4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

4. Hrvatski kongres 

kliniËke citologije 

4 th Croatian Congress 

of Clinical Cytology 

1. Hrvatski simpozij 

analitiËke citologije 

1 st Croatian Symposium 

of Analytical Cytology 

2. Hrvatski simpozij 

citotehnologije 

2 nd Croatian Symposium 

of Cytotechnology 

s meappleunarodnim sudjelovanjem 

with international participation 

Le Meridien Lav, Split 

October 11-14, 2009 

konaËni program i knjiga saæetaka 

final programme and abstract book

4. Hrvatski kongres kliniËke citologije 

4th Croatian Congress of Clinical Cytology 

1. Hrvatski simpozij analitiËke citologije 

1st Croatian Symposium of Analytical Cytology 

2. Hrvatski simpozij citotehnologije 

2nd Croatian Symposium of Cytotechnology 

s meappleunarodnim sudjelovanjem 

with international participation 

Le Meridien Lav, Split 

11-14. listopad 2009. 

October 11-14, 2009 

konaËni program i knjiga saæetaka / fi nal programme and abstract book 

1

4. Hrvatski kongres kliniËke citologije / 1. Hrvatski simpozij analitiËke citologije / 2. Hrvatski simpozij citotehnologije 

RIJEČ DOBRODOŠLICE 

2 

Konačni program i knjiga sažetaka 

Cijenjene kolegice i kolege, dragi prijatelji, 

Velika nam je čast i zadovoljstvo pozvati Vas u ime Organizacijskog Odbora na 

4. Hrvatski kongres citologa, 1. Hrvatski simpozij analitičke citologije i 2. Simpozij citotehnologa 

s međunarodnim sudjelovanjem koji će se održati od 11. do 14. listopada 2009. 

u Splitu. 

Neobično nam je drago što će se po prvi put u sklopu Kongresa održati i 1. Simpozij 

analitičke citologije, čime nam je pružena prilika za integraciju elemenata klasične citologije 

i citokemije, biologije, histologije, patologije, analize slike, protočne citometrije 

i informatike sa zajedničkim ciljem istraživanja stanica u znanstvene i primijenjene 

svrhe. 

Sada već utemeljeni 2. Simpozij citotehnologa je prilika za međusobnu razmjenu iskustava 

i zajednička neformalna druženja cijelog citološkog tima. 

Nadamo se da će odabir tema i aktivno sudjelovanje vrlo uglednih svjetskih i domaćih 

stručnjaka pobuditi iznimno zanimanje liječnika različitih specijalnosti koji se bave morfologijom 

ili njene rezultate koriste u svakodnevnom radu. Rad Kongresa odvijat će se 

kroz plenarna predavanja, simpozije, seminare, usmena izlaganja i poster sekcije. 

Želja nam je da iskoristimo ovaj boravak i za ugodno druženje tijekom Kongresa, u obilasku 

Splita, na izletu brodom, uz zajedničku večeru. 

Prema stranicama Turističke zajednice grada Splita, za grad u koji ćete stići, njegovi će 

vam stanovnici s puno ponosa kazati kako je “najlipši na svitu i okolici” i o tome s njima 

nemojte raspravljati, jer tisućljetni Split vedra duha koji ćete ubrzo otkriti, uvjerit će i vas 

u to! Taj vječno mladi grad s oko 200 tisuća stanovnika koji mu daju topli mediteranski 

temperament, živi svojim urbanim ritmom već 1700 godina, sa srcem u Dioklecijanovoj 

palači i dušom koja vas dočekuje raširenih ruku i srdačno. Split je kulturno, političko, 

privredno i prometno čudo u središtu Dalmacije. Grad dugogodišnje prošlosti; bilo gdje 

da zabodeš “motikom” nešto nađeš - raj za arheologe. Danas, Split je drugi grad po 

veličini u Hrvatskoj i značajno turističko odredište brojnih turista zbog svoje bogate povijesti, 

prirodnih ljepota, idealnog položaja u odnosu na brojne okolne gradiće i izletišta 

te pre lijepih plaža. 

Nadamo se da ćemo ispuniti vaša očekivanja, uz napomenu da uspjeh Kongresa ovisi i o 

vašem aktivnom sudjelovanju. 

Očekujemo vas u Splitu. 

Doc.dr.sc. Ika Kardum-Skelin 

Predsjednica, Hrvatsko društvo 

za kliničku citologiju HLZ 

Prof.dr.sc. Drago Batinić 

Predsjednik, Sekcija za 

analitičku citologiju 

Veronika Anić 

Predsjednica, Hrvatska 

udruga citotehnologa

Final programme and abstract book 

WELCOMING ADDRESS 

Dear colleagues, dear friends, 

We are honored and pleased to invite you, on behalf of the Organizing Committee, to the 

Fourth Croatian Congress of Cytology, First Croatian Symposium of Analytical Cytology, 

and Second Symposium of Cytotechnologists with International Participation to be held 

on October 11-14, 2009 in Split, Croatia. 

We are very glad that the First Croatian Symposium of Analytical Cytology is organized 

within the scope of the Congress, thus providing an opportunity to integrate the elements 

of classic cytology and cytochemistry, biology, histology, pathology, image analysis, flow 

cytometry and informatics, with a common endpoint of cell research for scientific and 

applied purposes. 

The already established Second Symposium of Cytotechnologists offers an additional 

opportunity for experience exchange and informal meetings of the cytologic team as a 

whole. 

We do hope that the topics selected and active participation of renowned international 

and Croatian experts will arouse great interest among physicians of various specialties 

involved in morphology or using these results in their daily routine. The work of the Congress 

will include plenary lectures, symposia, seminars, oral presentations and poster 

sections. 

It is our wish to use part of the time for pleasant contacts during the Congress and for 

Split sight-seeing including boat excursion and dinner. 

As the Split Tourist Office website says, the citizens will be proud to present Split as 

“the most beautiful town in the world and its surroundings”, and you are advised not 

to challenge this statement because the millennial Split of alert and keen spirit you 

will readily feel will certainly make you believe it. This forever young town with about 

200,000 inhabitants of warm, Mediterranean mentality has been living its urban rhythm 

for more than 1700 years now, with its heart rooted in the famous Palace of Diocletian 

and its soul embracing you sincerely and heartily. Split is a cultural, political, economic 

and communications miracle in the center of Dalmatia, a town of long-standing history; 

dig wherever you want, you will find some relic - paradise for archeologists. Today, Split 

is the second largest city in Croatia and an important tourist destination for numerous 

tourists because of its rich history, natural beauties, and ideal position relative to the 

many picturesque places, excursion resorts and beautiful beaches in its surroundings. 

We do hope that we will meet your expectations, however, the full success of the Congress 

will also depend on your active participation. 

We look forward to meet you in Split. 

Assist. Prof. Ika Kardum-Skelin, PhD 

President, Croatian Society 

for Clinical Cytology 

Professor Drago Batinić, PhD 

President, Section for 

Analytical Cytology 

Veronika Anić, Cytotechnologist 

President, Croatian Society 

for Cytotechnology 

3 

4 th Croatian Congress of Clinical Cytology / 1 st Croatian Symposium of Analytical Cytology / 2 nd Croatian Symposium of Cytotechnology


ORGANIZATORI / ORGANIZERS 

Akademija medicinskih znanosti Hrvatske 

Academy of Medical Sciences of Croatia 

Hrvatski liječnički zbor 

Croatian Medical Association 

Hrvatsko društvo za kliničku citologiju 

Croatian Society for Clinical Cytology 

Sekcija za analitičku citologiju 

Section for Analytical Cytology 

Hrvatska udruga citotehnologa 

Croatian Society of Cytotechnology 

Klinička bolnica Merkur, Zagreb 

University Hospital Merkur, Zagreb 

POKROVITELJI / UNDER THE AUSPICES OF 

Predsjednik Republike Hrvatske 

President of the Republic of Croatia 

Ministarstvo znanosti, obrazovanja i športa Rebublike Hrvatske 

Ministry of Science, Education and Sport of the Republic of Croatia 

Ministarstvo zdravstva i socijalne skrbi Rebublike Hrvatske 

Ministry of Health and Social Welfare of the Republic of Croatia 

Hrvatska liječnika komora 

Croatian Medical Chamber 

Grad Split 

City of Split 

Sveučilište u Splitu i Medicinski fakultet Sveučilišta u Splitu 

University of Split and University of Split School of Medicine 

Klinički bolnički centar Split 

Clinical Hospital Center Split 

POČASNI ODBOR / HONORARY COMMITTEE 

S. Anđelinović S. Audy-Jurković D. Boban 

I. Črepinko H. Harambašić T. Jeren 

M. Marinković M. Mazzi-Maržić M. Nakić 

Z. Papić I. Pongrac M. Roglić 

Z. Singer T. Stanković Đ. Šips 

B. Vukosavić-Cimić Ž. Znidarčić 

4 

Konačni program i knjiga sažetaka


ZNANSTVENI ODBOR / SCIENTIFIC COMMITTEE 

A. Batinica-Grgurević S. Boljkovac S. Ćurić-Jurić 

M. Dominis M. Drobnjak F. Gizdić 

B. Ivezić A. Knežević-Obad G. Kocjan 

R. Kušec Z. Mandić M. Marković-Glamočak 

A. Ovanin-Rakić M. Pajtler F. Selmani 

M. Sučić K. Trutin Ostović A. Vince 

ORGANIZACIJSKI ODBOR / ORGANIZING COMMITTEE 

Predsjednici / Presidents 

I. Kardum-Skelin D. Batinić V. Anić 

Dopredsjednici / Vice presidents 

V. Mahovlić 

K. Rubić 

Tajnici / Secretaries 

B. Molnar Stantić D. Šundov 

L. Škopljanac-Mačina 

Lj. Gavranović 

Rizničari / Treasurers 

B. Jelić-Puškarić R. Lasan-Trčić 

J. Antulov 

Članovi / Members 

S. Smojver-Ježek M. Švigir 

R. Beljan S. Cuvaj I. Fabijanić 

S. Harabajsa G. Kaić G. Knežević 

S. Kojić-Katović A. Krupec N. Mateša 

Z. Miletić M. Piljić-Burazer V. Ramljak 

I. Seili-Bekafigo Z. Šiftar D. Vrdoljak-Mozetič 

I. Zaneta S. Židovec-Lepej 

STRUČNI PROGRAM KONGRESA / SCIENTIFIC PROGRAMME 

Kongres će se odvijati u obliku plenarnih predavanja, simpozija, slide seminara, usmenih 

i poster prezentacija. 

The Congress presentations will include plenary sessions, symposiums, slide seminars, 

papers sessions and posters displays. 

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6 


UPUTE ZA PREDAVAČE / INSTRUCTION FOR SPEAKERS 

Prezentacija/Presentation 

Domaći predavači prezentaciju pripremaju na hrvatskom jeziku za sve oblike prezentacija, 

osim za postere koji mogu biti i na engleskom. Strani predavač pripremaju prezentacije 

na engleskom bez simultanog prevođenja na hrvatski. / Speakers from Croatia 

should prepare their presentation in Croatian language for all Presentation Formats 

except Poster Presentation. Foreign speakers should prepare their presentation in English 

(there will be no no simultaneous translation) 

Predavači se mole da pripreme svoje predavanje najmanje 1 sat prije predviđenog termina 

za prezentaciju. Soba za pripremu predavanja biti će otvorena dnevno od 8.00 do 19.00 sati. 

/ Speakers are kindly asked to prepare their computer presentations at least one hour 

before their lecture. Preparation room will be open daily from 8.00 a.m. to 7.00 p.m. 

Poster prezentacije / Poster presentations 

Posteri će biti izloženi na vidljivom jestu u kongresnom prostoru na panoima bijele boje, 

veličine 1m (širina) x 2m (visina). Dimenzije postera: 0,8 m (širina) x 1,2 m (visina).Posteri 

se donose osobno na Kongres. Materijal za ljepljenje postera osigurava organizator. / 

Posters will be displayed in the exhibition area on white poster panelling, 1m wide x 2m 

high. Posters would be 0.80 m wide x 1,2 m high. The authors will bring the posters in 

person. Supplies for mounting of posters will be provided by the Congress Service. 

PRIJAVA NA KONGRESU / REGISTRATION AT DESK 

Sudionici se mogu prijaviti na registracijskom mjestu u vrijeme: / The Congress Registration 

desk will be open for on-site registration at the following times: 

- nedjelja, 11. listopada 2009. / Sunday, October 11, 2009 

- ponedjeljak, 12. listopada 2009. / Monday, October 12, 2009 

- utorak, 13. listopada 2009. / Tuesday, October 13, 2009 

- srijeda, 14. listopada 2009. / Wednesday, October 14, 2009 

KOTIZACIJE / REGISTRATION FEES 

od 31. kolovoza 2009. i na mjestu održavanja 

after August 31st Specijalisti / Specialists 

, 2009 and on the site 

1.500,00 kn 

Specijalizanti i studenti / Residents and students 1.000,00 kn 

Citotehnolozi / Cytotechnologists 900,00 kn 

Dnevna kotizacija / Day registration fee 800,00 kn 

Radionice / Workshops 

U iznose je uključen PDV (23%) / VAT (23%) is included 

300,00 kn


Trodnevna kotizacija uključuje / Full registration fee includes: 

• nazočnost stručnom programu Kongresa 

admission to all congress sessions, poster and exhibition areas 

• kongresne materijale (konačni program, Knjiga sažetaka, kongresna torba 

congress materials (Final programme, Abstract book, congress bag) 

• nazočnost na svečanom otvorenju Kongresa, domjenku dobrodošlice / admission to 

the Opening Ceremony, Welcome party 

Jednodnevna kotizacija uključuje / Daily registration fee includes: 

• nazočnost stručnom programu Kongresa 

admission to all congress sessions, poster and exibition areas 

• kongresne materijale ( Konačni program, Knjigu sažetaka) 

congress materials (Final programme, Abstract book) 

OPĆE INFORMACIJE / GENERAL INFORMATION 

Mjesto održavanja Kongresa / Congress Venue 

HOTEL LE MERIDIEN LAV, Podstrana (Split), Hrvatska / Croatia 

Službeni jezik / Official Language 

Službeni jezik Kongresa je hrvatski i engleski (simultano prevođenje neće biti osigurano) 

Official languages are Croatian and English (the simultaneus translation will not be provided). 

Službene oznake / Official Badges 

Sudionici Kongresa i osobe u pratnji s plaćenom kotizacijom dobivaju prilikom prijave 

identifikacijsku karticu (kongresni bedž) s imenom koju su obvezni nositi na svim mjestima 

službenog radnog dijela Kongresa. / After paying the registration fee, all participants 

and accompanying persons will receive their name congress badges. Participants are 

kindly requested to wear the badges at all times and places during the official Congress 

Program. 

Potvrda o sudjelovanju / Attendance Certificate 

Svi sudionoci Kongresa s plaćenom kotizacijom dobit će verificiranu Potvrdu o sudjelovanju. 

Temeljem Pravilnika o trajnom usavršavanjem Hrvatske liječničke komore, sudjelovanje 

liječnika na Kongresu bodovno će se vrednovati. / A Certificate of Attendance will be issued to 

all registered participants. Active participation at the Congress will be valuated with points. 

7 



Izložbe / Exhibition 

Za cijelo vrijeme trajanja Kongresa, u kongresnim prostorima bit će postavljena izložba 

medicinske opreme i potrošnog materijala. Tvrtke zainteresirane za takav način 

promidžbe neka se obrate tehničkom organizatoru kongresa. / During the Congress, 

an exhibition of medical equipment, instruments and material will be organised in the 

exhibit space of the hotel. Companies interested in advertising their products should 

contact the Congress Technical Organizer PENTA PCO. 

Društvena događanja / Social Events 

Nedjelja, 11. listopada 2009. / Sunday, October 11th 2009 

17:45 Razgledavanje Splita / Tour Split 

20:00 Svečano otvorenje Kongresa / Opening Ceremony 

i / and Domjenak dobrodošlice / Welcome party 

(Split - Dioklecijanovi podrumi) / (Split - The cellars of the Diocletian’s Palace) 

Ponedjeljak, 12. listopada 2009. / Monday, October 12th 2009 

20:00 Svečana večera / Get Together Dinner 

Cijena svečane večere 500 kuna (cca 65 EUR) po osobi 

The price of Get Together Dinner: 65 EUR per person 

Utorak, 13. listopada 2009. / Tuesday, October 13th 2009 

Izlet brodom i domjenak na Brodu / Excursion by Boat and Cocktail 

Split -Kaštela-Trogir-Split 

8 

Konačni program i knjiga sažetaka


ZAHVALA / ACKNOWLEDGEMENTS 

Organizacijski odbor i Tehnički organizator zahvaljuju sponzorima i pokroviteljima koji 

su ovaj kongres te njegov stručni i društveni program učinili ostvarivim. / Organizing 

Comittee and Techical Organizer would like to express their gratitude to sponsors and 

donators who made this Congress and its scientific and social events possible. 

GLAVNI SPONZOR 

Klinička bolnica Merkur, Zagreb 

ZLATNI SPONZORI 

Grad Split 

Pliva Hrvatska d.o.o. 

SPONZORI / SPONSORS 

A & B d.o.o. 

Abbott Laboratories d.o.o 

Auto Hrvatska 

Grad Split 

Jadroplov d.d. 

Kamenoklesarski obrt Cvitković 

Klinička bolnica “Merkur” 

Medical Intertrade d.o.o. 

Merck d.o.o. 

Ministarstvo zdravstva i socijalne skrbi RH 

Ministarstvo znanosti obrazovanja i športa RH 

Olympus d.o.o. 

Pliva Hrvatska d.o.o. 

Poliklinik CITO 

Privatna specijalistička ordinacija medicinske citologije - 

dr.med. Branka Molnar Stantić, spec. medicinske citologije 

Roche d.o.o. 

Sonimed d.o.o. 

Tamiko Instruments d.o.o. 

DONATORI / DONATORS 

KUD “7 Kaštela” 

KUD “Pleter” 

Muška klapa “Šušur”, Split 

Plovput d.d. 

Poliklinika J&J Medici 

Privatna specijalistička ordinacija medicinske citologije - 

dr.med. Ivan Anđelko Lisec, spec. medicinske citologije 

Sretno d.o.o. 

Turistička zajednica grada Kaštela 

Turistička zajednica grada Splita 

ZYN BAND, Sinj 

Ženska klapa “Marjan”, Split 

9

Final programme and abstract book


12 

NEDJELJA 11.10.2009. PONEDJELJAK, 12.10.2009. 

Sunday 11th October Monday 12th October

UTORAK, 13.10.2009. SRIJEDA, 14.10.009. 

Tuesday 13th October Wednesday 14th October 

13 



program 

programme 

15 



NEDJELJA , 11.10.2009. / SUNDAY, October 11, 2009 

8,00-10,00 REGISTRACIJA / REGISTRATION 

10,00-10,30 PAUZA / BREAK 

16 


DVORANA 1/ HALL 1 (Grand Dalmacija) 

OKRUGLI STOL / ROUND TABLE 

Citologija u primarnoj zaštiti djece i odraslih / 

Cytology in Primary Health Care of Children and Adults 

Predsjedavajući/Chairpersons: Znidarčić Ž, Jeren T, Vince A 

10,30-13,00 CYTOLOGY IN PRIMARY HEALTH CARE OF CHILDREN AND ADULTS 

Jeren T, Kaić G, Kardum-Skelin I, Knežević-Obad A, Smojver-Ježek S, 

Vince A (Moderator: Znidarčić Ž) 

13,00-14,00 RUČAK / LUNCH 

PRIKAZI SLUČAJEVA / CASE REPORTS 

Specijalizanti / Residents 

Predsjedavajući/Chairpersons: Jelić Puškarić B, Beljan R, Miličić-Juhas V 

16,00-16,10 VILLOGLANDULAR PAPILLARY ADENOCARCINOMA OF THE UTERINE 

CERVIX WITH AGGRESSIVE CLINICAL COURSE - A CASE REPORT 

Rubeša-Mihaljević R, Vrdoljak-Mozetič D, Verša Ostojić D, 

Štemberger-Papić S, Sindik N, Krašević M (Rijeka, Croatia) 

16,10-16,20 PNEUMOCYSTIS CARINII IN THE TRANSBRONCHIAL LUNG BIOPSY 

IMPRINT OF THE PATIENT NOT KNOWN TO BE HIV INFECTED - 

CASE REPORT 

Juroš Z, Smojver Ježek S, Vrabec Branica B, Alerić I, Križanac Š 

(Zagreb, Croatia) 

16,20-16,30 DIFFUSE LARGE B-CELL LYMPHOMA IN PATIENT AFTER TREATMENT 

OF ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA 

Džeko-Škugor N, Perić Z, Vrhovac R, Radić-Krišto D, Kardum-Skelin I, 

Jakšić B (Šibenik, Zagreb, Croatia) 

16,30-16,40 FINE NEEDLE ASPIRATION CYTOLOGY OF 

ADRENOCORTICAL CARCINOMA: CASE REPORT 

Mišić M, Vidas Ž, Škegro D, Kocman B, Jelić-Puškarić B, 

Kardum-Skelin I (Slavonski Brod, Zagreb, Croatia) 

16,40-16,50 T-LYMPHOBLASTIC LYMPHOMA WITH AN UNUSUAL 

t(8;14)(q24;q11) - CASE REPORT 

Mandac I, Ostojić-Kolonić S, Vrhovac R, Lasan-Trčić R, 

Jakelić-Piteša J, Kardum-Skelin I (Zagreb, Split, Croatia)


16,50-17,00 T LYMPHOBLASTIC LEUKEMIA WITH AN UNUSUAL BURKITT 

LYMPHOMA MORPHOLOGY - A CASE REPORT 

Milas M, Jelić Puškarić B, Planinc-Peraica A, Šiftar Z, Kardum-Skelin I, 

Jakšić B (Zagreb, Croatia) 

17,00-17,10 AN UNUSUAL PRESENTATION OF GAUCHER’S DISEASE: AORTIC 

VALVE FIBROSIS IN A PATIENT HOMOZYGOUS FOR A RARE G377S 

MUTATION - A CASE REPORT 

Perić Z, Kardum-Skelin I, Jelić-Puškarić B, Letilović T, Vrhovac R, 


17,10-17,20 RASPRAVA / DISCUSSION 

DVORANA 2/ HALL 2 (BRAČ I) 

RADIONICE / WORKSHOPS 

10,00-17,45 

Pulmološka citologija - Karcinomi pluća / Pulmonary Cytology - Lung carcinoma 

Smojver-Ježek S, Vrabec-Branica B 

Urološka citologija / Urocytology 

Trutin Ostović K, Novak N-P 

18,00-19,30 RAZGLEDAVANJE SPLITA / TOUR-SPLIT 

20,00 OTVORENJE KONGRESA / OPENING CEREMONY 

Podrumi Dioklecianove palače, Split / Diocletian’s cellars, Split 

KOKTEL DOBRODOŠLICE / WELCOME PARTY 

POSTERI / POSTERS 

SPECIJALIZANTI / RESIDENTS 

P1. SEPTIC ARTHRITIS DUE TO STREPTOCOCCUS SANGUIS 

Mandac I, Prkačin I, Sabljar Matovinović M (Zagreb, Croatia) 

P2. APOPTOSIS OF LEUKEMIC CELLS - A CASE REPORT 

Vrbanus LJ, Sučić M, Marković-Glamočak M, Ries S,Gjadrov Kuveždić K, 

Fabijanić I, Antulov J, Labar B (Zagreb, Croatia) 

17 



PONEDJELJAK, 12.10.2009. / MONDAY, October 12, 2009 

18 



PLENARNA PREDAVANJA / PLENARY SESSION 

Predsjedavajući / Chairpersons: Audy-Jurković S, Mahovlić V 

08,30-09,00 WHY, HOW AND FOR WHAT BENEFIT INTEGRATING MOLECULAR 

TECHNIQUES INTO BREAST CYTOPATHOLOGY? 

Vielh P (Villejuif CEDEX - France) 

09,00-09,30 BENEFITS OF LBC OVER CONVENTIONAL PAP TEST, PRESENT 

AND FUTURE 

Verhest A (Brussels, Belgium) 

9,30-10,00 RISK-ADAPTED MULTIMODAL LABORATORY CERVICAL SCREENING - 

PAP TEST OF THE FUTURE? 

Bollmann R (Bonn-Duisdorf, Germany) 

10,00-10,30 PAUZA / BREAK 

SIMPOZIJ - Ginekološka citologija vrata maternice / 

SYMPOSIUM - Gynecological Cytology-Uterine Cervix 

I. Predsjedavajući / Chairpersons: Audy-Jurković S, Ćorušić A, Grce M 

10,30-10,45 CERVICAL CANCER AS A PUBLIC HEALTH ISSUE - WHAT NEXT? 

Ćorušić A, Škrgatić L, Mahovlić V, Mandić V, Planinić P, Karadža M 

(Zagreb, Mostar, Croatia, Bosna and Herzegovina) 

10,45-11,00 ROLE OF HPV TESTING IN CERVICAL CANCER PREVENTION 

Grce M (Zagreb, Croatia ) 

11,00-11,08 CERVICAL CANCER SCREENING PROGRAMME IN 

PRIMORSKO-GORANSKA COUNTY, CROATIA 

Vrdoljak-Mozetič D, Verša Ostojić D, Štemberger-Papić S, Janković S, 

Glibotić-Kresina H, Brnčić-Fischer A, Benić-Salamon K 

(Rijeka, Opatija, Croatia) 

11,08-11,16 CERVIX CANCER SCREENING IN CROATIA WITHIN THE EUROPEAN 

CERVICAL CANCER PREVENTION WEEK 

Škopljanac-Mačina L, Mahovlić V, Ovanin-Rakić A, Barišić A, 

Rajhvajn S, Jurič D, Babić D, Ćorušić A, Orešković S (Zagreb, Croatia) 

11,16-11,24 PAP TEST - WITH OR WITHOUT VAGINAL SMEAR? 

Miličić-Juhas V, Perić M, Pajtler M, Prvulović I, Čuržik D 

(Osijek, Slavonski Brod, Croatia) 

11,35-11,45 PAUZA / BREAK


II. Predsjedavajući / Chairpersons: Babić D, Pajtler M, Vrdoljak-Mozetič D 

11,45-12,00 ASSESSMENT OF HPV DNA TEST VALUE IN MANAGEMENT WOMEN 

WITH CYTOLOGICAL FINDINGS OF ASC-US, CIN1 AND CIN2 

Pajtler M, Miličić-Juhas V, Milojković M, Topolovec Z, Čuržik D, 

Mihaljević I (Osijek, Croatia) 

12,00-12,15 CONFIRMATION OF CIN I 

Babić D (Zagreb, Croatia) 

12,15-12,23 IS THE HSIL SUBCLASSIFICATION CYTOLOGICALLY REAL AND 

CLINICALLY JUSTIFIED? 

Miličić-Juhas V, Pajtler M (Osijek, Croatia) 

12,23-12,31 LIQUID-BASED CYTOLOGY - NEW POSSIBILITIES IN THE DIAGNOSIS 

OF CERVICAL LESIONS 

Jurič D, Mahovlić V, Rajhvajn S, Ovanin-Rakić A, Škopljanac-Mačina L, 

Barišić A , Šamija Projić I, Babić D, Suša M, Ćorušić A, Orešković S 


12,31-12,39 ESTIMATING CLINICAL OUTCOME OF HPV INDUCED CERVICAL 

LESION BY COMBINATION OF CAPSID PROTEIN L1 AND P16INK4a 

PROTEIN DETECTION 

Krivak Bolanča I, Šentija K, Katalenić Simon S, Kukura V, Vraneš J 


12,39-12,47 EVALUATION OF THE HPV L1 CAPSID PROTEIN IN PROGNOSIS OF 

MILD AND MODERATE DYSPLASIA OF THE CERVIX UTERI 

Štemberger-Papić S, Vrdoljak-Mozetič D, Verša Ostojić D, 

Rubeša-Mihaljević R, Markanjević T, Rešetar R, Manestar M 

(Rijeka, Croatia) 

13,00-14,00 RUČAK / LUNCH 

PLENARNA PREDAVANJA / PLENARY SESSION 

Predsjedavajući / Chairpersons: Znidarčić Ž, Kardum-Skelin I 

14,00-14,30 FINE NEEDLE ASPIRATION CYTOLOGY OF THE PANCREAS: A GUIDE 

TO DIAGNOSTIC APPROACH 

Kocjan G (London, United Kingdom) 

14,30-15,00 MORPHOLOGICAL AND MOLECULAR ANALYSIS OF GISTS ON 

CYTOLOGY 

Schmitt FC (Porto, Portugal) 

15,00-15,30 IMPLEMENTATION OF MODERN TECHNIQUES IN FNA OF THE 

THYROID 

Tötsch M (Essen, Germany) 

19 



SIMPOZIJ - Citologija štitnjače, glave i vrata / 

SYMPOSIUM - Thyroid and Head & Neck Cytology 

Predsjedavajući / Chairpersons: Mateša N, Knežević-Obad A, Markov D 

20 


16,00-16,15 THYROID FINE NEEDLE ASPIRATION IN PATIENTS UNDER 18 YEARS: 

A CLINICO-CYTOLOGIC STUDY 

Moslavac S, Mateša N, Kusić Z (Zagreb, Croatia) 

16,15-16,30 DIAGNOSTIC PITFALLS IN PARATHYROID GLAND CYTOLOGY 

Knežević-Obad A, Tomić-Brzac H, Žarković K, Dodig D (Zagreb, Croatia) 

16,30-16,45 ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION OF PARATHYROID 

LESIONS 

Fuštar-Preradović Lj (Slavonski Brod, Croatia) 

16,45-17,00 FINE NEEDLE ASPIRATION CYTOLOGY IN THE EVALUATION OF 

PAROTID GLAND TUMORS 

Belušić Gobić M, Pedisić D, Seili Bekafigo I, Cerović R, Starčević R, 

Manestar D, Juretić M (Rijeka, Croatia) 

17,00-17,15 THE VALUE OF CYTOLOGICAL SMEAR IN EVALUATION OF HEAD AND 

NECK NON-MELANOMA SKIN CANCER 

Pastorčić Grgić M, Ramljak V, Šarčević B, Gršić K, Pegan A (Zagreb, Croatia) 

17,30-17,45 PAUZA / BREAK 

SIMPOZIJ - Citologija gastrointestinalnog trakta / 

SYMPOSIUM - Gastrointestinal Cytology 

Predsjedavajući / Chairpersons: Štoos-Veić T, Kojić Katović S, Jelić-Puškarić B 

17,45-18,05 THE ROLE OF ENDOSCOPIC ULTRASOUND IN EVALUATION OF 

GASTRIC SUBEPITHELIAL LESIONS 

Pavić T, Hrabar D, Duvnjak M (Zagreb,Croatia) 

18,05-18,25 ENDOSCOPIC ULTRASOUND IN EVALUATION OF SOLID PANCREATIC 

MASSES - CURRENT STATE AND REWIEV OF THE LITERATURE 

Tadić M, Štoos-Veić T, Vukelić-Marković M, Ćurić J, Banić M, 

Čabrijan Ž, Grgurević I, Kujundžić M (Zagreb,Croatia) 

18,25-18,40 A CORRELATIVE STUDY OF HISTOLOGY AND IMPRINT CYTOLOGY OF 

GASTRIC MUCOSA BYOPSY IN THE DIAGNOSIS OF GASTRIC CANCER 

Fuštar Preradović Lj (Slavonski Brod,Croatia) 

18,40-18,55 BILIARY BRUSH CYTOLOGY FOR THE DIAGNOSIS OF MALIGNANCY: 

A SINGLE CENTER EXPERIENCE 

Štoos-Veić T, Bilić B, Kaić G, Trutin Ostović K, Babić Ž, 

Kujundžić M (Zagreb,Croatia)


18,55-19,10 TREATMENT OUTCOMES OF HEPATOCELLULAR CARCINOMA PROVEN 

BY FINE NEEDLE ASPIRATION CYTOLOGY: A SINGLE CENTER 

EXPERIENCE. 

Mrzljak A, Čolić Cvrlje V, Kardum-Skelin I, Škegro D, 

Filipec-Kanižaj T, Šušterčić D (Zagreb,Croatia) 


20,00 SVEČANA VEČERA / CONGRESS DINNER 


SIMPOZIJ - Pulmološka citologija / SYMPOSIUM - Pulmonary cytology 

Presjedavajući /Chairpersons: Šokčević M, Vrabec-Branica B, Smojver-Ježek S 

10,30-10,45 LUNG LAVAGE CELL PROFILES IN DIFFUSE LUNG DISEASE 

Peroš-Golubičić T, Smojver-Ježek S (Zagreb, Croatia) 

10,48-11¸00 LYMPHOMATOID GRANULOMATOSIS IN A 23-YEAR-OLD MAN- 

CYTOLOGICAL AND HYSTOLOGICAL TYPING AND RAPID RESPONSE 

TO STEROID AND CYCLOPHOSPHAMIDE 

Rakušić N, Krmpotić D, Hećimović A, Boras Z, Vrabec-Branica B, 

Džebro S, Rakušić N, Rašković T (Zagreb, Rijeka, Croatia) 

11,03-11,18 MORPHOMETRIC AND DNA IMAGE ANALYSIS OF 

BRONCHOALVEOLAR LAVAGE FLUID MACROPHAGES NUCLEI IN 

INTERSTITIAL LUNG DISEASES WITH LYMPHOCYTIC ALVEOLITIS 

Smojver-Ježek S, Peroš-Golubičić T, Tekavec-Trkanjec J, Alilović M, 

Vrabec-Branica B, Juroš Z, Mažuranic I (Zagreb, Croatia) 

11,21-11,33 NECROTISING SARCOID GRANULOMATOSIS OF THE SPINAL CORD: 

CASE REPORT 

Vrbica Ž, Boras Z, Rakušić N, Smojver-Ježek S, Baričević D, 

Rakušić N, Alerić I (Dubrovnik, Zagreb, Croatia) 

11,36-11,51 DETECTION OF HUMAN PAPILLOMAVIRUSES TYPE 16, 18 AND 33 IN 

BRONCHIAL ASPIRATES OF LUNG CARCINOMA PATIENTS BY 

POLYMERASE CHAIN REACTION: A STUDY OF 84 CASES IN CROATIA 

Vrabec Branica B, Smojver-Ježek S, Juroš Z, Grgić S, Srpak N, 

Mitrečić D, Gajović S (Zagreb, Croatia) 

11,54-12,06 METASTASES ON RARE LOCATIONS AS INITIAL MANIFESTATIONS OF 

NON-SMALL CELL LUNG CARCINOMA: TWO CASE REPORTS 

Lozić AAB, Besser Silconi Ž, Mišljenović N (Pula, Croatia) 

13,00-14,00 RUČAK / LUNCH 

21 



22 


SIMPOZIJ - Ginekološka citologija / SYMPOSIUM - Gynecological Cytology 

Predsjedavajući / Chairpersons: Grubišić G, Ovanin-Rakić A, Mahovlić V 

16,00-16,15 CYTOLOGIC FOLLOW-UP IN WOMEN WITH CIN TREATED BY LETZ, 

COLD KNIFE CONISATION AND SEMM’S COLD COAGULATION 

Grubišić G, Kraljević Z, Vukosavić-Cimić B, Pirkić A, Grbavac I, 

Bolanča I (Zagreb, Croatia) 

16,15-16,23 CERVICAL CYTOLOGY AND HPV TEST IN FOLLOW-UP AFTER 

CONISATION OR LLETZ 

Verša Ostojić D, Vrdoljak-Mozetič D, Štemberger-Papić S, Finderle A, 

Eminović S (Rijeka, Croatia) 

16,23-16,31 CYTOLOGY OF CERVICAL INTRAEPITHELIAL GLANDULAR LESIONS 

Ovanin-Rakić A, Mahovlić V, Audy-Jurković S, Barišić A, 

Škopljanac-Mačina L, Jurič D, Rajhvajn S, Ilić-Forko J, Babić D, 

Folnović D, Kani D (Zagreb, Croatia) 

16,31-16,39 DIGITAL MORPHOMETRY OF CYTOLOGIC ASPIRATE ENDOMETRIAL 

SAMPLES 

Mahovlić V, Ovanin-Rakić A, Škopljanac-Mačina L, Barišić A, 

Rajhvajn S, Jurič D, Šamija I, Ilić-Forko J, Babić D, Škrablin-Kučić S, 

Božikov J (Zagreb, Croatia) 

16,39-16,47 ALCOHOL SCLEROSING OVARIAN CYSTIC LESIONS, 20 YEARS EXPERIENCE 

Kukura V, Krivak Bolanča I, Šentija K, Katalenić Simon S 


16,47-16,55 EXPRESSION OF KI-67, P53 AND PROGESTERONE RECEPTORS IN 

UTERINE SMOOTH MUSCLE TUMORS. DIAGNOSTIC VALUE 

Petrović D, Babić D, Ilić Forko J, Martinac I (Zagreb, Croatia) 

16,55-17,00 CYTOLOGIC CHARACTERISTICS OF ADENOID CYSTIC CARCINOMA 

OF THE CERVIX UTERI - CASE REPORT 

Barišić A, Mahovlić V, Ovanin-Rakić A, Škopljanac-Mačina L, 

Rajhvajn S, Jurič D, Babić D (Zagreb, Croatia) 

17,00-17,05 VULVAR PAGET’S DISEASE - CASE REPORT 

Katalenić Simon S, Krivak Bolanča I, Šentija K, Kukura V, Škrtić A 


17,05-17,13 PREVIOUS CYTOLOGICAL FINDINGS IN WOMEN WITH FINAL 

HISTOLOGICAL DIAGNOSIS OF CERVICAL INTRAEPITHELIAL 

NEOPLASIA GRADE 3 

Milojković M, Pajtler M, Milojković D (Osijek, Croatia) 

20,00 SVEČANA VEČERA / CONGRESS DINNER


DVORANA 3 / HALL 3 (Brač III) 


10,00-19,30 

Hematološka citologija-akutne leukemije / Hematological Cytology-Acute Leukemias 

Ries S, Gjadrov Kuveždić K 

Hematološka citologija- limfni čvor / Hematological Cytology- Lymph Node 

Jelić Puškarić B, Šušterčić D, Kardum Skelin I 


P3. DIAGNOSIS OF VISCERAL LEISHMANIASIS BY FINE NEEDLE ASPIRATION 

CYTOLOGY OF AN ISOLATED CERVICAL LYMPH NODE: CASE REPORT 

Beljan R, Šundov D, Lukšić B, Šoljić V, Piljić Burazer M (Split, Croatia; Mostar, 

Bosnia and Herzegovina) 

P4. ADENOMATOID NODULES AND SUSPICIOUS FOLLICULAR LESIONS OF THE 

THYROID OBTAINED BY FINE NEEDLE ASPIRATION CYTOLOGY 

Dabelić N, Mateša N, Mateša-Anić D, Kusić Z (Zagreb, Crikvenica, Croatia) 

P5. FINE NEEDLE ASPIRATION BIOPSY OF FOLLICULAR THYROID TUMORS 

Pauzar B, Staklenac B, Lončar B (Osijek, Croatia) 

P6. ABDOMINAL NON-EPITHELIAL TUMORS DIAGNOSED BY FINE NEEDLE 

ASPIRATION CYTOLOGY 

Škegro D, Obad-Kovačević D, Škurla B, Mrzljak A, Filipec-Kanižaj T, 

Vidić-Paulišić I, Jelić-Puškarić B (Zagreb, Čakovec, Croatia) 

P7. FINE NEEDLE ASPIRATION CYTOLOGY OF CHONDROID SYRINGOMA 

Škoro M, Trutin Ostović K, Čikara I, Müller D, Novak NP, Virag M (Zagreb, Croatia) 

23 



UTORAK, 13.10.2009. / TUESDAY, October 13, 2009 

24 



SIMPOZIJ - Hematološka citologija / SYMPOSIUM - Hematological Cytology 

Ne-Hodgkinovi limfomi / Non-Hodgkin Lymphomas 

Predsjedavajući / Chairpersons: Jakšić B, Dominis M, Kardum-Skelin I 

08,00-08,15 DIAGNOSTIC CHALLENGES IN LYMPHOPROLIFERATIVE DIESASES 

Jakšić B, Kardum-Skelin I (Zagreb, Croatia) 

08,15-08,30 SMALL LYMPHOCYTIC LYMPHOMAS - PITFALLS IN METHODS AND 

INTERPRETATION 

Dominis M (Zagreb, Croatia) 

08,30-08,40 BONE LESIONS IN LYMPHOMA 

Planinc-Peraica A, Radić-Krišto D, Ostojić Kolonić S, Kardum-Skelin I, 


08,40-08,50 PRIMARY GASTROINTESTINAL NON HODGKIN LYMPHOMA IN 

ADULTS: CLINICOPATHOLOGICAL AND SURVIVAL CHARACTERISTICS 

Radić-Krišto D, Planinc-Peraica A, Ostojić Kolonić S, Vrhovac R, 

Kardum-Skelin I, Jakšić B (Zagreb, Croatia) 

08,50-09,00 FNA BASED DIAGNOSIS OF HEAD AND NECK LYMPHOMA 

Gjadrov Kuveždić K, Aurer I, Ries S, Sučić M, Marković-Glamočak M, 

Ilić I, Bašić-Kinda S, Radman I, Labar B (Zagreb, Croatia) 

09,00-09,10 RECURRING CHROMOSOMAL ABNORMALITIES IN LYMPHOMA IN 

FINE NEEDLE ASPIRATES OF LYMPH NODE 

Lasan Trčić R, Šušterčić D, Kuspilic M, Jelić Puškarić B, Fabijanić I, 

Kardum-Skelin I (Zagreb, Croatia) 

09,10-09,20 FLOW CYTOMETRY IMMUNOPHENOTYPING (FCI) OF FINE NEEDLE 

ASPIRATES (FNAs) OF LYMPH NODES 

Kardum Paro MM, Zoran Šiftar Z, Kardum-Skelin I, Šušterčić D, 

Nazor A, Flegar- Meštrić Z, Jakšić B (Zagreb, Croatia) 

SIMPOZIJ - Hematološka citologija / SYMPOSIUM - Hematological Cytology 

Hodgkin limfomi i kronična limfocitna leukemija / Hodgkin Lymphomas and Chronic 

Lymphocytic Leukemia 

Predsjedavajući / Chairpersons: Ostojić Kolonic S, Jakšić O, Gjadrov Kuveždić K 

09,25-09,35 VALUE OF FINE-NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSIS OF 

HODGKIN’S LYMPHOMA AND ANAPLASTIC LARGE CELL LYMPHOMA: 

ONE CENTRE EXPERIENCE 

Ostojić Kolonić S, Prašek-Kudrna K, Roso V, Radić-Krišto D, 

Planinc-Peraica A, Džebro S, Kardum-Skelin I, Jakšić B (Zagreb, Croatia)


09,35-09,45 NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA 

(NLPHL) - THE DIAGNOSTIC PROBLEM 

Borovečki A, Jelić-Puškarić B, Džebro S, Kardum-Skelin I 


09,45-09,55 CHRONIC LYMPHOCYTIC LEUKEMIA: INSIGHTS FROM LYMPH NODES 

& BONE MARROW AND CLINICAL PERSPECTIVES 

Jakšić O, Kardum-Skelin I, Jakšić B (Zagreb, Croatia) 

09,55-10,05 MULTIMODAL IMAGE ANALYSIS OF CHRONIC LEUKEMIC 

LYMPHOPROLIFERATIVE DISORDERS AND THE HYPOTHESIS OF 

„SINGLE“ AND „MULTIPLE“ PROGRAMMED STOPS IN THE 

DEVELOPMENT OF TYPICAL AND ATYPICAL FORMS OF LEUKAEMIAS 

AND LYMPHOMAS 

Kardum-Skelin I, Radić-Krišto D, Jelić Puškarić B, Jakšić O, 

Kardum M, Jakšić B (Zagreb, Croatia) 

10,05-10,30 PAUZA / BREAK 

SIMPOZIJ- Akutne leukemije / SYMPOSIUM - Acute leukemia 

Predsjedavajući / Chairpersons: Labar B, Sučić M 

10,30-10,50 CLINICAL AND DIAGNOSTIC APPROACH IN PATIENTS WITH 

ACUTE LEUKEMIA 

Labar B, Sučić M, Batinić D, Mrsić S, Zadro R, Ilić I, Dotlić S, 

Marković-Glamočak M, Ries S, Gjadrov-Kuveždić K, Antulov J, 

Fabijanić I, Vrbanus LJ, Čačić M, Franić Šimić I, Dubravčić K, 

Serventi-Seiwerth R, Sertić D, Mikulić M, Mrsić M, Nemet D 


10,50-11,30 ACUTE LEUKEMIA MORPHOLOGY, IMMUNOPHENOTYPE, GENETICS 

AND MOLECULAR BIOLOGY - DIAGNOSTIC DIRECTIONS AND 

PROGNOSTIC FACTORS 

Labar B, Sučić M, Batinić D, Mrsić S, Zadro R, Ilić I, Dotlić S, 

Marković-Glamočak M, Ries S, Gjadrov-Kuveždić K, Antulov J, 

Fabijanić I, Vrbanus LJ, Čačić M, Franić Šimić I, Dubravčić K, 

Serventi-Seiwerth R, Sertić D, Mikulić M, Mrsić M, Nemet D 


11,30-11,50 CURRENT THERAPY FOR ACUTE LEUKEMIA 

Labar B (Zagreb, Croatia) 



25 



SIMPOZIJ - Citologija dječje dobi / SYMPOSIUM - Childhood Cytology 

26 


Predsjedavajući / Chairpersons: Nakić M, Raić Lj, Ries S 

12,00-10,15 ROLE OF CYTOLOGY IN CHILDHOOD DISEASES 

Kardum-Skelin I, Šušterčić D, Jelić-Puškarić B, Milas M (Zagreb, Croatia) 

12,15-12,30 CD20 POSITIVE CHILDHOOD B-NON HODGKIN LYMPHOMA (B-NHL): 

MORPHOLOGY, IMMUNOPHENOTYPE AND A NOVEL TREATMENT 

APPROACH: A SINGLE CENTER EXPERIENCE. 

Bilić E, Femenić F, Konja J, Šimat M, Dubravčić K, Batinić D, Ries D, 

Rajić Lj (Zagreb, Croatia) 

12,30-12,40 SUBCUTANEOUS PANNICULITIS-LIKE T-CELL LYMPHOMA IN A 19 

MONTH-OLD BOY TREATED WITH ALL-IC-BFM 2002 PROTOCOL 

Rajić Lj, Bilić E, Femenić R, Meštrović D, Ilić I, Kardum-Skelin I, 

Tešović G, Konja J (Zagreb, Croatia) 

12,40-12,50 PELVIC GANGLIONEUROMA - CASE REPORT 

Roganović J, Šegulja S, Jonjić N, Seili-Bekafigo I (Rijeka, Croatia) 

12,50-13,00 JUVENILE MYELOMONOCYTIC LEUKEMIA WITH PTPN11 MUTATION IN 

A 23-MONTH-OLD GIRL 

Jakovljević G, Kardum-Skelin I, Nakić M, Batinić D, Rogošić S 


13,00-14,00 RUČAK / LUNCH 

SIMPOZIJ - Transplantacijska citologija / SYMPOSIUM - Transplantation Cytology 

Predsjedavajući / Chairpersons: Nemet D, Vrhovac R, Knotek M 

14,00-14,15 COLLECTION AND COMPOSITION OF AUTLOGOUS PERIPHERAL 

BLOOD STEM CELLS GRAFT IN PATIENTS WITH ACUTE MYELOID 

LEUKEMIA: INFLUENCE ON HEMATOPOIETIC RECOVERY AND OUTCOME 

Raos M, Nemet D, Bojanić I, Sertić D, Batinić D, Dušak V, Mazić S, 

Dubravčić K, Serventi-Seiwerth R, Mrsić M, Golubić-Ćepulić B, 

Labar B (Zagreb, Croatia) 

14,15-14,30 POST-THAW VIABILITY OF CRYOPRESERVED HEMATOPOIETIC 

PROGENITOR CELL GRAFTS: DOES IT MATTER? 

