21st Ljudevit Jurak Symposium On Comparative Pathology

Program and abstracts | Slide seminars |Poster presentations | Photo gallery

 
OUTLINE OF THE PROGRAM

includes
lectures, slide
seminar, free papers and posters on the symposium sections:
 

A) Pathological
Morphology of Human and  Animal Diseases

B) Iatrogenic,
Environmental and Experimental Pathology

C) Slide Seminar in
Histopathology

D) Advances in
pathomorphology techniques organized by Croatian Association of
Laboratory Medicine (CALM)

    

Friday June 4, 2010 (8.00-14.45)
Registration
– 8.00
a.m.
Opening
ceremony –
9.00 a.m.
Ljudevit Jurak Award ceremony
The “Ljudevit Jurak” Award for Comparative Pathology was established in
1998 with intention to encourage worldwide research on comparison
between animal and human diseases. The Award named by professor Jurak
is in memory to his contribution to the medical, forensic and
veterinary sciences and to his medical ethic. (http//www.mef.hr/Jurak/nagrada.html
and http://www.mef.hr/Jurak/JURAK-biog.html.)
PATHOLOGICAL
MORPHOLOGY OF THE HUMAN AND ANIMAL DISEASES
Invited lectures – Chair persons: G.
Mikuz, B. Krušlin , H. Čupić
10.00 KURT W. SCHMID (Essen,
Germany):
Thyroid Cancer – What is New?
10.30 ZORAN GATALICA (Omaha,
NE, USA):
Tumors of the Endocrine Organs in Hereditary Cancer Syndromes
11.00 VANJA ZJAČIĆ-ROTKVIĆ
(Zagreb,
Croatia): Neuroendocrine Tumors (NET) of the Gastrointestinal System:
Diagnosis and Therapy
11.30-12.15 Coffee
break and musical intermezzo
 
During the break Annual Meeting of Croatian Association of Pathology
and Forensic medicine will be held in main hall of the Multimedia
Center Sestre milosrdnice University Hospital

Invited lectures – Chair
persons: Ž.
Grabarević, S. Tkalčić, M. Belicza
12.15 THOMAS J. ROSOL
(Abstract)
(Columbus, OH, USA): Common Endocrine
Diseases in Domestic Animals
12.45 SUZANA TKALČIĆ
(Abstract)
 
(Pomona, CA, USA): Endocrine
Disorders of Animals: a few Good Lesions
13.15-13.45 Coffee
break and musical intermezzo
 

Invited lectures – Chair
persons: Z.
Gatalica, K. W. Schmid, M. Kos
13.45 GݎTER KLאPEL (Munich,
Germany): Neuroendocrine Tumors in the 21st Century
14.15 NIVES PEĆINA-ŠLAUS
(Zagreb,
Croatia): New Insights in the Genetics of Pheochromocytoma





14.45
Lunch time
20.00
– SYMPOSIUM
DINNER
Saturday June 5, 2010 (08.30-13.05)

SLIDE
SEMINARS
08.30 GREGOR MIKUZ (Austria):
SLIDE
SEMINAR IN HISTOPATHOLOGY
09.30 ZORAN GATALICA (USA):
SLIDE
SEMINAR IN HISTOPATHOLOGY

All cases will be
presented on
the Web site (Slide
seminars)
10.30 Presentation of the
Croatian
edition of “Rosai & Ackerman’s Surgical Pathology” (ninth edition).
Presentation will be held by Prof. Mladen Belicza, the editor of the
Croatian edition. During the whole symposium, the book will be
available at a promotion price.
11.00-11.30 Coffee
break and musical intermezzo
 
Award for
the best poster


11.30 ADVANCES IN PATHOMORPHOLOGY TECHNIQUES

organized by The Croatian
Association of Laboratory Medicine (CALM) – lectures will be presented
in Croatian language

Organizing Committee:
1. Jasna Matić, bacc.med.lab.diagn.
2. Neven Sučić, med.lab.diagn.
3. Mirka Batarelo, bacc.med.lab.diagn.
4. Sanja Kuštreba, dipl.ing.med.lab.diagn.

Chair
persons: D.
Baličević. J. Matić, S. Kuštreba
MAIN TOPIC

Molecular
methods in pathology
11.30 Pozvano predavanje:
doc.dr.sc.
D. Baličević: Trikromne metode u standardnoj histološkoj analizi
jetrenog cilindra
11.45 B. Karaula, J.
Jakić-Razumović:
Uloga biopsije iglom u dijagnostici bolesti dojke
11.55 T. Gudelj, P. Korać, M.
Dominis:
FISH vs. CISH: primjena u hematopatologiji
12.05 I. Jakovac, A. Demirović,
H.
Čupić: HIF-1α imunohistokemijska metodologija
12.15 A. M. Tušek, M. Sučić:
Različite
fiksacije i utjecaj na antigenost pojedinih molekula
12.25 P. Bešenić, D. Juratić, J. Matić, I.
Pavić, D. Baličević (Abstract in English)
:
Usporedba bojanja specijalnih metoda rutinskom tehnikom i Bio Optica
kitovima jetrenog cilindra
12.35 J. Matić, M. Ulamec, B. Krušlin
(Abstract in English)
: Detekcija i ekspresija mouse
monoclonal /9E10/ c-Myc imunohistokemijski postupak
12.45 M. Batarelo, N. Martinez (Abstract in
English)
: Cross-match u bubrežnoj
transplantaciji 
12.55-13.05
Diskusija
13.05
J. Matić:
Prezentacija HKZR
POSTERS
– Second
hall of the Multimedia Center Sestre milosrdnice University Hospital (All Posters)
PP1  P. Radulović, Z.
Marušić,
I. Pavić, L. Kalogjera, D. Tomas. RETROMOLAR SMALL CELL NEUROENDOCRINE
CARCINOMA – A CASE REPORT
PP2  A.
Pačić, I. Pavić, N. Mateša, M. Škerlj, L. Pažanin. MELANOMA METASTASIS
TO THYROID FOLLICULAR ADENOMA
PP3
D. Kolenc, K. Žarković.
THE
COEXPRESSION OF 4-HYDROXYNONENAL AND PROMININ-1 IN ASTROCYTOMAS
PP4 M.
Perić Balja, S. Ramić, T. Bujas, F. Knežević. NEUROENDOCRINE CANCER OF
THE BREAST: A REPORT OF 11 CASES
PP5
A. M. Szasz, C. S. Jakab,
F.
Szekely, B. Szekely, M. Dank, G. Szentmartoni, Z. Baranyai, L. Madaras,
A. Kiss, A. M. Tokes, J. Kulka. PROPOSAL OF CLAUDIN-LOW BREAST
CARCINOMA MODEL TO UNDERSTAND ITS AGGRESSIVE BIOLOGICAL PROPERTIES
PP6 M.
Pavić, A. Petak, S. Tkalčić. VERMINOUS PNEUMONIA IN CALIFORNIA SEA
LIONS: CORRELATION BETWEEN GROSS AND HISTOPATHOLOGICAL LESIONS
PP7 E. Lovrić, A. Škrtić, M.
Dominis. PRIMARY THYROID LYMPHOMAS: MOST COMMON SUBTYPES OF NON
HODGKIN’S LYMPHOMA
PP8 M.
Cigrovski Berković, M. Ulamec, P. Radulović, T. Čačev, V.
Zjačić-Rotkvić, B. Krušlin, S. Kapitanović. EXPRESSION OF TUMOR
NECROSIS FACTOR-ALPHA (TNF-Α) AND VASCULAR ENDOTHELIAL GROWTH FACTOR
(VEGF) IN GASTROENTEROPANCREATIC NEUROENDOCRINE TUMORS (GEP-NETS) AND
THEIR CORRELATION WITH TUMOR AGGRESSIVENESS
PP9 R. Limani, L. Gashi Luci,
M.
Frančina, D. Baličević, A. Mijić, Z. Jukić, D. Tomas. LARGE CELL
NEUROENDOCRINE CARCINOMA OF THE COLON AND RECTUM: A REPORT OF 7 CASES
PP10 N.
Vrsaljko, I. Žunić, Lj. Šerman, Đ. Grbeša. STEREOLOGY OF THE RAT
PLACENTA IN THE LAST TRIMESTER OF GESTATION
PP11 I. Pavić, Z. Marušić, A.
Bišćanin, D. Baličević. CHOLESTASIS AS THE INITIAL PRESENTATION OF
ILLNESS IN A FEMALE PATIENT- DIFFERENTIAL DIAGNOSIS IN LIVER BIOPSY
PP12 T.
Džombeta, M. Ulamec, B. Krušlin, M. Belicza. APOPTOSIS IN TESTICULAR
TERATOCARCINOMA
PP13 R. Limani, L. Gashi Luci,
Z.
Marušić, Z. Gatalica, B. Krušlin. PAPILLARY RENAL CELL CARCINOMA WITH
SMOOTH MUSCLE RICH STROMA: A CASE REPORT
PP14 N.
Sinčić, M. Vlahović, F. Paić, A. Katušić, Lj. Šerman, M. Belicza, F.
Bulić Jakuš. APOPTOSIS IN EXPERIMENTAL MOUSE TERATOCARCINOMA
PP15 C. Ardeleanu, D. Terzea,
A.
Georgescu, M. Stoicea, F. Cionca, M. Comanescu, F. Vasilescu, F.
Andrei, M. Mihai, A. Visan, S. Enache. CAROTID BODY PARAGANGLIOMA: TWO
CASE REPORTS
PP16 A.
Petak, M. Pavić, S. Tkalčić. NASAL MITES AND ASSOCIATED LESIONS IN THE
UPPER RESPIRATORY TRACT OF CALIFORNIA SEA LIONS (ZALOPHUS
CALIFORNIANUS)
PP17 N. Knežević, V. Kozina,
M.
Kosović, M. Bernat, Ž. Kaštelan, D. Ježek. LEYDIG CELLS, TESTIS VOLUME
AND SPERMATOGENESIS IN PATIENTS WITH NON-OBSTRUCTIVE AZOOSPERMIA
PP18 A.
Jakovčević, M. Macan, K. Žarković, M. Bura. WARTHIN-LIKE TUMOR VARIANT
OF PAPILLARY THYROID CARCINOMA: A CASE REPORT
PP19 R. Granić, M. Borić, T.
Jukić,
H. Čupić, B. Krušlin, Z. Kusić. EPIDEMIOLOGICAL AND HISTOPATHOLOGICAL
FEATURES OF THYROID CANCER IN CROATIA
PP20 S.
Cesarec, A. Demirović, H. Čupić, B. Krušlin, M. Belicza. APOPTOSIS IN
CHROMOPHOBE RENAL CELL CARCINOMA AND RENAL ONCOCYTOMA
PP21 Z. Marušić, B. Pigac, S.
Radiković, A. Kopljar, D.Tomas, B. Krušlin. SCROTAL DIROFILARIASIS IN A
3-YEAR-OLD
PP22 I.
Miše, M. Vučić, I. Maričević, M. Šokčević, S. Čurić-Jurić. HISTOLOGIC
SUBTYPES OF INVASIVE LOBULAR CARCINOMA IN CORRELATION WITH TUMOUR
STATUS AND HORMONE RECEPTORS
PP23 T. Leniček, D. Tomas, H.
Soljačić-Vraneš, Z. Kraljević, P. Klarić, M. Kos. STRUMAL CARCINOID OF
THE OVARY: THE REPORT OF TWO CASES
PP24 L.
Labinac-Peteh, T. Leniček, I. Kučinar, H.Čupić. MULTIPLE METASTASIS OF
RENAL CELL CARCINOMA TO THE THYROID GLAND- CASE REPORT
PP25 P. Sesar, I. Pavić, M.
Ulamec,
B. Krušlin. ADRENAL MYELOLIPOMA
PP26 P.
Šulentić, M. Berković, B. Bečejac, V. Čerina, H. I. Pećina, M. Vrkljan.
EFFECTIVENESS OF TRANSSPHENOIDAL SURGERY AS AN INITIAL TREATMENT FOR
NON-FUNCTIONING PITUITARY ADENOMAS – PERSONAL EXPERIENCE IN CLINICAL
PRACTICE
PP27 P. Šulentić, I. Kruljac,
V.
Čerina, H.I. Pećina, M. Vrkljan. EFFECTIVENESS OF TRANSSPHENOIDAL
SURGERY AS AN INITIAL THERAPY FOR PATIENTS WITH ACROMEGALY – PERSONAL
EXPERIENCE IN CLINICAL PRACTICE
PP28 P.
Šulentić, D. Herman, A. Marić, V. Čerina, H. I. Pećina, M. Vrkljan.
EFFECTIVENESS OF TRANSSPHENOIDAL SURGERY AS AN INITIAL TREATMENT FOR
PROLACTINOMAS – PERSONAL EXPERIENCE IN CLINICAL PRACTICE
PP29 J. Begić, D.
Bobonj-Hižak, B.
Fila, T. Leniček, B. Krušlin. ALVEOLAR RHABDOMYOSARCOMA OF FOOT – A
CASE REPORT

