Pranys, Darius

Background and Clinical Significance: Meningiomas are among the most common primary intracranial tumors, usually benign and slow-growing. Extracranial extension is exceptionally rare, particularly when arising from convexity meningiomas extending into the temporal fossa. Such cases pose unique diagnostic and therapeutic challenges due to their atypical growth patterns and anatomical complexity. Case Presentation: A 63-year-old woman previously treated for a right temporal convexity meningioma with subtotal resection and Gamma Knife radiosurgery demonstrated progressive extracranial tumor growth over five years, while the intracranial component remained stable. MRI revealed infiltration of the temporalis and lateral pterygoid muscles and erosion of the temporal bone. Due to extensive extracranial involvement and limited neurosurgical accessibility, resection was performed by a maxillofacial surgical team through a preauricular approach. Intraoperatively, the tumor was encapsulated but adherent to the deep temporal fascia and zygomatic arch. The temporal branch of the facial nerve was identified and preserved. Histopathology confirmed a meningothelial meningioma, WHO Grade I, with low proliferative activity (Ki-67 < 1%). Postoperative recovery was uneventful, with transient facial nerve weakness that resolved within weeks. Conclusions: This report adds to the limited literature describing temporal fossa involvement by convexity meningiomas and illustrates the value of collaboration between neurosurgical and maxillofacial teams. Regular MRI surveillance every 6–12 months is advised for early detection of recurrence.

Background & Objectives: Pheochromocytoma is a neuroendocrine neoplasm that originates from chromaffin cells of the adrenal medulla. The incidence of pheochromocytomas ranges from 0.4 to 9.5 cases per 1 million person-years with national and regional differences. The aim is to overview clinical and histopathological features of pheochromocytomas cases in local pathology department. Methods: Pheochromocytoma cases processed and analysed morphologically in pathology laboratory from 2007 to 2024 were selected for the study. The patient’s age, sex and pathology report data were collected, and cases were re-examined based on TNM classification, GAPP grading system (histological patterns, cellularity). Statistical analysis was performed (p ≤ 0,05). Results: Among 114 cases, 43% were male (n=49; median age: 53 years, IQR: 23) and 57% female (n=65; median age: 58 years, IQR: 23; U=1476, p=0.51). The number of cases increases linearly, peaking at 45-60 years for males (40.8%, n=20) and 55-75 for females (49.2%, n=32). Number of cases increased from 0.9% (n=1) in 2010 to 13.2% (n=15) in 2023. Right-sided tumours were subtly more common (51.8%), with 1.8% (n=2) bilateral cases. Most tumours (65.5%, n=74) were <5 cm. The zellballen pattern was most frequent (49.1%, n=56) mostly in females (60.7%, n=34), followed by large and irregular cell nests (47.2%, n=51, p=0.374). Moderate cellularity was most common amongst different patterns (43.5%, n=47, χ²=2.741, p=0.602). Metastasis was found in 7% (n=8) of the cases and in 75% (n=6) females. Metastasis occurred mainly 10-12 years after the primary tumour diagnosis with tumour size <5cm (87.5%, n=7). Conclusion: The incidence of diagnosed pheochromocytomas has been increasing annually. Pheochromocytomas were more prevalent in older age groups predominantly in females. No significant distribution difference was observed between left- and right-side tumours. Most metastases were detected 10–12 years after the initial tumour diagnosis, mostly in females, suggesting that follow-up should be prioritized beyond a decade after the primary diagnosis.

Objectives Whether vegetables and fruits consumption is associated with lower risk of breast cancer by tumour hormone receptor status is still unclear. The aim of the study was to examine the association between vegetables and fruits and breast cancer subtypes by tumor hormone receptor status. Materials and Methods A hospital-based case-control study was performed in 509 cases and 1170 controls. Information on vegetables and fruits consumption and other risk factors was collected via a questionnaire. Logistic regression was used for analyses. All statistical tests were two-sided. Results Adjusted odd ratio (OR; 95% confidence intervals (95% CI) found for the highest third, as compared with the lowest third, of intake of carrots was 0.39 (0.28-0.56, P for trend < 0.001), cabbages 0.49 (95% CI 0.35-0.70, P for trend < 0.001), garlic 0.54 (95% CI 0.38-0.75; P for trend < 0.001), and onions 0.63 (95% CI 0.47-0.85; P for trend 0.003). Intake of sweet paprika ≥1-2 times /week as compared with those women with lower intake, also decreased risk of breast cancer 1.75 times (OR=0.57, 95% CI 0.46-0.71; P for trend < 0.001). Consumption of citrus and non-citrus fruits was not associated with risk of breast cancer. There was no evidence of heterogeneity in the associations between dietary items (per category increase) and ER+/PR+, ER+/PR-, or ER-/PR- breast cancer. Conclusions The findings suggest that higher intake of vegetables such as carrots, cabbages, garlic, onions, and sweet paprika may reduce the risk of breast cancer in white Caucasian women, regardless of tumor hormone receptor subtype.

