Solitary primary intraosseous xanthoma of the mandible in a 15-year-old boy: a case report.

BACKGROUND: A xanthoma is a rare bone condition consisting of a predominant collection of lipid-rich, foamy histiocytes. The central xanthoma of the jaws is a unique benign tumor. CASE REPORT: A 15-year-old Caucasian male has been presented to our department. He had radiological changes in the area of the left mandibular angle, with an area of diffuse osteolysis of 3.0 cm by 2.0 cm. Computed tomography reveals an area of diffuse osteolysis that starts from the distal root of the lower second molar and reaches the ascending process. A bone biopsy was performed, which revealed a benign proliferative process composed of histiocytic cells involving and infiltrating trabecular bone in a background of loose fibrous connective tissue devoid of any other significant inflammatory infiltrate. The size of the formation was 2.9 cm by 2.0 cm. Immunohistochemical staining for CD68 was strongly positive and negative for S-100 and CD1a. From routine blood tests, cholesterol, triglycerides, and blood sugar are within normal values, which excludes systemic metabolic disease. Subsequent to the surgical intervention, the patient underwent postoperative assessments at intervals of 14, 30, 60 days, and a year later, revealing the absence of any discernible complications during the aforementioned observation periods. CONCLUSION: The diagnosis of primary xanthoma of the mandible is rare and can often be confused with other histiocytic lesions. A differential diagnosis should be made with nonossifying fibroma and Langerhans cell histiocytosis, as in our case. In these cases, immunohistochemistry with CD 68, S-100, and CD1a, as well as blood parameters, are crucial for the diagnosis.

[THE ROLE OF ESTROGENS IN THE CARCINOGENESIS OF LUNG CANCER].

Morbidity and mortality from lung cancer has dramatically increased in women as compared to men over the past few years. Historically, smoking has been considered the major risk factor for lung cancer regardless of gender. Several recent lines of evidence implicate gender differences in the observed differences in prevalence and histologic type which cannot be explained based on the carcinogenic action of nicotine. Several recent studies underscore the importance of reproductive and hormonal factors in the carcinogenesis of lung cancer Lung cancer morbidity and mortality in Bulgaria was 16.2/100000 women and 14.6/ 100000 women, resp. Lung cancer morbidity in Europe was 39/100000 women. Lung cancer is extremely sensitive to estrogens. The latter act directly or as effect modifiers for the relationship between smoking and lung cancer. Further research examining the relationship between serum estrogen levels and the estrogen receptor expression in normal and tumor lung tissue samples can help elucidate the importance of reproductive and hormonal (exogenous and endogenous) factors in the carcinogenesis of lung cancer.

Mammary gland papilloma--diagnostic and therapeutic behavior.

Papillary lesions of the mammary gland represent a serious disease and incorporate a broad spectrum of lesions. The goal of the current article is to reveal the diagnostic methods and therapeutic behavior in patients with pathological discharge from the nipple of the mammary gland. In this article we present 15 cases of histologically proven mammary gland papilloma. Mammographic, ultrasonographic and cytologic methods are applied for diagnostic specification. The chosen therapeutic behavior in all of the women is surgical. We take into consideration the possibilities of the different diagnostic methods as well as the therapeutic behavior-conservative or surgical approach. We reckon that when there is suspicion for mammary gland papilloma a surgical intervention is necessary to be carried out--due to the functional discomfort and due to the possibility intraductal carcinoma in situ to be missed out in some cases.

[VATS in patients with solitary periferal pulmonary tumors].

UNLABELLED: The patients with periferal solitary pulmonary nodule often present a serious diagnostic and therapeuthic challenge.The aim of our study is to present our experience in VATS for diagnosis and treatment of patients with solitary periferal pulmonary tumors. MATERIAL AND METHODS: For the period of 1997-2009, 146 patients with periferal pulmonary tumors underwent VATS for resection of the tumor. RESULTS: 112 (74.2%) of the patients underwent radical VATS resection of the tumor after intraoperative frozen sections for diagnosis. In the rest 39 cases (25.8%) due to different reasons VATS was converted to open thoracotomy and wedge resection. 54.55% of the resected tumors were malignant and 45.45% of them were benign. In 18 patients the intraoperative frozen sections confirmed primary lung cancer, and the procedure was converted to thoracotomy and radical resection. In 13 patients the results from the intraoperative frozen sections were not definite and we were not able to differ wether the tumor was a pulmonary metastase or a primary lung cancer, and after the final histological examination the patients were submitted to radical resection in interval. In 33 of the cases we resected pulmonary metastases from an extrapulmonary primary tumor. CONCLUSIONS: Despite the advances in diagnostic technics, only the VATS resection of the pulmonary tumor and the histological examination assures definitive diagnosis, it allows the definitive treatment for the benign lesions and indicates the correct treatment for malignant lesions.

