[Anticoagulation and Thrombembolism During Bevacizumab Treatment--To Be Careful or Fearful?]. / Antikoagulacní lécba a trombembolizmus pri lécbe bevacizumabem--opatrnost, ci obavy?

Inhibition of angiogenesis is a valid approach in today's medicine. Besides oncology, it is used in ophthalmology, as well. In oncology, angiogenesis inhibition has become a routine and accessible method. A combination of angiogenesis inhibition and other therapies, including anticoagulation and antiaggregation is common in many cases. Bevacizumab is the most used antiangiogenic agent and has been in use for the longest period of time. A concomitant administration of angiogenesis inhibitors and anticoagulation may be feared by oncologists. From the available literature it is obvious that concomitant administration of bevacizumab and anticoagulation is safe. Also, use of antiaggregation and bevacizumab is safe. The risk of venous and arterial thromboembolism is real during the treatment with bevacizumab. Therefore, concomitant anticoagulation is not only possible but also may be desirable.

Long term experience of patients with unresectable or metastatic KIT positive gastrointestinal stromal tumours.

A retrospective analysis of consecutive patients (183 in total, of which 105 were males and 78 females) with gastrointestinal stromal tumour (GIST) was performed. The mean age was 61 years, median age 64 years. The most frequent localization of the tumour was stomach in 74 patients (40.4 %) and the small intestine in 46 patients (25.1 %). Two or more different synchronous or metachronous cancers occurred in 34 (18.6 %) patients with histologically confirmed GIST. Ninety-six patients were treated with imatinib mesylate in palliative setting during the course of their disease. The therapy was finished in 60 patients and 36 patients have been treated so far. The median progression-free survival reached 32.9 months in the group of 96 patients treated with imatinib. The median overall survival in the group of 96 patients treated for metastatic disease reached 77 months. Two-year and 5-year survival was 85.2 % and 63.1 %, respectively. The second-line therapy with sunitinib malate was administered in 37 patients, of which 31 finished and 6 continued in the therapy. The median progression free survival and median survival since the sunitinib therapy initiation reached 8.4 and 22.1 months, respectively (Tab. 2, Fig. 2, Ref. 16).

Significant antitumor effectiveness of imatinib in c- kit negative gastrointestinal stromal tumor -  case report.

Inoperable c- kit negative gastrointestinal stromal tumor (GIST) is commonly considered to be highly resistant to systemic therapy. We present a case of a woman with an abdominal sarcomalike tumor diagnosed at the age of 26. The patient underwent several surgical procedures and courses of cytostatic therapy without any substantial effect. Later, the tumor was reclassified as c- kit negative GIST harbouring the mutation in exon 12 of PDGFRA gene. Hence, the therapy with imatinib mesylate was initiated, resulting in partial remission of metastatic lesions and further stabilization of the disease for five years to date. We therefore consider imatinib mesylate an appropriate therapy for c- kit negative GIST bearing PDGFRA mutations.

[A case report: patient with metastatic goblet cell carcinoid]. / Pacientka s metastatickým karcinoidem z pohárkových bunek.

BACKGROUND: Goblet cell carcinoid represents a unique entity of appendiceal neoplasia. Its pathological features and clinical behavior are distinct from the classic carcinoid tumor as well as primary adenocarcinoma of the appendix. Correct histopathological classification and diagnosis provide guidelines for treatment and prognosis. Morphological transformation of the Goblet cell carcinoid from typical Goblet cell carcinoid to adenocarcinoma morphology is likely associated with accumulation of additional genetic changes that is why subclassification of this group of tumors is needed. Investigation of molecular genetic changes could increase our understanding of this exotic but clinically important group of tumors. CASE: We present the case of a patient with metastatic goblet cell carcinoid involving terminal ileum, ascendent colon, ovary, omentum and peritoneal spreading, treated with debulking surgery and chemotherapy (FOLFOX4 regimen) with good response, reduction of disease on CT and PET complete remission. Improvement of clinical symptoms as well as quality of life was reached by combined palliative treatment. CONCLUSION: Correct diagnostics and therapeutic efforts bring patient benefit even in metastatic setting. Better knowledge of rare tumors and understanding of their biology help improve therapeutic approaches.

[Malignant melanoma treated with radical chemotherapy, resemblance histology of melanoma to soft tissue sarcomas, case report]. / Maligní melanom lécený intenzivní chemoterapií, podobnost histologického obrazu maligního melanomu a nádoru mekkých tkání, kazuistika pacientky.