Vrhovac R, Perić Z, Jurenec S, Jelić-Puškarić B, Kardum-Skelin I, 


14,30-14,45 C4D IN PATIENTS WITH ACUTE REJECTION AND/OR HEPATITIS C 

RECURRENCE AFTER LIVER TRANSPLANTATION- SINGLE 

CENTER EXPERIENCE 

Gašparov S, Buhin M, Filipec-Kanižaj T, Kocman B, Škrtić A 


14,45-14,55 PARVOVIRUS B 19 INDUCED PURE RED CELL APLASIA IN 

IMMUNOCOMPROMISED PATIENT AFTER LIVER TRANSPLANTATION 

Mrzljak A, Kardum Skelin I, Čolić Cvrlje V, Filipec Kanižaj T, 

Šušterčić D, Guštin D, Kocman B (Zagreb, Croatia)


14,55-15,05 EPITHELOID HEMANGIOENDOTHELIOMA IN PATIENT WITH LIVER 

TRANSPLANTATION 

Filipec Kanižaj T, Čolić Cvrlje V, Mrzljak A, Kardum Skelin I, 

Šušterčić D, Škegro D, Guštin D, Kocman B (Zagreb, Croatia) 

15,05-15,15 URINE IMMUNOCYTOLOGY AS A NONINVASIVE DIAGNOSTIC TOOL 

FOR ACUTE KIDNEY REJECTION: A SINGLE CENTER EXPERIENCE 

Mihovilović K, Kardum-Skelin I, Jelić-Puškarić B, Ljubanović D, 

Bulimbašić S, Sabljar-Matovinović M, Kovačević-Vojtušek I, Gracin S, 

Kocman B, Jadrijević S, Vidas Ž, Guštin D, Knotek M (Zagreb, Croatia) 


16,00 IZLET BRODOM I DOMJENAK NA BRODU / Excursion by Boat and Cocktail 



8,00-16,00 

Ginekološka citologija - vrat maternice (glandularne lezije), endometrij, ovarij / 

Gynecological Cytology - cervix (glandular lesions), endometrium, ovary 

Citologija glandularnih lezija / Cytology of Glandular Lesions 

Ovanin-Rakić A 

Citologija endometrija / Cytology of Endometrium 

Mahovlić V 

Citologija jajnika / Cytology of Ovary 

Vrdoljak-Mozetič D 


P8. APLASTIC CRISIS INDUCED BY HUMAN PARVOVIRUS B19 AS AN INITIAL 

PRESENTATION OF HEREDITARY SPHEROCYTOSIS 

Čaržavec D, Gaćina P, Vasilj A, Kojić Katović S, Stančić V (Zagreb, Croatia) 

P9. POLYOMAVIRUS ASSOCIATED NEPHROPATHY AFTER SIMULTANEOUS KIDNEY 

AND PANCREAS TRANSPLANTATION. CASE REPORT 

Gracin S, Knotek M, Sabljar Matovinovic M, Kardum Skelin I, Ljubanovic D, Vidas Z 


P10. CASE REPORT OF A PATIENT WITH PERITONEAL AND OMENTAL LYMPHOMA 

INFILATRATION AND ASCITES POSITIVE FOR LYMHOMA CELLS, FOLLOWING A 

RELAPSE OF SPLENIC MARGINAL ZONE LYMPHOMA (SMZL) 

Gredelj Šimec Nj, Ropar S, Baškot A, Dejanović M (Karlovac, Croatia) 

P11. FAMILIAL HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN A 6-WEEK-OLD 

MALE INFANT 

Jakovljević G, Kardum-Skelin I, Rogošić S, Čulić S, Stepan S, Bonevski A, 

Rimac M, Nakić M (Zagreb, Croatia) 

27 



28 


P12. RHABDOMYOSARCOMA WITH BONE MARROW INFILTRATION MIMICKING 

HEMATOLOGIC NEOPLASIA. CASE REPORT 

Jelić-Puškarić B, Rajković-Molek K, Raić Lj, Batinić D, Konja J, Kardum-Skelin I 

(Zagreb, Rijeka, Croatia) 

P13. SIMULTANEOUS OCCURRENCE OF CHRONIC LYMPHOCYTIC AND CHRONIC 

MYELOID LEUKEMIA 

Kojić Katović S, Vasilj A, Maričević I, Čaržavec D, Ćurić Jurić S 

P14. URINARY CYTOLOGY AS A FIRST AVAILABLE TOOL FOR DETECTION OF BK 

NEPHROPATHY- CASE REPORT 

Kovačević-Vojtusek I, Knotek M, Ljubanović D, Kardum-Skelin I, 

Sabljar-Matovinović M, Vidas Ž (Zagerb, Croatia) 

P15. KLINEFELTER SYNDROME AND ACUTE BASOPHILIC LEUKAEMIA - 

CASE REPORT 

Ljubić N, Lang N, Kardum Skelin I, Lasan R, Dominis M, Perković L, Županić- 

Krmek D, Grgurević-Batinica A (Zagreb, Croatia) 

P16. MYELOID/MEGAKARYOCYTIC BLAST PHASES AS A PRESENTING 

MANIFESTATION OF CHRONIC MYELOID LEUKEMIA: CASE REPORT 

Milas R, Kardum-Skelin I, Šušterčić D, Abalić M, Lebinec M, Predragović 

(Virovitica, Croatia; Zagreb, Croatia) 

P17. SERUM IMMUNOGLOBULINS IN NON-HODGKIN’S LYMPHOMA PATIENTS 

Planinc-Peraica A, Ostojić Kolonić S, Radić-Krišto D, Dominis M, Jaksic B 

P18. NEONATAL HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS - CASE REPORT 

Roganović J, Kvenić B, Jonjić N, Seili-Bekafigo I, Kardum-Skelin I 

(Rijeka, Zagreb, Croatia) 

P19. CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL) - TRANSFORMATION TO HODGKIN 

LYMPHOMA OR COMPOSITE TUMOR - CASE REPORT 

Škrtić A, Borovečki A, Milas M, Džebro S (Zagreb, Croatia) 

P20. FINE NEEDLE ASPIRATION OF INTRA-ABDOMINAL LYMPH NODES IN THE 

DIAGNOSIS AND FOLLOW UP OF MALIGNANT LYMPHOMA 

Šušterčić D, Jelić-Puškarić B, Milas M, Vidić-Paulišić I, Odak D, Vidjak V, Minigo 

H, Planinc-Peraica A, Radić-Krišto D, Ostojić Kolonić S, Kardum-Skelin I, Jakšić B 

(Zagreb, Čakovec, Croatia) 

P21. HODGKIN’S LYMPHOMA VARIANT OF RICHTER’S SYNDROME 

Vasilj A, Kojić-Katović S, Maričević I, Žokvić E, Bobuš Kelčec I, Tomas D, 

Silva Ćurić-Jurić S (Zagreb, Croatia) 

P22. THE VALUE OF URINARY DECOY CELL FINDING IN PATIENTS WITH KIDNEY 

TRANSPLANTATION: A SINGLE CENTER EXPERIENCE 

Vidas Ž, Mišić M, Pačić A, Jurenec F, Knotek M, Kardum-Skelin I 

(Zagreb, Slavonski Brod, Croatia)


SRIJEDA, 14.10.2009. / WEDNESDAY, October 14, 2009 

OD/FROM 8.00-10.00 


SIMPOZIJ - Citotehnologija / SIMPOSIUM - Citotechnnology 

Predsjedavajući / Chairpersons: Anić V, Rubić K 

NEW METHODS IN CYTOLOGY Korać P (Zagreb, Croatia) 

DETECTION OF P16INK4a PROTEIN IN PREMALIGNANT CERVICAL LESIONS ON 

ARCHIVED SLIDES 

Gavranović LJ, Rakek Novak S, Baburić M, Đorđijevski E, Šentija K, Katalenić Simon S, 

Krivak Bolanča I 

ERYTHROCYTE MORPHOLOGY IN MALIGNANT URINE SAMPLES. 

Knežević G, Parigros K, Anić V, Milas M, Šušterčić D, Kardum-Skelin I 

THE PREVALENCE OF INFECTION IN SWABS OF TRANSPLANTED HEMATOLOGIC 

PATIENTS 

Anić V, Križaj B, Jelić-Puškarić B, Perić Z, Vrhovac R, Kardum-Skelin I 

NUMBER OF COUNTING CELLS AND CYTOSPINS SELECTION INFLUENCES ON 

BRONCHOALVEOLAR LAVAGE CELL PROFILES 

Harabajsa S, Martinčić J, Peharec I, Popek B, Šušković- Medved S, Zadražil B, 

Smojver-Ježek S 

THE ROLE OF CYTOTECHNOLOGIST IN CYTOANALYSIS OF SYNOVIAL FLUIDS 

Bezdrob S, Aleksandrov C, Cvrk B, Čurin S, Ljevar I, Krupec AM, Čurin D, Knežević A, 

Perica B, Ćaleta B, Trutin Ostović K 

PROBLEMS WITH STAINING PROCEDURES IN IMMUNOCYTOCHEMISTRY 

Meandžija R, Fumić G, Naglić G, Štanfel O, Seili-Bekafigo I 

IMMUNODETECTION OF ANTIGENES IN CYTOLOGIC SAMPLES 

Rešetar R 

INFLUENCE OF INADEQUATE MATERIALS ON CYTOLOGICAL ANALISIS AND 

PROVIDING DIAGNOSIS 

Rubić K, Milankovic Lj, Horvat B, Ropar S 

MODIFICATION OF MGG STAINING METHOD 

Fumić G, Naglić G, Meandžija R, Štemberger C, Seili-Bekafigo I 

QUALITY OF INTAKE AND PROCESSING OF MATERIALS IN CYTOLOGICAL 

LABORATORY 

Begovic D, Belušić M, Maljić S 

PRESENTATION OF INTEGRATED MODULE FOR INPUT AND PROCESSING OF 

CYTOLOGICAL REPORTS WITHIN THE COMPUTER PROGRAMME “RIBIS“ 

Markanjević T, Vunić S 

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MICROSCOPIC IDENTIFICATION OF PARASITES IN CYTOLOGICAL PREPARATIONS - 

THE „GOLD STANDARD“ IN DIAGNOSTICS OF VISCERAL LEISHMANIASIS - 

A CASE REPORT 

Stupnišek M, Prstec Z, Vujević D, Čulig Z, Puljiz I, Lukas D, Begovac J 

Diskusija / Discussion 

10,00-10,30 PAUZA / Break 

SIMPOZIJ - Analitička citologija / SYMPOSIUM - Analytical Cytology 

Predsjedavajući/Chairpersons: Smojver Ježek S, Batinić D 

Plenarno predavanje / Plenary lecture 

10,30-10,45 ANALYTICAL CYTOLOGY - FROM BASIC METHODOLOGY TO ROUTIN 

CLINICAL DISCIPLINE 

Batinić D (Zagreb, Croatia) 

SECTION A - Analitička citologija u onkologiji / Analytical cytology in oncology 

10,45-10,55 MORPHOMETRIC AND CELL KINETIC CHARACTERISTICS IN 

THE DIAGNOSIS AND PROGNOSIS OF NEOPLASMS 

Kardum-Skelin I (Zagreb, Croatia) 

10,55-11,05 MOLECULAR PATHOGENESIS OF PHILADELPHIA-NEGATIVE 

CHRONIC MYLEOID NEOPLASMS 

Kušec R (Zagreb, Croatia) 

11,05-11,15 BIOMED-2 PCR DETECTION OF IGH/BCL2 REARRANGEMENT IN 

FOLLICULAR LYMPHOMA USING DNA OBTAINED FROM ARCHIVED 

CYTOLOGICAL SMEARS: AN OPTION FOR MONITORING 

Štoos-Veić T, Livun A, Ajduković R, Pejša V, Jakšić O, Kušec 


11,15-11,25 FLOW CYTOMETRIC CLONALITY ANALYSIS OF ENDOSCOPIC 

ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION OF 

LYMPH NODES 

Miletić Z, Gizdić B, Štoos-Veić T, Kaić G, Novak NP, Tadić M, Jakšić O, 

Trutin Ostović K (Zagreb, Croatia) 

11,25-11,35 CYTOGENETIC RESULTS IN 24 CASES OF MULTIPLE MYELOMA 

SHORT REPORT 

Lasan Trčić R, Kardum Skelin I, Šušterčić D , Planinc-Peraica A, 

Ajduković R, Hariš V, Kušec R, Begović D (Zagreb, Croatia) 

11,35-11,50 Diskusija / Discussion 

Predsjedavajući / Chairpersons: Flegar-Meštrić Z, Kaić G 

SECTION B - Dijagnostika i kontrola kvalitete / Diagnostics and quality control 

12,00-12,10 FLOW CYTOMETRY AND DIAGNOSTIC MONITORING OF HIV-INFECTED 

PATIENTS 

Židovec Lepej S (Zagreb, Croatia)


12,10-12,20 ACCREDITATION OF MEDICAL LABORATORIES IN CROATIA - 

EXPERIENCES OF THE INSTITUTE OF CLINICAL CHEMISTRY 

CLINICAL HOSPITAL MERKUR 

Flegar-Meštrić Z, Nazor A, Perkov S, Šurina B, Kardum Paro MM, 

Šiftar Z, Sikirica M, Sokolić I, Ožvald I, Vidas Ž (Zagreb, Croatia) 

12,20-12,30 EXTERNAL QUALITY ASSESSMENT IN CLINICAL CELL ANALYSIS BY 

FLOW CYTOMETRY. WHY IS IT SO IMPORTANT? 

Šiftar Z, Kardum Paro MM, Sokolić I, Nazor A, Flegar Meštrić Z 


12,30-12,40 QUARTER OF A CENTURY OF THE LABORATORY FOR HUMAN 

GENETICS, DEPARTMENT OF MEDICAL GENETICS, PEDIATRICS 

CLINIC, UNIVERSITY HOSPITAL SPLIT 

Čulić V, Lozić B, Oreško T, Ivko-Banovac T, Botić Lj, Kezić G, 

Milanović D (Split, Croatia) 

12,40-12,50 FUTURE PERSPECTIVES OF PERSONALIZED MEDICINE 

Štambuk S, Šundov D, Kuret S, Beljan R, Anđelinović Š (Split, Croatia) 

12,50-13,00 Diskusija / Discussion 


SIMPOZIJ - Dojka i slobodne teme / SYMPOSIUM - Breast and free topics 

Predsjedavajući / Chairpersons: Trutin Ostović K, Ramljak V, Staklenac B, Vasilj A 

8,00-8,20 CURRENT ORGANISATION OF CLINICAL CYTOLOGY IN CROATIA 

Miličić-Juhas V, Lončar B, Mahovlić V, Kardum-Skelin I, Pajtler M 

8,20-8,30 FINE NEEDLE ASPIRATION CYTOLOGY OF THE MINIMAL BREAST 

CARCINOMA IN ISTRIA COUNTY 

Besser-Silconi Ž, Lozić AAB, Mišljenović N 

8,30-8,40 RARE TUMORS OF THE BREAST- CASES REPORTS 

Staklenac B, Lončar B, Pauzar B, Dmitrović B 

8,40-8,50 FINE NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSING RARE 

BREAST CARCINOMA-TWO CASE REPORTS 

Ramljak V, Šarčević B, Vrdoljak DV, Bobuš Kelčec I, Agai M, 

Trutin Ostović K 

8,50-9,00 MORPHOMETRY OF TUMOUR CELLS IN DIFFERENT GRADES AND 

TYPES OF BREAST CANCER 

Prvulović I, Kardum-Skelin I, Jakić-Razumović J, Manojlović S 

9,00-9,10 THE IMPORTANCE OF URGENT CYTOLOGICAL EXAMINATION OF 

SYNOVIAL FLUIDS IN DIFFERENTIATION INFLAMMATORY AND 

NON-INFAMMATORY DISEASES 

Trutin Ostović K, Kaić G, Ostović I, Škoro M, Novak N-P, 

Morović-Vergles J 

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32 


9,10-9,20 IDENTIFICATION OF BRAIN CANCER STEM CELLS IN WHO STAGE IV 

BRAIN TUMOURS 

Tomuleasa CI, Soritãu O, Foris V, Ioani H, Ciucã DR, Susman S, 

Mihu C, Florian IS 

9,20-9,30 DEDIFFERENTIATION THERAPY AND DARWINISM FOR SORTING 

OF OVARIAN CANCER STEM CELLS 

Tomuleasa CI, Soritãu O, Ciucã DR, Susman S, Mihu C 

9,30-9,40 ADDITIONAL CYTOMORPHOLOGICAL CRITERIA IN DIAGNOSIS OF 

PILOMATRICOMA - BENIGN TUMOR WITH BAD REPUTATION 

Seili-Bekafigo I, Jonjić N, Štemberger C, Rajković-Molek K 

13,00 ZATVARANJE KONGRESA / Congress Closing 


P23. ANALYSIS OF ABNORMAL PAP TEST FINDINGS OF URBAN, RURAL AND 

INSULAR AREA 

Bašić D, Markanjević T 

P24. ALLELE FREQUENCIES OF FIVE X-LINKED MICROSATELLITES IN THE CROA- 

TIAN POPULATION AND THEIR APPLICATION IN PRENATAL DIAGNOSIS OF SEX 

CHROMOSOME ANEUPLOIDIES 

Crkvenac Gornik K, Štingl K, Grubić Z, Tonković Đurišević I, Huljev S, Begović D 


P25. THE ROLE OF CYTOLOGY IN THE DIAGNOSIS OF PYELON TUMOUR - A CASE REPORT 

Ezgeta Karačić D, Valetić J, Zeljko Ž, Vidas Ž, Jelić-Puškarić B, Sabljar- 

Matovinović M, Kardum-Skelin I (Vukovar, Croatia) 

P26. EXPRESSION OF P53, BCL-2, SURVIVIN AND AKT-1 IN PERIPHERAL BLOOD, 

BONE MARROW AND LYMPH NODES IN B-CLL 

Gizdić B, Miletić Z, Štoos Veić T, Pandžić Jakšić, Martinović M, Kušec R, Jakšić B, 

Pejša V, Trutin Ostović K, Jakšić O (Zagreb, Croatia) 

P27. PALLISTER KILLIAN SYNDROME: UNUSUAL SIGNIFICANT POSTNATAL 

OVERGROWTH IN A GIRL WITH OTHERWISE TYPICAL PRESENTATION 

Huljev Frković S, Tonković Đurišević I, Lasan Trčić R, Sarnavka V, Crkvenac Gornik 

K, Mužinić D, Letica Lj, Barić I, Begović D (Zagreb, Croatia) 

P28. MYELOID SARCOMA INVOLVING THE BREAST. CASE REPORT 

Jelić Puškarić B, Ostojić-Kolonić S, Planinc-Peraica A, Gašparov S, 

Kardum-Skelin I, Jakšić B (Zagreb, Croatia) 

P29. IMPACT OF STATIN, ANGIOTENSIN CONVERTING ENZYME INHIBITOR, 

ANGIOTENSIN II RECEPTOR BLOCKER AND DIHDROPYRIDINE TREATMENT ON 

PERITONEAL DIALYSATE COMPOSITION 

Jurić K, Cavrić G, Naumovski- Mihalić S, Bartolek D, Nassabain K, Novak NP 

(Zagreb, Croatia)


P30. MISLEADING PRESENTATIONS OF MALIGNANT BREAST DISEASES - ROLE OF 

CLINICAL CYTOLOGY 

Kaić G, Štoos-Veić T, Trutin Ostović K, Vojnović J , Vidović LJ, Lambaša S, Hariš V, 

Ajduković R, Stanec S, Budi S (Zagreb,Croatia) 

P31. FINE NEEDLE ASPIRATION CYTOLOGY OF BREAST ANGIOSARCOMA - CASE REPORT 

Kardum-Skelin I, Jelić-Puškarić B, Milas M, Vidić-Paulišić I, Jakić-Razumović J, 

Šeparović V (Zagreb, Croatia) 

P32. GRANULAR CELL TUMOR 

Lončar B, Marjanović K, Pauzar B, Staklenac B (Osijek, Croatia) 

P33. CYTOGENETICS AND MOLECULAR FINDINGS IN CHILDHOOD LEUKEMIA OF 

SOUTH CROATIA 

Lozić B, Ćulić S, Čulić V, Drmić I, Batinić D, Mrsić S, Lasan Trčić R, Zemunik T 

(Split and Zagreb, Croatia) 

P34. ANALYSIS OF IKAROS FAMILY SPLICING VARIANTS IN HUMAN HEMATOPOIETIC 

LINEAGES 

Matulić M, Paradžik M, Jelić Puškarić B, Stipić J, Antica M (Zagreb, Croatia) 

P35. INTERNATIONAL EXTERNAL QUALITY ASSESSMENT SCHEME FOR 

HAEMATOLOGY - 23 YEARS EXPIRIENCE IN INSTITUTE OF CLINICAL 

CHEMISTRY UNIVERSITY HOSPITAL “MERKUR” 

Nazor A, Flegar-Meštrić Z (Zagreb, Croatia) 

P36. FINE-NEEDLE ASPIIRATION CYTOLOGY OF APOCRINE HIDRADENOMA 

Novak NP, Kaić G, Tomasović-Lončarić Č , Žic R , Škoro M, Trutin Ostović K 

(Zagreb,Croatia) 

P37. MONOCYTE ACTIVATION IS RELATED TO INSULIN RESISTANCE IN 

POSTMENOPAUSAL WOMEN 

Pandžić Jakšić V (Zagreb, Croatia) 

P38. RESCREENING OF NEGATIVE CERVICAL CYTOLOGY FINDINGS 

Poduje V, Mustapić D, Mahovlić V 

P39. VIRAL CAPSID PROTEIN (HPV L1) DETECTION ON ARCHIVED CERVICAL SLIDES 

Rakek Novak S, Gavranović Lj, Baburić M, Đorđijevski E, Šentija K, Katalenić 

Simon S, Krivak Bolanča I 

P40. EOSINOPHILIC MASTITIS A CASE REPORT OF AN EOSINOPHILIC MASTITIS IN 

A 32-YEAR OLD FEMAL 

Ropar S, Gredelj Šimec NJ, Tokić T (Karlovac,Croatia) 

P41. ENTEROBIUS VERMICULARIS IN VAGINAL SMEARS 

Rubic K,Milankovic Lj,Plemić I, Ropar S 

P42. THE ACCURACY OF FINE NEEDLE ASPIRATION CYTOLOGY AND FLOW 

CYTOMETRY IN EVALUATION OF NODAL AND EXTRANODAL SITES IN PATIENTS 

WITH SUSPICION OF LYMPHOMA 

Šenjug P, Trutin Ostović K, Miletić Z, Tomasović Lončarić Č, Štoos-Veić T, 

Gizdić B, Kaić G, Aralica G, Križanac Š, Pejša V, Jakšić O (Zagreb, Croatia) 

33 



34 


P43. LYMPH NODE FINE NEEDLE ASPIRATION - SAMPLE ADEQUACY FLOW 

CYTOMETRY IMMUNOPHENOTYPING 

Švencbir V, Milas M, Anić V, Šiftar Z, Kardum Paro MM, Kardum-Skelin I 

P44. INTRAOPERATIVE IMPRINT CYTOLOGICAL ASSESSMENT OF THE SUBAREOLAR 

TISSUE OF THE NIPPLE AREOLA COMPLEX (NAC) 

Tomasović-Lončarić Č,Milanović R, Lambaša S, Križanac Š,Štoos-Veić T,Kaić G, 

Trutin Ostović K (Zagreb, Croatia) 

P45. ISOLATION AND CHARACTERIZATION OF LIVER CANCER STEM CELLS FROM 

A HEPATOCELLULAR CARCINOMA BIOPSY 

Tomuleasa C, Soritãu O, Páll E, Susman S, Rus D, Mihu C, Iancu C (Cluj Napoca, 

Romania) 

P46. DEXAMETHASONE AND CHITOSAN REDUCE HEPATIC FIBROSIS AND 

INFLAMATIO IN WISTAR RATS WITH BILE DUCT LIGATION 

Trip DM, Olteanu D, Filip A, Clichici S, Muresan A, Sofronie A, Nagy A, Moldovan R 

(Cluj Napoca, Romania) 

P47. FINE NEEDLE ASPIRATION CYTOLOGY OF METASTATIC MERKEL CELL 

CARCINOMA 

Trutin Ostović K, Hariš V, Miletić Z, Lambaša S, Lajtman Z, Štoos-Veić T 


P48. SINCHRONOUS BILATERAL BREAST CARCINOMA WITH TWO DIFFERENT 

MORPHOLOGY SUBTYPES:A CASE REPORT 

Vrabec Branica B, Smojver-Ježek S, Juroš Z, Neralić-Meniga I, Križanec Š 

(Zagreb, Croatia)

kliniËka citologija 

clinical cytology 

35


36 

Klinička citologija - Plenarna i pozvana predavanja 

CONFIRMATION OF CIN I 

Babić D 

Department of Gynecological Pathology, Medical School, University of Zagreb, Croatia 

The minimum histological change that justifies a diagnosis of CIN 1-3 is the presence, 

throughout the full thickness of the epithelium, of some degree of nuclear abnormality. 

The abnormalities that justifies a diagnosis of CIN 1 are most apparent in the basal third 

of the epithelium. These nuclear abnormalities are: a mild degree of pleomorphism, 

an increased nuclear-cytoplasmic ratio, some degree of enlargement, mild hyperchromasia 

with a finely stippled chromatin pattern. The abnormalities in mitotic figures are 

often subtle and focal, necessitating the examination of an adequate number of sections. 

Cytoplasmic maturation is limited to the upper two-thirds of the epithelium.Sometimes 

histopathologists also have diagnostic difficuIties: basal cell hyperplasia, immature 

metaplasia, transitional cell metaplasia, severely atrophic epithelium, in low-oestrogen 

states - after the menopause or in women using low-oestrogen contraceptives the 

squamous epithelium may be composed entirely of parabasal type cells and is usually 

thin with mild degree of hyperchromasia. Sometimes there are also problems with 

borderline lesions - ‘basal epithelial changes(atypia) of uncertain significance’- BAUS. 

The features of CIN can be found in epithelium in which there are koilocytes or koilocyteassociated 

features. CIN, even in the presence of koilocytosis or koilocytosis-associated 

changes, is recognised by exactly the same criteria as in the absence of koilocytosis. 

babic_damir@yahoo.com

Clinical Cytology - Plenary and Invited Lectures 

CD20 POSITIVE CHILDHOOD B-NON HODGKIN LYMPHOMA (B-NHL): MORPHOLOGY, 

IMMUNOPHENOTYPE AND A NOVEL TREATMENT APPROACH: A SINGLE CENTER 

EXPERIENCE. 

Bilić E, Femenić R, Konja J, Šimat M , Dubravčić K, Batinić D, Ries S, Rajić Lj 

University Clinical Hospital Center Zagreb, Zagreb, Croatia. 

Lymphomas represent the third most common group of cancers in childhood and adolescence, 

mature B non Hodgkin’s lymphoma (B-NHL) accounting for up to 60% of newly 

diagnosed patients. The diagnosis of specific entities of B-NHL is based on well-defined 

morphologic analysis, immunophenotyping, cytogenetics and molecular genetics, which 

determine the optimal treatment strategy. In adult population a major turning point in 

treatment of B-NHL has been achieved since rituximab, in combination with CHOP thus 

improving the survival rate up to 19%. Rituximab is a chimeric monoclonal antibody that 

targets CD20, a transmembrane calcium channel expressed on normal and malignant 

B-cells that mediates cytotoxic, apoptotic and anti-proliferative effects. The effect of 

rituximab in pediatric population is still not well enough investigated. Based on morphology 

and immunophenotype of malignant cells, seven children with B-NHL in our 

institution were eligible for treatment with modified B-NHL-Berlin-Frankfurt-Münster 

(BFM)-95-based protocol with rituximab administered on day -5. The complete remission 

was achieved in all seven patients. Six patients are still in complete remission at 

least 12 months after having finished chemotherapy and one patient relapsed two months 

after the last cycle and subsequently died. Major adverse effects observed during treatment 

were prolonged B-cell depletion and myelosupression. Rituximab in combination 

with B-NHL-BFM-95 protocol was otherwise well tolerated and proved to be effective in 

children and adolescents with B-NHL. The number of our patients is too small and the 

follow-up of a larger group of patients will help in defining the role of rituximab in the 

treatment of childhood B-NHL. 

RISK-ADAPTED MULTIMODAL LABORATORY CERVICAL SCREENING - PAP TEST 

OF THE FUTURE? 

Bollmann R 

Institut für Pathologie, Bonn-Duisdorf, Germany 

The objective of screening for cervical cancer is to reduce mortality and incidence of 

the disease. To date there is extensive and strong evidence that this can be achieved by 

cytol¬ogy-based screening programs, which con¬tinue to be the mainstay of cervical 

preven¬tion worldwide despite their inherent meth¬odological limitations. This article 

presents a review on the utility of conventional, ancil¬lary and experimental methods for 

cervical screening both as single tests and test combi¬nations, and describes possible 

future direc¬tions for enhanced screening accuracy using risk-adapted protocols. 

Magdolna@Bollmann.com 

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CERVICAL CANCER AS A PUBLIC HEALTH ISSUE - WHAT NEXT? 

Ćorušić A1 , Škrgatić L1 , Mahovlić V2 , Mandić V3 , Planinić P1 , Karadža M1 1 Division of Gynecological Oncology, Department of Obstetrics and Gynecology, University 

of Zagreb Medical School, Zagreb, Croatia 

2 Division of Gynecological Cytology, Department of Obstetrics and Gynecology, University 

of Zagreb Medical School, Zagreb, Croatia 

3Department of Obstretics and Gynecology, University Clinical Hospital Mostar, Mostar, 

Bosna and Herzegovina 

Cervical cancer is the world’s second most common cancer in women. There are about 

60 000 newly discovered cases in Europe annually and around 30 000 deaths. The largest 

incidence of this disease is in countries of Eastern Europe. In Croatia, according to data 

of the Department of Public Health incidence was 14.9 / 100 000 in 2006 and cervical cancer 

is at the eighth place of malignant diseases in women. Croatia has a lower incidence 

of this disease compared to many countries of Central and Southeast Europe. Large 

research carried out by International Agency for Research on Cancer (IARC) in 1995. on 

cervical cancer material gathered from 22 countries around the world, revealed HPV 

genome in 99.7%. There are good methods of cervical cancer detection as well as good 

screening methods for precancerous lesions (conventional PAPA swab). Cervical cancer 

prevention programs should include education (for health-care providers and women) 

that stresses the benefits of screening, the peak ages of cervical cancer incidence, and 

the signs and symptoms of precancerous lesions and invasive disease. Screening aims 

to detect precancerous changes, which may lead to cancer if not treated. Screening is 

only effective if there is a well-organized system for follow up, diagnosis and treatment. 

Cervical cytology, or Papanicolau (Pap) testing, has been the cornerstone of cervical 

cancer screening for decades. According to recent guidelines of the European Department 

of World Health Organization, primary task of the public health system is the introduction 

of secondary prevention through well-organized screening programs. Organization 

of national immunization program is possible only in countries with well-organized 

secondary prevention programs as well as in those who can afford it. 

lana.skrgatic@zg.t-com.hr


SMALL LYMPHOCYTIC LYMPHOMAS - PITFALLS IN METHODS AND INTERPRETATION 

Dominis M 

Dpt.of Pathology & Cytology, Clinical Hospital “Merkur”, Zagreb, Croatia 

Small B-cell lymphomas/leukemias are derived from the mature B-cells. In term of 

clinical, morphological and molecular aspects they represent a hetrogenous group of 

diseases. Although overlap is present, clinically distinct entities exist with characteristic 

presentation, response to therapy and/or prognosis. 

Despite well defined morphological, immunohistochemical and molecular characteristics, 

atypical case may exist in single entity. Overlap of morphological and immunohistochemical 

features between various entities of B small cell lymphomas can induce 

considerable diagnostic problems. It is of great importance to distinguish between such 

entities whenever is possible because of contrast of some poor prognosis cases and 

long survival of others. 

201 patients with predominantly small B-lymphocytic lymphoma were reevaluated. 100 

were diagnosed as follicular cell lymphoma (FCC), 45 as mantle cell lymphoma and 56 

as small lymphocytic lymphoma (SLL). Adverse findings were: in FCC group BCL2 was 

positive; 11 cases without any changes of BCL2 gene, however in another 4 cases BCL2 

was negative and gene was either in translocation or amplification. BCL6 was positive in 

70 cases but the BCL6 gene showed translocation only in 8 and amplification in 7 cases, 

respectively. Translocation of BCL2 and BCL6 genes was found in 8 and amplification 

in 7 patients. 45 mantle cell lymphomas were all CD20 and BCL2 positive and CD23 and 

CD43 negative; 32 out of 45 were CD5 positive, 8 were +/- and 5 were CD5 negative. In 43 

patients t(11;14) was found, and in one case BCL1 gene amplification. t(14;18) was found 

in one case, amplification of BCL2 gene in 7 cases. Two patients with blastiod variant of 

mantle cell lymphoma were CD5+, BCL2 as well as BCL1 were in one case positive and 

in another negative. Neither t(11;14) or t(14;18) were found. In so-called SLL group of 56 

patients, who were all CD19 and BCL2 positive, CD5, CD23 and CD43 were positive in 51 

patients. t(11;14) was found in 5 patients, 4 who were CD5 and CD23 positive and one 

who was CD5 and CD23 negative. Other abnormalities, i.e. 3-5 copies of BCL1 gene were 

found in 3 CD5, CD23 positive patients. Pitfalls in methods and interpretation will be discussed 

and are still matter of debate. 

mara.dominis@zg.t-com.hr 

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EPITHELOID HEMANGIOENDOTHELIOMA IN PATIENT WITH LIVER 

TRANSPLANTATION 

Filipec Kanizaj T1 , Colic Cvrlje V1 , Mrzljak A1 , Kardum Skelin I1 , Sustercic D1 , 

Škegro D1 , Gustin D2 , Kocman B3 1 Department of Internal Medicine, University Hospital Merkur, Zagreb, Croatia 

2Department of Anaesthesiology and Intensive Care, University Hospital Merkur, 

Zagreb, Croatia 

3 Department of Surgery, University Hospital, Merkur, Zagreb, Croatia 

Malignant hepatic epithelioid hemangioendothelioma (HEH) is a rare malignant tumor 

of vascular origin with unknown aetiology and a variable natural course. At the time of 

diagnosis, most patients present with multifocal tumours lesions that involve both liver 

lobes. From the therapeutic aspect, liver resection (LRx), liver transplantation (LTx), 

chemotherapy, radiotherapy, and/or immunotherapy have been used in the treatment 

of patients with HEH. However, because of the rarity of this tumor and its unpredictable 

natural history, it is impossible to assess the effectiveness of these respective therapies. 

In this report, our objective was to present clinical aspects, diagnostic options, therapeutic 

modalities, and the clinical outcome of single patient with LTx because of this 

rare tumor. 

tajana_filipec@yahoo.com


C4D IN PATIENTS WITH ACUTE REJECTION AND/OR HEPATITIS C RECURRENCE 

AFTER LIVER TRANSPLANTATION- SINGLE CENTER EXPERIENCE. 

Gašparov S1 , Buhin M2 , Filipec-Kanižaj T3 , Kocman B2 , Škrtić A1 1 Department of Clinical Pathology and Cytology 

2 Department of Surgery, Division of Transplantation Surgery 

3 Department of Medicine 3 Merkur University Hospital - Zagreb, Croatia 

Hepatitis C (HCV) induced cirrhosis is one of the most common indication for liver transplantation 

(LTX). Updated data suggest worse long-term outcomes for those transplanted 

with HCV than those transplanted for other indications. Re-infection with HCV following 

LTX is almost universal. The differentiation between acute cellular rejection (ACR) 

and recurrent HCV is very important as rejection treatments are likely to aggravate HCV 

recurrence. Many autors advocate/suggest restricted use of steroid treatment even in 

cases of validated rejection. Liver biopsy represents the gold standard for the diagnosis 

of both ACR and HCV reinfection. Nevertheless, discrimination can be very difficult due 

to quite similar morphological pictures. 

C4d is an end-product of the activated classical complement cascade typically detectable 

not only in infection and autoimmune disorders but also in early humoral rejection. 

According to some autors C4d can be detected in hepatic specimen in ACR after LTX. 

It is still matter of debate whether C4d may serve as a specific marker for differential 

diagnosis ACR in HCV reinfection cases. 

We performed retrospective analysis of 58 liver biopsies from liver transplanted patients 

who had either ACR (N=29) or HCV reinfection (n=19). Patients with no pathological 

alterations (n=10) served as control group. In most cases underlying diseases requiring 

LTX in group with ACR as well as in the group without morphological changes was 

alcohol-induced cirrhosis. Specimens were taken due to the suspicion of ACR and HCV 

reinfection according to clinical and laboratory findings or as standard protocol biopsies. 

Immunohistochemical analysis for C4d was performed. 

A total of 72,4 % of ACR samples (21/29) were positive for C4d whereas 26,3 % HCV recurrence 

samples (5/19) showed C4d positive staining. There was no immunohistochemical 

positivity for Cd4 in control group samples. Our results suggest that C4d may be 

indeed helpful in distinguishing ACR and HCV reinfection after LTX. 

gasparovslavko@yahoo.com 

41 



42 


ROLE OF HPV TESTING IN CERVICAL CANCER PREVENTION 

Grce M 

Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia 

Screening of cervical cancer based on the cervical cytology (Pap smear) has been undertaken 

since the 1950s and therefore saved hundred thousands lives. However, cervical 

cancer still remains an important health problem in Europe, being the 7th most common 

cause of cancer deaths in women with almost 50,000 new cases and 22,000 deaths 

per year. Although cervical cancer screening showed to be an excellent test, it has limitations 

for it application on large-scale population. On the other hand, detection of the 

cause of cervical cancer, the high-risk (oncogenic) types of the Human papillomaviruses 

(HPV) has obvious advantages. The HPV DNA test identifies women at risk for developing 

cervical cancer. Therefore, HPV testing has been widely used as secondary test for 

triage of borderline cytology and after treatment of severe cervical lesions. Currently, 

the use of HPV testing for primary cervical cancer screening with cytology reserved for 

HPV-positive women has been evaluated in several large-scale randomised controlled 

trials. Preliminary results indicate that although less specific than Pap spear, HPV DNA 

testing for primary screening showed to be substantially more sensitive in detecting severe 

cervical lesions. In addition, HPV testing will be useful for the upcoming generation 

of HPV-vaccinated women to be more accurately monitored. 

grce@irb.hr


CYTOLOGIC FOLLOW-UP IN WOMEN WITH CIN TREATED BY LETZ, COLD KNIFE 

CONISATION AND SEMM’S COLD COAGULATION 

Grubišić G, Kraljević Z, Vukosavić-Cimić B, Pirkić A, Grbavac I, Bolanča I 

University Hospital “Sestre Milosrdnice” Zagreb 

Aim. To compare follow-up cytology results in patient groups treated by LETZ (Loop 

Excision of Transformation Zone), cold knife conisation and Semm’s cold coagulation 

(Electro coagulation, ECG) according to CIN (Cervical Intraepithelial Neoplasia) on target 

biopsy specimens, and definite therapeutic approach according to patient age, parity and 

lesion grading. To evaluate therapeutic success in all three groups of patients regarding 

to the control cytology findings. Patients and Methods. The study included patients 

allocated to particular therapy group according to diagnostic and therapeutic guidelines 

for preinvasive lesions of the uterine cervix from January 1, 1999 till December 31, 2000. 

Results. LETZ was performed in 157, cold knife conisation in 42, and Semm’s cold coagulation 

in 30 women. The patients mean age was 33,7 years in the LETZ group, 36,5 

years in the cold knife conization group, and 30.0 years in the Semm’s cold coagulation 

group. LETZ prevailed in young nulliparous women, and cold knife conization in parous 

women. Cytology control underwent only 50 of 157 (32%) women with LETZ, 30 of 42 (71%) 

women with cold knife conisation, and all 30 women with Semm’s cold coagulation. In 

the LETZ group, 32 (64%) histology specimens revealed CIN III, whereas in the cold knife 

conization group it was found in 22 (72%) women. Normal cytologic findings after above 

mentioned procedures were recorded in 43 (88%) women from the LETZ group, 22 (73%) 

women from the Semm’n cold coagulation group. LETZ under colposcopy guidance revealed 

a high percentage of satisfactory cytologic follow-up.Conclusion. The importance 

of the use of diagnostic and therapeutic guidelines and regular follow-up is emphasized, 

bearing in mind primarily the young female population with severe preinvasive lesions of 

uterine cervix. Under colposcopy guidance it is possible to obtain an optimal LETZ specimen 

for histologic diagnosis. So, we report the satisfactory 88% rate of normal cytology 

follow-up after LETZ procedure. However, the low rate of presentation for cytologic 

controls in the LETZ group should stimulate us to invest additional efforts to achieve the 

highest possible control visits in this very sensible population. 

goran.grubisic@gmail.com 

43 



MYELOID SARCOMA OF THE SKIN 

Ilić I1 , Dotlić S1 , Gjadrov K1 , Sučić M1 , Bašić-Kinda S2 , Labar B2 44 


1 Zagreb University Clinical Hospital Center and School of Medicine, Clinical 

Department of Pathology and Cytology, Zagreb, Croatia 

2 3 Zagreb University Clinical Hospital Center and School of Medicine Department of 

Hematology, Zagreb, Croatia 

Background. Myeloid sarcoma (MS) is a solid tumor found at any site other than the bone 

marrow, composed of myeloid blasts that may show different degrees of maturation. 

Infiltrates of myeloid cells found in any site in the patient with leukemia are not classified 

as MS. Case. We present the case of a 75-year old man with a nodular tumor on his 

right calf. The tumor was grayish, measuring 1,8 cm in its largest diameter. Histologically, 

the dermis was diffusely infiltrated by large tumor cells. Immunohistochemistry 

showed that the tumor cells were positive for myeloperoxidase and myeloblasts were 

positive for CD34. The cells were mostly myeloblasts but there were also myeloid cells 

in different stages of maturation. The patient’s medical history revealed that he has 

been previously treated for a chronic myeloid leukemia (CML) and then for transition 

between accelerated phase and blast phase. So this case represents a disease progression 

of CML presented with myeloid sarcoma. Conclusion. Clinical presentation of acute 

leukemia as myeloid sarcoma of the skin is not rare, but always represents a diagnostic 

challenge. The differential diagnoses of MS include lymphoma and histiocytic sarcoma, 

both of which are excluded by the use of immunohistochemistry. To differentiate MS 

from AML or CML infiltrates the clinical data must be provided because morphology and 

immunohistochemistry are not sufficient. 

iilic5@yahoo.com


JUVENILE MYELOMONOCYTIC LEUKEMIA WITH PTPN11 MUTATION IN A 

23-MONTH-OLD GIRL 

Jakovljević G1 , Kardum-Skelin I2 , Nakić M1 , Batinić D3 , Rogošić S1 1 Department of Hematology and Oncology, Pediatric Clinic, Children’s Hospital Zagreb, 


2 Laboratory for Cytology and Hematology, Clinic of Internal Medicine, Merkur 

University Hospital, Zagreb, Croatia 

3 University Hospital Center Zagreb, Department of Laboratory Diagnosis, Zagreb, 

Croatia 

Juvenile myelomonocytic leukemia (JMML) is a rare clonal myeloproliferative disorder, 

afflicting young children, with 2 years median age at diagnosis. The natural course of 

JMML is rapidly fatal with 80% of patients surviving less than 3 years. Allogeneic hematopoietic 

stem cell transplantation (HSCT) is the only curative treatment modality 

for JMML, with event-free survival in about half of the children. We present a case of 

23-month-old girl with JMML and a somatic PTPN11 mutation. She was hospitalized 

due to upper respiratory tract infection, fever, rash and diarrhea. Enlarged liver, spleen, 

mesenterial and retroperitoneal lymph nodes were observed at presentation as well as 

severe elevation of white blood cell (WBC) count with monocytosis and myeloid progenitors 

present in peripheral blood. Hemoglobin F was also elevated. Subsequently, her 

bone marrow aspiration showed morphology suggestive of JMML, an unspecific immune 

phenotype and normal karyotype. Mutation analysis revealed a mutation in the PTPN11 

gene. The girl was diagnosed with JMML and treated with purinethol and low doses 

of cytarabine which resulted in normalization of WBC count and decrease in liver and 

spleen size. Her sister was a suitable bone marrow donor and allogeneic HSCT was 

successfully performed. Five months later she is in a good condition and in a complete 

remission of JMML. Early diagnosis and allogeneic HSCT were crucial for successful 

treatment outcome. 

gordanajakovljevic@yahoo.com 

45 



DIAGNOSTIC CHALLENGES IN LYMPHOPROLIFERATIVE DIESASES 

Jakšić B, Kardum-Skelin I 

University Hospital Merkur, Zagreb, Croatia 

46 


Recent development in diagnostic technology brought up a number of exciting challenges 

in lymphoid neoplasms. Traditional diagnostics and classifications, based on 

morphological characteristics of involved tissue, are amended with new (non-morphological) 

parameters. Current WHO consensus classification includes besides morphology 

basis also immunological phenotype and genetic parameters combined with clinical 

data to assure reproducible classification that is clinically sound. However, with proliferating 

of new diagnostics, a number of conceptual and practical issues are emerging. 

On the one hand exponential increase of new data from basic research, translated in 

a pletora of new diagnostic parameters that are competing for clinical evaluation of 

diagnostic relevance, on the other hand increasing numbers of various treatments are 

also competing for clinical evaluation. This is resulting in a complex, multidimensional 

system that requires appropriate, methodologically sound clinical research. Clinical relevance 

for both diagnosis & treatment should be assessed in longitudinal, interventional 

clinical trials including prognostic and survival analysis. Each simple or composite parameter 

should be individually tested for clinical relevance, mutual relationship among 

parameters should be explored by multivariate analyses. Mere correlation among new 

(and old) diagnostic parameters is suboptimal. Poor or inadequate methodology often 

translate in biased or invalid results. Practical diagnostic challenges include failure 

to address the role of (typical) characteristic sample, to discriminate between „static“ 

and „dynamic“ parameters , to disregard kinetic parameters , to misuse the clonality 

concept disregarding its quantitative aspect, or failure to analyze and manage complex 

genetic information etc. All this is of less importance in typical, full blown cases with 

predominantly uniform appearance of clonal infiltration. However, especially challenging 

are cases with composite cellularity in which clonal cells are scanty and surrounded 

with polyclonal or reactive cells. For this reason lymphoproliferative diseases may serve 

as an intriguing research model that could help elucidate yet not fully understood interactions 

between clonally affected neoplastic cells and other cells in the microenvironment. 

Break through in the field requires combined effort of diagnostics experts and 

clinicians to perform high quality, productive clinical research. Those experts should be 

not sealed in morphological categories unprepared to think “out of box”, but should be 

open-minded for paradigm change to come. 

bjaksic@mef.hr


CHRONIC LYMPHOCYTIC LEUKEMIA: INSIGHTS FROM LYMPH NODES & BONE 

MARROW AND CLINICAL PERSPECTIVES 

Jakšić O1 , Kardum-Skelin I2 , Jakšić B2 1 Dubrava University Hospital, Zagreb, Croatia 

2 Merkur University Hospital, Zagreb, Croatia 

B-cell chronic lymphocytic leukemia (B-CLL) is characterized by highly variable distribution 

of tumor mass between peripheral blood, bone marrow and lymphoid organs which 

is important for staging, classification and prognosis. These clinical findings with novel 

data about importance of B-cell receptor and its stimulation with the support of microenvironment 

indicate important role of tissues (lymphoid organs and bone marrow) 

in the pathogenesis of B-CLL. Here is presented the novel approach of simultaneous 

characterization of B-CLL cells form peripheral blood, bone marrow and lymph nodes by 

flow cytometry and immunocytochemistry, defining inter- and intraclonal diversity with 

respect to various molecules. These include adhesion molecules (integrins, immunoglobulins, 

selectins), chemokine receptors (including CXCR-4), signaling molecules and 

prognostic factors (CD38 and ZAP-70), proliferation and apoptosis markers (including 

Ki67, AgNORs with PK index, survivin, bcl-2) and therapeutic targets (CD20 and CD52) 

and residual hematopoietic stem cells. A number of interesting significant interactions 

have been discovered, pointing to the important role of neoplastic cell microenvironment. 

These may in addition to insights in pathogenesis and roles of different microenvironments 

add to diagnosis, prognosis and treatment of B-CLL patients. 

ojaksic@kbd.hr 

47 



48 


FLOW CYTOMETRY IMMUNOPHENOTYPING (FCI) OF FINE NEEDLE ASPIRATES 

(FNAs) OF LYMPH NODES 

Kardum Paro MM1 , Šiftar Z1 , Kardum- Skelin I2 , Šušterčić D2 , Nazor A1 , 

Flegar- Meštrić Z1 , Jakšić B3 1 Institute of Clinical Chemistry, University Hospital „Merkur“, Zagreb, Croatia 

2 Laboratory for Cytology and Hematology, Department of Internal Medicine University 

Hospital „Merkur“, Zagreb, Croatia 

3 Department of Internal Medicine, University Hospital „Merkur“, Zagreb, Croatia 

Flow cytometry immunophenotyping (FCI) has an important role in the clinic work-up 

of fine needle aspirates (FNAs) of lymph nodes. Its standardization has been defined by 

proposed analytical protocols and procedures used to assure proper analytical results 

also in those non- rutine samples. In Institute of Clinical Chemistry University Hospital 

„Merkur“ FCI is accredited method according to laboratory accreditation standard ISO 

15189. According to this laboratory accreditation standard, participation in external quality 

assessment (EQA) programs is a prerequisite for assuring integrity and quality of the 

entire laboratory process. 

A critical analysis of our institutional experience in the feasibility of FCI of the material 

obtained by FNA of lymph nodes with suspected lymphoma represented the purpose 

of the study. During an eight- year period in Institute of Clinical Chemistry, University 

Hospital „Merkur“, a total of 1295 FNA analysis was done, 245 of them with a possible 

diagnosis of B- cell Non- Hodgkin lymphomas (B- NHL) formed the basis of the study. 

Lymphocytes were isolated on density gradient according to Boyum et al. The average 

feasibility of FNAs for FCI analysis was 86 % (ranged 78 - 93%). An acceptable total cell 

number in FNAs for FCI analysis (4257) was established. In total population of respondents 

statistical significances in expressions of cellular antigens CD3, CD5, CD22, CD23, 

CD19 and CD5 on B- cells (CD5+CD19+) between patients with final diagnosis of benign, 

reactive lymphoid proliferations and patients with diagnosis of B- NHL were found. EQA 

results analysis showed that all results were either inside target values (X ± 1stdev) or 

or inside accepted values (X ± 2 stdev). Compatibility of the restriction of imunoglobulins 

light chains determinated by FCI and cytomorphology diagnosis depends on the choice 

of criterion values of the light chains ratio which determine the monoclonality. According 

to the matrix of shares of all classified data of retained neural network, ranges of diagnostic 

sensitivity, specificity, positive predictive value (PPV), negative predictive value 

(NPV) and prevalency of 82%, 72%, 93%, 48%, and 72% were produced. As a conclusion, 

FCI is a reliable methodology for phenotyping FNAs of lymph nodes with suspected B- 

NHLs detecting their clonality easily. 

mariana.kardum@zg.htnet.hr


FINE NEEDLE ASPIRATION CYTOLOGY OF THE PANCREAS: A GUIDE TO 

DIAGNOSTIC APPROACH 

Kocjan G 

Department of Cellular Pathology, University College London, United Kingdom 

The incidence of pancreatic cancer as on of the top ten leading causes of cancer death 

is relatively uniform among different countries and has a peak incidence in the 7th to 8th 

decades of life. The majority of tumours in the pancreas are ductal adenocarcinomas. 

