26 research outputs found
PrognostiÄka vrijednost odreÄivanja nm23, MAGE-3 i NY-ESO-1 u planocelularnim karcinomima glave i vrata
Head and neck squamous cell cancer is a group of tumors characterised by unique histological findings, the same etiological factors and frequent appereance of several cancers in the same patient. Metastasing is the most importrant accepted prognostic factor. Nm23 gene is one of the genes that suppress metastatic potential. Low expression of nm23 is associated with poor prognosis and more frequent metastasis in several types of cancers. MAGE-3 and NY-ESO-1 genes encoding antigenes expressed in a number of tumours with different hystology. Antigenes are recognized by CD8 (+) T lymphocytes. Antigen NY-ESO- 1 is considered one of the most immunogenic antigens. Retrospective research included 198 patients treated for head and neck squamous cell cancer. Immunohistochemical analysis of nm23, MAGE-3 and NY-ESO-1 expression was performed. We investigated the correlation between nm23, MAGE-A and NY-ESO-1 expression and tumor localization, TNM stage, histological grade and disease specific survival. Gene nm23 was expressed in 56.6% of tumors. The proportion of nm23 positive tumors in the group of patients with oral cavity and laryngeal cancer was lower (46.3%) than in the group of patients with the oropharyngeal and hypopharyngeal cancer (68.8%). The expression of nm23 gene in all patients showed no correlation with TNM stage, histological grade, nor the 5-year survival rate. The analysis of expression of only one gene, which is a part of a complex metastatic process, is not sufficient to differentiate tumors with high and low metastatic potential. MAGE-3 gene was expressed in 66.7% of analyzed sample showed no correlation of expression with localization, TNM stage, histological grade, nor survival. Although it is not a good prognostic factor, it could be a good target for immunotherapy. A large proportion of MAGE-3 positive tumors implicates the need to examine the effectiveness of immunotherapy in squamous cell head and neck cancer. The expression of NY-ESO-1 gene was present in 34.4% of analyzed tumors, and it was less frequently present in poorly differentiated carcinomas. It was a predictor of better prognosis. Due to a small proportion of tumors that show the expression of NY-ESO-1, the potential of clinical implementation is small
Lokalni nazolabijalni režanj u rekonstrukciji defekata dna usne Ŕupljine
After an extensive tumor resection, a defect of the floor of the mouth is a significant reconstructive challenge. The main goal is to preserve the mobility of the tongue, which allows the restauration of mastication, deglutition, and articulation. Today, a standard method for reconstruction of floor of the mouth defects is free microvascular flaps, especially radial forearm free flap. Despite that, a potential problem is the high perioperative risk and high complication rate associated with the patientās age and comorbidities. Current literature suggests that a local nasolabial flap is a reliable treatment option for reconstruction of this type of defect, with a low complication rate and excellent functional and aesthetic results. The aim of this case presentation is to show the use of a local nasolabial flap for reconstruction of the floor of the mouth and to determine the criteria for this type of reconstruction. We present a patient who underwent resection of a floor of the mouth tumor. Due to the patientās age, medical condition, and comorbidities, the defect was reconstructed with a local nasolabial flap. There were no postoperative complications. Articulation, mastication, and deglutition were satisfactorily rehabilitated. Follow-up showed no signs of recurrent disease twelve months postoperatively. To conclude, a local nasolabial flap is still an important reconstructive choice for oral cavity defects, especially for elderly patients with multiple comorbidities who have a higher risk of perioperative complications.Nakon opsežne onkoloÅ”ke resekcije, defekt dna usta predstavlja rekonstruktivni izazov u smislu oÄuvanja mobilnosti jezika i zadržavanja zadovoljavajuÄe funkcije žvakanja i govora. Danas se slobodni mikrovaskularni režnjevi, prvenstveno podlaktiÄni režanj, smatraju metodom izbora za rekonstrukciju defekata o ovoj regiji. UnatoÄ tome, kod bolesnika starije životne dobi i s multiplim komorbiditetima, oÄekujemo visok perioperativni rizik i poveÄanu stopu komplikacija nakon mikrokirurÅ”kog zahvata. Prema