4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta
4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta
4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta
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<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong><br />
<strong>kliniËke</strong> <strong>citologije</strong><br />
4 th <strong>Croatian</strong> <strong>Congress</strong><br />
of Clinical Cytology<br />
1. <strong>Hrvatski</strong> simpozij<br />
analitiËke <strong>citologije</strong><br />
1 st <strong>Croatian</strong> Symposium<br />
of Analytical Cytology<br />
2. <strong>Hrvatski</strong> simpozij<br />
citotehnologije<br />
2 nd <strong>Croatian</strong> Symposium<br />
of Cytotechnology<br />
s meappleunarodnim sudjelovanjem<br />
with international participation<br />
Le Meridien Lav, Split<br />
October 11-14, 2009<br />
konaËni program i knjiga saæetaka<br />
final programme and abstract book
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong><br />
<strong>4th</strong> <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology<br />
1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong><br />
1st <strong>Croatian</strong> Symposium of Analytical Cytology<br />
2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
2nd <strong>Croatian</strong> Symposium of Cytotechnology<br />
s meappleunarodnim sudjelovanjem<br />
with international participation<br />
Le Meridien Lav, Split<br />
11-1<strong>4.</strong> listopad 2009.<br />
October 11-14, 2009<br />
konaËni program i knjiga saæetaka / fi nal programme and abstract book<br />
1
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
RIJEČ DOBRODOŠLICE<br />
2<br />
Konačni program i knjiga sažetaka<br />
Cijenjene kolegice i kolege, dragi prijatelji,<br />
Velika nam je čast i zadovoljstvo pozvati Vas u ime Organizacijskog Odbora na<br />
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> citologa, 1. <strong>Hrvatski</strong> simpozij analitičke <strong>citologije</strong> i 2. Simpozij citotehnologa<br />
s međunarodnim sudjelovanjem koji će se održati od 11. do 1<strong>4.</strong> listopada 2009.<br />
u Splitu.<br />
Neobično nam je drago što će se po prvi put u sklopu Kongresa održati i 1. Simpozij<br />
analitičke <strong>citologije</strong>, čime nam je pružena prilika za integraciju elemenata klasične <strong>citologije</strong><br />
i citokemije, biologije, histologije, patologije, analize slike, protočne citometrije<br />
i informatike sa zajedničkim ciljem istraživanja stanica u znanstvene i primijenjene<br />
svrhe.<br />
Sada već utemeljeni 2. Simpozij citotehnologa je prilika za međusobnu razmjenu iskustava<br />
i zajednička neformalna druženja cijelog citološkog tima.<br />
Nadamo se da će odabir tema i aktivno sudjelovanje vrlo uglednih svjetskih i domaćih<br />
stručnjaka pobuditi iznimno zanimanje liječnika različitih specijalnosti koji se bave morfologijom<br />
ili njene rezultate koriste u svakodnevnom radu. Rad Kongresa odvijat će se<br />
kroz plenarna predavanja, simpozije, seminare, usmena izlaganja i poster sekcije.<br />
Želja nam je da iskoristimo ovaj boravak i za ugodno druženje tijekom Kongresa, u obilasku<br />
Splita, na izletu brodom, uz zajedničku večeru.<br />
Prema stranicama Turističke zajednice grada Splita, za grad u koji ćete stići, njegovi će<br />
vam stanovnici s puno ponosa kazati kako je “najlipši na svitu i okolici” i o tome s njima<br />
nemojte raspravljati, jer tisućljetni Split vedra duha koji ćete ubrzo otkriti, uvjerit će i vas<br />
u to! Taj vječno mladi grad s oko 200 tisuća stanovnika koji mu daju topli mediteranski<br />
temperament, živi svojim urbanim ritmom već 1700 godina, sa srcem u Dioklecijanovoj<br />
palači i dušom koja vas dočekuje raširenih ruku i srdačno. Split je kulturno, političko,<br />
privredno i prometno čudo u središtu Dalmacije. Grad dugogodišnje prošlosti; bilo gdje<br />
da zabodeš “motikom” nešto nađeš - raj za arheologe. Danas, Split je drugi grad po<br />
veličini u Hrvatskoj i značajno turističko odredište brojnih turista zbog svoje bogate povijesti,<br />
prirodnih ljepota, idealnog položaja u odnosu na brojne okolne gradiće i izletišta<br />
te pre lijepih plaža.<br />
Nadamo se da ćemo ispuniti vaša očekivanja, uz napomenu da uspjeh Kongresa ovisi i o<br />
vašem aktivnom sudjelovanju.<br />
Očekujemo vas u Splitu.<br />
Doc.dr.sc. Ika Kardum-Skelin<br />
Predsjednica, Hrvatsko društvo<br />
za kliničku citologiju HLZ<br />
Prof.dr.sc. Drago Batinić<br />
Predsjednik, Sekcija za<br />
analitičku citologiju<br />
Veronika Anić<br />
Predsjednica, Hrvatska<br />
udruga citotehnologa
Final programme and abstract book<br />
WELCOMING ADDRESS<br />
Dear colleagues, dear friends,<br />
We are honored and pleased to invite you, on behalf of the Organizing Committee, to the<br />
Fourth <strong>Croatian</strong> <strong>Congress</strong> of Cytology, First <strong>Croatian</strong> Symposium of Analytical Cytology,<br />
and Second Symposium of Cytotechnologists with International Participation to be held<br />
on October 11-14, 2009 in Split, Croatia.<br />
We are very glad that the First <strong>Croatian</strong> Symposium of Analytical Cytology is organized<br />
within the scope of the <strong>Congress</strong>, thus providing an opportunity to integrate the elements<br />
of classic cytology and cytochemistry, biology, histology, pathology, image analysis, flow<br />
cytometry and informatics, with a common endpoint of cell research for scientific and<br />
applied purposes.<br />
The already established Second Symposium of Cytotechnologists offers an additional<br />
opportunity for experience exchange and informal meetings of the cytologic team as a<br />
whole.<br />
We do hope that the topics selected and active participation of renowned international<br />
and <strong>Croatian</strong> experts will arouse great interest among physicians of various specialties<br />
involved in morphology or using these results in their daily routine. The work of the <strong>Congress</strong><br />
will include plenary lectures, symposia, seminars, oral presentations and poster<br />
sections.<br />
It is our wish to use part of the time for pleasant contacts during the <strong>Congress</strong> and for<br />
Split sight-seeing including boat excursion and dinner.<br />
As the Split Tourist Office website says, the citizens will be proud to present Split as<br />
“the most beautiful town in the world and its surroundings”, and you are advised not<br />
to challenge this statement because the millennial Split of alert and keen spirit you<br />
will readily feel will certainly make you believe it. This forever young town with about<br />
200,000 inhabitants of warm, Mediterranean mentality has been living its urban rhythm<br />
for more than 1700 years now, with its heart rooted in the famous Palace of Diocletian<br />
and its soul embracing you sincerely and heartily. Split is a cultural, political, economic<br />
and communications miracle in the center of Dalmatia, a town of long-standing history;<br />
dig wherever you want, you will find some relic - paradise for archeologists. Today, Split<br />
is the second largest city in Croatia and an important tourist destination for numerous<br />
tourists because of its rich history, natural beauties, and ideal position relative to the<br />
many picturesque places, excursion resorts and beautiful beaches in its surroundings.<br />
We do hope that we will meet your expectations, however, the full success of the <strong>Congress</strong><br />
will also depend on your active participation.<br />
We look forward to meet you in Split.<br />
Assist. Prof. Ika Kardum-Skelin, PhD<br />
President, <strong>Croatian</strong> Society<br />
for Clinical Cytology<br />
Professor Drago Batinić, PhD<br />
President, Section for<br />
Analytical Cytology<br />
Veronika Anić, Cytotechnologist<br />
President, <strong>Croatian</strong> Society<br />
for Cytotechnology<br />
3<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
ORGANIZATORI / ORGANIZERS<br />
Akademija medicinskih znanosti Hrvatske<br />
Academy of Medical Sciences of Croatia<br />
<strong>Hrvatski</strong> liječnički zbor<br />
<strong>Croatian</strong> Medical Association<br />
Hrvatsko društvo za kliničku citologiju<br />
<strong>Croatian</strong> Society for Clinical Cytology<br />
Sekcija za analitičku citologiju<br />
Section for Analytical Cytology<br />
Hrvatska udruga citotehnologa<br />
<strong>Croatian</strong> Society of Cytotechnology<br />
Klinička bolnica Merkur, Zagreb<br />
University Hospital Merkur, Zagreb<br />
POKROVITELJI / UNDER THE AUSPICES OF<br />
Predsjednik Republike Hrvatske<br />
President of the Republic of Croatia<br />
Ministarstvo znanosti, obrazovanja i športa Rebublike Hrvatske<br />
Ministry of Science, Education and Sport of the Republic of Croatia<br />
Ministarstvo zdravstva i socijalne skrbi Rebublike Hrvatske<br />
Ministry of Health and Social Welfare of the Republic of Croatia<br />
Hrvatska liječnika komora<br />
<strong>Croatian</strong> Medical Chamber<br />
Grad Split<br />
City of Split<br />
Sveučilište u Splitu i Medicinski fakultet Sveučilišta u Splitu<br />
University of Split and University of Split School of Medicine<br />
Klinički bolnički centar Split<br />
Clinical Hospital Center Split<br />
POČASNI ODBOR / HONORARY COMMITTEE<br />
S. Anđelinović S. Audy-Jurković D. Boban<br />
I. Črepinko H. Harambašić T. Jeren<br />
M. Marinković M. Mazzi-Maržić M. Nakić<br />
Z. Papić I. Pongrac M. Roglić<br />
Z. Singer T. Stanković Đ. Šips<br />
B. Vukosavić-Cimić Ž. Znidarčić<br />
4<br />
Konačni program i knjiga sažetaka
Final programme and abstract book<br />
ZNANSTVENI ODBOR / SCIENTIFIC COMMITTEE<br />
A. Batinica-Grgurević S. Boljkovac S. Ćurić-Jurić<br />
M. Dominis M. Drobnjak F. Gizdić<br />
B. Ivezić A. Knežević-Obad G. Kocjan<br />
R. Kušec Z. Mandić M. Marković-Glamočak<br />
A. Ovanin-Rakić M. Pajtler F. Selmani<br />
M. Sučić K. Trutin Ostović A. Vince<br />
ORGANIZACIJSKI ODBOR / ORGANIZING COMMITTEE<br />
Predsjednici / Presidents<br />
I. Kardum-Skelin D. Batinić V. Anić<br />
Dopredsjednici / Vice presidents<br />
V. Mahovlić<br />
K. Rubić<br />
Tajnici / Secretaries<br />
B. Molnar Stantić D. Šundov<br />
L. Škopljanac-Mačina<br />
Lj. Gavranović<br />
Rizničari / Treasurers<br />
B. Jelić-Puškarić R. Lasan-Trčić<br />
J. Antulov<br />
Članovi / Members<br />
S. Smojver-Ježek M. Švigir<br />
R. Beljan S. Cuvaj I. Fabijanić<br />
S. Harabajsa G. Kaić G. Knežević<br />
S. Kojić-Katović A. Krupec N. Mateša<br />
Z. Miletić M. Piljić-Burazer V. Ramljak<br />
I. Seili-Bekafigo Z. Šiftar D. Vrdoljak-Mozetič<br />
I. Zaneta S. Židovec-Lepej<br />
STRUČNI PROGRAM KONGRESA / SCIENTIFIC PROGRAMME<br />
Kongres će se odvijati u obliku plenarnih predavanja, simpozija, slide seminara, usmenih<br />
i poster prezentacija.<br />
The <strong>Congress</strong> presentations will include plenary sessions, symposiums, slide seminars,<br />
papers sessions and posters displays.<br />
5<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
6<br />
Konačni program i knjiga sažetaka<br />
UPUTE ZA PREDAVAČE / INSTRUCTION FOR SPEAKERS<br />
Prezentacija/Presentation<br />
Domaći predavači prezentaciju pripremaju na hrvatskom jeziku za sve oblike prezentacija,<br />
osim za postere koji mogu biti i na engleskom. Strani predavač pripremaju prezentacije<br />
na engleskom bez simultanog prevođenja na hrvatski. / Speakers from Croatia<br />
should prepare their presentation in <strong>Croatian</strong> language for all Presentation Formats<br />
except Poster Presentation. Foreign speakers should prepare their presentation in English<br />
(there will be no no simultaneous translation)<br />
Predavači se mole da pripreme svoje predavanje najmanje 1 sat prije predviđenog termina<br />
za prezentaciju. Soba za pripremu predavanja biti će otvorena dnevno od 8.00 do 19.00 sati.<br />
/ Speakers are kindly asked to prepare their computer presentations at least one hour<br />
before their lecture. Preparation room will be open daily from 8.00 a.m. to 7.00 p.m.<br />
Poster prezentacije / Poster presentations<br />
Posteri će biti izloženi na vidljivom jestu u <strong>kongres</strong>nom prostoru na panoima bijele boje,<br />
veličine 1m (širina) x 2m (visina). Dimenzije postera: 0,8 m (širina) x 1,2 m (visina).Posteri<br />
se donose osobno na Kongres. Materijal za ljepljenje postera osigurava organizator. /<br />
Posters will be displayed in the exhibition area on white poster panelling, 1m wide x 2m<br />
high. Posters would be 0.80 m wide x 1,2 m high. The authors will bring the posters in<br />
person. Supplies for mounting of posters will be provided by the <strong>Congress</strong> Service.<br />
PRIJAVA NA KONGRESU / REGISTRATION AT DESK<br />
Sudionici se mogu prijaviti na registracijskom mjestu u vrijeme: / The <strong>Congress</strong> Registration<br />
desk will be open for on-site registration at the following times:<br />
- nedjelja, 11. listopada 2009. / Sunday, October 11, 2009<br />
- ponedjeljak, 12. listopada 2009. / Monday, October 12, 2009<br />
- utorak, 13. listopada 2009. / Tuesday, October 13, 2009<br />
- srijeda, 1<strong>4.</strong> listopada 2009. / Wednesday, October 14, 2009<br />
KOTIZACIJE / REGISTRATION FEES<br />
od 31. kolovoza 2009. i na mjestu održavanja<br />
after August 31st Specijalisti / Specialists<br />
, 2009 and on the site<br />
1.500,00 kn<br />
Specijalizanti i studenti / Residents and students 1.000,00 kn<br />
Citotehnolozi / Cytotechnologists 900,00 kn<br />
Dnevna kotizacija / Day registration fee 800,00 kn<br />
Radionice / Workshops<br />
U iznose je uključen PDV (23%) / VAT (23%) is included<br />
300,00 kn
Final programme and abstract book<br />
Trodnevna kotizacija uključuje / Full registration fee includes:<br />
• nazočnost stručnom programu Kongresa<br />
admission to all congress sessions, poster and exhibition areas<br />
• <strong>kongres</strong>ne materijale (konačni program, Knjiga sažetaka, <strong>kongres</strong>na torba<br />
congress materials (Final programme, Abstract book, congress bag)<br />
• nazočnost na svečanom otvorenju Kongresa, domjenku dobrodošlice / admission to<br />
the Opening Ceremony, Welcome party<br />
Jednodnevna kotizacija uključuje / Daily registration fee includes:<br />
• nazočnost stručnom programu Kongresa<br />
admission to all congress sessions, poster and exibition areas<br />
• <strong>kongres</strong>ne materijale ( Konačni program, Knjigu sažetaka)<br />
congress materials (Final programme, Abstract book)<br />
OPĆE INFORMACIJE / GENERAL INFORMATION<br />
Mjesto održavanja Kongresa / <strong>Congress</strong> Venue<br />
HOTEL LE MERIDIEN LAV, Podstrana (Split), Hrvatska / Croatia<br />
Službeni jezik / Official Language<br />
Službeni jezik Kongresa je hrvatski i engleski (simultano prevođenje neće biti osigurano)<br />
Official languages are <strong>Croatian</strong> and English (the simultaneus translation will not be provided).<br />
Službene oznake / Official Badges<br />
Sudionici Kongresa i osobe u pratnji s plaćenom kotizacijom dobivaju prilikom prijave<br />
identifikacijsku karticu (<strong>kongres</strong>ni bedž) s imenom koju su obvezni nositi na svim mjestima<br />
službenog radnog dijela Kongresa. / After paying the registration fee, all participants<br />
and accompanying persons will receive their name congress badges. Participants are<br />
kindly requested to wear the badges at all times and places during the official <strong>Congress</strong><br />
Program.<br />
Potvrda o sudjelovanju / Attendance Certificate<br />
Svi sudionoci Kongresa s plaćenom kotizacijom dobit će verificiranu Potvrdu o sudjelovanju.<br />
Temeljem Pravilnika o trajnom usavršavanjem Hrvatske liječničke komore, sudjelovanje<br />
liječnika na Kongresu bodovno će se vrednovati. / A Certificate of Attendance will be issued to<br />
all registered participants. Active participation at the <strong>Congress</strong> will be valuated with points.<br />
7<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
Izložbe / Exhibition<br />
Za cijelo vrijeme trajanja Kongresa, u <strong>kongres</strong>nim prostorima bit će postavljena izložba<br />
medicinske opreme i potrošnog materijala. Tvrtke zainteresirane za takav način<br />
promidžbe neka se obrate tehničkom organizatoru <strong>kongres</strong>a. / During the <strong>Congress</strong>,<br />
an exhibition of medical equipment, instruments and material will be organised in the<br />
exhibit space of the hotel. Companies interested in advertising their products should<br />
contact the <strong>Congress</strong> Technical Organizer PENTA PCO.<br />
Društvena događanja / Social Events<br />
Nedjelja, 11. listopada 2009. / Sunday, October 11th 2009<br />
17:45 Razgledavanje Splita / Tour Split<br />
20:00 Svečano otvorenje Kongresa / Opening Ceremony<br />
i / and Domjenak dobrodošlice / Welcome party<br />
(Split - Dioklecijanovi podrumi) / (Split - The cellars of the Diocletian’s Palace)<br />
Ponedjeljak, 12. listopada 2009. / Monday, October 12th 2009<br />
20:00 Svečana večera / Get Together Dinner<br />
Cijena svečane večere 500 kuna (cca 65 EUR) po osobi<br />
The price of Get Together Dinner: 65 EUR per person<br />
Utorak, 13. listopada 2009. / Tuesday, October 13th 2009<br />
Izlet brodom i domjenak na Brodu / Excursion by Boat and Cocktail<br />
Split -Kaštela-Trogir-Split<br />
8<br />
Konačni program i knjiga sažetaka
Final programme and abstract book<br />
ZAHVALA / ACKNOWLEDGEMENTS<br />
Organizacijski odbor i Tehnički organizator zahvaljuju sponzorima i pokroviteljima koji<br />
su ovaj <strong>kongres</strong> te njegov stručni i društveni program učinili ostvarivim. / Organizing<br />
Comittee and Techical Organizer would like to express their gratitude to sponsors and<br />
donators who made this <strong>Congress</strong> and its scientific and social events possible.<br />
GLAVNI SPONZOR<br />
Klinička bolnica Merkur, Zagreb<br />
ZLATNI SPONZORI<br />
Grad Split<br />
Pliva Hrvatska d.o.o.<br />
SPONZORI / SPONSORS<br />
A & B d.o.o.<br />
Abbott Laboratories d.o.o<br />
Auto Hrvatska<br />
Grad Split<br />
Jadroplov d.d.<br />
Kamenoklesarski obrt Cvitković<br />
Klinička bolnica “Merkur”<br />
Medical Intertrade d.o.o.<br />
Merck d.o.o.<br />
Ministarstvo zdravstva i socijalne skrbi RH<br />
Ministarstvo znanosti obrazovanja i športa RH<br />
Olympus d.o.o.<br />
Pliva Hrvatska d.o.o.<br />
Poliklinik CITO<br />
Privatna specijalistička ordinacija medicinske <strong>citologije</strong> -<br />
dr.med. Branka Molnar Stantić, spec. medicinske <strong>citologije</strong><br />
Roche d.o.o.<br />
Sonimed d.o.o.<br />
Tamiko Instruments d.o.o.<br />
DONATORI / DONATORS<br />
KUD “7 Kaštela”<br />
KUD “Pleter”<br />
Muška klapa “Šušur”, Split<br />
Plovput d.d.<br />
Poliklinika J&J Medici<br />
Privatna specijalistička ordinacija medicinske <strong>citologije</strong> -<br />
dr.med. Ivan Anđelko Lisec, spec. medicinske <strong>citologije</strong><br />
Sretno d.o.o.<br />
Turistička zajednica grada Kaštela<br />
Turistička zajednica grada Splita<br />
ZYN BAND, Sinj<br />
Ženska klapa “Marjan”, Split<br />
9
Final programme and abstract book
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
12<br />
NEDJELJA 11.10.2009. PONEDJELJAK, 12.10.2009.<br />
Sunday 11th October Monday 12th October
UTORAK, 13.10.2009. SRIJEDA, 1<strong>4.</strong>10.009.<br />
Tuesday 13th October Wednesday 1<strong>4th</strong> October<br />
13<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
Final programme and abstract book<br />
program<br />
programme<br />
15<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
NEDJELJA , 11.10.2009. / SUNDAY, October 11, 2009<br />
8,00-10,00 REGISTRACIJA / REGISTRATION<br />
10,00-10,30 PAUZA / BREAK<br />
16<br />
Konačni program i knjiga sažetaka<br />
DVORANA 1/ HALL 1 (Grand Dalmacija)<br />
OKRUGLI STOL / ROUND TABLE<br />
Citologija u primarnoj zaštiti djece i odraslih /<br />
Cytology in Primary Health Care of Children and Adults<br />
Predsjedavajući/Chairpersons: Znidarčić Ž, Jeren T, Vince A<br />
10,30-13,00 CYTOLOGY IN PRIMARY HEALTH CARE OF CHILDREN AND ADULTS<br />
Jeren T, Kaić G, Kardum-Skelin I, Knežević-Obad A, Smojver-Ježek S,<br />
Vince A (Moderator: Znidarčić Ž)<br />
13,00-14,00 RUČAK / LUNCH<br />
PRIKAZI SLUČAJEVA / CASE REPORTS<br />
Specijalizanti / Residents<br />
Predsjedavajući/Chairpersons: Jelić Puškarić B, Beljan R, Miličić-Juhas V<br />
16,00-16,10 VILLOGLANDULAR PAPILLARY ADENOCARCINOMA OF THE UTERINE<br />
CERVIX WITH AGGRESSIVE CLINICAL COURSE - A CASE REPORT<br />
Rubeša-Mihaljević R, Vrdoljak-Mozetič D, Verša Ostojić D,<br />
Štemberger-Papić S, Sindik N, Krašević M (Rijeka, Croatia)<br />
16,10-16,20 PNEUMOCYSTIS CARINII IN THE TRANSBRONCHIAL LUNG BIOPSY<br />
IMPRINT OF THE PATIENT NOT KNOWN TO BE HIV INFECTED -<br />
CASE REPORT<br />
Juroš Z, Smojver Ježek S, Vrabec Branica B, Alerić I, Križanac Š<br />
(Zagreb, Croatia)<br />
16,20-16,30 DIFFUSE LARGE B-CELL LYMPHOMA IN PATIENT AFTER TREATMENT<br />
OF ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA<br />
Džeko-Škugor N, Perić Z, Vrhovac R, Radić-Krišto D, Kardum-Skelin I,<br />
Jakšić B (Šibenik, Zagreb, Croatia)<br />
16,30-16,40 FINE NEEDLE ASPIRATION CYTOLOGY OF<br />
ADRENOCORTICAL CARCINOMA: CASE REPORT<br />
Mišić M, Vidas Ž, Škegro D, Kocman B, Jelić-Puškarić B,<br />
Kardum-Skelin I (Slavonski Brod, Zagreb, Croatia)<br />
16,40-16,50 T-LYMPHOBLASTIC LYMPHOMA WITH AN UNUSUAL<br />
t(8;14)(q24;q11) - CASE REPORT<br />
Mandac I, Ostojić-Kolonić S, Vrhovac R, Lasan-Trčić R,<br />
Jakelić-Piteša J, Kardum-Skelin I (Zagreb, Split, Croatia)
Final programme and abstract book<br />
16,50-17,00 T LYMPHOBLASTIC LEUKEMIA WITH AN UNUSUAL BURKITT<br />
LYMPHOMA MORPHOLOGY - A CASE REPORT<br />
Milas M, Jelić Puškarić B, Planinc-Peraica A, Šiftar Z, Kardum-Skelin I,<br />
Jakšić B (Zagreb, Croatia)<br />
17,00-17,10 AN UNUSUAL PRESENTATION OF GAUCHER’S DISEASE: AORTIC<br />
VALVE FIBROSIS IN A PATIENT HOMOZYGOUS FOR A RARE G377S<br />
MUTATION - A CASE REPORT<br />
Perić Z, Kardum-Skelin I, Jelić-Puškarić B, Letilović T, Vrhovac R,<br />
Jakšić B (Zagreb, Croatia)<br />
17,10-17,20 RASPRAVA / DISCUSSION<br />
DVORANA 2/ HALL 2 (BRAČ I)<br />
RADIONICE / WORKSHOPS<br />
10,00-17,45<br />
Pulmološka citologija - Karcinomi pluća / Pulmonary Cytology - Lung carcinoma<br />
Smojver-Ježek S, Vrabec-Branica B<br />
Urološka citologija / Urocytology<br />
Trutin Ostović K, Novak N-P<br />
18,00-19,30 RAZGLEDAVANJE SPLITA / TOUR-SPLIT<br />
20,00 OTVORENJE KONGRESA / OPENING CEREMONY<br />
Podrumi Dioklecianove palače, Split / Diocletian’s cellars, Split<br />
KOKTEL DOBRODOŠLICE / WELCOME PARTY<br />
POSTERI / POSTERS<br />
SPECIJALIZANTI / RESIDENTS<br />
P1. SEPTIC ARTHRITIS DUE TO STREPTOCOCCUS SANGUIS<br />
Mandac I, Prkačin I, Sabljar Matovinović M (Zagreb, Croatia)<br />
P2. APOPTOSIS OF LEUKEMIC CELLS - A CASE REPORT<br />
Vrbanus LJ, Sučić M, Marković-Glamočak M, Ries S,Gjadrov Kuveždić K,<br />
Fabijanić I, Antulov J, Labar B (Zagreb, Croatia)<br />
17<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
PONEDJELJAK, 12.10.2009. / MONDAY, October 12, 2009<br />
18<br />
Konačni program i knjiga sažetaka<br />
DVORANA 1/ HALL 1 (Grand Dalmacija)<br />
PLENARNA PREDAVANJA / PLENARY SESSION<br />
Predsjedavajući / Chairpersons: Audy-Jurković S, Mahovlić V<br />
08,30-09,00 WHY, HOW AND FOR WHAT BENEFIT INTEGRATING MOLECULAR<br />
TECHNIQUES INTO BREAST CYTOPATHOLOGY?<br />
Vielh P (Villejuif CEDEX - France)<br />
09,00-09,30 BENEFITS OF LBC OVER CONVENTIONAL PAP TEST, PRESENT<br />
AND FUTURE<br />
Verhest A (Brussels, Belgium)<br />
9,30-10,00 RISK-ADAPTED MULTIMODAL LABORATORY CERVICAL SCREENING -<br />
PAP TEST OF THE FUTURE?<br />
Bollmann R (Bonn-Duisdorf, Germany)<br />
10,00-10,30 PAUZA / BREAK<br />
SIMPOZIJ - Ginekološka citologija vrata maternice /<br />
SYMPOSIUM - Gynecological Cytology-Uterine Cervix<br />
I. Predsjedavajući / Chairpersons: Audy-Jurković S, Ćorušić A, Grce M<br />
10,30-10,45 CERVICAL CANCER AS A PUBLIC HEALTH ISSUE - WHAT NEXT?<br />
Ćorušić A, Škrgatić L, Mahovlić V, Mandić V, Planinić P, Karadža M<br />
(Zagreb, Mostar, Croatia, Bosna and Herzegovina)<br />
10,45-11,00 ROLE OF HPV TESTING IN CERVICAL CANCER PREVENTION<br />
Grce M (Zagreb, Croatia )<br />
11,00-11,08 CERVICAL CANCER SCREENING PROGRAMME IN<br />
PRIMORSKO-GORANSKA COUNTY, CROATIA<br />
Vrdoljak-Mozetič D, Verša Ostojić D, Štemberger-Papić S, Janković S,<br />
Glibotić-Kresina H, Brnčić-Fischer A, Benić-Salamon K<br />
(Rijeka, Opatija, Croatia)<br />
11,08-11,16 CERVIX CANCER SCREENING IN CROATIA WITHIN THE EUROPEAN<br />
CERVICAL CANCER PREVENTION WEEK<br />
Škopljanac-Mačina L, Mahovlić V, Ovanin-Rakić A, Barišić A,<br />
Rajhvajn S, Jurič D, Babić D, Ćorušić A, Orešković S (Zagreb, Croatia)<br />
11,16-11,24 PAP TEST - WITH OR WITHOUT VAGINAL SMEAR?<br />
Miličić-Juhas V, Perić M, Pajtler M, Prvulović I, Čuržik D<br />
(Osijek, Slavonski Brod, Croatia)<br />
11,35-11,45 PAUZA / BREAK
Final programme and abstract book<br />
II. Predsjedavajući / Chairpersons: Babić D, Pajtler M, Vrdoljak-Mozetič D<br />
11,45-12,00 ASSESSMENT OF HPV DNA TEST VALUE IN MANAGEMENT WOMEN<br />
WITH CYTOLOGICAL FINDINGS OF ASC-US, CIN1 AND CIN2<br />
Pajtler M, Miličić-Juhas V, Milojković M, Topolovec Z, Čuržik D,<br />
Mihaljević I (Osijek, Croatia)<br />
12,00-12,15 CONFIRMATION OF CIN I<br />
Babić D (Zagreb, Croatia)<br />
12,15-12,23 IS THE HSIL SUBCLASSIFICATION CYTOLOGICALLY REAL AND<br />
CLINICALLY JUSTIFIED?<br />
Miličić-Juhas V, Pajtler M (Osijek, Croatia)<br />
12,23-12,31 LIQUID-BASED CYTOLOGY - NEW POSSIBILITIES IN THE DIAGNOSIS<br />
OF CERVICAL LESIONS<br />
Jurič D, Mahovlić V, Rajhvajn S, Ovanin-Rakić A, Škopljanac-Mačina L,<br />
Barišić A , Šamija Projić I, Babić D, Suša M, Ćorušić A, Orešković S<br />
(Zagreb, Croatia)<br />
12,31-12,39 ESTIMATING CLINICAL OUTCOME OF HPV INDUCED CERVICAL<br />
LESION BY COMBINATION OF CAPSID PROTEIN L1 AND P16INK4a<br />
PROTEIN DETECTION<br />
Krivak Bolanča I, Šentija K, Katalenić Simon S, Kukura V, Vraneš J<br />
(Zagreb, Croatia)<br />
12,39-12,47 EVALUATION OF THE HPV L1 CAPSID PROTEIN IN PROGNOSIS OF<br />
MILD AND MODERATE DYSPLASIA OF THE CERVIX UTERI<br />
Štemberger-Papić S, Vrdoljak-Mozetič D, Verša Ostojić D,<br />
Rubeša-Mihaljević R, Markanjević T, Rešetar R, Manestar M<br />
(Rijeka, Croatia)<br />
13,00-14,00 RUČAK / LUNCH<br />
PLENARNA PREDAVANJA / PLENARY SESSION<br />
Predsjedavajući / Chairpersons: Znidarčić Ž, Kardum-Skelin I<br />
14,00-14,30 FINE NEEDLE ASPIRATION CYTOLOGY OF THE PANCREAS: A GUIDE<br />
TO DIAGNOSTIC APPROACH<br />
Kocjan G (London, United Kingdom)<br />
14,30-15,00 MORPHOLOGICAL AND MOLECULAR ANALYSIS OF GISTS ON<br />
CYTOLOGY<br />
Schmitt FC (Porto, Portugal)<br />
15,00-15,30 IMPLEMENTATION OF MODERN TECHNIQUES IN FNA OF THE<br />
THYROID<br />
Tötsch M (Essen, Germany)<br />
19<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
SIMPOZIJ - Citologija štitnjače, glave i vrata /<br />
SYMPOSIUM - Thyroid and Head & Neck Cytology<br />
Predsjedavajući / Chairpersons: Mateša N, Knežević-Obad A, Markov D<br />
20<br />
Konačni program i knjiga sažetaka<br />
16,00-16,15 THYROID FINE NEEDLE ASPIRATION IN PATIENTS UNDER 18 YEARS:<br />
A CLINICO-CYTOLOGIC STUDY<br />
Moslavac S, Mateša N, Kusić Z (Zagreb, Croatia)<br />
16,15-16,30 DIAGNOSTIC PITFALLS IN PARATHYROID GLAND CYTOLOGY<br />
Knežević-Obad A, Tomić-Brzac H, Žarković K, Dodig D (Zagreb, Croatia)<br />
16,30-16,45 ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION OF PARATHYROID<br />
LESIONS<br />
Fuštar-Preradović Lj (Slavonski Brod, Croatia)<br />
16,45-17,00 FINE NEEDLE ASPIRATION CYTOLOGY IN THE EVALUATION OF<br />
PAROTID GLAND TUMORS<br />
Belušić Gobić M, Pedisić D, Seili Bekafigo I, Cerović R, Starčević R,<br />
Manestar D, Juretić M (Rijeka, Croatia)<br />
17,00-17,15 THE VALUE OF CYTOLOGICAL SMEAR IN EVALUATION OF HEAD AND<br />
NECK NON-MELANOMA SKIN CANCER<br />
Pastorčić Grgić M, Ramljak V, Šarčević B, Gršić K, Pegan A (Zagreb, Croatia)<br />
17,30-17,45 PAUZA / BREAK<br />
SIMPOZIJ - Citologija gastrointestinalnog trakta /<br />
SYMPOSIUM - Gastrointestinal Cytology<br />
Predsjedavajući / Chairpersons: Štoos-Veić T, Kojić Katović S, Jelić-Puškarić B<br />
17,45-18,05 THE ROLE OF ENDOSCOPIC ULTRASOUND IN EVALUATION OF<br />
GASTRIC SUBEPITHELIAL LESIONS<br />
Pavić T, Hrabar D, Duvnjak M (Zagreb,Croatia)<br />
18,05-18,25 ENDOSCOPIC ULTRASOUND IN EVALUATION OF SOLID PANCREATIC<br />
MASSES - CURRENT STATE AND REWIEV OF THE LITERATURE<br />
Tadić M, Štoos-Veić T, Vukelić-Marković M, Ćurić J, Banić M,<br />
Čabrijan Ž, Grgurević I, Kujundžić M (Zagreb,Croatia)<br />
18,25-18,40 A CORRELATIVE STUDY OF HISTOLOGY AND IMPRINT CYTOLOGY OF<br />
GASTRIC MUCOSA BYOPSY IN THE DIAGNOSIS OF GASTRIC CANCER<br />
Fuštar Preradović Lj (Slavonski Brod,Croatia)<br />
18,40-18,55 BILIARY BRUSH CYTOLOGY FOR THE DIAGNOSIS OF MALIGNANCY:<br />
A SINGLE CENTER EXPERIENCE<br />
Štoos-Veić T, Bilić B, Kaić G, Trutin Ostović K, Babić Ž,<br />
Kujundžić M (Zagreb,Croatia)
Final programme and abstract book<br />
18,55-19,10 TREATMENT OUTCOMES OF HEPATOCELLULAR CARCINOMA PROVEN<br />
BY FINE NEEDLE ASPIRATION CYTOLOGY: A SINGLE CENTER<br />
EXPERIENCE.<br />
Mrzljak A, Čolić Cvrlje V, Kardum-Skelin I, Škegro D,<br />
Filipec-Kanižaj T, Šušterčić D (Zagreb,Croatia)<br />
19,10-19,30 RASPRAVA / DISCUSSION<br />
20,00 SVEČANA VEČERA / CONGRESS DINNER<br />
DVORANA 2/ HALL 2 (BRAČ I)<br />
SIMPOZIJ - Pulmološka citologija / SYMPOSIUM - Pulmonary cytology<br />
Presjedavajući /Chairpersons: Šokčević M, Vrabec-Branica B, Smojver-Ježek S<br />
10,30-10,45 LUNG LAVAGE CELL PROFILES IN DIFFUSE LUNG DISEASE<br />
Peroš-Golubičić T, Smojver-Ježek S (Zagreb, Croatia)<br />
10,48-11¸00 LYMPHOMATOID GRANULOMATOSIS IN A 23-YEAR-OLD MAN-<br />
CYTOLOGICAL AND HYSTOLOGICAL TYPING AND RAPID RESPONSE<br />
TO STEROID AND CYCLOPHOSPHAMIDE<br />
Rakušić N, Krmpotić D, Hećimović A, Boras Z, Vrabec-Branica B,<br />
Džebro S, Rakušić N, Rašković T (Zagreb, Rijeka, Croatia)<br />
11,03-11,18 MORPHOMETRIC AND DNA IMAGE ANALYSIS OF<br />
BRONCHOALVEOLAR LAVAGE FLUID MACROPHAGES NUCLEI IN<br />
INTERSTITIAL LUNG DISEASES WITH LYMPHOCYTIC ALVEOLITIS<br />
Smojver-Ježek S, Peroš-Golubičić T, Tekavec-Trkanjec J, Alilović M,<br />
Vrabec-Branica B, Juroš Z, Mažuranic I (Zagreb, Croatia)<br />
11,21-11,33 NECROTISING SARCOID GRANULOMATOSIS OF THE SPINAL CORD:<br />
CASE REPORT<br />
Vrbica Ž, Boras Z, Rakušić N, Smojver-Ježek S, Baričević D,<br />
Rakušić N, Alerić I (Dubrovnik, Zagreb, Croatia)<br />
11,36-11,51 DETECTION OF HUMAN PAPILLOMAVIRUSES TYPE 16, 18 AND 33 IN<br />
BRONCHIAL ASPIRATES OF LUNG CARCINOMA PATIENTS BY<br />
POLYMERASE CHAIN REACTION: A STUDY OF 84 CASES IN CROATIA<br />
Vrabec Branica B, Smojver-Ježek S, Juroš Z, Grgić S, Srpak N,<br />
Mitrečić D, Gajović S (Zagreb, Croatia)<br />
11,54-12,06 METASTASES ON RARE LOCATIONS AS INITIAL MANIFESTATIONS OF<br />
NON-SMALL CELL LUNG CARCINOMA: TWO CASE REPORTS<br />
Lozić AAB, Besser Silconi Ž, Mišljenović N (Pula, Croatia)<br />
13,00-14,00 RUČAK / LUNCH<br />
21<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
22<br />
Konačni program i knjiga sažetaka<br />
SIMPOZIJ - Ginekološka citologija / SYMPOSIUM - Gynecological Cytology<br />
Predsjedavajući / Chairpersons: Grubišić G, Ovanin-Rakić A, Mahovlić V<br />
16,00-16,15 CYTOLOGIC FOLLOW-UP IN WOMEN WITH CIN TREATED BY LETZ,<br />
COLD KNIFE CONISATION AND SEMM’S COLD COAGULATION<br />
Grubišić G, Kraljević Z, Vukosavić-Cimić B, Pirkić A, Grbavac I,<br />
Bolanča I (Zagreb, Croatia)<br />
16,15-16,23 CERVICAL CYTOLOGY AND HPV TEST IN FOLLOW-UP AFTER<br />
CONISATION OR LLETZ<br />
Verša Ostojić D, Vrdoljak-Mozetič D, Štemberger-Papić S, Finderle A,<br />
Eminović S (Rijeka, Croatia)<br />
16,23-16,31 CYTOLOGY OF CERVICAL INTRAEPITHELIAL GLANDULAR LESIONS<br />
Ovanin-Rakić A, Mahovlić V, Audy-Jurković S, Barišić A,<br />
Škopljanac-Mačina L, Jurič D, Rajhvajn S, Ilić-Forko J, Babić D,<br />
Folnović D, Kani D (Zagreb, Croatia)<br />
16,31-16,39 DIGITAL MORPHOMETRY OF CYTOLOGIC ASPIRATE ENDOMETRIAL<br />
SAMPLES<br />
Mahovlić V, Ovanin-Rakić A, Škopljanac-Mačina L, Barišić A,<br />
Rajhvajn S, Jurič D, Šamija I, Ilić-Forko J, Babić D, Škrablin-Kučić S,<br />
Božikov J (Zagreb, Croatia)<br />
16,39-16,47 ALCOHOL SCLEROSING OVARIAN CYSTIC LESIONS, 20 YEARS EXPERIENCE<br />
Kukura V, Krivak Bolanča I, Šentija K, Katalenić Simon S<br />
(Zagreb, Croatia)<br />
16,47-16,55 EXPRESSION OF KI-67, P53 AND PROGESTERONE RECEPTORS IN<br />
UTERINE SMOOTH MUSCLE TUMORS. DIAGNOSTIC VALUE<br />
Petrović D, Babić D, Ilić Forko J, Martinac I (Zagreb, Croatia)<br />
16,55-17,00 CYTOLOGIC CHARACTERISTICS OF ADENOID CYSTIC CARCINOMA<br />
OF THE CERVIX UTERI - CASE REPORT<br />
Barišić A, Mahovlić V, Ovanin-Rakić A, Škopljanac-Mačina L,<br />
Rajhvajn S, Jurič D, Babić D (Zagreb, Croatia)<br />
17,00-17,05 VULVAR PAGET’S DISEASE - CASE REPORT<br />
Katalenić Simon S, Krivak Bolanča I, Šentija K, Kukura V, Škrtić A<br />
(Zagreb, Croatia)<br />
17,05-17,13 PREVIOUS CYTOLOGICAL FINDINGS IN WOMEN WITH FINAL<br />
HISTOLOGICAL DIAGNOSIS OF CERVICAL INTRAEPITHELIAL<br />
NEOPLASIA GRADE 3<br />
Milojković M, Pajtler M, Milojković D (Osijek, Croatia)<br />
20,00 SVEČANA VEČERA / CONGRESS DINNER
Final programme and abstract book<br />
DVORANA 3 / HALL 3 (Brač III)<br />
RADIONICE / WORKSHOPS<br />
10,00-19,30<br />
Hematološka citologija-akutne leukemije / Hematological Cytology-Acute Leukemias<br />
Ries S, Gjadrov Kuveždić K<br />
Hematološka citologija- limfni čvor / Hematological Cytology- Lymph Node<br />
Jelić Puškarić B, Šušterčić D, Kardum Skelin I<br />
POSTERI / POSTERS<br />
P3. DIAGNOSIS OF VISCERAL LEISHMANIASIS BY FINE NEEDLE ASPIRATION<br />
CYTOLOGY OF AN ISOLATED CERVICAL LYMPH NODE: CASE REPORT<br />
Beljan R, Šundov D, Lukšić B, Šoljić V, Piljić Burazer M (Split, Croatia; Mostar,<br />
Bosnia and Herzegovina)<br />
P<strong>4.</strong> ADENOMATOID NODULES AND SUSPICIOUS FOLLICULAR LESIONS OF THE<br />
THYROID OBTAINED BY FINE NEEDLE ASPIRATION CYTOLOGY<br />
Dabelić N, Mateša N, Mateša-Anić D, Kusić Z (Zagreb, Crikvenica, Croatia)<br />
P5. FINE NEEDLE ASPIRATION BIOPSY OF FOLLICULAR THYROID TUMORS<br />
Pauzar B, Staklenac B, Lončar B (Osijek, Croatia)<br />
P6. ABDOMINAL NON-EPITHELIAL TUMORS DIAGNOSED BY FINE NEEDLE<br />
ASPIRATION CYTOLOGY<br />
Škegro D, Obad-Kovačević D, Škurla B, Mrzljak A, Filipec-Kanižaj T,<br />
Vidić-Paulišić I, Jelić-Puškarić B (Zagreb, Čakovec, Croatia)<br />
P7. FINE NEEDLE ASPIRATION CYTOLOGY OF CHONDROID SYRINGOMA<br />
Škoro M, Trutin Ostović K, Čikara I, Müller D, Novak NP, Virag M (Zagreb, Croatia)<br />
23<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
UTORAK, 13.10.2009. / TUESDAY, October 13, 2009<br />
24<br />
Konačni program i knjiga sažetaka<br />
DVORANA 1/ HALL 1 (Grand Dalmacija)<br />
SIMPOZIJ - Hematološka citologija / SYMPOSIUM - Hematological Cytology<br />
Ne-Hodgkinovi limfomi / Non-Hodgkin Lymphomas<br />
Predsjedavajući / Chairpersons: Jakšić B, Dominis M, Kardum-Skelin I<br />
08,00-08,15 DIAGNOSTIC CHALLENGES IN LYMPHOPROLIFERATIVE DIESASES<br />
Jakšić B, Kardum-Skelin I (Zagreb, Croatia)<br />
08,15-08,30 SMALL LYMPHOCYTIC LYMPHOMAS - PITFALLS IN METHODS AND<br />
INTERPRETATION<br />
Dominis M (Zagreb, Croatia)<br />
08,30-08,40 BONE LESIONS IN LYMPHOMA<br />
Planinc-Peraica A, Radić-Krišto D, Ostojić Kolonić S, Kardum-Skelin I,<br />
Jakšić B (Zagreb, Croatia)<br />
08,40-08,50 PRIMARY GASTROINTESTINAL NON HODGKIN LYMPHOMA IN<br />
ADULTS: CLINICOPATHOLOGICAL AND SURVIVAL CHARACTERISTICS<br />
Radić-Krišto D, Planinc-Peraica A, Ostojić Kolonić S, Vrhovac R,<br />
Kardum-Skelin I, Jakšić B (Zagreb, Croatia)<br />
08,50-09,00 FNA BASED DIAGNOSIS OF HEAD AND NECK LYMPHOMA<br />
Gjadrov Kuveždić K, Aurer I, Ries S, Sučić M, Marković-Glamočak M,<br />
Ilić I, Bašić-Kinda S, Radman I, Labar B (Zagreb, Croatia)<br />
09,00-09,10 RECURRING CHROMOSOMAL ABNORMALITIES IN LYMPHOMA IN<br />
FINE NEEDLE ASPIRATES OF LYMPH NODE<br />
Lasan Trčić R, Šušterčić D, Kuspilic M, Jelić Puškarić B, Fabijanić I,<br />
Kardum-Skelin I (Zagreb, Croatia)<br />
09,10-09,20 FLOW CYTOMETRY IMMUNOPHENOTYPING (FCI) OF FINE NEEDLE<br />
ASPIRATES (FNAs) OF LYMPH NODES<br />
Kardum Paro MM, Zoran Šiftar Z, Kardum-Skelin I, Šušterčić D,<br />
Nazor A, Flegar- Meštrić Z, Jakšić B (Zagreb, Croatia)<br />
SIMPOZIJ - Hematološka citologija / SYMPOSIUM - Hematological Cytology<br />
Hodgkin limfomi i kronična limfocitna leukemija / Hodgkin Lymphomas and Chronic<br />
Lymphocytic Leukemia<br />
Predsjedavajući / Chairpersons: Ostojić Kolonic S, Jakšić O, Gjadrov Kuveždić K<br />
09,25-09,35 VALUE OF FINE-NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSIS OF<br />
HODGKIN’S LYMPHOMA AND ANAPLASTIC LARGE CELL LYMPHOMA:<br />
ONE CENTRE EXPERIENCE<br />
Ostojić Kolonić S, Prašek-Kudrna K, Roso V, Radić-Krišto D,<br />
Planinc-Peraica A, Džebro S, Kardum-Skelin I, Jakšić B (Zagreb, Croatia)
Final programme and abstract book<br />
09,35-09,45 NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA<br />
(NLPHL) - THE DIAGNOSTIC PROBLEM<br />
Borovečki A, Jelić-Puškarić B, Džebro S, Kardum-Skelin I<br />
(Zagreb, Croatia)<br />
09,45-09,55 CHRONIC LYMPHOCYTIC LEUKEMIA: INSIGHTS FROM LYMPH NODES<br />
& BONE MARROW AND CLINICAL PERSPECTIVES<br />
Jakšić O, Kardum-Skelin I, Jakšić B (Zagreb, Croatia)<br />
09,55-10,05 MULTIMODAL IMAGE ANALYSIS OF CHRONIC LEUKEMIC<br />
LYMPHOPROLIFERATIVE DISORDERS AND THE HYPOTHESIS OF<br />
„SINGLE“ AND „MULTIPLE“ PROGRAMMED STOPS IN THE<br />
DEVELOPMENT OF TYPICAL AND ATYPICAL FORMS OF LEUKAEMIAS<br />
AND LYMPHOMAS<br />
Kardum-Skelin I, Radić-Krišto D, Jelić Puškarić B, Jakšić O,<br />
Kardum M, Jakšić B (Zagreb, Croatia)<br />
10,05-10,30 PAUZA / BREAK<br />
SIMPOZIJ- Akutne leukemije / SYMPOSIUM - Acute leukemia<br />
Predsjedavajući / Chairpersons: Labar B, Sučić M<br />
10,30-10,50 CLINICAL AND DIAGNOSTIC APPROACH IN PATIENTS WITH<br />
ACUTE LEUKEMIA<br />
Labar B, Sučić M, Batinić D, Mrsić S, Zadro R, Ilić I, Dotlić S,<br />
Marković-Glamočak M, Ries S, Gjadrov-Kuveždić K, Antulov J,<br />
Fabijanić I, Vrbanus LJ, Čačić M, Franić Šimić I, Dubravčić K,<br />
Serventi-Seiwerth R, Sertić D, Mikulić M, Mrsić M, Nemet D<br />
(Zagreb, Croatia)<br />
10,50-11,30 ACUTE LEUKEMIA MORPHOLOGY, IMMUNOPHENOTYPE, GENETICS<br />
AND MOLECULAR BIOLOGY - DIAGNOSTIC DIRECTIONS AND<br />
PROGNOSTIC FACTORS<br />
Labar B, Sučić M, Batinić D, Mrsić S, Zadro R, Ilić I, Dotlić S,<br />
Marković-Glamočak M, Ries S, Gjadrov-Kuveždić K, Antulov J,<br />
Fabijanić I, Vrbanus LJ, Čačić M, Franić Šimić I, Dubravčić K,<br />
Serventi-Seiwerth R, Sertić D, Mikulić M, Mrsić M, Nemet D<br />
(Zagreb, Croatia)<br />
11,30-11,50 CURRENT THERAPY FOR ACUTE LEUKEMIA<br />
Labar B (Zagreb, Croatia)<br />
11,50-12,00 RASPRAVA / DISCUSSION<br />
POSTERI / POSTERS<br />
25<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
SIMPOZIJ - Citologija dječje dobi / SYMPOSIUM - Childhood Cytology<br />
26<br />
Konačni program i knjiga sažetaka<br />
Predsjedavajući / Chairpersons: Nakić M, Raić Lj, Ries S<br />
12,00-10,15 ROLE OF CYTOLOGY IN CHILDHOOD DISEASES<br />
Kardum-Skelin I, Šušterčić D, Jelić-Puškarić B, Milas M (Zagreb, Croatia)<br />
12,15-12,30 CD20 POSITIVE CHILDHOOD B-NON HODGKIN LYMPHOMA (B-NHL):<br />
MORPHOLOGY, IMMUNOPHENOTYPE AND A NOVEL TREATMENT<br />
APPROACH: A SINGLE CENTER EXPERIENCE.<br />
Bilić E, Femenić F, Konja J, Šimat M, Dubravčić K, Batinić D, Ries D,<br />
Rajić Lj (Zagreb, Croatia)<br />
12,30-12,40 SUBCUTANEOUS PANNICULITIS-LIKE T-CELL LYMPHOMA IN A 19<br />
MONTH-OLD BOY TREATED WITH ALL-IC-BFM 2002 PROTOCOL<br />
Rajić Lj, Bilić E, Femenić R, Meštrović D, Ilić I, Kardum-Skelin I,<br />
Tešović G, Konja J (Zagreb, Croatia)<br />
12,40-12,50 PELVIC GANGLIONEUROMA - CASE REPORT<br />
Roganović J, Šegulja S, Jonjić N, Seili-Bekafigo I (Rijeka, Croatia)<br />
12,50-13,00 JUVENILE MYELOMONOCYTIC LEUKEMIA WITH PTPN11 MUTATION IN<br />
A 23-MONTH-OLD GIRL<br />
Jakovljević G, Kardum-Skelin I, Nakić M, Batinić D, Rogošić S<br />
(Zagreb, Croatia)<br />
13,00-14,00 RUČAK / LUNCH<br />
SIMPOZIJ - Transplantacijska citologija / SYMPOSIUM - Transplantation Cytology<br />
Predsjedavajući / Chairpersons: Nemet D, Vrhovac R, Knotek M<br />
14,00-14,15 COLLECTION AND COMPOSITION OF AUTLOGOUS PERIPHERAL<br />
BLOOD STEM CELLS GRAFT IN PATIENTS WITH ACUTE MYELOID<br />
LEUKEMIA: INFLUENCE ON HEMATOPOIETIC RECOVERY AND OUTCOME<br />
Raos M, Nemet D, Bojanić I, Sertić D, Batinić D, Dušak V, Mazić S,<br />
Dubravčić K, Serventi-Seiwerth R, Mrsić M, Golubić-Ćepulić B,<br />
Labar B (Zagreb, Croatia)<br />
14,15-14,30 POST-THAW VIABILITY OF CRYOPRESERVED HEMATOPOIETIC<br />
PROGENITOR CELL GRAFTS: DOES IT MATTER?<br />
Vrhovac R, Perić Z, Jurenec S, Jelić-Puškarić B, Kardum-Skelin I,<br />
Jakšić B (Zagreb, Croatia)<br />
14,30-14,45 C4D IN PATIENTS WITH ACUTE REJECTION AND/OR HEPATITIS C<br />
RECURRENCE AFTER LIVER TRANSPLANTATION- SINGLE<br />
CENTER EXPERIENCE<br />
Gašparov S, Buhin M, Filipec-Kanižaj T, Kocman B, Škrtić A<br />
(Zagreb, Croatia)<br />
14,45-14,55 PARVOVIRUS B 19 INDUCED PURE RED CELL APLASIA IN<br />
IMMUNOCOMPROMISED PATIENT AFTER LIVER TRANSPLANTATION<br />
Mrzljak A, Kardum Skelin I, Čolić Cvrlje V, Filipec Kanižaj T,<br />
Šušterčić D, Guštin D, Kocman B (Zagreb, Croatia)
Final programme and abstract book<br />
14,55-15,05 EPITHELOID HEMANGIOENDOTHELIOMA IN PATIENT WITH LIVER<br />
TRANSPLANTATION<br />
Filipec Kanižaj T, Čolić Cvrlje V, Mrzljak A, Kardum Skelin I,<br />
Šušterčić D, Škegro D, Guštin D, Kocman B (Zagreb, Croatia)<br />
15,05-15,15 URINE IMMUNOCYTOLOGY AS A NONINVASIVE DIAGNOSTIC TOOL<br />
FOR ACUTE KIDNEY REJECTION: A SINGLE CENTER EXPERIENCE<br />
Mihovilović K, Kardum-Skelin I, Jelić-Puškarić B, Ljubanović D,<br />
Bulimbašić S, Sabljar-Matovinović M, Kovačević-Vojtušek I, Gracin S,<br />
Kocman B, Jadrijević S, Vidas Ž, Guštin D, Knotek M (Zagreb, Croatia)<br />
15,15-15,30 RASPRAVA / DISCUSSION<br />
16,00 IZLET BRODOM I DOMJENAK NA BRODU / Excursion by Boat and Cocktail<br />
DVORANA 2/ HALL 2 (BRAČ I)<br />
RADIONICE / WORKSHOPS<br />
8,00-16,00<br />
Ginekološka citologija - vrat maternice (glandularne lezije), endometrij, ovarij /<br />
Gynecological Cytology - cervix (glandular lesions), endometrium, ovary<br />
Citologija glandularnih lezija / Cytology of Glandular Lesions<br />
Ovanin-Rakić A<br />
Citologija endometrija / Cytology of Endometrium<br />
Mahovlić V<br />
Citologija jajnika / Cytology of Ovary<br />
Vrdoljak-Mozetič D<br />
POSTERI / POSTERS<br />
P8. APLASTIC CRISIS INDUCED BY HUMAN PARVOVIRUS B19 AS AN INITIAL<br />
PRESENTATION OF HEREDITARY SPHEROCYTOSIS<br />
Čaržavec D, Gaćina P, Vasilj A, Kojić Katović S, Stančić V (Zagreb, Croatia)<br />
P9. POLYOMAVIRUS ASSOCIATED NEPHROPATHY AFTER SIMULTANEOUS KIDNEY<br />
AND PANCREAS TRANSPLANTATION. CASE REPORT<br />
Gracin S, Knotek M, Sabljar Matovinovic M, Kardum Skelin I, Ljubanovic D, Vidas Z<br />
(Zagreb, Croatia)<br />
P10. CASE REPORT OF A PATIENT WITH PERITONEAL AND OMENTAL LYMPHOMA<br />
INFILATRATION AND ASCITES POSITIVE FOR LYMHOMA CELLS, FOLLOWING A<br />
RELAPSE OF SPLENIC MARGINAL ZONE LYMPHOMA (SMZL)<br />
Gredelj Šimec Nj, Ropar S, Baškot A, Dejanović M (Karlovac, Croatia)<br />
P11. FAMILIAL HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN A 6-WEEK-OLD<br />
MALE INFANT<br />
Jakovljević G, Kardum-Skelin I, Rogošić S, Čulić S, Stepan S, Bonevski A,<br />
Rimac M, Nakić M (Zagreb, Croatia)<br />
27<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
28<br />
Konačni program i knjiga sažetaka<br />
P12. RHABDOMYOSARCOMA WITH BONE MARROW INFILTRATION MIMICKING<br />
HEMATOLOGIC NEOPLASIA. CASE REPORT<br />
Jelić-Puškarić B, Rajković-Molek K, Raić Lj, Batinić D, Konja J, Kardum-Skelin I<br />
(Zagreb, Rijeka, Croatia)<br />
P13. SIMULTANEOUS OCCURRENCE OF CHRONIC LYMPHOCYTIC AND CHRONIC<br />
MYELOID LEUKEMIA<br />
Kojić Katović S, Vasilj A, Maričević I, Čaržavec D, Ćurić Jurić S<br />
P1<strong>4.</strong> URINARY CYTOLOGY AS A FIRST AVAILABLE TOOL FOR DETECTION OF BK<br />
NEPHROPATHY- CASE REPORT<br />
Kovačević-Vojtusek I, Knotek M, Ljubanović D, Kardum-Skelin I,<br />
Sabljar-Matovinović M, Vidas Ž (Zagerb, Croatia)<br />
P15. KLINEFELTER SYNDROME AND ACUTE BASOPHILIC LEUKAEMIA -<br />
CASE REPORT<br />
Ljubić N, Lang N, Kardum Skelin I, Lasan R, Dominis M, Perković L, Županić-<br />
Krmek D, Grgurević-Batinica A (Zagreb, Croatia)<br />
P16. MYELOID/MEGAKARYOCYTIC BLAST PHASES AS A PRESENTING<br />
MANIFESTATION OF CHRONIC MYELOID LEUKEMIA: CASE REPORT<br />
Milas R, Kardum-Skelin I, Šušterčić D, Abalić M, Lebinec M, Predragović<br />
(Virovitica, Croatia; Zagreb, Croatia)<br />
P17. SERUM IMMUNOGLOBULINS IN NON-HODGKIN’S LYMPHOMA PATIENTS<br />
Planinc-Peraica A, Ostojić Kolonić S, Radić-Krišto D, Dominis M, Jaksic B<br />
P18. NEONATAL HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS - CASE REPORT<br />
Roganović J, Kvenić B, Jonjić N, Seili-Bekafigo I, Kardum-Skelin I<br />
(Rijeka, Zagreb, Croatia)<br />
P19. CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL) - TRANSFORMATION TO HODGKIN<br />
LYMPHOMA OR COMPOSITE TUMOR - CASE REPORT<br />
Škrtić A, Borovečki A, Milas M, Džebro S (Zagreb, Croatia)<br />
P20. FINE NEEDLE ASPIRATION OF INTRA-ABDOMINAL LYMPH NODES IN THE<br />
DIAGNOSIS AND FOLLOW UP OF MALIGNANT LYMPHOMA<br />
Šušterčić D, Jelić-Puškarić B, Milas M, Vidić-Paulišić I, Odak D, Vidjak V, Minigo<br />
H, Planinc-Peraica A, Radić-Krišto D, Ostojić Kolonić S, Kardum-Skelin I, Jakšić B<br />
(Zagreb, Čakovec, Croatia)<br />
P21. HODGKIN’S LYMPHOMA VARIANT OF RICHTER’S SYNDROME<br />
Vasilj A, Kojić-Katović S, Maričević I, Žokvić E, Bobuš Kelčec I, Tomas D,<br />
Silva Ćurić-Jurić S (Zagreb, Croatia)<br />
P22. THE VALUE OF URINARY DECOY CELL FINDING IN PATIENTS WITH KIDNEY<br />
TRANSPLANTATION: A SINGLE CENTER EXPERIENCE<br />
Vidas Ž, Mišić M, Pačić A, Jurenec F, Knotek M, Kardum-Skelin I<br />
(Zagreb, Slavonski Brod, Croatia)
Final programme and abstract book<br />
SRIJEDA, 1<strong>4.</strong>10.2009. / WEDNESDAY, October 14, 2009<br />
OD/FROM 8.00-10.00<br />
DVORANA 1/ HALL 1 (Grand Dalmacija)<br />
SIMPOZIJ - Citotehnologija / SIMPOSIUM - Citotechnnology<br />
Predsjedavajući / Chairpersons: Anić V, Rubić K<br />
NEW METHODS IN CYTOLOGY Korać P (Zagreb, Croatia)<br />
DETECTION OF P16INK4a PROTEIN IN PREMALIGNANT CERVICAL LESIONS ON<br />
ARCHIVED SLIDES<br />
Gavranović LJ, Rakek Novak S, Baburić M, Đorđijevski E, Šentija K, Katalenić Simon S,<br />
Krivak Bolanča I<br />
ERYTHROCYTE MORPHOLOGY IN MALIGNANT URINE SAMPLES.<br />
Knežević G, Parigros K, Anić V, Milas M, Šušterčić D, Kardum-Skelin I<br />
THE PREVALENCE OF INFECTION IN SWABS OF TRANSPLANTED HEMATOLOGIC<br />
PATIENTS<br />
Anić V, Križaj B, Jelić-Puškarić B, Perić Z, Vrhovac R, Kardum-Skelin I<br />
NUMBER OF COUNTING CELLS AND CYTOSPINS SELECTION INFLUENCES ON<br />
BRONCHOALVEOLAR LAVAGE CELL PROFILES<br />
Harabajsa S, Martinčić J, Peharec I, Popek B, Šušković- Medved S, Zadražil B,<br />
Smojver-Ježek S<br />
THE ROLE OF CYTOTECHNOLOGIST IN CYTOANALYSIS OF SYNOVIAL FLUIDS<br />
Bezdrob S, Aleksandrov C, Cvrk B, Čurin S, Ljevar I, Krupec AM, Čurin D, Knežević A,<br />
Perica B, Ćaleta B, Trutin Ostović K<br />
PROBLEMS WITH STAINING PROCEDURES IN IMMUNOCYTOCHEMISTRY<br />
Meandžija R, Fumić G, Naglić G, Štanfel O, Seili-Bekafigo I<br />
IMMUNODETECTION OF ANTIGENES IN CYTOLOGIC SAMPLES<br />
Rešetar R<br />
INFLUENCE OF INADEQUATE MATERIALS ON CYTOLOGICAL ANALISIS AND<br />
PROVIDING DIAGNOSIS<br />
Rubić K, Milankovic Lj, Horvat B, Ropar S<br />
MODIFICATION OF MGG STAINING METHOD<br />
Fumić G, Naglić G, Meandžija R, Štemberger C, Seili-Bekafigo I<br />
QUALITY OF INTAKE AND PROCESSING OF MATERIALS IN CYTOLOGICAL<br />
LABORATORY<br />
Begovic D, Belušić M, Maljić S<br />
PRESENTATION OF INTEGRATED MODULE FOR INPUT AND PROCESSING OF<br />
CYTOLOGICAL REPORTS WITHIN THE COMPUTER PROGRAMME “RIBIS“<br />
Markanjević T, Vunić S<br />
29<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
30<br />
Konačni program i knjiga sažetaka<br />
MICROSCOPIC IDENTIFICATION OF PARASITES IN CYTOLOGICAL PREPARATIONS -<br />
THE „GOLD STANDARD“ IN DIAGNOSTICS OF VISCERAL LEISHMANIASIS -<br />
A CASE REPORT<br />
Stupnišek M, Prstec Z, Vujević D, Čulig Z, Puljiz I, Lukas D, Begovac J<br />
Diskusija / Discussion<br />
10,00-10,30 PAUZA / Break<br />
SIMPOZIJ - Analitička citologija / SYMPOSIUM - Analytical Cytology<br />
Predsjedavajući/Chairpersons: Smojver Ježek S, Batinić D<br />
Plenarno predavanje / Plenary lecture<br />
10,30-10,45 ANALYTICAL CYTOLOGY - FROM BASIC METHODOLOGY TO ROUTIN<br />
CLINICAL DISCIPLINE<br />
Batinić D (Zagreb, Croatia)<br />
SECTION A - Analitička citologija u onkologiji / Analytical cytology in oncology<br />
10,45-10,55 MORPHOMETRIC AND CELL KINETIC CHARACTERISTICS IN<br />
THE DIAGNOSIS AND PROGNOSIS OF NEOPLASMS<br />
Kardum-Skelin I (Zagreb, Croatia)<br />
10,55-11,05 MOLECULAR PATHOGENESIS OF PHILADELPHIA-NEGATIVE<br />
CHRONIC MYLEOID NEOPLASMS<br />
Kušec R (Zagreb, Croatia)<br />
11,05-11,15 BIOMED-2 PCR DETECTION OF IGH/BCL2 REARRANGEMENT IN<br />
FOLLICULAR LYMPHOMA USING DNA OBTAINED FROM ARCHIVED<br />
CYTOLOGICAL SMEARS: AN OPTION FOR MONITORING<br />
Štoos-Veić T, Livun A, Ajduković R, Pejša V, Jakšić O, Kušec<br />
(Zagreb, Croatia)<br />
11,15-11,25 FLOW CYTOMETRIC CLONALITY ANALYSIS OF ENDOSCOPIC<br />
ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION OF<br />
LYMPH NODES<br />
Miletić Z, Gizdić B, Štoos-Veić T, Kaić G, Novak NP, Tadić M, Jakšić O,<br />
Trutin Ostović K (Zagreb, Croatia)<br />
11,25-11,35 CYTOGENETIC RESULTS IN 24 CASES OF MULTIPLE MYELOMA<br />
SHORT REPORT<br />
Lasan Trčić R, Kardum Skelin I, Šušterčić D , Planinc-Peraica A,<br />
Ajduković R, Hariš V, Kušec R, Begović D (Zagreb, Croatia)<br />
11,35-11,50 Diskusija / Discussion<br />
Predsjedavajući / Chairpersons: Flegar-Meštrić Z, Kaić G<br />
SECTION B - Dijagnostika i kontrola kvalitete / Diagnostics and quality control<br />
12,00-12,10 FLOW CYTOMETRY AND DIAGNOSTIC MONITORING OF HIV-INFECTED<br />
PATIENTS<br />
Židovec Lepej S (Zagreb, Croatia)
Final programme and abstract book<br />
12,10-12,20 ACCREDITATION OF MEDICAL LABORATORIES IN CROATIA -<br />
EXPERIENCES OF THE INSTITUTE OF CLINICAL CHEMISTRY<br />
CLINICAL HOSPITAL MERKUR<br />
Flegar-Meštrić Z, Nazor A, Perkov S, Šurina B, Kardum Paro MM,<br />
Šiftar Z, Sikirica M, Sokolić I, Ožvald I, Vidas Ž (Zagreb, Croatia)<br />
12,20-12,30 EXTERNAL QUALITY ASSESSMENT IN CLINICAL CELL ANALYSIS BY<br />
FLOW CYTOMETRY. WHY IS IT SO IMPORTANT?<br />
