Potential use of thermography for more effective detection of breast carcinoma was evaluated on 26 patients scheduled for breast carcinoma surgery. Ultrasonographic scan, mammography and thermography ...were performed at the University Hospital for Tumors. Thermographic imaging was performed using a new generation of digital thermal cameras with high sensitivity and resolution (ThermoTracer TH7102WL, NEC). Five images for each patient were recorded: front, right semi-oblique, right oblique, left- semi oblique and left oblique. While mammography detected 31 changes in 26 patients, thermography was more sensitive and detected 6 more changes in the same patients. All 37 changes were subjected to the cytological analysis and it was found that 16 of samples were malignant, 8 were suspected malignant and 11 were benign with atypia or proliferation while only 2 samples had benign findings. The pathohistological method (PHD) recorded 75.75% malignant changes within the total number of samples. Statistical analysis of the data has shown a probability of a correct mammographic finding in 85% of the cases (sensitivity of 85%, specificity of 84%) and a probability of a correct thermographic finding in 92% of the cases (sensitivity of 100%, specificity of 79%). As breast cancer remains the most prevalent cancer in women and thermography exhibited superior sensitivity, we believe that thermography should immediately find its place in the screening programs for early detection of breast carcinoma, in order to reduce the sufferings from this devastating disease.
In this paper, we are presenting the two cases of very rare tumors: breast sebaceous carcinoma, which has been described for the first time in Croatian medical literature, and pure breast squamous ...carcinoma. First case, sebaceous carcinoma, is still quite unknown regarding its morphological characteristics and biological behavior. In the second case, squamous carcinoma, also very rare, was found in a patient who previously had a number of diagnosed head and neck skin carcinomas, and was diagnosed as primary squamous breast carcinoma. As a first case we present a 85-year-old female with a two months history of swelling of the left breast under the mammilla. The second one, a 69-year-old female presented to our hospital in January 2008 with a two months history of a lump in the lower outer region of the left breast and enlarged lymph nodes in left axillary region. Fine needle aspiration cytology (FNAC) of the breast was performed in order to diagnose the exact type of both tumours. This methodology was found important in diagnosis, but in both cases showed certain limitations in diagnosing such rare tumors. The final diagnoses were determined after carefully synthesizing the histological findings and clinical data. Careful and accurate classification of these tumors is necessary. A detailed analysis of their biological behavior and response to the therapy is necessary in order to formulate definite recommendations in managing these patients/diseases.
Primary adult Ewing's sarcoma is a rare entity. They most commonly occur in children and young adults. 6% of them are localized extraosseously. We present a case of a 51 year old patient with primary ...renal Ewing's sarcoma and multiple metastases in liver and iliac bone. Patients with metastatic disease are usually treated with aggressive chemotherapy and have a poor outcome. Our patient underwent complete surgical excision of tumour, and was treated with aggressive chemotherapy, respectively. Two and half years after presentation he is well, without any symptoms.
We aimed at analyzing the metastatic involvement in interpectoral (Rotter's) lymph nodes (RLN) in relation to tumor marker CA 15-3.
The study included 177 female patients undergoing surgery for ...primary breast cancer at the University Hospital for Tumors, Zagreb, Croatia from November 2001 to March 2004. In addition to the standard surgical procedure, interpectoral RLNs were removed in all of the patients. Levels of the serum tumor marker CA 15-3 was determined prior to surgery.
Rotter's lymph nodes were identified in 66.2% of the patients, with metastatic involvement revealed in 18.6% of the RLNs. Metastatic involvement of RLNs in patients with negative axillary lymph nodes was 2.8% and positive in 34.6%. Elevated serum levels of tumor marker CA 15-3 had 22 (12.4%) patients. Of 33 Rotter's node-positive patients, 27.3% had elevated serum levels of tumor marker CA 15-3 and in Rotter's node-negative patients only 9% had elevated serum levels of tumor marker CA 15-3, with the level statistically significantly higher in Rotter's positive patients compared to those with negative (or absent) RLNs (chi2=8.22, p=0.004).
