Pathologia

Protocol for pathologic examination of bladder cancer according to the updates of the 5th edition of the WHO classification (2022): radical cystectomy specimens

2025-03-13T13:52:43+02:00

Bladder cancer (BC) is the fourth most common cancer in men. Approximately a quarter of diagnosed cases of BC are characterized by the presence of invasion of the muscle layer of the organ (muscle-invasive BC), the treatment of which is usually associated with radical cystectomy. In 2022, the new 5th edition of the World Health Organization classification of tumors of the urinary system and male genital organs was presented. The new edition provides a comprehensive approach to the classification of BC, taking into account clinical, morphological and molecular genetic data.

The aim of the study is to highlight the main updates of the latest WHO classification of bladder tumors (2022) and to develop a pathology reporting standard for radical cystectomy specimens by adapting international check-lists and recommendations (CAP, ICCR).

Materials and methods. We analyzed the literature in the scientific databases PubMed and Web of Science. The following keywords were used for the search: bladder, cystectomy, pathology report, urothelial tumor, stage, molecular subgroups, WHO 2022.

Results. In this literature review, we proposed a standardized protocol for the pathologic examination of radical cystectomy specimens, taking into account the updates of the WHO classification of tumors of the urinary and male genital systems (2022) and described its components in detail.

Conclusions. Professional pathologic evaluation of BC radical cystectomy specimens is crucial for further treatment and prognosis. Knowledge of the updates of the 5th edition of the WHO tumor classification (2022) should be implemented in the daily clinical practice of a pathologist, in particular, by using the proposed pathology reporting standard for the BC radical cystectomy specimens.

Modeling insulin resistance in Wistar rats induced by a combined high-fat diet as a predictor of type 2 diabetes (experimental phase 1 study)

2024-12-05T10:28:51+02:00

The aim was to recreate an experimental model of insulin resistance in male Wistar rats by using a diet with a high fat content of combined origin.

Materials and methods. 42 male Wistar rats were taken into the experiment and divided into 2 groups: 1st – control (n = 7) and 2nd – experimental (n = 35). For modelling the insulin resistance (IRS) the rats were fed with a commercial compound feed with a fat content of 40 % for 8 weeks. To control the dynamics of metabolic changes, the rats of the experimental groups were weighed weekly, fasting glucose was measured once every 2 weeks, a glucose tolerance test (GTT), blood pressure measurement (BP) and body composition bioimpedance analysis (BIS) were performed once every 4 weeks, and an insulin tolerance test (ITT) was performed once at 8 week after receiving convincing changes in the glucose tolerance test.

Results. In rats of the IRS group, compared to the control group, body weight exceeded the control group by 13 % on the 4th week and by 9 % on the 8th week; fasting glucose concentration was higher by 11 % on the 4th week and by 37 % on the 8th week; GTT revealed changes towards impaired glucose tolerance at both periods, however, the hyperglycemic type of curve was detected on the 8th week, which was combinated by the absence of significant glucose changes during ITT; on the 4th week – systolic BP increase by 27 % and diastolic – by 6 %, and on the 8th week – by 21 % and 20 %, respectively; BIS on the 4th week revealed an increase in body fat mass, against which latent general dehydration with redistributive extracellular hyperhydration is formed, on the 8th week – progression of obesity and dehydration, but with redistribution of fluid towards intracellular hyperhydration.

Conclusions. Feeding animals a high-fat diet of combined origin for 4 weeks led to obesity, as evidenced by increased body weight and body fat mass with altered fat distribution. This was accompanied by latent general dehydration and extracellular hyperhydration. However, 4 weeks was insufficient to induce insulin resistance. Extending the diet to 8 weeks resulted in further obesity progression and the development of insulin resistance, characterized by fasting hyperglycemia, a hyperglycemic-type curve on the GTT, the absence of significant glucose fluctuations during ITT, and persistently elevated BP. These metabolic disturbances contributed to a relative total body water deficit, driven by extracellular dehydration with fluid redistribution towards intracellular hyperhydration.

