[Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease)]. / Histiocitni nekrotizirajuci limfadenitis (Kikuchi-Fujimotova bolest).

INTRODUCTION: Histiocytic necrotizing lymphadenitis is a disease of unknown etiology, favourable course and outcome, mostly encountered in young women. It exhibits increased temperature and lymphadenopathy. The illness resolved spontaneously after a few months. A CASE REVIEW: In a 32-year-old patient the disease developed gradually, with pain in the right axilla, within enlarged lymph. Two weeks later, her temperature increased to 39 degrees C, accompanied by fever, shivering, malaise and loss of appetite. The ultrasonographic finding showed a conglomerate of hypoechogenic lymph nodes, with a few enlarged lymph glands. By immunohistochemical examination of a gland tissue sample the diagnosis was established Kikuchi-Fujimoto disease ("Histiocytica necrotizing lymphadenitis"--"Apoptotic lymphadenitis"). Corticosteroid therapy had been administered for one year, which resulted in both subjective improvement and regression of enlarged lymph nodes. DISCUSSION: A connection between this disease and viruses has not been proved. Presence of intracellular tubuloreticular formations suggests autoimmune etiology of histiocytic necrotizing lymphadenitis. It is considered as hyperimmune reaction of the organism induced by a viral infection. Differential diagnosis should consider taxoplasmosis, tuberculosis, lymphadenitis and malignant lymphoma. CONCLUSION: Although histiocytic necrotizing lymphadenitis is a rare disease, this case shows that it should be considered when lymphadenopathy, particularly cervical, occurs in young women, accompanied by increased temperature.

[Postpolycythemic myeloid metaplasia in patients with polycythemia vera]. / Postpolicitemijska mijeloidna metaplazija u bolesnika s pravom policitemijom.

This study group comprised 58 patients with polycythemia vera. A retrospective study included 23/58 (39.60%) patients treated from 1968 to 1987, while a prospective study included 35/58 (60.34%) patients. Over the period 1986.-1996., 19/58 (32.76%) patients died: 10/23 (43.48%) from the retrospective group where mean disease duration was 12.7 years (6-24), and 9/35 (25.71%) from the prospective group where mean disease duration was 2.22 years (1-4). Erythrocytic phase of the disease was established in 50/58 (86.21%) patients; in 2/58 (3.45%) patients phase of spent hematopoiesis and postpolycythemic myeloid metaplasia in 6/58 (10.34%) patients. Postpolycythemic myeloid metaplasia has occurred after a mean time of 10.33 years (6-15) from establishing the first polycythemia. Two patients (10.53%) with postpolycythemic myeloid metaplasia died, one immediately after the diagnosis was established, the other patient two years after establishing the diagnosis. 16/19 (84.21%) patients died during the erythrocytic phase of the polycythemia vera, while 1/19 (5.26%) patient died in the phase of spent hematopoiesis. In regard to alive patients postpolycythemia myeloid metaplasia has been established in 4/39 (10.26%) patients, the phase of spent hematopoiesis in 1/39 (2.56%), while 34/39 (87.18%) patients are in the erythrocytic phase.

[Mesenchymoma--diagnostic dilemmas]. / Mezenhimom--dijagnosticke dileme.

This is a case report on retroperitoneal localization of a tumor formed of mixed-chondromatous tissue, bone tissue, fatty tissue and connective tissue together with angiomatous areas with blood vessels having unevenly thickened walls, being histopathologically diagnosed as a mesenchymoma. Apart from presenting the tumor, this paper deals with diagnostic dilemmas in cases of mixed tumors of mesenchymal origin because of numerous disagreements in literature data on morphologic characteristics, biological behavior and diverse nomenclature.

[Standards and criteria in histologic intraoperative diagnosis in the lymph nodes]. / Standardi i kriterijumi intraoperativne histoloske dijagnostike limfnog cvora.

