Intravascular large cell lymphoma: Clinicopathological and immunohistochemical description of a case

A 51-year-old female patient was admitted to the Neurological clinic because of motor seizures with myoclonus of the right hand and right side of the face. The results of initial brain CT scan, chest X rays, EEG ultrasonography of the great blood vessels and laboratory tests made in another hospital were unremarkable. Because of repeated partial seizures transient aphasic disturbances, urinary sphincter disturbances and periodic low-grade fever the patient was transferred to our hospital four months after the disease onset. Laboratory tests and NMR suggested a nonspecific disseminated viral encephalitis. After administration of Endoxan she was ambulatory for several weeks and then became increasingly exhausted confused, febrile, dyspneic, tachypneic and developed a shock status with hepatorenal insufficiency. She died after 7 months of disease duration. Postmortem examination revealed intravascular collections of large atypical lymphoid cells of B cell line. Blood vessels changed in this way were common in the brain and rare in other organs including skin, lungs, heart, liver spleen and digestive system. They were not found in the lymph nodes and bone marrow. A biopsy was not done because of absence of symptomatic and swollen tissues. However, correlation of clinical feature and postmortem findings shows that absence of clinical manifestations in an organ does not mean lack of microscopic pathological changes and biopsy should be done regardless of absence of clinical signs. This case shows that intravascular lymphoma may mimic vasculitis or disseminated nonspecific viral encephalitis

Pojava recidiva karcinoma rektuma u odnosu na pol ispitanika

Colorectal cancer is the most frequent gastrointestinal tumor, very often situated in the rectum. Serbia is for long period of time in group of European countries with average incidence and high mortality of rectal cancer. Aim: To investigate if histopathological type and grade of cancer and time before local recurrence depend on patients' sex, considering that rectal cancer is more often present in male than in female. Material and methods: A retrospective study (2004‒2013.) included 49 patients from Institute for oncology and radiology in Belgrade, with locally recurrent rectal cancer (29 male and 20 female). All the patients with primary rectal cancer had surgical treatment; postoperative adjuvant chemotherapy was applied in 25 patients. Results: Mean age of our patients is 68 years (min 32, max 84 years). Recurrent rectal cancer is most frequent in group 70‒79 years, both in men and women. Adenocarcinoma is histopathological type of rectal cancer in 96% of patients. The most frequent HP grade is moderately differentiated tumor, grade II (p lt 0,0001). Local recurrences appear within two years after surgery (p=0,0109). Conclusion: We didn't establish correlation between histopathological type and grade of rectal cancer and period of local recurrence related to patients' sex. Given the prevalence of both sexes, screening of patients, adequate diagnosis and timely treatment are most important.Karcinomi debelog creva su najčešći tumori digestivnog trakta sa veoma čestom lokalizacijom u rektumu. Naša zemlja se već duži niz godina nalazi u grupi evropskih zemalja sa srednje visokim stopama obolevanja i visokim stopama smrtnosti od ovog karcinoma. Cilj: Utvrditi da li histopatološki tip i gradus karcinoma i vreme do pojave recidiva zavise od pola pacijenta, s obzirom na to da je karcinom rektuma češće prisutan kod muškaraca nego kod žena. Materijal i metode: U retrospektivnu studiju koja obuhvata period od 2004. do 2013. godine uključeno je 49 pacijenata Instituta za onkologiju i radiologiju u Beogradu sa recidivima karcinoma rektuma (29 muškaraca i 20 žena). Svi bolesnici sa primarnim karcinomom rektuma bili su operisani, a postoperativno je sprovedena adjuvantna hemioterapija kod 25 pacijenata. Rezultati: Prosečna starost naših ispitanika bila je 68 godina (najmlađi pacijent imao je 32 godine, a najstariji 84). Najveća učestalost recidiva karcinoma rektuma je u starosnoj grupi 70‒79 godina kod oba pola. Kod 96% pacijenata histopatološki tip tumora je adenokarcinom. Najčešći histopatološki gradus tumora u ispitanoj grupi je srednje diferentovani tumor, gradus II (p lt 0,0001). Recidivi su se uglavnom javljali u prve dve godine nakon operacije (p=0,0109). Zaključak: Nije utvrđena statistički značajna razlika između histopatološkog tipa i gradusa karcinoma rektuma i vremena od operacije do pojave recidiva u odnosu na pol pacijenata. S obzirom na rasprostranjenost bolesti kod oba pola zaključujemo da je radi pravovremenog lečenja najvažniji skrining pacijenata i adekvatna dijagnostika

