Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease in Bosnia and Herzegovina and a major contributor to liver- and cardiovascular-related morbidity and mortality. These national guidelines provide the first country-specific, evidence-based recommendations for the diagnosis, risk stratification, and management of MASLD, covering the full disease spectrum from steatosis to cirrhosis and its complications. MASLD management is based on a coordinated, stepwise model across primary, secondary, and tertiary healthcare levels, with primary healthcare serving as the central gatekeeper and coordinator of care. Active case-finding of clinically significant fibrosis is emphasized, particularly in high-risk populations, such as individuals with type 2 diabetes mellitus or obesity. Primary healthcare plays a key role in early risk assessment through systematic evaluation of metabolic risk factors and first-line use of simple non-invasive tools, notably the FIB-4 index. A stepwise non-invasive diagnostic algorithm is recommended, with elastography (preferably vibration-controlled transient elastography or 2D shear wave elastography where available) used for further assessment in patients with indeterminate or high-risk results. Lifestyle modification and optimal management of cardiometabolic comorbidities remain the foundations of MASLD treatment. In eligible patients with type 2 diabetes mellitus and/or overweight or obesity, glucagon-like peptide-1 receptor agonists may be considered, while bariatric surgery represents an option for selected individuals with persistent obesity. Advanced MASLD, including cirrhosis, requires multidisciplinary management, surveillance for hepatocellular carcinoma, and evaluation for liver transplantation in cases of decompensation. These guidelines aim to standardize MASLD care in Bosnia and Herzegovina and strengthen the pivotal role of primary healthcare within the national MASLD care pathway.
OBJECTIVE:Myxopapillary ependymoma (MPE) is a rare tumor of ependymal origin that commonly arises within the spinal canal. It is rather benign and slow-growing; however, it tends to recur along the central nervous system (CNS), usually after incomplete resection or tumor seeding due to surgical manipulation. Extraneural metastases of MPE are extremely rare, with only a few documented cases in the literature. CASE REPORT:We describe a case of a middle-aged female patient with sacrococcygeal MPE, which was initially misdiagnosed as a pilonidal cyst and subjected to surgical excision. Over the following years, she experienced three local recurrences in the sacrococcygeal region, which were treated with surgery and radiotherapy. Ten years after the initial excision, the patient complained of dyspnea and hemoptysis, and imaging studies revealed multiple right lung nodules. A core biopsy of a lung lesion was performed, and histopathology was consistent with metastatic MPE. The patient was started on chemotherapy with per os temozolomide and has not experienced disease progression for nearly 3 years. CONCLUSION:Extraneural metastases of MPE represent an exceptionally rare and diagnostically challenging entity and should be considered in patients with a history of MPE who present with distant lesions, even years after the initial diagnosis.
OBJECTIVE:Total hip arthroplasty is one of the most common orthopedic procedures. When the surgery is successful and followed by high-quality physiotherapy, the patients' quality of life usually improves. This randomized controlled trial aimed to investigate the impact of anti-gravity treadmills on functional outcomes after total hip arthroplasty. MATERIALS AND METHODS:The trial was conducted at the Special Hospital for Medical Rehabilitation of Heart, Lung, and Rheumatic Diseases Thalassotherapia Opatija. The sample consisted of patients admitted for inpatient rehabilitation three months after total hip arthroplasty. A total of 34 subjects were randomly assigned to two groups: an experimental group (N=18) and a control group (N=16). The outcome measures included abductor muscle strength, range of motion, numeric pain rating scale, Timed Up and Go test, and 40-meter Fast-Paced Walk test. RESULTS:A statistically significant between-group difference was observed only for hip abduction range of motion, favoring the experimental group (P=0.044). The other measured variables did not show any statistically significant intergroup differences. CONCLUSIONS:Anti-gravity treadmill training improved hip abduction range of motion but did not demonstrate superiority over conventional rehabilitation in the other assessed functional outcomes.
