The study objective: to assess the diagnostic value of measuring the concentration of thyroglobulin (Tg) in the washout fluid of the fine needle aspiration (FNA) for the detection of well-differentiated thyroid cancer regional metastases.

Material and Methods. The study included 64 patients with well-differentiated thyroid cancer. Ultrasound examination revealed 71 enlarged regional lymph nodes. The patients underwent simultaneous FNA cytology examination of lymph nodes and the study of Tg concentration in the washout fluid of the needle aspiration. Regional lymph node metastases were verified in 38 patients. These patients underwent surgery. Histological examination of surgical specimens was performed in 43 out of 71 cases.

Results. The sensitivity, specificity, and accuracy of the FNA biopsy and the study of the concentration of thyroglobulin in the in the washout fluid of FNA were 88.5 %, 56.3 %, 76.2 % and 100 %, respectively. The rate of false-positive results of thyroid FNA biopsy was 16 %. The optimal cutoff value for FNA-Tg measurement was 4 g/ml. This made it possible to increase the sensitivity and specificity of the method to 100 %. It was found that the presence of circulating antibodies to Tg in the blood serum had no effect on the diagnostic value of FNA-Tg measurement (p=0.421). There were no statistically significant differences in the levels of thyroglobulin in the in the washout fluid of FNA between patients with Tg concentration above and below the cutoff values (3.9 [0.47; 39.9] ng/ ml vs 12.3 [0.57; 294.8] ng/ml). 

The aim of the study was to develop and validate a software package (SP) for computer simulation of the procedure for examining patients with lung cancer by SPECT/CT and assessing the accuracy of reconstruction of tumor lesions.

Material and Methods. Lung scintigraphy for a patient with peripheral squamous cell carcinoma of the upper lobe of the right lung was performed using a two-detector gamma camera GE Discovery NM/CT 670 DR (USA) with high-resolution collimators for an energy of 140 KeV and a radiopharmaceutical (RP) ^99mTc-Technetril (MIBI, Diamed, Moscow). The data obtained were subjected to computer processing using a specialized Xeleris 4.0 system from GE (USA). The SP included a program for generating a voxel phantom (“virtual patient”), a program for modeling the “raw” data acquisition (“virtual tomograph”) and an image reconstruction based on the OSEM algorithm (Ordered Subset Expectation Maximization). In order to validate the created SP, computer simulation of the above clinical case was performed. The semi-quantitative comparative image analysis was based on a tumor/background score.

Results. There was a good correlation between clinical “raw” data recorded from a real patient and projection data calculated by the Monte Carlo method from a “virtual patient”. The results of the comparative analysis showed that the tumor/background assessment was underestimated in the reconstructed images.

Conclusion. The problem of the accuracy of the tumor lesions reconstruction by using standard OSEM reconstruction algorithms has not been studied. This issue is important in the management of patients with tumor lesions of the lungs and requires study and systematization. The SP will be used in further studies to analyze errors and artifacts in images of tumor lesions, as well as to develop approaches to overcome them. 

Given the favorable prognosis associated with HPV-positive oropharyngeal cancer, cancer care professionals are actively discussing the feasibility of de-escalating treatment strategy for this cohort of patients.

The purpose of the study was to improve the treatment outcomes in patients with locally advanced HPV- positive oropharyngeal squamous cell carcinoma by identifying the optimal induction chemotherapy (ICH) regimen, in particular, by using a two-drug ICH.

Material and Methods. The study included 27 patients with locally advanced (T3–4N0–1, or T1–4N2–3) P16-positive oropharyngeal squamous cell carcinoma. All patients received 3 cycles of ICT according to the TP (docetaxel + cisplatin) regimen. To assess the effect and toxicity of two-drug ICH, a control group of patients, who received ICH according to the standard three-drug TPF (docetaxel, cisplatin and 5FU) regimen, was formed.

Results. In the TP group, complete response (CR) was achieved in 3 (11 %) patients, partial response (PR) in 17 (63 %), stable disease (SD) in 7 (26 %) patients. In the control group: CR 4 (20 %) patients, PR – 13 (60 %), SD – 4 (20 %) patients. The median follow-up time in the TP group was 9 months (range: 2 to 22 months). The 1-year progression-free (PFS) and overall survival (OS) rates were 88.2 % and 100 %, respectively. In the TPF group, the PFS and OS rates were 84.4 % and 100 %, respectively.

