UVODEpitelijalni tumor vretenastih ćelija sa diferencijacijom sličnoj timusu (SETTLE) ekstremno je rijedak tumor štitaste žlijezde za koji se smatra da se razvija iz škržne brazde ili ostataka timusa i pokazuje primitivnu diferencijaciju grudne žlijezde. Formalno su ga okarakterisali Chan i Rosai 1991. godine (1). Pojedinačni izvještaji o ovome tumorskom entitetu prethodno su objavljivani pod različitim oznakama kao što su: tumor vretenastih ćelija štitaste žlijezde sa mukoznom cistom, maligni teratom, tireoidni timom dječije dobi, neuobičajeni tireoidni tumor kod djece (2-6). Promjena je slabo rastumačena a njen potencijal za kasno metastaziranje postaje opštepriznat: iako tumor ima sklonost da razvija kasne hematogene metastaze, rizik od metastaziranja je nejasan jer prikazi slučajeva u novijoj literaturi imaju veoma kratak period praćenja. Prema podacima američkog Nacionalnog centra za biotehnološka istraživanja, naziv SETTLE spomenut je samo 26 puta u engleskoj literaturi do jula 2010. godine. Naveden je 42 puta do kraja juna 2015. u obliku pojedinačnih izvještaja i nepotpunog zbira prethodno objavljenih slučajeva (7-12). Donosimo slučaj bolesnika kod koga za razliku od svih dosad prikazanih slučajeva primarni tumor nikada nije bio pronađen. Zbog toga pacijent nije operisan. Pacijenta smo pratili dok je postojala samo klinička manifestacija oboljenja i od početka liječenja metastatske bolesti do prve ustanovljene RECIST progresije. Smatramo da bi osnivanje međunarodnog tijela za rijetke maligne tumore bilo veoma značajno. PRIKAZ SLUČAJAPrikazujemo slučaj SETTLE tumora kod dvadesettrogodišnjeg muškarca koji je praćen 24 mjeseca: od trenutka postavljanja dijagnoze dok nije ustanovljena progresija bolesti prema RECIST kriterijumima. Ovo je prvi slučaj SETTLE tumora opisan u Crnoj Gori.Polovinom 2011. godine kod bolesnika koji je imao 19 godina na desnoj strani vrata pojavio se bezbolan limfni čvor. Bolesnik nije imao subjektivnih tegoba. Limfni čvor bi postajao vidljiv prilikom okretanja glave na desnu stranu. Javio se stomatologu koji je objasnio da je pojava limfnog čvora posljedica rasta umnjaka i da će iščeznuti nakon što umnjak bude nikao. Izvjesno vrijeme poslije toga limfni čvor nije bio vidljiv. Kada je promjena ponovo postala uočljiva, u martu 2013, pacijent je zatražio
Just a few decades ago, death was considered and accepted as an expected part of human existence: people were dying of old age and/or severe illness. The new age has brought a new concept: to delay aging and dying for as long as possible. Most of the once-incurable, life-threatening diseases, which include malignancies, have today become chronic diseases and their poor prognoses—terminal condition and fatal outcome—are difficult or impossible for a large part of the population to accept. A holistic and multidisciplinary approach to the cancer patient has become increasingly complex due to the application of personalized medicine: the right medicine, for the right patient, at the right time. Surgery, oncological radiology, and medical oncology are on this path and are combined with modern diagnostics, especially genetics, but also with new domains: ethical, legislative, sociological, economic, customary, and spiritual. Success in determining the genetic map of humans has brought about emotional, psychological, cultural, and religious dilemmas. Spirituality is ubiquitous in sufferers of all nations, races, ages, and, regardless of different religious formats, it sets a need, almost an imperative, to create spiritual care teams (SCTs,). Developing countries have largely overcome the low-level state of enlightenment of certain communities which, even today, perceive cancer as God’s will, punishment, or destiny. On the other hand, their transition in some countries takes a very long time. They have not yet reached the level of a developed consumer society, and some have fallen into the trap of class stratification, corruption, and discrimination. Comprehensive, targeted individualization for each oncology patient is crucial to the final outcome of the malignant disease.
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