Atypical Type Research Articles

Chinese guildeline on diagnosis and treatment of basal cell carcinoma (2023 edition)

Basal cell carcinoma (BCC) is the most common skin malignancy, with a higher prevalence in Caucasians than in East Asians. Although there is a lack of epidemiological data in China, it is generally believed that the incidence of BCC in China is increasing due to the aging population. A variety of risk factors are related to the occurrence of BCC, among which ultraviolet rays and gene mutations play a major role, especially the abnormal activation of Hedgehog (Hh) signaling pathway, which is considered to be the most important pathogenesis of BCC. The clinical manifestations of BCC are highly specific, and most experienced doctors can make a preliminary diagnosis by clinical manifestations. Dermoscopy and other imaging methods can greatly improve the accuracy of diagnosis, but there are still some atypical or rare types of BCC that need further confirmation through histopathological examination. This guideline is initiated by the National Clinical Research Center for Skin and Immune Diseases (based on Peking University First Hospital). It has invited a panel of experts consisting of 24 senior dermatologists specializing in dermatologic surgery from the Dermatologic Surgery Group of the Chinese Medical Doctor Association of Dermatology, the Dermatologic Surgery Group of the Dermatology & Venereology Committee, Chinese Association of Integration Medicine, and the Dermatologic Surgery and Cosmetic Branch of Clina Leprosy Association. In addition, experts from the Burn and Plastic Surgery (Maxillofacial), Ophthalmology, Otolaryngology, Head and Neck Surgery, Radiation Therapy, and Pathology were also invited to participate. This panel forms the "Chinese Guideline for the Diagnosis and Treatment of Basal Cell Carcinoma" expert group. Based on the latest domestic and international research findings, the guideline was developed through four rounds of discussions by the expert group and revised to provide valuable references for clinical healthcare providers in the diagnosis and treatment of BCC.

Cystic meningioma of the brain

ABSTRACTMeningiomas with a cystic component are quite rare and account for 1.7–7.3 % of all intracranial meningiomas. The incidence of cystic meningioma in adults is 2–4 % of all meningiomas. Women have a higher incidence rate in comparison to men. Between 2014 and 2019, at the State Institution Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine, we collected data for a database of cystic meningioma cases. The data included preoperative imaging, surgery notes, and pathology reports. Over the course of 6 years, 1408 meningioma cases have been observed, and 1326 of those instances have undergone surgical treatment for intracranial meningioma. 73 (5.5 %) cases of cyst-associated meningiomas have been analyzed: 26 (2.0 %) of true cysts (primary), 47 (3.5 %) cases of pseudocysts (secondary). Nauta type IV was the most common cyst type accounting for 52.1 %, whereas atypical (27.4 %) and anaplastic (17.8 %) meningioma types were the most common histological subtypes. All patients were monitored for 24 months; only 73 patients had access to long-term monitoring, which lasted for an average of 49 months (range 36–96 months). The majority of atypical (2.7 %) and anaplastic (5.5 %) types of pseudocystic meningioma relapsed after radical tumor surgery removal. The preoperative diagnosis needs to be integrated with the examination performance, the surgical treatment is selected based on the Nauta classification, and most of the surgical operations can result in the complete resection of the tumor.

Horse riding as an atypical type of rehabilitation to improve physical capacity in a patient after cardiac surgeries and before liver transplantation.

Horse riding as an atypical type of rehabilitation to improve physical capacity in a patient after cardiac surgeries and before liver transplantation.

