Мультифокальная ангиомиолипома печени и легких

АНГИОМИОЛИПОМААНГИОМИОЛИПОМАНОВООБРАЗОВАНИЯ, СОСТОЯЩИЕ ИЗ ЖИРОВОЙ ТКАНИТОМОГРАФИЯТОМОГРАФИЯ РЕНТГЕНОВСКАЯ КОМПЬЮТЕРНАЯЭЛЕКТРОХИРУРГИЧЕСКАЯ СВАРКА /МЕТОДИММУНОГИСТОХИМИЧЕСКОЕ ИССЛЕДОВАНИЕПЕЧЕНИ НОВООБРАЗОВАНИЯБОЛЬНЫЕПАЦИЕНТЫРЕЗЕКЦИЯ ПЕЧЕНИ /ХИРВ статье представлен клинический случай хирургического лечения пациентки с редким онкологическим заболеванием – мультифокальной ангиомиолипомой печени и легких. Пациентка госпитализирована в клинику института, обследована, при спиральной компьютерной томографии органов брюшной полости и грудной клетки выявлены множественные образования легких билатерально, образования печени: в Sg2 и Sg4 – 3 образования до 2 см в диаметре, в Sg1 – крупное аналогичное образование 10х8 см, прилежащее к нижней полой вене. Выполнена дифференциальная диагностика с гепатоцеллюлярной карциномой при помощи определения онкомаркеров крови и трепан-биопсии опухоли хвостатой доли печени с последующим гистологическим исследованием. После подтверждения вероятного доброкачественного характера опухоли пациентка была оперирована. Интраоперационно в Sg2 и Sg4 печени выявлены образования до 2 см в диаметре; в Sg1 печени – опухоль размерами 9х8х10 см, вплотную прилежащая к нижней полой вене, легкоранимая и обильно кровоточащая при контакте. Выполнена резекция Sg1 печени с опухолью левосторонним способом с использованием методики афферентной васкулярной эксклюзии печени, техники "clamp crush", электрохирургического сваривания. Послеоперационный период протекал гладко, без осложнений, пациентка выписана на 12-е послеоперационные сутки. Иммуногистохимическое исследование удаленного препарата подтвердило диагноз – ангиомиолипома печени.The article presents a clinical case of surgical treatment of a patient with a rare oncological disease – multifocal angiomyolipoma of the liver and lungs. The patient had been hospitalized to the clinic, examined using spiral computed tomography of the abdominal organs and the chest. The following was revealed – bilateral multiple lung neoplasms, liver neoplasms: in Sg2 and Sg4 – 3 tumors up to 2 cm in diameter, in Sg1 – a large similar tumor 10x8cm adjacent to the inferior vena cava. Differential diagnostics with hepatocellular carcinoma was performed by using the determination of the blood tumor markers and trepan biopsy of the tumor of the caudate hepatic lobe, followed by histological examination. After confirming of probable benign nature of the tumor, the patient was operated on. Intraoperative findings were the following: in Sg2 and Sg4 of the liver – neoplasms up to 2 cm in diameter; in Sg1 of the liver – a neoplasm 9х8х10 cm, closely adjacent to the inferior vena cava, easily vulnerable with bleeding after contact. Resection of Sg1 of the liver with a tumor was performed by the left-sided method using afferent vascular exclusion of the liver, clamp crush technique, and electrosurgical welding. The postoperative period was stable, without complications, the patient was discharged from hospital on the 12th postoperative day. The immunohistochemical study of the removed tumor confirmed the diagnosis of liver angiomyolipoma

