Venclovas, Žilvinas

Background: An inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor, sometimes with urinary bladder involvement (though this is extremely uncommon). Due to its rarity, the exact etiology and optimal treatment strategy remain unclear. Methods: A review of the existing literature on IMT of the urinary bladder was performed. Results: We report a case of a 32-year-old female presenting with frequent urination, hematuria with clots, and lower abdominal pain for one month. Initially misdiagnosed as acute cystitis, the symptoms persisted despite antibiotic therapy. Laboratory findings revealed severe anemia, and imaging studies identified a large bladder mass. Transurethral resection of the bladder tumor (TURB) was performed, and a 96 g mass was removed. Histopathological examination confirmed IMT of the urinary bladder (IMTUB) with positive immunohistochemical staining for ALK, vimentin, and actin. Follow-up at 30 months showed no recurrence, with annual cystoscopy and CT scans confirming remission. Conclusions: IMTUB should be considered in young patients presenting with hematuria and lower urinary tract symptoms. Early diagnosis through cystoscopy, imaging, and histopathological confirmation is essential for appropriate management. TURB remains the gold standard for treatment, with ALK inhibitors providing additional therapeutic options in select cases. Long-term follow-up is necessary due to the unknown malignant potential of IMTUB.

Nutukimas - viena aktualiausių dabartinės visuomenės problemų, neigiamai veikianti daugelį organizmo sistemų ir trikdanti sergančiojo šia liga gyvenimo kokybę, darbingumą bei trumpinanti gyvenimą. Tai - metaboliškai aktyvi ir recidyvuojanti liga, kurios metu kūno masė didėja riebalinio audinio sąskaita. Nutukimą kaip ligą Amerikos medicinos asociacija oficialiai pripažino 2013 metais. Nutukimas pastaruoju metu yra labiausiai aptarinėjama tema tiek medicinos, tiek plačiojoje visuomenėje. Kalbant apie nutukimą, dažnai ši būklė siejama su asmeniniu kaltės priskyrimu: „reikia tik noro“, „reikia suimti save į rankas“ ir t. t. Įvairiais istoriniais laikotarpiais požiūris į žmogaus kūno formas keitėsi nuo Rubenso tipo moterų iki anoreksinių mados manekenių formų. Menamų kūno formų standartų neatitinkantis žmogus gali būti pavadintas putliu, stambiu, apkūniu, didelio dydžio ar net storuliu ar apsileidusiu. Medicinos bendruomenėje vyrauja terminai: antsvoris, hipotalaminis, pilvinis, centrinio tipo, kušingoidinis, morbidinis nutukimas ir kt. Nutukimas turi kompleksines pasekmes - skatina lėtines ligas, galinčias sutrumpinti žmogaus amžių 10-15 metų. Per pastaruosius 5 dešimtmečius nutukimo paplitimas pasaulyje padidėjo daugiau nei 3 kartus, ir dabar tai įvardijama kaip nutukimo pandemija. Klinikinėje praktikoje nustatomos įvairiausios nutukimo priežastys - nuo genetinių (Prader-Willi sindromas, Aistrom sindromas, LEPR (leptino receptoriaus) ar LEP (leptino) geno mutacijos ir kt.), endokrininių (hipotirozė, hiperkorticizmas, hipogonadizmas ir kt.) iki valgymo priklausomybių. Skirtingos yra ir nutukusių kūno formos bei kūno kompozicija. Todėl kūno masės indeksas (KMI) klinikiniu požiūriu jau nebetenka prasmės. KMI tikslinga naudoti populiaciniams, palyginamiesiems tyrimams. Statistiniais duomenimis (HIS Lietuva, Eurostat, 2019-2022 m.), pagal KMI nutukusių suaugusių Lietuvoje buvo 21-23 proc. Skaičiuojama, kad apie 60 proc. suaugusiųjų Lietuvoje turi antsvorio ar yra nutukę. Tai - tik statistika, neatspindinti konkrečios individo būklės. 2025 m. pasaulio 58 ekspertų grupė, atstovaujanti įvairioms medicinos specialybėms ir šalims, išanalizavo turimus įrodymus ir, pritarus 75 medikų ir pacientų organizacijoms, rekomendavo klasifikaciją, kurioje išskiriamas ikiklinikinis ir klinikinis nutukimas. Pagal epidemiologinius ir klinikinius duomenis, nutukimas susijęs su daugiau nei 200 skirtingų ligų ir sveikatos sutrikimų. [...]

