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Toxoplasmosis of the brain is a pressing issue in the practice of neurologists and neurosurgeons. Most patients with cerebral toxoplasmosis are persons with AIDS. However, toxoplasmic encephalitis can develop in patients with any immunodeficiency conditions that lead to reactivation of toxoplasmosis infection in the central nervous system. Although cerebral toxoplasmosis is not a neurosurgical pathology, patients sometimes require neurosurgical interventions: diagnostic biopsy and lesion removal. Moreover, literature shows cases of removal of brain lesions initially mistaken for a brain tumor, which, as a rule, occurs when the patient’s HIV status is unknown and the severity of their condition does not allow for a comprehensive additional examination.This article reviews Russian and foreign publications on neurosurgical interventions in patients with cerebral toxoplasmosis.

Aim: tosystematize the literature data on endoscopic semiotics and morphological changes in the gastric mucosa in autoimmune gastritis.Key points. Autoimmune gastritis is associated with an increased risk of developing adenocarcinoma and neuroendocrine tumours of the stomach. Clarification of diagnostic criteria for autoimmune gastritis is essential for gastroenterological practice. The diagnosis is based on the results of endoscopic and histological examination, and on data from laboratory tests. Isolated atrophy of the mucous membrane of the body of the stomach, the presence of difficult-to-wash creamy mucus, changes in the mucous membrane like “shed skin”, and the presence of whitish globule-like foci are typical endoscopic signs of autoimmune gastritis. Widespread pseudopyloric metaplasia, focal intestinal and pseudopancreatic metaplasia, hyperplasia of the ridges of the mucous membrane of the body of the stomach and their relationship to the glandular layer as in the antrum allow during a morphological study considering clinical data to suspect and verify autoimmune gastritis.Conclusion. During instrumental examination, knowledge of endoscopic symptoms and pathognomonic morphological changes is important for the timely diagnosis of autoimmune gastritis.

Annually increasing quantity of liver transplants and the growing population of long-survived recipients determine the relevance of late allograft dysfunction study. Variety of morphological and functional disorders of the transplanted liver complicates their timely diagnostics. Moreover, in some patients, serious graft damage may proceed for a long time without clinical manifestations and laboratory abnormalities.The review summarizes the structure, prevalence, risk factors and prognostic value of different liver allograft pathology determined by histological examination in the long term after transplantation.

Primary vasculitis of the central nervous system (PACNS) is a rare form of unknown cause vasculitis that affects the vessels of the brain, spinal cord and meninges without systemic damage. It was found that the average age of the onset of the disease was 50 years. Clinical manifestations depend on the caliber of the affected vessels. The most common initial symptoms are headache and vascular cognitive impairment associated with small vessel involvement. The development of stroke and focal symptoms is interrelated with vascular cognitive impairment and manifests as the lesion of the middle/large cerebral arteries. PACNS is difficult to diagnose, since symptoms of vasculitis outside the central nervous system are rare, serologic markers of inflammation are normal. The analysis of cerebrospinal fluid is usually abnormal due to a moderate nonspecific increase in the level of total protein or the number of leukocytes. Deviations from the norm (cerebral infarction, sometimes tumor-like lesions) are detected according to the data of magnetic resonance imaging of the brain in 97 % of patients with PACNS. Angiography has low sensitivity and low specificity, since it allows to verify vasculitis of only middle and large cerebral arteries, revealing segmental narrowing. To detect inflammation of the blood vessels, as well as to exclude other diseases, it is necessary to perform a biopsy of the substance and the soft membranes of the brain.

Introduction. The frequency of hip arthroplasty is steadily increasing throughout the world and, although this operation has become routine, the likelihood of postoperative complications reaches 4.3 % [1]. The most dangerous of them are infectious lesions in the area of the endoprosthesis and adjacent tissues. At the same time, in addition to the threat of generalization of the infectious process, there are functional disorders in the joint area and a general deterioration in the quality of life of the patient. Timely diagnosis and treatment of the infectious process and related disorders can minimize the adverse effects of infection.Target. The purpose of this review is to analyze modern methods for diagnosing and treating periprosthetic infection resulting from hip replacement.Materials and methods. The subject literature was searched using the PubMed and Google Sholar databases.Results. The main methods for diagnosing periprosthetic infection include histological and bacteriological examination of the biopsy specimen, determination of sensitivity to antibiotics, blood, and synovial fluid analysis for the content of leukocytes, IL-6, CRP, PCR diagnostics of infectious agents. Treatment consists of re-intervention and/or antibiotic therapy.Conclusion. The most optimal method for diagnosing periprosthetic infection is a bacteriological study of biopsy specimens taken intraoperatively. The preferred method of treatment is determined by the severity of the infection, the degree of involvement of tissues adjacent to the prosthesis, the comorbid background, the nature of the infectious agent, and includes repeated revision surgery.

Introduction. Transrectal biopsy under US-control has been standard diagnostic method for prostate cancer (PCa) detection for over 30 years. However, TRUS-guided biopsy is not without well-known drawbacks. MR-targeted biopsy methods were proposed to eliminate the drawbacks and improve detection rate of clinically significant Pca. Cognitive and mpMR/US-fusion biopsies have become the most widely used MR-targeted biopsies. However, there are contradictory data on detection of clinically significant Pca when comparing mpMR/US-fusion and cognitive biopsies.Objective. To compare the detection rate of clinically significant prostate cancer performing cognitive and mpMR/US-fusion biopsies.Materials and methods. Inclusion criteria: PSA > 2.0 ng/ml and/or a positive DRE, and/or a suspicious lesion on TRUS, and PI-RADSv2.1 score ≥ 3. The outcomes evaluated are the detection of clinically significant Pca (ISUP ≥ 2), the overall PСa detection, the detection of clinically insignificant Pca, histological yield (proportion of positive cores, maximum cancer core length).Results. Retrospective data analysis was performed: cognitive biopsy was performed in 102 patients and mpMR/US-fusion biopsy in 176 patients. The median age was 63 years, prostate volume 46 cc. The median PSA was 6.4 ng/ml in the mpMR/US-fusion and 6.7 ng/ml in the cognitive biopsy group. MpMR/US-fusion and cognitive biopsies were comparable about the detection rate of clinically significant (30.3% vs 25.0%; p=0.329) and overall Pca detection rate (50.5% and 42.1%; p = 0.176). It was detected to be less clinically insignificant Pca in the cognitive biopsy group (11.8% vs. 25.5%; p = 0.007). The proportion of positive cores (30.5% and 29.5% respectively; p = 0.754) and maximum cancer core length (6.6 mm vs 7.6 mm; p = 0.320) were equal when comparing cognitive and mpMR/US-fusion biopsies. The proportion of positive cores with clinically significant Pca was higher in the cognitive biopsy group (18.6% vs 13.1%; p = 0.029).Conclusion. Both cognitive and mpMR/US-fusion biopsies are equally accurate for clinically significant Pca detection. Therefore, cognitive biopsy may be an alternative to mpMR/US-fusion biopsy in hospitals where mpMR/US-fusion technology is not currently available.

Sarcoidosis is a chronic multisystem inflammatory disease characterized by non-caseous granulomas, most commonly in the lungs and intrathoracic lymph nodes. The nasopharyngeal disease is a rare localization of sarcoidosis. Clinical presentations include difficulty in nasal breathing, rhinophonia, and postnasal syndrome. Nasopharyngeal endoscopy, computed tomography, and magnetic resonance imaging are the main diagnostic methods for detecting lesions in this area. The histological examination provides the diagnosis verification. Considering the frequent secondary spread of sarcoidosis, all patients should consult a rheumatologist to select adequate systemic therapy. We provide a clinical case illustrating the management of a patient with nasopharyngeal sarcoidosis.

