Professor Ivan Damjanov, the Third Recipient of Tomas Kent Award from the Group for Research in Pathology Education

The Group for Research in Pathology Education (GRIPE) was founded in 1971 by Tom Kent, M.D. of the University of Iowa as an organization devoted to promoting excellence in teaching pathology to medical students. A few years ago, the Executive Board of GRIPE decided to recognize the pioneering work of Dr. Kent by giving an award in his name (for details see http://peir.path.uab.edu/griper). This prestigious award was established to formally recognize outstanding academic pathologists for their lifetime contributions to the field of pathology education. The first recipient of the Tom Kent Award was Dr Stanley L. Robbins, Boston University, Boston, Massachusetts, author of the leading textbook of pathology in the United States (USA), widely used throughout the world. The second recipient was Dr Emanuel Rubin, Thomas Jefferson University, Philadelphia, Pennsylvania, the author of the innovative pathology textbook, in which he has pioneered the use of conceptual color drawings, diagrams and algorithms in the teaching of pathology. The third recipient of the Tom Kent Award is Dr Ivan Damjanov, Professor of Pathology, The University of Kansas, Kansas City, Kansas. Since Ivan Damjanov is a graduate of the University of Zagreb, we were pleased to accept the invitation of Dr. Matko Marusic, Editor-in-Chief of the Croatian Medical Journal, and briefly outline the contributions of Ivan Damjanov to pathology practice, research and education, both in the USA and Croatia

Occurrence of Non-Hodgkin Lymphoma in the Oral Cavity - Case Presentation

Non-Hodgkinovi limfomi (NHL) su heterogena skupina limfoproliferativnih neoplazmi što ih obilježava pojava maligno promijenjenih limfocita u limfnome čvoru, a rjeđe primarno u drugim organima. Bolest se najčešće očituje bezbolnim povećanjem limfnih čvorova, koji pak u gastrointestinalnom i urinarnom traktu mogu praviti kompresiju. Infiltracija koπtane srži uzrokuje insuficijenciju mijelopoeze s posljedičnom anemijom, trombocitopeniju i neutropeniju. Klasifikacija bolesti temelji se na PHD nalazu i nalazu periferne krvi. Ekstranodularno bolest se najčešće javlja u gastrointestinalnom traktu, a često se javlja i u sinusima, tiroidnoj žlijezdi, salivarnim žlijezdama, dojci, bubrezima i plućima. Oko 25% ekstranodularnih limfoma javlja se na glavi i vratu i to u tzv. Waldejerovom prstenu, ali su primarni limfomi usne šupljine rijetkost. U radu prikazujemo slučaj šezdesettrogodišnjega muškarca s primarnom pojavom NHL-a na gingivi. Suspektna lezija u usnoj šupljini primijećena je tijekom vađenja upaljenoga korijena u gornjoj čeljusti. Promjena se nalazila u neposrednoj blizini odontogene upale, ali nije s njom bila povezana te se stoga uzme nalaz za biopsiju. Radiološki nalaz ne pokaže ništa specifično. PHD nalaz promjene pokaže nekrozu, krvarenje i polimorfnonuklearno upaljen infiltrat, te tumoroznu masu s atipičnim limfocitnim stanicama. Nakon dodatnoga pregleda hematopatologa utvrdi se NHL visoka stupnja malignosti B stanica. Po učinjenoj imunohistokemiji, utvrdi se NHL velikih stanica B-imunofenotipa, a pacijentovo se stanje definira kao NHL II E.Non-Hodgkin lymphomas (NHL) are a heterogenetic group of lymphoproliferative neoplasms, characterised by the occurrence of malignantly changed lymphocytes in a lymph node, and rarely primary in other organs. The disease most frequently manifests with painlessly enlarged lymph nodes, which in the gastrointestinal and urinary tract may cause compression. Infiltration of the bone marrow causes insufficiency of myelopoiesis, resulting in anaemia, trombocytopenia and neutropenia. Classification of the disease is based on PHD and peripheral blood findings. Extranodular disease occurs most frequently in the gastrointestinal tract, and also often occurs in the sinuses, thyroid gland, salivary glands, breasts, kidneys and lungs. Approximately 25% of extranodular lymphomas first occur on the head and neck in the so called Waldeyer\u27s ring, although primary lymphomas of the oral cavity are rare. We present the case of a 63-year-old man with primary occurrence of NHL on the gingiva. The suspect lesion in the oral cavity was noticed during extraction of an inflamed root in the upper jaw. The lesion was located in the immediate vicinity of odontogenic inflammation, although it was not connected with it, and thus a specimen was taken for biopsy. The radiographic finding did not show anything specific. PHD finding of the lesion showed necrosis, bleeding and polymorphonuclear inflamed infiltrate and a tumorous mass with atypical lymphocyte cells. After a further examination by a haematopathologist NHL was confirmed with a high degree of B-cell malignancy. Immunohistochemistry confirmed giant cell NHL, B immunophenotype, and the patient\u27s condition was defined as NHL II E