Tumor marker CA 15-3 is more frequently elevated in patients with positive RLNs. Elevated values of tumor marker CA 15-3 could be warning for possible positive interpectoral nodes. The removal of the RLNs may be beneficial for patients with (massive) axillary nodal involvement. For axillary node negative patients, sentinel node biopsy could avoid the unnecessary removal of the RLNs.
Uvod: Godišnje u Hrvatskoj od kolorektalnog karcinoma oboli oko 3500 bolesnika. Nacionalni program ranog otkrivanja raka debelog crijeva u Hrvatskoj se provodi od 2007. godine. Primarni cilj programa ...je otkrivanje raka debelog crijeva u ranoj fazi bolesti, što bi trebalo smanjiti učestalost i smrtnost od raka debelog crijeva.
Cilj: Utvrditi interes ciljne skupine za sudjelovanje u programu, razloge neodazivanja na program te njihovu ukupnu upućenost u program.
Materijali i metode: Anketiranje 50 pacijenata unutar ciljne skupine programa o njihovom odgovoru i razumijevanju razloga za probir.
Rezultati: Iako 84% sudionika zna za program, stopa odaziva nije bila zadovoljavajuća.
Zaključak: Većina ispitanika koji su bolovali od kolorektalnog karcinoma primili su poziv, ali se nisu odazvali zbog nepostojanja simptoma, što korelira s niskom razinom znanja o kolorektalnom karcinomu.
The aim of this study was to ascertain which histological types of melanoma can clinically and morphologically appear as polypoid melanomas. In 645 cases of primary cutaneous melanoma we have ...analyzed criteria for diagnosis of polypoid cutaneous melanoma and afterwards we have analyzed growth phase in each polypoid melanoma, histological type of atypical melanocytes, the number of epidermal ridges which are occupied by atypical melanocytes, and distribution according to age, sex and location, as well as the disease free survival. According to the criteria for polypoid melanomas we have found 147 (22.8%) polypoid cutaneous melanomas. Analyzing the growth phases, histological types of atypical melanocytes and the number of affected epidermal ridges in the group of polypoid melanomas we have ascertained 2 (1.4%) ALMs, 4 (2.8%) LMMs, 42 (28.6%) SSMs and 99 (67.2%) NMs. Our conclusion is that polypoid cutaneous melanomas are morphological forms of various histological melanoma types (ALM, LMM, SSM and NM) and they can all display polypoid morphological form. Polypoid cutaneous melanomas are most often of nodular histological type.
This study was aimed at analyzing metastatic involvement in interpectoral (Rotter's) lymph nodes in relation to tumor location, size, grade and hormone receptor status in primary breast cancer.
The ...study included 172 female patients undergoing surgery for breast cancer at the University Hospital for Tumors, Zagreb, Croatia from November 2001 to August 2003. In addition to the standard surgical procedure, interpectoral (Rotter's) lymph nodes were removed in all of the patients. Serum levels of the tumor marker CA 15-3 were determined before surgery and hormone receptor status after surgery.
Rotter's lymph nodes were identified in 67% of the patients, with metastatic involvement being found in 20% of the Rotter's nodes. Metastatic involvement of Rotter's nodes in patients with negative and positive axillary lymph nodes was 4% and 35%, respectively. When we looked at the location of the tumor in patients with metastatic involvement of Rotter's nodes, we found that tumors located in the upper quadrants were more prone to metastasis to Rotter's nodes; there was a significant positive correlation between tumor location and positive Rotter's nodes (r = 0.953, P = 0.012). As regards tumor size, Rotter's nodes were identified in 15%, 20% and 30% of stage T1 (< 2 cm), T2 (2-5 cm) and T3 (> 5 cm) tumors, respectively. Hormone receptor status showed no statistically significant difference in the expression of estrogen and progesterone receptors between patients with and those without positive Rotter's nodes. Of 35 Rotter's node-positive patients, 31.4% had elevated serum levels of CA 15-3; the level was significantly higher in Rotter's-positive patients compared to those with negative (or absent) Rotter's nodes.
The results show that one-fifth of breast cancer patients, or even one-third of those with positive axillary lymph nodes, are discharged with positive interpectoral lymph nodes that remain undiagnosed. As the nodes can be surgically removed without additional mutilation, exploration of Rotter's lymph nodes should be introduced into routine clinical practice.
