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Uvod: Meningeomi su najčešći primarni tumori središnjeg živčanog sustava kod odraslih, te čine preko 30% svih intrakranijalnih tumora. Prema Svjetskoj zdravstvenoj organizaciji (World Health Organization - WHO) klasificiraju se kao benigni (WHO gradus I), atipični (WHO gradus II), te maligni/anaplastični (WHO gradus III). Ekstrakranijalni meningeomi, bez intrakranijalne komponente, vrlo su rijetki, te čine samo 1-2% slučajeva svih meningeoma. Prikaz slučaja: Šezdesetjednogodišnjem muškarcu s recidivom tumora etmoidnog sinusa lijevo, učinjena je endoskopska resekcija. Bolesniku je prije 7 godina (2015. g.) učinjena prva endoskopska operacija tumora etmoida lijevo. Patohistološki nalaz tada je pokazao da se radi o metastazi karcinoma bubrega. Bolesniku je prije 17 godina (2005. g.) učinjena desnostrana nefrektomija radi primarnog karcinoma bubrega. Rezultati opsežne imunohistokemijske analize reseciranog recidiva tumora upućuju na to da se radi o atipičnom meningeomu. S obzirom na dvije različite patohistološke dijagnoze, učinjena je revizija materijala prve endoskopske operacije, odnosno dodatna imunohistokemijska analiza. U spomenutoj naknadnoj imunohistokemijskoj analizi upotrijebljeni su, ranije nedostupni, specifični markeri potencijalnog metastatskog karcinoma bubrežnih stanica. Pokazalo se da su spomenuti specifični markeri negativni u oba uzorka, odnosno da se nije radilo o metastazi karcinoma bubrega, već o atipičnom meningeomu. Zaključak: Atipični meningeomi paranazalnih šupljina vrlo su rijetka stanja nerazjašnjene etiologije. Radikalna kirurška ekscizija bi trebala biti glavni cilj, kako bi se smanjila pojava recidiva. S obzirom na to da su atipični meningeomi skloni recidiviranju, potrebno je redovito praćenje takvih bolesnika.

Karcinom bubrežnih stanica deveti je prema učestalosti maligni tumor u svijetu. Može imati različit mikroskopski izgled, a najčešći patohistološki tip je svjetlostanični karcinom. Najučestalije patološke promjene bubrežnih arterija jesu ateroskleroza i fibromuskularna displazija (FMD). Tijekom patohistološke obrade bubrega u kojem se nalazi karcinom ­rutinski se analizira bubrežna vena, dok se bubrežnoj arteriji većinom pridaje malo pozornosti. Rezultati nekoliko naših istraživanja pokazali su da su patološke promjene bubrežnih arterija statistički značajno učestalije u skupini pacijenata s karcinomom bubrežnih stanica u odnosu prema kontrolnoj skupini, kao i u skupini bolesnika s netumorskim bolestima bubrega. Utvrđeni odnosi ponajprije upućuju na zaključak da nastanak promjena bubrežnih arterija ne prethodi nastanku karcinoma ili netumorskih bolesti, nego nastaju istodobno s njima ili kao njihova posljedica. Daljnja bi istraživanja trebala biti usmjerena na utvrđivanje incidencije patoloških promjena bubrežnih arterija na većem broju uzoraka, kao i na otkrivanje njihove moguće uzročno-posljedične veze s karcinomom bubrega, Renal cell carcinoma is the ninth most common cancer in the world. It may have a varied microscopic appearance, and the most common histopathological type is clear cell carcinoma. The most common pathological changes of renal arteries are atherosclerosis and fibromuscular dysplasia (FMD). During histopathological evaluation of a kidney specimen containing carcinoma, the renal vein is routinely analyzed, while the renal artery is usually given little attention. Our studies have shown that pathological changes of renal arteries are significantly more frequent in the group of patients with renal cell carcinoma compared with the control group and the group of patients with non-tumor kidney diseases. These relations led us to the conclusion that the onset of renal artery changes is not prior to the carcinoma or non-tumor diseases and that they are formed simultaneously or as a consequence. Further studies should be aimed at determining the incidence of these changes in a larger number of samples and the detection of their possible correlation with renal cell carcinoma.

Introduction Primary liposarcoma is very rare in the parotid gland. To date, only 8 cases of primary parotid liposarcoma have been reported. The aim of this study is to report on a case of primary parotid liposarcoma highlighting the complexity of its treatment and analyze treatment outcomes of other reported cases. Case summary We report a case of parotid liposarcoma arising in the left parotid gland of a 66 year-old man, causing local morbidity, recurrence, repeated surgical treatment and death 5 months after initial treatment. Discussion Parotid liposarcoma is marked by a high probability of local recurrence of up to 70% and is prone to distant metastatic spread, as was the case in our patient. Based on limited experience from published literature, optimal treatment entails radical surgery with negative margins. Postoperative radiotherapy is an option for patients with large high-grade tumors, positive margins and involvement of complex anatomic subsites. High-grade tumors have a worse outcome despite the addition of surgery and postoperative radiotherapy.

Haemangiomas of the nasal cavity are rare benign tumours which usually arise in the Kiesselbach triangle of the septum. Mostly they are seen in young population with peak age 20 years. Epistaxis is the most common symptom in these patients. We present a case of a 62-year-old woman with recurrent epistaxis. On examination she had had an obstruction of both nasal cavities. Computed tomography imaging demonstrated a well-defined tumour originating from the posterior tip of the right inferior turbinate, passing into the nasopharynx. The tumour was managed via endoscopic endonasal approach. The histological analysis revealed a tumour tissue with the appearance of a cavernous haemangioma as well as capillary haemangioma. A focus of intravascular endothelial papillary hyperplasia was also observed. In patients with endonasal benign tumours choice of surgical approach depends on the exact location of the tumour and suspected pathology. The transnasal endoscopic approach and bipolar cautery resection enable adequate exposure and visualization of the tumour, control of bleeding and complete removal of the tumour.

Citotoxin-associated gene-A (CagA)-positive Helicobacter pylori strains have been associated with occurrence and destabilization of coronary atherosclerotic plaques. However, data on the relationship between CagA-positive H. pylori infection and carotid artery instability are lacking. Thus, the role of CagA antigen in patients with symptomatic and asymptomatic carotid atherosclerotic plaques was investigated. A total of 64 patients with advanced carotid artery stenosis, including 33 patients with symptomatic and 31 patients with asymptomatic internal carotid artery stenosis, verified by duplex ultrasound, all undergoing carotid endarterectomy, were studied. The control group consisted of 65 subjects without a history or presence of vascular diseases. Serology for H. pylori and CagA antigen was assessed in all participants. Specimens of atherosclerotic plaques obtained from all patients during carotid endarterectomy were analyzed immunohistochemically using anti-CagA monoclonal antibodies. The ultrasonographic plaque characteristics were also estimated. CagA antibody titers were significantly higher in symptomatic patients (8.8 ; range, 5.8-32.7) compared to asymptomatic patients (4.7 ; range, 2.1-8.8 ; P = 0.005) and the control group (5.0 ; range 2.2-7.9 ; P < 0.001). There was significant difference in echolucency (≥ 25% soft material) between the symptomatic and asymptomatic groups (P = 0.034) by ultrasonographic evaluation. Positive immunoreactivity between monoclonal CagA antibodies and antigens within atherosclerotic specimens was significantly higher among symptomatic patients compared to asymptomatic patients (97.0 vs. 74.2% ; P = 0.009). H. pylori may play a role in the pathogenesis of the atherosclerotic process due to autoimmune mechanisms and even contribute to destabilization of carotid atherosclerotic plaques.

