THE ROLE OF CYTOLOGY IN UROLOGY

U kratkim crtama prikazano je mjesto i uloga kliničke citologije u urologiji, s naglaskom na citološku analizu sedimenta urina. Pojašnjeni su tehnički aspekti uzimanja uzoraka urina za citološku analizu i dan je kratak pregled prednosti i ograničenja te dijagnostičke pretrage. Prikazane su osnovne kategorije citoloških nalaza urina te je dan kratak osvrt na nove tehnike za poboljšanje osjetljivosti analize urina u otkrivanju malignih tumora urotela.The aim of the paper was to describe the role of clinical cytology in urology, with emphasis on cytodiagnostic urinalysis. Technical aspects of specimen collection are reviewed, as well as advantages and limitations of urinary cytology. General categories of urinary cytodiagnoses are listed. Some new techniques – urinary marker tests and DNA image-cytometry, are shortly reviewe

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 ROLE OF CYTOLOGY IN UROLOGY

U kratkim crtama prikazano je mjesto i uloga kliničke citologije u urologiji, s naglaskom na citološku analizu sedimenta urina. Pojašnjeni su tehnički aspekti uzimanja uzoraka urina za citološku analizu i dan je kratak pregled prednosti i ograničenja te dijagnostičke pretrage. Prikazane su osnovne kategorije citoloških nalaza urina te je dan kratak osvrt na nove tehnike za poboljšanje osjetljivosti analize urina u otkrivanju malignih tumora urotela.The aim of the paper was to describe the role of clinical cytology in urology, with emphasis on cytodiagnostic urinalysis. Technical aspects of specimen collection are reviewed, as well as advantages and limitations of urinary cytology. General categories of urinary cytodiagnoses are listed. Some new techniques – urinary marker tests and DNA image-cytometry, are shortly reviewe

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

Neonatal Hemophagocytic Lymphohistiocytosis – Case Report

Hemophagocytic lymphohystiocytosis (HLH) represents a severe hyperinflammatory condition with the cardinal symptoms prolonged fever, hepatosplenomegaly, and cytopenias. The most prominent histopathological feature of HLH is an accumulation of activated T lymphocytes and macrophages predominantly in lymphoid tissues. Although it can occur in all age groups, neonatal-onset HLH is very rare. We report on a case of HLH presenting with anemia and respiratory distress at birth. Several weeks prior to diagnosis the symptoms were attributed to a systemic infection. The child developed typical clinical and laboratory findings, and was diagnosed with HLH according to HLH-2004 guidelines. Chemo- -immunotherapy was initiated, but after a temporary control of the disease the patient succumbed to rapidly progressive HLH. Post-mortem, extensive hemophagocytosis was found in multiple organs. No specific genetic defect was identified. HLH is potentially fatal childhood disease. It is important for pediatricians to be able to early identify this disorder and commence the therapy before overwhelming disease activity develops

Descriptive and functional definition of nucleolus – a pathway to cancer therapy

Očekuje se da moderna terapija tumora djeluje ciljano i sveobuhvatno. U novim kliničkim ispitivanjima terapije raka primjenjuju se mali molekularni inhibitori transkripcije ribosomalnih gena i aktivatori apoptoze. Model terapije prikazan ovdje je aktivacija supresora tumora koji djeluju u domeni jezgrice. Stanice tumora pokazuju poremećaj regulacije proteina i mutaciju P53 gena koji suprimira rast. Razvoj bolesti definira terapiju. Moderna se definicija bolesti temelji na etiopatogenezi staničnog stresa u kojem sudjeluju brojne organele, uključujući jezgricu. Jezgra i jezgrica su mikroskopski oblici. Ovaj prikaz daje sažet opis onoga što se vidi kada se kaže „jezgrica”. Nadalje su opisani kiseli nehistonski proteini koji se okupljaju oko transkripcijskog ustroja RNK polimeraze I te je istaknut značaj njihove vizualizacije za promjenu definicije jezgrice. Osim što je tjelešce u nukleoplazmi i subnuklearna organela, jezgrica se može vizualizirati pomoću njezinih funkcionalnih struktura – AgNOR-a. AgNOR proteini imaju ulogu u nukleolarnom stresu. Svrha ovoga teksta je raspraviti nukleolarni stres.Modern tumour therapy should be target specific and comprehensive. Recent clinical trials test small molecular inhibitors of transcription of ribosomal genes and activators of apoptosis. We treatise on models of activation of the suppressors of tumour growth acting in the nucleolar domain. Tumour cells demonstrate a disordered protein regulation and mutation of P53 gene which codes for a suppressor of growth. Therapy is guided by pathogenesis. Modern disease definition is based on etiopathogenesis of cell stress, wherein participate numerous organelles, including the nucleolus. Nucleus and nucleolus are forms seen on light microscopy. This presentation focuses on the description of the visible correlate of the notion of “nucleolus”. Further to this, acid non-histone proteins which gather around the transcriptional machinery of RNA polymerase I are described, and the significance of their visualisation towards the alteration of the definition of nucleolus is pointed out. Besides being a particle within the nucleoplasm and a subnuclear organelle, the nucleolus is visualized through its functional structures – the AgNORs. The AgNOR proteins have a role in nucleolar stress. The aim of this article is to discuss the nucleolar stress

