NK cells not only in endometrium but also in ovulatory cervical mucus in patients with decreased fertility.

OBJECTIVE: An increased number of NK cells is associated with autoimmune disorder and is known to play a role in infertility. The aim of our research was to monitor the density of NK cells CD56+ and CD16+ in ovulatory cervical mucus (OCM) and in endometrium in infertile women as well as in connection with the actual status of antibodies against phospholipids, sperm and HHV-6 antibodies. TYPE OF STUDY: Original aticle. SETTING: Genetika - Plzeň. METHODS: Seventy-two randomly selected women aged 20-39 (mean age: 32.3) years old resulted in fifty-seven patients with repeated unexplained miscarriages, and fifteen fertile healthy women. The hormonal status was studied including ovulation, the humoral autoimmune responses to eight phospholipids, trombophilia, karyotyping, hysteroscopy, and endometrium immunohistology. Patients were without any clinical and laboratory symptoms of vaginitis at the time of OCM sampling and endometrium study. In one patient antiphospholipid syndrome was present, and in one woman diabetes mellitus was identified. Uterine NK cells CD56+ , CD16+ and NK cells in OCM were identified by immunocytochemistry, antiphospholipid antiboides by ELISA. We used indirect MAR-test for study of local spermagglutinating antibodies in OCM. Indirect immunofluorescent method was used for detection of serum and OCM IgM, IgG antibodies against HHV-6 levels at the time of ovulation. RESULTS: We found both high density of NK cells CD56+ and CD16+ in OCM and in endometrium in only two infertile women with repeated abortions. NK cells in OCM were missing in other samples of patients. The prevalence of high density of NK cells CD56+ in the endometrium was seen in twenty three (40%), NK cells CD16+ in eleven (19%), NK cells 56+ and NK cells 16+ together in eight (14%). Levels of serum and OCM IgG against HHV-6 in all examined patients were not elevated, no cervical sperm antibodies were found. CONCLUSION: We compared density of NK cells CD56+ and CD16+ in OCM and secretory endometrium in all infertile patients. Our results show that cell mucosal activity in the cervical area at the time of ovulation in two infertile patients was evident. We excluded the abnormal number of NK cells owing to local and general viral infection (HHV-6). But our question still remains - are cervical NK cells fixed or still migrating from endometrium into OCM? New research is planned.

Can the One-Step Nucleic Acid Amplification method of lymph nodes examination make the staging of pulmonary tumours more precise?

INTRODUCTION: The aim of this article is to compare the sensitivity of detecting micrometastases in hilar and mediastinal lymph nodes in case of primary (non-small cell) and secondary (metastases of colorectal carcinoma) pulmonary tumours using standard histopathological examination with haematoxylin-eosin staining, immunohistochemistry examination with Anti-Cytokeratin 19 antibody and examination based on the One-Step Nucleic Acid Amplification method. METHOD: During radical surgical treatment of primary non-small cell lung carcinoma and pulmonary metastases of colorectal carcinoma, hilar and mediastinal lymph nodes of 100 patients enrolled in the study in the period from 2015 to 2017 were extracted based on a standard classification. These lymph nodes were subsequently divided along the longitudinal axis into 4 identical parts where part one and three on the left were intended for examination based on the One-Step Nucleic Acid Amplification method, whereas parts two and four were subjected to histopathological examination. In evaluating the respective parts of the nodes by histological examination, the nodes were first examined by a standard procedure that involves haematoxylin-eosin staining, followed by immunohistochemistry examination with Anti-Cytokeratin 19 antibody. The One-Step Nucleic Acid Amplification method was performed in the kit supplied by Sysmex (Kobe, Japan) and is based on the detection of cytokeratin 19 mRNA (messenger ribonucleic acid) by reverse transcription coupled with isothermal amplification. RESULTS: A total of 1,426 lymph nodes of the patients enrolled in the study were extracted and examined using the above mentioned methodology. In 78 patients (78%), identical results were obtained using haematoxylin-eosin staining, immunohistochemistry with Anti-Cytokeratin 19 and One-Step Nucleic Acid Amplification. Micrometastases in the lymph nodes using the One-Step Nucleic Acid Amplification method in the absence of the other methods were proven in 16 patients (16%). Only in 3 cases (3%), the examination by haematoxylin-eosin staining, or immunohistochemistry with Anti-Cytokeratin 19, was positive while One-Step Nucleic Acid Amplification was negative. The results obtained by immunohistochemistry with Anti-Cytokeratin 19 antibody were practically the same as those obtained by haematoxylin-eosin staining (97%). CONCLUSION: The results of the study have demonstrated a higher percentage of metastases detected in hilar and mediastinal lymph nodes if the One-Step Nucleic Acid Amplification method of examination was used compared to haematoxylin-eosin staining and immunohistochemistry with Anti-Cytokeratin 19 antibody (upstaging in 16%). This shows that the examination of lymph nodes using the One-Step Nucleic Acid Amplification method can have a certain potential to make the pulmonary tumours staging more accurate. On the other hand, immunohistochemistry with Anti-Cytokeratin 19 antibody seems to be not so useful. However, it is necessary to prove this hypothesis in follow-up studies, or where applicable, in a larger cohort of patients. Another task is to ascertain, by careful patient monitoring, the influence of the micrometastases detected in their lymph nodes using the One-Step Nucleic Acid Amplification method on these patients' follow-up. Key words: lung cancer - lymph nodes - H&E - IHC CK19 - OSNA assay.

