Šerėnaitė, Aušrinė

This literature review explores recent advances in the diagnosis and management of recurrent respiratory papillomatosis (RRP), a rare, chronic airway disease caused by HPV types 6 and 11. Despite surgical excision being the primary treatment, frequent recurrences—especially in juvenile-onset cases—pose significant challenges. The review highlights the importance of early diagnosis, effective surgical techniques, and adjuvant therapies like cidofovir and bevacizumab. It also underscores the impact of HPV vaccination in reducing incidence and recurrence, supporting its role in both prevention and treatment. A multidisciplinary approach remains essential for optimal long-term outcomes.

This study investigates the feasibility of achieving complete surgical radicality in early-stage laryngeal cancer through Transoral Laser Microsurgery (TOLMS). A retrospective analysis was conducted on 88 male patients treated between 2019 and 2024, with a focus on surgical outcomes, radicality (R0 vs. R1 resection), tumor stage and recurrence rates. The results demonstrate that achieving R0 resection largely depends on the tumor T stage. No significant association was found between surgical radicality and tumor location or preoperative CT imaging findings. Additionally, recurrence was found to be dependent on the resection radicality (R status).

This retrospective study evaluates surgical outcomes in 93 patients undergoing facial melanoma surgery between 2016 and 2023. Key factors analyzed include tumor localization, morphology, surgical radicality (R0, R1, Rx), excision width and recurrence rates. Lentigo maligna spectrum was the most common type (77.4%), with the left cheek being the most frequent tumor site (45.2%). R0 resections with a minimum margin of 0.6 cm significantly reduced recurrence, while R1 resections had higher recurrence rates, particularly in lentigo maligna cases. These findings highlight the importance of precise surgical planning to optimize oncological and functional outcomes.

High-pressure injection injuries pose serious risks to hand function and are often underestimated. They occur when fluid or air under pressure punctures the skin leading to internal damage that can be devastating. Immediate surgical intervention, including debridement and irrigation, is essential to prevent long-term complications. Despite advancements in treatment, long-term morbidity and functional impairment are common, highlighting the need for thorough management and postoperative physiotherapy. This case emphasizes a crucial aspect: although high-pressure injection injuries may present initially as benign they should be treated as urgent situations that could be missed without thorough history-taking and appropriate diagnostic measures.

Introduction: Artificial intelligence (AI) has undergone remarkable evolution in radiology since the 1960s, shifting from fully autonomous diagnostic goals to becoming a powerful assistive tool for radiologists. This transformation, particularly through artificial neural networks and deep learning methods, has significantly enhanced image interpretation, workflow efficiency and patient outcomes in oncologic imaging. Aims and Objectives: The aim of this paper is to review the historical development, current applications and future directions of AI in oncologic radiology, with a particular focus on breast and lung cancer diagnostics. The objective is to highlight how AI enhances diagnostic accuracy, supports clinical decision-making and paves the way toward personalized radiology. Materials and Methods: The article is a narrative literature review analyzing the progression of AI technologies in radiology. It includes studies and examples of deep learning systems, computer-aided detection (CADe) and diagnosis (CADx), with references to key AI models, such as CNNs and the CANARY system and their applications in various imaging modalities (CT, MRI, PET, X-ray). Results: AI systems, particularly deep learning and CAD tools, have demonstrated high diagnostic accuracy comparable to experienced radiologists. Applications in breast cancer imaging showed increased sensitivity and specificity in tumor detection. In lung cancer, AI enabled early detection, differentiation of benign vs malignant nodules and quantification of tumor heterogeneity, with significant reductions in radiologist workload. Nevertheless, limitations exist, such as lack of model generalizability and interpretability. Conclusions: AI is revolutionizing oncologic radiology by improving diagnostic precision, reducing radiologist workload and contributing to personalized medicine. Future advancements should focus on refining model generalizability, integrating AI into clinical workflows and addressing ethical, legal and interpretability challenges to maximize patient benefit.

