Pathohistological Diagnosis Research Articles

Evaluation of PD-L1 Expression in Colorectal Carcinomas by Comparing Scoring Methods and Their Significance in Relation to Clinicopathologic Parameters.

This study aims to evaluate PD-L1 expression in colorectal carcinomas (CRCs) by using the tumor proportion score (TPS) and the combined positive score (CPS), and to investigate whether there is a correlation with clinicopathologic features. A cross-sectional study was conducted that included samples from patients with colorectal adenocarcinoma treated with colon resection and rectal resection after neoadjuvant radio- and chemotherapy at the Department of Abdominal Surgery at Požega Hospital in the period from 2017 to 2022. The study included 102 tumor tissue samples from patients after resection and the pathohistological diagnosis of adenocarcinoma. In our study, the PD-L1 positivity rate after the TPS was 42 (41%) samples, and after the CPS, 97 (95%) of them (p < 0.001). The positive expression of PD-L1 in tumor cells using the TPS method showed a statistically significant association with adenocarcinoma (TPS ≥ 10-50% and ≥50%). There were significantly more that were moderately differentiated, with TPS ≥ 50%, and those poorly differentiated had values ≥ 10-50%. There were significantly more patients with a status of more than one positive lymph node with TPS values ≥ 10-50%. Patients without metastases in the lymph nodes are significantly more likely to have CPS values > 50%, compared with other lymph node statuses. These results suggest that the total number of PD-L1-expressing cells, including tumor and immune cells, is a more sensitive biomarker than the number of PD-L1-expressing tumor cells alone in CRC.

COMPARATIVE STUDY OF VARIOUS TECHNIQUES TONSILLECTOMY

Objective: The purpose of the study was to compare intraoperative factors and postoperative outcomes between the image-guided acute dissection technique and the endoscopic image-guided acute dissection technique. Material and methods: The study was conducted in 153 patients (81 men and 72 women, average age 26.4 years) who underwent tonsillectomy (2018-2023). Patients were randomly assigned 2 group 52% percent of patients(group1) underwent tonsillectomy with acute dissection technique under visual control, and 48% of patients (group 2) underwent tonsillectomy with acute dissection technique under endoscopic visualization using a 4.0 mm 0° endoscope (Karl Storz, Tuttlingen, Germany). Indications for tonsillectomy were hypertrophy of the tonsils in 82 patients, recurrent tonsillitis in 23 patients and focal infection of the tonsils in 48 patients. Tonsillectomy was performed under general anesthesia using an oral speculum specifically designed for tonsillectomy. All patients were assessed and compared for postoperative pain, bleeding, recurrence, or tonsil tissue growth in the immediate and late postoperative period. The removed adenoid is sent for histology. Clinical diagnosis: Chronic decompensated tonsillitis. Pathohistological diagnosis: Within the limits of the examined material, the histological picture corresponds to chronic tonsillitis, hypertrophy of nasopharyngeal adenoid tissue. Results: There were no serious intra- or postoperative complications. Bleeding points were identified in 47 patients (31 patients group1 and 16 patients group 2). The source of bleeding was observed in the central deep part of the adenoids - in 18 patients, in the lateral parts of the adenoids - in 16 patients, adenoids on both sides in 13. Remnants of adenoid tissue were found in 23 patients, (17 patients group 1 and 6 patients group 2). Remnants of adenoid tissue were removed using bipolar diathermy under image guidance. The operation time for endoscopic tonsillectomy is shorter than for traditional procedures. Conclusions: The visibility provided Tonsillectomy by endoscopic techniques improves the ease and precision of surgery. Clinical significance determines the need for further testing of already proposed means and methods.

