Intermitentne klaudikacije uzrokovane velikim intramuskularnim lipomom natkoljenice

Aim: To present a case of a very rare large intramuscular lipoma of the thigh with compression on blood vessels of the lower extremity. Case report: A 72-year-old man felt a formation on the medial side of his right thigh. From his medical history, it was found out that within the last four months he suffered from intermittent claudication. The patient did not present risk factors for atherosclerotic disease. Laboratory test results were normal. During the physical examination, a non-fixed tumour was found consuming almost the entire medial side of the thigh. An ultrasound examination indicated a soft tissue tumour, dimensions 27×20 cm. A Doppler ultrasound showed reduced flow in the popliteal artery and its branches, while the flow through the femoral artery was normal. A biopsy was performed which confirmed a mesenchymal tumour. Surgery was performed next and the tumour was extirpated from the adductor canal. During the operation it was confirmed that by its size and mass, the tumour compromised adjacent blood vessels. Pathohistological diagnosis confirmed an intramuscular lipoma. Postoperatively, the patient had no pain in the leg while walking. A follow-up Doppler ultrasound showed regular flow through the popliteal artery and its branches. Conclusion: This case report presented a patient with a rare, huge atypical intramuscular lipoma as a potential cause for intermittent claudication.Cilj: Cilj je ovog rada prikazati rijedak slučaj velikog intramuskularnog lipoma natkoljenice s kompresijom velikih krvnih žila donjeg ekstremiteta. Prikaz slučaja: 72-godišnji muškarac palpirao je čvrstu formaciju na medijalnoj strani desnog bedra. Iz anamneze se doznaje da je u posljednja četiri mjeseca patio od intermitentnih klaudikacija u desnoj potkoljenici. Pacijent nije imao faktore rizika za aterosklerotsku bolest perifernih arterija nogu. Učinjeni su laboratorijski nalazi koji su bili unutar referentnih vrijednosti. Fizikalnim pregledom otkrivena je tumorska formacija, pomična u odnosu na okolno tkivo, koja je zauzimala gotovo cijelu medijalnu stranu bedra. Ultrazvučni pregled ukazao je na tumor mekog tkiva dimenzija 27 × 20 cm. Doplerov ultrazvuk pokazao je smanjen protok u arterijama potkoljenice i njihovim granama, dok je protok kroz femoralnu arteriju bio uredan. Pacijent je potom podvrgnut citološkoj punkciji tumorske tvorbe te je time potvrđen tumor mezenhimalnog podrijetla. Nakon učinjene dijagnostike pacijent je podvrgnut operativnom zahvatu odstranjenja tumorske tvorbe. Intraoperativno se utvrdilo da tumor svojom veličinom i položajem komprimira krvne žile natkoljenice. Tumor se u cijelosti ekstirpirao iz aduktornog kanala. Patohistološkom dijagnostikom potvrđen je intramuskularni lipom. Postoperativni tijek protekao je uredno i rana je uredno cijelila. Pacijent više nije imao bolove u nozi u vidu intermitentnih klaudikacija. Kontrolni dopler ultrazvuk pokazao je uredan protok krvi kroz poplitealnu arteriju i njene ogranke. Zaključak: Prikazali smo rijedak slučaj pacijenta s velikim intramuskularnim lipomom te potencijalno mogućim uzrokom intermitentnih klaudikacija

A case of sporadic aggressive extraabdominal fibromatosis tumor of the abdominal wall

