Search

Background: Persistent alpha-fetoprotein elevation in a patient following orchiectomy and chemotherapy for non-seminomatous testicular germ cell tumor is a rare condition when persistence of the tumor and false positivity of tumor marker elevation has to be differentiated. This situation often leads to over-treatment and potential toxicity with adverse events which can be severe., Case: A case of a patient with the abovementioned disease and course of treatment is presented. As no radiological signs of the disease were present and the level of alpha-fetoprotein was mild and stable, the tumor marker elevation was evaluated as false positive. Possible causes of the tumor marker elevation were identified as other serious diseases are known to cause such a false positivity. The level of alpha-fetoprotein remained unchanged despite alcohol abstinence and hepatoprotective treatment by silymarin. Hepatitis B and C serological tests were negative, and no other malignant tumor was identified. Finding of terminal ileum circular wall thickening and stratification with a reaction of surrounding visceral fat and lymph nodes persisting in CT scans suggests the presence of inflammatory bowel disease, possibly explaining the alpha-fetoprotein elevation. The patient has no evidence of the disease more than 14 months after the end of chemotherapy treatment with no change in the elevation of alpha-fetoprotein., Conclusion: After the treatment, when no other indication of testicular cancer than an elevated alpha-fetoprotein level is present, the patient should be managed by ongoing surveillance.

Introduction and Aim: Survival of germ cell testicular cancer (TC) patients is better than for other malignancies and has not yet been exactly studied in the Slovak Republic. The aim of the study, based on the analyses of epidemiological data over time, was to present 5-year survival trends for germ cell TC patients., Patients and Methods: Survival is assessed within the framework of a nation-wide retroprospective study among TC patients newly diagnosed between 1993-2007 (divided to three 5-year periods according the time of diagnosis - 1993-1997, 1998-2002 and 2003-2007). Standardized 5-year survival rates were calculated and compared between the periods using a widely accepted methodology. TC patients were divided into two groups (seminomas and non-seminomas histopathologically) and to two groups according the age at diagnosis (< 40 vs. 40 years). The demographic characteristics of TC patients were analyzed using descriptive statistics. Statistical analysis was carried out using Microsoft Excel 2013, statistical software STATISTICA and Joinpoint Regression Programe, Version 4.3.1.0., Results: Five-year survival of TC patients (n = 2.748) diagnosed from 1993 to 2007 was 92.21%. TC patients diagnosed between 1993 and 1997 (n = 810) reached 5-year survival at 91.23%, between years 1998 and 2002 (n = 916) at 92.14% and between years 2003 and 2007 (n = 1.022) at 93.05%. There was not a statistically significant difference in survival among these three 5-year periods. Significant difference in 5-year survival was observed between seminomas and non-seminomas in each 5-year period. Compared with younger patients (age < 40 years), there was a significantly worse survival for TC patients (age 40 years) in all groups., Conclusion: Moderate improvement in survival for TC patients in the Slovak Republic is probably influenced by diagnostic and therapeutic progress, including multidisciplinary care and patients concentration in specialized centers. The long-term follow-up of TC survivors can also help to prevent late side effects of the treatment modalities and to detect second malignancies.Key words: testicular cancer - seminoma - non-seminoma - age at diagnosis - survival.

