The listeriosis triangle: Pathogen, host and the environment

Listeria monocytogenes is a foodborne pathogen well known for its adaptability to diverse environment and host niches and its high fatality rate among infected immunocompromised populations. Infection in the immunocompetent host occurs but risk factors for the disease primarily points to abnormalities in cell-mediated and innate immunity as major predispositions to listeriosis. After ingestion of contaminated food, this pathogen is able to cross the intestinal, blood-brain and placental barrier and leads to gastroenteritis, meningitis and maternofetal infections which may result in abortion and spontaneous stillbirth. Despite the extensive use of this bacterium in the study of cell-mediated immunity and intracellular growth, our understanding of the host, pathogen and environmental factors that impact the pathogenesis of listeriosis is still incomplete. This review will summarize current knowledge, including our own efforts, about pathogen, host and environmental factors that influence, and contribute to the pathogenesis of Listeria monocytogenes infection

The »Round Block« Surgical Technique in the Management of Multicentric Fibroadenomas

The »round block« surgical technique in the treatment of a female patient with multiple, multicentric fibroadenomas in both breasts is presented. The advantages of this technique for patients with multicentric benign breast lesions are minimal postoperative scar and a favourable aesthetic result. Breast dimensions and the areolar diameter were measured in 203 subjects of Primorsko-goranska county during examination in the Out-Patient Hospital for Breast Diseases, including the operated patient. Smaller breast dimensions and a larger areolar diameter provide an easier access to any part of the breast due to a smaller distance between the incision and a fibroadenoma and a larger circumference of circular periareolar incision, thus facilitating the surgery. The analysis of average, maximum and minimum values measured shows that the »round block« technique can be performed in all cases of multiple and multicentric fibroadenomas regardless of breast size, areolar diameter and the location of fibroadenoma in the breast

PATHOLOGY IN UROLOGY

Patohistološko izviješće uz dijagnozu mora sadržavati i prognostičku i biološku evaluaciju promjene. Zbog toga se razvijaju i neprestano nadopunjuju novi protokoli s jedinstvenim patološkim nalazom koji omogućuje lakšu komunikaciju između liječnika i institucija. Cilj je rada bio dati kratak opis uloge patologije u urologiji. U radu se izdvajaju važne postavke patohistoloških protokola tumora bubrega, mokraćnog mjehura i prostate, uz prikaz prevalencije ovih tumora u riječkoj regijiThe finality of all the pathological studies is not restricted to a diagnosis but a prognosis and a biological evaluation is demanded. For this reason the information transfer from the pathological report to the urologist can improve the communication among doctors and institutions. The aim of the paper was to describe the role of pathology in urology. In this part we consider protocols for handling and reporting renal cell carcinoma, bladder carcinoma and prostatic carcinoma. We also give the prevalence of these tumors in our regio

The »Round Block« Surgical Technique in the Management of Multicentric Fibroadenomas

The »round block« surgical technique in the treatment of a female patient with multiple, multicentric fibroadenomas in both breasts is presented. The advantages of this technique for patients with multicentric benign breast lesions are minimal postoperative scar and a favourable aesthetic result. Breast dimensions and the areolar diameter were measured in 203 subjects of Primorsko-goranska county during examination in the Out-Patient Hospital for Breast Diseases, including the operated patient. Smaller breast dimensions and a larger areolar diameter provide an easier access to any part of the breast due to a smaller distance between the incision and a fibroadenoma and a larger circumference of circular periareolar incision, thus facilitating the surgery. The analysis of average, maximum and minimum values measured shows that the »round block« technique can be performed in all cases of multiple and multicentric fibroadenomas regardless of breast size, areolar diameter and the location of fibroadenoma in the breast

Breast Infiltrating Ductal Carcinoma: Analysis of Hormone, HER-2 Receptors and Ki-67 Proliferation Marker

