Alcohol Sclerosing Ovarian Cystic Lesions, 20 Years Experience

The purpose of the study is to present technique of punction and conservative treatment of cystic ovarian lesions. The following criteria were included: 1) Cyst should be unilocular, sonolucent, with a smooth inner wall of capsule, without septa and without neovasculariation on transvaginal color and power Doppler. 2) Serum CA-125 levels must be lower than 35 U/mL. The capsule of the cyst was punctured with a 18 gauge needle under the control of 5 MHz transvaginal probe. Cyst fluid was sent for cytologic examination. After complete emptyng of the cyst, we injected sterile 95% ethanol in the 50–75% of the evacuated liquor amount. The alcohol remain in the cyst from 5 to 20 minutes and was then aspirated completely. We punctured cysts in 366 patients aged from 18 to 65 years, volume of cyst being between 40 and 300 mL. Patients were monitored for 24 hours and follow-up examinations were 3, 6 and 12 months after the procedure. Three cysts were ruptured (0.8%) and alcohol split in the Douglas cavity. Intensive pelvic pain had 8.1% and relapse appeared in 8.2% of the patients. Technique of punction is simple and easily performed. Method of treating by 95% alcohol has demonstrated good results. Relapse we treated by laparoscopy or laparotomy

Estimating Clinical Outcome of HPV Induced Cervical Lesions by Combination of Capsid Protein L1 and p16INK4a Protein Detection

The aim of this study was to investigate whether is possible to predict clinical outcome of cervical lesion by immunoassaying performed on cervical smears. During the two year study period the cervical smears of 81 patients were collected. All patients were tested for human papillomavirus (HPV) infections using Amplycor HPV test. Sixty-six of them were tested as positive for high risk types (hrHPV) and squamous intraepithelial lesion, and in those patients repeated cervical smears were taken every six months. The rest were hrHPV negative patients with normal smears which were used as a negative control in immunoassays with HPV L1 and p16INK4a antibodies. The results of p16INK4a staining in 66 hrHPV positive patients showed impairment of the cervical lesion in 22 (33.3%) and unchanged cytological finding in 21 (31.9%) p16INK4a positive patients, respectively, while improving of cytological finding was seen only in three (4.5%) p16INK4a positive patients. On the contrary, impairment of cytological finding was not seen in p16INK4a negative patients, while in 17 out of 20 patients from that group improving or normalisation of cytological finding were detected (p<0.01). Correlation between L1/p16 pattern and cytological finding showed that only in L1–/p16+ cervical lesions was detected impairment of cytological finding during the study period. In L1+/p16+ group the cytological finding was the same during the follow up in all 11 patients, while in L1+/p16– group in most patients (9/11) downgrading or normalisation of Pap test were detected. The usage of p16 and HPV L1 markers can be useful in estimation of biologic potentiality and clinical outcome of cervical lesions

Vulvar Paget’s Disease – A Case Report

Vulvar Morbus Paget (MP) represents a rare intraepithelial adenocarcinoma. It accounts for less than 1% of all vulvar neoplasia and usually appears in postmenopausal women. Histologically it is analogous to Paget’s disease of the breast. The most common clinical symptom is pruritus. The lesion appears as an erythematous or as an eczematous lesion with islands of hyperkeratosis. Occasionally, single anaplastic Paget’s cells can be found on the vulvar smears which make cytological diagnosis of the disease possible. However, the disease can be diagnosed only by biopsy. We present a case of 49-year old woman with vulvar symptoms of pruritus, who had liver and kidney transplantation two years ago. During the standard gynecological examination the vulvar smear was taken for cytological evaluation. The smear was scanty, with inflammatory background, overloaded with squamae. There were two types of cells: dysplastic squamous cells from lower layer of the epithelium and the single, anaplastic cells with a high nuclear:cytoplasmic ratio who possessed eccentric, large nucleus. Nucleoli were rare. Cytoplasm varied from pale and delicate to densely basophilic. Accordingly, cytological diagnosis vulvar intraepithelial neoplasia (VIN III) with differential diagnosis of vulvar Paget’s disease was made. The pathological verification supported the diagnosis of MP and an immunohistochemistry panel confirmed type III of Paget’s disease and an evaluation of bladder was suggested

