Introduction. Noncommunicable diseases are the cause of the majority of deaths in the world. In the near future, neoplasms will be a leading cause of death and a challenge for an increasing life expectancy in most countries of the world. In this regard, we aimed to analyze the structural changes in cancer mortality in Russia in the period 1965–2019, comparing them with trends in other countries, and to assess the hypothetical gain in life expectancy due to complete eliminating cancer mortality.

Material and methods. We used data on the age-specific mortality rates of the Russian Fertility and mortality database (rusfmd) of the centre of demographic Research of the New economic school (cdr Nes). We also used data from international databases: oecd Health statistics, global who mortality database, european Health for all database and international agency for Research on cancer. The analysis was carried out separately for males and females using decomposition and standardization methods.

Conclusion. During the soviet era, there were no positive changes in the rate and structure of cancer mortality. A decrease in the age-standardized death rate (asdr) was achieved only in the post-soviet period. However, despite the currently comparable cancer mortality rates in Russia and the eu, Russia is characterized by: a lower total number of deaths; higher asdrs of pediatric cancers; lower average life expectancy; lower five-year survival rate of patients. An increase in the average age at death and five-year survival rate may have a positive effect on an increase in the healthy life expectancy of the Russian population, but may not significantly affect the decrease in the asdr for cancer.  Therefore, these causes of death should not be considered as one of the main reserves for the growth of life expectancy (le), since even its complete elimination in the coming years can provide an increase in life expectancy by no more than 2 years. 

Introduction. A significant component in the system analysis of anti-cancer activities is the assessment of the impact of mortality on life expectancy, which indicates the social and economic situation in the region.

Material and methods. The economic damage caused by laryngeal and lung cancer mortality in the Tomsk region for the period 2005–2016 was analyzed using the database of the regional cancer registry and local agency of federal state statistics service of the tomsk region.

Results. The loss of the male working population ranged from 106.0 (2012–2013) to 161.5 (2008–2009) person/years of lifetime from larynx cancer and from 1058.5 (2013–2014) to 1576.3 (2006–2007) person/years of lifetime from lung cancer. The female working population lost up to 34.0 (2013–2014) person/years of lifetime due to mortality from larynx cancer and from 1445.3 (2005–2006) to 2553.9 (2015–2016) person/years of lifetime from lung cancer. The average number of undelivered years in working age due to the premature death of one man averaged 6.1 ± 2.0 years from larynx cancer and 11.1 ± 1.3 from lung cancer, one woman averaged 4.6 ± 0.9 years from larynx cancer and 6.2 ± 0.3 years from lung cancer. Economic losses associated with mortality from cancer of the respiratory system amounted to 2.251.97 million rubles: 202.07 million rubles from laryngeal cancer and 2.049.90 million rubles from lung cancer.

Conclusion. The quantitative analysis of social and economic losses associated with mortality from cancer of the respiratory system enables the regional health authorities to develop and implement anti-cancer interventions to maximize the use of funds for the prevention, treatment and rehabilitation of cancer patients.

The aim of the study was to assess the lung cancer incidence and mortality in the Khanty-mansi autonomous okrug – Yugra during the period 1999–2019.

Material and methods. We have studied the lung cancer incidence and mortality rates in Yugra over the last 21 years (1999–2019).

Results. In Yugra, the lung cancer (lc) incidence rates increased by 24.7 % from 1999 to 2019, demonstrating higher rates than those in the Russian Federation (RF), where lc incidence rates decreased by 20.3 %. In 2019, the age-standardized incidence rate was 30.5 per 100,000 (22.7 for RF); the age-standardized mortality rate was 16.4 per 100,000 (18.4 for RF). The mortality rate from lc in Yugra was 9.6 times higher in males than in females (35.5 vs. 3.7 per 100,000). The cross-correlation analysis revealed a correlation between the lc incidence/mortality and air pollution in Yugra. The main carcinogens in Yugra were formaldehyde, phenol, nitrogen dioxide, and benzapyrene. The assessment of the relationship between the age-standardized lc incidence/mortality rates and the amount of pollutants emitted into the atmosphere revealed that their synergistic effects with tobacco smoking can double the risk of lung cancer development. The increase in the number of chest computed tomography (ct) scans performed in the context of the pandemic caused by covid-19 infection led to an 18 % increase in the number of incidentally detected pulmonary nodules, of which 9 % of cases were diagnosed as lc.

