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The morphological study of surgical specimens in rectal cancer involves assessment of the quality of mesorectumectomy, examination of serial sections of a tumor growth area, and study of the proximal, distal, and circulatory ends of resection as a criterion for the quality and efficacy of surgery. The circulatory end of resection is regarded as positive when it has tumor cells inside or within 1 mm of it and the performed surgery is unradical. The data obtained with the use of this technology make it possible to most fully estimate the site and extent of a tumor process, to identify a number of important prognostic factors, and to assess the quality of a performed surgical intervention and preoperative diagnosis. The procedure is adapted to the standard technological equipment of morbid anatomy units.

The predictive role of submucosal invasion and metastatic spread to local lymph nodes at early gastric cancer was analyzed. Material from 32 patients was morphologically and immunohistochemically analyzed. The prognostic value of the depth of invasion, tenascin and positive MMP2 and MMP9 staining, proliferative activity and microvascular solidity in the lesion were studied. Watch lymph nodes were detected in 22 patients with the diagnosed early gastric cancer. The method is appropriate only by early cancer and in combination with other macro- and microscopic factors. Its' efficacy was 100% in the group of the early cancer (n=15), whereas in the group with the locally spread cancer the sensitivity, accuracy and specificity were 76, 71 and 100%, respectively. Though larger series are necessary to make definite conclusions about the predictive value of watch nodes in gastric cancer.

Laryngeal amyloidosis is a rare pathology (0.5-1% of all benign laryngeal newgrowths). Five patients with local laryngeal and tracheal amyloidosis were successfully diagnosed and treated endoscopically in the endoscopic department of the P.A. Herzen Moscow Research Cancer Institute in 1987-2007. Videoendolaryngeal operations were performed with application of Nd:YAG laser, argon-plasma coagulation and their combination. The patients were followed up for 15 years maximum. Two most interesting cases of primary local laryngeal amyloidosis with involvement of the upper third of the trachea are presented. Foreign and domestic literature data on diagnosis and treatment of respiratory amyloidosis are reviewed.

Two-stage combined treatment of chronic recurrent papillomatosis of the larynx and trachea has been designed and tested in P.A. Herzen Research Cancer Institute. Stage I of the treatment consisted in endolaryngeal videoendoscopic surgery with Nd:YAG-laser destruction, argon-plasma coagulation and electroresection of the papilloma; stage II - postoperative photodynamic therapy (PDT) to prevent recurrence. In 1995-2007 the treatment was given to 32 patients aged 10-66 years with recurrent papillomatosis of the airways with the disease history 5-58 years. In two thirds of the patients papillomatosis involved several parts of the larynx and trachea. Squamous cell papilloma was accompanied with dysplasia of the first-second degree in 10 (31%) patients, dysplasia of the third degree - in 4 (12,5%), cancer in situ - in 3 (9,4%) patients. Human papilloma virus (HPV) was detected by hybridization in situ in 96%. The course of the treatment resulted in a complete regression (CR) of papilloma in 25 of 32 (78%), partial regression in 7 patients. The recurrence-free interval averaged 32 months (maximal 7 years) in 14 of 25 patients with CR. HPV was eradicated in a group of patients with persistent clinical remission. A 6 to 19 month follow-up recorded papilloma recurrence in 11 patients. The recurrence-free period increased 2,5-fold. In patients with dysplasia of degree I-III and cancer in situ (n=17) CR of dysplasia and preinvasive cancer foci was achieved in 15 (88%) patients.

The study was made of 568 cases of "initial" cancer cases, 825 morphological substrates of the polyps and 90 ones of chronic gastric ulcer. Chronic gastritis was the most frequent precancer disease (88.7% of cases). Malignant polyps accounted for 10.7% and chronic ulcer for 0.6% of cases. Relevant criteria for risk groups are proposed. Severe epithelial dysplasia as a morphological manifestation of gastric precancer can serve a marker of the risk of malignant transformation.

25 cases of advanced stomach carcinoma were studied immunomorphologically with the use of the antibodies panel to the carcinoembryonic antigen and meconian antigen B1, collagen types IV, I and III, laminin, Ki-67, P-105, factor VIII. Secretory and proliferative activity of tumor cells was shown unrelated to histological structure and degree of tumor differentiation. The more was proliferative activity the weaker was the secretory function. Formation of the basal membrane (BM), the degree of collagen formation and angiogenesis in the tubular adenocarcinoma did not depend on the differentiation level and the degree of tumor cells secretory activity. On the contrary, carcinoid component was characterized by pronounced angiogenesis and tendency to correlation between the degree of differentiation and the degree of BM formation. Stomach carcinoma is a heterogeneous group of tumors whose various morphological features may have an independent prognostic value.

