Skučaitė, Patricija

Introduction Osteal giant cell tumor (OGCT) is considered to be a relatively uncommon, noncancerous primary bone lesion that may transform into a malignant form in rare cases [1,2]. OGCT typically arises in the epiphysis of long bones and, despite being benign in biological neoplastic context, it can spread locally in an aggressive manner and metastasize [3]. Several classification systems are used to determine OGCT aggressiveness, but none fully capture its local spreading potential [4]. Aim To identify morphological factors determining aggressive local spreading of OGCT. Methods 49 cases of OGCT cases morphologically diagnosed in pathology laboratory from 2009 through 2023 were selected for this study. Selected cases of hematoxylin/eosin-stained osteal tissue fragments were analyzed by light microscopy evaluating secondary osteal morphological features of aggressive local spreading and bone aneurysms. Gender, anatomical localization, tumor volume (cm3), presence of neurological symptoms (pain, paresthesia), local osteal symptoms (tumor mass, fracture, deformation), and skeletal dysfunction of the patients were also included in statistical analysis. Statistical analysis, including descriptive statistic (mean (standard deviation), median, interquartile range), tests of normality, Student’s T test, χ2 test, crosstabs of nominal by interval, was performed by applying SPSS 29.0 software (statistical significance p<0.05). Results 46.9% (n=23) men of 39.13 (14.38) years old (y. o.) and 53.1% (n=26) women of 40.04 (16.9) y. o. (t=0.201; p=0.841) were morphologically diagnosed with OGCT (tumor volume’s median – 9.75 cm3, interquartile range – 63 cm3), mostly in lower extremity bones (61.2%, n=30). Morphological features of aggressive local OGCT spreading were detected in 16.3% (n=8), whereas secondary osteal aneurysms were determined in 10.2% (n=5) OGCT cases. Neurological symptoms were present in 59.2% (n=29) OGCT cases. 24.5% (n=12) OGCT cases manifested with local osteal symptoms, and skeletal dysfunction was present in 18.4% (n=9) cases. Morphological features of aggressive local OGCT spreading were more likely to manifest in trunk OGCTs (χ2=12.28; p=0.02) and were most likely directly associated with tumor’s volume (η2=0.18). No secondary osteal aneurysms were detected for all men patients with OGCTs (χ2=4.92; p=0.05). Morphological features of aggressive OGCT local spreading were similar in presence of neurological (χ2=1.861; p=0.173), local osteal symptoms (χ2=0.875; p=0.35), and skeletal dysfunction (χ2=0.22; p=0.639). Conclusions Morphological features of local aggressive OGCT spreading are more likely to be associated with the tumor‘s volume and the OGCTs diagnosed in the trunk skeleton, suggesting.

Introduction Chronic sialadenitis is a recurrent inflammatory condition of the salivary glands. It is often associated with salivary duct obstruction caused by stones, strictures, or other anatomical abnormalities. In severe cases, surgical intervention may be required to alleviate symptoms. Case Presentation The case report describes a 61-year-old female patient who presented with left cheek asymmetry, parotid gland swelling, and significant dilation of Stensen’s duct. The magnetic resonance imaging (MRI) revealed a diffusely reduced parotid gland volume, fibrotic changes and no evidence of inflammatory or malignant lesions. The ductal papilla stenosis was attributed to a previous intervention during which a salivary stone was extracted by incising the papilla. The patient underwent minimally invasive sialendoscopy with ductal dilation to relieve stenosis. Post-procedure, she reported significant symptom relief with reduced swelling. Discussion This case highlights the importance of recognizing and managing ductal papilla stenosis after salivary stone extraction. Sialolithiasis affects more than 1% of the population, mostly the submandibular gland (80-90%). Prognosis is good with early treatment and sialendoscopy reduces recurrence risk. Prevention includes hydration, salivary stimulation and regular follow-up. In this case, minimally invasive techniques restored gland function avoiding surgery. Long-term monitoring remains essential but the patient recovered without complications. Conclusions Chronic parotid gland sialadenitis with ductal stenosis requires precise diagnosis and targeted intervention. This case underscores the efficacy of sialendoscopy and ductal transposition as minimally invasive yet effective solutions for managing chronic sialadenitis, improving gland function and patient quality of life.

