Dolichoectasia of Vertebrobasilar Arteries as a Cause of Hydrocephalus and Ischemic Cerebral Stroke.

INTRODUCTION: Dolichoectasia of vertebrobasilar artery is a rare vasculopathy, which is characterized by ectasia, elongation, and tortuosity of the basilar artery. CASE DESCRIPTION: A 85-year-old man was referred to the Clinic of Neurology with sudden-onset coma. A brain computed tomography scan showed remarkable fusiform dilatation with elongation of basilar artery, with compressive effect on brain stem. Autopsy confirmed existence of vertebrobasilar dolichoectasia, with organized old thrombus and partially with recent occlusive thrombosis. The histology and immunohistochemical staining were showing a loss of the elastic tissue with significant fibrosis in the tunica media and small groups of foam macrophages and cholesterol crystals in atherosclerotic plaque. CONCLUSIONS: We presented a case of dolichoectasia of vertebrobasilar artery with an obstructive hydrocephalus, due to direct compression on pons and midbrain, which is an extremely rare entity. This case had been analyzed during the patient's life through clinical, laboratory, and radiology examinations and after he died through autopsy.

The importance of Myd88 L265P mutation, clinical and immunohistochemical prognostic factors for the survival of patients with diffuse large B-cell non-Hodgkin lymphoma treated by immunochemotherapy in southeast Serbia.

PURPOSE: Immunochemotherapy used in the treatment of non-Hodgkin diffuse large B-cell lymphoma (DLBCL) modifies the course of disease and has a positive effect on overall survival (OS). The purpose of this study was to verify the existence of the important Myd 88 mutation and other immunohistochemical factors on disease prognosis in patients with DLBCL in southeast Serbia. METHODS: Immunohistochemical expression of CD10, Bcl- 2, Bcl-6, Ki-67 and MUM 1 was performed using paraffin blocks of DLBCL. Molecular-genetic study of MyD88 L265P gene polymorphism was done by isolation of genomic DNA from paraffin embedded tissue by means of polymerase chain reaction (PCR). RESULTS: Immunochemotherapy (rituximab+CHOP/R-CHOP) significantly improved the overall survival (OS) of patients with DLBCL compared with patients treated with CHOP alone (p<0.0001). OS in the R-CHOP group was longest in patients with International Prognostic Index (IPI) 2 score (p=0.012) and IPI 4 score (p=0.024). Patients with Bcl-2 +, and MUM 1+ benefited from R-CHOP and their expression had no effect on OS. Analysis of restriction fragment length on the genomic DNA showed a homozygous normal TT genotype. CONCLUSION: Addition of rituximab to CHOP standard protocol improved the OS rate in patients with DLBCL and altered the character and significance of previously recognized prognostic factors. IPI score in the immunochemotherapy era could not reveal possible predictive factors of poor prognosis which would help identify a high-risk subgroup of newly diagnosed DLBCL. In the patient population from Southeast Serbia pathological signaling pathway achieved by Myd 88 L265 mutation was not responsible for the development of DLBCL.

Experimental closure of gunshot wounds by fibrin glue with antibiotics in pigs.

