Browsing by Author "Šaponjski, Dušan (57193090494)"

Background and Objectives: Cervical squamous cell carcinoma (SCC) usually showed an infiltrative growth pattern into endocervical stroma. In rare cases, SCC spreads superficially as an intraepithelial lesion to proximal uterine segments, and more rarely, involves invasive and more aggressive behavior on secondary sites. Materials and Methods: In this study, we present the case of an interesting form of cervical SCC growth and we discuss the possible reasons for that presentation. Results: After clinical examination and repeated histomorphological analysis, we found remarkable cervical epithelial dysplasia (a high-grade squamous intraepithelial lesion-H-SIL). A histopathology report after conization and hysterectomy showed squamocellular carcinoma with microinvasive focuses. Interestingly, squamocellular carcinoma was found in the proximal uterine and adnexal structure, as well as intraepithelial and microinvasive lesions. Conclusions: Our study described a rare presentation of primary cervical SCC with unusual adnexal involvement. This pattern of tumor growth should be especially considered for patients who are proposed for sparing surgical procedures. A detailed and multidisciplinary approach for every patient is very important because unpredictable cases are present. However, they are rare.

Introduction Primary Non-Hodgkin lymphoma of the liver is an extremely rare disease. It most often occurs as a diffuse large B-cell type. Case outline We present the case of a 75-year-old patient who was admitted to our clinic with rightsided subcostal pain accompanied by malaise, weakness, and elevated body temperature. Laboratory analyzes were within normal limits. Ultrasonography and computed tomography findings showed a sharply marginated inhomogeneous lesion in the right liver lobe with central necrosis. Intraoperatively and pathohistologically, it was confirmed that it was diffuse large B-cell lymphoma of the liver. Surgery, chemotherapy, radiotherapy and their combination are the methods of treatment. Conclusion Surgical treatment with chemotherapy allows for a significantly higher survival rate. © 2025, Serbia Medical Society. All rights reserved.

Introduction Ectopic thyroid is a rare anomaly characterized by presence of thyroid tissue outside its normal location, which could be the consequence of developmental abnormality, sequestration of thyroid nodes from nodal thyroid goiter or mechanical implantation of thyroid tissue after resection or trauma. Ectopic thyroid is commonly incidentally detected and causes differential diagnostic dilemma towards the neck and mediastinal tumors. The object of this report was to present two types of ectopic thyroid nodes located in the upper mediastinum, incidentally discovered by computed tomography (CT). Outline of cases A hyperdense nodular lesion was found in the anterior upper mediastinum in a 42-year-old woman with adenocarcinoma of the esophagogastric junction in whom CT was performed due to staging purposes. Metastatic left supraclavicular lymph node was considered in the differential diagnosis. However, as the node was located in front of the neck fascia and just below the thyroid gland and showed similar density to thyroid tissue, the diagnosis of accessory thyroid gland was made, which was later confirmed by multiple repeated CT scans during the two-year follow-up period. In a 52-year-old woman presenting with intermittent chest pain and cough, contrast-enhanced CT scan revealed nodal thyroid goiter and three nodes of similar CT texture, located in the upper mediastinum, below the thyroid gland. Accordingly, the diagnosis of parasitic mediastinal goiter thyroid nodes was made. Conclusion Ectopic thyroid nodes are presented by CT as well-circumscribed nodes of the same density as the thyroid gland, typically located anteriorly in the upper mediastinum. © 2022, Serbia Medical Society. All rights reserved.

Introduction Positron emission tomography (PET) with computed tomography (CT) using fluorine-18-labeled fluorodeoxyglucose (18F-FDG PET/CT) is a hybrid diagnostic method based on the cell’s glucose uptake detection, which correlates with the degree of disease activity. While other diagnostic procedures fail to evaluate functional tissue,18F-FDG PET/CT can be helpful in discovering active disease in patients with vascular graft infection. Methods This cohort retrospective study included 22 patients (17 male, five female; aged 61.7 ± 16.1) with suspected vascular graft infection. Blood analyses and CT were performed in all patients. Degree of glucose uptake was evaluated visually and semiquantitatively using maximal standardized uptake value (SUVmax). Findings were considered positive if focal fluoro-deoxyglucose (FDG) accumulation was greater in vascular graft projection than other parts of the blood vessel and liver. Results The sighs of active disease were found in 19 patients (86%) (16 male, three female) at the level of implanted vascular grafts: Six aortobifemoral (27%), four aortoiliac (18.2%), four of abdominal aorta (18.2%), two of thoracic aorta (9.1%), two femoral (9.1%), one femoropopliteal (4.5%) (SUVmax 7.9 + 2.4). Two patients were considered true and one false negative- due to antibiotic usage, which reduces FDG uptake. PET/CT helped in treatment alteration of 12 patients, seven (31.8%) started new medicament therapy, five (22.7%) had a surgical graft replacement. Overall sensitivity of this method is 95%, specificity 100%, positive predictive value 100%, negative predictive value 66.6%, accuracy 95.4%. Conclusion18F-FDG PET/CT is a useful diagnostic method in detection of active vascular graft infection with high diagnostic accuracy, which is important in avoiding unnecessary surgery and appropriate therapy planning. © 2019, Serbia Medical Society. All rights reserved.

