Introduction/Objective. New World Health Organization Classification of Head and Neck Tumors from... more Introduction/Objective. New World Health Organization Classification of Head and Neck Tumors from 2017 has introduced significant changes, mainly considering tumors in the oropharyngeal region. New entities of HPV-positive and -negative squamous cell carcinomas have been acknowledged, not only based on the presence of an active viral infection and different tumor markers expression, but also because of their different histopathology, staging assessment, and prognosis. A retrospective study has been conducted, in order to determine p16 positivity in squamous cell carcinomas in oropharynx and in the oral cavity, and to see whether they differ in sex and age distribution. Methods. The presence of viral infection was verified based on p16 immunochemistry staining, p16 being the surrogate marker for HPV infection. A total of 177 cases of squamous cell carcinomas in the oropharynx and the oral cavity, found in the archives of the Histopathology Laboratory of the Clinic for Otorhinolaryngo...
ABSTRACT Combined antiretroviral therapy (cART) consisting of two nucleoside reverse transcriptas... more ABSTRACT Combined antiretroviral therapy (cART) consisting of two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI), such as efavirenz, is still the first-line treatment in resource-limited settings. However, efavirenz has shown strong prominence of disadvantages with variance in plasma concentration and central nervous side effects. Our study presents HIV infected, drug naïve, female patient with relatively low BMI, CYP2B6 516G>T (rs3745274) genotype with high efavirenz plasma concentration. In this case report, the patient was admitted at the hospital 6 months after cART initiation with drug-induced severe hepatotoxicity. Furthermore, pathophysiological findings proved confluent parenchymal necrosis after aspiration liver biopsy, with mild to moderate inflammation in portal tracts with focal interface hepatitis. All other possible causes were excluded. Thus, we conclude that efavirenz has a potential harmful effect in patients with low BMI, specific genotyping and interindividual pharmacokinetics affecting high plasma concentration.
Intrahepatic cholestasis of pregnancy (ICP) is a gestation-specific liver disorder, defined most ... more Intrahepatic cholestasis of pregnancy (ICP) is a gestation-specific liver disorder, defined most often as the onset of pruritus, usually from the third trimester of pregnancy, associated with abnormal liver test results and/or increased total serum bile acids and spontaneous relief after delivery. The 21-year-old patient was admitted to our ward in the 11th week of pregnancy due to raised liver enzymes. The first onset of pruritus and jaundice appeared a month before hospitalization. Immunology tests and Toxoplasma gondii were negative. We excluded viral etiology, while alpha-1-antitrypsin, serum and urine copper levels, and thyroid hormones were within the reference values. The patient denied she had taken any medicines and herbal preparations before and during pregnancy. Total bile acids in the serum were significantly elevated (242 μmol/L). The abdominal ultrasound revealed a regular finding. Liver biopsy suggested a cholestatic liver disorder. After a presentation of all risks, ...
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
The purpose of this study was to examine whether cytomegalovirus (CMV) is present in different hi... more The purpose of this study was to examine whether cytomegalovirus (CMV) is present in different histological types of salivary gland cancer (SGC) by detecting CMV immediate-early (IE) and early gene products, and to determine the presence of its association with the overexpression of interleukin (IL)-6. Immunohistochemical analysis of 92 cases of different histological types of SGC was performed to determine the presence of IL-6 and CMV antigen and its intensity in tumor tissue. Twenty samples of normal salivary gland tissue obtained during autopsy served as healthy controls. CMV antigens were not found in healthy acinar tissue of salivary glands, but were expressed in epithelium of salivary gland ducts. Negative expression of CMV antigens was also found in salivary gland tissue surrounding tumors. On the other hand, CMV was detected in 65/92 SGC cases (70.6%). Higher expression of IL-6 was found in SGC (70.7%) than in normal tissue (20%). There was a high association of CMV antigen ...
