The study objective was to investigate the role of ¹⁸ F-fluorodeoxyglucose (¹⁸ F-FDG) positron emission tomography combined with computed tomography (PET-CT) as an indirect determination of the differentiation status of metastases and for the prediction of radioactive iodine (RAI) therapy response in patients with metastatic differentiated thyroid cancer.
Materials and methods. The 40 metastatic differentiated thyroid cancer patients were enrolled in the study that underwent both post-therapeutic radioiodine scan and PET-CT at the same period.
Results. The study found that 12 (30 %) patients responded to RAI therapy. The remaining 28 (70 %) patients not responded to RAI therapy showed stabilization or progression. The accumulation of radioiodine by metastases positively correlated with the total response rate, while the ¹⁸ F-FDG avidity is negative. Significant direct correlation with response rate was observed in the group with only radioiodine uptake. However, this correlation was not observed in the patients with both tracers uptake. The patients with ¹⁸ F-FDG-positive metastases showed poor response to RAI therapy, regardless of the degree of radioiodine uptake.
Conclusion. The ¹⁸ F-FDG uptake by metastases is a predictor of a poor response to RAI therapy, even in the presence of RAI uptake. The use of ¹⁸ F-FDG PET-CT in patients with metastatic differentiated thyroid cancer can be recommended at the beginning of RAI therapy to clarify the prognosis and provide a personalized approach to the treatment and observation of the most difficult category of patients.

The study objective is to explore the potentialities of ultrasound in the detection of metastasis from papillary thyroid cancer (PTC) to cervical lymph nodes in levels II–IV.
Materials and methods. In 97 patients with first diagnosed PTC, surgical removal of the cervical lymph node-bearing fat at levels II–IV was performed. All patients underwent preoperative neck ultrasound. The results were verified by histology.
Results. Cervical levels II–IV lymph node metastases were revealed in 82 (84,5 %) cases by sonography and in 86 (88,6 %) cases by histology. Ultrasound showed a sensitivity of 93 %, specificity of 81 %, accuracy of 91 %, positive predictive value of 97 % and negative predictive value of 60 %. Of 1620 removed lymph nodes, 443 (27,3 %) showed metastases confirmed by histology. Sonography revealed 422 (26,0 %) metastatic lymph nodes. Metastasis from intra-thyroid tumors was noted in 94,1 % and from extra-thyroid tumors in 87,5 % of patients. Metastasis from solitary tumors occurred in 86,5 % and from multicentric tumors in 92,1 % of cases. Multiple metastases made up 89,5 % and solitary metastases – 10,5 %.
Conclusion. Sonography is a highly informative diagnostic imaging method in detecting metastasis from PTC to levels II–IV cervical lymph nodes and can be used for basic assessment of thyroid abnormalities.

The study objective is to evaluate the diagnostic capabilities of complex method based on the use of ¹⁸ F-fluoroethyltyrozine positron emission tomography (PET) combined with computed tomography (CT) and CT perfusion in the differential diagnosis of glial brain tumors.

Materials and methods. One hundred and two patients with glial brain tumors were included in the study. Depending on the degree of malignancy patients were divided into 2 groups: group 1–38 (37.26 %) patients with grade I–II tumors; group 2–64 (62.74 %) patients with grade III–IV tumors. Perfusion CT was performed in 20 (52.6 %) patients from the group with grade I–II tumors and 37 (57.8 %) patients from the group with grade III–IV gliomas. The sensitivity and specificity of such indicators as the maximum standardized uptake value (maxSUV) and the tumor to brain ratio (TBR), in combination with CT perfusion indicators (cerebral blood flow (CBF), cerebral blood volume (CBV), vascular permeability (FED) were studied.