Problems of Non-Contractual Transfer of Rights to Results of Intellectual Activity

Relevance. The article analyzes the cases in which the legislation recognizes the possibility of transfer of exclusive rights to the results of intellectual activity without concluding contracts with the right holders, including in the case of inheritance of such rights and in various forms of reorganization of a legal entity - the right holder. The purpose of the study is to develop theoretical provisions that take into account the interests of participants of civil legal relations in various cases of non-contractual transfer of rights to the results of intellectual activity.Objectives: to identify the problems associated with the non-contractual transfer of rights to the results of intellectual activity; to analyze the peculiarities of legal relations associated with such a transfer, taking into account the peculiarities of the existing legislative regulation; to propose solutions aimed at eliminating contradictions between the interests of the participants of legal relations arising from the non-contractual transfer of rights to the results of intellectual activity.Methodology. The dialectical-materialistic method, system method, methods of analysis and synthesis, formallegal method were used in writing the work.The results of the research are of theoretical and applied nature and are aimed at improving the quality of legal regulation of atypical types of civil legal relations.Conclusions. The conclusions are drawn on the need to ensure the possibility of documentary confirmation of the fact of non-contractual transfer of the exclusive right to the result of intellectual activity in all cases when such transfer occurs as a result of reorganization of a legal entity, as well as to provide authors and other right holders with the possibility to include in alienation contracts the obligations preventing the circumvention of the provisions on payment of remuneration and other essential conditions of such contracts. The proposed solutions will make it possible to ensure the circulation of exclusive rights to the results of intellectual activity and guarantee compliance with the obligations provided for in agreements on the alienation of such rights.The article is a continuation of the author's scientific research on the issues related to the protection of the rights of authors and their heirs.

Advanced Body Measurement Techniques Can Complement Current Methods of Cytotoxic Chemotherapy Dose Prescription

Within chemotherapy, estimates of a patient’s body surface area (BSA) are used to calculate drug dosages. However, the use of BSA for calculating chemotherapy dosage has been heavily criticised in previous literature, with potentially significant implications for the effectiveness and toxicity of treatment. BSA has been found to be a poor indicator of optimal drug exposure that does not account for the complex processes of cytotoxic drug distribution and elimination. In addition, differences in BSA estimates between existing formulae have been shown to be so large that they can affect patients’ mortality, particularly in patients with atypical body types. This uncertainty associated with BSA prediction may decrease the confidence of practitioners when determining chemotherapy dosages, particularly with regards to the risk of excess toxicity from over-dosing, or a reduced anti-cancer effect due to under-dosing. The use of national dose-banding in the UK may in some cases account for possible inaccuracies, but the threshold of variance in this case is small (+/−6%). Advanced body measurement techniques, utilising digital tools such as three-dimensional (3D) surface imaging, capture accurate external dimensions and detailed shape characteristics of the human body. Measures of body shape describe morphological variations that cannot be identified by traditional anthropometric techniques and improve the prediction of total body fat and distribution. It is our view that the use of advanced body measurement techniques can provide practitioners with tools for prescribing chemotherapy dosages that are valid for individuals, regardless of their body type.

Mitochondrial Localized In Situ Self-Assembly Reprogramming Tumor Immune and Metabolic Microenvironment for Enhanced Cancer Therapy.

The inherent immune and metabolic tumor microenvironment (TME) of most solid tumors adversely affect the antitumor efficacy of various treatments, which is an urgent issue to be solved in clinical cancer therapy. In this study, a mitochondrial localized in situ self-assembly system is constructed to remodel the TME by improving immunogenicity and disrupting the metabolic plasticity of cancer cells. The peptide-based drug delivery system can be pre-assembled into nanomicelles in vitro and form functional nanofibers on mitochondria through a cascade-responsive process involving reductive release, targeted enrichment, and in situ self-assembly. The organelle-specific in situ self-assemblyeffectively switches the role of mitophagy from pro-survival to pro-death, which finally induces intense endoplasmic reticulum stress and atypical type II immunogenic cell death. Disintegration of the mitochondrial ultrastructure also impedes the metabolic plasticity of tumor cells, which greatly promotes the immunosuppresive TME remodeling into an immunostimulatory TME. Ultimately, the mitochondrial localized in situ self-assembly system effectively suppresses tumor metastases, and converts cold tumors into hot tumors with enhanced sensitivity to radiotherapy and immune checkpoint blockade therapy. This study offers a universal strategy for spatiotemporally controlling supramolecular self-assembly on sub-organelles to determine cancer cell fate and enhance cancer therapy.

