Search

Introduction. Idiopathic granulomatous mastitis (GM) is described as a very rare, non-lactating, chronic mastitis that occurs primarily in women of childbearing age. Significant clinical problem related to GM is the diagnostic differentiation from breast cancer. Less advanced forms of GM can be successfully treated with limited surgical excisions and radical treatment is recommended only for the most extensive forms. Case report. First examination of the patient, by the surgeon at Oncology Institute of Vojvodina was in December 2018, when initial suspicion of breast cancer was set up. Core needle biopsy was performed and after histopathological (HP) analysis, confirmation of GM was obtained. The patient was initially offered Prednisone and Methotrexate therapy, which she refused and accepted only surgical treatment. Surgical treatment was performed few weeks after needle biopsy and consisted of performing a nipple spearing mastectomy with excision of the orifices of all fistulous ducts and their primary sutures. The HP findings of the operative specimen confirmed the diagnosis of GM. While there were no signs of dieses relapse, patient was suggested secondary reconstruction of the left breast. Twelve months after the primary operation, secondary breast reconstruction was performed with the interposition of a contoured silicone implant into a muscle pocket in a standard manner. Conclusion. Nipple spearing mastectomy with secondary breast reconstruction is esthetically satisfactory treatment for patients with locally advanced GM.

Introduction: Sentinel lymph node biopsy (SLNB) is a standard procedure at the Oncology Institute of Vojvodina since 1999 and during this period we have done more than 1700 biopsies. The aim of this study was to present our results in SLNB in breast cancer surgery. Materials and methods: This retrospective study was performed at the Department for Surgical Oncology at the Vojvodina Institute of Oncology in the period from January 1999 to December 2019. The study included 1762 patients who had undergone SLNB. The mean duration of the follow-up period was 121.89 months. All patients were women with clinically T1-2N0-1M0 breast cancer. Preoperatively, all patients were administered dual contrast media, radiotracer, and blue dye. Results: The majority of tumors were T1c (955 (54.18%). The mean number of extirpated sentinel lymph nodes (SLN) in both groups was 1.84. In 199 (36.72%) patients SLN was the only metastatic lymph node in the axilla. Micro metastases were found in 113 (21.03%) patients. The overall diagnostic accuracy of SLNB was 96%. Conclusion: Axillary SLN can serve as a reliable predictor of negativity of other ipsilateral axillary nodes. Micro metastases in the SLN are not an indication for complete axillary lymph node dissection.

Anorectal melanoma (AM) is an aggressive and very rare malignancy. The aim of this case report is to present a case of anorectal melanoma that occured in hemorrhoidal node after a colorectal surgery. A patient aged 69 years was treated at the Oncology Institute of Vojvodina for histopathological (HP) verified melanoma of the anorectum (S100, HMB45 and Melan A positive) localized in the hemorrhoidal node. Wide local excision was made. Three months after the operation secondary deposits ocurred at the site of the colorectal anasthomosis, stomach, lung and brain. Polymerase chain reaction analysis of tumor DNA found no mutation in the BRAF V600 gene. Five months after the operation the patient is still alive and on supportive and symptomatic therapy. Despite its rarity, AM should always be considered in unusual anorectal lesions first at all in hemorrhoid nodules.

Introduction. Dermatofibrosarcoma protuberans (DFSP) is a very rare mesenchymal tumor that accounts for approximately 0.1% of all malignancies. It is a locally aggressive fibrous tumor, with a high recurrence rate, which sometimes gives rise to distant metastases, usually to the bones and lungs. DFSP usually occurs on the trunk and extremities with only a small number of cases in the breast, especially in men. Case report. This paper analyzes a rare case of DFSP in the male breast. A 66-year-old man presented with gynecomastia of the left breast. The diagnostic work-up comprised of clinical examination, ultrasonography, core biopsy, and mammography. Immunohistochemistry revealed diffuse and strong positivity for vimentin, CD99, and CD34, while the tumor cells were completely negative for keratin, S100 protein, STAT6, CD31, and factor VIII, highly suggestive for DFSP. Subsequently, a radical mastectomy was performed and preoperative diagnosis of dermatofibrosarcoma protuberans was confirmed by pathological examination and immunohistochemistry. The patient was still disease-free six months after the surgical treatment. Conclusion. DFSP is a soft tissue sarcoma that rarely occurs in the breast, especially in men. The most common clinical presentation in the breast is a mass, but it can also present as gynecomastia, as in our case. The diagnosis of DFPS is based on anatomopathology with immunohistochemistry analysis since there are no specific imaging features for this rare entity. Surgical excision with wide and negative margins is optimal for reducing the risk of recurrence.

