The report covers the first case of insular thyroid cancer recorded in Croatian medical literature. A 71-year old female patient presented to our hospital with symptoms of inspiratory stridor. ...Clinical examination disclosed an expansive tumor mass. US guided FNA indicated anaplastic cancer and total thyroidectomy was accordingly indicated. Pathohistological analysis of H/E biopsies disclosed a tumor mass with a characteristic insular growth pattern of monomorphic tumor cells. Immunohistochemical analysis confirmed diagnosis by a diffuse positive reaction to thyreoglobulin, focally to TTF-1, and scant to cytokeratin, while calcitonin, FVIII, CD34 and LCA were clearly negative. P53 and bcl-2 were expressed in 35.9% and 85% of tumor cells, respectively. The proliferation index for Ki-67 was 4.19. According to our survey we suggest a panel of immunohistochemistry for diagnosing insular cancer. Even if partly present, insular cancer should be mentioned in the pathohistological description because of its prognostic meaning.
UVOD: Nacionalni program za mamografski probir raka dojke u Hrvatskoj započeo je 2006, s ciljem otkrivanja raka u ranijem stadiju bolesti. Program uključuje mamografski pregled žena u dobi od 50 do ...69. Cilj našeg istraživanja je utvrditi razlike u patohistološkim karakteristikama raka dojke prije uvođenja probira s novodijagnosticiranim.
MATERIJALI I METODE: Retrospektivno smo u jednom centru prikupili podatke o patohistološkim karakteristikama raka dojke bolesnica oboljelih na početku mamografskog probira (2005-2007; N=1833) i podatke o novooboljelima iz razdoblja više od deset godina nakon uvedenog probira (2017-2019; N=2676). Dobivene podatke analizirali smo upotrebom χ2 testa.
REZULTATI: Zbrinuli smo 31.5% više novodijagnosticiranih bolesnica s karcinomom dojke. Naši rezultati nisu pokazali statistički značajne razlike u veličini tumora, histološkom gradusu ili pozitivnom status limfnih čvorova u podpazušnoj jami u skupini novodijagnosticiranih bolesnica s karcinomom dojke u usporedbi s onima iz razdoblja prije mamografskog probira. Prosječna dob oboljevanja je 61 godina s prosječnom veličinom tumora od 22 mm (medijan 18 mm), u oba razdoblja. Oko 45 % bolesnica je dijagnosticirano s pT1N0, u oba razdoblja.
ZAKLJUČAK: U razdoblju nakon uvođenja probira zbrinuli smo 32% više oboljelih od raka dojke u našoj instituciji. Nismo zabilježili razlike u patohistološkim karakteristikama tumora, niti u prosječnoj veličini tumora između ova dva perioda.
Karcinomi kože su najčešći zloćudni tumori. Točno postavljanje dijagnoze karcinoma kože otežano je kod atipičnih promjena, sumnje na recidivni tumor, te kod bolesnika s multiplim kožnim promjenama. ...Citobris je bezbolna, neinvazivna i točna metoda, korisna u prepoznavanju zloćudnih kožnih tumora. U naše istraživanje uključili smo 91 bolesnika liječena
zbog karcinoma kože. Ukupna točnost citobrisa kod ovih blesnika bila je 91.2%. Ova metoda posebno je korisna kod razlikovanja malih promjena dobroćudnog izgleda, kod multiplih kožnih promjena, te kod sumnje na recidiv kožnog tumora.
Endometrial cancer is the most common gynecological cancer but there is no economically justified screening method. Although we can detect endometrial cells in the sample using PAP test, many studies ...show low sensitivity and positive predictive value of PAP test for the diagnosis of endometrial cancer. The goal of this research was to determine significance of PAP test for the diagnostics of endometrial carcinoma. Sensitivity and specificity were analyzed with statistical parameters. VCE (vaginal, cervical, endocervical) smears of patients with histologically proven endometrial carcinoma were re-examined in order to determine the proportion of false negative results for endometrial cancer cells in the VCE samples. Study group consisted of all consecutive patients with PAP test performed at the Department of Clinical Cytology of the University Hospital Osijek from 2002. until the end of 2014. There was one inclusion criteria: subsequent hysterectomy or curettage within the six month after the PAP test, regardless of histological finding. From a total of 263 patients with previous PAP test and histologically proven endometrial cancer, endometrial cancer was cytologicaly diagnosed in 24.7% (including suspicious and positive findings), while 66.2% patients had normal cytological findings. The diagnostic value of PAP test in detection of endometrial cancer was statistically revealed with 25% sensitivity and 99% specificity. To determine false negative rate VCE samples were reviewed for patients with histologically proven endometrial cancer and negative VCE findings. There were a total of five negative results. In one case revision did not changed the original negative diagnosis, but benign endometrial cells, a lot of blood and inadequate cytohormonal status were found. In three out of four reviewed samples there were missed cells of endometrial adenocarcinoma. Review of remaining VCE sample upgraded the diagnosis from negative to suspicious for endometrial cancer. Proportion of error in the detection of endometrial cancer using cytological findings was 3.4% (true false negatives). Negative rate of the cytological findings in the detection of endometrial cancer was 66.2%. PAP test is not a suitable method for detection of endometrial carcinoma due to low sensitivity (25%). The main cause of negative findings in PAP test was lack of diagnostic cells in the sample.
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.