BACKGROUND/AIM: Gunshot wounds caused by the automatic rifle M70AB2 (AK-47) 7.62 mm, after the primary surgical management, were closed with delayed primary suture during the next four to seven days. This period coincides with the fibroblastic phase of wound healing. Fibrin glue is used as a local hemostatic and as a matrix for the local dosed release of antibiotics. Antibiotics addition to fibrin glue resulted in continuous diffusion into the surrounding next 4 to 7 days. The aim of this study was to create the preconditions for gunshot wounds closing without complications by the application of fibrin glue with antibiotics 24 h after primary surgical treatment. METHODS: A total of 14 pigs were wounded in the gluteofemoral region by the bullet M67, initial velocity of 720 m/s. All wounded animals were surgically treated according to the principles of the war-surgery doctrine. Seven wounds were closed with primary delayed suture four days after the primary surgical treatment (traditional approach). Fibrin glue with antibiotics was introduced in seven wounds during the primary surgical treatment and primary delayed suture was done after 24 h. The macroscopic appearance and the clinical assessment of the wound were done during the primary surgical treatment and during its revision after 24 h, as well as histopathological findings at the days 4 and 7 after wounding. RESULTS: Gunshot wounds caused by the automatic rifle M70AB2 (AK-47) 7.62 mm, and treated with fibrin glue with antibiotics after primary surgical management, were closed with primary delayed suture after 24 h. In further wound evolution there were no complications. CONCLUSION: Uncomplicated soft-tissue wounds caused by an automatic M70AB2 rifle may be closed primarily with delayed suture without the risk of developing complications if on revision, 24 h after primary surgery, there were no present necrotic tissues, hematoma, and any signs of infection when fibrin glue with antibiotics (ceftriaxone and clindamycin) was applied. The use of this method should be limited to individual and strictly controlled cases in civil practice for now.

First evidence of Brucella ovis infection in rams in the Pirot Municipality, Serbia.

This paper describes a research on Brucella ovis infection in rams in the Pirot Municipality of South Serbia. A positive result with indirect immunoenzyme test (i-ELISA) was confirmed in 67 (29.8%) and suspicious in 31 (13.8%) out of 225 tested rams. Complement fixation test (CFT) was used as a confirmation test on 67 ELISA positive sera and gave positive reaction in 41 (61.2%) ram serum samples. Rams originated from 113 flocks with 4751 sheep, from 28 villages in the Pirot Municipality of southern Serbia. Clinical examination was performed on epididymis and testes of 12 rams from 7 seropositive flocks by inspection and palpation. The examination showed scrotum asymmetry and unilateral increase of the epididymistail in 5 (41.7%) out of 12 seropositive rams. Pathomorphological examination of testes and epididymis confirmed pathological changes in 7 (58.3%) of the 12 examined rams. Onesided epididymitis with pronounced hypertrophy of the epididymitis was also confirmed. Twelve rams were tested for the presence of bacteria, i.e. 21 epididymis, testes and lymph nodes samples. We isolated 20 Brucella strains from 11 (91.7%) of the 12 examined animals. All isolates were identified with bacteriological and molecular techniques as B. ovis. This is the first evidence of ovine epididymitis (B. ovis) in Republic of Serbia.

A rare case of retroperitoneal malignant Triton tumor invading renal vein and small intestine.

INTRODUCTION: Malignant Triton tumor is a very rare malignant peripheral nerve sheath tumor with rhabdomyosarcomatous differentiation. Most of those tumors occur in patients with von Recklinghausen's disease or as a late complication of irradiation and commonly seen in the head, neck, extremities and trunk. CASE REPORT: We reported retroperitoneal malignant Triton tumor in a 57-year-old female patient. Skin lesions were not present, and there was no family history of neurofibromatosis or previous irradiation. The presented case is one of a few recorded in the specialized literature that occurs in the retroperitoneal space in sporadic form. In this case, tumor consisted of a multilobular mass was in close relation with the abdominal aorta and inferior vena cava and involved the renal vein with gross invasion of the small intestine. The patient underwent total resection of the tumor and left nefrectomy was performed. The small intestine 10 cm in length was also resected and end-to-end anastomosis was conducted. The postoperative course was uneventful and the patient was discharged from the hospital ten days after the surgery. CONCLUSION: Diagnostically, it is crucial to recognize this uncommon histological variant because malignant Triton tumor has a worse prognosis than classic malignant peripheral nerve sheath tumor does. The use of the immunohistochemistry is essential in making the correct diagnosis. Only appropriate pathological evaluation supported by immunostaining with S-100 protein and desmin confirmed the diagnosis. Aggressive surgical management treatment improves the prognosis of such cases with adjuvant radiotherapy.

Giant renal oncocytoma.

