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Primary adrenal leiomyosarcomas are very rare adrenal mesenchymal tumours, only few dozen has been reported in the English language literature so far. We present two cases of patients with primary adrenal leiomyoosarcomas. 80 year-old female admitted with left adrenal tumour with presumptive diagnosis of nonadenoma, laparoscopic adrenalectomy was performed and 85 year-old man who underwent surgical resection by laparotomy of adrenal tumour suspected for adrenal carcinoma. Native density on unenhanced CT was 30 (HU) and 28 (HU) respectively and absolute and relative contrast washout was non-characteristic. Pathologic report reviled thinly encapsulated tumours composed of neoplastic cells with strong cytoplasmic reactivity for smooth muscle actin, desmin and vimentin. Male patient 20 months after surgery was diagnosed with multiple nonresectable metastases, systemic treatment was introduced. Female patient 28 months after surgery has no signs and symptoms of recurrence. We describe the clinical course and a brief review of clinical and histological features , biologic behaviour and diagnostic and therapeutic strategies. The extremely rare occurrence of primary adrenal leiomyosarcoma and a scientific literature based on single cases present challenges in establishing any firm conclusions on management and prognosis. Obviously it's impossible to have proper diagnosis based on clinical symptoms and diagnostic imaging. Radical surgery with free margins seems to be treatment of choice., (© 2018 MEDPRESS.)

Adrenal ganglioneuroma is a rare benign neuroblastic tumor. Most of adrenal ganglioneuromas are asymptomatic and discovered incidentally during imaging examinations performed for many different indications. Proper preoperative diagnosis is challenging and most of this masses are described as being poor lipid adenomas or pheochromocytomas., Aim: The aim of the study was to present experience of referral center with this rare adrenal pathologies., Materials and Methods: Analysis of our data - 374 adrenalectomies performed over last 13 years (2004-2016) in patients referred to our department from different endocrinological centers. Date of all patients were reviewed retrospectively in order to focus on adrenal ganlioneuroma., Results: Among this patients histopathological report confirmed 10 adrenal ganglioneuromas (2,67% of cases, median age 51 years, range 39-74), diagnosed in 4 men and 6 women. Preoperative CT tumors were described as homogenous masses with mean attenuation on unenhanced images 28 (19-39 HU). In 5 patients (50%), progressive enhancement on delayed-phase postcontrast imaging was observed. 7 right and 3 left adrenalectomies was performed (laparoscopic approach in 50% of cases) Mean size of the resected tumors in histopatogical report was 47mm ( 5-85 )., Conclusions: Proper preoperative diagnosis of adrenal ganglioneuroma is challenging. In our series all diagnosis was made by histopathological examination. Surgery is indicated because it's difficult to distinguish adrenal gangioneuroma from other adrenal malignances. Radical excision is a definitive cure and may be done safely by laparoscopy., (© 2018 MEDPRESS.)

Aim: The aim of the study was to analyze long term results and prognostic factors in women with preinvasive breast cancer (DCIS - ductal carcinoma in situ) who underwent breast conserving surgery with subsequent radiotherapy., Materials and Methods: A total number of 106 patients was analyzed aged 29-78 years; mean age was 54,3 years and median 55 years. In 78 (73,5%) patients the tumor was diagnosed incidentally on mammography or ultrasound scan, 28 (26,5%) had palpable lesion. 57 patients had the tumor in the left breast and 49 in the right one. Most often the tumor was localized in external quadrants, namely in 56 (52,8%) patients. All patients had breast conserving surgery and then adjuvant radiotherapy of the breast in typical doses. For evaluation of survival we used the Kaplan-Meier test and for evaluation of cumulated loco-regional recurrence we have applied the method of competing risks., Results: At present 101 patients are still alive, 85 have no relapse. 15 patients had local recurrence and 8 had another cancer. Five patients died during follow-up period. Overall 15-years survival in analyzed group was 88% and disease free survival was 74%. Of all prognostic factors only the value of Van Nuys index was relevant. Patients who had the index value less than 7 had significantly worse prognosis than patients with value 7 or more (p=0,043)., Conclusions: At present 101 patients are still alive, 85 have no relapse. 15 patients had local recurrence and 8 had another cancer. Five patients died during follow-up period. Overall 15-years survival in analyzed group was 88% and disease free survival was 74%. Of all prognostic factors only the value of Van Nuys index was relevant. Patients who had the index value less than 7 had significantly worse prognosis than patients with value 7 or more (p=0,043)., (© 2018 MEDPRESS.)

The neuroendocrine tumors of the stomach and duodenum constitute only minority of neoplasms in this localisation. However due to their clinical behaviour and/or hormonal syndromes they pose diagnostic and therapeutic challenge. They display distinct phenotypes, regarding their pathogenesis, pathology and clinical course. Herein we present Polish guidelines for biochemical, pathological and localisation diagnosis, and discuss therapeutic approaches, considering endoscopic and surgical treatment, pharmacological and radionuclide therapy.

We present a case of 50 year-old man with feminizing adrenal carcinoma. He was admitted to the hospital because of weakness and one year history of gynecomastia and high blood pressure. Examinations revealed a large left adrenal mass and increased levels of estradiol. Patient underwent adrenalectomy and followed by mitotan therapy as the result of histopathological examination was adrenocortical carcinoma. One year after operation patient stays free from the recurrence of the disease and his estradiol, androstendion and DHEA levels are below the detection limits. We report this case because feminizing adrenal carcinoma is a very rare but serious disease and gynecomastia that could be its manifestation is quite frequent symptom in men's population and thus it could easily be missed. In every case of gynecomastia related to estradiol excess feminizing tumors of testis and adrenal gland should be ruled out.