Teratom jajnika u rutinskom bioptičkom materijalu u petogodišnjem razdoblju

Teratomas are tumors derived from germ cells, most frequently arising in the gonads. The aim of this study was to determine the number of ovarian teratomas diagnosed in the routine biopsy material at Ljudevit Jurak Clinical Department of Pathology, Sestre milosrdnice University Hospital Center during a 5-year period, as well as their clinical, gross and microscopic characteristics. Teratomas accounted for 48.6% (n=166) of primary ovarian tumors. The patient mean age was 34.74±12.37 years. Difference in the incidence of teratoma between the left and right ovary was not significant; bilateral teratoma was found in 13 patients. Teratomas were detected by ultrasonography in 115 (69.27%) cases and the rest were found during surgery performed for other indications. Most teratomas (n=161; 96.9%) were mature and cystic (dermoid cysts). Mature and solid teratomas were diagnosed in 5 (3.01%), ovarian struma in 2 (1.8%) cases and strumal carcinoid in 1 (1.2%) case. Mature cystic teratomas contained sebaceous material in 123 (76.8%) cases, and a total of 16 teeth were found; 157 (94.5%) teratomas measured <10 cm in largest diameter. Microscopically, mature cystic teratomas most frequently contained ectodermal (skin with appendages, mature glia and nerve ganglia) and mesodermal (fibrous, fat tissue, cartilage and bone) tissues. Frequently found tissues of endodermal origin were respiratory and intestinal epithelia. Small foci of thyroid tissue were found in 20 (12%) teratomas. Chronic granulomatous foreign body reaction in the wall of mature cystic teratomas was found in 11 (6.8%) tumors.Teratomi su tumori podrijetla zametnih stanica koji se najčešće razvijaju u gonadama. Cilj rada bio je utvrditi koliko je dijagnoza teratoma jajnika postavljeno na rutinskom bioptičkom materijalu Kliničkoga zavoda za patologiju „Ljudevit Jurak“ Kliničkoga bolničkog centra „Sestre milosrdnice“ u Zagrebu u petogodišnjem razdoblju, kao i koje su bile njihove kliničke, makroskopske i mikroskopske osobine. U analiziranom razdoblju teratomi su sačinjavali 166 (44,86%) primarnih tumora jajnika. Srednja dob bolesnica s teratomom jajnika bila je 35±12,37 godina. Nije pronađena statistički značajna razlika u učestalosti teratoma lijevog i desnog jajnika, a u 13 (7,8%) bolesnica teratom je bio obostran. Teratom je u 115 (69.3%) slučajeva otkriven ultrazvukom, u 21 (12,6%) je ultrazvukom postavljena dijagnoza nespecifi ciranog cističnog tumora, a u 16 (9,6%) slučajeva teratom je otkriven prilikom operacijskog zahvata učinjenog iz nekog drugog razloga. U 160 (96,4%) slučajeva radilo se o zrelim cističnim teratomima (dermoidnim cistama), od kojih je 123 (76,8%) bilo ispunjeno lojem i u kojima je pronađeno sveukupno 16 zuba. U 157 (94,6%) slučajeva najveći promjer teratoma iznosio je do 10 cm. Mikroskopski, zreli cistični teratomi najčešće su sadržavali tkiva ektodermalnog i mezodermalnog podrijetla i to u 154 (96,3%) slučaja kožu s kožnim adneksima, odnosno u 148 (92,54%) slučaja vezivo. Od drugih ektodermalnih tkiva po učestalosti su slijedili zrela glija i živčani gangliji, a od mezodermalnih tkiva zrelo masno tkivo, hrskavica i kost. Od tkiva endodermalnog podrijetla najčešće je pronađen respiracijski i crijevni epitel. Manja žarišta tkiva štitnjače pronađena su u 19 (12%) cističnih teratoma. U 11 (7%) cističnih teratoma u stijenci su pronađena žarišta kronične upale tipa stranog tijela. Solidne građe bilo je 5 (3%) teratoma, od čega u 3 (2%) slučaja struma jajnika, a u 2 (1%) slučaja strumalni karcinoid

