COVID-19 i dijagnostika tumora prostate u KBC-u Zagreb

The aim of this study was to compare the number of biopsy and surgical procedures on prostate, as well as the number of newly diagnosed, histologically confirmed cases of prostate cancer during the COVID-19 pandemic at Zagreb University Hospital Center (UHC). We retrospectively collected and processed a total of 1344 histopathologic findings of the prostate at the Zagreb UHC. Our results show that during the COVID-19 pandemic, there was a statistically significant decrease in the absolute number of biopsy and surgical procedures on prostate at Zagreb UHC, and so was the number of newly diagnosed, histologically confirmed cases of prostate cancer. During the observed time of the pandemic (March 19, 2020 to December 31, 2020), there was a 37.5% decrease in the absolute number of newly diagnosed prostate cancer cases compared to the same period of the previous year (March 19, 2019 to December 31, 2019). To our knowledge, this is the first study of this kind that is based on the number of prostate cancer diagnoses in Croatia. By observing the early period of the pandemic, our results provide important guidelines for monitoring and understanding the long-term consequences of the pandemic on the prostate cancer morbidity and mortality.Cilj ovoga istraživanja bio je usporediti broj biopsijskih i kirurških zahvata na prostati, kao i broj novodijagnosticiranih, patohistološki potvrđenih slučajeva karcinoma prostate tijekom pandemije COVID-19 u Kliničkom bolničkom centru Zagreb. Retrogradno smo prikupili i obradili ukupno 1344 patohistoloških nalaza prostate na Kliničkom zavodu za patologiju i citologiju KBC-a Zagreb. Naši rezultati pokazuju da je tijekom pandemije COVID-19 došlo do statistički značajnog pada apsolutnog broja biopsijskih i kirurških zahvata na prostati, kao i broja novodijagnosticiranih, patohistološki potvrđenih slučajeva karcinoma prostate. Uočen je pad apsolutnog broja novodijagnosticiranih karcinoma prostate za 37,5% u promatranom vremenu pandemije (od 19. ožujka do 31. prosinca 2020. godine) u odnosu na isto razdoblje u prethodnoj godini (od 19. ožujka do 31. prosinca 2019. godine). Prema našim spoznajama ovo je prvo istraživanje ovakvog tipa temeljeno na broju pretraga karcinoma prostate na području Republike Hrvatske. Promatrajući rano razdoblje pandemije naši rezultati donose važne smjernice u budućem praćenju i dugoročnim posljedicama pandemije na pobol i smrtnost karcinoma prostate

COVID-19 i dijagnostika tumora prostate u KBC-u Zagreb

The aim of this study was to compare the number of biopsy and surgical procedures on prostate, as well as the number of newly diagnosed, histologically confirmed cases of prostate cancer during the COVID-19 pandemic at Zagreb University Hospital Center (UHC). We retrospectively collected and processed a total of 1344 histopathologic findings of the prostate at the Zagreb UHC. Our results show that during the COVID-19 pandemic, there was a statistically significant decrease in the absolute number of biopsy and surgical procedures on prostate at Zagreb UHC, and so was the number of newly diagnosed, histologically confirmed cases of prostate cancer. During the observed time of the pandemic (March 19, 2020 to December 31, 2020), there was a 37.5% decrease in the absolute number of newly diagnosed prostate cancer cases compared to the same period of the previous year (March 19, 2019 to December 31, 2019). To our knowledge, this is the first study of this kind that is based on the number of prostate cancer diagnoses in Croatia. By observing the early period of the pandemic, our results provide important guidelines for monitoring and understanding the long-term consequences of the pandemic on the prostate cancer morbidity and mortality.Cilj ovoga istraživanja bio je usporediti broj biopsijskih i kirurških zahvata na prostati, kao i broj novodijagnosticiranih, patohistološki potvrđenih slučajeva karcinoma prostate tijekom pandemije COVID-19 u Kliničkom bolničkom centru Zagreb. Retrogradno smo prikupili i obradili ukupno 1344 patohistoloških nalaza prostate na Kliničkom zavodu za patologiju i citologiju KBC-a Zagreb. Naši rezultati pokazuju da je tijekom pandemije COVID-19 došlo do statistički značajnog pada apsolutnog broja biopsijskih i kirurških zahvata na prostati, kao i broja novodijagnosticiranih, patohistološki potvrđenih slučajeva karcinoma prostate. Uočen je pad apsolutnog broja novodijagnosticiranih karcinoma prostate za 37,5% u promatranom vremenu pandemije (od 19. ožujka do 31. prosinca 2020. godine) u odnosu na isto razdoblje u prethodnoj godini (od 19. ožujka do 31. prosinca 2019. godine). Prema našim spoznajama ovo je prvo istraživanje ovakvog tipa temeljeno na broju pretraga karcinoma prostate na području Republike Hrvatske. Promatrajući rano razdoblje pandemije naši rezultati donose važne smjernice u budućem praćenju i dugoročnim posljedicama pandemije na pobol i smrtnost karcinoma prostate

