Breast cancer is the most common cancer among women. In Bosnia and Herzegovina (BiH), accurate data on the status of breast cancer are lacking due to the absence of a central registry. Multiple international guidelines imply that institutions that monitor breast cancer patients should have optimal therapeutic options for treatment. In addition, there have been several international consensus guidelines written on the management of breast cancer. Application of consensus guidelines has previously been demonstrated to have a positive influence on breast cancer care. The importance of specialty breast centers has previously been reported. As part of the 2021 Bosnian-Herzegovinian American Academy of Arts and Sciences (BHAAAS) conference in Mostar, a round table of multidisciplinary specialists from BiH and the diaspora was held. All were either members of BHAAAS or regularly participate in collaborative projects. The focus of the consortium was to write the first multidisciplinary guidelines for the general management of breast cancer in BiH. Guidelines were developed for each area of breast cancer treatment and management. These guidelines will serve as a resource for practitioners managing breast cancer in the BiH region. This might also be of benefit to the ministry of health and any future investors interested in developing breast cancer care policies in this region of the world.

Abstract Background We compared the accuracy of preoperative transvaginal ultrasound (TVUS) versus magnetic resonance imaging (MRI) for the assessment of myometrial invasion (MI) in patients with endometrial cancer (EC), while definitive histopathological diagnosis served as a reference method. Patients and methods Study performed at a single tertiary centre from 2019 to 2021, included women with a histopathological proven EC, hospitalized for scheduled surgery. TVUS and MRI were performed prior to surgical staging for assessment MI, which was estimated using two objective TVUS methods (Gordon’s and Karlsson’s) and MRI. Patients were divided into two groups, after surgery and histopathological assessment of MI: superficial (≤ 50%) and deep (> 50%). Results Sixty patients were eligible for the study. According to the reference method, there were 34 (56.7%) cases in the study with MI < 50%, and 26 (43.3%) with MI > 50%. Both objective TVUS methods and MRI showed no statistical significant differences in overall diagnostic performance for the preoperative assessment of MI. The concordance coefficient between both TVUS methods, MRI and histopathology was statistically significant (p < 0.001). Gordon’s method calculating MI reached a positive predictive value (PPV) of 83%, negative predictive value (NPV) of 83%, 77% sensitivity, 88% specificity, and 83% overall accuracy. Karlsson’s method reached PPV of 82%, NPV of 79%, 69% sensitivity, 88% specificity, and 80% overall accuracy. Accordingly, MRI calculating MI reached PPV of 83%, NPV of 97%, 97% sensitivity, 85% specificity, and 90% overall accuracy. Conclusions We found that objective TVUS assessment of myometrial invasion was performed with a diagnostic accuracy comparable to that of MRI in women with endometrial cancer.

The HERe2Cure project, which involved a group of breast cancer experts, members of multidisciplinary tumor boards (MTB) from health-care institutions in Bosnia and Herzegovina, was initiated with the aim of defining an optimal approach to the diagnosis and treatment of HER2 positive breast cancer. After individual multidisciplinary consensus meetings were held in all oncology centers in Bosnia and Herzegovina, a final consensus meeting was held to reconcile the final conclusions discussed in individual meetings. Guidelines were adopted by consensus, based on the presentations and suggestions of experts, which were first discussed in a panel discussion and then agreed electronically between all the authors mentioned. The conclusions of the panel discussion represent the consensus of experts in the field of breast cancer diagnosis and treatment in Bosnia and Herzegovina. The objectives of the guidelines include the standardization, harmonization, and optimization of the procedures for the diagnosis, treatment, and monitoring of patients with HER2-positive breast cancer, all of which should lead to an improvement in the quality of health care of mentioned patients. The initial treatment plan for patients with HER2-positive breast cancer must be made by a MTB comprised of at least: A medical oncologist, a pathologist, a radiologist, a surgeon, and a radiation oncologist/radiotherapist.

