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Introduction. Malignant biliary obstruction represents a poor prognostic sign of metastatic colorectal carcinoma. Percutaneous transhepatic biliary drainage (PTBD) is the procedure of choice for palliative biliary decompression, and this method has both diagnostic and therapeutic values. One of the wellknown complications following this procedure is the development of catheter tract metastases that occur in 0.6?6% of cases post-PTBD. In this case report, we present a patient with implantation metastases of colorectal cancer following PTBD. Case report. In the last six years, 89 patients underwent PTBD procedure at the Oncology Institute of Vojvodina. Among these patients, catheter tract implantation metastasis developed in one patient (1.1%). In this report, we present a patient who underwent right hemicolectomy in January 2015 at the Oncology Institute due to colon cancer located in the transverse colon. In January of 2018, a computed tomography scan of the abdomen showed metastatic disease and chemotherapy was initiated. However, 29 months following the start of chemotherapy, the patient developed jaundice, and as a result, PTBD procedure was performed. A control computed tomography scan of the abdomen in March of 2021 showed a de novo subcutaneous nodule 20 mm in diameter located at the level of ninth right rib. The nodule had been considered a part of the scar that formed at a place of catheter entry, and was still present eight months after PTBD procedure. Biopsy of the subcutaneous mass and pathohistological analysis confirmed well differentiated colon adenocarcinoma. Conclusion. Catheter tract implantation metastasis is not a rare complication following PTBD for malignant biliary obstruction. It generally has a poor prognosis. Nevertheless, literature review shows that radical surgical excision of the catheter tract tissue with hepatectomy can prolong survival in select group of patients.

Introduction. Idiopathic granulomatous mastitis (GM) is described as a very rare, non-lactating, chronic mastitis that occurs primarily in women of childbearing age. Significant clinical problem related to GM is the diagnostic differentiation from breast cancer. Less advanced forms of GM can be successfully treated with limited surgical excisions and radical treatment is recommended only for the most extensive forms. Case report. First examination of the patient, by the surgeon at Oncology Institute of Vojvodina was in December 2018, when initial suspicion of breast cancer was set up. Core needle biopsy was performed and after histopathological (HP) analysis, confirmation of GM was obtained. The patient was initially offered Prednisone and Methotrexate therapy, which she refused and accepted only surgical treatment. Surgical treatment was performed few weeks after needle biopsy and consisted of performing a nipple spearing mastectomy with excision of the orifices of all fistulous ducts and their primary sutures. The HP findings of the operative specimen confirmed the diagnosis of GM. While there were no signs of dieses relapse, patient was suggested secondary reconstruction of the left breast. Twelve months after the primary operation, secondary breast reconstruction was performed with the interposition of a contoured silicone implant into a muscle pocket in a standard manner. Conclusion. Nipple spearing mastectomy with secondary breast reconstruction is esthetically satisfactory treatment for patients with locally advanced GM.

Introduction. Mucormycosis is a life-threatening opportunistic infection whose incidence has significantly risen during the last two decades. The gastrointestinal form is very rare, with the stomach as the most common site of infection, followed by the colon and ileum. Risk factors include uncontrolled diabetes mellitus, corticosteroid use, and organ transplantation. We report a patient with a history of rheumatoid arthritis who has developed gastrointestinal mucormycosis. To the best of our knowledge, this is the first such case reported in the literature. Case report. A 53-year-old female patient with a prior medical history of rheumatoid arthritis was admitted to the hospital due to persisting diarrhea. Physical examination revealed diffuse abdominal tenderness to palpation without meteorism and peritoneal signs. Laboratory results demonstrated systemic inflammation, so antibiotic therapy was administered. Abdominal computed tomography findings revealed inflammation of the rectum and the left colon. Colonoscopy findings were indicative of Crohn?s disease. Additionally, the patient had developed profuse rectal bleeding and consequently underwent emergency surgery. Subtotal colectomy with ileostomy and partial gastrectomy was performed. The patient?s condition rapidly worsened after the operation, and she died due to multi-organ failure. Histologic findings of resection specimens discovered chronic active colitis and extensive gastric necrosis associated with dense mixed inflammatory infiltration and numerous non-septate and 90-degree branching hyphae. Diagnosis of invasive gastric mucormycosis was obtained, but unfortunately, several days after the patient?s death. Conclusion. It is very important to obtain high awareness among clinicians of this deadly infection to achieve a prompt diagnosis and effective therapy.