Mucinozna komponenta u kolorektalnom karcinomu – utjecaj na preživljenje

AIM. Clinical significance of mucin component in colorectal cancer is still unclear. We compared clinical and pathological features of mucinous and non-mucinous colorectal cancers and assessed the impact of mucinous differentiation and other specific features of colorectal cancer on survival. PATIENTS AND METHODS. We analyzed clinical and pathological data of 271 patients who underwent surgical resection of colorectal adenocarcinoma at our Department between 1994 and 2002. RESULTS. Patients with mucinous colorectal cancer had worse overall survival, but not statistically significant (P=0.296). In a multivariate model, only tumor size, the presence of hepatic metastases, and the presence of metastases in lymph nodes, but not mucinous differentiation, were found to be significant and independent predictors of survival. CONCLUSION. The results of this study confirm the frequent observation that mucinous colorectal cancer is associated with worse prognosis compared to non-mucinous type. However, these results do not provide evidence that mucinous differentiation is independently associated with more aggressive tumor behavior. Current findings justify surgical resection of all gross tumor deposits, together with the employment of perioperative intraperitoneal chemotherapy in the treatment of patients with mucinous colorectal cancer.CILJ. Klinička važnost mucinozne komponente u kolorektalnom karcinomu još nije jasan. Usporedili smo kliničke i patološke osobine kolorektalnog karcinoma mucinoznog i nemucinoznog tipa te mjerili utjecaj diferencijacije mucina i drugih specifičnih značajka kolorektalnog karcinoma na preživljenje. BOLESNICI I METODE. Analizirali smo kliničke i patološke podatke 271 bolesnika u kojih je na našem odjelu od 1994. do 2002. kirurškim putem uklonjen kolorektalni adenokarcinom. REZULTATI. Bolesnici s mucinoznim kolorektalnim karcinomom imaju lošije sveukupno preživljenje, ali to nije statistički značajno (P=0,296). Na multivarijatnom modelu uočeno je da su samo veličina tumora, prisutnost jetrenih metastaza i prisutnost metastaza u limfnim čvorovima, a ne i mucinozna diferencijacija, značajni i nezavisni prognostički faktori preživljenja. ZAKLJUČAK. Rezultati ovog ispitivanja potvrđuju ono što se često uočava, a to je da je prognoza za mucinozni kolorektalni karcinom lošija od prognoze za nemucinozni tip raka toga sijela. Međutim, tj. rezultati ne dokazuju da je mucinozna diferencijacija nezavisno povezana s agresivnijim ponašanjem tumora. Sadašnji nalazi opravdavaju kiruršku resekciju svih okom vidljivih tumorskih depozita uz primjenu perioperativne intraperitonejske kemoterapije u liječenju bolesnika s mucinoznim kolorektalnim karcinomom

Mucinozna komponenta u kolorektalnom karcinomu – utjecaj na preživljenje

AIM. Clinical significance of mucin component in colorectal cancer is still unclear. We compared clinical and pathological features of mucinous and non-mucinous colorectal cancers and assessed the impact of mucinous differentiation and other specific features of colorectal cancer on survival. PATIENTS AND METHODS. We analyzed clinical and pathological data of 271 patients who underwent surgical resection of colorectal adenocarcinoma at our Department between 1994 and 2002. RESULTS. Patients with mucinous colorectal cancer had worse overall survival, but not statistically significant (P=0.296). In a multivariate model, only tumor size, the presence of hepatic metastases, and the presence of metastases in lymph nodes, but not mucinous differentiation, were found to be significant and independent predictors of survival. CONCLUSION. The results of this study confirm the frequent observation that mucinous colorectal cancer is associated with worse prognosis compared to non-mucinous type. However, these results do not provide evidence that mucinous differentiation is independently associated with more aggressive tumor behavior. Current findings justify surgical resection of all gross tumor deposits, together with the employment of perioperative intraperitoneal chemotherapy in the treatment of patients with mucinous colorectal cancer.CILJ. Klinička važnost mucinozne komponente u kolorektalnom karcinomu još nije jasan. Usporedili smo kliničke i patološke osobine kolorektalnog karcinoma mucinoznog i nemucinoznog tipa te mjerili utjecaj diferencijacije mucina i drugih specifičnih značajka kolorektalnog karcinoma na preživljenje. BOLESNICI I METODE. Analizirali smo kliničke i patološke podatke 271 bolesnika u kojih je na našem odjelu od 1994. do 2002. kirurškim putem uklonjen kolorektalni adenokarcinom. REZULTATI. Bolesnici s mucinoznim kolorektalnim karcinomom imaju lošije sveukupno preživljenje, ali to nije statistički značajno (P=0,296). Na multivarijatnom modelu uočeno je da su samo veličina tumora, prisutnost jetrenih metastaza i prisutnost metastaza u limfnim čvorovima, a ne i mucinozna diferencijacija, značajni i nezavisni prognostički faktori preživljenja. ZAKLJUČAK. Rezultati ovog ispitivanja potvrđuju ono što se često uočava, a to je da je prognoza za mucinozni kolorektalni karcinom lošija od prognoze za nemucinozni tip raka toga sijela. Međutim, tj. rezultati ne dokazuju da je mucinozna diferencijacija nezavisno povezana s agresivnijim ponašanjem tumora. Sadašnji nalazi opravdavaju kiruršku resekciju svih okom vidljivih tumorskih depozita uz primjenu perioperativne intraperitonejske kemoterapije u liječenju bolesnika s mucinoznim kolorektalnim karcinomom

