1997 Frame 2

UNCOMMON CORONARY LESIONS CAUSING SUDDEN OR UNEXPECTED FATALITY

• Bussani R, Pavletić N, Mannone T, Silvestri F.
• lnstitute of Pathological Anatomy – College of Trieste – Italy.

We explain some unusual postmortem examination findings in 4 clients with sudden or unexpected fatality.

CASE N. 1: A 46-year old man was admitted to Health center as a result of a thought aseptic necrosis of the thigh. During hospitalisation the patient evidenced indications of severe pulmonary hypertension as well as passed away. At postmortem examination a huge, reciprocal pulmonary thromboembolism was found. The thrombotic material got to the ideal atrium, gone through the left ventricle to lodge in the circumflex left coronary artery. CASE N. 2: An 89-year old woman was hospitalised for ischemic heart disease and also anaemia. During gastroscopy the individual suddenly broke down as well as passed away. At autopsy a gigant Lambl's excrescence of the closure line of the totally free side of the best coronary ostium was evident. The heart provided a big myocardial infarction entailing the posterior wall of the left ventricle and the posterior third of the interventricular septum.

CASE N. 3: A 28-year old man was discovered dead at home by family members. At autopsy the heart showed no substantial atherosclerosis, nonetheless a large coronary infarction of the anterior wall surface of the left ventric( e and the former third of the interventricular septum was found. Microscopically, a lymphocytic coronaritis of the left descending artery was present. The inflammatory procedure involved neither various other coronary branches neither various other vascular areas. There was no histological evidence of myocarditis.

CASE N. 4: A 39 year old man sufćering of Prinzmetal's angina died suddenly. At postmortem examination, histologic areas of the left descendenting artery of the left coronary artery revealed diffuse eosinophilic adventitial granulomatous swelling. Huge areas of energetic lymphocytic myocarditis were biventricularly noticeable.

1. Pathological morphology of human and animal diseases.

• Patološka morfologija humanih i animalnih bolesti.
• HEART HAIR TRANSPLANT – ZAGREB EXPERIENCE.
• Planinc D, Sutlić Ž, Biočina B, Huseđinonić I, Anić D, Belicza M, Ferenčić Ž, Čupić H, Jelić I, Sokolić J.
• University Hospltal “Sestre milosrdnice”, Zagreb, Croatia Teaching Hospital “Dubrava”, Zagreb, Croatia.

University Hospital “Rebro”, Zagreb, Croatia.

From 30. September 1988. to 30. April 1997, 36 people (29 men and 7 ladies), aged from 19 to 62, went through orthotopic heart hair transplant (Htx). lndications for heart transplantation's were as complies with: in 27 patients dilatative cardiomyopathy, in 8 people ishaemic cardiomyopathy and also in one individual ishaemic cardiomyopathy with extreme aortal and also mitral valve failing. Ejection portion of left ventricle prior to hair transplant was 8 to 24 % (mean value 16.2%), and PRV 1.3 to 6.5 Wood' s units (mean value 2.8). ‘.

All individuals were receiving immunosuppressive medications like antithymocytic globulin (ATG), cyclosporine A, azathioprine as well as steroids. Diagnosis of grade of heart denial was based upon histological searchings for of right ventricle endomyocardium (based upon ME Billingham requirements and 1SHT). Immunosuppression was successfully accomplished in 40 moderate heart rejection processes, with high doses of metilprednisolone and also ATC. Ctinically show infections were developed in 16 situations (4 of them deadly) as well as issues and also negative results of immunosuppressive treatment in 74 situations (3.4 per client).

After Htx patients were fotlowed on the standard for 29 months. 9 people died in very early as well as 9 in late postoperative duration, 15 people had arterial hypertension (primarily cnild to modest) and two had kidney insufiiciency of grade 1-Il. The feature of graft was adequate or exceptional in 18 enduring individuals (3 of them are working complete- time) and also the quality of life is very good. Ejection portion of left ventricle after Htx is 35 to 68% (ordinary 55%) and patients remain in NYHA class I-II.