Pathomorphological features of inflammatory infiltrate in colorectal cancer

2025-02-03T12:07:28+02:00

Aim: to investigate the pathomorphological features and severity of inflammatory infiltration in colorectal cancers.

Materials and methods. A morphological study of surgical and biopsy material of patients with colon adenocarcinoma of various degrees of differentiation (n = 38) and mucinous adenocarcinoma (n = 7) was performed. Histological specimens were examined morphologically with morphometric analysis. The results were processed by descriptive statistics by calculating the median (Me) for quantitative variables. The statistical significance of the difference between the parameters was evaluated based on the Mann–Whitney U test.

Results. It was found that intestinal carcinoma developed on the background of chronic inflammation. Dysplasia was often detected in the glands, gradually increasing with an approach to the tumor tissue. In the tumor’s microenvironment, there were cells of the immune system: lymphocytes, macrophages, plasma cells, and cells of the myeloid lineage. In the absence of destructive changes in the tumor tissue, lymphocytes and macrophages predominated in the inflammatory microenvironment. In the conditionally standardized field of view of 100 × 100 μm (CSFV), the number of cells was 77.50 (72.25; 84.25), in the edges of the resection – 12.50 (9.00; 16.00). The development of necrotic changes led to a change in cellular representation with a significant increase in myeloid cells. In 3 cases, a significant number of eosinophils was found in the inflammatory, mainly peritumoral infiltrate, at the level of 14.5 (11.00; 18.00) in the CSFV. Invasive tumor growth with penetration into the muscle layer was accompanied by a decrease in inflammatory infiltration. The number of cells in the CSFV was 49.70 (43.50; 54.80). When the tumor invaded the entire thickness of the intestinal wall at the border with adipose tissue, the number of cells in the CSFV was 28.50 (21.45; 33.75). Mucin-producing carcinoma was characterized by a lower intensity of inflammatory infiltrate. The number of cells in the CSFV in the mucosal lamina propria in mucin-producing carcinoma was 42.40 (35.65; 48.55). At the border with the muscular layer and in case of invasion into the intestinal wall thickness, the number of inflammatory infiltrate cells decreased and amounted to 26.50 (18.90; 32.40) and 18.75 (14.00; 22.30), respectively. In areas of severe sclerotic changes, inflammatory infiltration was not detected. Tumor invasion into adipose tissue was accompanied by a mild diffuse inflammatory infiltrate in the surrounding tissues, at the level of 12.50 (7.40; 16.45) cells in the CSFV.

Conclusions. The inflammatory infiltration in the intestinal mucosa in colorectal carcinoma is represented by lymphocytes, macrophages, plasma cells and cells of myeloid lineage and is maximally expressed in the intestinal mucosa. Invasion of the adenocarcinoma into the muscle layer and invasion of the entire intestinal wall is accompanied by a decrease in peritumor inflammatory infiltration. Mucin-producing carcinoma is characterized by a lower intensity of inflammatory infiltrate compared to tubular adenocarcinoma.

Ensuring optimal metabolism during coronary artery bypass grafting with cardiopulmonary bypass

2025-02-03T12:11:03+02:00

Aim: to reduce perioperative complications in cardiac surgeries with cardiopulmonary bypass (CPB) by developing a comprehensive, personalized approach to ensure optimal tissue metabolism.

Materials and methods. A comprehensive approach to metabolic monitoring and correction was tested on 25 patients who underwent minimally invasive coronary artery bypass grafting under CPB conditions. As a component of multimodal analgesia, Pectoralis Plane Nerve Block I (PEC I) and Pectoralis Plane Nerve Block II (PEC II) were performed. For energy monitoring, a computer program titled “Energy Monitoring During Cardiac Surgery” was developed. This program allows for the assessment of the degree of metabolic disturbances in real time and facilitates timely adjustments in therapeutic strategy. The study was divided into three stages: Stage 1 – pre-CPB, Stage 2 – during CPB, and Stage 3 – post-CPB.

