A rare clinical case of synchronous colorectal cancer, affecting the transverse colon

Synchronous colorectal cancer is a rare condition, which presents with the simultaneous development of more than one primary carcinoma and affects different segments of the colon and rectum. The incidence of this disease is about 3.5 per cent of all carcinomas of the colon and rectum and more often affected men. Adenocarcinoma is the most common histological type for synchronous colorectal cancer.We present a rare clinical case of a 62-year-old woman with synchronous colorectal carcinoma, located in the transverse and sigmoid colon and verified histologically by colonoscopy

Retroperitoneal pelvic invasion in ovarian cancer: Possible modes of spread and survival impact

BackgroundOvarian cancer is the second-most common malignancy and the leading cause of death in women who develop cancers of gynaecologic origin and it spread primarily by direct exfoliation of cells along the peritoneal surface. Interesting fact, although not well studied, is that these tumours invade the mesothelium but very rarely they invade the peritoneum deeper through direct extension.AimsTo study the retroperitoneal pelvic invasion in parametrial ligaments and vagina in patients undergoing surgery for advanced epithelial ovarian carcinoma and the survival impact of it.MethodsThe study included 59 patients with advanced epithelial ovarian cancer that underwent radical hysterectomy during the 2004–2009 period. For the purpose of this study histopathologic examination was performed for the parametrial ligaments and vagina with inspection of the surgical resection lines.Results Retroperitoneal pelvic invasion was found in 42.4 per cent of the cases, involving different depths of parametrial ligaments and/or vaginal spread, and is associated to worse survival outcomes.ConclusionRetroperitoneal pelvic invasion is not a rare phenomenon and seems to be a feature of the more aggressive tumours. In the cases of distal retroperitoneal pelvic invasion (vaginal) the patients’ 5-year survival rate is similar to that of the stage IV ovarian cancer patients

Modern surgical treatment of malignant skin melanoma: A brief literature overview

BackgroundMalignant melanoma (MM) of the skin is a rare, highly malignant tumour, affecting younger age. Its incidence rate has been rising as compared to all malignant neoplasms – 5 per cent of all newly diagnosed cancers in men, and 6 per cent of those in women.AimsThe aim of the literature review is the present the contemporary tendencies in the surgical treatment and monitoring of patients with malignant melanoma of the skin.Methods Systematic Literature Review Made By Google and Science Direct.com Search Engines. Publications and guidelines in English, including the newest aspects in the overall care of patients with malignant melanoma of the skin. Information for the indications and contraindications of performing a sentinel biopsy.Results The study established that the most modern surgical treatment of a malignant melanoma of the skin includes: primary tumour biopsy, sentinel biopsy of the regional lymph nodes with wide re-excision of the affected area, usually with a radius of 2cm, and the removal of local recurrences, lymph and distant organ metastases. When it comes to monitoring, it has to be done according to the contemporary worldwide guidelines.ConclusionSuccessful treatment of skin MM is in direct correlation to keeping up with the most modern tendencies

Tumor-infiltrating lymphocytes and levels of PD-L1 and BRCA protein expression may identify patients with breast cancer with a higher rate of BRCA1 mutations

