Background. The annual reporting forms for malignant neoplasms do not provide for the division of lymphomas into variants. In international publications and statistical reference books of the Russian Federation, variants of non-Hodgkin’s lymphomas (NHL) are also not separated. For these reasons, a detailed assessment of the epidemiology of NHL in Russia is difficult, and data for individual variants of the disease are not provided.

Purpose: to present the clinical and epidemiological characteristics of Diffuse Large B-cell Lymphoma (DL BCL ) in Novosibirsk according to the data of the City Hematology Center (CHC).

Material and Methods. A retrospective analysis of primary medical documentation (case histories,  outpatient charts, and immunohistochemical study reports) of 271 patients with DL BCL was performed in the period from January 1, 2013 to December 31, 2018.

Results. The calculated registered primary morbidity and mortality from DL BCL in Novosibirsk for the analyzed years fluctuated slightly. The average incidence and mortality rates were 2.85 and 1.98 per 100,000 population, respectively. When analyzing the dynamics of the prevalence of DL BCL in Novosibirsk, a positive trend of annual increase in the indicator was revealed: 1.87 times over the past 6 years. In men, the tumor developed 2.6 years earlier than in women. In General, the risk of getting DL BCL after 50 years was 3 times higher than at the age of 30 years. Among patients diagnosed with primary lymphoma who underwent treatment at the Hematology department of CHC, half of the patients had DL BCL .Evaluation of the clinical characteristics showed a pronounced severity of the analyzed cohort.

Conclusion. The updated quantitative and qualitative indicators of clinical and epidemiological characteristics of DL BCL in Novosibirsk for 2013–18 were obtained. These indicators can be used for further monitoring, development and implementation of measures for the prevention, diagnosis and treatment of this form of hemoblastosis. 

The purpose of the study: to develop an expert system based on the construction of a «decision tree» for predicting the 5-year survival rate of patients with colorectal cancer.

Material and Methods. T he study included 654 patients with colorectal cancer (CRC) who were treated from 2013 to 2015, including 434 men and 220 women. The average age of patients was 64,1 ± 10,2 years. All patients underwent genetic analysis for the presence of a mutation in the K-ras gene from the primary tumor.

Results. For the Republic of Tatarstan, there are regional features of mutation of the K-ras gene: the frequency of mutations in tumors in men was less frequent (20.3 %) than in women (37.7 %), in patients of Slavic nationality, mutations were slightly more frequent – 39 % than in Tatars – 21 %. The gender approach to assessing long-term treatment results showed that in men with colorectal cancer, the most favorable treatment results were observed in patients with tumors in stage T1–2N0M0, regardless of the differentiation of the tumor and its mutational status. Low-grade tumors with any T should be considered prognostically unfavorable in men, with the presence of regional metastases and mutation of the K-ras gene, even in the absence of distant metastases: no patient lived 5 years. Based on the construction of a «decision tree», the most favorable treatment results were observed in female patients with tumors in stage T1–2–3N0M0 at the age of 70 years (5-year survival rate of 90 %), with tumors T1–2N0M0 at the age of 70 years (5-year survival rate of 81.8 %), regardless of the tumor differentiation and its mutational status. Tumors of any differentiation are prognostically unfavorable for women of the T3–4N0 stage with the presence of distant metastases (6 % of patients lived 5 years) and lowdifferentiated stage T4N0M0 tumors (5-year survival rate of 8 %).

Conclusion. G ender- and age-associated features of the development and course of CRC are relevant for oncologists to choose effective diagnostic and therapeutic measures.

Aim: to analyze short-and long-term treatment outcomes of thoracoscopic lobectomy in patients with stage
I NSCLC .

Material and Methods. A total of 479 NSCLC patients with clinical stage I NSCLC were treated at the Department of Thoracic Surgery of Hertzen Research Cancer Center from 2010 to 2019.