 

Posters

P01

RETROMOLAR SMALL CELL NEUROENDOCRINE CARCINOMA: CASE REPORT

 P. Radulović1, Z. Marušić1,
I. Pavić1, L. Kalogjera2, D. Tomas1

1Ljudevit Jurak University Department of Pathology, 2University
Department of ENT, Head and Neck Surgery, Sestre milosrdnice University
Hospital, Zagreb, Croatia

Small cell carcinoma (SmCC) is a poorly differentiated
neuroendocrine carcinoma that has been reported in several sites
throughout the head and neck region, including salivary glands where it
is a rare primary tumor accounting for less than 1% of all salivary
gland tumors. We report a case of a 55-year-old man with problems
consisting of neck pain and difficult swallowing induced by a
retromolar mass. Physical examination revealed an exophytic
infiltrative process in the right retromolar trigonum, measuring 2
centimeters in diameter. On cut surface the tumor was white and
grayish. Microscopically, it was composed of sheets, ribbons and nests
of mitotically active tumor cells set within a variably fibrous stroma.
There was a positive immunohistochemical reaction for broadγpectrum
keratin, EMA, synaptophysin and chromogranin. The combination of
findings was in favor of small cell neuroendocrine carcinoma with the
probable origin from a small salivary gland. In the 2005 WHO
classification of head and neck tumors, SmCC of salivary glands is
defined as a rare malignant epithelial tumor. Differential diagnosis
includes metastatic pulmonary SmCC and cutaneous neuroendocrine
carcinoma (Merkel cell carcinoma). Although salivary gland SmCC does
not metastasize as frequently as pulmonary SmCC, locoregional
metastases are present at diagnosis in as many as 50% of cases. SmCC
arising in major or minor salivary glands has a better prognosis than
pulmonary SmCC, but in our case the patient survived for just one month
after the diagnosis. The autopsy confirmed oropharynx as the primary
location of the tumor. Besides multiple liver metastases, there were no
signs of tumor anywhere else in the body.

 

P02

Melanoma metastasis to thyroid follicular adenoma

A. Pačić1, I. Pavić2, N. Mateša3,
M. Škerlj4, L. Pažanin2

1Department of Pathology, Dubrava University Hospital; 2Ljudevit
Jurak University Department of Pathology; 3Department of
Nuclear Medicine, Sestre milosrdnice University Hospital; 4Department
of Cytology, University Hospital for Tumors, Zagreb, Croatia

 

Clinically significant metastases to thyroid gland are very rare.
The incidence of thyroid involvement by metastatic disease ranges from
an average of 3.1% in surgical series to 5.3% in autopsy series.
Metastases to pre-existing thyroid neoplasms are distinctly uncommon.
Malignant melanoma is one of the tumors that may metastasize to thyroid
gland. We describe a case of a woman with thyroid metastases from a
nodular melanoma discovered by fine-needle aspiration biopsy of thyroid
nodule. Six months before, a 67-year-old woman was diagnosed with
malignant nodular melanoma on the right upper arm. Axillary lymph nodes
were positive. Follow-up examination revealed nodular enlargement of
the right thyroid lobe. Fine-needle aspiration (FNA) showed the
presence of epitheloid cells with nuclear atypia and cytoplasmic
pigmentation. Morphological features suggested thyroid metastasis from
malignant melanoma and thyroidectomy was performed. Pathologic
examination revealed a completely encapsulated nodule measuring up to 1
cm in diameter, showing histopathologic features of follicular adenoma
with no evidence of capsular or vascular invasion. The adenoma was
infiltrated by a nodule of immunohistochemically HMB45 positive
malignant cells containing dark pigment. The incidental metastatic
nodule was found in the opposite thyroid lobe. Thyroid nodule in
patients with a history of malignancy can be a benign lesion, new
primary carcinoma or distant metastasis. Our case supports the argument
that any patient with a thyroid mass and a history of malignancy should
be considered to have a metastasis until proven otherwise. FNA has an
important role in differentiation of benign, malignant and probably
malignant cell cells in thyroid gland. However, due to the possible
mimicking metastases that simulate primary thyroid neoplasm,
histopathology examination and appropriate use of immunohistochemistry
remain the gold standard in achieving an accurate diagnosis.

 

P03

COEXPRESSION OF 4-HYDROXYNONENAL AND PROMININ-1 IN
ASTROCYTOMAS

D. Kolenc, K. Žarković

Department of Pathology, School of Medicine, University of Zagreb,
Zagreb, Croatia

Oxidative stress (OS) is a condition that occurs when antioxidative
capacity of tissue and cells is overcome. The oxidative damage of cells
is caused by free radicals which are products of OS. In equilibrium,
free radicals are disintegrated by enzymatic and nonenzymatic proteins.
Lipid peroxidation is an autocatalytic process caused by OS, which
damages lipids and causes production of highly reactive species such as
hydroxynonenal (HNE). HNE is thought to be the second toxic messenger
that damages cells causing their death. Reactive oxygen species (ROS)
and reactive nitrogen species (RNS) are products of OS and they play an
important role in both initiation and promotion of carcinogenesis. The
brain is very vulnerable to damage mediated by ROS when cells in the
central nervous system (CNS) have low levels of antioxidant defenses,
high iron content and high level of poly-unsaturated fatty acids. The
cancer stem cell hypothesis suggests that not all cells in the tumor
have the same ability to proliferate and maintain the growth of the
tumor. Only a relatively small fraction of cells in the tumor, termed
cancer stem cells, possess the ability to proliferate and self-renew
extensively. Prominin-1 (CD133) has been identified in both human and
mice, and was originally classified as a marker of primitive
hematopoietic and neural stem cells. Different tissue damages to CNS,
such as trauma, viruses and ischemia, increase the amount of OS product
which damages the endothelial cells, which consequently increase
production from bone marrow-derived endothelial progenitor cells
(EPCs). EPCs are immunoreactive for CD133 and CD34 and thus important
in the process of angiogenesis. The aim of this study was to determine
the coexpression of HNE-histidine conjugates and CD133 in astrocytomas.
The expression of HNE in 30 diffuse astrocytomas (DA), 30 anaplastic
astrocytomas (AA), and 30 glioblastomas (GBM) was analyzed using
monoclonal antibody on HNE-histidine conjugates and polyclonal antibody
on prominin-1 (CD133). HNE immunopositivity was found in all
astrocytomas and the intensity was proportional to astrocytoma
malignancy. The weakest presence of HNE was found in DA, followed by AA
and GBM. The remarkable immunopositivity for HNE was found in tumor
cells, stroma and blood vessels in malignant variants of astrocytomas
(AA and GBM). CD133 was found in all astrocytomas and the intensity was
also proportional to astrocytoma malignancy. The remarkable
immunopositivity for CD133 was found in tumor cells and stroma in AA
and GBM. The coexpression of HNE and CD133 was significant in tumor
cells and stroma of AA and GBM compared to DA. The increase in HNE and
CD133 immunoreactivity in tumor cells, blood vessels and stroma in
astrocytomas with an increase in their malignancy indicates that both
markers could be good prognostic indicators.