Šiftar Z, Kardum Paro MM, Sokolić I, Nazor A, Flegar Meštrić Z<br />
(Zagreb, Croatia)<br />
12,30-12,40 QUARTER OF A CENTURY OF THE LABORATORY FOR HUMAN<br />
GENETICS, DEPARTMENT OF MEDICAL GENETICS, PEDIATRICS<br />
CLINIC, UNIVERSITY HOSPITAL SPLIT<br />
Čulić V, Lozić B, Oreško T, Ivko-Banovac T, Botić Lj, Kezić G,<br />
Milanović D (Split, Croatia)<br />
12,40-12,50 FUTURE PERSPECTIVES OF PERSONALIZED MEDICINE<br />
Štambuk S, Šundov D, Kuret S, Beljan R, Anđelinović Š (Split, Croatia)<br />
12,50-13,00 Diskusija / Discussion<br />
DVORANA 2/ HALL 2 (BRAČ I)<br />
SIMPOZIJ - Dojka i slobodne teme / SYMPOSIUM - Breast and free topics<br />
Predsjedavajući / Chairpersons: Trutin Ostović K, Ramljak V, Staklenac B, Vasilj A<br />
8,00-8,20 CURRENT ORGANISATION OF CLINICAL CYTOLOGY IN CROATIA<br />
Miličić-Juhas V, Lončar B, Mahovlić V, Kardum-Skelin I, Pajtler M<br />
8,20-8,30 FINE NEEDLE ASPIRATION CYTOLOGY OF THE MINIMAL BREAST<br />
CARCINOMA IN ISTRIA COUNTY<br />
Besser-Silconi Ž, Lozić AAB, Mišljenović N<br />
8,30-8,40 RARE TUMORS OF THE BREAST- CASES REPORTS<br />
Staklenac B, Lončar B, Pauzar B, Dmitrović B<br />
8,40-8,50 FINE NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSING RARE<br />
BREAST CARCINOMA-TWO CASE REPORTS<br />
Ramljak V, Šarčević B, Vrdoljak DV, Bobuš Kelčec I, Agai M,<br />
Trutin Ostović K<br />
8,50-9,00 MORPHOMETRY OF TUMOUR CELLS IN DIFFERENT GRADES AND<br />
TYPES OF BREAST CANCER<br />
Prvulović I, Kardum-Skelin I, Jakić-Razumović J, Manojlović S<br />
9,00-9,10 THE IMPORTANCE OF URGENT CYTOLOGICAL EXAMINATION OF<br />
SYNOVIAL FLUIDS IN DIFFERENTIATION INFLAMMATORY AND<br />
NON-INFAMMATORY DISEASES<br />
Trutin Ostović K, Kaić G, Ostović I, Škoro M, Novak N-P,<br />
Morović-Vergles J<br />
31<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
32<br />
Konačni program i knjiga sažetaka<br />
9,10-9,20 IDENTIFICATION OF BRAIN CANCER STEM CELLS IN WHO STAGE IV<br />
BRAIN TUMOURS<br />
Tomuleasa CI, Soritãu O, Foris V, Ioani H, Ciucã DR, Susman S,<br />
Mihu C, Florian IS<br />
9,20-9,30 DEDIFFERENTIATION THERAPY AND DARWINISM FOR SORTING<br />
OF OVARIAN CANCER STEM CELLS<br />
Tomuleasa CI, Soritãu O, Ciucã DR, Susman S, Mihu C<br />
9,30-9,40 ADDITIONAL CYTOMORPHOLOGICAL CRITERIA IN DIAGNOSIS OF<br />
PILOMATRICOMA - BENIGN TUMOR WITH BAD REPUTATION<br />
Seili-Bekafigo I, Jonjić N, Štemberger C, Rajković-Molek K<br />
13,00 ZATVARANJE KONGRESA / <strong>Congress</strong> Closing<br />
POSTERI / POSTERS<br />
P23. ANALYSIS OF ABNORMAL PAP TEST FINDINGS OF URBAN, RURAL AND<br />
INSULAR AREA<br />
Bašić D, Markanjević T<br />
P2<strong>4.</strong> ALLELE FREQUENCIES OF FIVE X-LINKED MICROSATELLITES IN THE CROA-<br />
TIAN POPULATION AND THEIR APPLICATION IN PRENATAL DIAGNOSIS OF SEX<br />
CHROMOSOME ANEUPLOIDIES<br />
Crkvenac Gornik K, Štingl K, Grubić Z, Tonković Đurišević I, Huljev S, Begović D<br />
(Zagreb, Croatia)<br />
P25. THE ROLE OF CYTOLOGY IN THE DIAGNOSIS OF PYELON TUMOUR - A CASE REPORT<br />
Ezgeta Karačić D, Valetić J, Zeljko Ž, Vidas Ž, Jelić-Puškarić B, Sabljar-<br />
Matovinović M, Kardum-Skelin I (Vukovar, Croatia)<br />
P26. EXPRESSION OF P53, BCL-2, SURVIVIN AND AKT-1 IN PERIPHERAL BLOOD,<br />
BONE MARROW AND LYMPH NODES IN B-CLL<br />
Gizdić B, Miletić Z, Štoos Veić T, Pandžić Jakšić, Martinović M, Kušec R, Jakšić B,<br />
Pejša V, Trutin Ostović K, Jakšić O (Zagreb, Croatia)<br />
P27. PALLISTER KILLIAN SYNDROME: UNUSUAL SIGNIFICANT POSTNATAL<br />
OVERGROWTH IN A GIRL WITH OTHERWISE TYPICAL PRESENTATION<br />
Huljev Frković S, Tonković Đurišević I, Lasan Trčić R, Sarnavka V, Crkvenac Gornik<br />
K, Mužinić D, Letica Lj, Barić I, Begović D (Zagreb, Croatia)<br />
P28. MYELOID SARCOMA INVOLVING THE BREAST. CASE REPORT<br />
Jelić Puškarić B, Ostojić-Kolonić S, Planinc-Peraica A, Gašparov S,<br />
Kardum-Skelin I, Jakšić B (Zagreb, Croatia)<br />
P29. IMPACT OF STATIN, ANGIOTENSIN CONVERTING ENZYME INHIBITOR,<br />
ANGIOTENSIN II RECEPTOR BLOCKER AND DIHDROPYRIDINE TREATMENT ON<br />
PERITONEAL DIALYSATE COMPOSITION<br />
Jurić K, Cavrić G, Naumovski- Mihalić S, Bartolek D, Nassabain K, Novak NP<br />
(Zagreb, Croatia)
Final programme and abstract book<br />
P30. MISLEADING PRESENTATIONS OF MALIGNANT BREAST DISEASES - ROLE OF<br />
CLINICAL CYTOLOGY<br />
Kaić G, Štoos-Veić T, Trutin Ostović K, Vojnović J , Vidović LJ, Lambaša S, Hariš V,<br />
Ajduković R, Stanec S, Budi S (Zagreb,Croatia)<br />
P31. FINE NEEDLE ASPIRATION CYTOLOGY OF BREAST ANGIOSARCOMA - CASE REPORT<br />
Kardum-Skelin I, Jelić-Puškarić B, Milas M, Vidić-Paulišić I, Jakić-Razumović J,<br />
Šeparović V (Zagreb, Croatia)<br />
P32. GRANULAR CELL TUMOR<br />
Lončar B, Marjanović K, Pauzar B, Staklenac B (Osijek, Croatia)<br />
P33. CYTOGENETICS AND MOLECULAR FINDINGS IN CHILDHOOD LEUKEMIA OF<br />
SOUTH CROATIA<br />
Lozić B, Ćulić S, Čulić V, Drmić I, Batinić D, Mrsić S, Lasan Trčić R, Zemunik T<br />
(Split and Zagreb, Croatia)<br />
P3<strong>4.</strong> ANALYSIS OF IKAROS FAMILY SPLICING VARIANTS IN HUMAN HEMATOPOIETIC<br />
LINEAGES<br />
Matulić M, Paradžik M, Jelić Puškarić B, Stipić J, Antica M (Zagreb, Croatia)<br />
P35. INTERNATIONAL EXTERNAL QUALITY ASSESSMENT SCHEME FOR<br />
HAEMATOLOGY - 23 YEARS EXPIRIENCE IN INSTITUTE OF CLINICAL<br />
CHEMISTRY UNIVERSITY HOSPITAL “MERKUR”<br />
Nazor A, Flegar-Meštrić Z (Zagreb, Croatia)<br />
P36. FINE-NEEDLE ASPIIRATION CYTOLOGY OF APOCRINE HIDRADENOMA<br />
Novak NP, Kaić G, Tomasović-Lončarić Č , Žic R , Škoro M, Trutin Ostović K<br />
(Zagreb,Croatia)<br />
P37. MONOCYTE ACTIVATION IS RELATED TO INSULIN RESISTANCE IN<br />
POSTMENOPAUSAL WOMEN<br />
Pandžić Jakšić V (Zagreb, Croatia)<br />
P38. RESCREENING OF NEGATIVE CERVICAL CYTOLOGY FINDINGS<br />
Poduje V, Mustapić D, Mahovlić V<br />
P39. VIRAL CAPSID PROTEIN (HPV L1) DETECTION ON ARCHIVED CERVICAL SLIDES<br />
Rakek Novak S, Gavranović Lj, Baburić M, Đorđijevski E, Šentija K, Katalenić<br />
Simon S, Krivak Bolanča I<br />
P40. EOSINOPHILIC MASTITIS A CASE REPORT OF AN EOSINOPHILIC MASTITIS IN<br />
A 32-YEAR OLD FEMAL<br />
Ropar S, Gredelj Šimec NJ, Tokić T (Karlovac,Croatia)<br />
P41. ENTEROBIUS VERMICULARIS IN VAGINAL SMEARS<br />
Rubic K,Milankovic Lj,Plemić I, Ropar S<br />
P42. THE ACCURACY OF FINE NEEDLE ASPIRATION CYTOLOGY AND FLOW<br />
CYTOMETRY IN EVALUATION OF NODAL AND EXTRANODAL SITES IN PATIENTS<br />
WITH SUSPICION OF LYMPHOMA<br />
Šenjug P, Trutin Ostović K, Miletić Z, Tomasović Lončarić Č, Štoos-Veić T,<br />
Gizdić B, Kaić G, Aralica G, Križanac Š, Pejša V, Jakšić O (Zagreb, Croatia)<br />
33<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
34<br />
Konačni program i knjiga sažetaka<br />
P43. LYMPH NODE FINE NEEDLE ASPIRATION - SAMPLE ADEQUACY FLOW<br />
CYTOMETRY IMMUNOPHENOTYPING<br />
Švencbir V, Milas M, Anić V, Šiftar Z, Kardum Paro MM, Kardum-Skelin I<br />
P4<strong>4.</strong> INTRAOPERATIVE IMPRINT CYTOLOGICAL ASSESSMENT OF THE SUBAREOLAR<br />
TISSUE OF THE NIPPLE AREOLA COMPLEX (NAC)<br />
Tomasović-Lončarić Č,Milanović R, Lambaša S, Križanac Š,Štoos-Veić T,Kaić G,<br />
Trutin Ostović K (Zagreb, Croatia)<br />
P45. ISOLATION AND CHARACTERIZATION OF LIVER CANCER STEM CELLS FROM<br />
A HEPATOCELLULAR CARCINOMA BIOPSY<br />
Tomuleasa C, Soritãu O, Páll E, Susman S, Rus D, Mihu C, Iancu C (Cluj Napoca,<br />
Romania)<br />
P46. DEXAMETHASONE AND CHITOSAN REDUCE HEPATIC FIBROSIS AND<br />
INFLAMATIO IN WISTAR RATS WITH BILE DUCT LIGATION<br />
Trip DM, Olteanu D, Filip A, Clichici S, Muresan A, Sofronie A, Nagy A, Moldovan R<br />
(Cluj Napoca, Romania)<br />
P47. FINE NEEDLE ASPIRATION CYTOLOGY OF METASTATIC MERKEL CELL<br />
CARCINOMA<br />
Trutin Ostović K, Hariš V, Miletić Z, Lambaša S, Lajtman Z, Štoos-Veić T<br />
(Zagreb, Croatia)<br />
P48. SINCHRONOUS BILATERAL BREAST CARCINOMA WITH TWO DIFFERENT<br />
MORPHOLOGY SUBTYPES:A CASE REPORT<br />
Vrabec Branica B, Smojver-Ježek S, Juroš Z, Neralić-Meniga I, Križanec Š<br />
(Zagreb, Croatia)
kliniËka citologija<br />
clinical cytology<br />
35
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
36<br />
Klinička citologija - Plenarna i pozvana predavanja<br />
CONFIRMATION OF CIN I<br />
Babić D<br />
Department of Gynecological Pathology, Medical School, University of Zagreb, Croatia<br />
The minimum histological change that justifies a diagnosis of CIN 1-3 is the presence,<br />
throughout the full thickness of the epithelium, of some degree of nuclear abnormality.<br />
The abnormalities that justifies a diagnosis of CIN 1 are most apparent in the basal third<br />
of the epithelium. These nuclear abnormalities are: a mild degree of pleomorphism,<br />
an increased nuclear-cytoplasmic ratio, some degree of enlargement, mild hyperchromasia<br />
with a finely stippled chromatin pattern. The abnormalities in mitotic figures are<br />
often subtle and focal, necessitating the examination of an adequate number of sections.<br />
Cytoplasmic maturation is limited to the upper two-thirds of the epithelium.Sometimes<br />
histopathologists also have diagnostic difficuIties: basal cell hyperplasia, immature<br />
metaplasia, transitional cell metaplasia, severely atrophic epithelium, in low-oestrogen<br />
states - after the menopause or in women using low-oestrogen contraceptives the<br />
squamous epithelium may be composed entirely of parabasal type cells and is usually<br />
thin with mild degree of hyperchromasia. Sometimes there are also problems with<br />
borderline lesions - ‘basal epithelial changes(atypia) of uncertain significance’- BAUS.<br />
The features of CIN can be found in epithelium in which there are koilocytes or koilocyteassociated<br />
features. CIN, even in the presence of koilocytosis or koilocytosis-associated<br />
changes, is recognised by exactly the same criteria as in the absence of koilocytosis.<br />
babic_damir@yahoo.com
Clinical Cytology - Plenary and Invited Lectures<br />
CD20 POSITIVE CHILDHOOD B-NON HODGKIN LYMPHOMA (B-NHL): MORPHOLOGY,<br />
IMMUNOPHENOTYPE AND A NOVEL TREATMENT APPROACH: A SINGLE CENTER<br />
EXPERIENCE.<br />
Bilić E, Femenić R, Konja J, Šimat M , Dubravčić K, Batinić D, Ries S, Rajić Lj<br />
University Clinical Hospital Center Zagreb, Zagreb, Croatia.<br />
Lymphomas represent the third most common group of cancers in childhood and adolescence,<br />
mature B non Hodgkin’s lymphoma (B-NHL) accounting for up to 60% of newly<br />
diagnosed patients. The diagnosis of specific entities of B-NHL is based on well-defined<br />
morphologic analysis, immunophenotyping, cytogenetics and molecular genetics, which<br />
determine the optimal treatment strategy. In adult population a major turning point in<br />
treatment of B-NHL has been achieved since rituximab, in combination with CHOP thus<br />
improving the survival rate up to 19%. Rituximab is a chimeric monoclonal antibody that<br />
targets CD20, a transmembrane calcium channel expressed on normal and malignant<br />
B-cells that mediates cytotoxic, apoptotic and anti-proliferative effects. The effect of<br />
rituximab in pediatric population is still not well enough investigated. Based on morphology<br />
and immunophenotype of malignant cells, seven children with B-NHL in our<br />
institution were eligible for treatment with modified B-NHL-Berlin-Frankfurt-Münster<br />
(BFM)-95-based protocol with rituximab administered on day -5. The complete remission<br />
was achieved in all seven patients. Six patients are still in complete remission at<br />
least 12 months after having finished chemotherapy and one patient relapsed two months<br />
after the last cycle and subsequently died. Major adverse effects observed during treatment<br />
were prolonged B-cell depletion and myelosupression. Rituximab in combination<br />
with B-NHL-BFM-95 protocol was otherwise well tolerated and proved to be effective in<br />
children and adolescents with B-NHL. The number of our patients is too small and the<br />
follow-up of a larger group of patients will help in defining the role of rituximab in the<br />
treatment of childhood B-NHL.<br />
RISK-ADAPTED MULTIMODAL LABORATORY CERVICAL SCREENING - PAP TEST<br />
OF THE FUTURE?<br />
Bollmann R<br />
Institut für Pathologie, Bonn-Duisdorf, Germany<br />
The objective of screening for cervical cancer is to reduce mortality and incidence of<br />
the disease. To date there is extensive and strong evidence that this can be achieved by<br />
cytol¬ogy-based screening programs, which con¬tinue to be the mainstay of cervical<br />
preven¬tion worldwide despite their inherent meth¬odological limitations. This article<br />
presents a review on the utility of conventional, ancil¬lary and experimental methods for<br />
cervical screening both as single tests and test combi¬nations, and describes possible<br />
future direc¬tions for enhanced screening accuracy using risk-adapted protocols.<br />
Magdolna@Bollmann.com<br />
37<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
38<br />
Klinička citologija - Plenarna i pozvana predavanja<br />
CERVICAL CANCER AS A PUBLIC HEALTH ISSUE - WHAT NEXT?<br />
Ćorušić A1 , Škrgatić L1 , Mahovlić V2 , Mandić V3 , Planinić P1 , Karadža M1 1 Division of Gynecological Oncology, Department of Obstetrics and Gynecology, University<br />
of Zagreb Medical School, Zagreb, Croatia<br />
2 Division of Gynecological Cytology, Department of Obstetrics and Gynecology, University<br />
of Zagreb Medical School, Zagreb, Croatia<br />
3Department of Obstretics and Gynecology, University Clinical Hospital Mostar, Mostar,<br />
Bosna and Herzegovina<br />
Cervical cancer is the world’s second most common cancer in women. There are about<br />
60 000 newly discovered cases in Europe annually and around 30 000 deaths. The largest<br />
incidence of this disease is in countries of Eastern Europe. In Croatia, according to data<br />
of the Department of Public Health incidence was 1<strong>4.</strong>9 / 100 000 in 2006 and cervical cancer<br />
is at the eighth place of malignant diseases in women. Croatia has a lower incidence<br />
of this disease compared to many countries of Central and Southeast Europe. Large<br />
research carried out by International Agency for Research on Cancer (IARC) in 1995. on<br />
cervical cancer material gathered from 22 countries around the world, revealed HPV<br />
genome in 99.7%. There are good methods of cervical cancer detection as well as good<br />
screening methods for precancerous lesions (conventional PAPA swab). Cervical cancer<br />
prevention programs should include education (for health-care providers and women)<br />
that stresses the benefits of screening, the peak ages of cervical cancer incidence, and<br />
the signs and symptoms of precancerous lesions and invasive disease. Screening aims<br />
to detect precancerous changes, which may lead to cancer if not treated. Screening is<br />
only effective if there is a well-organized system for follow up, diagnosis and treatment.<br />
Cervical cytology, or Papanicolau (Pap) testing, has been the cornerstone of cervical<br />
cancer screening for decades. According to recent guidelines of the European Department<br />
of World Health Organization, primary task of the public health system is the introduction<br />
of secondary prevention through well-organized screening programs. Organization<br />
of national immunization program is possible only in countries with well-organized<br />
secondary prevention programs as well as in those who can afford it.<br />
lana.skrgatic@zg.t-com.hr
Clinical Cytology - Plenary and Invited Lectures<br />
SMALL LYMPHOCYTIC LYMPHOMAS - PITFALLS IN METHODS AND INTERPRETATION<br />
Dominis M<br />
Dpt.of Pathology & Cytology, Clinical Hospital “Merkur”, Zagreb, Croatia<br />
Small B-cell lymphomas/leukemias are derived from the mature B-cells. In term of<br />
clinical, morphological and molecular aspects they represent a hetrogenous group of<br />
diseases. Although overlap is present, clinically distinct entities exist with characteristic<br />
presentation, response to therapy and/or prognosis.<br />
Despite well defined morphological, immunohistochemical and molecular characteristics,<br />
atypical case may exist in single entity. Overlap of morphological and immunohistochemical<br />
features between various entities of B small cell lymphomas can induce<br />
considerable diagnostic problems. It is of great importance to distinguish between such<br />
entities whenever is possible because of contrast of some poor prognosis cases and<br />
long survival of others.<br />
201 patients with predominantly small B-lymphocytic lymphoma were reevaluated. 100<br />
were diagnosed as follicular cell lymphoma (FCC), 45 as mantle cell lymphoma and 56<br />
as small lymphocytic lymphoma (SLL). Adverse findings were: in FCC group BCL2 was<br />
positive; 11 cases without any changes of BCL2 gene, however in another 4 cases BCL2<br />
was negative and gene was either in translocation or amplification. BCL6 was positive in<br />
70 cases but the BCL6 gene showed translocation only in 8 and amplification in 7 cases,<br />
respectively. Translocation of BCL2 and BCL6 genes was found in 8 and amplification<br />
in 7 patients. 45 mantle cell lymphomas were all CD20 and BCL2 positive and CD23 and<br />
CD43 negative; 32 out of 45 were CD5 positive, 8 were +/- and 5 were CD5 negative. In 43<br />
patients t(11;14) was found, and in one case BCL1 gene amplification. t(14;18) was found<br />
in one case, amplification of BCL2 gene in 7 cases. Two patients with blastiod variant of<br />
mantle cell lymphoma were CD5+, BCL2 as well as BCL1 were in one case positive and<br />
in another negative. Neither t(11;14) or t(14;18) were found. In so-called SLL group of 56<br />
patients, who were all CD19 and BCL2 positive, CD5, CD23 and CD43 were positive in 51<br />
patients. t(11;14) was found in 5 patients, 4 who were CD5 and CD23 positive and one<br />
who was CD5 and CD23 negative. Other abnormalities, i.e. 3-5 copies of BCL1 gene were<br />
found in 3 CD5, CD23 positive patients. Pitfalls in methods and interpretation will be discussed<br />
and are still matter of debate.<br />
mara.dominis@zg.t-com.hr<br />
39<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
40<br />
Klinička citologija - Plenarna i pozvana predavanja<br />
EPITHELOID HEMANGIOENDOTHELIOMA IN PATIENT WITH LIVER<br />
TRANSPLANTATION<br />
Filipec Kanizaj T1 , Colic Cvrlje V1 , Mrzljak A1 , Kardum Skelin I1 , Sustercic D1 ,<br />
Škegro D1 , Gustin D2 , Kocman B3 1 Department of Internal Medicine, University Hospital Merkur, Zagreb, Croatia<br />
2Department of Anaesthesiology and Intensive Care, University Hospital Merkur,<br />
Zagreb, Croatia<br />
3 Department of Surgery, University Hospital, Merkur, Zagreb, Croatia<br />
Malignant hepatic epithelioid hemangioendothelioma (HEH) is a rare malignant tumor<br />
of vascular origin with unknown aetiology and a variable natural course. At the time of<br />
diagnosis, most patients present with multifocal tumours lesions that involve both liver<br />
lobes. From the therapeutic aspect, liver resection (LRx), liver transplantation (LTx),<br />
chemotherapy, radiotherapy, and/or immunotherapy have been used in the treatment<br />
of patients with HEH. However, because of the rarity of this tumor and its unpredictable<br />
natural history, it is impossible to assess the effectiveness of these respective therapies.<br />
In this report, our objective was to present clinical aspects, diagnostic options, therapeutic<br />
modalities, and the clinical outcome of single patient with LTx because of this<br />
rare tumor.<br />
tajana_filipec@yahoo.com
Clinical Cytology - Plenary and Invited Lectures<br />
C4D IN PATIENTS WITH ACUTE REJECTION AND/OR HEPATITIS C RECURRENCE<br />
AFTER LIVER TRANSPLANTATION- SINGLE CENTER EXPERIENCE.<br />
Gašparov S1 , Buhin M2 , Filipec-Kanižaj T3 , Kocman B2 , Škrtić A1 1 Department of Clinical Pathology and Cytology<br />
2 Department of Surgery, Division of Transplantation Surgery<br />
3 Department of Medicine 3 Merkur University Hospital - Zagreb, Croatia<br />
Hepatitis C (HCV) induced cirrhosis is one of the most common indication for liver transplantation<br />
(LTX). Updated data suggest worse long-term outcomes for those transplanted<br />
with HCV than those transplanted for other indications. Re-infection with HCV following<br />
LTX is almost universal. The differentiation between acute cellular rejection (ACR)<br />
and recurrent HCV is very important as rejection treatments are likely to aggravate HCV<br />
recurrence. Many autors advocate/suggest restricted use of steroid treatment even in<br />
cases of validated rejection. Liver biopsy represents the gold standard for the diagnosis<br />
of both ACR and HCV reinfection. Nevertheless, discrimination can be very difficult due<br />
to quite similar morphological pictures.<br />
C4d is an end-product of the activated classical complement cascade typically detectable<br />
not only in infection and autoimmune disorders but also in early humoral rejection.<br />
According to some autors C4d can be detected in hepatic specimen in ACR after LTX.<br />
It is still matter of debate whether C4d may serve as a specific marker for differential<br />
diagnosis ACR in HCV reinfection cases.<br />
We performed retrospective analysis of 58 liver biopsies from liver transplanted patients<br />
who had either ACR (N=29) or HCV reinfection (n=19). Patients with no pathological<br />
alterations (n=10) served as control group. In most cases underlying diseases requiring<br />
LTX in group with ACR as well as in the group without morphological changes was<br />
alcohol-induced cirrhosis. Specimens were taken due to the suspicion of ACR and HCV<br />
reinfection according to clinical and laboratory findings or as standard protocol biopsies.<br />
Immunohistochemical analysis for C4d was performed.<br />
A total of 72,4 % of ACR samples (21/29) were positive for C4d whereas 26,3 % HCV recurrence<br />
samples (5/19) showed C4d positive staining. There was no immunohistochemical<br />
positivity for Cd4 in control group samples. Our results suggest that C4d may be<br />
indeed helpful in distinguishing ACR and HCV reinfection after LTX.<br />
gasparovslavko@yahoo.com<br />
41<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
42<br />
Klinička citologija - Plenarna i pozvana predavanja<br />
ROLE OF HPV TESTING IN CERVICAL CANCER PREVENTION<br />
Grce M<br />
Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia<br />
Screening of cervical cancer based on the cervical cytology (Pap smear) has been undertaken<br />
since the 1950s and therefore saved hundred thousands lives. However, cervical<br />
cancer still remains an important health problem in Europe, being the 7th most common<br />
cause of cancer deaths in women with almost 50,000 new cases and 22,000 deaths<br />
per year. Although cervical cancer screening showed to be an excellent test, it has limitations<br />
for it application on large-scale population. On the other hand, detection of the<br />
cause of cervical cancer, the high-risk (oncogenic) types of the Human papillomaviruses<br />
(HPV) has obvious advantages. The HPV DNA test identifies women at risk for developing<br />
cervical cancer. Therefore, HPV testing has been widely used as secondary test for<br />
triage of borderline cytology and after treatment of severe cervical lesions. Currently,<br />
the use of HPV testing for primary cervical cancer screening with cytology reserved for<br />
HPV-positive women has been evaluated in several large-scale randomised controlled<br />
trials. Preliminary results indicate that although less specific than Pap spear, HPV DNA<br />
testing for primary screening showed to be substantially more sensitive in detecting severe<br />
cervical lesions. In addition, HPV testing will be useful for the upcoming generation<br />
of HPV-vaccinated women to be more accurately monitored.<br />
grce@irb.hr
Clinical Cytology - Plenary and Invited Lectures<br />
CYTOLOGIC FOLLOW-UP IN WOMEN WITH CIN TREATED BY LETZ, COLD KNIFE<br />
CONISATION AND SEMM’S COLD COAGULATION<br />
Grubišić G, Kraljević Z, Vukosavić-Cimić B, Pirkić A, Grbavac I, Bolanča I<br />
University Hospital “Sestre Milosrdnice” Zagreb<br />
Aim. To compare follow-up cytology results in patient groups treated by LETZ (Loop<br />
Excision of Transformation Zone), cold knife conisation and Semm’s cold coagulation<br />
(Electro coagulation, ECG) according to CIN (Cervical Intraepithelial Neoplasia) on target<br />
biopsy specimens, and definite therapeutic approach according to patient age, parity and<br />
lesion grading. To evaluate therapeutic success in all three groups of patients regarding<br />
to the control cytology findings. Patients and Methods. The study included patients<br />
allocated to particular therapy group according to diagnostic and therapeutic guidelines<br />
for preinvasive lesions of the uterine cervix from January 1, 1999 till December 31, 2000.<br />
Results. LETZ was performed in 157, cold knife conisation in 42, and Semm’s cold coagulation<br />
in 30 women. The patients mean age was 33,7 years in the LETZ group, 36,5<br />
years in the cold knife conization group, and 30.0 years in the Semm’s cold coagulation<br />
group. LETZ prevailed in young nulliparous women, and cold knife conization in parous<br />
women. Cytology control underwent only 50 of 157 (32%) women with LETZ, 30 of 42 (71%)<br />
women with cold knife conisation, and all 30 women with Semm’s cold coagulation. In<br />
the LETZ group, 32 (64%) histology specimens revealed CIN III, whereas in the cold knife<br />
conization group it was found in 22 (72%) women. Normal cytologic findings after above<br />
mentioned procedures were recorded in 43 (88%) women from the LETZ group, 22 (73%)<br />
women from the Semm’n cold coagulation group. LETZ under colposcopy guidance revealed<br />
a high percentage of satisfactory cytologic follow-up.Conclusion. The importance<br />
of the use of diagnostic and therapeutic guidelines and regular follow-up is emphasized,<br />
bearing in mind primarily the young female population with severe preinvasive lesions of<br />
uterine cervix. Under colposcopy guidance it is possible to obtain an optimal LETZ specimen<br />
for histologic diagnosis. So, we report the satisfactory 88% rate of normal cytology<br />
follow-up after LETZ procedure. However, the low rate of presentation for cytologic<br />
controls in the LETZ group should stimulate us to invest additional efforts to achieve the<br />
highest possible control visits in this very sensible population.<br />
goran.grubisic@gmail.com<br />
43<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
MYELOID SARCOMA OF THE SKIN<br />
Ilić I1 , Dotlić S1 , Gjadrov K1 , Sučić M1 , Bašić-Kinda S2 , Labar B2 44<br />
Klinička citologija - Plenarna i pozvana predavanja<br />
1 Zagreb University Clinical Hospital Center and School of Medicine, Clinical<br />
Department of Pathology and Cytology, Zagreb, Croatia<br />
2 3 Zagreb University Clinical Hospital Center and School of Medicine Department of<br />
Hematology, Zagreb, Croatia<br />
Background. Myeloid sarcoma (MS) is a solid tumor found at any site other than the bone<br />
marrow, composed of myeloid blasts that may show different degrees of maturation.<br />
Infiltrates of myeloid cells found in any site in the patient with leukemia are not classified<br />
as MS. Case. We present the case of a 75-year old man with a nodular tumor on his<br />
right calf. The tumor was grayish, measuring 1,8 cm in its largest diameter. Histologically,<br />
the dermis was diffusely infiltrated by large tumor cells. Immunohistochemistry<br />
showed that the tumor cells were positive for myeloperoxidase and myeloblasts were<br />
positive for CD3<strong>4.</strong> The cells were mostly myeloblasts but there were also myeloid cells<br />
in different stages of maturation. The patient’s medical history revealed that he has<br />
been previously treated for a chronic myeloid leukemia (CML) and then for transition<br />
between accelerated phase and blast phase. So this case represents a disease progression<br />
of CML presented with myeloid sarcoma. Conclusion. Clinical presentation of acute<br />
leukemia as myeloid sarcoma of the skin is not rare, but always represents a diagnostic<br />
challenge. The differential diagnoses of MS include lymphoma and histiocytic sarcoma,<br />
both of which are excluded by the use of immunohistochemistry. To differentiate MS<br />
from AML or CML infiltrates the clinical data must be provided because morphology and<br />
immunohistochemistry are not sufficient.<br />
iilic5@yahoo.com
Clinical Cytology - Plenary and Invited Lectures<br />
JUVENILE MYELOMONOCYTIC LEUKEMIA WITH PTPN11 MUTATION IN A<br />
23-MONTH-OLD GIRL<br />
Jakovljević G1 , Kardum-Skelin I2 , Nakić M1 , Batinić D3 , Rogošić S1 1 Department of Hematology and Oncology, Pediatric Clinic, Children’s Hospital Zagreb,<br />
Zagreb, Croatia<br />
2 Laboratory for Cytology and Hematology, Clinic of Internal Medicine, Merkur<br />
University Hospital, Zagreb, Croatia<br />
3 University Hospital Center Zagreb, Department of Laboratory Diagnosis, Zagreb,<br />
Croatia<br />
Juvenile myelomonocytic leukemia (JMML) is a rare clonal myeloproliferative disorder,<br />
afflicting young children, with 2 years median age at diagnosis. The natural course of<br />
JMML is rapidly fatal with 80% of patients surviving less than 3 years. Allogeneic hematopoietic<br />
stem cell transplantation (HSCT) is the only curative treatment modality<br />
for JMML, with event-free survival in about half of the children. We present a case of<br />
23-month-old girl with JMML and a somatic PTPN11 mutation. She was hospitalized<br />
due to upper respiratory tract infection, fever, rash and diarrhea. Enlarged liver, spleen,<br />
mesenterial and retroperitoneal lymph nodes were observed at presentation as well as<br />
severe elevation of white blood cell (WBC) count with monocytosis and myeloid progenitors<br />
present in peripheral blood. Hemoglobin F was also elevated. Subsequently, her<br />
bone marrow aspiration showed morphology suggestive of JMML, an unspecific immune<br />
phenotype and normal karyotype. Mutation analysis revealed a mutation in the PTPN11<br />
gene. The girl was diagnosed with JMML and treated with purinethol and low doses<br />
of cytarabine which resulted in normalization of WBC count and decrease in liver and<br />
spleen size. Her sister was a suitable bone marrow donor and allogeneic HSCT was<br />
successfully performed. Five months later she is in a good condition and in a complete<br />
remission of JMML. Early diagnosis and allogeneic HSCT were crucial for successful<br />
treatment outcome.<br />
gordanajakovljevic@yahoo.com<br />
45<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
DIAGNOSTIC CHALLENGES IN LYMPHOPROLIFERATIVE DIESASES<br />
Jakšić B, Kardum-Skelin I<br />
University Hospital Merkur, Zagreb, Croatia<br />
46<br />
Klinička citologija - Plenarna i pozvana predavanja<br />
Recent development in diagnostic technology brought up a number of exciting challenges<br />
in lymphoid neoplasms. Traditional diagnostics and classifications, based on<br />
morphological characteristics of involved tissue, are amended with new (non-morphological)<br />
parameters. Current WHO consensus classification includes besides morphology<br />
basis also immunological phenotype and genetic parameters combined with clinical<br />
data to assure reproducible classification that is clinically sound. However, with proliferating<br />
of new diagnostics, a number of conceptual and practical issues are emerging.<br />
On the one hand exponential increase of new data from basic research, translated in<br />
a pletora of new diagnostic parameters that are competing for clinical evaluation of<br />
diagnostic relevance, on the other hand increasing numbers of various treatments are<br />
also competing for clinical evaluation. This is resulting in a complex, multidimensional<br />
system that requires appropriate, methodologically sound clinical research. Clinical relevance<br />
for both diagnosis & treatment should be assessed in longitudinal, interventional<br />
clinical trials including prognostic and survival analysis. Each simple or composite parameter<br />
should be individually tested for clinical relevance, mutual relationship among<br />
parameters should be explored by multivariate analyses. Mere correlation among new<br />
(and old) diagnostic parameters is suboptimal. Poor or inadequate methodology often<br />
translate in biased or invalid results. Practical diagnostic challenges include failure<br />
to address the role of (typical) characteristic sample, to discriminate between „static“<br />
and „dynamic“ parameters , to disregard kinetic parameters , to misuse the clonality<br />
concept disregarding its quantitative aspect, or failure to analyze and manage complex<br />
genetic information etc. All this is of less importance in typical, full blown cases with<br />
predominantly uniform appearance of clonal infiltration. However, especially challenging<br />
are cases with composite cellularity in which clonal cells are scanty and surrounded<br />
with polyclonal or reactive cells. For this reason lymphoproliferative diseases may serve<br />
as an intriguing research model that could help elucidate yet not fully understood interactions<br />
between clonally affected neoplastic cells and other cells in the microenvironment.<br />
Break through in the field requires combined effort of diagnostics experts and<br />
clinicians to perform high quality, productive clinical research. Those experts should be<br />
not sealed in morphological categories unprepared to think “out of box”, but should be<br />
open-minded for paradigm change to come.<br />
bjaksic@mef.hr
Clinical Cytology - Plenary and Invited Lectures<br />
CHRONIC LYMPHOCYTIC LEUKEMIA: INSIGHTS FROM LYMPH NODES & BONE<br />
MARROW AND CLINICAL PERSPECTIVES<br />
Jakšić O1 , Kardum-Skelin I2 , Jakšić B2 1 Dubrava University Hospital, Zagreb, Croatia<br />
2 Merkur University Hospital, Zagreb, Croatia<br />
B-cell chronic lymphocytic leukemia (B-CLL) is characterized by highly variable distribution<br />
of tumor mass between peripheral blood, bone marrow and lymphoid organs which<br />
is important for staging, classification and prognosis. These clinical findings with novel<br />
data about importance of B-cell receptor and its stimulation with the support of microenvironment<br />
indicate important role of tissues (lymphoid organs and bone marrow)<br />
in the pathogenesis of B-CLL. Here is presented the novel approach of simultaneous<br />
characterization of B-CLL cells form peripheral blood, bone marrow and lymph nodes by<br />
flow cytometry and immunocytochemistry, defining inter- and intraclonal diversity with<br />
respect to various molecules. These include adhesion molecules (integrins, immunoglobulins,<br />
selectins), chemokine receptors (including CXCR-4), signaling molecules and<br />
prognostic factors (CD38 and ZAP-70), proliferation and apoptosis markers (including<br />
Ki67, AgNORs with PK index, survivin, bcl-2) and therapeutic targets (CD20 and CD52)<br />
and residual hematopoietic stem cells. A number of interesting significant interactions<br />
have been discovered, pointing to the important role of neoplastic cell microenvironment.<br />
These may in addition to insights in pathogenesis and roles of different microenvironments<br />
add to diagnosis, prognosis and treatment of B-CLL patients.<br />
ojaksic@kbd.hr<br />
47<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
48<br />
Klinička citologija - Plenarna i pozvana predavanja<br />
FLOW CYTOMETRY IMMUNOPHENOTYPING (FCI) OF FINE NEEDLE ASPIRATES<br />
(FNAs) OF LYMPH NODES<br />
Kardum Paro MM1 , Šiftar Z1 , Kardum- Skelin I2 , Šušterčić D2 , Nazor A1 ,<br />
Flegar- Meštrić Z1 , Jakšić B3 1 Institute of Clinical Chemistry, University Hospital „Merkur“, Zagreb, Croatia<br />
2 Laboratory for Cytology and Hematology, Department of Internal Medicine University<br />
Hospital „Merkur“, Zagreb, Croatia<br />
3 Department of Internal Medicine, University Hospital „Merkur“, Zagreb, Croatia<br />
Flow cytometry immunophenotyping (FCI) has an important role in the clinic work-up<br />
of fine needle aspirates (FNAs) of lymph nodes. Its standardization has been defined by<br />
proposed analytical protocols and procedures used to assure proper analytical results<br />
also in those non- rutine samples. In Institute of Clinical Chemistry University Hospital<br />
„Merkur“ FCI is accredited method according to laboratory accreditation standard ISO<br />
15189. According to this laboratory accreditation standard, participation in external quality<br />
assessment (EQA) programs is a prerequisite for assuring integrity and quality of the<br />
entire laboratory process.<br />
A critical analysis of our institutional experience in the feasibility of FCI of the material<br />
obtained by FNA of lymph nodes with suspected lymphoma represented the purpose<br />
of the study. During an eight- year period in Institute of Clinical Chemistry, University<br />
Hospital „Merkur“, a total of 1295 FNA analysis was done, 245 of them with a possible<br />
diagnosis of B- cell Non- Hodgkin lymphomas (B- NHL) formed the basis of the study.<br />
Lymphocytes were isolated on density gradient according to Boyum et al. The average<br />
feasibility of FNAs for FCI analysis was 86 % (ranged 78 - 93%). An acceptable total cell<br />
number in FNAs for FCI analysis (4257) was established. In total population of respondents<br />
statistical significances in expressions of cellular antigens CD3, CD5, CD22, CD23,<br />
CD19 and CD5 on B- cells (CD5+CD19+) between patients with final diagnosis of benign,<br />
reactive lymphoid proliferations and patients with diagnosis of B- NHL were found. EQA<br />
results analysis showed that all results were either inside target values (X ± 1stdev) or<br />
or inside accepted values (X ± 2 stdev). Compatibility of the restriction of imunoglobulins<br />
light chains determinated by FCI and cytomorphology diagnosis depends on the choice<br />
of criterion values of the light chains ratio which determine the monoclonality. According<br />
to the matrix of shares of all classified data of retained neural network, ranges of diagnostic<br />
sensitivity, specificity, positive predictive value (PPV), negative predictive value<br />
(NPV) and prevalency of 82%, 72%, 93%, 48%, and 72% were produced. As a conclusion,<br />
FCI is a reliable methodology for phenotyping FNAs of lymph nodes with suspected B-<br />
NHLs detecting their clonality easily.<br />
mariana.kardum@zg.htnet.hr
Clinical Cytology - Plenary and Invited Lectures<br />
FINE NEEDLE ASPIRATION CYTOLOGY OF THE PANCREAS: A GUIDE TO<br />
DIAGNOSTIC APPROACH<br />
Kocjan G<br />
Department of Cellular Pathology, University College London, United Kingdom<br />
The incidence of pancreatic cancer as on of the top ten leading causes of cancer death<br />
is relatively uniform among different countries and has a peak incidence in the 7th to 8th<br />
decades of life. The majority of tumours in the pancreas are ductal adenocarcinomas.<br />
However, there is a wide variety of non-neoplastic, benign neoplastic and malignant<br />
solid and cystic lesions which are becoming more accessible due to our ability to recognize<br />
and delineate pancreatic masses and to detect them and sample them earlier as<br />
smaller mass lesions by virtue of modern imaging techniques that utilize CT, US or EUS.<br />
However, there is significant overlap in the clinical and radiological features of solid<br />
and cystic mass lesions of the pancreas precluding definitive management decisions<br />
based on clinical and radiological features alone. Mass in the pancreas is potentially a<br />
life threatening condition and management options vary significantly, usually involving<br />
major surgery. The management of patients with neoplastic cysts is based on the preoperative<br />
distinction of non-mucinous and mucinous cysts in general, and benign and<br />
malignant cysts in particular. The cytopathologist therefore plays a critical role in the<br />
management decisions. A cytological diagnosis can be obtained with minimally invasive<br />
techniques. EUS guided FNA is evolving as the diagnostic method of choice due to the<br />
higher resolution, shorter biopsy trajectory, decreased risk of tumour seeding and ability<br />
to more accurately stage the patient during a single procedure using EUS. A diagnostic<br />
algorithm for the cytopathologist starts with the initial basic information from the<br />
radiological image: Is the lesion solid or cystic? If solid, differential diagnosis includes:<br />
a) Malignant disease ( in 90% primary adenocarcinoma, conventional or variant , other<br />
malignancy: lymphoma, sarcoma, germ cell tumour, other haematopoetic malignancy,<br />
metastasis, primary neuroendocrine tumour, solid pseudopapillary neoplasm, acinar<br />
cell carcinoma and pancreatoblastoma. b) Indeterminate for malignancy or neoplasm<br />
(atypical or suspicious) in cases where cellular proliferation that is quantitatively and<br />
qualitatively insufficient for a confident malignant or neoplastic interpretation (Glandular<br />
ductal pattern: rule out carcinoma, monomorphic cell pattern: rule out solid cellular<br />
neoplasm).c) Negative for malignancy (Chronic pancreatitis, autoimmune pancreatitis,<br />
normal pancreatic tissue if the radiological studies define a “fullness” or “vague” mass)<br />
d) Non-diagnostic (Normal pancreatic tissue if the radiological studies clearly highlight<br />
a well defined mass or cyst, GI contamination only, lesional tissue obscured by blood or<br />
preparation artefact, insufficient cellularity for evaluation). If the lesion is cystic ( see<br />
Table 1)it can be one of the following : a) Pseudocyst -has no epithelial component and<br />
has non-mucoid cyst fluid grossly, is unilocular, contains inflammatory cyst debris, history<br />
of pancreatitis, high amylase and low CEA, no K-ras or LOH mutations. b) Serous<br />
cyst (Microcystic, rarely macrocystic and unilocular, low amylase and CEA) c) Mucinous<br />
cyst: (Intraductal papillary mucinous neoplasm (IPMN) or Mucinous cystic neoplasm<br />
(MCN), CEA > 200 ng/ml (at MGH), positive mucin stains , K-ras mutation or ≥ 3 LOH<br />
mutations supportive d) gastrointestinal duplication cyst , rarely (CEA can be elevated).<br />
Diagnostic accuracy of pancreatic FNA depends primarily on the nature of the lesion and<br />
the quality and quantity of the material available but also on the experience of both, the<br />
aspirator and the interpreter, and most importantly on the communication between the<br />
radiological, surgical and pathology teams.<br />
g.kocjan@ucl.ac.uk<br />
49<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
50<br />
Klinička citologija - Plenarna i pozvana predavanja<br />
RECURRING CHROMOSOMAL ABNORMALITIES IN LYMPHOMA IN FINE NEEDLE<br />
ASPIRATES OF LYMPH NODE<br />
Lasan Trčić R1 , Šušterčić D2 , Kušpilic M1 , Jelić Puškarić B2 , Fabijanić I2 ,<br />
Kardum-Skelin I2 1Cytogenetic Laboratory, Department of Pediatrics, University Hospital Center Zagreb,<br />
Zagreb, Croatia.<br />
2Department of Internal Medicine, Clinical Hospital Merkur Medical School University of<br />
Zagreb, Croatia.<br />
The detection of chromosomal abnormalities characteristic of lymphomas is important<br />
in the diagnostic workup of aggressive lymphomas given its impact on treatment strategies<br />
and prognosis. This has been accomplished using fluorescent in situ hybridization<br />
(FISH). What is attractive for diagnostics is the conformation of fine needle aspiration<br />
(FNA) of lymph node with other methods for collecting samples. We report the cytogenetic<br />
investigation in series of 80 patients with lymphoma (43 women and 37 men)<br />
median age 48, ranged 3-90 years. In our series 71 (89.0%) of the specimens yield sufficient<br />
number of analysable metaphases, comprising 63 non-Hodgkin lymphomas (NHL)<br />
and 8 examples of Hodgkin disease (HD). Among 71 successful karyotyped specimens<br />
58 (82.0%) showed clonal karyotypic abnormalities. Numerical changes in 4 of 54 NHL<br />
cases, and numerical with structural changes in 51of 54 NHL cases; trisomies 3, 7, 8,<br />
12, 18, X and monosomies 1 were most frequent. The NHL cases were typically characterised<br />
by structural rather than numerical aberrations with chromosome arms 1p/q,<br />
3p/q, 6q, 11q, 17p and 14q most frequently involved. The expected t(14;18)(q32;q21) in 8 and<br />
t(8;14)(q24;q34) in 6 cases, both translocations at the same time in three cases, complex<br />
rearrangement with chromosome 8, 14, and 18, namely t(8;14;18)(q24;q32;q21) in one<br />
case, t(11;14)(q13;q32) in three and one case with translocation 14q32 with chromosome<br />
3, 6 and 1<strong>4.</strong> In 24 of 64 (37.5%) NHL cases t(14;v) were present. Four abnormal clones detected<br />
in HD were typically consisted of a small percentage of metaphases. FISH permitted<br />
to detect loss or gain of genetic material and reveal rearrangements unsuspected by<br />
conventional cytogenetics in 34 (48.0%) cases.<br />
lasan_ruzica@hotmail.com
Clinical Cytology - Plenary and Invited Lectures<br />
URINE IMMUNOCYTOLOGY AS A NONINVASIVE DIAGNOSTIC TOOL FOR ACUTE<br />
KIDNEY REJECTION: A SINGLE CENTER EXPERIENCE<br />
Mihovilović K1 , Kardum-Skelin I1 , Jelić-Puškarić B1 , Ljubanović D2 , Bulimbašić S2 ,<br />
Sabljar-Matovinović M1 , Kovačević-Vojtušek I1 , Gracin S1 , Kocman B1 , Jadrijević S1 ,<br />
Vidas Ž1 , Guštin D1 , Knotek M1 1 Clinical Hospital “Merkur”, Zagreb, Croatia<br />
2 Clinical Hospital “Dubrava”, Zagreb, Croatia<br />
Aim - Renal biopsy is gold standard for diagnosing acute renal allograft rejection. Acute<br />
rejection may be associated with lymphocyte shedding in the urine. The aim of the present<br />
study was to evaluate diagnostic performance of urine immunocytology for CD3positive<br />
cells in diagnosing renal allograft rejection.<br />
Participants and methods - This was a prospective single centre study performed in<br />
Clinical Hospital “Merkur”, Croatia. 54 kidney and kidney-pancreas transplant patients<br />
with 70 kidney biopsies (for cause or by protocol) and simultaneous urine immunocytologies<br />
(immunostaining for CD3) were included.<br />
Results - There were 24 AR cases, while in 46 biopsies AR was absent. Urine sediment<br />
was positive for CD3+ lymphocytes in 5 cases of AR (21%) and in 6 cases without AR (13%).<br />
CD3 positivity had sensitivity of 21%, specificity of 87%, positive predictive value of 45%<br />
and negative predictive value of 68% for diagnosis of AR.<br />
Discussion - These results demonstrate insufficient both sensitivity and specificity of<br />
urine immunocytology for CD3 for establishing diagnosis of renal AR. With respect to<br />
sensitivity our results are at odd with some of the previously published studies. Reasons<br />
for that are unclear, but may reflect either poor intrinsic performance of urine immunocytology<br />
for detection of AR, or may involve several technical factors like small initial<br />
volume of urine for analysis.<br />
Conclusion - Kidney biopsy still remains gold standard for detection AR. Urine immunocytology<br />
may have potential to become one of the methods for detection AR in kidney<br />
transplant patients, if sensitivity and specificity could be improved.<br />
karlomihovilovic@gmail.com<br />
51<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
52<br />
Klinička citologija - Plenarna i pozvana predavanja<br />
PARVOVIRUS B 19 INDUCED PURE RED CELL APLASIA IN IMMUNOCOMPROMISED<br />
PATIENT AFTER LIVER TRANSPLANTATION<br />
Mrzljak A1 , Kardum Skelin I1 , Čolić Cvrlje V1 , Filipec Kanižaj T1 , Šušterčić D1 , Guštin D2 ,<br />
Kocman B3 1 Department of Medicine, University Hospital Merkur, Zagreb, Croatia,<br />
2Department of Anesthesiology and Intensive Care, University Hospital Merkur, Zagreb,<br />
Croatia,<br />
3 Department of Surgery, University Hospital, Merkur, Zagreb, Croatia<br />
Reported here is a case of human parvovirus B19 (PVB19) induced pure red-cell aplasia<br />
(PRCA) in immunocompromised patient after orthotopic liver transplantation (OLT).<br />
PVB19 is a small, single-stranded DNA whose target cell is the erythroid progenitor in<br />
bone marrow. Manifestations of PVB19 infection vary with the immunologic status of<br />
the patient, ranging from asymptomatic to severe infections and PRCA. Post-transplant<br />
PRCA is induced either by immunosuppression or PVB19. In the presented case, bone<br />
marrow aspiration characterized by the absence of mature erythroid precursors and<br />
detection of PVB19 DNA in blood led to treatment with high-dose intravenous human immunoglobulins<br />
(IVIG) and subsequent recovery of erythropoiesis. Due to insufficient antibody<br />
response in transplanted patients, suppression of the PVB19 infection is delayed<br />
and repetitive treatments may be administrated in attempt of reversing PRCA.<br />
anna.mrzljak@gmail.com
Clinical Cytology - Plenary and Invited Lectures<br />
COLLECTION AND COMPOSITION OF AUTOLOGOUS PERIPHERAL BLOOD STEM<br />
CELLS GRAFT IN PATIENTS WITH ACUTE MYELOID LEUKEMIA: INFLUENCE ON HE-<br />
MATOPOIETIC RECOVERY AND OUTCOME<br />
Raos M1 , Nemet D2 , Bojanić I1 , Sertić D2 , Batinić D3 , Dušak V4 , Mazić S1 , Dubravčić K3 ,<br />
Serventi-Seiwerth R2 , Mrsić M2 , Golubić-Ćepulić B1 , Labar B2 1Department of Transfusion Medicine and Cellular Therapy, Clinical Hospital Center<br />
Zagreb, Zagreb, Croatia<br />
2Division of Hematology, Department of Internal Medicine, Clinical Hospital Center<br />
Zagreb, Zagreb, Croatia<br />
3Division of Immunology, Department of Laboratory Diagnostics, Clinical Hospital<br />
Center Zagreb, Zagreb, Croatia<br />
4 Department for Quantitative Methods, University of Zagreb, Faculty of Organisation<br />
and Informatics, Varaždin, Croatia<br />
Hematopoietic stem cell (HSC) transplantation is a standard approach in the treatment<br />
of hematological malignant diseases. For the last 15 years the main source of cells for<br />
trasplantation have been peripheral blood stem cells (PBSC). With the availability of hematopoietic<br />
growth factors and understanding the advantages of treatment with PBSC,<br />