Results. Conversion to thoracotomy was required in 62 (12.9 %) of patients. Postoperative complications occurred in 19.9 % of patients in the thoracoscopic group and in 25.8 % of patients in the conversion group: the mortality rates were 0.4 % and 1.6 % respectively. The most common complication was prolonged air-leak (>5 days), which was diagnosed in 11.9 % and 8.0 % of patients respectively. In patients aged >70 years, the rate of complications was 35.8 % in the thoracoscopic group and 41.2 % in the conversion group. Thoracoscopic lobectomy had advantages over thoracotomy in terms of less postoperative pain syndrome and much less decrease in FEV1 during the first postoperative days and months. In patients with pT1-2aN0M0, stage I NSCLC , the overall and disease-free 5-year survival rates were respectively 92.2 % and 86.6 % after thoracoscopic lobectomy and 87.5 % и 81.2 % after conversion.

Conclusion. Thoracoscopic lobectomy is relatively safe procedure for patients with stage I NSCLC . To perform this type of surgery safely, the surgeon should pass the learning curve. Long-term outcomes were similar between patients undergoing thoracoscopic lobectomy and patients undergoing thoracotomy.

Diencephalic cachexia (DC ) is a metabolic disorder characterized by a decrease in body weight. DC usually occurs in the presence of glioma brain tumors extended into the optic pathway. These tumors are very aggressive and have poor prognosis.

Objective: to analyze the clinical course of optic pathway gliomas (OPG s) in patients with and without DC .

Material and Methods. The study included 264 patients aged 0 to 18 years with an initial diagnosis of OPG s registered in the N.N. Burdenko National Medical Research Center of neurosurgery from 01/01/2003 to 12/31/2015. Patients were divided into two groups: without DC (204 people) and with DC (60 children).

Results: neurofibromatosis type I (NFI) was much more common in children without DC , and pilomyxoid histology was much more prevalent in children with DC . Five-year overall survival (OS ) and event-free survival EFS were significantly lower in children with DC than in children without DC (82 ± 5 % and 96 ± 1 %, respectively versus 37 ± 7 % and 62 ± 3 %, respectively). It was found that in the DC group, the OS and EFS rates were significantly lower in girls, in children without NFI, in children without histological verification and in children with pilocytic astrocytomas. It was also found that in the DC group, OS rates were significantly lower in children under 1 year, and EFS rates were significantly lower in children aged more than 12 months. The number of patients without events were significantly higher in the group without DC (p=0.001). The number of deaths in the postoperative period was significantly higher in children with DC (p<0.001). Diabetes insipidus and hyponatremia were significantly more common in patients with diencephalic cachexia, and vision improvement after treatment was significantly more likely to occur in patients without DC .

Conclusion. OPG s in patients with DC have a more aggressive clinical course, which requires more careful treatment and observation. 

Objective: to assess the influence of the myxoid matrix in retroperitoneal well-differentiated liposarcoma
(WDLPS ) on the long-term results of surgical treatment of patients.

Material and Methods. The study included 111 patients with primary retroperitoneal WDLPS who underwent radical surgical treatment in Federal State Budgetary Institution «N.N. Blokhin National Medical Research Center of Oncology» of the Ministry of Health of the Russian Federation. Histological slides of all surgical specimens were reviewed by experienced pathologist and reclassified according to criteria of WHO (2013) for histological subtypes of the WDLPS . Patients were divided into groups depending on presence or absence of the myxoid matrix in WDLPS and enrolled in intergroup analysis of overall (OS ) and recurrence-free (RFS) survival.

Results. OS was significantly worse in the group of patients with the myxoid matrix in the tumor (p=0.002; log-rank test). The median OS was 142 (95 % CI , 108, 176) months in the group without the myxoid matrix, and 84 (95 % CI , 29, 139) months in the group with the myxoid matrix. The 5-year survival rates were 79 % and 44 % in the groups without myxoid matrix and with myxoid matrix, respectively. RFS was also significantly worse in the group of patients with the myxoid matrix than in the group of patients without the myxoid matrix (p=0.006; log-rank test). The median RFS was 55 (95 % CI , 38, 72) months in the WDLPS group without the myxoid matrix, and 31 (95 % CI , 15, 47) months in the WDLPS group with the myxoid matrix. The 2-year RFS rates were 75 % and 44 % in the groups without the myxoid matrix and with the myxoid matrix, respectively.