[Results of the treatment in selected infertile patients with high density of endometrial NK cells CD56+ and CD16+ Second part]. / Výsledky lécby u vybraných infertilních pacientek s vysokou denzitou endometriálních NK bunek CD56+ a CD16+ Druhá cást.

INTRODUCTION: This statements follows the first part of our publication entitled Screening of endometrial NK cells in selected infertile patients (First part - Methods and current results), where we dealt with methodology and endometrial findings of the natural killer cells CD16+ and CD56+. These cells are among the most important in preimplantaion, and in implantation period, in early pregnancy too, but can also negatively influence above mentioned processes. OBJECTIVE: We focused on the immunomodulatory treatment with intramuscular immunoglobulins in 21 infertile patients with a high density of endometrial NK cells CD16+ and CD56+. DESIGN: Original work-prospective study. SETTING: Genetics-Pilsen. METHODS: From the originally investigated 57 women aged 25-41 (average 34) years with their history of 3-9 abortions, we target on a high selective subgroup of 21 infertile patients with pathological density of endometrial NK cells CD56+ and CD16+. RESULTS: Twelve patients underwent immunomodulatory treatment with intramuscular immunoglobulin in time of positive HCG and went on the therapeutic scheme, nine infertile women continued with IVF-ET but did not achieve HCG positivity despite of initial treatment with immunoglobulins. Of the 12 treated patients, seven of them gave a birth to healthy babies, as to the next five pregnancies - one was extrauterine pregnancy, one genetically defective fetus, three pregnancies go on successfully.Nine women from the IVF program did not get pregnat. CONCLUSION: Immunomodulatory treatment with immunoglobulins also influences endometrial NK cells CD56+ and CD16+ associating with an overproduction of embryocytoxic cytokines. Treatment of our patients with the pathological endometrial density of NK cells must be solved strictly individually.

[Complications arising out of insufficient reporting of clinical data to the pathologist investigating placentas]. / Komplikace vyplývající z neposkytnutí relevantních klinických údaju patologovi vysetrujícímu placenty.

OBJECTIVE: To inform gynecologists-obstetricians about the problems associated with pathological examination of placentas, with special regard to the possibility of crucial role of complete and relevant clinical data in establishing the correct pathological diagnosis. DESIGN: Case report and overview of the problems associated with examination of placentas by pathologist. SETTING: Sikl´s Institute of Pathology, Faculty Hospital and Medical Faculty Pilzen of the Charles University in Prague; Biopticka laborator, s.r.o., Pilzen. METHODS: Own observation in the setting of routine pathological examination. RESULTS: Case report representing a typical complication resulting from insufficient interdisciplinary communication describes a case of unsatisfactory result of pathological investigation of placenta due to the missing clinical information about complications of the late phase of pregnancy which eventually led to intrauterine death of the fetus. Due to the absence of the clinical information of paramount importance, the initial investigation of placenta was untargeted and thus imperfect. Therefore, the primary investigation of the placenta did not reveal pathological changes responsible for the complications of pregnancy. It was only the revision of material necessitated by the information additionally conveyed by gynecologist-obstetrician leading to the final correct pathological diagnosis, which even averted the possibility of serious forensic consequences. CONCLUSION: The basic prerequisite for proper pathological examination of placenta is sharing the available clinical data with the pathologist performing the morphological investigation, mainly focusing on complications of pregnancy. Lack of such information causes examination of placenta more difficult and sometimes even unable to interpret, as the interpretation of morphological changes of placenta have to interpreted in the context of clinical data on the course of pregnancy. Regarding the extreme emotional and possibly even legal consequences of lethal complications of pregnancy or delivery, the correct pathological diagnosis may be of crucial importance.

