucial to appropriate patient management, prognosis assessment
and family counselling.
We performed a histological analysis of patients with colorectal carcinoma and precursors seen at our institution from 2019 to
2022.A total of 160 primary colorectal carcinoma and 27 precursors.Our study demonstrates that most cases were diagnosed
between the ages of 75-85 years.
Results
Our study presents the histopathology of colorectal carcinoma and its precursor lesions, with an emphasis on their clinical relevance.
Conclusion
Colorectal carcinoma is infrequently under 40 years of age and have a predilection for the distal colon.
Keywords: colorectal carcinoma, carcinoma precursors, primary colorectal
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Expression of serine/threonine kinase isoform PIM-1 in a monomorphic

epitheliotropic intestinal T-cell lymphoma
Miruna Cristian1,2,3, Madalina Bosoteanu1,3, Mariana Așchie2,3,4, Anca-Florentina Mitroi2,3, Costel-Stelian Branzan2,3, Catalin-
Adrian Bosoteanu3, Gabriela-Izabela Baltatescu2,3, Mariana Deacu 1,3
1) Faculty of Medicine , ”Ovidius” University of Constanta, Romania
2) Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology -CEDMOG, ”Ovidius”
University of Constanta, Romania
3) Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Romania
4) Academy of Medical Sciences, Bucharest, Romania
Introduction
The aggressively peripheral extranodal T-cell lymphoma known as monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL)
is uncommon in native European and Caucasian populations. The report outlines the clinicopathological and molecular features and
diagnostic strategy of this rare lymphoma subtype.
An abdominal mass, intestinal transit disorders, and weight loss are all symptoms a 69-year-old male patient is experiencing.
Following the clinical and imaging studies, the small intestine has been surgically removed along with other sections that were
involved. After the histopathological evaluation, the use of monoclonal antibodies was required. Total DNA was extracted and
purifiedusingtheextractionkitQiaAmpDNAFFPETissueKit(Qiagen,Germany)tomeasuretheDNAlevelsofthisgeneinMEITLcell
lines, primary tumoral, and normal T cells as well as to assess the efficacy of the PIM1 gene'knockdown. The expression of the PIM1
gene was measured using quantitative RT-PCR and TaqMan SNP Assay for PIM1.
Results
The tumour's morphology revealed a proliferation of medium- to large-sized monomorphic lymphocytes with vesicular nuclei,
protruding nucleoli, and a significant proportion of clear to pale eosinophilic cytoplasm, along with a small number of rare Reed-
Sternberg-like cells. The T cell proliferation line and the diagnosis of MEITL were both validated by immunohistochemical analysis
utilizing CD3, CD8, CD5, CD20, and CD30. Relative Quantification (RQ) was computed using the CT technique, and the outcome
indicated that the PIM1 gene was not present.
Conclusion
In conclusion, we described a rare case of MEITL, with the absence of gene PIM1, that was correctly diagnosed based on the typical
immunophenotypefeatures,epitheliotropicpatternsandmonomorphiccellshapeandinviewofthedifferencesinepidemiologyand
clinicopathologic features, we strongly believe that it is justified to separate out type II EATL from the EATL category as a distinct
form of lymphoma, with the lack of association with coeliac disease.
Keywords: Case report, Non-Hodgkin, Lymphoma, T-cell, Proto-Oncogene Protein pim-1
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Predictive clinicopathological factors for metastasis in cutaneous melanomas: a

case series and review of literature
Dana Antonia Țăpoi1,2, Adrian Vasile Dumitru1,2, Andrei Marin3, Maria Sajin1,2, Mariana Costache1,2, Ana Maria Ciongariu1,2
1) Department of Pathology, University Emergency Hospital, Bucharest, Romania
2) Department of Pathology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
3) Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy,
Bucharest, Romania
Introduction
Cutaneousmelanomasrepresentaggressivemalignancies,oftendiagnosedinlocallyadvancedstages.Ouraimistoestablishtherisk
for metastasis present at the time of the initial diagnosis of stage T4 skin melanomas, based on epidemiological and
histopathological features in order to provide better follow-up of such patients.
Wereportaseriesof21casesofstageT4cutaneousmelanomas,diagnosedhistopathologicallyattheUniversityEmergencyHospital
of Bucharest, since 2019. Full body CT scans were performed. We analysed the demographic, clinical and histopathological
characteristicsofeachcasetodeterminehowthesecouldpredictthepresenceofmetastasis.Wealsoperformedanextensivereview
of literature.
Results
11 patients were diagnosed with metastasis. Overall, female and male patients were almost equally represented, but males are
significantly more likely to have metastasis. The mean age was 67.52. While the patients in metastasis group were older, the
difference wasn’t significant. Melanoma subtype is a major prognostic factor, nodular melanomas being the most common in
metastatic cases. High mitotic rates, vascular emboli, perineural invasion and necrosis are strongly associated with metastasis. The
patternoftumor-infiltratinglymphocytes,ulceration,regressionandClarkleveldon’tdiffersignificantly.Breslowthicknesswashigher
in the metastatic group but the difference wasn’t relevant.
Conclusion
Locallyadvancedmelanomaisoftenassociatedwithmetastasisattheinitialpresentation.Olderpatients,particularlymales,aremost
likely to have widespread disease. Thorough histopathological examination is useful for identifying patients that require immediate
investigation to assess the presence of metastasis in order to provide the best therapeutic options.
Keywords: cutaneous, melanoma, metastasis, risk, factors
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Recurrence of nevoid melanoma – a case report
Raluca Niculescu1,3, Andreea Tinca1,3, Iuliu Gabriel Cocuz1,3, Emil Negovan2, Ovidiu Simion Cotoi1,3
1) Pathophysiology , University of Medicine, Pharmacy, Sciences and Technology G.E.Palade, Romania
2) Plastic Surgery, Mureș Clinical County Hospital , Romania
3) Pathology, Mureș Clinical County Hospital , Romania
Introduction
Melanoma represents one of the most complicated and complex pathologies within dermatopathology, due to its aggressive
behavior. Nevoid melanoma is a rare form of melanoma, which presents high recurrence rate and it is often mistaken with a benign
tumor.
We describe the case of a male patient, aged 74, with the clinical diagnosis of a recurrent tumor on the back. Previously he was
diagnosed in a different clinic with an intradermal melanocytic nevus, papillomatous variant. Excision was performed and the
specimen was sent for histopathological analysis.
Results
Thegrossexaminationrevealedapapillomatoustumor,poorlycircumscribed,consistingofseveralnoduleswithatotalsizeof40x25
mm, brown in color. On the Hematoxylin&Eosin sections we observed a tumoral proliferation with solid architecture and cells
organized in nests. Towards the depth, the nests were more harder to identify, and the cells became smaller. The tumoral cells had
enlarged nuclei with proeminent, eosinophilic nucleoli. Mitoses were observed (11 mitoses/ 10 HPF). Breslow index of 12 mm and
Clark invasion V(hypoderm), lymphovascular invasion (embolus), radial growth phase, pagetoid migration, Immunohistochemestry
staining showed positivity for the following markers:S100, SOX10, MelanA, HMB45 and the KI67 proliferation index of 25%. The
final diagnosis was nevoid melanoma, non-ulcerated, stage PT4aNxMx.
Conclusion
To distinguish nevoid melanoma from a benign melanocytic tumor, it is mandatory to pay attention to the tumoral architecture and
any sort of cytological atypia. Another important guide for the diagnosis is the recurrence of a previously diagnosed nevus.
Keywords: nevoid melanoma, recurrence, melanocytic tumor
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Morphologic characteristics of pleomorphic dermal sarcoma- case report
Andreea Tinca1, Raluca Niculescu1, Ovidiu S Cotoi1

1) Pathophysiology, University of Medicine, Pharmacy, Science and technology George Emil Palade, Romania
Introduction
Pleomorphicdermalsarcomaisaveryraremezenchymaltumorwhichhasorigininthedermis.Itisanaggressiveandpoorlydefined
tumor and develops predominantly on the UV exposed skin of the head and neck areas. The most affected are elderly male patients.
Wearedescribingthecaseofan80-year-oldfemalewhopresentedwithatumorlocatedontheskin,inthetemporalregion.Excision
was performed and the sample was sent for analysis.
Results
Grossing showed an ulcerated tumor with nodular aspect, measuring 25 mm in diameter. On the usual stain, Hematoxilin&Eosin, a
tumoral proliferation with solid architecture was shown. The proliferation consisted of nests and placards of tumoral cells. The
tumoral cells were epithelioid or spindle. Many of these tumoral cells presented multiple nuclei. Along with these changes, we also
identified high atypia, enlarged, irregular and hyperchromatic, pleomorphic nuclei. Particularities such as prominent nucleoli were
observed, along with a large number of mitoses. Immunohistochemistry showed intense positivity for the following markers:
vimentin, CD10 and CD68. The proliferation index ki67 reached 90% and the resection margins were infiltrated.
Conclusion
When encountering a tumor such as pleomorphic dermal sarcoma, one of the most important steps is differentiating it from
melanoma and poorly differentiated carcinoma. Our case emphasizes the importance of immunohistochemistry and describes the
appearance of the neoplasm. Because the tumor is characterized by local aggressivity and it is difficult to provide negative resection
margins, it’s important to diagnose the tumor and follow-up the patient.
Keywords: pleomorphic dermal sarcoma, morphology, immunohistochemistry, rare, skin
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Glomus tumor – Case report
Adrian-Horațiu Sabău1,2, Iuliu-Gabriel Cocuz1,2, Vicențiu Popa1, Carmen Carașca1, Ovidiu Simion Cotoi1,2, Adela Corina Nechifor-
Boilă1,3
1) Department of Pathology, Mureș Clinical County Hospital, Romania
2) Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu-Mureș,
Romania
3) Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu-Mureș,
Romania
Introduction
Glomus tumors are mesenchymal neoplasms consisting of cells similar to the smooth muscle fiber cells of the glomus bodies. They
represent a rare entity, representing less than 2% of soft tissue tumors. Most glomus tumors are located in the extremities, mainly at
the digital level.
Wepresentthecaseofa75-year-oldmanwhopresentedtotheOrthopaedicsDepartmentcomplainingofpainanddiscomfortinthe
pre-patellar area of the left knee. Following imaging investigations, a tumour mass was identified at this level, for which surgical
excision was performed. The Pathology Department performed the macroscopic examination and all the fragments that presented
macroscopic modifications underwent histopathological examination and immunohistochemical analysis.
Results
At macroscopy, the specimen of 23 mm in size, presented elastic consistency and brown colour. At microscopy, a nodular tumour,
delimitedattheperipherybyaconjunctival-vascularcapsule,wasidentify.Thisformationconsistedofaproliferationofsmall,nested
tumour cells with well-defined cell borders, centered by small, round nuclei, with abundant, eosinophilic cytoplasm. No mitotic
figureswereobserved.Tumour’snestswereseparatedbyastromawithareasofhyalinizationandbloodvesselswiththickenedwalls.
Tumour cells stained positive for SMA.
Conclusion
Despite the fact that glomus tumors are a rare entity, their extra-digital location should not exclude this diagnosis. The characteristic
morphological features, supported by immunohistochemistry are important in setting the correct diagnosis.
Keywords: Glomus tumour, Extra-digital, Histopathology
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Implications of the CDKN2A gene in glioblastoma IDH-wildtype
Cristian Ionuț Orășanu1,2, Mariana Așchie1,3,4, Mariana Deacu1,3, Mădălina Boșoteanu1,3, Manuela Enciu1,3, Georgeta Camelia
Cozaru2,5, Anca Florentina Mitroi2,5, Raluca Ioana Vodă1,2
1) Clinical Pathology Service, Department of Pathology, Emergency County Clinical Hospital , Romania
2) Development Research Center for Morphological and Genetic Study in Malignant Pathology - CEDMOG, "Ovidius" University
Constanța, Romania
3) Faculty of Medicine, Department of Pathology, "Ovidius" University Constanța, Romania
4) Academy of Medical Sciences, Romanian Academy, Romania
5) Clinical Pathology Service, Department of Genetics, Emergency County Clinical Hospital "St. Apostle Andrei", Constanta, Romania
Introduction
AccordingtothelatestWHO2021classification,IDH-wildtypeglioblastomarepresentsatumorentitydistinctfromotherglialtumors
of the central nervous system. A role in the process of tumorigenesis is attributed to the CDKN2A gene. The latest studies also
indicate a prognostic role for it in the case of gliomas. Our study aims to highlight the main implications of the gene in cases of IDH-
wildtype grade 4 gliomas.
We performed a retrospective study (10 years), in which we identified 39 IDH-wildtype glioblastomas. Clinical-paraclinical and
imaging data were extracted from observation sheets and the hospital's electronic database. The immunohistochemical and genetic
evaluations were carried out within the CEDMOG and consisted of the evaluation of the markers: IDH1 R132H, Ki-67, Nestin and
CDKN2A. The data were statistically analyzed with SPSS Statistics Version 26.
Results
Theaverageageofthepatientswas60.36years,withaslightpredispositiontowardsthemalesex(51.28%).CDKN2Agenedeletions
and amplifications were observed in 35.9% of cases, frequently deletions. An association between gene alterations and an increased
proliferative index was noted (p=0.029). Multivariate data analysis observed as the main risk factors in survival the association of
CDKN2A gene mutations with increased microvascularity quantified by Nestin (HR=1.747, p=0.030), age at presentation over 50
years (HR=3.012, p=0.041) and the presence of residual tumor volume (HR=1.369, p=0.033).
Conclusion
ThestudyrevealedanimportantassociationoftheCDKN2AgeneintheprognosisofthepatientwithIDH-wildtypeglioblastomaand
his survival, underlining the importance and necessity of its inclusion in the patient management protocol.
Keywords: CDKN2A, IDH1, Glioblastoma, glioma
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Renal oncocytoma - A case report
Vicențiu Popa1, Călin Chibelean2, Andrada Loghin1, Ovidiu Simion Cotoi1

1) Department of Pathology, Mureș County Clinical Hospital, Romania
2) Urology Clinic, Mureș County Clinical Hospital, Romania
Introduction
Renal oncocytoma is a rare benign tumor defined by the presence of the oncocytes, which are uniform, round or polygonal shape
cellsthatdisplayagranulareosinophiliccytoplasm.Usuallyitappearsasasolitaryandunilateraltumor,targetingmalepatientswith
a median age about 50 years old, most of them asymptomatic and picked incidentally on radiological imaging.
Our case is that of a 71-year-old patient underwent nephrectomy due to imagistic findings of a renal tumor.
Results
Histologic evaluation confirmed the presence of a mid-renal brown tumor measuring 30 mm at its greatest dimension.
Microscopically, the tumor revealed a solid, nested and tubular architecture composed of cells with granular eosinophilic cytoplasm,
withrounduniformnuclei,focallylargerinsizewithvisiblenucleoli.ThetumoralcellsshowedpositivityforCD117andnegativityfor
CK7. Based on the tumor features our final diagnostic was that of renal oncocytoma.
Conclusion
Renal oncocytoma is a rare benign tumor which can easily be confused with a series of malignant pathologies of the kidney.
Knowledge of a wide spectrum of pathologies in association with immunohistochemistry are essential for a correct diagnosis.
Keywords: rare benign tumor, oncocytes, immunohistochemistry
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Osteosarcoma lung metastasis – a case report
Iuliu Gabriel Cocuz1,2, Adrian Horatiu Sabau1,2, Raluca Niculescu1,2, Corina Eugenia Budin2,3, Ovidiu Simion Cotoi1,2
1) Pathology Department, Mureș Clinical County Hospital, Romania
2) Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures,
Romania
3) Pneumology Clinic, Mureș Clinical County Hospital, Romania
Introduction
Osteosarcoma is the most frequent malignant tumour of the bone which is diagnosed most frequently in children or young adults,
with a high possibility of metastasis, especially in the lung.
Wepresentthecaseofa38-year-oldmalepatientwhichisadmittedtothePneumologyClinicfordyspnoeaand30kgweightlossin
the last 3 months. From the personal pathological history of the patient, we note a histopathological diagnostic of osteosarcoma 7
years ago. A lung biopsy is performed via bronchoscopy and the tissue sample is sent to the Pathology Department for the
histopathological diagnostic.
Results
Microscopically, the tissue samples were represented by bronchial mucosae covered partially by respiratory epithelium which
presented squamous metaplasia. On some fragments, at the level of the chorion, a tumoral proliferation was observed, composed of
largecells,withround,ovalandpolygonalshape,withpaleeosinophiliccytoplasm.Thecellsweremultinucleated,andthenucleihad
various forms and hyperchromasia. In between the tumoral cells a discreet polymorphic inflammatory infiltrate was observed,
represented by granulocytes, lymphocytes, plasmacytes and histocytes. Immunohistochemically, the tumour cells were negative for
anti-S100 antibodies and showed focal positivity for anti-SMA, anti-CD99 and anti-NSE antibodies. The Ki67 proliferation index was
20-30% in the tumour cells.
Conclusion
The histological aspect and the immunohistochemical profile suggested a malignant tumour proliferation. Because of the anterior
histopathologicaldiagnosticofosteosarcoma,wehaveorientatedthediagnosistoanosteosarcomalungmetastasis.Theparticularity
of the case is represented by the difficulty in establishing the diagnostic without a multidisciplinary approach.
Keywords: osteosarcoma, metastasis, immunohistochemistry, lung
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Perinatal autopsy
Daniela Mihalache1
Introduction
Perinatal autopsy provides an opportunity to determine the cause of death and the abnormalities that may have a role in the
evolution of the pregnancy. An accurate diagnosis is required to provide counseling for a subsequent pregnancy.
The data presented is from a retrospective cohort study, using the autopsy protocols, macroscopy and microscopy. The autopsy
protocol assists in performing an adequate perinatal dissection, facilitates the recognition and documentation of all relevant
information and in addition also provides a format for the collection, recording and presenting of data which facilitates collaborative
research. It has been shown repeatedly that a placental examination is needed to understand the causes of perinatal deaths.
Results
The most common cause of death was prematurity and disease of the placenta and umbilical cord.
Conclusion
Perinatal autopsy remains the gold-standard for uncovering the cause of death and anomalies of neonates.
Keywords: perinatal autopsy, umbilical cord, placenta, prematurity
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Lynch syndrome – the hidden enemy from genes!
Oana Cristina Voinea1,2, Lucian George Eftimie3,4, Maria Sajin1,5, Ionut Teodor Constantin6, Adrian Vasile Dumitru1,5
1) Morphopathology, Carol Davila University of Medicine and Pharmacy, Romania
2) Experimental Toxicology, National Institute for Medical-Military Research and Development , Romania
3) Pathology, Central Military University Emergency Hospital , Romania
4) Anatomy, National Academy for Physical Education and Sports Bucharest, Romania
5) Pathology, University Emergency Hospital Bucharest, Romania
6) Oncology, National Institute of Endocrinology, Romania
Introduction
Lynch Syndrome , also known as “Hereditary non-polyposis colorectal cancer”, is the most common hereditary disorder with an
autosomal dominant transmission that predispose to early onset of various malignancies in adults. It’s hallmark is microsatellite
instability,represented by mutations in the repair genes MLH1, MSH2, MSH6, PMS2 and EPCM. Unrepaired replication defects will
lead to adenocarcinomas of the digestive tract, especially colon, endometrium, ovary, urothelium and skin,
at younger ages than their non-syndromic epidemiology.
We searched in the registers from Pathology Department of 2 University Emergency Hospitals in Bucharest, Central Military
Emergency Hospital Dr. Carol Davila (SUUMC) and Bucharest Emergency University Hospital (SUUB), for cases of patients with
adenocarcinomas suggestive for this syndrome, strictly following the HP criteria and age at diagnosis.
Results
The frequency of Lynch syndrome in the US registers an incidence of 1: 273, compared to the already famous BRCA1 and BRCA2
mutations whose frequency is estimated at 1: 400 people.
Currently, in Romania there is no evidence of these patients or a rigorous screening program.
Oursearchintheregistersoftheanteriormentioned2hospitalsrevealedthatintheSUUMC,duringaperiodof2years,nolessthan
210 cases were found, and in SUUB a number of 181. Colon cancers were dominating the scene, accounting 191 cases for the
Military Hospital and 109 in SUUB. In both hospitals, a significant number of endometrial, ovarian, gastric and urotelial
adenocarcinomas were found. Because many of them were found in metastatic stage of disease, more than 1\3 of those patient are
dead at the time this poster was written.
Conclusion
Itisnecessarytopopularizethissyndromebothamongcliniciansandlaboratorydoctors(pathologists,geneticists),astheprophylaxis
measures applied to carriers through early screening are a life-savior in terms of quantity and quality for primary and secondary
prophylaxis.
Keywords: Lynch syndrome, Colon cancer, Genetic disease
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Contributions to the study of the biopathology of the ischemic myocardium within

the adaptive states, stuning, myocardial hibernation, ischemic preconditioning,
with chronic and final evolution, apoptosis, necrosis
Dezideriu Laky1, Liliana Parascan2, Vasile Candea3