Diversity of Bathyarchaeia viruses in metagenomes and virus-encoded CRISPR system components.

Bathyarchaeia represent a class of archaea common and abundant in sedimentary ecosystems. Here we report 56 metagenome-assembled genomes of Bathyarchaeia viruses identified in metagenomes from different environments. Gene sharing network and phylogenomic analyses led to the proposal of four virus families, including viruses of the realms Duplodnaviria and Adnaviria, and archaea-specific spindle-shaped viruses. Genomic analyses uncovered diverse CRISPR elements in these viruses. Viruses of the proposed family "Fuxiviridae" harbor an atypical Type IV-B CRISPR-Cas system and a Cas4 protein that might interfere with host immunity. Viruses of the family "Chiyouviridae" encode a Cas2-like endonuclease and two mini-CRISPR arrays, one with a repeat identical to that in the host CRISPR array, potentially allowing the virus to recruit the host CRISPR adaptation machinery to acquire spacers that could contribute to competition with other mobile genetic elements or to inhibit host defenses. These findings present an outline of the Bathyarchaeia virome and offer a glimpse into their counter-defense mechanisms.

A RETROSPECTIVE COHORT STUDY IN AN INDIAN TERTIARY CARE HOSPITAL ON BREAST LESION CLASSIFICATION BY THE IAC YOKOHAMA SYSTEM USING FNAC

Objective: The International Academy of Cytology (IAC) Yokohama system was used to categorize breast lesions as the major goal of this investigation. Methods: Between January 2022 and March 2023, this study on breast fine needle aspiration cytology (FNAC) was carried out at a tertiary care facility in north India. This System of reporting breast cytopathology was used to classify a total of 100 patients. Histopathology correlation was available in 40 cases; Malignancy risk, sensitivity, specificity, and diagnostic precision were assessed. Results: Breast FNAC cytology was divided into five groups using the new IAC Yokohama system and discovered C1: Insufficient material (6%), C2: Benign type (72%), C3: Atypical type (05%), C4: Suspicious type of malignancy (06%), C5: Malignancy (11%). When histopathological reports were available, FNACs were connected with them. The likelihood of cancer, the precision, sensitivity, and specificity of the diagnosis were all calculated. Conclusion: The IAC Yokohama System for reporting breast cytopathology governs how breast FNAC are categorized, which offers an excellent method for reporting breast cytopathology with a uniform method of reporting and clear definition of each category as well as clear communication between pathologists and clinicians regarding the risk of malignancy and subsequent management.

IgD expression in various immunoarchitectural patterns of nodular lymphocyte predominant Hodgkin lymphoma in children

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) consist of lymphocyte predominant cell or LP-cell. Despite their origin from active germinal centers, in some cases LP-cells express IgD, which is characteristic of naive B-lymphocytes of the mantle zone. Due to the rarity of NLPHL, assessing the frequency of IgD-positive cases is difficult. This marker can serve not only for differential diagnosis with other diseases, but also indicate the possible heterogeneity of NLPHL, which is currently represented by six immunoarchitectural patterns. To determine the frequency of IgD-positive cases of NLPHL in children with subsequent assessment of the association with types of immunoarchitectural patterns. The study included 52 cases of NLPHL, which were divided to typical and atypical patterns. Differences between two groups were compared using Fisher's exact tests. IgD expression was found in LP-cells in 26 of 52 cases (50%) and was positively correlated with atypical types (typical - 5/23, 21.7% vs atypical - 21/29, 72.4%, p=0.0003), among which pattern C was most common. Due to the high incidence of IgD-positive cases in NLPHL, this marker may be useful in differential diagnosis with histologic mimics. At the same time, positive IgD status was associated with atypical patterns, which may likely determine the different biology of neoplastic cells within the same form.

