Učestalost pločaste metaplazije u karcinoma prijelaznog epitela mokraćnog mjehura

Squamous metaplasia in transitional cell carcinoma of urinary bladder is considered as an adverse prognostic factor. Those patients have weaker response on therapy and lower survival rate. The aim of our study was to determine the incidence of squamous metaplasia in bioptic material according to histologic grade and growth pattern. In our study we used pathohistological data of 1781 patients operated for urinary bladder cancer in Department of Urology of Sestre milosrdnice University Hospital during the period from 1989 to 2000 squamousmetaplasia was found in 5.7% of patients. According to growth pattern, this phenomenon is more frequent in patients with solid growth pattern. In papillary cancers, the higher incidence of squamousmetaplasia was determined in G1 and G2 histologic grade, while in solid growth pattern, the most cases with squamous metaplasia or over 90% were of G3 histologic grade. Muscle layer invasion were present in high percentage of both, papillary and solid urothelial cancers with squamous metaplasia, which imply the high malignant potential of cancers with foci of squamous metaplasia.Pločasta metaplazija u karcinomima urotela mokraćnog mjehura smatra se jednim od važnih, prognostički lošijih znakova ove bolesti. Bolesnici s karcinomima urotela koji sadrže žarišta pločaste metaplazije, slabije reagiraju na terapiju, i imaju značajno kraće preživljavanje. Cilj istraživanja bio je utvrditi učestalost pločaste metaplazije u karcinomima urotela mokraćnog mjehura s obzirom na histološki gradus i način rasta. U radu je pregledana 1771 biopsija karcinoma mokraćnog mjehura pacijenata operiranih na Klinici za urologiju Kliničke bolnice «Sestre milosrdnice». Pločasta metaplazija nađena je u 102 (5,7%) bolesnika. Ova promjena je češće bila zastupljena u karcinomima solidnog načina rasta, osim kod papilarnih karcinoma urotela G1 i G2 stupnja diferenciranosti. Invazija u mišićni sloj stjenke mokraćnog mjehura nađena je u visokom postotku istraživanih karcinoma i papilarnog i solidnog načina rasta, što nedvosmisleno govori o značajnim visokim malignim potencijalima karcinoma urotela s ovom promjenom

Primarni zloćudni melanom sluznice usne šupljine

Primary oral malignant melanoma usually presents as a dark brown or black lesion. It is a rare malignancy, accounting for less than 1% of all melanomas and 1.6% of all head and neck malignancies, thus forming up to 0.5% of all oral malignancies in the world literature. In general, the prognosis of oral melanoma is poor and worse than that of cutaneous melanoma. The preferred treatment is radical surgery alone or in combination with radiotherapy, chemotherapy, immunotherapy and immunomodulatory agents. A case is presented of a large malignant melanoma of oral cavity, noticed six months before initial biopsy and by history described as a rapidly growing mass.Primarni melanom sluznice usne šupljine obično je tamno smeđe ili crno pigmentirana lezija. Vrlo je rijetka zloćudna bolest koja se javlja u manje od 1% svih melanoma i čini 1,6% svih maligniteta glave i vrata tvoreći, kako navodi svjetska literatura, do 0,5% svih maligniteta u usnoj šupljini. Općenito, prognoza je lošija nego kod kožnih melanoma. Kirurška resekcija je jedan od najčešćih oblika liječenja, a pokušava se i radioterapijom, kemoterapijom, imunoterapijom i imunomodulatorima. Opisuje se slučaj velikog melanoma u usnoj šupljini ubrzani rast kojega je primijećen šest mjeseci prije biopsije i potvrđene dijagnoze

Hepatomegalija i povišene aminotransferaze u bolesnice s loše reguliranom šećernom bolešću