Introduction Central Pontine Myelinolysis is a rare neurological disorder caused by myelin loss in the central pons, often linked to rapid correction of chronic hyponatremia [1]. Symptoms range from mild encephalopathy to coma. Diagnosis relies on MRI and clinical signs, with prevention focusing on gradual sodium correction [2]. This case underscores the risks of rapid electrolyte shifts. Case Presentation This case report presents a 49-year-old male who developed pontine and extrapontine myelinolysis following rapid correction of severe hyponatremia. He was admitted to the Emergency Department at Kaunas Clinics from district hospital where he was treated for an unspecified infection for 11 days. During his hospitalisation severe hyponatremia of 98,6 mmol/L was identified, which improved to 140 mmol/L in 10 days. He presented with symptoms including altered consciousness, bulbar symptoms, and limb weakness. A head computed tomography scan was performed, which ruled out cerebrovascular accidents and other structural changes. For further evaluation, the patient was admitted to the Neurology Department, where it was decided to perform a brain magnetic resonance imaging scan, which suggested possible extrapontine and pontine myelinolysis. The patient was treated in the Neurointensive Care Unit for 5 days due to coma and respiratory failure. Based on a review of the scientific literature, treatment with methylprednisolone was initiated as there was no specific treatment available. Given the clinical progression and observed changes, the prognosis was deemed unfavorable and patient passed away on a fifth day. Discussion This case highlights that rapid sodium correction can lead to serious complications. Overcorrection of hyponatremia is defined as a serum sodium increase of >10 mmol/L in 24 hours, >18 mmol/L in 48 hours, or >8 mmol/L/day after the first 24 hours [3]. Therapeutic approaches for myelinolysis such as steroids, plasmapheresis, and intravenous immunoglobulin offer potential benefits but lack standardized protocols [4]. Further research is needed to enhance understanding and management of pontine and extrapontine myelinolysis, particularly in severe cases. Conclusions Rapid sodium correction can cause severe complications like myelinolysis. Gradual correction and further research are crucial for better management.

Pontine and extrapontine myelinolysis represents rare but serious neurological complications associated with the rapid correction of severe hyponatremia. We present a case report of a 49-year-old male who developed pontine and extrapontine myelinolysis following a rapid correction of severe hyponatremia. Initially, the patient was admitted to a district hospital on February 18, 2024 for generalized weakness and an unspecified infection, during which, his sodium level was found to be critically low at 98.6 mmol/L. Rapid treatment raised his sodium to 140 mmol/L over a short period, completing the cor-rection within 10 days. One day after discharge, he was readmitted to the Emergency Department at the Lithuanian University of Health Sciences Hospital Kaunas Clinics on February 29, 2024, with symptoms including altered consciousness, bulbar symptoms, and limb weakness. A head Computed Tomography(CT) scan was performed in the emergency department, which ruled out cerebrovascular accidents and other structural changes in the brain. For further evaluation, the patient was admitted to the Neurology Department, where it was decided to perform a brain Magnetic Resonance Imaging (MRI) scan. As res-piratory failure developed, the patient was transferred to the Neurosurgery Intensive Care Unit (NICU). The brain MRI results confirmed pontine and extrapontine myelinolysis. Based on a review of the scientific literature, treatment with methylprednisolone was initiated. The condition was complicated by septic shock with Multiple Organ Dysfunction Syndrome (MODS), with a potential infection source in the lungs. Despite the treatment provided, the patient passed away after five days in NICU. This case highlights that rapid sodium correction can lead to serious complications, such as myelinolysis. It underscores the neces-sity for gradual sodium correction in patients with severe hyponatremia so that to prevent irreversible neurological damage.

