Šarauskas, Valdas

Objectives Congenital epulis (CE) is a rare benign tumour typically arising from the alveolar ridge and more frequently observed in female neonates. The report highlights its potential impact on neonatal breathing and feeding, emphasizing the importance of early recognition and management.

Case presentation We present a case of a female neonate with a giant CE detected on prenatal ultrasound. After the birth the lesion interfered with feeding, while respiratory function remained unaffected. Three masses were surgically dissected from the maxillary mucosa and the neonate successfully transitioned to oral feeding within the first week. Histopathological examination revealed a granular cell tumour with negative immunoreactivity for S100.

Conclusions The case underlines the significance of prenatal diagnosis, collaborative multidisciplinary planning, and, when indicated, the application of the EXIT procedure for congenital orofacial tumours with potential airway obstruction. Early recognition and integrated care can substantially improve neonatal prognosis.

Plaučių vėžys vis dar tebėra didžiulė grėsmė ne tik pasaulio, Europos Sąjungos, bet ir Lietuvos gyventojams. Siekiant pagerinti pagalbą plaučių vėžiu sergantiems ligoniams, suvienodinti specialistų požiūrį į šios ligos diagnostikos ir gydymo standartus, Lietuvos sveikatos mokslų universiteto ir Lietuvos sveikatos priežiūros specialistų draugijų iniciatyva bei bendru darbu nuo 2007-ųjų kas kelerius metus išleidžiamos „Plaučių vėžio diagnostikos ir gydymo rekomendacijos“. Išlaikydami tradicijas ir tęstinumą pristatome aštuntąsias atnaujintas ir papildytas „Plaučių vėžio diagnostikos ir gydymo rekomendacijas“, kurios yra gausaus autorių, savo srities ekspertų ir pagrindinių Lietuvos sveikatos priežiūros specialistų draugijų atstovų, kolektyvo ilgametės patirties, bendro nuolatinio darbo rezultatas. Plaučių vėžio gydymas išlieka viena dinamiškiausių onkologijos sričių, todėl ankstesnes rekomendacijas buvo būtina atnaujinti apžvelgiant svarbiausias prigijusias naujoves. Plaučių vėžio profilaktika, ankstyva diagnostika ir atrankinė patikra yra viena iš prioritetinių sričių naujame Europos Sąjungos kovos su vėžiu plane. Kai kuriose Europos Sąjungos šalyse jau yra įdiegtos nacionalinės plaučių vėžio patikros programos, kitose, taip pat ir Lietuvoje, vykdomos ar jau atliktos bandomosios programos. Tačiau, kol nėra patvirtinta nacionalinė plaučių vėžio patikros programa Lietuvoje, šiose rekomendacijose paliekame tikslinės plaučių vėžio atrankinės patikros gaires, kurios sėkmingai pritaikytos daugelyje Europos Sąjungos šalių ir yra patvirtintos Lietuvoje Plaučių vėžio metodiniame dokumente. Tikimės, kad netolimoje ateityje galėsime pristatyti ir nacionalinę plaučių vėžio atrankinės patikros programą. [...].

Background & Objectives: Extensive study of a pathology autopsy data trends in different historical periods reflects a validated historical data on evolution of clinical medicine in different regions, also assisting in standardizing the control of disease frequency evaluation. Study objective is to determine trends of autopsies in 1923 – 1970 of local Lithuanian pathology centre. Methods: Archival documents of pathology autopsy of 2128 patients who died in 1923-1925, 1930, 1935, 1940, 1945, 1950, 1960, and 1970 in local Lithuanian pathology centre were selected. Data parameters of age, sex, and main disease diagnosed after pathology autopsy were collected from archival protocols. Descriptive statistics and χ2 test were applied (p<0.05). Bioethical committee approval no. BEC-MF-342. Results: Rate of adult pathology autopsies was 88.1% in 1923-1925, 82.9% in 1930, 88.7% in 1935, 71.1% in 1940, 88.7% in 1945, 45.6% in 1950, 62.4% in 1960, and 79.1% in 1970. Average patient‘s age of selected cases increased from 35.6 years old in 1923-1925 up to 57.4 years old in 1970. More than 60% of pathology autopsies were performed for men in 1923-1925, whereas 55.4% of selected cases were men autopsies in 1970. Infectious diseases were predominant in 1923-1925 (22.3%), which continued to decrease up to 4.9% in 1970 (p<0.05). Neoplasia were diagnosed in 16.5% cases in 1923-1925, and increased up to 35.4% in 1970 (p<0.05). Rate of cardiovascular diseases was 14.7% in 1923-1925 and increased up to 30.2% in 1970 (p<0.05). Conclusion: Significant trends of pathology autopsy of local Lithuanian pathology centre in 1923-1970 was characterized in the study. Rates of adult pathology autopsy, changes in patient‘s age and sex, as well as main disease reflects the impact of historical events on sociodemographic and clinical medicine trends, emphasizing the role of pathology autopsy as an effective tool to monitor accurate and timely status of clinical medicine situation in local region.