Anti-inflammatory activity of acetone extract of plant root sorts Polentilla speciosa Villd. and Potentilla tommasiniana FW.Schultz, Rosaceae was examined. The examined material was picked up in autumn in the surroundings of Sarajevo, dried in thin layer and pulverized immediately before the experiment. Swiss albino mice were used as experimental animals. The examinations word performed on mouse car in groups as presented in the Table 1. As comparing substance 1% hydro-cortisone cream was used. The other ear of the same animal was used as control one. It is found that acetone docs not influence the process of inflammation. The achieved results are presented by changes in car appearance after three days from the moment of examined extracts application. The treated car looked significantly better than untreated car. The examined mice groups and used substances are presented in Table 1. This method of local anti-inflammatory activity examination on mouse car is very suitable for examination because it gives data even for small sample quantities. Examined acetone extracts of plant sorts Potentilla speciosa Villd. and Potentilla tommasiniana FW. Schultz, Rosaceae showed to possess anti-inflammatory activity, and the achieved results can be objectively shown by photographs of the examined samples. Comparing the achieved results, we can come to the conclusion that acetone extract of the plant root Potentilla speciosa Villd. Showed stronger anti-inflammatory activity than the extract of plant root Potentilla tommasiniana FW. Schultz, Rosaceae.
OBJECTIVE:To analyze the characteristics, etiology, diagnostic evaluation, management, follow-up, and outcomes of children with chronic neutropenia treated at a tertiary care pediatric hospital in Croatia. MATERIALS AND METHODS:We retrospectively reviewed the demographic, clinical, and laboratory data of 48 children (23 males and 25 females; median age 7.75 months [IQR 5.13-11.75]) diagnosed with chronic neutropenia between 2013 and 2021. RESULTS:The median absolute neutrophil count (ANC) at presentation was 487/μL (IQR 198.5-837.5), and 52% of the patients had severe neutropenia. Autoimmune neutropenia (AIN) was diagnosed in 21 cases, chronic idiopathic neutropenia (CIN) in 26 cases, and neutropenia in the context of a genetic syndrome in one case. Antineutrophil antibodies were detected in 47% of the children tested. During follow-up, 23% received granulocyte-colony-stimulating factor (G-CSF), and 21% received antibiotics. The median follow-up duration was 21 months (IQR 12-32.75), during which 83% achieved spontaneous remission, with a median time to remission of 13.5 months. Lower ANC at diagnosis was associated with more frequent rehospitalizations, longer time to remission, and longer follow-up. No significant differences were found between AIN and CIN in terms of age, ANC at diagnosis, time to referral, or time to remission, although AIN cases were followed for a longer period. CONCLUSION:Pediatric chronic isolated neutropenia, including AIN and CIN, generally follows a mild clinical course with a low incidence of severe infection. Most children achieve spontaneous remission within one year. Comprehensive genetic testing is essential in children with suspected congenital neutropenia and those with features suggestive of an underlying genetic syndrome. Adherence to European guidelines supports standardized diagnosis, follow-up, and management, thereby improving patient care.
This review synthesizes current evidence on the global epidemiology and prevention of lung cancer, with a focused analysis of the Southeastern Europe region. Lung cancer remains the leading cause of cancer-related mortality worldwide, reflecting persistent exposure to modifiable risk factors and substantial inequities in early detection and treatment access. Data from GLOBOCAN, the Global Burden of Disease study, randomized controlled trials, and population-based registries were used to assess trends in incidence, mortality, and survival, and to examine the evolving distribution of histological subtypes and molecular profiles. While tobacco smoking remains the leading risk factor, a growing proportion of lung cancer, especially among never-smokers, is attributable to non-tobacco exposures, including ambient and household air pollution, occupational carcinogens, and residential radon. Despite advances in targeted therapies and immunotherapy, overall survival remains poor, largely due to late-stage diagnosis. Evidence from landmark trials demonstrates that low-dose computed tomography (LDCT) screening reduces lung cancer mortality primarily through stage migration, enabling detection at earlier, more treatable stages. Southeastern Europe continues to experience a high burden driven by tobacco exposure, limited screening implementation, and restricted access to molecular diagnostics. Inequities in screening eligibility, uptake, and access to advanced therapies worsen survival outcomes across socioeconomic and demographic groups. CONCLUSIONS: Effective lung cancer control requires a multilevel prevention strategy integrating strengthened tobacco control policies, risk-stratified LDCT screening, and equitable access to molecular testing and treatment. Future research priorities include understanding lung cancer in never-smokers, evaluating long-term risks of emerging exposures such as e-cigarettes, and utilizing multi-omics approaches to refine risk stratification and guide targeted therapy.