Jednodnevna dijagnostika Ramljak, Vesna; Vielh, Philippe
Libri Oncologici,
12/2014, Letnik:
42, Številka:
1-3
Paper
Odprti dostop
U Klinici za tumore Kliničkog bolničkog centra Sestre milosrdnice, godišnje se operira oko 700 karcinoma dojke i oko 150 benignih lezija dojke. Nakon mamografije i ultrazvuka, razlikovanje malignih ...od benignih tumora se postiže punkcijom pod kontrolom različitih radioloških metoda, prvenstveno ultrazvuka.
Važnost ranog otkrivanja raka i planiranje liječenja daju najbolje rezultate. Kako bi se premostili vremenski periodi između različitih dijagnostičkih postupaka i reducirao stres koji nastaje iščekivanjem rezultata, uveli smo koncept jednodnevne dijagnostike. Usluga se sastoji od trojnog dijagnostičkog testa u slučaju sumnje na tumor i plana liječenja u vremenskom okviru od 8 sati.
Jednodnevna dijagnostika djeluje zadnje dvije godine i izazvala je pozitivne reakcije kod pacijenata i kod osoblja.
Anesteziolog izborom premedikacije i anesteziološke tehnike može pridonijeti boljoj poslijeoperacijskoj analgeziji. Intenzitet, učestalost, kvaliteta i trajanje boli razlikuju se s obzirom na vrstu ...kirurškog zahvata: opseg, mjesto i trajanje operacije. Ovise također i o psihološkom profilu bolesnika, perioperacijskoj psihološkoj i fiziološkoj pripremi bolesnika, te o kvaliteti poslijeoperacijskih postupaka. Bol nakon mastektomije i evakuacije pazušnih limfnih čvorova u otprilike polovine bolesnika po jačini se ubraja u umjerenu bol, međutim, 10–30% bolesnika je doživljava kao jaku bol. U liječenju poslijeoperacijske boli upotrebljavaju se opioidni i neopioidni analgetici. Loše liječena poslijeoperacijska bol može se smatrati znakovitim čimbenikom povećanog morbiditeta i mortaliteta, koji rezultira produženim boravkom u bolnici i posljedično povećanim troškovima liječenja. Intenzitet kronične boli, koja se može pojaviti i u obliku fantomske boli u području prsnog koša, ramena i nadlaktice nakon operacije dojke ovisi o dobroj operacijskoj tehnici, uspjehu liječenja akutne poslijeoperacijske boli, dobro provedenoj radioterapiji, kemoterapiji i fizikalnoj terapiji. Prolongirana bol ima štetne posljedice na respiratornu, kardiocirkulatornu i neuroendokrinu funkciju, može dovesti do psihičkih poremećaje u smislu depresije, te izazvati dugotrajne posljedice u središnjem i perifernom živčanom sustavu. Terapija boli mora biti ugrađena u tzv.multimodalni koncept poslijeoperacijske rehabilitacije.
Kao dijagnostička metoda, citologija je do nedavno bila nedovoljno uključena u primarnu dijagnostiku raka jajnika. No, u novije se vrijeme stav prema aspiracijskoj citologiji tankom iglom jasno ...mijenja. Uz dostupne suvremene tehnologije, ultrazvukom i CT-om vođena citološka punkcija postaje optimalna metoda za dijagnozu primarnih i metastatskih novotvorina jajnika, te za rano otkrivanje relapsa maligne bolesti. Time se citologija izravno upliće i u management liječenja pacijenta. Citološka pretraga ispirka trbušne šupljine najčešće je indicirana u određivanju stadija karcinoma jajnika (tz v. „prvi pogled“).
Zahvati tz v. „drugog pogleda“ izvode se na bolesnicima koji su prethodno tretirani kirurški, zračenjem i/ili kemoterapijom da bi se odredila ostatna bolest ili recidiv karcinoma jajnika. U oba navedena slučaja („prvi i drugi pogled“) citologija se dokazala kao korisna dijagnostička metoda.
