[Diagnostic relevance of fine needle aspiration cytology in nodular thyroid lesions].

BACKGROUND/AIM: Fine needle aspiration cytology (FNAC) of the thyroid gland has been used as an initial investigative procedure of thyroid nodule(s) in the Department of Pathology at the Institute of Oncology of Vojvodina for more than 20 years. This procedure is rapid, inexpensive and technologically simple, yet it has found only limited, albeit increasing acceptance in medical practice in Serbia. The aim of the study was to evaluate our FNAC findings by correlating cytological results with histological diagnosis and to define the sensitivity, diagnostic accuracy and positive predictive value of FNAC. METHODS: A total of 266 patients with thyroid swellings were aspirated in one year investigated period at our Institute out of whom 69 underwent surgery between May 2008 and May 2009. The cytological results correlated with clinical features, ultrasound investigations (US) and subsequent histopathological examination of the resected tissue. RESULTS: By the use of cytology we found out thyroid carcinoma in 10 patients, and by histopathological examination in 12. We obtained 83% sensitivity, 100% specificity and 97% of diagnostic accuracy of FNAC. CONCLUSION: The obtained results confirm the importance of FNAC in preoperative assesment of thyroid nodule.

Colorectal carcinoma under microscopy: patohistology or much more?

Today the role of pathologists is increasingly focused on finding more accurate prognostic and predictive parameters that will be necessary for targeted treatment of patients. Improving understanding of colorectal carcinogenesis allow us to consider incorporation of these new knowledges in molecular classification of colorectal cancer. There are different ways of molecular classification, but most of them are based on: 1. type of genetic instability; 2. methylator phenotype and 3. single molecular events such are KRAS and BRAF mutations. This review considers a new molecular classification of colorectal carcinoma proposed by J. Jass in 2007 which is based on the correlation of molecular and morphological features. We would also like to point out to the new role of pathologists in the era of personalized medicine in diagnosis and prognosis of colorectal carcinomas as well as in selection of patients for some modalities of targeted therapy.

Chronic necrotizing pulmonary aspergillosis.

INTRODUCTION: Chronic necrotizing pulmonary aspergillosis (CNPA) is a cavitary, infectious process of lung parenchyma with slow progressive course. Vascular invasion and dissemination to other organs are unusual. CASE REPORT: We presented a 25-year old man with bilineal acute leukaemia who developed pulmonary and systemic symptoms. Chest CT showed nodular consolidations and cavitary lesions in both lungs. Bronchial biopsy revealed necrotic hyphae but it was negative for Aspergillus by culture. Serum was positive for antibodies to Aspergillus, but it was negative for antigens. A thoracoscopic lung biopsy of the upper left lobe revealed necrosis of lung tissue, with acute and chronic inflammation of the cavity wall and the presence of hyphae consistent with Aspergillus species. CONCLUSION: Although confirmation of the diagnosis is difficult, a combination of characteristic clinical, radiological and histological findings and either serological results positive for Aspergillus or the isolation of Aspergillus from respiratory samples are highly indicative of CNPA.

[Cavernous hemangioma of the lung].

INTRODUCTION: Cavernous hemangiomas are benign vascular tumours rarely described in the lungs. Symptoms include respiratory distress, cardiac failure and massive haemoptysis, but they are mostly asymptomatic. CASE REPORT: A 67-year-old woman was referred to our institute and treated for pneumonia. A computed tomography scan of the thorax showed an infiltrative mass about 46mm in its greatest dimension in the right upper lobe. The mass was in contact with the mediastinal pleura. Since bronchial biopsy and FNAC did not reveal the aetiology of the lesion, the video-assisted thoracic surgery with right anterolateral thoracotomy and enucleation was performed. The intraoperative and postoperative pathohistological study showed cavernous hemangioma and this diagnosis was confirmed on immunohistochemical staining. CONCLUSION: In spite of its benign behaviour and mostly asymptomatic clinical course it is necessary to consider cavernous hemangioma in the differential diagnosis of other pulmonary lesions. The definitive diagnosis can be made only by histopathological and immunohistochemical examination.

Pulmonary capillariasis miming bronchial carcinoma.

Pulmonary capillariasis is a zoonotic disease caused by the cosmopolitan nematode Capillaria aerophila, which circulates among wild carnivorous and omnivorous mammals. Only 11 cases have been documented to date. We describe a cryptic case of pulmonary capillariasis in a Serbian woman that resembled a bronchial carcinoma.

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.

[Pulmonary thromboembolism and acute renal insufficiency caused by renal artery thrombosis]. / Plucna tromboembolija udruzena sa akutnom renalnom insuficijencijom, nastalom zbog tromboze renalnih arterija.

INTRODUCTION: Pulmonary thromboembolism is a clinical and pathophysiological condition caused by occlusion of pulmonary arteries by thrombotic embolus. Deep venous thrombosis needn't necessarily be evident. Acute renal insufficiency is a syndrome manifested by rapid decrease or even complete urinary retention, which may be due to obturation of renal arteries by a thrombus. The condition is clinically manifested by hematuria, oliguria, anuria and death due to uremia. CASE REPORT: The patient had a history of disease and a chest X-ray finding both irrelevant for establishing the working diagnosis. Blood gas analysis presented prominent hypoxemia with hyperventilation and ECG finding exhibited right heart overload, pointing to pulmonary thromboembolism. On the third day of treatment with heparin, the patient developed hematuria, oliguria and excessive elevation of nitrogen in blood as a sign of acute renal insufficiency, leading to fatal outcome. Autopsy revealed deep venous thrombosis of the left femoral vein, with massive pulmonary thromboembolism and thrombosis of both femoral arteries, inducing acute renal failure. DISCUSSION: Although the patient had a typical radiologic presentation of pulmonary thromboembolism, treatment with heparin was initiated on the basis of his blood gas analysis and ECG findings. Deep venous thrombosis was not clinically evident and acute renal failure could not be explained during patient's lifetime. CONCLUSION: This is a rare case of acute renal failure due to a rare occurrence of bilateral acute thrombosis of renal arteries.