Pathological tumor volume as a simple quantitative predictive factor of survival in oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is the eighth most common type of cancer in the world. Knowledge of prognostic factors of survival in OSCC is key. Several clinical and pathological prognostic factors have been investigated to develop a prognostic model of survival for patients with oral cancer. The present study focused on the association between pathological tumor volume (PTV) and overall survival time in patients with OSCC, regardless of cervical nodal status. The present study was a prospective study and covered 65 consecutive patients who received surgical treatment for oral cancer. The PTV was calculated according to dimensions of the postoperative specimen. Other pathological parameters as perineural and perivascular tumor spreading and extra-nodular propagation were also determined. The data were analyzed using the IBM SPSS 25.0 software. Cox PH regression model was built to analyze association between the PTV and survival time. Survival time was defined as the period from surgery to a target event or last contact. The results of the present study showed that PTV >4.24 cm3 was significantly associated with shorter overall survival time in patients with OSCC. The PTV value was higher in patients with metastasis and in patients with higher pathological tumor and node stage. In conclusion, PTV was an important pathological prognostic factor for survival in patients with OSCC.

Predictive factors for survival and treatment outcomes of patients with minor salivary gland malignancies: a retrospective study.

INTRODUCTION: Aim of this study was to explore the incidence, pathology, clinical behaviour and evaluate factors predictive on survival and treatment outcomes in a cohort of patients with minor salivary gland (MiSG) malignancies treated at a single center over a period of 25 years. MATERIALS AND METHODS: Patients who had received primary treatment for MiSG malignancy during 25 years observation period were identified. Outcomes that were evaluated were overall survival (OS), disease specific survival (DSS), recurrence free survival (RFS), locoregional recurrence free survival (LRFS) and distant metastasis free survival (DFS). RESULTS: A total of 88 patients with MSG malignancies were included in the study. The most common location for MiSG malignancies was the oral cavity (65 tumors; 77%). Cumulative OS for 5 and 10 year follow up period was 82% and 62% respectively. Cumulative DSS for 5 and 10 year follow up period was 85% and 73% respectively. Twenty one (23%) patients developed distant metastases during follow-up. High-grade pathology and tumor stage were significant variables on multivariate analysis for all survival and treatment outcomes. CONCLUSIONS: Minor salivary gland malignancies are minor only by name. Tumor histological grade, AJCC tumor stage and pT stage were the strongest predictive factors for survival and treatment outcomes. The elective neck dissection could be considered therapeutic approach for selected cases of high grade MiSG malignancies. Distant metastases were the main cause of death and treatment failure.

Primary Intraparenchymal Meningiomas: A Case Report and a Systematic Review.

BACKGROUND: Primary intraparenchymal meningiomas are exceedingly rare and often challenging to diagnose, given their misleading radiologic features. It is hypothesized that they arise from the cap cells of the pia mater that enter the brain via penetrating blood vessels during brain development. We systematically reviewed and analyzed previously reported features of primary intraparenchymal meningiomas in terms of radiography, presenting symptoms, and histopathology. METHODS: A literature search of the Web of Science and PubMed databases and crossed references was performed in March 2021, per PRISMA guidelines, with no restrictions regarding publication date. Data regarding demographic features, clinical, radiographic, and histopathologic characteristics were extracted. RESULTS: A total of 52 patients (including the reported case) were included in this review. The mean age was 21.1 years (range, 0.3-66 years) with a male/female ratio of 1.9:1. The most common localizations of intraparenchymal meningiomas were in the frontal (30.8%) and temporal (21.2%) lobes. Cyst formation was more readily observed and was noted in 51.4% of patients. Histopathology showed a higher incidence of World Health Organization grade II (14/52, 26.9%) and World Health Organization grade III (7/52, 13.5%) of primary intraparenchymal meningiomas. CONCLUSIONS: We present a comprehensive analysis of every reported primary intraparenchymal meningioma. Because of their rarity and capacity to mimic other more common intra-axial tumors, they represent a diagnostic challenge. This systematic review highlights the importance of paying attention to atypical intra-axial lesions, with a particular reflection on the discrepancy between clinical characteristics and imaging features.

Mediastinal Cartilaginous Hamartoma.

