The synchronous occurrence of a gastrointestinal stromal tumor (GIST) and pancreatic ductal adenocarcinoma (PDAC) is exceptionally rare and poses significant diagnostic and therapeutic challenges. We report a 67-year-old female presenting with biliary obstruction, right upper quadrant pain, and dyspeptic symptoms. CT imaging revealed a pancreatic head mass, while a submucosal gastric lesion was identified only intraoperatively. Laparotomy enabled excision of a pedunculated gastric GIST, whereas the unresectable pancreatic tumor involved critical vascular structures, necessitating a palliative double bypass comprising cholecystectomy, hepaticojejunostomy, gastrojejunostomy, and enteroenterostomy. Histopathology confirmed a low-risk GIST and a moderately differentiated PDAC with distinct immunohistochemical profiles, supporting the presence of two independent primary tumors.

This case underscores the critical importance of meticulous intraoperative exploration, particularly in the presence of atypical or incidentally discovered lesions, and demonstrates the durable palliation afforded by surgical bypass in unresectable PDAC. Beyond the clinical context, potential molecular overlaps—activation of MAPK/ERK and PI3K/AKT/mTOR pathways, VEGF-mediated angiogenesis, and defects in DNA repair—provide a plausible biological basis for the synchronous occurrence of these otherwise unrelated neoplasms, informing potential strategies for personalized therapy

Background: Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor A (VEGF-A), represents an important component of systemic therapy for metastatic colorectal cancer (mCRC). By inhibiting angiogenesis and promoting vascular normalization, bevacizumab enhances the efficacy of cytotoxic drugs. However, despite proven benefits, some uncertainties remain regarding its safety profile, particularly the risk of gastrointestinal perforation and other vascular toxicities. Materials and Methods: This retrospective, single-center, observational study included patients with histologically confirmed mCRC treated with combination chemotherapy and bevacizumab (FOLFOX/FOLFIRI + bevacizumab) at the Oncology Department of Zemun Clinical Hospital Center between July 2022 and July 2025. Efficacy was assessed according to RECIST 1.1 criteria, including objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and duration of response (DoR). Adverse events were classified according to CTCAE v6.0. Results: A total of 74 patients were analyzed (56.8% male; mean age 67 ± 9 years). The median PFS was 6.5 months (IQR 3–9.8), and DoR 7.3 months (95% CI 5.2–9.5). ORR was 35.1%, and DCR 82.4%. The most common toxicities were hypertension (12.2%) and proteinuria (10.9%), while gastrointestinal perforation was observed in 4.1% of patients—slightly higher than in larger real-world series, which may be related to locally advanced disease, peritoneal carcinomatosis, or an intact primary tumor. Conclusion: Bevacizumab-based therapy demonstrated consistent efficacy and an acceptable safety profile in patients with mCRC. Although the incidence of perforation and fistula formation was somewhat higher, the therapy remained safe with careful patient selection and monitoring.

The aim of this review article is to provide an overview of available literature data on serum basal calcitonin (bCT) and stimulated calcitonin (sCT) cut-off values, highlighting them as a valuable diagnostic tool in everyday thyroidology practice. During the diagnostic evaluation of thyroid nodular disease, mildly elevated bCT values ​​are frequently encountered. If bCT values ​​remain above the reference range but are <100 pg/ml on repeated measurements, further evaluation is warranted. In addition to the usual diagnostic procedure for thyroid nodular disease (medical history, family history of thyroid malignancy, clinical examination, thyroid function tests, and thyroid ultrasonography), a stimulation test, most often a calcium test, is performed to assess the response by measuring the sCT levels. A precise diagnostic threshold, the so-called cut-off for clinically significant pathological values ​​of bCT and sCT that indicate medullary thyroid carcinoma (MTC), is still lacking. However, there are studies that recommend appropriate cut-off values ​​for bCT and sCT that allow a clear and safe distinction between healthy individuals and individuals with C-cell hyperplasia (CCH) from those with MTC. The aim of this review article is to present the latest literature data on existing cut-off values ​​for bCT and sCT in blood, which can certainly be useful to clinicians in everyday practice.

