Aim: Evaluation of the usefulness of flow cytometry (FCM) serous effusion analysis in a diagnosis of pediatric Non-Hodgkin lymphomas (NHL). Introduction: Serous effusions are often the first, life-threatening manifestation of pediatric NHL. FCM immunophenotyping of effusions with cytological analysis could help in diagnosis of NHL, and thus enable fast initiating of cytoreductive therapy. Material and Methods: FCM analysis of serous effusions obtained from 17 children and adolescents hospitalized in Mother and Child Healthcare Institute of Serbia under clinical suspicion of NHL using the standardized panel of monoclonal antibodies: CD19, iCD79a, CD20, CD10, iIgM, kappa/lambda, iCD3, sCD3, CD7, CD2, CD5, CD4, CD8, CD1a. Cytological examination was performed on May-Grunwald-Giemsa stained slides. The results were correlated with histopathological findings of available tumor biopsies. Results: Precursor T-cell (T-III/T-IV) phenotype was confirmed in 5 samples. In 7/9 samples with mature B (B-IV) phenotype, FAB L3 cytomorphology indicated Burkitt lymphoma (BL), and in 2/8 suggested diffuse large B-cell lymphoma (DLBCL). Tumor biopsy was available in 7/14 patients and in all cases preliminary diagnosis was confirmed. In 3 patients with no malignant cells in effusions, FCM and cytomorphologicaly only reactive changes were observed, and diagnosis had to be made by tumor biopsy (BL 2 patients, DLBCL 1 patient). Out of 7 patients diagnosed only by FCM and cytological analysis, 6 achieved a remission of the illness. Conclusion: FCM detects NHL cells in malignant serous effusions fast and accurate. In combination with cytological analysis, FCM is sufficient for diagnosis in most cases, allowing rapid initiation of therapy.

Aim: We present a rare case of simultaneous occurrence Concurrent occurrence of acute myeloid leukemia (AML) and monoclonal plasmacitosis (MP): Introduction: The simultaneous occurrence of acute myeloid leukemia (AML) and monoclonal plasmacytosis (MP) in bone marrow (BM) biopsy in patient without previous exposure to chemotherapy is very rare. Case report: We reported the case of a 45-year-old woman who presented with fatigue, fever, maculopapular rush, weight loss and bone pain. She was admitted to the Haematology Department of University CHC Bezanijska Kosa in November 2015. The complete blood count showed: white blood cell count 33x109/l (neutrophils 31%, myeloblasts 12%, monoblasts, promonocytes and monocytes 53%), hemoglobin 77gr/l, platelet count 34x109/l and 5% blastic cells in the peripheral smear. Serum immunoelectrophoresis showed increased monoclonal IgA (IgA 9,98, IgM 2,29, IgG 10,1), kappa/lambda 0,84, Beta2microglobulin 3,16. Biochemistry showed elevated creatinin level 93umol/l, uric acid 412 umol/l, high LDH 876U/l and sedimentation rate (50mm/h). Urine electrophoresis showed monoclonal heavy and light chains lambda type. Liquor immunophenotyping showed neuroleukemia. Skeletal survey showed no lytic lesions. The BM aspiration revealed around 10% plasma cells and BM biopsy showed infiltration by 20% monoclonal plasma cells (kappa-/lambda ) with 30% infiltration by cells with monocytes differentiation (without excess of blasts). Biopsy of skin lesion 17 MATERIA MEDICA • Vol. 34 • Issue 1, suplement 1 • april 2018. revealed myeloid sarcoma. Cytogenetic analysis detected normal karyiotype with FLT3 and NPM mutation. The patient was diagnosed as AML-M5, administered with induction therapy (DA Cytosar) and consolidation therapy (HiDAC) and she was successfully treated with allogenenic stem cell transplantation. She achieved and maintained complete remission. Conclusion: Monoclonal plasmacytosis of BM should be carefully examined due to possible association with other haematological malignancies