1) Department of Pathology, Semmelvais University, Budapest, Hungary
2) Department of Pathology, Emmergency Institute for Cardiovascular Diseases, Bucharest, Romania
3) Department of Cardiovascular Surgery, Emmergency Institute for Cardiovascular Diseases, Bucharest, Romania
Introduction
Pathologic findings in new ischemic entity: sweeling, hibernation, preconditioning, apoptosis.
During 1971-2001, the studies are effectuated on experimental material: 182 dogs with brief episodes of ischemia and reperfusion
during 5 to 20 minutes prolonged for preconditioning over 90 minutes and on human material: over 268 repeated intraoperatory
myocardial biopsies to valvular and congenital heart diseases patients and in hipokinetics to 60 atherosclerotic disease. On a
effectuated conventional histological, histochemical techniques, biochemical, immunohistochemical and ultrastructural
investigations.
Results
Myocardial stuning represent a consequence of brief ischemia of 3-5 minutes with regional contractile with reversibles lesions from
20 to days after reperfusion despite the absence of irreversible damages.
Hibernating myocardium represent an prolonged but potentially contractil dysfunction, an incomplete adaptation caused by chronic
myocardial ischemia.
Preconditioning is a cardioprotective mechanism in wich the heart expressed to a short period of sublethal ischemia that attennuate
cellular damage from a subsequent prolonged lethal episodes of ischemia.
Apoptosisofcardiomiocitesistheprogrammedcellulardeathandintensifiedinpathologicalstatesofhypoxia,ischemia-reperfusion,
irradiation, different treatments, congestive heart failure.
Cardiomyocyte necrosis or cell death represents the end of the biological cycle of cells, both in cellular aging and in multiple
circulatory and inflammatory diseases.
Conclusion
Changes in stunning and hibernating myocardium as adaptive lesions are viable but can evolve into reversible lesions with the
potential to lead to congestive heart failure. Apoptosis and necrosis are irreversible injuries.
Keywords: stunning, hibernation, preconditioning, apoptosis, necrosis
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Understanding computer science concepts for better digital pathology

collaboration
Mircea-Sebastian Serbanescu1
1) Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Romania
Introduction
In the era of evidence-based medicine, pathology is turning digital, introducing the power of computational medicine in current
practice.
Theliteratureshowsthatmoreandmoreresearchfocusonintroductionofdigitalandintegrativepathologyincurrentpractice.More
thanthat,conceptslikemachinelearningandartificialintelligencearebecomingacurrentapproachincurrentresearchandpractice.
In order to have a better collaboration with computer scientists, pathologists should integrate knowledge and vocabulary from
machine learning and artificial intelligence.
Results
Astoday,nobodytalksaboutdigitalradiology,andonlycallitradiology,theshifttowardspathologydigitalizationisirrefutably.Basic
concepts like: cleansing, pre-processing, post-processing, feature extraction, clustering, etc. and more diagnosis oriented ones like
classification, pattern recognition, anomaly detection, segmentation, object detection, deep learning, etc. should be meaningful and
integrated in the pathologist's vocabulary.
Working with colored images, digital pathology faces new challenges, as radiology basically has only grayscale images, while other
fully digitized specialities (e.g., laboratory medicine) face problems in the signal processing world.
Understanding and working with digital pathology will open new collaboration possibilities, between pathologists, between
pathologists and other physicians, and between pathologists and other specialists (e.g., computer scientist).
The digital transformation will happen anyway, and pathologists will have to change their mindset on the new concept. They will
have to realize that if they do not evolve their knowledge towards digital pathology, they will remain in the past. Digital pathology
should be perceived as a tool and not as a drawback. Of course, in order to start working with a new tool, one must invest time in
understanding it.
Conclusion
Understanding computer science concepts is the key to transform digital pathology as a current practice tool.
This research was funded by the University of Medicine and Pharmacy of Craiova, grant number 26/24c/13.07.2021.
Keywords: digital pathology, integrative pathology, collaboration, machine learning, artificial intelligence,
deep learning
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Feasibility of fetal portal venous system ultrasound assessment at the ft anomaly

scan
Rodica Nagy1, Dan Ruican1,2, George Lucian Zorila2,3, Anca-Maria Istrate-Ofiteru2,4,5, Anne Marie Badiu6,7, Dominic Gabriel
Iliescu2,3
1) Doctoral School, University of Medicine and Pharmacy of Craiova, Romania
2) Obstetrics and Gynecology, University Emergency County Hospital, Craiova, Romania
3) Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania
4) Histology, University of Medicine and Pharmacy of Craiova, Romania
5) Research Centre for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, Romania
6) Pathology, University Emergency County Hospital, Craiova, Romania
Introduction
Themainpurposeofourstudyistodemonstratethefeasibilityoffirsttrimesterultrasonographyinassessingtheanatomyofthefetal
portal venous system, to describe how the assessment rate may be affected, and to correlate ultrasound plans with appropriate
microscopic assessment as an audit of ultrasound findings.
We evaluated the appearance of the portal venous system in 200 cases in ultrasound examinations of fetuses of gestational age
12-13.6 weeks. Scans were performed in half of the cases by two examiners who had extensive experience in obstetric ultrasound
(group I) and in the other half of the cases by two examiners with less experience (group II). The examinations were initially
performedtransabdominallyand,inselectedcases,transvaginally.Weperformedamacroscopicandmicroscopicexaminationofthe
liver taken from a abortion specimen.
Results
Group I successfully assessed all portal venous system features by transabdominal approach in 27% of cases. The assessment rate
was lower for Group II, 14%. Transvaginal examination or rescheduling resulted in a better detection rate for both groups (88% in
Group I and 72% in Group II). Unfavorable fetal position, BMI greater than 24, abdominal scarr, retroverted uterus, fibroids or
combinations of the above were reasons for rescheduling or use of transvaginal examination. Following reassessment, the rate of
transabdominal assessment of L-shaped umbilical vein confluence increased from 91% to 98% in group I and from 79% to 95% in
group II. Microscopic examination confirmed the normal appearance of the portal venous system.
Conclusion
Early assessment of the fetal portal venous system is feasible. Examiner experience, uterine abnormalities or increased body mass
indexmaybefactorsaffectingtheassessmentrate.Combiningabdominalexaminationwithvaginalexamination,rescheduling,may
result in a higher assessment rate. Pathological examination of the portal venous system in the first trimester can only be performed
microscopically.
Keywords: portal venous system, fetal anomalies, ultrasound, autopsy, immunohistochemistry
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Confirmation of First Trimester Fetal Heart Anomalies using Three-Dimensional

Histological Autopsy
Dan Ruican1,5, Ana-Maria Petrescu1, Anca-Maria Istrate-Ofiţeru1,2,3, Laurențiu Mogoantă 2,3, Daniel Pirici2,3, Dominic Gabriel
Iliescu 1,4
1) Department of Obstetrics and Gynecology, University Emergency County Hospital, Craiova, Romania
2) Research Centre for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, Romania
4) Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania
5) Doctoral School, University of Medicine and Pharmacy of Craiova, Romania
Introduction
The current study aims to confirm the fesability of three-dimensional (3D) reconstruction of histology slides to confirm fetal
congenital heart disease (CHD) detected by ultrasound at the first trimester anomaly scan. First trimester fetal anomaly detection is
possible due to recent increase in performance of the ultrasound machines coupled with the examinator's experience. Misdiagnosis
may occur due to the complexity of this examination which entails a confirmation of the findings. Conventional autopsy is hindered
bythesmallsizeofthefirsttrimesterfetalheartandcurrentresearchesforCHDconfirmationimplytheuseofhighlyspecializedand
expensive methods.
An extended first trimester examination protocol was used to diagnose fetal heart anomalies in the first trimester. Medical
termination of pregnancies with CHD was followed by fetal heart extraction and histological preparation. The entire specimen was
sliced and the histology slides were scanned. The resulting images were processed and volume rendering was performed using a
three-dimensional reconstruction software. The volumes were analysed by a multidisciplinary team composed of materno-fetal
specialists and pathologists and compared with ultrasound findings.
Results
Six fetuses with heart malformations were investigated using three-dimensional reconstruction of histology slides: two hypoplastic
leftheartsyndrome(HLHS),twoatrioventricularseptaldefects(AVSD),oneisolatedventricularseptaldefect(VSD),onetransposition
ofgreatvessels.Moreover,itallowedustodetectsupplementaryanomaliesinoneoftheatrioventricularseptaldefectcases.Further
histological investigation on the hypoplastic left heart (HLHS) slides facilitated the diagnosis of associated endocardial fibroelastosis.
Conclusion
Virtualautopsyofthefetalheartusing3Dreconstructionfromseriatehistologyslidescanrepresentaviableconfirmationmethodof
fetal heart malformations detected in the first trimester. Additionally, this audit technique offers the opportunity for further
pathological evaluations, which may be important in cases referred for perinatal autopsy.
Keywords: virtual autopsy, fetal heart anomalies confirmations, fetal echocardiography
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Macroscopic/morphological evaluation of traumatic cranio-cerebral injuries in

patients who died as a result of road accidents
Marian Valentin Zorilă1, Răzvan Ștefan Țolescu1, Charoula Florou2, Roxana Eugenia Zăvoi1, Laurențiu Mogoantă3
1) Department of Forensic Medicine, University of Medicine and Pharmacy of Craiova, Romania
2) Department of Forensic Medicine, General University Hospital of Larissa, Greece
Introduction
Road accidents are one of the main causes of death in both adults and children. Romania is at the top of road mortality among
European countries with 85 deaths per million in 2020. The aim of the study was to evaluate the meningo-cerebral macroscopic
changes in patients who died by traumatic brain injuries (TBI) following a road accident.
Weevaluatedstatisticallyandmacroscopically333deathsbyTBIfollowingaroadaccident,autopsiedatForensicInstituteofCraiova
inanintervalof7years.Wedividedthecasesintocategoriesaccordingtothepositionoccupiedinthedynamicsoftheroadaccident:
pedestrians, drivers, passengers, cyclists, motorcycle or moped drivers and occupants of an animal-drawn vehicle. We aimed to
highlight the main macroscopic traumatic injuries and the differences according to the type of the accident.
Results
TBI after a road accident have an increased frequency, representing 33.16% of all TBI deaths. The TBI discovered during the autopsy
were complex, being associated injuries to the cranial box, vascular injuries and parenchymal injuries both localized and diffuse. The
intensity of traumatic injuries was generally inversely proportional to the period of survival. The most deceased patients were
pedestrians 40.24%, followed by the occupants of a motor vehicle 27.62%. The average age was 48.67 years. Cranial fractures were
revealed in 83.18% of the cases, in most cases vault fractures being associated with skull base fractures. The presence of ethyl
alcohol in the blood collected during forensic autopsies was highlighted, highlighting once again the correlation between the
consumption of ethyl alcohol and traffic accidents. The highest intensity of meningo-cerebral traumatic injuries was presented by
pedestrians, followed by drivers of 2-wheeled vehicles and occupants of animal-drawn vehicles.
Conclusion
Deaths by TBI following a road accident are very common in medico-legal practice. The evaluation of the morphology of traumatic
injuries and the understanding of the production mechanisms can lead in the future, through the involvement of competent
authorities, to the improvement of the protection measures of the traffic participants and the reduction of road morbidity and
mortality.
Keywords: road accidents, traumatic brain injuries, mortality, macroscopic
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Microscopic aspects of Traumatic Brain Injuries in population under 18 years
Răzvan Ștefan Țolescu1, Marian Valentin Zorilă1, Charoula Florou2, Roxana Eugenia Zăvoi1, Laurențiu Mogoantă3
1) Department of Forensic Medicine, University of Medicine and Pharmacy of Craiova, Romania
2) Department of Forensic Medicine, General University Hospital of Larissa, Greece
Introduction
TBI (traumatic brain injuries) are a global public health problem, with an increasing trend in almost all the world. We investigated
histologically and immunohistochemically the lesions in the secondary phase of severe TBI in minor patients, following the changes
according to the time elapsed between trauma and death.
The histological and immunohistological study was carried out on a group of 34 minors who died after a TBI and were autopsied at
Forensic Institute of Craiova in a 7-year interval. The biological material collected during the medico-legal autopsies was prepared
according to the classical histopathological technique. For the immunohistochemical study, we used the antibodies: anti-NeuN, anti-
GFAP, anti-Olig-2, anti IBA1 to highlight the complexity of the tissue and cellular changes that occurred following brain trauma.
Results
Weobservedanamplificationofmicroscopiclesionsatthemeningo-cerebrallevelcorrelatedwiththeincreaseinthesurvivalperiod,
changes that interested neurons, neural extensions, glial cells, but also blood vessels. We highlighted the neuronal and astrocytic
distressbydecreasingtheintensityofNeuNandGFAPreactionrespectivelywiththeprolongationofposttraumaticsurvivaltime.We
found the activation of microglia and their immunohistochemical expression through the IBA-1 reaction, which changed with the
prolongation of the survival period. Also, with the increase in the survival interval, several oligodendroglia showed an
immunohistochemical reaction, which represents a resumption of the myelination process of axons partially altered by trauma.
Conclusion
Our study showed an increase in neuronal death as survival time increases. Neuronal death takes on complex aspects of necrosis,
apoptosis, and even neuronal autophagy. Cellular changes, both neuronal and glial, had different intensities depending on the
survival period and the distance from the traumatic focus.
Keywords: traumatic brain injuries, microscopic lesions, immunohistochemical study, cellular changes
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Lung Injury Induced by SARS-CoV-2 Infection: Clinico-Statistical Study
Florin Ionuț Buibaș1, Mircea-Sebastian Șerbănescu2, Andreea Roberta Cercel1, Adina Turcu3, Florentina Dumitrescu4, Daniel
Pirici1, Ilona Mihaela Liliac1, Cristina Jana Busuioc1, Larisa Iovan1, Laurențiu Mogoantă1
1) Histology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
2) Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Craiova, Romania
3) Prevention of Oro-Dental Diseases, University of Medicine and Pharmacy of Craiova, Craiova, Romania
4) Infectious Diseases, University of Medicine and Pharmacy of Craiova, Craiova, Romania
Introduction
The disease caused by the SARS-CoV 2 virus infection, COVID-19, characterized by the onset of severe acute respiratory syndrome
(SARS), was first reported in Wuhan, the capital of China's Hubei province, in December 2019. World Organization of Health officially
declaredaglobalpandemiconMarch11th,2020,duetothesimultaneousandrapidtransmissionoftheinfectionworldwide.SARS-
CoV 2 infection has affected more than 215 countries and territories worldwide, with 618,271,950 confirmed cases and 6,533,869
deaths by September 15th, 2022.
Covid-19alsoseverelyaffectedRomania,where3,257,980infections(39thintheworld)and66,950confirmeddeathswerereported
until September 15th, 2022.
In our study, we analyzed patients diagnosed with Covid-19, that were admitted to the Hospital for Infectious Diseases and
Pneumology "Victor Babes" Craiova during 2020-2021. A group of 5649 patients, aged between 3 and over 100 years, was analyzed.
Results
Most cases were encountered in people aged between 55 and 75 years (3,060 patients; 54.17%). Regarding the gender of the
patients, SARS CoV-2 infection was found to affect equally both men and women. The most common symptoms caused by lung
damage were: cough (62%), followed by fever (54%), asthenia (45%), dyspnea (29%), chills (27%), sweating (11%) and thoracic pain.
(7%). It is also noteworthy that 43% of patients had digestive symptoms.
Among the comorbidities associated with COVID-19, were recorded: cardiovascular diseases (39%; hypertension (26%); ischemic
heartdisease(5.38%),heartfailure(5%)otherheartdiseases(2.62%));obesity(15%),diabetes(9%),lungdiseases(7%),liverdiseases
(4%) and neurological diseases (4%).
Conclusion
Conclusion: Covid-19 has mainly affected people over 55 years old. Its symptomatology was complex, but mostly pulmonary.
Keywords: Lung Injury, SARS-CoV-2, Clinico-Statistical Study
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Neurological manifestations in SARS-CoV2 infection
Andreea Roberta Cercel1, Mircea-Sebastian Șerbănescu2, Florin Ionuț Buibaș1, Adina Turcu3, Florentina Dumitrescu4, Daniel
Pirici1, Ilona Mihaela Liliac1, Cristina Jana Busuioc1, Larisa Iovan1, Laurențiu Mogoantă1
1) Histology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
2) Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Craiova, Romania
3) Prevention of Oro-dental Diseases, University of Medicine and Pharmacy of Craiova, Craiova, Romania
4) Infectious Diseases, University of Medicine and Pharmacy of Craiova, Craiova, Romania
Introduction
The first case of SARS-CoV-2 infection was reported in December 2019 in the Wuhan region of China, where it showed up as an
atypicalpneumoniaofunknownetiology.Internationalresearchlaterrevealedthatthediseaseiscausedbyacoronavirus,whichthe
World Health Organization (WHO) ultimately labeled as COVID-19. Although COVID-19 primarily affects the respiratory system,
causing pneumonia, multiple reports describe the fact that the pathogenesis of the virus can be accompanied by neurological
complications, indicating the neurotropism of this respiratory virus.
Several studies published in international journals reveal that patients with mild forms of COVID-19 can experience non-specific
neurological symptoms such as headaches, dizziness, fatigue, anorexia, myalgia, anosmia, and ageusia. Cerebrovascular accidents,
confusion, and changes in consciousness were common COVID-19 symptoms in severe neurological cases.
In this study, we looked for the existence of neurological symptoms indicating brain damage from viral infection in a group of 5,649
patients diagnosed with COVID-19, aged between 3 and over 100 years old, admitted to the Hospital for Infectious Diseases in
Craiova during 2020–2021.
Results
Among the neurological symptoms identified in this study, we mention:
-asthenia, which was found in 2540 patients, representing about 45% of the total group;
-headache, present in 1252 patients, representing 22% of the batch;
-myalgias were present in 958 patients, representing 17% of the batch;
-dizziness was present in 712 patients, representing 13%;
-anosmia was registered in a total of 536 patients, representing 9%;
-vertigo and balance disorders were present in 108 patients, representing 2%;
-strokes registered in patients with COVID-19 were in only 186 cases, representing 3% of the studied cases.
Conclusion
Patients with COVID-19 may have nonspecific neurological symptoms, which suggest more or less severe nervous system
impairment.
Keywords: neurological, manifestations, SARS-CoV2 infection
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Histopatological and immunohistochemical aspect of uveal melanoma- case report
Andrei Teodor Balasoiu 1, Cristiana Eugenia Simionescu2, Raluca-Niculina Ciurea2, Lavinia Stanescu3, Andrei Muraru3
1) Ophtalmology Department, University Of Medicine And Pharmacy Of Craiova, Romania
2) Pathology Department, University Of Medicine And Pharmacy Of Craiova, Romania
3) Pathology Department, Emergency County Hospital Craiova, Romania
Introduction
Uveal melanoma is a rarely occurring intraocular tumor with an aggressive clinical trajectory and a comparatively heterogenous
morphological presentation.
A 63 year old patient is admitted to the Emergency County Hospital of Craiova after experiencing unilateral (left side) visual acuity
drop and photophobia. Clinical and imaging results revealed a dome-shaped tumor of the choroid, highly suggestive of melanoma
with no superficial lymph node involvement or any extraocular pathological findings. The decision is made to enucleate the left eye.
The oncological team decided on a “watch and wait” strategy according to relevant protocols. The postoperative evolution was
unremarkable and, by April 2022, the patient presented to two follow-ups that certified no recurrences or metastases.
Results
Histopathological examination of the specimen and ancillary techniques confirmed the diagnosis of a melanoma composed of
spindle cells invading the ciliary processes and cornea. Immunohistochemical investigations revealed: HMB45 was diffusely
expressed,inmoderateamounts,inthecytoplasmofthecells;Bcl2displayedasimilarexpressionpattern;Ki67scorewasestimated
tobelessthan1%;S100expressionwasnegativeinthetumorcellsbutpositiveinsomestromalandSchwanncells;P16andCyclin
D1 showed focal positivity; P53 was negative. Histopathological and immunohistochemmical investigation sustained and confirmed
the diagnosis of uveal melanoma.
Conclusion
In spite of the definitive diagnosis of a pT4N0M0 melanoma, based on the robust expression of HMB45, this case offers a unique
outlook to the chaotic and surprising behavior of malignant melanoma. Contemporary research lacks a holistic understanding of the
underlying complex systems governing the oncogenic/antioncogenic interplay in these kind of tumors. Further efforts are necessary
to pinpoint changes to the proteomics that would be usable in future risk assessment or treatment protocols.
Keywords: uveal melanoma, histopatholgy, immunohistochemistry
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The usefulness of epithelial and mesenchymal immunoprofile in the assessment of