Background/Objectives: The role of extended pelvic lymph node dissection (ePLND) in prostate cancer remains uncertain. Sentinel lymph node (sLN) mapping improves diagnostic precision, yet some patients have no detectable sentinel nodes (“untraceable” sLNs). This study evaluates whether untraceable sLNs predict the absence of lymph node invasion (LNI) and can guide surgical decision-making during radical prostatectomy (RP) with ePLND. Methods: Patients with intermediate- or high-risk prostate cancer and with no radiologically evident LNI were included in the study. A 99mTc-nanocolloid was used as an sLN tracer. RP with sLN dissection and ePLND was performed <20 h after injection. Patients were categorized into two groups: Group 1, traceable sLNs and Group 2, untraceable sLNs (no radiological or intraoperative signal). Results: A total of 53 patients were included. LNI was present in 10 patients (18.9%). Group 1 had 41 patients (77.4%), and Group 2 had 12 patients (22.6%). None of the patients in Group 2 had LNI following ePLND, whereas 10 of 41 patients (24.4%) in Group 1 were node-positive (p = 0.016). Baseline clinical and pathological characteristics were comparable between groups. A total of 17/53 of men (32.1%) experienced biochemical recurrence, overall, with higher observed events in Group 1 (15/41, 36.6%) vs. Group 2 (2/12, 16.7%). However, this difference did not reach statistical significance (p = 0.2). Conclusions: A proportion of PCa patients have no radiologically or intraoperatively detectable sLNs, and none of the patients with untraceable sLNs exhibited LNI following ePLND. These findings suggest that untraceable sLNs may correlate with an extremely low probability of nodal invasion and could serve as a criterion for safely omitting ePLND in selected patients.

Background: Bladder leiomyosarcoma is an extremely rare non-urothelial malignancy, accounting for less than 0.1% of all bladder tumors. It presents significant diagnostic and therapeutic challenges due to its aggressive nature and the absence of standardized treatment protocols. Case presentation: We report the case of a 61-year-old woman who presented with hematuria, dysuria, and suprapubic pain. Imaging revealed a large, locally invasive bladder mass, and histopathological examination following transurethral resection confirmed leiomyosarcoma. The patient underwent radical cystectomy with resection of adjacent bowel segments and urinary diversion. Histology showed a high-grade leiomyosarcoma (pT3N0) with extensive necrosis and a high mitotic index. Two months postoperatively, peritoneal dissemination was detected. Systemic chemotherapy with dacarbazine and doxorubicin initially led to the regression of metastases, but disease progression occurred within months, including lung, liver, and bone metastases. Palliative radiotherapy and second-line chemotherapy were initiated. As of now, 16 months have elapsed since surgery. Conclusions: This case underscores the aggressive clinical course of bladder leiomyosarcoma despite multimodal therapy and the urgent need for individualized management strategies. Given its rarity, this case contributes to the limited literature and highlights the importance of vigilant follow-ups and further studies to establish evidence-based treatment protocols.

Lymph node-positive (pN1) prostate cancer (PCa) is a heterogeneous disease, and a clear definition of prognostic groups is urgently needed. We aimed to assess cancer-related mortality (CRM) in different prognostic groups of pN1 patients, created based on the pathological PCa characteristics and number of positive lymph nodes (LN+).

International Society of Urological Pathology grade group 1 (GG 1) prostate cancer (PCa) is generally considered insignificant, with recent suggestions that it should even be considered as "noncancerous". We evaluated outcomes for patients with GG 1 PCa on biopsy (bGG 1) and high-risk features (prostate-specific antigen [PSA] >20 ng/ml and/or cT3-4 stage) to challenge the hypothesis that every case of bGG 1 PCa has a benign disease course. We used the multi-institutional EMPaCT database, which includes data for 9508 patients with high-risk PCa undergoing surgery. We included patients with bGG 1 PCa (n = 848) in our analysis and divided them into three groups according to PSA >20 ng/ml, cT3-4 stage, or both. The estimated 10-yr cancer-specific survival (CSS) rate was 96% in the overall population, 88% in the group with both PSA >20 ng/ml and cT3-4 stage, 97% in the group with PSA >20 ng/ml alone, and 98% in the group with cT3-4 stage alone. Similar CSS outcomes were found in subgroups with GG 1 PCa on pathology (n = 502) and with GG 1 on biopsy diagnosed after 2005 (n = 253). Study limitations include the lack of magnetic resonance imaging (MRI) staging and MRI-targeted biopsies. In conclusion, patients with GG 1 and either PSA >20 ng/ml or cT3-4 stage have a low risk of dying from their cancer after surgery. However, patients with GG 1 PCa and both PSA >20 ng/ml and cT3-4 stage are at higher risk of cancer-specific mortality and active treatment should be discussed for this subgroup.

