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

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

Treatment of Pineal Region Lesions: Our Experience in 39 Patients

The pineal region is the origin of lesions with a highly diverse histopathology. The aim of this study was to present our experience in treating patients with the pineal region lesions. In period between 1990 and 2007, 39 patients with pineal region lesions were operated on at the Department of Neurosurgery, University Hospital »Sestre milosrdnice«, Zagreb, Croatia. The study group consisted of 21 female and 18 male patients with the median age of 24.4 years (4–66 years). Surgery was performed using the infratentorial supracerebellar approach in all patients. The pineal region lesions were removed totally in 23 (58.97%), subtotal in 14 (35.9%) and partially in 2 (5.13%) patients. Pathohistological examination revealed 13 pineocytomas (33.33%), 10 germinomas (25.64%), 7 glial cysts (17.94%), 3 pineoblastomas (7.69%), two pilocytic astrocytomas (7.69%) and one case (2.56%) of papilloma plexus chorioideus, epidermal cyst, yolk sack tumor and ganglioglioma. There was no surgical mortality. Thirteen patients (33.3%) experienced complications in the postoperative period. During the follow-up period that ranged from 3 to 48 months six patients died (15.4%). The infratentorial supracerebellar approach is a safe and effective surgical approach. Benign pineal lesions could be cured with surgery alone. In the case of malignant pineal lesions radical surgical resection allowed determining the exact pathohistological diagnosis and facilitated adjuvant therapy (irradiation and chemotherapy)

Treatment of Pineal Region Lesions: Our Experience in 39 Patients

The pineal region is the origin of lesions with a highly diverse histopathology. The aim of this study was to present our experience in treating patients with the pineal region lesions. In period between 1990 and 2007, 39 patients with pineal region lesions were operated on at the Department of Neurosurgery, University Hospital »Sestre milosrdnice«, Zagreb, Croatia. The study group consisted of 21 female and 18 male patients with the median age of 24.4 years (4–66 years). Surgery was performed using the infratentorial supracerebellar approach in all patients. The pineal region lesions were removed totally in 23 (58.97%), subtotal in 14 (35.9%) and partially in 2 (5.13%) patients. Pathohistological examination revealed 13 pineocytomas (33.33%), 10 germinomas (25.64%), 7 glial cysts (17.94%), 3 pineoblastomas (7.69%), two pilocytic astrocytomas (7.69%) and one case (2.56%) of papilloma plexus chorioideus, epidermal cyst, yolk sack tumor and ganglioglioma. There was no surgical mortality. Thirteen patients (33.3%) experienced complications in the postoperative period. During the follow-up period that ranged from 3 to 48 months six patients died (15.4%). The infratentorial supracerebellar approach is a safe and effective surgical approach. Benign pineal lesions could be cured with surgery alone. In the case of malignant pineal lesions radical surgical resection allowed determining the exact pathohistological diagnosis and facilitated adjuvant therapy (irradiation and chemotherapy)

Povezanost protočne citometrije s drugim kliničkim i patohistološkim parametrima u bolesnica s neuroendokrinim duktalnim karcinomom dojke