 

P04

NEUROENDOCRINE CANCER OF THE BREAST: A REPORT OF 11 CASES

M. Perić-Balja1, S. Ramić1, T. Bujas2,
F. Knežević1

1Department of Pathology, University Hospital for Tumors,
Zagreb; 2Department of Pathology, Karlovac General
Hospital, Karlovac, Croatia

 

Neuroendocrine cancer (NC) of the breast is rare, usually showing
alveolar structures or solid sheets of cells with a tendency to produce
peripheral palisading. The expression of neuroendocrine markers
chromogranin and/or synaptophysin in more than 50% of the cell
population confirms neuroendocrine differentiation. Depending upon the
cell types, grade and degree of differentiation, NC has been
categorized into the following subtypes: solid, small cell and large
cell NC. All 11 patients were aged from 48 to 86 (median 57) years. The
tumor size median was 17 mm (10-48 mm) in diameter. Eight tumors were
classified as solid, two as small cell and one as large cell type.
Immunohistochemical examination was carried out using the following
antibodies: chromogranin A, synaptophysin, estrogen receptor (ER),
progesterone receptor (PR), androgen receptor (AR), human epidermal
growth factor receptor-2 (HER-2) and Ki67. Positive reactivity for
chromogranin A (8/11) and synaptophysin (11/11) confirmed
neuroendocrine differentiation in 11 cases of breast cancer.
Immunohistochemically, the tumors expressed ER (11/11), PR (8/11) and
AR (10/11), while HER-2 was negative in all cases. Median value for
Ki-67 was 18% (range 7%-55%) and for the number of mitoses 4 (range
3-31). In one-way analysis of variance, histologic grade was influenced
by the number of mitoses (P=0.0096) and tumor size (P=0.0035).
Axillary lymph nodes were positive in two patients (2/11). Disease
recurrence with distant metastases occurred, after 20 months, only in
the patient with large cell subtype. All other patients were free of
disease at the time of writing. Median follow-up was 20.5 (range 11-45)
months. NC of the breast frequently expresses ER, PR and AR, while
HER-2 is negative. Histologic subtype, grade and size of tumor are very
important prognostic factors. More cases and longer follow-up periods
are required to determine the behavior of these tumors.

 

P05

Proposal of claudin-low breast carcinoma model to understand
its aggressive biological properties

A.M. Szasz1, C.S. Jakab1,2, F. Szekely2,
B. Szekely1,3, M. Dank3, G. Szentmartoni3,
Z. Baranyai4, L. Madaras1, A. Kiss1,
A.M. Tokes1, J. Kulka1

12nd Department of Pathology, Semmelweis
University; 2Szent Istvan University, Faculty of Veterinary
Medicine, Department of Pathology and Forensic Veterinary Medicine; 3Department
of Diagnostic Radiology and Oncotherapy, Semmelweis University; 4Department
of Surgery and Vascular Surgery, Uzsoki Memorial Hospital, Budapest,
Hungary

 

The claudin-low subclass has emerged relatively recently as a
further subtype of triple negative breast carcinomas. Although it has a
very low incidence, understanding its behavior is crucial for its poor
prognostic properties and therapeutic importance. Claudin-3, -4, -7 and
E-cadherin are able to separate the claudin-low subtype of tumors with
reasonable confidence both at RNA and protein level. An elevated
expression of claudin-4 has been described in basal-like breast cancer,
and further characterization of this subgroup has led to the
identification of claudin-low carcinomas with low claudin-4 expression.
Due to their rarity, claudin-low breast carcinomas pose a great
challenge for the breast cancer research community. As human triple
negative carcinomas bear myoepithelial properties and claudin-low
tumors are considered to originate from their progenitors, the stem
cells, we undertook a hypothesis driven approach to propose a claudin-4
low expression model of canine breast cancers for human claudin-low
tumors as 1) mammary cancer is the most common type of cancer in female
dogs and with a lifetime risk of over 24% when dogs are not spayed; 2)
these carcinomas frequently show an aggressive phenotype with 3) their
cells displaying myoepithelial features. We were able to confirm the
raising based on the following: histologic appearance (in order to find
the common and the divergent features) and claudin-4 expression in
metastasizing carcinomas of dogs compared to human triple negative
breast carcinomas; identification of the claudin-low group of cancers
amongst dog’s and human triple negative breast carcinomas; and
comparison of the biological behavior of the claudin-low tumors in the
two species.

 

P06

VERMINOUS PNEUMONIA IN CALIFORNIA SEA LIONS: CORRELATION
BETWEEN GROSS AND HISTOPATHOLOGIC LESIONS

M. Pavić1, A. Petak1, S. Tkalčić2

1Faculty of Veterinary Medicine, University of Zagreb,
Croatia; 2College of Veterinary Medicine, Western
University of Health Sciences, Pomona, CA, USA

Respiratory tract nematodes, along with gastrointestinal (GI) tract
nematodes, are common findings in marine mammals rescued along the
California Coast. Most of the parasites commonly found are metazoans:
small and large roundworms (Otostrongylus circumlitus, Anisakis
sp., Parafilaroides decorus). The animals typically present
with severe weight loss, weakness, anorexia, and respiratory distress,
in addition to dark diarrhea associated with GI parasitism. Pinnipeds
are either primary, intermediate or transport hosts for many parasites
in the marine environment, and therefore are intimately involved in
movement of parasites between aquatic birds, fish, and other aquatic
mammals. In this research, we studied the morphology and histopathology
of respiratory tract lesions associated with verminous pneumonia in
California Sea Lions (Zalophus californianus). Tissue
specimens were obtained from 30 stranded pinnipeds necropsied at the
local rehabilitation centers in the period of 3 years. The lesions were
identified, evaluated, and correlated with the associated gross
pathological findings. Adults and larvae of metazoans were found in the
pulmonary parenchyma and airways, with a considerable variation in the
response of the host tissue to the parasite. The goal of this project
is to identify common histopathologic findings of verminous pneumonia
in California Sea Lions, evaluate the extent of different parameters
present, and correlate histopathologic lesions with gross pathological
findings. These results are expected to provide a useful reference for
gross morphological and histopathologic evaluation of lesions
associated with respiratory parasites in pinnipeds at necropsy.

 

P07

PRIMARY THYROID LYMPHOMAS: MOST COMMON SUBTYPES OF NON
HODGKIN’S LYMPHOMA

E. Lovrić, A. Škrtić, M. Dominis

Department of Pathology and Cytology, Merkur University Hospital,
Zagreb, Croatia

Primary lymphoma in the thyroid gland (PTL) is a relatively rare
disease. Elderly individuals and females are mostly affected.
Definitive diagnosis of primary thyroid extranodal lymphoma can only be
established by exclusion of extranodal progression of any subtype of
primary nodal lymphoma. Diffuse large B-cell lymphoma
(DLBCL) and extranodal marginal zone B-cell lymphoma of
mucosa-associated lymphoid tissue (MALT lymphoma) are the most common
subtypes in thyroid gland. The aims of this review were to evaluate the
spectrum of PTLs using the WHO classification schemes (2008) and
immunohistochemical markers in our institution. The majority of cases
(n=7) were received as consultations from 2003 to 2009 and clinical
data were unavailable. There were seven women and one men, mean age at
diagnosis 79.8 years. PTLs were classified as MALT lymphoma (n=1),
DLBCL (n=6), and follicular lymphoma grade 3 (n=1). Immunohistochemical
staining was performed using diagnostic panel of primary antibodies
(CD20, CD79a, CD3, CD23, CD43, CD10, CD5, CD23, CD43, BCL6, BCL10,
BCL2, thyroglobulin). The tumor most commonly presented as diffusely
enlarged, rubbery firm thyroid gland. When forming mass, the tumor
ranged in size from 1 to 19.5 cm. In our cases, morphology
characteristics were those of DLBCL, MALT and follicular lymphoma,
respectively. The cases of DLBCL showed immunohistochemically positive
results for CD20, CD79a and negative for CD3, CD23, CD43, CD10. The
case of MALT lymphoma was positive for CD20, while CD5, CD23, CD43 were
negative. The case of follicular lymphoma was positive for CD20, CD10,
BCL6, BCL2 and negative for CD3. In this small series and in the
published literature, a striking female predominance for PTL was noted.
Histologically, it can be very difficult to distinguish PTL from
anaplastic thyroid carcinoma as well as Hashimoto’s thyroiditis due to
their similar appearance. The study by Smedby et al. showed
an increased risk of non Hodgkin’s lymphoma (NHL) in patients with
autoimmune disorders such as Sjn’s syndrome, systemic lupus
erythematosus, autoimmune hemolytic anemia, and celiac disease. These
results may be based on the common mechanisms of
lymphomagenesis for NHL and autoimmune disorders. Future efforts should
involve chronic antigenic stimulation (especially in thyroid gland) and
lymphoid malignancy including molecular studies of the population in
our country. It may help define the underlying biological mechanisms
and give important clues to lymphomagenesis.