[Postoperative survival in patients with inoperable lung cancer].

UNLABELLED: Despite the advances in treatment in the last two decades, the prognosis in lung cancer remains infavourable. Only 20-25% of the patients are suitable for operative treatment. Almost 75% of the patients are inoperable at the time of diagnosis. MATERIAL AND METHODS: We present 148 patients, who underwent non-radical operation for the period 01.01.1997 - 31.12.2005 - 129 men (87.16%) and 19 women (12.84%), age range - 29-65 years (53.67 +/- 0.60). RESULTS: The mean time of survival for the group submitted to radiotherapy is 13.74 months, while for the group without postoperative radiotherapy is 9.31 months. The mean time of survival for the group submitted to chemotherapy is 9.99 months, while for the group without adjuvant chemotherapy is 10.27 months. CONCLUSIONS: The radiotherapy significantly improves the survival in the patients with inoperable lung cancer, while the chemotherapy don't increase the survival.

[Stage of disease as a prognostic factor in radically operated patients with non-small cell lung cancer].

UNLABELLED: Despite the better diagnostic and therapeutic opportunities, lung cancer is still the major cause for cancer mortality. The surgical-pathological TNM-stage is known as the most reliable prognostic factor for survival in patients with lung cancer. MATERIAL AND METHODS: We present 440 patients with non-small cell lung cancer, radically operated in the Clinic of Thoracic and abdominal surgery of University Hospital "St.George" - Plovdiv for the period 01.01.1997 - 01.09.2004 - 378 men (85.91%) and 62 women (14.09%), age range 23-82 years. RESULTS: The mean time of survival according to the stage is as follows: IA - 77 months, IB - 67, IIA - 55, IIB - 42, IIIA - 33 IIIB - 14, IV - 27 months. CONCLUSIONS: The stage of the disease is an important prognostic factor for patients with lung cancer. We found the lowest survival in stage IIIB. For selected patients in stage IV, the operative treatment leads to good results.

[Extent of resection as a prognostic factor in patients with non-small cell lung cancer].

UNLABELLED: Despite the new methods of treatment during the last two decades, prognosis in lung cancer remains unfavourable. Only 20-25% of the patients are suitable for surgery, and the surgical resection is the unique alternative with curable intent. The extent of resection is an important prognostic factor in lung cancer patients. MATERIAL AND METHODS: We present 440 patients with non-small cell lung cancer, radically operated in the Clinic of Thoracic and abdominal surgery of University Hospital "St.George" - Plovdiv for the period 01.01.1997 - 01.09.2004.191 underwent lobectomy, 12 - limited resection, 39 - bilobectomy, and 198 - pneumonectomy. RESULTS: 63 patients underwent lobectomy for stage I, and the 5-year survival was 63.49%. For the 12 patients with limited resection we found mean time of survival of 50 months, and the 5-year survival was 50%.331 of our patients were in stage II and III. 123 of them underwent lobectomy--the 5-year survival was 28.46%. 208 patients underwent bilobectomy and pneumonectomy--the 5-year survival in this group was 17.79%. CONCLUSIONS: In conclusion we found that the extent of resection is an important prognostic factor for lung cancer patients in stage I. The patients submitted to lobectomy have better survival compared with those submitted to limited resection. The survival is better for the group of patients who underwent lobectomy,compared with the one for the group with bilobectomy and pneumonectomy, which is probably due to the earlier stage of the disease.

[Prognostic value of estrogen receptors--ERalpha and ERbeta, in patients with lung cancer].

SUMMARY: There are over 150 prognostic factors in lung cancer, which allow to predict the outcome of the disease.Many molecular factors are known to have independent prognostic significance. At present these factors are not routinely used in the clinical practice, but they may play an important role in the future for precise individual prognosis. MATERIAL AND METHODS: The study included 122 patients with non-small cell lung cancer.Using immunohistochemistry we examined the expression of estrogen receptors--ERalpha and Erbeta. RESULTS: The median time of survival depending on the expression of Eralpha was 31 months, while for Erbeta was 73 months. CONCLUSIONS: Erbeta is a positive prognostic factor in patients with non-small cell lung cancer.

