Jasna Trifunovic

Increasing frequency of soft tissue sarcomas in Vojvodina - comparison with the literature.

BACKGROUND Soft tissue sarcomas (STS) represent 1% of all malignant lesions. In this study the authors analyzed the incidence of STS in Vojvodina (the north region of Serbia) in the period from 1985 to 2009. A number of studies conducted worldwide indicate that STS incidence rates are tending to increase. MATERIALS AND METHODS On the basis of data from the Cancer Registry of Vojvodina, age standardized STS incidence rates were established as well as their linear trend, with data on histological structure, age, gender and STS distribution at specific locations. RESULTS The total number of registered patients was 1,308. Average age standardized rate was 1.90/100,000 per year. The investigated period showed a slight increase in the incidence rate (average annual percent increase=0.77%). The most frequent histological type was sarcoma not otherwise specified-NOS (27%), followed by leiomyosarcoma (21%), liposarcoma (14%), rhabdomyosarcoma (11%) and malignant fibrous histiocytoma (9%). The male/female ratio was 0.73:1. Every fifth patient was younger than 39. CONCLUSIONS Comparison among eight international STS epidemiology studies show that the incidence rate range is between 1.4/100,000-5.0/100,000, though our finding is closer to the lower limit. Furthermore, the incidence rate increase was lower than that characteristic for the half of the analyzed studies. A partial explanation for that should be looked for among changes in diagnostic criteria and STS classifications.

Segmental cavernous carotid ectasia in a patient with cluster-like headache

INTRODUCTION Cluster headache (CH) is a primary headache with severe, unilateral periorbital or temporal pain lasting 15-180 min, accompanied with various cranial autonomic features. A diagnosis of cluster-like headache can be made whenever underlying cause of CLH is present. METHODS AND RESULTS We report a case where an ectatic cavernous segment of the internal carotid artery triggered CHL, most probably due to compression of the ophthalmic nerve within cavernous sinus. The pathological substrate of a vessel ectasia is degeneration of the tunica intima as a consequence of atherosclerosis and hypertension. On the other hand, cavernous sinus is unique space where parasympathetic, sympathetic and nociceptive fibers are in intimate relationship which is of great importance for understanding of CH pathophysiology. CONCLUSION Magnetic resonance imaging and MR angiography are mandatory imaging tools used for precise localization of pathological changes in the cavernous sinus, especially in the group of secondary headaches attributed to vascular disorders.

Treatment of acute hepatitis C in breast cancer patient: a case report.

Abstract Oncologists worldwide are often dealing with hepatitis C virus positive breast cancer patients, questioning adequate chemotherapy protocol, reduction of doses, delays, or even interruptions of treatment. We present a case of a woman in stage IIIB breast cancer, who after the completion of neoadjuvant treatment developed significant increase in liver enzymes and was diagnosed positive for HCV. She was treated with interferon and after the resolving of acute liver disease continued concomitant treatment with interferon, ribavirin, docetaxel, and trastuzumab. Grade 4 neutropenia and grade 3 hepatotoxicity occurred after the third cycle of chemo and 5 months of antiviral therapy. Interferon and chemotherapy were postponed for 1 week. There are no sufficient data in order to recommend the concomitant antiviral and antineoplastic therapy. Hepatitis C virus and antiviral therapy may increase the toxicities of antineoplastic treatment. However, when lifesaving oncologic treatment is necessary, concomitant antiviral therapy can be administered with more intensive follow up.

Male breast cancer in the era of modern therapies: Serbian single centre experience report.