Conclusion. The results revealed that TP ICH regimen was non-inferior to the standard TPF regimen in the rates of the objective response, 1-year OS and PFS. 

Purpose: to study the level of LAG-3 expression on B-lymphocytes and the feasibility of using it as a marker for predicting response to therapy in patients with chronic lymphocytic leukemia (CLL).

Material and Methods. The study included 40 patients with newly diagnosed CLL. All patients were divided into two groups: group I: patients with Binet stage A, who did not receive therapy and group II: patients with Binet stage C, who received immunochemotherapy in RB and FCR regimes. According to the treatment regimen and hematological response to therapy, 4 subgroups were distinguished: IIA-RB, IIA-FCR, IIB-RB, and IIB-FCR. The control group consisted of 20 people matched in age and gender without cancer. The immunophenotype, level of B-lymphocytes, LAG-3 expression, and the minimal residual disease in group II after the 6th course of immunochemotherapy were initially determined in all groups by flow cytometry. The data were evaluated using Statistica 13.0.

Results. Compared to the control group, the LAG-3 expression on B-lymphocytes was found in all groups of CLL patients before treatment. The expression level was higher in patients with Binet stage C than in patients with Binet stage. The data demonstrated differences in the level of LAG-3 expression in patients with different hematological responses to therapy. The initially higher level of LAG-3 expression on B-lymphocytes was observed in patients with Binet stage C CLL with an unfavorable response to therapy. A good hematological response was found can be achieved at the level of LAG-3 expression within 14.57 ± 0.66 % regardless of the therapy regimen, and unfavorable response to therapy at the level of 41.95 ± 1.62 %.

Conclusion. The initial level of LAG-3 expression on B-lymphocytes in patients with CLL can be used as a marker for predicting and monitoring response to treatment, regardless of the immunochemotherapy regimen used. 

The aim of the study was to identify differences in the immune system parameters between metastatic melanoma patients who responded and did not respond to dendritic cell vaccination.

Material and Methods. The study group included 20 patients with stage III–IV metastatic melanoma, who received vaccine therapy with dendritic cells (DC) in a prophylactic mode. The control groups included 13 patients who had symptoms of disease progression at the time of starting vaccine therapy, and 5 healthy donors. The DC-vaccine was prepared in the form of a suspension of the patient’s autologous dendritic cells loaded with tumor antigens in vitro. A single dose had 2 million dendritic cells in 1 ml of phosphate buffer solution, which was administered intradermally in the nearest site to the regional lymphatic collectors. The immune system status was assessed before starting vaccination. The immune system status was evaluated according to the indices of 25 peripheral blood cell populations using multicolor flow cytometry and integral characteristic in the form of the visual image generated by the visualization method of multidimensional data (NovoSpark, Canada).

Results. The immune status in patients with metastatic melanoma at the start of DC-vaccination differed and was associated with the effectiveness of subsequent vaccine therapy. The response to vaccination was observed in patients whose immune system status was similar to that of healthy individuals. Low efficacy of DC-vaccine therapy was shown in patients whose immune system status corresponded to that of patients with disease progression. Alterations of the immune system in patients with metastatic melanoma were registered both at the level of individual immunological parameters and at the level of visualized integral characteristics. The integral characteristics of the immune system associated with the patient’s immunocompromised status can be considered as a criterion for stratification of patients with metastatic melanoma for the effective DC-vaccine therapy.

Conclusion. The effectiveness of vaccine therapy with dendritic cells in patients with metastatic melanoma is associated with the immune system state before starting this therapy. 

Aim of the study: to evaluate prognostic value of baseline lung immune prognostic index (LIPI) and its modification (mLIPI) for metastatic non-small cell lung cancer (mNSCLC) patients treated with immune checkpoint inhibitors (ICI).

Material and methods. Baseline neutrophil-to-lymphocyte ratio, lactate dehydrogenase, hemoglobin, platelets, and fibrinogen level were collected from 133 patients treated with ICI in monotherapy or combination between July 2015 and July 2022 in N.N. Blokhin NMRCO. According to evaluating factors patients were divided into three groups of “good” (LIPI 0/mLIPI 0–1), “intermediate” (LIPI 1/mLIPI 2–3) and “poor” prognosis (LIPI 2/mLIPI 4–5). The primary endpoint was progression free survival (PFS).

