Dejan Vuckovic

MR and MRS Characteristics of Intraventricular Meningioma

Meningiomas are frequent intracranial, non‐glial tumors of adults. We present the unusual left lateral ventricular localization of meningioma in a 51‐year‐old man. The magnetic resonance (MR) images showed well demarcated, large mass of the atrium of the left lateral ventricle with transependymal extension into the left temporal lobe. MR spectroscopy revealed the presence of “choline only” spectrum, typical for extra axial neoplasms. The mass was completely resected. The diagnosis of transitional type intraventricular meningioma, with psammoma bodies, histologic grade I was made. Progesterone and estrogen receptors were negative.

The Incidence of Anemia in the Adult Working Population of Vojvodina

Abstract Background: Anemia is a global public health problem of endemic proportions, especially in women, and with serious health consequences. Anemia was defined according to the World Health Organization criteria as hemoglobin concentration <130 g/L for men and <120 g/L for women. The incidence of anemia varies between regions, so the aim of the study was to determine the incidence of anemia in a randomly selected sample of adult working individuals of both sexes, in Vojvodina. Methods: The study included a total of 6087 subjects (4658 men and 1429 non-pregnant women) aged 18-65 years who presented for a regular checkup at the Public Health Institute of Vojvodina. Blood specimen collection was performed by antecubital venipuncture in all subjects. Results: The results showed that the incidence of anemia in adults in Vojvodina was 7.7%, and it was more frequent in women (20%) than in men (3.86%). The most frequent was normocytic anemia, whereas microcytic anemia was less prevalent. Macrocytic anemia was found in only 3.3% of subjects, exclusively in women. The greatest proportion of anemic subjects, regardless of sex, had hemoglobin levels that indicated mild anemia (Hb 100-119 g/L for women, and 100-129 g/L for men). Only 4% of men and 12% of women had Hb levels that indicated the presence of moderate or severe anemia (≤100 g/L). Conclusions: Considering the medical, social and economic consequences anemia may produce, identification of risk factors and application of adequate preventive measures should be a public health priority. Kratak sadržaj Uvod: Anemija je globalan, problem u oblasti javnog zdrav- stva, endemskih razmera, naročito među ženskom popu- lacijom, sa ozbiljnim posledicama po zdravije. Prema kriteriju- mima Svetské zdravstvene organizacije, anemija je definisana kao koncentracija hemoglobina <130 g/L za muškarce i <120 g/L za žene. Njena incidenca varira od regiona do regiona, te je cilj rada bio da se utvrdi učestalost anemije u slučajnom uzorku odraslih zaposlenih osoba oba pola u Vojvodini. Metode: Istraživanje je sprovedeno u 6087 ispitanika (4658 muškaraca i 1429 žena koje nisu trudne) starosti 18-65 go- dina koji su se javili na periodični sistematski pregled u Insti- tutu za javno zdravlje Vojvodine. Svim ispitanicima je ante- kubitalnom venepunkcijom uzet uzorak krvi za određivanje krvne slike. Rezultati: Utvrđeno je da na teritoriji Vojvodine incidenca anemije kod odraslih iznosi 7,7%, pri čemu je ona učestalija među ženskom populacijom (20%) u odnosu na mušku po- pulaciju (3,86%). Među anemičnom odraslom populacijom najveća je bila zastupljenost normocitne anemije, a daleko manja mikrocitne anemije. Makrocitna anemija je bila zastu- pljena kod svega 3,3% ispitanika i to isključivo ženskog pola. U najvećem procentu anemičnih ispitanika u ovoj studiji, bez obzira na pol, vrednosti hemoglobina ukazuju na blaži stepen anemije (Hb 100-119 g/L za žene, odnosno 100-129 g/L za muškarce). Samo 4% muškaraca i 12% žena je imalo vred- nosti Hb koje ukazuju na prisustvo umereno teške ili teške anemije (i 100 g/L). Zaključak: S obzirom na zdravstvene, socijalne i ekonomske posledice do kojih malokrvnost može dovesti, identifikacija faktora rizika za pojavu anemije i primena odgovarajućih pre- ventivnih mera bi trebalo da budu u javnom zdravstvu.