Results. The highest diagnostic accuracy was demonstrated by the following parameters: maxSUV 1 (sensitivity and specificity 81 and 82 %, threshold value 2.51, AUC 0.87); TBR ₁ (sensitivity and specificity 90.6 and 81.6 %, threshold value 2.07, AUC 0.89). The comprehensive evaluation of CT perfusion and ¹⁸ F-fluoroethyltyrozine PET / CT parameters: sensitivity and specificity of TBR ₁ + CBF – 97.1 and 94.4 %, respectively; TBR ₁ + CBV – 96.6 and 94.4 %, respectively; TBR ₁ + FED – 94.6 and 92.3 %, respectively.

Conclusion. According to results of obtained analysis, an increase in diagnostic accuracy was revealed for all studied parameters with complex use of two methods – ¹⁸ F-fluoroethyltyrozine PET / CT and CT perfusion, in differential diagnosis of glial brain tumors.

The study objective is to analyze the experience of conformal radiotherapy in combination with cetuximab for cervical lymph node (LN) metastasis in patients with early-stage tongue cancer who had undergone multicomponent surgeries.

Materials and methods. This retrospective study included 48 patients with primary squamous cell carcinoma of the tongue (Т1–2) that were treated in Nizhny Novgorod Regional Clinical Oncology Dispensary between 2012 and 2019. The experimental group comprised 25 patients who underwent hemiglossectomy with simultaneous preventive cervical lymph node dissection. The control group was composed of 23 patients who underwent hemiglossectomy alone due to the presence of concomitant somatic pathology. Before surgery, none of the patients had any signs of metastatic lesions in the cervical LNs according to the results of clinical and instrumental examinations. After surgery, 100 % of patients from the experimental group were found to have N1–2b cervical LN metastases at histological examination. Patients from the control group developed clinical signs of cervical LN metastasis within a year after operation. All patients underwent radiotherapy. The experimental group was divided into two subgroups: patients from subgroup 1 (n = 11) received cetuximab due to disease progression, whereas patients from subgroup 2 (n = 14) received cisplatin. Participants from the control group received no chemotherapy due to their concomitant somatic disorders and because regional metastasis was not confirmed.

Results. In the control group, the time between surgery and patient’s death varied between 8 and 14 months. Patients from subgroups 1 and 2 survived for 12–60 months and 8–48 months respectively. So far, 9 patients from subgroup 1 and 6 patients from subgroup 2 are alive. Among them, 8 participants from subgroup 1 and 4 participants from subgroup 2 have no signs of disease progression. Three patients from subgroup 2 died of cardiovascular diseases (they had no cancer progression within 3 months after the completion of chemotherapy).

Conclusion. Preventive lymph node dissection in patients with stage Т1–2 tongue cancer enables early detection of subclinical N1–2b metastases and ensures timely initiation of therapy. Our experience confirmed safety of cetuximab plus radiotherapy used to improve disease control and increase patient’s survival.

The study objective is to provide data on the use of the Hedgehog signaling pathway inhibitor (vismodegib) in the treatment of recurrent locally advanced and metastatic basal cell skin cancer at the N. N. Petrov National Medical Research Center of Oncology.

Materials and methods. Clinical data of 10 patients who participated in a multicenter, non-randomized clinical trial of phase II ERIVANCE BBC (ClinicalTrials. gov NCT833417). Patients took the daily studied drug vismodegib orally at a dose of 150 mg daily until disease progression or intolerance due to side effects. Efficiency and safety assessment was carried out once every 4 weeks.

Results. Complete regression was achieved in 7 patients, while the average duration of use of the drug was 240 ± 65 days. Stabilization was observed in 2 patients, the minimum duration of the drug was 336 days. One patient showed progression after 728 days of taking the drug. Side effects of the 1 grade according to CTCAE (Common Terminology Criteria for Adverse Events), v. 3.0 were observed in all patients, in 9 they were expressed in muscle cramps, alopecia and changes in taste sensitivity, and in 1 patient isolated in the form of muscle cramps.

Conclusion. The results show a good safety profile of vismodegib, which allows it to be used in elderly patients with concomitant pathology. The frequency of response to treatment, including the achievement of complete regression in 70 % of patients, makes vismodegib an acceptable treatment option for metastatic form of basal cell skin cancer and relapse of locally advanced forms.