Paratesticular malignant mesothelioma is an extremely rare type of mesothelioma with only a limited number of reported cases. Its clinical differentiation is challenging, and its diagnosis is almost exclusively accidental. The major risk factor is exposure to asbestos, typically with a long latency between exposure and diagnosis. The current study presents the clinical data of two patients diagnosed with paratesticular malignant mesothelioma. We evaluated a large spectrum of risk factors in the patients histories. The histomorphological and immunohistochemical characteristics were analysed and put into the perspective of a broad differential diagnosis. Both cases of malignant epithelial mesothelioma of the tunica vaginalis testis clinically presented as unilateral hydroceles. Patients underwent surgery with the perioperative finding of a tumour. Radical inguinal orchiectomy was the treatment of choice for both patients. After comprehensive staging, the second patient underwent a second step of inguinal and pelvic lymph node dis- section. Follow-up visits revealed recurrence of the disease in the first patient. Resection of the tumour was performed. The histology confirmed the relapse of a tumour with identical features to those of the first tumour. Chemotherapy and radiotherapy were not indicated. Both patients are currently in complete remission. In conclusion, surgical treatment had a determinative role in the prognosis of these patients. Radical orchiectomy is the treatment of choice for localized disease. Lymph node dissection can be considered in the case of lymph node enlargement. There is a lack of evidence-based data for adjuvant chemotherapy and radiotherapy. Patients should be referred to experienced multidisciplinary cancer centres for a second opinion on histology, treatment, and a follow-up plan.Key words: mesothelioma - tunica vaginalis testis - hydrocele - asbestos exposure.

Surveillance after orchiectomy alone has become popular in the management of clinical stage I of nonseminomatous germ cell testicular tumors (CSI NSGCTT). Efforts to identify patients at high-risk of relapse led to a search for risk factors in CSI NSGCTT. The aim of the current study was to analyze longterm experiences with risk-adapted therapeutic approaches (active surveillance and adjuvant chemotherapy). From 1/ 1992 to 2/ 2015, a total of 454 CSI NSGCTT patients were included in the study and stratified into two groups according to risk-adapted therapeutic approaches. In Group A (low- risk CSI NSGCTT), which consisted of 287 patients who underwent surveillance, relapse occurred in 48 (16.7%) patients with a median followup of 7.0 months. Six patients (2.1%) of this group died with a median followup of 34.3 months. In Group B (high-risk CSI NSGCTT), which consisted of 167 patients who were treated with adjuvant chemotherapy, relapse occurred in two (1.2%) patients with a median followup of 56.2 months. One patient (0.6%) died 139.4 months following orchiectomy. Statistically significant difference in progression free survival between these two groups was found, but no significant difference in overall survival.Key words: testicular cancer -  surveillance -  adjuvant chemotherapy -  disease progression.

Background: Malignant mesothelioma is a neoplasm arising in serosal membranes in the body cavities. Usual presentation of the tumor is in the pleura, peritoneum and less frequently pericardium. Paratesticular mesothelioma is the rarest known form of malignant mesothelioma with only a limited number of reported cases., Case: A case of malignant epithelial mesothelioma of the tunica vaginalis testis was reported with presentation of hydrocele and multinodular intrascrotal masses in a 20-year old male. The patient underwent surgery for post-traumatic long-term hydrocele with perioperative discovery of multiple small exophytic structures. After histological findings of the malignant mesothelioma of tunica vaginalis testis, he underwent left-side orchiectomy, followed by inguinal and pelvic lymph node dissection. Clinical staging did not reveal distant metastases. Regular follow-up visits based on physical examinations and imaging studies are to date negative for recurrence., Conclusion: Literature data were reviewed, and possible risk factors for the development of the neoplasm were analysed.

HPV infections of the lower genital tract are associated with the increasing incidence of vulvar intraepithelial neoplasia. The new classification divides vulvar intraepithelial neoplasia according to its incidence into two groups: usual and differentiated type. The usual type occurs mainly in young women and is associated with HPV infection, the differentiated type is HPV-negative and occurs in older women. The diagnosis is based on biopsy from a suspicious lesion. The standard treatment involves surgical excision. Topical treatment is now being preferred in young women in order to preserve appearance of the genitalia and sexual function. The high risk of recurrence is the reason for strict monitoring of patients after treatment completion.

