Vol 7, No 1 (2017)

In the article a case of non-resectable differentiated thyroid cancer (DTC) is described. A recurrent thyroid tumor deforms the oropharyngeal lumen and laryngeal vestibule and bears down on the left esophageal wall and trachea. The authors present literature data on Nexavar target therapy and focus on the fact that no cases of combination treatment with target therapy and surgery of non-resectable progressive DTC were described until now. In view of this, this clinical report is unique and dictates a need to determine new Nexavar (Sorafenib) indications for use in a neoadjuvant regimen.

Establishment of new centers for nuclear medicine in our country made diagnostic and treatment procedures more accessible for patients with differentiated thyroid cancer (DTC). It includes radioiodine therapy, considered as a non-alternative method of treatment, and positron emission tomography combined with computed tomography (PET/CT), which is essential in some clinical cases. For many years suspected tumor relapse with increased level of thyroglobulin and negative radioiodine scan was the only indication for PET/CT use among patients with DTC. But over the last decade the indications for PET/CT use in DTC cases expanded significantly. This review is aimed to analyze currently available data on PET/CT in DTC patients, its indications for use, advantages and limitations, new trends and recommendations.

Objective. Study of local lymphogenic metastasis (inside the conjunctiva) of conjunctival melanoma.

Introduction. Conjunctiva is a transparent mucous membrane with a large number of blood vessels. Normally, it contains melanocytes which explains possibility of development of pigmented tumors in the conjunctiva. Conjunctival melanoma is a rare tumor:
it constitutes about 1–3 % of all malignant tumors of the ocular adnexa, and according to different authors its incidence rate is 0.02–0.08 for 100 thousand people. Melanoma is characterized by frequent recurrences and hematogenic and lymphogenic metastases.

Materials and methods. Fifteen (15) patients with conjunctival melanoma were included in the study. Tumor recurrence and/or tumor seeding were reasons for inclusion in the study. For graphic representation of tumor localization, we developed a diagram of the conjunctival surface which subsequently was improved using a diagram of lymphatic vessels of the bulbar conjunctiva. An interpretive map of the conjunctival surface produced this way was taking into account lymph node structure of the bulbar conjunctiva.

Results and discussion. Recurrence was observed only in 4 of 15 patients. Seedings were usually localized in neighboring or distant areas in respect to the primary lesion localization, which, supposedly, can be explained by the structure of conjunctival lymphatic system.

Conclusion. In one third of the cases (in 5 of 15 patients) primary tumors were localized near large lymphatic vessels. Moreover, in all cases seeding was observed near the same lymphatic collectors, but at a distance from the primary lesion localization. This confirms possibility of local metastasis through conjunctival lymphatic paths.

Objective: to improve the results of parotidectomy with using the simultaneously reconstruction surgery in the postoperative defects.

Background. The radical surgical treatment for salivary gland tumors is parotidectomy with preservation of the facial nerve. However, this treatment leads to postoperative defects and Frey’s syndrome (25 % of cases). Elimination of the above-mentioned disadvantages requires plastic, reconstructive surgery.

Materials and methods. In the department of head and neck tumors in the National Cancer Center of Uzbekistan during the period 2015 to 2016 were performed parotidectomy with preservation of the facial nerve and simultaneous retromandibular zone reconstruction with displacing muscle flap in 29 patients. In 25 (86 %) patients diagnosed mixed tumor (pleomorphic adenoma) and 4 (14 %) patients had cancer of parotid gland with the verification of histology.

Results. In all of 29 patients were performed parotidectomy with preservation of the facial nerve and the simultaneous reconstruction of retromandibular zone with displacing own bodymuscle flap reduced postoperative complications, which had been revealed before as a defect and hypersensitivity of the retromandibular area.

Conclusions. Reconstructive-restorative surgery in patients with tumors in the parotid gland after parotidectomy with saving of the facial nerve is decreased number of cosmetic defect and hypersensitivity. Using the own bodymuscle flap is preferred to patients than allotransplant.

The article considers supportive therapy in patients with head and neck tumors during radiotherapy and chemoradiotherapy. Special attention is given to nutritional support on every stage of patient care. The main methods of evaluation of nutritional status and risks are presented, as well as principles of clinical nutrition selection.

Objective. Determination of mutation rates in KIT, NRAS and BRAF genes in 21 samples of mucosal melanoma of the upper aerodigеstive tract.

Background. Head and neck mucosal melanomas (or upper aerodigestive tract mucosal melanomas) are rare and aggressive tumors of melanocytic origin. Head and neck mucosal melanoma (HNMM) comprises over 50 % of all mucosal melanomas. The aim was to determine the KIT, NRAS and BRAF mutation frequencies in 21 series of primary HNMM.

Methods. Microdissected tumour cells were used from 21 formalin-fixed paraffin-embedded tumours. The tumour cells were screened for KIT, NRAS and BRAF mutations by direct sequencing.

Results. Overall, 19 % (4 out of 21) of HNMMs harboured KIT, NRAS or BRAF mutations. Mutations in these oncogenes occurred in a mutuаlly exclusive manner. Both NRAS and BRAF mutations were identified at a similar frequency of 4,75 % each (1 and 1 out of 21), whereas KIT mutations were detected in 9,5 % (2 out of 21) of the HNMMs. KIT mutations were located in exon 11.

Conclusion. Our findings shоw that NRAS and BRAF mutations, which are aсcessible for present targeted thеrapies, are only rarеly present in HNMMs, whereas KIT mutations seem to be relatively more frequent.

Data on 3597 patients with primary malignant tumors of the visual organ were submitted to the Moscow City Cancer Register of the Moscow Healthcare Department in 2006–2015. Rate of eyelid skin cancer is 75.62 %. Calculated incidence is 3.4 per 100,000 population. The peak of the disease is at 70–80 years of age. The disease was diagnosed in people of age 46–85 years, it was 66.65 % more frequent in women than in men. Basal cell carcinoma comprised 91.14 % of all cases. In 65.7 % of cases the tumor was diagnosed at stage Т1 and Т2, and at stage Т1, when patient can be cured, only in 34 % of cases. 

Objective. Study of incidence of malignant eyelid tumors of epithelial genesis, their prognostic characteristics using data from Moscow City Ophthalmic Oncology Center and Ophthalmic Oncology Department of the Branch # 1 “Ophthalmology Clinic” of the S.P. Botkin City Clinical Hospital of the Moscow Healthcare Department.