[Carcinoid of the Appendix Goblet Cells Metastasize to the Orbit - a Clinical Case Report and Review of the Literature]. / Karcinoid z pohárkových bunek apendixu metastazovaný do orbity -  klinická kazuistika a prehled literatury.

Goblet cell carcinoid (GCC) of the appendix is extremely rare, representing approximately 5% of all primary appendiceal neoplasms. Histologically there are three groups of GCC: group A (typical GCC), adenocarcinoma ex GCC signet ring cell type (group B), and adenocarcinoma ex GCC poorly differentiated carcinoma type (group C), which is the most aggressive. GCC metastasizes in 15-60% of cases, mainly to the ovaries, pelvis, abdominal cavity, ribs, vertebrae, and lymph nodes. Hematogenous metastasis to the liver or other parenchymal organs can occur, but this is very rare. The different organs metastases havent been described yet. The primary mode of treatment is radical surgical resection or debulking, followed by chemotherapy; however, patients with unresectable or recurrent GCC are candidates for systemic therapy. Here, we report a case of very aggressive GCC of the appendix, which had metastazed to the liver at the time of diagnosis and subsequently metastasized to the orbit.

[Endometriosis of the appendix presenting like acute appendicitis--a case report]. / Endometrióza apendixu s projevy akutní apendicitidy--kazuistika.

INTRODUCTION: In general, pain in the lower right abdomen is the most frequent reason for hospital surgical admissions, acute appendicitis representing the most common cause of operation for acute abdomen. Timely appendectomy remains the only treatment in the early stages of inflammation and is usually uncomplicated, requiring only a short hospital stay. A differential diagnostic analysis necessitates a search for other, particularly long-term symptoms that might be driven to the background in cases of acute exacerbation. CASE REPORT: The case report presents a 38-year-old female patient who was admitted for lower right abdominal pain. Clinical examination and a blood test both suggested typical acute uncomplicated appendicitis, and therefore the patient underwent appendectomy. Haemorrhagic peritoneal fluid and nodularity of the appendix not typical for appendicitis was found. Oedema of the terminal ileum and a right adnexal tumour were a surprising finding. A more extensive surgical procedure involving ileocaecal resection and right-side adnexectomy was finally performed with regard to the intraoperative finding. The definitive diagnosis of appendiceal endometriosis, endometrial mass in the terminal intestine and ovarian endometriosis was established by histological evaluation. Long-term follow-up revealed microadenocarcinoma of cervix uteri. CONCLUSION: It is generally very difficult to confirm appendiceal endometriosis before operation, and revealing primary appendiceal endometriosis is virtually impossible. It is advisable to consider endometriosis in fertile women with chronic abdominal pain of unclear aetiology and gynaecological symptoms in their personal history. The best diagnostic and therapeutic method, respectively, is laparoscopy enabling exploration of the entire peritoneal cavity including the minor pelvis, and performing appendectomy as well as excision of suspicious endometrial lesions. The definitive diagnosis is usually established by histopathological evaluation. Gynaecological assessment and follow-up is highly recommended after surgery.

[Pulmonary metastases - 12-year experience with surgical therapy]. / Plicní metastázy - dvanáctileté zkusenosti s chirurgickou lécbou.

