Učinak Tamoxifen na ženski reproduktivni sustav

Tamoxifen, a triphenylethyleneestrogen receptor modulator, is an eff ective treatment for estrogen receptor positive breast cancer patients. It acts as an estrogen antagonist in breast tissue and a week estrogen agonist in the female genital tract. Its estrogenagonist properties refl ects on increased risk of gynaecologic pathologies and includes the development of endometrial cancer, endometrial hyperplasia, endometrial polyps, adenomyosis, leiomyomas, uterine sarcomas, cervical polyps and ovarian cysts. Breast cancer patients during tamoxifen treatment should be under close gynaecological and ultrasonographic surveillance.Tamoxifen, trifeniletilenski modulator estrogesnih receptora, se koristi u liječenju raka dojke s pozitvnim estrogenskim receptorima. U tkivu dojke i tumorskim stanica ima estrogen-antagonistički učinak, a u ženskom spolnom sustavu blagi agonistički učinak što se očituje povećanim rizikom od ginekoloških bolesti koje uključuju rak endometrija, hiperplaziju endometrija, polipe endometrija, adenomiozu, miome, sarkome, polipe vrata maternice i ciste jajnika. Bolesnice s rakom dojke koje se liječe tamoxifenom trebaju biti redovito ginekološki i ultrazvučno pregledavane

Recidivirajuća pupčana endometrioza: prikaz slučaja i pregled literature

Umbilical primary endometriosis is a rare localization of the functional endometrial tissue outside of uterine cavity and it represents 0.5-1% of ectopical endometriosis. We are reporting a case in which recurrence of umbilical endometriosis has occurred 5 months after excision of umbilical endometriotic lesion and 19 years after the surgery of endometriotic cyst of the right ovary. It caused periodical bleeding from the umbilicus, associated with severe abdominal pain. Endometriosis was suspected and treated by wide surgical excision. Pathohistological analysis confirmed the diagnosis of endometriosis.Primarna endometrioza funkcionalnog endometrijskog tkiva izvan maternice s lokalizacijom u pupku je rijetkost sa zabilježenom pojavnoš}u 0,5-1% među ektopičnim endomteriozama. Opisujemo bolesnicu u koje je recidiv pupčane endomterioze nastupio 5 mjeseci nakon ekscizije pupčane endometriotičke lezije i 19 godina nakon operacije endometriotičke ciste u desnom jajniku. Endometrioza je uzrokovala povremeno krvarenje iz pupka, povezano s jakom boli u trbuhu. Zbog sumnje na endometriozu primijenjena je široka kirurška ekscizija. Patohistološka analiza potvrdila je dijagnozu endometrioze

Recidivirajuća pupčana endometrioza: prikaz slučaja i pregled literature

Umbilical primary endometriosis is a rare localization of the functional endometrial tissue outside of uterine cavity and it represents 0.5-1% of ectopical endometriosis. We are reporting a case in which recurrence of umbilical endometriosis has occurred 5 months after excision of umbilical endometriotic lesion and 19 years after the surgery of endometriotic cyst of the right ovary. It caused periodical bleeding from the umbilicus, associated with severe abdominal pain. Endometriosis was suspected and treated by wide surgical excision. Pathohistological analysis confirmed the diagnosis of endometriosis.Primarna endometrioza funkcionalnog endometrijskog tkiva izvan maternice s lokalizacijom u pupku je rijetkost sa zabilježenom pojavnoš}u 0,5-1% među ektopičnim endomteriozama. Opisujemo bolesnicu u koje je recidiv pupčane endomterioze nastupio 5 mjeseci nakon ekscizije pupčane endometriotičke lezije i 19 godina nakon operacije endometriotičke ciste u desnom jajniku. Endometrioza je uzrokovala povremeno krvarenje iz pupka, povezano s jakom boli u trbuhu. Zbog sumnje na endometriozu primijenjena je široka kirurška ekscizija. Patohistološka analiza potvrdila je dijagnozu endometrioze