Introduction: Chronic limb ischemia (CLI) and diabetic foot significantly impact patients’ quality of life, with high rates of amputation and mortality. Angiosome-oriented revascularization represents an anatomically precise approach, targeting the artery that directly supplies the lesion area. Direct revascularization (DR) is increasingly considered superior to indirect revascularization (IR) due to potentially better wound healing and limb salvage outcomes. Methods: A narrative literature review was conducted using PubMed, Cochrane Library, and Google Scholar, with the keywords: angiosome, critical limb ischemia, diabetic foot, direct revascularization, endovascular, bypass surgery. Studies published between 2020 and 2025 were included, focusing on systematic reviews, meta-analyses, and prospective cohort and clinical studies. In addition to clinical studies, anatomical data on the distribution of foot and lower leg angiosomes were analyzed, including a table illustrating the correlation between wound location and target artery. Results: Six main angiosomes of the lower limb were identified, each corresponding to a specific artery. DR was associated with higher rates of wound healing and limb preservation, reducing the risk of amputation by 20–30% compared to IR. Optimal candidates for DR are those with localized lesions, patent distal target arteries, and adequate microcirculation. DR is less effective or technically unfeasible in patients with diffuse microvascular disease, multisegment occlusions, poor distal vessels, or active severe infections. Advanced technologies such as hyperspectral imaging and indocyanine green (ICG) mapping improve intraoperative perfusion assessment. Conclusion: Angiosome-oriented revascularization is a logical and anatomically grounded approach for treating CLI and diabetic foot. When feasible, DR of the target artery provides better clinical outcomes than IR. Success requires precise diagnostics, patient selection, and multidisciplinary collaboration. Further randomized studies are needed to define optimal application algorithms for this concept.

Introduction: Esophageal cancer is one of the ten most common cancers globally with a high mortality rate. The etiology is multifactorial, non-hereditary risk factors are smoking, alcohol consumption, obesity, and hereditary risk factors are Lynch syndrome, Plummer-Vinson syndrome, Peutz-Jaegers syndrome, and Li-Fraumeni syndrome. The treatment is multidisciplinary, and combined, chemotherapy, radiotherapy, immunotherapy, and surgery are applied. From the moment of diagnosis, supportive therapy is necessary to alleviate and eliminate the symptoms of the disease. Dysphagia is present in almost all patients with esophageal cancer. A loss greater than 5% of total body weight is associated with a worse prognosis. Discomfort and vague chest pain, hoarseness, cough, and sore throat are less common. Locally invasive tumors cause other symptoms such as hematemesis, hemoptysis, melena, dyspnea, cough, and pleural effusion. Horner's syndrome and superior vena cava syndrome may also occur in advanced tumors. The involvement of large blood vessels can lead to fatal bleeding. In the case of metastatic disease, different symptoms may be present depending on the location. Objective: The objective of this literature review is to indicate the importance of supportive therapy in the treatment of patients with esophageal cancer. Supportive therapy in esophageal cancer: The purpose of good supportive therapy is to ensure the best possible quality of life for patients. In esophageal cancer, the reduction of symptoms significantly contributes to the extension of life. Esophageal cancer treatment is actually the treatment of symptoms. Given that the most common symptom of these cancers is dysphagia, treatment of the underlying disease will also lead to an improvement in symptoms. Patients who have a complete or severe obstruction at any level of the esophagus must be provided with adequate nutrition. Oral nutrition contributes to a better quality of life. Before starting pain therapy, it is necessary to assess the cause and characteristics of pain. A step-by-step approach involves the gradual introduction of analgesic therapy. Dosing of opioids and determining the therapeutic dose should be in accordance with the current guidelines of the World Health Organization. Conclusion: supportive therapy contributes to longer survival in esophageal cancer at an advanced stage of the disease, and better tolerance of aggressive treatment regimens, reducing the toxicity, which leads to improved quality of life.

