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Background/Aim. Lung cancer is one of the most com-mon cancer types worldwide. More than 70% of patients are diagnosed with lung cancer in the advanced stages of the disease, with limited therapeutic options based on cytological and histopathological material. The value of cytology in diagnosing and subtyping non-small cell lung cancer (NSCLC) is very important for modern personalized therapies. The aim of this study was to find out the concordance between cytological and histopathological diagnosis of NSCLC and the accuracy, sensitivity, specificity, and the positive and negative predictive value of cytology in diagnosing lung cancer. Methods. A two-year retrospective study included 169 patients with cytological diagnosis of NSCLC, who, at the same time, had small biopsy and surgical specimens for histopathological diagnoses confirmation that were compared with cytological one. Histopathological diagnosis on surgical specimens was the golden standard for evaluation concordance to the cytological diagnosis of NSCLC and evaluation accuracy, specificity, sensitivity, and the positive and negative prognostic value of cytology as a diagnostic method for detecting lung cancer. Results. This study included 129 (76.3%) male and 40 (23.7%) female patients, aged between 39 and 83, with the average of 62.53 ± 7.6. There was no statistically significant difference between the ages of different genders (p = 0.207). The most frequent diagnosis among cytological diagnoses was NSCLC in 99 (58.58%) patients. Concordance between cytological and histopathological diagnoses of surgical specimens was 61.48%. There was no statistically significant difference between cytological diagnoses and histopathological diagnoses of small biopsies specimens (p = 0.856). The sensitivity, specificity, positive and negative prognostic value, and accuracy of cytology as a diagnostic method of lung cancer were 94.98%, 98.60%, 95.72%, 98.35%, and 97.71%, respectively. Conclusion. Cytological diagnosis of NSCLC is accurate, with high sensitivity, specificity, and benefits for patients. Most patients are diagnosed with advanced cancer when there is no surgical therapy option, and the only available diagnostic material is a small biopsy sampled during bronchoscopy.

Background/Aim. Cocaine is an alkaloid extracted from the leaves of the plants Erythroxylum coca and Erythroxylum novogranatense. It can be taken orally, intranasally, intravenously, by inhalation, or intragenitally. Cocaine abuse can cause subarachnoid and intracerebral hemorrhage. The aim of this study was to determine cocaine and benzoylecgonine (BZ) concentrations in various body fluids and organs, the frequency of subarachnoid and intracerebral hemorrhage, and the relationship of concentration of cocaine and BZ in different body fluids with subarachnoid and intracerebral hemorrhage. Methods. The study analyzed a total of 26 autopsies reports from 2005 to 2018 with detected cocaine and/or BZ in the bodies during a forensic autopsy at the Institute of Pathology and Forensic Medicine, Military Medical Academy in Belgrade, Serbia. Brain tissue was taken for histopathological analysis and blood from the femoral vein, while urine, gastric content, brain, kidney, and liver with gallbladder samples were taken for toxicological analyses. Results. There were 26 autopsied patients aged 23 to 56 years (mean age 33.77±8.52); 20 (75.92%) were men and 6 (23.08%) were women. Cocaine was found in the blood of 12 (46.15%), in the urine of 15 (57.69%), and in the brain of 8 (30.77%) autopsied patients. BZ was found in the blood of 20 (76.92%), in the urine of 21 (80.77%), and in the brain of 10 (38.46%) autopsied patients. Subarachnoid hemorrhage was found in 10 (38.46%), intracerebral hemorrhage in 18 (69.23%), and both subarachnoid and intracerebral hemorrhage in 6 (23.07%) autopsied patients. Intracerebral (focal and perivascular) hemorrhage was more frequent. There were statistically significantly higher concentrations of both cocaine and BZ in most of the body fluids and organs of examinees with intracranial hemorrhage compared to examinees without hemorrhage. Conclusion. Subarachnoid and intracerebral hemorrhage were frequent findings in autopsied cocaine abusers. The correlation between subarachnoid and intracerebral hemorrhage and cocaine concentrations in blood was moderate. There were strong correlation between subarachnoid and intracerebral hemorrhage and BZ concentrations in almost all the samples.