Pregnancies after kidney transplantation are considered high risk. Preconceive care is crucial for favorable mother-fetal outcome but also for good renal graft function. Herein, we report a case of kidney transplant recipient secondary to lupus nephritis with three consecutive successful pregnancies and excellent graft function after 16 post-transplant years. Preconception care included two protocolar biopsies performed prior to immunosuppressive treatment modifications. No signs of rejections were found in either biopsy, no additional treatment was necessary, and the patient was safely converted from mycophenolate mofetil to azathioprine. First pregnancy was naturally conceived, its course was uncomplicated and a healthy female newborn wasdelivered via vaginal birth. Within one year after delivery the patient presented proteinuria, borderline changes were found in the biopsy of allograft and were treated with immunosuppression augmentation and ACEI. At 7th post implantation year, after surveillance biopsy showing no signs of rejection and appropriate pharmacotherapy adjustments, second pregnancy occurred from in vitro fertilization (IVF). It was complicated with deep vein thrombosis, intrauterine growth restriction and premature birth in 32nd week of gestation. Three months after delivery, the patient conceived spontaneously, third pregnancy course was uncomplicated. Close follow up, including protocol and indication biopsies, allowed to preserve excellent graft function in the context of multiple immunosuppressive treatment adjustments. Here we present a case where natural conception and in vitro fertilization intertwine without harming the transplanted organ.

Introduction. SARS-CoV-2 causes several negative processes in the body and complicates the course of chronic somatic diseases, causing dysfunction and having a negative effect on many organs and systems of the body, including organs of the reproductive system.Objective. To study morphological changes in testicles of patients who have undergone a new coronavirus infection.Materials and methods. Objects of morphological research were testicular tissues obtained by intraoperative biopsy under intravenous anesthesia served. Material sampling was carried out in 12 patients aged 25–29 years with idiopathic infertility who underwent COVID-19. Patients showed ultrasound signs of fibrosis in the testicles, which were absent before infection with SARS-CoV-2. The biopsy was performed 12 months after COVID-19.Results. In all observations, changes were observed that are characteristic of the inflammatory process, nonbacterial autoimmune genesis. Histio-lymphocytic infiltration of testicular tissue with destruction of single tubules and parenchyma atrophy, combined with varying degrees of sclerosis, was verified.Conclusion. In testicular biopsy specimens from patients who have undergone COVID-19, an autoimmune inflammatory process is recorded, manifested by lymphocytic infiltration of testicular tissue, which was combined with varying degrees of sclerosis.

Purpose of the study. To determine and compare the diagnostic efficacy of planar scintigraphy, SPECT (including SPECT/CT) and intraoperative gamma probe radiometry in the detection of sentinel lymph nodes (SLN) in patients with breast cancer.Material and methods. The study included 200 patients with diagnosed breast cancer who underwent SLN biopsy in the period 2020–2021. To identify SLN s, all patients underwent lymphoscintigraphy with a 99mtc-labeled colloidal radiopharmaceutical one day before surgery. Planar lymphoscintigraphy was performed on 200 patients included into the study, 181 underwent examination in the volume of SPECT or SPECT/CT (147 and 34 studies, respectively). The SLN was detected intraoperatively using a portable gamma probe (n=200). Subsequent histological examination determined the presence of lymphoid tissue and the status of the removed SLN.Results. SLN were detected in a comprehensive study (planar and tomographic studies) in all 200 patients studied (100 %), while planar scintigraphy did not visualize any SLN in 6 (3 %) cases, but they were determined during examination in tomographic mode. Also, in some cases, additional SLN were determined during tomography, which were not considered in the planar study. In 95 % of cases, SLN were localized in the axillary region. All non-axillary slns were identified on tomograms. The sensitivity of SPECT for SLN detection was 100 % (ci 98.0–100 %), which was higher than the sensitivity of planar scintigraphy and gamma probe (97.0 %, ci 96.5–97.4 % and 97.0 %, ci 96.1–97.4 %, respectively). The PPV values were also high (99.5 %, ci 99.0–100 % for planar scintigraphy, 99.5 %, ci 98.6–100 % for gamma probe and 98.3 %, ci 95.2–99.7 % for SPECT.Conclusion. Nuclear medicine imaging of sln with lymphotropic radiopharmaceuticals in patients with breast cancer is an effective and reliable method of navigation during surgery to perform a biopsy. SPECT and SPECT/CT can identify more lymph nodes than planar scintigraphy, improving their anatomical localization, and reducing the false negative rate. The diagnostic performance of SPECT/CT and SPECT is believed to be superior to that of planar lymphoscintigraphy and intraoperative navigation in detecting SLN.

Sarcoidoicle presents a clinical case of 5 years observation of a child with generalized sarcoidosis from 11 to 16 years old. The disease debuted with erythema nodosum of the legs, weakness. After 7 months the supraclavicular lymph nodes increase was found. Computed tomography of the chest organs revealed increased intrathoracic lymph nodes, small focal dissemination in the lungs, focal lesions of the spleen. Differential diagnosis between tuberculosis, lymphogranulomatosis, sarcoidosis was carried out. The final diagnosis is generalized sarcoidosis, active phase, involving the peripheral, intrathoracic lymph nodes, lungs, spleen and erythema nodosum of the legs. The diagnosis was based on clinical, laboratory and instrumental examination (computer tomogram) results, which revealed characteristic changes of intrathoracic lymph nodes and lungs. The morphological study of biopsy material (from supraclavicular lymph nodes) confirmed the diagnosis by the detection of granulomas with distinctive signs of sarcoidosis. The therapy with gradual decrease of methylprednisolone dose until the complete discontinuation of the drug was carried out within 13 months. In 2 months after the treatment initiation erythema nodosum of the legs resolution and positive radiological dynamics were noted. In 12 months focal lesions of the spleen disappeared. 3 years after the start of corticosteroid therapy clinical and radiological remission was diagnosed, which persisted for more than 4 years after stopping treatment.

The key side effects of antiplatelet therapy are associated with the damage of the upper gastrointestinal tract (GIT) mucous that can lead to erosions or ulcers and specifically complicated by bleeding. Aim. To assess the upper gastrointestinal mucosal condition by endoscopic and histological methods in patients with stable coronary arteries disease receiving long-term antiplatelet therapy with gastrointestinal bleeding (GIB) history or with high risk of this complication. Materials and methods.The study included patients from the single-center prospective registry of long-term antithrombotic therapy REGATTA-1. The gastric mucosa endoscopic examination with biopsy was performed in 20 patients with gastrointestinal bleeding history less than 1 year ago and in 24 patients without GIB, which have concomitant risk factors such as erosions and ulcers history and/or persistent dyspepsia clinical signs. The mucosal condition (erosions and ulcers) was estimated using a modified Lanz scale. The presence of Helicobacter pylori was determined by Histological verification. The inflammatory process characteristics were evaluated according to the modified Sydney classification. All participants received antithrombotic therapy at the time of esophagogastroduodenoscopy; 81.8% of patients received proton pump inhibitors. Results. Chronic inflammation (93.2%), atrophy (59.1%), multiple erosions (45.5%) or ulcers (18.2%) were the most frequent endoscopic finding. H. pylori infection, found in mucosal samples in 90.9% of patients was one of the most important pathogenesis mechanism, which support the gastrointestinal mucosa damage. Conclusion. Mucosal damage endoscopic signs remains despite long-term proton pump inhibitors therapy in patients with coronary arteries disease and concomitant GIB risk factors, receiving antithrombotic therapy. H. pylori contamination may be the cause of these changes. Therefore, its active screening and eradication is necessary in such patients.