Conclusion. The results of the study demonstrated that the presence of the myxoid matrix in WDLPS was associated with poor prognosis. We believe that the presence of the myxoid matrix in WDLPS can serve as an effective morphological marker of a less favorable prognosis for retroperitoneal WLPS .

The main goal of reconstructive surgery is to improve the quality of life of patients who have undergone surgery. However, recurrences and postoperative complications after such surgeries pose a serious challenge.

The purpose of the study was to evaluate immediate surgical outcomes in head and neck cancer patients who underwent reconstructive surgery following tumor resection, as well as to analyze the causes of postoperative complications.

Material and Methods. Immediate treatment outcomes were analyzed in 272 head and neck cancer patients, who were treated from 2008 to 2018. All patients were divided into 2 groups. Group I consisted of 172 patients, who underwent radical surgery and reconstruction. Group II comprised 100 patients, who underwent radical surgery alone. The groups were matched by stage, gender, age, previous treatment, and tumor location.

Results. The incidence of recurrence was lower in Group I than in Group II (19 % versus 32 %, p>0,05). Postoperative complications occurred in 14 % of patients who underwent reconstruction of postoperative defects with rotation flaps and in 35 % of patients who underwent reconstruction with free revascularized flaps (p<0,05). The rate of complications was higher in patients undergoing maxillary and mandibular reconstructions (39,6 %) than in patients undergoing reconstructions of the other parts of the head and neck (23,7 %) (p<0,05). Patients who received chemoradiotherapy had higher rate of postoperative complications than those who had no neoadjuvant treatment (37 % versus 22 %, p>0,05).

Conclusion. Knowledge of the factors that have a significant impact on the likelihood of developing postoperative complications after reconstructive surgeries makes it possible to take measures to prevent  them. 

Introduction. Serum chemokines are inflammatory mediators, which role is shown in the occurrence and progression of a number of malignant tumors. Produced by white blood cells, stem cells, tumor and endothelial cells, chemokines control their movement and positioning. Chronic inflammation underlies the progression of ovarian cancer (OC ). This increases the likelihood of chemokines stimulating or blocking tumor progression.

The aim of the study was to evaluate the relationship between the blood levels of inflammatory cytokines in blood and the number of circulating tumor cells (CTC s) with the response to standard chemotherapy (CT ) in patients with cancer.

Material and Methods. In patients with primary OC before and after 2–4 courses of chemotherapy and in patients with benign ovarian tumors (as a control), serum levels of CCL 2, CCL 3, CCL 4, CXCL 8 and CX3CL 1 were evaluated by multiplex xMAP analysis. The amount of CTC s (population CD 45-/ Epcam+/CK+) was determined using a flow cytometer. Patients with ovarian cancer were divided into 3 groups according to the platinum sensitivity criterion of GC JG 4th, and progression-free interval (PFI) was determined.

Results. It was found that the levels of CCL 2, CCL 3, CCL 4, CXCL 8, and CX3CL 1 in case of OC did not significantly differ from that in the control, strongly negatively correlated with age (except for the CCL 2 level). CT significantly increased the level of CCL 2 in the group of refractory OC ; of CCL 3 – in the group of sensitive OC , of CCL 4 – in the groups of resistant and sensitive OC , and C XCL 8 level increased in the groups with resistant and sensitive OC and decreased in the group of refractory OC . The number of CTC s in patients with OC was significantly higher than in the control. After CT , a decrease in the amount of CTC s strongly and significantly correlated with a decrease in the level of CX3CL 1 in the groups of refractory and
sensitive OC . The maximum PFI occurred with an increase in serum levels of CCL 3, CXCL 8, a decrease in CCL 4 and a constant level of CX3CL 1.

Conclusion. Thus, no significant differences in the levels of CCL 2, CCL 3, CCL 4, and IL -8 between patients with OC and control groups were found. The levels of chemokines studied and the amount of CTC s differed in the groups divided by the tumor sensitivity to CT . We observed significant correlations between the amount of CTC s and the level of CX3CL 1 in the group of platinumsensitive OC .

The aim of the study was to study and evaluate the predictive value of the immune microenvironment of gastric cancer and morphologically normal mucous membrane of the peritumoral area using an automatic morphometric analysis system on the example of CD 8+ cells.