Cervical Intraepithelial Neoplasia (CIN) - Comparison of Histological and Pap Results

Objectives: The aim of this study is to investigate the compatibility of pathohistological and Pap findings on material obtained by cervical biopsy and excoalation, and to investigate the compatibility of qualitative histological pattern and diagnosisMaterial and Methods: The study included 152 patients with premalignant lesions of the cervix who underwent Pap testing and targeted cervical biopsy. Archival data on Pap test and histologic diagnosis were collected from available medical records. Information on age and advisable clinical diagnoses was obtained from referrals for pathohistologic examination of tissue. The age of the subjects was determined at the time the tissue samples were collected for analysis. Data on the quality of the material were obtained from microscopic evaluation of the collected materialResults: The largest number of patients was diagnosed with cervical intraepithelial neoplasia type 3 (CIN 3) cytologically (57.2%) and pathohistologically (55.2%). The largest percentage of treated material was rated as very good (46.1%). The majority of respondents (92.4%) had no difference in diagnosis based on Pap test and pathohistological analysis. There was no statistically significant difference in the diagnosis made on the basis of the Pap test and pathohistologic analysis depending on the quality of the materialConclusion: There was a strong positive correlation between the grade established by cytology (Pap test) and the pathohistological diagnosis (PHD). There was no statistically significant difference in the diagnosis made on the basis of the Pap test and pathohistological analysis depending on the quality of the material.M

A 7-year experience in core needle biopsy of breast lesions: Correlation between imaging and hematoxylin and eosin-stained sections

Screening mammography is an imaging procedure which allows breast cancer detection in its early stage. The Breast Imaging and Reporting Data System (BI-RADS) determined six radiological categories for describing lesions. The core needle biopsy (CNB) is minimally invasive procedure that provides pathohistological samples. Via microscopic analysis, samples are categorized into five groups according to the B system for pathohistological report. The aim of the study was to follow the spectrum of pathohistological diagnoses; to define which BI-RADS and core categories are most commonly expressed in certain age groups; and to determine the incidence of histological diagnoses in different BI-RADS categories. The study included 631 patients and data was analysed in order to localise the lesion, BI-RADS and core category and pathohistological diagnosis. Within 631 biopsies, 33 diagnoses were given. In each age group, the findings indicating a high risk for malignancy were the most common (&gt;2 %). The highest percentage of malignant categories was found in patients over the age of 61. Final diagnoses showed a deviation compared to the radiological categories, especially in BI-RADS4 category. Pathohistological diagnosis is always a definite confirmation of a breast lesion type and it has significant contribution to the evaluation of CNB quality.

Rustrela Virus-Associated Encephalomyelitis ('Staggering Disease') in Cats from Eastern Austria, 1994-2016.

Clinical cases of 'staggering disease', a nonsuppurative encephalomyelitis associated with gait abnormalities in cats, have been documented for decades in Sweden. In Austria, an increased incidence was observed in the 1990s. Only recently, rustrela virus (RusV) was identified as the causative agent of this clinicopathologic disease entity. In this retrospective study, we analyzed a total of 23 brain and spinal cord samples from Austrian cats with the pathohistological diagnosis of nonsuppurative encephalomyelitis and clinical signs consistent with staggering disease from 1994 to 2016 using reverse transcription real-time polymerase chain reaction (RT-qPCR) and in situ hybridization. We were able to detect RusV nucleic acids in seven of the examined samples. Borna disease virus 1 (BoDV-1) could be excluded in all cases via immunohistochemistry and RT-qPCR. This study confirms that RusV has been a relevant etiological agent of nonsuppurative encephalomyelitis of cats in a geographically and temporally limited disease cluster in Austria, mainly in the 1990s. The geographic distribution of the positive samples in this study is consistent with earlier reports on 'staggering disease' in Austria. Further studies are necessary to confirm the reservoir host of 'staggering disease' in Austria, as well as investigations on the disappearance of this disease and its possible zoonotic potential.

Pyogenic granuloma — hypotheses of etiopathogenesis, clinical forms and features, modern diagnostic methods and choice of rational treatment tactics

