Prognostička vrijednost određivanja 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 šupljine

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 patient’s 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 patient’s 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 onkološke resekcije, defekt dna usta predstavlja rekonstruktivni izazov u smislu očuvanja mobilnosti jezika i zadržavanja zadovoljavajuće funkcije žvakanja i govora. Danas se slobodni mikrovaskularni režnjevi, prvenstveno podlaktični režanj, smatraju metodom izbora za rekonstrukciju defekata o ovoj regiji. Unatoč tome, kod bolesnika starije životne dobi i s multiplim komorbiditetima, očekujemo visok perioperativni rizik i povećanu stopu komplikacija nakon mikrokirurškog zahvata. Prema podatcima iz literature, lokalni nazolabijalni režanj se pokazao kao jednostavna i pouzdana metoda rekonstrukcije defekata usne šupljine uz nisku stopu komplikacija te dobar funkcionalni i estetski rezultat. Cilj ovog rada je ukazati na mogućnost korištenja lokalnog nazolabijalnog režnja za rekonstrukciju defekata dna usne šupljine i utvrditi kriterije za izbor bolesnika za ovakav tip rekonstrukcije. Prikazujemo bolesnika koji je kirurški liječen zbog karcinoma dna usne šupljine. Zbog lošijeg općeg stanja bolesnika, visoke životne dobi i komorbiditeta odlučili smo se za rekonstrukciju lokalnim nazolabijalnim režnjem. Operativni zahvat je prošao bez komplikacija. Bolesnik je zadovoljavajuće govorno i gluticijski rehabiliran te bez znakova recidiva bolesti dvanaest mjeseci postoperativno. Možemo zaključiti da lokalni nazolabijalni režanj i danas zadržava važno mjesto u rekonstrukciji defekata usne šupljine, osobito kod starijih bolesnika s brojnim komorbiditetima koji imaju visok perioperativni rizi

Facijalni karcinom Merkelovih stanica: prikaz dvaju slučajeva 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 kliničko ponašanje te lo. klinički ishod. Karcinom Merkelovih stanica je relativno rijedak, s nekih 600 objavljenih slučajeva, no čini se da mu incidencija raste zbog sve većeg izlaganja sunčevom zračenju i imunosupresiji. Sve je više izvješća o karcinomu Merkelovih stanica u bolesnika s transplantatima koji primaju imunosupresivne lijekove. Prikazujemo dva slučaja 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 kirurške ekscizije primarnog tumora, disekcije vrata zbog opipljivih čvorova i u većini slučajeva naknadne radioterapije. U ovom radu dajemo pregled novijih izvješća o karcinomu Merkelovih stanica u odnosu na dijagnostiku, klinički tijek i mogućnosti liječenja

Upotreba i odgođene komplikacije nakon ugradnje govorne proteze kod laringektomiranih bolesnika - naš pristup rješavanju 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 uspješnost korištenja govornih proteza, životni vijek proteza kao i odgođene komplikacije kod primarne ugradnje govorne proteze nakon totalne laringektomije kao i opisati naš pristup rješavanju curenja uz protezu. Uvod: Govorna rehabilitacija nakon totalne laringektomije se najčešće postiže ugradnjom silikonske govorne proteze u umjetno formiranu treheoezofagealnu fistulu. Metode: retrospektivno smo analizirali 187 bolesnika koji su u 15-godišnjem periodu liječeni u našoj bolnici te kod kojih je učinjena primarna ugradnja govorne proteze nakon totalne laringektomije. Rezultati: U grupi bolesnika koji su postoperativno praćeni više od godine dana, 87,7% je zadovoljavajuće govorno rehabilitirano. Prosječno trajanje govorne proteze je bilo 8 mjeseci. Odgođene komplikacije je razvilo 17,5% bolesnika. Najčešća komplikacija je bila curenje uz govornu protezu. Uspješno smo riješili odgođene komplikacije kod 19 od 24 bolesnika koji su se nakon toga nastavili služiti govornom protezom. Zaključak: Primarna ugradnja govone proteze je uspješan i siguran način postizanja govorne rehabilitacije nakon totalne laringektomije. Komplikacije nakon postupka je najčešće moguće rješiti već prilikom ambulantnog pregleda ili manjim kirurškim zahvatima

