Extreme gigantomastia in pregnancy: case report--my experience with two cases in last 5 years.

We present an extreme case of gigantomastia in pregnancy during the second gemelar pregnancy of a 30-year-old woman. Her first pregnancy was 8 years ago, was also gemelar and she delivered with caesarean section. From the beginning of her current pregnancy, the patient noted steady growth of both of her breasts that reached enormous dimensions at the end of the pregnancy. This kind of breast changes did not occur during her first pregnancy. The patient also suffered from myasthenia gravis that was in remission during this pregnancy, without any therapy. The patient was in the 38 weeks of gestation, and a delivery with caesarean section was performed in line with the reduction of her breasts. The main reasons that led me to perform these two interventions as one act were the fact that puerperal mastitis could develop on these enormous breasts, further the small regression of these huge breasts during the bromocriptine treatment, as well as the intention to avoid other operative traumas, considering possibility of exacerbation of myasthenia gravis. I had already performed bilateral reduction mammaplasty with free areola-nipple graft, when a tissue with total weight of 20 kg (2 × 10 kg) was removed. The patient had an excellent post-operation recovery course.

Granular cell tumor of the breast: a case report and review of literature.

A 22-year-old female patient presented with a breast mass lesion with a clinical suspicion of a fibroadenoma. Histological evaluation revealed a rare benign neoplasm - granular cell tumor.Granular cell tumor is rare neoplasm that may arise in virtually any body site, and in 5% it occurs in the breast. The histogenesis of this tumor is still rather controversial and currently the most acceptable theory is a Schwann cell origin. The main histological feature is granular cytoplasm of the tumor cells.From a clinical point of view there is a similarity between granular cell tumor and mammary carcinoma on mammography and ultrasound. Pathohistologically, sometimes, differential diagnostic difficulties exist concerning apocrine carcinoma, histiocytic lesions and metastatic neoplasms.

Increased oxidative/nitrosative stress and decreased antioxidant enzyme activities in prostate cancer.

OBJECTIVES: The study was aimed to evaluate the oxidative/nitrosative stress status in prostate cancer (CaP) and benign prostatic hyperplasia (BPH). DESIGN AND METHODS: 312 men from two different populations were included: 163 men from Macedonia (73 CaP patients, 67 BPH patients and 23 control subjects) and 149 men from Turkey (34 prostate cancer patients, 100 BPH patients and 15 control subjects). We measured erythrocyte malondialdehyde (MDA) levels, erythrocyte activities of superoxide dismutase (CuZn-SOD), glutathione peroxidase (GPX) and catalase (CAT); plasma nitrite/nitrate (NO(2)(-)/NO(3)(-)), cGMP and 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels. RESULTS: A similar pattern of alteration in the oxidative/nitrosative stress-related parameters was found in both, Macedonian and Turkish studied samples: higher MDA concentrations with lower GPX and CuZn-SOD activities in CaP patients versus controls and BPH groups. The CAT activity was decreased in the CaP patients versus controls in the Turkish studied sample. Furthermore, CaP patients had increased plasma NO(2)(-)/NO(3)(-) and cGMP levels versus controls and BPH groups in both studied samples. CONCLUSIONS: This study has confirmed an imbalance in the oxidative stress/antioxidant status and revealed an altered nitrosative status in prostate cancer patients.

Glutathione peroxidase 1 (GPX1) genetic polymorphism, erythrocyte GPX activity, and prostate cancer risk.

Glutathione peroxidase 1 (GPX1) is a ubiquitously expressed selenium-dependent enzyme that protects cells against oxidative damage by reducing hydrogen peroxide and a wide range of organic peroxides. Some epidemiological studies have correlated low GPX activity or particular GPX1 polymorphisms with enhanced risk of cancer, although these correlations have not been consistently observed in all populations. Therefore, we conducted the present study to evaluate the possible association of GPX1 Pro198Leu polymorphism and erythrocyte GPX activity with the risk of developing prostate cancer and to clarify whether erythrocyte GPX activity levels were correlated with the GPX1 Pro198Leu genotype in the Macedonian population. The GPX1 Pro198Leu genotype was determined in 82 prostate cancer cases and 123 control individuals. We found an overall protective effect of the variant Leu allele of the GPX1 polymorphism on the prostate cancer risk. Heterozygous carriers of the variant Leu allele had a significantly lower risk of prostate cancer compared with homozygous wild-type individuals (OR, 0.38; 95% CI, 0.20-0.75; P = 0.004). Erythrocyte GPX activity was analyzed in 73 cases and 91 controls. The erythrocyte GPX activity in the cancer group was lower than in the healthy controls. Additionally, we compared the erythrocyte GPX activity in the control group of 90 subjects and found no significant differences by genotype. These findings suggest that individual susceptibility of prostate cancer may be modulated by GPX1 polymorphism and that the combination of genetic factors involved in oxidative response with environmental carcinogens may play an important role in prostate carcinogenesis.

Manganese superoxide dismutase (MnSOD) genetic polymorphism is associated with risk of early-onset prostate cancer.