Gustoća limfnih i malih krvnih žila u stromi tumora i peritumoralnog tkiva u invazivnom karcinomu dojke bez posebnih obilježja

Background: Peritumoral clefts are noticed in carcinomas of many organs, and were thought to be artifacts due to fixation and preparation of slides. Today they are considered to be additional marker of malignancy and the refl ection of epithelial-stromal interaction. The hypothesis was that peritumoral clefts in breast carcinoma reflect changes in stromal composition and characteristics, and are related to lymphangiogenesis in tumor tissue. Materials and methods: One hunderd (59% with axillary lymph nodes metastases) invasive ductal breast carcinomas of no special type were analyzed for the presence and abundance of peritumoral clefts and immunohistochemically for CD34, vimentin, smooth muscle actin (SMA) and D2-40 (podoplanin) in tumor stroma. Results: Peritumoral clefts were found in 92% of invasive carcinomatous tissue and were absent in surrounding healthy tissue and around ducts of in situ component (with 5% do 100%. The threshold of 30% of peritumoral clefts was determined by receiver operating characteristic (ROC) analysis. The density of small lymphatic vessels in the stroma of the tumor, and outside the tumor tissue did not show significant correlation with the threshold value. In patients with axillary metastases, peritumoral lymphovascular invasion (LVI) was found twice and intratumoral LVI five times more often than in patients without axillary metastases. Neither peritumoral nor intratumoral LVI were significantly correlated with the threshold value of 30%. In patients with axillary lymph node metasases, peritumoral lymphovascular invasion (LVI) was found twice as often, and intratumoral LVI 5 times as often than in patients without axillary lymph node metastases. Conclusion: Peritumoral clefts in invasive breast carcinoma reflect stromal changes of fibroblasts and are not associated with lymphangiogenesis, that is probably caused by some other pathogenesis.Uvod: Peritumoralne retrakcijske pukotine više se ne smatraju samo artefaktom, već dodatnim pokazateljem ponašanja invazivnih karcinoma mnogih organa. One predstavljaju morfološki odraz promjena u građi i sastavu tumorske strome, a možda i jedan od stadija limfangiogeneze tumora. Hipoteza istraživanja bila je da su u tkivu invazivnog duktalnog karcinoma dojke peritumoralne retrakcijske pukotine povezane s povećanom gustoćom limfnih žila što doprinosi lakšem rasapu tumorskih stanica i lošijoj prognozi. Materijal i metode: Analizirano je 100 invazivnih duktalnih karcinoma dojke u žena, 41% bez, a 59% s metastazama u limfne čvorove aksile. Osim rutinski, analizirana je imunohistokemijska izraženost CD34, vimentina, glatkomišićnog aktina (SMA) i CD2-40 (podoplanina). Rezultati: Peritumoralne pukotine su nađene u 92% karcinoma, a u okolnom zdravom tkivu i oko žarišta duktalnog karcinoma in situ nisu nađene. Proširenost pukotina bila je 5% do 100%. Gustoća malih limfnih žila unutar tumora i peritumoralno nije pokazala statistički značajnu povezanost s apsolutnim postotkom peritumoralnih pukotina, kao niti s izraženošću peritumoralnih pukotina s obzirom na graničnu vrijednost od 30%. U bolesnica s metastazama peritumoralna limfovaskularna invazija (LVI) je nađena 2 puta češće, a intratumoralna LVI skoro 5 puta češće nego u bolesnica bez metastaza, što je statistički značajno različito. Ni peritumoralna, niti intratumoralna LVI nisu pokazale statistički značajnu povezanost s apsolutnim postotkom peritumoralnih pukotina, kao niti s izraženošću peritumoralnih pukotina s obzirom na graničnu vrijednost od 30%. Zaključak: U invazivnom duktalnom karcinomu dojke peritumoralne pukotine predstavljaju morfološki odraz promijenjenih osobina tumorske strome, ali nisu povezane s gustoćom malih krvnih žila kao odrazom limfangiogeneze, čija je patogeneza vjerojatno drugačija

Da li postoji povezanost između HER-2/neu statusa i gradusa primarnih tumora dojke?