Background. A stent is a cylindrical medical device used to normalize the flow of blood or body fluids, such as blood vessels, gastrointestinal tract, and bile duct, by inserting it into a narrowed or blocked area under image fluoroscopy without performing a surgical operation when the flow is not smooth. In particular, stents applied to blood vessels are divided into stents for coronary arteries, stents for blood vessels, stents for blood vessels in the brain, stents for iliac arteries, and stents made of absorbent materials. It is used to improve blood flow. Coronary artery disease refers to a lesion in which blood flow to the myocardium is impaired due to stenosis of the coronary arteries due to atherosclerosis. Atherosclerotic coronary artery disease has long been known as the most common cause of death in the West. Although it has not yet occurred frequently in the East, including Korea, it is reported that coronary artery disease is on the rise with the recent change in eating habits. Coronary artery disease is clinically manifested in one of three aspects: angina pectoris, myocardial infarction, and sudden death. Double myocardial infarction is usually caused by sudden thrombus in a coronary artery with atherosclerotic stenosis, resulting in complete blockage of myocardial blood flow. Myocardial infarction, which was supplied by blood vessels from blocked blood vessels, leads to necrosis. In order to improve blood flow in blood vessels blocked from blood supply due to myocardial infarction, stenting is in the spotlight along with surgical methods. Among the causes of blocking the flow of blood vessels, thrombus is seen as the main cause, so the frequency of using vascular stents with suppressed thrombus formation is increasing. Results. A coronary stent is a medical device used to improve blood flow by expanding a coronary artery narrowed by the formation of a thrombus, and is an intermediary procedure that minimizes side effects through surgery. Among the causes of blocking the flow of blood vessels, thrombus fish are seen as the main cause, so the frequency of using vascular stents with suppressed thrombus formation is increasing. S&G Biotech Research Institute is developing a self-expanding Nitinol stent graft that can ensure patency while suppressing the formation of blood clots. The graft material used here is a material that hardly decomposes in bodily fluids such as blood by using a thermoplastic polyurethane material, and is loaded with an antithrombotic agent. Our research team produced a stent graft by spinning the TPU graft onto the self-expanding Nitinol stent skeleton with an electrospinning device, and confirmed its safety and effectiveness by conducting a biological safety evaluation and animal testing. In addition to the vascular stent for the coronary artery for the treatment of coronary artery disease, the frequency of application of the aortic vascular stent graft for the treatment of aortic vascular disease is also increasing. The aortic vascular stent graft is a stent composed of a metal stent skeleton and a graft and suture made of a biocompatible polymer material and is used for aortic dissection and aneurysm treatment. Conclusion. After blood vessel extraction, the surface of the inserted stent and the inside of the blood vessel were checked, and the result was grade 0 (no thrombus observed). No other peculiarities were identified inside the blood vessels. As a result of checking the H&E results of 3 parts (distal part, middle part, and proximal part) of each blood vessel, in the stent group. Neointimal proliferation was not confirmed. Funding: This research was financially supported by the Ministry of Trade, Industry and Energy (MOTIE) and Korea Institute for Advancement of Technology (KIAT) through the International Cooperative R&D program (Project No. P0016047).

Aim. To study the possibilities of bronchoscopy in the detection and evaluation of metastatic lung tumors. Materials and methods. From 2017 to September 2020, 3719 bronchoscopies, including 1081 biopsies during bronchoscopy were performed at the Blokhin National Medical Research Center of Oncology. According to the results of the morphological verification, 40 patients had been diagnosed with lung metastasis. Results. Endobronchial metastatic tumors from extrapulmonary malignancies are quite rare. After had studying 40 cases of metastatic bronchial tumors, we found that the most commonly primary malignancies associated with endobronchial metastases were breast cancer (12 patients), colorectal cancer (6 patients) and thyroid cancer (4 patients). All patients who had been diagnosed with the pathology during the bronchoscopy had been required to make a biopsy for the purpose of morphological verification. Conclusion. The value of bronchoscopy lies in the possibility not only of the detailed visual studying and detecting the tumor pathology of the bronchial tree, but also of obtaining material for morphological analysis. In this regard, the role of biopsy during bronchoscopy is extremely important. In the visual signs of tumor lesion, it is necessary to take multiple biopsies from different parts of the tumor.

Aim. To study the frequency of fatty hepatosis in liver biopsies of consecutive brain death donors before cold preservation. Materials and methods. Liver biopsies (before cold preservation) of 300 consecutive donors with brain death were studied. Histological preparations were stained with hematoxylin and eosin, and tricolor Masson staining was performed. Results. The frequency of different degrees of fat hepatosis in men and women did not differ significantly (>0.05). Fat dystrophy of hepatocytes was absent in more than half of the cases (n = 182; 60.7%). A slight degree of fatty degeneration was diagnosed in 57 (19,0%) donors. In total, 239 (79.7%) donor livers were absolutely suitable for transplantation. Moderate degree of steatosis, which is associated with early biliary complications, was detected in 18 (6.0%) cases, and severe degree, which is a contraindication to the use of the organ for transplantation, was detected in 43 (14.3%) cases. Conclusion. Before cold preservation, liver from brain death donors is relatively rarely unsuitable for transplantation.

The purpose of this work was to study the relationships between urinary cytokines, mast cells and nerve growth factor (NGF) in the patients with interstitial cystitis/bladder pain syndrome (IC/BPS). Sixty-eight women with clinically diagnosed IC/BPS were under study. Their mean age was 54.2±12.4 years. Urinary concentrations of interleukins (IL-1β, IL-6, IL-8), tumor necrosis factor-α (TNFα), and NGF were determined by ELISA technique. Mast cells were identified in biopsies of mucous membranes from urinary bladder harvested during cystoscopy. Statistical evaluation was performed by Statistica program in Microsoft Excel. Pearson correlation quotients were calculated. Depending on the type of IC/BPS, the patients were divided into 2 groups: group I included 36 patients with classic type of disease; group II comprised 32 patients with non-ulcer type of IC/BPS. No significant differences were revealed between the groups. In 13.9% of patients from group I, the onset of clinical manifestations of the disease was observed at the age of less than 40 years; in group II, 28.1% of the examined mentioned appearance of the disease symptoms at this age. The levels of IL-1β in the patients from group I was 2.4 times higher than in controls (p < 0.05). IL-6, IL-8 and TNFα concentrations exceeded control values by 2.0 (p < 0.05), 2.5 (p < 0.05) and 2.0 times (p < 0.05), respectively. In the patients from group II, the content of IL-1β, IL-6, IL-8 and TNFα was 2.4 (p < 0.05), 2.0 (p < 0.05), 2.0 (p < 0.05) and 1.9 (p < 0.05) times higher than in the control group, respectively. There were no significant differences between groups I and II, in IL-1β, IL-6, and TNFα levels, except of IL-8 in women of group I that was 20.3% higher than in group II. The urinary NGF level in the patients with IC/BPS exceeded the control level 1.6 times (p < 0.05) for group I, and 1.5 times (p < 0.05) for group II. The number of mast cells in the patients of group I was significantly higher than in controls and in group II, i.e., 1.6 (p < 0.05) and 1.4 times (p < 0.05), respectively. In most cases, a direct weak correlation was revealed between the indices. Only in group I, a moderate correlation (r = + 0.508) could be detected between IL-1β and mast cells. Determination of cytokine levels allows to detect activation of inflammatory cells in bladder tissue and provides an opportunity for developing diagnostic strategies. Increased numbers of mast cells may indicate the importance of these cells in the disease progression, whereas elevated levels of NGF in urine suggests that IC/BPS may be caused by chronic inflammation.

Lung cancer is one of the leading causes of death in the world. Despite improvements in diagnostic procedures, most cases of this disease are diagnosed at common and metastatic stages. In recent years, new approaches to systemic antitumor treatment have been registered, which are the main method of treatment in patients with stage IIIB-IV. The diagnosis and staging of patients with lung cancer in recent decades has increasingly relied on minimally invasive tissue sampling techniques, such as endobronchial ultrasound (EBUS) or endoscopic ultrasound (EUS) needle aspiration, transbronchial biopsy, and transthoracic image guided core needle biopsy. These modalities have been shown to have low complication rates, and provide adequate cellular material for pathologic diagnosis and necessary ancillary molecular testing. It is important to understand how a small amount of biopsy material obtained using minimally invasive techniques is processed and evaluated by pathologists. An important condition is obtaining a sufficient number of cell or tissue substrate, can reliably establish the malignant process, to determine the histologic tumor type (whether it’s adenocarcinoma or squamous cell carcinoma), carry out the immunohistochemical and molecular genetic study to determine indications for the purpose of targeted, immunotherapy and the selection of chemotherapy regimen. It is necessary to conduct a single procedure that is as gentle as possible and provides a sufficiently large amount of tissue. The method of obtaining the material should be selected individually depending on the location of the pathological formation, the patient's condition and the capabilities of the clinic.

