Citološka punkcija trbušnih organa -desetogodišnje isustvo u jednom centru

The aim of the study was to assess the role of fine needle aspiration cytology (FNAC) in the diagnosis of focal changes in solid abdominal organs. A total of 1084 aspirates from intra-abdominal organs including liver, spleen, pancreas and kidneys obtained by ultrasound (US) guidance during a 10-year period were included in the study. The smears were classified as benign, malignant or suspected of malignancy, and unsatisfactory for interpretation. The liver accounted for more than half of the US-guided FNA procedures, followed by the pancreas with 38%. Out of 1084 aspirations, 192 (17.7%) were inadequate for cytologic analysis. Over half of aspirated lesions in the pancreas were primary cancers, while one-third of pancreatic lesions were benign. In the majority of kidney lesions (83%), cytology found benign changes, mostly cysts. Spleen FNA was least likely; in most cases (59%) it showed lymphoid tissue hyperplasia; in four cases cytologic diagnosis was lymphoma and three lesions were suspected lymphoma. During the study, no major complications were observed on any US-guided FNAC procedure. In conclusion, intra-abdominal FNA is a reliable, sensitive and specific method with a high diagnostic accuracy for the diagnosis of malignant lesions. It can be utilized as a preoperative procedure for the management of all intra-abdominal lesions.Svrha rada bila je procijeniti ulogu citološke punkcije u dijagnostici žarišnih promjena trbušnih organa. U studiju su bila uključena 1084 uzorka ultrazvučno vođene citološke punkcije trbušnih organa, uključujući jetru, gušteraču, bubrege i slezenu, dobivenih u 10-godišnjem razdoblju. Nalazi su klasificirani kao benigni, maligni, suspektni i neadekvatni. Preko polovine punkcija bile su punkcije jetre, a slijede punkcije gušterače. Od 1084 uzorka, 192 (17,7%) su bila neadekvatna za citološku analizu. U više od polovine uzoraka dobivenih punkcijom gušterače nađen je primarni karcinom, dok je oko trećine uzoraka bilo benigno. Većina bubrežnih lezija bila je benigna (83%). Punkcije slezene bile su najrjeđe, u najvećem broju slučajeva radilo se o hiperplaziji limfatičnog tkiva, u četiri slučaja citološka dijagnoza bila je limfom, a u tri slučaja suspektni limfom. Značajnije komplikacije nisu opažene niti u jednom slučaju. Zaključno se može reći da je ultrazvučno vođena citološka punkcija trbušnih organa pouzdana, osjetljiva i specifična metoda u prijeoperacijskoj dijagnostici abdominalnih lezija

FNAC limfnih čvorova glave i vrata tijekom 10-godišnjeg razdoblja - iskustvo jedne ustanove

A wide spectrum of diseases including reactive processes, infections, lymphomas and metastatic tumors can cause enlargement of lymph nodes. The present study on 4062 patients with lymphadenopathy was conducted in the Department of Cytology, Sestre milosrdnice University Hospital Center, Zagreb, during a 10-year period. Of 4062 patients with lymphadenopathy, 1624 were males and 2438 were females, age range from several months to 85 years. Of 4062 fine needle aspiration procedures, 232/4062 (5.7%) samples were nondiagnostic. Lymph node aspirates were benign in 2640/3830 (69%) and malignant in 1190/3830 (31%) cases. Hematologic disease (Hodgkin lymphoma and non-Hodgkin lymphoma) was diagnosed in 482/1190 (40.5%) and metastases in 708/1190 (59.5%) cases. Of 482 patients with hematologic disease, 48/482 (10%) had Hodgkin lymphomas and 434/482 (90%) non-Hodgkin lymphomas. In the group of malignant lymphadenopathy, there were 212/708 (30%) metastatic squamous cell carcinomas, 177/708 (25%) metastatic adenocarcinomas, 149/708 (21%) metastases of other carcinomas, and 170/708 (24%) metastases of other malignant tumors. The present study confirmed the fine needle aspiration cytology of enlarged head and neck lymph nodes to be an excellent first-line method to investigate the nature of the lesions.Najčešći uzrok povećanja limfnih čvorova su reaktivni procesi, upale, limfomi ili metastatski tumori. U ovom radu analizirani su punktati 4062 bolesnika punktirana u Kliničkoj jedinici za citologiju KBC-a „Sestre milosrdnice“ u Zagrebu tijekom 10-godišnjeg razdoblja. Muških bolesnika bilo je 1624, a ženskih 2438. Raspon dobi bolesnika bio je od nekoliko mjeseci do 85 godina. Nedijagnostička su bila 232/4062 (5,7%) uzorka. U 2640/3830 (69%) punktata nađene su dobroćudne promjene, dok su u 1190/3830 (31%) punktata nađene zloćudne lezije. Hematološka bolest (Hodgkinov limfom i ne-Hodgkinov limfom) nađena je u 482/1190 (40,5%) punktata, a metastaze u 708/1190 (59,5%) punktata. Od 482 bolesnika s hematološkom bolešću 48/482 (10%) ih je imalo Hodgkinovu bolest, a 434/482 (90%) ne-Hodgkinov limfom. U skupini malignih limfadenopatija bilo je 212/708 (30%) metastaza karcinoma pločastih stanica, 177/708 (25%) metastatskih adenokarcinoma, 149/708 (21%) metastaza ostalih karcinoma i 170/708 (24%) metastaza ostalih malignih tumora. Ovaj rad potvrđuje da je citološka punkcija povećanih limfnih čvorova glave i vrata odlična metoda za ispitivanje naravi navedenih lezija