However, there is a wide variety of non-neoplastic, benign neoplastic and malignant 

solid and cystic lesions which are becoming more accessible due to our ability to recognize 

and delineate pancreatic masses and to detect them and sample them earlier as 

smaller mass lesions by virtue of modern imaging techniques that utilize CT, US or EUS. 

However, there is significant overlap in the clinical and radiological features of solid 

and cystic mass lesions of the pancreas precluding definitive management decisions 

based on clinical and radiological features alone. Mass in the pancreas is potentially a 

life threatening condition and management options vary significantly, usually involving 

major surgery. The management of patients with neoplastic cysts is based on the preoperative 

distinction of non-mucinous and mucinous cysts in general, and benign and 

malignant cysts in particular. The cytopathologist therefore plays a critical role in the 

management decisions. A cytological diagnosis can be obtained with minimally invasive 

techniques. EUS guided FNA is evolving as the diagnostic method of choice due to the 

higher resolution, shorter biopsy trajectory, decreased risk of tumour seeding and ability 

to more accurately stage the patient during a single procedure using EUS. A diagnostic 

algorithm for the cytopathologist starts with the initial basic information from the 

radiological image: Is the lesion solid or cystic? If solid, differential diagnosis includes: 

a) Malignant disease ( in 90% primary adenocarcinoma, conventional or variant , other 

malignancy: lymphoma, sarcoma, germ cell tumour, other haematopoetic malignancy, 

metastasis, primary neuroendocrine tumour, solid pseudopapillary neoplasm, acinar 

cell carcinoma and pancreatoblastoma. b) Indeterminate for malignancy or neoplasm 

(atypical or suspicious) in cases where cellular proliferation that is quantitatively and 

qualitatively insufficient for a confident malignant or neoplastic interpretation (Glandular 

ductal pattern: rule out carcinoma, monomorphic cell pattern: rule out solid cellular 

neoplasm).c) Negative for malignancy (Chronic pancreatitis, autoimmune pancreatitis, 

normal pancreatic tissue if the radiological studies define a “fullness” or “vague” mass) 

d) Non-diagnostic (Normal pancreatic tissue if the radiological studies clearly highlight 

a well defined mass or cyst, GI contamination only, lesional tissue obscured by blood or 

preparation artefact, insufficient cellularity for evaluation). If the lesion is cystic ( see 

Table 1)it can be one of the following : a) Pseudocyst -has no epithelial component and 

has non-mucoid cyst fluid grossly, is unilocular, contains inflammatory cyst debris, history 

of pancreatitis, high amylase and low CEA, no K-ras or LOH mutations. b) Serous 

cyst (Microcystic, rarely macrocystic and unilocular, low amylase and CEA) c) Mucinous 

cyst: (Intraductal papillary mucinous neoplasm (IPMN) or Mucinous cystic neoplasm 

(MCN), CEA > 200 ng/ml (at MGH), positive mucin stains , K-ras mutation or ≥ 3 LOH 

mutations supportive d) gastrointestinal duplication cyst , rarely (CEA can be elevated). 

Diagnostic accuracy of pancreatic FNA depends primarily on the nature of the lesion and 

the quality and quantity of the material available but also on the experience of both, the 

aspirator and the interpreter, and most importantly on the communication between the 

radiological, surgical and pathology teams. 

g.kocjan@ucl.ac.uk 

49 



50 


RECURRING CHROMOSOMAL ABNORMALITIES IN LYMPHOMA IN FINE NEEDLE 

ASPIRATES OF LYMPH NODE 

Lasan Trčić R1 , Šušterčić D2 , Kušpilic M1 , Jelić Puškarić B2 , Fabijanić I2 , 

Kardum-Skelin I2 1Cytogenetic Laboratory, Department of Pediatrics, University Hospital Center Zagreb, 

Zagreb, Croatia. 

2Department of Internal Medicine, Clinical Hospital Merkur Medical School University of 

Zagreb, Croatia. 

The detection of chromosomal abnormalities characteristic of lymphomas is important 

in the diagnostic workup of aggressive lymphomas given its impact on treatment strategies 

and prognosis. This has been accomplished using fluorescent in situ hybridization 

(FISH). What is attractive for diagnostics is the conformation of fine needle aspiration 

(FNA) of lymph node with other methods for collecting samples. We report the cytogenetic 

investigation in series of 80 patients with lymphoma (43 women and 37 men) 

median age 48, ranged 3-90 years. In our series 71 (89.0%) of the specimens yield sufficient 

number of analysable metaphases, comprising 63 non-Hodgkin lymphomas (NHL) 

and 8 examples of Hodgkin disease (HD). Among 71 successful karyotyped specimens 

58 (82.0%) showed clonal karyotypic abnormalities. Numerical changes in 4 of 54 NHL 

cases, and numerical with structural changes in 51of 54 NHL cases; trisomies 3, 7, 8, 

12, 18, X and monosomies 1 were most frequent. The NHL cases were typically characterised 

by structural rather than numerical aberrations with chromosome arms 1p/q, 

3p/q, 6q, 11q, 17p and 14q most frequently involved. The expected t(14;18)(q32;q21) in 8 and 

t(8;14)(q24;q34) in 6 cases, both translocations at the same time in three cases, complex 

rearrangement with chromosome 8, 14, and 18, namely t(8;14;18)(q24;q32;q21) in one 

case, t(11;14)(q13;q32) in three and one case with translocation 14q32 with chromosome 

3, 6 and 14. In 24 of 64 (37.5%) NHL cases t(14;v) were present. Four abnormal clones detected 

in HD were typically consisted of a small percentage of metaphases. FISH permitted 

to detect loss or gain of genetic material and reveal rearrangements unsuspected by 

conventional cytogenetics in 34 (48.0%) cases. 

lasan_ruzica@hotmail.com


URINE IMMUNOCYTOLOGY AS A NONINVASIVE DIAGNOSTIC TOOL FOR ACUTE 

KIDNEY REJECTION: A SINGLE CENTER EXPERIENCE 

Mihovilović K1 , Kardum-Skelin I1 , Jelić-Puškarić B1 , Ljubanović D2 , Bulimbašić S2 , 

Sabljar-Matovinović M1 , Kovačević-Vojtušek I1 , Gracin S1 , Kocman B1 , Jadrijević S1 , 

Vidas Ž1 , Guštin D1 , Knotek M1 1 Clinical Hospital “Merkur”, Zagreb, Croatia 

2 Clinical Hospital “Dubrava”, Zagreb, Croatia 

Aim - Renal biopsy is gold standard for diagnosing acute renal allograft rejection. Acute 

rejection may be associated with lymphocyte shedding in the urine. The aim of the present 

study was to evaluate diagnostic performance of urine immunocytology for CD3positive 

cells in diagnosing renal allograft rejection. 

Participants and methods - This was a prospective single centre study performed in 

Clinical Hospital “Merkur”, Croatia. 54 kidney and kidney-pancreas transplant patients 

with 70 kidney biopsies (for cause or by protocol) and simultaneous urine immunocytologies 

(immunostaining for CD3) were included. 

Results - There were 24 AR cases, while in 46 biopsies AR was absent. Urine sediment 

was positive for CD3+ lymphocytes in 5 cases of AR (21%) and in 6 cases without AR (13%). 

CD3 positivity had sensitivity of 21%, specificity of 87%, positive predictive value of 45% 

and negative predictive value of 68% for diagnosis of AR. 

Discussion - These results demonstrate insufficient both sensitivity and specificity of 

urine immunocytology for CD3 for establishing diagnosis of renal AR. With respect to 

sensitivity our results are at odd with some of the previously published studies. Reasons 

for that are unclear, but may reflect either poor intrinsic performance of urine immunocytology 

for detection of AR, or may involve several technical factors like small initial 

volume of urine for analysis. 

Conclusion - Kidney biopsy still remains gold standard for detection AR. Urine immunocytology 

may have potential to become one of the methods for detection AR in kidney 

transplant patients, if sensitivity and specificity could be improved. 

karlomihovilovic@gmail.com 

51 



52 


PARVOVIRUS B 19 INDUCED PURE RED CELL APLASIA IN IMMUNOCOMPROMISED 

PATIENT AFTER LIVER TRANSPLANTATION 

Mrzljak A1 , Kardum Skelin I1 , Čolić Cvrlje V1 , Filipec Kanižaj T1 , Šušterčić D1 , Guštin D2 , 

Kocman B3 1 Department of Medicine, University Hospital Merkur, Zagreb, Croatia, 

2Department of Anesthesiology and Intensive Care, University Hospital Merkur, Zagreb, 

Croatia, 

3 Department of Surgery, University Hospital, Merkur, Zagreb, Croatia 

Reported here is a case of human parvovirus B19 (PVB19) induced pure red-cell aplasia 

(PRCA) in immunocompromised patient after orthotopic liver transplantation (OLT). 

PVB19 is a small, single-stranded DNA whose target cell is the erythroid progenitor in 

bone marrow. Manifestations of PVB19 infection vary with the immunologic status of 

the patient, ranging from asymptomatic to severe infections and PRCA. Post-transplant 

PRCA is induced either by immunosuppression or PVB19. In the presented case, bone 

marrow aspiration characterized by the absence of mature erythroid precursors and 

detection of PVB19 DNA in blood led to treatment with high-dose intravenous human immunoglobulins 

(IVIG) and subsequent recovery of erythropoiesis. Due to insufficient antibody 

response in transplanted patients, suppression of the PVB19 infection is delayed 

and repetitive treatments may be administrated in attempt of reversing PRCA. 

anna.mrzljak@gmail.com


COLLECTION AND COMPOSITION OF AUTOLOGOUS PERIPHERAL BLOOD STEM 

CELLS GRAFT IN PATIENTS WITH ACUTE MYELOID LEUKEMIA: INFLUENCE ON HE- 

MATOPOIETIC RECOVERY AND OUTCOME 

Raos M1 , Nemet D2 , Bojanić I1 , Sertić D2 , Batinić D3 , Dušak V4 , Mazić S1 , Dubravčić K3 , 

Serventi-Seiwerth R2 , Mrsić M2 , Golubić-Ćepulić B1 , Labar B2 1Department of Transfusion Medicine and Cellular Therapy, Clinical Hospital Center 

Zagreb, Zagreb, Croatia 

2Division of Hematology, Department of Internal Medicine, Clinical Hospital Center 


3Division of Immunology, Department of Laboratory Diagnostics, Clinical Hospital 

Center Zagreb, Zagreb, Croatia 

4 Department for Quantitative Methods, University of Zagreb, Faculty of Organisation 

and Informatics, Varaždin, Croatia 

Hematopoietic stem cell (HSC) transplantation is a standard approach in the treatment 

of hematological malignant diseases. For the last 15 years the main source of cells for 

trasplantation have been peripheral blood stem cells (PBSC). With the availability of hematopoietic 

growth factors and understanding the advantages of treatment with PBSC, 

the application of bone marrow (BM) was supplanted. The aim of this survey was to explore 

the success of PBSC collection, the factors which influence the success of PBSC 

collection, the composition and the quality of graft and their infuence on hematopoietic 

recovery and outcome after transplantation in patients with acute myeloid leukemia 

(AML). PBSC were collected by the method of leukapheresis after applying a combination 

of chemotherapy and growth factors or only growth factors. The quality of graft was 

determined with the clonogenic progenitor cell assay and with the flow citometry analysis. 

Of the total 134 patients with AML, who were sumitted to HSC mobilization, the collection 

was successful in 78 (58.2%) patients. The collection was more successful after 

the first than after the second attempt of HSC mobilization (49% vs 11%). The criteria for 

effective mobilization were the number of leukocytes >3 x 109/L and the concentration 

of CD34+ cells >20 x 103/mL in the peripheral blood on the first day of leukapheresis. 

The number of CD34+ cells infused had the strongest impact on hematopoietic recovery. 

We noted significantly faster hematological recovery of neutrophils and platelets, fewer 

number of transfused units of red blood cells and platelets, shorter duration of the tranfusion 

support, shorter treatment with intravenous antibiotic therapy and shorter hospitalization 

after PBSC compared to BM transplantation. These advantages could provide 

their standard application in the treatment of patients with AML. 

mraos@kbc-zagreb.hr 

53 



54 


VALUE OF FINE-NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSIS OF HODGKIN’S LYM- 

PHOMA AND ANAPLASTIC LARGE CELL LYMPHOMA: ONE CENTRE EXPERIENCE 

Ostojić Kolonić S1 , Prašek-Kudrna K1 , Roso V1 , Radić-Krišto D1 , Planinc-Peraica A1 , 

Džebro S2 , Kardum-Skelin I3 , Jakšić B1 1 Department of Medicine, University Hospital Merkur, Zagreb 

2 Department of Pathology and Cytology, University Hospital Merkur, Zagreb 

3 Laboratory for Cytology and Haematology, University Hospital Merkur, Zagreb 

It is commonly believed that cytological diagnosis of Hodgkin’s lymphoma (HL) is much 

easier than that of non-Hodgkin’s lymphoma (NHL). Anaplastic large cell lymphoma 

(ALCL) is NHL subtype which has created confusion with HL in fine-needle aspiration 

(FNA) smears. To study the value and limitations of cytology in diagnosis of HL and ALCL 

we analysed the initial FNA diagnosis and histopathological reports, as well as treatment 

and survival in 89 newly diagnosed consecutive patients with these lymphomas 

treated in our clinical department. These patients (40 male, 49 female; age range 16-93 

years, mean 38 years; 44 in clinical stages I-II; 38 with B symptoms) were diagnosed 

and treated during a period of 5 years and 4 months (1.1.2004.-1.5.2009.) The initial FNA 

diagnoses were available in 86 patients (3 patients were admitted with histopathological 

diagnosis and without enlarged lymph nodes suitable for FNA) and the initial pathohistological 

diagnosis were available in 84 patients. FNA revealed 65 classic HL, 18 ALCL and 

3 patients in which diagnosis was not informative due to inadequate material. Among 

65 FNA diagnoses as HL, comparison with histopathology was made in 61 cases (in 3 

cases a biopsy of lymph node was not possible and in one case there was no tumour 

infiltration in the analysed lymph node) and the histopathological diagnoses were as follows: 

56 (91,8%) HL; 3 ALCL; 1 diffuse large B cell lymphoma and 1 marginal zone B cell 

lymphoma. In the group of 18 FNA diagnoses of ALCL 2 patients didn’t have a lymph node 

biopsy; in 1 case tumour was not found in biopsy material; 8 patients (53,3%) had definitive 

diagnosis of ALCL( either as T-cell or O type), and 5 (33,3%) as HL. These results 

confirm the value of FNA in diagnostic procedure in patients with HL and ALCL, with very 

good results in comparison with histopathology, especially in HL group of patients. 

86 (96,6%) patients were treated with chemotherapy, 74 (83,1%) patients with ABVD chemotherapeutic 

protocol according to our policy that patients with HL and T-cell ALCL 

are treated with the same therapy as well. As we have almost uniform group of patients 

according to therapeutic approach, we done the univariante analyses and find out that 

patients with FNA diagnoses of HL, younger than 55 years, with early stage of the disease 

and without B symptoms had significantly longer overall survival (OS). FNA diagnosis 

has clinical relevance in differentiation between HL and ALCL. 

ostojic@net.hr


ASSESSMENT OF HPV DNA TEST VALUE IN MANAGEMENT WOMEN WITH CYTOLOGI- 

CAL FINDINGS OF ASC-US, CIN1 AND CIN2 

Pajtler M, Miličić-Juhas V, Milojković M, Topolovec Z, Čuržik D, Mihaljević I 

Department of Clinical Cytology, University Department of Gynaecology and Obstetrics, 

Clinical Institute of Nuclear Medicine and Radiation Protection, Osijek University Hospital, 

Osijek, Croatia 

The aim of this retrospective study was to answer the following questions: 1) is HPV DNA 

test for high-risk types able to predict lesion behaviour in women with cytological abnormalities 

lower than CIN3 (ASC-US, CIN1 and CIN2); 2) how to predict the histological 

diagnosis CIN3, and 3) is its use in diagnostic management in these patients justified or 

not? Subjects and Methods: The study included 345 women (11 ASC-US, 312 CIN1 and 22 

CIN2) that underwent conventional diagnostic management (repeat cytology and colposcopy 

with or without histology) and HPV testing for high-risk HPV types by PCR method. 

The value of HPV DNA test in predicting lesion regression/persistence was assessed in 

275 subjects without histology. In 70 subjects, diagnostic accuracy (sensitivity, specificity, 

and positive and negative predictive value) of repeat cytology and HPV DNA test in predicting 

severe intraepithelial lesion (CIN3) was determined on the basis of colposcopy 

guided biopsy. Results: The prevalence of persistent lesions was significantly higher in 

the group of HPV positive than in the group of HPV negative subjects (37.7% vs. 16.4%; 

P


56 


THE ROLE OF ENDOSCOPIC ULTRASOUND IN EVALUATION OF GASTRIC 

SUBEPITHELIAL LESIONS 

Pavić T, Hrabar D, Duvnjak M 

Department of Gastroenterology and Hepatology, Clinical Hospital Sestre Milosrdnice, 


A subepithelial mass is a common finding during endoscopic procedures. Endoscopic 

ultrasound (EUS) is an important diagnostic modality in the evaluation of subepithelial 

lesions of the GI tract. EUS is the diagnostic test of choice to assess the size, margins, 

the layer of origin, echotexture, and to differentiate between an intramural and extramural 

lesion. However, the EUS imaging lacks the specificity. EUS- guided fine needle 

aspiration (EUS-FNA) or core biopsy can help establish a tissue diagnosis and potentially 

characterize malignant risk. The aim of this article is to review the diagnosis and 

management of the most common subepithelial gastric lesions with an emphasis on the 

role of endoscopic ultrasound. 

tajana.pavic@gmail.com 

LUNG LAVAGE CELL PROFILES IN DIFFUSE LUNG DISEASE 

Peroš-Golubičić T1 , Smojver-Ježek S2 University Hospital for Lung Diseases Jordanovac, Zagreb, Croatia 

1 Department of Pneumology 

2 Department of Cytology 

The standard armamentarium of tests that are used by pulmonologist are laboratory 

tests, pulmonary function tests, different radiological techniques (conventional chest-X 

rays, HRCT scans, etc) and pathohistological analyses of biopsies. The minimally invasive 

bronchoalveolar lavage (BAL) procedure, in addition to methods earlier mentioned, 

is an important diagnostic instrument that can facilitate the diagnosis of various diffuse 

lung diseases (DLD). BAL fluid white blood cell profiles are analyzed, malignant cells 

looked for, and in certain circumstances particular stains are performed to detect yet 

other cell types. Additionally, BAL can play a very important role in the diagnosis of respiratory 

tract infections. All these analyses are usually readily performed in a moderately 

equipped cytological laboratory. 

tperos-golubicic@net.hr


BONE LESIONS IN LYMPHOMA 

Planinc-Peraica A, Radić-Krišto D, Ostojić Kolonić S, Kardum-Skelin I, Jakšić B 

Department of Medicine, University Hospital Merkur, Zagreb 

Bone lesions are rare events in patients with haematologic neoplasm except those with 

adult T-cell leukaemia lymphoma associated with HTLV-1 infection, and multiple myeloma. 

Primary lymphoma of bone is rare manifestation of this disease, and less than 

5% of all extranodal lymphomas are localized in bones. The most common localization 

is the long bones, and localized bone pain is usual accompanying symptom. Sometimes 

patients have systemic symptoms and multiple osteolyses. Less than 10% of patients 

with malignant lymphoma develop bone lesions during the course of their disease. Hypercalcaemia 

is rare in primary lymphoma of bone. 

In six years period at University Hospital “Merkur” out of 698 lymphoma patients bone 

lesions were diagnosed in 7 patients (3 men, 4 women, age - range 22 to 66 years, median 

of age 58 years). Two newly diagnosed patients with diffuse large B-cell lymphoma 

(DLBCL) had primary lymphoma of bone without lymph node involvement. In 5 patients 

bone lesions were discovered during the course of disease. In all patients localized bone 

pain was dominant symptom. No one patient had hypercalcaemia. In the course of their 

disease secondary bone lesions appeared in two patients with indolent lymphoma, in 

one patient with DLCB, and in two patients with Hodgkin’s disease, type mixed cellularity. 

Localization of primary bone lymphoma was femur, and rib, while secondary lymphoma 

lesions were in backbone, and pelvis. Patients were treated with chemotherapy 

(COP-R, CHOP, CHOP-R for lymphoma, and ABVD, LVPP, BEACOP for Hodgkin’s disease) 

combined with radiotherapy only in three patients. Three patients died. The median of 

survival is 75 months. 

We concluded that primary bone lesions of lymphoma are rare conditions. Correct diagnosis 

is very important because primary lymphoma of bone has a relatively favorable 

prognosis. 

ananas2907@hotmail.com 

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58 


PRIMARY GASTROINTESTINAL NON HODGKIN LYMPHOMA IN ADULTS: 

CLINICOPATHOLOGICAL AND SURVIVAL CHARACTERISTICS 

Radić-Krišto D1 , Planinc-Peraica A1 , Ostojić Kolonić S1 , Vrhovac R1 , Kardum-Skelin I2 , 

Jakšić B1 1 Department of Hematology, University Hospital Merkur, Zagreb, Croatia 

2 Department of Cytology, University Hospital Merkur, Zagreb, Croatia 

Primary non-Hodgkin lymphomas of gastrointestinal tract (PGI-NHL) are the most 

common extranodal lymphomas with increasing incidence. We retrospectively analyzed, 

incidence, clinicopathological features as well as treatement and survival data 

on 39, newly diagnosed PGI-NHL (23 male, 16 female), at University Hospital „Merkur“ 

in order to precisely evaluate their characteristics and compare them with results of 

other similar studies. The most common site of PGI-NHL was the stomach (29 patients, 

74%), followed by small intestine (5 patients,13%), and colon and rectosigmoid (5 patints,13%). 

According to the Ann Arboror classification 34 (87%) patients had stage IE, 

and IIE, and 5 patients (12%) stages III E and IVE. According World Health Organization8 

(WHO) classification 29 (87%) patients had diffuse large B-cell lymphoma (DLCBL), 2 

had mantle cell lymphoma, and 7 (18%) had marginal zone B- cell lymphoma-mucosa 

associated tissue (MALT). Twenty six patients (66%) underwent surgical resection and 

were later treated by chemotherapy, 10 (26%), were treated with chemotherapy alone, 

and 3 (8%) were treated only surgical. Complete remissione was achived in 28 patients 

(72%), partial remission in 7 (18 %). Four patients had progressive disease (10%).The 

major prognostic factor for outcome in our patients was the stage of disease. Patients 

with localized lymphoma (stage IE and II E) had significantly longer overall survival 

(OS): 85% at 5-years and 65 % at 10 years. Patients with extended disease (stage IIIE 

and IV E) had overall survival less than 33%. Prognostic power of ESR, total protein and 

serum albumin, concentration and LDH activity, was analyzed. Among these parameters 

only parametars only LDH had statistically significant influence on overall survival. We 

conclude, that our group of patients is similar to other publised groups of PGI-NHL patients 

according to clinical characteristics as well as to pathological features. Disease 

stage and LDH were the only parametars that had a statistically significant influence on 

patients survival. 

delfaradic@kb.merkur.com


SUBCUTANEOUS PANNICULITIS-LIKE T-CELL LYMPHOMA IN A 19 MONTH-OLD 

BOY TREATED WITH ALL-IC-BFM 2002 PROTOCOL - A CASE REPORT. 

Rajić Lj1 , Bilić E1 , Femenić R1 , Meštrović D1 , Ilić I2 , Kardum-Skelin I3 , Tešović G4 , Konja J1 1 Pediatric Clinic and 

2 Department of Pathology, Clinical Hospital Center Zagreb 

3 Clinical Hospital “Merkur“ 

4 University Hospital for Infectious Diseases, Zagreb, Croatia. 

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell lymphoma 

of CD3+CD8+ phenotype characterized by deep-seated skin nodules or plaques 

mimicking panniculitis, a result of neoplastic lymphocytes infiltrating the subcutaneous 

fatty tissue. SPTCL is very rare, especially in childhood (less than 1% of all non-Hodgkin 

lymphomas) and presents most commonly in young adults. Still, there are many uncertainties 

regarding the optimal therapy and definitive recommendations are still to be 

defined. Here we present a case of a 19-month year old boy with subcutaneous panniculitis-like 

T-lymphoma diagnosed and successfully treated in our institution. The disease 

presented with symptoms of high fever and a painful erythematous nodule located below 

the umbilicus. A thorough diagnostic workup was initiated and not even a month after 

the child was hospitalized a definite diagnosis of a subcutaneous panniculitis-like Tlymphoma 

was confirmed. As the most decisive in obtaining the diagnosis, skin biopsy 

showed infiltration of atypical, small to medium-sized lymphatic cells infiltrating the 

deeper dermal layers as well as the subcutaneous adipose tissue, surrounding the adipocytes. 

In addition, numerous hystiocytes and signs of cariorrhexis and focal necrosis 

were observed. No infiltration of blood vessels or epidermis was evident. We then initiated 

a specific treatment protocol for T-lymphomas (ALL-IC-BFM-2002) and saw a rapid 

regression of local symptoms. The treatment was completed according to schedule and 

the child is now, 14 months after the initiation of the treatment, in complete remission. 

ljubica.rajic@yahoo.com 

59 



PELVIC GANGLIONEUROMA - CASE REPORT 

Roganović J1 , Šegulja S1 , Jonjić N2 , Seili-Bekafigo I3 60 


1 Division of Hematology and Oncology, University Children’s Hospital Rijeka 

2 Department of Pathology, School of Medicine Rijeka 

3Department of Cytology, Department of Internal Medicine, Clinical Hospital Center 

Rijeka, Croatia 

Ganglioneuroma is a rare benign tumor originating from sympathetic tissue. The most 

common locations are the posterior mediastinum and retroperitoneum. Pelvic ganglioneuroma 

is extremely rare. 

We report a case of pelvic ganglioneuroma in a 12-year-old who presented with one 

week history of lower abdominal pain. Abdominal ultrasound demonstrated a large homogeneous 

well-circumscribed presacral tumor with few calcifications. This finding 

was confirmed by pelvic computed tomography (CT) and magnetic resonance imaging. 

CT-guided fine needle aspiration biopsy was performed. Cytologic and pathologic features 

were suggestive of ganglioneuroma. The patient underwent a complete surgical 

resection and the diagnosis of ganglioneuroma was subsequently confirmed on histopathologic 

examination. At 3-years follow-up the patient is asymptomatic and without 

evidence of disease. 

Ganglioneuroma should be considered in the differential diagnosis of soft tissue pelvic 

tumors in children. Fine needle aspiration biopsy plays an important role in facilitating 

an appropriate diagnosis and an adequate therapeutic approach. 

jelena.roganovic1@ri.t-com.hr


MORPHOLOGICAL AND MOLECULAR ANALYSIS OF GISTS ON CYTOLOGY 

Schmitt FC 

Medical Faculty of Porto University, Unit of Molecular Pathology - IPATIMUP, Porto, 

Portugal 

The term “targeted therapies” refers to treatment strategies directed against molecular 

targets considered to be involved in the process of neoplastic transformation. One of the 

most attractive molecular targets for therapeutic intervention in cancer is the protein tyrosine 

kinase (TK) family. More than 100 dominant oncogenes are recognized to data and 

many encode receptor and cytoplasmic TKs known to be mutated and/or overexpressed 

in human cancers. Targeting receptor protein kinases family as cancer therapy has continued 

to become a compelling approach with time. However, some general conditions 

should be considered prior to selecting a TK as a therapeutic target in cancer. It should 

be involved in experimental tumour progression and be demonstrable in diagnostic tumour 

tissue. (Cyto)pathology is crucial for the accurate assessment of the target to ensure 

that the patients who may benefit from the therapy are correctly identified. 

Since the last decade, there have been an increasing number of new drugs which indications 

depends upon a pathological report. Fine needle aspiration (FNA) cytology has 

proven its value as a minimally invasive, easy, accurate and reliable technique for the 

diagnosis of tumours and has also been used for the assessment of prognostic and predictive 

factors. The evaluation of predictive factors in FNA specimens should be largely 

confined to patients who will undergo neoadjuvant chemotherapy before surgery or in 

the setting of metastatic disease. FNA is a less traumatic method that provides a good 

source of cancer cells to study therapeutic targets. 

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of 

the gastrointestinal tract, with an annual incidence of 10 to 20 cases per million, being 

most commonly found in the stomach (40 to 70%), in the small intestine (20 to 50%), in 

the colon and rectum (5 to 15%), and in the esophagus (< 2%). Activating mutations of 

c-kit oncogene are the major genetic alterations in GISTs. c-kit is a proto-oncogene 

that codes for a transmembrane TK receptor: CD117. Once activated, KIT propagates 

signalling events throughout the cell via multiple signal transduction pathways. Until 

recently, the prognosis of patients with GISTs was poor due to its frequent recurrence 

and resistance to chemo and radiotherapy regimens. The development and current 

treatment with specific RTK inhibitors is changing this scenario. Imatinib mesylate is 

a selective inhibitor of RTKs, by competing with the ATP for its binding site, preventing 

further phosphorylations of signaling molecules downstream of the receptor, responsible 

for abnormal viability and proliferation signals in these cells. Several studies have 

linked different responses to the drug with c-kit alterations. In particular, tumors harboring 

exon 11 c-kit mutations are more likely to respond to an Imatinib therapy than 

those with either exon 9 c-kit mutations or no detectable mutation. Currently, Imatinib is 

used for the treatment of Kit positive GIST patients with unresectable and/or metastatic 

malignant tumor. Besides Imatinib, another RTK inhibitor, Sunitinib has been approved 

61 



62 


for the treatment of patients with GIST whose disease has progressed or who are unable 

to tolerate treatment with Imatinib. It is a fact that obtaining an accurate diagnosis 

is of utmost importance for a correct treatment, being an earlier diagnosis crucial for 

a prompt therapy. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS- 

FNA) has been increasingly used for the assessment of diverse intra-abdominal and 

intra-thoracic tumors. EUS-FNA not only allows for a meticulous representation of both 

extramural and intramural structures of the gastrointestinal tract but also permits tissue 

sampling from masses in these locations. Our group was one of the pioneers in 

analyze c-Kit mutations in EUS-FNA material. In 2007, we studied eighty-five patients 

with intramural gastrointestinal mesenchymal tumors and perform an immunohistochemical 

and molecular analysis of both c-kit and PDGFRA genes in formalin-fixed 

paraffin embedded cell blocks obtained by EUS-FNA. Cell-blocks of the initial 85 cases 

were obtained, however, complete immunocytochemical and molecular analysis was 

only possible in 51 cases. The mean age of patients was 62.4 yr (range, 26-92yr). Twenty 

(39.2%) patients were females and 31 (60.8%) were males. Topographically, 12 (23.5%) 

tumors were located in the esophagus, 35 (68.6%) tumors were gastric and 4 (7.8%) 

were located in the small intestine. The mean size of tumors documented by EUS was 

33.9mm (range 11-80mm). Immunoreactivity for CD117 was detected in a majority of tumors 

pre-classified as GISTs. CD117 positivity in GIST’s tumor cells was strongly present 

at the membrane and diffuses in the cytoplasm. CD117 was negative in 7/31 (22.6%) 

tumors pre-classified as GISTs. In two cases the immunostaining was not interpretable 

due the technical artifacts. PCR amplification and DNA sequencing revealed exon 11 mutation 

in 19 (57.6%, 19/33) GISTs, and exon 9 mutation in 1 (3.0%, 1/33) GIST. No PDGFRA 

activating mutations were detected in the c-kit wild type bearing tumors. In summary, 

our study demonstrates that 77.4% of GISTs strongly and diffusely express kit, irrespective 

of topography, age or gender. Albeit several studies indicate that 95-100% of GIST 

cases express kit, lower expression levels have been reported in Australian (78%) and 

Scandinavian studies (85%). Such differences in protein expression levels are probably 

due to distinct methodologies and population diversities. We identified c-Kit mutations 

in 61% of GIST cases, in accordance with previously published ranges (30-90%). Nearly 

95% (19/20) of c-kit-mutant tumors carried exon 11 mutations. 

EUS-FNA, a less costly, less risky, and less invasive strategy is an increasingly used 

procedure for the diagnosis of gastrointestinal tumors. In this study, we have shown 

that GISTs could be diagnosed pre-operatively on EUS-FNA specimens. In addition to 

immunocytochemistry, molecular analysis can be done in formalin-fixed and paraffinembedded 

cell block material obtained from these aspirates, avoiding more invasive 

diagnostic procedures to obtain a tissue diagnosis. 

In nowadays, with two RTK inhibitors available, there is an imperative need in re-defining 

GIST diagnosis and including a molecular analysis of both c-Kit and PDGFRA in the current 

diagnostic protocol, so as to better and faster establish the specific therapeutic 

approach to use in a particular patient. In conclusion, we are unquestionably taking one 

step forward in the diagnosis of GIST, by making the molecular analysis routinely feasible 

on a small sample.


References 

Akerman M, Alves VA, Bubendorf L, Colgan T, Itoh H, Kapila K, Katz R, Mitchell G, Mulvany 

NJ, Nasuti JF, Ng WK, Osamura RY, Schalper J, Schmitt FC, Serizawa A, Verhest 

A, Vielh P. How technology is reshaping the practice of nongynecologic cytology. Acta 

Cytologica 51: 123-152, 2007. 

Gomes AL, Bardales RH, Milanezi F, Reis RM, Schmitt F. Molecular analysis of c-Kit and 

PDGFRA in GISTs diagnosed by EUS. American Journal of Clinical Pathology 127: 1-8, 

2007. 

Schmitt FC. Cells carry the clue for targeted treatment: a new horizon for cytopathology. 

Cytopathology 18: 275-277, 2007. 

Schmitt FC, Longatto A, Valent A, Vielh P. Molecular techniques in cytopathology practice. 

Journal of Clinical Pathology 61: 258-267, 2008. 

fernando.schmitt@ipatimup.pt 

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64 


MORPHOMETRIC AND DNA IMAGE ANALYSIS OF BRONCHOALVEOLAR LAVAGE 

FLUID MACROPHAGES NUCLEI IN INTERSTITIAL LUNG DISEASES WITH LYMPHO- 

CYTIC ALVEOLITIS 

Smojver-Ježek S1 , Peroš-Golubičić T2 , Tekavec-Trkanjec J2 , Alilović M2 , 

Vrabec-Branica B1 , Juroš Z1 , Mažuranic I3 University Hospital for Lung Diseases “Jordanovac”, Zagreb, Croatia 


2 Department of Pneumology 

3 Department of Radiology 

Lymphocytic alveolitis is a characteristic of diverse interstitial lung diseases (ILD-s), but 

macrophages are often more numerous cell population in bronchoalveolar lavage fluid 

(BALF). Aim of this study is to analyze morphometric characteristics of macrophages 

nuclei in BALF in patients with ILD-s and to detect possible differences allowing distinguishing 

sarcoidosis from other lymphocytic alveolitis ILD-s. 

Patients and methods. Thirty-one patient with interstitial lung disease who had lymphocytic 

alveolitis in BALF cell count (17 sarcoidosis and 14 other ILD-s) and nine controls 

were included in the study. The following patients data were numbered: age, lymphocyte 

percentage and CD4/CD8 ratio in BALF. Investigated morphometric parameters of macrophages 

nuclei were: area, outline, maximal radius, minimal radius, length, breadth, 

form factor (FF), elongation factor (EF) and DNA image cytometry ploidy status determined 

with Van Velthoven method. Results. Predicted classifications in classification 

matrix (forward step-wise method in multivariate discriminant function analysis) based 

on macrophages nuclei length mean, minimum and maximum, breadth SD, FF mean 

and lymphocyte % were 100% (9/9) correct for control group, 88.235% (15/17) correct for 

sarcoidosis, and 92.857% (13/14) correct for other lymphocytic alveolitis ILD group. In 

total, 92.5% (37/40) of the examinees were correctly classified in particular group upon 

the observed variables. 

ssmojver@pbf.hr


CYTOMORPHOLOGY OF SELECTED SUBTYPES OF ACUTE LEUKEMIA (AL) 

Sučić M1 , Marković-Glamočak M1 , Ries S1 , Gjadrov-Kuveždić K1 , Antulov J1 , 

Fabijanić I1 , Vrbanus LJ1 , Ilić I1 , Dotlić S1 , Čačić M1 , Zadro R2 , Mrsić S2 , 

Franić Šimić I2 , Batinić D2 , Dubravčić K2 , Serventi-Seiwerth R3 , Sertić D3 , 

Mikulić M3 , Mrsić M3 , Nemet D3 , Labar B3 1 Zagreb University Clinical Hospital Center and School of Medicine, Clinical Department 

of Pathology and Cytology, Zagreb, Croatia 

2 Zagreb University Clinical Hospital Center and School of Medicine, 2Clinical Institute of 

Laboratory Diagnosis, Zagreb, Croatia 

3Zagreb University Clinical Hospital Center and School of Medicine 3Department of 


According to WHO classification of tumors of hematopoietic and lymphoid tissues, the 

major subgroups of acute myeloid leukemia (AML) and related precursor neoplasms 

are the following: AML with recurrent genetic abnormalities, AML with myelodisplasia, 

therapy-related myeloid neoplasms, AML-(NOS), myeloid sarcoma, myeloid proliferations 

related to Down syndrome and blastic plasmocytoid dendritic cell neoplasm. Acute 

lymphoblastic leukemia is classified together with B and T lymphoblastic lymphoma in 

a group of precursor lymphoid neoplasms. Mixed lineage acute leukemia (MPAL) and 

acute undifferentiated leukemia (AUL) are subtypes of AL of ambiguous lineage. 

The aim of the study was to analyze cytomorphology of selected AML and MPAL subtypes. 

Patients and methods: In the study are included AL patients treated at Zagreb University 

Hospital Center. Bone marrow and peripheral blood of AL patients were analyzed 

after Pappenheim and cytochemical staining and classified according FAB and WHOclassification. 

Results: Therapy related AML was diagnosed in two of AL patients: one had secondary 

AML-M4 after five years of initial diagnosis and treatment for B-NHL, and another had 

AML-M2 after diagnosis of breast carcinoma and melanoma. In one patient with AML- 

M8 the blasts were cytomorphologically undifferentiated with sparse mature basophiles, 

whereas in one AML-M1 patient blasts at relapse expressed lymphoid cytomorphology 

pointing to lineage switch (phenomenon of MPAL). 

Conclusion: Cytological diagnosis of AL subtypes together with multidisciplinary diagnostic 

approach is essential in initial diagnosis and continuous follow-up of patients with 

AL, especially for secondary AL, and some other subtypes of AL, i.e. AML-M3, AML-M8 

and MPAL requiring individual therapy approach. 

mirna.sucic@yahoo.com 

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66 


ENDOSCOPIC ULTRASOUND IN EVALUATION OF SOLID PANCREATIC 

MASSES -CURRENT STATE AND REVIEW OF THE LITERATURE 

Tadić M1 , Štoos-Veić T2 , Vukelić-Marković M3 , Ćurić J3 , Banić M1 , Čabrijan Z1 , 

Grgurević I1 , Kujundžić M1 1 Department of Gastroenterology, Dubrava University Hospital, Zagreb, Croatia 

2 Department of Cytology and Flow Cytometry, Dubrava University Hospital, Zagreb,Croatia 

3 Department of Radiology, Dubrava University Hospital, Zagreb, Croatia 

The aim of this review was to discuss the current evidence of clinical impact of EUS and 

EUS-guided fine needle aspiration (FNA) in evaluation of solid pancreatic masses with 

special emphasis on differentiation between benign and malignant pancreatic lesions. 

At the time of introduction in clinical practice EUS was superior to the other methods 

in detection of pancreatic masses allowing tissue diagnosis by later introduced EUS- 

FNA. During the time EUS was improved, electronic probes replaced mechanical probes 

adding ability of color Doppler, power Doppler, contrast enhanced endosonography as 

well as EUS elastography analysis. CT technology has also experienced significant improvements 

raising the question whether EUS has lost ground in diagnostics of solid 

pancreatic masses. Detection of small pancreatic tumors, preoperative localization of 

pancreatic endocrine tumors and tissue sampling by EUS-FNA of pancreatic masses are 

considered firm indications for EUS. Color Doppler, power Doppler, contrast enhanced 

endosonography and elastography are discussed as tools that are bringing additional 

information in evaluation of pancreatic masses, however insufficient for definitive judgment 

of the lesion’s nature. Cytological tissue analysis remains undisputed in differentiation 

benign from malignant lesions, but the question when FNA is needed as well as 

the question of pancreatic cancer staging is discussed. Conclusion: Resuming the role 

of EUS we can state that despite some controversies EUS is a very valuable method in 

evaluation of solid pancreatic masses and with EUS-FNA is by far the best method for 

obtaining tissue diagnosis. 

mtadic@kbd.hr


IMPLEMENTATION OF MODERN TECHNIQUES IN FNA OF THE THYROID 

Tötsch M 

Institute of Pathology and Neuropathology, University Hospital of Essen, Germany 

Fine needle aspiration of the thyroid started in the middle of the last century. It rapidly 

proved to be an excellent tool for management of thyroid nodules. Sensitivity of 

the method was improved significantly be the introduction of scintigraphy and ultrasonography. 

Later on, not only management but also the diagnosis of certain entities as 

papillary carcinoma or anaplastic carcinoma became possible by establishing appropriate 

diagnostic criteria. Nowadays fine needle aspiration biopsy has become a standard 

procedure, cytopathology has become adopted in the WHO - Classification of thyroid 

tumours (2004). Actually there is discussion concerning the diagnostic categories to be 

used as well as the definition of “non satisfactory” and satisfactory”, respectively. Additionally, 

the benefit of liquid based cytology is under evaluation. However, comparison 

of studies is hampered by different interpretation of the parameters mentioned above, 

furthermore the rate of incidental thyroid cancer in interpretation of “false-negative” 

results must be taken in consideration. 

The introduction of ancillary tests has improved the diagnostic sensitivity and specificity 

of cytology. While in former times DNA-cytometry and morphometry have been tried as 

an adjunct in discriminating follicular tumours, immunocytochemistry has proven now 

its value in the diagnosis of medullary carcinoma and metastases. Galectin-3 and others, 

however, can not be used today with reliabilty in practical diagnostic work. 

Nowadays, emphasis is laid on the introduction of molecular tests and lymphomas can 

be reliable diagnosed in most cases. Papillary carcinoma, having already a very good 

detection rate by cytology, may be diagnosed by investigation of the RET-RAS-BRAF- 

MAPK-pathway as well. Unfortunately, routine use is hampered by false negative respectively 

false positive results. Therefore, interest shifts to diagnosis of this tumour 

type by the detection of specific miRNA profiles. 

However, till now, there is no diagnostic tool for solving the dilemma of thyroid cytology, 

the distinction of follicular adenoma from follicular carcinoma. In these cases the diagnosis 

can be made only by histology. 

Martin.Toetsch@medizin.uni-essen.de 

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BENEFITS OF LIQUID BASED CYTOLOGY OVER CONVENTIONAL PAP TEST: 

PRESENT AND FUTURE. 

Verhest A 

Institute Jules Bordet, Brussels - Belgium 

Objective:The intention of this presentation is to provide insight into our everyday experience 

with the BD-SurePath TM liquid based technology that we used for cervical cancer 

screening since 1998. We will also focus on use of reflex HPV-DNA testing as an adjunct 

for external quality control and guided screening of cervical cytology specimens as a 

significant advance over routine manual screening . Methods:Conventional Pap screening 

has been credited with a 75 % reduction in cancer incidence and death rates in the 

last 50 years. Despite this, there was a growing evidence of a limited sensitivity of 77 % 

for detecting CIN 2 (when using LSIL as a threshold) with an individual Pap smear, a low 

positive predictive value (10-30%), a highly subjective interpretation leading to misclassification 

with unreducible false negative and positive rates. These factors limiting the 

performance of the Pap smear while increasing the complexity and costs of screening 

programmes, we replaced conventional smear in december 1997 by thin layer preparations 

made with BD-PrepStain TM automate from samples collected in BD-SurePath 

TM preservative fluid. Liquid based cytology (LBC) diagnoses were assessed on first 

screening sample with a second reading combined with HPV test to improve the ASCUS 

predictive value and offer an immediate evaluation of our personal performance and 

possible misinterpretation of the Bethesda TBS criteria. The LBC process is now widely 

used in the United States, many European countries and elsewhere. The slides facilitated 

the screening by skilled human observers or triggered an impetus for automated 

screening. In order to determine if use of the BD FocalPoint GS Imaging System (BD 

Diagnostics-TriPath) is more effective than manual screening, a large clinical trial has 

been recently performed. (1) A 2-armed, masked trial was run at 4 clinical sites. 12,313 

slides were evaluated. The control arm (CA) consisted of routine manual screening and 

quality control (QC) rescreening. The experimental arm (EA) consisted of screening by 

the BD FocalPoint GS Imaging System. Results: With the adoption of LBC we have 

significantly reduced the number of unsatisfactory smears minimizing cellular preparation 

artifacts, decreased the ASCUS rate and improved the sensitivity and specificity 

of our SIL diagnoses. The use of HPV testing has ascertained our diagnoses in the 

necessary learning curve of our morphologic interpretation of abnormals. BD-SurePath 

TM increased comfort and skill level of the all staff. More evenly dispersed single-cell 

population between aggregates enhances the clarity of the smear, makes them easier 

to evaluate for atypia; its utilization demonstrated evident superiority over conventional 

Pap smear in terms of disease detection. Using computer-assisted imaging, all positive, 

discordant, and a subsampling of negative slides were adjudicated to a reference 

diagnosis. The results obtained in the two arms were compared to the reference diagnoses 

and sensitivity, specificity, and negative predictive value (NPV) were calculated 

for ASC-US+, LSIL+ and HSIL+ groups. (1). The FocalPoint LGS reading gives a higher 

detection sensitivity than the manual reading for HSIL+ and for LSIL+. (1-2) For ASC-US+,


the sensitivities were not statistically different between the study arms in Tench’s Study 

(1) while Beccati (2) reports a more precise ASCUS diagnosis. Conclusions: The optimal 

preservation of the cells with BD-SurePath LBC is reducing collection, preparation 

and screening errors of conventional Pap smears. It facilitates comfort of screening by 

human observers. The lower rate of unsatisfactory smears and ASCUS/SIL ratio have 

contributed to an increased HSIL+ detection. Use of the BD FocalPoint GS Imaging 

System significantly improved the sensitivity for detection of the important categories 

of squamous intraepithelial lesion (SIL) and cancer with a much smaller decrement in 

specificity. (1) SurePath cytology, FocalPoint prescreening and HPV test can improve 

the efficacy of screening program in a low incidence/low endemicity setting. (2) The 

increased sensitivity compared to conventional smear with an increased specificity for a 

given sensitivity reduce recall rate and unnecessary colposcopies and biopsies avoiding 

overtreatment and emotional stress. 

1. WD Tench, RD Luff, TM Molina, KP Abraham, C Kemper, WS Black-Schaffer, DC Wilbur. 

2009. 35th EFCS Congress of Cytology 

Improved Sensitivity for Detection of Important Cervical Lesions in Liquid-Based Cytology 

using Computer-Assisted Imaging 

2. MD Beccati, C Buriani, O Bulzoni, G Binotti, A Carantoni, C Cavicchi, A . Delazer, S Immovilli, 

I Maestri, I Nenci. 2009. 

35th EFCS Congress of Cytology 

Efficacy of Cytology-Based Screening Program Optimized by Liquid Based Cytologywith 

Automated Pre-Screening and HPV Testing 

alainverhest@yahoo.com 

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WHY, HOW AND FOR WHAT BENEFIT INTEGRATING MOLECULAR TECHNIQUES INTO 

BREAST CYTOPATHOLOGY? 

Vielh P 

Cytopathology, Department of Pathology, Institut Gustave Roussy, Villejuif CEDEX - 

France 

Aim of the study Gene-expression arrays have generated molecular predictors of relapse 

and drug sensitivity in breast cancer. We aimed to identify exons differently expressed 

in malignant and benign breast lesions and to generate a molecular classifier 

for breast-cancer diagnosis. Methods A series of 165 breast samples were obtained by 

fine-needle aspiration cytology. Complementary DNA was hybridized on splice array. 

The 165 FNAC samples included in the study consisted of 120 breast cancers and 45 benign 

lesions. Results A molecular classifier for breast-cancer diagnosis with 1228 probe 

sets was generated from the training set (n=94). This signature accurately classified all 

samples (100% accuracy, 95% CI: 96-100%). In the validation set (n=71), the molecular 

predictor accurately classified 68 of 71 tumours (96% accuracy, CI: 88-99%). When the 

165 samples were taken into account, 37 858 exon probe sets (5.4%) and 3733 genes 

(7.0%) were differently expressed in malignant and benign lesions (threshold: adjusted 

p


POST-THAW VIABILITY OF CRYOPRESERVED HEMATOPOIETIC PROGENITOR CELL 

GRAFTS: DOES IT MATTER? 

Vrhovac R1 , Perić Z1 , Jurenec S2 , Jelić-Puškarić B1 , Kardum-Skelin I1 , Jakšić B1 1 Department of Medicine and 

2 Transfusion Medicine, University Hospital Merkur, Zajčeva 19, Zagreb, Croatia 

Cell viability in peripheral blood progenitor cell (PBPC) grafts and its influence on the 

clinical course following transplantation was evaluated in 81 consecutive transplantations 

(72 autologous, 9 allogeneic) performed in patients with hematological diseases. 

