Abstract Introduction: Melkersson Rosenthal syndrome (MRS) is a disease of multifactorial origin typically presented with a triad of symptoms including peripheral facial nerve paralysis, plicated tongue and orofacial edema. Diagnosing MRS requires the exclusion of other granulomatous diseases and the correlation of clinical with histopathological finding. Case presentation: We present the case of a 56-year-old female with a four-month history of lower lip and right mandible angle swelling together with a plicated tongue that appeared during COVID-19 infection. The patient was successfully treated with intralesional Triamcinolone Acetonide at a dose of 40 mg. Conclusion: The presented case is specific by its late onset since the patient experienced their first symptoms in fifties, which differs from the majority of cases where the diagnosis is usually established in young adults. Infectious factors are established as possible etiologic factors of MRS, but few cases are described to be triggered or worsened by COVID-19 infection.

Background: Basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer. Although there has been a noticeable increase in incidence over the last decades, the exact incidence is difficult to establish, because data and cancer registries are heterogeneous among countries. Objective: The study aimed to analyze the recent clinical trends of basal cell carcinoma by reviewing a six-year single institution’s experience. Methods: A total number of 582 patients with histologically diagnosed BCC were included in the study. All relevant data were collected from medical records and patients, using short questionnaire. Results: BCC was slightly more common among the male population with female to male ratio of 1:1.24. At the time of diagnosis, male patients were statistically significantly older (70.47±11.9 years) compared to female patients (67.64±12.22 years) (p=0.005). The most common types of BCC were nodular (51.64%) and superficial (25.95%), affecting most commonly the head and neck region (71.2%). Relative risk (RR) for development of BCC is 2.79 times higher in sun-exposed skin areas (p<0.001). Conclusion: Sun exposure remains one of the most important risk factors for the development of BCC, with episodes of sunburns, occupational and recreational risks noted among the majority of patients. Although non-fatal disease, due to morbidity and high frequency, prevention and early diagnosis are important to prevent further increase in the incidence of BCC among the population.

Abstract Objective of this study was to identify the histopathological patterns and their frequency in testicular biopsy specimens from azoospermic patients and to categorize it according to Modified Johnsen scoring system. Methods: Testicular biopsies from male patients with clinical diagnosis of azoospermia were included in this study. All tissue samples were fixed in buffered 10% formalin, routinely processed and stained with Hematoxylin and Eosin. All cases were examined microscopically and categorized according to the histopathological patterns and Modified Johnsen scoring system. Results: Total 219 cases of testicular biopsies from 125 azoospermic male patients were evaluated, with 94 cases of bilateral testicular biopsy. The most prevalent age group was of 30-39 years (66.2%). The most common histological pattern was of Sertoli cell only syndrome (58.4%) while the least represented pattern was germ cell maturation arrest, seen in 4.6% cases. The most common Modified Johnsen score was 2 (66.7%). There was discordance in histologic pattern in both testes in 12.76% of patients who had bilateral testicular biopsy. Conclusion: Our study gives an insight on the most common histopathological patterns of azoospermic patients and emphasizes the need for a better national statistics and epidemiological studies of this entity. It also points out the significance of the bilateral testicular biopsy, as both, diagnostic and therapeutic procedure.

Abstract Introduction: Bones, lungs, brain and liver are the most common metastatic sites of breast carcinoma, although invasive lobular carcinoma can give metastases to less common sites, such as the gastrointestinal tract and the female genital tract. Case presentation: We present the case of a 57-year-old female with colic abdominal pain that was sent to surgery for cholecystectomy. Histopathology revealed a poorly cohesive individual or in single file neoplastic cells infiltrating all layers of the gallbladder. Immunohistochemistry revealed these cells to be CK 116, CK7, GCDFP-15, ER and PR positive, and CK20, HER-2, S-100 and E-cadherin negative. PET/CT showed numerous lytic bone lesions, but ultrasound, mammography, MRI and PET/CT revealed no breast mass. Conclusion: Although rare and poorly understood, metastases of invasive lobular carcinoma to gallbladder do exist in a minor percentage of patients, presenting usually as exacerbated cholecystitis. The problem are silent cases and patients with no history of breast carcinoma. This case is unique in that even after the diagnosis of metastatic lobular breast carcinoma to the gallbladder, the primary tumour of the breast was not detected.