Background & objectives Breast cancer (BC) is a heterogeneous disease, treated as per the predictive role of immunohistochemistry (IHC) identifiers as estrogen / progesterone and HER2 receptor proteins. Deeper molecular classification (MC) identifies molecular subtypes according to the gene-expression profiles with different molecular genetic alterations and biological features, present in the different subtype. Overlap between IHC and MC exists, though incomplete. We aimed to identify overlap between IHC and MC and identify patients with basal-like subtype of BC. We hypothesized that the rates of the tumor expression of breast cancer 1 (BRCA1) protein, the type of tumor-infiltrating lymphocytes and the expression of programmed death ligand 1 (PD-L1) by immune cells may be incorporated in a prognostic algorithm to predict morphological screening, identifying patients with potentially altered BRCA1 gene activity. Methods Parafin-embedded samples from 100 patients with primary invasive BC were analyzed and expression levels estrogen and progesterone receptors, HER2 status and Ki-67 were assessed via IHC, defining four groups - Luminal A-like, Luminal B-like, HER2 positive non-luminal and triple negative (TN). The primary endpoint of our study was to identify via IHC with CK 5/6 and 17 basal-like subtype of BC amongst others and to describe specific clinicopathological features together with protein expression of BRCA1 and PD-L1 and tumor-infiltrating lymphocytes, using CD20, CD3, CD4, CD8 and FoxP3. Results Basal-like BC were predominantly characterized as triple negative by IHC (p < 0.05) and were more frequently seen among special BC ductal subtypes as compared to no special type (NST) with (p=0.036). Their immune response was represented mostly by high concentration of intratumoral cytotoxic CD8+ T-lymphocytes (p < 0.05) and stromal PD-L1 positive immune cells (p=0.008). In these tumors, absence of expression of BRCA1 protein was more frequent (p < 0.001). Basal-like subtype of BC with absent expression of BRCA1 is associated with worse < 5-year survival (p=0.001 and p=0.017, respectively). Conclusion The established dependencies can be, allowing better selection of patients with BC for subsequent genetic analysis of BRCA1 gene and for application of appropriate therapy

Primary, nodal, marginal zone lymphoma of a woman’s left breast imitated fibroadenoma

BackgroundPrimary breast lymphoma is a rare malignant neoplastic disease, accounting for around 0.5 per cent of all malignant diseases of that organ, and also 2.2 per cent of extranodal lymphomas. The most common histopathological types are: diffuse large B-cell lymphoma, extranodal B-cell marginal zone lymphoma and MALT lymphoma. The primary affected group is with median age between 55 and 62 years. The clinical manifestation is usually of a tumour process in the affected breast.Case presentationHere we present an extremely rare case of a 68 years old woman with primary, nodal, B-cell, marginal zone lymphoma of the left breast, presenting itself under the mask of a benign tumour process, found accidentally following a histopathological examination of excisional samples.ConclusionsPrimary, nodal, marginal zone, B-cell lymphoma of the breast is extremely rare. Its clinical and mammographic presentation completely overlaps with those of fibroadenoma, which makes diagnosing it preoperatively practically impossible. Main treatment method here is not surgical, but radiological and chemotherapeutic

Tumor-infiltrating lymphocytes and levels of PD-L1 and BRCA protein expression may identify patients with breast cancer with a higher rate of BRCA1 mutations

Introduction.Breast cancer (BC) is a heterogeneous disease, treated as per the predictive role of immunohistoche­mistry (IHC) identifiers as estrogen/progesterone and HER2 receptor proteins. Deeper molecular classification (MC) identifies molecular subtypes according to the gene-expression profiles, with different molecular genetic alterations and biological features, present in the different subtype. An overlap between IHC and MC exists, even if somewhat incomplete. We aimed to identify the overlap between IHC and MC, and identify patients with basal-like subtype of BC. We hypothesized that the rates of tumor expression of breast cancer-related protein 1 (BRCA1), the type of tumor-infiltrating lymphocytes, and the expression of programmed death ligand 1 (PD-L1) by immune cells vary among different subtypes of BC. Material and methods.Parafin-embedded samples from 100 patients with primary invasive BC were analyzed and expression levels of estrogen and progesterone receptors, HER2 status, and Ki-67 were assessed via IHC, defining four groups – luminal A-like, luminal B-like (LumA, LumB), HER2-positive non-luminal, and triple negative (TN). The pri­mary endpoint of our study was to identify via IHC with CK5/6 and 17 basal-like subtypes of BC amongst others, and to describe specific clinicopathological features together with protein expression of BRCA1 and PD-L1 and tumor-infiltrating lymphocytes, using CD20, CD3, CD4, CD8, and FoxP3. Results.Basal-like BC were predominantly characterized as triple negative by IHC (p < 0.05) and were more frequently seen among special BC subtypes as compared to no special type (NST), with p = 0.036. Their immune response was represented mostly by high concentration of intratumoral cytotoxic CD8 (+) T-lymphocytes (p < 0.05) and stromal PD-L1-positive immune cells (p = 0.008). In these tumors, absence of expression of BRCA1 protein was more frequent (p < 0.001). Basal-like subtype of BC with absent expression of BRCA1 is associated with poorer <5-year survival (p = 0.001 and p = 0.017, respectively). Conclusions.The use of IHC can establish basal-like BC, the type of its immune response and possible dysfunction in the BRCA-gene, reflected in the lack of expression in the BRCA-related protein

