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Clinical Oncology

APRIL 10, 2019

[New perspectives in the treatment of lung cancer]

SZONDY Klára, BOGOS Krisztina

[In recent years, huge research is going on in the fi eld of oncology and as a result, we can see a signifi cantly longer survival in this area of medicine. Lung cancer, which has been taken places in the back for decades, it has not become a curable disease, but begins to belong to the chronic diseases. As a result of brilliant surgical technics and stereotactic radiotherapy, or as a result of changes in drug treatment, 5-year survival is not uncommon in metastatic lung cancer patients, next to relatively long progression free survive. After the third-generation cytotoxic combinations the added growth inhibition (VEGF inhibitor) maintenance therapy or continuous pemetrexed cytotoxic chemotherapy were resulted in high survival benefi ts. The fi rst real breakthrough, long progression-free survival was achieved by targeted treatment, which proved to be effective with known driver mutations. The other great result, especially in squamous cell carcinoma, was the immunotherapy, the inhibition of immune checkpoints, which effi cacy was confi rmed in adenocarcinoma also. Several studies are going on with adjuvant or neoadjuvant immunotherapy, and combined use of immunotherapy (either in combination with radiotherapy or cytotoxic chemotherapy).]

Lege Artis Medicinae

JUNE 20, 2018

[Treatment of EGFR mutant lung adenocarcinoma after progression]

BOGOS Krisztina

[Precision medicine proposes the personalization of health services in order to make the best individual decisions about the interventions and treatments for the patient. Molecular genetic diagnostic tests help to select the appropriate therapy, so-called targeted therapy. In the case of extensive lung cancer with EGFR mutation, EGFR tyrosine kinase inhibitors are immediately applicable; they are very effective and can reach long-term remission of the disease. However, resistance mutation can develop during the treatment, which causes the progression of the disease; therefore change of therapy is needed. In our case, we show the possibility of targeted treatment beyond the progression, emphasizing the importance of detecting resistance mutation. ]

Clinical Oncology

MAY 20, 2016

[Systemic treatment of gastrooesophageal adenocarcinoma]

PFEIFFER Per, MOEHLER H. Markus

[Few of chemotherapeutic drugs are effective and used for the treatment aGEA. Palliative chemotherapy prolongs overall survival and improves quality of life. The median OS in large randomized trials are approaching 12 months but in unselected populations the median OS only around 6 months. The median age for mEGA is around 70 years but the median age in most of the randomized trials is only around 60 years or even younger and therefore patients in trials are highly selected. A number of different fi rst-line regimens have been validated for use in this setting, but there is as yet no consensus recommendation on a world-wide combination. A combination of a platinum based (cisplatin or oxaliplatin) and a fl uoropyrimidine (5-FU, capecitabien or S-1) represents the cornerstone of fi rst line treatment. The addition of docetaxel to such doublets improve overall survival further, albeit at the cost of increased toxicity but a docetaxel triple regimen should be considered in fit younger patients. Trastuzumab was the first targeted drug to be approved in aGEA. Addition of trastuzumab to double chemotherapy is very tolerable and increase effi cacy. Second-line therapy is standard and recently it was shown that ramucirumab deliver clinical meaningful benefit as monotherapy or in combination with paclitaxel. The preliminary show promising effi cacy of immunotherapy and randomized study are recruiting patients with aGEA.]

Clinical Neuroscience

NOVEMBER 30, 2013

[The fate of tyrosinaemic Hungarian patients before the NTBC aera]

LÁSZLÓ Aranka, RÓZSA Mária, SALLAY Éva, TISZLAVICZ László, JANOVSZKY Ágnes, VÁRKONYI Ágnes, KARG Eszter, WITTMANN Gyula, TÚRI Sándor, MAGDALENA Ugarte

[Before the introduction of the NTBC treatment (Orfadine) from two tyrosinemic Hungarian families 1-3 tyrosinemic homozygous male patients died of hepatocellular carcinoma and one patient of hepatocellular carcinoma combined with clear cell renal adenocarcinoma. From the third tyrosinemic family one homozygous girl patient has been treated with NTBC (Orfadine), IMTV-AM, she is symptom-free. Her molecular genetic mutations analysis in the FAH gene detected a common intronel mutation, affecting splicing and of predicted severe effect, IVS6-1 g > t/IVS6-1 g > t with systemic name c.456-1 g > t/c.456-1 g > t (Prof. Magdalena Ugarte).]