Comparison of multidetector-row computed tomography and duplex Doppler ultrasonography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage [Usporedba višeslojne kompjuterizirane tomografije i duplex Doppler ultrazvuka u otkrivanju aterosklerotskih karotidnih plakova kompliciranih krvarenjem u plak ]

This study compared sensitivity and specificity of multidetector-row computed tomography and duplex Doppler ultrasonography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage. Carotid plaques from 50 patients operated for carotid artery stenosis were analyzed. Carotid endarterectomy was performed within one week of diagnostic evaluation. Results of multidetector-row computed tomography and duplex Doppler ultrasonography diagnostic evaluation were compared with results of histological analysis of the same plaque areas. American Heart Association classification of atherosclerotic plaques was applied for histological classification. Median tissue density of carotid plaques complicated with intraplaque hemorrhage was 14.7 Hounsfield units. Median tissue density of noncalcified segments of uncomplicated plaques was 54.3 Hounsfield units (p = 0.00003). The highest tissue density observed for complicated plaques was 31.8 Hounsfield units. Multidetector-row computed tomography detected plaques complicated with hemorrhage with sensitivity of 100% and specificity of 70.4%, with tissue density of 33.8 Hounsfield units as a threshold value. Duplex Doppler ultrasonography plaque analysis based on visual in-line classification showed sensitivity of 21.7% and specificity of 89.6% in detecting plaques complicated with intraplaque hemorrhage. Multidetector-row computed tomography showed a very high level of sensitivity and a moderate level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage. Duplex Doppler ultrasonography plaque analysis based on visual in-line classification showed a low level of sensitivity and a moderate-high level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage

Hijalinizirajući tumor vretenastih stanica s gigantskim rozetama naen u uterusu – prikaz slučaja

Hyalinizing spindle cell tumor with giant rosettes (HSCTGR) is unusual, recently recognized entity, histologically characterized by the presence of large rosette-like structures. Apart from these formations, histological features of HSCTGR are indistinguishable from low-grade fibromyxoid sarcoma (LGFMS), and available data suggest that these two tumors present different variants of the same entity. Herein we report the case of HSTCGR found in the uterus. To our knowledge, the present case is the first description of HSTGR occurring at this location as well as the first HSCTGR described in the Croatian medical literature. A 38-year-old woman presented to her gynecologist with symptoms of acute pain in the lower abdomen. Gynecological ultrasound examination showed an enlarged uterus with a tumor mass. Total hysterectomy and bilateral adnexectomy with selective pelvic and para-aortal lymphadenectomy were performed. Serial slicing of the enlarged uterus revealed a grayish white tumor mass with 15 cm in maximum length. The margins of the tumor merged with the uterine wall and the tumor infiltrated more than one half of the myometrium. Histologically, the tumor showed typical features of HSTGR. Postoperatively, no complications occurred. Twenty-two months after surgery, our patient is alive with no signs of recurrence. She needs to be followed up for a long period because HSTCGR belongs to a low-grade malignancy group with the potential to recur and produce late metastasis.Hijalinizirajući tumor vretenastih stanica s gigantskim rozetama (HSCTGR) rijedak je, relativno nedavno opisan entitet, čija je histološka značajka stvaranje krupnih struktura koje nalikuju rozetama. Osim po prisutnosti ovih tvorbi, histološki ga se ne može razlikovati od fibromiksoidnog sarkoma niskoga gradusa i danas se vjeruje da su oni različite varijante istog entiteta. Opisujemo hijalinizirajući tumor vretenastih stanica s gigantskim rozetama nađen u uterusu. Prema našim spoznajama radi se o prvom slučaju opisanom na toj lokalizaciji te također prvom slučaju HSCTGR u hrvatskoj medicinskoj literaturi. Dotada zdrava 38-godišnja žena javila se ginekologu zbog akutne boli u donjem dijelu abdomena. Ginekološkim i ultrazvučnim pregledom nađena je veća tumorska tvorba u području uterusa. Učinjena je histerektomija s adneksektomijom i selektivnom limfadenektomijom. Serijskim rezovima kroz stijenku povećanog uterusa prikazao se sivkastobjelkasti tumor najvećeg promjera 15 cm, koji je infiltrirao više od ½ debljine miometrija. Patohistološkom analizom postavljena je dijagnoza HSCTGR. Postoperativni je tijek prošao bez komplikacija, a 22 mjeseca nakon operacije naša je pacijentica bez znakova recidiva bolesti. HSCTGR pripada skupini tumora s niskim malignim potencijalom te mogućnošću recidiviranja i metastaziranja nakon više godina, stoga se preporučuje dugoročno kliničko praćenj

