47 research outputs found
Dermatomyositis as paraneoplastic syndrome of peritoneal and ovarian relapse after long-term complete remission in patient with metastatic bilateral breast cancer [Dermatomiozitis kao paraneoplastiÄki sindrom peritonealnog i ovarijalnog relapsa nakon dugog perioda potpune remisije u bolesnice s metastatskim bilateralnim rakom dojke]
Dermatomyositis is a rare disease characterised by inflammatory muscle affection and characteristic cutaneous changes. When occuring in a patient with cancer, dermatomyositis may indicate recurrence or progression and poor outcome. Herein, the treatment of metastatic breast cancer, metastatic pattern, characteristics of long-term survivors, and link between dermatomyositis and breast cancer are discussed and the literature reviewed. We report a 57-year old female patient with metastatic bilateral breast cancer whose ovarian and peritoneal relapse after long-term remission was disclosed by occurence of paraneoplastic dermatomyositis. The patient previously had a 15-year long disease free-period after primary treatment for breast cancer before onset of pulmonary dissemination. Following antracycline-based chemotherapy, the complete remission lasting another 15 years was accomplished. Dermatomyositis had been resolved upon induction of second-line taxane-based chemotherapy. After completion of six cycles of gemcitabine and paclitaxel chemotherapy, check-up revealed further progression. The patient subsequently underwent six cycles of third-line CAP chemotherapy (cyclofosfamide, doxorubicine, cisplatin) but disease progressed and oral capecitabine chemotherapy was initiated. The patient received four cycles of capecitabine followed by further vast progression and finally expired following massive pulmonary embolism. Our case stresses the need of thorough staging and check-up when dermatomyositis arises in patients with breast cancer, regardless of previous stable long-term complete remission. Furthermore, we believe that treatment with curative intent in young patients with metastatic breast cancer, who have good performance statuses and no comorbidities is required, because it is more likely to produce long-term complete remission. However, following disease relapse a poor outcome can be expected
Novosti u imunoterapiji melanoma
Melanoma is considered to be the most immunogenic malignant tumour. This fact is recognized for many years, and certain forms of immunotherapy have been used in melanoma therapy for a considerable time.
Treatment options for patients with metastatic melanoma have changed dramatically in the past 5 years, with the FDA approval of eight new therapeutic agents (immunotherapies and targeted therapies). During this period, melanoma immunotherapy has transitioned from cytokine-based treatment to antibody-mediated blockade of the cytotoxic Tlymphocyteassociated antigen4 (CTLA4) and, recently, the programmed cell-death protein 1 (PD1) immune checkpoints. These changes in the treatment options have dramatically improved patient outcomes, with the median overall survival of patients with metastatic melanoma increasing from approximately 9 months before 2011 to at least 2 years, and probably longer.
Various types of immunotherapy, like pembrolizumab, nivolumab, ipilimumab, combined therapy with nivolumab and ipilimumab, and T-VEC, have been established in recent years as the standard-of-care treatment for metastatic melanoma patients.Melanomi se smatraju najimunogenijim zloÄudnim tumorima. Ova je Äinjenica prepoznata veÄ niz godina, te se neki oblici imunoterapije veÄ dugo primjenjuju u lijeÄenju melanoma.
Terapijske opcije za lijeÄenje bolesnika s metastatskim melanomom dramatiÄno su se promijenile u zadnjih pet godina, te je AmeriÄka agencija za lijekove (FDA) odobrila osam novih lijekova (imunoterapije i ciljane terapije). Tijekom ovog razdoblja, imunoterapija melanoma promijenila se iz terapije bazirane na citokinima u protutijelima posredovanu blokadu citotoksiÄnog T-limfocitnog antigena 4 (CTLA-4), a u zadnje vrijeme u protutijelima posredovanu inhibiciju imunoloÅ”kih
kontrolnih toÄaka, prvenstveno proteina programirane staniÄne smrti 1 (PD-1). Ove su promjene terapijskih opcija dramatiÄno poboljÅ”ale ishod lijeÄenja bolesnika, te se medijan ukupnog preživljenja kod bolesnika s metastatskim melanomom povisio s približno 9 mjeseci prije 2011. godine, na najmanje 2 godine, a vjerojatno i dulje. RazliÄiti oblici imunoterapije, poput pembrolizumaba, nivolumaba, ipilimumaba, kombinirane terapije nivolumabom i ipilimumabom, te T-VEC, postali
su zadnjih godina standardni oblici lijeÄenja bolesnika s metastatskim melanomom
Demografska i kliniÄko-patoloÅ”ka obilježja bolesnica s primarnim rakom dojke lijeÄenih u razdoblju od 1997. do 2010. godine: iskustvo jedne klinike