OBJECTIVE:This retrospective study aimed to record, analyze, and evaluate data concerning patients who underwent total thyroidectomy, focusing on the main indications that led to surgical therapy, as well as postoperative complications and oncological outcomes. MATERIALS AND METHODS:A retrospective study was conducted on 312 patients who underwent total thyroidectomy or lobectomy at the First Department of Surgery of Sismanogleio General Hospital in Athens between 2019 and 2024. Demographic data, indications, intraoperative parameters, complications, and histological findings were recorded. Statistical analyses were performed using SPSS v29.0. RESULTS:Among the 312 patients, 222 (71.2%) were female, and 90 (28.8%) were male, with a mean age of 54.3±13.3 years. Total thyroidectomy was performed in 96.5% of the cases. The main indications were nodular hyperplasia (31.4%), autoimmune thyroiditis (18.9%), multinodular goiter (12.8%), and papillary carcinoma (17.3%). The overall complication rate was 31.7%, with transient postoperative hypocalcemia being the most common complication (25.3%). Permanent hypocalcemia occurred in 1.9% of patients, hemorrhage in 3.5%, and recurrent laryngeal nerve palsy in 1.3% of patients. Papillary carcinoma was the most frequent malignancy, followed by follicular, medullary, and anaplastic carcinomas. Approximately 20% of patients were diagnosed with incidental carcinoma-mostly papillary microcarcinoma-emphasizing the importance of total thyroidectomy, even for benign thyroid diseases. CONCLUSIONS:Total thyroidectomy is a safe and effective therapeutic option with low rates of permanent complications. The systematic identification and preservation of the parathyroid glands, intraoperative nerve monitoring, and meticulous hemostasis are key factors for minimizing inadvertent complications and optimizing outcomes.
OBJECTIVE:To describe the epidemiological, molecular, and genomic characteristics of respiratory syncytial virus (RSV) detected through the national severe acute respiratory infection (SARI) surveillance system in North Macedonia across three consecutive seasons (2022/2023-2024/2025). MATERIALS AND METHODS:This study analysed SARI surveillance data from seven hospital-based sentinel sites. RSV detection and subgroup determination were performed using reverse transcription quantitative polymerase chain reaction (RT-qPCR), following season-specific testing strategies, which should be considered when interpreting seasonal differences in RSV positivity. Consensus genomes were generated, and phylogenetic analyses were performed using contemporaneous European reference sequences. Amino acid substitutions in the G and F proteins were assessed descriptively. RESULTS:Among 1,899 laboratory-tested SARI cases, 53.3% were tested for RSV, of which 24.8% were positive. RSV-A predominated overall, although seasonal shifts in subgroup dominance were observed. RSV infections were concentrated among young children, particularly those aged 0-2 years. Whole-genome sequencing of 85 RSV-positive samples revealed a dynamic seasonal turnover of RSV-A lineages, whereas RSV-B circulation remained largely confined to a single dominant lineage across seasons. Analysis of antigenically important genes showed greater variability in the G gene compared with the more conserved F gene in both subgroups. CONCLUSION:The integration of epidemiological, molecular, and whole-genome data within routine SARI surveillance provides a comprehensive overview of RSV circulation and evolution in North Macedonia. These findings contribute genomic data from an under-represented region and provide a foundation for future evaluation of RSV vaccination and monoclonal antibody effectiveness by detecting viral genetic changes, should such measures be implemented in North Macedonia.
OBJECTIVE:Infantile hemangiomas (IH) are common benign vascular tumors of infancy that typically undergo gradual spontaneous regression over several years, although a minority require treatment. Propranolol, a non-selective β‑adrenergic antagonist, is the first-line therapy for complicated or high-risk IH, demonstrating both efficacy and a favorable safety profile. MATERIALS AND METHODS:We retrospectively analyzed 37 infants treated with oral propranolol at a single center. Patients were monitored in-hospital during treatment initiation and at regular, outpatient visits. The response was assessed using clinical measurements, ultrasonography, and standardized photographs. RESULTS:Most patients had solitary lesions predominantly located in the head region. Complete regression occurred in 26 patients (70.3%) and partial regression in 11 (29.7%). Treatment duration ranged from 2 to 24 months (mean 10.1 months). Adverse events were rare and mild, including one case of hypoglycemia and one of transient somnolence. CONCLUSION:Oral propranolol is a safe and effective first-line therapy for IH, particularly when initiated early during the proliferative phase.
