[show abstract][hide abstract] ABSTRACT: To assess the frequency and forms of pulmonary tuberculosis at autopsy in a high-traffic hospital in the capital city of a country with a low tuberculosis incidence.
We performed a retrospective search of autopsy data from the period 2000 to 2009 at Sestre Milosrdnice University Hospital Center, Zagreb, Croatia. We also examined patients' records and histological slides.
Of 3479 autopsies, we identified 61 tuberculosis cases, corresponding to a frequency of 1.8%. Active tuberculosis was found in 33 cases (54%), 23 of which (70%) were male. Of the 33 active cases, 25 (76%) were clinically unrecognized and 19 (76%) of these were male.
Clinically undiagnosed tuberculosis accounted for a substantial proportion of active tuberculosis cases diagnosed at autopsy. Autopsy data may be an important complement to epidemiological data on tuberculosis frequency.
Croatian Medical Journal 02/2012; 53(1):48-52. · 1.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: Aim To assess the frequency and forms of pulmonary tu-berculosis at autopsy in a high-traffic hospital in the capital city of a country with a low tuberculosis incidence. Methods We performed a retrospective search of autopsy data from the period 2000 to 2009 at Sestre Milosrdnice University Hospital Center, Zagreb, Croatia. We also exam-ined patients' records and histological slides. Results Of 3479 autopsies, we identified 61 tuberculosis cases, corresponding to a frequency of 1.8%. Active tu-berculosis was found in 33 cases (54%), 23 of which (70%) were male. Of the 33 active cases, 25 (76%) were clinically unrecognized and 19 (76%) of these were male. Conclusion Clinically undiagnosed tuberculosis account-ed for a substantial proportion of active tuberculosis cases diagnosed at autopsy. Autopsy data may be an important complement to epidemiological data on tuberculosis fre-quency.
Croatian Medical Journal 01/2012; · 1.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: Micropapillary urothelial carcinoma (MPUC) is a rare aggressive variant of urothelial carcinoma, associated with advanced tumor stage, high tendency to invade lymphovascular spaces, and metastasize to lymph nodes and other organs. Therefore, it has a poor prognosis. One of the most prominent histological features is the presence of small, round empty spaces surrounding infiltrating tumor nests. If detected, even a small focus of micropapillary pattern may be therapeutically significant; the higher proportion of micropapillary component, the worse the prognosis. Radical nephroureterectomy is the treatment of choice even in the setting of superficially invasive disease. Although, MPUC has been well studied in urinary bladder, only a few cases of MPUC in upper urinary tract have been described. We are describing a case of a 79-year old woman with micropapillary urothelial carcinoma involving ureter and review the literature of this rare entity.
[show abstract][hide abstract] ABSTRACT: Cutaneous osteoma (CO) is a rare entity with only scattered cases reported in the literature. Cutaneous ossifications is divided into primary and secondary CO. Secondary CO account for 85% of cutaneous ossifications and develop within preexisting neoplastic or inflammatory skin lesions. Primary CO account for about 15% of cutaneous ossifications and develops on its own.
A 7-month-old child, born as second trigeminus by cesarean section after IVF pregnancy presented with incidental finding of multiple firm, nontender, subcutaneous pale-brownish papules scattered on the skin of the lower abdomen, arms and legs, measuring up to 7mm. Changes were unremarkable in neonatal period. Changes became visible by the end of fourth month of life. History specified no trauma, inflammatory changes, nevi, dermatological or other significant medical conditions. Family history for CO or other associated diseases was negative. First punch biopsy (3mm) obtained from the lower abdomen showed unremarkable epidermis but dermis underneath showed well circumscribed spicules of mature lamellar bone entrapped mature adipose tissue without hematopoietic elements. Pathologist indicated CO. One month later, second 2-mm punch biopsy obtained from left lower extremity confirmed CO indicated in first biopsy. Laboratory revealed an elevated thyrotropin (TSH) up to 8.79 mIJ/L (reference range; 0.4-4.0 mIJ/L) and parathyroid hormone (PTH) up to 88 (reference range; 15 -65 pg/ml). Other tests regarding thyroide hormon, calcium and phosphorous levels were unremarkable.
Final pathology report of CO found in biopsies suggested three possibilities: Albright’s hereditary osteodystrophy (AHO); Gardner syndrome and progressive osseous heteroplasia. CO as primary form can occur de novo in form of multiple miliary osteomas, widespread osteoma or plaque-like presenting as a single lesion, both found in neonatal period. All previous mentioned osteoma changes have a good prognosis. Unlike previously mentioned states with CO, AHO-psuedohypoparathyroidism type 1a has poor long term prognosis where it except CO manifests with obesity, developmental disability, short stature, round face, ganglia calcification.
In our case; laboratory findings supported by histology suggested the AHO syndrome, although according an infant stage of patient phenotype associated symptoms of disease were not present yet. Further follow up is needed. The initially mild cutaneous manifestations may herald a more progressive ossification disorder thus could be associated with multiple endocrine hormone resistance enhanced with neurobehavioral and developmental problems. The treatment of present underlying disease is the first step. If patient is symptomatic, surgical excision, including punch excisions, is currently the treatment of choice for CO.
22nd Ljudevit Jurak International Symposium on Comparative Pathology, Zagreb 2011; 01/2011
[show abstract][hide abstract] ABSTRACT: Micropapillary urothelial carcinoma (MUC) is a rare variant of urinary bladder carcinoma associated with highly aggressive behaviour. The aim of this study was to analyse clinicopathological features of MUC particularly a relationship between pathological stage at presentation and proportion of micropapillary component (MPC) in 10 patients with MUC. In the examined period (January 1st 2004 - June 30th, 2007) there were 610 patients with urinary bladder cancer (M:F = 456:154), while 10 (1.6%) of them were patients with MUC. All MUC were invasive at the time of diagnosis. Stage distribution at presentation was 4 T1(40%) and 6 T2 (60%) and the percentage of MPC correlated with pathological stage: 3 of 4 (75%) tumors staged T1 had less than 10% of MPC and 5 of 6 (83,3%) tumors staged T2 had more than 50% of MPC. MUC is an aggressive tumor, often in advanced stage of disease at the time of diagnosis, in which the pathological stage is related to the proportion of MPC.