Background/Aim. Small cell lung carcinoma (SCLC) is the most aggressive form of lung cancer. Patients with SCLC generally appear in a locally advanced or disseminated stage, when small biopsies and/or cytological materials are the only possibility for diagnosis. The aim of this study was to evaluate the validity of cytology in the initial diagnosis of SCLC, comparing cytological with histological findings of small biopsies. Methods. The retrospective study included 200 patients with cytological diagnosis of SCLC, established in the period from 2016 to 2018 based on examination of the exfoliative material (sputum), as well as abrasive and aspiration materials obtained during bronchoscopy. In the same act, bronchoscopic materials were taken for cytological and histological diagnosis. Cytological materials were stained by May Grünwald Giemsa and histological ones using hematoxylin-eosin and immunohistochemical stains. Results. The most frequently sampled materials were: transbronchial needle aspiration (TBNA) in 72.2% of the patients and bronchial brushing in 18.54% of the patients, in the following order: bronchial aspirate in 4.88%, tru-cut needle biopsy in 5.37%, and sputum in 2.44% of the patients. In 91.5% (183/200) of the patients cytological diagnosis of SCLC was histopathologically confirmed. Among 17 patients whose cytological diagnosis of SCLC was not confirmed histopathologically, another type of tumor was histopathologically proved for 12 (6%) of them: in 6 cases non SCLC not otherwise specified, and in each per one squamocellular carcinoma, adenocarcinoma, large cell carcinoma, mixed tumor (NSCLC with a neuroendocrine component), lymphoma and sarcoma. Finally, in five patients histological material was false-negative. Conclusion. Cytological diagnosis of SCLC is a reliable method which yields satisfactory accuracy. The best way is to be interpreted in conjunction with histology of small biopsies. When only cytological materials are available, in doubtful cases, other small round cell tumors, and poorly differentiated NSCLC, must be considered in the differential diagnosis.

Introduction. Meadow saffron (Colchicum autumnale L.) is a perennial herbaceous plant belonging to the Lily family (Liliacea). It is similar to the edible wild garlic (Allium ursinum L.). Toxic substance in meadow saffron is alkaloid colchicine. Colchicine poisoning is a very dangerous condition which can lead to a fatal outcome. Case report. A 50-yearsold male was addmited to the hospital complaining of weakness, abdominal pain, nausea, vomiting and diarrhea without blood. The day before, the patient ate two plants thinking they were wild garlic and seven hours after ingestion he felt first symptoms. During the course of the hospital stay, he had gastroenterocolitis, acute renal faliure, hepatic lesions and cardiorespiratory insufficiency with a fatal outcome. Post-mortem examination revealed: brain oedema, lung oedema and congestion, heart weighing 700 g with ventricular hypertrophy, myocardial fibrosis, liver congestion and steatosis, spleen congestion, pancreatic fibrosis. Organs sections were taken for histopathological analysis. Body fluids and parts of organs were toxicologically analyzed. Histopathological findings were: brain oedema, diffuse perivascular and interstitial myocardial fibrosis, myocardial haemorrhage, lungs congestion and oedema, microvesicular and macrovesicular liver steatosis, centrilobular liver necrosis, lymphocytic inflammatory infiltrate in liver portions, red pulp congestion of the spleen, kidney congestion and interstitial bleeding, coagulation necrosis of the proximal tubules of the kidney. Toxicological analysis showed colchicine in the blood – 0.011 mg/L, urine – 0.051 mg/L, liver with gallbladder – 0.007 mg/kg, kidney – 0.008 mg/kg. Conclusion. Ingestion of meadow saffron can lead to poisoning with a fatal outcome due to the presence of the alkaloid colchicine. Colchicine intoxication should be suspected in patients with gastrointestinal symptoms after consuming wild plants.

