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Open access

Ivica Pejčić, Svetislav Vrbić, Mirjana Todorović, Ivan Petković, Mirjana Balić and Ana Stanković

Summary

Metastatic carcinomas of unknown primary origin (cancer of unknown primary-CUP) represent 3-5% of all cancers. This term includes all patients presented with metastatic disease in whom the primary site could not have been identified. Despite the use of modern and comprehensive diagnostic techniques and procedures, there is no improvement in efficacy (efficiency) of indentifying the primary site of disseminated disease. That is why a diagnostic procedure should be rational and should include the basic diagnostic examination (analyses) with the aim to define biological and clinical characteristics of diagnosed disease, as well as an optimal therapeutic approach. Although the overall prognosis of the majority of these patients is poor, it is possible, nowadays, to distinguish the subgroups of patients with favorable prognosis. Results of new basic research, better understanding of pathogenesis at the molecular level and introduction of new drugs through clinical trials suggest an advance in this disease treatment and outcome.

Open access

Natasa Kos, Boris Kos and Mitja Benedicic

Abstract

Background

The number of patients with malignant brain tumours is on the rise, but due to the novel treatment methods the survival rates are higher. Despite increased survival the consequences of tumour properties and treatment can have a significant negative effect on the patients’ quality of life. Providing timely and appropriate rehabilitation interventions is an important aspect of patient treatment and should be started immediately after surgery. The most important goal of rehabilitation is to prevent complications that could have a negative effect on the patients’ ability to function.

Conclusions

By using individually tailored early rehabilitation it is often possible to achieve the patients’ independence in mobility as well as in performing daily tasks before leaving the hospital. A more precise evaluation of the patients’ functional state after completing additional oncologic therapy should be performed to stratify the patients who should be directed to complex rehabilitation treatment. The chances of a good functional outcome in patients with malignant brain tumours could be increased with good early medical rehabilitation treatment.

Open access

Arnis Abolins, Andrejs Vanags, Guna Volanska, Inga Melbarde-Gorkusa, Ilze Strumfa, Genadijs Trofimovics and Janis Gardovskis

Malignant Peripheral Nerve Sheath Tumour of the Breast in Complex Clinical Background

Here we describe a patient presenting with combination of three rare diseases, namely de novo malignant peripheral nerve sheath tumour of the breast, small cell variant of medullary thyroid carcinoma and multiple sclerosis. Although the combination by chance seems unlikely, the detailed history does not correspond to any of the known hereditary cancer syndromes and hypothetically may represent a new entity.

Open access

Ana Devic, Mladenko Vasiljevic, Aleksandar Devic and Marija Sorak

Abstract

Ovarian dysgerminoma (OD) is one of the most common malignant tumours of the ovarian germ cells, comprising 1-2% of all malignant ovarian tumours. It most commonly occurs between the ages of 10 and 30. The treatment is primarily surgical; however, in the advanced stages of the disease, surgical treatment is followed by chemotherapy.

We report a case of a 19-year-old female patient who was diagnosed with bilateral ovarian dysgerminoma. The patient was first operated for dysgerminoma on the left ovary and an ovariectomy was performed. A month later, she underwent surgery again because of the appearance of a residual tumour in the lodge of the removed ovary; the rest of the tumour was removed at that time. The histological finding was dysgerminoma ovarii, FIGO stage 1c. As agreed on by the consulting team, the patient returned for a follow-up ultrasound examination every three months. Nevertheless, nine months after the operation, she was diagnosed with dysgerminoma of the right ovary. Surgical treatment was performed again, and the tumour was removed. The histological finding on the second occasion was dysgerminoma ovarii, FIGO stage IIa, according to the TNM classification T2aNxMx. To preserve the reproductive capacity of the patient, the consulting team agreed to treat the patient with chemotherapy, i.e., 3 cycles of BEP [Bleomycin, Etoposide, Cisplatin (Platinum)]. Magnetic resonance imaging, ultrasound and clinical examination after the therapy were normal. The patient is monitored in regular intervals, feels good and has no signs of the disease after five years.