the application of bone marrow (BM) was supplanted. The aim of this survey was to explore<br />
the success of PBSC collection, the factors which influence the success of PBSC<br />
collection, the composition and the quality of graft and their infuence on hematopoietic<br />
recovery and outcome after transplantation in patients with acute myeloid leukemia<br />
(AML). PBSC were collected by the method of leukapheresis after applying a combination<br />
of chemotherapy and growth factors or only growth factors. The quality of graft was<br />
determined with the clonogenic progenitor cell assay and with the flow citometry analysis.<br />
Of the total 134 patients with AML, who were sumitted to HSC mobilization, the collection<br />
was successful in 78 (58.2%) patients. The collection was more successful after<br />
the first than after the second attempt of HSC mobilization (49% vs 11%). The criteria for<br />
effective mobilization were the number of leukocytes >3 x 109/L and the concentration<br />
of CD34+ cells >20 x 103/mL in the peripheral blood on the first day of leukapheresis.<br />
The number of CD34+ cells infused had the strongest impact on hematopoietic recovery.<br />
We noted significantly faster hematological recovery of neutrophils and platelets, fewer<br />
number of transfused units of red blood cells and platelets, shorter duration of the tranfusion<br />
support, shorter treatment with intravenous antibiotic therapy and shorter hospitalization<br />
after PBSC compared to BM transplantation. These advantages could provide<br />
their standard application in the treatment of patients with AML.<br />
mraos@kbc-zagreb.hr<br />
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4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
54<br />
Klinička citologija - Plenarna i pozvana predavanja<br />
VALUE OF FINE-NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSIS OF HODGKIN’S LYM-<br />
PHOMA AND ANAPLASTIC LARGE CELL LYMPHOMA: ONE CENTRE EXPERIENCE<br />
Ostojić Kolonić S1 , Prašek-Kudrna K1 , Roso V1 , Radić-Krišto D1 , Planinc-Peraica A1 ,<br />
Džebro S2 , Kardum-Skelin I3 , Jakšić B1 1 Department of Medicine, University Hospital Merkur, Zagreb<br />
2 Department of Pathology and Cytology, University Hospital Merkur, Zagreb<br />
3 Laboratory for Cytology and Haematology, University Hospital Merkur, Zagreb<br />
It is commonly believed that cytological diagnosis of Hodgkin’s lymphoma (HL) is much<br />
easier than that of non-Hodgkin’s lymphoma (NHL). Anaplastic large cell lymphoma<br />
(ALCL) is NHL subtype which has created confusion with HL in fine-needle aspiration<br />
(FNA) smears. To study the value and limitations of cytology in diagnosis of HL and ALCL<br />
we analysed the initial FNA diagnosis and histopathological reports, as well as treatment<br />
and survival in 89 newly diagnosed consecutive patients with these lymphomas<br />
treated in our clinical department. These patients (40 male, 49 female; age range 16-93<br />
years, mean 38 years; 44 in clinical stages I-II; 38 with B symptoms) were diagnosed<br />
and treated during a period of 5 years and 4 months (1.1.200<strong>4.</strong>-1.5.2009.) The initial FNA<br />
diagnoses were available in 86 patients (3 patients were admitted with histopathological<br />
diagnosis and without enlarged lymph nodes suitable for FNA) and the initial pathohistological<br />
diagnosis were available in 84 patients. FNA revealed 65 classic HL, 18 ALCL and<br />
3 patients in which diagnosis was not informative due to inadequate material. Among<br />
65 FNA diagnoses as HL, comparison with histopathology was made in 61 cases (in 3<br />
cases a biopsy of lymph node was not possible and in one case there was no tumour<br />
infiltration in the analysed lymph node) and the histopathological diagnoses were as follows:<br />
56 (91,8%) HL; 3 ALCL; 1 diffuse large B cell lymphoma and 1 marginal zone B cell<br />
lymphoma. In the group of 18 FNA diagnoses of ALCL 2 patients didn’t have a lymph node<br />
biopsy; in 1 case tumour was not found in biopsy material; 8 patients (53,3%) had definitive<br />
diagnosis of ALCL( either as T-cell or O type), and 5 (33,3%) as HL. These results<br />
confirm the value of FNA in diagnostic procedure in patients with HL and ALCL, with very<br />
good results in comparison with histopathology, especially in HL group of patients.<br />
86 (96,6%) patients were treated with chemotherapy, 74 (83,1%) patients with ABVD chemotherapeutic<br />
protocol according to our policy that patients with HL and T-cell ALCL<br />
are treated with the same therapy as well. As we have almost uniform group of patients<br />
according to therapeutic approach, we done the univariante analyses and find out that<br />
patients with FNA diagnoses of HL, younger than 55 years, with early stage of the disease<br />
and without B symptoms had significantly longer overall survival (OS). FNA diagnosis<br />
has clinical relevance in differentiation between HL and ALCL.<br />
ostojic@net.hr
Clinical Cytology - Plenary and Invited Lectures<br />
ASSESSMENT OF HPV DNA TEST VALUE IN MANAGEMENT WOMEN WITH CYTOLOGI-<br />
CAL FINDINGS OF ASC-US, CIN1 AND CIN2<br />
Pajtler M, Miličić-Juhas V, Milojković M, Topolovec Z, Čuržik D, Mihaljević I<br />
Department of Clinical Cytology, University Department of Gynaecology and Obstetrics,<br />
Clinical Institute of Nuclear Medicine and Radiation Protection, Osijek University Hospital,<br />
Osijek, Croatia<br />
The aim of this retrospective study was to answer the following questions: 1) is HPV DNA<br />
test for high-risk types able to predict lesion behaviour in women with cytological abnormalities<br />
lower than CIN3 (ASC-US, CIN1 and CIN2); 2) how to predict the histological<br />
diagnosis CIN3, and 3) is its use in diagnostic management in these patients justified or<br />
not? Subjects and Methods: The study included 345 women (11 ASC-US, 312 CIN1 and 22<br />
CIN2) that underwent conventional diagnostic management (repeat cytology and colposcopy<br />
with or without histology) and HPV testing for high-risk HPV types by PCR method.<br />
The value of HPV DNA test in predicting lesion regression/persistence was assessed in<br />
275 subjects without histology. In 70 subjects, diagnostic accuracy (sensitivity, specificity,<br />
and positive and negative predictive value) of repeat cytology and HPV DNA test in predicting<br />
severe intraepithelial lesion (CIN3) was determined on the basis of colposcopy<br />
guided biopsy. Results: The prevalence of persistent lesions was significantly higher in<br />
the group of HPV positive than in the group of HPV negative subjects (37.7% vs. 16.4%;<br />
P
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
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Klinička citologija - Plenarna i pozvana predavanja<br />
THE ROLE OF ENDOSCOPIC ULTRASOUND IN EVALUATION OF GASTRIC<br />
SUBEPITHELIAL LESIONS<br />
Pavić T, Hrabar D, Duvnjak M<br />
Department of Gastroenterology and Hepatology, Clinical Hospital Sestre Milosrdnice,<br />
Zagreb, Croatia<br />
A subepithelial mass is a common finding during endoscopic procedures. Endoscopic<br />
ultrasound (EUS) is an important diagnostic modality in the evaluation of subepithelial<br />
lesions of the GI tract. EUS is the diagnostic test of choice to assess the size, margins,<br />
the layer of origin, echotexture, and to differentiate between an intramural and extramural<br />
lesion. However, the EUS imaging lacks the specificity. EUS- guided fine needle<br />
aspiration (EUS-FNA) or core biopsy can help establish a tissue diagnosis and potentially<br />
characterize malignant risk. The aim of this article is to review the diagnosis and<br />
management of the most common subepithelial gastric lesions with an emphasis on the<br />
role of endoscopic ultrasound.<br />
tajana.pavic@gmail.com<br />
LUNG LAVAGE CELL PROFILES IN DIFFUSE LUNG DISEASE<br />
Peroš-Golubičić T1 , Smojver-Ježek S2 University Hospital for Lung Diseases Jordanovac, Zagreb, Croatia<br />
1 Department of Pneumology<br />
2 Department of Cytology<br />
The standard armamentarium of tests that are used by pulmonologist are laboratory<br />
tests, pulmonary function tests, different radiological techniques (conventional chest-X<br />
rays, HRCT scans, etc) and pathohistological analyses of biopsies. The minimally invasive<br />
bronchoalveolar lavage (BAL) procedure, in addition to methods earlier mentioned,<br />
is an important diagnostic instrument that can facilitate the diagnosis of various diffuse<br />
lung diseases (DLD). BAL fluid white blood cell profiles are analyzed, malignant cells<br />
looked for, and in certain circumstances particular stains are performed to detect yet<br />
other cell types. Additionally, BAL can play a very important role in the diagnosis of respiratory<br />
tract infections. All these analyses are usually readily performed in a moderately<br />
equipped cytological laboratory.<br />
tperos-golubicic@net.hr
Clinical Cytology - Plenary and Invited Lectures<br />
BONE LESIONS IN LYMPHOMA<br />
Planinc-Peraica A, Radić-Krišto D, Ostojić Kolonić S, Kardum-Skelin I, Jakšić B<br />
Department of Medicine, University Hospital Merkur, Zagreb<br />
Bone lesions are rare events in patients with haematologic neoplasm except those with<br />
adult T-cell leukaemia lymphoma associated with HTLV-1 infection, and multiple myeloma.<br />
Primary lymphoma of bone is rare manifestation of this disease, and less than<br />
5% of all extranodal lymphomas are localized in bones. The most common localization<br />
is the long bones, and localized bone pain is usual accompanying symptom. Sometimes<br />
patients have systemic symptoms and multiple osteolyses. Less than 10% of patients<br />
with malignant lymphoma develop bone lesions during the course of their disease. Hypercalcaemia<br />
is rare in primary lymphoma of bone.<br />
In six years period at University Hospital “Merkur” out of 698 lymphoma patients bone<br />
lesions were diagnosed in 7 patients (3 men, 4 women, age - range 22 to 66 years, median<br />
of age 58 years). Two newly diagnosed patients with diffuse large B-cell lymphoma<br />
(DLBCL) had primary lymphoma of bone without lymph node involvement. In 5 patients<br />
bone lesions were discovered during the course of disease. In all patients localized bone<br />
pain was dominant symptom. No one patient had hypercalcaemia. In the course of their<br />
disease secondary bone lesions appeared in two patients with indolent lymphoma, in<br />
one patient with DLCB, and in two patients with Hodgkin’s disease, type mixed cellularity.<br />
Localization of primary bone lymphoma was femur, and rib, while secondary lymphoma<br />
lesions were in backbone, and pelvis. Patients were treated with chemotherapy<br />
(COP-R, CHOP, CHOP-R for lymphoma, and ABVD, LVPP, BEACOP for Hodgkin’s disease)<br />
combined with radiotherapy only in three patients. Three patients died. The median of<br />
survival is 75 months.<br />
We concluded that primary bone lesions of lymphoma are rare conditions. Correct diagnosis<br />
is very important because primary lymphoma of bone has a relatively favorable<br />
prognosis.<br />
ananas2907@hotmail.com<br />
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4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
58<br />
Klinička citologija - Plenarna i pozvana predavanja<br />
PRIMARY GASTROINTESTINAL NON HODGKIN LYMPHOMA IN ADULTS:<br />
CLINICOPATHOLOGICAL AND SURVIVAL CHARACTERISTICS<br />
Radić-Krišto D1 , Planinc-Peraica A1 , Ostojić Kolonić S1 , Vrhovac R1 , Kardum-Skelin I2 ,<br />
Jakšić B1 1 Department of Hematology, University Hospital Merkur, Zagreb, Croatia<br />
2 Department of Cytology, University Hospital Merkur, Zagreb, Croatia<br />
Primary non-Hodgkin lymphomas of gastrointestinal tract (PGI-NHL) are the most<br />
common extranodal lymphomas with increasing incidence. We retrospectively analyzed,<br />
incidence, clinicopathological features as well as treatement and survival data<br />
on 39, newly diagnosed PGI-NHL (23 male, 16 female), at University Hospital „Merkur“<br />
in order to precisely evaluate their characteristics and compare them with results of<br />
other similar studies. The most common site of PGI-NHL was the stomach (29 patients,<br />
74%), followed by small intestine (5 patients,13%), and colon and rectosigmoid (5 patints,13%).<br />
According to the Ann Arboror classification 34 (87%) patients had stage IE,<br />
and IIE, and 5 patients (12%) stages III E and IVE. According World Health Organization8<br />
(WHO) classification 29 (87%) patients had diffuse large B-cell lymphoma (DLCBL), 2<br />
had mantle cell lymphoma, and 7 (18%) had marginal zone B- cell lymphoma-mucosa<br />
associated tissue (MALT). Twenty six patients (66%) underwent surgical resection and<br />
were later treated by chemotherapy, 10 (26%), were treated with chemotherapy alone,<br />
and 3 (8%) were treated only surgical. Complete remissione was achived in 28 patients<br />
(72%), partial remission in 7 (18 %). Four patients had progressive disease (10%).The<br />
major prognostic factor for outcome in our patients was the stage of disease. Patients<br />
with localized lymphoma (stage IE and II E) had significantly longer overall survival<br />
(OS): 85% at 5-years and 65 % at 10 years. Patients with extended disease (stage IIIE<br />
and IV E) had overall survival less than 33%. Prognostic power of ESR, total protein and<br />
serum albumin, concentration and LDH activity, was analyzed. Among these parameters<br />
only parametars only LDH had statistically significant influence on overall survival. We<br />
conclude, that our group of patients is similar to other publised groups of PGI-NHL patients<br />
according to clinical characteristics as well as to pathological features. Disease<br />
stage and LDH were the only parametars that had a statistically significant influence on<br />
patients survival.<br />
delfaradic@kb.merkur.com
Clinical Cytology - Plenary and Invited Lectures<br />
SUBCUTANEOUS PANNICULITIS-LIKE T-CELL LYMPHOMA IN A 19 MONTH-OLD<br />
BOY TREATED WITH ALL-IC-BFM 2002 PROTOCOL - A CASE REPORT.<br />
Rajić Lj1 , Bilić E1 , Femenić R1 , Meštrović D1 , Ilić I2 , Kardum-Skelin I3 , Tešović G4 , Konja J1 1 Pediatric Clinic and<br />
2 Department of Pathology, Clinical Hospital Center Zagreb<br />
3 Clinical Hospital “Merkur“<br />
4 University Hospital for Infectious Diseases, Zagreb, Croatia.<br />
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell lymphoma<br />
of CD3+CD8+ phenotype characterized by deep-seated skin nodules or plaques<br />
mimicking panniculitis, a result of neoplastic lymphocytes infiltrating the subcutaneous<br />
fatty tissue. SPTCL is very rare, especially in childhood (less than 1% of all non-Hodgkin<br />
lymphomas) and presents most commonly in young adults. Still, there are many uncertainties<br />
regarding the optimal therapy and definitive recommendations are still to be<br />
defined. Here we present a case of a 19-month year old boy with subcutaneous panniculitis-like<br />
T-lymphoma diagnosed and successfully treated in our institution. The disease<br />
presented with symptoms of high fever and a painful erythematous nodule located below<br />
the umbilicus. A thorough diagnostic workup was initiated and not even a month after<br />
the child was hospitalized a definite diagnosis of a subcutaneous panniculitis-like Tlymphoma<br />
was confirmed. As the most decisive in obtaining the diagnosis, skin biopsy<br />
showed infiltration of atypical, small to medium-sized lymphatic cells infiltrating the<br />
deeper dermal layers as well as the subcutaneous adipose tissue, surrounding the adipocytes.<br />
In addition, numerous hystiocytes and signs of cariorrhexis and focal necrosis<br />
were observed. No infiltration of blood vessels or epidermis was evident. We then initiated<br />
a specific treatment protocol for T-lymphomas (ALL-IC-BFM-2002) and saw a rapid<br />
regression of local symptoms. The treatment was completed according to schedule and<br />
the child is now, 14 months after the initiation of the treatment, in complete remission.<br />
ljubica.rajic@yahoo.com<br />
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4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
PELVIC GANGLIONEUROMA - CASE REPORT<br />
Roganović J1 , Šegulja S1 , Jonjić N2 , Seili-Bekafigo I3 60<br />
Klinička citologija - Plenarna i pozvana predavanja<br />
1 Division of Hematology and Oncology, University Children’s Hospital Rijeka<br />
2 Department of Pathology, School of Medicine Rijeka<br />
3Department of Cytology, Department of Internal Medicine, Clinical Hospital Center<br />
Rijeka, Croatia<br />
Ganglioneuroma is a rare benign tumor originating from sympathetic tissue. The most<br />
common locations are the posterior mediastinum and retroperitoneum. Pelvic ganglioneuroma<br />
is extremely rare.<br />
We report a case of pelvic ganglioneuroma in a 12-year-old who presented with one<br />
week history of lower abdominal pain. Abdominal ultrasound demonstrated a large homogeneous<br />
well-circumscribed presacral tumor with few calcifications. This finding<br />
was confirmed by pelvic computed tomography (CT) and magnetic resonance imaging.<br />
CT-guided fine needle aspiration biopsy was performed. Cytologic and pathologic features<br />
were suggestive of ganglioneuroma. The patient underwent a complete surgical<br />
resection and the diagnosis of ganglioneuroma was subsequently confirmed on histopathologic<br />
examination. At 3-years follow-up the patient is asymptomatic and without<br />
evidence of disease.<br />
Ganglioneuroma should be considered in the differential diagnosis of soft tissue pelvic<br />
tumors in children. Fine needle aspiration biopsy plays an important role in facilitating<br />
an appropriate diagnosis and an adequate therapeutic approach.<br />
jelena.roganovic1@ri.t-com.hr
Clinical Cytology - Plenary and Invited Lectures<br />
MORPHOLOGICAL AND MOLECULAR ANALYSIS OF GISTS ON CYTOLOGY<br />
Schmitt FC<br />
Medical Faculty of Porto University, Unit of Molecular Pathology - IPATIMUP, Porto,<br />
Portugal<br />
The term “targeted therapies” refers to treatment strategies directed against molecular<br />
targets considered to be involved in the process of neoplastic transformation. One of the<br />
most attractive molecular targets for therapeutic intervention in cancer is the protein tyrosine<br />
kinase (TK) family. More than 100 dominant oncogenes are recognized to data and<br />
many encode receptor and cytoplasmic TKs known to be mutated and/or overexpressed<br />
in human cancers. Targeting receptor protein kinases family as cancer therapy has continued<br />
to become a compelling approach with time. However, some general conditions<br />
should be considered prior to selecting a TK as a therapeutic target in cancer. It should<br />
be involved in experimental tumour progression and be demonstrable in diagnostic tumour<br />
tissue. (Cyto)pathology is crucial for the accurate assessment of the target to ensure<br />
that the patients who may benefit from the therapy are correctly identified.<br />
Since the last decade, there have been an increasing number of new drugs which indications<br />
depends upon a pathological report. Fine needle aspiration (FNA) cytology has<br />
proven its value as a minimally invasive, easy, accurate and reliable technique for the<br />
diagnosis of tumours and has also been used for the assessment of prognostic and predictive<br />
factors. The evaluation of predictive factors in FNA specimens should be largely<br />
confined to patients who will undergo neoadjuvant chemotherapy before surgery or in<br />
the setting of metastatic disease. FNA is a less traumatic method that provides a good<br />
source of cancer cells to study therapeutic targets.<br />
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of<br />
the gastrointestinal tract, with an annual incidence of 10 to 20 cases per million, being<br />
most commonly found in the stomach (40 to 70%), in the small intestine (20 to 50%), in<br />
the colon and rectum (5 to 15%), and in the esophagus (< 2%). Activating mutations of<br />
c-kit oncogene are the major genetic alterations in GISTs. c-kit is a proto-oncogene<br />
that codes for a transmembrane TK receptor: CD117. Once activated, KIT propagates<br />
signalling events throughout the cell via multiple signal transduction pathways. Until<br />
recently, the prognosis of patients with GISTs was poor due to its frequent recurrence<br />
and resistance to chemo and radiotherapy regimens. The development and current<br />
treatment with specific RTK inhibitors is changing this scenario. Imatinib mesylate is<br />
a selective inhibitor of RTKs, by competing with the ATP for its binding site, preventing<br />
further phosphorylations of signaling molecules downstream of the receptor, responsible<br />
for abnormal viability and proliferation signals in these cells. Several studies have<br />
linked different responses to the drug with c-kit alterations. In particular, tumors harboring<br />
exon 11 c-kit mutations are more likely to respond to an Imatinib therapy than<br />
those with either exon 9 c-kit mutations or no detectable mutation. Currently, Imatinib is<br />
used for the treatment of Kit positive GIST patients with unresectable and/or metastatic<br />
malignant tumor. Besides Imatinib, another RTK inhibitor, Sunitinib has been approved<br />
61<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
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62<br />
Klinička citologija - Plenarna i pozvana predavanja<br />
for the treatment of patients with GIST whose disease has progressed or who are unable<br />
to tolerate treatment with Imatinib. It is a fact that obtaining an accurate diagnosis<br />
is of utmost importance for a correct treatment, being an earlier diagnosis crucial for<br />
a prompt therapy. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-<br />
FNA) has been increasingly used for the assessment of diverse intra-abdominal and<br />
intra-thoracic tumors. EUS-FNA not only allows for a meticulous representation of both<br />
extramural and intramural structures of the gastrointestinal tract but also permits tissue<br />
sampling from masses in these locations. Our group was one of the pioneers in<br />
analyze c-Kit mutations in EUS-FNA material. In 2007, we studied eighty-five patients<br />
with intramural gastrointestinal mesenchymal tumors and perform an immunohistochemical<br />
and molecular analysis of both c-kit and PDGFRA genes in formalin-fixed<br />
paraffin embedded cell blocks obtained by EUS-FNA. Cell-blocks of the initial 85 cases<br />
were obtained, however, complete immunocytochemical and molecular analysis was<br />
only possible in 51 cases. The mean age of patients was 62.4 yr (range, 26-92yr). Twenty<br />
(39.2%) patients were females and 31 (60.8%) were males. Topographically, 12 (23.5%)<br />
tumors were located in the esophagus, 35 (68.6%) tumors were gastric and 4 (7.8%)<br />
were located in the small intestine. The mean size of tumors documented by EUS was<br />
33.9mm (range 11-80mm). Immunoreactivity for CD117 was detected in a majority of tumors<br />
pre-classified as GISTs. CD117 positivity in GIST’s tumor cells was strongly present<br />
at the membrane and diffuses in the cytoplasm. CD117 was negative in 7/31 (22.6%)<br />
tumors pre-classified as GISTs. In two cases the immunostaining was not interpretable<br />
due the technical artifacts. PCR amplification and DNA sequencing revealed exon 11 mutation<br />
in 19 (57.6%, 19/33) GISTs, and exon 9 mutation in 1 (3.0%, 1/33) GIST. No PDGFRA<br />
activating mutations were detected in the c-kit wild type bearing tumors. In summary,<br />
our study demonstrates that 77.4% of GISTs strongly and diffusely express kit, irrespective<br />
of topography, age or gender. Albeit several studies indicate that 95-100% of GIST<br />
cases express kit, lower expression levels have been reported in Australian (78%) and<br />
Scandinavian studies (85%). Such differences in protein expression levels are probably<br />
due to distinct methodologies and population diversities. We identified c-Kit mutations<br />
in 61% of GIST cases, in accordance with previously published ranges (30-90%). Nearly<br />
95% (19/20) of c-kit-mutant tumors carried exon 11 mutations.<br />
EUS-FNA, a less costly, less risky, and less invasive strategy is an increasingly used<br />
procedure for the diagnosis of gastrointestinal tumors. In this study, we have shown<br />
that GISTs could be diagnosed pre-operatively on EUS-FNA specimens. In addition to<br />
immunocytochemistry, molecular analysis can be done in formalin-fixed and paraffinembedded<br />
cell block material obtained from these aspirates, avoiding more invasive<br />
diagnostic procedures to obtain a tissue diagnosis.<br />
In nowadays, with two RTK inhibitors available, there is an imperative need in re-defining<br />
GIST diagnosis and including a molecular analysis of both c-Kit and PDGFRA in the current<br />
diagnostic protocol, so as to better and faster establish the specific therapeutic<br />
approach to use in a particular patient. In conclusion, we are unquestionably taking one<br />
step forward in the diagnosis of GIST, by making the molecular analysis routinely feasible<br />
on a small sample.
Clinical Cytology - Plenary and Invited Lectures<br />
References<br />
Akerman M, Alves VA, Bubendorf L, Colgan T, Itoh H, Kapila K, Katz R, Mitchell G, Mulvany<br />
NJ, Nasuti JF, Ng WK, Osamura RY, Schalper J, Schmitt FC, Serizawa A, Verhest<br />
A, Vielh P. How technology is reshaping the practice of nongynecologic cytology. Acta<br />
Cytologica 51: 123-152, 2007.<br />
Gomes AL, Bardales RH, Milanezi F, Reis RM, Schmitt F. Molecular analysis of c-Kit and<br />
PDGFRA in GISTs diagnosed by EUS. American Journal of Clinical Pathology 127: 1-8,<br />
2007.<br />
Schmitt FC. Cells carry the clue for targeted treatment: a new horizon for cytopathology.<br />
Cytopathology 18: 275-277, 2007.<br />
Schmitt FC, Longatto A, Valent A, Vielh P. Molecular techniques in cytopathology practice.<br />
Journal of Clinical Pathology 61: 258-267, 2008.<br />
fernando.schmitt@ipatimup.pt<br />
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Klinička citologija - Plenarna i pozvana predavanja<br />
MORPHOMETRIC AND DNA IMAGE ANALYSIS OF BRONCHOALVEOLAR LAVAGE<br />
FLUID MACROPHAGES NUCLEI IN INTERSTITIAL LUNG DISEASES WITH LYMPHO-<br />
CYTIC ALVEOLITIS<br />
Smojver-Ježek S1 , Peroš-Golubičić T2 , Tekavec-Trkanjec J2 , Alilović M2 ,<br />
Vrabec-Branica B1 , Juroš Z1 , Mažuranic I3 University Hospital for Lung Diseases “Jordanovac”, Zagreb, Croatia<br />
1 Department of Cytology<br />
2 Department of Pneumology<br />
3 Department of Radiology<br />
Lymphocytic alveolitis is a characteristic of diverse interstitial lung diseases (ILD-s), but<br />
macrophages are often more numerous cell population in bronchoalveolar lavage fluid<br />
(BALF). Aim of this study is to analyze morphometric characteristics of macrophages<br />
nuclei in BALF in patients with ILD-s and to detect possible differences allowing distinguishing<br />
sarcoidosis from other lymphocytic alveolitis ILD-s.<br />
Patients and methods. Thirty-one patient with interstitial lung disease who had lymphocytic<br />
alveolitis in BALF cell count (17 sarcoidosis and 14 other ILD-s) and nine controls<br />
were included in the study. The following patients data were numbered: age, lymphocyte<br />
percentage and CD4/CD8 ratio in BALF. Investigated morphometric parameters of macrophages<br />
nuclei were: area, outline, maximal radius, minimal radius, length, breadth,<br />
form factor (FF), elongation factor (EF) and DNA image cytometry ploidy status determined<br />
with Van Velthoven method. Results. Predicted classifications in classification<br />
matrix (forward step-wise method in multivariate discriminant function analysis) based<br />
on macrophages nuclei length mean, minimum and maximum, breadth SD, FF mean<br />
and lymphocyte % were 100% (9/9) correct for control group, 88.235% (15/17) correct for<br />
sarcoidosis, and 92.857% (13/14) correct for other lymphocytic alveolitis ILD group. In<br />
total, 92.5% (37/40) of the examinees were correctly classified in particular group upon<br />
the observed variables.<br />
ssmojver@pbf.hr
Clinical Cytology - Plenary and Invited Lectures<br />
CYTOMORPHOLOGY OF SELECTED SUBTYPES OF ACUTE LEUKEMIA (AL)<br />
Sučić M1 , Marković-Glamočak M1 , Ries S1 , Gjadrov-Kuveždić K1 , Antulov J1 ,<br />
Fabijanić I1 , Vrbanus LJ1 , Ilić I1 , Dotlić S1 , Čačić M1 , Zadro R2 , Mrsić S2 ,<br />
Franić Šimić I2 , Batinić D2 , Dubravčić K2 , Serventi-Seiwerth R3 , Sertić D3 ,<br />
Mikulić M3 , Mrsić M3 , Nemet D3 , Labar B3 1 Zagreb University Clinical Hospital Center and School of Medicine, Clinical Department<br />
of Pathology and Cytology, Zagreb, Croatia<br />
2 Zagreb University Clinical Hospital Center and School of Medicine, 2Clinical Institute of<br />
Laboratory Diagnosis, Zagreb, Croatia<br />
3Zagreb University Clinical Hospital Center and School of Medicine 3Department of<br />
Hematology, Zagreb, Croatia<br />
According to WHO classification of tumors of hematopoietic and lymphoid tissues, the<br />
major subgroups of acute myeloid leukemia (AML) and related precursor neoplasms<br />
are the following: AML with recurrent genetic abnormalities, AML with myelodisplasia,<br />
therapy-related myeloid neoplasms, AML-(NOS), myeloid sarcoma, myeloid proliferations<br />
related to Down syndrome and blastic plasmocytoid dendritic cell neoplasm. Acute<br />
lymphoblastic leukemia is classified together with B and T lymphoblastic lymphoma in<br />
a group of precursor lymphoid neoplasms. Mixed lineage acute leukemia (MPAL) and<br />
acute undifferentiated leukemia (AUL) are subtypes of AL of ambiguous lineage.<br />
The aim of the study was to analyze cytomorphology of selected AML and MPAL subtypes.<br />
Patients and methods: In the study are included AL patients treated at Zagreb University<br />
Hospital Center. Bone marrow and peripheral blood of AL patients were analyzed<br />
after Pappenheim and cytochemical staining and classified according FAB and WHOclassification.<br />
Results: Therapy related AML was diagnosed in two of AL patients: one had secondary<br />
AML-M4 after five years of initial diagnosis and treatment for B-NHL, and another had<br />
AML-M2 after diagnosis of breast carcinoma and melanoma. In one patient with AML-<br />
M8 the blasts were cytomorphologically undifferentiated with sparse mature basophiles,<br />
whereas in one AML-M1 patient blasts at relapse expressed lymphoid cytomorphology<br />
pointing to lineage switch (phenomenon of MPAL).<br />
Conclusion: Cytological diagnosis of AL subtypes together with multidisciplinary diagnostic<br />
approach is essential in initial diagnosis and continuous follow-up of patients with<br />
AL, especially for secondary AL, and some other subtypes of AL, i.e. AML-M3, AML-M8<br />
and MPAL requiring individual therapy approach.<br />
mirna.sucic@yahoo.com<br />
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ENDOSCOPIC ULTRASOUND IN EVALUATION OF SOLID PANCREATIC<br />
MASSES -CURRENT STATE AND REVIEW OF THE LITERATURE<br />
Tadić M1 , Štoos-Veić T2 , Vukelić-Marković M3 , Ćurić J3 , Banić M1 , Čabrijan Z1 ,<br />
Grgurević I1 , Kujundžić M1 1 Department of Gastroenterology, Dubrava University Hospital, Zagreb, Croatia<br />
2 Department of Cytology and Flow Cytometry, Dubrava University Hospital, Zagreb,Croatia<br />
3 Department of Radiology, Dubrava University Hospital, Zagreb, Croatia<br />
The aim of this review was to discuss the current evidence of clinical impact of EUS and<br />
EUS-guided fine needle aspiration (FNA) in evaluation of solid pancreatic masses with<br />
special emphasis on differentiation between benign and malignant pancreatic lesions.<br />
At the time of introduction in clinical practice EUS was superior to the other methods<br />
in detection of pancreatic masses allowing tissue diagnosis by later introduced EUS-<br />
FNA. During the time EUS was improved, electronic probes replaced mechanical probes<br />
adding ability of color Doppler, power Doppler, contrast enhanced endosonography as<br />
well as EUS elastography analysis. CT technology has also experienced significant improvements<br />
raising the question whether EUS has lost ground in diagnostics of solid<br />
pancreatic masses. Detection of small pancreatic tumors, preoperative localization of<br />
pancreatic endocrine tumors and tissue sampling by EUS-FNA of pancreatic masses are<br />
considered firm indications for EUS. Color Doppler, power Doppler, contrast enhanced<br />
endosonography and elastography are discussed as tools that are bringing additional<br />
information in evaluation of pancreatic masses, however insufficient for definitive judgment<br />
of the lesion’s nature. Cytological tissue analysis remains undisputed in differentiation<br />
benign from malignant lesions, but the question when FNA is needed as well as<br />
the question of pancreatic cancer staging is discussed. Conclusion: Resuming the role<br />
of EUS we can state that despite some controversies EUS is a very valuable method in<br />
evaluation of solid pancreatic masses and with EUS-FNA is by far the best method for<br />
obtaining tissue diagnosis.<br />
mtadic@kbd.hr
Clinical Cytology - Plenary and Invited Lectures<br />
IMPLEMENTATION OF MODERN TECHNIQUES IN FNA OF THE THYROID<br />
Tötsch M<br />
Institute of Pathology and Neuropathology, University Hospital of Essen, Germany<br />
Fine needle aspiration of the thyroid started in the middle of the last century. It rapidly<br />
proved to be an excellent tool for management of thyroid nodules. Sensitivity of<br />
the method was improved significantly be the introduction of scintigraphy and ultrasonography.<br />
Later on, not only management but also the diagnosis of certain entities as<br />
papillary carcinoma or anaplastic carcinoma became possible by establishing appropriate<br />
diagnostic criteria. Nowadays fine needle aspiration biopsy has become a standard<br />
procedure, cytopathology has become adopted in the WHO - Classification of thyroid<br />
tumours (2004). Actually there is discussion concerning the diagnostic categories to be<br />
used as well as the definition of “non satisfactory” and satisfactory”, respectively. Additionally,<br />
the benefit of liquid based cytology is under evaluation. However, comparison<br />
of studies is hampered by different interpretation of the parameters mentioned above,<br />
furthermore the rate of incidental thyroid cancer in interpretation of “false-negative”<br />
results must be taken in consideration.<br />
The introduction of ancillary tests has improved the diagnostic sensitivity and specificity<br />
of cytology. While in former times DNA-cytometry and morphometry have been tried as<br />
an adjunct in discriminating follicular tumours, immunocytochemistry has proven now<br />
its value in the diagnosis of medullary carcinoma and metastases. Galectin-3 and others,<br />
however, can not be used today with reliabilty in practical diagnostic work.<br />
Nowadays, emphasis is laid on the introduction of molecular tests and lymphomas can<br />
be reliable diagnosed in most cases. Papillary carcinoma, having already a very good<br />
detection rate by cytology, may be diagnosed by investigation of the RET-RAS-BRAF-<br />
MAPK-pathway as well. Unfortunately, routine use is hampered by false negative respectively<br />
false positive results. Therefore, interest shifts to diagnosis of this tumour<br />
type by the detection of specific miRNA profiles.<br />
However, till now, there is no diagnostic tool for solving the dilemma of thyroid cytology,<br />
the distinction of follicular adenoma from follicular carcinoma. In these cases the diagnosis<br />
can be made only by histology.<br />
Martin.Toetsch@medizin.uni-essen.de<br />
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BENEFITS OF LIQUID BASED CYTOLOGY OVER CONVENTIONAL PAP TEST:<br />
PRESENT AND FUTURE.<br />
Verhest A<br />
Institute Jules Bordet, Brussels - Belgium<br />
Objective:The intention of this presentation is to provide insight into our everyday experience<br />
with the BD-SurePath TM liquid based technology that we used for cervical cancer<br />
screening since 1998. We will also focus on use of reflex HPV-DNA testing as an adjunct<br />
for external quality control and guided screening of cervical cytology specimens as a<br />
significant advance over routine manual screening . Methods:Conventional Pap screening<br />
has been credited with a 75 % reduction in cancer incidence and death rates in the<br />
last 50 years. Despite this, there was a growing evidence of a limited sensitivity of 77 %<br />
for detecting CIN 2 (when using LSIL as a threshold) with an individual Pap smear, a low<br />
positive predictive value (10-30%), a highly subjective interpretation leading to misclassification<br />
with unreducible false negative and positive rates. These factors limiting the<br />
performance of the Pap smear while increasing the complexity and costs of screening<br />
programmes, we replaced conventional smear in december 1997 by thin layer preparations<br />
made with BD-PrepStain TM automate from samples collected in BD-SurePath<br />
TM preservative fluid. Liquid based cytology (LBC) diagnoses were assessed on first<br />
screening sample with a second reading combined with HPV test to improve the ASCUS<br />
predictive value and offer an immediate evaluation of our personal performance and<br />
possible misinterpretation of the Bethesda TBS criteria. The LBC process is now widely<br />
used in the United States, many European countries and elsewhere. The slides facilitated<br />
the screening by skilled human observers or triggered an impetus for automated<br />
screening. In order to determine if use of the BD FocalPoint GS Imaging System (BD<br />
Diagnostics-TriPath) is more effective than manual screening, a large clinical trial has<br />
been recently performed. (1) A 2-armed, masked trial was run at 4 clinical sites. 12,313<br />
slides were evaluated. The control arm (CA) consisted of routine manual screening and<br />
quality control (QC) rescreening. The experimental arm (EA) consisted of screening by<br />
the BD FocalPoint GS Imaging System. Results: With the adoption of LBC we have<br />
significantly reduced the number of unsatisfactory smears minimizing cellular preparation<br />
artifacts, decreased the ASCUS rate and improved the sensitivity and specificity<br />
of our SIL diagnoses. The use of HPV testing has ascertained our diagnoses in the<br />
necessary learning curve of our morphologic interpretation of abnormals. BD-SurePath<br />
TM increased comfort and skill level of the all staff. More evenly dispersed single-cell<br />
population between aggregates enhances the clarity of the smear, makes them easier<br />
to evaluate for atypia; its utilization demonstrated evident superiority over conventional<br />
Pap smear in terms of disease detection. Using computer-assisted imaging, all positive,<br />
discordant, and a subsampling of negative slides were adjudicated to a reference<br />
diagnosis. The results obtained in the two arms were compared to the reference diagnoses<br />
and sensitivity, specificity, and negative predictive value (NPV) were calculated<br />
for ASC-US+, LSIL+ and HSIL+ groups. (1). The FocalPoint LGS reading gives a higher<br />
detection sensitivity than the manual reading for HSIL+ and for LSIL+. (1-2) For ASC-US+,
Clinical Cytology - Plenary and Invited Lectures<br />
the sensitivities were not statistically different between the study arms in Tench’s Study<br />
(1) while Beccati (2) reports a more precise ASCUS diagnosis. Conclusions: The optimal<br />
preservation of the cells with BD-SurePath LBC is reducing collection, preparation<br />
and screening errors of conventional Pap smears. It facilitates comfort of screening by<br />
human observers. The lower rate of unsatisfactory smears and ASCUS/SIL ratio have<br />
contributed to an increased HSIL+ detection. Use of the BD FocalPoint GS Imaging<br />
System significantly improved the sensitivity for detection of the important categories<br />
of squamous intraepithelial lesion (SIL) and cancer with a much smaller decrement in<br />
specificity. (1) SurePath cytology, FocalPoint prescreening and HPV test can improve<br />
the efficacy of screening program in a low incidence/low endemicity setting. (2) The<br />
increased sensitivity compared to conventional smear with an increased specificity for a<br />
given sensitivity reduce recall rate and unnecessary colposcopies and biopsies avoiding<br />
overtreatment and emotional stress.<br />
1. WD Tench, RD Luff, TM Molina, KP Abraham, C Kemper, WS Black-Schaffer, DC Wilbur.<br />
2009. 35th EFCS <strong>Congress</strong> of Cytology<br />
Improved Sensitivity for Detection of Important Cervical Lesions in Liquid-Based Cytology<br />
using Computer-Assisted Imaging<br />
2. MD Beccati, C Buriani, O Bulzoni, G Binotti, A Carantoni, C Cavicchi, A . Delazer, S Immovilli,<br />
I Maestri, I Nenci. 2009.<br />
35th EFCS <strong>Congress</strong> of Cytology<br />
Efficacy of Cytology-Based Screening Program Optimized by Liquid Based Cytologywith<br />
Automated Pre-Screening and HPV Testing<br />
alainverhest@yahoo.com<br />
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WHY, HOW AND FOR WHAT BENEFIT INTEGRATING MOLECULAR TECHNIQUES INTO<br />
BREAST CYTOPATHOLOGY?<br />
Vielh P<br />
Cytopathology, Department of Pathology, Institut Gustave Roussy, Villejuif CEDEX -<br />
France<br />
Aim of the study Gene-expression arrays have generated molecular predictors of relapse<br />
and drug sensitivity in breast cancer. We aimed to identify exons differently expressed<br />
in malignant and benign breast lesions and to generate a molecular classifier<br />
for breast-cancer diagnosis. Methods A series of 165 breast samples were obtained by<br />
fine-needle aspiration cytology. Complementary DNA was hybridized on splice array.<br />
The 165 FNAC samples included in the study consisted of 120 breast cancers and 45 benign<br />
lesions. Results A molecular classifier for breast-cancer diagnosis with 1228 probe<br />
sets was generated from the training set (n=94). This signature accurately classified all<br />
samples (100% accuracy, 95% CI: 96-100%). In the validation set (n=71), the molecular<br />
predictor accurately classified 68 of 71 tumours (96% accuracy, CI: 88-99%). When the<br />
165 samples were taken into account, 37 858 exon probe sets (5.4%) and 3733 genes<br />
(7.0%) were differently expressed in malignant and benign lesions (threshold: adjusted<br />
p
Clinical Cytology - Plenary and Invited Lectures<br />
POST-THAW VIABILITY OF CRYOPRESERVED HEMATOPOIETIC PROGENITOR CELL<br />
GRAFTS: DOES IT MATTER?<br />
Vrhovac R1 , Perić Z1 , Jurenec S2 , Jelić-Puškarić B1 , Kardum-Skelin I1 , Jakšić B1 1 Department of Medicine and<br />
2 Transfusion Medicine, University Hospital Merkur, Zajčeva 19, Zagreb, Croatia<br />
Cell viability in peripheral blood progenitor cell (PBPC) grafts and its influence on the<br />
clinical course following transplantation was evaluated in 81 consecutive transplantations<br />
(72 autologous, 9 allogeneic) performed in patients with hematological diseases.<br />
Viability of cells in PBPC grafts immediately upon collection was 98.6±3.5%, after addition<br />
of dimethyl sulfoxide (DMSO) 73.3±21.8%, and post-thaw 65.2±16.1%. It did not differ<br />
significantly between patients with different diagnoses, gender, age, type of priming used,<br />
dose of G-CSF administered or number of CD34+ cells collected. However, grafts stored<br />
for more than 60 days showed lower post-thaw viability compared to the ones thawed<br />
in the 60 days following cryopreservation (56.6±15.2% vs. 67.6±15.5%, p=0.04). Post-thaw<br />
graft viability did not influence engraftment time, but there was a predisposition towards<br />
infectious complications in the post-transplant period in patients receiving grafts with<br />
lower percentage of viable cells. These patients developed febrile neutropenia more often<br />
(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)<br />
following transplantation. Our results demonstrate that PBPC grafts are capable of long<br />
term engraftment regardless of the graft storage time or percentage of viable cells postthaw,<br />
which confirms the robustness of CD34+ cells during the freeze/thaw procedures<br />
carried out in daily clinical practice. Granulocyte concentration in PBPC grafts could have<br />
an influence on infectious complications following transplantation. This intriguing finding<br />
needs to be further investigated on a larger number of patients.<br />
radovan.vrhovac@zg.t-com.hr<br />
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CLINICAL CYTOLOGY IN PRIMARY HEALTH CARE OF CHILDREN AND ADULTS<br />
Round Table Discussion<br />
Moderator: Znidarčić Ž<br />
Participants:<br />
Jeren T, Kaić G, Kardum-Skelin I, Knežević-Obad A, Smojver-Ježek S, Vince A<br />
Summary - Clinical cytology is well known in gynecology by Pap smears and it is usually<br />
considered a diagnosis of malignancy. However, many diseases in almost all fields of<br />
medicine can be cytologically diagnosed. Because of many advantages of cytology, such<br />
as minimal aggressiveness, simple technique and high accuracy, it is important for all<br />
medical specialties, primary practitioners in particular, to know more about this medical<br />
field about which they could not learn enough during their educational process. Perhaps<br />
this educational failure could now be connected with low costs, which was one of the<br />
cytology advantages at the beginning.<br />
Clinical cytology is used in the prevention, diagnosis, follow up and treatment of disease.<br />
It is a morphological medical field employing medical history data, clinical findings, technical<br />
procedures of material sampling and smear preparation and finally microscopic<br />
analysis in its diagnostic procedure. Sometimes some other technologies are necessary<br />
to classify the pathological process or, possibly, to differentiate similar morphological<br />
findings, which can be decided after microscopic analysis.<br />
Primary practitioners should know the indications for cytological examination, the way<br />
of material collection and interpretation of cytological findings. The participants in this<br />
discussion answer these three questions in several fields of medical practice where<br />
cytological diagnosis is most often used, i.e. infectious diseases, hematology, pulmonology,<br />
gastroenterology, urology, thyroid gland and breast. The last question refers to appropriate<br />
communication between primary practitioners and cytologists.<br />
Here the answers are summarized in short, almost tabular way because it provides<br />
information that is more practical and appears more suitable for educational purpose.<br />
Extensive texts will be printed after the <strong>Congress</strong> as journal articles (Collegium Antropologicum).<br />
Infectious diseases (Jeren T, Vince A):<br />
1. Indications: various inflammatory lesions of the skin and mucous membranes, often<br />
enlarged lymph nodes;<br />
2. Obtaining of material: smears, brushing, fine needle aspiration;<br />
3. Interpretation of cytological findings description of smears, conclusion, diagnosis,<br />
differential diagnosis (with regard to the pathological process dynamics);
Clinical Cytology - Plenary and Invited Lectures<br />
Hematology (Kardum-Skelin I):<br />
1. Indications: a) lymph node<br />
- children: clinically unexplained enlargement<br />
- adults: every enlarged lymph node<br />
b) bone marrow and peripheral blood: abnormal blood cell finding<br />
(number, form);<br />
2. Material collection: lymph node and bone marrow puncture, peripheral blood smear;<br />
3. Interpretation of cytological findings: conclusion - diagnosis/differential diagnosis,<br />
quantitative analysis of bone marrow and peripheral blood<br />
Pulmonology (Smojver-Ježek S):<br />
1. Indications: symptoms (cough with or without blood in sputum), asthma (eosinophils<br />
in sputum), x-ray abnormalities of the lung;<br />
2. Material collection: nasal smear, sputum, bronchial aspiration, bronchoalveolar<br />
lavage, brushing - bronchoscopy, imprint of biopsy specimen, pleural effusion; transtracheal<br />
or transbronchial puncture, transthoracic puncture (x-ray or US- or CTguided);<br />
3. Interpretation of cytological findings: conclusion – diagnosis (tumor classification),<br />
epithelial atypia, hyperplasia, metaplasia<br />
Gastroenterology (Kaić G):<br />
1. Indications: endoscopic or US-findings (tumors, inflammation);<br />
2. Material collection: smears, brushing, puncture (transmucous or transcutaneous);<br />
3. Interpretation of cytological findings: conclusion, diagnosis or suggestion<br />
Urology (Kaić G):<br />
1. Indications: clinical symptoms (especially hematuria);<br />
2. Material collection: urine (spontaneous, rarely catheterization or washing), brushing,<br />
puncture of prostate, rarely kidney;<br />
3. Interpretation of cytological findings: conclusion - diagnosis (atypia, suspected tumor)<br />
suggestions<br />
Thyroid gland (Knežević-Obad A):<br />
1. Indications: node(s) - palpable or impalpable (US found);<br />
2. Material collection: puncture (US-guided);<br />
3. Interpretation of cytological findings: diagnosis or suggestion for additional work-up<br />
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Breast (Kardum-Skelin I) :<br />
1. Indications: palpatory or US, mammography and/or MR findings, nipple secretion;<br />
2. Material collection: puncture (US- or stereotactic-guided), smear of secretion;<br />
3. Interpretation of cytological findings: diagnosis or suggestion.<br />
The last question for all participants whether or not the communication between primary<br />
practitioners and cytologists was appropriate, was unanimously answered: it should<br />
be enhanced.<br />
The intention of this Round Table Discussion is to improve the communication and to<br />
make up for the unsatisfactory education in clinical cytology as much as possible.
