Gliosarcoma is a rare and aggressive variant of glioblastoma, characterized by both a malignant glial component and a mesenchymal sarcomatous component. Gliosarcomas have genetic alterations with glioblastomas, including TP53, PTEN mutations, and EGFR amplification, but may also exhibit additional changes related to epithelial-mesenchymal transition pathways. Management is similar to glioblastoma, involving safe, maximal surgical resection followed by radiotherapy and chemotherapy with temozolomide, but the prognosis remains poor, with a median survival of 6-14 months. Both Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) play crucial roles in the detection, characterization, and treatment planning of gliosarcoma. While MRI is the gold standard, CT remains valuable in certain situations. Light microscopy is essential for definitive diagnosis, allowing pathologists to examine cellular morphology and tissue architecture. It is essential for distinguishing gliosarcoma from other high- grade gliomas and for guiding treatment decisions. In addition, two-photon excited fluorescence (TPEF) microscopy is an advanced optical imaging technique that enables real-time, high-resolution visualization of tumor tissue without the need for staining or contrast agents and enhances visualization of collagen structure and vascularization, key factors in gliosarcoma assessment. The study of radiological and histopathological (light microscopy) features in primary gliosarcomas of the brain is a priority to achieve an early diagnosis that can be translated into better outcomes. Here, we describe the radiological and histopathological features observed in multiple cases of gliosarcoma in current practice.
Chemotherapy is an important treatment in oncological disease, with a vast number of side effects. The cardiotoxicity of several chemotherapeutic agents and appropriate risk stratification and patient follow-up must be ensured by a multidisciplinary team which must include an oncologist and a cardiologist. Lynch syndrome is associated with younger-onset malignant tumors of various localizations, requiring aggressive chemotherapy. FOLFOX chemotherapy which is frequently used in Lynch syndrome-associated colorectal cancer has several cardiotoxic effects with mechanisms ranging from increased reactive oxidative species to Krebs cycle blockade or coronary vasospasm. These complex effects on the cardiovascular system have varied clinical effects, such as heart failure, arrhythmias, or acute ischemic events.
Lynch syndrome, also known as hereditary non-polyposis cancer syndrome, represents the most common autosomal dominant genetic predisposition for the early onset development of several malignancies. Nearly three decades ago, the discovery of microsatellite instability, a distinctive feature of pathogenic variants within genes encoding mismatch repair proteins, marked a significant leap forward in understanding cancer biology and the underlying spectrum of cancers triggered by these mutations – typical of Lynch syndrome. In recent years, a new treatment paradigm, using immune checkpoint inhibitors, as well as preventive measures has drastically improved the survival rates. Identifying individuals with an inherent predisposition to cancer, through diagnostic protocols followed by personalized screening and treatment algorithms, holds the potential to mitigate premature cancer-related fatalities as well as preventable mortality. It is estimated that only a limited number of patients have been diagnosed, underscoring the importance of implementing specific screening programs for early detection of malignancies to which these patients are susceptible. This article aims to underline the importance of a national protocol tailored to guide a Western-inspired practice for Lynch syndrome patient management, the main aim of the Romanian Society for Lynch Syndrome, by providing an overview of similar initiatives throughout the world.
Background: A germline mutation of the MisMatch Repairgene that causes a malfunctioning DNA system is the defining feature of the hereditary illness known as Lynch syndrome. This review will discuss the endocrine aspects of LS and highlight current advancements in the area. Methods: We searched the available literature of the last 10 years for terms such as endocrine tumors and LS. Our goal is to provide a summary of the most recent information available on the endocrine perspective in Lynch syndrome. Results: The hormonal chemoprevention methods cited are the use of combined oral contraceptives, the use of progestogen-releasing intrauterine devices, and the use of progesterone-only drugs. In addition, after surgical exclusion of the uterus and ovaries, a method frequently adopted for LS patients, it is necessary to start hormonal menopausal therapy, taking into account certain age-specific features. In addition, numerous LS-associated endocrine tumor types have been described. Conclusions: Many hormonal variants are available that are useful in the chemoprevention involved in the treatment of LS. Menopausal hormone therapy is imperative for LS patients who need it. Clinicians need to be aware of the possible association of certain types of aggressive endocrine cancers associated with LS.
Objective: The study subject approaches a topic of cerebral pathology, namely the development of a pathological diagnosis that is as accurate as possible for the cerebral tumors and the metastases, using a new method that complements the optical microscopic examination and immunohistochemistry to correctly diagnose cerebral malignancies. Methods: Two-photon excitation (TPE) microscopy techniques are non-linear optical imaging methods that are gaining momentum in the investigation of fixed tissue sections, fresh tissue, or even for in vivo experiments. This method can be used for offering complementary information on the tissue architecture. We argue that using non-linear optical microscopy (which includes TPE microscopy) images collected on this category of brain tissue samples, can facilitate the interpretation of brain tumors and metastases, thus it is a solution worthy to explore. Scanning large areas of the lesions is important to avoid false-negative diagnoses because lesions are often non-uniform. Finding potential invasion sites is also restricted when using a narrow field-of-view imaging method. Results: Our study demonstrated that TPE microscopy can detect specific cellular features of cerebral tumors and metastases in good correlation with histopathological results. This approach can improve the accuracy of the cerebral tumors diagnosis and possibly other neoplasms. Conclusion: TPE microscopy is very important for future research because it could prevent the false or inadequate diagnosis of specific lesions and differentiate a primary tumor from a metastasis. The significance of the findings is attributable to cross-disciplinary cooperation and the constant use of a working standard across all of the experiments in this study.
Breast carcinoma represents the leading cause of oncologic mortality for women. Due to therapeutic and diagnostic advances, the mortality and morbidity in the last decade declined, but breast cancer still has a great impact on quality of life and also on medical service cost. In the light of these facts, an integrated approach, considering histopathology features, molecular profiles and corroboration with clinical and imagistic data is necessary. A descriptive retrospective one-year study analyzed the breast cancer heterogeneity in 121 cases registered in the Pathology Department of the University Emergency Hospital in Bucharest, Romania. Our purpose was to evaluate histopathological, immunohistochemically, clinical and imagistic aspects of breast cancer considering the current molecular classification (Luminal A, Luminal B, HER2 enriched and triple negative/basal like). Our assay revealed that most prevalent histotype was NST (no special type) followed by invasive lobular carcinoma. Considering the molecular pattern, the most common was luminal B. Triple negative basal like and HER 2-enriched were correlated with an aggressive morphologic pattern and lymph-nodes positivity. Considering the imagistic acquisitions, mammography proved to be the most accurate technique for measuring the dimension of NST. In conclusion, breast carcinoma is a heterogeneous disease that needs an integrated approach and personalized treatment based on the histopathologic and molecular features. Considering the great number of advanced stages as diagnosis, a national screening program for breast cancer is imperiously needed.
