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Cilj: Osvijestiti liječnike o potencijalnom riziku razvoja progresije melanocitnih kožnih lezija i eventualnog nastanka malignog melanoma u pacijenata kronično liječenih adalimumabom (Humirom), antagonistom tumorskog faktora nekroze-alfa (TNF-alfa). Prikaz slučaja: U dermatološku ambulantu javio se tridesetosmogodišnji muškarac jer je unatrag mjesec dana primijetio makroskopski vidljivu promjenu postojeće melanocitne lezije na području kože abdomena, u vidu njezinog povećanja i promjene boje. Pacijent je unazad tri godine počeo osjećati zakočenost toraksa i leđa, jutarnju križobolju te bolove u leđima koji bi se smanjili uzimanjem nesteroidnih antireumatika. Na temelju kliničkih, laboratorijskih i radioloških nalaza, pacijentu je dijagnosticiran aksijalni spondiloartritis zbog kojeg mu je, dva mjeseca kasnije, u kroničnu terapiju uveden adalimumab. Primjena adalimumaba dovela je do izrazitog poboljšanja bolesnikovog stanja te ga je nastavio redovito uzimati. Nakon dvije godine kontinuirane terapije adalimumabom pacijent je uočio promjenu postojećeg nevusa na trbuhu, o čemu je obavijestio dermatologa koji je izvršio eksciziju lezije u cijelosti. Patohistološkom analizom potvrđen je displastični nevus visokog stupnja. Zaključak: Povezanost adalimumaba s razvojem melanoma još nije dovoljno istražena, iako mnogi dokazi govore u prilog tome. Važno je da liječnici budu upoznati s mogućim rizikom progresije postojećih melanocitnih lezija, kao i mogućim razvojem malignog melanoma te educiraju pacijente, savjetuju im redovne kontrole i povećan oprez, a sve u cilju pravovremenog otkrivanja i prevencije potencijalno ozbiljnih nuspojava adalimumaba. Istraživanja koja se bave ovom tematikom malobrojna su i potrebne su daljnje studije koje će u obzir uzeti više rizičnih čimbenika za nastanak melanoma., 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.

Malignant mesenchymal tumors of oropharyngeal mucosa are rare. Those with fibroblastic and histiocytic differentiation in the skin are called atypical fibroxanthoma (AFX) and in the soft tissue undifferentiated pleomorphic sarcoma (UPS). Here we present a case of an older patient with a history of multiple basal cell carcinomas and recently with a rapidly growing polypoid lesion in the mucosa of posterior oropharyngeal wall with AFX/UPS morphology. The differential diagnosis, histological pitfalls of this poorly characterized mesenchymal lesions, and the challenges associated with treatment are discussed.

Background: Peripheral T cell lymphoma (PTCL), NOS is heterogeneous category of nodal and extranodal mature T cell lymphoma and it accounts for 30% PTCLs in western countries. Its aberrant expression of B lineage markers can sometimes be very misleading especially in the setting of profound downregulation of T cell markers. Principals/Methodology: To describe a case of PTCL, NOS with down expression of T cell markers and aberrant expression of CD38. Results: A 66-year old woman presented with generalized lymphadenopathy, weight loss and left leg lymph-edema, one month in duration. Cytological examination of the enlarged cervical lymph node aspirate revealed lymphatic cells at different stages of transformation with some epithelioid cells. Conglomerate of enlarged right axillary lymph nodes measuring 3.6x2.6x2 cm was examined. Standard H&E and Giemsa staining showed obliterated lymph node architecture, interfollicular infiltration of polymorphic medium to large sized atypical lymphatic cells some with blastoid and plasmablastic morphology with numerous mitoses and apoptosis. Also there was lots of accompanying plasma cells, eosinophils, and histiocytes. By immunohistochemistry large atypical lymphoid cells were CD38+, CD138-, CD30-/+, MUM1+, PD-1-/+, CD20-, CD79a+/-, PAX-5-, CD3-, CD5-, CD4-/+, CD2-, CD8-, Bcl-2-, Bcl-6-, CD10-, HHV-8- and EBER in situ negative. CD68 staining showed lots of histiocytes and Ki-67 was around 50%. Therefore, initial provisional differential diagnosis was DLBCL. PCR of immunoglobulin heavy chain in FR2A and FR3A regions showed polyclonal distribution, while T cell receptor analysis of TCR gamma region showed bi-clonal and TCR beta region monoclonal distribution. It is only after additional molecular analysis of clonality that diagnosis of PTCL-NOS was made. Conclusion: PTCL, NOS with aberrant B lineage expression and down regulation of T cell markers represents a diagnostic challenge and PCR clonality analysis is crucial for accurate diagnosis.

