[Comparative immunohistochemistry study of different antibodies clones for detection of breast cancer markers (estrogen receptor, progesterone receptor, HER2/neu, Ki-67)]. / Sravnitel'noe issledovanie antitel razlichnykh klonov dlya vyyavleniya markerov raka molochnoi zhelezy (retseptorov estrogenov, progesterona, HER2/neu, Ki-67) immunogistokhimicheskim metodom.

OBJECTIVE: A comparative study of detection of breast cancer markers (estrogen receptors, progesterone receptors, HER2/neu, Ki-67) by immunohistochemical method with antibodies produced by PrimeBioMed (Russia) and antibodies produced by Roche Ventana (USA). MATERIAL AND METHODS: Surgical specimens and biopsies from 37 patients with invasive breast cancer were used. Sections were stained with antibodies of clones ER SP1 and GM030, PR 1E2 and PBM-5B8, HER2/neu 4B5 and PBM-46A6, Ki-67 30-9 and GM010. RESULTS: There was a high positive and significant correlation between the immunohistochemistry results and antibodies of the clones ER-SP1 and GM030, PR1E2 and PBM-5B8, HER2/neu4B5 and PBM-46A6, Ki-67 30-9 and GM010. CONCLUSION: The study showed the possibility of using antibodies of clones GM030, HER2/neu 4B5, PBM-46A6, GM010 (PrimeBioMed) on the Ventana Bench Marck Ultra automatic immunostainer using the detection system UltraView Universal DAB Detection Kit.

[Prognostic significance of PD-L1 expression as a potential predictor of survival in gastric cancer]. / Prognosticheskaya znachimost' ekspressii PD-L1 kak potentsial'nogo prediktora vyzhivaemosti pri rake zheludka.

BACKGROUND: Currently, PD-L1 expression in patients with tumors of various localizations is being actively studied. Studies on the expression of PD-L1 detected by clones SP142 and SP263 in gastric cancer (for the drugs atezolizumab and durvalumab, respectively) are rare in the literature. The prognostic role of PD-L1 expression in patients who were not treated with immune checkpoint inhibitors has also not been investigated. OBJECTIVE: To determine the expression level of PD-L1 (clones SP263 and SP142, Roche Ventana) in gastric cancer specimens and evaluate its effect on overall survival in patients who did not receive adjuvant therapy with immune checkpoint inhibitors. MATERIAL AND METHODS: The study included 131 patients with a verified diagnosis of gastric cancer. The material obtained from 127 patients was stained with antibodies to PD-L1 SP263, and from 126 patients - with antibodies to PD-L1 SP142. A multivariate Cox regression model with Wald's step-by-step exclusion algorithm was used to evaluate predictors of survival. RESULTS: The total five-year survival rate of patients in the PD-L1-negative tumor group was significantly lower than the total five-year survival rate of patients in the PD-L1-positive tumor group, which was 50.0% and 40.0% also for both clones (p=0.027). An increase in the expression of PD-L1 clone SP263, determined by both the CPS and TPS method, reduces the chances of death by 1.35 times (p=0.02) and 1.61 times (p=0.004), respectively. An increase in the expression of PD-L1 clone SP142, determined by the CPS method, reduces the chances of death by 1.54 times (p=0.005). CONCLUSION: The survival rate of patients in the group of PD-L1-positive tumors is significantly higher than in patients in the group of PD-L1-negative tumors. Elevated PD-L1 expression, as assessed by the SP263 and SP142 clones, is an important prognostic marker that predicts a higher chance of overall survival for patients, even though these patients are not receiving immune checkpoint inhibitors adjuvant therapy.

[Features of encrustation of ureteral stents in patients with calcium oxalate and urinary acid stones].

