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This review is aimed at the analysis the current state of acral lentiginous melanoma. This tumor has rather aggressive course and is the main cause of death in skin cancer patients. In Russia the incidence of melanoma during the period 2000-2010 increased from 3.18 to 3.95 cases per 100000 of population. The average annual growth rate was 1.99% and the total growth rate was 21.81%. Although skin melanoma is a visual tumor, more than one third of patients visit oncologists at advanced stages of the disease. Primary melanoma with localizations on the skin of fingers, interdigital spaces, soles, palms and nail plates is especially difficult for early diagnostics.

Gemistocytic astrocytomas (GA) are a variant of diffuse astrocytomas GII (WHO, 2016). Like all diffuse astrocytomas, GA recur with time, which is often accompanied by malignant degeneretion into the anaplastic astrocytoma GIII or to the secondary glioblastoma GIV. However, the progression-free survival and overall survival in patients with GA is less than in patients with diffuse astrocytomas. Given that this group of patients, according to the WHO classification (2016), is classified as GII, patients with GA usually do not receive comprehensive treatment. We have conducted a thorough analysis of research on this problem for the period from 1956 to 2017. Differences in the histological pattern, immunohistochemical and molecular-genetic profiles, survival of patients with GA and diffuse astrocytomas GII are shown there. A clinical case of a patient with transformation of a diffuse astrocytoma in GA (GIII) and then into a secondary glioblastoma is presented.Гемистоцитарные астроцитомы (ГА) - это вариант диффузных астроцитом GII (ВОЗ, 2016). Как и все диффузные астроцитомы, ГА рецидивируют со временем, что часто сопровождается их злокачественным перерождением в анапластическую астроцитому GIII или во вторичную глиобластому GIV. Однако безрецидивный период и общая выживаемость больных ГА меньше, чем у пациентов с диффузными астроцитомами. Учитывая, что данная группа больных, согласно классификации ВОЗ (2016), относится к категории GII, пациенты с ГА, как правило, не получают комплексного лечения. Нами проведен тщательный анализ исследований по этой проблеме за период с 1956 по 2017 г. Показаны отличия в гистологической картине, иммуногистохимическом и молекулярно-генетическом профиле, выживаемости пациентов с ГА (GII и GIII) и диффузными астроцитомами GII. Представлен клинический случай трансформации диффузной астроцитомы в ГА (GIII), а затем во вторичную глиобластому.

Primary fallopian tube carcinoma (PFTC) is a rare gynecological malignancy accounting 0.14-1.8% cases. The purpose of the study was to assess clinical, morphological and immunohistochemical features of PFTC. All the cases of PFTC were detected during 1980-2005. 31 cases of PFTC were analyzed as to Ki-67, HER-2 expression, estrogen receptors (ER), progesterone receptors (PR), grade and stage. 69 cases of PFTC were detected with an average age of 55, 6 years (range 21-73 years). Stage I detected in 34.2% cases, Stages II and III--32.8%, Ca in situ--10%. Among 31 patients ER were positive in 75% (n = 23), PR were positive in 46% (n = 14): ER+PR+ in 12 (38%) cases, ER+PR- in 11 (36%) cases, ER-PR+ in 2 (6%) cases, ER-PR- in 6 (19.4%) cases. Only 2 cases were HER-2 positive with ER+PR+ and ER-PR- status. Ki-67 labeling index (LI, %) values ranged from 15 to 95% (median 60) with average rate 58.03% +/- 4.08. Ki-67 LI valuesor = 60% were graded as high and60% as low. We did not find any significant differences in Ki-67 LI values among tumors of various Receptor Status. However Ki-67 L160% was associated with poor 5-year survival (14%), vs 75% in Ki-67 L160%. Primary fallopian tube carcinoma is mainly HER-2 negative, receptor positive in 79.6%. Ki-67 rate is irrespective of ER PR status. However the level of Ki-67 (60%) was a significant survival prognostic factor.