Introduction: Renal haemangioma is a benign tumour, and due to its characteristics, it must be distinguished from malignant diseases. We present a clinical case of primary renal angiosarcoma initially mistaken for haemangioma due to their similarity. Case report: A 58-year-old man was admitted to the hospital with suspicion of pulmonary embolism. The patient complained of pain on the left side. An ultrasound and CT scan of the abdomen showed a tumour mass ~20.5 × 17.2 × 15.4 cm in size in the projection of the left kidney. On CT images, there were data for clear cell renal clear cell carcinoma (ccRCC). A left nephrectomy was performed. However, histological examination revealed renal haemangioma. Three months later, the patient presented to the hospital with abdominal and lumbar pain. A CT scan showed multiple small hypoechoic foci up to 2 cm in size in the liver, lungs, and intra-abdominally, with the most data for carcinosis. Histological re-verification of the left kidney showed a renal vascular tumour with pronounced signs of infarction and necrosis with the majority of the evidence supporting angiosarcoma. Despite treatment, the patient’s outcome was fatal. Conclusions: Based on the clinical presentation, radiological images and histological examination data, the tumour was initially misdiagnosed as kidney haemangioma. Due to the rarity of this tumour, there are no established treatment protocols or clinical guidelines for managing primary kidney angiosarcoma.

Introduction & Objectives: Lymph node positive (pN1) prostate cancer (PCa) is a heterogeneous disease, and a clear definition of prognostic groups is urgently needed. We aimed to assess cancer-related mortality (CRM) in different risk groups of pN1 patients, created based on pathological PCa characteristics and number of positive lymph nodes (LN+). Materials & Methods: We conducted a retrospective, multicenter cohort study including 894 consecutive patients with pN1 disease and known number of LN+ treated at fifteen European high-volume centers. A prognostic model was constructed for the prediction of CRM, accounting for death from other causes (OCM) as a competing risk. In the different risk groups, the ten-year cumulative risk of mortality was assessed. Results: Combinations of predictive characteristics (pT-stage, ISUP score, number of LN+ and surgical margin [SM] status) were compared and pooled until all remaining subgroups differed significantly. We ended with a model including three risk groups, based on pT-stage, surgical margin status and number of LN+. The low-risk group includes patients with pT1-3a, 1-4 LN+ and either positive or negative SM. Patients with pT3b-4 disease and negative SM are also part of the low-risk group, independent of the number of LN+. Regarding the medium-risk group, patients with pT1-3a disease and >4 LN+ were included, independent of SM. Patients with pT3b-4 disease, 1-4 LN+ and positive SM were also part of the medium-risk group. Patiets with high-risk had all 3 high-risk factors present: pT3b-4, >4 LN+ and positive SM. The discriminative value (C-index) of this model was 0.73. Ten-year cumulative CRM in low-, medium-, and high-risk groups were 12% (95% CI: 7.3-16%), 32% (24-40%), and 58% (40-76%), respectively (figure), with significant difference between all groups (hazard ratio (HR) 2.2 to 6.4, p<0.005). Ten-year OCM were 12% (7.6-16%), 16% (9.5-22%), and 9.6% (0.4-19%), respectively. Conclusions: The pN1 patient population is extremely heterogeneous with an increased risk of death from PCa rather than death from other causes. In this group of patients, primary cancer characteristics (pT-stage, number of LN+ and surgical margin status) still represent the driving factors of CRM.

Introduction & Objectives: Muscle-invasive bladder cancer is associated with poor oncological outcomes. For localized disease one of the treatment options is radical cystectomy. However, even after aggressive local therapy, these patients are at significant risk for metastases. This study aimed to evaluate the impact of neoadjuvant chemotherapy after radical cystectomy on oncological outcomes in patients with muscle-invasive bladder cancer. Materials & Methods: The study cohort consisted of 102 patients with localized MIBCa (stage T2-to T4a NxM0) who underwent RC at the single tertiary referral centre between 2016 JAN and 2021 DEC. Patients were stratified into two groups: Group (GR) 1 - radical cystectomy vs. GR 2