ENDOMYOCARDIAL BIOPSY IN CARDIAC GRAFT PATHOLOGY.

• Čupić H, Belicza M, Ferenčić Ž, Planine D, Sutlić Ž, Biočina B, Anić D.
• KB “Sestre Milosrdnice, KB “Dubrava “, KBC “Rebro”, ZAGREB.

Thirty six orthotopic heart transplant treatments were perfonned in the nine years between September 1988 as well as April 1997. In order to determine the level of heart denial, hematoxylin-eosin and Mallory-stained areas of endomyocardial biopsies (EMB) were analysed.

Specimens were rated according to the International Culture for Heart Transplantation classification (considering that April 1991), which is basically an expansion of the original M.E. Billingham requirements.

To make a sufficient example, 4 items of myocardium are called for, 50% of which has to be evaluable myocardium as well as not a previous biopsy site or scar. Additional details is provided for inadequacy of samplings (less than four.pieces), “Quilty” impact, tightening bands and perimyocitic fibrosis.

Even with intensive search for simple non-invasive denial diagnostic treatments with a view to changing or reducing the number of EMB, EMB of hair transplanted heart stays essential for establishing the grade of graft rejection in administration of the posttransplant individuals.

TUMOURS METATATIC TO THE HEART AND PERICARDIUM.

1. Bussani R, Mannone T, Pavletic N, Silvestri F.
2. Institute of Pathological Anatonry – University of Trieste – Italy.

Tumour metastases to the heart are one to the least examined subjects in scientific oncology. However, this problem needs to maintain terrific sensible relevance being gotten in touch with operability along with the sort of treatment of neoplastic patients.

Of 4,796 clients autopsied at the Institute of Pathological Anatomy of Trieste from 1994 via 1995, 1,148 males (42%) as well as 780 (38%) had a primary tumour. Among them 162 subjects had heart metastases (8,4% of all cancers), with a considerable frequency reduction in the senior people. Mesothelioma cancer, melanoma and also lung cancers cells showed the highest possible regularity of heart involvement in men (100%, 50%, and also 31% respectively). Cancer malignancy, lung tumors and also kidney neoplasm's had the highest portions of heart additional sores in women (45%, 26%, and also 20% specifically).

Amongst lung cancer cells, anaplastic tiny cell cancer (37%), and also adenocarcinoma (33%) revealed one of the most regular heart participation in males, while squamous carcinoma (43%) and anaplastic little cell cancer (29%) had the highest regularity of heart metastases in women.

Adenocarcinoma (82%) as well as anaplastic small cell cancer (74%) of the lung, mesothelioma cancer (100%) and also bust tumours (73%) had the highest frequency of metastases to the pericardium.

A specifically high frequency of myocardial involvement was observed in squamous cell cancer of the lung (62%), urinary system tumours (60%) and also cancer malignancy (45%).

• UTILITY OF “THANATOS” COMPUTER SYSTEM IN THE EVALUATION OF CAUSES OF FATALITY REGARDING METEREOLOGICAL VARIANTS.
• Vučić M, Zaninović K, Cvjetko 1, Žurić M, Dumenčić B, Periz R, Plasaj T.
• ” Ljudevit Jurak” Scientific Department of Pathology, University Hospital “Sestre milosrdnice”, Zagreb.

Utilizing archives of “Ljudevit Jurak” Professional Division of Pathology we have evaluated information on died individuals in the University Hospital “Sestre milosrdnice” in 1995 and also 1996.

The major cause of death and major pathological condition were identified for each and every instance, according to referrals of the World Health Organisation published in the International Category of Illness as well as Related Health Problems (tenth revision, 1994). All information were memorised in, and evaluated by “Thanatos” computer system for clinical pathology.

During stated period 2566 clients died in health center, 1269 in 1995 (typical age 67), as well as 1297 in 1996 (ordinary age 69). Conditions of cardiac as well as vascular system were one of the most typical cause of death, where just myocardial infarct (MI) has actually created 1 17 deaths (4,5% of overall).

