The Effectiveness of a 40-year Long Iodine Prophylaxis in Endemic Goitre Region of Grobnik, Croatia

The region of Grobnik, in the north west of Croatia, 15 km away from the Adriatic coast and 400 meters above the sea level, used to be known as a centre of endemic goitre. Iodine prophylaxis of 10 mg KJ added per kilo salt started in Croatia during the year 1953 and it was increased to 25 mg KJ per kilo in 1996. During 1961, the prevalence of goiter among Grobnik school children was 63%, while in the adult population it was 34%. In 1981, 18% of goitrous school children and 11% of goitrous adults were found in the same region, which shows the fall in goitre prevalence in the twenty-year period, from a severe to a mild one. The aim of this study was to estimate the effectiveness of iodine prophylaxis in goitre eradication and to compare the obtained results to those found in the same region 20 and 40 years ago, namely, in 1961 and 1981. The research was conducted in 2001. We examined 472 Grobnik inhabitants, 378 children (196 girls and 182 boys, aged 7–15 years) and 94 adults. Regarding their size thyroid glands were graded according to WHO and PAHO classification. Data regarding lifestyles and health conditions were collected by individual and family questionnaires. The prevalence of goitre in 2001 was 6.6% in school children and 6.4% in adults. In relation to 1981, we found a statistically significant fall of goitre in school children at the level of p0.01, x2=1.419). The frequency of thyroid gland hereditary diseases in native inhabitants was high, 11.7%. There were no statistically significant differences in the prevalence of goitre or thyroid hereditary diseases between groups of native and newcomers’ children. According to our results, in the year 2001 the area of Grobnik was still was a region of a mildly expressed endemic goitre. This study presents final results of a 40-year long follow up of endemic goitre eradication, demonstrating the long-term effectiveness of iodine prophylaxis

The Effectiveness of a 40-year Long Iodine Prophylaxis in Endemic Goitre Region of Grobnik, Croatia

The region of Grobnik, in the north west of Croatia, 15 km away from the Adriatic coast and 400 meters above the sea level, used to be known as a centre of endemic goitre. Iodine prophylaxis of 10 mg KJ added per kilo salt started in Croatia during the year 1953 and it was increased to 25 mg KJ per kilo in 1996. During 1961, the prevalence of goiter among Grobnik school children was 63%, while in the adult population it was 34%. In 1981, 18% of goitrous school children and 11% of goitrous adults were found in the same region, which shows the fall in goitre prevalence in the twenty-year period, from a severe to a mild one. The aim of this study was to estimate the effectiveness of iodine prophylaxis in goitre eradication and to compare the obtained results to those found in the same region 20 and 40 years ago, namely, in 1961 and 1981. The research was conducted in 2001. We examined 472 Grobnik inhabitants, 378 children (196 girls and 182 boys, aged 7–15 years) and 94 adults. Regarding their size thyroid glands were graded according to WHO and PAHO classification. Data regarding lifestyles and health conditions were collected by individual and family questionnaires. The prevalence of goitre in 2001 was 6.6% in school children and 6.4% in adults. In relation to 1981, we found a statistically significant fall of goitre in school children at the level of p0.01, x2=1.419). The frequency of thyroid gland hereditary diseases in native inhabitants was high, 11.7%. There were no statistically significant differences in the prevalence of goitre or thyroid hereditary diseases between groups of native and newcomers’ children. According to our results, in the year 2001 the area of Grobnik was still was a region of a mildly expressed endemic goitre. This study presents final results of a 40-year long follow up of endemic goitre eradication, demonstrating the long-term effectiveness of iodine prophylaxis

Additional Cytomorphological Criteria in Diagnosis of Pilomatricoma – Benign Tumor with Bad Reputation

Pilomatricomas (PM) are benign skin appendageal tumors, with differentiation towards hair-forming cells, usually found in children. They are frequently misdiagnosed by clinicians, and there are also many reports of false positive diagnoses made on fine needle aspiration (FNA) cytology. PM are often mistaken for »small round blue cell« tumors in children, or for Merkel cell carcinoma, basalioma and metastatic small cell carcinoma in adults, with possible over-aggressive therapeutic approach. We present 6 cases of PM, correctly diagnosed preoperatively by FNA. Clinical, cytomorphologic and basic morphometric features were analyzed, and compared with 4 cases of malignant tumors with similar clinical presentation. Morphometric data (longest nuclear diameter) did not prove to be helpful, while basophilic cytoplasmatic protrusions, observed in all 6 analyzed cases, could be useful additional cytomorphologic feature of PM. We concluded that cytomorphologic characteristics of PM are reliable enough for correct preoperative diagnosis in adequate specimens, however the best results are achieved when FNA is performed by an experienced cytologist, and when all relevant clinical data are obtained