Open access

C. Abrudan, I.S. Florian, A. Baritchii, O. Soritau, S. Dreve, C. Tomuleasa and B. Petrushev

Abstract

Purpose : Glioblastoma multiforme (GBM) remains one of the most devastating diseases known to mankind and affects more than 17,000 patients in the United States alone every year. This malignancy infiltrates the brain early in its course and makes complete neurosurgical resection almost impossible. Recent years have brought significant advances in tumor biology. Many cancers, including gliomas, appear to be supported by cells with stemlike properties. Nanoparticles are excellent candidates to serve as delivery vectors of drugs or biologically active molecules because of their unique chemical and physical properties that result in specific transportation and deposition of such agents in specific organs and tissues..

In the current study we have investigated the in vitro action of nanostructural systems (temozolomide encapsulated in chitosan and polymer nanostructures) on high-grade gliomaderived cancer stem cells (CSCs), with the intention of developing a new therapy to treat specific brain tumors with increased efficacy and minimal toxicity. In vitro cytotoxicity and apoptosis measurements indicated that the drug/vector combination facilitated the ability of the alkylating drug TMZ to alter the resistance of these cancer stem cells, suggesting a new chemotherapy strategy even for patients diagnosed with inoperable or recurrent malignant gliomas

Methods : At the National Institute for R & D of Isotopic and Molecular Technologies form Cluj Napoca were synthesized three types of nanostructures chitosan-TMZ, TMZ-chitosan-PEG (polyethylene glycol), TMZ-chitosan-PPG (polypropylene glycol). Three type of cell lines (Glioma-derived stem, HFL and HUVEC) were treated with the 3 types of nanostructures and the survival rate of the cells was compare to standard therapy (TMZ).

Results : The results showed a reduction in the rate of survival of the tumor cells. Cell proliferation assays clearly demonstrate the differences betweenconventional chemotherapy (TMZ) and temozolomide encapsulated in chitosan and polymer nanostructures.

Conclusion: Nanostructures like chitosan, PEG, PPG are useful as vectors for drugs transport. Despite combined therapy (surgery, radiotherapy, chemotherapy), currently median patient survival is reduced. The key to improving life expectancy could be an effective therapy targeted, customized for each case. An increasingly important role will be new methods of treatment such as immunotherapy, gene therapy or nanotherapy.

Open access

Dace Žentiņa, Inga Stuķēna, Sarma Grīnberga, Alvils Krams and Aivars Lejnieks

Abstract

The significance of carbohydrate (cancer) antigen 125 (Ca-125) and carcinoembryonic antigen (CEA) tumour markers levels in differential diagnostics of malignant and benign pleural effusion was studied. Within this prospective study, 121 patients with fluids of various aetiology in the pleural cavity were analysed. Malignant pleural effusion was detected in 55 patients, parapneumonic effusion in 28 patients, transudative effusion of cardiac origin in 31 patients, pancreatitis in one patient and tuberculous pleurisy in five patients. The highest accuracy in diagnosis of malignancy was observed for Ca-125 and CEA levels in the pleural fluid: 75.2% at cut-off value ≥1452 U/mL and 76.9% at cut-off value ≥6.58 ng/mL, respectively. We conclude that the level of tumour markers in pleural fluid has additional diagnostic significance in the differential diagnosis of malignant and benign pleural effusions.

Open access

Neda Arsenijevic, Tatjana Kastratovic, Aleksandar Zivanovic, Janko Djuric and Marija Sorak

Abstract

The term ‘mixed Mullerian tumour’ applies to uterine tumours composed of epithelial and mesenchymal elements of Mullerian origin. These neoplasms are classified into adenomyomas, adenofi bromas, adenosarcomas, and carcinosarcomas (malignant Mullerian mixed tumours) based on whether the epithelial and stromal elements are benign or malignant. Adenosarcomas are low-grade neoplasms classified halfway along the spectrum of mixed Mullerian tumours, with adenofi bromas at one end and carcinosarcomas (malignant Mullerian mixed tumours) at the other. Adenosarcoma is a mixed Mullerian tumour composed of benignappearing but neoplastic glandular elements and a sarcomatous stroma, which is usually low grade. Histologically, there are heterologous mesenchymal elements (usually rhabdomyosarcoma, but also cartilage, fat, and other elements) in 20-25% of cases.

We have observed that some women with these tumours have received tamoxifen treatment for breast cancer or have a history of radiation therapy.

