Biopsija limfnoga čvora „čuvara“ kod raka dojke; iskustvo stečeno u Klinici za tumore, Zagreb, Hrvatska

The study was aimed at analyzing metastatic involvement in sentinel lymph node in patients with primary breast cancer. The study includes 51 female patients undergoing surgery for primary breast cancer at the University Hospital for Tumors, Zagreb, Croatia. Prior to the standard surgical procedure, sentinel lymph node biopsy was performed and patohistologically and immunohistochemically analyzed. Sentinel lymph node biopsy was done in 51 patients meeting the indication criteria for the procedure. In 39 (76.47%) biopsy samples immunohistochemical results were negative (no signs of metastases), in 11 (21.57%) the result was positive, and in 1 (1.96%) patient the sentinel lymph node was not located using the gamma probe following the preoperative lymphoscintigraphy. Recently, a new phase in conserving surgery for breast cancer has started. Considering the presence of the so-called skip metastases in 2% of the cases, the idea of conserving surgery for axillary lymph nodes occurred, and thus the sentinel node surgery has been developed. In simple terms, in case the sentinel lymph node is negative, other axillary lymph nodes should not be removed; if the node is positive, a classic axillary dissection, i.e. the removal of axillary lymph nodes should be done.U radu je analizirana metastatska zahvaćenost limfnoga čvora „čuvara“ u bolesnica s primarnim rakom dojke. Analizirana je 51 bolesnica s primarnim rakom dojke operirana u Klinici za tumore, Zagreb, Hrvatska u razdoblju.Prije standardnog kirurškog zahvata, učinjena je biopsija čimfnog čvora „čuvara“, a potom su uzorci analizirani patohistološki i imunohistokemijski. Biopsija limfnog čvora „stražara“ je učinjena u 51 bolesnice koje su zadovoljavale indikaciju za navedeni postupak. U 39 (76,47%) uzoraka biopsije imunohistokemijska obrada dala negativan rezultat (nema znakova metastaza), u 11 (21,57%) uzoraka je nalaz pozitivan, a u jedne (1,96%) bolesnice limfni čvor „stražar\u27\u27 nije lociran gama-kamerom nakon preoperacijske limfoscintigrafije U zadnje vrijeme teži se poštednim zahvatima u postupcima operacije raka dojke. Znajući da je postojanje tzv. „skip metastaza” negdje oko 2 %, pojavljuje se ideja o poštednoj operaciji aksilarnih limfnih čvorova. Tako je stvorena kirurgija „sentinel” limfnog čvora (limfnog čvora „stražara“). Pojednostavljeno, ako je „sentinel” limfni čvor negativan, ne bi trebalo uklanjati druge limfne čvorove u pazuhu, a ako je pozitivan, činila bi se i dalje klasična disekcija aksile s uklanjanjem aksilarnih limfnih čvorova

Značenje tumorskog markera Ca 15-3

In the postoperative course of breast tumor treatment, along with regular ultrasound and radiological assessments, measurements of tumor marker CA 15-3 levels are also used. The levels of tumor marker CA15-3 are of particular significance in the follow-up of patients with metastatic breast cancer. In this paper, the correlation between the tumor mass and the level of tumor marker CA l5-3 is confirmed (1,2).U postoperativnom tijeku uz redovitu ultrazvučnu te radiolo{ku obradu pacijentice, koriste se i vrijednosti tumorskog markera CA 15-3. Vrijednosti tumorskog markera CA 15-3 osobito su važne u praćenju bolesnica s metastatskim karcinomom dojke. I u ovom radu potvr|ena je korelacija izme|u tumorske mase i razine tumorskog markera CA l5-3 (1,2)

Biopsija limfnoga čvora „čuvara“ kod raka dojke; iskustvo stečeno u Klinici za tumore, Zagreb, Hrvatska

