BACKGROUND:Coronavirus disease 2019 (COVID-19) pandemic was associated with unexpected endocrine findings at imaging evaluation, including adrenal incidentalomas. AIM:To analyze adrenal findings at computed tomography (CT) in patients who underwent an abdominal and∕or thoracic CT scan for non-adrenal conditions and had a positive COVID-19 testing within six to 12 months before. METHODS:This was a retrospective, real-life study in adults. RESULTS:Two groups [group C (positive COVID-19 infection; N=46 patients) vs. group non-C (prior negative infection; N=74 patients)] had similar age: 57.72±14.23 vs. 53.74±13.90 years (p=0.134). 73.33% of patients of group C had abnormal adrenal features similar to 66.22% of patients in non-C. Prevalence of adrenal nodules (ANs) was statistically significantly higher in group C (54.35%) vs. non-C (33.78%) (p=0.026). Detection rate of unilateral AN (45.65% vs. 25.67%; p=0.029) was also higher. 41.67% of entire group (N=120) displayed an AN (group AN), while 58.33% were nodule-free (group non-AN), with similar age and gender distribution. The number of patients with a history of COVID-19 infection was statistically significantly higher in group AN vs. non-AN (50% vs. 30%; p=0.026). Multivariate logistic regression analysis explained 17.5% of the variance (R²: 0.175). After adjusting for age, gender, right unilateral hyperplasia and left unilateral hyperplasia, the presence of the COVID-19 history remained statistically significantly (p=0.028) associated with increased odds of having an AN [odds ratio (OR: 2.471, 95% confidence interval (CI): 1.105-5.527]. A statistically significant correlation was found between the age and the largest diameter of AN within group AN (r=0.387, p=0.009). CONCLUSIONS:Awareness remains the key factor in the CT-detected lesions that have been identified after prior coronavirus infection, some being a direct consequence, while others are incidental elements.
Acute abdominal emergencies remain a leading cause of mortality in the emergency setting, often resulting in death before surgical intervention can be performed. During the coronavirus disease 2019 (COVID-19) pandemic, these cases were further complicated by thrombotic and inflammatory mechanisms, with a notable increase in mesenteric ischemia. We conducted a retrospective monocentric study of 31 postmortem cases of acute abdomen occurring between January 1, 2019, and December 31, 2023, analyzing demographic characteristics, clinical presentation, laboratory parameters, imaging, and autopsy findings. Among 69 total deaths in the Emergency Department during this period, 31 were attributed to acute abdominal pathology, the majority involving elderly, septic patients with perforation or ischemia. Nine deaths from mesenteric ischemia occurred during the COVID-19 period, emphasizing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated hypercoagulability. Other fatal cases included perforated ulcers, ruptured hepatic or pancreatic tumors, and advanced neoplasms with secondary peritonitis. Laboratory markers such as elevated lactate, leukocytosis, and coagulopathy corresponded with postmortem evidence of intestinal necrosis, thrombosis, or peritoneal contamination. Although urban patients predominated, rural patients frequently presented with advanced sepsis at admission. These findings highlight that acute abdominal emergencies carry high mortality and underscore the critical importance of early recognition, rapid triage, and multidisciplinary management. Postmortem analysis provides essential insights into fatal mechanisms and supports the refinement of diagnostic and treatment protocols to improve outcomes.
Background: Chronic mesh infection is a severe implant-associated complication characterized by persistent inflammation and progressive tissue remodeling. This condition is closely associated with foreign body reaction (FBR), fibrosis, and biofilm-related chronic inflammatory processes, which significantly alter the structural integrity of the abdominal wall. Patients, Materials and Methods: We performed a retrospective clinicopathological study of patients treated for chronic abdominal wall mesh infection between January 2021 and December 2024. Explanted mesh specimens together with adjacent periprosthetic tissues were collected and processed using standard histological techniques, including formalin fixation, paraffin embedding, and Hematoxylin-Eosin staining. Histopathological (HP) evaluation focused on inflammatory infiltrates, FBR, fibrotic response, and tissue remodeling. Results: HP examination consistently demonstrated foreign body granulomatous reaction characterized by multinucleated giant cells surrounding mesh filaments, associated with chronic inflammatory infiltrates composed predominantly of lymphocytes and plasma cells. Extensive fibrosis and dense collagen deposition with fibrotic encapsulation of the prosthetic material were observed in all cases. These findings were associated with marked structural remodeling of the surrounding soft tissues. Conclusions: Chronic mesh infection is associated with characteristic HP features, including foreign body granulomatous reaction, chronic inflammation, and extensive fibrosis. These morphological alterations reflect persistent implant-associated inflammatory processes and contribute to progressive tissue remodeling. HP evaluation provides essential insights into the biological mechanisms underlying chronic mesh infection and its long-term tissue effects.
