Successful emergency endovascular aortic repair for intratumoral hemorrhage in extensive retroperitoneal mass of testicular origin.

BACKGROUND: Metastatic germ cell cancer of the testis is characterized by favorable prognosis since effective treatment methods are available even in cases of extensive disease. Retroperitoneal masses frequently encroach major blood vessels requiring a vascular intervention usually performed in association with the post-chemotherapy retroperitoneal lymph node dissection (RPLND). Reported clinical case describes a successful pre-treatment endovascular surgery for abdominal aortic rupture allowing for full-dose systemic chemotherapy administration, and subsequent radical surgical intervention at primary tumor site as well as metastatic retroperitoneal lymph node dissection including the reconstruction of inferior caval vein. CASE PRESENTATION: Patient presented with left-sided testicular tumor and voluminous retroperitoneal mass with vascular involvement. Soon after the patient had been admitted for the first cycle of cisplatin-based chemotherapy, computed tomographic angiography (CTA) revealed a dorsal aortic wall rupture with active extravasation and irregular pseudoaneurysmatic dilatation of the aorta below the leak area. Retroperitoneal intratumoral hemorrhage associated with the bilateral iliac venous thrombosis required an endovascular repair procedure of infrarenal abdominal aorta. CONCLUSIONS: Following the successful endovascular aortic repair 3 cycles of BEP (bleomycin, etoposide, cisplatin) regimen were administered with subsequent delayed left radical orchiectomy and RPLND associated with vena cava inferior (VCI) resection. Reconstruction of VCI was originally not deemed necessary as collateral blood flow appeared sufficient, however, intraoperative complications resulted in the need for unilateral VCI reconstruction, using the interposed bypass between right common iliac vein and infrarenal segment of VCI. Histopathologic examination of the attained specimen detected no vital cancer structures. The patient remains disease-free 18 months after the RPLND.

Strumal carcinoid of the ovary - report of two cases and review of literature.

OBJECTIVE: Strumal carcinoid (SC) is a rare ovarian germ-cell tumour, which is characterized by a mixture of thyroid tissue and carcinoid. It can be presented as a monodermal teratoma or as a part of mature cystic teratoma (dermoid cyst). DESIGN: Case report. SETTING: Department of pathology, St. Elisabeth Cancer Institute, Bratislava. METHODS AND RESULTS: Hereby the authors describe two cases of this rare tumour in clinically asymptomatic women, 46- and 52-year-old, whom tumours were diagnosed at preventive gynaecological examination. The tumours considered of solid - cystic features, measured 65×45×40 mm and 75×45×40 mm and both contained parts of SC represented by tougher yellowish gelatinous areas. In both cases, SC was a part of the mature cystic teratoma (dermoid cyst), with predominated content. Histologically, both SC had a characteristic composition of intimate mixture of mature thyroid tissue and carcinoid. Immunohistochemically, the thyroid tissue stained positively with cytokeratin7, thyroglobulin and thyroid transcription factor-1, and the carcinoid component exhibited expression of synaptophysin and chromogranin A (only in one case). Tumour cells of both components of SC were negative for calcitonin and carcinoembryonic antigen. Both tumours showed low proliferation activity expressed by Ki-67 (up to 2%). Tumours were diagnosed in stage IA, and up to now are patients without any complications associated with tumours, free of relapse for 3 years and 6 months, respectively. CONCLUSION: SC represents an interesting form of primary ovarian carcinoid, which is usually asymptomatic and when confined to ovary, mostly has benign behaviour and can be treated by simple one-sided or bilateral adnexectomy. Keywords ovary, germ cell tumours, strumal carcinoid, immunohistochemistry.

[CLINICO-MORPHOLOGICAL STUDY OF 68 CASES OF INVASIVE ENDOCERVICAL ADENOCARCINOMA].