Conclusion. The lc incidence rates in Yugra tended to increase. The high rate of lc incidence is caused by man-made and natural factors, which requires the implementation of a screening program with the use of low-dose computed tomography in order to improve the early detection and prevention of this disease.

Introduction. Determination of the cause of cholestasis and treatment of patients with obstructive jaundice syndrome remains challenging owing to the steady rise in diseases of the hepatopancreatoduodenal zone and the high frequency of diagnostic errors. In the differential diagnosis of the causes of obstructive jaundice, diagnostic imaging techniques are of the greatest importance. In the world literature, there are few reports on the assessment of the diagnostic potential of multispiral computed tomography under conditions of direct contrasting of the biliary tree using endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, or through pre-installed palliative drainage in the bile ducts. There is no generally accepted algorithm for determining the causes of biliary obstruction. It leads to ineffective use of various diagnostic imaging techniques, complicating the diagnostic process.

The purpose of the study was to evaluate the diagnostic efficacy of contrast-enhanced ct cholangiography (ct-cg) in the differential diagnosis of causes of malignant and benign biliary obstruction in cases with obstructive jaundice syndrome.

Material and methods. The study included 55 patients with obstructive jaundice, who were treated in a surgical hospital from july 2016 to july 2019.

Results. It was found that contrast ct-cg in diagnosing the causes of biliary obstruction of both malignant and benign genesis is more informative than x-ray endoscopic retrograde cholangiopancreatography. The diagnostic efficacy of ct-cg in detecting causes of malignant biliary obstruction was: 93.3% sensitivity, 92.9% specificity, and 93.1% accuracy. The diagnostic efficacy of ct-cg in detecting causes of benign biliary obstruction was: 92.9%, 93.3% and 93.1%, respectively.

Conclusion. Based on the high accuracy, contrast-enhanced ct-cg is a promising imaging technique in cases with bile duct obstruction.

Introduction. Neoadjuvant chemotherapy (nact) is a potential alternative to chemoradiation therapy (crt) for rectal cancer and may allow early prevention of distant metastasis.

Objective: to study the safety and efficacy of nact for patients with rectal cancer without damage to the mesorectal fascia.

Material and methods. From 2016 to 2019, patients with cancer of the upper ampullar (сmrt2-t4an+m0, cmrt4an0m0), medium ampullar (cmrt3сn0m0, cmrt2n+m0) rectal regions were included in the pilot prospective study. All patients underwent nact according to the capox 4 scheme. Evaluation of the effect was carried out on the basis of mri of the small pelvis. In the case of regression or stabilization, surgery was performed, and in the case of progression, crt was followed by surgery. After surgery, all patients were scheduled for adjuvant chemotherapy for a total duration of 6 months. The primary endpoint was the rate of pathological complete response (mandard trg 1). Secondary endpoints included disease progression, toxicity (nci-ctc v. 5.0), postoperative complications (clavien-dindo), chemotherapy regimen, and long-term treatment outcomes.

Results. 136 patients were included into the study. Of 130 (11 %) patients, who underwent only nact prior to surgery, 15 had pathological complete response. 99 patients (72.8 %) received a full course of chemotherapy for 6 months (nact + adjuvant pct). 6 (4.3 %) patients after neoadjuvant chemotherapy were treated with crt, 5 (3.67 %) of them due to local progression according to mri data, 1 (0.7 %) due to grade 3 toxicity during 1 course of pct and inability to continue chemotherapy treatment plan. Radiation therapy resulted in partial tumor regression in all patients. Systemic progression was not observed in any patient. Grade iii–iv toxicity was observed in 7 (5.1 %) patients, including bronchospasm (n=2, 1.4 %), thrombocytopenia (n=1, 0.7 %), neutropenia (n=1, 0.7 %), peripheral neuropathy (n=1, 0.7 %), cardiotoxicity (n=1, 0.7 %), diarrhea (n=1, 0.7 %). Grade v toxicity (acute myocardial infarction) was observed in 1 (0.7 %) patient. R0 resection was performed in all cases. Grade iiia postoperative complications occurred in 6 (4.4 %) patients, iiib complications in 5 (3.7 %) patients, and death due to sepsis after postoperative pneumonia in 1 (0.7 %) patient. The frequency of anastomotic leak was 3.6 % (n=5). The median follow-up was 31.4 months, the overall survival (os) and disease-free survival (dfs) rates were 94 % and 92.8 %.

