Accuracy of minor salivary gland biopsy in the diagnosis of Sjögren syndrome.

OBJECTIVES: The aim of this study was to find out the correlation and evaluate the accuracy of labial minor salivary gland biopsy as a diagnostic tool in the multidisciplinary management of patients with Sjögren syndrome. MATERIALS AND METHODS: Patients, referred to our outpatient office between January 2014 and December 2018 from a rheumatologist for biopsy examination, as part of the complex diagnostic plan for suspected Sjögren syndrome, were included in the current study. Each specimen was examined histomorphometrically by the pathologist to calculate the focus score describing the degree of salivary gland inflammatory infiltration. RESULTS: Fifty patients met the inclusion criteria. From the total number of patients, 39 presented with an established Sjögren syndrome by fulfilling the revised American-European criteria. From those, 27 had a positive lip biopsy. The remaining 12 patients from the total group, who were diagnosed with Sjögren syndrome based on the same criteria, had a negative lip biopsy. CONCLUSION: The labial minor salivary gland biopsy is a valuable diagnostic tool to establish the diagnosis of Sjögren syndrome. However, a positive biopsy result must always be correlated with all the other diagnostic criteria to prove the exact diagnosis (Tab. 1, Fig. 4, Ref. 49). Text in PDF www.elis.sk Keywords: Sjögren syndrome, keratoconjunctivitis sicca, xerostomia, labial minor salivary glands, biopsy, focal lymphocytic infiltration, focus score.

Idiopathic Granulomatous Mastitis - a new approach in diagnostics and treatment.

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease mimicking carcinoma and puerperal or non-puerperal mastitis. The primary purpose of this prospectively performed case control study was to compare clinical and imaging signs of IGM with the reference group of nonspecific, non- puerperal mastitis (NM) to identify the most typical clinical and imaging signs essential for a correct differential diagnosis. The secondary purpose was to present a new approach to non-invasive treatment. Thirty-nine women with histologically proven IGM and twenty-six patients with nonspecific mastitis underwent clinical examination, breast ultrasound (US), mammography (MG) and MRI examination. The most typical signs were selected for each group, and method and were statistically evaluated. The effectivity of colchicine, vitamin E and ribwort plantain tincture in treatment was assessed by clinical examination and imaging. Typical clinical signs of IGM included unilateral acute onset of breast edema, redness, palpable masses, missing fever, lymphadenopathy, no response to antibiotics or surgical interventions. Ultrasound revealed: "finger-like" structures (100%), ductectasias (76.9%), abscesses (76.9%), and lymphadenopathy (15.4%), while in MRI skin and tissue edema (100%), multicentric lesions (100%), abscesses (76.9%), ring enhancement (84.6%), lymphadenopathy (15.4%) and small enhancing lymph nodes (38.5%) were observed. Among the clinical signs, fistulas, hypoechoic mass, ductectasias and diffusion weighted images (DWI) restriction were significantly more frequent in patients with IGM than in those with NM. Treatment effectivity yielded 100% with a complete response between 6-19 months, depending on the disease extent. Targeted questions together with imaging can speed up selection for proper treatment with colchicine, vitamin E and local treatment. Long lasting use of antibiotics and repeated surgical interventions should be avoided.

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.

Flow Cytometry Panel-Reactive Antibody Screening of Anti-HLA Antibodies in the Waiting List Significantly Reduces the Occurrence of Acute Rejection After Kidney Transplantation.

INTRODUCTION: The presence of preformed HLA-reactive antibodies in recipient serum before transplantation has long been recognized as a prominent risk factor for a generally worse graft outcome. Screening and identification of HLA antibodies can be used to stratify patients into high- and low-risk categories. MATERIALS AND METHODS: We determined patients' anti-HLA antibodies using flow cytometry panel-reactive antibody (flowPRA) screening, specifying more than 5% after positive screening. According to the results of the screening test, patients were allocated to the induction immunosuppressive protocol according to the actual immunologic risk. RESULTS: In the group of 78 patients, screening with flowPRA of anti-HLA antibodies was done twice a year. Patients were divided into 2 groups of immunologic risk (low or medium), and we chose the induction immunosuppressive protocol according to the risk. Stratification of the risk was correct, because the only predictor for development of acute rejection in the monitored period of 12 months was delayed graft function (odds ratio 33.2501; 95% confidence interval 10.0095-110.4508; P < .0001). The occurrence of acute rejection upon implementing the screening was reduced in our transplant center from 44% to 19% (P < .0001). No difference was recorded in the 12-month survival of grafts and patients according to the applied induction immunosuppressive protocol. CONCLUSION: We confirmed significantly reduced occurrence of acute rejection in the follow-up period of 12 months by using individualized induction according to flowPRA screening of anti-HLA antibodies. FlowPRA screening represents a suitable alternative for screening and specification of anti-HLA antibodies in case the Luminex methodology is unavailable.