[Prognostic value of the molecular markers ICAM-1 and C-JUN in patients with lung cancer].

UNLABELLED: Many of the clinical and fundamental scientific studies are directed to the investigation of the prognostic factors in patients with lung cancer. Many molecular factors are known to have independent prognostic significance and although these factors are not routinely used in the clinical practice, they may play an important role in the future. MATERIAL AND METHODS: The study included 122 patients with non-small cell lung cancer. We examined the expression of ICAM-1 and C-Jun. RESULTS: The median time of survival for the group with poor expression of C-Jun was 39 months, and 26 months for the group with strong expresssion. The median time of survival for the group with poor expression of ICAM-1 was 51 months and only 9 months for the group with strong expresssion. CONCLUSION: The increased levels of ICAM-1 and C-Jun are negative prognostic factors for the patients with non-small cell lung cancer.

[The role of surgical treatment of primary non-small cell lung cancer with synchronous brain metastases].

UNLABELLED: Although several studies confirm the superiority of surgical resection of the primary lung cancer and metachronous brain metastases to other treatment modalities, the results of resection of the primary non-small cell lung cancer and synchronous brain metastases are still controversial. MATERIAL AND METHODS: In the clinic of Thoraco-abdominal surgery of the University Hospital "St.George" for the period 01.01.1997-01.09.2004 radically operated are 440 patients with non-small cell lung cancer, 6 of them had solitary brain metastases, succefully resected in clinic of neurosurgery. RESULTS: We found 5-year survival in only 1 of the patients, the mean survival for the rest of them was 16 months. CONCLUSIONS: Although the overall survival for the patients with non-small cell lung cancer and brain metastases is poor, the surgical resection may be beneficial in a select group of patients without lymph node metastases.

[Prognostic value of the molecular markers cyclin D1 and P53 in patients with lung cancer].

UNLABELLED: The discovery of new genes with important regulatory functions on cellular level, allowed the investigation of many biological and molecular changes and defining their value as potential prognostic factors. MATERIAL AND METHODS: The study included 122 patients with non-small cell lung cancer. We examined the expression of cyclin D1 and p53. RESULTS: The 5-years survival rate was 26% for the group with strong nuclear expression of cyclin D1, and 80% for the group with moderate expression of the marker. We found 5-years survival rate of 100% for the group with poor expression of p53, and 24.55% for the group with strong expression. CONCLUSIONS: The increased levels of cyclin D1 and p53 are negative prognostic factors for the patients with non-small cell lung cancer.

[A case of heterotopic pregnancy].

Heterotopic pregnancy is the simultaneous occurrence of intrauterine and ectopic pregnancy. Because of the increasing use of assisted reproductive technology techniques, the frequency of heterotopic pregnancy rises during the past years. We present a case of simultaneous occurrence of ruptured extrauterine /tubal/pregnancy and intrauterine /twin/pregnancy after IVF and ET.

[Sex as a prognostic factor for the patients with non-small cell lung cancer].

UNLABELLED: Lung cancer is the leading cause for cancer mortality in the men and has an increasing prevalence in the women worldwide. There is growing evidence that the sex is an important prognostic factor for the patients with lung cancer. MATERIAL AND METHODS: We present 440 radically operated patients with non-small cell lung cancer between 1997 and 2004, age range: 23-82 years (378 male- 85.91% and 62 female14.09%). RESULTS: The 5-years survival rate was 26,19% for the men (99 patients) and 51.61% for the female patients (32 patients). CONCLUSIONS: Sex is a significant prognostic factor for the patients with non-small cell lung cancer. Female sex is a good prognostic factor for survival.

[Adenocarcinoma of the pancreas with distant meningeal metastasis].

The incidence of meningeal metastasis from pancreatic cancer is extremely low. In our country patients die rapidly from pancreatic cancer and are extremely rarely subjected to autopsy--they either die at home, or complications from primary tumor result in low clinical interest. We had the rare chance to perform an autopsy on a female patient with meningeal spread of pancreatic carcinoma, in which the patient initially developed signs of neurologic disorder without exhibiting any symptoms of pancreatic disease.

[The role of video-assisted thorascopy in determination of surgical behaviour in patients with non-small cell lung cancer and pleural effusion].