INTRODUCTION: Stent encrustation is one of the most difficult problems that can lead to difficulties in stent removal, while ureteral obstruction can lead to renal failure. Despite the search for various preventive measures, it still remains unresolved. AIM: To study the effect of Blemaren on stent encrustation in patients with calcium-containing and uric acid stones after ureteroscopy with lithotripsy. MATERIALS AND METHODS: A total of 60 patients with ureteral stones who underwent ureteroscopy with lithotripsy in A.V. Vishnevsky National Medical Research Center of Surgery from January to August 2022, were included in the study. In all cases ureteral stents 6 Ch were placed at the end of the procedure. Patients with uric acid and calcium oxalate stones (n=48) were randomized into two groups: in the main group (n=20), they were prescribed Blemaren up to the stent removal. In the control group (n=28), patients did not receive additional therapy. To determine the severity of incrustation, we used our own classification, where the percentage of lithogenic deposits relative to the lumen of the stent was calculated. Visual assessment and microscopic examination of the removed stents were performed on days 30+/-4.1 and 60+/-7.3. RESULTS: In patients of both groups, the severity of encrustation on the 30th day after stent placement was low (up to 30%). There were no significant differences between the groups (p=0.421). The main changes were detected 60 days after stent placement. Microscopic study revealed significant differences between two groups. In patients who did not receive Blemaren, microscopic signs of encrustation of the proximal curl of the stent occurred 2.5 times more often than in the main group (p=0.001). CONCLUSIONS: 1. The number of encrusted stents in patients with calcium oxalate and uric acid stones who did not receive Blemaren significantly increases after two months. 2. Upper urinary tract drainage with a stent for a period of more than 2 months is possible if clinically necessary, however, preventive measures to reduce the risk of encrustation should be applied.

[Mortality in acute appendicitis in Russia]. / Letal'nost' pri ostrom appenditsite v Rossii.

OBJECTIVE: To analyze the causes of mortality in patients with acute appendicitis in Russia. MATERIAL AND METHODS: We retrospectively studied mortality in patients with acute appendicitis in the Russian Federation in 2020. We surveyed the hospitals with mortality reported in the electronic database of annual reports to the chief surgeon of the Ministry of Health of the Russian Federation. RESULTS: There were 259 deaths among 150.393 patients with acute appendicitis aged ≥18 years (in-hospital mortality 0.17%). We obtained data about 95.8% (n=248) of lethal cases including 86.3% (n=214) complicated and 13.7% (n=34) uncomplicated forms of disease. Two patients died without surgery (0.8%). Among the deceased, 58.2% (n=145) were men and 41.8% (n=103) were women. Mean patient age was 66.2 years [0.95% CI 64.2-68.1]. The main cause of death in complicated appendicitis was late presentation (after 4.9 days [0.95% CI 4.3-5.4]) that resulted peritonitis and sepsis in 71.5% (n=153) of patients. Cardiovascular diseases were noted in 23.4% (n=50) of cases. A new coronavirus infection was detected in 7.0% (n=15) of patients. However, COVID-19 as a direct cause of death was recognized in 2.8% (n=6) of cases. Other reasons accounted for 2.3% (n=5). In uncomplicated appendicitis, cardiovascular diseases were the main cause of mortality (73.5%, n=25). Peritonitis and sepsis were found in 11.8% (n=4) of cases, COVID-19 - in 5.9% (n=2). Other causes accounted for 8.8% (n=3). Diagnostic, tactical, technical problems and their combination were revealed in 54.4% of lethal outcomes. CONCLUSION: Mortality from acute appendicitis in the Russian Federation is low, comparable with international data, and mainly associated with delayed treatment and complicated course of disease. However, the impact of diagnostic, tactical and technical errors on the outcome of acute appendicitis is significant.

[PD-L1 expression in EBV-associated gastric carcinomas]. / Ekspressiya PD-L1 v EBV-assotsiirovannom rake zheludka.

