• Publikační typ
• abstrakt z konference MeSH

Transcatheter aortic valve replacement (TAVR) is a minimally invasive therapeutic procedure with a consistent, linear increase in the number of implantations worldwide. Recently, TAVR has been rapidly expanding into lower-risk populations. Sporadic cases of late prosthesis-related Stanford type A dissection have been documented in self-expanding, as well as balloon-expandable TAVR valves, manifested primarily as acute aortic syndrome. We present the case of a 76-year-old male, who experienced refractory in-hospital cardiac arrest with non-shockable rhythm due to the obstruction of coronary flow caused by aortic dissection type A, with entry directly adjacent to the aortic prosthesis according to autopsy. The patient died despite the engagement of extracorporeal cardiopulmonary resuscitation. Aortic dissection developed one year after a transfemoral TAVR procedure using an Edwards SAPIEN 3 29 mm self-expanding valve. TAVR-associated late aortic dissection type A represents a rare, life-threatening condition with various clinical manifestations. The risk factors have not been well described and the differential diagnosis may be challenging. As the number of TAVR recipients and their life expectancy is increasing, we may face this complication more often in future.

• Publikační typ
• kazuistiky MeSH

BACKGROUND: The latest WHO classification of tumours of endocrine organs defines new units of borderline thyroid tumours (BTT). The aim of our study was to evaluate ultrasonographic and cytological features, mutation profile and surgery treatment in rare thyroid tumours. METHODS: An analysis of 8 BTT out of 487 patients, who underwent thyroid surgery between June 2016 and June 2020. The definitive diagnosis was made postoperatively by extensive histopathological examination. Molecular genetic analysis of genes associated with thyroid oncology (BRAF, HRAS, KRAS, NRAS, TERT, TP53, fused genes) were performed from one FNAB, and 7 formalin-fixed paraffin-embedded (FFPE) samples. RESULTS: BTT were found in a total of 8 patients (1.6%), with a predominance of men with respect to other operated patients. FNAB samples were classified in the Bethesda system as Bethesda I, Bethesda II and Bethesda III in one, four and three cases, respectively. Hemithyroidectomy and total thyroidectomy were performed equally in four patients. The histopathological diagnosis revealed non-invasive encapsulated follicular neoplasm with papillary-like nuclear features (NIFTP) in three patients, follicular tumour of uncertain malignant potential (FT-UMP) in three patients, well differentiated tumour of uncertain malignant potential (WDT-UMP) in one patient, and hyalinizing trabecular tumour (HTT) in one case. In NIFTP cases mutation in HRAS gene in one patient together with probable pathogenic variant in TP53 gene and in NRAS gene in two patients were detected. In HTT patient PAX8/GLIS3 fusion gene was detected. CONCLUSION: The surgical treatment of BTT is necessarily individual influenced by preoperative clinical, ultrasonographic, cytological and molecular genetic findings, and the presence of other comorbidities.

• MeSH
• folikulární adenokarcinom * patologie   MeSH
• lidé MeSH
• nádory štítné žlázy * genetika   chirurgie   patologie   MeSH
• tyreoidektomie MeSH
• uridinmonofosfát MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Brain metastases are a very common and serious complication of oncological diseases. Despite the vast progress in multimodality treatment, brain metastases significantly decrease the quality of life and prognosis of patients. Therefore, identifying new targets in the microenvironment of brain metastases is desirable. Fibroblast activation protein (FAP) is a transmembrane serine protease typically expressed in tumour-associated stromal cells. Due to its characteristic presence in the tumour microenvironment, FAP represents an attractive theranostic target in oncology. However, there is little information on FAP expression in brain metastases. In this study, we quantified FAP expression in samples of brain metastases of various primary origin and characterised FAP-expressing cells. We have shown that FAP expression is significantly higher in brain metastases in comparison to non-tumorous brain tissues, both at the protein and enzymatic activity levels. FAP immunopositivity was localised in regions rich in collagen and containing blood vessels. We have further shown that FAP is predominantly confined to stromal cells expressing markers typical of cancer-associated fibroblasts (CAFs). We have also observed FAP immunopositivity on tumour cells in a portion of brain metastases, mainly originating from melanoma, lung, breast, and renal cancer, and sarcoma. There were no significant differences in the quantity of FAP protein, enzymatic activity, and FAP+ stromal cells among brain metastasis samples of various origins, suggesting that there is no association of FAP expression and/or presence of FAP+ stromal cells with the histological type of brain metastases. In summary, we are the first to establish the expression of FAP and characterise FAP-expressing cells in the microenvironment of brain metastases. The frequent upregulation of FAP and its presence on both stromal and tumour cells support the use of FAP as a promising theranostic target in brain metastases.