Pulmonary hamartomas are usually solitary, nodular benign lesions in the parenchyma of the lung. They are rarely situated in endobronchial areas, and very few cases are reported with the mediastinum.  A 56-year-old female patient got a CT-scan conducted due to coughing and breathlessness and was diagnosed with a nodular lesion in the medial mediastinum. The lesion was operated: it measured up to 4 cm in the largest diameter, had a smooth surface, was of rather soft but elastic consistency, and was extirpated. At pathology, on cut section, it was yellowish and lobular, and with a mixture of cartilaginous, fibrous and adipose tissues with some smooth muscle cell fibers and myxoid areas. The diagnosis of pulmonary hamartoma was made with atypical medial mediastinal localization. This rare presentation could pose some differential diagnostic problems in the clinical diagnosis of more frequent primary and metastatic malignant diseases.

Tumour-to-tumour Metastasis: Cutaneous Melanoma Metastasizing to Leiomyoma Uteri.

The incidence of melanoma is increasing worldwide. It is known that melanoma frequently progresses to metastatic disease. The aim of this report is to emphasise the metastatic potential of cutaneous melanoma to various body areas, as well as the ability to produce unexpected presentation of the disease. A 48-year female had a myomatous uterus and underwent hysterectomy. At the pathological examination, multiple leiomyomas were diagnosed and in one of them, the metastatic melanoma was found, the later confirmed with immunohistochemical analysis. The medical history revealed that the patient was previously operated two years back due to skin superficial spreading melanoma. The metastasis to uterine leiomyoma was the first site of distant spread. Melanoma is a type of tumour with aggressive and unpredictable behaviour, so metastases to unexpected localisations could occur. A careful examination of patient's body is mandatory, including the remote areas and even benign tumours.

Solitary Fibrous Tumor of the Dorsal Tongue Area.

Solitary fibrous tumor (SFT) is a rare tumor occurring in pleura or extrapleural areas. The tongue is infrequently affected, in less than 25 published cases. A female patient, 35 years of age, noticed an oval mass in the posterior dorsal part of the tongue. The operated mass was nodule, 10 mm in size, sharply circumscribed, rather firm. The histology shows uniform CD34 positive spindle tumor cells. The diagnosis of benign SFT of the tongue was made.

Nocardial brain abscess mimicking lung cancer metastasis in immunocompetent patient with pulmonary nocardiasis: a case report.

Nocardia is a ubiquitous microorganism which can be the cause of local and disseminated infection in humans. Immunocompetent and immunocompromised patients both can be affected and Nocardia cyriacigeorgica was reported as a pathogen isolated in patients worldwide. In most cases, nocardiosis is present as pulmonary infection because inhalation is the primary way of bacterial exposure. Nocardial brain abscess occurs usually secondary to a septic focus elsewhere in the body. Considering the facts that the elderly population is growing, such as the number of immunocompromised patients together with high mortality rate in patients with nocardial infection of the central nervous system, we have to raise awareness of the possibility for this rare but potentially fatal condition. We present a case where nocardial abscesses of lung and brain were initially suspected as lung cancer with brain metastases. The patient was treated with a combination of surgical resection and antimicrobial therapy with good outcome.

The VEGF gene polymorphism in glioblastoma may be a new prognostic marker of overall survival.

PURPOSE: Glioblastoma (GBM) is the most aggressive primary brain tumor. Vascular endothelial growth factor (VEGF) gene polymorphisms and overexpression are involved in high-grade malignant gliomas. The aim of this study was to assess the distribution of +405C>G VEGF gene polymorphism in patients diagnosed by glioblastoma and to test its association with the overall survival (OS). METHODS: Patients diagnosed for glioblastoma were randomly selected, and follow-up was conducted for a minimum of 36 months. Tissue paraffin embedded GBM samples were subjected for the VEGF polymorphism detection. The associations of the observed genotypes and clinical data were evaluated. RESULTS: The most frequent single nucleotide polymorphism (SNP) variant was G (72.58%). The GG genotype was proved to have statistically significant longer OS and patient status (alive/dead) compared to CC and CG genotypes (p=0.022 and 0.005, respectively). CONCLUSION: Our results indicate that +405C>G VEGF gene polymorphism may be used as prognostic genetic marker of OS in GBM patients.

VARIATIONS IN TIMING OF ELECTIVE ORCHIDOPEXY.