The Bethesda system for reporting thyroid cytopathology – our first experiences

Citološka punkcija štitnjače nezamjenjiva je dijagnostička metoda u procjeni rizika za malignitet u čvorovima štitnjače. Bethesda klasifikacija citoloških nalaza štitnjače nastala je 2007. godine kao rezultat analize velikog broja podataka prikupljenih iz različitih ustanova i sadrži šest kategorija. Za svaku kategoriju procijenjen je rizik za malignitet i usvojene preporuke za daljnji postupak s pacijentom, a ujednačena je i terminologija u citološkim nalazima. Primjenjuje se u Sjedinjenim Američkim Državama i većini europskih zemalja uz neke nacionalne modifikacije. Prikazani su također i prvi rezultati njene primjene na Odjelu za opću citologiju Kliničkog bolničkog centra Rijeka u 2015. godini.. Fine needle aspiration is the essential tool in evaluation of patients with a thyroid nodule. The Bethesda system for reporting Thyroid cytopathology proposed in 2007, is the result of a large amount of data gathered from many medical institutions and literature. Cytological reports are divided in six categories. Each of them implies a certain cancer risk and contains a recommendation for further management of patients. It is used in the USA and the majority of European countries with some national modifications. Our first experiences with Bethesda classification in thyroid cytology in 2015 are presented

Clinical cytology

Klinička citologija je dijagnostička medicinska struka koja pomoću analize citoloških uzoraka pod svjetlosnim mikroskopom prepoznaje fiziološka stanja te dijagnosticira razne benigne, premaligne i maligne patološke procese, a uključena je u dijagnostiku gotovo svih organa i organskih sustava. Kod nas je gotovo 40 godina postojala kao samostalna specijalizacija iz medicinske, a potom kliničke citologije. Od 2015. godine uveden je novi program specijalizacije koji objedinjava citologiju i patologiju, pod nazivom specijalizacija iz patologije i citologije. Citologija je od svojih početaka neraskidivo vezana s klinikom i najbolji rezultati dobivaju se u uskom kontaktu pacijenta, kliničara raznih specijalnosti i citologa. Kao minimalno invazivna i brza metoda, gotovo bez kontraindikacija i značajnih komplikacija, citologija je izuzetno atraktivna dijagnostička metoda, a citološki uzorci prikladni su i za dodatne analize (imunofenotipizacija, citogenetika, molekularna analiza). U članku je prikazana primjena citologije u dijagnostici pojedinih organskih sustava, kao i prednosti i ograničenja citološke dijagnostike i čimbenici o kojima ovisi kvaliteta citoloških nalaza. Posebnu pažnju treba posvetiti pravilnom uzimanju uzoraka i pripremi preparata, i neophodno je da svaku fazu dijagnostičkog postupka izvode primjereno educirani zdravstveni djelatnici. Citološka analiza neizostavna je dijagnostička pretraga za rano otkrivanje, dijagnostiku i praćenje prvenstveno upalnih, benignih neoplastičnih, premalignih i malignih promjena gotovo svih organa i organskih sustava.Clinical cytology is a diagnostic medical branch that by means of light microscopic analysis of cell and tissue specimens recognizes various physiological variations, benign and malignant diseases. Cytology is involved in diagnostics of virtually every organ and tissue. Cytology has been a separate specialization in Croatia for almost 40 years, at first as Medical cytology, later as Clinical cytology. In 2015 a new specialization was introduced, synthesizing cytology and pathology, and is called “specialization in pathology and cytology”. From the very beginning, cytology is closely connected to clinics, and the best results are achieved in team work of the cytologists and clinicians of different specialities, and in direct contact with the patient. As minimally invasive and rapid diagnostic method, with almost no contraindications and rare and minor potential complications, cytology is extremely attractive diagnostic method, especially considering that cytological specimens are convenient for ancillary diagnostic methods such as flow cytometric immunofenotypization, cytogenetic, molecular techniques. In this paper we discuss the role of cytology in the diagnostics of some organ systems, as well as its advantages and limitations, and factors that influence the end the result and quality of cytological findings. Particular attention should be paid to the quality of sampling, and specimen preparation techniques. It is of utmost importance that all phases of the procedure are performed by adequately educated medical staff. Cytological analysis is an indispensable diagnostic procedure for early detection, diagnosis and follow-up of various, especially inflammatory, benign, premalignant and malignant conditions in various organs and organ systems

The role of the pathologist in diagnosis and therapy of the breast cancer patients