Fibrillin-1 (FBN-1) a new marker of germ cell neoplasia in situ.

BACKGROUND: Germ cell neoplasia in situ (GCNIS), is preinvasive stage of testicular germ cell tumours (TGCTs). Fibrillins, which are integral components of microfibrils are suggested to be involved in cancer pathogenesis and maintenance of embryonic stem cells pluripotency. The aim of this study was to examine fibrillin-1 (FBN-1) expression in TGCTs patients. METHODS: Surgical specimens from 203 patients with TGCTs were included into the translational study. FBN-1 expression was evaluated in the tumour tissue, in GCNIS and in adjacent non-neoplastic testicular tissue in all available cases. Tissue samples were processed by the tissue microarray method. FBN-1 was detected by immunohistochemistry using goat polyclonal antibody and the expression was evaluated by the multiplicative quickscore (QS). RESULTS: The highest FBN-1 positivity was detected in GCNIS (mean QS = 11.30), with overexpression of FBN-1 (QS >9) in the majority (77.1 %) of cases. Expression of FBN-1 in all subtypes of TGCTs was significantly lower in comparison to expression in GCNIS (all p <0.001). Seminoma had significantly higher expression compared to EC, ChC and TER (all p <0.05), but not to YST (p = 0.84). In non-neoplastic testicular tissue the FBN-1 positivity was very low (mean QS = 0.02). Sensitivity, specificity, positive and negative predictive value of FBN-1 expression for diagnosis of GCNIS were 97.1, 98.8, 98.6 and 97.7 %. CONCLUSIONS: FBN-1 is overexpressed in TGCTs and especially in GCNIS when compared to non-neoplastic testicular tissue in patients with germ cell tumors and could be involved in germ cell neoplasia in situ development.

Prognostic value of programmed-death-1 receptor (PD-1) and its ligand 1 (PD-L1) in testicular germ cell tumors.

BACKGROUND: Testicular germ cell tumors (TGCTs) belong to the most chemosensitive solid tumors; however, a small proportion of patients fail to be cured with cisplatin-based chemotherapy. Inhibitors of PD-1/PD-L1 pathways represent a new class of promising drugs in anticancer therapy. The aim of this study was to evaluate expression and prognostic value of PD-1 and PD-L1 in TGCTs. PATIENTS AND METHODS: Surgical specimens from 140 patients with TGCTs (131 with primary testicular tumor and 9 with extragonadal GCTs) were included into the translational study. PD-1 and PD-L1 expression was detected in the tumor tissue by immunohistochemistry using monoclonal antibodies, scored by the multiplicative quickscore (QS) method, compared with their expression in normal testicular tissue and correlated with clinicopathological characteristics and clinical outcome. RESULTS: None of the GCTs exhibited PD-1 protein, although expression of PD-L1 was significantly higher in GCTs in comparison with normal testicular tissue (mean QS = 5.29 versus 0.32, P < 0.0001). Choriocarcinomas exhibit the highest level of PD-L1 with decreasing positivity in embryonal carcinoma, teratoma, yolk sac tumor and seminoma. PD-L1 expression was associated with poor prognostic features, including ≥3 metastatic sites, increased serum tumor markers and/or non-pulmonary visceral metastases. Patients with low PD-L1 expression had significantly better progression-free survival [hazard ratio (HR) = 0.40, 95% confidence interval (CI) 0.16-1.01, P = 0.008] and overall survival (HR = 0.43, 95% CI 0.15-1.23, P = 0.040) compared with patients with high PD-L1 expression. CONCLUSIONS: In this translational study, we showed, for the first time, the prognostic value of PD-L1 expression in TGCTs and our data imply that the PD-1/PD-L1 pathway could be a novel therapeutic target in TGCTs.

