Předmětem sdělení je případ pacientky, u níž byl ve 47 letech radikálně excidován amelanotický melanom vulvy stadia IA, bez přítomnosti rizikových histologických parametrů. Přesto u ní došlo v průběhu 9 let k osmi lokálním recidivám, které si nakonec vyžádaly provedení totální pelvické exenterace. Pro zvýšení rizika lokálních rekurencí hrály s největší pravděpodobností významnou úlohu prvotní opakované biopsie nádoru. Po 10 letech došlo k lymfogennímu metastazování do pelvických lymfatických uzlin. V léčbě nádoru byly využity všechny léčebné modality, které umožnily pacientce nezvykle dlouhé přežívání při zachování dobré kvality života, které od diagnostiky nádoru dosud činí 13,5 roku.

The case of a 47 age old patient with radically excised IA stage amelanotic melanoma without the presence of risky histologicalparameters is reported. Eight local recurrences during the 9 years have been treated and required total pelvic exenteration at theend. To increase the risk of local recurrences, initial primary tumor biopsy played an important role. After 10 years, lymphogenicmetastasis occurred in pelvic lymph nodes. All treatment modalities have been used in the treatment of the tumor, which allowedthe patient an unusually long survival 13.5 years from the diagnosis of the tumor.

• MeSH
• Biopsy methods   utilization   MeSH
• Diagnostic Imaging methods   MeSH
• Gynecologic Surgical Procedures methods   MeSH
• Histological Techniques methods   utilization   MeSH
• Immunotherapy methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Melanoma * diagnosis   surgery   therapy   MeSH
• Vulvar Neoplasms * diagnosis   surgery   therapy   MeSH
• Positron Emission Tomography Computed Tomography methods   MeSH
• Antineoplastic Protocols MeSH
• Radiotherapy methods   MeSH
• Recurrence MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Karcinom ovaria je mezi gynekologickými nádory nejčastější příčinou úmrtí a je na pátém místě v úmrtí celkově na všechna onkologická onemocnění. V posledním desetiletí došlo k výrazným pokrokům v genomovém mapování nádorových buněk a ve znalostech molekulárních mechanismů v jeho patogenezi. Ve farmakoterapii ovariálního karcinomu se začíná kromě cytostatik uplatňovat cílená molekulární léčba. Široce zkoumanou a slibnou možností cílené léčby jsou inhibitory PARP (poly-adenozindifosfát-ribózo-polymerázy) olaparib, veliparib, niraparib, rucaparib a talazoparib, které jsou zkoumány v monoterapii, v kombinaci s dalšími molekulami nebo jako potenciální zesilovače cytotoxického poškození při chemoterapii či radiační léčbě. Inhibitory PARP působí cílenou smrt nádorových buněk u nádorů s mutovanými geny BRCA1 a BRCA2 s deficiencí homologní rekombinace (HR) využitím syntetické letality. Mezi pěti klíčovými inhibitory PARP v současné době dominuje olaparib, který prošel nejrozsáhlejšími klinickými studiemi. Inhibitory PARP v monoterapii prokázaly výraznou protinádorovou aktivitu u pokročilých ovariálních karcinomů s mutací genů BRCA1/2 v léčbě první linie i v udržovací léčbě, a to zejména u nádorů citlivých na platinu. Současný výzkum se rozšiřuje na využití inhibitorů PARP i mimo léčbu BRCA1/2 mutovaných nádorů, tj. v terapii jiných molekulárních vad, které vedou k HR-deficitním nádorům.