Introduction. Dermatofibrosarcoma protuberans (DFSP) is a very rare mesenchymal tumor that accounts for approximately 0.1% of all malignancies. It is a locally aggressive fibrous tumor, with a high recurrence rate, which sometimes gives rise to distant metastases, usually to the bones and lungs. DFSP usually occurs on the trunk and extremities with only a small number of cases in the breast, especially in men. Case report. This paper analyzes a rare case of DFSP in the male breast. A 66-year-old man presented with gynecomastia of the left breast. The diagnostic work-up comprised of clinical examination, ultrasonography, core biopsy, and mammography. Immunohistochemistry revealed diffuse and strong positivity for vimentin, CD99, and CD34, while the tumor cells were completely negative for keratin, S100 protein, STAT6, CD31, and factor VIII, highly suggestive for DFSP. Subsequently, a radical mastectomy was performed and preoperative diagnosis of dermatofibrosarcoma protuberans was confirmed by pathological examination and immunohistochemistry. The patient was still disease-free six months after the surgical treatment. Conclusion. DFSP is a soft tissue sarcoma that rarely occurs in the breast, especially in men. The most common clinical presentation in the breast is a mass, but it can also present as gynecomastia, as in our case. The diagnosis of DFPS is based on anatomopathology with immunohistochemistry analysis since there are no specific imaging features for this rare entity. Surgical excision with wide and negative margins is optimal for reducing the risk of recurrence.

Introduction. Leiomyosarcoma is a malignant smooth muscle tumor that is most often found in the gastrointestinal tract, uterus, and retroperitoneum. It is uncommon in the upper respiratory tract. Case report. A 53-year-old woman sought treatment for a 3-month history of nasal obstruction and facial pain. An endoscopic examination revealed a polypoid mass involving the right nasal cavity. The patient was operated on. During surgery, a bulky tumor mass was found, which involved the posterior part of the right inferior concha projecting into the lumen of the epipharynx and upper part of the oropharynx. The lesion was completely excised with adequate margins of uninvolved tissue. Histologic slides stained with hematoxylin and eosin showed interlacing fascicles of atypical spindle-shaped cells. Mitotic figures and bizarre giant cells were frequently observed. Immunohistochemical staining revealed that the tumor was positive for smooth muscle actin and h-caldesmon and negative for S-100. Histological and immunohistochemical features were consistent with leiomyosarcoma. The follow-up was regularly performed by nasal endoscopy and computed tomography, and the disease-free period has been 53 months so far. Conclusion. To the best of our knowledge, this is the longest disease-free period in a patient with leiomyosarcoma of the upper respiratory tract since 1996. This tumor has obscure clinical behavior and prognosis, thus we believe it is necessary to have more published data to determine the best combination of existing therapies, as well as potential new therapies, and enable a longer survival period.

Introduction: More than 50% of patients with colorectal cancer (CRC) develop liver metastases during the natural course of disease. Surgical resection is currently the most potentially curative method in the treatment of colorectal liver metastases (CRLM). The goal of surgery is to achieve a negative resection margin (RM) of at least 1 mm, which provides the best prognosis for patients. The RM can be assessed by the pathologist of the resected liver specimen (RLS) and by the surgeon intraoperatively. The aim of this research paper is to determine the degree of agreement on intraoperative assessment of the RM by the surgeon and histopathological RM assessment by the pathologist. Material and methods: This prospective non-randomized double-blind study was approved by the Ethics Committee of the Oncology Institute of Vojvodina and registered on ClinicalTrials.gov #NCT04634526. The study was conducted at the Oncology Institute of Vojvodina, Sremska Kamenica, Serbia. An experienced hepatobiliary surgeon assessed RM for every specimen intra-operatively, immediately after CRLM resection. Resected CRLM lesions were analyzed by two experienced pathologists. These data were compared with pathological RM assessment as a "gold standard". RM of 1 mm or more was rated as negative RM (RM-). Disease-free survival (DFS) and recurrence rate was calculated by RM status defined by surgeon and by pathologist. Results: From 01 January 2015 to 31 August 2019, 98 patients were enrolled in the study. There were 219 RLS with 245 CRLM. The surgeon registered positive RM (RM+) of

Introduction/Background Endometrial cancer is the most common malignancy of the female reproductive tract. Lymph node metastases are an important prognostic factor in endometrial cancer. Several prognostic factors have been shown to correlate with lymph node metastasis: depth of myometrial invasion, cervical infiltration, histologic grade of the tumor, tumor diameter, serous histology, lymphovascular invasion, and positive peritoneal cytology. Methodology Finding the pathohistological parameters that will indicate with greater certainty the possibility of metastases in the lymph nodes, on the basis of which it will be evaluated whether such patients should undergo lymphadenectomy or not. A retrospective analysis of patients with endometrial cancer who underwent surgery at the Oncology Institute of Vojvodina (Clinic for Operative Oncology – Department of Gynecology) in the period from 2012 to 2018.The study included 120 patients who underwent hysterectomy with bilateral adnexectomy and pelvic lymphadenectomy. Results Among patients who had lymph node metastases, there were statistically significant more patients (p Conclusion Histopathological parameters such as type 2 endometrial cancer, myometrial invasion depth greater than 50%, cervical stroma infiltration, lymphovascular invasion and positive peritoneal cytology increase the chances of lymph node metastases. Tumor size (> 2 cm) as well as histologic grade did not correlate with a higher incidence of lymph node metastases. In this study, both the parametrial infiltration and the number of lymph nodes removed have clinical significance, but not statistical significance.