INTRODUCTION: Nowadays, radical surgical therapy of selected secondary pulmonary tumours is a generally accepted therapeutic procedure that has been proven to extend long-term survival of the patients with acceptable perioperative morbidity and mortality. The authors present a retrospective analysis of a set of patients who underwent surgery for pulmonary metastases of various tumours in a 12-year period. MATERIAL AND METHODS: In 2001-2012, 159 patients with secondary pulmonary tumours were operated on at the authors department, of whom 80 were men; the median age was 65 years. Solitary metastases were present in 112 patients (70.4%); the other patients had multiple metastases; 24 patients (15.1 %) suffered from bilateral involvement, and 6 patients (3.8%) suffered from relapsed metastatic disease after previous radical surgery. Colorectal carcinoma metastases were diagnosed in most cases (75 people - 47.2%). The median disease-free period from the surgery of the primary tumour was 27 months in the patient set. RESULTS: In total, 166 unilateral (87.4%) and 24 bilateral surgeries were performed using one- or two-stage procedure (12.6%). Precise laser excisions represented the most common type of surgery (59 procedures - 31.1%). In total, 296 metastases were radically resected, and 13 were treated using radiofrequency ablation. Perioperative morbidity was 13.2% with a zero lethality rate. 90 operated patients (56.6%) still survive after the metastasectomy, with median survival of 44 months. The overall 3-year survival in the set was 59%, and 5-year survival was 39%. The number of metastases is a statistically significant factor affecting survival in the patient cohort with colorectal carcinoma metastases, the risk of death being 2.7 times higher in patients with 2 and more colorectal carcinoma metastases. 68 patients (42.8%) live without progression of the disease after the metastasectomy, with the median disease-free interval of 29 months. In total, 43% of the patients were free of any signs of relapse or disease progression for 3 years, and 27% for 5 years. The risk of disease progression is 2.1 times higher in patients with 2 and more metastases of any tumour, and for colorectal carcinoma this risk is 2.3 times higher. CONCLUSION: The achieved results confirm the positive role of pulmonary metastasectomy in disseminated tumour therapy. The number of metastases is the decisive prognostic factor affecting both long-term survival of operated patients and their DFI.

[Examination of lymph nodes in resected colon segments with colorectal carcinoma]. / Hodnocení lymfatických uzlin v resekátech tlustého streva s kolorektálním karcinomem.

INTRODUCTION: Optimized staging of colorectal carcinoma (CRC) is essential for treatment planning and for estimating the prognosis of the disease. In addition to tumour size and the depth of bowel wall infiltration, the lymph node status is very important for the determination of the disease stage. For this reason, detection and assessment of the maximum number of lymph nodes is emphasized in the examination of resected segments of the large bowel. The number of lymph nodes (LNs) found in the segments resected depends on various circumstances. In our study, we focused on factors which could influence the number of pericolic LNs. MATERIAL AND METHODS: We examined two groups of CRC patients. The first group included 30 patients within the age range of 32-50 years (average: 47.5 years) and the second group consisted of 90 patients aged between 51 and 87 years (average: 68 years). The tumours were localized in various parts of the colon, predominantly in the descending colon and the sigmoid colon. Rectal tumour was present in 23 patients; 13 of them underwent preoperative chemoradiation therapy and 10 of them received no preoperative therapy. The length of the resected colon segments (radical intervention) ranged from 6 to 51 cm. The size of CRC ranged from 0.5 to 15 cm (average: 4.5 cm). The maximum tumour invasion depth reached into the subserosal tissue and pericolic adipose tissue. RESULTS: The number of LNs found in 120 resected colon segments ranged from 1 to 60 LNs per case. The number of LNs showed differences among the patients and also depended on the location of CRC within the large intestine. In the resected segments of the ceacum with CRC, the average number of LNs was 11.5, whereas it was only 7 in rectal CRC. The largest volume of pericolic adipose tissue was found in the caecum, whereas the smallest volume was seen on the rectal circumference. In CRC patients aged 50 years or younger, the number of LNs was from 2 to 60 (average: 17). In contrast, the number of LNs ranged from 1 to 46 (average: 11) in patients older than 50 years. In resected segments that were 6 to 12 cm long, the number of LNs ranged from 1 to 18 (average: 8). In resected segments that were 12 to 51 cm long, the number of LNs was from 1 to 60 (average: 13.8). In 13 cases of rectal CRC with preoperative chemoradiation therapy, small LNs of an average length of 1-3 mm predominated, and the number of LNs ranged between 1 and 13 (average: 5). The required number of 12 LNs was reached in 4 resected parts of the rectum (31%). CONCLUSION: The number of pericolic LNs found in the resected segments of the colon and the rectum with CRC depends on various factors. Besides individual differences, the number of LNs is influenced by the CRC location in the colon, the extent of the resected pericolic adipose tissue, the patients age and the length of the segment resected. In cases of rectal CRCs, it is also influenced by preoperative chemoradiation therapy.

Surgical therapy of pulmonary metastases - 10-year results.