BACKGROUND: Malignant melanoma is considered to be highly resistant to chemotherapy, radiotherapy, hormonotherapy and standard immunotherapy (interleukin 2, interferon alpha). Radical surgery in the early stages of the disease is still the most efficient method. Since the development of immunotherapy and targeted therapy, the role of palliative chemotherapy for advanced disease may be changing. CASE: A case report regarding 44-year-old woman with extensive tumor of the pectoral wall with contralateral axillary lymphadenopathy is presented. On the basis of imaging methods, histology and immunohistochemistry, the tumor was defined as a sarcoma. Due to PAX7-FKHR fusion gene positivity, rhabdomyosarcoma was the most probable classification. The patient was treated with radical chemotherapy including iphosphamide, vincristine, actinomycin D and doxorubicin with the effect of partial regression of the tumor. This enabled radical surgery of the chest wall tumor. Pathology proved 70% necrosis of the tumor. A contralateral axillary dissection was performed with a finding of two lymph nodes infiltrated with melanoma. The immunohistochemistry markers S100, HMB-45 and Melan A were positive. This resulted in a reclassification of the chest wall tumor to malignant melanoma. The following PET/CT scan was negative. A massive progression of the disease occurred after 5 months. B-RAF mutation leads to a plan of targeted therapy with vemurafenib. CONCLUSION: The case demonstrates the limits of the sensitivity and specificity of immunohistochemical markers of melanoma and the ability of this tumor to imitate various tumors including soft tissue sarcomas. A rare -PAX7-FKHR fusion gene positivity considered specific for rhabdomyosarcoma was found. An extraordinary response to radical chemotherapy with surgical resection led to an improvement of the quality of life and to a prolonged survival comparable with the effect of new targeted treatment for malignant melanoma.

[Analysis of prognostic factors in osteosarcoma adult patients, a single institution experience]. / Prognostické faktory konvencního osteosarkomu dospelých pacientu

BACKGROUND: The objective of this report was to estimate long-term outcome and prognostic factors in adult patients with high-grade osteosarcoma. The intended therapeutic strategy included preoperative and/or postoperative chemotherapy as well as surgery of all operable lesions. PATIENTS AND METHODS: We reviewed the clinical data of 36 newly diagnosed adult patients (aged 19-82, average 37.5, median 28.5 years) with high-grade osteosarcoma of the trunk or limbs evaluated by a multidisciplinary team and treated between 1999 and 2010 in Brno. Forty-five percent of patients were over thirty, more than 36% over forty. Thirty-one percent of patients had metastasis at the time of diagnosis. Demographic parameters, tumor-related and treatment-related variables included possible prognostic factors and their impact on response, overall survival (OS) and event-free survival (EFS) were analyzed. RESULTS: All the patients were followed up after treatment. Seventy-three percent of patients were poor responders to chemotherapy. Sixteen patients are alive, and twenty patients died. The survival time ranged from 2 to 177 months (average 45 months, median survival 23 months). The 5-year OS of all patients was 52.4%. OS of patients without metastasis was 68.12%, while 2-year OS with metastasis was 26% only. 5-year EFS was 38.7%. Univariate analysis revealed that the prognosis of adult osteosarcoma patients was significantly related to distant metastasis (p = 0.006), surgical stage (p = 0.00582), serum alkaline phosphatase (ALP) level (p = 0.00841) and serum lactatdehydrogenase (LD) level (p = 0.047). The other analyzed prognostic factors including age had no statistically significant influence on outcome of osteosarcoma in adult patients. CONCLUSION: The prognosis of osteosarcoma in adult patients was significantly correlated to surgical stage, distant metastasis, serum ALP and LD.

Application of word-formation models in medical terms fixation.

In their article the authors present goals of Latin teaching at medical faculties in Slovakia. They analyze in more details word-formation and structure of one-word medical terms from the point of view of their model teaching/learning and fixation. Presentation of the medical terms in models proved to be very effective for adult learners because they provide exact and easy-to-memorize scheme mechanisms that can be analogically applied in the production/manipulation and fixation of a whole range of medical terms. In conclusion several examples--excercises are presented to illustrate their use in teaching practice. (Fig. 1, Ref. 7.).

Hippocrates' humoral pathology in nowaday's reflections.

Ancient medicine integrated three components: experience (empirical observation), religion/magic and speculations of natural philosophers. The Greek medicine out-achieved medicine of other ancient nations in starting to investigate the true causes of health and diseases and thus laying foundations for the diagnosis, prognosis and treatment. Hippocrates, the most famous physician of the ancient times, made a synthesis of existing philosophical opinions from the point of view of a physician. His 58 writings were preserved in the collection "Corpus Hippocraticum". The most relevant writing in it--"Peri fyseos anthropu" (On the nature of man)--is ascribed to Hippocrates' son-in-law Polybos to whom we are grateful for the ancient humoral-pathological theory. In explaining human organism and its processes the author integrated ancient teachings on 4 basic humors (humoral theory), elements and qualities with observations of manifestations of health and disease. Normal condition (health) was defined as balance between the body fluids (eukrasia) and external environment. If this balance is disturbed, the result is dyskrasia, i.e. disease studied by pathology. According to Hippocrates disease causes can be understood only through empirical study. A man has a power to overcome disease, but to achieve it the right diet is necessary to keep harmony in body fluids of an organism. The role of a physician was just to support the nature. "Prognosis", another writing included in "Corpus Hippocraticum", reflects Hippocrates' understanding of prognosis as a necessary development of diagnosis based on past knowledge (anamnesis) and present observation. Ideas of Hippocrates and his medical school are still valuable and inspiring especially for today's very sophisticated medicine--concept of fighting diseases by natural means: maintaining healthy lifestyle and harmony within the organism, or an effort for perfect understanding of human creature and for humanization of medicine. (Fig. 3, Ref. 14.)