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Background:Triple-negative breast cancer (TNBC) has the worst prognosis and the highest immunogenic potential of all breast cancer subtypes. The tumour microenvironment (TME) of TNBC consists mostly of tumour-infiltrating lymphocytes (TILs), tumour-associated macrophages and dendritic cells. TILs are involved in host immunity against tumour cells through the activation of tumour-specific CD8+ cytotoxic T cells. However, there are opposing data about the prognostic value of TILs in TNBC. Programmed cell death receptor ligand 1 (PD-L1) from immune or tumour cells binding programmed cell death receptor 1 (PD-1) disable the effector role of CD8 T cells. Therefore, antibodies that block the target in the PD-1 signalling pathway elicit a stronger immune response. Cytotoxic T lymphocyte-associated protein 4 (CTLA-4) mediates immunosuppression and it is expressed in tumours on infiltrating Tregs, activated CD4+ T cells, exhausted T cells and tumour cells. In tumours with high TILs, PD-L1 and CTLA-4 blockades are more effective. Methods:We have performed a comprehensive IHC analysis of all major TIL components (CD8, CD4, FOXP3 Tregs) as well as inhibitory molecules PD-L1 and CTLA4) in a superficial (invasive tumour front, ITF) and deep tumour layer of TNBC, and compared it with established clinicopathological and prognostic parameters. Clinical data and surgical tissue samples from 68 TNBC patients who underwent initial surgery were included in the analysis and 36 control samples from benign breast tissue biopsies. Results:Several statistically significant associations between the TILs status of TNBC patients and the established prognostic factors were observed. In the ITF, the proportion of TILs and CD8+T cells were increasing toward second pathological T status (pT2), and decreasing thereafter toward higher pT status (P=0.017, P=0.021, Chi-square test). Similar trends for both variables were observed in association with anatomic (P=0.057, P=0.050, Chi- square test) and prognostic (P=0.059, P=0.048, Chi-square test) stages of the disease. Furthermore, the increase of CD8+T cells at ITF was statistically correlated with the increased expression of PDL-1, CTLA-4, FOXP3 and CD4+T cells (N=65, rho 0.31, P=0.011 ; N=65, rho 0.40, P

Metallothioneins (MTs) are a family of small cysteine-rich proteins involved in many physiological and pathological processes. Genes that encode the four isoforms of metallothioneins (MT1-M4) are located on chromosome 16q13. Strucutures of these four isoforms allow metallothioneins their various biological functions. Many studies have shown that MT plays an important role in carcinogenesis, tumour growth, its progression from local to metastatic disease and may contribute to resistence to chemotherapy and radiotherapy. Due to the fact that breast cancer is one of the leading causes of death in women worldwide it is important to better understand the biology of breast cancer. So, findings of MT could evenutally help as a prognostic tool and could lead to a possible new specific anti-cancer treatment., Metalotioneini su skupina proteina bogatih cisteinima koji su uključeni u mnoge fiziološke i patološke procese. Geni koji kodiraju četiri izoforme metalotioneina locirani su na lokusu 16q13. Strukture ovih četiriju izoformi omogućuju metalotioneinima njihove razne biološke funkcije. Mnoge su studije pokazale da metalnotionein ima važnu ulogu u karcinogenezi, rastu tumora, njegovoj progresiji od lokalne prema metastatskoj bolesti te je povezan sa razvojem rezistencije na kemoterapiju i radioterapiju. Rak dojke jedan je od vodećih uzroka smrti u svijetu i važno je bolje razumijeti ulogu metalotioneina u različitim podtipovima karcinoma dojke. Ovakvi podaci mogli bi pomoći kao prognostički alat i voditi pronalasku novog specifičnog liječenja karcinoma.

Background: Our objective was to assess the effects of COVID-19 antiepidemic measures and subsequent changes in the function of the health care system on the number of newly diagnosed breast cancers in the Republic of Croatia. Subjects, materials, and methods: We performed a retrospective, population- and registry-based study during 2020. The comparator was the number of patients newly diagnosed with breast cancer during 2017, 2018, and 2019. The outcome was the change in number of newly diagnosed breast cancer cases. Results: The average monthly percent change after the initial lockdown measures were introduced was -11.0% (95% confidence interval - 22.0% to 1.5%), resulting in a 24% reduction of the newly diagnosed breast cancer cases in Croatia during April, May, and June compared with the same period of 2019. However, during 2020, only 1% fewer new cases were detected than in 2019, or 6% fewer than what would be expected based on the linear trend during 2017-2019. Conclusion: It seems that national health care system measures for controlling the spread of COVID-19 had a detrimental effect on the number of newly diagnosed breast cancer cases in Croatia during the first lockdown. As it is not plausible to expect an epidemiological change to occur at the same time, this may result in later diagnosis, later initiation of treatment, and less favorable outcomes in the future. However, the effect weakened after the first lockdown and COVID-19 control measures were relaxed, and it has not reoccurred during the second COVID-19 wave. Although the COVID-19 lockdown affected the number of newly diagnosed breast cancers, the oncology health care system has shown resilience and compensated for these effects by the end of 2020. Implications for practice: It is possible to compensate for the adverse effects of COVID-19 pandemic control measures on breast cancer diagnosis relatively promptly, and it is of crucial importance to do it as soon as possible. Moreover, as shown by this study's results on the number of newly diagnosed breast cancer cases during the second wave of the pandemic, these adverse effects are preventable to a non-negligible extent.

Aim of the study: Membrane EGFR (mEGFR) protein overexpression is frequently found in the head and neck squamous cell carcinoma (HNSCC). It has been found that mEGFR upon stimulation translocates to nucleus and its nuclear localisation is associated with poor prognosis in many cancers. The main focus of this study is to asses if nuclear EGFR (nEGFR) expression affects biologically more aggressive tumor behaviour in comparison to mEGFR expression in laryngeal SCC. Material and Methods: We examined 42 laryngeal squamous cell carcinomas (SCC) for nEGFR and mEGFR expression as well as cell cycle proliferative markers Ki-67, p53, cyclin D1 using immunohistochemistry. Results: In our study group, we found in 28.57% (12/42) SCC cases a strong (3+) nEGFR expression, 64.28% (27/42) SCC had weak to moderate (1+/2+) nEGFR expression while 7.14% (3/42) cases were negative for nEGFR. The majority of patients with SCC had strong (3+) mEGFR (52.38% or 22/42) expression and 45.23% (19/42) had weak to moderate (1+/2+) mEGFR expression and one case (1/42) was negative for mEGFR. The mean values ± standard deviation (%) of Ki-67, p53 and cyclin D1 expression in our study group were 39.04 ± 18.08, 38.88 ± 32.22 and 43.82 ± 18.34, respectively. When assessing the association of nEGFR with mEGFR and cell cycle proliferation markers there was statistically significant negative correlation between nEGFR and mEGFR expression (τ = -0.389 ; P = 0.002) and statistically significant negative correlation between nEGFR and cyclin D1 (τ = -0.274 ; P = 0.032). In the analysis of mEGFR correlations with the examined cell proliferation markers there were no statistically significant associations. We also observed that higher number of patients with strong nEGFR expression and concomitant negative/weak to moderate mEGFR expression died (70% or 7/10 patients) in comparison to number of patients with strong mEGFR expression and negative/weak to moderate nEGFR expression (40% or 8/20 patients). Moreover, univariate statistical analysis showed a statistically significant correlation between strong nEGFR protein expression with worse overall survival in laryngeal SCC, alone or in co-expression with strong cyclin D1 and high Ki-67 (P=0.025, P=0.046, P=0.043, respectively). However, there was no statistically significant difference in the overall survival, when we analyzed strong mEGFR expression, alone or in co- expression with cyclin D1 and Ki-67 cell cycle proteins (P=0.953, P=0.731, P=0.647, respectively). Conclusion: Our data indicate that nuclear EGFR cellular localization with strong expression might influence the more aggressive biological behaviour of laryngeal SCC carcinoma with poor patient survival.