PREOPERATIVE DIAGNOSTICS OF THYROID MEDULLARY CARCINOMA WITH EMPHASIS ON CYTOMORPHOLOGICAL FEATURES AND DIFFERENTIAL DIAGNOSIS OF PRIMARY AND SECONDARY THYROID TUMORS

Medularni karcinom štitnjače rijetka je neuroendokrina neoplazma koja nastaje iz parafolikularnih C stanica koje proizvode kalcitonin. Čini 4-10 % svih karcinoma štitnjače. U većini slučajeva (75-80 %) javlja se sporadično, dok je u ostalim slučajevima dio sindroma multiple endokrine neoplazije (MEN). Najčešće se medularni karcinom štitnjače prikazuje u obliku solitarnog čvora u štitnjači. U vrijeme postavljanja dijagnoze oko polovina pacijenata ima povećane vratne limfne čvorove, dok mali broj pacijenata ima udaljene metastaze. Ako je tumor hormonski aktivan, pacijent može imati sistemske simptome. Razmazi dobiveni punkcijom medularnog karcinoma obično su celularni, tumorske stanice najčešće su plazmacitoidne, s ekscentrično postavljenim jezgrama i kromatinom koji pokazuje značajke neuroendokrinih tumora. Citoplazme tumorskih stanica su obilnije, trokutaste ili poligonalne, amfofi lne, fi no zrnate i neoštro ograničene. Pozadina preparata je čista, a može se naći amiloid. U slučajevima diferencijalno-dijagnostičkih poteškoća, od velike pomoći je određivanje kalcitonina imunocitokemijski, te u punktatu ili serumu. Biološko ponašanje medularnih karcinoma može biti povoljno i pokazivati sporu progresiju i dugogodišnje preživljenje, ali može se raditi o brzo progredirajućim tumorima kod kojih se preživljenje mjeri u mjesecima. Preoperacijska dijagnoza medularnog karcinoma izuzetno je bitna ponajprije zbog adekvatne preoperacijske pripreme bolesnika u smislu isključivanja feokromocitoma kod sindroma MEN-a.Medullary thyroid cancer is a rare neuroendocrine neoplasm that arises from the parafollicular C cells that produce calcitonin, a hormone essential for the regulation of calcium metabolism. It accounts for 4%-10% of all thyroid cancers. In most cases (75%-80%), it is sporadic, while in other cases it is part of the multiple endocrine neoplasia (MEN) syndrome. Most often, medullary thyroid carcinoma is presenting as a solitary nodule. At the time of diagnosis, about half of the patients have enlarged cervical lymph nodes, while a small number of patients have distant metastases in the liver, lungs, bones and brain. If the tumor is hormone active, the patient may have systemic symptoms such as diarrhea or fl ushing. Ultrasonically, medullary carcinoma usually appears as a hypoechogenic node with marked vascularity and uneven contours that can sometimes contain microcalcifi cations, and in most cases is located in the upper poles of the thyroid. The sample obtained by fi ne needle aspiration is usually cellular, tumor cells are disseminated or arranged in poorly cohesive groups. They are most often plasmacytoid, but sometimes can also be spindled. The nuclei are eccentric and chromatin shows features of neuroendocrine tumors. Cytoplasms of tumor cells are abundant, triangular or polygonal, amphophilic, fi nely granulated and unsharply limited. Background is clean and sometimes amyloid can be found. Depending on the cytologic picture, differential diagnostic problems can be well differentiated thyroid tumors, primarily follicular neoplasm, lymphomas, poorly differentiated insular carcinoma, metastatic small cell carcinoma, mesenchymal tumors or melanoma. In case of differential diagnostic diffi culties, of great help is to determine calcitonin immunocytochemically or in aspirate or serum. Medullary carcinoma may show low progression and long-time survival, but can also be a rapidly progressive tumor where survival is measured in months. Good prognostic indicators are younger age, female gender, tumor size, tumor localization only in the thyroid gland, and absence of local or distant metastases. In conclusion, medullary thyroid carcinoma is a rare tumor in which we still have to think in diagnosing thyroid nodules, mainly due to adequate preoperative preparation in terms of exclusion of pheochromocytoma in MEN syndrome. Cytologic picture in some cases is typical; however, immunocytochemical evidence of calcitonin is of great help to confi rm morphological diagnosis