Clinical Cytology - Oral Presentations<br />
FINE NEEDLE ASPIRATION CYTOLOGY IN THE EVALUATION OF PAROTID<br />
GLAND TUMORS<br />
Belušić Gobić M1 , Pedisić D2 , Seili Bekafigo I3 , Cerović R1 , Starčević R2 , Manestar D2 ,<br />
Juretić M1 1Clinic for Oral and Maxillofacial Surgery, Clinical Hospital Center Rijeka, School of<br />
Medicine, University of Rijeka, Rijeka, Croatia<br />
2Department of Otorhinolaryngology- Head and Neck Surgery, School of Medicine,<br />
University of Rijeka, Rijeka, Croatia<br />
3Department of Cytology, Department of Internal Medicine, Clinical Hospital Center<br />
Rijeka, Croatia<br />
Main objective of this study was to evaluate the usefulness and accuracy of fine needle<br />
aspiration cytology (FNAC) diagnosis of parotid masses to distinguish reliably between<br />
benign and malignant lesions. In the period of 5 years, 214 parotid glands where resected<br />
at the Clinical Hospital Center Rijeka (Croatia), but 176 patients had cytopathological and<br />
histopathological diagnoses and therefore fulfilled the criteria for study. The results of<br />
the FNAC were analyzed and compared to the corresponding histopathological diagnosis<br />
obtained of the surgical specimen. Histological evaluation revealed 17 malignant and<br />
159 benign lesions. There where 13 true positive, 147 true negative, 3 false negative, and<br />
13 true negative. Sensitivity of FNAC was 81%, and specificity was 98%. FNAC results<br />
provide useful predictive preoperative information and better preparation the surgeon<br />
and patient for surgical procedure.<br />
mfk@kbc-rijeka.hr<br />
FINE NEEDLE ASPIRATION CYTOLOGY OF THE MINIMAL BREAST CARCINOMA<br />
IN ISTRIA COUNTY<br />
Besser-Silconi Ž, Lozić AAB, Mišljenović N<br />
Pula General Hospital, Department of Cytology, Pula, Croatia<br />
Breast cancer is the most frequent malignant tumor in women in Western countries.<br />
Minimal invasive carcinoma and carcinoma in situ have a better prognosis so we try to<br />
find them during preventive exams. The aim of this study was to identify minimal cancer<br />
in fine needle aspiration biopsies of breast lesions made in Pula General Hospital between<br />
the years 2006 and 2008. There were 39 tumors with maximal diameter less than<br />
10 mm in our material of 1316 biopsies and 251 cytological diagnosed breast cancers.<br />
Mostly, they were solitary, well differentiated neoplasm (48.7%). They were diagnosed<br />
in woman age 40 to 89 years and the most frequently found in women age 61 to 70 years.<br />
The most frequent pathohistological type of operated minimal breast carcinoma was<br />
invasive ductal carcinoma. Fine needle aspiration cytology of minimal breast carcinoma<br />
is a reliable diagnostic method. However, the minimal breast carcinoma percentage of<br />
all malignant breast cancers was only 15.5% and this result is not satisfactory.<br />
besser-silconi@hotmail.com<br />
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NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA (NLPHL) -<br />
THE DIAGNOSTIC PROBLEM<br />
Borovečki A, Jelić-Puškarić B2 , Džebro S1 , Kardum-Skelin I2 1 University Hospital “Merkur”, Department of Pathology and Cytology, Zagreb, Croatia<br />
2University Hospital “Merkur”, Department of Medicine, Laboratory of Cytology and<br />
Haemathology, Zagreb, Croatia<br />
NLPHL represents 5% of all HL. Compared with CHL, NLPHL shows a slightly older<br />
median age at presentation (med. 37), male predominance and localized peripheral<br />
lymphadenopathy with less mediastinal involvement (
Clinical Cytology - Oral Presentations<br />
DIFFUSE LARGE B-CELL LYMPHOMA IN PATIENT AFTER TREATMENT OF<br />
ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA<br />
Džeko-Škugor N1 , Perić Z2 , Vrhovac R2 , Radić-Krišto D2 , Kardum-Skelin I3 , Jakšić B2 1 General Hospital Šibenik, Department of Cytology, Šibenik<br />
2 Merkur University Hospital, Department of Medicine, Zagreb<br />
3Merkur University Hospital, Department of Medicine, Laboratory for Cytology and<br />
Hematology, Zagreb,Croatia<br />
Relatively few cases of Epstein-Barr (EBV)-positive B-cell lymphomas arising in patients<br />
with angioimmunoblastic T-cell lymphoma (AITL) have been reported, the most common<br />
of them diffuse large B-cell lymphoma (DLBCL).We report a case of angioimmunoblastic<br />
T-cell lymphoma in which diffuse large B-cell lymphoma arose 13 months after the<br />
initial diagnosis of AITL. A 36-year-old female patient was evaluated in March and April<br />
2008 with moderate leukocytosis, peripheral and abdominal lymphadenopathy. AITL was<br />
diagnosed after a fine-needle aspiration cytology (FNAC) of the enlarged cervical and<br />
supraclavicular lymph nodes was performed and confirmed by an immunophenotyping<br />
and biopsy of the cervical lymph nodes. The patient recieved chemotherapy regimen<br />
FED (fludarabine, endoxane, dexamethasone) and autologous hematopoietic stem cells<br />
transplantation was done. In April 2009 the patient was hospitalized because of fever,<br />
pancytopenia, hyperbilirubinemia and peripheral lymphadenopathy. A computed tomography<br />
(CT) study showed enlarged mediastinal and abdominal lymph nodes. A relapse of<br />
non-Hodgkin lymphoma (NHL) was suspected. The FNAC of the enlarged cervical lymph<br />
nodes was performed again, but this time the smears were composed of polymorphous<br />
population of lymphocytes with the predomination of large cells, CD20¬+ on immunocytochemical<br />
stains. The immunophenotyping confirmed a predomination of monoclonal<br />
mature B-cells. Serologic testing revealed increased titers of EBV VCA IgG and EBV<br />
EBNA IgG; the plasma EBV DNA levels were also increased. The patient showed a positive<br />
response to an additional chemotherapy regimen CHOP-R (cyclophosphamide, doxorubicin,<br />
vincristine, prednisone and rituximab) and there is the possibility of allogenic<br />
stem cell transplantation. AITL is a rare lymphoproliferative disorder in which the neoplastic<br />
T-cells represent the minority of the lymph node cell population and almost all<br />
cases harbor EBV-infected B-cells. Various authors postulated that immunodeficiency<br />
in AITL patients together with immunosupresive efects of cytotoxic drugs, may be responsible<br />
for EBV-induced proliferation of latently or newely EBV-infected B-cells with<br />
eventual clonal selection and proggresion to aggressive B-cell lymphoma.<br />
nivesdzeko@gmail.com<br />
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A CORRELATIVE STUDY OF HISTOLOGY AND IMPRINT CYTOLOGY OF GASTRIC<br />
MUCOSA BIOPSY IN THE DIAGNOSIS OF GASTRIC CANCER<br />
Fuštar-Preradović Lj1 , Coha B2 , Pajić-Penavić I3 1 Department of Pathology, Forensic Medicine and Cytology, General Hospital<br />
“Dr. Josip Benčević”, Slavonski Brod, Croatia<br />
2Department of Internal Medicine, General Hospital “Dr. Josip Benčević”,<br />
Slavonski Brod, Croatia<br />
3 Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital<br />
“Dr. Josip Benčević”, Slavonski Brod, Croatia<br />
The aim of the paper is to establish the value of gastric mucosa imprint cytology in detection<br />
of gastric cancer. 389 biopsy samples, taken from patients by endoscopic examination,<br />
with suspected diagnosis of stomach cancer were analyzed. Each specimen was<br />
first submitted to slide imprinting and then formalin fixed for further routine histopathology<br />
treatment. The imprints were air dried for cytological analysis, stained according to<br />
May- Grünwald-Giemsa and analyzed under a light microscope. 194 specimens were<br />
adequate for final comparison of gastric cancer detection methods. Using pathological<br />
and histological analyzes gastric cancer was found in 45 specimens and cytological<br />
analysis detected it in 63 specimens. Combining these two methods cancer was found in<br />
67 specimens. Patients having positive cytological finding and negative pathohistologic<br />
finding went for repeated gastroscopy with biopsy. All patients with positive findings were<br />
operated and the obtained material was entirely pathohistologically examined. Cancer<br />
was found in 67 patients. Cytological analysis of the imprints of bio-optic material of the<br />
stomach mucosa increases number of positive findings in preoperative stage of stomach<br />
cancer diagnosis. The biggest advantage of the method is its speed, simplicity and low<br />
price. All information on morphological changes of mucosa is also pathohistologically<br />
checked, because taking of imprints does not damage the specimen.<br />
ljubica.fustar.preradovic@sb.htnet.hr
Clinical Cytology - Oral Presentations<br />
ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION OF PARATHYROID LESIONS<br />
Fuštar-Preradović Lj<br />
Department of Pathology, Forensic Medicine and Cytology, General Hospital, Slavonski<br />
Brod, Croatia<br />
Hyperparthyreoidism is a syndrome caused by adenoma, hyperplasia or rarely by cancer<br />
of parathyroid glands. Secondary hyperparathyroidism is a common complication<br />
in cases of chronic renal insufficiency, with clinical and biochemical signs of increased<br />
function of parathyroid glands. It may be so pronounced that surgery is necessary. Sometimes<br />
medical treatment hyperparthyreoidism consist percussing inactivity of the tumor<br />
of parathyroid glands with alcohol. Both procedures demand preoperative localization<br />
of the tissue of the parathyroid glands. The preoperative localization of abnormal, nonpalpable<br />
parathyroid glands in patients with hyperparthyreoidism is largely dependent<br />
on use of high-resolution sonography. However, such a technique has some limitations<br />
and aid of fine needle biopsy (FNAB) may be relevant. On the other hand, cytology also<br />
has some limitations in identification of parathyroid cells. The accuracy of diagnosis of<br />
suspected enlarged parathyroid glands can be improved by combination of ultrasound<br />
examination, ultrasound-guided FNAB and simultaneous analysis of the obtained cell<br />
material by cytology, cytochemistry and immunocytochemistry. A systematic morphologic<br />
description will be given in stained smears all cell types and their cytomorphologic<br />
presentation, with use chromogranin A and calcitonin immunocytochemistry. Conclusion:<br />
Medical treatment hyperparthyreoidism consists of surgical removal of magnified<br />
parathyroid glands or percussing inactivity of tumor of parathyroid glands with alcohol.<br />
It is beneficial for surgeons to know the number, the size, and locality of parathyroid<br />
glands prior to surgery, so they can plan the operative procedure and make it shorter<br />
and safer.<br />
ljubica.fustar.preradovic@sb.htnet.hr<br />
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FNA BASED DIAGNOSIS OF HEAD AND NECK LYMPHOMA<br />
Gjadrov Kuveždić K1 , Aurer I2 , Ries S1 , Sučić M1 , Marković-Glamočak M1 , Ilić I1 ,<br />
Bašić-Kinda S2 , Radman I2 , Labar B2 1 Department of Pathology and Cytology, Zagreb University Hospital, Zagreb, Croatia<br />
2Division of Hematology, Department of Internal Medicine, Zagreb University Hospital,<br />
Zagreb, Croatia<br />
Today the accepted World Health Organization (WHO) classification defines lymphoid diseases<br />
with combination of morphologic, immunologic, genotypic and molecular features,<br />
putting less emphasis on histopathology as a sole determination of lymphoma subtype.<br />
It enables FNA to become complementary morphologic method in lymphoma diagnostics.<br />
Aim: The aim of this study was to assess the efficacy of FNA in that region and to<br />
evaluate its sensitivity regarding lymphoma diagnostics. Patients and methods: in the<br />
study were included patients reffered to our laboratory from hematology department,<br />
in whom head and neck lymphadenopathia was found, and FNA preceded other procedure.<br />
Specimens were stained with MGG, and antibodies against CD3, CD5, CD10, CD20,<br />
CD23, CD43,CD68,CD45, CD15,CD30, ALK, and EMA were administered. Lymphomas were<br />
classified according to WHO classification. Results: In 248 patients 285 aspirations were<br />
performed. Diagnosis of lymphoma was given in 100 cases. Overall sensitivity was 90%,<br />
specificity 88%, predictive value of a positive result 97%, and predictive value of negative<br />
result 66%, with exact agreement in75% cases between cytomorphology and histopathology<br />
diagnoses. Conclusion: Based on our results FNA can be a method of choice, serving<br />
as a method complementary to histopathology in selected lymphoma cases.<br />
gjadrov@yahoo.co.uk
Clinical Cytology - Oral Presentations<br />
LIQUID-BASED CYTOLOGY - NEW POSSIBILITIES IN THE DIAGNOSIS OF<br />
CERVICAL LESIONS<br />
Jurič D1 , Mahovlić V1 , Rajhvajn S1 , Ovanin-Rakić A1 , Škopljanac-Mačina L1 , Barišić A1 ,<br />
Šamija Projić I1 , Babić D2 , Suša M2 , Ćorušić A3 , Orešković S4 1 Department of Gynecologic Cytology<br />
2 Department of Gynecologic and Perinatal Pathology<br />
3 Department of Gynecologic Oncology<br />
4 Department of Gynecology and Urogynecology, University Department of Gynecology<br />
and Obstetrics, Zagreb University Hospital Center, Zagreb, Croatia<br />
Introduction. Liquid-based cytology (LBC) enables the use of supplementary methods in<br />
the diagnosis and prognosis of cervical lesions. Aim. To analyse the correlation between<br />
p16INK4a immunoexpression in ThinPrep cervical cytologic samples and human papillomavirus<br />
(HPV) detection by polymerase chain reaction (PCR) from the same sample.<br />
Materials and methods. LBC-ThinPrep (Cytyc, USA) cervical cytology samples, prepared<br />
and stained by Papanicolaou method, were analysed using modified Bethesda cytologic<br />
classification named Zagreb 2002. A second ThinPrep slide, prepared from the same<br />
sample, was immunostained for p16INK4a using CINtec p16INK4a Cytology Kit (Dako-<br />
Cytomation, Denmark). Increased expression of the high-risk HPV E6 and E7 oncogenes<br />
results in a highly specific increase in p16 protein expression and overexpression of<br />
p16INK4a acts as a potential biomarker for cervical cancer progression from premalignant<br />
lesions. Brown nuclear and/or cytoplasmic staining of abnormal cells was considered<br />
a positive result. Residual material was used for 13 HR HPV-DNA detection by PCR<br />
based AMPLICOR HPV test ( Roche Molecular Systems). Results. A total of 120 Thin-<br />
Prep Pap tests with following cytological diagnosis: 17 within normal limits, 17 atypical<br />
squamous cell (ASC) (7 ASC of undetermined significance - ASCUS and 10 ASC of highgrade<br />
squamous intraepithelial lesions cannot be excluded – ASC-H ), 26 low-grade<br />
squamous intraepithelial lesions (LSIL) corresponding cervical intraepithelial neoplasia<br />
(CIN) I , 57 high-grade SIL (HSIL) i.e. 24 CIN II and 33 CIN III and 3 squamous cell carcinoma<br />
(SCC) were included in the study. All CIN III (n=33) and SCC (n=3) specimens<br />
expressed p16 immunoreactivity, whereas the HR HPV test was positive in 97% (32/33) of<br />
CIN III and 100% (3/3) of SCCs. The p16INK4a biomarker was positive in 87,5% (21/24) of<br />
CIN II and 69% (18/26) of CIN I, while the HR HPV was positive in 75% (18/24) of CIN II and<br />
50% (13/26) of CIN I. In ASCUS cytology, p16 and HR HPV showed the same rate of positivity<br />
(28,5%; 2/7). Expression of p16 was detected in all cytological (10/10) ASC-H lesions,<br />
in contrast to HR HPV detected in only 20% (2/10) of the ASC-H cases. Conclusion. These<br />
data suggest the p16INK4a evaluation in ThinPrep cervical samples to be significantly<br />
associated with HR HPV testing by PCR in the same sample for a diagnosis of HSIL lesions<br />
and cervical carcinomas. A prospective study with longer follow up may clarify the<br />
predictive values in management of LSIL and ASC diagnosis.<br />
danijela_juric@yahoo.com<br />
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PNEUMOCYSTIS CARINII IN THE TRANSBRONCHIAL LUNG BIOPSY IMPRINT OF THE<br />
PATIENT NOT KNOWN TO BE HIV INFECTED- CASE REPORT<br />
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<br />
Diseases Jordanovac, Zagreb, Croatia<br />
2 Department of Clinical Pathology, Dubrava University Hospital, Zagreb, Croatia<br />
Patients with HIV infection are exposed to the different opportunistic infections and the<br />
most commom among them is Pneumocystis. Over 85% of HIV patients without treatment<br />
would eventually develope Pneumocystis pneumonia which still causes death in<br />
about 10% of cases. Diagnosis may be suspected by the patient’s clinical presentation in<br />
typical cases but the best diagnostic yield is achieved by analyzing samples obtained by<br />
bronchoalveolar lavage and induced sputum. We present the case of 42 years-old male<br />
with long-time period undiagnosed and untreated Pneumocystis infection.First morphological<br />
diagnosis was established in transbronchial lung biopsy imprint cytology.<br />
zrinka.juros@zg.t-com.hr
Clinical Cytology - Oral Presentations<br />
MULTIMODAL IMAGE ANALYSIS OF CHRONIC LEUKEMIC LYMPHOPROLIFERATIVE<br />
DISORDERS AND THE HYPOTHESIS OF „SINGLE“ AND „MULTIPLE“ PROGRAMMED<br />
STOPS IN THE DEVELOPMENT OF TYPICAL AND ATYPICAL FORMS OF LEUKAEMIAS<br />
AND LYMPHOMAS<br />
Kardum-Skelin I1 , Radić-Krišto D1 , Jelić Puškarić B1 , Jakšić O2 , Kardum M3 , Jakšić B1 1 University Hospital Merkur, Zagreb<br />
2 University Hospital Dubrava, Zagreb<br />
3 Faculty of Veterinary Medicine<br />
The analysis consisted of morphometric studies, assessment of the nucleolar organization<br />
region (AgNOR) characteristics, and image cytometry (ICM), performed in 71895<br />
cells on a SFORM PC (VAMSTEC, Zagreb). Correlation between morphometric, AgNOR<br />
and ICM characteristics revealed the low proliferative cells to possess small, homogeneous<br />
AgNOR, with the majority of cells in the peak of DNA histogram. The high proliferative<br />
cells had inhomogeneous AgNOR, mostly containing greater DNA amount than<br />
peak cells, or pathologic mitoses (DNA >4N), or the majority of cells being in the Sphase<br />
of the cell cycle. Cells with medium proliferative activity and annular AgNOR were<br />
in-between. Analysis of different tumor mass compartments showed the lymphatic cells<br />
with affinity to accumulation in bone marrow to regularly exhibit low proliferative activity<br />
(a lower percentage of cells in SFC and highest percentage of cells in the peak of the G0/<br />
G1 phase). The cells in lymph nodes, exhibiting the characteristics of proliferative cells<br />
(an increased number of AgNOR, larger more proliferative inhomogeous AgNOR and<br />
lowest percentage of cells in the G0/G1 phase). The migration of cells from bone marrow<br />
to lymph nodes and between lymph nodes occurs in peripheral blood (a mixture of<br />
cells with low and high proliferative activity: a higher proportion of cells in SFC and at<br />
the same time in the G0/G1 phase of the cell cycle). Analysis of cell size and proliferative<br />
activity in different compartments of tumor mass revealed the cells in bone marrow and<br />
peripheral blood did not differ substantially according to size and proliferative activity, an<br />
inverse pattern was observed between peripheral blood and lymph node. As small cells<br />
are inactive and larger cells more proliferative, the analysis quite unexpectedly showed<br />
the peripheral blood cells to be largest and most inactive, in contrast to lymph node<br />
where the cells were smallest and most active. The “single” and “multiple programmed<br />
stops” in the development of typical forms of leukemias and lymphomas, subacute and<br />
and subchronic leukemias were hypothesized.<br />
ikardum@hi.t-com.hr<br />
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ROLE OF CYTOLOGY IN CHILDHOOD DISEASES<br />
Kardum-Skelin I, Šušterčić D, Jelić-Puškarić B, Milas M<br />
Merkur University Hospital, Zagreb, Croatia<br />
84<br />
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Diseases of childhood pose a diagnostic challenge to cytologists. Lysosomal storage<br />
diseases comprise a large group of congenital disorders including Gaucher’s disease,<br />
Niemann-Pick disease, Farber’s disease, etc. At cellular level, foam cells can be identified<br />
in circulating blood and reticuloendothelial system of bone marrow, liver and spleen.<br />
Cytomorphologically, large histiocytes contain striated rod-shaped inclusion bodies that<br />
give it a wrinkled paper or crumpled silk appearance. Gaucher cells, sea blue histiocytes<br />
are found in bone marrow preparation in patients with Niemann-Pick disease and other<br />
systemic lipidoses. Foam cell staining properties (cytochemical or immunocytochemical<br />
reaction) may differ in various storage diseases. Langerhans cell histiocytosis (dendritic<br />
cell histiocytosis, erythrophagocytic macrophage disorders, malignant histiocytosis,<br />
congenital self-healing form called Hashimoto-Pritzker disease, etc.) is a group<br />
of idiopathic disorders characterized by the proliferation of immunophenotypically and<br />
functionally immature, morphologically rounded Langerhans cells along with eosinophils,<br />
macrophages, lymphocytes, and commonly, multinucleated giant cells. Dendritic<br />
cell histiocytosis includes Letterer-Siwe disease, eosinophilic granulomas, and Hand-<br />
Schüller-Christian disease. Fine-needle aspiration (large, ovoid, mononuclear cells,<br />
with folded nuclei, discrete nucleoli, and a moderate amount of slightly homogeneous<br />
cytoplasm) combined with immunocytochemistry (S-100 protein, CD1a, CD207) of cytologic<br />
smears plays an important role in demonstrating organ involvement by Langerhans<br />
cell histiocytosis. Acute lymphoblastic leukemia (ALL) is primarily a disease of<br />
children; 75% of cases occur in children under six years of age. Cytomorphologically,<br />
lymphoblasts are typically small, medium-sized to large blasts (of B or T origin), involving<br />
bone marrow and blood (ALL) or presenting with primary involvement of thymus,<br />
lymph node, spleen or extranodal sites (lymphoblastic lymphoma). B lymphoblastic<br />
leukemia/lymphoma with t(v;11q23) - MLL rearranged; B lymphoblastic leukemia/<br />
lymphoma with t(12;21)(p13;q22) - TEL-AML1 (etv6-RUNX1); B lymphoblastic leukemia/<br />
lymphoma/lymphoma with hyperdiploidy; B lymphoblastic leukemia/lymphoma with<br />
T(1;19)(Q23;P13.3) - E2A-PBX1 (TCF3-PBX1) are common leukemias in children. There are<br />
no unique morphological, cytochemical or immunophenotypical features to distinguish<br />
these types of ALL. Over the last few years, fine needle aspiration cytology (FNAC) has<br />
been used more extensively in the diagnosis of pediatric solid tumors. The most common<br />
solid tumors of childhood are small round cell tumors (SRCT) that include Ewing<br />
sarcoma/primitive neuroectodermal tumor, Wilm’s tumor, neuroblastoma, malignant<br />
lymphoma, rhabdomyosarcoma, and desmoplastic small round cell tumor. These tumors<br />
of different origin are a heterogeneous group of malignant neoplasms that are very<br />
similar in their histologic and cytologic appearance with undifferentiated, uniform, small<br />
round cells with big, hyperchromatic nuclei. The diagnosis of SRCT can be made accurately<br />
by applying clinicopathological criteria and a panel of immunocytochemical and<br />
genetic studies in appropriate cases. FNAC interpretation of childhood disease is easy<br />
when cytologic findings are correlated with relevant cytochemical, immunocytochemical,<br />
genetic and clinical data.<br />
ikardum@hi.t-com.hr
Clinical Cytology - Oral Presentations<br />
DIAGNOSTIC PITFALLS IN PARATHYROID GLAND CYTOLOGY<br />
Knežević-Obad A1 , Tomić-Brzac H1 , Žarkovic K2 , Dodig D1 1 Clinical Department of Nuclear Medicine and Radiation Protection,<br />
University Hospital Zagreb,<br />
2 Clinical Department of Pathology, University Hospital Zagreb<br />
Aim: The aim of this study was to establish possibilities of cytology in diagnosing adenomas<br />
of parathyroid gland. Material and methods: During the three years period (1st of<br />
January 2006 to 31st of December 2008) in Clinical Department of Nuclear Medicine and<br />
Radiation Protection 475 ultrasonographic examinations were performed under suspicion<br />
for parathyroid gland disease. In all of them FNAB was done. 374 patients were<br />
female and 101 male, aged 20 -88 years, and most of them were 50-69 years old. Slides<br />
were stained by May-Grünwald-Giemsa, air dried and analysed under light microscope.<br />
Results: In 217 patients cytological diagnosis was hyperplasia, adenoma in 71 and in 187<br />
there was not sufficient material for cytological analysis. Only in 36 of those 187 inadequate<br />
samples, parathyroid hormone (PTH) was positive in the aspirate. On echosonography,<br />
adenomas were presented in most of the cases as hypoechoic, solitary nodule and<br />
in 84% located behind lower pole of the right or left thyroid lobe. Al of the patients with<br />
cytological diagnosis of parathyroid adenoma were submitted to surgery, and adenoma<br />
of the parathyroid gland was patohistologicaly verified. There were also three cases of<br />
patohoistologicali diagnosed adenoma, in which cytology was negative, meaning adenoma<br />
was not recognized. In one case due to cystic degeneration of a nodule, in other<br />
case there were intranuclear inclusions present so it was mistaken for papillary thyroid<br />
carcinoma, and in third case it was reported as oncocytic thyroid adenoma. In 96% of<br />
cases we were able to diagnose adenoma of the parathyroid gland, based on examination<br />
of MGG stained slides, with additional staining for argyrophil reaction. Based on cell<br />
morphology we were able to distinguish oncocytic adenoma of parathyroid gland, atypical<br />
adenoma and chief-cell adenoma. In 4% (3 cases) of analysed FNAB of parathyroid<br />
gland nodules adenoma was not properly recognized. Conclusion: Ultrasound-guided<br />
FNAB, with data about localisation and ehosonographic structure of a nodule, assuming<br />
there is adequate material obtained, can be diagnostic for parathyroid gland adenoma<br />
in 96% of cases. Possible pitfalls are oncocytic type of parathyroid adenoma that can be<br />
mistaken for oncocytic thyroid adenoma, presence of intranuclear inclusions that can be<br />
mistaken for papillary thyroid carcinoma and cystic degeneration of a nodule. Mistakes<br />
can be avoided if we perform PTH level in FNAB obtained material.<br />
ivana.knezevic@vz.t-com.hr<br />
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86<br />
Klinička citologija - Usmena predavanja<br />
ESTIMATING CLINICAL OUTCOME OF HPV INDUCED CERVICAL LESION BY<br />
COMBINATION OF CAPSID PROTEIN L1 AND P16INK4a PROTEIN DETECTION<br />
Krivak Bolanča I, Šentija K, Katalenić Simon S, Kukura V*, Vraneš J**<br />
Laboratory for Clinical Cytology and Genetics<br />
*Department of Gynaecology and Obstetrics<br />
“Merkur” University Hospital, Zagreb<br />
** “Dr.Andrija Stampar” Institute of Public Health, Zagreb, Croatia<br />
The aim of this study was to investigate whether is possible to predict clinical outcome of<br />
cervical lesion by immunoassaying performed on cervical smears. During the two year<br />
study period the cervical smears of 81 patients were collected. All patients were tested<br />
for human papillomavirus (HPV) infections using Amplycor HPV test. Sixty-six of them<br />
were tested as positive for high risk types (hrHPV) and squamous intraepithelial lesion,<br />
and in those patients repeated cervical smears were taken every six months. The rest<br />
were hrHPV negative patients with normal smears which were used as a negative control<br />
in immunoassays with HPV L1 and p16INK4a antibodies. The results of p16INK4a staining<br />
in 66 hrHPV positive patients showed impairment of the cervical lesion in 22 (33.3%)<br />
and unchanged cytological finding in 21 (31.9%) p16INK4a positive patients, respectively,<br />
while improving of cytological finding was seen only in three (<strong>4.</strong>5%) p16INK4a positive<br />
patients. On the contrary, impairment of cytological finding was not seen in p16INK4a<br />
negative patients, while in 17 out of 20 patients from that group improving or normalisation<br />
of cytological finding were detected (p
Clinical Cytology - Oral Presentations<br />
ALCOHOL SCLEROSING OVARIAN CYSTIC LESIONS, 20 YEARS EXPERIENCE<br />
Kukura V, Krivak Bolanča I*, Šentija K*, Katalenić Simon S*<br />
Department of Gynecology and Obstetrics<br />
*Laboratory for Cytology and Clinical Genetics<br />
“Mekur“ University Hospital, Zagreb, Croatia<br />
Objectives: The purpose of the study is a technique of punction and conservative treatment<br />
of cystic ovarian lesions. Methods: The cyst should be unilocular, sonolucent, with<br />
a smooth inner wall of capsule, without septa and without neovasculariation on transvaginal<br />
color Doppler. CA-125 levels must be lower than 35 U/ml. The capsule of the cyst<br />
was punctured with a 18 gauge needle under the control of 5 MHz transvaginal probe.<br />
Cyst fluid was sent for cytologic examination. After complete emptyng of the cyst, we<br />
injected sterile 95% ethanol in the 50-75% of the evacuated liquor amount. The alcohol<br />
remain in the cyst from 5 to 20 minutes and was then aspirated completely. Results: We<br />
punctured 366 patients with ovarian cyst volume between 40 and 300 ml in the age from<br />
18 to 65. Patients were monitored for 24 hours and follow-up examinations are 3, 6 and 12<br />
months after the procedure. Intensive pelvic pain had 8,1% and relapse appeared in 8,2%<br />
of the patients. Three cysts were ruptured (0,8%) and alcohol split in the Douglas cavity.<br />
Conclusion: Technique of punction is simple and easily performed. Method of treating by<br />
95% alcohol showed good results. Relapse we treated by laparoscopy or laparotomy.<br />
vlastimir.kukura@zg.t-com.hr<br />
METASTASES ON RARE LOCATIONS AS INITIAL MANIFESTATIONS OF<br />
NON-SMALL CELL LUNG CARCINOMA: TWO CASE REPORTS<br />
Lozić AAB, Besser Silconi Ž, Mišljenović N<br />
Department of Cytology, Pula General Hospital, Pula, Croatia<br />
The non-small cell carcinoma of the lung is a malignant epithelial tumor slow in growth<br />
but still metastasizing out of its site. When the primary tumor treatment starts, about<br />
60% of patients already have some kind of malignant cell spreading. Metastases to hand<br />
bones and skeletal muscles are very rare (metastatic hand lesions represent 0,1% of all<br />
osseous metastases while metastases to muscles represent from 0,8 to 16% incidence<br />
in autopsy series) but the metastatic involvement of these sites usually indicate that<br />
metastatic disease has already spread. Fine needle aspiration cytology has an important<br />
task to give accurate diagnosis or at least diagnosis of suspicion and thus to set the<br />
guidelines to a clinician for the further specific and cost-effective treatment.<br />
We will show two cases where the metastases of non-small cell carcinoma of the lung<br />
were the first signs of the disease in uncommon body parts: a man with the metastasis<br />
to distal phalanx of the right hand thumb and a woman with nodal metastasis to the<br />
right gluteal muscle and subcutaneous tissue near muscle, so we have to pay our attention<br />
to the potential development of such lesions in uncommon body parts.<br />
alex_lozic@yahoo.co.uk<br />
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88<br />
Klinička citologija - Usmena predavanja<br />
DIGITAL MORPHOMETRY OF CYTOLOGIC ASPIRATE ENDOMETRIAL SAMPLES<br />
Mahovlić V1 , Ovanin-Rakić A1 , Škopljanac-Mačina L1 , Barišić A1 , Rajhvajn S1 , Jurič D1 ,<br />
Šamija I1 , Ilić-Forko J2 , Babić D2 , Škrablin-Kučić S3 , Božikov J4 1Department of Gynecologic Cytology, University Department of Gynecology and Obstetrics,<br />
Zagreb University Hospital Center, Zagreb, Croatia<br />
2Department of Gynecologic and Perinatal Pathology, University Department of Clinical<br />
Pathology, Zagreb University Hospital Center, Zagreb, Croatia<br />
3Department of Perinatal Medicine, University Department of Gynecology and<br />
Obstetrics, Zagreb University Hospital Center, Zagreb, Croatia<br />
4Andrija Štampar School of Public Health, School of Medicine, University of Zagreb,<br />
Zagreb, Croatia<br />
Unlike cervical cytology, morphological cytology criteria in the differential diagnosis of<br />
endometrium have not yet been clearly defined, and methods to allow for more precise<br />
evaluation of endometrium status have been searched for. Aim. To assess the value of<br />
morphometric nucleus analysis of cytologic aspirate endometrial samples in proliferative,<br />
hyperplastic and malignant endometrium by use of digital image analysis. Materials<br />
and methods. Morphometric analysis was performed on archival cytologic aspirate endometrial<br />
samples (at least 10 per group) stained according to Papanicolaou (n=77) and<br />
May-Grünwald-Giemsa (MGG; n=80) with the following histopathologic diagnoses: proliferative<br />
endometrium, hyperplasia simplex, hyperplasia complex, hyperplasia complex<br />
atypica, and adenocarcinoma endometriodes endometrii (grade I, II and III). Interactive<br />
image analysis (nuclear area, convex area, perimeter, maximum and minimum radius,<br />
length and breadth, as well as nucleus form factor and elongation factor) was performed<br />
by use of the SFORM software (VAMSTEC, Zagreb) on at least 50 (Papanicolaou stain) and<br />
100 (MGG stain) well preserved endometrial epithelial cell nuclei without overlapping, at<br />
magnification of X1000. Statistical data analysis was done by use of the Statistica Ver. 6<br />
statistical package. Results. Multivariate analysis (ANOVA) distinguished malignant, hyperplastic<br />
and proliferative endometrium according to all morphometric variables with<br />
both staining methods (P0.05) from<br />
atypical hyperplasia, adenocarcinoma and proliferative endometrium only according to<br />
the nucleus form factor and elongation factor (Papanicolaou stain), whereas malignant<br />
and atypical hyperplastic endometrium (MGG stain) differed statistically significantly<br />
(P0.05). According to the cytologic<br />
staining method, morphometric parameters were considerably higher in MGG<br />
stained endometrial samples, reaching the level of statistical significance (P0.05) in the groups of hyperplasia<br />
simplex and complex, well differentiated adenocarcinoma (form factor) and<br />
atypical hyperplasia (elongation factor). Conclusion. A combination of cytomorphology<br />
and the morphometric variables assessed in this study can yield useful information on<br />
the cytologic state of endometrium, with special reference to the possible differentiation<br />
of the group of hyperplasia without atypia from the group of adenocarcinoma and atypical<br />
hyperplasia.<br />
vesna.mahovlic@zg.t-com.hr
Clinical Cytology - Oral Presentations<br />
T-LYMPHOBLASTIC LYMPHOMA WITH AN UNUSUAL t(8;14)(q24;q11) - CASE REPORT<br />
Mandac I1 , Ostojić-Kolonić S1 , Vrhovac R1 , Lasan-Trčić R2 , Jakelić-Piteša J3 ,<br />
Kardum-Skelin I1 1 University Hospital Merkur, Zagreb, Croatia<br />
2 Clinical Hospital Zagreb, Zagreb, Croatia<br />
3 Clinical Hospital Split, Split, Croatia<br />
The cytogenetic abnormalities seen at presentation of acute lymphoblastic leukemia<br />
or lymphoblastic lymphoma (ALL/LBL) are associated with distinct clinical and hematologic<br />
disease entities. T-ALL/LBL are morphologically indinguishable from those of<br />
B-ALL/LBL. An abnormal kariotype is found in 50-70% of cases of T-ALL/LBL. Here we<br />
present a 35-year old male patient with T-ALL/LBL and t(8;14)(q24;q11.2). Our patient<br />
presented with B-symptoms, bulky mediastinal disease and CNS infiltration. Bone marrow<br />
was morphologically normal without clonal aberations in bone marrow cytogenetics.<br />
Cytological findings of the supraclavicular lymph node showed numerous CD3<br />
positive (100%) and CD2 positive (88%) lymphoblasts which were negative for CD34 and<br />
CD10. Flow cytometry of lymph node showed T cell phenotype of immature cells: CD45<br />
+CD2+CD5+CD7+CD4+CD8+CD3cyt+CD3TdT+CD10-CD34-HLAD/DR-. Cytogenetic analysis<br />
of lymph node showed translocation t(1;4)(p32;p12), t(8;14)(q24;q11.2). Southern blot<br />
analysis of extracted DNA from the supraclavicular lymph node demonstrated clonal<br />
rearrangement of the T cell antigen receptor (TCR/J) gene (region Vb+Jb2). Based on<br />
these findings, diagnosis of T lymphoblastic non Hodgkin lymphoma was established.<br />
Lumbal puncture and liquor analysis showed CNS infiltration with 49% lymphoblasts<br />
positive for CD4 and CD8. The disease progressed rapidly and response to therapy was<br />
poor. T-ALL/LBL with an unusual t(8;14)(q24;q11.2) is a very rare hematologic disorder<br />
with rapid disease progression and poor response to conventional therapy because of<br />
frequent central nervous system involvement and early relapses.<br />
imandac@yahoo.com<br />
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90<br />
Klinička citologija - Usmena predavanja<br />
T LYMPHOBLASTIC LEUKEMIA WITH AN UNUSUAL BURKITT LYMPHOMA<br />
MORPHOLOGY - A CASE REPORT<br />
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<br />
Hematology, Zagreb, Croatia<br />
2 Merkur University Hospital, Department of Medicine, Zagreb, Croatia<br />
3 Merkur University Hospital, Institute of Clinical Chemistry, Zagreb, Croatia<br />
Precursor T- cell acute lymphoblastic leukaemia (T-ALL)/lymphoma (T-LBL) is a neoplasm<br />
committed to the T-cell lineage. It comprises about 20 – 25% of adult cases of<br />
ALL and about 85 - 90% of LBL. In adults it is still a disease with poor prognosis with<br />
median survival to 12 months in spite of progress made in understanding its pathogenesis<br />
and treatment. Complications such as infections, sepsis, meningeal involvement<br />
can occur at any time during treatment and be the cause of fatal outcome. We report a<br />
case of a 56-year-old male who was hospitalized due to high fever and kidney infection.<br />
Further examination showed anemia, thrombocytopenia, normal level of white blood<br />
cells and high level of lactat-dehidrogenase (LDH). Bone marrow aspiration revealed<br />
87% and peripheral blood 41% of lymphoblasts with cytoplasmic vacuoles which suggested<br />
Burkitt lymphoma morphology. Patient’s karyotype showed no chromosomal aberations.<br />
Identification of immunophenotype discovered cells which were CD2 positive<br />
and CD20 negative with focal acid phosphatase activity in 67% of blasts. This excluded<br />
Burkitt lymphoma and led to diagnosis of T-ALL. Patient was submitted to a numerous<br />
chemotherapy treatments and autologous stem cell transplantation. Despite these<br />
efforts, complicatons of disease (infection and pleural effusion) led to fatal outcome<br />
after 10 months from diagnosis. Our case report showed how morphology alone can be<br />
misleading and is not enough in diagnosing ALL. Beside morphologic criteria, setting<br />
correct diagnosis depends on identification of immunophenotype by flow cytometry and<br />
cytogenetic-molecular abnormalities. Further improvements in the molecular definition<br />
of ALL subtypes, development of new and targeted drugs will improve patient’s outcome<br />
and prognosis.<br />
marina.milas@gmail.com
Clinical Cytology - Oral Presentations<br />
CURRENT ORGANISATION OF CLINICAL CYTOLOGY IN CROATIA<br />
Miličić-Juhas V1 , Lončar B1 , Mahovlić V2 , Kardum-Skelin I3 , Pajtler M1 1 Clinical Hospital Osijek, Department of Clinical Cytology, Osijek, Croatia<br />
2 Zagreb University Hospital Center, Department of Gynecologic Cytology, University<br />
Department of Gynecology and Obstetrics, Zagreb, Croatia<br />
3 University Hospital Merkur, Laboratory for Cytology and Hematology, Zagreb, Croatia<br />
Current cytological service in Croatia is organised in 46 cytological organisational units<br />
in 23 towns with total of 350 employees: 101 specialists of clinical cytology, 20 residents<br />
in clinical cytology, 141 cytotechnologists (cytoscreeners), 45 health technicians, and 25<br />
administrators and 18 auxiliary personnel. In spite of employment of significant number<br />
of cytotechnologists in the last ten years, there is still an unacceptable ratio of number<br />
of cytologists and cytotechnologists (1:1.4) which is the result of unresolved education of<br />
cytotechnologists which should be permanent, complete and acknowledged. Education<br />
and scientific promotion of cytologists is continuous and today our profession has 31<br />
masters of science and 9 doctors of science, one of which is assistant professor, and four<br />
of them are associate or full professors at medical schools in Zagreb and Osijek. <strong>Croatian</strong><br />
cytology, in average, is in its “best years”, i.e. average cytologist is 46 years old, and<br />
cytotechnologist is in average 43 years old, but „suffers” from personnel deficit. With regard<br />
to type of activity, the most numerous are units dealing the entire diagnostic cytology<br />
(72%), 13% general cytology without gynaecological cytology, while 15% are engaged<br />
in one diagnostic field (gynaecological, pulmological or thyroid cytology). According to<br />
accessible data, total of 770996 cytological examinations were done in Croatia in 2008.<br />
The increasing application of additional methods (cytochemical, immunocytochemical,<br />
molecular, cytogenetics and computer-assisted image analysis) has become a trend<br />
in numerous cytological units. Exclusively morphological analysis of standard stained<br />
samples is performed in 37% of units, morphological and cytochemical staining methods<br />
are used in 17% of units, and additional immunocytochemical methods in 30% of<br />
units. According to the long tradition of cytology in Croatia, that has progressed thanks<br />
to the enthusiasm and great effort of our teachers, we believe that the following generations<br />
of cytologists will continue working on its improvement and will be able to concord<br />
basic cytomorphology and sophisticated diagnostic procedures with other diagnostics,<br />
to stay the field of optimal results in the shortest time with the reasonable price.<br />
valerija.mj@gmail.com<br />
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92<br />
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IS THE HSIL SUBCLASSIFICATION CYTOLOGICALLY REAL AND CLINICALLY JUSTIFIED?<br />
Miličić-Juhas V, Pajtler M<br />
Department of Clinical Cytology, Clinical Hospital Osijek, Osijek, Croatia<br />
The purpose of this work was to evaluate the justification of <strong>Croatian</strong> modification of<br />
Bethesda classification after thirteen years of its application, answering the question<br />
is the subclassification of HSIL into CIN2 and CIN3 cytologically real and clinically justified.<br />
The retrospective study covered 3110 women examinees at Clinical Department<br />
in Clinical hospital Osijek from 1993 to 2005. By cytological examination of VCE smear<br />
intraepithelial lesion of cervix of different weight has been diagnosed. Cytologically and<br />
colposcopically 57,1% women examinees were monitored, while 42,9% had also pathohistological<br />
examination. In determining the lesion’s biological behaviour, regression<br />
has been defined with two or more negative control cytological findings in a year or<br />
more, persistence was defined with two or more abnormal or intermittently abnormal<br />
control cytological findings, which pointed out the intraepithelial squamous lesion of<br />
different weight in a year or more, while progression was defined with cytological finding<br />
which pointed out the invasive lesion. Positive predictive value has been estimated<br />
on the base of comparison of the worst cytological finding with the worst pathological<br />
finding not depending on histological sample. The spontaneous regression of cytological<br />
finding showed in 66,3% cases. CIN2 regressed significantly more often (in 50,98%<br />
cases) than CIN3 (31,3%) and considerably more rarely than CIN1 (70,1%). Comparing<br />
the first and the worst cytological diagnosis during monitoring, it has been found that<br />
CIN1 is also the heaviest diagosis in 80,1% cases, while in 19,9% of examinees the initial<br />
diagnoses progressed in heavier lesion. CIN2 was also the heaviest cytological diagnosis<br />
in 65,35 cases, and it progressed in CIN3 in 34,1% cases. CIN2 progressed more often<br />
in CIN3 than CIN1 (34,1% in relation to 12,7%). The positive predictive value of cytological<br />
differential diagnoses CIN3 (84,3%) is significantly higher than CIN2 (36,9%), and CIN1<br />
(44,3%), but positive predictive value of CIN1 and CIN2 doesn’t considerably differ. Pathohistologically<br />
CIN3 has been found considerably more often in cytological diagnosis CIN2<br />
(38,9%) than in cytological diagnosis CIN1 (22,8%), but significantly more rarely than in<br />
cytological diagnosis CIN3 (84,2%). Therefore, cytological CIN2 and CIN3 lesions differ<br />
mutually in biological behaviour, and histological finding. Namely, 50,9% of CIN2 spontaneously<br />
regressed, additional 14,4% persisted during monitoring, i.e. didn’t progress<br />
in CIN3 or heaviest lesion, and 59,7% had a histological finding less than CIN3. In other<br />
words, in almost 65% of CIN2 lesions it is not justified to apply diagnostic therapeutic<br />
procedures for CIN3 lesions. In accordance with this, the cytological subclassification<br />
of HSIL on CIN2 and CIN3 lesions is clinically justified. The positive predictive value of<br />
cytological differential diagnosis CIN2 is significantly lower than CIN3, but doesn’t differ<br />
significantly from CIN1, so CIN2 is equally real cytological differential diagnosis as CIN1,<br />
which is classified as an independent diagnosis in all classifications, so based on this the<br />
subclassification of HSIL is cytologically possible.<br />
valerija.mj@gmail.com
Clinical Cytology - Oral Presentations<br />
PAP TEST - WITH OR WITHOUT VAGINAL SMEAR?<br />
Miličić-Juhas V1 , Perić M1 , Pajtler M1 , Prvulović I2 , Čuržik D3 1 Department of Clinical Cytology, Clinical Hospital Osijek, Osijek, Croatia<br />
2 Department of Clinical Cytology, General Hospital Dr. J. Bencevic, Sl. Brod, Croatia<br />
3 Clinic of Obstetrics and Gynecology, Clinical Hospital Osijek, Osijek, Croatia<br />
The aim of this study was to evaluate medical and economic justification of vaginal<br />
smears as part of primary screening for cervical carcinoma and its precursors. Study<br />
included 245.048 participants whose VCE (vaginal, cervical, endocervical) smears were<br />
examined at Department of clinical cytology of Clinical hospital Osijek from 2003 till<br />
2008. There were 12.639 (5,2%) abnormal findings, and they were divided into three<br />
groups: abnormal cells found only in vaginal smear (V), abnormal cells found in vaginal<br />
and in at least one other smear (V+) and abnormal cells not found in vaginal smear (C/E).<br />
These three groups were analysed in respect to cytological differential diagnosis and<br />
age of participants. It was estimated how many women could be additionally included<br />
in the screening, if vaginal smear would be included in the Pap test only after 50 years<br />
of age. In 6,9% of cytologically diagnosed lesions abnormal cells were found exclusively<br />
in vaginal smears (0,35% of all findings). In squamous cell lesions, 91,2% were mild lesions<br />
(ASC and LSIL). Invasive squamous cell carcinoma was not diagnosed exclusively<br />
by vaginal smear in either woman under 50 years of age, while in women over 50 years<br />
of age it was diagnosed in 2,3% of cases. Exclusively by vaginal smear was diagnosed<br />
3,9% of all AGC and 6,3% of adenocarcinoma, while in 85,0% of glandular epithelium lesions<br />
abnormal cells were not found in vaginal smears. Two thirds of adenocarcinoma<br />
diagnosed exclusively by vaginal smears were endometrial adenocarcinoma, but that is<br />
only 10,3% of all endometrial carcinoma diagnosed by Pap test. Obtained results show<br />
that taking of vaginal smears along with cervical and endocervical smears as a part of<br />
primary screening for cervical carcinoma and its precursors in women under 50 years<br />
of age is not justifiable, since vaginal smear only has a role in detection of endometrial<br />
carcinoma that are extremely rare in younger age groups. If vaginal smear would be<br />
taken only in women over 50 years of age, additional 37,7% of women under 50, or 25,1%<br />
women over 50 years of age could be included in the screening.<br />
valerija.mj@gmail.com<br />
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94<br />
Klinička citologija - Usmena predavanja<br />
PREVIOUS CYTOLOGICAL FINDINGS IN WOMEN WITH FINAL HISTOLOGICAL<br />
DIAGNOSIS OF CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE 3<br />
Milojkovic M1 , Pajtler M2 , Milojkovic D1 1 Department of Gynecology and Obstetrics,<br />
2 Department of Clinical Cytology, Clinical Hospital Osijek<br />
Objective. To evaluate the reliability of the previous cytological smears in relation to the<br />
final histological diagnosis of cervical intraepithelial neoplasia grade 3 (CIN 3). In addition,<br />
to determine the importance of the follow up period and the number of cytological<br />
smears of patients with abnormal cytological findings in order to evaluate the lesion<br />
accurately. Methods. During the period 1 January 2000 – 31 December 2005, 805 women<br />
with a final histological diagnosis CIN 3 were analysed retrospectively. With regard to<br />
the length of the monitoring period before the histological verification, the women were<br />
classified in two groups: 1st group: less than a year, 2nd group: longer than a year.<br />
Results. During the monitoring period, 701 patients (87.1%) had a cervical finding of a<br />
high grade intraepithelial lesion (HIL) thus: only HIL (reliable cytological finding) in 357<br />
women (4<strong>4.</strong>3%) whereas 344 women (42.7%) had HIL and sometimes low grade intraepithelial<br />
lesion (LIL) and a normal finding (unreliable cytological finding). Cytological<br />
finding underestimated the histological one, only LIL or LIL/normal finding was found<br />
in 45 women (5.6%). The cytological finding suspicious for carcinoma (overestimated)<br />
was found in 20 (2.5%) women. The permanently normal cytological finding (false negative)<br />
had 8 (1.0%) women. The cytological finding was unknown in 31 (3.9%) women. For<br />
less than a year 470 (58.4%) women had been monitored cytologically (1st group). For<br />
more than a year 296 (36.8%) women had been monitored (2nd group). Conclusion. If the<br />
women with an abnormal cytological finding are monitored regularly and in continuity,<br />
the reliability of cytology in diagnostics of CIN 3 is high. Performing a single cytological<br />
screening is very unreliable.<br />
pajtler.marija@kbo.hr
Clinical Cytology - Oral Presentations<br />
FINE NEEDLE ASPIRATION CYTOLOGY OF ADRENOCORTICAL CARCINOMA:<br />
CASE REPORT<br />
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<br />
2 University Hospital Merkur, Division of Urology, Zagreb<br />
3 University Hospital Merkur, Department of Medicine, Zagreb<br />
4 University Hospital Merkur, Department of Surgery, Zagreb<br />
5University Hospital Merkur, Department of Medicine, Laboratory for Cytology and Hematology,<br />
Zagreb, Croatia<br />
Adrenocortical carcinoma (ACC) is a malignant epithelial tumour of adrenal cortical<br />
cells. Approximately half of all ACCs are hormonaly functional. A 49-year-old woman<br />
presented for hirsutism, deep voice and hypertension. Ultrasonography (US) revealed a<br />
solitary tumor mass, 8 cm in size, of the right adrenal gland. Laboratory tests showed<br />