Mezonefric cervical cancer was more prevalent in younger women (mean age 42.2 +/- 1.2 years) with no classic predisposing factors. In most cases (62.1%) the localized stage of the disease (I, II stages) dominated. Regional metastases correlated with depth of tumor invasion (with a depth of invasion of more than 10 mm--57.8%). There was marked low expression of HER2/neu (only in 1 of 14 samples it was revealed light positive reaction. Proliferation index Ki-67 was 37.5% and the signs of mutation in the p53 gene were found in 28.4% of cases. Estimating that two thirds of patients with clear-cervical cancer revealed localized forms of the disease, and that most of the women had received the combination treatment (51.8%)--a 5-year survival rate was quite high and was 79.3%.

The locally advanced cancer of thoracic esophagus was treated by induction chemo-irradiation therapy (IHRT) with intraluminal medium dose-rate brachytherapy (IMBT). From July 2009 to February 2012 twenty five patients (mean age 54.3 +/- 1.3 years) were included in the study. The length of the primary tumor was up to 6 cm in 10 pts and more than 6 cm in 15 pts. Induction therapy consisted of three IMBT sessions (7 Gy X 3; q7d) and two cycles of chemotherapy (PF; q28d), 26-31 days later the surgery was performed. Subtotal resection of the esophagus type of I Lewis was performed in 23 pts, transtracheal extirpation of the esophagus was performed in 2 pts.In all the cases 3F lymphodissection was performed. After IHRT in 15 of 25 pts. was obtained complete or partial response, in 10 of 25 pts was obtained disease stabilization. Perioperative complications occurred in 17 (68%) patients receiving conservative treatment, one patient (4%) died of treatment complications. In 6 cases (24%) morphology had shown the complete regression of primary tumor. Thus, the combination of intraluminal medium dose-rate brachytherapy and chemotherapy lead to reduction of primary tumor local spread and can be an efficient factor in improving the results of surgical treatment.

Wide-range research in the efficacy of neoadjuvant therapy of breast cancer has been conducted worldwide for over two decades. Promising end results have been reported on completion of clinical and pathomorpologic response. It has become a standard practice in managing relatively operable and inoperable breast cancer. However, preoperative chemotherapy in operable disease is still a subject of discussion. For many years anthracycline-based treatment has remained a therapy of choice in the neoadjuvant setting. Higher efficacy of its combined use with taxotere and anthracycline was demonstrated. It was followed by higher rates of complete pathomorphologic response and survival. Besides, regimens using taxotere and target therapies are being investigated. Tentative results suggest that better survival may be achieved due to decreased toxicity profiles.

Radiochemotherapy is leading the universal research effort in fighting lethality: it is improving relapse-free survival of patients with inoperable glioblastoma, the most pernicious brain tumor in adults. Its effectiveness was found to depend on expression of Mgmt gene of tumor DNA reparation following radiochemotherapy and adequate medication based on the molecular phenotype of tumor. Our study involved a 40-year old male with a low level of Mgmt gene expression as established by stereotactic biopsy. The patient received hypofractionated three-dimensional conformational proton therapy with the benefit of temozolomide (140 mg/24 hr). Subsequently, the dose was raised to 360 mg/24 hr, on days 1-5 of the cycle. Contrast-enhanced MRI examination established significant diminishing of the size of tumors on completion of cycles 7 and 8; patients felt better, memory and blood indices improved. As of the time this paper was written, relapse-free survival was 17.5 months, as compared with the literature data on inoperable glioblastoma--5.5 months.

Three hundred and thirty-six cases of clear-cell renal carcinoma (CCRC) were examined for epidermal growth factor receptor (EGFR) mutation: exon 19 deletion and L858R mutation in exon 21 of the EGFR gene. The expression of Ki-67, bcl-2, p53, and estrogen receptors alpha was studied in CCRC with EGFR mutation. There were 4 cases of CCRC with EGFR exon 19 deletion. The frequency of EGFR gene mutations was 1.2%. L858R missense mutations in exon 21 of the EGFR gene were absent. In CCRC, EGFR gene mutation (exon 19 deletion) was detected in 3 men and 1 woman with an age range of 50 to 60 years and Fuhrman differentiation grade 2 or 3. The Ki-67 index varied from 4 to 23%. The expression of bcl-2 and p53 was negative. A moderate estrogen receptor alpha expression was revealed in 1 of 4 cases.

