Non Small Cell Lung Cancer Incidence by Age and Histological Types Distribution

INTRODUCTION AND AIM Lung cancer is one of the most common malignant neoplasms and the leading cause of tumor-related death in both sexes. As the advancing age is an important risk factor for its development this tumor occurs mostly in elderly people. There are four histological types: small lung cell cancer (SCLC), adenocarcinoma, squamous and large cell carcinoma. The last three are together referred to as non-small cell lung cancer (NSCLC). This research was conducted to determine the incidence of NSCLC among different age groups and estimate the distribution of different histological types of NSCLC. METHODS Center for Pathology at Clinical Center of Montenegro was done. The data were analysed using Microsoft Office Excell 2016. RESULTS AND CONCLUSION There were 442 non small cell lung cancers in total and from 2012 to 2014 the number of NSCLCs increased by 11%. The highest incidence of NSCL was noted in individuals aged 60 to 69 (40.04%) and 50 to 59 (30.32%). Out of 364 NSCLCs that were in more details histologically specified, 183 (50.27%) were squamous and 171 (46.98%) were adenocarcinomas. The predominant histological type was squamous, which correlates to high cigarette smoking incidence in Montenegro and more than one third of new cases were diagnosed in people in seventh decade of life, which might be due to late cancer diagnosis

Small Cell Neuroendocrine Tumor of the Larynx – A Small Case Series

Neuroendocrine tumors are the most common nonsquamous types of laryngeal neoplasms. They are classified as typical carcinoids, atypical carcinoids, small-cell neuroendocrine carcinomas, and paragangliomas. The aim of the paper is to present four patients with small-cell neuroendocrine tumor arising in larynx. There were one woman and three men whose ages were 47–77 years; all of them had metastases when first seen. The clinical presentation and management of such type of tumor are discussed. Small-cell neuroendocrine carcinomas are very aggressive neoplasms. Patients could benefit from surgery, but radiotherapy and chemotherapy remain the treatment of choice. Examination of a large series is required to define the most useful diagnostic methods and the most successful treatment modalities

Lung cancer mortality in Montenegro, 1990 to 2015

Aim To analyze the trend of lung cancer mortality in Montenegro from 1990 to 2015. Methods Data on lung cancer mortality were collected from death certificates obtained from the Statistical Office of Montenegro for the period 1990-2009 and the Institute for Public Health for the period 2010-2015. Population data were obtained from the Statistical Office of Montenegro. Rates were age-standardized to the World Standard Population, and mortality trends were analyzed with the joinpoint regression. Results In 2015, lung cancer accounted for 5.44% of all deaths and 22.92% of all cancer deaths. It was the leading cause of all cancer deaths and the third-leading cause of all deaths. A joinpoint was observed in 2004 in women and in the entire population, and in 2005 in men. The overall mortality rates increased from 1990 to 2004 by an average of 3.91% per year and decreased from 2004 to 2015 by an average of 1.95%; which in the entire observed period resulted in an average increase of 1.3% per year. A particularly strong growth rate was observed in women, even 7.14% in the period from 1990 to 2004. Conclusion The observed increase in lung cancer mortality warrants improved tobacco control