it to be a hormonally active, androgen secreting tumour (elevated testosterone level),<br />
which was consistent with the clinical picture of the disease. After histopathologic analysis<br />
tumor was signet out as adrenocortical carcinoma, a low risk carcinoma according<br />
to Weiss’ classification. On regular follow up US study performed at one year, a 65x43<br />
mm growth was diagnosed in the lower pole of the right kidney. The finding was verified<br />
by computerized tomography and the patient was reoperated on. Exploration revealed<br />
secondary growth in the region of greater omentum, without infiltration of adjacent organs.<br />
Histopathologic analysis confirmed metastatic ACC. At 8 months of the second<br />
operation and after 6 chemotherapy cycles according to EAP protocol, enlarged paraaortic<br />
lymph nodes and a node along the upper pole of the right kidney were diagnosed<br />
by cytologic puncture. Cytologic analysis showed numerous large tumor cells (individual<br />
and in papillary clusters) with polymorphic, hyperchromic, irregular nuclei, prominent<br />
nucleoli with perinucleolar halo, and abundant pale basophilic cytoplasm. The cells<br />
were positive for vimentin, NSE, synaptophysin and epithelial markers (BerEP4 and epithelial<br />
membrane antigen - EMA). ACC is a rare tumor of high malignant potential. Morphologically<br />
(histopathology and cytology), there is the problem of differential diagnosis<br />
from adenoma on the one hand, and from renal cell carcinoma (RCC) and hepatocellular<br />
carcinoma (HCC) on the other hand. A combined evaluation of clinical features , size or<br />
weight, microscopic appearance, immunohistochemical and molecular genetic data is<br />
necessary.<br />
maja.misic1@gmail.com<br />
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96<br />
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THYROID FINE NEEDLE ASPIRATION IN PATIENTS UNDER 18 YEARS: A CLINICO-<br />
CYTOLOGIC STUDY<br />
Moslavac S1 , Mateša N2 , Kusić Z2 1 Poliklinika Sunce, Zagreb, Croatia<br />
2Department of Oncology and Nuclear Medicine, University Hospital Sestre Milosrdnice,<br />
Zagreb, Croatia<br />
Objective: Thyroid fine needle aspiration (FNA) is the most accurate and cost effective<br />
method in the evaluation of the thyroid nodule and has been commonly used in adults.<br />
Thyroid nodules are uncommon in younger patients (1-2%). Our aim was to determine<br />
some relevant clinical and cytological parameters in this demographic group. Patients<br />
and Methods: Ultrasound-guided thyroid FNAs performed from May 1, 1995 to May 31,<br />
2008 in patients under 18 years of age were retrospectively reviewed. The following clinical<br />
parameters were retrieved: age and gender, number of nodules, and nodule size.<br />
Cytological parameters included cytologic diagnosis and cyto-patohistological correlation.<br />
Results: 236 cases, representing 206 patients under 18 years of age, were retrieved<br />
from a total of 11748 thyroid FNA cases (2.0%). The patient’s age ranged from 2 to 18<br />
years (mean 14). There were 180 (87.4%) females and 26 (12.6%) males with a female/<br />
male ratio 4:1. For 56 patients data concerning the number of nodules were recorded. 20<br />
(35.7%) patients did not have any nodules, 20 (35.7%) patients had solitary thyroid nodule<br />
and 16 (28.6%) patients had multiple nodules. The size of nodules ranged from 0.4 – 5.4<br />
cm (mean 0.14 cm). The cytologic diagnoses were: unsatisfactory (9), cyst fluid (7), benign<br />
(204), cellular follicular lesion/follicular neoplasm (9) and papillary thyroid carcinoma<br />
(7). The prevalence of malignancy among cytologic diagnoses was 3.4%. 21 patients had<br />
surgical follow up. 5 patients (23.8%) had thyroid malignancies (all papillary carcinomas).<br />
The remainder had benign thyroid lesions; follicular adenomas (8), multinodular<br />
goiters (5), diffuse goiters (2) and Hashimoto thyreoiditis (1). There were no false negative<br />
or false positive cytologic diagnoses. Conclusion: Our study supports previously reported<br />
uncommon use of thyroid FNA in patients under 18 years of age. The prevalence of thyroid<br />
malignancies among cytologic diagnoses was similar to those reported in adults. In<br />
limited number of patients with surgical follow up there were no false negative or false<br />
positive cytologic diagnoses.<br />
sandra.moslavac@sunce.hr
Clinical Cytology - Oral Presentations<br />
TREATMENT OUTCOMES OF HEPATOCELLULAR CARCINOMA PROVEN BY FINE<br />
NEEDLE ASPIRATION CYTOLOGY: A SINGLE CENTRE EXPERIENCE<br />
Mrzljak A, Čolić Cvrlje V, Kardum-Skelin I, Škegro D, Filipec-Kanižaj T, Šušterčić D<br />
Department of Medicine, University Hospital Merkur, Zagreb, Croatia<br />
Hepatocellular carcinoma (HCC) mostly occurs in chronic liver disease and cirrhosis.<br />
Surgical resection and liver transplantation (LT) represent potentially curative treatments<br />
of choice and if not feasible, palliative strategies such as percutaneous interventional<br />
techniques (PITs) and systemic therapy (ST) are considered. Elevated alfafetoprotein,<br />
typical imaging pattern, needle core biopsy (NCB) and fine needle aspiration<br />
cytology (FNAC) complement diagnostic assessment of HCC.<br />
We have retrospectively analyzed HCC diagnosed by FNAC at our institution from 2004-<br />
2009 regarding treatment options. Ultrasound guided FNAC was performed in cases of<br />
contraindications for NCB. No complications were documented, except for mild transitory<br />
discomfort at the site of puncture. The diagnosis was verified by May-Grunwald-<br />
Giemsa (MGG) staining and immunohistochemistry. In overall of 62 patients, HCC developed<br />
in 61% and 39% in cirrhotic and non-cirrhotic liver, respectively. Underlying cause<br />
of liver disease was alcohol abuse in 32% and viral diseases in 13% of cases. In the setting<br />
of cirrhosis 16% of patients underwent PITs, 18% liver transplantation, 26% ST and<br />
40% symptomatic therapy. In non-cirrhotic patients resection, ST, symptomatic therapy<br />
and PIT were applied in 46%, 25%, 25% and 4%, respectively. Pathohistology of resected<br />
and explanted livers (18 cases) confirmed the initial diagnosis.<br />
Our observations demonstrate that screening of high-risk groups and early identification<br />
of HCC should be addressed more intensely, since only early stage of HCC offers potentially<br />
curative treatment options. FNAC offers minimally invasive, rapid and uncomplicated<br />
diagnostic approach in the setting of abnormal coagulation and ascites commonly<br />
seen in advanced liver disease, providing therefore simple and effective diagnostic tool.<br />
anna.mrzljak@gmail.com<br />
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98<br />
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CYTOLOGY OF CERVICAL INTRAEPITHELIAL GLANDULAR LESIONS<br />
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,<br />
Zagreb University Hospital Center, Zagreb, Croatia<br />
2University Department of Clinical Pathology, Zagreb University Hospital Center, Zagreb,<br />
Croatia<br />
3 University Department of Gynecologic Oncology, Department of Obstetrics and Gynecology,<br />
Zagreb University Hospital Center, Zagreb, Croatia<br />
4 Children’s Hospital Zagreb, Zagreb, Croatia<br />
Introduction. Cytological criteria for the identification of glandular intraepithelial lesions<br />
(GIL) have not yet been fully described, especially for the precursors of adenocarcinoma<br />
in situ (AIS), thus these lesions may frequently remain unrecognized. As most patients<br />
diagnosed with AIS or mild to moderate GIL (grades I, II) are free from clinical symptoms,<br />
cytology has a very responsible role in the detection of these lesions. Aim. The aim<br />
of the study was to achieve the most appropriate cytologic diagnosis of intraepithelial<br />
lesions of endocervical columnar epithelium, analyzing the cytology findings in patients<br />
with histologically verified AIS and GIL (I, II). Patients and Methods. The value of cytology<br />
in the detection and differential diagnosis was assessed in 123 patients with definitive<br />
histologic diagnosis of glandular lesions (AIS, n=13; GIL I, n=11; and GIL II, n=7), and<br />
glandular lesions associated with squamous component (AIS associated with cervical<br />
intraepithelial neoplasia (CIN) or invasive squamous cell carcinoma (SCC), n=58; GIL I<br />
or GIL II associated with CIN, n=28; and GIL associated with microinvasive squamous<br />
carcinoma (MIC), n=6). Results. In 95.1% of patients, lesions were detected by cytologic<br />
analysis that indicated additional diagnostic procedure. In terms of differential diagnosis,<br />
cytology showed higher accuracy in predicting lesion severity vs. type of epithelial alteration<br />
(75.6% vs. 55.3%) and abnormalities of columnar epithelium (95.7%; vs. 7<strong>4.</strong>2%).<br />
The accuracy of cytology was higher in pure (AIS, 61.5% and GIL I, II, 22.2%) than in mixed<br />
lesions (25.9% and 20.6%). Conclusion. Continuous improvement in cervical specimens<br />
and cytodiagnostic skills, better understanding of intraepithelial adenocarcinoma and<br />
precursors, and their inclusion in the classification of cytologic and histologic findings<br />
are expected to upgrade the detection of these lesions, and to reduce the invasive cervical<br />
adenocarcinoma morbidity and mortality.<br />
ana.ovanin@gmail.com
Clinical Cytology - Oral Presentations<br />
THE VALUE OF CYTOLOGICAL SMEAR IN EVALUATION OF HEAD AND NECK<br />
NON- MELANOMA SKIN CANCER<br />
Pastorčić Grgić M1 , Ramljak V2 , Šarčević B3 , Gršić K1 , Pegan A4 1Department of Head and Neck Surgery, University Hospital for Tumours, Zagreb, Croatia<br />
2Department of Clinical Cytology, University Hospital for Tumours, Zagreb, Croatia<br />
3Department of Clinical Pathology, University Hospital for Tumours, Zagreb, Croatia<br />
4Department of Otorhinolaryngology and Cervicofacial Surgery, University Hospital<br />
“Sisters of Mercy”, Zagreb, Croatia<br />
Non-melanoma skin cancer is the most common malignancy in humans. Although clinical<br />
recognition of typical tumours is usually sufficient, it is sometimes difficult to correctly<br />
diagnose atypical or recurrent tumours. Cytological sampling is painless, noninvasive<br />
and accurate method, useful in skin cancer evaluation. In our study, which<br />
included 91 patients, overall accuracy of cytological diagnosis in non-melanoma skin<br />
cancer was 91.2%. We find this method especially useful in differentiating small benign<br />
looking lesions, in multiple skin changes and in suspected recurrent skin cancer.<br />
marija_pastgrgic@yahoo.com<br />
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100<br />
Klinička citologija - Usmena predavanja<br />
AN UNUSUAL PRESENTATION OF GAUCHER’S DISEASE: AORTIC VALVE FIBROSIS IN<br />
A PATIENT HOMOZYGOUS FOR A RARE G377S MUTATION - A CASE REPORT<br />
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<br />
Merkur, Zagreb, Croatia<br />
Gaucher’s disease (GD) has variable presentations, but cardiac involvement is a generally<br />
uncommon clinical manifestation of the disease. In the past 25 years, the underlying<br />
genetic disorder in GD has been well characterized, with almost 300 mutations identified<br />
in the glucocerebrosidase gene (GBA). Nevertheless, clear genotype-phenotype<br />
correlations have been confirmed only for the most frequent mutations. We present a<br />
female patient, who was known to have aortic valve pathology from the age of 30. Despite<br />
medical followup, at the age of 60 she presented with heart failure (NYHA III). At that<br />
time echocardiography showed severe fibrosed aortic valve stenosis. Valvuloplasty was<br />
planned, when thrombocytopenia, previously considered to be autoimmune, became<br />
severe. Anemia and leukopenia were also noted. Moderate splenomegaly and severe<br />
bone marrow infiltration were found on MRI. Bone marrow aspiration revealed typical<br />
Gaucher cells and the enzyme activity assay confirmed the diagnosis. DNA investigation<br />
showed that the patient is homozygous for the G377S mutation. To our knowledge, of all<br />
mutations identified so far, only homozygosity for the D409H mutation has been associated<br />
with cardiovascular valvular disease in patients with a rare type 3c GD. G377S, found<br />
in our patient, is a rare mutation, previously reported as a ‘mild’ mutation, because of<br />
the finding that homoallelic patients were essentialy asymptomatic or had mild disease.<br />
Our patient, also homozygous for G377S mutation, had a severe form of type 1 GD, with<br />
rare cardiac valve involvement, which is a previously unreported clinical presentation for<br />
this mutation. This case further proves that patients with the same genotypes can have<br />
different phenotypes, emphasizing the influence of other genetic and/or environmental<br />
factors.<br />
zina_peric@yahoo.com
Clinical Cytology - Oral Presentations<br />
EXPRESSION OF KI-67, P53 AND PROGESTERONE RECEPTORS IN UTERINE SMOOTH<br />
MUSCLE TUMORS. DIAGNOSTIC VALUE<br />
Petrović D, Babić D, Ilić Forko J, Martinac I<br />
Department of Gynecological and Prenatal Pathology, University Hospital Centre, Zagreb,<br />
Croatia<br />
Aim was to investigate expression of Ki-67, P53 and progesterone receptors (PR) in leiomyomas<br />
(LM), smooth muscle tumors of uncertain malignant potential (STUMP) and<br />
leiomyosarcomas (LMS) and to establish possible usefulness of these three parameters<br />
in distinguishing between LM and STUMP, and STUMP and LMS. Materials and methods.<br />
Retrospective study of 51 uterine smooth muscle tumors (16 LM, 18 STUMP, 17 LMS)<br />
technically acceptable for analyses from years 2002. - 2007. from Department of Gynecological<br />
and Prenatal Pathology, Zagreb University Hospital, Croatia. Immunohystochemical<br />
analysis of Ki-67, P53 and PR expression was performed. Non-parametric<br />
analysis of variance Kruskal-Walis test was performed. Results. Ki-67 expression was<br />
negative in all LM and higher than 5% in 12/18 STUMP and 10/17 LMS. Significant differences<br />
were observed between LM and STUMP expression for Ki-67 (P= 0.000), and LM<br />
and LMS expression for Ki-67 (P=0.000). There was no expression of P53 in LM, expression<br />
of P53 was found in 7/17 LMS and 5/18 STUMP. Expression of P53 was significant<br />
between LM and LMS (P=0.002), and between LM and STUMP (P=0.006). Expression of<br />
PR was found in 16/16 LM and 18/18 STUMP, 10/17 LMS did not show PR expression.<br />
Expression of PR was significant between LM and LMS (P=0.018) and STUMP and LMS<br />
(P=0.004). Conclusion. The findings of our study in concordance with other study results<br />
are helpful information establishing more diagnostic criteria and parameters for diagnosis<br />
in doubtful cases between three entities. Immunostaining for Ki-67, P53 and PR<br />
are such parameters. The panel of their expression in specific case eases diagnosis.<br />
dvrptrvc@yahoo.com<br />
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102<br />
Klinička citologija - Usmena predavanja<br />
MORPHOMETRY OF TUMOUR CELLS IN DIFFERENT GRADES AND TYPES<br />
OF BREAST CANCER<br />
Prvulović I1 , Kardum-Skelin I2 , Jakić-Razumović J3 , Manojlović S4 1General Hospital Slavonski Brod, Department of Cytology, Slavonski Brod, Croatia<br />
2Merkur University Hospital, Laboratory of Cytology and Hematology, Zagreb, Croatia<br />
3Clinical Hospital Centre Zagreb, Department of Pathology, Zagreb, Croatia<br />
4Dubrava University Hospital, Department of Pathology, Zagreb, Croatia<br />
Objective. To compare morphometric features between different types and grades of<br />
breast cancer. Methods. Morphometric analysis was performed using the Sform (Vamstec,<br />
Zagreb) software on the May-Grunwald-Giemsa stained fine needle aspiration cytology<br />
specimens of breast tissue. Selected specimens represented all breast smears in<br />
Clinical Hopsital Merkur from 2001 to 2005, malignant on cytological report and histologicaly<br />
confirmed. Investigated group consisted of 42 patients. The following features were<br />
investigated: area, outline, maximum radius, minimum radius, convex area, breadth,<br />
length, nucelar/cytoplasmatic ratio, form factor and elongation. Statistic 7.1 and chi2-<br />
test were used. Results. Morphometric analysis showed statistically significant differences<br />
between all investigated groups. Conclusion. Morphometric features considered<br />
individually were highly associated with type and grade of breast tumour.<br />
ivanahodak@yahoo.com<br />
LYMPHOMATOID GRANULOMATOSIS IN A 23-YEAR-OLD MAN- CYTOLOGICAL AND<br />
HYSTOLOGICAL TYPING AND RAPID RESPONSE TO STEROID AND CYCLOPHOSPHAMIDE<br />
Rakušić N1 , Krmpotić D1 , Hećimović A1 , Boras Z1 , Vrabec-Branica B1 , Džebro S2 ,<br />
Rakušić N3 , Rešković T4 1University Hospital for Lung Diseases „Jordanovac“, Zagreb, Croatia<br />
2Department of Pathology, Clical Hospital „Merkur“, Zagreb, Croatia<br />
3Medical School University of Rijeka, Croatia<br />
4Medical School University of Zagreb, Croatia<br />
Lymphomatoid granulomatosis (LG) is currently called as extranodal angiocentric and<br />
angiodestructive immunoproliferative lesion with various degree of histological diferentiation<br />
and clinical agression. Histological grading and clinical manifestations are<br />
due to number of atypical large EBV+ B-lymphatic cells. We report case of 23-years old<br />
man, clinicaly presented with fever, sweating, and physical intolerance, and with bilateral<br />
pulmonary infiltrates of nodular type and destructive changes on the chest x-ray,<br />
previously treated with antituberculotics for 1,5 months. As the disease showed progression,<br />
diagnostic procedures extended to transbroncial lung biopsy and percutaneous<br />
fine needle aspiration with cytologic and histologic analysis of colected speciemens, all<br />
being not enough conclusive. LG was confirmed by open lung biopsy, followed by induction<br />
of corticosteroids and cyclophosphamide therapy. Very good clinical, functional and<br />
radiomorphologic improvement was achieved in a few weekls and remission of diseases<br />
maintanined in long term follow-up.<br />
neven.rakusic@zg.t-com.hr
Clinical Cytology - Oral Presentations<br />
FINE NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSING RARE BREAST<br />
CARCINOMA-TWO CASE REPORTS<br />
Ramljak V1 , Šarčević B2 , Vrdoljak DV3 , Bobuš Kelčec I1 , Agai M1 , Trutin Ostović K4 1 University Hospital for Tumors, Department of Cytology, Zagreb, Croatia<br />
2 University Hospital for Tumors, Department of Pathology, Zagreb, Croatia<br />
3 University Hospital for Tumors Department of Surgical Oncology, Zagreb, Croatia<br />
4Dubrava University Hospital., Department of Clinical Cytology and Cytometry, Zagreb,<br />
Croatia<br />
In this paper, we are presenting the two cases of very rare tumors: breast sebaceous<br />
carcinoma, which has been described for the first time in <strong>Croatian</strong> medical literature,<br />
and pure breast squamous carcinoma. First case, sebaceous carcinoma, is still quite<br />
unknown regarding its morphological characteristics and biological behavior. In the<br />
second case, squamous carcinoma, also very rare, was found in a patient who previously<br />
had a number of diagnosed head and neck skin carcinomas, and was diagnosed<br />
as primary squamous breast carcinoma. As a first case we present a 85-year-old female<br />
with a two months history of swelling of the left breast under the mammilla. The<br />
second one, a 69-year-old female presented to our hospital in January 2008 with a two<br />
months history of a lump in the lower outer region of the left breast and enlarged lymph<br />
nodes in left axillary region. Fine needle aspiration cytology (FNAC) of the breast was<br />
performed in order to diagnose the exact type of both tumours. This methodology was<br />
found important in diagnosis, but in both cases showed certain limitations in diagnosing<br />
such rare tumors. The final diagnoses were determined after carefully synthesizing<br />
the histological findings and clinical data. Careful and accurate classification of these<br />
tumors is necessary. A detailed analysis of their biological behavior and response to the<br />
therapy is necessary in order to formulate definite recommendations in managing these<br />
patients/diseases.<br />
vesna.ramljak@kzt.hr<br />
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104<br />
Klinička citologija - Usmena predavanja<br />
VILLOGLANDULAR PAPILLARY ADENOCARCINOMA OF THE UTERINE CERVIX WITH<br />
AGGRESSIVE CLINICAL COURSE - A CASE REPORT<br />
Rubeša-Mihaljević R1 , Vrdoljak-Mozetič D1 , Verša Ostojić D1 , Štemberger-Papić S1 ,<br />
Sindik N2 , Krašević M3 1 Department of Gynecological Cytology, University Department of Gynecology and<br />
Obstetrics, University Hospital Center Rijeka, Rijeka, Croatia<br />
2University Department of Gynecology and Obstetrics, University Hospital Center Rijeka,<br />
Rijeka, Croatia<br />
3 Department of Pathology, Rijeka University School of Medicine, Rijeka, Croatia<br />
Aim of the study: Villoglandular papillary adenocarcinoma (VGA) of cervix is an uncommon<br />
but well recognized histologic subtype of cervical adenocarcinoma which usually<br />
affects young women. Based on the favorable outcomes reported in most of previous<br />
cases the tumor is generally considered to have an indolent clinical course with excellent<br />
prognosis. We present a case of a 22-year-old woman admitted for glandular abnormality<br />
on cervical smear and episodes of vaginal bleeding. In the Pap smear, the cytologic<br />
features were suspicious but not diagnostic of adenocarcinoma, therefore reported as<br />
atypical glandular cells (AGC). Histological examination confirmed VGA associated with<br />
lymphovascular space invasion. The patient underwent radical operative procedure. Intraoperative<br />
cytologic examination detected pelvic lymph nodes metastasis. The patient<br />
was confirmed to be in an advanced stage - III B (FIGO). During a two years follow-up<br />
period a rapid dissemination of the tumor occurred and resulted with a fatal outcome.<br />
Conclusion: Although VGA has been reported to have a favorable prognosis, several cases<br />
with lymph node involvement have already been described. Cervical smears examination<br />
would be helpful for an early diagnosis of VGA, however the cytologic recognition<br />
is often difficult. Further investigation of the pathogenesis, diagnosis and therapy of the<br />
tumor is needed.<br />
roberta.rubesa@gmail.com
Clinical Cytology - Oral Presentations<br />
ADDITIONAL CYTOMORPHOLOGICAL CRITERIA IN DIAGNOSIS OF PILOMATRICOMA -<br />
BENIGN TUMOR WITH BAD REPUTATION<br />
Seili-Bekafigo I1 , Jonjić N2 , Štemberger C1 , Rajković-Molek K1 1 KBC Rijeka, Department of Cytology, Department.of Internal Medicine, Rijeka, Croatia<br />
2 Rijeka University School of Medicine, Department of Pathology, Rijeka, Croatia<br />
Aim. Pilomatricomas (PM) are benign skin appendageal tumors,with differentiation towards<br />
hair-forming cells,usually found in children. They are frequently misdiagnosed by<br />
clinicians, and there are many reports of false positive diagnoses made on fine needle<br />
aspirates (FNA). PM are often mistaken for «small round cell tumors in children, or for<br />
Merkel cell carcinoma, basalioma and metastatic small cell carcinoma in adults, with<br />
possible over-aggressive therapeutic approach. The aim of this study was to confirm<br />
existing and possibly add some new morphologic and morphometric characteristics of<br />
PM. Patients and methods. In 6 cases of PM, correctly diagnosed preoperatively by FNA,<br />
clinical, cytomorphologic and basic morphometric features (the longest nuclear diameter),<br />
were analyzed, and compared with 4 cases of malignant tumors with similar clinical<br />
presentation. Smears were stained according to May-Gruenwald-Giemsa (MGG) method.<br />
Results. Morphometric data did not prove to be helpful. In addition to well known<br />
cytomorphologic characteristics of PM, in all 6 cases we found basophilic cytoplasmatic<br />
protrusions, that could be useful additional cytomorphologic feature of PM. Conclusion.<br />
We concluded that cytomorphologic characteristics of PM are reliable enough for correct<br />
preoperative diagnosis in adequate specimens. The best results are achieved when<br />
FNA is performed by an experienced cytologist, considering all relevant clinical data.<br />
irena.seili-bekafigo@ri.t-com.hr<br />
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RARE TUMORS OF THE BREAST- CASES REPORTS<br />
Staklenac B1 , Lončar B1 , Pauzar B1 , Dmitrović B2 1 Clinical Hospital Osijek, Department of Clinical Cytology, Osijek, Croatia<br />
106<br />
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2 Clinical Hospital Osijek, Department of Pathology and Forensic Medicine, Osijek, Croatia<br />
Introduction. FNAB and cytomorphology are standard diagnostic tools for breast tumors.<br />
The aim of this study was to demonstrate FNAC of rare breast tumors correlated with<br />
pathological and immunohistological findings. Material and methods. FNAB was performed<br />
with or without ultrasound using 22 gauge needle attached to 10 ml syringe. Material<br />
was spread to glass. Air dried smears were stained according to May-Grunwald-<br />
Giemsa method. We reported some rare tumors presented as a primary breast lumps<br />
(malignant epithelioid schwannoma, carcinoma apocrineum, malignant phyllodes tumor,<br />
carcinoma neuroendoccrineum and carcinoma planocellulare invasivum). Another<br />
two breast tumors had already established pathohistological diagnoses. The first one<br />
was Lymphoma non Hodgkin- Burkitt type (of uterus, adnexsis, cervix, omentum and<br />
appendix), and second one was CLL. Conclusion. FNAB is very useful method for distinguish<br />
rare, benign and malignant breast tumors.<br />
staklenac.blazenka@kbo.hr
Clinical Cytology - Oral Presentations<br />
CERVIX CANCER SCREENING IN CROATIA WITHIN THE EUROPEAN CERVICAL<br />
CANCER PREVENTION WEEK<br />
Škopljanac-Mačina L 1 , Mahovlić V 1 , Ovanin-Rakić A 1 , Barišić A 1 , Rajhvajn S 1 , Jurič D 1 ,<br />
Babić D 2 , Ćorušić A 3 , Orešković S 4<br />
1 Department of Gynecologic Cytology, University Department of Gynecology and<br />
Obstetrics, Zagreb University Hospital Center, Zagreb, Croatia<br />
2 Department of Gynecologic and Perinatal Pathology, University Department of Clinical<br />
Pathology, Zagreb University Hospital Center, Zagreb, Croatia<br />
3 Department of Gynecologic Oncology, University Department of Gynecology and<br />
Obstetrics, Zagreb University Hospital Center, Zagreb, Croatia<br />
4 Department of Gynecology and Urogynecology, University Department of Gynecology<br />
and Obstetrics, Zagreb University Hospital Center, Zagreb, Croatia<br />
Aim: To evaluate the outcome of the information campaign “For All Women” and to<br />
provide recommendations for the future national screening programme. Methods: The<br />
European Cervical Cancer Prevention Week was held twice in Croatia, in January 2008<br />
and 2009. Within the first one in 2008, information campaign “For All Women” via mass<br />
media was held, and women were invited to the organized free gynecological examination<br />
and Papanicolaou test (Pap test) in the University Department of Gynecology and<br />
Obstetrics, University Hospital Center Zagreb. Within the European Cervical Cancer<br />
Prevention Week in 2009, employed women from one national company were invited<br />
by internal information to the same procedure. Results: Following invitation during the<br />
campaign “For All Women 2008” 481 women attended the testing; the median age was<br />
55 years. There were more women aged ≥50 (n=353), with the highest participation in<br />
the age group 55-59 years (n=94). Some women came because of subjective symptoms<br />
(n=10), but the majority of them came only for testing (n=471). According to history of previous<br />
cytological testing, 400 women have had ≥1 negative findings, 71 women have had<br />
≥1 positive findings, 9 women attended Pap test for the first time, and 1 woman does not<br />
know about previous testing. Cervical cytology was abnormal in 35 women (7.28%), the<br />
median age was 42 years with the highest proportion in the age group 30-34 years (n=7);<br />
among all of them 21 women (60%) had no abnormal Pap test previously. The findings<br />
were: Atypical squamous cells of undetermined significance - ASC-US (n=9), ASC cannot<br />
exclude high-grade squamous intraepithelial lesion - ASC-H (n=1), cervical intraepithelial<br />
neoplasia - CIN 1 (n=13), CIN 2 (n=1), CIN 3 (n=6), carcinoma planocellulare (n=2), atypical<br />
glandular cells - AGC-favor reactive endocervical cells (n=3). Among women aged £49<br />
there were 20.47% abnormal findings and among those aged ≥50, 2.55%. According to ≥1<br />
positive Pap tests previously, among women aged £49 there were 30.71% while among<br />
those aged ≥50 there were 9.07%. A smaller group of younger asymptomatic women<br />
came for testing in 2009 (n=53), median age 39 years. According to history of previous cytological<br />
testing, 50 women have had ≥1 negative findings, 3 women have had ≥1 positive<br />
findings. In this study, Pap test was positive in 3.77% (n=2). Conclusion: National screening<br />
programme should be focused on the participation of all personally invited women,<br />
especially younger age groups and under-screened women. Well designed information<br />
campaign should be implemented in national screening programme.<br />
lskopljanac@yahoo.com<br />
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108<br />
Klinička citologija - Usmena predavanja<br />
EVALUATION OF THE HPV L1 CAPSID PROTEIN IN PROGNOSIS OF MILD AND<br />
MODERATE DYSPLASIA OF THE CERVIX UTERI<br />
Štemberger-Papić S1 , Vrdoljak-Mozetič D1 , Verša Ostojić D1 , Rubeša-Mihaljević R1 ,<br />
Markanjević T1 , Rešetar R1 , Manestar M2 1 Department of Gynecological Cytology, University Department of Gynecology and<br />
Obstetrics, University Hospital Centre Rijeka, Croatia<br />
2 Department of Gynaecology, University Department of Gynaecology and Obstetrics,<br />
University Hospital Centre Rijeka, Croatia<br />
Objective: To determine weather HPV L1 immunoreactivity could help us to discriminate<br />
between regresing and persistent/progressing mild and moderate cervical dysplasia in<br />
cytological specimens. Materials and Methods: We immunostained archival Pap smears<br />
from 114 hr HPV DNA positive squamous lesions with mild or moderate dysplasia. The<br />
staining results were correlated with follow-up smears for lesions which are going to<br />
remission or for persistent lesions with mild dysplasia. Progressive or persistent lesions<br />
with moderate dysplasia were correlated with histologic verification on Large Loop Excision<br />
of the Transformation Zone (LLETZ) or conization. Results: Immunochemical analyses<br />
with L1 antibody revealed positively stained nuclei of squamous epithelial cells in<br />
56 of 114 smears (49,1%). Regression (negativisation of the Pap smear for 24 months or<br />
longer) was noticed in 31 of 56 ( 55,4% ) L1-positive cases and in 20 of 58 (34,5%) L1-negative<br />
cases. Persistent disease occured in 13 (23,2%) L1-positive cases and in 14 (24,1%)<br />
L1-negative cases. Progressive disease occured in 12 (21,4%) L1-positive cases and in 24<br />
(41,4%) L1-negative cases. The difference in the clinical course between the L1-positive<br />
and L1-negative patients was statistically significant (p=0,025). Also, the difference in the<br />
clinical course of the L1-negative staining in the under-30 and over-30 years age group<br />
was statistically significant (p=0,04). Conclusion: Our data confirm that immunostaining<br />
for HPV L1 capsid protein could offer prognostic information about mild and moderate<br />
intraepithelial cervical squamous lesions.<br />
snjezana.stemberger@ri.t-com.hr
Clinical Cytology - Oral Presentations<br />
BILIARY BRUSH CYTOLOGY FOR THE DIAGNOSIS OF MALIGNANCY:<br />
A SINGLE CENTER EXPERIENCE<br />
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<br />
2 Department of Gastroenterology, Dubrava University Hospital, Zagreb, Croatia<br />
Brush cytology during the endoscopic retrograde cholangiopancreatography (ERCP) is<br />
the most commonly used method for obtaining tissue confirmation of the nature of biliary<br />
strictures. Its specificity is remarkably high but reported sensitivities for the diagnosis of<br />
malignancy are low. Aim of our study was to assess sensitivity and specificity of biliary<br />
brush cytology in our institution, to find out main causes of false negative diagnoses and<br />
to confirm impression that the team approach has impact on sensitivity. Materials and<br />
methods: Out of total of 201brushings, 143 specimens with available definitive diagnosis<br />
were analyzed. Gold standard for diagnosis was definitive surgical histology or adequate<br />
clinical follow up for minimum of six month. Direct smears made by cytotechnician at<br />
the endoscopy room, and stained according to Papanicolaou and May-Grünwald Giemsa<br />
(MGG), were examined for well-recognized features of malignancy on conventional<br />
smears as a part of diagnostic routine. Cytologic diagnoses were benign, atypical/reactive,<br />
suspicious for malignancy and malignant. Out of 143specimens, 36 (25%) had malignant<br />
cytologic diagnosis and 91(63.6%) were benign, 3 were atypical/reactive and 13<br />
suspicious for malignancy with 20 “false-negative” cases. When specimens with atypical<br />
and suspicious cytology were excluded from data analysis sensitivity was 64% and specificity<br />
was 100% and when suspicious findings were taken into account as true positives,<br />
sensitivity rose to 71%. Conclusion: We find that biliary brush cytology, although mainly<br />
depending on the skill of endoscopist, as well as the experience of the cytologist, is a<br />
valuable method for obtaining accurate tissue diagnosis of biliary strictures, thus solving<br />
eternal diagnostic dilemma: benign or malignant.<br />
tveic@kbd.hr<br />
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110<br />
Klinička citologija - Usmena predavanja<br />
IDENTIFICATION OF BRAIN CANCER STEM CELLS IN WHO STAGE IV BRAIN TUMOURS<br />
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,<br />
Romania<br />
2Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj<br />
Napoca, Romania<br />
3Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy,<br />
Cluj, Npoca, Romania<br />
Tumours of the nervous system represent the leading cause of cancer-related death in<br />
children and the fourth leading cause in adults. Despite decades of research and clinical<br />
experience, the life expectancy of an adult diagnosed with a high-grade brain tumour<br />
is typically less than one year. Our ability to develop new therapies for these deadly<br />
cancers is highly dependent on an improved understanding of the molecular and cellular<br />
changes that contribute to their development and continued growth. Brain cancers<br />
comprise a complex microcosm of both neoplastic and non-neoplastic cells that each<br />
have distinct roles in dictating tumor formation and growth. The most important of these<br />
cells are cancer stem cells, responsable for post-radiochemotherapy relapse and progression.<br />
We cultured 5 fresh surgical specimens of human glioblastoma multiforme<br />
using the same protocols used for culturing bone marrow mesenchymal stem cells. At<br />
passage 3, cells had a spindle-shaped morphology, formed spheroids and were resitant<br />
to chemotherapy agents. Immunocytochemistry staining and Reverse Transcriptase –<br />
Polymerase Chain Reaction showed that cells expressed CD 133 cancer stem cell specific<br />
marker. The identification of brain tumour stem cells provides a powerful tool to investigate<br />
the tumorigenic process in the central nervous system and to develop targeted<br />
therapies, capable of increasing the survival of patients diagnosed with WHO grade four<br />
brain cancers.<br />
ciprian_tomuleasa@yahoo.com
Clinical Cytology - Oral Presentations<br />
DEDIFFERENTIATION THERAPY AND DARWINISM FOR SORTING OF OVARIAN<br />
CANCER STEM CELLS<br />
Tomuleasa C1 , Soritãu O1 , Ciucã DR2 , Susman S2 , Mihu C2 1Ion Chiricuta Oncology Institute, Department of Cancer Immunology, Cluj Napoca, Romania<br />
2Iuliu Hatieganu University of Medicine and Pharmacy, Department of Pathology, Cluj<br />
Napoca, Romania<br />
Introduction. The cellular mechanisms underlying the increasing aggressiveness associated<br />
with ovarian cancer progression are poorly understood. Coupled with a lack of<br />
identification of specific markers that could aid early diagnoses, the disease becomes<br />
a major cause of cancer-related mortality in women. The high incidence of recurrence<br />
attributable to multidrug resistance and the multiple histologic phenotypes indicative<br />
of multipotency suggest a stem-like etiology of ovarian cancer. Here we adopted suspension<br />
culture combined with anti-cancer regimens as a strategy for screening ovarian<br />
cancer stem cells. These tumor stem cells could survive and be highly enriched in<br />
non-adherent suspension culture while chemotherapeutic agents could destroy most<br />
rapidly dividing cancer cells and spare relatively quiescent cancer stem cells. Material<br />
and Methods. MLS human ovarian cancer cells were cultured in serum-free medium,<br />
suplemented with Epidermal Growth Factor, basic Fibroblast Growth Factor, B27 and<br />
N2. Cells of passage 8 were treated in combination with anticancer agents Doxorubicin<br />
and Carboplatin at different peak plasma concentrations for 24 hours, and then maintained<br />
under suspension culture. The stem-like properties were confirmed by immunocytochemistry<br />
staining techniques, by multidrug resistance assays and by their ability<br />
to grow in an anchorage-independent manner in vitro as spheroids. Selected cells were<br />
also injected subcutaneously into CD1 mice to observe tumour formation. Results and<br />
Discussion.Here we present direct evidence that the aggressiveness of human ovarian<br />
cancer may be a result of transformation and dysfunction of stem cells in the ovary.<br />
The tumorigenic clones, even on serial transplantation continue to establish tumours,<br />
theraby confirming their identity as tumor stem cells. Suspension culture combined with<br />
anticancer regimens provides an effective means of isolating, culturing and purifying<br />
ovarian cancer stem cells.<br />
ciprian_tomuleasa@yahoo.com<br />
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112<br />
Klinička citologija - Usmena predavanja<br />
THE IMPORTANCE OF URGENT CYTOLOGICAL EXAMINATION OF SYNOVIAL FLUIDS<br />
IN DIFFERENTIATION INFLAMMATORY AND NON-INFAMMATORY DISEASES<br />
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,<br />
Croatia<br />
2Faculty of Humanities and Social Sciences, University of Zagreb, Department of<br />
Psychology, Zagreb, Croatia<br />
3Dubrava University Hospital, Department of Clinical Immunology and Rheumatology,<br />
Zagreb, Croatia<br />
Aim. To imply the possibilities of the urgent cytological examination of synovial fluids<br />
in differentiation of arthropathies and to motivate clinicians to use this method. Methods.<br />
This examination consists of macroscopic analysis (volume, colour, clarity, viscosity<br />
and mucin clot test), native microscopic analysis for crystals, counting total nucleated<br />
cell count in Bürker-Türk counting chamber and microscopic analysis rapid Hemacolor<br />
stained smears for neutrophil granulocyte percentage. All these analyses are done within<br />
one hour since FNA. Results. The study includes 115 synovial fluids (81 with inflammation,<br />
34 with non-inflammation) obtained by FNA between 2003 and 2008. The clarity,<br />
viscosity, mucin clot test, the total nucleated cell count and the neutrophil granulocyte<br />
percentage enables distinction between inflammation and non-inflammation with statistically<br />
significant difference at the 0.01 level. Crystals (monosodium urate) are detected<br />
in 12 synovial fluids and we can diagnose gout. Conclusion. The urgent cytological<br />
analysis of the synovial fluid is useful basic diagnostic screening test in differentiation<br />
inflammatory and non-inflammatory joint diseases and we recommend using it as the<br />
initial test in the diagnostic procedure of these illnesses using our protocol.<br />
ktrutin@kbd.hr
Clinical Cytology - Oral Presentations<br />
CERVICAL CYTOLOGY AND HPV TEST IN FOLLOW-UP AFTER CONISATION OR LLETZ<br />
Verša Ostojić D1 , Vrdoljak-Mozetič D1 , Štemberger-Papić S1 , Finderle A2 , Eminović S3 1 Department of Gynecological Cytology, University Department of Gynecology and Obstetrics,<br />
University Hospital Center Rijeka, Croatia<br />
2 Department of Perinatology, University Department of Gynecology and Obstetrics, University<br />
Hospital Center Rijeka, Croatia<br />
3 Department of Pathology, School of Medicine, University of Rijeka, Croatia<br />
Objective: To determine cytology-histology correlation after conisation or Large Loop<br />
Excision of the Transformation Zone (LLETZ) for cervical intraepithelial neoplasia (CIN),<br />
resection margin status, compliance to the follow-up protocol and evaluation of cervical<br />
cytology and HPV testing in two years period after surgical treatment. Materials<br />
and Methods: We made a retrospective analysis of the case records of 251 conisations<br />
and LLETZ performed between January and December 2006. The conventional cervical<br />
smears were analysed and digene Hybrid capture 2 test was used for detection of<br />
13 high-risk HPV types. Results: Histology analysis demonstrated CIN1+ lesion in 234<br />
cases (93,2%) with cytology-histology correlation in 97,9 % of cases. Preoperative HPV<br />
test was made in 142 histology confirmed CIN1+ lesions and 137 (96,5%) tested positive.<br />
The resection margins were involved in 48 (35,8%) cases and in 24 (10,2%) the margins<br />
were difficult to determine. 217 (86,5%) patients attended the posttreatment visits and<br />
abnormal cytology was found in 33 (15,2%) cases. The post-treatment HPV test was performed<br />
in 159 women and was positive in 25 (15,7%) cases. The complete follow-up control<br />
cytology, with at least three Pap smears in two years or with second treatment was<br />
found in only 146 (58,2 %) patients. 14/217 (6,5 %) patients underwent second treatment<br />
with histology confirmed treatment failure. In all patients where control smear was performed,<br />
repeated cytology found HSIL. In six women control HPV test was performed, in<br />
five cases it was positive and in one case with VAIN2 on biopsy of vagina it was negative.<br />
Conclusion: Our study confirme important place of cervical cytology in the diagnisis of<br />
cervical intraepitelial lesions and monitoring after treatment. In the future we have to<br />
improve compliance to the follow-up protocols and use of HPV test in the selection of<br />
women at risk of treatment failure.<br />
dversa.ostojic@gmail.com<br />
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114<br />
Klinička citologija - Usmena predavanja<br />
NECROTISING SARCOID GRANULOMATOSIS OF THE SPINAL CORD: CASE REPORT<br />
Vrbica Ž1 , Boras Z2 , Rakušić N2 , Smojver-Ježek S2 , Baričević D2 , Rakušić N3 , Alerić I2 1 Dubrovnik General Hospital, Dubrovnik, Croatia<br />
2 University Hospital for Lung Diseases, Zagreb, Craotia<br />
3 Medical Faculty, Rijeka, Croatia.<br />
We report a patient with leg weakness and cervical lymphadenopathy. Magnetic resonance<br />
showed an inhomogenously increased signal in the thickened portion of the cord.<br />
Multilevel laminectomy and spinal cord biopsy revealed granulomatous infiltrations with<br />
necrosis. Review of the histopathological finding established the diagnosis of necrotising<br />
sarcoid granulomatosis (NSG) of the spinal medulla, and cytological and histopathological<br />
analysis of the neck lymph node disclosed granulomatous inflammation without<br />
necrosis. Further radiographic chest evaluation showed mediastinal lymphadenopathy.<br />
Immunophenotyping of lymphocytes in bronchoalveolar lavage fluid (BALF) was indicative<br />
of sarcoidosis. The patient clinicaly improved to corticosteroid therapy, and lymph<br />
nodes subsided with minor changes remaining in the spinal medulla, which were considered<br />
to be irreversible. To our knowledge, this is the first described case with finding<br />
of granulomatous inflammation with and without vasculitis in various organs, consistent<br />
with the study of Churg who believes NSG to be a histological variant of sarcoidosis.<br />
zarkov@bolnica-du.hr
Clinical Cytology - Oral Presentations<br />
CERVICAL CANCER SCREENING PROGRAMME IN PRIMORSKO-GORANSKA COUNTY,<br />
CROATIA<br />
Vrdoljak-Mozetič D1 , Verša Ostojić D1 , Štemberger-Papić S1 , Janković S2 ,<br />
Glibotić-Kresina H2 , Brnčić-Fischer A3 , Benić-Salamon K4 1 Department of Gynaecological Cytology, University Department of Gynaecology and<br />
Obstetrics, University Hospital Centre Rijeka, Rijeka, Croatia<br />
2 Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia<br />
3 Department of Gynaecology, University Department of Gynaecology and Obstetrics,<br />
University Hospital Centre Rijeka, Rijeka, Croatia<br />
4 Gynaecology Practice Klaudia Benić-Salamon, Opatija, Croatia<br />
In Primorsko-goranska County (PGC) a screening programme “Early detection of cervical<br />
cancer” was started in 2006. Target group were women aged from 20 to 64 years. Out<br />
of the patients of six primary care gynaecologists 6000 women were randomly invited by<br />
personal letter along with a questionnaire. Response to the anamnestic questionnaire<br />
was 49.1 %. The participation rates to screening were 35.2 % in 2007, and 46.5 % in 2008,<br />
total of 42.7 %. Increase of participation between years 2007. and 2008. was statistically<br />
significant (p=0.01). According to the age the lowest participation rate of 33.3% was observed<br />
in the youngest group of women (20-29) and the highest of 60.7% in the oldest<br />
group (60-64). The detection rate of cytological abnormalities was <strong>4.</strong>6 % with 2.6 % of<br />
borderline (ASCUS) cytology and referral rate of 1.2 %. The highest abnormal Pap test<br />
frequencies of 6.8 % and 7.1 % were observed in younger age groups (20-29 and 30-39)<br />
and the lowest (2%) in the age group of 60-6<strong>4.</strong> Specimen adequacy was generally of high<br />
quality with unsatisfactory rate of 0.8 %, with statistically significant improvement in<br />
2008. compared to the previous year (p=0.001). Even of limited extension, in two years<br />
of conducting cervical cancer screening programme in PGC we improved participation<br />
rates and Pap smear adequacy. By continuing this program we expect further increase<br />
of participation and overall quality of the programme.<br />
danijela.vrdoljak-mozetic@ri.t-com.hr<br />
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116<br />
Klinička citologija - Posteri<br />
CYTOLOGIC CHARACTERISTICS OF ADENOID CYSTIC CARCINOMA OF THE CERVIX<br />
UTERI - CASE REPORT<br />
Barišić A1 , Mahovlić V1 , Ovanin-Rakić A1 , Škopljanac-Mačina L1 , Rajhvajn S1 ,<br />
Jurič D1 , Babić D2 1Department of Gynecologic Cytology, Department of Obstetrics and Gynecology,<br />
Zagreb University Hospital Center, Zagreb, Croatia<br />
2Department of Clinical Pathology, Zagreb University Hospital Center, Zagreb, Croatia<br />
Adenoid cystic carcinoma is a rare malignancy, usually found in the salivary glands,<br />
although this unusual tumor can be found at other sites of the body. In particular, regarding<br />
adenoid cystic carcinoma of the cervix (ACCC) most frequently reports are given<br />
for postmenopausal women. In this respect, our work is one among very few in the literature<br />
that considers a cytologic picture of this uncommon cervix carcinoma. The case<br />
of 74 year old patient with postmenopausal bleeding is described. Both Pap smear and<br />
air dried smear of the uterine cervix were analysed. The cytologic findings revealed very<br />
few small clusters of abnormal glandular cells, as well as some amorphous eosinophilic<br />
globule-like material, with granulomatous and necrotic background. The latter includes<br />
a lot of histiocytes, multinucleated giant cells, large aggregates of epitheloid cells and<br />
lymphocytes. Histology revealed the diagnosis of ACCC. We emphasize the importance<br />
of careful screening of Pap smear that might be crucial in the case of suspicious clinical<br />
findings in postmenopausal women, when the possibility of ACCC has to be considered.<br />
ana.barac@zg.t-com.hr<br />
DIAGNOSIS OF VISCERAL LEISHMANIASIS BY FINE NEEDLE ASPIRATION CYTOLOGY<br />
OF AN ISOLATED CERVICAL LYMPH NODE: CASE REPORT<br />
Beljan R1 , Šundov D1 , Lukšić B2 , Šoljić V3 , Piljić Burazer M1 1Institute of Pathology, Forensic Medicine and Cytology, Split University Hospital, Split, Croatia<br />
2Department of Infectious Diseases, Split University Hospital, Split, Croatia<br />
3Department of Pathology, Cytology and Forensic Medicine Mostar, University Hospital<br />
Mostar, Bosnia and Herzegovina<br />
A 61-year-old woman presented with an isolated, painless, slightly enlarged right laterocervical<br />
lymph node without any other signs and symptoms of disease. Laboratory test<br />
including haematological and biochemical parameters were normal. A cervical ultrasonography<br />
demonstrated one lymph node (10mm) on the right laterocervical side and<br />
one small reactive lymph node on the left laterocervical side. The fine needle aspiration<br />
(FNA) smears revealed a polymorphic population of cells composed of lymphocytes,<br />
histiocytes, epitheloid cells, plasma cell, tingible body macrophages and macrophages<br />
infiltrated with Leishmania amastigotes. Treatment was initiated with Stiboglukonat Na<br />
(Pentostam) and led to a full recovery.<br />
rbeljan @krizine.kbsplit.hr
Clinical Cytology - Posters<br />
APLASTIC CRISIS INDUCED BY HUMAN PARVOVIRUS B19 AS AN INITIAL<br />
PRESENTATION OF HEREDITARY SPHEROCYTOSIS<br />
Čaržavec D 1 , Gaćina P 1 , Vasilj A 2 , Kojić Katović S 2 , Stančić V 1<br />
1Department of Hematology, University Clinic of Internal Medicine, Sestre Milosrdnice<br />
University Hospital, Zagreb, Croatia.<br />
2Department of Cytology, University Clinic of Internal Medicine, Sestre Milosrdnice University<br />
Hospital, Zagreb, Croatia<br />
The association between aplastic crisis and human parvovirus (HPV) B19 infection is<br />
described in patients with hereditary spherocytosis (HS). Most cases of aplastic crisis in<br />
patients with HS induced by HPV B19 have been reported in children and adolescents. In<br />
this paper , we describe an aplastic crisis induced by HPV B19 in an 34 year old female as<br />
an initial presentation of HS. Although other viral illnesses cause some decompensation<br />
in HS, the anaemia is very rarely as profound as that seen in acute HPV B19 infections.<br />
dubravka.carzavec@zg.t-com.hr<br />
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118<br />
Klinička citologija - Posteri<br />
ADENOMATOID NODULES AND SUSPICIOUS FOLLICULAR LESIONS OF THE THYROID<br />
OBTAINED BY FINE NEEDLE ASPIRATION CYTOLOGY<br />
Dabelić N1 , Mateša N1 , Mateša-Anić D2 , Kusić Z1 1Department of Oncology and Nuclear Medicine, Sisters of Charity University Hospital,<br />
Zagreb, Croatia<br />
2 Department of Otorhinolaryngology, Special Hospital for Medical Rehabilitation<br />
“Thalassotherapia”, Crikvenica, Croatia<br />