• MeSH
• fibroblasty patologie   MeSH
• individualizovaná medicína MeSH
• karcinom z renálních buněk * patologie   MeSH
• kvalita života MeSH
• lidé MeSH
• membránové proteiny metabolismus   MeSH
• nádorové mikroprostředí MeSH
• nádory ledvin * patologie   MeSH
• nádory mozku * patologie   MeSH
• serinové endopeptidasy metabolismus   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference MeSH

Calcifying pseudoneoplasm of neuroaxis (CAPNON) is a rare lesion of the central nervous system with uncertain histogenesis. We further explored phenotypic spectrum of the entity with respect to possible histogenesis. We collected 5 cases of CAPNONs, performed a detailed morphological assessment, and performed an extensive immunohistochemical analysis (EMA, progesterone receptors, MUC4, SSTR2A, cytokeratin AE1/3, cytokeratin 18, GFAP, neurofilaments, desmin, nestin, synaptophysin, S100 protein, SOX10, CD56, Podoplanin, SATB2, ERG, CD45, and CD163) to elucidate the histogenesis. Furthermore, we performed NGS analysis of one case. The clinical course was benign in all cases. All lesions showed extensively calcified matrix in multilobular arrangement, with a palisade of osteoblast-like cells. Characteristic fibrohyaline matrix was notable in 4/5 cases, while one case was myxoid with rod-like calcifications. Metaplastic lamellar bone was present in 4/5 cases and psammoma bodies were present in 2/5 cases. In 4/5 cases, areas of entrapped glial tissue were present. Expression of EMA was focally present in 3/5 cases, SSTR2A and nestin in 2/5 cases, and progesterone receptor in 2/5 cases in rare cells. We did not observe concomitant expression of EMA, SSTR2A, and progesterone receptor in the same cellular subsets. In one case, NGS showed multiple chromosomal alterations and missense mutation in PIK3CA, attributable to the admixed meningothelial population compatible with meningioma. In another case, biphasic proliferation with myoepithelial phenotype was present. The lesions showed no lineage-specific immunoprofile. Additional pathology was identified in two cases, furthermore suggestive of a possible reactive origin of the lesion.

• MeSH
• kalcinóza * patologie   MeSH
• lidé MeSH
• meningeální nádory * MeSH
• meningeom * MeSH
• nestin MeSH
• receptory progesteronu MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: The prognosis of glioblastoma remains unfavorable. TTFields utilize low intensity electric fields (frequency 150-300 kHz) that disrupt cellular processes critical for cancer cell viability and tumor progression. TTFields are delivered via transducer arrays placed on the patients' scalp. Methods: Between the years 2004 and 2022, 55 patients (20 female), aged 21.9-77.8 years (mean age 47.3±11.8 years; median 47.6 years) were treated with TTFields for newly-diagnosed GBM, and compared to 54 control patients (20 females), aged 27.0-76.7 years (mean age 51.4±12.2 years; median 51.7 years) (p=0.08). All patients underwent gross total or partial resection of GBM. One patient had biopsy only. When available, MGMT promoter methylation status and IDH mutation was detected. RESULTS: Patients on TTFields therapy demonstrated improvements in PFS and OS relative to controls (hazard ratio: 0.64, p=0.031; and 0.61, p=0.028 respectively). TTFields average time on therapy was 74.8% (median 82%): median PFS of these patients was 19.75 months. Seven patients with TTFields usage ≤60% (23-60%, mean 46.3%, median 53%) had a median PFS of 7.95 months (p=0.0356). Control patients with no TTFields exposure had a median PFS of 12.45 months. Median OS of TTF patients was 31.67 months compared to 24.80 months for controls. DISCUSSION: This is the most extensive study on newly-diagnosed GBM patients treated with TTFields, covering a period of 18 years at a single center and presenting not only data from clinical trials but also a group of 36 patients treated with TTFields as a part of routine clinical practice.

• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference MeSH

Srdeční angiosarkom je nejčastější primární maligní tumor srdce u dospělých. Vzhledem k často nespecifickému klinickému obrazu bývá odhalení angiosarkomu pozdní. Zásadní roli v diagnostice má echokardiografie a bioptické vyšetření; k ověření generalizace a stanovení dalšího postupu se využívá výpočetní tomografie (CT) a pozitronová emisní tomografie (PET). Samotné možnosti léčby (chirurgická resekce, chemoterapie a radioterapie, případně ortotopická transplantace) jsou limitované a mají nejistý efekt na prodloužení doby přežití. Strategie léčby není dosud jasně určena a je založena spíše na kazuistických zkušenostech. V naší kazuistice se věnujeme 52letému muži, který byl na našem pracovišti vyšetřen pro palpitace, tlakovou bolest na hrudi a krátký prekolapsový stav. Iniciálně byla zjištěna setrvalá úzkokomplexová tachykardie s frekvencí 220/min. V rámci přípravy ke katetrizační ablaci arytmie byla provedena CT angiografie plicních žil s vedlejším nálezem intrakardiálně uloženého tumoru, který byl dle jícnové echokardiografie a bioptického vyšetření verifikován jako primární srdeční angiosarkom. Indikováno bylo radikální chirurgické řešení s následnou chemoterapií v kombinaci s biologickou léčbou. Dle PET vyšetření došlo po osmi měsících od chirurgického výkonu k relapsu nádorové aktivity a následnému úmrtí nemocného 16 měsíců od primární diagnostiky onemocnění.

Cardiac angiosarcoma is the most common primary malignant cardiac tumor in adults. Due to nonspecific clinical symptoms its diagnosis is often late. A key role in diagnosis plays echocardiography and the cardiac biopsy; computed tomography and positron emission tomography (PET) can help in determining the presence of metastasis and the treatment strategy. Available methods of treatment are limited and based solely on individual case reports – surgical excision, chemotherapy, radiotherapy, or orthotopic heart transplantation have uncertain effect on survival. In this presented case, we report of a 52-year-old male who was admitted for palpitations, chest pain, and brief presyncope. Initially, a narrow complex tachycardia 220/min was recorded and a catheter ablation scheduled. However, an intracardiac tumor mass was revealed by CT angiogram and later verified as a primary cardiac angiosarcoma by transoesophageal echocardiography and biopsy. The patient underwent a radical surgical resection with subsequent chemotherapy and biological therapy. Unfortunately, in 8 months a relapse was discovered by PET and the patient died 16 months after the primary diagnosis.

• MeSH
• amiodaron aplikace a dávkování   MeSH
• biopsie MeSH
• bolesti na hrudi etiologie   MeSH
• cévní mozková příhoda MeSH
• CT angiografie MeSH
• echokardiografie transezofageální MeSH
• echokardiografie MeSH
• edém MeSH
• fatální výsledek MeSH
• hemangiosarkom * chirurgie   diagnostické zobrazování   farmakoterapie   krevní zásobení   patologie   MeSH
• histologické techniky MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory srdce * chirurgie   diagnostické zobrazování   farmakoterapie   krevní zásobení   patologie   MeSH
• neúspěšná terapie MeSH
• PET/CT MeSH
• pleurální výpotek MeSH
• plíce diagnostické zobrazování   patologie   MeSH
• progrese nemoci MeSH
• recidiva MeSH
• srdeční síně patologie   MeSH
• tachykardie etiologie   MeSH
• vena cava inferior chirurgie   patologie   MeSH
• venae pulmonales diagnostické zobrazování   patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Schwannom je benigní, pomalu rostoucí nádor, který vyrůstá ze Schwannových buněk, myelinové pochvy axonů periferních, hlavových a autonomních nervů. Prezentujeme případ 63leté pacientky s nodózní štítnou žlázou, která byla doporučena k ORL vyšetření pro objemnou rezistenci na pravé straně krku se známkami impresivního syndromu. Na základě klinického vyšetření a nálezu zobrazovacích metod (UZ, CT, MR) bylo indikováno operační odstranění tumoru a totální tyreoidektomie. Pooperační histologie prokázala schwannom, nejspíše z větve krčního plexu, a makro-normofolikulární koloidně nodózní strumu s ložisky chronické tyroiditidy.

Schwannoma is a benign, slowly growing tumour arising from Schwann cells, i.e. myelin sheath of axons of peripheral, cranial and autonomous nerves. We present the case report of a 63-year-old patient with a nodose thyroid gland who was referred to ENT testing for a large mass on the right side of her neck with signs and symptoms of impression syndrome. The surgical removal of tumour and total thyroidectomy was indicated based on clinical examination and imaging methods (ultrasonography, CT, MRI). Postoperative histology proved schwannoma, most probably originating from a branch of cervical plexus, and macro-normo-follicular colloid nodose goiter with foci of chronic thyroiditis.

• MeSH
• nádory mediastina diagnóza   chirurgie   patologie   MeSH
• nádory nervového systému diagnóza   chirurgie   patologie   MeSH
• nádory štítné žlázy * chirurgie   patologie   sekundární   MeSH
• nemoci štítné žlázy MeSH
• neurilemom MeSH
• senioři MeSH
• štítná žláza chirurgie   patologie   MeSH
• uzlová struma chirurgie   MeSH
• uzly štítné žlázy MeSH
• Check Tag
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH