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Aim: To make doctors aware of the potential risk of developing melanocytic skin lesions and the possible development of malignant melanoma in patients chronically treated with adalimumab (Humira), a tumor necrosis factor-alpha (TNF-alpha) antagonist. Case report: A 38-year-old man came to the dermatology clinic because a month ago, he noticed the macroscopically visible change of the previously existing melanocytic lesion on the skin of the abdominal wall, in the form of enlargement and color change. Three years ago, the patient began to feel tightness in the thorax and back, morning low back pain and back pain, which would be reduced by taking non-steroidal anti-rheumatic drugs. Based on clinical, laboratory and radiological findings, the patient was diagnosed with axial spondyloarthritis, for which, two months later, adalimumab was introduced into his chronic therapy. The use of adalimumab led to a marked improvement in the patient’s condition, and he continued to take it regularly. After two years of continuous therapy with adalimumab, the patient noticed a change in the pre-existing nevus on his abdomen. He informed the dermatologist, who performed a total excision of the lesion. The pathohistological analysis confirmed a dysplastic nevus with a high degree of dysplasia. Conclusion: The association of adalimumab with melanoma development has not yet been sufficiently investigated, although much evidence supports this. Physicians must be aware of the possible risk of progression of pre-existing melanocytic lesions and the possible development of malignant melanoma, educate patients, and advise regular monitoring and caution to detect and prevent potentially serious side effects of adalimumab. Research on this topic is not numerous, and further studies are needed to consider several risk factors for melanoma. [ABSTRACT FROM AUTHOR]

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Aim: To report a case of a patient with the pineal parenchymal tumor of intermediate differentiation grade II, with emphasis on histopathological diagnosis of this clinical entity. Case report: A 30-year-old patient was admitted at the Clinic for Neurosurgery at the Clinical Hospital Centre Rijeka in order to surgically remove a cyst in the pineal region. The only and main symptoms were headaches in the past four years. Magnetic resonance was performed to visualize the pineal cyst. Osteoclastic suboccipital median craniotomy with extirpation of the cyst had been done and the biopsy specimen was sent to the Pathology Department of the Clinical Hospital Centre Rijeka. Histologically, the tissue of the brain was infiltrated by a moderately cellular tumor tissue consisting of diffusely distributed small uniform cells with scarce cytoplasms and with the tendency to form perivascular acellular areas with discrete pineocytomatous rosettes. Nuclei of the tumor cells were oval and monomorphic with an occasional mild polymorphism. Mitotic activity was low and measured less than 0.5 %. The biopsy specimen included several smaller foci of calcification without the presence of necrosis. Immunohistochemistry showed strong diffuse positivity for neuron-specific enolase and synaptophysin, which suggested neuroendocrine differentiation. According to the histological findings and immunohistochemistry profile, the pineal parenchymal tumor of intermediate differentiation - WHO gradus II has been diagnosed. The patient was feeling well aft er the operation and had been dismissed for further home treatment. Conclusions: Only precisely determined histopathological diagnosis will result in adequate choice of therapy and accurate clinical approach to any patient with this type of tumor. Further molecular research needs to be conducted in order to form standardized guidelines which would help in process of confirming the exact diagnosis. [ABSTRACT FROM AUTHOR]

Histopathological features of breast cancer include numerous details that are essential for the further choice of patient's therapy because it must be clear, unambiguously stated and reliable. In addition to traditional data on invasion, metastasis and response to therapy more information on prognostic and predictive factors that affect the treatment provide patients and genetic research on the basis of which tumors according to the expression of certain genes in the stratified subtypes. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Fluminensis is the property of Croatian Medical Association, Rijeka Branch & Faculty of Medicine, University of Rijeka and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina Fluminensis is the property of Croatian Medical Association, Rijeka Branch & Faculty of Medicine, University of Rijeka and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina Fluminensis is the property of Croatian Medical Association, Rijeka Branch & Faculty of Medicine, University of Rijeka and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina Fluminensis is the property of Croatian Medical Association, Rijeka Branch & Faculty of Medicine, University of Rijeka and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina Fluminensis is the property of Croatian Medical Association, Rijeka Branch & Faculty of Medicine, University of Rijeka and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina Fluminensis is the property of Croatian Medical Association, Rijeka Branch & Faculty of Medicine, University of Rijeka and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina Fluminensis is the property of Croatian Medical Association, Rijeka Branch & Faculty of Medicine, University of Rijeka and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)