BACKGROUND: Renal onkocytoma is a distinctive benign tumor derived from epithelial cells of the distal renal tubules. These tumors are often clinically asymptomatic, diagnosed accidentally and difficult to distinguish from renal cell carcinoma. CASE REPORT: We presented a giant renal onkocytoma in a man aged 64, without any signs or symptoms of the urogenital system disorder. The preoperative diagnosis described the tumor mass of the right kidney, size 16 x 14 cm, and indicated a malignant tumor of kidney. The patient underwent radical nephrectomy. The tumor was encapsulated at the intersection with the characteristic central hyaline scar. Microscopically, it was built of uniform polygonal cells with abundant eosinophilic cytoplasm. Immunohystochemiclly, tumor cells were immunoreactive to CK AE1/AE3 and CD 117, but showed negative immunoreactivity to CK 7, RCC marker and Vimentin. CONCLUSION: Giant renal oncocytomas are rare tumors with benign clinical course. As a rule, they are discovered by accident. Clinical differentiation from malignant tumors of the kidney is not possible. They are treated surgically, mainly by radical nephrectomy. A definitive diagnosis is made only by histopathological examination of tumors using immunohistochemical marker panels.

Correlation of cell cycle regulatory proteins (p53 and p16(ink)4(a)) and bcl-2 oncoprotein with mitotic index and thickness of primary cutaneous malignant melanoma.

The purpose of the study was to determine the frequency of expression p53 and p16INK4a proteins and bcl-2 oncoprotein in malignant skin melanoma and to determine their correlation with the proliferative index and tumor thickness. The study involved 53 patients: 27 (51%) male and 26 (49%) female. Mitotic index showed a correlation with p53 protein expression, a negative correlation with p16INK4a protein expression. Statistically significant correlations were determined between the Breslow tumor thickness, Clark invasion level and p53 protein expression, as well as Breslow tumor thickness and bcl-2 oncoprotein expression (p<0.05), whereas there was no correlation between the p16INK4a protein expression and melanoma thicknes and Clark invasion level. Overexpression p53 protein and bcl-2 oncoprotein, with the loss p16INK4a protein of expression in the nodular melanoma, confirms a frequent loss of function of these tumor suppressor gene and oncogene, and indicates a vertical tumor growth phase. The loss of tumor suppression function the p53 protein and bcl-2 oncoprotein overexpression in cutaneous melanoma correlates with larger tumor thickness, whereas the overexpression of mutated p53 protein and loss p16INK4a protein of expression indicate a higher proliferative tumour potential. Therefore, these evaluated proteins may be the aggressive biological tumour activity markers.

[Primary ovarian malignant melanoma].

BACKGROUND: Primary ovarian malignant melanoma is extremely rare. It usually appears in the wall of a dermoid cyst or is associated with another teratomatous component. Metastatic primary malignant melanoma to ovary from a primary melanoma elsewhere is well known and has been often reported especially in autopsy studies. CASE REPORT: We presented a case of primary ovarian malignant melanoma in a 45-year old woman, with no evidence of extraovarian primary melanoma nor teratomatous component. The tumor was unilateral, macroscopically on section presented as solid mass, dark brown to black color. Microscopically, tumor cells showed positive immunohistochemical reaction for HMB-45, melan-A and S-100 protein, and negative immunoreactivity for estrogen and progesteron receptors. CONCLUSION: Differentiate metastatic melanoma from rare primary ovarian malignant melanoma, in some of cases may be a histopathological diagnostic problem. Histopathological diagnosis of primary ovarian malignant melanoma should be confirmed by immunohistochemical analyses and detailed clinical search for an occult primary tumor.

Malignant schwannoma of the pancreas involving transversal colon treated with en-bloc resection.