Objective. This study aimed to analyze the frequency of workplace violence against nurses in Croatia, its psychological consequences, and existing institutional measures to address this issue. Materials and Methods. A cross-sectional online survey was conducted among Croatian nurses in October and November 2023 using a convenience sample recruited via a social media platform. The questionnaire included 38 closed-ended questions covering socio-demographic data, experiences of physical, verbal, and sexual violence, and measures implemented to prevent or address workplace violence. Results. A total of 318 nurses participated in the study. Most participants (70%) reported experiencing some form of workplace violence in the past 12 months. Verbal violence was most frequent (66%), followed by physical (21%) and sexual violence (13%). Patients were the most common perpetrators of physical violence (84%), followed by relatives and healthcare staff. No statistically significant differences were found between the reporting of violent incidents and the level of nurses’ education, nor between the intensity of psychological consequences and years of nurses’ work experience. Nearly half of the participants (48%) stated that no formal measures existed in their workplace to prevent or respond to violence. Conclusion. Among nurses participating in this study, workplace violence was frequently reported, while work experience was not associated with psychological consequences. The findings indicate that workplace violence remains a relevant issue and may inform future efforts to improve preventive measures in healthcare settings.
OBJECTIVE:The Yale Physical Activity Survey (YPAS) is one of the most commonly used questionnaires to assess physical activity (PA) levels in older adults. Although previous studies have explored its validity properties against accelerometry, to date, no evidence has been provided in Croatian older adults. Therefore, the primary purpose of this study was to examine whether the YPAS is a valid tool for measuring PA levels. MATERIALS AND METHODS:A total of 46 older women (mean age 72.3±1.2 years) were recruited from three randomly selected public residential aged-care facilities. During the first stage, all participants wore a triaxial GENEActiv accelerometer on their non-dominant hand for 7 consecutive days. After the wearing period, the participants completed the YPAS questionnaire. The correlations between the YPAS and GENEActiv data were calculated using Spearman's order-rank coefficients. RESULTS:The YPAS total PA was positively and moderately correlated with the number of steps, light and moderate PA, and moderate-to-vigorous PA (MVPA; ρ=0.48-0.64), yet a low positive correlation was found with vigorous PA (ρ=0.33). The YPAS total energy expenditure (EE) and the number of stairs performance showed similar correlation patterns with GENEActiv accelerometry data as the total PA (ρ=0.33-0.64). The summary index score exhibited moderate and positive correlations with the number of steps, light, moderate, and vigorous PA and MVPA (ρ=0.28-0.49). CONCLUSION:This study shows that the YPAS is a valid tool for assessing PA patterns in older Croatian adults.
Objective. This review aims to summarize the Henle trunk configurations and tributary patterns presented in cadaveric, intraoperative, and imaging studies. Background. The Henle gastrocolic trunk is a highly variable venous structure formed by the confluence of the gastric, colic, and pancreatic veins. It has notable surgical importance, particularly during laparoscopic procedures, such as right colectomy and pancreaticoduodenectomy. Methods. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted using the PubMed/MEDLINE and Google Scholar databases. Discussion. Twenty-one publications comprising 2,454 cases were analyzed to classify Henle trunk configurations and tributary patterns. The trunk was iden- tified in 92.5% of the cases, with the gastropancreatocolic (GPC) type being the most prevalent (73.1%). A total of 38 unique venous confluences were recorded, highlighting the considerable anatomical complexity and variability of the trunk. The Henle gastrocolic trunk is a common anatomical structure with significant heterogeneity in its venous configurations. The GPC type, most frequently formed by the confluence of the right gastroepiploic vein, the anterior superior pancreaticoduodenal vein, and either the right colic vein or the superior right colic vein, predominates across cadaveric, intraoperative, and imaging studies. Understanding this variability is crucial for ensuring safe dissection during pancreatic and colorectal resections. Conclusion. Comprehensive knowledge of the Henle trunk anatomy and its variations enhances operative planning, minimizes the risk of vascular injury, and supports safer and more efficient minimally invasive abdominal surgery.