The study analyzes exon 15 of the adenomatous polyposis coli gene (APC) in a 49-year-old male patient with brain metastasis. The primary site was lung carcinoma.PCR method and direct DNA sequencing of the metastasis and autologous lymphocyte samples identified the presence of a somatic mutation. The substitution was at position 5883 G– A in the metastasis tissue. The mutation was confirmed by RFLP analysis using Msp I endonuclease, since the mutation strikes the Msp I restriction site.Immunohistochemical analysis revealed the lack of protein expression of this tumor suppressor gene. The main molecular activator of the wnt pathway, beta-catenin, was expressed, and located in the nucleus. The mutation is a silent mutation that might have consequences in the creation of a new splice site. Different single-base substitutions in APC exons need not only be evaluated by the predicted change in amino acid sequence, but rather at the nucleotide level itself. In our opinion, such silent mutations should also be incorporated in mutation detection rate and validation.

Melanoma inhibitory activity (MIA) protein was identified in significant quantities in primary and metastatic malignant melanomas, where it has an important role in promoting tumor development and progression. Our hypothesis was that MIA serum level will be elevated in patients with metastases or local spreading of the disease before any symptom of such progression is clinically apparent. We compared MIA serum levels in two groups of patients with primary melanoma ; those with positive as opposed to those with negative sentinel lymph nodes. In addition, MIA serum levels were studied in two control groups ; patients with dysplastic nevi and patients with basal cell carcinoma. A blood sample was obtained from each patient included in the study and MIA levels were assessed using standard enzyme-linked immunosorbent assay method. Patients with histologically positive sentinel lymph nodes, meaning that tumor cells were found in the lymph nodes, had much higher mean MIA values than any other patient group considered in this study. With mean value of 14.53 ng/ml, it was almost twice as high as mean MIA value in patients with histologically negative sentinel lymph nodes (7.32 ng/ml) and more than twice as high than any of the two control groups (P

The purpose of this study was to evaluate the presence and extent of periacinar retraction clefting in proliferative prostatic atrophy and carcinoma in radical prostatectomy specimens. Atrophic foci and neoplastic glands were analyzed in specimens from 50 patients who underwent radical prostatectomy. Analyzed atrophic glands were classified in two main groups, proliferative atrophy (PA) and proliferative inflammatory atrophy (PIA), and each group was subclassified into simple atrophy (SA) and postatrophic hyperplasia (PAH). According to the presence and extent of periacinar retraction clefting atrophic and neoplastic glands were classified as: group 1 - glands without clefts or with clefts affecting up to 50% of gland circumference, group 2 - glands with clefts that affected more than 50% of the circumference in less than 50% of examined glands and group 3 - glands with clefts that affected more than 50% of the circumference in more than 50% of examined glands. Forty-four (88.0%) atrophic foci were without periacinar clefts or clefts were present in less than half of gland circumference (Group 1). In 6 (12.0%) atrophic foci clefts affected more than 50% of gland circumference (Groups 2 and 3). Forty-five (90.0%) carcinomas were with clefts which affected more than 50% of gland circumference (Groups 2 and 3), and only in five carcinomas clefts were not found or affected less than 50% of gland circumference (Group 1). Our results indicate that periacinar retraction clefting represents a reliable criterion in differential diagnosis between proliferative atrophy and carcinoma.

Nasal polyps recur in approximately one-third of patients after surgical treatment. It would be beneficial to be able to predict the patients in whom we might expect recurrence and to predict the clinical outcome after surgery. The study included 30 patients operated for nasal polyps. Removed polyps were analyzed by immunohistochemical analysis for IL-5, IgE, vascular endothelial growth factor and eosinophilic infiltration. These parameters together with preoperative CT score were used as independent variables, and subjective score improvement after 2 years was used as a dependent variable in multiple linear regression analysis. Furthermore, the patients were divided into two groups: low and high polyp tissue immunoreactivity. The Chi-squared test was used to determine whether polyp immunoreactivity influences polyp recurrence and subjective score. Preoperative CT score had a slightly positive correlation with subjective score after 2 years. High eosinophil infiltration significantly predicted a higher risk for polyp recurrence. High IL-5 positivity was related to greater risk for polyp recurrence than low IL-5 reactivity but not significantly. IgE and VEGF reactivity in polyp specimens did not have any effect on polyp recurrence. High eosinophilic infiltration in polyps can predict worse outcome after surgical treatment of chronic rhinosinusitis with nasal polyposis. IgE and VEGF do not have prognostic significance to polyp recurrence after surgery. The preoperative extent of disease measured by CT score had a slightly positive correlation with worse outcome after surgery.

Background Recent investigations consider actinic keratosis (AK) as an earliest visible pattern of squamous cell carcinoma (SCC). We have analysed the expression of apoptosis-related proteins TP53, Bcl-2 and Bax in 30 atrophic and 30 hypertrophic AK cases. Material and methods Immunohistochemical analysis was performed following microwave streptavidin immunoperoxidase protocol on DAKO TechMate TM Horizon automated immunostainer (DAKO, Copenhagen, Denmark). Monoclonal antibody for TP53 and Bcl-2 and polyclonal antibody for Bax (DAKO, Copenhagen, Denmark) were used. Results Expression of TP53 showed no significant differences between two analysed groups ( χ 2 -test, P = 0.35636) whereas expression of Bcl-2 and Bax protein was significantly higher in atrophic compared to hypertrophic AK ( χ 2 -test, P = 0.01458 and P = 0.00358, respectively). Comparison of Bcl-2 : Bax ratio in two analysed AK showed significantly higher value in hypertrophic compared to atrophic AK (Mann– Whitney U test, P = 0.02272). Statistical analysis did not show any correlation between patient’ s sex and age, localization and size of the lesion with expression of investigated oncoproteins ( ANOVA , P > 0.05). Conclusions Our results may indicate higher resistance of keratinocytes on apoptotic stimuli in hypertrophic compared to atrophic AK. Thus, we suppose that keratinocytes in hypertrophic AK live longer and probably have higher propensity for additional mutations and conversion to overt SCC.