Two hundred and two lung adenocarcinomas were examined for epidermal growth factor receptor (EGFR) mutation: exon 19 deletion and L85R mutation in exon 21. The expression of EGFR, Ki-67, bcl-2, p53 in the lung adenocarcinomas was studied in relation to the type of EGFR mutation. Lung adenocarcinomas harboring the EGFR L858R mutation in exon 21 have a less proliferative activity than those with EGFR mutation in exon 19 and in those without EGFR mutation. The p53 protein expression was higher in a group of adenocarcinomas having the EGFR L858R mutation than in that of adenocarcinomas with EGFR mutation in exon 19. There was no bcl-2 expression in adenocarcinomas showing the EGFR mutation.

The paper discusses morphologic and immunohistochemical characteristics of sclerosing perineurioma. Generally, it is well circumscribed and consists of tiny spindle-shaped plump epitheloid cells embedded in collagenous hyalinized matrix. Immunohistochemically, it was represented by EMA+, S-100, AE1/AE3, CAM 5.2, smooth muscle actin and desmin. Being benign, tumor was identified by differential diagnosis using fibroma of tendon sheath, sclerosing one, glomal tumor, giant cell tumor and sclerosing epitheloid cell sarcoma.

A long-term (15 years) investigation of risk factors of locally-advanced recurrences of breast cancer following organ-saving surgery was carried out involving a large number of cases (667). It was shown that tumor size larger than 2 cm (T2), presence of intraductal component (EIC+), high grade (III), lymph node involvement (pN+), multicentricity and positive wound edge contribute to risk of such recurrences by 10-15%.

The paper describes a rare case of a stromal tumor of the esophagus in a 68-year-old male who was initially diagnosed as having esophageal leiomyoma after biopsy and study of a surgical material. Stromal tumour could be diagnosed by immunohistochemical (positive expression of oncomarkers; CD117, CD34, vimentin, CD99, and GFAP) and molecular genetic (real-time PCR) studies. This case confirms that it is necessary to use an immunohistochemical study in patients with spindle-cell tumors of the gastrointestinal tract.

The paper describes a case of cystic papillary glioneuronal tumor of the temporal lobe in an 18-year-old girl. It is shown that in addition to the characteristic histological pattern, the diagnosis of this rare neoplasm recently included into the WHO classification text s should be verified by the immunohistological evidence suggesting the coexpression of glial and neuronal markers.

Central nervous system (CNS) tumors cannot be, for a number of reasons, organically included into the existing tumor classification system - TNM. This hampers the registration and systematization of CNS tumors, the acquisition of valid data on their prevalence, and the organization of treatment in patients with CNS tumors. A variant of a classification of CNS tumors is proposed, which takes into account the specific features of this group of neoplasms.

Statistical analysis of 333 case histories has established main prognostic factors and their combinations determining general and recurrence-free survival of patients with locally spread rectal cancer. The one-factor analysis considered gender, age, prevalence degree, histological type of the tumor, operation volume, the presence of postoperative complications, non-adjuvant and adjuvant radiation therapy, chemotherapy, chemo-radiation therapy. Total survival in men was 51.3%, in women - 50.0% (p0.05). In patients with local spread of rectal neoplasias the disease has systemic character and requires, when algorithm of treatment was determined for each patient, imperative use of schemes of combined and complex treatment including many components, since the surgical treatment only can not give satisfactory results.

There is a great variety of histological patterns of skin melanoma and, in particular, that of its metastatic patterns. Malignant melanocytes are capable of influencing tumor-associated antigen expression. As of now, several varieties of melanoma-associated antigens (MAA) have been identified: MART1/melan A, tyrosinase, MITF, gp100, members of MAGE family, S100, CD63 and CD146. Peptides isolated from such molecules can induce MHC-restricted response of cytotoxic T-lymphocytes. It has been shown that level and nature of specific antigen expression caused by melanocytes correlate with tumor stage and a relationship between survival and MAA expression on tumor cells identified. Morphological features, growth pattern and proliferation rate varied in melanoma cell cultures used in our study. Our experiments involved evaluation of changes in the properties of antigens HLA (class 1 and 2), tumor tissue samples and cells isolated from them, which were capable of stable proliferative activity during passages 5, 10, 15, 20, 25, 30 and 35, and assay for MAA content. Levels of the antigens were significantly lower following long-term culturing melanoma cell melanoma cells in vitro. At initial passages (1-5), antigen profile in most cultures was similar to that in tumor tissue samples. Later on each cell population showed greater antigen expression heterogeneity matched by increased number of cells going through mitotic cycle; their nuclei were stained with antibodies to Ki-67. No HLF A/B/C molecule expression took place during tumor cell culturing: stained cells--in 68.9% of cultures (passages 1-5) and 36.3% (passage 35). However, HLA DQ/DP/DR molecule identification showed an inverse relationship: 44.1% (passage 5) while virtually all the cell lines did synthesize those molecules after passage 35. Hence, MAA and MHC (class 1 and 2) antigens expression in tumor cell should be monitored when they are used for preparation of autologuos and allogenic vaccines. In case of allogenic vaccine production, cell lines capable of stable production of MAA should be selected.