Aim: to assess malignancy risk in adenomatoid nodules and suspicious follicular lesions<br />
of the thyroid obtained by fine needle aspiration (FNA) cytology. Methods: retrospective<br />
research of 276 patients (pts) who underwent thyroid surgery after preoperative<br />
ultrasound-guided FNA diagnosis of adenomatoid nodule, cellular follicular lesion,<br />
“suspicious for follicular neoplasm” or follicular neoplasm. Results: Out of 276 pts, FNA<br />
reports showed 15 diagnoses (5%) of adenomatoid nodules, 73 (26%) cellular follicular lesions,<br />
76 (28%) “suspicious for follicular neoplasm”, and 112 diagnoses (41%) of follicular<br />
neoplasm. FNA reports were compared with pathohistological findings. In FNA reports<br />
of adenomatoid nodule, there were 7 (47%) pathohistological diagnoses (PHDs) of nodular<br />
goiter, and 8 (53%) PHDs of follicular adenoma. In FNA reports of cellular follicular<br />
lesion,, there were 2 (3%) PHDs of thyroiditis, 32 (44%) PHDs of nodular goiter, 38 (52%)<br />
PHDs of follicular adenoma, and 1 (1%) PHD of papillary carcinoma. In FNA reports of<br />
“suspicious for follicular neoplasm), there was 1 (1%) PHD of thyroiditis, 24 (32%) PHDs<br />
of nodular goiter, 47 (62%) PHDs of follicular adenoma and 4 (5%) diagnoses of papillary<br />
carcinoma. In FNA reports of follicular neoplasm, there were 25 (22%) PHDs of nodular<br />
goiter, 72 (64%) PHDs of follicular adenoma, and 15 (14%) PHDs of thyroid carcinoma. We<br />
found significant difference (p
Clinical Cytology - Posters<br />
THE ROLE OF CYTOLOGY IN THE DIAGNOSIS OF PYELON TUMOUR - A CASE REPORT<br />
Ezgeta Karačić D1 , Valetić J2 , Zeljko Ž3 , Vidas Ž3 , Jelić-Puškarić B4 ,<br />
Sabljar-Matovinović M5 , Kardum-Skelin I4 1 Vukovar General Hospital, Department of Cytology, Vukovar, Croatia<br />
2 University Hospital Merkur, Department of Gynaecology & Obstetrics, Zagreb, Croatia<br />
3 University Hospital Merkur, Division of Urology, Zagreb, Croatia<br />
4University Hospital Merkur, Department of Medicine, Laboratory for Cytology and Hematology,<br />
Zagreb, Croatia<br />
5 University Hospital Merkur, Department of Medicine, Zagreb, Croatia<br />
Tumours of the renal pelvis and ureter arising from epithelial and mesenchymal elements<br />
account for 8% of all urinary tract neoplasms and of these greater than 90%<br />
are urothelial carcinomas. Haematuria and lumbal pain are the major symptoms. In a<br />
72-year-old woman hospitalized for acute myocardial infarction, mediastinal lymphadenopathy<br />
is detected incidentally as well as a left supraclavicular lymph node, approximately<br />
1.5 cm in diameter, from which samples were taken for cytological analysis. The<br />
smears revealed a number of single, very large cells, with distinct anisonucleosis and<br />
eccentric nuclei, often with large nucleoli and tiny granules in a prominent cytoplasm.<br />
Immunocytochemical staining showed positivity for CK18, 20 and 7 and negativity for vimentin,<br />
HMB45, AFP, thyreoglobulin, synaptophysin and chromogranin. The findings indicate<br />
malignant epithelial cells, most probably of the transitional cell epithelium. Urine<br />
sediment analysis of 3 samples discovered cells identical to those found in the lymph<br />
node sample. Further diagnostic tests (abdominal ultrasound, MR, PET-CT, cystoscopy)<br />
confirmed the presence of a tumour in the pyelon of the right kidney, which had caused<br />
an obstruction and atrophy of the right kidney. The patient started to receive chemotherapy,<br />
however metastases have been detected (by scintigraphy and PET-CT) in the skelet<br />
and a lymph nodes. This work confirms the clinically valuable role of cytology (exfoliative<br />
and FNA) in the diagnosis of rare occurrences and localizations of malignant tumours.<br />
In this case, cytology detected the presence of malignant cells in the lymph node and in<br />
the urine much before the onset of clinical signs of the disease before other diagnostic<br />
methods.<br />
draz_ezgeta@hotmail.com<br />
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120<br />
Klinička citologija - Posteri<br />
POLYOMAVIRUS ASSOCIATED NEPHROPATHY AFTER SIMULTANEOUS KIDNEY AND<br />
PANCREAS TRANSPLANTATION. CASE REPORT.<br />
Gracin S1 , Knotek M1 , Sabljar Matovinovic M1 , Kardum Skelin I1 , Ljubanovic D2 , Vidas Z1 1 Clinical hospital Merkur, Zagreb, Croatia.<br />
2 Clinical hospital Dubrava, Zagreb, Croatia.<br />
In renal allograft recipient, immunosuppressive drug therapy is the major cause of immunocompromised<br />
status and opportunistic infections leading to transplanted organ<br />
failure.<br />
During the last decade, polyomavirus virus associated nephropathy (PVAN) has been the<br />
major cause of a serious complication allograft failure in these patients. The prevalence<br />
of PVAN has increased from 1% to 10 % leading to loss of transplanted organ in 30% to<br />
80% of cases. Viremia precedes PVAN, and in the absence of specific antiviral drugs,<br />
early detection of disease and modification/reduction of immunosuppressive regimen<br />
currently is the cornerstone of therapy.<br />
Although PVAN nephropathy is well documented, it has not been thoroughly investigated<br />
in nonrenal and/or multiple organ transplantation; such are simultaneous kidney and<br />
pancreas transplantation (SPKT). In these specific conditions the diagnosis and therapy<br />
of PVAN can be even more challenging problem.<br />
We report a 32 years old patient who presented with PVAN 6 month after SPKT due to<br />
diabetic nephropathy. He received induction immunosuppression which included IL-2<br />
antibody (daclizumab), steroids, mycophenolate mofetil and tacrolimus. Diagnosis was<br />
made on the basis of protocol cytologic study in urine, examining Decoy cell and confirmed<br />
by histological examination of renal biopsy which revealed viral inclusions on<br />
light microscopy as well as positive immunohistochemistry analysis. Patient was treated<br />
with reduced immunosuppressive regimen, both tacrolimus and mycophenolate mofetil<br />
with continuation of small dose of prednisone. At two years follow up, patient has preserved<br />
kidney and pancreas function with estimated glomerular filtration rate of 84 ml/<br />
min and no signs of PVAN on his 2 year protocol kidney biopsy.<br />
sonja.gracin@gmail.com
Clinical Cytology - Posters<br />
CASE REPORT OF A PATIENT WITH PERITONEAL AND OMENTAL LYMPHOMA<br />
INFILATRATION AND ASCITES POSITIVE FOR LYMPHOMA CELLS,<br />
FOLLOWING A RELAPSE OF SPLENIC MARGINAL ZONE LYMPHOMA (SMZL)<br />
Gredelj Šimec Nj1 , Ropar S2 , Baškot A3 , Dejanović M1 1 Department od Internal Medicine<br />
2 Department of Cytology<br />
3 Department of Radiology G.H. Karlovac, Croatia<br />
We have presented a patient with marginal NHL of Splenic type. The disease was manifested<br />
in splenomegaly and leukocytosis, without lymphadenopathy. The diagnose was<br />
set by immunocytochemical and immunophenotypic assessment of the peripheral<br />
blood. The patient was treated with 8 cycles of chemotherapy following the COP scheme<br />
in combination with Rituximab. Following treatment, complete remission was achieved.<br />
18 months later, the disease was manifested in splenomegaly, leukocytosis with 9%<br />
atypical lymphatic cells in the peripheral blood, multiple masses of solid peritoneal and<br />
omental tumours in size up to 6.5 cm, same as massive ascites with cytologically proven<br />
lymphoma cells.<br />
njetocka.gredelj@zg.t-com.hr<br />
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122<br />
Klinička citologija - Posteri<br />
FAMILIAL HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN A 6-WEEK-OLD<br />
MALE INFANT<br />
Jakovljević G1 , Kardum-Skelin I2 , Rogošić S1 , Čulić S3 , Stepan S1 , Bonevski A1 ,<br />
Rimac M1 , Nakić M1 1Department of Hematology and Oncology, Pediatric Clinic, Children’s Hospital Zagreb,<br />
Zagreb, Croatia<br />
2Laboratory for Cytology and Hematology, Department of Medicine, Merkur University<br />
Hospital, Zagreb, Croatia<br />
3 Department of Pediatric Hematology and Oncology, Clinical Hospital Centre Split and<br />
Medical School University of Split, Split, Croatia<br />
Familial hemophagocytic lymphohistiocytosis (FLH) is an autosomal recessively inherited<br />
multisystem disease. This defect in cellular cytotoxicity is a life threatening condition<br />
characterized by fever, rash, splenomegaly, cytopenias and neurologic manifestations.<br />
PRF1, UNC13D and STX11 gene defects underlie in about 40-50% of primary cases.<br />
Chemoimmunotherapy followed by hematopoietic stem cell transplantation improved<br />
disease outcome. We report the case of a 6-week-old boy who presented with a fever,<br />
diffuse rash, disseminated intravascular coagulation, hypofibrinogenemia, hypertrigliceridemia,<br />
hepatosplenomegaly, leukocytosis with 90% of lymphocytes, granulocytopenia,<br />
anemia, trombocytopenia, hyperferritinemia and pathological findings in cerebrospinal<br />
fluid. The patient had decreased frequency of NK cells and low NK cell activity<br />
in peripheral blood. Bone marrow aspiration analysis showed degenerative changes of<br />
histocyte cells, with preserved cytophages (lymphophages and erythrophages) consistent<br />
with hematophagocytic syndrome. Given that the molecular diagnosis of the known<br />
mutations in genes PRF1 and UNC13D showed a mutation in UNC13D, the diagnosis of<br />
familial hemophagocytic lymphohistiocytosis subtype 3 was established. HLH-2004 chemotherapy<br />
protocol was performed and partial remission with residual central nervous<br />
system disease was achieved. Hematopoietic stem cell transplantation was successfully<br />
performed with an unrelated HLA-identical donor. Familiar HLH is generaly a progressive<br />
and fatal disease. Early diagnosis with molecular genetic analysis and chemoimmunotherapy<br />
followed by hematopoietic stem-cell transplantation is the best approach.<br />
gordanajakovljevic@yahoo.com
Clinical Cytology - Posters<br />
MYELOID SARCOMA INVOLVING THE BREAST<br />
Jelić Puškarić B1 , Ostojić-Kolonić S2 , Planinc-Peraica A2 , Obad-Kovačević D3 ,<br />
Kardum-Skelin I1 , Jakšić B2 1Merkur University Hospital, Department of Medicine, Laboratory for Cytology and Hematology,<br />
Zagreb, Croatia<br />
2 Merkur University Hospital, Department of Medicine, Zagreb, Croatia<br />
3Merkur University Hospital, Department of Diagnostic and Interventional Radiology,<br />
Zagreb, Croatia<br />
Myeloid sarcoma is a tumor mass with extramedulary growth pattern, composed of myeloblasts<br />
or immature myeloid cells. The development of myeloid sarcoma may precede<br />
or concur with acute or chronic myeloid leukemia or other myeloproliferative diseases<br />
or myelodysplastic syndromes. Isolated myeloid sarcoma of the breast is very rare. A<br />
case is presented of a 25-year-old, previously healthy woman that presented to our department<br />
for a palpable node, 5x2 cm in size, in the upper medial quadrant of her left<br />
breast. Fine needle aspiration cytology (FNAC) FNAC produced a sample consisting of<br />
medium sized blasts of dispersed, gentle chromatin and basophile cytoplasm structure<br />
showing negative reaction to PAS, nonspecific esterase and myeloperoxidase; however,<br />
immunocytochemistry yielded positive reaction to myeloperoxidase and negative reaction<br />
to lymphocytic markers CD20, CD3 and CD10. Additional work-up revealed anemia<br />
(E <strong>4.</strong>1x10/L), thrombocytopenia (53x109/L) and leukocytosis (10x109/L), along with atypical<br />
blasts detected in peripheral blood smear (76%). Bone marrow FNAC yielded a hypercellular<br />
sample of bone marrow with 97% of atypical blasts of the same cytochemical and<br />
immunocytochemical characteristics as the breast FNAC sample. On flow cytometry,<br />
the phenotype of the breast and bone marrow samples showed a very high percentage<br />
expression of the immature myeloid cell markers CD34, CD33 and HLA DR. Cytogenetic<br />
analysis of the breast and bone marrow samples indicated numerous alterations (81,XX,-<br />
X,-X,-7,-8,-8,-9,add(17p)x2,-18,-18[15]/46,xx[3]). Based on the morphology, cytochemical<br />
characteristics and immature cell immunophenotype, it was considered a case of acute<br />
myeloid leukemia without maturation, AML-M1. In spite of intensive chemotherapy, the<br />
patient died within a year of diagnosis. In cases of isolated breast myeloid sarcoma, the<br />
diagnosis can be missed if the possibility of myeloid sarcoma is not remembered on differential<br />
diagnosis of a breast neoplasm. Immunohistochemical studies are extremely<br />
helpful to recognize isolated myeloid sarcoma.<br />
biljana.jelic.puskaric@zg.t-com.hr<br />
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124<br />
Klinička citologija - Posteri<br />
RHABDOMYOSARCOMA WITH BONE MARROW INFILTRATION MIMICKING<br />
HEMATOLOGIC NEOPLASIA. CASE REPORT<br />
Jelić-Puškarić B1 , Rajković-Molek K2 , Raić Lj3 , Batinić D4 , Konja J3 , Kardum-Skelin I1 1 Merkur University Hospital, Department of Medicine, Zagreb;<br />
2 University Hospital Center Rijeka, Department of Medicine, Rijeka;<br />
3 University Hospital Center Zagreb, Department of Pediatrics, Zagreb;<br />
4 University Hospital Center Zagreb, Department of Laboratory Diagnosis, Zagreb, Croatia<br />
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children younger<br />
than 15 years. According to the World Health Organization, there are embryonal, alveolar<br />
and pleomorphic types of RMS. Most RMS patients present with a tumor mass<br />
in the head and neck region, urogenital tract or lower extremities. Unusual clinical<br />
presentation of the disease with massive bone marrow infiltration at the disease onset<br />
and mimicking hematologic neoplasm is rarely seen. A case is presented of a 14-yearold,<br />
previously healthy girl hospitalized for outpatiently detected leukocyte elevation (L<br />
2<strong>4.</strong>8x109/L). For two weeks before, she had complained of fatigue, myalgia and frequent<br />
bruising. On admission, clinical examination revealed numerous petechiae and hematomas<br />
on the skin, enlarged lymph node inguinally on he left, and palpable spleen 2 cm.<br />
Laboratory findings showed leukocytosis (L 28.5x109/L), anemia (E 3.02x1012/L, Hb 85<br />
g/L) and thrombocytopenia (Plt 15x109/L). Bone marrow biopsy produced a hypercellular<br />
bone marrow sample with suppression of all three hemocytopoiesis lines and bone<br />
marrow infiltration with numeorous immature tumor cells that were cytochemically and<br />
immunocytochemically positive for PAS, vimentin and desmin, and negative for LCA,<br />
CD20, CD19, CD3, CD10, NSE, Ber EP 4, OIL RED and ANAE. Considering the morphological,<br />
cytochemical and phenotypic characteristics, the cytologists believed it was a case<br />
of bone marrow infiltration with RMS cells. Abdominal computed tomography revealed<br />
a primary tumor occupying the entire retropeoritoneal space. Tumor biopsy confirmed it<br />
to be alveolar RMS subtype. In conclusion, in case of bone marrow infiltration with primitive,<br />
immature cells, RMS should be taken in consideration on differential diagnosis.<br />
Adjuvant technologies (e.g., cytochemistry, immunocytochemistry, cytogenetic analysis,<br />
flow cytometry, and molecular analysis) can be very helpful in this diagnostic work-up,<br />
and may even lead to definitive diagnosis in some cases.<br />
biljana.jelic.puskaric@zg.t-com.hr
Clinical Cytology - Posters<br />
IMPACT OF STATIN, ANGIOTENSIN CONVERTING ENZYME INHIBITOR,<br />
ANGIOTENSIN II RECEPTOR BLOCKER AND DIHDROPYRIDINE TREATMENT<br />
ON PERITONEAL DIALYSATE COMPOSITION<br />
Jurić K1 , Cavrić G2 , Naumovski-Mihalić S2 , Bartolek D3 , Nassabain K4 , Novak NP5 1University Hospital Dubrava, Department of Internal Medicine, Zagreb, Croatia<br />
2University Hospital Merkur, Department of Internal Medicine, Zagreb, Croatia<br />
3University Hospital Merkur, Department of Anaesthesiology, Reanimation and<br />
Intensive Care, Zagreb, Croatia<br />
4 General Practice, Zagreb, Croatia<br />
5University Hospital Dubrava, Department of Clinical Cytology and Cytometry, Zagreb,<br />
Croatia<br />
Peritoneal dyalisis is increasingly used in the treatment of end-stage renal failure. Macrophage<br />
domination in peritoneal dialysate when there are no signs of acute peritonitis<br />
can reflect increased macrophage count in peritoneum, commonly found in patients<br />
on peritoneal dialysis. This indicates that the peritoneum of these patients is a chronically<br />
inflamed organ. Numerous studies suggest the pleiotropic properties of statins,<br />
agniotensin converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB)<br />
and dihydropyridines. The objective of the study was to investigate the effect of these<br />
medicines on the cellular composition of the peritoneal dialysate, regarding their assumed<br />
antiinflammatory properties. In this retrospective study we analyzed 21 peritoneal<br />
dialysate samples in total of 12 patients. In the samples of the patients on statin<br />
therapy significantly higher percentage of monocytes were found in peritoneal dialysate<br />
(p=0.005). Likewise, a higher percentage of lymphocytes and a lower percentage of macrophages<br />
were found, although not yielding statistical significance (p = 0.143 for lymphocytes<br />
and p = 0.063 for macrophages). In the samples of patients receiving ACEi or ARB<br />
treatment significantly lower lymphocyte count was found (p = 0.001) and a lower percentage<br />
of monocytes, with a higher percentage of macrophages, but with no statistical<br />
significance. In the samples of patients on dihydropyridine therapy significantly higher<br />
percentage of lymphocytes was found (p = 0.004). At the same time a higher percentage<br />
of monocytes and a lower percentage of macrophages were observed, that was not<br />
significant (p = 0.077 for monocytes and p = 0.158 for macrophages). As a result of treatment<br />
with these medicines certain changes in the cellular composition of the peritoneal<br />
dialysate were observed but further larger scale studies would be warranted.<br />
kjuric@kbd.hr<br />
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126<br />
Klinička citologija - Posteri<br />
MISLEADING PRESENTATIONS OF MALIGNANT BREAST DISEASES - ROLE OF<br />
CLINICAL CYTOLOGY<br />
Kaić G1 , Štoos-Veić T1 , Trutin Ostović K1 , Vojnović J2 , Vidović LJ2 , Lambaša S3 , Hariš V4 ,<br />
Ajduković R4 , Stanec S5 , Budi S5 1Dubrava University Hospital, Department of Clinical Cytology and Cytometry, Zagreb,<br />
Croatia<br />
2 Dubrava University Hospital, Department of Radiology, Zagreb, Croatia<br />
3 Dubrava University Hospital, Department of Pathology, Zagreb, Croatia<br />
4 Dubrava University Hospital, Department of Hematology, Zagreb, Croatia<br />
5Dubrava University Hospital, Department of Plastic, Reconstructive and Aesthetic<br />
Surgery, Zagreb, Croatia<br />
We described two examples with misleading presentations to draw attention to the role<br />
of clinical cytology as a part of multidisciplinary approach to breast lesions. In the first<br />
case - Paget’s disease of the nipple, there was no obvious clinical and radiological evidence<br />
of breast cancer, while the second case – primary non-Hodgkin lymphoma of the<br />
breast imitated advanced breast carcinoma. The question is whether accurate and fast<br />
diagnoses can be made without cytological examinations. It must be kept in mind that<br />
first-hand clinical information and contact with the patient is necessary in rendering<br />
accurate cytological diagnoses.<br />
gordana.kaic@zg.t-com.hr
Clinical Cytology - Posters<br />
FINE NEEDLE ASPIRATION CYTOLOGY OF BREAST ANGIOSARCOMA - CASE REPORT<br />
Kardum-Skelin I1 , Jelić-Puškarić B1 , Milas M1 , Vidić-Paulišić I2 , Jakić-Razumović J3 ,<br />
Šeparović V4 1Merkur University Hospital, Zagreb, Department of Medicine, Laboratory for Cytology<br />
ang Hematology, Zagreb,Croatia<br />
2 County Hospital Čakovec, Čakovec, Croatia<br />
3 Clinical Hospital Center Zagreb, Department of Pathology, Zagreb, Croatia<br />
4 School of Medicine, Department of Pathology, Zagreb, Croatia<br />
Angiosarcoma is a rare disease of the breast with the reported incidence of only 0.04% of<br />
all breast malignancies. The etiology of angiosarcoma remains unknown. It occurs postmastectomy,<br />
in association with chronic lymphedema or after radiotherapy. We present<br />
a patient with angiosarcoma that developed 12 years after the diagnosis of breast carcinoma<br />
and 8 years after operative procedure for disease recurrence and radiotherapy.<br />
A small angiomatous lesion of a few mm in size, cytologically suspect of vascular tumor<br />
(hemangioma or hemangiopericytoma), histopathologically verified to be atypical<br />
vascular lesion, was detected two years before breast enlargement and cytologic and<br />
histologic diagnosis of angiosarcoma. The patient died 15 months after the diagnosis of<br />
angiosarcoma, after two tumor recurrences and intrathoracic cavity invasion.<br />
ika.kardum-skelin@zg.t-com.hr<br />
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VULVAR PAGET’S DISEASE - CASE REPORT<br />
Katalenić Simon S, Krivak Bolanča I, Šentija K, Kukura V* Škrtic A**<br />
Laboratory for Cytology and Clinical Genetics<br />
*Department of Gynecology and Obstetrics<br />
**Department of Pathology and Cytology<br />
“Merkur“ University Hospital, Zagreb, Croatia<br />
128<br />
Klinička citologija - Posteri<br />
Vulvar Morbus Paget’s (MP) represents a rare intraepithelial adenocarcinoma. It appears<br />
in less than 5% of all vulvar neoplasia usually in postmenopausal women. Histological<br />
it is analogous to Paget’s disease of the breast. The most common clinical symptom is<br />
pruritus.The lesions appear as an erythematous or eczematous lesion with islands of<br />
hyperkeratosis. Occasionally, single anaplastic Paget’s cells can be found on the vulvar<br />
smears which make cytological diagnosis of the disease possible. However, the disease<br />
can be diagnosed only by biopsy. MP is classified into three distinct type based upon the<br />
origin of the neoplastic cell: type I - primary vulvar cutaneus Paget disease; type II - MP<br />
as a manifestation of an associated adjacent primary anal or rectal adenocarcinoma and<br />
type III - pagetoid urothelial intraepithelial neoplasia. To distinguish these subtypes the<br />
panel of immunohistochemistry markers must be done. We present a case of 49-year<br />
old woman with vulvar symptoms of pruritus, who had liver and kidney transplatation a<br />
two years ago. During the standard gynaecological examination the vulvar smear was<br />
taken for cytological evaluation. The smear was scanty, overload with squamae, with two<br />
kinds of cells: dysplastic squamous cells from lower layer of the epithelium and the single,<br />
anaplastic cells with enlarged nuclei, visible nucleoli and pale indistinct cytoplasm.<br />
According to that cytological diagnosis was vulvar intraepithelial lesions III (VIN III) with<br />
differential diagnosis of vulvar Paget disease. The pathological verification support the<br />
diagnosis of MP and an immunohistochemistry panel confirm type III of Paget disease<br />
so a evaluation of bladder was suggested.<br />
suzana.simon@kb-merkur.hr
Clinical Cytology - Posters<br />
SIMULTANEOUS OCCURRENCE OF CHRONIC LYMPHOCYTIC AND CHRONIC<br />
MYELOID LEUKEMIA<br />
Kojić Katović S1 , Vasilj A1 , Maričević I1 , Čaržavec D2 , Ćurić Jurić S1 1Department of Cytology, University Clinic of Internal Medicine, Sestre Milosrdnice<br />
University Hospital, Zagreb, Croatia<br />
2Department of Hematology, University Clinic of Internal Medicine, Sestre Milosrdnice<br />
University Hospital, Zagreb, Croatia<br />
The coexistence of chronic lymphocytic (CLL) and chronic myeloid leukemia (CML) in the<br />
same patient has only been reported occasionally. Most of these cases represent the<br />
patients who developed CML during the cource of CLL. Reviewing the literature, only a<br />
few cases of simultaneous occurrence of CLL and CML was found. Here we represent a<br />
preveously fit 50-year old man in whom the diagnosis of CLL and CML was established<br />
by FNAB of the bone marrow. The diagnosis was then confirmed by histopathology, immunophenotypization<br />
of the peripheral blood and by cytogenetic study of the bone marrow.<br />
Four years after the diagnosis the patient is well, with leucocytosis of 40x109 , on the<br />
count of lymphocytes (93%).<br />
skojic@kbsm.hr<br />
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URINE CYTOLOGY AS A FIRST AVAILABLE TOOL FOR DETECTION OF BK<br />
ASSOCIATED NEPHROPATHY-CASE REPORT<br />
Kovačević Vojtušek I1 , Knotek M1 , Ljubanović D2 , Kardum Skelin I1 ,<br />
Sabljar Matovinović M1 , Vidas Ž1 1 University Hospital Merkur, Zagreb, Croatia,<br />
2 University Hospital Dubrava, Zagreb, Croatia<br />
130<br />
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Polyomavirus BK-associated nephropathy (PVAN), although first recognised in the late<br />
1970-es, continues to represent a challenge in kidney transplantation, mainly because<br />
the optimal treatment approach has not been determined yet. The fact that about 10-30%<br />
of patients have simultaneously some stage of acute rejection, complicate the treatment<br />
even more. Herein we present a case of PVAN one year posttransplant, in the patient<br />
with combined liver and kidney transplantation, complicated by episode of acute T-cell<br />
mediated rejection. Identification of so-called decoy cells in the urine sediment of the<br />
patient with acute deterioration of graft function (eGFR from 71,5 to 56 ml/min) raised<br />
suspicion of PVAN, and diagnosis has been confirmed by histological finding of viral<br />
inclusions in renal tubular cells and immunohistochemical staining for poliomaviruses.<br />
The patient has been treated with leflunomide, intravenous immunoglobulin and reduction<br />
of overall immunosupression therapy. After short period (1,5 month) of stable<br />
renal function,further deterioration of graft function (eGRF 46,6ml/min) raised suspicion<br />
of acute rejection, which had been confirmed by patohistology. He received 500 mg of<br />
metilprednisolon intravenously and mycophenolatemofetil had been reintroduced, which<br />
resulted in slow partial recovery of the graft function, but never to the baseline values.<br />
For the past two years his renal graft function has been stable, maintaining lower levels<br />
of immunosupressive therapy. Conclusion: Prospective, multicentric studies are needed<br />
to assess different treatment approaches. Early diagnosis with close monitoring of renal<br />
function seems to represent the most efficacious tool in prevention of graft loss, but<br />
longer follow-up is necessary to determine the impact of immunosupression reduction<br />
on the long term graft outcomes.<br />
ikovacevicvojtusek@gmail.com
Clinical Cytology - Posters<br />
GRANULAR CELL TUMOR<br />
Lončar B1 , Marjanović K2 , Pauzar B1 , Staklenac B2 1Department of Clinical Cytology, University Hospital Osijek, Osijek, Croatia<br />
2Department of Pathology and Forensic Medicine, University Hospital Osijek, Osijek, Croatia<br />
Granular cell tumors are relatively uncommon benign lesions occurring in almost any<br />
part of the body. We report the cytological diagnosis of granular cell tumor in 25-year-old<br />
male patient who presented with an inguinal mass clinically suspected to be a lymphadenopathy.<br />
Fine needle aspiration revealed polygonal cells with abundant, granular cytoplasm<br />
and eccentrically located vesicular nuclei and inconspicuous nucleoli. The histopathological<br />
examination of the surgical excision confirmed the diagnosis. If resection<br />
is complete, local surgical excision is curative for benign granular cell tumors. Granular<br />
cell tumor has a characteristic cytological appearance, and fine-needle aspiration cytology<br />
(FNAC) has been suggested to be diagnostic modality of choice.<br />
loncar.branka@kbo.hr<br />
KLINEFELTER SYNDROME AND ACUTE BASOPHILIC LEUKAEMIA - CASE REPORT<br />
Ljubić N1 , Lang N2 , Kardum Skelin I3 , Lasan R4 , Dominis M5 , Perković L1 ,<br />
Županić-Krmek D2 , Grgurević-Batinica A1 1Department of Pathology and Cytology, General Hospital “Sveti Duh”, Zagreb, Croatia<br />
2Department of Internal Medicine, General Hospital “Sveti Duh”, Zagreb, Croatia<br />
3Division of Cytology, University Hospital “Merkur”, Zagreb, Croatia<br />
4Department of Cytogenetic, Zagreb University Hospital Center, Zagreb, Croatia<br />
5Department of Pathology and Cytology, University Hospital “Merkur”, Zagreb, Croatia<br />
Patients with 47, XXY karyotype (Klinefelter syndrome) appear to have increased risk of<br />
developing cancer, especially male breast cancer, germ cell tumours and non Hodgkin<br />
lymphomas, but rarely acute myeloid leukaemia. We report a patient with acute basophilic<br />
leukaemia with 47, XXY karyotype in both the tumour and constitutional cells.<br />
Acute basophilic leukaemia is very rare disease comprising less than 1% of all acute<br />
myieloid leukaemias. Morphological characteristic of leukaemic blast cells is moderately<br />
basophilic cytoplasm containing a variable number of coarse basophilic granules.<br />
The most characteristic cytochemical reaction is metachromatic positivity with toluidine<br />
blue. Blast are myeloperoxidase negative. Also leukemic blasts express myeloid and<br />
monocyte markers. There is no consistent chromosomal abnormality identified in this<br />
leukaemia. This is the first reported case of acute basophilic leukaemia in patient with<br />
Klinefelter syndrome. In this article the medical history of the patient is given and the<br />
possible connection between Klinefeter syndrome and acute myeloid leukaemia is discussed.<br />
nives.ljubic@zg.htnet.hr<br />
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SEPTIC ARTHRITIS DUE TO STREPTOCOCCUS SANGUIS<br />
Mandac I, Prkačin I, Sabljar Matovinović M<br />
Clinical Hospital Merkur, Zagreb, Croatia<br />
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Septic arthritis may represent a direct invasion of joint space by various microorganisms,<br />
including bacteria, viruses and fungi. Although any infectious agent may cause<br />
bacterial arthritis, bacterial pathogens are the most significant because of their rapidly<br />
destructive nature.<br />
We present a case of septic arthritis in a 56-year old male patient due to Streptococcus<br />
viridans which is member of the viridans group streptococci. Patient was admitted<br />
to Our Hospital presented as fever of unknown origin, losing more than 30 kg of body<br />
weight during couple of months, and anemia of chronic disease as paraneoplastic process.<br />
He had long history of arterial hypertension and cerebrovascular insult. There<br />
was swelling and pain of the right sternoclavicular joint and precordial systolic murmur<br />
in physical status. A large diagnostic panel has been made, CT of right sternoclavicular<br />
joint showed widening of periarticular soft tissue and loss of clavicular corticalis.<br />
Cytologic analysis of synovial fluid showed more than 90% of polymorphonuclear leukocytes.<br />
There were no crystals on microscopic examination and Gram stain of fluid<br />
was negative.Blood cultures were positive for S. sanguis and there was a consideration<br />
about possible periodontal disease. Stomatologic examination verified periapical ostitis<br />
and extraction of potential cause of infection has been done. Therapy with benzilpenicilline<br />
was followed by the gradual improvement of clinical and laboratory parameters.<br />
Although viridans group streptococci and S. sanguis in particular are rare causes of<br />
septic arthritis in native joints, they should be considered in the differential diagnosis of<br />
periodontal disease.<br />
imandac@yahoo.com
Clinical Cytology - Posters<br />
MYELOID/MEGAKARYOCYTIC BLAST PHASES AS A PRESENTING MANIFESTATION<br />
OF CHRONIC MYELOID LEUKEMIA: CASE REPORT<br />
Milas R1 , Kardum-Skelin I2 , Sustercic D2 , Abalic M1 , Lebinec M1 , Predragovic I1 1 General hospital Virovitica, Virovitica, Croatia<br />
2 Clinical hospital Merkur, Zagreb, Croatia<br />
Chronic myeloid leukemia is a myeloproliferative disease that originate in an abnormal<br />
pluripotent bone marrow stem cell and is consistently associated with the Philadelphia<br />
chromosome and/or BCR/ABL fusion gene. The disease is bi- or triphasic: an initial indolent<br />
chronic phase is followed by one or both of the agressive transformed phase, accelerated<br />
and blast phase (crisis). The majority of patients are diagnosed in the chronic<br />
phase. The blast phase resembles acute leukemia. Blast crisis as a presentig manifestation<br />
of CML is rare. Here we report a 23-year-old man with no prior hematologic<br />
disease, who presented with fever, gluteal pain, hepatosplenomegaly, unspecific skeletal<br />
lesions. White blood count was 121,6 x 109. Bone marrow aspiration of breastbone<br />
revealed the chronic phase of CML. Bone marrow aspiration of the pelvic bone (crista<br />
posterior) after 6 days revealed the accelerated phase of CML with 10 % atypical blasts.<br />
Bone marrow aspiration (crista posterior) after 8 days indicated blastic transformation<br />
of CML with 61% poorly differentiated blasts. Blasts expressed ANAE 75%, partly CD61<br />
33% and MPO 21%. Using RT-PCR we detected BCR/ABL fusion gene and the abnormal<br />
fusion transcript, p210.The karyotyype was: 46, xy, t(9;22) [6]/36,idem,-3,-4, del(5q),-7,<br />
del(8p), -13,-15,-16,-17,-20,-22(cp19). Here we reported the blast crisis as a presenting<br />
manifestation of CML with megakaryocytic and myeloid differentation.<br />
rmilas@net.hr<br />
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134<br />
Klinička citologija - Posteri<br />
INTERNATIONAL EXTERNAL QUALITY ASSESSMENT SCHEME FOR HAEMATOLOGY-<br />
23 YEARS EXPERIENCE IN INSTITUTE OF CLINICAL CHEMISTRY UNIVERSITY<br />
HOSPITAL “MERKUR”<br />
Nazor A, Flegar-Meštrić Z<br />
Institute of Clinical Chemistry University Hospital “Merkur” Zagreb, Croatia<br />
Introduction: External Quality Control is an obligate part of requirements for quality<br />
menagement. From 1985 Institute of Clinical Chemistry University Hospital “Merkur”,<br />
accredit by ISO 15189:2008 is involved in the International External Quality Assessment<br />
Scheme for Haematology (IEQAS - H) organized by World Health Organization (WHO).<br />
In year 1987, the institute received a certificate with obligation of active participation in<br />
conducting external quality control on regional level, which was fulfilled.<br />
Aim: The aim of external quality assessment is harmonysation of the results in laboratory<br />
haematology, by continuous education based on feedback of the results from each<br />
stage of the control.<br />
Matherial and methods: Through 6 controls a year, 12 samples for haemoglobin, leucocytes<br />
and thrombocytes, on haematological counter in total (special preparations);<br />
8 samples for leucogram, 8 samples for parasites (preparations coloured according to<br />
Pappenheim) and 8 samples for reticulocytes (preparations coloured with brilliant cresyl<br />
blue).<br />
Results: The results for haemoglobin, leucocytes, thrombocytes and reticulocytes are<br />
valued according to the deviation index DI. (DI >3.0 is unacceptable)<br />
The results for the differential blood count – leucogram are compared with declared<br />
intervals for each type of leucocytes, and found morphological changes on blood cells<br />
descriptive, up to 5 most important morphological marks in the smear.<br />
For reticulocytes the allowed deviation is ± 50%.<br />
For accurate recognition of blood parasites, it is required to define the type and subtype<br />
of the parasites.<br />
Acceptable results during 23 years of control (DI
Clinical Cytology - Posters<br />
FINE-NEEDLE ASPIIRATION CYTOLOGY OF APOCRINE HIDRADENOMA<br />
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<br />
2Dubrava University Hospital, Department of Pathology, Zagreb, Croatia<br />
3Dubrava University Hospital, Department of Plastic, Reconstructive and Aesthetic<br />
Surgery, Zagreb, Croatia<br />
An apocrine hidradenoma is a benign adnexal neoplasm, usually covered by intact skin,<br />
but may show superficial ulceration and serous discharge. This feature is raising the<br />
possibility of malignancy as it was in our case of macroscopically suspicious tumor. We<br />
described cytomorphologic features of cutaneous nodule that might be a lead to the cytologic<br />
diagnosis of hidradenoma, but primary or secondary malignant tumor has been<br />
ruled out first.<br />
dr.nina.novak@gmail.com<br />
FINE NEEDLE ASPIRATION BIOPSY OF FOLLICULAR THYROID TUMORS<br />
Pauzar B, Staklenac B, Lončar B<br />
Department of Clinical Cytology, Clinical Hospital Osijek, Croatia<br />
US-guided fine needle aspiration cytology is currently the best diagnostic tool for thyroid<br />
nodules. However, it is not sensitive and specific enough for discriminating between<br />
benign and malignant follicular tumors. The aim of this research is to make a detailed<br />
and objective determination of the morphological characteristics of cells in cytological<br />
smears of aspirated material of pathohistologically verified follicular and Hürthle adenomas<br />
and carcinoma. The research included 62 patients with cytologically diagnosed<br />
follicular or Hürthle cell tumors, and 15 patients with hyperplastic nodules. Echographic<br />
findings are divided into three groups: isoechogenic, hypoechogenic and hyperechogenic<br />
nodules. The nodules are classified by size according to the WHO pT classification.<br />
The semiquantitative analysis determined the frequency of particular morphological<br />
elements in the cytological smear. We analyzed the cellularity of the smear, cohesion<br />
between follicular cells, acinar formations, bare nuclei, characteristics of the nucleus<br />
and the cytoplasm, and the presence of colloid. The statistical analysis of cytological<br />
parameters has indicated that none of the cytological parameters alone is discriminating<br />
enough between non-tumor and tumor changes, or benign and malignant follicular<br />
thyroid nodules. The analysis of age, sex, nodule size and ultrasound findings has not<br />
shown the correlation between any of these parameters with the malignant or benign<br />
follicular tumors. The cytological analysis of the smears for patients with follicular tumors,<br />
in combination with clinical data and other diagnostic methods, contributes to<br />
more precise diagnostics, but is not sufficient for the discrimination between benign and<br />
malignant follicular tumors.<br />
pauzar.biljana@kbo.hr<br />
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Klinička citologija - Posteri<br />
SERUM IMMUNOGLOBULINS IN NON-HODGKIN’S LYMPHOMA PATIENTS<br />
Planinc-Peraica A1 , Ostojić Kolonić S1 , Radić-Krišto D1 , Dominis M2 , Jaksic B1 1 Department of Medicine, University Hospital “Merkur”, Zagreb;<br />
2 Department of Clinical Pathology, University Hospital “Merkur”, Zagreb<br />
As tumours of immune system non-Hodgkin lymphoma (NHL) causes very often the alteration<br />
of immune function because one function of the immune system is the production<br />
and secretion of immunoglobulin molecules. Immunoglobulin production depends<br />
on normal B- and T-cell interactions and may be estimated by measuring serum immunoglobulin<br />
levels. The papers with laboratory findings in patients with NHL are rather<br />
scarce. Although there are some studies dealing with this problem it is hard to compare<br />
data from these studies because some old classifications of NHL were used.<br />
The aim of the present study was to measure serum immunoglobulin levels in NHL patients<br />
in order to find out whether certain histological types could be characterised by<br />
the particular immmunogloubline profile.<br />
Serum proteins and immunoglobulin (Ig) findings in 119 non-Hodgkin’s lymphoma (NHL)<br />
patients were analysed. Out of them 96 (81%) patients had B-NHL, and 23 (19%) T-NHL.<br />
Indolent type of NHL was more frequent (77 patients, 65%), then aggressive type of NHL<br />
(42 patients, 35%). Most patients had normal serum protein concentration; the increased<br />
protein concentration was seen in 17% of patients while decreased concentration was<br />
noticed in 7% of patients. Hypoalbuminaemia was more frequent (43%) then hyperalbuminaemia<br />
(1%). In contrast to albumin, low levels of other protein fractions (alpha1-,<br />
alpha2-, and beta-globulin) were rather rare (0.6%, 4%, and 3% of patients, respectively)<br />
and high levels were frequent (23%, 37%, and 8%, respectively). Polyclonal hyperimmunoglobulinaemia<br />
was more frequent finding than hypoimmunoglobulinaemia. In 29%<br />
patients higher IgG level and in 25% patients higher IgA level were found. IgM hypoimmunoglobulinaemia<br />
(22%) was more frequent than IgG (11%) and IgA (8%) hypoimmunoglobulinaemia.<br />
M-spike in serum protein electrophoresis was found in 11 (7%) patients.<br />
The statistically significant correlation was not found between serum Ig concentration<br />
and lymphoma malignancy grade as well as between serum Ig concentration and immunologic<br />
origin of lymphoma. T-NHL patients have more often IgA concentration level<br />
above or under normal values than B-NHL patients (p
Clinical Cytology - Posters<br />
NEONATAL HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS - CASE REPORT<br />
Roganović J1 , Kvenić B1 , Jonjić N2 , Seili-Bekafigo I3 , Kardum-Skelin I4 1Division of Hematology and Oncology, University Children’S Hospital Rijeka;<br />
2Department of Pathology, School of Medicine Rijeka;<br />
3Department of Cytology, Department of Internal Medicine,<br />
Clinical Hospital Centar Rijeka, Croatia<br />
4Laboratory for Hematology and Cytology, Clinical Hospital Merkur, Zagreb, Croatia<br />
Hemophagocytic lymphohystiocytosis (HLH) represents a severe hyperinflammatory<br />
condition with the cardinal symptoms prolonged fever, hepatosplenomegaly, and cytopenias.<br />
The most prominent histopathological feature is an accumulation of activated<br />
T lymphocytes and macrophages predominantly in lymphoid tissues. Although it can occur<br />
in all age groups, neonatal-onset HLH is very rare. We report on a case of HLH presenting<br />
with anemia and respiratory distress at birth. Several weeks prior to diagnosis<br />
the symptoms were attributed to a systemic infection. The child developed typical clinical<br />
and laboratory findings, and was diagnosed with HLH according to the HLH-2004 guidelines.<br />
Chemo-immunotherapy was initiated, but after a temporary control of the disease<br />
he succumbed to rapidly progressive HLH. Post-mortem, extensive hemophagocytosis<br />
was found in multiple organs. No specific genetic defect was identified.<br />
HLH is potentially fatal childhood disease. It is important for pediatricians to be able<br />
to early identify this disorder and commence the therapy before overwhelming disease<br />
activity develops.<br />
jelena.roganovic1@ri.t-com.hr<br />
EOSINOPHILIC MASTITIS: A CASE REPORT OF AN EOSINOPHILIC MASTITIS IN<br />
A 32-YEAR OLD FEMAL<br />
Ropar S1 , Gredelj Šimec NJ2 , Tokić T2 1General Hospital Karlovac, Department for cytology, Karlovac, Croatia<br />
2General Hospital Karlovac, Department of Internal Medicine, Karlovac, Croatia<br />
Eosinophilic mastitis is a rare entity and mainly connected with significant eosinophilia<br />
in peripheral blood. We have presented a case of eosinophilic mastitis which appeared<br />
in a 32-year old female patient after unusually intense exposure to house dust. The disease<br />
has manifested itself with redness and itching of the skin of both breasts, bilateral<br />
retromamilar nodes painful to palpation, same as dense secretion from both breasts.<br />
The cytological analysis of the breast’s secretion, same as the aspirate of a nodule of the<br />
breast has shown numerous eosinophils, some phagocytes and numerous eosinophilic<br />
granules. Eosinophilia was also present in the blood. Allergy against house dust was<br />
proven with cutaneous prick test. A therapy with antihistamines led to total regression<br />
of symptoms, same as to normalisation of laboratory results which convinced us in addition<br />
that the case was related to eosinophilic mastitis.<br />
samija66@gmail.com<br />
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ABDOMINAL NON-EPITHELIAL TUMORS DIAGNOSED BY FINE NEEDLE<br />
ASPIRATION CYTOLOGY<br />
Škegro D1 , Obad-Kovačević D1 , Škurla B1 , Mrzljak A1 , Filipec-Kanižaj T1 ,<br />
Vidić-Paulišić I2 , Jelić-Puškarić B1 1 University Hospital Merkur, Zagreb, Croatia<br />
2 County Hospital Čakovec, Čakovec, Croatia<br />
138<br />
Klinička citologija - Posteri<br />
Non-epithelial tumor in abdominal cavity is less frequent finding than epithelial tumor<br />
regardless of site or primary or metastatic origin. Abdominal palpation discovers tumor<br />
mass occasionally; therefore visualization is possible by using imaging technologies.<br />
Ultrasound (US) and computed tomography (CT) enables precise localization and tissue<br />
sampling by fine needle aspiration (FNA) for cytology analysis and additional diagnostic<br />
technologies. Material and methods: Data of 761 FNA of intraabdominal mass performed<br />
with CHIBA needle in last 10 years were analyzed. Tumor mass suitable for FNA were<br />
punctured in liver (335), pancreas (124), spleen (32) kidney (21), adrenal gland (7) and<br />
retroperitoneal and mesenterial lymph nodes (242). Smears were stained according<br />
to May-Grünwald-Giemsa and according to cytochemistry and immunocytochemistry<br />
methods. For differentiation of malignant lymphomas flow-cytometry immunofenotypisation,<br />
cytogenetic and/or molecular analysis (PCR) were additionally performed.<br />
Results: Out of total of 761 specimens malignant tumor was diagnosed in 532 (70%). Nonepithelial<br />
tumor was diagnosed in 154 (20%) - 21 sarcoma, 6 melanoma, 7 embriogenic<br />
tumors and 120 malignant lymphomas. Subtypes of sarcoma were determined based on<br />
cytomorphology and immunocytochemistry - 4 gastrointestinal stromal tumor (GIST), 3<br />
liposarcoma, 2 rhabdomysarcoma, 2 leiomyosarcoma, 2 angiosarcoma, 1 fibrosarcoma<br />
and 7 samples were without subtype.<br />
Conclusion: US or CT guided FNA of abdominal tumor mass followed by cytoanalysis<br />
(cytochemistry and immunocytochemistry methods, flow-cytometry immunofenotypisation,<br />
cytogenetic and/or molecular analysis) is trustworthy diagnostic procedure for<br />
distinguishing non-epithelial from epithelial tumor and moreover for subtypisation of<br />
non-epithelial tumors.<br />
dinko.skegro@kb-merkur.hr
Clinical Cytology - Posters<br />
FINE NEEDLE ASPIRATION CYTOLOGY OF CHONDROID SYRINGOMA<br />
Škoro M1 , Trutin Ostović K1 , Čikara I2 , Müller D3 , Novak NP1 , Virag M4 1Dubrava University Hospital, Department of Clinical Cytology and Cytometry, Zagreb,<br />
Croatia<br />
2Dubrava University Hospital, Department of Diagnostic and Interventional Radiology,<br />
Zagreb, Croatia<br />
3 Dubrava University Hospital, Department of Patology, Zagreb, Croatia<br />
4 Dubrava University Hospital, Department of Maxillofacial Surgery, Zagreb, Croatia<br />
Aim: The aim of this case report is to show importance of FNA cytology in preoperative<br />
investigation and differential diagnosis of rare skin lesions. Methods: FNA cytology is a<br />
safe diagnostic procedure that may be used for diagnostic purposes. We present a 63<br />
year-old man with painless, subcutaneous nodule on the neck of five years duration.<br />
Ultrasonography showed a small subcutaneous, inhomogeneous mass with hypervascularisation.<br />
Radiologist required an ultrasound-guided FNA biopsy. During that procedure<br />
the lesion started to abundantly bleed. Results: The smears were cellular with<br />
numerous clusters of small, monomorphic epithelial cells embedded in a PAS positive<br />
myxoid stroma. The nuclei were round to oval with fine, evenly distributed chromatin<br />
and cytoplasm was dense, moderate in amount , with well-defined cell borders. The<br />
combination of epithelial elements and myxoid stroma suggested a diagnosis of chondroid<br />
syringoma. Conclusion: Chondroid syringoma is rare, benign appendageal tumor.<br />
Because of its unremarkable clinical presentation it is often overlooked. FNA cytology<br />
plays important role in the preoperative investigation of skin tumors such as chondroid<br />
syringoma. It may be useful to determine pathology before histological examination.<br />
marija.skoro@kbd.hr<br />
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Klinička citologija - Posteri<br />
CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL) - TRANSFORMATION TO HODGKIN<br />
LYMPHOMA OR COMPOSITE TUMOR - CASE REPORT<br />
Škrtić A1 , Borovečki A1 , Milas M2 , Džebro S1 1 University Hospital „Merkur“, Department of Pathology and Cytology, Zagreb, Croatia<br />
2University Hospital „Merkur“, Department of Medicine, Laboratory of Cytology and<br />
Haemathology, Zagreb, Croatia<br />
Over time, 2-8% of patients with CLL develop DLBCL and
Clinical Cytology - Posters<br />
FINE NEEDLE ASPIRATION OF INTRA-ABDOMINAL LYMPH NODES IN THE<br />
DIAGNOSIS AND FOLLOW UP OF MALIGNANT LYMPHOMA<br />
Šušterčić D1 , Kardum-Skelin I1 , Jelić-Puškarić B1 , Milas M1 , Odak D2 , Vidjak V2 ,<br />
Minigo H3 , Planinc-Peraica A3 , Radić-Krišto D3 , Ostojić Kolonić S3 , Jakšić B3 1Merkur University Hospital, Department of Medicine, Laboratory for Cytology and Hematology,<br />
Zagreb, Croatia<br />
2 Merkur University Hospital, Department of Diagnostic and Interventional Radiology<br />
3 Merkur University Hospital, Department of Medicine, Zagreb, Croatia<br />
Aim of the study. To assess appropriateness of the material obtained by fine-needle biopsy<br />
of intra-abdominal lymph nodes and the possibility of malignant lymphoma differentiation<br />
from other malignant tumors by cytomorphology supplemented by smear immunocytochemistry<br />
and flow cytometry using cytogenetic and molecular analysis (PCR)<br />
of cell suspension of sample obtained by fine-needle biopsy. Patients and methods. During<br />
a 10-year period, 242 intra-abdominal lymph nodes were examined. US-guided biopsy<br />
was done in 226 and CT-guided biopsy in two cases; biopsy was done blindly in only<br />
one patient. Biopsy was performed by 22-gauge CHIBA needle, length 15-20 cm, depending<br />
on lesion localization. Samples were analyzed on May-Grünwald-Giemsa stained<br />
smears by determination of cellular markers by smear immunocytochemistry and flow<br />
cytometry using cytochemical, cytogenetic and/or molecular analysis (PCR). Results.<br />
The material was inadequate for cytologic analysis in 8 cases. Malignant lymphoma was<br />
found in 97 patients (non-Hodgkin’s lymphoma (NHL) in 85 and Hodgkin’s lymphoma<br />
(HL) in 12 cases). In 81 patients, the diagnosis of malignant lymphoma was made for the<br />
first time (NHL in 72 and HL in nine patients). In cases of newly detected lymphoma,<br />
diagnostic work-up was supplemented by smear immunocytochemistry in 66, phenotyping<br />
on flow cytometer in 48, PCR in 13 and FISH in two cases. Out of 16 patients with previously<br />
diagnosed malignant lymphoma, NHL was present in 13 and HL in three cases.<br />
A tumor of another genesis was detected in three patients with previously diagnosed<br />
lymphoma (carcinoma in two patients with HL and bronchial small cell carcinoma in one<br />
patient with NHL), acute inflammation was found in 14 and elements of granulomatous<br />
lesion in three patients. Conclusion. Visualization of intra-abdominal lymph nodes by imaging<br />
