JUVENILE POLYP IN ADULTS.

Colorectal juvenile polyp as a pathologic entity was first described by Verse. These non-neoplastic lesions are most commonly found in children and infants, while in older children after the age of 14 and adults are a rare phenomenon. A 75-year-old female underwent colonoscopy. There was a pedunculated polyp in the transverse colon. Complete endoscopic electroresection of this polyp was performed and the polyp was sent for histopathologic analysis. Macroscopically, the polyp was described as a fragment of irregular round shape, size of about 2.5x2x1 cm, with fine-grained, reddish surface, showing dark red color on serial sections. Histologic examination of the polyp showed some irregularly distributed glands, some of which were cystically dilated. All glandular formations were coated with normal intestinal epithelium. The surface of the polyp was partially eroded and replaced by non-specific cellular granulation tissue. There were some signs of hemorrhagic infarction in the stroma of the polyp. Histopathologic examination indicated that histopathologic characteristics of this polyp corresponded to juvenile polyp. Juvenile polyps are very rarely found in adults. Therefore, we describe a case of this patient in her eighties with juvenile polyp localized in the transverse colon.

The influence of chronic intake of saccharin on rat hepatic and pancreatic function and morphology: gender differences.

There are opposite hypotheses on the effect of saccharin. Our aim was reviewing the influence of chronically ingested saccharin on the function and histological structure of liver and pancreas and all this in light of gender differences. The rats were divided into control group - (Group C) and saccharin-treated group - (Group S) which was given a normal diet and 0.0005% saccharin in drinking water for 6 weeks. Liver and pancreas were histologically processed and quantitative histological analysis was performed. Glucose blood levels and plasma activities of aspartate transaminase (AST) and alanine transaminase (ALT), body weight, and food intake were analyzed. Quantitative histological analysis determined that the values of diameter and volume density of both Langerhans islets and exocrine acini were significantly higher in S group, especially in males. AST levels were significantly higher in treated group. Glucose levels were higher in treated group, mainly due to the values of the female subgroup. Food intake was significantly higher in control group, while weight gain was higher in treated group. Treated males had significantly higher food intake and weight gain in comparison with treated females. The data presented here suggests that chronic saccharin intake affects the examined parameters. Reported facts reflect various metabolic, hormonal and neural responses in males and females.

Squamous cell carcinoma in mature cystic teratoma of the ovary.

INTRODUCTION: Malignant transformation is a rare complication of mature cystic teratoma, with squamous cell carcinoma as the most common malignancy (in 75% of cases). In this article we present a case of a well-differentiated squamous cell carcinoma arising in a mature cystic teratoma and discuss the morphological and clinico-pathological features of malignant transformation in teratoma. CASE REPORT: An 80-year-old woman with symptoms of acute abdomen underwent left salpingo-oophorectomy. Gross examination showed a cystic mass measuring 20 cm in diameter, with papillary formation on its internal surface. Histology revealed a well-differentiated squamous cell carcinoma arising in mature cystic teratoma. Squamous epithelium surrounding the tumor was dysplastic. CONCLUSION: Squamous cell carcinoma in mature cystic teratoma is a rare pathologic event and in most cases it is an accidental pathohistological finding.

[Morphology and immunohistochemical studies of ovarian strumal carcinoid].

INTRODUCTION: Teratomas are tumors derived from pluripotent germ cells, and they appear most frequently in ovaries. Strumal carcinoid belongs to the group of monodermal teratomas. Strumal carcinoid is characterized by the presence of carcinoid tumor, intermingled with thyroid tissue. CASE REPORT: A 52-year-old postmenopausal woman was referred to the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina, Novi Sad with complex right adnexal mass for surgery. Laparotomy revealed tumor arising from the right ovary, of firm consistency and intact capsule. On gross examination, yellowish brown tumor was 26 x 17 x 10 cm, with vague nodularity. The cut sections revealed predominantly solid mass with two cystic areas, and one of the cysts showed a tuft of hair. On histopathological examination, the cystic spaces were lined with skin and mucinous epithelium. The solid areas showed a population of monomorphic cells with eosinophilic cytoplasm and nuclei with "salt and pepper" chromatin, arranged in acinar and trabecular patterns, respectively. In addition, focally follicular structures with central eosinophilic colloid-like material were seen. Based on the presence of these two components, a diagnosis of Strumal Carcinoid was made and confirmed on immunohistochemistry. The tumor cells were diffusely immunopositive for synaptophysin, chromogranin, and the follicles including the central coIloid were immunopositive for thyroglobulin and Thyroid transcription factor-1. Neither proliferative or mitotic activity nor capsular or angiolymphatic invasion were noticed. At 3 year follow up the patient was disease free. CONCLUSION: In order to diagnose this rare tumor a team, consisting of a pathologist, surgeon and radiologist, is needed. Diagnosis of strumal carcinoid has to be confirmed on immunohistochemistry.

Age-related skin changes.

