Karcinosarkomi su rijetki maligni tumori s mezenhimalnom i epitelnom diferencijacijom. Najčešće su sijelo glava i vrat, a svega nekoliko slučajeva opisano je u debelom crijevu, s vrlo agresivnim ...tijekom. Mikropapilarna varijanta karcinoma također vrlo rijetko nastaje u crijevu i povezana je s lošom prognozom. Opisujemo neuobičajeni slučaj karcinosarkoma sigmoidnog kolona s mikropapilarnom diferencijacijom, kod 83-godišnje žene. Tumor je bio promjera do 3,8 cm, mikroskopski se sastojao od žljezdolikih struktura, mikropapilarnih formacija sa psamomskim tjelešcima i solidnih područja koja su uglavnom građena od vretenastih stanica, a žarišno pokazuju hrskavičnu diferencijaciju. Žljezdana i mikropapilarna komponenta imunohistokemijski su pozitivne na epitelni membranski antigen i citokeratin, a mezenhimalna komponenta pozitivna je na vimentin. Tumor je infiltrirao cijelu debljinu stijenke crijeva sa širenjem u okolno masno tkivo. Metastaze u limfnim čvorovima sastojale su se samo od žljezdane komponente. Prema našim saznanjima ovo je prvi takav slučaj opisan u literaturi.
Carcinosarcomas are very rare malignant tumors showing both mesenchymal and epithelial differentiation. They most commonly occur in the head and neck region. Few cases were described in the colon ...associated with very aggressive course. Micropapillary variant is also very rare in the colon and associated with poor prognosis. We report an unusual case of carcinosarcoma of the colon with micropapillary features and psammomatous calcification in an 83-year-old female patient. Tumor was located in the sygmoid colon and measured up to 3.8 cm in the largest diameter. Microscopically it was composed of glandular structures and micropapillary formations with psammomatous calcifications and solid areas built up of spindle cells with focal areas of cartilaginous differentiation. Glandular and micropapillary components immunohistochemically showed positive staining for cytokeratin and EMA while mesenchymal areas were positive for vimentin. The tumor was spreading through the whole thickness of the wall into adjacent fat tissue. Metastases in regional lymph nodes were composed entirely of glandular component. To the best of our knowledge, this is the first case of carcinosarcoma of the colon showing micropapillary features and psammomatous calcification.
Gallstone ileus with impaction of gallstone in distal duodenum is an extremely rare complication of cholecystolithiasis. Gallstone ileus in itself accounts for less than 1% of these complications ...with 800 cases described so far. However, there are less than 15 cases described with the impaction of gallstone in distal duodenum. We report a case of an 84-year-old male patient in whom gallstone impacted in distal duodenum was found by ultrasonography and confirmed by computed tomography. Cholecystitis and a remaining large gallstone in the gallbladder were found intraoperatively, which made us opt for one-step procedure, i.e. lithotomy and fistula repair with cholecystectomy. Due to the rare position of impacted gallstone, we believe that cases like this should be reported in detail in order to generate enough data for establishing optimal treatment options.
Secondary angiosarcoma is an aggressive tumor that can develop in breast cancer patients treated with conserving therapy and radiotherapy. The symptoms can be misleading, whereas mammography and ...fine-needle aspiration (FNA) are typically negative in early stage of the disease. A high grade of clinical suspicion is very important for early diagnosis. A case of angiosarcoma involving breast parenchyma in a patient treated with quadrantectomy and radiotherapy for T1cN1Mx breast carcinoma is presented.
Spontaneous splenic rupture is a rare but potentially fatal complication of infectious mononucleosis. Abdominal pain is uncommon in infectious mononucleosis, and splenic rupture should be strongly ...considered whenever abdominal pain occurs. The onset of pain may be insidious or abrupt. The pain is usually in the left upper quadrant.
To indicate that infectious mononucleosis is not always the innocent kissing disease, but could be complicated with splenic rupture as a life-threathenig condition.
Our first case is described and a short literature review is provided. We report on the case of a 27-year-old man with infectious mononucleosis who had spontaneous splenic rupture that was successfully managed by splenectomy. On admission, he was febrile (38.5 degrees C) with hepatosplenomegaly, and had a blood pressure of 100/70 mm Hg. Six hours later, the patient complained of increasing abdominal pain. Abdominal ultrasound and computed tomography showed a 16.5 cm heterogeneous splenomegaly with subcapsular hematoma as well as free ascites. Laparotomy confirmed spontaneous rupture of the splenic capsule with active abdominal bleeding. Splenectomy was performed with a good clinical response. Examination of the spleen revealed a ruptured capsule with a subcapsular hematoma.
Infectious mononucleosis is the most common infectious disease to result in spontaneous spleen rupture. The prognosis is favorable when diagnosis is made on time and correct treatment is started immediately. Although splenectomy was advocated as definitive therapy in the past, numerous recent reports have documented good outcomes with non-operative management. Based on the literature review, an approach to the management of a spontaneously ruptured spleen secondary to infectious mononucleosis is suggested. Non-operative management can be successful in hemodynamically stable patients, i.e. in patients with subcapsular hematoma without overt rupture of the capsule to avoid complications of splenectomy (e.g. post-splenectomy sepsis).
We report on a 27-year-old man with infectious mononucleosis who had spontaneous splenic rupture that was successfully managed by splenectomy.
Ileus sa zaglavljenim žučnim kamencem u distalnom duodenumu je izrazito rijetka komplikacija kolelitijaze. Odgovoran je za manje od 1% komplikacija kolelitijaze uz oko 800 opisanih slučajeva. Samo je ...u 15 slučajeva opisan kamenac zaglavljen u distalnom duodenumu. Predstavaljamo slučaj 84-godišnjeg bolesnika u kojega je žučni kamenac u duodenumu potvrđen pomoću ultrazvuka i kompjutorizirane tomografije. Intraoperacijski je nađen kolecistitis i zaostao žučni kamenac u žučnjaku, što nas je usmjerilo prema jednostupanjskom postupku: ekstrakciji kamenca iz duodenuma i popravku fistule te kolecistektomiji. Smatramo da zbog izrazito rijetkog položaja zaglavljenog žučnog kamenca ovakve slučajeve treba podrobno opisati kako bi se prikupilo dovoljno podataka za donošenje odluke o optimalnom liječenju.
Sekundarni angiosarkom je agresivni tumor koji se može razviti kod bolesnica s rakom dojke liječenih terapijom očuvanja i radioterapijom. Simptomi mogu dovesti u zabunu, dok su mamografija i ...citološka punkcija redovito negativne u ranom stadiju bolesti. Za ranu dijagnozu vrlo je važna visoka klinička sumnja na ovu bolest. Prikazuje se slučaj angiosarkoma koji je zahvatio parenhim dojke u bolesnice liječene kvadrantektomijom i radioterapijom zbog raka dojke T1cN1Mx.
