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Introduction. Gestational trophoblastic neoplasias are rare tumors, which consist of about 1% of gynecological cancers. High rate of diagnostic and treatment mistakes leads to late diagnosis, metastatic appearance, resistance to chemotherapy, poor prognosis. Aim. To demonstrate possibilities of 18F-FDG PET/CT to find resistant lesions of gestational trophoblastic neoplasias. In the article, we analyze several medical reports to illustrate advantages of 18F-FDG PET/CT for evaluation of resistant gestational trophoblastic neoplasias.

The purpose of the study: to present an experience of the N. N. Blokhin Russian Cancer Research Center in the treatment of relapses of gestational trophoblastic neoplasias (GTN). Materials and methods. We performed a retrospective analysis of medical case histories at the N. N. Blokhin Russian Cancer Research Center from 1996 until 2019. 545 patients with GTN were treated. Relapses occurred in 25 (4.6%) patients: 8 (2.1%) patients with low risk of resistance (6 (75%) early relapses and 2 (25%) late relapses) and 17 (10%) patients with high risk of resistance (11 (65%) early relapses and 6 (35%) late relapses). Treatment of relapses was done by standard chemotherapy regimens (Dactinomycin 500mcg in days 15, EMA-CO, EMA-EP). Different surgical interventions and radiosurgery were used in some cases additionally. Results. Out of 6 patients with early relapses of low-risk GTN, 5 were cured with chemotherapy and one patient by lung resection only. Two patients with late relapses of low-risk GTN were cured with chemotherapy (EMA-CO) and hysterectomy/resection of uterus to achieve complete remission. As a result, all patients with relapses of low-risk GTN were cured, mainly (88%) by chemotherapy. Among 11 patients with early relapses of high-risk GTN, complete remission was achieved in 6 (55%) cases: in 2 patients as a result of EMA-EP chemotherapy, other patients needed combined approaches (chemotherapy + surgery). Three patients with recurrent course continue treatment, two patients died of progression. Of the 6 patients with late relapses of high-risk GTN, 4 (66%) patients were managed mainly through combined treatment (surgery + chemotherapy) and were cured. One patient continues treatment for more than 4 years, and one patient died of progression. In total, out of 17 patients with high-risk relapses, complete remission was achieved in 10 (59%) as a result of combined treatment in the majority of cases (80%). Conclusion. The optimal method of treatment for patients with relapses of low-risk GTN is chemotherapy; and for high-risk GTN combined approaches (chemotherapy + surgery)

The training module was developed by the staff of the department under the leadership of the head. Department of Academician of RAS, Professor I.V. Poddubnoy and Rector of FSBEI DPO RMANPO of the Ministry of Health of Russia, Corr. RAS, Professor D.A. Sychev.

Objective. To compare the immediate and long-term results of laparoscopic and open radical nephrectomies in renal parenchymal tumors.Subjects and methods. The study covered 195 patients who underwent nephrectomy in 1986 to 2006. Their median age was 54,1 years; male/female ratio was 1,5:1. All the patients were divided into 2 groups. A study group comprised 102 (52,3%) patients with renal tumors, including 93 (91,2%) with renal-cell carcinoma (pT1-3N0-1M0-1) and 9 (8,8%) with benign tumors, who had undergone laparoscopic nephrectomy. Ninety-three (47,7%) patients who had undergone open radical nephrectomy for localized renal cancer were retrospectively selected for a control group. The median follow-up in the laparoscopic and open surgery groups were 19,6±13,2 and 62,3±35,9 months, respectively.Results. The median time of laparoscopic nephrectomy was significantly more than that of open surgery (170 and 100 min, respectively; p < 0,001). The median blood loss volume did not differ in the groups (280,1 and 283,5 ml, respectively; p = 0,342). In the study and control groups, the frequency of intraoperative complications was 10,9 and 4,3% (p = 0,075) and that of postoperative ones was 10,8 and 7,5%, respectively (p > 0,05). In 8 (7,9%) cases, conversion was required to suture defects of large vessels. In the laparoscopic group, the median length of stay was significantly less than that in the control group (7,0±3,6 and 12,0±3,1 days, respectively; p < 0,001). The differences were insignificant in the average cost of endoscopic and open surgeries. Questionnaire survey revealed a significant improvement in the quality of life after surgery via laparoscopic access. Relapses were detected in 2 (2,2%) patients from the study group: a local recurrence in 1 (1,1%) patient and metastases in 1 (1,1%); and in 5 (5,4%) control patients: metastases in 4 (4,3%), local relapse and distant metastases in 1 (1,1%; p = 0,271). In renal cancer patients undergoing laparoscopic and open nephrectomies, overall, specific, and relapse-free 4-year survival rates were 100; 100, and 94,9% and 96,4, 97,5, and 96,2%, respectively (p > 0,05).Conclusion. Laparoscopic nephrectomy is the method of choice in treating renal cancer — pT1—3aN0M0, which yields the same long-term results as open surgery and provides a better quality of life.

