Uterine leiomyosarcoma (uLMS) is a rare but aggressive cancer with a high metastatic potential and an unfavorable prognosis. A 54-year-old woman with a history of uterine fibroids clinically presented with a painless, palpable left breast mass measuring 20 mm. A core biopsy of the breast mass demonstrated a cellular spindle cell neoplasm (a potentially malignant smooth muscle neoplasm; B4). A wide local breast-mass excision was performed, revealing grade-2 leiomyosarcoma. A re-review of the uterine fibroids revealed that the largest one (200 × 130 mm), initially diagnosed as symplastic leiomyoma, was morphologically identical to the breast lesion. Additional diagnostic work-up revealed multiple liver and pulmonary metastases with a suspected metastatic sclerotic lesion in the L3 projection. The patient was subsequently treated with chemotherapy protocol for metastatic uLMS. The latest follow-up in September 2023 confirmed stable disease. This case highlights the importance of considering unusual metastatic patterns when evaluating breast masses, particularly in patients with a history of non-specific uterine conditions. Comprehensive diagnostic work-up, including imaging and histopathologic examinations, is crucial for an accurate diagnosis of uLMS and appropriate treatment selection. Further studies are needed to better understand the underlying mechanisms and optimal management strategies for metastatic uLMS.

The HERe2Cure project, which involved a group of breast cancer experts, members of multidisciplinary tumor boards (MTB) from health-care institutions in Bosnia and Herzegovina, was initiated with the aim of defining an optimal approach to the diagnosis and treatment of HER2 positive breast cancer. After individual multidisciplinary consensus meetings were held in all oncology centers in Bosnia and Herzegovina, a final consensus meeting was held to reconcile the final conclusions discussed in individual meetings. Guidelines were adopted by consensus, based on the presentations and suggestions of experts, which were first discussed in a panel discussion and then agreed electronically between all the authors mentioned. The conclusions of the panel discussion represent the consensus of experts in the field of breast cancer diagnosis and treatment in Bosnia and Herzegovina. The objectives of the guidelines include the standardization, harmonization, and optimization of the procedures for the diagnosis, treatment, and monitoring of patients with HER2-positive breast cancer, all of which should lead to an improvement in the quality of health care of mentioned patients. The initial treatment plan for patients with HER2-positive breast cancer must be made by a MTB comprised of at least: A medical oncologist, a pathologist, a radiologist, a surgeon, and a radiation oncologist/radiotherapist.

T he commendable multicenter study by Dr Tiwari et al1 focuses on the comparison of outcomes of laparoscopic and open appendectomy (OA) in management of uncomplicated and complicated appendicitis. The authors conclude that laparoscopic appendectomy (LA) is superior or comparable to OA in terms of several surgical outcome measures for both uncomplicated and complicated appendicitis, across most illness severity groups and so they recommend it as the preferred technique, irrespective of appendicitis diagnosis or disease severity. On the basis of our long-term experience,2 we would like to highlight certain issues regarding the possibility of percutaneous catheter drainage (PCD) as the treatment modality that can successfully solve acute perforated appendicitis in some patients. Authors specified that the study1 results have clearly demonstrated superiority of LA over OA, as it had shown to be a safe, efficacious, and cost-effective method for complicated (mostly perforated) and uncomplicated appendicitis.

References 1 Saito M, Seo Y, Yano Y, Miki A, Yoshida M, Azuma T. A high value of serum des-g-carboxy prothrombin before hepatocellular carcinoma treatment can be associated with long-term liver dysfunction after treatment. J Gastroenterol 2012; 47:1134–1142. 2 Toyoda H, Kumada T, Osaki Y, Tada T, Kaneoka Y, Maeda A. Novel method to measure serum levels of des-gamma-carboxy prothrombin for hepatocellular carcinoma in patients taking warfarin: a preliminary report. Cancer Sci 2012; 103:921–925. 3 Murata K, Suzuki H, Okano H, Oyamada T, Yasuda Y, Sakamoto A. Cytoskeletal changes during epithelial-to-fibroblastoid conversion as a crucial mechanism of des-gamma-carboxy prothrombin production in hepatocellular carcinoma. Int J Oncol 2009; 35:1005–1014. 4 Copple BL. Hypoxia stimulates hepatocyte epithelial to mesenchymal transition by hypoxia-inducible factor and transforming growth factor-betadependent mechanisms. Liver Int 2010; 30:669–682.

Background Peanut butter is known as a healthy food . It is a type one hypersensitivity reaction to dietary substances from peanuts causing an overreaction of the immune system which in a small percentage of children may lead to severe physical symptoms. Peanut allergy is one of the most common causes of anaphylaxis, a pediatrics medical emergency that requires treatment with an epinephrine (adrenaline).