Viability of cells in PBPC grafts immediately upon collection was 98.6±3.5%, after addition 

of dimethyl sulfoxide (DMSO) 73.3±21.8%, and post-thaw 65.2±16.1%. It did not differ 

significantly between patients with different diagnoses, gender, age, type of priming used, 

dose of G-CSF administered or number of CD34+ cells collected. However, grafts stored 

for more than 60 days showed lower post-thaw viability compared to the ones thawed 

in the 60 days following cryopreservation (56.6±15.2% vs. 67.6±15.5%, p=0.04). Post-thaw 

graft viability did not influence engraftment time, but there was a predisposition towards 

infectious complications in the post-transplant period in patients receiving grafts with 

lower percentage of viable cells. These patients developed febrile neutropenia more often 

(72.2% vs. 50% of patients, p=0.05) and had more febrile days (2.4±2.6 vs. 1.5±2.3, p=0.05) 

following transplantation. Our results demonstrate that PBPC grafts are capable of long 

term engraftment regardless of the graft storage time or percentage of viable cells postthaw, 

which confirms the robustness of CD34+ cells during the freeze/thaw procedures 

carried out in daily clinical practice. Granulocyte concentration in PBPC grafts could have 

an influence on infectious complications following transplantation. This intriguing finding 

needs to be further investigated on a larger number of patients. 

radovan.vrhovac@zg.t-com.hr 

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72 


CLINICAL CYTOLOGY IN PRIMARY HEALTH CARE OF CHILDREN AND ADULTS 

Round Table Discussion 

Moderator: Znidarčić Ž 

Participants: 

Jeren T, Kaić G, Kardum-Skelin I, Knežević-Obad A, Smojver-Ježek S, Vince A 

Summary - Clinical cytology is well known in gynecology by Pap smears and it is usually 

considered a diagnosis of malignancy. However, many diseases in almost all fields of 

medicine can be cytologically diagnosed. Because of many advantages of cytology, such 

as minimal aggressiveness, simple technique and high accuracy, it is important for all 

medical specialties, primary practitioners in particular, to know more about this medical 

field about which they could not learn enough during their educational process. Perhaps 

this educational failure could now be connected with low costs, which was one of the 

cytology advantages at the beginning. 

Clinical cytology is used in the prevention, diagnosis, follow up and treatment of disease. 

It is a morphological medical field employing medical history data, clinical findings, technical 

procedures of material sampling and smear preparation and finally microscopic 

analysis in its diagnostic procedure. Sometimes some other technologies are necessary 

to classify the pathological process or, possibly, to differentiate similar morphological 

findings, which can be decided after microscopic analysis. 

Primary practitioners should know the indications for cytological examination, the way 

of material collection and interpretation of cytological findings. The participants in this 

discussion answer these three questions in several fields of medical practice where 

cytological diagnosis is most often used, i.e. infectious diseases, hematology, pulmonology, 

gastroenterology, urology, thyroid gland and breast. The last question refers to appropriate 

communication between primary practitioners and cytologists. 

Here the answers are summarized in short, almost tabular way because it provides 

information that is more practical and appears more suitable for educational purpose. 

Extensive texts will be printed after the Congress as journal articles (Collegium Antropologicum). 

Infectious diseases (Jeren T, Vince A): 

1. Indications: various inflammatory lesions of the skin and mucous membranes, often 

enlarged lymph nodes; 

2. Obtaining of material: smears, brushing, fine needle aspiration; 

3. Interpretation of cytological findings description of smears, conclusion, diagnosis, 

differential diagnosis (with regard to the pathological process dynamics);


Hematology (Kardum-Skelin I): 

1. Indications: a) lymph node 

- children: clinically unexplained enlargement 

- adults: every enlarged lymph node 

b) bone marrow and peripheral blood: abnormal blood cell finding 

(number, form); 

2. Material collection: lymph node and bone marrow puncture, peripheral blood smear; 

3. Interpretation of cytological findings: conclusion - diagnosis/differential diagnosis, 

quantitative analysis of bone marrow and peripheral blood 

Pulmonology (Smojver-Ježek S): 

1. Indications: symptoms (cough with or without blood in sputum), asthma (eosinophils 

in sputum), x-ray abnormalities of the lung; 

2. Material collection: nasal smear, sputum, bronchial aspiration, bronchoalveolar 

lavage, brushing - bronchoscopy, imprint of biopsy specimen, pleural effusion; transtracheal 

or transbronchial puncture, transthoracic puncture (x-ray or US- or CTguided); 

3. Interpretation of cytological findings: conclusion – diagnosis (tumor classification), 

epithelial atypia, hyperplasia, metaplasia 

Gastroenterology (Kaić G): 

1. Indications: endoscopic or US-findings (tumors, inflammation); 

2. Material collection: smears, brushing, puncture (transmucous or transcutaneous); 

3. Interpretation of cytological findings: conclusion, diagnosis or suggestion 

Urology (Kaić G): 

1. Indications: clinical symptoms (especially hematuria); 

2. Material collection: urine (spontaneous, rarely catheterization or washing), brushing, 

puncture of prostate, rarely kidney; 

3. Interpretation of cytological findings: conclusion - diagnosis (atypia, suspected tumor) 

suggestions 

Thyroid gland (Knežević-Obad A): 

1. Indications: node(s) - palpable or impalpable (US found); 

2. Material collection: puncture (US-guided); 

3. Interpretation of cytological findings: diagnosis or suggestion for additional work-up 

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Breast (Kardum-Skelin I) : 

1. Indications: palpatory or US, mammography and/or MR findings, nipple secretion; 

2. Material collection: puncture (US- or stereotactic-guided), smear of secretion; 

3. Interpretation of cytological findings: diagnosis or suggestion. 

The last question for all participants whether or not the communication between primary 

practitioners and cytologists was appropriate, was unanimously answered: it should 

be enhanced. 

The intention of this Round Table Discussion is to improve the communication and to 

make up for the unsatisfactory education in clinical cytology as much as possible.

Clinical Cytology - Oral Presentations 

FINE NEEDLE ASPIRATION CYTOLOGY IN THE EVALUATION OF PAROTID 

GLAND TUMORS 

Belušić Gobić M1 , Pedisić D2 , Seili Bekafigo I3 , Cerović R1 , Starčević R2 , Manestar D2 , 

Juretić M1 1Clinic for Oral and Maxillofacial Surgery, Clinical Hospital Center Rijeka, School of 

Medicine, University of Rijeka, Rijeka, Croatia 

2Department of Otorhinolaryngology- Head and Neck Surgery, School of Medicine, 

University of Rijeka, Rijeka, Croatia 

3Department of Cytology, Department of Internal Medicine, Clinical Hospital Center 


Main objective of this study was to evaluate the usefulness and accuracy of fine needle 

aspiration cytology (FNAC) diagnosis of parotid masses to distinguish reliably between 

benign and malignant lesions. In the period of 5 years, 214 parotid glands where resected 

at the Clinical Hospital Center Rijeka (Croatia), but 176 patients had cytopathological and 

histopathological diagnoses and therefore fulfilled the criteria for study. The results of 

the FNAC were analyzed and compared to the corresponding histopathological diagnosis 

obtained of the surgical specimen. Histological evaluation revealed 17 malignant and 

159 benign lesions. There where 13 true positive, 147 true negative, 3 false negative, and 

13 true negative. Sensitivity of FNAC was 81%, and specificity was 98%. FNAC results 

provide useful predictive preoperative information and better preparation the surgeon 

and patient for surgical procedure. 

mfk@kbc-rijeka.hr 

FINE NEEDLE ASPIRATION CYTOLOGY OF THE MINIMAL BREAST CARCINOMA 

IN ISTRIA COUNTY 

Besser-Silconi Ž, Lozić AAB, Mišljenović N 

Pula General Hospital, Department of Cytology, Pula, Croatia 

Breast cancer is the most frequent malignant tumor in women in Western countries. 

Minimal invasive carcinoma and carcinoma in situ have a better prognosis so we try to 

find them during preventive exams. The aim of this study was to identify minimal cancer 

in fine needle aspiration biopsies of breast lesions made in Pula General Hospital between 

the years 2006 and 2008. There were 39 tumors with maximal diameter less than 

10 mm in our material of 1316 biopsies and 251 cytological diagnosed breast cancers. 

Mostly, they were solitary, well differentiated neoplasm (48.7%). They were diagnosed 

in woman age 40 to 89 years and the most frequently found in women age 61 to 70 years. 

The most frequent pathohistological type of operated minimal breast carcinoma was 

invasive ductal carcinoma. Fine needle aspiration cytology of minimal breast carcinoma 

is a reliable diagnostic method. However, the minimal breast carcinoma percentage of 

all malignant breast cancers was only 15.5% and this result is not satisfactory. 

besser-silconi@hotmail.com 

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76 

Klinička citologija - Usmena predavanja 

NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA (NLPHL) - 

THE DIAGNOSTIC PROBLEM 

Borovečki A, Jelić-Puškarić B2 , Džebro S1 , Kardum-Skelin I2 1 University Hospital “Merkur”, Department of Pathology and Cytology, Zagreb, Croatia 

2University Hospital “Merkur”, Department of Medicine, Laboratory of Cytology and 

Haemathology, Zagreb, Croatia 

NLPHL represents 5% of all HL. Compared with CHL, NLPHL shows a slightly older 

median age at presentation (med. 37), male predominance and localized peripheral 

lymphadenopathy with less mediastinal involvement (


DIFFUSE LARGE B-CELL LYMPHOMA IN PATIENT AFTER TREATMENT OF 

ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA 

Džeko-Škugor N1 , Perić Z2 , Vrhovac R2 , Radić-Krišto D2 , Kardum-Skelin I3 , Jakšić B2 1 General Hospital Šibenik, Department of Cytology, Šibenik 

2 Merkur University Hospital, Department of Medicine, Zagreb 

3Merkur University Hospital, Department of Medicine, Laboratory for Cytology and 

Hematology, Zagreb,Croatia 

Relatively few cases of Epstein-Barr (EBV)-positive B-cell lymphomas arising in patients 

with angioimmunoblastic T-cell lymphoma (AITL) have been reported, the most common 

of them diffuse large B-cell lymphoma (DLBCL).We report a case of angioimmunoblastic 

T-cell lymphoma in which diffuse large B-cell lymphoma arose 13 months after the 

initial diagnosis of AITL. A 36-year-old female patient was evaluated in March and April 

2008 with moderate leukocytosis, peripheral and abdominal lymphadenopathy. AITL was 

diagnosed after a fine-needle aspiration cytology (FNAC) of the enlarged cervical and 

supraclavicular lymph nodes was performed and confirmed by an immunophenotyping 

and biopsy of the cervical lymph nodes. The patient recieved chemotherapy regimen 

FED (fludarabine, endoxane, dexamethasone) and autologous hematopoietic stem cells 

transplantation was done. In April 2009 the patient was hospitalized because of fever, 

pancytopenia, hyperbilirubinemia and peripheral lymphadenopathy. A computed tomography 

(CT) study showed enlarged mediastinal and abdominal lymph nodes. A relapse of 

non-Hodgkin lymphoma (NHL) was suspected. The FNAC of the enlarged cervical lymph 

nodes was performed again, but this time the smears were composed of polymorphous 

population of lymphocytes with the predomination of large cells, CD20¬+ on immunocytochemical 

stains. The immunophenotyping confirmed a predomination of monoclonal 

mature B-cells. Serologic testing revealed increased titers of EBV VCA IgG and EBV 

EBNA IgG; the plasma EBV DNA levels were also increased. The patient showed a positive 

response to an additional chemotherapy regimen CHOP-R (cyclophosphamide, doxorubicin, 

vincristine, prednisone and rituximab) and there is the possibility of allogenic 

stem cell transplantation. AITL is a rare lymphoproliferative disorder in which the neoplastic 

T-cells represent the minority of the lymph node cell population and almost all 

cases harbor EBV-infected B-cells. Various authors postulated that immunodeficiency 

in AITL patients together with immunosupresive efects of cytotoxic drugs, may be responsible 

for EBV-induced proliferation of latently or newely EBV-infected B-cells with 

eventual clonal selection and proggresion to aggressive B-cell lymphoma. 

nivesdzeko@gmail.com 

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78 


A CORRELATIVE STUDY OF HISTOLOGY AND IMPRINT CYTOLOGY OF GASTRIC 

MUCOSA BIOPSY IN THE DIAGNOSIS OF GASTRIC CANCER 

Fuštar-Preradović Lj1 , Coha B2 , Pajić-Penavić I3 1 Department of Pathology, Forensic Medicine and Cytology, General Hospital 

“Dr. Josip Benčević”, Slavonski Brod, Croatia 

2Department of Internal Medicine, General Hospital “Dr. Josip Benčević”, 

Slavonski Brod, Croatia 

3 Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital 

“Dr. Josip Benčević”, Slavonski Brod, Croatia 

The aim of the paper is to establish the value of gastric mucosa imprint cytology in detection 

of gastric cancer. 389 biopsy samples, taken from patients by endoscopic examination, 

with suspected diagnosis of stomach cancer were analyzed. Each specimen was 

first submitted to slide imprinting and then formalin fixed for further routine histopathology 

treatment. The imprints were air dried for cytological analysis, stained according to 

May- Grünwald-Giemsa and analyzed under a light microscope. 194 specimens were 

adequate for final comparison of gastric cancer detection methods. Using pathological 

and histological analyzes gastric cancer was found in 45 specimens and cytological 

analysis detected it in 63 specimens. Combining these two methods cancer was found in 

67 specimens. Patients having positive cytological finding and negative pathohistologic 

finding went for repeated gastroscopy with biopsy. All patients with positive findings were 

operated and the obtained material was entirely pathohistologically examined. Cancer 

was found in 67 patients. Cytological analysis of the imprints of bio-optic material of the 

stomach mucosa increases number of positive findings in preoperative stage of stomach 

cancer diagnosis. The biggest advantage of the method is its speed, simplicity and low 

price. All information on morphological changes of mucosa is also pathohistologically 

checked, because taking of imprints does not damage the specimen. 

ljubica.fustar.preradovic@sb.htnet.hr


ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION OF PARATHYROID LESIONS 

Fuštar-Preradović Lj 

Department of Pathology, Forensic Medicine and Cytology, General Hospital, Slavonski 

Brod, Croatia 

Hyperparthyreoidism is a syndrome caused by adenoma, hyperplasia or rarely by cancer 

of parathyroid glands. Secondary hyperparathyroidism is a common complication 

in cases of chronic renal insufficiency, with clinical and biochemical signs of increased 

function of parathyroid glands. It may be so pronounced that surgery is necessary. Sometimes 

medical treatment hyperparthyreoidism consist percussing inactivity of the tumor 

of parathyroid glands with alcohol. Both procedures demand preoperative localization 

of the tissue of the parathyroid glands. The preoperative localization of abnormal, nonpalpable 

parathyroid glands in patients with hyperparthyreoidism is largely dependent 

on use of high-resolution sonography. However, such a technique has some limitations 

and aid of fine needle biopsy (FNAB) may be relevant. On the other hand, cytology also 

has some limitations in identification of parathyroid cells. The accuracy of diagnosis of 

suspected enlarged parathyroid glands can be improved by combination of ultrasound 

examination, ultrasound-guided FNAB and simultaneous analysis of the obtained cell 

material by cytology, cytochemistry and immunocytochemistry. A systematic morphologic 

description will be given in stained smears all cell types and their cytomorphologic 

presentation, with use chromogranin A and calcitonin immunocytochemistry. Conclusion: 

Medical treatment hyperparthyreoidism consists of surgical removal of magnified 

parathyroid glands or percussing inactivity of tumor of parathyroid glands with alcohol. 

It is beneficial for surgeons to know the number, the size, and locality of parathyroid 

glands prior to surgery, so they can plan the operative procedure and make it shorter 

and safer. 

ljubica.fustar.preradovic@sb.htnet.hr 

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FNA BASED DIAGNOSIS OF HEAD AND NECK LYMPHOMA 

Gjadrov Kuveždić K1 , Aurer I2 , Ries S1 , Sučić M1 , Marković-Glamočak M1 , Ilić I1 , 

Bašić-Kinda S2 , Radman I2 , Labar B2 1 Department of Pathology and Cytology, Zagreb University Hospital, Zagreb, Croatia 

2Division of Hematology, Department of Internal Medicine, Zagreb University Hospital, 


Today the accepted World Health Organization (WHO) classification defines lymphoid diseases 

with combination of morphologic, immunologic, genotypic and molecular features, 

putting less emphasis on histopathology as a sole determination of lymphoma subtype. 

It enables FNA to become complementary morphologic method in lymphoma diagnostics. 

Aim: The aim of this study was to assess the efficacy of FNA in that region and to 

evaluate its sensitivity regarding lymphoma diagnostics. Patients and methods: in the 

study were included patients reffered to our laboratory from hematology department, 

in whom head and neck lymphadenopathia was found, and FNA preceded other procedure. 

Specimens were stained with MGG, and antibodies against CD3, CD5, CD10, CD20, 

CD23, CD43,CD68,CD45, CD15,CD30, ALK, and EMA were administered. Lymphomas were 

classified according to WHO classification. Results: In 248 patients 285 aspirations were 

performed. Diagnosis of lymphoma was given in 100 cases. Overall sensitivity was 90%, 

specificity 88%, predictive value of a positive result 97%, and predictive value of negative 

result 66%, with exact agreement in75% cases between cytomorphology and histopathology 

diagnoses. Conclusion: Based on our results FNA can be a method of choice, serving 

as a method complementary to histopathology in selected lymphoma cases. 

gjadrov@yahoo.co.uk


LIQUID-BASED CYTOLOGY - NEW POSSIBILITIES IN THE DIAGNOSIS OF 

CERVICAL LESIONS 

Jurič D1 , Mahovlić V1 , Rajhvajn S1 , Ovanin-Rakić A1 , Škopljanac-Mačina L1 , Barišić A1 , 

Šamija Projić I1 , Babić D2 , Suša M2 , Ćorušić A3 , Orešković S4 1 Department of Gynecologic Cytology 

2 Department of Gynecologic and Perinatal Pathology 

3 Department of Gynecologic Oncology 

4 Department of Gynecology and Urogynecology, University Department of Gynecology 

and Obstetrics, Zagreb University Hospital Center, Zagreb, Croatia 

Introduction. Liquid-based cytology (LBC) enables the use of supplementary methods in 

the diagnosis and prognosis of cervical lesions. Aim. To analyse the correlation between 

p16INK4a immunoexpression in ThinPrep cervical cytologic samples and human papillomavirus 

(HPV) detection by polymerase chain reaction (PCR) from the same sample. 

Materials and methods. LBC-ThinPrep (Cytyc, USA) cervical cytology samples, prepared 

and stained by Papanicolaou method, were analysed using modified Bethesda cytologic 

classification named Zagreb 2002. A second ThinPrep slide, prepared from the same 

sample, was immunostained for p16INK4a using CINtec p16INK4a Cytology Kit (Dako- 

Cytomation, Denmark). Increased expression of the high-risk HPV E6 and E7 oncogenes 

results in a highly specific increase in p16 protein expression and overexpression of 

p16INK4a acts as a potential biomarker for cervical cancer progression from premalignant 

lesions. Brown nuclear and/or cytoplasmic staining of abnormal cells was considered 

a positive result. Residual material was used for 13 HR HPV-DNA detection by PCR 

based AMPLICOR HPV test ( Roche Molecular Systems). Results. A total of 120 Thin- 

Prep Pap tests with following cytological diagnosis: 17 within normal limits, 17 atypical 

squamous cell (ASC) (7 ASC of undetermined significance - ASCUS and 10 ASC of highgrade 

squamous intraepithelial lesions cannot be excluded – ASC-H ), 26 low-grade 

squamous intraepithelial lesions (LSIL) corresponding cervical intraepithelial neoplasia 

(CIN) I , 57 high-grade SIL (HSIL) i.e. 24 CIN II and 33 CIN III and 3 squamous cell carcinoma 

(SCC) were included in the study. All CIN III (n=33) and SCC (n=3) specimens 

expressed p16 immunoreactivity, whereas the HR HPV test was positive in 97% (32/33) of 

CIN III and 100% (3/3) of SCCs. The p16INK4a biomarker was positive in 87,5% (21/24) of 

CIN II and 69% (18/26) of CIN I, while the HR HPV was positive in 75% (18/24) of CIN II and 

50% (13/26) of CIN I. In ASCUS cytology, p16 and HR HPV showed the same rate of positivity 

(28,5%; 2/7). Expression of p16 was detected in all cytological (10/10) ASC-H lesions, 

in contrast to HR HPV detected in only 20% (2/10) of the ASC-H cases. Conclusion. These 

data suggest the p16INK4a evaluation in ThinPrep cervical samples to be significantly 

associated with HR HPV testing by PCR in the same sample for a diagnosis of HSIL lesions 

and cervical carcinomas. A prospective study with longer follow up may clarify the 

predictive values in management of LSIL and ASC diagnosis. 

danijela_juric@yahoo.com 

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PNEUMOCYSTIS CARINII IN THE TRANSBRONCHIAL LUNG BIOPSY IMPRINT OF THE 

PATIENT NOT KNOWN TO BE HIV INFECTED- CASE REPORT 

Juroš Z1 , Smojver Ježek S1 , Vrabec Branica B1 , Alerić I1 and Križanac Š2 1 Department of Cytology and Department of Pneumology, University Hospital for Lung 

Diseases Jordanovac, Zagreb, Croatia 

2 Department of Clinical Pathology, Dubrava University Hospital, Zagreb, Croatia 

Patients with HIV infection are exposed to the different opportunistic infections and the 

most commom among them is Pneumocystis. Over 85% of HIV patients without treatment 

would eventually develope Pneumocystis pneumonia which still causes death in 

about 10% of cases. Diagnosis may be suspected by the patient’s clinical presentation in 

typical cases but the best diagnostic yield is achieved by analyzing samples obtained by 

bronchoalveolar lavage and induced sputum. We present the case of 42 years-old male 

with long-time period undiagnosed and untreated Pneumocystis infection.First morphological 

diagnosis was established in transbronchial lung biopsy imprint cytology. 

zrinka.juros@zg.t-com.hr


MULTIMODAL IMAGE ANALYSIS OF CHRONIC LEUKEMIC LYMPHOPROLIFERATIVE 

DISORDERS AND THE HYPOTHESIS OF „SINGLE“ AND „MULTIPLE“ PROGRAMMED 

STOPS IN THE DEVELOPMENT OF TYPICAL AND ATYPICAL FORMS OF LEUKAEMIAS 

AND LYMPHOMAS 

Kardum-Skelin I1 , Radić-Krišto D1 , Jelić Puškarić B1 , Jakšić O2 , Kardum M3 , Jakšić B1 1 University Hospital Merkur, Zagreb 

2 University Hospital Dubrava, Zagreb 

3 Faculty of Veterinary Medicine 

The analysis consisted of morphometric studies, assessment of the nucleolar organization 

region (AgNOR) characteristics, and image cytometry (ICM), performed in 71895 

cells on a SFORM PC (VAMSTEC, Zagreb). Correlation between morphometric, AgNOR 

and ICM characteristics revealed the low proliferative cells to possess small, homogeneous 

AgNOR, with the majority of cells in the peak of DNA histogram. The high proliferative 

cells had inhomogeneous AgNOR, mostly containing greater DNA amount than 

peak cells, or pathologic mitoses (DNA >4N), or the majority of cells being in the Sphase 

of the cell cycle. Cells with medium proliferative activity and annular AgNOR were 

in-between. Analysis of different tumor mass compartments showed the lymphatic cells 

with affinity to accumulation in bone marrow to regularly exhibit low proliferative activity 

(a lower percentage of cells in SFC and highest percentage of cells in the peak of the G0/ 

G1 phase). The cells in lymph nodes, exhibiting the characteristics of proliferative cells 

(an increased number of AgNOR, larger more proliferative inhomogeous AgNOR and 

lowest percentage of cells in the G0/G1 phase). The migration of cells from bone marrow 

to lymph nodes and between lymph nodes occurs in peripheral blood (a mixture of 

cells with low and high proliferative activity: a higher proportion of cells in SFC and at 

the same time in the G0/G1 phase of the cell cycle). Analysis of cell size and proliferative 

activity in different compartments of tumor mass revealed the cells in bone marrow and 

peripheral blood did not differ substantially according to size and proliferative activity, an 

inverse pattern was observed between peripheral blood and lymph node. As small cells 

are inactive and larger cells more proliferative, the analysis quite unexpectedly showed 

the peripheral blood cells to be largest and most inactive, in contrast to lymph node 

where the cells were smallest and most active. The “single” and “multiple programmed 

stops” in the development of typical forms of leukemias and lymphomas, subacute and 

and subchronic leukemias were hypothesized. 

ikardum@hi.t-com.hr 

83 



ROLE OF CYTOLOGY IN CHILDHOOD DISEASES 

Kardum-Skelin I, Šušterčić D, Jelić-Puškarić B, Milas M 

Merkur University Hospital, Zagreb, Croatia 

84 


Diseases of childhood pose a diagnostic challenge to cytologists. Lysosomal storage 

diseases comprise a large group of congenital disorders including Gaucher’s disease, 

Niemann-Pick disease, Farber’s disease, etc. At cellular level, foam cells can be identified 

in circulating blood and reticuloendothelial system of bone marrow, liver and spleen. 

Cytomorphologically, large histiocytes contain striated rod-shaped inclusion bodies that 

give it a wrinkled paper or crumpled silk appearance. Gaucher cells, sea blue histiocytes 

are found in bone marrow preparation in patients with Niemann-Pick disease and other 

systemic lipidoses. Foam cell staining properties (cytochemical or immunocytochemical 

reaction) may differ in various storage diseases. Langerhans cell histiocytosis (dendritic 

cell histiocytosis, erythrophagocytic macrophage disorders, malignant histiocytosis, 

congenital self-healing form called Hashimoto-Pritzker disease, etc.) is a group 

of idiopathic disorders characterized by the proliferation of immunophenotypically and 

functionally immature, morphologically rounded Langerhans cells along with eosinophils, 

macrophages, lymphocytes, and commonly, multinucleated giant cells. Dendritic 

cell histiocytosis includes Letterer-Siwe disease, eosinophilic granulomas, and Hand- 

Schüller-Christian disease. Fine-needle aspiration (large, ovoid, mononuclear cells, 

with folded nuclei, discrete nucleoli, and a moderate amount of slightly homogeneous 

cytoplasm) combined with immunocytochemistry (S-100 protein, CD1a, CD207) of cytologic 

smears plays an important role in demonstrating organ involvement by Langerhans 

cell histiocytosis. Acute lymphoblastic leukemia (ALL) is primarily a disease of 

children; 75% of cases occur in children under six years of age. Cytomorphologically, 

lymphoblasts are typically small, medium-sized to large blasts (of B or T origin), involving 

bone marrow and blood (ALL) or presenting with primary involvement of thymus, 

lymph node, spleen or extranodal sites (lymphoblastic lymphoma). B lymphoblastic 

leukemia/lymphoma with t(v;11q23) - MLL rearranged; B lymphoblastic leukemia/ 

lymphoma with t(12;21)(p13;q22) - TEL-AML1 (etv6-RUNX1); B lymphoblastic leukemia/ 

lymphoma/lymphoma with hyperdiploidy; B lymphoblastic leukemia/lymphoma with 

T(1;19)(Q23;P13.3) - E2A-PBX1 (TCF3-PBX1) are common leukemias in children. There are 

no unique morphological, cytochemical or immunophenotypical features to distinguish 

these types of ALL. Over the last few years, fine needle aspiration cytology (FNAC) has 

been used more extensively in the diagnosis of pediatric solid tumors. The most common 

solid tumors of childhood are small round cell tumors (SRCT) that include Ewing 

sarcoma/primitive neuroectodermal tumor, Wilm’s tumor, neuroblastoma, malignant 

lymphoma, rhabdomyosarcoma, and desmoplastic small round cell tumor. These tumors 

of different origin are a heterogeneous group of malignant neoplasms that are very 

similar in their histologic and cytologic appearance with undifferentiated, uniform, small 

round cells with big, hyperchromatic nuclei. The diagnosis of SRCT can be made accurately 

by applying clinicopathological criteria and a panel of immunocytochemical and 

genetic studies in appropriate cases. FNAC interpretation of childhood disease is easy 

when cytologic findings are correlated with relevant cytochemical, immunocytochemical, 

genetic and clinical data. 

ikardum@hi.t-com.hr


DIAGNOSTIC PITFALLS IN PARATHYROID GLAND CYTOLOGY 

Knežević-Obad A1 , Tomić-Brzac H1 , Žarkovic K2 , Dodig D1 1 Clinical Department of Nuclear Medicine and Radiation Protection, 

University Hospital Zagreb, 

2 Clinical Department of Pathology, University Hospital Zagreb 

Aim: The aim of this study was to establish possibilities of cytology in diagnosing adenomas 

of parathyroid gland. Material and methods: During the three years period (1st of 

January 2006 to 31st of December 2008) in Clinical Department of Nuclear Medicine and 

Radiation Protection 475 ultrasonographic examinations were performed under suspicion 

for parathyroid gland disease. In all of them FNAB was done. 374 patients were 

female and 101 male, aged 20 -88 years, and most of them were 50-69 years old. Slides 

were stained by May-Grünwald-Giemsa, air dried and analysed under light microscope. 

Results: In 217 patients cytological diagnosis was hyperplasia, adenoma in 71 and in 187 

there was not sufficient material for cytological analysis. Only in 36 of those 187 inadequate 

samples, parathyroid hormone (PTH) was positive in the aspirate. On echosonography, 

adenomas were presented in most of the cases as hypoechoic, solitary nodule and 

in 84% located behind lower pole of the right or left thyroid lobe. Al of the patients with 

cytological diagnosis of parathyroid adenoma were submitted to surgery, and adenoma 

of the parathyroid gland was patohistologicaly verified. There were also three cases of 

patohoistologicali diagnosed adenoma, in which cytology was negative, meaning adenoma 

was not recognized. In one case due to cystic degeneration of a nodule, in other 

case there were intranuclear inclusions present so it was mistaken for papillary thyroid 

carcinoma, and in third case it was reported as oncocytic thyroid adenoma. In 96% of 

cases we were able to diagnose adenoma of the parathyroid gland, based on examination 

of MGG stained slides, with additional staining for argyrophil reaction. Based on cell 

morphology we were able to distinguish oncocytic adenoma of parathyroid gland, atypical 

adenoma and chief-cell adenoma. In 4% (3 cases) of analysed FNAB of parathyroid 

gland nodules adenoma was not properly recognized. Conclusion: Ultrasound-guided 

FNAB, with data about localisation and ehosonographic structure of a nodule, assuming 

there is adequate material obtained, can be diagnostic for parathyroid gland adenoma 

in 96% of cases. Possible pitfalls are oncocytic type of parathyroid adenoma that can be 

mistaken for oncocytic thyroid adenoma, presence of intranuclear inclusions that can be 

mistaken for papillary thyroid carcinoma and cystic degeneration of a nodule. Mistakes 

can be avoided if we perform PTH level in FNAB obtained material. 

ivana.knezevic@vz.t-com.hr 

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ESTIMATING CLINICAL OUTCOME OF HPV INDUCED CERVICAL LESION BY 

COMBINATION OF CAPSID PROTEIN L1 AND P16INK4a PROTEIN DETECTION 

Krivak Bolanča I, Šentija K, Katalenić Simon S, Kukura V*, Vraneš J** 

Laboratory for Clinical Cytology and Genetics 

*Department of Gynaecology and Obstetrics 

“Merkur” University Hospital, Zagreb 

** “Dr.Andrija Stampar” Institute of Public Health, Zagreb, Croatia 

The aim of this study was to investigate whether is possible to predict clinical outcome of 

cervical lesion by immunoassaying performed on cervical smears. During the two year 

study period the cervical smears of 81 patients were collected. All patients were tested 

for human papillomavirus (HPV) infections using Amplycor HPV test. Sixty-six of them 

were tested as positive for high risk types (hrHPV) and squamous intraepithelial lesion, 

and in those patients repeated cervical smears were taken every six months. The rest 

were hrHPV negative patients with normal smears which were used as a negative control 

in immunoassays with HPV L1 and p16INK4a antibodies. The results of p16INK4a staining 

in 66 hrHPV positive patients showed impairment of the cervical lesion in 22 (33.3%) 

and unchanged cytological finding in 21 (31.9%) p16INK4a positive patients, respectively, 

while improving of cytological finding was seen only in three (4.5%) p16INK4a positive 

patients. On the contrary, impairment of cytological finding was not seen in p16INK4a 

negative patients, while in 17 out of 20 patients from that group improving or normalisation 

of cytological finding were detected (p


ALCOHOL SCLEROSING OVARIAN CYSTIC LESIONS, 20 YEARS EXPERIENCE 

Kukura V, Krivak Bolanča I*, Šentija K*, Katalenić Simon S* 

Department of Gynecology and Obstetrics 

*Laboratory for Cytology and Clinical Genetics 

“Mekur“ University Hospital, Zagreb, Croatia 

Objectives: The purpose of the study is a technique of punction and conservative treatment 

of cystic ovarian lesions. Methods: The cyst should be unilocular, sonolucent, with 

a smooth inner wall of capsule, without septa and without neovasculariation on transvaginal 

color Doppler. CA-125 levels must be lower than 35 U/ml. The capsule of the cyst 

was punctured with a 18 gauge needle under the control of 5 MHz transvaginal probe. 

Cyst fluid was sent for cytologic examination. After complete emptyng of the cyst, we 

injected sterile 95% ethanol in the 50-75% of the evacuated liquor amount. The alcohol 

remain in the cyst from 5 to 20 minutes and was then aspirated completely. Results: We 

punctured 366 patients with ovarian cyst volume between 40 and 300 ml in the age from 

18 to 65. Patients were monitored for 24 hours and follow-up examinations are 3, 6 and 12 

months after the procedure. Intensive pelvic pain had 8,1% and relapse appeared in 8,2% 

of the patients. Three cysts were ruptured (0,8%) and alcohol split in the Douglas cavity. 

Conclusion: Technique of punction is simple and easily performed. Method of treating by 

95% alcohol showed good results. Relapse we treated by laparoscopy or laparotomy. 

vlastimir.kukura@zg.t-com.hr 

METASTASES ON RARE LOCATIONS AS INITIAL MANIFESTATIONS OF 

NON-SMALL CELL LUNG CARCINOMA: TWO CASE REPORTS 

Lozić AAB, Besser Silconi Ž, Mišljenović N 

Department of Cytology, Pula General Hospital, Pula, Croatia 

The non-small cell carcinoma of the lung is a malignant epithelial tumor slow in growth 

but still metastasizing out of its site. When the primary tumor treatment starts, about 

60% of patients already have some kind of malignant cell spreading. Metastases to hand 

bones and skeletal muscles are very rare (metastatic hand lesions represent 0,1% of all 

osseous metastases while metastases to muscles represent from 0,8 to 16% incidence 

in autopsy series) but the metastatic involvement of these sites usually indicate that 

metastatic disease has already spread. Fine needle aspiration cytology has an important 

task to give accurate diagnosis or at least diagnosis of suspicion and thus to set the 

guidelines to a clinician for the further specific and cost-effective treatment. 

We will show two cases where the metastases of non-small cell carcinoma of the lung 

were the first signs of the disease in uncommon body parts: a man with the metastasis 

to distal phalanx of the right hand thumb and a woman with nodal metastasis to the 

right gluteal muscle and subcutaneous tissue near muscle, so we have to pay our attention 

to the potential development of such lesions in uncommon body parts. 

alex_lozic@yahoo.co.uk 

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DIGITAL MORPHOMETRY OF CYTOLOGIC ASPIRATE ENDOMETRIAL SAMPLES 

Mahovlić V1 , Ovanin-Rakić A1 , Škopljanac-Mačina L1 , Barišić A1 , Rajhvajn S1 , Jurič D1 , 

Šamija I1 , Ilić-Forko J2 , Babić D2 , Škrablin-Kučić S3 , Božikov J4 1Department of Gynecologic Cytology, University Department of Gynecology and Obstetrics, 

Zagreb University Hospital Center, Zagreb, Croatia 

2Department of Gynecologic and Perinatal Pathology, University Department of Clinical 

Pathology, Zagreb University Hospital Center, Zagreb, Croatia 

3Department of Perinatal Medicine, University Department of Gynecology and 

Obstetrics, Zagreb University Hospital Center, Zagreb, Croatia 

4Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, 


Unlike cervical cytology, morphological cytology criteria in the differential diagnosis of 

endometrium have not yet been clearly defined, and methods to allow for more precise 

evaluation of endometrium status have been searched for. Aim. To assess the value of 

morphometric nucleus analysis of cytologic aspirate endometrial samples in proliferative, 

hyperplastic and malignant endometrium by use of digital image analysis. Materials 

and methods. Morphometric analysis was performed on archival cytologic aspirate endometrial 

samples (at least 10 per group) stained according to Papanicolaou (n=77) and 

May-Grünwald-Giemsa (MGG; n=80) with the following histopathologic diagnoses: proliferative 

endometrium, hyperplasia simplex, hyperplasia complex, hyperplasia complex 

atypica, and adenocarcinoma endometriodes endometrii (grade I, II and III). Interactive 

image analysis (nuclear area, convex area, perimeter, maximum and minimum radius, 

length and breadth, as well as nucleus form factor and elongation factor) was performed 

by use of the SFORM software (VAMSTEC, Zagreb) on at least 50 (Papanicolaou stain) and 

100 (MGG stain) well preserved endometrial epithelial cell nuclei without overlapping, at 

magnification of X1000. Statistical data analysis was done by use of the Statistica Ver. 6 

statistical package. Results. Multivariate analysis (ANOVA) distinguished malignant, hyperplastic 

and proliferative endometrium according to all morphometric variables with 

both staining methods (P0.05) from 

atypical hyperplasia, adenocarcinoma and proliferative endometrium only according to 

the nucleus form factor and elongation factor (Papanicolaou stain), whereas malignant 

and atypical hyperplastic endometrium (MGG stain) differed statistically significantly 

(P0.05). According to the cytologic 

staining method, morphometric parameters were considerably higher in MGG 

stained endometrial samples, reaching the level of statistical significance (P0.05) in the groups of hyperplasia 

simplex and complex, well differentiated adenocarcinoma (form factor) and 

atypical hyperplasia (elongation factor). Conclusion. A combination of cytomorphology 

and the morphometric variables assessed in this study can yield useful information on 

the cytologic state of endometrium, with special reference to the possible differentiation 

of the group of hyperplasia without atypia from the group of adenocarcinoma and atypical 

hyperplasia. 

vesna.mahovlic@zg.t-com.hr


T-LYMPHOBLASTIC LYMPHOMA WITH AN UNUSUAL t(8;14)(q24;q11) - CASE REPORT 

Mandac I1 , Ostojić-Kolonić S1 , Vrhovac R1 , Lasan-Trčić R2 , Jakelić-Piteša J3 , 

Kardum-Skelin I1 1 University Hospital Merkur, Zagreb, Croatia 

2 Clinical Hospital Zagreb, Zagreb, Croatia 

3 Clinical Hospital Split, Split, Croatia 

The cytogenetic abnormalities seen at presentation of acute lymphoblastic leukemia 

or lymphoblastic lymphoma (ALL/LBL) are associated with distinct clinical and hematologic 

disease entities. T-ALL/LBL are morphologically indinguishable from those of 

B-ALL/LBL. An abnormal kariotype is found in 50-70% of cases of T-ALL/LBL. Here we 

present a 35-year old male patient with T-ALL/LBL and t(8;14)(q24;q11.2). Our patient 

presented with B-symptoms, bulky mediastinal disease and CNS infiltration. Bone marrow 

was morphologically normal without clonal aberations in bone marrow cytogenetics. 

Cytological findings of the supraclavicular lymph node showed numerous CD3 

positive (100%) and CD2 positive (88%) lymphoblasts which were negative for CD34 and 

CD10. Flow cytometry of lymph node showed T cell phenotype of immature cells: CD45 

+CD2+CD5+CD7+CD4+CD8+CD3cyt+CD3TdT+CD10-CD34-HLAD/DR-. Cytogenetic analysis 

of lymph node showed translocation t(1;4)(p32;p12), t(8;14)(q24;q11.2). Southern blot 

analysis of extracted DNA from the supraclavicular lymph node demonstrated clonal 

rearrangement of the T cell antigen receptor (TCR/J) gene (region Vb+Jb2). Based on 

these findings, diagnosis of T lymphoblastic non Hodgkin lymphoma was established. 

Lumbal puncture and liquor analysis showed CNS infiltration with 49% lymphoblasts 

positive for CD4 and CD8. The disease progressed rapidly and response to therapy was 

poor. T-ALL/LBL with an unusual t(8;14)(q24;q11.2) is a very rare hematologic disorder 

with rapid disease progression and poor response to conventional therapy because of 

frequent central nervous system involvement and early relapses. 

imandac@yahoo.com 

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T LYMPHOBLASTIC LEUKEMIA WITH AN UNUSUAL BURKITT LYMPHOMA 

MORPHOLOGY - A CASE REPORT 

Milas M1 , Jelić Puškarić B1 , Planinc-Peraica A2 , Šiftar Z3 , Kardum-Skelin I1 , Jakšić B2 1Merkur University Hospital, Department of Medicine, Laboratory for Cytology and 


2 Merkur University Hospital, Department of Medicine, Zagreb, Croatia 

3 Merkur University Hospital, Institute of Clinical Chemistry, Zagreb, Croatia 

Precursor T- cell acute lymphoblastic leukaemia (T-ALL)/lymphoma (T-LBL) is a neoplasm 

committed to the T-cell lineage. It comprises about 20 – 25% of adult cases of 

ALL and about 85 - 90% of LBL. In adults it is still a disease with poor prognosis with 

median survival to 12 months in spite of progress made in understanding its pathogenesis 

and treatment. Complications such as infections, sepsis, meningeal involvement 

can occur at any time during treatment and be the cause of fatal outcome. We report a 

case of a 56-year-old male who was hospitalized due to high fever and kidney infection. 

Further examination showed anemia, thrombocytopenia, normal level of white blood 

cells and high level of lactat-dehidrogenase (LDH). Bone marrow aspiration revealed 

87% and peripheral blood 41% of lymphoblasts with cytoplasmic vacuoles which suggested 

Burkitt lymphoma morphology. Patient’s karyotype showed no chromosomal aberations. 

Identification of immunophenotype discovered cells which were CD2 positive 

and CD20 negative with focal acid phosphatase activity in 67% of blasts. This excluded 

Burkitt lymphoma and led to diagnosis of T-ALL. Patient was submitted to a numerous 

chemotherapy treatments and autologous stem cell transplantation. Despite these 

efforts, complicatons of disease (infection and pleural effusion) led to fatal outcome 

after 10 months from diagnosis. Our case report showed how morphology alone can be 

misleading and is not enough in diagnosing ALL. Beside morphologic criteria, setting 

correct diagnosis depends on identification of immunophenotype by flow cytometry and 

cytogenetic-molecular abnormalities. Further improvements in the molecular definition 

of ALL subtypes, development of new and targeted drugs will improve patient’s outcome 

and prognosis. 

marina.milas@gmail.com


CURRENT ORGANISATION OF CLINICAL CYTOLOGY IN CROATIA 

Miličić-Juhas V1 , Lončar B1 , Mahovlić V2 , Kardum-Skelin I3 , Pajtler M1 1 Clinical Hospital Osijek, Department of Clinical Cytology, Osijek, Croatia 

2 Zagreb University Hospital Center, Department of Gynecologic Cytology, University 

Department of Gynecology and Obstetrics, Zagreb, Croatia 

3 University Hospital Merkur, Laboratory for Cytology and Hematology, Zagreb, Croatia 

Current cytological service in Croatia is organised in 46 cytological organisational units 

in 23 towns with total of 350 employees: 101 specialists of clinical cytology, 20 residents 

in clinical cytology, 141 cytotechnologists (cytoscreeners), 45 health technicians, and 25 

administrators and 18 auxiliary personnel. In spite of employment of significant number 

of cytotechnologists in the last ten years, there is still an unacceptable ratio of number 

of cytologists and cytotechnologists (1:1.4) which is the result of unresolved education of 

cytotechnologists which should be permanent, complete and acknowledged. Education 

and scientific promotion of cytologists is continuous and today our profession has 31 

masters of science and 9 doctors of science, one of which is assistant professor, and four 

of them are associate or full professors at medical schools in Zagreb and Osijek. Croatian 

cytology, in average, is in its “best years”, i.e. average cytologist is 46 years old, and 

cytotechnologist is in average 43 years old, but „suffers” from personnel deficit. With regard 

to type of activity, the most numerous are units dealing the entire diagnostic cytology 

(72%), 13% general cytology without gynaecological cytology, while 15% are engaged 

in one diagnostic field (gynaecological, pulmological or thyroid cytology). According to 

accessible data, total of 770996 cytological examinations were done in Croatia in 2008. 

The increasing application of additional methods (cytochemical, immunocytochemical, 

molecular, cytogenetics and computer-assisted image analysis) has become a trend 

in numerous cytological units. Exclusively morphological analysis of standard stained 

samples is performed in 37% of units, morphological and cytochemical staining methods 

are used in 17% of units, and additional immunocytochemical methods in 30% of 

units. According to the long tradition of cytology in Croatia, that has progressed thanks 

to the enthusiasm and great effort of our teachers, we believe that the following generations 

of cytologists will continue working on its improvement and will be able to concord 

basic cytomorphology and sophisticated diagnostic procedures with other diagnostics, 

to stay the field of optimal results in the shortest time with the reasonable price. 

valerija.mj@gmail.com 

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IS THE HSIL SUBCLASSIFICATION CYTOLOGICALLY REAL AND CLINICALLY JUSTIFIED? 

Miličić-Juhas V, Pajtler M 

Department of Clinical Cytology, Clinical Hospital Osijek, Osijek, Croatia 

The purpose of this work was to evaluate the justification of Croatian modification of 

Bethesda classification after thirteen years of its application, answering the question 

is the subclassification of HSIL into CIN2 and CIN3 cytologically real and clinically justified. 

The retrospective study covered 3110 women examinees at Clinical Department 

in Clinical hospital Osijek from 1993 to 2005. By cytological examination of VCE smear 

intraepithelial lesion of cervix of different weight has been diagnosed. Cytologically and 

colposcopically 57,1% women examinees were monitored, while 42,9% had also pathohistological 

examination. In determining the lesion’s biological behaviour, regression 

has been defined with two or more negative control cytological findings in a year or 

more, persistence was defined with two or more abnormal or intermittently abnormal 

control cytological findings, which pointed out the intraepithelial squamous lesion of 

different weight in a year or more, while progression was defined with cytological finding 

which pointed out the invasive lesion. Positive predictive value has been estimated 

on the base of comparison of the worst cytological finding with the worst pathological 

finding not depending on histological sample. The spontaneous regression of cytological 

finding showed in 66,3% cases. CIN2 regressed significantly more often (in 50,98% 

cases) than CIN3 (31,3%) and considerably more rarely than CIN1 (70,1%). Comparing 

the first and the worst cytological diagnosis during monitoring, it has been found that 

CIN1 is also the heaviest diagosis in 80,1% cases, while in 19,9% of examinees the initial 

diagnoses progressed in heavier lesion. CIN2 was also the heaviest cytological diagnosis 

in 65,35 cases, and it progressed in CIN3 in 34,1% cases. CIN2 progressed more often 

in CIN3 than CIN1 (34,1% in relation to 12,7%). The positive predictive value of cytological 

differential diagnoses CIN3 (84,3%) is significantly higher than CIN2 (36,9%), and CIN1 

(44,3%), but positive predictive value of CIN1 and CIN2 doesn’t considerably differ. Pathohistologically 

CIN3 has been found considerably more often in cytological diagnosis CIN2 

(38,9%) than in cytological diagnosis CIN1 (22,8%), but significantly more rarely than in 

cytological diagnosis CIN3 (84,2%). Therefore, cytological CIN2 and CIN3 lesions differ 

mutually in biological behaviour, and histological finding. Namely, 50,9% of CIN2 spontaneously 

regressed, additional 14,4% persisted during monitoring, i.e. didn’t progress 

in CIN3 or heaviest lesion, and 59,7% had a histological finding less than CIN3. In other 

words, in almost 65% of CIN2 lesions it is not justified to apply diagnostic therapeutic 

procedures for CIN3 lesions. In accordance with this, the cytological subclassification 

of HSIL on CIN2 and CIN3 lesions is clinically justified. The positive predictive value of 

cytological differential diagnosis CIN2 is significantly lower than CIN3, but doesn’t differ 

significantly from CIN1, so CIN2 is equally real cytological differential diagnosis as CIN1, 

which is classified as an independent diagnosis in all classifications, so based on this the 

subclassification of HSIL is cytologically possible. 

valerija.mj@gmail.com


PAP TEST - WITH OR WITHOUT VAGINAL SMEAR? 

Miličić-Juhas V1 , Perić M1 , Pajtler M1 , Prvulović I2 , Čuržik D3 1 Department of Clinical Cytology, Clinical Hospital Osijek, Osijek, Croatia 

2 Department of Clinical Cytology, General Hospital Dr. J. Bencevic, Sl. Brod, Croatia 

3 Clinic of Obstetrics and Gynecology, Clinical Hospital Osijek, Osijek, Croatia 

The aim of this study was to evaluate medical and economic justification of vaginal 

smears as part of primary screening for cervical carcinoma and its precursors. Study 

included 245.048 participants whose VCE (vaginal, cervical, endocervical) smears were 

examined at Department of clinical cytology of Clinical hospital Osijek from 2003 till 

2008. There were 12.639 (5,2%) abnormal findings, and they were divided into three 

groups: abnormal cells found only in vaginal smear (V), abnormal cells found in vaginal 

and in at least one other smear (V+) and abnormal cells not found in vaginal smear (C/E). 