INTRODUCTION: The surgical therapy of selected secondary pulmonary tumors, including both solitary and multiple or bilateral tumours, is currently a generally accepted therapeutic procedure demonstrably extending the long term survival of these patients. PURPOSE: The purpose of the present study is a ten-year retrospective analysis of a group of patients who underwent surgery due to pulmonary metastases of various primary tumors. METHODS: In 2000-2009, 87 patients (of which 44 were male with a median age of 64 years) with secondary pulmonary tumors underwent surgery at the departments of the authors of this study. Solitary metastases were found in 60 patients, multiple metastases in the remaining patients, while 13 patients had bilateral metastases. The median disease-free period from surgery of the primary tumor was 31 months. RESULTS: In total, 74 unilateral and 13 bilateral surgeries were performed in one or two periods. The most common type of surgery included anatomical pulmonary resections (32 procedures), wedge resections (29 procedures) and laser excisions (24 procedures). In total, the radical resection was performed in 156 metastases. Post-operative morbidity was 17.2 % with zero mortality. A proportion of 50.6 % of operated patients survived after resection of metastases with median survival of 39 months. The overall three-year and five-year survivals in the group were 57 % and 38 %, respectively. A proportion of 35.6 % of patients live after resection of metastases without disease progression, and the median is 15 months. CONCLUSION: The achieved results confirm the positive role of pulmonary metastasectomy in the therapy of disseminated cancer disease (Tab. 1, Fig. 5, Ref. 34).

Perineural cell differentiation in ganglioneuromas. Report of 8 cases with immunohistochemical expression of perineural cell markers.

Eight cases of ganglioneuroma were examined for a presence of perineural cell differentiation, using the immunohistochemical markers epithelial membrane antigen (EMA), claudin-1 and GLUT-1. The mean age of the patients was 42.3 years (range 26-68 years), six patients were females and two were males. Five tumors were located in the adrenal gland and 3 tumors in the retroperitoneum. Morphology of the tumors was typical, i.e., they were composed of neuroid spindle cell population and scattered mature appearing ganglion cells. Spindle cells positive for perineural cell markers claudin-1 and GLUT-1 were found in all lesions, at least focally. EMA+ cells were seen in 2 of 8 tumors. These perineural-type cells were often arranged in organoid fashion around the schwannoid bundles or around the vessels. Our findings indicate that perineural cell differentiation is commonly present in ganglioneuromas.

[Surgical therapy of pulmonary metastases of colorectal cancer--ten-year results]. / Chirurgická léba plicních metastáz kolorektálního karcinomu--desetileté výsledky.

INTRODUCTION: Nowadays, surgical therapy of pulmonary metastases of colorectal cancer is a generally accepted therapeutic approach that has been proven to extend long term patient survival with acceptable perioperative morbidity and mortality rates. The aim of the study is to retrospectively analyse a group of patients who underwent surgery for pulmonary metastases of colorectal cancer over a period of ten years. MATERIALS AND METHODS: From 2000 to 2009, 39 patients with pulmonary metastases of colorectal cancer underwent surgical therapy at the site of the authors, out of whom 21 were males (53.8%), with a mean age of 60.4 years. Out of the total, 24 patients (61.5%) presented with solitary metastases, multiple metastases were found in the remaining patients. 8 patients (20.5%) bileral affection was detected. 34 patients (87.2%) underwent adjuvant oncological therapy of a radically surgically curable primary tumor before metastasectomy and 6 patients (15.4%) underwent surgery for liver metastases. Five patients in the group (12.8%) had both pulmonary and secondary liver affections at the same time. The median disease-free period after the primary tumor surgery was 27 months in the whole group. RESULTS: In total, we performed 31 unilateral (79.5%) and 8 bilateral (20.5%) one- or two- step surgeries. The most common type of surgery included anatomical pulmonary resections (18 procedures), laser excisions (13 procedures) and wedge resections (9 procedures). In total, we performed 73 radical resections of metastases and 5 metastases were treated by radiofrequency ablation (RFA). Metastatic affection of hilar lymph nodes was found in three patients (7.7%). Perioperative morbidity reached 12.8%, mortality was zero, and two re-operations were required because of complications (5.1%). 53.8% of patients with metastasectomy are still alive, the median survival time is 38 months. The three-year survival rate is 52% and the five-year survival rate is 41% five years. Pre-operatively increased value of tissue polypeptid specific antigen (TPS) was the only statistically significant factor that had a negative impact on the overall survival. 30.7% of patients with metastasectomy show no disease progression, the median disease- free interval is 14 months. There is a statistically significant correlation between DFI (Disease Free Interval) following metastasectomy and the type of surgery and the lowest value of DFI was achieved with radiofrequency ablation. The risk of disease progression is 3.4-times higher in patients with two and more metastases of colorectal cancer up to 3.9-times higher in subjects with three and more metastases. CONCLUSION: The positive effect of pulmonary metastasectomy on the long-term survival is evident. However, careful selection of patients with individual evaluation of each single case is required. In particular, indication for metastasectomy should be carefuly considered in cases of multiple affection, which are associated with higher risk of disease progression. The essential requirement is to achieve complete resection of the pathological focus, with a maximum effort aimed at sparing healthy pulmonary tissue, which allows for potential necessary reoperations in case of the disease recurrence. Systematic mediastinal lymphadenectomy (SMLA) should be an integral part of any pulmonary metastasectomy.

