Frequency of tuberculosis at autopsies in a large hospital in Zagreb, Croatia: a 10-year retrospective study.

AIM: To assess the frequency and forms of pulmonary tuberculosis at autopsy in a high-traffic hospital in the capital city of a country with a low tuberculosis incidence. METHODS: We performed a retrospective search of autopsy data from the period 2000 to 2009 at Sestre Milosrdnice University Hospital Center, Zagreb, Croatia. We also examined patients' records and histological slides. RESULTS: Of 3479 autopsies, we identified 61 tuberculosis cases, corresponding to a frequency of 1.8%. Active tuberculosis was found in 33 cases (54%), 23 of which (70%) were male. Of the 33 active cases, 25 (76%) were clinically unrecognized and 19 (76%) of these were male. CONCLUSION: Clinically undiagnosed tuberculosis accounted for a substantial proportion of active tuberculosis cases diagnosed at autopsy. Autopsy data may be an important complement to epidemiological data on tuberculosis frequency.

The frequency and malignant transformation rate of oral lichen planus and leukoplakia--a retrospective study.

The aim of this retrospective study was to determine the frequency and malignant transformation rate of oral lichen planus and leukoplakia in a large group of oral medicine patients. Study included 12 508 patients who were referred between 1998 and 2007 to the Department of Oral Medicine. The frequency of OLP was 4.30%, leukoplakia 1.11%, and combined diagnoses 0.14%. In primary biopsies dysplasia was found in 12.96% of patients with leukoplakia and not in one with OLP and combined lesions. The highest frequency of leukoplakia was found in smokers. Women were found as predominant sufferers of both diseases and their combination. During the observed period often years malignant transformation of OLP was not detected, unlike leukoplakia where it was 0.64%. The frequency of OLP and leukoplakia in our study are comparable to other similar studies. The highest frequency of malignant transformation was observed in those patients who did not respond to our invitation to regular check-up. It is therefore neccessary to perform a detailed examination of the oral cavity in these patients and to raise patients awareness of the disease and the importance of regular follow-up.

CD138-positive plasmacytoid urothelial carcinoma of urinary bladder with focal micropapillary features.

Both the plasmacytoid and micropapillary types of urothelial carcinoma of the urinary bladder are uncommon, distinct clinical and pathological findings. To date, several reports in the English medical literature have been published on either of these variants. CD138 is commonly used as a marker for tumors of plasma cell origin. However, few authors have described positive immunoreactivity of plasmacytoid cells in urothelial carcinoma. Mixed histological differentiation is thought to be a phenotype of locally aggressive and advanced urothelial carcinoma. Therefore, a precise histopathological diagnosis should be made and awareness of all the entities is crucial. We report a case of CD138-positive plasmacytoid urothelial carcinoma of the bladder with focal micropapillary features. To our knowledge this is the first case of these two rare subtypes of urothelial carcinoma combined in a single cystectomy specimen.

Synchronous anorectal melanoma.

Anorectal melanoma is a very rare tumor with poor prognosis. Rectal bleeding is the most frequent symptom and surgical treatment ranges from local excision to radical abdominoperineal resection. We report a case of a 75-years-old male patient who presented with a history of recurrent rectal bleeding, and whose histopathological diagnosis was melanoma. Macroscopically, we found two distinct tumors in anorectal region, 0.5 cm and 1.5 cm from dentate line. The first one was pedunculated, on a thin stalk, measuring 1 cm in greatest diameter, and the second one was sessile and nodular measuring up to 2.8 cm in largest diameter. Microscopic examination and immunohistochemical analysis of both tumors confirmed the diagnosis of melanoma. This case represents multiple synchronous primary melanoma of the anorectal region, with a possibility that one of the lesions is primary melanoma and the second one is a satellite lesion.

CX43 Expression in Colonic Adenomas and Surrounding Mucosa Is a Marker of Malignant Potential.

BACKGROUND/AIM: Colorectal cancer is a major public health problem. The adenoma-carcinoma sequence offers potential for screening and surveillance. We tested the clinical behavior and diagnostic utility of connexin 43 (CX43) in connection with pathohistological risk. PATIENTS AND METHODS: Immunohistochemical expression of CX43 in colonic adenomas and surrounding mucosa from 87 patients was determined. RESULTS: CX43 expression was higher in mucosa surrounding adenomas with high-grade dysplasia (p=0.047), larger adenomas (p=0.015) and villous adenomas (p=0.02). No difference of CX43 expression in adenomas according to grade of dysplasia was found (p=0.87). CX43 expression in adenomas was dependent on the patient's hemoglobin level (p=0.002), family history of colorectal cancer (p=0.009) and statin therapy (p=0.049). CONCLUSION: CX43 expression in mucosa surrounding adenoma could be an additional factor indicative of malignant potential. CX43 expression in colonic adenoma seems to be closely related to family history of colorectal cancer, statin therapy and hemoglobin level.

Correlation of periacinar retraction clefting in needle core biopsies and corresponding prostatectomy specimens of patients with prostatic adenocarcinoma.

One of the underemphasized supportive criteria for the diagnosis of prostatic cancer is the presence of retraction clefting around neoplastic glands. We analyzed a series of 152 prostatic cancer cases to determine the frequency, extent, and correlation of periacinar retraction clefting between needle core biopsies (NCB) and corresponding matched radical prostatectomy (RP) specimens. Clefting was significantly more frequent in neoplastic compared to nonneoplastic acini in NBC and RP (p<0.05). There was no significant difference in the frequency of retraction clefting in neoplastic acini between NCB and corresponding RP (p>0.05). We have also found a concordance in matched RP and NCB (Kappa=0.582). We conclude that periacinar retraction clefting appears more frequently in neoplastic acini and could serve as a reliable criterion in the diagnosis of prostatic adenocarcinoma.