Aims. The aim of the study was to determine cellular ploidy of invasive ductal breast carcinoma with neuroendocrine (NE) differentiation and its share in certain phases of the cell cycle. It was also aimed at assessing the relationship of the cell cycle profile with other clinical and histopathological features. Methods. The study was carried out in 80 patients with invasive ductal breast cancer, and classified as breast carcinoma with NE differentiation according to their histopathological parameters. The patients underwent treatment at the University Hospital for Tumors, Zagreb, Croatia during the period January 1 to December 31, 1992. Data about patients’ age, estrogen and progesterone receptor concentration, cancer size, and treatment modality were retrospectively collected from their case histories. Paraffin blocks were used for immunohistochemical and histochemical analysis and flow cytometric analysis of the tumor cell cycle. Neuroendocrine tumor diagnosis was made using Grimelius and immunohistochemical staining including neuron-specific enolase (NSE), chromogranin A and synaptophysin. Results. Analysis by flow cytometry detected 27 tumors (33.8%) with DNA diploidy showing proliferative activity lower than 20%, and 53 tumors (66.2%) with DNA aneuploidy, tetraploidy and/or DNA diploidy with proliferative activity over 20%. Progesterone receptor concentration in DNA-diploid tumors was significantly higher that in DNA-aneuploid, tetraploid tumors and tumors with proliferative activity of ≥20% (p<0.001). Concentration of estrogen receptors, age, histological grade, tumor size, Grimelius staining and immnohistochemical markers did not significantly differ between the groups. Conclusion. Data collected in our study show a higher mean concentration of progesterone receptors in the group of diploid tumors and tumors with low proliferative activity. In consideration with the above criterium, other pathological and clinical parameters did not show any significant difference relative to both tumor ploidy and its proliferative activity. For final conclusion on the clinical significance of neuroendocrine differentiation in breast cancer further studies that would include monitoring of the course and outcome of the disease are required.Ciljevi. Cilj našeg istraživanja bio je odrediti ploidnost stanica kod invazivnih duktalnih karcinoma dojke s neuroendokrinom (NE) diferencijacijom i njihov udio u pojedinim fazama staničnog ciklusa. Također se htjelo utvrditi povezanost profila staničnog ciklusa s drugim kliničkim i patohistološkim značajkama. Metode. Istraživanje je provedeno na 80 bolesnica s duktalnim invazivnim karcinomom dojke koji su prema patohistološkim parametrima svrstani u karcinome dojke s NE diferencijacijom. Bolesnice su liječene u razdoblju od 01.01. do 31.12.1992. godine na Klinici za tumore u Zagrebu. Podaci o dobi bolesnica, koncentraciji estrogenskih i progesteronskih receptora, veličini karcinoma, te načinu liječenja dobiveni su retrospektivno iz povijesti bolesti. Parafinski blokovi upotrijebljeni su za imunohistokemijsku i histokemijsku analizu te analizu staničnog ciklusa tumorskih stanica protočnom citometrijom. Dijagnoze neuroendokrinih tumora postavljene su na temelju bojenja po Grimeliusu te imunohistokemijskih bojenja uključujući neuron-specifičnu enolazu (NSE), kromogranin A i sinaptofizin. Rezultati. Protočnom citometrijom kod 27 tumora (33.8%) nađena je DNA diploidija i visina proliferativne aktivnosti manja od 20%, dok su DNA aneuploidija, tetraploidija i/ili DNA diploidija s proliferativnom aktivnošću većom od 20% nađene kod 53 tumora (66.2%). Koncentracija progesteronskih receptora u DNA-diploidnim tumorima bila je značajno viša nego kod DNA-aneuploidnih, tetraploidnih i tumora s proliferativnom aktivnošću ≥20% tumora (p<0.001). Koncentracija estrogenskih receptora, dob, histološki stupanj, veličina tumora, bojanje po Grimeliusu te imunohistokemijski markeri nisu se značajno razlikovali u ove dvije skupine. Zaključak. Podaci iz našeg istraživanja upućuju na veću prosječnu koncentraciju progesteronskih receptora u skupini diploidnih tumora i tumora s niskom proliferativnom aktivnošću. Prema navedenom kriteriju drugi patološki i klinički parametri nisu pokazali značajnu razliku u odnosu na ploidnost i proliferativnu aktivnost. Za donošenje konačnog zaključka o kliničkoj važnosti neuroendokrine diferencijacije kod karcinoma dojke potrebno je provesti istraživanja koja bi uključila praćenje tijeka i ishoda bolesti

Povezanost protočne citometrije s drugim kliničkim i patohistološkim parametrima u bolesnica s neuroendokrinim duktalnim karcinomom dojke