Analysis of radiation-induced angiosarcoma of the breast.

Breast angiosarcoma may occur de novo, or as a complication of radiation therapy, or chronic lymphedema secondary to axillary lymph node dissection for mammary carcinoma. Both primary and secondary angiosarcomas may present with bruise like skin discoloration, which may delay the diagnosis. Imaging findings are nonspecific. In case of high-grade tumours, MRI may be used effectively to determine lesion extent by showing rapid enhancement, nevertheless earliest possible diagnostics is crucial therefore any symptoms of angiosarcoma have to be carefully analysed. The case analysed here reports on results of 44-year old premenopausal woman who was treated for a T1N1M0 invasive ductal carcinoma. After a biopsy diagnosis of carcinoma, the patient underwent quadrantectomy with axillary lymph node dissection. She received partial 4 cycles of chemotherapy with adriamycin and cyclophosphamide, followed by radiation treatment. Thereafter, a standard postoperative radiotherapy was applied at our institution four months after chemotherapy (TD 46 Gy in 23 fractions followed by a 10 Gy electron boost to the tumour bed). Adjuvant chemotherapy was finished six months after operation, followed by tamoxifen. Follow up: no further complications were detected during regular check-ups. However, 12-years later, patient reported significant changes at breast region which was exposed to radiation during treatment of original tumour. In this article, we describe the clinical presentation, imaging and pathological findings of secondary angiosarcoma of the breast after radiotherapy (Fig. 2, Ref. 26).

[Expression of carbonic anhydrase IX in the breast carcinomas]. / Expresia karbonickej anhydrázy IX v karcinómoch prsníka.

OBJECTIVE: Carbonic anhydrase IX (CA IX) is one indicator of hypoxia in the tumor and its expression is associated with more aggressive forms of breast cancer. The aim of this study is to point out its own set of correlation between CA IX expression and selected morphological and biological indicators. TYPE OF STUDY: Cohort prospective study. SETTING: Department of Pathology of Slovak Medical University and St. Elisabeth Cancer Institute, Bratislava, Slovak Republic. METHODS: These were 145 cases of breast cancer aged 25 to 85 years (median 59 years) from the Register of the Institute of Pathology and Slovak Medical University and St. Elisabeth Cancer Institute in Bratislava for the period 1. 9. 2012 to 28. 2. 2013. In all cases were examined CA IX, estrogen receptor (ER), progesterone receptor (PR), HER2, p53 and Ki67 by immunohistochemistry. Typing, grading and staging of the disease were evaluated according to the classification systems currently in place. RESULTS: CA IX expression was demonstrated in 51 cases (35.2%). CA IX positivity correlated with the degree of differentiation (p = 0.0001), with ER status (p <0.0001) and PR (p <0.01) and HER2 (p <0.01) and proliferative activity as measured by Ki67 (p <0.001). HER2-positive cancers and triple-negative cancers were more frequently associated with the expression of CA IX compared with luminal subtypes (p <0.0001). The state of CA IX and age range of the tumor - pT and lymph node status - pN and p53 have not been shown statistically significant correlations. CONCLUSION: CA IX examination in breast cancer provides valuable information on the state of hypoxia in the tumor, thereby supplementing view of prognosis of the disease.

[Acatholytic variant of squamous carcinoma of the breast. A case report and review of literature]. / Akantolytický variant skvamózneho karcinómu prsnej zl'azy. Kazuistika a prehl'ad literatúry.