carcinomas
Alex Emilian Stepan1, Cristiana Eugenia Simionescu1, Claudiu Mărgăritescu1, Raluca-Niculina Ciurea1, Mirela Marinela Florescu1,
Anne Marie Badiu1, Bianca Cătălina Andreiana1, Oana Iulia Crețu1
Introduction
Epithelial and mesenchymal markers have proven their practical utility in the differential diagnosis of carcinomas, recent data
suggesting their potential in evaluating the aggressiveness of lesions.
The study is retrospective and represents a meta-analysis of the experience of the Pathology Department from UMF Craiova in
investigatingtheexpressionofepithelialandmesenchymalmarkersinthyroid,gastric,colon,ovarian,endometrial,renalandurinary
bladder carcinomas, carried out in the period 2012-2021. The statistical analysis of the immunoexpression of specific or cocktail
cytokeratins, vimentin and fibronectin, expressed by positivity scores, was done integrated, in relation to the main histopathological
parameters of aggressiveness for carcinomas.
Results
In high-grade and / or advanced lesions, cytokeratins presented low altered scores in renal clear cell (AE1/AE3) and urothelial (CK7)
carcinomas, compared with high altered scores in papillary thyroid carcinomas (CK19) and urothelial (CK20) ones, without variations
intheepithelialprofileforotherlocations.Relatedtotumorgradeandstage,inaggressivecarcinomasvimentinwaseitherexpressed
intratumorally or in the advancing edge (gastric discohesive / mixed, ovarian, urothelial carcinomas), or overexpressed (renal clear
cell, thyroid follicular carcinomas), or indicated low immunoexpression scores (thyroid papillary and endometrioid endometrioid
carcinomas), or was not expressed (colonic carcinoma). Fibronectin was expressed in a reduced number of gastric and renal
carcinomas.
Conclusion
The epithelial and mesenchymal profiles of carcinomas present different degrees of alteration in relation to the location and
aggressiveness of the lesions, aspects that can be useful in the evaluation of the lesions and which open perspectives in the
interference of tumor progression mechanisms.
Keywords: carcinomas, cytokeratins, vimentin
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Demodex Folliculorum and the Hospitality of the Hair Follicle
Flavia Baderca1,2, Maria-Bianca Tat2, Adeline Roxana Bucur2, Raluca Maria Closca2, Bogdan George Cioc2, Alin Marian Vasile2,
Caius Silviu Solovan3
1) Department of Microscopic Morphology , “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
2) Service of Pathology, Emergency City Hospital Timisoara, Romania
3) Romanian Society of Dermatopathology, Timisoara, Romania
Introduction
It is already known that inflammation interferes in all stages of carcinogenesis, from initiation, to growth, invasion and later to
metastasis spreading. Even if some researches demonstrated that inflammasome protects against development of different
malignancies (e.g. colon cancer), it was suggested that melanoma progression is induced by inflammasome.
Demodex is a commensal ectoparasite that usually inhabits the pilosebaceous units of the face, its incidence increasing with age.
There are two species hosted by humans, Demodex folliculorum and Demodex brevis.
The paper carried out a retrospective study of 275 biopsies with different cutaneous pathologies, selected from 2739 archived files
diagnosed in Service of Pathology of Emergency City Hospital of Timisoara, between January and June 2022. Tissue fragments were
processed at Service of Pathology by standard hematoxylin-eosin staining and Giemsa stain.
Results
The microscopic examination showed the presence of Demodex folliculorum in the follicular infundibulum of 42 patients in
association with malignant and pre-malignant tumors (squamous cell carcinoma, basal cell carcinoma, carcinoma in situ), benign
tumor (squamous papilloma, seborrheic keratosis, actinic keratosis, nevi) and also inflammatory conditions. In only one case, the
mites were localized deep into the dermis, between cells of sebaceous gland that imposed the diagnosis of Demodex brevis
infestation.
In the connective tissue of superficial dermis, diffuse inflammatory infiltrate composed of neutrophils, macrophages, eosinophils,
lymphocytes and few mast cells, was noted.
In some cases, the ectoparasites were associated with bacterial infection, small basophilic microorganisms being observed between
keratin filaments.
Conclusion
In the present study, among the two species of Demodex, Demodex folliculorum was identified in the majority of cases. The
association of Demodex folliculorum with different pathologies, from inflammatory diseases to pre-malignant conditions and also,
malignant tumors could suggest its oncogenic role, that must be sustained by further researches.
Keywords: Demodex folliculorum, carcinogenesis, inflammasome
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The Chick Embryo Chorioallantoic Membrane: A Milestone in Revealling the

Patterns of Tumor Vasculogenesis
Șerban Comșa1, Amalia-Raluca Ceaușu1, Roxana Popescu2, Anca-Maria Cîmpean1, Marius Raica1
1) Histology, University of Medicine and Pharmacy Victor Babeș Timișoara, Romania
2) Cell and Molecular Biology, University of Medicine and Pharmacy Victor Babeș Timișoara, Romania
Introduction
Vasculogenesis is a key process in tumor progression, so that the inhibition of tumor vasculogenesis represents a cornerstone for
tumor regression. Using the chick embryo chorioallantoic membrane (CAM) experimental model, we recreated the breast cancer
environment in order to analyze the patterns of tumor vasculogenesis in vivo.
Human mesenchymal stem cells (hMSC) and MCF-7 breast cancer cells (MCF-7) were seeded onto CAM and 7 days later the
vasculogenic reaction was analyzed morphologically and immunohistochemically.
Results
hMSC and MCF-7 generated onto CAM hotspots of vasculogenesis and hematopoiesis in the chorionic epithelium and underneath.
Endothelial-like cells and hematopoietic cells formed at the level of the hotspots cord/capillary-like structures (CLS), developing a
clearly visible plexus with a polygonal pattern. Immunohistochemically, the endothelial-like cells were CD105+/AC133-/Oct3/4-,
while the hematopoietic cells were CD105+/AC133+/Oct3/4+.
Conclusion
Tumor and developmental vasculogenesis share common features, CD105, AC133 and Oct3/4 being important tools in staging
vasculogenesis and hematopoiesis.
Keywords: breast cancer , chorioallantoic membrane, human mesenchymal stem cells, vasculogenesis
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Characteristics of follicular-stellate cells in newborn pituitary gland
Valeria Nicoleta Nastase1, Alina-Cristina Barb1, Andrei Alexandru Cosma1, Amalia Raluca Ceausu1, Pusa Nela Gaje1, Eugen
Melnic2, Marius Raica1
1) Department of Histology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Romania
2) Department of Morphopathology, University of Medicine and Pharmacy "Nicolae Testemitanu" Chisinau, Moldova
Introduction
The pituitary gland is one of the main regulators of growth, metabolism, reproduction, and homeostasis. It consists of three lobes:
anterior, posterior, and intermediate lobe (the latter being less developed in humans). The anterior pituitary gland contains both
granular(secretory)andagranularcellsrepresentedbyfollicular-stellatecells.Itiswellknownthatthesecellsproducemanykindsof
growth factors (FGF, VEGF), but their major functions remain obscure. There are few data regarding the development of these cells.
Histopathological (hematoxylin and eosin staining) and immunohistochemical (using glial fibrillary acidic protein) evaluation of 54
newborn pituitary glands obtained from autopsy (ages between 0 days and 6 months).
Results
Histopathological evaluation of the anterior pituitary gland showed acidophilic-basophilic differentiation starting with 0 days.
Between 0 days and one month the pituitary anterior cells are distributed in nests and cords. Starting with one month the nests
became dominant. Follicular-stellate cells, evaluated using GFAP, presented isolated IHC expression during first month,
morphologically having round and oval shape. The follicular-stellate cells density increased progressively starting with five-seven
days, with a more intense IHC cytoplasmic reaction. The one-month specimens are characterized by follicular-stellate cells having
star-like appearance with a strong IHC expression, being predominantly located in perivascular areas.
Conclusion
There are very few data about newborn pituitary gland and even less few data about follicular-stellate cells development. Newborn
pituitaryglandshowsdifferenthistopathologicalandimmunohistochemicalcharacteristicscomparedtoadult.Follicular-stellatecells
density increases with age, starting one week after birth.
Keywords: newborn pituitary gland, follicular-stellate cells, GFAP
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Identifying Mycobacterium Tuberculosis in histopathological slides by Artificial

Intelligence
Sabina Zurac1,2,3, Cristian Mogodici2, Teodor Poncu2,4, Mihai Trascau2,4, Cristiana Popp1,2, Luciana Nichita1,2,3, Mirela Cioplea1,2,
Bogdan Ceachi2,4, Liana Sticlaru1,2, Alexandra Cioroianu1,2, Mihai Busca1,2, Oana Stefan1, Irina Tudor1, Andrei Voicu2, Daliana
Stanescu2, Petronel Mustatea2,5, Carmen Dumitru1, Alexandra Bastian1,3
1) Department of Pathology, Colentina University Hospital, Romania
2) Department of Research, Zaya Artificial Intelligence, Romania
3) Department of Pathology, Faculty of Dental Medicine, University of Medicine and Pharmacy Carol Davila, Romania
4) Department of Computer Science, Faculty of Automatic Control and Computers, University Politehnica of Bucharest, Romania
5) Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Romania
Introduction
Mycobacteria identification is crucial to diagnose tuberculosis. Since the bacillus is very small (minute rod of 2-4/0.2-0.5 microns),
findingitinZiehl–Neelsen(ZN)-stainedslidesisalongtaskrequiringsignificantpathologist’seffort.Wedevelopedanautomated(AI-
based) method of identification of mycobacteria.
We prepared a training dataset of over 260,000 positive and over 700,000,000 negative patches annotated on scans of 510 whole
slide images (WSI) of ZN-stained slides (110 positive and 400 negative). Several image augmentation techniques coupled with
different custom computer vision architectures were used. WSIs automatic analysis was followed by a report indicating areas more
likely to present mycobacteria. Our model performs AI-based diagnosis (the final decision belongs to pathologist).
Results
Theresultswerevalidatedinternallyonadatasetof286,000patchesandtestedinpathologylaboratorysettingson60ZNslides(23
positive and 37 negative). We compared the pathologists’ results obtained by separately evaluating slides and WSIs with the results
given by a pathologist aided by automatic analysis of WSIs. Our architecture showed 0.977 area under the receiver operating
characteristic curve. We compared the results obtained by 4 teams of pathologists (with different level of experience) by separately
evaluatinga)theoriginalslides;b)theWSIsandc)theresultsgivenbyautomaticanalysisofWSIs.Theclinicaltest(algorithmversus
pathologistevaluatingWSIs,algorithmversuspathologistevaluatingslidesandpathologistevaluatingWSIsversusslides)presented
98.33% accuracy, 95.65% sensitivity, and 100% specificity for the AI-assisted method.
Conclusion
Our algorithm outperforms any other AI-based proposed methods for mycobacteria detection.
This work was partially supported by a grant of the Ministry of Research, Innovation and Digitization, CNCS - UEFISCDI,
project number PN-III-P4-PCE-2021-0546, within PNCDI III.
Keywords: Artificial intelligence, tuberculosis, Mycobacterium tuberculosis, Ziehl-Neelsen
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Immunohistochemical challenges in a case of lung adenosquamous carcinoma
Raluca Margit Szilveszter1,2, Mădălina Boian1, Irina Negulescu1, Diana Gonciar1,2, Bogdan Gheban2, Maria Bungărdean1,2, Bogdan
Pop2, Alexandra Buruiană-Simic2, Camelia Albu2, Doinița Crișan1,2, Carmen Georgiu1,2
1) Department of Pathology, Emergency County Hospital Cluj-Napoca, Romania
2) Department of Pathology, Faculty of Medicine, ”Iuliu Hațieganu” University of Medicine and Pharmacy, Romania
Introduction
Adenosquamous carcinoma shows both adenocarcinoma and squamous cell carcinoma features, and also a dual immunophenotype.
Furthermore, it is important to make the differential diagnosis with other carcinomas - basaloid squamous cell carcinoma and poorly
differentiated carcinoma.
Adenosquamousandbasaloidsquamouscarcinomahaveapoorerprognosiscomparedwithothernon-smallcelllungcancers,hence
the importance of accurate diagnosis.
A left superior lobectomy specimen of a 71-year-old patient was sent to our Department of Pathology.
We inspected the specimen, made serial sections, and submitted the entire lesion for microscopic examination. Hematoxylin-eosin
stain, special stains (PAS, mucicarmine, Verhoeff), and immunohistochemical analysis were performed.
Results
The gross examination of the specimen reveals a whitish-gray nodular lesion, measuring 2/1.2/1.7 cm, located 0.1 cm from the
pleura and 0.3 cm from the resection margin. The pleura presents a whitish, thickened area (0.2 cm).
On microscopic examination we identified a malignant proliferation of medium-sized, basaloid cells, with reduced cytoplasm, with
large, hyperchromatic nuclei, with mitoses, nuclear atypia, forming cell islands, focally with squamous differentiation without
keratinization, focally with small lumen formation, and central necrosis.
Immunohistochemically, the cells are negative for synaptophysin and chromogranin (which excludes a large cell neuroendocrine
carcinoma).
Certain islets of cells are intensely positive for CK7 in the center of the islets and intensely positive for p63 towards the periphery,
focally positive for TTF-1, and focally positive for p40 (islands are observed of simultaneously positive cells for TTF-1, p40, p63, and
CK7; non-keratinized squamous carcinoma can very rarely express TTF-1).
MucicarmineandPASstainsdidnothighlightintra-andextracellularmucuswithinthetumorcells(mucuscanbeabsentinthesolid
component of adenocarcinoma).
The pleural thickening corresponds to an area of atelectasis, highlighted using Verhoeff staining.
Conclusion
The morphologic and immunohistochemical features suggest an adenosquamous carcinoma, without ruling out basaloid squamous
cell carcinoma or poorly differentiated carcinoma.
Keywords: Adenosquamous carcinoma, Lung, Squamous cell carcinoma, Basaloid, Immunohistochemistry
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Melanocitic lesions
Daniela Mihalache1, Oana Maria Balan1

Introduction
The pathology of melanocytic lesions is one of the most challenging field in diagnostic histopathology, due to subtle differentiating
features. Particular pitfalls include benign nevi that show features associated typically with melanoma and unusual melanoma
variants.
Uveal melanoma is the most common primary intraocular malignancy which can be fatal in adults.
We present a case of uveal melanoma in a 85-years-old woman who presented with a malignant tumour of the eyeball. The tumour
was treated by enucleation and specimen sent for histopathology analysis which confirmed the diagnosis of uveal melanoma.
Results
Features commonly present in melanoma include asymmetry, peripheral epidermal invasion, “dusty” pigmentation, deep and
abnormal dermal mitoses, HMB-positivity in deep dermal melanocytes, vascular invasion, neurotropism and satellites.
Cluestobenignlesionsincludegoodsymmetry,V-shapedsilhouette,absentepidermalinvasion,uniformcellularity,deepmaturation,
absent/rare dermal mitosis and Kamino bodies.
In this article, the pathological features of common and uncommon benign and malignant melanocytic lesions are reviewed and
pitfalls in their diagnosis are highlighted.
Conclusion
Melanocitic tumours are often challenging and constitute one of four skin biopsies. Immumohistochemical studies may assist
diagnosis.
More caution shoud be taken when excising melanocytic lesions in the head and neck area for complete excision. Punch biopsies
should be avoided.
It is important to recognize the clinical and histopathological features of intraocular malignant melanoma, in order to offer patients
the best possible treatments.
Keywords: benign melanocytic lesions, malignant melanocytoc lesions, diagnosis of uveal melanoma
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Prognostic value of Cyclin D1, P53 and E-cadherin expression in papillary thyroid
carcinoma
Mihail Parnov 1, Cristiana Eugenia Simionescu 2, Eremei Zota 1, Claudiu Mărgăritescu 2, Eugeniu Cazacu 1
1) Pathomorphology , Nicolae Testemițanu State University of Medicine and Pharmacy, Moldova
2) Morphopathology, University of Medicine and Pharmacy of Craiova, Romania
Introduction
Papillary thyroid carcinoma (PTC) is generally known as a malignant tumor with a slow growth and good prognosis, but in some
cases, it leads to death due to rapid growth, repeated recurrence, and systemic metastasis. In this study, we aimed to compare the
expressions of Cyclin D1, P53 an E-cadherin to classical prognostic factors, and to investigate the correlation with prognosis.
Ourretrospectivestudyincluded19papillarythyroidcarcinomas.ImmunohistochemicalanalysisofCyclind1,P53anE-cadherinwas
performed. We set four groups in order to assess the percentage of labeled cells and intensity of reaction. For statistical analysis, the
composite score was used.
Results
Mean age of the patients was 39.8, and tumor size was 1.75 cm (range 1–3.5). Positivity of cyclin D1 and p53 and negativity of E-
cadherin were related with larger tumor size, older age, tumor size, female gender and presence of metastases in regional lymph
nodes.ImmunoreactivityofCyclinD1andp53inallcasesofT3andN1tumorswere(89.3%/90.3%)forCyclinD1and80%/85%for
p53 in comparison with T1/T2 and N0 (52.3 %/49%) for Cyclin D1 and 48.3 %/45% for p53 (P<0.05). Immunoreaction of E-cadherin
was low in all cases of T3 and N1 tumors (20.3 %/20%) in comparison with T1/T2 and N0 (85.3 %/86%) (P<0.05).
Conclusion
ThecorrelationofexpressionofcyclinD1andp53intumorsT3comparedtoT1/T2andinN1comparedtoN0andlossofexpression
of E-cadherin supports the existence of common mechanism involved in tumor progression.
Keywords: Papillary thyroid carcinoma, Cyclin D1, p53, E-cadherin
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The pre-analytical and analytical phase of lab testing: implications for diagnosis
and therapy
Alis Dema1, Mărioara Cornianu1, Codruța Lăzureanu1, Octavia Vița1, Aura Jurescu1, Bianca Natarâș1, Robert Barna2, Adrian
Văduva1, Sorina Tăban1
1) Department II Microscopic Morphology - Discipline of Morphopathology, "Anapatmol" Research Center, "Victor Babeș" University
of Medicine and Pharmacy, Timișoara, , Romania
2) Department of Internal Medicine II - Discipline of Gastroenterology and Hepatology, , "Victor Babeș" University of Medicine and
Pharmacy, Timișoara, , Romania
Introduction
The pathology laboratory/service has an important role in the management of patients from whom tissue/cytological samples were
taken, by establishing the diagnosis and guiding the therapy. It is estimated that over 70% of clinical decisions are based on
laboratory tests. Performing and interpretation of a conventional (hematoxylin-eosin - HE) or immunohistochemical (IHC) stained
slide is a process that includes, in essence, three stages: the pre-analytical, analytical and post-analytical stage. Any error that occurs
in one of the three stages can be catastrophic, both for the patient and for the health system.
There have been studied articles from the specialized literature dedicated to the subject.
Results
Severalstepsinthepre-analyticalandanalyticalstageofHEandIHC-stainedslidepreparationthatmaycausedifficultiesorerrorsin
evaluation and interpretation have been identified.
Conclusion
Knowing the variables of the pre-analytical and analytical stage of the usual and IHC staining performed in the histopathology
laboratories is indispensable both for the pathologist and for the laboratory technicians and even for the clinicians because these
variables can represent the source of errors with serious consequences for the patient, errors that can thus be prevented.
Keywords: pathology lab, pre-anaytical stage, analytical stage, hematoxylin-eosin, immunohistochemical,
errors
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SARS - CoV-2 from structure to pathology
Elena-Roxana Avadanei1, Andreea Rusu1, Bianca Mariana Chifu1, Irina-Draga Căruntu1, Simona-Eliza Giușcă1
1) Department of Morphofunctional Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy Iași, Romania
Introduction
The infection with SARS-CoV-2 was declared a "pandemic" by the WHO on March 11, 2020. The number of cases of COVID-19
worldwide exceeded 20 million with over 700,000 deaths.
Inthiscontext,ourgoalwastocarryoutasystematicanalysisoftheliteratureinordertodescribeascompleteaprofileaspossibleof
the lesions produced by the cyto- and histopathological effect of the SARS-CoV-2 virus.
Articles presenting data on the results of histopathological examinations of organs taken during autopsy or intra-vital were included
in the study. We specifically identified 226 autopsied cases and 9 biopsied cases.
Results
Dataanalysisconfirmedthattherespiratorysistemwasthemostfrequentlyandseverelyaffected.Enlarged,heavy,nonaeratedlungs
with areas of hemorrhagic necrosis and embolic lesions have been described. Microscopic examination revealed diffuse alveolar
lesions with hyaline membranes, congestion, interstitial lymphocytic inflammation, presence of damaged pneumocytes, and
multinucleated syncytial giant cells.
Cardiac localization was often encountered, being followed by lesions in the gastrointestinal and renal areas, at the skin level the
manifestations being varied and non-specific.
Conclusion
Although restricted by legislative regulations, autopsies have reaffirmed their value for public health, bringing a significant
contribution to the understanding of the specific pathogenic mechanism for COVID-19. The results of the studies based on the
necroptic examination of patients with COVID-19 revealed a predominant damage to the lung site, the microscopic profile revealing
the absence of specificity of the lesional pattern in the context of SARS-CoV-2 infection, but supporting the systemic damage.
Keywords: SARS-CoV-2, COVID-19, histopathology
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Correlations between genetic, immunological, and histopathological factors and

SARS-CoV-2 infection progression
Cornelia Amalinei1,2, Adriana Grigoraș1,2, Raluca Anca Balan1