Results. The functionality of the program was demonstrated using the case of a patient who underwent minimally invasive triple-vessel coronary artery bypass grafting. At Stage 1, the patient’s baseline condition showed metabolic strain despite normal hemodynamic parameters. Performing PEC I and PEC II blocks improved the patient’s metabolic status. During CPB, metabolism could be influenced by factors such as the composition and volume of the priming solution for the extracorporeal circuit, hemoglobin levels, perfusion index, gas-air mixture flow rate, patient body temperature, acid-base balance of the blood, and pharmacological regulation of vascular tone. Post-CPB, the indication for the use of sympathomimetics was a decrease in oxygen delivery and worsening metabolic parameters.

Conclusions. The use of the “Energy Monitoring During Cardiac Surgery” program enables real-time assessment of a patient’s metabolic needs, allowing for informed decisions regarding therapeutic adjustments at all stages of the surgical intervention. Performing PEC I and PEC II blocks contributes to improved metabolism by reducing the severity of metabolic disturbances.

Assessment of the comorbidity index in patients with ischemic heart disease before coronary artery bypass treatment

2025-02-18T17:35:27+02:00

The aim of the work: to determine the prevalence and establish the frequency of comorbidity in patients with ischemic heart disease when planning myocardial revascularization by performing coronary artery bypass grafting.

Materials and methods. The study included patients with ischemic heart disease who underwent coronary artery bypass grafting on a working heart (n = 3672), both male (n = 3059, 83,3 %) and female (n = 613, 16,7 %), the average age of the study participants was 61.1 ± 0.8 years. The study design consisted of dividing participants into four age groups according to the WHO classification. The material for the analysis was anamnestic and diagnostic and treatment data of 3672 electronic medical histories of patients with ischemic heart disease for the period from 2015 to 2021. All patients included in the study were under dispensary observation at the State Institution “National Institute of Cardiovascular Surgery named after M. M. Amosov NAMS of Ukraine” and at the municipal non-profit enterprise “Cherkasy Regional Cardiology Center of the Cherkasy Regional Council”. To standardize approaches to assessing comorbidity, the Charlson Comorbidity Index (CCI) and the Charlson Age-Augmented Comorbidity Index (CA-CCI) were determined, and a comprehensive assessment of comorbidity was compared with the results of coronary artery bypass grafting.

Results. The frequencies of the most common comorbidities in patients with ischemic heart disease on the eve of myocardial revascularization by coronary artery bypass grafting were determined. In accordance with the study design, taking into account the age of the patients, the frequencies of comorbidities included in the standard deficit of the calculation of the СCI were established. It was determined that the most common comorbidities with ischemic heart disease are: chronic heart failure – 84.0 %, myocardial infarction – 58.7 %, chronic kidney disease – 29.5 % and type 2 diabetes mellitus – 19.7 %. Statistical differences in the frequencies of the most common comorbidities were established taking into account the age of the patients. It was found that the highest CA-CCI was in patients of senile age – 6.8 and in elderly patients – 5.4.

Conclusions. It was determined that the average number of diseases per patient in this sample was 2.6 ± 0.3, and the variation series of the number of existing concomitant diseases ranged from 1 to 7 diseases. The determined average СCI was 3.1 ± 0.3, and the average age-associated СA-СCI was 4.6 ± 0.3, which must be taken into account when planning the method of myocardial revascularization due to the interaction of a separate pathology, which is exacerbated by the aggression of surgical trauma and causes a different spectrum of complications during surgical interventions, increasing perioperative mortality. A comprehensive assessment of the frequency of existing concomitant diseases in a cohort of patients with ischemic heart disease of a large center-based study on the eve of myocardial revascularization by calculating СCI and СA-СCI increases the objectivity of the choice of treatment tactics.

Pathomorphological analysis of the qualitative composition of the inflammatory infiltrate around the pilosebaceous unit of the scalp in perifolliculitis capitis abscedens et suffodiens

2024-12-05T10:31:26+02:00

Perifolliculitis capitis abscedens et suffodiens (PCAS) or Hoffman’s disease is considered a rather rare therapeutically complex purulent skin disease of unknown etiology. An active search for information regarding the qualitative and quantitative composition of the inflammatory infiltrate in PCAS, which could become a source for understanding the pathogenesis of this disease, revealed a lack of studies using the immunohistochemical staining method and authoritative recommendations on the interpretation of the obtained histological changes in punch biopsies for further treatment.

