Usporedba seronegativnog i seropozitivnog reumatoidnog artritisa u odnosu na izvjesne kliničke karakteristike

The aim of this study is to establish a scientific comparative analysis between seronegative and seropositive rheumatoid arthritis (RA), with regard to some clinical characteristics. The studied group consisted of RA seronegative patients with titters lower then 1:64 defined by Rose-Waaler test, while the control group consisted of RA seropositive patients with titters of 1:64 or higher. Examinees all belonged to the 2nd and 3rd functional classes according to ARA criteria, were between 25-60 years of age (Xb=49.96), with disease duration between 1-27 years (Xbox=6.41). In the disease onset most frequently affected joints were metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint of the hands, almost equally represented with regard to sero-status and sex. During the examination seropositive patients showed a higher presence of inflamation of peripheral joints of hand and foot, but only the presence of PIP of the hands was statistically significant (χ2=15.63, p<0.01). Knees, talocrural joints and elbows were more frequently affected in seropositive patients, whereas humeroscapular, coxofemoral and sacroiliacal joints were more frequently affected in seronegative patients, but without significant statistical difference with regard to sero-status. The presence of affected PIP of the hands (χ2=9.96, p<0.01) and knees (χ2=4.17, p<0.05) with regard to sex was statistically significant in seropositive female patients, as well as the presence of atacked PIP of the hands (χ2=6.08, p<0.05), and cervical vertebrae (χ2=6.00, p<0.05) in seropositive male patients. There were some differences between groups with regard to sex in metatarsophalangeal joints (MTP), PIP of the foot, and other joints, but without any statistical significance. In both subsets statistically significant domination was found in affected second (χ2=20.85, p<0.01) and third (χ2= 15.70, p<0.01) fingers of the PIP level of hands and third finger (χ2=6.52, p<0.05) of the MCP level. The mentioned parameters did not show a significant statistical difference with regard to sero-status and sex. Majority of patients had 1-4 deformities. Seropositive group had prevalent knee contractures, e.g. the eversion of the foot, while seronegative group had more “swan neck” deformities. The mentioned parameters did not show a significant statistical difference with regard to sero-status and sex. Longer duration of the disease resulted in an increased number of deformities, and this difference was statistically significant (t=5.92, p<0.01). Linear correlation between these two parameters resulted as high positive in general (r=0.49, p<0.01) and for groups separately, but without significant statistical difference with regard to sero-status. Duration of the disease with regard to the type of deformities was different in both subsets: in case of the longer duration of the disease “buttonhole” was prevalent with statistically significant difference in seropositive patients (t=2.10, p<0.05), whereas “fibular deviation” was prevalent in seronegative patients (t=2.64, p<0.01).U našem istraživanju uspoređena je skupina seronegativnog i seropozitivnog reumatoidnog artritisa (RA) u odnosu na neke kliničke karakteristike. Ispitivana skupina je obuhvatila seronegativne bolesnike s titrom manjim od 1:64 određenim pomoću Waaler-Roseova testa, dok su kontrolnu činili seropozitivni bolesnici s titrom 1:64 ili višim. Svi ispitanici su pripadali II. i III. funkcionalnom razredu (ARA), bili životne dobi u rasponu 25-60 godina (Xb=49,96) s trajanjem bolesti 1-27 godina (Xb=6,41). U početku bolesti, najčešće zahvaćeni zglobovi su bili metakarpofalangealni (MCP) i proksimalni interfalangealni (PIP) zglobovi ruku, približno jednako zahvaćeni u odnosu na serološki status i spol. Tokom ispitivanja, seropozitivni bolesnici imali su znatno zahvaćenije periferne zglobove ruku i nogu, ali statistički značajno samo u slučaju rasprostranjenosti PIP ruku (χ2=15,63 p<0,01). Koljena, talokruralni zglobovi i laktovi su bili znatno više zahvaćeni u seropozitvnih bolesnika, dok humeroskapularni, koksofemoralni, sakroilijakalni i radiokarpalni zglobovi u seronegativnih, bez znatne statističke razlike u odnosu na serološki status. U odnosu na spol, relevantna statistička razlika je nađena u zahvaćenosti PIP ruku (χ2=9,96, p<0,01) i koljena (χ2=4,17, p<0,05) u seropozitivnih ženskih bolesnika, kao i kod zahvaćenosti PIP ruku (χ2=6,08, p<0,05) i cervikalnog dijela kralježnice (χ2=6,00, p<0,05) u seropozitivnih muških bolesnika. Kod metatarzofalangealnih (MTP) zglobova, PIP nogu, kao i kod drugih zglobova, nađene su određene razlike između skupina u pogledu spola, ali statistički neznačajne. U obje ispitivane skupine statistički značajno je bila zahvaćenost drugih (χ2=20,85, p<0,01) i trećih (χ2= 15,70, p<0,01) prstiju u razini PIP ruku, kao i trećeg prsta (χ2=6,52, p<0,05) u razini MCP, ali statistički neznačajno u odnosu na serološki status i spol. Veliki broj bolesnika je imao 1-4 deformiteta. U seropozitivnih bolesnika su dominirale kontrakture koljena, laktova, kao i everzija stopala, a u seronegativnih bolesnika deformiteti u obliku labuđeg vrata. Nisu nađene statistički relevantne razlike u odnosu na serološki status i spol. Broj deformiteta se povećao s povećanjem prosječnog trajanja bolesti i ova razlika je izražena sa znatnom statističkom razlikom (t=5,92, p<0,01). Izračunavanjem linearne korelacije između ovih dviju pojava, nađena je pozitivna i visoka korelacija (r=0,49, p<0,01) u cjelini i po skupinama, ali bez znatne statističke razlike u odnosu na serološki status. Trajanje bolesti u odnosu na vrstu deformiteta između skupina bilo je različito. Znatne statističke razlike su nađene za deformitet “bottonhole” s dužim trajanjem bolesti u seropozitvnih bolesnika (t=2,10, p<0,05), i za fibularnu devijaciju u seronegativnih bolesnika (t=2,64, p<0,01)

