Introduction. Oral squamous cell carcinoma is associated with a high risk of regional metastasis even in early stages (T1–2N0M0). Morphological examination reveals concealed metastases in 20 % of removed clinically unaffected lymph nodes.

Objective – to evaluate the effectiveness of flow cytometry for detection of concealed metastases in sentinel lymph nodes as an indication for cervical lymph node dissection in patients with stage сT1–2N0M0 oral squamous cell carcinoma.

Materials and methods. This study included 27 patients, including 13 patients (48.1 %) with stage T1N0M0 cancer and 14 patients with stage T2N0M0 cancer (51.9 %). At the first stage, all participants underwent primary tumor removal and cervical lymph node dissection with sentinel lymph node examination. After mobilization, half of these lymph nodes was used for routine morphological examination followed by immunohistochemical examination, while the second half of them was analyzed using flow cytometry. Then we compared the results obtained.

Results. We examined 46 removed sentinel lymph nodes from 27 patients. Conventional histological examination revealed 4 concealed metastases (8.7 %). Polymerase chain reaction allowed us to detect another 16 metastases (37.8 %). Levels I, II, and III lymph nodes were most frequently affected. Flow cytometry demonstrated that 20 % of patients with a <4 mm invasion had concealed metastases, whereas patients with a 4 to 8 mm invasion had concealed metastases in 60 % of cases. Median follow-up time was 20.4 ± 11.7 months (range: 2.2 to 42.5 months; median 19.5 months). All participants were alive during this time. Seventeen out of 27 patients with stage T1–2N0M0 disease (63 %) were found to have concealed metastases, while the remaining ten patients (37 %) had no metastasis. One patient with stage T1N0M0 oral floor squamous cell carcinoma underwent the removal of the primary tumor and sentinel lymph node. Morphological examination and flow cytometry showed no metastatic lesions. After 14.8 months, the patient developed ipsilateral regional CN3 metastasis. The three-year progression-free survival rate was 94.7 ± 5.1 %.

Conclusion. Highly sensible and rapid flow cytometry can become the method of choice in the diagnosis of metastases and deciding on cervical lymph node dissection in patients with cN0 disease. The study is still ongoing.

Introduction. The surgical stage takes an important place in the complex treatment of patients with cerebral metastases of malignant tumors. In general, all efforts during surgical intervention should be aimed at restoring a good functional status, since severe neurological symptoms can deprive patients of the opportunity to continue complex treatment, which will negatively affect overall survival. The most pronounced neurological symptoms are observed in patients with metastases in the motor area. In this article, we tried to substantiate the need for surgery of cerebral metastases in patients with severe motor deficits, evaluate the results of surgical treatment and also to develop optimal surgical removal techniques.

The study object – to assess the effectiveness of surgical removal of metastases in the motor cortex by evaluating the dynamics of motor function recovery and regression of paroxysmal symptoms.

Materials and methods. An analysis of the surgical treatment of 18 patients with metastases in the motor area was carried out. Tumor localization was verified using magnetic resonance imaging, before surgery, neuronavigation system Brainlab during surgery. Мagnetic resonance tractography made it possible to assess the localization and degree of compression of the fibers of the cortico-spinal tract. Functional monitoring was not performed during the operation. The operations were performed using a ZEISS OPMI PENTERO 800 microscope.

Results. Recovery of motor function after surgery was noted in 17 (94.5 %) cases. It was complete or partial. With metastases of a solid, solid-necrotic, solid-cystic structure, regression of pyramidal symptoms developed gradually, starting from 4 days after surgery. As a rule, rehabilitation therapy (therapeutic exercise, massage, electromyostimulation) is carried out on patients from 3 days after surgery, which accelerated the recovery process. The maximum effect developed on the 15th day after the operation. Faster recovery of motor function was observed in patients with large cystic metastases who underwent surgery in the volume of Ommaya reservoir implantation. They began to recover motor function a few hours after awakening. Regression of paroxysmal symptoms was noted in all cases. Although the patients continued to take anticonvulsants. The observation period was 6 months.

Сonclusion. Surgical removal of cerebral metastases in the motor area allows achieving complete or partial regression of neurological symptoms. At the same time, the recovery period is short – from several hours to 14 days. It becomes possible to cancel glucocorticoids 7–10 days after the operation. Conditions are being created for the continuation of complex treatment of patients previously considered incurable.

This article discusses current approaches to first-line chemotherapy for non-resectable head and neck squamous cell carcinoma and describes factors affecting the choice of treatment regimen according to the results of randomized clinical trials. We provide a rationale for creating a long-term strategy of chemotherapy in different clinical situations. We also report two cases of concomitant administration of cetuximab and platinum-based therapy as an example of high efficacy of monoclonal antibodies.

Introduction. The frequency of intraocular metastases is 64–67 % of all metastatic tumors of eye, with the choroid being mainly affected (88–90.7 %). In the majority of cases, metastases are localized in the central regions of the fundus (in 80 % between the equator and the macular zone) and, are characterized by rapid growth and rapid symptoms increase. There is practically no information in the literature about choroidal metastases foloww-up during polychemotherapy.

The study objective – to analyze changes in the optical coherence tomography (OCT) of the choriodeal metastatic lesion at the end of polychemotherapy.

Materials and methods. Three patients with choroidal metastases were under observation. Two of them were examined once after polychemotherapy. One patient was examined in dynamics before and after the end of polychemotherapy.