Background. Preoperative biopsy is recommended for morphological verification of colorectal epithelial neoplasms prior to their endoscopic resection. However, histological reports for endoscopic biopsy and resected lesions are not reliably consistent.Aim. Assessment of sensitivity, specificity and accuracy of endoscopic biopsy in differential diagnosis of colorectal serrated adenomas and risk factors for variance between biopsy results and morphological examination of completely resected lesions.Materials and methods. The assay used data on 56 morphologically verified serrated adenomas diagnosed and resected in 50 patients (14 men, 36 women; average age 66.9 ± 10.5 years). Biopsy was taken from all tumours before endoscopic resection. Results of morphological examination of biopsy samples and resected tumours were analysed and compared. Sensitivity, specificity and accuracy of biopsy was assessed, with the tumour size and type and biopsy forceps system taken as criteria.Results. The identified cases included 22 (39.3%) right-colon, 21 (37.5%) left-colon and 13 (23.2%) rectal lesions of 28.5 ± 2.6 mm average size. Polypoid were 17 (30.3%), non-polypoid — 6 (10.7%) and spreading — 33 (59%) of the tumours. Full consistency of morphological examination was observed for 12 cases (21.4%). In 9 cases (16%), dysplasia was established as mild-graded with biopsy, whilst the eradicated tumours contained severe dysplastic foci. Foci of adenocarcinoma were detected in 10 tumours (including 2 with submucosal invasion), but only 2 cases were correctly diagnosed for malignant adenoma with biopsy. Tumour morphology was misidentified in 32 cases (57.1%).Conclusions. Preoperative forceps biopsy is shown to possess low sensitivity in differential diagnosis of serrated colorectal lesions and very low sensitivity to predict malignant serrated adenomas.

The article describes an unusual course and complex differential diagnosis of fibrotic pericarditis, which imitated a heart tumor at the base of aorta. The key point in the progression of the disease was the appearance of concomitant fungal infection, which led to the emergence of its clinical manifestations. Due to the external compression of the main trunk of the left coronary artery up to 90 %, its stenting was performed. A biopsy followed by histopathological examination, along with other diagnostic methods, allowed to prescribe an adequate treatment for this pathology

Alcoholic liver disease (ALD) is one of the major liver diseases associated with high mortality rates. There are about 3 million alcohol-related deaths worldwide every year. ALD covers the spectrum of liver damage ranging from asymptomatic steatosis, alcoholic steatohepatitis and fibrosis to cirrhosis. In addition, patients may suffer from acute and chronic liver failure, alcoholic hepatitis (AH), bleeding from esophageal or gastric varices, ascites, coagulopathy, hepatic encephalopathy and liver cancer. In most patients, AH is diagnosed at advanced stages of the disease with higher complication and mortality rates. Patients abusing alcohol may simultaneously have viral hepatitis B or C, genetic diseases such as alpha-1 antitrypsin deficiency or hemochromatosis. The clinical manifestations of the disease are very diverse. There is no special laboratory test to detect the alcoholic cause of liver damage. A liver biopsy in the context of alcohol abuse in the history is a diagnostic test, but is not indicated for all patients. The main focus of therapy for ALD patients regardless of the stage of the disease is prolonged alcoholic abstinence. Abstinence is also the main key to preventing alcoholic liver diseases. Corticosteroids provide short-term survival improvement in about half of the patients with severe AH, and long-term survival is related to the severity of the underlying liver disease and depends on alcohol abstinence. General therapeutic measures in patients hospitalized with ALD include inpatient treatment of complications, treatment of alcohol withdrawal syndrome, monitoring of concomitant infectious diseases and their early effective antibiotic therapy, addition of hepatoprotectors to therapy regimens, and treatment of the underlying alcohol-related disorder. Liver transplantation (LT) is the final treatment option in patients with decompensated alcoholic liver cirrhosis. LT may also be considered in individual patients with AH who do not respond to drug therapy. Existing AH treatment regimens have insufficient efficacy, therefore, development of new methods and regimens of ALD targeted therapy is required. In this article we will consider the pathogenesis and treatment of ALD, paying more attention to AH, its topical and promising methods of treatment.

Aim: To evaluate the clinical and pathological features and prognosis of idiopathic membranous nephropathy (IMN) with focal segmental sclerosis (FSGS) in a group of Russian patients., Materials and Methods: 101 patients with morphologically verified IMN were enrolled in our single-center cohort retrospective study. The patients were divided into IMN group and IMN+FSGS group. The primary and secondary outcomes were analyzed in 59 patients, which had follow-up data for period more than 6 months., Results: At the time of renal biopsy the median age was 46.0 (33.0; 55.0) years and the median follow-up was 6.8 (4.0; 15.6) months. Secondary FSGS was revealed in 15 (14.9%) patients with IMN. The IMN and IMN+FSGS groups did not differ in gender, age of onset IMN and age of renal biopsy. In the IMN+FSGS group proteinuria was higher and estimated glomerular filtration rate was lower than that in the IMN group ( p <0.05). The systolic arterial pressure and creatinine levels in the IMN+FSGS group were slightly higher than in the IMN group, but the difference was not significant. Anti-PLA2R positivity was similar in both groups. Chronic kidney disease (CKD) progression was observed in 10/52 (19.2%) and 5/7 (71.4%) patients in IMN and IMN+FSGS groups, respectively. In a multivariate Cox regression model, age of renal biopsy (odds ratio - OR 1.12, 95% confidence interval - CI 1.03-1.22; р =0.07), FSGS (OR 0.05, 95% CI 0.01-0.34; р =0.002) и response to initial course of immunosuppression (OR 0.33, 95% CI 0.12-0.95; р =0.039) were associated with the CKD progression., Conclusion: In patients with IMN secondary FSGS is associated with a greater severity of proteinuria and a decrease in estimated glomerular filtration rate, and is also an independent factor of the CKD progression.

One of the most serious complications of diabetes mellitus is a diabetic foot with damage to soft tissues, ligamentous apparatus and bone structure. Charcot foot (there are several terms for this pathology: neuroosteoarthropathy, Charcot osteoarthropathy, Charcot joint, diabetic osteoarthropathy in the literature) is a chronic progressive disease of the bones and joints of the foot. In clinical practice, it is difficult to differentiate between Charcot foot and osteomyelitis. Charcot foot often affects the middle and back of the foot, several bones at once, followed by dislocation of the joints. As a rule, one bone of the forefoot is affected without dislocation of the joints in osteomyelitis. For osteomyelitis characterized by a triad of signs: ulcers soft tissue area of more than 2cm2; depth of the ulcer more than 3 mm; ESR 70 mm/h. In addition, osteomyelitis is characterized by a positive Bprobe-tobone test (bone sensation when probing an ulcer with a metal probe). To differentiate these two diseases, imaging methods are used: simple (conventional radiography, computed tomography, magnetic resonance imaging) and hybrid (positron emission tomography (PET) using 2-18f fluorine-2-deoxy-D-glucose, PET/CT, scintigraphy using technetium 99m or indium 111). Tissue biopsy remains the “gold standard” of diagnosis.

