Distribution patterns of the metastases of the lung carcinoma in relation to histological type of the primary tumor: An autopsy study.

INTRODUCTION: Lung cancer is among leading causes of death worldwide. Different histological types of the lung carcinoma show significant differences in behavior. OBJECTIVES: The aim of this study is to determine the distribution patterns of metastases of different lung cancer histological types in autopsied individuals. METHODS: Protocols from all autopsies performed at the Institute of Pathology from 2008 till 2014 were reviewed retrospectively, and information on individuals' age, sex, histological type of primary lung cancer, presence and location of metastases, and causes of death were recorded. RESULTS: More than 90% of the individuals with lung cancer metastases were older than 50 years (mean age: 64.5 ± 10.3), with two-fold male predominance. The most frequent histological type in both sexes was adenocarcinoma (48%). Although, in general, hematogenous metastases were mostly found in the liver and adrenal glands, various histological types of lung cancer show specific dissemination patterns. Metastases in adrenal glands derived mostly from adenocarcinoma and large-cell carcinoma. Metastases in the intestines most frequently originated from large-cell carcinoma (P = 0.01). Metastatic complications and bronchopneumonia were the most frequent causes of death. CONCLUSIONS: While, overall, the most frequent hematogenous metastases occur in the liver and adrenal glands, various histological types of lung cancer show specific dissemination patterns. Knowing distribution of metastases is essential for making algorithms of treatment, as well as for improving clinical assessment of the patients with unclear clinical findings and suspicion on occult primary lung cancer.

Clinically unrecognized miliary tuberculosis: an autopsy study.

BACKGROUND: Miliary tuberculosis (TB) usually presents with atypical clinical manifestations; thus it is often recognized only at autopsy. OBJECTIVES: Our objectives were to study the frequency of MT diagnosed at autopsy and determine clinical diagnoses that masked TB, as well as causes of death and comorbidities. DESIGN: Retrospective study of all autopsies performed between 2008 and 2014. SETTING: Institute of Pathology, Belgrade, Serbia. SUBJECTS AND METHODS: in subjects where autopsy showed the presence of MT that was not recognized clinically, we recorded the clinical diagnoses (presumed causes of death) as reported in autopsy request forms, as well as actual cause of death and comorbidities as determined at autopsy. MAIN OUTCOME MEASURES: Clinically unrecognized MT. RESULTS: The total number of autopsies in this period was 6206. thirty-five individuals showed clinically unrecognized MT (0.56% of all autopsies, age: 62.2 [17.2] years, M:F=2:3). Common clinical diagnoses masking pulmonary MT were exacerbation of COPD (25%) and pulmonary thromboembolism (25%), with common radiological presentation of diffuse pulmonary infiltrates (56.3%). Dominant clinical diagnoses in patients with generalized MT were adult respiratory distress syndrome, sepsis, gastrointestinal bleeding and meningoencephalitis. Disseminated MT was often associated with secondary anemia or thrombocytopenia (15.8%) and recent surgery (15.8%). Frequent comorbidities included chronic renal failure and malignancies, whereas MT was a dominant cause of death. CONCLUSION: Greater awareness of MT is needed to improve recognition in clinical settings. In particular, MT should be considered in patients with atypical clinical presentation and diffuse pulmonary infiltrates on chest X-ray, particularly if they have chronic renal failure, malignancy, hematological disorders or a history of recent surgery. LIMITATIONS: None.

Expression of neural cell adhesion molecule in renal cell carcinoma.

Neural cell adhesion molecule (NCAM) is important for cell migration and it could be expressed in some renal cell carcinoma (RCC). In recent decades, the incidence of RCC has been steadily rising by 2-4% each year. In this study NCAM expression and correlation with nuclear grade in different RCC were analyzed. We analyzed NCAM expression on 7 different RCC cell lines and 32 different RCC by immunohistochemistry, immunofluorescence, Western blot and FACS analysis. NCAM expression is detected in 6 cell lines and 16 RCC cases. NCAM-140 kDa isoform is expressed in different RCC and RCC cell lines. NCAM expression in non-invasive clear cell RCC is lower than in clear cell RCC with high nuclear grade. Expression of NCAM is not exclusive for specific RCC type, so NCAM can not be used as a specific diagnostic marker for RCC. NCAM expression is in correlation with nuclear grade in clear cell RCC, suggesting that NCAM expression is involved in aggressive behavior and metastatic potential in RCC.

[Reaction time in relation to duration of heroin abuse].

