Aim. We present a case report of a female patient with metastasis of breast carcinoma to the medullary conus and cauda equina.Methods. A 48-year-old woman with a history of breast tumor, suddenly felt severe weakness and numbness of the lower extremities. MRI of the spine disclosed a mass lesion within the medullary conus, with leptomeningeal involvement of cauda equina at the spinal level L1. Laminectomy was performed and partial resection of the medullary conus tumor and especially release of nerve roots of cauda equina was achieved using microsurgical techniques.Results. Her clinical status, especially right leg weakness and sensory loss in the lower extremities have immediately improved but bladder dysfunction remained and she was unable to walk.The histological picture and immunophenotype indicates the presence of metastatic ductal adenocarcinoma of the mammary gland. Patient died 4 months after the spinal cord and cauda equina surgery.Conclusion. To our knowledge, this is the first report of successful surgical treatment of metastatic leptomeningeal infiltration of breast carcinoma.

Abstract:We report a patient who presented with synchronous second primary human epidermal growth factor receptor (HER)-2-positive breast cancer and rectal cancer that both required simultaneous neoadjuvant therapy. A modified regimen combining anti-HER-2 monoclonal antibody trastuzumab with chemotherapy and external beam radiation was selected. An organ-preserving surgical procedure was possible both in the breast and the rectum. Citrulline decreased rapidly after the start of the treatment, and then gradually returned to pre-treatment levels after the completion of chemoradiation. Urinary neopterin concentrations exhibited a fluctuating course. Both serum neopterin and C-reactive protein concentrations were more or less stable during the initial administration of trastuzumab, paclitaxel and carboplatin and then increased steeply during chemoradiation and subsequently declined to pre-treatment levels during the weekly trastuzumab administration. Changes were observed in the serum retinol concentrations. A decline in lymphocyte counts was accompanied by marked changes in peripheral blood cell count-derived ratios. The present case report demonstrates a successful combination of two neoadjuvant regimens in a patient with two synchronous different second primary tumors. Data from this case also illustrate the use of biomarkers for monitoring of intensive therapeutic regimens in medical and radiation oncology.

III. interní klinika -nefrologická, revmatologická a endokrinologická, FN a LF UP Olomouc 2 Ústav klinické a molekulární patologie, LF UP Olomouc Výskyt ANCA protilátek bývá u pacientů se systémovým lupus erytematodes (SLE) popisován asi ve 24-31 % případů, nemají však vztah k distribuci a tíži orgánového postižení u SLE a jejich rutinní monitoring se nedoporučuje. Overlap syndrom systémového lupus erytematodes s ANCA asociovanou vaskulitidou (AAV) bývá popisován zcela vzácně, následující kazuistika pacientky SLE s těžkým postižením ledvin v rámci AAV poukazuje na obtížnou diagnostiku a léčbu tohoto syndromu.Klíčová slova: ANCA asociovaná vaskulitida, overlap syndrom, systémový lupus erytematodes. Overlap syndrome SLE -ANCA associated vasculitisIncidence of ANCA antibodies in patients with systemic lupus erythematosus (SLE) is described in 24-31 %, but they are not related to the distribution and severity of organ involvement in SLE; the routine monitoring is not recommended. Overlap syndrome of systemic lupus erythematosus and ANCA associated vasculitis (AAV) is rare. The difficult diagnosis and treatment of this syndrome is described in this case report of the patient with SLE and severe kidney involvement resulting from AAV.

Ústav klinické a molekulární patologie, Fakultní nemocnice Olomouc 3 I. chirurgická klinika, Fakultní nemocnice Olomouc Mezi nejčastěji diagnostikované lokálně pokročilé nádory prsu s exulcerací patří maligní nádory prsní žlázy -nejčastěji invazivní duktální karcinom (dle novější histologické klasifikace invazivní karcinom NST -"no special type"), ev. invazivní lobulární karcinom prsu. V tomto sdělení je popsán histologicky vzácný případ lokálně pokročilého maligního adenomyoepiteliomu prsu. Pacientka s lokálně pokročilým exulcerovaným nádorem prsu, který ze dvou předoperačních biopsií vychází jako benigní adenomyoepiteliom, podstoupila na našem pracovišti radikální mastektomii. Z definitivní histologie vyplývá, že šlo o benigní adenomyoepiteliom s předpokládanou malignizací epitelové složky. U lokálně pokročilých nádorů benigního histologického typu je nutné předem myslet na přechodové formy těchto nádorů nebo na možnou malignizaci jedné ze složek histologicky různorodých nádorů. Vzhledem k nejisté povaze adenomyoepiteliomů by vždy měla následovat chirurgická resekce s negativními resekčními okraji.Klíčová slova: adenomyoepiteliom, epitelové-myoepitelové léze, tumor prsu, karcinom. A giant exulcerated adenomyoepithelioma of the breastMalignant tumors of the mammary gland -most commonly invasive ductal carcinoma (according to the new histological classification invasive carcinoma NST -no special type) and invasive lobular cancer are most frequently seen in the locally advanced breast tumors with ulceration of the skin. This report describes a histologically rare case of locally advanced malignant breast adenomyoepithelioma. A patient with locally advanced exulcerated breast tumor, with benign preoperative histopathological finding of benign adenomyoepithelioma, underwent a radical mastectomy at our department. The definitive histology suggests that it was a benign adenomyoepithelioma with supposed malignant epithelial component. In locally advanced tumors of benign histological type, it is necessary to think about the transient forms of these tumors or the possible malignancy of one of the components of histologically diverse tumors. According to uncertain nature of adenomyoepitheliomas, surgical resection with negative resection margins should always follow.