Karcinom dojke u trudnoći

Pregnancy-associated breast cancer is a difficult psychosocial and health problem for the patient, demanding an individual multidisciplinary treatment approach. Due to the need for aggressive oncological treatment with minimal adverse effects on the growing fetus, numerous studies are carried out to fi nd an optimal protocol, concerning the interest of both the mother and the child. Due to the physiological changes in the breasts in pregnancy, the diagnosis of breast cancer can be delayed and therefore patients have often higher clinical stage of the disease at initial presentation comparing to non-pregnant patients. Pregnancy termination due to breast cancer diagnosis had no effect on the prognosis of the patient, and longterm studies did not find a higher incidence of malignant disease in children who were exposed to chemotherapy in utero compared to the general population. Although prognosis data of those patients is controversial, recent studies have not found a worse outcome compared to breast cancer unrelated to pregnancy.Karcinom dojke povezan s trudnoćom teški je psihosocijalni i zdravstveni problem za pacijenticu i zahtjeva individualni multidisciplinarni pristup liječenju. Zbog potrebe za agresivnim onkološkim liječenjem, uz minimalne štetne utjecaje na rastući fetus, provode se brojne studije, čiji je zadatak pronaći optimalan protokol, vodeći se interesom i majke i djeteta. Zbog fizioloških promjena dojke tijekom trudnoće, može doći do kašnjenja u postavljanju dijagnoze karcinoma dojke i samim time višeg stadija bolesti pri inicijalnoj prezentaciji. Prekid trudnoće zbog dijagnoze karcinoma dojke nije mijenjao prognozu bolesti, a dugogodišnje studije nisu pokazale višu učestalost zloćudnih bolesti u djece intrauterino izložene kemoterapiji, u odnosu na opću populaciju. Iako su podaci o prognozi tih bolesnica kontroverzni, ipak većina novih studija nije ustanovila lošiji ishod u odnosu na bolesnice s karcinomom dojke nepovezanim sa trudnoćom

Učinak Tamoxifen na ženski reproduktivni sustav

Tamoxifen, a triphenylethyleneestrogen receptor modulator, is an eff ective treatment for estrogen receptor positive breast cancer patients. It acts as an estrogen antagonist in breast tissue and a week estrogen agonist in the female genital tract. Its estrogenagonist properties refl ects on increased risk of gynaecologic pathologies and includes the development of endometrial cancer, endometrial hyperplasia, endometrial polyps, adenomyosis, leiomyomas, uterine sarcomas, cervical polyps and ovarian cysts. Breast cancer patients during tamoxifen treatment should be under close gynaecological and ultrasonographic surveillance.Tamoxifen, trifeniletilenski modulator estrogesnih receptora, se koristi u liječenju raka dojke s pozitvnim estrogenskim receptorima. U tkivu dojke i tumorskim stanica ima estrogen-antagonistički učinak, a u ženskom spolnom sustavu blagi agonistički učinak što se očituje povećanim rizikom od ginekoloških bolesti koje uključuju rak endometrija, hiperplaziju endometrija, polipe endometrija, adenomiozu, miome, sarkome, polipe vrata maternice i ciste jajnika. Bolesnice s rakom dojke koje se liječe tamoxifenom trebaju biti redovito ginekološki i ultrazvučno pregledavane

Recidivirajuća pupčana endometrioza: prikaz slučaja i pregled literature

Umbilical primary endometriosis is a rare localization of the functional endometrial tissue outside of uterine cavity and it represents 0.5-1% of ectopical endometriosis. We are reporting a case in which recurrence of umbilical endometriosis has occurred 5 months after excision of umbilical endometriotic lesion and 19 years after the surgery of endometriotic cyst of the right ovary. It caused periodical bleeding from the umbilicus, associated with severe abdominal pain. Endometriosis was suspected and treated by wide surgical excision. Pathohistological analysis confirmed the diagnosis of endometriosis.Primarna endometrioza funkcionalnog endometrijskog tkiva izvan maternice s lokalizacijom u pupku je rijetkost sa zabilježenom pojavnoš}u 0,5-1% među ektopičnim endomteriozama. Opisujemo bolesnicu u koje je recidiv pupčane endomterioze nastupio 5 mjeseci nakon ekscizije pupčane endometriotičke lezije i 19 godina nakon operacije endometriotičke ciste u desnom jajniku. Endometrioza je uzrokovala povremeno krvarenje iz pupka, povezano s jakom boli u trbuhu. Zbog sumnje na endometriozu primijenjena je široka kirurška ekscizija. Patohistološka analiza potvrdila je dijagnozu endometrioze