Primary Sjogren’s syndrome (pSS) is one of the most frequent among the connective tissue diseases. Histological examination of the minor salivary gland (MSG) is important diagnostic method. The currently established histological criteria for pSS do not have absolute sensitivity and specificity, which makes the search for additional morphological hallmark relevant.Aim – to study of the qualitative and quantitative composition of cellular populations inflammatory infiltrates in MSG pSS patient with the assessment of additional diagnostic criteria for disease based on the data obtained.Subjects and methods. The study included 55 patients with a diagnosis of pSS according to the criteria of ACR/ EULAR 2016. The control group consisted of 18 healthy volunteers. A MSG biopsy was performed all subjects for histological and immunohistochemical studies with a quantitative assessment of CD3+, CD4+, CD8+, CD20+, CD21+, CD68+, CD138+ cells. Statistical data analysis was performed using the Statistica 10.0 for Windows (StatSoft Inc., USA). For comparison of quantitative traits, the Mann – Whitney U-test was used. To determine the diagnostic threshold of the number of a ROC analysis was performed. An operating characteristic curve was plotted. The area under the curve (AUC), diagnostic specificity, diagnostic sensitivity, diagnostic accuracy, likelihood ratio of the positive and negative results of the test were calculated. The construction of classification models, including the number of different cell types, was carried out using linear discriminant analysis.Results and discussion. The number of CD3+, CD4+, CD8+, CD20+, CD138+ cells in 4 mm2 (area of section) was significantly higher in the pSS group. The largest AUC were observed for the quantitative evaluation of CD3+ cells – 0.88 [95% confidence interval (CI): 0.80–0.96] and CD8+ cells – 0.87 [95% CI: 0.79–0.95], which at the specified diagnostic thresholds corresponded to the sensitivity of 70.9% [95% CI: 57.86–81.23] and 65.45% [95% CI: 52.25–76.64], specificity of 94.4% [95% CI: 74.24–99.72] and 100% [95% CI: 82.41–100], respectively. The CD21+ follicular dendritic cells were detected only in MSG of pSS group. AUC for quantitative assessment of these cells was 0.65 [95% CI: 0.52–0.78], sensitivity 29.1% [95% CI: 18.77–42.14] and specificity 100% [95% CI: 82.41–100]. Using the method of discriminant analysis, we designed classification models that included various combinations of the studied markers. The highest AUC among all possible combinations was observed for the decimal logarithms of the number of CD3+ and CD68+ cells – 0.92 [95% CI: 0.85–0.98], which for a given diagnostic threshold corresponded sensitivity – 81.82% [95% CI: 69.67–89.81], specificity – 94.4% [95% CI: 74.24–99.72].

The article reviews the literature on the diagnosis and treatment of primary lymphomas of the central nervous system and describes a case of mental disorder before and after surgery in a patient with lymphoma of the third ventricle. Using an interdisciplinary approach, psychopathological dynamics is analyzed taking into account the structural and functional state of the brain, which allowed to clarify the possible causes of mental disorders and methods of treatment. Acute onset of confusion and headache was associated with disorders of the liquor outflow, due to the localization of the tumor. The reason for the disintegration of consciousness after surgery was brain hypoxia and the instability of connections between cerebral structures associated with it. The peculiarity of the consciousness recovery could be determined by premorbid personal traits.

The aim of the work was to study the clinical case of systemic amyloidosis.Materials and methods. Patient Ch., 63 уears old, have admitted to the regional cardiological dispensary with complaints of short stabbing pains in the heart, without reaction to nitroglycerin, interruptions in the work of the heart, mainly at night, shortness of breath with little exertion, weakness, swelling of the legs and feet in September 2018. Sick from April 2016, when was dyspnea on exertion. The high level of creatinine, normochromic anemia have detected. In June 2016 chronic pyelonephritis was diagnosed. In August 2018, a right-sided hydrothorax was diagnosed, a pleural puncture was performed.Results. Laboratory and instrumental research methods were performed. Based on anamnesis data (normochromic anemia, proteinuria, increased creatinine in the blood), clinical picture, data of instrumental studies (restrictive cardiomyopathy, bilateral hydrothorax) clinical diagnosis was made: systemic amyloidosis the kidneys and heart with chronic kidney disease C5 and chronic heart failure. Histological evidence of amyloid and determination of the variant of amyloidosis by immunohistochemical method was recommended. But the patient died before the study. The histological verification of the diagnosis was carried out at the autopsy.Conclusion. This clinical observation is an example of late diagnosis of systemic amyloidosis and postmortal verification of the diagnosis, which is associated with the nonspecific symptoms and the rapidly progressing course of the disease. This case is interesting because amyloidosis proceeded under the guise of other diseases, quickly led to the development of severe heart and renal failure and to the death of the patient before verifying the disease.

Nonspecific infectious lesions of the spine are relatively rare, difficult to diagnose and severe diseases of the spine. The urgency of treating nonspecific infectious spinal diseases is explained by an increase in the frequency of these diseases, new antibiotic-resistant strains of microorganisms, and the severity of the course and unsatisfactory treatment outcomes. In this review, we describe spondylodiscitis and epiduritis in detail. On the basis of literature data, we thoroughly studied and described etiology, clinical pattern and diagnosis of these diseases. We thoroughly covered modern laboratory and radiologic methods for the diagnosis of spondylodiscitis and epiduritis, such as spondylography, computed tomography, magnetic resonance imaging, scintigraphy, positron emission tomography of the spine and biopsy and described modern methods of conservative and surgical treatment. The particular attention is paid to the technique of surgical treatment of spondylodiscitis and epiduritis.

The study objective is to evaluate the possibility of determining the signaling lymph node (SLN) in oral cancer (T1–2N0M0) with lymphoscintigraphic method.Materials and methods. In 2016–2018, SLNs were determined for 23 patients with oral cancer (cT1–2N0M0): for 15 patients with cancer of the tongue, for 8 patients with cancer of the floor of the mouth cavity. SLNs were determined by radiolymphoscintigraphic method by peritumoral administration of Tehnefit radiopharmaceutical in a dose of 40 to 80 MBq, depending on the timing of the signal lymph node biopsy. Visualization of the signaling lymph node was carried out by planar scintigraphy and single-photon emission computed tomography combined with x-ray computed tomography. Intraoperative SLN was detected using intraoperative radiometry using a gamma probe.Results. In cancer of the floor of the mouth, SLNs were identified only in 2 (25 %) of 8 cases. In cancer of the language, SLN were identified in 14 (93.3 %) of 15 cases. In total, SLNs were diagnosed with cancer in 17 patients. In 4 (26.7 %) of 15 patients, cancer metastases in SLNs were identified. False negative results were obtained in 6.7 % of cases.Conclusion. A biopsy of the SLN by the lymphoscintigraphic method has a high diagnostic value for staging the early stages of cancer of the tongue.

Introduction. Contemporary diagnosis of prostate cancer is crucial to the patient’s further fate. Difficulties in the histological verification of the final diagnosis and false-negative results of biopsy research are often associated with the similarity of the prostate adenocarcinoma`s micromorphological picture and its benign lesions.Purpose of the study. Comprehending the possibilities of immunohistochemical identification of tumor cells and the basal epithelial layer of prostate glandular structures in prostate cancer suspected cases.Materials and methods. A biopsy material was taken from 134 patients. Prostate adenocarcinoma was verified by routine histological examination in 72 samples, in 62 samples there were no signs of malignant transformation. Subsequently, immunohistochemical analysis of biopsy specimens was performed using antibodies to α-methylacyl-CoA racemase, nuclear p63 protein and high-molecular cytokeratin.Results. The AMACR-positive reaction of malignant cells and a negative reaction of the basal epithelium to nuclear p63 protein antibodies and high-molecular cytokeratin were detected during prostate adenocarcinoma.Conclusion. If prostate cancer is suspected, immunohistochemical assays with monoclonal antibodies to AMACR, p63 and high-molecular cytokeratin greatly facilitate the detection of adenocarcinoma.

The review presents literature data on the possibilities of modern diagnostic methods in detecting and determining the nature of secondary lung tumors, and also analyzes their main advantages and disadvantages.

Neuroblastoma is a malignant tumor derived from the neuroblasts of the sympathetic nervous system, which develop in any region of the nervous system. Usually, neuroblastoma is detected in children aged 1–2 years. About 90% of cases are diagnosed before the age of 5 years. The incidence of adult neuroblastoma is only 0.3 cases per million people per year. The clinical course and biological activity of adult neuroblastoma is different than children neuroblastoma. Early diagnosis of this disease in adults is necessary for timely start of treatment and increasing life expectancy. In this clinical observation, we present a detailed description of the course of this rare disease in the 34-year-old male and literature review on adult neuroblastoma.

This review analyze data of clinical trials, systematic reviews and meta-analyses, which evaluated the sensitivity and specificity of any biomarkers using for diagnostics of prostate cancer before an initial prostate biopsy or after a negative initial biopsy.

