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The breast carcinoma is the most frequent cancer in women. The diagnosis has certain rules but sometimes it brings diagnostic difficulties. The aim of this article is to point out specific cases of breast cancer and to transmit our practical experience with the situations when ordinary diagnostic methods failed. The authors present four cases of the patients with breast carcinoma.

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BACKGROUND: The aim of the study was to assess positivity nonsentinel lymph nodes in patients with macro, micro and submicrometastases in sentinel lymph nodes and find predictive factors of positivity nonsentinel lymph nodes. Study was conducted at the Department of Surgery in Pardubice, Pilsen, Ostrava and Zlín. MATERIAL AND METHODS: Sentinel lymph nodes were assessed based on standards of Czech Pathological Society. Detection of sentinel lymph nodes was performed based on radionavigation or combination of radionavigation and blue dye method. RESULTS: In group N1 (macrometastases) there was found positivity of nonsentinel lymph nodes in 50% (45 from 90 patients). In group N1 Mi (micrometastases) there was found positivity of nonsentinel lymph nodes in 26.7% (16 from 60 patients). In group NO I+ (sub-micrometastases) there was found positivity of nonsentinel lymph nodes in 6.7% (1 from 15 patients). Predictive factors were size of metastasis, number of positive sentinel lymph nodes and grading. Size of tumor was not found to be a predictive factor of positivity nonsentinel lymph nodes. DISCUSSION: High positivity of nonsentinel lymph nodes in pacients with macro and micrometastases in sentinel lymph nodes advocates to perform axillary lymph nodes dissection. Due to small number of patients with submicrometastases it is not possible to assess if axillary dissection is necessary or not. Predictive factors of positivity of nonsentinel lymph nodes are size of metastasis in sentinel lymph nodes, number of positive sentinel lymph nodes and grading. Size of tumor was not found to be a predictive factor due to small tumors in the study. In spite of this it is necessary to consider it like a predictive factor of positivity nonsentinel lymph nodes. CONCLUSION: In patients with macro and micrometastases it is necessary to perform axillary dissection. In patients with submicrometastases in sentinel lymph nodes it is necessary to consider predictive factors.

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INTRODUCTION: Kidney transplantation improves the quality of life in patients with chronic renal insufficiency. Immunosuppression therapy has a significant impact on good quality long-term function of the transplanted kidney and on the long-term survival of the patients. However, long-term administration of immunosuppressives may be associated with a number of complications. These, in particular, include infectious events, as well as increased rates of malignancies in the population of transplantation patients, compared to normal population. The median time of de novo breast carcinoma post- transplantation onset is approximately 56 months. Although studies have not confirmed its increased incidence rates, immunosuppression facilitates increased biological activity of the tumor and more frequent affection of axillary lymh nodes, resulting in reduced overall survival rates of the patients, compared to normal female population. A CASE REVIEW: The authors present a case review of a 65-year old female patient, who underwent transplantation of a cadaver kidney 7 years ago. Since then, the patient has been on immunosuppression therapy. For 8 years, the patient was screened in a breast care unit and was put on a waiting list for microcalcifications in her right breast, detected on mammography. In the Plzen Faculty Hospital Surgical Clinic, the patient underwent surgery and was then referred to oncology. The kidney graft was functioning well and she was in a good overall condition, therefore, nephrologists did not indicate graphectomy. During the perioperative period, the patient's condition was well controlled by immunosuppressives, and the patient continues with the medication during the postoperative period. CONCLUSION: The overall malignancy risk profile in a transplantation patient is defined by immunological, as well as non-immunological factors. These include the following: age, genetic factors, environmental factors, exposure to radiation or to solar radiation and smoking. Immunological factors include effects of immunosuppression medication on cellular imunity, effects on normal lymphoproliferation of cells providing tumor control, potential for development of cellular mutations and autonomic behavior of these cells, as well as effects on humoral immunity components, resulting in dysregulation of potentially malignant cellular mutations caused by viral infections. It is impossible to prevent these malignancies, neither in the post-transplantation population, nor in the normal population. However, knowing principal risk factors, the general effort should be aimed at reducing their incidence and, in case of their occurrence, to establish the diagnosis in time and to initiate adequate treatment. Every patient who udergoes transplantation, must be considered at risk of malignancy development, therefore, increased oncological awareness should be employed and the patient should be enrolled in screening programmes, including regular clinical and laboratory check ups, which should include more extensive examination than that of the transplanted organ function only.

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OBJECTIVE: To describe rare hamartoma of the breast in a 31-year-old female. DESIGN: Case report. SETTINGS: Department of Special Diagnostics SPAU, Charles University Hospital Pilsen. SUBJECT AND METHOD: A 31-year-old female was examined for breast asymmetry. A huge tumor was revealed in right mammary gland using ultrasonography. Encapsulated tumor 10x10x10 cm was removed. Subsequent histological examination revealed breast hamartoma. The patient is alive and well without signs of disease one year after excision. CONCLUSION: Hamartoma of the breast is a rare benign tumor. Diagnostics is very complicated and it is almost impossible to establish correct diagnosis preoperatively. A simple excision is a sufficient treatment with good curative effect.