podatcima iz literature, lokalni nazolabijalni režanj se pokazao kao jednostavna i pouzdana metoda rekonstrukcije defekata usne Å”upljine uz nisku stopu komplikacija te dobar funkcionalni i estetski rezultat. Cilj ovog rada je ukazati na moguÄnost koriÅ”tenja lokalnog nazolabijalnog režnja za rekonstrukciju defekata dna usne Å”upljine i utvrditi kriterije za izbor bolesnika za ovakav tip rekonstrukcije. Prikazujemo bolesnika koji je kirurÅ”ki lijeÄen zbog karcinoma dna usne Å”upljine. Zbog loÅ”ijeg opÄeg stanja bolesnika, visoke životne dobi i komorbiditeta odluÄili smo se za rekonstrukciju lokalnim nazolabijalnim režnjem. Operativni zahvat je proÅ”ao bez komplikacija. Bolesnik je zadovoljavajuÄe govorno i gluticijski rehabiliran te bez znakova recidiva bolesti dvanaest mjeseci postoperativno. Možemo zakljuÄiti da lokalni nazolabijalni režanj i danas zadržava važno mjesto u rekonstrukciji defekata usne Å”upljine, osobito kod starijih bolesnika s brojnim komorbiditetima koji imaju visok perioperativni rizi
Facijalni karcinom Merkelovih stanica: prikaz dvaju sluÄajeva i pregled literature
Merkel cell carcinoma is an aggressive tumor of the skin deriving from neuroendocrine cells with unpredictable clinical behavior and poor clinical outcome. Merkel cell carcinoma is relatively rare with some 600 cases reported, but seemingly with an increasing incidence due to the increased sun exposure and immunosuppression. There are increasing reports of Merkel cell carcinoma occurring in transplant patients receiving immunosuppressive therapy. We present two cases of Merkel cell carcinoma of the facial skin, one of them in a patient who received immunosuppressive therapy. According to the literature, standard therapy for Merkel cell carcinoma includes large scale surgical excision of the primary tumor, neck dissection for palpable nodes, and in most cases subsequent radiotherapy. This article also reviews some recent reports of Merkel cell carcinoma regarding the diagnosis, clinical course and therapeutic modalities.Karcinom Merkelovih stanica je agresivan tumor kože koji nastaje iz neuroendokrinih stanica i ima nepredvidivo kliniÄko ponaÅ”anje te lo. kliniÄki ishod. Karcinom Merkelovih stanica je relativno rijedak, s nekih 600 objavljenih sluÄajeva, no Äini se da mu incidencija raste zbog sve veÄeg izlaganja sunÄevom zraÄenju i imunosupresiji. Sve je viÅ”e izvjeÅ”Äa o karcinomu Merkelovih stanica u bolesnika s transplantatima koji primaju imunosupresivne lijekove. Prikazujemo dva sluÄaja karcinoma Merkelovih stanica na koži lica, jedan od njih u bolesnice koja je primala imunosupresivne lijekove. Prema literaturi, standardna terapija kod karcinoma Merkelovih stanica sastoji se od opsežne kirurÅ”ke ekscizije primarnog tumora, disekcije vrata zbog opipljivih Ävorova i u veÄini sluÄajeva naknadne radioterapije. U ovom radu dajemo pregled novijih izvjeÅ”Äa o karcinomu Merkelovih stanica u odnosu na dijagnostiku, kliniÄki tijek i moguÄnosti lijeÄenja
Upotreba i odgoÄene komplikacije nakon ugradnje govorne proteze kod laringektomiranih bolesnika - naÅ” pristup rjeÅ”avanju curenja uz protezu
Aim: To determine success in use of voice prosthesis, prosthesis lifetime and long-term complications after total laryngectomy with primary tracheoesophageal puncture and to describe our approach to periprosthetic leakage.
Introduction: Voice restoration after total laryngectomy is usually performed by placing a silicone voice prosthesis in an artificially formed tracheoesophageal fistula.
Methods: We performed a retrospective study on 187 laryngectomies with primary tracheoesophageal puncture in the 15-year period, treated in our hospital.
Results: In the group of patients with more than 1 year follow up, 87.8% of patients had successful voice restoration. Average prosthesis lifetime was 8 months. Long-term complications developed in 17.5% of patients. Periprosthetic leakage was the most common. We were able to successfully resolve long-term complications in 19/24 patients and they continued to use their vocal prostheses.
Conclusion: The primary placement of the voice prosthesis is successful and safe way to restore a voice after a total laryngectomy. Complications are commonly treatable in an outpatient clinic or with minor surgery.Cilj rada je analizirati uspjeÅ”nost koriÅ”tenja govornih proteza, životni vijek proteza kao i odgoÄene komplikacije kod primarne ugradnje govorne proteze nakon totalne laringektomije kao i opisati naÅ” pristup rjeÅ”avanju curenja uz protezu.