Backround/Aim. Heroin is a semisynthetic opioid that may cause morphological and histopathological changes in heart: ventricular hypertrophy, myocardial fibrosis, hypertrophy of cardiomyocytes, myofibrils contraction band necrosis, loss of myocytes nuclei and cross-striation, perivascular bleeding, inflammatory cells infiltrate. The aim of the study was to show morphological and histopathological heart changes in autopsies of the long-time heroin abusers with positive toxicological analysis for 6-monoacetylmorphine (6-MAM) and morphine in blood and urine. Methods. Retrospective study was done at the Institute of Pathology and Forensic of the Medicine Military Medical Academy in Belgrade between 2010 and 2014 and included forensic autopsies of 27 examinees aged between 18 and 60. Heart ventricles thicknesses was analysed and histopathological myocard findings from processed material stained by hematoxyline-eosine (H&E) and trichrome stains (Masson) were examined. 6-MAM and morphine concentration in blood and urine using high-performance liquid chromatography coupled with photodiode (HPLC-PDA) and ultraviolet (UV) detector were analysed. Results. Heart ventricles thickness was increased in all persons (27/27; 100%) left 1.74 ± 0.17 cm and right 0.6 ± 0.09 cm. Myocardial fibrosis affected 27/27 (100%) of the examined persons including perivascular one in 24/27 (88.89%) and interstitial focal fibrosis in 3/27 (11.11%); hypertrophy of cardiomyocytes was present in 22/27 (81.48%); myofibril contraction band necrosis in 22/27 (81.48%); loss of myocytes nuclei and cross-striation in 10/27 (37.04%); fresh perivascular bleeding in 23/27 (85.19%); focal inflammatory cells infiltrate in 14/27 (51.85%). In toxicological findings, in 27/27 (100%), 6-MAM and morphine were found in urine. Both 6-MAM and morphine in blood were found in 3/27 (11.11%) and only morphine in blood in 16/27 (59.26%) persons subjected to an autopsy. Conclusion. Our results indicate both morphological (left and right ventricle hypertrophy) and histopathological heart changes (myocardial fibrosis, hypertrophy of cardiomyocytes, contraction-band necrosis, loss of myocytes nuclei and cross-striation, fresh perivascular bleeding and focal inflammatory infiltrate) in long-term heroin obusers. These changes are non-specific and could be caused either by long-term heroin abuse or by other factors. Having in mind a lack of medical histories of examined we could not exclude other factors besides long-term heroin abuse as cause of heart changes.

Background/Aim. Sarcoidosis is a multisystem infmammatory disease of unknown etiology, with the lungs and intrathoracic lymph nodes the most commonly involved. The aim of this study was to assess the contribution of conventional transbronchial needle aspiration (TBNA) cytology in the diagnosis of sarcoidosis presenting as mediastinal/hilar lymphadenopathy. Methods. In this retrospective study, 58 patients with suspicion of stage I and II sarcoidosis underwent first flexibile, and then, a rigid bronhoscopy, during which TBNA of mediastinal or hilar lumph node with a 19 gauge (G) needle was done. Material from the needle was put on glass slide and prepared for the cytological and histopathological examination. Results. Out of 58 patients submitted to TBNA of mediastinal or hilar lymph nodes, adequate material for cytological diagnostics was obtained in 53 (91.37%). Out of 53 adequate cytological samples, in 38 (71.69%) noncaseous granulomatous inflammation (NGI) was found, while in corresponding histopathological samples, NGI was found in 48 (90.56%), which was significantly higher (p < 0.05). Of cytological smears, out of the cell types typical for granulomatous inflammation, in 26 (63.15%) patients the clusters of the epitheloid cells were found, in 8 (21.05%) there were both, clusters of epitheloid cells and giant multinuclear hystiocytes, and in 6 (15.76%) only single scattered epitheloid cells or small clusters of several epitheloid cells were found. The sensitivity of TBNA cytology in our group of patients with sarcoidosis was 76%, specificity 100% and accuracy 77.34%. Conclusion. TBNA is an efficient and safe procedure in the diagnosis of sarcoidosis, minimally invasive and with a little risk of complications. Using 19 G needle enables obtaining material for histological and cytological analyses, as well which contribute to the sensitivity of diagnosting sarcoidosis. The value of this type of diagnostics depends on qualification and experience both of bronchoscopist and cytologist/pathologist, as well, of the interpreter of such a material.