The aim of the work is to investigate the peculiarities of the location and number of CD20+, CD3+ cells and their populations of CD4+ / CD8+ T-lymphocytes of the inflammatory infiltrate around the pilosebaceous unit of the scalp in PCAS.

Materials and methods. In the work, the material of 12 male patients with a diagnosis of undermining abscessing perifolliculitis of the head (Hoffman’s disease), aged from 20 to 51 years, the average age was 35.50 ± 11.54 years, and 5 samples of clean resection edges (conditional norm) of benign nevi of the scalp were examined. Heads of men aged 34 to 48 years, the average age was 32.10 ± 9.42 years (the control group compared with the research group did not show a statistically significant difference, p > 0.05). Immunohistochemical examination was performed according to the protocols of TermoScientific (TS) with primary antibodies against B-lymphocytes (CD20, RTU), T-lymphocytes (CD3, RTU), T-helper / T-regulatory cells (CD4, RTU), T-cytotoxic lymphocytes (CD8, RTU). Lab Vision Quanto imaging system (TS, USA) was used with detection of the reaction using DAB Quanto Chromogen (TS, USA).

Results. The pathohistological pattern of damage to the pilosebaceous unit of the scalp in PCAS is characterized by a deep inflammatory infiltrate located at the level of the reticular dermis or hypodermis, the development of perifolliculitis in the direction of the formation of deep abscesses and the destruction of follicles with the formation of lymphoplasmacytic granulomas or granulomas with giant cells, obligatory hyperplasia of the sebaceous apparatus glands that open into the hair follicle. Given the bactericidal and fungicidal properties of each fat that actively produces sebaceous glands, their hyperplasia in PCAS may be an indirect confirmation of an adaptive response to commensal biological factors in the development of this pathology. Accumulation of CD20 (+) cells in the outer root epithelial sheath and CD3 (+) cells in the outer and inner root epithelial sheath around the shaft of the hair follicle bud, which is a source of stem cells for reparative regeneration of the epidermis and epithelization of the wound surface, is likely to lead to long-term healing period and alopecia in PCAS. A high density of infiltration by CD20 (+) and CD3 (+) cells in the area of the excretory ducts of the sebaceous glands and CD3 (+) cells in the area of the secretory departments of the sebaceous glands probably leads to hyperplasia of the sebaceous gland apparatus as a reactive process of reparative regeneration in PCAS.

Conclusions. The predominance of CD4⁺–T-helpers, compared to CD8⁺–T-cytotoxic lymphocytes, among the CD3 (+) cells of the inflammatory infiltrate in PCAS indicates the superiority of the effector mechanisms of the immune response, which as a result leads to the activation of macrophages, neutrophils and CD20 (+) B-lymphocytes, which is reflected in the accumulation of these cells in the foci of chronic inflammation around pilosebaceous units of the scalp. The strong humoral response that develops in PCAS as a result of the activation of CD20 (+) B-lymphocytes through effector CD4⁺–T-helpers is effective in the fight against extracellular microorganisms and their toxins and works most powerfully against microorganisms that have a capsule of polysaccharides and lipids, which become a target for antibodies produced by plasma cells, while the smaller number of CD8⁺–T-cytotoxic lymphocytes are able to respond only to protein antigens. Thus, the study of the features of the immune response in PCAS indirectly helps to clarify the spectrum of etiological factors for improving the treatment strategy.

An experimental study on the effectiveness of probiotic disinfectants in the treatment of disseminated peritonitis

2024-11-04T20:11:30+02:00

The aim of the work was to investigate the effectiveness of probiotic disinfectants for sanitation of the abdominal cavity in experimental peritonitis.