Material and Methods. Surgical samples from 130 patients with a verified diagnosis of gastric cancer were used. After immunohistochemical staining with antibodies to CD 8, a morphological assessment was performed according to the original method. We assessed the average area of CD 8+ cells in three fields of view (lens magn. ×20) using the automatic system of morphometric analysis LAS X (Leica) in the central part of the tumor and areas of morphologically normal mucous membrane of the peritumoral region directly adjacent to the tumor tissue. The results were compared with the main clinical and morphological characteristics of the tumor as well as with the overall five-year survival of patients.

Results and Discussion. A high density of CD 8+ infiltration of normal mucous membrane of the peritumoral area was observed in groups T4a and T4b by the depth of invasion (n=96, p=0.0089) and was associated with the presence of emboli in the lymphatic vessels (n=96, p=0.0102) and with the more advanced stage of gastric cancer (n=96, p=0.0107). The studied cases were divided into two groups: less than 3300 square micrometers (better patient survival; n=79, p=0.01) and more than 3300 square micrometers according to the average area of CD 8+ cells in normal mucous membrane of the peritumoral area. According to multivariate survival analysis using the Cox regression model, it was found that the average area of CD 8+ cells in normal mucous membrane of the peritumoral area was a significant negative prognostic factor (RR=1.537; CI : 0.761–3.105; p<0.01) comparable in degree covariance with the stage of the tumor A similar indicator assessed in central part of the tumor was not significantly associated with patient survival (RR=0.803; CI : 0.574–1.122; p>0.05).

Conclusion. The possibility of using an automatic analysis system to evaluate the immune microenvironment in gastric cancer was demonstrated for the first time. It was found that a high level of CD 8+ lymphocyte infiltration of morphologically normal mucous membrane of the peritumoral area was an independent negative prognostic factor. Therefore, we recommend the mandatory preoperative biopsy sampling from the mucous membrane of the peritumoral region for morphometric assessment of CD 8+ lymphocyte infiltration. 

The purpose of the study was a comparative experimental assessment of long-term toxic effects of cytostatic drugs (epirubicin, etoposide, platidiam, carboplatin, paclitaxel) on the female reproductive function and search for pharmacological ways to reduce them.

Material and Methods. Experiments were carried out on 200 outbred male rats, Wistar stock, 2.5 months old. Antitumor drugs were administered once, intravenously, in maximum tolerated dose. The reproductive status in rats was assessed 90 and 180 days after injection of cytostatic drugs. Correction of ovariotoxicity of cytostatic drugs was carried out using a recombinant human granulocyte colony stimulating factor (rhG-CS F, Neupomax, FARMSTA NDA RT-UfaVITA OJSC , Russia) and liquid extract of Scutellaria Baikalsky («GNTsLS », Kharkov). The mating and fertility ability of female rats as well as pre- and post-implantation fetal mortality were determined. Ovarian reserve was evaluated using morphological analysis of the ovaries using quantitative assessments of structural damage. Concentration of anti-Muller hormone in the blood of adult rats-females receiving etoposide and rhG-CS F were evaluated by enzyme immunoassay (IFA, ELISA , Cloud clone, Corp. Wuhan). Statistical processing of obtained experimental data was performed using Mann-Whitney U-test and Fisher angular transformation.

Results. The mating and fertility ability of animals was found to be persisted. However, signs of early depletion of the ovarian reserve and a decrease in reproductive potential were observed. The risk of early menopause was increased to a greater extent after using epirubicin, etoposide and paclitaxel, and to a lesser extent after platidiam and carboplatin. The reproductive potential of animals was reduced due to increased fetal death. Platinum-containing drugs were found to be the most toxic. G-CS F was the effective drug for protecting the ovarian reserve from cytostatic effects. The use of Scutellaria baicalensis extract increased the reproductive potential of animals by reducing the rate of embryonic death. 

Background. Gastric cancer is the second leading cause of cancer-related death due to advanced disease. A special role in the pathogenesis and metastasis of the tumor is assigned to tumor stem cells (TSC ),  responsible for resistance to chemotherapy and radiotherapy and causing tumor progression.