Conclusion. Neoadjuvant chemotherapy is a promising treatment option for rectal cancer patients with negative prognostic factors.

The aim is to present the experience of treating patients with spinal metastases, who underwent decompression laminectomy with posterior stabilization.

Material and methods. The study included 326 patients with spine metastasis, who underwent posterior thoracic laminectomy (199, 61 %) and lumbar laminectomy (127, 39 %). The mean age of patients was 63 (range, 29–78 years). There were 91 (28 %) males and 235 (72 %) females. Breast cancer was diagnosed in 137 (42 %) patients, kidney cancer in 69 (21 %) patients, prostate cancer in 39 (12 %) patients, lung cancer in 19 (6 %) patients, colorectal cancer in 16 (5 %) patients, thyroid cancer in 13 (4 %) patients, and the remaining 10 % of patients accounted for other more rare forms of malignancies

Results. The mean time of surgery was 95 min. (55–245 min.). Intraoperative blood loss volume was 245 ml (150–3200 ml). The mean hospital stay was 8 days (5–20 days). The pain intensity according to vas reduced in 160 (49 %) patients. According to the frankel classification system, neurological status improved in 85 (26 %) patients. Neurological deterioration was observed in 7 (2 %) patients. Intra-and early-/late postoperative complications were observed in 66 (20 %) patients. Traumatic dural tears occurred in 16 (5 %) patients. Infection rate was 4.5 %. Cardiac complications were observed in 12 (3.5 %) patients. Postoperative hematoma was revealed in 7 (2.4 %) patients.

Conclusion. The results obtained indicate that patients with metastatic spine disease represent a difficult group of patients for surgical treatment because of a high risk of developing postoperative complications, the most serious of which are neurological disorders with paraplegia and other fatal outcomes. Nevertheless, modern surgical techniques can improve the quality of life of these patients, improve psycho-emotional abilities and avoid disability.

Purpose: to study the expression of vascular endothelial growth factor (vegf-a) and its receptors (vegfr-1 and vegfr-2) in renal cell carcinoma (rcc) cells and assess the effect of the expression levels of these markers on the tumor characteristics and prognosis of patients with rcc.

Material and methods. The study included 65 patients with rcc (pt1a-t4n0/+m0/+). All patients underwent radical surgery. Histological tumor tissue samples obtained during surgery were used for the study. Expression of vegfa, vegfr-1, -2 was studied by immunohistochemical staining using appropriate antibodies to receptors and growth factors.

Results. Expression of vegf and vegfr-1 and vegfr-2 receptors was ound in the cytoplasm and on the membrane of primary tumor cells of patients with rcc. There was a significant direct correlation of overexpression of the markers with g 3-4 anaplasia (vegfr-1, -2) and signs of significant tumor extension, including high pt category (vegfr-1, -2), larger size of the primary tumor (vegfr-1 , -2), tumor invasion of paranephria (vegf, vegfr-1), tumor venous thrombosis (vegfr-1, -2), multiple metastases (vegf-2), metastases in the adrenal gland (vegf, vegfr-2) and liver (vegfr-1) (p<0.05). There was a trend towards a significant effect of the level of vegf expression on the risk of progression of rcc after cytoreductive nephrectomy (p=0.0821). A tendency towards a significant effect of the level of vegfr-2 expression on the risk of death from rcc was revealed (p=0.089). No other relationships between the expression of vegf-a/vegfr-1, -2 and the prognosis of rcc were found (p>0.05).