Korelacija između Gleasonova stadija u uzorcima dobivenim prijeoperacijskom biopsijom prostate i tijekom prostatektomije

The aim of the study was to compare Gleason scores obtained from sextant preoperative prostate biopsy and radical prostatectomy specimens in patients with localized prostate cancer. Seventy-three patients with prostate biopsy and operated on at our hospital from 2000 till 2002 were included in the study. Definitive postprostatectomy Gleason score was accurately predicted by preoperative biopsy in 43.8% and undergraded by 1 grade in 39.7% of study patients. Although a fairly good concordance was recorded between Gleason scores obtained on biopsy and prostatectomy specimens, the problem of undergrading remains to be improved. The web-based free tutorial can improve the accuracy of Gleason grading by practicing pathologists. It is available at: www.pathology.jhu.edu/prostate.Cilj ove studije bio je usporediti Gleasonov zbroj dobiven prijeoperacijskom sekstant biopsijom i konačan nalaz nakon radikalne prostatektomije u bolesnika s lokaliziranim karcinomom prostate. U ispitivanje su bila uključena 73 bolesnika koji su podvrgnuti biopsiji i radikalnoj prostatektomiji u našoj ustanovi između 2000. i 2002. godine. Prijeoperacijska biopsija prostate točno je predvidjela konačan Gleasonov zbroj nakon prostatektomije u 43,8% bolesnika, dok je u 39,7% bolesnika Gleasonov zbroj bio podcijenjen za 1. Premda je nađena prilično dobra usuglašenost nalaza stupnja diferenciranosti tumora na bioptičkom i definitivnom materijalu, problem podcjenjivanja stupnja diferenciranosti jo. treba biti riješen. Točnija procjena Gleasonova zbroja može se postići uporabom i vježbom na besplatnoj Internet stranici: www.pathology.jhu.edu/prostate

Kliničke karakteristike i liječenje lupusnog nefritisa - preliminarna analiza opservacijskih podataka Nacionalnog referentnog centra

Lupus nephritis (LN) is one of the most severe features of systemic lupus erythematosus (SLE). Data on LN is scarce in the Croatian population. We analysed the characteristics of LN patients diagnosed at our tertiary referral centre. In this retrospective study, we analysed the following features of patients with biopsy-proven LN diagnosed between 2011 and 2020: demographics, renal laboratory parameters, renal histopathology, and treatment. A total of 38 patients were included (30 females; mean age 39±15 years). The most common indication for kidney biopsy was proteinuria (89%). The proportion of LN classes was: class I (2.6%), II (5.3%), III (18.4%), IV (42.1%), V (13.2%), III+V (10.5%), IV+V (5.3%). The median time from SLE diagnosis to histologic confirmation of LN was 1.0 year. All patients were treated with methylprednisolone (MP), 68% received MP pulses. Induction treatment included intravenous (IV) cyclophosphamide (CYC) (71%) (15 patients treated per Euro-Lupus and 9 per the National Institutes of Health regimen), oral CYC (3%), or mycophenolate mofetil (11%). 79% of patients received antimalarials. While there is heterogeneity between different populations, our patient profile was similar to that from other European studies. Further follow-up of this group is necessary to assess outcomes in our population.Lupusni nefritis (LN) je česta i vrlo ozbiljna manifestacija sustavnog eritemskog lupusa (SLE). Još uvijek nema dovoljno podataka o karakteristikama bolesnika s LN u Hrvatskoj. Analizirali smo karakteristike bolesnika s LN koji su liječeni u referentnom centru naše tercijarne ustanove. U ovu retrospektivnu studiju uključili smo bolesnike s biopsijom potvrđenim LN u periodu od 2011. do 2020. godine, analizirali smo demografske podatke, parametre bubrežne funkcije, patohistološki nalaz bioptata bubrega i liječenje. U studiju je uključeno 38 bolesnika (30 žena, prosječna dob 39±15godina). Najčešća indikacija za biopsiju bubrega bila je proteinurija (89%). Raspodjela klasa LN bila je sljedeća: klasa I(2,6 %), II(5,3 %), III(18,4 %), IV(42,1 %), V(13,2 %), III+V(10,5 %), IV+V(5,3 %). Prosječno vrijeme od dijagnoze SLE do histološke potvrde LN bilo je 1,0 godina. Svi bolesnici su liječeni kortikosteroidima, 68 % liječeno je bolusima metilprednizolona. Indukcijska terapija uključivala je parenteralnu primjenu ciklofosfamida (CYC) (71 %) (15 bolesnika liječeno je prema Euro-lupus protokolu, 9 bolesnika prema protokolu Nacionalnog instituta za zdravlje (NIH)), peroralni CYC (3 %) ili mikofenolat mofetil (11 %). Antimalarike je primilo 79 % bolesnika. Unatoč heterogenosti između različitih populacija s LN, profil bolesnika uključen u ovu studiju sličan je ostalim europskim studijama. Daljnje praćenje potrebno je da bi se istražili ishodi u ovoj populaciji