Background: This study aimed to examine the incidence of surgical complications associated with nipple-sparing mastectomy (NSM) with primary implant reconstruction, analyze risk factors for early and late surgical complications of NSM, and determine the incidence of local recurrences and the safety of sparing the nipple-areola complex (NAC). Methods: This retrospective cohort study included 435 patients with 441 NSM procedures over a period of 9 years (2004-2012). All surgical complications and the oncological outcome were recorded during follow-up. Results: The most common early surgical complication was skin flap ischemia/necrosis (26 patients, 5.9%). Prosthesis explantation due to complications was carried out in 11 (2.5%) cases. Neoadjuvant chemotherapy, implant size >500 ml, diabetes mellitus, body mass index > 25 kg/m2, and incisions other than lateral were risk factors for early complications (p < 0.001). The NAC excision rate was 5.4% (24 cases) due to confirmed presence of cancer cells in the subareolar tissue. Capsular contracture as a late complication occurred in 33 (7.48%) cases. Local relapse occurred in 32 (7.3%) patients. Distant metastases were diagnosed in 68 (15.6%) patients, and 53 (12.2%) patients died during the follow-up period. Conclusions: NSM with immediate implant reconstruction has an acceptable morbidity rate and is an oncologically and surgically appropriate treatment for most women requiring mastectomy.

Introduction/Background During the last three decades, fertility preservation was established as a new treatment modality for young patients with early cervical cancer, less than 2 cm, using different surgical approaches and techniques such as vaginal or abdominal simple or radical trachelectomy, total laparoscopic or robotic trachelectomy even large conisation with laparoscopic lympadenectomy. A further goal for gynecological oncology is to consider a fertility-preserving approach in patients with bulky cervical cancer, without compromising the oncology outcome. Methodology The thirty years old nulliparous with uterine sqamous cervix cancer FIGO stage IB2, 3 cm, underwent neoadjuvant chemotherapy, three cycles of Cisplatin and Ifosfamide dose dense regime according to Prague protocol. MRI was performed pre and post NACT treatment. Results Due to complete pathologic response after three cycles of neoadjuvant chemotherapy conservative surgery was performed. The patient underwent laparoscopic pelvic lymphadenectomy, uterine cervix conisation and the cervical canal curettage. The histopathology of specimen confirmed the complete response, with H SIL only. There was no need for adjuvant treatment. At the first follow up the length of uterine cervix was sufficient and PAP smear was normal. One year after surgery, patient is without disease. At the last control she was in sixteen weeks of gestation. Conclusion Until now, small case control studies concluded that neoadjuvant chemotherapy followed by conservative fertility spare surgery in young patients with bulky cervical cancer who respond well to chemotherapy, is an acceptable approach. Still, more evaluation and data is needed for this group of patients before widespread use. Disclosure Nothing to disclose.

Introduction. Leiomyosarcoma of the penis (LSP) is an extremely rare form of penile tumor. LSP can be divided into two subtypes: deep and superficial. The goal of this manuscript is to present very rear case of LSP. Case outline. On exam, the patient presented with a slowly ?growing penile bump?, for which an initial diagnosis of non-inflamed penile atheroma was given. Further diagnostic workup was omitted. Outpatient excisional biopsy was performed, and the tumor was sent for pathohistological examina-tion (PHE), which revealed LSP. The patient has not received any further treatment. The most recent follow up was 2.5 years after surgery, and the patient continues to do well without any complications. Conclusion. LSP is an extremely rare disease which can be cured if it is diagnosed in its early stage. PHE is necessary for diagnosis of LSP.