High throughput screening of semiconductors with low lattice thermal transport induced by long-range interactions.

Semiconductors with long-range interactions (LRI) due to resonant bonding exhibit delocalized electronic states and low lattice thermal conductivity, contributing to the efficiency of heat-to-electricity conversion. Here, we build a descriptor for high-throughput screening of LRI materials from the second-order interaction force constants. We identify 75 semiconducting candidates from the binary compounds in the MatHub-3d database that contain LRI. By analyzing the bonding properties of LRI atoms, we classify LRI in materials into two categories: type I and type II. In the structural unit of type I LRI, the atoms have strong bond connections, while a weak bond exists between the two groups in the structural unit of type II LRI. We have identified atypical type I LRI formed by Sb-Sb and Mg-Mg pairs in the emerging thermoelectric material Mg3Sb2, resulting in the softening of TA1 phonons and large anharmonicity. For type II LRI, the LRI of Ge-Ge and Se-Se pairs in R3m-GeSe can cross different layers. Moreover, we observe a combination of type II LRI and rattling effect in BaSe2 to restrict thermal transport. This work is of great significance for understanding the relationship between LRI and thermal transport properties, and for designing new LRI-induced low lattice thermal conductivity materials.

Feasibility and Clinical Outcomes of Vasa Vasorum Embolization for Atypical Type 2 or Type 5 Endoleaks after Endovascular Aneurysm Repair

Feasibility and Clinical Outcomes of Vasa Vasorum Embolization for Atypical Type 2 or Type 5 Endoleaks after Endovascular Aneurysm Repair

Met1-linked ubiquitination in cell signaling regulation.

Met1-linked ubiquitination (Met1-Ub), also known as linear ubiquitination, is a newly identified atypical type of polyubiquitination that is assembled via the N-terminal methionine (Met1) rather than an internal lysine (Lys) residue of ubiquitin. The linear ubiquitin chain assembly complex (LUBAC) composed of HOIP, HOIL-1L and SHARPIN is the sole E3 ubiquitin ligase that specifically generates Met1-linked ubiquitin chains. The physiological role of LUBAC-mediated Met1-Ub has been first described as activating NF-κB signaling through the Met1-Ub modification of NEMO. However, accumulating evidence shows that Met1-Ub is broadly involved in other cellular pathways including MAPK, Wnt/β-Catenin, PI3K/AKT and interferon signaling, and participates in various cellular processes including angiogenesis, protein quality control and autophagy, suggesting that Met1-Ub harbors a potent signaling capacity. Here, we review the formation and cellular functions of Met1-linked ubiquitin chains, with an emphasis on the recent advances in the cellular mechanisms by which Met1-Ub controls signaling transduction.

Magnetic Resonance Imaging Findings in Mayer- Rokitansky-Küster-Hauser (MRKH) Syndrome: A Report of Two Cases

Introduction: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a kind of Müllerian duct anomaly characterized by the absence or underdevelopment of the uterus and the top two-thirds of the vagina. MRKH syndrome is characterized by primary amenorrhea in young women who exhibit typical development of secondary sexual characteristics and normal external genitalia. These individuals have normal and functioning ovaries and a karyotype of 46, XX. Gonadal dysgenesis is the most prevalent cause of primary amenorrhea, followed by this condition. This case report aims to elaborate on MRI findings in females with typical and atypical types of MRKH syndrome. Case Description: The authors describe two female patients who presented with primary amenorrhea, normal external genitalia, and typical secondary sexual characteristics. These patients underwent MRI to identify the uterine and vaginal structure and additional non-gynaecologic abnormalities. Conclusion: MRI is the best imaging technique for the accurate evaluation of pelvic anatomy, uterine aplasia, uterine development, vaginal structure, and location of the ovaries, hence essential in the diagnosis, classification, and surgical planning of MRKH syndrome.