Age-related skin changes can be induced by chronological ageing, manifested in subcutaneous fat reduction, and photo-ageing eliciting increased elastotic substance in the upper dermis, destruction of its fibrilar structure, augmented intercellular substance and moderate inflammatory infiltrate. Forty-five biopsy skin samples of the sun-exposed and sun-protected skin were analyzed. The patients were both males and females, aged from 17 to 81 years. The thickness of the epidermal layers and the number of cellular living layers is greater in younger skin. The amount of keratohyaline granules is enlarged in older skin. Dermoepidermal junction is flattened and the presence of elastotic material in the dermis is pronounced with age. The amount of inflammatory infiltrate is increased, the fibrous trabeculae are thickened in older skin and the atrophy of the hypodermis is observed. Chronological ageing alters the fibroblasts metabolism by reducing their life span, capacity to divide and produce collagen. During ageing, the enlargement of collagen fibrils diminishes the skin elasticity.

Lipomas of the gastrointestinal system.

Lipomas are rare benign tumors in the gastrointestinal system. Within the gastrointestinal system, 65% of the lipomas are located in the colon (sigmoid part of the colon or rectum) and rarely in the stomach and esophagus. The paper presents two gastrointestinal lipomas. First is the case of lipoma of the sigmoid colon and the other one is gastric lipoma. In both cases the material was sent for histopathological analysis due to suspicion of malignancy of the lesions. In both cases, the histopathologic analysis showed tumor made of mature adipocytes, localized in the submucosa both of the stomach and intestine. Hypercellularity and/or atypia of the cell was found in neither case. Lipomas are shown because of its atypical localization and clinically suspicious malignancy in the stomach and sigmoid colon. These cases show that the applied methods of preoperative diagnosis of tumors in the gastrointestinal system are not sufficient to determine the origin and biological behavior of tumors. Histopathological diagnosis provides a correct insight into the nature of tumors and determine the course of treatment. This paper presents a rare localization of lipomas in the gastrointestinal system. The preoperative diagnosis of lesions in the gastrointestinal system may not be sufficient to determine the origin and biological behavior of the lesions, hence the histopathological diagnosis gives an accurate insight into the nature of the change, preventing the possibility of further aggressive therapy.

[Pathohistological changes in fetuses with cystic fibrosis].

INTRODUCTION: Cystic fibrosis or mucoviscidosis is a genetically caused disease. The intensity of disease and histopathological changes grow throughout the life. According to the literature, pathological changes characteristic of cystic fibrosis become noticeable around the sixth month of life. CASE REPORT: After amniocentesis of a 5-lunar month-old fetus had been done, which confirmed cystic fibrosis, the Ethics Commission approved the preterm labor. The autopsy and histopathological analysis demonstrated the existence of typical histopathological changes in the pancreas and intestines. DISCUSSION: In the late fetal period or during the period around the delivery, cystic fibrosis is usually manifested as meconial cap with or without obstruction of the intestinal lumen. Morphological changes in the exocrine glands usually develop only after birth. In this case, the existence of meconial obstruction, as well as the typical acidofil content in the secretory ducts and acini of the pancreas was confirmed, which is unusual for the fetal age of five months.

[Mucinous cystadenofiobroma of the ovary].

INTRODUCTION: Cystadenofibromas are tumors of the ovary which originate from the surface coelomic epithelium. Benign mucinous cystadenofibroma is a very rare form of these tumors, which consists of dominant stromal component of the connective tissue and one or more cysts. CASE REPORT: The case of a 62-year-old female with tumor of right ovary is reported in this paper. Histologically, tumor of the ovary had multilocular cystic formation, lined by a single-layer of mucoproductive cylindrical epithelium - endocervical type. In one area of tumor, the stromal component was abundant and made from partially hyalinised dense connective tissue. Mucinous cystadenofibroma was diagnosed on the basis of histological examination. Since the mucinous type of cystadenofibroma or adenofibroma is rare, this case has been chosen to be presented. CONCLUSION: Mucinous cystadenofibromas are differentially-diagnostically very similar to different malignant tumors and it is extremely important to make correct diagnosis of these neoplasms.

Fatal intoxication because of trihexyphenidyl.

Trihexyphenidyl (THP) is an anticholinergic agent with forensic toxicological interest. We present a case of a 59-year-old woman with a history of paranoid disorder, who was found dead in the house where she lived alone. The autopsy findings revealed no marked pathological changes. Toxicological analysis based on gas chromatography-mass spectrometry (GC-MS) analysis revealed THP and its major metabolite (hydroxy-THP) in blood and urine, with THP concentrations of 0.053 and 0.560 mg/L, respectively. The blood and urine ethanol concentrations were low 0.096 and 0.100 g/L, respectively. Based on these results, we determined the cause of death to be THP poisoning. It is suggested that rare case of death associated with THP overdosage should be taken in conjunction with central nervous system depressants (benzodiazepines, ethanol) and/or with other pathological disorders. Thus, our case could not be supportive for this allegation.

[The contribution of pathologic diagnosis and research of the faculty members engaged in teaching histology and embryology to undergraduate medical studies].