Klinička važnost VEGF-A i mikrožilne gustoće u difuznom limfomu velikih B-stanica i folikularnom limfomu niskog stupnja

Angiogenesis is essential for the development, growth and progression of tumors. Although vascular endothelial growth factor (VEGF) is a well-known proangiogenic factor, its impact on lymphoma has not yet been fully clarified. The aim of this study was to evaluate VEGF-A ­expression and microvessel density (MVD) in aggressive lymphoma such as diffuse large B-cell lymphoma (DLBCL), in indolent lymphomas such as low-grade follicular lymphoma (FL), and in lymph node reactive follicular hyperplasia (FH). In 80 prospective and retrospective cases (30 DLBCL, 30 FL and 20 FH), CD31 was analyzed by immunohistochemical staining assessing density of blood vessels, as well as the total number of CD31 positive endothelial cells. The results were compared with relevant clinical data. MVD was 85% in FH, followed by 60% in DLBCL and 43% in low-grade FL. VEGF-A was significantly higher in DLBCL than in low-grade FL and FH. A statistically significant association of MVD and VEGF-A with the International Prognostic Index (IPI) was found in DLBCL. High MVD and VEGF-A expression was observed in DLBCL patients with high IPI, while there was no statistically significant association between MVD and VEGF-A with the Follicular Lymphoma International Prognostic Index in low-grade FL. Our results suggested an important relationship between angiogenesis and high-grade lymphoma.Angiogeneza je bitna za razvoj, rast i progresiju tumora. Iako je vaskularni endotelni faktor rasta (VEGF) dobro poznati proangiogeni čimbenik, njegov utjecaj na limform nije u potpunosti razjašnjen. Cilj ovoga istraživanja bio je procijeniti izraženost VEGF-A i mikrožilnu gustoću (MVD) kod agresivnog limfoma kao što je difuzni limfom velikih B-stanica (DLBCL), kod indolentnih limfoma kao što je folikularni limfom niskog stupnja (FL) i kod reaktivne folikularne hiperplazije limfnih čvorova (FH). Analiza CD31 provedena je u 80 prospektivnih i retrospektivnih slučajeva (30 DLBCL, 30 FL i 20 FH) imunohistokemijskim bojenjem za procjenu gustoće krvnih žila, kao i ukupnog broja endotelnih stanica pozitivnih na CD31. Rezultati su uspoređeni s relevantnim kliničkim podacima. MVD je bila 85% kod FH, 60% kod DLBCL i 43% kod FL niskog stupnja. VEGF-A je bio značajno viši u DLBCL u odnosu na FL niskog stupnja i FH. Statistički značajna udruženost MVD i VEGF-A s Internacionalnim prognostičkim indeksom (IPI) utvrđena je kod DLBCL. Visoka izraženost MVD i VEGF-A zabilježena je u bolesnika s DLBCL s visokim IPI, dok nije bilo statistički značajne udruženosti MVD i VEGF-A s Internacionalnim prognostičkim indeksom za folikularni limfom kod FL niskog stupnja. Rezultati ovog istraživanja ukazuju na važan odnos između angiogeneze i limfoma visokog stupnja