Objective: This study aimed to assess the diagnostic value of contrast-enhanced ultrasound (CEUS) time–intensity curve (TIC) parameters in detecting non-ossified thyroid cartilage invasion in patients with laryngeal squamous cell carcinoma (SCC). Methods: A CEUS TIC analysis was performed on 32 cases from 27 patients with histologically confirmed laryngeal SCC. The diagnostic performance of time to peak (TTP), peak intensity (PI), wash-in slope (WIS), area under the curve (AUC), and their quantitative differences (∆TTP, ∆PI, ∆WIS, and ∆AUC) to discriminate between the invaded and the non-invaded non-ossified thyroid cartilage was determined using ROC analysis. A logistic regression analysis was employed to identify significant predictors. Results: In an ROC analysis, of all TIC parameters analyzed separately, ∆TTP showed the greatest diagnostic performance (AUC: 0.85). A ∆TTP cut-off of ≤ 8.9 s differentiated between the invaded and the non-invaded non-ossified thyroid cartilage with a sensitivity of 100%, specificity of 76.9%, and accuracy of 81.3%. A combination of ∆TTP and PI increased the AUC to 0.93, specificity to 100%, and accuracy to 96.8%, but reduced the sensitivity to 83.3%. Meanwhile, the visual assessment of enhancement on CEUS to detect cartilage invasion had 83.3% sensitivity and 84.6% specificity. In a univariate logistic regression, only ∆TTP was a significant predictor of non-ossified thyroid cartilage invasion (OR: 0.80; 95% CI: 0.64–1.00). For every second increase in ∆TTP, the probability of thyroid cartilage invasion decreased by 20%. Conclusions: CEUS TIC parameters, particularly a combination of ∆TTP and PI, showed high diagnostic performance in the detection of non-ossified thyroid cartilage invasion in laryngeal SCC.

Introduction Papillary thyroid carcinoma (PTC), originating from follicular epithelial cells, accounts for over 90% of thyroid cancers. In contrast, medullary thyroid carcinoma (MTC) arises from the parafollicular cells, and is characterized by the production of calcitonin. The simultaneous occurrence of PTC and MTC is a rare phenomenon and occurs in less than 1% of thyroid tumors. Therefore, it is crucial to conduct further research on the outcomes of concurrent PTC and MTC. Case A 72-year-old female had been monitored for 3 years due to nodular thyroid disease and subclinical hyperthyroidism. Hashimoto’s thyroiditis and Graves’ disease were excluded. Thyroid ultrasound There are hypoechoic nodules in the upper part of the thyroid (1.7 x 1.1 cm) and in the isthmus (0.7 cm). Fine-needle aspiration biopsy (FNAB) was performed. Thyroid scintigraphy with 99mTc "Cold" nodule in the thyroid gland. Cytological examination Not possible to rule out a tumor. Treatment In 2018, the patient underwent thyroidectomy and neck lymphadenectomy. Levothyroxine 100 mg/day for replacement maintains stable euthyroidism. Microscopic examination Papillary thyroid microcarcinoma pT1a / Medullary thyroid carcinoma pT1b. No mutations were found in KRAS codons 12/13, 61, 117, 146, or in NRAS codons 12/13, 59-61, 117, 146. Genetic consultation No known pathogenic or potentially pathogenic mutations in the RET gene, nor mutations of unknown clinical significance or likely benign sequence alterations were detected. Laboratory tests Pre-surgery calcitonin level was measured at 17.1 pmol/l. The following markers were monitored for the evaluation of recurrence post-surgery: CEA, calcitonin, thyroglobulin, and antiTg. All values remained within the reference range. Follow-up The patient undergoes annual oncological surveillance for thyroid carcinoma recurrence, including neck, chest, and abdomen imaging. No metastasis or recurrence has been observed. Neck ultrasound shows no pathological changes. Conclusions The concurrent occurrence of PTC and MTC in a single patient is exceptionally rare. Therefore, this case provides valuable insights into the management of simultaneous thyroid malignancies, emphasizing the importance of early detection and long-term follow-up to monitor for recurrence or metastasis.