OBJECTIVE: Assessment of the incidence of PD-L1 expression in EBV-associated gastric adenocarcinomas, as well as clarification of the clinical and morphological characteristics and median survival of patients with PD-L1-positive EBV-associated gastric cancer. MATERIAL AND METHODS: Samples of surgical material from 127 patients with stomach cancer were studied. Each sample was stained by in situ hybridization using primers for the Epstein-Barr virus-encoded small RNAs (EBER). Expression of PD-L1 was assessed immunohistochemically (PD-L1 SP263, PD-L1 SP142). The results obtained were compared with the main clinical and morphological characteristics of gastric cancer and median survival of patients. RESULTS: The detection rate of PD-L1 SP263 and PD-L1 SP142 in EBV-associated gastric adenocarcinoma in our sample was 100% and 76.9% respectively, thus, PD-L1 expression (SP263, SP142) is significantly more frequently detected in EBV-associated gastric carcinomas. It was found that patients with positive expression of PD-L1 in EBV-associated gastric carcinomas are younger (mean age 56.3 years for SP263 and 55.6 years for SP142), belonging to male gender. In addition, this group is dominated by proximal localization of tumors, ulcerative form of growth, tubular histological type, intermediate subtype according to P. Lauren. These characteristics do not depend on the antibody clone: positive expression of SP142 and SP 263 was detected in the same patients with a few exceptions. The overall median survival of patients with positive PD-L1 status SP263 in EBV-associated gastric carcinomas was 35 months, for patients with positive PD-L1 status SP142 - 25 months. Median survival of SP142 PD-L1 positive patients is higher than overall median survival of PD-L1 negative patients in EBV-associated gastric carcinomas. It was found that PD-L1 status in EBV-associated gastric cancer is not a significant prognostic factor. CONCLUSION: A single PD-L1 status does not significantly affect the prognosis in patients with gastric cancer, including those in the group of EBV-associated carcinomas, and can only be considered in conjunction with 'classic' clinical and morphological characteristics, primarily with the stage of the tumor process, since they determine the prognostic properties of the tumor.

[Study of gastric adenocarcinomas association with the Epstein-Barr virus-encoded small RNAs]. / Issledovanie assotsiatsii adenokartsinom zheludka s malymi virusnymi RNK virusa Epshteina­Barr.

OBJECTIVE: Assessment of the incidence of EBV-associated gastric adenocarcinomas in a sample of Russian patients, as well as clarification of the clinical and morphological characteristics and median survival of patients with EBV-associated gastric cancer. MATERIAL AND METHODS: We used samples of surgical material from 282 patients with a verified diagnosis of gastric cancer. Each sample was stained by in situ hybridization using primers for the Epstein-Barr virus-encoded small RNAs (EBER). The results obtained were compared with the main clinical and morphological characteristics of gastric cancer. RESULTS: The detection rate of EBV-associated gastric adenocarcinoma in our sample was 9.57%. EBER-positive tumors much more often (p=0.021) belong to the intermediate type according to the P. Lauren classification (66.67%) in comparison with EBER-negative tumors (38.82%). EBER-positive tumors significantly more often (p=0.035) belong to high-grade tumors - 75.00% in comparison with EBER-negative tumors (52.13%). The overall median survival of all patients with EBER-positive tumors (53.5 months) was higher compared to the overall median survival of all patients with EBER-negative tumors - 36.5 months (p=0.5379). The median survival of patients with EBER-positive stage III tumors (30.0 months) was also higher compared to that for patients with EBER-negative tumors - 20.0 months (p=0.5622). It was found that a single EBER status is not a significant prognostic factor (HR=1.0143; CI: 0.9897-1.0196). CONCLUSION: Separately taken EBER-status is not a significant independent prognostic factor and can be considered only in conjunction with the «classical¼ clinical and morphological characteristics, primarily with the stage of the tumor process, since it is they that determine the prognostic properties of the tumor.

[Effect of morphological state of pancreatic parenchyma on the long-term outcome of surgery for chronic pancreatitis]. / Vliyanie morfologicheskogo sostoyaniya parenkhimy podzheludochnoi zhelezy na otdalennye rezul'taty khirurgicheskogo lecheniya khronicheskogo pankreatita.

OBJECTIVE: To determine the effect of baseline morphological state of the pancreas on the long-term outcomes of duodenum-preserving pancreatic head resection (DPPHR). MATERIAL AND METHODS: The study included 104 patients with chronic pancreatitis (CP), who underwent DPPHR in 2014-2019. Pain syndrome, exocrine and endocrine pancreatic insufficiency and quality of life (QoL) were assessed in long-term postoperative period. Patients were stratified depending on CT enhancement of pancreatic parenchyma as an indicator of fibrosis and amount of preserved acinar cells in resected pancreatic tissue. RESULTS. S: Ignificant relief of pain syndrome in long-term period was observed in patients with higher density of pancreatic tissue in venous phase of CT compared to delayed phase. Moreover, these patients needed less additional enzyme intake and had higher QoL. Exocrine insufficiency depended on the number of preserved acinar cells. The percentage of preserved acinar cells also affects the QoL of patients with CP. There were no correlations between endocrine insufficiency and CT-findings, as well as the number of preserved acinar cells. CONCLUSION: Higher CT-density of pancreatic parenchyma in venous phase indicates a lesser degree of fibrosis. It is a favorable prognostic factor for postoperative pain relief and preservation of exocrine function. The percentage of preserved acinar cells in the resected pancreatic tissue is a reliable predictor of exocrine insufficiency.