Conclusion. Expression of vegfa, as well as vegfr-1 and vegfr-2 receptors, was found on the surface and in the cytoplasm of cells of the primary tumor of patients with rcc (pt1a-t4n0/+m0/+). There was a significant correlation between vegf/vegfr overexpression with a high grade (g3-4) tumor anaplasia and significant tumor extension. In univariate analysis, a significant adverse effect on specific survival of vegfr-2 overexpression was observed. In regression analysis, vegfr-2 overexpression tended to independently affect specific survival. These results show the importance of vegf/vegfr expression as biomarkers in renal cell carcinoma.

Background. Currently, the use of nanoparticles and nanostructures as components of tumor therapy is the subject of numerous scientific articles. To change the parameters of cell microenvironment in presence of nanoparticles and nanostructures is a promising approach to reducing the tumor cell viability. Aluminum hydroxides and oxides have a number of advantages over other particles due to their porous surface, low toxicity, and thermal stability.

The purpose of the study was to investigate the influence of the acid-base properties of aluminum hydroxide structures with different phase composition on the tumor cell viability (Hela, mda, pymt, a549, B16F10).

Material and methods. Aln/al nanoparticles were used as a precursor for obtaining structures with various phase compositions. The anoparticles were produced by electric explosion of an aluminum wire in a nitrogen atmosphere. Such nanoparticles interact with water at 60 °Ϲ, resulting in formation of porous nanostructures. They are agglomerates of nanosheets with a planar size of up to 200 nm and a thickness of 5 nm. The phase composition of the structures was varied by the calcination temperature. A change in the phase composition of nanostructures led to a change in the acid-base properties of their surface. To estimate the number of acidic and basic centers on the surface of nanostructures, the adsorption of Hammett indicators was used. The amount of adsorbed dyes was determined spectrophotometrically.

Results. It was found that the differences in the acid-base characteristics of the surface of the nanostructures led to a change in their antitumor activity. Γ-al2o3 had 6.5 times more basic centers than acidic ones, which determined its ability to exhibit more pronounced antacid properties, i.e. Longer to neutralize protons secreted by tumor cells. This sample had the highest antitumor activity against all tested cell lines.

Conclusion. The antitumor activity of synthesized structures was found to be related not only to an increase in the ph of the cell microenvironment, but also to the ability to maintain the alkalinity of the microenvironment for a longer time due to the adsorption of protons released by tumor cells.

The aim of the study was to improve surgical outcomes in patients with proximal gastric cancer without invading the esophagus.

Material and methods. Data regarding lymph node metastasis, short-term postoperative complications/lethality, and long-term outcomes were analyzed in 162 patients with proximal gastric cancer without invasion of the esophagus. All patients underwent gastrosplenectomy with expanded d2 lymph node dissection. The age of the patients ranged from 25 to 91 years, and the median age was 60 years. There were 105 (64.8 %) patients aged over 60 years and 45 (27.8 %) over 70 years.

Results. Postoperative complications occurred in 14 patients (8.6 %), 8 of them (4.9 %) died. The 1-, 3- and 5 year survival rates were 85.4 %, 61.8 %, and 38.9 %, respectively.

Discussion. In patients with gastric cancer without esophageal invasion, perigastric lymph nodes (№ 3b, 4d) located in segments iv and v are often affected by metastases; therefore, we consider it inexpedient to perform proximal resections in these cases.

Conclusion. In patients with proximal gastric cancer without esophageal invasion, it is not advisable to perform proximal subtotal gastric resections due to the high frequency of 3b and 4d lymph node metastases. Postoperative complication and mortality rates were 8.6 % and 4.9 %, respectively in patients who underwent gastrosplenectomy with d2 lymph node dissection.

The aim of the study was to determine and analyze the most significant risk factors for developing cardiac, pulmonary and skin toxicities among patients who received concurrent radiation therapy and chemotherapy with trastuzumab.

Material and methods. The study included 66 patients with histologically verified invasive intermediate or low-grade breast carcinoma, who received radiation therapy and chemotherapy with trastuzumab from 2018 to 2019. The average age of the patients was 53.1 ± 4.2 years. Locally advanced stage iii a and iii b breast cancer was the most common (52 %) followed by stage ii a and ii b cancer (36 %). The lvef of all patients was ≥50 %. All patients received neoadjuvant chemotherapy with anthracyclines and/or taxanes. Radiation-induced side effects were assessed using the rtog/eortc scoring criteria. Dose-volume histogram (dvh) of radiotherapy planning was matched to the quantec criteria.