Straipsnyje pateikiamos idiopatinės plaučių fibrozės (IPF) ir progresuojančios plaučių fibrozės (PPF), sergant fibrozuojančia intersticine plaučių liga (IPL), išskyrus IPF, diagnostikos ir gydymo rekomendacijos. Šiose rekomendacijose pateikiami radiologiniai ir histopatologiniai IPF ir PPF diagnostikos kriterijai, taip pat dabartinio gydymo galimybės.

Kvėpavimo organų pažeidimas dažnai nustatomas pacientams, sergantiems pirminiu humoraliniu imunodeficitu. Infekcinės ir neinfekcinės plaučių komplikacijos dažnai lemia nepalankią prognozę. Kvėpavimo ligos, susijusios su imunodeficitu, nustatymas laiku, komplikacijų stebėsena ir gydymas gali sumažinti ligos naštą.

Pasaulyje kasmet nustatoma daugiau nei 180 000 naujų gerklų vėžio atvejų ir apie 100 000 mirties atvejų. Jungtinėse Amerikos Valstijose per metus diagnozuojama apie 12 400 naujų gerklų karcinomos atvejų ir aprašoma apie 3800 mirčių nuo šios ligos [1], Gerklų vėžys yra antra dažniausia galvos ir kaklo srities onkologinė liga. Tai yra vienuolikta dažniausia vėžinė liga vyrų populiacijoje, tačiau gerokai rečiau nustatoma moterims. Pagal įvairius literatūros duomenis sergamumo gerklų vėžiu vyrų ir moterų santykis yra 11 :1 [2]. Daugiausia pacientų, sergančių gerklų karcinoma, nustatoma 60-70 metų grupėje. Didelę reikšmę gerklų vėžiui atsirasti turi rūkymas ir alkoholinių gėrimų vartojimas. Rūkantys asmenys turi 6,5 karto didesnę tikimybę susirgti gerklų vėžiu. Prie rizikos veiksnių taip pat priskiriama darbas su naftos perdirbimo ir deginimo produktais, gastroezofaginis refliuksas, žmogaus papilomos virusas. Pagal naujausius prieinamus nacionalinio vėžio registro duomenis kiekvienais metais 100 000 gyventojų tenka 6,6 naujų gerklų vėžio atvejų, penkerių metų realiatyvus išgyvenamumas - 69 proc., o 60 proc. pacientų kreipiasi jau esant įsisenėjusiai (III-IV stadijų) ligai [3, 4], Todėl ypač svarbu gerinti gerklų vėžio diagnostikų. Svarbu atsiminti, jog žmogus, kuris skundžiasi ilgiau nei 3 savaites nepraeinančiu užkimimu, privalo būti konsultuojamas gydytojo otorinolaringologo.