Karcinom stidnice kod mlade žene i terapija multiple skleroze: prikaz slučaja

Vulvar cancer is a rare disease among young women. Risk factors for vulvar cancer are smoking, chronic dermatitis and human papilloma virus infection. However, no correlation between multiple sclerosis and increased risk of cancer has been established. We present a case of vulvar cancer in 35 year old women with multiple sclerosis. Radical vulvectomy with right-sided inguinofemoral lymphadenectomy was performed. Pathohistological analysis confi rmed the diagnosis of a squamous cell carcinoma, grade II, International Federation of Gynecology and Obstetrics (FIGO) IB. Adjuvant radiotherapy was not indicated. After two years of follow up, there was no evidence of the recurrence. The occurrence of vulvar cancer in multiple sclerosis patients may be coincidental. Nevertheless, the long term use of immunomodulatory drugs in multiple sclerosis and incidence of cancer may be associated.Karcinom stidnice je rijetka bolest u mladih žena. Rizični faktori za karcinom stidnice su pušenje, kronični dermatitis i infekcija humanim papiloma virusom. Nije dokazana povezanost između multiple skleroze i povećanog rizika za razvoj karcinoma. Opisujemo slučaj karcinoma stidnice u 35-godišnje žene koja boluje od multiple skleroze. Učinjena je radikalna vulvektomija s desnostranom ingvinofemoralnom limfadenektomijom. Patohistološka analiza potvrdila je dijagnozu planocelularnog karcinoma, gradus II, FIGO 1B. Adjuvantna radioterapija nije bila indicirana. Nakon dvije godine praćenja, nema znakova povrata bolesti. Pojava karcinoma stidnice u mlade bolesnice s multiplom sklerozom, može biti koincidencija. Moguća je povezanost dugotrajnog korištenja imunomodulatornih lijekova u multiploj sklerozi i incidencije karcinoma

Intranazalni prekobrojni zub: prikaz dvaju slučajeva i pregled literature

The presence of supernumerary tooth (SNT) in the nasal cavity is a rare condition with limited literature data. We report two cases with a history of nasal obstruction and difficulty breathing. In both cases, clinical and radiological examination confirmed intranasal SNT. Extractions were executed in general anesthesia using Rochester-Pean instruments transnasally. In addition, a literature review of intranasal SNT was performed. The database search retrieved a total number of 50 cases in time period from 1970. to 2020. Mean age of patients was 22.5 years. Most common symptoms were unilateral obstruction of breathing and headache. Surgical extraction of intranasal SNT is recommended to eliminate the symptoms.Prekobrojni zub u nosnoj šupljini rijetko je stanje o kojemu postoje ograničeni literaturni podatci. U ovom radu predstavljena su dva slučaja sa simptomima nazalne opstrukcije i otežanog disanja. U oba slučaja klinička i radiološka pretraga potvrdila je da postoji intranazalni prekobrojni zub. Ekstrakcije su obavljene transnazalno u općoj anesteziji Rochester-Peanovim instrumentima. Uz to, pregledana je literatura o prekobrojnim intranazalnim zubima. Pretragom baze podataka pronađeno je ukupno 50 slučajeva u razdoblju od 1970. do 2020. godine. Prosječna dob pacijenata bila je 22,5 godine. Najčešći simptomi bili su jednostrana opstrukcija disanja i glavobolja, a za njihovo uklanjanje preporučeno je kirurško vađenje prekobrojnoga intranazalnog zuba