1) Department of Morphofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
2) Department of Histopathology, Institute of Legal Medicine Iasi, Romania
Introduction
The thymus is playing an important role in T lymphocytes development and its architectural defects lead to immunity alterations.
Down Syndrome, determined by the commonest chromosomal anomaly, 21 trisomy, is characterized by altered thymus size and
architecture, resulting in a high risk of recurrent infections and autoimmunity development.
The case of a girl, of 5 years old, diagnosed with Down Syndrome, hospitalized for COVID-19 infection, with fatal progression is
currently presented.
Results
The necroptic examination revealed bronchopneumonia, associated with characteristic acute respiratory distress and
microthrombosis. The thymus had a smaller size, with lobular hypotrophy, hypocellularity, increased medullary component, as an
indicator of accelerated kinetics of lymphocytes maturation or a premature involution, lymphocytes depletion, obscured cortico-
medullary junction, and Hassall’s corpuscles hypertrophy, associated with focal calcifications.
Conclusion
In conclusion, our findings, in agreement with literature data, support a premature senescence picture characteristic for patients
diagnosedwithDownSyndrome.Severeinfectiousdiseases,e.g.COVID-19,maydeveloponthebackgroundofthisgeneticanomaly,
characterized by T cell population reduction. Considering the spectrum of specific anomalies of this genetic disease, prophylactic
measures are required in order to prevent the contamination with different infectious agents, especially in pandemic context.
Keywords: thymus, Down Syndrome, SARS-CoV-2
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Implications and relevance of experimental models in deciphering cellular and

tissular morphology
Carmen Lacramioara Zamfir1, Daniela Gurgus2, Roxana Folescu2

1) Morpho-Functional Sciences I, University of Medicine and Pharmacy Grigore T Popa Iasi, Romania
2) Family Medicine, University of Medicine and Pharmacy Victor Babes Timisoara, Romania
Introduction
Correlations between experiment and the induced pathology offers multiple possibilities to evaluate cellular and tissular alterations.
The use of an adequate experimental design allows an assessment and a particular approach not only of the pathology of different
organs, but also of the sequence in time and the evolution of these dysfunctions.
Today there are numerous types of experimental models which are used, adapted to the specific research, in order to ensure the
coherence and the transparency of the resulted data, as well as their compact reference to control basis data.
Regardless of their configuration, in order to be reelvant, these models must ensure a close translation of the results to human
pathology.Unlike the studies on human subjects,which are away from a rapid course,most of the tissues being not always available
for the scientific research, with a reduced oportunity for the interventional studies, an experimental model can be performed in a
relatively short period of time and allows interventional processes.
Results
The results obtained after diverse experimental studies can be extrapolated to human, allowing the understanding of alterations at
cellular/tissular level in the context of the induced pathology and also the dynamics of the pathologic process and involved
mechanisms.
Conclusion
The experimental models still represent an important source to obtain new data to facilitate the deciphering of the pathologic
substrate of diverse pathologies and the start of a targeted therapy.
Keywords: model, experimental, design, tissular, cellular
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Varia
White Matter Dissection in Fetal Brain
Armand Boer1, Raluca Pascalau5, Bianca Horgos1, Miruna Mecea1, Razvan Ciortea3,6, Carmen Mihaela Mihu2,7, Sergiu Susman2,4
1) Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
2) Department of Morphological Sciences - Histology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
3) Department of Obstetrics and Gynecology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
4) Department of Pathology and Neuropathology, Imogen Research Center, Cluj-Napoca, Romania
5) Department of Ophthalmology, Emergency County Hospital, Cluj-Napoca, Romania
6) Department of Gynecology, Emergency County Hospital, Cluj-Napoca, Romania
7) Department of Radiology, Emergency County Hospital, Cluj-Napoca, Romania
Introduction
Neuroplasticityisacomplexprocessofstructuralandfunctionalreorganizationofbraintissue.Inthefetalperiod,neuroplasticityhas
an important role in the development of white matter tracts.
Ten normal brains were collected from in utero fetuses (aged between 13 and 35) (GW). We aimed to study the architecture of
normal fetal brains by way of Klingler's dissection. Brains were immersed in 10% formaline and frozen at-20 for 14 days and
dissected with the aid of a Wheeler spatula.
Results
We observed modifications in shape and sulci configuration. We found that the major white matter tracts follow four waves of
development. The first wave (13 GW) involves the corpus callosum, the fornix, the anterior commissure, and the uncinate fasciculus.
In the second one (14 GW), the superior and inferior longitudinal fasciculi and the cingulum could be identified. The third wave (17
GW) concerns the internal capsule and in the fourth wave (20 GW) all the major tracts, were depicted.
Conclusion
Our results suggest an earlier development of the white matter tracts than estimated by DTI tractography studies. Correlating
anatomical dissection with tractography data is of great interest for further research in the field of fetal brain mapping.
Keywords: fetal brain, white matter tracts, fiber dissection, human brain development, cerebral connectivity
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Varia
The assessment of aortic wall intimal layer with ageing
Mirela Albu1, Doru Adrian Seicaru1, Mircea-Sebastian Serbanescu2, Florentina Gherghiceanu3, Ion Daniel Avramescu4, Florin
Giuroiu4, Oana Cristina Mirea5, Razvan Mihail Plesea6, Iancu Emil Plesea1,4
1) Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
2) Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Romania
3) Department of Marketing and Medical Technology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
4) Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania
5) Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
6) Department of Cellular and Molecular Biology, University of Medicine and Pharmacy of Craiova, Romania
Introduction
Aorta is the main representative of the group of arteries that carry large amounts of blood, called elastic arteries. The authors aimed
to quantitatively assess the variation with age of one of the two main layers of the aortic wall, namely intima tunic, in different
regions of the vessel.
Four aortic rings (base, cross, thoracic, abdominal) were taken during autopsies from 90 autopsied cases. Samples were processed
using the classical HP technique and stained with Orcein, and Goldner’s trichrome. Age was stratified in periods: AP1-Childhood and
Adolescence, AP2-Young Adulthood, AP3-Mature Adulthood and AP4-Senescence. Intimal thickness IN-Th was measured using
custom-made software, developed in Matlab (Mathworks, USA) on virtual slides. Average values (AV) were compared with t test for
two independent samples (Two tailed), ANOVA: Single factor test and Pearson’s test.
Results
The AVs of IN-Th increased with age in all aortic regions, both in men and women (Pearson’s test p values <0.05).
IN-Th AVs were higher in men than in women in all regions and in all periods of life, excepting AP1.
TheincreasingtrendalongtheaorticregionswasdiscreetinAP1(ANOVAtestpvalues>0.05)andobviousandconstantintheother
three periods of life (ANOVA test p values <0.05), with a mild attenuation towards the distal region in AP3and AP4 (Pearson’s test p
values >0.05).
TheincreasingtrendduringlifewasdiscreetbutconstantinBaseregion(ANOVAtestpvalues>0.05)andobviousandconstantinthe
other three topographic regions (ANOVA test p values <0.05), with a mild attenuation towards the Senescence in the Cross region
(Pearson’s test p values >0.05).
Conclusion
Our preliminary data show that one of the main parts of the aortic intimal layer remodeling process consists of the increase of its
thickness both along the aortic length and during life.
Keywords: aortic wall, intimal layer, ageing
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Varia
The assessment of aortic wall media layer with ageing
Doru Adrian Seicaru1, Mirela Albu1, Mircea-Sebastian Serbanescu2, Florentina Gherghiceanu3, Florin Giuroiu4, Paula Loredana
Chiriac4, Oana Cristina Mirea5, Razvan Mihail Plesea6, Iancu Emil Plesea1,4
1) Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
2) Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Romania
3) Department of Marketing and Medical Technology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
4) Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania
5) Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
6) Department of Cellular and Molecular Biology, University of Medicine and Pharmacy of Craiova, Romania
Introduction
Morphological and functional changes appearing in all tissues with ageing affect also all vascular structures, including aorta. The
authors aimed to quantitatively assess the variation with age of one of the two main layers of the aortic wall, namely Media tunic, in
different topographic regions of the aorta.
Four aortic rings (Base-B, Cross-C, Thoracic-T, Abdominal-Ab) were taken during autopsies from 90 autopsied cases. Samples were
processed using the classical HP technique and stained with Orcein, and Goldner’s trichrome. Age was stratified in periods:
AP1-Childhood and Adolescence, AP2-Young Adulthood, AP3-Mature Adulthood and AP4-Senescence. The assessed parameter was
Media thickness MED-Th. It was measured using custom-made software, developed in Matlab (Mathworks, USA) on virtual slides.
Average values (AV) were compared with t test for two independent samples (Two tailed), ANOVA: Single factor test and Pearson’s
test.
Results
The AVs of MED-Th increased with age in all aortic regions, both in men and women. (Pearson’s test p values <0.05).
MED-Th AVs were higher in women than in men in all regions excepting T region and in AP3 and AP4 periods of life.
In each of the four regions, in turn, The AVs of MED-Th revealed, a general increasing trend during life (ANOVA test p values <0.05)
with mild attenuations in the second part of life in distal regions (Thoracic and Abdominal) (Pearson’s test p values are decreasing or
are >0.05).
Conclusion
Our preliminary data show that the remodeling process of the aortic medial layer has two different and diverging pathways of
evolution of the AVs of MED-Th: on one hand, an evident increase of its thickness during age in all topographic regions of the vessel
and, on the other hand, an obvious decreasing trend of its thickness from the proximal towards the distal regions of the vessel.
Keywords: aortic wall, media layer, ageing
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Digestive
Poster Session
pathology
Poster Session
Morphological and Immunohistochemical Aspects for Squamous Cell Carcinoma of

the Head and Neck
Bogdan-George Cioc 1, Nicolae Constantin Balica 2, Alexandru Chioreanu2, Adeline-Roxana Bucur1, Raluca Maria Closca 1, Maria-
Bianca Tat1, Alin Marian Vasile 1, Flavia Baderca 1,3
1) Service of Pathology, Emergency City Hospital, Timișoara , Romania
2) Department of Otorhinolaryngology, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
3) Department of Microscopic Morphology, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
Introduction
Squamous cell carcinoma is an invasive epithelial malignancy arising from squamous cells of stratified epithelium that feature
varying degrees of differentiation and cytological features. Represents the most common histological type of cancer in all head and
neck carcinomas.
The study was performed on 20 patients of the Emergency City Hospital, Timișoara, Romania. All the specimens were fixed in 10%
buffered formalin solution and sent for the histopathological evaluation. The histologic features were evaluated based on
hematoxylin and eosin stained slides. Additional immunohistochemistry tests for p16 were performed.
Results
The following types of cancer were found: keratinizing squamous cell carcinoma moderately differentiated (15%), nonkeratinizing
squamous cell carcinoma moderately differentiated (80%) and nonkeratinizing squamous cell carcinoma poorly differentiated (5%).
Thep16reactionwasvariable,withpositivecasesontumorcellsandnegativeonthesurfaceepithelium(20%whichrepresents15%
non-keratinizing squamous cell carcinoma moderately differentiated and 5% keratinizing squamous cell carcinoma moderately
differentiated), positive on both (35% which represents non-keratinizing squamous cell carcinoma moderately differentiated) and
negative on both (45% which represents 30% non-keratinizing squamous cell carcinoma moderately differentiated, 5% non-
keratinizing squamous cell carcinoma poorly differentiated and 10% keratinizing squamous cell carcinoma moderately
differentiated).
Conclusion
The immunohistochemical response to p16 is variable in head and neck carcinomas and can be considered a prognostic factor of
head and neck carcinomas
Keywords: squamous cell carcinoma, head and neck carcinomas, p16, prognostic factor
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Poster Session
Non-Hodgkin follicular B cell lymphoma (NHFBCL) an incidental finding in a

parotidectomy for Warthin tumor
Alexandra Corina Faur1,2, Adeline-Roxana Bucur2, Nicolae Constantin Balica3, Flavia Baderca2,4
1) Department of Anatomy and Embriology, „V. Babes” University of Medicine and Pharmacy Timisoara, Romania
2) Service of Pathology, City Hospital Timisoara, Romania
3) Oto-Rhino-Laryngology Department, , „V. Babes” University of Medicine and Pharmacy Timisoara, Romania
4) Department of Microscopic Morphology, „V. Babes” University of Medicine and Pharmacy Timisoara, Romania
Introduction
Warthin tumor (WT) is a benign salivary gland tumor with a bilayer oncocytic epithelium and an underlying lymphoid stroma which
uncommonly undergoes malignant transformation.
A 59-years-old man was admitted to the Oto-Rhino-Laryngology Department of the City Hospital of Timisoara with an enlargement
oftherightparotidglandandaleftadenopathyintheareaoftheangleofthemandiblethatwereincreasinginsizegraduallyfor5to
3 years. The excised parotidectomy specimen showed a 5/3/2.5 cm tan to brown mass with solid and cystic areas. The 4µ-thick
formalin-fixed paraffin-embedded tissue samples were stained with hematoxilin and eosin (HE). For the immunohistochemical (IHC)
analysis were used the antibodies CD20, CD5, CD10, CD23, Cd79a, BCL-2, BCL-6 and Ki-67 with DAB visualisation system.
Results
TheHEslidesrevealedaWTwithanatypicallymphoidstroma.TheIHCanalysisresultswerepositiveforCD10,CD79a,BCL-2,CD20
and the Ki67 index in the interfolicular area was estimated less than 20%. The final diagnosis was low-grade NHFBCL in a WT.
Conclusion
There are rare examples of disseminating Non-Hodgking and Hodgkin lymphomas associated with WT in the English literature. To
the best of our knowledge this is the fifteen case of an Non-Hodgkin follicular lymphoma first detected in a WT.
Keywords: Warthin tumor, salivary gland, follicular lymphoma
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Poster Session
Mantle cell lymphoma of the submandibular salivary gland
Alexandra Corina Faur1,2, Adeline-Roxana Bucur2, Horatiu Urechescu3, Flavia Baderca2,4

1) Department of Anatomy and Embriology, „V. Babes” University of Medicine and Pharmacy Timisoara, Romania
2) Service of Pathology, City Hospital Timisoara, Romania
3) Oro-Maxillo-Facial Department, „V. Babes” University of Medicine and Pharmacy Timisoara, Romania
4) Department of Microscopic Morphology, „V. Babes” University of Medicine and Pharmacy Timisoara, Romania
Introduction
Mantle cell lymphoma (MCL) represents 6% of the non-Hodgkin lymphomas (NHL) involving the head and neck region with only
2.5-4% of the cases affecting the salivary glands, mostly the parotid salivary glands.
A 52-years-old woman presented to the Oro-Maxillo-Facial Department of the City Hospital of Timisoara with a left submandibular
glandmass.Surgicalexcisionofthelesionwasdoneandthegrossexaminationrevealeda4.2/2.8/2.1cmwelldefinedmultinodular
creamy brown solid mass. The 4µ-thick formalin-fixed paraffin-embedded tissue samples were stained with hematoxilin and eosin
(HE).FortheimmunohistochemicalanalysiswereusedtheantibodiesCD20,CD5,CD10,CD23,ciclynD1,BCL-6andKi-67withDAB
visualisation system.
Results
The HE slides revealed a monomorphic small to medium-sized proliferation of lymphoid cells involving the salivary gland with with
distruction of the normal architecture of ducts and acini and lymphoepithelial lesions. The neoplastic cells were positive for CD20,
CD5andciclynD1.TheKi-67indexwas55%inhot-spots.Clinicallynolymphomatouslesionwasdetectedinotherpartsofthebody
before this diagnosis. A final histopathological diagnosis of B-cell NHL of MCL-type of the submandibular salivary gland was made.
Conclusion
MCL occurs mostly as a lesion localised in the head and neck region in the Waldayer ring. MCL of the salivary gland is a rare
condition. Diagnosis of MCL requires morphological and immunophenotypic studies and clinical informations.
Keywords: salivary gland, lymphoma, immunohistochemistry
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Poster Session
Lymph Node Metastasis of Gastric Adenocarcinoma, Clinically Mimicking