Objective — to analyze modern hypotheses of etiopathogenesis and clinical features of pyogenic granulomas (PG) and to determine the importance of ultrasound of these neoplasms for the choice of individualized tactics of their treatment, taking into account the stage of tumor proliferation. Materials and methods. During 2020—2022, 94 patients with a diagnosis of «pyogenic granuloma» (PG) underwent outpatient treatment under our supervision at Dr. Bogomolets Institute of Dermatology and Cosmetology (Kyiv). The largest number of patients with PG examined by us was aged from 1 to 12 years (72 %), which correlates with the data of scientific research by other authors on the relevant problem. Anamnesis was collected in all examined patients (according to the patients and their parents) regarding the possible causes of neoplasms and the nature of their development. All the patients underwent a complex diagnostic instrumental examination of PG (dermoscopy, ultrasound, histopathology). The choice of treatment tactics was carried out individually in each specific clinical case, taking into account the results of the examination and the stage of tumor proliferation (radio wave removal or treatment with a 595­nm pulsed dye laser was carried out). Results and discussion. A total of 94 patients with PG were examined and treated on an outpatient basis. By age, children from 1 to 8 years old (48 %) and from 8 to 12 years old (24 %) prevailed among the examined. There were 6 % of teenagers and young adults (12—18 years old), 22 % over 18 years old. In 45 patients, neoplasms were localized on the skin of the face, in 7 — on the neck, in 9 — on the upper limbs, in 6 — on the lower limbs, in 27 — on the skin of the trunk. In 87 clinical cases, radio wave removal of neoplasms with their subsequent pathohistological diagnosis was carried out taking into account the results of a comprehensive examination of patients with PG, including the data of ultrasound of the skin in the areas affected by PG, which makes it possible to determine the depth of tumor invasion together with the exophytic part. In 6 clinical cases, PG removal therapy was selected and performed using a pulsed vascular dye laser with a wavelength of 595 nm. In one clinical case, taking into account the sufficiently large size of the tumor (more than 2 cm) and the significant vascularization of the neoplasm revealed by ultrasound, a diagnostic excisional biopsy was performed within healthy tissues. Recurrences of PG after treatment were observed after 2 months in 2 of 94 patients, in particular, after pulsed vascular laser therapy. Subsequently, in these two patients, PG was removed using the radio wave method. No recurrences of the disease were registered. Conclusions. The analysis of modern literature on the problem of PG and the results of own clinical observation and treatment of patients with the corresponding neoplasms indicate that ultrasound of these skin tumors is a sufficiently informative and promising diagnostic method that allows identifying the stage of proliferation and choosing the rational individualized treatment tactics. Considering that the use of ultrasound of skin tumors is a relatively new methods in dermatology, further research in the relevant direction is appropriate, which will increase its diagnostic informativeness.

Effective radiotherapy in rarely observed para-aortic lymph node metastases of sinonasal schwannoma-clinical case from our practice

Schwannoma is benign neurogenic tumor, that arise from Schwann cells of the peripheral nerve sheath. Malignant schwannomas transformation is extremely rare. Histopathological and immunohistochemical analysis confirmed the final pathohistological diagnosis, which is extremely important for the assessment of the therapeutic approach. Schwannomas lymph node metastases are extremely rare and poorly characterized. We present an extremely rare sinonasal schwannoma with metastases in the para-aortic lymph nodes. More interesting is that metastatic para-aortic lymph nodes were affected by radiotherapy . In this article, we share the surprising fact, that the proved through FDG-PET/CT para -aortic lymph node metastases in sinonasal schwannoma with a limitation of more than 3 years, is effectively responded after radiotherapy with total dose over 45 Gy.

Foreign body in the external auditory canal described as a pseudotumor of the middle ear: a case report

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction. &amp;lt;/strong&amp;gt;The aim of this article was to present a case of a foreign body in the external auditory canal described as a pseudotumor of the middle ear, as well as to point out diagnostic and therapeutic aspects of this problem.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Case report. &amp;lt;/strong&amp;gt;An 8-year-old girl was hospitalized several times in our department due to the surgery of left-sided chronic otitis media. Mastoidectomy and posterior atticotomy were performed during initial hospitalization. Six months later, she was admitted for the second act of the left-sided tympanoplasty. However, two months prior hospitalization, symptoms regarding the right ear appeared: sense of fullness, gradual hearing loss and occasional pain. An otoscopic finding on the right indicated the presence of &amp;amp;ldquo;tumefaction&amp;amp;rdquo; in the external auditory canal with a surface that was markedly hyperemic. This pseudotumor was finally interpreted as the foreign body in the external auditory canal.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Conclusion. &amp;lt;/strong&amp;gt;Foreign bodies in the external auditory canal (EAC) are relatively common in pediatric population. The medical history sometimes is not reliable, and the clinical and radiological interpretation of pseudotumor in the external auditory canal or middle ear must include this possibility in the differential diagnosis as well. Surgical exploration and pathohistological diagnosis are necessary to make a definitive diagnosis and to avoid potential complications.&amp;lt;/p&amp;gt;