Liver abscess in human toxocariasis.

BACKGROUND: Toxocariasis is a parasitic infection caused by Toxocara canis or Toxocara cati. It is distributed worldwide. Liver is the main organ affected by Toxocara infection, typically with multiple eosinophilic infiltrates. Liver abscess formation is a very rare condition. METHOD: The authors report on a case of Toxocariasis infection with abscess formation in the right liver lobe. The diagnosis was made upon patient's history, clinical examination, use of ultrasonography, computed tomography and especially upon positive serologic test and hypereosinophilia. After unsuccessful conservative treatment (Mebendazole, antibiotics and corticoids), right hepatectomy was performed. RESULTS: The postoperative course was complicated by biliary fistula in the resection area. The complication was successfully managed by temporary stent implantation to the left hepatic duct. Six months after the operation, the patient is with no complications. CONCLUSION: Liver abscess formation is a rare condition associated with Toxocara infection. It is still a matter of debate whether liver abscess results from severe parasitic infection or whether human toxocariasis is a predisposing cause of pyogenic liver abscess formation. Liver resection is the only treatment option when sepsis fails to respond to conservative treatment (Fig. 5, Ref. 22).

[Pulmonary metastases of the clear cell (conventional) renal cell carcinoma--options and results of surgical treatment]. / Moznosti a výsledky chirurgické lécby plicních metastáz svetlobunecného (konvencního) renálního karcinomu.

BACKGROUNDS: At the diagnosis, up to one third of patients with clear cell (conventional) renal cell carcinoma have metastases, and the disease will progress in a half of patients with localized disease; the lungs are the most frequently affected organ. Despite clear advances in targeted biological treatment, radical surgery of organ, mainly pulmonary, metastases is a justified treatment approach with good results. AIM: A nine-year retrospective analysis of patients with clear cell renal cell carcinoma undergoing surgical treatment of pulmonary metastases. MATERIALS AND METHODS: At our centre, 13 patients with the mean age of 65 years, 9 of which were men, underwent surgical treatment between 2001 and 2009. Surgery was only indicated in patients after renal tumour resection without extrapulmonary metastases in whom presurgical assessment suggested that the pulmonary metastases were resectable (with respect to their number and location) and in whom the benefits of performing the surgery outweighed any potential risks. Metastases were solitary in 9 patients and multiple in the rest, 2 patients had bilateral involvement. Median disease-free interval following nephrectomy was 28 months. RESULTS: A total of 11 unilateral and 2 bilateral resections were performed during one or two surgical operations. Most frequently, wedge resection was performed (7 patients). A total of 23 metastases were resected. Perisurgical morbidity was 15.4%, zero mortality. Of those undergoing metastasectomy, 53.8% are still surviving with a median survival of 24.3 months. Three-year survival in the sample was 66%, 5-year survival was 53%. Five patients (38.5%) have had no disease progression for a median of 8.8 months. CONCLUSION: Our results confirm the positive role of metastasectomy in the treatment of pulmonary metastases of clear cell (conventional) renal cell carcinoma. Long-term survival after pulmonary metastasectomy might be expected in patients with solitary metachrone small metastases with DFI after nephrectomy > 1 year, without tumour involvement of the relevant lymph nodes and R0 resection.

[Caroli disease--dilatation of intrahepatic bile ducts]. / Caroliho nemoc--dilatace intrahepatálních zlucových cest.

Caroli disease is a rare congenital condition characterized by a non-obstructive saccular or fusiform multi-focal segmental dilatation of the intrahepatic bile ducts and the frequent formation of the intrahepatic calculi. It can affect the entire liver with manifestations in the childhood, or only some segments, which may be an asymptomatic condition found accidentally in the adulthood. In other cases, the condition is manifested primarily with tract infections. The authors of the three case reports describe pitafalls of the diagnosis and treatment of the segmental Caroli disease, which is manifested in the adulthood. The treatment was a resection of the affected liver segments.

