The human epidermal growth receptor 2 (HER2, c-erb-B2) is present in 15-20% of breast cancer at the time of diagnosis. Overexpression of HER2 receptor is associated with more aggressive form of breast cancer. Trastuzumab is a human monoclonal antibody that blocks the signaling pathways of cell proliferation by binding to the HER2 receptor. Due to the possible occurrence of resistance to trastuzumab (binds to the subdomain of II HER2 receptor and thus achieves the ligand-independent inhibition of cell proliferation), another monoclonal antibody pertuzumab was produces in the course of time (binds to the subdomain of IV HER2 receptor and thus achieves the ligand-dependent inhibition of cell proliferation), forming the basis of dual HER2 receptor blockade. Numerous studies have shown the benefits of administering trastuzumab and pertuzumab, initially in metastatic, and then in adjuvant and neoadjuvant regimens. Neoadjuvant (preoperative) therapy is given in inoperable tumors, in patients at high risk of poor outcomes (HER2-positive tumors, nodus positive tumors, inflammatory breast cancer, large tumors), as well as in additional risk factors - HR negative tumors where no beneficial effect is expected from the hormonal therapy in the adjuvant setting. Neoadjuvant therapy also provides an "in vivo" insight into the tumor response to neoadjuvant therapy. A pathological complete response (pCR) is an early parameter of the effectiveness of neoadjuvant therapy which also allows us to discover the sensitivity of the tumor in time and make a decision on adjuvant treatment. pCR has a predictive and prognostic value. Namely, the rate of pCR is associated with desease-free survival and overall survival. On the basis of the rate of pCR, numerous studies have shown that there are subgroups of HER2-positive breast cancer: subgroup of hormone receptor-negative tumors that have a higher response rate to the existing anti-HER2 therapy and HER2-positive breast carcer; the subgroup of hormone-dependent tumors in which an adequate pCR rate is not achieved by existing therapeutic options, which represents a new area of research and the possibility for finding new treatment strategies.

Introduction/Objective Activation of insulin-like growth factor receptor (IGF-1R) results in cell transition from growth phase to synthesis phase of cell cycle. Breast cancer is categorized into prognostic and therapeutic subtypes based upon hormone receptor, estrogen receptor (ER), and progesterone receptor (PR) expression and human epidermal growth factor receptor 2 (HER-2) expression. The objective of this study was to examine the expression of IGF-1R in а specific subtype invasive breast cancer and its correlation with basic histopathological and immunohistochemical prognostic parameters. Methods Formalin-fixed paraffin-embedded tumor samples were obtained from 129 female patients with invasive breast cancer (I–III disease stage) with the follow-up ranging 36–108 months (average 48 months). For immunohistochemical staining, we used monoclonal antibodies for ER, PR, IGF-1R, and polyclonal antibody for HER-2. Results IGF-1R inversely correlated with tumor stage (p = 0.017), tumor grade (p = 0.001), HER-2 (p = 0.003), whereas significant positive correlation was found with multifocality/multicentricity of breast cancer (p = 0.036), ER (p = 0.001) and PR (p = 0.0001) expression. Cox-regression analysis for relapse-free survival (RFS) showed that disease stage (p = 0.039) and HER-2 (p = 0.033) were independent prognostic factors. IGF-1R did not predict clinical outcome in patients with breast cancer (p = 0.488, Kaplan–Meier test for RFS). Conclusion Patients with low stage and grade hormone-dependent breast cancer had a significantly higher IGF-1R expression than patients with triple negative or HER-2 overexpressed cancer. The present findings also highlight that IGF-1R expression in multicentric/multifocal breast cancer supports the key roles in tumor initiation.

Introduction Thoracic splenosis is defined as the autotransplantation of splenic tissue into thorax. It occurs due to splenic rupture in association with a diaphragmatic tear on the left side after a traumatic event. It is a rare disease that most commonly remains undiscovered as it is usually asymptomatic. Case Outline We present a symptomatic case of thoracic splenosis in a 53-year-old smoker male patient with a medical history of abdominal surgery and splenectomy for a thoracoabdominal gunshot. Three years before the medical examination he was suffering from dyspnea, frequent coughing, left pleuritic chest pain and complained about faster fatigue. A chest radiograph obtained during a medical checkup showed a multinodular left pleura-based mass in the upper lobe. Established histopathological diagnosis after surgical removal of the nodule was splenosis. No evidence of malignancy was observed. Conclusion Splenosis should be considered as a differential diagnosis by the undertaken workup of left pulmonary nodules or masses in patients with a history of trauma.