• neoadjuvant chemotherapy followed by radical cystectomy. The chi-square and t-tests were used to compare baseline characteristics between both groups. Clinical progression-free survival (CPFS), overall survival (OS) and cancer-specific survival (CSS) rates were estimated using KaplanMeier analysis and the log-rank test. Results: The median follow-up was 20.5 months (IQR 8.7-34.3), and the median age was 67 years (IQR 60-74). The majority of the patients were males (80/102, 78.4%). 60 patients (58.8%) received surgery alone and 42 patients (41.2%) received combination therapy. After the surgery, the rate of downstaging to pT0-pT1 was found in 23.8% (10/42) of cases in GR 2, the rate of the pT2 was similar between both groups: 17/60 (28.3%) in GR 1 vs. 12/42 (28.6%) in GR2. Patients in GR1 more often had adverse pathological features ≥ pT3 (42/60, 71.7% vs. 20/42, 47.6%) (p=0.002). Lymph node invasion (LNI) was found in 41/102 cases (47.1%), but there was no difference between GR 1 (27/60, 45.8%) and GR 2 (14/42, 33.3%) (p=0.2). Clinical progression (CP) was diagnosed in 48 (47.1%) cases. The median time from operation to CP was 8 (3-19.4) months. During the follow-up, 54 patients (52.9%) died. In 39 cases (38.2%) MIBCa was the cause of death. The 2-yr CPFS rate was 51.2% in GR1 and 49% in GR2 (p=0.6), OS rate was 60.5% vs. 58.3%; (p=0.8) and CSS rate was 69.9% vs. 66.2%; (p=0.6). Conclusions: These results support the effect of neoadjuvant chemotherapy on downstaging after radical cystectomy. However, we did not confirm any benefit of combination therapy on disease progression, cancer-specific or overall survival. A longer follow-up is needed to assess the possible benefit of neoadjuvant chemotherapy on oncological outcomes.

Introduction & Objectives: Recent reports have demonstrated that persistent prostate-specific antigen (pPSA) is an important predictor of prostate cancer (PCa) progression and cancer-specific survival after radical prostatectomy (RP). In most studies, this parameter is defined as PSA ≥0.1 ng/L 4-12 weeks after RP. However, the data remains limited, often with weak evidence. This study aimed to evaluate the significance of different pPSA thresholds on the prediction of long-term oncological outcomes after RP. Materials & Methods: Men with localized PCa who underwent RP in the 2001-2019 period at the single tertiary referral center were included in the study. According to the first postoperative PSA, which was defined as PSA 1-3 months after RP, patients were stratified into 5 groups: group (GR) 1 - PSA <0.1 ng/ml, GR 2 – PSA 0.1-0.2 ng/ml, GR 3 – PSA 0.2-0.4 ng/ml, GR 4 – PSA 0.4-1.0 ng/ml, and GR 5 – PSA >1.0 ng/ml. The 10-yr cumulative incidence of metastases (MTS) and cancer-specific mortality (CSM) was estimated. The logistic regression model was used to test the predictive probability of each group for 10-yr MTS and CSM. The PSA threshold <0.1 ng/ml was used as a reference. Results: Of all 2,612 men, 1,720 (65.8%) had a first PSA test within 1-3 months after RP. Patients who received neoadjuvant (n=9) or adjuvant (n=49) treatment, had metastases before RP (n=2), or had less than 6 months follow-up (n=55) were excluded from the study. Overall, 1,604 men were eligible for final analysis. The median follow-up was 105 (IQR 67-159) months. Cumulative incidence rate of 10-yr MTS was 4.3% (95%CI 3.1-5.9) in group 1, 7.1% (3.4-14.6) in group 2, 27.3% (17.2-43.4) in group 3, 35.9% (23.1-55.7) in group 4 and 67.6% (55-83) in group 5. No difference in 10-yr MTS rate was found between GR1 vs. GR2, and GR3 vs. GR4 (p=0.14 and p=0.2, respectively), while within other groups MTS rate differed significantly. Regression analysis revealed that men in GR2 had a similar risk of MTS (HR 1.6, p=0.2), while in GRs 3-5 risk of MTS increased gradually: HR 7.3, HR 10.2 and HR 25.7, respectively (all p <0.0001). Cumulative incidence of 10-yr CSM was 0.9% (0.5-1.6) in group 1, 4.5% (1.7-11.8) in group 2, 13.4% (6.2-29) in group 3, 17.4% (9.6-31.5) in group 4 and 35.5% (23.5-53.6) in group 5 with significant difference between groups, except GR3 vs. GR4 (p=0.3). The risk of 10-yr CSM increased from GR2 to GR5: HR 5.3, HR 16.6, HR 22 and HR 50.5, respectively (p<0.003 to p<0.0001). Conclusions: First PSA value has a significant effect on PCa progression. Persistent PSA threshold <0.1ng/ml could be used as an important predictor of CSM, while more studies are needed to confirm its significance in the prediction of MTS.