Clinical staging and histopathological findings after radical hysterectomy in FIGO stage IIB cervical cancer.

PURPOSE: Advanced cervical cancer still represents a major health care challenge in the developing world. According to standard protocols the treatment of choice for stage IIB cervical cancer is cisplatin-based chemoradiotherapy. However, in some European countries, and especially in Japan, patients with stage IIB cervical cancer are generally treated with radical hysterectomy as initial treatment. The aim of this study was to compare clinical stage with pathological findings, and also to correlate any relationship between parametrial infiltration and nodal status. PATIENTS AND METHODS: From 1997 to 2006, 26 patients with FIGO stage IIB cervical cancer were radically operated (Piver class III operation). Preoperative clinical findings were compared with the pathological findings of the surgical material. The correlation between infiltration of the parametria and lymph node status was also examined. Fisher's exact test was used to examine statistical significance. RESULTS: The patients' median age was 48.3 years (range 36-61). The median number of removed lymph nodes was 16 (range 8-40). The histopathological types of cervical tumors were: squamous cell carcinoma 80%, adenosquamous carcinoma 15% and adenocarcinoma 5%. In 50% of the patients the parametria were infiltrated, suggesting that 50% of the patients were clinically overstaged. Positive lymph nodes were found in 69% of patients with positive parametria and 15% in patients with negative parametria (p <0.05). Patients with positive lymph nodes received adjuvant chemoradiotherapy. CONCLUSION: Adequate preoperative staging such as clinical examination under anesthesia or nuclear magnetic resonance could help to exclude parametrial involvement in equivocal cases. Parametrial invasion presents an important risk factor for lymph nodes metastases.

Blue dye versus combined blue dye-radioactive tracer technique in detection of sentinel lymph node in breast cancer.

BACKGROUND: Sentinel lymph node biopsy in breast cancer can be used to select patients in which axillary lymph node dissection could be avoided. In this study we compared the value of two methods for identification of sentinel node (SN) using either only blue dye or combination of blue dye and radioactive tracer. MATERIAL AND METHODS: All patients were women with clinically T(1-2)N(0)M(0) breast cancer. They were randomized into two groups. In Group A (50 patients) SN marking was performed only with blue dye and in Group B (100 patients) combined SN marking with blue dye and radiotracer was done. We used 2 ml of blue dye Patentblau V (Byk Gulden). Radiotracer was Antimony sulfide marked with Tc 99m and of 0.3 mCy (11.1 MBq) activity. Application method of both contrasts was peritumoral. After SN biopsy all patients underwent mastectomy or conservative surgery with axillary lymph node dissection of levels I and II. RESULTS: In Group A mean of 1.7 SNs were identified (median 1, range 1-4). False-negative rate in this group was 3/17 (17.6%) with negative-predictive value 20/23 (86.9%), sensitivity 14/17 (82%), specificity 20/33 (60%) and accuracy 34/50 (68%). In Group B mean number of SNs excised per case was 1.6 (median 1, range 1-5). False-negative rate was 2/44 (4.5%), negative-predictive value 41/43 (95.3%), sensitivity 42/44 (95%), specificity 41/56 (73%) and accuracy 83/100 (83%). The combination technique was significantly superior to blue-dye alone technique for negative-predictive value (p=0.033) and overall accuracy (p=0.048). CONCLUSIONS: The prediction of axillary lymph node status in breast cancer patients using combined technique has significantly higher accuracy than marking of SN with blue dye alone and therefore should be preferred.

[Endobronchial metastases in extrapulmonary malignant tumors]. / Endobronhijalne metastaze vanplucnih malignih tumora.

Endobronchial metastases of extrapulmonary malignant tumors are very rare and they appear in 1-2% of all the pulmonary metastases cases. By their endoscopic presentation, they are similar to primary bronchogenic carcinoma. Eleven patients with endobronchial metastases were presented, 8 male and 3 female. The average age was 58.27 years (from 37 to 72 years). Primary renal carcinoma existed in 2 patients. The one was operated 5 years before the metastases appeared in bronchus, and the metastases in bronchial wall contributed to the discovery of primary tumor in the other patient. Endobronchial metastases appeared in 3 patients, 2 years after the surgery of malignant colonic or rectal tumor, and in fourth patient it appeared 5 years after the surgery. One female patient sustained mastectomy and the radiation therapy was performed 11 years before the bronchial metastases occurred and the other female patient had the disease revealed a year ago and the polytherapy was performed. In the female patient with non Hodgkin Lymphoma, the change in bronchus was revealed simultaneously as the primary disease. Endobronchial metastases appeared in 2 patients two years after the surgery of malignant melanoma. The disease diagnosis was set by clinical-radiological examination, by endoscopy and by the comparison of histopathologic finding of primary carcinoma and metastases.

[Personal experience in the treatment of tuberculosis in patients in war areas]. / Nasa iskustva u lecenju tuberkuloze kod obolelih sa ratnih podrucja.

In the four-year period (1991-1995), 96 tuberculosis patients from the war areas of former Yugoslavia were treated in the Clinic for Lung Diseases of Military Medical Academy, that makes 31% of total number of sick and treated for tuberculosis-309 (100%). In group I (patients from war areas) there were 45 cases of cavernous pulmonary tuberculosis (47%), 28 bilateral (29%), 16 pleurisy (16.7%) and 6 cases of extensive pulmonary tuberculosis (5.1%). Among 213 patients (100%) from group II (patients from FR Yugoslavia), 81 patients had cavernous pulmonary tuberculosis (38%), 49 patients had bilateral (23%), 33 patients had pleurisy (15.5%) and 6 patients had extensive pulmonary tuberculosis (2.8%). In group I the diagnosis was bacteriologically and/or histopathologically proved in 94.8% cases: by finding of acid-resistant bacilli in sputum and other biological materials in 69 patients (72%), by positive Löwenstein's cultures in 73 patients (76%) and by histopathological result of tuberculosis inflammation in 34 patients (35.4%). In group II tuberculosis was bacteriologically and/or histopathologically proved in 134 patients (63%) by acid-resistant bacilli in sputum and other biological materials, in 141 patient (66%) by positive Löwenstein's culture and in 71 patient by positive histopathological results. Pulmonary tuberculosis in war areas is characterized by greater frequency of severe clinical forms (cavernous, bilateral and extensive) and by high direct bacillarity.

[Hürthle cell carcinoma of the thyroid gland]. / Hürthle cell karcinom stitaste zlezde.

The authors have analysed 9 cases of Hürthle cell thyroid carcinoma diagnosed on the bioptic material in the period 1975-1991. In 7 patients subtotal and in 2 total thyroidectomy was performed. In one patient only signs of metastases of the tumour in the region of the mediastinum, neck lymphatic nodes and brain developed and the patient died a year after surgery. For differential diagnosis of Hürthle cell thyroid carcinoma and Hürthle cell adenoma the authors recommend as necessary that beside the presence of the basic criteria for malignancy (infiltration of the capsule and adjacent tissue, invasion of the blood vessels, pleomorphism and pathologic mytoses) the electron microscopic examination and immunohistochemical methods should be also used which could be of a great help for establishment of a correct diagnosis on which depends further therapy as well.

[Tuberculous inflammation of the synovial membrane]. / Tuberkulozno zapaljenje sinovijalne membrane.

Four patients with tuberculous synovitis of the large joints are reported in whom primary tuberculous process has not been confirmed as a possible foci of spreading of the acidoresistant bacilli. The authors, describing in details the histologic picture of tuberculous synovitis, point out the importance of an early biopsy of the synovial membrane and obligatory microbiological confirmation of the established diagnosis.