T-stanična leukemija velikih granuliranih limfocita – prikaz slučaja

T-cell large granular lymphocytic leukemia (T-LGLL) is an uncommon but probably underdiagnosed disease caused by clonal proliferation of large granular lymphocytes. Diagnosis is typically based on the high number of morphologically characteristic lymphoid cells and finding of an abnormal immunophenotype by flow cytometry. Because of its relatively indolent clinical behavior, observation is often an appropriate therapy. Here we present a case of a 53-year-old male admitted to the hospital because of abdominal pain. Blood examination revealed mild mycrocitic anemia and multiplied lactate dehydrogenase level. Abdominal ultrasound showed splenomegaly of 16 cm, with no lymphadenopathy. Fine needle aspiration of bone marrow revealed hypocellular marrow with 50% of atypical lymphoid cells. There were 81% of atypical medium sized granular lymphocytes with ir-regularly shaped nuclei in peripheral blood, so the cytologic diagnosis was lymphoproliferative proc-ess. Bone marrow biopsy showed nodular and interstitial proliferation of small, partially atypical T lymphocytic cells positive for CD2, CD3, CD5, CD8, granzyme and TIA, and negative for hairy cell markers, CD10, MUM 1, bcl 1, CD4 and CD56. The finding was consistent with T-LGLL. Due to splenomegaly, the patient was treated with cyclosporine and gradually reduced dose of corticoster-oids, leading to regression of splenomegaly and normalization of lactate dehydrogenase level

Aplastic Crisis Induced by Human Parvovirus B19 as an Initial Presentation of Hereditary Spherocytosis

The association between aplastic crisis and human parvovirus (HPV) B19 infection has been described in patients with hereditary spherocytosis (HS). Most cases of aplastic crisis in patients with HS induced by HPV B19 have been reported in children and adolescents. In this paper, we describe an aplastic crisis induced by HPV B19 in the 34 year old female as an initial presentation of HS. Although other viral illnesses cause some decompensation in HS, the anemia is rarely as profound as seen in acute HPV B19 infections15

Hodgkin’s Lymphoma Variant of Richter’s Syndrome

Chronic lymphocytic leukemia/small lymphocitic lymphoma (CLL/SLL) is low-grade malignant lymphoprolipheration, that has tendency to conwert to a higher-grade neoplasam over time. More common is the development of a diffuse large cell lymphoma or transformation into prolymphocytic cell population. In rare cases, 0.1–0.5% of patients develop multiple myeloma or Hodgkin’s disease. We present 65-year old female with Hodgkin’s variant of Richter’s syndrome. On the basis of clinical simptoms, cytological, hystological and immunohistological finding in April 2008 CLL/SLL were diagnosed. The patient was treated with 8 courses of R-CHOP. After 10 month, FNA of the one of the enlarged lymph node on the neck was performed. The diagnosis was Hodgkin’s disease. Immuno-hystological studies of the lymph node was consistent with type I Hodgkin’s type of Richter’s syndrome. Patient was treated with 3 courses of ABVD and radiotherap