 

P08

Expression of tumor necrosis factor-alpha (TNF-α) and
vascular endothelial growth factor (VEGF) in gastroenteropancreatic
neuroendocrine tumors (GEP-NETs) and their correlation with tumor
aggressiveness

M. Cigrovski-Berković1, M. Ulamec2, P.
Radulović2, T. Čačev3, V. Zjačić-Rotkvić1,
B. Krušlin2, S. Kapitanović3

 1Department of Endocrinology, Diabetes and
Metabolism; 2Ljudevit Jurak University Department of
Pathology, Sestre milosrdnice University Hospital; 3Division
of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia

 

Angiogenesis is a crucial step for tumor growth. Vascular
endothelial growth factor (VEGF) is a potent endothelial cell mitogen,
known to induce vascular permeability. Its expression is under the
influence of proinflammatory cytokines, mainly tumor necrosis
factor-alpha (TNF-α). Recent clinical data have proved the correlation
between microvessel density and tumor progression with VEGF expression
in tumor tissue. As gastroenteropancreatic neuroendocrine tumors
(GEP-NETs) are highly vascularized neoplasms with still unknown
etiopathogenesis, we investigated the expression of proinflammatory
cytokine TNF-α and VEGF in 48 GEP-NET tissues, and correlated it with
the expression of Ki67. Surgical and biopsy specimens from 46
gastrointestinal neuroendocrine tumors (GI-NETs) and 2 pancreatic
neuroendocrine tumors (PETs) were examined for TNF-α and VEGF
expression by immunohistochemistry. Of GI-NETs 15 were of foregut (14
gastric and 1 duodenal) and 31 of midgut origin (12 small intestine, 12
appendix and 7 colon). Among tumors, overall 21 had high proliferative
index (>2% Ki67 positive tumor cells) and 27 (including 2 PETs) had
low proliferative activity. Immunostaining was graded as follows: 0 no
positive cells; 1 ≤25% positive GEP-NET cells; 2 >25%-50% positive
GEP-NET cells; and 3 ӵ0% positive GEP-NET cells. Spearman test was
used on correlation of TNF-α and VEGF with Ki67. Results were
considered significant at p<0.05. Weakly positive TNF-α
staining was detected in one PET, 4 foregut and 12 midgut tumors, while
stronger TNF-α expression (2 and 3) existed in 1 foregut and 17 midgut
tumors. Overall 13 tumors were negative for TNF-α. Strong cytoplasmic
VEGF immunostaining was detected in 30 midgut and 5 foregut GI-NETs and
both PETs, while 5 GI-NETs of foregut origin completely lacked VEGF
expression. When TNF-α and VEGF expression was correlated with Ki67,
there was a statistically significant correlation between TNF-α and
Ki67 (p=0.03), and a tendency to statistically significant
correlation between VEGF and Ki67 (p=0.09). Our study has
demonstrated that neuroendocrine cells are a major source of TNF-α and
VEGF, particularly in midgut GI-NETs. This finding suggests that the
mentioned cytokines/growth factor are needed to maintain the
differentiated state of capillary vessels in these highly vascularized
tumors but also, as there was a correlation between the TNF-α and VEGF
expression and tumor proliferative activity, that they are important
for tumor progression.

 

P09

LARGE CELL NEUROENDOCRINE CARCINOMA OF THE
COLON AND RECTUM: A REPORT OF 7 CASES

R. Limani1, L. Gashi Luci1, M.
Frančina2, D. Baličević3, A. Mijić4,
Z. Jukić2, B. Krušlin3, D. Tomas3

1Institute of Pathology, Faculty of Medicine, University
Clinical Center of Kosovo, Prishtina, Kosovo; 2Nova
Gradiška General Hospital, Nova Gradiška; 3Ljudevit Jurak
University Department of Pathology, 4University Department
of Surgery, Sestre milosrdnice University Hospital, Zagreb, Croatia

 

Neuroendocrine tumors encompass a wide range of pathologic entities
that display distinct biologic behaviors. Large cell neuroendocrine
carcinoma (LCNEC) is a highly aggressive neoplasm with a very low
frequency in the gastrointestinal tract, usually resulting in
unfavorable outcome. We present a series of seven patients diagnosed
with LCNEC of the colon and rectum in the time period between 2005 and
2010 at Ljudevit Jurak University Department of Pathology, Sestre
milosrdnice University Hospital. The average patient age was 64 (range,
34-94) years. There were five female and two male patients. The mean
tumor size was 7.8 (range, 2-15) cm. Five tumors were located in the
colon (1 ascending, 1 transverse, 2 descending and 1 sigmoid), 1 in
cecum and 1 in rectum. Grossly, tumors were of endophytic/ulcerative,
annular and polypoid appearance. Histologically, the tumors were
composed of large cells of organoid, nesting, trabecular, rosette-like
and palisading pattern and had a high mitotic rate. All seven tumors
stained positive for immunohistochemical neuroendocrine markers,
including chromogranin (4/7), synaptophysin (5/7), and/or neuron
specific enolase (6/7). Tumors were advanced at the time of diagnosis:
stage II (n=1), stage III (n=4) and stage IV (n=2). We present cases
for being rare and to emphasize the need of increased awareness of the
condition as one of the poorest prognostic subgroups among primary
colorectal tumors.

 

P10

Stereology of the rat placenta in the last trimester of
gestation

N. Vrsaljko1, I. Žunić1, Lj. Šerman1,
Đ. Grbeša2

1Department of Biology, 2Department of
Histology and Embryology, School of Medicine, Zagreb, Croatia

 Because of the numerous roles of the placenta
in fetal period, it is important to understand its development and
structure, and due to similarities with human placenta, rat is an
appropriate experimental model. Animals were sacrificed on 16th
or 19th day of gestation. The uterus was removed, the
placentas were isolated, fixed in 10% formalin and a complete series of
histologic sections of 10-mm thickness was made. Thirty five rat
placentas were collected, 21 in the experimental group of 16th
and 14 in the experimental group of 19th day of gestation.
Three randomly selected placentas from each group were stereologically
analyzed. Absolute volumes of placentas and their compartments
(labyrinth, basal portion and decidua) were estimated. Using volume
density, we calculated the share of glycogen cells and trophoblast
giant cells (TGC) in the basal part of the placenta. The average
absolute volume of the placenta on 16th day of gestation was
0.064 cm3, from which a labyrinth made 0.027 cm3,
basal part 0.027 cm3, and decidua 0.009 cm3
The average absolute volume of the placenta on 19th day of
gestation was 0.163 cm3, of which the labyrinth made 0.0923
cm3, basal part 0.059 cm3 and decidua 0.011 cm3.
In the 16th day of gestation, volume density of TGC in the
basal layer was higher (0.174) in comparisson with 19th day
of gestation (0.107). The volume density of glycogenic cells was 0.379
on the 16th day and 0.236 on the 19th day of
gestation. In conclusion, the absolute volume of the whole placenta on
19th day of gestation significantly increased, as well as
the share of the labyrinth as the most important part. The volume
densities of glycogenic and giant trophoblast cells were higher on the
16th day of gestation compared to the 19th day,
because the 19th day marks the time when the trophoblast
invasion is finished and the definitive placenta is formed.

 

P11

Cholestasis as the initial presentation of illness in a
female patient – Differential diagnosis in liver biopsy

I. Pavić1, Z. Marušić1, A. Bišćanin2,
D. Baličević1

1Ljudevit Jurak University Department of Pathology, 2University
Department of Medicine, Sestre milosrdnice University Hospital, Zagreb,
Croatia

 

The aim is to underline the importance of bilirubin laboratory
findings in the interpretation of liver biopsy performed for the
evaluation of cholestatic jaundice. We report on retrospective study of
repeat liver and colon biopsies in a 24-year-old female patient with
cholestasis. Twelve years before, the patient was diagnosed with
autoimmune hepatitis and hyperbilirubinemia associated with ulcerative
colitis that presented as a dysplasia associated lesion or mass (DALM).
Genetic analysis showed heterozygous TATA genotype for bilirubin
uridine diphosphate-glucuronosyltransferase (UGT-1A1) detecting
Gilbert’s syndrome (GS). Since then, the patient has been under
continuous therapy with immunosuppressive drugs and corticosteroids.
During the last hospitalization, the course of autoimmune hepatitis and
ulcerative colitis was reevaluated. Both liver biopsy specimens, one
performed in 2004 and the other at the time of present hospitalization
were cut in three step sections and stained with hematoxylin and eosin.
Seven additional sections were stained; one with a trichrome method,
the next four with pigment detection methods, and the last two were
immunohistochemically analyzed for CK7 and 19. All specimens were
scored using the histological activity index (HAI) of Ishak et al.
In addition, all colon biopsy slides were reevaluated to confirm the
initial diagnosis of DALM. Revisited colon biopsy specimens confirmed
the initial diagnosis of DALM. Additional colon biopsy was preformed
one month before the present liver biopsy. It showed only mild
lymphocytic infiltrate and no evidence of DALM. Liver biopsy performed
in 2004 was scored according to the histological activity index of
Knodell et al. and reevaluated together with the new liver
biopsy according to Ishak et al. There was no significant
difference in liver biopsy scoring by the two methods mentioned.
Histology revealed only mild portal chronic inflammation with few
piecemeal necroses, occasional lymphocytic spillover and only 4 spotty
acinar necroses along the whole cylinder, which measured up to 2.3 cm.
Portal tracts were slightly enlarged due to mild fibrosis. Periportal
and intralobar bile ducts showed mild periductal fibrosis and in one
lobar bile duct lymphocytic cholangitis was detected by
immunohistochemistry. Predominant histological and immunohistochemical
findings were periportal proliferation of slightly dilated bile
ductules with no bile concretions. Reported HAI grade was 3, and
fibrosis staging score 1. In conclusion, histological features were
consistent with chronic hepatitis of minimal necroinflammatory
activity. Mild histological findings in liver biopsy resembling almost
normal liver that do not correlate with cholestatic jaundice require
additional attention of the pathologist. Potential pitfalls could be
bypassed with good clinician-pathologist cooperation. First, if the
hyperbilirubinemia is of the unconjugated type, clinicians should think
about GS. Failure to consider GS as the cause of jaundice may lead to
diagnostic misinterpretation and, consequentially, inappropriate
therapy. It is estimated that GS is found in about 5% in Caucasians.
Although some other conditions can present with cholestasis, no
additional symptoms in a patient with unconjugated hyperbilirubinemia
present the clue in differential diagnosis. Liver biopsy is not a
helpful tool in the diagnosis of GS.