Results. The median PFS for the LIPI groups were 9.7 months (1.4–17.9; 95 % CI), 7.9 months (5.9–9.9; CI 95 %) and 6.0 months (4.07–7.93; 95 % CI) in the “good”, “intermediate” and “poor” prognosis groups, respectively; the hazard ratio (HR) for patients in the “poor” prognosis group (17 patients) was 2.02 (1.06–3.84; 95 % CI) compared with the “good” LIPI group (p=0.03). The median PFS for mLIPI groups were 9.0 months (4.53–13.47; 95 % CI), 8.0 months (5.4–10.6; CI 95 %) and 2.0 months. (1.33–2.67; 95 % CI) in the “good”, “intermediate” and “poor” prognosis groups, respectively. The HR for patients in the “poor” prognosis group (n=12) was 3.12 (1.51–6.46; 95 % CI) compared with the “good” mLIPI group (p=0.002).

Conclusion. Baseline LIPI and mLIPI predicts potential resistance to ICI treatment in mNSCLC patients. 

Purpose: to study the changes in the temperature outside and inside the long tubular bones of animals under the influence of different temperature regimes for a given time.

Material and Methods. The experiments were conducted using fresh frozen pig long bones. The heating was carried out using surface heaters, the temperature of which was determined by the selected mode for 1 hour; fixation of temperature values was carried out every minute. Four heating modes were used: 3 modes of constant heating (60, 70, 80 °C) and the maximum heating mode, in which no special temperature limit was set, so heating was carried out up to 120 °C.

Results. During the first 10 min of heating, a rapid rise in temperature occurred. The temperature increase rate on the outer surface outstripped the temperature increase rate on the inner surface of the bone, thus leading to a significant temperature difference. Further, there was a slowdown in the rate of temperature increase, which led to a gradual convergence of the temperature values inside and outside the bone, followed by temperature stabilization at a stable level (plateau), which was different for the studied areas. During this period, the temperature difference was 3.5–6 °C and it remained at this level until the end of the study. At a constant heating mode (60/70/80 °C), temperature stabilization occurred at the level of 55/61/70 °C in the center of the medullary canal and at the level of 58/67/75 °C under the heater, respectively. The period before reaching the stabilization temperature was 30–40 min. The stable temperature levels both inside and outside the bone were below the temperature stabilization level of the heater. Therefore, to achieve the planned temperature in the center of the bone to its outer surface, it is necessary to apply a high temperature, i.e., a downward temperature gradient is formed: the heater stabilization temperature – the temperature on the outer surface – the temperature inside the medullary canal. Increasing the exposure temperature can shorten the heating period, but increase the temperature difference during the heating period (up to 25 °C in the fifth minute of heating when using the maximum heating mode).

Conclusion. To ensure reaching the required temperature (60°C) within a short time (15–20 min) while maintaining optimal temperature parameters, it was proposed to develop variable temperature modes that would combine the initial use of the maximum heating mode until reaching the desired temperature in medullary cavity, followed by switching to a constant temperature mode, which allowed maintaining the achieved temperature level during therapeutic exposure. 

Introduction. The histone methylation regulates gene expression and plays a role in genomic stability participating in DNA repair. Dimethylation of histone 3 lysine 36 (H3K36me²) is an important histone modification which is responsible for gene expression activation. H3K36me² is a product of methyltransferase activity of NSD1, NSD2, NSD3, and ASH1L proteins. NSD1 mutations are known to often occur in head and neck squamous carcinoma. The presence of NSD1 mutations highly correlates with increased survival, especially for patients with laryngeal cancer. The aim of this study was an in vitro investigation of the role of NSD1 in the cell proliferation of laryngeal squamous cell cancer and non-small lung cancer cells, as well as a study of the effect of disruption of the NSD1 gene expression on cisplatin treatment response.

Material and Methods. Using TCGA, correlation analysis was performed to compare NSD1 wild type and mutant patient survival. NSD1 knockout cell lines models of laryngeal and non-small cell lung cancer were developed using the CRISPR/ Cas9 system. The effect of NSD1 knockout on H3K36me2 level was evaluated by western blot. Proliferation and IC50 of cisplatin in control and knockout cells were studied as well.

Results. It was demonstrated that NSD1 knockout decreased the H3K36me² level and cell proliferation in laryngeal squamous cell cancer cells and increased the sensitivity of head and neck cancer cells to cisplatin treatment, while there was no effect of NSD1 knockout in a non-small cell lung cancer cell line.

