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Introduction. In 2018, the number of newly diagnosed breast carcinomas in the 28 countries of the European Union was 404 920, with an estimated annual incidence of 144.9/100 000. Figures have increased since the introduction of mammography screening and continue to rise with population aging. Mammograms may convey clinically occult breast cancer, which is associated in some cases with the presence of clustered microcalcifications. Case presentation. We present the case of a 64-year-old patient with multifocal invasive ductal left breast cancer and lobular carcinoma in situ, diagnosed after biopsy of a mammogram-marked area with clustered microcalcifications. The patient underwent subsequent radical surgical treatment. Conclusions. Clustered microcalcifications on mammograms may indicate clinically occult breast cancer. These lesions cause clinical and diagnostic difficulties due to the inability of ultrasound visualisation and the option to perform punch biopsy, as recommended by European Society for Medical Oncology. Excision biopsy by mammography-guided wire marking and pathological-anatomical examination of the entire resectate can detect tumour heterogeneity, which is important for the subsequent therapeutic strategy and prognosis of the disease. En 2018, le nombre de cancers du sein nouvellement diagnostiqués dans les 28 pays de l’Union européenne était de 404 920, avec une incidence annuelle estimée à 144,9/ 100 000. Les chiffres ont augmenté depuis l’introduction du dépistage par mammographie et continuent d’augmenter avec le vieillissement de la population. Les mammographies peuvent signaler un cancer du sein cliniquement occulte, associé dans certains cas à la présence de microcalcifications en grappes. Présentation du cas. Nous présentons le cas d’une patiente de 64 ans atteinte d’un cancer du sein gauche canalaire invasif multifocal et d’un carcinome lobulaire diagnostiqué in situ après biopsie d’une zone marquée par mammographie avec des microcalcifications en grappes. Le patient a subi un traitement chirurgical radical ultérieur. Conclusion. Les microcalcifications groupées sur les mammographies peuvent indiquer un cancer du sein cliniquement occulte. Ces lésions entraînent des difficultés cliniques et diagnostiques en raison de l’impossibilité de visualiser par les ultrasons et de l’option d’effectuer une biopsie par ponction selon la recommandation de la Société Européenne d’Oncologie Médicale. La biopsie d’excision par marquage au fil guidé par mammographie et l’examen anatomo-pathologique de la zone réséquée peuvent détecter une hétérogénéité tumorale qui est importante pour la stratégie thérapeutique et le pronostic de la maladie.

Introduction Radiotherapy (RT) is a widely used treatment modality of malignant tumours of the uterine cervix and body. There are different techniques to deliver RT to the tumour lesions, including external beam radiation and brachytherapy. All international guidelines recommend RT as treatment modality for many stages of uterine cervical and body cancers because it improves a number of oncological outcomes, such as disease-free and overall survival. However, it may also lead to a number of complications, which can be roughly divided into early or late, depending on the time of their manifestation. The most frequent RT-induced early complications involve the skin and the soft subcutaneous tissues. They typically present as inflammatory conditions of all abdominal wall layers: dermatitis, cellulitis, and necroses of subcutaneous fatty tissue, muscles, or fasciae. Case report This paper presents a case report of a 38-year-old woman diagnosed with endometrial cancer (EC). She was initially treated with open abdominal surgery, and subsequently the treatment was continued with external beam adjuvant RT. Discussion While RT was ongoing, a necrosis of the anterior abdominal wall in the surgical scar developed. It manifested at the end of the RT treatment and is thus regarded as an early complication of the RT for EC. It was successfully managed with surgery, and there was no compromise in the treatment of the oncological condition. Conclusions RT-induced necrosis of the surgical scar of the anterior abdominal wall is a very rare complication. Surgical treatment is the main method of treatment of this condition.

The primary sarcoma of breast is a rare malignant tumour, which develops from the mesenchymal tissue of the mammary gland. It represents less than 1 per cent of all malignant diseases of the breast. The incidence is about 17 new cases per 1 000 000 women. The aetiology of that disease is unknown. The main method of treatment is the surgical excision with which includes the "safety-margin" of healthy-looking tissues. We present a 57-year-old woman with probably familial, primary, malignant malignant phyllodes sarcoma. Her niece was diagnosed with periductal stromal sarcoma of the left breast five years ago. This evoked in us the idea that there is probably a familial connection between the two diseases. After radical surgery the patient was undergone to radiotherapy and she is without any signs of recurrence till now.