There are only a few studies so far on IMP3 role as a potential diagnostic biomarker in the laryngeal carcinogenesis. Therefore, it makes sense to analyze IMP3 together with other biomarkers of carcinogenesis. The aim of this study was to investigate the immunohistochemical expression patterns of IMP3, Ki-67, p53 and cyclin D1 in laryngeal carcinogenesis. The study included 153 patients divided into three groups: 68 operated for primary invasive laryngeal squamous cell carcinoma (LSCC) ; 41 with precancerous lesions of atypical and abnormal hyperplasia and 44 with hyperplastic laryngeal nodule without atypia. Tissue microarray technique was used for immunohistochemical analysis. As for the IMP3 staining pattern, a cytoplasmic staining of low intensity in a few cells of superficial layers was found in both control and precancerosis groups. On the other hand, in tumor cells of LSCC there was a high percentage of cytoplasmic staining against IMP3 of high intensity. Additionally, IMP3 staining showed significant intertumoral and intratumoral heterogeneity in different cases of LSCC. In well- differentiated LSCC with present keratinization we noticed that negative areas of the tumor alternate with areas of cytoplasmic staining of low intensity. In tumor cells of moderately differentiated LSCC there was a pattern of combined focal cytoplasmic staining of strong intensity with cytoplasmic staining of low intensity, while a diffuse cytoplasmic staining of moderate to strong intensity was found in tumor cells of poorly differentiated LSCC. Ki67 staining showed a low percentage of nuclear staining of medium to high intensity against Ki-67 in parabasal and a few suprabasal layers of samples from both control and precancerosis groups. High percentage of nuclear staining of high intensity was found in samples from the LSCC group. p53 staining showed different patterns in all three groups. In control group, there was a low percentage of nuclear staining of moderate to strong intensity in parabasal and few suprabasal layers, while in precancerosis group it was medium percentage of nuclear staining of moderate to strong intensity in basal, parabasal and few suprabasal layers. In the LSCC group there was a high percentage of nuclear staining of moderate to strong intensity in tumor cells. Cyclin D1 showed a high percentage of nuclear staining of moderate to strong intensity in parabasal and few suprabasal layers of samples from the control group and in tumor cells of LSCC. However, in the precancerosis group there was a medium percentage of nuclear staining of moderate to strong intensity in a few basal, parabasal and several suprabasal layers. Immunohistochemical expressions of Ki-67 and pronouncedly IMP3 generally follow the same pattern where control and precancerosis are similar and LSCC significantly differs, as opposed to p53 and cyclin D1. In that sense, IMP3 expression increase and difference in LSCC, as opposed to control and precancerosis, is especially pronounced, which points toward its possibly important diagnostic, therapeutic and prognostic value.Further studies on the exact molecular mechanisms behind these differences are, of course, needed.

Cilj istraživanja je bio utvrditi utjecaj pandemije COVID-19 na sveukupni rad patohistološkog i citološkog laboratorija u KBC-u Rijeka kao i na dijagnostiku nekih od najčešćih malignih bolesti. Retrospektivno su iz računalne baze podataka izvučeni i međusobno uspoređeni brojevi patohistoloških i citoloških nalaza, novodijagnosticiranih malignoma dojke, pluća, debelog crijeva, endometrija i prostate te molekularnih testova za analizu mutacije EGFR i HPV-infekcije za razdoblje od 1. ožujka do 30. rujna 2019. (prije pandemije) te od 1. ožujka do 30. rujna 2020. (za vrijeme pandemije COVID-19). Ukupni broj izvršenih pretraga bio je statistički značajno manji za vrijeme pandemije COVID-19 u 2020. u odnosu na isto razdoblje 2019. (p

Uvod: Nakon konsenzusa postignutog na konferenciji u St. Gallen-u i revizije NCCN-ovih smjernica za liječenje karcinoma dojke, u svibnju 2017. godine u Kliničkom Bolničkom Centru Rijeka, biopsija sentinel limfnog čvora uvedena je u kliničku praksu kirurškog liječenja bolesnica oboljelih od karcinoma dojke koje su neoadjuvantnim liječenjem postigle kliničku remisiju u aksili. Primarni cilj ovog istraživanja bila je evaluacija kliničkog utjecaja metode u gore navedenoj skupini pacijentica. Metode: U ovu retrospektivnu analizu uključene su sve bolesnice oboljele od karcinoma dojke, liječene u KBC Rijeka u period od svibnja 2016. do svibnja 2018., kod kojih je preoperativno provedeno sistemsko onkološko liječenje. U prvoj postoperativnoj godini praćena je pojava lokoregionalnog i sistemskog recidiva. Rezultati: Četrdeset i osam od sveukupno 65 bolesnica uključenih u analizu prezentiralo se je sa pozitivnim aksilarnim limfnim čvorovima u vrijeme postavljanja dijagnoze, od kojih je 45.83% postiglo kompletnu patološku aksilarnu remisiju. Kod ove skupine pacijentica u prvoj postoperativnoj godini nije zabilježen niti jedan slučaj lokoregionalnog recidiva, niti statistički značajna razlika u pojavnosti udaljenih metastaza u korelaciji sa opsegom kirurškog zahvata u aksili. Međutim, u komparaciji sa ovom skupinom, kod bolesnica koje nisu postigle kompletnu aksilarnu remisiju zabilježene su više stope i lokoregionalnog i distalnog recidiva. Zaključak: Biopsija sentinel limfnog čvora je pouzdana alternativa aksilarnoj disekciji za postizanje lokoregionalne kontrole i kontrole bolesti uopće, kod bolesnica oboljelih od karcinoma dojke koje neoadjuvantnim sistemskim liječenjem postignu kompletnu kliničku aksilarnu remisiju. Odgovor aksilarnih limfnih čvorova na neoadjuvantno liječenje važniji je prognostički čimbenik od statusa limfnih čvorova na početku liječenja., Introduction: After the consensus conference in St. Gallen and updated NCCN guidelines, we started doing sentinel lymph node biopsy (SLNB) in May 2017, for breast cancer patients who achieve clinical axillary remission following neoadjuvant treatment. This study’s primary goal was to evaluate the clinical impact of SLNB after neoadjuvant therapy in the group mentioned above. Methods: We retrospectively analyzed all neoadjuvant breast cancer patients from May 2016 until May 2018 at Clinical Hospital Center Rijeka. Our preliminary results recorded the appearance of locoregional and distant recurrence. Results: From 65 patients involved in this analysis, 48 patients were node-positive at the time of diagnosis, and 45.83% among those achieved complete pathological axillary remission. After the first postoperative year, there were no locoregional relapses nor statistically significant differences in the prevalence of distant recurrences, regardless of the extent of surgical procedure. However, results showed higher rates of locoregional and distant relapse for the group of patients that did not attain complete axillary remission. Conclusion: SLNB is a reliable alternative to ALND for locoregional and overall disease control for breast cancer patients who achieve complete clinical axillary remission after preoperative systemic treatment. The clinical axillary lymph node status, after neoadjuvant therapy, is a more relevant prognostic factor than the clinical axillary lymph node status at the beginning of the treatment.