Aims. The aim of the study was to determine cellular ploidy of invasive ductal breast carcinoma with neuroendocrine (NE) differentiation and its share in certain phases of the cell cycle. It was also aimed at assessing the relationship of the cell cycle profile with other clinical and histopathological features. Methods. The study was carried out in 80 patients with invasive ductal breast cancer, and classified as breast carcinoma with NE differentiation according to their histopathological parameters. The patients underwent treatment at the University Hospital for Tumors, Zagreb, Croatia during the period January 1 to December 31, 1992. Data about patients’ age, estrogen and progesterone receptor concentration, cancer size, and treatment modality were retrospectively collected from their case histories. Paraffin blocks were used for immunohistochemical and histochemical analysis and flow cytometric analysis of the tumor cell cycle. Neuroendocrine tumor diagnosis was made using Grimelius and immunohistochemical staining including neuron-specific enolase (NSE), chromogranin A and synaptophysin. Results. Analysis by flow cytometry detected 27 tumors (33.8%) with DNA diploidy showing proliferative activity lower than 20%, and 53 tumors (66.2%) with DNA aneuploidy, tetraploidy and/or DNA diploidy with proliferative activity over 20%. Progesterone receptor concentration in DNA-diploid tumors was significantly higher that in DNA-aneuploid, tetraploid tumors and tumors with proliferative activity of ≥20% (p<0.001). Concentration of estrogen receptors, age, histological grade, tumor size, Grimelius staining and immnohistochemical markers did not significantly differ between the groups. Conclusion. Data collected in our study show a higher mean concentration of progesterone receptors in the group of diploid tumors and tumors with low proliferative activity. In consideration with the above criterium, other pathological and clinical parameters did not show any significant difference relative to both tumor ploidy and its proliferative activity. For final conclusion on the clinical significance of neuroendocrine differentiation in breast cancer further studies that would include monitoring of the course and outcome of the disease are required.Ciljevi. Cilj našeg istraživanja bio je odrediti ploidnost stanica kod invazivnih duktalnih karcinoma dojke s neuroendokrinom (NE) diferencijacijom i njihov udio u pojedinim fazama staničnog ciklusa. Također se htjelo utvrditi povezanost profila staničnog ciklusa s drugim kliničkim i patohistološkim značajkama. Metode. Istraživanje je provedeno na 80 bolesnica s duktalnim invazivnim karcinomom dojke koji su prema patohistološkim parametrima svrstani u karcinome dojke s NE diferencijacijom. Bolesnice su liječene u razdoblju od 01.01. do 31.12.1992. godine na Klinici za tumore u Zagrebu. Podaci o dobi bolesnica, koncentraciji estrogenskih i progesteronskih receptora, veličini karcinoma, te načinu liječenja dobiveni su retrospektivno iz povijesti bolesti. Parafinski blokovi upotrijebljeni su za imunohistokemijsku i histokemijsku analizu te analizu staničnog ciklusa tumorskih stanica protočnom citometrijom. Dijagnoze neuroendokrinih tumora postavljene su na temelju bojenja po Grimeliusu te imunohistokemijskih bojenja uključujući neuron-specifičnu enolazu (NSE), kromogranin A i sinaptofizin. Rezultati. Protočnom citometrijom kod 27 tumora (33.8%) nađena je DNA diploidija i visina proliferativne aktivnosti manja od 20%, dok su DNA aneuploidija, tetraploidija i/ili DNA diploidija s proliferativnom aktivnošću većom od 20% nađene kod 53 tumora (66.2%). Koncentracija progesteronskih receptora u DNA-diploidnim tumorima bila je značajno viša nego kod DNA-aneuploidnih, tetraploidnih i tumora s proliferativnom aktivnošću ≥20% tumora (p<0.001). Koncentracija estrogenskih receptora, dob, histološki stupanj, veličina tumora, bojanje po Grimeliusu te imunohistokemijski markeri nisu se značajno razlikovali u ove dvije skupine. Zaključak. Podaci iz našeg istraživanja upućuju na veću prosječnu koncentraciju progesteronskih receptora u skupini diploidnih tumora i tumora s niskom proliferativnom aktivnošću. Prema navedenom kriteriju drugi patološki i klinički parametri nisu pokazali značajnu razliku u odnosu na ploidnost i proliferativnu aktivnost. Za donošenje konačnog zaključka o kliničkoj važnosti neuroendokrine diferencijacije kod karcinoma dojke potrebno je provesti istraživanja koja bi uključila praćenje tijeka i ishoda bolesti

Distrofična bulozna epidermoliza s kožnim karcinomom – utjecaj na anesteziju – prikaz slučaja

