Biomedical subjects

M Micev

Publications and source records attributed to M Micev.

At least 19 recordsLinked to original sources

PubMed2006

Endoscopic removal of pedunculated leiomyoma of the sigmoid colon (case report and literature review of dignostic and treatment options).

Colonic leiomyoma are remarkably rare cause of colonic symptoms in clinical practice. They constitute only 3% of gastrointestinal leiomyomas and complete endoscopic removal of the tumour can be a problem because of its submucosal origin. We describe a 62-year female patient with a 8 mm leiomyoma of sigmoid colon that was successfully removed by conventional endoscopic snare electrocauterisation, without complications.

Colonoscopy↗

PubMed2005

[The role of endoscopic ultrasound(EUS) in differential diagnosis of subepithelial oesophago-gastric lesions].

BACKGROUND: Endoscopic ultrasonography(EUS) allows high-resolution demonstration of the entire gut wall. The aim of the study was to clarify the usefulness of the EUS in differential diagnosis of upper gastro-intestinal subepithelail lesions(SEL). METHODS: From September 1998- March 2005, EUS was performed in 1600 patients. Among them, in 206pts (13%), this examination was carried out due to previous upper endoscopy, which revealed the suspicion to SEL or extraluminal compression. We studied the location, the size, echo pattern and originating layer of SEL. The results were compared with CT, angiography and operation with histology when possible. All EUS examinations were performed using Olympus GIF-130 videoecho-endoscope with 7,5/12MHz switchable radial probe. RESULTS: EUS accuracy in separating intramural masses from extraluminal compression was 96%(44/46). Among 160 pts with true SEL, in 95(59.3%), EUS revealed the existence of a stromal tumor arising from muscularis propria (92) or muscularis mucosae (3). The size of the tumor varied from 5-75mm; depth: 8-40mm. 33 patients were operated on. In 14/16(87%), the EUS diagnosis of benign stromal tumor was confirmed on operation. In 18/19(95%), EUS correctly disclosed the malignant tumor. EUS accuracy in predicting malignancy was 91.5%(32/35). Findings suggestive for malignancy were: size 40mm; inhomogenicity with microcysts and irregular outer margin. In 12 pts, EUS revealed lypoma. Abberant pancreas was correctly diagnosed in all 22pts. In 16 persons, EUS disclosed submucosal cysts: 6 of them were operated on and EUS diagnosis was confirmed in all. In 10 patients EUS visualized varices. The finding was confirmed on angiography. CONCLUSION: The EUS appears to be very effective in differential diagnosis of SEL in upper gastro-intestinal tract. Tumour size greater than 40mm, inhomomogenous echo pattern and irregular outer margin are very suggestive for malignancy.

Diagnosis, Differential↗

PubMed2005

The significance of lymphonodal micrometastasis in the patients with gastric adenocarcinoma.

Micrometastasis is defined as microscopical deposit of malignant cells, less than 2mm in diameter, separated from the primary tumor. This does not include discontinous growth in peritumoral region, but include microinolvement of regional lymph nodes. The literature on micrometastases, with special resperct to nodal micrometastasis, and their implications in gastric adenocarcinoma have been reviewed. Immunohistochemical detection offer the best accuracy for detection of nodal micrometastasis. Molecular techniques are more sensitive than method of immunohistochemical detection, but methods are compromised with false positive results caused by various sources of biological contamination. It is more than obvious that there is no definite agreement neither about risk factors, nor definitive clinical significance of micrometastatic node involvement in the patients with gastric adenocarcinoma. At present, the role of occult lymph node involvement proved its significance in two major fields: defining criteria for limited surgical dissection in the patients with early (sm) carcinoma in respect to detection of micrometastatic tissue in sentinel lymph node, and distinguishing the category of pN0 (Mi+) patients with potential benefit of postoperative adjuvant therapy.

Adenocarcinoma↗

PubMed2005

[Peritoneal hepatobiliary cystadenoma--case report].