Actinic keratosis (AK) is extremely common precancerous cutaneous lesion [1]. AK was initially considered precancerous or premalignant, because it presents no invasion into the dermis. We examined immunohistochemically the P53, BCL-2 and GHR positivity in twenty-five specimens of AAK taken from regularly sun-exposed skin in 13 male and 12 female patients, older than 60 years (mean age 72.8 years). Nuclear staining for P53 was detected in all 25 (100%) investigated AAK specimens. IHC staining for BCL-2 was detected in all investigated AAK (100%). GHR was determined in 36% of investigated HAK specimens and GHR positivity was significantly lower than in NS [6]. On contrary to finding in HAK, this investigation detected GHR positivity in 80% of investigated AAK lesions. Statistical correlation showed no differences of GHR positivity in AAK compared to NS (c2-test, p>0.05). Detected significant differences of GHR positivity in atrophic AK, compared to hypertrophic AK, imply that differences on molecular level could reflect distinctive pathohistological pictures of AK types. Investigations of various other proto-oncogenes and tumor suppressor genes are needed in order to support this hypothesis.

The diagnosis of prostatic adenocarcinoma in needle core biopsy is based on major and supportive criteria. One of the supportive criteria is the presence of retraction clefting around neoplastic glands. We analyzed a series of 137 prostatic cancer cases diagnosed by needle core biopsy to determine the frequency, extent and criteria for periacinar retraction clefting. Clefting was analyzed on ten neoplastic and ten normal glands in three different high power fields. One-third or more glands with clefts affecting more than 50% of circumference were significantly more common in tumors (51.8%) than in benign glands (8%) (P

According to novel investigations, actinic keratosis (AK) is not a premalignant lesion but is a malignant lesion in the evolution to invasive squamous cell carcinoma (SCC). Thus, we analyzed p53, bcl-2 and growth hormone receptor (GHR) expression in hypertrophic-type AK (HAK) to determine the relative importance of these protooncogenes in the biological behavior of HAK. Expression of p53, bcl-2 and GHR was determined by immunohistochemistry in 33 HAK specimens and surrounding perilesional normal skin (PNS). The relative proportions of immunoreactive cells were determined. Of the 33 HAK specimens, 30 (91%) showed immunopositive staining for p53, 33 (100%) for bcl-2, and 12 (36%) for GHR. Highly positive p53 expression in HAK lesions could indicate that p53 mutation is an early and crucial event in lesion development. The detected pattern of the p53/ bcl-2 ratio in HAK suggests an important role for another gene: the proapoptotic gene bax. Our findings indicate that GHR expression could be a biological marker of progression of HAK to SCC.

Papillary thyroid cancer belongs to most commonly diagnosed well-differentiated malignant tumor of the thyroid gland, with only minority of cases being more aggressive, recurring locoregionally and developing distant metastatic foci. The aim of this study was to determine the clinical relationship between parameters of age, gender, size of primary tumor, intraglandular dissemination and regional metastatic spread and evaluate the importance of each parameter; analyze other major aggressive factors (tumor border, thyroid capsule invasion, perivascular, perilymphatic spread) on prevalence and extent of intraglandular dissemination and relation to metastatic spread in neck. This study is a retrospective analysis of clinical and pathological data from 714 patients with papillary thyroid cancer, presented and operated at the Department of ENT/Head and Neck surgery, Sisters of Charity University Hospital, Zagreb, in the period from 1980 to 2008. All patients were operated upon with total thyroidectomy and some type of neck lymphonode dissection (paratracheal or lateral). In results, we found 46.9 % tumors were aggressive; 34.7 % tumors were multicentric, with foci in the contralateral lobe nearly twice as often as in the ipsilateral lobe; 27.8 % were regionally metastatic, with equal distribution between paratracheal and lateral regions. In conclusion, we revealed contralateral lobe multicentricity and male gender as independent risk factors for regional metastatic dissemination. Nodular goiter has been identified as a protective parameter.

The aim of this study was to correlate the expression of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor-1α (HIF-1α) with pathological renal artery changes in patients with renal cell carcinoma (RCC). A further aim was to correlate intratumoral microvessel density (MVD) with VEGF and HIF-1α expression and prognostic factors for RCC, including tumour necrosis. Material and methods. Formalin-fixed and paraffin-embedded tissue blocks from 150 patients with RCC and 50 patients with non-tumorous kidney diseases were analysed. The control group consisted of specimens from both renal arteries obtained from 25 decedents at routine autopsy (50 cases in total). Immunohistochemistry was performed using primary antibodies to VEGF, HIF-1α and CD31. Results.Pathological renal artery changes were more common in patients with RCC and non-tumorous kidney diseases than in the control group. MVD was higher in the RCCs of patients with pathological renal artery changes. Tumours with higher HIF-1α expression had higher MVD ; however, VEGF expression was not associated with MVD. A significant association was also found between MVD and the extent of tumour necrosis, in that less necrotic tumours had higher MVD. No association between renal artery changes and VEGF and HIF-1α expression was established. Conclusion. Considering the results of this study, the evaluation of renal artery changes in forthcoming research on RCC would be helpful for several reasons: to estimate their incidence in a larger number of patients, to clarify their connection with RCC and to reveal their relationship with MVD in RCC.

Eine 53-jahriger Patientin wurde zur diagnostischen Abklarung und weiteren Behandlung eines Neovaskularisationsglaukoms des rechten Auges uberwiesen. Wir berichten uber den Fall eines kutanen Melanoms mit Metastasierung in den Glaskorperraum und die vordere Augenkammer, was sich klinisch als ein Neovaskularisationsglaukom manifestierte.

Karcinosarkomi su rijetki maligni tumori s mezenhimalnom i epitelnom diferencijacijom. Najčešće su sijelo glava i vrat, a svega nekoliko slučajeva opisano je u debelom crijevu, s vrlo agresivnim tijekom. Mikropapilarna varijanta karcinoma također vrlo rijetko nastaje u crijevu i povezana je s lošom prognozom. Opisujemo neuobičajeni slučaj karcinosarkoma sigmoidnog kolona s mikropapilarnom diferencijacijom, kod 83-godišnje žene. Tumor je bio promjera do 3,8 cm, mikroskopski se sastojao od žljezdolikih struktura, mikropapilarnih formacija sa psamomskim tjelešcima i solidnih područja koja su uglavnom građena od vretenastih stanica, a žarišno pokazuju hrskavičnu diferencijaciju. Žljezdana i mikropapilarna komponenta imunohistokemijski su pozitivne na epitelni membranski antigen i citokeratin, a mezenhimalna komponenta pozitivna je na vimentin. Tumor je infiltrirao cijelu debljinu stijenke crijeva sa širenjem u okolno masno tkivo. Metastaze u limfnim čvorovima sastojale su se samo od žljezdane komponente. Prema našim saznanjima ovo je prvi takav slučaj opisan u literaturi., Carcinosarcomas are very rare malignant tumors showing both mesenchymal and epithelial differentiation. They most commonly occur in the head and neck region. Few cases were described in the colon associated with very aggressive course. Micropapillary variant is also very rare in the colon and associated with poor prognosis. We report an unusual case of carcinosarcoma of the colon with micropapillary features and psammomatous calcification in an 83-year-old female patient. Tumor was located in the sygmoid colon and measured up to 3.8 cm in the largest diameter. Microscopically it was composed of glandular structures and micropapillary formations with psammomatous calcifications and solid areas built up of spindle cells with focal areas of cartilaginous differentiation. Glandular and micropapillary components immunohistochemically showed positive staining for cytokeratin and EMA while mesenchymal areas were positive for vimentin. The tumor was spreading through the whole thickness of the wall into adjacent fat tissue. Metastases in regional lymph nodes were composed entirely of glandular component. To the best of our knowledge, this is the first case of carcinosarcoma of the colon showing micropapillary features and psammomatous calcification.

