Hepatosplenic gamma-delta T-cell lymphoma in a female patient after delivery

Hepatosplenic γδ T-cell lymphoma (HSTCL) is a very rare peripheral T-cell lymphoma characterized by extranodal infiltration of mature malignant post-thymic T-lymphocytes into sinusoids of the liver and spleen without lymphadenopathy and significant cytopenias. The aetiology of the disease is unknown. We describe the case of a female patient in whom HSTCL developed after delivery and who was previously without disease. Flow cytometry and liver puncture are essential for diagnosing HSTCL, especially in patients with unexplained pancytopenia and hepatosplenomegaly. Since phenotypic results can easily be misinterpreted as non-malignant, the examiner should have enough experience to recognize clonal changes of T-lymphocytes. Namely, in contrast to B-lymphocytes, T-lymphocytes do not have an efficient indicator of clonality and are recognized by flow cytometry based only on aberrant expression of commonly present antigens of T-cell and NK-cell subsets. At present, there is no known cure for HSTCL with a maximum survival up to 2 years

Prikaz bolnika z zasevkom v telesu vretenca L1 nejasnega izvora

Metastases of bone malignancies are much more common than primary neoplasms. The site of origin remains unknown in approximately 2% of metastases. We present a case of a 59-year-old patient referred to our Institute for pathological fracture of the L1 vertebral body. After removing the majority of the body, a detailed pathological examination and extensive diagnosis, the question of primary tumour origin still remains unsolved.Zasevki malignomov v kosti so znatno pogostejši od primarnih novotvorb. Približno 2 % zasevkov, kljub številnim opravljenim preiskavam, ostane brez jasnega mesta izvora. Predstavljeni 59-letni bolnik je bil sprejet zaradi patološkega preloma telesa vretenca L1. Po odstranitvi večine telesa, natančni patološki preiskavi in razširjeni diagnostiki, vprašanje glede izvora primarnega tumorja še vedno ostaja nerazrešeno. ; slv - slovensk

Case report of a patient with a metastasis in the L1 vertebral body of unknown origin

Zasevki malignomov v kosti so znatno pogostejši od primarnih novotvorb. Približno 2 % zasevkov, kljub številnim opravljenim preiskavam, ostane brez jasnega mesta izvora. Predstavljeni 59-letni bolnik je bil sprejet zaradi patološkega preloma telesa vretenca L1. Po odstranitvi večine telesa, natančni patološki preiskavi in razširjeni diagnostiki, vprašanje glede izvora primarnega tumorja še vedno ostaja nerazrešeno.Metastases of bone malignancies are much more common than primary neoplasms. The site of origin remains unknown in approximately 2% of metastases. We present a case of a 59-year-old patient referred to our Institute for pathological fracture of the L1 vertebral body. After removing the majority of the body, a detailed pathological examination and extensive diagnosis, the question of primary tumour origin still remains unsolved

Pre-treatment risk assessment of women with endometrial cancer: differences in outcomes of molecular and clinical classifications in the Slovenian patient cohort

BACKGROUND: The aim of this study was to evaluate changes in prognostic risk profiles of women with endometrial cancer by comparing the clinical risk assessment with the integrated molecular risk assessment profiling. PATIENTS AND METHODS: This prospective study recruited patients with biopsy proven endometrial cancer treated at the University Medical Centre Maribor between January 2020 to February 2021. Patient clinical data was assessed and categorized according to the currently valid European Society of Gynaecological Oncology, European SocieTy for Radiotherapy and Oncology, and European Society of Pathology (ESGO/ESTRO/ESP) guidelines on endometrial cancer. Molecular tumour characterization included determination of exonuclease domain of DNA polymerase-epsilon (POLE) mutational status by Sanger sequencing and imunohistochemical specimen evaluation on the presence of mismatch repair deficiencies (MMRd) and p53 abnormalities (p53abn). RESULTS: Fourty-five women were included in the study. Twenty-two tumours were of non-specific mutational profile (NSMP) (56.4%), 13 were classified as MMRd (33.3%), 3 were classified as p53abn (7.7%) and 1 was classified as POLE mutated (2.6%). Six tumours (15.4%) had multiple molecular classifiers, these were studied separately and were not included in the risk assessment. The clinical risk-assessment classified 21 women (53.8%) as low-risk, 5 women (12.8%) as intermediate risk, 2 women as high-intermediate risk (5.1%), 10 women (25.6%) as high risk and 1 patient as advanced metastatic (2.6%). The integrated molecular classification changed risk for 4 women (10.3%). CONCLUSIONS: Integrated molecular risk improves personalized risk assessment in endometrial cancer and could potentially improve therapeutic precision. Further molecular stratification with biomarkers is especially needed in the NSMP group to improve personalized risk-assessment