Uvod: Govorna rehabilitacija nakon totalne laringektomije se najÄeÅ”Äe postiže ugradnjom silikonske govorne proteze u umjetno formiranu treheoezofagealnu fistulu.
Metode: retrospektivno smo analizirali 187 bolesnika koji su u 15-godiÅ”njem periodu lijeÄeni u naÅ”oj bolnici te kod kojih je uÄinjena primarna ugradnja govorne proteze nakon totalne laringektomije.
Rezultati: U grupi bolesnika koji su postoperativno praÄeni viÅ”e od godine dana, 87,7% je zadovoljavajuÄe govorno rehabilitirano. ProsjeÄno trajanje govorne proteze je bilo 8 mjeseci. OdgoÄene komplikacije je razvilo 17,5% bolesnika. NajÄeÅ”Äa komplikacija je bila curenje uz govornu protezu. UspjeÅ”no smo rijeÅ”ili odgoÄene komplikacije kod 19 od 24 bolesnika koji su se nakon toga nastavili služiti govornom protezom.
ZakljuÄak: Primarna ugradnja govone proteze je uspjeÅ”an i siguran naÄin postizanja govorne rehabilitacije nakon totalne laringektomije. Komplikacije nakon postupka je najÄeÅ”Äe moguÄe rjeÅ”iti veÄ prilikom ambulantnog pregleda ili manjim kirurÅ”kim zahvatima
Pleomorfni adenom mekog nepca ā prikaz sluÄaja
A case of a minor salivary gland tumor of the soft palate in a 64-year-old female patient is reported. Fine-needle aspiration cytology diagnosed pleomorphic adenoma. Transoral extirpation was done. Histological examination confirmed cytological diagnosis. There is no recurrence after 4 years of follow-up.
Tumors of the salivary glands constitute about 3% of all tumors. Most of them arise in the major glands. Tumors localized in the minor glands are more often malignant. Pleomorphic adenoma constitutes 10% of minor salivary gland tumors.
Diagnosis of intraoral tumors includes diagnostic imaging as well as fine-needle aspiration cytology. Preoperative work up influences surgical approach.Prikazana je bolesnica s tumorom male žlijezde slinovnice mekog nepca. CitoloÅ”ki se radilo o pleomorfnom adenomu. UÄinjena je transoralna ekstirpacija. PatohistoloÅ”ka dijagnoza potvrdila je citoloÅ”ki nalaz. Na redovitim kontrolama bolesnica je viÅ”e od 4 godine bez recidivnog tumora.
Tumori žlijezda slinovnica Äine oko 3% svih lokalizacija tumora. ÄeÅ”Äi su tumori velikih žlijezda slinovnica, tumori lokalizirani u malim žlijezdama slinovnicama ÄeÅ”Äe su maligni. Pleomorfni adenomi Äine 10% tumora malih žlijezda slinovnica.
DijagnostiÄka obrada intraoralnih tumora ukljuÄuje metode vizualizacije tumora, kao i aspiracijsku citodijagnostiku. Rezultati uÄinjenih pretraga utjeÄu na odluku o kirurÅ”kom pristupu
Elektivna disekcija regije IV ne poveÄava rizik postoperativnog hipoparatireoidizma kod bolesnika lijeÄenih zbog dobro diferenciranog karcinoma Å”titnjaÄe
The aim of this study was to compare the incidence of postoperative hypoparathyroidism
in two groups of patients who were treated for differentiated thyroid cancer. Methods:
A retrospective analysis of 179 patients who were treated for differentiated thyroid cancer in our institution
from January 2011 until December 2018 was performed. Only patients initially treated with
total thyroidectomy and those who did not have preoperatively confirmed central compartment and
lateral neck lymph node metastases were included in this study. Two main groups of patients were
analysed. The patients who were treated with total thyroidectomy and elective central compartment
lymph node dissection simultaneously were included in the first group. The patients who were treated
only with total thyroidectomy were included in the second group. The rate of transitory and persistent
postoperative hypoparathyroidism was compared between the two groups. Results: A total of 117
patients (65.4%) underwent total thyroidectomy and elective central compartment lymph node dissection
simultaneously (TT + CCLN d group). The remaining 62 patients (34.6%) underwent total
thyroidectomy only (TT group). A total of 22.6% patients in the TT group developed postoperative
hypoparathyroidism compared with 25.6% in the TT + CCLN d group. The rate of persistent hypoparathyroidism
in the TT and TT + CCLN d groups was 3.2% and 6.0%, respectively. The difference
in the rate of transient and persistent postoperative hypoparathyroidism was not statistically significant
between the two groups. Within the TT + CCLN d group, 82.9% of patients underwent ipsilateral
paratracheal lymph node dissection and 17.1% underwent bilateral paratracheal lymph node dissection.