Double primary tumors-renal cell carcinoma and duodenal mucinous adenocarcinoma.

A 59-year old patient was admited to the Gastroenterology Clinic with the signs of gastrointestinal bleeding. Computerized tomography (CT) and a barium-meal radiography revealed a circumferential nodular wall narrowing and incomplete stricture at the D2 part of the duodenum. CT also showed a poorly demarcated mass in the upper and lower poles of the left kidney. During the operation, the whole kidney together with the tumor was removed and also a part of the duodenum. Morphological features of both tumors were typical and distinctive enough to set the diagnosis of two independent primary tumors. The possibility of one being the metastasis of the other was excluded. The diagnosis of double primary malignant neoplasms - renal cell carcinoma and duodenal mucinous adenocarcinoma was made.

Fatal bronchial obstruction due to a tumor fragment originating from the contralateral lung during pneumonectomy

A 61-year old male patient who had been a heavy smoker for 30 years presented with hemoptysis of fresh blood and blood clots, which he had been experiencing for 2 days. He was admitted to hospital for radiological examination, and a right lung lobe tumor was diagnosed. The CT scan of the right upper lung showed a non-homogeneous infiltrative mass that measured 40 9 45 9 50 mm, with a protrusion around and into the main right bronchus (Fig. 1). The tumor also encircled the right pulmonary artery, but the lymph nodes were not involved. The patient had undergone gastric, duodenal ulcer and gallbladder surgery 12 years prior. During bronchoscopy, tumor biopsy specimens, that included the surrounding mucosa, were taken. The tumor was inside the lumen of the right main bronchus with almost complete luminal obstruction. The tumor biopsy revealed a necrotic non-small-cell carcinoma. The patient underwent right pneumonectomy. During the surgery, the bronchial resection margin was determined to be normal on frozen section. The operation was uneventful and upon its completion the patient started breathing spontaneously and was reacting to stimuli adequately. Blood pressure, oxygen saturation, and respiratory volume measurements were satisfactory (172/82 mmHg; 98 %; 7.5 l) so he was extubated. Two minutes later he started choking and became cyanotic. Intubation was performed and ventilation was started with pressure, but the patient showed no improvement. Fiber-optic endoscopy showed obstruction of the left main bronchus by a tumorous mass which could not be removed. Macroscopic evaluation of the right pneumonectomy specimen showed a tumor mass in the upper right lobe, size: 4.5 9 3 9 3 cm, inside all three segmental bronchi and infiltrating the surrounding alveolar tissue, without pleural involvement (Fig. 2). On histology, the tumor mass was extremely necrotic, consistent with large-cell neuroendocrine carcinoma (Fig. 3); synaptophysin and CD56 were positive; chromogranin, CK7, CK20, and TTF1 were negative. No metastatic foci were detected in any of the 33 examined lymph nodes. Autopsy revealed a massive atelectasis of the left lung due to obstruction of the main bronchus with tumorous tissue (Fig. 4). The mass measured 2.5 9 1.5 9 1 cm. It was smooth, intact, and without any connection to the mucosa (Fig. 5). The histology and immunohistochemistry of this tumor showed the same characteristics as the tumor from the operated right lung. The rest of the left lung tissue, and all internal organs and tissues were macroscopically and histologically unremarkable. After autopsy, the cause of death was attributed to the malignancy related to acute upper airway obstruction. Sudden obstruction of left main bronchus with a massive tumor fragment caused asphyxiation within a matter of minutes. This intra-bronchial tumor particle acted like a & Dejan Vuckovic dinvucko@yahoo.com

The sarcoid granuloma: 'epithelioid' or 'lymphocytic-epithelioid' granuloma?