Until recently, a discussion about the mechanisms of development and the biological role of the ductular reaction, which develops in patients with chronic liver diseases continues among hepatologists and pathomorphologists. Purpose of the study. To characterize the pathomorphological features and significance of the ductular response in liver cirrhosis in patients with chronic non-alcoholic, alcoholic and viral hepatitis in hepatobioptats with the use of immunohistochemical (IHC) techniques. Material and methods of investigation. Histological, histochemical and IHC study of the ductular liver reaction in liver biopsies of 52 patients aged 24 to 66 years with cirrhosis of the liver on the background of non-alcoholic steatohepatitis (13 patients), and alcoholic steatohepatitis (13 patients) and on the background of chronic viral hepatitis C (10 patients, 26–47 years), as well as those suffering from severe biliostasis (8 patients) and focal nodular liver hyperplasia (8 patients). Results. The ductular reaction can be detected in the active phase with maximum manifestations in patients with liver cirrhosis on the background of chronic hepatitis, it may have an average or weak degree of severity; in a significant number of patients, the effects of the ductular reaction of the liver are revealed. Cellular chains and groups of cells with the immunophenotype of the progenitor cells of the liver appear in the active phase of the ductular reaction at the periphery of the hepatic lobules in the projection of the Goering canals, in the fibrotically altered portal tracts, in the subcapsular zone of the liver and in the thickened fibrosis septa (c-kit CD117+, CD34+, CD56+ CK7-, CK19-, Hepar-) without presence of figures of mitosis or increased level of expression of Кі-67 in them. In small ductules localized in the projection of the Goering canals, single cells with the expression of c-kit CD 117+, CD44 Std./HCAM+, CD34+, CD56+, expressing the markers of biliary (CK7+, CK19+) and hepatocyte (Hepar+, α-fetoprotein+) differentiation are revealed. Cellular chains and ductules in the intermediate zones of the hepatic lobules are represented by cells of biphasic differentiation: biliary (CK7+, CK19+), hepatocyte (Hepar+) differentiation and intermediate hepatobiliary CK7+ cells. Hepatocyte differentiation of progenitor cells in lobules of the liver is facilitated by local expression of laminin by perisinusoidal stellate cells. New pseudolobes arise in the active phase of the ductular reaction in the lobes with perisinusoidal pericellular fibrosis from disorderly located large hepatocytes without linear perisinusoid spaces and centrolobular veins, with the presence of “intermediate” SC7+ hepatocytes on the periphery. One-two-row chains and ductules from SC7+ and CK19+ cells dominate in the fibro-altered portal tracts, septa and the subcapsular zone of the liver among the collagen fibers of I, III, IV type and the processes of α-SMA+ myofibroblasts, and small short chains from Hepar+ and α- fetoprotein-cells. When the severity of micronodular liver cirrhosis increases, when the area of hepatic lobules and pseudotypes becomes equal to or less than the area of the surrounding fibrosis, there is a parallel increase in the number of Ki-67+ cells in portal-lobular ductules and chains, as well as the number of Ki-67+ hepatocytes in hepatic lobules and pseudolobes. The long-term consequences of the ductular reaction in liver cirrhosis reflect the presence of the different number of bile-free ductules with CK7 + epithelium in the fibrous tissue of portal tracts, septa and under the liver capsule. In the lobules of the liver with perisinusoidal pericellular fibrosis, fuzzy outlines of hepatocyte hyperplasia without ordered sinusoids and liver-celled beams are found. Conclusions. The ductular reaction in liver cirrhosis in patients with chronic non-alcohol, alcoholic and viral hepatitis is the process of activation and evolution of a complex liver repair complex aimed at replenishing the deficit of hepatocytes and biliary structures. The reparative process, activating by liver cirrhosis on the background of the disturbed portal-lobular intercellular matrix and the progressive deficit of hepatocytes, does not provide the reconstruction of full-fledged liver structures, it is discordant towards the creation of new, functionally low-value hepatocellular pseudolobes and the accumulation of biliary terminals in fields of portal-septal fibrosis.

In this report we present a case of patient with a tumor of the paranasal sinuses. A non-homogeneous formation spreading to the right maxillary sinus, right nasal cavity, and right orbit (with the destruction of the bone wall of the anterior cranial fossa) in the ethmoid bone was detected on a computed tomography scan. A esthesioneuroblastoma was suspected after the needle biopsy (accompanied by bleeding). To clarify the diagnosis and to determine treatment strategy, we performed open biopsy under general anesthesia, which showed that the patient had hemangioma. The patient underwent radical removal of the tumor. Histopathological examination confirmed the diagnosis of hemangioma.The aim of this study was to describe a case of orbital tumor, when the results of needle biopsy were inconsistent with clinical manifestations.In this case, clinical manifestations had the decisive role in determining treatment strategy.

A biopsy of lung tissues was a conventional diagnostic method for detection of disseminated processes in the lung, which weren’t diagnosed on preoperative stage. It was used during surgical anti-relapse treatment of spontaneous pneumothorax (SP). A retrospective analysis of the results of lung parenchyma biopsy was made in 143 patients, who have been operated for SP. Basic entry criteria of the research were: the age younger than 40 years old, a presence of one episode of spontaneous pneumothorax, an absence of complaints for respiratory organs before the development of the first episode of spontaneous pneumothorax. The biopsy with following pathomorphological investigation allowed a formulation of exact variant of disseminated processes, which gave the reason for the development of spontaneous pneumothorax in 9 (6%) patients out of 143. The presence of disseminated processes in the lung was detected with multispiral CT in all these patients on preoperative stage. The study of biopsy material found out the presence of emphysema of different degree of manifestation or fibrosis sites in the rest of the patients. An analysis of presented materials allowed the conclusion, that a performance of biopsy was indicated in the case of suspicion for lung disseminated processes in patients with SP. The biopsy with the following histological study didn’t explain the reason of the development of emphysematous and fibrous changes in lung parenchyma in all other cases. At the same time, it didn’t give the option for pathogenetic treatment and it wasn’t possible to predict the following pathogenesis.

An analysis of modern methods of diagnostics such as morphological, immunohistochemical and spectral, which included the bronchoscopy and spectrometry by using reflectance and autofluorescent regime, was made. The data involved the results of prospective follow-up study of 167 patients (620 biopsies). An obligatory spectrometry of suspicious area was carried out before the forceps biopsy. The microslides, which met the requirements of criteria of one of the carcinogen steps (n=201), were subjected to the in-depth morphological and immunohistochemical investigations. The tendency of angiogenesis (CD31 and CD34), proliferative activity (Ki-67), level of apoptosis (P53), EGFR expression were estimated. The sensitivity of combined endoscopic method was 94,74% by specificity 79,95% and high prognostic value of negative endoscopic diagnosis — 99,4%.

Differential diagnostics of tumors of anterior mediastinum is one of the most difficult problems of thoracic surgery and oncology. The authors conducted a retrospective analysis of the results of transthoracal puncture biopsy under ultrasonic induction in 44 patients with the tumors of the anterior mediastinum. Transthoracal biopsy was carried out using the device for biopsy (Multiple Biopsy Device-MBD-23) and ultrasonic scanner (Voluson 730 Expert), the patients being under intravenous (38 patients) and under local (6 patients) anesthetization. The diagnosis was made as a result of morphological research in all 100% of patients, the biopsy being performed the second time in one patient. The general information value of puncture biopsy under ultrasonic induction was 98%. A complication (localized pneumothorax, cupping off by itself) took place only in one of the follow-up study (2%). The analysis of presented material let the authors make a conclusion that transthoracal puncture biopsy under ultrasonic induction is a safe and highly informative method of diagnostics of tumors of the anterior mediastinum in selected patients.

Background. Male etiology is responsible for nearly half of cases of infertility. Frequency of azoospermia in infertile men reaches 30 %; varicocele is diagnosed in almost 40 % of the patients. Varicocele- associated infertility has traditionally been considered an indication for surgical treatment. At the same time, the main method of sperm retrieval in azoospermia is testicular biopsy (testicular sperm extraction, TESE).Objective: to assess the efficacy of surgical treatment in patients with non-obstructive azoospermia (NOA) and varicocele.Materials and methods. The study included 327 patients with NOA and varicocele aged between 22 and 48 years treated in the Department of Andrology and Urology at the V. I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology in 2012– 2016. Study participants were divided into two comparable groups. Patients in the first group underwent microsurgical varicocelectomy (Marmara procedure) on the first stage and testicular biopsy (micro-TESE) on the second stage. Patients in the second group underwent micro-TESE with no surgical correction of varicocele prior to it.Results. In the first group, the appearance of spermatozoa in ejaculate was observed in 84 (44.4 %) patients 6 month post microsurgical varicocelectomy. Upon micro-TESE, spermatozoa suitable for use in assisted reproductive technologies were obtained in 60 (56.7 %) men. Treatment was effective in 144 (76.2 %) patients from the first group. In the second group, spermatozoa were retrieved in 66 (47.8 %) men upon micro-TESE.Conclusion. Microsurgical varicocelectomy increases treatment efficacy in males with NOA and varicocele. In the absence of severe degeneration of the seminiferous epithelium, 72.6 % of patients had the opportunity of becoming a genetic parent, avoiding in some cases testicular biopsy.