The acantholytic variant of squamous carcinoma (ASC) represents a rare type of metaplastic breast carcinoma with typical occurrence of pseudoglandular and pseudovascular structures, arising as a result of cohesion loss between the neoplastic cells. Up to the present, there have been only 10 cases of mammary ASC described in the English written literature. The authors present a case of a 57-year-old woman with a large (6 x 7 cm) suspicious lump on ultrasonography in her right breast treated by mastectomy with an ipsilateral axillary lymph node dissection due to histologically verified ASC. Additional postoperative staging computer tomography revealed metastatic foci in the left lungs, thus calling for adjuvant chemotherapy for the patient. Six months after setting the diagnosis, the patient is alive with a partial therapeutic response. In the differential diagnosis of ASC it is important to exclude angiosarcoma, phyllodes tumor and metastatic sarcomas to the breast. The useful tools for differentiation between the above-mentioned entities are extensive bioptic examination and detailed immunohistochemical staining, enabling the pathologist to exclude the endothelial lineage (using CD31 and CD34) and to verify the epithelial origin through the detection of cytokeratins (spectra of high-molecular weight cytokeratins). Furthermore, the ASC shows positive immunohistochemical staining for markers of the myoepithelial differentiation, e.g. cytokeratin 14, CD10 and p63, suggesting an immature cell population with basaloid features. In conclusion, as ASC is an aggressive subtype of the breast carcinoma with a poor prognosis, the correct diagnosis set by the pathologist is of great importance on the therapeutic management in affected patients.

[Ductal carcinoma in situ (DCIS) and biopsy of the sentinel lymph node]. / DCIS a biopsia sentinelovej uzliny.

INTRODUCTION: Ductal carcinoma in situ (DCIS) is the disease with increasing incidence. Nowadays, approximately 80% DCIS are diagnosed via mammography and represent more than 20% of all types of breast cancer. The acceptance of surgical procedures with this type of breast carcinoma is controversial as primary diagnosis of non-invasive carcinoma is often underestimated and in the end, histopathological examination reveals invasive carcinoma with biological potential to metastasize. In cases of "risk" patient groups with DCIS, several studies report lymph node metastases. The aim of the study has been to assess the incidence of sentinel lymph node metastatic involvement in high-risk patient group with DCIS and in ductal carcinoma in situ with microinvasion (DCISMI), to note the incidence of invasive carcinoma in definitive histopathology in patients with pre-operative diagnosis of DCIS and to analyze some predictors of invasivity. STUDY TYPE AND PATIENT GROUP: In retrospective analysis, we evaluated the setting of 119 patients who have been operated on at our Clinic from January, 1st 2008 until December, 31th 2010 for the diagnosis of DCIS. Prospectively, we have created the setting of 44 patients with high-risk DCIS with sentinel lymph node biopsy (SLNB) performed. METHODS AND RESULTS. Metastatic involvement of sentinel lymph node in high-risk DCIS has been found in 4 cases (9.0%)--in 1 patient (2.2%) with correct diagnosis of DCIS and in 3 patients (6.8%) with invasive carcinoma according to final histopathology. In the patient with DCIS, a micrometastasis of 0.4 mm was found in one sentinel lymph node. After complete axillary dissection, non-sentinel axillary lymph nodes metastatic involvement was not demonstrated (14/0). In 6 cases (5.0%), we identified DCISMI and did not find metastasis in sentinel lymph node. In the high-risk DCIS group, in 4 patients (9.0%) DCISMI and in 12 patients (27.2%) invasive carcinoma was found after definitive histopathologic examination. In this group, the overall ratio of invasive lesions was 36.2%. As for predictors of invasivity, high-grade carcinoma (OR 4.2; 95% CI 1,40-12,58) has more than 4-fold higher influence and lesion size

One-year follow-up of kidney transplant recipients with increased expression of mRNA for granzyme B in urinary cells.

BACKGROUND: Measurement of mRNA encoding cytotoxic proteins in urinary cells is recognized as a potential noninvasive means to diagnose acute rejection in kidney allograft recipients. We sought to evaluate kidney graft function after 1 year follow-up without therapeutic intervention among patients with increased urinary expression of mRNA for granzyme B, albeit with stable graft function at the time of measurements. PATIENTS AND METHODS: The 29 randomly selected patients were at a median of 39 months (range, 10-156) after transplantation with stable graft function over the previous 3 months. The reference housekeeping gene GAPDH was used for expression measurement in a TaqMan Gene Expression Assay with the target granzyme B gene. Delta delta ct relative gene expression analysis compared results with reference samples from 10 healthy individuals. Kidney graft function was reassessed after 1 year follow-up; immunosuppression was not changed during this period. RESULTS: mRNA granzyme B expression was significantly higher among the group of randomly assessed out-clinic patients with stable graft function than among healthy volunteers (mean ± standard error of the mean, 6.18 ± 1.27; P < .01). Despite no therapeutic intervention, no significant changes were observed in delta glomerular filtration rate or quantitative proteinuria between groups with mRNA expression > 5× versus <2× higher than the healthy controls at 1 year of follow-up. CONCLUSION: Increased mRNA expression for granzyme B in urinary cells over the medium to long term among kidney transplant recipients did not predict changes in renal allograft function after 1 year follow-up.