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

Background: Hepatectomies are mostly performed for the treatment of hepatic benign or malignant neoplasms, intrahepatic gallstones, or parasitic cysts of the liver. The most common malignant neoplasms of the liver are metastases from colorectal cancer. Anatomic liver resection involves two or more hepatic segments, while non-anatomic liver resection involves resection of the metastases with a margin of uninvolved tissue. The aim of this manuscript was to show results of hepatectomies performed at the Oncology Institute of Vojvodina. Methods: We performed 133 liver resections from January 1997 to December 2013. Clinical and histopathological data were obtained from operative protocols, histopathological reports, and patients? medical histories. Results: We did 80 metastasectomies, 51 segmentectomies, and 18 radiofrequent ablations (RFA). Average number of colorectal cancer metastases was 1.67 per patient. We also made 10 left hepatectomies. In all cases, we made non-anatomic resections. Conclusion: Decision about anatomic versus non-anatomic resections for colorectal metastasis and primary liver tumors should be made before surgical exploration. Preservation of liver parenchyma is important with respect to liver failure and postoperative chemotherapy treatment.

A 21-year-old patient, in her first and regularly controlled uneventful pregnancy, was admitted to hospital due to lower leg edema, hypertension, proteinuria, and weight gain. Fetal death occurred the next day and a female nonhydropic fetus, 40 cm CH, 1460 grams, at 29-week gestation was delivered. An autopsy showed no visible gross abnormalities except in the heart. The heart was enlarged, with five intramural and subendocardial nodules, 0.3 to 1 cm in size, three in the left ventricular free wall, and one in the right ventricle and right atrium, sharply demarcated, reddish-gray, moderately firm, with the typical appearance of rhabdomyoma.

Pulmonary granular cell tumors (GCTs) are uncommon and usually benign and their coexistence with bronchogenic adenocarcinoma is rare. We report the case of 50-year-old woman with GCT located in the left lung hilum, which occurred simultaneously with a primary bronchogenic adenocarcinoma in the same area. Contrast CT scan of the head revealed secondary deposits in the right cerebellum, presumably of adenocarcinomas origin. Bronchoscopy revealed narrowing on the beginning of the left lingular bronchus and infiltration of the medial distal wall of the left main bronchus. Large tumor cells with eosinophilic granular cytoplasm were seen on light microscopic examination. Tumor cells fully occupied submucosa and had small, round nuclei with no signs of pleomorphism. Immunohistochemically, these cells were S-100 positive. In small area, groups of atypical oval-shaped cells of adenocarcinomas origin were noticed. This confirmed the diagnosis of GCT coexisting with adenocarcinoma. After consultation with oncologists, the patient was scheduled for further polychemotherapy and radiation treatment.

Background: Soft tissue sarcomas (STS) represent 1% of all malignant lesions. In this study the authors analyzed the incidence of STS in Vojvodina (the north region of Serbia) in the period from 1985 to 2009. A number of studies conducted worldwide indicate that STS incidence rates are tending to increase. Materials and Methods: On the basis of data from the Cancer Registry of Vojvodina, age standardized STS incidence rates were established as well as their linear trend, with data on histological structure, age, gender and STS distribution at specific locations. Results: The total number of registered patients was 1,308. Average age standardized rate was 1.90/100,000 per year. The investigated period showed a slight increase in the incidence rate (average annual percent increase=0.77%). The most frequent histological type was sarcoma not otherwise specified-NOS (27%), followed by leiomyosarcoma (21%), liposarcoma (14%), rhabdomyosarcoma (11%) and malignant fibrous histiocytoma (9%). The male/female ratio was 0.73:1. Every fifth patient was younger than 39. Conclusions: Comparison among eight international STS epidemiology studies show that the incidence rate range is between 1.4/100,000-5.0/100,000, though our finding is closer to the lower limit. Furthermore, the incidence rate increase was lower than that characteristic for the half of the analyzed studies. A partial explanation for that should be looked for among changes in diagnostic criteria and STS classifications.

Gastrointestinal tract xanthomas are non tumor, well demarcated mucosal lesions that consist of foamy histiocytes, most commonly diagnosed in the stomach. The histologic appearance of xanthomas can resemble certain malignant lesions. After retrospective data base search, we have encountered only 2 cases of xanthomas, both in the antral part of the stomach. Lamina propria of the mucosa contained rare, chronic inflammatory infiltrate and clusters of oval and polygonal cells with abundant, foamy cytoplasm. The cytoplasm of described cells did not show the presence of mucin (Periodic acid-Schiff (PAS) and Alcian blue staining). The cells showed distinct cytoplasmic CD68 positivity and CKMNF116 negativity, which confirmed the diagnosis of xanthoma. Given the frequent association of xanthomas and known precancerous lesions of gastric mucosa, and occasional coexistence of malignant change, we need to pay attention to its diagnosis, and it is advisable to use both histochemical and immunohistochemical methods.

Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal proliferation with numerous slit-like spaces lined by spindle cells. This is not an uncommon finding showing small microscopic foci, but tumor-forming PASH is rare, especially in postmenopausal women. It has to be distinguished from other benign and malignant tumor, especially from low-grade angiosarcoma. The recommended treatment is wide local excision.