Hepatobiliary cystadenoma with mesenchymal stroma are infrequent form of cystic neoplasm that may be found in females only. It is difficult to reach correct diagnosis prior to surgery. We are presenting a case of 32 years-old female referred to our institution for revealing a cause of discomfort and pain in right subcostal region whereas peritoneal hepatobiliary cystadenoma has been determined. Abdominal ultrasonography and computerized tomography revealed cystic lesion adjacent to gall bladder, which was initially thought to be of echynococcal origin. At surgery, a mesenterial cystic neoplasm has been revealed, having a close contact with gall bladder, without signs of its infiltration. Pathophysiology discovered hepatobiliary cystadenoma with mesenchymal stroma. Pre-surgical differential diagnosis in hepatobiliary cystadenoma may be very difficult, especially if, like in the presented case, neoplasm has extra hepatic localization. Radical surgical excision is treatment of choice, concerning malignant potential of these neoplasms.

Adult↗

PubMed2004

Histopathology of residual rectal carcinoma following preoperative radiochemotherapy.

Preoperative radiotherapy with (CRT) or without chemotherapy (RT) in the management of patients with locally advanced rectal carcinoma is increasingly accepted as therapeutic modality to reduce local recurrence and improve survival, decrease tumor size and/or stage, has less toxicity compared to postoperative therapy, improves sphincter preservation and the ability to perform a curative resection. In a brief review of literature we discussed the possible prognostic role of most important pathologic parameters and their clinical implications. At present, predictive value of tumor response to neoadjuvant therapy remains uncertain, whether evaluated as five-point histological tumor regression grade (TRG) or recently proposed three-point rectal cancer regression grade (RCRG). However, most reports emphasize reduced local reccurence rates and disease-free survival advantage in patients with complete tumour regression or tumour down-staging, occuring in up to 20% and 60% of cases, respectively. Patients with advanced post-treatment tumour stage (ypT3/4), positive lymph nodes (ypN1/2), vascular invasion, positive circumferential resection margin, clearance < 2mm, or absence of tumor regression are shown to have poor clinical outcome. Among CRT-induced morphological features, only "fibrotic-type" stromal response with minimal inflammatory infiltrates and absence of surface ulceration are correlated to recurrence-free survival. Preliminary unpublished results of a pilot study from our multidisciplinary prospective trial relate to correlation of histopathologic parameters and morphologic changes to rectal cancer regression grade (RCRG). Therefore, we studied 22 consecutive patients, mean age 56 (range 23-69) years, with transmural cT3/4 stage and were subgrouped as follows: RCRG-1 (7 patients, 31.8%), RCRG-2 (9 patients, 40.,9%) and RCRG-3 (6 patients, 27,2%). In addition, 14 patients (63%) showed tumour downstaging and only 1 patient (4.5%) nodal down-staging after ypTNM restaging. There was the predominance of fibrotic-type stroma (16 patients, 72.8%) versus fibro-inflammatory response (6 patients, 27.2%), frequent tumoral necrosis (13 patients, 59%) but infrequent surface ulceration (5 patients, 22.7%) and peritumoural eosinophylic infiltration as well as endocrine cell differentiation (4 patients, 18%). The second aim of our study was to investigate determinants of radiosensitivity, i.e. the relationship between proliferative activity indices (Ki-67 and PCNA) as well as the induction of apoptosis (p53) and the tumour regression (RCRG) after neoadjuvant CRT. The interaction between Ki-67 and PCNA immunoexpression levels and the benefit of CRT was significant for Ki-67 (p = 0.03), but not for PCNA (p = 0.08) and p53 levels (p = 0.4). In a conclusion, high percentage of Ki-67-positive tumor cells in the preoperative biopsy predicts an decreased treatment response after preoperative CRT of rectal cancer. However, long-term follow-up and large studies are necessary to establish the value of regression grade and the need for its prediction by reliable biological markers.