Breast cancer accounted for 28% of all new cancers and 18% of female cancer deaths in Europe in 2010. It is the most common type of cancer in women in Croatia, with an incidence rate of 56.9/100 000 in the year 2010, and the highest number of newly diagnosed women aged between 60 and 64. Multiple factors are associated with an increased risk of breast cancer: advancing age, family history, exposure to endogenous and exogenous reproductive hormones, dietary factors, benign breast disease, and environmental factors. To assess demographic and clinicopathologic features of primary breast cancer, we retrospectively analyzed 870 patients treated in our institution between 1997 and 2010. Data were obtained from medical documentation and a printed questionnaire regarding life habits. Most of our patients presented with a breast lump and were self-diagnosed
by breast examination. This fact highlights the need of regular breast self-examination, although it should also be taken into account that most of our patients did not attend regular mammography screening (only 31%). One of the most concerning facts is that the mean time from observing the first symptom to visiting a physician was 4 months. Previous studies have identified ignorance, fear and fatalistic attitudes, poor socioeconomic conditions, and illiteracy as important factors resulting in delay. Considering these facts, education and raising awareness about the disease in the general population is one of the key weapons for lowering breast cancer mortality.U europskoj populaciji rak dojke Äinio je 2010. godine 28% svih novodijagnosticiranih zloÄudnih tumora te bio uzrokom smrti u 18% žena oboljelih od raka. Prvi je po uÄestalosti zloÄudni tumor u žena u Hrvatskoj, s incidencijom od 56,9/100.000 (2010. godine), a najveÄi broj bolesnica dijagnosticira se u dobi izmeÄu 60 i 64 godine. RiziÄni Äimbenici za rak dojke su viÅ”estruki: dob, pozitivna obiteljska anamneza, izloženost endogenim i egzogenim hormonima, prehrana, dobroÄudna bolest dojke te okoliÅ”ni Äimbenici. Radi procjene demografskih i kliniÄko-patoloÅ”kih znaÄajka primarnog raka dojke retrospektivno smo analizirali 870 bolesnica koje su lijeÄene u naÅ”oj ustanovi izmeÄu 1997. i 2010. godine. Podaci su prikupljeni iz medicinske dokumentacije te formuliranog upitnika koji se odnosio na životne navike. U veÄine bolesnica se bolest prezentirala kao Ävor u dojci te su bolest dijagnosticirale same. Ova Äinjenica naglaÅ”ava potrebu redovitog samopregleda, iako takoÄer treba uzeti u obzir Äinjenicu da je tek manji broj bolesnica redovito pohaÄao kontrolne mamografske preglede (31%). Zabrinjava podatak da je prosjeÄno vrijeme od prvog simptoma bolesti do javljanja lijeÄniku bilo Äak 4
mjeseca. Prema ranijim studijama najvažniji razlozi odgode javljanja lijeÄniku su neznanje, strah i fatalistiÄki odnos prema bolesti, niži socioekonomski status te nepismenost. U skladu s dobivenim rezultatima, izobrazba i podizanje svijesti o bolesti u opÄoj populaciji meÄu kljuÄnim su metodama za snižavanje smrtnosti od raka dojke
Novodijagnosticirani dijabetes kao znak karcinoma guÅ”teraÄe ā prikaz sluÄaja
Diabetes is often related to pancreatic cancer and sometimes the only symptom of an underlying pancreatic malignancy. We report a case of new-onset diabetes in a 83-year-old male patient that exposed an unknown pancreatic carcinoma. Patient was treated with chemoradiotherapy and diabetes was regulated by glicazide introduction. Taking into account its late recognition and poor prognosis, in a case of sudden new-onset diabetes, pancreatic cancer should be considered.Dijabetes se Äesto dovodi u vezu s karcinomom guÅ”teraÄe, Å”toviÅ”e, katkad je prvi simptom maligne bolesti guÅ”teraÄe.
U ovom radu prikazujemo sluÄaj novonastalog dijabetesa u 83-godiÅ”njeg bolesnika koji je ukazao na skriveni karcinom guÅ”teraÄe. Bolesnik je lijeÄen primarnom kemoradioterapijom, a dijabetes je reguliran uvoÄenjem glikazida. UzimajuÄi u obzir njegovo kasno otkrivanje i loÅ”u prognozu, u sluÄaju naglog razvoja dijabetesa trebalo bi posumnjati na karcinom guÅ”teraÄe
Novodijagnosticirani dijabetes kao znak karcinoma guÅ”teraÄe ā prikaz sluÄaja
Diabetes is often related to pancreatic cancer and sometimes the only symptom of an underlying pancreatic malignancy. We report a case of new-onset diabetes in a 83-year-old male patient that exposed an unknown pancreatic carcinoma. Patient was treated with chemoradiotherapy and diabetes was regulated by glicazide introduction. Taking into account its late recognition and poor prognosis, in a case of sudden new-onset diabetes, pancreatic cancer should be considered.Dijabetes se Äesto dovodi u vezu s karcinomom guÅ”teraÄe, Å”toviÅ”e, katkad je prvi simptom maligne bolesti guÅ”teraÄe.
