[Schwannoma of the gallbladder]. / Svanom zucne kesice.

Schwanomas of the biliary tract are very rare with about 55 reported cases. Schwanomas of the gallbladder are the rarest, probably with less then ten reported cases. We reported a 61 old woman in whom we did a cholecystectomy for a tumor of gallbladder 6.5 x 9 cm in diameter with a central softness which showed a histologic appearance of schwanoma. Ten years after surgery the patient is symptom-free and with no signs of recurrency.

[Diagnostic dilemmas in surgical pathology]. / Dijagnosticke dileme u hirurskoj patologiji.

In the majority of presented cases persisted certain diagnostic perplexities even after the careful investigations were performed, which required surgical exploration. For example, carcinomatous pericarditis as the sequel of metastasis from occult thyroid carcinoma and two cases of double malignity (papillary carcinoma and Hodgkin's lymphoma of the thyroid), retroperitoneal leiomyosarcoma and the clear cells renal carcinoma. All the cases were not successfully solved until the application of highly sophisticated and precise methods of immunohistochemical staining, which without a mistake confirmed our assumed histopathologic diagnosis. Metastatic lesion of folicular thyroid carcinoma in the adrenal gland should be mentioned because of the long remission period of 15 years following total thyroidectomy and neck irradiation during the primary therapy of thyroid carcinoma. It is very significant to point out that pathologic disorders such as undifferentiated neoplasm, strange inflammatory conditions, endocrine proliferative lesions deserve special attention because in certain cases consultative approach is necessary for obtaining the definite finding that can in some degree histoprognostically predict the outcome of pathologic process.

[Epidermoid cyst of the spleen]. / Epidermoidna cista slezine.

A 33-year old woman with 6 x 6 cm splenic cyst of the lower pole of a moderately enlarged spleen, found during ultrasonographic examination for epigastric and left subcostal abdominal pain, is presented. At operation the spleen of 900 grams with a subcapsular cyst in pedunculated extension of the lower splenic pole, ie. accessory lobe, was removed. No other abdominal disease was found. Postoperative recovery was uneventful. Pathohistological examination revealed a cyst, 6 cm in diameter, with whitish wall filled with dark-red turbid fluid containing yellow flocules. The wall of the cyst consisted of the fibrous connective tissue with sclerotic and hyaline changes. The cyst was entirely lined by the stratified squamous epithelium, in some areas flattened, transformed into endothelium. Diagnosis of a very rare splenic epidermoid cyst in the "accessory lobe" of the lower pole, was confirmed.

[Pseudocyst of the adrenal gland causing hypertension]. / Pseudocista nadbubrezne zlezde pracenja hipertenzijom.

We describe a 45-year-old women in whom during the investigation of hypertension a small, 2 cm in diameter, cyst of the left adrenal gland was found, which continued to grow up to 9 cm in diameter for a year. At the operation a three-locular cyst of the left adrenal gland was entirely removed with all surrounding organs undamaged. The postoperative recovery was uneventful. Histological examination showed a pseudocyst probably of posthaemorrhagic origin. Blood pressure dropped to normal and left abdominal pain disappeared. Since then the is symptom-free.

[Diffuse adenomyomatosis of the gallbladder]. / Difuzna adenomiomatoza zucne kesice.

Adenomyomatosis is a rare benign proliferative disease of the gallbladder characterized by epithelial proliferation and formation of mucosal pouches through the thickened muscular layer of gall bladder wall. It appears in three different types: diffuse, segmental and localised adenomyomatosis. Diffuse type is the rarest. Etiology is unknown. Patients sometimes feel a dull pain in the upper right abdominal quadrant. Preoperative diagnosis is based on cholecystography and ultrasonography. Cholecystectomy is a method of treatment. Diagnosis is confirmed on histology. Very rarely, adenomyomatosis seems to bee a premalignant condition. We present four patients treated during the last two years, a woman and three men, 27-41 years old (average 37 years). All these patients had a dull pain in the right subcostal region, approximately 6 months before the diagnosis was established. One patient had chronic alcoholic pancreatitis with dilated pancreatic duct. Diagnosis of diffuse adenomyomatosis was made preoperatively on ultrasonography in all patients. Cholecystectomy was carried out Diagnosis was confirmed on histology. There was no carcinoma. In a patient with chronic pancreatitis Wirsungojejunostomy (Puestow) and choledochojejunostomy were also carried out.

[Mixed colon tumour: leiomyoma-haemangioma]. / Miksni tumor kolona: lejomiom-hemangiom

Leiomyoma and heamangioma of the colon are extremely rare tumours. Only 27 cases were published in world literature up to 1954. A few new were published after that period. We describe a 46-year-old man with 3-months-history of occlusive symptoms in whom during the operation for complete colon obstruction mixed colon tumour (leiomyoma-haemangioma) was found, 10 cm distal to hepatic flexure. The tumour was of intraluminal pedunculated type", 7 cm in maximal diameter. Four enlarged, firm lymph nodes in the mesocolon close to the tumour were found. Right colectomy was carried out as the most resonable procedure. Histopathology showed leiomyoma of the colon with massive fibrous tissue, degeneration, bleeding of the tumour and many dilated blood vessels, so that its pedunculated part resembled a haemangioma. No sign of malignancy was found. The recovery of the patient was normal, and he stayed symptom-free, with normal small bowel function, clinical and laboratory data.

Enhanced acid protease activity of lysosomes from papillary thyroid carcinoma.

In vitro lysosomal acid protease activity was studied in human papillary thyroid carcinoma (n = 13). As a control, morphologically normal thyroid tissue from the same patient was used in each individual case of carcinoma. Although a marked variation may be observed between individual cases, each examined papillary thyroid carcinoma showed significantly greater activity of acid proteases, both per unit weight of wet thyroid tissue and per unit of lysosomal proteins, in comparison to the corresponding control (range, 24%-248%). In conclusion, it is suggested that enhanced proteolytic activity of lysosomal acid proteases in papillary carcinoma is probably a result of disturbance in catabolic degradation of the thyroglobulin molecule in malignantly transformed thyroid tissue.

Occult papillary carcinoma of the thyroid gland revealed by cancer pericarditis.

We report a case of hemorrhagic exudative pericarditis in a 41-year-old man which was found to be due to metastatic dissemination of a 4 mm sclerosing carcinoma of the thyroid. Many psammoma bodies were found in the pericardial specimens and malignant cells with folliculoid pattern were observed in the pleural biopsy, arousing suspicion of occult papillary thyroid carcinoma. In the thyroid gland after total thyroidectomy a 4 mm sclerosing carcinoma was found.

Adrenal cysts in the newborn.

We report on 2 newborns with adrenal cysts who were treated successfully with an operation. One patient had been well after birth with no adrenal insufficiency. However, 2 large and 2 small cysts were found, all of which were attached to the adrenal gland without a clear vascular stalk. The other patient had adrenal cortical insufficiency. His mother had had gestational diabetes and hypertension during pregnancy. The adrenal cyst was partially resected. Both patients were in good condition 5 years postoperatively.