Vitalijus Sokolovas

Alveolar echinococcosis, Lithuania.

Alveolar Echniococcosis, Lithuania

Echinococcus infections in the Baltic region

In the Baltic countries, the two zoonotic diseases, alveolar echinococcosis (AE) caused by Echinococcus multilocularis, and cystic echinococcosis (CE) caused by Echinococcus granulosus, are of increasing public health concern. Observations from Estonia, Latvia and Lithuania indicate that the distribution of both parasites is wider in the Baltics than previously expected. In this paper, we review and discuss the available data, regarding both parasitoses in animals and humans, from the Baltic countries and selected adjacent regions. The data are not easily comparable but reveal a worrisome situation as the number of human AE and CE cases is increasing. Despite improvements in diagnostics and treatment, AE has a high morbidity and mortality in the Baltic region. For the control of both zoonoses, monitoring transmission patterns and timely diagnosis in humans as well as the development of local control programs present major challenges.

Emerging alveolar echinococcosis (AE) in humans and high prevalence of Echinococcus multilocularis in foxes and raccoon dogs in Lithuania

Summary The presence of the most important definitive and intermediate hosts suggests that conditions for the live cycle of E. multilocularis are favorable in Lithuania. While the main rodent hosts have not been investigated systematically in Lithuania, E. multilocularis has already been identified in one of 5 muskrats (Ondatra zibethicus) captured in the Silutė district. The high prevalence of E. multilocularis in red foxes and raccoon dogs as well as a notable increase of AE in humans document that E. multilocularis is of emerging concern in Lithuania. The human AE cases were recorded from many parts of the country suggesting that the whole territory of Lithuania should be considered as an endemic area for E. multilocularis. Considering the long prepatent period of AE in humans we suggest that this zoonosis is present in the area investigated for at least a few decades.

Fatal liver and lung alveolar echinococcosis with newly developed neurologic symptoms due to the brain involvement

The fox tapeworm Echinococcus multilocularis causes human alveolar echinococcosis, commonly affecting the liver. However, in ∼1% of cases, systematic spread of the disease involves the brain as well. A patient had a 6-year history of liver and lung alveolar echinococcosis that was considered not suitable for surgery, and treatment with albendazole was introduced. After the appearance of neurologic disturbances, an intracranial mass lesion was demonstrated by radiologic imaging. The lesion was surgically removed, and histologic analysis revealed metacestode tissue of E. multilocularis . Despite the surgical resection of the lesion, the patient died of progression of systemic alveolar echinococcosis. The authors highly recommend implementing neurologic monitoring to the follow-up algorithm for patients with systemically disseminated alveolar echinococcosis. When neurologic symptoms occur, radiologic imaging of the brain should be obtained immediately. Surgery should be considered for all intracranial echinococcal lesions, unless the lesion is located in the eloquent brain area.

Malignant mixed epithelial and stromal tumour of the kidney: a case report and a literature review

Introduction. Mixed epithelial and stromal tumour of the kidney (MEST) is a rare and distinctive neoplasm accounting for 0.2% of all renal cancers. Most of these tumours behave in a benign fashion but 13 cases with malignant transformation have already been reported. We present the first case of an extremely aggressive MEST with rapid recurrence after radical treatment, demonstrating objective response to chemotherapy. Case presentation. A 31-year-old female presented to the hospital complaining of gross hematuria. Computed tomography (CT) revealed an intraparenchymal mass in the left kidney forming a tumour thrombus in the inferior vena cava (IVC). Metastatic disease was ruled out and, under the clinical diagnosis of renal cell carcinoma, left radical nephrectomy with IVC thrombectomy was performed. The histopathological examination confirmed malignant MEST of the kidney. At the follow-up 12 months after surgery, a recurrent tumour in the left paravertebral area and a tumour thrombus in the IVC were detected. A second surgery was recommended and the mass from the paravertebral area was removed, so resection of the IVC with prosthetic replacement was performed. The histopathologic examination confirmed a recurrent malignant MEST. At the follow-up three months after the second surgery disease progression was diagnosed, so chemotherapy with ifosfamide and doxorubicin was initiated. The CT scan performed 14 months after the chemotherapy confirmed a stable process of the disease with no signs of progression. Conclusions. A literature review and our case report confirm the existence of extremely aggressive malignant MEST that shows response to chemotherapy. However, more reports are needed to improve our understanding about the biology of the MEST to develop any recommendations on personalized therapy.

