Received 2018-11-12 Received in revised form 2019-05-22 Accepted 2019-05-29 INTRODUCTION Breast cancer is the most common malignant disease in women (1). It makes up about 26.5% of all newly discovered malignancies in the European female population and is responsible for 17.5% of the deaths. In males, this type of cancer is rare (one man per 100 women) (2). The frequency of the disease differs in various parts of the world. It is rarely seen before the age of 30, it rises with age and reaches its maximum around the age of 50 (3). The incidence of breast cancer in the world increases by 1-2% per year, and it is estimated that in the first decade of the third millennium, almost one million of women will suffer from breast cancer (4). However, in spite of the increasing possibilities of treatment, survival depends primarily on the extent and stage of the disease at the time of detection. In the early stage of the disease in which the largest number of patients is detected, healing is quite possible. Still, 24-30% of patients with lymph node negative and 50-60% with lymph node positive breast cancer will develop relapse. At the moment of diagnosis metastatic disease is present in 6-10% of patients (5). Treatment of breast cancer is multidisciplinary. Combination of surgical treatment, radiation and systemic therapeutic treatment ensure good results in patient survival. The type and order of particular treatments must be planned multidisciplinary by surgeons-oncologists, radiotherapists and internists-oncologists (6). Clinical features of tumor such as size, the existence of tumor cells in the armpit lymph nodes, and distant metastases are considered essential in determining prognosis and choices of treatment. Prognostic factors, derived from breast tissue after biopsy or surgery, have significance in measuring tumor aggressiveness and general disease prognosis. The standard prognostic parameters are patient (menopausal status, age) and tumor related (tumor size, histological type, axillary lymphatic status, tumor gradient, ER, PR and HER2 status). Some of them (ER, PR and HER2 status) have a predictive value because the best therapeutic modality is chosen based on these. According to St. Gallen Consensus and ESMO recommendations from year 2013 breast cancers fall into different types according to histopathological findings and results of predictive and prognostic tests. Based on this, specific therapeutic approach is recommended. When luminal A type patient receive only endocrine therapy, and chemotherapy is considered only in cases of high risk tumor (with four or more positive lymph nodes, tumor size T3 or tumor grade 3). When luminal B-like type (HER2 negative) patient is treated using chemotherapy and endocrine therapy. When luminal B-like (HER2 positive) patient is treated using chemotherapy, anti-HER2 and endocrine therapy. In case of non-luminal (HER2 positive) breast cancer type chemoand anti-HER2 therapy is recommended. In patients with basal-like (triple-negative) cancer application of chemotherapy is indicated (7).

Introduction/Objective. Tarsal dislocations are rare injuries. Usually, they are caused by high-energy trauma. Depending on the type of dislocation, surgical treatment or closed reduction is used. In this study, 13 patients are presented with the aim to analyze the type of feet dislocations, their treatment, and outcome. Methods. Tarsal dislocation cases treated in the University Hospital in Foca were analyzed during the period 2009?2016. All the cases were clinically and radiographically examined and monitored on control examinations at least three years. The mobility of joints was measured and pain existence was estimated by visual analogue scale. Results. All 13 patients with tarsal dislocation were male. Four patients were treated surgically (two patients with tarsometatarsal and one with cuboid and navicular dislocation) and other patients had non-surgical treatment. In 10 patients, an excellent functional result has been achieved and in two patients with tarsometatarsal dislocation a good functional result. In one patient with cuboidal dislocation satisfactory functional result has been achieved. Conclusion. Out of the 13 reviewed patients with tarsal dislocations, functional results were rated as excellent in 10 dislocations, good in two, and satisfactory in one. Diagnosis and treatment of foot dislocations are demanding, but a favorable functional outcome can be expected with an adequate treatment of these injuries.

Possibility of oxidative stress protection in perioperative period plays its role in pain therapy and inflammation after surgical interventions. The aim of our study is to analyze the action effects of preoperatively ordained vitamin C on the level of antioxidative stress enzymes and the intensity of painful sensations after the elective laparoscopic cholecystectomy (LC).