Background: Tumor infiltrating lymphocytes (TILs) are involved in host imunity against tumor cells. However, in later phases of the disease high TIL infiltration is related to disease progression. Tumor immunogenicity is strongly correlated with the higher tumor mutation burden. Triple negative (TN) and HER-2 enriched breast cancers have the highest immunogenic potential so the aim of our study was to investigate the TIL infiltration and expression of PD-L1, HSP-70 in such tumors. Material and Methods: TIL infiltration was investigated in the 112 tissue samples of TN and HER-2 enriched breast cancers of women diagnosed and treated in the Clinical Hospital Centre Rijeka, Croatia, in the period between 2008 and 2016. The invasive front of the tumor (host-tumor interface), the surface layer, as well as the deep layer of the tumor were analysed. Immunohistochemistry staining of PDL-1 (SP142), HSP70 (ab2787), CD4 (SP35 Cell Marque) and CD8 (144B DakoCytomation) was performed. The results were analysed using Statistica 13 software. Results: Overall, there is a statistically significant correlation of high (over 50%) TIL infiltration with longer 5-year survival (p = 0.035, Long rank test). In the surface layer of the tumor (invasive front) there is statistically significant correlation of the intermediate TIL infiltration with the higher survival (p = 0.051, Long rank test) whereas there is no significant difference in the deep layer of the tumor. There is significant association of TIL infiltration with CD8+ T lymphocyte expression in the surface and deep layers of the tumor (Mann Whitney U test, p = 0.004 and p < 0.001, respectively), CD4+ lymphocyte expression (p < 0.001, p < 0.001, respectively) and PDL-1 expression (p < 0.001, p < 0.001, respectively). Statistically significant correlation of TIL infiltration and HSP-70 protein was only detected in the deep tumor layer (Mann Whitney U test, p < 0.001). Furthermore, in the TIL infiltrated deep tumor layer there is statistically significant positive correlation of PD-L1 and HSP-70 expression (Mann Whitney U test, p = 0.029) as well as positive European Journal of Cancer 138, Suppl. 1 (2020) correlation of the HSP-70 expression and the stage of the disease (Anova, p = 0.08). Conclusion: Although TIL infiltration in the surface layer of the tumor is corellated with higher survival rate, there is no such correlation in the deep layer. We have shown that in both layers there is increased expression of CD4 and CD8 positive T lymphocytes. However, the increased expression of inhibitory molecules PD-L1, and in the deep layer HSP-70 protein is noted as well. It is possible that in this context HSP-70 is involved in activation of Tregs and thus inducing immunotolerance to oncoproteins and along with PD-L1 molecule stimulates the development of immunosuppressive environment in the deep tumor layer thus supporting tumor immune evasion.

Background: Breast cancer (BC) is the most common malignancy in women. Aim: To assess the impact of HER2 status on axillary lymph node (ALN) involvement in patients with invasive ductal carcinoma of no special type (IDC-NST) both at diagnosis and during the 4-year postoperative period. Patients and Methods: We retrospectively included 375 women with an early clinical stage of non-luminal IDC-NST who between 2007 and 2013 underwent breast surgery at a clinical hospital. They were divided into phenotype-based groups: HR+HER2-, HR+HER2+, HR-HER2+ and HR-HER2-. Only patients with sentinel lymph node (SLN) macrometastases underwent ALN dissection. If > 3 ALNs were positive, radiotherapy was delivered. All patients were treated with chemotherapy, HER2+ BC patients received trastuzumab, and hormone receptor (HR)-positive BC patients received hormonal therapy. Results: Larger tumor size, higher grade, HR+, HER2+ status, and lymphovascular invasion (LVI) were predictive for ALN metastases at diagnosis. The poorest overall, disease-free, and distant recurrence-free survival (OS, DFS, DRFS) were found in the HR-HER2- group, while the poorest locoregional recurrence-free survival (LRFS) was observed in HR-HER2+ and HR-HER2- groups. HER2 status was not predictor of survival. Conclusions: HER2+ status was predictive for ALN involvement at diagnosis but had no effect on 4-year LRFS in these patients. Antecedentes: El cáncer de mama es el tumor maligno más común en mujeres. Objetivo: Conocer el impacto del estado HER2 sobre el compromiso ganglionar axilar al momento del diagnóstico y durante los primeros cuatro años después de la cirugía en mujeres con carcinoma ductal invasivo de tipo no especial (IDC-NST). Pacientes y Métodos: Incluimos retrospectivamente a 375 mujeres en etapas clínicas iniciales de IDC-NST que fueron operadas en un hospital clínico. Ellas se dividieron en grupos de acuerdo al fenotipo: HR+HER2-, HR+HER2+, HR-HER2+y HR-HER2-. La disección de ganglios axilares se efectuó solo en las pacientes con macrometástasis en el ganglio centinela. Si había más de tres ganglios comprometidos, se efectuó radioterapia. Todas las pacientes se trataron con quimioterapia. Las pacientes HER2+ recibieron trastuzumab y las pacientes HR+ recibieron hormonoterapia. Resultados: Tumores más grandes, de mayor grado de malignidad, HR+, HER2+ y la invasión linfovascular fueron predictivos de la presencia de metástasis axilares al momento del diagnóstico. La sobrevida más baja se observó en pacientes HR-HER2+. La sobrevida libre de recurrencia locorregional más baja, se observó en pacientes HR-HER2+ y HR-HER2-. HER2 no fue predictor de sobrevida. Conclusiones: En estas mujeres, HER2+fue predictor de la presencia de compromiso ganglionar axilar al momento del diagnóstico pero no de la sobrevida a cuatro años.

Background: Upon St. Gallen consensus conference (1) and updated version of NCCN guidelines (2) from 2017, in May 2017 in Clinical Hospital Center Rijeka sentinel lymph node biopsy (SLNB) was introduced in clinical practice for axillary staging of breast cancer patients that achieved complete clinical axillary remission after neoadjuvant systemic oncologic treatment. This trial aims to evaluate the clinical impact of SLNB performance after neoadjuvant systemic treatment (NAST) in initially node-positive breast cancer patients and to determine the prognostic value of the axillary complete pathological response. Patients and Methods: Breast cancer patients in clinical stage T1-T3 N0-N2 M0, surgically treated in our institution from September 2018 till May 2022 would be included in this trial and divided into three groups according to protocol. SLNB would be performed in all patients presenting with cN0 stage at the time of surgery, including those patients who shift from cN1-N2 to cN0 during NAST. All patients involved in this trial would be monitored for five postoperative years in order to determine following parameters: rates of local and regional recurrence, rate of disease progression to M1 stage, regional recurrence- free survival, disease progression-free survival, cancer-related mortality rate, and overall survival. Results: Results gained from this trial would be compared among groups and with our previous data of patients in equivalent stage treated in period from 2011 till 2014 when all patients were primary surgically treated, therefore axillary lymph node dissection (ALND) was performed for all node-positive patients. Conclusion: Hopefully, the results of this trial would provide enough evidence that SLNB performance after NAST does not have a negative impact on clinical outcome in breast cancer patients who had reached complete clinical axillary remission. In addition, we would try to determine the prognostic value of the axillary complete pathologic response. ClinicalTrials.gov: This protocol has been registered at clinicaltrials.gov with ID: NCT03719833 Abbreviations: SLNB=sentinel lymph node biopsy, ALND=axillary lymph node dissection, NAST=neoadjuvant systemic treatment, US=ultrasound, MRI= magnetic resonance imaging, RRR=regional recurrence rate, RRFS=regional recurrence-free survival, DFS=disease free survival, CSMR=cancer specific mortality rate, OS=overall survival