Elevated liver function tests, right upper quadrant abdominal pain, and hepatomegaly occurring in a diabetic patient treated with high doses of insulin may point to the presence of pathologic glycogen accumulation in the liver parenchymal cells. The condition was first described in children, however, studies performed in adults have shown a condition that is similar in many aspects. A case is presented of a 41-year-old female diabetic patient with abnormal liver tests and hepatomegaly. Abdominal ultrasound confirmed liver enlargement without any signs of fatty liver. Liver biopsy revealed a picture compatible with glycogenosis. As excessive hepatic glycogen deposition occurred at an adult age and without a related family history, while the patient presented with normal mental and motor development, the diagnoses of Mauriac syndrome and hereditary were ruled out. The condition was attributed to insulin hyperdosage. The patient was recommended improved glycemic control, more appropriate diet and physical exercise. On follow-up visit 3 months of discharge from the hospital, significant hepatomegaly regression was demonstrated by palpation and ultrasonography, and was accompanied by normalization of serum aminotransferases, blood glucose and glycosylated hemoglobin. Elevated serum aminotransferases and alkaline phosphatase with hepatomegaly as a consequence of hepatocellular glycogen accumulation can occur in diabetic patients of any age who are treated with high doses of insulin, and should therefore be included in the differential diagnosis.Pojava povišenih jetrenih enzima, bolova u desnom gornjem abdominalnom kvadrantu i hepatomegalije u bolesnika sa šećernom bolešću liječenih visokim dozama inzulina može ukazivati na patološko nakupljanje glikogena u stanicama jetrenog parenhima. Ovo je stanje prvotno opisano u djece, a kasnije studije provedene na odraslima pokazale su jednaku kliničku sliku. Prikazan je slučaj 41-godišnje žene oboljele od šećerne bolesti s poremećenim jetrenim nalazima i hepatomegalijom, kod koje je ultrazvuk potvrdio povećanje jetre bez znakova steatoze, a biopsijom je postavljena dijagnoza glikogenoze. S obzirom na to da je izrazito nakupljanje glikogena u ovom slučaju nastupilo u odrasloj dobi, bez pozitivne obiteljske anamneze, a bolesnica je imala uredan psihički i tjelesni razvoj, iz diferencijalne dijagnoze se je mogao isključiti Mauriacov sindrom i nasljedna glikogenoza. Uzrok ovoga stanja u ove bolesnice bilo je liječenje osnovne bolesti visokim dozama inzulina. Stoga joj je preporučena poboljšana kontrola glikemije praćena ispravnom dijetom i tjelesnom aktivnošću. Na kontrolnom pregledu nakon tri mjeseca došlo je do regresije hepatomegalije potvrđene palpacijom i ultrazvukom, te do normaliziranja serumskih aminotransferaza, glukoze u krvi i glikoziliranog hemoglobina. Povišene aminotransferaze i alkalna fosfataza uz hepatomegaliju mogu se naći kod bolesnika dijabetičara liječenih visokim dozama inzulina, kao posljedica nakupljanja glikogena u jetrenim stanicama, pa ovo stanje treba uključiti u diferencijalnu dijagnozu

Frequency of tuberculosis at autopsies in a large hospital in Zagreb, Croatia: a 10-year retrospective study

Aim To assess the frequency and forms of pulmonary tuberculosis at autopsy in a high-traffic hospital in the capital city of a country with a low tuberculosis incidence. Methods We performed a retrospective search of autopsy data from the period 2000 to 2009 at Sestre Milosrdnice University Hospital Center, Zagreb, Croatia. We also examined patients’ records and histological slides. Results Of 3479 autopsies, we identified 61 tuberculosis cases, corresponding to a frequency of 1.8%. Active tuberculosis was found in 33 cases (54%), 23 of which (70%) were male. Of the 33 active cases, 25 (76%) were clinically unrecognized and 19 (76%) of these were male. Conclusion Clinically undiagnosed tuberculosis accounted for a substantial proportion of active tuberculosis cases diagnosed at autopsy. Autopsy data may be an important complement to epidemiological data on tuberculosis frequency

Značaj FHIT i Bcl-2 u bolesnika s oralnim lihen planusom u usporedbi s zdravom oralnom sluznicom i oralnim karcinomom pločastih stanica

