Histopathology of glial tumors

Glijalni tumori najèešći su tumori mozga. Ova skupina obuhvaća cijeli raspon tumora, od najdobroćudnijih, kao što su to pilocitni astrocitomi, do najzloæudnijih tumora u čovjeka, kao što su glioblastomi. Glijalni tumori ponekad predstavljaju pravi dijagnostièki izazov, ne samo neurolozima, neuroradiolozima i neurokirurzima, veæ i neuropatolozima. Dijagnostièki izazov ponekad je tim veæi i stoga što ukljuèuje i komunikacijske probleme koji proizlaze iz èinjenice da lijeènici razlièitih specijalizacija ponekad govore o jednom, istom tumoru, ali se meðusobno ne razumiju. Cilj je ovog èlanka da patološke osobitosti glijalnih tumora središnjeg živèanog sustava približi lijeènicima klinièarima, te time prevlada moguæe pojmovne prepreke.The most prevalent tumors of the central nervous system are glial tumors. This group of tumors encompasses the whole span from the most benign brain tumors such as pilocytic astrocytomas to the most malignant tumors such as glioblastomas. These tumors are sometimes diagnostically challenging not only for clinicians but also for neuropathologists. Diagnostic challenge is even greater because of the usage of different terminologies – physicians of different specialties frequently talk about the same tumor but without understanding each other. The aim of this article is to overcome this obstacles by presenting concise histopathological features in order to make them more familiar to clinicians

Pathology diagnosis of idiopathic inflammatory myopathies

Idiopatske upalne miopatije predstavljaju skupinu imunološki posredovanih bolesti uzrokovanih upalnim promjenama skeletnog mišića koje mogu dovesti do njegova ireverzibilnog oštećenja. Na temelju kliničkih, histoloških i imunoloških obilježja razlikujemo tri zasebna entiteta, a to su dermatomiozitis, polimiozitis i miozitis inkluzijskih tjelešaca. Za definitivnu potvrdu dijagnoze idiopatskih upalnih miopatija treba napraviti histološku, histokemijsku, imunohistokemijsku i elektronsko-mikroskopsku analizu odgovarajućeg biopsijskog uzorka skeletnog mišića. Međutim, unatoč iscrpnoj morfološkoj analizi razlikovanje ovih bolesti nije uvijek očito te je za postizanje konačne dijagnoze često ključna kliničko-patološka korelacija. U ovom su članku detaljno opisana morfološka obilježja idiopatskih upalnih miopatija i njihova povezanost s patogenezom patoloških zbivanja.The idiopathic inflammatory myopathies represent a group of immunologically mediated diseases characterized by inflammation of skeletal muscle potentially leading to irreversible damage. On the basis of clinical, histological and immunological features dermatomyositis, polymyositis and sporadic inclusion-body myositis are recognized as separate entities. A definitive diagnosis of idiopathic inflammatory myopathies requires detailed histological, histochemical, immunohistochemical and electron-microscopic analysis of adequate muscle biopsy sample. However, in spite of thorough morphological analysis distinction of these disorders is not always straightforward and a close clinicopathological correlation is often essential to reach a correct diagnosis. Detailed morphological features of idiopathic inflammatory myopathies and their relationship to pathogenesis is outlined

Histopathology of glial tumors

Glijalni tumori najèešći su tumori mozga. Ova skupina obuhvaća cijeli raspon tumora, od najdobroćudnijih, kao što su to pilocitni astrocitomi, do najzloæudnijih tumora u čovjeka, kao što su glioblastomi. Glijalni tumori ponekad predstavljaju pravi dijagnostièki izazov, ne samo neurolozima, neuroradiolozima i neurokirurzima, veæ i neuropatolozima. Dijagnostièki izazov ponekad je tim veæi i stoga što ukljuèuje i komunikacijske probleme koji proizlaze iz èinjenice da lijeènici razlièitih specijalizacija ponekad govore o jednom, istom tumoru, ali se meðusobno ne razumiju. Cilj je ovog èlanka da patološke osobitosti glijalnih tumora središnjeg živèanog sustava približi lijeènicima klinièarima, te time prevlada moguæe pojmovne prepreke.The most prevalent tumors of the central nervous system are glial tumors. This group of tumors encompasses the whole span from the most benign brain tumors such as pilocytic astrocytomas to the most malignant tumors such as glioblastomas. These tumors are sometimes diagnostically challenging not only for clinicians but also for neuropathologists. Diagnostic challenge is even greater because of the usage of different terminologies – physicians of different specialties frequently talk about the same tumor but without understanding each other. The aim of this article is to overcome this obstacles by presenting concise histopathological features in order to make them more familiar to clinicians