The rate of postoperative hypoparathyroidism was analysed in those two subgroups of patients
and did not prove to be statistically significant. Discussion: While its impact on the local recurrence
rate is still controversial, elective central compartment lymph node dissection could be a great tool for
selection of patients who could profit from adjuvant radioiodine treatment. On the other hand, central
compartment lymph node dissection could potentially increase the risk of hypoparathyroidism due to
involuntary injury to parathyroid glands and/or their blood supply. Our study did not find a statistically
significant difference regarding postoperative hypoparathyroidism between patients who underwent
central compartment lymph node dissection compared with patients who underwent total thyroidectomy only. Our data are not in accordance with some of the previously published studies.
Our results demonstrated that elective central compartment lymph node dissection is a safe
procedure and does not significantly increase the risk of postoperative hypoparathyroidism when it is
performed simultaneously with total thyroidectomy.Cilj rada je usporediti incidenciju postoperativnog hipoparatireoidizma izmeÄu dvije skupine bolesnika lijeÄenih
zbog dobro diferenciranog karcinoma Å”titnjaÄe. Metode: Retrospektivno smo analizirali 179 bolesnika koji su u naÅ”oj ustanovi
lijeÄeni zbog dobro diferenciranog karicnoma Å”titnjaÄe u periodu od sijeÄnja 2011 do prosinca 2018. U studiju su bili
ukljuÄeni samo bolesnici kod kojih je inicijalno uÄinjena totalna tiroidektomija te oni koji na osnovu preoperativne obrade
nisu imali potvrÄene metastaze na lateralnom vratu i u regiji VI. Analizirane su dvije skupine bolesnika. U prvu skupinu su
ukljuÄeni bolesnici kod kojih je u istom aktu uÄinjena totalna tireoidektomija i disekcija regije VI. Svi ostali bolesnici kod
kojih je uÄinjena samo totalna tireoidektomija ukljuÄeni su u drugu skupinu. Stopa tranzitornog i trajnog hipoparatireoidizma
je usporeÄivana izmeÄu dvije skupine. Rezultati: Kod ukupno 117 bolesnika (65,4%) uÄinjena je disekcija regije VI
istodobno s totalnom tireoidektomijom. (TT + CCLN d skupina). Kod preostalih 62 bolesnika (34,6%) uÄinjena je samo
totalna tireoidektomija. (TT skupina). Ukupno 22,6% bolesnika iz TT skupine je razvilo postoperativni hipoparatireoidizam
usporedno s 25,6% bolesnika iz TT + CCLN d skupine. Stope trajnog hipoparatireoidizma u TT i TT + CCLN d skupinama
su iznosile 3,2 i 6 %. Stopa tranzitornog kao i trajnog postoperativnog hipoparatireoidizma nije bila statistiÄki znaÄajna izmeÄu
dvije skupine. Unutar TT + CCLN d skupine, kod 82,9% bolesnika je uÄinjena disekcija ipsilateralnih paratrahealnih
limfnih Ävorova, za razliku od 17,1% bolesnika kod kojih je uÄinjena disekcija bilateralnih paratrahealnih Ävorova. Stopa
postoperativnog hipoparatireoidizma je analizirana u dvjema podskupinama i nije se pokazala statistiÄki znaÄajnom. Rasprava:
Iako je utjecaj elektivne disekcije regije VI na lokoregionalno recidiviranje i dalje kontroverzan, ona može biti odliÄan alat
za probir bolesnika koji mogu imati korist od adjuvantne radiojodne ablacije. S druge strane, disekcija regije VI potencijalno
može poveÄati rizik hipoparatireoidizma zbog nenamjerne ozljede doÅ”titnih žlijezda ili/i njihove krvne opskrbe. NaÅ”a studija
nije pokazala statistiÄki znaÄajnu razliku u stopi postoperativnog hipoparatireoidizma izmeÄu skupine bolesnika kod kojih
je uÄinjena disekcija regije VI u usporedbi sa skupinom bolesnika kod kojih je uÄinjena samo totalna tireoidektomija. NaÅ”i
podaci su u proturijeÄju s nekim ranije publiciranim studijama. NaÅ”i rezultati su pokazali da je elektivna disekcija
regije VI sigurni postupak i znaÄajno ne poveÄava rizik postoperativnog hipoparatireoidizma kada se izvodi istodobno s totalnom
tireoidektomijom