THE GREAT PRETENDER: COULD A PHEOCHROMOCYTOMA MANIFEST ITSELF AS A SEIZURE?

Objective: Seizures are defined as transient occurrence of signs or symptoms due to the abnormally excessive or synchronous neuronal activity in the cerebral cortex. Pheochromocytomas and paragangliomas (PPGL) are chromaffin cell tumors arising from the adrenal medulla in 80–85% of patients and from extra-adrenal sympathetic tissue in 10–20% of patients. PPGL has been referred to as ‘‘the great mimic’’ disease. We present a patient with pheochromocytoma possibly disguised as seizures. Design and method: A 44 years old woman was referred to University Clinic of Endocrinology by radiologist. Two years earlier she had syncopal crises . She complained of headache, heart palpitation and malaise, heart palpitations and fatigue during exertion and sense of panic. The maximal self-measured blood pressure was 160/100 mmHg, the pulse is 90-100 beats per min. Abdominal US: a hyperechoic change, 76x65mm was seen, then described in the right lobe of the liver. The following year she had two commotional crises of consciousness and spasms of the extremities . She had a non-specific slowing of FC on EEG on the right for 1-2 seconds. MSCT abdomenal : in the right adrenal gland, a mass 144 x 90mm, with clear borders, pressing into the liver and pushing the right kidney,. The 24h urine was collected, which confirmed a norepinephrine secreting pheochromocytoma. We administered long acting alpha blocking agent preoperatively. The complete surgical excision of the right adrenal mass was done, pathohistological diagnosis: Pheochromocytoma. The last EEG after sleep deprivation performed 2 months postoperatively was described as normal. The patient had no headache or seizure. Results: PPGLs have a notable ability of boosting NE levels systemically and hypertension, the most common sign of PPGL could facilitate the permeability of blood brain barrier to NE. Studies showed NE could play its anticonvulsant property at an appropriate concentration but has a proconvulsant effect in either too high or too low concentrations . Conclusions: The definite pathogenetic mechanisms explaining how PPGL can cause seizures are far from being clearly understood, though “the great pretender” should be considered as a possible etiological factor of seizures.

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization.

The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism. To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism. Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed. The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands. The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization.

The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism. To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism. Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed. The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands. The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.

Ekspresija neuralnog ćelijskog adhezionog molekula u intersticijumu bubrega sa različitim stepenom fibroze

Introduction: In healthy adult kidneys, differentiated tubular epithelial cells do not express the neural cell adhesion molecule (NCAM), while a small number of NCAM-expressing cells can be detected in the renal interstitium. The role and the significance of these cells have not yet been clarified, but it has been observed that the number of NCAM-expressing cells increases in the initial stage of interstitial fibrosis. Aim: The aim of the study is to examine the significance of the expression of NCAM molecules in the renal interstitium, in etiologically different diseases, with varying degrees of interstitial fibrosis, as well as to define the pathohistological and clinical indicators (predictors) of impaired kidney function. Materials and methods: The study included 69 patients who underwent needle biopsies of the kidneys in 2011 and 2012. Clinical and laboratory data were collected at the time of the biopsy and at the time of the latest follow-up examination. Pathohistological characteristics were defined optically-microscopically, while NCAM-expressing interstitial cells were detected with immunohistochemical staining, using the primary NCAM antibody (1:50, clone 123C3.D5). Results: NCAM-expressing interstitial cells were detected in 59.4% of kidney biopsies, the presence of these cells was significantly more frequent in the initial stages of interstitial fibrosis than in the remaining stages (p &lt; 0.001), and it did not depend on the pathohistological diagnosis (p = 0.995). Patients in whom NCAM cells were detected had significantly lower proteinuria levels at the time of biopsy, as compared to patients without NCAM interstitial cells (p = 0.024). The levels of serum creatinine (p &lt; 0.001) and urea (p = 0.007) significantly influenced the probability of the deterioration of renal function. Conclusion: The presence of NCAM cells in the kidney interstitium is a characteristic of the early stages of chronic kidney disease with incipient interstitial fibrosis and a lesser degree of proteinuria