A 35-year-old woman presented with a 5-month history of lower abdominal pain and bloody stools. I... more A 35-year-old woman presented with a 5-month history of lower abdominal pain and bloody stools. In 2001, the patient had been diagnosed with multicentric reticulohistiocytosis (MRH) after a biopsy of papulonodular skin lesions on the distal interphalangeal joints (a,b). Since the onset of the disease, the patient has been treated with prednisolone (20 mg/day) and methotrexate (25 mg every 15 days), which was discontinued in the last two years. Stool tests for Salmonella, Shigella, Escherichia coli, and Clostridium difficile toxins were negative. A colonoscopy revealed superficial ulceration, edema, and diffuse mucosal inflammation in the left colon (c). A biopsy specimen stained with hematoxylin and eosin showed features of chronic colitis: inflammatory cell infiltrate, erosion of surface epithelium with cryptitis and crypt abscess, crypt branching, and depletion of mucin (d). To our knowledge this is the first report of MRH and chronic colitis coexisting or of MRH affecting the colon, causing inflammatory disease, most likely ulcerative colitis. (Informed consent was obtained from the patient to publish these images.)
Introduction. Intraosseous vascular malformation could be life-threatening due to uncontrolled he... more Introduction. Intraosseous vascular malformation could be life-threatening due to uncontrolled hemorrhage after tooth extraction. According to biological behavior of this lesion, adequate diagnostic and treatment strategies are necessary in order to avoid possible complications. We reported cone beam computed tomography (CBCT) planning of an urgent en bloc resection of an intraosseous venous malformation by piezoelectric knife. Case report. A 55-year-old man was submitted to CBCT planning followed by piezoelectric knife resection of an intraosseous focal venous malformation of the mandibular body. Immediate reconstruction of the defect using iliac bone free graft was performed. The surgical treatment was uneventful and a 2-year follow-up revealed no signs of recurrence. Conclusion. Piezoelectric knife could provide precise, safe and bloodless procedure which is especially important in this pathology. Advantages of this technique are: lower risk of damaging soft tissue structures, pr...
Hepatocellular carcinoma is the most common type of primary liver cancer. It metastasizes via blo... more Hepatocellular carcinoma is the most common type of primary liver cancer. It metastasizes via blood or through lymphatic dissemination, most comonly to the lungs, abdominal lymph nodes, and bones. Metastases to the bones of the head and neck region, however, are extremely uncommon. A 70-year-old male was presented with a mass in the left zygomatic region. After the incisional biopsy, the histopathologic and immunohistochemical analysis confirmed a metastasis of hepatocellular carcinoma. An abdominal computerized tomography (CT) scan revealed a large primary tumor in the right liver lobe. To the best of our knowledge, this is the second case of an isolated zygomatic metastasis as an initial presentation of hepatocellular carcinoma. We also reviewed the literature regarding clinical and histopathologic characteristics of hepatocellular carcinoma that produced metastases to the zygomatic bone and the maxilla.
Clinical manifestations, required additional diagnostic techiques, treatment, complications and d... more Clinical manifestations, required additional diagnostic techiques, treatment, complications and diagnostic pitfalls of tuberculous otitis media are presented and discussed along with published literature. Because tuberculosis is such an uncommon cause of chronic infection in the middle ear and mastoid the index of suspicion is low and the diagnosis is quite difficult. In order to avoid delayed diagnosis and irreversible complications, it is always necessary to think about tuberculosis in cases that present with chronic painless otitis media, perforated tympanic membrane and facial nerve palsy.
Journal of gastrointestinal and liver diseases : JGLD, 2009
There is positive correlation between the number of activated hepatic stellate cells and necroinf... more There is positive correlation between the number of activated hepatic stellate cells and necroinflammatory activity and/or the stage of liver fibrosis in viral hepatitis. No study has investigated such a relationship with regard to the activated hepatic cells within specified zones of liver tissue in chronic C hepatitis. The aim of the present study was to correlate the level of activated hepatic stellate cells within perivenular, intermediate, periportal, and portal tracts area and fibrous septa with stages of liver fibrosis and necroinflammatory activity in patients with chronic C hepatitis. This retrospective study included 20 liver biopsy samples from patients with chronic C hepatitis and 10 normal liver biopsies. Biopsy specimens were processed routinely and stained with haematoxylin-eosin, periodic acid-Schiff, Masson;s trichrome, aldechide fuchsin, reticulin and iron (Pearls). Activated hepatic stellate cells were identified immunohistochemically using antibody to alpha-smoot...
Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is a benign vascular tumor, ... more Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is a benign vascular tumor, most commonly arising on the skin and the oral mucosa. Gastrointestinal localization of PG, except for the oral cavity, is exceptionally rare. We describe a case of ileal PG occurring in a 13-year-old girl, presenting with intestinal obstruction. Histological examination revealed proliferation of capillary-sized vessels, with prominent intravascular component, involving the entire thickness of the intestinal wall. Immunohistochemistry showed positivity for CD31, CD34 and von Willebrand factor, whereas immunostaining for glucose transporter-1 protein (GLUT1) and for human herpes virus 8 (HHV-8) was negative. We suggest that PG should be considered in the differential diagnosis of childhood gastrointestinal polypoid lesions.
Journal of gastrointestinal and liver diseases : JGLD, 2008
Quality of life may be reduced in patients with chronic liver diseases. The purpose of this study... more Quality of life may be reduced in patients with chronic liver diseases. The purpose of this study was to assess the impact of chronic viral liver disease on health-related quality of life (HRQOL). Quality of life was prospectively investigated in 227 patients with chronic viral liver disease and 75 controls. The generic Short Form 12 questionnaire was applied to measure the HRQOL: Mental and physical component scores were expressed as numeric and categorical values (presence/absence of disability). The electronic database (SPSS for Windows) was used for statistical analysis with 95% confidence intervals. Mental and physical numeric and categorical scores for the absence of disability were significantly worse in patients compared with controls. Patients were a negative predictive factor for the absence of disability on both mental and physical components while the physical component was the significant factor in multivariate regression analysis (p =0.000). There was no difference in ...
Introduction/Objective. New World Health Organization Classification of Head and Neck Tumors from... more Introduction/Objective. New World Health Organization Classification of Head and Neck Tumors from 2017 has introduced significant changes, mainly considering tumors in the oropharyngeal region. New entities of HPV-positive and -negative squamous cell carcinomas have been acknowledged, not only based on the presence of an active viral infection and different tumor markers expression, but also because of their different histopathology, staging assessment, and prognosis. A retrospective study has been conducted, in order to determine p16 positivity in squamous cell carcinomas in oropharynx and in the oral cavity, and to see whether they differ in sex and age distribution. Methods. The presence of viral infection was verified based on p16 immunochemistry staining, p16 being the surrogate marker for HPV infection. A total of 177 cases of squamous cell carcinomas in the oropharynx and the oral cavity, found in the archives of the Histopathology Laboratory of the Clinic for Otorhinolaryngo...
ABSTRACT Combined antiretroviral therapy (cART) consisting of two nucleoside reverse transcriptas... more ABSTRACT Combined antiretroviral therapy (cART) consisting of two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI), such as efavirenz, is still the first-line treatment in resource-limited settings. However, efavirenz has shown strong prominence of disadvantages with variance in plasma concentration and central nervous side effects. Our study presents HIV infected, drug naïve, female patient with relatively low BMI, CYP2B6 516G>T (rs3745274) genotype with high efavirenz plasma concentration. In this case report, the patient was admitted at the hospital 6 months after cART initiation with drug-induced severe hepatotoxicity. Furthermore, pathophysiological findings proved confluent parenchymal necrosis after aspiration liver biopsy, with mild to moderate inflammation in portal tracts with focal interface hepatitis. All other possible causes were excluded. Thus, we conclude that efavirenz has a potential harmful effect in patients with low BMI, specific genotyping and interindividual pharmacokinetics affecting high plasma concentration.