Uloga laparoskopije u liječenju raka jajnika

Laparoscopy is usually undertaken in young women with adnexal disease that is believed to be benign, but found to be malignant at surgery. Some surgeons use laparascopy for staging, but mainly for presumed stage I or II ovarian cancer. Also, laparoscopy can be useful for selecting women who can be optimally debulked at primary surgery. There are some concerns about using laparoscopic approach in women with ovarian cancer: port-site metastasis, possibility of intraoperative rupture of tumor and eff ect of pneumoperitoneum. Studies showed that rate of port-site metastasis after laparoscopic surgery in women with ovarian cancer is low and usually occurs when there is peritoneal carcinomatosis or distant metastatic disease. Also, it seems that laparoscopy with CO(2) pneumoperitoneum does not reduce the overall survival in women with intraabdominal metastases. Preoperative rupture, surface capsular invasion and positive peritoneal cytology are more relevant in terms of prognosis than intraoperative rupture, but further research is needed. Conventional laparoscopy and robotic-assisted laparoscopy are comparable in both early and advanced disease. These approaches are not inferior to laparotomy and they are acceptable access in selected patients.Laparoskopija se najčešće koristi kod žena za koje se mislilo da imaju benignu bolest, ali se tijekom operacije ispostavilo da se radi o malignoj bolesti. Neki kirurzi koriste laparoskopski pristup za stupnjevanje bolesti i to najčešće za pretpostavljeni I ili II stadij. Također, laparoskopija može biti korisna za odabir žena kojima se može primarno napraviti „debulking“. Postoji nekoliko briga prilikom korištenja laparoskopskog pristupa: pojava metastaza na mjestu ulaska troakara, mogućnost intraoperacijske rupture tumora i učinak pneumoperitoneuma. Studije su pokazale da je udio metastaza na mjestu ulaska troakara nizak i da se najčešće javlja kod žena koje imaju karcinomatozu peritoneuma i udaljene metastaze. Također, čini se da laparoskopija s CO2 pneumoperitoneumom ne smanjuje ukupno preživljenje žena s intraabdominalnim metastazama. Preoperacijska ruptura, površinska invazija kapsule i pozitivan peritonealni ispirak su važniji za prognozu od intraoperacijske rupture, no daljnja istraživanja su potrebna. Konvencionalna i laparoskopija pomoću robota su usporedivei u ranoj i u proširenoj bolesti.Ovi pristupi nisu inferiorni laparotomiji i prihvatljivi su kod odabranih pacijenata

Gastrointestinalni stromalni tumor koji oponaša ginekološku patologiju: prikaz slučaja

Diagnosis of gastrointestinal stromal tumors (GISTs) of the terminal part of the small intestine on ultrasound examination can be difficult because of their similarity in appearance to gynecological tumors. We present a case of a 49-year-old asymptomatic female patient with GIST of the small intestine, which presented as a pelvic mass, mimicking an ovarian tumor. Tumor was diagnosed during the control check up and ultrasound gynecological examination. Computed tomography (CT) showed tumor mass in the pelvis on the right and free fluid in the lesser pelvis. During the surgery, exploration of the abdominal cavity displayed tumor of the terminal part of the small intestine (ileum). The uterus and both adnexes were normal. The patient was treated by resection of the terminal part of the small intestine and termino-terminal anastomosis. Immunohistochemical evaluation demonstrated positive vimentin, positive CD117, and negative CD 34. In the presence of a pelvic mass, especially if other unusual anamnestic data are present, the possibility of other than a gynecologic tumor has to be considered.Dijagnozu gastrointestinalnih stromalnih tumora (GIST) završnog dijela tankog crijeva teško je postaviti ultrazvučnim pregledom jer su izgledom nalik ginekološkim tumorima. Opisujemo slučaj 49-godišnje asimptomatične bolesnice s GISTom tankog crijeva koji se prikazuje kao tvorba u zdjelici i oponaša tumor jajnika. Tumor je dijagnosticiran na kontrolnom i ultrazvučnom ginekološkom pregledu. Kompjutorizirana tomografija (CT) otkrila je tumorsku tvorbu u zdjelici i slobodnu tekućinu maloj zdjelici. Pretraživanjem trbušne šupljine tijekom operacije otkriven je tumor završnog dijela tankog crijeva (ileuma). Maternica i adneksi bili su zdravi. Bolesnici je napravljena resekcija završnog dijela tankog crijeva i termino-terminalna anastomoza. Imunohistokemijska analiza pokazala je pozitivnu reakciju na vimentin i CD117; te negativnu na CD 34. Kad je u zdjelici prisutna tvorba; osobito ako su i drugi anamnestički podaci neuobičajeni; treba uzeti u obzir mogućnost da je riječ o nekom drugom; a ne ginekološkom tumoru