Hepatoceliulinės karcinomos prognostinės sistemos

Jonas Pivoriūnas 1 , Jonas Jurgaitis 2, 3 , Marius Paskonis 2, 3 , Agnius Juska 1 , Janina Didžiapetrienė 3 , Eugenijus Stratilovas 3 , Narimantas Evaldas Samalavicius 3 , Vitalijus Sokolovas 3 , Gintautas Brimas 2 , Kestutis Strupas 2 1 Vilniaus universiteto Medicinos fakultetas, M. K. Ciurlionio g. 21, LT-03101 Vilnius 2 Gastroenterologijos, urologijos ir abdominalinės chirurgijos klinika, Vilniaus universiteto ligoninės Santariskių klinikos, Santariskių g. 2, LT-08661 Vilnius 3 Vilniaus universiteto Onkologijos institutas Santariskių g. 1, LT-08660 Vilnius El pastas: jonas.jurgaitis@santa.lt Įvadas / tikslas Hepatoceliulinė karcinoma – tai penktas tarp dažniausių navikų pasaulyje ir trecias pagal mirstamumą. Per pastaruosius desimtmecius sergamumas siuo naviku didėja Jungtinėse Amerikos Valstijose ir Europoje. Lietuvoje hepatoceliulinės karcinomos atvejų taip pat daugėja. Manoma, kad kepenų navikų per kitus du desimtmecius dar padaugės. Hepatoceliulinė karcinoma yra sunkiai įvertinama, heterogoniska liga, dėl to pasaulyje kuriamos prognostinės sistemos, kurios turi padėti gydytojui parinkti tinkamą gydymą ir įvertinti ligos prognoze. Sio straipsnio tikslas – isrinkti ir apibūdinti labiausiai pasaulyje paplitusias hepatoceliulinės karcinomos prognostines sistemas, palyginti jų taikymo rezultatus, parinkti Lietuvai tinkamiausias sistemas. Metodai Pasinaudojus „PubMed“ duomenų baze ir įvedus reiksminius žodžius hepatocellular carcinoma, prognostic scores ir staging system buvo rasti 205 straipsniai, publikuoti nuo 1984 iki 2007 metų. Atrinkti 54 straipsniai, kuriuose minimos 24-ios hepatoceliulinės karcinomos prognostinės sistemos. Rezultatai Isanalizavus sistemas buvo nuspresta atmesti tas, kurių pritaikyti Lietuvoje nėra galimybių dėl to, kad salyje neatliekami tyrimai. Placiau aprasytos devynios sistemos. Isvados Isrinke placiausiai pasaulyje naudojamas hepatoceliulinės karcinomos prognostines sistemas ir palygine jų taikymo rezultatus, manome, kad būtų vertinga atlikti retrospektyvųjį lyginamąjį tyrimą, kad issiaiskintume, kokia prognostinė sistema geriausiai tinka hepatoceliuline karcinoma sergantiems Lietuvos populiacijos pacientams diferencijuoti pagal isgyvenamumą. Reiksminiai žodžiai: hepatoceliulinė karcinoma, prognostinė sistema, prognostiniai kriterijai, pacientų isgyvenamumas Prognostic scores of hepatocellular carcinoma Jonas Pivoriūnas 1 , Jonas Jurgaitis 2, 3 , Marius Paskonis 2, 3 , Agnius Juska 1 , Janina Didžiapetrienė 3 , Eugenijus Stratilovas 3 , Narimantas Evaldas Samalavicius 3 , Vitalijus Sokolovas 3 , Gintautas Brimas 2 , Kestutis Strupas 2 1 Vilnius University Faculty of Medicine, M. K. Ciurlionio str. 21, LT-03101 Vilnius, Lithuania 2 Clinic of Gastroenterology, Urology and Abdominal Surgery, Vilnius University Hospital Santariskių Clinic, Santariskių str. 2, LT-08661 Vilnius, Lithuania 3 Institute of Oncology, Vilnius University, Santariskių str. 1, LT-08660 Vilnius, Lithuania E-mail: jonas.jurgaitis@santa.lt Background / objective Hepatocellular carcinoma is the most common primary liver cancer. It is the fifth most common neoplasm and the third most common cause of cancer-related death in the world. Over the last decade the incidence of this cancer has been rising in the United States of America and in Europe as well as in Lithuania. The incidence of this cancer in the next two decades is expected to rise. Hepatocelullar carcinoma is a difficult and heterogenic disease. Therefore, prognostic scores are being created to help clinicians to choose the best treatment for the patient. The aim of this review is to select and describe the most widely used prognostic systems of hepatocellular carcinoma, to compare results of their usage, applicability and to choose the most suitable scoring systems for the further use in Lithuania. Methods The PubMed data base was used to search for the keywords: “hepatocellular carcinoma”, “prognostic scores” and “staging systems”. 205 published articles were found from the year 1984 though 2007; 54 articles with 24 prognostic systems were selected. Results Upon analysing the prognostic systems, it was decided to reject the scoring systems that are impossible to use in Lithuania because of the absence of related tests. In total, nine prognostic systems were overviewed. Conclusions A retrospective cohort study is advisable to ascertain which prognostic system of hepatocellular carcinoma is most suitable for Lithuanian population. Key words: hepatocellular carcinoma, prognostic score, prognostic factors, survival of the patient