Material and methods. An experimental study was conducted at the Shupyk National Healthcare University of Ukraine on 45 white sexually mature male Wistar rats aged 4–5 months, which were used to simulate peritonitis. The rats were divided into 3 groups, 15 animals in each. The treatment of animals in the main group (group I) was as follows: the abdominal cavity was washed with a 5 % solution of probiotic disinfectant, after which a probiotic disinfectant spray was applied, and after suturing the surgical wound, a gel with probiotics was applied to it. A sorbent solution was used to clean the abdominal cavity of rats in the comparison group (group II). Treatment of rats in the placebo control group (group III) consisted of washing the abdominal cavity with 0.9 % NaCl solution. In the postoperative period, all animals received antibacterial and analgesic therapy. Relaparotomies for the purpose of abdominal cavity sanitation were performed at intervals of 24–48 hours. Immunological, histological, histochemical and immunohistochemical studies were performed.

Results. In the group of animals treated with probiotic disinfectants, 10 (66.7 %) rats survived, in which peritonitis was eliminated, as evidenced by clinical, immunological and morphological results. In the animals of the comparison group, 8 (53.3 %) rats survived, in which peritonitis was eliminated. All animals of the placebo control group died from severe peritonitis. The use of the developed treatment in the experiment in animals of group I contributes to a decrease in the cytolytic activity of blood serum in relation to their own leukocytes and the preservation of the functional capabilities of monocytes at an adapted level already on the 5th day of the study. At the same time, on the 7th day, the indicators of the functional activity of monocytes corresponded to the reference values. At the same time, in experimental animals of group II, optimization of the studied indicators occurred only on the 7th day of the experiment. However, they did not correspond to the limits of the reference values. In group III, the studied indicators were significantly reduced relative to the reference values throughout the study.

Conclusions. In group I, 66.7 % of animals survived, in group II – 53.3 %, while in group III – all animals died, which indicates the ineffectiveness of abdominal cavity sanitation with 0.9 % NaCl solution in widespread peritonitis. When using probiotic disinfectants in animals of group I, there is a gradual increase in the number of CD68+ cells in the tissue infiltrate with a significant restoration of monocyte functionality according to the general NCT test. While when using the sorbent and 0.9 % NaCl solution, a critical decrease in the number of CD68+ cells with simultaneous suppression of their function is noted on the 7th day, which indicates the activation of the immune response and the positive effect of the developed treatment in animals of group I.

Neuroaxial anesthesia for lower limbs peripheral vascular disease reconstructive surgeries

2025-02-03T12:12:16+02:00

Combined spinal-epidural anesthesia (CSEA) is an effective approach that combines the advantages of both spinal and epidural anesthesia into a single technique. This method is particularly beneficial for patients who have undergone lower extremity surgery and require additional anesthesia, with the ability to administer epidural anesthetics both during the surgery and in the early postoperative period.

The aim of the study was to compare the effectiveness of different methods of anesthetic support during reconstructive surgery for atherosclerosis obliterans of the lower extremities.

Methods and materials. We compared the effectiveness of spinal anesthesia (SA) without the use of adjuvants and CSEA in order to determine the optimal approach to achieve better anesthesia, analgesic effect, and reduce postoperative complications. A total of 60 patients, aged 65.61 ± 7.36 years, with indications for reconstructive surgery due to for peripheral artery disease of the lower limbs and classified as ASA III–IV, participated in the study. The SA group (30 patients) received a 0.5 % hyperbaric bupivacaine solution (3 ml) without an adjunct, while the CSEA group (30 patients) received a 0.5 % hyperbaric bupivacaine hydrochloride solution (15 mg, 3 ml). Epidural anesthesia – test dose of 0.25 % isobaric bupivacaine hydrochloride solution (12.5 mg), followed by the administration of 0.25 % isobaric bupivacaine hydrochloride solution (20 mg) through the epidural catheter 3 hours after the start of the surgery. The duration of analgesia, onset and regression times of sensory and motor blockade, VAS scores, and any side effects were evaluated and recorded.

Results. The duration of analgesia was significantly prolonged in the CSEA group (437.05 ± 43.36 minutes) compared to the SA group (238.33 ± 32.27 minutes; p < 0.0801). The onset of sensory and motor blockade did not show significant differences between the groups. The VAS scores were lower in the CSEA group throughout the 48 hours postoperatively. The SA group experienced a higher incidence of postoperative nausea and vomiting, as well as tremors. In contrast, the CSEA group had a higher incidence of hypotension and urinary retention. Respiratory depression was not observed in either group.