Ovarian cancer is among gynecological tumors the most common cause of death and the fifth in deaths among oncological diseases. In the last decade there have been significant advances in genomic mapping of tumor cells and in the knowledge of molecular mechanisms in the pathogenesis of ovarian cancer. Targeted molecular therapy starts to apply in addition to cytotoxic chemotherapy. Widely researched and promising possibility of targeted treatment of ovarian cancer are PARP inhibitors olaparib, veliparib, niraparib, rucaparib and talazoparib that are examined in monotherapy and in combination with other molecules as potential amplifiers or cytotoxic damage during chemotherapy or radiation treatment. Poly(ADP-ribose)-polymerase (PARP) inhibitors cause targeted tumour cell death in homologous recombination (HR)-deficient cancers, including gene BRCA1, BRCA2 mutated tumours, by exploiting synthetic lethality. Among the five key PARP inhibitors currently in clinical development, olaparib has undergone the most extensive clinical investigation. PARP inhibitors have demonstrated durable antitumour activity in BRCA1/2 mutated advanced ovarian cancer as a single agent in the treatment and maintenance setting, particularly in platinum sensitive disease. Current research is extending the use of PARP inhibitors beyond BRCA1/2 mutations to other sensitising molecular defects that result in HR-deficient cancer.

• Keywords
• olaparib, veliparib, rucaparib, talazoparib, niraparib, studie SOLO,
• MeSH
• Benzimidazoles therapeutic use   MeSH
• Molecular Targeted Therapy MeSH
• Hereditary Breast and Ovarian Cancer Syndrome drug therapy   MeSH
• Phthalazines administration & dosage   adverse effects   therapeutic use   MeSH
• Indazoles therapeutic use   MeSH
• Indoles therapeutic use   MeSH
• Clinical Trials, Phase II as Topic MeSH
• Clinical Trials, Phase III as Topic MeSH
• Humans MeSH
• Survival Rate MeSH
• Mutation MeSH
• Ovarian Neoplasms * drug therapy   genetics   classification   pathology   MeSH
• Poly(ADP-ribose) Polymerase Inhibitors * administration & dosage   adverse effects   therapeutic use   MeSH
• Piperazines administration & dosage   adverse effects   therapeutic use   MeSH
• Piperidines therapeutic use   MeSH
• Disease-Free Survival MeSH
• BRCA1 Protein genetics   MeSH
• BRCA2 Protein genetics   MeSH
• Antineoplastic Combined Chemotherapy Protocols therapeutic use   MeSH
• Randomized Controlled Trials as Topic MeSH
• Recurrence MeSH
• Maintenance Chemotherapy MeSH
• Check Tag
• Humans MeSH
• Female MeSH

Přehledový článek pojednává o vzniku a složitém vývoji terminologie dlaždicobuněčných prekanceróz vulvy a konsenzu Mezinárodní společnosti pro výzkum vulvovaginálních nemocí, Americké společnosti pro kolposkopii a cervikální patologii, Společnosti amerických patologů a Světové zdravotnické organizace na současné terminologii. Článek charakterizuje jednotlivé typy dlaždicobuněčných lézí, rozebírá jejich etiologii, incidenci a onkogenní potenciál.

This review article discribes the genesis and development of vulvar squamous precancerous lesions terminology and discusses the consensus of the International Society for the Study of Vulvovaginal Disease, the American Society for Colposcopy and Cervical Pathology, College of American Pathologists and the World Health Organization on the current terminology. The article describes the different types of vulvar squamous precancerous lesions, according to their etiology, incidence and malignant potential.

• MeSH
• Diagnosis, Differential MeSH
• Squamous Intraepithelial Lesions of the Cervix diagnosis   etiology   MeSH
• Humans MeSH
• Vulvar Diseases diagnosis   etiology   classification   MeSH
• Precancerous Conditions * diagnosis   epidemiology   pathology   MeSH
• Carcinoma, Squamous Cell * diagnosis   etiology   classification   MeSH
• Terminology as Topic MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Review MeSH