Background: Oral lichen planus (OLP) is a precancerous lesion which might progress into oral squamous cell cancer (OSCC) in 0-1.2 % of the affected patients. Albeit there are many published studies upon this topic, there are no universally accepted clinical and histopathological criteria which would suggest which patients will develop OSCC. Therefore, the aim of this study was to compare epithelial and sub epithelial FHIT and Bcl-2 expression between patients with OLP, OSCC and healthy oral mucosa.Materials and Methods: Fifty patients with OLP, 20 with OSCC who had histologically confi rmed diagnoses and 20 healthy controls were included in this study. Immuno-histochemical analysis was performed on primary monoclonal antibodies Bcl-2 (Dako, Finland) and FHIT (Zymed Laboratories Inc., USA) were used. Statistical analysis included Kolmogorov-Smirnoff test, χ2 test and Spearman’s correlation. All p values lower than p<0.05 were considered as significant. Results: Expression of FHIT in the OLP and OSCC epithelium is significantly decreased when compared to the healthy oral mucosa. However, no significant differences between FHIT expression between OLP and OSCC could be found. OLP and OSCC patients have signifi cantly increased expression values of Bcl-2 in the epithelium when compared to the epithelium of healthy participants. Furthermore, Bcl-2 expression is significantly increased in patients with OLP when compared to the patients with OSCC. Subepithelial infiltrate in OLP and OSCC reveals signifi cantly higher Bcl 2 expression when compared to the healthy controls. However, Bcl-2 expression in the infl ammatory infi ltrate is signifi cantly higher in OSCC patients when compared to the OLP patients. Conclusion: Loss of FHIT expression in the epithelium is not suffi cient for malignant transformation in OLP patients. It seems that other molecular changes are needed for OLP progression into OSCC. Bcl-2 expression in the infl ammatory infi ltrate is signifi cantly higher in OSCC patients when compared to the OLP patients and healthy controls, however bcl-2 expression in the epithelium does not correlate with precancerous (OLP) and OSCC lesions.Uvod: Oralni lihen planus (OLP) je prekancerozna lezija koji u 0-1,2 % oboljelih može progredirati u oralni karcinom pločastih stanica (OKPS). Premda su objavljeni brojni radovi na ovu temu, ne postoje opće prihvaćeni klinički i patohistološki kriteriji koji bi upućivali na to u kojih će se bolesnika razviti OKPS. Dakle, cilj je ovog istraživanja bio usporediti ekspresiju FHIT i Bcl-2 u epitelu i subepitelu pacijenata s OLP, OKPS te osoba sa zdravom oralnom sluznicom. Materijal i metode: U istraživanje je bilo uključeno pedeset pacijenata s histološki potvrđenom dijagnozom OLP, 20 pacijenata s histološki potvrđenom dijagnozom OKPS te 20 zdravih pacijenata kao kontrolna skupina. Korištene su imunohistokemijske analize na primarnim monoklonim protutijelima Bcl (Dako, Finska) i FHIT (Zymed Laboratories Inc., SAD). U statističkoj analizi korišteni su Kolmogorov-Smirnovljev test, hi kvadrat test i Spearmanov koefi cijent korelacije. P vrijednosti manje od 0.05 su smatrane značajnima. Rezultati: Ekspresija FHIT u epitelu zahvaćenom s OLP i OKPS je značajno smanjena u usporedbi sa zdravom oralnom sluznicom. Međutim, nije nađena značajna razlika u FHIT ekspresiji kod OLP i OKPS. Pacijenti oboljeli od OLP i OKPS imaju značajno pojačanu ekspresiju Bcl-2 u usporedbi s zdravim sudionicima. Nadalje, Bcl-2 ekspresija je značajno veća u pacijenata s OLP, nego u pacijenata s OKPS. Subepitelni infi ltrat u pacijenata s OLP i OKPS pokazuje značajno povećanje Bcl-2 ekspresije u odnosu na zdrave osobe iz kontrolne skupine. Međutim, Bcl-2 ekspresija u upalnom infiltratu je značajno viša u OKPS pacijenata nego li u OLP pacijenata. Zaključak: Gubitak FHIT ekspresije u epitelu sam po sebi nije dovoljan za zloćudnu transformaciju kod pacijenata koji boluju od OLP. Čini se da su za progresiju OLP u OKPS potrebne i druge molekularne promjene. Ekspresija Bcl-2 u upalnom infi ltrate je znakovito visa u bolesnika s OPKS u odnosu na bolesnicke s OLP i zdrave kontrole, ipak, ekspresija bcl-2 u epitelu ne korelira s prekanceroznim (OLP) odnosno lezijama OPKS