Metastaza malignog ameloblastoma na vratu - radiološka i patohistološka dilema

Introduction. Ameloblastomas are odontogenic epithelial, locally invasive tumors of slow growth and mostly of benign behavior. Their frequency is low (they account for 1% of all head and neck tumors and about 11% of tumors of dental origin). Malignant variations of ameloblastoma are malignant ameloblastoma and ameloblastic carcinoma. They constitute less than 1% of all ameloblastomas. We presented a case of malignant ameloblastoma of the mandible with neck metastasis. Case report. A patient, aged 72, presented with the following symptoms: pain in the lower jaw, swelling in the left submandibular area and difficult mouth opening. The patient was admitted to the Department of Oral and Maxillofacial Surgery, Clinical Center of Montenegro, two months after he had noticed the symptoms. Panoramic radiography (OPG) showed that both jaws were partially toothless with terminal stage of periodontitis of the remaining teeth. Also, OPG showed sharply limited semicircular defect in the retromolar region and along the front edge of the mandible rami. Conventional histopathologic examination of the neck masses showed malignant ameloblastoma which contained central fields of squamous differentiation. Immunoreactivity of several markers was determined using immunohistochemical analyses. After these diagnostic methods a definite histopathology diagnosis was made: Ameloblastoma metastaticum in textus fibroadiposus regio colli (typus acanthomatosus). Conclusion. It is not possible to distinguish conventional, ie intraosseous, ameloblastoma from malignant ameloblastoma according to histopathologic features. It is necessary to pay special attention, especially in elderly patients, and to carry out further clinical, radiological and pathohistological diagnostic procedures, such as immunohistochemical analysis. A timely and correct diagnosis and treatment of malignant ameloblastoma require a multidisciplinary approach.Uvod. Ameloblastomi su odontogeni epitelni tumori, lokalno invazivni, sporog rasta, i u većini slučajeva pokazuju benigno ponašanje. Veoma su rijetki. Njihova učestalost je 1% u grupi tumora glave i vrata, kao i 11% kod tumora koji potiču od zubnih tkiva. Maligne varijante ameloblastoma su maligni ameloblastom i ameloblastički karcinom. Oni čine manje od 1% svih ameloblastoma. U radu je prikazan bolesnik sa malignim ameloblastomom donje vilice sa metastazom na vratu. Prikaz bolesnika. Prve subjektivne tegobe bolesnika, starog 72 godine, manifestovale su se kao bolovi u predelu donje vilice, otok u podviličnom predelu sa leve strane i otežano otvaranje usta. Bolesnik je primljen u Odeljenje oralne i maksilofacijalne hirurgije Kliničkog centra Crne Gore dva meseca nakon što je primetio prve tegobe. Ortopantomografski snimak pokazao je suptotalnu bezubost obeju vilica sa terminalnim stadijumom parodontopatije na preostalim zubima. U retromolarnoj regiji i duž prednje ivice ramusa donje vilice, uočen je jasno ograničen polukružni defekt. Biopsija promene na vratu pokazala je metastazu malignog ameloblastoma, sa prisutnim centralnim poljima skvamozne diferencijacije. Imunohistohemijskom analizom određivana je imunoreaktivnost više markera. Nakon ovih dijagnostičkih metoda postavljena je definitivna patohistološka dijagnoza: Ameloblastoma metastaticum in textus fibroadiposus regio colli (typus acanthomatosus). Zaključak. Na osnovu histopatološkog nalaza nije moguće razlikovati konvencionalni, tj. intraosealni, ameloblastom od malignog ameloblastoma. Zbog toga je potrebno obratiti posebnu pažnju, naro čito kod bolesnika starijeg životnog doba, i sprovesti sve dodatne kliničke, radiološke i histopatološke, ali i imunohistohemijske dijagnostičke procedure. Za postavljanje blagovremene i tačne dijagnoze, kao i sprovođenje adekvatnog terapijskog tretmana malignog ameloblastoma, neophodan je multidisciplinarni pristup

Bleeding gastroduodenal ulcers in patients without Helicobacter pylori infection and without exposure to non-steroidal anti-inflammatory drugs

Background/Aim. A high risk of bleeding in Helicobacter pylori (H.pylori)-negative, non-steroidal anti-inflammatory drugs (NSAID)-negative ulcers highlights the clinical importance of analysis of the changing trends of peptic ulcer disease. The aim of the study was to investigate the risk factors for ulcer bleeding in patients with non-H. pylori infection, and with no NSAIDs use. Methods. A prospective study included patients with endoscopically diagnosed ulcer disease. The patients were without H. pylori infection (verified by pathohistology and serology) and without exposure to NSAIDs and proton pump inhibitors (PPI) within 4 weeks before endoscopy. After endoscopy the patients were divided into 2 groups: the study group of 48 patients with bleeding ulcer and the control group of 47 patients with ulcer, but with no bleeding. Prior to endoscopy they had completed a questionnaire about demographics, risk factors and habits. The platelet function, von Willebrand factor (vWF) and blood groups were determined. Histopathological analysis of biopsy samples were performed with a modified Sydney system. The influence of bile reflux was analyzed by Bile reflux index (BRI). Results. Age, gender, tobacco and alcohol use did not affect the bleeding rate. The risk of bleeding did not depend on concomitant diseases (p = 0.509) and exposure to stress (p = 0.944). Aspirin was used by 16/48 (33.3%) patients with bleeding ulcer, as opposed to 7/47 (14.9%) patients who did not bleed (p = 0.036). Abnormal platelet function had 12/48 (25.0%) patients who bled, as opposed to 2/47 (4.3%) patients who did not bleed (p = 0.004). Patients with BRI < 14 bled in 79.2%, and did not bleed in 57.4% of the cases (p = 0.023). There was no statistical difference between groups in regards to blood groups and range of vWF. Antrum atrophy was found in 14/48 (29.2%) patients with bleeding ulcer and in only 5/47 (10.6%) patients who had ulcer without bleeding (p = 0.024). Conclusion. Abnormal platelet function, aspirin use and antrum atrophy were the risk factors for ulcer bleeding in non-H. pylori, non- NSAIDs ulcer disease