Intrahepatic cholestasis of pregnancy (ICP) is a gestation-specific liver disorder, defined most ... more Intrahepatic cholestasis of pregnancy (ICP) is a gestation-specific liver disorder, defined most often as the onset of pruritus, usually from the third trimester of pregnancy, associated with abnormal liver test results and/or increased total serum bile acids and spontaneous relief after delivery. The 21-year-old patient was admitted to our ward in the 11th week of pregnancy due to raised liver enzymes. The first onset of pruritus and jaundice appeared a month before hospitalization. Immunology tests and Toxoplasma gondii were negative. We excluded viral etiology, while alpha-1-antitrypsin, serum and urine copper levels, and thyroid hormones were within the reference values. The patient denied she had taken any medicines and herbal preparations before and during pregnancy. Total bile acids in the serum were significantly elevated (242 μmol/L). The abdominal ultrasound revealed a regular finding. Liver biopsy suggested a cholestatic liver disorder. After a presentation of all risks, ...
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
The purpose of this study was to examine whether cytomegalovirus (CMV) is present in different hi... more The purpose of this study was to examine whether cytomegalovirus (CMV) is present in different histological types of salivary gland cancer (SGC) by detecting CMV immediate-early (IE) and early gene products, and to determine the presence of its association with the overexpression of interleukin (IL)-6. Immunohistochemical analysis of 92 cases of different histological types of SGC was performed to determine the presence of IL-6 and CMV antigen and its intensity in tumor tissue. Twenty samples of normal salivary gland tissue obtained during autopsy served as healthy controls. CMV antigens were not found in healthy acinar tissue of salivary glands, but were expressed in epithelium of salivary gland ducts. Negative expression of CMV antigens was also found in salivary gland tissue surrounding tumors. On the other hand, CMV was detected in 65/92 SGC cases (70.6%). Higher expression of IL-6 was found in SGC (70.7%) than in normal tissue (20%). There was a high association of CMV antigen ...
A 35-year-old woman presented with a 5-month history of lower abdominal pain and bloody stools. I... more A 35-year-old woman presented with a 5-month history of lower abdominal pain and bloody stools. In 2001, the patient had been diagnosed with multicentric reticulohistiocytosis (MRH) after a biopsy of papulonodular skin lesions on the distal interphalangeal joints (a,b). Since the onset of the disease, the patient has been treated with prednisolone (20 mg/day) and methotrexate (25 mg every 15 days), which was discontinued in the last two years. Stool tests for Salmonella, Shigella, Escherichia coli, and Clostridium difficile toxins were negative. A colonoscopy revealed superficial ulceration, edema, and diffuse mucosal inflammation in the left colon (c). A biopsy specimen stained with hematoxylin and eosin showed features of chronic colitis: inflammatory cell infiltrate, erosion of surface epithelium with cryptitis and crypt abscess, crypt branching, and depletion of mucin (d). To our knowledge this is the first report of MRH and chronic colitis coexisting or of MRH affecting the colon, causing inflammatory disease, most likely ulcerative colitis. (Informed consent was obtained from the patient to publish these images.)
Introduction. Intraosseous vascular malformation could be life-threatening due to uncontrolled he... more Introduction. Intraosseous vascular malformation could be life-threatening due to uncontrolled hemorrhage after tooth extraction. According to biological behavior of this lesion, adequate diagnostic and treatment strategies are necessary in order to avoid possible complications. We reported cone beam computed tomography (CBCT) planning of an urgent en bloc resection of an intraosseous venous malformation by piezoelectric knife. Case report. A 55-year-old man was submitted to CBCT planning followed by piezoelectric knife resection of an intraosseous focal venous malformation of the mandibular body. Immediate reconstruction of the defect using iliac bone free graft was performed. The surgical treatment was uneventful and a 2-year follow-up revealed no signs of recurrence. Conclusion. Piezoelectric knife could provide precise, safe and bloodless procedure which is especially important in this pathology. Advantages of this technique are: lower risk of damaging soft tissue structures, pr...