Tissue precursors and genesis of female reproductive tract carcinoma vis-a-vis its carcinomatous and sarcomatous patterns remain unknown. To determine the clonal origin of 17 female reproductive tract carcinomas, such molecular, genetic and immunohistochemical techniques as PCR-SSCP and/or denaturing gel electrophoresis for K-ras, p53 and PTEN genes; D17S786, CHRNB1, TP53, BAT26 and BAT40 microsatellites and immunostaining for p53 protein were used. Carcinomatous and sarcomatous components were studied separately. Eight tumors were assumed to be monoclonal (combination or conversion tumors), while one--of an obscure origin. Our results suggest that carcinosarcomas were characterized by chromosomal instability. Moreover, it was shown that it is necessary to combine immunohistochemical techniques with a battery of methods including genetic ones to determine clonal origin of immunologically--stained carcinosarcomas.

Renal oncocytoma is a distinct benign tumor accounting for approximately 3-5% of all renal tumors. This neoplasm is easily recognizable in its classic form: there are polygonal cells with abundant granular eosinophilic cytoplasm filled with mitochondria. The tumor cells are arranged in nests and tubular pattern. Here, 1 case of renal oncocytoma with a domination of small cells is reported (the so-called "oncoblasts") arising in elderly woman. These small cells have scant cytoplasm, dense hyperchromatic nuclei, and a high nuclear/cytoplasmic ratio. The term "small-cell variant of renal oncocytoma" was proposed for these cases. The unusual extensive small-cell component of the tumor may represent a potential diagnostic pitfall for primary or metastatic malignant small cell tumors.

7 cases of pituitary adenomas with the pronounced signs of invasive growth, confirmed by MRI, clinical and intraoperative observations. Invasive growth of adenomas was related to neither the structure of the tumor, the degree of anaplasia, or the nature of a generated hormone.

Research was conducted on 26 adult outbred male and female mice, which were implanted with nickel-titanium wire in the paravertebral zone. The tissues surrounding the implants were studied macroscopically and histologically 2-8 months after the implantation. It was found that the morphological changes of tissues after nickel-titanium wire implantation were detected by microscopical study at the time intervals greater than 2 months after the operation. They included the formation of a thin connective tissue capsule in close vicinity to the implant. No signs of reactive changes in the distant tissues and organs were detected. It is concluded, that the nickel-titanium alloy possesses high degree of biological inertness and may be used for making fixating devices with the memory of mechanical shape that are employed in cranioreconstructive surgery.

The paper analyzes the outcomes of intravascular treatment in 87 patients with cerebral aneurysms with separable a balloon catheter with a valve device. In the cold and hemorrhagic periods, mortality rates were 6.4 and 40%, respectively. The postoperative follow-ups lasted 1 to 17 years (mean 7.7 years). Recurrent subarachnoidal hemorrhage (SAH) was noted in 6.5% of cases, with not earlier than 4.5 years after intervention. The remaining patients (even with partial aneurysmal occlusion) had no recurrent SAH.

Vascular anomalies of the spinal cord were studied in 49 patients. Thirty-three cases were morphologically studied (30 cases presented with operative findings and 3 cases with autopsy material). The anomalies presented as defects of vascular genesis without signs of blastomatous growth (venous and capillary-venous malformations, arteriovenous anastomose and fistulas, varicosis of the spinal cord, etc. located in the spinal cord, its roots, coats, adjacent fat, and vertebra which affect the spinal cord, roots or vessels participating in their blood supply and venous outflow. In 41% of the cases, the above anomalies were associated with congenital anomalies of other systems and organs. The anomalies are clinically characterized. Specific signs are given to differentiate them from their intracranial analogues. Recommendations are given on pathological examination of the content of the vertebral canal in vascular anomalies.