HER-2/neu amplification is a marker of poor prognosis in breast cancer. Patients whose tumors show over expression of HER-2/neu have shortened disease-free and overall survival. The aim of this study was to determinate immunohistochemistry HER-2/neu over expression in 121 cases of primary breast cancer. In addition HER-2/neu status was correlated with hormone receptor status, grades and pTNM stage. The both groups of HER-2/neu negative and HER-2/neu positive patients were average ages of about60 years. In all the HER-2/neu groups (negative, 1+, 2+ and 3+) estrogen and progesterone receptor were highly positive in a high percentage of cases. Also in both groups of HER-2/neu negative and HER-2/neu positive invasive ductal carcinoma the most common grades were 2, but in HER-2/neu 3+ group, there were also 30.0% of cases having grade 3. Our results show that there might be a correlation between HER-2/neu over expression and higher grade of breast cancer. The two most common pTNM stages were T1N0MX and T2N1MX. HER-2/neu receptor is important therapeutic target and testing for HER-2/neu status is now recommended as a part of routine breast cancer diagnosis. The role of new biomarkers, such as HER2/neu and clinical value of its determination must be provided by prospective clinical studies.HER-2/neu onkogen u tumorskim stanicama pokazatelj je loše prognoze karcinoma dojke. Pacijenti u kojih HercepTest daje jako pozitivne vrijednosti (3+) statistički imaju kraće vrijeme bez pojave bolesti i općenito kraće preživljenje. Cilj ovog istraživanja bio je utvrditi vrijednosti HER-2/neu proteina u 121 bolesnika s primarnim karcinomom dojke uz pomoć imunohistokemijske analize HercepTest-om. Nadalje su rezultati dobiveni HercepTest-om uspoređivani s vrijednostima estrogenskih i progesteronskih receptora, gradusom i pTNM stadijem tumora. U skupini pacijenata s negativnim, kao i u skupini s pozitivnim vrijednostima HercepTest-a prosječna starost bolesnika kretala se oko 60 godina. U svim grupama pacijenata (grupa HER-2/neu negativni, HER-2/neu 1+, HER-2/neu 2+ te HER-2/neu 3+) imunohistokemijski određeni estrogenski i progesteronski receptori bili su pozitivni u visokom postotku. Najčešće nađeni gradus invazivnog duktalnog karcinoma bio je 2, ali je osim toga u grupi HER-2/neu 3+ karcinoma dojke 30.0% karcinoma bilo gradusa 3. Rezultati pokazuju mogućnost korelacije između 3+ pozitivnog HercepTest-a i višeg gradusa tumora. Pacijentima je bolest dijagnosticirana najčešće u stadiju T1N0MX i T2N1MX HER-2/neu receptor važan je terapijski cilj u liječenju pacijenata s karcinomom dojke te bi HercepTest trebao postati dio rutinske dijagnostike karcinoma dojke. Ulogu otkrivanja novih biomarkera, kao što je HER-2/neu, te njihovu kliničku važnost valja utvrditi prospektivnim kliničkim studijama

Klinička vrijednost transvaginalne ultrasonografije u usporedbi s histeroskopijom i histopatološkom analizom kod dijagnoze endometralnih abnormalnosti