Introduction: The development of laparoscopic colorectal surgery began in 1991. Today, laparoscopic surgery presents standard approach in the surgical treatment of malignant colon and rectal diseases. Aim: Surgical and oncological outcomes and survival rates of laparoscopic colorectal surgery at the Oncology Institute of Vojvodina. Methods: Data were collected prospectively from 66 patients undergoing laparoscopic colorectal surgery between December 2009 and December 2019. Registered data included sex, age, surgical indication and type for the procedure, indication and reason for conversion to open surgery, operative time, performing temporary or permanent stoma, intraoperative bowel perforation, pathologic TNM grade, number of harvested lymph nodes, inclusion of positive resection margin, number of postoperative days at the hospital, postoperative complications, postoperative mortality, presence of distant metastases and survival rates. Results: Laparoscopic procedures were right hemicolectomy in 11/66 (16.7%), left hemicolectomy in 1/66 (1.5%), sigmoid colectomy in 19/66 (28.8%), high anterior rectal resection in 13/66 (19.7%), low anterior rectal resection in 12/66 (18.2%), abdominoperineal amputation of the rectum in 7/66 (10.6%), colectomy in 2/66 (3%) and proctocolectomy in 1/66 (1.5%) patient. The median follow-up was 37.5 months (range 6 to 128). The total number of surviving patients was 60 (90.9%). Conclusion: This study showed that laparoscopic colorectal surgery has good clinical and oncological outcomes.

Introduction: The ?gold standard? for patients with locally advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. Aim: Evaluation of local recurrence after surgery for locally advanced rectal cancer. Methods and patients: Retrospective study included 189 patients, who were operated at Oncology Institute of Vojvodina from January 1st 2012 until December 31st 2017. Patients were divided into two groups. In the first group 73 patients who received chemoradiotherapy were included, while 116 patients without neoadjuvant treatment were in the second group. All patients were diagnosed with locally advanced rectal cancer. The existence of operable metastases in the liver and/or lungs did not exclude patients from the study. Patients who had undergone resection of the rectum by Miles, Hartmann or local tumor excision were excluded from the study. Results: The median follow-up period was 48 months (range 13-84). In total, 23 (12.2%) patients developed local recurrence. In the chemoradiotherapy group, 15.1% (11 of 73 patients) had a local recurrence, as compared with 10.3% (12 of 116 patients) in the group without neoadjuvant treatment. In both groups, there were no correlation between rate of local recurrence with other clinical and pathological parameters such as gender, tumor location, T and N stage, histological differentiation, or lymphovascular and perineural invasion (p>0.05). We confirmed significant association between circumferential resection margin with local recurrence in patients who were treated by preoperative chemoradiation (p=0.014). Conclusion: This study has not shown reduced risk of local recurrence after neoadjuvant therapy most likely due to small number of patients. Despite our results, neoadjuvant treatment followed by surgery remains the best treatment protocol for patients with locally advanced rectal cancer.

Purpose: Purpose of this study was to evaluate early complications and risk factors associated with nipple sparing mastectomy and immediate breast reconstruction. Methods: This retrospective study was made using data from 246 breast cancer patients treated at the Oncology Institute of Vojvodina in the period from January 2010 to December 2015. In all patients nipple sparing mastectomy was performed along with primary breast reconstruction. Results: The mean indication for nipple sparing mastectomy was multicentricity of the tumor (114 patients; 46.3%). The majority of surgically treated patients were in stage II of the disease. The total percentage of local relapses after the nipple sparing mastectomy was 1.6% (4 patients). Total percentage of early complications was 15% (37 patients). Median follow-up after nipple sparing mastectomy was 260 weeks (ranging from 417 to 104 weeks). Conclusion: Primary reconstruction of the breasts using heterologous implants is standard surgical procedure for breast cancer that does not lead to increased number of complications, nor to increased percentage of the local recurrence.

Introduction. Epithelioid sarcoma is a slow-growing malignant soft tissue tumor and occurs approximately in 1% of all soft tissue malignant tumors. This case report describes epithelioid sarcoma in femoral nerve and as we know it is the first described case of epithelioid sarcoma at this anatomical localisation. Case report. A 44-years-old female patient presented with strong pain in her left leg. On magnetic resonance imaging (MRI), tumor was presented as a node 8 cm in the diameter at left femoral nerve between ileopsoas and iliacus muscle, without infiltration of muscle fascia and tendons. Four enlarged lymph nodes described in left iliac fosa, were suspected on secondary tumor deposits. We preformed radical surgical excision of the tumor and femoral nerve transection with local lymp hnode disection. Histopathological analysis revealed epithelioid sarcoma, and tumor stained highly positive for anti-pan cytokeratin antibody (AE1/AE3), vimentin, cancer antigen 125 (CA125), anticytokeratin antibody (MNF116), hematopoietic progenitor cell antigen (CD34) and epithelial membrane antigen (EMA) markers. After the operation patient recived radiotherapy without chemotherapy. Six months postoperatively, there was no evidence of local relapses or distant metastases. Conclusion. Initial wide surgical resection and adjuvant radiotherapy is beneficial in treatment of epitheloid sarcoma.