Hodgkin lymphoma (HL) is an uncommon malignancy usually limited to the lymph nodes and lymphatic system while extranodal involvement is much less common than in non-Hodgkin lymphoma. The current report presents an unusual case of primary classical HL (cHL), nodular sclerosis type with mixed cellularity in buttock soft tissue of 78-year old man. Primary lymphoma of the gluteal muscle is a rare disease and primary cHL is even rarer. In addition, to this unusual extranodal presentation, the present case highlight a diagnostic challenge in fine-needle biopsy masquerading a low grade sarcoma, primarily myxoinflammatory fibrosarcoma or an inflammatory lesion. However, surgical biopsy and immunohistochemistry guided correct diagnosis that was of major interest for further successful treatment.

Sacrococcygeal teratoma (SCT) is the most common neoplasm in neonates and the most common germ cell tumor in children. SCT with malignant elements is very rare in infants. Prenatal diagnosis is of exceptional importance for the adequate fetal intervention, evaluation of perinatal complications and the selection of the optimal treatment. The treatment of choice is complete surgical resection. Postsurgical approach for immature teratoma with malignant elements is not well established. Considering the risk for tumor recurrence, long term follow-up is mandatory. We report clinical, laboratory, radiological and histological findings, surgical procedure, and follow-up in the preterm female neonate with immature SCT with malignant elements.

Cilj: Limfomi su skupina hematopoetskih tumora koji nastaju iz limfocita. Nosna šupljina i paranazalni sinusi rijetko su zahvaćeni primarnim limfomom. Cilj ovog članka je prikazati slučaj pacijentice s primarnim ekstranodalnim limfomom rijetke lokalizacije. Prikaz slučaja: 66-godišnja pacijentica javila se u Kliniku za otorinolaringologiju zbog frontalne glavobolje i nosne kongestije. Endoskopijom nazofarinksa uočena je suspektna tvorba na septumu nosa u lijevoj nosnoj šupljini. Po uzetoj biopsiji dobio se nalaz difuznog velikostaničnog B-limfoma CD20+, te je potvrđena dijagnoza B-staničnog limfoma nosnog septuma. Zaključak: Važna je diferencijalna dijagnoza limfoma od ostalih tumora glave i vrata radi ranog postavljanja dijagnoze i adekvatnog pravovremenog liječenja., Aim: Lymphomas are a group of blood cell tumors that originate from lymphocytes. The nasal cavity and paranasal sinuses are rarely affected by primary lymphomas. The purpose of this article is to show a case study of a patient with a primary extranodal lymphoma of rare origin. Case report: A 66 year-old patient presented at the Otorhinolaryngology Clinic with frontal headaches and nasal congestion. Nasal endoscopy revealed a septal mass in the left nasal cavity. Punch biopsy reported a lymphoplasmocytic diffuse B-cell lymphoma with associated markers CD20+, thus the diagnosis of B-cell lymphoma of the nasal septum was concluded. Conclusion: The differential diagnosis of lymphomas from other head and neck tumors is important because of the early staging of the disease and adequate therapy.