Introduction: Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common skin malignancies in the heterogeneous group of non-melanoma skin cancer (NMSC). Due to increasing incidence these tumours remain significant health problem worldwide. Methods: We conducted retrospective analysis to evaluate the incidence of primary BCCs and SCCs in our institution from 2003 to 2022, and to correlate it with available clinical data. Results: We noticed that the incidence of NMSC increased between 2018 and 2022 (p<0.01). Among 1570 patients diagnosed with NMSC, BCC represented 77.9% of cases. BCC was constantly more common type of NMSC with statistically significant difference in the period from 2003-2005 and in the period from 2017- 2022 (p<0.01). Nodular subtype of the BCC was the most common, affecting primarily face. Superficial BCC occurred most commonly on trunk (p<0.01), affecting younger patients than the other histological subtypes (mean age 61.29±13.47 years (p<0.01). High-risk BCCs in men were more common on face and scalp (p<0.05). BCCs were predominantly smaller tumours (<2 cm) in contrast to SCCs with highest incidence in pT2-pT4 group (p<0.01). SCC patients were older (mean age 72.89±9.7) than BCC patients (mean age 65.15±12.80) (p<0.01). Conclusion: In order to improve prevention strategies and prevent further increase in incidence, there is need to develop current and exact registries of these malignancies, especially separately BCC and SCC.

Abstract Morphologic changes in organs vary from nonspecific to specific ones, depending on causes of sudden death, e.i whether it is an acute, subacute or chronic event. The aim of this pilot study was to observe the appearance and occurrence of morphological characteristics on organs that were exposed to long-term effects of hyperthermia. A sample of 7 rats was exposed to a water temperature of 41 °C, which is defined in the literature as “heat stroke temperature”, both sexes, weighing 250 to 300 g were used. Tissue samples, obtained by dissection of rats, were fixed in 10% buffered neutral formalin, at room temperature, then incorporated into paraffin blocks, cut at 4-5 microns, mounted and stained with standard hematoxylin-eosin (HE) method. In order to prove/exclude lipid and glycogen accumulation in hepatocytes we did additional histochemical staining, using Sudan black and Periodic Acid Shiff (PAS) method, respectively. We obtained samples from kidney, liver, pancreas, spleen, lung and brain. Analyzing tissue samples of different organs obtained from seven Wistar rats, we gained insight into morphological changes caused by induced hyperthermia. All sampled organs showed congestion and some degree of oedema. The most prominent changes were observed in liver and lung samples. Tissue samples of the lung of all seven rats showed signs of acute bronchitis and bronchiolitis, together with signs of initial bronchopneumonia. We also noticed signs of focal acute emphysema as well as focal accumulations of foamy macrophages. Our study suggests that changes in the vascular bed occur soon after hyperthermia and while some organs are more tolerant to heat stroke than others, most organs show similar changes consisting of capillary dilation, congestion and interstitial extravasation, observed after 30 minutes at a temperature of 40.5 °C, with the most significant changes observed in liver and lung samples.

Ankylosing spondylitis is a serious ailment that affects people, and the first signs or symptoms usually occurr between the ages of 15 and 45. While the condition is mostly prevalent in men, women are not immune to this disease. This problem is diagnosed with a combination of clinical history and X-rays, pathology and HLAB27 test. The aim of this case study is to demonstrate how macroscopic and microscopic analysis can be used for identification of the disease from a forensic point of view. In April 2018, we exhumed 11 remains near the city Višegrad, twenty-five years after the last war. All the remains were completely skeletonized. The skeleton of a female was specific and shaped like a bamboo branch, with a partial knitting of vertebral bodies in the lumbar region of spine and with total knitting in the thoracic part. The spinous processes were completely knitted. Her son gave informations for verbal autopsy that she had trouble walking and doing normal activities during life. Samples for analysis and pathological diagnostics were used to determine the real bone condition for forensic purposes. To our best knowledge our case is first one in the literature which combines macroscopic and microscopic analysis of AK in exhumed skeletal remains after 25 years of death in modern era of Europe.