Jednou z nejzávažnějších komplikací resekcí rekta jsou anovaginální a rektovaginální píštěle, které se vyskytují v 0,9–10 % s letalitou 6 % až 22 %. Následné reoperace mohou zvýšit výskyt lokálních recidiv a snižují celkové přežívání pacientek. Píštěle mohou být klasifikovány podle doby vzniku, místa vzniku a podle vztahu ke staplerové linii. Nejčastější příčinou vzniku píštělí je anastomotická sepse a perianastomotická infikovaná kolekce, většinou na podkladě dehiscence anastomózy. Mezi rizikové faktory pro vznik píštělí patří anastomózy ve vzdálenosti 4-7 cm, totální mesorektální excize, chemoradioterapie, intraoperační komplikace spojené s krevní ztrátou, pokročilá stadia karcinomu rekta, nízce diferencovaný nebo mucinózní adenokarcinom. Terapie rektovaginální píštěle je obtížná, často vyžadující opakované chirurgické intervence zvyšující morbiditu pacientek a odsouvající nebo vylučující adjuvantní léčbu s dopadem na onkologické výsledky. Z těchto důvodů je důležitá zejména maximální prevence této komplikace. Pokud již tato komplikace vznikne, je nezbytné vybrat pro danou pacientku optimální léčebný postup, který by nejméně ovlivnil morbiditu pacientky a nesnížil její šanci na vyléčení.

Anovaginal and rectovaginal fistulas are among the most serious complications of rectal resection that occur in 0.9–10% with a case fatality rate of 6–22 %. Subsequent reoperations can increase the rate of local recurrence and reduce the overall survival of patients. Fistulas can be classified based on the time of origin, site of origin, and relation to the staple line. Anastomotic sepsis and infected perianastomotic collection, usually due to anastomotic dehiscence, are the most common causes of developing a fistula. The risk factors for developing fistulas include anastomoses within 4–7 cm, total mesorectal excision, chemoradiotherapy, intraoperative complications associated with blood loss, advanced stages of rectal cancer, and poorly differentiated or mucinous adenocarcinoma. The treatment of a rectovaginal fistula is challenging, frequently requiring repeated surgical interventions increasing the morbidity of patients and delaying or precluding adjuvant therapy with an impact on the oncological outcome. For these reasons, maximum prevention of this complication is particularly important. If this complication does occur, it is essential to choose an optimal therapeutic approach for the particular patient, i.e. such that would least affect the patient’s morbidity and would not reduce her chance of being cured.

• MeSH
• Chemoradiotherapy methods   utilization   MeSH
• Ileostomy methods   utilization   MeSH
• Colorectal Surgery * methods   adverse effects   MeSH
• Colorectal Neoplasms * surgery   complications   therapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Neoadjuvant Therapy methods   utilization   MeSH
• Preoperative Care methods   utilization   MeSH
• Rectovaginal Fistula * surgery   complications   therapy   MeSH
• Rectum surgery   MeSH
• Self Expandable Metallic Stents utilization   MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Review MeSH

• Keywords
• Olaparib, veliparib, studie M12-69M, studie MILO, DCVAC/OvCa,
• MeSH
• Survival Analysis MeSH
• Bevacizumab pharmacology   therapeutic use   MeSH
• Biological Therapy MeSH
• Tertiary Care Centers MeSH
• Molecular Targeted Therapy * MeSH
• Gynecologic Surgical Procedures methods   MeSH
• Antibodies, Monoclonal, Humanized MeSH
• Carboplatin pharmacology   therapeutic use   MeSH
• Carcinoma drug therapy   immunology   MeSH
• Combined Modality Therapy MeSH
• Humans MeSH
• Ovarian Neoplasms * drug therapy   surgery   MeSH
• Paclitaxel pharmacology   therapeutic use   MeSH
• Cancer Vaccines pharmacology   therapeutic use   MeSH
• Randomized Controlled Trials as Topic MeSH
• Check Tag
• Humans MeSH
• Female MeSH

• MeSH
• Adenocarcinoma MeSH
• Carcinoma, Basal Cell diagnosis   etiology   surgery   MeSH
• Surgicenters MeSH
• Diagnosis, Differential MeSH
• Adult MeSH
• Paget Disease, Extramammary diagnosis   etiology   surgery   radiotherapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Neoplasm Recurrence, Local MeSH
• Melanoma diagnosis   etiology   drug therapy   surgery   therapy   MeSH
• Vulvar Neoplasms * diagnosis   epidemiology   etiology   surgery   therapy   MeSH
• Prognosis MeSH
• Recurrence MeSH
• Sarcoma diagnosis   etiology   surgery   MeSH
• Aged MeSH
• Carcinoma, Squamous Cell diagnosis   epidemiology   surgery   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