The aim of this study was to analyse breast carcinomas with discordant receptor status, probably hormonal dependent (estrogen receptor (ER) positive, progesterone receptor (PR) negative or ER-PR+ subgroup profile) infiltrating ductal breast carcinomas not otherwise specified (IDC NOS). Specimens from 90 IDC NOS were grouped into three categories according to hormonal status: dependent (D) (ER+PR+), probably dependent (PD) (ER+PR- or ER-PR+) and non-dependent (ND) (ER-PR-); they were evaluated considering some established prognostic parameters in breast carcinomas. Statistically significant difference was found between tumor receptor status distribution and menopausal status (p= 0.0235), age of the patients (p=0.000467), histological grade (p=0.000003), vascular invasion (p=0.006), HER-2 status (p=0.0039) and Ki-67 proliferation rate (p=0.000311). D tumors were found exclusively in post-menopausal patients (average age 68.9 years), most of which had intermediate (II) grade, without vascular invasion, with HER-2 status score predominantly 0 or 1+ and lower Ki-67 proliferation rate. PD tumors were found predominantly in younger post-menopausal patients (average age 57.5 years), with vascular invasion found in 23% of the cases. ND tumors mostly had higher histological grade, showed the highest percentage of the Ki-67 positive tumor cells and vascular invasion in 30% of the cases. We conclude that the patients with PD breast carcinomas were younger post-menopausal women with the tumors moderately differentiated, HER-2 score 0 or 1+ and with lower Ki-67 proliferation rate

Expression of Matrix Metalloproteinase 9 in Primary and Recurrent Breast Carcinomas

The matrix metalloproteinases (MMPs) comprise a family of zinc-dependent endopeptidases that are secreted as inactive precursors, which are activated by cleavage of an N-terminal pro-peptide. Their basic mechanisms of action include cancer cell growth, differentiation, apoptosis, migration and invasion, and the regulation of tumour angiogenesis and immune surveillance. The expression of MMP2 and MMP9 has been associated with high potential of metastasis in several human carcinomas including breast cancer. The 29 female patients, 9 premenopausal and 20 postmenopausal, aged from 37 to 79 years were included in this study. Tissue samples were examined in 29 primary and 48 recurrent carcinomas using the tissue microarrays which included 102 cores of primary breast carcinomas and 96 of recurrent breast carcinomas. Immunohistochemistry determined a pattern of expression for MMP9. The staining was diffuse cytoplasmic, strong, moderate, faint/weak and negative. The majority of the breast carcinomas stained homogenously for MMP9 on tumor cells. Statistically significant correlation was found for the expression of MMP9 between primary and recurrent breast carcinomas in general (p<0.001) and in tumors that were grouped as recurrence before (p=0.039) and after 24 months (p<0.001). Strong expression of MMP9 was observed in primary tumors that recurred after 24 months, median: 162.5 (score range 0–300) and those tumors that recurred before 24 months of the initial diagnosis, median: 102.5 (score range 0–250) (p=0.026)

The role of the pathologist in diagnosis and therapy of the breast cancer patients

Histopatološke značajke karcinoma dojke uključuju brojne podatke koji su neophodni za daljnji odabir terapije pacijentica, stoga oni moraju biti jasni, nedvojbeno navedeni i pouzdani. Osim tradicionalnih podataka o invaziji, metastatskom potencijalu i odgovoru na terapiju, sve više informacija o prognostičkim i prediktivnim čimbenicima koji utječu na terapiju pacijentica daju i genetska istraživanja na temelju kojih su tumori prema ekspresiji određenih gena stratificirani u podtipove.Histopathological features of breast cancer include numerous details that are essential for the further choice of patient’s therapy because it must be clear, unambiguously stated and reliable. In addition to traditional data on invasion, metastasis and response to therapy more information on prognostic and predictive factors that affect the treatment provide patients and genetic research on the basis of which tumors according to the expression of certain genes in the stratified subtypes

