Diabetes mellitus is a well known risk factor for infections, which remain a major cause of morbidity and mortality in patients treated with autologous peripheral blood stem cell transplantation (PBSCT). We have evaluated infectious complications following transplantation in 132 consecutive patients with relapsed or refractory Non-Hodgkin’ s lymphoma (n=101) and Hodgkin’ s disease (n=31) treated with PBSCT. Febrile neutropenia occurred in 86 (65.6%) patients at a mean of 6 days after transplantation (range 1-9, SD 1.59). Patients with diabetes mellitus had a clear predisposition for infectious complications following PBSCT. All 10 patients with diabetes developed febrile neutropenia. Compared to patients not having diabetes mellitus, they also had significantly longer median time to defervescence (4 days vs. 2 days, Logrank p=0.03). Furthermore, diabetic patients had a higher incidence of serious infections: 60% of febrile episodes in these patients (vs. 30.3% in non- diabetics) were microbiologically proven bacteremias (p=0.07). Gram positive microorganisms were responsible for the majority of documented infections with Staphylococcus epidermidis being the most frequently isolated pathogen. Infections are serious but manageable complications of PBSCT, even in patients with unfavorable risk factors. Patients with lymphoma and diabetes mellitus undergoing stem cell transplantation are especially prone to infections during the neutropenic period following transplantation. Early empirical antimicrobial therapy, tailored according to local microbiological epidemiology is essential for their optimal treatment.

We hypothesized that quadrant prostate biopsy (QPB) provides sufficient first-line pathological evaluation of patients with presumed advanced prostate cancer (PC). The aim of this study was to investigate whether the reduction of core number in first-line PB from 6–12 to 4 in patients with presumed advanced PC leads to loss of clinically relevant information. We retrospectively studied 113 men that underwent PB, classified in two groups: “H” (high) and “L” (low likelihood of having advanced PC), according to PSA, digital rectal and transrectal ultrasound findings. Pathological results of 6–12-core PB and QPB were retrospectively compared for the presence of malignancy, percentage of positive cores, Gleason score (GS), and the presence of high-grade prostatic intraepithelial neoplasia (HGPIN). PC detection rate was not impaired in group H but dropped significantly in group L, and the percentage of positive cores was not significantly changed in group H (p=0.39), but decreased in group L (p=0.04), due to sampling scheme reduction. No HGPIN was missed with QPB in group H, while 2 HGPINs were missed in group L. No significant change in GS in either group was observed (p=0.12, p=0.13) due to reduction to QPB. We conclude that in patients with presumed advanced PC, reduction of the number of cores in PB may be an acceptable diagnostic strategy, but further studies are needed to analyze the impact of PB scheme reduction on other relevant pathological information obtained from PB.

Background. While extensive prostate biopsy (PB) in the patients with early prostate cancer (PC) provides better sensitivity and more precise tumour staging, in the patients with advanced PC, it is virtually only a confirmation of malignancy. The purpose of our study was to find out whether the quadrant prostate biopsy (QPB) provides a sufficient first-line pathological evaluation in the patients likely to have advanced PC, and whether the reduction of core number impairs the competence of PB through missing quantitative histology information. Methods. We studied 84 men who underwent PB and classified into groups »H« (highly-) and »L« (low likely to have advanced PC). Pathological results of 5-12 cores PB and simulated QPB were retrospectively compared, particularly for the presence of PC, tumour volume, Gleason score (GS), and the presence of highgrade prostatic intraepithelial neoplasia (HGPIN). Results. The PC detection rate was not impaired in group H, but dropped significantly in group L, while the percentage of positive cores was insignificantly changed in group H (p=0.39), but significantly decreased in group L (p=0.04) due to the sampling scheme reduction. No HGPIN was missed with QBP in group H, while 2 HGPIN were missed in group L. Insignificant GS changes resulted in both groups as a consequence of the limitation to QPB. Conclusions. QPB is an appropriate first-line scheme in the patients with advanced PC as the information lost due to the core number reduction is mainly not critical for patient management.

Mediastinal ( thymic) large B-cell lymphoma (Med-DLBCL) is a subtype of diffuse large B-cell lymphomas (DLBCL) with a typical radiological appearance of bulky anterior mediastinal mass, often with areas of necrosis. We report a case of Med-DLBCL with unusual radiological findings and clinical development. Computed tomography (CT) obtained at presentation revealed a huge anterior mediastinal tumor with an axial diameter of 180 mm. Nineteen days after the first cycle of chemotherapy, chest radiography and CT revealed large areas of tumor necrosis and pneumomediastinum with air-fluid levels. To our knowledge, air-fluid levels inside Med-DLBCL have not been previously described. This finding, in combination with necrotic sputum, may indicate communication between the tracheobronchial tree and the tumor.

Metastatic tumours are frequently more vaguely differentiated or non-differentiated and, sometimes, it is difficult to determine the cellular origin based on the cytomorphologic picture, and even more complex, the primary focus of the tumour. Aims: (1) To analyse the possibility of determining cellular origin and primary focus of the metastatic process by adding the cellular markers to cytomorphology ; (2) to estimate the proliferation status and ploidy of vaguely differentiated metastatic tumours. Methods: The total of 1753 liver and lymph nodes aspirates have been analysed. The aspiration of localised lesions of liver and abdominal lymph nodes was performed by CHIBA needle controlled by ultrasound (US) or computerised tomography (CT), and of superficial lymph nodes by fine needle (FNA) under the US control or based on palpable finding. The preparations were stained by the May-Griinwald-Giemsa method, immunocytochemical treatment was performed by LSAB method monoclonal antibodies (DAKO). The proliferation status was determined in the analysis of the nuclear organiser region (AgNOR), and aneuploidy by the static DNA image cytometry, both by the SFORM programme (VAMSTEC brand from Zagreb). Results: Out of 678 liver aspirates, malignant lesions were dete ; ted in 404 ones. The primary tumours numbered 68, plus 336 metastatic ones (329 of epithelial, and 31 of mesenchymal and embryonal origin). Out of 1075 lymph nodes aspirates, in 540 cases malignant lesions were found (409 malignant lymphomas, 87 epithelial and 25 nonepithelial metastatic tumours, while in four cases the cellular origin couldn't be determined). All together, based on the morphologic picture and immunocytochemic treatment by mononucleal antibodies, the epithelial, mesenchymal or embryonal cellular origin could be determined in 99.1 % cases of all metastatic tumours, while in the epithelial tumours primary focus was recognised in 33.4% cases. In weakly differentiated tumours, the tumour aggressiveness was confirmed by high aneuploidy (DNA image cytometry) and by high proliferation status (AgNOR determination). The cellular markers are unreplaceable addition to the cytomorphologic picture in the determination of cellular origin of tumour cells. However, very often, specific tumour markers reveal tissue co-expression and, as a rule, are not typical for only one organ. Despite this, their combination improves the search for primary focus of the metastatic process or, possibly, determine the additional targeted diagnostic treatment (CT, US, MR, etc.).