Aim: The aim of our study was to evaluate status of estrogen and progesteron hormone receptors (ER and PR), and HER2 receptors in diagnostic core biopsy specimens, compared to surgical resection specimens of the same patients after NAC regimens all including trastuzumab. Introduction: Neoadjuvant chemotherapy (NAC) is associated with phenotypic alteration in breast carcinoma, especially with the change of molecular phenotype through the modulation of hormone and HER2 receptors expression. Material and Methods: The study included 35 patients with HER2-amplified locally advanced breast carcinoma that were treated with NAC regimens that included trastuzumab, and which had receptors status determined on pre-NAC core biopsy, and on surgical specimen after the completion of the therapy. Results: Pathological complete response (pCR) was observed in 4 cases (11.4%), while partial response to therapy was noted in 31 cases (88.6%). Invasive breast carcinoma of no special type (NST) was the most common histological type in 27 cases (87.1%), while the most common histological grade (HG) was HG3 in 27 cases (87.1%). There were no noted changes in histological type or grade of the carcinoma. The rates of ER and PR receptors positivity on diagnostic core biopsy compared to post-NAC surgical resection specimens were 61.29% to 67.74% and 48.39% to 64,52%, respectively. HER2 receptors status changed from positive to negative in 2 cases (6,45%). Conclusion: Changes in status of the receptors in breast carcinoma after NAC is significant due to implications in tailored therapy approach, and subsequent modification of adjuvant therapy regimens.

Aim: Evaluation of pathological estimation results of therapeutic response of primary breast carcinoma to applied neoadjuvant therapy. Introduction: Breast carcinoma is heterogeneous disease, that could be classified into several molecular subtypes by using immunohistochemical analysis and in situ hybridization. Neoadjuvant therapy is applied in cases of locally advanced breast carcinoma and for tumor chemosensitivity evaluation, which is very significant for disease prognosis. Material and Methods: The research was conducted on 35 female patients, that were treated with radical mastectomy in 2017, after IV cycle of neoadjuvant therapy, in Clinical Centre of Montenegro. Before treatment, all patients underwent core biopsy (confirmed invasive breast carcinoma, molecular subtype determined).Pathohistological response of primary tumor to applied therapy was estimated as complete response (pCR), partial response (pPR) and no response (pNR). Results: Average age in examined group of patients was 59,25 years.In 68,58% of cases it was invasive ductal, in 17,14% invasive lobular and in 14,28% mixed invasive carcinoma. Representation of molecular subtypes was (without change in respect to the core biopsy): 34,28% Luminal A, 42,85% Luminal B Her2 negative, 5,71% Luminal B Her2 positive, 8,58% Her2 positive and 8,58% triple negative. In 6 patients (17,15%) pCR was obtained, in 21 (71,42%) pPR, and in 4 (11,43%) no response. In group of patients confirmed for pCR, it was Her2 positive or triple negative carcinoma. Conclusion: Applying of neoadjuvant therapy leads to tumor response to applied therapy. Most commonly it is partial response, while complete response most commonly occurs in Her2 positive or triple negative carcinomas.

Aim: We present a rare case of gastrointestinal tumor in a boy. Introduction: Gastrointestinal stromal tumors (GISTs) represent rare mesenchymal tumors in pediatric population. Most of these tumors originate in the stomach and very rarely in the oesophagus. They are more frequent in young girls. As opposed to adult GISTs, those that occur in childhood show mutations in PDGFRA receptors or so called “Wild type” mutations. Case report: A fifteen years and 2 months old boy with symptoms of dysphagia and stenocardia for the last six months. Endoscopy showed nodular solid lesion at the distal part of the thoracal oesophagus, later surgically removed. Dimensions of the lession were 35x25x20mm with whitishPOSTER SESIJA 57 MATERIA MEDICA • Vol. 34 • Issue 1, suplement 1 • april 2018. yellow cut surface and areas of hemorrhage. Histology showed predominant spindle cell pattern with minor epithelioid component, with pronounced cellular and nuclear pleomorphism, rare areas of necrosis and hemorrhage, with the mitotic count more than 18 per 50 high power fields and numerous atypical mitotic figures. Immunohistochemical studies were CD117 and DOG-1 negative, but positive for PDGFRA. Tumor expressed focal alpha-SMA and CD34 positivity. Conclusion: Informations regarding pediatric gastrointestinal stromal tumors are still insufficient. Even though these tumors are rare in childhood, when analysing mesenchymal neoplasms potential GISTs should be considered.