Lege Artis Medicinae

DECEMBER 10, 2009

[Systemic adjuvant pharmacotherapy of colorectal cancer]

BODOKY György

[Colorectal cancer is one of the most frequent cancer in the postindustrial world; its most common form is adenocarcinoma. In Hungary, colorectal cancer has the second highest mortality among tumours. If diagnosed early, it might be successfully treated by surgery, however, chemotherapy is necessary to prevent tumor relapse and development of metastases and achieve adequate palliation. In the past few years, adjuvant treatment of colorectal cancer has improved substantially. Many new drugs have been developed, which are also being used in combination with previously known agents. This article will discuss the novelties in the field of adjuvant chemotherapy for colorectal cancer and the main guidelines of adjuvant treatment.]

Clinical Neuroscience

JANUARY 30, 2010

[Extracellular matrix of intracerebral tumors with different invasion activity]

KLEKNER Álmos, VARGA Imre, BOGNÁR László, HUTÓCZKI Gábor, KENYERES Annamária, TÓTH Judit, HANZÉLY Zoltán, SCHOLTZ Beáta

[Objectives - Ineffective surgical and radiotherapy of glioblastoma is mainly due to its intensive infiltrating behavior. Contrarily, brain metastases of anaplastic carcinomas are well-circumscribed intracerebral lesions that can be easily exstirpated in most cases. The molecules of the extracellular matrix (ECM) play a pivotal role in the peritumoral infiltration. In this study the mRNA expression of the ECM components was investigated in two types of intracerebral malignoma with different invasion activity. Our aim was to identify the ECM molecules that are responsible for the different intensity of peritumoral infiltration of tumors from different origin. Methods - The mRNA expression of twenty-three ECM molecules was determined by quantitative reverse transcriptase polymerase chain reaction. Four pieces of glioblastoma and four pieces of intracerebral lung adenocarcinoma metastasis from neurosurgical operation were investigated. Immunohistochemical investigations were performed in case of five molecules. Results - The mRNA expression of nine molecules (brevican, neurocan, neuroglycan-C, syndecan-1,2,4, tenascin-C, versican and matrix-metalloproteinase-[MMP]2) differed significantly by comparison of the two tumor types. By immunohistochemistry, neurocan, syndecan, versican and MMP-2 showed alteration in staining intensity according to the mRNA expression, while MMP-9 showed higher staining intensity in the metastatic tumor. Conclusions - The identified molecules can play an important role in the different infiltration activity of tumors from different origin. Thus these ECM-components could serve as targets for anti-invasion therapy in the future.]

Lege Artis Medicinae

OCTOBER 20, 2010

[Pancreatic carcinoma mimicking primary retroperitoneal fibrosis]

RÉDEI Csaba, ESZES Noémi, HAJNAL Péter, MÁTÉ Miklós, SIMON Károly, TÓTH Julianna, POZSÁR József, TOPA Lajos

[INTRODUCTION - One of the defining feature of pancreatic ductal adenocarcinoma (PDA) is the presence of extensive desmoplasia. The volume of stroma production can be disproportionate relative to mass of the tumor. Primary retroperitoneal fibrosis (PRF) is characterized by progressive accumulation and spread of connective tissue in the retroperitoneal space often leading to entrapment of ureters and/or the distal part of the duodenum. The large amount of stroma can mimic the radiologic features of PRF. We present a case when the diagnosis of pancreatic ductal adenocarcinoma was delayed because of the tumor showed retroperitoneal spread and imaging studies were distinctive for PRF. CASE REPORT - The past medical history of the 77 year old patient was significant for chronic renal failure of postrenal origin diagnosed one year before. The abdominal CT-scan performed six month ago was unremarkable except for focal stricture and upstream dilation of both ureters. After a relatively uneventful course during the past six months, the patient presented with abdominal distension and vomiting of five days period. Abdominal CT-scan revealed an extensive infiltration of the retroperitoneal space by a tissue with radiologic features characteristic for PRF. The fibrotic tissue involved the prerenal fascia, both ureters, and the third part of the duodenum. Duodenoscopy disclosed complete duodenal obstruction caused by an external compression at the level of ligament of Treitz. At surgery, a hard, fibrous tissue extending form the hepatic hilum down to the pelvis have been seen. The infiltrating tissue also entrapped the distal duodenum leading to its obstruction. Histologic evaluation of specimens taken at surgery showed features of fibroplastic PDA. CONCLUSION - PDA may present as an extensive retroperitoneal fibrosing process without detectable intrapancreatic tumor on radiologic studies. Obsructive signs of any retroperitoneal organ (ie. ureters, duodenum) should raise the possibility of retroperitoneally expanding PDA.]