[Surgical treatment of pulmonary carcinoids - ten-year results]. / Chirurgische Behandlung von Lungenkarzinoiden - Zehnjahresergebnisse.

INTRODUCTION: Carcinoids are malignant neuro-endocrine tumours occurring in the bronchopulmonary location in about 25 %, and accounting for approximately 2 % of all pulmonary tumours. MATERIAL AND METHODS: Our retrospective analysis included 27  patients, 14  men and 13  women, mean age 58.4  years, treated from 2000 to 2009 for carcinoids in bronchopulmonary locations. The tumour manifested clinically in 52 % of the cases, the most common symptom being cough; one tumour manifested as carcinoid syndrome. All patients underwent fibrobronchoscopy that was positive in 20  cases (74.1 %). Pre-surgery histological diagnoses were made in 13  patients (48.1 %). Chest CT scans were carried out in 26  patients, and the investigation failed to detect the expected pathological process in 2  of the patients. Octreoscans were carried out in 12  patients, and were successful in identifying a primary neuroendocrine tumour in 75 %. RESULTS: All patients in the sample underwent rad-ical surgical therapy; the most common surgical procedure was lobectomy (70.4 %). Perioperative morbidity and mortality were zero. Typical carcinoids were found in 20  cases while 7  cases were atypical carcinoids, 20  tumours were located centrally. 74 % of the tumours were consistent with stage  I A disease. Mean follow-up period was 47 (range: 6-134)  months. Local recurrences were observed in 2  patients (7.4 %), but the tumour disseminated in 4  patients (14.8 %). Two patients (7.4 %) died during the follow-up period. Overall five-year survival in the sample was 92.3 %, 90.9 % in the typical carcinoid group and 100 % for atypical carcinoids. We found a statistically significant association between disease-free interval and histological type of the tumour; the risk of progression was 8  times higher in -patients with atypical carcinoids compared to patients with typical carcinoids (Log-Rank-Test: p-value = 0.0049). CONCLUSION: Radical surgical treatment of bronchopulmonary carcinoids is the optimum therapeutic approach that results in the best results both regarding perioperative morbidity and mortality and regarding long-term survival of the patients.

Pseudoglandular (adenoid, acantholytic) squamous cell carcinoma of the penis. A case report.

A case of so-called pseudoglandular (adenoid, acantholytic) squamous cell carcinoma (SCC) of the penis occurring in a 60-year-old man is described. The tumor showed, in addition to the pattern of conventional moderately to poorly differentiated SCC, a component of tubular-appearing pseudoglandular SCC. No precancerous dysplastic lesion was found near the lesion. Immunohistochemically, the tumor cells expressed pancytokeratin, p53 and p63, and they were negative for endothelial markers, carcinoembryonic antigen and p 16. Stains for mucin were negative. Metastases were found in the regional lymph nodes and spermatic cord. Four weeks after the penectomy, multiple cutaneous/subcutaneous metastases appeared and metastases in the pelvic lymph nodes were visualized through a CT scan. The advanced stage of the tumor seen in the present case further confirms that pseudoglandular SCC represents a highly aggressive tumor.

Histologic findings after sodium phosphate bowel preparation for colonoscopy. Diagnostic pitfalls of colonoscopic biopsies.

Oral sodium phosphate (NaP) has been increasingly used for bowel preparation before the colonoscopy because it shows good patients tolerance and effective bowel cleansing ability. However, new studies describe that NaP can induce colonic mucosal damage. For better characterization of these changes, we examined histologically segmental colonic biopsies from 42 patients receiving NaP bowel solution before the colonoscopy. The series includes 25 male and 17 female patients in age from 19 to 81 years (average age 46.7 ys). Clinical symptoms in 37 patients included diarrhea, constipation, bleeding and abdominal cramps. The most frequent reason for colonoscopy was suspicion of microscopic colitis. Five patients underwent endoscopy to rule out the presence of neoplasia. None of the patients took drugs before the colonoscopy. Histologically, all specimens showed mild focal edema, hyperemia and hemorrhages. In addition to edema and hemorrhage, in 26 patients (61.9%), patchy mononuclear infiltration in the upper part of lamina propria and increased epithelial cell proliferation of individual crypts were seen. Mucosal structure was normal, with partial sloughing of normal or flattened surface epithelium. In 5 patients (11.9%), some biopsy samples contained scattered neutrophilic leucocytes in the lamina propria/superficial epithelium, isolated basal cryptitis, increased proliferation and apoptosis of the crypt epithelium. In two patients with focal cryptitis (4.8%), small erosions were found. Mild basal cryptitis, increased proliferation and striking apoptosis were present in two inflammatory pseudopolyps (in two patients). In 4 patients, solitary tubular adenomas with low-grade dysplasia without any reactive changes were found. In addition, 300 hyperplastic polyps removed endoscopically after the NaP application, were examined. Two polyps (0.75%) showed cryptitis and isolated multinucleated epithelial cells in the superficial part of the crypts. Our results are similar to those previously described in other studies of colonic changes after the NaP application. It reflects probably a similarity in composition of used NaP solutions.