The aim of our retrospective study was to compare the performance of transvaginal sonography in relation to histologic diagnosis of samples obtained by hysteroscopy through analysis of data collected over 16 years. Data on suspected formation of endometrial polyp or submucosal fibroid found on ultrasound examination were extracted. The study included a total of 3679 women examined during the 2000-2015 period. All women underwent ultrasound examination preoperatively for better planning the type and scope of operation to be performed. The study included only women with samples for histopathologic analysis collected during the operation. Ultrasound diagnosis of polyps compared with histology showed 89.6% sensitivity and 39.1% specificity. For submucosal myomas, sensitivity was 69.2% and specificity 91.3%. In conclusion, ultrasound is not reliable method for definitive diagnosis but it is an excellent orientation method.Cilj ovog retrospektivnog istraživanja je bila usporedba pouzdanosti transvaginalnog ultrazvuka u odnosu na histološki nalaz dobiven histeroskopijom kroz analizu podataka skupljenih tijekom 16 godina. Podatci o suspektnim endometralnim polipima i submukoznim miomima primijećenim na ultrazvučnom pregledu su izdvojeni. U istraživanje je uključeno 3679 žena pregledanih u razdoblju od 2000. do 2015. godine. Svim ženama je učinjen prijeoperacijski ultrazvučni pregled radi planiranja tipa i opsega zahvata. U istraživanje su uključene samo žene kojima je uzet histološki uzorak tijekom operacije. Ultrazvučno utvrđeni polipi u usporedbi s histološkim nalazom pokazali su osjetljivost od 89,6% i specifičnost od 39,1%. Za submukozne miome utvrđena je osjetljivost od 69,2% i specifičnost od 91,3%. Može se zaključiti kako je ultrazvuk nepouzdana metoda pri donošenju konačne dijagnoze, ali odlična orijentacijska metoda

Primary osteosarcoma of bladder diverticulum mimicking intradiverticular calculus: a case report

There is a well-documented relationship between urinary bladder diverticula and intradiverticular neoplasms. The great majorities of these tumors are urothelial carcinomas, but may also be of glandular or squamous type. Sarcomas occurring within bladder diverticula are exceptionally rare and highly malignant lesions, with only 20 well documented cases published in the literature to date (including carcinosarcomas). We report a case of osteosarcoma of the bladder diverticulum in a 68-year old man, which clinically mimicked intradiverticular calculus. To our knowledge, this is the second case described in the literature to date, and the first in English literature

Endometrial stromal sarcome – rare uterine tumor. A case report and literature review

Endometrial stromal sarcoma (ESS) is uncommon uterine malignant tumor and makes approximately 0.2 % of all gynecological malignancies. It is the rarest tumor in the group of mesenchymal uterine tumors. Diagnosis may be difficult, since differentiation between several soft-tissue uterine neoplasms such as highly cellular leiomyoma, cellular endometrial polyp, low-grade Mullerian carcinosarcoma and adenomyosis is tricky. Treatment is surgical, hysterectomy and bilateral adnexectomy is obligatory, the role of lymphadenectomy is still controversial. Since ESS is hormone dependent tumor, hormone therapy as adjuvant therapy can be taken into consideration. In this article we present a 57-yearold patient, clinically asymptomatic, with peculiar TV ultrasound feature, and ESS diagnosed on patho-histologically after operation due to presumed benign diagnosis

Patohistološki nalazi kod žena podvrgnutih histeroskopskoj resekciji endometralnih polipa i mioma maternice