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.

The aim of the study is to assess the positive and negative prognostic factors of survival in patients with bilateral synchronous renal cancer (BRC). Materials and methods. The study was conducted on the basis of N.N.Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation. Cohort of patients with the synchronous BRC consisted of 160 patients between 1996 and 2014. All patients after finishing treatment were observed on an ambulatory basis during the period from 11 months to 12 years (median follow-up 81.05±46.7 months). We studied factors affecting 5-year survival rate, both positive and negative. Statistical analysis of the obtained results carried out using generally accepted statistical methods such as SPSS 23.0 - block of programs for Windows. Results. In case of synchronous BRC in 2/3 (65%) of patients the first kidney was operated on using organ-preserving surgery, in 1/4 of patients (n=21, 26.2%) both kidneys were operated on using organ-preserving surgery. In case of synchronous renal cancer the best results of survival, but without statistical significance (p=0.112) had patients with bilateral renal cancer who operated on using organ-preserving surgery. The 10-year overall survival in this group of patients was 90.5% in comparison with 62.5% - when nephrectomy was performed on the first stage and 76.4% in patients who had nephrectomy performed because of the renal cancer in the second kidney. Conclusions. The main factors affecting the 5-year survival rate of patients with synchronous BRC were: smoking, primary tumor size, age and type of surgery.

Melanoma is a malignant tumor that originates in melanocytes. Melanoma is characterized by rapid and early development of metastatic disease. Most often, metastases develop in regional lymph nodes. Metastases of melanoma can be the first signs of advanced process and the only manifestation of the disease. Patients with metastatic melanoma of unknown primary site represent approximately 1 to 8% of all cases of melanoma and up to 12.6% of all cases of metastatic melanoma of unknown primary site. The understanding of clinical course of metastatic melanoma of unknown primary is necessary to determine disease prognosis. This article shows the analysis of issues devoted to the description of the clinical manifestations of the disease and the characteristics of the clinical course, depending on the localization of the tumor.

The neglect of lung cancer and the unsatisfactory results of its treatment depend to a large extent on untimely diagnosis in the early stages of the disease. The reason for this is the absence of pathognomonic clinical signs and a specific radiographic picture of early lung cancer, which has to be differentiated from other respiratory diseases, including those occurring with infiltrative changes. According to statistical data, hyperdiagnosis of infiltrative pulmonary tuberculosis in patients with oncological diseases of the respiratory system was from 14 to 39%, which leads to long-term monitoring of patients with lung cancer in phthisiological institutions with anti-tuberculosis therapy, which causes delays in the treatment of patients with lung cancer. The pronounced visual similarity of various pathological processes of the lungs, the mixed incidence and immunodeficiency combined with subjective factors, such as gaps in the training of doctors, omissions in the survey method and the lack of continuity, can collectively be the cause of differential diagnostic errors. This article describes the similarities and differences between these diseases, the main causes of erroneous diagnosis, as well as the prospects for the development of modern diagnostic methods.

Renal cancer morbidity grows in most of the developed countries. Incidence of bilateral renal cell carcinoma, per various authors, amounts to 2–6 % of all cases of this disease. The study included 160 patients with bilateral kidney cancer who received surgical treatment at the N.N. Blokhin National Medical Research Center of Oncology in the period from 1996 to 2014. Median follow-up duration for all patients included in the analysis was 81.05 ± 46.7 months. In our study, the groups for synchronous and metachronous cancer were equal (n = 80) and constituted 3.5 % of all cases of kidney cancer. For synchronous and metachronous cancer types, the most common concomitant disease was arterial hypertension. The most common morphological variant for the first, as well as the second, kidney tumor was clear cell carcinoma. Smoking and ischemic heart disease as a concomitant pathology negatively affected relapse-free and overall survival. Overall 5-year survival for synchronous renal cancer was 84.4 ± 4.2 %, for metachronous – 64.8 ± 9.3 %.