[Computed tomography in determining the differentiation of ductal adenocarcinoma of pancreatic head]. / Vozmozhnosti komp'yuternoi tomografii v opredelenii stepeni differentsirovki protokovoi adenokartsinomy golovki podzheludochnoi zhelezy.

OBJECTIVE: To evaluate the features of «hypervascular rim¼, tumor dimensions and density as prognostic factors of differentiation of pancreatic head adenocarcinoma. MATERIAL AND METHODS: Pancreatoduodenectomy was performed in 311 patients with pancreatic head adenocarcinoma for the period 2013-2019. A retrospective study included 81 patients who met the following criteria: available data of morphological and immunohistological examination indicating tumor grade from Grade 1 to Grade 3, as well as available preoperative CT images in four phases (native, arterial, portal and delayed). Tumor dimensions, density of the pancreas, adenocarcinoma and abdominal aorta by the phases of contrast enhancement were analyzed in all patients. Moreover, we estimated coefficient of relative enhancement change. Perifocal hypervascular enhancement was assessed in arterial and portal phases. Contrast-enhanced MRI was performed in 15 out of 81 patients. MR images were analyzed regarding a hypervascular rim, and the last one was compared with CT images. RESULTS: There was no significant difference in density values between different tumor grades. Coefficient of relative enhancement change >1 was observed in 63.64% of highly-differentiated tumors. REC ≤1 was found in 85.11% of tumors grade 2 and 82.6% of tumors grade 3 (p=0.005). According to Chi-square test, there was a correlation between tumor differentiation and hypervascular rim (p=0.03). Moderate and low differentiation was observed in 96.42% of tumors with perifocal enhancement. Hypervascular rim was absent in 81.82% of tumors grade 1. Adenocarcinoma grade 2 was found in 85.71% of cases with unclear perifocal enhancement. CONCLUSION: Preoperative contrast-enhanced CT is valuable to assume the tumor grade in patients with pancreatic head adenocarcinoma due to assessment of hypervascular rim and REC.

Effect of Silicon Dioxide Nanoparticles on Syrian Hamsters Infected by Opisthorchis felineus: 1H MRS Study of the Brain.

In recent years, silicon dioxide nanoparticles have been widely used in medicine and the pharmaceutical industry, however, their effect on the brain has hardly been studied. We assessed the effects of long-term consumption of 5-nm amorphous silicon dioxide nanoparticles (SiO2-NPs) by Syrian hamsters infected with the trematodes Opisthorchis felineus on the hippocampus and frontal cortex. Spectroscopic determination of brain neurometabolites, performed using a horizontal Magnetic Resonance Imaging system at 11.7 Tesla magnetic field, has shown that the ratio of the excitatory neurotransmitters (glutamate + glutamine + aspartate) to the inhibitory ones (GABA + glycine) was higher in the animals infected with O. felineus. However, pre-consumption of the SiO2-NPs solution prevented this imbalance. In addition, the protective effect of SiO2-NPs on the level of myo-inositol and glycine was found. It is concluded that the use of SiO2-NPs can neutralize the negative effects of infectious factors on the brain.

[Miocarditis in Patients with COVID-19 Confirmed by Immunohistochemical].