Uvod: Temeljem konsenzusa konferencije u St. Gallen-u i revidiranih NCCN-ovih smjernica za liječenje raka dojke iz 2017., u svibnju iste godine u KBC-u Rijeka biopsija sentinel limfnog čvora (SLNB) uvedena je u kliničku praksu kao metoda izbora procjene aksilarnog stadija za bolesnice oboljele od karcinoma dojke sa inicijalno zahvaćenom aksilom, a koje su neoadjuvantnim sistemskim liječenjem (NAST) postigle kompletnu kliničku aksilarnu remisiju. Kako bi evaluirali utjecaj izvođenja SLNB nakon NAST na ishod liječenja kod spomenute skupine pacijentica i pokušali objektivizirati prognostički značaj kompletnog patološkog aksilarnog odgovora (pCR) osmislili smo protokol prospektivnog opservacijskog kliničkog istraživanja. Pacijenti i metode: U istraživanje će biti uključene bolesnice oboljele od karcinoma dojke u stadiju T1-T3 N0-N2 M0, kirurški liječene u KBC Rijeka u periodu od rujna 2018. do svibnja 2022. Iste će biti podijeljene u tri grupe u skladu sa definiranim protokolom. SLNB će se učiniti kod svih bolesnica koje se preoperativno prezentiraju u stadiju cN0, uključujući i bolesnice koje su se neoadjuvantnim liječenjem konvertirale iz stadija cN1-N2 u stadij cN0. U petogodišnjem postoperativnom periodu pratit će se pojavnost lokalnog i regionalnog recidiva, progresije bolesti u M1 stadij, smrtnost od karcinoma i sveukupno preživljenje. Rezultati: Rezultati će se usporedit između skupina definiranih protokolom ovog istraživanja te sa rezultatima skupina bolesnica ekvivalentnog stadija bolesti liječenih u periodu od 2011. do 2014. kada su bolesnice bile primarno kirurški liječene, odnosno kada je svim bolesnicama sa inicijalno pozitivnim aksilarnim limfnim čvorovima standardno učinjena aksilarna disekcija (ALND). Zaključak: Dobivenim rezultatima želimo potvrditi osnovnu hipotezu ovog istraživanja; da procedura SLNB nakon NAST nema negativan utjecaj na ishod liječenja kod bolesnica sa inicijalno pozitivnom aksilom koje su preoperativnom sistemskom terapijom postigle remisiju bolesti u aksili. Uz navedeno pokušat ćemo odrediti prognostički značaj downstaging- a aksile neoadjuvantnim liječenjem. ClinicalTrial.gov: Protokol istraživanja je registriran i javno dostupan na stranicama www.clinicaltrials.gov (ID:NCT03719833), Background: Upon St. Gallen consensus conference (1) and updated version of NCCN guidelines (2) from 2017, in May 2017 in Clinical Hospital Center Rijeka sentinel lymph node biopsy (SLNB) was introduced in clinical practice for axillary staging of breast cancer patients that achieved complete clinical axillary remission after neoadjuvant systemic oncologic treatment. This trial aims to evaluate the clinical impact of SLNB performance after neoadjuvant systemic treatment (NAST) in initially node-positive breast cancer patients and to determine the prognostic value of the axillary complete pathological response. Patients and Methods: Breast cancer patients in clinical stage T1-T3 N0-N2 M0, surgically treated in our institution from September 2018 till May 2022 would be included in this trial and divided into three groups according to protocol. SLNB would be performed in all patients presenting with cN0 stage at the time of surgery, including those patients who shift from cN1-N2 to cN0 during NAST. All patients involved in this trial would be monitored for five postoperative years in order to determine following parameters: rates of local and regional recurrence, rate of disease progression to M1 stage, regional recurrence-free survival, disease progression-free survival, cancer related mortality rate, and overall survival. Results: Results gained from this trial would be compared among groups and with our previous data of patients in equivalent stage treated in period from 2011 till 2014 when all patients were primary surgically treated, therefore axillary lymph node dissection (ALND) was performed for all node-positive patients. Conclusion: Hopefully, the results of this trial would provide enough evidence that SLNB performance after NAST does not have a negative impact on clinical outcome in breast cancer patients who had reached complete clinical axillary remission. In addition, we would try to determine the prognostic value of the axillary complete pathologic response. ClinicalTrials.gov: This protocol has been registered at clinicaltrials.gov with ID: NCT03719833 Abbreviations: SLNB=sentinel lymph node biopsy, ALND=axillary lymph node dissection, NAST=neoadjuvant systemic treatment, US=ultrasound, MRI= magnetic resonance imaging, RRR=regional recurrence rate, RRFS=regional recurrence- free survival, DFS=disease free survival, CSMR=cancer specific mortality rate, OS=overall survival

Histopatološke značajke karcinoma dojke uključuju brojne podatke koji su neophodni za daljnji odabir terapije pacijentica, stoga oni moraju biti jasni, nedvojbeno navedeni i pouzdani. Osim tradicionalnih podataka o invaziji, metastatskom potencijalu i odgovoru na terapiju, sve više informacija o prognostičkim i prediktivnim čimbenicima koji utječu na terapiju pacijentica daju i genetska istraživanja na temelju kojih su tumori prema ekspresiji određenih gena stratificirani u podtipove., 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.

hrcak.srce.hr/medicina 408 medicina fluminensis 2016, Vol. 52, No. 3, p. 408-414 Sažetak. Cilj: Utvrditi gradus invazivne tumorske fronte (GITF) u karcinomu pločastih stanica usne šupljine (KPSUŠ), usporediti ga s tradicionalnim histološkim gradusom te ispitati prognostičku vrijednost obaju načina gradiranja. Materijali i metode: Na HE-obojanim mikroskopskim preparatima 86 KPSUŠ-a, odstranjenim na Klinici za maksilofacijalnu kirurgiju KBC-a Rijeka, određen je gradus invazivne tumorske fronte i ispitana njegova povezanost s kliničkopatološkim prognostičkim parametrima kao što su patološki T stadij (pT stadij), patološki N stadij limfnih čvorova (pN stadij), klinički stadij bolesti (TNM stadij) te dužina preživljavanja pacijenata. Podatci o tradicionalnom histološkom gradusu dobiveni su iz patohistološkog nalaza. Rezultati: Tradicionalni histološki gradus nije bio značajno povezan s kliničkim parametrima niti preživljavanjem pacijenata (P = 0,906). Visoki GITF bio je povezan s pozitivnim limfnim čvorovima (P = 0,006) i kliničkim stadijem bolesti (P = 0,025), dok s patološkim T stadijem nije dobivena statistička povezanost (P = 0,086). U univarijatnoj analizi visoki GITF bio je povezan s kraćim preživljavanjem pacijenata (P = 0,001), a u multivarijatnoj analizi se pokazao prognostičkim čimbenikom (P = 0,006). Za pojedinačne parametre koji određuju GITF poput upalnog infiltrata, načina invazije te stupnja keratinizacije također je utvrđena prognostička vrijednost u univarijatnoj (P < 0,001, P = 0,013, tj. P = 0,009) i multivarijatnoj analizi. Zaključak: GITF ima veću prognostičku vrijednost u odnosu na tradicionalni histološki gradus. Njegovo određivanje može pomoći u prepoznavanju pacijenata s većim rizikom za povrat bolesti nakon kirurškog odstranjenja tumora, kojima bi koristile dodatne metode liječenja., Aim: To establish invasive tumor front grade (ITFG) in squamous cell carcinoma of the oral cavity (OCSCC), compare it with traditional histological grade and to investigate the prognostic value of both. Materials and methods: The whole tumor-tissue sections, stained with HE of 86 OCSCC cases were evaluated for the invasive tumor front grade and compared with the clinicopathological prognostic parameters such as pathological stage (pT stage), pathological lymph node stage (pN stage), clinical stage (TNM stage) and length of survival of patients. Tissue has been disposed at the Department of Maxillofacial Surgery, University Hospital Rijeka. Data of traditional histological grade were obtained from previous histological findings. Results: Traditional histological grade was not significantly associated with clinical parameters or survival of patients (P = 0.906). High ITFG was associated with positive lymph nodes (P = 0.006) and clinical stage of disease (P = 0.025), but not to pathological T stage (P = 0.086). In univariate analysis high ITFG was associated with shorter survival of patients (P = 0.001), and multivariate analysis showed it as the independent prognostic factor (P = 0.006). For individual parameters that determine ITFG like inflammatory infiltrate, way of invasion and degree of keratinization was also established statistically significant prognostic value in univariate (P < 0.001, P = 0.013, i.e., P = 0.009) and multivariate analysis. Conclusion: ITFG has greater prognostic value than the traditional histological grade. Determination of ITFG may help identify patients with a higher risk of disease recurrence after surgical removal of the tumor, which would use additional methods of treatment.