The aim of this study was, firstly, to classify patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP) into inflammatory endotypes and, secondly, to investigate the relationships between blood and tissue eosinophilia and clinical outcomes in CRSwNP, including disease severity, and recurrence. This cross-sectional, observational, nonrandomized study has been realized between January 2023-December 2024 enrolling a sample of 469 consecutive patients with chronic rhinosinusitis, of which 239 patients with CRSwNP and 230 patients with CRSsNP. The classification of CRSwNP and CRSsNP into inflammatory endotypes was performed by analyzing the levels of blood and tissue eosinophilia. The prevalence of asthma and allergy to nonsteroidal anti-inflammatory drugs (NSAIDs) in the two groups was also analyzed. In the group of patients with CRSwNP, the severity of the disease and the level of quality of life impairment were evaluated, depending on the degree of tissue eosinophilia. The importance of the association between blood vs. tissue eosinophilia and the relapse of CRSwNP was also assessed. The proportion of patients with elevated blood eosinophil levels was higher in CRSwNP than CRSsNP (17.4% vs. 4.35%). Tissue eosinophilia was identified in 163 of 235 (69.4%) patients with CRSwNP compared with 29 of 230 (12.6%) patients with CRSsNP. From an inflammatory perspective, revision surgery was strongly associated with tissue eosinophilia. In contrast, elevated blood eosinophil levels were only moderately associated with revision surgery.
BACKGROUND:Local recurrence after breast-conserving surgery (BCS) remains clinically relevant and is associated with poorer long-term outcomes. While several prediction tools exist, many rely on costly genomic assays or omit key biological variables routinely assessed by immunohistochemistry (IHC). PATIENTS, MATERIALS AND METHODS:We retrospectively analyzed 100 consecutive patients with invasive breast carcinoma treated by BCS (2013-2018). IHC data included estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2∕neu) [0-3+, with 2+ confirmed by chromogenic in situ hybridization (CISH)], as well as hormonal phenotypes. Local recurrence occurred in 21 cases. An integrated IHC score (0-6 points) was constructed using weighted biological predictors (ER-, PR-, HER2+, and ER-∕PR- phenotype), stratifying cases into low (0-2), moderate (3-4), and high (≥5) risk categories. Although ER, PR, and HER2 status were available for all cases, case-level linkage between HER2 positivity and ER∕PR phenotypes was not consistently available; therefore, three sensitivity scenarios (optimistic, neutral, and pessimistic) were applied to assess the robustness of the findings. RESULTS:Recurrence was higher in biologically unfavorable subgroups: ER- (26.47% vs. 9.09% in ER+), PR- (21.42% vs. 10.34% in PR+), ER-∕PR- phenotype (37.5%), and HER2-positive tumors (33.33% vs. 11.36% in HER2-). The integrated score achieved consistent separation of risk categories, with most recurrences concentrated in moderate- and high-risk groups. Sensitivity analyses showed stable stratification across all three HER2 allocation scenarios, supporting the robustness of the model despite uncertainty in HER2- phenotype overlap. CONCLUSIONS:A pragmatic IHC-based risk score based on routinely available biomarkers stratified local recurrence risk in breast cancer patients treated with BCS and remained stable under sensitivity testing. External validation in larger, multicenter cohorts is warranted.