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: We present an illustrative autopsy case of thrombosed giant bilateral vertebral artery aneurysms. Introduction: A 61-year-old male died at Department of Infective disease with a clinical diagnosis for bilateral bronchopneumonia, cerebral aneurism, fibro muscular dysplasia, CVI, HTA, chronic CMP, cardiac arrest. Material and Methods: Standard autopsy technic with neuropathology brain dissection and standard procedure of paraffin embedded section routinely stained with HE was performed. Results: Gross examination of the brain at the autopsy showed saccular giant bilateral vertebral artery aneurysms that measured 58 mm on the right and 40 mm on the left artery. They were tumor-like and compressed the medulla and pons. Both were thrombosed. The right was ruptured with subacute subarachnoid bleeding. Sections of the cerebral vessels exhibited minimal atherosclerotic plaques, with mild stenosis (focally up to 10%) of the left internal carotid artery. We found mild dilatation on ventricles and minimal cortical atrophy of the brain. During the microscopic examination angiodysplasia with abnormally dilated blood vessels on visceral organs, predominantly on brain and heart was detected. The cause of death was central type of cardiopulmonary insufficiency with pulmonary edema. Conclusion: We presented an extremely rare case with bilateral giant vertebral aneurysms. Giant cerebral aneurysms are ones that measure >25 mm in greatest dimension and account for ~5% of all intracranial aneurysms. They occur in the 5th-7th decades and are more common in females. Vertebral artery aneurysms constitute 0.5 to 3% of intracranial aneurysms and 20% of posterior circulation aneurysms.

The presentation will reflect on a one-month period of education that the author spent with the Cleveland Clinic soft tissue pathology team. Cleveland is a US city in the state of Ohio. One of its nicknames is
“The Rock and Roll Capital of the world”, due to the fact that the term R’n’R was coined in the 1950s by
a Cleveland-based disc jockey Alan Freed. The city hosts the Rock and Roll Hall of Fame, established in
1983. It is also home to the Cleveland Clinic, a multispecialty academic hospital currently ranked as the
#2 hospital by U.S. News & World Report1. In 2014, Cleveland Clinic had a total revenue of $11.63 billion, making it the #2 hospital in US on the Becker’s Hospital Review revenue list2. The author spent one
month on a UICC ICRETT fellowship in November 2016 with the Cleveland Clinic soft tissue pathology
team. The main strength of the soft tissue team is the presence of several internationally known experts
with diverse interests within the field of soft tissue and beyond, with team philosophy highlighting the
synergy of team work and individual reputation. Among various topics that were covered during the
one-month fellowship, certainly one of the most interesting was differentiation among different fibrohistiocytic neoplasms. Fibrohistiocytic tumors are among the most frequent soft tissue tumors and they
are most commonly encountered in the skin. “Fibrohistiocytic” is in fact a merely descriptive term for
cells that resemble both normal fibroblasts and histiocytes, and not a true line of differentiation3. Like
other soft tissue tumors, fibrohistiocytic neoplasms are divided into benign, intermediate and malignant
categories. In presentation, the author will reflect on the key points in the pathology diagnosis within this
category of tumors, and these are:
- being able to give a common denominator to numerous variants of benign fibrous histiocytoma
- awareness of the pitfalls in the diagnosis of dermatofibrosarcoma protuberans
- discrimination of malignant fibrohistiocytic skin-based tumors from other, more adverse cutaneous
malignancies.

The Norvegian University of Science and Technology is the largest educational institution in Norway. It was founded in 1760 as the Trondheim Academy. The Faculty of Medicine and Health Sciences is part of the St Olav’s Hospital in Trondheim, and being there, as participant of the Annual Cytology Tutorial of the European Federation of Cytology Societies, was an outstanding experience. Colleagues from all over the world had the opportunity to meet and learn from experts in various fields of cytology. Particularly, differences between conventional and Thin Prep Pap smears, as well as immunocytochemistry of air-dried smears were thoroughly discussed.

