Povezanost morfoloških i kinetičkih osobitosti duktalnoga invazivnoga karcinoma dojke dobivenih magnetnom rezonancijom s patohistološkim prognostičkim pokazateljima [Correlation of morphological and kinetic features at magnetic resonance imaging and pathohistological prognostic factors in invasive ductal breast cancer]

Objective. The aim of this study was to correlate magnetic resnonace imaging (MRI) features of invasive ductal carcinomas (IDC) with pathohistological prognostic factors, as well as with molecular subtypes of breast cancer. Such an association, if present, could have significant translational implications for early identification of aggressive types of breast cancer, where rapid identification can expedite tumor treatment. Methods. 114 women with IDC who underwent breast MRI within one month prior to surgery were included in this retrospective study. MRI features were analyzed and then interpreted with a Göttingen score (GS) that included morphological (shape, margins and pattern of enhancement) and kinetic characteristics (initial signal increase and post-initial behaviour of the time-signal intensity curve). Histological specimens were analyzed for tumor size, axillary lymph node status, histological grade, estrogene receptors (ER), progesterone receptors (PR), HER2, and Ki-67. Results. By multivariate analysis, a smooth margin was a significant, independent predictor of a larger tumor size (p=0.041), lymph node invasion (p=0,013), and lower expression of ER (p=0.022). High GS was significant, independent predictor of a higher histological grade (p=0.022) while round or oval shape of lesion was independent predictor of a higher PR expression (p=0,027). Conclusion. A smooth margin of breast cancer on breast MRI was able to predict positive axillary lymph nodes, larger tumor size and lower expression of ER. Except for a higher histological grade, GS was not able to predict other unfavourable prognostic factors, mainly due to the fact that smooth margins were assigned less points than spiculated margins

CT arthrography prior to CT guided bone lesion biopsy, a case report

Background: Suspicious bone lesions are very common and often need a pathohistological verification. Surgical (open) and percutaneous image guided biopsies can be used to get a sample for pathology analysis. As the barriers of lesion compartment shouldn’t be crossed due to risk of dissemination, transarticular approach is not advised. Case study: We present a case of 57-year-old female patient with lung cancer history and left knee pain. Lytic lesion in lateral femoral epycondile with fluorodeoxyglucose (FDG) uptake was confirmed by positron emission tomography with computed tomography (PET/CT). Surgical biopsy was performed and pathohistological analysis showed no tumor cells. A month later a computed tomography (CT)-guided percutaneous bone biopsy with CT arthrography was performed and pathohistological analysis confirmed metastatic lesion. Conclusion: CT-guided percutaneous bone biopsy is a safe, effective and minimally invasive procedure. CT arthrography can add some additional information for anatomical positioning in order to avoid transarticular approach in reaching the targeted lesion

Usporedba kratkoročnih ishoda perkutane radiofrekventne i mikrovalne ablacije u liječenju malih tumora bubrega

Although the gold standard in the management of kidney tumors is surgical treatment, thermal ablation methods are a viable therapeutic option for patients with small (<4 cm) renal masses who are poor surgical candidates. The aim of this study was to compare the technical success, primary efficacy and complication rate of percutaneous radiofrequency and microwave ablation in the treatment of small renal masses. A retrospective analysis of consecutive patients with small renal masses treated with radiofrequency or microwave ablation between December 2017 and January 2022 was conducted. Response to the ablative therapy was assessed on contrast-enhanced computed tomography examination after 3 months. Ablations of 44 kidney lesions were performed in 43 patients. Sixteen lesions were treated with radiofrequency and 28 with microwave ablation. Both methods were associated with high technical success (100%). Primary efficacy rates of radiofrequency and microwave ablation were 81.3% and 89.3%, respectively. Ablation-related complications were noted only in the patients treated with microwave ablation (18.5%), all of them being low grade (Clavien-Dindo 1 and 2). Radiofrequency and microwave ablation exhibited comparable efficacy in the treatment of small renal masses. Microwave ablation was associated with a comparatively higher number of complications.Iako je zlatni standard u liječenju tumora bubrega kirurško liječenje, metode termalne ablacije dobar su izbor za bolesnike s malim (<4 cm) tumorima bubrega koji nisu kandidati za operativni zahvat. Cilj ovoga rada je usporediti tehnički uspjeh, odgovor na terapiju i učestalost komplikacija perkutane radiofrekventne i mikrovalne ablacije u liječenju malih tumora bubrega. Učinjena je retrospektivna analiza uzastopnih bolesnika s malim tumorima bubrega liječenih radiofrekventnom ili mikrovalnom ablacijom između prosinca 2017. i siječnja 2022. godine. Odgovor na terapiju procijenjen je na temelju pregleda kompjutoriziranom tomografijom 3 mjeseca nakon zahvata. Ablacijom su liječene 44 lezije kod 43 bolesnika, pri čemu je 16 lezija liječeno radiofrekventnom, a 28 mikrovalnom ablacijom. Kod obje metode postignuta je visoka razina tehničkog uspjeha (100%). Potpun odgovor na terapiju zabilježen je kod 81,3% lezija liječenih radiofrekventnom i 89,3% lezija liječenih mikrovalnom ablacijom. Komplikacije vezane uz ablaciju zabilježene su samo kod bolesnika liječenih mikrovalnom ablacijom (18,5%), no sve su bile niskog gradusa (Clavien-Dindo 1 i 2). Radiofrekventna i mikrovalna ablacija podjednako su uspješne u liječenju malih tumora bubrega, pri čemu je mikrovalna ablacija povezana s usporedbeno većim brojem komplikacija