INTRODUCTION: Undescended testis or cryptorchidism is detected in 3% of full-term male newborns, and inup to 33% of preemies. As the testicular descent may sometimes resolve spontaneously during first months of life, cryptorchidism is found in 1% of boys one year old. According to Consensus of Nordic experts in. pediatric urology regarding cryptorchidism the optimal period for surgery is 12-18 months of age. The goal of this study was to identify the age of patients with congenital undescended testis at the time of surgery. MATERIAL AND METHODS: A retrospective study included all the cases of cryptorchid patients who had undergone orchidopexy in the period from 2007 to 2014. The patients'. age and the place of residence were analyzed. RESULTS: A total of 637 patients (722 orchidopexies) underwent the elective operative treatment of undescended testis during the observed period. The analysis revealed that only 144 (22.60%) of cryptorchid infants were operated on within their first 18 months of life. In the group of 359 patients from* the urban environment, 101 (28.13%) were operated under the age of 18 months. Among the 278 patients from the rural enviornment, 43 (15.46%) were 18 months and younger at the time of surgery. CONCLUSION: The timing of surgical treatment of undescended testis in the study period was far from the recommended optimal time. It is evidently necessary to plan and provide additional information for pediatricians and parents about the current view on cryptorchidism and consequences of the late treatment.

Fungal infections in corn picker hand injury.

INTRODUCTION: Hand injuries caused by corn pickers are relatively rare but in most cases extensive, with massive tissue destruction. Severe wounds sustained during agricultural work are contaminated, with high incidence of infection. OBJECTIVE: The aim of the study was to determine the frequency and type of fungal infection in corn picker injuries and their impact on the course and outcome of treatment. METHODS: Corn picker hand injuries for the period 2006-2012 were analyzed. After setting up clinical suspicion, direct examination of repeated swabs and histopathological analysis of biopsy material were done in order to detect fungi. RESULTS: From the total number of 60 patients, there was a fungal infection in nine of them (which makes 15% of the total number of patients). Aspergillus spp. was isolated in seven patients, Candida spp. in three, and Mucor spp. in one patient. None of the patients had increased risk factors for developing a fungal infection. In most cases, there was loss of graft and tissue necrosis in previously normally look- ing wound, after seven or more days. All patients were treated with repeated surgical debridement and concomitant parenteral and topical application of appropriate antifungal agents. There was no need for reamputation in any patient. CONCLUSION: A high degree of suspicion and a multidisciplinary approach are needed for early diagnosis of fungal infection. Confirmation of diagnosis and the initiation of surgical and appropriate antifungal therapy are essential for a successful outcome.

Neonatal multiple blood cysts of heart valves.

The female neonate, 27 days, 53 cm, 3450 g, was found dead in early morning hours. Baby was healthy, well nourished, and not neglected, up to the day before when she started to cough and scheduled for next-day regular pediatrician visit. Due to unexpected death, the autopsy was performed. Multiple oval, blood cysts, up to 0.5 cm, were found on the free valvular margins of the mitral valve, tricuspid valve, and aortic valve. The blood cysts were unilocular, filled with blood, and lined with flattened endothelial cells. The surrounding stroma was slightly edematous but without myxoid changes.

Pituitary Abscess with Unusual Clinical Course

The aim is to present unusual clinical course and magnetic resonance imaging (MRI) features of pituitary abscess. A 59-year-old man presented with fever, polyuria, polydipsia and marked weight loss within the last two months. Basic endocrinology tests revealed the presence of anterior pituitary dysfunction, associated with central diabetes insipidus and increased levels of inflammatory markers. The presence of expansile sellar lesion, showing restricted diffusion signal pattern compatible with acute pituitary pyogenic abscess was found on MRI. Regression of pituitary abscess was obvious during the next few weeks of parenteral antibiotic treatment. Adequate substitution treatment with L thyroxine, hydrocortisone, testosterone and desmopressin was achieved. Seventeen months later, clinical deterioration associated with recurrent pituitary abscess was confirmed on MRI. Abscess regression was obvious again after conservative treatment. However, control MRI study performed three years after initial scanning revealed the presence of pituitary tumor, most consistent with macroadenoma. Surgical intervention was ordered. Histologic evaluation indicated the presence of fibrotic changes, associated with granulation tissue and rare cellular elements, compatible with chronic inflammation. To the best of our knowledge, there are no studies in the literature describing such a pattern of chronic evolution of pyogenic pituitary abscess with consequent chronic inflammatory changes with granulation tissue proliferation, mimicking macroadenoma.