Introduction: Voice dysfunction represents a significant postoperative complication following total thyroidectomy, particularly in patients whose profession depends on their voice (singers, lecturers). The main causes include injury to the recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN), as well as vocal cord trauma during intubation or the occurrence of postoperative edema. Methods: A systematic search of PubMed and Cochrane databases was conducted for studies published between 2014 and 2025. Included studies comprised randomized controlled trials, meta-analyses, systematic reviews, and relevant clinical guidelines. Data were analyzed regarding the incidence of voice dysfunction, mechanisms of nerve injury, surgical and anesthetic risk factors, prevention strategies, and postoperative management, including the use of intraoperative neuromonitoring (IONM). Results and Discussion: Recurrent laryngeal nerve paresis leads to dysphonia and reduced phonatory power, whereas superior laryngeal nerve injury decreases the high-frequency vocal range and vocal endurance. The risk is increased in reoperations, large retrosternal goiters, and invasive tumors. The use of IONM reduces the risk of permanent RLN injury, although its reliability may be compromised by improper use of neuromuscular blockers or anesthetic protocols. Anesthetic factors, including improper intubation, excessive cuff pressure, and multiple intubation attempts, significantly contribute to voice changes. Prevention includes careful anesthetic management, precise intubation technique, and coordinated work between surgeons and anesthesiologists. Early postoperative evaluation, fiberendoscopic examination, acoustic analysis, and speech therapy contribute to preserving vocal cord function. Conclusion: Voice dysfunction following total thyroidectomy arises from both surgical and anesthetic factors. Prevention of complications requires a multidisciplinary approach, coordination between surgeons and anesthesiologists, and the use of intraoperative neuromonitoring. Therapy and rehabilitation, including otolaryngological assessment and speech therapy, aim to preserve and restore vocal function.

Introduction: Primary adenocarcinoma of the appendix is a rare and heterogeneous malignancy, most commonly presenting as mucinous adenocarcinoma. Due to its nonspecific clinical manifestations, the diagnosis is often established at an advanced stage, frequently with already present peritoneal dissemination. Standard treatment for advanced mucinous appendiceal carcinoma involves cytoreductive surgery with HIPEC followed by systemic chemotherapy, or initial systemic therapy for downstaging, followed by repeat CRS and HIPEC. In cases where radical surgery is not feasible, the average survival is less than one year. Case report: We report a case of a 72-year-old woman with no relevant family history, who presented with acute right lower abdominal pain and distension. Imaging revealed multiple cystic peritoneal implants, ascites, and small bowel obstruction. Palliative emergency surgery demonstrated an appendiceal mass invading the right ovary, with widespread peritoneal mucinous deposits. Histopathological analysis confirmed mucinous adenocarcinoma of the appendix with peritoneal carcinomatosis. Postoperatively, the patient received 12 cycles of bevacizumab plus FOLFOX chemotherapy, achieving marked radiologic and biochemical improvement. Maintenance therapy with bevacizumab plus 5-FU/LV led to sustained disease stabilization. After 32 cycles, the patient developed an entero-vaginal fistula, which was surgically managed due to poor quality of life. Intraoperatively, the decision was made for cytoreductive surgery and fistulectomy. Postoperative imaging showed no evidence of disease. The patient remains progression-free for nearly three years, and disease-free for one year. Conclusion: This case highlights the potential for long-term survival in initially inoperable patients with advanced mucinous appendiceal adenocarcinoma and peritoneal carcinomatosis when treated with combined cytoreductive surgery and bevacizumab plus chemotherapy. Multimodal and individualized treatment strategies may significantly improve outcomes in this rare malignancy.

Introduction: Parasitic leiomyomas are extremely rare benign smooth muscle tumors that develop independently of the uterus. They may arise spontaneously from pedunculated subserosal fibroids that detach and establish an independent blood supply from surrounding structures, or they may develop iatrogenically following laparoscopic morcellation. Owing to their nonspecific clinical and radiologic features, they are often misdiagnosed preoperatively. Surgical excision with histopathological verification remains the standard of care. Case report: We present the case of a 51-year-old postmenopausal woman with progressive abdominal distension and a sensation of pelvic pressure. Imaging revealed a large heterogeneous abdominopelvic mass measuring 30 × 20 cm, compressing adjacent bowel loops and major vessels. The uterus was myomatous but of normal size, and both ovaries appeared unremarkable. The patient underwent open surgical resection of the mass with total hysterectomy, bilateral adnexectomy, and omentectomy. Intraoperatively, a giant tumor connected to the uterine fundus by a thin pedicle was identified. Histopathological examination confirmed a benign leiomyoma without atypia or necrosis and a Ki-67 proliferation index below 1%. The postoperative course was uneventful, and the patient remained asymptomatic three months after surgery. Conclusion: Primary parasitic leiomyomas are exceedingly uncommon, particularly in patients without a history of prior gynecologic surgery. They should be considered in the differential diagnosis of large abdominopelvic masses. This case emphasizes the importance of comprehensive diagnostic evaluation and highlights that parasitic leiomyomas can attain remarkable size while maintaining benign histological features.