Melanoma
Raluca Maria Closca1, Emil Florin Huț2, Octavian Marius Crețu2, Adeline-Roxana Bucur1, Maria-Bianca Tat1, Bogdan George Cioc1,
Alin Marian Vasile1, Flavia Baderca1,3
2) Department of Surgical Semiology, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
3) Department of Microscopic Morphology, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
Introduction
Workers who are long-term exposed to coal dust in the workplace, such as miners, tend to show a higher incidence of gastric
carcinoma.
The current paper presented a case of an 85-years-old with gastric pigmented mass and liver, peritoneal and hepatic artery
pigmented lymph node enlargement. The harvested specimens were processed with usual histological stain and
immunohistochemicalreactionsforfurtherantibodies:anti-S100protein,anti-HMB45,anti-MelanA,anti-CD68,anti-CK7,anti-CK20,
anti-CDX2 and anti-CK19.
Results
On microscopic examination, the gastric biopsy sample presented medium size glands with moderated atypia. A lymph node on the
lesser curvature showed enlarged subcapsular and interfollicular sinuses with macrophages with intracytoplasmic black pigment,
CD68 positive. Two lymph nodes surrounding the hepatic artery also showed the same mentioned characteristics as perigastric
lymphnodeandathirdonepresentedadenocarcinomatousmetastasis.ThetumorcellswerenegativeforMelanA,HMB45andS100
protein. The peritoneal tissue sample was microscopically confirmed as the metastasis of gastric adenocarcinoma.
The liver fragment showed intracytoplasmic black pigment in the macrophages occupying the portal spaces and atypical glands
strongly and diffusely positive for CK7, CK19, CDX2 and negative for CK20.
Conclusion
Following the microscopic examination on H&E stained sections and the additional immunohistochemical stains, the diagnosis of
intestinal-type gastric adenocarcinoma was assigned, with hepatic, peritoneal and lymph nodes metastases, associated with many
black pigment laden macrophages situated in the portal spaces and in the lymph node sinuses. The immunohistochemical stains
ruled out the clinical suspicion of a melanoma synchronous with the gastric adenocarcinoma.
Keywords: gastric adenocarcinoma, occupational condition, immunohistochemistry
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Poster Session
Adenocarcinoma arising from pyloric metaplasia of the ileum
Marius Teodorescu1, Bogdan Stancu2, Bogdan Pop3, Alexandra Buruiana-Simic3, Bogdan Gheban3, Diana Gonciar1,3, Raluca
Margit Szilveszter1,3, Camelia Albu3, Maria Bungărdean1,3, Carmen Georgiu1,3, Doinița Crișan1,3
2) Surgery Clinc II, Emergency County Hospital Cluj-Napoca, Romania
3) Department of Pathology, "Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
Introduction
Smallboweladenocarcinomaaccountsforlessthan5%ofallgastrointestinaltractmalignancies.Itscausativeagentsincludespecific
dietary habits, chronic inflammatory disorders and hereditary syndromes associated with an increased risk of developing intestinal
polyps. Chronic inflammation has been previously linked to variation in tumor morphology through its potential to entail gastric
metaplastic changes, with adenocarcinomas arising in an inflammatory bowel disease setting often displaying a gastric phenotype.
However, this behavior was scarcely observed in association with tumors affecting individuals with no prior history of disease and
reports of malignant transformation involving ectopically located gastric tissue at this site are exceedingly rare.
A 47-year-old woman presented with malaise, weight loss and diffuse abdominal pain with a tendency of localization to the right
lumbar and iliac regions, associated with episodic abdominal distension and changes in bowel habits. Colonoscopy was unrevealing,
whereas an abdominal CT scan revealed a circumferential, non-obstructive thickening of the distal ileal wall. An exploratory
laparotomy identified a protrusive mass located in the distal ileum, approximately 2 cm proximally from the ileocecal valve, and an
ileo-colectomy with primary anastomosis was performed.
Results
Themacroscopicexaminationoftheresectedintestinalspecimenrevealedthepresenceofanilealpolypoidtumorthatinfiltratedthe
intestinal wall reaching the serosal adipose tissue. The mass was an adenocarcinoma with a mixed, tubular, papillary and solid
growth pattern. The malignant epithelial cells were CK7+/CK20- and yielded a strong (3+) reaction for the HER2 oncoprotein, while
the adjacent ileal mucosa was CK7-/CK20+. Peripherally, the lamina propria was occupied by multiple, PAS+, pyloric-type mucous
glands. The adenocarcinoma was staged pT3, pN0 (0/21), pMx, G2, R0.
Conclusion
Themicroscopicfindingsarehighlysuggestiveofametaplasticoriginofthemalignancy,elicitingahigherdemandforunderstanding
the etiopathogenesis of ectopic tissue and the malignant transformation potential borne by metaplastic cells.
Keywords: Adenocarcinoma, ileum, pyloric gland metaplasia
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Poster Session
Jejunal Adenocarcinoma – a rare small bowel neoplasm
Andrada Raicea1, Raluca-Diana Hagău1, Andreea-Raluca Szőke1, Marius-Florin Coroș2, Ovidiu Simion Cotoi1, Jenő Róbert Bartha1
2) Surgery Department, Mureș Clinical County Hospital, Romania
Introduction
Adenocarcinomaofthesmallbowelisararemorphopathologicalentity,representinglessthan3%ofallgastrointestinalneoplasms.
The duodenal location is the most common site of occurrence, followed by jejunum and ileum. Adenocarcinoma of the small
intestine is difficult to diagnose and often occurs at a late stage with a poor prognosis. The average age at diagnosis is around 60
years, with a higher rate of development seen in men.
We report the case of a 62-year-old man, with non-specific symptoms that showed up to the Surgery Department of Mureș County
Clinical Hospital, with a tumoral mass of the small intestine with a jejunal localization. The patient underwent surgery and a
segmental resection of the jejunum was performed, along with the excision of the mesenteric lymph nodes. The resulting sample
was sent further for histopathological examination.
Results
Thehistopathologicalexaminationshowsmacroscopicallyavoluminous,vegetativetumoralmasswiththesizeof140x120x60mm,
locatedatdistancefromthesurgicalresectionmargins.Microscopically,itisobservedthepresenceofatumoralproliferationmadeof
irregularwell-differentiatedglands,linedbycolumnarepithelialcellswithcyto-nuclearatypia,withenlarged,irregular,hyperchromic,
pseudostratified nuclei, which infiltrates the intestinal wall up to the subserosal layer, without producing lymph nodal metastases,
stage pT3N0. Immunohistochemical profile: tumor cells are positive for CDX-2 and negative for Chromogranin A and Synaptophysin.
Conclusion
Duetothelowincidenceofjejunaladenocarcinoma,wehighlighttheparticularityofthelocationoftheidentifiedadenocarcinomaas
well as the voluminous size of the tumor formation.
Keywords: adenocarcinoma, prognostic, jejunum, small intestine
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Poster Session
Intestinal diffuse large B-cell lymphoma – a case report
Raluca-Diana Hagău1, Andrada Raicea1, Ghenadie Pascarenco2, Ovidiu S. Cotoi1, Jenő Róbert Bartha1
1) Serviciul de Anatomie Patologică, Spitalul Clinic Județean Mureș, Romania
2) Clinica de Chirurgie Generală, Spitalul Clinic Județean Mureș, Romania
Introduction
Primary malignant tumors of the small intestine are very rare, representing less than 2% of all gastrointestinal malignancies, diffuse
large B-cell lymphoma being a lymphoproliferative disorder involving lymph nodes, with a poor prognosis due to high recurrence
rates. This type of lymphoma most often affects the stomach, small intestine, and ileo-cecal region. The average age of diagnosis is
about 64 years old.
We report the case of a 78-year-old patient, who presented in the Gastroenterology department of the Mureș County Clinical
Hospital, in order to investigate an anemic condition. Following the ultrasound imaging examinations, the suspicion of an ascending
colon tumor was raised, later the CT examination revealed an aspect similar to intestinal lymphoma, which is why the segmental
resection of the affected small intestine was performed.
Results
Macroscopically, the histopathological examination shows four tumoral masses, with an ulcero-vegetative and infiltrative
appearance,alongwithmultiplelymphnodesinthemesentery.Microscopically,thesemasseshaveasimilarsemblance,beingmade
up of a diffuse proliferation of medium and large tumor cells, which reaches the subserosa. These cells are positive for the
immunohistochemical markers CD20, BCL-6, and Vimentin, and show a Ki-67 tumor proliferation index of 80%.
Conclusion
We intend to emphasize the histological and immunohistochemical characteristics specific to lymphoma located in the small
intestine, but also the particular presentation of the case in the form of four distinct tumoral masses.
Keywords: Intestinal diffuse large B-cell lymphoma, gastrointestinal lymphoma, lymphoma
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Poster Session
The histopathological study of endoscopically resected colonic polyps.
Mirela Marinela Florescu1, Dan Nicolae Florescu2, Alex Emilian Stepan1, Raluca-Niculina Ciurea1, Claudiu Margaritescu1, Bianca
Cătălina Andreiana1, Anne Marie Badiu1, Cristiana Eugenia Simionescu1
2) Gastroenterology, University of Medicine and Pharmacy of Craiova, Romania
Introduction
The purpose of colorectal cancer screening is represented by the detection of preneoplastic lesions, such as colonic polyps that will
be resected endoscopically, thus preventing their transformation into malignant tumors.
In our study, we evaluated the polypectomy resection parts from the Gastroenterology Department from the first 6 months of 2022.
In total, 109 polypectomies were performed (83 sessile polyps, 12 pedunculated polyps, 5 semi-pedunculated polyps and 10 flat
polyps) at patients aged between 27 and 86 years, and the polypectomy pieces were fixed in 10% buffered formalin, processed by
the usual paraffin embedding technique, followed by sectioning at 3-5 μm and standard staining with Hemalaum-Eosin (Bio kit -
Optics).
Results
The clinical-epidemiological analysis shows that 30 patients were women and 58 were men. Among the detected lesions were: 21
sessile serous adenomas (SSA), 19 traditional serous adenomas (TSA), 32 tubular adenomas, 8 villous adenomas, 12 tubulovillous
adenomas, 5 adenocarcinomas, 12 hyperplastic polyps.
Regarding the resection margin, of the 109 resected polyps, 78 had intact margins, 19 had serrated margins, and in 12 cases the
resection margins could not be appreciated.
Regarding the degree of dysplasia: 67 resection pieces showed areas of low-grade dysplasia, 38 high-grade dysplasia and in 5 cases
adenocarcinoma was highlighted (2 cases of carcinoma in situ and 3 cases of well-differentiated G1 adenocarcinoma).
Conclusion
The histopathological study supports the opportunity of colorectal cancer screening in order to obtain complete resections of
preneoplastic lesions.
Keywords: colorectal cancer, polyp, dysplasia
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Poster Session
A case of biliary type adenocarcinoma of the gallbladder
Rada Teodora Sufleţel1, Maria Crişan1, Alina Şovrea1, Sergiu Şuşman1, Bianca Boşca1, Carmen Melincovici1, Mariana Mărginean1,
Anne-Marie Constantin1, Mihaela Jianu1, Andrei Coneac1, Ioana Moldovan1, Roxana Ștefan1, Carmen Mihaela Mihu1
1) Discipline of Histology, Department of Morphological Sciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-
Napoca, Romania
Introduction
Adenocarcinoma of the gallbladder represents a rare and aggressive malignancy, commonly affecting women in their sixth and
seventh decades. The main risk factor is chronic lithiasis cholecystitis.
A 74-year-old woman presented in the gastroenterology department accusing right upper abdominal pain, nausea, bloating and
flatulence.Laboratoryexaminationrevealedelevatedalkalinephosphataseandgamma-glutamyltransferase.Abdominalultrasound
highlighted a thickened gallbladder wall with gallstones in the lumen. Laparoscopic cholecystectomy was performed.
Inthepathologydepartment,wereceivedtheresectionspecimenthatwasfixedin10%bufferedformalinandembeddedinparaffin.
Slides sections of 4 microns were made, that were stained with hematoxylin eosin.
Results
On gross examination, the gallbladder specimen presented thickened, indurated wall, friable mucosa and a gritty, hard, tan-white to
yellow-gray cut surface. The lumen contained yellow gallstones.
Light microscopic examination revealed a malignant glandular proliferation, composed of pleomorphic cells, cuboidal to polygonal,
with large, irregular nuclei, vesicular chromatin, prominent nucleoli and mitoses, disposed in a desmoplastic stroma. The malignant
proliferation invaded the whole gallbladder wall, originating from the mucosa, extending and perforating the serosa.
The liver parenchymal margin was infiltrated by the malignant tumor.
Lymphovascular invasion was identified.
Furthermore, the background gallbladder showed ulcerations of the mucosa and a lymphoplasmacytic inflammatory infiltrate in
lamina propria, which extended into the muscularis.
Conclusion
The case was interpreted as a biliary type adenocarcinoma of the gallbladder, developed on the background of a chronic lithiasis
cholecystitis.Gallbladderadenocarcinomarepresentsachallengingdiagnosis,beinganincidentalfindinginroutinecholecystectomy
specimens due to absence of symptoms and gross modifications.
Keywords: gallbladder, adenocarcinoma, cholecystitis, lithiasis
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Poster Session
Collecting Duct Carcinoma – a Diagnostic and Therapeutic Challenge
Andrei Dorin Ciocoiu1,2, Nusa Alina Segarceanu2, Cristina Marinela Oprean2, Raluca Maria Closca3, Flavia Baderca3,4
1) Medical Oncology Department, Municipal Emergency Hospital, Timișoara, Romania
2) Medical Oncology Department, Oncohelp Hospital, Timișoara, Romania
3) Service of Pathology, Municipal Emergency Hospital, Timișoara, Romania
4) Department of Microscopic Morphology, University of Medicine and Pharmacy “Victor Babeș” , Timișoara, Romania
Introduction
Renal collecting duct carcinoma is a rare subtype of cancer, with a poor prognosis, that originates from the distal collecting ducts.
Despite the immunohistochemical features of this subtype, differential diagnosis is difficult. It is, generally, refractory to treatment
with tyrosine-kinase inhibitors. Similar case studies have reported chemotherapy, immunotherapy and radiotherapy use for this
subtype of cancer.
A 62 year old patient was admitted to the hospital with inguinal lymph node enlargement that was excised for diagnosis. The
sampled tissues were processed using usual stains and, furthermore, for the following immunohistochemical reactions: CK7, CK20,
Ki67, PSA, vimentin, CEA, androgen receptors, CDX2, TTF1, CK8/18, GATA3 and PAX8.
Results
Conventional histopathological examination revealed a massive lymph node metastasis, with extracapsular extension. The tumor
presented tubular and tubulo-papillary architecture, with desmoplastic stroma and extensive tumor necrosis, with areas of comedo
necrosis. Tumor cells showed eosinophilic cytoplasm, with irregular nucleolated nuclei, of moderate and large sizes, and easily
detectable mitotic activity. Additionally, the tumor cells reacted for PAX8 and CK8/18 and were negative for CK7, CK20, CEA, TTF1,
CDX2, vimentin, PSA and GATA3. The Ki67 reaction releaved a high mitotic index.
Conclusion
Through the microscopic examination of the slides, using the usual stainings, following the immunohistochemical reactions, the
patient was diagnosed with collecting duct carcinoma, Fuhrman grade 4. The immunohistochemical profile CK7-, CK20-, vimentin-
and PAX+ excluded a carcinoma of thyroid origin (TTF1+, CK7+), Müllerian/primitive peritoneal (CK7+), bladder/urachal (CK7+,
CK20+), clear cell renal carcinoma (vimentin+) and a renal papillary carcinoma. Prostatic (PSA-) and digestive (PAX8+, CDX2+) origin
was also excluded. Therefore, based on the morphopathological examination, the diagnosis of renal collecting ducts carcinoma,
Fuhrman grade G4 was established.
Keywords: collecting ducts carcinoma, immunohistochemistry, prognostic factors
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Poster Session
Chloride intracellular channel 1 immunoexpression in liver metastases of

colorectal origin - clinical and experimental model
Amalia Raluca Ceausu1, Alexandru Ciolofan2, Pusa Nela Gaje1, Octavian Marius Crețu2, Marius Raica1
1) Department of Microscopic Morphology/ Histology, Angiogenesis Research Center, Timisoara, "Victor Babeș" University of
Medicine and Pharmacy, Timișoara, Romania
2) Department of Surgery, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
Introduction
Chlorideintracellularchannel1(CLIC1)playanimportantroleinproliferationanddifferentiationofcells,changesincellvolume,the
regulation of membrane potential. It was identified also in pathological conditions: cell migration, invasion and metastasis.
The present study included 20 cases of primary tumor and corresponding liver metastases (LM). The CLIC 1 immunopositive cells
were evaluated as follow: score 0 (less than 10% of positive cells), 1(10-30%), 2 (30-50%) and 3 (more than 50%). The experimental
part involved the application on CAM of a suspension of tumor cells derived from CRLM (dHGP).
Results
ThefollowingdistributionwasnoticedforthehistologicalgrowthpatternofLM:replacement(3),desmoplastic(10)andpushingtype
(7 cases). All LM expressed CLIC 1 heterogeneously as distribution and intensity. CLIC 1 intensity score values varied between 1 and
3.ThediagnosticandprognosticrolesofCLIC1weresustainedbyasignificantcorrelationbetweentheCLIC1scoreandthedegree
ofdifferentiationofLMCRadenocarcinomas,withdesmoplasticgrowthpattern(dHGP).Itwasfoundasignificantcorrelationbetween
CLIC 1 immunoexpression in all three HGP of LMCR adenocarcinomas and microvascular density in the metastatic area. CLIC 1
immunoexpression on CAM was noticed in more than 70% of metastatic cells, with cytoplasmic pattern, only few cells with nuclear
expression were seen. Reaction intensity values varied between 2 and 3 (isolated cells).
Conclusion
TheresultsofthestudysupporttheuseofCLIC1asamarkerwithprognostic,diagnosticandtherapeuticvalueinpatientswithLMof
colorectal origin.
Keywords: colorectal cancer, histological growth pattern, liver metastasis, Chloride intracellular channel 1
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Poster Session
Kissing tumors: when a metastatic ovary lesion meets an adenocarcinoma of the

colon – a rare case of two malignant collision tumors
Adrian Bejenariu1, Adrian Vasile Dumitru1,2, Maria Sajin1,2, Mariana Costache1,2, Cătălin Aliuș2,3, Tiberiu Trotea2,3, Dan
Dumitrescu2,3, Ana Maria Ciongariu1,2, Dana Antonia Țăpoi1,2
1) Pathology Department, Emergency University Hospital, Bucharest, Romania
2) “Carol Davila”, University of Medicine and Pharmacy, Bucharest, Romania
3) General Surgery Department, Emergency University Hospital, Bucharest, Romania
Introduction
Collision tumors are rare entities where two independent neoplasms coexist in the same organ, each having distinctive borders and
different histological and immunohistochemical characteristics. Different neoplasms could exist in the same organ, any combination
of benign and malignant tumors being possible.
We report a case of a 75 year-old woman who presented to the emergency room of our hospital with abdominal pain and bowel
obstruction.CTscansrevealeddiffusestenosisofthesigmoidcolonwithproximallydistendedcolon,notbeingabletoappreciatethe
integrity of the ovaries. Emergency Hartmann colectomy and left ovarectomy were performed, followed by histopathological and
immunohistochemical assessment.
Results
Microscopic examination revealed two colonic lesions consisting of malignant epithelial proliferations: the primary one showing
glandular differentiation and a metastatic lesion consisting of large cells with papillary, micropapillary and solid architecture with
multiple psammoma bodies. The left ovary presented a tumor mass with the same microscopic features as the secondary tumor of
the colon. Thus the diagnosis of collision tumors represented by colonic adenocarcinoma and high grade serous ovarian carcinoma
wasestablished.UponimmunohistochemicalanalysisthetumorcellsoftheprimarylesionshowedintensediffusepositiveCDX2and
CK20andnegativeCK7staining,revealingthecolonicoriginoftheproliferation.Thesecondarylesiondemonstratedintensepositive
PAX8, p16, ER and CK7, while CK20 was negative.
Conclusion
Despitethefactthatcolonicadenocarcinomaandhighgradeserousovariancarcinomaaretwoofthemostcommonmalignanciesof
thecolonandovary,diagnosingbothtumorssimultaneouslyatthesamepatientisextremelyrare.Collisiontumorsweredescribedin
many organs, but in most cases there is an association between a malignant and a benign tumor. The case we presented represents
an incredibly rare association of two different malignant lesions incidentally discovered in an emergency presentation.
Keywords: collision tumors, colonic adenocarcinoma, high grade serous ovarian carcinoma
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Poster Session
Lymphangitic carcinomatosis in a case of caudal pancreatic ductal adenocarcinoma
Madalina Boian1, Irina Negulescu1, Maria Bungardean1,2, Alexandra Buruiana-Simic2, Bogdan Gheban2, Bogdan Pop2, Diana
Gonciar1,2, Raluca Margit Szilveszter1,2, Camelia Albu1,2, Dana Fodor3, Dan Sebastian Dirzu4, Crisan Doinita1,2, Carmen Georgiu1,2
1) Department of Pathology, Emergency County Hospital Cluj Napoca, Romania
2) Department of Pathology, Faculty of Medicine, Iuliu Haţieganu University of Medicine, and Pharmacy Cluj-Napoca, Romania
3) Department of Semiology, Faculty of Medicine, Iuliu Haţieganu University of Medicine, and Pharmacy Cluj-Napoca, Romania
4) Department Anesthesiology and Intensive Care, Emergency County Hospital Cluj Napoca, Romania
Introduction
Lymphangitic carcinomatosis is defined as the spreading of a tumor through the lymphatic vessels throughout the body from the
primarysite,associatedmostcommonlywithbreast,lungandstomachcancers.Pancreaticductaladenocarcinomausuallyhaslargely
invasive characteristics, with early spreading directly in the surroundings, and distally in the lymph nodes.
Case presentation. A 59-year-old female patient was admitted to the hospital, after being treated for pneumonia without any
improvement, accusing dyspnea, asthenia, and fatigue for a month. CT scan revealed a metastatic pancreatic tumor. The patient's
condition deteriorated with hemodynamic instability, and obstructive shock, eventually leading to death. The autopsy revealed a
caudal pancreatic tumor with splenic invasion, multiple white firm nodules and tracts in the lung, thick placards on the pleura,
mediastinum, covering and compressing the heart, nodules in the liver, kidneys, left adrenal gland, paraaortic and epiploic lymph
nodes.
Results
Themicroscopicfindingswereconsistentwithpancreaticductaladenocarcinoma,withnumerouslymphatictumoremboli.Themost
impressivemetastaticspreadingwasinthelung,andpleura,withanimportantlymphatic,periandparietalvascularinvasion,leading
to the final diagnosis. Microscopic metastases were observed, additionally in the myocardium, and even inside a uterine leiomyoma.
Conclusion
Although lymphangitic carcinomatosis is very rare it is very important to raise this possibility in patients with nonspecific respiratory
symptoms. This case was peculiar because of the multiple foci in the lymphatic vessels of the lung, pleura but also in other unusual
sites such as in the mediastinum, myocardium, and even inside a uterine leiomyoma.
Keywords: Lymphangitic carcinomatosis, pancreatic ductal adenocarcinoma, pulmonary metastasis
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Poster Session
Cystic lesions of the mediastinum - a case series based on pathological aspects
Florina Almarii1,2, George Simion1, Andrei Dobrea3,4, Maria Sajin1,2