MI is thought about to have several provoking risk factors, amongst which are also detailed weather condition modifications. This has actually stimulated us to associate, by using “Thanatos” computer system, regularity of deaths brought on by MI with three weather parameters average air temperature, ordinary air pressure and standard family member moisture.

Connection of pointed out pathological and also climate data was done on a basis of contrast of seven-day durations throughout both years. Visual evaluation has plainly exposed three peaks of Ml fatalities, followed by 2 distinctive patterns of climate adjustments. In the period 28 Jan. – 3 Feb.

1995 average air temperature level, and also ordinary air pressure were boosted while ordinary relative humidity was reduced in comparison with periods before and after MI death optimal. On the other hand, in the durations 8-14 Apr. 1995, and also 23-29 Nov. 1996, ordinary air temperature level was reduced, while average atmospheric pressure as well as average loved one moisture did not vary in connection with periods prior to and after MI death peaks.

Although our populace was not random( y chosen (health center individuals), presented outcomes suggest need of additional investigation of influence of climate adjustments on human athophysiology.

IMMUNOHISTOCHEMISTRY OF BORDERLINE OVARIAN TUMOR.

• Krušlin B, Pirkić A, Matković M, Klarić P, Hodek B.
• Clinical Department of Pathology “Ljudevit Jurak” as well as Division of Gynecology and Obstretics, Teaching Hospital “Sestre milosrdnice “, Zagreb, Crontia.

In the duration 1990-95 one hundred forty 8 deadly epithelia! ovarian neoplasm's were identified, 10 of whom were borderline tumours (7 serous and 3 mucinous). Borderline epithelial tumors of the ovary (tumors of reduced malignant potential, LMP) still represent an excellent problem as a result of the absence of uniform pathohistological standards and also unclear organic behavior.

Extra criteria for examination as well as forecast of organic behaviour of these tumours are undoubtedly needed. In this study, we check out proliferative kinetics of cells of LMP tumors. It is well known that these tumors, particularly mucinous, extremely usually consist of interspersed areas of well-differentiated in addition to atypical cells.

Expression of proliferative antigens (Ki-67 as well as PCNA) was researched utilizing immunohistochemical approaches Strept AB/AP and Strept AB/HRP after microwave antigen access treatment. We likewise examined the expression of c-erbB-2 as well as p53 by the very same methods.

In this research 8 LMP tumors were analysed. Two individuals were shed from follow-up and also were not included. Favorable nuclear staining for Ki-67 was observed in 5 samplings. This response showed mosaic pattern, and also was highly favorable in the locations showing epithelial atypia.

PCNA nuclear positivity was located in 6 situations, independently of the level of cell differentiation. Positive staining with c-erbB-2 protein antibody was obtained on the cell membrane layer in 5 tumors, as well as was mostly shared in the locations showing eytological atypia. Favorable nuclear reaction to p53 oncoprotein with mosaic pattern was located in 4 situations, specifically in the areas revealing atypical epithelium.

The expression of examined antibodies in all samplings was highly favorable in locations revealing cytological atypia and dedifferentiation, other than of PCNA that showed positivity additionally in the areas without proliferative activity. Different expression of proliferative antigens was most likely due to their guideline of the numerous stages of cell cycle.

Expression of p53 and c-erbB-2 in investigated tumors possibly indicate their potential aggression.

Our results of immunohistochemical expression of investigated antigens may be useful as an additional criteria in morphological evaluation of LMP ovarian neoplasm's, and might have a prognostic importance. Further studies of bigger collection are certainly needed.

• REFERRALS.
• Kiyokawa T. Int J Gynecol Pathol 1994; 13:311.
• Wang DP et al. Virchows Arc [A] 1992; 421:393.
• Hall PA et al. J Pathol 1990; 162:285.

WORTHS OF HORMONAL AGENT STEROID RECEPTORS, HORMONAL FACTORS AND DNA WEB CONTENT IN INDIVIDUALS WITH ENDOMETRIAL CANCER BEFORE AND ALSO AFTER THERAPY WITH TAMOXIFEN.