Uvod. Uspjesnost izvođenja vaskularnih rekonstrukcija, narocito velikih abdominalnih i torakalnih krvnih sudova, nije promijenila stavove vecine onkoloskih hirurga koji smatraju da je tumorska invazija vaskularnih struktura relativna kontraindikacija za uklanjanje tumora. Cilj rada je pokazati da operacije retroperitonealnih tumora koji su u koliziji sa velikim krvnim sudovima imaju prihvatljiv perioperativni morbiditet i mortalitet u ranom postoperativnom toku i zadovoljavajuce udaljene rezultate. Metode. Rad predstavlja prospektivnu studiju koja obuhvata 46 bolesnika (31 muskarac) starosti između 29 i 84 godina (prosjecna starost 58 godina) kod kojih je urađena resekcija i rekonstrukcija visceralnih krvnih sudova retroperitoneuma, tokom hirurske resekcije primarnih i sekundarnih tumora retroperitoneuma. Glavni rezultati mjerenja u ovoj studiji su rani ( 30 dana) vaskularni morbiditet i mortalitet, primarna prohodnost vaskularne rekonstrukcije i preživljavanje. Rezultati. Resekcija donje suplje vene sa rekonstrukcijom PTFE graftom izvedena је kod 4 bolesnika, а aortna resekcija sa rekonstrukcijom graftom kod 2 bolesnika. Rekonstrukcija portne vene bila je izvedena tokom resekcije neoplazmi pankreasa i neoplazme jetre u 3 bolesnika. Resekcija i rekonstrukcija gornje mezentericne arterije kod 2 bolesnika, zajednicke ilijacne arterije kod 2, zajednicke ilijacne vene u 3 bolesnika. Lijenalna, femoralna i donja mezentericna arterija rekonstruisane su kod 3 bolesnika. Tridesetodnevni mortalitet bio je 8,7% (4 bolesnika). Opsti tridesetodnevni morbiditet bio je 17,39%, dok rani vaskularni morbiditet ukljucuje krvarenje na arterijskoj ili venskoj anastomozi kod 2 bolesnika i ranu trombozu vaskularnog grafta kod 2 bolesnika. Primarna prohodnost vaskularne rekonstrukcije za 12 mjeseci bila je 80%, a preživljavanje 56,5%. Tokom perioda pracenja 26 bolesnika je bilo živo, bez recidiva osnovne bolesti. Kumulativna stopa preživljavanja bila je 64,3% i 48,2% za 1 i 3 godine. Zakljucak. Istovremene rekonstruktivne vaskularne procedure dozvoljavaju resekciju tumora koji zahvataju vaskularne strukture sa prihvatljivim ranim i kasnim morbiditetom i mortalitetom.

INTRODUCTION Primitive neuroectodermal tumor or Ewing's sarcoma is a tumor of undifferentiated small round cells that arise from the soft tissues, and is believed to be of neural origin. It occurs most often in children, followed by adolescents and young adults. CASE OUTLINE A case of a 24-year-old patient with ulcerostenosans Ewing's sarcoma of the initial part of the small intestine is presented in our paper. Reviewing the literature and using as an example the case of a female patient with signs of sideropenic anemia caused by primitive neuroectodermal tumor of the small intestine, an attempt was made to clarify the etiology, clinical presentation, diagnosis and therapy with the aim of its rapid detection and treatment. CONCLUSION Mesenteric primitive neuroectodermal tumor is a rare neoplasm in adults, while it usually occurs in children and young adults. Surgical resection of the lesions with the application of chemotherapy is the main form of treatment of patients suffering from this disease.

<p><strong>Introduction.</strong> Extramural venous invasion (EMVI) is a significant predictive factor of the prognosis for patients with colorectal carcinoma and it is directly connected with the relapse of a disease, especially with the appearance of distant metastases. <strong>Methods.</strong> The research comprises 90 patients with colorectal cancer. Representative samples of tumor tissues obtained by surgical resection are fixed in 4% formalin and embedded into paraffin blocks. Semi-series incisions of 4&mu;m thickness were stained by HE method and Van Gieson&rsquo;s method. <strong>Results. </strong>Out of 90 analyzed patients, 21 (23,33%) were with EMVI, and 69 (76.67%) without EMVI on the histological preparations stained by HE method. EMVI was found in 7 more tumors on the preparations stained by Van Gieson&rsquo;s method. Sensitivity of the method determining EMVI on the histological preparations stained by Van Gieson&rsquo;s method was better for 25% (7/28) than on the preparations stained by HE method. EMVI was not found in patients at A and B1 stage of disease according to Astler- Coller classification, but out of 77 patients which were at B2, C1 and C2 stage EMVI was found in 28 (36,36%) patients, p&le;0,01. EMVI was found in 18/77 (23,38%) patients who had a tumor of low histological gradus, p&le;0,01 and in 10/13 (76,92%) patients who had a tumor of high histological gradus, p&le;0,01. In patients with neural invasion, EMVI was found in 18/22 (81,82%), whereas in patients without neural invasion EMVI was found in 10/68 (14,71%), p&le;0,01. In patients with weak intensity of peritumoral lymphocytic reaction EMVI was found in 20/41 (48,78%) whereas in patients with moderate and noticeable level it was found in 8/49 (16,33%), p&le;0,01. There was a significant correlation between extramural venous invasion and other parameters of unfavorable prognosis. <strong>Conclusion.</strong> EMVI is an important indicator in administration of postoperative adjuvant therapy in patients with colorectal carcinoma. A special histochemical method of elastic fiber stain should be applied in everyday practice when EMVI is not found on HE stained preparations in patients with CRC.</p>

<p><strong>Introduction. </strong>The Bcl-2 gene codes an oncoprotein, inhibits a programmed cell death or apoptosis and it plays a very important role in colorectal cancerogenesis. The aim of our study is to determine Bcl-2 expression in colorectal carcinomas in relation with the stage of disease, histology of tumor type, localization and macroscopic growth pattern. <strong>Methods.</strong> Immunohistochemichal detection of Bcl-2 protein expression was carried out on 90 resected colorectal carcinomas. The patients were divided into three groups according to the degree of Bcl-2 expression in a tumor: group 0 - there were no cells with positive immunohistochemical reaction; group I- up to 20 % of positive cells, and group II- above 20% of positive cells. The groups were compared in relation to the stage of disease, T stage of local spread of disease, histology of tumor type, localization and macroscopic growth pattern. <strong>Results.</strong> 58% of patients at the second stage of disease had no expression of Bcl-2. Higher percentage (61%) of the patients with metastases ( stages III and IV) had high level of Bcl-2 expression. Tumors with polipoid growth pattern have higher level of Bcl-2 expression. <strong>Conclusion. </strong>There is a statisticaly significant difference in Bcl-2 protein expression in patients surgically treated at the II and III stage of disease, stage T3a/b, T3c/d of local spread of disease and tumors whith polipoid growth pattern in relation to infiltrative growth pattern.</p>