Using frozen sections and classic paraffin sections of the lymph nodes, comparative diagnostic analysis was done in the patients with differently localized malignant tumours. The analysis was based on 86 patients with malignant tumours mostly localized in the maxillofacial region. The frozen sections diagnoses are divided into "metastasing carcinoma in the lymph node", "reactive lymphadenitis", "malignant", "benign", "malignant lymphoma" and "normal lymph node". Diagnostic reproducibility on the level of 90% cases using classic sections was estimated. Negative results in 10% were discussed and some recommendations for improvement of the 9:1 relation were done.

[Prognostic significance of cytologic and histomorphologic changes in bone marrow in the treatment of patients with chronic lymphocytic leukemia]. / Prognozni znacaj citoloskih i histomorfoloskih promena kosne srzi u lecenih bolesnika obolelih od hronicne limfocitne leukemije.

In the aim of establishing the prognosis of chronic lymphocytic leukemia (HLL) in relation to the severeness and course of the disease, during the course of treatment of the patients, two parameters were followed prior to therapy and one year following conducted therapy regarding the morphological changes of lymphocytes in bone marrow specimens and peripheral blood samples and the type of cell infiltration in the bone marrow by means of histomorphological examination. The obtained results point to the fact that progression of illness can be expected also in those patients who are in a milder clinical stadium (stadium A), in the cases when we find more than 20% of atypical lymphocyte forms (prolymphocytes and forms with nucleus aberrations) in the peripheral blood and in the bone marrow, as well as in the cases with a diffuse type of bone marrow infiltration. Such forms should be checked more often. At the same time application of therapy is suggested right after the diagnosis is set, even though the patient may be in the early clinical stadium of the disease, as well as the decision about aggressive treatment.

[The present approach to the morphologic analysis of lymph nodes draining a tumor area]. / Savremeni pristup morfoloskoj analizi limfnih cvorova koji dreniraju podrucje tumora.

The paper reviews the results of an extensive morphological analysis of 49 lymph nodes draining the area of histologically evidenced tumor on the basis of immunomorphological changes by the quantitative and semiquantitative methods. Reactive changes in different topographic zones being a morphological manifestation of the immune response to the presence of tumor depend on the type and localization of the tumor. Sinus histiocytosis is the most significant morphological reaction in the analyzed draining nodes. The intensity of sinus histiocytosis could, by itself, represent an important factor in a morphological recognition of the lymph node draining the tumor area.

[Evolution of chronic lymphocytic thyroiditis in primary malignant lymphoma in an extranodal location]. / Evolucija hronicnog limfocitnog tireoiditisa u primarni maligni limfom ekstranodalne lokalizacije.

Primary malignant lymphoma of extranodal localization is a rare disease which mainly occurs in organs with greater or less quantity of lymphocytic tissue or in the organs with the previous history of lymphocytic infiltrate. Extranodal localization of malignant lymphoma in the thyroid gland is rare and numerous authors associate it with the previous existence of chronic lymphocatic thyroiditis (Hashimoto struma). This paper dealt with the histologically analysed material obtained by subtotal or total thyreoidectomy over one-year period. Out of 49 cases, histologic diagnosis of chronic diffuse lymphocytic thyroiditis was established in nine patients (18%) but the frequency of the appearance of this autoimmune disease may well be grater because a relatively small number of patients underwent the operation. Apart from all morphologic characteristics of Hashimoto struma, primary malignant lymphoma of extranodal localization in the thyroid gland was diagnosed in one patient. Simultaneous or previous evolution of chronic lymphocyttic thyroiditis into malignant lymphoma was confirmed in the papers of numerous authors. The authors presented a patient aged 58 in whom malignant lymphoma had evolved from the chronic diffuse lymphocytic thyroiditis. Cellular characteristics pointed to lymphoma of transformed cells being extended extrathyroidically into the surrounding connecting and muscular tissue with the involvement of regional lymph glands. Of particular importance was the area in which the usual architectonics of lymphocytic thyroiditis was discretely ruined and the infiltrate received neoplastic characteristics. On the basis of data from literature, lymphocytic thyroiditis should be regarded as a prelymphomatous state which was attached a great importance from the aspect of histopathologic analysis. Beside the operation, conservative therapy was employed and it showed good results until now, although it was too early to make decisive conclusions on the outcome of disease.