Aim To investigate the correlation of body mass index (BMI) with severity of intervertebral disc degeneration. Methods The study enrolled patients who had undergone surgical intervention for a herniated disc at the Department of Neurosurgery of the Cantonal Hospital Zenica. Patients underwent thorough preoperative evaluation, including medical history, neurological and physical assessments, and radiological analysis. The surgical intervention consisted of a posterior lumbar discectomy, and the excised disc material was preserved and subjected to histopathological analysis based on Histopathologic Degeneration Score (HDS). Patients were divided in two groups according to Body Mass Index (BMI): study group with BMI≥25 and control group with BMI<25. Results Among 69 patients with herniated IVD, 26 (37.7%) were with BMI≥25 (study group), and 43 (62.3%) were with BMI<25 (controls). The study group displayed substantial increase in height, 1.80±0.06 m compared to controls, 1.74±0.06 m (p=0.001). Weight and BMI were significantly higher in the study group of patients (weight: 91.60±10.22 vs. 67.37±9.20 kg, BMI: 28±2 vs. 22±2; p<0.001). Differences were confirmed in HDS values in the study group comparing to the control group (p<0.001). The study group exhibited significant differences in chondrocyte proliferation, tears and clefts, granular changes, and mucous degeneration (p<0.05), and positive correlations were found between BMI and these alterations found in the herniated discs (p<0.05). Therefore, HDS showed positive correlations with BMI (R=0.599; p<0.001) and weight (R=0.696; p<0.001). Conclusion The study's findings confirmed that BMI has a significant impact on intervertebral disc degeneration, emphasizing the importance of weight management in preventing disc degeneration.

AbstractAim Hydatidiform mole is a rare pregnancy disorder, with wide variety of reported incidence. The aim of the study was to estimate the incidence of hydatidiform moles (HM) in Tuzla Canton, specifically partial (PHM) and complete (CHM) forms.Material and methods All cases of HM that have been diagnosed at the University Clinical Center, Tuzla, between January 2011 and December 2015 were registered. The overall incidence of HM, as well as the incidence of PHM and CHM was calculated using the Tuzla Canton's live birth rate during the study period. A second review of tissue slides and p57 immunohistochemistry (IHC) staining was performed to determine the validity of the criteria for the diagnosis and distinction of the molar specimens.  Results There have been 256 cases of HM, 243 cases of PHM, 12 cases of CHM, and one case of unspecified HM. The average incidence of PHM was estimated at 11.03/1,000 and CHM at 0.54/1,000 live births. A second pathologist review revealed one PHM as a non-molar specimen, confirmed all CHM and identified an unknown HM as a PHM. Out of the 50 randomly chosen samples of PHM, p57 expression confirmed the diagnosis in 48 cases, disclosed one case as unrecognized CHM, and one sample showed discordant staining. IHC staining for p57 approved the diagnosis for all cases of CHM.Conclusion: HM incidence reporting remains a challenge due to the study design. p57 immunohistochemistry confirmed the strong validity of histopathological criteria in the diagnosis of CHM.

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.

Background: Invasive ductal cancer (IDC) represents about 75% of all breast malignancies. There are many breast cancer prognostic factors, but the ones that have the most impact on the survival rates in advanced breast cancer are tumor size and regional lymph node involvement. Axillary lymph node dissection (ALND) has particularly important and undoubtful role in current surgical options for breast cancer treatment. With the introduction of sentinel lymph node biopsy (SLNB) for breast cancer patients it was possible to identify those to whom regional spread of the disease did not occur at the time of surgery, and thus spare them an unnecessary ALND procedure. Objective: To determine the rate of sentinel lymph node (SLN) detection using only methylene blue dye as a mapping agent, as well as to correlate the number of positive SLNs with the number of positive non-sentinel lymph nodes (non-SLNs). Methods: The study represents a prospective study that included 50 female patients with histologically confirmed invasive ductal carcinoma (IDC) who underwent SLNB using only methylene blue dye as the mapping agent, while the detection and harvest of SNL was done by visual control only. All patients also underwent an obligatory complete ALND, which was as that time the institutional oncological protocol for surgical treatment of histologically confirmed IDC. The final data such as tumor size, SLN and non-SLN status were obtained by further analysis of pathohistological reports from tumor biopsy and other surgical specimens. Results: The accuracy rate of SLN detection was 98%. The number of detected SLN was in the range of 1 to 6, with an average of 2 for each patient. The number of positive SLN was in significant correlation with the number of tumor-affected non-SNL (p<0,001). Further analysis showed that for each increase in the number of positive SLN by 1, the risk of positive non-SLN increased 6-fold, OR=6,22 (p<0,001). Conclusion: Use of methylene blue dye as a sole mapping agent when performing SLNB in patients with IDC is a reliable and effective method that can be safely implemented in medical institutions that lack availability of nuclear medicine services or significant monetary funds.