The results of treatment of 394 patients with gastric cancer were analysed to compare the effectiveness of surgical and two variants of combined treatment (preoperative irradiation with intensive-concentrated IKK method and dynamic DFD dose-fractioning). The advantages of combined treatment over surgical treatment are demonstrated. The 3-year survival in the combined treatment is 70.2%, in surgical treatment 34.5 +/- 6.2%. The advantages of SDF preoperative irradiation over IKK irradiation are revealed, that is proved by the increase of the 3-year survival rate (76 vs. 56.7%), and decrease in the rate of recurrence from 50 to 27.3%. The addition of metronidazol leads to increase of anticancer effectiveness, that is proved with the examination of tumor pathomorphosis and the rates of survival.

The analysis of 49 cases of T1 initial signet-ring cell carcinoma of the stomach showed the intestinal differentiation to be a main type of differentiation making doubtful Lauren's classification of the stomach carcinoma. This differentiation proceeds in various directions as indicated by the presence of different types of mucins, antigens and endocrine granules. The presence of the endocrine granules and characteristic structural arrangement allow singling out neuroendocrine tumours (24.5%) from the group of signet-ring cell carcinomas. It is emphasized that thorough morphological preoperative control is necessary in the choice of treatment.

129 cases of non-malignant gastric lesions and 171 cases of gastric carcinoma were studied immunohistochemically for pepsinogen C. PgC was constantly expressed at the bottom of the gastric glands irrespective of the disease. PgC was much more frequently observed in cancer patients (p < 0.001). PgC-positive were carcinoma tissues (38%), particularly of the intestinal type (53.4%), but also in mixed (40%) and diffuse (15.5%) types. PgC-negative carcinomas were more frequently observed in combination with PgC-positive areas of the surface epithelium (p < 0.001) and intestinal metaplasia (p < 0.05). PgC-positive dysplastic foci were observed in both groups of PgC-positive and PgC-negative malignant tumours.

On the basis of analysis of the histological structure of 1,095 polypoid and nonpolypoid tumors, the frequency of detection of "primary" carcinoma and its clinical and histological features were studied. It is shown that one third of pTI category carcinomas are devoid of signs of a preceding adenoma. Polypoid primary carcinomas account for only 15.8% of cases. The prevailing plaque-like, flat, and ulcerated tumors invade the submucous layer more frequently than malignancy adenomas of the corresponding size and produce metastases to the lymph nodes more frequently. The tumor develops against the background of precancerous and dysplastic changes in the epithelium in the nonpolypoid mucosa and in the adenomas. The indications for economical operations in primary carcinoma, in distinct from those in malignancy adenomas, should be determined with caution.

Morphology of the neuroendocrine stomach tumours, including carcinoid tumours (CT) and so-called carcinoids of complex structure is studied (189 tumours of patients operated in the Institute), 164 tumours are studied using routine histological methods including Grimelius methods. Immunophenotyping with the use of antibodies to VIII type keratin, carcinoembryonic antigen, meconial intestinal antigen B1MA, Factor VIII, IV-type collagen and laminin were performed in 25 cases. Neuroendocrine carcinomas represented a group of 86 tumours (45.5%), 28 (14.4%) of them were carcinoid tumours and 58 (30.7%)--complex carcinoids. Among CT, moderately differentiated tumours predominated (18), 4 tumours were poorly differentiated and there was a combination of structures in 6 tumours. The conclusion is made that neuroendocrine stomach carcinomas are epithelial tumours with a complex functional differentiation manifesting in different types of secretion: neuroendocrine and non-endocrine characteristic of stomach epithelium.

The expression of pregnancy-specific beta-1-globulin (SP1) was studied in cancer-affected and nonaffected colon mucosa. The antigen was revealed in 19 out of 50 (38%) cases of carcinoma and in 1 out of 4 cases of ulcerative colitis. SP1 was found neither in noncancer colon mucosa nor in transitional mucosa and adenomas. The antigen was detected in the epithelium and stromal macrophages of carcinoma. SP1-positive cells were located mainly in the sites of tumor invasion. The results allow considering SP1 the tumor marker suitable for immunohistochemical diagnosis of colon cancer.