Povezanost histopatoloških karakteristika karcinoma usne sa progresijom bolesti

The most common malignancy of the lip is squamous cell carcinoma (SCC). In our population, according to epidemiological data, almost a half of all (45%) SCC of oral mucous tissue spreads over the lower and upper lip. The aim of this study was to estimate prognostic importance of histopathologic characteristics - histologic grade, nuclear grade and tumor size in relation to the appearance of lymph node metastases and relapse in SCC of the lip. Methods. In the retrospective- prospective study 70 cases of lower and upper lip SCC were analyzed. They were diagnosed from 2002 to 2006 in the Clinic of Maxillofacial Surgery, Clinical Center of Montenegro. The data about localization of the carcinomas, histopathologic characteristics and lymph node status were taken from medical files of the patients. The patients were followed up in a 3-year period and the disease relapse or/and metastatic disease appearance were registereds. Results. There was statistically significant difference in tumor size among the patients with and without disease relapse (p = 0.027). Logistic regression analysis showed that the tumor size is a statistically significant factor (R = 0.186; p = 0.011) for the appearance of regional lymph node metastases. Relative risk [exp (B)] for the appearance of regional lymph node metastases in relation to tumor size was 2.807. Conclusion. Histologic and nuclear grade of lip SCC are not prognostic factors for the appearance of the disease relapse and regional lymph node metastases. Tumor size is a predictive factor of the relapse appearance, as well as for lymph node metastases appearance. In clinical practice, tumor size is a factor that classifies patients with lip SCC into the groups of higher and smaller risk of relapse appearance and for lymph node metastases appearance. Our results suggest that, risk for lymph node metastases appearance increases 2.8 times with increasing of the tumor size over 2 cm in diameter.Uvod/Cilj. Planocelularni karcinom (PCC) je najčešće maligno oboljenje usne. Prema epidemiološkim podacima, u našoj populaciji skoro polovina (45%) PCC sluzokože usne duplje zahvata i donju i gornju usnu. Cilj ovog rada bio je utvrđivanje prognostičkog značaja histopatoloških karakteristika PCC usne: histološkog gradusa, nuklearnog gradusa i veličine tumora za pojavu recidiva bolesti i metastaza u regionalnim limfnim čvorovima. Metode. U retrospektivno-prospektivnoj studiji analizirano je 70 bolesnika sa PCC donje i gornje usne, dijagnostikovanim u periodu od 2002. do 2006. godine u Klinici za maksilofacijalnu hirurgiju Kliničkog centra Crne Gore. Podaci o lokalizaciji neoplazmi, životnom dobu i polu bolesnika, kao i o histopatološkim karakteristikama neoplazmi uzeti su iz uputnika za histopatološki pregled. Tokom tri godine, na redovnim postoperativnim kliničkim kontrolama, registrovana je eventualna pojava recidiva i/ili metastatske bolesti. Rezultati. Veličina tumora se statistički značajno razlikovala između ispitanika sa i bez recidiva bolesti (p = 0,027). Logističkom regresionom analizom utvrđeno je da je veličina tumora bila statistički značajan faktor (p = 0,011, R = 0,186) za pojavu metastaza u regionalnim limfnim čvorovima. Relativni rizik [exp (B)] od pojave metastaze u regionalnim limfnim čvorovima u odnosu na veličinu tumora iznosio je 2,807. Zaključak. Histološki i nuklearni gradusi tumora nisu prognostički faktori pojave recidiva i metastatske bolesti PCC usne. Veličina tumora predstavlja prognostički faktor za pojavu recidiva i regionalnih metastaza PCC usne, tj. faktor koji omogućava podelu bolesnika sa karcinomom usne u grupu sa većim, odnosno manjim rizikom od pojave recidiva i/ili metastatske bolesti. Prema našim rezultatima, sa povećanjem veličine PCC usne iznad 2 cm rizik od pojave regionalnih metastaza povećava se 2,8 puta