Objective Parathyroid carcinoma (PC) is considered a rare malignancy which accounts for less than 1% of hyperparathyroidism cases in reported literature. In B. C. James study there were only 348 cases of PC reported in SEER database 2000-2012, which compose 0,36 (per 1 million) incidence rate. PC occurrence is equal in men and women, while benign parathyroid diseases incidence is higher in women with ratio 3-4:1. Diagnostic criteria were established in 1973 by A. Schantz and B. Castleman which include thick fibrous bands, mitotic activity, vascular and capsular invasion in pathomorphological tests. The variations and pathognomic features are debated as there have been reported large series of patients with metastatic tumours of which as many as 50% were initially misdiagnosed as benign tumours, therefore preoperative diagnosis and staging is often incorrect or not available. Imaging techniques such as sestamibi scintigraphy and neck ultrasound are only used in localizing the parathyroid tissue preoperatively and >3cm size mass may raise suspicion of PC as denoted in Cetani study, however these techniques are in no way diagnostic of PC. This lead to diagnostic markers application such as Ki-67, Cyclin D1, which are more specific to PC than parathyroid adenoma. The course of disease is indolent and most deaths occur due to untreated complications of hypercalcemia. Ten cases of PC were treated in our hospital during the period of 17 years. This review focuses on our experience with the diagnosis, treatment and survival of the patients. Our aim was to review the demographics, diagnostics, treatment and outcomes of the patients, who were surgically treated for parathyroid carcinoma in the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. As large part of contemporary literature on the topic is referencing the older studies from the year 2000 and before, we think that a more recent standpoint can contribute to better understanding the PC. Methods The model of the study was retrospective. Data on demographics, initial symptoms, preoperative diagnostic blood tests and instrumental procedures, surgical operations, complications, postoperative blood tests, and histology of tumours was collected. The data concerning patients‘ survival was acquired from the Lithuanian National Cancer Institute’s Cancer Registry. Results There were 10 patients who were treated surgically for parathyroid carcinoma. During the study period patients with PC accounted for 2,2 percent of all the patients with parathyroid gland pathology treated surgically in our clinic. Among PC patients there were 7 females, age distribution was from 54 – 74, mean – 64 years. Eighty percent of admitted patients suffered from complications. The most prevalent symptoms were renal function impairment, nephrolithiasis and subsequent pyelonephritis. Three patients had suffered from spontaneous bone fractures. Other common complaints included joint pain and malaise, hoarseness of voice.. Five patients had palpable disease at time of admission. One patient was asymptomatic (Table 1). Preoperative blood tests showed increased serum calcium 2,62-3,4 mmol/l (normal range (NR) – 2,15-2,55 mmol/l), ionized calcium 1,15- 1,57 mmol/l (NR – 0,98-1,13 mmol/l), and PTH 23,91 – 210 pmol/l (NR – 1,2-5,3 pmol/l), which plunged to normal range after surgical treatment. All patients were tested with ultrasound and scintigraphy. Five fine needle aspirational (FNA) punctures of nodules were performed (Table 3). None of the tests were diagnostic of parathyroid carcinoma preoperatively, nevertheless 5 out of 5 cytology showed features of malignancy. En-bloc parathyroidectomies were performed on all patients with various extents of thyroid gland removal. The diagnoses of PC were confirmed with histologic tests. Most prevalent features included vascular invasion (70%), capsular invasion (60%) and presence of fibrous bands (60%). There were no cases with distant metastases at initial surgery and lymphonodectomies were not performed. Data from Cancer registry showed, that 8 out of 10 patients were alive (survivability ranging from 4 months to 16 years postoperatively). Two of the patients have deceased due to carcinoma of pancreas and thyroid gland 2 and 4 years respectively after the operation. Conclusions Parathyroid carcinoma has complex diagnostics and staging because of its rarity and lack of studies. Majority of PC patients present with hypercalcemia and its complications – renal insufficiency, nephrolithiasis. Palpable neck mass is prevalent in half of the patients. Lesser than 3,5 mmol/l values of serum calcium should not lessen the suspicion of PC. The outcome of non-metastasized PC is favourable when en-bloc resection of the tumour is performed. Brief description of the abstract Objective: Review the diagnostics, treatment and outcomes of the patients, who were surgically treated for parathyroid carcinoma in the Hospital of LUHS Kauno klinikos from 2003 to 2019. Conclusions: Majority of PC patients present with hypercalcemia and its complications – renal insufficiency, nephrolithiasis. Lesser than 3,5 mmol/l values of serum calcium should not lessen the suspicion of PC. The outcome of non-metastasized PC is favourable when en-bloc resection of the tumour is performed.

Background: Imaging staging of local laryngeal cancer spread plays an important role in choosing suitable treatment strategy which can affect the quality of life. The main diagnostic radiology exams are contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI), however cross-sectional modalities sometimes might have false-positive results, especially in detection of non-ossified thyroid cartilage invasion. Contrast-enhanced ultrasound (CEUS) has a potential in assessing non-ossified thyroid cartilage invasion. Purpose: to assess the value of CEUS, CECT, MRI in detection of non-ossified thyroid cartilage invasion. Methods: Twenty-three patients with laryngeal squamous cell carcinoma with suspected invasion to non-ossified thyroid cartilage initially had CECT, followed by CEUS and eighteen of the patients also had MRI before surgery. Five patients had more than one possible invasion site. The imaging findings of laryngeal carcinoma were evaluated and compared with the postoperative histopathological findings, which were chosen as a gold standard. The dependence of possible thyroid cartilage invasion on laryngeal carcinoma local and distant spread were evaluated. Results: In total 9 thyroid cartilage invasion sites were detected on histopathological examination. The sensitivity, specificity, and accuracy in detection of thyroid cartilage invasion were 88.9%, 78.9%, and 82.1% for CEUS, 66.7%, 78.9%, and 75.0% for CECT, and 100.0%, 50.0%, and 61.9% for MRI, respectively. Our study showed that CEUS and CECT are more accurate than MRI (P<0.05), there was no statistically significant difference between CEUS and CECT. Also, there was tendency of false positive results in CEUS and CECT when laryngeal carcinoma was more locally disseminated. Thyroid cartilage invasion did not show dependence on distant spread of disease. Conclusion: CEUS showed high diagnostic value in detection of non-ossified thyroid cartilage invasion comparing with MRI and could be used as a complementary study to CECT especially in less locally disseminated laryngeal cancer.