Retka prezentacija pleomorfnog adenoma kao peritonzilarni tumor - prikaz slučaja

Pleomorphic adenoma, which is considered to be the most common benign neoplasm of small salivary glands, occurs mainly in the region of the hard palate with mild predilection for women and the peak incidence between the third and sixth decades of life. We present the case of a fifty-one-year-old patient with a left peritonsillar region tumor that the patient has been familiar with for several years. Clinical and radiological examination (computed tomography) indicated a clearly limited, encapsulated tumor change in the left peritonsillar region, 2.5 x 2.5 cm in diameter. The change was completely surgically removed transorally and pathohistologically verified as a pleomorphic adenoma of the small salivary gland. Computed tomography and correct pathohistological diagnosis are essential for the decision on surgical treatment in order to completely remove the lesion. Although it is a benign tumor, early detection is important for a timely decision for surgical treatment. Complete excision of tumor is necessary to prevent regrowth and possible malignant transformation.

Hitno stanje u pedijatriji neočekivanog uzroka - infantilna fibromatoza - prikaz slučaja

Introduction: Infantile fibromatosis (IF) is a rare benign mesenchymal tumor of early childhood , located solitarily or multicentrically in the skin, soft tissues, muscles, bones, or visceral organs. The cause is unknown, and some cases are linked to mutations in two different genes. Rapid growth is typical, and while there are reports of spontaneous regression, relapses have also been recorded. Treatment depends on the location of the lesions, with surgery being the main treatment option. Case report: This paper presents an unusual emergency presentation of infantile fibromatosis in a 16-month-old girl, initially manifested as acute laryngitis. The rapid development of respiratory failure necessitated immediate life-saving treatment. Emergency diagnostics revealed a large mass deep within the neck structures, causing significant compression and endangering the airways. The child's condition was critical, and the multidisciplinary team thoroughly discussed available treatment options. Eventually, after careful preparations, the tumormass was surgically removed on the sixth day. The postoperative course was challenging, but the outcome was positive. Pathohistological diagnosis confirmed infantile fibromatosis, and the treatment was successfully completed. Conclusion: Despite its rarity, infantile fibromatosis must be considered a potential cause of urgent, life-threatening conditions in children. Treatment requires individual adaptation and collaboration with a multidisciplinary team.

MANAGEMENT OF A GIANT LIPOMA IN THE AXILLA: A CASE REPORT

Lipomas are the most common benign mesenchymal tumors in adults. Generally, they are less than 5 cm in size but sometimes they can present as giant lipomas. Axillary region is an unusual localization for lipomas in general, especially for giant lipomas. A case of a 62-year-old male with a giant lipoma in the axillary region is presented. The tumor was located in the left axillary region beneath the pectoralis major muscle and extended all along to the scapula. It was adjacent to the axillary vessels and the brachial plexus, but did not invade the neurovascular bundle. A team of a plastic and thoracic surgeon performed the operation. The pathology report confirmed a benign lipoma weighting 454 grams and measuring 13.5x8x7 cm. Follow-up examinations (clinical examination and ultrasound) revealed no recurrence three years after the operation. The mechanism of lipoma formation is not completely clear. It includes two potential and overlapping mechanisms in which trauma seem to have the major role. The treatment includes surgical excision or liposuction. However, excision of large lipomas can sometimes be a surgical challenge. Giant lipomas in axillary region should be removed in order to establish the pathohistological diagnosis and to prevent possible compression of the neurovascular structures. In our opinion, surgical excision is a preferred method of treatment because there is less possibility of damaging vital structures and it offers better control against local tumor recurrence.

