Karcinom želuca zauzima četvrto mjesto među najčešće dijagnosticiranim karcinomima, a godišnje se dijagnosticira preko milijun novih slučajeva diljem svijeta.1 U vrijeme postavljanja dijagnoze većina ...oboljelih je uznapredovalog stadija bolesti obzirom na nespecifične simptome ranijeg stadija bolesti i nepostojanja ranog probira, osim u državama Istočne Azije.2,3,4 Adjuvantno liječenje adenokarcinoma želuca uključuje kemoterapiju ili kemoradioterapiju u bolesnika stadija bolesti IB-III, ovisno o prethodno provedenom kirurškom zahvatu. Adjuvantna kemoterapija bazira se na kombiniranom liječenju preparatima soli platine i fluoropirimidina. Zbog boljeg podnošenja, uz podjednak učinak, u svakodnevnoj kliničkoj praksi prednost ima primjena oksaliplatina u odnosu na cisplatin. Najčešće nuspojave liječenja oksaliplatinom su hematološke (neutropenija, trombocitopenija, anemija), alergijske i infuzijske reakcije, periferna senzorna neuropatija, laringofaringealna disestezija. Rjeđa, no po život ugrožavajuća nuspojava oksalipatina je sindrom sinusoidne opstrukcije jetre, tj. SOS (eng. Sinusoidal Obstruction Syndrome) ili PSVD (eng. Porto-Sinusoidal Vascular Disease), ovisno o tome radi li se o presinusoidalnom (PSVD) ili postsinusoidalnom (SOS) obliku oštećenja vaskularnog endotela. U ovom radu prikazan je slučaj bolesnika koji je razvio portalnu hipertenziju praćenu obilnim ascitesom kao nuspojavu liječenja oksaliplatinom u sklopu adjuvantne kemoterapije adenokarcinoma želuca. Učinjenom neinvazivnom i invazivnom dijagnostičkom obradom potvrđeno je da se radi o intrahepatalnom uzroku portalne hipertenzije. Obzirom na široku primjenu oksaliplatina u liječenju karcinoma probavnog sustava, ovo je jedna od mogućih nuspojava koju bi trebalo imati na umu kod bolesnika s trombocitopenijom i razvojem splenomegalije za vrijeme liječenja ili najčešće 6-12 mjeseca nakon završetka liječenja oksaliplatinom.
Gastric cancer ranks fourth among the most frequently diagnosed cancers, with over a million new casesdiagnosed worldwide each year.1 At the time of diagnosis, most patients are in an advanced stage of thedisease due to non-specific symptoms in the early stages and the lack of early screening, except in EastAsian countries.2,3,4 Adjuvant treatment for gastric adenocarcinoma involves chemotherapy orchemoradiotherapy for patients in stages IB-III, depending on the previous surgical procedure. Adjuvantchemotherapy is based on combination therapy using platinum salts and fluoropyrimidines, with oxaliplatinbeing preferred over cisplatin due to better tolerance and similar effectiveness in clinical practice. Commonside effects of oxaliplatin treatment include hematological issues, allergies, infusion reactions, peripheralsensory neuropathy, and laryngopharyngeal dysesthesia. A rare but life-threatening side effect is thedevelopment of sinusoidal obstruction syndrome/porto-sinusoidal vascular disease of the liver. The textpresents a case of a patient who developed portal hypertension with significant ascites as a side effect ofoxaliplatin treatment for gastric adenocarcinoma. Non-invasive and invasive diagnostic tests confirmed thatthe cause of portal hypertension was intrahepatic. Given the widespread use of oxaliplatin in gastrointestinalcancer treatment, this is a possible side effect to consider, especially in patients with thrombocytopenia andthe development of splenomegaly during or, most commonly, 6-12 months after oxaliplatin treatment.