Background/Aim. Although it is well-known the high sensitivity of brush cytology for the diagnosis of colorectal adenocarcinoma, this kind of diagnostics is not routinely used, and for the past years it has even been declining. The purpose of this study was to evaluate the value of brush cytology for the diagnosis of colorectal carcinoma, by comparison the results of brush cytology and biopsy, and then the results of both diagnostic methods with the final patohistological diagnosis of colorectal resection. Methods. This retrospective study included 173 patients with brush cytology of colorectal region during colonoscopy. In 166 patients concomitant biopsy specimens were obtained, and in 116 of them resection of the intestine as well. A total of the 106 patients underwent to all three diagnostic procedures. Results. Out of 166 patients who went through both brush cytology and biopsy, the congruent diagnosis was made in 129 (77.7%) patients: in 109 (65.7%) adenocarcinoma was diagnosed, which was confirmed after the resection of the intestine in 75 of the patients, and in 14 (8.4%) benign lesion, so there was no need for resection of the intestine. In 6 (3.6%) of the patients, both cytology and biopsy were negative, but the resected specimen was malignant. In 10 of the patients with malignant cytology in whom biopsy was not done, resection of the intestine confirmed malignancy. The sensitivity of detecting malignancy by brush cytology and biopsy were 87.9% and 78.3%, respectively (but this difference was not statistically significant, p = 0.083). Both methods had specificity and positive predictive values 100%. Negative predictive values for cytology and biopsy were 50% and 37.8%, respectively. The accuracy of cytology and biopsy was 89.2% and 80.8%, respectively. The combination of the results of brush cytology and biopsy increased the sensitivity of preoperative diagnostics to 94.8% which was significantly higher than sensitivity of biopsy (p < 0.001), but not than sensitivity of cytology (p = 0.102). Conclusion. Brush cytology could be a routine method, along with biopsy, in the diagnosis of colorectal malignancy. Both methods have comparable both sensitivity and accuracy, and its combination increases sensitivity of preoperative diagnostics of colorectal adenocarcinoma, which gives opportunity to better estimation of further diagnostic and therapeutic approach.

Background/Aim. Sarcoidosis is a multisystem infmammatory disease of unknown etiology, with the lungs and intrathoracic lymph nodes the most commonly involved. The aim of this study was to assess the contribution of conventional transbronchial needle aspiration (TBNA) cytology in the diagnosis of sarcoidosis presenting as mediastinal/hilar lymphadenopathy. Methods. In this retrospective study, 58 patients with suspicion of stage I and II sarcoidosis underwent first flexibile, and then, a rigid bronhoscopy, during which TBNA of mediastinal or hilar lumph node with a 19 gauge (G) needle was done. Material from the needle was put on glass slide and prepared for the cytological and histopathological examination. Results. Out of 58 patients submitted to TBNA of mediastinal or hilar lymph nodes, adequate material for cytological diagnostics was obtained in 53 (91.37%). Out of 53 adequate cytological samples, in 38 (71.69%) noncaseous granulomatous inflammation (NGI) was found, while in corresponding histopathological samples, NGI was found in 48 (90.56%), which was significantly higher (p< 0.05). Of cytological smears, out of the cell types typical for granulomatous inflammation, in 26 (63.15%) patients the clusters of the epitheloid cells were found, in 8 (21.05%) there were both, clusters of epitheloid cells and giant multinuclear hystiocytes, and in 6 (15.76%) only single scattered epitheloid cells or small clusters of several epitheloid cells were found. The sensitivity of TBNA cytology in our group of patients with sarcoidosis was 76%, specificity 100% and accuracy 77.34%. Conclusion. TBNA is an efficient and safe procedure in the diagnosis of sarcoidosis, minimally invasive and with a little risk of complications. Using 19 G needle enables obtaining material for histological and cytological analyses, as well which contribute to the sensitivity of diagnosting sarcoidosis. The value of this type of diagnostics depends on qualification and experience both of bronchoscopist and cytologist/pathologist, as well, of the interpreter of such a material. [ABSTRACT FROM AUTHOR]