Intraoperative tumor lysis syndrome in a giant teratoma: a case report.

BACKGROUND: Tumor lysis syndrome is an unusual metabolic emergency in solid tumors. Perioperative occurrence of this syndrome is extremely rare but may have fatal consequences if not detected and treated on time. CASE REPORT: We report a 19-year patient with testicular germ cell tumor after first line chemotherapy with giant growing teratoma syndrome in retroperitoneum. He underwent radical resection, however, perioperatively, a fatal case of heart failure due to unrecognized intraoperative tumor lysis syndrome developed. CONCLUSION: Surgeons, anesthesiologists and oncologists should be aware of this complication in order to be prepared for such an emergency.

[Importance of lymphangiogenesis and ultrastructure of lymphatic capillaries in metastasis of malignant melanoma]. / Význam lymfangiogenézy a ultrastruktúry lymfatických kapilár pri metastázovaní malígneho melanómu.

Lymphangiogenesis - proliferation of lymphatic capillaries - in melanoma and in its vicinity plays an important role in metastatic process of malign melanoma cells in organism. Melanoma produces epidermal growth factor EGF which induces vascular endothelial growth factor VEGF-C and thereby starts lymphangiogenesis. It is very probable that malignant melanoma cells enter lymphatic capillaries also through specialized inter-endothelial junctions (endothelial microvalves, primary valves) situated in their walls. After entry of malign cells into lymphatic capillaries, these cells travel in lymph to the sentinel lymph node. Malign cells metastasize through lymphatic vessels probably also directly into distal regional lymphatic nodes. Metastasizing through blood vessels is suggestible also in early stage melanoma.

[Sentinel lymph node in malignant melanoma]. / Sentinelová uzlina pri malígnom melanóme.

Melanoma is highly malignant tumor which arises through malignant transformation of melanocytes. Surgical treatment of primary cutaneous melanoma including radical excision and intervention in regional lymphatic drainage is irreplaceable. Sentinel node biopsy is a recognized method of defining the stage of disease. Performance of sentinel node biopsy in patients in clinical stage Ib and II may reveal clinically occult nodal disease and thereby help identify a group of patients with occult stage III disease who may thereafter undergo complete lymphadenectomy and systemic treatment. Sentinel node biopsy is beneficial in treatment of melanoma, but the therapeutic value of sentinel node biopsy is still not completely clear and remains disputable.