Until recently, among the pathologists, hepatologists and gastroenterologists, a discussion continues on the morphogenesis and gradation of liver fibrosis in non-alcoholic patients (NASH) and alcoholic steatohepatitis (ASH). Purpose of the study. Studying the main types and sources of liver fibrosis in patients with nonalcoholic and alcoholic steatohepatitis, justifying the gradation of its severity, taking into account the quantitative dynamics of fibrogenic producer cells, the relative area of fibrosis and the deposition of type I, III and IV collagen in the liver. Material and methods. Histological and histochemical examination of liver fibrosis was performed in 198 patients with NASH of 18-79 years and in 79 patients with ASH of 47-63 years. Immunohistochemical study with measurement of the area of expression of activated αSMA + perisinusoidal stellate cells and αSMA + portal myofibroblasts with F1 (mild), F2 (moderate), F3 (severe) fibrosis and F4 fibrosis / cirrhosis was performed in 80 trepanobioptates of patients with NASH (20 cases in each group), electron microscopic examination of the liver – in 10 deceased patients suffering from NASH. Results. In patients with NASH and ASH, there are two major types of liver fibrosis progress: the perisinusoidal pericellular and portal-Z3 perisinusoidal fibrosis, the development of which is the new generation of αSMA + star cells and αSMA + portal myofibroblasts of the fibrogenic immunophenotype, with co-expression of fascin and vimentin and absence of desmine expression. As the perisinusoidal pericellular fibrosis progresses from the mild F1 degree, to the severe F3 fibrosis and to the extremely severe F4 fibrosis / cirrhosis of the pericellular type, the area of the Masson-positive extracellular molecular-fibrous matrix (H = 88,70 р = 0,05 ) and the area of αSMA + collagen-producing stellate cells of perisinusoidal-pericellular localization (H = 45,12, p = 0,05). According to the data of photometric morphometry, with increasing severity of portal-Z3 perisinusoidal hepatic fibrosis from F1 to F4, the area of the Masson-positive extracellular molecular-fibrous matrix (N = 76,56 p = 0,05) in areas fibrofacitiously increases, as well as the area of activated αSMA + collagen-producing portal myofibroblasts and perisinusoid stellate cells of Z3 zones of hepatic lobules (H = 43,18, p = 0,05). Activation and increase in the number of CD-68+ macrophages in the centers of intensive hepatocyte steatosis, as well as the appearance of S100 (A4)+ macrophages that activate stellate cells, suggests that the phenomenon of pericellularity of liver fibrosis in NASH and ASH is due to exosomal macrophage involvement in zone of balloon steatonecrosis and necroptosis of hepatocytes, as well as local exosomal-cytokine activation of perisinusoid stellate cells of fibrogenic type. Conclusion: As the progression of fibrosis from F1 to F4 degree in the liver the area of activated αSMA + fibroblasts, and the area of deposition of collagen I, III and IV type perisinusoidal pericellular or portal-Z3 perisinusoidal localization significantly increase.

OBJECTIVE. The authors developed methods and assessment of efficacy of infrared fluorescence imaging of pleural carcinomatosis using indocyanine green (ICG). MATERIAL AND METHODS. The prospective study included 14 patients with malignant pleural carcinomatosis. All patients underwent standard thoracoscopy with pleural biopsy, then pleural cavity was examined under fluorescence control using ICG solution. Comparison of accuracy of biopsy materials obtained in white light and fluorescence was made. RESULTS. Signs of malignancy had 21 biopsy specimens out of 28, which were obtained in white light (in 12 patients out of 14). Research of biopsy specimens using fluorescence allowed doctors to make the precise diagnosis in all 14 patients, with 33 out of 34 biopsy materials being informative. CONCLUSIONS. Intraoperative application of infrared ICG fluorescence developed accuracy of biopsy and histological verification of the diagnosis.

Sensitivity of multi-parametric magnetic resonance imaging (MRI) for prostate cancer in normal clinical practice setting was studied retrospectively in single hospital. 249patients with traditional indication for initial biopsy had MRI before biopsy. MRI was normal in 174 patients, but 13 % of them had clinically significant prostate cancer after biopsy.

OBJECTIVE. The authors investigated the value of comprehensive assessment of clinical and laboratory factors including prostate specific antigen (PSA) fractions and prostate health index (PHI) in diagnostics of prostate cancer. MATERIALS AND METHODS. The study numbered 148 patients who were examined for suspected prostate cancer. Clinicians made the measurement of total PSA and fractions, PHI, multifocal transrectal biopsy of prostate. The statistical data were analyzed. RESULTS. The formulas obtained used the discriminant analysis of all clinical and laboratory factors (PSA fractions and PHI). These formulas showed the high possibility (77-80 %) to predict the presence of prostate cancer with sensitivity 70-78 % and specificity 77-83 %. Percentage of [-2]proPSA depended on PHI value and had the significant influence on the possibility of prostate cancer detection.

Objective: At the histological and ultramicroscopic level, compare biopsy specimens of donor heart under standard (up to 240 min) and extended (more than 240 min) periods of pharmaco-cold preservation., Material and Methods: Biopsy specimens of the left atrium of donor hearts: group 1 - 8 samples after transportation with pharmaco-cold preservation of the graft in Bretschneider solution (Dr. Franz Köhler Chemie GmbH, Germany) up to 240 min, (Me 140), and group 2 - 5 samples after an extended pharmaco-cold period (more than 240 min; Me 375) were examined using light microscopy of semi-thin sections and transmission electron microscopy, followed by stereological and statistical analysis., Results: A comparative study of the myocardium of donor hearts revealed stereotypical dystrophic changes in cardiomyocytes. Semi-thin sections demonstrated a mosaic pattern of myocardial parenchyma in both groups, caused by contracture and less pronounced lytic changes in myocytes, which were accompanied by stromal edema without statistically significant differences according to stereological studies. Ultrathin sections of the perinuclear zones of cardiomyocytes visualized reduction and focal damage to myofibrils and mitochondria in combination with pronounced autophagy; at the same time, with a shorter duration of the pharmaco-cold period, the stereological indicators of cardiomyocyte organelles indicated a relatively better supply of myofibrils with mitochondria., Conclusion: The results obtained suggest a sufficiently high degree of preservation of the tissue and ultrastructural organization of donor hearts with prolonged (more than 240 min) pharmaco-cold ischemia to restore adequate cardiac activity after heart transplantation.

Background: Among oral biopsies, small incisional tissues, have to be preserved all through the processing and embedding to ensure optimal visualization of all the mucosal layers without compromise. Optimal tissue orientation is the most critical step in tissue processing for demonstration of definitive morphology in the sections, which is often more challenging in cases of minute/small or thinner sections using routine paraffin techniques to evaluate accurate diagnosis. Some modification is needed to handle these samples to get a better result. Double embedding technique with some modification has been widely used for small/ thin/ multiple biopsies and gives excellent results in many other fields like general pathology and biotechnology. The double embedding technique though produced excellent and significant results in mucosal biopsies yet, it is of minimal interest among oral pathologists. To best of our knowledge, this is the first study to use double embedding technique for pulp tissues., Objective: The present study was aimed to evaluate and compare the ease of embedding and sectioning sections using Agar-Paraffin double embedding technique for small oral mucosal biopsies and thin pulp tissues., Material and Methods: A total of 40 oral tissue samples categorized into two groups were taken for the present study. Group I included 20 small oral mucosal biopsy samples of size ranging from 0.2 to 0.5 cm and Group II included 20 pulp tissues obtained from freshly extracted non carious tooth. 10 blocks were prepared by routine paraffin method and 10 blocks were prepared by modified double embedding method for each group. Scores were given by comparing all the criteria with that of the routine paraffin technique. Chi-square test was used for statistical analysis., Results: The average ease score for the Agar-Paraffin double embedded small/minute biopsies showed better scores than the pulp tissue with that of the routine technique. However, no statistically significant difference was seen among embedding and sectioning sections between the two groups., Conclusion: Modified double embedding method is simple and reliable alternative technique that helps in better orientation, processing and sectioning especially for oral small or thin biopsies and delicate pulp tissues.