Correlation between disease progression and histopathologic criterions of the lip squamous cell carcinoma

The most common malignancy of the lip is squamous cell carcinoma (SCC). In our population, according to epidemiological data, almost a half of all (45%) SCC of oral mucous tissue spreads over the lower and upper lip. The aim of this study was to estimate prognostic importance of histopathologic characteristics - histologic grade, nuclear grade and tumor size in relation to the appearance of lymph node metastases and relapse in SCC of the lip. Methods. In the retrospective- prospective study 70 cases of lower and upper lip SCC were analyzed. They were diagnosed from 2002 to 2006 in the Clinic of Maxillofacial Surgery, Clinical Center of Montenegro. The data about localization of the carcinomas, histopathologic characteristics and lymph node status were taken from medical files of the patients. The patients were followed up in a 3-year period and the disease relapse or/and metastatic disease appearance were registereds. Results. There was statistically significant difference in tumor size among the patients with and without disease relapse (p = 0.027). Logistic regression analysis showed that the tumor size is a statistically significant factor (R = 0.186; p = 0.011) for the appearance of regional lymph node metastases. Relative risk [exp (B)] for the appearance of regional lymph node metastases in relation to tumor size was 2.807. Conclusion. Histologic and nuclear grade of lip SCC are not prognostic factors for the appearance of the disease relapse and regional lymph node metastases. Tumor size is a predictive factor of the relapse appearance, as well as for lymph node metastases appearance. In clinical practice, tumor size is a factor that classifies patients with lip SCC into the groups of higher and smaller risk of relapse appearance and for lymph node metastases appearance. Our results suggest that, risk for lymph node metastases appearance increases 2.8 times with increasing of the tumor size over 2 cm in diameter.Uvod/Cilj. Planocelularni karcinom (PCC) je najčešće maligno oboljenje usne. Prema epidemiološkim podacima, u našoj populaciji skoro polovina (45%) PCC sluzokože usne duplje zahvata i donju i gornju usnu. Cilj ovog rada bio je utvrđivanje prognostičkog značaja histopatoloških karakteristika PCC usne: histološkog gradusa, nuklearnog gradusa i veličine tumora za pojavu recidiva bolesti i metastaza u regionalnim limfnim čvorovima. Metode. U retrospektivno-prospektivnoj studiji analizirano je 70 bolesnika sa PCC donje i gornje usne, dijagnostikovanim u periodu od 2002. do 2006. godine u Klinici za maksilofacijalnu hirurgiju Kliničkog centra Crne Gore. Podaci o lokalizaciji neoplazmi, životnom dobu i polu bolesnika, kao i o histopatološkim karakteristikama neoplazmi uzeti su iz uputnika za histopatološki pregled. Tokom tri godine, na redovnim postoperativnim kliničkim kontrolama, registrovana je eventualna pojava recidiva i/ili metastatske bolesti. Rezultati. Veličina tumora se statistički značajno razlikovala između ispitanika sa i bez recidiva bolesti (p = 0,027). Logističkom regresionom analizom utvrđeno je da je veličina tumora bila statistički značajan faktor (p = 0,011, R = 0,186) za pojavu metastaza u regionalnim limfnim čvorovima. Relativni rizik [exp (B)] od pojave metastaze u regionalnim limfnim čvorovima u odnosu na veličinu tumora iznosio je 2,807. Zaključak. Histološki i nuklearni gradusi tumora nisu prognostički faktori pojave recidiva i metastatske bolesti PCC usne. Veličina tumora predstavlja prognostički faktor za pojavu recidiva i regionalnih metastaza PCC usne, tj. faktor koji omogućava podelu bolesnika sa karcinomom usne u grupu sa većim, odnosno manjim rizikom od pojave recidiva i/ili metastatske bolesti. Prema našim rezultatima, sa povećanjem veličine PCC usne iznad 2 cm rizik od pojave regionalnih metastaza povećava se 2,8 puta