The oncological substantiation of endoscopic and economical surgical treatment of T1N0-1M0 gastric carcinoma in 46 patients was appraised. The results were studied with due regard for the peculiarities of early gastric carcinoma (EGC) revealed in 290 patients after standard surgical management. It was established that organ-preserving treatment of ECG is possible--5-years survival was 96.2%. Endoscopic removal can be considered radical only in T1P1 tumors without invasion of the lymphatic vessels of the wall and was of a multistage character in 86.2% of cases. Careful surveillance after its completion is necessary. Surgical treatment in indicated in repeated recurrences; they were encountered in 44.8% of cases. The causes of the recurrences were noncoincidence of the macroscopic and histological boundaries of the tumor (33.6%), multicentric growth (30.4%), and invasion of the submucosa. Metastases are encountered in the lymph nodes in 9.1% of cases in economical treatment. In T1N0-1M0P1-2 carcinoma, absence of multicentric growth, and III degree dysplasia in the surrounding mucosa (reflecting increased risk of multicentric growth) the volume of organ resection may be limited on condition that P1 lymphadenectomy is performed. The results of organ-preserving treatment are comparable with those of surgical treatment conducted in a standard volume.

The expression of specific-pregnancy beta 1-globulin (SP1) was studied in gastric mucosa with chronic gastritis. The expression of SP1 was revealed in focus of intestinal metaplasia, dysplasia as well as in cover epithelial cells.

An indirect immunofluorescent method with polyclonal antibodies to thymidine was used to assess the proliferative activity (PA--percent of cells in the S-phase of the cell cycle) of 79 stomach tumors from primary cancer patients. Stomach cancer PA was shown to vary from 0.1 to 69.7%. PA did not depend either on a tumor size or a degree of the involvement of regional lymph nodes. The mean PA of well-differentiated adenocarcinoma was slightly lower (14.9 +/- 4.7%) than that of low differentiated ones. Of 79 patients a tumor process was interpreted as a resectable one in 62. They were given preoperative irradiation at a total focal dose of 36 Gy followed by operation. In addition to initial investigation PA in tumor biopsy specimens was assessed after delivering a dose of 12 Gy. PA changes at the beginning of a course of irradiation were compared with a degree of a radiation injury of tumor tissue after a course of irradiation was discontinued in 32 (explorative laparotomy was performed in 30). It was shown that tumor radioresistance could be predicted in unchanged PA indices of their increase at the beginning of a course of irradiation with the probability of 95%.

Multifactorial statistical analysis was used to identify differential diagnostic cytological features of glandular hyperplasia, atypical hyperplasia and well-differentiated adenocarcinoma of the endometrium. Twelve cytological features were identified for calculating linear discriminant function. The effectiveness of the diagnostic algorithm depends upon the diagnostic value of the sample and proficiency of the cytologist.

The expression of CEA was studied with the help of rabbit antibody and CEA-specific lectin-krustacin in pepsinogen positive gastric glands near carcinomas and in gastric mucosa with intestinal metaplasia and dysplasia of the epithelium without neoplasia. CEA-krustacin was revealed in 20 out of 41 cases and CEA-antibody in 2 out of 41 cases of gastric glands in mucosa near carcinomas. The results of investigation discover the development in the gastric glands near carcinoma subcellular components. Paraneoplastic phenomenon was found in the majority of the cases.

Morphological characteristics of endometrial precancerous changes (dysplasia) are given with special reference to the degree and the direction of differentiation (endometrial, metaplastic). On the basis of these data the signs of endometrial carcinoma are standardized.

The location of embryonic prealbumin (EPA) was investigated by indirect immune peroxidase test in gastric mucosa: 16 cases of chronic gastritis without malignant tumour and in 48 cases of gastric carcinoma. EPA in the mucosa was found in 35% cases of carcinoma outside the tumour and 31.3% cases of mucosa without tumour. The highest expression of EPA was found in stromal component of hyperplastic polyp without malignancy. Comparison of EPA and carcinoembryonic antigen in tissue did not reveal the presence of correlation between these oncofetal markers. Most likely this antigen is of a reactive nature and it can not be used for the evaluation of the probability of gastric mucosa malignant transformation.

Electron microscopic examinations of pleomorphic adenoma tissue showed epithelial and myoepithelial cell elements to take part in morphogenesis of both epithelial and "mesenchymal" zones. The epithelial component of pleomorphic adenoma is represented by cells showing signs of structural-functional differentiation of the squamous epithelium,, epithelium of terminal secretory parts of the salivary gland, and myoepithelial cells. The "mesenchymal" component is also represented by myoepithelial and epithelial cells. Differences in the structure of the epithelial and "mesenchymal" components are due to the pattern of arrangement and the functional status of the cells rather than to the set of the cell forms. A slow growth of the tumor and the marked functional activity of myoepithelial cells result in the accumulation of the substance of basal membranes released into the intercellular space, separation of the cells and degenerative changes in them. The results of ultrastructural examinations confirm the theory of the epithelial genesis of salivary gland pleomorphic adenoma. In this connection it sould be acknowledged that the term "mixed tumor" does not relate the essence of this neoplasia because the point at issue is a tumor of epithelial nature, whereas the term "pleomorphic adenoma" recommended by the WHO is more acceptable and emphasized the epithelial origin and heterogeneity of the cell composition and structures of the tumor.

