[Malignant vulvar soft tissue myoepithelioma].

The authors describe a case of malignant vulvar soft tissue myoepithelioma in a 41-year-old woman. Microscopically, epithelioid and spindle cells were located in the myxoid stroma. Tumor cells co-expressed pan-cytokeratin, EMA, and cytokeratin 18, vimentin, protein S100, and smooth muscle actin. The tumor was found to have a very high proliferative activity (Ki-67 was as high as 80%). The disease was fulminant with a fatal outcome 4 months after the occurrence of the first symptoms of the tumor.

[Epitheliod hemangioendothelioma of the lung].

The authors give a morphological and immunohistochemical description of epitheliod hemangioendothelioma of the lung in two women aged 62 and 74 years. Evident neovascularization capacity, a significant tumor cell intracytoplasmic lumen frequently packed with red blood cells, and positive immunohistochemical reactions to endothelial antigens are of prime importance in making its diagnosis.

[An immunohistochemical study of aromatase, estrogen 4-hydroxylase and fatty acid synthetase in breast cancer tissues from BRCA1 mutation carriers].

Breast cancer in germline BRCA1 mutation carriers features a peculiar endocrine and metabolic profile which is yet to be studied properly in clinical settings. We used a novel immunohistochemical method to compare expression levels of aromatase, estrogen 4-hydroxylase (CYP1B1) and fatty acid synthetase in breast cancer tissues from 12 BRCA1 mutation carriers and 22 non-carriers. Rates of aromatase in carriers were significantly higher than in control (p=0.04) to match the data obtained earlier in cell lines employed in down-regulation of the wild BRCA1 gene. These findings make a case for use of aromatase inhibitors in such patients. No differences in CYP1B1 and fatty acid synthetase expression levels were found between the mutation and the wild BRCA1 gene groups. Further search is warranted for manifestations of excess genotoxic effects of estrogens and enhanced lipogenesis in BRCA1 mutation carriers.

[Kinetic features of ascites and solid Ehrlich tumors].

Such biological parameters as tumor volume, Ki-67 and p53, which characterize the development of ascites and solid tumor of Ehrlich were evaluated. The kinetic curve of growth of ascites tumor was S-shaped (Gomperts) while that of the solid one--cubic (Speer-Retsky). Ki-67 expression level was found to be in cyclic correlation with duration (3 and 6 day intervals) which might be worth considering when working out therapeutic procedure. Moreover, no increase in cell death was observed when tumor growth slowed down.

[The volume of the liver and its functional status in primary and metastatic malignant lesions].

84 patients with primary and metastatic malignant liver lesions predominantly at stage T4N0M0 were studied liver volumes and volumes of foci of lesions, also personal normal liver formula. Obtained data was compared with the functional state of the liver, as determined by the scale of hepatotoxicity NIH-NIAD with additional index points of higher levels of ALT, SCHF and total bilirubin in serum. We found that liver increase in most cases is not only a total foci destruction and predominantly blood disorders and lymphokinesis bodies. Even with 50% dissemination of the malignant growth of functional compensation body remains at a sufficient level, which enables extensive cytoreductional intervention and chemotherapy.

[Clinico-morpho-sonographic parallels in skin melanoma].

Data on sonographic features of different variants of skin melanoma are presented. Relationship between skin to tumor thickness ratio and invasion depth (Clark) or tumor thickness (Breslow) were found. Tumor extent was effectively identified by ultrasound tomography of primary focus preoperatively. Such patterns of melanoma blood supply as "avascular" (superficial tumor) and "vascular" (node-like tumor) were established. A "tree-like" vascular pattern was typical of melanoma in color Doppler imaging. Tumor with such pattern had poor prognosis.

[Immunohistochemical profile of endometrioid adenocarcinoma of the uterus: ER, PR, HER-2, Ki-67 and their prognostic value].

76 endometrioid adenocarcinomas of the uterine body were studied. Expression of the above markers is of essential value together with metastatic involvement of regional lymph nodes, stage of the disease and pathogenetic variant for determining prognosis of carcinoma aggressiveness and disease outcome. Positive hormonal-receptor status of the tumor is characterized by well-differentiated tumor cells, small depth of invasion, rare metastases to regional lymph nodes and higher survival (5 year--81%) of patients comparing with cases where ER and PR were not determined (53%). On the contrary, overexpression of oncoprotein HER-2 and Ki-67 higher than median (42%) was associated with high tumor aggression resulting finally in a significant fall in the survival (from 75% to 58% and from 79% to 60%, respectively). Combination of HER-2 overexpression with a high level of Ki-67 is particularly unfavourable (5-year survival--43%).

