Mukokela u bolesnice s recidivom karcinoma dojke - prikaz slučaja i pregled literature

Mucocele or cystic distention of the appendix is a rare entity found in only 0.25% of all appendectomies and 8% of all appendicular tumors. We report a case of a 68-year-old female patient in whom asymptomatic mucocele was found at abdominal CT imaging a month after excision of recurrent invasive ductal carcinoma to the right pectoral region, and 26 years after modifed radical mastectomy. After adequate preoperative treatment, a right hemicolectomy was performed with the final pathology of mucocele of the appendix.Mukokela, odnosno cistično proširenje apendiksa rijetka je pojava koja se pronalazi u samo 0,25 % apendektomija, te čini samo 8 % svih tumora crvuljka. Prikazujemo slučaj 68-godišnje pacijentice kod koje je asimptomatska mukokela pronađena na CT-u abdomena mjesec dana nakon ekscizije recidiva duktalnog invazivnog karcinoma desne pektoralne regije, 26 godina nakon modificirane radikalne mastektomije. Nakon odgovarajuće preoperativne obrade učinjena je desna hemikolektomija s konačnim patohistološkim nalazom mukokele apendiksa

Minimalno invazivno liječenje raka dojke

The development of diagnostic methods and screening leads to early detection of breast cancer, which is why aspirations are moving towards more conservative local treatment methods. New, non invasive and minimally invasive methods, should att ain same local control, with less cosmetic defects, side eff ects and complications compared to standard surgery. Five methods are being researched in clinical trials: cryoablation, radiofrequency ablation, laser ablation, microwave ablation and ablation by focused high intensity ultrasound waves. Although some results are promising, these methods need further technical development and prospective comparison with today’s golden standard - oncoplastic breast surgery.Razvojem dijagnostičkih mogućnosti, i probira karcinom dojke se otkriva u sve ranijem stadiju, zbog čega se teži sve poštednijim metodama lokalnog liječenja tumora. Nove, neinvazivne i minimalno invazivne metode trebale bi pružiti jednaku lokalnu kontrolu, ali uz manje kozmetske defekte, nuspojave i komplikacije u odnosu na kirurške zahvate. Trenutno je u istraživanju pet metoda: krioablacija, radiofrekvencijska ablacija, laserska ablacija, mikrovalna ablacija i ablacija fokusiranim ultrazvučnim valovima. Neke od navedenih metoda pokazuju ohrabrujuće rezultate, ali zahtijevaju dodatno tehničko usavršavanje i prospektivnu usporedbu s današnjim zlatnim standardom - onkoplastičnim kirurškim zahvatima

Kirurško liječenje kolorektalnog karcinoma

Surgery remains the only radical treatment for colorectal cancer. However, with introduction of multidisciplinary teams and availability and advancement in all modes of treatments (surgical technique, technology and perioperative care, sistemic therapy and radiotherapy protocols), in more advanced stages the better disease control is achieved. In this article we outline primarily indications and considerations in surgical treatment modeKirurško liječenje je jedini kurativni pristup liječenju kolorektalnog karcinoma. Ipak, uvođenjem multidisciplinarnih timova i napretkom i dostupnošću svih načina liječenja (kirurška tehnika i tehnologija kao i perioperativna skrb za pacijenta, te napredak u sistemskoj i radioterapiji) u poodmaklim stadijima, su omogućili uspješniju kontrolu bolesti. U ovom članku izosimo primarno indikacije i dileme kirurškog načina liječenj

Sentimag biopsija limfnog čvora stražara u konzervativnoj kirurgiji dojke – preliminarni rezultati

Segmentectomy and sentinel lymph node biopsy is a golden standard for early breast cancer (clinical and radiological cT1-2, c N0). Recently, superparamagnetic iron oxide (SPIO) nanoparticle tracer has been introduced enabling intraoperative tracer injection. We prospectively recorded data on tumor histology, marked lymph nodes and their final histology and patient characteristics for early breast cancer patients who underwent breast conservative surgery. At 128 female breast cancer patients underwent sentinel lymph node biopsy by SentiMag. Three patients were excluded from further analysis because the postoperative pathology report was ductal carcinoma in situ (DCIS). The identifi cation rate was 95.2 % (119 of 125). Of the 19.2 % (24 of 125) patients with lymph node involvement, 1.6% (2 of 125) had micrometastasis, and 1 % (1 of 125) had single tumor cells within the sentinel, l at least a micrometastasis. Of 30 positive lymph nodes removed, 24 (80 %) were true sentinel nodes. The average lymph node retrieval rate was 2.3 nodes per patient. SentiMag’s performance was comparable to published data and to standard sentinel with blue patent die and/or technetium. The benefi t of easier application and logistics is a great advantage.Segmentektomija i biopsija limfnog čvora stražara zlatni su standard za kirurško liječenje ranog raka dojke (klinički i radiološki cT1-2, c N0). Čestice superparamagnetskog željeznog oksida (superparamagnetic iron oxide, SPIO) od nedavno se koriste kao unutaroperacijski nanočestični obilježivač. Prospektivno smo bilježili demografske podatke o bolesnicama, histologiju tumora te označenih i neoznačenih limfnih čvorova. U 128 bolesnica učinjena je biopsija limfnog čvora stražara u aksili detektorom SentiMag. Tri bolesnice su isključene, jer je konačan patohistoloski nalaz bio carcinoma ductale in situ (DCIS). Limfni čvor je pronađen u 119 od 125 bolesnica (95.2%), pozitivne limfne čvorove su imale 24 (19.2%), makrometasaze 2 (1.6%) i mikrometastaze 1 bolesnica (0.08%). Od 30 pozitivnih odstranjenih limfnih čvorava, obilježenih je bilo 24 (80 %). Prosječno su po bolesnici izvađena 2.3 limfna čvora. Mogućnost otkrivanja limfnog čvora stražara SentiMagom usporediva je s dosad objavljenim podatcima i zlatnim standardom. Prednosti metode su lakše rukovanje i minimalna logistika