Primary peritonitis in a previously healthy child

Primarni peritonitis se rijetko javlja u dječjoj dobi i zahvaća uglavnom djecu s kroničnim bolestima jetre ili nefrotskim sindromom, a vrlo rijetko se javlja u prethodno zdrave djece. Cilj ovog prikaza je opisati kliničke i radiološke značajke primarnog peritonitisa kod prethodno zdravog djeteta.Primary peritonitis rarely occurs in childhood, affecting mainly children with chronic liver disease or nephrotic syndrome, but occurs very rarely in previously healthy children. The aim of this case report is to describe the clinical and radiological features of primary peritonitis in a previously healthy child

Biopsije koštanih lezija pod kontrolom ct-a, naša iskustva iz 2018. I 2019.

To present our results from 2018 and 2019 and to present the clinical data of the accuracy and clinical usefulness of computed tomography (CT)-guided biopsy for diagnosing suspicious bone lesion. The retrospective study included 98 consecutive patients who underwent CT-guided bone lesion biopsy from January 2018 to December 2019. The localization of the bone lesions, the adequacy of the sample for histopathological analysis, histopathological results, and the procedure’s complications were analyzed. The specimens collected from 76 patients/lesions (77.6%) were considered appropriate for diagnosis. Histological analysis of bone samples showed 52 (68.4%) metastatic lesions. The most common primary tumor origins were breast carcinoma 28 (53.8%) and lung carcinoma six (11.5%). In three patients (4%), the infection was confirmed. No tumor cells were found in 17 (22.4%) patients. There were no post-procedural complications. CT-guided bone lesion biopsy is a safe and effective method for diagnosing suspicious bone lesions that has a great effect in clinical practice without any significant complications.Cilj rada je predstaviti naše rezultate iz 2018. i 2019. i dodati saznanja kliničkim podatcima o točnosti i kliničkoj korisnosti biopsije vođene kompjuteriziranom tomografijom kod dijagnosticiranja suspektnih koštanih lezija. Retrospektivno istraživanje obuhvatilo je 98 uzastopnih bolesnika koji su podvrgnuti biopsiji koštanih lezija pod kontrolom CT-a od siječnja 2018. do prosinca 2019. Analizirani su lokalizacija koštanih lezija, adekvatnost uzorka za patohistološku analizu, patohistološki rezultati i komplikacije postupka. Uzorci prikupljeni od 76 pacijentata iz 76 lezija (77,6%) smatrani su prikladnima za dijagnozu. Histološka analiza uzoraka kostiju pokazala je 52 (68,4%) presadničke lezije. Najčešći izvor primarnog tumora bio je rak dojke 28 (53,8%), a rak pluća 6 (11,5%). U 3 bolesnika (4%) potvrđena je infekcija. U 17 (22,4%) bolesnika nisu pronađene tumorske stanice. Biopsija koštanih oštećenja pod kontrolom CT-a sigurna je i učinkovita metoda bez ozbiljnijih komplikacija