This article continues a series of papers dwelling on endo-surgery techniques in diagnosing lymphomas. It describes the history of the thoracoscopic surgery and its potential and current use when malignant lymphoproliferative diseases with involvement of chest organs and tissues. It provides brief description of basic instruments, equipment and technique of surgical interventions via the thoracic access. It lists indications and contraindications for the thoracoscopic surgery. In addition, the paper presents analysis of video-assisted thoracoscopic surgeries in 178 patients with suspected malignant lymphoproliferative diseases. During these surgeries, samples for further morphological assessment were obtained from all patients. Lymphomas were confirmed in 120 patients. The article contains two case reports on the video-assisted thoracoscopic interventions performed.

Objective: to compare immediate, oncological, and functional results, as well as quality of life in patients undergoing open and laparoscopic transperitoneal radical nephrectomy (RNE) for clinically localized kidney cancer (KC).Subjects and methods. Data from 426 cT1-2N0M0 KC patients after radical nephrectomy in 1991 to 2011 were retrospectively selected. Their median age was 57 years. The male/female ratio was 1.1:1. The median highest tumor diameter was 5.0±2.2 cm. RNE was carried out in all 426 patients: in 211 (49.5 %) patients through open access and in 215 (50.5 %) through transperitoneal laparoscopic one. The patient groups operated on via different accesses were matched for major signs; however, the laparoscopy group displayed a preponderance of cT1a tumors. The median follow-up was 50.0±12.3 months.Results. There were no significant differences in the frequency of intraoperative and postoperative complications of laparoscopic and open nephrectomies. The five-year overall, specific, and relapse-free survival rates in the patients who had undergone open nephrectomy were 95.4, 98.4, and 92.2 %, respectively; those in the patients who had laparoscopic nephrectomy were 94.5, 100.0, and 93.6 %, respectively (p > 0.05 for all). The incidence of acute renal dysfunction and its distribution according to the RIFLE classes, the rate of acute dialysis and that of a decrease and a continued reduction in glomerular filtration rate, as well as the distribution of patients according to the stages of chronic kidney disease after RNE did not depend on the surgical access (p > 0.05 for all). The QLQ-30 survey data show that the laparoscopic access versus the laparotomic one improves quality of life within 1 month after RNE.Conclusion. Laparoscopic transperitoneal RNE is a safe alternative to open surgery that can improve quality of life in the patients with clinically localized kidney cancer within one month after surgical intervention.

Objective: to assess the advisability and safety of transperitoneal laparoscopic nephrectomy for renal parenchymal tumors.Subjects and methods. The investigation enrolled 163 patents with clinically localized renal parenchymal tumors that had been resected through laparoscopic (n = 81 (49.7 %)) and open (n = 82 (50.3 %) accesses). The groups of patients operated on via laparoscopic and laparotomic accesses were matched for demographic characteristics, somatic status, baseline renal function, and nephrometric signs of tumor nodules, except the involved side (7 patients in the laparoscopic group had bilateral renal tumors). Renal resection was carried out in all the patients; a contralateral kidney tumor was also removed in 7 patients with a bilateral lesion (nephrectomy and kidney resection were done in 3 and 4 patients, respectively). Histological examination verified benign tumors in 15 (9.2 %) cases, renal cell carcinoma in 148 (90.8 %), including all bilateral renal tumors [рТ1а (n = 135 (91.2 %) cases; рТ1b (n = 4 (2.7 %); рТ3а (n = 9 (6.1 %)]; according to the pT category, the distribution of patients in the laparoscopic and open resection groups was even (p = 0.586). No additional treatment was performed in any case. The median follow-up was 48.2 ± 11.8 months.Results. The use of the laparoscopic access significantly increased the frequency of intraoperative complications (6.1 and 16.0 %; p = 0.037), but failed to affect that of postoperative complications (13.0 and 18.3 %, respectively; p = 0.291) versus the open access. Laparoscopic versus conventional techniques did not cause any reduction in 5-year overall, specific, and relapse-free survival rates (93.3, 100.0, 80.0 % and 97.1, 100.0, 98.5 %, respectively; р > 0.05 for all). The rate of acute renal dysfunction and its distribution by the RIFLE classes, the rate and level of a decrease in glomerular filtration rate in the late postoperative period did not depend on the surgical access (p > 0.05) for all). Questioning has shown that the laparoscopic versus laparotomic access significantly improves quality of life within one month after renal resection.Conclusion. Transperitoneal laparoscopic nephrectomy is a safe alternative to open surgery, which can improve quality of life in the patients with clinically localized kidney tumors within one month after surgical intervention.