Introduction/Objective Activation of insulin-like growth factor receptor (IGF-1R) results in cell transition from growth phase to synthesis phase of cell cycle. Breast cancer is categorized into prognostic and therapeutic subtypes based upon hormone receptor, estrogen receptor (ER), and progesterone receptor (PR) expression and human epidermal growth factor receptor 2 (HER-2) expression. The objective of this study was to examine the expression of IGF-1R in а specific subtype invasive breast cancer and its correlation with basic histopathological and immunohistochemical prognostic parameters. Methods Formalin-fixed paraffin-embedded tumor samples were obtained from 129 female patients with invasive breast cancer (I–III disease stage) with the follow-up ranging 36–108 months (average 48 months). For immunohistochemical staining, we used monoclonal antibodies for ER, PR, IGF-1R, and polyclonal antibody for HER-2. Results IGF-1R inversely correlated with tumor stage (p = 0.017), tumor grade (p = 0.001), HER-2 (p = 0.003), whereas significant positive correlation was found with multifocality/multicentricity of breast cancer (p = 0.036), ER (p = 0.001) and PR (p = 0.0001) expression. Cox-regression analysis for relapse-free survival (RFS) showed that disease stage (p = 0.039) and HER-2 (p = 0.033) were independent prognostic factors. IGF-1R did not predict clinical outcome in patients with breast cancer (p = 0.488, Kaplan–Meier test for RFS). Conclusion Patients with low stage and grade hormone-dependent breast cancer had a significantly higher IGF-1R expression than patients with triple negative or HER-2 overexpressed cancer. The present findings also highlight that IGF-1R expression in multicentric/multifocal breast cancer supports the key roles in tumor initiation.

Introduction Thoracic splenosis is defined as the autotransplantation of splenic tissue into thorax. It occurs due to splenic rupture in association with a diaphragmatic tear on the left side after a traumatic event. It is a rare disease that most commonly remains undiscovered as it is usually asymptomatic. Case Outline We present a symptomatic case of thoracic splenosis in a 53-year-old smoker male patient with a medical history of abdominal surgery and splenectomy for a thoracoabdominal gunshot. Three years before the medical examination he was suffering from dyspnea, frequent coughing, left pleuritic chest pain and complained about faster fatigue. A chest radiograph obtained during a medical checkup showed a multinodular left pleura-based mass in the upper lobe. Established histopathological diagnosis after surgical removal of the nodule was splenosis. No evidence of malignancy was observed. Conclusion Splenosis should be considered as a differential diagnosis by the undertaken workup of left pulmonary nodules or masses in patients with a history of trauma.

INTRODUCTION Primitive neuroectodermal tumor or Ewing's sarcoma is a tumor of undifferentiated small round cells that arise from the soft tissues, and is believed to be of neural origin. It occurs most often in children, followed by adolescents and young adults. CASE OUTLINE A case of a 24-year-old patient with ulcerostenosans Ewing's sarcoma of the initial part of the small intestine is presented in our paper. Reviewing the literature and using as an example the case of a female patient with signs of sideropenic anemia caused by primitive neuroectodermal tumor of the small intestine, an attempt was made to clarify the etiology, clinical presentation, diagnosis and therapy with the aim of its rapid detection and treatment. CONCLUSION Mesenteric primitive neuroectodermal tumor is a rare neoplasm in adults, while it usually occurs in children and young adults. Surgical resection of the lesions with the application of chemotherapy is the main form of treatment of patients suffering from this disease.

AIM To determine the pattern of origin of medial circumflex femoral artery (MCFA), its origin distance from the midpoint of the inguinal ligament and the topographical relations of the origin, which have great significance in clinical work. METHODS Dissections on the autopsy group of 42 thighs were performed, and anatomical relationships of MCFA was analyzed. All data were entered into a scheme of the protocol which was designed for this research containing the case number, age and sex, side, topographical-anatomical relations of MCFA, artery dimensions and variations, and the distance between the place of origin of MCFA and the midpoint of the inguinal ligament. RESULTS Commonly, in 25 (59.5%) limbs MCFA originated from the deep femoral artery. In 14 (33.3%) limbs MCFA arose from the femoral artery (FA), in one case (2.4%) a common source of deep femoral artery (DFA) and MCFA was identified, and in two limbs MCFA was not noticed. The distance between the level of origin of MCFA and the central point of the inguinal ligament was 44.2 mm, in average, when it was emerging from FA, and 57.9 mm, in average, in cases where MCFA originated from DFA. CONCLUSION Surgeons and radiologists should be familiar with the variations of clinically important MCFA, which is commonly involved in peripheral occlusive arterial diseases, to improve effectiveness of diagnosis and treatment of various pathological conditions in the femoral region.