Primary Ewing’s Sarcoma of the Kidney: A Case Report

Primary adult Ewing’s sarcoma is a rare entity. They most commonly occur in children and young adults. 6% of them are localized extraosseously. We present a case of a 51 year old patient with primary renal Ewing’s sarcoma and multiple metastases in liver and iliac bone. Patients with metastatic disease are usually treated with aggressive chemotherapy and have a poor outcome. Our patient underwent complete surgical excision of tumour, and was treated with aggressive chemotherapy, respectively. Two and half years after presentation he is well, without any symptoms

Tumorska kalcinoza prikazana kao mekotkivna tvorba u 16-godišnjeg bolesnika

Background: Tumoral calcinosis is a rare clinicopathological condition characterized by periarticular tumor-like calcium deposits most commonly found around major joints, especially the hips, shoulders and elbows. Tumoral calcinosis is not primarily a bone-or cartilage-forming lesion, but it can closely simulate osteocartilaginous tumors. These lesions are predominantly seen during the first two decades of life and may be multicentric or bilateral. Laboratory analysis frequently shows high serum phosphate but normal serum calcium levels. A 16 year old male presented with a huge mass in the left hip which had been growing for a month. MR detected large tumor mass in the left gluteal region with possible infi ltration of m.gluteus maximus. Soft tissue mass was surgically resected, measuring 24 cm in diameter. Histologically, it was composed of multiple large cystic spaces with nodules of amorphous calcifi ed deposits surrounded by multinucleated giant cells and mononuclear infi ltrates. The lesion was poorly circumscribed with infi ltration into surrounding striated muscle. Tumoral calcinosis is an uncommon and benign condition that generally occurs as a complication of trauma or renal dialysis, and is rarely seen in familial and sporadic cases. It can occur in a variety of clinical sett ings: primary normophosphatemic, primary hyperphosphatemic and secondary tumoral calcinosis occuring along with disorders that are capable of producing soft tissue calcifi cation. Histologically, tumoral calcinosis is characterized by amorphous calcifi ed deposits in the background of granulomatous appearance with multinucleated giant cells and other infl ammatory cells. The diff erential diagnosis is broad and includes all tumoral calcinosis-like lesions that lead to abnormal dystrophic or metastatic calcium deposition in soft tissues. Surgical excision is the primary treatment.Tumorska kalcinoza je rijetko kliničko-patološko stanje obilježeno periartikularnim kalcificiranim depozitima nalik tumorima najčešće smještenim u području kuka, ramena i lakta. Tumorska kalcinoza nije primarna bolest koštano-hrskavičnog sustava, iako svojim obilježjima nalikuje i upućuje na tumor koštano-hrskavičnog sustava. Izraslina se obično pojavljuje multicentrično i bilateralno u prva dva desetljeća života. Laboratorijska analiza učestalo pokazuje povećanu razinu fosfata i normalnu razinu kalcija u serumu. Lječeni dječak (16 god) imao je veliku tvorbu u području lijevog kuka koja je rasla mjesecima. MR je prikazala izraslinu s mogućom infiltracijom velikog glutealnog mišića. Kirurški je odstranjena neoštro ograničena tvorba najvećeg promjera 24 cm koja je infiltrirala strijatni mišić. Histološki je bila građena od brojnih velikih cističnih prostora s okruglastim kalcificiranim nakupinama okruženim multinuklearnim orijaškim stanicama i mononuklearnim upalnim infi ltratom.Tumorska kalcinoza je rijetko, benigno stanje koje se uglavnom očituje kao komplikacija traume ili bubrežne dijalize, a rijetko se viđa i u obiteljskom i u sporadičnom obliku. Može se očitovati u nekoliko kliničkih oblika: primarna normofosfatemična, primarna hiperfosfatemična i sekundarna tumorska kalcinoza. Neovisno o obliku uvijek je prisutan poremećaj s nakupljanjem kalcifikata u mekom tkivu. Histološki se vide amorfni kalcificirani depoziti okruženi granulomatoznom upalom s multinuklearnim orijaškim i mononuklearnim upalnim stanicama. Diferencijalna dijagnoza obuhvaća široki spektar promjena koje uključuju pretjerano distrofično i metastatsko nakupljanje kalcija u mekom tkivu. Kirurška ekscizija je izbor liječenja