Aim Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumours with varying clinical expression and behaviour. Because of indolent behaviour of NENs, reviewing and evaluation of epidemiological characteristics is a challenge. The aim of this study was to assess prevalence of NENs at tertiary hospitals considering age, gender, location, and grade. Methods Electronic files were used for a retrospective assessment of the patients with NENs of the gastroenteropancreatic tract and bronchopulmonary system in tertiary hospitals in Bosnia and Herzegovina over the past 15 years (2005-2020). Results Among 438 patients, 291(66.4%) were males and 147 (33.6%) females; the median age was 62 years. The lungs were the most frequent site, 304 (69.4%), followed by the pancreas, 22 (5.0%), colon, 14 (3.2%), stomach, 13 (2.9%), appendix, 13 (2.9%), rectum,11 (2.5%), small intestine, eight (1.8%) and gallbladder, one (0.2%). Metastases were most frequently found in the liver, 35 (8%) and lymph nodes, 15 (3.42%). Conclusion The results were largely consistent with those in literature, including age, gender, location, and the degree of differentiation. Most metastases originated from high-grade tumours and greater impairment of the liver.

INTRODUCTION Cervical cancer is the second leading cause of female cancer in Bosnia and Herzegovina, and it is the most common female cancer in women 15 to 44 years old. Cervical cancer is etiologically associated with high-risk human papillomaviruses (HRHPV). Data on the prevalence of HRHPV in Bosnia and Herzegovina are scant. This study investigates the prevalence of HRHPV infection among women of reproductive age compared with cervical cytology in the Tuzla Canton. METHODS We analyzed the results of HRHPV testing and Papanicolaou (Pap) test results in women up to 40 years old diagnosed at the Tuzla University Clinical Center (UCC) from January 2019 to March 2020. RESULTS Among 880 women tested for HRHPV, 27.2% (n = 239) were ≤ 40 years. In this age group HRHPV was detected in 33.5% (n = 80) of women, and 23.8% (n = 19) were women < 30 years. Out of 239 women tested for HRHPV, 60.2% had an abnormal Pap smear result. Therefore, 40.7% (n = 59) of HRHPV-positive women had an abnormal Pap test result. Women with a normal Pap test result had an HRHPV-positive test in 22.3% (n = 21) of cases. CONCLUSION The results obtained contribute to the knowledge about HPV prevalence and the incidence of squamous cell abnormalities in the most populous canton in Bosnia and Herzegovina, possibly reflecting the situation nationally. The high prevalence of HRHPV in women of reproductive age calls for urgent implementation of an organized cervical cancer screening program and HPV vaccination.

Marinacci anastomosis, also known as Ulnar-Median anastomosis, is an anastomosis in which the branch anastomotic originates proximally in the ulnar nerve and unites distally with the median nerve. A purpose of this study was to determine the incidence and  the characteristics of Marinacci anastomosis in the Bosnian population. The 60 anterior forearms of fresh frozen adult cadavers were dissected in the Department of Pathology,  University Clinical Centre Tuzla and the morgue of Tuzla during a time period of two years. The Marinacci anastomosis was evidenced in one male forearm in the right side behind the ulnar artery, following an transversal course of 5.2 cm until its connection with the median nerve in only one branch. The incidence of Marinacci anastomosis was 1.67%. Since this anastomosis can expalin some cases where injuries in the forearm nerves are not reflected in the hand muscles, it is important to study. Our study contributes to a limited research on the Marinacci anastomosis, a condition that is rarely found and reported in anatomical research.

