Parotid gland pathology represents a web of differential diagnoses. There are many complex cases that require extensive diagnostic tests for a complete and correct final pathology diagnosis. Currently the official classification of parotid gland tumors extends over more than 40 subtypes. We performed a query of the PubMed database regarding the use of molecular biology tests in performing a better characterization of the tumors in specific cases. By using fluorescence in situ hybridization (FISH), reverse transcription polymerase chain reaction (RT-PCR) or next-generation sequencing, the team managing complex cases can offer a personalized therapeutic solution. We review the molecular differential diagnosis according to published articles in the last 5 years for many types of parotid gland tumors ranging from benign to borderline malign tumors to malign aggressive tumors. Mucoepidermoid carcinoma is a distinct subtype of parotid malignancy that was the subject of a consistent number of articles. However, the molecular biology diagnosis techniques helped more in excluding the diagnosis of mucoepidermoid carcinoma, and probably retrospectively limiting the number of cases with this final diagnosis. In Romania, the molecular biology diagnosis is available only in limited research facilities and should receive more consistent funding that will make it available on a larger scale. The novelty of this scoping review is that we propose an algorithm for molecular differential diagnosis of the tumors that could be encountered in the parotid gland.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract, originating from structures differentiating towards Cajal cells. Due to their morphology and localization, the extragastrointestinal stromal tumors (EGISTs) can be a diagnostic challenge. We investigated a series of 51 EGISTs diagnosed in our institutions, aiming to explore the immunophenotypes and to analyze the process and the utility of the antibodies required for a positive diagnosis. Immunohistochemical examinations were done for pan-cytokeratin (pan-CK), Ki67, discovered on GIST1 (DOG1) protein and platelet-derived growth factor receptor alpha (PDGFRA), as necessary. The main tumor site was abdominal wall in 43 (84%) cases, most of the tumors showed spindle cell cellularity, followed by mixed and epithelioid type. Twenty-six cases revealed a full conventional immunohistochemical profile with DOG1 positivity. In 10 cases, c-KIT expression was absent but with the preservation of cluster of differentiation (CD)34 positivity, and eight cases were positive for PDGFRA. In our study, we found a subgroup of eight cases presenting in extra-abdominal settings (including one in lung and two in the head-and-neck area). We concluded EGISTs represent a histopathological and immunohistochemically challenging subgroup testing more often negative for c-KIT mutations and positive for PDGFRA compared to GIST. DOG1 remains the marker of choice regardless of tumor site, while CD34 and CD117 should be considered as adjuvants.

Background and Objectives: Carcinoma ex-pleiomorphic adenoma (CXPA) is a carcinoma derived from a primary or recurrent pleiomorphic adenoma. Microscopically, non-invasive CXPA (intracapsular and carcinoma in situ), minimally invasive CXPA (extracapsular invasion less than 1.5 mm), and invasive CXPA (extracapsular invasion more than 1.5 mm) are described. Materials and Methods: We performed a retrospective clinical study over the period of 2009–2023 in patients admitted to the ENT Department of the Bucharest University Emergency Hospital. Results: In the studied group, there was a net male predominance of 2.5:1. The tumor evolution until presentation was 6.64 years on average, with values between 2 and 20 years. The reasons for presenting to our department included a sudden increase in size in eleven cases (78.57%), pain in nine cases (64.29%), peripheral facial paralysis in eight cases (57.14%), skin invasion/ulceration in five cases (35.71%), and massive tumor hemorrhage in one case (7.14%). There were histopathological results on paraffin of myoepithelial CXPA in four cases (28.57%), of high-grade CXPA (salivary duct, secretory) in eight cases (57.14%), and of squamous CXPA in two cases (14.29%). The patients with unfavorable evolution showed the following characteristics: a tumor diameter over 11 cm (four cases), integument invasion (four cases), perivascular invasion at HP exam (six cases), perineural invasion at HP exam (six cases), and invasion of the ganglion (three N3b cases and two N1 cases). Conclusions: CXPA is a neoplasia that, when associated with large tumor volumes or peripheral facial paralysis in particular, is a challenge for both the doctor and patient.

Background/Objectives: Sinonasal inverted papilloma is a rare Schneiderian epithelial tumor, histologically benign in most cases, but characterized by locally aggressive behavior, a high recurrence rate and a recognized potential for malignant transformation, most frequently into sinonasal squamous cell carcinoma. The present article is a scoping review that maps and critically synthesizes the available evidence on epithelial, immunohistochemical and selected molecular markers in malignant-transformed sinonasal inverted papilloma, rather than a quantitative systematic review or meta-analysis. Methods: The literature search was performed according to PRISMA-ScR principles in PubMed/MEDLINE, Embase, Scopus/Web of Science and Google Scholar, using the search keywords sinonasal inverted papilloma, malignant transformation, markers, HPV, p63, p40, p16 and Ki-67, as well as complementary markers of the cell cycle and of the EGFR/CDKN2A/TP53 pathways. Results: Based on the available data, p40 and p63 have diagnostic value for defining and mapping the squamous phenotype, including invasive carcinomatous nests, but they are not standalone predictive markers of malignant transformation. p16 cannot be automatically used as a surrogate for active HPV infection in inverted papilloma, while the results regarding HPV remain inconclusive in relation to malignant transformation of sinonasal inverted papilloma. Ki-67, especially when interpreted topographically and in relation to dysplasia and invasion, may suggest proliferative acceleration, but prognostic thresholds have not yet been validated. Conclusions: The conclusion of our study is that the risk of malignant transformation cannot be reduced to a single marker; it must be interpreted through an integrative clinical, imaging, histopathological, immunohistochemical and molecular model, which requires prospective multicenter validation.

Introduction: Birth Asphyxia is a severe condition that includes many potential pathways of occurrence both in utero and during childbirth. We aimed to identify and describe specific macroscopic and microscopic placental injuries in birth asphyxia to serve as a quick tool to stratify a newborn’s potential further evolution, as hypoxic-ischemic encephalopathy can be responsible for neonatal death or severe neurologic sequelae further compromising the affected persons’ quality of life. Materials and methods: We conducted an observational prospective study over 3 years. 62 patients diagnosed with birth asphyxia which had placental histopathological examination performed were enrolled. The control group consisted of 69 term newborns that required neonatal intensive care for at least three days, in the same period, for any other reason and that also had available placental exams. In our study, placental histopathological lesions identified in birth asphyxia have been classified according to Amsterdam Criteria. Results: We analysed data gathered from both groups by applying specific statistical tests for each type of variable and hypothesis. Thus, umbilical cord abnormalities were associated with hypoxic-ischemic encephalopathy in a statistically significant manner when comparing the birth asphyxia group of newborns with the control group. Also, we identified a high statistical level of significance for maternal and fetal vascular malperfusion and the occurrence of hypoxic-ischemic syndrome when comparing the two groups (p = .00). Conclusion: The macroscopic and microscopic placental examination can provide important information on the evolution of the disease in selected newborns according to the identified lesions.