Comparison of Three Postoperative Follow-up Methods in Patients with Oral Cancer

The goal of this research was to determine the existence of the significant time differences in the identification of the recurrences and neck metastases in the patients surgically treated for the oral cavity cancer by comparing three postoperative follow up methods. The study included 286 patients surgically treated for oral and pharyngeal cancer in period from 1991 to 2007 at three different institutions, divided into three groups based on the different postoperative follow up protocol. In this study we were able to show that the period of identification of recurrences and neck metastases was significantly shorter in the group of patients whose follow up included neck ultrasound, along with methods of inspection and palpation of the oral cavity and the neck. In conclusion, implementation of more contemporary methods such as the neck ultrasound is needed along with usual follow up methods, such as inspection and palpation of the oral cavity and the neck. Also, follow up of the patients surgically treated for the oral cavity cancer should be conducted systematically. Ultrasound examination of the neck should be recommended due to its low cost, harmlessness, possible frequent usage,high quality visual imaging and possibility of combination with the fine needle aspiration cytology (FNAC) of the suspicious lymph nodes

Combined evaluation of bone marrow aspirate and biopsy is superior in the prognosis of multiple myeloma

<p>Abstract</p> <p>Background</p> <p>Estimation of plasma cell infiltrates in bone marrow aspirates (BMA) and bone marrow biopsy (BMB) is a standard method in the diagnosis and monitoring of multiple myeloma (MM). Plasma cell fraction in the bone marrow is therefore critical for the classification and optimal clinical management of patients with plasma cell dyscrasias. The aim of the study was to compare the percentage of plasma cells obtained by both methods with the patient clinical parameters and survival.</p> <p>Methods</p> <p>This retrospective study included BMA and BMB of 59 MM patients. The conventional differential count was determined in BMA to estimate the percentage and cytologic grade of plasma cells. The pattern of neoplastic infiltration and percentage of plasma cells were estimated on CD138 immunostained BMB slides microscopically and by computer-assisted image analysis (CIA).</p> <p>Results</p> <p>Significantly higher values of plasma cell infiltrates were observed in pathologist (47.7 ± 24.8) and CIA (44.1 ± 30.6) reports in comparison with cytologist analysis (30.6 ± 17.1; <it>P </it>< 0.001 and <it>P </it>< 0.0048, respectively). BMB assessment by pathologist counting and using CIA showed strongest correlation (r = 0.8; <it>P </it>< 0.0001). Correlation was also observed between the pathologist and cytologist counts (r = 0.321; <it>P </it>= 0.015) as well as comparing the percentage of plasma cells in BMA and CIA (r = 0.27; <it>P </it>= 0.05). Patients with clinical stage I/II had a significantly lower CIA plasma cell count than those with clinical stage III (<it>P </it>= 0.008). Overall survival was shorter in patients with more than 25% of atypical plasma cell morphology estimated in BMA (<it>P </it>= 0.05) and a higher percentage of tumor cell infiltrates estimated by the pathologist and CIA (<it>P </it>= 0.0341 and <it>P </it>= 0.013, respectively).</p> <p>Conclusion</p> <p>Study results suggested the combined analyses to be useful as a routine procedure to achieve more accurate and informative diagnostic data.</p

Comparison of Three Postoperative Follow-up Methods in Patients with Oral Cancer

The goal of this research was to determine the existence of the significant time differences in the identification of the recurrences and neck metastases in the patients surgically treated for the oral cavity cancer by comparing three postoperative follow up methods. The study included 286 patients surgically treated for oral and pharyngeal cancer in period from 1991 to 2007 at three different institutions, divided into three groups based on the different postoperative follow up protocol. In this study we were able to show that the period of identification of recurrences and neck metastases was significantly shorter in the group of patients whose follow up included neck ultrasound, along with methods of inspection and palpation of the oral cavity and the neck. In conclusion, implementation of more contemporary methods such as the neck ultrasound is needed along with usual follow up methods, such as inspection and palpation of the oral cavity and the neck. Also, follow up of the patients surgically treated for the oral cavity cancer should be conducted systematically. Ultrasound examination of the neck should be recommended due to its low cost, harmlessness, possible frequent usage,high quality visual imaging and possibility of combination with the fine needle aspiration cytology (FNAC) of the suspicious lymph nodes