Adult↗

PubMed2003

Isolated choroidal metastasis from primary adenocarcinoma of the distal esophagus: a case report.

We present a case of a 41-year-old male patient who, 1 year after transhiatal esophagectomy and transmediastinal gastroplasty for an adenocarcinoma of the distal esophagus, presented with an isolated metastasis in the choroids of the left eye. Because of pains caused by secondary glaucoma, enucleation of the left eyeball had to be performed as the treatment of choice. At 1 year after surgery of the eye, the secondaries in both adrenal glands were revealed. Despite the applied chemotherapy, the patient died with signs of generalized disease 3 years after the initial surgery.

Adenocarcinoma↗

PubMed2002

Changing pattern of cytokeratin 7 and 20 expression from normal epithelium to intestinal metaplasia of the gastric mucosa and gastroesophageal junction.

It is currently unclear whether intestinal metaplasia at the esophagogastric junction and in the distal esophagus represent a continuum of the same underlying disease process, i.e., gastroesophageal reflux, or constitute different entities with a different pathogenesis. Biopsies below the Z line might show specialized epithelium in some patients and the question is whether this is another form of short segment Barrett's esophagus or whether it is related to a generalized atrophic process of the stomach. Data from recent studies regarding the expression of cytokeratin CK7 and CK20 in intestinal metaplasia (IM) found at the gastroesophageal junction are conflicting. Prompted by these data we undertook the present study: a) to evaluate the expression of CK7 and CK20 in IM of the gastric cardia and to compare the findings with those in patients with Barrett's esophagus and IM of the gastric corpus and antrum mucosa; and b) to evaluate the immunophenotype of non-intestinalized cardiac mucosa and to compare it with that of normal gastric epithelium. We studied the expression of CK7 and CK20 on biopsy specimens from patients with long-segment Barrett's esophagus (n=17) and surgical resection and biopsy specimens of gastric cardia (n=15), corpus (n=14) and antrum (n=22) from patients with histological evidence of IM. Eighty-four biopsy specimens from 42 patients (antrum n=15, corpus n=20, cardia n=7) without evidence of IM were studied as a control group. We observed an immunophenotype characterised by diffuse moderate to strong CK7 staining on the surface and crypt epithelium combined with strong CK20 staining on the surface and superficial part of the crypts in 94.1% (16/17) of the cases with long-segment Barrett's esophagus, but in none of the 36 cases with IM in distal stomach (antrum and corpus). IM in the gastric cardia expressed the immunophenotype seen in IM of the gastric mucosa in 93.3% (14/15) of the cases. On the other hand, normal cardiac epithelium expressed patchy strong CK7 staining on the surface epithelium and on both, superficial and deep parts of the pits combined with patchy strong CK20 staining on the surface epithelium and superficial pits, a feature permitting distinction of the normal cardiac epithelium from those of the normal gastric antrum and corpus epithelium. We conclude that the expression of cytokeratins 7 and 20 can be used to distinguish the origin of IM of the gastroesophageal junction. The CK7/20 immunophenotype of IM in the gastric cardia closely resembles that of the IM in the gastric antrum and corpus and is different from IM in long-segment Barrett's esophagus. In contrast, the CK7/20 immunophenotype of the cardiac epithelium is different from that of the gastric antrum and corpus mucosa, suggesting that cardiac epithelium might not be a native normal gastric epithelium but one that is acquired as a consequence of longstanding inflammation. Changing pattern of CK7 and CK20 expression from normal to intestinalized epithelium suggests that IM arising from cardiac epithelium might have distinctive features.

Barrett Esophagus↗

PubMed2002

[Non-functioning tumor of the islets of Langerhans].