Introduction: Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common skin malignancies in the heterogeneous group of non-melanoma skin cancers (NMSC). Due to their increasing incidence, these tumors remain a significant health problem worldwide. The aim is to analyze the relative frequency of primary cutaneous BCC and SCC and to correlate it with the available pathological and clinical features. Methods: We conducted a retrospective analysis to evaluate the incidence of NMSCs in our institution from 2003 to 2022 and to correlate it with patient’s age and sex, together with available pathological and clinical features: Anatomical location, histopathological subtypes of prognostic implications, and size (local stage) of the tumor. Results: We noticed that the incidence of NMSC increased between 2018 and 2022 ( p < 0.01). Among 1570 patients diagnosed with NMSC, BCC represented 77.9% of cases. BCC was a constantly more common type of NMSC, with a statistically significant difference in the period from 2003 to 2005 and in the period from 2017 to 2022 ( p < 0.01). Nodular subtype of the BCC was the most common, affecting primarily face. Superficial BCC occurred most commonly on trunk ( p < 0.01), affecting younger patients than the other histological subtypes (61.29 ± 13.47 years), p < 0.01. BCCs were predominantly smaller tumors (<2 cm) in contrast to SCCs, with the highest incidence in the pT2-pT4 group ( p < 0.01). SCC patients were older (mean age 72.89 ± 9.7) than BCC patients (mean age 65.15 ± 12.80), p < 0.01. Conclusion: To improve prevention strategies and prevent further increases in the incidence of NMSCs, there is a need to develop current and exact registries of these malignancies, especially separately for the most common types – BCC and SCC.

Background: Bone morphogenetic protein -4 (BMP-4) plays important role in many aspects of carcinogenesis but is also involved in progression and metastasis of breast cancer where its precise role is yet to be elucidated. Objective: Since the majority of studies related to BMP-4 expression in breast cancer were conducted on cell lines of mouse models, we aimed to investigate BMP-4 tissue expression in primary human breast cancer and to correlate it with standard pathological factors for breast cancer, progression and survival. Methods: We analyzed immunohistochemical expression of BMP-4 in primary breast cancer tissue of 97 patients, correlated it with standard pathological factors for breast cancer and investigated its impact on progression and survival. Results: BMP-4 expression was positive in 74.23% breast cancer tissue specimens. We found that hormone positive breast tumors are more likely to show BMP-4 strong granular staining pattern (p<0.01; p=0.029, respectively). There was significant association between stage group and BMP-4 expression in order that stage III breast cancer group were predominantly BMP-4 positive tumors (p=0.046). Although the most common site of distant metastases in patients with BMP-4 positive tumors were bones, we found no significant association (p>0.05). Patients with BMP-4 positive breast cancer showed longer overall and progression-free survival, but the results did not reach statistical significance (p>0.05). Conclusion: The results of our study in some extent can confirm the current available data and suggest that the role of BMP-4 in breast cancer is ambiguous, acting both as tumor suppressor and tumor promoter in breast cancer. For final elucidation of its impact on survival and progression in breast cancer, multicentric studies on larger sample size are required.