Criminal legal protection of pharmaceutical activity on the circulation of medicinal products in acts of foreign criminal legislation

The article examines the issue of the specifics of the criminal law protection of pharmaceutical activity in the circulation of medicinal products in acts of foreign criminal legislation.
 The author proposes to single out the most typical types of criminal offenses that encroach on pharmaceutical activity depending on the typical types of "impact” of pharmaceutical activity, namely when ensuring various stages of trade and other circulation (turnover) of medicinal products and other items of pharmaceutical activity.
 The author conducts a thorough review of the criminal legislation of such countries as the Federal Republic of Germany, the Republic of Austria, the Swiss Confederation, the Kingdom of Spain, the Republic of Estonia, the Republic of Poland, Turkey, Romania, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Uzbekistan, the Republic of Moldova, the Republic of Tajikistan and the Republic of Azerbaijan . Such acts of criminal legislation are analyzed from the point of view of the scope of criminal legal protection of the sphere of circulation of medicinal products and in relation to the norms defined in the criminal legislation of Ukraine.
 The article notes that the provisions of acts of foreign criminal legislation establish typical and atypical types of criminal offenses that encroach on pharmaceutical activity as an independent object of criminal law protection.
 The author's attention is drawn to the fact that acts of foreign legislation define both a more "broad" and a smaller ("narrow") scope of criminal offenses of a specific type. And in separate acts of foreign criminal legislation, the concept of illegal medicinal products trafficking as an independent type of criminal offense is defined in different ways.
 It is noted that the conducted comparative legal research demonstrated that the most complete scope of criminal legal protection of circulation of medicinal products and circulation of medical devices as elements of pharmaceutical activity is presented in the German and Swiss "models" of criminal legal protection. These models of criminal law protection received a detailed review and analysis, due to the detailed provisions of the criminal legislation of the Federal Republic of Germany and the Swiss Confederation.

Two Putative Pheromone Receptors, but Not Their Cognate Pheromones, Regulate Female Fertility in the Atypical Mating Fungus Colletotrichum fructicola.

Colletotrichum fungi are a group of damaging phytopathogens with atypical mating type loci (harboring only MAT1-2-1 but not MAT1-1-1) and complex sexual behaviors. Sex pheromones and their cognate G-protein-coupled receptors are conserved regulators of fungal mating. These genes, however, lose function frequently among Colletotrichum species, indicating a possibility that pheromone signaling is dispensable for Colletotrichum sexual reproduction. We have identified two putative pheromone-receptor pairs (PPG1:PRE2, PPG2:PRE1) in C. fructicola, a species that exhibits plus-to-minus mating type switching and plus-minus-mediated mating line development. Here, we report the generation and characterization of gene-deletion mutants for all four genes in both plus and minus strain backgrounds. Single-gene deletion of pre1 or pre2 had no effect on sexual development, whereas their double deletion caused self-sterility in both the plus and minus strains. Moreover, double deletion of pre1 and pre2 caused female sterility in plus-minus outcrossing. Double deletion of pre1 and pre2, however, did not inhibit perithecial differentiation or plus-minus-mediated enhancement of perithecial differentiation. Contrary to the results with pre1 and pre2, double deletion of ppg1 and ppg2 had no effect on sexual compatibility, development, or fecundity. We concluded that pre1 and pre2 coordinately regulate C. fructicola mating by recognizing novel signal molecule(s) distinct from canonical Ascomycota pheromones. The contrasting importance between pheromone receptors and their cognate pheromones highlights the complicated nature of sex regulation in Colletotrichum fungi.