About 15% of tumors of Langerhans, islets do not cause any hormone induced syndrome although they sintetise and secrete one or more regulatory peptides. These tumors are most frequently localised in the head and tail of the pancreas. They are usually greater then 5 cm. In diameter and present with pain, jaundice, palpable mass and malaise, rarely with variceal bleeding due to compression of the splenic vein. About 50% of the tumors present with symptoms caused by metastases. We present a 51 year old women in whom during the investigation for paraumbilical pain, predominantly on the left side a tumor of the tail of the pancreas was discovered and subsequently surgically removed. Standard histology showed a neuroendocrine tumor. Immunohistochemistry showed generalised immunoreactivity with antibodies against chromographin A, neuron specific enolasa and glucagon in more then 95% of cells. Somatostatatin was coexpressed in more then 5% of cells, PP in rare scattered cells. No reactivity was found for the other hormone markers. Ten years after surgery the patient has no signs of tumor recurrency.

Female↗

PubMed2002

Local recurrence and five year survival after abdominoperineal resection of the rectum due to rectal carcinoma.

In the period 01.01.1991-12.31.1996, 523 operations due to rectal carcinoma were performed on the First Surgical Clinic, the Third Department for Colorectal Surgery. Most common localization of tumor was in the distal third of the rectum 65.2%. In the middle third, there were 28.9% and in the upper, intraperitoneal third 5.9%. We performed 286 low anterior stapled resections, 93 anterior resections with hand-sewn anastomosis and 144 Abdominoperineal excisions of rectum (Miles procedure). Pathohistological examination revealed adenocarcinoma in all cases. In this study we analyzed local recurrence and five-year survival after long-term follow-up in the group where Miles procedure was carried out as a potentially curative procedure (except 4.9% cased with Dukes D stage). There were 74.3% males and 23.7% females median age 59.2 years. According to Dukes classification there were 4.9% in stage A, 47.2% in stage B, 43.1% stage C, and 4.9% stage D. There were 4(2.7%) postoperative deaths. Recurrence of the disease was registered in 44 (30.5%) patients. Local recurrence alone was found in 14 (9.7%) patients, while distant spread was registered in 30 (20.8%) patients. At present, the median follow-up is at 72.9 months. Analysis by the Kaplan-Meier's test shows cumulative survival of 61%, and disease free survival of 63.4% at 60 months of the follow-up. Dukes C is associated with a very poor prognosis; survival after 60 months of follow up shows cumulative Survival of 0.35 while Dukes B has far better prognosis (0.86). Analysis of disease free survival by Dukes stage shows that Dukes C has the worst prognosis (disease free survival 0.36 after 60 months), while stage B has much better prognosis (0.84). Local recurrence analysis by the Kaplan-Meier's test shows disease free survival of 84.9% at 60 months of follow-up. Analysis of local recurrence by Dukes stage shows 1.00% disease free survival for cases in stage A, 0.94 for Dukes B and 0.66 for Dukes C, while overall comparison between groups regarding local recurrence using the Wilcoxon (Gehan) statistic shows statistically significant difference (p-0.005). There is no statistical difference between Dukes A and Dukes B cases in distribution of local recurrence.

Adenocarcinoma↗

PubMed2001

Leiomyosarcoma of the duodenum. A successful reoperation after recurrency.

Leiomyosarcomas of the duodenum are rare tumours. Approximately 160 cases have been reported so far. Pain, bleeding and duodenal obstruction causing vomiting and weight loss are the leading symptoms. The mass may be palpable. If resected, prognosis is favorable in a majority of cases, much better then in carcinomas of the duodenum. Patients have to be followed up as eventual recurrencies are frequently suitable for resection. We present a 62 years old male who was submitted to cephalic duodenopancreatectomy for duodenal leiomyosarcoma (reported earlier) who developed recurrency 6 years after original surgery and in whom a successful reoperation was performed. Two years after second surgery the patient stayed disease free.

Duodenal Neoplasms↗

PubMed2001

[Topographic and structural characteristics of the minor duodenal papilla].