Pancreatic schwannoma is a very uncommon tumor of the pancreas, with only 27 cases reported. Most pancreatic schwannomas are benign, with only four malignant tumors reported. We describe a case of giant malignant schwannoma of the pancreatic body and tail, which involved the transverse colon. The tumor was treated successfully with en bloc distal splenopancreatectomy and colon resection. This is believed to be the first reported radical operation for malignant schwannoma of the pancreatic body, with infiltration of the transverse colon, with excellent long-term results. The patient is alive and well 28 mo after the operation. The authors conclude that pancreatic schwannomas should be considered in the differential diagnosis of cystic neoplasms of the pancreas, although the diagnosis can only be confirmed by microscopic examination. In the case of the benign tumors, local excision is adequate, but in the case of malignant schwannoma, oncological standards must be fulfilled.

Three cases of death caused by shots from blank cartridge.

The authors describe 3 cases of lethal injuries caused by 7.62 mm blank cartridge shots from military automatic rifle of domestic origin (AK 47, 7.62 mm). In 1 case, the cartridge was fired from a weapon that had been leaned on the head, with subsequent destruction of brain, and in other 2 cases, the weapon had been leaned on the chests, which led to destruction of heart parts. The injuries were caused by the action of striking wave of gunpowder explosion, the air blast type. The cases demonstrate that the gas pressure from the exploding propellant of blank cartridge is powerful enough to penetrate the thoracic wall and the skull.

[Histopathological characteristics and coexpression of p53 and p16(INK4a) proteins in renal cancer].

BACKGROUND/AIM: Renal carcinoma represents histologically heterogeneous group of malignant tumors, with various clinical aggressiveness. The frequency of p53 mutation in primal renal carcinoma is rare, although there are information about its heterogeneous accumulation. The loss of protein p16 expression in primal renal carcinoma is detected in 20-30% of the cases. The aim of this paper was to determine frequency of mutated protein p53 and expression of protein p16(INK4a) in renal carcinoma, to analyze their correlative relation and relation with the examined clinicopathological parameters. METHODS: The examination included 12 patients (66.7% men, 33.3% women), with patohistologically verified renal carcinoma. Expression of mutated form of protein p53 and protein p16 was determined in tissue samples, by immunohistochemical analysis using of mice monoclonical antibodies produced by DAKO, Denmark RESULTS: In 9 (75%) of the cases was detected mutated protein p53, of whom 66.6% had higher histological gradus of tumor (G3-4) and higher pathological stadium of the disease (pT3a-b) at the same time. In 7 (58.3%) and 5 (41.7%) of the cases expression of protein p16, the loss of expression of protein p16 were detected respectively. A statistically significant positive correlation was determined between pathological stadium of disease (TNM) and the degree of tumor differentiation (G) (p = 0.834; p < 0.001), as well as between TNM and mitotic index (p = 0.622; p = 0.031). CONCLUSION: A mutated form of protein p53 exists in 75% of the cases with the renal carcinoma and 66.6% of then have higher histological gradus of tumor and higher stadium of tumor disease at the same time. Coexpression of mutated protein p53 and protein p16(INK4a) in renal carcinoma is not statistically significant and it is not in correlation with clinicopathological parameters. Immunohistochemical analysis of mutated protein p53 in renal carcinoma can have predictive significance.

Giant paraovarian cyst in a child complicated with torsion.

BACKGROUND: A variety of benign cyst may occur in and around the ovary and broad ligament and may simulate serous cystadenomas. The majority of broad ligament and paraovarian epithelial tumors are serous neoplasms of low malignant potential and presented with a pelvic mass with or without ascites or pain, but without involvement of the ovary. Ovarian torsion and paraovarian serous cystadenoma are rarely reported. CASE REPORT: We presented a case of giant paraovarian cyst in an 14-year-old girl, with characteristics of serous cystadenomas grossly and microscopically, and complicated with double adnexal torsion. A computed tomography scan showed large hypodense cystic mass (measuring 30 x 26 x 12 cm), occupying the whole abdominal cavity, with no adhesion to the surrounding organs. CONCLUSION: Precise clinical data as well as pathological examinations based on immunohistochemical stainings were important in making the diagnosis. These rare cystic lesions of para/mesoovarian location in children and their unclear histogenesis might be a histopathological diagnostical problem.