These three groups were analysed in respect to cytological differential diagnosis and 

age of participants. It was estimated how many women could be additionally included 

in the screening, if vaginal smear would be included in the Pap test only after 50 years 

of age. In 6,9% of cytologically diagnosed lesions abnormal cells were found exclusively 

in vaginal smears (0,35% of all findings). In squamous cell lesions, 91,2% were mild lesions 

(ASC and LSIL). Invasive squamous cell carcinoma was not diagnosed exclusively 

by vaginal smear in either woman under 50 years of age, while in women over 50 years 

of age it was diagnosed in 2,3% of cases. Exclusively by vaginal smear was diagnosed 

3,9% of all AGC and 6,3% of adenocarcinoma, while in 85,0% of glandular epithelium lesions 

abnormal cells were not found in vaginal smears. Two thirds of adenocarcinoma 

diagnosed exclusively by vaginal smears were endometrial adenocarcinoma, but that is 

only 10,3% of all endometrial carcinoma diagnosed by Pap test. Obtained results show 

that taking of vaginal smears along with cervical and endocervical smears as a part of 

primary screening for cervical carcinoma and its precursors in women under 50 years 

of age is not justifiable, since vaginal smear only has a role in detection of endometrial 

carcinoma that are extremely rare in younger age groups. If vaginal smear would be 

taken only in women over 50 years of age, additional 37,7% of women under 50, or 25,1% 

women over 50 years of age could be included in the screening. 

valerija.mj@gmail.com 

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PREVIOUS CYTOLOGICAL FINDINGS IN WOMEN WITH FINAL HISTOLOGICAL 

DIAGNOSIS OF CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 3 

Milojkovic M1 , Pajtler M2 , Milojkovic D1 1 Department of Gynecology and Obstetrics, 

2 Department of Clinical Cytology, Clinical Hospital Osijek 

Objective. To evaluate the reliability of the previous cytological smears in relation to the 

final histological diagnosis of cervical intraepithelial neoplasia grade 3 (CIN 3). In addition, 

to determine the importance of the follow up period and the number of cytological 

smears of patients with abnormal cytological findings in order to evaluate the lesion 

accurately. Methods. During the period 1 January 2000 – 31 December 2005, 805 women 

with a final histological diagnosis CIN 3 were analysed retrospectively. With regard to 

the length of the monitoring period before the histological verification, the women were 

classified in two groups: 1st group: less than a year, 2nd group: longer than a year. 

Results. During the monitoring period, 701 patients (87.1%) had a cervical finding of a 

high grade intraepithelial lesion (HIL) thus: only HIL (reliable cytological finding) in 357 

women (44.3%) whereas 344 women (42.7%) had HIL and sometimes low grade intraepithelial 

lesion (LIL) and a normal finding (unreliable cytological finding). Cytological 

finding underestimated the histological one, only LIL or LIL/normal finding was found 

in 45 women (5.6%). The cytological finding suspicious for carcinoma (overestimated) 

was found in 20 (2.5%) women. The permanently normal cytological finding (false negative) 

had 8 (1.0%) women. The cytological finding was unknown in 31 (3.9%) women. For 

less than a year 470 (58.4%) women had been monitored cytologically (1st group). For 

more than a year 296 (36.8%) women had been monitored (2nd group). Conclusion. If the 

women with an abnormal cytological finding are monitored regularly and in continuity, 

the reliability of cytology in diagnostics of CIN 3 is high. Performing a single cytological 

screening is very unreliable. 

pajtler.marija@kbo.hr


FINE NEEDLE ASPIRATION CYTOLOGY OF ADRENOCORTICAL CARCINOMA: 

CASE REPORT 

Mišić M1 , Vidas Ž2 , Škegro D3 , Kocman B4 , Jelić-Puškarić B5 , Kardum-Skelin I5 1 General Hospital “Dr. J. Benčević”, Department of Cytology, Slavonski Brod 

2 University Hospital Merkur, Division of Urology, Zagreb 

3 University Hospital Merkur, Department of Medicine, Zagreb 

4 University Hospital Merkur, Department of Surgery, Zagreb 

5University Hospital Merkur, Department of Medicine, Laboratory for Cytology and Hematology, 


Adrenocortical carcinoma (ACC) is a malignant epithelial tumour of adrenal cortical 

cells. Approximately half of all ACCs are hormonaly functional. A 49-year-old woman 

presented for hirsutism, deep voice and hypertension. Ultrasonography (US) revealed a 

solitary tumor mass, 8 cm in size, of the right adrenal gland. Laboratory tests showed 

it to be a hormonally active, androgen secreting tumour (elevated testosterone level), 

which was consistent with the clinical picture of the disease. After histopathologic analysis 

tumor was signet out as adrenocortical carcinoma, a low risk carcinoma according 

to Weiss’ classification. On regular follow up US study performed at one year, a 65x43 

mm growth was diagnosed in the lower pole of the right kidney. The finding was verified 

by computerized tomography and the patient was reoperated on. Exploration revealed 

secondary growth in the region of greater omentum, without infiltration of adjacent organs. 

Histopathologic analysis confirmed metastatic ACC. At 8 months of the second 

operation and after 6 chemotherapy cycles according to EAP protocol, enlarged paraaortic 

lymph nodes and a node along the upper pole of the right kidney were diagnosed 

by cytologic puncture. Cytologic analysis showed numerous large tumor cells (individual 

and in papillary clusters) with polymorphic, hyperchromic, irregular nuclei, prominent 

nucleoli with perinucleolar halo, and abundant pale basophilic cytoplasm. The cells 

were positive for vimentin, NSE, synaptophysin and epithelial markers (BerEP4 and epithelial 

membrane antigen - EMA). ACC is a rare tumor of high malignant potential. Morphologically 

(histopathology and cytology), there is the problem of differential diagnosis 

from adenoma on the one hand, and from renal cell carcinoma (RCC) and hepatocellular 

carcinoma (HCC) on the other hand. A combined evaluation of clinical features , size or 

weight, microscopic appearance, immunohistochemical and molecular genetic data is 

necessary. 

maja.misic1@gmail.com 

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THYROID FINE NEEDLE ASPIRATION IN PATIENTS UNDER 18 YEARS: A CLINICO- 

CYTOLOGIC STUDY 

Moslavac S1 , Mateša N2 , Kusić Z2 1 Poliklinika Sunce, Zagreb, Croatia 

2Department of Oncology and Nuclear Medicine, University Hospital Sestre Milosrdnice, 


Objective: Thyroid fine needle aspiration (FNA) is the most accurate and cost effective 

method in the evaluation of the thyroid nodule and has been commonly used in adults. 

Thyroid nodules are uncommon in younger patients (1-2%). Our aim was to determine 

some relevant clinical and cytological parameters in this demographic group. Patients 

and Methods: Ultrasound-guided thyroid FNAs performed from May 1, 1995 to May 31, 

2008 in patients under 18 years of age were retrospectively reviewed. The following clinical 

parameters were retrieved: age and gender, number of nodules, and nodule size. 

Cytological parameters included cytologic diagnosis and cyto-patohistological correlation. 

Results: 236 cases, representing 206 patients under 18 years of age, were retrieved 

from a total of 11748 thyroid FNA cases (2.0%). The patient’s age ranged from 2 to 18 

years (mean 14). There were 180 (87.4%) females and 26 (12.6%) males with a female/ 

male ratio 4:1. For 56 patients data concerning the number of nodules were recorded. 20 

(35.7%) patients did not have any nodules, 20 (35.7%) patients had solitary thyroid nodule 

and 16 (28.6%) patients had multiple nodules. The size of nodules ranged from 0.4 – 5.4 

cm (mean 0.14 cm). The cytologic diagnoses were: unsatisfactory (9), cyst fluid (7), benign 

(204), cellular follicular lesion/follicular neoplasm (9) and papillary thyroid carcinoma 

(7). The prevalence of malignancy among cytologic diagnoses was 3.4%. 21 patients had 

surgical follow up. 5 patients (23.8%) had thyroid malignancies (all papillary carcinomas). 

The remainder had benign thyroid lesions; follicular adenomas (8), multinodular 

goiters (5), diffuse goiters (2) and Hashimoto thyreoiditis (1). There were no false negative 

or false positive cytologic diagnoses. Conclusion: Our study supports previously reported 

uncommon use of thyroid FNA in patients under 18 years of age. The prevalence of thyroid 

malignancies among cytologic diagnoses was similar to those reported in adults. In 

limited number of patients with surgical follow up there were no false negative or false 

positive cytologic diagnoses. 

sandra.moslavac@sunce.hr


TREATMENT OUTCOMES OF HEPATOCELLULAR CARCINOMA PROVEN BY FINE 

NEEDLE ASPIRATION CYTOLOGY: A SINGLE CENTRE EXPERIENCE 

Mrzljak A, Čolić Cvrlje V, Kardum-Skelin I, Škegro D, Filipec-Kanižaj T, Šušterčić D 

Department of Medicine, University Hospital Merkur, Zagreb, Croatia 

Hepatocellular carcinoma (HCC) mostly occurs in chronic liver disease and cirrhosis. 

Surgical resection and liver transplantation (LT) represent potentially curative treatments 

of choice and if not feasible, palliative strategies such as percutaneous interventional 

techniques (PITs) and systemic therapy (ST) are considered. Elevated alfafetoprotein, 

typical imaging pattern, needle core biopsy (NCB) and fine needle aspiration 

cytology (FNAC) complement diagnostic assessment of HCC. 

We have retrospectively analyzed HCC diagnosed by FNAC at our institution from 2004- 

2009 regarding treatment options. Ultrasound guided FNAC was performed in cases of 

contraindications for NCB. No complications were documented, except for mild transitory 

discomfort at the site of puncture. The diagnosis was verified by May-Grunwald- 

Giemsa (MGG) staining and immunohistochemistry. In overall of 62 patients, HCC developed 

in 61% and 39% in cirrhotic and non-cirrhotic liver, respectively. Underlying cause 

of liver disease was alcohol abuse in 32% and viral diseases in 13% of cases. In the setting 

of cirrhosis 16% of patients underwent PITs, 18% liver transplantation, 26% ST and 

40% symptomatic therapy. In non-cirrhotic patients resection, ST, symptomatic therapy 

and PIT were applied in 46%, 25%, 25% and 4%, respectively. Pathohistology of resected 

and explanted livers (18 cases) confirmed the initial diagnosis. 

Our observations demonstrate that screening of high-risk groups and early identification 

of HCC should be addressed more intensely, since only early stage of HCC offers potentially 

curative treatment options. FNAC offers minimally invasive, rapid and uncomplicated 

diagnostic approach in the setting of abnormal coagulation and ascites commonly 

seen in advanced liver disease, providing therefore simple and effective diagnostic tool. 

anna.mrzljak@gmail.com 

97 



98 


CYTOLOGY OF CERVICAL INTRAEPITHELIAL GLANDULAR LESIONS 

Ovanin-Rakić A1 , Mahovlić V1 Audy-Jurković S1 , Barišić A1 , Škopljanac-Mačina L1 Jurič D1 , Rajhvajn S1 , Ilić-Forko J2 , Babić D2 , Folnović D3 , Kani D4 1 Department of Gynecologic Cytology, University Department of Obstetrics and Gynecology, 


2University Department of Clinical Pathology, Zagreb University Hospital Center, Zagreb, 

Croatia 

3 University Department of Gynecologic Oncology, Department of Obstetrics and Gynecology, 


4 Children’s Hospital Zagreb, Zagreb, Croatia 

Introduction. Cytological criteria for the identification of glandular intraepithelial lesions 

(GIL) have not yet been fully described, especially for the precursors of adenocarcinoma 

in situ (AIS), thus these lesions may frequently remain unrecognized. As most patients 

diagnosed with AIS or mild to moderate GIL (grades I, II) are free from clinical symptoms, 

cytology has a very responsible role in the detection of these lesions. Aim. The aim 

of the study was to achieve the most appropriate cytologic diagnosis of intraepithelial 

lesions of endocervical columnar epithelium, analyzing the cytology findings in patients 

with histologically verified AIS and GIL (I, II). Patients and Methods. The value of cytology 

in the detection and differential diagnosis was assessed in 123 patients with definitive 

histologic diagnosis of glandular lesions (AIS, n=13; GIL I, n=11; and GIL II, n=7), and 

glandular lesions associated with squamous component (AIS associated with cervical 

intraepithelial neoplasia (CIN) or invasive squamous cell carcinoma (SCC), n=58; GIL I 

or GIL II associated with CIN, n=28; and GIL associated with microinvasive squamous 

carcinoma (MIC), n=6). Results. In 95.1% of patients, lesions were detected by cytologic 

analysis that indicated additional diagnostic procedure. In terms of differential diagnosis, 

cytology showed higher accuracy in predicting lesion severity vs. type of epithelial alteration 

(75.6% vs. 55.3%) and abnormalities of columnar epithelium (95.7%; vs. 74.2%). 

The accuracy of cytology was higher in pure (AIS, 61.5% and GIL I, II, 22.2%) than in mixed 

lesions (25.9% and 20.6%). Conclusion. Continuous improvement in cervical specimens 

and cytodiagnostic skills, better understanding of intraepithelial adenocarcinoma and 

precursors, and their inclusion in the classification of cytologic and histologic findings 

are expected to upgrade the detection of these lesions, and to reduce the invasive cervical 

adenocarcinoma morbidity and mortality. 

ana.ovanin@gmail.com


THE VALUE OF CYTOLOGICAL SMEAR IN EVALUATION OF HEAD AND NECK 

NON- MELANOMA SKIN CANCER 

Pastorčić Grgić M1 , Ramljak V2 , Šarčević B3 , Gršić K1 , Pegan A4 1Department of Head and Neck Surgery, University Hospital for Tumours, Zagreb, Croatia 

2Department of Clinical Cytology, University Hospital for Tumours, Zagreb, Croatia 

3Department of Clinical Pathology, University Hospital for Tumours, Zagreb, Croatia 

4Department of Otorhinolaryngology and Cervicofacial Surgery, University Hospital 

“Sisters of Mercy”, Zagreb, Croatia 

Non-melanoma skin cancer is the most common malignancy in humans. Although clinical 

recognition of typical tumours is usually sufficient, it is sometimes difficult to correctly 

diagnose atypical or recurrent tumours. Cytological sampling is painless, noninvasive 

and accurate method, useful in skin cancer evaluation. In our study, which 

included 91 patients, overall accuracy of cytological diagnosis in non-melanoma skin 

cancer was 91.2%. We find this method especially useful in differentiating small benign 

looking lesions, in multiple skin changes and in suspected recurrent skin cancer. 

marija_pastgrgic@yahoo.com 

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100 


AN UNUSUAL PRESENTATION OF GAUCHER’S DISEASE: AORTIC VALVE FIBROSIS IN 

A PATIENT HOMOZYGOUS FOR A RARE G377S MUTATION - A CASE REPORT 

Perić Z1 , Kardum-Skelin I1 , Jelić-Puškarić B1 , Letilović T2 , Vrhovac R1 and Jakšić B1 Department of Medicine, Divisions of Hematology1 and Cardiology2 , University Hospital 

Merkur, Zagreb, Croatia 

Gaucher’s disease (GD) has variable presentations, but cardiac involvement is a generally 

uncommon clinical manifestation of the disease. In the past 25 years, the underlying 

genetic disorder in GD has been well characterized, with almost 300 mutations identified 

in the glucocerebrosidase gene (GBA). Nevertheless, clear genotype-phenotype 

correlations have been confirmed only for the most frequent mutations. We present a 

female patient, who was known to have aortic valve pathology from the age of 30. Despite 

medical followup, at the age of 60 she presented with heart failure (NYHA III). At that 

time echocardiography showed severe fibrosed aortic valve stenosis. Valvuloplasty was 

planned, when thrombocytopenia, previously considered to be autoimmune, became 

severe. Anemia and leukopenia were also noted. Moderate splenomegaly and severe 

bone marrow infiltration were found on MRI. Bone marrow aspiration revealed typical 

Gaucher cells and the enzyme activity assay confirmed the diagnosis. DNA investigation 

showed that the patient is homozygous for the G377S mutation. To our knowledge, of all 

mutations identified so far, only homozygosity for the D409H mutation has been associated 

with cardiovascular valvular disease in patients with a rare type 3c GD. G377S, found 

in our patient, is a rare mutation, previously reported as a ‘mild’ mutation, because of 

the finding that homoallelic patients were essentialy asymptomatic or had mild disease. 

Our patient, also homozygous for G377S mutation, had a severe form of type 1 GD, with 

rare cardiac valve involvement, which is a previously unreported clinical presentation for 

this mutation. This case further proves that patients with the same genotypes can have 

different phenotypes, emphasizing the influence of other genetic and/or environmental 

factors. 

zina_peric@yahoo.com


EXPRESSION OF KI-67, P53 AND PROGESTERONE RECEPTORS IN UTERINE SMOOTH 

MUSCLE TUMORS. DIAGNOSTIC VALUE 

Petrović D, Babić D, Ilić Forko J, Martinac I 

Department of Gynecological and Prenatal Pathology, University Hospital Centre, Zagreb, 

Croatia 

Aim was to investigate expression of Ki-67, P53 and progesterone receptors (PR) in leiomyomas 

(LM), smooth muscle tumors of uncertain malignant potential (STUMP) and 

leiomyosarcomas (LMS) and to establish possible usefulness of these three parameters 

in distinguishing between LM and STUMP, and STUMP and LMS. Materials and methods. 

Retrospective study of 51 uterine smooth muscle tumors (16 LM, 18 STUMP, 17 LMS) 

technically acceptable for analyses from years 2002. - 2007. from Department of Gynecological 

and Prenatal Pathology, Zagreb University Hospital, Croatia. Immunohystochemical 

analysis of Ki-67, P53 and PR expression was performed. Non-parametric 

analysis of variance Kruskal-Walis test was performed. Results. Ki-67 expression was 

negative in all LM and higher than 5% in 12/18 STUMP and 10/17 LMS. Significant differences 

were observed between LM and STUMP expression for Ki-67 (P= 0.000), and LM 

and LMS expression for Ki-67 (P=0.000). There was no expression of P53 in LM, expression 

of P53 was found in 7/17 LMS and 5/18 STUMP. Expression of P53 was significant 

between LM and LMS (P=0.002), and between LM and STUMP (P=0.006). Expression of 

PR was found in 16/16 LM and 18/18 STUMP, 10/17 LMS did not show PR expression. 

Expression of PR was significant between LM and LMS (P=0.018) and STUMP and LMS 

(P=0.004). Conclusion. The findings of our study in concordance with other study results 

are helpful information establishing more diagnostic criteria and parameters for diagnosis 

in doubtful cases between three entities. Immunostaining for Ki-67, P53 and PR 

are such parameters. The panel of their expression in specific case eases diagnosis. 

dvrptrvc@yahoo.com 

101 



102 


MORPHOMETRY OF TUMOUR CELLS IN DIFFERENT GRADES AND TYPES 

OF BREAST CANCER 

Prvulović I1 , Kardum-Skelin I2 , Jakić-Razumović J3 , Manojlović S4 1General Hospital Slavonski Brod, Department of Cytology, Slavonski Brod, Croatia 

2Merkur University Hospital, Laboratory of Cytology and Hematology, Zagreb, Croatia 

3Clinical Hospital Centre Zagreb, Department of Pathology, Zagreb, Croatia 

4Dubrava University Hospital, Department of Pathology, Zagreb, Croatia 

Objective. To compare morphometric features between different types and grades of 

breast cancer. Methods. Morphometric analysis was performed using the Sform (Vamstec, 

Zagreb) software on the May-Grunwald-Giemsa stained fine needle aspiration cytology 

specimens of breast tissue. Selected specimens represented all breast smears in 

Clinical Hopsital Merkur from 2001 to 2005, malignant on cytological report and histologicaly 

confirmed. Investigated group consisted of 42 patients. The following features were 

investigated: area, outline, maximum radius, minimum radius, convex area, breadth, 

length, nucelar/cytoplasmatic ratio, form factor and elongation. Statistic 7.1 and chi2- 

test were used. Results. Morphometric analysis showed statistically significant differences 

between all investigated groups. Conclusion. Morphometric features considered 

individually were highly associated with type and grade of breast tumour. 

ivanahodak@yahoo.com 

LYMPHOMATOID GRANULOMATOSIS IN A 23-YEAR-OLD MAN- CYTOLOGICAL AND 

HYSTOLOGICAL TYPING AND RAPID RESPONSE TO STEROID AND CYCLOPHOSPHAMIDE 

Rakušić N1 , Krmpotić D1 , Hećimović A1 , Boras Z1 , Vrabec-Branica B1 , Džebro S2 , 

Rakušić N3 , Rešković T4 1University Hospital for Lung Diseases „Jordanovac“, Zagreb, Croatia 

2Department of Pathology, Clical Hospital „Merkur“, Zagreb, Croatia 

3Medical School University of Rijeka, Croatia 

4Medical School University of Zagreb, Croatia 

Lymphomatoid granulomatosis (LG) is currently called as extranodal angiocentric and 

angiodestructive immunoproliferative lesion with various degree of histological diferentiation 

and clinical agression. Histological grading and clinical manifestations are 

due to number of atypical large EBV+ B-lymphatic cells. We report case of 23-years old 

man, clinicaly presented with fever, sweating, and physical intolerance, and with bilateral 

pulmonary infiltrates of nodular type and destructive changes on the chest x-ray, 

previously treated with antituberculotics for 1,5 months. As the disease showed progression, 

diagnostic procedures extended to transbroncial lung biopsy and percutaneous 

fine needle aspiration with cytologic and histologic analysis of colected speciemens, all 

being not enough conclusive. LG was confirmed by open lung biopsy, followed by induction 

of corticosteroids and cyclophosphamide therapy. Very good clinical, functional and 

radiomorphologic improvement was achieved in a few weekls and remission of diseases 

maintanined in long term follow-up. 

neven.rakusic@zg.t-com.hr


FINE NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSING RARE BREAST 

CARCINOMA-TWO CASE REPORTS 

Ramljak V1 , Šarčević B2 , Vrdoljak DV3 , Bobuš Kelčec I1 , Agai M1 , Trutin Ostović K4 1 University Hospital for Tumors, Department of Cytology, Zagreb, Croatia 

2 University Hospital for Tumors, Department of Pathology, Zagreb, Croatia 

3 University Hospital for Tumors Department of Surgical Oncology, Zagreb, Croatia 

4Dubrava University Hospital., Department of Clinical Cytology and Cytometry, Zagreb, 

Croatia 

In this paper, we are presenting the two cases of very rare tumors: breast sebaceous 

carcinoma, which has been described for the first time in Croatian medical literature, 

and pure breast squamous carcinoma. First case, sebaceous carcinoma, is still quite 

unknown regarding its morphological characteristics and biological behavior. In the 

second case, squamous carcinoma, also very rare, was found in a patient who previously 

had a number of diagnosed head and neck skin carcinomas, and was diagnosed 

as primary squamous breast carcinoma. As a first case we present a 85-year-old female 

with a two months history of swelling of the left breast under the mammilla. The 

second one, a 69-year-old female presented to our hospital in January 2008 with a two 

months history of a lump in the lower outer region of the left breast and enlarged lymph 

nodes in left axillary region. Fine needle aspiration cytology (FNAC) of the breast was 

performed in order to diagnose the exact type of both tumours. This methodology was 

found important in diagnosis, but in both cases showed certain limitations in diagnosing 

such rare tumors. The final diagnoses were determined after carefully synthesizing 

the histological findings and clinical data. Careful and accurate classification of these 

tumors is necessary. A detailed analysis of their biological behavior and response to the 

therapy is necessary in order to formulate definite recommendations in managing these 

patients/diseases. 

vesna.ramljak@kzt.hr 

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104 


VILLOGLANDULAR PAPILLARY ADENOCARCINOMA OF THE UTERINE CERVIX WITH 

AGGRESSIVE CLINICAL COURSE - A CASE REPORT 

Rubeša-Mihaljević R1 , Vrdoljak-Mozetič D1 , Verša Ostojić D1 , Štemberger-Papić S1 , 

Sindik N2 , Krašević M3 1 Department of Gynecological Cytology, University Department of Gynecology and 

Obstetrics, University Hospital Center Rijeka, Rijeka, Croatia 

2University Department of Gynecology and Obstetrics, University Hospital Center Rijeka, 


3 Department of Pathology, Rijeka University School of Medicine, Rijeka, Croatia 

Aim of the study: Villoglandular papillary adenocarcinoma (VGA) of cervix is an uncommon 

but well recognized histologic subtype of cervical adenocarcinoma which usually 

affects young women. Based on the favorable outcomes reported in most of previous 

cases the tumor is generally considered to have an indolent clinical course with excellent 

prognosis. We present a case of a 22-year-old woman admitted for glandular abnormality 

on cervical smear and episodes of vaginal bleeding. In the Pap smear, the cytologic 

features were suspicious but not diagnostic of adenocarcinoma, therefore reported as 

atypical glandular cells (AGC). Histological examination confirmed VGA associated with 

lymphovascular space invasion. The patient underwent radical operative procedure. Intraoperative 

cytologic examination detected pelvic lymph nodes metastasis. The patient 

was confirmed to be in an advanced stage - III B (FIGO). During a two years follow-up 

period a rapid dissemination of the tumor occurred and resulted with a fatal outcome. 

Conclusion: Although VGA has been reported to have a favorable prognosis, several cases 

with lymph node involvement have already been described. Cervical smears examination 

would be helpful for an early diagnosis of VGA, however the cytologic recognition 

is often difficult. Further investigation of the pathogenesis, diagnosis and therapy of the 

tumor is needed. 

roberta.rubesa@gmail.com


ADDITIONAL CYTOMORPHOLOGICAL CRITERIA IN DIAGNOSIS OF PILOMATRICOMA - 

BENIGN TUMOR WITH BAD REPUTATION 

Seili-Bekafigo I1 , Jonjić N2 , Štemberger C1 , Rajković-Molek K1 1 KBC Rijeka, Department of Cytology, Department.of Internal Medicine, Rijeka, Croatia 

2 Rijeka University School of Medicine, Department of Pathology, Rijeka, Croatia 

Aim. Pilomatricomas (PM) are benign skin appendageal tumors,with differentiation towards 

hair-forming cells,usually found in children. They are frequently misdiagnosed by 

clinicians, and there are many reports of false positive diagnoses made on fine needle 

aspirates (FNA). PM are often mistaken for «small round cell tumors in children, or for 

Merkel cell carcinoma, basalioma and metastatic small cell carcinoma in adults, with 

possible over-aggressive therapeutic approach. The aim of this study was to confirm 

existing and possibly add some new morphologic and morphometric characteristics of 

PM. Patients and methods. In 6 cases of PM, correctly diagnosed preoperatively by FNA, 

clinical, cytomorphologic and basic morphometric features (the longest nuclear diameter), 

were analyzed, and compared with 4 cases of malignant tumors with similar clinical 

presentation. Smears were stained according to May-Gruenwald-Giemsa (MGG) method. 

Results. Morphometric data did not prove to be helpful. In addition to well known 

cytomorphologic characteristics of PM, in all 6 cases we found basophilic cytoplasmatic 

protrusions, that could be useful additional cytomorphologic feature of PM. Conclusion. 

We concluded that cytomorphologic characteristics of PM are reliable enough for correct 

preoperative diagnosis in adequate specimens. The best results are achieved when 

FNA is performed by an experienced cytologist, considering all relevant clinical data. 

irena.seili-bekafigo@ri.t-com.hr 

105 



RARE TUMORS OF THE BREAST- CASES REPORTS 

Staklenac B1 , Lončar B1 , Pauzar B1 , Dmitrović B2 1 Clinical Hospital Osijek, Department of Clinical Cytology, Osijek, Croatia 

106 


2 Clinical Hospital Osijek, Department of Pathology and Forensic Medicine, Osijek, Croatia 

Introduction. FNAB and cytomorphology are standard diagnostic tools for breast tumors. 

The aim of this study was to demonstrate FNAC of rare breast tumors correlated with 

pathological and immunohistological findings. Material and methods. FNAB was performed 

with or without ultrasound using 22 gauge needle attached to 10 ml syringe. Material 

was spread to glass. Air dried smears were stained according to May-Grunwald- 

Giemsa method. We reported some rare tumors presented as a primary breast lumps 

(malignant epithelioid schwannoma, carcinoma apocrineum, malignant phyllodes tumor, 

carcinoma neuroendoccrineum and carcinoma planocellulare invasivum). Another 

two breast tumors had already established pathohistological diagnoses. The first one 

was Lymphoma non Hodgkin- Burkitt type (of uterus, adnexsis, cervix, omentum and 

appendix), and second one was CLL. Conclusion. FNAB is very useful method for distinguish 

rare, benign and malignant breast tumors. 

staklenac.blazenka@kbo.hr


CERVIX CANCER SCREENING IN CROATIA WITHIN THE EUROPEAN CERVICAL 

CANCER PREVENTION WEEK 

Škopljanac-Mačina L 1 , Mahovlić V 1 , Ovanin-Rakić A 1 , Barišić A 1 , Rajhvajn S 1 , Jurič D 1 , 

Babić D 2 , Ćorušić A 3 , Orešković S 4 

1 Department of Gynecologic Cytology, University Department of Gynecology and 


2 Department of Gynecologic and Perinatal Pathology, University Department of Clinical 

Pathology, Zagreb University Hospital Center, Zagreb, Croatia 

3 Department of Gynecologic Oncology, University Department of Gynecology and 


4 Department of Gynecology and Urogynecology, University Department of Gynecology 

and Obstetrics, Zagreb University Hospital Center, Zagreb, Croatia 

Aim: To evaluate the outcome of the information campaign “For All Women” and to 

provide recommendations for the future national screening programme. Methods: The 

European Cervical Cancer Prevention Week was held twice in Croatia, in January 2008 

and 2009. Within the first one in 2008, information campaign “For All Women” via mass 

media was held, and women were invited to the organized free gynecological examination 

and Papanicolaou test (Pap test) in the University Department of Gynecology and 

Obstetrics, University Hospital Center Zagreb. Within the European Cervical Cancer 

Prevention Week in 2009, employed women from one national company were invited 

by internal information to the same procedure. Results: Following invitation during the 

campaign “For All Women 2008” 481 women attended the testing; the median age was 

55 years. There were more women aged ≥50 (n=353), with the highest participation in 

the age group 55-59 years (n=94). Some women came because of subjective symptoms 

(n=10), but the majority of them came only for testing (n=471). According to history of previous 

cytological testing, 400 women have had ≥1 negative findings, 71 women have had 

≥1 positive findings, 9 women attended Pap test for the first time, and 1 woman does not 

know about previous testing. Cervical cytology was abnormal in 35 women (7.28%), the 

median age was 42 years with the highest proportion in the age group 30-34 years (n=7); 

among all of them 21 women (60%) had no abnormal Pap test previously. The findings 

were: Atypical squamous cells of undetermined significance - ASC-US (n=9), ASC cannot 

exclude high-grade squamous intraepithelial lesion - ASC-H (n=1), cervical intraepithelial 

neoplasia - CIN 1 (n=13), CIN 2 (n=1), CIN 3 (n=6), carcinoma planocellulare (n=2), atypical 

glandular cells - AGC-favor reactive endocervical cells (n=3). Among women aged £49 

there were 20.47% abnormal findings and among those aged ≥50, 2.55%. According to ≥1 

positive Pap tests previously, among women aged £49 there were 30.71% while among 

those aged ≥50 there were 9.07%. A smaller group of younger asymptomatic women 

came for testing in 2009 (n=53), median age 39 years. According to history of previous cytological 

testing, 50 women have had ≥1 negative findings, 3 women have had ≥1 positive 

findings. In this study, Pap test was positive in 3.77% (n=2). Conclusion: National screening 

programme should be focused on the participation of all personally invited women, 

especially younger age groups and under-screened women. Well designed information 

campaign should be implemented in national screening programme. 

lskopljanac@yahoo.com 

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108 


EVALUATION OF THE HPV L1 CAPSID PROTEIN IN PROGNOSIS OF MILD AND 

MODERATE DYSPLASIA OF THE CERVIX UTERI 

Štemberger-Papić S1 , Vrdoljak-Mozetič D1 , Verša Ostojić D1 , Rubeša-Mihaljević R1 , 

Markanjević T1 , Rešetar R1 , Manestar M2 1 Department of Gynecological Cytology, University Department of Gynecology and 

Obstetrics, University Hospital Centre Rijeka, Croatia 

2 Department of Gynaecology, University Department of Gynaecology and Obstetrics, 

University Hospital Centre Rijeka, Croatia 

Objective: To determine weather HPV L1 immunoreactivity could help us to discriminate 

between regresing and persistent/progressing mild and moderate cervical dysplasia in 

cytological specimens. Materials and Methods: We immunostained archival Pap smears 

from 114 hr HPV DNA positive squamous lesions with mild or moderate dysplasia. The 

staining results were correlated with follow-up smears for lesions which are going to 

remission or for persistent lesions with mild dysplasia. Progressive or persistent lesions 

with moderate dysplasia were correlated with histologic verification on Large Loop Excision 

of the Transformation Zone (LLETZ) or conization. Results: Immunochemical analyses 

with L1 antibody revealed positively stained nuclei of squamous epithelial cells in 

56 of 114 smears (49,1%). Regression (negativisation of the Pap smear for 24 months or 

longer) was noticed in 31 of 56 ( 55,4% ) L1-positive cases and in 20 of 58 (34,5%) L1-negative 

cases. Persistent disease occured in 13 (23,2%) L1-positive cases and in 14 (24,1%) 

L1-negative cases. Progressive disease occured in 12 (21,4%) L1-positive cases and in 24 

(41,4%) L1-negative cases. The difference in the clinical course between the L1-positive 

and L1-negative patients was statistically significant (p=0,025). Also, the difference in the 

clinical course of the L1-negative staining in the under-30 and over-30 years age group 

was statistically significant (p=0,04). Conclusion: Our data confirm that immunostaining 

for HPV L1 capsid protein could offer prognostic information about mild and moderate 

intraepithelial cervical squamous lesions. 

snjezana.stemberger@ri.t-com.hr


BILIARY BRUSH CYTOLOGY FOR THE DIAGNOSIS OF MALIGNANCY: 

A SINGLE CENTER EXPERIENCE 

Štoos-Veic T1 , Bilic B2 , Kaic G1 , Trutin Ostovic K1 , Babic Z2 , Kujundzic M2 1 Department of Cytology and Flow Cytometry, Dubrava University Hospital, Zagreb, Croatia 

2 Department of Gastroenterology, Dubrava University Hospital, Zagreb, Croatia 

Brush cytology during the endoscopic retrograde cholangiopancreatography (ERCP) is 

the most commonly used method for obtaining tissue confirmation of the nature of biliary 

strictures. Its specificity is remarkably high but reported sensitivities for the diagnosis of 

malignancy are low. Aim of our study was to assess sensitivity and specificity of biliary 

brush cytology in our institution, to find out main causes of false negative diagnoses and 

to confirm impression that the team approach has impact on sensitivity. Materials and 

methods: Out of total of 201brushings, 143 specimens with available definitive diagnosis 

were analyzed. Gold standard for diagnosis was definitive surgical histology or adequate 

clinical follow up for minimum of six month. Direct smears made by cytotechnician at 

the endoscopy room, and stained according to Papanicolaou and May-Grünwald Giemsa 

(MGG), were examined for well-recognized features of malignancy on conventional 

smears as a part of diagnostic routine. Cytologic diagnoses were benign, atypical/reactive, 

suspicious for malignancy and malignant. Out of 143specimens, 36 (25%) had malignant 

cytologic diagnosis and 91(63.6%) were benign, 3 were atypical/reactive and 13 

suspicious for malignancy with 20 “false-negative” cases. When specimens with atypical 

and suspicious cytology were excluded from data analysis sensitivity was 64% and specificity 

was 100% and when suspicious findings were taken into account as true positives, 

sensitivity rose to 71%. Conclusion: We find that biliary brush cytology, although mainly 

depending on the skill of endoscopist, as well as the experience of the cytologist, is a 

valuable method for obtaining accurate tissue diagnosis of biliary strictures, thus solving 

eternal diagnostic dilemma: benign or malignant. 

tveic@kbd.hr 

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110 


IDENTIFICATION OF BRAIN CANCER STEM CELLS IN WHO STAGE IV BRAIN TUMOURS 

Tomuleasa C1 Soritãu O1 , Foris V1 , Ioani H3 , Ciucã DR2 , Susman S2 , Mihu C2 , Florian IS3 1Ion Chiricuta Oncology Institute, Department of Cancer Immunology, Cluj Napoca, 

Romania 

2Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj 

Napoca, Romania 

3Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, 

Cluj, Npoca, Romania 

Tumours of the nervous system represent the leading cause of cancer-related death in 

children and the fourth leading cause in adults. Despite decades of research and clinical 

experience, the life expectancy of an adult diagnosed with a high-grade brain tumour 

is typically less than one year. Our ability to develop new therapies for these deadly 

cancers is highly dependent on an improved understanding of the molecular and cellular 

changes that contribute to their development and continued growth. Brain cancers 

comprise a complex microcosm of both neoplastic and non-neoplastic cells that each 

have distinct roles in dictating tumor formation and growth. The most important of these 

cells are cancer stem cells, responsable for post-radiochemotherapy relapse and progression. 

We cultured 5 fresh surgical specimens of human glioblastoma multiforme 

using the same protocols used for culturing bone marrow mesenchymal stem cells. At 

passage 3, cells had a spindle-shaped morphology, formed spheroids and were resitant 

to chemotherapy agents. Immunocytochemistry staining and Reverse Transcriptase – 

Polymerase Chain Reaction showed that cells expressed CD 133 cancer stem cell specific 

marker. The identification of brain tumour stem cells provides a powerful tool to investigate 

the tumorigenic process in the central nervous system and to develop targeted 

therapies, capable of increasing the survival of patients diagnosed with WHO grade four 

brain cancers. 

ciprian_tomuleasa@yahoo.com


DEDIFFERENTIATION THERAPY AND DARWINISM FOR SORTING OF OVARIAN 

CANCER STEM CELLS 

Tomuleasa C1 , Soritãu O1 , Ciucã DR2 , Susman S2 , Mihu C2 1Ion Chiricuta Oncology Institute, Department of Cancer Immunology, Cluj Napoca, Romania 

2Iuliu Hatieganu University of Medicine and Pharmacy, Department of Pathology, Cluj 

Napoca, Romania 

Introduction. The cellular mechanisms underlying the increasing aggressiveness associated 

with ovarian cancer progression are poorly understood. Coupled with a lack of 

identification of specific markers that could aid early diagnoses, the disease becomes 

a major cause of cancer-related mortality in women. The high incidence of recurrence 

attributable to multidrug resistance and the multiple histologic phenotypes indicative 

of multipotency suggest a stem-like etiology of ovarian cancer. Here we adopted suspension 

culture combined with anti-cancer regimens as a strategy for screening ovarian 

cancer stem cells. These tumor stem cells could survive and be highly enriched in 

non-adherent suspension culture while chemotherapeutic agents could destroy most 

rapidly dividing cancer cells and spare relatively quiescent cancer stem cells. Material 

and Methods. MLS human ovarian cancer cells were cultured in serum-free medium, 

suplemented with Epidermal Growth Factor, basic Fibroblast Growth Factor, B27 and 

N2. Cells of passage 8 were treated in combination with anticancer agents Doxorubicin 

and Carboplatin at different peak plasma concentrations for 24 hours, and then maintained 

under suspension culture. The stem-like properties were confirmed by immunocytochemistry 

staining techniques, by multidrug resistance assays and by their ability 

to grow in an anchorage-independent manner in vitro as spheroids. Selected cells were 

also injected subcutaneously into CD1 mice to observe tumour formation. Results and 

Discussion.Here we present direct evidence that the aggressiveness of human ovarian 

cancer may be a result of transformation and dysfunction of stem cells in the ovary. 

The tumorigenic clones, even on serial transplantation continue to establish tumours, 

theraby confirming their identity as tumor stem cells. Suspension culture combined with 

anticancer regimens provides an effective means of isolating, culturing and purifying 

ovarian cancer stem cells. 

ciprian_tomuleasa@yahoo.com 

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112 


THE IMPORTANCE OF URGENT CYTOLOGICAL EXAMINATION OF SYNOVIAL FLUIDS 

IN DIFFERENTIATION INFLAMMATORY AND NON-INFAMMATORY DISEASES 

Trutin Ostović K1 , Kaić G1 , Ostović I2 , Škoro M1 , Novak N-P1 , Morović-Vergles J3 1Dubrava University Hospital, Department of Clinical Cytology and Cytometry, Zagreb, 

Croatia 

2Faculty of Humanities and Social Sciences, University of Zagreb, Department of 

Psychology, Zagreb, Croatia 

3Dubrava University Hospital, Department of Clinical Immunology and Rheumatology, 


Aim. To imply the possibilities of the urgent cytological examination of synovial fluids 

in differentiation of arthropathies and to motivate clinicians to use this method. Methods. 

This examination consists of macroscopic analysis (volume, colour, clarity, viscosity 

and mucin clot test), native microscopic analysis for crystals, counting total nucleated 

cell count in Bürker-Türk counting chamber and microscopic analysis rapid Hemacolor 

stained smears for neutrophil granulocyte percentage. All these analyses are done within 

one hour since FNA. Results. The study includes 115 synovial fluids (81 with inflammation, 

34 with non-inflammation) obtained by FNA between 2003 and 2008. The clarity, 

viscosity, mucin clot test, the total nucleated cell count and the neutrophil granulocyte 

percentage enables distinction between inflammation and non-inflammation with statistically 

significant difference at the 0.01 level. Crystals (monosodium urate) are detected 

in 12 synovial fluids and we can diagnose gout. Conclusion. The urgent cytological 

analysis of the synovial fluid is useful basic diagnostic screening test in differentiation 

inflammatory and non-inflammatory joint diseases and we recommend using it as the 

initial test in the diagnostic procedure of these illnesses using our protocol. 

ktrutin@kbd.hr


CERVICAL CYTOLOGY AND HPV TEST IN FOLLOW-UP AFTER CONISATION OR LLETZ 

Verša Ostojić D1 , Vrdoljak-Mozetič D1 , Štemberger-Papić S1 , Finderle A2 , Eminović S3 1 Department of Gynecological Cytology, University Department of Gynecology and Obstetrics, 

University Hospital Center Rijeka, Croatia 

2 Department of Perinatology, University Department of Gynecology and Obstetrics, University 

Hospital Center Rijeka, Croatia 

3 Department of Pathology, School of Medicine, University of Rijeka, Croatia 

Objective: To determine cytology-histology correlation after conisation or Large Loop 

Excision of the Transformation Zone (LLETZ) for cervical intraepithelial neoplasia (CIN), 

resection margin status, compliance to the follow-up protocol and evaluation of cervical 

cytology and HPV testing in two years period after surgical treatment. Materials 

and Methods: We made a retrospective analysis of the case records of 251 conisations 

and LLETZ performed between January and December 2006. The conventional cervical 

smears were analysed and digene Hybrid capture 2 test was used for detection of 

13 high-risk HPV types. Results: Histology analysis demonstrated CIN1+ lesion in 234 

cases (93,2%) with cytology-histology correlation in 97,9 % of cases. Preoperative HPV 

test was made in 142 histology confirmed CIN1+ lesions and 137 (96,5%) tested positive. 

The resection margins were involved in 48 (35,8%) cases and in 24 (10,2%) the margins 

were difficult to determine. 217 (86,5%) patients attended the posttreatment visits and 

abnormal cytology was found in 33 (15,2%) cases. The post-treatment HPV test was performed 

in 159 women and was positive in 25 (15,7%) cases. The complete follow-up control 

cytology, with at least three Pap smears in two years or with second treatment was 

found in only 146 (58,2 %) patients. 14/217 (6,5 %) patients underwent second treatment 

with histology confirmed treatment failure. In all patients where control smear was performed, 

repeated cytology found HSIL. In six women control HPV test was performed, in 

five cases it was positive and in one case with VAIN2 on biopsy of vagina it was negative. 

Conclusion: Our study confirme important place of cervical cytology in the diagnisis of 

cervical intraepitelial lesions and monitoring after treatment. In the future we have to 

improve compliance to the follow-up protocols and use of HPV test in the selection of 

women at risk of treatment failure. 

dversa.ostojic@gmail.com 

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114 


NECROTISING SARCOID GRANULOMATOSIS OF THE SPINAL CORD: CASE REPORT 

Vrbica Ž1 , Boras Z2 , Rakušić N2 , Smojver-Ježek S2 , Baričević D2 , Rakušić N3 , Alerić I2 1 Dubrovnik General Hospital, Dubrovnik, Croatia 

2 University Hospital for Lung Diseases, Zagreb, Craotia 

3 Medical Faculty, Rijeka, Croatia. 

We report a patient with leg weakness and cervical lymphadenopathy. Magnetic resonance 

showed an inhomogenously increased signal in the thickened portion of the cord. 

Multilevel laminectomy and spinal cord biopsy revealed granulomatous infiltrations with 

necrosis. Review of the histopathological finding established the diagnosis of necrotising 

sarcoid granulomatosis (NSG) of the spinal medulla, and cytological and histopathological 

analysis of the neck lymph node disclosed granulomatous inflammation without 

necrosis. Further radiographic chest evaluation showed mediastinal lymphadenopathy. 

Immunophenotyping of lymphocytes in bronchoalveolar lavage fluid (BALF) was indicative 

of sarcoidosis. The patient clinicaly improved to corticosteroid therapy, and lymph 

nodes subsided with minor changes remaining in the spinal medulla, which were considered 

to be irreversible. To our knowledge, this is the first described case with finding 

of granulomatous inflammation with and without vasculitis in various organs, consistent 

with the study of Churg who believes NSG to be a histological variant of sarcoidosis. 

zarkov@bolnica-du.hr


CERVICAL CANCER SCREENING PROGRAMME IN PRIMORSKO-GORANSKA COUNTY, 

CROATIA 

Vrdoljak-Mozetič D1 , Verša Ostojić D1 , Štemberger-Papić S1 , Janković S2 , 

Glibotić-Kresina H2 , Brnčić-Fischer A3 , Benić-Salamon K4 1 Department of Gynaecological Cytology, University Department of Gynaecology and 

Obstetrics, University Hospital Centre Rijeka, Rijeka, Croatia 

2 Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia 

3 Department of Gynaecology, University Department of Gynaecology and Obstetrics, 

University Hospital Centre Rijeka, Rijeka, Croatia 

4 Gynaecology Practice Klaudia Benić-Salamon, Opatija, Croatia 

In Primorsko-goranska County (PGC) a screening programme “Early detection of cervical 

cancer” was started in 2006. Target group were women aged from 20 to 64 years. Out 

of the patients of six primary care gynaecologists 6000 women were randomly invited by 

personal letter along with a questionnaire. Response to the anamnestic questionnaire 

was 49.1 %. The participation rates to screening were 35.2 % in 2007, and 46.5 % in 2008, 

total of 42.7 %. Increase of participation between years 2007. and 2008. was statistically 

significant (p=0.01). According to the age the lowest participation rate of 33.3% was observed 

in the youngest group of women (20-29) and the highest of 60.7% in the oldest 

group (60-64). The detection rate of cytological abnormalities was 4.6 % with 2.6 % of 

borderline (ASCUS) cytology and referral rate of 1.2 %. The highest abnormal Pap test 

frequencies of 6.8 % and 7.1 % were observed in younger age groups (20-29 and 30-39) 

and the lowest (2%) in the age group of 60-64. Specimen adequacy was generally of high 

quality with unsatisfactory rate of 0.8 %, with statistically significant improvement in 

2008. compared to the previous year (p=0.001). Even of limited extension, in two years 

of conducting cervical cancer screening programme in PGC we improved participation 

rates and Pap smear adequacy. By continuing this program we expect further increase 

of participation and overall quality of the programme. 

danijela.vrdoljak-mozetic@ri.t-com.hr 

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116 

Klinička citologija - Posteri 

CYTOLOGIC CHARACTERISTICS OF ADENOID CYSTIC CARCINOMA OF THE CERVIX 

UTERI - CASE REPORT 

Barišić A1 , Mahovlić V1 , Ovanin-Rakić A1 , Škopljanac-Mačina L1 , Rajhvajn S1 , 

Jurič D1 , Babić D2 1Department of Gynecologic Cytology, Department of Obstetrics and Gynecology, 


2Department of Clinical Pathology, Zagreb University Hospital Center, Zagreb, Croatia 

Adenoid cystic carcinoma is a rare malignancy, usually found in the salivary glands, 

although this unusual tumor can be found at other sites of the body. In particular, regarding 

adenoid cystic carcinoma of the cervix (ACCC) most frequently reports are given 

for postmenopausal women. In this respect, our work is one among very few in the literature 

that considers a cytologic picture of this uncommon cervix carcinoma. The case 

of 74 year old patient with postmenopausal bleeding is described. Both Pap smear and 

air dried smear of the uterine cervix were analysed. The cytologic findings revealed very 

few small clusters of abnormal glandular cells, as well as some amorphous eosinophilic 

globule-like material, with granulomatous and necrotic background. The latter includes 

a lot of histiocytes, multinucleated giant cells, large aggregates of epitheloid cells and 

lymphocytes. Histology revealed the diagnosis of ACCC. We emphasize the importance 

of careful screening of Pap smear that might be crucial in the case of suspicious clinical 

findings in postmenopausal women, when the possibility of ACCC has to be considered. 

ana.barac@zg.t-com.hr 

DIAGNOSIS OF VISCERAL LEISHMANIASIS BY FINE NEEDLE ASPIRATION CYTOLOGY 

OF AN ISOLATED CERVICAL LYMPH NODE: CASE REPORT 

Beljan R1 , Šundov D1 , Lukšić B2 , Šoljić V3 , Piljić Burazer M1 1Institute of Pathology, Forensic Medicine and Cytology, Split University Hospital, Split, Croatia 

2Department of Infectious Diseases, Split University Hospital, Split, Croatia 

3Department of Pathology, Cytology and Forensic Medicine Mostar, University Hospital 

Mostar, Bosnia and Herzegovina 

A 61-year-old woman presented with an isolated, painless, slightly enlarged right laterocervical 

lymph node without any other signs and symptoms of disease. Laboratory test 

including haematological and biochemical parameters were normal. A cervical ultrasonography 

demonstrated one lymph node (10mm) on the right laterocervical side and 

one small reactive lymph node on the left laterocervical side. The fine needle aspiration 

(FNA) smears revealed a polymorphic population of cells composed of lymphocytes, 

histiocytes, epitheloid cells, plasma cell, tingible body macrophages and macrophages 

infiltrated with Leishmania amastigotes. Treatment was initiated with Stiboglukonat Na 

(Pentostam) and led to a full recovery. 

rbeljan @krizine.kbsplit.hr

Clinical Cytology - Posters 

APLASTIC CRISIS INDUCED BY HUMAN PARVOVIRUS B19 AS AN INITIAL 

PRESENTATION OF HEREDITARY SPHEROCYTOSIS 

Čaržavec D 1 , Gaćina P 1 , Vasilj A 2 , Kojić Katović S 2 , Stančić V 1 

1Department of Hematology, University Clinic of Internal Medicine, Sestre Milosrdnice 

University Hospital, Zagreb, Croatia. 