A female patient with a giant congenital nevus associated with plexiform neurinoma and malignant peripheral nerve sheath tumor (MPNST) on head and neck is presented. We theoretically discuss possibilities of mutual origin all three entities, including the Boland theory of neurochristopaty. The clinical, surgical, and histologic aspects of the disease are discussed. Only one similar case in written literature was described.

Gangliogliomas are well differentiated and slowly growing neuroepithelial tumors composed of neoplastic ganglion cells and neoplastic glial cells corresponding mostly to the World Health Organization grade I tumors. However, some of these tumors disclose histologically more malignant glial component and correspond to grade II or grade III tumors. We report a case of left temporal lobe tumor in a 42-year-old woman fulfilling the diagnostic criteria for atypical (grade II) ganglioglioma with high Ki-67 proliferation index and p53 immunoreactive tumor cells. In spite of gross total removal of the tumor, it recurred eight months after surgery. Histopathological examination of the recurrent tumor revealed that it had undergone malignant transformation into a glioblastoma. This case indicates that gangliogliomas with high Ki-67 proliferating index and p53 immunoreactivity should be carefully monitored for recurrence and malignant progression regardless of their morphological grading and seemingly total surgical removal.

Compared with rhinologic patients without chronic rhinosinusitis (CRS), a higher prevalence of sinonasal Helicobacter pylori (HP) in patients with CRS was found. This study investigated if HP sinonasal colonization has a prognostic value for efficacy of functional endoscopic sinus surgery (FESS). Nasal polyps of 40 patients with CRS, undergoing FESS, were analyzed for presence of HP using immunohistochemistry (IHC). Patients were categorized as to whether the IHC was positive (HP+ group) or negative (HP- group). HP+ group and HP- group were compared according to the nasal polyp eosinophil density, and to the improvement (difference between pre- and post-operative scores) of the subjective symptom scores, and the nasal endoscopic scores. Nasal polyps in 28 (70%) patients were positive for HP. There were no significant differences between HP+ group and HP- group comparing the eosinophils, and the improvement of the single symptom and the total symptom scores. HP+ group had significantly greater improvement of the nasal endoscopic scores (F[1.38] = 6.212 ; P = 0.017). There is no influence of sinonasal HP on tissue eosinophilia and on CRS symptoms. There is a prognostic value for endonasal findings: CRS patients with HP have statistically significant greater improvement of the postoperative endoscopic scores.

Retraction clefting is known to appear in various types of tumors, but it has only recently been recognized as a specific histological phenomenon. Previously, it was considered merely a laboratory procedure artifact, but lately, there have been some assumptions that peritumoral retractions actually represent lymphatic spaces. In our study, we analyzed neoplastic glands in 52 specimens of prostatic adenocarcinoma. Immunohistochemical analysis was performed using D2-40 antibody, to highlight lymphatic endothelium and thereby differentiate actual lymph vessels or lymphovascular invasion from periacinar retractions. Our results showed that the number of lymph vessels was significantly lower in tumorous tissue compared to adjacent normal prostatic tissue. On the other hand, the number of lymph vessels in tumorous tissue was significantly higher than the number of lymph vessels mimicking periacinar retractions. Overall, the number of lymph vessels mimicking periacinar clefts was particularly low. These results are in accordance with our previous studies, which had shown that periacinar clefting appears due to lack of basal cells and stromal changes around tumorous acini. Also, these results support our hypothesis that retractions do not represent lymph vessels but should be considered a distinct entity, which is proven to be helpful both as diagnostic and predictive factor.

Background: Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) rarely affects intracranial structures without involvement of other sites. We herein review the tumour characteristics, differential diagnosis and treatment policy of this rare disease. Method: We conducted a PUBMED search using a combination of words 'Rosai-Dorfman disease', 'Central nervous system', and identified 42 cases of such a disease infecting exclusively central nervous system. Out of those cases only one case was reported to be purely intracerebellar making our case the second one in the literature. Clinical features, differential diagnosis, treatment details and follow-up were discussed. We also described the case of 41-year-old man presented with vertiginous symptoms and mild cerebellar ataxia who was diagnosed with a solitary lesion localised deep in the right cerebellar hemisphere. Immunohistological findings revealed Rosai-Dorfman disease. Findings: The most common locations of the tumour were frontal and parietal region, but CNS lesions have commonly involved the skull base with a leptomeningeal component too. The median age at presentation was in the third decade, ranging from 3 to 78 years. There is a slight male predominance. The follow-up ranged from 1 month to 11 years. Recurrence was not observed in the cases where total surgical excision was performed. Conclusion: Though Rosai-Dorfman disease is a rarity, one should take it into a consideration when treating solitary intracerebellar lesion. Thorough preoperative evaluation is mandatory and biopsy should be done whenever feasible. Surgical treatment of this type of tumour is not always necessary, however, it is essential for postulating the right diagnosis. When total tumour removal is achieved, the outcome is generally better, with minimal risk of recurrence and with no need for further additional therapy.