Intraoperacijska analiza limfnih čvorova kod radikalne prostatektomije: Je li ona doista neophodna?

Radical prostatectomy is a treatment of choice for localized prostatic adenocarcinoma. In most cases, radical prostatectomy is combined with pelvic lymph node dissection. During the last decade, the necessity to perform lymphadenectomy in all patients has been questioned. Lymph node dissection adds the risk of complications, and increases operation time and medical costs. Data of patients with prostatic adenocarcinoma who underwent radical prostatectomy at Department of Urology, Sestre milosrdnice University Hospital, Zagreb during the period from January 1, 1998 till December 31, 2002, were analyzed. There were 110 patients who had complete preoperative data including prostate-specific antigen (PSA) value, Gleason score, T stage and lymph node status on frozen section analysis. Using predictive nomograms the patients were divided into different risk groups. Positive lymph node(s) were found in one patient with T2 and in five patients with T3, whereby three, two and one of these patients had Gleason score 6, 7 and 8, respectively. There was a correlation between increasing PSA value and positive lymph nodes (p<0.005). A statistically significant correlation between T stage and PSA value (p<0.005) as well as between T stage and Gleason score (p=0.0014) was also observed. The majority of patients belonged to low and intermediate risk groups, known to benefit very little from lymph node dissection and frozen section analysis. Thus, it seems reasonable to reconsider the use of these predictive nomograms on advising and therapy strategy planning for newly diagnosed patients, especially those with clinically organ-confined disease.Radikalna prostatektomija je metoda izbora u liječenju lokaliziranog karcinoma prostate, a najčešće se izvodi u kombinaciji s disekcijom zdjeličnih limfnih čvorova. Disekcija zdjeličnih limfnih čvorova povećava rizik komplikacija, produžava trajanje operacije, povisuje troškove liječenja i medicinske skrbi, pa se je potreba za njenim provođenjem u svih bolesnika s dijagnosticiranim karcinomom prostate tijekom prošloga desetljeća višekratno preispitivala. Radi boljeg probira bolesnika sa značajnijom koristi od disekcije zdjeličnih limfnih čvorova različiti autori su obrađivali čimbenike kojima je moguće predvidjeti rizik metastaziranja u regionalne limfne čvorove. Studijom su obuhvaćeni svi bolesnici kojima je zbog dijagnoze karcinoma prostate u razdoblju od 1. siječnja 1998. do 31. prosinca 2002. u Kliničkoj bolnici Sestara milosrdnica učinjena radikalna prostatektomija. Uz primjenu prediktivnih nomograma bolesnici su bili podijeljeni u različite rizične skupine. Većina bolesnika pripadala je skupini niskog i srednjeg rizika metastaziranja, s vrlo ograničenom koristi od disekcije zdjeličnih limfnih čvorova i njihove intraoperacijske analize. Od 110 bolesnika za koje su dobiveni svi podaci uključujući vrijednost antigena specifičnog za prostatu (PSA), Gleasonov zbroj, T stadij i stanje limfnih čvorova analiziranih na intraoperacijskim rezovima, pozitivni limfni čvorovi su utvrđeni u 6 slučajeva. Utvrđena je statistički značajna povezanost između vrijednosti PSA i pozitivnih limfnih čvorova (p<0,005). Također je opažena korelacija između T stadija i vrijednosti PSA (p<0,005) odnosno T stadija i Gleasonova zbroja (p=0,0014). Zaključeno je kako bi bilo uputno razmotriti uporabu prediktivnih nomograma kod planiranja terapijskog pristupa bolesnicima s novootkrivenim, a poglavito onima s klinički lokaliziranim karcinomom prostate