Incidentalom nadledvičnice je sprememba brez simptomov, naključno odkrita pri slikovnih preiskavah zaradi razlogov, ki ne vključujejo bolezni nadledvičnic. Njihova prevalenca strmo narašča na račun ...vedno večjega števila opravljenih slikovnih preiskav. Pretežno gre za benigne, hormonsko neaktivne adenome. Ob odkritju incidentaloma moramo razlikovati med benignimi in malignimi spremembami ter ugotoviti morebitno hormonsko aktivnost. Sodobno obravnavo incidentalomov predstavljava na izjemnem kliničnem primeru bolnice z drobnim incidentalomom leve nadledvičnice. Kljub visoki gostoti na nativni računalniški tomografiji (CT) smo na podlagi izplavljanja kontrasta v skladu s takratno prakso spremembo označili za benigno in odsvetovali nadaljnje morfološko spremljanje. Kljub temu je bolnica v naslednjih letih zaradi različnih zdravstvenih težav opravila več slikovnih preiskav, vendar spremembe velikosti tumorja ni bilo. Šele 6 let od odkritja so zaradi posledic covida-19 svetovali CT prsnega koša, ki je razkril izrazito rast tumorja. Bolnico smo napotili na levostransko laparoskopsko adrenalektomijo. Patohistološko je bil potrjen karcinom skorje nadledvične žleze, zato smo uvedli adjuvantno adrenolitično zdravljenje z mitotanom. Incidentalomi nadledvičnic so pretežno benigni in klinično nepomembni, včasih pa lahko ogrozijo življenje. Zato je pomembno, da jih obravnavamo v skladu s predstavljenimi smernicami. V izjemnih primerih z atipičnim potekom, kot je bilo pri naši bolnici, bo za ugoden razplet ključna obravnava v okviru interdisciplinarnega tima.
Cilj rada: Analizirati funkcionalni i onkološki ishod bolesnika s ranim stadijem karcinoma grkljana, liječenih frontolateralnom laringektomijom. Bolesnici i metode: U retrospektivno istraživanje ...uključeno je 45 kirurški liječenih bolesnika s ranim stadijem karcinoma grkljana. Funkcionalni ishod uključivao je procjenu respiratorne i fonatorne funkcije, te akta gutanja. Respiratorna funkcija grkljana smatrana je primjerenom u slučaju nepostojanja stenoza i uspješnog dekanilmana. Za evaluaciju glasa korištene su GRBAS skala, Voice Handicap Index 30 upitnik i spektralna akustična analiza glasa. Akt gutanja procjenjivan je na osnovu anamnestičkih podataka i fiberlaringoskopskog pregleda. Onkološki ishod prikazan je Kaplan-Meierovim krivuljama ukupnog preživljenja (overall survival), preživljenja bez bolesti (disease free survival) i preživljenja vezanog uz bolest (disease specific survival). Rezultati: Od ukupno 45 bolesnika, 3 su bila ženskog, a 42 muškog spola. Medijan dobi iznosio je 64 godine (raspon 44-79). Svi su se tumori nalazili u glotičkoj regiji, te su svrstani u T1 (60%) ili T2 (40%) klasifikaciju bolesti. Postoperativna radioterapija primijenjena je u 15 (33,3%) bolesnika zbog limfovaskularne invazije tumora ili R1 resekcijskih rubova. Svi su bolesnici imali urednu respiratornu funkciju te uredno izvršen dekanilman. Kod niti jednog bolesnika nismo verificirali poremećaj gutanja. Analiza fonatorne funkcije pokazala je umjerene teškoće bolesnika vezane uz kvalitetu glasa. Procjenom onkološkog ishoda utvrđeno je da je petogodišnje preživljenje vezano uz bolest iznosilo 100%, petogodišnje ukupno preživljenje 93,3%, dok je petogodišnje preživljenje bez bolesti iznosilo 86,7%. U sklopu praćenja bolesnika (medijan 86,2 mjeseca), dva su bolesnika razvila lokalni, a jedan regionalni recidiv bolesti. Zaključak: Iako noviji modaliteti liječenja nude bolji funkcionalni ishod što se najviše očituje u kvaliteti glasa, frontolateralna laringektomija nudi podjednak onkološki ishod i vrijedna je alternativna kirurška opcija u pomno izabranim slučajevima.