Malignant ameloblastoma metastasis to the neck: Radiological and pathohistological dilemma

Introduction. Ameloblastomas are odontogenic epithelial, locally invasive tumors of slow growth and mostly of benign behavior. Their frequency is low (they account for 1% of all head and neck tumors and about 11% of tumors of dental origin). Malignant variations of ameloblastoma are malignant ameloblastoma and ameloblastic carcinoma. They constitute less than 1% of all ameloblastomas. We presented a case of malignant ameloblastoma of the mandible with neck metastasis. Case report. A patient, aged 72, presented with the following symptoms: pain in the lower jaw, swelling in the left submandibular area and difficult mouth opening. The patient was admitted to the Department of Oral and Maxillofacial Surgery, Clinical Center of Montenegro, two months after he had noticed the symptoms. Panoramic radiography (OPG) showed that both jaws were partially toothless with terminal stage of periodontitis of the remaining teeth. Also, OPG showed sharply limited semicircular defect in the retromolar region and along the front edge of the mandible rami. Conventional histopathologic examination of the neck masses showed malignant ameloblastoma which contained central fields of squamous differentiation. Immunoreactivity of several markers was determined using immunohistochemical analyses. After these diagnostic methods a definite histopathology diagnosis was made: Ameloblastoma metastaticum in textus fibroadiposus regio colli (typus acanthomatosus). Conclusion. It is not possible to distinguish conventional, ie intraosseous, ameloblastoma from malignant ameloblastoma according to histopathologic features. It is necessary to pay special attention, especially in elderly patients, and to carry out further clinical, radiological and pathohistological diagnostic procedures, such as immunohistochemical analysis. A timely and correct diagnosis and treatment of malignant ameloblastoma require a multidisciplinary approach.Uvod. Ameloblastomi su odontogeni epitelni tumori, lokalno invazivni, sporog rasta, i u većini slučajeva pokazuju benigno ponašanje. Veoma su rijetki. Njihova učestalost je 1% u grupi tumora glave i vrata, kao i 11% kod tumora koji potiču od zubnih tkiva. Maligne varijante ameloblastoma su maligni ameloblastom i ameloblastički karcinom. Oni čine manje od 1% svih ameloblastoma. U radu je prikazan bolesnik sa malignim ameloblastomom donje vilice sa metastazom na vratu. Prikaz bolesnika. Prve subjektivne tegobe bolesnika, starog 72 godine, manifestovale su se kao bolovi u predelu donje vilice, otok u podviličnom predelu sa leve strane i otežano otvaranje usta. Bolesnik je primljen u Odeljenje oralne i maksilofacijalne hirurgije Kliničkog centra Crne Gore dva meseca nakon što je primetio prve tegobe. Ortopantomografski snimak pokazao je suptotalnu bezubost obeju vilica sa terminalnim stadijumom parodontopatije na preostalim zubima. U retromolarnoj regiji i duž prednje ivice ramusa donje vilice, uočen je jasno ograničen polukružni defekt. Biopsija promene na vratu pokazala je metastazu malignog ameloblastoma, sa prisutnim centralnim poljima skvamozne diferencijacije. Imunohistohemijskom analizom određivana je imunoreaktivnost više markera. Nakon ovih dijagnostičkih metoda postavljena je definitivna patohistološka dijagnoza: Ameloblastoma metastaticum in textus fibroadiposus regio colli (typus acanthomatosus). Zaključak. Na osnovu histopatološkog nalaza nije moguće razlikovati konvencionalni, tj. intraosealni, ameloblastom od malignog ameloblastoma. Zbog toga je potrebno obratiti posebnu pažnju, naro čito kod bolesnika starijeg životnog doba, i sprovesti sve dodatne kliničke, radiološke i histopatološke, ali i imunohistohemijske dijagnostičke procedure. Za postavljanje blagovremene i tačne dijagnoze, kao i sprovođenje adekvatnog terapijskog tretmana malignog ameloblastoma, neophodan je multidisciplinarni pristup