Histopatološke značajke karcinoma dojke uključuju brojne podatke koji su neophodni za daljnji odabir terapije pacijentica, stoga oni moraju biti jasni, nedvojbeno navedeni i pouzdani. Osim tradicionalnih podataka o invaziji, metastatskom potencijalu i odgovoru na terapiju, sve više informacija o prognostičkim i prediktivnim čimbenicima koji utječu na terapiju pacijentica daju i genetska istraživanja na temelju kojih su tumori prema ekspresiji određenih gena stratificirani u podtipove.Histopathological features of breast cancer include numerous details that are essential for the further choice of patient’s therapy because it must be clear, unambiguously stated and reliable. In addition to traditional data on invasion, metastasis and response to therapy more information on prognostic and predictive factors that affect the treatment provide patients and genetic research on the basis of which tumors according to the expression of certain genes in the stratified subtypes

The Effectiveness of a 40-year Long Iodine Prophylaxis in Endemic Goitre Region of Grobnik, Croatia

The region of Grobnik, in the north west of Croatia, 15 km away from the Adriatic coast and 400 meters above the sea level, used to be known as a centre of endemic goitre. Iodine prophylaxis of 10 mg KJ added per kilo salt started in Croatia during the year 1953 and it was increased to 25 mg KJ per kilo in 1996. During 1961, the prevalence of goiter among Grobnik school children was 63%, while in the adult population it was 34%. In 1981, 18% of goitrous school children and 11% of goitrous adults were found in the same region, which shows the fall in goitre prevalence in the twenty-year period, from a severe to a mild one. The aim of this study was to estimate the effectiveness of iodine prophylaxis in goitre eradication and to compare the obtained results to those found in the same region 20 and 40 years ago, namely, in 1961 and 1981. The research was conducted in 2001. We examined 472 Grobnik inhabitants, 378 children (196 girls and 182 boys, aged 7–15 years) and 94 adults. Regarding their size thyroid glands were graded according to WHO and PAHO classification. Data regarding lifestyles and health conditions were collected by individual and family questionnaires. The prevalence of goitre in 2001 was 6.6% in school children and 6.4% in adults. In relation to 1981, we found a statistically significant fall of goitre in school children at the level of p0.01, x2=1.419). The frequency of thyroid gland hereditary diseases in native inhabitants was high, 11.7%. There were no statistically significant differences in the prevalence of goitre or thyroid hereditary diseases between groups of native and newcomers’ children. According to our results, in the year 2001 the area of Grobnik was still was a region of a mildly expressed endemic goitre. This study presents final results of a 40-year long follow up of endemic goitre eradication, demonstrating the long-term effectiveness of iodine prophylaxis

Rhabdomyosarcoma with Bone Marrow Infiltration Mimicking Hematologic Neoplasia

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children younger than 15 years. According to the World Health Organization, there are embryonal, alveolar and pleomorphic types of RMS. Most RMS patients present with a tumor mass in the head and neck region, urogenital tract or lower extremities. Unusual clinical presentation of the disease with massive bone marrow infiltration at the disease onset and mimicking hematologic neoplasm is rarely seen. A case is presented of a 14-year-old, previously healthy girl hospitalized for outpatiently detected leukocyte elevation. For the last two weeks, she had complained of fatigue, myalgia and frequent bruising. On admission, clinical examination revealed numerous petechiae and hematomas, enlarged left inguinal lymph node and palpable spleen 2 cm below left costal arch. Laboratory findings showed leukocytosis, anemia and thrombocytopenia. Bone marrow fine needle aspiration (FNA) produced a hypercellular bone marrow sample with suppression of all three hemocytopoiesis lines and bone marrow infiltration with numerous undifferentiated tumor cells. Considering the morphological, cytochemical and phenotypic characteristics, the cytologic diagnosis was: bone marrow infiltration with RMS cells. Abdominal computerized tomography revealed a primary tumor occupying the entire retropeoritoneal space. Tumor biopsy confirmed alveolar subtype of RMS. In conclusion, in cases of bone marrow infiltration with primitive, immature cells, RMS should be considered as differential diagnostic possibility. Adjuvant technologies (cytochemistry, immunocytochemistry, cytogenetic analysis, flow cytometry, and molecular analysis) can be very helpful in diagnostic work-up, and may lead to definitive diagnosis in some cases

Aksilarnu limfadenektomiju trebalo bi izostaviti kod bolesnica sa karcinomom dojke i minimalnom rezidualnom bolesti u sentinel limfnom čvoru nakon neoadjuvantnog sistemskog liječenja

