Aim: To present a case report of choristoma of the stomach. Introduction: Ectopic pancreas is defined as the presence of pancreatic tissue outside its normal location without anatomic or vascular connections with the pancreas. It mostly occurs in upper gastrointestinal tract, predominantly in the stomach. It s likely to occur in men, at the age of 30-50 years. Case report: A thirty-year old male patient presented to the hospital for evaluation of epigastric symptoms. After clinical examinations, he underwent an esophago-gastroduodenoscopy which showed intramural tumor located along the greater curvature. The biopsy was taken which revealed normal gastric mucosa so it was suspected for gastrointestinal stromal tumor. The patient was submitted to laparoscopic partial gastrectomy and the material was received for pathohistological analysis. Macroscopically, there were several fragments, gray-pink coloured and lined with pink mucosa. In the largest fragment it was noticed irregular, oval gray-white node, measured 4x2.5x0.5cm. On serial cutting it was yellow. Histologically, described fragments revealed normal fundic mucosa and irregular node was consisted of pancreatic tissue localized in submucosa and lamina muscularis. It was formed of normal acini and Langerhans islets, with focally dilated pancreatic ducts and presence of mixed inflammatory infiltrate. Dysplasia wasn t found in the pancreatic tissue. The POSTER SESIJA 58 MATERIA MEDICA • Vol. 34 • Issue 1, suplement 1 • april 2018. established diagnosis was Ectopic pancreatic tissue in stomach Choristoma of the stomach. Conclusion: Choristoma is rare condition and usually incidental finding important to be diagnosed because of the serious complications depending on which tissue is present in the organ, such as inflammation, bleeding and mailignant transformation.

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: To reported extremely rare case of collision adenocarcinomma et small cell neuroendocrine carcinomma of the gallbladder (SCNEC). Introduction: Collision cancers are malignancies in the same organ or anatomical site that comprises et least two different tumor components, with no mixed or transitional area between two component. Case report: 76 year old woman with abdominal pain, underwent ultrasonography evaluation which demonstrated cholelithiasis and gallbladder wall thickening. Cholecystectomy due to cholelithiasis was performed.The macroscopic analysis revealed 2,5cm sized round nodular lesions in the fundus of the gallbladder.Formalin fixed, paraffin embedded tissues were stained with H.E. Selected samples were stained immunochistochemically with chromogranin, synaptophysin et CK7. Microscopicaly, the tumor was composed of two components. Dominant component is adenocarcinomma, composed of tubular glands lined predominantly by columnar cells with pseudostratified et ovoid or elongated nuclei.In the area close to this component there was neuroendocrine carcinomma that came in touch with the previous one, but didnt infiltrate it. Neuroendocrine carcinomma was composed of round or fusiform cells, arranged in sheets, nests and cords.Tumor cells have round hyperchromatic nuclei with inconspicuous nucleoli. Neuroendocrine tumor cells were immunoreactive for chromogranin, synaptophysin. Epithelial cells were positive for CH7.The final pathologycal diagnosis was SCNEC. The tumor stage was II, T2, Nx, Mx. Conclusion: Prognosis for patient is poor.About 40-50 percent of patients have disseminated disease at the time of the diagnoses.SCNEC appear to be highly responsive to chemotherapy as well as radiotherapy and survival time more than one year have been reported.

Aim: We present an interesting case of pancreatic ectopic tissue in the gallbladder. Introduction: Ectopic or heterotopic pancreas is defined as the presence of pancreatic tissue outside the boundaries of the pancreas that show no anatomical or vascular connection with the main body of the pancreas. Case report: We present a rare case of ectopic pancreas found in a 38 year-old man s gallbladder. Male patient was admitted to the Surgical Department Clinical Hospital Center Zvezdara, as scheduled for an elective laparoscopic cholecystectomy. One year prior to the surgery he had had abdominal ultrasonography done during a routine hospital check up. Ultrasonographic examination of the whole abdomen had showed no abnormality, except for cholelithiasis. Laparoscopic cholecystectomy was done. On gross examination, the gallbladder measured 9 cm in length and 3.5 cm in circumference, with a wall thickness ranging from 0.2 to 0.4 cm. On cutting open, one yellowish round stone, measuring 0.6 cm in diameter, was noted in the fundus. The mucosa was velvety flattened. A nodule of 1,5 cm in diameter was seen in the neck region, which on microscopic examination, showed a well circumscribed rest of heterotopic pancreatic tissue, composed of lobules of exocrine pancreatic acini and an occasional duct. Islets of Langerhans were also present. Conclusion: Ectopic pancreatic tissue in a gallbladder is a very rare condition which is usually diagnosed incidentally. Up to the presents, only about 30 cases have been reported. The clinical significance of the ectopic pancreas remains unclear and it requires further exploration.