Stanice karcinoma dojke na svojim membranama mogu imati različitu razinu ekspresije HER2 receptora. HER2 signalni put važan je za rast tumora i metastaze. Bolesnice s HER2 pozitivnom bolešću imale su ...lošije ishode liječenja sve dok nije uvedena upotreba trastuzumaba, a potom i drugih anti-HER2 lijekova. Do sada su se koristili isključivo za jaku ekspresiju HER2 receptora. Razvojem novih lijekova, prije svega konjugata protutijelo-citostatik, dokazana je učinkovitost djelovanja na tumorske stanice koje imaju niže razine HER2 receptora, danas poznatih kao HER2-low tumori. Budući da su rezultati studije DESTINY Breast04 pokazali produljenje preživljenja bez progresije bolesti i ukupnog preživljenja u prethodno liječenih pacijenatica s HER-low tumorima, otvaraju se nove mogućnosti, kako u liječenju, tako i u testiranju HER2 receptora.
VULVAR CANCER – A CASE REPORT Špela Smrkolj; Andrej Omahen; Matija Barbič ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Volume:
78
Journal Article
Peer reviewed
Open access
Background: Malignant vulvar lesions arise from premalignant vulvar intraepithelial neoplasm (VIN) and occur only rarely (3–4 % of all malignancies of the female genital organs), especially in the ...menopause. They are associated with human papillomavirus infection. If the change is found sufficiently early and if it is properly treated, the prognosis is favourable. Methods and patients: We present a case of a 60-year-old multiparous postmenopausal woman with recurrence of the vulvar cancer. In May 1995 vulvar biopsy revealed VIN III. In February 2006 she was examined at the Oncology Institute because of expansive lesions which covered the entire area of external genitals from clitoris to the anus. On 7th March, 2006 vulvectomy with broad safety margins and right-sided lymphadenectomy were made. Histological di- agnosis revealed a well-differentiated invasive squamous cell carcinoma (FIGO II, grade I); postoperative radiotherapy followed. In February 2007, suspicious lesions reoccurred in the external genital area, the smear was negative. In December 2007 histological diagnosis of recurrent squamous cancer was made. On 7th October, 2008 the patient was admitted to the Department of Gynecology, University Medical Centre, Ljubljana. Abdominal computed tomography showed a widespread vulvar cancer, T4 in appearance, suspicious lymph nodes in the pre-sacral area and suspicious left inguinal lymph node. Metastases to the liver were not confirmed. On 28th October, 2008 total Brunschwig operation was performed (pelvic exenteration of the bladder, uterus, pelvic lymph nodes, rectum and radical vulvectomy with resection of both ramus ossis pubis), anus praeter and transposition of skin-muscle flap (m. rectus abdominis). The interdisciplinary operation, which lasted 9 hours and blood loss was 6 litres, involved gynaecologists, a urologist, a plastic surgeon, and an oncology surgeon. The histological diagnosis of a 27 × 24 cm large preparation was a moderately differenti- ated planocellular carcinoma, which was totally removed. The operation was followed by prolonged post-operative physical and mental rehabilitation, during which beside wound infections with various microbes also Klebsiella pneumoniae ESBL sepsis, and later Candida sp. caused sepsis developed. This led to prescription of a long lasting treatment with systemic antibiotics and antimycotics. On 2nd February, 2009 re-necrectomy and plastic surgery of the sacral region were made. During a 143-day hospitalization, the patient’s depression was regularly managed by clinical psychologist. On discharge from hospital she was in good physical and mental condition, did not have problems with digestion, took care of the anus praeter herself, the reconstruction of the defect was aesthetically good and functional. On the follow-up examination 3 months later she was in good physical and mental condition, and returned to her workplace. Conclusions: This case report is intended to remind us that regular follow-up examinations of patients after completed treatment is of utmost importance; in case of recurrence of suspicious changes they require to be treated by appropriate and most qualified medical experts.
Karcinom pluća jedan je od vodećih javno-zdravstvenih problema, kako u svijetu, tako i u Republici Hrvatskoj. Većina bolesnika u Hrvatskoj otkriva bolest u lokalno uznapredovalom ili metastatskom ...stadiju bolesti, što u konačnici rezultira petogodišnjim preživljenjem od svega 10%. Nakon učinjene slikovne obrade i postavljene sumnje na tumor pluća, u sklopu daljnje dijagnostičke obrade slijedi uzorkovanje tkiva za citološku i patohistološku dijagnostiku, što može predstavljati velike izazove za kliničara. Cilj ovog istraživanja je ukazati na problematiku prilikom postavljanja dijagnoze kod bolesnika s nesitnostaničnim karcinomom pluća u Općoj bolnici Zadar, odnosno odrediti vremenske intervale za pojedine dijagnostičke postupke prije patohistološke ili citološke potvrde bolesti. Ovaj rad ukazuje na poteškoće u pravovremenom postavljanju dijagnoze karcinoma pluća kod određenog broja bolesnika, što u konačnici rezultira odgodom početka onkološkog liječenja.