OBJECTIVE:To synthesize current evidence on the diagnosis, histopathological evaluation, clinical features, management, and follow-up of appendiceal neuroendocrine tumors (aNETs) in children and adolescents, and to outline key differences from their adult counterparts. BACKGROUND:Pediatric aNETs are rare gastrointestinal neoplasms that typically exhibit an indolent clinical course with minimal risk of recurrence or metastasis. Their biological and prognostic features differ from those in adults, limiting the applicability of adult-derived guidelines in children. METHODS:A mini review of the current literature was conducted, focusing on epidemiology, clinical presentation, diagnostic workup, key pathological features, surgical management, and follow- up strategies for pediatric aNETs. DISCUSSION:Contemporary evidence supports a de-escalated, risk-adapted approach to management, with simple appendectomy being curative in most cases. Multidisciplinary Team (MDT) discussion remains critical for atypical or borderline cases requiring individualized decision-making. Differences from adult aNETs highlight the need for pediatric-specific clinical decision-making. CONCLUSION:Early recognition, accurate histopathologic evaluation, and tailored surgical management are essential to optimize outcomes for children and adolescents with aNETs.
Objective. To describe a rare cadaveric topographical variation of the median nerve (MN) involving an atypical relationship with the brachialis muscle (BM). Such variations, although uncommon, may complicate surgical procedures, regional anesthesia, and imaging interpretation. This report documents a variation in which the MN traverses the BM without providing motor innervation. Case Report. During the routine dissection of the right upper limb of a 75-year-old male donated cadaver, a unilateral (right-sided) topographical variation of the MN was identified. The MN diverged from its usual close association with the brachial artery (BA) and followed a medial and posterior course toward the BM. Within the middle third of the arm, the nerve penetrated a macroscopically distinct bundle of BM fibers, traversed the muscle belly, and exited in its distal third. Distally, the MN resumed a superficial course, re-approached the BA, and continued normally through the cubital fossa. No motor or accessory branches from the MN to the BM were identified during its intramuscular course. The surrounding muscle fibers closely encircled the nerve along its intramuscular segment, indicating a restricted anatomical corridor. The musculocutaneous nerve, BA, and the remaining neurovascular structures followed their typical anatomical pathways. Conclusion. This anatomical configuration may represent a potential anatomical substrate for proximal MN irritation or compression and may clinically resemble pronator teres syndrome. Awareness of such variants is important for clinicians evaluating MN neuropathies and for surgeons, anesthesiologists, and radiologists working in the anterior compartment of the arm.
OBJECTIVE:This retrospective case series study aims to assess the clinical role of surgical re-resection for isolated local recurrence of pancreatic cancer, integrating detailed case presentations with current evidence to clarify patient selection criteria, operative feasibility, and oncologic outcomes. CASE PRESENTATIONS:We present three patients with locally recurrent pancreatic cancer who underwent repeat pancreatic resection. Patient 1, who previously underwent distal pancreatectomy for an Intraductal Papillary Mucinous Neoplasm (IPMN)-associated adenocarcinoma, developed a new pancreatic head lesion three years later and underwent pylorus-preserving pancreaticoduodenectomy; histopathology confirmed a small invasive IPMN, and the patient remains alive 8 years after the initial diagnosis and 5 years after the reoperation. Patient 2, who had previously undergone Pylorus-Preserving Pancreaticoduodenectomy for distal bile duct adenocarcinoma, developed recurrent disease in the pancreatic body and tail three years later. He underwent distal pancreatectomy but developed liver recurrence due to hematogenous metastasis one month postoperatively and succumbed 6 months later from generalized widespread disease. Patient 3, who previously underwent a Whipple procedure for IPMN-associated adenocarcinoma, developed a recurrent mass at the pancreatojejunostomy five years later and underwent distal pancreatectomy, with an uneventful recovery. CONCLUSION:Our findings suggest that repeat pancreatic resection may be feasible in carefully selected patients with isolated local recurrence, potentially offering a survival benefit. Strict selection criteria, including the absence of distant metastases, good performance status, and technically resectable disease, appear essential to optimize outcomes, supporting the consideration of surgical re-resection as an option within a multidisciplinary management framework.