Immunotherapy treatment with checkpoint inhibitors (ICIs) has led to a breakthrough in the treatment of oncological diseases. Despite its clinical effectiveness, this treatment differs from others, such as cytotoxic chemotherapy, in that it causes immune-related adverse events. This type of toxicity can affect any organ or organ system of the body. We present a literature review and a rare clinical case from our clinical practice, in which a patient with metastatic clear cell renal carcinoma was treated with a single dose of dual checkpoint blockade (cytotoxic T-lymphocyte-4 (CTLA-4) and programmed death-1 (PD-1)) and simultaneously diagnosed with colitis, hepatitis, and nephritis. After early immunosuppressive treatment with the glucocorticoids, complete organ function recovery was achieved. The follow-up revealed a sustained complete response lasting more than a year.

Plaučių vėžys vis dar tebėra didžiulė grėsmė ne tik pasaulio, Europos Sąjungos, bet ir Lietuvos gyventojams. Siekiant pagerinti pagalbą plaučių vėžiu sergantiems ligoniams bei suartinti 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 septintąsias 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 vėžys išlieka viena dinamiškiausių naujovių atžvilgiu onkologijos sričių, todėl ankstesnes rekomendacijas buvo būtina atnaujinti apžvelgiant svarbiausias ir prigijusias naujoves. Plaučių vėžio prevencija, ankstyva diagnostika ir atrankinė patikra yra viena prioritetinių sričių naujame Europos Sąjungos kovos su vėžiu plane – numatoma šią patikrą Europos Sąjungos šalyse įdiegti artimiausioje ateityje. Todėl šiose rekomendacijose pristatome tikslinės plaučių vėžio atrankinės patikros gaires, kurios sėkmingai pritaikytos daugelyje Euriopos Sąjungos šalių. Dar kartą akcentuojama darinių plaučiuose, kurių bus randama vis daugiau įdiegus atrankinę plaučių vėžio patikrą, diagnostikos rekomendacijų ir naujų invazinių diagnostinių pulmonologinių technologijų svarba. Plaučių vėžio diagnozė neretai dėl besimptomės eigos ar nespecifinių simptomų nustatoma pavėluotai, kai liga jau būna pažengusi ir radikalūs gydymo būdai negalimi, pacientų ištyrimas užsitęsia, jis fragmentuojamas, todėl pirmą kartą šiose rekomendacijose pristatome detalų ir standartizuotą paciento kelią – nuo šeimos gydytojo iki gydytojo specialisto, nuo įtarimo iki gydymo. Atrandant vis daugiau molekulinių plaučių vėžio taikinių, tobulėja patologijos ir molekulinės biologijos technologijos, plečiasi taikinių terapijos ir imunoterapijos arsenalas. Autoriai tiki, kad atnaujintas leidinys bus naudingas mūsų šalies gydytojams, kuriems tenka panaudoti savo profesines žinias ir sugebėjimus teikiant pagalbą šia grėsminga liga sergantiems pacientams.