Cilj: Cilj je ovog rada prikazati rijedak slučaj agresivne ekstraabdominalne fibromatoze trbušne stijenke nastale nakon radijacijske terapije zbog karcinoma prostate u području postoperativnog ožiljka u sedamdesetogodišnjeg pacijenta, opisati dijagnostički postupak, liječenje te konačan ishod. Prikaz slučaja: Sedamdesetogodišnji pacijent potražio je liječničku pomoć zbog palpabilne tvorbe trbušne stijenke desne ingvinalne i suprapubične regije. Fizikalnim pregledom palpirala se tvrda, fiksirana tvorba, promjera 9 cm koja se palpatorno doimala infiltrativnom. Preoperativno je uzeta otvorena biopsija, a patohistološki nalaz govorio je u prilog ekstraabdominalnoj fibromatozi. Učinili smo kompjutoriziranu tomografiju trbuha i zdjelice, te se prikazala tvorba koja pripada samo trbušnoj stijenci, bez znakova intraabdominalne propagacije. Radi boljeg prikaza odnosa prema mekim tkivima učinili smo i magnetsku rezonanciju trbuha. Pristupilo se operacijskom zahvatu prilikom kojeg su se uspjeli sačuvati mišići, a zajedno s tumorom odstranila se aponeuroza vanjskog kosog trbušnog mišića. S obzirom na mogućnost nastanka postoperacijske mišićne kile u svrhu prevencije navedenog postavljena je u defect prolenska mrežica, a pravi mišić trbuha pokrio se šavovima prednjeg lista njegove ovojnice. Defekt stijenke rekonstruiran je bez značajne tenzije tkiva. Tumor je odstranjen u cijelosti, sa slobodnim rubom od 1 cm te poslan na PH analizu koja je potvrdila nalaz ekstraabdominalne fibromatoze. Postoperativni tijek protekao je uredno. Zaključak: Ekstraabdominalna fibromatoza abdominalne stijenke je sporadični tumor. Dijagnoza se postavlja na temelju fizikalnog nalaza, slikovnih pretraga te patohistološke analize, a optimalna terapija je radikalna kirurška ekstripacija. Ishod našeg pacijenta je u praćenju od dvije godine bez recidiva.Aim: To present a case of a very rare huge aggressive extraabdominal fibromatosis of the abdominal wall, which appeared after adjuvant radiotherapeutic treatment of prostatic cancer at the place of the postoperative scar in a 70-year-old patient, describe the diagnostic pathway, treatment and final outcomes. Case report: A 70-year-old male presented with palpabile anterior abdominal wall tumor mass. Clinical examination revealed firm and painless, 9 cm tumor mass of the right inguinal and suprapubic region, which was fixed and appeared infiltrative. Preoperative pathohistology analysis of tumor biopsy referred to aggressive extraabdominal fibromatosis. An abdominal computed tomography scan showed that the mass belonged to the abdominal wall without intraabdominal propagation. Magnetic resonance was performed in order to see the relationship between the tumor and the soft tissue. The tumor assessed as operabile. During the operation the muscles were perserved but the aponeurosis of external abdominal oblique muscle was removed along with the tumor. The resultant defect of aponeurosis was reconstructed with a prolene mesh which was fixed in the defect of the aponeurosis of external abdominal oblique muscle in order to prevent postoperative muscle hernia. The rectus abdominis muscle was covered with the seams of the anterior leaf of its sheath. The defect was primary reconstructed without significant tissue tension. The tumor was extirpated radically and sent to PH examination that revealed the extraabdominal aggressive fibromatosis with 1 cm of free margins. The postoperative course was uncomplicated. Conclusion: Extraabdominal fibromatosis of the abdominal wall is a sporadic tumor. Pathohistological examination, imaging and physical examination are essential diagnostic methods. The radical extirpation is essential for treatment. Our patient is without signs of recidive for a follow up of two years after surgery

A case of sporadic aggressive extraabdominal fibromatosis tumor of the abdominal wall