Aim To investigate the impact of pre-treatment serum total prostate-specific antigen (PSA) level on prevalence of prostate carcinoma detection in prostate core needle biopsy, and its correlation with established prognostic factors. Methods Prostate needle biopsy samples of 115 patients with available pre-treatment serum total PSA (tPSA) level were analysed. For all cases where morphology alone was insufficient, immunohistochemistry was performed using p63, CKHMW and AMACR antibody panel in order to confirm or exclude the existence of prostate carcinoma. Results Statistically significant positive correlation between serum total PSA values and prevalence of finding prostate carcinoma in needle biopsy specimens was found (p=0.011), as well as in the case when the patients were classified into groups according to tPSA levels (p=0.028). Serum total PSA values and levels (level groups) showed significant positive correlation with Gleason score (p=0.029 and p=0.036, respectively) and Grade Group of prostate carcinomas (p=0.044 and p=0.046, respectively). Sensitivity of the screening test by using 4 ng/mL as cut off value for tPSA was 94.12% (CI: 80.32-99.28%), specificity 8.64% (CI: 3.55-17.00%), positive predictive value 30.19% (CI: 21.65-39.87%) and negative predictive value 77.78% (CI: 39.99-97.19%). Conclusion The increase of serum tPSA value increases the likelihood of finding prostate cancer on needle biopsy specimens. Due to such findings and its positive correlation with a grade of prostate cancer, our study indicates that tPSA can still be considered as a useful tool both in detecting and predicting aggressiveness of prostate cancer.

Aim To evaluate the relationship between numerical and categorical immunohistochemical score of Ki-67 and human epidermal growth factor of receptor 2 (HER2) with clinicopathological parameters of breast cancer (BC). Methods The study included 311 patients with invasive BC diagnosed at the Department of Pathology, School of Medicine in Sarajevo, Bosnia and Herzegovina, during the period 2015-2019. The expression level of Ki-67 and HER2 was detected by immunohistochemical analysis. Results The expression of Ki-67, as a numerical variable correlated significantly with tumour grade (p=0.025), progesterone receptor (PR) (p=0.034) and categorical score of HER2 (p=0.028). When Ki-67 was categorized into high (>14%) and low (≤14%) level groups, a statistically significant association was found between Ki-67 level groups and HER2 status (categorical and numerical) (p=0.001 and p=0.043, respectively), as well as significant negative linear correlation with PR (p=0.037). The expression of HER2, as a numerical variable, showed a statistically significant correlation with tumour grade (p=0.038), PR (p=0.025) and categorical Ki-67 (p=0.043). Categorical score of HER2 correlated significantly with age (p=0.025), histologic type (p=0.039), tumour grade (p=0.016), estrogen receptor (ER), (p=0.002) progesterone receptor (PR) (p=0.0001), and categorical and numerical value of Ki-67 (p=0.0001 and p=0.0001, respectively). Conclusion The results demonstrated that the categorical immunohistochemical score of HER2 provided a greater association with clinicopathological parameters than numerical score of BC. Furthermore, a slightly better correlation with clinicopathological parameters was shown by the numerical value than by the categorical score of Ki-67 by applying a cut-off value of 14%.

Introduction: Tumor microenvironment plays a significant role in tumor progression. Tumor stroma is one of the strongest modifiers of tumor cell response, cancer behavior, and cancer progression. This study aimed to investigate the correlation of matrix metalloproteinase-9 (MMP-9) expression and tumor-stroma ratio (TSR) with standard clinicopathological parameters in different molecular subtypes of breast cancer.Methods: Ninety biopsy samples of primary breast cancer diagnosed at the Department of Pathology, School of Medicine, Sarajevo, were selected for this study. The molecular subtype was determined based on the immunohistochemical expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki-67. Stromal and tumoral MMP-9 immunohistochemical expression and the TSR were determined for each tumor.Results: Tumoral MMP-9 expression correlated positively with the presence of lymphovascular invasion (p= 0.016). TSR showed significant association and correlation with tumor grade (G) (p= 0.031; p= 0.049) and tumor size (pT) (p = 0.049;p= 0.021, respectively). Stromal MMP-9 expression correlated with histologic type, histologic grade of tumor, and lymphocytic inflammatory infiltrate (p= 0.021;p= 0.047, p= 0.038, respectively). A higher percentage of stromal MMP-9 expression correlated with the strongest lymphocytic response (p = 0.007). Significant correlation was observed between molecular subtypes and histologic grade of the tumor (p= 0.032).Conclusion: Our results, to some extent, confirm the significance of the tumor microenvironment in breast cancer, especially when it is about stromal MMP-9 expression. Although we observed significant association, without linear correlation, we found no significant correlation between molecular subtypes of breast cancer and MMP-9 expression.