Liječenje malih tumora bubrega ablacijskim metodama

Mali tumor bubrega je radiološkim metodama utvrđena tvorba promjera do 4 cm. Kirurško liječenje je terapija izbora ovakvih tumora, ali se kod starijih bolesnika s komorbiditetima preporučuju i ablacijske metode. Cilj je ovoga rada prikazati naša iskustva liječenja malih tumora bubrega ablacijskim metodama. Učinili smo retrospektivnu analizu serije bolesnika liječenih radiofrekventnom i mikrovalnom ablacijom u Kliničkom bolničkom centru Zagreb u razdoblju od siječnja 2017. godine do kolovoza 2019. godine. Svim bolesnicima učinjena je odgovarajuća radiološka i preoperativna obrada, biopsija tumora i ablacija. Praćeni su prema standardnom protokolu radiološkim metodama 3, 6 i 12 mjeseci postoperativno te nakon toga jednom godišnje. Ablacija 32 mala tumora bubrega učinjena je kod 31 pacijenta, od čega 27 radiofrekventnih i 7 mikrovalnih ablacija. Jednogodišnje ukupno i tumor specifično preživljenje bilo je 100%, a kod 12,9% bolesnika utvrđen je rezidualni tumor. Troje ih je liječeno ponovnom ablacijom, a jedan radikalnom nefrektomijom. Imali smo četiri komplikacije iz 2. skupine po Clavien-Dindo klasifikaciji. Ablacijske metode su onkološki dobra i sigurna terapija kod bolesnika koji nisu pogodni za kirurški zahvat

Clinical guidelines for diagnostics, treatment and monitoring of patients with testicular cancer

Rak testisa najčešći je solidni tumor u muškaraca u dobi od 15. do 34. godine. Incidencija raka testisa u svijetu udvostručena je u posljednjih 40 godina. Tumori zametnih stanica čine 95% svih tumora testisa, a podijeljeni su u dva osnovna histološka tipa: seminomi i neseminomi. Osobito značenje daje im velik postotak izlječivosti i u diseminiranoj fazi bolesti. Tom je uspjehu najviše pridonijela kemoterapija, ali kirurgija je i dalje neizostavan dio uspješnog liječenja. U znatnog dijela bolesnika danas se nastoji odrediti terapijski minimum kojim se izbjegava niz nuspojava, a dovodi do jednakog uspjeha kao i donedavno agresivniji terapijski pristup. U tekstu koji slijedi iznesene su kliničke upute radi standardizacije dijagnostike, liječenja i praćenja bolesnika s tumorima zametnih stanica testisa u Republici Hrvatskoj.Testicular tumors are the most common solid tumors in men between age 15- 34 years. The worldwide incidence of these tumors has doubled in the past 40 years. Germ cell tumors comprise 95% of malignant tumors arising in the testes and they are classified as seminoma and nonseminoma. Testicular cancer has high cure rates even in disseminated stage of disease. The chemotherapy mostly contributed to these results, but surgery is an unavoidable part of this success. In significant number of these patients treatment algorithms today have intention to offer the same cure rates with minimally aggressive therapy. The following text presents the clinical guidelines in order to standardize procedures and criteria for diagnosis, treatment, and follow-up of patients with testicular cancer in the Republic of Croatia

Management of patients with adrenal incidentaloma – 2019 update

Zadnjih desetak godina došlo je do značajnih promjena u zdravstvenom zbrinjavanju bolesnika s incidentalomima nadbubrežne žlijezde koje su rezultirale novim preporukama za dijagnostiku i liječenje ovih bolesnika napravljenim u suradnji Europskoga endokrinološkog društva i Europske mreže za istraživanje tumora nadbubrežne žlijezde. Na temelju navedenih preporuka i višegodišnjega vlastitog iskustva Referentni centar Ministarstva zdravstva Republike Hrvatske za bolesti nadbubrežne žlijezde predlaže izmjene i dopune preporuka za dijagnostiku i liječenje ovih bolesnika objavljenih u Liječničkom vjesniku 2010. godine.In the last decade, the clinical care of patients with adrenal incidentaloma has been significantly changed which prompted the European Society of Endocrinology and European Network for the Study of Adrenal Tumors to develop an updated clinical practice guideline for the management of these patients. In accordance with the aforementioned recommendations and based on its own experience, the Croatian Referral Center for adrenal gland disorders provides an update of the previous guideline for the clinical management of patients with adrenal incidentaloma published in Liječnički vjesnik in 2010

Clinical Recommendation for Diagnostics, Treatment and Monitoring of Patients with Prostate Cancer