The study was aimed at analyzing metastatic involvement in sentinel lymph node in patients with primary breast cancer. The study includes 51 female patients undergoing surgery for primary breast cancer at the University Hospital for Tumors, Zagreb, Croatia. Prior to the standard surgical procedure, sentinel lymph node biopsy was performed and patohistologically and immunohistochemically analyzed. Sentinel lymph node biopsy was done in 51 patients meeting the indication criteria for the procedure. In 39 (76.47%) biopsy samples immunohistochemical results were negative (no signs of metastases), in 11 (21.57%) the result was positive, and in 1 (1.96%) patient the sentinel lymph node was not located using the gamma probe following the preoperative lymphoscintigraphy. Recently, a new phase in conserving surgery for breast cancer has started. Considering the presence of the so-called skip metastases in 2% of the cases, the idea of conserving surgery for axillary lymph nodes occurred, and thus the sentinel node surgery has been developed. In simple terms, in case the sentinel lymph node is negative, other axillary lymph nodes should not be removed; if the node is positive, a classic axillary dissection, i.e. the removal of axillary lymph nodes should be done.U radu je analizirana metastatska zahvaćenost limfnoga čvora „čuvara“ u bolesnica s primarnim rakom dojke. Analizirana je 51 bolesnica s primarnim rakom dojke operirana u Klinici za tumore, Zagreb, Hrvatska u razdoblju.Prije standardnog kirurškog zahvata, učinjena je biopsija čimfnog čvora „čuvara“, a potom su uzorci analizirani patohistološki i imunohistokemijski. Biopsija limfnog čvora „stražara“ je učinjena u 51 bolesnice koje su zadovoljavale indikaciju za navedeni postupak. U 39 (76,47%) uzoraka biopsije imunohistokemijska obrada dala negativan rezultat (nema znakova metastaza), u 11 (21,57%) uzoraka je nalaz pozitivan, a u jedne (1,96%) bolesnice limfni čvor „stražar\u27\u27 nije lociran gama-kamerom nakon preoperacijske limfoscintigrafije U zadnje vrijeme teži se poštednim zahvatima u postupcima operacije raka dojke. Znajući da je postojanje tzv. „skip metastaza” negdje oko 2 %, pojavljuje se ideja o poštednoj operaciji aksilarnih limfnih čvorova. Tako je stvorena kirurgija „sentinel” limfnog čvora (limfnog čvora „stražara“). Pojednostavljeno, ako je „sentinel” limfni čvor negativan, ne bi trebalo uklanjati druge limfne čvorove u pazuhu, a ako je pozitivan, činila bi se i dalje klasična disekcija aksile s uklanjanjem aksilarnih limfnih čvorova

Značenje tumorskog markera Ca 15-3

In the postoperative course of breast tumor treatment, along with regular ultrasound and radiological assessments, measurements of tumor marker CA 15-3 levels are also used. The levels of tumor marker CA15-3 are of particular significance in the follow-up of patients with metastatic breast cancer. In this paper, the correlation between the tumor mass and the level of tumor marker CA l5-3 is confirmed (1,2).U postoperativnom tijeku uz redovitu ultrazvučnu te radiolo{ku obradu pacijentice, koriste se i vrijednosti tumorskog markera CA 15-3. Vrijednosti tumorskog markera CA 15-3 osobito su važne u praćenju bolesnica s metastatskim karcinomom dojke. I u ovom radu potvr|ena je korelacija izme|u tumorske mase i razine tumorskog markera CA l5-3 (1,2)