Įvadas Antinksčių žievės karcinoma - tai retas, dažnai agresyvios eigos piktybinis navikas. Dauguma pacientų (80 proc.) diagnozės nustatymo metu yra besimptomiai. Paprastai šios ligos prognozė bloga, o 5 metų išgyvenamumas yra 20-25 proc. Klinikinis atvejis 37 m. amžiaus vyras atvyko į LSMUL KK dėl bendro silpnumo, nuovargio, protarpinio pilvo skausmo ir svorio kritimo (~ 10 kg per 9 mėn.). Atsitiktinai pilvo UG rastas dešiniojo antinksčio darinys. Klinikinė apžiūra: klinikinių hiperkortizolemijos požymių nestebėta. Laboratoriniai tyrimai: duomenų už feochromocitomą ir pirminį hiperaldosteronizmą nepakanka. 1 mg deksametazono supresijos mėginys - kortizolio supresija negauta. Mažų dozių ir didelių dozių Deksametazono mėginys - patologinis. Pilvo organų KT tyrimas: dešiniajame antinkstyje yra nehomogeniškas, aiškių ribų, ~4.6 x 4.1 cm dydžio, netolygiai kaupiantis kontrastą darinys su smulkiais kalcinatais. Atlikta laparoskopinė totalinė dešinės pusės adrenalektomija. Makroskopinio tyrimo aprašymas: dešinysis antinkstis su aplinkiniu riebaliniu audiniu 7.5 x 5 x 4 cm, pjūviuose gelsvas, su kraujosruvomis 5 x 4.5 x 3.1 cm dydžio darinys. Mikroskopinio tyrimo aprašymas: pašalintame antinkstyje rastas navikas, kurio apie 50 proc. ploto sudaro lobulinėmis ir alveolinėmis struktūromis besidėstančios, vidutinio dydžio ląstelės, turinčios apvalius, chromatingus branduolius bei vidutinio gausumo, švelniai eozinofilišką citoplazmą. Kitą naviko komponentą, apimantį iki 3.0 cm ploto, formuoja polimorfiškos, vidutinio dydžio bei didelės atipinės ląstelės, turinčios labai akcentuotus, polimorfiškus, chromatingus branduolius bei įvairaus gausumo, švelniai eozinofilišką citoplazmą. Dalis navikinių ląstelių monstriškos. Rasti siauri naviko nekrozės plotai bei platūs fibrozinio audinio intarpai. Šio komponento navikinių ląstelių mitozių rasta iki 3/10DPRL (6/50DPRL). Fibrozinės antinksčio kapsulės peraugimo nerasta. Išvada: antinksčio žievės karcinoma žievės adenomos fone pT1 Nx Mx LVI R0. Krūtinės ir pilvo KT: dešinysis antinkstis pašalintas, kairysis - be pakitimų, kita - norma - išplitimo požymių nematyti. DEXA: osteopenija. Genetiko konsultacija dėl galimo MEN1, Beckwith-Wiedemann‘o, Lynch‘o sindromų. Taikyta pooperacinė pakaitinė terapija Hidrokortizonu 30 mg/p. Reninas, aldosteronas, kortizolis (hidrokortizono vartojimo fone), AKTH, elektrolitai - normos ribose. Išvados Nefunkcionuojanti antinksčių karcinoma ir jos nespecifinė klinika gali būti iššūkis ligos diagnostikoje ir reikalauja atidžių klinikinių tyrimų. Nespecifinė antinksčių žievės karcinomos klinika dažnai gali lemti vėlyvą diagnozę, o tai lemia ligos progresavimą lokaliai bei sistemiškai.

Introduction Adrenal cortical carcinoma (ACC) is a rare and aggressive malignancy. Most patients (80%) are asymptomatic at the time of diagnosis. ACC generally has a poor prognosis with a 5-year survival rate of 20–25%. Case A 37-year-old man came to the Hospital of Lithuanian University of Health Sciences Kaunas Clinics for general weakness, fatigue, intermittent abdominal pain, and weight loss (w 10 kg in 9 months). During the abdominal US, the mass in the right adrenal gland was found. Physical examination: no clinical signs of hypercortisolemia and no changes in other endocrine systems were observed. Laboratory tests Diagnosis of pheochromocytoma and primary hyperaldosteronism excluded. 26.10.20 – 1 mg of Dexamethasone test – no suppression of cortisol was detected, low-dose and high dose Dexamethasone suppression tests – pathologic (Table 1). Abdominal CT In the right adrenal gland – w 4.6!4.1 cm mass, non-homogeneous with microcalcifications, unevenly accumulates contrast. Laparoscopic right adrenalectomy was performed. Macroscopic examination Right adrenal gland 7.5!5!4 cm, in incisions yellowish 5!4.5!3.1 cm mass. Microscopic examination About 50% of the tumor consists of cells, which layout in lobular and alveolar structures. Cells are medium-sized with round, chromatic nuclei and a moderately abundant, mildly eosinophilic cytoplasm. Another component of the tumor takes up to 3.0 cm of the tumor itself and is formed by polymorphic medium-sized and large atypical cells with highly accentuated, polymorphic, and chromatic nuclei. The cells have mildly eosinophilic cytoplasm of varying abundance. Part of the tumor cells is monstrous. Narrow areas of tumor necrosis and wide inclusions of fibrous tissue were found. No overgrowth of the fibrous adrenal capsule was found. Conclusion: adrenal cortical carcinoma against the background of cortical adenoma pT1 Nx Mx LVI R0. Chest and abdominal CT Right adrenal gland is removed, no signs of metastases were observed, left without changes. DXA Osteopenia. MEN1, Beckwith-Wiedemann, and Lynch syndromes were ruled out by genetic tests. Post-operative treatment included Hydrocortisone 20–30 mg/d replacement therapy. Renin, aldosterone, cortisol (in the background of Hydrocortisone use), ACTH, electrolytes – all in the normal range (Table 1). Conclusion Non-functioning adrenal carcinoma and its nonspecific clinic may be a challenge in the diagnosis of the disease and require careful clinical examination. Nonspecific clinics of adrenal cortical carcinoma can often lead to a late diagnosis, leading to local and systemic progression of the disease.