Survivin: a promising biomarker in breast carcinoma.

The antiapoptotic protein survivin can be detected in most types of malignant tumors, but it is rarely expressed in corresponding normal adult tissues. Therefore, survivin appears to represent a promising diagnostic biomarker. We examined survivin expression in 13 cases of normal breast tissue, 38 cases of fibroadenomas and 80 cases of breast carcinomas by immunohistochemical staining using anti-survivin antibody (DAKO, Clone 12C4). In each section, the intensity of staining, percentage of labeled cells, and the subcellular location of survivin antigen were assessed. Survivin was detected in 4/13 cases of normal breast tissue (30.7%), in 28/38 cases of fibroadenomas (73.7%), and in 67/80 cases of carcinomas (83.8%). Normal breast tissue showed cytoplasmic positivity only. In fibroadenomas, 19 cases (50.0%) revealed cytoplasmic reaction, and in 9 cases (23.7%), small foci of cells with combined nuclear and cytoplasmic location were identified. In carcinomas, cytoplasmic staining was found in 12/80 cases (15.0%), nuclear staining in 10/80 cases (12.5%), and combined cytoplasmic and nuclear staining in 45/80 cases (56.3%). Subcellular location of survivin between benign and malignant lesions revealed significant differences (p<0,001). Our findings point at practical use of survivin detection. We confirm the importance of nuclear staining of survivin antigen in breast carcinoma, which seems to be a notable diagnostic marker for estimation of the degree of neoplasia.

[Retiform hemangioendotelioma in a 8-year-old girl--case report]. / Retiformný hemangioendotelióm U 8-rocného dievcata--kazuistika.

Retiform hemangioendothelioma (RHE) is a rare vascular tumoriform lesion characterized by rete testis--like vascular structures. RHE belongs to a group of vascular tumors of intermediate malignancy and together with Dabska tumor form a category of so-called hobnail hemangioendotheliomas. Authors present a case of a 8-year-old girl with RHE which was located in right calf and measured 12 x 8 mm. Histologically, the tumor consisted of a net of vessel formations with retiform appearance and prominent endothelial nuclei. Some of vascular channels had intraluminal projections. Other benign and malignant vascular lesions with hobnail cells (hemangioma, angiosarcoma) have to be considered in differential diagnosis.

[Unusual clinical presentation of hepatic yolk sac tumour in periappendical region. A case report and review of the literature]. / Nezvycajná klinická prezentácia pecenového yolk sac tumoru v periapendikálnej oblasti. Kazuistika a prehl'ad literatúry.

Primary hepatic yolk sac tumour (YST) is a very rare neoplasm. The authors present a case of a 20-year-old woman with fever and pain in the epigastrium, clinically resembling acute appendicitis along with high levels of serum alpha-fetoprotein. From laparoscopic appendectomy there was bioptically verified a diagnosis of YST. Consequently, there was discovered a tumor in the liver and the patient underwent right hemihepatectomy, hemicolectomy and ovariectomy, from which the YST was disclosed in the liver and in the coecum with spread into regional lymph nodes. While the gonadal, mediastinal and central nervous system origin of the YST was excluded, the diagnosis of the primary hepatic YST could have been established. The exact etiology of primary hepatic YST is still unclear. It has been suggested that these YSTs might originate from the germ cells that escaped during migration course from the yolk sac to the genital ridge during embryogenesis with subsequent malignant transformation or from persistent pluripotent embryonic cells in the liver, which escaped from the influence of differentiation during embryogenesis. This tumour is aggressive with ability to spread into distant sites, where it can lead to the first clinical presentation.

Primary B-cell pituitary lymphoma of the Burkitt type: case report of the rare clinic entity with typical clinical presentation.