Aim: Pathohistological diagnostics (PD) of the Yolc Sac tumor (YST) of primary mediastinal localization. Introduction: YST are malignant germ cell tumors of primitive endodermal gonadal differentiation. In 1% -5% of cases their localization is extragonadal, including mediastinal in 50% -70% published cases. Case report: A 30-year-old man was admitted to the Thoracic Surgery Clinic for diagnosis and treatment of mediastinal tumor with lungs and liver metastases. Laboratory analyzes revealed high elevations in serum alpha-fetoprotein (AFP), in addition moderate elevation of beta-chorionic gonadotropin (ß-HCG). No pathological changes in testis and retroperitoneum have been found. An open biopsy of the mediastinal change was made for PD. Histologically, tumor tissue showed a significant degree of necrosis. There were reticular, microcystic and pseudopapillary forms of neoplastic cell growth, surrounded by myxomatosis stroma. Tumor cells cytoplasm was scarce and vacuolated with high nuclear polymorphism and hyperchromasia. Positive immunohistochemical (IMH) reaction was obtained for panCK, AFP, PLAP. Immunoreactivity for TTF-1 was found in about 50% of tumor cells, as well as the focal reaction for ß-HCG in rare multinuclear cells. Reactions for D2-40, CD5, CK-7, CK-20, p63, CD117, CD30, napsin A and calretinin were negative. Conclusion: The results of our analysis showed the expression of divergent endodermal linear markers in the mediastinal YST, especially TTF-1 expression. The diagnosis of YST in small biopsies can be difficult and requires using of a wide range of IMH markers in order to closer the differentiation of primary tumor localization and the application of appropriate chemotherapy

Aim: To examine the quality of tested lung carcinoma samples, frequency and type of EGFR mutations, and their correlation with patients clinical characteristics (gender, age, smoking habits, clinical stage). Introduction: Mutations in Epidermal Growth Factor Receptor (EGFR) have a role in lung carcinoma development and they are more prevalent in women and non-smokers. Evaluation of EGFR mutations in lung carcinomas in mandatory for targeted therapy with tyrosine kinase inhibitors. Test performance depends on the quality of tested samples and a test type. Material and Methods: We evaluated reports of EGFR mutation real-time PCR analyses in lung carcinoma samples performed from June 2017 till February 2018. Presence of mutations was correlated with clinical characteristics of lung carcinoma patients. Results: A total of 341 samples was received for testing, among which 40 (11.7%) was unsuitable for analysis due to a low tumor cell content (<5%). Three types of mutations were detected in a total of 24 (8%) cases: L858R in 12 (50%) cases, exon 19 deletion in 10 (41.7%) cases, and G719A/C/S in two cases (8.3%). Mutations were more prevalent in women (13.7%) then in men (4.3%) (p=0.004). Patients with EGFR mutated tumors were older (67,6ą9,4 years), compared to those with non-mutated tumors (62,3ą8,8 years) (p=0,003). Smoking habits and clinical stage were not associated with mutation status in lung carcinomas. Mutations were detected only in adenocarcinomas. Conclusion: Our results suggest the low frequency of EGFR mutations in tested patients, but they are more prevalent in women and older patients.