MAST CELL LEUKEMIA - CASE REPORT

Mastocitna leukemija je iznimno rijetka, češće nastaje de novo, a oko 15% ih se razvija iz ostalih oblika mastocitoza. Definira se kao visoko-maligna leukemija s lošom prognozom i kratkim preživljenjem. Prikazujemo 72-godišnju bolesnicu, koja je zaprimljena u bolnicu zbog kliničke sumnje na plazmocitom. Pri pregledu nađene su ekcematozne promjene na koži trupa i podlaktica, te slabija pokretljivost. Radiološke slike kostiju pokazale su osteolitičke lezije zdjelice i desne natkoljenice. Punkcijom koštane srži dobivena je hipercelularna koštana srž u kojoj 80% stanica čine mastociti i atipične nezrele mastocitne stanice koje su pozitivne na toluidin, kloracetat, alcian-blu, kiselu fosfatazu i Sudan black, a PAS (Periodic acid schiff) i POX (peroksidaza) su negativni. U razmazu periferne krvi također su nađeni pojedinačni mastociti. Na osnovi morfologije stanica i citokemijskih reakcija postavljena je citološka dijagnoza mastocitne leukemije. Učinjena je i biopsija kosti koja potvrđuje citološku dijagnozu. Bolesnica je liječena antihistaminicima i analgeticima. Dva mjeseca nakon postavljene dijagnoze došlo je do prijeloma prethodno bolne desne natkoljenice nakon čega je provedena lokalna radioterapija. Bolesnica je umrla unutar 6 mjeseci od postavljanja dijagnoze. Zaključujemo da, iako iznimno rijetka, mastocitna leukemija se citološki može dijagnosticirati kada se u koštanoj srži nađe više od 20% patoloških oblika mastocita uz njihovu pojavu u perifernoj krvi.Mast cell leukemia is extremely rare, more offen arises de novo and in 15% of cases developes from preexistence mast cell diseases. It is a high malignant leukemia with bad prognosis and a short survival. A 72-year old female was admitted to hospital with clinically suspected plasmocytoma. She had eccematoid changes on her trunk and underarms. Radiogramm showed osteolytic lesions of the right thigh and pelvis. FNA of the bone marrow revealed hypercellular smear with 80% of mast cells and immature mast cells which were cytochemically positive to toluidin (Figure 1. and 2.), chloracetate, alcian blue, acid fosphatase and Sudan black and negative to periodic acid Schiff (PAS) and peroxidase (POX). The peripheral blood smear showed single mast cells which were positive to toluidin. The bone marrow biopsy confirmed mast cell leukemia. The chariogramm of the bone marrow showed numerical and structural chromosomal changes. Two month after the diagnosis the patient suffered from right thigh fracture and was treated with local radiotherapy, antihistaminic and analgetic therapy. The patient died within 6 month after the diagnosis. Conclusion: Mast cell leukemia is very rare and high grade leukemia with short survival time. Cytological diagnosis is possible, when there is more then 20% of atypical mast cells in the bone marrow aspirate. The diagnosis of aleukemic variant of mast cell leukemia could be stated if there is less then 10% of mast cells in the peripheral blood

Hodgkin’s Lymphoma Variant of Richter’s Syndrome

Chronic lymphocytic leukemia/small lymphocitic lymphoma (CLL/SLL) is low-grade malignant lymphoprolipheration, that has tendency to conwert to a higher-grade neoplasam over time. More common is the development of a diffuse large cell lymphoma or transformation into prolymphocytic cell population. In rare cases, 0.1–0.5% of patients develop multiple myeloma or Hodgkin’s disease. We present 65-year old female with Hodgkin’s variant of Richter’s syndrome. On the basis of clinical simptoms, cytological, hystological and immunohistological finding in April 2008 CLL/SLL were diagnosed. The patient was treated with 8 courses of R-CHOP. After 10 month, FNA of the one of the enlarged lymph node on the neck was performed. The diagnosis was Hodgkin’s disease. Immuno-hystological studies of the lymph node was consistent with type I Hodgkin’s type of Richter’s syndrome. Patient was treated with 3 courses of ABVD and radiotherap

Undergraduate Grade Point Average is a Poor Predictor of Scientific Productivity Later in Career

The aim of this study was to investigate the usefulness of the undergraduate grade point average in prediction of scientific production of research trainees during their fellowship and later in career. The study was performed in 1,320 research trainees whose fellowships from the Croatian Ministry of Science, Education and Sports were terminated between 1999 and 2005. The data were analyzed using logistic regression. The results indicated that undergraduate grade point average was negatively associated with scientific productivity both during and after the fellowship termination. Other indicators, such as undergraduate scientific productivity exhibited much stronger positive association with scientific productivity later in career and should be given more weight in candidate selection process in science and research