The study of minor duodenal papilla topography and structure was carried out on 36 fresh autopsy specimens of human duodenopancreas. We performed precise measurements of its distance to the major duodenal papilla and to the superior duodenal flexure. There was no correlation between the position of the minor papilla and the incidence of duodenal ulcer disease. Microdissection and histological staining of the minor papilla did not reveal an anatomically defined sphincter around the terminal portion of the accessory pancreatic duct. All the specimens of the minor papilla contained within acini of pancreatic tissue. A terminal dilation of the accessory pancreatic duct was found in 22% of the cases.

Adult↗

PubMed2000

[Indeterminate colitis (nonspecific inflammatory bowel disease)].

Distinguishing of indeterminate colitis from ulcerative colitis or Crohn's disease in more than 10% of IBD cases as separate diagnostic category (IIBD) is defined by: first, overlapping or paucity of features of two major IBD forms in acute fulminant colitides and few chronic slowly progressive cases without differentiating markers of chronicity, and second, inability to reach specific diagnosis during or after completed clinical, radiological, endoscopical and histopathological examination of chronic colitis with inconclusive presentation of IBD-compatible cases. It implicates the contemporary category of IIBD, until some new relevant data of further clinical (preferably natural history and course of the disease) and histopathological examination of prior biopsies will possibly reclassify 20-75% of these cases into ulcerative colitis category (up to 40%) or Crohn's disease (up to 25%) at a median of 10 years' follow-up. The presence of ileal and/or perianal disease as well as later evident granulomatous and/or fissuring disease, including cases with pouchitis and diversion colitis in addition, could be helpful in favouring of Crohn's disease. Lacking specific signs of disease, IIBD is not a distinct entity. Still, many patients remain in this category. The most far is acute fulminant disease in adolescents and young adults with unusual distribution of transmural inflammation with deep fissuring ulcerations, sometimes of "collar-stud" type and normal mucosa between them, often with relative rectal sparing. There is significant risk of relapse and complications, but mild clinical course and even spontaneous regression are also reported. Failure of ileal pouch-anal anastomosis surgery is about 20% more frequent then in ulcerative colitis with overall worse prognosis in life expectations. Diagnostic problems and the main presentations are discussed in detail, as well as genetic and etiopathogenetic basis for heterogeneity of IBD.

Adult↗

PubMed2000

[Metastasis of malignant melanoma in the small intestine--case report].

Small bowel metastases of the malignant melanoma are usually discovered in 2-5% of the patients with malignant melanoma of the skin during the life. They are usually being diagnosed with a complication on the small bowel, such as occlusion, bleeding, anemia and perforation of the intestine. Authors show three patients with metastases of the malignant melanoma in the small bowel, which lead to invagination, subocclusion and anemia due to bleeding. In all the patients, resection of the small bowel was performed with termino-terminal anastomosis. One of them lived 7, the other 4 months after the surgery and is in pretty well condition, while third patient was not controlled at all.

Aged↗

PubMed2000

[Reconstruction of the hypopharynx and cervical esophagus using a free jejunal graft].

Extensive malignant tumors of the hypopharynx and cervical esophagus continue to challenge surgeons in respect to both type and extent of resection as well as type of reconstruction. In the period between November 1st, 1996 and November 1st, 1998, at our Department, five patients have been operated due to squamocellular carcinoma of the hypopharynx using a free jejunal graft reconstruction method. The first free jejunal graft operation due to hypopharyngeal carcinoma, at the same time the first operation of this kind ever done in our Country, was performed on November 13th, 1998. There were 4 female and one male patient, average age 47.75 years. Disfagia for solid foods was a leading symptom in all patients (mean duration of 3.5 months) and was always accompanied with weight loss (average of 8 kg for two months). In all patients barium swallow, endoscopy, CT as well as intraoperative endoscopy was performed. Radical surgical procedure was always accompanied with the bilateral modified lympf node neck dissection. As a arterial donor vessel superior thyroid artery was used in all patients. As a venous drainage in three patients a external jugular vein was used and in two facial vein. Reconstruction using a free jejunal graft of approximately 25 cm long was performed in all patients creating upper, oropharingeal, anastomosis end to side and distal, esophageal, end to end (in only one patients side to end) using 3/0 apsorbable sutures. Mean duration of the operation was six hours. The postoperative course in all patients was uneventful. On the 9th postoperative day gastrografin and three days later barium swallow radiography was performed as a standard control study. Regular check ups were done on three, six, nine months, year and two years. On all controls all patients were symptom free and feeling well. It is our opinion that in the patients with isolated carcinoma of the hypopharynx due to low morbidity and mortality rate, free jejunal graft method is the surgical procedure of choice.