2Department of Cytology, University Clinic of Internal Medicine, Sestre Milosrdnice University 

Hospital, Zagreb, Croatia 

The association between aplastic crisis and human parvovirus (HPV) B19 infection is 

described in patients with hereditary spherocytosis (HS). Most cases of aplastic crisis in 

patients with HS induced by HPV B19 have been reported in children and adolescents. In 

this paper , we describe an aplastic crisis induced by HPV B19 in an 34 year old female as 

an initial presentation of HS. Although other viral illnesses cause some decompensation 

in HS, the anaemia is very rarely as profound as that seen in acute HPV B19 infections. 

dubravka.carzavec@zg.t-com.hr 

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118 


ADENOMATOID NODULES AND SUSPICIOUS FOLLICULAR LESIONS OF THE THYROID 

OBTAINED BY FINE NEEDLE ASPIRATION CYTOLOGY 

Dabelić N1 , Mateša N1 , Mateša-Anić D2 , Kusić Z1 1Department of Oncology and Nuclear Medicine, Sisters of Charity University Hospital, 


2 Department of Otorhinolaryngology, Special Hospital for Medical Rehabilitation 

“Thalassotherapia”, Crikvenica, Croatia 

Aim: to assess malignancy risk in adenomatoid nodules and suspicious follicular lesions 

of the thyroid obtained by fine needle aspiration (FNA) cytology. Methods: retrospective 

research of 276 patients (pts) who underwent thyroid surgery after preoperative 

ultrasound-guided FNA diagnosis of adenomatoid nodule, cellular follicular lesion, 

“suspicious for follicular neoplasm” or follicular neoplasm. Results: Out of 276 pts, FNA 

reports showed 15 diagnoses (5%) of adenomatoid nodules, 73 (26%) cellular follicular lesions, 

76 (28%) “suspicious for follicular neoplasm”, and 112 diagnoses (41%) of follicular 

neoplasm. FNA reports were compared with pathohistological findings. In FNA reports 

of adenomatoid nodule, there were 7 (47%) pathohistological diagnoses (PHDs) of nodular 

goiter, and 8 (53%) PHDs of follicular adenoma. In FNA reports of cellular follicular 

lesion,, there were 2 (3%) PHDs of thyroiditis, 32 (44%) PHDs of nodular goiter, 38 (52%) 

PHDs of follicular adenoma, and 1 (1%) PHD of papillary carcinoma. In FNA reports of 

“suspicious for follicular neoplasm), there was 1 (1%) PHD of thyroiditis, 24 (32%) PHDs 

of nodular goiter, 47 (62%) PHDs of follicular adenoma and 4 (5%) diagnoses of papillary 

carcinoma. In FNA reports of follicular neoplasm, there were 25 (22%) PHDs of nodular 

goiter, 72 (64%) PHDs of follicular adenoma, and 15 (14%) PHDs of thyroid carcinoma. We 

found significant difference (p


THE ROLE OF CYTOLOGY IN THE DIAGNOSIS OF PYELON TUMOUR - A CASE REPORT 

Ezgeta Karačić D1 , Valetić J2 , Zeljko Ž3 , Vidas Ž3 , Jelić-Puškarić B4 , 

Sabljar-Matovinović M5 , Kardum-Skelin I4 1 Vukovar General Hospital, Department of Cytology, Vukovar, Croatia 

2 University Hospital Merkur, Department of Gynaecology & Obstetrics, Zagreb, Croatia 

3 University Hospital Merkur, Division of Urology, Zagreb, Croatia 

4University Hospital Merkur, Department of Medicine, Laboratory for Cytology and Hematology, 


5 University Hospital Merkur, Department of Medicine, Zagreb, Croatia 

Tumours of the renal pelvis and ureter arising from epithelial and mesenchymal elements 

account for 8% of all urinary tract neoplasms and of these greater than 90% 

are urothelial carcinomas. Haematuria and lumbal pain are the major symptoms. In a 

72-year-old woman hospitalized for acute myocardial infarction, mediastinal lymphadenopathy 

is detected incidentally as well as a left supraclavicular lymph node, approximately 

1.5 cm in diameter, from which samples were taken for cytological analysis. The 

smears revealed a number of single, very large cells, with distinct anisonucleosis and 

eccentric nuclei, often with large nucleoli and tiny granules in a prominent cytoplasm. 

Immunocytochemical staining showed positivity for CK18, 20 and 7 and negativity for vimentin, 

HMB45, AFP, thyreoglobulin, synaptophysin and chromogranin. The findings indicate 

malignant epithelial cells, most probably of the transitional cell epithelium. Urine 

sediment analysis of 3 samples discovered cells identical to those found in the lymph 

node sample. Further diagnostic tests (abdominal ultrasound, MR, PET-CT, cystoscopy) 

confirmed the presence of a tumour in the pyelon of the right kidney, which had caused 

an obstruction and atrophy of the right kidney. The patient started to receive chemotherapy, 

however metastases have been detected (by scintigraphy and PET-CT) in the skelet 

and a lymph nodes. This work confirms the clinically valuable role of cytology (exfoliative 

and FNA) in the diagnosis of rare occurrences and localizations of malignant tumours. 

In this case, cytology detected the presence of malignant cells in the lymph node and in 

the urine much before the onset of clinical signs of the disease before other diagnostic 

methods. 

draz_ezgeta@hotmail.com 

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120 


POLYOMAVIRUS ASSOCIATED NEPHROPATHY AFTER SIMULTANEOUS KIDNEY AND 

PANCREAS TRANSPLANTATION. CASE REPORT. 

Gracin S1 , Knotek M1 , Sabljar Matovinovic M1 , Kardum Skelin I1 , Ljubanovic D2 , Vidas Z1 1 Clinical hospital Merkur, Zagreb, Croatia. 

2 Clinical hospital Dubrava, Zagreb, Croatia. 

In renal allograft recipient, immunosuppressive drug therapy is the major cause of immunocompromised 

status and opportunistic infections leading to transplanted organ 

failure. 

During the last decade, polyomavirus virus associated nephropathy (PVAN) has been the 

major cause of a serious complication allograft failure in these patients. The prevalence 

of PVAN has increased from 1% to 10 % leading to loss of transplanted organ in 30% to 

80% of cases. Viremia precedes PVAN, and in the absence of specific antiviral drugs, 

early detection of disease and modification/reduction of immunosuppressive regimen 

currently is the cornerstone of therapy. 

Although PVAN nephropathy is well documented, it has not been thoroughly investigated 

in nonrenal and/or multiple organ transplantation; such are simultaneous kidney and 

pancreas transplantation (SPKT). In these specific conditions the diagnosis and therapy 

of PVAN can be even more challenging problem. 

We report a 32 years old patient who presented with PVAN 6 month after SPKT due to 

diabetic nephropathy. He received induction immunosuppression which included IL-2 

antibody (daclizumab), steroids, mycophenolate mofetil and tacrolimus. Diagnosis was 

made on the basis of protocol cytologic study in urine, examining Decoy cell and confirmed 

by histological examination of renal biopsy which revealed viral inclusions on 

light microscopy as well as positive immunohistochemistry analysis. Patient was treated 

with reduced immunosuppressive regimen, both tacrolimus and mycophenolate mofetil 

with continuation of small dose of prednisone. At two years follow up, patient has preserved 

kidney and pancreas function with estimated glomerular filtration rate of 84 ml/ 

min and no signs of PVAN on his 2 year protocol kidney biopsy. 

sonja.gracin@gmail.com


CASE REPORT OF A PATIENT WITH PERITONEAL AND OMENTAL LYMPHOMA 

INFILATRATION AND ASCITES POSITIVE FOR LYMPHOMA CELLS, 

FOLLOWING A RELAPSE OF SPLENIC MARGINAL ZONE LYMPHOMA (SMZL) 

Gredelj Šimec Nj1 , Ropar S2 , Baškot A3 , Dejanović M1 1 Department od Internal Medicine 


3 Department of Radiology G.H. Karlovac, Croatia 

We have presented a patient with marginal NHL of Splenic type. The disease was manifested 

in splenomegaly and leukocytosis, without lymphadenopathy. The diagnose was 

set by immunocytochemical and immunophenotypic assessment of the peripheral 

blood. The patient was treated with 8 cycles of chemotherapy following the COP scheme 

in combination with Rituximab. Following treatment, complete remission was achieved. 

18 months later, the disease was manifested in splenomegaly, leukocytosis with 9% 

atypical lymphatic cells in the peripheral blood, multiple masses of solid peritoneal and 

omental tumours in size up to 6.5 cm, same as massive ascites with cytologically proven 

lymphoma cells. 

njetocka.gredelj@zg.t-com.hr 

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122 


FAMILIAL HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN A 6-WEEK-OLD 

MALE INFANT 

Jakovljević G1 , Kardum-Skelin I2 , Rogošić S1 , Čulić S3 , Stepan S1 , Bonevski A1 , 

Rimac M1 , Nakić M1 1Department of Hematology and Oncology, Pediatric Clinic, Children’s Hospital Zagreb, 


2Laboratory for Cytology and Hematology, Department of Medicine, Merkur University 


3 Department of Pediatric Hematology and Oncology, Clinical Hospital Centre Split and 

Medical School University of Split, Split, Croatia 

Familial hemophagocytic lymphohistiocytosis (FLH) is an autosomal recessively inherited 

multisystem disease. This defect in cellular cytotoxicity is a life threatening condition 

characterized by fever, rash, splenomegaly, cytopenias and neurologic manifestations. 

PRF1, UNC13D and STX11 gene defects underlie in about 40-50% of primary cases. 

Chemoimmunotherapy followed by hematopoietic stem cell transplantation improved 

disease outcome. We report the case of a 6-week-old boy who presented with a fever, 

diffuse rash, disseminated intravascular coagulation, hypofibrinogenemia, hypertrigliceridemia, 

hepatosplenomegaly, leukocytosis with 90% of lymphocytes, granulocytopenia, 

anemia, trombocytopenia, hyperferritinemia and pathological findings in cerebrospinal 

fluid. The patient had decreased frequency of NK cells and low NK cell activity 

in peripheral blood. Bone marrow aspiration analysis showed degenerative changes of 

histocyte cells, with preserved cytophages (lymphophages and erythrophages) consistent 

with hematophagocytic syndrome. Given that the molecular diagnosis of the known 

mutations in genes PRF1 and UNC13D showed a mutation in UNC13D, the diagnosis of 

familial hemophagocytic lymphohistiocytosis subtype 3 was established. HLH-2004 chemotherapy 

protocol was performed and partial remission with residual central nervous 

system disease was achieved. Hematopoietic stem cell transplantation was successfully 

performed with an unrelated HLA-identical donor. Familiar HLH is generaly a progressive 

and fatal disease. Early diagnosis with molecular genetic analysis and chemoimmunotherapy 

followed by hematopoietic stem-cell transplantation is the best approach. 

gordanajakovljevic@yahoo.com


MYELOID SARCOMA INVOLVING THE BREAST 

Jelić Puškarić B1 , Ostojić-Kolonić S2 , Planinc-Peraica A2 , Obad-Kovačević D3 , 

Kardum-Skelin I1 , Jakšić B2 1Merkur University Hospital, Department of Medicine, Laboratory for Cytology and Hematology, 



3Merkur University Hospital, Department of Diagnostic and Interventional Radiology, 


Myeloid sarcoma is a tumor mass with extramedulary growth pattern, composed of myeloblasts 

or immature myeloid cells. The development of myeloid sarcoma may precede 

or concur with acute or chronic myeloid leukemia or other myeloproliferative diseases 

or myelodysplastic syndromes. Isolated myeloid sarcoma of the breast is very rare. A 

case is presented of a 25-year-old, previously healthy woman that presented to our department 

for a palpable node, 5x2 cm in size, in the upper medial quadrant of her left 

breast. Fine needle aspiration cytology (FNAC) FNAC produced a sample consisting of 

medium sized blasts of dispersed, gentle chromatin and basophile cytoplasm structure 

showing negative reaction to PAS, nonspecific esterase and myeloperoxidase; however, 

immunocytochemistry yielded positive reaction to myeloperoxidase and negative reaction 

to lymphocytic markers CD20, CD3 and CD10. Additional work-up revealed anemia 

(E 4.1x10/L), thrombocytopenia (53x109/L) and leukocytosis (10x109/L), along with atypical 

blasts detected in peripheral blood smear (76%). Bone marrow FNAC yielded a hypercellular 

sample of bone marrow with 97% of atypical blasts of the same cytochemical and 

immunocytochemical characteristics as the breast FNAC sample. On flow cytometry, 

the phenotype of the breast and bone marrow samples showed a very high percentage 

expression of the immature myeloid cell markers CD34, CD33 and HLA DR. Cytogenetic 

analysis of the breast and bone marrow samples indicated numerous alterations (81,XX,- 

X,-X,-7,-8,-8,-9,add(17p)x2,-18,-18[15]/46,xx[3]). Based on the morphology, cytochemical 

characteristics and immature cell immunophenotype, it was considered a case of acute 

myeloid leukemia without maturation, AML-M1. In spite of intensive chemotherapy, the 

patient died within a year of diagnosis. In cases of isolated breast myeloid sarcoma, the 

diagnosis can be missed if the possibility of myeloid sarcoma is not remembered on differential 

diagnosis of a breast neoplasm. Immunohistochemical studies are extremely 

helpful to recognize isolated myeloid sarcoma. 

biljana.jelic.puskaric@zg.t-com.hr 

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124 


RHABDOMYOSARCOMA WITH BONE MARROW INFILTRATION MIMICKING 

HEMATOLOGIC NEOPLASIA. CASE REPORT 

Jelić-Puškarić B1 , Rajković-Molek K2 , Raić Lj3 , Batinić D4 , Konja J3 , Kardum-Skelin I1 1 Merkur University Hospital, Department of Medicine, Zagreb; 

2 University Hospital Center Rijeka, Department of Medicine, Rijeka; 

3 University Hospital Center Zagreb, Department of Pediatrics, Zagreb; 

4 University Hospital Center Zagreb, Department of Laboratory Diagnosis, Zagreb, Croatia 

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children younger 

than 15 years. According to the World Health Organization, there are embryonal, alveolar 

and pleomorphic types of RMS. Most RMS patients present with a tumor mass 

in the head and neck region, urogenital tract or lower extremities. Unusual clinical 

presentation of the disease with massive bone marrow infiltration at the disease onset 

and mimicking hematologic neoplasm is rarely seen. A case is presented of a 14-yearold, 

previously healthy girl hospitalized for outpatiently detected leukocyte elevation (L 

24.8x109/L). For two weeks before, she had complained of fatigue, myalgia and frequent 

bruising. On admission, clinical examination revealed numerous petechiae and hematomas 

on the skin, enlarged lymph node inguinally on he left, and palpable spleen 2 cm. 

Laboratory findings showed leukocytosis (L 28.5x109/L), anemia (E 3.02x1012/L, Hb 85 

g/L) and thrombocytopenia (Plt 15x109/L). Bone marrow biopsy produced a hypercellular 

bone marrow sample with suppression of all three hemocytopoiesis lines and bone 

marrow infiltration with numeorous immature tumor cells that were cytochemically and 

immunocytochemically positive for PAS, vimentin and desmin, and negative for LCA, 

CD20, CD19, CD3, CD10, NSE, Ber EP 4, OIL RED and ANAE. Considering the morphological, 

cytochemical and phenotypic characteristics, the cytologists believed it was a case 

of bone marrow infiltration with RMS cells. Abdominal computed tomography revealed 

a primary tumor occupying the entire retropeoritoneal space. Tumor biopsy confirmed it 

to be alveolar RMS subtype. In conclusion, in case of bone marrow infiltration with primitive, 

immature cells, RMS should be taken in consideration on differential diagnosis. 

Adjuvant technologies (e.g., cytochemistry, immunocytochemistry, cytogenetic analysis, 

flow cytometry, and molecular analysis) can be very helpful in this diagnostic work-up, 

and may even lead to definitive diagnosis in some cases. 

biljana.jelic.puskaric@zg.t-com.hr


IMPACT OF STATIN, ANGIOTENSIN CONVERTING ENZYME INHIBITOR, 

ANGIOTENSIN II RECEPTOR BLOCKER AND DIHDROPYRIDINE TREATMENT 

ON PERITONEAL DIALYSATE COMPOSITION 

Jurić K1 , Cavrić G2 , Naumovski-Mihalić S2 , Bartolek D3 , Nassabain K4 , Novak NP5 1University Hospital Dubrava, Department of Internal Medicine, Zagreb, Croatia 

2University Hospital Merkur, Department of Internal Medicine, Zagreb, Croatia 

3University Hospital Merkur, Department of Anaesthesiology, Reanimation and 

Intensive Care, Zagreb, Croatia 

4 General Practice, Zagreb, Croatia 

5University Hospital Dubrava, Department of Clinical Cytology and Cytometry, Zagreb, 

Croatia 

Peritoneal dyalisis is increasingly used in the treatment of end-stage renal failure. Macrophage 

domination in peritoneal dialysate when there are no signs of acute peritonitis 

can reflect increased macrophage count in peritoneum, commonly found in patients 

on peritoneal dialysis. This indicates that the peritoneum of these patients is a chronically 

inflamed organ. Numerous studies suggest the pleiotropic properties of statins, 

agniotensin converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB) 

and dihydropyridines. The objective of the study was to investigate the effect of these 

medicines on the cellular composition of the peritoneal dialysate, regarding their assumed 

antiinflammatory properties. In this retrospective study we analyzed 21 peritoneal 

dialysate samples in total of 12 patients. In the samples of the patients on statin 

therapy significantly higher percentage of monocytes were found in peritoneal dialysate 

(p=0.005). Likewise, a higher percentage of lymphocytes and a lower percentage of macrophages 

were found, although not yielding statistical significance (p = 0.143 for lymphocytes 

and p = 0.063 for macrophages). In the samples of patients receiving ACEi or ARB 

treatment significantly lower lymphocyte count was found (p = 0.001) and a lower percentage 

of monocytes, with a higher percentage of macrophages, but with no statistical 

significance. In the samples of patients on dihydropyridine therapy significantly higher 

percentage of lymphocytes was found (p = 0.004). At the same time a higher percentage 

of monocytes and a lower percentage of macrophages were observed, that was not 

significant (p = 0.077 for monocytes and p = 0.158 for macrophages). As a result of treatment 

with these medicines certain changes in the cellular composition of the peritoneal 

dialysate were observed but further larger scale studies would be warranted. 

kjuric@kbd.hr 

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126 


MISLEADING PRESENTATIONS OF MALIGNANT BREAST DISEASES - ROLE OF 

CLINICAL CYTOLOGY 

Kaić G1 , Štoos-Veić T1 , Trutin Ostović K1 , Vojnović J2 , Vidović LJ2 , Lambaša S3 , Hariš V4 , 

Ajduković R4 , Stanec S5 , Budi S5 1Dubrava University Hospital, Department of Clinical Cytology and Cytometry, Zagreb, 

Croatia 

2 Dubrava University Hospital, Department of Radiology, Zagreb, Croatia 

3 Dubrava University Hospital, Department of Pathology, Zagreb, Croatia 

4 Dubrava University Hospital, Department of Hematology, Zagreb, Croatia 

5Dubrava University Hospital, Department of Plastic, Reconstructive and Aesthetic 

Surgery, Zagreb, Croatia 

We described two examples with misleading presentations to draw attention to the role 

of clinical cytology as a part of multidisciplinary approach to breast lesions. In the first 

case - Paget’s disease of the nipple, there was no obvious clinical and radiological evidence 

of breast cancer, while the second case – primary non-Hodgkin lymphoma of the 

breast imitated advanced breast carcinoma. The question is whether accurate and fast 

diagnoses can be made without cytological examinations. It must be kept in mind that 

first-hand clinical information and contact with the patient is necessary in rendering 

accurate cytological diagnoses. 

gordana.kaic@zg.t-com.hr


FINE NEEDLE ASPIRATION CYTOLOGY OF BREAST ANGIOSARCOMA - CASE REPORT 

Kardum-Skelin I1 , Jelić-Puškarić B1 , Milas M1 , Vidić-Paulišić I2 , Jakić-Razumović J3 , 

Šeparović V4 1Merkur University Hospital, Zagreb, Department of Medicine, Laboratory for Cytology 

ang Hematology, Zagreb,Croatia 

2 County Hospital Čakovec, Čakovec, Croatia 

3 Clinical Hospital Center Zagreb, Department of Pathology, Zagreb, Croatia 

4 School of Medicine, Department of Pathology, Zagreb, Croatia 

Angiosarcoma is a rare disease of the breast with the reported incidence of only 0.04% of 

all breast malignancies. The etiology of angiosarcoma remains unknown. It occurs postmastectomy, 

in association with chronic lymphedema or after radiotherapy. We present 

a patient with angiosarcoma that developed 12 years after the diagnosis of breast carcinoma 

and 8 years after operative procedure for disease recurrence and radiotherapy. 

A small angiomatous lesion of a few mm in size, cytologically suspect of vascular tumor 

(hemangioma or hemangiopericytoma), histopathologically verified to be atypical 

vascular lesion, was detected two years before breast enlargement and cytologic and 

histologic diagnosis of angiosarcoma. The patient died 15 months after the diagnosis of 

angiosarcoma, after two tumor recurrences and intrathoracic cavity invasion. 

ika.kardum-skelin@zg.t-com.hr 

127 



VULVAR PAGET’S DISEASE - CASE REPORT 

Katalenić Simon S, Krivak Bolanča I, Šentija K, Kukura V* Škrtic A** 

Laboratory for Cytology and Clinical Genetics 

*Department of Gynecology and Obstetrics 

**Department of Pathology and Cytology 

“Merkur“ University Hospital, Zagreb, Croatia 

128 


Vulvar Morbus Paget’s (MP) represents a rare intraepithelial adenocarcinoma. It appears 

in less than 5% of all vulvar neoplasia usually in postmenopausal women. Histological 

it is analogous to Paget’s disease of the breast. The most common clinical symptom is 

pruritus.The lesions appear as an erythematous or eczematous lesion with islands of 

hyperkeratosis. Occasionally, single anaplastic Paget’s cells can be found on the vulvar 

smears which make cytological diagnosis of the disease possible. However, the disease 

can be diagnosed only by biopsy. MP is classified into three distinct type based upon the 

origin of the neoplastic cell: type I - primary vulvar cutaneus Paget disease; type II - MP 

as a manifestation of an associated adjacent primary anal or rectal adenocarcinoma and 

type III - pagetoid urothelial intraepithelial neoplasia. To distinguish these subtypes the 

panel of immunohistochemistry markers must be done. We present a case of 49-year 

old woman with vulvar symptoms of pruritus, who had liver and kidney transplatation a 

two years ago. During the standard gynaecological examination the vulvar smear was 

taken for cytological evaluation. The smear was scanty, overload with squamae, with two 

kinds of cells: dysplastic squamous cells from lower layer of the epithelium and the single, 

anaplastic cells with enlarged nuclei, visible nucleoli and pale indistinct cytoplasm. 

According to that cytological diagnosis was vulvar intraepithelial lesions III (VIN III) with 

differential diagnosis of vulvar Paget disease. The pathological verification support the 

diagnosis of MP and an immunohistochemistry panel confirm type III of Paget disease 

so a evaluation of bladder was suggested. 

suzana.simon@kb-merkur.hr


SIMULTANEOUS OCCURRENCE OF CHRONIC LYMPHOCYTIC AND CHRONIC 

MYELOID LEUKEMIA 

Kojić Katović S1 , Vasilj A1 , Maričević I1 , Čaržavec D2 , Ćurić Jurić S1 1Department of Cytology, University Clinic of Internal Medicine, Sestre Milosrdnice 


2Department of Hematology, University Clinic of Internal Medicine, Sestre Milosrdnice 


The coexistence of chronic lymphocytic (CLL) and chronic myeloid leukemia (CML) in the 

same patient has only been reported occasionally. Most of these cases represent the 

patients who developed CML during the cource of CLL. Reviewing the literature, only a 

few cases of simultaneous occurrence of CLL and CML was found. Here we represent a 

preveously fit 50-year old man in whom the diagnosis of CLL and CML was established 

by FNAB of the bone marrow. The diagnosis was then confirmed by histopathology, immunophenotypization 

of the peripheral blood and by cytogenetic study of the bone marrow. 

Four years after the diagnosis the patient is well, with leucocytosis of 40x109 , on the 

count of lymphocytes (93%). 

skojic@kbsm.hr 

129 



URINE CYTOLOGY AS A FIRST AVAILABLE TOOL FOR DETECTION OF BK 

ASSOCIATED NEPHROPATHY-CASE REPORT 

Kovačević Vojtušek I1 , Knotek M1 , Ljubanović D2 , Kardum Skelin I1 , 

Sabljar Matovinović M1 , Vidas Ž1 1 University Hospital Merkur, Zagreb, Croatia, 

2 University Hospital Dubrava, Zagreb, Croatia 

130 


Polyomavirus BK-associated nephropathy (PVAN), although first recognised in the late 

1970-es, continues to represent a challenge in kidney transplantation, mainly because 

the optimal treatment approach has not been determined yet. The fact that about 10-30% 

of patients have simultaneously some stage of acute rejection, complicate the treatment 

even more. Herein we present a case of PVAN one year posttransplant, in the patient 

with combined liver and kidney transplantation, complicated by episode of acute T-cell 

mediated rejection. Identification of so-called decoy cells in the urine sediment of the 

patient with acute deterioration of graft function (eGFR from 71,5 to 56 ml/min) raised 

suspicion of PVAN, and diagnosis has been confirmed by histological finding of viral 

inclusions in renal tubular cells and immunohistochemical staining for poliomaviruses. 

The patient has been treated with leflunomide, intravenous immunoglobulin and reduction 

of overall immunosupression therapy. After short period (1,5 month) of stable 

renal function,further deterioration of graft function (eGRF 46,6ml/min) raised suspicion 

of acute rejection, which had been confirmed by patohistology. He received 500 mg of 

metilprednisolon intravenously and mycophenolatemofetil had been reintroduced, which 

resulted in slow partial recovery of the graft function, but never to the baseline values. 

For the past two years his renal graft function has been stable, maintaining lower levels 

of immunosupressive therapy. Conclusion: Prospective, multicentric studies are needed 

to assess different treatment approaches. Early diagnosis with close monitoring of renal 

function seems to represent the most efficacious tool in prevention of graft loss, but 

longer follow-up is necessary to determine the impact of immunosupression reduction 

on the long term graft outcomes. 

ikovacevicvojtusek@gmail.com


GRANULAR CELL TUMOR 

Lončar B1 , Marjanović K2 , Pauzar B1 , Staklenac B2 1Department of Clinical Cytology, University Hospital Osijek, Osijek, Croatia 

2Department of Pathology and Forensic Medicine, University Hospital Osijek, Osijek, Croatia 

Granular cell tumors are relatively uncommon benign lesions occurring in almost any 

part of the body. We report the cytological diagnosis of granular cell tumor in 25-year-old 

male patient who presented with an inguinal mass clinically suspected to be a lymphadenopathy. 

Fine needle aspiration revealed polygonal cells with abundant, granular cytoplasm 

and eccentrically located vesicular nuclei and inconspicuous nucleoli. The histopathological 

examination of the surgical excision confirmed the diagnosis. If resection 

is complete, local surgical excision is curative for benign granular cell tumors. Granular 

cell tumor has a characteristic cytological appearance, and fine-needle aspiration cytology 

(FNAC) has been suggested to be diagnostic modality of choice. 

loncar.branka@kbo.hr 

KLINEFELTER SYNDROME AND ACUTE BASOPHILIC LEUKAEMIA - CASE REPORT 

Ljubić N1 , Lang N2 , Kardum Skelin I3 , Lasan R4 , Dominis M5 , Perković L1 , 

Županić-Krmek D2 , Grgurević-Batinica A1 1Department of Pathology and Cytology, General Hospital “Sveti Duh”, Zagreb, Croatia 

2Department of Internal Medicine, General Hospital “Sveti Duh”, Zagreb, Croatia 

3Division of Cytology, University Hospital “Merkur”, Zagreb, Croatia 

4Department of Cytogenetic, Zagreb University Hospital Center, Zagreb, Croatia 

5Department of Pathology and Cytology, University Hospital “Merkur”, Zagreb, Croatia 

Patients with 47, XXY karyotype (Klinefelter syndrome) appear to have increased risk of 

developing cancer, especially male breast cancer, germ cell tumours and non Hodgkin 

lymphomas, but rarely acute myeloid leukaemia. We report a patient with acute basophilic 

leukaemia with 47, XXY karyotype in both the tumour and constitutional cells. 

Acute basophilic leukaemia is very rare disease comprising less than 1% of all acute 

myieloid leukaemias. Morphological characteristic of leukaemic blast cells is moderately 

basophilic cytoplasm containing a variable number of coarse basophilic granules. 

The most characteristic cytochemical reaction is metachromatic positivity with toluidine 

blue. Blast are myeloperoxidase negative. Also leukemic blasts express myeloid and 

monocyte markers. There is no consistent chromosomal abnormality identified in this 

leukaemia. This is the first reported case of acute basophilic leukaemia in patient with 

Klinefelter syndrome. In this article the medical history of the patient is given and the 

possible connection between Klinefeter syndrome and acute myeloid leukaemia is discussed. 

nives.ljubic@zg.htnet.hr 

131 



SEPTIC ARTHRITIS DUE TO STREPTOCOCCUS SANGUIS 

Mandac I, Prkačin I, Sabljar Matovinović M 

Clinical Hospital Merkur, Zagreb, Croatia 

132 


Septic arthritis may represent a direct invasion of joint space by various microorganisms, 

including bacteria, viruses and fungi. Although any infectious agent may cause 

bacterial arthritis, bacterial pathogens are the most significant because of their rapidly 

destructive nature. 

We present a case of septic arthritis in a 56-year old male patient due to Streptococcus 

viridans which is member of the viridans group streptococci. Patient was admitted 

to Our Hospital presented as fever of unknown origin, losing more than 30 kg of body 

weight during couple of months, and anemia of chronic disease as paraneoplastic process. 

He had long history of arterial hypertension and cerebrovascular insult. There 

was swelling and pain of the right sternoclavicular joint and precordial systolic murmur 

in physical status. A large diagnostic panel has been made, CT of right sternoclavicular 

joint showed widening of periarticular soft tissue and loss of clavicular corticalis. 

Cytologic analysis of synovial fluid showed more than 90% of polymorphonuclear leukocytes. 

There were no crystals on microscopic examination and Gram stain of fluid 

was negative.Blood cultures were positive for S. sanguis and there was a consideration 

about possible periodontal disease. Stomatologic examination verified periapical ostitis 

and extraction of potential cause of infection has been done. Therapy with benzilpenicilline 

was followed by the gradual improvement of clinical and laboratory parameters. 

Although viridans group streptococci and S. sanguis in particular are rare causes of 

septic arthritis in native joints, they should be considered in the differential diagnosis of 

periodontal disease. 

imandac@yahoo.com


MYELOID/MEGAKARYOCYTIC BLAST PHASES AS A PRESENTING MANIFESTATION 

OF CHRONIC MYELOID LEUKEMIA: CASE REPORT 

Milas R1 , Kardum-Skelin I2 , Sustercic D2 , Abalic M1 , Lebinec M1 , Predragovic I1 1 General hospital Virovitica, Virovitica, Croatia 

2 Clinical hospital Merkur, Zagreb, Croatia 

Chronic myeloid leukemia is a myeloproliferative disease that originate in an abnormal 

pluripotent bone marrow stem cell and is consistently associated with the Philadelphia 

chromosome and/or BCR/ABL fusion gene. The disease is bi- or triphasic: an initial indolent 

chronic phase is followed by one or both of the agressive transformed phase, accelerated 

and blast phase (crisis). The majority of patients are diagnosed in the chronic 

phase. The blast phase resembles acute leukemia. Blast crisis as a presentig manifestation 

of CML is rare. Here we report a 23-year-old man with no prior hematologic 

disease, who presented with fever, gluteal pain, hepatosplenomegaly, unspecific skeletal 

lesions. White blood count was 121,6 x 109. Bone marrow aspiration of breastbone 

revealed the chronic phase of CML. Bone marrow aspiration of the pelvic bone (crista 

posterior) after 6 days revealed the accelerated phase of CML with 10 % atypical blasts. 

Bone marrow aspiration (crista posterior) after 8 days indicated blastic transformation 

of CML with 61% poorly differentiated blasts. Blasts expressed ANAE 75%, partly CD61 

33% and MPO 21%. Using RT-PCR we detected BCR/ABL fusion gene and the abnormal 

fusion transcript, p210.The karyotyype was: 46, xy, t(9;22) [6]/36,idem,-3,-4, del(5q),-7, 

del(8p), -13,-15,-16,-17,-20,-22(cp19). Here we reported the blast crisis as a presenting 

manifestation of CML with megakaryocytic and myeloid differentation. 

rmilas@net.hr 

133 



134 


INTERNATIONAL EXTERNAL QUALITY ASSESSMENT SCHEME FOR HAEMATOLOGY- 

23 YEARS EXPERIENCE IN INSTITUTE OF CLINICAL CHEMISTRY UNIVERSITY 

HOSPITAL “MERKUR” 

Nazor A, Flegar-Meštrić Z 

Institute of Clinical Chemistry University Hospital “Merkur” Zagreb, Croatia 

Introduction: External Quality Control is an obligate part of requirements for quality 

menagement. From 1985 Institute of Clinical Chemistry University Hospital “Merkur”, 

accredit by ISO 15189:2008 is involved in the International External Quality Assessment 

Scheme for Haematology (IEQAS - H) organized by World Health Organization (WHO). 

In year 1987, the institute received a certificate with obligation of active participation in 

conducting external quality control on regional level, which was fulfilled. 

Aim: The aim of external quality assessment is harmonysation of the results in laboratory 

haematology, by continuous education based on feedback of the results from each 

stage of the control. 

Matherial and methods: Through 6 controls a year, 12 samples for haemoglobin, leucocytes 

and thrombocytes, on haematological counter in total (special preparations); 

8 samples for leucogram, 8 samples for parasites (preparations coloured according to 

Pappenheim) and 8 samples for reticulocytes (preparations coloured with brilliant cresyl 

blue). 

Results: The results for haemoglobin, leucocytes, thrombocytes and reticulocytes are 

valued according to the deviation index DI. (DI >3.0 is unacceptable) 

The results for the differential blood count – leucogram are compared with declared 

intervals for each type of leucocytes, and found morphological changes on blood cells 

descriptive, up to 5 most important morphological marks in the smear. 

For reticulocytes the allowed deviation is ± 50%. 

For accurate recognition of blood parasites, it is required to define the type and subtype 

of the parasites. 

Acceptable results during 23 years of control (DI


FINE-NEEDLE ASPIIRATION CYTOLOGY OF APOCRINE HIDRADENOMA 

Novak NP1 , Kaić G1 , Tomasović-Lončarić Č2 , Žic R3 , Škoro M1 , Trutin Ostović K1 1Dubrava University Hospital, Department of Clinical Cytology and Cytometry, Zagreb, Croatia 

2Dubrava University Hospital, Department of Pathology, Zagreb, Croatia 

3Dubrava University Hospital, Department of Plastic, Reconstructive and Aesthetic 


An apocrine hidradenoma is a benign adnexal neoplasm, usually covered by intact skin, 

but may show superficial ulceration and serous discharge. This feature is raising the 

possibility of malignancy as it was in our case of macroscopically suspicious tumor. We 

described cytomorphologic features of cutaneous nodule that might be a lead to the cytologic 

diagnosis of hidradenoma, but primary or secondary malignant tumor has been 

ruled out first. 

dr.nina.novak@gmail.com 

FINE NEEDLE ASPIRATION BIOPSY OF FOLLICULAR THYROID TUMORS 

Pauzar B, Staklenac B, Lončar B 

Department of Clinical Cytology, Clinical Hospital Osijek, Croatia 

US-guided fine needle aspiration cytology is currently the best diagnostic tool for thyroid 

nodules. However, it is not sensitive and specific enough for discriminating between 

benign and malignant follicular tumors. The aim of this research is to make a detailed 

and objective determination of the morphological characteristics of cells in cytological 

smears of aspirated material of pathohistologically verified follicular and Hürthle adenomas 

and carcinoma. The research included 62 patients with cytologically diagnosed 

follicular or Hürthle cell tumors, and 15 patients with hyperplastic nodules. Echographic 

findings are divided into three groups: isoechogenic, hypoechogenic and hyperechogenic 

nodules. The nodules are classified by size according to the WHO pT classification. 

The semiquantitative analysis determined the frequency of particular morphological 

elements in the cytological smear. We analyzed the cellularity of the smear, cohesion 

between follicular cells, acinar formations, bare nuclei, characteristics of the nucleus 

and the cytoplasm, and the presence of colloid. The statistical analysis of cytological 

parameters has indicated that none of the cytological parameters alone is discriminating 

enough between non-tumor and tumor changes, or benign and malignant follicular 

thyroid nodules. The analysis of age, sex, nodule size and ultrasound findings has not 

shown the correlation between any of these parameters with the malignant or benign 

follicular tumors. The cytological analysis of the smears for patients with follicular tumors, 

in combination with clinical data and other diagnostic methods, contributes to 

more precise diagnostics, but is not sufficient for the discrimination between benign and 

malignant follicular tumors. 

pauzar.biljana@kbo.hr 

135 



136 


SERUM IMMUNOGLOBULINS IN NON-HODGKIN’S LYMPHOMA PATIENTS 

Planinc-Peraica A1 , Ostojić Kolonić S1 , Radić-Krišto D1 , Dominis M2 , Jaksic B1 1 Department of Medicine, University Hospital “Merkur”, Zagreb; 

2 Department of Clinical Pathology, University Hospital “Merkur”, Zagreb 

As tumours of immune system non-Hodgkin lymphoma (NHL) causes very often the alteration 

of immune function because one function of the immune system is the production 

and secretion of immunoglobulin molecules. Immunoglobulin production depends 

on normal B- and T-cell interactions and may be estimated by measuring serum immunoglobulin 

levels. The papers with laboratory findings in patients with NHL are rather 

scarce. Although there are some studies dealing with this problem it is hard to compare 

data from these studies because some old classifications of NHL were used. 

The aim of the present study was to measure serum immunoglobulin levels in NHL patients 

in order to find out whether certain histological types could be characterised by 

the particular immmunogloubline profile. 

Serum proteins and immunoglobulin (Ig) findings in 119 non-Hodgkin’s lymphoma (NHL) 

patients were analysed. Out of them 96 (81%) patients had B-NHL, and 23 (19%) T-NHL. 

Indolent type of NHL was more frequent (77 patients, 65%), then aggressive type of NHL 

(42 patients, 35%). Most patients had normal serum protein concentration; the increased 

protein concentration was seen in 17% of patients while decreased concentration was 

noticed in 7% of patients. Hypoalbuminaemia was more frequent (43%) then hyperalbuminaemia 

(1%). In contrast to albumin, low levels of other protein fractions (alpha1-, 

alpha2-, and beta-globulin) were rather rare (0.6%, 4%, and 3% of patients, respectively) 

and high levels were frequent (23%, 37%, and 8%, respectively). Polyclonal hyperimmunoglobulinaemia 

was more frequent finding than hypoimmunoglobulinaemia. In 29% 

patients higher IgG level and in 25% patients higher IgA level were found. IgM hypoimmunoglobulinaemia 

(22%) was more frequent than IgG (11%) and IgA (8%) hypoimmunoglobulinaemia. 

M-spike in serum protein electrophoresis was found in 11 (7%) patients. 

The statistically significant correlation was not found between serum Ig concentration 

and lymphoma malignancy grade as well as between serum Ig concentration and immunologic 

origin of lymphoma. T-NHL patients have more often IgA concentration level 

above or under normal values than B-NHL patients (p


NEONATAL HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS - CASE REPORT 

Roganović J1 , Kvenić B1 , Jonjić N2 , Seili-Bekafigo I3 , Kardum-Skelin I4 1Division of Hematology and Oncology, University Children’S Hospital Rijeka; 

2Department of Pathology, School of Medicine Rijeka; 

3Department of Cytology, Department of Internal Medicine, 

Clinical Hospital Centar Rijeka, Croatia 

4Laboratory for Hematology and Cytology, Clinical Hospital Merkur, Zagreb, Croatia 

Hemophagocytic lymphohystiocytosis (HLH) represents a severe hyperinflammatory 

condition with the cardinal symptoms prolonged fever, hepatosplenomegaly, and cytopenias. 

The most prominent histopathological feature is an accumulation of activated 

T lymphocytes and macrophages predominantly in lymphoid tissues. Although it can occur 

in all age groups, neonatal-onset HLH is very rare. We report on a case of HLH presenting 

with anemia and respiratory distress at birth. Several weeks prior to diagnosis 

the symptoms were attributed to a systemic infection. The child developed typical clinical 

and laboratory findings, and was diagnosed with HLH according to the HLH-2004 guidelines. 

Chemo-immunotherapy was initiated, but after a temporary control of the disease 

he succumbed to rapidly progressive HLH. Post-mortem, extensive hemophagocytosis 

was found in multiple organs. No specific genetic defect was identified. 

HLH is potentially fatal childhood disease. It is important for pediatricians to be able 

to early identify this disorder and commence the therapy before overwhelming disease 

activity develops. 

jelena.roganovic1@ri.t-com.hr 

EOSINOPHILIC MASTITIS: A CASE REPORT OF AN EOSINOPHILIC MASTITIS IN 

A 32-YEAR OLD FEMAL 

Ropar S1 , Gredelj Šimec NJ2 , Tokić T2 1General Hospital Karlovac, Department for cytology, Karlovac, Croatia 

2General Hospital Karlovac, Department of Internal Medicine, Karlovac, Croatia 

Eosinophilic mastitis is a rare entity and mainly connected with significant eosinophilia 

in peripheral blood. We have presented a case of eosinophilic mastitis which appeared 

in a 32-year old female patient after unusually intense exposure to house dust. The disease 

has manifested itself with redness and itching of the skin of both breasts, bilateral 

retromamilar nodes painful to palpation, same as dense secretion from both breasts. 

The cytological analysis of the breast’s secretion, same as the aspirate of a nodule of the 

breast has shown numerous eosinophils, some phagocytes and numerous eosinophilic 

granules. Eosinophilia was also present in the blood. Allergy against house dust was 

proven with cutaneous prick test. A therapy with antihistamines led to total regression 

of symptoms, same as to normalisation of laboratory results which convinced us in addition 

that the case was related to eosinophilic mastitis. 

samija66@gmail.com 

137 



ABDOMINAL NON-EPITHELIAL TUMORS DIAGNOSED BY FINE NEEDLE 

ASPIRATION CYTOLOGY 

Škegro D1 , Obad-Kovačević D1 , Škurla B1 , Mrzljak A1 , Filipec-Kanižaj T1 , 

Vidić-Paulišić I2 , Jelić-Puškarić B1 1 University Hospital Merkur, Zagreb, Croatia 

2 County Hospital Čakovec, Čakovec, Croatia 

138 


Non-epithelial tumor in abdominal cavity is less frequent finding than epithelial tumor 

regardless of site or primary or metastatic origin. Abdominal palpation discovers tumor 

mass occasionally; therefore visualization is possible by using imaging technologies. 

Ultrasound (US) and computed tomography (CT) enables precise localization and tissue 

sampling by fine needle aspiration (FNA) for cytology analysis and additional diagnostic 

technologies. Material and methods: Data of 761 FNA of intraabdominal mass performed 

with CHIBA needle in last 10 years were analyzed. Tumor mass suitable for FNA were 

punctured in liver (335), pancreas (124), spleen (32) kidney (21), adrenal gland (7) and 

retroperitoneal and mesenterial lymph nodes (242). Smears were stained according 

to May-Grünwald-Giemsa and according to cytochemistry and immunocytochemistry 

methods. For differentiation of malignant lymphomas flow-cytometry immunofenotypisation, 

cytogenetic and/or molecular analysis (PCR) were additionally performed. 

Results: Out of total of 761 specimens malignant tumor was diagnosed in 532 (70%). Nonepithelial 

tumor was diagnosed in 154 (20%) - 21 sarcoma, 6 melanoma, 7 embriogenic 

tumors and 120 malignant lymphomas. Subtypes of sarcoma were determined based on 

cytomorphology and immunocytochemistry - 4 gastrointestinal stromal tumor (GIST), 3 

liposarcoma, 2 rhabdomysarcoma, 2 leiomyosarcoma, 2 angiosarcoma, 1 fibrosarcoma 

and 7 samples were without subtype. 

Conclusion: US or CT guided FNA of abdominal tumor mass followed by cytoanalysis 

(cytochemistry and immunocytochemistry methods, flow-cytometry immunofenotypisation, 

cytogenetic and/or molecular analysis) is trustworthy diagnostic procedure for 

distinguishing non-epithelial from epithelial tumor and moreover for subtypisation of 

non-epithelial tumors. 

dinko.skegro@kb-merkur.hr


FINE NEEDLE ASPIRATION CYTOLOGY OF CHONDROID SYRINGOMA 

Škoro M1 , Trutin Ostović K1 , Čikara I2 , Müller D3 , Novak NP1 , Virag M4 1Dubrava University Hospital, Department of Clinical Cytology and Cytometry, Zagreb, 

Croatia 

2Dubrava University Hospital, Department of Diagnostic and Interventional Radiology, 


3 Dubrava University Hospital, Department of Patology, Zagreb, Croatia 

4 Dubrava University Hospital, Department of Maxillofacial Surgery, Zagreb, Croatia 

Aim: The aim of this case report is to show importance of FNA cytology in preoperative 

investigation and differential diagnosis of rare skin lesions. Methods: FNA cytology is a 

safe diagnostic procedure that may be used for diagnostic purposes. We present a 63 

year-old man with painless, subcutaneous nodule on the neck of five years duration. 

Ultrasonography showed a small subcutaneous, inhomogeneous mass with hypervascularisation. 

Radiologist required an ultrasound-guided FNA biopsy. During that procedure 

the lesion started to abundantly bleed. Results: The smears were cellular with 

numerous clusters of small, monomorphic epithelial cells embedded in a PAS positive 

myxoid stroma. The nuclei were round to oval with fine, evenly distributed chromatin 

and cytoplasm was dense, moderate in amount , with well-defined cell borders. The 

combination of epithelial elements and myxoid stroma suggested a diagnosis of chondroid 

syringoma. Conclusion: Chondroid syringoma is rare, benign appendageal tumor. 

Because of its unremarkable clinical presentation it is often overlooked. FNA cytology 

plays important role in the preoperative investigation of skin tumors such as chondroid 

syringoma. It may be useful to determine pathology before histological examination. 

marija.skoro@kbd.hr 

139 



140 


CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL) - TRANSFORMATION TO HODGKIN 

LYMPHOMA OR COMPOSITE TUMOR - CASE REPORT 

Škrtić A1 , Borovečki A1 , Milas M2 , Džebro S1 1 University Hospital „Merkur“, Department of Pathology and Cytology, Zagreb, Croatia 

2University Hospital „Merkur“, Department of Medicine, Laboratory of Cytology and 

Haemathology, Zagreb, Croatia 

Over time, 2-8% of patients with CLL develop DLBCL and


FINE NEEDLE ASPIRATION OF INTRA-ABDOMINAL LYMPH NODES IN THE 

DIAGNOSIS AND FOLLOW UP OF MALIGNANT LYMPHOMA 

Šušterčić D1 , Kardum-Skelin I1 , Jelić-Puškarić B1 , Milas M1 , Odak D2 , Vidjak V2 , 

Minigo H3 , Planinc-Peraica A3 , Radić-Krišto D3 , Ostojić Kolonić S3 , Jakšić B3 1Merkur University Hospital, Department of Medicine, Laboratory for Cytology and Hematology, 


2 Merkur University Hospital, Department of Diagnostic and Interventional Radiology 


Aim of the study. To assess appropriateness of the material obtained by fine-needle biopsy 

of intra-abdominal lymph nodes and the possibility of malignant lymphoma differentiation 

from other malignant tumors by cytomorphology supplemented by smear immunocytochemistry 

and flow cytometry using cytogenetic and molecular analysis (PCR) 

of cell suspension of sample obtained by fine-needle biopsy. Patients and methods. During 

a 10-year period, 242 intra-abdominal lymph nodes were examined. US-guided biopsy 

was done in 226 and CT-guided biopsy in two cases; biopsy was done blindly in only 

one patient. Biopsy was performed by 22-gauge CHIBA needle, length 15-20 cm, depending 

on lesion localization. Samples were analyzed on May-Grünwald-Giemsa stained 

smears by determination of cellular markers by smear immunocytochemistry and flow 

cytometry using cytochemical, cytogenetic and/or molecular analysis (PCR). Results. 

The material was inadequate for cytologic analysis in 8 cases. Malignant lymphoma was 

found in 97 patients (non-Hodgkin’s lymphoma (NHL) in 85 and Hodgkin’s lymphoma 

(HL) in 12 cases). In 81 patients, the diagnosis of malignant lymphoma was made for the 

first time (NHL in 72 and HL in nine patients). In cases of newly detected lymphoma, 

diagnostic work-up was supplemented by smear immunocytochemistry in 66, phenotyping 

on flow cytometer in 48, PCR in 13 and FISH in two cases. Out of 16 patients with previously 

diagnosed malignant lymphoma, NHL was present in 13 and HL in three cases. 