OBJECTIVE:This case report describes the capability of a smartphone-based electrocardiogram (ECG) in detecting multivessel coronary artery disease (CAD), with initial findings suggestive of double-vessel involvement, which was later confirmed as triple-vessel disease (TVD) by coronary angiography. CASE REPORT:In this case report, we describe a 51-year-old woman with a known medical history of CAD, hypertension, TVD, and a prior episode of acute coronary syndrome who presented to Swami Rama Himalayan University, Dehradun, with complaints of chest pain. She had previously undergone percutaneous coronary intervention with stent placement. Conventional 12-lead ECG (Philips PageWriter ECG) indicated myocardial ischemia. Follow-up smartphone-based ECG (Spandan Pro) revealed inferolateral ischemia possibly affecting the left anterior descending artery (LAD) and left circumflex artery (LCX), with a possible diagnosis of double-vessel disease (DVD). Coronary angiography later confirmed the diagnosis of TVD with significant stenosis of the LAD, LCX, and right coronary artery, along with additional involvement of the left main coronary artery. Post-angiography, the patient was recommended for coronary artery bypass grafting as the first option and percutaneous transluminal coronary angioplasty as an alternative. CONCLUSION:This case illustrates the clinical efficacy of the smartphone-based ECG device in detecting inferolateral ischemia suggestive of DVD in patients with suspected or known CAD and highlights its diagnostic concordance with standard investigations, particularly coronary angiography.
OBJECTIVE:This study aimed to conduct a thorough literature review regarding the ansa pancreatica as a potential risk factor for recurrent acute pancreatitis, exploring its pathophysiological mechanisms and possible complications during the surgical management of pancreatic conditions. METHODS:A comprehensive search was performed in the PubMed and Scopus databases using the keyword 'Ansa Pancreatica', yielding a total of 80 articles (PubMed: 34, Scopus: 46, with 52 unique articles). After applying strict inclusion and exclusion criteria, unrelated and duplicate articles were removed, resulting in the selection of 38 relevant studies. RESULTS:Ansa pancreatica was found to be a statistically significant independent risk factor for recurrent acute pancreatitis in the majority of the literature reviewed. The suggested pathophysiological mechanism involves anatomical obstruction and subsequent pre-activation of the pancreatic enzymes, causing an inflammatory cascade. Diagnosis can be established using Endoscopic Retrograde Cholangiopancreatography, Magnetic Resonance Cholangiopancreatography, or Endoscopic Ultrasonography, while treatment options are either conservative or surgical, with the invasive procedures being associated with a significant risk of complications. Furthermore, some studies have indicated a correlation between ansa pancreatica and intraductal mucinous neoplasms. CONCLUSION:The findings clearly show that Ansa Pancreatica is a rare anatomical variant with significant clinical and surgical implications, underscoring the necessity for clinicians to be aware of it to mitigate complications and effectively manage pancreatic diseases.
This review summarises the current knowledge of the interactions between Histoplasma capsulatum (Hc) and the human immune system, with particular emphasis on host immune responses and fungal immune evasion mechanisms that modulate disease pathogenesis and clinical outcomes. Histoplasmosis is a disease caused by Hc, a fungus found worldwide. Upon inhalation, complex interactions occur between the pathogen and the human immune system, primarily involving the recognition of fungal cell wall components. Both innate and adaptive immune responses are orchestrated to eliminate the fungus through a tightly regulated balance. However, Hc has evolved multiple strategies to evade host defences and establish infection. The clinical spectrum of histoplasmosis varies, ranging from isolated pulmonary involvement to disseminated disease, depending on host factors and pathogen characteristics. CONCLUSION: Overall, host-pathogen interactions between Hc and the human immune system play a central role in determining disease outcomes and represent key targets for improving preventive, diagnostic, and treatment strategies.
OBJECTIVE:This article aims to emphasize the importance of considering invasive thymoma in the differential diagnosis of mediastinal masses and highlights the critical role of timely surgical and oncological management in improving patient outcomes. CASE REPORT:We present the case of a 70-year-old woman who presented with signs of superior vena cava syndrome, including dyspnea, facial swelling, and fatigue. Advanced imaging and intraoperative findings revealed a large anterior mediastinal mass infiltrating the left brachiocephalic vein and superior vena cava, extending into both the right atrium and right ventricle. Surgical intervention was performed, and histopathological analysis confirmed B2 thymoma with a high Ki-67 proliferation index. Despite surgical intervention, the patient's condition deteriorated, and she ultimately succumbed to the disease. CONCLUSION:To the best of our knowledge, this is the first reported Bosnian case of B2 thymoma invading the brachiocephalic vein and superior vena cava and infiltrating both the right atrium and ventricle, causing superior vena cava syndrome. Despite their rarity, thymomas should always be considered in patients presenting with an enlarged mediastinum.