Aim: To highlight the widespread metastatic potential of the cutaneous melanoma, as well as its tendency for unusual presentation of metastatic disease. Introduction: Melanoma is an aggressive, highly malignant disease that is derived from melanocytes. The incidence of melanoma is significantly increasing. Melanoma has a strong tendency for metastasis. After primary excision of tumour, about 30% of all patients shall develop distant metastasis within first 5 years after tumour diagnosis. Case report: A 48-year-old female patient had undergone a hysterectomy because of myomatous uterus. After pathohistological examination metastasis of melanoma was diagnosed in one of multiple leimyoma. Diagnosis was confirmed with positive immunohistochemical staining with MART1 and S100 protein. Insight into the medical records, revealed that patient was diagnosed with superficially spreading melanoma (Clark IV, Breslow III) on skin above her left breast, as well as 2 regional tumour-involved lymph nodes (pT3aN2bM0), 2 years prior to this hysterectomy. Uterine leiomyoma was the first diagnosed distant metastasis of cutaneous melanoma. Diagnosis of stadium IV melanoma was established. Conclusion: Melanoma is a particularly aggressive disease with unpredictable evolution, so the occurrence of metastases in unusual and unexpected localizations, as is the distant benign tumour in the presented case, shall probably happen more often in the future.

Aim: Report of two cases of benign skin tumors of different histogenesis with anaplastic lymphoma kinase (ALK) gene rearrangement. Introduction: ALK gene mutation or rearrangement positive tumors (ALKomas) are heterogeneous group in which such genetic finding has diagnostic or predictive value. ALK gene fusions are associated with tumorigenesis of some cutaneous tumors, e.g. plexiform Spitz nevus (PSN) and epithelioid fibrous histiocytoma (EFH). Cases reports: Histological, immunohistochemical (IHC) and genetic characteristics were analyzed in two skin tumors with ALK gene rearrangement proved by fluorescent in situ hybridization (FISH). First case is PSN localized on face in a 8-year-old boy. Tumor was consisted of spindle cells arranged in plexiform growth pattern throughout epidermis and dermis, with following IHC characteristics: HMB45  focally, p16 , Ki67  in 1% of cells. Deletion of CDKN2A gene was not detected in significant number, while ALK gene rearrangement was positive in 37/50 (74,2%) of cells. Second case is EFH localized on shoulder in a 16-year-old girl. This dermal based tumor was consisted of tightly packed large epithelioid cells, which were CD68 , p16 , S100-, HMB45-, SOX10-, CD1a-, Ki67 (<5% of cells). ALK gene rearrangement was positive in 24/100 (24%) of cells, and focal chromosome 2 polysomy was noted. Neither mitoses nor necrosis were present in any of presented cases. Conclusion: Skin ALKomas are tumors with heterogeneous histological and immunohistochemical characteristics, and also with variable extent of ALK rearrangement.

Aim: Case report for rare complication rectorrhagia induced by rectal lipoma incarcerated in the anus . Introduction: Colorectal lipomas are rare tumors that are commonly diagnosed in the right colon, accidentaly during colonoscopy. When the lipomas are larger then 2 cm, they cause pain, bleeding, obstruction, incarceration and torsion. Material and Methods: We present the case of 50-year old man who comes to emergency ambulance with abundant rectorrhagia and blood presented on underwear and thighs. It is noted prolapse of the soft structure through the anus which is reponated into the anus. Anoproctoscopy was performed, which determines that it is polyp of rectum, although it seemed to be incarcerated hemorrhoids, due to the fact that the patient has been suffering from hemorrhoids with bleeding for several years,which is treated conservatively. It was found that it was not hemorrhoids prolaps or bleeding from them. Flexibile rectoscopy was performed on the untreated gut. The polypoid structure on peduncle,was verified in the distal rectum,3,5 cm from the pectinate line. Polypoid formation was electroresected and sent for pathohistological examination. Results: The patient was well tolerated intervention. Resected specimen revealed sessile pseudopolypoid tumor,eroded mucosa , diameter 28x25x24 mm.Histopathology revealed submucosal lipoma . Eroded mucosa is accompanied by focuses microbloods. Microcircuits of fatty necrosis are visible inside the lipoma. Conclusion: Lipom of the rectum is rare entity which is accidentaly diagnosed during colonoscopy. Extremly rare, lipom causes bleeding, which we present here.