Aim      Despite the regular heart damage in patients with coronavirus pneumonia caused by SARS-Cov-2, a possibility of developing lymphocytic myocarditis as a part of COVID-19 remains unsubstantiated. The aim of this study was to demonstrate a possibility of lymphocytic myocarditis and to study its morphological features in patients with the novel coronavirus infection (COVID-19) with a severe course.Material and methods   Postmortem data were studied for 5 elderly patients (74.8±4.4 years; 3 men and 2 women) with the novel coronavirus infection and bilateral, severe polysegmental pneumonia (stage 3-4 by computed tomography). COVID-19 was diagnosed based on the typical clinical presentation and positive polymerase chain reaction test in nasopharyngeal swabs. All patients were treated in different hospitals repurposed for the treatment of patients with COVID-19. A standard histological study was performed with hematoxylin and eosin, toluidine blue, and van Gieson staining. Serial paraffin slices were studied immunohistochemically with antibodies to CD3, СD68, CD20, perforin, and toll-like receptors (TLR) 4 and 9.Results In none of the cases, myocarditis was suspected clinically, added to the diagnosis or indicated as a possible cause of death. IHD and acute myocardial infarction were mentioned as error diagnoses not confirmed by the postmortem examination. The morphological examination of the heart identified signs of lymphocytic myocarditis consistent with Dallas criteria for this diagnosis. Myocardial infiltrate was characterized in detail, and a combined inflammatory damage of endocardium and pericardium was described. The immunohistochemical study with cell infiltrate typing confirmed the presence of CD3-positive Т lymphocytes and the increased expression of TLR-4. A picture of coronaritis, including that with microvascular thrombosis, was found in all cases.Conclusion      A possibility for development of lymphocytic viral myocarditis in COVID-19 was confirmed morphologically and immunohistochemically. Specific features of myocarditis in COVID-19 include the presence of coronaritis and a possible combination of myocarditis with lymphocytic endo- and pericarditis.

[Massive localized lymphedema of anterior abdominal wall]. / Massivnaya lokalizovannaya limfedema perednei bryushnoi stenki.

Massive localized lymphedema (MLL) is a rare disease observed in people with morbid obesity. MLL is easily confused with soft tissue sarcoma. Therefore, MLL is sometimes called as pseudosarcoma in the literature. MLL was initially described by G. Farshid and S. Weiss in 1998. However, etiology of MLL is still unknown despite certain relationships with injuries, operations and hypothyroidism. Since the term «MLL¼ was introduced only 20 years ago, there are no reliable statistical data on the prevalence of MLL. According to the World Health Organization data (2016), 13% of the adult world population are obese. Therefore, the risk of MLL is increased in these people. Thigh is the most common site of lesion. Abdominal wall lesion is rare and can cause diagnostic difficulties due to large dimensions and appearance. We report a 50-year-old obese woman with MLL of anterior abdominal wall. She experienced discomfort while walking and sleeping due to giant MLL of anterior abdominal wall that significantly reduced quality of life. Removal of MLL (weight 22160 g) was followed by favorable cosmetic and functional outcome. Analysis of differences between MLL and soft tissue sarcoma in the era of «obesity epidemic¼ is valuable for correct diagnosis and treatment of this rare complication. This report is the first case of MLL, registered in Russia. In our opinion, this is associated with insufficient awareness of physicians about this complication of obesity. We hope our observation will help clinicians to identify and treat this complication.

[Predicting of pancreatic fistula after pancreatoduodenectomy]. / Prognozirovanie vozniknoveniya pankreaticheskogo svishcha posle pankreatoduodenal'noi rezektsii.

OBJECTIVE: Identifying the opportunity of objective prognosis of pancreatic fistula emergence after pancreatoduodenectomy. MATERIAL AND METHODS: In the department of abdominal surgery in 2016-2019, 177 pancreatoduodenectomies for pancreatobiliary tumors were performed. 4 risk factors were identified: type of tumor, preoperative CT with an accumulation coefficient in the pancreas of more than 1, soft pancreas, the number of functioning acinar structures identified during intraoperative histological examination. Statistical data processing and predictive modeling were performed using a binary logistic regression model. RESULTS: Clinically significant pancreatic fistula was developed in 47 (26,6%) patients. Risk indicators for the occurrence of pancreatic fistula depending on the presence or absence of risk factors were obtained. Groups of patients were identified that require various preventive and therapeutic measures aimed to treat postoperative pancreatitis and its consequences. CONCLUSION: Predicting the pancreatic fistula emergence allows to take timely preventive and therapeutic measures, both minimal and aggressive (early extracorporeal detoxification, pancreatectomy), which may lead to complications. Well-reasoned pancreatectomy and extracorporeal detoxification is a surgeon's defense in an insured case or legal conflict.

[Duodenopancreatectomy for pancreatic tumors - pros and cons]. / Duodenopankreatéktomiia pri opukholiakh podzheludochnoi zhelezy - PRO ET CONTRA.