U ovom radu prikazujemo sluÄaj novonastalog dijabetesa u 83-godiÅ”njeg bolesnika koji je ukazao na skriveni karcinom guÅ”teraÄe. Bolesnik je lijeÄen primarnom kemoradioterapijom, a dijabetes je reguliran uvoÄenjem glikazida. UzimajuÄi u obzir njegovo kasno otkrivanje i loÅ”u prognozu, u sluÄaju naglog razvoja dijabetesa trebalo bi posumnjati na karcinom guÅ”teraÄe
Endometrioza trbuÅ”ne stijenke jedanaest godina nakon carskog reza: prikaz sluÄaja
Endometriosis is a common chronic disease characterized by growth of the endometrial gland and stroma outside the uterus. Symptoms affect physical, mental and social well-being. Extrapelvic location of endometriosis is very rare. Abdominal wall endometriosis occurs in 0.03%-2% of women with a previous cesarean section or other abdominopelvic operation. Th e leading symptoms are abdominal nodular mass, pain and cyclic symptomatology. Th e number of cesarean sections is increasing and so is the incidence of abdominal wall endometriosis as a potential complication of the procedure. There are cases of malignant transformation of abdominal wall endometriosis. Therefore, it is important to recognize this condition and treat it surgically. We report a case of a 37-year-old woman with abdominal wall endometriosis 11 years after cesarean section. She had low abdominal pain related to menstrual cycle, which intensified at the end of menstrual bleeding. A nodule painful to palpation was found in the medial part of previous Pfannenstiel incision. Ultrasound guided biopsy was performed and the diagnosis of endometriosis confirmed. Surgery is the treatment of choice for abdominal wall endometriosis. Excision with histologically proven free surgical margins of 1 cm is mandatory to prevent recurrence. A wide spectrum of mimicking conditions is the main reason for late diagnosis and treatment of abdominal wall endometriosis. In our case, the symptoms lasted for eight years and had intensified in the last six months prior to surgery.Endometrioza je Äesta kroniÄna bolest obilježena rastom endometrijskih žlijezda i storme izvan maternice. Simptomi utjeÄu na pad fiziÄkog, mentalnog i socijalnog blagostanja. EkstrapelviÄna lokacija endometrioze je rijetka. Pojavnost endometrioze trbuÅ”ne stijenke je 0,03%-2% žena s prethodnim carskim rezom ili nekom drugom abdominopelviÄkom operacijom. VodeÄi simptomi su abdominalna nodularna masa, bol i cikliÄka simptomatologija. Broj carskih rezova je u porastu pa tako raste i pojavnost endometrioze trbuÅ”ne stijenke kao potencijalne komplikacije ovoga zahvata. Opisani su sluÄajevi maligne transformacije endometrioze trbuÅ”ne stijenke. Zato je potrebno pravodobno prepoznati ovo stanje i lijeÄiti ga kirurÅ”ki. Prikazan je sluÄaj 37-godiÅ”nje bolesnice s endometriozom trbuÅ”ne stijenke 11 godina nakon carskog reza. Imala je bolove u donjem dijelu trbuha koji su bili povezani s menstruacijskim ciklusom i pojaÄavali su se prema kraju menstrualnog krvarenja. Bolni ÄvoriÄ se pipao u srednjem dijelu ožiljka od carskog reza. UltrazvuÄno navoÄena biopsija je potvrdila dijagnozu endometrioze. Metoda izbora u lijeÄenju endometrioze trbuÅ”ne stijenke je kirurÅ”ki zahvat. Å iroka ekscizija s patohistoloÅ”ki dokazanim slobodnim rubom od 1 cm je obvezna kako bi se sprijeÄio recidiv endometrioze. Å iroka diferencijalna dijagnoza je razlog kasne dijagnoze i lijeÄenja endometrioze trbuÅ”ne stijenke. Simptomi su trajali osam godina, a pojaÄali su se Å”est mjeseci prije operacije
Chloasma ā The Mask of Pregnancy
Chloasma is a required hypermelanosis of sun-exposed areas occurred during pregnancy and it can affect 50ā70% of
pregnant women. It presents as symmetric hyperpigmented macules, which can confluent or punctuate. The most common
locations are the cheeks, the upper lip, the chin and the forehead. The exact mechanism by which pregnancy affects
the process of melanogenesis is unknown. Estrogen, progesterone, and melanocyte-stimulating hormone (MSH) levels
are normally increased during the third trimester of pregnancy. However, nulliparous patients with chloasma have no
increased levels of estrogen or MSH. In addition, the occurrence of melasma with estrogen- and progesterone-containing
oral contraceptive pills has been reported. The observation that postmenopausal woman who are given progesterone develop
melasma, while those who are given only estrogen do not, implicates progesterone as playing a critical role in the
development of melasma. UV-B, UV-A, and visible light are all capable of stimulating melanogenesis. The condition is
self-limited; however spontaneous resolution is time-consuming and may take months to resolve normal pigmentation.
Therefore, it is worthwhile to prevent the onset of chloasma, by strict photoprotection. Prudent measures to avoid sun exposure
include hats and other forms of shade combined with the application of a broad-spectrum sunscreen at least daily.
Sunscreens containing physical blockers, such as titanium dioxide and zinc oxide, are preferred over chemical blockers
because of their broader protection. Chloasma can be difficult to treat. Quick fixes with destructive modalities (eg, cryotherapy,
medium-depth chemical peels, lasers) yield unpredictable results and are associated with a number of potential
adverse effects. The mainstay of treatment remains topical depigmenting agents. Hydroquinone (HQ) is most commonly
used