Povezanost protočne citometrije s drugim kliničkim i patohistološkim parametrima u bolesnica s neuroendokrinim duktalnim karcinomom dojke

Aims. The aim of the study was to determine cellular ploidy of invasive ductal breast carcinoma with neuroendocrine (NE) differentiation and its share in certain phases of the cell cycle. It was also aimed at assessing the relationship of the cell cycle profile with other clinical and histopathological features. Methods. The study was carried out in 80 patients with invasive ductal breast cancer, and classified as breast carcinoma with NE differentiation according to their histopathological parameters. The patients underwent treatment at the University Hospital for Tumors, Zagreb, Croatia during the period January 1 to December 31, 1992. Data about patients’ age, estrogen and progesterone receptor concentration, cancer size, and treatment modality were retrospectively collected from their case histories. Paraffin blocks were used for immunohistochemical and histochemical analysis and flow cytometric analysis of the tumor cell cycle. Neuroendocrine tumor diagnosis was made using Grimelius and immunohistochemical staining including neuron-specific enolase (NSE), chromogranin A and synaptophysin. Results. Analysis by flow cytometry detected 27 tumors (33.8%) with DNA diploidy showing proliferative activity lower than 20%, and 53 tumors (66.2%) with DNA aneuploidy, tetraploidy and/or DNA diploidy with proliferative activity over 20%. Progesterone receptor concentration in DNA-diploid tumors was significantly higher that in DNA-aneuploid, tetraploid tumors and tumors with proliferative activity of ≥20% (p<0.001). Concentration of estrogen receptors, age, histological grade, tumor size, Grimelius staining and immnohistochemical markers did not significantly differ between the groups. Conclusion. Data collected in our study show a higher mean concentration of progesterone receptors in the group of diploid tumors and tumors with low proliferative activity. In consideration with the above criterium, other pathological and clinical parameters did not show any significant difference relative to both tumor ploidy and its proliferative activity. For final conclusion on the clinical significance of neuroendocrine differentiation in breast cancer further studies that would include monitoring of the course and outcome of the disease are required.Ciljevi. Cilj našeg istraživanja bio je odrediti ploidnost stanica kod invazivnih duktalnih karcinoma dojke s neuroendokrinom (NE) diferencijacijom i njihov udio u pojedinim fazama staničnog ciklusa. Također se htjelo utvrditi povezanost profila staničnog ciklusa s drugim kliničkim i patohistološkim značajkama. Metode. Istraživanje je provedeno na 80 bolesnica s duktalnim invazivnim karcinomom dojke koji su prema patohistološkim parametrima svrstani u karcinome dojke s NE diferencijacijom. Bolesnice su liječene u razdoblju od 01.01. do 31.12.1992. godine na Klinici za tumore u Zagrebu. Podaci o dobi bolesnica, koncentraciji estrogenskih i progesteronskih receptora, veličini karcinoma, te načinu liječenja dobiveni su retrospektivno iz povijesti bolesti. Parafinski blokovi upotrijebljeni su za imunohistokemijsku i histokemijsku analizu te analizu staničnog ciklusa tumorskih stanica protočnom citometrijom. Dijagnoze neuroendokrinih tumora postavljene su na temelju bojenja po Grimeliusu te imunohistokemijskih bojenja uključujući neuron-specifičnu enolazu (NSE), kromogranin A i sinaptofizin. Rezultati. Protočnom citometrijom kod 27 tumora (33.8%) nađena je DNA diploidija i visina proliferativne aktivnosti manja od 20%, dok su DNA aneuploidija, tetraploidija i/ili DNA diploidija s proliferativnom aktivnošću većom od 20% nađene kod 53 tumora (66.2%). Koncentracija progesteronskih receptora u DNA-diploidnim tumorima bila je značajno viša nego kod DNA-aneuploidnih, tetraploidnih i tumora s proliferativnom aktivnošću ≥20% tumora (p<0.001). Koncentracija estrogenskih receptora, dob, histološki stupanj, veličina tumora, bojanje po Grimeliusu te imunohistokemijski markeri nisu se značajno razlikovali u ove dvije skupine. Zaključak. Podaci iz našeg istraživanja upućuju na veću prosječnu koncentraciju progesteronskih receptora u skupini diploidnih tumora i tumora s niskom proliferativnom aktivnošću. Prema navedenom kriteriju drugi patološki i klinički parametri nisu pokazali značajnu razliku u odnosu na ploidnost i proliferativnu aktivnost. Za donošenje konačnog zaključka o kliničkoj važnosti neuroendokrine diferencijacije kod karcinoma dojke potrebno je provesti istraživanja koja bi uključila praćenje tijeka i ishoda bolesti