 

P12

APOPTOSIS IN TESTICULAR TERATOCARCINOMA

 T. Džombeta, M. Ulamec, B. Krušlin, M. Belicza

Ljudevit Jurak University Department of Pathology, Sestre
milosrdnice University Hospital, Zagreb, Croatia

Apoptosis is an active process which occurs in both physiological
and pathological conditions. It serves to eliminate cells that are no
longer needed or are potentially harmful. Testicular teratocarcinoma is
a very interesting tumor because of its two completely different
components: mature, differentiated tissue and carcinomatous,
undifferentiated part. The aim of this study was to compare the number
of apoptotic cells in these two components of testicular
teratocarcinoma. Fifteen paraffin blocks with the diagnosis of mixed
germ cell tumor (containing both components of mature teratoma and
embryonal carcinoma) from the Ljudevit Jurak University Department of
Pathology archive were used in the study. Apoptotic cells were counted per
10 high power fields (HPF) under light microscope. The number of
apoptotic cells in teratoma ranged from 18 to 31 in 10 HPF (mean
24.9/10 HPF) and in carcinoma from 30 to 38 in 10 HPF (mean 35.3/10
HPF). In teratoma, columnar epithelium had a mean of 52.6 apoptotic
cells/10 HPF, stratified epithelium 8.7 apoptotic cells/10 HPF and
cartilage 2.6 apoptotic cells/10 HPF. This was a pilot study in which
we detected an increased number of apoptotic cells in the component of
embryonal carcinoma compared to teratoma. In columnar epithelium of
teratoma, the number of apoptotic cells was higher than in carcinoma,
which can be explained by its physiological function. Further studies
on more samples and comparison between p53 expression and apoptotic
index in different parts of tumor are needed.

 

P13 

PAPILLARY RENAL CELL CARCINOMA WITH SMOOTH MUSCLE RICH
STROMA: CASE REPORT

R. Limani1, L. Gashi Luci1, Z. Marušić2,
Z. Gatalica3, B. Krušlin2

1Institute of Pathology, Faculty of Medicine, University
Clinical Center of Kosovo, Prishtina, Kosovo; 2Ljudevit
Jurak University Department of Pathology, Sestre milosrdnice University
Hospital, Zagreb, Croatia; 3Department of Pathology,
Creighton University Medical Center, Omaha, Nebraska, USA

Papillary renal cell carcinoma (PRCC) is the second most common malignant 
epithelial renal neoplasm. PRCCs exhibit a broad morphological spectrum;
areas containing classic papillary, papillary-trabecular, and/or
papillary-solid
patterns of growth are seen in virtually all cases. True papillae with a
fibrovascular
core lined by neoplastic epithelial cells are the hallmark of the tumor.
Merino et al. have recently reported a series of 6 unusual renal cell
tumors with prominent proliferation of smooth muscle and tubular,
cystic and papillary elements. We report a case of PRCC composed of
 smooth muscle rich stroma in a 44-year-old man with no prior history
of disease. Grossly, the tumor measured up to 6 cm in greatest diameter,
 had a moderate consistency, with a gray-white color and necrosis presenting
 in up to 30% of tumor tissue. It penetrated the capsule and invaded the
perirenal fat. No lymph nodes were encountered. Histologically, the tumor
 was composed of papillary and micropapillary fronds with prominent
proliferation of fibrous tissue and smooth muscle in the tumor stroma.
 Immunohistochemistry revealed positive reaction of tumor cells for
cytokeratin, CK7, vimentin, CD10 and RCC, while CK20 was negative. Tumor
 stroma stained strongly positive for SMA. There was no VHL mutation. The
smooth muscle rich stroma in a PRCC is a new finding; further research is
necessary to clarify the pathogenesis of this tumor.

 

P14

APOPTOSIS IN EXPERIMENTAL MOUSE TERATOCARCINOMA

N. Sinčić1, M. Vlahović1, F. Paić1,
A. Katušić1, Lj. Šerman1, M. Belicza2,
F. Bulić-Jakuš1

1Department of Biology, School of Medicine; 2 Ljudevit
Jurak University Department of Pathology, Sestre milosrdnice University
Hospital, Zagreb, Croatia

The aim of this study was to determine the intensity of apoptosis in
experimental teratocarcinoma during its development, especially during
the period of its intensive growth (6th-8th
week). The 7.5-day-old C3H embryos were transplanted under the kidney
capsule of syngeneic adults. Tumors were isolated and weighted after 2,
4, 5, 6 and 8 weeks. The other group of animals were treated twice a
week for 4 weeks with the demethylating agent 5-azacytidine (5azaC)
immediately, at one week, two weeks or four weeks after
transplantation. Apoptosis was analyzed by counting apoptotic cells per
10 microscopic fields on hematoxylin-eosin slides under X400
magnification. On statistical analyses, Student’s t-test was
used. Results showed the apoptotic activity to rise during 8 weeks of
teratocarcinoma development in untreated animals. No difference was
observed in the number of apoptotic cells between differentiated and
undifferentiated tissue compartments. In 6th week of
development, apoptosis was significantly higher in differentiated
compartment, whereas in 8th week it was higher in
undifferentiated compartment. Apoptosis in 5azaC treated tumors seems
to have occurred with no difference during development except for a
more pronounced apoptosis in differentiated compartment in 5th
week. Apoptosis was significantly lower in tumors treated with 5azaC in
6th and 8th weeks of development compared to
controls.  It is concluded that apoptotic activity rises during
teratocarcinoma development in untreated animals, with a specific shift
of apoptotic activity in the period of the most intense teratocarcinoma
growth. The demethylating agent 5azaC slightly suppressed apoptotic
activity during the most intense teratocarcinoma growth period as
compared to untreated tumors.

P15

CAROTID BODY PARAGANGLIOMA: TWO CASE REPORTS

C. Ardeleanu, D. Terzea, A. Georgescu, M. Stoicea, F. Cionca, M.
Comanescu, F. Vasilescu, F. Andrei, M. Mihai, A. Visan, S. Enache

National Institute of Pathology, Bucharest, Romania

Paragangliomas of the carotid body are rare tumors (incidence
0.012%) originating from sympathetic fibers at the carotid bifurcation.
Their growth is slow, becoming symptomatic through local mechanical
compression of neighboring vascular and neural structures. The aim of
the current report is to present the evaluation, management and final
outcome in two patients with carotid body tumor. The first case was a
27-year-old woman who presented a cervical tumor detected by
self-examination. Hormonal status was: high serum serotonin (362
ng/mL), normal cathecolamines and chromogranin A. MRI revealed a 2-cm
mass near the left external carotid artery. Immunohistochemical
examination showed chromogranin A and synaptophysin positivity, and a
2%-5% Ki67 proliferative index. Octreoscan did not identify any other
localization. After surgery, serum serotonin descended to normal levels
in three months. The second case was a 40-year-old woman who presented
with a neglected 7-year-old latero-cervical tumor, with progressive
enlargement. Preoperative serum serotonin level was two times above
normal; cathecolamines and chromogranin A were normal. The
histopathological and immunohistochemical examinations revealed a
paraganglioma of the carotid body with positivity for neuron specific
enolase, chromogranin A in tumoral cells, and S100 protein (in numerous
dendritic cells); Ki67 proliferative index was 5%-10%. Postoperatively,
serum serotonin persisted at high levels. Under treatment with
octreotide LAR 20 mg/month, serotonin decreased to normal in 6 months.
Surgical excision of carotid body tumors is curative. Due to a
potentially infiltrating and disseminating growth, carotid body tumors
should be regarded as semi-malignant and should therefore be indicated
for surgery at the time of diagnosis.