BackgroundThis study aims to analyze the structure and quantities of cellular elements in sarcoid granulomas.MethodsWe investigated 34 transbronchial lung biopsy samples obtained from 34 sarcoid patients. The quantity and composition of the cellular elements inside a granuloma were determined by the quantitative stereometry method, employing the numerical density as a stereological method.ResultsA total of 102 sarcoid granulomas were analyzed. The central part of all granulomas was occupied by epithelioid cells. Besides these, giant cells, lymphocytes, macrophages and plasma cells were also seen. The mean numerical density of all the cells in the central part of a sarcoid granuloma was 111,751 mm-3. Lymphocytes prevailed in number, exceeding the total count of all other cells. With a mean numerical density of 74,321 mm-3, lymphocytes were twice as numerous as both epithelioid cells and macrophages with a mean numerical density of 37,193 mm-3.ConclusionsLymphocytes are the predominant cell type in the central part of a sarcoid granuloma, significantly exceeding both epithelioid cells and macrophages in number, raising the question if the term “epithelioid granuloma”, routinely used to designate sarcoid granulomas, is correct, or if it would be more logical to call them “lymphocytic-epithelioid granulomas” instead.Trial registrationThis study was supported by the Serbian Ministry of Science and Environmental Protection Grant Number 175006/2011.

Intrauterine Fetal Death Due To Cardiac Rhabdomyomas

A 21-year-old patient, in her first and regularly controlled uneventful pregnancy, was admitted to hospital due to lower leg edema, hypertension, proteinuria, and weight gain. Fetal death occurred the next day and a female nonhydropic fetus, 40 cm CH, 1460 grams, at 29-week gestation was delivered. An autopsy showed no visible gross abnormalities except in the heart. The heart was enlarged, with five intramural and subendocardial nodules, 0.3 to 1 cm in size, three in the left ventricular free wall, and one in the right ventricle and right atrium, sharply demarcated, reddish-gray, moderately firm, with the typical appearance of rhabdomyoma.

Pneumonia: Features registered in autopsy material.

Background: Despite improvements in clinical practice, pneumonia remains one of the leading causes of death worldwide. Pathologic findings from autopsy reports could provide more precise and valid data on characteristics of pneumonia patients. Methods: We retrospectively reviewed autopsy reports of deceased patients admitted to the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica, Serbia, between 1994 and 2003. The patients were classified into two groups: group 1 (n = 161) comprised patients in whom pneumonia was the main cause of death, while group 2 (n = 165) consisted of patients in whom pneumonia was confirmed at autopsy but had various different causes of death. Results: From 1776 patients who underwent autopsy 326 (18.3%) were diagnosed with pneumonia. The most common underlying diseases were atherosclerosis (29.4%), chronic obstructive pulmonary disease (COPD) (26.7%), and malignancies (20.2%). Pneumonia was the main cause of death in 161 cases (group 1) while in group 2 major causes of death were heart failure (HF) (26.7%), acute myocardial infarction (AMI) (16.4%), and pulmonary embolism (PE) (10.9%). Multilobar involvement (91% vs.27%), pulmonary effusion (29% vs.14%), and lung abscess (23.6% vs.8.5%) were more frequently found in group 1, compared to group 2. Conclusion: In patients with pneumonia who underwent autopsy most common underlying diseases were atherosclerosis, COPD, and malignancies, while major causes of death were: progression of pneumonia, HF, AMI, and PE.

Neonatal multiple blood cysts of heart valves

The female neonate, 27 days, 53 cm, 3450 g, was found dead in early morning hours. Baby was healthy, well nourished, and not neglected, up to the day before when she started to cough and scheduled for next-day regular pediatrician visit. Due to unexpected death, the autopsy was performed. Multiple oval, blood cysts, up to 0.5 cm, were found on the free valvular margins of the mitral valve, tricuspid valve, and aortic valve. The blood cysts were unilocular, filled with blood, and lined with flattened endothelial cells. The surrounding stroma was slightly edematous but without myxoid changes.