OBJECTIVE: In this study, we aimed to describe the value of pelvic lymph node dissection (LND) after sentinel lymph node (SN) biopsy in early-stage cervical cancer. METHODS: We performed a retrospective multicenter cohort study in 8 gynecological oncology departments. In total, 645 women with International Federation of Gynecology and Obstetrics stage IA to IIB cervical cancer of squamous, adeno, or adenosquamous histologic type who underwent SN biopsy followed by pelvic LND were enrolled in this study. Radioisotope tracers and blue dye were used to localize the sentinel node, and pathologic ultrastaging was performed. RESULTS: Among the patients with low-volume disease (micrometastases and isolated tumor cells) in the sentinel node, the overall survival was significantly better (P = 0.046) if more than 16 non-SNs were removed. No such significant difference in survival was detected in patients with negative or macrometastatic sentinel nodes. CONCLUSIONS: Our findings indicate that in patients with negative or macrometastatic disease in the sentinel nodes, an additional LND did not alter survival. Conversely, our data suggest that the survival of patients with low-volume disease is improved when more than 16 additional lymph nodes are removed. If in a prospective trial our data are confirmed, we would suggest a 2-stage operation.

• MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Lymph Node Excision * MeSH
• Lymph Nodes pathology   MeSH
• Uterine Cervical Neoplasms pathology   surgery   MeSH
• Pelvis pathology   surgery   MeSH
• Survival MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

• Publication type
• Comment MeSH

AIMS: To evaluate the incidence of parametrial involvement in women with early-stage cervical cancer with tumour <20 mm and with negative sentinel lymph nodes (SLN). METHODS: We reviewed the cases of all women who underwent radical hysterectomy and pelvic lymphadenectomy with SLN biopsy for invasive cervical cancer between April 2004 and December 2009. Parametrial involvement was defined as direct extension, nodal disease or spread through vascular channels. RESULTS: From the 204 women who underwent radical surgery with SLN biopsy, 63 (FIGO stage IA2-10, IB1-53) met the inclusion criteria: tumour <20 mm in the largest diameter regardless of the depth of stromal invasion (less or more than half stromal invasion) and negative sentinel lymph nodes. Median age was 44.3 years (range 24-72). Lymph-vascular space invasion was present in 25 women. The histology identified squamous carcinoma in 50 women, adenocarcinoma in 11 women and adenosquamous carcinoma in two women. Tumour grade 1 occurred in 41, grade 2 in 16 and grade 3 in 6 of the cases. No parametrial involvement was observed. The false negative rate of SLN biopsy was 0%. CONCLUSION: No parametrial involvement was observed in women with early-stage cervical cancer with tumour <20 mm in diameter and negative sentinel lymph nodes regardless of the presence of lymph-vascular space invasion, histology subtype and grade of the tumour. Radical removal of the parametrium in this low-risk group is questionable.