Aim: Lobular endocervical glandular hyperplasia is very rare, differential diagnostic difficult entity, which often mimics more aggressive endocervical lesions, with worse prognosis. Introduction: Lobular glandular endocervical hyperplasia(LEGH) is benign lesion with lobular proliferation of endocervical glands and endocervical epithelium without or with minimal nuclear atypia. Lobular structure can be deep into the cervical tissue without stromal invasion, which is important difference between adenocarcinoma of minimal deviation(MDA), well-differentiated endocervical type of adenocarcinoma, similar to LEGH. Case report: The patient is 50 years, with demarcated, nodular, multicystic tumor, localized deep in cervical tissue. Microscopic analysis shows numerous cystically dilated endocervical glands with lobular presentation, surrounded by hyperplastic fibrous stroma. Glandular acini are diffusely localized, with centrally dilated acinus and peripheral smaller tubular structures. Glands are without the presence of architectural changes and cytonuclear atypia, with uniform, endocervical epithelium.Immunochemical analysis showed:CEA- /CA125focal /p16 focal /Er and Pr focal epithelium, diffusely in stroma. Because structures were described deep in the cervical tissue, MDA is considered diagnostically differential. However, glands do not show signs of distortion(architectural atypia), which is important feature of this entity, as well as no pronounced surrounding desmoplastic stromal reaction. Macroscopic tumor is well demarcated, and the CEA marker is negative, which also suggested LEGH. Conclusion: LEGH and MDA show a quiet clinical and histological similarity. Association of LEGH(50%) with MDA and 40% with cervical adenocarcinoma has been demonstrated, suggesting the possible precancerous potential of LEGH. Research of the lesion microenvironment could be an interesting subject for further research.

Aim: We present a case of a patient with pneumothorax and subcutaneous emphysema as the first manifestation of miliary tuberculosis. Introduction: Miliary tuberculosis is the result of hematogenous dissemination of Mycobacterium tuberculosis in patients with weak immuno-defensive mechanisms. Pneumothorax and subcutaneous emphysema are possible complications of miliary tuberculosis. Case report: A woman aged 64 years old reported to the regional institution because of breathing difficulties. On the radiograph of the chest, pneumothorax was observed left, and the left thoracic drain was placed. Subcutaneous emphysema and global respiratory insufficiency were reported an hour later after which the patient was transferred to our facility. At the admission the patient was in poor general condition, intubated, hemodynamically unstable, markers of inflammation were elevated with the presence of electrolyte imbalance and severe anemia. On the chest radiogram, there was recorded: pneumothorax left, pneumonia right and generalized subcutaneous emphysema, and thoracal drain that was placed. Intensive therapy had improved the condition of the patient, after which she was extubated. Progression of respiratory insufficiency and lethal outcome occurred on the second day of admission. An autopsy was performed. A macroscopic examination and pathohistological analysis found: massive subcutaneous emphysema in the chest, well-placed thoracal drain, bilateral pleural effusion, bilateral acute tuberculous caverns in the lungs and necrotizing granulomas in: the lungs, liver, spleen and larynx which have led to asphyxiation and aviation outcome. Conclusion: In poorly-fed patients with the development of pneumothorax, subcutaneous emphysema and severe respiratory disorders, it is necessary to suspect tuberculosis.

Aim: The aim of this research is to analyze the profile of Ezh2 expression in superficial urothelial bladder cancer, to investigate its correlation with clinicopathological parameters, as well as to determine the prognostic significance of Ezh2. Introduction: Superficial urothelial bladder cancer, without invasion of muscle layer, is associated with frequent recurrence, and represents significant burden for health care system. Ezh2 is epigenetic regulator with a major role in urothelial oncogenesis. Clinical investigations of Ezh2 inhibitors in treatment of solid cancers have already given encouraging results. Materials and Methods: Tumor samples from 410 patients with superficial bladder cancer (172 pTa, 238 pT1), obtained by transurethral resection, were incorporated in tissue microarrays, and analyzed immunohistochemically to Ezh2 expression. Correlation analysis with clinicopathological parameters was performed using SPSS 18.0. Results: High nuclear expression was found in 33.4% tumors, and it was significantly more frequent in pT1 (46.6%), compared to pTa tumors (15.1%) (p<0.001). Ezh2 expression was associated with high histologic grade, presence of carcinoma in situ, and cancer specific death (p<0.001, respectively). In Kaplan-Mayer survival analysis high Ezh2 expression was significantly associated with poor prognosis and shorter patients survival (p<0.001). There was no significant correlation between Ezh2 and recurrence of the disease, and recurrence free interval (p<0.05). Conclusion: Immunohistochemical expression of transcription repressor Ezh2 in superficial urothelial bladder cancer indicates aggressive behavior of the tumor, and poor prognosis. Ezh2 could be used as pronostic marker in selection of the patients that might require more intense clinical treatment, and as potential target of anticancer therapy.