Rare non-epithelial ovarian neoplasms: Pathology, genetics and treatment.

Rare non-epithelial ovarian neoplasms have posed management challenges for many years. Their rarity means that most specialist practitioners will see one such case every several years, and most generalists may never see a case. The first step in management is to establish the correct diagnosis and this may necessitate specialist pathology review. Here, we review recent developments in the pathology, genetics and treatment of small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) and sex cord-stromal tumours. Pathologically, these tumours often display morphological overlap with other neoplasms; for example, SCCOHT overlaps with many other "small round blue cell" tumours. Specific immunohistochemical stains, while useful, may not always be definitive. The discovery of somatic mutations in FOXL2 (adult granulosa cell tumours) and germline and somatic mutations in DICER1 (Sertoli-Leydig cell tumours) and SMARCA4 (SCCOHT) has demonstrated the value of molecular investigation as an adjunct to traditional histopathological approaches. In addition, the presence of germline mutations in a significant proportion of some of these neoplasms points to the need for genetic counselling and testing, offering the prospect of prevention and early diagnosis. Treatment of these rare tumours, as a group, should be on the basis of sound oncological principles, given that level 1 evidence will almost always be lacking. The rationale for experimental therapies must be clearly established. In view of the complex issues involved in the management of these conditions, expert opinion in pathology, genetics and treatment may be essential to offer the patient and her family the best chance of a good outcome

Alveolar ridge augmentation in irradiated rabbit mandibles

Oral carcinomas are frequently treated with a nonsegmental mandibulectomy plus radiotherapy. Improving the quality of life of these patients depends on the possibilities for dental rehabilitation. The aim of this study was to increase the alveolar ridge height. Twelve white New Zealand rabbits underwent surgery to produce a 11 x 9 x 7 mm(3) horizontal bicortical full-thickness defect at the alveolar ridge of the left mandible. Six were implanted with a composite associating resorbable collagen membrane filled with micro-macroporous biphasic calcium phosphate granules. After a daily radiation delivery schedule for 4 weeks, a total autologous bone marrow graft was injected percutaneously into the center of the implant. All animals were sacrificed at 16 weeks. Successful osseous colonization was observed in all implants. Significant ridge augmentation was observed (p = 0.0349) in the implanted group compared with the control group. This study contributed to producing an experimental model for oncological mandible defects in rabbits

Imaging features of rare mesenychmal liver tumours: beyond haemangiomas.

Tumours arising from mesenchymal tissue components such as vascular, fibrous and adipose tissue can manifest in the liver. Although histopathology is often necessary for definitive diagnosis, many of these lesions exhibit characteristic imaging features. The radiologist plays an important role in suggesting the diagnosis, which can direct appropriate immunohistochemical staining at histology. The aim of this review is to present clinical and imaging findings of a spectrum of mesenchymal liver tumours such as haemangioma, epithelioid haemangioendothelioma, lipoma, PEComa, angiosarcoma, inflammatory myofibroblastic tumour, solitary fibrous tumour, leiomyoma, leiomyosarcoma, Kaposi sarcoma, mesenchymal hamartoma, undifferentiated embryonal sarcoma, rhabdomyosarcoma and hepatic metastases. Knowledge of the characteristic features of these tumours will aid in guiding the radiologic diagnosis and appropriate patient management

Change in Nephrometry Scoring in Small Renal Masses (<4cm) on Active Surveillance: Preliminary Observations from Tayside Active Surveillance Cohort (TASC) Study