The expression and localization of estrogen receptor beta in hyperplastic and neoplastic prostate lesions.

BACKGROUND/AIM: Benign acini in benign prostatic hyperplasia (BPH) are lined with pseudostratified cylindrical epithelium with a continuous basal cell layer. Adenocarcinoma of the prostate is the most common cancer in men. High gradus-prostatic intraepithelial neoplasia (HGPIN) lesions precede invasive cancer. Prostate adenocarcinoma (PCa) implies a complete absence of basal cells and stromal invasion by malignant acini. Estrogen receptor (ER) is located in nuclei of acinar basal and secretory cells and partially in stromal cells. The aim of this research was to demonstrate and localize ER in BPH and in PCa of different Gleason scores. Considering literature data for ER-beta. expression in different morphologic prostate lesions, it is assumed that there is expression of ER-beta in most moderately differentiated PCa, and that the observed receptor expression is lost with increasing of the Gleason score. METHODS: Four groups of patients were formed: the control with BPH and three experimental groups with PCa of different grades and scores, according to the Gleason grading system. The patients were male of various ages suspected of PCa, based on clinical and laboratory parameters. The study was conducted in a period 2010-2012. None of the patients received prior hormonal therapy. Sextant byopsies with BPH and PCa were treated for ER-beta (Novacastra). Localization and intensity of ER-beta expression is reported through the score: 0 = zero; 1 = < 1%; 2 = 1-10%; 3=11-33%; 4= 34-66%; 5- > 66%. Positive fibroblasts and endothelial cells are used for comparison. RESULTS: ER-beta expression in acinar epithelial cells was the weakest in well-differentiated adenocarcinoma. A decline of ER-beta expression was noticed in malignant lesions of the prostate vs. benign ones. Less differentiated adenocarcinomas showed a decrease of ER-beta expression in basal and in the secretory cells. ER-beta expression in basal cells was stronger than in secretory ones in BPH and well-differentiated adenocarcinoma. CONCLUSION: ER-beta expression was most pronounced in BHP samples and declined in malignant prostate lesions. This finding supports statement on anticiproliferative role of ER-beta in prostatic tissue.

CHRONICLE OF THE "ANGLO-YUGOSLAV CHILDREN'S HOSPITAL" IN SREMSKA KAMENICA.

As a peacetime work of Katherine S. Macphail (Glasgow, 1887- St.Andrews, 1974) MB ChB (Bachelor of Medicine and Surgery), the Anglo-Serbian Children's Hospital in Belgrade was established after World War I, and the English-Yugoslav Children's Hospital for Treatment of Osteoarticular Tuberculosis was founded in Sremska Kamenica in 1934. Situated on the Fruska Gora slope, the hospital-sanatorium was a well-equipped medical institution with an operating theatre and x-ray machine providing very advanced therapy, comparable to those in Switzerland and England: aero and heliotherapy, good quality nourishment, etc. In addition, school lessons were organized as well as several types of handwork as the work-therapy. It was a privately owned hospital but almost all the children were treated free of cost. The age for admission was up to 14. During the period from 1934 to 1937, around 458 children underwent hospital treatment, most of them with successful results. During the war years the Sanatorium was closed but after the war it was reactivated. In 1948 by the act of final nationalization of all medical institutions in the communist Yugoslavia, the hospital was transformed into a ward of orthopedic surgery under the supervision of the referent departments in Belgrade and Novi Sad. Today, hospital is out of work and deprived of its humanitarian mission. The building is neglected and in ruins although it has been proclaimed the national treasure by the Regional Institute for Protection of Monuments of Culture.

Congenital Cervical Bronchogenic Cyst: A Case Report.