We report a patient with recessive dystrophic epidermolysis bullosa who developed multiple skin cancer on the upper arm. She was scheduled for arm amputation. Skin and mucosa lesions render more difficulty in anesthetic management, especially monitoring, positioning and airway instrumentation. General anesthesia based on ketamine enables us to avoid some of the problems.Opisujemo bolesnicu s distrofičnim oblikom buloznog dermatitisa u koje su se razvili multipli kožni karcinomi nadlaktice. Bolesnica je predviđena za amputaciju ruke. Kožne promjene i promjene sluznice otežavaju vođenje anestezije, a osobito promatranje, namještanje i pristup dišnom putu. Opća anestezija ketaminom omogućila nam je da izbjegnemoneke od navedenih problema

Asimptomatične promjene koje oponašaju metasaze slezene u bolesnika s rakom dojke – prikaz slučaja

The spleen is very rarely involved by meatstatic disease in breast cancer patients. These metastases are rarely described in the literature. In this case report the authors report a case of a breast cancer patient having undergone the radical mastectomy for breast cancer one year ago, who was admitted to the hospital for regular follow-up evaluation of the disease with no symptoms. As the findings were suspicious for splenic metastases, explorative laparatomy and splenectomy were performed. The findings showed mimicking splenic metastases with the diagnosis of cavernous hemangioma of the spleen. We discuss the pathological and clinical features, the presentation, assessment and treatment of this case. The patient was in a good postoperative condition and referred for further oncological treatment.U bolesnika s rakom dojke slezena je vrlo rijetko zahvaćena metastatskom bolešću. Te se metastaze u literaturi rijetko opisuju. U ovom prikazu slučaja autori iznose slučaj bolesnice s rakom dojke koja je godinu dana nakon radikalne mastektomije zbog raka dojke bez simptoma primljena u bolnicu radi redovitih pretraga u sklopu praćenja bolesti. Kako su nalazi upućivali na metastaze u slezeni, obavljena je eksplorativna laparotomija i splenektomija. Nalazi su pokazali promjene koje oponašaju metastaze slezene s dijagnozom kavernoznog hemangioma slezene. U radu se raspravlja o patološkim i kliničkim značajkama, predstavljanju, procjeni i liječenju te bolesnice. Stanje bolesnice nakon operacije bilo je dobro i upućena je na daljnje onkološko liječenje

Distrofična bulozna epidermoliza s kožnim karcinomom – utjecaj na anesteziju – prikaz slučaja

We report a patient with recessive dystrophic epidermolysis bullosa who developed multiple skin cancer on the upper arm. She was scheduled for arm amputation. Skin and mucosa lesions render more difficulty in anesthetic management, especially monitoring, positioning and airway instrumentation. General anesthesia based on ketamine enables us to avoid some of the problems.Opisujemo bolesnicu s distrofičnim oblikom buloznog dermatitisa u koje su se razvili multipli kožni karcinomi nadlaktice. Bolesnica je predviđena za amputaciju ruke. Kožne promjene i promjene sluznice otežavaju vođenje anestezije, a osobito promatranje, namještanje i pristup dišnom putu. Opća anestezija ketaminom omogućila nam je da izbjegnemoneke od navedenih problema

Poštedni kirurški zahvati karcinoma dojke u Klinici za tumore

Surgical treatment for breast cancer remains the dominant method despite a number of minor changes in the approach. While some twenty-odd years ago, a diagnosis of breast cancer meant removal of the entire breast and beyond, today the same result (both success or fail results) can be achieved with conservative care. Participants of the Consensus Conference in Paris in 1990 reached the conclusion that breast- conserving surgery followed by irradiation is an appropriate method of primary therapy for the majority of women with stage I and II breast cancer, and is preferable because it provides survival equivalent to mastectomy while preserving the breast.Kirurško liječenje raka dojke i dalje je dominantan postupak i uz brojne manje promjene koncepta. Dok je prije dvadesetak godina dijagnoza raka dojke značila uklanjanje cijele dojke pa i više, danas je moguće s jednakim rezultatom (uspjehom i neuspjehom) liječiti rak dojke poštednim zahvatom. Na Konsenzus konferenciji u Parizu 1990. godine donesen je zaključak da je poštedni kirurški zahvat s popratnom iradijacijom odgovarajuća metoda primarne terapije u liječenju raka dojke u žena sa stadijemI i II, te se preferira u odnosu na mastektomiju zbog jednakog preživljenja