Aim: We present the case of a rare localization of the alveolar soft part of the sarcoma in the visceral organ. Introduction: Alveolar soft part sarcoma (ASPS) is a rare mesenchymal tumor typically occurring in young patients, more frequently in females. Common localization of ASPS is skeletal musculature of lower extremities. ASPS in visceral organs usually represents a metastasis from the more common primary location in skeletal muscles. ASPS is characterized by a tumor-specific translocation which causes the fusion of the TEF3 with a ASPL gene (also known as ASPSCR1). Case report: Female 47 years old was admitted to hospital due to abdominal pain. Urgent surgery was performed due to ileus. Ileal tumor was detected intraoperatively as a cause of ileus. Tumor was infiltrated whole intestinal circumference, with dimension 70mm x 47cm and evident perforation. Histology showed well-defined nests of pleomorphic cells separated by delicate fibrovascular septae. Within described nests there is a prominent lack of cellular cohesion, representing for the distinctive pseudoalveolar pattern. Immunohistochemical stadies were diffusely positive for TFE3 and focally positive for CD34 and alpha-SMA and negative for panCK, DOG-1, CD117, S-100, HMB45, Desmin. Immunopositivity for Ki67 was present in 20% of tumor cells. FISH analysis was done using locus specific dual color break-apart TFE3 (3 and 5 ) probe and rearrangement in the TFE3 gene was confirmed. Conclusion: Despite the fact that ASPS is rare mesenchymal tumor in visceral organs it have to be considered as possible diagnosis especially in cases with typical histological features and immunohistochemical profile. Definitive diagnosis of ASPS must be confirmed by FISH analysis.

Aim: Purpose of this report is to present metastasis of lymph nodes melanoma with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) as an example of collision tumor of an uncommon synchronic occurrence in the lymph node. Introduction: Synchronic, composite tumors are rare and their simultaneous and synchronic occurence within the same tissue/organ is even more rare. CLL/SLL is an indolent, clonal disease of mature B-lymphocytes which occurs mostly with adults. After the treatment with chemotherapeutic agents the occurence of the secondary malignancies (melanoma,squamous-cell carcinoma). Material and Methods: We present a 77 year old male who, after right sided nephrectomy caused by clear-cell carcinoma was diagnosed with CLL/SLL with bone marrow and lymph node infiltration. After three years and chemotherapy, skin changes were excised which histomorphologically resembles melanoma. After the immunotherapy for melanoma, the enlarged lymph nodes were extripated from the neck and histomorphologically and immunohistochemically treated. Results: Histomorphologically, a diffused infiltration of small B-lymphocytes was found in the lymph node, with round nuclei, condensed chromatin, inconspicuous nucleoli, scant cytoplasm unique immunophenotype: CD20 ,PAX-5 ,CD5 ,CD23 ,Cyclin D1-,CD3-. A part of lymph node was infiltrated by epitheloid cells with immunohistochemic profile: S-100 ,Melan A ,HMB-45 . Histomorphological and immunohistochemical CLL/SLL with melanoma infiltration as an example of a collision tumor was proved. Conclusion: Lymphoproliferative neoplasms including CLL/SLL represent an risk of synchronous, metachronous development of secondary malignancies including melanoma itself and they can uncommonly present themselves as synchronic collision tumors within the same organ.

