Cristina Jana Busuioc

Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a severe adverse event associated with antiresorptive therapy, particularly bisphosphonates, and represents a significant challenge in oral and maxillofacial practice. This study aimed to characterize the epidemiological profile, clinical presentation, and anatomical distribution of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and to investigate potential associations between demographic variables and major underlying systemic diseases. Methods: A retrospective single-center observational study was performed using medical records collected between January 2020 and December 2025 at the Emergency County Clinical Hospital of Craiova. After data validation and removal of duplicate records, 121 patients diagnosed with osteonecrosis of the jaw were identified. Among them, 94 patients fulfilled the inclusion criteria for BRONJ and were included in both the statistical and clinical analyses. Demographic characteristics, systemic diseases, bisphosphonate therapy, lesion localization, clinical manifestations, and statistical associations were evaluated using appropriate non-parametric and categorical statistical methods. Results: The final analytical sample comprised 94 patients with BRONJ associated with bisphosphonate therapy. Of these, 75 (79.8%) had received bisphosphonates for malignant disease and 19 (20.2%) for osteoporosis. The mandible was affected in 77% of patients, predominantly in the posterior premolar–molar region, whereas maxillary lesions mainly involved the posterior maxilla and maxillary tuberosity. Exposed necrotic bone was identified in all patients, while purulent discharge and oral fistulas were recorded in 37% and 35% of cases, respectively. Associations involving sex, age, residence, diabetes, hypertension, and other comorbidities were re-evaluated using the final 94-patient cohort. Conclusions: Among the BRONJ cases identified at this referral center, most patients had received bisphosphonate therapy for malignant disease, and lesions showed a marked predilection for the mandible, particularly its posterior region. These findings describe the clinical profile of the cases managed at our institution but do not permit estimation of BRONJ incidence or comparative risk between treatment regimens. The results support careful dental assessment before bisphosphonate therapy and multidisciplinary follow-up of patients receiving antiresorptive treatment.

Background/Objectives: Ectopic pregnancy (EP) remains a major cause of maternal morbidity. This study aimed to describe the clinical, ultrasonographic and histopathological features of EP, including changes following methotrexate (MTX) therapy. Methods: A retrospective analysis was conducted on 60 patients diagnosed with EP between 2018 and 2024. Clinical characteristics, serum β-hCG (beta-human chorionic gonadotropin) dynamics, treatment type, site-specific ultrasonographic features, and histopathological aspects were evaluated. Results: Extrauterine EPs accounted for 63.3% of cases, predominantly tubal ectopic pregnancy (T-EP), while uterine ectopic pregnancy represented 33.3%, including cesarean scar pregnancy (CSP) in 20%. Heterotopic pregnancy was identified in 3.3%. T-EP most frequently required surgical management, whereas MTX was effective in selected T-EP and CSP cases, as demonstrated by a ≥ 15% decline in serum β-hCG levels at 7 days. Transvaginal ultrasonography (TVUS) enabled accurate site-specific localization of ectopic implantation. Histopathological evaluation confirmed ectopic implantation and MTX-related changes in treated cases. Conclusions: Integrating clinical findings, β-hCG dynamics, and targeted TVUS allows accurate diagnosis and individualized management of EP, with histopathology providing definitive confirmation and insight into treatment-related changes.

Background/Objectives: Adenomyosis (A) is a benign but invasive uterine condition frequently associated with structural changes in the uterine wall that may contribute to infertility. Methods: This is a retrospective study involving 140 patients: 100 diagnosed with primary infertility (PI) or secondary infertility (SI) and 40 in the control group. All patients were assessed using transvaginal two-dimensional, three-dimensional, and hysterosalpingo-contrast sonography (HyCoSy), performed in the early proliferative phase. Evaluated parameters included uterine dimensions, endometrial thickness, and characteristics of the junctional zone (JZ). Criteria such as JZmax > 5 mm or JZmax − JZmin > 5 mm, alongside other findings, supported the diagnosis of adenomyosis. Results: Patients with PI showed larger uterine longitudinal diameters, while SI patients had thicker JZ measurements. PI patients were significantly younger. Histopathological examination confirmed the presence of endometrial glands and periglandular stroma disrupting myometrial architecture, forming chronic lesions potentially linked to infertility. Conclusions: HyCoSy revealed variable depths of myometrial invasion by A, with some cases extending near the serosa. The chronic lesions found in histopathological examination were potentially linked to infertility.

