[Simultaneous prophylactic surgery for colon cancer in women. Viewpoint of the gynecologist].

A 5-year survival of patients with Stage III colon cancer with prophylactic panhysterectomy in anamnesis was 83.3%, significantly higher than that of patients with Stage III colon cancer without panhysterectomy (69.3%) and than in colon cancer patients with metachronous ovarian metastases (42%). In families of patients with primary multiple malignant tumors (PMMT) of colon, endometrium and/or ovaries as well as in cases of accumulation in the same family of solitary tumors of the above locations it is necessary to carry out genetic testing to identify mutations in genes MSH2, MLH1, MSH6. Carriers of mutations in genes of mismatch repair MSH2, MLH1, MSH6 should be assumed to the high-risk group for the development of malignancies both PMMT of colon and organs of the female reproductive system and solitary tumors of the above locations. All women suffering from colon cancer, especially in the presence of mutations in genes of mismatch repair, in pre- and menopause should be undergone simultaneous prophylactic surgery: panhysterectomy. The question about the greater omentum should be decided situationally.

[Biotherapy of malignant peritoneal effusions in ovarian carcinoma].

Malignant peritoneal effusions often arise in patients with ovarian carcinoma. They are a hazardous complication of cancer. Systematic intraperitoneal chemotherapy is not necessarily followed by long-term remission and may even induce untoward side effects. Intraperitoneal interleukin-2 (IL-2) and IL-2/lymphokine-activated killers (LAK) biotherapy showed high efficacy in treatment of ovarian carcinoma patients suffering from peritoneal effusions. The objective effect was 80.1% and 82.6%, respectively. Our results suggest that intraperitoneal biotherapy may be extended to dealing with malignant peritoneal effusions in ovarian carcinoma.

[c-Kit and PDGFRA mutations and clinico-morphological features of gastrointestinal stromal tumors].

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasms of the digestive tract. Inherent overexpression of receptor tyrosine kinase KIT (CD117) and mutations in c-Kit or PDGFRA genes are highly significant prognosticators. A first Russian investigation of c-Kit and PDGFRA mutations in GIST was carried out in 60 patients. c-Kit mutations were identified in 83.3% (50/60), the most frequent being mutations in c-Kit exon 11 (73.4%, 44/60). Among them, different mutations were identified in the 5'-end of c-Kit exon 11 in 37 GISTs. Duplications in the 3'-end of c-Kit exon 11 were reported in 7 tumors. Mutations in c-Kit exon 9 (73.4%, 44/60) were found in 5 tumors (8.3 3%, 5/60) while mutations in c-Kit exon 13 (0%, 44/60) and 17 (1.7%, 1/60) were rare. PDGFRA mutations in exon 18 were identified in (8.3 3%, 5/60). Substitution D842V occurred only in one gastric epithelioid-cell GIST. The remaining PDGFRA mutations contained deletions with aminoacids 842-846. There were no c-Kit and PDGFRA mutations in five tumors. Our findings point to a significant correlation between c-Kit and PDGFRA mutations, on the one hand, and tumor site and histological pattern, on the other. Hence, c-Kit and PDGFRA mutation detection should be used as an additional prognosticator for efficacy of target therapy.

[Low molecular-weight heparin (clexane) in the prevention of thrombotic events in patients with malignancies].

The basic links of the hemostatic system and the markers of intravascular thrombogenesis were studied, by using an automatic STA Compact analyzer in 80 patients with locomotor tumors. The patients were divided into 2 groups: 1) 50 patients received clexane, 40 mg, 12 hours before and within 7-18 days after surgery (a study group); 2) 30 patients underwent only nonspecific prevention of thrombotic events (a control group). Postoperatively, hypercoagulation was shown to persist long (up to 18 days) in patients with locomotor tumors. Clexane used in the pre- and postoperative periods within 18-20 days was effective in reducing the rate of intravascular blood coagulation, preventing thrombotic events, and failing to cause hemorrhages.

[Female genital tract polyneoplasia: primary multiple neoplasms or metastases?].

The analysis of 49 cases of synchronous and metachronous malignant mucinous tumors of the colon (rectum) and ovaries in the patients treated in 1990 to 2004 again has confirmed the data that metastatic ovarian cancer occurs from a primary focus in the colorectal region. Immunohistochemical studies (using cytokeratin 7 and cytokeratin 20) may be used in the differential diagnosis of ovarian mucinous ovarian carcinoma from metastatic colonic mucinous tumors.

