Ectopic pancreas is an infrequent submucosal tumor in the gastrointestinal tract defined as a pancreatic tissue lacking vascular or anatomic continuity with the main body of the pancreas. Ectopic pancreas in the ileum is a rare and often an incidental finding. We report a case of ectopic pancreas in the ileum causing obscure gastrointestinal bleeding and episodes of abdominal pain. 59-year-old man with 3 months history of intermittent melena, accompanied by the episodes of abdominal pain in the left upper quadrant and generalized fatigue was admitted to our department. The investigations showed that the patient had a low hemoglobin level, i.e. 10.9 g/dL with hypochromic microcytic anemia pattern seen in complete blood count (MCV 70.2 fl, MCH 21.4 pg). Esophagogastroduodenoscopy and colonoscopy did not reveal any abnormalities. Magnetic resonance enterography revealed a large (2.5 × 2.3 cm) pedunculated polyp in the ileum. Examination by single-balloon enteroscopy revealed a polyp with long pedicle located approximately 1.5 m distal to terminal ileum. Polypectomy was performed. Histopathologic examination stated, that the specimen contained ectopic pancreatic tissue which was involving muscular layer of the ileum. Ectopic pancreatic tissue included acinar cells and cystically dilated secretory ducts without islets of Langerhans. Our case report reveals a very rare cause of obscure gastrointestinal bleeding accompanied by the episodes of abdominal pain – an ectopic pancreas located in the ileum.

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.

Background/Objectives: In 2024, Lithuania developed a national lung cancer screening program (the Program), targeting individuals aged 50 to 70 years, regardless of their smoking history, with screenings conducted once every three years. The Program aims not only to actively detect lung nodules (lung cancer) but also to identify clinically significant concomitant findings. The pilot study aimed to evaluate the screening process’s feasibility and organizational efficiency of the screening process, as well as its potential clinical effectiveness. Methods: Three family medicine centers were selected for participation. The Coordinating Center contacted individuals aged 50 to 70 sequentially and invited them to participate, regardless of smoking status. In total, 1014 individuals were prospectively enrolled and underwent low-dose chest computed tomography (LDCT) screening between 26 September 2024 and 14 February 2025. Results: Of the individuals invited, 76.1% agreed to participate. Lung-RADS v2022 category 4 nodules were identified in 1.4% of participants (n = 14), including six smokers and eight non-smokers. Additionally, one participant with a Lung-RADS category 2 nodule was diagnosed with squamous cell carcinoma originating from peripheral lung changes. Newly identified significant incidental findings were detected in 25.9% of participants: 5.1% had pulmonary or mediastinal findings (most commonly emphysema, interstitial lung changes, and bronchiectasis), 18.7% had cardiovascular findings (usually coronary artery calcification, aortic valve calcification, and aorta dilation), and 2.1% had other clinically relevant conditions (e.g., thyroid nodules, diaphragmatic changes). Following assessment by family physicians, 17.6% of all participants were referred to medical specialists, including pulmonologists, cardiologists, and others. Conclusions: This pilot study demonstrated that the Lithuanian lung cancer screening model is feasible, well-organized, and clinically valuable. The findings support the Program’s readiness for broader implementation at the national level.