Introduction: Angiomyofibroblastoma is a tumor which is consists of two components: blood vessels and stromal cells, with always prominent vascular component. Angiomyofibroblastoma is benign tumor, but in literature is reported a case of recurrence and one case with sarcomatous transformation, which shoved that these tumors may rarely be associated with malignant component. Case report: A 78-year-old multiparous housewife was hospitalized at University Clinical Center because of painless, asymptomatic tumor of vaginal portion (posterior side). Tumor size was 7 millimeters in diameter. Internal genital organs did not present abnormalities. The patient underwent operative removal of the tumor and went to home at some day. At the histological examination the tumor presented as a angiomyofibroblastoma cervices uteri.

AIM To determine the efficiency and safety of talc pleurodesis in treating the malignant pleural effusion and recurrent spontaneous pneumothorax. METHODS The study included 54 patients with malignant pleural effusion and recurrent spontaneous pneumothorax, who underwent talc pleurodesis using the "talc slurry" method of pleural talc obliteration. RESULTS Pleurodesis was successful in 52 (96%) patients. The average duration of thoracic drainage was 4.4 days. Procedure complications included higher body temperature, pneumonia and pleural effusion separation. All of the patients had satisfying radiological findings at the point of discharge and three months later. There was no death outcome related to the procedure of pleurodesis itself. CONCLUSION Our study has proved the efficiency and simplicity of talc pleurodesis in treating symptomatic malignant pleural effusions and cases with recurrent spontaneous pneumothorax.Appropriate patient selection and compliance with surgical principles during the procedure make this method safe, efficient and successful in treating pleuropulmonal diseases. Large particle talc should be used for pleurodesis because of the minimum risk of complications.

Introduction: Angiomyofibroblastoma is a tumor which is consists of two components: blood vessels and stromal cells, with always prominent vascular component. Angiomyofibroblastoma is benign tumor, but in literature is reported a case of recurrence and one case with sarcomatous transformation, which shoved that these tumors may rarely be associated with malignant component. Case report: A 78-year-old multiparous housewife was hospitalized at University Clinical Center because of painless, asymptomatic tumor of vaginal portion (posterior side). Tumor size was 7 millimeters in diameter. Internal genital organs did not present abnormalities. The patient underwent operative removal of the tumor and went to home at some day. At the histological examination the tumor presented as a angiomyofibroblastoma cervices uteri.

A case of a 45-year-old Caucasian male initially reported with symptoms of acute intestinal obstruction was presented. Diagnostic tests revealed presence of eosinophilic ascites with marked peripheral eosinophilia, a significant thickening of stomach and intestinal wall and infiltration of gastric and duodenal mucosa with eosinophiles. Findings were conclusive with subserosal type of eosinophilic gastroenteritis and the patient's treatment started with a combination of parenteral methylprednisolone and oral loratadine. A prompt clinical response was encountered after 5 days of treatment with complete resolution.

A 6.6-year-old girl presented for leftsided cardiac enlargement on chestradiography (Panel A). Th ree yearsearlier she had undergone a lobectomyof the lower lobe of the leftlung for extraction of an echinococcalcyst.

Sarcomas of the female genital tract in general are rare and ovarian sarcomas comprise less than 1% of ovarian malignancies. In the literature there are 15 reported angiosarcomas of patients 21 year old and younger with no one originated in the ovary. We report a case of ovarian angiosarcoma in an 11 year old girl, presented with left side hip pain. MRI of abdomen and pelvis confirmed expansive solid and cystic mass occupied both ovaries. Imunohistochemistry staining was performed, CD34, Factor VIII, CD31, in order to confirm the diagnosis. Final diagnosis was angiosarcoma. The patient received 6 cycles of chemotherapy, according to the CWS-2002P protocol. 8 months after the diagnosis was established, there were no signs of any tumors according to the ultrasound, CT scan, and MRI. Although, extremely rare, angiosarcoma can also affect children and this diagnosis should be considered carefully in tumor with rich vascular network, necrosis and brisk mitotic activity.