methods enables target sampling for cytologic analysis as a reliable method in the<br />
diagnosis and follow up of malignant lymphoma, when supplemented by some adjuvant<br />
sophisticated technologies.<br />
dunjasustercic@yahoo.com<br />
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INTRAOPERATIVE IMPRINT CYTOLOGICAL ASSESSMENT OF THE SUBAREOLAR<br />
TISSUE OF THE NIPPLE AREOLA COMPLEX (NAC)<br />
Tomasović-Lončarić Č1 ,Milanović R2 , Lambaša S1 , Križanac Š1 , Štoos-Veić T3 ,Kaić G3 ,<br />
Trutin Ostović K3 1 University Hospital Dubrava, Department of Pathology, Zagreb, Croatia<br />
2University Hospital Dubrava, Department of Plastic, Reconstructive and Aesthetic<br />
Surgery, Zagreb, Croatia<br />
3University Hospital Dubrava, Department of Clinical Cytology and Cytometry, Zagreb,<br />
Croatia<br />
One of the criteria of selection for skin sparing mastectomy (SSM) with nipple areola<br />
complex (NAC) preservation is to exclude the neoplastic involvement of subareolar tissue<br />
(NAC base) in order to minimize the possibility of local recurrence. The most common<br />
way to assess the possible neoplastic involvement is intraoperative frozen section<br />
of the NAC base tissue. Because of its limitations, particularly the false negative results<br />
due to unsampling, we tried to use intraoperative imprint cytology for more thorough<br />
intraoperative assessment. The aim was to evaluate diagnostic accuracy of this method<br />
and possibility to substitute frozen section for intraoperative assessment of NAC base<br />
A prospective clinical study was conducted of 208 consecutive female patients who underwent<br />
open biopsy because of carcinoma. Intraoperative imprints were taken from the<br />
excised subareolar tissue which was then routinely processed for definitive histology.<br />
Intraoperative imprint findings were compared with the definitive histology of the NAC<br />
base. Our results with 7.5% false negative rate, 9.8% false positive rate, sensitivity of<br />
50% and specificity of 87.58% argue that imprint cytology might not be sufficient as an<br />
exclusive method for the intraoperative assessment of the NAC base though it should<br />
be used routinely in conjuction with frozen section examination.<br />
ctomasov@kbd.hr
Clinical Cytology - Posters<br />
ISOLATION AND CHARACTERIZATION OF LIVER CANCER STEM CELLS FROM A<br />
HEPATOCELLULAR CARCINOMA BIOPSY<br />
Tomuleasa C1 , Soritãu O1 , Páll E2 , Susman S3 , Rus D4 , Mihu C4 , Iancu C5 1Ion Chiricuta Oncology Institute, Department of Cancer Immunology, Cluj Napoca,<br />
Romania<br />
2 University of Veterinary Medicine, Department of Obstretics and Gynecology,<br />
Cluj Napoca, Romania<br />
3Iuliu Hatieganu University of Medicine and Pharmacy, Department of Histology,<br />
Cluj Napoca, Romania<br />
4Iuliu Hatieganu University of Medicine and Pharmacy, Department of Pathology,<br />
Cluj Napoca, Romania<br />
5Iuliu Hatieganu University of Medicine and Pharmacy, Department of Abdominal<br />
Sugery, Cluj Napoca, Romania<br />
Cancers are composed of heterogeneous cell populations, including highly proliferative<br />
immature precursors and differentiated cells. Recently, eloquent studies have provided<br />
proofs that cancers originate from cancer stem cells, their discovery in both solid and<br />
non-solid tumors changing our view of carcinogenesis and chemotherapy. Cancer stem<br />
cells exist in a wide array of tumours and are becoming increasingly important to understand<br />
the molecular mechanisms that regulate self-renewal and differentiation. We<br />
have isolated hepatocellular cancer stem cells from a liver biopsy, in an effort to unreveal<br />
more details about liver carcinogenesis, very important for the early detection and<br />
understanding of the mechanisms responsable for the highly aggressive clinical picture<br />
of hepatocellular carcinoma.<br />
In the current study, liver cancer stem cells were isolated from a surgical specimen<br />
of hepatocellular carcinoma in a patient whose malignancy had progresses during the<br />
previous six months. At passage 3, cells had a spindle-shaped morphology, formed<br />
spheroids and were resitant to chemotherapy agents. Immunocytochemistry staining<br />
and Reverse Transcriptase - Polymerase Chain Reaction showed that cells were pozitive<br />
for stem cell specific markers (CD 90, Oct 3/4, Nanog, SOX2, CD 133, CK19). Cells were<br />
also injected subcutaneously into CD1 mice to observe tumor formation.<br />
The cells faithfully retained the characteristics of their original tumors and provide a reliable<br />
resource for investigating the mechanisms of formation and recurrence of human<br />
liver cancer. Such investigatins may eventually have major impacts on the understanding<br />
and treatment of human cancer and metastasis.<br />
ciprian_tomuleasa@yahoo.com<br />
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DEXAMETHASONE AND CHITOSAN REDUCE HEPATIC FIBROSIS AND INFLAMATIO<br />
IN WISTAR RATS WITH BILE DUCT LIGATION<br />
Trip DM1 , Olteanu D1 , Filip A1 , Clichici S1 , Muresan A1 , Sofronie A1 , Nagy A2 ,<br />
Moldovan R2 1Iuliu Hatieganu University of Medicine and Pharmacy, Department of Physiology,<br />
Cluj Napoca, Romania<br />
2University of Veterinary Medicine and Sciences, Department of Pathology, Cluj Napoca,<br />
Romania<br />
Introduction:Chronic liver disease is characterized by excessive deposition of extracellular<br />
matrix in the liver during chronic injury. During early stages of this disease, cells<br />
begin to synthesize and secrete profibrotic proteins that stimulate matrix production<br />
and inhibit matrix degradation. Although it is clear that this process is important for the<br />
development of fibrosis, what remains unknown are the effects of dexamethasone and<br />
chitosan on cholestasis and subsequent fibrosis, induced by common bile duct ligation.<br />
Material and Methods:A total of 30 female Wistar rats were used in this study. The control<br />
group underwent laparotomy and the bile duct was dissected. Experimental groups<br />
received various daily doses of dexamethasone intramuscular and chitosan orogastric<br />
for 6 days after biliary duct ligation. The liver and serum was analyzed for reactive oxygen<br />
species levels and the serum for usual liver function tests after 6 days of treatment.<br />
Also histopathological examination was performed using a histological scoring system.<br />
Results:The levels of MDA in the liver were significantly lower in the groups treated with<br />
dexamethasone compare to the group that underwent only biliary duct ligation (p=0,008)<br />
the same was seen in the group with chitosan (p=0,027) and chitosan with dexamethasone<br />
(p=0,014). Biliary duct ligation induced severe cholestasis, confirmed by altered<br />
liver function, portal and focal inflammation, necrosis and fibrosis.<br />
Conclusion: Dexamethasone and chitosan reversed all the biochemical parameters used<br />
to quantify liver pathophysiology and ameliorated histopathological changes previously<br />
induced by BDL. Findings of the present study suggest that this treatment may favor<br />
collagenolytic activity, an assumption supported by amelioration of necroinflammatory<br />
liver injury and fibrogenesis.<br />
dora.trip@yahoo.com
Clinical Cytology - Posters<br />
FINE NEEDLE ASPIRATION CYTOLOGY OF METASTATIC MERKEL CELL CARCINOMA<br />
Trutin Ostović K1 , Hariš V2 , Miletić Z1 , Lambaša S3 , Lajtman Z4 , Štoos-Veić T1 1Dubrava University Hospital, Department of clinical cytology and cytometry, Zagreb,<br />
Croatia<br />
2 Dubrava University Hospital, Department of hematology, Zagreb, Croatia<br />
3Dubrava University Hospital, Department of clinical and experimental pathology, Zagreb,<br />
Croatia<br />
4Merkur University Hospital, Department of otorhinolaryngology and cervicofacial surgery,<br />
Zagreb, Croatia<br />
Aim: To present a case of metastatic Merkel cell carcinoma (MCC) diagnosed by fine<br />
needle aspiration cytology (FNAC), flow cytometric DNA analysis, pathohistology and<br />
electron microscopy. Case report: FNAC was performed of the nodule on left arm and<br />
neck 21 months since the primary MCC was diagnosed in 76-year-old female patient.<br />
We used a 23-gauge needle and a 20-ml syringe. One part of aspirate was used for<br />
cytological smears stained by Papenheim and Papanicolaou and the rest was used for<br />
DNA analysis by flow cytometry. The cytological features included increased cellularity,<br />
discohesive groups of malignant cells with large oval to irregular nuclei with moulding<br />
effect, inconspicuous micronucleoli and scanty cytoplasm. The tumour contained diploid<br />
peak with DNA index of 1.1and elevated S-phase fraction (21%). The cytological diagnosis<br />
of metastatic MCC was confirmed by histological one and by electron microscopy presented<br />
the pathognomonic features for MCC: dense-core neurosecretory granules with<br />
diameter of 100-250 nm surrounded by whorls of intermediate filaments. Conclusion:<br />
The MCC provides an enormous challenge for the morphologist because of a wide range<br />
of differential diagnosis. This case appears to be the first report of DNA analysis of a<br />
MCC from the aspirate.<br />
ktrutin@kbd.hr<br />
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HODGKIN’S LYMPHOMA VARIANT OF RICHTER’S SYNDROME<br />
Vasilj A1 , Kojić-Katović S1 , Maričević I1 , Žokvić E1 , Bobuš Kelčec I2 , Tomas D3,4 ,<br />
Ćurić-Jurić S1 1Department of Cytology, University Clinic of Internal Medicine, Sestre Milosrdnice University<br />
Hospital, Zagreb, Croatia.<br />
2 Department of Cytology, University Clinic for Tumors, Zagreb, Croatia.<br />
3University Department of Pathology, Sestre Milosrdnice University Hospital, Zagreb,<br />
Croatia.<br />
4University of Zagreb, School of Medicine, Zagreb, Croatia<br />
Chronic lymphocytic leukemia/small lymphocitic lymphoma (CLL/SLL) is low-grade malignant<br />
lymphoprolipheration, that has tendency to convert to a higher-grade neoplasam<br />
over time. More common is the development of a diffuse large cell lymphoma or<br />
transformation into prolymphocytic cell population.. In rare cases, 0,1-0,5% of patients<br />
develop multiple myeloma or Hodgkin’s lymphoma. We present 65-year old female with<br />
Hodgkin’s variant of Richter’s syndrome. On the basis of clinical simptoms, cytological,<br />
hystological and immunohistological finding in April 2008 CLL/SLL were diagnosed.<br />
The patient was treated with 8 courses of R-CHOP. After 10 month, FNA of the one of<br />
the enlarged lymph node on the neck was performed . The diagnosis was Hodgkin’s<br />
lymphoma. Immuno-hystological studies of the lymph node was consistent with type I<br />
Hodgkin’s type of Richter’s syndrome. Patient was treated with 3 courses of ABVD and<br />
radiotherapy.<br />
avasilj@kbsm.hr
Clinical Cytology - Posters<br />
THE VALUE OF URINARY DECOY CELL FINDING IN PATIENTS WITH KIDNEY<br />
TRANSPLANTATION: A SINGLE CENTER EXPERIENCE<br />
Vidas Ž1 , Mišić M2 , Pačić A4 , Jurenec F1 , Knotek M3 , Kardum-Skelin I5 1 Division of Urology, Clinical Hospital “Merkur”, Zagreb, Croatia<br />
2 Department of Cytology, General Hospital “Dr. J. Benčević”, Slavonski Brod, Croatia<br />
3 Department of Medicine, Clinical Hospital “Merkur”, Zagreb, Croatia<br />
4 Department of Pathology, Clinical Hospital “Dubrava”, Zagreb, Croatia<br />
5 Laboratory of Cytology and Hematology, Clinical Hospital “Merkur”, Zagreb, Croatia<br />
Childhood infection with polyomaviruses leads to a life-long latent infection of renal and<br />
urinary tract epithelia. Replication in the reno-urinary epithelium is associated with viral<br />
cytopathic changes such as nuclear inclusions and decoy cells (DC). Three species<br />
cause infection in humans, i.e. BK virus (BKV), JC virus (JCV), and simian virus (SV40).<br />
During the 2005-2009 period, cytological urine analysis was performed in 154 patients<br />
(94 male and 60 female) with kidney transplantation (n=19), simultaneous pancreaskidney<br />
transplantation (SPKT) (n=9) and simultaneous kidney and liver transplantation<br />
(n=2). Urine samples were analyzed according to the protocol once monthly following<br />
transplantation. Fresh urine samples were analyzed within 15 min of sampling (not the<br />
first morning void). Briefly, 0.5 mL urine was centrifuged in a cytocentrifuge at 600 rpm<br />
for 5 min and slides were stained by the methods of May-Grünwald-Giemsa (MGG) and<br />
Papanicolaou. The period from transplantation to the first occurrence of decoy cells in<br />
the urine and the period of decoy cell persistence in the urine were assessed. The presence<br />
of decoy cells (10 DC) and red blood cells (100<br />
E) per cytospin smear was semiquantitatively determined, along with analysis of inflammatory<br />
cells (neutrophilic granulocytes) and fungi. Kidney biopsy was done according to<br />
the protocol (75% of patients), clinical indication (18% of patients), or immediately upon<br />
transplantation as so-called zero biopsy (7% of patients). In patients where decoy cells<br />
were detected, their sensitivity, specificity, and negative and positive predictive value for<br />
BK nephropathy were calculated. Correlation of the study parameters was estimated by<br />
use of Kruskal-Wallis test (Statistica 7.1). Decoy cells were found in 30 patients (20 male<br />
and 10 female), age median 40 (range 16-69) years, at a mean of day 115 (range day 5-747)<br />
of transplantation, whereas their presence was recorded for a mean of 141 (range 77-<br />
771) days. Immunohistochemical staining of kidney biopsy sample for polyomavirus (BK<br />
type) yielded positive reaction in 2/30 (7%) patients. Erythrocyturia was present in 29/30<br />
patients with decoy cells. Up to 20 red blood cells per cytospin smear were recorded in<br />
14 patients, more pronounced erythrocyturia (>100 red blood cells per cytospin smear)<br />
in eight patients, and 20-100 red blood cells per cytospin smear in seven patients. The<br />
number of decoy cells per cytospin smear generally ranged less than 10 in 25/30 patients,<br />
whereas more than 10 decoy cells per cytospin smear were only recorded in 5/30<br />
patients. There was no statistically significant correlation between the finding of neutrophilic<br />
granulocytes and fungi, and the presence of decoy cells. Immunohistochemistry<br />
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Klinička citologija - Posteri<br />
produced positive finding for BKV in one patient with SPKT and simultaneous kidney and<br />
liver transplantation each, which was statistically significantly more common as compared<br />
with patients with kidney transplantation alone (P=0.0244). Immunohistochemical<br />
positivity for BKV was more significant in cases with more than 10 decoy cells detected in<br />
cytospin smear (P=0.013). In BK nephropathy, the finding of urinary decoy cells showed a<br />
100% sensitivity, 84% specificity, 100% negative predictive value and 6,6% positive predictive<br />
value. BKV nephropathy remains a significant posttransplantation complication.<br />
ravnateljstvo@kb-merkur.hr<br />
SINCHRONOUS BILATERAL BREAST CARCINOMA WITH TWO DIFFERENT<br />
MORPHOLOGY SUBTYPES:A CASE REPORT<br />
Vrabec-Branica B1 , Smojver-Ježek S1 , Juroš Z1 , Neralić-Meniga I2 , Križanac Š3 1Department of Cytology, University Hospital for Lungs Diseases “Jordanovac”,<br />
Zagreb, Croatia<br />
2Department of Radiology, University Hospital for Lungs Diseases “Jordanovac”,<br />
Zagreb, Croatia<br />
3 Department of Pathology, University Medical School, Zagreb, Croatia<br />
We report a case of synchronous bilateral breast cancer with ductal and medullary<br />
carcinoma. A 60-year-old woman presented with lesion in both breasts which were<br />
mammographicaly found two years ago. Ultrasonography proved two suspected masses<br />
in breasts. Fine needle cytology was performed and confirmed bilateral carcinoma but<br />
with different cytological findings. The cytological feature of left breast suggested ductal<br />
carcinoma and of right breast raised possibility of a medullary carcinoma. Patient<br />
underwent bilateral quadrectomy with evacuation of axillary lymph nodes. Histological<br />
examination showed bilateral carcinoma with two different histology: ductal in left and<br />
medullary carcinoma in right breast.<br />
bozica.vrabec.branica@zg.t-com.hr
Clinical Cytology - Posters<br />
APOPTOSIS OF LEUKEMIC CELLS - A CASE REPORT<br />
Vrbanus LJ1 , Sučić M1 , Marković-Glamočak M1 , Ries S1 , Gjadrov-Kuveždić K1 ,<br />
Fabijanić I1 , Antulov J1 , Labar B2 1 Zagreb University Clinical Hospital Center and School of Medicine, Clinical Department<br />
of Pathology and Cytology, Zagreb, Croatia<br />
2Zagreb University Clinical Hospital Center and School of Medicine, Department of<br />
Hematology, Zagreb, Croatia<br />
Transformation of leukemic cells is linked to delay of maturation, delay in apoptosis and<br />
altered responsiveness to growth factors. However, in some studies were found that<br />
FAS (CD95/APO1) that mediates apoptotic signal is more frequently expressed in M4/M5<br />
leukemic cells, and could be related to poor clinical outcome of acute myeloid leukemia<br />
(AML) patients. Apoptosis of bone marrow (BM) leukemic cells in our patient with<br />
AML-M5 could be also related to FAS expression on leukemic cells. The aim of the study<br />
was to compare cytomorphology and cytochemistry of BM apoptotic leukemic cells to<br />
preserved peripheral blood (PB) leukemic cells in our patient with AML-M5. Patients<br />
and methods: In the study is reported a 76 years old men with AML-M5 treated at Zagreb<br />
University Hospital Center. BM and PB of AL patient were analyzed after Pappenheim<br />
and cytochemical stainings and classified according FAB and WHO classification. Flow<br />
cytometry and cytogenetic analyses of BM cells were also done. Results: In BM were<br />
found numerous apoptotic cells with characteristic nuclear chromatin condensation<br />
and formation of pyknotic nuclei and only few preserved monoblasts and promoncytes.<br />
Analysis of PB revealed leukocytosis and 80-90% monocytic cells (46% monoblasts, 29%<br />
promonocytes and 11% monocytes). In almost all of BM apoptotic leukemic cells and<br />
PB leukemic cells esterase was strongly positive. Conclusion: Cytomorphology and cytochemistry<br />
of PB leukemic cells point to proliferation of immature monocytic cells and<br />
cytomorphology of BM to cell apoptosis. Cytochemistry of BM apoptotic cells confirmed<br />
monocytic cell lineage and AML-M5b was diagnosed in our patient.<br />
ljkuzmanovic@yahoo.com<br />
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analitiËka citologija<br />
analytical cytology<br />
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Analitička citologija - Plenarna i pozvana predavanja<br />
ANALYTICAL CYTOLOGY - FROM BASIC METHODOLOGY TO ROUTINE CLINICAL<br />
DISCIPLINE<br />
Batinić D<br />
Referral Center for Immunodiagnostics of Hematological and Immunological Diseases,<br />
Clinical Hospital Center, Zagreb, Croatia<br />
Analytical cytology may be generally defined as the measurement of cells and their constituents<br />
for biological, diagnostic and therapeutic purposes. Although it incorporates<br />
elements of different disciplines such as anatomy, biology, cytology, physiology and pathology,<br />
its backbone is formed by two sophisticated techniques – multiparameter flow<br />
cytometry and image analysis/digital microspcopy. The major advantage of analytical cytology<br />
is its quantitative nature which makes it more specific and precise in comparison<br />
to classical types of cell analysis. It also allows reproducible gathering of data in statistical<br />
terms enabling a faster and more consistent analysis. The focus of this presentation<br />
is on reviewing scientific advances that have enabled the widespread use of analytical<br />
cytology in clinical setting, i.e. for the diagnosis, prognosis and therapeutic purposes.<br />
drago.batinic@zg.t-com.hr<br />
QUARTER OF A CENTURY OF THE LABORATORY FOR HUMAN GENETICS,<br />
DEPARTMENT OF MEDICAL GENETICS, PEDIATRICS CLINIC,<br />
UNIVERSITY HOSPITAL SPLIT<br />
Čulić V, Lozić B, Oreško T, Ivko-Banovac D, Botić Lj, Kezić G, Milanović D.<br />
Laboratory for Human Genetics, Departement for Medical genetics, Pediatrics Clinic,<br />
Clinical Hospital Center Split, Croatia<br />
Laboratory founded in 1983. year. According to data from the archives 12th December<br />
1983rd first karyogram was made from peripheral blood sample. 1987th begin genetic<br />
counseling, 1989. analysis of bone marrow, and from 10th july of 2007. amnyocentesis<br />
and spontaneous abortion. Since 1991.yr. laboratory is available to students from the<br />
Faculty of Medicine, University of Split, professional studies (nursing, radiologists, etc.)<br />
and other faculties of the University of Split (PMF) for the following subjects: pediatrics,<br />
biology and pathology. Of. 12th December 1983. to 10th july 2009. there were totaly<br />
analyzed 8777 samples of peripheral blood (6148), bone marrow (1370), amnyocentesis<br />
(413) and spontaneous abortion (166). This work will show some interesting cases, and<br />
collaborating institutions in the country and the world with which they analyzed in all<br />
kinds of samples in this regional laboratory.<br />
vculci1@yahoo.com
Analytical Cytology - Plenary and Invited Lectures<br />
ACCREDITATION OF MEDICAL LABORATORIES IN CROATIA - EXPERIENCES OF THE<br />
INSTITUTE OF CLINICAL CHEMISTRY CLINICAL HOSPITAL MERKUR, ZAGREB<br />
Flegar-Meštrić Z1 , Nazor A1 Perkov S1 , Šurina B1 , Kardum-Paro MM1 , Šiftar Z1 ,<br />
Sikirica M1 , Sokolić I1 , Ožvald I1 , Vidas Ž2 1 Institute of Clinical Chemistry, University Hospital Merkur, Zagreb, Croatia<br />
2 University Hospital Merkur, Zagreb, Croatia<br />
Since 2003 when the international norm for implementation of quality management in<br />
medical laboratories (EN ISO 15189, Medical laboratories - Particular requirements for<br />
quality and competence) was established and accepted, accreditation has become practical,<br />
generally accepted method of quality management and confirmation of technical<br />
competence of medical laboratories in the whole world. This norm has been translated<br />
into <strong>Croatian</strong> and accepted by the <strong>Croatian</strong> Institute for Norms as <strong>Croatian</strong> norm. Accreditation<br />
is carried out on voluntary basis by the <strong>Croatian</strong> Accreditation Agency that<br />
has up to now accredited two clinical medical biochemical laboratories in the Republic<br />
of Croatia. Advantages of accredited laboratory lie in its documented management system,<br />
constant improvement and training, reliability of test results, establishing users’<br />
trust in laboratory services, test results comparability and interlaboratory (international)<br />
test results acceptance by adopting the concept of metrological traceability in laboratory<br />
medicine.<br />
zlata.mestric@zg.t-com.hr<br />
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<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
MORPHOMETRIC AND CELL KINETIC CHARACTERISTICS IN THE DIAGNOSIS AND<br />
PROGNOSIS OF NEOPLASMS<br />
Kardum-Skelin I<br />
Merkur University Hospital, Zagreb, Croatia<br />
The majority of cytologic and histopathologic diagnoses still rely on the basic light microscopy<br />
interpretation, based on visual perception and clearly defined diagnostic criteria<br />
for each particular disease. Yet, different interpretations and variations in reproducibility<br />
(inter- and intra-morphologist) are possible in various neoplasms as well as in<br />
inflammatory diseases and other pathologic events. The problem of reproducibility may<br />
even increase with the inclusion of prognostic criteria such as grade of differentiation,<br />
mitotic activity, etc. Nowadays, optimal treatment demands from the morphologist more<br />
than simple distinction between the malignant and the benign. Additional information<br />
is necessary to identify patients at an increased risk of recurrence or those with rapid<br />
disease progression, and to detect disease recurrence before its clinical manifestation.<br />
Furthermore, identification of precancerous lesions in a population at a high risk<br />
of malignancy may help in planning the approach of surveillance strategy. In the last<br />
years, efforts have been invested to improve diagnostic accuracy and to obtain new,<br />
more appropriate and objective information on the process through the introduction of<br />
sophisticated computer technologies. Malignant cell alteration leads to changes at the<br />
cell, cytoplasm, nucleus and nuclear structure levels, the latter being most numerous.<br />
Cell enlargement is most common, resulting in an increased nucleus/cytoplasmic (N/C)<br />
ratio and morphologic changes characteristic of particular tumor types. Pronounced<br />
pleomorphism and nuclear multinucleation or multilobulation are important nuclear<br />
characteristics of malignant growth. Chromatin structure may show hypo- or hyperchromatism<br />
as a reflection of abnormal DNA amount due to pathologic mitosis and an<br />
increased number of nuclei in the synthetic phase of preparation for mitosis. Both of<br />
these parameters, DNA amount and proliferative activity, reflect in abnormal cell function;<br />
abnormal DNA amount characterizes malignant and premalignant cells, whereas<br />
considerably increased proliferative activity is associated with neoplasia and biological<br />
tumor behavior. Within the nucleus, the number and size of nucleoli increase, along with<br />
changes that occur in the nucleolar substructure, the nucleolar organizer region (NOR).<br />
Generally, tumor cell nuclear morphology is highly relevant for two reasons. First, the<br />
substructure may provide diagnostic help in the identification of specific tumor types.<br />
Second, abnormalities of nuclear morphology play a major role in tumor staging. All<br />
these alterations can be numerically objectified by computer technologies through analysis<br />
of the morphometric characteristics of the cell as a whole, the nucleus and nuclear<br />
structures (AgNOR), and by determination of DNA amount using image DNA cytometry.<br />
ikardum@hi.t-com.hr<br />
154<br />
Analitička citologija - Plenarna i pozvana predavanja
Analytical Cytology - Plenary and Invited Lectures<br />
MOLECULAR PATHOGENESIS OF PHILADELPHIA-NEGATIVE CHRONIC MYLEOID<br />
NEOPLASMS<br />
Kušec R<br />
Department of Hematology and Molecular diagnostics and genetics, Dubrava University<br />
Hospital, and Zagreb School of Medicine, Zagreb, Croatia<br />
Myeloproliferative disorders or neoplasms (MPNs), as they have recently been renamed<br />
by the WHO 2008 classification, have been divided into polycythaemia vera (PV), essential<br />
thrombocythaemia (ET) and primary myelofibrosis (PMF). The discovery of the JAK2<br />
V617F mutation in nearly all patients with PV and half those with ET and PMF has redefined<br />
the classification and will most likely influence the management of MPNs in the<br />
near future. It seems likely, however, that any attempt to reclassify the MPNs on the<br />
basis of JAK2 mutation status will need to retain the concepts of a disease with predominant<br />
erythrocytosis, a disease with predominant marrow fibrosis and a disease with<br />
isolated thrombocytosis, since both therapy and prognosis vary substantially across the<br />
three entities. Examination of the JAK/STAT signaling pathway and cytokine receptors<br />
led to the discovery of various gain-of-function mutations in the thrombopoietin receptor<br />
(MPL). They occur in patients with PMF and ET with a frequency of 1-9%. Both JAK2<br />
and MPL mutations, as shown in animal models, clearly induce a myeloproliferative<br />
phenotype in vivo. For JAK2 it was shown that ratio of mutant JAK2-V617F to wild-type<br />
JAK2 determines the MPD phenotype in transgenic mice. Monoclonal origin of MPNs<br />
has been a pathogenetic fundamental and extensive studies at cytogenetic and molecular<br />
level are being conducted in search of invariant aberration of MPN specific (gene)<br />
defect. This has not been found so far. In cytogenetics lesions frequently seen in other<br />
myeloid neoplasms were detected: deletions (chr5q,13q,20q), numerical changes (1,8,9)<br />
and gains of 9p. For the increase in mutated allele frequency of JAK2 V617F a mechanism<br />
of uniparental disomy (UPD) of the short arm of chromsome 9 (9UPD) was found<br />
to be the most frequent mechanism. Besides JAK2 and MPL, recently other sporadic<br />
oncogenic point or other type of mutations (mostly small deletions) have been found in<br />
different oncogenes (e.g. TET2, CBL, IKZF1). However, all of them in a relatively small<br />
proportion and different MPN phenotypic subtypes. All these lesions create number of<br />
genotype classes of progenitors and when cultured progenitor colonies are genotyped<br />
complex pattern of different clones is found in which also variable acquisition order<br />
of genetic abberations is evident. Simulatanously occuring two different mutations are<br />
possible (JAK2 and MPL, or two independent JAK2 mutations) which suggests that MPN<br />
exhibits a certain form of mutator phenotype resulting in increased mutation frequency.<br />
Recently an MPN susceptibility haplotype of JAK2 was identified based on the uneven<br />
distribution of JAK2 V617F mutations between the two most frequent haplotypes. While<br />
it still remains to be seen wheter and which somatic mutation can make clone more<br />
suscetible to acquire a JAK2 mutation with subsequent development of MPN, in very<br />
recent study of MPNs transforming to acute leukemia interesting novel insights into<br />
the molecular pathogenesis of these event have been made. Acute leukemia following<br />
JAK2+MPN can be JAK2-mutant and JAK2-wild type. Patterns of second hits, however,<br />
155<br />
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<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
were similar between JAK2-mutant and wild-type leukemias and included alterations of<br />
RUNX1, WT1 and TP53. Loss of the JAK2 mutation by mitotic recombination, gene conversion<br />
or deletion was excluded in all wild-type AMLs. In some patients, mutations in<br />
TP53, CBL or TET2 were present in JAK2 wild-type leukemic blasts, but absent from the<br />
JAK2-mutant MPN, demonstrating that in some patients TET2 mutations are present<br />
in a clone distinct from that harboring a JAK2 mutation. By contrast in a chronic phase<br />
patient, different clones harboring mutations in JAK2 or MPL represented the progeny of<br />
a shared TET2-mutant ancestral clone. These data uncover further clonal heterogeneity<br />
in the MPN.<br />
rkusec@irb.hr<br />
CYTOGENETIC RESULTS IN 24 CASES OF MULTIPLE MYELOMA: SHORT REPORT<br />
Lasan Trčić R1 , Kardum Skelin I2 , Šušterčić D2 , Planinc-Peraica A2 , Ajduković R3 ,<br />
Hariš V3 , Kušec R3 , Begović D1 1Cytogenetic Laboratory, Department of Pediatrics, University Hospital Zagreb, Zagreb,<br />
Croatia<br />
2 Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia<br />
3Clinical Institute of Laboratory Diagnostics, Dubrava University Hospital, Zagreb,<br />
Croatia<br />
Great studies of multiple myeloma (MM) strongly suggested that specific chromosomal<br />
changes are of prognostic significance in patients with MM1. We have performed cytogenetic<br />
analysis and recently fluorescent in situ hybridization (FISH) on 43 cases of<br />
MM. Clonal chromosomal changes were present in 24 (56%) cases. Hyperdiploid karyotype<br />
was found in 12 (50%) cases, hypodiploid in 8 (33%) cases, and 4 (17%) cases<br />
had a pseudodiploid karyotype. The most common numerical abnormalities were gains<br />
of whole chromosomes 15, 11, 3 and 6. Whole chromosome losses were also frequent<br />
involving chromosomes X, 13, 14, and 8. Most cases showed also structural rearrangments<br />
(n=17, 71%): del(1p), dup(1q), del(5q), del(13q), del(17p) and t(11;14)(q13;q32) (n=4,<br />
17%). Chromosome -13/13q deletion was found in 42% (n=10) cases; complete loss of 13<br />
was observed in 67% (n=7) cases, whereas 33% (n=3) had interstitial deletions. In the<br />
majority of the cases there was a mixture of abnormal and normal metaphases.<br />
lasan.ruzica@hotmail.com<br />
156<br />
Analitička citologija - Plenarna i pozvana predavanja
Analytical Cytology - Plenary and Invited Lectures<br />
FLOW CYTOMETRIC CLONALITY ANALYSIS OF ENDOSCOPIC ULTRASOUND-GUIDED<br />
FINE-NEEDLE ASPIRATION OF LYMPH NODES<br />
Miletić Z1 , Gizdić G2 , Štoos-Veić T1 , Kaić G1 , Novak NP1 , Tadić M3 , Jakšić O2 ,<br />
Trutin Ostović K1 1Department of clinical cytology and cytometry, Dubrava University Hospital, Zagreb,<br />
Croatia<br />
2Clinic of internal medicine, Department of hematology, Dubrava University Hospital,<br />
Zagreb, Croatia<br />
3Clinic of internal medicine, Department of gastroenterology, Dubrava University<br />
Hospital, Zagreb, Croatia<br />
Immunophenotyping by flow cytometry (FC) is an essential tool in the diagnosis of<br />
non-Hodgkin’s lymphomas (NHLs) in fine-needle aspiration cytology (FNAC) of palpable<br />
lymph nodes or endoscopic ultrasound-guided (EUS) FNAC of deep-seated lymph<br />
nodes. Because at least 80% of NHLs are of B-cell type, detection of immunoglobulin<br />
(Ig) light-chain-restriction (clonality) represents the most commonly used evidence for<br />
a diagnosis of B-cell lymphoma. In our study we wanted to evaluate accuracy of FC<br />
clonality compared to morphologic diagnosis of EUS-FNA of deep-seated lymph nodes.<br />
Direct smears were made and selected slide was stained for rapid-on site evaluation<br />
procedure and if needed additional samples were sent for FC clonality analysis. Sixteen<br />
patients with suspicious NHL of deep-seated lymph nodes obtained by EUS-FNA were<br />
submitted for FC clonality analysis. Six of the patients had supected pancreatic lesions,<br />
6 had abdominal and 4 had mediastinal lesion. Adequacy of samples with diagnostically<br />
relevant material were 68,7%. Monoclonality was demonstrated in 7 of 11 cases cytologically<br />
diagnosed as NHL. Polyclonality was demonstrated in 4 of 11 cases cytologically<br />
diagnosed as benign reactive lymphadenopathy. Our results show that EUS-FNAC with<br />
FC is a sensitive and specific tool in the diagnosis of deep-seated B-NHL. Successful<br />
cytologic diagnosis combined with FC clonality analysis can be performed in majority of<br />
cases and may eliminate need for open biopsy, especially in relapsed disease.<br />
zorana.miletic@kbd.hr<br />
157<br />
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EXTERNAL QUALITY ASSESSMENT IN CLINICAL CELL ANALYSIS BY FLOW<br />
CYTOMETRY. WHY IS IT SO IMPORTANT?<br />
Šiftar Z, Kardum Paro MM, Sokolić I, Nazor A, Flegar Meštrić Z<br />
Institute of Clinical Chemistry, Merkur University Hospital, Zagreb, Croatia<br />
Participation in external quality assessment is an integral part of laboratory work and<br />
mandatory when the results have a clinical application, which is one of the requirements<br />
of standard 15189 for accreditation of medical laboratories. Institute of Clinical Chemistry,<br />
the first laboratory accredited for clinical cell analysis by flow cytometry in Croatia,<br />
participated in UKNEQAS for Leukocyte Immunophenotyping in 3 schemes: “Immune<br />
Monitoring”, “CD34 Stem Cell Enumeration” and “Leukaemia Immunophenotyping“.<br />
For sample processing on EPICS XL flow cytometer, lyse/no wash preparation technique<br />
with ammonium chloride (NH4Cl) or ImmunoPrep lysing reagent was employed.<br />
In “Immune monitoring” programme CD45/sideward light scatter (SSC) proposed gating<br />
strategy was adopted for lymphocyte subsets, while modified ISHAGE protocol was<br />
used for CD34+ cell enumeration. Absolute count determination was performed on flow<br />
cytometer using FlowCount beads solution. In the period from the beginning of 2006<br />
until the middle of 2009. a total number of 100 stabilized whole blood samples were<br />
processed. The relative and absolute enumeration results for lymphocyte subsets were<br />
within tolerable limits, in 97.1 and 97.1% of cases, and 95 and 90% of CD34+ cell enumeration,<br />
respectively. In immune monitoring CD45/SSC proposed gating strategy is the<br />
most frequent analysis used (>85% participants) and ISHAGE protocol for CD34+ cell<br />
determination with continuous rise from 76 to 83%. A number of participants who accept<br />
beads method for absolute count enumeration on flow cytometer get greater, 69 to 86%,<br />
while FlowCount was the second of bead-based techniques used (25 and 35%).Sample<br />
treatment in lyse/no wash technique using NH4Cl lysing solution was dominant procedure<br />
used by more than 1/3 participants, although its home made solution has replaced<br />
slowly by commercial reagents. The unacceptable results, 6 of 244, were obtained for 20<br />
most frequently determined cell antigens in “Leukaemia Immunophenotyping“ samples<br />
screened for leukaemia/lymphoma. Processing results of all participants showed that<br />
the deviation from laboratory guidelines and the use of older methods for cell identification,<br />
quantification of cell counting on haematology analyser, or usage an antibody conjugated<br />
with fluorochrome lesser fluorescence quantum often lead to an unacceptable<br />
result, although is noticeable trend to accept new referrals and protocols to reduce the<br />
inter-laboratory differences.<br />
zoran.siftar@hdmb.hr<br />
158<br />
Analitička citologija - Plenarna i pozvana predavanja
Analytical Cytology - Plenary and Invited Lectures<br />
FUTURE PERSPECTIVES OF PERSONALIZED MEDICINE<br />
Štambuk S1 , Šundov D2 , Kuret S2 , Beljan R2 , Anđelinović Š2 1 University Center for Forensic Sciences, University of Split, Split, Croatia,<br />
2Institute of Pathology, Forensic Medicine and Cytology, Split University Hospital, Split,<br />
Croatia<br />
Molecular medicine provides information on gene/protein/metabolic pathway-based<br />
diagnosis of the origin of diseases, their progression and their response to drugs.<br />
Pharmaco-omics serves in providing prescriptions for specific sub-populations or individuals,<br />
based upon their molecular make-up, thus ensuring drug effectiveness and<br />
avoiding lack of response to drugs or their toxicity. Hence, the main rational of personalized<br />
medicine, involving molecular medicine and molecular pharmacology, is treating<br />
disease in each patient on the basis of the patient’s unique genome/proteom/metabolom<br />
in interaction with its unique environmental conditions, implying ‘right drug for the<br />
right patient at the right dose and time’. Interindividual differences in drug response are<br />
mostly due to sequence variants in genes that encode drug-metabolizing enzymes, drug<br />
transporters, or drug targets. However, a wide variety of common illnesses and other<br />
health conditions, including cancer, also have epigenetic etiology.<br />
Cancer has a high priority for pharmacogenetic research, owing to its heterogeneous<br />
character due to multiple mutations acquired over time and continuous evolution of its<br />
response to environment. By providing a molecular portrait of an individual cancer, the<br />
clinicians may determine the cancer origin, its potential for metastasis, its specific drug<br />
responsiveness, and the probability of its recurrence.<br />
The semples obtained by fine needle aspiration or the surgically resected tissue hold<br />
the molecular information required for characterization of the patient’s tumor, specific<br />
therapies to which the tumor would be expected to respond, and even specific risks of<br />
adverse reactions to given therapies, all predicted by the patient’s molecular make-up.<br />
sstambuk@unist.hr<br />
159<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
BIOMED-2 PCR DETECTION OF IGH/BCL2 REARRANGEMENT IN FOLLICULAR<br />
LYMPHOMA USING DNA OBTAINED FROM ARCHIVED CYTOLOGICAL SMEARS:<br />
AN OPTION FOR MONITORING<br />
Štoos-Veić T, Livun A, Ajduković R, Pejša V, Jakšić O, Kušec R<br />
Dubrava University Hospital, Zagreb, Croatia<br />
Aim. To determine the rate of PCR detection of IgH/BCL2 in DNA samples isolated from<br />
archival cytological slides of lymph node aspirates, bone marrow and/or peripheral<br />
blood (PB) obtained from patients with histologicaly confirmed follicular lymphoma using<br />
primers and protocol proposed by BIOMED-2 consortium. We also compared molecular<br />
with cytomorphological findings in bone marrow/ peripheral blood and tested<br />
the clinical value of IgH/BCL2 molecular marker in monitoring minimal residual disease<br />
(MRD). According to WHO classification follicular lymphoma is a neoplasm composed<br />
of follicle centre B-cells, which usually has at least a partially follicular pattern. Bone<br />
marrow (BM) infiltration by lymphoma occurs in 40-70% of cases at the time of diagnosis.<br />
The characteristic genetic aberration of follicular lymphoma is t(14;18)(q32;q21)<br />
with transposition of BCL2 oncogene to the regulatory region of immunoglobulin heavy<br />
chain gene IgH. Methods. DNA was isolated from archival cytological slides obtained by<br />
fine needle aspiration of lymph nodes from 19 patients and PCR based detection of IgH/<br />
BCL2 was performed. Results. Fusion oncogene was detected in 10 of 19 patients (52%).<br />
For patients with IgH/BCL2 positive lymph nodes molecular test found BM infiltration<br />
in 5 cases (83%), while cytomorphology detected infiltration in three of eight cases<br />
(37%) available for comparison. Conclusions. May-Grünwald Giemsa stained cytological<br />
smears can be used for PCR-based ancillary methods and the rate of detection of IgH/<br />
BCL2 rearrangement is similar to results reported for paraffin-embedded tissues. For<br />
cases with detectable baseline molecular marker, PCR is a highly suitable method for<br />
detection of bone marrow involvement and monitoring MRD.<br />
tveic@kbd.hr<br />
160<br />
Analitička citologija - Plenarna i pozvana predavanja
Analytical Cytology - Plenary and Invited Lectures<br />
FLOW CYTOMETRY AND DIAGNOSTIC MONITORING OF HIV-INFECTED PATIENTS<br />
Židovec Lepej S<br />
University Hospital for Infectious Diseases Zagreb, Croatia<br />
Aim. Quantification of CD4+ T-cells in the peripheral blood of infected patients is an important<br />
diagnostic parameter for the classification of patients and monitoring of immune<br />
reconstitution. Immune hyperactivation also plays an important role in the pathogenesis<br />
of HIV-disease. The aim of this study was to compare the expression of activation marker<br />
CD38 on CD8+ T-cells in HIV-infected patients and controls as well as in treated and<br />
untreated HIV-patients. Methods. Expression of CD38 on CD8+ T-cells was analyzed by<br />
flow cytometry (Cytomics FC500, Beckman Coulter, USA). Immune status of HIV-patients<br />
was determined by using Centers for Disease Control and Prevention panel for HIV/AIDS<br />
recommended in 2003 (5-color staining). Results. Expression of CD38 on CD8+ T-cells in<br />
untreated HIV-infected patients (n=47, median 3<strong>4.</strong>2%, range 17.9- 43.2%) was significantly<br />
higher compared to treated patients (n=50, median 17.2%, range 10.4-20.9%, p
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
ALLELE FREQUENCIES OF FIVE X-LINKED MICROSATELLITES IN THE CROATIAN<br />
POPULATION AND THEIR APPLICATION IN PRENATAL DIAGNOSIS OF SEX<br />
CHROMOSOME ANEUPLOIDIES<br />
Crkvenac Gornik K1 , Štingl K2 , Grubić Z2 , Tonković Đurišević I1 , Huljev Frković S1 ,<br />
Begović D1 1 Division of Genetics and Metabolism, Clinic of Paediatrics<br />
2 Tissue Typing Centre, University Hospital Centre, Zagreb, Croatia<br />
Five STR loci located on the X chromosome (DXS9895, GATA172D05, DXS6810, DXS6803<br />
and HPRTB) were investigated in the group of 183 unrelated healthy individuals from<br />
Croatia (90 males and 93 females). No deviation from the Hardy-Weinberg equilibrium<br />
could be detected while allele frequencies showed similar distribution in male and female<br />
samples. All investigated loci with the exception of DXS6810 locus have demonstrated<br />
sufficient polymorphism to be considered valuable in prenatal diagnosis of sex<br />
chromosome aneuploidies. The DXS6810 locus showed low polymorphism with only 6<br />
observed alleles and polymorphism information content (PIC) value lower than 0.75. The<br />
analysis of these five STR loci was also performed on the samples from 13 patients with<br />
X chromosome disorders (Turner Syndrome - 6 cases; Klinefelter Syndrome - 5 cases<br />
and Triplo X Syndrome - 2 cases). The comparison of results obtained by the analysis<br />
of STR loci with the results from the standard cytogenetic methods did not reveal any<br />
discrepancies. The present data therefore confirm the diagnostic value of investigated<br />
X-STR loci for the prenatal detection of chromosome X numerical disorders.<br />
kcrkven@kbc-zagreb.hr<br />
162<br />
Analitička citologija - Posteri
Analytical Cytology - Posters<br />
EXPRESSION OF P53, BCL-2, SURVIVIN AND AKT-1 IN PERIPHERAL BLOOD,<br />
BONE MARROW AND LYMPH NODES IN B-CLL<br />
Gizdić B1 , Miletić Z1 , Štoos Veić T1 , Pandžić Jakšić V1 , Martinović M1 , Kušeć R1 ,<br />
Jakšić B2 , Pejša V1 , Trutin Ostović K1 , Jakšić O1 1 Dubrava University Hospital, Zagreb, Croatia<br />
2 Merkur University Hospital, Zagreb, Croatia<br />
Aims.We examined expression of several key factors regulating proliferation and apoptosis<br />
in B-CLL and difference in expression between them in peripheral blood (PB), bone<br />
marrow (BM) and lymph nodes (LN) representing major compartments in B-CLL. Methods.<br />
Samples from 25 B-CLL patients were taken by conventional techniques from PB,<br />
BM and LN. We analyzed CD5+CD19+ cells for expression of survivin, p53, bcl-2, Akt-1 and<br />
Ki-67 using flow cytometry and expressed results as mean fluorescence intensity (MFI).<br />
Results were statistically analyzed by pair tests. Results. Mean age of analyzed patients<br />
was 69 years (56% male). Mean b-2 microglobulin was <strong>4.</strong>65 mg, mean TTM 9.76. There<br />
were 10, 10 and 5 patients in Binet stages A, B and C respectively. Median expressions (MFI)<br />
for PB, BM and LN respectively were: survivin 1.44, 1.19 and 2.15 (p
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
PALLISTER KILLIAN SYNDROME: UNUSUAL SIGNIFICANT POSTNATAL<br />
OVERGROWTH IN A GIRL WITH OTHERWISE TYPICAL PRESENTATION<br />
Huljev Frković S, Tonković Đurišević I, Lasan Trčić R, Sarnavka V, Crkvenac Gornik K,<br />
Mužinić D, Letica Lj, Barić I, Davor Begović<br />
Division of Genetics and Metabolism, Department of Pediatrics, University Hospital Centre<br />
Zagreb, Zagreb, Croatia<br />
Pallister Killian syndrome (PKS) is a rare genetic disorder caused by tetrasomy of the<br />
short arm of chromosome 12, revealed usually in mosaic distribution of an extra i(12)<br />
(p10) chromosome in fibroblasts. The syndrome presents with a recognizable pattern of<br />
findings including pigmentary skin changes, coarse face, high forehead, sparse anterior<br />
scalp hair, hypertelorism, seizures and progressive psychomotor developmental delay. It<br />
was first described independently by Pallister in 1977 and by Killian and Teschler-Nikola<br />
in 19811,2. We report a case of 21 month old girl with PKS and significant overgrowth.<br />
Cytogenetic analysis was performed using the GTG banding technique. The karyotype<br />
of cultured lymphocytes was normal. The karyotype from skin fibroblasts was established<br />
as mosaic tetrasomy of 12p 47,XX,+i(12)(p10)/46,XX. The origin of the extra marker<br />
chromosome was determinated by fluorescence in situ hybridization with chromosome<br />
12 specific DNA probes confirming that supernumerary marker is chromosome i(12p) in<br />
68% of cells. Despite the excessive postnatal growth we found low serum growth hormone<br />
levels and reduced response to pharmacological stimulation test. This is also the<br />
first report of a postnatal patient in our country.<br />
sanda.huljev@zg.htnet.hr<br />
164<br />
Analitička citologija - Posteri
Analytical Cytology - Posters<br />
CYTOGENETICS AND MOLECULAR FINDINGS IN CHILDHOOD LEUKEMIA OF<br />
SOUTH CROATIA<br />
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<br />
2Department of Pathology and Forensic Medicine, Clinical Hospital Centre Split, Croatia<br />
3Department of Immunology, Rebro Clinical Hospital, Zagreb, Croatia<br />
4Department of Pediatrics, Rebro Clinical Hospital Zagreb, Croatia<br />
5Department of Medical Biology, School of Medicine, University of Split, Croatia<br />
The aim of this study was to identify cytogenetic and molecular findings among the major<br />
pediatric leukemia in the South Croatia. Leukemia is the most common malignant<br />
disease in childhood and presents approximately 25% of all childhood cancer. This study<br />
showed the incidence of 3.2 new cases of acute leukemia per 100 000 children under the<br />
age of 18 years in our population. Immunophenotype characteristics of the 27(82%) pediatric<br />
patients with ALL and 6 patients with AML (18%) were analyzed. The most frequent<br />
abnormalities found in ALL were different abnormalities of chromosome short arm 9p<br />
(3/24 cases), and between AML it was t(8;21)(q22;q22) (2/6). The most frequent gene rearrangement<br />
was TEL/AML1 in 14/27 (51.5%) of all ALL cases. Due to the small number of<br />
patients in each genetic subgroup and short time of their follow-up, we could not analyze<br />
the relationship between the outcome and each gene rearrangement.<br />
blozic@kbsplit.hr<br />
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ANALYSIS OF IKAROS FAMILY SPLICING VARIANTS IN HUMAN HEMATOPOIETIC<br />
LINEAGES<br />
Matulić M1 , Paradžik M2 , Jelić Puškarić B3 , Stipić J4 , Antica M2 1 Faculty of Natural Sciences, Zagreb, Croatia<br />
1 Rudjer Boskovic Institute, Zagreb, Croatia<br />
3 Merkur University Hospital, Zagreb, Croatia<br />
4 Clinical Hospital Center Zagreb, Croatia<br />
Introduction: Transcription factors from the Ikaros family are involved in lymphocyte<br />
differentiation and have a critical role at specific check points of the haemopoietic pathway.<br />
However, how developmentally regulated changes are reflected in gene expression<br />
programs of lymphocyte differentiation is not well understood. It has been suggested<br />
that disregulation of transcription factors from the Ikaros family is associated with the<br />
development of different human leukemias. Aims: In this work we analyzed the state of<br />
Ikaros family members in different leukemic cells with the aim to explore the transcriptional<br />
control of human hematopoietic lineages and shed some new light on our understanding<br />
of transcription factor significance in human leukemias. Methods: By means of<br />
RT-PCR and specific primers we investigated the expression of Ikaros, Aiolos and Helios<br />
transcription factors and their splicing variants in seven leukemia cell lines derived<br />
from different types of leukemia (ALL, CML, AML) and lymphoma (histiocytic lymphoma,<br />
Burkitt lymphoma and anaplastic large cell lymphoma). Results: In all of the cell lines<br />
examined Ikaros was present in dominant Ik1 to Ik4 isoforms and small Ik6 isoform was<br />
absent. Aiolos was expressed in the majority of the cell lines, of both, B and T origin, in<br />
the form of the full length Aio1. Helios was also present only in two long isoforms Hel1<br />
and Hel2, and was absent in one third of the lines. Conclusion: Similar distribution of<br />
positive and negative expression of Aiolos and Helios found in various types of leukemias<br />