Introduction: Pseudoaneurysm (PSA) is defined as a defect in the arterial wall at the puncture site, leading to an extraluminal blood collection surrounded by fibrous tissue, and represents the most common vascular complication after coronary angiography. The aim of this study was to identify risk factors for PSA development after coronary interventions and to define criteria for surgical treatment. Materials and Methods: A retrospective analysis was conducted on 32 patients treated at CHC Zemun over a ten-year period (2012–2022). During the observed period, 16,787 coronary procedures were performed (10,498 coronary angiographies, 6,289 PCIs). The study group included 17 patients with PSA, and 15 patients in the control group with a hematoma that did not progress to PSA. Demographic data, comorbidities, laboratory parameters, therapy, smoking habits, procedural details, and PSA characteristics were recorded, with comparison between surgically and conservatively treated patients. Results: The mean time to PSA diagnosis was 3.29 ± 4.7 days, whereas hematomas were diagnosed within 24 hours. No significant differences in sex or age were observed between groups. More than half of the patients had hypertension, hyperlipidemia, and chronic cardiac or renal diseases. Low hemoglobin, thrombocytopenia, and INR >3 were identified as independent risk factors. Most interventions were performed via the right femoral artery, with PSA most commonly located in the common femoral artery. Median PSA diameter was 44 mm in surgically treated patients and 19 mm in conservatively treated patients. No deaths occurred; the most common postoperative complication was residual hematoma. Conclusion: The first 72 hours after intervention represent the most critical period for PSA detection. PSA diameter is a key factor in therapy selection, lesions >2 cm and complicated ones require surgical intervention, while smaller lesions can be treated conservatively. Timely diagnosis and treatment improve outcomes, and our findings may help optimize patient monitoring protocols and early surgical intervention selection.

Fractal dimension is a mathematical parameter that quantifies the complexity and irregularity of biological structures. In medical sciences, fractal analysis enables quantitative differentiation between normal and pathological tissues, as well as the detection of subtle structural alterations associated with senescence, inflammation and carcinogenesis. Integration with artificial intelligence and machine learning approaches further enhances its diagnostic potential and brings it closer to clinical practice. Despite current limitations related to methodological standardization and interpretation, accumulating evidence suggests that fractal dimension may evolve into a valuable component of digital pathology, otolaryngology and personalized medicine.

The development of colposcopy and the Papanicolaou (Pap) test marked a turning point in the prevention and early detection of one of the most aggressive gynecological cancers—cervical carcinoma. Hans Hinselmann (1884–1959) first used the colposcope in March 1924 and published his research, along with a description of the instrument, in 1925. This year is considered the beginning of the colposcopic era. Using his device, Hinselmann was able to identify early stages of cervical cancer and describe epithelial changes he termed “precancerous lesions.” He emphasized the importance of systematic prevention and advocated for the establishment of centers dedicated to early cervical cancer detection. Although a persistent and methodical researcher, Hinselmann crossed ethical boundaries under the Nazi regime, participating in forced sterilization programs of women from 1935 onward. After World War II, he spent three years in prison (1946–1949), was removed from clinical work, and later incriminated for his involvement. Following his sentence, he was allowed to practice privately until his retirement in 1949. Hinselmann died in 1959 in Goethehaus. In Serbia, the first article on the importance of colposcopy in gynecological diagnostics was published by Berislav Berić in 1954. Štucinova and Mladen Broćić were pioneers in introducing colposcopy in the country. The Section for Colposcopy and Cervical Pathology was established on September 26, 1995, in Brezovica, marking the institutionalization of this field in Serbia. With the adoption of a new Statute on November 12, 2006, the Section evolved into the Serbian Association for Colposcopy and Cervical Pathology.