Uloga laparoskopije u liječenju raka jajnika

Laparoscopy is usually undertaken in young women with adnexal disease that is believed to be benign, but found to be malignant at surgery. Some surgeons use laparascopy for staging, but mainly for presumed stage I or II ovarian cancer. Also, laparoscopy can be useful for selecting women who can be optimally debulked at primary surgery. There are some concerns about using laparoscopic approach in women with ovarian cancer: port-site metastasis, possibility of intraoperative rupture of tumor and eff ect of pneumoperitoneum. Studies showed that rate of port-site metastasis after laparoscopic surgery in women with ovarian cancer is low and usually occurs when there is peritoneal carcinomatosis or distant metastatic disease. Also, it seems that laparoscopy with CO(2) pneumoperitoneum does not reduce the overall survival in women with intraabdominal metastases. Preoperative rupture, surface capsular invasion and positive peritoneal cytology are more relevant in terms of prognosis than intraoperative rupture, but further research is needed. Conventional laparoscopy and robotic-assisted laparoscopy are comparable in both early and advanced disease. These approaches are not inferior to laparotomy and they are acceptable access in selected patients.Laparoskopija se najčešće koristi kod žena za koje se mislilo da imaju benignu bolest, ali se tijekom operacije ispostavilo da se radi o malignoj bolesti. Neki kirurzi koriste laparoskopski pristup za stupnjevanje bolesti i to najčešće za pretpostavljeni I ili II stadij. Također, laparoskopija može biti korisna za odabir žena kojima se može primarno napraviti „debulking“. Postoji nekoliko briga prilikom korištenja laparoskopskog pristupa: pojava metastaza na mjestu ulaska troakara, mogućnost intraoperacijske rupture tumora i učinak pneumoperitoneuma. Studije su pokazale da je udio metastaza na mjestu ulaska troakara nizak i da se najčešće javlja kod žena koje imaju karcinomatozu peritoneuma i udaljene metastaze. Također, čini se da laparoskopija s CO2 pneumoperitoneumom ne smanjuje ukupno preživljenje žena s intraabdominalnim metastazama. Preoperacijska ruptura, površinska invazija kapsule i pozitivan peritonealni ispirak su važniji za prognozu od intraoperacijske rupture, no daljnja istraživanja su potrebna. Konvencionalna i laparoskopija pomoću robota su usporedivei u ranoj i u proširenoj bolesti.Ovi pristupi nisu inferiorni laparotomiji i prihvatljivi su kod odabranih pacijenata

Gastrointestinalni stromalni tumor koji oponaša ginekološku patologiju: prikaz slučaja