Results. Radiation-induced pulmonitis was observed in 2 patients within 2 to 6 months after the completion of radiation therapy. A 10 % reduction in lvef was observed in 3 patients, while a 20 % decrease in ef was not found. Long qt syndrome was observed in 3 patients, and it was accompanied by clinical manifestations in 2 patients. When evaluating the echo-cg protocols after treatment, normal lv diastolic function was recorded in 39 patients, moderate diastolic dysfunction (lv dd) in 27, and 1 patient had severe lv dd. When assessing the dose received by the lv myocardium, the excess of the average dose to the myocardium was present both on the left and on the right. Only in 16 % of cases, left myocardial irradiation met criterion v 25. Clinically, arrhythmias, unstable angina pectoris, and other manifestations of coronary artery disease were mostly observed among patients with left-sided breast cancer. Significant factors for the development of cardiotoxicity were left-sided breast cancer, previous chemotherapy with anthracyclines and/or taxanes, as well as myocardial doses. The occurrence of radiation pulmonitis did not show an obvious relationship with any factor, while the body mass index (bmi) of >30 was a significant factor for the occurrence of radiation-induced skin damage.

Conclusion. The combination of radiation therapy and trastuzumab was associated with an acceptable risk of cardiotoxicity. Monitoring of the cardiovascular system parameters during treatment and detection of early signs of cardiotoxicity were shown to be of great importance.

Background. Breast cancer is the most common cancer in women worldwide. Despite advances in treatment of breast cancer, early-stage breast cancer detection is limited by screening mammography and often requires additional breast imaging.

The purpose of the study was to analyze available data on modern imaging techniques of additional breast visualization used for improving breast cancer screening.

Material and methods. The review includes data from randomized controlled trials and meta-analyzes on the effectiveness of breast imaging techniques for early-stage breast cancer detection. The search was carried out in pubmed, Web of science, scopus and cochrane library databases. Out of 100 publications published over the past 7 years, 51 were included in the presented review.

Results. Breast cancer screening using various imaging techniques has been carried out in the world for more than 30 years, and over the past 10 years significant progress has been made in improving X-ray, ultrasound and magnetic resonance technologies in the early breast cancer detection. At present, healthcare organizers are faced with the question of choosing a vector for improving the breast cancer screening program by introducing digital tomosynthesis, contrast spectral mammography, or accelerated mri. According to the current results of the analysis of literature data, contrast spectral mammography and accelerated mri have the highest sensitivity, but studies of sensitivity, specificity, positive and negative predictive values (ppv, npv) are ongoing.

Conclusion. The data presented in the review confirm the necessity for finding the vector for improving the breast cancer screening program using multicenter prospective trials.

Introduction. Prostate cancer is one of the most common malignant neoplasms. Strategies to improve early diagnosis and subsequent therapy are being improved. An emphasis is placed on maintaining the quality of life and working capacity of patients after treatment. This can be achieved by improving methods of focal therapy, which depends on the accuracy of topical diagnosis and classification of the tumor. Hybrid molecular imaging (pet/ct and spect/ct) is used in addition to the methods of structural imaging (ultrasound, ct, mri). Intraoperative imaging using radionavigation systems is also used in open and endoscopic surgery for prostate cancer. Currently, it is a tool capable of reducing the invasiveness of surgery, localizing the area of metastatic lesions with a sensitivity and specificity of up to 95 %.

Objective of the study: an overview of current and promising future methods of intraoperative radio navigation in the surgical treatment of prostate cancer.

Material and methods. The review presents the methods of intraoperative radionavigation in the surgical treatment of prostate cancer. Radionavigation in the context of using tumarotropic radiopharmaceutical based on a prostate-specific membrane antigen, in which the drug accumulates in all tumor foci expressing this receptor, is also considered.