INTRODUCTION: Although of introduction of new methods for diagnosis in patients with lung cancer and pleural effusion, VATS remain "the gold standart". AIM OF THE STUDY: The aim of this study is to present our experience in using VATS for diagnosis and surgical behaviour in patients with lung cancer and pleural effusion. MATERIALS AND METHODS: Between January 2007 - March 2009 in Department of thoracic and abdominal surgery UMBAL St. George Plovdiv we made 62 VATS in patients with lung cancer and pleural effusion. RESULTS: In 30 patients we discover pleural carcinomatosis and we made pleurodesis. In other 32 patients, we didn't find pleural carcinomatosis and we made radical operations. CONCLUSION: On the basis of small number of complications. directly related with this manipulation, we can conclude that this technique is safe and help us to decrease the number of unnecessary thoracotomy until 50%.

["M"-category as a prognostic factor in operated patients with non-small cell lung cancer].

UNLABELLED: Review of the world literature reveals more than 150 prognostic factors for the non-small cell lung cancer. Distant metastases are the most important negative prognostic factor for the long-term survival. MATERIAL AND METHODS: We present 440 patients, operated in our clinic for the period 1997-2004. Distant metastases were found in 19 of them age range: 23-74 years (4 women and 15 men). RESULTS: The 5-years survival rate was 30.40% ( 128 patients) for the patients with M0- disease and 15.79% (3 patients) for those with distant metastases. CONCLUSIONS: Selected group of patients with lung cancer and distant metastases without involvement of the lymph nodes are may be the group who will benefit from the operative treatment.

[Histoligic type of the tumor as an independent factor for survival in non-small cell lung cancer].

UNLABELLED: Evaluation of individual prognostic factors in patients with non-small cell lung cancer (NSCLC) is extremely difficult. Review of literature shows more than 150 prognostic factors for this type of lung cancer. One of them is the histological grade. MATERIAL AND METHODS: We present 440 patients with NSCLC, operated in our clinic for the period of 1997-2004. RESULTS: We present the 5-years survival rate and the average period of survival for the patients with non-small cell lung cancer according the stage and the histologic type of the tumor. CONCLUSIONS: In I and III stage of the disease bronchiolo-alveolar cancer group shows 5-year survival while III and IV stage show 5-year survival only for squamous cell cancer.

[Postoperative complications in radically operated patients with non-small cell lung cancer].

SUMMARY: Lung cancer is the leading cause of cancer death. Despite the advances in medicine only 22% of the patients with lung cancer are candidates for radical operative treatment. Postoperative complications and mortality remain relatively high. MATERIAL AND METHODS: We present 320 patients, operated in our clinic for the period 2001-2005. 136 patients underwent lobectomy, 158--pulmonectomy, 22--bilobectomy, and 4--wedge resection. RESULTS: Postoperative complications occurred in 63 (19,61%) patients. Nine deaths (2,81%) occurred within 10 days after the operation. Five patients (1,56%) developed bronchopleural fistula. We observed inflammatory pulmonary complications in 14 (4,37%), atelectasis in 26 (8,12%), postoperative empyema in 6 (1,87%), and wound infection in 3 (0,93%) patients. CONCLUSIONS: The postoperative complications in radically operated patients with lung cancer remain relatively frequent. Precise preoperative evaluation and assessment of the patients are crucial to lower the risk of postoperative complications.

[Molecular genetics of ovarian cancer].

Ovarian cancer is the most lethal gynecologic neoplasia. The risk of ovarian cancer in Europe is 1 to 80. In 80-90% of cases, the clinical manifestation is in advanced stage. The 5 year survival is for III /IV stage 25%, but for I/II stage is 90%. In the present study we present the molecular and genetic changes of hereditary and sporadic ovarian cancer.

[Remote results for cases of non-small cell lung cancer treated by limited resection].

UNLABELLED: The choice between the limited pulmonary resection and the standard anatomical resection depends on many factors. The most important are the tumor size, age and general condition of the patient. MATERIAL AND METHODS: We present 12 patients with non-small cell lung cancer-IA stage, who underwent limited resection. RESULTS: The 5-year survival rate is 50% (6 patients), the 3-year survival rate is 75% (9 patients), and the 1-year survival rate is 91,6% (11 patients). CONCLUSIONS: We conclude that the limited resection for patients with non-small cell lung cancer-IA stage is associated with a lower 5-year survival, but less complications, which makes it suitable for elderly and compromised patients.