Patho-histological features of fibroblastic sarcoid in horses

Sarcoid is one of the most common skin tumours, which is diagnosed in various breeds of horses at any age regardless of the animal’s sex. Such fibroblastic neoplasm manifests itself in several clinical ways with its specific morphological features. As a rule, it metastasizes rarely but can be locally invasive. The disease’setiology is multifactorial and includes the confirmed role of the bovine papillomavirus and genetic and environmental factors. The article introduces the results of a retrospective study of horses of the Ukrainian riding breed with a fibroblastic sarcoid type, which was localized mainly in the area of the external thoracic vein. Neoplasms were represented by two types. The first one included broad base neoplasms without a pronounced pedicle but with signs of hyperkeratosis. Massive rounded dense formations with an ulcerated surface refer to the second type. To verify the studied types of sarcoid, wide surgical excision of the lesion’svisible parts was performed, followed by the selection of fragments for the pathohistological diagnosis. Also, additional staining methods were used to detect the connective and muscle tissue (Van Gieson’s staining) and elastic fibers (Weigert’s resorcin-fuchsin staining). Microscopically, the neoplasm without a visible pedicle showed signs of hyperkeratosis and acanthosis in the peritumoral epidermal layer. Epidermis desquamation with a significant amount of oxyphilic detritus, diapedesis hemorrhages, and dilated vessels was also detected in some areas. Chaotic placement of fibroblasts and fibrocytes was noted, to a greater extent, subdermally. Anisocytosis and anisokaryosis were expressed moderately. Sarcoids, macroscopically presented in the form of massive dense formations with an ulcerated surface, were histologically characterized by the replacement of the epidermis with cellular elements, subdermal hemorrhages, and the characteristic perpendicular orientation of coarse collagen fibers towards the basement membrane. Closely spaced spindle-shaped cells with fibers forming moiré structures were visualized in the deep dermis layers. Nuclei were hyperchromic and elongated in shape, no atypical mitoses were noted. Pathohistological examination during the identification of a sarcoid type for diagnostic purposes can cause rapid growth and formation of an ulcer. The final diagnosis regarding equine sarcoid can be made based on a combination of clinical signs, histopathological examination, and molecular genetic testing with the isolation of BPV DNA.

Comparative analysis of preoperative and postoperative diagnosis in skin melanoma

Introduction: Taking into account the increase in incidence and high mortality in advanced stages, early diagnosis is a prerequisite for successful treatment of melanoma. The aim of this study was to determine the concordance between dermatological (with dermoscopy), surgical and pathohistological diagnosis in patients with a suspicious finding of skin melanoma. Material and methods: A comparison between the clinical and pathohistological diagno­sis of patients of both sexes, of all ages, with a referral diagnosis of skin melanoma was made. Results: Out of a total of 535 analyzed cases, 469 (87.5%) had preoperative dermato­lo­gical findings. In 329 of these patients the referral diagnosis was in favor of melanoma. In 140 cases with a dermatological finding other than melanoma, a pathohistological finding of melanoma was obtained, 30% with a dermatological finding. In addition to melanoma, in 289 cases out of 329 cases with dermatological findings a pathohistological finding for melanoma was obtained, and in 40 cases a pathohistological finding other than melanoma was obtained. Of 66 cases without dermatological findings, 27 patients with a surgical diagnosis other than melanoma were operated on, with a pathohistological finding for melanoma - 41%. With a diagnosis of melanoma without prior dermatological examination, 39 cases were operated on, of which in 12 cases the pathohistological finding was in support of melanoma. Of 58 patients who underwent dermoscopy, 78% had a matching dermoscopic and pa­thohistological diagnosis. Conclusion: The results of this study showed a high percentage of erroneous pre­ope­ra­tive diagnoses.