Backgrounds: Angiomyofibroblastoma (AMFB) is a rare histopathologic finding of the female lower genital tract. This tumor belongs to the group of mesenchymal tumors. Mesenchymal neoplasms of the modified genital skin and mucosa are uncommon. The majority of these lesions are seen in females and, collectively, they form a family of vulvovaginal soft tissue tumors. This family includes fibroepithelial stromal polyps, angiomyofibroblastoma, cellular angiofibroma, aggressive angiomyxoma, vaginocervical myofibroblastoma, vulvar leiomyomatosis, and other smooth muscle tumors. Angiomyofibroblastoma is a benign tumor, histologically very similar to pelvic aggressive angiomyxoma (AMM), a distinctive, locally infiltrative but non-metastasizing mesenchymal neoplasm with a tendency to occur in the female pelvic and perineal regions., Case: 44 years old woman with angiomyofibroblastoma of cervix uteri., Conclusion: A recognition of this entity is important to avoid misdiagnosis of other angiomyxoid neoplasms. Furthermore, unlike other, more aggressive, mesenchymal tumors of the lower genital tract, AMFB shows benign behaviour.

Backgrounds: This paper analyzes the incidence and mortality of prostate cancer in the Slovak (SR) and Czech (CR) Republics (as Central European countries with population-based cancer registries) before and after the introduction of PSA testing, the possible reasons for any differences disclosed, and compares the results with selected regions and countries around the world., Material, Methods and Results: In SR, the age-adjusted incidence of prostate cancer rose from 14.6/100,000 in 1968 to 36.2/100,000 in 2005. The estimated annual increase of incidence from 1968 to 1991 (before nation-wide PSA testing) was 0.421 and 1991-2003 it reached 0.941. The mortality rates rose from 7.3/100,000 in 1968 to 14.9/100,000 in 2005. The increase in incidence occurred faster in CR than in SR, from 15.8/100,000 in 1977 to 59.5/100,000 in 2005. The estimated annual increase of incidence in CR in 1977-1991 was 0.581,while in 1991-2003 it reached 1.981. Before 1991, mortality rose more sharply in CR than in SR while after the introduction of PSA testing mortality stabilized more quickly in the CR than in SR. In SR a significant reduction of mortality was observed after 2002 and is probably affected by more factors than those associated with the increase in PSA testing., Conclusion: The difference in the incidence and mortality of prostate cancer in SR and in CR results from a difference in the intensity of PSA testing as well as from the earlier introduction of effective treatment in CR.

Backgrounds: Even though the incidence and mortality from stomach cancer declined dramatically, it remains the third most frequent cancer worldwide. This study analysed the incidence and resulting mortality, and possible reasons for any differences identified between the Slovak Republic and other countries., Material and Methods: Analysis of national data covering the period from 1968 to 2006. Trends have been estimated using linear regression model and are presented with corresponding 95% Confidence Intervals (CI) and p-values with null hypothesis being constant in time., Results: In 2006, standardized incidence index for stomach cancer in Slovak males (related to 1968) declined by 0.28, annual percentage change was -3.2% and the average decrease of standardized incidence represented -0.956/100,000 (95% CI -1.059 to -0.853, p <0.0001). The incidence in men had statistically significantly more rapidly declining tendency in the first half of the analyzed period (1968-1986). Decrease in the mortality index was 0.32 with annual percentage change of -2.9% and the mean decrease in standardized mortality of -0.691/100,000 (95% CI -0.750 to -0.632, p < 0.0001). In 2006, the standardized incidence index for stomach cancer in Slovak females (related to 1968) declined by 0.23, annual percentage change was -3.7% and the mean decrease in standardized incidence was -0.491/100,000 (95% CI -0.554 to -0.428, p < 0.0001), the decline in incidence was more pronounced in the first half of the analyzed period. The mortality index (1968-2006) declined by 0.26, annual percentage change was -3.4% and annual decrement of standardized mortality represented -0.367/100,000 (95% CI -0.407 to -0.326, p < 0.0001). Only a non-significant change was identified for the proportions of the individual stomach cancer clinical stages with high proportion of clinical stages III and IV in both sexes., Conclusion: Decline in the incidence and mortality appears to be decelerating, intervention in primary prevention is essential.