Conclusion. Based on the data obtained, it can be concluded that the NSD1 protein is a potential target for inhibitor development following in vitro and in vivo testing in head-neck squamous cell carcinoma models. More studies are needed for better understanding of the regulation of tumor cell growth by NSD1. 

Background. The insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene has recently been reported to be associated with the pathogenesis and development of human cancers.

This study aimed to assess the potential association between ACE (I/D) polymorphism and glioblastoma in an Iranian population.

Material and Methods. This case-control study was conducted on 80 patients with glioblastoma and 80 healthy blood donors as controls. Gap-polymerase chain reaction (Gap-PCR) was used to determine the ACE (I/D) genotypes. PCR products were separated and measured by electrophoresis on a 2 % agarose gel.

Results. Analysis of demographic data showed a significant difference in the family history of cancer between the case and control groups (p=0.03). The distribution of ACE gene variants including II, ID, and DD genotypes was also calculated, and significant differences were seen in the DD genotype (p=0.03) and D allele (p=0.04) between the glioblastoma cases and controls.

Conclusion. ACE gene polymorphism was associated with glioblastoma in the study population. Further studies are needed to approve this finding.

Background. Pancreatic cancer is characterized by pronounced invasive growth and a high tendency to lymphogenous and hematogenous metastasis. Molecular mechanisms underlying the epithelial-mesenchymal transition, in particular, changes in the expression of β1, β3 integrins and MMP2, contribute to the invasion and metastasis of pancreatic cancer. A phenotypic manifestation of invasive potential of pancreatic cancer may be the heterogeneity of the morphological structure of the parenchymal component of ductal adenocarcinoma.

The aim of the study was to analyze the expression levels of β1 integrin, β3 integrin, MMP2 and the morphological heterogeneity in the tissue of pancreatic ductal adenocarcinoma, as well as to compare the data obtained with distant metastasis.

Material and Methods. The study group included 84 patients with morphologically verifed pancreatic ductal adenocarcinoma (T1–4N0–2M0–1). The median age of the patients was 58.6 ± 9.1 years. All patients underwent surgery, during which an incisional biopsy of the primary tumor tissue was performed. Expression of integrin β1, integrin β3, and MMP2 markers was assessed by immunohistochemistry.

Results. The positive expression of β3 integrin in glandular, trabecular, and solid structures was observed more frequently in patients with hematogenous metastases than in patients without distant metastases (87 vs 12 %, р=0.001; 100 vs 22 %, р=0.004; 100 vs 8 %, р=0.001, respectively). The positive expression of MMP2 in glandular and solid structures was also observed more often in patients with hematogenous metastases than in patients without distant metastases (87 vs 32 %, р=0.001 and 100 vs 27 %, р=0.001, respectively). The positive expression of integrin β1 in glandular, trabecular, solid structures and tumor cells was observed less frequently in patients with hematogenous metastases than in patients without distant metastases (27 vs 86 %, р=0.001; 25 vs 79 %, р=0.007; 0 vs 93 %, р=0.001 and 18 vs 60 %, respectively). The logistic regression model for predicting the risk of hematogenous metastasis of pancreatic ductal adenocarcinoma was developed: Y=(-6.71 + 30.9×X1 – 27.2×X2), where X1 – the presence or absence of β3 integrin expression in the cells of the glandular structures, X2 – the presence or absence of MMP2 in the cells of the glandular structures. The risk of developing hematogenous metastasis was determined by the formula: Р=е^Y/(1+е^Y). Model confdence interval: χ² =34.0; p<0.001, sensitivity: 89 %, specifcity: 87 %. Conclusion. Expression of integrin β1, integrin β3, and MMP2 markers in various structures of the parenchymal component of pancreatic ductal adenocarcinoma is associated with distant metastasis. The localization of the expression of the studied markers in the glandular structures of tumor tissue is of particular importance. The presence of positive expression of integrin β3 and MMP2 in almost all types of tumor structures is associated with the highest frequency of distant dissemination. Key words: ductal pancreatic adenocarcinoma, β1 integrin, β3 integrin, MMP2, tumor morphological heterogeneity, distant metastases> ˂ 0.001, sensitivity: 89 %, specifcity: 87 %.