Lung cancer remains a significant global public health concern, and the Republic of Croatia is no exception where a majority of patients are diagnosed in advanced stages, leading to a five-year survival rate of only 10%. The diagnostic process for non-small cell lung cancer (NSCLC) involves image processing followed by cytological and histopathological sampling. This study aims to identify the challenges clinicians face during the diagnostic procedure and determine the time intervals required before obtaining histopathological or cytological confirmation of the disease in Zadar General Hospital. By analyzing these time intervals, this paper points to the factors contributing to delayed diagnosis, which leads to a delay in the initiation of crucial oncological treatments for patients.
Strawberry tree (
L.) honey (STH), also known as “bitter honey”, is a traditional medicine widely used in the Mediterranean area. Regardless of geographical origin, it usually has a very high content ...of phenolic compounds and strong antioxidant capacity. Yet, little is still known about the effects of STH, its phenolic extract (STHE), and its main bioactive compound – homogentisic acid (HGA) – at the cell level. The aim of this study was to estimate total phenolic content, DPPH radical scavenging activity, and ferric reducing antioxidant power of STH made in Croatia and investigate cytotoxic and pro-oxidative effects of STH, STHE and HGA on three human cell lines: tongue squamous cell carcinoma (CAL 27), hepatocellular carcinoma (HepG2), and epithelial colorectal adenocarcinoma cells (Caco-2) cells. These substances were tested at four concentrations (0.5–5× average human daily intake of STH) and over 30 min and 1 and 2 h. Croatian STH had a total phenolic content of 1.67 g gallic acid equivalents (GAE) per kg of honey, DPPH radical scavenging activity of 2.96 mmol Trolox equivalents (TE) per kg of honey, and ferric reducing antioxidant power (FRAP) of 13.5 mmol Fe
per kg of honey. Our results show no clear and consistent time- or concentration-dependent cytotoxicity in any of the cell lines. ROS levels in all the three cell types at almost all exposure times were not significantly higher than control. The most important observation is that the tested substances have low cytotoxicity and high biocompatibility, regardless of concentration, which is a good starting point for further research of their biological effects in other models.
Cilj: Ukazati na potrebu trajnog praćenja pacijenata kod kojih je zbog karcinoma učinjena parcijalna laringektomija. Prikaz slučaja: Prikazali smo pacijenta koji je u vremenskom razmaku od dvadeset ...godina tri puta imao karcinom larinksa. 1982. godine učinjena je parcijalna laringektomija. Drugi primarni tumor nastao je na sluznici ostatka larinksa 2000. godine, kada je učinjena traheotomija i laringofisura s ekscizijom tumora. Treće javljanje tumora bilo je 2002. godine kada je učinjena retraheotomija i totalna laringektomija. U sva tri javljanja radilo se o planocelularnom karcinomu. Pacijent je od 2000. godine bio pod redovitom kontrolom, a preminuo je 2013. godine u dobi od 85 godina. Zaključak: Pojava planocelularnog karcinoma larinksa moguća je godinama nakon uspješnog liječenja početnog tumora. Objašnjenje nalazimo u ostatku sluznice koja je obilježena poljima kancerizacije, što čini podlogu za nastanak novih tumora.
Aim: To point out the need for permanent monitoring of patients with partial laryngectomy due to cancer. Case report: We have shown a patient who has had the laryngeal cancer three times at intervals of twenty years In 1982, a partial laryngectomy was performed. The second primary tumour was formed on the mucosa of the rest of the larynx in 2000, when the tracheotomy and laryngofissure were performed. The third tumour incidence was in 2002, when retracheotomy and total laryngectomy were performed. In all three cases, there was the case of a planocellular carcinoma. The patient was regularly checked-up since 2000, but he passed away in 2013 at the age of 85. Conclusion: The appearance of the laryngeal planocellular carcinoma is possible years after the successful treatment of the primary tumour. The explanation is found in the remains of the mucosa, which is marked by the field of cancerisation, which is the basis for the incidence of new tumours.
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