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Introduction. Thyroid cancer is one of the most common malignant neoplasms of the endocrine system. well-differentiated thyroid cancer constitutes about 90 % of all malignant tumors of the thyroid gland. Despite growing morbidity and high incidence of this pathology, in case of timely diagnosis and treatment well-differentiated thyroid cancer has favorable prognosis.Aim. using clinical examples, to demonstrate the possibility of thyroglobulin measurement in needle washouts of fineneedle aspiration biopsy in the detection of cervical metastases of highly differentiated thyroid cancer.Materials and methods. five patients (2 patients with combined oncological pathology, 2 patients with nodes in the thyroid gland, 1 patient after a thyroidectomy) with cervical adenopathy measured the level of thyroglobulin in the wash out fluid of lymph-nodes biopsy using the immunoradiometric method using the commercial kits of the Institute of Isotopes-IRmA (Hungary).Results. Cervical metastases of highly differentiated thyroid cancer were detected or excluded by the determination of fine-needle aspiration biopsy in patients with non-informational cytological studies. The determination of fineneedle aspiration biopsy is a useful diagnostic method in the differential diagnosis of cervical metastases in patients who have other morphological forms of cancer in addition to well-differentiated thyroid cancer, as well as for the differential diagnosis of cervical adenopathy in patients with a history of highly differentiated thyroid cancer.Conclusion. Determination of thyroglobulin level in puncture needle washout is a simple and useful diagnostic method for differential diagnosis of metastases in lymph nodes of the neck in patients with several morphological forms of malignant tumors.

Introduction. Lymphomas are a heterogenic group of tumors of the lymphatic and hematopoietic systems, and in many cases tumor process develops in the area of the head and neck including skin and mucosa, orbit, nasal cavity and paranasal sinuses, oral cavity, oropharynx, salivary glands, thyroid, and cervical lymph nodes. Differential diagnosis of lymphomas of the head and neck is complicated because it can be accompanied by another non-tumor pathology. High heterogeneity of lymphomas of the head and neck requires structurization of knowledge on their epidemiological and clinical manifestations.The study objective is to optimize early diagnosis as it allows to significantly increase cancer alertness in local practitioners, oncologists, diagnosis specialists and, in turn, to decrease verification frequency in generalized disease processes. Study of clinical characteristics of lymphoproliferative disorders of the head and neck leads to increased quality of differential diagnosis.Materials and methods. A study of lymphoproliferative disorders affecting head and neck was performed. Study material consisted of data on 174 patients hospitalized at the N.N. Blokhin National medical Research Center of Oncology between 1999 and 2020.Results. Based on the current clinical and morphological classification of lymphoproliferative disorders, data on location of lesions, characteristic signs of extranodal lesions and cervical lymph nodes involvement, as well as methods of diagnosis of lymphomas of the head and neck, are presented.Conclusion. The obtained data helps solve problems of diagnosis of lymphoproliferative disorders affecting the head and neck and serve as a basis for successful, predictable treatment of lymphomas.

A review of accumulated international clinical experience and prognostic significance calculations of metastatic involvement of the lingual lymph nodes is given. Anatomical terminology of lingual lymph nodes and its contradictive aspects are discussed. It is shown that metastatic lesions of the lingual lymph nodes posses high prognostic value, therein a topographic anatomic classification of the lingual lymph nodes is needed to increase the efficiency of diagnosis and augmenting of the oncologic treatment results. This classification should be unified to avoid misunderstanding between researchers.

Erdheim–Chester disease (ECD) is a rare disease with a poor prognosis. The first two cases were reported by Jakob Erdheim and William Chester in 1930. The etiology and disease incidence are unknown. One of the main components of this disorder is a chronic uncontrollable inflammation. In 2016 ECD was classified as histiocytic neoplasm by the World Health Organization and was categorized as “tumors of histiocytes and dendritic cells”. More than half of patients testing positive for the BRAF mutation. The final diagnosis is made on the basis of histological finding. There are radiological markers indicating a possible association with the disease. This is a specific, almost pathognomonic scintigraphic picture of the skeleton, “coated” aorta, “hairy” kidney patterns on computer tomography. There is a Erdheim–Chester Disease Global Alliance (ECDGA), which try to unite and provide with information about diagnostics and treatment of this rare disease both patients and doctors. Today, there are 571 registered patients and only one from Russia. We demonstrate three clinical cases of patients with newly diagnosed ECD and the role of nuclear medicine methods in assessing the prevalence of this disease.