[Morphological characteristics of stromal gastrointestinal tumors].

Stromal tumors are singled out from smooth muscle and neurogenic neoplasms into a special group due to differences in CD117 expression caused by mutation of c-kit gene. Out of 57 stromal tumors, 37 (64,9%) located in the stomach, 17 (29,8%) in the small intestine and 3 (5,3%) in the colon. Immunohistochemically, all the tumors expressed CD117 and vimentine. Smooth muscle actin was found in 82% tumors, S-100 protein in 75%, neuron-specific enolase in 66% cases. Malignant tumors were in 93% cases, and in 7% benign. Metastases were observed in 47.7% cases, recurrences in 14%. The liver was most frequent site of metastases (88.9%), peritoneum (51.9%). 21% patients died of progression of the underlying disease during the follow-up of 6-60 months.

[Identification of the hereditary variants of skin melanoma]. / Identifikatsiia nasledstvennykh variantov melanomy kozhi.

The identification of hereditary variants of cutaneous melanoma and analysis of the role of hereditary factors and syndromes predisposing to cutaneous melanoma were carried out. The involvement of individual nevus phenotypes in the development of this disease was determined. Based on a survey of recent molecular biological data and our studies, the etiological and genetic heterogeneity of cutaneous melanoma is reported. In relatives of patients with cutaneous melanoma and persons with multiple pigmented nevi, the malignant tumors proved to be differentiated in the direction of the neural crist tissues and/or derivatives of cutaneous mesenchyma. Based on the evidence obtained, the approaches have been developed to formation of risk groups for the purpose of early diagnostics of cutaneous melanoma.

[Surgical treatment of multiple primary neoplasms]. / Khirurgicheskoe lechenie previchno-mnozhestvennykh sinkhronnykh zlokachestvennykh novoobrazovanii.

Comparison of two groups of patients with polyneoplasia was carried out: in group 1 surgeries were performed simultaneously, in group 2--at different time. Choice of surgical technique seems to depend on the time between detection of the tumors. When polyneoplasias were revealed at the same time, surgeries were performed simultaneously. These operations were conducted more often when the tumors were localized in organs accessible by one surgical approach. When multiple synchronous tumors located in various anatomic regions consecutive operations were performed more often. The stage of the tumor does not influence the choice of time of operation for the first and second tumor. Simultaneous operations are preferable for young patients without concomitant diseases.

[Hereditary cancer: identification, genetic heterogeneity, medico-genetic consult]. / Nasledstvennyi rak: identifikatsiia, geneticheskaia geterogennost', mediko-geneticheskoe konsul'tirovanie.

The paper deals with a role of inherited factors responsible for the occurrence of malignant tumors. Inherited types of cancer are shown to occur virtually at its sites and averaged 5-15%. Formalized criteria for identifying inherited cancer diseases and their etiological and genetic heterogeneity are presented. A role of genes that genetically predispose to particular forms of cancer is shown, which allows for early (preclinical) diagnosis and prevention of cancer diseases.

[Current principles of diagnosis and surgical treatment of non-organ retroperitoneal tumors]. / Sovremennye printsipy diagnostiki i khirurgicheskogo lecheniia neorgannykh zabriushinnykh opukholei.

The data on surgical treatment of 455 patients operated on for primary and recurrent non-organ retroperitoneal tumors (NRT) are discussed. 64.2% of tumors were resected; postoperative lethality was 8.2%. Particular emphasis is placed on the complex nature of diagnosis and an algorithm of examination is suggested. The sequence of main procedures and stages are described; 43% of radical procedures were performed in combination with one another. NRTs tended to relapse and malignant tumors recurred most frequently within the first 18 months. In the course of 182 operations, 54.4% of NRTs were resected: postoperative lethality was 11.1%. The end results were determined by a number of factors, primarily, nature of tumor (benign or malignant), tumor process (primary or recurrent), tumor size and histological pattern. Because of the poor end results, surgical procedures should be improved and their range should be extended.

[Surgical treatment of adrenal gland tumors]. / K voprosu o khirurgicheskom lechenii opukholei nadpochechnikov.

The data on surgical treatment of 146 patients with adrenal gland malignancies as well as literature on the problem are discussed.

[Submerged esophago-intestinal anastomosis in surgical treatment of gastric cancer]. / Pogruzhnye pishchevodno-kishechnye anastomozy v khirurgicheskom lechenii raka zheludka.