P16

NASAL MITES AND ASSOCIATED LESIONS IN THE UPPER RESPIRATORY
TRACT OF CALIFORNIA SEA LIONS ( Zalophus californianus)

A. Petak1, M. Pavić1, S. Tkalčić2

1Faculty of Veterinary Medicine, University of Zagreb,
Zagreb, Croatia; 2College of Veterinary Medicine, Western
University of Health Sciences, Pomona, CA, USA

Upper respiratory parasites are uncommon finding in marine mammals.
Although it is not a common practice to open and thoroughly examine
nasal turbinates at the time of routine necropsy, we found nasal
passages of several California sea lions (Zalophus californianus),
to contain nasal mites (order Halarachnidae) of the genera Orthohalarachne,
as reported in otarrid seals. Of these, most commonly reported in
California sea lions are adults and larvae of Orthohalarachne
attenuata
and O. diminuata. Although
accompanied by a mild nasal discharge, clinical observations have
indicated that this infestation does not represent a serious clinical
condition for the sea lions. However, histopathologic findings
associated with a heavy parasitic load suggested different. Most common
pathological findings include erosions of the respiratory mucosa
surrounding attachment sites of the mites and accumulations of cellular
debris, edema fluid and inflammatory cells (predominantly neutrophils
and eosinophils) in nasal passages, nasopharynx, and larynx. In
non-eroded areas, the epithelium varies from normal to atrophic,
disorganized to hyperplastic. The histopathologic lesions observed
suggest that sea lions could present with dyspnea due to blockage of
upper respiratory passages and spread of adult mites and larvae deeper
into the airways and lungs. We calculated the density of mites in nasal
mucosa and suggest that large scale infestations of Orthohalarachne
sp. in nasopharyngeal mucosa and spread into the pharynx could
significantly affect the clinical condition of the affected animal.
Also, the nasal mites could lead to lower respiratory diseases,
pulmonary emphysema, and transmit other pathogens, so they should be
considered of significance to the health and rehabilitation efforts of
diseased California sea lions. Examination of nasal turbinates should
therefore be recommended on routine necropsy of marine mammals.

 

P17

LEYDIG CELLS, TESTIS VOLUME AND SPERMATOGENESIS IN PATIENTS
WITH NON-OBSTRUCTIVE AZOOSPERMIA

N. Knežević, V. Kozina, M. Kosović, M. Bernat, Ž. Kaštelan, D. Ježek

Departments of Urology, of Physics, and of Histology and Embryology,
School of Medicine, University of Zagreb, Zagreb, Croatia

In males, Leydig cells are responsible for more than 95% of androgen
production. The aim of our study was: (a) to assess morphological
features and testosterone production in situ of Leydig cells
in infertile patients; and (b) to correlate the above-mentioned Leydig
cell parameters with testis volume and spermatogenesis. In total, 120
testicular biopsies were used (12 controls and 108 specimens from
patients with non-obstructive azoospermia). The morphology of Leydig
cells was assessed by semi-thin and ultra-thin sections (transmission
electron microscopy). Testosterone production in situ was
visualized by immunohistochemistry, followed by morphometric
(stereological) analysis. Testicular volume was determined by
ultrasound and/or orchidometer, and the status of spermatogenesis by
applying Johnsen’s scoring system. Patients with non-obstructive
azoospermia exhibited statistically significantly lower values of
testicular volume and score. Morphological analysis indicated that some
Leydig cells displayed an extensive change of the nucleus and
cytoplasm, whereas the number of testosterone-producing cells was
significantly lower in azoospermia cases. Based on our results,
patients with azoospermia have significant changes in the morphology of
Leydig cells and their capacity to produce testosterone. Some of these
patients could be candidates for premature andropause.

P18

WARTHIN-LIKE TUMOR VARIANT OF PAPILLARY THYROID CARCINOMA:
CASE REPORT

A. Jakovčević1, M. Macan1, K. Žarković1,
M. Bura2

 1University Department of Pathology and Cytology, 2University
Department of ENT, Head and Neck Surgery, Zagreb University Hospital
Center, Zagreb, Croatia

Papillary carcinoma is the most common form of thyroid carcinoma and
generally has a more favorable prognosis than other carcinoma types.
Within the group of papillary carcinomas, several morphological
variants have been described. We present a case of a rare variant of
thyroid papillary carcinoma similar to Warthin’s tumor of salivary
gland. In a 67-year-old woman with euthyroid goiter and tumor nodule in
the isthmus, fine needle aspiration was suspect of papillary carcinoma.
Thyroidectomy was performed. An irregularly bordered grayish tumor
nodule measuring 2 cm in diameter was found in the isthmus. The
surrounding thyroid tissue was normal. Histologically, the tumor was
composed of solid areas and papillary structures. The cells covering
the papillae often had oncocytic appearance. Nuclei were monomorphous,
clear and ground glass-like with grooves. The fibrovascular core of the
papillae contained an intense lymphoplasmacytic inflammatory
infiltrate. All these features resembled Warthin’s tumor of salivary
gland. Within the surrounding thyroid parenchyma there was nodular
lymphocytic infiltration with germinal center formation. The lymph
nodes were free from metastases. Two years after surgical therapy the
patient is disease-free. This is a rare variant of thyroid papillary
carcinoma showing histologic similarities to Warthin’s tumor of
salivary gland and therefore may present a differential diagnostic
problem. Its clinical behavior does not differ from conventional
papillary carcinoma.

 

P19

EPIDEMIOLOGIC AND HISTOPATHOLOGIC FEATURES OF THYROID CANCER
IN CROATIA

R. Granić1, M. Borić1, T. Jukić1,
H. Čupić2, B. Krušlin2, Z. Kusić1

 1University Department of Oncology and Nuclear
Medicine, 2Ljudevit Jurak University Department of
Pathology, Sestre milosrdnice University Hospital, Zagreb, Croatia

Thyroid cancer is the most common malignant endocrine tumor. In a
great number of countries, this neoplasm is among the ten most common
malignancies. In recent decades, the incidence of thyroid cancer
(mostly papillary cancer) in the world as well as in Croatia has
increased dramatically, probably due to more efficient diagnostic
tools. Between 1968 and 2004, the age standardized incidence rate of
thyroid cancer in Croatia has increased 8.6 times in women and 3.6
times in men. Croatia is a country with a high incidence but a very low
mortality rate of thyroid cancer. The most recent WHO histopathologic
classification of thyroid tumors (updated and revised in 2004)
distinguishes three major categories of thyroid tumors: 1) thyroid
cancer (differentiated thyroid cancer – papillary and follicular;
poorly differentiated thyroid cancer, medullary and anaplastic); 2)
adenomas and related tumors; and 3) other tumors (thyroid lymphomas,
metastatic tumors, etc.). Approximately 90% of thyroid cancers are
differentiated thyroid cancers (mostly papillary) that are fortunately
less malignant and have excellent prognosis. Detailed and exact
histologic classification is of utmost importance not only to the
pathologists but also to the clinicians because it can lead to better
diagnosis and more rational therapy. The aim of this poster is to
indicate thyroid cancer incidence and mortality rates in recent decades
and to show changes in the histopathologic features of these cancers
during this period in Croatia. The aim is also to discuss the probable
influences of the modifications in histopathologic classification
systems, iodine intake, ionizing radiation and other factors on thyroid
cancer histopathology in Croatia. The data shown here have been
assembled from the database of thyroid cancer patients treated at
University Department of Oncology and Nuclear Medicine, Sestre
milosrdnice University Hospital, in close cooperation with Ljudevit
Jurak University Department of Pathology and University Hospital for
Tumors.

 

P20

 Apoptosis in chromophobe renal cell carcinoma and
renal oncocytoma

S. Cesarec, A. Demirović, H. Čupić, B. Krušlin, M. Belicza

Ljudevit Jurak University Department of Pathology, Sestre
milosrdnice University Hospital, Zagreb, Croatia

Renal oncocytoma is a benign epithelial tumor composed of oncocytes,
large eosinophilic cells. It accounts for 3%-9% of renal tumors.
Chromophobe renal cell carcinoma (ChRCC) is a distinct subtype of renal
cell carcinoma and comprises approximately 5% of all renal tumors. Two
main variants are classic and eosinophilic ChRCC. Although considered
less aggressive than other renal cell carcinomas, ChRCC has a
metastatic potential. Due to overlapping morphological characteristics
of renal oncocytoma and ChRCC, particularly its eosinophilic variant
with the abundant granular eosinophilic cytoplasm, making a correct
diagnosis can be challenging. The aim of this study was to assess and
compare the apoptotic index, defined as the absolute number of
apoptotic cells per 10 high power fields (HPFs), in the two
tumor groups. The files from Ljudevit Jurak University Department of
Pathology, Sestre milosrdnice University Hospital were searched for
cases of histologically confirmed ChRCCs and renal oncocytomas. Slides
of 10 ChRCCs and 10 renal oncocytomas, stained by hematoxylin and
eosin, were analyzed under the light microscope. Apoptotic cell was
defined as a cell with dense, eosinophilic cytoplasm and picnotic or
defragmented nucleus. The absolute number of apoptotic cells per
10 HPFs in the two tumor groups was counted. In the group of renal
oncocytomas there were a mean of 7.8% apoptotic cells per 10
HPFs (range 4-12). In the group of ChRCCs there were 2.5% apoptotic
cells per 10 HPFs (range 1-6). Apoptosis is the process of
programmed cell death. Dysregulation of apoptosis is a key process in
cancer development and progression. The aim of this study was to assess
and compare the apoptotic index in the two tumor groups. Although there
was visible difference in the mean number of apoptotic cells between
the two tumor groups, this study was partially limited by the modest
number of cases and further studies are needed to explore the possible
use of apoptotic index assessment in the differential diagnosis between
renal oncocytoma and ChRCC. 