Kirurško liječenje polipoidnih karcinoma kolorektuma u Klinici za tumore

Treatment of polypoid carcinoma raises the problem of invasiveness to be solved by a competent pathologist. Upon diagnosis of the invasiveness, a radical surgical procedure (resection of the colorectum) is indicated. A problem that occurs is a problem of adequate resection margins, or marking the primary tumor bed (1, 2). In the colorectal resection segment, an ulcer may persist in the area of polypectomy, although without pathohistological signs of malignancy. In 7 patients treated in the University Hospital for Tumors, Zagrb, Croatia, discrete ulcer nishes were verified in resection segments of the colorectum. In none of the patients, pathohistological signs of the primary tumor were found. In 3/7 patients malignant cells in the regional lymph nodes were verified. A year after the surgery, metastatic transformations of the liver were found in 1/7 patients.U liječenju polipoidnih karcinoma postavlja se problem invazivnosti, koji razrješuje ovlašteni patolog. Po dijagnosticiranju invazivnosti indicira se radikalni kirurški zahvat (resekcija pripadajućeg kolorektuma). Tu nastaje problem resekcije adekvatnog segmenta kolorektuma, odnosno markiranja ležišta primarnog tumora (1,2). U reseciranom segmentu kolorektuma može perzistirati ulkus u području polipektomije, ali bez patohistološki tragova maligniteta. U 7 bolesnika liječenih u klinici za tumore verificirane su diskretne ulkusne niše u reseciranim segmentima kolorektuma. Ni u jednog bolesnika nisu nađeni patohistološki tragovi primarnog tumora. U 3 od 7 bolesnica verificirane su maligne stanice u regionalnim limfnim čvorovima. U 1 od 7 bolesnika godinu dana po operaciji su verificirane jetrene metapromjene

Lokalnirecidivi raka dojke poslije poštedne operacije - pravi recidivi ili novi primarni tumor

In the group of 1,161 patients submitted to conservative surgery for breast cancer in the period from 1992 to 2002, 95 (8.2%) were found to have locoregional recurrence. The most frequent localization of the recurrent disease was the site of prior excision; in 39% of the patients recurrence developed early, i.e. within the first two years after initial treatment. As a secondary surgical procedure, mastectomy was the most frequent, after which 5 patients presented with repeated recurrence.U skupini od 1.161 pacijentice u kojih je u razdoblju od 1992. do 2002. godine učinjen poštedni kirurški zahvat zbog karcinoma dojke, u njih 95 otkriven je lokoregionalni recidiv (8,2%). Najčešća lokalizacija recidivnog tumora bila je na mjestu prijašnje ekscizije, a u 39% pacijentica recidiv se pojavio rano, to jest u prve dvije godine nakon inicijalnog liječenja. Kao sekundarni kirurški zahvat najčešće je učinjena mastektomija, a ponovni razvoj recidiva otkriven je u 5 pacijentica

Kirurško liječenje polipoidnih karcinoma kolorektuma u Klinici za tumore

Treatment of polypoid carcinoma raises the problem of invasiveness to be solved by a competent pathologist. Upon diagnosis of the invasiveness, a radical surgical procedure (resection of the colorectum) is indicated. A problem that occurs is a problem of adequate resection margins, or marking the primary tumor bed (1, 2). In the colorectal resection segment, an ulcer may persist in the area of polypectomy, although without pathohistological signs of malignancy. In 7 patients treated in the University Hospital for Tumors, Zagrb, Croatia, discrete ulcer nishes were verified in resection segments of the colorectum. In none of the patients, pathohistological signs of the primary tumor were found. In 3/7 patients malignant cells in the regional lymph nodes were verified. A year after the surgery, metastatic transformations of the liver were found in 1/7 patients.U liječenju polipoidnih karcinoma postavlja se problem invazivnosti, koji razrješuje ovlašteni patolog. Po dijagnosticiranju invazivnosti indicira se radikalni kirurški zahvat (resekcija pripadajućeg kolorektuma). Tu nastaje problem resekcije adekvatnog segmenta kolorektuma, odnosno markiranja ležišta primarnog tumora (1,2). U reseciranom segmentu kolorektuma može perzistirati ulkus u području polipektomije, ali bez patohistološki tragova maligniteta. U 7 bolesnika liječenih u klinici za tumore verificirane su diskretne ulkusne niše u reseciranim segmentima kolorektuma. Ni u jednog bolesnika nisu nađeni patohistološki tragovi primarnog tumora. U 3 od 7 bolesnica verificirane su maligne stanice u regionalnim limfnim čvorovima. U 1 od 7 bolesnika godinu dana po operaciji su verificirane jetrene metapromjene