• Nola M, Jukić S, Ilić-Forko J, Babić D, Kos M, Užarević B, Petronečki M.
• Department of Gynaecological and Perinatal Pathology, Medical Facility Centre, Zagreb, Croatia.
• Intro. Tarnoxifen is a non-steroidal triphenylethylene derivate with primary anti-oestrogen task.

Purposes. To determine the impact of tamoxifen on hormone steroid receptors, hormonal condition as well as values of DNA web content in individuals operated for endometrial cancer. Thirty individuals with endometrial carcinoma were treated with tamoxifen in dose of 30 mg for 10 days after curettage.

Approaches. During analysis curettage hormone status (luteinizing hormone (LH), follicle-stimulating hormonal agent (FSH), progesterone, estradiol, testosterone, androstendione, dehydroepiandrosterone sulphate (DHEAS), sex hormone binding globulin (SHBG)), hormone steroid receptors (oestrogen and also progesterone receptors) and DNA content (DNA ploidy, proliferative task and DNA-index) were estimated. On the day of operation degrees of the same criteria were established once more.

Outcomes as well as Final thoughts. The level of PH were significantly greater and also the level of ER were considerably reduced after the tamoxifen therapy. This was identified in the group of people with deep myometrial intrusion, medical stage 1, high as well as moderate degree of distinction and beneficial histologic kind. The analytical distinction was not found according to DNA content. Hormonal therapy consisting of mix of progestine and tamoxifen can be boosted if we focus our examination on finding out specifications of prognostic relevance.

CONTRAST OF PATHOLOGICAL AS WELL AS MEDICAL SEARCHINGS FOR OF PLACENTAS AT DIVISION OF GYNAECOLOGY AND ALSO OBSTETRICS OF GENERAL HEALTH CENTER “SVETI DUH” IN ZAGREB.

• Jandrić D, Belicza M, Kurjak A, Šumski R, Latin V.
• Departmerrt of Gynaecology as well as Obstetric of General Medical Facility “Sveti Duh”, Zagreb.

From regular biopsy product from maternity ward of General Healthcare facility “Sveti Duh” in Zagreb a variety of placentas have actually been extracted as well as relationship of pathological as well as clinical findings from pathological pregnancies as well as distributions has actually been done. The intention of the clinical job was to existing possibilities of investigating placental pathology in regular diagnostic product. Initial research study shows that most usual clinical conditions due to which placentas were sent to pathological analysis are following:.

1. a) Severe hypoxia of unborn child with which offsetting angiomatosis of chorionic villi was found, a lot more bountiful as well as stressed sincicial knots, in fewer variety of situations infarct of placenta and in one case big retroplacental hematoma.
2. b) With placentas provided by caesarean section was noticed compensatory angiomatosis of chorionic villi as well as emphasised sincicial knots.
3. c) With hypotrophia of fetus major pathological substratum was branching disorder of chorionic villi with absence of branches of I and also II rank (Respite villorum), after that much more abundant perivillosus fibrinoid and also calcifications. In several placentas countervailing angiomatosis of chorionic villi was located.
4. d) Several placentas gotten in touch with trisomy 18 and also 21 were processed. Disordered maturation with chorionic villi of premature type was found by histology, as well as branching disorder of chorionic villi (Respite villorum), in a number of placentas just one umbilical artery was located, and in almost all placentas, infiltration of decidua capsularis was found.
5. e) In evaluation of premature delivery completely established chorioamnionitis was found.

CHORANGIOMA PLACENTAE.

Glumbić I, Lež C, Pirkić A.

” Ljudevit Jurak” Clinical Departnaent of Pathology, Teaching Hospital “Sestre milosrdnice”, Zagreb.