[The correlation of inflammation and epithelial changes in the Pap smears of cervix uteri]. / Povezanost upale i promjena epitela na uzorku citoloskih razmaza vrata maternice.

UNLABELLED: A modification of The Bethesda System classification of cytologic findings of uterine cervix named Zagreb 1990 has been accepted in Croatia as a unique classification, the use of which has begun after the publication and printing of the new, uniform method of cytologic examination. AIM: The aim of this study was to assess the number and type of cytologic abnormalities of uterine cervix classified according to Zagreb 1990, on routinely examined Pap smears during the 6-year period, and to investigate the connection of these abnormalities with lower genital tract infections. MATERIAL AND METHODS: The retrospective study included Pap smears from the City of Zagreb and from the town of Imotski. A total of 59901 Pap smears (patients aged 17-79) were routinely examined: the cytopathologic diagnosis of CIN I or higher recorded in 3664 (6.12%) of them. The control group consisted of 401 Pap smears of age-matched women referred by the same gynecologists and free from cytologic abnormalities. The most frequently diagnosed epithelial change was CIN 1 (84.57% of all epithelial changes, and 5.17% of total study population), followed by CIN II (10.92%; 0.67%), CIN III (3.11%; 0.19%), and invasive squamous carcinoma (1.31%; 0.08%). Endocervical adenocarcinoma was cytologically diagnosed in only 0.0055% of all Pap smears examined. Inflammation was significantly more common in the group with epithelial dysplasia/carcinoma than in the control group (p < 0.01). Of specific causative agents HPV and Chlamydia trachomatis were significantly more frequently found in the group with epithelial dysplasia/carcinoma than in the control group (p < 0.05 both), however, Gardnerella vaginalis, Trichomonas vaginalis or Candida yielded no significant differences. It is concluded that inflammation very likely contributes to the development of precancerous lesions of the cervix, HPV and Chlamydia showing strongest correlation, at least in a part of our population.

Primary oral malignant melanoma: case report.

Primary oral malignant melanoma usually presents as a dark brown or black lesion. It is a rare malignancy, accounting for less than 1% of all melanomas and 1.6% of all head and neck malignancies, thus forming up to 0.5% of all oral malignancies in the world literature. In general, the prognosis of oral melanoma is poor and worse than that of cutaneous melanoma. The preferred treatment is radical surgery alone or in combination with radiotherapy, chemotherapy, immunotherapy and immunomodulatory agents. A case is presented of a large malignant melanoma of oral cavity, noticed six months before initial biopsy and by history described as a rapidly growing mass.

A case of signet-ring cell carcinoma of the gallbladder: immunohistochemistry and differential diagnosis.

The morphological spectrum of gallbladder carcinoma is broad and variable. Most of these tumors are tubular adenocarcinomas. There are some tumors with unusual morphology that may be difficult to classify due to their rarity. One of such tumors is the signet-ring cell carcinoma, which is a highly aggressive, mucin producing variant of gallbladder adenocarcinoma predominantly or exclusively composed of signet-ring cells. Histologically, these tumors are similar to their counterparts in other organs such as stomach, colon and breast, and should not be misinterpreted as metastatic carcinoma from one of these primary sites. The literature about this variant of carcinoma is sparse and little is known about it. We found only three cases of signet-ring cell carcinoma of the gallbladder previously reported. We present the case of an 86-year-old woman with signet-ring cell carcinoma of the gallbladder and discuss the potential diagnostic dilemmas

Identification and analysis of human remains recovered from wells from the 1991 War in Croatia.

From 1996 to the present, the remains of 61 individuals killed during the 1991 War in Croatia were recovered from both dried out and functioning wells. Positive identification was established in 60.7% or 37/61 cases. Remains recovered from the same geographical region but from non-well settings were identified in 77.4% or 1256/1623 cases. The purpose of this paper is to report on the taphonomic, demographic and trauma characteristics of remains recovered from wells and identify factors responsible for the discrepancy in the identification ratios. The age and sex distributions in the well and non-well series were similar, as were the frequencies of recovered personal documents, jewelry and other artifacts. The taphonomic features of the remains were, however, significantly different. Preservation of remains was considerably better in non-well settings (1400/1623 or 86.3% compared to 40/61 or 65.5% in wells). Congruently, commingling of remains was more frequent in wells (26/61 or 42.6% compared to 77/1623 or 4.7% in non-well settings). In bodies recovered from non-well settings the preservation, state and commingling of the remains were strongly correlated with positive identification. None of these features were correlated with the identification of bodies from wells. Instead, identification of remains from wells was significantly affected by the presence or absence of water in the well. As both series have similar frequencies, and identical rankings of identification factors, the reason for the discrepancy in the identification ratios lies in the fact that by themselves, these factors were rarely sufficient for positive identification. In both series the majority of identifications (51.4% in the well, and 58.1% in the non-well series) were established through a combination of biological and non-biological features. The significantly lower identification ratio in the well series resulted from the difficult recovery conditions in wells with significant amounts of water, and the negative effect that water had on the preservation of clothing, personal artifacts and some dental features. Significant differences were also noted in the types and locations of perimortem traumas. There is a significantly higher frequency of entrance gunshot wounds to the back of the head, suggestive of execution style murders, in the well series.