To present pathological processes of the TG with histological detection of granulomas, analysis of morphological forms of granulomas, and their diagnostic significance. This paper is based on literature review and insight into the archival materials of the Institute of Pathology and Forensic Medicine of the Military Medical Academy.The presence of granulomas in the thyroid gland (TG) includes specific pathological processes such as subacute thyroiditis (SAT) and palpation thyroiditis (PT). The clinical manifestations of the granulomas may be accompanied by symmetrical or asymmetrical enlargement and palpatory pain in the gland, which requires further clinical examination. Granulomas in the TG can be associated with various benign and malignant processes. There are two large groups of granulomas: foreign-body giant cell granulomas (FBG) and immune granulomas (IGR). FBG are histiocytic reactions to chemically inert, exogenous or endogenous materials. Etiologically, IGRs arise in the framework of infectious, autoimmune, toxic, drug-induced or pathological processes of unknown etiology. According to the presence of necrosis IGRs can be further divided as necrotizing or non-necrotizing type. TG granulomas of the infectious, autoimmune or inflammatory nature of the unknown etiology are extremely rare. 1. Granulomas in specific pathological processes of the TG Subacute (de Quervain’s) thyroiditis or granulomatous thyroiditis is an inflammatory process that is clinically presented as enlarged and painful TG. In most cases, the result is a complete recovery of the TG function. Permanent hypothyroidism is found in about 5% of patients. SAT is usually preceded by upper respiratory tract infection. The disease is etiologically related to viral infections, genetic predisposition and the use of immuno therapy. Macroscopically, TG is usually symmetrically enlarged, but there are also localized forms with nodular morphology, which imitate neoplastic lesions. The microscopic characteristic is the presence of multifocal and diffusely distributed folliculocentric granulomas. They are found in different phases and consist of epitheloid histiocytes, lymphocytes, plasma cells, neutrophils, and multinuclear giant cells (MGC). At the center of the granuloma, the colloid is reduced or absent. In later phases, fibrosis can develop perifollicularly. In terms of differential diagnosis (DDG), it is important to differentiate SAT from other granulomatous inflammations. Palpation thyroiditis (Multifocal granulomatous folliculitis) is the most common pathological process in TG with microscopic detection of granulomas. It is an incidental microscopic finding involving individual or minor follicular groups. Changes arise as a result of mechanical microtrauma after the palpation of the TG. Microscopic changes are characterized by damage to the follicles with interfollicular APSTRAKTI 73 MATERIA MEDICA • Vol. 34 • Issue 1, suplement 1 • april 2018. accumulation mainly of histiocytes in the presence of lymphocytes, plasma cells and MGCs. In the DDG of PT, the following conditions must be considered: SAT, primary and secondary microscopic foci of papillary microcarcinoma, C-cell hyperplasia, and focal forms of Langerhans histiocytosis. 2. Foreign-body giant cell granuloma is frequent incidental microscopic finding in TG. It arises as a reaction to the accumulation of endogenous substances in the areas of spontaneous or degenerations induces by fine-needle aspiration biopsy (FNAB). The most common forms of FBGs on endogenous material are cholesterol granulomas. These FBGs are composed of MGCs, foamy histiocytes, and hemosiderophages arranged around crystal deposits. Depending on how old the lesion is, there may be a focal necrosis, a different degree of fibrosis, extracellular deposits of hemosiderin, and other inflammatory cells. The presence of FBGs and histiocytic aggregates is not only important in the preoperative cytological diagnostics, but also in the post-operative pathohistological analysis of TG nodules. Large nuclei of histiocytes with hypochromasia, nuclear membrane irregularities and the presence of MGC can imitate the cytological features of papillary thyroid carcinoma (PTC). Exogenous biomaterials are rarely cause of FBGs in TG. After thyroidectomy, in cases of diagnosed TG malignancies, the presence of suture FBGs in thyroid bed imitates recurrence or the rest of malignancy and is the cause of repeated surgeries. 3. Necrotizing granulomas (NGR) in TG Granulomas with necrosis may be of infectious and noninfectious etiology. Tuberculosis is the most common cause of NGR in TG. Tuberculosis in TG can be presented as a solitary nodal lesion, diffuse microlesions, nodular goiter, and rarely as an abscess or a chronic skin sinus. As a infectious cause of NGR in TG, sporadically reported cases have been caused by histoplasmosis, coccidioidomycosis and nocardiosis. Rare non-infectious NGR in TG or in the TG bed, of autoimmune etiologies, have been described as part of Wegener’s granulomatosis and rheumatoid arthritis. Post-operative necrotizing granulomas also represent NGR of non-infectious cause. Microscopically, there is a morphology that matches post biopsy granulomas in other organs (prostate, urinary bladder). 4. Non-necrotizing granulomas (NNGR) in TG Sarcoidosis is a multi-systemic chronic granulomatous inflammation of unknown etiology. Thyroid is rarely affected by sarcoidosis. Macroscopically, the gland is diffusely or nodularly enlarged or reduced in volume. Interstitially localized NNGR represent a typical histological presentation. Sarcoidosis of TG should be distinguished from the sarcoid-like stromal reactions of PTC in the gland or regional lymph nodes. In these cases, it is necessary to clinically exclude the systemic disease. 5. Granulomas and histiocytic reactions in neoplastic processes of TG Apart from the described FBGs, PT and sarcoid-like reactions, in epithelial tumors of the TG histiocytic aggregates (not granulomas) may also be seen as secondary changes after FNAB. Interfollicular/ intraluminal presence of MGCs with or without the presence of histiocytes and granuloma-like morphology represents a characteristic finding in PTC. The cytological and histological detection of MGCs is one of the diagnostic criteria for PTC. Their presence in tumors may be due to a reaction to an altered colloid produced by PTC or as a non-specific immune response to due tumor cells. Conclusion: Granulomas in the TG are not rare. Knowing the morphology of granulomas, pathological processes and the circumstances in which they occur is significant in DDG of primary tumors of the TG, their recurrence and metastases in the cervical lymph nodes. The diagnosis of granulomatous inflammation in TG can be based on the histological characteristics of granulomas in correlation with clinical and laboratory findings.