Cilj: Cilj je ovog rada prikazati rijedak slučaj agresivne ekstraabdominalne fibromatoze trbušne stijenke nastale nakon radijacijske terapije zbog karcinoma prostate u području postoperativnog ožiljka u sedamdesetogodišnjeg pacijenta, opisati dijagnostički postupak, liječenje te konačan ishod. Prikaz slučaja: Sedamdesetogodišnji pacijent potražio je liječničku pomoć zbog palpabilne tvorbe trbušne stijenke desne ingvinalne i suprapubične regije. Fizikalnim pregledom palpirala se tvrda, fiksirana tvorba, promjera 9 cm koja se palpatorno doimala infiltrativnom. Preoperativno je uzeta otvorena biopsija, a patohistološki nalaz govorio je u prilog ekstraabdominalnoj fibromatozi. Učinili smo kompjutoriziranu tomografiju trbuha i zdjelice, te se prikazala tvorba koja pripada samo trbušnoj stijenci, bez znakova intraabdominalne propagacije. Radi boljeg prikaza odnosa prema mekim tkivima učinili smo i magnetsku rezonanciju trbuha. Pristupilo se operacijskom zahvatu prilikom kojeg su se uspjeli sačuvati mišići, a zajedno s tumorom odstranila se aponeuroza vanjskog kosog trbušnog mišića. S obzirom na mogućnost nastanka postoperacijske mišićne kile u svrhu prevencije navedenog postavljena je u defect prolenska mrežica, a pravi mišić trbuha pokrio se šavovima prednjeg lista njegove ovojnice. Defekt stijenke rekonstruiran je bez značajne tenzije tkiva. Tumor je odstranjen u cijelosti, sa slobodnim rubom od 1 cm te poslan na PH analizu koja je potvrdila nalaz ekstraabdominalne fibromatoze. Postoperativni tijek protekao je uredno. Zaključak: Ekstraabdominalna fibromatoza abdominalne stijenke je sporadični tumor. Dijagnoza se postavlja na temelju fizikalnog nalaza, slikovnih pretraga te patohistološke analize, a optimalna terapija je radikalna kirurška ekstripacija. Ishod našeg pacijenta je u praćenju od dvije godine bez recidiva.Aim: To present a case of a very rare huge aggressive extraabdominal fibromatosis of the abdominal wall, which appeared after adjuvant radiotherapeutic treatment of prostatic cancer at the place of the postoperative scar in a 70-year-old patient, describe the diagnostic pathway, treatment and final outcomes. Case report: A 70-year-old male presented with palpabile anterior abdominal wall tumor mass. Clinical examination revealed firm and painless, 9 cm tumor mass of the right inguinal and suprapubic region, which was fixed and appeared infiltrative. Preoperative pathohistology analysis of tumor biopsy referred to aggressive extraabdominal fibromatosis. An abdominal computed tomography scan showed that the mass belonged to the abdominal wall without intraabdominal propagation. Magnetic resonance was performed in order to see the relationship between the tumor and the soft tissue. The tumor assessed as operabile. During the operation the muscles were perserved but the aponeurosis of external abdominal oblique muscle was removed along with the tumor. The resultant defect of aponeurosis was reconstructed with a prolene mesh which was fixed in the defect of the aponeurosis of external abdominal oblique muscle in order to prevent postoperative muscle hernia. The rectus abdominis muscle was covered with the seams of the anterior leaf of its sheath. The defect was primary reconstructed without significant tissue tension. The tumor was extirpated radically and sent to PH examination that revealed the extraabdominal aggressive fibromatosis with 1 cm of free margins. The postoperative course was uncomplicated. Conclusion: Extraabdominal fibromatosis of the abdominal wall is a sporadic tumor. Pathohistological examination, imaging and physical examination are essential diagnostic methods. The radical extirpation is essential for treatment. Our patient is without signs of recidive for a follow up of two years after surgery