Objective: to determine the CD 44 and CD 133 markers of TSC in tumor tissues of non-metastatic and metastatic gastric cancer using the immunohistochemical method.

Material and Methods. A prospective study of tumors in patients with gastric cancer was conducted: Group 1 – 20 people with T3–4aN0–3M0G2 tumor, average age 58.9 ± 9.7; Group 2 – 20 people with T3–4aN0–3M1G2 tumor, with metastases in the peritoneum, average age 53.4 ± 11.9. The expression of CD 44 and CD 133 in the tumor tissue was determined by immunohistochemistry.

Results. Differences were found in the number of tumor cells expressing the CD 44 marker in the presence and absence of metastases in patients with gastric cancer – their number was 10.0 ± 3.08 and 6.0 ± 2.3, respectively. The CD 133 molecule was detected in 100 % of cases having metastases, while in cases having no metastases, the marker was detected only in 80 % of cases. The average percentage of CD 133 + cells was 21.3 ± 11.6 % in patients with metastatic gastric cancer and 10.0 ± 2.4 % in patients having no metastases.

Conclusion. The degree of expression of the CD 44 and CD 133 markers had characteristic differences in patients with gastric cancer, which can be used further to explain the results of the treatment and the prognosis of the disease.

Background. Еmbryonal tumors of the central nervous system are malignant neoplasms that mainly occur in pediatric patients with a peak incidence at the age of 4 years. These tumors usually have small round blue cell histology and low differentiation.

Method and case description. A report of three cases with embryonal CNS tumors of supratentorial localization has been presented. Immunohistochemical analysis classified these tumors as neuroblastoma (2 cases: Syn (+), NSE (+), CD (+) and Ki67 10/40 %; ages were 33 and 52 years) or ganglioneuroblastoma (1 case: Syn (+), NSE (+), CD 99 (+) and Ki67 40 %; age was 37 year). All patients underwent RT in a total dose of 60 Gy delivered to the area of the removed tumor and 6 cycles of adjuvant chemotherapy: patients with neuroblastoma received chemotherapy using EP regimen (cisplatin + etoposide), and patient with ganglioneuroblastoma received temozolomide.

Results. An objective response to therapy was achieved in all 3 patients. The relapse-free survival (RFS) in the first case of neuroblastoma was 51 months, the overall survival (OS ) was more than 105 months (8 years 9 months); in the second case of neuroblastoma, RFS was 25 months 2 weeks and OS was more than 26 months. Both neuroblastomas contained ID H1(R132H) mutation. In the patient with ganglioneuroblastoma, the RFS was 87 months, and the OS was over 93 months (7 years, 9 months, 3 weeks).

Conclusion. Supratentorial embryonal tumors of the central nervous system in adults are exceptionally rare and have a relatively favorable response to the standard treatment.

The purpose of the study was to analyze and summarize data regarding a significance of PD -L1 expression in various molecular subtypes of colorectal cancer.

Material and Methods. A systemic literature search was conducted in the electronic databases Medline, Cochrane Library, Elibrary, PubMed. Of identified and reviewed 201 full-text articles, we included data from 47 studies.

Results. The literature review described the features of the molecular genetic classification of colorectal cancer and revealed the key characteristics of each of the molecular subtypes of this disease. Much attention was paid to the molecular mechanisms of anti-PD -1/PD -L1 therapy. The main problems associated with the standardization of methods for pathomorphological assessment of the expression of this marker and the difficulties of its interpretation in colorectal carcinomas were outlined.

Conclusion. Analysis of the literature revealed problems associated with the assessment of PD -L1 expression in colorectal cancer, in particular, with the lack of generally accepted methods for interpreting research results and standardizing methods for pathomorphological diagnosis of malignant tumors of this localization. Further studies are needed for introducing the molecular genetic classification of colorectal carcinomas into a wide clinical practice and personalizing the approach to therapy of this disease.

