Nada Vuckovic

Age-related skin changes.

Age-related skin changes can be induced by chronological ageing, manifested in subcutaneous fat reduction, and photo-ageing eliciting increased elastotic substance in the upper dermis, destruction of its fibrilar structure, augmented intercellular substance and moderate inflammatory infiltrate. Forty-five biopsy skin samples of the sun-exposed and sun-protected skin were analyzed. The patients were both males and females, aged from 17 to 81 years. The thickness of the epidermal layers and the number of cellular living layers is greater in younger skin. The amount of keratohyaline granules is enlarged in older skin. Dermoepidermal junction is flattened and the presence of elastotic material in the dermis is pronounced with age. The amount of inflammatory infiltrate is increased, the fibrous trabeculae are thickened in older skin and the atrophy of the hypodermis is observed. Chronological ageing alters the fibroblasts metabolism by reducing their life span, capacity to divide and produce collagen. During ageing, the enlargement of collagen fibrils diminishes the skin elasticity.

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.

Mixed fungal infection (Aspergillus, mucor, and Candida) of severe hand injury.

Severe hand injuries are almost always heavily contaminated and hence wound infections in those patients are frequent. Fungal wound infections are rare in immunocompetent patients. A case of mixed fungal infection (Aspergillus, Mucor, and Candida) was documented in a young male patient, with a severe hand injury caused by a corn picker. The diagnosis of fungal infection was confirmed microbiologically and histopathologically. The treatment was conducted with repeated surgical necrectomy and administration of antifungal drugs according to the antimycogram. After ten weeks the patient was successfully cured. The aggressive nature of Mucor and Aspergillus skin infection was described. A high degree of suspicion and a multidisciplinary approach are necessary for an early diagnosis and the initiation of the adequate treatment. Early detection, surgical intervention, and appropriate antifungal therapy are essential in the treatment of this rare infection that could potentially lead to loss of limbs or even death.

Ectopic Adrenocortical Tissue: An Incidental Finding During Inguinal Surgery in Children

Adrenal rests are usually unrecognized during operation, and the incidence of ectopic adrenal cortical tissue in pediatric patients during inguinal surgery procedures is unknown. We performed 3028 groin surgical explorations in 2680 patients aged 1 month to 17 years. Ectopic adrenal tissue was found in 69 inguinal operations (2.2%): 37 during 1.524 orchiopexy (2.4%), 23 during 1.115 herniectomy (2.0%), and 9 during 389 hydrocoela operation (2.3%). Statistically there were no significant differences among those three groups. No adrenal rests were detected in females. Although a few reported cases with hormonal activity of ectopic adrenocortical tissue (EACT), the recommendation is to remove them if found.

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.

Vaginal Outlet Obstruction - A Review of Cases

Vaginal Outlet Obstruction - A Review of Cases The paper focuses on anatomical varieties of developmental anomalies of female vagina’s outlet, emphasizing the role of their early recognition in preventing retrograde menstruation by surgical treatment at the beginning of puberty. Three different types of vaginal outlet obstruction are described: imperforate hymen - from the group of hymen misdevelopment, transversal vaginal septum - from the group of failed transverse Mullerian fusion, and vaginal atresia - from the Mullerian aplasia group of disorders.

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

Overlap Between Ulerythema Ophryogenes and Keratosis Follicularis Spinulosa Decalvans: a Case Report