[Inflammatory myofibroblastic tumor of the larynx].

BACKGROUND/AIM: Inflammatory myofibroblastic tumor (IMT) of the larynx is a rare borderline lesion composed of myofibroblastic and inflammatory cells. CASE REPORT: We presented a case of 77-year-old male with hoarseness for about three months. Laryngoscopy showed a polypoid tumor originated from the anterior commissure with glottic projection. Grossly, the tumor was 22 x 15 mm, whitish, oval nodus with firm consistency. Histologically, the lesion was composed of spindled to stellate cells arranged in a fascicular to storiform pattern and inflammatory cells: lymphocytes, histiocytes, plasma cells and neutrophils. The stroma was fibromyxoid and collagenous. Immunohistochemically, tumor cells showed strong positivity for actin and vimentin and negativity for cytokeratin, CD34, S100 and desmin. The proliferation (Ki67) was less than 10%. CONCLUSION: Inflammatory myofibroblastic tumor may be mistaken as a malignancy and the differential diagnosis can be difficult without immunohistochemistry. It is critical to recognize this uncommon entity to avoid unnecessary aggressive treatment.

[Safety of simultaneous colon and liver resection for colorectal liver metastases].

BACKGROUND/AIM: Surgical strategy for the treatment of resectable synchronous hepatic metastases of colorectal cancer (CRC) remains controversial. The aim of this study was to assess safety of simultaneous colon and liver rese cions and the direct effects of this type of treatment upon morbidity and mortality of the patients with synchronus hepatic metastases of CRC. METHODS: Intraoperative and postoperative data of 31 patients with simultaneous liver and colorectal resection were compared with the data of 51 patients who had undergone colon and hepatic resection in the staging setting. Analized were demographic data, number of metastases, type of the liver resection, operation time, intraoperative blood loss, percentage of postoperative complications, morbidity and mortality and lenght of hospitalisation. RESULTS: In the group of the patients operated simultaneously 5 hepatectomies, 3 sectionectomies, 2 trisegmentectomies, 3 bisegmentectomy, 6 segmentectomies, and 12 metastasectomies were combined with colon resection. In this group operation time (280 vs. 330 minutes) and in traoperative blood loss (450 vs. 820 ml) were lower than those in the two staged operation group. Postoperative complication rate was lower in the simultaneous group (19.35%o) than in the two-staged operation group (19.60%), without statistical significance. There was no hospital mortality in both groups. The patients having simultaneous resection required fewer days in the hospital (median 10.2 days) than the patients undergone operation in the two stage (18.34 days). CONCLUSION: By avoiding a second laparotomy, overall operation time, blood loss, hospital stay and complication rate are reduced with no change in hospital mortality, so simultaneous colon and hepatic resection performed by the competent surgeons are safe and efficient for the treatment of synchronous colorectal liver metastases.

[Cerebellar hemangioblastomas--a study of the immunoprofile of neoplastic stromal component]. / Hemangioblastomi malog mozga--ispitivanje imunoprofila neoplasticne strmalne komponente.

BACKGROUND: Central nervous system hemangioblastomas (HBs) are uncommon, highly vascularized tumors that are predominantly found in the cerebellum. They occur sporadically or in association with von Hippel-Lindau (VHL) disease. HBs are of unknown histogenesis, and the origin of stromal cells is still a subject of debate. The aim of this study was to investigate the immunoprofile of neoplastic stromal component, and to determine whether the profile of the expression of immunomarkers used can contribute to the elucidation of the histogenesis of HBs. METHODS: A series of eight cerebellar HBs were histochemically examined for the detection of mast cells and immunohistochemically for the expression of factor VIII-related antigen (FVIII-RAg), CD34, vimentin, factor XIIIa (FXIIIa), S-100 protein, glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), neurofilaments (NF), synaptophysin, chromogranin, and somatostatin. RESULTS: Mast cells were present in all hemangioblastomas, and were particularly abundant in one tumor. Immunohistochemically, intense reactivity for vimentin and NSE in the stromal cells was constantly seen. Immunoreactivity with S-100 protein and FXIIIa was variable, but generally many HBs stromal cells were negative for these markers. However, stromal cells were uniformly negative for FVIII-RAg in all HBs investigated. They were negative for CD34, GFAP, NF, synaptophysin, chromogranin, as well as somatostatin. GFAP-positivity of the occasional stromal type cells, located only peripherally, was interpreted as "pseudopositivity". CONCLUSION: The immunoprofile of neoplastic stromal component in this study suggested a possible origin from undifferentiated multipotential mesenchymal cells. High expression of NSE (glycolytic and hypoxia-inducible enzyme) in the HBs stromal cells might be related to the loss of the VHL protein function.