Introduction: To the best of our knowledge, this is the first study about malignant eyelid tumors in the region of Tuzla, Bosnia and Herzegovina, and it shows similar results comparing with other countries (the annual incidence of eyelid tumors in Tuzla region is about 3.73/100 000 population). Malignant eyelid tumors are relatively uncommon, but potentially fatal disease. However, if detected early and treated adequately, the prognosis is generally excellent. Aim: The aim of this study was the clinical and microscopical analysis of malignant eyelid tumors in treated patients, the presentation of surgical treatment and reconstructive methods of eyelid tumors. Methods: This retrospective study included 60 patients surgically treated at the University Clinical Center Tuzla from January 2012 to December 2016, who were initially diagnosed with malignant eyelid tumors in accordance to the final results obtained by histological examination of excised lesions. Results: In the group of malignant tumors, the most common tumors were BCC (85%), which were predominantly found on the lower eyelids (92.16%) and showed female predominance (51.06%). SCC was the second most common eyelid malignancy (15%) and showed a predilection for the lower eyelid involvement and male predominance (55.56%). Tumors up to 2 cm in diameter (clinical stage T1) were found in 78.33% of cases, 95.74% of which with radical excision, while 4.26% with non-radical excision. Conclusion: Treatment by complete excision with histological confirmation of tumor clearance is recommended. Perineural spread is an adverse prognostic sign, which may require postoperative radiotherapy. Orbital invasion is a rare complication but, if recognized early, it can be treated effectively with exenteration. Because presentation varies and histological examination is required for accurate diagnosis, any suspicious lesion occurring on the eyelids should be excised or biopsied. All patients with malignant tumors should be advised of the risk of recurrent or new tumors and encouraged to attend lifelong follow up.

Introduction: Malignant ovarian germ cell tumors (MOGCTs) account for 2-5% of all ovarian cancers and among them pure embryonal cell cancer is rare condition (1, 2, 3, 4). Aim: To show successful pregnancy after unilateral salpingooopherectomy and chemotherapy in a girl with embryonal carcinoma of ovary (ECO). Case report: Patient had FIGO stage III c disease. After the surgical removal of the tumour, the patient underwent six cycles of adjuvant chemotherapy with bleomycin, etoposide and cisplatin (BEP). Eight years after chemotherapy she conceived spontaneously. The patient went through regular antenatal checkups in a consultation with a gynecological oncologist. In addition to all regular examinations and controls, monthly monitoring of carbohydrate antigen (CA) 125, human epididymis protein 4 (HE 4), Roma Index is also recommended. Congenital malformation excluded at 20 weeks of gestation by level III ultrasonography. At 39th gestational week, laparotomy as well as a C-section was done and the patient was managed successfully in giving birth to a healthy female baby. Three months after delivery, the woman was recurrence free and the infant did not show any problems. At the last follow-up visit (May 5, 2018), all the tumor markers were negative, and the control MRI and ultrasound examinations did not reveal tumor recurrence or pathological lymph nodes. Conclusion Normal gonadal function and fertility are possible after fertility preservation surgery for ovarian germ cell malignancies, even with adjuvant chemotherapy.

Introduction: Benign and malignant tumors can arise from each of the eyelid layers. Our aim was to investigate the frequency and distribution of the eyelid tumors in tertiary health institution in Tuzla Region in Bosnia and Herzegovina.             Methods: We analyzed medical records for all the patients treated for eyelid malignancies in University Clinical Center Tuzla, from January 2012 to December 2016. Demographic, clinical and pathological data were collected and analyzed.           Results: A total of 89 patients were treated during the 5 year period. Forty seven of the patients were male (52 %) and 42 (48 %) were female. Patient age ranged from 11 to 92 years, with the mean age of 66.6 years. The most common eyelid malignancy was basal cell carcinoma (80.95%), followed by squamous cell carcinoma (14.29%), merkel cell carcinoma (3.17%) and melanoma (1.59%). Conclusion: The annual incidence of eyelid tumors in Tuzla region is about 3.73/100 000 population. Majority of the malignant tumors were basal cell carcinoma, while melanoma was the least frequent. Most frequent benign lesions were seborrheic keratosis and benign nevi.

