Background/Objectives: Chronic idiopathic thrombocytopenic purpura (chITP) is an autoimmune disease which develops in 10–30% of patients with newly diagnosed idiopathic thrombocytopenic purpura (ndITP). It is defined as thrombocytopenia which lasts longer than 12 months, with extremely diverse clinical expressions. The aim is to present the most significant clinical and laboratory characteristics of children with chITP. Methods: This is retrospective, observational research, which included children between 2–18 years with chITP who were treated in the Republic of Serbia for 25 years. We analyzed clinical data from personal and family medical histories and different laboratory analyses. Results: The total number of respondents was 152, with female predominance (F:M = 1.27:1) and mild predominance of adolescents. Of the patients, 15% were asymptomatic, but 15% had periodically life-threatening bleeding. Transfusion was not required for 70% of patients. Thirty-five percent of patients had chITP alone, and 45% had high titer levels of autoantibodies. The most frequent comorbidity was Hashimoto thyroiditis (15%). The same percentage (45%) of family members were reported with and without autoimmune diseases. Twenty-five percent of patients were resistant to initial therapy. Helicobacter pylori was detected in 20%, 70% had higher levels of lactate dehydrogenase (LDH), three patients had sufficient serum vitamin D levels, splenomegaly was found in 25%, and accessory spleen in 14% of patients. Around 50% of patients had a platelet count between 20–50 × 10⁹/L, and 40% below 20 × 10⁹/L. Mean platelet volume (MPV) was 10.6 ± 1.4 fL. No dysplastic changes were noted in bone marrow aspirate. Initial first-line therapy was sufficient for 45% of patients, second-line therapy was administered in 25%, splenectomy was performed in 20%, and 10% received all available treatments. Conclusions: The severe clinical form of pediatric chITP is accompanied by a low platelet count, the presence of autoimmune comorbidities, a positive family medical history, resistance to initial therapy, hypovitaminosis D, and rare megakaryocytes in the bone marrow.

Background/Objectives: The assessment of platelet kinetics (APK) is recommended for patients with chronic idiopathic thrombocytopenic purpura (chITP). The aim of this study was to examine the importance of APK as a prognostic instrument in the selection of therapy in children with chITP. Methods: Retrospective, observational research, which included chITP children who were treated and subjected to APK in Serbia for 25 years (total number was 152). Results: In the acute phase of the disease, 15% of patients had life-threatening bleeding, 15% were asymptomatic, and there were no cases of fatal bleeding. Mean platelet life was 0.89 ± 0.47 days. A total of 45% of patients had normal platelet production, and 35% had very low production. Among the patients, 55% exhibited splenic platelet sequestration, 35% had mixed sequestration, and 10% showed hepatic platelet sequestration. Platelet lifespan and production indices were less reliable parameters, due to numerous contradictory results, especially when compared with the location of platelet sequestration. Distribution of bleeding and therapy-resistant patients was dominant with mixed sequestration. Good therapy responders had dominant splenic sequestration. In the chronic phase of the disease, initial therapy was sufficient for 40–45% of patients, while another 25% required second-line therapy, regardless of platelet sequestration location. A total of 25% percent of patients had undergone splenectomy, and all of them were in stable remission. The remaining 10%, which represented the most severe cases, required all available therapies, had equally mixed and liver sequestration, and splenectomy showed no effect. Conclusions: APK may be a determining factor for the selection of splenectomy as a therapeutic option in case of predominantly splenic sequestration. Although the platelet production index has been explored in several studies, its clinical relevance remains controversial. In our findings, it did not contribute to therapeutic decision-making and may even lead to misinterpretation. The factors distinguishing the minority of bleeding and therapy-resistant patients with similar laboratory profiles remain unclear.

Introduction. Orbital localization of follicular lymphoma is exceedingly rare, and its diagnosis is often challenged due to a broad spectrum of ophthalmic differential diagnoses. We report a case of orbital relapse of follicular lymphoma detected five years after complete remission using 18F-fluorodeoxyglucose positron emission tomography with computed tomography. Case Report. A 53-yearold man diagnosed with follicular lymphoma in 2013 achieved complete remission following chemotherapy in 2017 and remained under routine follow-up for the subsequent five years. In 2022, he presented with a 10-day history of right orbital pain. Clinical examination revealed right-sided exophthalmos and eyelid ptosis. 18F-fluorodeoxyglucose positron emission tomography with computed tomography demonstrated increased metabolic activity in the right orbit, raising suspicion of disease relapse. Subsequent ophthalmologic assessment and additional imaging confirmed the presence of an orbital mass, which was surgically excised. Histopathological analysis verified a localized orbital recurrence of follicular lymphoma. The patient was subsequently treated with localized radiotherapy. Follow-up 18F-fluorodeoxyglucose positron emission tomography with computed tomography performed in 2023 demonstrated a complete metabolic response. Conclusion. The case highlights the important role of 18F-fluorodeoxyglucose positron emission tomography with computed tomography in detecting atypical and rare manifestations of follicular lymphoma. Integration of 18Ffluorodeoxyglucose positron emission tomography/computed tomography findings with ophthalmologic evaluation and histopathological confirmation is essential for accurate diagnosis and appropriate therapeutic decision-making.

We present a case of metastatic cutaneous melanoma without a BRAF mutation that showed an unusually aggressive disease course despite favorable initial histopathological features. The patient was initially diagnosed with superficial spreading melanoma with a negative sentinel node. After resection of the subcutaneous metastasis, rapid and extensive systemic dissemination occurred within two months. Metastases affected the liver, lungs, bone, soft tissue structures, and a large parailiac tumor. Therapy included combined immunotherapy (pembrolizumab + ipilimumab) and multiple series of stereotactic body radiotherapy (SBRT) for oligometastatic lesions. After an initial mixed response, secondary SBRT resulted in complete metabolic regression of most lesions on fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). The remaining parailiac remnant showed a gradual decrease in size and metabolic activity during follow-up. Continuous pembrolizumab monotherapy and targeted SBRT provided long-term disease control, with no evidence of active disease on the last FDG PET/CT. This case highlights the heterogeneity of melanoma, the possible limitations of prognostic factors, and the potential role of earlier initiation of systemic therapy and a combined approach of SBRT and immunotherapy in selected patients.