UNLABELLED: Recent studies have demonstrate an increase in both relative and absolute frequency of the cervical adenocarcinoma (ECA) with incidence about 10-25% of all cervical malignancy. THE AIM: clinicopathological study of invasive ECA. MATERIALS AND METHOD: From 2007 to end of 2011, 68 cases of invasive ECA were collected. The tumors were classified according the WHO classification of tumors of Tumors of the Female Reproductive Organs 2014. RESULTS: The distribution of different histological types of ECA was as follow: Usual type-29 (42.65%); Endometroid type-15 (22.06%); Adenosquamous type-15 (22.06%); Villoglandular type-6 (8.82%); Signet-ring type-2 (2.94%); and Intestinal type-1(1.47%). The middle age of patients was 45 years and varied in large diapason 27-73 years. A synchrony presence of CIN and glandular dysplasia even to AIS in some cases with usual and adenosquamous type were detected. The clinical and morphological data of every type ECA was analised.

Current possibilities of cervical precancerous lesions screening in Slovakia: prevalence of high risk human papillomavirus in patients with cytological diagnoses of atypical squamous cells of unknown significance.

INTRODUCTION: It has been confirmed, that there is a causal relationship between persistent infection of high risk human papillomavirus (HR-HPV) and the development of cervical cancer. In population of women older than 30 years HPV infection becomes a significant etiological factor of precancerous lesion of the cervix, but HPV infection may spontaneously regress in the majority of the cases. PATIENTS AND METHODS: The analysed study group consisted of 397 samples with cytological diagnosis of atypical squamous cells of unknown significance (ASCUS). All cases underwent HPV DNA testing using the Hybrid Capture 2 (HC2) assay. We analysed prevalence of HR-HPV and a viral load expressed as relative light units/cut off ratio (RLU/CO) in different age groups with cytological diagnoses of ASCUS. RESULTS: The prevalence of HR-HPV with cytological diagnoses of ASCUS was detected in 44 %. The prevalence of HR-HPV between patients aged 17-29 and between patients aged 30-40 was 55 % and 48 % respectively and we detected significant reduction of prevalence (28 %) in patients older than 41 years. CONCLUSION: Based on the results of presented study we assumed that age the 40 and over is crucial for the development of serious precancerous lesions in Slovakia, thus this age group is the most suitable for HPV triage of ASCUS. As a refinement of that type of ASCUS triage we recommend to add to the algorithm quantitative measurement of viral load in the specimens in the form of RLU/CO ratio (Fig. 3, Ref. 27).

Renal oncocytoma with invasive histopathologic features -  case report.

BACKGROUND: Renal oncocytoma is an uncommon tumor, classified as a benign renal neoplasm in the World Health Organisation classification of renal tumours. Despite it there were described several reports with invasive histopathologic features. CASE REPORT: We describe a case of renal oncocytoma with bizzare cells and invasion of renal sinus fat tissue. We performed immunohistochemical analysis of the case and a review of relevant literature. CONCLUSION: In order to set up the right dia-gnosis the perfect co- operation of clinicians and pathologists is necessary. In our opinion, in accordance with other authors, the renal oncocytomas should be considered as having a very low rather than no malignant potential, in spite of clinically benign behavior, supplementing a hypothesis, whether renal oncocytomas may be considered as a precancerous lesion of chromophobe carcinoma.

[Precancerous and cancerous lesions of the uterine cervix--risks of the morphological diagnostics].

In this article authors are analyzing the current state of the morphological-macroscopic and microscopic diagnostics of precancerous and cancerous tumors and lesions of the uterine cervix it is made a brief, retrospective view of the development of the relevant questions, examining closely the routinely applied procedures and indicators leading to possible risks of erroneous diagnostics. The evaluation is focusing on diagnostic problems within the area of cytological, as well as, histological analyses. Some lesions in endocervical pathology have the potential to be misinterpreted and are discussed as sources of false-positive smears in cytological diagnostics. More emphasis is placed on those benign lesions which mimics malignancy: ectopias, metaplasias and hyperplasias (mesonephric remants, endometriosis: tunnel clusters, tubal metaplasia, microglandular hyperplasia etc.).