1 JZU Univerzitetska klinika za digestivna hirurgija, 2 JZU Univerzitetska klinika za nefrologija, "Sv. Kiril i Metodij", Medicinski fakultet Skopje, Republika Makedonija Apstrakt Voved. Normalnata anatomija na дuktus цistikus (DC) e opi{ana odamna а osnovnite postulati se validni i deneska: prose~na dol`ina 2-4 cm, kalibar 1-1,5 mm, a volumenot e reduciran so spiralni mukozni nabori na Haister. Anatomskite varijanti na DC i negovata aberantna insercija vodat do konfuzija pri predoperativnite imixing isleduvawa, i neprijatna situacija pri hirur{kite intervencii, koga hirurgot mora da ja potvrdi sigurnata identifikacija na anatomskite strukturi, so cel da odbegne jatrogena bilijarna lezija. Celta na ovaa na{a prospektivna, oпservaciona studija be{e utvrduvawe na eventualnata vrska pome|u niskata insercija na duktus cistikus vo duktus hepatikus komunis, od edna strana, i prisustvoto-pojavata na karcinom na glavata na pankreasot, od druga strana. Metodi. Vo tekот na studijata isledivme 21 pacient so pankreati~en cefali~en karcinom (PCK). Inkluzioniot kriterium be{e dijagnosticiran PCK vo operabilen stadium. Metodata za odreduvawe na vlivot na DC vo дuktus хepati-kus кomunis (DHK) se sostoe{e od ultrazvuk, endoskopska retrogradna holangiopankreatografija, kompjuterski i magnetni isleduvawa za natamo{na hirur{ka intervencija. Rezultati. Kaj 6 pacienti (>28%), pronajdovme нiska иnsercija na дuktus цistikus (NIDC) kaj koi hirur{ki se napravi еkstenzivna рadikalna дuodenopankreatektomija (ERDP). Kaj 4 pacienti (3 ma`i i 1 `ena), postoe{e NIDC so kompletna dilatacija na bilijarnoto steblo, vklu~uvaj-}i go i DC, DHK i `ol~noto }ese, dodeka kaj 2 ____________ Korespondencija i reprint do: Aleksandar [umkovski, JZU Univerzitetska klinika za digestivna hirurgija, "Vodwanska" 17, 1000 Skopje, R. Makedonija; Tel.: 00 389 2 31 47 025; E-mail: aleksum@yahoo.com pacienti, DC i negovata niska insercija bea otsutni na slikite-ERCP kako posledica na tumorskata nagorna invazija na NIDC. Zaklu~ok. Vo sporedba so drugi referentni radiolo{ki i anatomski studii na{ite rezultati zna~ajno se razlikuvaat vo odnos na ~esto-tata na NIDC {to delumno mo`e da se dol`i na brojnite i razli~ni kriteriumi i definicii {to e NIDC. No, ovaa razlika mo`e da bide uslovena i od eventualno postoјната vrska pome|u NIDC i pojavata na PCK od druga strana. Zatoa, potrebni se studii so pogolem broj pacienti (anatomski, patolo{ki, a i genetski), koi bi ja potvrdile ili pak otfrlile pretpostavenata vrska me|u ovie два entitetа-NIDC i PCK.Klu~ni zborovi: нiska insercija, дuktus цistikus, дuktus хepatikus, пankreati~en cefali~en karcinom, ERCP, ekstenzivna duodenopankreatektomija ___________________________________________ Abstract Introduction. The normal anatomy of the cystic duct (CD) has been described a long time ago, but the basic description is valid up today: average length 2-4 mm, caliber 1-1.5 mm, and reduced volume by the spiral mucous folds of Heister. Anatomic variants of the CD and its aberrant insertion lead to confusion during preoperative imaging e...

Primary retroperitoneal tumors are an exceedingly rare clinical problem. Masses in the retroperitoneum can be categorized as one of three entities: lymphomas, extragonadal germ cell tumors, and sarcomas. Malignant peripheral nerve sheath tumors are uncommon, biologically aggressive soft tissue sarcomas of neural origin that pose tremendous challenges to effective therapyWe present a young adult with retroperitoneal tumor. The patient presented a lumbar pain on the left side. Echotomography of the abdomen was madeand cystic tumor under the pancreas was detected. CT showed retroperitoneal tumor with hypodense features,with defined borders with size of 5,6x9,6 cm. Blood results and tumor markers showed no abnormalities. The patient had a surgery and whole extirpation was made without damaging the surrounding organs.This case illustrate early diagnosis of MPNST is key to reduce mortality, with complete surgical extirpation with clear margins as treatment of choice.