INTRODUCTION: The theoretical and practical aspects of teaching are generally defined by the curriculum, but professional experience plays an important role as well. The teaching experience of the faculty members is developed through health services, education and research. THE DEPARTMENT OFHISTOLOGY AND EMBRIOLOGY: This paper reviews the activities of the teaching staff of the Department of Histology and Embryology, pointing to the importance of pathologic diagnostics and research. It underlines the necessity of using some non-standard histologic staining methods on some tissues, organs and pathogens, as well as the results of experimental studies of the endocrine system. The experimental tumor models are used to demonstrate the interdependence of the endocrine and immune systems. Modalities and possibilities of regeneration of the digestive tract and connective tissue mucosa are explained This paper also deals with histologic criteria used for assessment of fetal age and in the diagnosis of developmental malformations. Linear and stereologic methods, used in quantification of normal morphology, the degree of pathologic changes, and regeneration of normal structures in the courses of and after therapy, are given. The authors particularly emphasized the importance of above-mentioned activities in the teaching of Histology and Embryology to undergraduate students.

Evaluation of large intestinal mucosa regeneration in ulcerative colitis using linear measurements.

Ulcerative colitis is a chronic inflammatory condition characterized by three phases: active, regression and remission phase. The active phase is followed by atrophy of the large intestinal mucosa. Although its evaluation is sometimes difficult, quantification of ceratin mucosal parameters can be used as an accessory method. The aim of the study was to determine the parameters of linear micrometry in order to estimate the regeneration of the large intestinal mucosa in ulcerative colitis, and to evaluate the efficiacy of this method in everyday work. The measurements were performed on routine bioptic samples after qualitative histologic analysis and determination of the type and stage of the disease. The measurements were carried out to determine: the number of crypts per unit length, the height of crypt epithelium, diameter of crypts, their lumen and interstices; also, the quotient between the diameters of crypts and interstices was calculated. The analysis of the measured parameters points to presence and degree of regeneration and/or atrophy of mucosa, particularly by following the parameters of crypt epithelium. Linear measurements can be used in estimation of regeneration and atrophy of large intestinal mucosa.

[Von Meyenburg complex associated with adult polycystic liver disease].

INTRODUCTION: The von Meyenburg complex (bile duct hamartoma) is a rare developmental disorder, manifested by multiple bile ducts. The polycystic liver disease is a rare congenital anomaly which may remain undiscovered until adult life, occurring more frequently in women. It is mostly asymptomatic, but sometimes surgical intervention is necessary. In the majority of cases, it is combined with cysts in the kidney and, rarely, in other organs as well. The cysts may vary in diameter from 1 mm to 20 cm, or even more. CASE REPORT: A 55-year-old woman underwent surgery based on clinical diagnosis: suspected Echinococcus liver cyst. Liver biopsy was performed, and a parenchymal tissue of 6.5x4x3 cm, with a cyst with a diameter of 2.5 cm, was resected. Within the cyst lumen there was a necrotic, mushy, yellow contents. Microscopically examined, it showed plenty of cholesterol crystals. The wall of the cyst consisted of hypocellular connective tissue. In the surrounding liver parenchyma, there were cystical formations of the same structure, measuring 1-2 mm. Also, there were some multiple bile duct hamartomas. The ducts were encircled by a delicate connective tissue. DISCUSSION AND CONCLUSION: These changes correspond to von Meyenburg complex, i.e. biliary microhamartoma combined with adult polycystic disease. In our case, in the wall of the cyst there were numerous cholesterol crystals, pointing to its retention character and, probably, to the mechanism of its origin. After degeneration of biliary epithelium, the cyst wall grew very thick, due to proliferation of the connective tissue evoked by the aggressive chemical contents of the bile. Frequent development of cholangiocarcinoma within the cyst wall also points to long-term chemical irritation.

[Gastrointestinal stromal tumor: case report]. / Gastrointestinalni stromalni tumor: prikaz slucaja.

INTRODUCTION: Gastrointestinal stromal tumors represent extremely rare tumors of the gastrointestinal system, especially when localized on the small intestine. CASE REPORT: We report a case of a female patient, with recurrent gastrointestinal bleeding and severe anemia, caused by gastrointestinal stromal tumor of the small intestine. After negative endoscopic findings, she underwent radiological examination of the small intestine. Primary diagnostic radiological evaluation included: small intestine passage enteroclysis, computed tomography of the abdominal cavity and selective angiographic study of the three major aortic branches that supply the gastrointestinal tract in the abdomen (celiac axis, superior mesenteric artery and inferior mesenteric artery). Secondly, ultrasound of abdominal cavity was performed. Findings of small intestine passage and enteroclysis were negative. The tumor was visualized by computed tomography and ultrasound, but without distinctive anatomical localization in the abdominal cavity. DISCUSSION: The diagnostic dilemma has been resolved by using selective angiographic examination of celiac axis and superior mesenteric artery and thus a tumor formation was visualized in the mesenterium of the small intestine. Radiological findings were confirmed by surgery. Histopathological findings were positive for gastrointestinal stromal tumor. CONCLUSION: Gastrointestinal stromal tumors of the small intestine rarely cause recurrent bleeding, but they should be included in differential diagnosis.