Epitelioidni hemangiom orbite: prikaz slučaja

Epithelioid hemangioma (EH) and Kimura’s disease (KD) were once considered different stages of the same disease, as they share many clinical and histopathologic similarities. Nowadays, they are considered as two different entities, but some authors still confuse these terms. Our objective is to present a case of EH occurring in a very uncommon location and to emphasize the microscopic and clinical differences between EH and KD. We present a case of EH of the orbit in an 83-year-old man diagnosed after histopathologic evaluation of a mass that was surgically removed from the orbit. The tumor showed typical microscopic appearance with pathognomonic epithelioid endothelial cells. The diagnosis was also confirmed by immunohistochemical analysis. Our case clearly illustrates typical appearance of EH and the main differences between EH and KD are thoroughly discussed.Epitelioidni hemangiom (EH) i Kimurina bolest (KD) su zbog mnogih kliničkih i histopatoloških sličnosti smatrani različitim stadijima iste bolesti. Danas se smatraju dvama različitim entitetima, ali neki autori još uvijek poistovjećuju ova dva pojma. Naš cilj je predstaviti slučaj EH koji se pojavio na vrlo neuobičajenom mjestu te naglasiti mikroskopske i kliničke razlike između EH i KD. Predstavljamo slučaj EH orbite koji se pojavio kod 83-godišnjeg muškarca. Dijagnoza EH potvrđena je patohistološkom analizom kirurški uklonjenog tumora iz orbite u kojem su nađene specifične epitelioidne endotelne stanice koje nikad nisu prisutne kod oboljelih od KD. Dijagnoza je potvrđena imunohistokemijskom analizom. Opisani slučaj rijetkog orbitalnog tumora jasno pokazuje značajke specifične za EH, uz podrobno prikazane razlike između EH i KD

NEUROMUSKULARNE BOLESTI (novije spoznaje)

Although new diagnostic methods have been developed, unfortunately no causal treatment of inherited neuromuscular diseases exists so far. However, there have been numerous new findings in this area in the last ten years. For example, it has been found that genes mutated in family cases of amiotrophic lateral sclerosis are the SOD1 gene, senataxin (SETX or ALS4), ALS2 gene, vesicle associated protein B (VAPB), NEFH and ALS8. Riluzole is still used in the treatment of ALS. In the treatment of muscular dystrophy in mouse models another potential form of future gene therapy has been demonstrated. It is called treatment with “booster genes”. Numerous genes that cause different forms of Charcot-Marie-Tooth disease have been discovered. The genetic-molecular analysis confirms the disease. The treatment of the disease is symptomatic, but as a possible future treatment option ascorbic acid and antagonists of the progesterone receptors is mentioned. More recently a new group of diseases that are classified as neuromuscular diseases was described. This group includes diseases of ion channels, which are also known as channelopathies. It was proven that this group of diseases is caused by mutations of chloride, calcium, sodium and potassium ion channels. Episodic ataxia type 1 and 2, hyperkaliemic periodic paralysis, familial hemiplegic migraine and malignant hyperthermia are just some of channelopathies