Normal gastric mucosa and that in atrophic gastritis was studied by indirect immunoperoxidase method. Intestinal antigens CEA and beta 1MA were found in the foetal stomach and in the foci of intestinal metaplasia with and without dysplastic epithelial changes. Gastric antigens, pepsinogens of the foetal and 2-nd type, were found in foetal and adult stomach, as well as in the foci of intestinal metaplasia with dysplastic changes. The discovery of concomitant presence of gastric and colonic antigens in the dysplastic epithelium may indicate the existence of pluripotent stem cells capable of differentiation in the direction of gastric glandular epithelium, and in the direction of enterocytes. The possibility is suggested of origination of gastric carcinoma of different histologic structure from intestinal metaplasia with dysplastic changes.

The article presents results of investigations of 207 case records and protocols of autopsies of deceased patients who suffered from breast cancer, covering the period from 1953 to 1972 (materials of the USSR AMS Oncological Research Centre). It was established that in 154 patients (74.4%) the cause of death was the progress of the main disease, the most common and "typica" causes of death being pulmonary-cardiac, renal insufficiency (as a result of metastatic lesions of the above mentioned organs) and complications associated with metastases of breast cancer in to the brain and its meninx. In 39 patients (18.8%) the cause of death was directly associated with therapy complications, 14 patients died of diseases not connected with carcinoma of the mammary gland. The structure of causes in the group of deceased patients who when alive suffered from cancer of the mammary gland and who survived 10 and more years from the moment of establishing the diagnosis and carrying out primary treatment (11 observations) was found to be the same as that for the whole group of observations.

Altogether 217 phyllode tumours, 28 sarcomas and 5 carcinosarcomas of the mammary gland have been studied in the Institute from 1946 to 1980. Three structural variants of phyllode tumour are distinguished: 1) early stages of formation, 2) classical phyllode tumour, 3) phyllode tumour with sarcomatous stroma. 20 out of 28 sarcomas are linked with phyllode tumours while the morphogenesis of primary sarcomas, which are characterized by a more malignant clinical course, remains unclear. When studied electron-microscopically, classical phyllode tumour reveals marked and peculiar vascular proliferation which not infrequently coincides with cellular stroma. Various directions of functional and structural differentiation of stromal cells are observed. The alternation in the tumour of areas with different morphology found in light microscope is reflected by the dependence of the structure of intercellular substance upon the type of stromal cells observed electron-microscopically.

The paper covers a number of morphogenetic problems of endometrial cancer with reference to multidirectional differentiation of the uterine epithelium affected by tumor. Metaplastic changes of the endometrium observable in three basic variants (tubal, endocervical, squamous cell) can entail dysplasia with resultant malignant transformation. Endometrial cancer shows complex structure of the tumor with sings of multidirectional epithelial differentiation: endometrial, tubal, endocervical, squamous). Morphological features of the tumor and adjacent mucosa, assessed comparatively, suggest a close relationship between the direction of endometrial epithelium differentiation and the new growth histological structure.

Immunologic techniques were used to examine localization of the intestinal antigen beta-2-MA in 87 cases of malignant gastric tumors and 25 cases of non-neoplastic diseases of the stomach. The antigen was identified in 46.4% of gastric carcinomas. The presence of the antigen was not found to be related to a histological type of cancer. The beta-2-MA antigen was detected in the areas of intestinal metaplasia alone in 48% of the cases and in combination with malignant tumors in 50.9%. The antigen was found to be more common in the mucosa adjacent to those of diffuse cancer than in the mucosa located around cancer of intestinal type (p less than 0.01). beta-2-MA is one of the antigens showing intestine-differentiated cells in a number of gastric tumors and may be useful for immunological studies of gastric neoplastic types.

58 human tumors have been studied immunohistologically with the aid of CEA-specific precipitin--crustacin (Cr). The results were in general similar to those which were achieved with anti-CEA-antibodies. But there were some differences. The reaction with Cr in the cytoplasm was mostly diffuse, while the reaction with Ab was localized usually in the peripheral parts of the cytoplasm. The reaction with Cr has a more restricted character and is more expressed in ovarian tumors and less expressed in gastric and colonic tumors than the reaction with Ab.