Karcinom dojke je najčešća maligna bolest u žena, a najzastupljeniji receptorski podtip čine karcinomi s pozitivnom ekspresijom hormonskih receptora i negativnom ekspresijom receptora za humani epidermalni faktor rasta 2 (HR+/HER2-). Cilj istraživanja bio je usporediti dvije metode procjene tumorskog infiltrata limfocita (TIL) u HR+/HER2- karcinomu dojke te ispitati njegovu povezanost s kliničkopatološkim karakteristikama i prognozom. U istraživanju su analizirani bioptički materijali 37 pacijentica liječenih u Kliničkom bolničkom centru (KBC) Rijeka u razdoblju 2007.-2019. godine. Medijan dobi bio je 57 godina, s rasponom od 39 do 75 godina. Klinički i patološki podaci su prikupljeni u računalnoj bazi podataka Zavoda za patologiju Medicinskog fakulteta Sveučilišta u Rijeci i u računalnoj bazi podataka WinBis KBC-a Rijeka. Procjena TIL je učinjena svjetlosno mikroskopskom analizom rezova rutinski bojenih hemalaun-eozinom; metodom Međunarodne radne skupine za imuno-onkološke biomarkere te četvero stupanjskom skalom ranije korištenom u istraživanju upalne reakcije u kolorektalnom karcinomu (Klinturp i suradnici). Podaci su statistički obrađeni računalnim programom MedCalc. Neovisno o metodi procjene, utvrđena je pozitivna korelacija razine TIL s prisustvom limfovaskularne invazije (LVI) te prisustvo TIL u značajno većim proporcijama u tumora nižih stadija. Procjenom četvero stupanjskom skalom, prisustvo TIL se pokazalo povezano s pozitivnom LVI, uz negativnu korelaciju s kliničkim stadijem. Usporedbom podudarnosti između očitanih gustoća TIL, dobivena je vrijednost interklasnog koeficijenta korelacije od 0.7577, čime je utvrđena dobra razina pouzdanosti metoda korištenih u njegovoj procjeni., Breast cancer is the most common malignancy in women, with hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancers representing the vast majority of receptor subtypes. This study aimed to compare two assessment methods of the tumor-infiltrating lymphocytes (TILs) in HR+/HER2- breast cancer and to examine the associations of the TILs density with clinicopathological characteristics and prognostic significance. The analysis included Bioptic material from 37 female patients treated in the Clinical Hospital Center (CHC) Rijeka from 2007 to 2019. The median age was 57 years, with a range of 39 to 75 years. Clinical and pathological data were collected from the computer database of the Department of Pathology and Pathological Anatomy of the Faculty of Medicine, University of Rijeka, and from the WinBis database of CHC Rijeka. The TIL density was evaluated by light microscopic analysis of hematoxylin and eosin (HE) stained specimens; following the International Immuno-Oncology Biomarker Working Group recommendations, and by a four-degree scale previously used in the inflammatory reaction in colorectal cancer research work (Klinturp et al). MedCalc statistical software was used for statistical analysis. Evaluated by both methods, TIL was significantly positively correlated with the presence of lymphovascular invasion (LVI) and was predominantly presented in low-stage disease. Assessed with a four-degree scale, TIL was presented in more significant proportions in positive LVI cases and was negatively correlated with the clinical stage. The intraclass correlation coefficient was calculated to determine the agreement of TIL densities evaluated in both ways. The value of 0.7577 demonstrated good reliability among the methods used.

Karcinom dojke najčešća je maligna bolest u populaciji žena. Mutacije gena BRCA 1 i BRCA 2 odgovorne su za 10% svih nastalih karcinoma dojke. Napretkom genetike danas postoji mogućnost identifikacije žena s visokim rizikom za obolijevanje. Takvim ženama pruža se pomoć u vidu genetičkog savjetovanja, psihološke pomoći i smanjenje rizika od nastanka karcinoma dojke kirurškim metodama. Profilaktičku mastektomiju danas je moguće napraviti s poštedom kože, s poštedom kože i bradavice te jednostavnu mastektomiju koja podrazumijeva potpuno odstranjivanje parenhima, kože i bradavice obiju dojki. U istom aktu s profilaktičkom mastektomijom moguće je učiniti i rekonstrukciju dojke, tada se to naziva primarnom rekonstukcijom. Kada se izvodi kao zaseban kirurški zahvat naziva se sekundarnom rekonstrukcijom. Rekonstrukcija dojke može biti učinjena alogenim tkivnim implantatom ili silikonskim implantatom. Danas se gotovo isključivo koriste implantati izrađeni od umjetnih materijala koji pružaju vrhunske estetske rezultate, osiguravaju brži oporavak, a ožiljak je manji. Postoperativne komplikacije ovakvih zahvata mogu biti razne. Infekcija, stvaranje hematoma i nastajanje seroma rane su postoperativne komplikacije. Specifično kod rekonstrukcije alogenim transplantatima može doći do nekroze tkivnog režnja ili nekroze bradavice. Upotrebom umjetnih implantata specifično može nastati kapsularna kontraktura, ruptura implantata i anaplastični limfom velikih stanica. Komplikacijama su sklonije pacijentice oboljele od pretilosti i dijabetesa, te pušači. Općenito, za opću populaciju bez komorbiditeta komplikacije su vrlo rijetke., In the female population, breast cancer is the most common malignant disease. Breast cancers caused by mutations in the BRCA 1 and BRCA 2 genes are responsible for up to 10% of all cases. With advances in genetics today, there is the possibility of identifying women at high of developing breast cancer. These women receive assistance in the form of genetic counseling, psychological support, and surgical treatments to reduce their risk of developing breast cancer. Prophylactic mastectomy can be performed as skin sparing mastectomy, as skin and nipples sparing mastectomy, and a simple mastectomy, which involves the complete removal of the parenchyma, skin and nipples of both breasts. In the same act with prophylactic mastectomy it is possible to do breast reconstruction then it is called primary reconstruction or as a separate surgical procedure then it is called secondary reconstruction.An allogenic tissue implant or a silicone implant can be used for breast reconstruction. Artificial-material implants are almost entirely utilized today, as they provide superior aesthetic results, faster healing, and a smaller scar. Such operations can have a variety of postoperative problems. Infection, hematoma formation and seroma formation are early postoperative complications. Specifically, allogeneic graft reconstruction can lead to tissue lobe necrosis or nipple necrosis. Capsular contracture, implant rupture, and anaplastic large cell lymphoma have all been linked to the use of artificial implants. Obese and diabetic patients, as well as smokers, are more prone to complications. Complications are quite infrequent in the normal population without comorbidities.