242 cases of brain arterio-venous malformations (AVM) are analysed clinically and anatomically. Their pathology, histological, ultrastructural and immunohistochemical characteristics, therapeutic pathomorphosis are described. The concept is suggested according to which AVM is a collective term including true developmental defects, dysembryogenetic tumors and outcomes of various pathologic processes (trauma, brain circulation and compensatory-adaptive disturbances, etc.). The necessity of therapeutic methods corrections in agreement with the disease pathogenesis is outlined.

This paper presents a case with 11-year history of disseminated cerebral polycystosis in a 23-year-old female. Physical examination and CT, MRT, histological and biochemical data suggest that the disease is morphologically progressive; however, the spread on brain lesions showed no correlation with relatively mild clinical manifestations of the disease. Variants of nosological interpretation of histological data are discussed.

The author's classification of vascular malformations in the central nervous system is presented approved by neurosurgeons, pathologists and in forensic medicine. The description of the cavernous angiomas pathology is given showing possibility of their radical surgery. The notion of micro-malformation is formulated. The pathogenetic concept of Sturge-Weber disease with recommendations for the clinics is given. The author's model of the malformation morphogenesis in the vessels of the central nervous system is presented and the ways for the decrease in the incidence of these malformations are indicated.

The characteristics of colour TV system made on the basis of microscope MBI-15 with the use of imported details are presented. The system can be used for clinico-anatomical conferences, scientific lectures, in teaching, and allows to avoid laborious preparing of colour slides. The design made it possible to keep information (images) in form of figures (for example, by means of a personal computer) and video-cassettes. This may be used in computer morphometry and quantitative analysis in histochemistry.

Analysis of the brain circulation and consequences of the intravascular surgery in a woman of 22 with a combined pathology--a primitive trifacial artery with an arteriovenous brain malformation--are presented. The arteriovenous malformation was cured surgically with the use of polystyrene emboli some of which penetrated through the primitive trifacial artery into the branches of carotis interna. The possibilities of the above combinations should be taken into consideration when the method of the intra-vascular surgery is to be chosen.

Clinico-anatomical characteristics of 9 intracranial cavernous haemangiomas (CH) are given, 7 of them being found in the brain and 2 in the arachnoid membrane. The average age of patients with clinical manifestations of CH was 23.5 years. The emphasis is made on the appearance of the first CH symptoms in the females during the gestation, delivery or on the oestrogen treatment. The blood supply of CH is shown to be brought about from the small vessels on their periphery. The role of concomitant intracerebral cysts as an additional symptom is underlined. 6 clinical variants and 2 histologic types (typical and atypical) are distinguished. The suggestion about general embryogenetic roots of all intracranial angiomatous vascular malformations is put forward. CH, in spite of difficulties in their clinical diagnosis, are, as distinct from other vascular malformations, favourable object for the radical surgical treatment.

The authors describe a case of angiographically verified arteriovenous shunting of the cerebral blood flow coupled with basal ++meningo-cerebral developmental abnormality and paraganglioma of the glomus jugulare in a 52-year-old patient. Such a unique combination made it possible to suggest the existence of potential mechanisms of blood flow shunting either via tumorous vessels or vessels (arteriovenous shunts) of the basal ++meningo-cerebral developmental abnormality. In the latter case, the shunts were likely to occur latently while the clinical manifestations of the disease might be related to the tumor growth, impairment of the venous outflow and disclosure of arteriovenous shunts.

Morphological changes in the vascular malformations of pia mater and neighbouring parts of the brain surgically removed in 9 patients with Sturge-Weber syndrome were studied light- and electron-microscopically. On the basis of the results obtained the concept of Sturge-Weber syndrome pathogenesis is formulated. According to this concept the disease develops due to the brain hypoxia resulting from the long-lasting congestion in the pia mater with angiomatosis. Respectively, the surgical treatment of the disease is founded and the necessity of such a treatment at young age is outlined. The authors' own data on the nearest (up to one year) and remote (up to 15 years) results of such treatment are presented.