Conclusion. The use of preoperative hybrid imaging and radio-guided surgery facilitate lesion identification and resection. Gamma probing allows detection of psma-positive tumor foci regardless of their depth. Fluorescence imaging methods (icg, photodynamic diagnostics, autofluorescence) are also used for intraoperative detection of pathological foci in real time. Multichannel gamma probing and cherenkov radiation detection, which combine the advantages of indirect and direct intraoperative imaging, have enormous potential.

The purpose of the study was to present the most recent data on the outcomes of breast-conserving surgery after neoadjuvant chemotherapy for breast cancer patients.

Material and methods. We analyzed relevant publications available in the pubmed, cochrane library, e-library databases between 1990 and 2020, and 24 of them were used to write this review.

Results. Neoadjuvant chemotherapy for breast cancer patients is currently a widespread treatment option. The main advantage of this type of treatment for patients with early stage breast cancer is the feasibility of performing breast-conserving surgery in cases of partial or complete clinical response and, therefore, the improvement of the quality of life of patients with equivalent rates of disease-free survival compared to radical mastectomies.

Conclusion. Numerous studies have shown that breast-conserving surgery following neoadjuvant chemotherapy is the safe surgery with good oncologic outcomes and an alternative to radical mastectomies in breast cancer patients. However, further studies are required to determine the optimal safe resection margin width in patients with complete and partial responses to neoadjuvant chemotherapy.

The purpose of the study was to review available data on the combined use of local hyperthermia and chemotherapy/radiotherapy in the treatment of locally advanced cervical cancer, as well as to analyze longterm treatment outcomes.

Material and methods. A systemic literature review was conducted using medline, cochrane library, and elibrary databases in the interval time between 2003 and 2020.

Results. The review describes the mechanisms of biological efficiency of local hyperthermia and evaluates the effect of hyperthermia combined with chemotherapy and radiation therapy on cancer cells. Analysis of the thermobiological effects of local hyperthermia indicates that it is a potent sensitizer of cell killing by ionizing radiation and chemotherapy. The increase in tumor radiosensitivity is caused by the inhibition of the repair processes of damaged dna strands. Hyperthermia enhances perfusion and oxygenation of hypoxic tumor cells with a consecutive increase in tumor radiosensitivity. During chemotherapy, local hyperthermia ensures the maximum targeted delivery of cytotoxic agents to the tumor, thus increasing the effectiveness of treatment. Moreover, local hyperthermia has a direct cytotoxic effect on tumor cells. Randomized trials on the use of hyperthermia in the treatment of locally advanced cervical cancer have shown positive immediate and long-term treatment outcomes.

Conclusion. Local hyperthermia combined with chemotherapy and radiation therapy is a promising treatment modality for locally advanced cervical cancer, because it can significantly improve treatment outcomes and reduce the frequency of early and late adverse effects. However, despite the available world experience, there are no unified methodological approaches to local hyperthermia, and therefore further research is required.

Background. Type 2 diabetes mellitus, obstructive sleep apnea, osteoarthritis and certain types of cancer are known to correlate with obesity. The mechanisms underlying the link between metabolic disorders and cancer remain obscure, yet assuming a potentially important role of reduced insulin sensitivity, altered glucose metabolism in tumor cells (the so-called Warburg effect), changes in the spectrum of secreted adipokines or interaction with their cognitive receptors as well as changes in steroid sex hormone production.

Material and methods. A search for articles published in peer-reviewed journals indexed in pubmed, Wos, scopus and Rsci was carried out. More than 150 articles devoted to the study of the relationship between metabolic disorders and tumor progression were analyzed, of which 69 were included in this review.

Results. The main strategy of anticancer therapy is to suppress the proliferation of tumor cells and metastasis. However, one should take into consideration a significant role of additional factors that can enhance side effects of anticancer therapy, ensure the resistance of tumor cells to chemotherapy or change cancer cell metabolic profile. New data recently emerging in the literature indicate an important function of proteins such as t-cadherin and urokinase receptor (upar) and their possible involvement in the regulation of tumor cell metabolism, in particular, sensitivity to insulin and adipose tissue hormones. The review encompasses recent data on the involvement of t-cadherin and upar in the regulation of metabolism and proposes a model explaining the relationship between these proteins and metabolic disorders associated with the processes of carcinogenesis and chemoresistance of cancer cells.