Pleomorphic adenoma (PA) is the most common benign tumour of the salivary glands, accounting for up to two-thirds of all salivary gland tumors. It most frequently occurs in the parotid gland and typically presents as a slow-growing, asymptomatic mass, predominantly affecting females between the third and sixth decades of life. Histologically, PA exhibits a mixed composition of epithelial, myoepithelial, and mesenchymal components embedded in a myxoid or chondroid stroma, with eosinophilic cytoplasm in polygonal myoepithelial cells. Although often well-circumscribed and localized in the superficial lobe of the parotid, PA can extend into deeper regions, including the parapharyngeal space, which complicates surgical management due to the proximity of critical neurovascular structures. This study aims to highlight the histopathological features of pleomorphic adenoma and correlate them with intraoperative findings. Advanced imaging techniques, particularly MRI, are crucial for accurate preoperative assessment, as delayed surgical intervention increases the risk of malignant transformation into carcinoma ex-pleomorphic adenoma, a more aggressive entity associated with recurrence and metastasis. In recent years, machine learning and deep learning models applied to MRI and ultrasound imaging have demonstrated significant potential in differentiating pleomorphic adenoma from other benign and malignant parotid tumours, improving diagnostic accuracy and supporting earlier clinical decision-making. Microscopic findings confirmed characteristic features of PA, including epithelial proliferation, myoepithelial components, haemorrhagic zones, eosinophilic stroma, and incomplete tumour capsules. Additionally, recent AI-assisted radiomic and convolutional neural network approaches have been shown to complement classical histopathology by extracting high-dimensional imaging features that enhance tumour subtype classification and prognostic assessment. When integrated with clinical and imaging data, these machine learning techniques offer promising avenues for reducing diagnostic uncertainty, optimising surgical planning—particularly in relation to facial nerve preservation—and contributing to more personalised management strategies in parotid gland pathology.

Obesity is a major, modifiable driver of endometrial carcinogenesis. This review distills how excess adiposity promotes malignant change and synthesizes prevention strategies across the hyperplasia–cancer continuum. Three converging axes underpin risk: aromatase-mediated estrogen excess; insulin resistance with hyperinsulinemia activating PI3K–AKT–mTOR signaling; and adipokine-driven low-grade inflammation with downstream NF-κB/STAT3 activity. Within this framework, EIN is the key precursor in which these pathways coalesce. Risk can be attenuated through progestin-based therapy (levonorgestrel-releasing intrauterine system or continuous oral regimens), structured weight management, and metabolic adjuncts in selected phenotypes (e.g., metformin for insulin resistance; incretin-based anti-obesity agents as emerging options). Bariatric surgery produces substantial weight loss and favorable metabolic shifts, though evidence for cancer risk reduction is largely observational. Overall, a practical precision-prevention approach—combining progestins with durable weight control and metabolic optimization under guideline-concordant surveillance—appears feasible in routine gynecologic care. Future research should establish causal effects, durability, and optimal sequencing/combination of interventions in trials with endometrial endpoints.

As in any other field, medicine is advancing and striving to adapt to increasingly complex demands, aiming to find rapid solutions in establishing certain diagnoses that can save or significantly improve the patient's quality of life. The integration of AI systems in the medical field is vital and requires openness, as well as a continuous desire for learning and improvement. Although the use of artificial intelligence in the medical field in Romania has not yet reached widespread development, there are still some AI software and applications that prove their effectiveness and ease the work of medical specialists. Oral cancer is one of the most common forms of malignant or premalignant lesions globally, with a high prevalence. Although developed countries are less affected compared to developing ones, they are also seeing an increasing incidence of cancers in the oro-maxillofacial region. The etiology of oral cancer is complex, influenced by both genetic and epigenetic factors. Currently, research is increasingly focused on epigenetic factors, including smoking, chronic alcoholism, diet, and improper use of mouthwash. These behaviours are associated with significant risks for the development of oral cancer, highlighting the importance of awareness and prevention within the global population. In Romania, factors such as low dental visit frequency, poor infrastructure, and lack of education contribute to disease prevalence. According to GLOBOCAN data, oral cancer in Romania ranks second in incidence, after leukemia, with a rate of 5.6 per 100,000 individuals. The purpose of our study is to highlight the importance of histopathological examination in establishing a definitive diagnosis, as well as the significance of AI software used in storing and processing the data obtained in the laboratory.

Oral papilloma lesions may appear as a result of HPV infection, or not, and only special molecular methods could differentiate them. Low-risk and high-risk HPV types could induce oral HPV papillomatosis with different natural evolution, clearance and persistence mechanisms. The pathogenic mechanisms are based on the crosstalk between the oral epithelial and immune cells and this very efficient virus. HPV acts as a direct inducer in the process of transforming a benign lesion into a malignant one, the cancerization process being also debated in this paper. According to the degree of malignity, three types of papillomatous lesions can be described in the oral cavity: benign lesions, potential malign disorders and malignant lesions. The precise molecular diagnostic is important to identify the presence of various virus types and also the virus products responsible for its oncogenicity. An accurate diagnostic of oral papilloma can be established through a good knowledge of etiological and epidemiological factors, clinical examination and laboratory tests. This review intends to update the pathogenic mechanisms driving the macroscopic and histological features of oral papillomatosis having HPV infection as the main etiological factor, focusing on its interreference in the local immunity. In the absence of an accurate molecular diagnostic and knowledge of local immunological conditions, the therapeutic strategy could be difficult to decide.