Introduction: Mixed adenoneuroendocrine carcinoma (MANEC) is a tumor of the gastrointestinal tract that contains both exocrine and endocrine components, with each component representing a minimum of 30% of the total tumor mass.

Introduction: Testicular tumors account for approximately 1% of all malignancies in men, but the age of patients and its increasing incidence make this malignancy one of the leading oncological problems. In spite of the fact that the testicles are organs accessible for self-examination and the accessibility of ultrasound examination as the method of choice in diagnostics, these tumors are often detected in an advanced stage of the disease. Aim of the Study: The aim of this study is to evaluate the occurrence of advanced disease at the time of diagnosis of testicular germ cell tumors, through retrospective analysis. Patients and Methods: Our study examines patients with testicular germ cell tumor (seminomatous and non-seminomatous) according to numerous parameters-anamnesis with special emphasis on risk factors, clinical examination, laboratory analyses with tumor markers, and diagnostic imaging examinations (thorax, abdomen and pelvis CT scan). Before the specific treatment, spermiogram and semen cryopreservation were done for most patients, while in some cases additional diagnostics (MRI of the endocranium, skeletal scintigraphy) was indicated as well. Results: During the observation period, 132 patients with testicular germ cell tumor were treated and observed, of which 58 patients (44%) with seminomatous tumor type and 74 patients (56%) with non-seminomatous tumors. Of the total number of patients, at the time of disease diagnosis, there were 41 patients (31%) with N1-N3 status of retroperitoneal lymph nodes and 17 patients (12.8%) with M1a-M1b metastatic status. Conclusion: A large number of newly detected testicular tumors are diagnosed in an advanced stage of the disease. It is necessary to raise awareness of the general population about this malignancy, emphasise the importance of self-examination in younger men, and promote the possibility of routine ultrasound examinations with the aim of early detection of the disease.

Cancer of the testis is a relatively uncommon disease, accounting for approximately 1-1.5% of all cancers in males.  5% of the malignant germ cell tumors are made of extragonadal origin. Germ cell tumors occur in men younger, usually between 20 and 35 years old. We report a case of a patient with metastatic extragonadal germ cell tumor with multiple sites of metastases, and very high initial values of tumor marker human chorionic gonadotrophin (HCG)- 1351308. At the time of diagnosis, the patient was in a very poor general condition. After the applied chemotherapy, there was a complete response and 7 years later the patient is without any symptoms of disease.

Introduction: The introduction of BRAF inhibitor vemurafenib significantly improvedoverall survival (OS) in metastatic melanoma patients.Aim of the Study: The purpose of this study was to determine OS and progressionfree survival (PFS) in patients with advanced metastatic melanoma treated withvemurafenib in the Oncology Clinic, University Clinical Centre of the Republic ofSrpska (UKC RS). The secondary goal is to determine the effect of elevated serumlactate dehydrogenase (LDH) on OS.Patients and Methods: We analysed patients that received vemurafenib in theApril 2015. until March 2018. They had pathohistologically confirmed B-RAF positivemetastatic melanoma. LDH values were measured at the start of the treatment.Results: A total of 16 patients were analyzed, with an average age of 53 years(37-78). A large number of patients at the start had multiple sites of metastases.Calculated OS in patients who received vemurafenib is 11.8 months (p=0,23), withstandard deviation (SD) 9.18. The calculated PFS is 9.5, SD 7,57. OS in patients withnormal LDH is 14.4 months, SD 10.73, and with elevated LDH is 8.4 months, SD4.9 (p=0.079).Conclusion: Use of vemurafenib resulted in an improvement in PFS, with improvedOS in patients with advanced BRAF-mutated melanoma. In patients with elevatedLDH OS was reduced. This shows that LDH is a good prognostic marker and thatwe should do it routinely for all patients with melanoma. This study has indicatedthe need for new diagnostic and therapeutic options for melanoma in Republic ofSrpska.

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