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Clinical, pathological, and molecular-genetic features as well as etiology of cutaneous pseudolymphoma (CPL, cutaneous lymphoid hyperplasia, lymphocytoma cutis) of the breast nipple are summarized. CPL presents as a nipple induration and it is often suspected to be Paget carcinoma pre-operatively. Histologically, atypical microscopic features of a dense lymhoid infiltrate with follicles often mislead to the diagnosis of a malignant lymphoma. However, CPL runs a benign course. Rare cases of CPL contain a clonal lymphoid population. A substantial number of CPL in the breast nipple is caused by antigenic stimulation by Borrelia burgdorferi. In some patients a tick bite is documented. CPL of the breast is commonly treated by excision, but some patients may be cured by antibiotic therapy. The presence of Borrelia burgdorferi should be detected using methods of serology, culture, and molecular biology. Beside CPL, the differential diagnosis of the breast nipple lesions further includes Paget carcinoma, eczema, and florid papillomatosis.

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A summary work presenting technically difficult to process lesion samples and those which cannot be diagnosed on peroperative biopsy. The authors specify arguments against examinations of small mammary gland tumors (measuring less than 1 cm in diameter), post-bioptic tumors and sentinel lymph nodes. Furthermore, the authors describe difficulties in processing the adipose tissue resulting in complicated evaluation of the mammary gland tumors in the resection line. Obstacles in the peroperative examination of the thyroid gland lesions are also listed here. In this case, the freezing technique results in smearing specific cytological featuries of the examined tissue. Diagnostic criteria for all non-papillary tumors of the thyroid gland are explained in this article. Application of the above mentioned criteria is, however, worthless in the peroperative biopsy, which is also explained in this work. In the last part of this study, the authors describe macroscopic featuries of the mucinous ovarial tumors and their differentiation from the gastrointestinal tract adenocarcinoma metastases, using macroscopy and histological techniques.

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AIM: Until recently, metastasizing of the breast carcinoma to the liver has been considered the sign of the disease process generalization with a poor therapeutic prognosis. Therefore, the aim of this work was to assess any positive effects of liver resections in cases of patients with metastases with respect to the patients' survival rate and the relapse rate of the disorder. METHODOLOGY: From January 2000 until September 2003, 13 women aged 55.8 years on average (39-71 years of age) underwent surgery in the Surgical clinic of the Faculty Hospital in Plzen for liver metastases of the breast carcinoma. The average period of time from the date of the primary surgery for the breast carcinoma till the breast carcinoma liver metastasis appeared, was 4.3 years (3 months to 9 years). The breast carcinoma liver metastases were solitary in 11 cases and in two cases the metastases were multiple. The authors conducted four right-sided hepatectomies, three segmentectomies, two left-sided lobectomies, three radiofrequence ablations (RFA), one combined surgery--the liver resection and RFA, in total. In seven cases, the histological examination proved a ductal carcinoma and in six cases a lobular carcinoma. Following the surgery, all female patients underwent curative chemotherapy. None of the patients died earlier than 30 days after the surgery. In case of one patient during the complicated hepatectomy, the ductus hepaticus communis was iatrogenically injured, and the situation was solved using hepaticojejunoanastomosis according to Roux. The data were statistically evaluated according to the Kaplan-Meier long-term survival rate and the mestases relapse rate curve. A twelve-month and a thirty-month survival rate were 100%, and 66.7%, respectively. A probability of the relapse anywhere in the body is rated 0% and 71.5%, respectively for the same periods of time following the liver surgery for the breast carcinoma. CONCLUSION: Based on the authors' own findings and in conjunction with the current literature data, it is clearly evident that surgical therapy (liver resection, eventually RFA) followed by adjacent chemotherapy is the therapeutic method of choice in cases of patients suffering from the breast carcinoma liver metastases. The above method represents the only chance for a considerable extension of a quality life for women suffering from the breast carcinoma liver metastases.

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BACKGROUND: Paper deals with detection of the early disease progression in breast cancer patients during follow up using tumor markers. METHODS AND RESULTS: The basic group of 1184 patients with breast carcinoma in follow up after primary therapy were examined from 1996 to 2002. Sera were tested using commercial kits CA 15-3 (MEIA, Abbot), CEA (IRMA, Immunotech), TPA (IRMA, Byk Sangtec), TPS (IRMA, Beki). Results were compared with the retrospectively confirmed clinical status of individual patients. The authors calculated optimal cut offs and sensitivities and their combinations for particular tumor markers at 95% level of specificity. Best sensitivities for the detection of distant metastases into bone, liver, lung and brain was achieved by CA 15-3 (53-68%). As an optimal combination of tumor markers seems to be the tricombination CA 15-3, CEA and TPA. All the tumor markers have insufficient sensitivity for the metastatic process into the lymphnodes. CONCLUSIONS: As optimal combination of tumor markers during the follow up seem to be tricombination CA 15-3, CEA and TPA, but also the clinical relevance and cost effectiveness of these assessments have to be considered. For the tumor disease follow up only CA 15-3 has sufficient sensitivities (at 95% specificities) for the early diagnosis of the metastatic process.

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At the surgical clinic of the Faculty Hospital in Plzen in 1987-1991 a total of 230 operations of the thyroid gland were performed in 227 patients, incl., 30 operations on account of malignancies in 27 patients. The presented study is focused on malignant diseases. The mean age of the patients was 57.7 years, women predominated. Postoperative complications such as pareses of the recurrent nerve occurred only in one patient. Only one patient died from generalization of thyroid carcinoma. The authors compared the group with a previous clinical study made in 1967-1983 and with the year 1992. In 1992 they proved an increase of benign and malignant thyroid disease.

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