• MeSH
• Adenocarcinoma secondary   surgery   MeSH
• Carcinoma, Adenosquamous secondary   surgery   MeSH
• Sentinel Lymph Node Biopsy MeSH
• Adult MeSH
• Hysterectomy MeSH
• Neoplasm Invasiveness MeSH
• Middle Aged MeSH
• Humans MeSH
• Lymphatic Metastasis MeSH
• Lymph Nodes pathology   MeSH
• Young Adult MeSH
• Uterine Cervical Neoplasms pathology   surgery   MeSH
• Pelvis MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Carcinoma, Squamous Cell secondary   surgery   MeSH
• Neoplasm Grading MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Karcinom ovaria patří mezi gynekologickými nádory k onemocněním s nejvyšší úmrtností, kdy až u 75 % pacientek dojde po léčbě k relapsu a úmrtí na toto nádorové onemocnění. První skupinou pacientek, u nichž je podezření na relaps nemoci, jsou pacientky s elevací tumorózního markeru Ca 125, u nichž v současnosti není zahájení chemoterapie doporučováno. U pacientek s klinicky nebo radiologicky prokázanou recidivou nemoci je nejvýznamnějším faktorem časový interval mezi ukončením chemoterapie 1. linie a objevením se recidivy nemoci. Za platina-rezistentní je považována nemoc s progresí do 6 měsíců po ukončení léčby. Sem patří taktéž primárně refrakterní nemoc, situace, kdy k progresi nádorového onemocnění dojde během cytostatické léčby 1. linie, nebo situace, kdy nádor není léčbou ovlivněn. Při progresi nemoci později než za 6 měsíců je onemocnění považováno za platina-senzitivní. Léčebný záměr při aplikaci chemoterapie při relapsu nemoci je, s výjimkou zařazení chirurgické intervence s kompletním odstraněním metastatických ložisek, paliativní, jeho cílem je prodloužení intervalu bez nemoci (disease-free interval, DFI) a prodloužení celkového přežití (overall survival, OS) – s oddálením symptomů nemoci a zvýšením kvality života.

Ovarian cancer is one of the gynaecological malignancies with the highest mortality rates, with up to 75% of post-treatment recurrences, often fatal. Recurrent ovarian cancer is suspected in patients with an elevated tumor marker Ca 125. In this group, chemotherapy is not currently recommended. In patients clinically or radioloqicallv diagnosed with recurrent ovarian cancer, the most important factor is tne from the end of the first-line chemotherapy to the emergence of recurrence. Disease progressive within six months from the end of Chemotherapy Is classified as platinum resistant. Primary refractory disease, i.e. disease progressive during first-line chemotherapy or unresponsive to first-line chemotherapy, is also considered as such. Disease progressive within more than six months after chemotherapy is platinum sensitive. The therapeutic goal in recurrent ovarian cancer, apart from surgical intervention to completely remove metastatic tumors, is palliative care aiming at prolonging the disease free interval (DFI) and overall survival (OS) - i.e. delaying symptoms and improving the quality of life. The second-line non-platinum based chemotherapy is recommended in platinum-refractory or platinum-resistant disease. Platinum based chemotherapy should be used in platinum-sensitive disease, mostly in combination with another cytostatic drug the choice of which depends on the spectrum of adverse effects. In patients who had run out of chemotherapy options, hormone therapy which has anti-estrogenic, anti-prollferative effects may be recommended. A novel approach in recurrent ovarian cancer is targeted molecular therapy to inhibit angiogenesis as the prerequisite for tumor progression. Patients with ovarian cancer should be treated in comprehensive cancer centres to benefit from access to both highly skilled cancer surgeons who are able to achieve radical tumor removal with no tumor residues and leading clinical oncologists who can tailor the therapy to the individual needs of patients, taking into account the available therapeutic modalities, achievable therapeuticoutcomes, and quality of life.

• Keywords
• chemoterapie, cílená molekulární léčba,
• MeSH
• CA-125 Antigen blood   MeSH
• Bevacizumab MeSH
• Time Factors MeSH
• Molecular Targeted Therapy methods   MeSH
• Antineoplastic Agents, Hormonal therapeutic use   MeSH
• Angiogenesis Inhibitors therapeutic use   MeSH
• Humans MeSH
• Antibodies, Monoclonal therapeutic use   MeSH
• Ovarian Neoplasms drug therapy   MeSH
• Palliative Care methods   MeSH
• Platinum administration & dosage   therapeutic use   MeSH
• Disease-Free Survival MeSH
• Prognosis MeSH
• Disease Progression MeSH
• Antineoplastic Agents adverse effects   therapeutic use   MeSH
• Antineoplastic Combined Chemotherapy Protocols administration & dosage   pharmacology   therapeutic use   MeSH
• Recurrence MeSH
• Risk Factors MeSH
• Vascular Endothelial Growth Factor A MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Review MeSH