There are some types of breast cancer (BC) that depend on their molecular characteristics. However, lately researchers provide date regarding the presence of additional receptors of triple negative breast cancer (TNBC). One of them is LA R-subtype that has androgen receptors (AR) on breast cancer cells. The role of AR in the development of this pathology is still controversial. According to some authors, stimulation of AR leads to the proliferation suppression, in the opinion of others – to the activation and potentiation of tumor invasion. There is also a version of the dichotomous effect of androgens that depends on the concentration of this hormone. The various effects of LA R-subtype therapy of BC are also explained by the presence of many other regulator proteins that interact with AR. The first attempts to treat BC with androgen have begun since the 40s of the last century, but in those years it did not have the desired effect and was not used until recently. Currently, the basic mechanisms of the effect of androgens on BC cells on the molecular level are known, and researches try to use androgen therapy, also in combination with aromatase inhibitors to increase the concentration of endogenous testosterone. The effects of selective androgen receptor modulators and anabolic steroids are being studied. However, in the last decade, the largest number of studies focused on the study of anti-androgen therapy. Patients receive AR antagonists, such as enzalutamide, bicalutamide, that are prescribed for prostate cancer. Enzalutamide blocks both androgen- and estrogen-mediated tumor growth, and therefore can be used regardless of the presence of estrogen receptors (ER), in contrast to bicalutamide. The results showed a significant increase in disease free survival up to 16.5 months in patients with hormone positive BC.

The purpose of the study was a systemic literature review on data regarding the efficacy, safety and prospects for the use of adjuvant chemotherapy for locally advanced gastric cancer.

Material and Methods. The study contained a thorough literary analysis of the results of international studies on the use of preoperative and postoperative chemotherapy for locally advanced gastric cancer. Relevant sources were searched in Medlin and Cochrane Library databases, and publications from 2001 to 2019 were included. Of all the studies analyzed, 28 were used to write the systematic review.

Results. The increase in survival rates was mainly achieved due to the use of a multimodal approach to the treatment of gastric cancer. The effectiveness of this approach, which combined surgery with chemotherapy or chemoradiotherapy, was proven in several large clinical studies. However, despite the large number of treatment options for locally advanced gastric cancer, there is still no single standard for the management of patients with this disease. One of the treatment options successfully practiced in a number of leading countries is the use of adjuvant chemo/chemoradiation therapy.

Conclusion. Analysis of the literature data of the last 18 years has shown the high relevance of studies on adjuvant chemotherapy for gastric cancer and the need to continue further study of this problem.

Cancer of the major duodenal papilla is a rare disease with a reported population incidence of 6 per million. Endoscopic ultrasonography and intraductal ultrasonography are useful for diagnosing tumor  extension of the major duodenal papilla. However, there are no specific biochemical studies or tumor markers, and an algorithm for early diagnosis of cancer of the major duodenal papilla has not been developed. Pancreatoduodenal resection remains the main treatment method for patients with a resectable tumor. However, long-term outcomes of radical surgeries are not satisfactory, with the median survival rate of 52–113 months, and the 5-year survival rate of 30–78.8 %. The study of prognostic factors will allow the development of the effective schemes of radical treatment, a therapeutic algorithm that will inevitably increase life expectancy. Radical surgery should be integrated into multi-modal treatment. Of all the variety of prognostic factors, the morphological differentiation of the tumor is of interest. According to our data, the overall 5-year survival rate, the average life expectancy for pancreatobiliary and intestinal subtypes of cancer of the major duodenal papilla after expanded pancreatoduodenal resection, respectively, was 0 % versus 38.05 % and 9.3 ± 1.79 months versus 48.0 ± 7.69 months. An accurate morphological diagnosis is of paramount prognostic importance, since it can have therapeutic consequences; that is, morphologically oriented and specific (neo)adjuvant treatment corresponding to subtypes of cancer of the major duodenal papilla. Currently, a multi-modal approach in the treatment of cancer of the major duodenal papilla is under development. Data on the use of adjuvant therapy in the radical treatment regimen are contradictory. There are no randomized controlled trials for neoadjuvant treatment. Little attention is paid to complications of chemotherapy and radiation therapy in the neoadjuvant treatment option. According to our data, chemoembolization of the gastro-duodenal artery resulted in complications in 21.4 %, and external beam radiation therapy resulted in radiation-induced injuries in 25 %. NCC N and ESMO currently do not provide recommendations for (neo)adjuvant treatment of cancer of the major duodenal papilla.