Slučaj karcinoma stanica prstena pečatnjaka žučnog mjehura: Imunohistokemija i diferencijalna dijagnostika

The morphological spectrum of gallbladder carcinoma is broad and variable. Most of these tumors are tubular adenocarcinomas. There are some tumors with unusual morphology that may be difficult to classify due to their rarity. One of such tumors is the signet-ring cell carcinoma, which is a highly aggressive, mucin producing variant of gallbladder adenocarcinoma predominantly or exclusively composed of signet-ring cells. Histologically, these tumors are similar to their counterparts in other organs such as stomach, colon and breast, and should not be misinterpreted as metastatic carcinoma from one of these primary sites. The literature about this variant of carcinoma is sparse and little is known about it. We found only three cases of signet-ring cell carcinoma of the gallbladder previously reported. We present the case of an 86-year-old woman with signet-ring cell carcinoma of the gallbladder and discuss the potential diagnostic dilemmas and pitfalls.Morfološki spektar karcinoma žučnog mjehura širok je i raznolik. Većina tumora su tubularni adenokarcinomi. Postoje neki tumori neobične morfologije koje je teže klasificirati zbog njihove rijetkosti. Jedan od takvih tumora je karcinom stanica prstena pečatnjaka, visoko agresivna varijanta adenokarcinoma žučnjaka koja proizvodi sluz, a pretežito je ili isključivo sastavljena od stanica tipa prstena pečatnjaka. Histološki, ovi su tumori slični svojim pandanima u drugim organima kao što su želudac, debelo crijevo i dojka te ih se ne bi smjelo pogrešno interpretirati kao metastatske karcinome iz spomenutih organa. Literatura na temu ovoga tipa karcinoma je rijetka i o njemu se malo zna. Našli smo samo 3 prethodno objavljena slučaja ovoga karcinoma. U članku se prikazuje slučaj 86-godišnje žene s karcinomom stanica prstena pečatnjaka žučnjaka i raspravlja o potencijalnim dijagnostičkim dvojbama i mogućim pogreškama

Hepatomegalija i povišene aminotransferaze u bolesnice s loše reguliranom šećernom bolešću