BACKGROUND:Metastatic melanoma concerning the gastrointestinal (GI) tract is a well-documented yet often clinically silent phenomenon, with the most common site of involvement being the small intestine. Intussusception in adults is rare and usually secondary to an underlying tumor. Melanoma of unknown primary (MUP), a diagnosis made in the absence of identifiable cutaneous, mucosal, or ocular lesions, adds further diagnostic complexity. CASE PRESENTATION:We present the case of a 64-year-old female who was referred to the Emergency Department with subacute symptoms of intestinal obstruction. Imaging revealed ileal intussusception with a suspected tumoral cause. Surgical exploration confirmed an ulcerated intraluminal mass acting as the lead point. A segmental enterectomy with primary anastomosis was accomplished. Histopathological (HP) and immunohistochemical results confirmed the diagnosis of malignant melanoma, with positive staining for S100, Melan-A, preferentially expressed antigen in melanoma (PRAME), and cluster of differentiation 117 (CD117). No primary lesion was identified on full-body dermatological and mucosal examination. The patient had a favorable postoperative outcome and was discharged with a favorable clinical status. DISCUSSIONS:This particular case illustrates an uncommon initial manifestation of metastatic melanoma in the form of small bowel occlusion. MUP remains an infrequent disease with a paradoxically similar or even more favorable prognosis compared to melanomas with known primaries. Literature review supports surgical resection as the primary therapeutic strategy in isolated GI metastasis, particularly in symptomatic patients. Immunohistochemistry plays a critical role in establishing diagnosis, although it cannot reliably distinguish primary from metastatic lesions in the small bowel. CONCLUSIONS:Melanoma should be taken into consideration in the differential diagnosis of adult intussusception and small bowel tumors, even without a known primary lesion. This particular case highlights the importance of HP evaluation and multidisciplinary assessment in reaching an accurate diagnosis.
Background: Accurate detection of coronary artery disease (CAD) from cardiac magnetic resonance (CMR) imaging can support earlier diagnosis and streamlined clinical decision-making. Objective: This study evaluated the performance and statistical robustness of two deep learning architectures - DenseNet121 and ResNet50 - for automated CAD classification using multiparametric CMR imaging. Methods: Images were preprocessed using a valid pipeline and partitioned strictly at the patient level. Model performance was quantified through average accuracy, area under the receiver operating characteristic (ROC) curve (AUC-ROC), precision recall, while distributional assumptions were assessed using Shapiro-Wilk tests and variance homogeneity was explored with Brown-Forsythe test. Results: ResNet50 demonstrated the strongest performance, achieving an average accuracy of 90.43%, AUC-ROC of 0.862, and area under the precision recall curve (PR-AUC) of 0.891. DenseNet121 showed lower accuracy (81.72%). Statistical analysis revealed non-normal performance distributions and significant variance differences between models. Conclusions: The findings indicate that ResNet50 offers a reliable and statistically validated solution for CAD detection from CMR imaging. The combined use of realistic preprocessing and comprehensive inferential testing supports the generation of reproducible and clinically meaningful performance estimates.
Patients with lung cancer commonly report a broad spectrum of symptoms driven by both side effects of treatment and aggressive progression of disease. As a result, growing evidence indicates that pulmonary rehabilitation (PR) can meaningfully improve exercise performance, health-related quality of life (QoL), fatigue, and dyspnea. The core objective of any PR program is to improve the patient's overall functional profile. In this study conducted at the Marius Nasta Institute of Pneumophthisiology, Bucharest, Romania, we assessed the functional profile of patients with non-small cell lung cancer (NSCLC)-specifically lung adenocarcinoma (LUAD) and squamous cell carcinoma (SCC)-and explored its relationship with key biomarkers: programmed death-ligand 1 (PD-L1), anaplastic lymphoma kinase (ALK), and epidermal growth factor receptor (EGFR). Functional status was evaluated using the International Classification of Functioning, Disability, and Health-Rehabilitation Core Set (ICF-RCS). Exercise capacity was measured with the 6-Minute Walk Distance (6MWD) test, health-related QoL was evaluated using the validated European Organization for the Research and Treatment of Cancer Core Quality of Life 30-item Questionnaire (EORTC QLQ-C30) questionnaire and anxiety levels were assessed with the Generalized Anxiety Disorder 7-item (GAD-7) instrument. The study identified a correlation between the patients' functional profiles and specific biomarker patterns. Based on these findings, we believe that incorporating biomarker information into functional evaluation could help build a clearer and more clinically relevant understanding of patient needs during PR, ultimately contributing to more personalized comprehensive care. We propose that future research should examine whether the relationship between biomarker status and functional, psychological, and QoL outcomes remains consistent following a structured rehabilitation program, and whether these biological markers can predict which patients are most likely to experience functional and emotional improvements. Such insight could prove valuable in guiding individualized rehabilitation strategies for patients with NSCLC.