Backgrounds: Treatment of recurrent ovarian cancer is not standardized. Pre-clinical tests have confirmed the synergistic effect of gemcitabine and platinum, which can break through drug resistance to platinum. Therefore, efficacy of a combined gemcitabine and platinum-based regimen can be expected not only in therapy platinum-sensitive but also in platinum-resistant disease. Surgery--so-called secondary (eventually tertiary) cytoreductive surgery, should be considered in recurrent disease before planning the chemotherapy., Patients and Methods: This is a retrospective analysis of 58 patients with recurrent ovarian cancer treated with a gemcitabine and platinum-based regimen (GP) as the second or third-line chemotherapy. Some of the patients underwent secondary cytoreductive surgery before starting the systemic treatment. The aim of the study was to detect the response rate, progression-free survival and overall survival in the whole group of patients and in subgroups with platinum-sensitive and platinum-resistant disease. Another aim was to detect the correlation between secondary cytoreductive surgery and the efficacy of chemotherapy., Results: Systemic treatment (GP) has helped to achieve a response rate of 53.5%, with time to progression 10 months and overall survival 23.5 months. A better response rate, progression free survival and overall survival were achieved in the group of patients with platinum-sensitive disease compared to patients with platinum-resistant disease, but this difference was not statistically significant. 20 patients underwent effective secondary cytoreductive surgery before the systemic treatment. Patients who underwent effective secondary cytoreductive surgery had a statistically better response rate (RR: 80% vs 39.5%), longer progression-free survival (PFS: 13.5 m vs 9 m, p = 0.006) and longer overall survival (OS: 40 m vs 16.9 m, p = 0.006) when compared to patients without secondary cytoreductive surgery., Conclusion: We have confirmed the efficacy of a gemcitabine and platinum-based regimen in the therapy of recurrent ovarian cancer, in both platinum-sensitive and platinum-resistant disease. An important prognostic factor in the whole group of patients was the realization of effective secondary cytoreductive surgery.

Disseminated malignancies are responsible for the majority of cancer-related deaths. During the metastatic process, circulating tumour cells (CTCs) are generated. The presence of CTCs, epithelial cells found in the peripheral blood, is an essential step in establishing distant metastases. Circulating epithelial cells have the morphology of malignant cells and their number in the blood correlates with tumour burden. To identify CTCs in peripheral blood, two major approaches are used involving additional antibodies and nucleic acid-based techniques. Tumour cells with HER-2 overexpression are frequently resistant to cytotoxic drugs and radiotherapy. Wider clinical application of the detection of minimal residual disease is partly limited by the lack of standardized methods for detection. Recent studies suggest that in addition to the prognostic significance of tumour cells, determination of CTCs may be important in therapy monitoring or as potential targets for targeted therapy. Persistence of minimal residual disease after primary treatment may be an indication for extensive adjuvant treatment in order to prevent relapse of the disease. Detection of CTCs and the use of prognostic markers such as HER-2 overexpression may help us to better understand the biology and clinical significance of the presence of CTCs in breast cancer patients.

Backgrounds: Primary debulking surgery and chemotherapy (paclitaxel and carboplatin) remain the standard treatment for advanced ovarian cancer. The size of the residual tumour after primary debulking surgery has proved to be an important prognostic determinant. Complete tumour debulking without any macroscopic residual disease is considered the optimal primary debulking surgery. It is not possible to perform such an aggressive operation in patients with advanced ovarian cancer due to the bad performance status and extensive disease. Neo-adjuvant chemotherapy and interval debulking surgery seem to be an effective treatment strategy in this group of patients., Material and Methods: The retrospective analysis evaluated the efficiency of interval debulking surgery in correlation with progression-free and overall survival in patients with advanced ovarian cancer. 38 patients were treated with standard chemotherapy: paclitaxel 175 mg/m2 and carboplatin 5-6 AUC every three weeks. According to the clinical response, surgical debulking was considered, after which postoperative chemotherapy was given. Ineligible patients for interval debulking were treated with 2nd line chemotherapy., Results: After neo-adjuvant chemotherapy, 24 patients of the group of 38 achieved partial remission and interval debulking surgery was indicated. Optimal interval debulking surgery was performed in 12 patients, suboptimal debulking surgery in 12 patients. Of the entire group, 14 patients did not show any adequate response to the primary treatment, they did not have interval debulking surgery indicated and they were treated with 2nd line chemotherapy. Progression-free survival in patients after optimal debulking was 11 months, median overall survival was not achieved (OS > 42.5 months). Progression-free survival in patients after suboptimal debulking was 6 months and median overall survival was 33 months. Median overall survival in patients without surgical treatment was 21.5 months., Conclusion: The results of the study confirm that neo-adjuvant chemotherapy with subsequent interval debulking surgery is a suitable therapeutic approach in primary inoperable patients with advanced ovarian cancer.