Professor Ivan Damjanov, the Third Recipient of Tomas Kent Award from the Group for Research in Pathology Education

The Group for Research in Pathology Education (GRIPE) was founded in 1971 by Tom Kent, M.D. of the University of Iowa as an organization devoted to promoting excellence in teaching pathology to medical students. A few years ago, the Executive Board of GRIPE decided to recognize the pioneering work of Dr. Kent by giving an award in his name (for details see http://peir.path.uab.edu/griper). This prestigious award was established to formally recognize outstanding academic pathologists for their lifetime contributions to the field of pathology education. The first recipient of the Tom Kent Award was Dr Stanley L. Robbins, Boston University, Boston, Massachusetts, author of the leading textbook of pathology in the United States (USA), widely used throughout the world. The second recipient was Dr Emanuel Rubin, Thomas Jefferson University, Philadelphia, Pennsylvania, the author of the innovative pathology textbook, in which he has pioneered the use of conceptual color drawings, diagrams and algorithms in the teaching of pathology. The third recipient of the Tom Kent Award is Dr Ivan Damjanov, Professor of Pathology, The University of Kansas, Kansas City, Kansas. Since Ivan Damjanov is a graduate of the University of Zagreb, we were pleased to accept the invitation of Dr. Matko Marusic, Editor-in-Chief of the Croatian Medical Journal, and briefly outline the contributions of Ivan Damjanov to pathology practice, research and education, both in the USA and Croatia

CONGENITAL EPULIS IN NEWBORNS: CASE REPORT

Kongenitalni epulis, poznat i pod imenom kongenitalni tumor granularnih stanica (granular cell tumor), vrlo je rijedak benigni tumor u novorođenčadi. Najveći broj opisan je u području incizalne regije alveolarnog nastavka gornje ili donje čeljusti, a rijetko i u jeziku. Lezija je najčešće solitarna, premda su opisane i multiple. Ako je lezija većih dimenzija, otežava ili sasvim onemogućava prehranu (sisanje), a rijetko kompromitira disanje. Premda se poslije rođenja ne povećava, spontana regresija nije očekivana, pa se razmjerno funkcijskim teškoćama preporuča rano kirurško uklanjanje. Opisujemo slučaj ženskog novorođenčeta s kongenitalnim epulisom alveolarnog nastavka mandibule, koji je zbog veličine onemogućavao prehranu na usta, te je uklomjen nekoliko sati nakon rođenja.Congenital epulis, also known as congenital granular cell tumor, is a very rare benign tumor in newborns. It most frequently occurs on the incisal part of the alveolar ridge of the upper or lower jaw, but tongue involvement has also been reported. The lesion is usually solitary, but has also been noted as multiple. A larger lesion may interfere with nursing or occasionally cause breathing obstruction. Although it does not grow after birth, spontaneous regression is not expected and early surgical removal is preferred, especially if functional impairment is present. A female newborn is presented with congenital epulis of the mandibular alveolus, which impaired oral feeding and was removed several hours after birth