Pleomorfni adenom mekog nepca – prikaz slučaja

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. Citološki se radilo o pleomorfnom adenomu. Učinjena je transoralna ekstirpacija. Patohistološka dijagnoza potvrdila je citološki nalaz. Na redovitim kontrolama bolesnica je više od 4 godine bez recidivnog tumora. Tumori žlijezda slinovnica čine oko 3% svih lokalizacija tumora. Češći su tumori velikih žlijezda slinovnica, tumori lokalizirani u malim žlijezdama slinovnicama češće su maligni. Pleomorfni adenomi čine 10% tumora malih žlijezda slinovnica. Dijagnostička obrada intraoralnih tumora uključuje metode vizualizacije tumora, kao i aspiracijsku citodijagnostiku. Rezultati učinjenih pretraga utječu na odluku o kirurškom pristupu

Elektivna disekcija regije IV ne povećava rizik postoperativnog hipoparatireoidizma kod bolesnika liječenih zbog dobro diferenciranog karcinoma štitnjače

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 između dvije skupine bolesnika liječenih zbog dobro diferenciranog karcinoma štitnjače. Metode: Retrospektivno smo analizirali 179 bolesnika koji su u našoj ustanovi liječeni zbog dobro diferenciranog karicnoma štitnjače u periodu od siječnja 2011 do prosinca 2018. U studiju su bili uključeni samo bolesnici kod kojih je inicijalno učinjena totalna tiroidektomija te oni koji na osnovu preoperativne obrade nisu imali potvrđene metastaze na lateralnom vratu i u regiji VI. Analizirane su dvije skupine bolesnika. U prvu skupinu su uključeni bolesnici kod kojih je u istom aktu učinjena totalna tireoidektomija i disekcija regije VI. Svi ostali bolesnici kod kojih je učinjena samo totalna tireoidektomija uključeni su u drugu skupinu. Stopa tranzitornog i trajnog hipoparatireoidizma je uspoređivana između dvije skupine. Rezultati: Kod ukupno 117 bolesnika (65,4%) učinjena je disekcija regije VI istodobno s totalnom tireoidektomijom. (TT + CCLN d skupina). Kod preostalih 62 bolesnika (34,6%) učinjena 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 statistički značajna između dvije skupine. Unutar TT + CCLN d skupine, kod 82,9% bolesnika je učinjena disekcija ipsilateralnih paratrahealnih limfnih čvorova, za razliku od 17,1% bolesnika kod kojih je učinjena disekcija bilateralnih paratrahealnih čvorova. Stopa postoperativnog hipoparatireoidizma je analizirana u dvjema podskupinama i nije se pokazala statistički značajnom. Rasprava: Iako je utjecaj elektivne disekcije regije VI na lokoregionalno recidiviranje i dalje kontroverzan, ona može biti odličan alat za probir bolesnika koji mogu imati korist od adjuvantne radiojodne ablacije. S druge strane, disekcija regije VI potencijalno može povećati rizik hipoparatireoidizma zbog nenamjerne ozljede doštitnih žlijezda ili/i njihove krvne opskrbe. Naša studija nije pokazala statistički značajnu razliku u stopi postoperativnog hipoparatireoidizma između skupine bolesnika kod kojih je učinjena disekcija regije VI u usporedbi sa skupinom bolesnika kod kojih je učinjena samo totalna tireoidektomija. Naši podaci su u proturiječju s nekim ranije publiciranim studijama. Naši rezultati su pokazali da je elektivna disekcija regije VI sigurni postupak i značajno ne povećava rizik postoperativnog hipoparatireoidizma kada se izvodi istodobno s totalnom tireoidektomijom