Background: Testicular cancer (TC) is quite a rare malignancy, however, its medical importance has risen due to the rapid growth in incidence in the last three decades. Age-adjusted mortality rates have fallen within the space of 20 years., Patients and Methods: A national retrospective descriptive study evaluated the data of 1,805 patients with 1,832 TC diagnosed in Slovakia from 1993 to 2002. Patients and medical questionnaires, case histories, clinical symptoms and objective parameters in all cases of TC were analyzed., Results: The average age-adjusted incidence (to the world-standard population) (1993-2002) was 6.2/100,000; mortality 0.5/100,000 of males. When comparing the risk factors between the group of patients with bilateral and unilateral TC, the most frequent risk factor was inguinal hernia (8.6%, p = 0.0026). 3% of patients developed a bilateral TC. Metachronous tumors were found in 70.4% of patients with bilateralTC. The average age at diagnosis of the first tumor in patients with bilateral TC was 27.5 years (p = 0.001); most of them (55%) were diagnosed between the age of 20-29 years. The average age of patients with unilateral TC was 34 years. 8 patients presented with a synchronous bilateral tumor, 47 patients had a second tumor diagnosed 2-302 months after primary orchiectomy. In the case of seminomas, the time interval between the first and second tumor was 85 months, while for nonseminomatous tumors, the same interval was 72 months (a statistically insignificant difference).The median follow-up time of patients with TC was 112.5 months (range of 7-342 months), five-year survival was 96.2%., Conclusion: Further studies of the epidemiologic characteristics of TC are inevitable in order to define the risk factors of the disease and the possibilities of timely therapeutical intervention.

Background: Lung metastasectomy as a treatment option in pulmonary metastases has been discussed for a long time.Testicular cancer belongs to a group of tumours primarily treated with chemotherapy because of the high efficacy of anticancer chemotherapy. Surgical treatment plays only a secondary role in the removal of residual pulmonary metastases. Decision-making in the treatment of pulmonary metastases requires histological investigation.The aim of this prospective clinical study is to evaluate 20 years of experience with the surgical treatment of pulmonary metastases in germ-cell testicular cancer., Patients and Methods: In the period 1988-2008, 63 patients were surgically treated for residual pulmonary metastases of testicular germ-cell tumours. All of the patients were indicated for surgery--pulmonary metastasectomy after the anticancer chemotherapy had been carried out.The survival rate of patients was evaluated according to the Kaplan-Meier method., Results: In total, 57 thoracotomies and 27 sternotomies were performed. 9 patients underwent repeated thoracotomy due to recurrent metastases. In the case of primary resection of pulmonary metastases, minor procedures dominated--atypical partial resections were performed in 84% of all patients. Postoperative mortality was 1.2%. The histological result of metastasis determined a further procedure. Patients in whom vital tumorous tissue was detected (16% of patients) were subsequently treated by second-line chemotherapy, while the rest of the patients were strictly followed-up. In long-term survival, where the mean duration of follow-up was 8.9 years, an almost 60% remission rate was achieved., Conclusion: Based on the long-term results, the authors consider surgical treatment of pulmonary metastases of testicular germ-cell tumours as the treatment fully indicated.