Conclusion. Expression of integrin β1, integrin β3, and MMP2 markers in various structures of the parenchymal component of pancreatic ductal adenocarcinoma is associated with distant metastasis. The localization of the expression of the studied markers in the glandular structures of tumor tissue is of particular importance. The presence of positive expression of integrin β3 and MMP2 in almost all types of tumor structures is associated with the highest frequency of distant dissemination. 

Background. The diagnostic yield of a standard forceps biopsy for central lung cancer is 74 %. However, the diagnostic value is significantly reduced in the presence of necrosis in the tumor. In Russia, cryobiopsy for central lung cancer diagnosis is currently used only in a few clinical centers.

The purpose of this study is to present a series of clinical cases showing the effectiveness of the cryobiopsy method in the morphological verification of central neoplasms with necrosis.

Description of clinical cases. The article presents 3 clinical cases of patients with central lung cancer, in which standard forceps biopsy was ineffective due to the presence of severe necrosis in the tumor. The cryobiopsy performed at the second stage made it possible in all cases to obtain a suffcient amount of morphological material for histological and immunohistochemical studies and to reconalize the lumens of the large bronchi.

Conclusion. Cryobiopsy is an effective and safe method of morphological verification of central lung cancer, which has an advantage over standard forceps biopsy, especially in the presence of a visible necrotic component in the tumor structure. 

Background. Anastomotic leakage is one of the most severe complications of colorectal cancer surgery. The formation of a preventive stoma can avoid the consequences of this complication. Given the increase in the rate of sphincter-preserving surgeries, the number of surgeries with the formation of preventive stoma has also increased significantly. There are several techniques and each of them has its advantages and disadvantages.

The aim of the study was to compare the effectiveness of surgical treatment and techniques of preventive stoma formation.

Material and Methods. The retrospective study included 353 patients with stage II–IV rectal cancer who underwent surgery with the formation of preventive stoma (110 with ileostomy formation, 243 with transversostomy) from 2016 to 2020. Both intraoperative parameters (operation time, blood loss, intraoperative complications) and postoperative parameters (postoperative bed-day, complications) were evaluated. Immediate complications within 30 days after surgery using the Clavien–Dindo complication scale and infectious complications mainly related to the stoma formation (prolapse, stoma retraction, presence of peristomal dermatitis, reoperation) were assessed.

Conclusion. The choice in the formation of a preventive ileo- or transversostomy during rectal resection has no effect on the frequency of anastomosis failure; however, there is a tendency that patients with colostomy spend fewer bed days in a hospital. Stoma-related complications in the postoperative period are mild and can be treated conservatively in the vast majority of cases. In compliance with the standardized surgical procedures and the protocol of perioperative management of patients, the number of severe complications is minimal. It is necessary to evaluate the second step of management of patients with preventive stomas – their elimination. 

Purpose of the study: to evaluate the overall survival and local control in patients with inoperable kidney cancer treated with stereotactic body radiotherapy (SBRT).

Material and Methods. From 2011 to 2021, 42 patients with histologically verified kidney cancer underwent SBRT to a total dose ranging from 30 to 45 Gr in 3 fractions using the CyberKnife robotic radiosurgical system. SBRT was performed for inoperable patients, taking into account various factors (age, severity of concomitant pathology, ASA IV physical status level), patients’ refusal of surgical treatment, and tumor size of ≤5.0 cm in diameter. SBRT was not performed for patients with tumor size of ≥5.0 cm in diameter, impaired renal function, generalization of cancer and decompensation of concomitant pathology. The median age of the patients was 67.9 years. 93 % of patients had stage I kidney cancer. The primary tumor was diagnosed in 37 cases, recurrence after previous surgical treatment in 6, including 1 patient with recurrence of cancer of both kidneys. The average tumor volume was 28.1 cm³.

Results. The median overall survival (OS) was not reached due to the fact that the majority of patients (n=36) were alive at the time of the study. The 1-, 3- and 5-year OS rates were 94.1 %, 88.7 %, and 72.6 %, respectively. The 1-year local control rate was 93 %. At 3-6 months, 26.2 % of patients showed partial response, 66.8 % had stable disease and 7 % had disease progression (according to the RECIST 1.1 criteria). Renal toxicity occurred in 23.8 % of patients 3 months after radiation therapy; however, kidney function was restored in these patients within a year.