SILIKONSKI IMPLANTATI ZA DOJKE: PROŠLOST, SADAŠNJOST I BUDUĆNOST

The authors have provided an in-depth review of the history of saline and silicone gel–filled breast implants. In the history of medicine, no devices have been more scrutinized and thoroughly studied than breast implants. Although we as plastic surgeons recognize and appreciate the benefits that our patients derive from these devices, society as a whole continues to remain skeptical. The reasons for this are complex and multifactorial but appear to be fueled by the media, oppositional organizations, and several trial lawyers. Prior to 1990, when the silicone gel implant controversy began, there were only eight indexed publications that dealt with the issue of silicone gel breast implants. Since 1990, there have been more than 500 indexed publications dealing with silicone gel implants. At the time of the moratorium in 1992, we as plastic surgeons did not have a leg to stand on because there was a paucity of scientific evidence to support our observations that silicone breast implants were safe and effective devices.Autori daju širok pregled povijesti silikonskih implantata za dojke punjenih fiziološkom otopinom i silikonskim gelom. U povijesti medicine niti jedna vrsta implantata nije bila toliko pomno i temeljito proučavana kao implantati za dojke. Iako plastični kirurzi prepoznaju i cijene koristi koje pacijentice imaju od ovih vrsta implantata, društvo u cijelosti ne prestaje biti skeptično. Razlozi za to su kompleksni i multifaktorijalni, ali čini se da su uveličavani od medija, nekih organizacija, pa čak i lobija odvjetnika. Do 1990., kada su započele polemike oko silikonskih implantata za dojke, tek se osam članaka u indeksiranim časopisima bavilo tom temom, a 1990. do danas objavljeno ih je više od 500. U vrijeme moratorija 1992. plastič- ni kirurzi nisu imali čvrstog uporišta zbog nedostatka znanstvenih dokaza koji bi podržavali stajalište da su silikonski implantati za dojke sigurni i djelotvorni

Effects of ultrasonic impact treatment on fatigue life of pre-exfoliated AA-2024-t351.

In this study investigations were made into the effects of Ultrasonic Impact Treatment (UIT) on pre-exfoliated AA 2024 T351. Electrochemical tests were conducted to determine any changes in electrochemical behaviour of the alloys due to UIT condition. Uniaxial monotonic, cyclic and fatigue crack propagation (FCG) tests were conducted on material in As-Received (AR) condition and UIT condition in air and in a corrosive environment by pre-exfoliating the test specimens at pre-defined set of time periods and temperature range (20 °C). It was clear that the fatigue performance was severely reduced by the introduction of the corrosion environment for AR specimens. SEM analysis suggests that UIT conditioned AA 2024-T351 exhibits resistance to exfoliation corrosion at ambient and temperatures ranging between 20°C to 40°C when compared to AR specimens. However, these results are not supported by potentiodynamic polarisation curves which show a decrease in corrosion resistance of UIT specimens. Also it is understood that there is a considerable amount of Cu refinement and enrichment near the surface when the AA 2024-T351 is subjected to exfoliation corrosion tests. Whilst hydrogen is in an atomic state, it can be adsorbed onto the metal surface and consequently diffuses into the matrix and can have serious detrimental effects. A reference line for minimal pre-existing hydrogen in the alloy is identified and the magnitude of hydrogen is found to be 180 Arbitrary Hydrogen Units (AHU). It is also found that in corrosion environment, the hydrogen ingress and further charging is prominent at ambient temperatures for AR samples, and showed damage over the full width of cross-section. The following conclusions were drawn: 1. UIT surface treatments, followed by exfoliation corrosion have shown increased resistance to a reduction in mechanical properties, notably tensile and yield strength. Fractographic analysis further supported this finding by showing smaller average brittle failure depths for UIT specimens when compared to AR specimens. SEM analysis of AR samples (without exfoliation) showed a crystallographic contribution to the mode of failure where high density slip bands are formed and the initial failure exhibits a step format. 2. It is observed that during exfoliation, hydrogen ingress and adsorption is more prominent at ambient temperatures for AR samples. 3. A slight improvement In Low Cycle Fatigue (LCF) life is observed for pre-exfoliated and UIT conditioned sample but not for UIT conditioned samples only. Little effect is observed for either treatment in the High Cycle Fatigue (HCF) region. 4. Fatigue crack initiation occurred from the edges for all samples. 5. Fatigue crack propagation of exfoliated specimens exhibited faster crack propagation than As-Received specimens. UIT caused retardation in crack propagation rate in AR samples but not in corroded samples. Failure of pre-exfoliated, UIT treated samples failed within the treated strip. It is also noted that crack deviation can occur when the crack tip reaches a secondary phase particle. 6. Nanocrystallisation generates uniformity of the surface which refines the secondary phase particles and helps mitigate crack initiation sites