Abstract Ulerythema ophryogenes and keratosis follicularis spinulosa decalvans are rare folliculocentric keratotic disorders, from the group of follicular genokeratoses, characterized by keratosis pilaris atrophicans: follicular keratotic papules, sometimes with surrounding erythema, which eventually result in fibrosis, atrophy, progressive scarring and permanent hair loss. Ulerythema ophryogenes begins at birth or soon thereafter; it involves the lateral eyebrows, spreads medially and eventually affects the entire eyebrows, cheeks, and less frequently, forehead and asjecebt scalp. Involvement of the scalp has apparently not been reported in cases in which the eyebrows were predominantly involved. In addition to sporadic cases, ulerythema ophryogenes has been reported among relatives. Keratosis follicularis spinulosa decalvans is also a genetically heterogeneous syndrome which begins in infancy or childhood by involving hair bearing skin, especially the scalp; rarely it is confined to the face involving only eyebrows and eyelashes, but affects predominantly the scalp, leading to severe progressive cicatricial alopecia. Both conditions tend to progress until puberty. The authors present a case of an otherwise healthy 19-year-old male patient, with absence of lateral eyebrows since childhood, which spread symmetrically and medially, until puberty affecting the entire eyebrows, whereas the eyelashes were completely spared. On examination, skin findings on the face, trunk and extremities pointed to ulerythema ophryogenes: apart from hair loss, the lateral eyebrows were highly erythematous; a great number of disseminated follicular, slightly keratotic papules (keratosis pilaris) pin- or match-head sized, were seen on the trunk, extensor surface of the arms and legs, as well as the buttock, and on palpation the skin felt like a “nutmeg grater”. However, follicle-based erythematous papules (focal patchy alopecia) were found not only along the eyebrows but also partly in the parietal capillitium forming focal patchy alopecia, which is a finding characteristic for keratosis follicularis spinulosa decalvans; the histopathological analysis of the biopsy specimens taken from the parietal capillitium has confirmed the clinical diagnosis. Cytogenetic analysis showed no karyotypic abnormalities. Family history showed that the patient’s mother and maternal grandfather also suffered from hair loss especially of the lateral eyebrows. This paper presents an overlap between two rare follicular genokeratoses in a young male with a positive family history, who presented with ulerythema ophryogenes involving not only the eyebrows, but also the scalp, in the form of parietal, focal cicatricial patchy alopecia.

Treatment of olfactory neuroblastoma: a new approach

A 24-year-old male presented with a 6-month history of progressive left nasal obstruction, hypoanosmia, and discrete enophthalmos. As well, hypertension is present for years and peeling hands of palmar side 2–3 times a year during the winter months. Computed tomography and magnetic resonance imaging of the head showed an expansive mass in the left maxillary sinus of maximum oblique diameter 47 mm, extending into the nasal cavity (Fig. 1a). There was a partial dehiscence of the medial wall of the left maxillary sinus. Magnetic resonance angiography indicated a slightly higher caliber of maxillary artery on the left side and cervical artery angiography identified visible signs of pathological vascularization of the tumor mass, which comes from branches of the left maxillary artery and ophthalmic artery (Fig. 2). According to MRI examination, structure of tumor mass was nonhomogeneous, with numerous flow-voids that indicate the good vascularization. Intrusion of the mass through expanded sinus antrum was present in middle meatus. After application of contrast, intensive and easily nonhomogeneous staining was displayed. Endoscopic examination revealed a polypoid mass in the left nasal cavity and left maxillary sinus. The biopsy of lesion was indicated and performed under the general anesthesia and then the last tamponade was made because of massive hemorrhage which occurred during the procedure. Immunohistochemical analysis showed deposits of lobular tumors in the mucosa (Fig. 3). Tumor cells were relatively uniform, small scant cytoplasm, with some places formed pseudorosettes. Nucleus of tumor cells were round, there was no visible mitosis or nucleoluses. Blood vessels were dilated. There were no areas of necrosis. Cells were well-differentiated. Numerous rounded calcifications were found on the margins. Tumor cells were chromogranin and synaptophysin positive and analysis was detected olfactory neuroblastomagrade I (Hyams’ grading system, 1988). Described localization of tumor is atypical, since the most of the mass is in the maxillary sinus. This localization and expansion corresponds to Kadish Stage B. Embolization of maxillary and ophthalmic artery branches was performed to prevent a massive bleeding during operation. The 80 % of arteries lumen were embolized because the total lumen embolization could result with vision loss. A day after embolization, the patient was treated with endoscopic resection assisted by Caldwell-Luc with navigation under general anesthesia. The lesion in anterior and posterior ethmoidal regions was excised. Ethmoidal bone was skeletonized. There was no cerebrospinal fluid leak. Operation was performed with endoscopic transnasaltransmaxillar (Caldwell-Luc incision) approach. Tumor was excised subperiosteal and piecemeal. We did not perform a N. Vucinic (&) M. Eric Department of Anatomy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia e-mail: nikolavucinic87@gmail.com