Šiame straipsnyje aptariama seborėjinio dermatito pa­togenezė, simptomai ir gydymo galimybės. Remiantis analizuotais šaltiniais aptartas pagrindinis numanomas seborėjinio dermatito sukėlėjas – Malassezia spp. grybe­lis, sukeliantis dermatito klinikinius simptomus: eritemą, niežulį ir pleiskanojimą. Šie bėrimai dažniausiai loka­lizuojasi galvos, veido ir krūtinės srityse. Efektyviausi gydymo metodai apima emolientų, ketokonazolio prepa­ratų, vietinių kortikosteroidų ir kalcineurino inhibitorių naudojimą. Supratimas apie šios ligos patogenezę bei tinkamų gydymo metodų taikymą yra esminis siekiant efektyviai pagerinti pacientų gyvenimo kokybę.

Introduction & Objectives: cutaneous melanoma (CM) is a malignant skin tumour originating from altered melanocytes and metastasizing quickly to the sentinel lymph node (SLN). The incidence of CM is increasing every year by 2%. The biggest influence on development of CM has sun exposure and genetic predisposition. 5-year survival rate of CM reaches up to 93% and depends on several factors: CM morphological type, Breslow depth, number of mitoses, ulceration, as well as metastases to the SLN and other organs. The exact localization of metastases in the SLN also plays important role in the prognosis. According to research, the best prognosis is when metastases are in the peripheral sinuses of the SLN. Therefore, this study aims to evaluate CM metastases localization in the SLN, correlation with the primary tumour and characteristics of skin melanoma, in the presence of the metastases in the SLN. Materials & Methods: 154 patients diagnosed with localized cutaneous melanoma and regional sentinel lymph metastases between 2002 and 2021 were retrospectively reviewed. The patients were categorized into different groups based on several factors: age (≤44, 45-64, 65-79, ³80; mean age 61), CM localization (head-neck, upper extremities, abdomen-chest, back-trunk, lower extremities), Breslow thickness (<1mm, 1-2mm, 2-4mm, >4mm) and morphological types (superficial spreading, nodular, acral, lentigo maligna, rare). The statistical program IBM SPSS was used for the statistical analysis of the data. Chi-square test and descriptive statistics was used during statistical analysis. Correlation was considered statistically significant when p<0.05. Results: this research indicates that metastases in SLN are more frequent in nodular CM (53.7%), in CM of the lower extremities (37%), Breslow depth >4 mm (51.3%). Additionally, a strong association between CM with SLN metastases Breslow depth and CM morphological type and ulceration was found. Higher Breslow thickness was notably prevalent in nodular and acral CM (68.7% and 66.7% respectively) compared to superficial spreading CM (17%) (x2 =61.01; p<0.001). Presence of ulceration is more likely when CM with SLN metastases Breslow depth is >4mm (61.1%) compared to Breslow thickness <1mm (2.1%), 1-2mm (10.5%), 2-4mm (25.3%) (x2 =11.79; p=0.008).** Conclusion: in this study it was observed that when cutaneous melanoma (CM) is located on the lower extremity and has a Breslow thickness exceeding 4mm, it tends to metastasize to the sentinel lymph node (SLN).

Laimo liga (LL) yra infekcinė liga, kurią sukelia bakterija Borrelia burgdorferi. Šios ligos simptomai pasireiškia odos bėrimu, karščiavimu, nuovargiu, raumenų ir sąnarių skausmais, galvos skausmu ir neurologiniais sutrikimais. Gydoma antibiotikais priklausomai nuo ligos stadijos.

Supūliavęs hidradenitas (SH) tai lėtinė pasikartojanti uždegiminė odos, plauko maišelio ir poodžio liga. Dažniausiai ji pasireiškia pažastų, kirkšnių, išangės ar lytinių organų srityse. Klinikai būdingi įvairaus gylio skausmingi mazgai, pūlingą sekretą išskiriančios fistulės ir randai. SH gydymas parenkamas atsižvelgiant į SH sunkumą pagal Hurley stadiją. SH gydyti skiriama antibiotikų (vietinio veikimo arba sisteminių). Chirurginiu būdu šalinamos fistulės, pūlingi bėrimai.

