Analysis of Survival and of Time Until Recurrence of Disease of Patients With Papillary Thyroid Carcinoma-Multivariant Analysis.

BACKGROUND: We examined survival and time until recurrence of disease by multivariant analysis in patients treated for papillary thyroid carcinoma (PTC). PATIENTS AND METHODS: In the period from January 2003 to January 2018, we analyzed 102 patients with PTC in Public Health Institution-Hospital "Sveti Vracevi" in Bijeljina. Survival and time until recurrence of the disease were analyzed using patients' general data and factors based on preoperative, intraoperative and postoperative examinations. Many prognostic factors were analyzed together; the AGES prognostic score, consisting of age, grade, extent and size, and the AMES prognostic score, consisting of age, metastases, extent and size. RESULTS: We analyzed 102 patients with PTC. Out of these 87 patients had AGES p.s ≤ 3.99 and 15 patients had AGES p.s> 4. The survival of patients was affected by the presence of distant metastases at the time of diagnosis p = 0.00109 and age p = 0.0436. Recurrence of the disease was recorded in 14 patients. Most patients had recurrence of the disease in the first 5 years after initial surgery. Analyzing the time until recurrence, we concluded that, statistically speaking, AGES p.s> 4 affect recurrence of the disease p = 0.0355 in a significant way, while distant metastases affect it in a very significant way (p = 0.008). CONCLUSIONS: Prognostic factors of papillary thyroid carcinoma can be divided into 4 categories, patients' general data and factors based on preoperative, intraoperative and postoperative examinations.

Lymph Node Metastases Papillary Thyroid Carcinoma and their Importance in Recurrence of Disease.

BACKGROUND: The purpose of this study is to establish whether the lymph node metastases of the papillary thyroid carcinoma are a significant factor in recurrence of the disease by analyzing the time until recurrence of the disease and frequency of recurrence of the disease. METHODS: From 1 January 1995 until 30 June 2017, 102 patients were treated at the Public Health Institute Hospital "Sveti Vracevi" in Bijeljina for PTC. In all patients, surgery of the thyroid gland and/or lymph nodes of the neck was performed. Total thyroidectomy (TT) was performed in 20 patients and near-total thyroidectomy leaving <1 g thyroid tissue adjacent to the recurrent laryngeal nerve in 7 patients. TT and lymph nodes dissection were performed in 71 patients. Palliative surgery and biopsy due to locally advanced disease were performed in 3 patients. RESULTS: In our study, 102 patients with PTC were analyzed. 82 patients experienced pure PTC (80.4%), the other 20 patients (19.6%) experienced other variants of PTC. 24 patients (23.5%) experienced multi centric or bilateral tumors. 71 patients (69.6%) experienced histologically verified metastases in the lymph nodes of the neck. 7 patients (6.8%) experienced distant metastases. 20 patients underwent total thyroidectomy (TT), and 7 near-total thyroidectomy. Total thyroidectomy + dissection of central and lower jugular lymph nodes with frozen section histopathology verification was performed in 71 patients (69.6%). Out of these 71 patients, in 50 patients (70.4%) metastases were verified in the lower jugular lymph nodes. A modified lymph node dissection (MRND) was also performed in these patients. CONCLUSION: Lymph node metastases of the papillary thyroid carcinoma are a plausible prognostic factor. They are important for recurrence of the disease, but not for survival.

Double tract reconstruction after total gastrectomy in patients with gastric cancer: our experience.

PURPOSE: Gastric cancer (GC) remains one of the most frequent cancers worldwide. After total gastrectomy it is necessary to reconstruct the upper part of the digestive tract. The double tract (DT) method is the optimal reconstruction procedure aftertotal gastrectomy for patients with gastric cancer. METHODS: In General Hospital "Sveti Vracevi" in Bijeljina, from January 2006 to January 2009 37 patients who underwent a total gastrectomy with a curative resection were included in the research. RESULTS: In this study we observed early postoperative complications and mortality, postoperative food intake and nutritional status (hemoglobin, total proteins and albumin), and incidence of diarrhea and dumping syndrome at 1 and 3 years. Tumor diffused in the sections of stomach in 37 cases: cardia and body in 14 cases, body and antrum in 16 cases, and in only body of stomach in 7 cases. In the pathological examination, the tumors of 34 patients were diagnosed as adenocarcinoma, 2 as malignant lymphoma, and i as leiomyosarcoma. CONCLUSIONS: The benefits of this method are (1) a simple procedure; (2) preservation ofthe duodenal passage; (3) no duodenal stump, resulting in no risk of postoperative stump rupture.