Major adverse cardiovascular events in patients with ECG changes during dipyridamole infusion as a myocardial stress agent and normal MPI among filipino patients at a tertiary hospital

Abstract Introduction There is paucity and conflicting results of data regarding the prognostic significance of ST-segment depression during vasodilator stress testing in patients with normal myocardial perfusion imaging (MPI). It is even less well studied in minorities such as Filipino population. Purpose This study aims to determine the major adverse cardiovascular events (MACE) in patients with ECG changes during dipyridamole infusion as a myocardial stress agent and normal myocardial perfusion imaging. Methodology We performed a cross-sectional retrospective analysis of 266 adult patients aged 18 years and above who underwent dipyridamole MPI. Patients with abnormal baseline ECG, patients subjected to tests other than the Dipyridamole VST and those with missing clinical, electrocardiogram, or myocardial perfusion Imaging data were excluded. The primary endpoint was the composite MACE: of all-cause mortality, nonfatal MI, stroke, hospitalization because of heart failure, and revascularization. Results Among 226 included patients (mean age ‘61.11 + 10.72’ years; 58% women), those with ST segment depression >0.5mm were more likely to have MACE (OR 281.12; 95% CI 37.59 to 2101.82, p-value <0.001), female patients were more likely to have MACE compared to male patients (OR 2.1839; 95% CI 1.1373 to 4.1936; p-value 0.019), and patients with atypical type of chest pain were likely to have MACE (OR 2.1767; CI 1.1844 to 4.0003; p-value 0.012). During follow-up of 3 years, a total of 55 patients had MACE. All-cause mortality occurred in 3 patients, non-fatal MI in 40 patients, Hospitalization due to heart failure in 5 patients, stroke in 6 patients, and revascularization in 1 patient. Conclusion Dipyridamole-induced ischemic ST depression is more common in women, and is associated with increased risk for future cardiac events compared with similar patients without ECG evidence of ischemia. Ischemic ECG changes during dipyridamole MPI should warrant further evaluation and follow up, even when perfusion images are reassuring.

MENINGIOMA-04 PATTERN OF KI67 INDEX IN RELATION TO ANATOMICAL, HISTOLOGICAL AND DEMOGRAPHIC CHARACTERISTICS AMONG PATIENTS WITH MENINGIOMA SEEN AT KENYATTA NATIONAL HOSPITAL

Abstract BACKGROUND Meningioma remains the most frequently reported primary intracranial tumor that is indicated in the brain or spinal cord. It is relatively under-studied in Kenya, and hence literature and data are scarce on its immunohistochemically expression as well as its correlated clinical outcomes. The role of Ki-67 in the prognosis of meningioma’s has been indicated to be still debatable. METHODOLOGY Using a cross-sectional study design, patients who presented with meningioma were recruited through consecutive sampling. Data collected age, sex and the location of the tumor. Samples archived in the laboratory after surgery were retrieved, and Ki67 testing done to assess outcomes.Data analysis: SPSS version 26 was used. The Chi-square test was used to test the association between categorical exposure variables and the occurrence of Ki67. A p-value of 0.05 was considered statistically significant. RESULTS The study showed the average age of patients with new onset meningioma, as identified by histology, was 48.4 years. Our study found a higher percentage of female participants (79.5%) compared to male (20.5%). Meningothelial was the most common histological subtype, accounting for 34.1% of cases and classified as Grade 1 according to the WHO Grade system. 26.5% of grade 1 meningiomas had Ki67 labeling index of above 4%. The atypical type was the most significantly associated with Ki67 with a p-value of 0.012. The expression of Ki-67 labeling index was associated with WHO grade 2, and patients with this grade had a 6 times greater chance of having a Ki67 labeling index of more than 4%. The AUC model performance was 67.8%. This study found age, gender and location of tumor has no influence on mean Ki 67 labelling index. CONCLUSION High level of Ki-67 expression is associated with high pathological WHO grade II meningioma. 26.5% of grade 1 meningiomas had high Ki67 labeling index above 4%.