INTRODUCTION The lateral circumflex femoral artery usually originates from the lateral side of the initial part of the deep femoral artery, or less frequently from the femoral artery. If it is a branch of the femoral artery, it arises directly above the point of origin of the deep femoral artery. The aim of this study was to determine the origin of the lateral circumflex femoral artery, its origin distance from the midpoint of the inguinal ligament and the topographical relations of the origin, which have a great significance in clinical work. MATERIAL AND METHODS A dissection was performed on the autopsy group of 42 thighs, followed by the analysis of anatomical relationships of the lateral circumflex femoral artery. All data were entered into the custom-made protocol, which contained the case number, age and sex, side, topographical-anatomical relations of the lateral circumflex femoral artery, artery dimensions and variations, and the distance between the place of origin of the lateral circumflex femoral artery and the midpoint of the inguinal ligament. RESULTS In our study, the lateral circumflex femoral artery most frequently originated from the deep femoral artery, i.e. in 78.6% of cases. In 19.0% of limbs, it originated from the femoral artery, and in one case (2.4%) from a common stem of the deep femoral artery and the lateral circumflex femoral artery, coming from the femoral artery. CONCLUSION In clinical practice, it is of great importance to know the origin variations of the lateral circumflex femoral artery while planning and performing various surgical and invasive diagnostic procedures in the inguino-femoral region.

INTRODUCTION This paper presents two cases of very rare tumors of breast: breast sebaceos carcinoma, which has rarely been described in medical literature, and breast carcinosarcoma. Morphological characteristics and biological behavior of sebaceos carcinoma are still rather vague. Carcinosarcoma of the breast is a rare malignancy with distinct cell lines described as a breast carcinoma of ductal type with a sarcoma-like component. CASE REPORT The first presented case is a 73-year-old female referred to our hospital in January 2008 with tumor of the right breast in the upper outer region of the breast and enlarged lymph nodes in the right axillary region. The second presented case is a 51-year-old female with carcinosarcoma, also a very rare primary breast tumor. She was admitted to our hospital in June 2011 with history of lump in the upper and lower outer quadrant of the left breast. In both cases, biopsy of tumor tissue was carried out with a thin needle, i.e. the aspiration cytology was applied as a diagnostic method, and during the operation the fast diagnostics of frozen sections and cytologic diagnostics were done. Although this methodology is important in diagnosis, in both cases it showed certain limitations in diagnosing such rare tumors. The final diagnosis was made after carefully synthesizing the histological findings and immunohistochemical phenotype. CONCLUSION An accurate classification of breast tumors on cytological preparations is not possible in case of poorly differentiated and rare tumors. A careful and accurate classification of these tumors is necessary.

INTRODUCTION Acute bleeding from the upper gastrointestinal system is a medical emergency which is followed by high mortality rate, ranging from 6 to 15% in spite of modern diagnostic methods and treatment. Bleeding from the upper gastrointestinal system may be caused by gastrointestinal stromal tumors of the stomach, which are mainly characterized by occult bleeding, while profuse bleeding rarely occurs accompanied by hemorrhagic shock. Gastrointestinal stromal tumors of stomach are the most common mesenchimal tumors of the gastrointestinal tract. CASE REPORT In our study we showed a 60-year-old female patient with profuse bleeding from the stomach and the clinical picture of severe hemorrhagic shock, caused by gastrointestinal stromal tumor. An ovoid junction, raised towards the lumen, covered with ulcerated mucosa in several places and followed by massive arterial bleeding was found intraoperatively, after the performed gastrotomy. Histopathological examination with immunohistochemical analysis confirmed that this was a gastrointestinal stromal tumor of the stomach. DISCUSSION Acute bleeding from the digestive system is a sudden and serious condition of the body. Urgent esophagogastroduodenoscopy is a sensitive and specific diagnostic and therapeutic method of choice. Massive bleeding from the upper gastrointestinal tract is very rarely caused by gastrointestinal stromal tumors, whose clinical picture is very heterogeneous and depends on tumor size and location. Abundant bleeding from the tumor is an indication for urgent surgical intervention. CONCLUSION According to the literature massive hemorrhage of the upper digestive system can rarely be caused by gastrointestinal stromal tumor of the stomach. It is shown that abundant hemorrhage of the upper digestive tract can be caused with gastric gastrointestinal stromal tumor. Surgical resection is the main form of treatment of gastrointestinal stromal tumors of the digestive system and bleeding from these tumors caused by failure of endoscopic hemostasis.