Diagnosis of gastrointestinal stromal tumors (GISTs) of the terminal part of the small intestine on ultrasound examination can be difficult because of their similarity in appearance to gynecological tumors. We present a case of a 49-year-old asymptomatic female patient with GIST of the small intestine, which presented as a pelvic mass, mimicking an ovarian tumor. Tumor was diagnosed during the control check up and ultrasound gynecological examination. Computed tomography (CT) showed tumor mass in the pelvis on the right and free fluid in the lesser pelvis. During the surgery, exploration of the abdominal cavity displayed tumor of the terminal part of the small intestine (ileum). The uterus and both adnexes were normal. The patient was treated by resection of the terminal part of the small intestine and termino-terminal anastomosis. Immunohistochemical evaluation demonstrated positive vimentin, positive CD117, and negative CD 34. In the presence of a pelvic mass, especially if other unusual anamnestic data are present, the possibility of other than a gynecologic tumor has to be considered.Dijagnozu gastrointestinalnih stromalnih tumora (GIST) završnog dijela tankog crijeva teško je postaviti ultrazvučnim pregledom jer su izgledom nalik ginekološkim tumorima. Opisujemo slučaj 49-godišnje asimptomatične bolesnice s GISTom tankog crijeva koji se prikazuje kao tvorba u zdjelici i oponaša tumor jajnika. Tumor je dijagnosticiran na kontrolnom i ultrazvučnom ginekološkom pregledu. Kompjutorizirana tomografija (CT) otkrila je tumorsku tvorbu u zdjelici i slobodnu tekućinu maloj zdjelici. Pretraživanjem trbušne šupljine tijekom operacije otkriven je tumor završnog dijela tankog crijeva (ileuma). Maternica i adneksi bili su zdravi. Bolesnici je napravljena resekcija završnog dijela tankog crijeva i termino-terminalna anastomoza. Imunohistokemijska analiza pokazala je pozitivnu reakciju na vimentin i CD117; te negativnu na CD 34. Kad je u zdjelici prisutna tvorba; osobito ako su i drugi anamnestički podaci neuobičajeni; treba uzeti u obzir mogućnost da je riječ o nekom drugom; a ne ginekološkom tumoru

Rak jajnika, jajovoda i potrbušnice: kirurško liječenje

Surgery is the cornerstone of eff ective management of the ovarian, tubal and peritoneal cancer. In 2014 the International Federation of Gynecology and Obstetrics (FIGO) published a new classifi cation collectively covering cancer of ovary, fallopian tube and peritoneum as well as malignant ovarian germ cell tumors and malignant sex-cord stromal tumors. Comprehensive surgical staging according to the 2014 FIGO classifi cation system plays an important role in management of apparently early stage of ovarian, tubal and peritoneal cancer. Primary debulking (cytoreductive) surgery followed by paclitaxel and platinum based combination chemotherapy is the cornerstone of the advanced-stage disease treatment. In cases of suboptimal primary cytoreduction, interval debulking surgery performed after two to four cycles of chemotherapy based on the clinical judgment of the gynecologic oncologist is second att empt to achieve optimal cytoreduction. Secondary cytoreductive surgery can be considered in patients with platinum-sensitive locally recurrent ovarian cancer. The volume of residual tumor remaining after these surgical approaches is one of the most important independent prognostic factors for survival.Kirurško liječenje je temelj uspješnog liječenja raka jajnika, jajovoda i potrbušnice. Međunarodno federacija ginekologa i opstetričara (FIGO) u 2014. godini objavila je novu klasifi kaciju koja zajedno obuhvaća rak jajnika, jajovoda, potrbušnice, zloćudne tumore zametnih stanica i zloćudne tumore specijalizirane strome jajnika. Kirurško stupnjevanje bolesti prema FIGO 2014 klasifi kaciji je ključno u liječenju raka jajnika, jajovoda i potrbušnice naizgled ranog stadija bolesti. Primarna citoredukcijska kirurgija i dodatno liječenje kemoterapijom je standardni pristup uznapredovaloj bolesti. Prilikom suboptimalne citoredukcije tijekom primarnog kirurškog zahvata “interval debulking surgery” nakon drugog do četvrtog ciklusa kemoterapije, ovisno o procjeni ginekološkog onkologa, drugi je pokušaj postizanja optimalne ciotredukcije. Sekundarna citoredukcijska kirurgija dolazi u obzir kod pacijentica koje su osjetljive na kemoterapiju, a imaju lokalni povrat bolesti. Veličina rezidualnog tumorskog tkiva nakon kirurških zahvata je najznačajniji prognostički čimbenik na koji se može utjecati tijekom liječenja