We herein report the case of a 46-year-old patient who was hospitalized at OGC CC Kragujevac because of excessive bleeding from the uterus. The patient had undergone right mastectomy three years earlier for breast cancer. After surgery, she had received Nolvadex (tamoxifen) treatment. Exploratory curettage was performed, and then, a classic abdominal hysterectomy with bilateral adnexectomy was completed. The histopathological findings indicated adenosarcoma Mulleri; therefore, the patient received postoperative radiation therapy according to our current protocol.

Open access

Aleksandra Sobczyńska-Rak, Izabela Polkowska and Adam Brodzki

Abstract

The aim of the study was to determine the levels of the vascular endothelial growth factor (VEGF) in the serum of dogs suffering from splenic malignant tumours, prior to splenectomy, as well as three and six months after the surgery. Tumours and blood samples were collected from 10 dogs of various breeds, aged between 7 and 13 years, and from 10 control animals. Tumour sections were fixed in 10% buffered formalin for 24 h. The type of tumour was determined according to the WHO classification. Blood samples were centrifuged and the obtained sera were subjected to immunoenzymatic assays to determine the VEGF levels. The median of VEGF levels in the serum of dogs suffering from splenic malignant tumours was 37.85 pg/mL (15.40-107.18 pg/mL). The highest values were observed in dogs with confirmed metastases (107.18 pg/mL and 65.43 pg/mL). The VEGF values in control group were between 0.1 pg/mL and 13.04 pg/mL. A comparative analysis of the VEGF levels against the animals' survival time indicated that VEGF overexpression may serve as a prognostic factor in cases of malignant tumours of the spleen.

Open access

Bing Liu

Abstract

Oral lesions are highly correlated with the occurrence and development of many diseases. In addition, the treatment of systemic diseases may aggravate oral focal infections, affect the life quality of patients, interfere with the treatment of systemic diseases, and even cause systemic infection in serious cases. Treatment strategies for systemic diseases may induce or aggravate oral local lesion infections. In specific, administration of oral antiepileptic drugs and immunosuppressive drugs may induce gingivitis, radiotherapy or chemotherapy for malignant tumors may cause oral mucositis, long-term use of bisphosphonates for inhibition of tumor bone metastasis or prevention of osteoporosis may cause osteonecrosis of the jaw, and allogeneic hematopoietic stem cell transplantation may cause oral rejection reactions.

Open access

Sophia Constance Kamran, Atul Bhanudas Shinagare, Stephanie Anne Holler Howard, Mizuki Nishino, Jason Laurence Hornick, Katherine Margaret Krajewski and Nikhil Himmatsinh Ramaiya

Abstract

Background. The aim of the study was to analyze the clinical and imaging characteristics of primary intrathoracic malignant peripheral nerve sheath tumors (MPNSTs).

Patients and methods. In this institutional review board (IRB)-approved retrospective study, clinical and imaging features of 15 patients (eight men; mean age 50 years [range 18-83)] with pathologically proven malignant peripheral nerve sheath tumors seen from January 1999 to December 2011 were analyzed. Imaging features (CT in 15, MRI in 5 and PET/CT in 4) of primary tumors were evaluated by three radiologists and correlated with clinical management.

Results. Of the 15 tumors, six were located in the mediastinum (two each in anterior, middle and posterior mediastinum), four in chest wall, two were paraspinal, and three in the lung. Four patients had neurofibromatosis-1 (NF1); four tumors had heterologous rhabdomyoblastic differentiation (malignant triton tumor). Masses typically were elongated along the direction of nerves, with mean size of 11 cm. The masses were hypo- or isodense to muscles on CT, isointense on T1-weighted images, hyperintense on T2-weighted images and intensely fluorodeoxyglucose (FDG) avid (mean standardized uptake value [SUV]max of 10.5 [range 4.4-23.6]). Necrosis and calcification was seen in four tumors each. Finding of invasion of adjacent structures on imaging led to change in management in seven patients; patients with invasion received chemoradiation.

Conclusions. Intrathoracic MPNSTs appear as large elongated masses involving mediastinum, lung or chest wall. Radiological identification of invasion of adjacent structures is crucial and alters therapy, with patients with invasion receiving neoadjuvant or adjuvant chemoradiation.