Objectives. Sarcomas are rare, complex tumors originating from mesenchymal tissues, known for their histological diversity and challenging clinical presentations. Their management requires a multidisciplinary approach due to the complexity of diagnosis and treatment. Multidisciplinary team (MDT) consultations integrate expertise from various specialists to optimize treatment strategies. This study aimed to evaluate the demographics, clinical characteristics, and outcomes of sarcoma patients, focusing on the impact of MDT consultations on surgical radicality, preoperative planning, and overall care quality. Materials and methods. This retrospective study analyzed 67 sarcoma cases diagnosed between May 22, 2022, and October 30, 2023, at Kaunas Clinics, Ocology and Hematology Department. Statistical analysis was performed using IBM SPSS Statistics version 29.0.2.0. Results. The study included 67 patients, 44.8% female (n=30) and 55.2% male (n=37), with a mean age of 58 years (range 10–92). Most patients (79.1%, n=53) presented with primary tumors. Tumors were most commonly located in the extremities (54.5%, n=36) and retroperitoneum (22.7%, n=15). Soft tissue sarcomas were the most frequent (43.3%, n=29). Surgical treatment was performed on 56 patients; 25 had no prior biopsy, and 9 lacked preoperative imaging. Among 11 recurrence cases, 8 had incomplete resections (R1/R2) without MDT consultation. Recurrence rates were significantly associated with surgical radicality (p=0.004). MDT involvement reduced incomplete resections from 60% to 26%. MDT consultations occurred in 76.1% of cases, mostly for surgical planning (28.4%, n=19). Neoadjuvant therapy guided by MDTs was used in 13.4% of cases. Four patients died due to advanced disease. Conclusions. MDT consultations significantly improve sarcoma management by enhancing surgical outcomes and reducing incomplete resections. Neoadjuvant therapy guided by MDTs contributes to better preoperative planning, emphasizing the value of multidisciplinary collaboration in optimizing treatment and patient outcomes.

Objectives. Laryngeal cancer is one of the most common oncological diseases in the head and neck region, particularly prevalent among male smokers and often diagnosed at early stages (T1 and T2). Transoral laser microsurgery (TOLMS) is a widely used minimally invasive technique for treating early-stage laryngeal cancer. This study evaluates the effectiveness of TOLMS, the achieved radicality, and the relationship between radicality and recurrence over six years in patients treated with this method. Materials and methods. A retrospective analysis from Kaunas Clinics included 88 male patients with early-stage laryngeal cancer who underwent surgery between January 1, 2019, and December 31, 2024. Statistical analysis using SPSS summarized demographic and clinical data with descriptive statistics, and compared tumor stage, surgical radicality, and recurrence rates using chisquare tests, with p<0.05 considered significant. Results. The study included 88 male patients, average age 68.6 years. Of these, 88.5% had risk factors like smoking, alcohol use, or toxic work exposure. The most common tumor type was infiltrative keratinizing moderately differentiated squamous cell carcinoma (95.4%), with four cases of sarcomatoid carcinoma (4.6%). R0 resection was achieved in 67 cases (76.1%), and histopathology showed no neoplastic changes in 63 cases (71.6%). Over six years, 10 recurrences occurred—7 within the first year and 3 between one and two years post-treatment. Recurrence was significantly associated with tumor stage (N) (Chi-square, p=0.02) and surgical radicality (Chi-square, p<0.001). Radicality was influenced by tumor stage (T) (Chi-square, p=0.032), with T1a being most frequent. Conclusions. TOLMS is an effective, safe treatment for early-stage laryngeal cancer, achieving high surgical radicality (R0 resection in 76.1%). Recurrence rates were influenced by tumor stage (N) and surgical radicality, with most recurrences occurring within the first year. These findings support TOLMS as a valuable treatment for early-stage laryngeal cancer.