Cilj: Rosai-Dorfman bolest (RDD) je idiopatska histiocitna proliferacijska bolest koja zahvaæa limfne èvorove. RDD se rijetko pojavljuje kao izolirana intrakranijska bolest, bez zahvaæenosti ostalih regija. U ovom èlanku prikazat æemo dva sluèaja RDD koja su se manifestirala kao izolirani intrakranijski procesi. Prikaz sluèaja: Prvi bolesnik je tridesetdevetogodišnji muškarac s dobro ogranièenom lezijom desnog temporalnog režnja, za koju se preoperativno smatralo da je meningeom. Histološkom i imunohistokemijskom analizom ustanovljeno je da se radi o RDD. Intracerebralna pojava ove bolesti ima benigan tijek. Drugi bolesnik je èetrdesetjednogodišnji muškarac koji se klinièki prezentirao vertiginoznim sindromom i blagom cerebelarnom ataksijom. Raèunalna tomografija prikazala je solitarnu leziju lokaliziranu desno cerebelarno. Imunohistopatološke karakteristike takoðer su ukazale na to da se radi o RDD. Rasprava i zakljuèak: U èlanku æemo prikazati znaèajke, diferencijalnu dijagnozu i terapiju intrakranijske lokalizacije RDD. Detaljna preoperativna priprema bolesnika je obavezna, a kad god je moguæe treba uèiniti i biopsiju. Neurokirurško lijeèenje ovog tumora nije uvijek nužno, no bitno je za postavljanje prave dijagnoze. Ishod bolesti i rizik od recidiva manji je kod kompletnog odstranjenja tumora. Recidiv tumora nije opažen prilikom kompletnog odstranjenja tumora, te u tim sluèajevima ne postoji potreba za daljnjom terapijom. S klinièkog stajališta, RDD se može smatrati važnim intracerebralnim tumorskim entitetom zato što može oponašati druge tumorske procese., Aim: Rosai-Dorfman Disease (RDD) is an idiopathic histiocytic proliferation affecting lymph nodes. Rosai-Dorfman disease rarely affects intracranial structures without involvement of other sites. In this paper we are presenting two cases of RDD with isolated intracranial involvement. Case report: The first patient is a 39-year-old male presenting with an isolated well-circumscribed brain mass in the right temporal lobe, preoperatively thought to be a meningioma. Histological and immunohistochemical analysis confirmed that the lesion was RDD. The intraparenchymal brain location of RDD appears to have a benign course. We also describe the case of 41-year-old man presenting with vertiginous symptoms and mild cerebellar ataxia who was diagnosed with a solitary lesion localised deep in the right cerebellar hemisphere. Immunohistological findings also revealed Rosai-Dorfman disease. Discussion and conclusion: In this paper we are presenting the clinical features, tumor characteristics, differential diagnosis and treatment options. Thorough preoperative evaluation is mandatory and biopsy should be done whenever possible. Surgical treatment of this type of tumour is not always necessary, however, it is essential for postulating the right diagnosis. When total tumor removal is achieved, the outcome is generally better. Recurrence was not observed in our cases where total surgical excision was performed and there was no need for additional therapy. From the clinical point of view RDD might be an important intracerebral entity because it might mimic other lesions, particularly other histiocytic disorders.,îÿÀ

Lipidized tumours of the central nervous system are very rare. Lipidization of tumour cells is a histological hallmark of pleomorphic xanthoastrocytoma and cerebellar neurolipocytoma and has been described in some other primary neuroepithelial tumours such as glioblastoma, cerebral primitive neuroectodermal tumour, central neurocytoma and ependymoma. However, a few cases of lipidized low-grade glial tumours that could not be classified to the fore mentioned categories have been reported, as well. We report a new case of such a tumour occupying the right temporal lobe in a 23-year old woman. Histologically, the tumour was composed of GFAP positive glial cells with areas of complete cell lipidization. More than a two years after the surgery, the patient is well and asymptomatic supporting presumed favourable clinical course of these rare tumours. The recommended treatment plan for these presumably benignant tumours should be continued with radiographic surveillance after the gross total resection.

Glioblastoma is the most frequent, the most malignant and the best vascularised primary brain tumor. Substantial evidence suggests that IGFBP-2 (insulin-like growth factor binding protein) may play a significant role in the development and progression of various types of cancer, including the anaplastic progression of astroglial tumors. The correlation of IGFBP-2 and VEGF over-expression in diffuse gliomas and strong IGFBP-2 immunostaining and co-expression with VEGF in the cells of pseudopalisading necrosis suggests the induction of IGFBP-2 expression by hypoxia and/or possible involvement of its protein product in angiogenesis. The aim of this study was to analyze the expression of IGFBP-2 and the relationship between the IGFBP-2 expression, extent of bizarre angiogenesis and the presence of pseudopalisades. The prognostic impact of these variables was estimated, as well. Our results revealed that most glioblastoma (75%) express IGFBP2 and that IGFBP2 expression was associated with the presence of pseudopalisading necrosis as well as extensive bizarre angiogenesis. IGFBP-2 immunoreactivity in more than 5% of tumor cells and the presence of pseudopalisading necrosis were prognostically significant in univariate analysis (p=0.034) while in multivariate analysis only a patient’s age and the presence of pseudopalisades remained statistically significant (p=0.004). The results of our study showed the association of IGFBP-2 expression in glioblastoma with pseudopalisades and bizarre angiogenesis thus confirming on morphological grounds presumed induction of this gene under hypoxic conditions and its possible role in angiogenesis.

The distinction between renal oncocytoma (RO) and chromophobe renal cell carcinoma (ChRCC), especially the eosinophilic variant, can often be difficult. Our study has documented for the first time the expression of MAGE-A3/4 and NY-ESO-1 cancer testis antigens (CTAs) in these tumors. A total of 35 patients (17 ROs and 18 ChRCCs) were included in the study. Two antibodies were used for immunohistochemical staining: 57B recognizing multiple MAGE-A and D8.38 recognizing NY-ESO-1 CTAs. Fifteen (88.2%) samples of RO stained positively for both MAGE-A3/4 and NY-ESO-1 antigens. Regarding ChRCC, seven (38.9%) stained positively for MAGE-A3/4 and six (33.3%) for NY- ESO-1 antigens. Median MAGE-A3/4 expression was moderately positive in RO and negative in ChRCC. The difference in MAGE-A3/4 expression between two tumor groups was significant (P=0.0013). Median NY-ESO-1 expression was strongly positive in RO and negative in ChRCC. The difference in NY-ESO-1 expression between two tumor groups was also significant (P=0.0008). Our study has shown that RO had a significantly higher expression of both CTAs. However, additional research is needed to clarify their potential diagnostic implications. Copyright © 2010 Elsevier GmbH. All rights reserved.

Xanthogranuloma of the sellar region is a very rare brain tumor with favorable prognosis and without reported relapses of purely xanthogranulomatous lesion after complete resection. A case is presented of a 40-year-old male diagnosed with and treated for sarcoidosis,complaining of headache, photophobia and loss of libido. Physical examination revealed generally scarce hairiness, while laboratory investigations showed panhypopituitarism. Expansive sellar and suprasellar mass compressing the floor of the third ventricle and optical chiasm was confirmed by cranial multi-slice computerized tomography (MSCT). Complete resection of the tumor mass using trans-sphenoidal approach was performed. Histopathologic analysis revealed cholesterol clefts, sparse lymphoplasmacellular infiltrates, macrophages, siderophages and foreign body giant cells around cholesterol clefts confirming the diagnosis of xanthogranuloma of the sellar region. Since preoperative diagnosis of xanthogranuloma is very difficult, therapeutic algorithm does not differ from other expansive lesions of the sellar region, but pituitary involvement should always be considered inpatient with sarcoidosis since therapeutic management is non-surgical. Follow up MSCT imaging after 6 months revealed a solid, contrast-enhanced mass at the posterior base of the sella., Ksantogranulom selarnog područja je vrlo rijedak tumor mozga s povoljnom prognozom i bez opisanih recidiva čisto ksantogranulomatozne lezije nakon potpunog odstranjenja. Prikazuje se slučaj 40-godišnjeg bolesnika s dijagnosticiranom i liječenom sarkoidozom koji se tužio na glavobolju, fotofobiju i gubitak libida. Fizikalni pregled je pokazao oskudnu dlakavost, dok su laboratorijske pretrage otkrile panhipopituitarizam. Ekspanzivnu selarnu i supraselarnu tvorbu koja je pritiskala dno trećeg ventrikla i optičkog hijazma potvrdila je višeslojna kompjutorizirana tomografija (MSCT). Tumorska tvorba je odstranjena u potpunosti transsfenoidnim pristupom. Histopatološka analiza je pokazala nakupine kolesterola,rijetke infiltrate limfoplazmatskih stanica, makrofage, siderofage i divovske stanice stranog tijela oko nakupina kolesterola, potvrđujući dijagnozu ksantogranuloma selarnog područja. Kako je prijeoperacijsku dijagnozu ksantogranuloma vrlo teško postaviti, terapijski algoritam se ne razlikuje od onoga za druge ekspanzivne lezije selarnog područja, no zahvaćenost hipofize treba uvijek imati na umu u bolesnika sa sarkoidozom, jer je liječenje neoperacijsko. Kontrolni MSCT nakon 6 mjeseci pokazao je čvrstu, kontrastom pojačanu tvorbu na stražnjoj bazi sele.