Conclusion. Understanding of the factors and mechanisms that support obesity and metabolic disorders is relevant both for the development of cancer preventive measures and optimization of therapeutic strategies for combating cancer.

 the purpose of the study was to analyze facts and mechanisms of the development of second malignancies after radiodiagnostic and radiotherapy procedures as well as after different medicamental treatments. the search for relevant articles published over the last 6 years was carried out using  medline, elibrary, pubmed databases, and 34 publications were included in this review. the risk of second malignancies from ct scans and radiation therapy is increased by 1.5–3 times in cancer patients. some drugs for  treatment of chronic non-oncology diseases and many chemotherapeutic agents possess high carcinogenic potential in longtime period. invasive diagnostic and treatment methods, especially organ transplantations, have  protumorogenic effects. some of the diagnostic and treatment methods used in oncology should be considered as «inevitable oncoiatrogenic». applications of these methods require reasonable limitations. 

Background. Pseudosarcomas of soft tissues can cause diagnostic and treatment challenges. On the one hand, it is difficult to make a nosological diagnosis based on a biopsy specimen of a tumor; on the other hand, it is difficult to determine the most appropriate treatment strategy based on a histological pattern.

The purpose of the study was to analyze available literature data and systematize the histological characteristics of the chondroid lipoma and pseudosarcoma.

Case description. We present the case of chondroid lipoma in a 57-year-old female patient with atypical clinical symptoms. This case shows the difficulties of differential diagnosis of soft tissue sarcomas. Using a clinical example of chondroid lipoma, a rare soft tissue tumor, and an analysis of literature data, the authors showed the importance of a detailed study of the obtained material, a qualified description of the morphological picture, in those cases when the diagnostic conclusion cannot be unambiguous about the malignancy of the tumor process. Additional biopsy is not always possible to clarify the histotype of the tumor. The presented observation shows the difficulties of differential diagnosis of soft tissue sarcomas. Minimally invasive biopsy provides no a full appreciation of histological structure; therefore, if there is a suspicion for chondroid lipoma, it is necessary to perform total surgical biopsy followed by a morphological study using the immunohistochemical method.

Introduction. Penile cancer (pc) is a rare cancer. The standardized incidence rate of pc in russia is 0.82 cases per 100,000 males. On average, 58 % of patients (20–96 %) with pc have a local infection process: tumor decay, the presence of erosion, tumor ulceration, inflammatory changes in regional lymph nodes, etc. During hospitalization nosocomial pathogens may be possible causes of infection in ulcerative lesions.

The aim of the study was to present the results of the treatment of tumor ulcer in a patient with penile cancer infected with multiresistant acinetobacter baumannii and klebsiella pneumoniae.

Material and methods. We present a clinical observation of 54-year-old patient diagnosed with penile cancer pt4n3m0, with ulceration of the tumor, localized at the root of the penis and ulceration of metastatic lymph nodes in the left inguinal region and subsequent infection with highly resistant nosocomial microorganisms.

Results. The patient received 6 courses of paclitaxel, ifosfamide and cisplatin with clinical effect, such as significant reduction of the tumor and therapeutic pathomorphosis of 3-rd degree. Then ileo-inguinal lymphadenectomy was performed on the left. A few months later the tumor continued to grow in the left groin area. During the 2nd line of chemotherapy (cisplatin, docetaxel and capecitabine), the patient had grade iii–iv neutropenia, febrile neutropenia. High fever and localized infection in the area of tumor ulceration with multiresistant hospital microorganisms was detected. Combined antibiotic therapy had temporary effect. After isolation of multiresistant carbapenemresistant k. Pneumoniae from the ulcer, the patient was prescribed ceftazidim/avibactam 2.5 g 3 times a day. Clinical effect, such as defervescence and significant reduction of the ulceration zone was seen subsequently.

Conclusion. Etiotropic antibacterial therapy of the infected tumor ulcer resulted in a significant reduction in the manifestation of the infection process, allowing antitumor therapy to be continued, as well as surgery to be performed.