[Atypical aneurysms of the superficial femoral artery in a young patient]. / Atypické aneuryzma povrchní stehenní tepny u mladého nemocného.

The authors present an unusual case of an urgent aneurysm of the superficial femoral artery in a young patient. The case raised a suspicion of a possibility of a genetic collagen disorder, primarily of the Marfan's syndrome. Also a malignant ethiology of the process was considered. The finding was managed by its radical extirpation and the resected part of the superficial femoral artery was replaced by a reverse graft of the vena saphaena magna. The original diagnosis of the Marfan's syndrome or a malignancy was not confirmed.

[Metastasing and relapsing "low grade" adenosquamous metaplastic breast cancer--is there a really indolent lesion? A description of three cases and review of literature]. / Metastazující a recidivující "low grade" adenoskvamózní metaplastický karcinom prsu--jde skutecne o indolentní lezi? Popis trí prípadu a rozbor literatury.

OBJECTIVE: To describe personnel experience with three unusual cases of low-grade adenosquamous carcinoma of the breast. Due to the aggressive course in two cases, the review of the literature does not concentrate on morphology and differential diagnosis only, but discuss overall biology of this lesion too. DESIGN: Three case reports. SETTING: Biopsy Lab s.r.o. and Sikl's Department of Pathology, Charles University and Faculty Hospital, Pilsen. METHODS: Included are cases from mammary register of Biopsy Lab s.r.o. and from personnel consulting registry of Prof. Michal. In details are documented both clinical presentations, including follow up, and spectrum of histologic patterns of the lesion. Immunohistochemistry performed by streptavidin-biotin system (LSAB+, Dako) as detection system and diaminobenzidin tetrahydrochlorid as chromogen, employed standard myoepitelial markers (actin, CD10, calponin and p63), hormonal receptors, oncogen Her-2/neu, CK7, CAM5.2, CD34 and CD117. RESULTS: Partial mastectomy and segmentectomy were performed in three women 46, 72 and 74 years-old resp. for tumor, which size ranged from 20-35 mm in maximum diameter (mean 28 mm). Histology revealed low-grade adenosquamous metaplastic carcinoma displaying typical biphasic appearance combining regular tubular structures with surrounding storiform, sclerosing fibrous stroma. Variably present was characteristic squamous metaplasia of the gland forming either luminal morules or evident squamous pearls. Using immunohistochemistry, a total absence of myoepithelial layer in epithelial structures was confirmed. The stromal component expressed smooth muscle actin in two cases, one of which contained areas of heterologous chondrosseal differentiation. There were recognized metastases by one woman in two ipsilateral axillary lymph nodes mimicking benign breast heterotopia in one of them. One patient experienced recurrence in the scar 37 months after mastectomy where only mesenchymal heterologous component element was found. In two women with aggressive course the original biopsy was falsely interpreted, once as phyllodes tumor and secondly as benign sclerosing pseudotumor. CONCLUSION: low-grade adenosquamous carcinoma, despite its bland histology, should be understood as regular malignancy prone to frequent recurrences and recognized metastatic potential. It arises in the deep breast tissue and structurally resembles the microcystic adnexal carcinoma of the skin. Low-grade adenosquamous carcinoma, however, has nothing to do with syringomatous adenoma of the nipple, which is a benign tumor of the skin adnexa. Differential diagnosis includes spectrum of non-neoplastic slerosing lesions and above-mentioned phylloid tumor. The rarity of this neoplasm does not exclude deep knowledge.

[Systemic disease caused by the fungus Aspergillus fumigatus in immunocompromised patients]. / Systémové onemocnení vyvolané plísní Aspergillus fumigatus u imunokompromitovaných pacientu.

The authors describe an invasive pulmonary Aspergillus infection in three immunocompromised patients (1x plasmacytoma, 1x autoimmune thrombocytopenia, 1x asthma bronchiale) and draw attention to the possible occurrence of this disease also in subjects without serious neutropenia. The common risk factor in all three patients was corticoid treatment. In immunocompromised patients only early adequate and sufficiently long antimycotic treatment gives hope that the infection will be controlled.

[Streptococcus pneumoniae--an infectious agent in coxitis]. / Streptococcus pneumoniae--jako infekcní agens koxitidy.

Based on their own observation the authors describe pneumococcal coxitis in a young man. With regard to the atypical clinical picture of the disease the authors draw attention to the necessity to consider in the differential diagnosis of pain in the inguinal and coxal area also infectious arthritis. This concerns in the first place physicians in the first line of contact.

[Plastic surgery in large abdominal hernias using collagen patches]. / Plastiky velkých brisních kýl s pouzitím kolagenové záplaty.

The authors describe their experience with the use of a Zenoderm implant in large abdominal hernias and hernias in the scar. Satisfactory results were obtained with its use and the authors consider this material equivalent to other implants.

[Traumatic rupture of the thoracic aorta as part of a multiple injury]. / Traumatická ruptura hrudní aorty jako soucást polytraumatu.

The authors submit case-histories of four patients with traumatic ruptures of the aorta where the patients survived for 1-10 days. All cases were fatal. The general condition of the patients did not permit surgical operation. The survival time of the patients provides evidence that in rupture of the aorta it is in some instances possible to make inevitable examinations and operations. If time permits, then transport to a specialized department is indicated. The operation requires satisfactory approach and availability of extracorporeal circulation.