Prostate cancer continues to be the most frequently diagnosed neoplasm, and the second leading cause of cancer-related mortality in men. Oxidative stress may enhance prostatic carcinogenesis. Manganese superoxide dismutase (MnSOD) is the only known superoxide scavenger in mitochondria. It plays a key role in antioxidant defense as mitochondria are important for oxidative metabolism coupled to the electron transport chain and oxidative phosphorylation and hence, ROS production. A T-->C single nucleotide substitution, resulting in a Val-->Ala change at position 9 (Ala-9Val), which alters the secondary structure of the protein, has been noted to affect transport of MnSOD into the mitochondria. We have determined the MnSOD genotype in 85 prostate cancer cases and 151 control subjects. Ala-9Val polymorphism was determined using real time polymerase chain reaction (PCR) amplification with fluorescently labeled primers. No significant difference was found in prostate cancer susceptibility in the subjects with Ala/Ala and Val/Ala genotype compared with Val/Val genotype (Odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.69-2.42; p = 0.416). We did not observe an association of the MnSOD genotype or allele frequency between subgroups of cases divided by disease status (aggressive vs. non-aggressive prostate cancer). However, in the analyses stratified by the age at diagnosis we have observed that men homozygous for Ala had a 5.2-fold increased risk of early-onset prostate cancer (under age of 65) compared to men homozygous for Val allele (p = 0.05). These data suggest that Ala/Ala MnSOD genotype in the Macedonian population could have an influence on early onset of prostate cancer, but no impact on the subsequent development of the disease.

Penile strangulation: two case reports and review of the literature.

INTRODUCTION: Entrapment or strangulation of the penis is a rare emergency situation that can lead to a wide range of vascular and mechanical injuries. AIM: The aim of this article is to present our experience dealing with penile strangulation. A review of the literature is also summarized in this report. Current treatment options and outcomes are also evaluated. METHODS: We performed a computerized MEDLINE search followed by a manual bibliographic review of cross-references. These reports were analyzed and the important findings summarized. RESULTS: Penile strangulation has been first time reported in 1755. Since that time, sporadic reports have appeared in the literature describing a variety of foreign bodies on the penis that have in common only the property of circularity. We noted motives, types of objects, types of strangulation, symptomatology, trauma grades, diagnoses, including psychological involvement, as well as possible treatment options. Furthermore, two cases of penile strangulation from our clinical practice are presented involving different degrees of vascular insult leading to different pathogenesis, clinical presentation, and surgical approach. CONCLUSION: Penile strangulation is an unusual clinical condition and the consequences can be severe. Penile strangulation could lead to different degrees of vascular obstruction. Consequently, several clinical syndromes can occur: from mild nonsignificant vascular obstruction that resolves after decompression to severe gangrene of the penis accompanied with impaired renal function. The most common motive associated with foreign bodies on the penis is sexual or erotic in nature. The choice of method for removal depends upon type, size, incarceration time, trauma grade, and availability of the equipment. Prompt diagnosis and early treatment are essential to avoid the potential complications of ischemic necrosis and autoamputation.

Extreme gigantomastia in pregnancy: case report and review of literature.

We present an extreme case of Gigantomastia in pregnancy in a 24-year old woman, gravida 2, in a 28 weeks' of gestation, with a total breast weight of 33 kg, complicated by infection, ulcerations and subsequent hemorrhage. Thorough laboratory analyses did not reveal any hint as to the cause of this enormous breast enlargement. Gynecological examinations and ultrasound revealed a viable, progressive normal fetus. The severity of the problem is further emphasized by the patients' breathing problems and even big difficulty in standing and walking. We performed bilateral simple mastectomy as a life-saving procedure to prevent fatal complications. The procedure finished without any complications or large amount of blood loss. There are less than 100 cases of gravid gigantomastia reported, but never to such extreme breast weight. Etiology remains uncertain, and controversy exists in therapeutic modality. According to the literature the most reliable conservative treatment is bromocriptine therapy, but if the condition progresses surgical intervention, in the form of reduction mammoplasty or simple mastectomy, is the treatment of choice.

[The possible pathogenesis of AA type amyloidosis in a patient with ulcerative colitis and renal cell carcinoma]. / Sistemna amiloidoza tipa AA u bolesnika s ulceroznim kolitisom i bubreznim karcinomom.

A 43-year-old male with a two-month history of ulcerative colitis and nephrectomy due to a renal cell carcinoma performed a month before was admitted to University Department of Nephrology for nephrotic syndrome and chronic renal failure. Biopsy of the remnant kidney revealed secondary AA amyloidosis with deposits in the glomeruli and walls of intrarenal blood vessels. Re-evaluation of the nephrectomized kidney also showed amyloid deposits both in the renal tissue free from malignant cells and in tumor tissue. In this case the amyloid deposition may have been the result of two coexisting disorders, ulcerative colitis and renal cell carcinoma, both known to be stimulators of amyloid deposition. The remnant kidney function worsened during the follow up and the patients started chronic dialysis after 6 months.

Chondrolipoma of the breast--case report and a review of literature.

Chondrolipoma of the breast is a rare mesenchymal tumor and only a few cases have been reported so far. We present a case of a patient with a breast mass that was surgically removed, diagnosed as a fibroadenoma, and pathohistologically verified as a chondrolipoma. Macroscopically, the tumor presented as a well-circumscribed, firm white nodule resembling a fibroadenoma, and was microscopically characterized as fat lobules with isles of hyaline cartilage. We also present a review of literature and differential diagnoses.