[Expression of estrogen and progesterone receptors and oncoprotein HER-2 as a marker for clinical course and outcome in endometrioid adenocarcinoma of the uterine body (immunohistologic study)]. / Ekspressiia retseptorov éstrogenov, progesterona i onkobelka HER2 kak pokazateli klinicheskogo techeniia i iskhoda éndometrioidnoi adenokartsinomy tela matki (immunogistokhimicheskoe issledovanie)

A retrospective immunohistological assay identified estrogen (ER) (72%) and progesterone (PR) (71%) receptor content in tumors from 76 patients with endometroid cancer (ER+ PR(+)--63.2%; ER- PR(-)--22.3%; ER+ PR- 9.2%; ER- PR+ -5.3%). Pattern R+ involved well differentiated cells, slight invasion of the myometrium and infrequent spreading to the regional lymph nodes, as compared with cases of unidentified ER or PR. Five-year survival in patients with ER+ PR+ tumors was 83% vs. 53% in cases without steroid hormone receptor expression (p = 0.04). HER 2 overexpression was found in 31.6% of tumors involving a decrease in total survival from 73 to 54.2% (p = 0.04). No significant correlation was established between ER and PR, on the one hand, and HER 2 expression, on the other. HER 2 overexpression leveled off the prognostic value of steroid receptor expression to a considerable degree; relapse incidence in patients with HER 2 overexpression in ER+ PR+ tumors rose 9-26.7% while five-year survival dropped 88-60% (p = 0.03). A distinct correlation between ER and PR expression (r = 0.96) was reported by D.C. Alfred et al. and verified by the H-scor procedure (R.A. Mc Clelland et al.). This procedure for steroid receptor expression determination is as the first unsophisticated, yet informative, method.

[The apoB genotype and the efficacy of hypolipidemic therapy]. / Genotip apoB i éffektivnost' gipolipidemicheskoi terapii.

Several men were examined for association between restriction fragment length polymorphism (RELP) Xba I (exon 26) number of tandem repeats in 3'-hypervariable region of the apolipoprotein-B gene and serum levels of cholesterol and triglyceride. These two types of polymorphism were studied. An association of the Xba I site and alleles containing more repeats in the 3'-hypervariable region with higher cholesterol and triglyceride was observed. 32 patients with CHD aged 24-56 years were examined. All the patients are males with clinical picture of CHD (stable angina pectoris of II-III functional classes) and dyslipoproteinemia of II a, II b and IV types by D. S. Fredrickson. Xba-I polymorphism of apo-B gene was detected by DNA polymerase reaction method. The following Xba-I genotypes were distinguished: X1X1 (absence of Xba I site); X1X2 (heterozygosity on Xba I site) and X2X2 (homozygosity on Xba-I site). Lipantil (fenofibratte) was prescribed in a dose of 300 mg daily after meals (100 mg three times a day). Data obtained show that DNA polymorphism of apo-B gene not only influences plasma lipids concentration but also determines effectiveness of hypolipidemic therapy. Hypolipidemic effect of lipantil depends on Xba-I site presents in apo-B gene and is significantly expressed in homozygous patients with X1X1 genotype.

[Plasmapheresis in combined treatment of acute rejection crises after kidney transplantation]. / Primenenie plasmafereza v kompleksnoi terapii ostrykh krizov ottorzheniia posle peresadki pochki.

The aim of the study was assessment of effectiveness and safety of extracorporeal procedures (plasmapheresis) in prevention and combined treatment of acute rejection crises (ARC) after kidney transplantation in patients at high risk to develop acute immunological conflicts in early postoperative period. 94 patients aged 21-56 years after allotransplantation of cadaver kidney (ATCK) entered the study. They were divided into two groups: group 1 patients (n = 47) received plasmapheresis procedures in combined preventive and therapeutic treatment of ARC; matched group 2 patients (n = 47, retrospective) received the same therapy but plasmapheresis. In both groups there were many patients with a high titer of pre-existing antibodies and massive hemotransfusions in the past. The analysis covered also recipients with the second ATCK (9 and 4 patients, respectively). After ATCK both groups received three-component immunosuppressive treatment (neoral, prednisolone, azatioprin and/or sell-cept). The analysis of the transplant and recipient 11-month survival has estimated that it was 93.6 and 91.5% for the recipients, respectively, and 91.5 and 76.5% for the transplanted kidney for group 1 and 2, respectively. The conclusion is that plasmapheresis in combined prevention and treatment of ARC by humoral type in sensitized patients (high titer of the pre-existing antibodies, repeat transplantations, hemotransfusions) is pathogenetically grounded and lowers the percentage of irreversible episodes of acute transplant rejection early after surgery.