Background: This study aimed to examine the incidence of surgical complications associated with nipple-sparing mastectomy (NSM) with primary implant reconstruction, analyze risk factors for early and late surgical complications of NSM, and determine the incidence of local recurrences and the safety of sparing the nipple-areola complex (NAC). Methods: This retrospective cohort study included 435 patients with 441 NSM procedures over a period of 9 years (2004-2012). All surgical complications and the oncological outcome were recorded during follow-up. Results: The most common early surgical complication was skin flap ischemia/necrosis (26 patients, 5.9%). Prosthesis explantation due to complications was carried out in 11 (2.5%) cases. Neoadjuvant chemotherapy, implant size >500 ml, diabetes mellitus, body mass index > 25 kg/m2, and incisions other than lateral were risk factors for early complications (p < 0.001). The NAC excision rate was 5.4% (24 cases) due to confirmed presence of cancer cells in the subareolar tissue. Capsular contracture as a late complication occurred in 33 (7.48%) cases. Local relapse occurred in 32 (7.3%) patients. Distant metastases were diagnosed in 68 (15.6%) patients, and 53 (12.2%) patients died during the follow-up period. Conclusions: NSM with immediate implant reconstruction has an acceptable morbidity rate and is an oncologically and surgically appropriate treatment for most women requiring mastectomy.

Introduction: In the last two decades there has been a significant progress in rectal cancer surgery. Preoperative radiotherapy, the introduction of staplers and largely improved surgical techniques have greatly contributed to better treatment outcomes, primarily by reducing the frequency of early surgical complications and the rate of local recurrence. The aim of this study was to compare operative and postoperative results in the treatment of rectal cancer between the two groups of surgeons - those who are closely engaged in colorectal surgery and those who deal with these issues sporadically. Material and Methods: A retrospective study on 146 patients who underwent rectal cancer surgery at the Institute of Oncology in the period from 01.01.2008. to 31.12.2010. Patients were divided into two groups. The first group (N1 = 101) consisted of patients operated by trained colorectal surgeons, and in the second (N2 = 45) there were patients who were operated on by surgeons without training in TME. Results: Preoperative chemoradiotherapy was received by 49 (33.56%) patients. Statistically significant difference between the two groups was noted in the duration of surgery and the need for blood transfusion during surgery. Anastomotic leakage occurred in 3 patients from N1 and in 10 patients from group N2. Seven patients (4.79%) developed local recurrence after surgical treatment. Significant differences exist in local recurrence rate and anastomotic leakage rate between compared groups. Conclusion: It is necessary to continue education and training in surgery for rectal cancer to master new technologies and surgical techniques and to improve the results of surgical treatment.

Background: Benefits from the neoadjuvant approach are survival benefits and breast conservation surgery rather than mastectomy. The purpose of our study was to evaluate the incidence and risk factors that influence early local complications in patients that had breast surgery after neoadjuvant polychemotherapy. Methods: This retrospective study was undertaken with 361 breast cancer patients (women) who were treated at the Oncology Institute of Vojvodina from January 2007 to December 2012. In the first group (N1=103) were the patients who underwent neoadjuvant polychemotherapy and in the second group (N2=258) were patients who did not take neoadjuvant polychemotherapy. Surgery procedures were breast conservative surgery, mastectomy, or nipple sparing mastectomy with immediate breast reconstruction, depending on tumor stage after polychemotherapy. Median follow-up of patients after operation was 49 months (ranging from 15 to 75 months). Results: The average reduction of tumor volume after neoadjuvant polychemotherapy was 30%. Most common complications were prolonged seroma formation and minor skin necrosis. Obesity, older age, smoking, and diabetes mellitus were recognized as risk factors for early postoperative complications after neoadjuvant polychemotherapy (p

Background: Hepatectomies are mostly performed for the treatment of hepatic benign or malignant neoplasms, intrahepatic gallstones, or parasitic cysts of the liver. The most common malignant neoplasms of the liver are metastases from colorectal cancer. Anatomic liver resection involves two or more hepatic segments, while non-anatomic liver resection involves resection of the metastases with a margin of uninvolved tissue. The aim of this manuscript was to show results of hepatectomies performed at the Oncology Institute of Vojvodina. Methods: We performed 133 liver resections from January 1997 to December 2013. Clinical and histopathological data were obtained from operative protocols, histopathological reports, and patients? medical histories. Results: We did 80 metastasectomies, 51 segmentectomies, and 18 radiofrequent ablations (RFA). Average number of colorectal cancer metastases was 1.67 per patient. We also made 10 left hepatectomies. In all cases, we made non-anatomic resections. Conclusion: Decision about anatomic versus non-anatomic resections for colorectal metastasis and primary liver tumors should be made before surgical exploration. Preservation of liver parenchyma is important with respect to liver failure and postoperative chemotherapy treatment.

