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Publikacije (6)

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E. Sokolović, Amil Druzic, Una Stojanovic, Elma Kapisazovic, Emina Borovac-Gurda, Jasmina Redžepagić, Amina Aljić, Mattar Layan et al.

Introduction. The aim of this article is to evaluate the efficacy and outcomes of FOLFIRINOX as a first-line treatment for initial metastatic pancreatic cancer patients at the Clinical Center University of Sarajevo. Methods. The research presents a retrospective analysis was conducted on 33 patients treated with FOLFIRINOX, between January 2021 and January 2023. Baseline characteristics, tumor markers (CEA, CA 19-9, CA 125), neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR) and initial metastatic site were evaluated using Cox regression analysis in order to identify predictive and prognostic factors for progression-free survival (PFS) and overall survival (OS). Results. The median age of patients was 64 (range 38-76). There were 18 males and 15 females. The median OS was 21.7 months (95% CI, 10.5-32.9) and the median PFS was 10.0 months (95% CI, 8.2-11.8). A statistically significant negative correlation was found between NLR and OS (r=-0.464, p=0.045). Patients with initial liver metastasis had a numerically worse median OS (16.3 months, 95% CI, 5.1-27.5), compared to those with non-liver metastasis (OS not reached, p=0.058). Tumor markers, NLR, NPR, and initial metastatic site were not independent predictors of PFS and OS. Conclusion. FOLFIRINOX demonstrates significant efficacy in treating metastatic pancreatic cancer in a real-world setting. Personalized approaches, including genetic profiling and microbiome analysis, along with AI integration, offer promising avenues to enhance treatment outcomes and quality of life for patients. Keywords: metastatic pancreatic cancer, enhanced outcomes, overall survival, progression-free survival.

Abstract Malignant peritoneal mesothelioma is an extremely rare and poorly recognized neoplasm in children. A 5-year-old boy presented with a 1-year history of progressive painless abdominal distension. A CT revealed a 19 × 19 × 11 cm3 cystic mass in the right hemiabdomen, without infiltrating the surrounding structures. The tumor was completely removed by surgery. The microscopic and immunohistochemical analyses confirmed peritoneal mesothelioma. Comprehensive genomic profiling revealed no major driving mutations including BAP1, no fusions, but with amplifications of AURKA, AURKC, HLA-1B, ZNF-217, OR5F1 and MEN1 genes. Imaging follow-up 3 months after surgery revealed metastatic disease. The patient died of pneumonia at another hospital shortly after the last follow-up examination at our institution. Pediatric peritoneal mesothelioma is an extremely rare malignancy with limited targeted options and a poor prognosis. Some of the identified molecular genomic biomarkers require further exploration and validation in this cancer.

K. Karavdić, S. Muhović, E. Becic, M. Gučanin, J. Redžepagić

A 16-year-old girl with an asymptomatic large splenic cyst. The disease was discovered by an accidental ultrasound of the abdomen due to a urinary infection. The patient was followed up conservatively for 3 years, and after the gradual enlargement of the cyst, laparoscopic surgery was indicated. The operation and postoperative follow-up for a period of 6 months is satisfactory.

Nerma Čustović, Lejla Džananović, I. Rašić, Nadža Zubčević, Lejla Šaranović-Čečo, Aida Drljević, Jasmina Redžepagić

Aim To evaluate the pattern of indications and a spectrum of colonic pathology, and to determine appropriateness of indications for colonoscopy in order to improve patient selection for colonoscopy. Methods This retrospective study includes 294 patients who were referred to the Gastroenterology Department from a primary care physician in order to approach endoscopic examination. Study data included patients' anamnestic data (comorbidities, positive family history, performed radiological examinations) an indication for the procedure, and colonoscopy findings. Results Haematochezia was confirmed in 186 (63.26%), positive radiologic finding in183 (62.24%) and anaemia in 157 (53.40%) patients. Adenoma and colorectal carcinoma were detected in 40 (13.6%) and 53 (18%) patients, respectively. A significant association between haematochezia and colorectal neoplasm was confirmed (p=0.019), haematochezia and inflammatory bowel disease (p=0.027), and between radiological finding and colorectal neoplasm (p=0.018). There was no significant association between anaemia and any of the colonoscopic findings. According to EPAGE II criteria indications were appropriate in 187 (63.6%), uncertain in 67 (22.8%) and inappropriate in 40 (13.6%) patients. Conclusion This study confirmed a slightly larger number of uncertain and inappropriate indications for colonoscopy compared to other studies that examined indications for colonoscopy, which can be attributed to a high number of patients with functional bowel disorders.

To the Editor A 65-year-old woman with a positive family history for breast cancer presented with the palpable mass in the upper outer quadrant of the left breast. Ultrasonography and mammography revealed an oval, hypoechogenic, sharply demarcated mass, measuring 23 9 14 mm, classified as Bi-RADS 4 (Fig. 1A). A core needle biopsy revealed a cellular spindle cell lesion (AE1/AE3 negative) without prominent atypia and mitotic activity (B3 category, Fig. 1B). The multidisciplinary breast meeting discussed the case and recommended a wide local excision of the mass. Grossly, the 20-mm tumor was well-circumscribed, grayish-white on cut section, without necrosis and hemorrhage (Fig. 1C). Histopathologic examination revealed a well circumscribed, spindle cell neoplasm composed of the cells with mild to moderate atypia and sporadic mitotic activity (up to 5/10 hpf mitotic figures, Fig. 1D,E). An extensive immunohistochemical (IHC) examination revealed only convincing S-100 positivity in about 20% of neoplastic cells (Fig. 1F). All other markers were negative (AE1/AE3, Cam5.2, p63, GFAP, SMA, desmin, CD34, HMB-45, SOX-10) while beta-catenin retained cytoplasmic/membranous expression without nuclear positivity. Morphologic and immunohistochemical findings were consistent with a low-grade malignant peripheral nerve sheath tumor (MPNST). Due to the tumor size, clean margins, and the tumor grade, a close follow-up without further treatment of the patient was recommended (1–3). Additional clinical

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