Uvod: Proksimalna pankreatektomija je operativni zahvat kojim se odstranjuje tumorska i netumorska patologija glave pankreasa, distalnog koledokusa, papille Vateri, ampule i duodenuma. Distalna pankreatektomija je operativni zahvat kojim se odstranjuje tumorska i netumorska patologija trupa i repa pankreasa te slezene. Svrha rada je analizirati: vrste pankreatektomija u odnosu na uzrok (netumorska i tumorska patologija), dob i spol pacijenata, lokalizaciju i histološke karakteristike tumora i kliničkopatološki analizirati duktalni adenokarcinom pankreasa. Ispitanici i postupci: Ovim retrospektivnim istraživanjem obuhvaćeni su pacijenti KBC Rijeka kojima je u periodu od 2015. do 2021. izvršena proksimalna ili distalna pankreatektomija. Prikupljeni su podaci od 115 pacijenata iz baze podataka Kliničkog zavoda za patologiju i citologiju KBC-a Rijeka. Rezultati: U 115 pankreatektomija tijekom 7 godina uzrok je u 87 % tumorska patologija, a 13 % netumorska patologija. Najčešće se izvodi proksimalna pankreatektomija (78 %), u muškaraca (59 %), dobi od 60. do 79. godine života s najčešćom dijagnozom duktalnog adenokarcinoma glave pankreasa. Slijede tumori papile Vateri, adenokarcinomi distalnog koledokusa, ampule i duodenuma. Svi tumori dijagnosticirani nakon distalne pankreatektomije smješteni su u trupu i repu gdje također dominira duktalni adenokarcinom. Duktalni adenokarcinomi (46 % svih tumora) najčešće nastaju u glavi pankreasa, u muškaraca, srednje dobi od 68 godina, srednje veličine tumora 3,35 cm, gradusa GIII, s prisutnom perineuralnom i limfovaskularnom invazijom i stadija IIB. Zaključak: Proksimalna pankreatektomija je učestaliji zahvat od distalne zbog učestalosti patologije koja zahvaća glavu pankreasa i okolne bliske strukture – najčešće duktalni adenokarcinom pankreasa., Introduction: Proximal pancreatectomy is an operation to remove tumor and non-tumor pathology of the head of the Pancreas, the distal Choledochus, the papilla of Vater, the ampulla of Vater and the duodenum. Distal pancreatectomy is an operation to remove tumor and non-tumor pathology of the body and the tail of the pancreas and the spleen. The purpose of this retrospective research is to analyze: types of pancreatectomy in relation to the cause (tumor and non-tumor diagnoses), age and sex of patients, localization and histological characteristics of diagnosed tumors and to analyze clinical and pathological characteristics of pancreatic ductal adenocarcinoma. Subjects and methods: This retrospective research includes patients treated with proximal or distal pancreatectomy between 2015 and 2021. The research includes 115 patients from Clinical Hospital Center Rijeka database. Results: In 115 operations over 7 years 87 % were caused by tumor, while 13 % were caused by non-tumor pathology. Proximal pancreatectomy was performed more often than distal (78 %), mostly in men 60 to 79 years old with diagnosis of PDAC localized in the head of the pancreas. They are followed by tumors of the papilla of Vater, the adenocarcinomas of the distal Choledochus, the ampulla of Vater and the duodenum. After distal pancreatectomy, all diagnosed tumors are localized in the body and the tail of the pancreas and mostly are PDAC's. Pancreatic ductal adenocarcinoma (46 % of all tumors) most commonly occur in the head of the pancreas, in men, average age 68 years, average tumor size 3.35 cm, grade GIII, with positive perineural and lymphovascular invasion, and at stage IIB. Conclusion: Proximal pancreatectomy is a more frequent procedure than distal due to the frequency of pathology involving the head of the pancreas and surrounding structures - most often pancreatic ductal adenocarcinoma.

Karcinomi dojke su velika heterogena skupina malignih epitelnih neoplazmi podrijetla iz žljezdanog tkiva dojke. Ako se izuzmu karcinomi kože, karcinom dojke je u žena najčešći dijagnosticirani maligni tumor, incidencije 24,2 % te je vodeći uzrok smrti od malignih bolesti. TNKD je imunohistokemijski ER, PR i HER2 negativan. Čini približno 15 – 20 % karcinoma dojke. U usporedbi s ostalim karcinomima dojke, TNKD je agresivnije prirode, ima veliki potencijal metastaziranja i loš klinički ishod. TMO je stanični okoliš tumorskih stanica ili matičnih stanica tumora. Sastoji se od različitih komponenata: imunoloških stanica (granulocita, limfocita, makrofaga), fibroblasta, pericita, adipocita, krvnih žila, ECM i signalnih molekula. Složene interakcije između tumorskih stanica i imunološkog sustava nazivamo imunouređenje. Imunouređenje označava dvostruku ulogu imunološkog sustava – ulogu zaštite domaćina te ulogu u rastu i razvoju tumora. Ne-maligne stanice u TMO-u često imaju protumorsku ulogu u karcinogenezi. Budući da komponente TMO-a (kao što su imunološke stanice) utječu na razvoj tumora, značajne su u procjeni prognoze tumora kao i u odabiru odgovarajućeg liječenja., Breast cancers are a large heterogeneous group of malignant epithelial neoplasms originating from breast glandular tissue. With the exception of skin cancer, breast cancer is the most commonly diagnosed malignant tumor in women, with an incidence of 24.2 % and the leading cause of death from malignant diseases. Triple negative breast cancer (TNBC) is immunohistochemically ER, PR and HER2 negative. It accounts for about 15 - 20 % of breast cancers. Compared to other breast cancers, TNBC is more aggressive in nature, has a high potential for metastasis and a poor clinical outcome. Tumor microenvironment (TME) is the cellular environment of tumor cells or tumor stem cells. It consists of various components: immune cells (granulocytes, lymphocytes, macrophages), fibroblasts, pericytes, adipocytes, blood vessels, ECM and signaling molecules. Complex interactions between tumor cells and the immune system are called immune regulation. Immune regulation means the dual role of the immune system - the role of protecting the host and the role in tumor growth and development. Non-malignant cells in TME often play an antitumor role in carcinogenesis. Since they affect tumor development, TME components (such as immune cells) are important in assessing tumor prognosis as well as in selecting appropriate treatment.