Tumors of unknown primary site (CUP-syndrome) – an intriguing clinical phenomenon that each year 5% of patients with newly diagnosed malignancies. The absence of clinical manifestations of the primary tumor, early development, unusual, often multiple metastases – signs of this heterogeneous group of neoplasms. However, there is no consensus whether the CUP-syndrome metastases undetected primary tumor or an independent biological phenomenon with certain genetic and phenotypic characteristics. Identification of major molecular abnormalities that characterize CUP-syndrome, slow progressive. Profile of gene expression and the expression of miRNAs are highly specific tests that can help to identify histogenesis of tumors without primary site.

В последнее время все чаще в лечении онкологических больных применяют малоинвазивные методики оперирования. По сравнению с ранее выполняемыми хирургическими вмешательствами использование видеоэндоскопической хирургии позволяет уменьшить травматичность операции, ускорить реабилитацию пациентов, снизить сроки пребывания больных в стационаре. Однако постоянно возникают вопросы о сопоставимости отдаленных результатов лечения. Анализ последних данных литературы свидетельствует, что результаты лапароскопических вмешательств у онкологических больных сопоставимы с таковыми при лапаротомном доступе или превосходят их, что объясняют влиянием оперативного доступа на показатели клеточного и гуморального иммунитета.В большинстве исследований, сделанных в этом направлении, доказано, что минимально инвазивный доступ приводит к более низкому послеоперационному уровню С - реактивного белка, интерлейкина (ИЛ) 1, 6, 8, 10, меньшей супрессии лимфоцитарной активности, общего количества Т-лимфоцитов, Т-хелперов, цитотоксических Т-лимфоцитов, нормальных киллерных (NК) клеток. Однако влияние пневмоперитонеума (тип газа, уровень давления, продолжительность инсуфляции) и операционной травмы на опухолевый рост, диссеминацию и противоопухолевый иммунитет требует дальнейшего тщательного изучения.

A case of clinical application of endoscopy in the course of surgery for sacral resection is discussed. Video-assisted frontal approach was used to ligate internal ileac vessels and to detach the fore end of tumor. Subsequently, the sacrum was removed via back access. Unlike standard methods using trans- or extraperitoneal frontal approach, our procedure involved less trauma and was followed by a shorter rehabilitation period.

The cytotoxic activity of peripheral blood platelets and mononuclears from 82 patients with cancer, 9 with diseases other than cancer, and 18 healthy donors towards a continuous cell line of pulmonary adenocarcinoma was studied. There were no appreciable differences in the killer activity of platelets in cancer patients (32±3.5%), patients with diseases other than cancer (33±8.1%), and healthy donors (30±6.7%). In contrast to platelets, mononuclears of cancer patients possessed a higher cytotoxicity than mononuclears of healthy donors. The cytotoxicity of platelets of cancer patients was found to reliably drop in cases with disseminated metastases and after polychemo-and radiotherapy.

Представленные наблюдения иллюстрируют необходимость и сложность проведения дифференциальной диагностики онкологических заболеваний с такой сравнительно редкой патологией, как саркоидоз Бека. Окончательный диагноз в этой ситуации может быть установлен только после проведения морфологического исследования биопсийного или другого операционного материала. Хирургическое же вмешательство в данном случае в большей степени является завершающим этапом диагностического поиска, чем лечебным мероприятием.

Radioimmunologic procedures were employed in comparing the levels of carcino-embryonic antigen in the gastric juice, blood plasma and saliva in cases of stomach cancer, gastritis, polyposis and gastric ulcer. No correlation between the antigen levels in different biological fluids was established. It was found, however, that the assay of carcino-embryonic antigen level in gastric juice may be instrumental in detecting precancerous lesions of the stomach.