Introduction: Hydatidiform moles (HM), presenting as complete (CHM) and partial (PHM) form, are rare pregnancy disorder. Diagnosis is based on clinical presentation, ultrasound imaging findings and pathological examination of products of conception. Protein p57, encoded by CKDN1C gene, is paternally imprinted and maternally expressed gene and provides quick insight in genetic basis of HM and allows distinction of CHM from all other conceptions. compare the preevacuational and pathohistological diagnosis with outcome of p57 immunostaining. Material and methods: All cases of HM diagnosed between January 2011 and December 2015 were included in this research. Maternal age, gestational age and input diagnosis data were recored. p57 immunostaining was performed in order to evaluate the diagnosis based on tissue slides examination. Results: There were 198 cases of histologically confirmed HM, 185 PHM, 12 CHM and one case of undefined HM. Mean maternal age in the CHM group was 24,7 and in the PHM group 26,9 years, with no significant differences among these two groups (p=0,27). For CHM mean gestational age was estimated at eight and for PHM 9,2 gestational weeks. Pregnant woman older than 40 years present significant earlier compared with younger woman (p<0,01), and those younger than 20 years tend to present at the beginning of the second trimester more often than older women (p<0,05). In the CHM group, 9 (75%) input diagnoses were mola in obs, and 3 (25%) of them were signed as abortion, unlike the PHM where 126 (67%) were qualified as abortion, 35 (19%) as blighted ovum, and 26 (14%) were suggestive for molar pregnancy. p57 immunostaining results confirmed all pathohistological diagnosis of CHM whereas 8% of PHM demonstrated divergent p57 expression. Conclusion: PHM, compared with CHM, represent a greater diagnostic challenge for both gynecologist and pathologist even when presenting in more advanced pregnancies.

Introduction: The treatment response and outcome in acute myeloid leukaemia (AML) is heterogeneous. Aim: To analyze the prognostic parameters of AML at presentation. Methods: The total sample of 44 AML patients was analyzed on the basis of age <55 and ≥55 years, sex, WBC count <50x10/9/l and ≥50x10/9/l, the Hb concentration <100 g/l and ≥100 g/l, PLT count <100x10/9/l and ≥100x10/9/l, Karnofsky score <60% and >60%, cytogenetics, CD56 expression, morphological type and types of treatment (standard and reduced induction chemotherapy, high–dose chemotherapy/stem cell transplantation – autologous and HLA matched, related, allogeneic, together and separately). Results: The age <55 years, Karnofsky score >60% and standard induction chemotherapy statistically correlated with the higher complete remission (CR) rates, longer relapse free survival (RFS), lower relapse rate (RR), and longer overall survival (OS) (p<0.01). The difference in terms of CR and RR between the sexes were not statistically significant (p<0.05), however women had statistically lower OS comparing to men (9.71±4.54 months vs. 38.03±9.17 months) (p<0.01). WBC count ≥ 50x10/9/l and the Hb concentration <100 g/l statistically correlated with shorter OS (p<0.05), while the WBC count ≥50x10/9/l statistically correlated with shorter RFS (p<0.05). The PLT count <100x10/9/l and ≥100x10/9/l was not found as prognostically significant for CR, RR, RFS, and OS (p<0.05). In comparison to the standard induction chemotherapy, both types of high dose chemotherapy/stem cell transplantation (HDT/SCT) (10/22), together and separately, resulted in longer RFS, lower RR, and longer OS (p<0.05). The frequency of cytogenetic risk was intermediate 81.6%, unfavorable 13.2%, and favorable 5.3%, respectively. CD56 + expression statistically correlated with the lower PLT count, higher RR, shorter RFS, and shorter OS (p<0.05). Statistical analysis of the cytogenetic risk and morphological types of AML were not possible due to the small number of patients in stratified groups. Conclusions: Female sex, the WBC count >50x10/9/l, the concentration of Hb <100 g/l, and CD56 + expression, at presentation of AML, should be considered as parameters of adverse risk, especially in latter decisions considering post-remission treatment with HDT/SCT.

Desmoid tumor represents a rare monoclonal, fibroblastic proliferation characterized by a variable and often unpredictable clinical course. Although histologically benign, desmoids are locally invasive and associated with a high local recurrence rate, but lack of metastatic potential. Many issues regarding the optimal treatment of patients with desmoids remain controversial. Surgical resection and radiotherapy are standard treatment options for these patients. Due to heterogeneity of the biological behavior of desmoids, including long periods of stable disease or even spontaneous regression, treatment needs to be individualized to optimize local tumor control and preserve patient's quality of life. Therapeutic approaches to the treatment of recurrent or unresectable desmoid tumors comprise anti-hormonal therapy, non-steroidal anti-inflammatory drugs, classic chemotherapy regimens and tyrosine kinase inhibitor, with highly variable results. It has not yet been possible to establish an optimal therapy protocol for this disease. In this case report we present our experience with the treatment of recurrent extra-abdominal desmoid tumor.