Objective. The aim of this study was to analyse individual and combinedsensitivity and specificity of ultrasound and mammography inbreast cancer diagnosis and emphasize the importance of combiningbreast imaging modalities. Patients and methods. By means ofa cross-sectional study, ultrasound and mammographic examinationsof 148 women (mean age 51.6 ± 10.8 years) with breast symptomswere analysed. All women underwent surgery and all lesions were examinedby histopathology analysis which revealed the presence of 63breast cancers, and 85 benign lesions. In relation to age, the womenwere separated in to a group under 50 years and a group 50 years andolder. Ultrasound and mammographic findings were classified on theBI-RADS categorical scale of 1-5. Categories 1, 2 and 3 were considerednegative, while categories 4 and 5 were positive for cancer. Forstatistical data processing the McNemar chi-square test for pairedproportions was used. The differences on the level of p<0.05 were consideredstatistically significant. Results. In the group under 50 years,the ultrasound sensitivity was significantly higher than the mammographicsensitivity (p=0.045, c2=4), without a statistically significantdifference in specificity (p=0.24, c2=1.39). In the women over 50, asignificant difference between sensitivity of ultrasound and mammographywas not proved (p=0.68, c2=0.17), nor any difference in thespecificities (p=0.15, c2=2.08). In the group consisting of all patients,the sensitivity of ultrasound was statistically significantly higher incomparison with the sensitivity of mammography (p=0.04, c2=4.27)with higher specificity (p=0.04, c2=4). By combining the two methodsin all patients sensitivity of 96.8% was achieved, in patients up to 50sensitivity was 90.47% and in patients over 50, sensitivity was 100%.When the two methods were combined in all patients, a decrease inspecificity was noted. Conclusion. The combination of ultrasound andmammography in breast cancer diagnosis achieves high sensitivityand the number of undetected breast cancers is reduced to minimum.

Introduction: Reed-Sternberg cells are typical for Hodgkin’s lymphoma. They are transformed post-germinative B cells that not achieve successful immunoglobulin gene rearrangement, and therefore predetermined to apoptosis. Several mechanisms, including latent Epstein Barr virus infection (EBV), enable survival of Hodgkin’s lymphoma neoplastic cells. Goal of this study is correlation of Hodgkin’s lymphoma EBV status with expression of apoptosis associated proteins in neoplastic cells. Association of Hodgkin’s lymphoma with EBV was determined by chromogenic hybridization in situ detection of EBER1 and EBER2. Material and Methods: Presence of apoptosis associated proteins: bcl-2, bcl-X, bax and p53, were determined immunohistochemicaly in neoplastic cells of 39 EBV positive, and 42 EBV negative Hodgkin’s lymphomas. Results: Bcl-2 protein was detected in neoplastic cells in 22.2%, Bcl-X in 87.7%, Bax in 80.2% and p53 in 67.8% of cases. In 44.4% cases simultaneous presence of Bcl-X, Bax and p53 protein was detected. Bcl-X is significantly more produced in mixed cellularity, and Bcl-X and Bax in nodular sclerosis. No significant difference was found in production of all four proteins between EBV positive and negative Hodgkin’s lymphoma. Median intensity of p53, Bcl-2, Bcl-X and Bax staining of complete examined group, EBV positive and EBV negative group show significant difference, except between Bcl-X and Bax. Discussion: Survival capacity of Hodgkin’s lymphoma neoplastic cells depends on activity of numerous regulators of programmed cell death. Expression of bcl-2, bcl-X, bax and p53 proteins is not different in neoplastic cells of EBV positive and EBV negative Hodgkin’s lymphoma.