Conclusions. CSEA is a superior alternative to both epidural blockade and spinal anesthesia, combining the benefits of both techniques while minimizing their side effects. CSEA reduces the required doses of local anesthetics compared to epidural anesthesia to achieve the desired level of blockade. Additionally, CSEA provides better perioperative analgesia than spinal anesthesia.

Features of comprehensive diagnostics of Crohn’s disease in pediatric practice

2024-10-17T13:57:03+03:00

Inflammatory bowel diseases, particularly Crohn’s disease and ulcerative colitis, represent some of the most challenging conditions in contemporary gastroenterology. These disorders are associated with significant complications and a high tendency toward chronicity. Onset typically occurs during childhood or early adulthood. The immune system plays a central role in the pathogenesis of inflammatory bowel diseases; however, the precise mechanisms involved remain incompletely understood. It is well established that dysregulation of the immune response to the intestinal microbiota is a key factor contributing to the development of chronic inflammation.

Aim: to demonstrate the features and challenges of diagnosing Crohn’s disease in children.

Material and methods. The case of an 11-year-old girl who was admitted to the hospital with symptoms of systemic inflammation, abdominal pain, hepatomegaly, and other signs mimicking a viral-bacterial infection is presented. Laboratory tests and endoscopy revealed inflammatory changes in the gastrointestinal tract characteristic of Crohn’s disease. However, histopathological examination did not show classical signs of the disease. The diagnosis of Crohn’s disease was made based on a comprehensive analysis of clinical manifestations and examination results.

Conclusions. Chronic inflammatory bowel diseases remain a diagnostic challenge in children due to their variable presentation. A meticulous evaluation of patient complaints and medical history, integrated with a comprehensive assessment of physical examination findings supported by auxiliary diagnostic methods, and guided by adherence to established diagnostic standards, minimizes the risk of misdiagnosis and supports the selection of the most appropriate treatment strategy.

A clinical case of diffuse odontogenic facial phlegmon

2025-02-23T14:13:38+02:00

The aim of the work is to describe and discuss an unusual clinical case of diffuse facial phlegmon in order to increase the awareness and competence of clinicians who may encounter similar cases.

Materials and methods. For the study, a clinical analysis of episodes of inpatient treatment of patients with odontogenic phlegmon (cellulitis) of one or more cellular spaces of the maxillofacial region was conducted. All clinical cases underwent a thorough clinical analysis, and a treatment plan was drawn up. In this article, we present a description of a case, in our opinion, the most difficult during the studied period, with a hospital treatment period of 25 days.

Results. Patient M., 56 years old, was hospitalized in the department of maxillofacial surgery and otolaryngology of the Municipal Non-Commercial Enterprise “City Hospital of Emergency and Urgent Medical Care” of the Zaporizhzhia City Council. The diagnosis was “Odontogenic diffuse phlegmon of the right half of the face. Exacerbation of chronic periodontitis 4.6”.

The course of the disease was slow. The severity of the disease was due to the prevalence of the purulent process and the presence of concomitant chronic pathologies in the patient, such as diabetes mellitus, nephropathy of mixed genesis. In the hospital, the patient suffered hospital pneumonia. Several surgical interventions were performed to drain purulent foci, necrectomy, and sanitation of the oral cavity. The patient’s treatment was carried out comprehensively with the involvement of related specialists. At the time of recovery, after 25 days of inpatient treatment, the patient had significant local negative consequences of the disease and surgical intervention: facial nerve paresis, cicatricial facial deformities, muscle contracture, atrophy of the fatty tissue of half of the face.

Conclusions. The given case shows that odontogenic phlegmons of the face retain the position of severe and dangerous purulent diseases, which can have (despite the presence of powerful antibiotics and surgical options) a severe and diffuse course with a long hospital treatment period, and lead to functional and aesthetic disorders.