Rijetki tumori dojke

Invasive breast cancer is a heterogeneous disease which occurs with diff erent clinical presentations, pathohistological characteristics and clinical course. Most common types are invasive ductal carcinoma not otherwise specified (IDC-NOS, 70-80%) and invasive lobular carcinoma (5 – 15%). Systemic therapy of breast carcinomas is mostly determined by their molecular classification, which is based on genetic research of NOS ductal breast cancer, without the inclusion of rare histological types. Since some rare breast tumors have excellent prognosis despite unfavorable molecular characteristics, when deciding on the optimal treatment, both molecular and prognostic characteristics should be considered. Tumors of non-epithelial origin, such as sarcomas, lymphomas and phyllodes tumors also appear in breasts.Karcinom dojke je heterogena bolest s raznolikom kliničkom slikom, patohistološkim karakteristikama i kliničkim tijekom. Najčešći tipovi karcinoma dojke su invazivni duktalni karcinom (IDC-NOS, 70-80 %) i invazivni lobularni karcinom (5-15%). Sustavno liječenje karcinoma dojke temelji se na molekularnoj klasifikaciji, koja je osnovana na genetskim istraživanjima NOS karcinoma, bez uključivanja rijetkih karcinoma dojke. Kako su neki rijetki tumori unatoč nepovoljnim molekularnim karakteristikama vrlo dobre prognoze, pri odlučivanju o načinu liječenja rijetkih tumora dojki, osim molekularnih, potrebno je uzeti u obzir i prognostičke karakteristike tih tumora. U dojkama se pojavljuju i tumori neepitelnog porijekla, poput sarkoma, limfoma i phyllodes tumora

Rekonstrukcija dojke

Breast cancer is most common cancer in women in Croatia. It is a leading cause of death in women wirh malignant disease. Breast cancer treatment causes anxiety in women also because of the fear of losing one or both breasts. This disease has a psychological impact eff ect and increasing number of women decide to undergo reconstruction. There has been a substantial progress in reconstructive tehniques in last two decades. This article summarizes short history, development and today’s state of the art of reconstructive possibilities. As well as, advantages and disadvantages of reconstructive tehniques that help us choose the right timing and the right type of reconstruction. The final goal of breast reconstruction is oncological safety and women’s statisfaction with the outcome.Karcinom dojke je načešći maligni tumor kod žena u Hrvatskoj. On je i vodeći uzrok smrti kod žena oboljelih od malignih bolesti. Njegovo liječenje izaziva jedan od najvećih strahova kod žena a to je gubitak jedne ili obje dojke. Tako se radi pogubnog psihološkog učinka ove bolesti sve veći broj žena odlučuje za rekonstrukciju. Zadnjih dvadesetak godina pratimo izraziti napredak u rekonstrukcijskim tehnikama, bilo vlastitim tkivom bilo ugradbenim materijalima. Ovaj članak nam daje kratki povjesni razvoj i današnji pregled o mogućnostima rekonstrukcije. Također, pregled prednosti i nedostataka rekonstrukcijskih tehnika, koje nam mogu pomoći u izboru, vremena i načina rekonstrukcije. Krajnji cilj rekonstrukcije dojke treba biti, onkološki siguran zahvat kojime je žena zadovoljna

Mukokela u bolesnice s recidivom karcinoma dojke - prikaz slučaja i pregled literature

Mucocele or cystic distention of the appendix is a rare entity found in only 0.25% of all appendectomies and 8% of all appendicular tumors. We report a case of a 68-year-old female patient in whom asymptomatic mucocele was found at abdominal CT imaging a month after excision of recurrent invasive ductal carcinoma to the right pectoral region, and 26 years after modifed radical mastectomy. After adequate preoperative treatment, a right hemicolectomy was performed with the final pathology of mucocele of the appendix.Mukokela, odnosno cistično proširenje apendiksa rijetka je pojava koja se pronalazi u samo 0,25 % apendektomija, te čini samo 8 % svih tumora crvuljka. Prikazujemo slučaj 68-godišnje pacijentice kod koje je asimptomatska mukokela pronađena na CT-u abdomena mjesec dana nakon ekscizije recidiva duktalnog invazivnog karcinoma desne pektoralne regije, 26 godina nakon modificirane radikalne mastektomije. Nakon odgovarajuće preoperativne obrade učinjena je desna hemikolektomija s konačnim patohistološkim nalazom mukokele apendiksa