Primarni hiperparatireoidizam (pHPT) je stanje povećane i nekontrolirane sekrecije paratireoidne žlijezde radi hiperfunkcije jedne ili vi e paratireoidnih žlijezda. U 80-85% slučajeva pHPT je ...uzrokovan adenomom žlijezde. Ustrajan hiperparatireoidizam uzrokuje promjene u metabolizmu kostiju. Rijetko, približno u svakog tridesetog bolesnika s pHPT, mogu se razviti i ne-neoplastične lezije kostiju, tzv. sme|i tumor u primarnom hiperparatireoidizmu. Kirurško uklanjanje hiperaktivne žlijezde jedini je način korekcije stanja pHPT. Ovim se prikazom slučaja prvi put izvješćuje o intraoperativnom mjerenju koncentracije PTH u pHPT u Hrvatskoj. Monitoriranje intraoperativne koncentracije PTH pruža mogućnost dodatne sigurnosti za bolesnika i operatera, te ujedno postaje egzaktan vodič (navigator) operateru-kirurgu, koji na temelju pada vrijednosti ovog peptida izrazito kratkog vremena poluživota donosi trenutnu odluku o tomu je li operacija završena ili je potrebno daljnje uklanjanje paratireoidnih žlijezda zbog hiperplazije. Jamstvo uspješne dijagnoze, koja je preduvjet pravilnog liječenja, jest kontinuirana multidisciplinarna, sistematična i sinkronizirana suradnja cijelog i raznorodnog medicinskog tima koji uključuje kliničara, radiologa, citologa, patologa i medicinskog biokemičara.
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.
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.
Adenom bradavice dojke – prikaz slučaja Ramljak, Vesna; Ranogajec, Irena; Šarčević, Božena ...
Libri Oncologici,
12/2003, Letnik:
31, Številka:
1-3
Web Resource
Odprti dostop
U radu je prikazan slučaj rjeđega benignog tumora dojke – adenoma bradavice. Adenom bradavice je benigni tumor bez vezivne čahure građen od malih tubula obloženih epitelnim i mioepitelnim stanicama ...sa ili bez proliferacije epitelne komponente oko sabirnih kanalića. Kao zasebni kliničko patološki entitet 1955. ga izdvaja Jones. Tumor se najčešće pojavljuje u žena između 40-50 godine uz simptome često krvavog iscjetka te promjene bradavice u obliku eritema, kruste ili ulceracije zbog čega se klinički često zamijeni s Pagetovom bolesti.
Izvještavamo o pacijentici koja je u citološki laboratorij upućena pod kliničkom sumnjom da se radi o malignoj bolesti, s eritematoznom, egzulceriranom bradavicom uz povremeni krvavi iscjedak. Mamografski nalaz je bio uredan, a UZV nalaz je pokazivao manju hipoehogenu zonu neposredno ispod bradavice. Materijal za citološku analizu dobije se metodom struganja, oboji standardno MGG-om te se citološki postavi sumnja na zloćudni tumor.
Na PHD analizu se zaprimila bradavica s tumorom čvršće konzistencije. Biopsije standardnog H&E bojenja pokazivale su tumor koji je dijelom bio pokriven višeslojnim pločastim epitelom uz kanaliće u kojima se mjestimice vidjela i proliferacija epitela te se postavila dijagnoza adenoma bradavice.
Zbog rijetke pojave ovog tumora, njegove kliničke prezentacije te citološke slike jake celularnosti, disocijacije stanica uz mjestimice izražene znakove atipije, nije neobično da se tumor citološki klasificira kao karcinom. Za lezije bradavice koje se prezentiraju kao egzulcerirane promjene, te općenito promijenjeni izgled bradavice, osim Pagetove bolesti treba svakako razmišljati i o benignim tumorima kao što je adenom bradavice.
Terapija izbora je uklanjanje bradavice u cijelosti zato jer se, iako rijetko, mogu naći i žarišta karcinoma.
U radu prikazujemo rijedak slučaj primarnog slabo diferenciranog sinovijalnog sarkoma (SS) aksilarne regije čija je dijagnoza potvr|ena patohistološkom analizom.
Sinovijalni sarkom čini 5-10% ...mekotkivnih sarkoma. Oko 20% slučajeva ima sliku slabo diferencirane varijante, malih okruglih stanica podsjećajući na Ewingov sarkom. Diferencijana dijagnoza uključuje ES/PNET skupinu tumora, rabdomiosarkom, desmoidnu fibromatozu i maligni melanom.
Četrdesetšestogodišnja pacijentica primljena je u našu ustanovu žaleći se na lagano bolnu 10 cm veliku tumorsku masu u desnoj aksilarnoj regiji u trajanju od dva mjeseca. Klinički pregled (CT; UZV) potvrdili su ekspanzivnu tumorsku masu, a citološka analiza upućivala je na dijagnozu sarkoma te je učinjen operativni zahvat.
Histološka i imunohistokemijska analiza potvrdila je dijagnozu slabo diferenciranog SS.
Unatoč primjeni dodatnih metoda citološke analize, poput imunocitokemije, slabo diferencirana varijanta sinovijalnog sarkoma može se lako, zbog kompleksne, preklapajuće morfologije kao i ograničenog iskustva citologa na polju rijetkih tumora mekih tkiva, zamijeniti s drugim tumorima. Ipak prepoznavanje ove varijante SS od važnosti je zbog njegove lošije prognoze.
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