The study objective is to estimate the prevalence of different tumors of the visual organ among the adult population of the Nizhny Novgorod Region.

Materials and methods. Epidemiological study was conducted on the basis of a retrospective analysis of medical documents of 1601 patients over 18 years of age, both sexes and different age groups receiving treatment and diagnostic measures in the period from 2008 to 2017.

Results. It was found that the share of benign tumors accounted for 64.08 %, and malignant – 35.92 %. The most common tumors of the eyelids, epithelial benign diseases account for 25.23 %. Among tumors of the uveal tract (21.17 %) malignant neoplasms in the choroid are 10.68 %.

Conclusion. In the structure of oncopathology of the population of the Nizhny Novgorod Region, eyelid tumors are common, most of which are of epithelial origin. Among the neoplasms of the uveal tract malignant neoplasms of the choroid prevail.

According to the American Thyroid Association’s 2015 guidelines: “Since hyperfunctioning nodules rarely harbor malignancy, if one is found that corresponds to the nodule in question, no cytologic evaluation is necessary”. These findings are based on numerous studies proving the rareness of the combination of functional autonomy and thyroid cancer, and when such casuistry is detected, the non-aggressive course of the malignant process is observed.
Rare revealing of malignant nodules functional autonomy can be attributed to several fundamental bases of non-medullary thyroid carcinoma pathogenesis. According to one of the hypotheses of carcinogenesis, dedifferentiation of thyrocytes occurs initially with the loss of the possibility of the sodium-iodine symporter synthesis, and later of the thyroid-stimulating hormone receptor synthesis by the cell, which reduces the hormone production by tumor cells. In addition, hyperthyroidism has a protective feature. It reduces the level of thyroid-stimulating hormone (which causes hypertrophy, hyperplasia of thyrocytes and has an antiapoptotic effect). This protective function is used in practice for suppressive therapy in the postoperative period, which reduces the progression, recurrence and mortality from thyroid cancer. The above circumstances prove the rareness of the clinical observation described below, which deserves additional attention and subsequent discussion.

The study objective is to present a rare clinical case of an aggressive myofibroblastic tumor of the tongue.
Clinical case. A 24-year-old patient was revealed a 44 × 25 × 50 mm volumetric formation of the left side of the tongue spreading to the contralateral side and bottom of the oral cavity. The patient denied injuries or chronic autoimmune diseases. Additional studies did not reveal failure of other organs or systems. Histological conclusion: malignant spindle-polymorphic cell neoplasm with myxomatosis, perineal growth, muscle fiber infiltration and their death. An immunohistochemistry revealed expression of vimentin, CD34, S100; Ki-67 – 30 % in tumor cells. He was diagnosed with T3N0M0 fibrosarcoma of the tongue. Subtotal resection of the tongue with simultaneous microsurgical plasty via re-activated radiation autograft was performed. According to morphological study of the removed tissues, he was finally diagnosed with an aggressive inflammatory myofibroblastic tumor of the tongue. Observation period at the time of writing was 15 months. The patient eats solid food, sound pronunciation is restored in full. There are no signs of relapse or metastasis.
Conclusion. Diagnostics of an inflammatory myofibroblastic tumor of the oral cavity is complex and depends on clinical and morphological features of a particular tumor. We need reliable criteria to differentiate aggressive forms of inflammatory myofibroblastic tumor of the tongue from non-aggressive ones to choose treatment. The main difficulties arise in determining the resection volume and predicting relapse or metastasis.

The implementation of robotic surgery, in particular the da Vinci surgical system, is one of the biggest breakthroughs in surgery since the invention of anesthesia, and represents the most significant achievement in minimally invasive surgery of this decade. If the use of the da Vinchi robotic system in pelvic surgery has long been the gold standard, the use of this system in surgery of the base of the skull and sinuses is quite rare and is currently more experimental. Due to the lack of description in the domestic and foreign literature, it seems interesting to us to demonstrate the clinical observation of a patient with an orbital tumor.