Introduction Melanoma is a highly aggressive and life-threatening form of skin cancer, accounting for approximately 60% of skin cancer-related deaths, with its incidence steadily rising over the past century [1,2]. Early diagnosis and surgery are crucial, especially in stage 0, I, and most stage II melanomas, where complete excision with clear margins is essential to reduce recurrence risk [3]. In advanced stages, additional therapies may be needed, but surgery remains key to controlling the disease and improving survival [4]. Facial melanoma accounts for 10-15% of melanomas, but radical excision is more challenging due to the complex anatomy of the face, which requires balancing tumor removal with functional and aesthetic considerations [5,6]. Aim The study aimed to evaluate the distribution of melanoma localization on the face, their dimensions, and morphological types, as well as the degree of radicality achieved during surgical treatment. Methods The study was conducted at Kaunas Clinics, Department of Plastic and Reconstructive Surgery, where data was collected from 93 patients who underwent facial melanoma surgeries between January 1, 2016, and December 31, 2023. Statistical data analysis was performed using IBM SPSS Statistics 29.0.2.0 software. Results The study included 93 patients, 68 women (73.1%) and 25 men (26.9%), with an average age of 71 years. Most tumors were benign (77.4%) compared to malignant ones (22.6%). The most common tumor was lentigo maligna (75.2%), followed by superficial spreading melanoma (14%) and nodular melanoma (10.8%). Among all tumors, the left cheek was the most frequent facial location (45.2%). A significant correlation was found between the T criterion and melanoma morphology: Tis was most often observed in lentigo maligna, T2 in superficial spreading melanoma, and T4 in nodular melanoma (p < 0.01). Surgical radicality was significantly linked to recurrence rates (p = 0.012, χ2 = 11.673). ROC curve analysis suggested that an excision margin of at least 0.6 cm can reduce recurrence, but the optimal margin should be adjusted based on tumor thickness, with thicker tumors requiring wider excisions for clear resection. Over an 8-year period, 8 recurrences were reported: 3 within the first year, 2 within two years, 2 after three years, and 1 more than five years post-surgery. Lentigo maligna accounted for the majority of recurrences (6 cases), with one case each of nodular melanoma and superficial spreading melanoma. The most frequent adjuvant treatment following non-radical surgery or recurrence was repeated excision, used in 66.7% of cases. Conclusions Facial melanoma excision is challenging due to complex anatomy. This study found that a surgical margin of at least 0.6 cm significantly reduces recurrence, though the ideal margin may vary with tumor thickness. Clear margins and repeat excisions are essential for better long-term outcomes.

Introduction. High-pressure injuries (HPIs) of the hands which occur in about one out of every 600 hand traumas are caused by tools that emit high-pressure jet streams. These incidents which frequently involve paint or diesel oil can lead to material diffusion into tendon sheaths, impacting neurovascular bundles. HPIs are often underestimated due to their small entry wounds, but they pose serious risks from pressure, chemicals and infections so it is critically important to recognize these cases and treat them properly. Case report. A 42-year-old industrial worker suffered a high-pressure injury to his right hand’s second finger from a ruptured oil pipe (3 bar). Following surgical repair of the 1 cm laceration, the patient re-presented the subsequent day with escalating pain and edema extending dorsally. X-ray and ultrasound confirmed subcutaneous emphysema extending from the index finger to the palm. A multidisciplinary approach ensued, encompassing surgical incisions, drain placement and lavage with a chlorhexidine and hydrogen peroxide solution to reduce excessive oil retention. The wound was dressed in octenidine dihydrochloride bandages and chlorhexidine irrigation was conducted every two days. After 17 days the patient was transitioned to outpatient care, with necrectomy performed a month later. Normal finger function was restored after four months though with residual swelling. Discussion. The presented case underscores the severity of HPIs to the hands, emphasizing the need for fast and comprehensive management. The successful restoration of finger function and residual swelling after four months emphasize the importance of an attentive approach in managing HPIs for optimal patient outcomes. Conclusions. Doctors should assess the patient’s anamnesis and initiate appropriate treatment as soon as possible in cases of high-pressure injuries (HPIs). The use of multiple incisions and decompression, followed by wound washouts proves to be an effective treatment.