Hepatocellular carcinoma is the most common type of primary liver cancer. It metastasizes via blo... more Hepatocellular carcinoma is the most common type of primary liver cancer. It metastasizes via blood or through lymphatic dissemination, most comonly to the lungs, abdominal lymph nodes, and bones. Metastases to the bones of the head and neck region, however, are extremely uncommon. A 70-year-old male was presented with a mass in the left zygomatic region. After the incisional biopsy, the histopathologic and immunohistochemical analysis confirmed a metastasis of hepatocellular carcinoma. An abdominal computerized tomography (CT) scan revealed a large primary tumor in the right liver lobe. To the best of our knowledge, this is the second case of an isolated zygomatic metastasis as an initial presentation of hepatocellular carcinoma. We also reviewed the literature regarding clinical and histopathologic characteristics of hepatocellular carcinoma that produced metastases to the zygomatic bone and the maxilla.
Clinical manifestations, required additional diagnostic techiques, treatment, complications and d... more Clinical manifestations, required additional diagnostic techiques, treatment, complications and diagnostic pitfalls of tuberculous otitis media are presented and discussed along with published literature. Because tuberculosis is such an uncommon cause of chronic infection in the middle ear and mastoid the index of suspicion is low and the diagnosis is quite difficult. In order to avoid delayed diagnosis and irreversible complications, it is always necessary to think about tuberculosis in cases that present with chronic painless otitis media, perforated tympanic membrane and facial nerve palsy.
Journal of gastrointestinal and liver diseases : JGLD, 2009
There is positive correlation between the number of activated hepatic stellate cells and necroinf... more There is positive correlation between the number of activated hepatic stellate cells and necroinflammatory activity and/or the stage of liver fibrosis in viral hepatitis. No study has investigated such a relationship with regard to the activated hepatic cells within specified zones of liver tissue in chronic C hepatitis. The aim of the present study was to correlate the level of activated hepatic stellate cells within perivenular, intermediate, periportal, and portal tracts area and fibrous septa with stages of liver fibrosis and necroinflammatory activity in patients with chronic C hepatitis. This retrospective study included 20 liver biopsy samples from patients with chronic C hepatitis and 10 normal liver biopsies. Biopsy specimens were processed routinely and stained with haematoxylin-eosin, periodic acid-Schiff, Masson;s trichrome, aldechide fuchsin, reticulin and iron (Pearls). Activated hepatic stellate cells were identified immunohistochemically using antibody to alpha-smoot...
Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is a benign vascular tumor, ... more Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is a benign vascular tumor, most commonly arising on the skin and the oral mucosa. Gastrointestinal localization of PG, except for the oral cavity, is exceptionally rare. We describe a case of ileal PG occurring in a 13-year-old girl, presenting with intestinal obstruction. Histological examination revealed proliferation of capillary-sized vessels, with prominent intravascular component, involving the entire thickness of the intestinal wall. Immunohistochemistry showed positivity for CD31, CD34 and von Willebrand factor, whereas immunostaining for glucose transporter-1 protein (GLUT1) and for human herpes virus 8 (HHV-8) was negative. We suggest that PG should be considered in the differential diagnosis of childhood gastrointestinal polypoid lesions.
Journal of gastrointestinal and liver diseases : JGLD, 2008
Quality of life may be reduced in patients with chronic liver diseases. The purpose of this study... more Quality of life may be reduced in patients with chronic liver diseases. The purpose of this study was to assess the impact of chronic viral liver disease on health-related quality of life (HRQOL). Quality of life was prospectively investigated in 227 patients with chronic viral liver disease and 75 controls. The generic Short Form 12 questionnaire was applied to measure the HRQOL: Mental and physical component scores were expressed as numeric and categorical values (presence/absence of disability). The electronic database (SPSS for Windows) was used for statistical analysis with 95% confidence intervals. Mental and physical numeric and categorical scores for the absence of disability were significantly worse in patients compared with controls. Patients were a negative predictive factor for the absence of disability on both mental and physical components while the physical component was the significant factor in multivariate regression analysis (p =0.000). There was no difference in ...
Uploads