Introduction. Choroidal melanoma is a rare form of cancer, with a total of 3-5% of the patients suffering from this type of disease. People who are more likely to suffer from the disease are of the white race, bright skin color and iris, as well as those with a genetic mutation BAP 1 and GNAQ. Studies indicate the micro-metastatic disease before the primary process is diagnosed. There is no effective therapy to prevent the development of metastases. In 90% of cases the metastases are in the liver. Metastases can occur any time after the diagnosis of melanoma, even after 40 years. The prognosis of metastatic disease is bad, the median of survival per year is 4 to 15 months. Case report. The patient had enucleation of the eye, when he was primarily treated for malignant melanoma of choroid in 2007. He also appeared regularly for checkups. Felt healthy. 9 years later, dizziness and instability occurred. After a seizure, on July 2016, echotomography and computed tomography diagnosed liver, brain metastases as well as changes in the right lung. Radio-oncology treatment deposits in the brain done with Gama knife, as well as systemic hemotherapy with Dacarbazine. Changes in the lung treated as a secondary deposit. Despite oncology and palliative treatment, the patient passed away 6 months after the diagnosis of the metastatic disease. Conclusion. It is important to point out the importance of early and accurate diagnosis and early treatment of malignant diseases. During the period of monitoring the patient, rare localizations of the metastases must be considered, as well as the possibility of their occurrence long time after the discovery of the primary malignancy. For this case report, the data obtained from extensive medical documentation was used, as well as several years of monitoring patients in Primary care.

Soft tissue sarcomas are heterogeneous group of neoplasms making up to 1% of all malignant tumors in the adult population. The tumor generally appears on the extremities near large joints of middle-aged patients, especially in the popliteal fossa. Our patient presented in February 2014 due to a slowly enlarging, darker-colored swelling in the left popliteal fossa. Upon physical examination, a somewhat nodular, immobile, tender subcutaneous mass was observed. There was no locoregional lymphadenopathy. Patohistological findings showed a high-grade primary malignant mesenchymal tumor, biphasic synovial sarcoma type. The patient underwent surgery with wide surgical excision, followed by radiotherapy treatment. Magnetic resonance imagining follow up after one year revealed tumor recurrence. Neurovascular bundle involvement was detected, but without adjacent bone and muscular invasion and above-the-knee partial amputation of the left leg was performed. The intervention resulted in a remission of the neoplastic process and the patient was scheduled for regular check-ups. Broad surgical resection of the tumor with negative margins was the primary treatment in this case. Mutilating operations are necessary when anatomical structures around the tumor do not allow complete reintervention.

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Cholangiocarcinoma is a malignant tumor originating from the ductal epithelium. It is divided into intrahepatic, gallbladder carcinoma and peripheral cholangiocarcinoma. The prevalence depends on the region, ethnicity, gender, and localization of the tumor. The most common symptoms are jaundice, pain, nausea, weight loss. The tumor is mostly found in the advanced stage when local and distant metastases are detectable. Median survival rate in patients who are in an advanced inoperable stage is 3.9 months. A 60-year-old patient came in January 2018 with pain in the epigastrium, weight loss and nausea. Objectively positive Murphy sign and enlarged liver were found. The ultrasound showed a lobulated, heterogeneous, fatty liver with a tumor mass in the right liver lobe, measuring more than 12 cm in diameter. Laboratory findings: Alpha-fetoprotein 13.0 ng/mL, carcinoembryonic antigen 7.25 mg/ml, carbohydrate antigen 19-9 56.7 U/ml, erythrocyte sedimentation rate 29, bilirubin 24.7 mmol/L, alanine aminotransferase 32.0 U/L, aminotransferase 56 U/L, alkaline phosphatase 181 U/L, C-reactive protein 43.1 µg/mL, uric acid 561 µmol/L. Computerized tomography showed an enlarged, lobular, non-homogeneous liver and non-homogeneous, as well as hetero-dense changes of indistinct contours, measuring 98x90x80 mm and 8x16 mm. All these findings were confirmed by magnetic resonance. Chest x-ray showed multiple metastases. Liver biopsy confirmed primary malignancy of the bile. The patient was treated palliatively and passed away in March, two months after the initially occurrence of disease symptoms.

Sažetak: Uvod. Ciste timusa su retke, benigne, većinom kongenitalne anomalije i predstavljaju 1-3% svih medijastinalnih masa, najčešće u prednjem medijastinumu. Mogu biti kongenitalne ili stečene, u sklopu različitih imunoloških i malignih bolesti. Oko 60% pacijenata sa cistama timusa je asimptomatsko, a ukoliko postoje simptomi nisu specifični već su to kašalj, dispnoja i bol u grudima. Prikaz bolesnika. Pacijent star 48 godina, u martu 2018. godine dolazi na pregled zbog visoke temperature, upornog suvog kašlja i krvi u ispljuvku. Radiografija i kompjuterizovana tomografija pokazale jasno ograničenu promenu desno paratrahealno, promera 64x53 mm, jasnih ivica, bez invazije i kontinuiteta u okolno tkivo. Inicijalna bronhoskopija ukazala na kompresiju traheje, a drugom je eksplorisano sedam limfnih žlezda sa nespecifičnim nalazom kada je dobijeno i pet mililitara žućkastog tečnog sadržaja. U međuvremenu, kod pacijenta prestaju znaci respiratorne infekcije, kašalj i iskašljavanje sukrvice krvi, takođe i dobro se osećao. Video-asistiranom torakoskopskom hirurgijom učinjena je kompletna resekcija promene uz očuvanje timusa. Promena je bila jasno ograničena od okoline, inkapsulirana, tankog zida. Patohistološki nisu nađene maligne ćelije, zid se sastojao od fibroznog cističnog tkiva sa fragmentima timusnog tkiva. Radilo se o benignoj, prostoj, kongenitalnoj timusnoj cisti. Zaključak. Svakog pacijenta sa sumnjom na cistu timusa uputiti na multidisciplinarni tim sa iskustvom u medijastinalnoj patologiji. Hirurška resekcija kod našeg pacijenta sprovedena je u dijagnostičke i terapijske svrhe. Ključne reči. Medijastinum, torakoskopska hirurgija, timusna cista. THYMIC CYST AS A DIAGNOSTIC CHALLENGE Introduction. Thymic cysts are rare, benign, mostly congenital anomalies and represent 1-3% of all mediastinal masses, most frequently found in the front mediastinum. They can be congenital or acquired, as part of