Aim and introduction: Pediatric nodal marginal zone lymphoma (NMZL) is a rare, but distinct subtype of NMZL with characteristic clinical presentation, pathohistological and molecular features, therapy and prognosis. Results: We report the case of a 15-year-old boy with no remarkable past history, presented with painless enlargement of left submandibular lymph node (LN) for three months. He was admitted to the University Children’s Hospital in Belgrade in May 2016. The cervical ultrasound demonstrated moderate left submandibular lymphadenopathy, but also mild enlargement of two right submandibular LNs (17x7mm, 14x7mm). Physical examination, chest radiography and abdominal ultrasound revealed no hepatosplenomegaly and lymphadenopathy elsewhere. The result of blood count test was normal. Biochemistry showed elevated uric acid 499 umol/l, AST 45U/l, ALT 98U/l, and sedimentation rate (65mm/h). Urea, creatinine, alkaline phosphatase, LDH and CRP were normal. The patient underwent left submandibular LN excisional biopsy. The size of the LN was 47x37x20mm. The histopathological examination revealed partial architectural effacement: follicular hyperplasia and nodular B-cell infiltration with features of progressive transformation of germinal centers (PTGC) in the form of fragmentation of follicles. A CD20 immunostain shows an abnormal expansion of the marginal zone with infiltration of interfollicular space. These B-cells were negative for CD3, CD5, CD23, EBV-LMP1, bcl-6, CD10, EMA, CD30, CD15, MUM-1, and positive for bcl-2 and IgD. A CD21/ CD23/ fascin immunostain showed an expanded and disrupted follicular dendritic cell meshwork. Ki-67 highlighted residual follicular polarisation and a low proliferation rate in the interfollicular areas. Based on these pathohistological findings it was concluded that LN likely represent reactive follicular hyperplasia with atypical marginal zone hyperplasia or possible PNMZL, with APSTRAKTI 95 MATERIA MEDICA • Vol. 34 • Issue 1, suplement 1 • april 2018. recommendation of polymerase chain reaction (PCR) analysis of clonality. Additional IGH PCR analysis demonstrated biclonal heavy chain gene rearrangement. These findings were consistent with PNMZL. After consultation with members of International BFM study group for non-Hodgkin lymphomas, followup was recommended without any treatment. The patient has remained disease free for 22 months since diagnosis. Conclusion: We presented a rare case of PNMZL with morphological features of PTGC, but immunohistochemistry and additional PCR clonality analysis were crucial for final diagnosis. This case represents a diagnostic and therapeutic challenge because of their rarity in the pediatric population.

Karcinom dojke je najčešća maligna neoplazmu u žena, čini oko 25% svih svih malignih bolesti i 15% svih smrtnih slučajeva, u ženskoj populaciji. Cilj našeg rada je ispitivanje učestalosti karcinoma dojke u pirotskom okrugu u periodu od 1998-2017 godine. Za ispitivanje smo koristili histopatološke izveštaje Službe za patologiju Opšte bolnice u Pirotu. Istraživanjem je obuhvaćeno 573 pacijenta operisana od karcinoma dojke u periodu od 1998-2017god. Analizirani su broj obolelih,vreme nastanka bolesti, starosno doba pacijenta u vreme dijagnoze, pol i histopatološki tip tumora. Za ispitivanje statističke značajnosti između grupa korišćen je Studentov t test. Karcinom dojke je verifikovan u 558 (97.38%) žena i u 15 muškaraca (2.62%). Prosečna starost žena sa karcinomom dojke u vreme dijagnoze je 62 god, a prosečna starost obolelih muškaraca je 64 godine Najveća učestalost karcinoma dojke zabeležena je u 2017 godini, pri čemu je zapažen statistički značajan porast broja obolelih od 2007 do 2017 godine. U radu se diskutuje o mogućim patogenetskim faktorima koji su uticali na signifikantan porast incidence karcinoma dojke u pirotskom okrugu.

Strano telo u disajnim putevima predstavlja životno ugrožavajuće stanje i zahteva urgentnu evaluaciju i lečenje. Prepoznavanje kliničke slike gušenja, anestezija i uklanjanje stranog tela u dečijem uzrastu predstavljaju veliki izazov za dečijeg anesteziologa i otorinolaringologa. U slučaju organskih stranih tela iritacija, inflamacija i bubrenje mogu dodatno komplikovati situaciju. Najuži deo disajnih puteva u deteta je subglotis i rigidni bronhoskop iritira ovo područje što može uzrokovati postoperativnu opstrukciju disajnog puta. Prikazujemo slučaj 13 mesečnog deteta koje je aspiriralo strano telo u levi bronh, kliničku sliku, preoperativnu pripremu, tehniku anestezije, tok rigidne bronhoskopije, kao i probleme sa kojima smo se susretali do izlečenja deteta.