The short-term results of 1,605 gastrectomies performed for stomach cancer, using different types of esophagoenterostomy, are discussed. Anastomotic leakage is the main criterion for a choice of the most optimal procedure of forming an anastomosis. The contribution of the first and second rows of sutures to leakage is evaluated. An analysis of data on anastomotic leakage incidence points to the advantages offered by application of submerged esophagus-related anastomosis. A new modification of procedure of formation of muffle-type of esophagoenterostomy is presented. Leakage was registered in 1.3% which was due to technical errors during surgery. The non-reflux properties of the anastomosis are emphasized, with particular emphasis on its reliability, good functional characteristics, simplicity and wide range of application. The clinical applications are described.

[Restriction polymorphism of the proto-oncogene c-Ha-ras-1 in patients with multiple primary malignant neoplasms and non-small-cell lung cancer]. / Restriktsionnyi polimorfizm protoonkogena c-Ha-ras-1 u patsientov s pervichno-mnozhestvennymi zlokachestvennymi novoobrazovaniiami i nemelkokletochnkym rakom legkogo.

Restriction fragment length polymorphism in the human c-Ha-ras-1 locus, associated with a minisatellite sequence, was examined in 45 multiple primary cancer (MPC) patients, 56 patients with squamous cell lung cancer (SCLC), 21 patients with lung adenocarcinoma (LAC), and 53 individuals having no oncopathology. Southern analysis of cellular DNA revealed the presence of 4 common alleles (with collective allele frequency close to 94% in the control group) and a set of rare alleles. Allele a3, (2.1 kb in size under MspI/HpaII digestion) was shown to be more frequent in the MPC than in the control group. The same tendency was observed in the patients with highly differentiated cell lung cancer. An increased frequency of the a4 allele (2.5 kb under MspI/HpaII digestion) was observed in the patients with adenocarcinomas as well as in the patients with metastases and low levels of tumor tissue differentiation. The elevated frequencies of a3 in the MPC group and of a4 in the LAC patients did not correlate with increased risk of the cancers mentioned above but was associated with type of tumor progression. Previously, it was reported that the mini-satellite sequence within the c-Ha-ras-1 locus possesses enhancer activity. Our data indirectly confirm the hypothesis that the efficiency of minisatellite modulator activity is associated with fragment size.

[Analysis of the genetic predisposition to cancer in families of patients with multiple primary malignant neoplasms]. / Analiz geneticheskoi predraspolozhennosti k raku v sem'iakh bol'nykh pervichno mnozhestvennymi zlokachestvennymi novoobrazovaniiami.

Clinical-genetic examination of 305 patients with multiple primary tumors aimed at determining the rate of genetic burden to their development and community of joint accumulation of tumors in families of these patients has revealed a significant genetic community of inheritance of breast cancer, carcinomas of colon, endometrium, ovaries and stomach in the families of patients with multiple primary tumors. Comparative analysis of genetic correlations has shown the greatest genetic burden in families of patients with multiple primary tumours as against the families of patients with solitary cancer.

[Genetic analysis of predisposition to cancer of the stomach]. / Geneticheskii analiz predraspolozheniia k raku zheludka.

The results of a complex family and population epidemiologic study of gastric cancer pointed to inheritance as an important factor of the incidence of this disease. However, there may be different combinations of genetic factors, on the one hand, and genetic and environmental ones, on the other, versus age and sex. This should be considered in conducting screening for families at genetic risk for stomach cancer and taking measures aimed at eliminating carcinogenic factors which increase the likelihood of familial cancer incidence. Such considerations should contribute to a certain degree to early diagnosis and prevention of the disease.

[Multiple primary cancer of the gastro-intestinal tract]. / O pervichno-mnozhestvennom rake zheludochno-kishechnogo trakta.

Peculiarities of the clinical course of primary multiple malignant tumors of the gastrointestinal tract are discussed. Out of 25 cases of synchronous gastrointestinal malignancies, both stomach and large bowel tumors were found in 10 patients and simultaneous neoplasms in different segments of the large bowel--in 15. In the latter group, radical surgery was performed in 13 patients. Out of 54 cases of metachronous cancer, 28 revealed combinations of stomach and large bowel tumors, while in 26 cases metachronous tumors appeared in succession in different segments of the large bowel. Synchronous single and multiple polyps of the large bowel were detected in 19 out of 54 patients. Radical surgery was carried out in 33 and palliative surgery--in 6 patients.