Chorangioma placentae was considered as a really rare tumour of placenta, yet in the recent literary works its frequency has to do with 1% (1 ). Being identified as an haemangioma, its histological look is variable and pleomorphic. It could be divided right into endotheliomatous, capillarious, spacious and fibromatous form, where the capillarious is the most typical of all chorangiomas. Chorangiomata probably emerge as malformations of the primitive angioblastic cells of the early palcenta. There are numerous reported circumstances of threat maternities, which were accompanied with the placental chorangiomata, such as hydramnion, pre-eclampsia, antepartum bleeding, early onset of labour, but the general perinatal death is only very little raised. On the other hand, medically considerable chorangiomas, greater after that 4 centimeters, are connected with fetal loss price of about 40%.

Recently, we have observed chorangioma as a subordinate finding during the routine macroscopic exam of the placenta of the 28 year primipara whose pregnancy was clinically typical. She was confessed to the medical facility for labour at 40 weeks of gestation. Pregnancy, labor and also distribution were uncomplicated. She was delivered of a healthy and balanced female youngster gauging 52 centimeters, 3500 g, with Apgar rating 1= 9, 5= 10. Placenta gauged 16:16:2,5 em, 350 g, with centrally attached umbilical cable and radially distributed alantoic capillary. Singular, ovoid mass was observed on the fetal side of the placenta, gauging 4 centimeters in greatest size with soft and also bright red cut surface.

Histologically, our instance of chorangioma was of the capillarious look, as well as in this way, the immunohistoreactivity to UEA lectin was highly revealed in tumours tissue. Regardless of to the scientific information, we believe that transient early pregnancy hypoxia have set off a circumscribed too much angioblastic expansion in the placental cells.

Wallenburg HCS. Chorangioma of the placenta: thirteen brand-new situations and an evaluation of the literature from 1939 to 1970 with unique reference to professional issues. Obstet and also Gynecol Survey, 1971; 26:411 -425.

Quintero R, Reich H, Johnson MP, Gonacalves L, Evans MI. In utero endoscopic devascularisation of a big chorangioma. Ultrasound Obstet Gynecol, 1996, 8/1:48 -52.

ASSESSMENT OF MORPHOMETRICAL INFORMATION ON AgNOR LOCATION AS WELL AS NUMBER IN THE STRAIGHTFORWARD AS WELL AS COMPLEX KIND ADENOCARCINOMAS OF THE MAMMARY GLAND IN THE DOG.

• Juntes P.
• Institute of Pathology, Veterinary professors Ljubljana, Slovenia.

Silver discoloration of nucleolar organizer areas (NORs), or much better their artyrophilic proteins (AgNORs), is a technique used in tumour pathology for analysis of the speed of tumor cell proliferation. The quantity of AgNor healthy proteins is in corre( ation to the ratio of cells in cell cycle as evaiated with Ki-67 and PCNA in some researches. That classification discriminate 2 major teams of tumours of the mammary gland in the pet – simple as well as intricate kind. AgNOR location and also number were morphometrically assessed in adenocarcinoma of simple and complicated type using semiquantitative image evaluation system Prodit 5.2 (BMA, The Netherlands). Substantial distinctions were located between both sorts of tumours, for complete mean AgNOR location (P= 0.0541). The mean number of AgNORs and also maximal variety of AgNORs were substantially higher in simple kind adenocarcinomas (P= 0.0000, P= 0.0012), and remained in correlation with total mean AgNOR area (r– 0.4379, P= 0.0002; r= 0.3485, P= 0.0004). Overall mean AgNOR location in basic kind tumours was in negative connections with two years postsurgical period without tumour (r= -0.4002, P= 0.0284) therefore was the mean area of a typical AgNOR granule (r= -0.4534, P= 0.0119) and optimum area (r– 0.4340, P= 0.0166). The number of AgNORs remained in correlation with the number of mitoses (r= 0.3109, P= 0.0111).

ENTERIC REDMOUTH ILLNESS IN RAINBOW TROUTH (Onchorhyncus mykiss).

Oraić D, Zrnčić S, Šoštarić B.

Croatian Vet Institute.