Usporedna analiza seronegativnog i seropozitivnog reumatoidnog artritisa u odnosu na neke epidemiološke i anamnestičke značajke

Classifying patients into two subsets of the disease - seronegative RA and seropositive RA - has been the subject of many studies which aim to clarify this phenomenon - without any conclusive or acceptable answer so far. The aim of this prospective study was to establish a scientific comparative analysis between seronegative and seropositive rheumatoid arthritis (RA) regarding some epidemiological and anamnestic characteristics. The studied group consisted of seronegative patients with titers lower than 1:64 as defined by Rose-Waaler test, while the control group consisted of seropositive patients with titers of 1:64 or higher. All patients belonged to 2nd and 3rd functional class according to the ARA criteria, were between 25-60 years of age (Xb=49,96), with disease duration between 1-27 years (Xb=6,41). Education, residence, economic and living conditions did not show any significant statistical difference regarding sero-status. Familial clustering of RA confirmed higher susceptibility in the seropositive group (χ2=7,02; p<0,01). In both subsets banal diseases, psychic and physical trauma, weakness, and numbness of hands and legs dominated, without any statistical difference regarding sero-status. Some differences between groups regarding sex were noticed, but were not statistically significant, except regarding physical trauma, which was more pre­sent in seronegative females (χ2=8,05; p<0,01).Klasifikacija bolesnika s reumatoidnim artritisom (RA) u dvije skupine - seronegativni RA i seropozitivni RA - predmet je mnogih dosadašnjih istraživanja. U ovome prospektivnom istraživanju provedena je usporedna analiza seronegativnog i seropozitivnog reu­matoidnog artritisa u odnosu na neke epidemiološke i anamnestičke karakteristike. Ispitivanu skupinu činili su bolesnici sa seronegativnim RA s titrom manjim od 1:64 određenim pomoću Waaler-Roseova testa, dok su kontrolnu skupinu činili bolesnici sa seropozitivnim RA s titrom 1:64 ili višim. Svi ispitanici su pripadali II. I III. funkcijskom razredu (ARA), bili su životne dobi između 25-60 godina (Xb=49,96) s trajanjem bolesti 1-27 godina (Xb=6,41). Edukacija, mjesto boravka, ekonomski i životni uvjeti nisu pokazali znatnu statističku razliku u odnosu na serološki status. U bliskih rođaka RA je bio češće prisutan u seropozitivnoj skupini (χ2=7,02; p<0,01). U obje skupine dominirale su tzv. banalne bolesti, psihičke i fizičke traume, malaksalost, ali bez istaknute statističke razlike u odnosu na serološki status. Nađene su određene razlike između skupina u pogledu spola, ali nisu bile statistički značajne, osim kod fizičkih trauma koje su bile češće prisutne u seronegativnih žena (χ2=8,05; p<0,01)