The Romanian School of Pathology has a complex history, which must be thoroughly known to be appreciated at its value. The research includes data on the pathology' evolution in our country, the overview of the most important research centers and their dealings. It also contains landmarks about the most important Romanian pathologists, their activities etc. Among them was Augustin Mureşan (1908-1985). He was member of three important Romanian pathology centers: Cluj, Bucharest and Timişoara. Cluj was the place of his career debut and the place where he ended his professional activity. In Bucharest, his professional training and career took place over two decades. In Timişoara, he taught pathology courses for students for two years. Among his professional achievements, it should be noted that under his editorship was published the unique textbook of pathology for Romanian faculties of medicine (1962). He also supervised doctoral theses for more than 20 years. He described the first three cases of histoplasmosis in Romania, and he was one of the first Romanian researchers who studied liver biopsies (1942) and kidney biopsies (1947).
While ectopic thyroid is an uncommon congenital condition, the occurrence of malignant transformation within ectopic lingual thyroid tissue is exceptionally atypical. We report a rare case of not otherwise specified (NOS) thyroid carcinoma (TC) arising in a sublingual ectopic thyroid in a 54-year-old male. The patient presented with progressive dysphonia, dysphagia, and upper airway obstruction, accompanied by severe hypothyroidism. Imaging studies, including ultrasonography, thyroid scintigraphy with technetium-99m pertechnetate, and cross-sectional computed tomography (CT), confirmed the absence of orthotopic thyroid tissue, identifying a highly vascularized sublingual tumor. Preoperative selective arterial embolization was performed to minimize intraoperative bleeding, followed by a successful surgical excision of the described mass. Histopathological analysis revealed NOS carcinoma arising in ectopic lingual thyroid tissue. The patient was subsequently maintained on suppressive Levothyroxine therapy and referred for radioiodine treatment. This case highlights the importance of a multidisciplinary diagnostic and therapeutic approach in the treatment of ectopic lingual TC. To our knowledge this is one of the few cases of NOS TC arising in a lingual thyroid gland.
Peripheral nerve sheath tumors are a group of neoplasms that arise from Schwann cells. This study evaluates the histopathological and immunohistochemical (IHC) characteristics of these entities, spanning a spectrum from benign to malignant lesions. We focused on tumor variants, particularities, and differential diagnoses. A total of 25 cases were analyzed, with conventional schwannomas being the most common benign tumor subtype. Classic schwannomas exhibited typical Antoni A and Antoni B patterns, with Verocay bodies as defining features. Additionally, less common variants, such as cystic and myxoid schwannomas, were identified, highlighting the morphological variations of these entities. Malignant peripheral nerve sheath tumors (MPNSTs), representing the malignant counterpart, were characterized by spindle cell and epithelioid morphologies, high mitotic activity, and aggressive clinical behavior. Differentiating MPNSTs from other soft tissue tumors, such as neurofibromas and melanomas, was challenging due to overlapping histological features. IHC markers, particularly S100 and sex determining region Y (SRY)-box transcription factor 10 (SOX10), played an important role in the diagnostic process, though their interpretation required precision to avoid diagnostic pitfalls. This study highlights the importance of integrating histopathology and immunohistochemistry for accurate diagnosis and differentiation of peripheral nerve sheath tumors. The recognition of rare variants and analysis of tumor subtypes contribute to a better understanding of these entities, which is crucial for appropriate clinical management.
The aim of this study was to examine the morphology of poly(methyl methacrylate) bone cement manually loaded with meropenem and vancomycin, in order to determine the structural changes in the polymer matrix that occur with antibiotic addition, as well as the relationship between antibiotic particles and the matrix and the changes that occur with cement aging. Samples of SmartSet Endurance™ MV bone cement manually mixed with meropenem, vancomycin and their combinations were examined with scanning electron microscopy after 24 hours storage at room temperature in air and after 28 days of incubation in Ringer's solution at 37°C. Manually prepared bone cement was characterized with microporosity of up to 65 μm and homogenous polymer structure that does not change significantly with incubation of 28 days. Incubation causes changes in mechanical properties that result with more pronounced cracking of the parts subjected to bending stress. Adding vancomycin causes increase in cement porosity and irregularity in shape and size of pores, not only by creation of antibiotic-filled voids, but also by interference with polymer formation and creation of microporosity areas. Incubation of 28 days causes release of antibiotic particles almost completely from the surface of the sample and less towards the center, with more meropenem particles being released compared to vancomycin.