Karcinomi štitne žlijezde u stalnom su porastu. Papilarni i folikularni su najčešća varijanta i sa karcinomom Hurthleovih stanica nazivaju se diferencirani karcinomi štitne žlijezde te imaju bolju prognozu u odnosu na medularni i anaplastični. Ovisno o proširenosti i tipu karcinoma, postoji šest različitih metoda liječenja: operativno liječenje, terapija jodom-131, supresivna terapija levotiroksinom, radioterapija vanjskim snopom, ciljana terapija i kemoterapija. Temeljno liječenje diferenciranih karcinoma čine operativna terapija i potom primjena 131I. Primarni karcinom može se ukloniti lobektomijom ili totalnom tireoidektomijom. Totalna tireoidektomija češće se koristi zbog velike učestalosti multicentričnosti tumora i zahvaćenosti oba režnja žlijezde te je pokazala manji rizik od recidiva tumora većih od 1 cm. U liječenju metastatskog i rekurentnog karcinoma operacija je korisna kod resekcije ograničenih simptomatskih metastaza ili regionalnih limfnih čvorova, posebice kada je tumor refrakteran na 131I. Radiojodna terapija primjenjuje se nakon totalne tireoidektomije kako bi uništila sve preostale stanice zdravog i tumorskog tkiva štitnjače, bilo malignog ili suspektnog, te recidiva bolesti. Radioterapija vanjskim snopom i kemoterapija koriste se najviše u pacijenata čiji je karcinom neresektabilan, metastazirao ili čije stanje zahtijeva palijativnu terapiju zbog uznapredovale bolesti. Kemoterapija uglavnom ne daje zadovoljavajuće rezultate. Ciljana terapija je noviji modalitet liječenja koji daje odlične rezultate i sve se više koristi u slučaju proširene bolesti, recidiva ili metastaza koji su refrakterni na 131I. Prva linija sistemske ciljane terapije su inhibitori tirozin kinaze, čija primjena ima poseban značaj u liječenju karcinoma štitne žlijezde refrakternih na jod-131., Thyroid cancers are on the rise. Papillary and follicular are the most common variants and with Hurthle cell cancer are called differentiated thyroid cancers. They have good prognosis compared to medullary and anaplastic. Depending on the extent and type of cancer, there are six different treatment methods: surgery, iodine-131 therapy, levothyroxine suppressive therapy, external beam radiotherapy, targeted therapy, and chemotherapy. The basic treatment consists of surgical therapy and the use of 131I. Primary cancer can be removed by lobectomy or total thyroidectomy. Total thyroidectomy is more commonly used due to the high frequency of multicentric tumours of the gland and has shown lower risk of tumour recurrence greater than 1 cm. In the treatment of metastatic and recurrent cancer, surgery is useful in resection of limited symptomatic metastases or regional lymph nodes, especially when the tumour is refractory to 131I. Radioiodine therapy is applied after total thyroidectomy to destroy all remnant cells and malignant thyroid tissue or recurrence of the disease. External beam radiotherapy and chemotherapy are mostly used in patients whose cancer is unresectable, metastatic, or whose condition requires palliative therapy due to advanced disease. Chemotherapy generally does not give satisfactory results. Targeted therapy is a newer treatment modality that gives excellent results and is increasingly used in case of extended disease, recurrence or metastasis that is refractory to 131I. The first line of systemic targeted therapy are tyrosine kinase inhibitors, the use of which is of particular importance in the treatment of thyroid cancers refractory to 131I.

Poznato je kako je rak dojke jedan od najčešćih zloćudnih tumora u žena. Čini gotovo 25% tumora u žena i uzrokuje oko 15% smrti zbog raka. U muškaraca je rak muške dojke rijetka bolest koja čini svega 0, 1% ukupnog broja karcinoma u muškaraca. Najveća incidencija tog malignoma jest u starijoj životnoj dobi od oko 70 godina. Najvažniji poznati rizični čimbenici pri nastanku raka muške dojke jesu dob, genetska predispozicija, rasa, izloženost djelovanju estrogena i vanjski čimbenici okoline. Nažalost malignom muške dojke najčešće se otkriva u kasnijem stadiju bolesti nego u žena. Kad je riječ o liječenju raka dojke u muškaraca, tada možemo reći kako se koriste iste metode kao i kod liječenja karcinoma dojke u žena. Nakon postavljanja dijagnoze, ovisno o stadiju bolesti i podtipu invazivnog karcinoma, određuje se način liječenja. Prognoza bolesti i preživljenje bolesnika uvelike ovisi o stadiju dijagnosticiranja same bolesti, što znači da otkrivanje karcinoma u ranom stadiju bolesti osigurava veću mogućnost izlječenja kao i samog oporavka bolesnika, u usporedbi s uznapredovalim ili metastatskim karcinomom dojke., Breast cancer is known to be the second most common malignancy, and by far the most common tumor in women. It makes up almost 25% of tumors in women and causes about 15% of cancer deaths. However, the situation is quite different in men, because if it is male breast cancer, it is then a rare disease that accounts for only 0.1% of the total number of cancers in men. The highest incidence of this malignancy is in the older age of about 70 years. The most important known risk factors for the development of male breast cancer are age, genetic predisposition, race, estrogen exposure and external environmental factors. Unfortunately, male breast malignancy is most often detected at a later stage of the disease than in women. When it comes to treating breast cancer in men, then we can say that the same methods are used as in the treatment of breast cancer in women. After establishing an accurate diagnosis, including an assessment of the affected areas, the method is prescribed, as well as the treatment itself. The prognosis of patient survival largely depends on the stage of diagnosing the disease itself, which means earlier detection ensures a greater possibility of cure as well as the patient's recovery.

Cilj: Cilj istraživanja bio je usporediti rezultate naše institucije s rezultatima drugih istraživanja u svrhu informiranja o kvaliteti rada i metode općenito. Ispitanici i postupci: Retrospektivno je analizirana medicinska dokumentacija 145 ispitanika (sve ispitanici su ženskog spola) u dobi od 45 do 85 godina u razdoblju od siječnja 2018. godine do studenog 2019. godine koji su pristupili tomosintezom vođenoj vakuum asistiranoj biopsiji dojke. Analizirani patohistološki rezultati svrstani su u 3 glavne kategorije (benigna promjena dojke, karcinom dojke in situ, invazivni karcinom dojke). Zabilježene su osnovne karakteristike karcinoma te broj podcijenjenih patohistoloških nalaza. Rezultati: Od ukupno 145 patohistoloških nalaza, patohistološkom analizom uzoraka VABD utvrđeno je 119 benignih lezija dojke, 18 DKIS te 8 IKD. Patohistološka analiza kirurške biopsije utvrdila je podcijenjene rezultate u 7 od ukupno 27 slučajeva. Konačni rezultati su 118 benignih lezija dojke, 13 KDIS te 14 IKD. Zaključak: Niski broj podcijenjenih patohistoloških rezultata te velik broj ispitanika pošteđenih kirurške biopsije naglašava važnost tomosintezom vođene vakuum asistirane biopsije dojke kao nove metode dijagnosticiranja koja bi u budućnosti mogla u potpunosti zamijeniti kiruršku biopsiju., Aim: The aim of this study was to compare the results achieved by our institution with results from other studies so we can evaluate quality of this method and our own work. Patients and methods: This was a retrospective analysis based on medical documentation of 145 women, ranging from 45 to 85 years old, who underwent tomosynthesis guided vacuum assisted breast biopsy. Pathohistological results were classified into 3 main groups (benign breast lesion, ductal carcinoma in situ and invasive breast cancer). Besides that, basic cancer characteristics and number of pathohistological underestimates was recorded. Results: Out of 145 total pathohistological results obtained by tomosynthesis guided VABB, 119 were benign breast changes, 18 were CIS and 8 were IBC. Surgical biopsy revealed that 7 out of 27 cases were underestimated by VABB. Final results are 118 benign breast changes, 13 CIS and 14 IBC. Conclusion: Low number of histological underestimates along with a large number of women who did not have to undergo breast surgery, emphasizes the importance of tomosynthesis guided vacuum assisted breast biopsy as the new diagnostic method which could replace surgical biopsy in near future.