A tumor of another genesis was detected in three patients with previously diagnosed 

lymphoma (carcinoma in two patients with HL and bronchial small cell carcinoma in one 

patient with NHL), acute inflammation was found in 14 and elements of granulomatous 

lesion in three patients. Conclusion. Visualization of intra-abdominal lymph nodes by imaging 

methods enables target sampling for cytologic analysis as a reliable method in the 

diagnosis and follow up of malignant lymphoma, when supplemented by some adjuvant 

sophisticated technologies. 

dunjasustercic@yahoo.com 

141 



142 


INTRAOPERATIVE IMPRINT CYTOLOGICAL ASSESSMENT OF THE SUBAREOLAR 

TISSUE OF THE NIPPLE AREOLA COMPLEX (NAC) 

Tomasović-Lončarić Č1 ,Milanović R2 , Lambaša S1 , Križanac Š1 , Štoos-Veić T3 ,Kaić G3 , 

Trutin Ostović K3 1 University Hospital Dubrava, Department of Pathology, Zagreb, Croatia 

2University Hospital Dubrava, Department of Plastic, Reconstructive and Aesthetic 


3University Hospital Dubrava, Department of Clinical Cytology and Cytometry, Zagreb, 

Croatia 

One of the criteria of selection for skin sparing mastectomy (SSM) with nipple areola 

complex (NAC) preservation is to exclude the neoplastic involvement of subareolar tissue 

(NAC base) in order to minimize the possibility of local recurrence. The most common 

way to assess the possible neoplastic involvement is intraoperative frozen section 

of the NAC base tissue. Because of its limitations, particularly the false negative results 

due to unsampling, we tried to use intraoperative imprint cytology for more thorough 

intraoperative assessment. The aim was to evaluate diagnostic accuracy of this method 

and possibility to substitute frozen section for intraoperative assessment of NAC base 

A prospective clinical study was conducted of 208 consecutive female patients who underwent 

open biopsy because of carcinoma. Intraoperative imprints were taken from the 

excised subareolar tissue which was then routinely processed for definitive histology. 

Intraoperative imprint findings were compared with the definitive histology of the NAC 

base. Our results with 7.5% false negative rate, 9.8% false positive rate, sensitivity of 

50% and specificity of 87.58% argue that imprint cytology might not be sufficient as an 

exclusive method for the intraoperative assessment of the NAC base though it should 

be used routinely in conjuction with frozen section examination. 

ctomasov@kbd.hr


ISOLATION AND CHARACTERIZATION OF LIVER CANCER STEM CELLS FROM A 

HEPATOCELLULAR CARCINOMA BIOPSY 

Tomuleasa C1 , Soritãu O1 , Páll E2 , Susman S3 , Rus D4 , Mihu C4 , Iancu C5 1Ion Chiricuta Oncology Institute, Department of Cancer Immunology, Cluj Napoca, 

Romania 

2 University of Veterinary Medicine, Department of Obstretics and Gynecology, 

Cluj Napoca, Romania 

3Iuliu Hatieganu University of Medicine and Pharmacy, Department of Histology, 


4Iuliu Hatieganu University of Medicine and Pharmacy, Department of Pathology, 


5Iuliu Hatieganu University of Medicine and Pharmacy, Department of Abdominal 

Sugery, Cluj Napoca, Romania 

Cancers are composed of heterogeneous cell populations, including highly proliferative 

immature precursors and differentiated cells. Recently, eloquent studies have provided 

proofs that cancers originate from cancer stem cells, their discovery in both solid and 

non-solid tumors changing our view of carcinogenesis and chemotherapy. Cancer stem 

cells exist in a wide array of tumours and are becoming increasingly important to understand 

the molecular mechanisms that regulate self-renewal and differentiation. We 

have isolated hepatocellular cancer stem cells from a liver biopsy, in an effort to unreveal 

more details about liver carcinogenesis, very important for the early detection and 

understanding of the mechanisms responsable for the highly aggressive clinical picture 

of hepatocellular carcinoma. 

In the current study, liver cancer stem cells were isolated from a surgical specimen 

of hepatocellular carcinoma in a patient whose malignancy had progresses during the 

previous six months. At passage 3, cells had a spindle-shaped morphology, formed 

spheroids and were resitant to chemotherapy agents. Immunocytochemistry staining 

and Reverse Transcriptase - Polymerase Chain Reaction showed that cells were pozitive 

for stem cell specific markers (CD 90, Oct 3/4, Nanog, SOX2, CD 133, CK19). Cells were 

also injected subcutaneously into CD1 mice to observe tumor formation. 

The cells faithfully retained the characteristics of their original tumors and provide a reliable 

resource for investigating the mechanisms of formation and recurrence of human 

liver cancer. Such investigatins may eventually have major impacts on the understanding 

and treatment of human cancer and metastasis. 

ciprian_tomuleasa@yahoo.com 

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144 


DEXAMETHASONE AND CHITOSAN REDUCE HEPATIC FIBROSIS AND INFLAMATIO 

IN WISTAR RATS WITH BILE DUCT LIGATION 

Trip DM1 , Olteanu D1 , Filip A1 , Clichici S1 , Muresan A1 , Sofronie A1 , Nagy A2 , 

Moldovan R2 1Iuliu Hatieganu University of Medicine and Pharmacy, Department of Physiology, 


2University of Veterinary Medicine and Sciences, Department of Pathology, Cluj Napoca, 

Romania 

Introduction:Chronic liver disease is characterized by excessive deposition of extracellular 

matrix in the liver during chronic injury. During early stages of this disease, cells 

begin to synthesize and secrete profibrotic proteins that stimulate matrix production 

and inhibit matrix degradation. Although it is clear that this process is important for the 

development of fibrosis, what remains unknown are the effects of dexamethasone and 

chitosan on cholestasis and subsequent fibrosis, induced by common bile duct ligation. 

Material and Methods:A total of 30 female Wistar rats were used in this study. The control 

group underwent laparotomy and the bile duct was dissected. Experimental groups 

received various daily doses of dexamethasone intramuscular and chitosan orogastric 

for 6 days after biliary duct ligation. The liver and serum was analyzed for reactive oxygen 

species levels and the serum for usual liver function tests after 6 days of treatment. 

Also histopathological examination was performed using a histological scoring system. 

Results:The levels of MDA in the liver were significantly lower in the groups treated with 

dexamethasone compare to the group that underwent only biliary duct ligation (p=0,008) 

the same was seen in the group with chitosan (p=0,027) and chitosan with dexamethasone 

(p=0,014). Biliary duct ligation induced severe cholestasis, confirmed by altered 

liver function, portal and focal inflammation, necrosis and fibrosis. 

Conclusion: Dexamethasone and chitosan reversed all the biochemical parameters used 

to quantify liver pathophysiology and ameliorated histopathological changes previously 

induced by BDL. Findings of the present study suggest that this treatment may favor 

collagenolytic activity, an assumption supported by amelioration of necroinflammatory 

liver injury and fibrogenesis. 

dora.trip@yahoo.com


FINE NEEDLE ASPIRATION CYTOLOGY OF METASTATIC MERKEL CELL CARCINOMA 

Trutin Ostović K1 , Hariš V2 , Miletić Z1 , Lambaša S3 , Lajtman Z4 , Štoos-Veić T1 1Dubrava University Hospital, Department of clinical cytology and cytometry, Zagreb, 

Croatia 

2 Dubrava University Hospital, Department of hematology, Zagreb, Croatia 

3Dubrava University Hospital, Department of clinical and experimental pathology, Zagreb, 

Croatia 

4Merkur University Hospital, Department of otorhinolaryngology and cervicofacial surgery, 


Aim: To present a case of metastatic Merkel cell carcinoma (MCC) diagnosed by fine 

needle aspiration cytology (FNAC), flow cytometric DNA analysis, pathohistology and 

electron microscopy. Case report: FNAC was performed of the nodule on left arm and 

neck 21 months since the primary MCC was diagnosed in 76-year-old female patient. 

We used a 23-gauge needle and a 20-ml syringe. One part of aspirate was used for 

cytological smears stained by Papenheim and Papanicolaou and the rest was used for 

DNA analysis by flow cytometry. The cytological features included increased cellularity, 

discohesive groups of malignant cells with large oval to irregular nuclei with moulding 

effect, inconspicuous micronucleoli and scanty cytoplasm. The tumour contained diploid 

peak with DNA index of 1.1and elevated S-phase fraction (21%). The cytological diagnosis 

of metastatic MCC was confirmed by histological one and by electron microscopy presented 

the pathognomonic features for MCC: dense-core neurosecretory granules with 

diameter of 100-250 nm surrounded by whorls of intermediate filaments. Conclusion: 

The MCC provides an enormous challenge for the morphologist because of a wide range 

of differential diagnosis. This case appears to be the first report of DNA analysis of a 

MCC from the aspirate. 

ktrutin@kbd.hr 

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146 


HODGKIN’S LYMPHOMA VARIANT OF RICHTER’S SYNDROME 

Vasilj A1 , Kojić-Katović S1 , Maričević I1 , Žokvić E1 , Bobuš Kelčec I2 , Tomas D3,4 , 

Ćurić-Jurić S1 1Department of Cytology, University Clinic of Internal Medicine, Sestre Milosrdnice University 

Hospital, Zagreb, Croatia. 

2 Department of Cytology, University Clinic for Tumors, Zagreb, Croatia. 

3University Department of Pathology, Sestre Milosrdnice University Hospital, Zagreb, 

Croatia. 

4University of Zagreb, School of Medicine, Zagreb, Croatia 

Chronic lymphocytic leukemia/small lymphocitic lymphoma (CLL/SLL) is low-grade malignant 

lymphoprolipheration, that has tendency to convert to a higher-grade neoplasam 

over time. More common is the development of a diffuse large cell lymphoma or 

transformation into prolymphocytic cell population.. In rare cases, 0,1-0,5% of patients 

develop multiple myeloma or Hodgkin’s lymphoma. We present 65-year old female with 

Hodgkin’s variant of Richter’s syndrome. On the basis of clinical simptoms, cytological, 

hystological and immunohistological finding in April 2008 CLL/SLL were diagnosed. 

The patient was treated with 8 courses of R-CHOP. After 10 month, FNA of the one of 

the enlarged lymph node on the neck was performed . The diagnosis was Hodgkin’s 

lymphoma. Immuno-hystological studies of the lymph node was consistent with type I 

Hodgkin’s type of Richter’s syndrome. Patient was treated with 3 courses of ABVD and 

radiotherapy. 

avasilj@kbsm.hr


THE VALUE OF URINARY DECOY CELL FINDING IN PATIENTS WITH KIDNEY 

TRANSPLANTATION: A SINGLE CENTER EXPERIENCE 

Vidas Ž1 , Mišić M2 , Pačić A4 , Jurenec F1 , Knotek M3 , Kardum-Skelin I5 1 Division of Urology, Clinical Hospital “Merkur”, Zagreb, Croatia 

2 Department of Cytology, General Hospital “Dr. J. Benčević”, Slavonski Brod, Croatia 

3 Department of Medicine, Clinical Hospital “Merkur”, Zagreb, Croatia 

4 Department of Pathology, Clinical Hospital “Dubrava”, Zagreb, Croatia 

5 Laboratory of Cytology and Hematology, Clinical Hospital “Merkur”, Zagreb, Croatia 

Childhood infection with polyomaviruses leads to a life-long latent infection of renal and 

urinary tract epithelia. Replication in the reno-urinary epithelium is associated with viral 

cytopathic changes such as nuclear inclusions and decoy cells (DC). Three species 

cause infection in humans, i.e. BK virus (BKV), JC virus (JCV), and simian virus (SV40). 

During the 2005-2009 period, cytological urine analysis was performed in 154 patients 

(94 male and 60 female) with kidney transplantation (n=19), simultaneous pancreaskidney 

transplantation (SPKT) (n=9) and simultaneous kidney and liver transplantation 

(n=2). Urine samples were analyzed according to the protocol once monthly following 

transplantation. Fresh urine samples were analyzed within 15 min of sampling (not the 

first morning void). Briefly, 0.5 mL urine was centrifuged in a cytocentrifuge at 600 rpm 

for 5 min and slides were stained by the methods of May-Grünwald-Giemsa (MGG) and 

Papanicolaou. The period from transplantation to the first occurrence of decoy cells in 

the urine and the period of decoy cell persistence in the urine were assessed. The presence 

of decoy cells (10 DC) and red blood cells (100 

E) per cytospin smear was semiquantitatively determined, along with analysis of inflammatory 

cells (neutrophilic granulocytes) and fungi. Kidney biopsy was done according to 

the protocol (75% of patients), clinical indication (18% of patients), or immediately upon 

transplantation as so-called zero biopsy (7% of patients). In patients where decoy cells 

were detected, their sensitivity, specificity, and negative and positive predictive value for 

BK nephropathy were calculated. Correlation of the study parameters was estimated by 

use of Kruskal-Wallis test (Statistica 7.1). Decoy cells were found in 30 patients (20 male 

and 10 female), age median 40 (range 16-69) years, at a mean of day 115 (range day 5-747) 

of transplantation, whereas their presence was recorded for a mean of 141 (range 77- 

771) days. Immunohistochemical staining of kidney biopsy sample for polyomavirus (BK 

type) yielded positive reaction in 2/30 (7%) patients. Erythrocyturia was present in 29/30 

patients with decoy cells. Up to 20 red blood cells per cytospin smear were recorded in 

14 patients, more pronounced erythrocyturia (>100 red blood cells per cytospin smear) 

in eight patients, and 20-100 red blood cells per cytospin smear in seven patients. The 

number of decoy cells per cytospin smear generally ranged less than 10 in 25/30 patients, 

whereas more than 10 decoy cells per cytospin smear were only recorded in 5/30 

patients. There was no statistically significant correlation between the finding of neutrophilic 

granulocytes and fungi, and the presence of decoy cells. Immunohistochemistry 

147 



148 


produced positive finding for BKV in one patient with SPKT and simultaneous kidney and 

liver transplantation each, which was statistically significantly more common as compared 

with patients with kidney transplantation alone (P=0.0244). Immunohistochemical 

positivity for BKV was more significant in cases with more than 10 decoy cells detected in 

cytospin smear (P=0.013). In BK nephropathy, the finding of urinary decoy cells showed a 

100% sensitivity, 84% specificity, 100% negative predictive value and 6,6% positive predictive 

value. BKV nephropathy remains a significant posttransplantation complication. 

ravnateljstvo@kb-merkur.hr 

SINCHRONOUS BILATERAL BREAST CARCINOMA WITH TWO DIFFERENT 

MORPHOLOGY SUBTYPES:A CASE REPORT 

Vrabec-Branica B1 , Smojver-Ježek S1 , Juroš Z1 , Neralić-Meniga I2 , Križanac Š3 1Department of Cytology, University Hospital for Lungs Diseases “Jordanovac”, 


2Department of Radiology, University Hospital for Lungs Diseases “Jordanovac”, 


3 Department of Pathology, University Medical School, Zagreb, Croatia 

We report a case of synchronous bilateral breast cancer with ductal and medullary 

carcinoma. A 60-year-old woman presented with lesion in both breasts which were 

mammographicaly found two years ago. Ultrasonography proved two suspected masses 

in breasts. Fine needle cytology was performed and confirmed bilateral carcinoma but 

with different cytological findings. The cytological feature of left breast suggested ductal 

carcinoma and of right breast raised possibility of a medullary carcinoma. Patient 

underwent bilateral quadrectomy with evacuation of axillary lymph nodes. Histological 

examination showed bilateral carcinoma with two different histology: ductal in left and 

medullary carcinoma in right breast. 

bozica.vrabec.branica@zg.t-com.hr


APOPTOSIS OF LEUKEMIC CELLS - A CASE REPORT 

Vrbanus LJ1 , Sučić M1 , Marković-Glamočak M1 , Ries S1 , Gjadrov-Kuveždić K1 , 

Fabijanić I1 , Antulov J1 , Labar B2 1 Zagreb University Clinical Hospital Center and School of Medicine, Clinical Department 

of Pathology and Cytology, Zagreb, Croatia 

2Zagreb University Clinical Hospital Center and School of Medicine, Department of 


Transformation of leukemic cells is linked to delay of maturation, delay in apoptosis and 

altered responsiveness to growth factors. However, in some studies were found that 

FAS (CD95/APO1) that mediates apoptotic signal is more frequently expressed in M4/M5 

leukemic cells, and could be related to poor clinical outcome of acute myeloid leukemia 

(AML) patients. Apoptosis of bone marrow (BM) leukemic cells in our patient with 

AML-M5 could be also related to FAS expression on leukemic cells. The aim of the study 

was to compare cytomorphology and cytochemistry of BM apoptotic leukemic cells to 

preserved peripheral blood (PB) leukemic cells in our patient with AML-M5. Patients 

and methods: In the study is reported a 76 years old men with AML-M5 treated at Zagreb 

University Hospital Center. BM and PB of AL patient were analyzed after Pappenheim 

and cytochemical stainings and classified according FAB and WHO classification. Flow 

cytometry and cytogenetic analyses of BM cells were also done. Results: In BM were 

found numerous apoptotic cells with characteristic nuclear chromatin condensation 

and formation of pyknotic nuclei and only few preserved monoblasts and promoncytes. 

Analysis of PB revealed leukocytosis and 80-90% monocytic cells (46% monoblasts, 29% 

promonocytes and 11% monocytes). In almost all of BM apoptotic leukemic cells and 

PB leukemic cells esterase was strongly positive. Conclusion: Cytomorphology and cytochemistry 

of PB leukemic cells point to proliferation of immature monocytic cells and 

cytomorphology of BM to cell apoptosis. Cytochemistry of BM apoptotic cells confirmed 

monocytic cell lineage and AML-M5b was diagnosed in our patient. 

ljkuzmanovic@yahoo.com 

149 



150

analitiËka citologija 

analytical cytology 

151 



152 

Analitička citologija - Plenarna i pozvana predavanja 

ANALYTICAL CYTOLOGY - FROM BASIC METHODOLOGY TO ROUTINE CLINICAL 

DISCIPLINE 

Batinić D 

Referral Center for Immunodiagnostics of Hematological and Immunological Diseases, 

Clinical Hospital Center, Zagreb, Croatia 

Analytical cytology may be generally defined as the measurement of cells and their constituents 

for biological, diagnostic and therapeutic purposes. Although it incorporates 

elements of different disciplines such as anatomy, biology, cytology, physiology and pathology, 

its backbone is formed by two sophisticated techniques – multiparameter flow 

cytometry and image analysis/digital microspcopy. The major advantage of analytical cytology 

is its quantitative nature which makes it more specific and precise in comparison 

to classical types of cell analysis. It also allows reproducible gathering of data in statistical 

terms enabling a faster and more consistent analysis. The focus of this presentation 

is on reviewing scientific advances that have enabled the widespread use of analytical 

cytology in clinical setting, i.e. for the diagnosis, prognosis and therapeutic purposes. 

drago.batinic@zg.t-com.hr 

QUARTER OF A CENTURY OF THE LABORATORY FOR HUMAN GENETICS, 

DEPARTMENT OF MEDICAL GENETICS, PEDIATRICS CLINIC, 

UNIVERSITY HOSPITAL SPLIT 

Čulić V, Lozić B, Oreško T, Ivko-Banovac D, Botić Lj, Kezić G, Milanović D. 

Laboratory for Human Genetics, Departement for Medical genetics, Pediatrics Clinic, 

Clinical Hospital Center Split, Croatia 

Laboratory founded in 1983. year. According to data from the archives 12th December 

1983rd first karyogram was made from peripheral blood sample. 1987th begin genetic 

counseling, 1989. analysis of bone marrow, and from 10th july of 2007. amnyocentesis 

and spontaneous abortion. Since 1991.yr. laboratory is available to students from the 

Faculty of Medicine, University of Split, professional studies (nursing, radiologists, etc.) 

and other faculties of the University of Split (PMF) for the following subjects: pediatrics, 

biology and pathology. Of. 12th December 1983. to 10th july 2009. there were totaly 

analyzed 8777 samples of peripheral blood (6148), bone marrow (1370), amnyocentesis 

(413) and spontaneous abortion (166). This work will show some interesting cases, and 

collaborating institutions in the country and the world with which they analyzed in all 

kinds of samples in this regional laboratory. 

vculci1@yahoo.com

Analytical Cytology - Plenary and Invited Lectures 

ACCREDITATION OF MEDICAL LABORATORIES IN CROATIA - EXPERIENCES OF THE 

INSTITUTE OF CLINICAL CHEMISTRY CLINICAL HOSPITAL MERKUR, ZAGREB 

Flegar-Meštrić Z1 , Nazor A1 Perkov S1 , Šurina B1 , Kardum-Paro MM1 , Šiftar Z1 , 

Sikirica M1 , Sokolić I1 , Ožvald I1 , Vidas Ž2 1 Institute of Clinical Chemistry, University Hospital Merkur, Zagreb, Croatia 

2 University Hospital Merkur, Zagreb, Croatia 

Since 2003 when the international norm for implementation of quality management in 

medical laboratories (EN ISO 15189, Medical laboratories - Particular requirements for 

quality and competence) was established and accepted, accreditation has become practical, 

generally accepted method of quality management and confirmation of technical 

competence of medical laboratories in the whole world. This norm has been translated 

into Croatian and accepted by the Croatian Institute for Norms as Croatian norm. Accreditation 

is carried out on voluntary basis by the Croatian Accreditation Agency that 

has up to now accredited two clinical medical biochemical laboratories in the Republic 

of Croatia. Advantages of accredited laboratory lie in its documented management system, 

constant improvement and training, reliability of test results, establishing users’ 

trust in laboratory services, test results comparability and interlaboratory (international) 

test results acceptance by adopting the concept of metrological traceability in laboratory 

medicine. 

zlata.mestric@zg.t-com.hr 

153 



MORPHOMETRIC AND CELL KINETIC CHARACTERISTICS IN THE DIAGNOSIS AND 

PROGNOSIS OF NEOPLASMS 

Kardum-Skelin I 


The majority of cytologic and histopathologic diagnoses still rely on the basic light microscopy 

interpretation, based on visual perception and clearly defined diagnostic criteria 

for each particular disease. Yet, different interpretations and variations in reproducibility 

(inter- and intra-morphologist) are possible in various neoplasms as well as in 

inflammatory diseases and other pathologic events. The problem of reproducibility may 

even increase with the inclusion of prognostic criteria such as grade of differentiation, 

mitotic activity, etc. Nowadays, optimal treatment demands from the morphologist more 

than simple distinction between the malignant and the benign. Additional information 

is necessary to identify patients at an increased risk of recurrence or those with rapid 

disease progression, and to detect disease recurrence before its clinical manifestation. 

Furthermore, identification of precancerous lesions in a population at a high risk 

of malignancy may help in planning the approach of surveillance strategy. In the last 

years, efforts have been invested to improve diagnostic accuracy and to obtain new, 

more appropriate and objective information on the process through the introduction of 

sophisticated computer technologies. Malignant cell alteration leads to changes at the 

cell, cytoplasm, nucleus and nuclear structure levels, the latter being most numerous. 

Cell enlargement is most common, resulting in an increased nucleus/cytoplasmic (N/C) 

ratio and morphologic changes characteristic of particular tumor types. Pronounced 

pleomorphism and nuclear multinucleation or multilobulation are important nuclear 

characteristics of malignant growth. Chromatin structure may show hypo- or hyperchromatism 

as a reflection of abnormal DNA amount due to pathologic mitosis and an 

increased number of nuclei in the synthetic phase of preparation for mitosis. Both of 

these parameters, DNA amount and proliferative activity, reflect in abnormal cell function; 

abnormal DNA amount characterizes malignant and premalignant cells, whereas 

considerably increased proliferative activity is associated with neoplasia and biological 

tumor behavior. Within the nucleus, the number and size of nucleoli increase, along with 

changes that occur in the nucleolar substructure, the nucleolar organizer region (NOR). 

Generally, tumor cell nuclear morphology is highly relevant for two reasons. First, the 

substructure may provide diagnostic help in the identification of specific tumor types. 

Second, abnormalities of nuclear morphology play a major role in tumor staging. All 

these alterations can be numerically objectified by computer technologies through analysis 

of the morphometric characteristics of the cell as a whole, the nucleus and nuclear 

structures (AgNOR), and by determination of DNA amount using image DNA cytometry. 

ikardum@hi.t-com.hr 

154 

Analitička citologija - Plenarna i pozvana predavanja


MOLECULAR PATHOGENESIS OF PHILADELPHIA-NEGATIVE CHRONIC MYLEOID 

NEOPLASMS 

Kušec R 

Department of Hematology and Molecular diagnostics and genetics, Dubrava University 

Hospital, and Zagreb School of Medicine, Zagreb, Croatia 

Myeloproliferative disorders or neoplasms (MPNs), as they have recently been renamed 

by the WHO 2008 classification, have been divided into polycythaemia vera (PV), essential 

thrombocythaemia (ET) and primary myelofibrosis (PMF). The discovery of the JAK2 

V617F mutation in nearly all patients with PV and half those with ET and PMF has redefined 

the classification and will most likely influence the management of MPNs in the 

near future. It seems likely, however, that any attempt to reclassify the MPNs on the 

basis of JAK2 mutation status will need to retain the concepts of a disease with predominant 

erythrocytosis, a disease with predominant marrow fibrosis and a disease with 

isolated thrombocytosis, since both therapy and prognosis vary substantially across the 

three entities. Examination of the JAK/STAT signaling pathway and cytokine receptors 

led to the discovery of various gain-of-function mutations in the thrombopoietin receptor 

(MPL). They occur in patients with PMF and ET with a frequency of 1-9%. Both JAK2 

and MPL mutations, as shown in animal models, clearly induce a myeloproliferative 

phenotype in vivo. For JAK2 it was shown that ratio of mutant JAK2-V617F to wild-type 

JAK2 determines the MPD phenotype in transgenic mice. Monoclonal origin of MPNs 

has been a pathogenetic fundamental and extensive studies at cytogenetic and molecular 

level are being conducted in search of invariant aberration of MPN specific (gene) 

defect. This has not been found so far. In cytogenetics lesions frequently seen in other 

myeloid neoplasms were detected: deletions (chr5q,13q,20q), numerical changes (1,8,9) 

and gains of 9p. For the increase in mutated allele frequency of JAK2 V617F a mechanism 

of uniparental disomy (UPD) of the short arm of chromsome 9 (9UPD) was found 

to be the most frequent mechanism. Besides JAK2 and MPL, recently other sporadic 

oncogenic point or other type of mutations (mostly small deletions) have been found in 

different oncogenes (e.g. TET2, CBL, IKZF1). However, all of them in a relatively small 

proportion and different MPN phenotypic subtypes. All these lesions create number of 

genotype classes of progenitors and when cultured progenitor colonies are genotyped 

complex pattern of different clones is found in which also variable acquisition order 

of genetic abberations is evident. Simulatanously occuring two different mutations are 

possible (JAK2 and MPL, or two independent JAK2 mutations) which suggests that MPN 

exhibits a certain form of mutator phenotype resulting in increased mutation frequency. 

Recently an MPN susceptibility haplotype of JAK2 was identified based on the uneven 

distribution of JAK2 V617F mutations between the two most frequent haplotypes. While 

it still remains to be seen wheter and which somatic mutation can make clone more 

suscetible to acquire a JAK2 mutation with subsequent development of MPN, in very 

recent study of MPNs transforming to acute leukemia interesting novel insights into 

the molecular pathogenesis of these event have been made. Acute leukemia following 

JAK2+MPN can be JAK2-mutant and JAK2-wild type. Patterns of second hits, however, 

155 



were similar between JAK2-mutant and wild-type leukemias and included alterations of 

RUNX1, WT1 and TP53. Loss of the JAK2 mutation by mitotic recombination, gene conversion 

or deletion was excluded in all wild-type AMLs. In some patients, mutations in 

TP53, CBL or TET2 were present in JAK2 wild-type leukemic blasts, but absent from the 

JAK2-mutant MPN, demonstrating that in some patients TET2 mutations are present 

in a clone distinct from that harboring a JAK2 mutation. By contrast in a chronic phase 

patient, different clones harboring mutations in JAK2 or MPL represented the progeny of 

a shared TET2-mutant ancestral clone. These data uncover further clonal heterogeneity 

in the MPN. 

rkusec@irb.hr 

CYTOGENETIC RESULTS IN 24 CASES OF MULTIPLE MYELOMA: SHORT REPORT 

Lasan Trčić R1 , Kardum Skelin I2 , Šušterčić D2 , Planinc-Peraica A2 , Ajduković R3 , 

Hariš V3 , Kušec R3 , Begović D1 1Cytogenetic Laboratory, Department of Pediatrics, University Hospital Zagreb, Zagreb, 

Croatia 

2 Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia 

3Clinical Institute of Laboratory Diagnostics, Dubrava University Hospital, Zagreb, 

Croatia 

Great studies of multiple myeloma (MM) strongly suggested that specific chromosomal 

changes are of prognostic significance in patients with MM1. We have performed cytogenetic 

analysis and recently fluorescent in situ hybridization (FISH) on 43 cases of 

MM. Clonal chromosomal changes were present in 24 (56%) cases. Hyperdiploid karyotype 

was found in 12 (50%) cases, hypodiploid in 8 (33%) cases, and 4 (17%) cases 

had a pseudodiploid karyotype. The most common numerical abnormalities were gains 

of whole chromosomes 15, 11, 3 and 6. Whole chromosome losses were also frequent 

involving chromosomes X, 13, 14, and 8. Most cases showed also structural rearrangments 

(n=17, 71%): del(1p), dup(1q), del(5q), del(13q), del(17p) and t(11;14)(q13;q32) (n=4, 

17%). Chromosome -13/13q deletion was found in 42% (n=10) cases; complete loss of 13 

was observed in 67% (n=7) cases, whereas 33% (n=3) had interstitial deletions. In the 

majority of the cases there was a mixture of abnormal and normal metaphases. 

lasan.ruzica@hotmail.com 

156 



FLOW CYTOMETRIC CLONALITY ANALYSIS OF ENDOSCOPIC ULTRASOUND-GUIDED 

FINE-NEEDLE ASPIRATION OF LYMPH NODES 

Miletić Z1 , Gizdić G2 , Štoos-Veić T1 , Kaić G1 , Novak NP1 , Tadić M3 , Jakšić O2 , 

Trutin Ostović K1 1Department of clinical cytology and cytometry, Dubrava University Hospital, Zagreb, 

Croatia 

2Clinic of internal medicine, Department of hematology, Dubrava University Hospital, 


3Clinic of internal medicine, Department of gastroenterology, Dubrava University 


Immunophenotyping by flow cytometry (FC) is an essential tool in the diagnosis of 

non-Hodgkin’s lymphomas (NHLs) in fine-needle aspiration cytology (FNAC) of palpable 

lymph nodes or endoscopic ultrasound-guided (EUS) FNAC of deep-seated lymph 

nodes. Because at least 80% of NHLs are of B-cell type, detection of immunoglobulin 

(Ig) light-chain-restriction (clonality) represents the most commonly used evidence for 

a diagnosis of B-cell lymphoma. In our study we wanted to evaluate accuracy of FC 

clonality compared to morphologic diagnosis of EUS-FNA of deep-seated lymph nodes. 

Direct smears were made and selected slide was stained for rapid-on site evaluation 

procedure and if needed additional samples were sent for FC clonality analysis. Sixteen 

patients with suspicious NHL of deep-seated lymph nodes obtained by EUS-FNA were 

submitted for FC clonality analysis. Six of the patients had supected pancreatic lesions, 

6 had abdominal and 4 had mediastinal lesion. Adequacy of samples with diagnostically 

relevant material were 68,7%. Monoclonality was demonstrated in 7 of 11 cases cytologically 

diagnosed as NHL. Polyclonality was demonstrated in 4 of 11 cases cytologically 

diagnosed as benign reactive lymphadenopathy. Our results show that EUS-FNAC with 

FC is a sensitive and specific tool in the diagnosis of deep-seated B-NHL. Successful 

cytologic diagnosis combined with FC clonality analysis can be performed in majority of 

cases and may eliminate need for open biopsy, especially in relapsed disease. 

zorana.miletic@kbd.hr 

157 



EXTERNAL QUALITY ASSESSMENT IN CLINICAL CELL ANALYSIS BY FLOW 

CYTOMETRY. WHY IS IT SO IMPORTANT? 

Šiftar Z, Kardum Paro MM, Sokolić I, Nazor A, Flegar Meštrić Z 

Institute of Clinical Chemistry, Merkur University Hospital, Zagreb, Croatia 

Participation in external quality assessment is an integral part of laboratory work and 

mandatory when the results have a clinical application, which is one of the requirements 

of standard 15189 for accreditation of medical laboratories. Institute of Clinical Chemistry, 

the first laboratory accredited for clinical cell analysis by flow cytometry in Croatia, 

participated in UKNEQAS for Leukocyte Immunophenotyping in 3 schemes: “Immune 

Monitoring”, “CD34 Stem Cell Enumeration” and “Leukaemia Immunophenotyping“. 

For sample processing on EPICS XL flow cytometer, lyse/no wash preparation technique 

with ammonium chloride (NH4Cl) or ImmunoPrep lysing reagent was employed. 

In “Immune monitoring” programme CD45/sideward light scatter (SSC) proposed gating 

strategy was adopted for lymphocyte subsets, while modified ISHAGE protocol was 

used for CD34+ cell enumeration. Absolute count determination was performed on flow 

cytometer using FlowCount beads solution. In the period from the beginning of 2006 

until the middle of 2009. a total number of 100 stabilized whole blood samples were 

processed. The relative and absolute enumeration results for lymphocyte subsets were 

within tolerable limits, in 97.1 and 97.1% of cases, and 95 and 90% of CD34+ cell enumeration, 

respectively. In immune monitoring CD45/SSC proposed gating strategy is the 

most frequent analysis used (>85% participants) and ISHAGE protocol for CD34+ cell 

determination with continuous rise from 76 to 83%. A number of participants who accept 

beads method for absolute count enumeration on flow cytometer get greater, 69 to 86%, 

while FlowCount was the second of bead-based techniques used (25 and 35%).Sample 

treatment in lyse/no wash technique using NH4Cl lysing solution was dominant procedure 

used by more than 1/3 participants, although its home made solution has replaced 

slowly by commercial reagents. The unacceptable results, 6 of 244, were obtained for 20 

most frequently determined cell antigens in “Leukaemia Immunophenotyping“ samples 

screened for leukaemia/lymphoma. Processing results of all participants showed that 

the deviation from laboratory guidelines and the use of older methods for cell identification, 

quantification of cell counting on haematology analyser, or usage an antibody conjugated 

with fluorochrome lesser fluorescence quantum often lead to an unacceptable 

result, although is noticeable trend to accept new referrals and protocols to reduce the 

inter-laboratory differences. 

zoran.siftar@hdmb.hr 

158 



FUTURE PERSPECTIVES OF PERSONALIZED MEDICINE 

Štambuk S1 , Šundov D2 , Kuret S2 , Beljan R2 , Anđelinović Š2 1 University Center for Forensic Sciences, University of Split, Split, Croatia, 

2Institute of Pathology, Forensic Medicine and Cytology, Split University Hospital, Split, 

Croatia 

Molecular medicine provides information on gene/protein/metabolic pathway-based 

diagnosis of the origin of diseases, their progression and their response to drugs. 

Pharmaco-omics serves in providing prescriptions for specific sub-populations or individuals, 

based upon their molecular make-up, thus ensuring drug effectiveness and 

avoiding lack of response to drugs or their toxicity. Hence, the main rational of personalized 

medicine, involving molecular medicine and molecular pharmacology, is treating 

disease in each patient on the basis of the patient’s unique genome/proteom/metabolom 

in interaction with its unique environmental conditions, implying ‘right drug for the 

right patient at the right dose and time’. Interindividual differences in drug response are 

mostly due to sequence variants in genes that encode drug-metabolizing enzymes, drug 

transporters, or drug targets. However, a wide variety of common illnesses and other 

health conditions, including cancer, also have epigenetic etiology. 

Cancer has a high priority for pharmacogenetic research, owing to its heterogeneous 

character due to multiple mutations acquired over time and continuous evolution of its 

response to environment. By providing a molecular portrait of an individual cancer, the 

clinicians may determine the cancer origin, its potential for metastasis, its specific drug 

responsiveness, and the probability of its recurrence. 

The semples obtained by fine needle aspiration or the surgically resected tissue hold 

the molecular information required for characterization of the patient’s tumor, specific 

therapies to which the tumor would be expected to respond, and even specific risks of 

adverse reactions to given therapies, all predicted by the patient’s molecular make-up. 

sstambuk@unist.hr 

159 



BIOMED-2 PCR DETECTION OF IGH/BCL2 REARRANGEMENT IN FOLLICULAR 

LYMPHOMA USING DNA OBTAINED FROM ARCHIVED CYTOLOGICAL SMEARS: 

AN OPTION FOR MONITORING 

Štoos-Veić T, Livun A, Ajduković R, Pejša V, Jakšić O, Kušec R 

Dubrava University Hospital, Zagreb, Croatia 

Aim. To determine the rate of PCR detection of IgH/BCL2 in DNA samples isolated from 

archival cytological slides of lymph node aspirates, bone marrow and/or peripheral 

blood (PB) obtained from patients with histologicaly confirmed follicular lymphoma using 

primers and protocol proposed by BIOMED-2 consortium. We also compared molecular 

with cytomorphological findings in bone marrow/ peripheral blood and tested 

the clinical value of IgH/BCL2 molecular marker in monitoring minimal residual disease 

(MRD). According to WHO classification follicular lymphoma is a neoplasm composed 

of follicle centre B-cells, which usually has at least a partially follicular pattern. Bone 

marrow (BM) infiltration by lymphoma occurs in 40-70% of cases at the time of diagnosis. 

The characteristic genetic aberration of follicular lymphoma is t(14;18)(q32;q21) 

with transposition of BCL2 oncogene to the regulatory region of immunoglobulin heavy 

chain gene IgH. Methods. DNA was isolated from archival cytological slides obtained by 

fine needle aspiration of lymph nodes from 19 patients and PCR based detection of IgH/ 

BCL2 was performed. Results. Fusion oncogene was detected in 10 of 19 patients (52%). 

For patients with IgH/BCL2 positive lymph nodes molecular test found BM infiltration 

in 5 cases (83%), while cytomorphology detected infiltration in three of eight cases 

(37%) available for comparison. Conclusions. May-Grünwald Giemsa stained cytological 

smears can be used for PCR-based ancillary methods and the rate of detection of IgH/ 

BCL2 rearrangement is similar to results reported for paraffin-embedded tissues. For 

cases with detectable baseline molecular marker, PCR is a highly suitable method for 

detection of bone marrow involvement and monitoring MRD. 

tveic@kbd.hr 

160 



FLOW CYTOMETRY AND DIAGNOSTIC MONITORING OF HIV-INFECTED PATIENTS 

Židovec Lepej S 

University Hospital for Infectious Diseases Zagreb, Croatia 

Aim. Quantification of CD4+ T-cells in the peripheral blood of infected patients is an important 

diagnostic parameter for the classification of patients and monitoring of immune 

reconstitution. Immune hyperactivation also plays an important role in the pathogenesis 

of HIV-disease. The aim of this study was to compare the expression of activation marker 

CD38 on CD8+ T-cells in HIV-infected patients and controls as well as in treated and 

untreated HIV-patients. Methods. Expression of CD38 on CD8+ T-cells was analyzed by 

flow cytometry (Cytomics FC500, Beckman Coulter, USA). Immune status of HIV-patients 

was determined by using Centers for Disease Control and Prevention panel for HIV/AIDS 

recommended in 2003 (5-color staining). Results. Expression of CD38 on CD8+ T-cells in 

untreated HIV-infected patients (n=47, median 34.2%, range 17.9- 43.2%) was significantly 

higher compared to treated patients (n=50, median 17.2%, range 10.4-20.9%, p


ALLELE FREQUENCIES OF FIVE X-LINKED MICROSATELLITES IN THE CROATIAN 

POPULATION AND THEIR APPLICATION IN PRENATAL DIAGNOSIS OF SEX 

CHROMOSOME ANEUPLOIDIES 

Crkvenac Gornik K1 , Štingl K2 , Grubić Z2 , Tonković Đurišević I1 , Huljev Frković S1 , 

Begović D1 1 Division of Genetics and Metabolism, Clinic of Paediatrics 

2 Tissue Typing Centre, University Hospital Centre, Zagreb, Croatia 

Five STR loci located on the X chromosome (DXS9895, GATA172D05, DXS6810, DXS6803 

and HPRTB) were investigated in the group of 183 unrelated healthy individuals from 

Croatia (90 males and 93 females). No deviation from the Hardy-Weinberg equilibrium 

could be detected while allele frequencies showed similar distribution in male and female 

samples. All investigated loci with the exception of DXS6810 locus have demonstrated 

sufficient polymorphism to be considered valuable in prenatal diagnosis of sex 

chromosome aneuploidies. The DXS6810 locus showed low polymorphism with only 6 

observed alleles and polymorphism information content (PIC) value lower than 0.75. The 

analysis of these five STR loci was also performed on the samples from 13 patients with 

X chromosome disorders (Turner Syndrome - 6 cases; Klinefelter Syndrome - 5 cases 

and Triplo X Syndrome - 2 cases). The comparison of results obtained by the analysis 

of STR loci with the results from the standard cytogenetic methods did not reveal any 

discrepancies. The present data therefore confirm the diagnostic value of investigated 

X-STR loci for the prenatal detection of chromosome X numerical disorders. 

kcrkven@kbc-zagreb.hr 

162 

Analitička citologija - Posteri

Analytical Cytology - Posters 

EXPRESSION OF P53, BCL-2, SURVIVIN AND AKT-1 IN PERIPHERAL BLOOD, 

BONE MARROW AND LYMPH NODES IN B-CLL 

Gizdić B1 , Miletić Z1 , Štoos Veić T1 , Pandžić Jakšić V1 , Martinović M1 , Kušeć R1 , 

Jakšić B2 , Pejša V1 , Trutin Ostović K1 , Jakšić O1 1 Dubrava University Hospital, Zagreb, Croatia 


Aims.We examined expression of several key factors regulating proliferation and apoptosis 

in B-CLL and difference in expression between them in peripheral blood (PB), bone 

marrow (BM) and lymph nodes (LN) representing major compartments in B-CLL. Methods. 

Samples from 25 B-CLL patients were taken by conventional techniques from PB, 

BM and LN. We analyzed CD5+CD19+ cells for expression of survivin, p53, bcl-2, Akt-1 and 

Ki-67 using flow cytometry and expressed results as mean fluorescence intensity (MFI). 

Results were statistically analyzed by pair tests. Results. Mean age of analyzed patients 

was 69 years (56% male). Mean b-2 microglobulin was 4.65 mg, mean TTM 9.76. There 

were 10, 10 and 5 patients in Binet stages A, B and C respectively. Median expressions (MFI) 

for PB, BM and LN respectively were: survivin 1.44, 1.19 and 2.15 (p


PALLISTER KILLIAN SYNDROME: UNUSUAL SIGNIFICANT POSTNATAL 

OVERGROWTH IN A GIRL WITH OTHERWISE TYPICAL PRESENTATION 

Huljev Frković S, Tonković Đurišević I, Lasan Trčić R, Sarnavka V, Crkvenac Gornik K, 

Mužinić D, Letica Lj, Barić I, Davor Begović 

Division of Genetics and Metabolism, Department of Pediatrics, University Hospital Centre 


Pallister Killian syndrome (PKS) is a rare genetic disorder caused by tetrasomy of the 

short arm of chromosome 12, revealed usually in mosaic distribution of an extra i(12) 

(p10) chromosome in fibroblasts. The syndrome presents with a recognizable pattern of 

findings including pigmentary skin changes, coarse face, high forehead, sparse anterior 

scalp hair, hypertelorism, seizures and progressive psychomotor developmental delay. It 

was first described independently by Pallister in 1977 and by Killian and Teschler-Nikola 

in 19811,2. We report a case of 21 month old girl with PKS and significant overgrowth. 

Cytogenetic analysis was performed using the GTG banding technique. The karyotype 

of cultured lymphocytes was normal. The karyotype from skin fibroblasts was established 

as mosaic tetrasomy of 12p 47,XX,+i(12)(p10)/46,XX. The origin of the extra marker 

chromosome was determinated by fluorescence in situ hybridization with chromosome 

12 specific DNA probes confirming that supernumerary marker is chromosome i(12p) in 

68% of cells. Despite the excessive postnatal growth we found low serum growth hormone 

levels and reduced response to pharmacological stimulation test. This is also the 

first report of a postnatal patient in our country. 

sanda.huljev@zg.htnet.hr 

164 



CYTOGENETICS AND MOLECULAR FINDINGS IN CHILDHOOD LEUKEMIA OF 

SOUTH CROATIA 

Lozić B1 , Čulić S1 , Čulić V1 , Drmić I2 , Batinić D3 , Mrsić S4 , Lasan Trčić R4 , Zemunik T5 1Department of Pediatrics, Clinical Hospital Centre Split, Croatia 

2Department of Pathology and Forensic Medicine, Clinical Hospital Centre Split, Croatia 

3Department of Immunology, Rebro Clinical Hospital, Zagreb, Croatia 

4Department of Pediatrics, Rebro Clinical Hospital Zagreb, Croatia 

5Department of Medical Biology, School of Medicine, University of Split, Croatia 

The aim of this study was to identify cytogenetic and molecular findings among the major 

pediatric leukemia in the South Croatia. Leukemia is the most common malignant 

disease in childhood and presents approximately 25% of all childhood cancer. This study 

showed the incidence of 3.2 new cases of acute leukemia per 100 000 children under the 

age of 18 years in our population. Immunophenotype characteristics of the 27(82%) pediatric 

patients with ALL and 6 patients with AML (18%) were analyzed. The most frequent 

abnormalities found in ALL were different abnormalities of chromosome short arm 9p 

(3/24 cases), and between AML it was t(8;21)(q22;q22) (2/6). The most frequent gene rearrangement 

was TEL/AML1 in 14/27 (51.5%) of all ALL cases. Due to the small number of 

patients in each genetic subgroup and short time of their follow-up, we could not analyze 

the relationship between the outcome and each gene rearrangement. 

blozic@kbsplit.hr 

165 



ANALYSIS OF IKAROS FAMILY SPLICING VARIANTS IN HUMAN HEMATOPOIETIC 

LINEAGES 

Matulić M1 , Paradžik M2 , Jelić Puškarić B3 , Stipić J4 , Antica M2 1 Faculty of Natural Sciences, Zagreb, Croatia 

1 Rudjer Boskovic Institute, Zagreb, Croatia 


4 Clinical Hospital Center Zagreb, Croatia 

Introduction: Transcription factors from the Ikaros family are involved in lymphocyte 

differentiation and have a critical role at specific check points of the haemopoietic pathway. 

However, how developmentally regulated changes are reflected in gene expression 

programs of lymphocyte differentiation is not well understood. It has been suggested 

that disregulation of transcription factors from the Ikaros family is associated with the 

development of different human leukemias. Aims: In this work we analyzed the state of 

Ikaros family members in different leukemic cells with the aim to explore the transcriptional 

control of human hematopoietic lineages and shed some new light on our understanding 

of transcription factor significance in human leukemias. Methods: By means of 

RT-PCR and specific primers we investigated the expression of Ikaros, Aiolos and Helios 

transcription factors and their splicing variants in seven leukemia cell lines derived 

from different types of leukemia (ALL, CML, AML) and lymphoma (histiocytic lymphoma, 

Burkitt lymphoma and anaplastic large cell lymphoma). Results: In all of the cell lines 

examined Ikaros was present in dominant Ik1 to Ik4 isoforms and small Ik6 isoform was 

absent. Aiolos was expressed in the majority of the cell lines, of both, B and T origin, in 

the form of the full length Aio1. Helios was also present only in two long isoforms Hel1 

and Hel2, and was absent in one third of the lines. Conclusion: Similar distribution of 

positive and negative expression of Aiolos and Helios found in various types of leukemias 

could implicate common pathways of their regulation. 

antica@irb.hr 

166 



MONOCYTES IN METABOLIC DISORDERS - OPPORTUNITIES FOR FLOW CYTOMETRY 

CONTRIBUTION 

Pandžić Jakšić V1 , Gizdić B2 , Miletić Z2 , Trutin Ostović K2 , Jakšić O3 1 Department of Endocrinology and Metabolism, Dubrava University Hospital, Zagreb, Croatia 

2 Department of Clinical Cytology and Cytometry, Dubrava University Hospital, Zagreb, Croatia 

3 Department of Hematology, Dubrava University Hospital, Zagreb, Croatia 

Chronic inflammation has arised as a major underlying cause of atherosclerosis, obesity 

and diabetes. It is mediated by cells of innate immune system like macrophages but 

also by their antecedents, monocytes in circulation. Roles of monocyte subsets and different 

markers of monocyte activation in the context of metabolic disorders have been 

reviewed. Applying cell based approach through flow cytometry in this field has resulted 

with new understanding of pathophysiologic mechanisms. Possible implications of 

these insights in diagnosis, prognosis and revealing of therapeutic targets in metabolic 

disorders remain a challenge for future. 

vpandzic@kbd.hr 

167 



THE ACCURACY OF FINE NEEDLE ASPIRATION CYTOLOGY AND FLOW CYTOMETRY 

IN EVALUATION OF NODAL AND EXTRANODAL SITES IN PATIENTS WITH SUSPICION 

OF LYMPHOMA 

Šenjug P1 , Trutin Ostović K2 , Miletić Z2 , Tomasović Lončarić Č3 , Štoos-Veić T2 , 

Gizdić B4 , Kaić G2 , Aralica G3 , Križanac Š3 , Pejša V4 , Jakšić O4 1 Medical student, Zagreb University School of Medicine, Zagreb, Croatia 

2Department of Clinical Cytology and Cytometry, Dubrava University Hospital, Zagreb, 

Croatia 

3Department of Clinical and Experimental Pathology, Dubrava University Hospital, 


4Clinic of Internal Medicine, Department of Hematology, Dubrava University Hospital, 


Aim. Our goal was to determinate how is information given by FNA and FC correlated 

with pathohistologic diagnosis and to evaluate ability to diagnose and subclassify malignant 

lymphomas by FNAC and FC. Methods. This study is a retrospective chart review of 

patients with suspicion of lymphoma processed at Dubrava University Hospital in Zagreb. 