Background: In modern breast cancer management, SLNB is a standard of care. For the patients with limited sentinel lymph node involvement in the upfront surgery setting, ALND can be safely omitted. However, for any sentinel node metastasis detected following neoadjuvant systemic treatment (NST), ALND is still considered a mandatory procedure. Patients and methods: Present retrospective analysis has included all breast cancer patients submitted to surgery following NST in Clinical Hospital Centre (CHC) Rijeka in the period from 2017 till 2020. Results: SLNB was performed in 151 of 222 consecutive patients, and sentinel node metastasis was detected in 49 cases. The risk of non-sentinel lymph node involvement in sentinel node-positive patients was 34.7%, but exclusively for cases with macro-metastatic disease detected in the sentinel node. In addition, for the patients diagnosed with clinically uninvolved axilla, the risk of ypN2-3 status was only 2.8%. Conclusions: ALND following NST is overtreatment in 65.3% of sentinel node-positive patients. Axillary irradiation with the omission of ALND should be considered for the sentinel-positive patients with only micro-metastatic disease detected in the sentinel node following neoadjuvant chemotherapy, as well as for those with low volume macro metastatic disease, diagnosed with the uninvolved axilla.Uvod: U modernom kirurškom pristupu liječenja kacinoma dojke SLNB je univerzalno prihvaćeni standard. Izostavljanje ALND, u slučajevima sa metastazom pronađenom u do dva sentinel limfna čvora, ne utječe na onkološke ishode kod primarno kirurški liječenih pacijentica, Međutim, svaka metastaza detektirana u sentinel limfnom čvoru nakon provedenog neoadjuvantnog sistemskog liječenja još uvijek se smatra apsolutnom indikacijom za ALND. Pacijenti i metode: Sve pacijentice operirane zbog karcinoma dojke u Kliničkom Bolničkom Centru (KBC) Rijeka nakon provedene neoadjuvantne kemoterapije, u periodu od 2017. do 2020., uključene su u ovu retrospektivnu analizu. Rezultati: SLNB je učinjena kod 151 od 222 uzastopne pacijentice, a metastaza u sentinel čvoru pronađena je u 49 slučajeva. Rizik metastatske bolesti u ne-sentinel limfnim čvorovima kod sentinel-pozitivnih pacijentica je 34.7%, međutim isključivo u slučajevima sa makrometastazom u sentinel čvoru. Nadalje, kod skupine pacijenica dijagnosticiranih sa klinički i radiološki negativnom aksilom, rizik od ypN2-3 statusa je samo 2.8% Zaključak: Nakon neoadjuvantne kemoterapije ALND je overtreatment u 65.3% sentine-pozitivnih pacijentica. Izostavljanje ALND uz zračenje aksile nakon provedenog neoadjuvantnog liječenja je opcija koju bi trebalo razmotriti za sentinelpozitivne bolesnice sa mikro-metastazom u sentinel čvoru, kao i za bolesnice sa malim volumenom makrometastatske bolesti u sentinel limfnim čvorovima, a koje su inicijalno dijagnosticirane sa klinički negativnom aksilom

Predictive value of intraoperative sentinel lymph node imprint cytology analysis for metastasis in patients with melanoma

Since there are no standardized protocols regarding the detection of microscopic melanoma deposits in sentinel lymph nodes (SLN), the aim of this study was to present our experience with intraoperative cytological evaluation of SLN in patients with melanoma. The study included 475 SLN biopsies (SLNB) from 201 patients with primary cutaneous melanoma of intermediate thickness. Each lymph node was cut in half; touch imprint cytology (TIC) preparations of all cut surfaces were performed and stained according to a modified May-Grünwald-Giemsa method. The results were compared to definitive postoperative histology. Twenty of 25 SLNB positive on TIC proved to be metastatic when compared to definitive histology. Most of 32 SLN that were suspicious but not diagnostic on TIC were proven negative (23/32, 71.8%), while 7 nodes had metastases (one micrometastasis and one with isolated tumor cells only). The majority (94%) of SLNBs negative on TIC remained negative on final histology, while 6% or 25 nodes were positive, mostly with micrometastases or isolated tumor cells (17/25). In frozen sections performed in cases of suspicious or positive SLN cytology, metastasis was confirmed in 80% of positive and in 21.9% of suspicious TIC. Altogether, 49% (27/55) of positive SLNB were identified intraoperatively in 57% (24/42) of patients, and in those cases a complete regional lymph node dissection was performed in the first step. TIC assessment of SLNB with 99% specificity and 57% sensitivity for intraoperative identification of metastasis is useful and beneficial for avoiding a second operative procedure.  </p