Recidivirajuća pupčana endometrioza: prikaz slučaja i pregled literature

Umbilical primary endometriosis is a rare localization of the functional endometrial tissue outside of uterine cavity and it represents 0.5-1% of ectopical endometriosis. We are reporting a case in which recurrence of umbilical endometriosis has occurred 5 months after excision of umbilical endometriotic lesion and 19 years after the surgery of endometriotic cyst of the right ovary. It caused periodical bleeding from the umbilicus, associated with severe abdominal pain. Endometriosis was suspected and treated by wide surgical excision. Pathohistological analysis confirmed the diagnosis of endometriosis.Primarna endometrioza funkcionalnog endometrijskog tkiva izvan maternice s lokalizacijom u pupku je rijetkost sa zabilježenom pojavnoš}u 0,5-1% među ektopičnim endomteriozama. Opisujemo bolesnicu u koje je recidiv pupčane endomterioze nastupio 5 mjeseci nakon ekscizije pupčane endometriotičke lezije i 19 godina nakon operacije endometriotičke ciste u desnom jajniku. Endometrioza je uzrokovala povremeno krvarenje iz pupka, povezano s jakom boli u trbuhu. Zbog sumnje na endometriozu primijenjena je široka kirurška ekscizija. Patohistološka analiza potvrdila je dijagnozu endometrioze

Karcinom stidnice kod mlade žene i terapija multiple skleroze: prikaz slučaja

Vulvar cancer is a rare disease among young women. Risk factors for vulvar cancer are smoking, chronic dermatitis and human papilloma virus infection. However, no correlation between multiple sclerosis and increased risk of cancer has been established. We present a case of vulvar cancer in 35 year old women with multiple sclerosis. Radical vulvectomy with right-sided inguinofemoral lymphadenectomy was performed. Pathohistological analysis confi rmed the diagnosis of a squamous cell carcinoma, grade II, International Federation of Gynecology and Obstetrics (FIGO) IB. Adjuvant radiotherapy was not indicated. After two years of follow up, there was no evidence of the recurrence. The occurrence of vulvar cancer in multiple sclerosis patients may be coincidental. Nevertheless, the long term use of immunomodulatory drugs in multiple sclerosis and incidence of cancer may be associated.Karcinom stidnice je rijetka bolest u mladih žena. Rizični faktori za karcinom stidnice su pušenje, kronični dermatitis i infekcija humanim papiloma virusom. Nije dokazana povezanost između multiple skleroze i povećanog rizika za razvoj karcinoma. Opisujemo slučaj karcinoma stidnice u 35-godišnje žene koja boluje od multiple skleroze. Učinjena je radikalna vulvektomija s desnostranom ingvinofemoralnom limfadenektomijom. Patohistološka analiza potvrdila je dijagnozu planocelularnog karcinoma, gradus II, FIGO 1B. Adjuvantna radioterapija nije bila indicirana. Nakon dvije godine praćenja, nema znakova povrata bolesti. Pojava karcinoma stidnice u mlade bolesnice s multiplom sklerozom, može biti koincidencija. Moguća je povezanost dugotrajnog korištenja imunomodulatornih lijekova u multiploj sklerozi i incidencije karcinoma

An Incidental Finding of Unicornuate Uterus with Unilateral Ovarian Agenesis during Laparoscopy in Patient who Gave Birth to Eleven Children: A Case Report

Congenital uterine anomalies are often asymptomatic. They may present with infertility, recurrent miscarriage, preterm delivery, abnormal lie in pregnancy and other obstetric complications. We report the case of a 38-year old patient with unicornuate uterus without rudimentary horn and with unilateral left ovarian agenesis and unilateral left renal agenesis who gave birth to eleven children. Anomaly was incidentally diagnosed during laparoscopic sterilization

Gastrointestinalni stromalni tumor koji oponaša ginekološku patologiju: prikaz slučaja