Investing in the health of mother and child during pregnancy and postpartum reduces inequality of achieving health care. Maternal and child health indicates health of the population, society as a whole and the effectiveness of health care. Since people in our area knows little and doesn’t talk about the postpartum depression, we tried to identify information how many maternal knows about the postpartum depression, mood disorder, which basis is not only biological, but also the psycho-social nature. Furthermore, we examined the relationship between being informed about postpartum depression and sociodemographic characteristicss and the level of the self-esteem.Instruments used in the study were a questionnaire on sociodemographic characteristics and Rosenberg’s self-esteem scale.The results of our study show that 68% of women don’t know what is postpartum depression, and that the knowledge of postpartum depression is associated with women’s education and employment. Correlation of being informed about postpartum depression and selfesteem is not determined.On the basis of these results, we believe that it is necessary that the institutions, experts from different areas and the future mothers learn more about postpartum depression, symptoms, treatment, causes and possible risks because the concern about the health of mothers and babies has to be primary concern of healthy society.

Za postavljanje dijagnoze sepse, najpouzdanije je određivanje PSP u kombinaciji sa drugim markerima sistemske infekcije. Pojedinačno merenje je često bez značaja, tako da je kontinuirano merenje u vremenu, sa trendovima pada ili porasta nivoa markera sistemske infekcije, daleko informativnije. Nivo PSP značajno zavisi od GFR. Kod obolelih od ABI, PSP je solidan pokazatelj sistemske infekcije do težih i prologiranih stadijuma ABI. Kod obolelih od HBI, tumačenje vrednosti PSP je veoma spekulativno, te postoji potreba za definisanjem novihcut-off vrednosti za PSP kod ovih bolesnika. Kod oblelih pod tretmanom HD, pokazan je različit klirens PSP sa različitim dijaliznim membranama. Svakako, nivo PSP se po HD vraća na pređašnji nivo, koji je inače povišen.