AIM: To optimize surgical treatment of multiple and advanced pancreatic tumors. MATERIAL AND METHODS: There were 852 patients with various pancreatic tumors for the period 2011 - September 2019. Duodenopancreatectomy (DPE) was performed in 18 patients. Locally advanced ductal adenocarcinoma was diagnosed in 10 patients, acinar cell carcinoma - in 1 patient, multiple neuroendocrine tumors - in 4 cases, intraductal papillary mucinous tumor - in 2 patients, multiple metastases of renal cell carcinoma - in 1 patient. This procedure was avoided in 9 patients who underwent alternative operations: pancreatoduodenectomy (PDE) with pancreatic body resection for intraductal papillary mucinous tumor - 5 cases, two-stage (2) and one-stage (1) distal pancreatectomy and PDE for multiple neuroendocrine tumors - 2 patients, simultaneous pancreatic head resection and distal pancreatectomy for multiple metastases of renal cell carcinoma - 1 patient. RESULTS: Postoperative complications occurred in 14 patients after DPE (77.8%) and in 5 patients after alternative operations (55.5%). Alternative procedures in patients with neuroendocrine tumors, intraductal papillary mucinous tumors and metastases of renal cell carcinoma ensured radical surgical treatment. These patients did not need for insulin replacement therapy and enzyme drugs. CONCLUSION: Strict adherence to oncological canons and differentiated approach in patients with multiple neuroendocrine tumors, metastases of renal cell carcinoma and intraductal papillary mucinous tumors are essential to avoid DPE in some cases in favor of alternative operations.

[Novel Genes Associated with the Development of Carotid Paragangliomas].

Carotid paragangliomas (CPGLs) are rare neuroendocrine tumors of the head and neck. "Germline" and somatic mutations in a number of genes were shown to be associated with the development of CPGLs; however, molecular mechanisms of the tumor pathogenesis have not been fully understood. In the work, we have used whole exome sequencing data of 52 CPGLs obtained earlier. Using MutSigCV, the search for genes with high mutation rate was performed. Thirty four genes (MADCAM1, SARM1, ZFPM1, CTDSP2, DSPP, POTED, ANP32B, FRG2B, BAGE3, CCDC89, ACOT2, KRTAP10-1, ATXN1, GXYLT1, MUC2, AQP7, TMPRSS13, KRTAP4-3, PRR21, PSPH, PLBD1, ZNF595, IGSF3, PRR16, FAM157A, KCNJ12, HYDIN, IGFBP2, KIAA1671, DISC1, MUC6, XKR3, HRNR, and MUC4) potentially associated with the CPGL initiation and progression were revealed. The involvement of these genes in the pathogenesis of CPGLs was first shown, and possible mechanisms of their participation in that were discussed.

[The expression of moesin, p21-activated kinase 4 (PAK 4), matrix metalloproteinases (MMP 2, MMP 9), and CD34 in the eutopic and ectopic endometrium in adenomyosis]. / Ékspressiia moézina, p21-aktivirovannoi kinazy 4 (PAK 4), matriksnykh metalloproteinaz (MMR 2, MMR 9) i CD34v éutopicheskom i éktopicheskom éndometrii pri adenomioze.

OBJECTIVE: To investigate the expression of moesin, p21-activated kinase 4 (PAK 4), matrix metalloproteinases (MMP 2, MMP 9), and CD34 in the eutopic and ectopic endometrium in different forms of adenomyosis. MATERIAL AND METHODS: Fifty uteri removed for diffuse adenomyosis and for adenomyomas were examined in reproductive-aged (n=25) and premenopausal (n=25) women. A comparison group included 20 uteri removed for intramural and subserosal fibroids in reproductive-aged and premenopausal women. The investigators performed histological and immunohistochemical (using antibodies to moesin, PAK 4, MMP 2, MMP 9, and CD34) examinations of the eutopic and ectopic endometrium. RESULTS: Different forms of adenomyosis were characterized by the irregular border of the endometrium and myometrium due to that there were multiple foci of ingrowth of the basal layer of the endometrium through the terminal plate into the myometrium. In both diffuse adenomyosis and adenomyomas, the basal layer of the eutopic and ectopic endometrium differed many (3-8.5) times, showing the higher expression of the enzymes in the epithelial and stromal cells, which affected their invasive activity (moesin, PAK 4, MMP 2 and MMP 9), and the increased number of CD34 cells in its stroma. At the same time, there were no statistically significant differences in their expression in the basal layer of the eutopic and ectopic endometrium in diffuse adenomyosis and adenomyomas. CONCLUSION: The findings favor the theory of the pathogenesis of adenomyosis due to the invasion of the eutopic endometrium into the myometrium.