Rekonstrukcija dojke važan je segment liječenja pacijentica oboljelih od raka dojke, ali također može biti rješenje i za ispravljanje određenih kongenitalnih i stečenih anomalija. Rekonstrukcijom dojke nastoji se napraviti nova dojka koja će izgledom i funkcijom odgovarati prirodnoj te time doprinijeti samoj estetici kao i boljem psihološkom stanju pacijentice. Vrijeme i metodu rekonstrukcije određuje kirurg koji obavlja detaljno pregled pacijenata, uzimajući u obzir njihovo zdravstveno stanje, želje i eventualne komplikacije. Kirurg može obaviti rekonstrukciju dojke odmah po mastektomiji i takav zahvat zovemo primarna rekonstrukcija ili može biti sekundarna, odnosno odgođena za nekoliko mjeseci ili godina. Metode rekonstrukcije su različite, a operacija uključuje implantate punjene fiziološkom otopinom ili silikonske implantate- punjene gelom, a može uključivati i autolognu rekonstrukciju koja obuhvaća širok spektar režnjeva s abdomena, unutrašnjosti bedara, gluteusa, leđa. Rekonstrukcija dojke završava rekonstrukcijom areole bradavice., Breast reconstruction is an important part of the treatment of patients with breast cancer, but it can also be a treatment of choice for certain congenital and acquired anomalies. Breast reconstruction seeks to create a new breast that will match the appearance and function of the natural one and thus contribute to the aesthetics as well as the better psychological state of the patient. The time and method of reconstruction is determined by the surgeon who performs a detailed examination of the patients, considering their health condition, expectations and possible complications. Surgeon can preform breast reconstruction immediately after mastectomy and such a procedure is called primary reconstruction or it can be secondary or delayed for several months or years. Reconstruction methods vary and surgery involves implants filled with saline or silicon implants, filled with gel, and may include autologus transplantation that includes a wide range of lobes from the abdomen, inner thighs, gluteus, and back. Breast reconstruction ends with reconstruction of the nipple areola.

Uvod: Kolorektalni karcinom maligni je tumor porijekla žljezdanog epitela sluznice debelog crijeva. Nalazi se na četvrtom mjestu najučestalijih karcinoma te predstavlja treći vodeći uzrok smrti od karcinoma u svijetu. Rizik za razvoj CRC-a pod utjecajem je brojnih etioloških faktora. Incidencija je značajno viša nakon 50. godine života te u muškog spola. Stadij tumora značajno utječe na preživljenje. Svrha rada: Cilj ovoga rada bio je ustanoviti postoji li pomak u dijagnostici CRC-a između 2008. i 2018. godine u KBC-u Rijeka. Također, analizirati kliničkopatološke karakteristike, najčešće lokalizacije kolorektalnog karcinoma te usporediti njegovu učestalost prema spolu i dobi. Nadalje, analizirati odnos lokalizacije i veličine tumora prema stadiju bolesti. Ispitanici i postupci: Ovo retrospektivno istraživanje obuhvaća bolesnike KBC-a Rijeka s prvotnom dijagnozom CRC-a u 2008., odnosno 2018. godini. Istraživanje je obuhvatilo 215 bolesnika iz 2008. godine te 224 bolesnika iz 2018. godine. Rezultati: Dobiveni rezultati pokazali su da je incidencija CRC-a viša u muškom spolu te da se 95% ovog karcinoma javlja nakon 50. godine života. Najčešća lokalizacija primarnog sijela CRC-a je rektum, kojeg slijedi lijevi kolon. Većina dijagnosticiranih CRC-a je niskog gradusa, a u većem postotku radi se o klasičnom adenokarcinomu (NOS). Usporedbom 2008. i 2018. godine zaključujemo da se broj niskih stadija povećao za 21, a visokih smanjio za 12, na statistički značajnoj razini. Zaključak: Iz navedenih podataka i rezultata može se zaključiti da postoji pomak u ranijoj dijagnostici kolorektalnog karcinoma u 2018. godini, u odnosu na 2008. godinu u KBC-u Rijeka., Introduction: Colorectal cancer is a malignant tumor originating from the glandular epithelium of the colonic mucosa. It is the fourth most common cancer and the third leading cause of cancer death in the world. The risk of developing CRC is influenced by a number of etiological factors. The incidence is significantly higher after the age of 50 and in males. Tumor stage significantly affects survival. Purpose: The aim of this study was to determine whether there is a shift in the diagnosis of CRC between 2008 and 2018 at the University Hospital Center Rijeka. Also, to analyze the clinical and pathological characteristics and the most common localizations of colorectal cancer and compare its frequency with sex and age. Furthermore, analyze the relationship of tumor localization and size to stage of the disease. Subjects and methods: This retrospective study includes patients of KBC Rijeka with the initial diagnosis of CRC in years 2008 and 2018 . The study included 215 patients from 2008 and 224 patients from 2018. Results: The obtained results showed that the incidence of CRC is higher in males and that 95% of this cancer occurs after the age of 50. The most common localization of the primary site of CRC is the rectum, followed by the left colon. The majority of diagnosed CRCs are of low grade and classic adenocarcinomas (NOS). Comparing 2008 and 2018, we conclude that the number of low stages increased by 21 and high stages lowered by 12, at a statistically significant level. Conclusion: From the above data and results, it can be concluded that there is a shift in the earlier diagnosis of colorectal cancer in 2018, compared to 2008 in KBC Rijeka.

Karcinom dojke predstavlja najčešće sijelo karcinoma i vodeći je uzrok smrti u žena. Rizik od karcinoma dojke raste sa dobi. Poznavanje patoloških lezija u dojci od iznimne je važnosti kako bi se moglo što prije započeti s praćenjem ili liječenjem pacijentica. Lezije u dojci mogu se podijeliti na benigne i maligne lezije. Dijagnostiku patologije dojke, nakon sistematske anamneze i fizikalnog pregleda, slijede slikovne metode kojima ćemo pobliže znati o kakvoj se leziji radi. Glavna metoda otkrivanja malignih lezija je mamografija. Naposljetku, odlučiti ćemo se i za moguće citološke i patohistološke metode. Perkutana biopsija osnovna je metoda u dijagnostici sumnjivih lezija dojke. Temeljni cilj perkutane biopsije (engl., core needle biopsy, CNB) je da se vidljiva ili suspektna lezija nađena radiološkim metodama ili fizikalnim pregledom pošalje na patohistološku analizu kako bi došli do konačne dijagnoze, ali i da izbjegnemo kirurški zahvat moguće benigne lezije i ne izlažemo pacijenticu većem stresnom čimbeniku. Ultrazvuk je metoda izbora za nadzor vođenja biopsija jer je jednostavna, najbrža i najmanje štetna za pacijente. Jedine apsolutne kontraindikacije su odbijanje intervencije i lezija koja se ne vidi na prisutnom UZV. Najčešće se javlja malena bolnost u području biopsije, a rijetke komplikacije koje se mogu pojaviti su hematom ili infekcija. U 2 % slučajeva široko iglene biopsije, iako je manja učestalost u odnosu na ostale metode, dolazi do lažno negativnih rezultata. Širokoiglena biopsija je dovoljno vrijedna i dostatna metoda za točnu dijagnozu., Globally, breast cancer is the most frequently diagnosed malignancy and the leading cause of cancer death in women. The risk of breast cancer increases with older age. Knowledge of pathological lesions in the breast is extremely important in order to begin monitoring or treatment of patients as soon as possible. Breast lesions can be divided into benign and malignant lesions. The diagnosis of breast pathology, after a systematic anamnesis and physical examination, is followed by imaging methods by which we will know in more detail what kind of lesion it is. The main method of detecting malignant lesions is mammography. Finally, we will decide on possible cytological and pathohistological methods. Percutaneous breast biopsy is widely practised to evaluate suspicious breast lesions. The primary goal of core needle biopsy (CNB) is to send a visible or suspicious lesion found by radiological methods or physical examination for pathohistological analysis to arrive at a definitive diagnosis, but also to avoid surgery for possible benign lesions and not expose the patient to a major stressor. Ultrasound is the method of choice for guiding biopsy management because it is simple, fastest, and least harmful to patients. The only absolute contraindications are refusal of intervention and lesions that are not visible on the present ultrasound. Minor pain in the biopsy area is most common and rare complications that may occur are hematoma or infection. In 2 % of cases of wide-needle biopsy, although the frequency is lower compared to other methods, false negative results can occur. Wide-needle biopsy is a sufficiently valuable and sufficient method for accurate diagnosis.