Background. The parasternal lymphatic collector is an important pathway of the lymph drainage from the breast in breast cancer patients. Evaluation of parasternal lymph nodes is not available during physical examination. To date, no algorithm for diagnostic imaging of the parasternal lymphatic pathway has been developed. The presence of metastases in parasternal lymph nodes upstages the breast cancer patient to a minimum of clinical stage III disease.

Case description. We present the case of breast cancer progression in a 40-year-old woman. The patient received treatment for triple-negative stage IIA breast cancer (Т2N0M0) in 2018. In August, 2019, 18-FDG PET /CT images revealed a solitary metastasis in the parasternal lymph node. Ultrasound images also showed the same lymph node assessed by PET -CT and the additional parasternal lymph node metastasis. A fine-needle aspiration biopsy of both lymph nodes confirmed the specific involvement of the parasternal lymph nodes.

Conclusion. Ultrasound scans are used to assess the axillary, subclavian and supraclavicular lymphatic collectors, but there is little evidence in the literature on the use of ultrasound in the assessment of parasternal lymph nodes. Our clinical case shows the feasibility of using ultrasound in assessing the status of the parasternal of lymph nodes, as well as the feasibility of performing fine-needle aspiration biopsy by ultrasound navigation.

Background. The use of modern induction chemotherapy programs for primary Hodgkin’s lymphoma allows achievement of high long-term outcomes even in patients with initially poor prognosis. However, the toxicity of treatment is quite high. Despite the effectiveness of chemotherapy, the frequency of relapses and resistant forms varies from 20 to 30 %. In extremely rare cases, the use of intensive chemotherapy regimens, including high-dose chemotherapy, leads to long-term remissions.

Description of the clinical case. We present a case of advanced-stage Hodgkin’s lymphoma in a young patient with symptoms of intoxication and adverse risk factors, such as: massive lesion in the mediastinum, increased ES R, infiltration of soft tissues, pleura, pericardium, multiple lesions of both lungs, damage to more than 3 areas of the lymphatic collectors. Given all these factors, the disease prognosis was extremely unfavorable, with a low probability of achieving remission and a high risk of early progression. The use of the intensive EACOPP -14 program allowed the achievement of short-term partial remission. Due to poor treatment tolerance, but taking into account the achievement of a partial response, further treatment was continued using the ABVD chemotherapy regimen. Follow-up examination revealed disease progression. Further courses of chemotherapy using various combinations of chemotherapy drugs resulted in a short-term positive effect with subsequent disease progression. Considering the fact that the disease was resistant to most basic chemotherapeutic agents, immunotherapy with nivolumab (PD -1 inhibitor) was administered. This alternative treatment method allowed the disease to be stabilized.

Conclusion. The use of the immunological drug in a patient with chemoresistant Hodgkin’s lymphoma made it possible to stop the progression of the disease and to improve the patient’s quality of life, without significant infectious complications and adverse events.

Background. Endometrial cancer is the most common malignancy of the female reproductive system. Patients with metastatic endometrial cancer have the overall 5-year survival rate of less than 20 %. The efficacy of treatment of advanced endometrial cancer remains low; therefore, the search for novel approaches for treating endometrial cancer is of great importance.

Case description. We report a case of a 68-year-old female who presented with advanced endometrial cancer with metastatic lesions found in the axillary and lumbar lymph nodes, liver and lungs. The disease progressed after third-line chemotherapy, with no deficiency in the DNA repair system. The patient was successfully treated with lenvatinib and pembrolisumab. The treatment was characterized by controlled minimal toxicity and a satisfactory quality of life. At 5 months, the patient is alive with stable disease.

Conclusion. Despite the progress in treating endometrial cancer including chemotherapy and hormone therapy, the prognosis of patients with metastatic endometrial cancer is poor. The discovery of new molecular markers (MSI , PD -L1) made it possible to develop a clinical approach using a combination of pembrolizumab and lenvatinib for patients with no deficiency in the repair system, for whom, the standard chemotherapy is ineffective. The presented case gives hope for the treatment of this category of patients.