Effects of radiotherapy on oral cavity tissues

Radiotherapy in the treatment of head and neck tumors is most often used as an independent method or in combination with surgery and / or chemotherapy. These therapeutic methods in a multidisciplinary approach generally lead to favourable therapeutic response. During radiotherapy of this region, oral mucosa is inevitably covered within irradiated volume. Radical therapy is achieved with high doses of radiation, which usually results in development of undesired toxic effects, which, depending on the time of manifestation can be acute and late. Acute radiation toxicity occurs during or immediately after completion of performed therapy, and the late one several months or years after the completed treatment. The most common acute complications in the oral cavity are inflammation of oral mucosa, loss of taste, dry mouth and secondary infections. Late complications include radiation caries, trismus, and osteoradionecrosis. The aim of this paper was to present the effects and specificities of toxicity observed on oral cavity tissues after radiotherapy

Traumatski neurom mentalnog nerva nakon ekscizije mukokele donje usne

Traumatic neuroma represents reactive hyperplasia of irregularly positioned Schwann neurofibril cells and connective tissue - stroma that develop as a result of unsuccessful attempts to regenerate peripheral nerve after injury. This paper presents the case of a patient with painless traumatic neuroma of the lower lip formed in the same place where he previously had surgically removed salivary cyst of minor salivary gland - mucocele. Histopathological examination confirmed the diagnosis of traumatic neuroma.Traumatski neurom predstavlja reaktivnu hiperplaziju iregularno postavljenih Švanovih ćelija i neurofibrila u vezivno-tkivnoj stromi koja nastaje kao posledica neuspešnih pokušaja regeneracije nakon povrede perifernog nerva. U ovom radu je prikazan slučaj pacijenta sa bezbolnim traumatskim neuromom donje usne koji se pojavio na istom mestu gde je prethodno hirurški uklonjena salivarna cista male pljuvačne žlezde donje usne - mukokela. Histopatološki nalaz je pokazao da je uklonjena promena bila traumatski neurom

Postoperative radiotherapy after conservative surgery for early breast cancer: 5-year results

BACKGROUND: Breast conserving surgery followed by postoperative radiotherapy, as alternative to radical mastectomy, has been accepted as an optimal method for loco- regional treatment of the majority of women with early stage of breast carcinoma. The aim of the study was to evaluate the results of postoperative radiotherapy after breast conserving surgery in the Institute for oncology and radiology of Serbia. METHODS: During the 3-year period, 109 breast cancer patients with stage I and II were treated with postoperative radiotherapy after breast conserving surgery. Ninety- four patients underwent quadrantectomy with axillary node dissection, and 15 patients underwent only tumorectomy. After surgery all patients received postoperative radiotherapy to the whole breast with tumor dose 50 Gy in 15 fractions every second day. In 52 patients radiotherapy was given to the regional lymphatics with tumor dose 45 Gy in 15 fractions every second day. Twenty-eight patients received a booster dose (10 Gy) to the tumor bed. Adjuvant systemic therapy was administered depending on the nodal involvement and steroid receptors content: 17 patients received adjuvant chemotherapy (CMF or FAC), 18 received adjuvant hormonal therapy (tamoxifen or ovarian ablation), and 6 patients received both chemo- and hormonotherapy. RESULTS: After median follow-up period of 62 months, there was no evidence of loco- regional recurrence in anyone of patients. Distant metastases occurred in 7 patients (6.4%) with median disease free interval of 27.6 months. At last follow-up 91 patients (83.4%) were alive, 4 patients (3.7%) were dead of disease, and the same number was dead of other causes. The 5-year overall survival rate was 92.9% and disease-free survival rate was 92.7%. CONCLUSION: According to our results the combined surgery and radiotherapy approach provides good local control of early breast cancer patients. Postoperative radiotherapy after breast conserving surgery with or without adjuvant systemic therapy has important role in adjuvant treatment of early breast cancer

Immunohistochemical expression of caspases 9 and 3 in adenoid cystic carcinoma of salivary glands and association with clinicopathological parameters

Purpose: Adenoid cystic carcinoma (ACC) is one of the most common malignant salivary gland tumors. It is characterized by a high rate of recurrence, perineural invasion and development of distant metastases many years after removal of the primary tumor. Disorders of the induction of apoptosis and its cascade reactions where caspases are involved may be significant in the pathogenesis of this tumor. Methods: The immunohistochemical expression of caspase 9 and caspase 3 was analyzed by tissue microarray (TMA) in 50 cases of ACC in relation with different clinicopathological parameters (gender, age, localization, histological type and overall survival). Results: Caspase 9 was expressed in the cytoplasm and nuclei of ACC tumor cells with varying degrees of staining intensity (1+, 6%; 2+, 54%, 3+, 40%). Comparison of caspase 9 expression in tumor cells with clinicopathological parameters (gender, age, localization, histological type and overall survival) showed no statistically significant difference except that the expression was more pronounced in females. Caspase 3 was expressed in the cytoplasm of tumor cells with varying degrees of staining intensity (1+, 22%; 2+, 36%; 3+, 42%). No correlation between the expression of caspase 3 and clinicopathological parameters was noticed. Conclusions: The expression of caspases 9 and 3 in ACC of the salivary glands can contribute in the better characterization of molecules involved in apoptosis of tumor cells