Introduction. Sentinel node biopsy in breast cancer has been a standard procedure at the Institute for Oncology of Vojvodina since 1999 and we have done more than 700 biopsy. Before the introduction of axillary sentinel lymph node biopsy, lymph nodes were routinely dissected, and this approach was the gold standard in surgical treatment of breast cancer. The study was aimed at presenting our results in performing sentinel node biopsy in clinical practice for operative treatment in breast cancer. Material and Methods. All patients (n=791) were women with clinically T1-2, N0-1, M0 breast cancer. Sentinel lymph node marking was performed by both contrast blue dye (Patentblau V) and radiotracer (antimony sulfide marked with Tc99m). Both contrast media were applied peritumorally or periareolarly. After sentinel lymph node biopsy all patients underwent breast-conserving surgery or mastectomy with or without lymph node dissection of level I and II (depending on sentinel lymph node status). Results. Sentinel lymph node biopsy was negative in 543 (68.7%) patients, and positive in 248 (31.3%) patients. Solitary tumor was present in 722 (91.2%) cases, multifocal tumors in 36 (4.57%), multicentric in 28 (3.55%) and bilateral in 5 (0.68%) patients. The mean duration of follow-up was 60.59 months (median 65, range 12- 132). Distant metastases were mostly found in bones (39.13%). Conclusion. The number of complications related to axillary dissection can be reduced and the patient’s quality of life can be improved by avoiding complete axillary lymph node dissection.

Background/Aim. Prediction and prevention of preterm delivery remain great challenge. It is important to include in everyday medical practice determination of certain markers that could help identifying pregnant women with preterm delivery. Insulin like growth factor (IGF) is involved in the control mechanism of fetal and placental growth and development. The aim of this study was to examine the presence of insulin-like growth factor binding protein 1 (IGFBP-1) in cervicovaginal secretion of pregnant women with symptoms of preterm labor, but with apparently intact fetal membranes and to point out a possible application of the strip test for detection of phIGFBP-1 in diagnosis of preterm premature rupture of total membranes (PPROM) in everyday medical practice. Methods. The study was performed at the Department for Obstetrics and Gynecology, Clinical Center of Vojvodina between October 2008 and May 2009. The study included 54 pregnant women between 20-35 weeks of gestation (WG), divided into two groups: the study group (16 pregnant women with symptoms of preterm delivery that gave birth before 37 WG) and the control group (38 pregnant women with the normal course of pregnancy that gave birth on term). In cervicovaginal secretion of the examined pregnant women the level of IGFBP-1 was determined by the immunochromatographic assay with monoclonal antibodies 6303 as a detecting antibody (Actim PROM test, Medix Biochemica, Kauniainen, Finland). Results. Gestational age (GA) at delivery in the study group was 32.6 WG and in the control group it was 38.4 WG. Weight of newborns in the study group was 2,021 g and in the control group 3,430 g. IGFBP test was positive in 15 women (93.75%) of the study group, while in the control group it was positive only in 1 woman (2.63%). Conclusion. Test on phIGFBP-1 in cervicovaginal mucus was positive in 93.75% women with preterm delivery, suggesting that this test could be used in diagnosis of silent rupture of fetal membranes and in prediction of preterm delivery.

Idiopathic granulomatosus mastitis (IGM) is chronic breast lesion that can mimic breast carcinoma and breast abscess. In this article, we presented a case of IGM and reviewed the etiology, clinical presentation, diagnosis, and treatment of this breast disorder. A 32-years old patient suffered from a painful tumor in the upper lateral quadrant of the left breast. A histopathologist diagnosed idiopathic granulomatous mastitis after breast-conserving surgery. All blood (biochemical and immunological) tests and test on tuberculosis were negative. The diagnosis of IGM can be challenging for surgeons, radiologists, and pathologists because it can be mistaken for breast carcinoma and breast abscess.

Struma ovarii is composed of thyroid tissue originated from germ cells in a mature teratoma. Thyroid carcinoma found in struma ovarii is very rare. Primary thyroid carcinoma should be excluded. We present a 62-year-old female with papillary thyroid carcinoma in a mature teratoma as a incidentally found diagnosis. The patient underwent the surgery because of the endometrial carcinoma, while the histopathological examination found endometrial carcinoma as well as malignant struma ovarii. From the surgical point of view, it is very important to evaluate thyroid gland status in patients with malignant struma ovarii.