could implicate common pathways of their regulation.<br />
antica@irb.hr<br />
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Analytical Cytology - Posters<br />
MONOCYTES IN METABOLIC DISORDERS - OPPORTUNITIES FOR FLOW CYTOMETRY<br />
CONTRIBUTION<br />
Pandžić Jakšić V1 , Gizdić B2 , Miletić Z2 , Trutin Ostović K2 , Jakšić O3 1 Department of Endocrinology and Metabolism, Dubrava University Hospital, Zagreb, Croatia<br />
2 Department of Clinical Cytology and Cytometry, Dubrava University Hospital, Zagreb, Croatia<br />
3 Department of Hematology, Dubrava University Hospital, Zagreb, Croatia<br />
Chronic inflammation has arised as a major underlying cause of atherosclerosis, obesity<br />
and diabetes. It is mediated by cells of innate immune system like macrophages but<br />
also by their antecedents, monocytes in circulation. Roles of monocyte subsets and different<br />
markers of monocyte activation in the context of metabolic disorders have been<br />
reviewed. Applying cell based approach through flow cytometry in this field has resulted<br />
with new understanding of pathophysiologic mechanisms. Possible implications of<br />
these insights in diagnosis, prognosis and revealing of therapeutic targets in metabolic<br />
disorders remain a challenge for future.<br />
vpandzic@kbd.hr<br />
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<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
THE ACCURACY OF FINE NEEDLE ASPIRATION CYTOLOGY AND FLOW CYTOMETRY<br />
IN EVALUATION OF NODAL AND EXTRANODAL SITES IN PATIENTS WITH SUSPICION<br />
OF LYMPHOMA<br />
Šenjug P1 , Trutin Ostović K2 , Miletić Z2 , Tomasović Lončarić Č3 , Štoos-Veić T2 ,<br />
Gizdić B4 , Kaić G2 , Aralica G3 , Križanac Š3 , Pejša V4 , Jakšić O4 1 Medical student, Zagreb University School of Medicine, Zagreb, Croatia<br />
2Department of Clinical Cytology and Cytometry, Dubrava University Hospital, Zagreb,<br />
Croatia<br />
3Department of Clinical and Experimental Pathology, Dubrava University Hospital,<br />
Zagreb, Croatia<br />
4Clinic of Internal Medicine, Department of Hematology, Dubrava University Hospital,<br />
Zagreb, Croatia<br />
Aim. Our goal was to determinate how is information given by FNA and FC correlated<br />
with pathohistologic diagnosis and to evaluate ability to diagnose and subclassify malignant<br />
lymphomas by FNAC and FC. Methods. This study is a retrospective chart review of<br />
patients with suspicion of lymphoma processed at Dubrava University Hospital in Zagreb.<br />
We reviewed patient’s charts at the Department of clinical and experimental pathology<br />
and the Department of clinical cytology and cytometry within two years and two months<br />
(from March 2007 to May 2009). Results. After analysis 50 patients fulfilled inclusion<br />
criteria for this study (FNAC diagnosis with or without FC and consecutive confirmatory<br />
pathohistological diagnosis). When analyzing accuracy of FNAC according to suspicion<br />
of lymphoma or NHL and differential diagnosis lymphoma sensitivity was 97.7%, specificity<br />
85.7% and the diagnostic accuracy was 96%. When analyzing accuracy of FNAC<br />
according to the subclassification of lymphoma, sensitivity was 7<strong>4.</strong>4%, specificity 85.7%<br />
and the diagnostic accuracy 76%. Combined FNAC and FC improved sensitivity, positive<br />
predictive value, negative predictive value and diagnostic accuracy. Sensitivity was 79.1%<br />
and the diagnostic accuracy 80%. Conclusion. We have shown that these methods can<br />
distinguish benign lymphadenopaties from lymphomas and also subclassify lymphomas<br />
and quickly provide clinicians with dose information.<br />
petar.senjug@inet.hr<br />
168<br />
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citotehnologija<br />
cytotechnology<br />
169<br />
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NEW METHODS IN CYTOLOGY<br />
Korać P<br />
Merkur University Hospital, Zagreb, Croatia<br />
170<br />
Citotehnologija - Plenarna i pozvana predavanja<br />
Development of new methods allows better insight into malignant processes in tumor<br />
cells. Detection of gene aberrations, mRNA expression and/or protein expression helps<br />
in some cases: to determine precise diagnosis; to predict prognosis; to make decisions<br />
about adequate therapy.<br />
FISH method is used for detection of chromosomal/gene aberrations in tumor cells.<br />
mRNA expression can be detected by using in situ hybridization and presence of specific<br />
protein by immunoenzymatic staining. Combination of these methods can detect gene<br />
abnormalities in specific cells, presence of specific protein in specific cell compartment<br />
and specific cell population that express specific antigen.<br />
All these methods are simple, protocols are easy to perform in well equipped laboratories<br />
and results could be easily interpreted.<br />
pkorac@gmail.com
Cytotechnology - Oral Presentations<br />
THE PREVALENCE OF INFECTION IN SWABS OF TRANSPLANTED HEMATOLOGIC<br />
PATIENTS<br />
Anić V, Križaj B, Jelić-Puškarić B, Perić Z, Vrhovac R, Kardum-Skelin I<br />
Merkur University Hospital, Zagreb, Croatia<br />
The aim of the study was to show the prevalence of infection in swabs from different<br />
locations (oral cavity, tongue, demerit of skin, etc.) in hematologic patients post-transplantation.<br />
Data were collected from patient files and cytology results obtained in swabs<br />
of transplanted hematologic patients. Patients undergoing allogeneic bone marrow or<br />
peripheral blood stem cell transplantation received antiviral, antifungal and antibiotic<br />
prophylaxy; and before autologous transplantation procedure, patients received antifungal<br />
and antibiotic prophylaxy. Positive swab results were recorded in 38 patients (20<br />
female and 18 male), aged 19-66, treated in sterile units at our hematology department.<br />
All study patients had hematologic diseases, i.e. non-Hodgkin’s lymphoma (n=14), Hodgkin’s<br />
disease (n=3), multiple myeloma (n=2), acute lymphoblastic leukemia (n=7), and<br />
acute myeloid leukemia (n=12), in post-transplantation recovery. According to type of<br />
transplantation, 27 patients underwent autologous and 11 patients allogenic transplantation.<br />
Stem cells were collected from peripheral blood in 28 and from bone marrow in ten<br />
patients. Out of 70 swabs, negative finding was recorded in 28 swabs, whereas 20 swabs<br />
were positive for fungal infection, 21 swabs for viral infection and one swab for malignant<br />
cells. In conclusion, in spite of antiviral, antifungal and antibiotic therapy administered<br />
to patients as prophylaxis before transplantation procedure, there was still a high risk of<br />
infection caused by fungal and viral agents.<br />
veronika.anic@zg.t-com.hr<br />
QUALITY OF INTAKE AND PROCESSING OF MATERIALS IN CYTOLOGICAL<br />
LABORATORY<br />
Begović D, Belušić M, Maljić S<br />
General Hospital Pula, Pula, Croatia<br />
The aim of this presentation is to indicate mistakes of taking and processing cytological<br />
materials that causes inadequacy of samples. Inadequate cytological samples prevent<br />
their further analyses. Methods to obtain the better cytological smears are dependent<br />
on the technique of taking, application and processing of cytological materials. Only<br />
samples taken from appropriate places with adequate equipment and their proper further<br />
processing lead to a precise and quality cytological analysis. Good technical samples<br />
of cytological materials is prerequisite for the quality of cytological analyses. For<br />
the efficacious work in the cytological laboratory is essential to have a good cooperation<br />
between cytotechnologists, cytologists and clinicians.<br />
citologija@obpula.hr<br />
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THE ROLE OF CYTOTECHNOLOGIST IN CYTOANALYSIS OF SYNOVIAL FLUIDS<br />
Bezdrob S, Aleksandrov C, Cvrk B, Čurin S, Ljevar I, Krupec A, Čurin D, Knežević A,<br />
Perica B, Ćaleta B, Trutin Ostović K<br />
Dubrava University Hospital, Zagreb, Croatia<br />
Aim: To point out possible mistakes in procedures in cytoanalysis of synovial fluids processed<br />
by cytotechnologists. Methods: Cytoanalysis is performed by two steps: urgent<br />
and standard. The urgent examination consists of macroscopic analysis (determination<br />
of volume, colour, clarity, viscosity and mucin clot test), counting of total count of nuclear<br />
cells in Burker-Turk counting chamber, native microscopic analysis for crystals and<br />
analysis of neutrophil granulocyte percentage in cytospin sediments stained by Hemacolor.<br />
All these procedures except the last two are performed only by cytotechnologists.<br />
They are done at least by two persons separately one from another because of subjective<br />
analysis. Standard procedure consists of microscopic examination of sediments of synovial<br />
fluids stained by Papenheim, Papanicolaou and cytochemistry of acid phosphatase<br />
done by cytotechnologists (semiquantitative analysis) and by cytologist (qualitative and<br />
semiquantitative analysis) separately. Results: We have analysed 115 synovial fluids, 81<br />
patients with inflammation (type I and II) and 34 patients with degenerative illnesses<br />
and injuries (type 3). Conclusion: Cytotechnologists play very important role in cytological<br />
diagnosis of synovial fluids and therefore well education is necessary.Citotehnolozi/<br />
CytotechnologistsComputationalORAL<br />
samirbezdrob@yahoo.com<br />
172<br />
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Cytotechnology - Oral Presentations<br />
MODIFICATION OF MGG STAINING METHOD<br />
Fumić G, Naglić G, Meandžija R, Štemberger C, Seili-Bekafigo I.<br />
Department of Cytology, Department of Internat Medicine, Clinical Hospital<br />
Center Rijeka, Croatia<br />
Aim: May-Gruenwald.Giemsa staining method is a standard procedure in fine-needle<br />
aspiration cytology (FNA). There are some commercial kits for rapid staining available,<br />
but modified MGG technique could be used for intraoperative analysis, and for rapid<br />
on-site examination of smears. If, due to some errors in staining procedure, slides are<br />
over-stained with MGG, there is a simple procedure for partial destaining. Materials<br />
and methods: For intraoperative examinations we used the modified protocol: shortened<br />
staining time, and increased concentration of Giemsa (G). For rapid on-site examination,<br />
minimum of equipment needed was: a microscope, May-Gruenwald (MG) staining solution,<br />
tap water and distilled water, and a shallow dish with a rack. Air-dried smears were<br />
stained with MG. Afterwards we continued the staining procedure with Giemsa stain in<br />
the laboratory. Overstained slides were treated by immersing 3 times in 80% ethanol.<br />
Results: Rapid staining with MGG in 5’ 30’’ for liquid specimens, or in 4’ 30’’ for smears,<br />
provided preparations good enough for cytologic analysis during the operation. Staining<br />
with MG only, enabled us to evaluate the quality of specimen while patient is still available<br />
for repeating FNA, without losing those slides for definitive examination. Immersing<br />
over-stained MGG smears in 80% ethanol, made them suitable for analysis. Conclusion:<br />
Using standard stains, MG and G, it is possible to perform rapid intraoperative staining<br />
and rapid on-site evaluation of FNA specimens, without additional costs. Slides accidentally<br />
overstained can easily be partially destained with 80% ethanol.<br />
gordana.fumic@ri.t-com.hr<br />
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DETECTION OF P16INK4a PROTEIN IN PREMALIGNANT CERVICAL LESIONS ON<br />
ARCHIVED SLIDES<br />
Gavranović Lj, Rakek Novak S, Baburić M, Đorđijevski E, Šentija K, Katalenić Simon S,<br />
Krivak Bolanča I<br />
University Hospital Merkur, Zagreb, Croatia<br />
Objective: It is well known that infection with human papilloma virus (HPV) is main risk<br />
factor for developing premalignant and malignant changes on squamous epithelium of<br />
cervix. Up today data showed that HPV has specific affinity for the epithelium of anogenital<br />
region. Usually it takes at least 10 years for one to develop initial morphologic<br />
changes on epithelium and for developing cancer it takes even longer period. Therefore<br />
it is crucial to detect early changes for identification of those patients who are in greater<br />
danger of developing cervical cancer. For that intention, detection of tumor markers was<br />
proposed. Through immunoassaying methods with specific monoclonal antibodies it is<br />
possible to visualise specific tumor markers. Aim of our study is to investigate overexpression<br />
of p16 INK4a protein (p16) in cervical low (LSIL) and high grade squamous lesion<br />
(HSIL) on archived slides of high risk HPV positive patients. Methods: The p16 overexpression<br />
was investigated immunocytochemically by using p16INK4a - specific monoclonal<br />
antibody (clone E6H4). We decolourised 21, 58 and 95 archived cervical slides of normal<br />
cytology, LSIL and HSIL, including carcinoma in situ (CIS), respectively. Results: Positivity<br />
of p16 staining was 0%, 29%, 31% and 84%, in slides with normal cytology, LSIL and<br />
HSIL, respectively. Conclusion: The incidence of p16INK overexpression was significantly<br />
higher on slides with HSIL lesion than in LSIL lesion or on slides without abnormality<br />
suggesting the use of p16 as a tumor marker for high grade dysplasia.<br />
ljiljana.gavranovic@zg.t-com.hr<br />
174<br />
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Cytotechnology - Oral Presentations<br />
NUMBER OF COUNTING CELLS AND CYTOSPINS SELECTION INFLUENCES ON<br />
BRONCHOALVEOLAR LAVAGE CELL PROFILES<br />
Harabajsa S, Martinčić J, Peharec I, Popek B, Šušković- Medved S, Zadražil B,<br />
Smojver-Ježek S<br />
University Hospital for Lung Diseases Jordanovac, Zagreb, Croatia<br />
BAL fluid cells count provides information about presence or absence of interstitial lung<br />
diseases. BAL fluid samples were taken from 50 patients hospitalized in University Hospital<br />
for Lung Diseases Jordanovac in Zagreb, Croatia. The samples of BAL fluid were<br />
prepared by cytocentrifuge. From each sample two cytospin were selected (C1 and C2)<br />
and after determing adequacy, counted up to 200 and 400 cells. After air-drying, samples<br />
were stained according to May Grünwald Giemsa (MGG). Cells were counted by<br />
light microscope at magnification of 400 x. Obtained results were analyzed in Statistics<br />
version 6 and Med Calc. Results for bronchial epithelial cells, alveolar macrophages,<br />
lymphocytes and neutrophilic granulocytes showed insignificant statistical differences<br />
between groups (p>0.05). Eosinophils percentages showed borderline insignificant statistical<br />
difference between groups of these cells (p=0.052). As it was exemplificated, the<br />
percentages of differentiated cells do not significant differ according to differentiation on<br />
200 and 400 cells and cytospin selection.<br />
suzana.harabajsa@zg.t-com.hr<br />
ERYTHROCYTE MORPHOLOGY IN MALIGNANT URINE SAMPLES<br />
Knežević G, Parigros K, Milas M, Šušterčić D, Kardum-Skelin I<br />
Merkur University Hospital, Zagreb, Croatia<br />
The aim of the study was to show the origin of erythrocytes in malignant urine sample,<br />
assuming that a finding of 80% and more of dysmorphic erythrocytes indicated the<br />
bleeding to derive from upper urinary tract, and 80% and more of smooth erythrocytes<br />
indicated them to derive from lower urine tract; in urine samples without significant<br />
origin of bleeding there were 20%-80% mixed results with both dysmorphic and isomorphic<br />
erythrocytes. Data were collected from the findings recorded in malignant urine<br />
samples received. Samples were fresh native urine sediment contrast stained with 0.1%<br />
Safranin solution and analyzed under light microscope (X40). Out of 72 patients with<br />
malignant cells detected in urine, the origin of erythrocytes was identified in 25 patients<br />
(nine female and 16 male) through 190 samples (approximately 4 samples per patient).<br />
A mixed origin of erythrocytes was identified in 70 (36.9%) samples, 55 (28.9%) samples<br />
did not have enough erythrocytes to define their origin, dysmorphic erythrocytes were<br />
found in 53 (27.9%) samples, and isomorphic erythrocytes in 12 (6.3%) samples. In conclusion,<br />
there was no specific connection between malignant cell findings in urine and<br />
origin of erythrocytes. However, the high presence of mixed erythrocyte origin in malignant<br />
samples may suggest that the existence of a malignant process and renal disease<br />
should be taken in consideration.<br />
gordana.knezevic1@zg.t-com.hr<br />
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PRESENTATION OF INTEGRATED MODULE FOR INPUT AND PROCESSING OF CYTO-<br />
LOGICAL REPORTS WITHIN THE COMPUTER PROGRAMME “RIBIS“<br />
Markanjević T1 , Vunić S2 1 University Hospital Center Rijeka, Croatia<br />
2 ‘SING’ company for computer engineering, Rijeka, Croatia<br />
Objective: The presentation of computer programme for input, processing and assesing<br />
of cytological findings stressing the Pap test results. Methods: In collaboration of<br />
Department of Gynecological Cytology, University Department of Gynecology and Obstetrics,<br />
University Hospital Center Rijeka, Croatia and ‘SING’ company for computer<br />
engineering from Rijeka we made and improve a computer programme for input and<br />
processing of cytological findings. The input of Pap tests is based on the classification<br />
‘ZAGREB 2002’. The programme is adapted to the workprocess of cytological laboratory<br />
from the reception of referral slides to the issuing of reports in print. By means of this<br />
programme data base of all the patients is created. This ensures a simple insight into<br />
the previous Pap test findings and patients’ chart. It also ensures the input of other cytological<br />
findings as well as HPV tests performed on our department. The programme<br />
has an option of statistical data processing - the performance of cytotechnologist and<br />
specialists in clinical cytology, a number of daily examined slides, a share of unsarisfactoty<br />
samples and a number of negative and abnormal findings with the possibility<br />
of subcategorisation. The Department of Gynaecological cytology operates interactively<br />
with the Department of Gynaecological Polyclinic and other departments in the Clinic for<br />
Obstretics and Gynaecology thus the request forms are sent electronically. We also have<br />
an insight into the electronic patient charts containing the information about medical<br />
history as well as all the diagnostic procedures and findings. We also operate interactivelly<br />
with the Department of Pathology and we have the access to pathology results<br />
of gynaecological patients. Results: By means of an example of normal and abnormal<br />
Pap test we will demonstrate the sequence of procedures using computer programme:<br />
the input of general and clinical data, the part performed by cytotechnologiests along<br />
with rescreening, the part performed by doctors, print-out of the results and the patient<br />
chart. Conclusion: Computerization of the Department of Gynaecological cytology contributed<br />
to the effectiveness of daily work and the quality of processing and evaluation od<br />
cytological findings with the possibility of improved quality control.<br />
tina.valencic@ri.t-com.hr<br />
176<br />
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Cytotechnology - Oral Presentations<br />
PROBLEMS WITH STAINING PROCEDURES IN IMMUNOCYTOCHEMISTRY<br />
Meandžija R1 , Fumić G1 , Naglić G1 , Štanfel O2 , Seili-Bekafigo I1 1Department of Cytology, Department of Internal Medicine, Clinical Hospital Center<br />
Rijeka, Croatia<br />
2 Rijeka University School of Medicine, Department of Pathology, Rijeka, Croatia<br />
Aim: To identify weaknesses of immunocytochemistry (ICK) staining procedures, and to<br />
propose solutions for some of them, since data in the literature are very scarce on that<br />
subject. Material and methods: During 3 years period in The Department for Cytology,<br />
Department of Internal Medicine, Clinical Hospital Center Rijeka, we performed totally<br />
475 ICK analyses for 151 patients, mean 3,15 per patient. Most monoclonal antibodies<br />
used (Ber-ep4, CD3, CD20, Calretinin) react with membrane-bound antigenes, so any<br />
kind of pretreatment was not applied. We also tried to show TTF positivity in primary<br />
lung tumors, with and without pretreatment with TRIS- EDTA puffer on 96-97oC. Results:<br />
Staining for membrane-bound antigenes, gave good results using standard protocols<br />
recommended by manufacturer. The best results were obtained when using special<br />
Polysine slides. After pretreatment we got positive reaction with the nuclear antigen TTF<br />
as well. Conclusion: ICK is a powerfull diagnostic tool, but the staining procedure itself<br />
has to be precisely defined and standardized. The most important problems are: quality<br />
of particular slides (we do not know in advance if there are enough well preserved cells<br />
on each given slide), maintaining of the specimen on the slide during staining procedure<br />
if standard slides are used, correct determination of dillution and incubation period for<br />
each monoclonal antibody, revealing of the nuclear antigenes without interfering with<br />
specimen quality, and lack of control slides. There is a lot of work to be done in this field,<br />
regarding standardization and quality control.<br />
rmeandzija@net.hr<br />
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IMMUNODETECTION OF ANTIGENES IN CYTOLOGIC SAMPLES<br />
Rešetar R<br />
University Hospital Center Rijeka, Croatia<br />
Objective: Presentation of the procedures of antigene detection in cytologic smears<br />
depending on their cell location. Methods: Basic rules of immunodetection methods<br />
have been used in the research. Cell antigens can be divided into three basic groups:<br />
membrane, cytoplasmic and nuclear antigens. Since membrane and cytoplasmic antigens<br />
are more accessible to the reaction with specific antibody due their cell location,<br />
there were no difficulties in their detection. However, nuclear antigens, especially Ki-67<br />
placed deep in the cell nucleus, can not be detected just by using classic procedures<br />
of immunocytochemistry. Due to its specific location in the cell and in order to prove<br />
nuclear antigens, an additional special technique called ‘antigen demasking’ is needed.<br />
This technique is performed with the help of special fluid for ‘antigen demasking’ and<br />
thermic treatment in the water bath. In immunocytochemical methods there are three<br />
key steps important for the validity and positive result of reactions: 1. preparation fixation<br />
time; 2. precisely performed ‘antigen demasking’; 3. incubation time for primary<br />
monoclonal antibody. In immunocytochemical methods we have combined the following<br />
procedures:1.fixation time: 2-10 min, 2.’antigen demasking’ time: 5-20 min, 3. fluid for<br />
‘antigen demasking’: citrate buffer (ph=6) or Tris/EDTA (ph=9),<strong>4.</strong> incubation time for primary<br />
monoclonal antibody: 30-90 min. For all types of antigens we used sylanized glass<br />
impregnated by special adhesion matters. Results: Membrane and cytoplasmic antigens<br />
are detected by classic procedures of immunocytochemistry with 10 minute fixation and<br />
30-60 minute incubation with antibodies. The following procedure showed the best results<br />
for the detection of nuclear antigens: 10 minute fixation in cold acetone, 5 minute<br />
incubation in water bath on 95 °C in citrate buffer (ph=6) and 90 minute incubation with<br />
primary antibody. Conclusion: For proving specific nuclear antigens all four steps are<br />
needed as well as the procedure of ‘antigene demasking’ which includes thermic treatment<br />
in water bath with obligatory use of fluid for ‘antigene demasking’. Membrane and<br />
cytoplasmic antigens require only the combination of fixation and adequate incubation<br />
time.<br />
nale.kralj@gmail.com<br />
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Cytotechnology - Oral Presentations<br />
INFLUENCE OF INADEQUATE MATERIALS ON CYTOLOGICAL ANALISIS AND<br />
PROVIDING DIAGNOSIS<br />
Rubić K, Milanković Lj, Horvat B, Ropar S<br />
General Hospital Karlovac, Karlovac, Croatia<br />
Identification of disease and providing diagnosis are often hard to establish because<br />
of inadequate material. More and more is the case that exfoliative materials which are<br />
often inadequate to examine are brought to a cytological laboratory. In some cases materials<br />
are not brought on time, so their analysis is not possible. Some materials are not<br />
usable medium for cells and longer air-contact and holding on warm area cause decay<br />
of cells and replication of bacteria, which all influence cell-analysis. Such materials<br />
are hard to analyse, most of them even impossible. All specimens whol centrifugate in<br />
cytocentrifuge-cytospin and painted with May-Grunwald stain. Specimens are repeated<br />
many times.Repeating the specimens more slowly, malign diagnosis have been noticed<br />
with some of them. In order to get better quality, faster and exacter diagnosis, better<br />
staff-education and team-communication are among persons who work on taking and<br />
distribuing materials in purpose of removal of causes are needed. That would minimize<br />
mistakes, diagnosis would be faster and exacter and the number of controls would be<br />
smaller.<br />
katica.rubic@ka.t-com.hr<br />
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<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
MICROSCOPIC IDENTIFICATION OF PARASITES IN CYTOLOGICAL PREPARATIONS -<br />
THE „GOLD STANDARD“ IN DIAGNOSTICS OF VISCERAL LEISHMANIASIS -<br />
A CASE REPORT<br />
Stupnišek M, Prstec Z, Vujević D, Čulig Z, Puljiz I, Lukas D, Begovac J.<br />
University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Zagreb, Croatia<br />
Visceral leishmaniasis (VL) is an infectious, potentially fatal, systemic disease characterized<br />
by fever, fatigue, splenomegaly, hepatomegaly, progressive anemia, pancytopenia<br />
and hypergammaglobulinemia. VL is caused by protozoan parasites that belong to the<br />
genus Leishmania and are transmitted to mammals by the bite of female sandfly. The<br />
causative agent can be detected by: microscopic identification of parasites in stained<br />
cytological preparations (usually from bone-marrow, spleen, lymph-node); cultivation;<br />
serological and molecular methods. VL is spread worldwide. In Croatia, VL occurs rarely<br />
(around 3-5 cases per year) usually in persons who reside or live in middle and southern<br />
Dalmatia. Of particular concern is the emerging problem of VL/HIV co-infection,<br />
especially in southern Europe. The clinical presentations as well as organ involvement<br />
of VL are often atypical in HIV+ patients. We report a rare case of VL with pulmonary localization<br />
in a 57-year-old HIV+ patient. Leishmania amastigotes were detected in bonemarrow<br />
aspirates in several instances. The patient was re-admitted to the Hospital due<br />
to high fever and the presence of pulmonary infiltrate. Bronchoscopy was performed<br />
and bronchoalveolar lavage (BAL) specimen collected. The preparations were stained<br />
by May-Grünwald-Giemsa and Diff-Quick technique and observed by light microscope.<br />
Leishmania amastigotes were found. In samples of BAL obtained during subsequent<br />
bronchoscopy, planocellular carcinoma was also detected. Conclusions: In patients<br />
with VL, especially immunocompromised, atypical clinical presentations and unusual<br />
localizations of disease are commonly found, but pulmonary localization is rarely than<br />
others. Microscopic identification of parasites in cytological preparations presents the<br />
„gold standard“ in diagnostics of VL, which primarily requires well educated laboratory<br />
personnel.<br />
stupnisek@gmail.com<br />
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Cytotechnology - Posters<br />
ANALYSIS OF ABNORMAL PAP TEST FINDINGS OF URBAN, RURAL AND INSULAR<br />
AREA<br />
Bašić D, Markanjević T<br />
University Hospital Center Rijeka, Croatia<br />
Objective: Comparison of abnormal Pap test findings of women sampled in urban, rural<br />
and insular area.Methods: In the Department of Gynaecological cytology, University<br />
Department of Gynecology and Obstetrics, University Hospital Center Rijeka, Croatia,<br />
Pap tests from almost entire County of Primorje-Gorski kotar and a part of County of<br />
Lika-Senj are analyzed. In 2008 36,153 Pap tests have been analyzed. In the research we<br />
analyzed the findings of Pap tests choosing one medical clinic in urban, one in rural and<br />
one in insular area. The frequency of abnormal findings has been analyzed as well as<br />
distribution according to age and the frequency of abnormal findings of squamous and<br />
glandural epithelium. Statistical significance between the groups has been analyzed by<br />
using chi-square test.Results: From total of 4492 samples analyzed we found 279 (6,2%)<br />
abnormal Pap test, out of which 279 (93,5%) of squamous and 18 (6,5%) of glandular epithelium<br />
origin. In the urban area 125 (5,7%) abnormal Pap test were found, out of which<br />
121 (96,8%) of squamous epithelium and 4 (3,2%) of glandural epithelium. In the rural<br />
area 50 (6,2%) abnormal Pap test were found, out of which 44 (88%) of squamous epithelium<br />
and 6 (12%) of glandural epithelium. In the insular area 104 (7%) abnormal Pap<br />
test were found, out of which 96 (96%) of squamous epithelium and 8 (8%) of glandural<br />
epithelium. By distribution according to age, in urban area 50 (40%) abnormal findings<br />
were found among women up to age 30, 54 (43%) among women from age 30 to 50 and<br />
21 (17%) among women above age 50. In the rural area there were 15 (30%) abnormal Pap<br />
test among women up to age 30 and 25 (50%) abnormal Pap test among women from<br />
age 30 to 50 and 10 (20%) among women above age 50. In the insular area there were<br />
48 (46%) abnormal Pap test among women up to age 30, 39 (38%) among women from<br />
age 30 to 50 and 17 (16%) among women above age 50. By statistical analysis a statistically<br />
significant higher values of frequency of abnormal findings of glandular epithelium<br />
was detected in rural area in comparison to women of urban area (p
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
RESCREENING OF NEGATIVE CERVICAL CYTOLOGY FINDINGS<br />
Poduje V, Mustapić D, Mahovlić V<br />
Zagreb University Hospital Center, Zagreb, Croatia<br />
Aim: To determine the rate of false-negative cervical cytology findings using the methods<br />
of internal quality control. Material and methods: During a 3-year period, 83547 conventional<br />
Pap smears were analyzed. Out of 40000 negative cytology findings on initial<br />
screening, 1033 (2.59%) Pap smears were submitted to random rescreening, whereas<br />
23.72% (10200/43547) Pap tests initially evaluated as inflammatory or reactive lesions<br />
of squamous epithelial cells were separated for control cytology and rescreened by senior<br />
cytologist. Employing the method of random sample, the cytologist analyzed 693<br />
(6.79%) of these 10200 Pap smears. Results: The initially negative screening findings<br />
were confirmed in 97.39% (1006/1033) Pap smears, whereas 2.61% (27/1033) proved to be<br />
false-negative findings including ASCU-S (1.65%), ASC-H (0.29%), H-SIL (CIN III) (0.10%)<br />
and AGC - probably reactive lesions of endocervical origin(0.58%). Negative rescreening<br />
performed by senior cytologist was confirmed in 85.43% (592/693) of Pap tests, whereas<br />
1<strong>4.</strong>57% (101/693) proved to be false-negative findings including ASCU-S (12.84%), LSIL<br />
(CIN I) (0.58%) and AGC - probably reactive lesions of endocervical origin (1.15%). No case<br />
of HSIL was recorded in this group. Conclusion: Employing the methods of internal quality<br />
control on initially negative Pap smears upgrades not only the sensitivity of cytologic<br />
screening but also the quality of cytotechnologist performance.<br />
otok7@yahoo.com<br />
182<br />
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Cytotechnology - Posters<br />
VIRAL CAPSID PROTEIN (HPV L1) DETECTION ON ARCHIVED CERVICAL SLIDES<br />
Rakek Novak S, Gavranović Lj, Baburić M, Đorđijevski E, Šentija K, Katalenić Simon S,<br />
Krivak Bolanča I<br />
University Hospital Merkur<br />
Objective: Cohort studies have shown that HPV infection is crucial for developing precancerous<br />
and cancerous lesions of uterine cervix. But the main event in the carcinogenesis<br />
is not simple detection of infection, but its persistency and viral integration in association<br />
with HPV physical status (episomal or integrated). Aim of the study is to investigate<br />
the prevalence of HPV L1 capsid protein in low grade and high grade squamous lesion<br />
(LSIL/HSIL) of the uterine cervix and to present cytoactive method for immunostaining<br />
performed on archive cervical slides. Examinees and Methods: We analysed cervical<br />
smears from 107 patients. All of them are high risk HPVDNA positive. After decolourising<br />
slides we preformed immunoassaying with cytoaktiv screening set for HPV L1 (cytoimmun<br />
diagnostic GbmH, Pirmanses, Germany). Results: Cytological diagnose of LSIL<br />
was made in seventy-six patients (76/107), and nineteen patients (19/107) had HSIL with<br />
carcinoma in situ included. In all 19 patients HSIL was confirmed by biopsy or cold knife<br />
conisation. After immunoassaying positive HPV L1 was found in 42, 11% (32/76) of LSIL<br />
and in 15, 79% (3/19) of HSIL specimens. Conclusion: Lower L1 detection rate in HSIL<br />
can be explained by possible loss of viral L1 genes and consequently lower production<br />
of capsid proteins. Hence, in patients whose smears are L1 negative, additional cytology<br />
control is suggested.<br />
sanjarakeknovak1@gmail.com<br />
ENTEROBIUS VERMICULARIS IN VAGINAL SMEARS<br />
Rubić K, Milanković Lj, Plemić I, Ropar S<br />
General Hospital Karlovac, Karlovac,Croatia<br />
A patient 27 years old, went to the routine gynecological examination during which papa<br />
smear was taken.<br />
In treated smear which was painted with Papanicolau stain, eggs of Enterobius vermicularis<br />
were found. Enterobius vermicularis is the mostcommon parasite in children,<br />
which often appears within the family, kindergarten, schools and camps. Enterobius<br />
vermicularis can induce vaginitis with itch. The case was not about infection and was<br />
diagnosticed in routine screening. The interpretation of the case was given with the purpose<br />
of turning attention although rarely, Enterobius vermicularis eggs can be found in<br />
vaginal smears.<br />
katica.rubic@ka.t-com.hr<br />
183<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
LYMPH NODE FINE NEEDLE ASPIRATION - SAMPLE ADEQUACY FLOW CYTOMETRY<br />
IMMUNOPHENOTYPING<br />
Švencbir V1 , Milas M2 , Anić V2 , Šiftar Z2 , Kardum Paro MM2 , Kardum-Skelin I2 1 Sestre Milosrdnice University Hospital, Zagreb, Croatia<br />
2 Merkur University Hospital, Zagreb, Croatia<br />
In a modern clinical laboratory, lymphatic cell immunophenotyping by flow cytometry<br />
helps determine the diagnosis of clonal B-lymphocytes and thus discriminate benign<br />
from malignant lymphoproliferative diseases. The aim of the study was to assess adequacy<br />
and appropriateness of lymph node fine needle aspiration (FNA) for flow cytometry<br />
analysis in cases of benign and primary malignant disorders. The study was based<br />
on medical documentation, cytologic smear of FNA lymph node sample and flow cytometry<br />
immunophenotyping results. The study included 239 patients during the 2006-2007<br />
period. According to cytologic test results, patients were classified into several groups:<br />
benign lymphoproliferative disease (22%), undefined monomorphous population of lymphatic<br />
cells (16%), B cell non-Hodgkin’s lyphoma (55%), and non-B cell non-Hodgkin’s<br />
lyphoma (5%). Lymphocytes were isolated from FNA lymph node samples using density<br />
gradient. The suspension of mononuclear cells was labeled by appropriate combination<br />
of negative control and monoclonal antibodies and then analyzed by flow cytometry. The<br />
acceptable minimum number of cells from lymph node sample as representative for<br />
flow cytometry analysis was determined by maximal control of electronic gates around<br />
the specific cell population. In the study material, 85% of samples contained an adequate<br />
cell quantity for analysis, in 12% of samples the number of cells was only adequate<br />
to determine clonality, whereas in 3% of samples the number of cells was inadequate<br />
for any analysis. Although cell adequacy for analysis varied among groups, there was<br />
no statistically significant difference in the adequacy of samples obtained from patients<br />
with benign lymphoproliferative diseases (87%), monomorphous population of lymphatic<br />
cells (76%), B cell non-Hodgkin’s lymphoma (89%) and non-B cell lymphoma (69%). In<br />
conclusion, cytologic diagnosis of lymphoproliferative disease is a simple and reliable<br />
diagnosis in both separation of benign from primary lymphoproliferative diseases (lymphoma)<br />
and secondary malignancies, as well as in tissue typing and subtyping of malignant<br />
lymphoma. Since FNA provides enough cells for flow cytometry analysis, these two<br />
diagnostic methods improve diagnostic accuracy and safety<br />
viktorija_svencbir@net.hr<br />
184<br />
Citotehnologija - Posteri
indeks autora<br />
authors’ index<br />
185<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
Abalic M 28, 133<br />
Agai M 31, 103<br />
Ajduković R 30, 33, 126, 156, 160<br />
Aleksandrov C 29, 172<br />
Alerić I 16, 21, 82, 114<br />
Alilović M 21, 64<br />
Anđelinović Š 4, 31, 159<br />
Anić V 29, 34, 171, 184<br />
Antica M 33, 166<br />
Antulov J 17, 25, 65, 149<br />
Aralica G 33, 168<br />
Audy-Jurković S 18, 22, 98<br />
Aurer I 24, 80<br />
Babić D 18, 19, 22, 36, 81, 88,<br />
98, 101, 107, 116<br />
Babić Ž 20, 109<br />
Baburić M 29, 33, 174, 183<br />
Banić M 20, 66<br />
Baričević D 21, 114<br />
Barić I 32, 164<br />
Barišić A 19, 19, 22, 81, 88, 98, 107, 116<br />
Bartolek D 32, 125<br />
Bašić D 32, 112, 181<br />
Bašić-Kinda S 24, 44, 80<br />
Baškot A 27, 121<br />
Batinić D 25, 26, 28, 30, 33, 37,<br />
45, 53, 65, 124, 152, 165<br />
Begovac J 30, 180<br />
Begović D 29, 30, 32, 156, 162, 164, 171<br />
Belušić Gobić M 20, 75<br />
Belušić M 29, 171<br />
Beljan R 16, 23, 31, 116, 159<br />
Benić-Salamon K 18, 115<br />
Besser-Silconi Ž 31, 75<br />
Bezdrob S 29, 172<br />
Bilić B 20, 109<br />
Bilić E 26, 37, 59<br />
Bobuš Kelčec I 28, 31, 103, 146<br />
Bojanić I 26, 53<br />
Bolanča I 22, 43<br />
Bollmann R 18, 37<br />
Bonevski A 27, 122<br />
Boras Z 21, 102, 114<br />
Borovečki A 25, 28, 76, 140<br />
Botić Lj 31, 52<br />
186<br />
Božikov J 22, 88<br />
Brnčić-Fischer A 18, 115<br />
Budi S 33, 126<br />
Buhin M 26, 41<br />
Bulimbašić S 27, 51<br />
Cavrić G 32, 125<br />
Cerović R 20, 75<br />
Crkvenac Gornik K 32, 162, 164<br />
Cvrk B 29, 172<br />
Čabrijan Ž 20, 66<br />
Čačić M 25, 65<br />
Čaržavec D 27, 28, 117, 129<br />
Čikara I 23, 139<br />
Čolić Cvrlje V 21, 26, 27, 40, 52, 97<br />
Čulić V 31, 33, 152, 165<br />
Čulig Z 30, 180<br />
Čurin D 29, 172<br />
Čurin S 29, 172<br />
Čuržik D 18, 19, 55, 93<br />
Ćaleta B 29, 172<br />
Ćorušić A 18, 19, 38, 81, 107<br />
Ćulić S 27, 33, 122, 165<br />
Ćurić J 20, 66<br />
Ćurić Jurić S 5, 28, 129, 146<br />
Dabelić N 23, 118<br />
Dejanović M 27, 121<br />
Dmitrović B 31, 106<br />
Dodig D 20, 85<br />
Dominis M 5, 24, 28, 39, 131, 136<br />
Dotlić S 25, 44, 65<br />
Drmić I 33, 165<br />
Dubravčić K 25, 26, 37, 53, 65<br />
Dušak V 26, 53<br />
Duvnjak M 20, 56<br />
Džebro S 21, 24, 25, 28, 54, 76, 102, 140<br />
Džeko-Škugor N 16, 77<br />
Đorđijevski E 29, 33, 174, 183<br />
Eminović S 22, 113<br />
Ezgeta Karačić D 32, 119<br />
Fabijanic I 17, 24, 25, 50, 65, 149<br />
Femenić R 26, 37, 59<br />
Filip A 34, 144<br />
Filipec-Kanižaj T 21, 23, 26, 41, 97, 138<br />
Finderle A 22, 113<br />
Flegar-Meštrić Z 24, 30, 31, 33, 48, 134, 153
Florian IS 32, 110<br />
Folnović D 22, 98<br />
Foris V 32, 110<br />
Franić Šimić I 25, 65<br />
Fumić G 29, 173, 177<br />
Fuštar-Preradović Lj 20, 78, 79<br />
Gaćina P 21, 117<br />
Gajović S 21, 70<br />
Gašparov S 26, 32, 41<br />
Gavranović LJ 29, 33, 174, 183<br />
Gizdić B 30, 32, 33, 163, 167, 168<br />
Gjadrov-Kuveždić K 25, 65, 149<br />
Glibotić-Kresina H 18, 115<br />
Golubić-Ćepulić B 26, 53<br />
Gracin S 27, 51, 120<br />
Grbavac I 22, 43<br />
Grce M 18, 42<br />
Gredelj Šimec NJ 27, 33, 121, 137<br />
Grgić S 21, 70<br />
Grgurević I 20, 66<br />
Grgurević-Batinica A 28, 131<br />
Gršić K 20, 99<br />
Grubić Z 32, 162<br />
Grubišić G 22, 43<br />
Guštin D 26, 27, 40, 51, 52<br />
Harabajsa S 29, 175<br />
Hariš V 30, 33, 34, 126, 145, 456<br />
Hećimović A 21, 102<br />
Horvat B 29, 179<br />
Hrabar D 20, 56<br />
Huljev Frković S 32, 162, 164<br />
Iancu C 34, 143<br />
Ilić Forko J 22, 88, 98, 101<br />
Ilić I 24, 25, 26, 44, 59, 65, 80<br />
Ioani H 32, 110<br />
Ivko-Banovac T 31, 152<br />
Jadrijević S 27, 51<br />
Jakelić-Piteša J 16, 89<br />
Jakić-Razumović J 31, 33, 102, 127<br />
Jakovljević G 26, 27, 45, 122<br />
Jaksic B 16, 17, 24, 25, 26, 28, 32,<br />
46, 47, 48, 54, 57, 58, 71, 77,<br />
83, 90, 100, 123, 136, 141, 163<br />
Jakšić O 24, 25, 30, 32, 33, 47,<br />
83, 90, 100, 123, 136, 141, 163<br />
Janković S 18, 115<br />
Jelić-Puškarić B 16, 17, 20, 23, 25, 26,<br />
27, 28, 29, 32, 33, 51, 71, 76, 84, 95, 100, 119,<br />
124, 127, 138, 141, 171<br />
Jeren T 16, 72<br />
Jonjić N 26, 28, 32, 60, 105, 137<br />
Jurenec F 28, 147<br />
Jurenec S 26, 71<br />
Juretić M 20, 75<br />
Jurič D 18, 19, 22, 81, 88, 98, 107, 116<br />
Jurić K 32, 125<br />
Juroš Z 16, 21, 34, 64, 70, 82, 148<br />
Kaić G 5, 16, 20, 30, 31, 33, 34, 72, 73,<br />
109, 112, 126, 135, 142, 157, 168<br />
Kani D 22, 98<br />
Karadža M 18, 38<br />
Kardum M 25, 83<br />
Kardum Paro MM 24, 31, 34, 48,<br />
153, 158, 184<br />
Kardum-Skelin 16, 17, 19, 21, 24, 25, 26, 27,<br />
28, 29, 30, 31, 32, 33, 34, 45, 46, 47, 48, 50, 51, 54,<br />
57, 58, 59, 71, 72, 73, 74, 76, 77, 83, 84, 89,<br />
90, 91, 95, 97, 100, 102, 119, 122, 123, 124, 127,<br />
133, 137, 141, 147, 154, 171, 175, 184<br />
Katalenić Simon S 19, 22, 29, 33, 86,<br />
87, 128, 174, 183<br />
Kezić G 31, 152<br />
Knežević A 29, 172<br />
Knežević G 29, 175<br />
Knežević-Obad A 16, 20, 72, 73, 85<br />
Knotek M 26, 27, 28, 51, 120, 130, 147<br />
Kocjan G 19, 49<br />
Kocman B 16, 26, 27, 40, 41, 51, 52, 95<br />
Kojić-Katović S 28, 146<br />
Konja J 26, 28, 37, 59, 124<br />
Korać P 29, 170<br />
Kovacević-Vojtusek I 27, 28, 51<br />
Kraljević Z 22, 43<br />
Krašević M 16, 104<br />
Krivak Bolanča I 19, 22, 29, 33, 86, 87,<br />
128, 174, 183<br />
Križaj B 29, 171<br />
Križanac Š 16, 33, 34, 82, 142, 148, 168<br />
Krmpotić D 21, 102<br />
Krupec AM 29, 172<br />
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<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
Kujundžić M 20, 66, 109<br />
Kukura V 19, 22, 86, 87, 128<br />
Kuret S 31, 159<br />
Kusić Z 20, 23, 96, 102, 118<br />
Kuspilic M 24, 50<br />
Kušec R 30, 32, 155, 156, 160, 163<br />
Kvenić B 28, 137<br />
Labar B 17, 24, 25, 26, 44, 53, 65, 80, 149<br />
Lajtman Z 33, 145<br />
Lambaša S 33, 34, 126, 142, 145<br />
Lang N 28, 131<br />
Lasan R 28, 50, 131<br />
Lasan-Trčić R 16, 89<br />
Lebinec M 28, 133<br />
Letica Lj 32, 164<br />
Letilović T 17, 100<br />
Livun A 30, 160<br />
Lončar B 23, 31, 33, 91, 106, 131, 135<br />
Lozić AAB 21, 31, 75, 87<br />
Lozić B 31, 33, 152, 165<br />
Lukas D 30, 180<br />
Lukšić B 23, 116<br />
Ljevar I 29, 172<br />
Ljubanovic D 27, 28, 51, 120, 130<br />
Ljubić N 28, 131<br />
Mahovlić V 18, 19, 22, 27, 31, 33, 38,<br />
81, 88, 91, 98, 107, 116, 182<br />
Maljić S 29, 171<br />
Mandac I 16, 17, 89, 132<br />
Manestar D 20, 75<br />
Manestar M 19, 108<br />
Manojlović S 31, 102<br />
Maričević I 28, 129, 146<br />
Markanjević T 19, 29, 32, 108, 176, 181<br />
Marković-Glamočak M 17, 24, 25, 65,<br />
80, 149<br />
Martinac I 22, 101<br />
Martinčić J 29, 175<br />
Martinović M 32, 163<br />
Mateša N 20, 23, 96, 118<br />
Mateša-Anić D 23, 118<br />
Matulić M 33, 166<br />
Mazić S 26, 53<br />
Mažuranic I 21, 64<br />
Meandžija R 29, 173, 177<br />
188<br />
Meštrović D 26, 59<br />
Mihaljević I 19, 55<br />
Mihovilović K 27, 51<br />
Mikulić M 25, 65<br />
Milankovic Lj 29, 33, 179, 183<br />
Milanović D 31, 152<br />
Milanović R 34, 142<br />
Milas M 17, 26, 28, 29, 33, 34, 84, 90,<br />
127, 140, 141, 175, 184<br />
Milas R 28, 133<br />
Miletić Z 30, 32, 33, 34, 145, 157, 163,<br />
167, 168<br />
Miličić-Juhas V 16, 18, 19, 31, 55, 91, 92, 93<br />
Milojkovic D 22, 94<br />
Milojkovic M 19, 22, 55, 94<br />
Minigo H 28, 141<br />
Mišić M 16, 28, 95, 147<br />
Mišljenović N 21, 31, 75, 87<br />
Mitrečić D 21, 70<br />
Moldovan R 33, 144<br />
Morović-Vergles J 31, 112<br />
Moslavac S 20, 96<br />
Mrsić M 25, 26, 53, 65<br />
Mrsić S 25, 33, 65, 165<br />
Mrzljak A 21, 23, 26, 27, 40, 52, 97, 138<br />
Müller D 23, 139<br />
Muresan A 34, 144<br />
Mustapić D 33, 182<br />
Mužinić D 32, 164<br />
Naglić G 29, 173, 177<br />
Nagy A 34, 144<br />
Nakić M 26, 27, 45, 122<br />
Nassabain K 32, 125<br />
Naumovski- Mihalić S 32, 125<br />
Nazor A 24, 31, 33, 48, 134, 153, 158<br />
Nemet D 25, 26, 53, 65<br />
Novak NP 23, 30, 32, 33, 125, 135, 139, 157<br />
Obad-Knežević D 23, 138<br />
Obad-Kovačević 23, 32, 123, 138<br />
Odak D 28, 141<br />
Olteanu D 34, 144<br />
Oreško T 31, 152<br />
Orešković S 18, 19, 81, 107<br />
Ostojić Kolonić S 16, 24, 28, 32, 54, 57,<br />
58, 89, 123, 136, 141
Ostović I 32, 112<br />
Ovanin-Rakić A 18, 19, 22, 27, 81, 88,<br />
98, 107, 116<br />
Ožvald I 31, 153<br />
Pačić A 28, 147<br />
Pajtler M 18, 19, 22, 31, 55, 91, 92, 93, 94<br />
Páll E 34, 143<br />
Pandžić Jakšić V 32, 33, 163, 167<br />
Paradžik M 33, 166<br />
Parigros K 29, 175<br />
Pastorčić Grgić M 20, 99<br />
Pauzar B 23, 31, 33, 106, 131, 135<br />
Pavić T 20, 56<br />
Pedisić D 20, 75<br />
Pegan A 20, 99<br />
Peharec I 29, 175<br />
Pejša V 30, 32, 33, 160, 163, 168<br />
Perica B 18, 93<br />
Perić M 16, 17, 26, 29, 71, 77, 100, 171<br />
Perić Z 29, 172<br />
Perkov S 31, 153<br />
Perković L 28, 131<br />
Peroš-Golubičić T 21, 56, 64<br />
Petrović D 22, 101<br />
Piljić Burazer M 23, 116<br />
Pirkić A 22, 43<br />
Planinc-Peraica A 17, 24, 28, 30, 32, 54,<br />
57, 58, 90, 123, 136, 141, 156<br />
Planinić P 18, 38<br />
Plemić I 33, 183<br />
Poduje V 33, 182<br />
Popek B 29, 175<br />
Prašek-Kudrna K 24, 54<br />
Predragovic I 28, 133<br />
Prkačin I 17, 132<br />
Prstec Z 30, 180<br />
Prvulović I 18, 31, 93, 102<br />
Puljiz I 30, 180<br />
Radić-Krišto D 16, 24, 25, 28, 54, 57, 58,<br />
77,83, 136, 141<br />
Radman I 24, 80<br />
Raić Lj 26, 28, 124<br />
Rajhvajn S 18, 19, 22, 81, 88, 98, 107, 116<br />
Rajić Lj 26, 37, 59<br />
Rajković-Molek K 28, 32, 105, 124<br />
Rakek Novak S 29, 33, 174, 183<br />
Rakušić N 21, 102, 114<br />
Ramljak V 20, 31, 99, 103<br />
Raos M 26, 53<br />
Rešetar R 19, 29, 108, 178<br />
Ries S 17, 23, 24, 25, 26, 37, 65, 80, 149<br />
Rimac M 27, 122<br />
Roganović J 26, 28, 60, 137<br />
Rogošić S 26, 27, 45, 122<br />
Ropar S 27, 29, 33, 121, 137, 179, 183<br />
Roso V 24, 54<br />
Rubeša-Mihaljević R 16, 19, 104, 108<br />
Rubić K 29, 33, 179, 183<br />
Rus D 34, 143<br />
Sabljar-Matovinović M 27, 28, 32, 51, 119<br />
Sarnavka V 32, 164<br />
Schmitt FC 19, 61, 63<br />
Seili-Bekafigo I 26, 28, 29, 32, 60, 105,<br />
137, 177<br />
Sertić D 25, 26, 53, 65<br />
Serventi-Seiwerth R 25, 26, 53, 65<br />
Sikirica M 31, 153<br />
Sindik N 16, 104<br />
Smojver-Ježek S 16, 17, 21, 29, 34, 56,<br />
64, 70, 72, 73, 114, 148, 175<br />
Sofronie A 34, 144<br />
Sokolić I 31, 153, 158<br />
Soritu O 32, 34, 110, 111, 143<br />
Srpak N 21, 70<br />
Staklenac B 23, 31, 33, 106, 131, 135<br />
Stančić V 27, 117<br />
Stanec S 33, 126<br />
Starčević R 20, 75<br />
Stepan S 27, 122<br />
Stipić J 33, 166<br />
Stupnišek M 30, 180<br />
Sučić M 17, 24, 25, 44, 65, 80, 149<br />
Susman S 32, 34, 110, 111, 143<br />
Suša M 19, 81<br />
Šamija I 22, 88<br />
Šamija Projić I 19, 81<br />
Šarčević B 20, 31, 99, 103<br />
Šegulja S 26, 60<br />
Šentija K 19, 22, 29, 33, 86, 87, 128, 174, 183<br />
Šenjug P 33, 168<br />
189<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
Šeparović V 33, 127<br />
Šiftar Z 17, 24, 31, 34, 48, 90, 153, 158, 184<br />
Šimat M 26, 37<br />
Škegro D 16, 21, 23, 27, 40, 95, 97, 138<br />
Škopljanac-Mačina L 18, 19, 22, 81, 88,<br />
98, 107, 116<br />
Škoro M 23, 31, 33, 112, 135, 139<br />
Škrablin-Kučić S 22, 88<br />
Škrgatić L 18, 38<br />
Škrtić A 22, 26, 28, 41, 128, 140<br />
Škurla B 23, 138<br />
Šoljić V 23, 116<br />
Štambuk S 31, 159<br />
Štanfel O 29, 177<br />
Štemberger C 29, 32, 105, 173<br />
Štemberger-Papić S 16, 18, 19, 22, 104,<br />
108, 113, 115<br />
Štingl K 32, 162<br />
Štoos-Veić T 20, 30, 33, 34, 66, 109,<br />
126, 142, 142, 145, 157, 160<br />
Šundov D 23, 31, 116, 159<br />
Šurina B 31, 153<br />
Šušković- Medved S 29, 175<br />
Šušterčić D 21, 23, 24, 26, 27, 28, 29,<br />
30, 40, 48, 50, 52, 84, 97, 133, 141, 156, 175<br />
Švencbir V 34, 184<br />
Tadić M 20, 30, 66, 157<br />
Tekavec-Trkanjec J 21, 64<br />
Tešović G 26, 59<br />
Tokić T 33, 137<br />
Tomas D 28, 146<br />
Tomasović-Lončarić Č 33, 34, 135, 142<br />
Tomić-Brzac H 20, 85<br />
Rešković T 102<br />
Tomuleasa C 32, 34, 110, 111, 143<br />
Tonković Đurišević I 32, 162, 164<br />
Topolovec Z 19, 55<br />
Tötsch M 19, 67<br />
Trip DM 34, 144<br />
Trutin Ostović K 17, 20, 23, 29, 30, 31,<br />
32, 33, 34, 103, 109, 112, 126, 135, 139, 142,<br />
145, 157, 163, 167, 168, 172<br />
Valetić J 32, 119<br />
Vasilj A 27, 28, 31, 117, 129, 146<br />
Vergles J 31, 112<br />
190<br />
Verhest A 18, 63, 68<br />
Verša Ostojić D 16, 18, 19, 22, 104, 108,<br />
113, 115<br />
Vidas Z 27, 120<br />
Vidas Ž 16, 27, 28, 31, 32, 51, 95, 119,<br />
120, 130, 147, 153<br />
Vidić-Paulišić I 23, 28, 3, 127, 138<br />
Vidjak V 28, 141<br />
Vidović LJ 33, 126<br />
Vielh P 18, 63, 70<br />
Vince A 16, 72<br />
Virag M 23, 139<br />
Vojnović J 33, 126<br />
Vrabec-Branica B 16, 17, 21, 34, 64, 70,<br />
82, 102, 148<br />
Vraneš J 19, 86<br />
Vrbanus LJ 17, 25, 65, 149<br />
Vrbica Ž 21, 114<br />
Vrdoljak DV 31, 103<br />
Vrdoljak-Mozetič D 16, 18, 19, 22, 27, 104,<br />
108, 113, 115<br />
Vrhovac R 16, 17, 24, 26, 29, 58, 71, 77,<br />
89, 100, 171<br />
Vujević D 30, 180<br />
Vukelić-Marković M 20, 66<br />
Vukosavić-Cimić B 4, 22, 43<br />
Vunić S 29, 176<br />
Zadražil B 29, 175<br />
Zadro R 25, 65<br />
Zeljko Ž 32, 119<br />
Zemunik T 33, 165<br />
Žarkovic K 20, 85<br />
Žic R 33, 135<br />
Židovec Lepej S 5, 30, 161<br />
Žokvić E 28, 146<br />
Županić-Krmek D 28, 131
ilješke / notes<br />
191<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology
<strong>4.</strong> <strong>Hrvatski</strong> <strong>kongres</strong> <strong>kliniËke</strong> <strong>citologije</strong> / 1. <strong>Hrvatski</strong> simpozij analitiËke <strong>citologije</strong> / 2. <strong>Hrvatski</strong> simpozij citotehnologije<br />
bilješke / notes<br />
192
tehniËki organizator <strong>kongres</strong>a<br />
tehnical organizer and official pco<br />
PCO<br />
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tel: +385 1 45 53 290<br />
fax: +385 1 45 53 284<br />
e-mail: ksenija.zunic@penta-zagreb.hr<br />
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