Diagnosis of gastrointestinal stromal tumors (GISTs) of the terminal part of the small intestine on ultrasound examination can be difficult because of their similarity in appearance to gynecological tumors. We present a case of a 49-year-old asymptomatic female patient with GIST of the small intestine, which presented as a pelvic mass, mimicking an ovarian tumor. Tumor was diagnosed during the control check up and ultrasound gynecological examination. Computed tomography (CT) showed tumor mass in the pelvis on the right and free fluid in the lesser pelvis. During the surgery, exploration of the abdominal cavity displayed tumor of the terminal part of the small intestine (ileum). The uterus and both adnexes were normal. The patient was treated by resection of the terminal part of the small intestine and termino-terminal anastomosis. Immunohistochemical evaluation demonstrated positive vimentin, positive CD117, and negative CD 34. In the presence of a pelvic mass, especially if other unusual anamnestic data are present, the possibility of other than a gynecologic tumor has to be considered.Dijagnozu gastrointestinalnih stromalnih tumora (GIST) završnog dijela tankog crijeva teško je postaviti ultrazvučnim pregledom jer su izgledom nalik ginekološkim tumorima. Opisujemo slučaj 49-godišnje asimptomatične bolesnice s GISTom tankog crijeva koji se prikazuje kao tvorba u zdjelici i oponaša tumor jajnika. Tumor je dijagnosticiran na kontrolnom i ultrazvučnom ginekološkom pregledu. Kompjutorizirana tomografija (CT) otkrila je tumorsku tvorbu u zdjelici i slobodnu tekućinu maloj zdjelici. Pretraživanjem trbušne šupljine tijekom operacije otkriven je tumor završnog dijela tankog crijeva (ileuma). Maternica i adneksi bili su zdravi. Bolesnici je napravljena resekcija završnog dijela tankog crijeva i termino-terminalna anastomoza. Imunohistokemijska analiza pokazala je pozitivnu reakciju na vimentin i CD117; te negativnu na CD 34. Kad je u zdjelici prisutna tvorba; osobito ako su i drugi anamnestički podaci neuobičajeni; treba uzeti u obzir mogućnost da je riječ o nekom drugom; a ne ginekološkom tumoru

Rak jajnika, jajovoda i potrbušnice: kirurško liječenje

Surgery is the cornerstone of eff ective management of the ovarian, tubal and peritoneal cancer. In 2014 the International Federation of Gynecology and Obstetrics (FIGO) published a new classifi cation collectively covering cancer of ovary, fallopian tube and peritoneum as well as malignant ovarian germ cell tumors and malignant sex-cord stromal tumors. Comprehensive surgical staging according to the 2014 FIGO classifi cation system plays an important role in management of apparently early stage of ovarian, tubal and peritoneal cancer. Primary debulking (cytoreductive) surgery followed by paclitaxel and platinum based combination chemotherapy is the cornerstone of the advanced-stage disease treatment. In cases of suboptimal primary cytoreduction, interval debulking surgery performed after two to four cycles of chemotherapy based on the clinical judgment of the gynecologic oncologist is second att empt to achieve optimal cytoreduction. Secondary cytoreductive surgery can be considered in patients with platinum-sensitive locally recurrent ovarian cancer. The volume of residual tumor remaining after these surgical approaches is one of the most important independent prognostic factors for survival.Kirurško liječenje je temelj uspješnog liječenja raka jajnika, jajovoda i potrbušnice. Međunarodno federacija ginekologa i opstetričara (FIGO) u 2014. godini objavila je novu klasifi kaciju koja zajedno obuhvaća rak jajnika, jajovoda, potrbušnice, zloćudne tumore zametnih stanica i zloćudne tumore specijalizirane strome jajnika. Kirurško stupnjevanje bolesti prema FIGO 2014 klasifi kaciji je ključno u liječenju raka jajnika, jajovoda i potrbušnice naizgled ranog stadija bolesti. Primarna citoredukcijska kirurgija i dodatno liječenje kemoterapijom je standardni pristup uznapredovaloj bolesti. Prilikom suboptimalne citoredukcije tijekom primarnog kirurškog zahvata “interval debulking surgery” nakon drugog do četvrtog ciklusa kemoterapije, ovisno o procjeni ginekološkog onkologa, drugi je pokušaj postizanja optimalne ciotredukcije. Sekundarna citoredukcijska kirurgija dolazi u obzir kod pacijentica koje su osjetljive na kemoterapiju, a imaju lokalni povrat bolesti. Veličina rezidualnog tumorskog tkiva nakon kirurških zahvata je najznačajniji prognostički čimbenik na koji se može utjecati tijekom liječenja