Background: Peritoneal lymphangiomatosis is a rare benign lymphatic disorder with diagnostic and therapeutic challenges. It may mimic peritoneal carcinomatosis or mesothelioma, often requiring histological confirmation. Management options are limited, and long-term data on targeted therapies, including sirolimus, remain scarce. Case Presentation: We present the case of a 45-year-old woman with a history of surgically corrected atrial septal defect, who developed progressive abdominal distension and dysuria in May 2014. Abdominal ultrasound (US) and contrast-enhanced abdominal computed tomography (CT) revealed diffuse ascites, peritoneal thickening, and cystic changes. Diagnostic uncertainty led to an exploratory laparotomy in May 2015, where histopathology confirmed peritoneal lymphangiomatosis. After failed conservative management including dietary modification, diuretic therapy, and repeated paracenteses, she was started on sirolimus 2 mg/day in August 2016. Her serum trough levels were maintained between 5–15 ng/mL. She achieved a Karnofsky Performance Score of 100% (indicating full functional capacity) within two months and has remained in complete clinical and radiologic remission for over 8 years. Diabetes mellitus type 2 was diagnosed during follow-up and is well controlled with insulin therapy. Conclusion: This case underscores the difficulty of diagnosing peritoneal lymphangiomatosis and highlights the transformative potential of sirolimus therapy. To our knowledge, this is one of the longest documented remissions of peritoneal lymphangiomatosis under mechanistic target of rapamycin (mTOR) inhibition. Keywords: peritoneal lymphangiomatosis, sirolimus, mTOR inhibitor, rare disease, ascites, lymphatic malformation, case report, remission, Karnofsky score, targeted therapy.

Sex cord-stromal tumors are rare ovarian neoplasms, with fibromas comprising approximately 4% and thecomas accounting for 0.5%–1% of all ovarian tumors. The occurrence of these tumors outside the ovaries is exceptionally rare and diagnostically challenging, often mimicking malignancy when associated with ascites, elevated CA-125 levels, or Meigs-like syndrome. This review aims to synthesize current knowledge on the histopathological, immunohistochemical, radiological, and molecular features of ovarian fibroma-thecoma group tumors and highlight their clinical relevance. We report two postmenopausal women with large abdominal masses located extraovarian: one in the broad ligament and the other adherent to the omentum and intestines. In the first case, markedly elevated CA-125, ascites, and pleural effusion initially suggested Meigs syndrome. The second case presented with an abdominal mass and ascites. Imaging studies indicated the possibility of malignant ovarian tumors in both patients, leading to surgical excision. Histopathological examination revealed spindle-to-oval tumor cells arranged in fascicular or storiform patterns, with focal lipid-rich theca-like cells. Immunohistochemical analysis showed that the tumors were positive for vimentin, WT1, progesterone receptor (PR), and variably for estrogen receptor (ER), CD56, inhibin, and calretinin, while being negative for markers of epithelial, melanocytic, and gastrointestinal stromal tumors. A review of the literature identified only 11 well-documented cases of extraovarian fibroma-thecoma group tumors, which most commonly arise in the broad ligament or pelvic cavity. These cases are frequently associated with ascites and elevated CA-125 levels and are often misdiagnosed preoperatively as malignant disease. Our cases underscore the importance of considering extraovarian fibromas and thecomas in the differential diagnosis of pelvic and abdominal masses presenting with similar features. Accurate pathological assessment can prevent unnecessary radical surgeries and promote more favorable patient outcomes.

Introduction: Various studies conducted in the past few years have shown a causal relationship between human papillomavirus(HPV) and benign and malignant lesions on the laryngeal mucosa. There are no other studies on the association between HPV and laryngeal lesions in Bosnia and Herzegovina. The aim of the study was to investigate the influence of HPV infection on the development of benign and malignant lesions in the larynx. Methods: Samples for the recommended HPV analysis were taken using cotton swabs from Digene’s Specimen Collection Kit (Sample Collection Kit) from the surface of the affected area of the laryngeal mucosa with a gentle rotational movement through the directoscope. Detection of the presence of HPV in the endolaryngeal swab was performed using Digene’s HPV test-Hybrid Capture II, and results were obtained on a DML 2000 luminometer.Results: In this study, a total of 40 patients were enrolled. Among them, 17 cases (42.5%) presented with benign lesions of the larynx, whereas 23 cases (57.5%) had malignant lesions. Within the group of 17 cases with benign lesions, 5 tested positive for HPV: 2 for high-risk HPV (HR HPV), 2 for low-risk HPV (LR HPV), and 1 for both high-risk and LR HPV. Among the 23 cases with malignant lesions, 11 (47.83%) were HPV positive: 5 for HR HPV, 4 for LR HPV, and 2 for both high-risk and LR HPV. Conclusion: Our findings underscore the noteworthy influence of HPV infection on both benign and malignant changes in the laryngeal mucosa. However, future studies necessitate larger sample sizes and the identification of specific virus types.

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.