Introduction Primary, “pure” squamous cell carcinoma (SCC) is an exceptionally rare pancreatic malignancy that has been described in sporadic case reports. The appearance of this rare entity created a diagnostic dilemma for us, therefore, in this case report, we are focused on the radiological detection and characterization, pathogenesis, and therapeutic options of pure pancreatic SCC. Case outline In an 80-year-old female patient, a partially necrotic mass in the tail of the pancreas was detected by computed tomography, which is the rarest localization of this tumor. On the performed imaging, the tumor showed predominantly malignant features with a surprising definitive histopathological diagnosis in the direction of pure SCC. Distal pancreatectomy with splenectomy was performed because of the infiltration of lienal vascular structures. Conclusion Due to the very aggressive form of this tumor and poor prognosis, early detection, risk factors control, genetic burden, and optimization of surgical and therapeutic management can improve the quality of life and prolong the overall survival period. © 2024, Serbia Medical Society. All rights reserved.

Background/Aim. Segmental fractures represent com-plex tibial injuries, featuring a unique fracture type that is most commonly caused by high-energy trauma. These fractures are considered to be a treatment challenge for or-thopaedic surgeons due to their sporadic presentation, wide zone of soft tissue injury, and increased rate of com-plications. They are characterized by a highly unstable in-termediary segment and a high rate of open fractures. The method of Ilizarov with its characteristics could offer many advantages over the existing operative techniques. This method, using a percutaneous approach, minimizes the intraoperative trauma and avoids the additional com-promising of the biological environment at the fracture site. The aim of this study was to evaluate the results of the Ilizarov fixator in the treatment of segmental tibial fractures. Methods. We analyzed 30 patients treated with the Ilizarov fixator between 2012 and 2017. The average age of patients was 36 years (from 24 to 65). The most common mechanism of injury was a road traffic accident. Open fractures were noted in 22 cases. All fractures were reduced using indirect percutaneous techniques with a great focus on achieving the correct length, rotation, and axial alignment of fragments. All patients were advised to bear weight as tolerated from the second postoperative day. Bone healing and functional results were evaluated according to the criteria established by the Association for the Study and Application of the Method of Ilizarov. Re-sults. Bone healing was achieved in all patients. The aver-age time to union was 25 weeks (19 to 36 weeks). Bone results were excellent in 23 patients, good in five, and fair in two patients. Functional results were excellent in 22 cases, good in 5, and fair in three cases. Eight patients had minor pin-tract infections, successfully treated with oral antibiotics. Patients were without any major complica-tions. Conclusion. The Ilizarov method is a safe and effi-cient treatment modality for segmental tibial fractures. © 2021 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction Spontaneous cholecystoduodenal fistula is a rare complication of the gallbladder calculosis. Bowel obstruction is the complication in less than 1% of these patients. The pathognomonic triad (Rigler triad) of pneumobilia, small-bowel distention, and ectopic gallstones is typical for gallstone ileus. In only 1–3% of the patients with bowel obstruction by ectopic gallstone the localization of obstruction is in the duodenum, and it is called Bouveret syndrome. The rarest complication is a floating non-obstructing gallstone trapped in the stomach. Outline of cases We present three elderly female patients with persistent abdominal pain and known gallbladder calculosis in the patients’ histories. Plain radiography of the thorax and abdomen and ultrasound were performed as the first choice and contrast-enhanced computer tomography (CT) was done subsequently. In the first patient, CT and magnetic resonance imaging (MRI) showed signs of pneumobilia, cholecystoduodenal fistula, and the presence of the gallstone in the stomach. The iodine contrast X-ray swallow test revealed a cholecysto-duodenal bulb fistula and floating calculus in the stomach, confirmed by endoscopy. In the second patient with persistent abdominal pain, CT and barium swallow test showed signs of pneumobilia, cholecystoduodenal fistula, and two ectopic gallstones obstructing duodenum – Bouveret syndrome. The third case showed signs of the Rigler triad – typical signs of gallstone ileus. Conclusion Spontaneous cholecystoduodenal fistula is a rare condition with possible complications such as Bouveret syndrome, gallstone ileus and floating, non-obstructive gallstones in the stomach, as the rarest possible complication. CT, MRI with magnetic resonance cholangiopancreatography, as well as the contrast X-ray swallow test can be very helpful in the detection of the bilio-enteric fistula and ectopic gallstones. © 2019, Serbia Medical Society. All rights reserved.

Introduction Extremely rarely, the evolution of abdominal aortic aneurysm (AAA) includes the phase when extravasations of the blood from a ruptured aneurysm is contained by the surrounding tissue, referred to as chronic (contained) rupture of the AAA. Our aim was to call attention to this life-threatening condition, which is always challenging for diagnosis. Case outline A 58-year-old man reported to the Emergency Center for significant abdominal pain. Ultrasound examination showed an infrarenal aneurysm of the abdominal aorta. A computed tomography scan of the thorax, abdomen, and pelvis with iodine contrast in arterial phase was performed. A free gas collection was observed between the liver and the anterior abdominal wall that is traced to a ruptured inflamed diverticulum on the transversal colon. Immediately distal to the branching sites of the renal arteries, the abdominal aorta extended forward and aneurismatically expanded. Posterior left, along the psoas muscle, a rupture of the aortic wall was seen, with an organized hematoma that accompanied the muscle. Between the hematoma and the aortic aneurysm, erosions of the anterior and lateral part of the vertebral bodies L2 and L3 were discovered. The patient underwent endovascular AAA repair (EVAR) and recovered well. Conclusion Multidetector computed tomography angiography is a reliable, non-invasive, and necessary examination for localization and evaluation of the size of the AAA form, its chronic rupture, and complications such as vertebral body erosion. © 2019, Serbia Medical Society. All rights reserved.