Prostate cancer continues to be a health problem by epidemiological indicators, despite prevention and detection programs and advanced knowledge of molecular biology. Acinar forms are the most common and constitute a tumor group with a relatively good prognosis, but sometimes unpredictable compared to the associated histopathological (HP) parameters. Among the molecular mechanisms involved in tumor cell proliferation is the disruption of the cell cycle, and the evaluation of the expression of key proteins involved can assist the histological stratification of cases. The study investigated the immunoexpression of Cyclin D1, P53 and Ki67 in 55 prostatic acinar adenocarcinomas (PAAs), in relation to the HP prognostic parameters of the lesions. High reaction scores expressed as positivity index (PI) indicated the significant association of the three markers with increased grading groups recommended by International Society of Urological Pathology (ISUP), perineural and lymphovascular invasion. P53 PI and Ki67 PI were significantly or at the limit of significance increased in conventional and colloidal PAA, and in the case of P53 and in addition in advanced stages. Analysis of the effective values of the reactions indicated significant positive linear correlations between the investigated immunomarkers. The reactions were variable in a relatively homogeneous group of PAA and although they were generally associated with aggressive HP behavior, they seem useful in the punctual identification of cases that require a particular management, in the context of specific oncological therapy.
The columnar cell variant (CCV) of papillary thyroid carcinoma (PTC) is a rare histological subtype with distinct morphological and immunohistochemical (IHC) features, which can present diagnostic challenges. We report a case of a 13-year-old girl diagnosed with CCV of PTC (CCV-PTC) following a total thyroidectomy for a solitary thyroid nodule. Histopathological (HP) examination revealed aggressive features, including vascular invasion and extrathyroidal extension. However, no metastases or recurrences were observed during six years of follow-up. This case report provides a comprehensive analysis of a rare CCV-PTC in an adolescent, focusing on its HP, IHC, and molecular characteristics. It also discusses diagnostic pitfalls and differential diagnoses that should be considered.
Metastatic involvement of the oral and maxillofacial region is an uncommon clinical event. These secondary lesions may develop in several anatomical locations, most frequently within the parotid glands or orbital structures. While many primary tumors that spread to these regions arise from neighboring sites such as the scalp, face, oral cavity, or pharynx, distant subclavicular malignancies can also give rise to metastases in these areas. Among such tumors, renal cell carcinoma (RCC) is the third most frequent source of metastasis to the oral and maxillofacial region. Nevertheless, reports of RCC spreading to the parotid or orbital regions remain exceptionally rare. We present a distinctive clinical case of a 54-year-old man with clear cell RCC that, during its progression, produced simultaneous metastases to both parotid glands and to the orbital region - a combination that, to our knowledge, has not been previously documented in the medical literature.
Testicular germ cell malignancies have a low prevalence among pediatric neoplasia, presenting a bimodal distribution, the two peaks being around the age of five years and postpuberty. Early identification of these types of solid tumors is extremely important, since the prognosis has improved significantly in recent decades through the multimodal diagnostic and therapeutic approach. Our study refers to two cases of testicular neoplasm diagnosed in the postpubertal period. The two adolescents were diagnosed in the Department of Oncopediatrics, in a short interval (February and March 2023). The diagnostic process was based on biological dosing, histopathological (HP) and immunohistochemical examination of orchiectomy specimens and imaging evaluations (computed tomography and magnetic resonance imaging). Following the investigations described, non-seminomatous germ cell tumors were identified in both cases. In the first patient, the tumor was classified in stage IB, while the second patient presented with advanced stage disease, presenting pulmonary, hepatic and ganglia metastases, being classified in stage IIIC. In both patients, chemotherapy was initiated according to current therapeutic protocols. Testicular tumors are a rare pathology with a specific clinical-biological and HP picture that require a multimodal approach (pediatric oncologist, pediatric surgeon, pathologist, radiologist), and for which the prognosis differs depending on the diagnosis stage and the detected histological type.
