The article presents the use of clinical and morphological concept of the development of neoplastic process in the cervix to devise a strategy of management based on a diffi cult clinical case of a menopause patient with microinvasive cervical cancer. The patient presented with abnormal cervical smear test results — HSIL, having had a history of LSIL in the smears without having undergone additional examination and treatment for 1,5 years. There was no visible object for biopsy on the ectocervix, and an invasive tumor had not been found in the fi rst conization tissue sample, that had revealed CIN2–3 with positive for CIN in subsequent scraping of the endocervical canal. Despite the absence of abnormalities in the smears after conization, excision strategy was defi ned based on the clinical and morphological concept of the course of cervical neoplasias which we had developed earlier. Latent microinvasion was located very high in the zone of transition to the isthmic part of the uterine body and uncommonly deep along the length of the crypts which is observed rarely. Cervical conization, performed twice, allowed to diagnose preinvasive foci in the lower part of the canal and to increase the area of the crypts available for visualization and examination after their excision and inclusion of cancer cells into the smears after two conizations, that along with preserved and growing viral load, led to a decision to perform a hysterectomy that revealed invasion. Clinical and morphological concept of the development of neoplastic process in the cervix, introduced by us, contributed to avoiding mistakes in this challenging case and to diagnosing the process at an early stage.
Keywords: cervical cancer in situ, HGSIL, CIN2–3, microinvasive cervical cancer, diagnostic challenges, conization, clinical and morphological concept.
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Currently the search for the new effective treatment options after providing the fi rst-line therapy in patients with metastatic and recurrent cervical cancer is being carried out. The article presents a clinical observation of a long-term successful use of pembrolizumab in a patient with metastatic cervical cancer in the late lines of drug therapy.
Keywords: cervical cancer, immune checkpoint inhibitor, immunotherapy, pembrolizumab.
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Objective of the study: to carry out a systematic analysis of the data available in current literature on the uterine tumors resembling ovarian sex cord stromal tumors (SCST-resembling uterine tumors), to consider the current state of the issue to date.
Materials and Methods. The review comprises the data from foreign and Russian scholarly articles found in PubMed on the subject published over the past 5 years.
Results. This group of diseases has been poorly studied and described in the literature in separate research briefs. In our work we provide the data on the morphology of uterine tumors resembling ovarian sex cord stromal tumors (SCSTs), on their clinical features, and review the most compelling clinical observations.
Conclusion. Uterine tumors resembling ovarian sex cord stromal tumors is a rare pathology, so there are currently no clinical guidelines in the world on the management of such patients. Therefore, to optimize diagnostics and treatment of the tumors of this nosology, research in this fi eld should be continued.
Keywords: uterine tumors resembling ovarian sex cord stromal tumors, sex cord stromal tumors, morphology, clinical observations.
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Introduction. To date the properties of hematopoiesis in malignant tumors is one of the promising areas of research. Bone marrow is the site of the generation of precursors of the cellular components of the blood and of their maturation into functionally mature forms. The study of hematopoiesis in malignant neoplasia revealed a number of patterns that demonstrate bone marrow involvement into the process of tumor progression.
Objective is the assessment of quantitative indicators of granulocytic bone marrow lineage in patients with ovarian cancer.
Materials and Methods. The study included 52 patients with verifi ed diagnosis of ovarian cancer aged 29 to 81. Serous adenocarcinoma accounted for 90,4% (n = 47) of cases, endometrioid adenocarcinoma was diagnosed in 5,8% (n = 3) of patients. Patients with ovarian cancer stage III prevailed in the research. All patients underwent bone marrow biopsy, the tissue sample was examined using morphological method. The evaluation of the parameters and the myelogram calculation was carried out by two independent morphologists. The content of myelokariocytes in the biopsy specimen, the total percentage of the entire granulocytic lineage, the percentage of young and mature neutrophils, the neutrophil maturation index and the relationship between these parameters and the clinical and morphological features of ovarian cancer were evaluated. Microscopic examination of the bone marrow aspirates excluded metastatic lesions of the bone marrow in all patients. Statistical processing of the data was performed using IBM-SPSS Statistics v.21 software package.
Results. The research found a decrease in bone marrow cellularity, a reduction in the young forms of granulocytes, predominance of mature neutrophil cells in a signifi cant number of patients with ovarian cancer. Correlational relationships between the levels of metamyelocyte, myelocyte counts and the clinical and morphological features of ovarian cancer were identifi ed. A decrease in a level of myelocytes was observed more frequently with a larger tumor size (T3): 41,5% versus 0%, p = 0,012. With regard to myelocyte content: 12,5% and 73,2% respectively in T1 and T3 (р = 0,008).
Conclusion. There is a relationship between the level of granulocytes and the clinical features of ovarian cancer. A link between the parameters of granulocytic lineage and the degree of tumor differentiation was revealed.