Elevated liver function tests, right upper quadrant abdominal pain, and hepatomegaly occurring in a diabetic patient treated with high doses of insulin may point to the presence of pathologic glycogen accumulation in the liver parenchymal cells. The condition was first described in children, however, studies performed in adults have shown a condition that is similar in many aspects. A case is presented of a 41-year-old female diabetic patient with abnormal liver tests and hepatomegaly. Abdominal ultrasound confirmed liver enlargement without any signs of fatty liver. Liver biopsy revealed a picture compatible with glycogenosis. As excessive hepatic glycogen deposition occurred at an adult age and without a related family history, while the patient presented with normal mental and motor development, the diagnoses of Mauriac syndrome and hereditary were ruled out. The condition was attributed to insulin hyperdosage. The patient was recommended improved glycemic control, more appropriate diet and physical exercise. On follow-up visit 3 months of discharge from the hospital, significant hepatomegaly regression was demonstrated by palpation and ultrasonography, and was accompanied by normalization of serum aminotransferases, blood glucose and glycosylated hemoglobin. Elevated serum aminotransferases and alkaline phosphatase with hepatomegaly as a consequence of hepatocellular glycogen accumulation can occur in diabetic patients of any age who are treated with high doses of insulin, and should therefore be included in the differential diagnosis.Pojava povišenih jetrenih enzima, bolova u desnom gornjem abdominalnom kvadrantu i hepatomegalije u bolesnika sa šećernom bolešću liječenih visokim dozama inzulina može ukazivati na patološko nakupljanje glikogena u stanicama jetrenog parenhima. Ovo je stanje prvotno opisano u djece, a kasnije studije provedene na odraslima pokazale su jednaku kliničku sliku. Prikazan je slučaj 41-godišnje žene oboljele od šećerne bolesti s poremećenim jetrenim nalazima i hepatomegalijom, kod koje je ultrazvuk potvrdio povećanje jetre bez znakova steatoze, a biopsijom je postavljena dijagnoza glikogenoze. S obzirom na to da je izrazito nakupljanje glikogena u ovom slučaju nastupilo u odrasloj dobi, bez pozitivne obiteljske anamneze, a bolesnica je imala uredan psihički i tjelesni razvoj, iz diferencijalne dijagnoze se je mogao isključiti Mauriacov sindrom i nasljedna glikogenoza. Uzrok ovoga stanja u ove bolesnice bilo je liječenje osnovne bolesti visokim dozama inzulina. Stoga joj je preporučena poboljšana kontrola glikemije praćena ispravnom dijetom i tjelesnom aktivnošću. Na kontrolnom pregledu nakon tri mjeseca došlo je do regresije hepatomegalije potvrđene palpacijom i ultrazvukom, te do normaliziranja serumskih aminotransferaza, glukoze u krvi i glikoziliranog hemoglobina. Povišene aminotransferaze i alkalna fosfataza uz hepatomegaliju mogu se naći kod bolesnika dijabetičara liječenih visokim dozama inzulina, kao posljedica nakupljanja glikogena u jetrenim stanicama, pa ovo stanje treba uključiti u diferencijalnu dijagnozu

Hemangiopericitom ili hemangiopericitomu nalik tumor jednjaka: prikaz slučaja i pregled literature

Hemangiopericytoma is a rare malignant vascular tumor deriving from pericytes. It usually occurs in the extremities and retroperitoneum, and extremely rarely in the gastrointestinal tract. A case of hemangiopericytoma in the gastroesophageal region is reported. A 56-year-old man was treated with H2-receptor antagonist for dyspeptic symptoms that had occurred three months before. Therapy failed to prove successful and gastroendoscopy was performed in March 2001 to reveal slightly reddish ventricular mucosa with normal rugal folds and a sessile, polypoid, grayish mass of rough surface located at the gastroesophageal junction. Histopathologic examination of polypoid mass samples revealed a vascular tumor covered with squamous epithelium. The hallmarks of the tumor were numerous branching, slit-like capillary channels with "staghorn" appearance, and large gaping sinusoidal spaces enclosed within nests of ovoid cells. Vascular invasion, mitotic activity, giant cells and necrosis were not found. Immunohistochemical analysis showed diffuse and strong reactivity for vimentin and focal, low or moderate reactivity for actin, S-100 and smooth muscle actin. Proliferation index measured by PCNA and Ki-67 ranged from 2% to 13% (median 11.2%) and from 5% to 18% (median 7.6%), respectively. A diagnosis of hemangiopericytoma with low malignant potential was made. Almost two years of the intervention, the patient is alive and free from any signs of tumor spread.Hemangiopericitom je rijedak maligni vaskularni tumor koji potječe od pericita. Najčešće je javlja na ekstremitetima, te u području peritoneuma, a iznimno rijetko ga se nalazi u probavnom sustavu. Opisuje se slučaj hemangiopericitoma nađenog u gastroezofagusnom području. Bolesnik star 56 godina liječen je tri mjeseca antagonistima H-2 receptora zbog dispeptičnih problema. Preporučena terapija nije pokazala očekivani rezultat, pa je učinjena gastroskopija. Nađena je sesilna polipozna tvorba veličine novčića, sivkaste boje i neravne površine u gastroezofagusnom području. Histopatološki je odstranjena tvorba bila građena od razgranatih kapilarnih prostora tipa "staghorn", okruženih gnijezdima ovalnih stanica koje su tvorile solidan uzorak. Nekroze, vaskularna invazija, velike stanice i mitoze nisu nađene. Tumorske stanice su pokazivale difuznu, izrazito pozitivnu imunoreakciju na vimentin, dok je reakcija na aktin, S-100 i glatkomišićni aktin bila žarišna i slabog intenziteta. Proliferacijska aktivnost tumora iznosila je između 2% i 13% (medijan 11,2%) mjerena pomoću PCNA, te između 5% i 18% (medijan 7,6%) mjerena pomoću Ki-67. Postavljena je dijagnoza hemangiopericitoma niskog malignog potencijala. Skoro dvije godine nakon postavljene dijagnoze bolesnik je bez znakova bolesti