[Haemangioma of the left atrium]. / Gemangioma levogo predserdiia.

Presented herein is a clinical case report concerning successful surgical management of a rare variety of a primary tumour of the heart, i. e., a capillary haemangioma of the left atrium, simulating by the contours and localization a myxoma. The final diagnosis was verified only by histological examination. The authors describe difficulties of diagnosis of the disease involved, underlying the necessity of plastic correction for restoration of the normal anatomical configuration of the heart. This is followed by a review of the literature, reflecting a possible course of the disease, problems of diagnosis, and therapeutic policy.

[Surgical treatment of retroperitoneal masses]. / Khirurgicheskoe lechenie neorgannykh zabriushinnykh opukholei.

AIM: To improve the results of treatment of patients with retroperitoneal tumors. MATERIAL AND METHODS: The study included 83 patients with retroperitoneal tumors including 57 cases of benign tumors and 26 patients with malignancies. Laparotomy (Lt), robot-assisted (RA) and laparoscopic (Ls) techniques were used in 35, 34 and 14 patients respectively. Median tumor sizes in the largest dimension were 102 mm, 75 mm and 81.5 mm in Lt, RA and Ls groups respectively. RESULTS: Average time of surgery was 112.5 minutes in Lt-group, 140 min in RA group and 125 minutes in Ls group. Median blood loss was 125 ml, 50 ml and 50 ml in the same groups respectively. Conversion was performed in 1 patient during RA-surgery and in 7 patients during laparoscopy. Postoperative complications occurred in 6 patients after laparotomy and in 5 patients after RA-intervention. There were no deaths. CONCLUSION: Comprehensive evaluation of different surgical methods is necessary to achieve successful treatment of retroperitoneal tumors. Conventional approach is indicated for tumors over 10 cm while minimally invasive techniques are justified for tumors less than 10 cm. RA-interventions facilitates surgery for tumors located in difficult areas and small anatomical spaces as well as for neoplasms adjacent to great vessels.

[Clinico-pathological factors and prognosis scale for portal cholangiocarcinoma]. / Kliniko-patologicheskie faktory i shkala prognoza pri vorotnoi kholangiokartsinome.

INTRODUCTION: The objective of this study was to derive a prognostic scale to predict overall survival (OS) after a curative resection of perihilar cholangiocarcinoma (PHC). MATERIAL AND METHODS: The data of 55 patients with portal cholangiocarcinoma were analysed. Patients were treated at the A.V. Vishnevsky Institute of Surgery from 2011 to 2015. Surgical treatment after biliary decompression was performed in 37 (67.3%) patients. In the long-term period we observed 36 (97.3%) of the operated patients. The dependence of the OS of clinical and pathological factors of the tumor was analysed using mono- and multifactor regression analysis of Cox proportional hazards models for all operated patients. RESULTS: Total 1-3-, 5-year survival rate was 75.1, 60.5, 37.7, 35% respectively. Significant prognostic factors (monofactorial analysis) include perineural (p=0,05) and vascular invasion (p=0,049), R1 resection (p=0,01), disease stage III or higher (p=0,03), invasion of SI liver (p=0,004), tumor cells differentiation degree (grade) 2 and higher (p=0,0006). Multifactor analysis revealed that the low OS have determined by perineural (p=0,05) and vascular invasion (p=0,008), the degree of differentiation of tumor cells (p=0,001), disease stage (p=0,05), surgical resection margin (p=0.0345). Developed method of predicting OS is a score of prognostic factors. CONCLUSION: The scale of individual prognosis in patients PHC takes into account both clinical and histopathological tumor characteristics. This scale may be useful to optimize the individual treatment.