Rationale and Objectives: - Prediction of growth, in particular knowing the possibility of aggressive cancer in small renal masses on active surveillance, remains poorly understood. The study was designed to determine whether serial nephrometry score measurements could predict possibility of aggressive malignancy (grade of cancer) in patients with small renal masses opting for active surveillance initially. Materials and Methods: - One hundred sixteen patients between January 2000 and December 2016 undergoing partial nephrectomy were recruited. Out of these, 97 were analyzed using different nephrometry scoring systems. Measurement of nephrometry scores (Radius of tumors, Exo/Endophytic; Nearness of tumors to the collecting system or sinus; Anterior/posterior; Location in relation to polar lines, Preoperative Aspects and Dimensions Used for Anatomical, Centrality Index) was performed by two researchers. Among the patients opting for partial nephrectomy, 40 were on active surveillance for at least 12 months (mean 32; 12-60 months) before partial nephrectomy. Computed tomography scan images of these patients were retrieved and analyzed including comparison to histopathology. Results: - Nephrometry scores measured on serial computed tomography scan images showed a significant correlation between change in score and grade of cancer on multivariate analysis (P value .001). Addition of multivariate analysis to nomogram based on change in size alone did not improve predictive value of area under the curve significantly. Conclusions: - Change in nephrometry scoring measurements correlates with grade of cancer in small renal masses but falls short of significantly predicting presence of malignancy or grade of cancer on nomogram in patients opting for active surveillance for small renal masses. At present, this approach may be inadequate for decision-making

Pilomatriksom periokularnog područja: prikaz slučaja

The aim is to present a case of pilomatrixoma in the periocular area in a 10-yearold female through retrospective review of medical records of a single patient. A 10-year-old female developed a lesion under her right eyebrow over a period of one year. The rest of the ophthalmic history was unremarkable. On examination, oval, well-defined, subcutaneous tumor measuring 7x4 mm was found under the right eyebrow. It gave bluish tint under the firmly adherent overlying skin of normal color and texture. Rocky hard and non-tender, it was mobile over the underlying tissues. Total excision biopsy was performed under general anesthesia. Histopathologic analysis confirmed the diagnosis of pilomatrixoma. Pilomatrixoma is a rare tumor with head, neck and periocular area being the commonest sites. It is often clinically misdiagnosed and/or missed on differential diagnosis. Although a benign tumor, malignant transformation into pilomatrix carcinoma has been described. Thus, total surgical excision of the mass is recommended.Prikazuje se slučaj pilomatriksoma periokularnog područja u desetogodišnje djevojčice kroz retrospektivnu analizu povijesti bolesti jednog bolesnika. Desetogodišnja djevojčica dolazi zbog tvorbe ispod desne obrve koja raste godinu dana. Kliničkim pregledom se nađe ovalni, dobro ograničeni, potkožni tumor, pomičan po podlozi, veličine 7x4 mm. Plavičasto prosijava ispod nepromijenjene kože. Učinjena je ekscizijska biopsija tumora. Histopatološka analiza potvrdila je kliničku dijagnozu pilomatriksoma. Pilomatriksom je rijedak kožni tumor koji se najčešće javlja u području glave i vrata te u periokularnom području. Često je izostavljen u diferencijalnoj dijagnozi. Iako je benigan, tumor se može maligno promijeniti, stoga se preporuča potpuna kirurška ekscizija

Rijedak slučaj karcinoma bubrega u bolesnika s križanom distopijom i fuzijom: radiološka i kirurška problematika

Crossed-fused renal ectopia is an uncommon condition and cases of malignant tumors in such anomalies are extremely rare. A case of renal cell carcinoma in a patient with crossed-fused-ectopia is reported. The patient was successfully treated with partial nephrectomy following isthmus division. Radiologic investigations and operative findings are presented. It is thought to be the fourth reported case of renal cell carcinoma in crossed-fused ectopia.Križana distopija bubrega je neuobičajena anomalija koja se rijetko susreće u kliničkoj praksi. Incidencija tumora u ovim anomalijama iznimno je rijetka. Prikazan je slučaj karcinoma bubrega u bolesnika s križanom distopijom i fuzijom bubrega. Bolesnik je uspješno liječen djelomičnom nefrektomijom s razdvajanjem fuziranih bubrega. Raspravlja se o dijagnostičkoj i terapijskoj problematici ove rijetke bolesti. Prema našim saznanjima ovo je četvrti prikaz slučaja u literaturi