Promjene u pojavnosti karcinoma debelog crijeva s obzirom na dob, spol, anatomsku lokalizaciju i preživljavanje (1989. - 2002.)

Recent epidemiological studies have suggested that the anatomic distribution of colorectalcarcinoma, especially in developed countries may have undergone a distal to proximal shift over several decades, which has been attributed variously to environmental and genetics factors as well as preventive measures. The aim of the study was to compare some colorectal cancer features (age and sex distribution, anatomic localization, and survival) during fourteen years, in order to assess the possible changing trends of these disease during the observed period and to compare observed data with our previous study published in 1985 as well as with similar colorectal cancer features reported worldwide. The mean age of patients with right-sided carcinomas was slightly higher than in patients with left-sided colorectal carcinomas (65.9 vs+ 65.2). Sex distribution showed male predominance (57.3% vs. 42.7%). Males and females had similar anatomic distribution. Recto-sigmoid was the most common site (77.9%) followed by transverse colon cancers (6.8%), ascending colon cancers (6.5%), cancers in cecum (6.2%) and descending colon cancers (2.6%). In the last four years of the observed period (1999 to 2002) the incidence of right-sided cancers was increased compared to the previous period. Our study showed a continuing trend of the increased incidence of right-sided carcinomas that is similar with reports from western European countries and North America.Novije epidemiološke studije pokazuju da je u razvijenim zemljama došlo do pomaka sijela karcinoma debelog crijeva iz sigme i rektuma prema desnoj strani, odnosno prema cekumu i uzlaznom kolonu što se u prvom redu pripisuje promjenama u načinu prehrane, genetskim čimbenicima te preventivnim mjerama. Svrha ovog istraživanja je da usporedi određene karakteristike karcinoma debelog crijeva i njihove promjene tijekom četrnaest promatranih godina (1989 do 2002) te da ih usporedi s našim prethodnim istraživanjem provedenim 1985. godine i novijim svjetskim istraživanjima. Prosječena dob pacijenata s karcinomom smještenim u desnoj polovini crijeva bila je neznatno viša od dobi pacijenata s lijevostranim karcinomima (65,9 vs. 65,2). Muškarci su obolijevali češće od žena (57.3% vs. 42.7%) međutim anatomska lokalizacija karcinoma u oba spola bila je podjednaka. Rektosigmoidni dio crijeva bio je najčešće zahvaćen tumorom (77.9%), zatim slijedi poprečni kolon (6.8%), uzlazni kolon (6.5%), cekum (6.2%) i silazni kolon (2,6%). U posljednje četiri godine promatranog razdoblja (1998. do 2002.) vidljiv je stalni porast incidencije karcinoma smještenih u desnoj polovini debelog crijeva. Ovo istraživanje pokazalo je da je broj karcinoma desne strane debelog crijeva u naših pacijenata u stalnom porastu što se podudara s istraživanjima provedenim u razvijenim zemljama Europe i Sjeverne Amerike