We reviewed patient’s charts at the Department of clinical and experimental pathology 

and the Department of clinical cytology and cytometry within two years and two months 

(from March 2007 to May 2009). Results. After analysis 50 patients fulfilled inclusion 

criteria for this study (FNAC diagnosis with or without FC and consecutive confirmatory 

pathohistological diagnosis). When analyzing accuracy of FNAC according to suspicion 

of lymphoma or NHL and differential diagnosis lymphoma sensitivity was 97.7%, specificity 

85.7% and the diagnostic accuracy was 96%. When analyzing accuracy of FNAC 

according to the subclassification of lymphoma, sensitivity was 74.4%, specificity 85.7% 

and the diagnostic accuracy 76%. Combined FNAC and FC improved sensitivity, positive 

predictive value, negative predictive value and diagnostic accuracy. Sensitivity was 79.1% 

and the diagnostic accuracy 80%. Conclusion. We have shown that these methods can 

distinguish benign lymphadenopaties from lymphomas and also subclassify lymphomas 

and quickly provide clinicians with dose information. 

petar.senjug@inet.hr 

168 


citotehnologija 

cytotechnology 

169 



NEW METHODS IN CYTOLOGY 

Korać P 


170 

Citotehnologija - Plenarna i pozvana predavanja 

Development of new methods allows better insight into malignant processes in tumor 

cells. Detection of gene aberrations, mRNA expression and/or protein expression helps 

in some cases: to determine precise diagnosis; to predict prognosis; to make decisions 

about adequate therapy. 

FISH method is used for detection of chromosomal/gene aberrations in tumor cells. 

mRNA expression can be detected by using in situ hybridization and presence of specific 

protein by immunoenzymatic staining. Combination of these methods can detect gene 

abnormalities in specific cells, presence of specific protein in specific cell compartment 

and specific cell population that express specific antigen. 

All these methods are simple, protocols are easy to perform in well equipped laboratories 

and results could be easily interpreted. 

pkorac@gmail.com

Cytotechnology - Oral Presentations 

THE PREVALENCE OF INFECTION IN SWABS OF TRANSPLANTED HEMATOLOGIC 

PATIENTS 

Anić V, Križaj B, Jelić-Puškarić B, Perić Z, Vrhovac R, Kardum-Skelin I 


The aim of the study was to show the prevalence of infection in swabs from different 

locations (oral cavity, tongue, demerit of skin, etc.) in hematologic patients post-transplantation. 

Data were collected from patient files and cytology results obtained in swabs 

of transplanted hematologic patients. Patients undergoing allogeneic bone marrow or 

peripheral blood stem cell transplantation received antiviral, antifungal and antibiotic 

prophylaxy; and before autologous transplantation procedure, patients received antifungal 

and antibiotic prophylaxy. Positive swab results were recorded in 38 patients (20 

female and 18 male), aged 19-66, treated in sterile units at our hematology department. 

All study patients had hematologic diseases, i.e. non-Hodgkin’s lymphoma (n=14), Hodgkin’s 

disease (n=3), multiple myeloma (n=2), acute lymphoblastic leukemia (n=7), and 

acute myeloid leukemia (n=12), in post-transplantation recovery. According to type of 

transplantation, 27 patients underwent autologous and 11 patients allogenic transplantation. 

Stem cells were collected from peripheral blood in 28 and from bone marrow in ten 

patients. Out of 70 swabs, negative finding was recorded in 28 swabs, whereas 20 swabs 

were positive for fungal infection, 21 swabs for viral infection and one swab for malignant 

cells. In conclusion, in spite of antiviral, antifungal and antibiotic therapy administered 

to patients as prophylaxis before transplantation procedure, there was still a high risk of 

infection caused by fungal and viral agents. 

veronika.anic@zg.t-com.hr 

QUALITY OF INTAKE AND PROCESSING OF MATERIALS IN CYTOLOGICAL 

LABORATORY 

Begović D, Belušić M, Maljić S 

General Hospital Pula, Pula, Croatia 

The aim of this presentation is to indicate mistakes of taking and processing cytological 

materials that causes inadequacy of samples. Inadequate cytological samples prevent 

their further analyses. Methods to obtain the better cytological smears are dependent 

on the technique of taking, application and processing of cytological materials. Only 

samples taken from appropriate places with adequate equipment and their proper further 

processing lead to a precise and quality cytological analysis. Good technical samples 

of cytological materials is prerequisite for the quality of cytological analyses. For 

the efficacious work in the cytological laboratory is essential to have a good cooperation 

between cytotechnologists, cytologists and clinicians. 

citologija@obpula.hr 

171 



THE ROLE OF CYTOTECHNOLOGIST IN CYTOANALYSIS OF SYNOVIAL FLUIDS 

Bezdrob S, Aleksandrov C, Cvrk B, Čurin S, Ljevar I, Krupec A, Čurin D, Knežević A, 

Perica B, Ćaleta B, Trutin Ostović K 

Dubrava University Hospital, Zagreb, Croatia 

Aim: To point out possible mistakes in procedures in cytoanalysis of synovial fluids processed 

by cytotechnologists. Methods: Cytoanalysis is performed by two steps: urgent 

and standard. The urgent examination consists of macroscopic analysis (determination 

of volume, colour, clarity, viscosity and mucin clot test), counting of total count of nuclear 

cells in Burker-Turk counting chamber, native microscopic analysis for crystals and 

analysis of neutrophil granulocyte percentage in cytospin sediments stained by Hemacolor. 

All these procedures except the last two are performed only by cytotechnologists. 

They are done at least by two persons separately one from another because of subjective 

analysis. Standard procedure consists of microscopic examination of sediments of synovial 

fluids stained by Papenheim, Papanicolaou and cytochemistry of acid phosphatase 

done by cytotechnologists (semiquantitative analysis) and by cytologist (qualitative and 

semiquantitative analysis) separately. Results: We have analysed 115 synovial fluids, 81 

patients with inflammation (type I and II) and 34 patients with degenerative illnesses 

and injuries (type 3). Conclusion: Cytotechnologists play very important role in cytological 

diagnosis of synovial fluids and therefore well education is necessary.Citotehnolozi/ 

CytotechnologistsComputationalORAL 

samirbezdrob@yahoo.com 

172 

Citotehnologija - Usmena predavanja


MODIFICATION OF MGG STAINING METHOD 

Fumić G, Naglić G, Meandžija R, Štemberger C, Seili-Bekafigo I. 

Department of Cytology, Department of Internat Medicine, Clinical Hospital 

Center Rijeka, Croatia 

Aim: May-Gruenwald.Giemsa staining method is a standard procedure in fine-needle 

aspiration cytology (FNA). There are some commercial kits for rapid staining available, 

but modified MGG technique could be used for intraoperative analysis, and for rapid 

on-site examination of smears. If, due to some errors in staining procedure, slides are 

over-stained with MGG, there is a simple procedure for partial destaining. Materials 

and methods: For intraoperative examinations we used the modified protocol: shortened 

staining time, and increased concentration of Giemsa (G). For rapid on-site examination, 

minimum of equipment needed was: a microscope, May-Gruenwald (MG) staining solution, 

tap water and distilled water, and a shallow dish with a rack. Air-dried smears were 

stained with MG. Afterwards we continued the staining procedure with Giemsa stain in 

the laboratory. Overstained slides were treated by immersing 3 times in 80% ethanol. 

Results: Rapid staining with MGG in 5’ 30’’ for liquid specimens, or in 4’ 30’’ for smears, 

provided preparations good enough for cytologic analysis during the operation. Staining 

with MG only, enabled us to evaluate the quality of specimen while patient is still available 

for repeating FNA, without losing those slides for definitive examination. Immersing 

over-stained MGG smears in 80% ethanol, made them suitable for analysis. Conclusion: 

Using standard stains, MG and G, it is possible to perform rapid intraoperative staining 

and rapid on-site evaluation of FNA specimens, without additional costs. Slides accidentally 

overstained can easily be partially destained with 80% ethanol. 

gordana.fumic@ri.t-com.hr 

173 



DETECTION OF P16INK4a PROTEIN IN PREMALIGNANT CERVICAL LESIONS ON 

ARCHIVED SLIDES 

Gavranović Lj, Rakek Novak S, Baburić M, Đorđijevski E, Šentija K, Katalenić Simon S, 


University Hospital Merkur, Zagreb, Croatia 

Objective: It is well known that infection with human papilloma virus (HPV) is main risk 

factor for developing premalignant and malignant changes on squamous epithelium of 

cervix. Up today data showed that HPV has specific affinity for the epithelium of anogenital 

region. Usually it takes at least 10 years for one to develop initial morphologic 

changes on epithelium and for developing cancer it takes even longer period. Therefore 

it is crucial to detect early changes for identification of those patients who are in greater 

danger of developing cervical cancer. For that intention, detection of tumor markers was 

proposed. Through immunoassaying methods with specific monoclonal antibodies it is 

possible to visualise specific tumor markers. Aim of our study is to investigate overexpression 

of p16 INK4a protein (p16) in cervical low (LSIL) and high grade squamous lesion 

(HSIL) on archived slides of high risk HPV positive patients. Methods: The p16 overexpression 

was investigated immunocytochemically by using p16INK4a - specific monoclonal 

antibody (clone E6H4). We decolourised 21, 58 and 95 archived cervical slides of normal 

cytology, LSIL and HSIL, including carcinoma in situ (CIS), respectively. Results: Positivity 

of p16 staining was 0%, 29%, 31% and 84%, in slides with normal cytology, LSIL and 

HSIL, respectively. Conclusion: The incidence of p16INK overexpression was significantly 

higher on slides with HSIL lesion than in LSIL lesion or on slides without abnormality 

suggesting the use of p16 as a tumor marker for high grade dysplasia. 

ljiljana.gavranovic@zg.t-com.hr 

174 



NUMBER OF COUNTING CELLS AND CYTOSPINS SELECTION INFLUENCES ON 

BRONCHOALVEOLAR LAVAGE CELL PROFILES 

Harabajsa S, Martinčić J, Peharec I, Popek B, Šušković- Medved S, Zadražil B, 

Smojver-Ježek S 

University Hospital for Lung Diseases Jordanovac, Zagreb, Croatia 

BAL fluid cells count provides information about presence or absence of interstitial lung 

diseases. BAL fluid samples were taken from 50 patients hospitalized in University Hospital 

for Lung Diseases Jordanovac in Zagreb, Croatia. The samples of BAL fluid were 

prepared by cytocentrifuge. From each sample two cytospin were selected (C1 and C2) 

and after determing adequacy, counted up to 200 and 400 cells. After air-drying, samples 

were stained according to May Grünwald Giemsa (MGG). Cells were counted by 

light microscope at magnification of 400 x. Obtained results were analyzed in Statistics 

version 6 and Med Calc. Results for bronchial epithelial cells, alveolar macrophages, 

lymphocytes and neutrophilic granulocytes showed insignificant statistical differences 

between groups (p>0.05). Eosinophils percentages showed borderline insignificant statistical 

difference between groups of these cells (p=0.052). As it was exemplificated, the 

percentages of differentiated cells do not significant differ according to differentiation on 

200 and 400 cells and cytospin selection. 

suzana.harabajsa@zg.t-com.hr 

ERYTHROCYTE MORPHOLOGY IN MALIGNANT URINE SAMPLES 

Knežević G, Parigros K, Milas M, Šušterčić D, Kardum-Skelin I 


The aim of the study was to show the origin of erythrocytes in malignant urine sample, 

assuming that a finding of 80% and more of dysmorphic erythrocytes indicated the 

bleeding to derive from upper urinary tract, and 80% and more of smooth erythrocytes 

indicated them to derive from lower urine tract; in urine samples without significant 

origin of bleeding there were 20%-80% mixed results with both dysmorphic and isomorphic 

erythrocytes. Data were collected from the findings recorded in malignant urine 

samples received. Samples were fresh native urine sediment contrast stained with 0.1% 

Safranin solution and analyzed under light microscope (X40). Out of 72 patients with 

malignant cells detected in urine, the origin of erythrocytes was identified in 25 patients 

(nine female and 16 male) through 190 samples (approximately 4 samples per patient). 

A mixed origin of erythrocytes was identified in 70 (36.9%) samples, 55 (28.9%) samples 

did not have enough erythrocytes to define their origin, dysmorphic erythrocytes were 

found in 53 (27.9%) samples, and isomorphic erythrocytes in 12 (6.3%) samples. In conclusion, 

there was no specific connection between malignant cell findings in urine and 

origin of erythrocytes. However, the high presence of mixed erythrocyte origin in malignant 

samples may suggest that the existence of a malignant process and renal disease 

should be taken in consideration. 

gordana.knezevic1@zg.t-com.hr 

175 



PRESENTATION OF INTEGRATED MODULE FOR INPUT AND PROCESSING OF CYTO- 

LOGICAL REPORTS WITHIN THE COMPUTER PROGRAMME “RIBIS“ 

Markanjević T1 , Vunić S2 1 University Hospital Center Rijeka, Croatia 

2 ‘SING’ company for computer engineering, Rijeka, Croatia 

Objective: The presentation of computer programme for input, processing and assesing 

of cytological findings stressing the Pap test results. Methods: In collaboration of 

Department of Gynecological Cytology, University Department of Gynecology and Obstetrics, 

University Hospital Center Rijeka, Croatia and ‘SING’ company for computer 

engineering from Rijeka we made and improve a computer programme for input and 

processing of cytological findings. The input of Pap tests is based on the classification 

‘ZAGREB 2002’. The programme is adapted to the workprocess of cytological laboratory 

from the reception of referral slides to the issuing of reports in print. By means of this 

programme data base of all the patients is created. This ensures a simple insight into 

the previous Pap test findings and patients’ chart. It also ensures the input of other cytological 

findings as well as HPV tests performed on our department. The programme 

has an option of statistical data processing - the performance of cytotechnologist and 

specialists in clinical cytology, a number of daily examined slides, a share of unsarisfactoty 

samples and a number of negative and abnormal findings with the possibility 

of subcategorisation. The Department of Gynaecological cytology operates interactively 

with the Department of Gynaecological Polyclinic and other departments in the Clinic for 

Obstretics and Gynaecology thus the request forms are sent electronically. We also have 

an insight into the electronic patient charts containing the information about medical 

history as well as all the diagnostic procedures and findings. We also operate interactivelly 

with the Department of Pathology and we have the access to pathology results 

of gynaecological patients. Results: By means of an example of normal and abnormal 

Pap test we will demonstrate the sequence of procedures using computer programme: 

the input of general and clinical data, the part performed by cytotechnologiests along 

with rescreening, the part performed by doctors, print-out of the results and the patient 

chart. Conclusion: Computerization of the Department of Gynaecological cytology contributed 

to the effectiveness of daily work and the quality of processing and evaluation od 

cytological findings with the possibility of improved quality control. 

tina.valencic@ri.t-com.hr 

176 



PROBLEMS WITH STAINING PROCEDURES IN IMMUNOCYTOCHEMISTRY 

Meandžija R1 , Fumić G1 , Naglić G1 , Štanfel O2 , Seili-Bekafigo I1 1Department of Cytology, Department of Internal Medicine, Clinical Hospital Center 


2 Rijeka University School of Medicine, Department of Pathology, Rijeka, Croatia 

Aim: To identify weaknesses of immunocytochemistry (ICK) staining procedures, and to 

propose solutions for some of them, since data in the literature are very scarce on that 

subject. Material and methods: During 3 years period in The Department for Cytology, 

Department of Internal Medicine, Clinical Hospital Center Rijeka, we performed totally 

475 ICK analyses for 151 patients, mean 3,15 per patient. Most monoclonal antibodies 

used (Ber-ep4, CD3, CD20, Calretinin) react with membrane-bound antigenes, so any 

kind of pretreatment was not applied. We also tried to show TTF positivity in primary 

lung tumors, with and without pretreatment with TRIS- EDTA puffer on 96-97oC. Results: 

Staining for membrane-bound antigenes, gave good results using standard protocols 

recommended by manufacturer. The best results were obtained when using special 

Polysine slides. After pretreatment we got positive reaction with the nuclear antigen TTF 

as well. Conclusion: ICK is a powerfull diagnostic tool, but the staining procedure itself 

has to be precisely defined and standardized. The most important problems are: quality 

of particular slides (we do not know in advance if there are enough well preserved cells 

on each given slide), maintaining of the specimen on the slide during staining procedure 

if standard slides are used, correct determination of dillution and incubation period for 

each monoclonal antibody, revealing of the nuclear antigenes without interfering with 

specimen quality, and lack of control slides. There is a lot of work to be done in this field, 

regarding standardization and quality control. 

rmeandzija@net.hr 

177 



IMMUNODETECTION OF ANTIGENES IN CYTOLOGIC SAMPLES 

Rešetar R 


Objective: Presentation of the procedures of antigene detection in cytologic smears 

depending on their cell location. Methods: Basic rules of immunodetection methods 

have been used in the research. Cell antigens can be divided into three basic groups: 

membrane, cytoplasmic and nuclear antigens. Since membrane and cytoplasmic antigens 

are more accessible to the reaction with specific antibody due their cell location, 

there were no difficulties in their detection. However, nuclear antigens, especially Ki-67 

placed deep in the cell nucleus, can not be detected just by using classic procedures 

of immunocytochemistry. Due to its specific location in the cell and in order to prove 

nuclear antigens, an additional special technique called ‘antigen demasking’ is needed. 

This technique is performed with the help of special fluid for ‘antigen demasking’ and 

thermic treatment in the water bath. In immunocytochemical methods there are three 

key steps important for the validity and positive result of reactions: 1. preparation fixation 

time; 2. precisely performed ‘antigen demasking’; 3. incubation time for primary 

monoclonal antibody. In immunocytochemical methods we have combined the following 

procedures:1.fixation time: 2-10 min, 2.’antigen demasking’ time: 5-20 min, 3. fluid for 

‘antigen demasking’: citrate buffer (ph=6) or Tris/EDTA (ph=9),4. incubation time for primary 

monoclonal antibody: 30-90 min. For all types of antigens we used sylanized glass 

impregnated by special adhesion matters. Results: Membrane and cytoplasmic antigens 

are detected by classic procedures of immunocytochemistry with 10 minute fixation and 

30-60 minute incubation with antibodies. The following procedure showed the best results 

for the detection of nuclear antigens: 10 minute fixation in cold acetone, 5 minute 

incubation in water bath on 95 °C in citrate buffer (ph=6) and 90 minute incubation with 

primary antibody. Conclusion: For proving specific nuclear antigens all four steps are 

needed as well as the procedure of ‘antigene demasking’ which includes thermic treatment 

in water bath with obligatory use of fluid for ‘antigene demasking’. Membrane and 

cytoplasmic antigens require only the combination of fixation and adequate incubation 

time. 

nale.kralj@gmail.com 

178 



INFLUENCE OF INADEQUATE MATERIALS ON CYTOLOGICAL ANALISIS AND 

PROVIDING DIAGNOSIS 

Rubić K, Milanković Lj, Horvat B, Ropar S 

General Hospital Karlovac, Karlovac, Croatia 

Identification of disease and providing diagnosis are often hard to establish because 

of inadequate material. More and more is the case that exfoliative materials which are 

often inadequate to examine are brought to a cytological laboratory. In some cases materials 

are not brought on time, so their analysis is not possible. Some materials are not 

usable medium for cells and longer air-contact and holding on warm area cause decay 

of cells and replication of bacteria, which all influence cell-analysis. Such materials 

are hard to analyse, most of them even impossible. All specimens whol centrifugate in 

cytocentrifuge-cytospin and painted with May-Grunwald stain. Specimens are repeated 

many times.Repeating the specimens more slowly, malign diagnosis have been noticed 

with some of them. In order to get better quality, faster and exacter diagnosis, better 

staff-education and team-communication are among persons who work on taking and 

distribuing materials in purpose of removal of causes are needed. That would minimize 

mistakes, diagnosis would be faster and exacter and the number of controls would be 

smaller. 

katica.rubic@ka.t-com.hr 

179 



MICROSCOPIC IDENTIFICATION OF PARASITES IN CYTOLOGICAL PREPARATIONS - 

THE „GOLD STANDARD“ IN DIAGNOSTICS OF VISCERAL LEISHMANIASIS - 

A CASE REPORT 

Stupnišek M, Prstec Z, Vujević D, Čulig Z, Puljiz I, Lukas D, Begovac J. 

University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Zagreb, Croatia 

Visceral leishmaniasis (VL) is an infectious, potentially fatal, systemic disease characterized 

by fever, fatigue, splenomegaly, hepatomegaly, progressive anemia, pancytopenia 

and hypergammaglobulinemia. VL is caused by protozoan parasites that belong to the 

genus Leishmania and are transmitted to mammals by the bite of female sandfly. The 

causative agent can be detected by: microscopic identification of parasites in stained 

cytological preparations (usually from bone-marrow, spleen, lymph-node); cultivation; 

serological and molecular methods. VL is spread worldwide. In Croatia, VL occurs rarely 

(around 3-5 cases per year) usually in persons who reside or live in middle and southern 

Dalmatia. Of particular concern is the emerging problem of VL/HIV co-infection, 

especially in southern Europe. The clinical presentations as well as organ involvement 

of VL are often atypical in HIV+ patients. We report a rare case of VL with pulmonary localization 

in a 57-year-old HIV+ patient. Leishmania amastigotes were detected in bonemarrow 

aspirates in several instances. The patient was re-admitted to the Hospital due 

to high fever and the presence of pulmonary infiltrate. Bronchoscopy was performed 

and bronchoalveolar lavage (BAL) specimen collected. The preparations were stained 

by May-Grünwald-Giemsa and Diff-Quick technique and observed by light microscope. 

Leishmania amastigotes were found. In samples of BAL obtained during subsequent 

bronchoscopy, planocellular carcinoma was also detected. Conclusions: In patients 

with VL, especially immunocompromised, atypical clinical presentations and unusual 

localizations of disease are commonly found, but pulmonary localization is rarely than 

others. Microscopic identification of parasites in cytological preparations presents the 

„gold standard“ in diagnostics of VL, which primarily requires well educated laboratory 

personnel. 

stupnisek@gmail.com 

180 


Cytotechnology - Posters 

ANALYSIS OF ABNORMAL PAP TEST FINDINGS OF URBAN, RURAL AND INSULAR 

AREA 

Bašić D, Markanjević T 


Objective: Comparison of abnormal Pap test findings of women sampled in urban, rural 

and insular area.Methods: In the Department of Gynaecological cytology, University 

Department of Gynecology and Obstetrics, University Hospital Center Rijeka, Croatia, 

Pap tests from almost entire County of Primorje-Gorski kotar and a part of County of 

Lika-Senj are analyzed. In 2008 36,153 Pap tests have been analyzed. In the research we 

analyzed the findings of Pap tests choosing one medical clinic in urban, one in rural and 

one in insular area. The frequency of abnormal findings has been analyzed as well as 

distribution according to age and the frequency of abnormal findings of squamous and 

glandural epithelium. Statistical significance between the groups has been analyzed by 

using chi-square test.Results: From total of 4492 samples analyzed we found 279 (6,2%) 

abnormal Pap test, out of which 279 (93,5%) of squamous and 18 (6,5%) of glandular epithelium 

origin. In the urban area 125 (5,7%) abnormal Pap test were found, out of which 

121 (96,8%) of squamous epithelium and 4 (3,2%) of glandural epithelium. In the rural 

area 50 (6,2%) abnormal Pap test were found, out of which 44 (88%) of squamous epithelium 

and 6 (12%) of glandural epithelium. In the insular area 104 (7%) abnormal Pap 

test were found, out of which 96 (96%) of squamous epithelium and 8 (8%) of glandural 

epithelium. By distribution according to age, in urban area 50 (40%) abnormal findings 

were found among women up to age 30, 54 (43%) among women from age 30 to 50 and 

21 (17%) among women above age 50. In the rural area there were 15 (30%) abnormal Pap 

test among women up to age 30 and 25 (50%) abnormal Pap test among women from 

age 30 to 50 and 10 (20%) among women above age 50. In the insular area there were 

48 (46%) abnormal Pap test among women up to age 30, 39 (38%) among women from 

age 30 to 50 and 17 (16%) among women above age 50. By statistical analysis a statistically 

significant higher values of frequency of abnormal findings of glandular epithelium 

was detected in rural area in comparison to women of urban area (p


RESCREENING OF NEGATIVE CERVICAL CYTOLOGY FINDINGS 

Poduje V, Mustapić D, Mahovlić V 


Aim: To determine the rate of false-negative cervical cytology findings using the methods 

of internal quality control. Material and methods: During a 3-year period, 83547 conventional 

Pap smears were analyzed. Out of 40000 negative cytology findings on initial 

screening, 1033 (2.59%) Pap smears were submitted to random rescreening, whereas 

23.72% (10200/43547) Pap tests initially evaluated as inflammatory or reactive lesions 

of squamous epithelial cells were separated for control cytology and rescreened by senior 

cytologist. Employing the method of random sample, the cytologist analyzed 693 

(6.79%) of these 10200 Pap smears. Results: The initially negative screening findings 

were confirmed in 97.39% (1006/1033) Pap smears, whereas 2.61% (27/1033) proved to be 

false-negative findings including ASCU-S (1.65%), ASC-H (0.29%), H-SIL (CIN III) (0.10%) 

and AGC - probably reactive lesions of endocervical origin(0.58%). Negative rescreening 

performed by senior cytologist was confirmed in 85.43% (592/693) of Pap tests, whereas 

14.57% (101/693) proved to be false-negative findings including ASCU-S (12.84%), LSIL 

(CIN I) (0.58%) and AGC - probably reactive lesions of endocervical origin (1.15%). No case 

of HSIL was recorded in this group. Conclusion: Employing the methods of internal quality 

control on initially negative Pap smears upgrades not only the sensitivity of cytologic 

screening but also the quality of cytotechnologist performance. 

otok7@yahoo.com 

182 

Citotehnologija - Posteri

Cytotechnology - Posters 

VIRAL CAPSID PROTEIN (HPV L1) DETECTION ON ARCHIVED CERVICAL SLIDES 

Rakek Novak S, Gavranović Lj, Baburić M, Đorđijevski E, Šentija K, Katalenić Simon S, 


University Hospital Merkur 

Objective: Cohort studies have shown that HPV infection is crucial for developing precancerous 

and cancerous lesions of uterine cervix. But the main event in the carcinogenesis 

is not simple detection of infection, but its persistency and viral integration in association 

with HPV physical status (episomal or integrated). Aim of the study is to investigate 

the prevalence of HPV L1 capsid protein in low grade and high grade squamous lesion 

(LSIL/HSIL) of the uterine cervix and to present cytoactive method for immunostaining 

performed on archive cervical slides. Examinees and Methods: We analysed cervical 

smears from 107 patients. All of them are high risk HPVDNA positive. After decolourising 

slides we preformed immunoassaying with cytoaktiv screening set for HPV L1 (cytoimmun 

diagnostic GbmH, Pirmanses, Germany). Results: Cytological diagnose of LSIL 

was made in seventy-six patients (76/107), and nineteen patients (19/107) had HSIL with 

carcinoma in situ included. In all 19 patients HSIL was confirmed by biopsy or cold knife 

conisation. After immunoassaying positive HPV L1 was found in 42, 11% (32/76) of LSIL 

and in 15, 79% (3/19) of HSIL specimens. Conclusion: Lower L1 detection rate in HSIL 

can be explained by possible loss of viral L1 genes and consequently lower production 

of capsid proteins. Hence, in patients whose smears are L1 negative, additional cytology 

control is suggested. 

sanjarakeknovak1@gmail.com 

ENTEROBIUS VERMICULARIS IN VAGINAL SMEARS 

Rubić K, Milanković Lj, Plemić I, Ropar S 

General Hospital Karlovac, Karlovac,Croatia 

A patient 27 years old, went to the routine gynecological examination during which papa 

smear was taken. 

In treated smear which was painted with Papanicolau stain, eggs of Enterobius vermicularis 

were found. Enterobius vermicularis is the mostcommon parasite in children, 

which often appears within the family, kindergarten, schools and camps. Enterobius 

vermicularis can induce vaginitis with itch. The case was not about infection and was 

diagnosticed in routine screening. The interpretation of the case was given with the purpose 

of turning attention although rarely, Enterobius vermicularis eggs can be found in 

vaginal smears. 

katica.rubic@ka.t-com.hr 

183 



LYMPH NODE FINE NEEDLE ASPIRATION - SAMPLE ADEQUACY FLOW CYTOMETRY 

IMMUNOPHENOTYPING 

Švencbir V1 , Milas M2 , Anić V2 , Šiftar Z2 , Kardum Paro MM2 , Kardum-Skelin I2 1 Sestre Milosrdnice University Hospital, Zagreb, Croatia 


In a modern clinical laboratory, lymphatic cell immunophenotyping by flow cytometry 

helps determine the diagnosis of clonal B-lymphocytes and thus discriminate benign 

from malignant lymphoproliferative diseases. The aim of the study was to assess adequacy 

and appropriateness of lymph node fine needle aspiration (FNA) for flow cytometry 

analysis in cases of benign and primary malignant disorders. The study was based 

on medical documentation, cytologic smear of FNA lymph node sample and flow cytometry 

immunophenotyping results. The study included 239 patients during the 2006-2007 

period. According to cytologic test results, patients were classified into several groups: 

benign lymphoproliferative disease (22%), undefined monomorphous population of lymphatic 

cells (16%), B cell non-Hodgkin’s lyphoma (55%), and non-B cell non-Hodgkin’s 

lyphoma (5%). Lymphocytes were isolated from FNA lymph node samples using density 

gradient. The suspension of mononuclear cells was labeled by appropriate combination 

of negative control and monoclonal antibodies and then analyzed by flow cytometry. The 

acceptable minimum number of cells from lymph node sample as representative for 

flow cytometry analysis was determined by maximal control of electronic gates around 

the specific cell population. In the study material, 85% of samples contained an adequate 

cell quantity for analysis, in 12% of samples the number of cells was only adequate 

to determine clonality, whereas in 3% of samples the number of cells was inadequate 

for any analysis. Although cell adequacy for analysis varied among groups, there was 

no statistically significant difference in the adequacy of samples obtained from patients 

with benign lymphoproliferative diseases (87%), monomorphous population of lymphatic 

cells (76%), B cell non-Hodgkin’s lymphoma (89%) and non-B cell lymphoma (69%). In 

conclusion, cytologic diagnosis of lymphoproliferative disease is a simple and reliable 

diagnosis in both separation of benign from primary lymphoproliferative diseases (lymphoma) 

and secondary malignancies, as well as in tissue typing and subtyping of malignant 

lymphoma. Since FNA provides enough cells for flow cytometry analysis, these two 

diagnostic methods improve diagnostic accuracy and safety 

viktorija_svencbir@net.hr 

184 

Citotehnologija - Posteri

indeks autora 

authors’ index 

185 



Abalic M 28, 133 

Agai M 31, 103 

Ajduković R 30, 33, 126, 156, 160 

Aleksandrov C 29, 172 

Alerić I 16, 21, 82, 114 

Alilović M 21, 64 

Anđelinović Š 4, 31, 159 

Anić V 29, 34, 171, 184 

Antica M 33, 166 

Antulov J 17, 25, 65, 149 

Aralica G 33, 168 

Audy-Jurković S 18, 22, 98 

Aurer I 24, 80 

Babić D 18, 19, 22, 36, 81, 88, 

98, 101, 107, 116 

Babić Ž 20, 109 

Baburić M 29, 33, 174, 183 

Banić M 20, 66 

Baričević D 21, 114 

Barić I 32, 164 

Barišić A 19, 19, 22, 81, 88, 98, 107, 116 

Bartolek D 32, 125 

Bašić D 32, 112, 181 

Bašić-Kinda S 24, 44, 80 

Baškot A 27, 121 

Batinić D 25, 26, 28, 30, 33, 37, 

45, 53, 65, 124, 152, 165 

Begovac J 30, 180 

Begović D 29, 30, 32, 156, 162, 164, 171 

Belušić Gobić M 20, 75 

Belušić M 29, 171 

Beljan R 16, 23, 31, 116, 159 

Benić-Salamon K 18, 115 

Besser-Silconi Ž 31, 75 

Bezdrob S 29, 172 

Bilić B 20, 109 

Bilić E 26, 37, 59 

Bobuš Kelčec I 28, 31, 103, 146 

Bojanić I 26, 53 

Bolanča I 22, 43 

Bollmann R 18, 37 

Bonevski A 27, 122 

Boras Z 21, 102, 114 

Borovečki A 25, 28, 76, 140 

Botić Lj 31, 52 

186 

Božikov J 22, 88 

Brnčić-Fischer A 18, 115 

Budi S 33, 126 

Buhin M 26, 41 

Bulimbašić S 27, 51 

Cavrić G 32, 125 

Cerović R 20, 75 

Crkvenac Gornik K 32, 162, 164 

Cvrk B 29, 172 

Čabrijan Ž 20, 66 

Čačić M 25, 65 

Čaržavec D 27, 28, 117, 129 

Čikara I 23, 139 

Čolić Cvrlje V 21, 26, 27, 40, 52, 97 

Čulić V 31, 33, 152, 165 

Čulig Z 30, 180 

Čurin D 29, 172 

Čurin S 29, 172 

Čuržik D 18, 19, 55, 93 

Ćaleta B 29, 172 

Ćorušić A 18, 19, 38, 81, 107 

Ćulić S 27, 33, 122, 165 

Ćurić J 20, 66 

Ćurić Jurić S 5, 28, 129, 146 

Dabelić N 23, 118 

Dejanović M 27, 121 

Dmitrović B 31, 106 

Dodig D 20, 85 

Dominis M 5, 24, 28, 39, 131, 136 

Dotlić S 25, 44, 65 

Drmić I 33, 165 

Dubravčić K 25, 26, 37, 53, 65 

Dušak V 26, 53 

Duvnjak M 20, 56 

Džebro S 21, 24, 25, 28, 54, 76, 102, 140 

Džeko-Škugor N 16, 77 

Đorđijevski E 29, 33, 174, 183 

Eminović S 22, 113 

Ezgeta Karačić D 32, 119 

Fabijanic I 17, 24, 25, 50, 65, 149 

Femenić R 26, 37, 59 

Filip A 34, 144 

Filipec-Kanižaj T 21, 23, 26, 41, 97, 138 

Finderle A 22, 113 

Flegar-Meštrić Z 24, 30, 31, 33, 48, 134, 153

Florian IS 32, 110 

Folnović D 22, 98 

Foris V 32, 110 

Franić Šimić I 25, 65 

Fumić G 29, 173, 177 

Fuštar-Preradović Lj 20, 78, 79 

Gaćina P 21, 117 

Gajović S 21, 70 

Gašparov S 26, 32, 41 

Gavranović LJ 29, 33, 174, 183 

Gizdić B 30, 32, 33, 163, 167, 168 

Gjadrov-Kuveždić K 25, 65, 149 

Glibotić-Kresina H 18, 115 

Golubić-Ćepulić B 26, 53 

Gracin S 27, 51, 120 

Grbavac I 22, 43 

Grce M 18, 42 

Gredelj Šimec NJ 27, 33, 121, 137 

Grgić S 21, 70 

Grgurević I 20, 66 

Grgurević-Batinica A 28, 131 

Gršić K 20, 99 

Grubić Z 32, 162 

Grubišić G 22, 43 

Guštin D 26, 27, 40, 51, 52 

Harabajsa S 29, 175 

Hariš V 30, 33, 34, 126, 145, 456 

Hećimović A 21, 102 

Horvat B 29, 179 

Hrabar D 20, 56 

Huljev Frković S 32, 162, 164 

Iancu C 34, 143 

Ilić Forko J 22, 88, 98, 101 

Ilić I 24, 25, 26, 44, 59, 65, 80 

Ioani H 32, 110 

Ivko-Banovac T 31, 152 

Jadrijević S 27, 51 

Jakelić-Piteša J 16, 89 

Jakić-Razumović J 31, 33, 102, 127 

Jakovljević G 26, 27, 45, 122 

Jaksic B 16, 17, 24, 25, 26, 28, 32, 

46, 47, 48, 54, 57, 58, 71, 77, 

83, 90, 100, 123, 136, 141, 163 

Jakšić O 24, 25, 30, 32, 33, 47, 

83, 90, 100, 123, 136, 141, 163 

Janković S 18, 115 

Jelić-Puškarić B 16, 17, 20, 23, 25, 26, 

27, 28, 29, 32, 33, 51, 71, 76, 84, 95, 100, 119, 

124, 127, 138, 141, 171 

Jeren T 16, 72 

Jonjić N 26, 28, 32, 60, 105, 137 

Jurenec F 28, 147 

Jurenec S 26, 71 

Juretić M 20, 75 

Jurič D 18, 19, 22, 81, 88, 98, 107, 116 

Jurić K 32, 125 

Juroš Z 16, 21, 34, 64, 70, 82, 148 

Kaić G 5, 16, 20, 30, 31, 33, 34, 72, 73, 

109, 112, 126, 135, 142, 157, 168 

Kani D 22, 98 

Karadža M 18, 38 

Kardum M 25, 83 

Kardum Paro MM 24, 31, 34, 48, 

153, 158, 184 

Kardum-Skelin 16, 17, 19, 21, 24, 25, 26, 27, 

28, 29, 30, 31, 32, 33, 34, 45, 46, 47, 48, 50, 51, 54, 

57, 58, 59, 71, 72, 73, 74, 76, 77, 83, 84, 89, 

90, 91, 95, 97, 100, 102, 119, 122, 123, 124, 127, 

133, 137, 141, 147, 154, 171, 175, 184 

Katalenić Simon S 19, 22, 29, 33, 86, 

87, 128, 174, 183 

Kezić G 31, 152 

Knežević A 29, 172 

Knežević G 29, 175 

Knežević-Obad A 16, 20, 72, 73, 85 

Knotek M 26, 27, 28, 51, 120, 130, 147 

Kocjan G 19, 49 

Kocman B 16, 26, 27, 40, 41, 51, 52, 95 

Kojić-Katović S 28, 146 

Konja J 26, 28, 37, 59, 124 

Korać P 29, 170 

Kovacević-Vojtusek I 27, 28, 51 

Kraljević Z 22, 43 

Krašević M 16, 104 

Krivak Bolanča I 19, 22, 29, 33, 86, 87, 

128, 174, 183 

Križaj B 29, 171 

Križanac Š 16, 33, 34, 82, 142, 148, 168 

Krmpotić D 21, 102 

Krupec AM 29, 172 

187 



Kujundžić M 20, 66, 109 

Kukura V 19, 22, 86, 87, 128 

Kuret S 31, 159 

Kusić Z 20, 23, 96, 102, 118 

Kuspilic M 24, 50 

Kušec R 30, 32, 155, 156, 160, 163 

Kvenić B 28, 137 

Labar B 17, 24, 25, 26, 44, 53, 65, 80, 149 

Lajtman Z 33, 145 

Lambaša S 33, 34, 126, 142, 145 

Lang N 28, 131 

Lasan R 28, 50, 131 

Lasan-Trčić R 16, 89 

Lebinec M 28, 133 

Letica Lj 32, 164 

Letilović T 17, 100 

Livun A 30, 160 

Lončar B 23, 31, 33, 91, 106, 131, 135 

Lozić AAB 21, 31, 75, 87 

Lozić B 31, 33, 152, 165 

Lukas D 30, 180 

Lukšić B 23, 116 

Ljevar I 29, 172 

Ljubanovic D 27, 28, 51, 120, 130 

Ljubić N 28, 131 

Mahovlić V 18, 19, 22, 27, 31, 33, 38, 

81, 88, 91, 98, 107, 116, 182 

Maljić S 29, 171 

Mandac I 16, 17, 89, 132 

Manestar D 20, 75 

Manestar M 19, 108 

Manojlović S 31, 102 

Maričević I 28, 129, 146 

Markanjević T 19, 29, 32, 108, 176, 181 

Marković-Glamočak M 17, 24, 25, 65, 

80, 149 

Martinac I 22, 101 

Martinčić J 29, 175 

Martinović M 32, 163 

Mateša N 20, 23, 96, 118 

Mateša-Anić D 23, 118 

Matulić M 33, 166 

Mazić S 26, 53 

Mažuranic I 21, 64 

Meandžija R 29, 173, 177 

188 

Meštrović D 26, 59 

Mihaljević I 19, 55 

Mihovilović K 27, 51 

Mikulić M 25, 65 

Milankovic Lj 29, 33, 179, 183 

Milanović D 31, 152 

Milanović R 34, 142 

Milas M 17, 26, 28, 29, 33, 34, 84, 90, 

127, 140, 141, 175, 184 

Milas R 28, 133 

Miletić Z 30, 32, 33, 34, 145, 157, 163, 

167, 168 

Miličić-Juhas V 16, 18, 19, 31, 55, 91, 92, 93 

Milojkovic D 22, 94 

Milojkovic M 19, 22, 55, 94 

Minigo H 28, 141 

Mišić M 16, 28, 95, 147 

Mišljenović N 21, 31, 75, 87 

Mitrečić D 21, 70 

Moldovan R 33, 144 

Morović-Vergles J 31, 112 

Moslavac S 20, 96 

Mrsić M 25, 26, 53, 65 

Mrsić S 25, 33, 65, 165 

Mrzljak A 21, 23, 26, 27, 40, 52, 97, 138 

Müller D 23, 139 

Muresan A 34, 144 

Mustapić D 33, 182 

Mužinić D 32, 164 

Naglić G 29, 173, 177 

Nagy A 34, 144 

Nakić M 26, 27, 45, 122 

Nassabain K 32, 125 

Naumovski- Mihalić S 32, 125 

Nazor A 24, 31, 33, 48, 134, 153, 158 

Nemet D 25, 26, 53, 65 

Novak NP 23, 30, 32, 33, 125, 135, 139, 157 

Obad-Knežević D 23, 138 

Obad-Kovačević 23, 32, 123, 138 

Odak D 28, 141 

Olteanu D 34, 144 

Oreško T 31, 152 

Orešković S 18, 19, 81, 107 

Ostojić Kolonić S 16, 24, 28, 32, 54, 57, 

58, 89, 123, 136, 141

Ostović I 32, 112 

Ovanin-Rakić A 18, 19, 22, 27, 81, 88, 

98, 107, 116 

Ožvald I 31, 153 

Pačić A 28, 147 

Pajtler M 18, 19, 22, 31, 55, 91, 92, 93, 94 

Páll E 34, 143 

Pandžić Jakšić V 32, 33, 163, 167 

Paradžik M 33, 166 

Parigros K 29, 175 

Pastorčić Grgić M 20, 99 

Pauzar B 23, 31, 33, 106, 131, 135 

Pavić T 20, 56 

Pedisić D 20, 75 

Pegan A 20, 99 

Peharec I 29, 175 

Pejša V 30, 32, 33, 160, 163, 168 

Perica B 18, 93 

Perić M 16, 17, 26, 29, 71, 77, 100, 171 

Perić Z 29, 172 

Perkov S 31, 153 

Perković L 28, 131 

Peroš-Golubičić T 21, 56, 64 

Petrović D 22, 101 

Piljić Burazer M 23, 116 

Pirkić A 22, 43 

Planinc-Peraica A 17, 24, 28, 30, 32, 54, 

57, 58, 90, 123, 136, 141, 156 

Planinić P 18, 38 

Plemić I 33, 183 

Poduje V 33, 182 

Popek B 29, 175 

Prašek-Kudrna K 24, 54 

Predragovic I 28, 133 

Prkačin I 17, 132 

Prstec Z 30, 180 

Prvulović I 18, 31, 93, 102 

Puljiz I 30, 180 

Radić-Krišto D 16, 24, 25, 28, 54, 57, 58, 

77,83, 136, 141 

Radman I 24, 80 

Raić Lj 26, 28, 124 

Rajhvajn S 18, 19, 22, 81, 88, 98, 107, 116 

Rajić Lj 26, 37, 59 

Rajković-Molek K 28, 32, 105, 124 

Rakek Novak S 29, 33, 174, 183 

Rakušić N 21, 102, 114 

Ramljak V 20, 31, 99, 103 

Raos M 26, 53 

Rešetar R 19, 29, 108, 178 

Ries S 17, 23, 24, 25, 26, 37, 65, 80, 149 

Rimac M 27, 122 

Roganović J 26, 28, 60, 137 

Rogošić S 26, 27, 45, 122 

Ropar S 27, 29, 33, 121, 137, 179, 183 

Roso V 24, 54 

Rubeša-Mihaljević R 16, 19, 104, 108 

Rubić K 29, 33, 179, 183 

Rus D 34, 143 

Sabljar-Matovinović M 27, 28, 32, 51, 119 

Sarnavka V 32, 164 

Schmitt FC 19, 61, 63 

Seili-Bekafigo I 26, 28, 29, 32, 60, 105, 

137, 177 

Sertić D 25, 26, 53, 65 

Serventi-Seiwerth R 25, 26, 53, 65 

Sikirica M 31, 153 

Sindik N 16, 104 

Smojver-Ježek S 16, 17, 21, 29, 34, 56, 

64, 70, 72, 73, 114, 148, 175 

Sofronie A 34, 144 

Sokolić I 31, 153, 158 

Soritu O 32, 34, 110, 111, 143 

Srpak N 21, 70 

Staklenac B 23, 31, 33, 106, 131, 135 

Stančić V 27, 117 

Stanec S 33, 126 

Starčević R 20, 75 

Stepan S 27, 122 

Stipić J 33, 166 

Stupnišek M 30, 180 

Sučić M 17, 24, 25, 44, 65, 80, 149 

Susman S 32, 34, 110, 111, 143 

Suša M 19, 81 

Šamija I 22, 88 

Šamija Projić I 19, 81 

Šarčević B 20, 31, 99, 103 

Šegulja S 26, 60 

Šentija K 19, 22, 29, 33, 86, 87, 128, 174, 183 

Šenjug P 33, 168 

189 



Šeparović V 33, 127 

Šiftar Z 17, 24, 31, 34, 48, 90, 153, 158, 184 

Šimat M 26, 37 

Škegro D 16, 21, 23, 27, 40, 95, 97, 138 

Škopljanac-Mačina L 18, 19, 22, 81, 88, 

98, 107, 116 

Škoro M 23, 31, 33, 112, 135, 139 

Škrablin-Kučić S 22, 88 

Škrgatić L 18, 38 

Škrtić A 22, 26, 28, 41, 128, 140 

Škurla B 23, 138 

Šoljić V 23, 116 

Štambuk S 31, 159 

Štanfel O 29, 177 

Štemberger C 29, 32, 105, 173 

Štemberger-Papić S 16, 18, 19, 22, 104, 

108, 113, 115 

Štingl K 32, 162 

Štoos-Veić T 20, 30, 33, 34, 66, 109, 

126, 142, 142, 145, 157, 160 

Šundov D 23, 31, 116, 159 

Šurina B 31, 153 

Šušković- Medved S 29, 175 

Šušterčić D 21, 23, 24, 26, 27, 28, 29, 

30, 40, 48, 50, 52, 84, 97, 133, 141, 156, 175 

Švencbir V 34, 184 

Tadić M 20, 30, 66, 157 

Tekavec-Trkanjec J 21, 64 

Tešović G 26, 59 

Tokić T 33, 137 

Tomas D 28, 146 

Tomasović-Lončarić Č 33, 34, 135, 142 

Tomić-Brzac H 20, 85 

Rešković T 102 

Tomuleasa C 32, 34, 110, 111, 143 

Tonković Đurišević I 32, 162, 164 

Topolovec Z 19, 55 

Tötsch M 19, 67 

Trip DM 34, 144 

Trutin Ostović K 17, 20, 23, 29, 30, 31, 

32, 33, 34, 103, 109, 112, 126, 135, 139, 142, 

145, 157, 163, 167, 168, 172 

Valetić J 32, 119 

Vasilj A 27, 28, 31, 117, 129, 146 

Vergles J 31, 112 

190 

Verhest A 18, 63, 68 

Verša Ostojić D 16, 18, 19, 22, 104, 108, 

113, 115 

Vidas Z 27, 120 

Vidas Ž 16, 27, 28, 31, 32, 51, 95, 119, 

120, 130, 147, 153 

Vidić-Paulišić I 23, 28, 3, 127, 138 

Vidjak V 28, 141 

Vidović LJ 33, 126 

Vielh P 18, 63, 70 

Vince A 16, 72 

Virag M 23, 139 

Vojnović J 33, 126 

Vrabec-Branica B 16, 17, 21, 34, 64, 70, 

82, 102, 148 

Vraneš J 19, 86 

Vrbanus LJ 17, 25, 65, 149 

Vrbica Ž 21, 114 

Vrdoljak DV 31, 103 

Vrdoljak-Mozetič D 16, 18, 19, 22, 27, 104, 

108, 113, 115 

Vrhovac R 16, 17, 24, 26, 29, 58, 71, 77, 

89, 100, 171 

Vujević D 30, 180 

Vukelić-Marković M 20, 66 

Vukosavić-Cimić B 4, 22, 43 

Vunić S 29, 176 

Zadražil B 29, 175 

Zadro R 25, 65 

Zeljko Ž 32, 119 

Zemunik T 33, 165 

Žarkovic K 20, 85 

Žic R 33, 135 

Židovec Lepej S 5, 30, 161 

Žokvić E 28, 146 

Županić-Krmek D 28, 131

ilješke / notes 

191 



bilješke / notes 

192

tehniËki organizator kongresa 

tehnical organizer and official pco 

PCO 

A. Hebranga 20, 10000 ZAGREB, Hrvatska 

tel: +385 1 45 53 290 

fax: +385 1 45 53 284 

e-mail: ksenija.zunic@penta-zagreb.hr 

www.penta-zagreb.hr 

congress website: 

www.penta-zagreb.hr/citologija

4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

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