Primary malignant melanoma of the female urethra is a rare tumor that most commonly affects meatus and the distal urethra. The prognosis is poor. We report the case of 65-year-old woman who was refered by a gynaecologist due to an urethral mass mimicking a caruncule. The tumor was removed by a local exscision, and pathological analysis revealed malignant melanoma. After three months distal urethrectomy was performed with no evidence of residual tumor. The patient was uneventful during 6-year follow up period., Primarni maligni melanom ženske uretre je rijedak tumor. Najčešće je lokaliziran u meatusu i distalnom dijelu uretre. Prognoza je loša. Prikazujemo šezdesetpetogodišnju bolesnicu upućenu od ginekologa zbog tumorske promjene uretre nalik karunkulu. Tumor je odstranjen lokalnom ekscizijom, a patohistološkim pregledom je postavljena dijagnoza malignog melanoma. Nakon tri mjeseca učinjena je resekcija donje trećine uretre, pri čemu tumor nije nađen. Bolesnica je bez znakova recidiva, odnosno metastatskog širenja bolesti i nakon šest godina kliničkog praćenja.

Cerebellar glioblastoma in the elderly is rare. Only 33 cases have been reported in the literature. We report on a 65-year-old male patient with cerebellar glioblastoma. Computed tomography scan revealed a posterior fossa tumor of 34x33x52 mm in size, with hydrocephalus. The patient presented with posterior fossa symptoms, ataxia, nausea and vomiting. He deteriorated rapidly and ventricular drainage was performed. When the patient's condition improved, suboccipital median craniectomy was performed and the tumor was removed. Postoperative treatment included radiotherapy and temozolomide chemotherapy., Glioblastom maloga mozga je veoma rijedak. Dosad su u literaturi prikazana 33 bolesnika starije životne dobi s glioblastomom maloga mozga. Prikazan je slučaj muškarca u dobi od 65 godina. Kompjutorizirana tomografija maloga mozga pokazala je ekspanzivni proces maloga mozga veličine 34x33x52 mm. U kliničkoj slici je bila prisutna cerebelarna simptomatologija. Bolesnik je operiran u dva zahvata: najprije je zbog hipertenzijskog opstrukcijskog hidrocefalusa učinjena vanjska ventrikularna drenaža, a u drugom zahvatu medijalna subokcipitalna kraniektomija i ablacija tumora. Histopatološki nalaz je ukazao na glioblastom maloga mozga. Poslijeoperacijski je provedeno onkološko liječenje koje je uključivalo radioterapiju i kemoterapiju temozolomidom.

The aim of this study was to estimate and compare some histopathologic predictors of efficacy of endoscopic sinus surgery (ESS) in allergic and non-allergic patients with chronic rhinosinusitis (CRS). Symptomatology was rated in 50 allergic and 50 non-allergic patients prior to as well as 12 and 24 months after surgery. Specimens taken during the procedure were scored for goblet cells, subepithelial thickening, mast cells and eosinophils. The correlation between histopathology and symptoms was evaluated. Goblet cells and subepithelial thickening were the best predictors in both groups of patients. These parameters are significant global outcome predictors for allergic, but not for non-allergic patients. It is concluded that certain histopathologic parameters in CRS correlate with certain symptoms. Certain histopathologic changes are predictable for persistence of some bothersome symptoms after ESS. Pathologic evaluation might give prediction of response to ESS in allergic and non-allegic patients with CRS.

The molecular mechanisms and candidate genes involved in development of meningiomas still need investigation and elucidation. In the present study thirty-three meningiomas were analyzed regarding genetic changes of tumor suppressor gene Adenomatous polyposis coli (APC), a component of the wnt signaling. Gene instability was tested by polymerase chain reaction/loss of heterozygosity (LOH) using Restriction Fragment Length Polymorphism (RFLP) method. RFLP was performed by two genetic markers, Rsa I in APC’ s exon 11 and Msp I in its exon 15. The results of our analysis showed altogether 15 samples with LOH of the APC gene out of 32 heterozygous patients (47%). Seven patients had LOHs at both exons, while 4 LOHs were exclusive for exon 11 and 4 for exon 15. The changes were distributed according to pathohistological grade as follows: 46% of meningothelial meningioma showed LOH ; 33% of fibrous ; 75% of mixed (transitional) ; 75% of angiomatous, and one LOH was found in a single case of psammomatous meningioma. None of the LOHs were found in atypical and anaplastic cases. Immunostaining showed that samples with LOHs were accompanied with the absence of APC protein expression or presence of mutant APC proteins ( 2 =13.81, df = 2, P 0.001). We also showed that nuclear localization of beta-catenin correlates to APC genetic changes ( 2 =21, 96, df = 2, P 0.0001). The results of this investigation suggest that genetic changes of APC gene play a role in meningioma formation.

Embolisation of coronary artery from cardiac myxoma is very rare and it is not clear what happens with embolic material inside coronary artery after myocardial infarction. The natural course of myxomatous embolus is important because it determines the mode of surgical intervention. Different options of the course of embolus have been speculated, from spontaneous resorption to growth at artery wall. We report a case of embolisation of the circumflex artery trifurcation from a villous left atrial myxoma. The course of the embolus was displayed by coronary angiography repeated 6 months after myocardial infarction. Unlike the previously published case report, we found the embolus to be unremitting.