1) Pathology, Emergency University Hospital Bucharest, Romania
2) Morphological sciences, University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania
3) Thoracic surgery, Emergency University Hospital, Bucharest, Romania
4) Thoracic surgery, University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania
Introduction
Cysticlesionsofthemediastinumarerarefindingsandbecauseofthenumerousstructureslocatedwithinmediastinum,thecystsare
anatomically and histologically diverse.
We gathered the histologic types of the cystic lesions of the mediastinum encountered amongst the patients that were treated since
first of January 2021 in the Thoracic Surgery Department of the Emergency University Hospital of Bucharest, with emphases on one
case presentation for each category.
Results
Wefoundsixcases,withfourhistologictypesofcysticlesionsdiagnosedinthePathologyDepartment.Therewasonecaseofbenign
cystic teratoma in a 43 year old male patient with the clinical suspicions of abscess of the anterior mediastinum, two Mullerian cysts
of the anterior mediastinum, one developed in the thymic department of a 43 years old women, and the other in a 47 years old
woman, located in the cervical-mediastinal region, near the left thyroid lobe. We found two pericardial cysts, one of them, an
incidental finding in a 36 years old woman, and the other in a 52 years male male investigated for retrosternal pain and one hydatic
cyst, discovered in a 45 years old woman who lives in the countryside.
Conclusion
Although mediastinal cyst are more frequently discovered, they remain relatively uncommon in any pathologist experience and it is
important for them to know their histological aspects and to think about them in order to be able to make an accurate diagnosis.
Keywords: Cyst, Mediastinum, Pathology
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Poster Session
Pilot study on the role of AI-enhanced pCLE in lung cancer surgery
Liliana Streba1, Andreea Gheorghe2, Ciprian Tradian Berisha1, Daniel Pirici3, Alin Demetrian4, Mădălin Mămuleanu5, Costin
Teodor Streba 2, Marius Matei 3, Mircea-Sebastian Șerbănescu6
1) Oncology, University of Medicine and Pharmacy of Craiova, Romania
2) Pulmonology , University of Medicine and Pharmacy of Craiova, Romania
3) Histology , University of Medicine and Pharmacy of Craiova, Romania
4) Thoracic Surgery, University of Medicine and Pharmacy of Craiova , Romania
5) Automatic Control and Electronics, University of Craiova, Romania
6) Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Romania
Introduction
The role of probe-based confocal laser endoscopy (pCLE) in the on-site rapid diagnosis of lung lesions is yet to be established.
Intraoperatory use may help surgeons correctly identify resection margins, maximizing parenchymal sparing and giving better
prognosis to patients. Artificial intelligence has greatly increased its yield in image recognition, using deep learning, convolutional
neural networks (CNNs).
We included lung resection pieces containing parenchymatous and tumor tissue from 34 patients with proven malignancies,
irrespective of tumor type, who underwent surgery between 2019-2021 at the University Emergency Hospital of Craiova, Romania.
Ethicalapprovalwaspriorlyobtainedandallpatientsgavewrittenconsentfortheuseoftissue.Normaldiagnosisandfurtherfollow-
up was not affected in any way and no personal identifying data was collected. On-site pCLE was performed on the fresh specimens
on the day of collection, followed by paraffin inclusion and histology. Both tumor and parenchymal tissue were visualized by pCLE,
and recordings were digitally stored and retrieved for analysis. Consecutive images were labeled as malignant or benign,
corroborating with both the macroscopic aspect and further histology. We trained three trained convolutional neural networks
(AlexNet, GoogleNet and ResNet) to classify images as malignant or benign.
Results
We used accuracy and area under the curve (AUC) to analyze the results given by the three CNNs. AlexNet had a mean accuracy of
93.3% and mean AUC of 0.987, GoogleNet 89% mean accuracy and 0.957 mean AUC, while ResNet only 87.9% mean accuracy but
0.959 mean AUC. When comparing means, we did not find statistically significant differences between GoogleNet and ResNet
(Student's t-test, p=0.06 for accuracy and 0.59 for AUC), while AlexNet outperformed both (Student's t-test, p<0.001).
Conclusion
WesuccessfullydemonstratedthatDNNscanbeusedasanon-siteaidforrapidhistology,aidingsurgery.FurtherDNNmodelscanbe
developed to improve results.
This research was funded by the University of Medicine and Pharmacy of Craiova, grant number 26/23C/13.07.2021.
Keywords: lung cancer, probe-based confocal laser endomiscroscopy, surgery, deep neural networks,
pathology , diagnosis
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Poster Session
Pulmonary Metastasis of Hydatidiform Mole
Ioan Adrian Petrache1,2, Flavia Baderca3,4, Raluca Maria Cloșca4, Vasile Găborean2, Ovidiu Nicolae Burlacu1,2, Gabriel Veniamin
Cozma1,2
1) Department of Surgical Semiology, “Victor Babeş” University of Medicine and Pharmacy Timișoara, Romania
2) Thoracic Surgery Clinic, Emergency City Hospital, Timișoara, Romania
3) Department of Microscopic Morphology, “Victor Babeş” University of Medicine and Pharmacy Timișoara, Romania
4) Service of Pathology, Emergency City Hospital, Timișoara, Romania
Introduction
Thehydatidiformmoleisarareconditionconsistinginplacentalpathologyofandrogeneticoriginduetoabnormalhyperproliferation
and hydropic degeneration of chorionic villi. If diagnosed, the disease can be easy to treat. In some cases, it can lead to
choriocarcinoma, with high potential for metastasis and invasiveness. In rare cases ectopic lesions were described, even without the
presence of a pregnancy – small bowel, lung, lacrimal gland.
Thisarticlepresentsacaseofayoungfemalepatientadmittedinourclinicwithaleftlowerlobetumor,discoveredataroutinex-ray
before employment. She had a history of pregnancy interruption a few years before presentation, but with no pathology report after
abortion and a high level of hCG. An uneventful left lower lobectomy was performed. The specimens were sent to Service of
Pathology and processed with routine histological technique. Morphological stain hematoxylin and eosin and immunohistochemical
reactions were performed.
Results
On gross examination, the tumor was cystic. At microscopy, all mediastinal lymph nodes had sinusal histiocytosis, with brown
anthracoticpigmentdeposits.Lungspecimenshowedawell-delimitedfibro-hematicsubstratecontainingchorionicvilli,borderedby
hyperplastic cyto- and syncytiotrophoblast with nuclear pleomorphism. The avascular mesenchymal axes showed hydropic
degeneration and necrotic areas. The diagnosis of hydatidiform mole was signed out.
The patient developed Claude Bernard Horner’s Syndrome on the 2nd postoperative day, which disappeared after the chest drain
removal. The patient’s prognosis was good, with no disease recurrence at 10 years follow-up.
Conclusion
Lungtrophoblasticdisease,especiallywithaonesinglenodulepresent,isaverydifficultlesiontodiagnose,inabsenceofpregnancy
or high hCG levels, due to low specificity of imagistic examination. In patients that do present a high hCG levels, the trophoblastic
etiology must be taken into account.
Keywords: hydatidiform mole, trophoblastic disease, hCG
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Poster Session
Langerhans Cell Histiocytosis of the Rib: Case Report and Review of the Literature
Vasile Găborean1, Raluca Maria Cloșca2, Gabriel Veniamin Cozma1,3, Ovidiu Nicolae Burlacu1,3, Adeline Roxana Bucur2, Flavia
Baderca2,4
1) Department of Thoracic Surgery, Emergency City Hospital, Timisoara, Romania
2) Service of Pathology, Emergency City Hospital, Timisoara, Romania
Introduction
Langerhans cell histiocytosis is a rare clonal neoplastic proliferation of dendritic cells caused by clonal expansion of myeloid
precursors that differentiate into CD1a+/CD207+ cells.
A 37 year old female patient with smoking history was admitted to the Thoracic Surgery with severe chest pain associated with
extremely painful coughing and deep breathing. The patient had no history of trauma associated. The patient underwent posterior
segment costectomy of the 5th rib, and a 7 cm costal fragment was removed.
Results
Chest computed tomography and magnetic resonance imaging of the thorax revealed osteolytic lesion at the 5th left rib, with
pathological fracture and minimal local pleural thickening. Also, pulmonary micronodules of up to 5.5 mm diameter were observed
bilaterally, subpleural and in the intraparenchymal broncho-vascular proximities, with solid-like density values, well defined margins
and no irregularities. Intraoperative evaluation of surgical specimens by frozen sections was done from the costal fragment and it
showed malignant cells. Microscopic examination in hematoxylin-eosin staining of the costal fragments embedded in paraffin
revealedthepresenceofmalignanttumorcells.Thehistopathologicalexaminationwascompletedwithimmunohistochemicalstains
that highlighted tumor cells positive for common leukocyte antigen, CD68, Bcl-6 and S100 protein. Langerhans histiocytosis was
signed out.
Conclusion
This case was interpreted as a single system Langerhans histiocytosis so local therapy and observation was considered the right
conduit, with very good results and no pain in the long run.
Keywords: Langerhans histiocytosis, immunohistochemistry, dendritic cells proliferation
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Poster Session
Mesonephric Adenocarcinoma, a Challenging Diagnosis
Flavia Baderca1,2, Raluca Maria Closca2, Maria-Bianca Tat2, Adeline-Roxana Bucur2, Ioan Adrian Petrache3,4, Vasile Gaborean4,
Gabriel Veniamin Cozma3,4, Claudiu Ionita3, Octavian Marius Crețu3, Marius Lucian Craina5
4) Thoracic Surgery Clinic, Emergency City Hospital Timisoara, Romania
5) Department of Obstetrics-Gynecology, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
Introduction
Mesonephric adenocarcinoma is a rare neoplasm of the female genital tracts that derives from mesonephric Wolffian remnants. The
most common site is the cervix, being extremely rarely reported in the vagina.
A74yearoldfemalepatientpresentedtotheGeneralSurgeryDepartmentoftheTimisoaraCityHospitalwithamassivepelvictumor
associated with thrombosis of the left iliac vein and left ureterohydronephrosis. The computed tomographic examination reveals
abdominal, pelvic and mediastinal lymph nodes enlargement as well as multiple pulmonary nodules disseminated bilaterally. A year
before, the patient had a total hysterectomy with bilateral adnexectomy for metrorrhagia, which was negative for malignancy. A
biopsy was carried out of the pelvic tumor and of the lung nodules and sent to the Pathology Department. The specimens were
processed with usual hematoxylin and eosin, histochemical stain and immunohistochemical reactions for further antibodies: anti-
CK8/18, anti-CK7, anti-CK20, anti-CK5, anti-TTF1, anti-p63, anti-GCDFP15, anti-GATA3 and anti-napsin A.
Results
On microscopic examination, the pelvic tumor and the pulmonary nodules presented glandular and solid pattern, containing
intraluminalcolloid-likesecretionsthatstainedpositiveformucicarmine.Themalignantcellsshowedmoderatelypleomorphicnuclei
with prominent nucleoli and increased mitotic activity. The cytoplasm of the majority of the tumor cells was positive for CK8/18 and
CK7. Small cellular groups were positive for TTF1 with nuclear pattern and CK5 on cell cytoplasm. Only few cells were positive for
CK20. The tumor cells were negative for p63, GCDFP15 and napsin A. Following the microscopic examination on H&E stained
sectionsandtheadditionalhistochemicalandimmunohistochemicalstains,thediagnosisofmesonephricadenocarcinomawithmost
likely vaginal primary site and pulmonary metastases was signed out.
Conclusion
Vaginal mesonephric adenocarcinoma represents a very rare tumor and its diagnosis is a challenge for both, pathologists and
surgeons.
Keywords: mesonephric adenocarcinoma, vaginal tumor, immunohistochemistry
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Poster Session
Series of 11 High-Grade Squamous Intraepithelial Cervical Lesions (HSIL),

p16INK4a positive cases linked to non-high-risk HPV monoinfections, in a
colposcopy referral population
Miruna-Ruxandra Burcin1,2,3, Mihaela Badea4, Maria Sajin1,2

1) Department of Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2) Department of Pathology, University Emergency Hospital, Bucharest, Romania
3) Department of Pathology, Micomi Clinic, Bucharest, Romania
4) Department of Colposcopy, Micomi Clinic, Bucharest, Romania
Introduction
Routinely performed clinical HPV tests merely screen for 13-14 high-risk HPV types with recognized carcinogenicity. Nevertheless,
other possibly carcinogenic HPV types (26, 53, 67, 70, 73 and 82) can, in a minority of cases, cause HSIL or even invasive cancer that
standard high-risk HPV screening methods may miss. p16INK4a is a surrogate biomarker for transforming HPV infection, playing a
key role in highlighting HSIL CIN2+ lesions.
Extracted from preliminary data of a larger retrospective study on cervical biomarkers conducted in the Micomi Clinic between
2016–2020, this series of 11 consecutive cases comprises women with HSIL linked to a non-high-risk HPV monoinfection. All 11
patients with HSIL cytology were referred to colposcopy. 5 cases were previously HPV high-risk negative; the other 6 were not HPV
tested. All cases were further investigated using a PCR test for detecting high-risk, possibly high-risk, and low-risk HPV subtypes,
colposcopy and cervical biopsy with p16INK4a immunostaining.
Results
The median age was 36.54 years; all patients were multiparous. The extended genotyping detected HPV73 monoinfection in 9/11
cases (81.81%) and HPV82 monoinfection in 2/11 cases (18.18%). Colposcopy identified 7 transformation zone type 1 cases with
small acidophilic exocervical areas of non-homogenous intensity and 4 transformation zone type 2 cases displaying limited
endocervical extension. All 11 patients underwent multiple punch biopsy and/or endocervical brushing in accordance with
colposcopic criteria. Histopathological examination of H&E-stained sections revealed 8 CIN 3 (7 HPV73, 1 HPV82) and 3 CIN 2 (2
HPV73, 1 HPV82) HSIL, all confirmed by p16INK4a immunostaining.
Conclusion
The study highlights the importance of acknowledging the etiological role of non-high-risk HPV types in HSIL and of the diagnostic
value of p16INK4a immunostaining in such cases. Our findings also advocate for applying a broader spectrum of molecular HPV
testing, as this will positively impact individual risk management and patient outcome.
Keywords: HSIL, non-high-risk HPV, p16 biomarker
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Poster Session
Malignant Phyllodes Tumor of the Breast: A Case Report
Mihaela Covaciuc1, Diana Maria Chiorean1, Rareș Georgescu2, Orsolya Bauer2, Ovidiu Simion Cotoi1,3, Sabin Gligore Turdean1,4
2) Surgery Department, Mureș Clinical County Hospital, Romania
3) Pathophysiology Department, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș,
Romania
4) Morphopathology Department, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș,
Romania
Introduction
Phyllodestumors(PT),knownasfibroepitheliallesionsofthebreast,presentalocalrecurrenceriskorasystemicmetastasisrisk,with
rare lymphatic spread, according to their malignant type. According to the World Health Organization (WHO), PT are classified as:
benign, borderline or malignant, characterized by a pushing or infiltrative growth pattern, cyto-nuclear atypia, mitotic activity (<5
mitoses/10 HPFs, 5-9 mitoses/10 HPFs, ≥ 10/10 HPFs) and heterologous elements.
We aim to present the case of a 54-year-old patient, with a previous pathological report of a borderline PT at the level of the left
breast. Surgery and radical left breast mastectomy was performed.
Results
Gross examination revealed an irregular-shaped tumor, white in color and firm consistency, measuring 40 x 45 x 85 mm, distant to
surgical resection margins. Routine histological stain revealed a biphasic tumor proliferation, composed of an epithelial component
withdilatedductalstructuresand"leaf"-likeintraluminalprojections,delimitedbyabistratifiedepitheliumandmyoepithelialcellsat
the periphery. The hypercellular mesenchymal component presented a storiform and infiltrative pattern, characterized by large cells
withmarkednuclearpleomorphism,bizarremultinucleatedgiantcells,necrosisareasandfrequenttypicalandatypicalmitoticfigures
- 17 mitoses/10 HPF. The results of immunohistochemical techniques using antibodies against Desmin, SMA, S100 and CD68 were
negative. The grade and the stage of the tumor were determined as a G3 and pT3Ns0Mx, according to French Federation of Cancer
Centers Sarcoma Group (FNCLCC) and pathological Tumor-Node-Metastasis (pTNM) staging system.
Conclusion
The diagnosis of a malignant PT is supported by the coexistence of both epithelial component without atypia and mesenchymal
component with cyto-nuclear atypia, frequent mitotic figures and infiltrative pattern.
Keywords: WHO, breast tumors, Phyllodes tumor, AJCC, biphasic tumor proliferation
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Poster Session
Quantification of the nuclear proliferation rate in invasive breast carcinomas with

the help of artificial intelligence
Gabriela Izabela Baltatescu1,2, Mariana Așchie1,2,4, Mariana Deacu1,3, Anca Antonela Nicolau1,2, Georgeta-Camelia Cozaru1,2, Anca-
Florentina Mitroi1,2, Miruna Cristian1,2, Nicolae Dobrin2,3, Manuela Enciu1,3, Oana Cojocaru1,3
1) Department of Clinical Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanţa, Romania
2) Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology -CEDMOG, Ovidius”
University of Constanta, Romania
3) Faculty of Medicine, “Ovidius” University of Constanţa, Romania
4) Academy of Medical Sciences, Bucharest, Romania
Introduction
Breast cancer (BC) in women represents a huge health burden worldwide and numerous efforts had been made to improve the
diagnosis and therapeutical options in order to increase the disease-free survival and overall survival. The availability of very good
biomarkers has improved the therapeutical options and the quality of life. One of the most important is anti-Ki67 antibody, which is
associated with tumor cell proliferation and growth, and the assessment of KI-67 labeling index is crucial for tailored therapy.
Artificial intelligence software is nowadays increasingly used to assess the breast cancer Ki67 LI. We aim to compare the assessment
Ki67LI between automated AI and manual interpretation.
We select 100 cases of invasive breast cancer surgical specimens diagnosed in the Clinical County Emergency Hospital Constanța,
Romania between 2015 – 2020. The slides had been digitized using the HURON-TissueEscopeTM LE120 on scanner obtaining
wholeslideimages.Basedonthere-assessmentofhematoxylin-eosinstainingsectionandKi67immunostain,thecasesweregroped
inhomogenousandheterogenousBCcases.EvaluationoftheKi67LIwasperformedbytwopathologiststhroughmicroscopicvisual
assessment and AI software. The intraclass correlation coefficient (ICC) was used to assess the consistency and reproducibility
between groups
Results
The ICC was excellent in the homogeneous group of invasive BC using either manual counting or AI; In the heterogenous group, the
ICC was good (k=0.80) using VA but was excellent when AI software was applied (k=0.95).
Conclusion
AIsolutionsforquantificationofproliferationrateininvasivebreastcarcinomaareextremelyusefulandprovidethepathologistwith
a powerful tool which, in the end, offers a tailored therapeutical option for each patient.
Keywords: Artificial intelligence, invasive breast carcinoma, KI-67 labeling index, whole slide image
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Poster Session
A Rare Subtype of Breast Cancer
Alexandra Georgeta Stan1, Petra Curescu1,2, Cristina Marinela Oprean3,4, Razvan Daniel Bobora1, Anca Fluture1, Roxana
Scheusan5, Carmen Mihaela Radulescu6, Flavia Baderca4,7
1) Department of Medical Oncology, Emergency City Hospital, Romania
2) Department of Immunology , “Victor Babeş” University of Medicine and Pharmacy, Romania
3) Department of Medical Oncology, ONCOHELP Hospital , Romania
4) Department of Microscopic Morphology , “Victor Babeş” University of Medicine and Pharmacy, Romania
5) Department of Medical Oncology, ONCOCENTER Hospital , Romania
6) Department of Surgery, Emergency City Hospital, Romania
7) Service of Pathology, Emergency City Hospital, Romania
Introduction
Breast cancer is the most common cancer in women in the United States and affluent European countries. However, metaplastic
breast cancer is a rare and heterogeneous entity, accounting for less than 1% of breast malignancies. It consists of a variety of
neoplasms with predominantly non-glandular differentiation of spindle cell, squamous, and/or mesenchymal origin.
The study includes two female patients with breast tumor. The harvested biopsies were sent to Service of Pathology, embedded in
paraffin and stained with hematoxylin and eosin and immunohistochemical reactions.
Results
Thefirstcaseisa75yearoldwomandiagnosedwithstageIIIB,cT4dN2M0inDecember2021.Onhematoxylin-eosinstainedslides,
moderated differentiated infiltrative NST carcinoma was signed out. Immunohistochemical reactions revealed a basal-like triple
negative tumor, with Ki67 37%. The patient had undergone neoadjuvant chemotherapy with progressive disease, followed by a
palliativemastectomy,withhistopathologyofdifferentiatedkeratinizingsquamouscellcarcinomawassignedout,withcellspositive
for CK8/18, AE1/AE3 pan-cytokeratin, p63, CK5 and negative for HMB45. After the surgery, the patient received 1 cycle of
chemotherapy, but died shortly afterward with COVID-19 infection.
The second case was a 63 year old woman diagnosed with stage II A, cT2N0M0. The biopsy revealed keratinizing squamous cell
carcinoma. The tumor cells were positive for ER (80%), PR (2%), CK5/6, mammaglobin, and negative for TTF1 and CK20. Ki67 index
was 70%, and Her2/neu 1+.
After one month, the patient had undergone a sectorial mastectomy, and poorly differentiated keratinizing squamous cell carcinoma
was signed out. The patient underwent adjuvant chemotherapy, radiotherapy and hormonotherapy.
Conclusion
Metaplastic breast cancers are aggressive tumors, with no standard treatment approach and with poor prognosis, worse than for
other triple negative invasive breast carcinomas. Further studies are needed to establish a standard of care for these patients.
Keywords: metaplastic breast cancer, squamous cell carcinoma, immunohistochemical reactions
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Poster Session
Analysis of tumor size and location - a valuable approach for the risk stratification
of the patients with thyroid papillary microcarcinomas
Emőke-Andrea Szász1, Adela Corina Nechifor-Boilă1,2, Angela Borda1,3

1) Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş,
Romania
2) Department of Pathology , Mureş County Hospital, Târgu Mureş, Romania
3) Department of Pathology , Emergency County Hospital, Târgu Mureş, Romania
Introduction
Our study aimed to determine in a series of cases whether two clinically accessible parameters, tumor size and location within the
thyroid, correlate with clinico-pathological features that are predictors of high risk in papillary thyroid microcarcinomas (PTMC) and
consequently whether they could have an impact on the clinical management of patients with PTMC.
PTMCcaseswereobtainedfromthedatabaseoftheDepartmentofPathology,EmergencyCountyHospital,Târgu-MureșEmergency
County Hospital. We divided our series of cases into four study groups: I- large subcapsular PTMC ≥5 mm, II- large non-subcapsular
PTMC ≥5 mm, III- small subcapsular PTMC <5 mm, and IV- small non-subcapsular PTMC <5 mm. Clinicopathological features and
follow-up data were compared by univariate and multivariate analysis.
Results
Our study included 164 patients with PTMC. Based on these two parameters, all patients were classified into the four study groups.
Group I PTMCs were significantly associated with high-risk morphological features predictive of tumor aggressiveness. In contrast,
group IV PTMCs were significantly less likely to exhibit high-grade morphological features.
Conclusion
We demonstrated, by evaluating these two morphological parameters, that correlate with specific clinicopathological factors,
enabling easy four-group risk subdivision of PTMC cases. This subdivision of PTMCs could have a clinical impact on the preoperative
assessment of subcentimeter thyroid nodules.
Keywords: microcarcinoma, size, location
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Poster Session
Thymic parenchymal-stromal microscopic aspects in the newborn
Garofita-Olivia Mateescu1,2, Simona Neamtu3, Liliana Stanca4, Adelia-Valeria Neamtu5, Mihaela-Cezarina Mehedinti6, Carla-
Maria Barbulescu-Mateescu2, Radu Stanescu7, Anca-Maria Istrate-Ofiteru1,2
1) Department of Histology, University of Medicine and Pharmacy Craiova, Romania
2) Centre for Microscopic Morphology and Immunology Studies, University of Medicine and Pharmacy Craiova, Romania
3) Department of Hematology and Immunology, University of Medicine and Pharmacy Craiova, Romania
4) Department of Forensic Medicine, University of Medicine and Pharmacy Craiova, Romania
5) Department of Anaesthesia and Intensive Care, National Institute of Infectious Diseases "Prof. Dr. Matei Bals" Bucharest, Romania
6) Department of Histology, "Dunărea de Jos" University of Galati, Romania
7) Department of Anatomy, University of Medicine and Pharmacy Craiova, Romania
Introduction
The authors aimed to bring to attention the structural elements of the newborn thymus - a lymphoepithelial organ, functional at
birth.
A total of 13 cases were studied in the Pathological Anatomy Service - Filantropia Municipal Clinical Hospital.
The processing by paraffin embedding technique, the usual and histochemical staining, the statistical processing of the data were
performed in the Centre for Microscopic Morphology and Immunology Studies-University of Medicine and Pharmacy Craiova.
Results
The thymic capsule contains collagen fibres, fibroblasts, rare lymphocytes and macrophages.
From the thymic capsule, trabeculae extend into the parenchyma, delimiting the thymic lobules, thus describing areas where the
thymic medulla and cortical-outer parenchyma can be seen.
In 73% of the cases this was intensely basophilic stained (H&E), due to the presence of developing T lymphocytes, thus occupying
the spaces of the epithelio-reticular network.
In only 20% of the cases could the presence of Hassall's thymic corpuscles at the level of the medulla be evidenced, possibly as a
result of a stage process of differentiation from the epithelio-reticular cells.
Bloodvasculardevicesshowedendothelialcontinuitylesionsinmorethan10%ofcases,whilestromashowedasignificantpresence
of fibroblasts and plasma cells.
Conclusion
We consider the thymus to be an organ with a dynamic structure in the newborn.
Keywords: thymus, dynamics, newborn
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Poster Session
SARS-CoV-2 and its Oncological Associations
Flavia Baderca1,2, Raluca Maria Closca2, Adeline Roxana Bucur2, Maria-Bianca Tat2, Bogdan George Cioc2, Alin Marian Vasile2,
Caius Silviu Solovan3
3) Romanian Society of Dermatopathology, Timisoara, Romania
Introduction
It is widely accepted the role of different microorganisms in oncogenesis. Some authors suggested that SARS-CoV-2, the widely
known coronavirus causing COVID-19, might be associated with endometrial cancer, while other articles hypothesized that a long-
term inhibition of p53 by the SARS-CoV-2 could be carcinogenic.
The present paper describes a case of Kaposi’s sarcoma in an immunosuppressed patient previously diagnosed with COVID-19
infection.
Thispaperpresentsaninterestingcaseofa76yearoldpatient,previouslydiagnosedwithCOVID-19whichstartedtodeveloppurple
nodules on both hands while being held for one month and a half on the intensive care unit. The lesions were biopsied and the
specimens were processed with usual histological stain, PAS reaction and immunohistochemical reactions for CD34, HHV8, D2-40
and Ki67.
Results
On microscopic examination, the skin specimen showed a malignant tumor developed in the dermis and subcutis composed of
medium and large spindle cells with slightly atypical nuclei and eosinophilic cytoplasm, disposed around variable sized slit-like
vascular channels, bordered by prominent endothelial cells and filled with erythrocytes. Tumor stroma contained many extravasated
erythrocytes and hemosiderin pigment deposits. The tumor cells were immunohistochemically positive for HHV8, CD34 and D2-40.
The Ki67 index was high.
Conclusion
The article presented a case with association between COVID-19 infection and Kaposi’s sarcoma. Microscopic examinations of
hematoxylin and eosin stained sections and auxiliary immunohistochemical reactions allowed to establish the diagnosis of Kaposi’s
sarcoma and to rule out other vascular tumors. The role of SARS-CoV-2 in the apparition of soft tissue tumors needs further
investigations.
Keywords: SARS-CoV-2, Kaposi’s sarcoma, immunohistochemistry, oncogenesis
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Poster Session
Nodal Follicular Dendritic Cell Sarcoma, a Rare and Under-recognized Entity
Adeline-Roxana Bucur1, Flavia Baderca1,2, Octavian Constantin Neagoe3,4, Raluca Maria Closca1, Alin-Marian Vasile1, Bogdan
George Cioc1, Maria-Bianca Tat1
2) Department of Microscopic Morphology, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, , Romania
3) Second Discipline of Surgical Semiology and Medical and Surgical Oncology, First Department of Surgery, “Victor Babeş”
University of Medicine and Pharmacy, Timişoara, Romania
4) Second Clinic of General Surgery and Surgical Oncology, Emergency Clinical City Hospital, Romania
Introduction
Nodal follicular dendritic cell sarcomas are rare and distinctive biological entities first described in 1986. Most present as slow-
growingmassesthatariseinthesuperficiallymphnodesofadults,mostcommonlyinthecervicallymphnodes,buttheycaninvolve
a variety of nodal and extranodal tissues.
A 66 years old female patient presented with a left well demarcated, painless, solid, firm, left axillary mass of approximately 50/40
mm and multiple lymph nodes enlargement of maximum 15 mm were detected. Soft tissue ultrasound revealed a hyperechoic,
ovoidal, well demarcated image with an inconspicuous hilum, raising the suspicion of a malignant lymph node, with no mammary
abnormalities.
A complete axillary dissection was performed, the biological material harvested was sent to the Pathology Department, where was
included in paraffin. There were performed 4-μm serial sections stained with hematoxylin–eosin and immunohistochemical
reactions.
Results
Histopathologicalexaminationshowedalymphnodewithcompletelyeffacedarchitecturebyanabnormalpopulationofepithelioid
to spindle shaped cells in a whorling pattern. The neoplastic cells have ovoid nuclei, ~10 mitotic figures on 10 high power fields,
delicatechromatin,smallnucleoliandpaleeosinophiliccytoplasmvariablyadmixedwithsmalllymphocytes,suggestinganeoplasm
of immune accessory cells in the form of a histiocytic sarcoma. The other lymph nodes had only reactive changes.
The immunohistochemical reactions were positive for vimentin, negative for CD68 and AE1/AE3. Further staining demonstrated
intense and diffuse CD21 and CD23 positivity and weak for epithelial membrane antigen. The reactions for CD31, CD34, CD99 and
S100 protein were negative. Given this immune phenotype, follicular dendritic cell sarcoma was diagnosed.
Conclusion
Nodal follicular dendritic cell sarcoma is a very rare malignant neoplasia without specific simptomatology or imaging. Confirmation
through specific immunohistochemical stains is mandatory.
Keywords: Dendritic cell sarcoma, Immunohistochemistry, lymph nodes
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Poster Session
Intravascular Large B-Cell Lymphoma, an Extremely Rare and Chameleonic Entity

with Challenging Management
Adeline-Roxana Bucur1, Flavia Baderca1,2, Diana Luisa Lighezan3, Raluca Maria Closca1, Alin Marian Vasile1, Bogdan George
Cioc1, Maria-Bianca Tat1
2) Department of Microscopic Morphology, “Victor Babeş” University of Medicine and Pharmacy, Romania
3) Department of Hematology, “Victor Babeş” University of Medicine and Pharmacy, Romania
Introduction
Intravascular large B cell lymphoma is a rare disease entity of non-Hodgkin lymphoma according to the current WHO classification.
ThisrareformofB-celllymphomaischaracterizedbytheselectivegrowthoftumorcellsintheluminaofmainlysmallbloodvessels
in various organs primarily affecting the middle-aged to elderly population, with a slight predominance in men.
An autopsy was performed to a 66-year-old female who presented in the Emergency Unit of the Emergency City Hospital Timisoara
with fever, generalized muscle aches, weight loss and fatigue.
The external body exam revealed marked edema of the trunk, upper and lower limbs. No tumor masses were detected. After the
autopsy, the cause of death was defined as acute respiratory failure due to the pulmonary edema and consolidation.
Fragments of the major organs were taken, the biological material harvested was fixed in 10% neutral formalin solution and sent to
the Pathology Department, where it was sectioned and included in paraffin, according to the histopathology protocol. There were
performed 4-μm serial sections stained with hematoxylin–eosin and immunohistochemical reactions.
Results
Themicroscopyinusual,hematoxylin-eosinshowedsmallcaliberbloodvesselsespeciallyinthelung,filledwithatypicalcells,some
of them attached to the vessel endothelium, with large, irregular, hyperchromatic nuclei with uneven distributed chromatin and
reduced cytoplasm. Some of the cells showed atypical mitotic figures. The suspicion of an intravascular lymphoma was raised and
CD20 was performed, with a positive result.
Conclusion
Intravascular large B-cell lymphoma is a rare, clinically aggressive lymphoma entity with no specific signs and symptoms. Patients
may present with a variety of symptoms, with any tissue potentially being infiltrated. Suspicion is often raised too late, usually after
treatment unresponsiveness.
Keywords: intravascular large B-cell lymphoma, immunohistochemistry, aggressive lymphoma
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Poster Session
Aggressive Type of Prostatic Adenocarcinoma
Andrei Dorin Ciocoiu1,2, Nusa Alina Segarceanu2, Raluca Maria Closca3, Flavia Baderca3,4
1) Medical Oncology Department, Municipal Emergency Hospital, Timișoara, Romania
2) Medical Oncology Department, Oncohelp Hospital, Timișoara, Romania
3) Service of Pathology, Municipal Emergency Hospital, Timișoara, Romania
4) Department of Microscopic Morphology, University of Medicine and Pharmacy “Victor Babeș”, Timișoara, Romania
Introduction
Prostatecanceristhesecondmostcommonneoplasiaintheworldaffectingmainlypatientsover65yearsofage.Clinically,patients
can be classified into risk groups according to the Gleason score, PSA value, tumor extension and the presence of systemic
metastases. The Gleason grading system was introduced in 1966 to assess the prognosis of prostate cancer and is based on the
evaluation of glandular patterns in the histopathological specimen.
In January 2021, an 81-year-old man presented to Urology Clinic for chronic progressive pollakiuria, which later culminated in acute
urine retention. Blood tests reveal an elevated initial PSA value (11.5 ng/ml). On MRI, the prostate was enlarged, and presented a
gadophilic voluminous tumor in the middle 1/3 and the base of both lobes with diffusion restriction, that infiltrates the
posteroinferior bladder wall and both seminal vesicles, without having a fatty cleavage plane with the right anterior rectal wall,
enlargement of the lymph nodes of the mesorectal fat, fascia, common, external and internal iliac groups and a single osteosclerotic
bone metastasis in the acetabular cavity. A prostate biopsy was taken. Tissue examination was performed on slides stained with
hematoxylin and eosin.
Results
The microscopic examination revealed a malignant tumor with solid and trabecular areas, zonally with pseudopapillary
characteristics and foci of comedonecrosis that imposed the diagnosis of prostatic ductal adenocarcinoma, Gleason score 5+5 = 10
(group 5).
Conclusion
The Gleason grading system has stood the test of time and has important prognostic value. Even if the blood PSA level wasn’t very
high, following the analysis of a prostate tissue fragment, on routine staining, a high grade prostatic adenocarcinoma with Gleason
group5wasidentified,aspectsthatwerecorrelatedwithhighnumberoflymphnodesmetastasisandalsobonemetastasisthatwere
present from the diagnosis.
Keywords: prostatic adenocarcinoma, Gleason grade, prognostic factor
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Poster Session
Cyclopia, as a Rare and Lethal Congenital Anomaly: Case Report
Diana Maria Chiorean1, Ovidiu Simion Cotoi1,2, Mennan Yiğitcan Çelik3, Havva Serap Toru3
1) Department of Pathology, County Clinical Hospital of Targu Mures, Romania
2) Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures,
Romania
3) Department of Pathology, Akdeniz University, Türkiye
Introduction
Cyclopia - also known as cyclocephaly or synophthalmia - is the most extreme form of holoprosencephaly (HPE), a congenital
disorder characterised by the failure of the embryonic prosencephalon to precisely divide the orbits into two cavities.
We aim to report the case of a cyclopic fetus diagnosed at 18 weeks of gestation, in a 39-year-old woman with an obstetric score of
G2P1.
Results
Following the first trimester assessment, the three-dimensional ultrasound examination revealed the fetal anatomy and abnormal
brain development with a suspicion of alobar holoprosencephaly (HPE). The patient reported no significant medical and family
history.Subsequently,theabortionprocedurewasperformed,themacroscopicexaminationofthefetusrevealingcyclopia,proboscis
on the upper midline of the face, malposition of the ears and postaxial polydactyly.
Conclusion
Although this rare congenital abnormality is incompatible with life, early diagnosis of cyclopia during pregnancy using appropriate
genetic counseling can determine the outcome of current and upcoming pregnancies and it should be strongly highlighted, in order
to prevent further harm to the mother and newborn.
Keywords: holoprosencephaly, cyclopy, postaxial polydactyly, synophtalamia, proboscis
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Poster Session
Osteofibrous dysplasia - like adamantinoma of the tibia
Silvia Spânu 1, Horea Rareș Benea2, Liliana Rogojan1, Bogdan Gheban3, Camelia Albu3, Bogdan Pop3, Alexandra Buruiana-Simic3,
Diana Gonciar1,3, Raluca Margit Szilveszter1,3, Carmen Giorgiu1,3, Doinița Crișan 1,3
2) Department of Orthopaedics and Traumatology, „Iuliu Hațieganu“ University of Medicine and Pharmacy Cluj-Napoca, Romania
3) Department of Pathology, „Iuliu Hațieganu“ University of Medicine and Pharmacy Cluj-Napoca, Romania
Introduction
Long bone adamantinoma belongs to the category of mesenchymal tumours of long bones. It is a byphasic tumour with a variable
epithelial component, which is included in a fibrous stroma. It represents 0.4% of primary bone tumors, and affects mainly young
adults. The entity encompasses two forms: a benign form – osteofibrous dysplasia-like adamantinoma, where the osteofibrous
dysplasia-like stroma predominates with isolated epithelial islands. The second form - adamantinoma of the long bones - is a
malignanttumor,whithadominantepithelialcomponent.In85-90%ofthecasesthetibiaisinvolved,multifocalitybeingacommon
feature.
We present the case of 40-year-old female patient who was admitted into the Department of Ortopaedics with a fracture of the left
tibia after a fall from the same level. Bone x-ray examination showed the fracture situs on a pathologic background represented by
multiple areas of osteolysis with partial destruction of the compact bone and extension to the soft tissues. MRI examination
confirmed the presence of three poorly demarcated lesions, suggesting a malignant, multifocal tumor, most probable of the
adamantinoma type, with invasion of the fascia and the surrounding muscle.
Results
The tissue submitted for histological examination consisted of multiple brown-whitish, partially hard fragments. Histology showed
trabeculae of woven bone embedded in a moderately cellular, bland stroma. Focally, osteoclast-like giant cells were present. One
fragment showed small islands of epithelioid cells, which were panCK positive. The osteoclast like giant cells were positive against
CD68 and the stromal spindle cells were pozitive against vimentin. Based upon the clinical picture, the imaging data correlated with
the histopathological examination, a diagnosis of osteofibrous dysplasia-like adamantinoma was formulated.
Conclusion
This case illustrates the importance of correlating clinical data and imaging studies of the lesion with the results of the
histopathological examination for the diagnosis of bone tumors.
Keywords: adamantinoma, long, bones
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Poster Session
Otosclerosis under the Magnifying Glass
Claudia Raluca Balasa Virzob1, Raluca Maria Closca2, Nicolae Constantin Balica3, Adeline-Roxana Bucur2, Maria-Bianca Tat2,
Bogdan George Cioc2, Alin Marian Vasile2, Flavia Baderca2,4
1) Discipline of Practical Clinical Skills, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, , Romania
2) Service of Pathology, Emergency City Hospital Timisoara, România
3) ENT Department, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, România
Introduction
Introduction: Otosclerosis is a bone disorder of unknown etiopathology confined to the otic capsule of stapes bone. Failure of
remodeling of newly formed vascular and woven bone results in sclerotic bone with abnormal osteons.
MaterialsandMethods:Thepapercarriedoutaretrospectivestudyof25patientsdiagnosedwithotosclerosiswhohaveperformeda
stapedectomyinDepartmentofOtorhinolaryngologyofEmergencyCityHospitalofTimisoara,betweenJanuaryandDecember2021.
Tissue fragments were processed at Service of Pathology by standard hematoxylin-eosin staining. The histopathological diagnosis
was completed using Masson staining, Giemsa histochemical staining and immunohistochemical reactions with antibodies anti-
CD20, anti-CD3, anti-CD4, anti-CD8, anti-CD34 and anti-CD31.
Results
Results: The microscopic examination showed a chronic diffuse inflammatory infiltrate. The inflammatory infiltrate consisted
predominantly of mature T lymphocytes, immunohistochemically positive for CD3, CD4 and CD8. There were also present rare B
lymphocytes CD20 positive. Among the lymphocytes, relatively numerous mast cells were identified, highlighted histochemically by
theGiemsastaining.Theyhadnumerouspurple-violetintracytoplasmicgranules.Intheconjunctivalsupport,arelativelyrichvascular
network developed, consisting of hyperemic capillary structures, highlighted immunohistochemically with anti-CD31 and anti-CD34
antibodies.Bonetissuestrabeculaeshowedextensiveareasoffibrosis.ThecollagenfiberswerehighlightedbythetrichromeMasson
staining, being colored in green, blue or bluish-green. About a third of the examined preparations also showed cystic lesions such as
epidermal cyst or cholesteatoma, lined with keratinized squamous layered epithelium, with granular layer present and endoluminal
keratin filaments.
Conclusion
Conclusions: Microscopic examination of stapedectomy specimens provides information about the histopathological substrate of
otosclerosis.
Keywords: otosclerosis, histochemically, immunohistochemically
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Poster Session
Dancer Foot, Between Art and Medicine
Maria-Bianca Tat1, Emil Florin Huț2, Octavian Marius Crețu2, Adrian Tiberiu Lupașcu3, Dragoș Costin Miroșu3, Adeline Roxana
Bucur1, Raluca Maria Cloșca1, Bogdan George Cioc1, Alin Marian Vasile1, Flavia Baderca1,4
1) Service of Pathology , Emergency City Hospital Timișoara, Romania
2) Department of Surgical Semiology, Victor Babeș University of Medicine and Pharmacy of Timișoara, Romania
3) Department of Orthopedics and Traumatology , Emergency City Hospital Timișoara, Romania
4) Department of Microscopic Morphology , Victor Babeș University of Medicine and Pharmacy of Timișoara, Romania
Introduction
Pacinian corpuscle hyperplasia is an uncommon condition that could appear after trauma as a tender nodule, more common on the
hands, and rarely on the foot.
This paper presents the case of a 25-year-old dancer female who came to Orthopedic Department of Emergency City Hospital with
algia located at the level of the proximal space of the III and IV metatarsal of the left foot. The clinical examination of the foot
revealed no characteristic or special signs and a Morton’s neuroma suspicion was raised. At the soft tissue ultrasound examination, a
small, solid and asymmetrical mass was revealed, which is concluded to be a non-specific image. A biopsy was performed and the
harvested specimens were processed with usual histological stain and immunohistochemical reactions for further antibodies: anti-
S100 protein, anti-PGP 9.5, anti-EMA and anti-CD34.
Results
On microscopic examination, the biopsy sample presented fibrous connective tissue and adipose tissue that include blood vessels
and nerve fibers, which showed an increased number of Vater-Pacini corpuscles, some increased in volume, isolated or in groups.
Immunohistochemical stains for S100 protein and PGP 9.5 highlighted numerous nerve fibers. EMA was positive on perineurial cells
and CD34 showed a rich vascular network.
ThehistopathologicalaspectsrevealedatmicroscopicexaminationofH&Estainedsectionsandtheadditionalimmunohistochemical
stains sustained the diagnosis of Vater-Pacini corpuscles hyperplasia associated with Morton’s neuroma.
Conclusion
The particularity of presented case was the finding of Pacinian corpuscle hyperplasia in an uncommon site, and its association with
Morton’s neuroma.
Keywords: Morton’s neuroma, Pacinian corpuscle hyperplasia, Immunohistochemistry
Notes:
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Poster Session
Occasional Finding of Extramedullary Hematopoiesis at Autopsy
Alin Marian Vasile1, Violeta Todorescu2, Diana Luisa Lighezan2, Adeline Roxana Bucur1, Raluca Maria Closca1, Maria-Bianca Tat1,
Bogdan George Cioc1, Flavia Baderca1,3
1) Service of Pathology, Emergency City Hospital Timișoara, Romania
2) Department of Hematology, “Victor Babeș” University of Medicine and Pharmacy Timișoara, Romania
3) Department of Microscopic Morphology, “Victor Babeș” University of Medicine and Pharmacy Timișoara, Romania
Introduction
Fociofextramedullaryhematopoiesiscanappearindifferentorgansincertainpathologicalconditions,whentheproperfunctionality
ofthebonemarrowisimpairedfromhematopoieticstemcellsandhematopoieticprogenitorcellsreleasedinlargenumbersintothe
bloodstream.
The paper presents an interesting case of a 62 years old female, known with insulin-dependent type 2 diabetes, morbid obesity and
cardiovascular disease history. The patient was admitted to the Hematology Department with severe macrocytic anemia
(hemoglobin=4.9 g/dl) and moderate thrombocytopenia (platelets=69000/mm3). Ten days later the patient died and subsequently,
anautopsywasperformed.Theharvestedspecimens(brain,heart,lungs,stomach,liver,spleen,pancreas,kidneys,andbonemarrow)
were processed with morphological stains (hematoxylin-eosin and trichrome Masson). In order to complete the diagnosis
histochemical reactions, silver impregnation and Periodic Acid-Schiff (PAS) were used.
Results
During the autopsy, in the adipose tissue surrounding left kidney there were observed multiple hemorrhagic areas with diffuse
distribution. Also, hepatosplenomegaly was noted.
Following the light microscopy examination, between adipocytes, islands of myeloid tissue were observed. Subsequently, the
examination of the bone marrow revealed few PAS positive hyphae, pseudohyphae and hyphae yeast.
Conclusion
Followingthelightmicroscopyexamination,inrelationwiththeclinicalandbiochemicalfindings,thediagnosisadvocatedforfungal
infection of the bone marrow associated with extramedullary hematopoiesis as response to the hematopoietic stress.
Keywords: extramedullary hematopoiesis, fungal infection, histochemistry
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Poster Session
Trichinella spiralis, Friend or Enemy
Adeline-Roxana Bucur1, Nicolae Constantin Balica2, Caius Silviu Solovan3, Raluca Maria Closca1, Maria-Bianca Tat1, Alin Marian
Vasile1, Bogdan George Cioc1, Flavia Baderca1,4
2) ENT Department, “Victor Babeş” University of Medicine and Pharmacy, Romania
3) Romanian Society of Dermatopathology, Romanian Society of Dermatopathology, Romania
4) Department of Microscopic Morphology, “Victor Babeş” University of Medicine and Pharmacy, Romania
Introduction
Trichinellosis is the most frequent food-transmitted helminth zoonosis caused by Trichinella spiralis. Humans are prone to infection
by consuming inadequately cooked meat that contains larvae of the parasite, which migrate through blood vessels especially to the
tongue, larynx, and masseteric, extraocular, pectoral and deltoid muscles, causing local inflammation.
A 64 year old male presented in the Otorhinolaryngology Department of Timisoara City Hospital with progressive hoarseness. The
laryngoscopy showed a reduced mobility of the right vocal cord, apparently due to an exophytic tumor extending to the anterior
commissure and arytenoid cartilage. The left vocal cord had normal mobility and the glotic space was unaffected. A fragment of the
right thyroid cartilage and a fragment of the left vocal cord were sampled and sent to the Pathology Department, processed into
slides and stained with hematoxylin-eosin.
Results
At microscopic examination, the right thyroid cartilage showed laryngeal muscle fibers with numerous Trichinella spiralis encysted
larvae, some of them calcified and a papillomatous proliferation of stratified squamous epithelium with acanthosis, nuclear atypia
and loss of nuclear polarity consistent with in situ squamous carcinoma. The left vocal cord fragment showed numerous Trichinella
encysted larvae in and in-between the muscle fibers.
Conclusion
The article presented a rare case of Trichinella spiralis associated with in situ squamous carcinoma of the larynx. There are studies
referring to the anti-tumor effect of Trichinella spiralis by inducing apoptosis in vivo and in vitro or through the immunomodulatory
effect of cytokines produced by eosinophils in the early stage of the infection, before the encysting of the larvae. Other studies argue
that oncogenesis could be induced by increasing the local neovascularization as an effect of the chronic inflammation. Further
evaluation of the parasitic effect on the development and progression of cancers requires clinical trials with statistically relevant
cohorts.
Keywords: Trichinella spiralis, carcinogenesis, inflammation
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Poster Session
Mast cell reaction in skin neoplastic lesions
Pusa Nela Gaje1, Amalia Raluca Ceausu1, Andrei Alexandru Cosma1, Cristian Silviu Suciu1, Marius Raica1
1) Department of Microscopic Morphology/ Histology, Angiogenesis Research Center, Timisoara, "Victor Babeș" University of
Medicine and Pharmacy, Timișoara, Romania
Introduction
The accumulation of mast cells (MC) in human tumors was reported by Paul Ehrlich. They appeared a long time before the
developmentofadaptiveimmunity.HumanMCrepresentaheterogeneouspopulationofcellsregardingtheirmorphology,mediator
content, and surface receptors. Their accumulation in the tumor-microenvironment of the skin is not yet explained.
The present study included 60 cases of squamous cell carcinoma from lips outer layer and skin melanomas. CD34/AAS and
CD34/MCT immunostaining were performed.
Results
The density of peritumoral and/or intratumoral MC increased in nonmelanoma skin cancers and melanomas. MC responds by
degranulation to cytokines released by tumor stromal cells. They release mediators and induce neovascularization, degradation of
extracellular matrix, and mitogenesis. A significant correlation was found between the number of vessels and MC (p = 0.003) in lips
squamous cell carcinoma. MC showed VEGF expression and was correlated to MVD in melanoma.
Conclusion
Although in many human tumors MC seem to play a pro-tumorigenic role, there are data that sustained their protective role against
cancer, even in the same tumor type. These contradictory results might reflect some important differences regarding the number,
stage,differentiationgrade,andsizeoftumors,aswellasmethodsusedformastcellevaluation.Thecompletedescriptionoftumor-
associatedMChasanimportantclinicalinterestinordertodiscoverdiagnostic,prognosticbiomarkersandnewtherapeutictargetsin
skin cancers.
Keywords: mast cell, cancer, skin, squamous cell carcinoma, melanoma
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Poster Session
Possibilities of testing biomaterials with intra-oral and extra-oral approaches in