Atypical chromitite deposit in the Gaositai mafic-ultramafic complex, North China Craton: Geochemical, geochronological, and isotopic systematics

The Gaositai mafic-ultramafic complex in the North China Craton hosts a significant chromitite deposit featuring morphological and geochemical characteristics that deviate from the usual characteristics of typical high-Cr and low-Al podiform chromitites. Field observations and microscopic studies reveal notable variations in textural layering, mineralogy, and geochemical composition, challenging conventional features of stratiform chromitite deposits. Zircon UPb ages indicate that chromitite is most likely Carboniferous-Permian in age (330–275 Ma), but also contains numerous inherited zircons with concordant ages as old as 2544 Ma, reflecting a complex geological evolution. Post-formation metasomatic or metamorphic imprints can be evident by concordant zircon ∼247 Ma. Variable zircon εHf(t) values (−15 to +9.6) and depleted mantle model ages (432 to 2819 Ma) attest the presence of heterogeneous or reworked source materials.The PGE and trace element characteristics of the Gaositai chromitite are comparable to the geochemical features of Bushveld and Great Dyke deposits. Pyrite, millerite, norsethite, galena, and PGM (mainly OsIr alloys) inclusions are ubiquitous in chromite. Galena inclusions with homogenous Pb-isotopic ratios (206Pb/204Pb, 207Pb/204Pb, and 208Pb/204Pb) suggest a mixed sources of lead. In contrast, pyrite inclusions display significant variations in δ34SV-CDT values (−0.11 ‰ to 18.31‰) indicative of a crustal origin of sulfur. Bulk-rock ReOs isotope data of 0.1264–0.1294 shows 187Os/188Os ratios similar to abyssal peridotites, implying a potential connection between chromitite and the host ultramafic rocks. Highly disparate mantle model ages (55 to 2141 Ma) and re-depletion ages (28 to 692 Ma) suggest disturbance of the ReOs isotopic system during post-formational metasomatic or metamorphic events. These variations may, alternatively, reflect heterogeneity by subduction components. The obtained results do not support the Alaskan-type genesis of the host complex, but point towards an atypical stratiform type.

Multifocal motor neuropathy. A clinical case and literature review

Multifocal motor neuropathy is a rare motor neuron disease characterised by a progressive, gradual loss of muscle strength, although sensory functions are preserved. The worldwide frequency of this disease is estimated at 1 person per 100,000 people. MMN is diagnosed when there are characteristic clinical signs, electroneuromyography test results support the clinical findings, and other possible diagnoses are excluded. To prove the progressive course of the disease, the patient must be under long-term medical supervision, since the deteriorating state of the patient may imitate other diseases affecting the motor neuron, such as amyotrophic lateral sclerosis, chronic inflammatory demyelinating polyneuropathy, spinal muscular atrophy, and other.We present the clinical case of a 71-year-old patient who presented to the Neurology Department of the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. She complained of pain in her right hip and progressing weakness of the right foot which had lasted for a year. After laboratory tests, long-term supervision, and exclusion of other diagnoses, the patient was diagnosed with an atypical type of multifocal motor neuropathy responsive to treatment with intravenous immunoglobulin.

Giant Molluscum Contagiosum Opportunistic Infection in a HIV/AIDS Patient

Atypical types of molluscum contagiosum (MC), which are present in immunocompromised patients and show substantial weakening of cellular immunity, can be difficult to diagnose. Low CD4 cell counts are associated with MC lesions, which are most frequently seen in HIV patients. We report MC lesions in the trunk and lower extremities in a 40-year-old HIV-positive female patient. A 75 cells/mm CD4 count was present in the patient. To rule out more dangerous disorders including dimorphic fungal infections, a skin biopsy was performed. The hypogastrum of the trunk and vulva were affected by the lesions which were painless, flesh-colored papules and nodules. Syphilis and hepatitis B virus testing came out negative, while serological tests for HIV-1 were positive. Intracytoplasmic molluscum bodies were detected in the skin biopsy. However, the opportunity for an early diagnosis in our case was lost.