<p><strong>Introduction.</strong> Extramural venous invasion (EMVI) is a significant predictive factor of the prognosis for patients with colorectal carcinoma and it is directly connected with the relapse of a disease, especially with the appearance of distant metastases. <strong>Methods.</strong> The research comprises 90 patients with colorectal cancer. Representative samples of tumor tissues obtained by surgical resection are fixed in 4% formalin and embedded into paraffin blocks. Semi-series incisions of 4&mu;m thickness were stained by HE method and Van Gieson&rsquo;s method. <strong>Results. </strong>Out of 90 analyzed patients, 21 (23,33%) were with EMVI, and 69 (76.67%) without EMVI on the histological preparations stained by HE method. EMVI was found in 7 more tumors on the preparations stained by Van Gieson&rsquo;s method. Sensitivity of the method determining EMVI on the histological preparations stained by Van Gieson&rsquo;s method was better for 25% (7/28) than on the preparations stained by HE method. EMVI was not found in patients at A and B1 stage of disease according to Astler- Coller classification, but out of 77 patients which were at B2, C1 and C2 stage EMVI was found in 28 (36,36%) patients, p&le;0,01. EMVI was found in 18/77 (23,38%) patients who had a tumor of low histological gradus, p&le;0,01 and in 10/13 (76,92%) patients who had a tumor of high histological gradus, p&le;0,01. In patients with neural invasion, EMVI was found in 18/22 (81,82%), whereas in patients without neural invasion EMVI was found in 10/68 (14,71%), p&le;0,01. In patients with weak intensity of peritumoral lymphocytic reaction EMVI was found in 20/41 (48,78%) whereas in patients with moderate and noticeable level it was found in 8/49 (16,33%), p&le;0,01. There was a significant correlation between extramural venous invasion and other parameters of unfavorable prognosis. <strong>Conclusion.</strong> EMVI is an important indicator in administration of postoperative adjuvant therapy in patients with colorectal carcinoma. A special histochemical method of elastic fiber stain should be applied in everyday practice when EMVI is not found on HE stained preparations in patients with CRC.</p>

<p><strong>Introduction. </strong>The Bcl-2 gene codes an oncoprotein, inhibits a programmed cell death or apoptosis and it plays a very important role in colorectal cancerogenesis. The aim of our study is to determine Bcl-2 expression in colorectal carcinomas in relation with the stage of disease, histology of tumor type, localization and macroscopic growth pattern. <strong>Methods.</strong> Immunohistochemichal detection of Bcl-2 protein expression was carried out on 90 resected colorectal carcinomas. The patients were divided into three groups according to the degree of Bcl-2 expression in a tumor: group 0 - there were no cells with positive immunohistochemical reaction; group I- up to 20 % of positive cells, and group II- above 20% of positive cells. The groups were compared in relation to the stage of disease, T stage of local spread of disease, histology of tumor type, localization and macroscopic growth pattern. <strong>Results.</strong> 58% of patients at the second stage of disease had no expression of Bcl-2. Higher percentage (61%) of the patients with metastases ( stages III and IV) had high level of Bcl-2 expression. Tumors with polipoid growth pattern have higher level of Bcl-2 expression. <strong>Conclusion. </strong>There is a statisticaly significant difference in Bcl-2 protein expression in patients surgically treated at the II and III stage of disease, stage T3a/b, T3c/d of local spread of disease and tumors whith polipoid growth pattern in relation to infiltrative growth pattern.</p>