To the Editor: Male breast cancer is a rare disease, accounting for less than 1% of total malignant diseases and less than 1% of all breast cancer cases (1). Inspired by the Ruddy and Winer’s article published in Annals of Oncology (2), we analyzed our group of patients treated at the Oncology Institute of Vojvodina from 2006 to 2010. We analyzed the medical records of 44 patients managed at our Institute. The median follow-up was 50 months (25–83). Diagnosis was established after radical mastectomy in case of 72% of studied patients; the rest of patients underwent less radical surgery or biopsy in case with primary metastatic disease. Adjuvant radioand chemotherapy were administered according to standard protocols (3). The Kaplan–Meier estimator and Mann–Whitney U-test were used for statistical analyses. In our group, 34% of patients had T1 disease, while 50%, 3%, and 13% had T2, T3, and T4, respectively. Lymph node status was—N0 32%, N1 32%; also, N3 and N4 both by 18%. Seventeen patients (39%) had stage IV disease in the time of diagnosis while stage I, II, and III was found in 9%, 41%, and 11%, respectively. Hormone receptor positive disease in our group of male patients was diagnosed in 78% of patients, while three patients (10%) had HER2 positive disease from 32 patients with known HER2 status. Grade two was the most often determined (62%), while G1 and G3 disease was diagnosed in 21% and 17% of patients. In the time of diagnosis, 27 patients had no metastases and 21 of them were treated with adjuvant chemotherapy. FAC protocol (5-flurouracil, doxorubicin, and cyclophosphamide) was applied in case of 81% of patients; combination of AC protocol (doxorubicin and cyclophosphamide) and taxanes was administered in two patients (10%), and CMF (cyclophosphamide, methotrexate, and 5-flurouracil) was also applied in two patients. Tamoxifen was given to all patients with positive estrogen receptors. After disease progression, the patients were mostly treated with taxane therapy and/or capecitabine. None of the patient was given trastuzumab therapy. Primary metastatic disease was found in 17 studied patients and 14 (82%) of them were given FAC therapy and followed with tamoxifen in case of hormone positive disease; two patients were treated with taxanes initially, and one patient was treated with hormonal therapy only. The median of progression free survival (PFS) in the analyzed group of patients was 29 months, and median overall survival (OS) was 40 months. Fouryear PFS was 28% and OS was 43%. In addition, we analyzed survival based on clinical and histopathologic parameters. The univariate analysis showed that tumor size and number of involved lymph nodes in axilla had no significant impact to 4-year PFS and OS. Patients with stage III and stage IV disease had shorter 4-year PFS (5% versus 64%, p = 0.0006) and OS (19% versus 70%, p = 0.0044), mainly on the account of 17 patients with primary metastatic disease. Four-year survival of the patients with metastases was 17% with the median time to progression of 11 months and median time for overall survival of 35 months. These data speak in favor of the efficacy of larger number of therapies administered in metastatic stage of disease. Hormone receptor status did not influence PFS and OS. None of the patients with HER2 positive or grade 3 disease survived more than 3 years, but we didn’t find statistical significance because of the small number of studied patients. Patients with primary metastatic disease had more often tumors of ≥5 cm (p = 0.03) and ≥4 positive ipsilateral axillary lymph nodes (p = 0.01). In contrast to the majority of studies that have been analyzed by Ruddy and Winer (2) our study was a report of the 44 patients who were treated after the year 2005, with more recent standards in adjuvant treatment and with more drugs to treat metastatic Address correspondence and reprint requests to: Lazar Popovic, MD, TA, Clinic for medical Oncology, Oncology Institute of Vojvodina, Put dr Goldmana 4, Sremska Kamenica 21204, Serbia, or e-mail: lazar.popovic@ yahoo.com

Concurrent Chronic Lymphocytic Leukemia and Merkel Cell Carcinoma in Primary Skin Tumor and Metastatic Lymph Node

Association between chronic lymphocytic leukemia and other malignancies has been known for a long time. This epidemiological phenomenon is explained by immunosuppression caused by disease itself or by the applied therapy. Merkel cell carcinoma is a rare malignant tumor of the skin of neuroendocrine origin diagnosed almost exclusively in immunocompromised host. We presented an unique case of coexisting infiltration of chronic lymphocytic leukemia cells within primary cutaneous Merkel cell carcinoma and metastatic lymph node in young HIV-negative female patient.

Hepatitis B reactivation after therapy for non-Hodgkin lymphoma: A case report with review of literature

The natural course of hepatitis B virus (HBV) infection depends on the immune status of the host. In cancer patients, as the consequence of immune suppression due to chemotherapy and malignant disease itself, the balance between replicative potential of the virus and immune response of the host is disrupted leading to acute HBV infection or reactivation. We present a case of HBsAg positive, diffuse large B cell gastric lymphoma patient CD20+ staged IB, treated with six cycles of R-CHOP protocol and two cycles with rituximab monotherapy. Five months after the successful anticancer treatment, patient developed reactivation of chronic HBV infection (ten-fold increase in liver enzymes, HBsAg+, IgM antiHBc+, HBeAg(-), and HBV DNA 5×10 copies/ml). Antiviral therapy with lamivudine was started. Four weeks after the antiviral therapy initiation liver enzymes were in normal ranges. One year after the start of antiviral treatment HBV DNA PCR test did not detect any viral particles. The patient is in complete remission of malignant disease, and still receiving therapy with lamivudine. HBV screening in cancer patients is necessary in order to provide a prompt antiviral therapy and to prevent postponement or even cessation of planned anticancer treatment. HBsAg positive patients should start prophylactic antiviral treatment before the start of immunosuppressive treatment. Chemotherapy protocols consisting rituximab and corticosteroids significantly increase the risk of reactivation. If reactivation is diagnosed in course of chemotherapy, the therapy should be stopped and antiviral treatment should be applied as soon as possible. Treatment with lamivudine is continued at least 6 months after the chemotherapy end.