Keywords: bone marrow, granulocytes, ovarian cancer, serous adenocarcinoma, metamyelocytes, hematopoiesis.
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Introduction. The article considers the possibilities of modern antitumor drug therapy using CDK 4/6 cyclin-dependent kinase inhibitors in the treatment of patients with metastatic hormone-positive Her-2 negative breast cancer and discusses a clinical observation of long-term survival of a patient who underwent this treatment scheme in late-line therapy.
Objective. The evaluation of current methods of antitumor drug treatment of metastatic hormone-positive Her-2 negative breast cancer and their use in clinical practice.
Materials and Methods. The paper considers clinical research on the use of the novel targeted therapy of metastatic hormone-positive Her-2 negative breast cancer, as well as a case of the treatment of a patient from clinical practice.
Results. The novel antitumor drug therapy using CDK 4/6 cyclin-dependent kinase inhibitors in the treatment of metastatic hormone-positive Her-2 negative breast cancer increased the overall and recurrence-free survival of patients even in the late-line therapy out of clinical trial data. As a proof of that, the patient has been living for 10 years since the diagnosis, long-term effect of the therapy with CDK 4/6 cyclin-dependent kinase inhibitors in the fi fth-line therapy with overcoming hormone resistance for 36 months was observed.
Conclusions. Antitumor drug therapy with the use of CDK 4/6 cyclin-dependent kinase inhibitors allowed to increase overall and recurrence-free survival of patients with metastatic hormone-positive Her-2 negative breast cancer.
Keywords: breast cancer, metastases, targeted therapy, hormone therapy, CDK 4/6 inhibitors.
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Objective of the study – is to carry out a systematic analysis of the data available in current literature on the possibilities of brachytherapy in organ-preserving and function-sparing treatment of vaginal rhabdomyosarcoma in girls.
Materials and Methods. The review comprises the data from foreign and Russian academic articles found in PubMed on the subject published over the past 5 years.
Results. Rhabdomyosarcoma is the most common tumor of soft tissues in children: it accounts for 45-60% of soft tissue tumors and for 5-10% of solid tumors at this age. This article provides a summary on the epidemiology, pathogenesis, clinical presentation and treatment of such common tumor of soft tissues in children as rhabdomyosarcoma. The present possibilities of image-guided brachytherapy in organ-preserving and function-sparing treatment are demonstrated in the example of a clinical observation of a 5-year-old girl.
Conclusion. Introduction of such technologies as image-guided brachytherapy (IGBT) into clinical practice permits to achieve more effective results of the treatment and to signifi cantly improve the quality of life of patients.
Keywords: rhabdomyosarcoma, soft tissue tumors in children, brachytherapy, organ-preserving treatment.
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Objective of the study is to analyze the current literature data on the possibilities of antitumor drug therapy of patients with malignant tumors of reproductive system and comorbid renal and/or hepatic insuffi ciency.
Materials and Methods. The review comprises the data from foreign and Russian scholarly articles found in PubMed on the subject.
Results. The paper presents the current data on the diagnostic algorithm, on dose adjustment of anticancer drugs in case of comorbid tumor lesion of female reproductive system and dysfunction of the organs of natural detoxifi cation process.
Conclusion. The potential of antitumor agents in gynecologic oncology in cases with concomitant impaired liver and/or kidney function is possible to realize if their adverse effects on healthy organs are suffi ciently prevented and corrected.
Keywords: renal failure, liver failure, chemotherapy, female reproductive system tumors.
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Objective of the study: to carry out an analysis of the data, available in current literature on the feasibility and effectiveness of the use of nutritional support in the comprehensive rehabilitation of patients with gynecologic cancers.
Materials and Methods. The review comprises the data from English-language and Russian authors.
Results. The role of nutritional support as a component of comprehensive rehabilitation program in gynecologic oncology is shown.
Conclusion. The use of enteral nutrition in the perioperative period in gynecologic oncology can reduce the number of infectious complications, shorten the hospital stay, improve the quality of life of patients. No effect on survival was found.
Keywords: gynecologic oncology, nutritional support, rehabilitation, enteral nutrition.
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Objective of the study: to evaluate population risk factors for the development of malignant neoplasms in patients with indications for assisted reproductive technologies.
Materials and Methods. 200 women of reproductive age diagnosed with primary female infertility were enrolled in the study. Anamnestic and statistical assessments were used.
Results. The main risk factors for the development of malignant neoplasms in a group of women with primary infertility are: tobacco use, obesity, and the presence of chronic viral hepatitis B and C infections. Infertility is a global risk factor for the development of malignant neoplasms as well.
Keywords: risk factors for malignant neoplasms, infertility, assisted reproductive technologies.
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