Cancer of oral cavity is an increasingly public health concern, ranking as the seventh most frequent cancer in Europe and it is the eleventh deadliest cancer. Oral squamous cell carcinoma (OSCC) has one of the lowest 5-year survival rates, about 50% of these patients will die within five years. Tumors arising in this area often exhibit highly aggressive characteristics, with a strong tendency toward local infiltration and distant spread, leading many patients to be diagnosed with advanced locoregional disease. Thus, it becomes necessary to identify new biomarkers with significant impact on the diagnosis and prognosis of OSCC, to improve clinical management and the quality of life of these patients. Studies in recent decades have investigated the involvement of adhesion molecules in OSCC initiation, tumorigenesis, progression and dissemination. Based on these considerations, this study sought to evaluate the immunoreactivity of three transmembrane adhesion molecules (desmoglein-3, claudin-4, and claudin-7) in primary OSCC and their lymph node (LN) metastases, as well as to assess their potential prognostic significance. To achieve this, we analyzed 39 OSCC samples from diverse anatomical regions and their associated locoregional LN metastases using enzymatic immunohistochemistry, applying integrated optical density (IOD) for quantitative assessment. Our results highlighted a progressive decrease of membranous staining pattern followed by a progressive increase in cytoplasmic and nuclear reactivity for all three investigated markers as these lesions progress from low-grade to high-grade one. The highest cytoplasmic and nuclear reactivity was noticed in poorly differentiated forms, mainly at the periphery of tumor proliferation and at the invasion front. A similar reactivity to that from primary tumors was also noticed in metastatic LN proliferations. So, we concluded that these three biomarkers are involved in OSCC progression and dissemination and their investigation may have prognostic and therapeutic utility.
Extradural arachnoid cysts (EACs) are rare, fluid-filled lesions located outside the dura mater, predominantly found in the thoracic spine. While many remain asymptomatic, their progressive enlargement may lead to significant neurological deficits due to spinal cord compression. This case report describes a 43-year-old patient presenting with incomplete paraplegia (Frankel grade C) due to a thoracic EAC at the T5–T6 level. Surgical management involved laminectomy, complete cyst excision, and dural defect repair, leading to neurological improvement. The discussion reviews current diagnostic and therapeutic approaches, emphasizing the importance of early intervention to optimize patient outcomes.
Neural tube defects represent a heterogeneous and complex group of congenital abnormalities affecting the central nervous system. These defects occur during embryogenesis as a result of the failure of the neural tube to close completely. A highly clinically significant form is myelomeningocele, often referred to as open spina bifida or spina bifida aperta. Delayed diagnosis presents considerable challenges, and folate deficiency is an important risk factor. This case reports a severe myelomeningocele located in the lumbosacral region of a female neonate, identified at 28-29 weeks' gestation during the only prenatal consultation of a 29-year-old woman who had three previous normal pregnancies and did not take folic acid (FA) supplementation. The delayed diagnosis contributed to the progression of degenerative and traumatic lesions in the neural tissue, leading to the development of Chiari malformation type II and hydrocephalus. These conditions had a profound impact on brain development, significantly increasing the severity of the case. Primary prevention through the periconceptional use of FA supplements has been shown in extensive research to significantly reduce the probability of neural tube defects, including myelomeningocele. For this reason, FA fortification programs as a public health measure have been implemented in many countries.
BACKGROUND:Localized gingival enlargements (GEs) are frequently encountered reactive lesions with various etiologies, including chronic irritation, trauma, systemic conditions, hormonal influences, and medication use. Despite their benign nature, these lesions can significantly affect oral function and aesthetics and may occasionally mimic neoplastic processes. This case series aims to present the clinical and histopathological (HP) features of five patients with localized GEs, describe different surgical approaches including scalpel and diode laser excision, and report short-term clinical outcomes. CASE PRESENTATIONS:Five patients with gingival overgrowths of varying etiology were evaluated. All underwent thorough periodontal debridement and oral hygiene instruction prior to surgical intervention. HP evaluation followed surgical excision. Patients were monitored for recurrence for at least three months. Lesions included inflammatory epithelial hyperplasia, cavernous hemangioma, and squamous cell papilloma. One case revealed immunoglobulin G4 (IgG4)-positive plasma cells and was referred to Rheumatology Department. A suspected vascular lesion was successfully managed with laser excision to minimize bleeding. One patient exhibited recurrence of a papillomatous lesion, prompting referral to infectious disease. No major complications occurred during the follow-up period. CONCLUSIONS:Localized GEs can present diverse HP profiles. Biopsy remains essential for definitive diagnosis, especially when clinical features are ambiguous. Laser surgery proved beneficial in vascular lesions by reducing intraoperative bleeding and enhancing patient comfort. Identifying and managing underlying systemic or local factors is crucial to prevent recurrence.