Bilateral breast carcinoma in patients with Klinefeleter syndrome: report of case.

PURPOSE: Men with Klinefelter syndrome have one or more extra X chromosomes and have endocrine abnormalities. Klinefelter syndrome has been consistently associated with breast cancer in men (MBC). CASE REPORT: We report a 54-year old man was diagnosed as synchronous bilateral breast cancer with Klinefelter syndrome. On clinical examination there was mass in the lateral upper quadrant right breast. The overlying skin was slightly retracted. In the left breast, there was also a subareolar mass. Mammography, ultrasonography imaging showed bilateral suspicious breast masses with microcalcifications. There were no radiological findings of muscle invasion or axillary lymphadenopathy. We performed bilateral fine-needle aspiration biopsy (FNAB), and the aspiration smears were positive for carcinoma. The pathologic diagnosis of infiltrating ductal carcinoma in the biopsy specimen on the bilateral breast. The patient was successfully treated by bilateral radical modified mastectomy according to Madden's technique followed by external irradiation and adjuvant endocrine therapy. CONCLUSION: Breast cancer commonly occurs in women, but now the incidence is also seen in men. Risk factors include age, family history, genes, liver diseases (cirrhosis), alcohol, diet, and obesity. Klinefelter syndrome, in which patients carry XXY chromosome, may be present in men with breast cancer for this reason they often develop gynecomastia.

[Primary squamous cell carcinoma of the breast: rare form carcinoma]. / Primarni planocelularni karcinom dojke: rijetka forma karcinoma.

Primary squamous cell carcinoma (SCC) is a rare form of breast carcinoma. Incidence is reported to be 0.1-3.6%. We report a case of a young woman, 37-year-old, with history of a lump in the upper outer quadrant of the left breast with ulceration of the skin surface. Menarche occurred at age of 12. The patient was married, had two deliveries and had her first child at age of 26. She did not use contraceptive pills. Diagnosis of the tumour of the breast was made at the Department of surgery in General Hospital in Bijeljina in September 2007. Clinical examination, mammography and ultrasonography were performed. Physical examination revealed a circumscribed and firm mass measuring 60 x 60 x 80 mm. Mammogram showed a round, high-density mass with almost regular but partially irregular margin. Ultrasonogram of the left breast tumor identified an irregularly shaped hypoechoic lesion. After clinical staging of the disease, we performed incision biopsy of the skin and tumour of the left breast with histopathology examination (standard hematoxylin and eosin). Patient had estrogen and progesteron receptors negative and was HER2/neu negative. After histopathology, patient's case was presented to the working group for breast tumors which decided to start with the neoadjuvant chemotherapy using platinum. After six cycles of neoadjuvant chemotherapy, regression of breast tumor was confirmed. Working group decided that radical mastectomy of left breast should be performed.

[Laboratory-immunology indicators according as prognostic factors of patients with colon and rectum cancer]. / Laboratorijsko-imunoloski pokazatelji kao prognosticki faktori kod bolesnika sa karcinomom kolona i rektuma.

INTRODUCTION: The occurrence of colon and rectum cancers has risen gradually in the past twenty years. In order to make a precise forecast about a patient's life expectancy and/or treatment, the factors of prognosis and outlook are used in oncology. These can be classified as clinical-surgical, pathological-histological and laboratory-immunology. PURPOSE OF THE WORK: To establish the significance of the laboratory-immunology indicators, carcino-embryonic antigen (CEA), proliferate nuclear antigen (PCNA) as well as Ki67 and p53 in the survival rate of patients who have colon or rectum cancer. PATIENTS AND METHODS: In "Sveti Vracevi" Hospital in Bijeljina 33 patients suffering from cancer of the left half of the colon and rectum received treatment from 1st January 2000 to 1st January 2003. They all had immunohistochemical analysis of CEA, PCNA, Ki67 and p53. RESULTS: The patients with positive immunohistochemical CEA, PCNA and p53 values had statistically shorter life expectancy in comparison with the patients with negative CEA, PCNA and p53 values. There was not statistically significant difference in the survival rate of patients with positive immunohistochemical Ki67 values in relation to the patients with the negative values. CONCLUSION: Immunohistochemical analysis is not used in the routine analysis of colon and rectum cancers. Establishing them gives enough information on the patient's survival rate.