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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 7 h left rib, left iliac wing, in the left bones of cranial vault, in C 7 , Th 6 , Th 9 , Th I2 vertebrae and right foot bones. Additional examination using SPECT/CT (from the skull base to the hip joints) revealed metastases in corpuses of Th 9 , Th I2 vertebrae and the left iliac wing, and suspicion for metastasis in 7 h left rib. Magnetic resonance imaging (MRI) confirmed metastasis in Th 9 , Th I2 , L 3 vertebral bodies and in the left iliac wing. Conclusion. Conclusion . In this clinical example, SPECT/CT allowed to correctly detect metastases in both Th 9 and Th I2 vertebrae while bone scan was questionable, and MRI showed an additional damage of L 3 vertebra. Changes in the 7 h 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.

This review paper describes the possibilities of visualization of regional lymph nodes using contrast-enhanced ultrasound. Discussed is the experience of contrast-enhanced ultrasound implication for differential diagnosis of regional metastases of squamous cell carcinoma of the oral mucosa. The basics of the technique of contrast-enhanced ultrasound examination of the neck lymphatic basin are described.В данной работе представлено описание возможностей визуализации регионарных лимфоузлов с применением контрастно-усиленного ультразвука. Обсуждается опыт применения контрастно-усиленного ультразвука в дифференциальной диагностике регионарных метастазов плоскоклеточного рака слизистой полости рта. Описываются основы методики технического и клинического обеспечения выполнения контрастно-усиленного ультразвука для обследования лимфоаппарата шеи.

Improvement functional and aesthetic results of treatment patients with defects of the hard and soft palate after resections for malignant tumors.During the period from 2014 to 2020, 30 patients underwent microsurgical reconstruction of hard and soft palate defects using a radial forearm free flap. For the primary tumor process, surgery was performed in 21 patients (70%), for relapse after chemotherapy, combined or complex treatment - in 9 patients (30%). The majority of patients at the time of surgery had a locally advanced process of the T2 category (12 patients - 40%), T3 (2 patients - 7%) and T4 - 2 patients (7%). Localized stage T1 process was diagnosed in 5 patients (17%).Total flap necrosis was noted in 3 cases (10%) due to venous thrombosis on the 2nd and 3rd days after surgery and arterial thrombosis on the 2nd day. In one observation, on the 2nd day after surgery, a tense hematoma was diagnosed in the zone of formation of microanastomoses without signs of impaired flap perfusion, which required an emergency surgical intervention. All patients returned to their normal meals. No rhinolalia was observed in any of the cases. In one case, a patient with a defect in the anterior part of the hard palate obtained an unsatisfactory aesthetic result deformity of the midface; in all other cases, an excellent aesthetic result was obtained.For defects of the hard palate of posterior localization and minimal or no defect of the alveolar edge of the maxilla (class I, a, b according to Braun, class Ia, Ib according to Okay, class V according to Armany), as well as for the defects of the soft palate, the method of choice is radial forearm free flap. The size of the skin area of the flap can reach 6X8 cm, which makes it possible to replace the combined defects of the hard and soft palate, the lateral wall of the oropharynx, and the retromolar region. The plasticity of the flap makes it possible to reconstruct the total defects of the soft palate by forming it in the form of a duplication.Улучшение функциональных и эстетических результатов лечения пациентов с дефектами твердого и мягкого неба после резекций по поводу злокачественных опухолей.За период с 2014 по 2020 г. 30 пациентам выполнена микрохирургическая реконструкция дефектов твердого и мягкого неба с использованием лучевого кожно-фасциального лоскута. По поводу первичного опухолевого процесса оперативное вмешательство выполнено 21 (70%) пациентам, по поводу рецидива после химио-, лучевого, комбинированного или комплексного лечения — 9 (30%) пациентам. Большинство пациентов на момент выполнения оперативного вмешательства имели местнораспространенный процесс категории T2 (12 больных — 40%), T3 (2 больных — 7%) и T4 (2 больных — 7%). Локализованный процесс стадии T1 диагностирован у 5 (17%) больных.Тотальный некроз лоскута отмечен в 3 (10%) случаях вследствие венозного тромбоза на 2-е и 3-е сутки после оперативного вмешательства и артериального тромбоза на 2-е сутки. В одном наблюдении на 2-е сутки после оперативного вмешательства диагностирована напряженная гематома в зоне формирования микроанастамозов без признаков нарушения перфузии лоскута, что потребовало выполнения экстренного оперативного вмешательства. Все пациенты вернулись к приему обычной пищи. Ни в одном наблюдении не отмечено ринолалии. В одном наблюдении у пациента с дефектом переднего отдела твердого неба получен неудовлетворительный эстетический результат — рубцовая деформация средней зоны лица, во всех остальных наблюдениях — отличный эстетический результат.При дефектах твердого неба задней локализации и минимальном или в отсутствие дефекта альвеолярного края верхней челюсти (класс I, a,b по Braun, класс Ia, Ib по Okay, V класс по Armany), а также при дефектах мягкого неба методом выбора является лучевой кожно-фасциальный лоскут. Размеры кожной площадки лоскута могут достигать 6×8 см, что позволяет замещать комбинированные дефекты твердого и мягкого неба, боковой стенки ротоглотки, ретромолярной области. Пластичность лоскута дает возможность реконструировать тотальные дефекты мягкого неба, формируя его в виде дупликатуры.

The paper describes properties of clinical visualization approaches which are applied for detection of sentinel lymph nodes in patients suffering from oral cavity squamous cell cancer. Diagnostic efficiency results and technological features of different imaging techniques are discussed.В данной статье представлена характеристика способов визуализации, применяемых при выявлении сторожевых лимфатических узлов у пациентов, страдающих плоскоклеточным раком слизистой оболочки полости рта. Обсуждаются результаты оценки диагностической эффективности и особенности технологического обеспечения биопсии сторожевых лимфатических узлов.

The paper presents literature review and clinical case of patient with fibromyxoid sarcoma of maxilla illustrating diagnostic difficulties and efficacy of multidisciplinary treatment approach.В статье представлен анализ данных литературы и клинический случай больной с фибромиксоидной саркомой верхней челюсти, иллюстрирующий трудности диагностики данного новообразования и необходимость междисцилинарного подхода к лечению.