Uloga metalotionina u karcinomu dojke

Metallothioneins (MTs) are a family of small cysteine-rich proteins involved in many physiological and pathological processes. Genes that encode the four isoforms of metallothioneins (MT1-M4) are located on chromosome 16q13. Strucutures of these four isoforms allow metallothioneins their various biological functions. Many studies have shown that MT plays an important role in carcinogenesis, tumour growth, its progression from local to metastatic disease and may contribute to resistence to chemotherapy and radiotherapy. Due to the fact that breast cancer is one of the leading causes of death in women worldwide it is important to better understand the biology of breast cancer. So, findings of MT could evenutally help as a prognostic tool and could lead to a possible new specific anti-cancer treatment.Metalotioneini su skupina proteina bogatih cisteinima koji su uključeni u mnoge fiziološke i patološke procese. Geni koji kodiraju četiri izoforme metalotioneina locirani su na lokusu 16q13. Strukture ovih četiriju izoformi omogućuju metalotioneinima njihove razne biološke funkcije. Mnoge su studije pokazale da metalnotionein ima važnu ulogu u karcinogenezi, rastu tumora, njegovoj progresiji od lokalne prema metastatskoj bolesti te je povezan sa razvojem rezistencije na kemoterapiju i radioterapiju. Rak dojke jedan je od vodećih uzroka smrti u svijetu i važno je bolje razumijeti ulogu metalotioneina u različitim podtipovima karcinoma dojke. Ovakvi podaci mogli bi pomoći kao prognostički alat i voditi pronalasku novog specifičnog liječenja karcinoma

Utjecaj preoperacijske magnetske rezonancije dojki na kirurško liječenje Novodijagnosticiranog raka dojke

Introduction: Breast cancer is the most commonly diagnosed malignancy in women and the leading cause of cancer death in women. Tumor size is a critical factor in determining the type and extent of surgical and oncologic treatment. It is accurately determined by imaging modalities such as mammography, ultrasound, and magnetic resonance imaging (MRI), which provide a more reliable determination of tumor size. The aim of our study was to investigate the impact of preoperative breast magnetic resonance imaging on surgical treatment of newly diagnosed breast cancer. Material and Methods: The study retrospectively reviewed the records of 241 participants with newly diagnosed breast cancer who underwent preoperative mammography, breast ultrasound, and MRI between 2016 and 2020 at University Hospital Centre Rijeka. Patients were diagnosed with invasive ductal carcinoma, invasive lobular carcinoma, ductal carcinoma in situ, or a combination of the types. Surgical treatment included one of the following procedures: simple quadrantectomy, quadrantectomy and sentinel lymph node biopsy, quadrantectomy and axillary lymph node dissection, mastectomy and sentinel biopsy, or mastectomy and axillary dissection. Results: Compared with histopathologic tumor size, breast MRI overestimated size in 10% of patients. T stage was underestimated in 5% of patients (p>0.050). In comparison, breast ultrasound overestimated tumor size in 12% and underestimated it in 48% (p<0.001). Similarly, mammography overestimated tumor size in 14% and underestimated it in 62% (p<0.001). Conclusion: In patients with newly diagnosed breast cancer, the use of preoperative breast MRI as an adjunct to mammography and ultrasound for locoregional staging significantly alters subsequent surgical treatment.Uvod: Rak dojke je najčešće dijagnosticirana zloćudna bolest u žena i vodeći uzrok smrti od raka u žena. Veličina tumora je ključan čimbenik u određivanju vrste i opsega kirurškog i onkološkog liječenja. Točno se utvrđuje slikovnim modalitetima poput mamografije, ultrazvuka i magnetske rezonancije (MRI) koja omogućuje najpouzdanije određivanje veličine tumora. Cilj našeg istraživanja bio je istražiti utjecaj preoperativne magnetske rezonancije dojke na kirurško liječenje novodijagnosticiranog raka dojke. Materijal i metode: U studiju su bile retrospektivno uključene 241 bolesnice s novodijagnosticiranim karcinomom dojke koje su podvrgnute preoperativnoj mamografiji, ultrazvuku dojke i magnetskoj rezonanci između 2016. i 2020. godine u KBC-u Rijeka. Pacijentima je dijagnosticiran invazivni duktalni karcinom, invazivni lobularni karcinom, duktalni karcinom in situ ili kombinacija tipova. Kirurško liječenje uključivalo je jedan od sljedećih zahvata: kvadrantektomiju, kvadrantektomiju i biopsiju sentinel limfnog čvora, kvadrantektomiju i disekciju pazuha, mastektomiju i sentinel biopsiju ili mastektomiju i disekciju pazuha. Rezultati: U usporedbi s histopatološkom veličinom tumora, MRI dojke je precijenio veličinu u 10% bolesnica. T stadij je podcijenjen u 5% bolesnica (p>0,050). Za usporedbu, ultrazvuk dojke precijenio je veličinu tumora u 12%, a podcijenio u 48% slučajeva (p<0,001). Slično, mamografija je precijenila veličinu tumora u 14%, a podcijenila u 62% slučajeva (p<0,001). Zaključak: U bolesnica s novodijagnosticiranim rakom dojke, primjena preoperativne MRI dojke kao dopune mamografiji i ultrazvuku za lokoregionalno određivanje stadija značajno mijenja naknadno odluku kirurškog liječenja raka dojke