The role of radiotherapy in combined treatment for locally advanced breast cancer with ipsilateral supraclavicular metastases

Background: Locally advanced breast cancer (LABC) includes a heterogeneous group of breast neoplasms classified from stage IIB, IIIA to IIIB. LABC with ipsilateral supraclavicular adenopathy without evidence of distant disease is included in the stage IV (but regional stage IV). Purpose of this study was to assess the role of radiotherapy (RT) in combined treatment with systemic therapy (chemotherapy and hormonotherapy) in LABC with ipsilateral supraclavicular adenopathy. Methods: In 5-year period 45 patients with LABC and ipsilateral supraclavicular metastases were treated with radiotherapy and chemo- or hormonotherapy depending on the physical condition, age and steroid receptors (ER, PGR) content. Twenty patients received TD 30 Gy in 10 fractions on breast and regional lymph nodes and 25 patients received TD 51 Gy in 15 fractions on the breast and TD 45 Gy in 15 fractions on regional lymph nodes. Twenty-three patients received chemotherapy (CMF or FAC), 10 received hormonotherapy, and 12 received both chemo- and hormonotherapy. Results: After finishing complete treatment the overall response rate was 93.3%. Complete response was 20% and partial response was 73.3%. Locoregional relapse occurred in 5 patients and distant metastases occurred in 10 patients. Conclusion: Treatment of LABC with ipsilateral supraclavicular lymph node involvement should be aggressive, what means combined radiotherapy and systemic chemo-hormonotherapy. Such treatment provides for these patients maximum chance of long-term disease - free and overall survival

Comparison of four different suture materials in respect to oral wound healing, microbial colonization, tissue reaction and clinical features-randomized clinical study

Objectives Sutures are the most frequently used medical device for wound closure. They support tissue during the early phase of healing until it regains enough tensile strength. The aim of this study was to compare four different suture materials in terms of the influence on wound healing, microbial adherence, tissue reaction, and relevant clinical parameters which determine their clinical value. Materials and Methods Total number of 32 patients undergoing surgical extraction of four impacted third molars were involved in the study. Clinical parameters were estimated intraoperatively and during the control check-ups. Soft tissue healing around sutures were evaluated on the 3rd and 7th day postoperatively. Microbial colonization was assessed by means of qPCR. Also, histological analysis was done to assess inflammatory reaction. Results Significantly better soft tissue healing was found around monofilament and synthetic sutures compared to multifilament and natural ones respectively. Soft tissue healing was significantly better around all sutures on the 7th day than on the 3rd day postoperatively. Conclusions Non-resorbable polypropylene suture showed superior clinical characteristics among all sutures. Moreover, the best healing of soft tissue and the least inflammatory reaction was found around this thread. The poorest soft tissue healing was found around non-resorbable silk suture. This suture elicited strongest inflammatory reaction and showed the greatest microbial adherence affinity compared to alternative sutures

The superficial palmar branch of the radial artery, a corrosion cast study

Background: Surgical procedures such as thenar flaps and radial artery (RA) harvesting call for an elaborate anatomical study of the RA’s superficial palmar branch (SPB). The aim of this study was to describe the branching pattern of this vessel related to the morphometric characteristics and variations of this artery. Materials and methods: Twenty 4% formalin solution injected hands were dissected. For the morphometric study we used another group of thirty five human hands of adult persons, injected with methylmethacrylate fluid into the ulnar and radial arteries. As soon as polymerization was completed, a 40% solution of potassium hydroxide was applied for corrosion. The vascular arterial casts were examined under the stereoscopic microscope and precise drawings of each specimen were made. Results: In the majority of cases (75%) SPB passed superficially, over the abductor pollicis brevis muscle. The mean diameter of the SPB, very variable depending on its length and field of supply, was 1.52±0.49 mm, ranging from 0.8 to 2.7 mm. Developed SPB type, was present in 31.4% of hands, with the diameter of 1.7 mm and larger (mean 1.95 mm), continuing distally to become the radialis indicis artery (RIA), with an average caliber of 1.2 mm, and with important branches to the thumb. In most hands, (68.6%), the hypoplastic SPB, was present, with a mean diameter of 1.17 mm, and the field of supply within the thenar area. Conclusions: Knowledge of the SPB dominance, and existence of anastomotic vessels in its field of supply are of importance to avoid the risk of possible ischemic sequelae in the hand associated with harvesting the RA