Synchronous Neck Melanoma and Papillary Thyroid Cancer: A Case Report

Abstract Introduction: The synchronous malignant melanoma of the neck and papillary thyroid cancer is rare but severe condition. Here, we describe the case of a patient with papillary thyroid cancer and melanoma invasivum cutis. Case report: A 49-year-old man had a change on the neck at the last 3-4 months that he accidentally noticed. He had hoarse voice, was afebrile, did not sweat more than usual and feel exhausted, without rash or itching. MR examination of the neck and upper mediastinum before the surgery indicated a hyperintense focal change in the left thyroid gland which dimensions was 19 x 15 mm and several hyperintense inhomogeneous lymph glands of the jugular chain, on the both sides, with different sizes. On the basis of the conducted analyzes, in addition to total thyroidectomy, two-sided functional dissection of the lymph nodes of the neck was performed. The pathohistological diagnosis of the left lobus was: Carcinoma papillary glandulae thyreoideae invasivum (G-I, nG-I, pT2, Lx, Vo). CT of head, neck and thorax were made, where it was noticed that the CT of the head and lungs were normal. PET/CT findings indicated that there was no rest or recurrence of the tumor. Conclusion: The message from this case report is that when diagnosing and treating thyroid cancer, the observed changes in the neck lymph nodes also indicate cancers of non-thyroid pathology such as malignant melanoma.

Clinical application of the RONNA G4 system – preliminary validation of 23 robotic frameless brain biopsies

AimsTo report the outcomes of robot-assisted brain biopsies performed using a novel RONNA G4 system. The system was developed by a research group from the Faculty of Mechanical Engineering and Naval Architecture and a team of neurosurgeons from Dubrava University Hospital, University of Zagreb School of Medicine.MethodsThis prospective study included 49 biopsies analyzed during one year: 23 robotic frameless and 26 frame-based Leksell stereotactic biopsies. We analyzed the presenting symptoms, tumor range and location, postoperative complications, pathohistological diagnosis, diagnostic yield, as well as operation and hospitalization duration. The target point error was calculated to assess the accuracy of the RONNA system.ResultsNo postoperative mortality, morbidity, or infections were observed. In the frameless robotic biopsy group, only one pathohistological diagnosis was inconclusive. Therefore, the diagnostic yield was 95.6% (22/23), similar to that of the framebased Leksell stereotactic biopsy group (95.1% or 25/26). The average target point error in the frameless robotic biopsy group was 2.15 ± 1.22 mm (range 0.39-5.85).ConclusionThe RONNA G4 robotic system is a safe and accurate tool for brain biopsy, although further research warrants a larger patient sample, comparison with other robotic systems, and a systematic analysis of the entry and target point errors.

18F-FET and 18F-choline PET-CT in patients with MRI-suspected low-grade gliomas: a pilot study

AimTo investigate the diagnostic accuracy of O-(2-[18F]-fluoroethyl)-L-tyrosine (18F-FET) and fluoromethyl-(18F)-dimethyl-2-hydroxyethyl-ammonium chloride (18F-FCH) computed tomography (CT) in patients with primary low-grade gliomas (LGG).MethodsThe study enrolled patients with magnetic resonance imaging (MRI)-suspected LGG. Patients underwent both 18F-FET and 18F-FCH positron emission tomography (PET)-CT. Brain PET-CT was performed according to standard protocol – 20 minutes after intravenous injection of 185 MBq of 18F-FET and 185 MBq of 18F-FCH PET. Surgery and pathohistological diagnosis were performed in the next two weeks.ResultsWe observed significantly better concordance between tumor histology and 18F-FET PET (weighted Kappa 0.74) compared with both 18F-FCH (weighted Kappa 0.15) and MRI (weighted Kappa 0.00). Tumor histology was significantly associated with 18F-FET (odds ratio 12.87; 95% confidence interval [CI], 0.49-333.70; P = 0.013, logistic regression analysis). Receiver operating characteristic curve analysis comparing 18F-FCH (area under the curve [AUC] 0.625, 95% CI 0.298-0.884) and 18F-FET (AUC 0.833, 95% CI 0.499-0.982) showed better diagnostic properties of 18F-FET (AUC difference 0.208, 95% CI -0.145 to 0.562, P = 0.248).ConclusionPerforming PET-CT in patients with newly diagnosed LGG should be preceded by a selection of an appropriate radiopharmaceutical. 18F-FET seems to be more accurate than 18F-FCH in the LGG diagnosis.