Carcinoma, Squamous Cell↗

PubMed2000

[Surgical treatment of cardial carcinoma].

In the period from 1970 to 1996, in the Departmenf of Esophagogastric Surgery, Belgrade, Yugoslavia 562 have been operated with curative intent due to cardiac carcinoma. Since 1970 until 1985, in 182 patients a distal esophagectomy and proximal gastrectomy followed by eosphagogastro anastomosis had been performed. In the period between 1982 and 1996, a distal esophagectomy with total gastrectomy and radical or extended radical dissection and intrathoracic esophagojejuno anastomosis in 380 patients (192 hand sewn 3/0 interrupted sutures and 188 spapled anastomosis) had been performed. In our opinion for the majority of patients with advanced cardiac carcinoma distal esophagectomy and total gastrectomy, via the left thoracoabdominal approach, with D2 pancreas preserving splenectomy and dissection of lymph nodes in stations 16a1 and 16a2 is a surgical therapy of choice. Overall complications of such a procedure not differ in type and number from those after standard total gastrectomy and D2 dissection.

Adenocarcinoma↗

PubMed2000

[Surgical strategy in the treatment of primary lymphoma of the stomach].

Primary gastric lymphoma has been traditionally accounted for only 1-7% of all malignancies of the stomach. During the period 1980-1996 in Department of Esophagogastric Surgery of University Surgical Hospital in Belgrade 41 patients have been operated due to primary gastric lymphoma. Radical surgery is the only therapeutic procedure in more then 45% of patients. It is also a safe procedure with specific complication rate less then 22%, and specific mortality rate less then 5%. In our experience, total gastrectomy with systematic lymphadenectomy is a therapy of choice in most patients with primary gastric lymphoma.

Adult↗

PubMed2000

[A large duplication cyst of the proximal section of the stomach in an adult--case report].

Intestinal duplication is a rare congenital anomaly. It appears through out entire gastrointestinal tract, specially in the ileum. Gastric duplication cyst in adults is extremely rare. Diagnosis is often missed, often established at operation. Preoperative diagnosis may be suspected on CT or MRI with contrast given oraly as well as on EUS. Management of symptomatic gastric duplications is surgical. Recommended management is complete exscision of the duplication without major violation of the gastric lumen. In most cases giant cyst does not allow smaller resection but partial gastrectomy. In this report a rare case of gastric duplicatione cyst of the proximal stomach is presented. Diagnostic finding and surgical therapy are discussed.

Adult↗

PubMed2000

[Localized plano-cellular type of Castleman's disease].

Castleman was first to study lymphoid tumour of the mediastinum with characteristic histologic features which had until then been mistaken for thymommas grossly, radiologically and histologically. It was soon evidented that the condition occurred in regions other then the mediastinum and even in places where lymph nodes are not normally presents. Localised plasma cell type is rare variant of Castlemans disease, especially as an intraabdominal variant. Most patients present with local symptoms, but general malaise or fever, anaemia, elevated sedimentation rate, polyclonal hypergamaglobulinemia etc. can be present. Using preoperative imaging procedures solid, well-circumscribed expansive mass can be detected. After surgical excision and patohistological examination diagnosis can be established. In this paper we report rare case of localised plasma cell type of Castlemans disease. Other types of disease, diagnostic findings and therapeutic possibilities are discussed.

Abdominal Neoplasms↗