http://repository.usmf.md:80/handle/20.500.12710/982 2026-04-07T03:59:59Z http://repository.usmf.md:80/handle/20.500.12710/32970 Title: Immunohistochemical assessment of proliferation, angiogenesis, and viral markers in recurrent laryngeal papillomatosis Authors: Cernev, Daniela; Saptefrați, Lilian; David, Valeriu; Cabac, Vasile Abstract: Recurrent laryngeal papillomatosis (RLP) is a benign but clinically aggressive condition, characterized by frequent recurrences and significant morbidity. Although infection with the human papillomavirus (HPV) represents the main etiological factor, the biological mechanisms underlying the persistence and recurrence of lesions remain incompletely understood. This study aimed to perform a comprehensive histopathological and immunohistochemical evaluation of recurrent laryngeal papillomatosis, focusing on epithelial proliferat ion, angiogenesis, the inflammatory microenvironment, and HPV expression. A retrospective tissue-based study was conducted on a cohort of 32 surgically excised laryngeal papilloma specimens obtained from adult patients. Conventional histopathological examination was performed using hematoxylin–eosin staining. Immunohistochemical analysis included HPV markers, Ki-67, VEGF-A, CD31, and CD68. Proliferative activity, angiogenesis, and inflammatory infiltrates were assessed using semi-quantitat ive and quantitative methods. Statistical analysis was performed using standard comparative tests, with a p-value < 0.05 considered statistically significant. Histopathological evaluation revealed a typical papillary architecture, with fibrovascular stromal cores, epithelial acanthosis, koilocytic changes, and chronic inflammatory infiltrates. HPV immunopositivity was detected in 21.9% of cases, predominantly in the suprabasal epithelial layers, displaying a mosaic pattern. All lesions showed positivity for Ki-67, with heterogeneous proliferative indices. CD68-positive macrophages were variably distributed within the subepithelial stroma. CD31 immunostaining demonstrated a dense and mature microvascular network in all cases. VEGF-A expression was present in the majority of lesions and showed a moderate positive correlation with microvascular density, indicating active angiogenesis. Recurrent laryngeal papillomatosis is characterized by a complex interaction between epithelial proliferation, angiogenesis, chronic inflammation, and HPV-associated changes. VEGF-A-mediated angiogenesis appears to play a significant role in sustaining lesion growth. Comprehensive immunohistochemical profiling provides valuable insights into the biological behavior of RLP and may contribute to improved risk stratification and the development of targeted therapeutic strategies. 2026-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/32969 Title: Immunohistochemical detection of pepsin in recurrent laryngeal papillomatosis: findings consistent with laryngopharyngeal reflux exposure Authors: Cernev, Daniela; Saptefrați, Lilian; David, Valeriu; Cabac, Vasile Abstract: Background. Recurrent laryngeal papillomatosis (RLP) is a benign epithelial disease with a relapsing course that often requires repeated interventions and imposes a substantial clinical burden. While human papillomavirus infection is the primary etiologic factor, the marked variability in recurrence suggests that additional cofactors may contribute. Laryngopharyngeal reflux has been proposed as one such cofactor through chronic irritation of the laryngeal mucosa. Objective. To assess pepsin immunoreactivity in RLP specimens and interpret the findings as tissue markers consistent with laryngopharyngeal reflux exposure. Materials and methods. We conducted a retrospective, tissue-based analysis of 32 surgically excised laryngeal papilloma specimens from adult patients with RLP, without a control group. Pepsin immunohistochemistry was performed using a standardized protocol with an anti-pepsinogen C (PGC) antibody. Staining was evaluated semi-quantitatively (score 0–3) and characterized by epithelial and stromal localization. Statistical analysis was descriptive. Results. Pepsin immunoreactivity (score ≥1) was detected in 24/32 cases (75.0%; 95% CI: 57.9–86.7). Positivity was typically granular and cytoplasmic within the epithelium, with stratified involvement and a focal/mosaic distribution. Occasional weak staining was also observed in stromal inflammatory cells and vascular endothelium. Score 0 cases showed no epithelial or stromal staining. Conclusions. In this series, pepsin immunoreactivity was frequently detected in RLP tissue, a pattern consistent with laryngopharyngeal reflux exposure. These findings suggest that reflux-related mucosal injury may be a cofactor in disease persistence and recurrence. 2026-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/32968 Title: Laryngeal granuloma – experience of the ENT clinic of ”Timofei Mosneaga” Republican Clinical Hospital Authors: Osman, Victor; Vetricean, Sergiu; Sencu, Eusebiu; Noroc, Iurie; Chiriac, Ana-Maria; Vita, Andrian; Zveaghintev, Piotr Abstract: Vocal fold granuloma is a benign laryngeal lesion located at the vocal processes of the arytenoid cartilages and characterized by the formation of granulation tissue as a response to chronic mucosal irritation. Material and methods. A retrospective analysis of data from 12 patients diagnosed with laryngeal granuloma and treated between 2019 and 2024 at the ENT Clinic of the “Timofei Moșneaga” Republican Clinical Hospital. Results. In the examined series, males predominated (58.33%). Age distribution showed a bimodal pattern: 16–30 years (33.3%) and 41–50 years (33.3%). The clinical presentation was dominated by dysphonia (58.3%), foreign body sensation (41.66%), and irritative cough (50%). Most patients sought medical care more than one month after symptom onset (41.66% of cases). Constant vocal abuse was associated with 41.66% of cases, gastroesophageal reflux disease (GERD) with 33.3%, intubation with 16.6%, and 1 case (8.35%) was idiopathic. Morphologically, medium-sized granulomas predominated (66.6%), followed by microgranulomas (25%) and large granulomas (8.35%). Conservative therapy proved effective in the vast majority of cases, 9 of 12 patients (75%). A favorable outcome after CO₂ laser ablation assisted by jet ventilation was observed in 66.6% of the patients undergoing the procedure (1 recurrence among 3 operated cases). Conclusions. Conservative treatment (proton pump inhibitors, corticosteroids—3 days intramuscularly followed by 7 days inhalation, proteolytic enzymes, NSAIDs, antihistamines, and phoniatric therapy) represents the initial treatment option for laryngeal granulomas. Surgery is reserved for symptomatic, treatment-refractory, or recurrent cases. Late presentation, likely associated with the gradual increase in granuloma size, combined with gastroesophageal reflux disease, increases the probability of conservative treatment failure and the need for surgical intervention. 2026-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/32563 Title: Impactul rinitei cronice hipertrofice asupra calității vieții ale copilului Authors: Furculița, Daniel; Maniuc, Mihail; Ababii, Polina; Danilov, Lucian; Obadă, Elena Abstract: Nasul este prima componentă a căilor respiratorii superioare și este responsabil de încălzire, umiditate și, în mare măsură, de purificarea aerului inspirat, care îi asigură funcția respiratorie cu influență asupra tuturor organelor și sistemelor corpului | 2|. Existența unor obstacole anatomice în calea curgerii aerului sau a bolilor învecinate afectează alterarea mecanismelor de autoreglare. Rinita hipertrofică cronică reprezintă o problemă actuală și majoră în otorinolaringologie, cu o frecvență de 16-25% din populație în diferite țări|1|, cu o prevalență în creștere și reprezentând aproximativ jumătate din patologia pacienților, care se adresează medicul Otorinolaringolog 2024-01-01T00:00:00Z