Primary CNS lymphomas (PCNSLs) constitute 3% of all intracranial neoplasms. From these, primary pituitary lymphomas (PPLs) represent extremely rare clinical entity. Nearly all of PCNSLs are non-Hodgkin diffuse large B-cell lymphomas. We present a 60-year-old female with right-sided third cranial nerve palsy, mild bitemporal visual field deficit, severe cephalea, and polyuria-polydipsia. Hypopituitarism with hyperprolactinemia was confirmed; brain imaging revealed a 16 mm-diameter sellar mass with suprasellar extension. A presumptive diagnosis of pituitary adenoma was established. The patient underwent a neurosurgical intervention. Histopathological examination and immunophenotyping (cytokeratin, CD45+, CD79+, bcl-2-) verified high-grade B-cell non-Hodgkin lymphoma of the Burkitt type. Systemic work-up showed no other foci of lymphoma, the patient's HIV status was negative, Epstein-Barr virus status was not disclosed. Although PPL can be undistinguishable from pituitary adenoma at imaging, one should consider lymphoma when evaluating an invasive sellar mass that is iso- to hypointense on T2-weighted magnetic resonance images, particularly when the patient is immunocompromised or old and presents with diabetes insipidus, cranial nerve palsy and fever of unknown origin in addition to the expected finding of hypopituitarism.

Neoplastic effects of exemestane in premenopausal breast cancer model.

Aromatase inhibitor exemestane as a single - agent has no established role in the treatment of premenopausal breast cancer women. The aim of this study was to evaluate preventive effects of exemestane in the model of premenopausal Nmethyl- N-nitrosourea - induced mammary carcinogenesis in female rats. Exemestane treatment begun 7 days prior to carcinogen administration and continued next 12 weeks - till the end of experiment. Exemestane was dietary administered in two concentrations of 1 mg / 1kg (EXE 1), or 10 mg/1 kg (EXE 10), respectively. Exemestane increased the tumor frequency by 80.5 % (P=0.034) in the group EXE 1 and by 61.5 % (P=0.045) in the group EXE 10 in comparison with control animals. In the group EXE 10, the incidence of mammary tumors was increased by 11.5 % (P=0.31) and tumor volume by 41.5 % (P=0.23), also the latency was shortened by 8 days (P=0.078) compared with controls. In the groups with exemestane, changes in weights and histology of uterus and vagina were not found at the end of experiment. Exemestane did not alter serum concentrations of estradiol, testosterone and dehydroepiandrosterone. In the group EXE 10 in comparison with untreated animals, exemestane decreased serum concentrations of triacylglycerols by 9 % (P=0.032), total cholesterol by 19.5 % (P=0.0002) and cholesterol of low - density and high - density lipoprotein fractions by 41 % (P<0.0001), or 21.5 % (P=0.0002), respectively. In the group EXE 1, the decrease in cholesterol of low-density lipoprotein fraction by 22.5 % (P=0.0005) was recorded. An increase in food intake (P=0.023) and body weight gain (P=0.036) was found in the group EXE 10 compared with the control group (P<0.05). The present study points to apparent tumor - promoting effects of dietary administered exemestane in the model of premenopausal mammary carcinogenesis in female rats. Exemestane as a steroidal agent indicated androgenic effects on rat lipid metabolism in this experiment.

[Cutaneous angiosarcoma following conservative surgery and radiotherapy for breast carcinoma. A case report]. / Kozný angiosarkóm vzniknutý po chirurgickom konzervatívnom zákroku a následnej rádioterapii pre karcinóm prsníka--kazuistika.

Breast angiosarcomas (AS) are very rare neoplasms, which can be divided into primary (or sporadic), and secondary AS, the latter arising either on the base of lymphoedema after mastectomy (so called AS with Stewart-Treves syndrome- ASSTS), or skin AS after breast conservation surgery with subsequent radiotherapy for breast cancer (KPRAS). The authors present a case of a 55-year-old female patient with a 17mm tumour in nipple region, developing 8 years after primary diagnosis of tubulolobular carcinoma of the breast which was treated by breast conservation surgery and radiotherapy. A probatory bioptic examination of the lesion proved well-differentiated KPRAS. The patient underwent mastectomy. The authors analyse the basic clinical and morphological features of KPRAS, which distinguish it from other forms of AS, e.g. occurrence in older age, shorter period of latency after radiation therapy when compared to ASSTS, absence of lymphoedema, and rare involvement of the breast tissue. Prognosis of this entity is very poor; today the most reliable prognostic marker is histological grading. However, it will be needed to assess in the future new indicators of prognosis of patients with this rare disease.