Lokalnirecidivi raka dojke poslije poštedne operacije - pravi recidivi ili novi primarni tumor

In the group of 1,161 patients submitted to conservative surgery for breast cancer in the period from 1992 to 2002, 95 (8.2%) were found to have locoregional recurrence. The most frequent localization of the recurrent disease was the site of prior excision; in 39% of the patients recurrence developed early, i.e. within the first two years after initial treatment. As a secondary surgical procedure, mastectomy was the most frequent, after which 5 patients presented with repeated recurrence.U skupini od 1.161 pacijentice u kojih je u razdoblju od 1992. do 2002. godine učinjen poštedni kirurški zahvat zbog karcinoma dojke, u njih 95 otkriven je lokoregionalni recidiv (8,2%). Najčešća lokalizacija recidivnog tumora bila je na mjestu prijašnje ekscizije, a u 39% pacijentica recidiv se pojavio rano, to jest u prve dvije godine nakon inicijalnog liječenja. Kao sekundarni kirurški zahvat najčešće je učinjena mastektomija, a ponovni razvoj recidiva otkriven je u 5 pacijentica

Metastatska zahvaćenost interpektoralnih (Rotterovih) limfnih čvorova u bolesnica s rakom dojke

The study was aimed at analyzing metastatic involvement in interpectoral (Rotter\u27s) lymph nodes in patients with primary breast cancer. The study includes 172 female patients undergoing surgery for breast cancer at the University Hospital for Tumors, Zagreb, Croatia from November 2001 to August 2003. In addition to the standard surgical procedure, interpectoral (Rotter\u27s) lymph nodes were removed in all of the patients. Rotter\u27s lymph nodes were identified in 67% of the patients, with metastatic involvement revealed in 20% of the Rotter\u27s nodes. Metastatic involvement of Rotter\u27s nodes in patients with negative and positive axillary lymph nodes was 4% and 35%, respectively. The results show that one-fifth of breast cancer patients, or even one-third of them with positive axillary lymph nodes, are discharged with positive interpectoral lymph nodes that remain undiagnozed and non-extirpated. As the nodes can be surgically removed without additional mutilation or resections, the exploration of Rotter\u27s lymph nodes should be introduced into routine clinical practice for diagnostic and therapeutic reasons.U radu je analizirana metastatska zahvaćenost interpektoralnih (Rotterovih) limfnih čvorova u bolesnica s primarnim rakom dojke. Analizirane su 172 bolesnice s rakom dojke operirane u Klinici za tumore u Zagrebu, Hrvatska u razdoblju od studenog 2001. do kolovoza 2003. U svih su bolesnica, uz standardni kirurški zahvat, uklonjeni i interpektoralni (Rotterovi) limfni čvorovi. Rotterovi limfni čvorovi otkriveni su 67% bolesnica, od kojih je 20% bilo zahvaćeno metastazama. Metastatska zahvaćenost Rotterovih limfnih čvorova otkrivena je u 4% bolesnica s negativnim aksilarnim čvorovima, odnosno u 35% bolesnica s pozitivnim limfnim čvorovima aksile. Rezultati pokazuju da je jedna petina bolesnica s rakom dojke, ili čak jedna trećina s pozitivnim aksilarnim limfnim čvorovima otpuštena iz bolnice s pozitivnim interpektoralnim limfnim čvorovima koji nisu dijagnosticirani, pa tako ni uklonjeni. Kako se ti čvorovi mogu ukloniti bez dodatne mutilacije, otkrivanje Rotterovih limfnih čvorova treba postati redovitom kliničkom praksom u dijagnostici i terapiji