Background & objectives: Histopathologic status of sentinel lymph node is a powerful prognostic factor for primary cutaneous melanoma, contributing towards planning treatment. Study aim is to determine if microanatomical location of lymphonodal metastasis can be a relevant diagnostic tool defning metastatic melanoma status. Methods: 151 cases with melanoma metastasis in sentinel lymph node were selected in retrospective study, evaluating morphologic microanatomical metastasis location (sinus, parenchymal, extracapsular) signifcance in context to patient’s age, gender, morphologic melanoma type, Breslow thickness, and pT stage of melanoma TNM classifcation. Statistical analysis of Mann-Whitney U and χ2 tests was applied (p<0.05). Results: Predominant morphologic types of melanoma (Breslow thickness median=4.05 mm, interquartile range=4.09 mm) for 53.6% (n=81) males and 46.4% (n=70) females were nodular (35.8%, n=54) and unspecifed (33.1%, n=50) with frequent pT4b stage (45.7%, n=69). Lymphonodal parenchyma was the most common microanatomical localization (61.6%, n=93), following sinus (57%, n=86) and extracapsular (12.6%, n=19) microanatomical sites. Patients with lymphonodal sinus metastasis were younger compared to metastasis-negative cases (median=61 years, interquartile range=29 years vs median=71 years, interquartile range=20 years; p<0.05), extracapsular metastasis was more common for males (p<0.05) and less likely to be detected in nodular and unspecifed melanomas (p<0.05). No signifcant tendencies were detected in context of Breslow thickness and pT stage. Conclusion: Study results demonstrated signifcant tendencies of sinus and extracapsular melanoma metastasis of sentinel lymph nodes in context of melanoma patient’s age, gender, and melanoma type. Detected microanatomical tendencies in metastatic lymphonodal melanoma may suggest a potentially novel direction for further scientifc research in melanoma metastasis morphology and disease prognosis, considering new guidelines for treatment strategies in advanced melanoma cases.

Background & objectives: Microenvironmental cytotoxic T lymphocytes play a critical role in NSCLC progression. However, results of studies investigating microenvironmental cytotoxic T lymphocytes and NSCLC remain controversial. Study’s objective is to apply digital approach to morphometric analysis optimizing microenvironmental studies in NSCLC model. Methods: Immunohistochemical reactions (DAKO monoclonal mouse anti-human CD8 antibody, clone C8/144B) were performed for CD8+ cytotoxic T lymphocytes in 79 selected NSCLC cases. Samples were scanned with „Pannoramic Viewer (3D Histech)“, CD8+ T lymphocytes were counted in three annotated 304 558 μm2 microscopic felds per sample in “Slide Viewer” digital microimaging analysis software. Statistical analysis (Mann-Whitney, Kruskal-Wallis’s tests) was applied (p<0.05). Results: Median of 78 (interquartile range-110) CD8+ T lymphocytes was identifed in NSCLC microenvironment. Median of CD8+ T lymphocytes was similar in adenocarcinoma vs. squamous cell carcinoma NSCLC types (79, interquartile range-95 cells vs. 72, interquartile range-145 cells; p>0.05) and G2 vs. G2/3 vs. G3 diferentiation grades of NSCLC (79, interquartile range-137 cells vs. 114, interquartile range-113 cells vs. 76, interquartile range-86 cells; p>0.05). Conclusion: Accurate cytotoxic (CD8+) T lymphocyte status of immune microenvironment in NSCLC model was characterized by digital microimaging analysis technique, optimizing morphometric analysis of NSCLC microenvironment via digital approach. Similar count of CD8+ T lymphocytes was detected in diferent NSCLC histological types and grade diferentiation groups, demonstrating potential application scope of digital morphometric analysis method in practical setting of pathology diagnostics.