Basal cell carcinoma is the most common malignant neoplasm of the skin of the face in old, caucasian humans. The tumour growth slow and rarely has metastases. The clinical presentation is different. The main method for treating is radical surgical excision, but if the tumour is very big or there are metastases, there is a very effective target therapy with the peroral capsules Vismodegib 150mg. In this case we introduce a patient whit cancer of upper lip of preoperative target therapy whit Vismodegib 150mg, which destroy the tumour cells and help us to make cosmetic surgical excision.

Background Ovarian carcinoma (OC) is one of the most common types of cancer diagnosed in women and its clinical significance is reflected in the leading place it holds in the morbidity and mortality rates among women diagnosed with cancer. The evaluation of lymph node involvement by the oncosurgeons is a pivotal step towards proper disease staging and adjuvant therapeutic choices, towards optimal treatment outcomes. Aims The aim of this study was to investigate the lymph node metastases and patient characteristics in women with advanced OC (FIGO II-IV). Methods The study includes 58 patients with advanced OC (FIGO IIIV) operate in our clinic for the period 2004-2012. The patients were analysed with respect to age, FIGO stage, histological type and tumour grading, type of surgical verification of lymph nodes (biopsy, pelvic and/or paraaortic lymphadenectomy), results from histopathological reports describing the extent of lymphatic involvement, localization of lymph node metastases, and presence of ascites. Results Lymph node metastases were found in 56.7 per cent of the patients. 24.1 per cent of the patients had micrometastases in lymph nodes that were not initially detected on both preoperative diagnostic imaging and intraoperative inspection. Conclusion The only reliable method for initial/early detection of lymphatic metastases in patients with OC is the surgical, through lymphadenectomy, with subsequent histological evaluation.

The primary cutaneous adenoid-cystic carcinoma represents a very rare neoplasm - less than 100 similar cases are reported in the literature until now. It affects persons of middle age or elder the female is involved a little more often the local relapses are observed in about half of the cases and it metastasizes most frequently in the regional lymph nodes and lungs. We present a case of a 31-year-old woman with primary adenoid-cystic carcinoma of skin which was treated for a pigmented cutaneous fibroma. This required reoperating the patient. The clinical manifestation of primary cutaneous adenoid-cystic carcinoma may imitate benign pigmented cutaneous fibroma. The final diagnosis of this disease is made by a pathologist based on the pathomorphological exam and immunohistochemistry. The basic method for treatment in these cases is the extensive local excision in a radius of 2cm from the lesion to avoid the risk of local relapse.

An isthmocele appears as a fluid-filled pouch-like defect in the anterior uterine wall at the site of a prior caesarean section, and ranges in prevalence from 19 per cent to 84 per cent, a direct relation to the increase in caesarean sections performed worldwide. It is the result of incomplete healing of the isthmic myometrium after a low transverse uterine incision performed for caesarean section. Although mostly asymptomatic, it may cause menstrual abnormalities, chronic pelvic pain, and secondary infertility. Scar tissue dehiscence, scar pregnancy, and abnormally adherent placenta are some of the obstetric complications associated with this defect. Diagnosis of the defects can be made with transvaginal ultrasound (TVUS), saline infused sonohysterogram (SIS), hysterosalpingogram, hysteroscopy, and magnetic resonance imaging (MRI). Surgical treatment of an isthmocele is still a controversial issue but it should be offered to symptomatic women or asymptomatic patient who desires future pregnancy. When surgery is the treatment choice, laparoscopy guided by hysteroscopy, or hysteroscopy alone are the best options depending on the isthmocele's characteristics and surgeon expertise. We would like to present a mini-review of the topic with contribution of three cases.

Basaloid squamous cell carcinoma of the uterine cervix is an extremely rare and aggressive malignancy. It has poorer clinical outcomes than squamous cell carcinoma of the uterine cervix. The tumour has specific microscopic features, and usually affects patients in their late 60s and 70s. We present a very rare case of a 30-year-old woman, who was diagnosed on a prophylactic examination and was treated with radical hysterectomy and pelvic lymph node dissection. The follow-up of the patient is ongoing.