Gastric antral vascular ectasia (GAVE) - case report

Izhodišča. Žilne ektazije antruma želodca (GAVE) ali lubenični želodec (watermelon stomach) so redek, a pomemben vzrok kronične krvavitve iz prebavne cevi in posledične slabokrvnosti. Bolezen ima svojo značilno endoskopsko in histološko sliko. Patogeneza bolezni je nepojasnjena. Cilj zdravljenja je zmanjšati kronično krvavitev do te mere, da transfuzije niso več potrebne. V literaturi so opisani poskusi zdravljenja z zdravili, endoskopskimi terapevtskimi metodami in z operacijo. Danes se pri zdravljenju GAVE najpogosteje uporablja elektrokoagulacija z argonskim plazemskim koagulatorjem in z laserjem Nd: YAG. Bolniki in metode. Prikazan je primer 77-letne bolnice z žilnimi ektazijami antruma želodca. Bolnica je bila zaradi nepojasnjenega vzroka krvavitve iz prebavne cevi in ponavljajoče se slabokrvnosti kljub nadomeščanju železa odvisna od transfuzij. Uspešno je bila zdravljena z argonsko plazemsko koagulacijo (APC). Dve leti po zdravljenju bolnica ni slabokrvna in ne potrebuje transfuzij. Zaključki. Žilne ektazije antruma želodca so pogosto nespoznane in napačno opredeljene kot erozivni gastritis. Čeprav je bolezen redka, je pomemben vzrok prikrite krvavitve iz zgornje prebavne cevi, zlasti pri starejših ženskah.Background. Gastric antral vascular ectasia (GAVE), or "watermelon stomach" is a rare but important cause of gastrointestinal blood loss and anaemia, and has characteristic endoscopic and histological features. The pathogenesis of this condition remains unclear. The goal in treating a patient with gastric antral vascular ectasia should be the complete elimination of transfusion requirements. Various medical, surgical and endoscopic therapeutic modalities have been attempted with variable success. Currently available evidence favours endoscopic therapy using argon plasma coagulation or Nd: YAG laser. Patients and methods. A case of 77-year-old women with gastric antral vascular ectasia is presented who was transfusion dependent due to recurrent anaemia despite iron supplements. She was successfully treated with argon plasma coagulation (APC). Two years after treatment she didn\u27t have anaemia and no need for transfusion. Conclusions. It is widely belived that GAVE is under-recognized and is most often misinterpreted as antral gastritis. Although rare, it is an important cause of occult upper gastrointestinal bleeding, particularly in elderly women

Thyrotoxic struma ovarii after thyroid ablation: a case report of laparoscopic management

Struma ovarii is a rare type of germ cell tumor and a rare cause of ectopic thyroidal hormonal production. We report a case of laparsocopic management of a thyrotoxic struma ovarii. In a 49-year-old patient, previously treated by ablative surgery and radioactive iodine for Graves\u27 disease, a new onset of hyperthyroidism occurred unexpectedly. A whole-body scan with 131I detected increased pelvic uptake, suggesting struma ovarii. The patient was subsequently treated with laparoscopic bilateral salpingo-oophorectomy. The postoperative course was uneventful. Histopathologic examination revealed the presence of a benign struma ovarii. Three years after treatment the patient is disease free and is receiving thyroid replacement therapy with levothyroxine. In this case the thyrotoxic struma ovarii was diagnosed preoperatively and laparoscopic surgery proved to be a useful and reliable method for ovarian ablation.Struma jajčnika je redka oblika tumorja zarodnih celic, ki predstavlja redek vzrok ektopičnega izločanja ščitničnih hormonov. Poročamo o primeru laparoskopskega zdravljenja strume jajčnika. Pri 49-letni bolnici, ki je bila zaradi Gravesove bolezni predhodno zdravljena z ablativno operacijo in radioaktivnim jodom, se je nepričakovano pojavil hipertiroidizem. Scintigrafija telesa z 131J je pokazala povečano aktivnost v medenici in s tem nakazavala na strumo jajčnika. Bolnico smo zdravili z laparoskopsko običajno adneksektomijo. V pooperativnem poteku ni bilo posebnosti. Histopatološka preiskava je pokazala prisotnost benigne strume jajčnika. Trenutno je bolnica brez znakov bolezni in prejema ščitnično nadomestno zdravljenje z levotiroksinom. V obravnavanem primeru amo še pred operacijo ugotovili diagnozo tirotoksične strume jajčnika, laparoskopska operacija pa se je izkazala za koristno in zanesljivo metodo za odstranitev jajčnika