Background: Pulmonary tumour thrombotic microangiopathy (PTTM) is a fatal disease in which tumour cells embo‑lize to the pulmonary vasculature leading to pulmonary hypertension and right heart failure. Early diagnosis is essen‑tial for timely treatment which can reduce intimal pulmonary vascular proliferation and prolong survival, improve the symptoms. Due to rare occurrences and no clear diagnostic guidelines the disorder usually is found post-mortem. We present a review of this rare disease and a case of post-mortem diagnosed pulmonary tumour thrombotic microangi‑opathy in a young female.Case presentation: 51 years old woman presented with progressively worsening dyspnea, right ventricular failure signs and symptoms. Computerized tomography denied pulmonary embolism. 2D transthoracic echocardiography demonstrated right ventricle dilatation and dysfunction, severely increased systolic pulmonary pressure. Right heart catheterization revealed pre-capillary pulmonary hypertension with mean pulmonary artery pressure of 78 mmHg, pulmonary wedge pressure of 15 mmHg, reduced cardiac output to 1.78 L/min with a calculated pulmonary vascular resistance of 35 Wood units, and extremely low oxygen saturation (26%) in pulmonary artery. Because of worsening ascites, pelvic magnetic resonance imaging was performed, tumours in both ovaries were diagnosed. Due to the high operative risk, detailed tumour diagnosis surgically was not established. The patient developed progressive cardiores‑piratory failure, unresponsive to optimal heart failure drug treatment. A postmortem morphology analyses revealed tumorous masses in pre-capillary lung vessels, right ventricle hypertrophy, ovary adenocarcinoma.Conclusions: An early diagnosis of PTTM is essential. Most cases are lethal due to respiratory failure progressing rapidly. Patients with a history of malignancy, symptoms and signs implying of PH should be considered of having PTTM. If detected early enough, combination of chemotherapy with specifc PH therapy is believed to be benefcial in reducing intimal proliferation and prolonging survival, along with improving the symptoms.

Plaučių vėžys vis dar tebėra didžiulė grėsmė ne tik pasaulio, Europos Sąjungos, bet ir Lietuvos gyventojams. Siekiant pagerinti pagalbą plaučių vėžiu sergantiems ligoniams bei suartinti 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 keleri metai išleidžiamos "Plaučių vėžio diagnostikos ir gydymo rekomendacijos". Šios – šeštosios atnaujintos ir papildytos plaučių vėžio diagnostikos ir gydymo rekomendacijos yra gausaus autorių, savo srities ekspertų ir pagrindinių Lietuvos sveikatos priežiūros specialistų draugijų atstovų, kolektyvo ilgametės patirties, bendro nuolatinio darbo rezultatas. Plaučių vėžys išlieka viena dinamiškiausių naujovių atžvilgiu onkologijos sričių, todėl ankstesnes rekomendacijas buvo būtina atnaujinti apžvelgiant svarbiausias ir prigijusias naujoves, iš kurių paminėtinos plaučių vėžio patikros perspektyvos atliekant mažų dozių krūtinės ląstos kompiuterinę tomografiją didelės rizikos asmenims ir nauji gydymo metodai, tapę gydymo standartais imunoterapijos ir taikinių terapijos srityse.

As the majority of experimental studies suggest cadmium being metalloestrogen, we examined cadmium/breast cancer (BC) association by histological and tumor receptor subtype in 509 invasive BC patients and 1170 controls. Urinary cadmium was determined by atomic absorption spectrometry, and categorized using tertiles of its distribution in the controls: <0.18, 0.18-0.33, >0.33 kg × 10-9/kg × 10-3 creatinine. Relative to the lowest category of urinary cadmium adjusted odds ratio (OR) of ductal BC was 1.18 (95% confidence interval (CI): 0.89-1.58) in the intermediate and 1.53 (95% CI: 1.15-2.04) in the highest category. There was a significant association for hormone receptor-positive ductal BC: ORs per category increase were 1.34 (95% CI: 1.14-1.59) for estrogen receptor-positive (ER+), 1.33 (95% CI: 1.09-1.61) for progesterone receptor-positive (PR+) and 1.35 (95% CI: 1.11-1.65) for ER+/PR+ BC. We found a significant association between cadmium and human epidermal growth factor receptor 2-negative (HER2-) ductal BC. The strongest association with cadmium was for ER+/PR+/HER2- ductal BC. The associations between cadmium and lobular BC with hormone receptor-positive and HER2- were positive but insignificant. There was no evidence that the associations with cadmium differed for cancers with different tumor histology (p-heterogeneity > 0.05). This study provides evidence that urinary cadmium is associated with the risk of hormone receptor-positive and HER2- breast cancer independent of tumor histology.