Clear cell variant of diffuse large B-cell lymphoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Diffuse large B-cell lymphoma is a diffuse proliferation of large neoplastic B lymphoid cells with a nuclear size equal to or exceeding the normal macrophage nuclei. We report a case of a clear cell variant of diffuse large B-cell lymphoma involving a lymph node in the neck, which was clinically suspected of being metastatic carcinoma.</p> <p>Case presentation</p> <p>A 39-year-old Caucasian ethnic Albanian man from Kosovo presented with a rapidly enlarging lymph node in his neck, but he also disclosed B symptoms and fatigue. A cytological aspirate of the lymph node revealed pleomorphic features. Our patient underwent a cervical lymph node biopsy (large excision). The mass was homogeneously fish-flesh, pale white tissue replacing almost the whole structure of the lymph node. The lymph node biopsy showed a partial alveolar growth pattern, which raised clinical suspicion that it was an epithelial neoplasm. With regard to morphological and phenotypic features, we discovered large nodules in diffuse areas, comprising large cells with slightly irregular nuclei and clear cytoplasm admixed with a few mononuclear cells. In these areas, there was high mitotic activity, and in some areas there were macrophages with tangible bodies. Staining for cytokeratins was negative. These areas had the following phenotypes: cluster designation marker 20 (CD20) positive, B-cell lymphoma (Bcl)-2-positive, Bcl-6^-, CD5^-, CD3^-, CD21⁺(in alveolar patterns), prostate-specific antigen-negative, human melanoma black marker 45-negative, melanoma marker-negative, cytokeratin-7-negative and multiple myeloma marker 1-positive in about 30% of cells, and exhibited a high proliferation index marker (Ki-67, 80%).</p> <p>Conclusion</p> <p>According to the immunohistochemical findings, we concluded that this patient has a clear cell variant of diffuse large B-cell lymphoma of activated cell type, post-germinal center cell origin. Our patient is undergoing R-CHOP chemotherapy treatment.</p

Hepatobiliary neuroendocrine carcinoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Neuroendocrine carcinoma of the gallbladder is a rather uncommon disease. We report a case of a neuroendocrine tumor that was located in the wall of the gallbladder and that extended into the liver.</p> <p>Case presentation</p> <p>A 52-year-old Caucasian woman presented with right-sided abdominal pain, ascites and jaundice. An MRI scan revealed a tumor mass located in the gallbladder wall and involving the liver. A partial hepatectomy and cholecystectomy were performed. Histology revealed a neuroendocrine tumor, which showed scattered Grimelius positive cells and immuno-expressed epithelial and endocrine markers. Our patient is undergoing chemotherapy treatment.</p> <p>Conclusion</p> <p>Gastroenteropancreatic neuroendocrine tumors need a multidisciplinary approach, involving immunohistochemistry and molecular-genetic techniques.</p

Colorectal Cancer: Prognostic Values

After lung cancer colorectal cancer (Cc) is ranked the second, as a cause of cancer-related death. The purpose of this study was to analyze the Cc cases in our material with respect to all prognostic values including histological type and grade, vascular invasion, perineural invasion, and tumor border features. There were investigated 149 cases of resection specimen with colorectal cancer, which were fixed in buffered neutral formalin and embedded in paraffin. Tissue sections (4(µm thick) were cut and stained with H&E. Adenocarcinoma was the most frequent histological type found in 85,90% of cases, in 60,94% of males and 39,06% of females; squamous cell carcinoma in 7,38%, in 63,63% of males and 36,36% of females; mucinous carcinoma in 4,68%, in 57,15% of males and 42,85% of females; while adenosquamous carcinoma, undifferentiated carcinoma and carcinoma in situ in 0,71% of cases each. Dukes' classification was used in order to define the depth of invasion. Dukes B was found in 68,45% of cases, whereas in 31,54% of cases Dukes C was found. As far as histological grading is concerned, Cc was mostly with moderate differentiation (75,16%) with neither vascular nor perineural invasion. Resection margins were in all cases free of tumor. Our data indicate that the pathologic features of the resection specimen constitute the most powerful predictors of postoperative outcome in Cc. Dukes' stage and degree of differentiation provide independent prognostic information in Cc. However, differentiation should be assessed by the worst pattern