Adenokarcinom prostate najčešća je zloćudna neoplazma u muškaraca u Republici Hrvatskoj. Klinički je često asimptomatski, a najčešće se otkriva na osnovi povišenih vrijednosti PSA u serumu. Odluka o liječenju donosi se na temelju TNM-klasifikacije, gradusne skupine i vrijednosti PSA. Klinički lokalizirana bolest vrlo se uspješno liječi radikalnom prostatektomijom ili radikalnom radioterapijom s hormonskom terapijom ili bez nje. Klinički lokalno uznapredovala bolest najčešće se liječi združenom primjenom radikalne radioterapije i hormonske terapije. Metastatska bolest godinama se može kontrolirati androgenom deprivacijom, a nakon razvoja kastracijski rezistentne bolesti opravdani su kemoterapija ili dodatni oblici hormonske terapije. U radu su prikazane kliničke upute radi ujednačenja postupaka i kriterija postavljanja dijagnoze, liječenja i praćenja bolesnika s rakom prostate u Republici Hrvatskoj.Prostate adenocarcinoma is the most common solid neoplasm in male population in Croatia. It is often asymptomatic. The finding of PSA rise is the most common reason for diagnostic workout. Treatment plan is based on TNM classification, grade group and PSA. Clinically localized disease is successfully treated by radical prostatectomy or radiotherapy with or without hormonal therapy. Locally advanced disease is treated with radiotherapy and hormonal therapy. Metastatic disease can be controlled for many years by androgen deprivation. For castration resistant metastatic disease appropriate treatment is chemotherapy or secondary hormonal therapy. The following paper presents the clinical guidelines to standardize procedures for the diagnosis, treatment and follow-up of patients with prostate cancer in the Republic of Croatia

Clinical recommendations for diagnosis, treatment and monitoring of patients with bladder cancer

Rak mokraćnog mjehura (RMM) jest, u skladu s podatcima hrvatskog Registra za rak iz 2015. godine, drugi prema učestalosti tumor urinarnog sustava, odmah nakon raka prostate. U 90% slučajeva radi se o urotelnom karcinomu, a razlika u preživljenju kod bolesnika s mišićnoinvazivnim RMM-om (MIRMM) i nemišićnoinvazivnim RMM-om (NMIRMM) znatna je. Liječenje NMIRMM-a usmjereno je na smanjenje recidiva i sprječavanje napredovanja bolesti, a sastoji se od transuretralne resekcije (TUR) tumora i primjene intravezikalne terapije ovisno o procjeni rizika od povrata bolesti. Temelj liječenja bolesnika s MIRMM-om jest radikalno kirurško liječenje, tj. cistektomija kojoj u bolesnika koji su sposobni primiti cisplatinu prethodi neoadjuvantna kemoterapija (NKT). U trenutku postavljanja dijagnoze bolest je kod 4 – 6% bolesnika proširena, dok će se u 50% bolesnika razviti povrat bolesti nakon cistektomije. Metode liječenja proširenje bolesti uključuju: kemoterapiju temeljenu na cisplatini, imunoterapiju, palijativnu radioterapiju te simptomatsko i potporno liječenje. Važno obilježje RMM-a jest prisutnost visoke stope somatskih mutacija koje su omogućile promjenu paradigme u liječenju proširenog RMM-a i dovele do odobravanja niza novih lijekova koji pripadaju inhibitorima PD-1 i PD-L1, tj. inhibitorima nadzornih točaka imunosnog odgovora posredovanog T-stanicama .Bladder cancer is the second most common malignancy of urinary system according to data from the Croatian National Cancer Registry for 2015. In 90% of cases the underlying histology is urothelial carcinoma. Difference in survival in patients with muscle-invasive disease (MIBC) compared to the survival of patients with non-muscle invasive disease (NMIBC) is enormous. Management of NMIBC, traditionally, has been focused on the reduction of subsequent bladder recurrence and prevention of disease progression and is primarily based on transurethral resection (TUR) of the tumor, followed by intravesical therapy based on estimated individual risk of recurrence. Conversely, in patients with MIBC radical cystectomy remains the corne stone of the treatment, optimally in conjunction with neoadjuvant platinum-based chemotherapy in cisplatin-eligible patients. At the moment of diagnosis, 4–6% of patients already have distant metastases, and post cystectomy recurrence could be expected in 50% of patients. Treatment options in metastatic disease range from cisplatin-based chemotherapy, immunotherapy, palliative radiotherapy and finally supportive care. Landmark feature of bladder cancer is the high prevalence of somatic mutations which enabled profound change for decades held treatment paradigm for advanced bladder cancer leading to regulatory approval of whole array of novel immunotherapy agents. These emerging therapeutics (programmed death ligand-1 (PD-L1) and programmed cell death protein-1 (PD-1)) belong to the class of inhibitors of checkpoint proteins, which are key targets that regulate T-cell mediated immune response