 

P21

Scrotal dirofilariasis in a 3-year-old child

 Z. Marušić1, B. Pigac2,
S. Radiković2, A. Kopljar2, D. Tomas1,
B. Krušlin1

1Ljudevit Jurak University Department of Pathology,
Sestre milosrdnice University Hospital, Zagreb; 2Department
of Pathology, Varaždin General Hospital, Varaždin, Croatia

Dirofilariasis is an uncommon zoonosis caused by parasites of the
genus Dirofilaria, most notably D. repens and D. immitis
in Europe. Canines represent the reservoir of infection,

while human infections are sporadic. The infection is transmitted by
the bite of a mosquito carrying parasitic larvae. We report a case of a
3-year-old boy with a scrotal nodule measuring up to 1 cm in diameter.
Upon excision of the nodule, the surgeon noticed a thread-like parasite
exiting the incision site, which he submitted separately from the
nodule. Microscopic examination of the excision specimen revealed a
canal of granulation tissue located in deep dermis, which did not
extend to the excision margin. Microscopic examination of the
thread-like material disclosed a parasite whose morphology was
well-preserved in some of the sections. It was composed of a thick
cuticle with longitudinal ridges (micro-ruffling of the surface), large
lateral chords, tall, slender coelomian muscle layer, a single gut tube
and spermatocytes in the genital tubule. The morphology of the parasite
was consistent with a helminth from the genus Dirofilaria. In humans,
dirofilariasis most often manifests as a subcutaneous nodule or less
frequently as the so-called “coin lesion” in the lung comprising of
microfilarial emboli in a branch of pulmonary artery. In Croatia, there
have been approximately a dozen case reports of dirofilarial infection
in humans. Most of the cases reported were from the Mediterranean part
of Croatia, which may represent an endemic area of dirofilariasis. The
diagnosis of subcutaneous dirofilariasis should be considered in the
differential diagnosis of a subcutaneous helminthic infection.
Physicians should be aware of this disease and its features for several
reasons, primarily in order not to mistake coin lesions in the lung for
malignancy and not to mistake dirofilarias in subcutaneous nodules for
other, more harmful tropical parasites such as Wuchereria bancrofti
or Onchocerca volvulus. In subcutaneous nodules, PCR analysis
is an elegant way to overcome diagnostic obstacles caused by altered
morphology and/or lack of familiarity with the specific morphology of
filarial species. Surgical treatment of subcutaneous dirofilariasis in
humans is considered curative and there is no need for further
interventions besides clinical monitoring.

 

P22

Histologic subtypes of invasive lobular
carcinoma in correlation with tumour status and hormone receptors

I. Miše1,  M. Vučić2,  I. Maričević1,
M. Šokčević 1, S. Čurić-Jurić1

 1Cytology Division, University Department of
Medicine, 2Ljudevit Jurak University Department of
Pathology, Sestre milosrdnice University Hospital, Zagreb, Croatia

Invasive lobular carcinoma is a distinct biological entity with
several histologic variants the prognostic value of which has not yet
been fully elucidated. The aim of this study was to determine the
immunohistochemical expression of estrogen receptors (ER) and
progesterone receptors (PR) in the subtypes of lobular breast carcinoma
(classic and variant types) and to correlate them with clinical and
tumor parameters. Fifty lobular carcinomas, 33 classic and 17 variant,
were analyzed. The classic type was more frequent (66%) in older women
(age 61) and smaller in size (1.5 cm), with N0 status and modestly
positive ER and PR. Variant types were more frequent in younger women
(age 55), larger in size (2.5 cm), with N1 status and maximal positive
ER and PR. ER was expressed in 82% and PR in 78% of tumors, mostly with
maximal expression without differences in the intensity among the
subtypes. Only one tumor of classic type was HER/2neu 3+, ER and PR-.
ER expression was significantly associated with a lower incidence of
other proliferative lesions (P=0.043). The total sample and
classic type were characterized by a significant positive correlation
between ER and PR (P=0.004) and between tumor size and N
status (P=0.005), and negative correlation between HER/2neu
and N status (P=0.042). In variant types, larger tumors were
related to higher N (P=0.021) and higher ER expression was
associated with smaller tumors (P=0.044). The study indicated
distinct biological features of lobular carcinoma subtypes and pointed
to the need of a more selective therapeutic approach.

 

P23

STRUMAL CARCINOID OF THE OVARY: A REPORT OF TWO CASES

T. Leniček1, D. Tomas1,3, H. Soljačić-Vraneš2,
Z. Kraljević2, P. Klarić2, M.
Kos1,3

1Ljudevit Jurak University Department of Pathology, 2University
Department of Gynecology and Obstetrics, Sestre milosrdnice University
Hospital; 3School of Medicine, University of Zagreb,
Zagreb, Croatia

Strumal carcinoid is an unusual form of ovarian teratoma composed of
an intimate admixture of thyroid and carcinoid tissues that vary in
their relative proportions. We describe two patients with primary
ovarian strumal carcinoid. Case 1: a 40-year-old woman was admitted to
the hospital with a 4-year clinical history of myoma uteri and no
symptoms, except for constipation persisting for several months. At
laparotomy, a smooth, hard, solid tumor originating in the left ovary,
measuring 9 cm in largest diameter, was found. Case 2: a 44-year-old
asymptomatic woman was admitted to the hospital for a clinical finding
of the left ovarian cyst. At laparoscopy, a multicystic left ovarian
tumor with a smooth outer surface, measuring up to 9 cm in largest
diameter, was found. Histopathologically, both tumors were composed of
an admixture of carcinoid tumor and normal thyroid tissue. A trabecular
variant of carcinoid was found in case 1 and insular variant of
carcinoid in case 2. Immunohistochemically, the carcinoid cells were
diffusely positive for synaptophysin and neuron specific enolase (NSE)
and focally positive for chromogranin A. Thyroid tissue with typical
thyroid follicles was immunohistochemically positive for thyroglobulin
and TTF. Strumal carcinoid was definitive diagnosis in both cases.
Primary ovarian carcinoid tumors are uncommon and account for less than
0.1% of ovarian malignancies. Secondary or metastatic carcinoids from
the gastrointestinal tract in the ovary are four times less common than
primary carcinoids. Patients with primary ovarian carcinoids show
symptoms of an abdominal mass, or the tumor is an incidental finding.
Some patients show signs of carcinoid syndrome (episodic cutaneous
flushing, cyanosis, abdominal cramps, diarrhea, carcinoid heart
disease, etc.), mediated by bioactive polypeptides produced by
carcinoid tumor cells. Microscopically, there are four major variants
of ovarian teratomas of carcinoid type: insular, trabecular, strumal
and mucinous. Carcinoid syndrome is a very rare manifestation of
strumal carcinoid. Even though carcinoids can typically cause the
carcinoid syndrome, with diarrhea as one of the symptoms, several cases
of strumal carcinoid were reported in patients exhibiting severe
constipation, induced by the gut hormone, peptide YY that has a strong
inhibitory effect on intestinal motility. The first patient we describe
also suffered from constipation that was relieved after the surgery.
Strumal carcinoid can also be responsible for carcinoid heart disease.
The patients presented had ovarian tumors showing typical morphology of
ovarian strumal carcinoids. Clinical follow up of the patients is only
two years in case 1 and six months in case 2, and the patients have no
signs of recurrence or distant spread of the tumor.

 

P24

MULTIPLE METASTASES OF RENAL CELL CARCINOMA TO THE THYROID
GLAND: case report

L. Labinac-Peteh1, T. Leniček2, I. Kučinar1,
H.Čupić2

1Department of Pathology and Forensic Medicine, Pula
General Hospital, Pula; 2Ljudevit Jurak University
Department of Pathology, Sestre milosrdnice University Hospital,
Zagreb, Croatia

We present a rare case of multiple metastases of clear cell renal
cell carcinoma (RCC) presenting as thyroid tumor 4 years after
nephrectomy. The patient, a 75-year-old woman, was referred to Pula
General Hospital for total thyroidectomy because of a giant, euthyroid,
retrosternal struma, with the symptoms of tracheal compression. All
laboratory findings including thyroid hormone status were within the
normal limits. On gross examination, the thyroid gland was enlarged,
with few well circumscribed, whitish nodes on the cut surface. On
microscopic analysis, well confined solid and alveolar clusters of
atypical epithelial cells were found in the thyroid gland. A distinct
feature of tumor cells was their clear cytoplasm and a hyperchromatic
nucleus. On immunohistochemical examination, tumor cells showed
positive reaction for CD 10, EMA and vimentin. The reaction for TTF-1
was negative. According to history data, histologic examination and
immunohistochemical analysis, the case was signed out as RCC metastases
to the thyroid gland. One month after the operation, there were no
signs of metastatic disease on postoperative computer tomography of the
head and thorax and on abdominal ultrasound examination. All laboratory
findings were within the normal limits.

 

P25

Adrenal myelolipoma

P. Sesar, I. Pavić, M. Ulamec, B. Krušlin

1Department of Pathology, Sisak General Hospital, Sisak; 2Ljudevit
Jurak University Department of Pathology, Sestre milosrdnice University
Hospital, Zagreb, Croatia

Adrenal gland myelolipoma (ML) is a rare disease. Most lesions are
discovered incidentally at autopsy or imaging studies performed for
other reasons. Differential diagnosis of the suprarenal mass depends on
preoperative imaging and biopsy. We performed a ten-year retrospective
cross sectional study of 11 MLs. Diagnosis was established by the set
of typical histologic findings on standard hematoxylin-eosin staining.
In all 11 cases, ML was incidentally found by computer tomography (CT)
scan. Seven MLs were found in six men (one man had bilateral adrenal
ML) and four in women. The diameter of adrenal tumor mass ranged from
0.5 to up to 13.9 cm. Macroscopic examination revealed an oval
encapsulated yellowish soft tumor located in the adrenal gland, with a
thin rim of macroscopically normal adrenal tissue. Histologic
examination showed proliferation of adipocytes which were dissociated
from several hemorrhagic foci and myeloid tissue that contained
megakaryocytes, erythroid cells and lymphocytes. The surface of the
tumor mass was covered with a fibrous capsule. On the periphery there
was normal adrenal tissue with no significant changes. Since first
described in 1905 by Girke, MLs are arising out as a rare, probably
benign adrenal neoplasm. Most of the lesions are small and
asymptomatic, incidentally discovered on clinical and CT scan
examination, with the size varying from several millimeters to more
than 30 cm. The most common complications develop due to pressure upon
the neighboring organs. Differential diagnosis of a suprarenal fatty
mass includes myelolipoma, renal angiomyolipoma extending from the
upper pole, and retroperitoneal lipoma and liposarcoma.