OBJECTIVE: To analyze histopathologic mucosal findings as predictors of response to endoscopic sinus surgery (ESS) in allergic and nonallergic patients with chronic rhinosinusitis (CRS). METHODS: Fifty allergic and 50 nonallergic patients with CRS who underwent ESS were enrolled in the study. Patients completed a questionnaire concerning sinusitis symptoms (congestion, discharge, nasal secretion, headache, sneezing, cough, facial swelling and olfaction) before intervention and at 12 and 24 months after surgery. The following histopathologic parameters were assessed: goblet cells, subepithelial thickening, mast cells and eosinophils. Multiple regression analysis was performed to evaluate prediction of total score of subjective symptoms by histopathologic findings. The correlation between histopathologic findings and postoperative symptoms was then evaluated. The results in the two groups were compared. RESULTS: Analysis showed prediction of improvement in total scores at 12 and 24 months after surgery by subepithelial thickening and mast cells in allergic patients (P 0.001). Analysis showed prediction of outcome in nonallergic patients (P 0.05) was not possible. The following histopathologic findings correlate with symptoms at both observed terms in allergic patients: goblet cells correlate with 3 symptoms as well as subepithelial thickening (P 0.005). Mast cells infiltration correlate with 1 symptom (P 0.005). Eosinophilic infiltration does not correlate with any symptom (P 0.05). In the nonallergic patients goblet cells correlate with 4 symptoms (P 0.005). Subepithelial thickening correlates with 3 symptoms (P 0.005). Mast cells infiltration correlates with 2 symptoms as well as eosinophilic infiltration (P 0.005). CONCLUSIONS: Certain histopathologic findings in CRS are predictive of favorable response to ESS.

The aim was to investigate stromal reaction, including inflammation and stromal desmoplasia in in situ and invasive urothelial carcinoma of urinary bladder and to determine the possible value of reactive stromal changes in the diagnosis of lamina propria invasion. We analyzed specimens from 24 consecutive patients with synchronous in situ and invasive urothelial carcinoma in the same biopsy. Specimens were obtained by transurethral resection, fixed and routinely stained with H&E and Mallory method. Immunohistochemistry was performed by monoclonal antibodies to vimentin, smooth muscle actin and desmin. The intensity of immunostaining was graded semiquantitatively on a scale of 0-3, and expressed as 0 = 0%; 1 = up to 33%; 2 = more than 33% to 66%; and 3 = more than 66% of positive stromal cells. The intensity of inflammation was labeled as 0 = no inflammation, 1 = weak, 2 = moderate, and 3 = dense inflammatory reaction. Mallory trichrome method showed predominantly no staining or weak green staining in 14/24 invasive and 20/24 in situ urothelial carcinomas (p>0.05). There was statistically significantly increased vimentin and smooth muscle actin immunostaining in the stroma of invasive carcinoma as compared with in situ carcinoma (p, Cilj istraživanja bio je analizirati stromalnu reakciju, uključujući upalu i dezmoplaziju strome, u in situ i invazivnim urotelnim karcinomima mokraćnog mjehura te odrediti moguću vrijednost reaktivnih stromalnih promjena u dijagnostici invazije lamine proprije. Analiza je provedena na 24 uzorka tumora s istodobnom in situ i invazivnom sastavnicom urotelnog karcinoma u istoj biopsiji. Uzorci su dobiveni transuretralnom resekcijom, fiksirani i bojeni standardnom metodom hemalaun-eozinom te metodom po Malloryju. Imunohistokemija je učinjena pomoću monoklonskih protutijela protiv vimentina, glatkomišićnog aktina i dezmina. Intenzitet imunohistokemijskih reakcija je određen semikvantitativno i označen kao 0 = negativna reakcija, 1 = do 33% pozitivnih stanica u stromi, 2 = više od 33% do 66% pozitivnih stromalnih stanica i 3 = više od 66% pozitivnih stromalnih stanica. Intenzitet upale označen je kao 0 = nema upale, 1 = slaba upalna reakcija, 2 = umjerena upalna reakcija i 3 = jaka upalna reakcija. Metoda po Malloryju je pokazala negativnu odnosno slabu reakciju zelenog bojenja u 14/24 invazivna i 20/24 in situ urotelna karcinoma (p>0,05). Utvrđena je statistički značajno jača reakcija na vimentin i glatkomišićni aktin u stromi invazivnih karcinoma u odnosu na karcinom in situ (p

The aim of the present study was to correlate the presence and extent of retraction clefting and the expression of p63 in neoplastic glands and glands with prostatic intraepithelial neoplasia (PIN) in needle core biopsies. We analyzed needle core biopsies from 28 patients with PIN and 41 patients with adenocarcinoma. Neoplastic glands and those with PIN were analyzed on high power field (400x) and classified in three groups according to the extent of clefting. Immunohistochemical staining was performed following Microwave Streptavidin ImmunoPeroxidase (MSIP) protocol on DAKO TechMate Horizon automated immunostainer. Periacinar retraction clefting was significantly more prominent in prostatic carcinoma compared to PIN (p

tumor lesion in the right parietal region, with the surrounding zone of perifocal oedema. During the operative procedure the tumor was maximally reduced using a microneurosurgical technique. The collected tumor tissue was frozen in liquid nitrogen and transported to the laboratory, where it was immediately frozen at )75 � C. The peripheral blood sample was processed immediately. The local Ethical Committee approved our study and

OBJECTIVE AND IMPORTANCE: Traumatic leptomeningeal cysts represent a rare complication of a childhood cranial fracture, and occur in only 0.05 to 0.6% of all cranial fractures. In adults, clinical manifestations of a childhood trauma are very rare and usually appear in the form of nontender, nonpulsatile, subcutaneous mass, accompanied by a progressive neurological deficit and seizures, as shown in our case. CLINICAL PRESENTATION: We present the case of a 24-year-old man with seizures caused by a traumatic leptomeningeal cyst resulting from the head injury he suffered at the age of 9 months. INTERVENTION: Right-sided craniotomy was performed with consequent microsurgical removal of the leptomeningeal cyst. The dura was reconstructed in a watertight manner and a cranioplasty was performed with Palacos (Howmedica International, Limerick, Ireland). CONCLUSION: It is important to consider traumatic leptomeningeal cysts when treating adult patients with erosive bone lesions who have a history of head trauma.

OBJECTIVE: To estimate the predictable value of histopathologic parameters in chronic rhinosinusitis (CRS) for response to endoscopic sinus surgery (ESS). - - - - - STUDY DESIGN: Symptomatology was rated in 100 patients prior to as well as 12 and 24 months after surgery. Specimens taken during the procedure were examined and scored for goblet cells, subepithelial thickening, mast cells, and eosinophils. Multiple regression analysis was performed to predict the total score of subjective symptoms before treatment by histopathologic parameters. The correlation between histopathologic parameters and postoperative symptoms was then evaluated. - - - - - RESULTS: Goblet cells were the best predictor correlating with 5 symptoms. Subepithelial thickening correlated with 4 symptoms. Mast cell infiltration correlated with 3 symptoms. Eosinophilic infiltration correlated with only one symptom (P