INTRODUCTION: Bronchogenic cysts are rare congenital anomalies of the embryonic foregut. They are caused by abnormal budding of diverticulum of the embryonic foregut between the 26th and 40th day of gestation. Bronchogenic cysts can appear in the mediastinum and pulmonary parenchyma, or at ectopic sites (neck, subcutaneous tissue or abdomen). So far, 70 cases of cervical localization of bronchogenic cysts have been reported. Majority of bronchogenic cysts have been diagnosed in the pediatric population. Bronchogenic cysts of the cervical area are generally asymptomatic and symptoms may occur if cysts become large or in case of infection of the cyst. The diagnosis is made based on clinical findings, radiological examination, but histopathologic findings are essential for establishing the final diagnosis. Treatment of cervical bronchogenic cyst involves surgical excision. CASE OUTLINE: Authors present a case of a 6-year-old female patient sent by a pediatrician to a maxillofacial surgeon due to asymptomatic lump on the left side of the neck. The patient had frequent respiratory infections and respiratory obstructions. Magnetic resonance imaging (MRI) of the neck was performed and a well-circumscribed cystic formation on the left side of the neck was observed, with paratracheal location. The complete excision of the cyst was made transcervically. Histopathological findings pointed to bronchogenic cyst. CONCLUSION: Cervical bronchogenic cysts are rare congenital malformations. Considering the location, clinical findings and the radiological features, these cysts resemble other cervical lesions. Surgical treatment is important because it is both therapeutic and diagnostic. Reliable diagnosis of bronchogenic cysts is based on histopathological examination.

Urinary kidney injury molecule-1 rapid test predicts acute kidney injury in extremely low-birth-weight neonates.

BACKGROUND: The new urinary and serum biomarkers are discovered and are being investigated. With them we can diagnose acute kidney injury (AKI) faster and more precisely and they also have a significant role in the outcome prediction. METHODS: The study included 22 extremely low-birth-weight neonates who were hospitalized in the neonatal intensive care units. They were divided into two groups based on serum creatinine (SCr) level-with and without AKI. Detection and quantification of urinary kidney injury molecule-1 (uKIM-1) was done on the third day of life, using commercially available KIM-1 rapid test. Subsequently, measurements were repeated only in subjects who were diagnosed with AKI, at different values of SCr. RESULTS: Logistic regression analysis showed that AKI is an independent risk factor for mortality. In a group of neonates with AKI, 50% of neonates administered the KIM-1 rapid test showed positive findings. KIM-1 rapid test was positive in patients with a wide range of SCr levels (range of 78.73-385 µmol/l), but all subjects had oliguria and died in the next 24 h. CONCLUSION: KIM-1 is a significant predictor of death. On the other hand, our study failed to prove that KIM-1 rapid test has any significance for early prediction of AKI.

Unusual growth of upper lip squamous cell carcinoma: a case report.

INTRODUCTION: Squamous cell carcinoma is the most common type of lip and oral cavity cancers. In majority of cases it follows quite common course, and after the surgery it does not produce any harm. This case presents unusual and unexpected growth of upper lip squamous cell carcinoma with severe cosmetic problems, and possible health threats. CASE PRESENTATION: A 46-year-old woman noticed on her upper lip "a spot, the size of a wheat grain", which grew rapidly and reached the size of 0.6 cm during a two-week period. The lesion was red, hard and painful, attached to the skin. It was surgically removed, and primary histopathological finding was follicular keratosis. Recurrent tumor appeared seven days after the operation, with the extreme swelling of the upper lip. The patient was sent to a tertiary hospital, where fungal or bacterial infection was excluded. The change on the patient's upper lip reached the size of 5 × 2 cm, as soft, reddish nodular tumor. Squamous cell carcinoma was diagnosed after the histopathological audit. With the second surgical intervention the tumor was removed and the defect reconstructed. CONCLUSIONS: Prognosis of this type of tumor, apart from its size and differentiation level, depends on infiltration in tumor-surrounding tissue, perineural and perivascular spread. Therefore, it is always necessary to analyze the removed skin especially on margins.

Mixed fungal infection (Aspergillus, mucor, and Candida) of severe hand injury.

Severe hand injuries are almost always heavily contaminated and hence wound infections in those patients are frequent. Fungal wound infections are rare in immunocompetent patients. A case of mixed fungal infection (Aspergillus, Mucor, and Candida) was documented in a young male patient, with a severe hand injury caused by a corn picker. The diagnosis of fungal infection was confirmed microbiologically and histopathologically. The treatment was conducted with repeated surgical necrectomy and administration of antifungal drugs according to the antimycogram. After ten weeks the patient was successfully cured. The aggressive nature of Mucor and Aspergillus skin infection was described. A high degree of suspicion and a multidisciplinary approach are necessary for an early diagnosis and the initiation of the adequate treatment. Early detection, surgical intervention, and appropriate antifungal therapy are essential in the treatment of this rare infection that could potentially lead to loss of limbs or even death.