Introduction – An enlarged lymph node is the most common neck mass in children. The usual causes of enlargement are infections such as bacterial and viral adenitis, pharyngitis, an infectious diseases and Hodgkin disease. However, sometimes enlarged lymph nodes can be found in thyroid carcinoma as the first manifestation of the disease.  Case report – Here we report on 11- year old girl with painful cervical lymphadenopathy. An ultrasound and cytological examination followed by fine-needle aspiration cytology from the thyroid gland revealed a papillary carcinoma. A total thyroidectomy with lymph nodes dissection was performed. The postoperative diagnosis confirmed thyroid carcinoma metastaticum in the lymph nodes. With a view to implementing the further diagnostic and therapeutic protocol a whole body scintigraphy was performed and it revealed a radioiodine collection in the area of the remaining thyroid tissue. As a result radioiodine therapy i.e. 100 mCi (370 MBq) was administered. Substitution therapy was administered. A year later the whole body scan showed a focus of increased uptake in the neck indicating that there was a need to repeat radioiodine therapy. This time a dose of 100 mCi was administered (total dose of radioiodine ablation amounts to 200 mCi). Since the surgery was performed five years ago there have not been any signs of local recurrence or metastasis.  Conclusion – Enlarged lymph nodes are a serious clinical problem. Therefore, lymphadenopathy regardless of its occurrence demands detailed clinical testing. Priority should be given in this pathology diagnostics to ultrasound examination in combination with fine-needle aspiration cytology, which can reveal the cause of the disease in good time and reliably.

The role of Epstein Barr virus (EBV) in the onset of Hodgkin's lymphoma has been a subject of ongoing research. However, confirmation of EBV oncogenic involvement was not possible due to the small number of neoplastic cells characteristic for this type of tumor. Presence of EBV infection in neoplastic and non-neoplastic cells was analyzed in 81 cases of Hodgkin's lymphoma. In neoplastic cells, using an immunohistochemical method, latent membrane protein 1 (LMP1) was found in 33,3% of cases, while in situ hybridization results demonstrated the presence of EBER RNA in 48,1% of the cases. EBER RNA was found in non-neoplastic lymphocytes in 38,3% of cases. EBV is most frequently associated with Hodgkin's lymphoma in the first and seventh decade of life, specifically the nodular sclerosis subtype. No apparent difference was observed in the association of Hodgkin's lymphoma with EBV between genders, or in relation to clinical stage of the disease and average age of the patient. However, association with childhood age is significantly greater in comparison to adults. EBV associated disease shows a significantly greater prevalence in T lymphocytes. Slightly more abundant are cytotoxic T lymphocytes, which are also more frequently in contact with Reed-Sternberg cells, although there is no difference in number and positioning of histiocytes. Variations between the data on the association of EBV with Hodgkin's lymphoma among studies from different parts of the world suggest that factors of age, gender, ethnic background and social status might present biological modifiers of EBV influence on the pathogenesis of this neoplasm. The differences in non-neoplastic infiltrate EBV+ and EBV- lymphoma indicate the effect of the virus on the immune interaction of tumor and host in this disease.

of ongoing research. However, confi rmation of EBV oncogenic involvement was not possible due to the small number of neoplastic cells characteristic for this type of tumor. Presence of EBV infection in neoplastic and non-neoplastic cells was analyzed in  cases of Hodgkin's lymphoma. In neoplastic cells, using an immunohistochemical method, latent membrane protein  (LMP) was found in , of cases, while in situ hybridization results demonstrat- ed the presence of EBER RNA in , of the cases. EBER RNA was found in non-neoplastic lymphocytes in , of cases. EBV is most frequently associated with Hodgkin's lymphoma in the fi rst and seventh decade of life, specifi cally the nodular sclerosis subtype. No apparent diff erence was observed in the association of Hodgin's lymphoma with EBV between genders, or in relation to clinical stage of the disease and average age of the patient. However, asso- ciation with childhood age is signifi cantly greater in comparison to adults. EBV associated disease shows a signifi cantly greater prevalence in T lymphocytes. Slightly more abundant are cytotoxic T lymphocytes, which are also more frequently in contact with Reed-Sternberg cells, although there is no diff erence in number and positioning of histiocytes. Variations between the data on the association of EBV with Hodgkin's lymphoma among studies from diff erent parts of the world suggest that factors of age, gender, ethnic background and social status might present biological modifi ers of EBV infl uence on the pathogenesis of this neoplasm. Th e diff erences in non-neoplastic infi ltrate EBV+ and EBV- lymphoma indicate the eff ect of the virus on the immune interaction of tumor and host in this disease.