Conclusion. SBRT has demonstrated high efficacy with minimal toxicity in the treatment of inoperable patients with kidney cancer. 

Objective. To conduct a systematic analysis of data on the results of studies published in scientific journals on the pro-carcinogenic and anticarcinogenic role of microbiota, as well as on the therapeutic potential of microorganisms in oncogenesis.

Material and Methods. The articles were searched using the Web of Science, Scopus, PubMed, Medline, and eLIBRARY databases. More than 150 sources dedicated to the study of the carcinogenic function of the microbiota and the possible influence of its species and quantitative composition on the efficacy and toxicity of antitumor therapy were found. Data from 71 articles were included in the review.

Results. The relationship between the gut microbiota and cancer is multifactorial and bilateral: pro-carcinogenic on the one hand and anti-carcinogenic on the other hand. Microorganisms can induce tumor growth and cancer development through DNA damage and induction of mutagenesis, trigger oncogenic signals, disruption of barrier function, as well as immune response system disruption. Depletion of microbiota, the development of dysbiosis and induction of chronic inflammatory state are negative factors in the development of cancer. The anticancer effect of microorganisms is presumably based on the production of tumor-suppressive metabolites that function through multiple immune reactions. Maintenance of barrier function, competitive exclusion of pathogenic bacteria, and direct action on immune cells to prevent inflammation are also important protective factors. The presence of intratumor microorganisms in various tumors has been noted. Changes in species and quantitative composition of cancer patients’ microbiota are influenced by diet, taking antibacterial drugs, chemo-, immuno- and radiation therapy. In turn, the microbiota can affect the ongoing treatment. Numerous studies on the influence of the gut microbiota on the efficacy of immunotherapy, particularly in disseminated melanoma, have been conducted. It has been suggested that primary resistance to immunotherapy may be related to the abnormal composition of the gut microbiota. The level of gut microfora composition diversity and the number of Faecalibacterium or Bacteroidales in the fecal microbiota have been suggested to be the predictor of response to anti-PD-1 therapy. To change the composition and activity of the gut microbiota, several therapeutic methods, such as the administration of prebiotics, probiotics, synbiotics, postbiotics, fecal microbiota transplantation, as well as the change in the microbiota composition through a specific diet, are available. 

The purpose of the study was to summarize and analyze the available data on modern methods of additional imaging using indocyanine green (ICG) used in abdominal surgical oncology.

Material and Methods. The search and analysis of publications over the last 7–10 years was carried out using RSCI (Russian Science Citation Index), E-library, PubMed, Scopus, MedLine, Elsevier, Web of Science, ScienceDirect systems. The following keywords were used for the search: “ICG-fluorescent navigation”, “ICG-fluorescence”, “gastric cancer”, “colorectal cancer”, “indocyanine green”.

Results. The role of ICG-fluorescent navigation in abdominal oncology, in particular, in surgery for cancer of the stomach, colon and rectum, identification of peritoneal carcinomatosis and liver metastases, as well as in biliary surgery and cholangiography, was shown. Intraoperative visualization of sentinel lymph nodes and mapping of lymph nodes in patients with gastric and colorectal cancers were described. In addition, the information on the diagnostic value of vascular imaging in colorectal surgery, detection of the boundaries of hepatocellular carcinoma and surrounding tissues, as well as real-time liver metastases using indocyanine green, was provided. Special attention was paid to ICG-mediated cholecystectomy and cholangiography. ICG fluorescence imaging in colorectal and gastric cancer surgery makes it possible to individualize the surgical approach and provide functional surgery associated with the performance of a sufficient and prophylactically excessive volume of surgical intervention more effectively. Conclusion. The presented data confirm the relevance of the search for a vector of improving the imaging methods used in abdominal surgical oncology, which requires even more even more multicenter prospective cohort studies to determine the best ways of improving the technique. 

Background. Colorectal cancer (CRC) is one of the most common cancers and one of the most leading causes of cancer-related deaths worldwide. Approximately 35 % of CRC patients have liver metastases at the time of diagnosis. These patients have a poor prognosis, with the 5-year survival rate of 15 %. Given the poor survival with currently approved methods, the development of the optimal treatment options is needed.

The purpose of the study was to search for data on the development of surgical techniques for the treatment of patients with metastatic CRC (mCRC) with isolated liver metastasis.

