The aim of our retrospective study was to analyze patterns of subtype specific metastatic spread and to identify the time course of distant metastases. A consecutive series of 490 patients with breast cancer who underwent surgery and postoperative treatment at Semmelweis University, Hungary, and diagnosed between the years 2000 and 2007 was identified from the archives of the 2nd Department of Pathology, Hungary. Molecular subtypes were defined based on the 2011 St. Gallen recommendations. Statistical analysis was performed with SPSS Statistics for Windows, Version 22.0. Distant metastasis free survival (DMFS) was defined as the time elapsed between the first pathological diagnosis of the tumor and the first distant metastasis detection. Distant metastases were detected in 124 patients. Mean time to develop metastasis was 29 months (range 0-127 months). The longest DMFS was observed in the Luminal A (LUMA) subtype (mean 39 months) whereas the shortest was seen in the HER2-positive (HER2+) subtype (mean 21 months; p = 0.012). We confirmed that HER2+ tumors carry a higher risk for distant metastases (42.1%). LUMA-associated metastases were found to be solitary in 59% of cases, whereas HER2+ tumors showed multiple metastases in 79.2% of cases. LUMA tumors showed a preference for bone-only metastasis as compared with HER2+ and triple negative breast cancer (TNBC) cases, which exhibited a higher rate of brain metastasis. The most frequent second metastatic sites of hormone receptor (HR) positive tumors were the lung and liver, whereas the brain was the most affected organ in HR-negative (HR-) cases. Tumor subtypes differ in DMFS and in pattern of distant metastases. HER2+ tumors featured the most aggressive clinical course. Further identification of subtype-specific factors influencing prognosis might have an impact on clinical care and decision-making.
Laparoscopic (LAP) colorectal surgery has become increasingly popular worldwide. Large comparative studies demonstrate the benefit of the method, but data about routine application are relatively moderate. This study presents the results of laparoscopic colorectal linterventions in a non-selected patient population, who were admitted to the 1st Department of Surgery, Semmelweis University between January 2004 and December 2011. 393 patients underwent LAP surgery. In 333 cases the malignant tumor indicated surgery. T3 tumor rate was 62.7%. Synchronous liver metastases were detected in 17 cases, three of them were single and operable, but 14 cases were multiplex and inoperable. Bowel was successfully resected in all cases. Complication rate was 9.9 percent. In-hospital mortality was 2.0%. Length of hospital stay of non-complicated cases was 6.7 days. In 9 cases single incision intervention was performed, with an average length of hospital stay of four days. Rate of sphincter preserving rectal resections were 87.2%. 59 (15.0%) patients underwent conversion from LAP to open surgery. Operating time decreased by time, but both OP time and conversion rate were tipically determinded by the surgeon's skill. LAP surgery was found to be useful for all kind colorectal diseases requiring elective resection. Application of LAP method requires organized training programs.
A combination of ovarian tumors with the same histogenetic origin but different histologic subtype is relatively common, whereas a co-occurrence of tumors with different histogenetic origin is rare. We report a case of mixed ovarian tumor composed of Brenner tumor and adult-type granulosa cell tumor, a combination that to the best of our knowledge has not been reported in the literature until now.
Összefoglaló. Esetismertetések: 66 éves nő vizsgálatai irreponibilis fájdalmas inguinalis terime miatt kezdődtek. Ultrahangvizsgálat során a panaszok hátterében femoralis sérvben kizárt gangraenás appendix vermiformis igazolódott. Inguinalis metszésből appendectomiát és hernioplasticát végeztünk. Posztoperatív szövődménye nem volt, szövettana appendicitist igazolt. Pár héttel később egy 76 éves, több társbetegséggel rendelkező férfi fájdalmas, sercegő gangraenás, jobb inguinalis terime miatt került átvételre. CT-vizsgálat femoralis sérvbe kizárt abscedáló appendix vermiformist ábrázolt. Inguinalis metszésből, illetve alsó median laparotomiából a féregnyúlványt a hasüregbe reponáltuk, majd appendectomia és inguinalis necrectomia történt. Posztoperatív adhéziós ileus és hasfali disruptio miatt egy alkalommal reoperáltuk, adhaesiolysist és hasfali resuturát végeztünk. Ezt követően lágyéki sebén negatív nyomásos sebkezelést alkalmaztunk, a beteget a 22. napon otthonába bocsájtottuk. Az appendix szövettana low grade mucinosus neoplasiát igazolt. Megbeszélés: A femoralis sérvbe szorult appendix vermiformis de Garengeot-sérvként ismeretes, extrém ritka incidenciájú sérvtípus, ennél is ritkább az appendix mucinosus neoplásiájával szövődő variánsa. E sérv klinikai megjelenése széles spektrumon mozoghat, pontos preoperatív diagnózisa CT-vizsgálat nélkül kifejezetten nehéz. A műtéti megoldásra többféle lehetőség választható, mely nagyban függ az esetleges komplikációktól, a rendelkezésre álló eszközöktől, az intraoperatív lelettől, valamint az operáló sebész jártasságától. Summary. Case reports: a 66-year-old woman was admitted to our Department due to a painful inguinal lump. During examinations an incarcerated femoral hernia was found with an inflamed vermiform appendix inside the hernial sac. Appendectomy and femoral hernioplasty was performed from inguinal approach. The patient was discharged home without complications. Pathological examinations of the specimen showed signs of acute appendicitis. A few weeks later a 76-year-old man with severe comorbidities was admitted to our unit due to painful gangraenous inguinal skin lesion. CT scan showed an incarcerated femoral hernia containing the appendix with subcutaneous abscess. Appendectomy, hernioplasty, and inguinal necrosectomy was performed from an inguinal and low median approach. Another operation was necessary due to postoperative obstruction and subcutaneous dehiscence. After intraabdominal adhaesiolysis and abdominal wall reconstruction negative pressure wound therapy was applied to the inguinal wound, the patient was discharged 22 days after the primary operation. Pathological examinations of the appendix showed low grade mucinous neoplasm. Discussion: The femoral hernia containing the appendix is called de Garengeot’s hernia and is one of the rarest types of inguinofemoral hernias. The clinicopathology of this type of hernia can cover a wide range of symptoms. The definitive preoperative diagnosis is relatively difficult to find without a CT-scan. The surgical approach and treatment depends on the manifestation, clinical findings and on the available equipment and the expertise of the surgeon.
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