[Primary localized cutaneous amyloidosis--lichen amyloidosis]. / Primarna lokalizovana kutana amiloidoza--lichen amyloidosus.

This case report presented a female patient with primary-localized-cutaneous-amyloidosis in the form of lichen amyloidosus. Primary-localized-cutaneous-amyloidosis is a rare idiopathic dermatosis caused by abnormal deposition of amyloid composed primarily of degenerated keratin filaments. In order to establish the final diagnosis, detailed clinical and laboratory investigations were performed, with a particular emphasis on pathohistological analysis of skin specimens, special stains, and electron microscopy.

[Bladder tumors in young people]. / Tumori mokracne besike kod mladih ljudi.

Tumors of the bladder, particularly urothelial carcinoma (UC) are very rare malignant diseases in young people. They mostly occur in elder persons of male gender. We present 8 patients below 35 years of age, (average age 24.7), in whom the presence of UC was verified. The main symptom was total or terminal hematuria. The results showed that 5 patients had low-risc group of tumors (G1, pTa), while 3 tumors were of medium-risk group (G2, pT1). We concluded that UC in young people was low-grade and non-invasive. However, for better evaluation it was necessary to observe patients for longer period of time.

[Relation of serum prostate-specific antigen and the Gleason grade in patients with prostatic carcinoma]. / Odnos serumskog prostata specificnog antigena i Glisonovog gradusa kod bolesnika sa karcinomom prostate.

The prostatic adenocarcinoma is one of the most frequent malignant tumors of men over 50 years of age. It is distinguished by aggressive clinical course and heterogeneous multifocal histomorphologic changes. PSA is the most reliable serum marker in diagnostics and observation of prostatic carcinoma, and Gleason's system of tumor-diferentiation grading is generally accepted way of determining the histologic grade. Gleason's system is correlated with serum levels of PSA and with biological behaviour of the tumor. We presented 40 patients with verified ACP in whom the level of serum PSA, Gleason's grade and score were compared. Highly significant correlation was found between serum level of PSA and the differentiation grade of the tumor--Gleason's grade and score. Combination of PSA parameters and Gleason's score enables correct estimation of tumor's behaviour and correct therapeutic protocol.

[Solid papillary breast carcinoma with mucinous differentiation]. / Solidni papilarni karcinom dojke sa mucinoznom diferencijacijom.

A case is reported of a solid variant of infiltrating papillary carcinoma of the breast with mucinous differentiation in a 74-year-old woman. Macroscopically, the tumor was solid and lobular, 4.5 cm in diameter. Light microscopy showed solid papillary invasive carcinoma mixed with infiltrating ductal carcinoma, not otherwise specified. Abundant intracellular and extracellular acid mucin produced by the solid papillary tumor cells was proven histochemically by: PAS, PAS-D, mucicarmine and alcian blue. Immunohistochemically, the papillary carcinoma cells were strongly reactive to estrogen receptors, and weakly to moderately reactive to smooth muscle actin. We suggest that papillary carcinoma of the breast could have potentially high degree of aggressiveness, and that differential diagnosis of these rare tumors might be a histopathological problem.