Prognostic Significance of B-cell Differentiation Genes Encoding Proteins in Diffuse Large B-cell Lymphoma and Follicular Lymphoma Grade 3

Aim To define prognostic significance of B-cell differentiation genes encoding proteins and BCL2 and BCL6 gene abnormalities in diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern. Methods In 53 patients with diffuse large B-cell lymphoma and 20 patients with follicular lymphoma grade 3 with >75% follicular growth pattern the following was performed: 1) determination of protein expression of BCL6, CD10, MUM1/IRF4, CD138, and BCL2 by immunohistochemistry; 2) subclassification into germinal center B-cell-like (GCB) and activated B-cell-like (ABC) groups according to the results of protein expression; 3) detection of t(14;18)(q32;q21)/IgH-BCL2 and BCL6 abnormalities by fluorescent in situ hybridization in diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern as well as in GCB and ABC groups; and 4) assessment of the influence of the analyzed characteristics and clinical prognostic factors on overall survival. Results Isolated BCL6 expression was more frequently found in follicular lymphoma grade 3 with >75% follicular growth pattern than in diffuse large Bcell lymphoma (P = 0.030). There were no differences in BCL2 and BCL6 gene abnormalities between diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern. Diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern patients were equally distributed in GCB and ABC groups. t(14;18)(q32;q21) was more frequently recorded in GCB group, and t(14;18)(q32;q21) with BCL2 additional signals or only BCL2 and IgH additional signals in ABC group (P = 0.004). The GCB and ABC groups showed no difference in BCL6 gene abnormalities. There was no overall survival difference between the patients with diffuse large B-cell lymphoma or follicular lymphoma grade 3 with >75% follicular growth pattern; however, GCB group had longer overall survival than ABC group (P = 0.047). Multivariate analysis showed that BCL6, CD10, and BCL2 expression, BCL2 and BCL6 abnormalities, and International Prognostic Index were not significantly related to overall survival. Conclusion Diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern patients have very similar characteristics and their prognosis is more influenced by protein expression of B-cell differentiation stage genes than by tumor cells growth pattern, BCL2 and BCL6 abnormalities, and International Prognostic Index

Giant Basal Cell Carcinoma of the Back: A Case Report and Review of the Literature

Basal cell carcinoma (BCC) is the most common cutaneous malignancy and the most common human malignancy in general. Out of all basal cell carcinomas, giant basal cell carcinoma represents less than 1%. Only 10% of all basal cell carcinomas are located on the trunk and majority is located on the head and neck. We describe a patient with a exophytic giant basal cell carcinoma of the back size 8.5 x 8 x 6 cm, infiltrating skin 1.5 cm. Two years after the lesion has occurred, diagnosis was made by pathohistological analysis. The patent was treated surgically, by excision. Review of the literature that refers to giant basal cell carcinoma was carried out

Professor Ivan Damjanov, the third recipient of Tomas Kent Award from the Group for Research in Pathology Education

The Group for Research in Pathology Education (GRIPE) was founded in 1971 by Tom Kent, M.D. of the University of Iowa as an organization devoted to promoting excellence in teaching pathology to medical students. A few years ago, the Executive Board of GRIPE decided to recognize the pioneering work of Dr. Kent by giving an award in his name (for details see http://peir.path.uab.edu/griper). This prestigious award was established to formally recognize outstanding academic pathologists for their lifetime contributions to the field of pathology education. The first recipient of the Tom Kent Award was Dr Stanley L. Robbins, Boston University, Boston, Massachusetts, author of the leading textbook of pathology in the United States (USA), widely used throughout the world. The second recipient was Dr Emanuel Rubin, Thomas Jefferson University, Philadelphia, Pennsylvania, the author of the innovative pathology textbook, in which he has pioneered the use of conceptual color drawings, diagrams and algorithms in the teaching of pathology. The third recipient of the Tom Kent Award is Dr Ivan Damjanov, Professor of Pathology, The University of Kansas, Kansas City, Kansas. Since Ivan Damjanov is a graduate of the University of Zagreb, we were pleased to accept the invitation of Dr. Matko Marusic, Editor-in-Chief of the Croatian Medical Journal, and briefly outline the contributions of Ivan Damjanov to pathology practice, research and education, both in the USA and Croatia