A sporadic case of myositis ossificans of the forearm presenting clinically as mesenchimal tumor

Cilj: Osificirajući miozitis je benigna, solitarna, samoograničavajuća lezija koja je karakterizirana ekstraskeletnim tvorbama fokalne heterotopične kosti i hrskavice u mekim tkivima. Uglavnom zahvaća mišiće, ligamente i fascije. Osificirajući miozitis pretežno se javlja u mlađih osoba nakon lokalizirane traume u području prednje skupine mišića natkoljenica i ruku. Cilj ovog prikaza slučaja je opisati rijedak slučaj osificirajućeg miozitisa podlaktice koji se prezentirao izbočinom u području podlaktice te slabošću ruke. Klinički znakovi i slikovni prikazi često se mogu poistovjetiti s malignim lezijama, kao što je bio slučaj i kod naše pacijentice. Prikaz slučaja: 48-godišnja žena dolazi zbog tvorbe u distalnom i volarnom dijelu desne podlaktice. U anamnezi navodi da je nekoliko tjedana osjećala slabost podlaktice, ali bez ikakve prethodne akutne ozljede ili traume podlaktice. Preoperativna snimka magnetske rezonancije pokazala je tvorbu nalik malignom fibroznom histiocitomu. Završna dijagnoza postavljena patohistološkim pregledom preparata govorila je u prilog rijetkoj bolesti, osificirajućem miozitisu. Nakon operacije pacijentica je imala parestezije te manje razgibane prste. Nakon šest mjeseci pacijentica je pokazala značajno poboljšanje na fizikalnoj terapiji te su nalazi magnetske rezonancije bili bez osobitosti. Zaključak: Osificirajući miozitis valja uzeti u obzir kao moguću dijagnozu za mekotkivne tvorbe u području podlaktice dokazane slikovnim metodama. S obzirom na rijetku lokaciju lezije, postoperativna patohistološka analiza nužna je za dobivanje točne dijagnoze.Aim: Myositis ossificans is a benign, solitary, self-limiting lesion characterized by extraskeletal formation of focal heterotopic bone and cartilage in soft-tissue. It generally affects the muscles, ligaments, and fascia. Myositis ossificans usually occurs in young adults mostly after localized trauma, with predilection in the anterior muscle groups of the thighs and arms. The aim of this case report was to present a rare case of myositis ossificans in the forearm, which presented as a bump on the forearm and weakness of the hand. The clinical signs and imaging appearance can be easily confused with malignant lesions, as was the case in our patient. Case report: A 48-year old woman was presented with a palpable formation in the distal and volar part of the right forearm. She had suffered from weakness of the forearm for a while, and had no history of acute injury or trauma of the forearm. Preoperative magnetic resonance imaging demonstrated malignant fibrous histiocytoma-like tumor, but final pathohistological examination revealed rare disease, myositis ossificans. Postoperatively, the patient had some minor neurological deficits, such as paresthesia, and less flexible fingers. After six months, the patient showed a major improvement in physical therapy, and the MRI findings were unremarkable. Conclusion: Myositis ossificans should be considered as a possible diagnosis for a soft-tissue mass in the forearm shown on the imaging findings. Due to the rare location of the lesion, the postoperative histopathological examination is necessary for making an ultimate diagnosis