The study objective: using a clinical example to demonstrate possibilities of single photon emission computerized tomography (SPECT) in combination with computed tomography (CT) in identifying latent bone metastases, taking into account the dynamics growth of serum basal calcitonin.Materials and methods. Patient S., 60 years old, visited N.N. Blokhin National Medical Research Center of Oncology for consultation on multiple lung metastases of cancer of unknown primary.Results. Taking into account basal calcitonin level, immunohistochemistry, ultrasound investigation andfine-needle aspiration biopsy of the node in the right thyroid lobe a diagnose of medullary thyroid cancer was made. CT revealed multiple metastases in both lungs. Specialist erformed thyroidectomy with central lymphadenectomy and facial neck dissection on both sides. During next four months basal calcitonin level increased twice. Control contrast CT lung screening showed the growth of previously identified metastases and the appearance of multiple new ones. Bone scan showed focuses of increased radio-pharmaceutical accumulation in the area of 7h left rib, left iliac wing, in the left bones of cranial vault, in C7, Th6, Th9, ThI2 vertebrae and right foot bones. Additional examination using SPECT/CT (from the skull base to the hip joints) revealed metastases in corpuses of Th9, ThI2 vertebrae and the left iliac wing, and suspicion for metastasis in 7h left rib. Magnetic resonance imaging (MRI) confirmed metastasis in Th9, ThI2, L3 vertebral bodies and in the left iliac wing.Conclusion. Conclusion. In this clinical example, SPECT/CT allowed to correctly detect metastases in both Th9 and ThI2 vertebrae while bone scan was questionable, and MRI showed an additional damage of L3 vertebra. Changes in the 7h left rib could not be verified using CT, although this changes may be an emerging metastasis. Obviously, extensive use of radiation methods does not guarantee complete identification of all pathological focuses, it therefore allows assessing the prevalence of the pathological process. It is crucially important to control calcitonin level in these patients, since its rapid growth allowed suspecting additional distant metastases.

Rosai–Dorfman disease or sinus histiocytosis is a rare entity which may affect various lymph node groups. Extranodal form is observed in 45 % of cases, facial bone involvement is especially rare. A 62-year old male presented with complaints on dumb sensation of the chin and lower lip. After clinical assessment and surgical exploration an intraosseous extranodal Rosai–Dorfman disease was diagnosed. The patient under-went free fibula osseous graft reconstruction. After 2 years the patient is recurrent free. The purpose of this publication is to describe a rare case of lower jaw involvement in an intraosseous form with significant bone destruction. The clinical and microscopic features of the process are discussed.

Introduction. The issue of selecting treatment strategy for сT2N0M0 cancer of the oral mucosa remains relevant. Induction chemotherapy (applied in order to evaluate the possibility of organ-preserving chemoradiotherapy) is widely used in clinical practice. In this case, surgical treatment is performed only when chemotherapy (CT) is ineffective or a residual tumor is detected after chemoradiotherapy (CRT). However, many specialists recommend surgical treatment on the first stage of treatment.Objective: evaluation of the induction chemotherapy feasibility in the treatment of T2N0M0 cancer of the oral mucosa.Materials and methods. A total of 122 patients with primary Т2N0М0 cancer of oral mucosa without regional metastases (according to clinical examination) were included in the study.Results. In order to determine the best treatment strategy, we have compared treatment outcomes in three groups of patients. The most favorable outcomes were observed in the group of patients receiving combined treatment according to a scheme «surgery + radiotherapy (RT)/ CRT, where the overall 5-year survival rate and the progression-free 5-year survival rate were 70.4 % and 68.5 % respectively. Survival rate in this group was significantly higher (р < 0.05) than that in the group «induction CT (ICT) ± RT ± surgery» where these parameters comprised 42.2 % and 36.2 % respectively.Conclusion. Combined treatment with a surgery on the first stage followed by RT or CRT ensures better outcomes of the cancer of the oral mucosa than the strategies that include ICT.

The paper analyzes the results of surgical treatment in 57 patients with recurrent oropharyngeal cancer after an ineffective chemoradiaton therapy cycle performed in 1995 to 2014.It shows that it is important to estimate the extent of a tumor process by different methods and to choose a surgical approach.