Precancerous lesions of the cervix — aetiology, classification, diagnosis, prevention

The present review introduces the aetiology and classification of cervical precancers. The principles of diagnosis based on colposcopy are reviewed. The indications for colposcopy and targeted biopsy are steps in the diagnostic process of cervical precancers. Prophylaxis of these diseases prevents cervical cancer as high-grade precancerous lesions represent a direct precursor to cervical cancer. The basics of primary and secondary prevention, the types of screening, and the behaviour of the already-alerted patients after different screenings are presented

Pregnancy and malignant diseases — principles of management

Pregnancy-associated malignant diseases introduce multiple dilemmas to the multidisciplinary boards, related to both the oncological treatment as well as to obstetrical management. The most frequent oncological diseases diagnosed during pregnancy are breast cancer, oncohematological conditions, uterine cervix cancer and skin cancers. There are different clinical scenarios: interruption of the pregnancy and further use of the most appropriate oncological strategy; it is also possible to postpone the oncological treatment for the postpartum period with a watch-and-wait strategy until the foetus is mature and the delivery is planned. The third scenario includes concurrent treatment of both conditions: use of chemotherapy, radiotherapy and surgery during an ongoing pregnancy. Choosing among these scenarios is considering many factors, including type and stage of the malignant tumour, pregnancy term, desire and informed decision of the pregnant woman to keep or interrupt the pregnancy. The current review is focused on the basic principles of the oncological modalities (surgery, chemotherapy and radiotherapy) during pregnancy as well as their influence over the pregnant woman and the foetus, over the obstetrical management and the timing and mode of delivery, delivery anaesthesia, lactation and breastfeeding from the point of view of the evidence-based medicine

Endometriosis and risk of ovarian cancer

Endometriosis is common in premenopausal women and affects about 10% of women of reproductive age. It is a benign condition but demonstrates malignant behaviour with recurrences and metastases. Its tendency to increase the risk of specific subtypes of ovarian cancer is being discussed, because they exhibit specific clinical features that distinguish them from classical ovarian cancer. Malignant transformation of endometriosis goes through its transition to atypical endometriosis. Although endometriosis-associated ovarian carcinomas have a good prognosis, adequate follow-up and monitoring after treatment of endometriosis are recommended

Amelanotic melanoma of the skin – detailed review of the problem

BackgroundMalignant melanoma (MM) of the skin accounts for about one per cent of all malignancies in humans. Amelanotic melanoma is a rare tumour, diagnosed in eight per cent of all melanomas.AimsThe study aimed to analyse our clinical experience with amelanotic MM of the skin and the statistical data from a retrospective five year analysis of pigmented and amelanotic types of skin melanoma. Furthermore, we compare our results to those from other teams' studies. To reach the corresponding in-depth conclusions.MethodsThe study included 151 patients with malignant melanoma of the skin, diagnosed and treated at Dr. Georgi Stranski University in Pleven, Bulgaria, between 2012 and 2016. All the patients signed informed consent forms.ResultsOf the 151 patients we studied, 14 (9.3 per cent) were diagnosed with amelanotic melanoma. The average Breslow thickness in patients with amelanotic MM was 4.2mm, while in pigmented MM patients it 2.1mm. Local recurrence rates (35.7 per cent) were higher in patients with amelanotic melanoma. Distant metastases were found in 39 of all tested patients with melanoma. Of the 14 patients with amelanotic MM, eight had such metastases.ConclusionAmelanotic melanoma was diagnosed too late. Local recurrences were six times as many as the ones diagnosed in pigment melanoma. Distant metastases were twice as many, and mortality rates were three times higher