The aim of our study was to determine the prevalence of endometrial premalignant and malignant lesions in women undergoing hysteroscopy and to identify anthropologic factors related to the presence of malignancy. Data on 3470 women with submucosal myomas or endometrial polyps suspected on ultrasound were retrospectively analyzed. Hysteroscopy was performed in all these women in order to make a more precise diagnosis. Histologic analysis of endometrial samples obtained during hysteroscopy was used to confirm the diagnosis. Statistical analysis was performed using the SPSS 20.0.0 software. The mean age of study women was 49.1±13.3 years. The number of procedures performed due to the referral diagnosis of endometrial or submucosal myoma significantly increased over the 16-year study period. A significantly higher number of women had a benign histopathologic diagnosis. Histologic analysis revealed malignancy in 67 women. The youngest woman and oldest woman with malignant findings was aged 32 and 75, respectively. A significantly higher number of women with atypical hyperplasia and malignancy were in menopause. A comparable number of women with different histologic findings lived in urban and rural areas. There were a significantly larger proportion of widows among women with the histologic diagnosis of atypical hyperplasia or malignancy. The prevalence rate of malignancy in women having undergone hysteroscopy for polyps and myoma found by ultrasound was 1.93%. Postmenopausal status and older age were associated with an increased risk of malignancies, but premalignant changes and malignancies were also found in young and premenopausal women. Therefore, diagnostic hysteroscopy can be recommended in women of all age groups.Cilj ove studije bio je odrediti učestalost endometralnih premalignih i malignih lezija nakon histeroskopije te identificirati antropološke čimbenike povezane s malignitetom. Retrospektivno su analizirani podaci za 3470 žena s ultrazvučnom sumnjom na submukozni miom ili endometralni polip. Svim ženama je učinjena histeroskopija kako bi se dobila precizna dijagnoza. Uzorci iz endometrija dobiveni histeroskopijom poslani su na histološku analizu. Statistička analiza učinjena je primjenom programa SPSS 20.0.0. Prosječna dob žena u studiji bila je 49,1±13,3 godine. Broj zahvata zbog uputne dijagnoze endometralnog ili submukoznog mioma značajno je porastao u šesnaestogodišnjem razdoblju trajanja studije. Značajno veći broj žena imao je benignu histopatološku dijagnozu. Histološka analiza pokazala je malignitet u 67 žena. Najmlađa i najstarija žena s malignitetom imale su 32 i 75 godina. Značajno veći broj žena s atipičnom hiperplazijom i malignitetom bio je u menopauzi. Usporediv broj žena s različitim histološkim nalazima živio je u urbanim i ruralnim sredinama. Bio je značajnije viši udio udovica s dijagnozom atipične hiperplazije ili maligne bolesti. Učestalost malignosti kod žena kojima je učinjena histeroskopija zbog ultrazvučnog nalaza mioma ili polipa bila je 1,93%. Menopauza i starija dob bile su povezane s povišenim rizikom za zloćudne bolesti, ali premaligne i maligne promjene nađene su i kod mladih i premenopauzalnih žena. Stoga se dijagnostička histeroskopija preporuča u svim dobnim skupinama

Ekspresija hormona rasta i receptora hormona rasta kod fibroadenoma dojke

Fibroadenoma is the most prevalent benign breast tumor. It consists of epithelial and stromal components. In general, breast tumors are highly hormonally dependent and growth hormone by its physiology may have a possible oncogenic potential. Therefore, the aim of this study was to determine the expression of growth hormone and growth hormone receptor in epithelial and stromal components of fibroadenomas. Study group included 30 randomly chosen fibroadenomas from female patients aged between 18 and 69 years. The expression of growth hormone and growth hormone receptor was defined in both histologic components of fibroadenomas. Growth hormone was expressed in 96.7% of both epithelial and stromal components of fibroadenomas, with stronger expression in the stromal component. The same percentage of positive reaction (96.7%) was obtained in the epithelial component of fibroadenomas for growth hormone receptor expression. Only 6.7% of stromal components tested for growth hormone receptor were positive. The high expression of growth hormone and growth hormone receptor in fibroadenoma tissue indicates their possible role in the pathogenesis of this tumor. Follow up of patients with high expression of growth hormone and growth hormone receptor may be suggested.Fibroadenom je najčešća dobroćudna novotvorina dojke, a sastoji se od epitelne i stromalne komponente. Uzimajući u obzir hormonsku osjetljivost tumora dojke, te potencijalni onkogeni potencijal hormona rasta, cilj našega rada bio je utvrditi ekspresiju hormona rasta i receptora hormona rasta u epitelnoj i stromalnoj komponenti fibroadenoma. U studiju je bilo uključeno 30 nasumice odabranih fibroadenoma nastalih u žena u dobi od 18 do 69 godina. Ekspresija hormona rasta i receptora hormona rasta određivana je u obje histološke komponente fibroadenoma. Ekspresija hormona rasta nađena je u 96,7% epitelne i stromalne komponente, uz jaču izraženost ekspresije u stromalnoj komponenti. Ekspresija receptora hormona rasta u epitelnoj je komponenti također iznosila 96,7%, a u stromalnoj samo 6,7%. Visoka ekspresija hormona rasta i receptora hormona rasta u fibroadenomima označava potencijalnu ulogu ovoga hormona u patogenezi ispitivane bolesti, te bi se u bolesnica ove skupine mogle preporučiti češće kliničke kontrole