Enteric redmouth (ERM), an acute to persistent septicemic disease affects all types of salmonids and is brought on by the germs Yersinia ruckeri from the household Enterobacteraceae. Losses brought on by this disease may rise to 70% of general losses in all salmonid fish ranch and 25% of the fish can be infected yet asymptomatic. The bacteria Yersinia ruckeri was separated from unhealthy rainbow trout having scientific appearance of ERM at a number of fish ranches in Croatia. The goal is to describe medical habits, pathological modifications as well as bacteriological searchings for of endophtalmitis as well as encephalitis identified by visibility of microbial organism compatible with Yersinia ruckeri. The skin of damaged fish was darkly pigmented, with independent or bilateral exophtalmia. They swam slowly, near the water surface, and were divided from the rest of the great deal. A few of impacted fish provided noticeable CNS signs, such as slow-moving convulsice swimming. Reaction to excitement of any type (such as feeding or alarm response) were significantly reduced. On pathoanatomical assessment marbled liver, transparent as well as hemorrhaged intestines, articulated hemorrhage on swim bladder as well as bigger spleen were most consistent searchings for.

COMPARISON OF NUMERIC AS WELL AS VOLUME THICKNESS OF APOPTOTIC BODIES WITH FREQUENCY OF APOPTOTIC BODIES IN 10 HPF IN PROSTATIC HYPERPLASIA.

• Heinzl R, Banek Lj, Belicza M.
• University Hospital Dubrava, Zagreb, Croatia.

As a controlling system of set cell death, apoptosis is important factor in cells development kinetics, not only in tumors yet also in typical and hyperplastic transformed cells. This procedure can be promote or stopped by countless endogenous and also exogenous elements which are (the majority of them, most likely) in direct link with cells proliferative task, controlled by in this manner. Apoptosis is morphologically in light microscopy clearly noticeable as apoptotic cell or apoptotic body – round or oblong acidophylic cell or body containing nuclear pieces as basophilic particles – so it is available to morphologic as well as quantitative analysis.

Considering apoptosis as a process corresponding to mitotic task, it is clear that examination of “apoptotic index” must be of useful relevance in evaluation of tissue growth kinetics (particularly in tumours as well as hyperplastic tissues) and in following up its deadly or premalignant potentia) – just as mitotic index currently is.

For everyday regular practice, it is important for treatment of examining “apoptotic index” to be adequate trusted and also fast (and also inexpensive) versus reasonably difficult and also slow-moving stereologic techniques (reviewing of numeric or quantity thickness, for example). lmage – evaluation is still readily available for a couple of pathohistologic research laboratories. This trouble can be settled extremely merely – by counting apoptotic bodies in 10 HPF – equally as for mitotic index. Because these are complementary specifications, in this way they should be contrasted rather well.

ln this job we compared outcomes of counting apoptotic bodies in 10 HPF with results of assessing numeric as well as quantity densities in hyperplastic prostate – glandular, basal and also atypical (P1N II) kind of hyperplasia. Numeric and also quantity densities were greatest in basic hyperplasia group, something lower however statistically considerable in PIN 11 as well as the most affordable in easy glandular team.

Very same outcomes we obtained by counting apoptotic bodies in 10 HPF. Our outcomes validate integrity of this technique of “apoptotic index” reviewing; so we suggest to employ this term as well as this approach of its assessing in routine practice.

LITERARY WORKS:.

1. Kyprianou N, Tu H, Jacobs SC. Apoptotic versus proliferative tasks in human benign prostatic hyperplasia. Hum Pathol 1996; 27( 7 ); 668-75.
2. Baličević D. The relevance of apoptotic bodies look in prostatic hyperplasia and also cancer. (Magisterij) Zagreb: Medicinski fakultet Sveučilišta u Zagrebu, 1993. 108 str.
3. Šarčević B, Belicza M, Šeparović V. Apoptosis in bust cancer. Libri Oncol 1992; 21( 12 )43-8.
4. Heinzl R. Assessment of apoptosis in hyperplastic prostata. (Magisterij, u izradi).