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH OVARIAN CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak jajnika i jajovoda po učestalosti je peta zloćudna bolest žena u Hrvatskoj. Histološki je rak jajnika najčešće epitelnog podrijetla, i to seroznog podtipa. Rjeđi su različiti neepitelni malignomi jajnika, a posebnu skupinu čine epitelni karcinomi niskoga zloćudnog potencijala karakterizirani neinvazivnošću, klinički indolentnim tijekom i dobrom prognozom te primarni rak potrbušnice i rak jajovoda. Klinički su ovi zloćudni tumori u ranim stadijima razvoja uglavnom asimptomatski, zbog čega se najčešće dijagnosticiraju u kasnijim stadijima bolesti. Dijagnoza se potvrđuje patohistološkim nalazom, a iznimno citološkim nalazom nakon provedene dijagnostičke obrade. O liječenju odlučuje multidisciplinarni tim uzimajući u obzir dob, opće stanje i komorbiditete bolesnice, kao i obilježja samog tumora uključujući stadij bolesti, histološki tip i gradus tumora. Principi liječenja primarnog raka potrbušnice i jajovoda temelje se na principima liječenja epitelnog raka jajnika koji obuhvaćaju primjenu kirurških zahvata, kemoterapije, imunoterapije i hormonske terapije, kao i suportivno-simptomatskih mjera tijekom cijelog liječenja. Razlikuje se terapijski pristup rjeđim, neepitelnim histološkim tipovima tumora koji se češće dijagnosticiraju u ranim stadijima bolesti, imaju indolentniji tijek pa se kod ovih bolesnica češće primjenjuju poštedni kirurški zahvati s ciljem očuvanja plodnosti. U tekstu koji slijedi predstavljene su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnica s rakom jajnika, jajovoda i potrbušnice u Republici Hrvatskoj.Ovarian cancer together with fallopian tube represents the fifth most common female cancer in the Republic of Croatia. Epithelial ovarian cancer, serous subtype, encompasses most of malignant ovarian neoplasms. Less common are various non-epithelial ovarian malignancies. A special group consists of epithelial carcinomas of low malignant potential with clinically indolent flow, good prognosis and no invasion, and primary cancer of the peritoneum and fallopian tube cancer. Clinically, these malignant tumors are generally asymptomatic in early stages, and usually diagnosed in advanced stages. The diagnosis is confirmed by pathological examination, and occasionally, cytological findings after completing diagnostic procedures. Multidisciplinary team makes treatment decisions, taking into account age, general condition and comorbidities of the patient and characteristics of the tumor itself, including disease stage, histological type and grade of the tumor. The principles of treatment of primary peritoneal and fallopian tube cancer are based on the principles of treatment of epithelial ovarian cancer involving surgery, chemotherapy, immune and hormone therapy, and symptomatic-supportive care throughout the treatment. Less common histological types have a different treatment approach being more frequently diagnosed in the early stages of the disease, have more indolent flow, so in these patients conservative surgeries with the goal of preserving fertility are more often employed. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with ovarian carcinoma, fallopian tube and primary peritoneal cancer in the Republic of Croatia

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH UTERINE CERVICAL CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak vrata maternice, u odnosu na malignome drugih ginekoloških sijela, jest bolest mlađih žena koja se može redovitim kontrolama i zdravstvenim odgojem prevenirati, a u slučaju pojave bolesti učinkovito liječiti. Metode liječenja uključuju kirurgiju, radioterapiju i kemoterapiju, ovisno o stadiju bolesti i općem stanju bolesnica. Odluku o liječenju donosi multidisciplinarni tim. S obzirom na važnost ove bolesti, potrebno je definirati i provoditi standardizirani pristup u dijagnostici, liječenju i praćenju ovih bolesnica. U tekstu koji slijedi iznesene su kliničke smjernice s ciljem implementacije standardiziranih postupaka u radu s bolesnicama s rakom vrata maternice u Republici Hrvatskoj.Cervical cancer, in comparison with other gynecological malignancies, mainly affects younger women. It can be prevented trough educational programs, screening and early detection. It also can be efficiently treated when it appears. Treatment modalities include surgery, chemotherapy and radiotherapy, according to the stage of the disease and patient condition. Treatment decisions should be made after multidisciplinary team discussion. Due to the significance of this disease it is important to define and implement standardized approach for diagnostic, treatment and monitoring algorithm as well. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with uterine cervical cancer in the Republic of Croatia

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH ENDOMETRIAL CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak trupa maternice javlja se u većini slučajeva u poslijemenopauzalnih žena, a najčešće se očituje ginekološkim krvarenjem. Nakon raka jajnika i vrata maternice treći je uzrok smrti žena od raka spolnog sustava. Dijagnoza se postavlja patohistološkim pregledom kiretmana ili bioptata, a definitivni stadij bolesti utvrđuje se analizom uzoraka dobivenih histerektomijom i obostranom salpingoovariektomijom sa zdjeličnom i paraaortalnom limfadenektomijom. U tekstu koji slijedi sadržane su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja i praćenja bolesnica s rakom trupa maternice u Republici Hrvatskoj.Uterine cancer occurs mainly in postmenopausal women, usually as vaginal bleeding. Following ovarian and cervical cancer it is the third most common cause of female reproductive system cancer death. Diagnosis is set by analyzing samples obtained via hysterectomy with salpingo-oophorectomy and pelvic / paraaortal lymphadenectomy. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, treatment and monitoring of patients with uterine cancer in the Republic of Croatia

THE VEIN OF GALEN ANEURYSM – THE RARE VASCULAR MALFORMATION OF FETAL BRAIN

Aneurizma vene Galenae je rijetka vaskularna malformacija ploda, koja se u trudnoći dijagnosticira uglavnom u trećem tromjesječju. Prikazana je antenatalno postavljenu dijagnozu ove rijetke krvožilne malformacje fetusa u 33. tjednu trudnoće. Dijagnoza je postavljena ultrazvučnim pregledom. Ostala vidljiva morfologija ploda je bila uredna. Trudnoća je završena elektivnim carskim rezom. Postnatalno je potvrđeno da se radi o aneurizmi vene Galenae. Naglašavamo važnost detaljnog ultrazvučnog pregleda morfologije ploda, kao i važnost odgovarajućih visokokvalitetnih ultrazvučnih aparata.The vein of Galen aneurysm is a rare vascular malformation of the fetal brain. During pregnancy it is mainly diagnosed in the third trimester. We present a successful antenatal diagnosis of this rare vascular malformation of the fetus in the 33rd week of pregnancy. The diagnosis was made by ultrasonography. The other visible morphology of the fetus was normal. The pregnancy was terminated by an elective Caesarean section. The vein of Galen aneurysm was confirmed postnatally. We place emphasis upon the detailed ultrasonography of the morphology of the fetus, as well as on the significance of the adequate and high-quality, sophisticated ultrasound machine