RezumatLimfomul difuz cu celulă mare B mamar la bărbaţi reprezintă o entitate rară ce poate mima carcinomul mamar ca prezentare clinică, de aceea tratamentul iniţial pentru majoritatea pacienţilor rămâne cel chirurgical. Diagnosticul şi tratamentul precoce complementar, chimioterapia şi radioterapia, sunt foarte importante. Vom prezenta cazul unui bărbat de 56 ani diagnosticat cu limfom difuz cu celulă mare B, primitiv cu localizare mamară -formaţiune tumorală mamară fără limfadenopatie axilară. În urma biopsiei mamare, examenul histopatologic susţinut de testele imunohistochimice stabilesc diagnosticul de limfom difuz cu celula mare B mare primitiv cu pozitivitate pentru CD 20, CD 10, şi negativitate pentru BCL 2, myc şi BCL 6 cu index de proliferare foarte mare (Ki 67 90%). Pacientul a primit trei cure de chimioterapie R-CHOP (rituximab, ciclofosfamida, adriamicina, vincristine si prednisolon). Limfomul difuz cu celulă mare primitiv mamar la bărbat reprezintă o entitate foarte rară, fiind necesară o supiciune ridicată pentru diagnosticul şi tratamentul precoce.Cuvinte cheie: limfom difuz cu celule mare B, sân, bărbat, tratament

RezumatCele mai frecvente leziuni canceroase întâlnite la nivelul glandei suprarenale sunt metastazele de suprarenală. Dintre aceste metastaze, originea tumorală cea mai des întâlnită este cancerul pulmonar, urmată de cancerul gastric sau colonic, cel esofagian, cel hepatic sau de căi biliare şi, în ultimul rând, cancerul renal. De regulă, neoplasmul mamar de tip carcinom mamar invaziv are ca şi localizări preferate de metastazare oasele, plămânii, ganglionii, ficatul şi creierul. Metastazele de glandă suprarenală după neoplasmul mamar de tip carcinom mamar invaziv sunt extreme de rare. Vom prezenta cazul unei paciente în vârstă de 66 de ani ce a prezentat o metastază unică la nivelul glandei suprarenale după ce a fost diagnosticată cu carcinoma mamar invaziv triplu negativ. Pacienta a suferit o suprarenalectomie stângă totală în iunie 2016, fără a fi urmată de tratament adjuvant. La momentul redactării articolului, pacienta se află în stare clinică bună, fără semne de recidivă locală. Rolul tratamentului chirurgical şi chimioterapiei adjuvante în tratamentul metastazelor de glandă suprarenală după neoplasm mamar de tip carcinoma ductal învaziv în ceea ce priveşte rata de supravieţiure se află încă în studiu.Cuvinte cheie: carcinoma mamar invaziv, metastază glandă suprarenală, suprarenalectomie totală

The major challenge in the evaluation of pancreatic cystic neoplasms is identifying lesions with malignant potential or signs of malignancy. Overall, the risk of malignancy in incidentally detected pancreatic cysts is low. Pancreatic cystic neoplasms with malignant potential are: serous cystic tumors (SCTs), mucinous cystic neoplasms (MCNs), intraductal papillary mucinous neoplasms (IPMNs) and solid pseudopapillary neoplasms (SPNs). The risk for developing malignancy is very low for SCTs, moderate to high in MCNs, solid pseudopapillary tumors and some IPMNs (up to 70 percent for main-duct IPMNs). We present a thirty-five years old female patient, without risk factors for the occurrence of pancreatic cancer was diagnosed via clinical examination and crosssectional imaging of the abdomen with a 7 cm cystic lesion located in the pancreatic body and tail, in the context of gastric outlet obstruction and upper abdominal pain with no improvement following conservative treatment. A distal pancreatectomy was thus performed, with favorable postoperative outcome. The histopathology examination described a non-invasive mucinous cystic neoplasm with low grade dysplasia. Many pancreatic cysts can be followed with surveillance imaging, through an algorithm which combines CT scan, MRI or endoscopic ultrasound. The decision to recommend surgery should take into account factors such as the patient's age and general health, the malignant risk of the specific lesion, potential complications and the suspicion for malignancy.

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BackgroundOrgan transplantation has become as effective therapy for end-stage renal, hepatic, cardiac and pulmonary diseases within the past 2 decades. Osteoporosis, low level of vitamin D and hyperuricemia have emerged as frequent and sometimes devastating complications of organ solid transplantation process.ObjectivesThe objective of the study was to detect the prevalence of osteoporosis, low level of vitamin D and hyperuricemia in liver and lung transplant patients.MethodsWe evaluated a cohort of 48 patients who underwent liver and lung transplantation in a single Romanian center between July 2014 and January 2019. 44 pts undergone liver transplantation and 4 undergone lung transplantation. We have measured the level of the 25-hydroxyvitamin D and serum urate before and after the transplantation in all patients.ResultsThe average age of the patients was 53.7 ± 10 years (range 32–69) with a sex ratio 1:1. 32 (66%) of patients came from urban area. 8 (16.6%) patients were excluded from this study due to recurrent HCV infection with hepatic failure in the first few months after transplantation. The final group consisted of 40 patients.The indications of the orthotopic liver transplantation in these patients were: cirrhosis secondary chronic hepatitis B, C, D virus infection in 24 (60%) cases, autoimmune hepatitis in 7 (17.5%) patients, alcoholic liver disease in 2 (5%) patients, hepatocellular carcinoma in 1 (2.5%) patient, polycystic liver disease in 1 (2.5%) patient and nonalcoholic fatty liver disease in 1 (2.5%) patient.In all 4 cases with lung transplantation, the reason for of the lung transplantation was chronic obstructive pulmonary disease (COPD).36 (91%) patients were receiving combination immunosuppressant therapy (tacrolimus and) and only 4 (9%) patients were receiving cyclosporine; in this situation, the association between tacrolimus and mycophenolate mofetil was preferred versus cyclosporine because of the negative effect of cyclosporine on the bone.Post-transplant, hyperurcemia (according to local laboratory reference values >6.5 mg/dL) was presented in 28 (70%) transplant recipients but none of the hyperuricemic patients developed gout. Despite this fact, all of them were treated with allopurinol.Vitamin D deficiency was reported in 22 (55%) transplant recipients. Also, a DXA scan of the lumbar spine and femoral neck measuring T-score and bone mineral density (BMD) was routinely performed after a mean interval of 4-6 months post-transplant. From this group of patients, 10 (25%) patients had decreased bone mineral density (<2.5 SD) and 8 (20%) of them who complained of back pain in the early posttransplantation period, presented on x-rays vertebral fragility fractures at different sites (most frequently in the thoracic spine). The mean T-score was -2.7 and the mean BMD was 27.4 kg/m2.ConclusionThe standard care of liver and lung transplant recipients must includes, besides other lab tests, a measurement of 25-hydroxyvitamin D and serum urate. For patients with low levels of 25-hydroxyvitamin D, eva...