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.

Introduction: Current literature suggests various predictors related to the stone and patient, which could influence stone fragmentation and clearance rates. Aim: Our goal was to establish clinical characteristics of stone disease for patients undergoing extracorporeal shockwave lithotripsy (ESWL) which may predict the success of the procedure. Material and methods: One hundred and nine patients with renal stone disease diagnosed by non-contrast computed tomography (NCCT) who underwent ESWL between January 2015 and December 2019 were included in the study. Endpoints: patient being stone free (SF) or when < 4 mm fragments were detected. Age, gender, location, skinto-stone distance, maximum stone length, stone volume, stone surface area, mean stone Hounsfield units (HU) and highest HU score were explored in uni-and multivariate regression analysis. Results: Stone size revealed the highest prognostic power for ESWL failure, where OR for stone volume and stone surface area were 1.06 (1.03-1.10) and 1.04 (1.02-1.06), respectively (all p < 0.01) while a tendency was observed for skin-to-stone distance 1.02 (1.00-1.03). The amount of energy applied during the procedure to one cubic millimeter of stone volume (SMLI/stone volume) was predictive for treatment success (

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Introduction. Prostate cancer is the most common malignant neoplasia among men in Lithuania, though it presents a low mortality rate. In 2007 more than 3 500 Lithuanians were diagnosed with prostate cancer. Many patients were treated with radiotherapy. Unfortunately, after several years the number of cases of prostate cancer recurrence after radiotherapy started to grow. This new problem requires the following difficult decision to make: which treatment method to choose? Radical prostatectomy, high-dose radiotherapy, cryotherapy, high-intensityfocused ultrasound, active surveillance or hormone therapy – all are viable salvage methods. In 2012 we performed the first cryotherapy procedures. Now we want to present our first clinical experience in prostate cancer salvage cryotherapy. Materials and methods. Five patients diagnosed with prostate cancer were selected for prostate cryotherapy. Four patients were treated only with radiotherapy, one patient was treated with radiotherapy plus neoadjuvant hormonal treatment. Prostate cancer recurrences were diagnosed by multiparametric MRI and ultrasound guided transrectal or transperineal biopsies. MRI findings were validated with the Magnetic Resonance Prostate Imaging Reporting and Data System (PI-RADS). CT, MRI, ultrasound scanning, and bone scintigraphy were performed for patients before treatment. No pathological bone changes were detected. All patients received 2-cycle cryotherapy with real-time ultrasound guidance and temperature change tracking. Results. The described treatment scheme for these patients enables to deliver two freezing-thawing cycles with 10–12 probes and a urethra-warming catheter. All procedures were completed succesfully without any intraoperative complications. Urinal obstruction was observed after 1 week for 1 of 5 patients. He had to stay with epicystostomy and overwent prostate transurethral resection. After these procedures the patient could urinate normally. One patient had biochemical progression due to metastasis in parailiacal lymph nodes, and he got external beam therapy to lymph-node projection. After 6 months there was no cancer progresion signs on MRI and PSA was 1.77 ng/ml. No patients suffered from urinary incontinence. Conclusions. Our initial experience shows that cryotherapy can be a viable alternative for patients with disease progression after radiotherapy. Currently the biggest advantages of cryotherapy are as follows: possibility to treat patients not suitable for salvage prostatectomy, short hospitalization, low complication risk and lower overall cost than other methods. Short term data seems to be promising but longer follow-up is necessary to verify oncological and functional results.

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