Uvod: Debljina odnosno indeks tjelesne mase (ITM) je etiološki i prognostički čimbenik te ima ulogu u imunološkom odgovoru u žena oboljelih od karcinoma dojke. Cilj ove preliminarne studije je utvrditi odnos između ITM-e i odgovora na neoadjuvantno liječenje u bolesnica s karcinomom dojke te utvrditi odnos ITM-e prema imunološkom odgovoru tumor infiltrirajućih limfocita (TIL) u stromi tumora. Slučajevi i metode: U analizu je uključeno 66 bolesnica s uznapredovalim rakom dojke koje su na Klinici za onkologiju i radioterapiju KBC-a Rijeka liječene neoadjuvantnom kemoterapijom i bioterapijom te operirane od 2016. do 2017. godine. Materijal su uzorci iglenih biopsija i tkiva dojke uzetih na Klinici za radiologiju KBC-a Rijeka i na Klinici za opću i onkološku kirurgiju KBC-a Rijeka, preparati kojih su napravljeni na Zavodu za Patologiju KBC-a Rijeka, Medicinskog fakulteta Sveučilišta u Rijeci. ITM je izračunat uz pomoć formule koja koristi omjer tjelesne težine i visine bolesnica nakon čega je kategoriziran prema vrijednostima navedenim definicijom Svjetske Zdravstvene Organizacije te za potrebe statistike dodatno podijeljen u dvije skupine koje čine bolesnice normalne odnosno smanjene tjelesne težine i bolesnice povećane tjelesne težine odnosno adipozne. Na HE obojenim rezovima iglenih biopsija procijenjen je postotak stromalne limfocitne upalne infiltracije na četiri područja na granici tumora prema zdravom tkivu, te je izračunata srednja vrijednost postotka TIL-a. Nakon kompletne kirurške obrade na operacijskom materijalu je procijenjen rizik za nastanak recidiva karcinoma uz pomoć sustava Pathologic Residual Burden Calculator (PRCB) kojim se klasificira ostatni primarni tumor i ostatni metastatski tumor u lokalnom limfnom čvoru nakon neoadjuvantnog liječenja. Statistička analiza je napravljena uz pomoć programa Statistica 13.3. Rezultati: Uspoređene su dobivene vrijednosti ITM-e s PRCB odgovorom, veličinom ostatnog tumora, statusom limfnih čvorova, postotkom stromalnih limfocita, histološkim gradusom tumora u iglenoj biopsiji, imunofenotipom tumora i Ki-67 indeksom proliferacije. Nađen je pozitivan odnos ITM-e i PRCB-a (p=0.007, hi kvadrat test), ITM-e i veličine ostatnog tumora (p=0.005, T-student test) kao i ITM-e i statusa limfnih čvorova (p=0.006, hi kvadrat test). Odnos ITM-e prema histološkom gradusu tumora nije statistički značajan (p=0.211, hi kvadrat test). Dobivena je statistički značajna povezanost između ITM-e i limfocitnog upalnog infiltrata pri čemu bolesnice s većim ITM-e imaju niži postotak limfocitnog upalnog infiltrata (p=0.005, hi kvadrat test). Nađena je statistički značajna povezanost između ITM i postotka izraženosti progesteronskih receptora (PR) pri čemu porast ITM-e prati porast PR –a (p=003, Mann Whitney test). Odnos ITM i izraženosti estrogenskih receptora nije statistički značajan (p=0.085, Mann Whitney test) kao niti odnos ITM-e i Ki-67 indeksa proliferacije (p=0.481, hi kvadrat test). Zaključak: Pozitivan odnos ITM-e i izražaja hormonskih receptora prikazan je u više studija s naglaskom na poslijemenopauzalnu životnu dob. Navedeni rezultati pozitivnog međuodnosa ITM –e i veličine tumora kao i statusa limfnih čvorova odgovaraju rezultatima nekoliko studija. Međutim rezultati studija o povezanosti ITM-e i odgovora na neoadjuvantno liječenje nisu ujednačeni. Pojedine studije ITM prikazuju kao nezavisan prognostički čimbenik lošijeg odgovora na neoadjuvantno liječenje i čimbenik ranijeg povrata bolesti. Odgovor imunološkog sustava u karcinomu dojke ovisi o više čimbenika od kojih je debljina samo jedan od modulatora. Na prikazani rezultat najvjerojatnije utječe veći broj slučajeva s visokom ekspresijom hormonskih receptora u skupini visokog ITM-e koji negativno posreduju imuni odgovor.