Material and Methods. Literature search was carried out in Medline, Cochrane Library, Elibrary and Pubmed databases, including publications characterizing historical and modern results (from 1976 to 2021).

Results. Liver resection in mCRC patients with isolated liver metastasis is the only treatment that offers a chance of increasing the 5-year survival rate up to 45–60 %. Radical surgery should include the removal of the primary tumor and all metastases with negative histological resection margins while preserving sufficient functional liver parenchyma. The paper discusses various approaches to surgical treatment of mCRC patients with liver metastases, with an assessment of their advantages and disadvantages, as well as presents data on perioperative and oncological outcomes.

Conclusion. The surgical treatment strategy should be adapted for each mCRC patient with synchronous liver metastases. The core function of a multidisciplinary team is to determine the patient’s treatment plan combining surgery and systemic chemotherapy, which will improve the immediate and long-term treatment outcomes. 

Background. Neuroendocrine tumors are rare neoplasias accounting for 1 % of all digestive malignancies. In 2010, mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) were classified by the World Health Organization This type of tumor is extremely rare and most commonly occurs in the appendix, colon, and rectum. To date, only 30 clinical cases of MINEN of the major duodenal papilla (MDP) have been described in the available world literature, while we have not found a description of this pathology in the domestic literature.

Description of the clinical case. We present a case of a 64-year-old male patient with MiNEN MDP. The first clinical manifestation of the disease was obstructive jaundice. To eliminate the jaundice, papillosphincterotomy, transpapillary stenting of the choledochus with a plastic stent was performed. MDP tumor was verifed as adenocarcinoma by histological examination. The patient underwent gastropancreatoduodenal resection. Postoperative immunohistochemical examination showed the expression of antibodies in tumor cells: Synaptophysin (clone 27G12) +++, Chromogranin A (5H7) +, CD 57 (NK-1) ++, Ki 67 (Mib 1) 80 %.

Conclusion: mixed neuroendocrine (G3) non-neuroendocrine carcinoma (G2) of the major duodenal papilla with growth within the wall of the duodenum; metastases of the neuroendocrine component in three lymph nodes, adenocarcinoma metastasis in 1 out of 15 lymph nodes examined; pT2N2M0, MiNEN high grade (classified by S. La Rosa). Conclusion. Mixed neuroendocrine-non-neuroendocrine tumors of MDP are an extremely rare pathology. The accuracy of preoperative morphological diagnostics is not high, therefore, this diagnosis can be easily missed at the preoperative stage. In the morphological study of malignant tumors of MDP, a pathologist should take into account the feasibility of a combination of a neuroendocrine tumor with adenocarcinoma. 

Purpose of the study: differential diagnosis of tumors arising from the mediastinum, as well as the analysis of the biological potential of the tumor, taking into account the relatively low incidence of these tumors among the population.

Material and Methods. Macroscopic and microscopic examinations of the surgical specimen were performed using routine H&E staining. Immunohistochemical staining of paraffin-embedded tissue sections was performed using a Roche Ventana BenchMark Ultra system. The results obtained were evaluated taking into account the available literature data published on this nosology.

Description. We present a rare case of a benign neoplasm of the thymus, lipofibroadenoma (LFA), which was localized in the left pleural cavity and originated from the anterior mediastinum with partial compression of the lower lobe of the left lung in a 59-year-old man. The tumor was revealed during a routine medical examination. The patient underwent left-sided thoracotomy with complete excision of the tumor and anterior mediastinal lymph node dissection. Macroscopic examination reveled that the tumor was predominantly composed of adipose tissue with fibrous layers. Histological examination showed a tumor composed of mature adipocytes of various sizes, among which remnants of the thymus with Hassal’s bodies and small number of lymphocytes and calcifications were found. Areas of fibrous stroma predominated over narrow strands of anastomosing epithelial cells with clear nuclei. Epitheliocytes formed slit-like structures infiltrated with lymphocytes, resembling the structure of breast fibroadenoma. Immunohistochemical examination revealed that epithelial cells were positive for PanKeratin and CK19, lymphocytes were positive for CD3 and CD20, and thymic cells expressed TdT. In this case, the neoplasm was almost asymptomatic, in contrast to previously published observations, which described an association with erythrocyte aplasia.

Conclusion. Considering the clinical, histological and immunohistochemical data, it was feasible to make a differential diagnosis of the neoplasm and determine the histological type of the tumor as lipofibroadenoma.