Case report of the secondary breast angiosarcoma

Cilj: Sekundarni angiosarkom dojke rijetka je ali ozbiljna dugoročna komplikacija karcinoma dojke kod pacijenata koji su liječeni poštednim kirurškim zahvatom i radioterapijom. Prikazan je slučaj pacijentice kojoj se sekundarni angiosarkom pojavio sedam godina nakon radioterapije uz naglasak na ulogu pažljivog histološkog pregleda tih tumora. Prikaz slučaja: Pacijentici staroj 66 godina kojoj je 2006. godine dijagnosticiran invazivni duktalni karcinom dojke učinjen je konzervativni kirurški zahvat i odstranjen je limfni čvor čuvar (pT1c, pN0). Postoperativni tretman uključivao je radioterapiju i endokrinu terapiju. Sedam godina nakon radioterapije, 2013. godine pacijentica je primijetila purpurno crveno mjesto na koži u ozračenom području desne dojke. Patohistološka dijagnoza promjene je angiosarkom. Zaključak: Razvoj sekundarnog angiosarkoma dojke povezan je s radioterapijom (RIA) i kroničnim limfedemom (Stewart-Treves sindrom nakon latentnog perioda od 4 do 8 godina). Zbog njegove rijetkosti i naizgled bezopasne prezentacije, jer se često radi o bezbolnoj promjeni nalik modrici na koži, pacijenti i liječnici često zanemaruju početne simptome, što vodi kasnom postavljanju dijagnoze. U vrijeme postavljanja dijagnoze pacijenti često imaju lokaliziranu bolest koja je ograničena na dojku, ali s multifokalnim rastom.Aim: Secondary angiosarcoma of the breast is a rare but severe long-term complication of breast carcinoma treated with breast-conserving surgery and radiotherapy. We report here a case which occurred seven years after radiotherapy to highlight the awareness of the disease and the role of careful histological evaluation of these tumours. Case report: The 66-year-old patient with right breast infiltrating ductal carcinoma in December 2006. She underwent conservative breast surgery and sentinel lymph node dissection (pT1c, pN0). Her postoperative treatment included radiotherapy and endocrine therapy. Seven years after the radiotherapy (2013), the patient noticed a purplish spot in the skin of the previously irradiated field of the right breast. The histopathology reviewed a diagnosis of angiosarcoma. Conclusion: The development of secondary angiosarcoma has been linked to radiotherapy (RIA) and chronic lymphedema (Stewart–Treves syndrome) after median latency period of 4–8 years. Because of their rarity and seemingly harmless presentation, frequently comprising painless and bruise like skin lesions, both patients and doctors often neglect the initial symptoms and diagnosis is delayed

The Listeriosis Triangle: Pathogen, Host and the Environment

Listeria monocytogenes is a foodborne pathogen well known for its adaptability to diverse envirnoment and host niches and its high fatality rate among infected immunocompromised populations. Infection in the immunocompetent host occurs but risk factors for the disease primarily points to abnormalities in cell-mediated and innate immunity as major predispositions to listeriosis. After ingestion of contaminated food, this pathoge is able to cross the intestinal, blood-brain and placental barrier and leads to gastroenteritis, meningitis and maternofetal infections which may result in abortion and spontaneous stillbirth. Deispite the extensive use of this bacterium in the study of cell-mediated immunity and intracellular growth, our understanding of the host, pathogen and environmental factor that impact the pathogenesis of listeriosis is still inclomplete. This review will summarize current knowledge, including our own efforts, about pathogen, host and environmental factors that influence, and contribute to the pathogenesis of Listeria monocytogenes infection

The Listeriosis Triangle: Pathogen, Host and the Environment

Listeria monocytogenes is a foodborne pathogen well known for its adaptability to diverse envirnoment and host niches and its high fatality rate among infected immunocompromised populations. Infection in the immunocompetent host occurs but risk factors for the disease primarily points to abnormalities in cell-mediated and innate immunity as major predispositions to listeriosis. After ingestion of contaminated food, this pathoge is able to cross the intestinal, blood-brain and placental barrier and leads to gastroenteritis, meningitis and maternofetal infections which may result in abortion and spontaneous stillbirth. Deispite the extensive use of this bacterium in the study of cell-mediated immunity and intracellular growth, our understanding of the host, pathogen and environmental factor that impact the pathogenesis of listeriosis is still inclomplete. This review will summarize current knowledge, including our own efforts, about pathogen, host and environmental factors that influence, and contribute to the pathogenesis of Listeria monocytogenes infection