Poslijeintubacijske ozljede traheje: prikazi slučajeva i pregled literature

Post-intubation tracheal injury is a rare and potentially fatal complication. The most common causes are overinflation of endotracheal tube cuffs and multiple intubation attempts in emergency cases. The diagnosis is based on clinical and radiological suspicion of tracheal injury confirmed by fiberoptic bronchoscopy. Decision between conservative and surgical management of the injury depends on clinical presentation (respiratory instability, concomitant diseases), lesion characteristics (lesion site, size, and number), and time elapsed from injury to diagnosis. We present three cases of post-intubation tracheal injury. In two cases, the patients were treated conservatively; in the third case, the patient died from asphyxia caused by thrombus occlusion of the trachea after a longitudinal tracheal lesion. Pre-anesthetic examination did not indicate any possibility of difficult intubation in any of the patients; however, in one of the patients admitted through the emergency department, emergency intubation was performed.Poslijeintubacijska ozljeda traheje je rijetka i potencijalno fatalna komplikacija. Najčešći uzroci ozljeda su prenapuhnuti balončić tubusa i višekratni pokušaji intubacije u hitnim slučajevima. Dijagnoza se temelji na kliničkoj i radiološkoj sumnji koja se potvrđuje fiberoptičkom bronhoskopijom. Odluka o konzervativnom ili kirurškom zbrinjavanju ozljede ovisi o kliničkoj slici bolesnika (respiracijskoj nestabilnosti, pratećim bolestima), značajkama ozljede (mjestu, duljini i broju oštećenja) i vremenu koje je proteklo između trenutka oštećenja i postavljanja dijagnoze. Prikazujemo troje bolesnika s poslijeintubacijskom ozljedom traheje, dvoje od njih liječeni su konzervativno, a jedna je bolesnica preminula zbog asfiksije izazvane začepljenjem traheje ugruškom nastalim nakon longitudinalne lezije. Niti u jednog od njih u prijeoperacijskom anesteziološkom pregledu ništa nije ukazivalo na moguću otežanu intubaciju, osim što je jedan bolesnik zaprimljen i operiran kao hitan slučaj

Poslijeintubacijske ozljede traheje: prikazi slučajeva i pregled literature

Post-intubation tracheal injury is a rare and potentially fatal complication. The most common causes are overinflation of endotracheal tube cuffs and multiple intubation attempts in emergency cases. The diagnosis is based on clinical and radiological suspicion of tracheal injury confirmed by fiberoptic bronchoscopy. Decision between conservative and surgical management of the injury depends on clinical presentation (respiratory instability, concomitant diseases), lesion characteristics (lesion site, size, and number), and time elapsed from injury to diagnosis. We present three cases of post-intubation tracheal injury. In two cases, the patients were treated conservatively; in the third case, the patient died from asphyxia caused by thrombus occlusion of the trachea after a longitudinal tracheal lesion. Pre-anesthetic examination did not indicate any possibility of difficult intubation in any of the patients; however, in one of the patients admitted through the emergency department, emergency intubation was performed.Poslijeintubacijska ozljeda traheje je rijetka i potencijalno fatalna komplikacija. Najčešći uzroci ozljeda su prenapuhnuti balončić tubusa i višekratni pokušaji intubacije u hitnim slučajevima. Dijagnoza se temelji na kliničkoj i radiološkoj sumnji koja se potvrđuje fiberoptičkom bronhoskopijom. Odluka o konzervativnom ili kirurškom zbrinjavanju ozljede ovisi o kliničkoj slici bolesnika (respiracijskoj nestabilnosti, pratećim bolestima), značajkama ozljede (mjestu, duljini i broju oštećenja) i vremenu koje je proteklo između trenutka oštećenja i postavljanja dijagnoze. Prikazujemo troje bolesnika s poslijeintubacijskom ozljedom traheje, dvoje od njih liječeni su konzervativno, a jedna je bolesnica preminula zbog asfiksije izazvane začepljenjem traheje ugruškom nastalim nakon longitudinalne lezije. Niti u jednog od njih u prijeoperacijskom anesteziološkom pregledu ništa nije ukazivalo na moguću otežanu intubaciju, osim što je jedan bolesnik zaprimljen i operiran kao hitan slučaj

Cluster analysis of chronic rhinosinusitis suggests gender-based differences

Purpose: We aimed to evaluate the interaction between the overall severity of chronic rhinosinusitis (CRS) before treatment and subjective improvement following surgical or medical treatment. ----- Procedures: A group of 97 patients with CRS completed the visual analog scale (VAS) symptom score and the Sino-Nasal Outcome Test 22 (SNOT-22) questionnaire in the moment of their sinus computerized tomography (CT) scan. Data were analyzed via a 2-step cluster analysis based on gender, polyp presence, CT scan, and VAS scores for symptoms. ----- Results: There were 3 clusters: the first cluster comprised 37 female patients with CRS without nasal polyps (CRSsNP), the second cluster comprised 30 patients with CRS and NP (CRSwNP; 15 males and 15 females); and third cluster had 30 male patients with CRS without NP (CRSsNP). Different symptom patterns between clusters were identified. After adjustment for polyp presence, gender, eosinophilia (p = 0.021), and the SNOT-22 score (p = 0.005) were found to be better outcome predictors than the CT score (p = 0.26). ----- Conclusion: Long-term patient satisfaction is significantly associated with the subjective symptom severity prior to treatment, i.e., postnasal drip and overall disease severity (SNOT-22 score), but not with the objective severity of the disease (CT score and inflammation)

Ishemijska apopleksija hipofize, hipopituitarizam i dijabetes insipidus: trijada specifična za nekrotizirajući hipofizitis

A rare case of necrotizing hypophysitis (NH) in a 52-year-old man presenting with pituitary apoplexy and sterile meningitis is described. This case indicates that the diagnosis of NH could be made without biopsy, based on concomitant presence of diabetes insipidus, hypopituitarism and radiologic features of ischemic pituitary apoplexy. Conservative management of pituitary apoplexy should be advised in NH. Additionally, this is the first report of a case of sterile meningitis caused by ischemic pituitary apoplexy.Autori prikazuju rijedak slučaj nekrotizirajućeg hipofizitisa u 52-godišnjeg muškarca koji se inicijalno prezentirao apopleksijom hipofize i sterilnim meningitisom. Ovaj slučaj ukazuje na mogućnost da je dijagnozu nekrotizirajućeg hipofizitisa moguće postaviti i bez biopsije ako postoji patognomonična trijada ovoga sindroma: dijabetes insipidus, hipopituitarizam i radiološki znakovi ishemijske apopleksije hipofize. Dodatno, ovo je prvi opisani slučaj sterilnog meningitisa uzrokovanog ishemijskom apopleksijom hipofize

Tumefaktivni oblik multiple skleroze

Multiple sclerosis is a chronic demyelinating disease of the central nervous system. Tumor-like manifestation of multiple sclerosis is one of the rare clinical variants and it is frequently misdiagnosed. This is a report on a 45-year-old man who presented with right-sided hemiparesis. Initial computed tomography and magnetic resonance imaging studies of the brain revealed a large hyperintense signal lesion in the left hemisphere surrounding the cerebral edema. Low grade glioma was among the likely differential diagnoses. The patient underwent surgery. Brain biopsy showed demyelination. Lumbar puncture was performed and cerebrospinal fluid was positive for intrathecal synthesis of immunoglobulins. Other findings were compatible with the unusual form of multiple sclerosis. This case report illustrates a demyelinating process mimicking tumor lesions of the brain and it is of high importance to consider the diagnosis of multiple sclerosis on differential diagnosis of a tumor-like lesion of the central nervous system.Multipla skleroza je kronična demijelinizacijska bolest središnjega živčanog sustava. Pojava tumefaktivnog oblika multiple skleroze je jedna od rijetkih kliničkih varijanta i često je pogrešno dijagnosticirana. Ovo je prikaz slučaja 45-godišnjeg muškarca s desnostranom hemiparezom. Početna kompjutorizirana tomografija i magnetska rezonanca mozga prikazale su veliku hiperintenzivnu leziju lijeve hemisfere mozga okruženu cerebralnim edemom. Diferencijalno dijagnostički nalaz je upućivao na nisko diferencirani glioblastom mozga. Bolesnik je podvrgnut kirurškom zahvatu. Biospija mozga potvrdila je demijelinizaciju. Učinjena je lumbalna punkcija i nalaz likvora ukazao je na intratekalnu sintezu imunoglobulina. Drugi su nalazi dijagnostičke obrade bili u skladu s rijetkim oblikom multiple skleroze. Ovaj prikaz slučaja ilustrira demijelinizacijski proces koji se prikazao kao tumoska lezija mozga i od iznimne je važnosti razmotriti dijagnozu multiple skleroze kao diferencijanu dijagnozu tumefaktivne lezije središnjega živčanog sustava