Primary central nervous system lymphoma (PCNSL) is a rare neoplasm that can affect the brain, eyes, and, rarely, the spinal cord. Clinical presentation and MRI findings can mimic a variety of diseases, including high-grade gliomas, infectious and granulomatous diseases, and demyelinating diseases. We describe three cases where the diagnosis of PCNSL was difficult due to an ambiguous clinical, radiological and laboratory results. The role of stereotactic biopsy remains leading in differential diagnosis; however, the invasiveness and frequent limitations of this method determine the search for additional biological markers of the disease. New evidence suggests a potential role for cerebrospinal fluid (CSF) cytokine profiles and proteomic analysis in differential diagnosis, disease progression, and treatment response.

Background: Eosinophilic esophagitis (EoE) is an immune-mediated disease, manifested by dysphagia and characterized by intraepithelial infiltration: more than 15 eosinophils per field of view at x400 magnification, and requiring differential diagnosis with reflux esophagitis (RE)., Objective: To access the implication of EoE histologic scoring system (EoEHSS) for differential diagnosis of EoE and RE and to characterize features of immune response in these diseases., Material and Methods: 38 patients with EoE and 38 patients with RE were enrolled in the study. All the patients had esophagogastroduodenoscopy with biopsy. Biopsy specimens were stained with H&E and combined PAS/Alcian blue staining. Immunohistochemical evaluation was conducted with antibodies to CD3, CD4, CD8, CD20, CD56 and CD68., Results: Grade score of EoEHSS in EoE was 2.4 times more than in RE ( p <0.05). Stage score in EoE was 2.75 more than in RE ( p <0.05). Intraepithelial count of CD3+ T-lymphocytes comprised 87 (76-95.5) in high-power view in EoE and 45 (38.5-48.5) in high-power view in RE. Intraepithelial count of CD4+ T-lymphocytes was 35 (28-41.5) in high-power view in EoE and 19 (16.5- 22.5) in high-power view in RE. Intraepithelial count of CD8+ T-lymphocytes comprised 59 (50.5-67.5) in high-power field in EoE and 27 (24-28.5) in high-power field in RE., Conclusion: The use of the EoEHSS histological rating scale for eosinophilic esophagitis is effective in the differential diagnosis of EoE and EC. Predominant cells in intraepithelial infiltrate are CD3+ T-lymphocytes both in EoE and RE, CD8+ cells prevail over CD4+ cells. In EoE intraepithelial count of CD3+ T-lymphocytes is 1.93 times more, count of intraepithelial CD4+ lymphocytes is 1.84 times more and count of CD8+ lymphocytes is 2.19 times more than in RE.

Surgery for mediastinal tumors is still one of the most difficult in modern medicine. This is due to vital organs and various nature of tumors in this area. Teratomas are relatively rare among mediastinal tumors. However, they have certain features that is important for treatment strategy and management of possible complications. This can complicate diagnostic algorithm, exclude transthoracic biopsy and contribute to active surgical approach even for benign process. Oncogenesis of teratoma has its own characteristics. Tissues of different organs are always present in this tumor. Among these, pancreatic tissue inclusions are rare. A few data in the world literature on the treatment of such patients do not allow to develop a universally accepted algorithm of diagnosis and treatment. The authors present two patients with mediastinal teratoma. The second patient had teratoma with pancreatic tissue. The authors discuss the diagnostic algorithm for similar cases. A special attention is paid to description of possible complications throughout long-term follow-up period. Surgical aspects including the choice of access and local spread of process (adhesions in the area of surgical interest) are considered. The report on the treatment of two patients with rare mediastinal tumors containing pancreatic tissue will be useful for primary care physicians, thoracic surgeons, oncologists and morphologists.

The Aim of the Study: Was to determine the presence of an amoxicillin-based antibiotic in bone implant biopsies by Raman spectroscopy in an experiment., Materials and Methods: Experimental animals ( n =10, a miniature pig of the Svetlogorsk breed) were divided into 2 groups of 5 animals. Groups 1 and 2 were injected with amoxicillin 2 ml per 20 kg of body weight 30 minutes before dental implantation surgery, then group 2 was additionally injected with 1 ml per 20 kg of body weight for 5 days. Each animal has 6 implants installed. On the 1st, 3rd, 7th, 14th day, an implant-bone biopsy was removed from each animal, micro-preparations were made and Raman spectroscopy was performed to assess the peak matching of the Raman spectrum., Results: In animals of the 1st and 2nd groups, the main peak of the Raman spectrum, which is closest to the values of the antibiotic spectrum of interest to us, is located closer to 1448 cm - 1 and 1446 cm -1 , respectively. At the same time, in both observations, the peaks relate to the spectrum of bone tissue, which cannot indicate the content of an antibiotic in the drug., Conclusion: No scattering spectra corresponding to the antibiotic molecule were found in any animal from both groups, regardless of the mode of administration and dosage of amoxicillin. The detected peaks corresponded to bone tissue without an antibiotic.

The paper reviews the diagnostic possibilities of different methods for the evaluation of liver fibrosis in chronic viral hepatitis from the point of view of their clinical application. Histological examination retains its value as the gold standard method in evaluating the liver. Transient elastography is a rather effective tool for identifying severe liver fibrosis.

Objective: to perfect and estimate the possibilities of using a mini-invasive diagnostic procedure under magnetic resonance (MR) guidance in the complex anatomic situations in cases of pathological small pelvic changes of unknown origin.Material and methods. Ten small pelvic interventions were made under MR guidance. The indications for bone biopsy under MR guidance were poor visualization of bone changes or their absence during radiography, including computed tomography. Small pelvic organ and soft tissue biopsies were carried out in the situations of complex location of pathological changes adjacent to critical organs, large vascular and neural structures. All interventions were done using a high-field MR scanner. Freehand biopsy was performed in a stepwise fashion under axial and sagittal T2-weighted image control.Results. Informative histological material was obtained in 100% of cases. No complications were observed.Conclusions. It became possible to verify the diagnosis based on morphological findings and to timely determine management tactics only by target biopsy under MR guidance in these 10 patients with small pelvic changes of unknown origin.

Aim. The article presents the value of different methods of sampling biopsy during endoscopy with cytological and morphological examination of biopsy material in the diagnostic algorithm of various pathological processes of the respiratory system. Methods and results. The retrospective cohort study of 194 biopsy cases that were obtained during endoscopic studies with morphological study of biopsy material for 2011–2012 periods was presented in the article. The method of biopsy obtaining at endoscopy was determined by the nature and spread of the pathological process in the bronchi and/or lung tissue, which is specified directly in the course of bronchoscopy. In 31.44% of cases it was established that the most often diagnosis was «malignant lung neoplasm» in result of the endoscopy. The parameters of sensitivity, diagnostic value and effectiveness of cytological and histological examinations were calculated. Cytological studies were characterized by high levels of sensitivity and diagnostic value in cases of diagnosis of malignant and benign tumors, non-specific inflammation of the bronchus and lung in cases of direct biopsy at fiberoptic bronchoscopy (FBS) (100.0%). For verification of the diagnosis of benign tumors, tuberculosis, sarcoidosis and «rare» diseases of the respiratory system the histological examination of the material from transbronchial lung biopsy (TBLB) was most important, the value of these indicators was 100.0%. Conclusion. Effectiveness of the complex morphological study of biopsy material at direct biopsy at FBS was 80.5%, while TBLB – 73.6%. Overall effectiveness of complex cytological-histological examination of biopsies in endoscopic studies was 77.05%.