[Bilateral spontaneous pneumothorax--wrong therapies]. / Oboustranný spontánní pneumotorax--chybný lécebný postup.

In spite of being a relatively rare disorder, synchronous bilateral spontaneous pneumothorax requires proper attention because of its consequences that essentially constitute an acute life-threatening chest cavity event. Standard of care is stabilization of the patient's condition with emergency drainage of both pleural cavities that should be followed by early surgical revision, preferably using miniinvasive approach involving intervention of the lung, or pleura. The case report uses the example of a 19-year-old patient to alert to possible errors in the process of therapy of this disorder, presenting, at the same time, the correct alternative of the process.

[Elective videothoracoscopy--a tool for prevention of primary spontaneous pneumothorax?]. / Elektivní videotorakoskopie jako prevence vzniku primárního spontánního pneumotoraxu--ano ci ne?

AIM: Based on the retrospective analysis of the selected group of patients with primary spontaneous pneumothorax (PSP), the authors aim to demonstrate contribution of CT scan examinations and elective videothoracoscopic procedures in diagnostics and treatment of pulmonary conditions, predisposing the patient to the disorder. MATERIAL AND METHODOLOGY: During 2005-2007, 45 patients with PSPs underwent post-treatment CT lung examinations. Pathological findings potentially resulting in collapsed lung, were detected in nearly 25% of the subjects. All of the subjects (males, the mean age of 22.4 years) were then indicated for elective videothoracoscopy, in order to prevent potential PSP events. The procedure included peripheral endostapler lung lesion resection and mechanical pleurodesis (pleuroabrasion), resp. partial apical pleurectomy. RESULTS: Pathological changes of the lung tissue were detected with the same rate in the both, right and left lung apices. In miniinvasive procedures, they were always easily located, as anticipated. In all of the subjects, the changed tissue was removed using peripheral lung resections, with concomittant pleuroabrasion in a half of the subjects, while in the other half of the subject, the procedure was combined with partial apical pleurectomy. Intraoperative morbidity and mortality were nil. The mean period of postoperative drainage was 5.5 days, the mean duration of hospitalization was a week. During the study period, no further PSP events were recorded. CONCLUSION: CT examination-based detection of pneumothorax-predisposing pathological lung tissue changes and their subsequent removal using elective videothoracoscopy, is a valid and a patient-beneficial procedure.

Diagnostic problems of abdominal desmoid tumors in various locations.

BACKGROUND: Abdominal desmoid tumor is one of the forms of deep (musculoaponeurotic) fibromatosis. It occurs more often as a desmoid tumor in the abdominal wall, less often in various intra-abdominal locations. In this work, we performed retrospective study concerning diagnostic problems of this disease with the use of imaging techniques. METHOD: Four patients (three females and one male) were examined by postcontrast CT (computed tomography) and one of them also by MR (magnetic resonance). All findings were correlated with the operational findings and histologic examination. RESULTS: The findings were typical only in the case with the lesion located in the abdominal wall, three described cases of the intra-abdominal desmoid provided a broad range of differentially diagnostic possibilities (metastases, GIT tumors, lymphomas, etc.). In particular, the findings in infiltrative processes in intra-abdominal location and retroperitoneal involvement were less typical. Ultimately, the histological findings were decisive. CONCLUSION: The possibility of the occurrence of intra-abdominal desmoid tumor must be considered particularly in younger individuals with rapidly growing tumorous process, which does not immediately arise from the surrounding organs (digestive tract, internal genitalia, etc.), and is located in the abdominal wall or in the abdominal cavity.