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Background/Aim. Incidentalomas of the adrenal gland are adrenal masses commonly discovered by chance on imaging not performed for suspected adrenal disease. The aim o f t his study was to analyze clinical, hormonal and histopathological characteristics of adrenal incidentalomas. Methods. This retrospective study included 85 patients (32 men and 53 women) examined for adrenal incidentalomas at the Clinic for Endocrinology, Military Medical Academy in Belgrade, from January 2013 to December 2017. The age of the patients, gender, size, and localization of adrenal tumors, functional activity, as well as the presence of comorbidities were analyzed. Adrenalectomy was performed in 35 patients due to its size and functional activity, and histological findings were analyzed. Results. The largest number (56.4%) of the adrenal tumors, was detected by ultrasound examination of the abdomen, 23 (27.2%) by abdominal computed tomography (CT) scan, 13 (15.2%) by chest CT scan and 1 (1.2%) by magnetic resonance (MR) imaging of the abdomen. The average tumor size was 3.8 ± 2.3 cm (range from 1 to 1 5 c m). Adrenal tumors were bilateral in 20 (23%) patients, in 39 (46%) patients, the tumors were localized in the right adrenal gland, and in 26 (31%) in the left gland. Subclinical hypercortisolism, defined as insufficient cortisol suppression during overnight dexamethasone test (1 mg), was observed in 34 (40%) patients, while the absence of cortisol suppression (autonomous cortisol secretion) was found in 4 (4.7%) patients. In the remaining 47 (55.3%) patients, complete overnight suppression of cortisol secretion was achieved. Thirty-five (41%) patients underwent adrenalectomy; among them, in 4 (11.4%) cases, adrenocortical carcinoma was found, 15 (42.9%) were adenomas, pheochromocytoma was found in 4 (11.4%) cases, nodular hyperplasia in 5 (14.3%) cases, distant metastasis in one (2.8%) case and the remaining were different benign masses. Conclusion. For patients with adrenal incidentalomas, two fundamental questions on determining the functionality of the tumor and/or the presence of malignancy need to be clarified. All patients with adrenal incidentaloma should undergo hormonal evaluation for autonomous or possible autonomous cortisol secretion, as well as for autonomous, adrenergic, and mineralocorticoid excess. In patients with autonomous adrenal secretion, surgery is indicated even if the typical clinical manifestation is absent.

Introduction. Paraganglioma is a rare neuroendocrine neoplasm that may arise from the extra-adrenal autonomic paraganglia. Urinary bladder paraganglioma is typically presented as repeated episodes of palpitations, headache or blood pressure rise immediately after micturition. Management of these tumors includes radical surgical treatment with preoperative antihypertensive preparation, and a life-long follow-up. Case report. We presented a middle- age female patient with functional urinary bladder paraganglioma, with a 3-year history of repeated episodes of abdominal pain, dysuria and hematuria. After obtaining more precise anamnestic data, the patient reported occasional simultaneous presence of mild adrenergic symptoms, that did not cause any particular attention at first. Morphological and biohumoral examinations suggested paraganglioma of the urinary bladder. Open partial cystectomy was performed, detecting a submucosal mass, while immunohistochemical analysis confirmed the presence of chromaffin tissue. Clinical manifestations, diagnostic approach, management and histopathological findings of urinary bladder paraganglioma are discussed. Conclusion. Since the prognosis with localized paraganglioma is good, we underlined the importance of a well-timed, accurate and detailed medical history in all the patients with even mild, inexplicable micturition-provoked adrenergic symptomatology.

Introduction. The presence of bilateral exophthalmos and palpebral, periorbital edema associated with hyperthyroidism is most often considered as an initial sign of Graves’ ophthalmopathy. However, in up to 20% of cases, Graves’ ophthalmopathy might precede the occurrence of hyperthyroidism, which is very important to be considered in the differential diagnosis, especially if it is stated as unilateral. Among other less common causes of non-thyroid-related orbitopathy, orbital lymphoma represents rare conditions. We presented of a patient with Graves’ disease, initially manifested as bilateral orbitopathy and progressive unilateral exophthalmos caused by the marginal zone B-cell non-Hodgkin lymphoma of the orbit. Case report. A 64-yearold man with the 3-year history of bilateral Graves’ orbitopathy and hyperthyroidism underwent the left orbital decompression surgery due to the predominantly left, unilateral worsening of exophthalmos resistant to the previously applied glucocorticoid therapy. A year after the surgical treatment, a substantial exophthalmos of the left eye was again observed, signifying that other non-thyroid pathology could be involved. Orbital ultrasound was suggestive of primary orbital lymphoma, what was confirmed by orbital CT scan and the biopsy of the tumor tissue. Detailed examinations indicated that the marginal zone B-cell non-Hodgkin lymphoma extended to IV - B-b CS, IPI 3 (bone marrow infiltration: m+ orbit+). Upon the completion of the polychemiotherapy and the radiation treatment, a complete remission of the disease was achieved. Conclusion. Even when elements clearly indicate the presence of thyroid-related ophthalmopathy, disease deteriorating should raise a suspicion and always lead to imaging procedures to exclude malignancy.

Backgraund/Aim. Conventional cytomorphology of thyroid cell aspirates is limited in preoperative differential diagnosis of follicular adenomas (FA) and hyperplastic adenomatoid nodular goiters from well differentiated thyroid follicular carcinoma (FTC) and follicular variant of thyroid papillary carcinoma (PTC). This is the reason of inaccurate presurgical differential diagnosis and in the same cases of inadequate operative managament. The aim of the study was to evaluate the role of quantitative estimation of thyreocite nuclear features (cariomorphometry) in thyroid aspirated smears in preoperative differential diagnosis of benign from malignant thyroid lesions. Methods. A total of 48 patients with thyroid nodular disease underwent fine needle aspiration biopsy for cytomorphology, cariomorphometric analysis of the aspirates, and histopathologic explorations conducted fully postoperatively. On the basis of cytomorphology classification the patients were divided into three groups: benign (B), n = 8; malignant (M), n = 15, and suspicious for malignancy (S), n = 25. Using a microscope connected to a computerized video system, mean nuclear area, the nuclear area coefficient of variation (NACV) and anisocariosis ratio were measured and calculated. Results. In all the 15 patients with cytologically malignant results the diagnosis of PTC was confirmed histopathologically. All cytologically benign lesions were confirmed histopathologically. Thyroid carcinoma was found in 15 out of 25 patients with suspicious lesions. The highest mean values of nuclear area were in the PCT (90.74 ± 26.71 μm2), and were significantly different from all other groups (p < 0.001). The mean nuclear area in FTC was 69.20 ± 27.31 μm2 and was significantly higher than in the benign adenomatous group (p < 0.01). There was no significant difference in mean nuclear area between FTC and FA, but there was a significant difference in NACV between these two groups (FTC: 39.46 % vs FA: 23.42%, p < 0.001). In 27 out of 30 patients with thyroid carcinoma higher values of NACV than 18% were found. Conclusion. Preoperatively cariomorphometry is a useful method in differential diagnosis of thyroid carcinoma from benign lesions, as a complementary method to convencional cytodiagnostics. The NACV showed highest sensitivity as a parameter of malignant thyroid cell transformation.