Hungarian Immunology

JUNE 20, 2002

[Ocular myositis]

KISS Emese, FACSKÓ Andrea, DÉVÉNYI Katalin, DANKÓ Katalin, ZEHER Margit

[INTRODUCTION - Dermato-/polymyositis is an autoimmune disorder, which belongs to the idiopathic inflammatory myopaties. It involves skeletal muscles in form of weakness and inflammatory infiltrates. Characteristic skin lesions are present in dermatomyositis. Other organs may also be affected mainly in the presence of myositis specific autoantibodies. The inflammation usually involves the proximal muscles of extremities. CASE REPORT - In the present work we report the case of a 52-year-old woman. In the previous history the removal of rectal adenocarcinoma was remarkable in 1994. After that she received chemotherapy. She complied for severe headache and pain in the right eye in 2000 October, therefore a skull CT was performed, indicating thickening of rectus medalis muscle within orbital cavity. There was an enhancement of contrast material in the muscle. Glaucoma was excluded. Neurologist suspected the presence of myositis and indicated 0.5 mg/kg corticosteroid therapy. Soon after the left eye became painful, but due to the corticosteroid treatment both eyes became painless. A control orbital CT was completely negative in 2000 November. Immunology consultancy revealed a mild proximal muscle atrophy in both lower extremities, but CPK and LDH enzyme levels were normal, EMG was characteristic for mild chronic nerve lesion. The biopsy, taken from the involved proximal muscle of lower extremity, did not show inflammatory infiltration. Complete screening for cancer was negative. Thyroid gland disease could be excluded. Immune laboratory data were negative, autoantibodies, including anti-Jo1, could not be detected. Based on the results a rare disease, ocular myositis was diagnosed. Considering the clinical improvement, the withdrawal of corticosteroid therapy was offered. Stringent immunology and oncology follow-up is required. CONCLUSION - In relation to our case report, we discuss clinical symptoms of orbital myositis, diagnostic procedures to identify the disease and also differential diagnostic considerations.]

Lege Artis Medicinae

APRIL 01, 2009

[Metastatic tumour with papillary structure in the colon]

CSERNI Gábor, BORI Rita, FEKETE Katalin, OLÁH Csaba, SVÉBIS Mihály, KOVÁCS Katalin, SZŰCS Miklós

[INTRODUCTION - Colorectal carcinomas are frequent and their diagnosis and treatment is generally considered a routine task in oncology, but in some cases, using a routine approach may cause unforeseeable difficulties. CASE REPORT - A 72-year-old woman underwent segmental bowel resection of a tumour diagnosed as colon cancer 15 months earlier. The tumour also metastasized in the lungs. Autopsy findings raised a high level of suspicion that her colon tumour was a metastasis from a uterine cervical adenocarcinoma undiscovered before the post mortem examination. CONCLUSION - Occasionally metastases do not arise from the tumour that we are aware of, and metastases may mimic primary tumours. Although the papillary structure of a colon cancer should raise the possibility of a metastatic nature, also primary - at least partially - papillary carcinomas may arise in the large intestines.]

Lege Artis Medicinae

JULY 10, 2001

[Endoscopic diagnosis of oesophageal intramural metastasis from an adenocarcinoma of the gastrooesophageal junction]

SZÁNTÓ Imre, VÖRÖS Attila, NAGY Pál, GONDA Gábor, ALTORJAY Áron, BANAI János, GAMAL E. Mohamed, KISS János

[INTRODUCTION - Authors present six cases of intramural oesophageal metastases of adenocarcinomas located in the gastro-oesophageal junction. The tumours and metastases were diagnosed by endoscopic examinations. PATIENTS AND METHODS - Between 01. 01. 1994. and 31. 12. 2000. a total number of 143 patients were examined with the diagnosis of adenocarcinoma of the gastro-oesophageal junction. In six patients (4,19 %), intramural oesophageal metastases were verified. In each case the diagnosis was confirmed by histological examination. TNM stage of the tumours was assessed considering the results of endoscopic ultrasound examination, the findings at initial operation and the pathological data in all cases, where resection was performed. The tumours were localized according to Siewert- Stein’s classification. RESULTS - In six patients who had adenocarcinoma of the gastro-oesophageal junction, the diagnosis of intramural oesophageal metastases was confirmed. The histological structure of the primaer tumours and metastases were the same. Metastases were detected by endoscopic ultrasound examination in three cases of the four examined patients as submucosal masses. All of the cardiac tumours proved to be well advanced: four of them classified as T4N1 by endoscopic ultrasound. Intramural metastases were diagnosed in each Siewert-Stein subgroups. CONCLUSION - Endoscopic examination is of crucial importance in the diagnosis of adenocarcinomas of the gastro-oesophageal junction and in their intramural metastases as well. Beside the endoscopic identification the primary tumour, the thorough examination of the proximal part of the oesophagus seems to be of great importance. These metastatic cancers appeared in the advanced stage of the disease. Endoscopic ultrasound examination is of great help in these cases to identify whether the mass causing oesophageal impression is outside of the wall of the organ, or in which layer it is localized. Endoscopic ultrasound examination also gives the possibility for preoperative assessment of the TNM stage of the disease.]