Concordance of estimated residual tumor size by magnetic resonance imaging and pathohistologic findings in breast cancer patients after neoadjuvant chemotherapy

Cilj. Cilj istraživanja je procijeniti podudarnost veličine rezidualnog tumora, izmjerene magnetskom rezonancijom (MR) i patohistološkom dijagnostikom (PHD) u pacijentica s karcinomom dojke nakon provedene neoadjuvantne kemoterapije (NAK) te procijeniti mogući utjecaj ypT stadija tumora na nepodudarnost veličina izmjerenih navedenim metodama. Ispitanici i metode: U retrospektivno istraživanje uključeno je 50 pacijentica. Uključni kriterij su pacijentice kod kojih je učinjen operativni zahvat uz prethodno proveden NAK karcinoma dojke, na što je odgovor praćen s najmanje dva MR pregleda. Veličina tumora na MR-u uspoređena je s veličinom na PHD-u (zlatni standard) pomoću regresijske analize Passing-Bablok te je izračunat njihov koeficijent korelacije. Analizirana su sva odstupanja i podudarnosti veličine, kao i eventualni utjecaj ypT stadija tumora na razliku između dviju metoda. Razlika od ± 0,5 cm u veličini tumora procijenjenih slikovnom metodom i u PHD nalazu smatrale su se podudarnima veličinama. Rezultati: Srednja vrijednost veličine rezidualnog tumora na MR-u iznosila je 19,1 ± 17,71 mm, dok je na PHD-u iznosila 16,87 ± 18,19 mm. Izračunati r koeficijent korelacije iznosi 0.64 (p < 0.001). Provedenom analizom potvrđeno je da nema značajne razlike izmjerenih veličina tumora na MR-u i PHD-u (p = 0.552) te se metode mogu smatrati podudarnima. Nije uočena statistički značajna razlika u ovisnosti o ypT stadiju tumora koja bi utjecala na nepodudarnost veličina. Zaključci: Među dvjema metodama nema konstantnog niti proporcionalnog odstupanja u mjerenjima te se metode mogu smatrati podudarnim. MR dojke je dobra metoda za procjenu veličine rezidualnog tumora dojke kod pacijentica koje su podvrgnute neoadjuvantnoj kemoterapiji usporedno s PHD-om (zlatni standard).Aim: The goal of this study is to evaluate the concordance between residual tumour size measured on magnetic resonance imaging (MRI) and pathohistological findings in patients who underwent neoadjuvant chemotherapy and operative procedure, and if any pathohistological features may affect that agreement. Respondents and methods: Fifty patients with breast cancer were retrospectively evaluated. Patients who underwent neoadjuvant chemotherapy before the operative procedure, and were assessed with at least two MRI examinations, where included in this study. The primary tumour size measured by MRI was compared with pathohistological findings, which was considered as the gold standard. All differences and size correspondence were analyzed as well as the possible influence of ypT stage of tumour between the two methods. Results: The mean value of residual tumour size on MRI was 19,2 ± 17,71 mm, while on pathohistological findings it was 16,87 ± 18,29 mm. A calculated correlation coefficient between the two methods was 0.64 (p < 0.001). There was no statistically significant difference between two methods for measuring residual tumour size (p = 0.552), as well as a statistically significant influence of ypT stage on measuring, so these methods may be considered to be concordant. Conclusions: There is neither a constant nor a proportional deviation in the measurements between the two methods, so these methods can be considered concordant. Breast MRI is a reliable method for estimating residual tumour size in patients undergoing neoadjuvant chemotherapy in comparison to pathology