 

P26

EFFECTIVENESS OF TRANSSPHENOIDAL SURGERY AS AN INITIAL
TREATMENT FOR NON-FUNCTIONING PITUITARY ADENOMAS

PERSONAL EXPERIENCE IN CLINICAL PRACTICE 

P. Šulentić, M. Berković, B. Bečejac, V. Čerina, H. I. Pećina, M.
Vrkljan

Department of Endocrinology, Diabetes and Metabolism, Sestre
milosrdnice University Hospital, Zagreb, Croatia

 

The vast majority (>80%) of clinically non-functioning pituitary
adenomas (NFPAs) are gonadotroph-cell adenomas, as demonstrated by
immunocytochemistry. However, they are rarely associated with increased
levels of dimeric LH or FSH and usually clinically presented by tumor
mass effect, and therefore need to be distinguished from asymptomatic
incidentalomas. The aim of this study was to define the impact of
surgery on regression of tumor compression symptoms in a series of
patients with NFPAs undergoing endoscopic transsphenoidal surgery (TSS)
during the 2008-2009 period at our Department, which is the Reference
Center for Hypothalamus-Pituitary Diseases in Croatia. A total of 31
patients underwent TSS, 11 (35.5%) of them female. The male and female
patients were aged 17-84 and 62-76 years, respectively. Twenty-eight
(90%) patients had macroadenoma, which was the predominant type of NFA
both in men (n=19; 95%) and women (n=9; 82%). After surgery, visual
field defects remained in 10 cases. Postoperatively, three (9.7%)
patients had hypogonadism, 15 (48%) adrenal insufficiency, one (3.2%)
patient hypothyroidism and two (6.5%) patients panhypopituitarism; all
of which initially were macroadenomas. Two (6.5%) out of six (19.3%)
MRI detected residual masses were successfully reoperated.
Postoperatively, the three patients operated on for microadenomas had
no residual masses on MRI and no need for hormone replacement therapy
or additional treatment. In conclusion, considering that the results of
medical treatment with dopamine agonists and somatostatin analogues are
disappointing, TSS is the primary therapeutic approach in resolving
symptomatic NFAs, especially microadenomas. The strategy of observation
for patients with incidentally discovered pituitary adenomas is
appropriate, provided that the tumor is well-delimited, small, has no
extension with the risk of neurologic or visual chiasm compression, and
that a meticulous hormonal work-up has ruled out the possibility of
minimal hormonal hypersecretion.

 

P27

EFFECTIVENESS OF TRANSSPHENOIDAL SURGERY AS AN INITIAL
THERAPY FOR PATIENTS WITH ACROMEGALY – PERSONAL EXPERIENCE IN CLINICAL
PRACTICE

P. Šulentić, I. Kruljac, V. Čerina, H. I. Pećina, M. Vrkljan

Department of Endocrinology, Diabetes and Metabolism,
Sestre milosrdnice University Hospital, Zagreb, Croatia

Department of Endocrinology, Diabetes and Metabolism, Sestre
milosrdnice University Hospital is reference center for
hypothalamus-pituitary diseases in Croatia. Acromegaly is a rare
chronic debilitating disorder mainly caused by a growth hormone
(GH)-producing pituitary adenoma. Acromegaly is associated with a two-
to fourfold increase in mortality risk, mainly from cardiovascular
disease, unless serum growth hormone (GH) levels are below 2 microg/L
and serum insulin-like growth factor (IGF)-I levels are normal
following medical treatment. These combined criteria were used to
define remission of the disorder in this study. The aim of this
retrospective analysis was to evaluate, using the biochemical parameter
of remission, the initial outcome in a series of acromegaly patients
operated by endoscopic transsphenoidal pituitary surgery (TSS). A total
of 21 consecutive patients, 12 (57%) of them female, underwent surgery
in 2008-2009. The male and female patients were aged 25-70 and 27-74
years, respectively. Twelve (57%) patients had macroadenoma, which was
the predominant type of pituitary tumor in men (66%). In women, the
number of micro- and macroadenomas was equal (n=6). None of the
patients had ever been treated before. Hormonal assessment was
performed at 6 months of surgery. Fifteen (71.4%) patients achieved
biochemical remission of acromegaly. The remission rate at 6 months was
100% in patients with microadenoma and 50% in those with macroadenoma.
The combined use of TSS and treatment with somatostatin analogues was
beneficial for another three (14 %) patients, and two more (9.5%)
achieved optimal control of tumor growth and endocrinological
normalization by applying gamma knife radiosurgery (GKRS). In one
(4.7%) patient, there was no favorable clinical result despite optimal
combined therapy. In conclusion, TSS is beneficial and considered as
the treatment of choice in the hands of experienced neurosurgeon
because for providing rapid cure and normalization of survival in most
cases. However, in some patients optimal control of tumor growth and
normalization of hypersecretory states are achieved by secondary
treatment modalities, including GKRS and somatostatin analogues.

 

P28

EFFECTIVENESS OF TRANSSPHENOIDAL SURGERY AS AN INITIAL
TREATMENT FOR PROLACTINOMAS – PERSONAL EXPERIENCE IN CLINICAL PRACTICE
 

P. Šulentić, D. Herman, A. Marić, V. Čerina, H. I. Pećina, M. Vrkljan

Department of Endocrinology, Diabetes and Metabolism,
Sestre milosrdnice University Hospital, Zagreb, Croatia

Prolactinomas are the most common hormone-secreting pituitary
tumors. Medical therapy with dopaminergic agonists (DA) is the
preferred initial treatment for symptomatic prolactin (PRL)-secreting
adenomas. However, in recent years, there has been a renewed interest
in surgery. The aim of this retrospective analysis is to report a
series of patients operated for prolactinoma in 2008-2009 at our
Department, which is the reference center for hypothalamus-pituitary
diseases in Croatia. All patients were diagnosed on the basis of
neuroradiological imaging and endocrine assessment of pituitary
function. A total of 61 consecutive patients underwent endoscopic
transsphenoidal pituitary surgery (TSS), 46 (75.4%) of them female. The
male and female patients were aged 20-67 and 19-70 years, respectively.
Twenty-two (36.0%) patients had macroadenoma, which was the predominant
type of prolactinoma in men (73.3%). In women, microadenomas were more
common (n=35; 76.0%). None of the patients had ever been treated
before. After surgery, normalization of PRL levels occurred in 55
(90.2%) patients. Complete remission was achieved in all microadenoma
cases. Six (9.8 %) patients with postoperatively high PRL levels
initially had macroadenomas, and were in sequence treated with DA. Four
patients resistant to DA and TSS underwent gamma knife radiosurgery
(GKRS) with subsequent endocrinological normalization of PRL in two
additional patients. The two remaining patients with incomplete
remission had follow-up duration of one year that may have
underestimated the complete response rate for tumors treated with GKRS.
In summary, initial TSS therapy normalized PRL levels and relieved
symptoms of hyperprolactinemia in a significant majority of patients,
whereas morbidity of TSS is low in the hands of experienced pituitary
surgeons. TSS can be offered as a definitive therapy, especially to
patients with microadenomas.

 

P29

ALVEOLAR RHABDOMYOSARCOMA OF FOOT: CASE REPORT

J. Begić1, D. Bobonj-Hižak1, B. Fila1,
T. Leniček2, B. Krušlin2

1Department of Pathology and Surgery, Bjelovar General
Hospital, Bjelovar; 2Ljudevit Jurak University Department of Pathology,
Sestre milosrdnice University Hospital, Zagreb, Croatia

The clinical and pathologic features of alveolar rhabdomyosarcoma of
the left ankle joint in a 73-year-old woman are presented. The patient
presented to surgery clinic because of redness and edema in the foot
area (she mentioned a possible insect sting), and edema of her left
leg. Urgent CD test of arteries and left leg veins was done and
vascular events were excluded. On ultrasonography scan, a hypoechoic
lesion of solid appearance was subcutaneously verified in the area of
the left ankle lateral malleolus. Computed tomography (CT) scan of the
pelvis confirmed the test results, showing enlarged lymph nodes of up
to 30 mm in diameter parailiacally on the left and in the left inguinal
region. Biopsy of the solid formation in the area of the lateral ankle
was obtained, later followed by needle biopsy of the left inguinal
lymph nodes. Histopathologic analysis of the solid tumor showed tumor
tissue composed of fibrous septa covered with small to polygonal,
mitotically active atypical tumor cells, and of hyperchromatic nuclei
of solid and alveolar growth. Tumor cell mimunohistochemistry showed
positive reaction for desmin, vimentin and myoglobin. Histology and
immunohistochemistry (desmin, myoglobin, vimentin, CK-PAN, S-100
protein, synaptophysin, CD31) corresponded to alveolar
rhabdomyosarcoma. Needle biopsy of lymph nodes was indicative of a
malignant tumor of undiferentiated round cells. The patient died two
months of the surgery. Alveolar rhabdomyosarcoma of foot is a rare
cause of lymphedema of foot in adults. Alveolar rhabdomyosarcoma is a
primitive, malignant, round-cell neoplasm that cytologically resembles
lymphoma and shows partial skeletal muscle differentiation. The
prognosis of alveolar rhabdomyosarcoma is distinctly worse than for the
embryonal variety, even with the most recent combined treatment
modalities.

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