Dermatomyositis as paraneoplastic syndrome of peritoneal and ovarian relapse after long-term complete remission in patient with metastatic bilateral breast cancer [Dermatomiozitis kao paraneoplastički 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 zloćudnim tumorima. Ova je činjenica prepoznata već niz godina, te se neki oblici imunoterapije već dugo primjenjuju u liječenju melanoma. Terapijske opcije za liječenje bolesnika s metastatskim melanomom dramatično su se promijenile u zadnjih pet godina, te je Američka 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 citotoksičnog T-limfocitnog antigena 4 (CTLA-4), a u zadnje vrijeme u protutijelima posredovanu inhibiciju imunoloških kontrolnih točaka, prvenstveno proteina programirane stanične smrti 1 (PD-1). Ove su promjene terapijskih opcija dramatično poboljšale ishod liječenja 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. Različiti oblici imunoterapije, poput pembrolizumaba, nivolumaba, ipilimumaba, kombinirane terapije nivolumabom i ipilimumabom, te T-VEC, postali su zadnjih godina standardni oblici liječenja bolesnika s metastatskim melanomom

Demografska i kliničko-patološka obilježja bolesnica s primarnim rakom dojke liječenih 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 činio je 2010. godine 28% svih novodijagnosticiranih zloćudnih tumora te bio uzrokom smrti u 18% žena oboljelih od raka. Prvi je po učestalosti zloćudni tumor u žena u Hrvatskoj, s incidencijom od 56,9/100.000 (2010. godine), a najveći broj bolesnica dijagnosticira se u dobi između 60 i 64 godine. Rizični čimbenici za rak dojke su višestruki: dob, pozitivna obiteljska anamneza, izloženost endogenim i egzogenim hormonima, prehrana, dobroćudna bolest dojke te okolišni čimbenici. Radi procjene demografskih i kliničko-patoloških značajka primarnog raka dojke retrospektivno smo analizirali 870 bolesnica koje su liječene u našoj ustanovi između 1997. i 2010. godine. Podaci su prikupljeni iz medicinske dokumentacije te formuliranog upitnika koji se odnosio na životne navike. U većine bolesnica se bolest prezentirala kao čvor u dojci te su bolest dijagnosticirale same. Ova činjenica naglašava potrebu redovitog samopregleda, iako također treba uzeti u obzir činjenicu da je tek manji broj bolesnica redovito pohađao kontrolne mamografske preglede (31%). Zabrinjava podatak da je prosječno vrijeme od prvog simptoma bolesti do javljanja liječniku bilo čak 4 mjeseca. Prema ranijim studijama najvažniji razlozi odgode javljanja liječniku su neznanje, strah i fatalistički odnos prema bolesti, niži socioekonomski status te nepismenost. U skladu s dobivenim rezultatima, izobrazba i podizanje svijesti o bolesti u općoj populaciji među ključnim su metodama za snižavanje smrtnosti od raka dojke

Novodijagnosticirani dijabetes kao znak karcinoma gušterače – prikaz slučaja

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 često dovodi u vezu s karcinomom gušterače, štoviše, katkad je prvi simptom maligne bolesti gušterače. U ovom radu prikazujemo slučaj novonastalog dijabetesa u 83-godišnjeg bolesnika koji je ukazao na skriveni karcinom gušterače. Bolesnik je liječen primarnom kemoradioterapijom, a dijabetes je reguliran uvođenjem glikazida. Uzimajući u obzir njegovo kasno otkrivanje i lošu prognozu, u slučaju naglog razvoja dijabetesa trebalo bi posumnjati na karcinom gušterače

Novodijagnosticirani dijabetes kao znak karcinoma gušterače – prikaz slučaja

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 često dovodi u vezu s karcinomom gušterače, štoviše, katkad je prvi simptom maligne bolesti gušterače. U ovom radu prikazujemo slučaj novonastalog dijabetesa u 83-godišnjeg bolesnika koji je ukazao na skriveni karcinom gušterače. Bolesnik je liječen primarnom kemoradioterapijom, a dijabetes je reguliran uvođenjem glikazida. Uzimajući u obzir njegovo kasno otkrivanje i lošu prognozu, u slučaju naglog razvoja dijabetesa trebalo bi posumnjati na karcinom gušterače

Endometrioza trbušne stijenke jedanaest godina nakon carskog reza: prikaz slučaja

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 česta kronična bolest obilježena rastom endometrijskih žlijezda i storme izvan maternice. Simptomi utječu na pad fizičkog, mentalnog i socijalnog blagostanja. Ekstrapelvična lokacija endometrioze je rijetka. Pojavnost endometrioze trbušne stijenke je 0,03%-2% žena s prethodnim carskim rezom ili nekom drugom abdominopelvičkom operacijom. Vodeći simptomi su abdominalna nodularna masa, bol i ciklička simptomatologija. Broj carskih rezova je u porastu pa tako raste i pojavnost endometrioze trbušne stijenke kao potencijalne komplikacije ovoga zahvata. Opisani su slučajevi maligne transformacije endometrioze trbušne stijenke. Zato je potrebno pravodobno prepoznati ovo stanje i liječiti ga kirurški. Prikazan je slučaj 37-godišnje bolesnice s endometriozom trbušne stijenke 11 godina nakon carskog reza. Imala je bolove u donjem dijelu trbuha koji su bili povezani s menstruacijskim ciklusom i pojačavali su se prema kraju menstrualnog krvarenja. Bolni čvorić se pipao u srednjem dijelu ožiljka od carskog reza. Ultrazvučno navođena biopsija je potvrdila dijagnozu endometrioze. Metoda izbora u liječenju endometrioze trbušne stijenke je kirurški zahvat. Široka ekscizija s patohistološki dokazanim slobodnim rubom od 1 cm je obvezna kako bi se spriječio recidiv endometrioze. Široka diferencijalna dijagnoza je razlog kasne dijagnoze i liječenja endometrioze trbušne stijenke. Simptomi su trajali osam godina, a pojačali su se šest mjeseci prije operacije

Chloasma – The Mask of Pregnancy

Chloasma is a required hypermelanosis of sun-exposed areas occurred during pregnancy and it can affect 50–70% 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