Methodological approach towards a Gap Assessment of the Serbian microbiology system in the function of surveillance in line with EU standards and acquis.

INTRODUCTION: Italian and Serbian Health authorities performed an in-depth Gap Assessment of the Serbian microbiology system in the function of communicable disease surveillance using a methodology adapted to context and information needs. METHODS: There were two study phases: a capacity based survey and an equipment mapping survey. Invited participants included national health authorities, heads of national reference laboratories and of public/private diagnostic laboratories in Serbia. Findings were analysed preliminarily and identified gaps were discussed, prioritized and validated through two ad hoc workshops involving all concerned institutions. RESULTS: The Gap Assessment was performed between September and December 2017. The overall response rate was 69% for phase one and 74% for phase two. Identified gaps were assessed as highly relevant during the project workshops. DISCUSSION: Gaps and priorities were highlighted, validated, and studied with a suitable level of detail to develop a concrete action-plan. The same methodological approach could be used to monitor progress in Serbia as well as in other EU candidate countries.

Buschke-Löwenstein tumor: squamous cell carcinoma of the anogenital region.

INTRODUCTION: Buschke-Löwenstein tumor (BLT), as a rare form of condylomata acuminatum, was firstly described by Buschke in 1886 as a "carcinoma-like condyloma acuminatum of the penis". BLT is generally considered to be a low-grade variant of squamous cell carcinoma of the anogenital region. CASE OUTLINE: We describe a case of BLT in a 56-year-old male patient who was referred to our institute due to a large defect in the gluteal region. The biopsy of the lesion was performed and the diagnosis of BLT was made on histopathological examination. Magnetic resonance imaging of the pelvis showed the extensive vegetant lesion that significantly infiltrated pelvic organs accompanied with an enlargement of para-iliac lymph nodes. Sygmoidostomy for fecal diversion was done and chemotherapy with 5-fluorouracil and cisplatin was initiated. Unfortunately, the patient's severe condition caused fatal outcome. CONCLUSION: Our case points out that BLT should be treated at the initial stage in order to prevent untreatable condition which happened in our patient. Therefore, early diagnostics and staging of the disease using modern technologies are crucial in order to treat patients effectively.

Bilateral bloody nipple discharge in a male infant: sonographic findings and proposed diagnostic approach.

Bloody nipple discharge is an uncommon finding in the pediatric population, without clear diagnostic and therapeutic guidelines established. We noted a case of a 3-month-old male infant who presented with bilateral blood-stained nipple discharge, with unremarkable medical history. Sonographic findings revealed bilaterally dilated ducts and cysts with mixed iso- and hypoechoic intraductal content. Possible causes of this condition include hyperlaxity syndrome with decreased function of elastic fibers and fibrocystic changes in breasts, and unusual response to maternal hormones, transferred to the neonate either transplacentally or through breastfeeding. Given the most probable benign etiology and self-limiting nature of the described condition, a conservative approach is suggested. Unnecessary invasive procedures should be avoided.

[Expression of cytokeratins 5/6 and cytokeratin 17 in invasive breast carcinoma].

BACKGROUND/AIM: Cytokeratins (CK) 5/6 and 17, myoepithelial markers, are also expressed in a proportion of breast carcinomas. Breast carcinomas expressing basal epithelium cytokeratins constitute a tumor subgroup that shows common but heterogeneous morphological, genetical, and immunophenotypical features and is associated with poor clinical outcome. The aim of this study was to determine the incidence of basal expression of cytokines CK5/6 and CK17 in the tested samples of ductal invasive breast cancers, as well as to test the presence of a correlation of tumor expression of basal cytokines and clinicopathological prognostic factors: age, the level of histological differentiation, hormone receptor status, HER2 (human epidermal growth factor receptor 2) protein expresion and HER2 gene amplification in tumorous tissue. METHODS: Immunohistochemistry (IHC) was used to evaluate the CK5/6 and CK17 status of 121 ductal invasive breast cancers. The results thus obtained were compared with clinicopathological characteristics. RESULTS: From the 117 analyzed tumor specimens, 22% and 30% were immunohistochemically positive for CK5/6 and CK17, respectively. Basal cytokeratins showed significant inverse relationship with estrogen and progesterone receptor status and HER2 protein expression. CK5/6 and CK17 immunoreactivities were directly associated with triple-negative phenotype and higher histological grade. CONCLUSION: Our findings are similar to reports that tumours expression of basal cytokeratins are correlated with adverse pathological parameters. Given the limited number of emerging therapeutic targets in these tumors, routine IHC identification of basal-like subtype as a poor prognostic group of breast cancer could be based on the expression of basal CKs.

Dermatofibrosarcoma protuberans of the breast: mammographic, ultrasound, MRI and MRS features.

Dermatofibrosarcoma protuberans (DFSP) of the breast is a rare malignant tumor, and its preoperative diagnosis is extremely difficult. Local recurrence of DFSP is frequent after incomplete resection because of either false diagnosis or inadequate standard surgical excision. We present a case of DFSP that showed disconcordant results using different imaging modalities, suggesting that the MRI finding of subcutaneously located highly vascular tumor with suspicious kinetics but together with negative Cho peak on (1H) MRS, might be suggestive of the diagnosis of DFSP.

Evolving hypopituitarism as a consequence of traumatic brain injury (TBI) in childhood - call for attention.

Hypopituitarism is a common complication of TBI in long-term survivors, more frequent than previously realized. It may be partial or complete, sometimes very subtle without visible lesions in hypothalamo-pituitary region and is diagnosed only by biochemical means. Neuroendocrine abnormalities caused by TBI may have significant implications for the recovery and rehabilitation of these patients. The subjects at risk are those who have suffered moderate to severe trauma, although mild intensity trauma may precede hypopituitarism also. Particular attention should be paid to this problem in children and adolescents. We describe a patient with hypopituitarism thought to be idiopathic due to mild head trauma which caused diabetes insipidus in childhood, gradual failure of pituitary hormones during the period of growth and development, and metabolic (dyslipidemia), physical (obesity), and cognitive impairments in the adult period.

Correlation of HER-2/neu protein overexpression with other prognostic and predictive factors in invasive ductal breast cancer.

BACKGROUND: The objective of our study was to investigate the association between Her-2/neu status and other clinicopathological characteristics of ductal breast carcinoma. PATIENTS AND METHODS: A total of 120 cases of breast carcinoma were included in this study. The immunohistochemical staining for HER-2/neu, hormone receptors, p53 and Ki-67 were evaluated. RESULTS: HER-2/neu protein overexpression was present in 4 out of 63 T1 lesions, in 13 out of 44 T2 lesions, in 3 out of 7 T3 lesions, and in 3 out of 6 T4 lesions. Protein overexpression was found in 10 out of 21 grade III tumors and 13 out of 72 grade II tumors. Overexpression was not detected in grade I tumors. Of the 23 Her-2/Neu-positive cases, ER- and PR-negative status was detected in 61% and 69%, respectively. Her-2 protein overexpression was seen in 23 out of 93 high Ki-67 tumors, whereas overexpression was not detected in low Ki-67 cases. CONCLUSION: Statistically significant correlation was found between HER-2/neu protein overexpression and large tumour size, high histological grade, ER and PR negativity, and high Ki-67 proliferative index.

Leptomeningeal metastasis from malignant pleural mesothelioma.

Leptomeningeal metastasis from malignant mesothelioma is very rare; to our knowledge, only one imaging report exists in the literature. We present the case of widespread leptomeningeal lesions secondary to a malignant mesothelioma in a 61-year-old woman.