INTRODUCTION: Consequences of heroin abuse include organic damage of cerebral structures. The level of impairments is in a direct and positive relation with the length of heroin abuse. OBJECTIVE: The aim of this research was the evaluation of the reaction time with heroin addicts with different length of substance abuse. RESEARCH METHOD: 90 examinees were divided into three groups with relation to the length of heroin abuse. Data collection included a questionnaire referring to socio-demographic and addictive characteristics. A specially designed programme was used for the evaluation of reaction time to audio/ visual signal. RESULTS: In relation to the reaction time as overall model, the difference between examinees with different length of heroin abuse can be found on the marginal level of significance (F = 1.69; df = 12; p = 0.07). In visual modality, with the increase of length of heroin abuse leads to a significant prolongation of simple (the first visual sign: F = 3.29; df = 2; p = 0.04) and choice reaction time (the second visual sign: F = 4.97; df = 2; p = 0.00; the third visual sign: F = 3.08; df = 2; p = 0.05). Longer heroin consumption also leads to the prolongation of the simple (the first auditory task: F = 3.41; df = 2; p = 0.04) and the complex auditory reaction time (the second auditory task: F = 5.67; df = 2; p = 0.01; the third auditory task: F = 6.42; df = 2; p = 0.00). CONCLUSION: Heroin abuse leads to the prolongation of both simple and choice reaction time in visual as well as auditory modality. The average daily dose of opiates was the most important predictor of the abovementioned cognitive dysfunction.

The effect of heroin on verbal memory.

BACKGROUND: As a result of long-term heroin abuse we can see impairment of cerebral structures, that leads to specific psychopathological and neuro - physiological deficits in the cognitive and connative areas. There is a positive correlation between the mentioned deficits and the duration of heroin abuse. The memory is a cognitive function highly sensitive to toxic effects of opiates. The aim of this study was to establish the psychiatric and psychological consequences of heroin abuse, in the sense of verbal memory deficits, and the specific relation between mentioned deficits with the duration of abuse. SUBJECTS AND METHODS: The research was devised as a prospective study, including ninety heroin addicts, divided into three groups, based on the abuse duration. The following instruments were used for data collecting: questionnaire, with basic social-demographic and addictive characteristics of subjects and Rey Test of Verbal Learning, a neuropsychological test for verbal memory estimation. RESULTS: Only the examinees who have abused heroin for less than a year obtained scores within the domain of the expected performances within the part of the test which relates to the direct verbal memory, as well as, the part of the test that relates to delayed verbal memory. With regard to the mentioned criteria, the difference between examinees with different length of opiates abuse is statistically important (direct memory: F=2.706; p=0.063, delayed memory: F=2.538; p=0.045). With the increase of heroin abuse length the number of examinees with a rising learning curve is decreased significantly, and the number of examinees with a flat learning curve is increased (Chi-square=19.589; p=0.003). CONCLUSION: Heroin abuse, lasting longer than one year, is connected with impairment of short-term and delayed verbal memory. The intensity of the mentioned effects is higher with addicts who use a higher daily dose of heroin.

Primary non-hodgkin lymphoma of urinary bladder with nine years later renal involvement and absence of systemic lymphoma: a case report.

AIMS: Primary bladder non-Hodgkin lymphoma (PBNHL) is very rare, especially as extranodal B-small lymphocytic lymphoma (B-SLL). Also, late isolated renal manifestation of PBNHL is extremely unusual. We report a very rare type of extranodal B-SLL of bladder wall with extremely unusual late isolated renal involvement, clinically manifested by nephrotic syndrome and incipient renal failure. A CASE REPORT: A 56-year-old woman was presented with a solitary tumor of bladder wall, with history of dysuria and night sweating. A transvaginal needle biopsy of the tumor was performed, and diagnosis of primary extranodal B-SLL was made in the absence of bone marrow, lymph node, or blood involvement. She was treated with chemotherapy until the achievement of complete remission. Nine years later, she developed nephrotic syndrome. The renal biopsy revealed parenchymal lymphoma's involvement associated with glomerular lesion. Immunohistochemical analysis confirmed the same imunophenotype of lymphoma cells like in bladder wall nine years ago. Restaging procedure showed no evidence of disease elsewhere. CONCLUSION: To our knowledge, it is the first case of association of very rare primary bladder B-SLL with late isolated renal involvement.

[Expression of Fas and Fas-L in renal cell carcinoma].

INTRODUCTION: The previous investigations revealed that Fas-L expression on tumor cells can be one of the reasons of tumor growth, or tumor regression, with or without activation of the immune response. OBJECTIVE: The objective of our study was to investigate the expression of Fas and Fas-L in situ in normal human renal tissue as well as in different types of renal cell carcinoma (RCC) according to tumor grading. METHOD: Expression of Fas and Fas-L was examined in 25 RCCs classified according to nuclear grades: G1-G3 and to cell type: 17 clear cells, 3 chromophilics (2 eosinophilics, 1 basophilic), 2 chromophobes and 3 spindle cells. Ten normal human kidneys were analyzed, too. Indirect immunoperoxidase technique was applied. Spread and intensity of staining of Fas and Fas-L molecules expression were scored semiquantitatively. RESULTS: Distribution of Fas expression in these RCC was typically diffuse. However, Fas-L was almost completely absent in clear cell RCC. In 3 clear cell RCC, some tumor stromal cells exhibited strong expression of Fas-L. On the contrary, chromophilic, chromophobe and spindle cell RCCs grading from G2-G3, manifested variable combinations of Fas and Fas-L expression. CONCLUSION: The most of clear cell type low grade RCCs manifested intensive and extensive expression of Fas and completely absence of Fas-L. However, RCCs of high grade malignancy belonging to the clear cell, eosinophilic, chromophobe or spindle cell types can have various combinations of Fas and Fas-L expression. It may probably lead to development of different mechanisms of avoidance of immune response to RCC.