Summary Breast cancer is the most common cancer in women worldwide. The standard for detecting it includes clinical exam, mammography and fine-needle aspiration cytology. Our aim was to establish the role of the tru-cut biopsy in the diagnosis of malignant breast lesions. We provideatwo-year retrospective clinical study defining 98.67%sensitivity, 100%specificity, 100%positive predictive value, 80%negative predictive value and an overall diagnostic accuracy of 98.73%. In 89.1%of the malignant lesions, the sample was adequate to define the receptor status. Therefore, tru-cut biopsy is an easy, cheap, safe and accurate alternative to fine-needle aspiration cytology in the diagnosis of breast lesions.

Background Primary breast lymphoma is a rare malignant neoplastic disease, accounting for around 0.5 per cent of all malignant diseases of that organ, and also 2.2 per cent of extranodal lymphomas. The most common histopathological types are: diffuse large B-cell lymphoma, extranodal B-cell marginal zone lymphoma and MALT lymphoma. The primary affected group is with median age between 55 and 62 years. The clinical manifestation is usually of a tumour process in the affected breast. Case presentation Here we present an extremely rare case of a 68 years old woman with primary, nodal, B-cell, marginal zone lymphoma of the left breast, presenting itself under the mask of a benign tumour process, found accidentally following a histopathological examination of excisional samples. Conclusions Primary, nodal, marginal zone, B-cell lymphoma of the breast is extremely rare. Its clinical and mammographic presentation completely overlaps with those of fibroadenoma, which makes diagnosing it preoperatively practically impossible. Main treatment method here is not surgical, but radiological and chemotherapeutic.

Summary Colon cancer is one of the most common malignant diseases with high grade of malignancy and mortality at high rate. Approximately one million people are diagnosed with colorectal cancer each year. Metastases affect mostly the liver, followed by the lungs. Here is a rare case of a patient with rectal cancer without disease progression or recurrence who underwent surgery due to a trans-stomal hernia, combined with high transstomal fistula of the ileum. Acute respiratory failure developed in the postoperative period and led to fatal deterioration as a result of enlarged metastatic mediastinal lymph nodes, which was very difficult to diagnose.

Summary In the last 15 years, sentinel lymph node biopsy (SLNB) for patients with malignant melanoma (MM) has been introduced into the clinical practice. Our aim was to make a retrospective analysis of clinical results in order to assess the success ratio of SLNB and the variables affecting it in MM patients, treated in the Oncology Center at the University Hospital “Dr George Stranski” - Pleven, Bulgaria for a 4-year period. A research index card was used to process the oncologic files of 82 out of 102 patients with MM, treated and monitored at the Oncology centre between 01.01.2008 and 31.12.2011. TNM-stages, Breslow and Clark levels, location, characteristics of the skin lesion, diagnostic excision, type of lymph node dissection, number of SLN, localization of SLN, etc. were registered in the index card. SLNB staging was carried out in 28 patients. Sentinel lymph nodes were found in 22 of them. The success ratio of the method was 78.6%. Histologically, metastatic SLN were found in 4 cases. The Patent Blue Dye method was used in 22 of the cases (78%). A combined radiocolloid and dye method was used in 5 cases (18%). A radiocolloid method was used in 1 case (4%) only. Our research showed that more therapeutic lymph node dissections were performed in cases of locally advanced MM, which in turn worsened the clinical results. According to our research, the SLNB success ratio depends on the precision of diagnostic excision (p=0.019), lesion location (p=0.015), Clark level (p=0.0229), mapping method (p=0.08) and the type of melanoma (p=0.088).

A 68-year-old female presented to the Gynecologic Oncology Clinic with a right-lower quadrant abdominal mass 3×4 cm in diameter palpable on pelvic examination. Her routine laboratory tests were normal. Transvaginal ultrasonography revealed a cystic mass in the right adnexa 3.9 cm in diameter, which was thought to arise in the ovary. At the time of laparoscopy, a 3×4 cm tumor arising from the distal end of the appendix was noted. A laparoscopic appendectomy with tumor removal was performed. Histologic examination of the surgical specimen revealed a mucocele of the appendix (AM). Although rare, this tumor should be considered in the differential diagnosis of a right adnexal mass. These tumors can be identified laparoscopically and removed by minimally invasive surgery.