KIRURŠKO LIJEČENJE KARCINOMA DOJKE I AKSILARNIH METASTAZA: POVIJESNA PERSPEKTIVA

Breast cancer (BC) is the most common malignancy to affect females. The first suggestions of BC and its treatment date back to Ancient Egypt, 1500-1600 B.C. Throughout history, the management of BC has evolved from extensive radical mastectomy towards less invasive treatments. Radical mastectomy was introduced by W.S. Halsted in 1894, involving the resection of the breast, regional lymph nodes, pectoralis major and minor. Despite its mutilating effect, it had been the main surgical approach to BC patients until 1948, when Patey and Dyson proposed its modified form that conserved pectoralis major and minor and the level III of axillary lymph nodes. The latter was associated with less postoperative morbidity and improved quality of life. The idea of limited breast tissue resection was introduced in the 1970s by Umberto Veronesi and led to further minimizations of surgery in BC patients until breast conservation became the standard of care for early-stage disease. In the 1990s, intraoperative lymphatic mapping and the concept of sentinel lymph node (SLN) biopsy (SLNB) have been developed. SLNB has replaced axillary lymph node dissection (ALND) to be the standard procedure for axillary staging in patients with clinically node-negative BC. Many women have since been spared ALND, including those with negative SLNB or with SLNs involved with micrometastases (0.2-2 mm in size). In the last decade, evidence gathered from new clinical trials suggests that ALND may be safely omitted even in BC patients with 1 or 2 positive SLNs if adjuvant radiotherapy is delivered.&nbspKarcinom dojke najčešći je maligni tumor u žena. Prvi zapisi o karcinomu dojke i njegovu liječenje datiraju iz drevnog Egipta 1500 - 1600 godina pr. n. e. Terapijski pristup bolesti mijenjao se kroz povijest te je nekadašnji invazivni, kao npr. radikal-na mastektomija, s vremenom zamijenjen manje invazivnim kirurškim metodama. W. S. Halsted 1894. predstavlja metodu radikalne mastektomije koja uključuje potpunu resekciju dojke, regionalnih limfnih čvorova te velikog i malog pektoralnog mišića. Unatoč čestim postoperacijskim komplikacijama, zauzimala je glavno mjesto među kirurškim moda-litetima liječenja karcinoma dojke sve do 1948. kada su Patey and Dyson predstavili modifici-ranu radikalnu mastektomiju kojom su se, za razliku od radikalne, sačuvali pektoralni mišići te pazušni limfni čvorovi lože III, a postoperacijske su komplikacije smanjene, uz poboljšanje kvalitete života bolesnica. Ideju ograničene resekcije tkiva dojke predstavlja Veronesi 70-ih godina 20. stoljeća, nakon čega je i dalje nastavljeno smanjenje opsega i radikalnosti kiruških zahvata. Konačno, poštedna operacija dojke postaje standard u liječenju žena s ranim sta-dijem karcinoma dojke. Koncept biopsije limfnog čvora čuvara kod karcinoma dojke nailazi na svekoliku prihvaćenost, a njegovim usvajanjem mnoge su bolesnice pošteđene radikalnih disekcija aksilarnih limfnih čvorova, od onih čiji je nalaz biopsije limfnog čvora čuvara bio negativan do onih s mikrometastazom u istome (malim tumorskim depozitom veličine 0,2-2 mm), dok zaključci novijih studija iz posljednjih deset godina sugeriraju da se i u žena kojima je biopsijom utvrđena metastaza u jednome do dva limfna čvora čuvara disekcija aksilarnih limfnih čvorova može izbjeći bez štetnih posljedica, uz primjenu adjuvantne radioterapije