laboratory animals
Ioana Mitruț1, Alexandra Drăghici1, Alex Ioan Sălan2, Ioana Neagu3, Andreea Stănuși4, Horia Octavian Manolea1
1) Department of Prosthesis Technology and Dental Materials, Faculty of Dental Medicine, University of Medicine and Pharmacy in
Craiova, Romania
2) Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy in Craiova,
Romania
3) Department of Periodontology, Craiova Emergency Clinical Hospital, Romania
4) Department of Dental Prosthetics, Faculty of Dental Medicine, University of Medicine and Pharmacy in Craiova, Romania
Introduction
Periodontal disease is a significant oral inflammatory disease that leads to gingival inflammation, alveolar bone loss, and has a great
impact on quality of life and overall health. There has been continued interest in the scientific world in testing new therapies and
therapeutic materials for periodontal disease. One of the most important tools for investigating the pathogenesis of periodontal
disease and testing new therapeutic materials are laboratory animals. In addition, there is a wide range of materials used in
periodontal therapy, especially in bone augmentation, so choosing the ideal material is often difficult to achieve.
In this study we studied, developed and compared two different protocols for inducing periodontal defects in rats. We analyzed two
different approaches to the periodontium and alveolar bone - intra-oral and extra-oral, which will allow further studies of different
materials used for periodontal disease.
Results
We created two protocols for extraoral and intraoral approaches. By following them, we were able to successfully create the
periodontaldefectsandapplythetherapeuticmaterials.Wealsomadeacomparisonbetweenthetwomethodsandthepossibilities
of the materials that can be used.
Conclusion
Tests in laboratory animals will remain an important milestone for evaluating new approaches to improve tissue regeneration
therapies. As there are continuous advances in the study of dental materials, we must also look for new, easy-to-perform, ethical
methods to evaluate the biological response of these materials.
Keywords: biomaterials, Lab animals, periodontal disease
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Poster Session
Testing biocompatibility of bone augmentation materials used in dentistry
Alexandra Drăghici1, Elena Ruxandra Caracaș1, Ioana Mitruț1, Alex Ioan Sălan2, Sanda Mihaela Popescu3, Horia Octavian
Manolea1
1) Department of Prosthesis Technology and Dental Materials, Faculty of Dental Medicine, University of Medicine and Pharmacy in
Craiova, Romania
2) Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy in Craiova,
Romania
3) Oral Rehabilitation Department, Faculty of Dental Medicine, University of Medicine and Pharmacy in Craiova, Romania
Introduction
Bone augmentation materials are currently used in dentistry both in periodontology but especially in implantology to preserve the
volume of post-extraction alveolar processes.
Animaltestingrepresentsanimportantstepbetweeninvitrostudiesandclinicalapplicationsinhumans.Thesemodelsarecrucialfor
biomedical research and regenerative medicine studies.
For the experimental studies to evaluate the biocompatibility of bone augmentation materials, the working methodology followed a
series of stages starting from the application of the studied materials in cavities created in laboratory animals at the level of the jaw
and calvaria, the clinical evaluation of the bone remodeling process, the sampling of biological material from laboratory animals,
optical coherence tomography analysis of collected bone samples, histological preparations and correlative interpretation of clinical
and histological data.
Results
Clinicalevaluationsperformedatthetimeofeuthanasiaofthelaboratoryanimalsgenerallyshowedgoodintegrationoftheinserted
materials
The evaluation by optical coherence tomography of the integration of the augmentation materials inserted in the experimental
cavities along the three time periods offered the possibility of making some interesting observations, especially in the case of the
samples made in calvaria.
Theevaluationofthetissueintegrationoftheaugmentationmaterialsinsertedintheexperimentalcavitiesmadeincalvariaandthe
mandibular bone showed the stages of the common healing pattern of a bone lesion with the existence of an initial inflammatory
response in a first stage, in the second stage could be observed the invasion of the defect by neo-formation vascular structures, and
the third stage refers to the osteogenesis finalization
Conclusion
The analysis of the biological integration of an experimental synthetic augmentation material with potential for use in dentistry,
evaluated by the split-mouth method compared to an augmentation material already on the market, with a known integration
pattern, provided interesting results that prove the biocompatibility of these materials.
Keywords: bone augmentation materials, Optical coherence tomography, Lab animals
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Poster Session
Development of a somatic malignancy in an ovarian mature teratoma of an elderly

patient
Ioana-Maria Pavel1, Irina Negulescu1, Alexandra Buruiana-Simic1, Carmen Georgiu1

1) Department of Pathology, Emergency County Hospital Cluj Napoca, Romania
Introduction
Mature cystic teratoma of the ovary is one of the most common types of ovarian tumors, mainly occurring in women of reproductive
age.MalignanttransformationofMCTisrarewithanincidenceof1-3%,representingthetransformationofoneMCTcomponentinto
a cancerous tissue of non-germinal nature. Squamous cell carcinoma is the most frequent malignancy arising from the ectodermal
sheet. The clinical presentation is nonspecific and varies based on the tumor stage.
A77-year-oldwomanwasadmittedtothegeneralsurgerydepartmentpresentinginsidiousnon-specificsymptomatology.Themain
symptoms were distention and chronic abdominal pain. The abdominal ultrasound revealed a mass in the right iliac fossa.
Macroscopically, the tumor involving the ovary was of 15/12/10 cm, well delimited, with a cystic appearance, and with a smooth
external surface. Sectioning revealed multiple cystic spaces filled with yellow content and hair, tumor-like growths of friable
consistency and hemorrhagic areas.
Results
Microscopically, the tumor consisted mainly of mature tissues, derived from all embryonic sheets and multiple nests and large
trabecularstructuresformedbymultilayered,slightlybasaloidsquamousepithelium,withhighnuclei-cytoplasmicindex,andfibrous
stroma. High mitotic activity was observed. Immunohistochemical profile: p63, GATA3 positive, CK7 focally positive, CK20 negative,
suggesting a basaloid squamous cell carcinoma.
Conclusion
MalignanttransformationinaMCTisveryrare,representinglessthan3%ofthecases.Themostcommonmalignancyencounteredis
squamous cell carcinoma. This case highlights a very uncommon basaloid squamous cell carcinoma that emerged on an MCT,
diagnosed in an elderly woman.
Keywords: mature teratoma, ovary, squamous
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Author's Index
Branzan CS 39
A Bucur AR 59, 73, 74, 75, 76, 89,
90, 97, 98, 99, 103,
Albu C 63, 77, 85, 102 104, 105, 106
Albu M 71, 72 Budin CE 46
Alius C 84 Buibas FI 55, 56
Almarii F 86 Bungardean M 63, 77, 85
Amalinei C 5, 12, 68 Burcin MR 91
Amezaga AO 26 Burlacu ON 88, 89
Andrei EC 33, 34 Buruiana-Simic A 63, 77, 85, 102, 110
Andreiana BC 4, 11, 21, 58, 80 Busca M 62
Aschie M 37, 39, 44, 93 Busuioc CJ 55, 56
Avadanei ER 67 Buteica SA 15
Avramescu ID 71
B C
Cadenasi IF 24
Badea M 91 Calvo M 26
Baderca F 59, 73, 74, 75, 76, 82, Candea V 49
88, 89, 90, 94, 97, 98, Caracas ER 109
99, 100, 103, 104, 105, Carasca C 43
106 Caruntu ID 1, 7, 8, 10, 16, 19, 20,
Badiu AM 4, 11, 21, 51, 58, 80 23, 67
Balan OM 18, 64 Catalin B 31
Balan RA 12, 16, 68 Cazacu E 14, 65
Balan TA 12, 16 Ceachi B 62
Balasa Virzob CR 103 Ceausu AR 2, 60, 61, 83, 107
Balasoiu AT 57 Celik MY 101
Balica NC 73, 74, 103, 106 Cercel AR 55, 56
Baltatescu GI 39, 93 Chibelean C 45
Banita IM 33, 34 Chifu BM 20, 67
Barb AC 13, 17, 61 Chiorean DM 92, 101
Barbulescu-Mateescu 96 Chioreanu A 73
CM Chiriac PL 72
Barna R 9, 66 Chirila SI 37
Bartha JR 36, 78, 79 Cimpean AM 13, 17, 60
Bastian A 62 Ciobanu-Apostol DG 1, 6, 7, 8, 10
Bauer O 92 Cioc BG 59, 73, 76, 97, 98, 99,
Bejenariu A 84 103, 104, 105, 106
Benea HR 102 Ciocoiu AD 82, 100
Berisha CT 87 Ciolofan A 83
Bobora RD 94 Ciongariu AM 40, 84
Boer A 70 Cioplea M 62
Boian M 63, 85 Cioroianu A 62
Borda A 22, 95 Ciortea R 70
Bosca B 81 Ciurea RN 4, 11, 21, 57, 58, 80
Bosch A 26 Closca RM 59, 73, 76, 82, 88, 89,
Bosoteanu CA 39 90, 97, 98, 99, 100,
Bosoteanu M 37, 39, 44 103, 104, 105, 106
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Cocuz IG 41, 43, 46 Florescu DN 80
Cojocaru O 93 Florescu MM 4, 11, 21, 58, 80
Comsa S 60 Florou C 53, 54
Coneac A 81 Fluture A 94
Constantin AM 81 Fodor D 85
Constantin IT 48 Folescu R 69
Cornea R 9
Cornianu M 3, 9, 66
Coros MF 36, 78
G
Cosma AA 13, 17, 61, 107
Costache M 40, 84 Gaborean V 88, 89, 90
Cotoi OS 35, 36, 41, 42, 43, 45, Gaje PN 2, 61, 83, 107
46, 78, 79, 92, 101 Georgescu R 92
Covaciuc M 36, 92 Georgiu C 63, 77, 85, 110
Covic AS 19 Gheban B 63, 77, 85, 102
Cozaru GC 44, 93 Gheorghe A 87
Cozma GV 88, 89, 90 Gherghiceanu F 71, 72
Craina ML 90 Giorgiu C 102
Cretu OI 4, 11, 58 Girlescu N 23
Cretu OM 76, 83, 90, 104 Giuroiu F 71, 72
Crisan D 63, 77, 102 Giusca SE 1, 10, 16, 19, 20, 23, 67
Crisan M 81 Gonciar D 63, 77, 85, 102
Cristian M 39, 93 Grigoras A 68
Curca GC 32 Gurgus D 69
Curescu P 94
H
D
Hagau RD 78, 79
Deacu M 37, 39, 44, 93 Heriche JK 26
Decaussin-Petrucci M 22 Hermann D 27, 30
Dema A 3, 9, 66 Horgos B 70
Demetrian A 87 Hostiuc S 32
Dirzu DS 85 Hut EF 76, 104
Dobrea A 86
Dobrin N 93 I
Doinita C 85
Draghici A 108, 109 Iliescu DG 51, 52
Dumitrescu D 84 Ionita C 90
Dumitrescu F 55, 56 Iovan L 55, 56
Dumitru AV 40, 48, 84 Istrate-Ofiteru AM 31, 32, 51, 52, 96
Dumitru C 62
Dumitru CS 2
J
E Jianu M 81
Jurescu A 3, 9, 66
Eftimie LG 48
Enciu M 44, 93
Ertugrul K 28 K
Kumar-Singh S 32
F
Faur AC 74, 75 L
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Laky D 49 Nechifor-Boila A 22
Lazureanu C 9, 66 Nechifor-Boila AC 22, 43, 95
Lighezan DL 99, 105 Negovan E 41
Liliac IM 55, 56 Negru SM 13
Loghin A 22, 45 Negulescu I 63, 85, 110
Lozneanu L 1, 6, 10 Nichita L 62
Lupascu AT 104 Nicolau AA 93
Lupu V 3 Niculescu R 41, 42, 46
M O
Mamuleanu M 87 Oprean CM 82, 94
Manescu MD 31 Orasanu CI 37, 44
Manolea HO 108, 109
Margaritescu C 4, 11, 14, 21, 58, 65, 80
Marginean M 81
P
Marin A 40
Marjan O 15 Parascan L 49
Martinez A 26 Parnov M 14, 65
Mateescu GO 96 Pasca-Fenesan MM 13, 17
Mateescu VO 32 Pascalau R 70
Matei M 87 Pascarenco G 79
Mecea M 70 Pavel IM 110
Mehedinti MC 96 Penciu RC 37
Melincovici C 81 Petegnief V 26
Melnic E 61 Petrache IA 88, 90
Mihaiescu DE 15 Petrescu AM 52
Mihalache D 18, 38, 47, 64 Pirici D 31, 32, 52, 55, 56, 87
Mihu CM 70, 81 Pirici I 31, 32
Mindrila I 15, 32 Planas AM 26
Mindrila LA 15 Plesea IE 71, 72
Mirea OC 71, 72 Plesea RM 71, 72
Mirosu DC 104 Plopeanu A 3
Mitroi AF 39, 44, 93 Poncu T 62
Mitrut I 108, 109 Pop B 63, 77, 85, 102
Mogoanta L 31, 32, 52, 53, 54, 55, 56 Popa V 43, 45
Mogodici C 62 Popa-Wagner A 25, 30
Moldovan I 81 Popelea MC 35, 36
Munteanu CM 33, 34 Popescu R 60
Muraru A 57 Popescu SM 109
Muresan A 3, 9 Popp C 62
Mustatea P 62 Prutianu I 23
N R
Nagy R 51 Radulescu CM 94
Nastase VN 61 Raica M 2, 17, 60, 61, 83, 107
Nataras B 3, 66 Raicea A 36, 78, 79
Neagoe OC 98 Rogojan L 102
Neagu I 108 Rosu GC 31, 32
Neamtu AV 96 Ruican D 51, 52
Neamtu S 96 Rusu A 6, 8, 10, 67
Page 113/114
Trascau M 62
Trotea T 84
S Tudor I 62
Turcu A 55, 56
Sabau AH 43, 46 Turdean SG 36, 92
Sajin M 40, 48, 84, 86, 91
Salan AI 108, 109
Scheusan R 94 U
Segarceanu NA 82, 100
Seicaru DA 71, 72 Ungureanu C 6
Serbanescu MS 50, 55, 56, 71, 72, 87 Urechescu H 75
Simion G 86
Simionescu A 32
Simionescu CE 4, 11, 21, 57, 58, 65, 80
V
Slevin M 29
Solovan CS 59, 97, 106 Vaduva A 9, 66
Sovrea A 81 Vasile AM 59, 73, 76, 97, 98, 99,
Spanu S 102 103, 104, 105, 106
Spiridon IA 7, 8 Vita O 3, 66
Stan AG 94 Voda RI 37, 44
Stanca L 96 Voicu A 62
Stancu B 77 Voidazan S 22
Stanescu D 62 Voinea OC 48
Stanescu L 57
Stanescu R 96 Z
Stanusi A 108
Stefan O 62 Zamfir CL 69
Stefan R 81 Zavoi RE 53, 54
Stepan AE 4, 11, 21, 58, 80 Zorila GL 51
Sticlaru L 62 Zorila MV 53, 54
Streba CT 87 Zota E 14, 65
Streba L 87 Zurac S 62
Suciu CS 2, 107
Sufletel RT 81
Surugiu R 30
Susman S 70, 81
Szasz EA 95
Szilveszter RM 63, 77, 85, 102
Szőke AR 35, 36, 78
T
Taban S 3, 9, 66
Tapoi DA 40, 84
Tat MB 59, 73, 76, 90, 97, 98,
99, 103, 104, 105, 106
Teodorescu M 77
Timofte AD 10, 19, 20, 23
Tinca A 41, 42
Tischer C 26
Todorescu V 105
Tolescu RS 53, 54
Toru HS 101
Page 114/114
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