[Mammary carcinoma with osteoclast-like giant cells--report of two cases]. / Mamárny karcinóm s osteoklastoidnými obrovskými bunkami--opis dvoch prípadov.

Authors describe two cases of a rare type of mammary carcinoma occurring in 47-year and 49-year-old women, characterised by osteoclast-like giant cells, hypervascular stroma, and signs of older and recent haemorrhages on the background of the conventional type of breast carcinoma. In both cases there was diagnosed moderately differentiated ductal invasive carcinoma with osteoclast-like giant cells, which were present in tumorous stroma as well as scattered between tumorous cells. Immunohistochemical analysis (vimentin and CD68 positivity and negativity of cytokeratins, EMA and S-100 protein) confirmed a histiocytic origin of these giant cells as well as their reactive non-neoplastic nature. Clinical and morphological features of this unusual type of breast carcinoma indicate that it should be regarded as an unique clinical- histomorphological entity with probably better prognosis when compared to ductal invasive carcinoma not otherwise specified and it should not be included among metaplastic breast carcinomas.

Cystic dysplasia of the rete testis. Case report.

Cystic dysplasia of the rete testis (CDRT) is a very rare cause of a paediatric scrotal mass often associated with renal and other genitourinary tract anomalies. These complex malformations are probably due to a developmental defect of the mesometanephric system during embryogenesis. A case of asymptomatic scrotal swelling in a 4-year-old boy is presented. Ultrasonography, showed a cystic lesion of the left testis associated with absence of the left kidney. Orchiectomy was performed because of extensive gonad involvement. Pathologic examination revealed multiple, anastomosing, irregular cystic spaces of varying sizes and shapes predominantly located in the region of the rete testis. The cysts had spread irregularly, displacing the testicular parenchyma, which was subsequently compressed under the tunica albuginea. Preoperative diagnosis of CDRT is easy if age, precise localisation, characteristic ultrasonographic features and other genitourinary malformations are considered. Other paediatric cystic lesions should be included in the differential diagnosis. It is possible to cure CDRT by orchiectomy or by conservative treatment. Nowadays the later option is preferred, but diagnosis of CDRT must be precisely established and followed by careful monitoring.

[TNF-alpha serum levels in women with endometriosis: prospective clinical study]. / Sérové hladiny TNF-alpha u zien s endometriózou: prospektivna klinická studia.

OBJECTIVE: To determine serum levels of TNF-alpha (tumor necrosis factor alpha) as a prediction of endometriosis. DESIGN: Prospective clinical case control study. SETTING: Department of Obstetrics and Gynaecology and Department of Pathology, Jessenius Faculty Hospital, Kollarova 2, Martin, Slovakia. METHODS: The serum TNF-alpha was determined in women who underwent laparoscopy or laparotomy due to pelvic pain, infertility, dysmenorea or pelvic tumor. Endometriosis was confirmed histologically and classified by rAFS. RESULTS: On the basis of entering criteria 65 women were enrolled in this study. In 61 cases serum level of TNF-alpha was evaluated. The average serum level of TNF-alpha in the endometriotic group was 73.847 pg/ml (n=30) and without endometriosis was 21.089 pg/ml (n=31). We have found a significant statistical difference between the above mentioned groups in the medium levels of TNF-alpha (p<0.0001). We did not find statistical significance between TNF-alpha levels and in the group of women with endometriosis in relation to the stage of the disease (I.-II., III.-IV., adenomyosis). At a cut-off level of TNF-alpha 30 pg/ml there was a 63.33% sensitivity, 77.42% specificity, a positive prediction value 73.07%, and 68.57% of negative predictive value. CONCLUSION: TNF-alpha serum levels are good diagnostic markers of endometriosis in the spectrum of noninvasive methods.