Radical prostatectomy is a treatment of choice for localized prostatic adenocarcinoma. In most cases, radical prostatectomy is combined with pelvic lymph node dissection. During the last decade, the necessity to perform lymphadenectomy in all patients has been questioned. Lymph node dissection adds the risk of complications, and increases operation time and medical costs. Data of patients with prostatic adenocarcinoma who underwent radical prostatectomy at Department of Urology, Sestre milosrdnice University Hospital, Zagreb during the period from January 1, 1998 till December 31, 2002, were analyzed. There were 110 patients who had complete preoperative data including prostate-specific antigen (PSA) value, Gleason score, T stage and lymph node status on frozen section analysis. Using predictive nomograms the patients were divided into different risk groups. Positive lymph node(s) were found in one patient with T2 and in five patients with T3, whereby three, two and one of these patients had Gleason score 6, 7 and 8, respectively. There was a correlation between increasing PSA value and positive lymph nodes (p, Radikalna prostatektomija je metoda izbora u liječenju lokaliziranog karcinoma prostate, a najčešće se izvodi u kombinaciji s disekcijom zdjeličnih limfnih čvorova. Disekcija zdjeličnih limfnih čvorova povećava rizik komplikacija, produžava trajanje operacije, povisuje troškove liječenja i medicinske skrbi, pa se je potreba za njenim provođenjem u svih bolesnika s dijagnosticiranim karcinomom prostate tijekom prošloga desetljeća višekratno preispitivala. Radi boljeg probira bolesnika sa značajnijom koristi od disekcije zdjeličnih limfnih čvorova različiti autori su obrađivali čimbenike kojima je moguće predvidjeti rizik metastaziranja u regionalne limfne čvorove. Studijom su obuhvaćeni svi bolesnici kojima je zbog dijagnoze karcinoma prostate u razdoblju od 1. siječnja 1998. do 31. prosinca 2002. u Kliničkoj bolnici Sestara milosrdnica učinjena radikalna prostatektomija. Uz primjenu prediktivnih nomograma bolesnici su bili podijeljeni u različite rizične skupine. Većina bolesnika pripadala je skupini niskog i srednjeg rizika metastaziranja, s vrlo ograničenom koristi od disekcije zdjeličnih limfnih čvorova i njihove intraoperacijske analize. Od 110 bolesnika za koje su dobiveni svi podaci uključujući vrijednost antigena specifičnog za prostatu (PSA), Gleasonov zbroj, T stadij i stanje limfnih čvorova analiziranih na intraoperacijskim rezovima, pozitivni limfni čvorovi su utvrđeni u 6 slučajeva. Utvrđena je statistički značajna povezanost između vrijednosti PSA i pozitivnih limfnih čvorova (p

Primarni maligni melanom ženske mokraćne cijevi vrlo je rijedak i agresivan tumor s lošom prognozom. Prikazali smo slučaj 65-godišnje žene s polipoidnim tumorom na vanjskom ušću mokraćne cijevi. Tumor je lokalno odstranjen i imunohistokemijski je potvrđena dijagnoza malignoga melanoma. Poslije tri mjeseca učinjena je donja uretrektomija. Rub je bio negativan na tumor i bolesnica je živa nakon više od pet godina praćenja., Primary malignant melanoma of the female urethra is a rare tumor with great agressivity and poor prognosis. We reported the case of 65-year-old woman with polypoid tumor on the external meatus of the urethra. Tumor was localy resected, and immunohistochemistry revealed diagnosis of malignant melanoma. After three months distal urethrectomy was performed with tumor-free margin, and the patient is still alive during more than five years follow up period.

Frozen section (intraoperative biopsy) is one of the most important and most difficult procedures that a pathologist performs during his/her practice. It is performed daily at most pathology departments and requires experience, the capacity to make quick decisions under pressure, the knowledge of clinical medicine, and awareness of the limitations of the method. The aim of the study was to determine the number of frozen sections according to surgical departments and diagnoses at Surgical Pathology Division of the Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital in Zagreb, during the 1998-2004 period. Data were retrieved from the Thanatos program for data archiving, analyzed and divided according to departments (ENT, general surgery, neurosurgery, urology, gynecology, and others) and diagnoses (benign tumor, malignant tumor, other conditions and description). During the 1998-2004 period, the relative frequency of frozen sections rose steadily from 6.25% in 1998 to 7.78% in 2004 (p, Intraoperacijska biopsija je jedan od najvažnijih i najtežih dijagnostičkih postupaka koje patolozi poduzimaju tijekom svog rada. Na većini odjela za patologiju ona se izvodi svakodnevno. Cilj rada bio je utvrditi broj intraoperacijskih biopsija i na njima postavljenih dijagnoza na Kliničkom zavodu za patologiju «Ljudevit Jurak», Kliničke bolnice «Sestre milosrdnice» u Zagrebu, tijekom razdoblja od 1998. do 2004. godine. Za analizu podataka uporabljen je program za pohranjivanje i obradu podataka iz patologije «Thanatos». Podaci su podijeljeni s obzirom na kirurški odjel (ORL, opća kirurgija, neurokirurgija, urologija, ginekologija i ostali) te s obzirom na postavljenu dijagnozu (dobroćudni tumor, zloćudni tumor, ostala stanja, metastaze i opis). Tijekom razdoblja od 1998. do 2004. broj intraoperacijskih biopsija se neprekidno povećavao, s relativnom učestalošću od 6,25% u 1998. do 7,78% u 2004. godini (p

The aim of the study was to evaluate morphological changes of maxillary sinus mucosa and to compare them with the levels of tryptase, myeloperoxidase (MPO) and eosinophil cationic protein (ECP) in sinus lavage, and also with subjective outcomes in patients with chronic rhinosinusitis after endosinusal treatment. Thirty patients with the symptoms of chronic rhinosinusitis were recruited for the study. Inclusion criteria were sinusitis symptoms persisting for more than 3 months and maxillary sinus mucosa thickening by >6 mm, considered as maxillary sinusitis. Patients with asthma, polyposis, recent infection, systemic steroid therapy or previous sinus surgery were excluded. Patients were treated endosinusally with 2 mg dexamethasone and 40 mg gentamicin per maxillary sinus daily for 5 days. Patients rated their nasal/ chronic rhinosinusitis disease-specific symptoms and completed a self-administered questionnaire concerning sinusitis symptoms at inclusion and after 30 days. Sinus lavage with 5 ccm of saline was obtained prior to the first endosinusal treatment. Tryptase, MPO and ECP were determined from lavage fluid. Biopsy specimens of maxillary sinus mucosa were obtained by biopsy forceps during sinusoscopy through the inferior meatus in local anesthesia. Fifteen (50%) patients showed improvement and symptom alleviation after the treatment (responders), and 15 (50%) were unchanged or worsened (IR 0.05) between the responders and nonresponders. Responders had a higher level of MPO and ECP in sinus lavage and higher number of mononuclears and eosinophils in biopsy specimens of maxillary sinus mucosa than nonresponders. There was no statistical difference in tryptase and other histologic parameters (number of mononuclears, edema, fibrosis, seromucous glands and goblet cell density) between responders or nonresponders. Eosinophilia in maxillary sinus mucosa specimens showed close correlation with ECP level in sinus lavage and inverse correlation with fibrosis (p