Objective: To investigate a possible association between peritumoral lymphatic vessel density (LVD) and adipose tissue invasion (ATI) of cancer cells at the tumor margin and their correlation with other prognostic parameters in breast cancer, including lymph node status. Material and methods: Data of 75 patients with breast carcinoma were evaluated through combination of peritumoral LVD and ATI at the tumor margin and compared with clinicopathological parameters. Peritumoral LVD was assessed by immunostaining for D2-40 using the Chalkley counting method. Marginal ATI was defined as either the presence of more than 20 cancer cells in direct contact with the adipose tissue or as the presence of cancer cells in the adipose tissue. Cases were evaluated concerning to patient’s age, tumor size using the TNM staging system, histological type, histological grade (Nottingham histological score, Elston and Ellis), lymphovascular invasion, lymph node metastasis, estrogen receptor (ER), progesterone receptor (PR), HER2/neu status and Ki-67. Results: The relationship was identified between LVD and marginal ATI but without statistical significancy (r = -0,207; p=0,113). There was a significant correlation of the marginal ATI with Ki-67 expression (r=0,250; p =0.03). The regression model (all variables according to ATI) showed a significant total effect (p <0.05), where Ki-67 was an only independent indicator of ATI. Conclusion: The present study suggests that adipose tissue invasion of cancer cells at the tumor margin can be a better predictive biologic indicator of aggressiveness than peritumoral lymphatic vessel density in breast carcinoma. Keywords: breast carcinoma, peritumoral lymphatic vessel density, marginal adipose tissue invasion.

Introduction: The aims of this study were to investigate the immunohistochemical expression of cyclooxygenase-2 (COX- 2) and vascular endothelial growth factor-C (VEGF-C), their correlation with lymphangiogenesis, angiogenesis and clinicopathological significance in human gastric cancer. Material and methods: Tissue samples of gastric cancer of 60 patients, who underwent Billroth II resection, were analyzed. The expression of COX-2 and VEGF-C proteins was calculated using a semi-quantitative immunoreactive score method. Quantitative analysis of lymphangiogenesis and angiogenesis was performed according to the method described by Weidner. Lymphangiogenesis was evaluated by immunostaining with D2-40. Angiogenesis was assessed by CD105 immunostaining. Results: There was a statistically significant difference in the mean values of COX-2 (p< 0.01) and VEGF-C (p< 0.05) between gastric cancer samples and in control samples. Angiogenesis was significantly higher in neoplastic tissue then in control group (p<0.001). Expression of COX-2 showed a significant positive linear correlation with angiogenesis (p<0.05). However, COX-2 did not correlate with VEGF-C or lymphangiogenesis. There was an association between VEGF-C and lymphangiogenesis, but without statistical significance. Lymphangiogenesis significantly correlated with lymph node metastasis (p=0.007). Expression of COX-2 showed significant correlation with type of Bormann’s classification (p=0.019) and depth of invasion (p=0.03). Conclusions: The tumor cells are the major source of COX-2 and VEGF-C in gastric carcinomas. Their correlation did not show that COX-2 overexpression promotes tumor lymphangiogenesis through augmentation of VEGF-C. The results of this study suggest that neoangiogenesis is a dominant process during tumor progression, whereas lymphangiogenesis plays an important role in lymph node metastasis. Keywords: angiogenesis, CD105, COX-2, D2-40, gastric cancer, lymphangiogenesis, VEGF-C