[Mucinous cystic liver tumors: diagnosis and surgical treatment]. / Mutsinoznye kistoznye opukholi pecheni: diagnostika i khirurgicheskoe lechenie.

AIM: To optimize diagnostics and treatment of cystic liver tumors. MATERIAL AND METHODS: The analysis included outcomes of 46 patients with liver cystic tumors. RESULTS AND DISCUSSION: The use of abdominal Doppler-sonography (37 patients), abdominal contrast-enhanced CT (44 patients) and MRI of abdominal cavity with MR-cholangiography (24 patients) defined radiological semiotics of cystic liver diseases. The most important features of cystic tumors are intraluminal septums with blood flow (82% of patients), solid component (6.8%), daughterly cysts (11.3%), as well as biliary hypertension (39.2% of patients). Research of oncomarkers (CEA, SA 19-9, AFP) in 40 patients showed increased level of SA 19-9 only in case of cystadenocarcinoma and intraductal papillary mucinous neoplasm of biliary type. Benign and malignant cystic tumors had increased contents of oncomarkers in all cases. Surgical treatment was used in 42 patients. Extended liver resections were performed in 10 (23.8%) patients, atypical and anatomical resections (removal of less than 3 segments) - in 31 (73.8%) patients. In one case we applied cryoablation of CA in segment I of the liver in view of invasion into the wall of inferior vena cava and hepatoduodenal ligament. In 2 cases surgery was carried out laparoscopically. Also robot-assisted technique was used in 3 patients. Immunohistochemical study was performed in 22 (44.8%) patients. The diagnosis of CAC and biliary type of IPMN was confirmed in case of high expression of CK7, SK19, MUC1, S100p, SDH2, p53 antibodies. Cystadenomas were associated with moderate expression of ER, PR and p53 antibodies by stroma and CK7, SK19, CDX2, MUC1, S100p antibodies by epithelium. CONCLUSION: There are considerable difficulties of differential diagnosis of liver cystic tumors. Therefore, the use of single algorithm of diagnostics and treatment is necessary to confirm accurately the diagnosis at the perioperative stage. Cystic tumor is more likely to be assumed in women with solitary cyst in segment IV of liver. If the diagnosis is suspected or confirmed anatomical liver resection with complete tumor removal is necessary to prevent the recurrence.

[Diagnosis and treatment of duodenal dystrophy in patients with chronic pancreatitis]. / Diagnostika i taktika lecheniya duodenal'noi distrofii u bol'nykh khronicheskim pankreatitom.

AIM: to define optimal treatment of duodenal dystrophy in patients with chronic pancreatitis. MATERIAL AND METHODS: 515 patients with chronic pancreatitis have been treated for the period 2004-2015 in A.V.Vishnevsky Institute of Surgery. Duodenal dystrophy (DD) was diagnosed in 79 (15.3%) of them. The diagnosis was confirmed by sonography, CT, MRI and endosonography. 5 patients are under observation without surgery. 74 patients were operated after previous medical therapy during 39 months on the average. Pancreatoduodenectomy was performed in 36 patients. Organ-sparing interventions were applied in 34 cases including different duodenal resections in 20 patients and pancreatic head resections in different modifications in 14 cases. 4 patients underwent palliative surgery. Chronic pancreatitis and DD were verified by morphological analysis of specimens. Long-term results were estimated in 47 patients. Median follow-up was 49.9 months. RESULTS: X-ray diagnostics showed that DD was combined with chronic pancreatitis in 87.3% of cases while morphological analysis revealed 93.8%. Clinical signs of DD were caused by striated pancreatitis in 69.6% and ectopic pancreatic tissue in 30.4%. Clinical manifestations of DD did not depend on its cause and were presented by symptoms of chronic pancreatitis. Postoperative complications occurred in 25 (34.7%) patients. There were 33.5% of complications after pancreatoduodenectomy and 70% after duodenal resection. 1 patient died. Overall mortality was 1,3%. In long-term period complete regression of symptoms was observed in 66% of cases, significant improvement - in 32%, absence of the effect - in 2%. CONCLUSION: Medical therapy should be preferred for patients with DD and chronic pancreatitis. Surgery is indicated in case of persistent pain, complicated course of chronic pancreatitis and duodenal obstruction. Pancreatoduodenectomy and pancreatic head resection are preferred.