Results. In all cases, there was a decrease in the thickness of the choroidal complex, compaction of its structure, impaired visualization of the choriocapillaries in the area of metastases localization in the choroid, detected by OCT after polychemotherapy, which should be regarded as evidence of the replacement of the metastatic focus with a scar. Optical coherence tomography – angiography indicates the appearance of ishimization in the projection of the inner choroidl layers, which is evidence of pronounced vascular disorders. We believe that the signs of vascular collateral formation at the level of the choriocapillary layer revealed by OCT-angiography indicate a compensatory reaction of the body.

The study objective – to identify specific morphological criteria characteristic of papillary thyroid cancer with translocations in the NTRK genes.

Materials and methods. A retrospective analysis of 130 cases of morphologically confirmed papillary thyroid cancer from the archives of the Moscow City Oncology Hospital No 62, Moscow Healthсare Department was performed. The morphological selection criteria for the immunohistochemical study were: metastatic lesions of the lymph nodes, microcalcifications, extrathyroid spread of the tumor, the presence of a capsule / intratumorous areas of connective tissue, invasion (into the tumor capsule, blood vessels, lymphatic vessels), the presence of intranuclear pseudo-inclusions, the follicle quantity <5 %. Thus, all criteria of thyroid cancer with detected translocation in NTRK genes found in the literature were used. If the tumor met the criteria we performed an immunohistochemistry study with Ventana pan-TRK (EPR17341) Assay antibodies was performed on a BenchMark Ultra immunoassayer. In case of a positive immunohistochemistry reaction, next-generation sequencing on the Illumina HiSeq high-throughput genome-wide sequencing system.

Results. Of the 130 cases analyzed, we identified 10 cases of tumor with histological features characteristic of NTRK positive thyroid cancer. In all cases, the disease was characterized by an indolent course, a slow increase in the tumor over a long time. In patient 5, a tumor of the thyroid gland was combined with extra-organ sarcoma of the retroperitoneal space. The sizes of the tumor node varied from 0.5 . 0.5 cm to 4.0 . 3.0 cm. All patients had metastases to the lymph nodes, in 3 cases the tumor grew beyond the thyroid capsule. According to the results of an immunohistochemical study with antibodies to NTRK (out of 10 applicants) mutation was detected in 1 case. Cytoplasmic expression of varying severity was observed in 95 % of tumor cells. TPM3‑NTRK1 translocation was confirmed by next-generation sequencing.

Conclusion. The presented study demonstrates the possibility of using morphological criteria for detecting thyroid tumors with mutations in the NTRK genes. In the case of a larger sample, it will be possible to identify the structural features of tumors with NTRK mutations. This will clarify morphological criteria and increase the probability of detecting a mutation, which is essential when choosing treatment methods (prescribing targeted therapy).

Introduction. The increasing incidence of oropharyngeal squamous cell carcinoma observed globally in recent decades gave rise to research in this area. In 2005, human papillomavirus was proved to be an etiological factor of oropharyngeal squamous cell carcinoma. Currently, oropharyngeal squamous cell carcinoma associated with human papillomavirus is believed to have some unique characteristics. The analysis of oropharyngeal squamous cell carcinoma epidemiology appears to be highly relevant.

Objective – to assess the incidence and prevalence of oropharyngeal squamous cell carcinoma associated with human papillomavirus in Russia on the example of a certain sample of patients.

Materials and methods. We analyzed medical records of 199 oropharyngeal squamous cell carcinoma patients treated in N. N. Blokhin Russian Cancer Research Center between 2016 and 2021. We analyzed the frequency of tumors associated with human papillomavirus, age, sex, tumor spread and stage depending on р16 status.

Results. More than half of the patients from our cohort (58.3 %) were р16‑positive. The peak incidence was observed in individuals aged 45 to 64 years (more than 60 % of cases). Males were twice as likely to have р16‑positive tumors than females. A total of 60.9 % of patients with р16‑positive tumors had stage I disease, whereas 51.2 % of patients with p16‑negative tumors had stage IV disease.

Conclusion. The results obtained for a sample of Russian patients are comparable with the findings of foreign authors.

Introduction. Nowadays discussed and actual issues of modern oncology are the diagnostics problems and care organization for patients with oral mucosa and lips precancerous diseases.

Study purposes – to analyze the prevalence, structure, and primary diagnosis quality of oral mucosa and lips precancerous diseases and to identify the organizing medical care problems for the adult population with the oral cavity precancerous diseases in residents of Tomsk city and Tomsk Region.

Materials and methods. For the period 2014–2019 1,664 patients were examined and treated for oral mucosa and lips diseases. The main complaints and medical history were clarified in all patients, according to the recommendations of the World Health Organization, assessed the state of the oral mucosa and lips according to the visual inspection data. To assess the primary diagnosis quality of an oral mucosa disease, we analyzed the data from a dental patient’s medical record, dentist’s referrals, and anamnesis data.

Results. In the general oral mucosa and lips pathology structure almost a quarter (25.7 %) of patients were diagnosed with precancerous diseases – leukoplakia (12.5 %), lichen planus (10.8 %), viral papillomas (2.0 %) and Manganotti cheilitis (0.4 %). Malignant neoplasms of the oral cavity at different stages was established in 8.3 % of cases. A retrospective errors analysis revealed that in 100 % of leukoplakia, lichen planus, candidiasis and stomatitis cases the disease form was not indicated. In 22 % cases out of the total number of oral leukoplakia patients, the diagnosis was made mistakenly. In 12 cases of malignant neoplasm underdiagnoses, lichen planus and oral mucosa candidiasis prevailed. In half of the cases of the mistakenly diagnosed oral leukoplakia (10.2 %), oral cavity squamous cell carcinoma was detected. The average waiting time for the oncologist»s appointment was 44.3 ± 10 days.

Conclusion. The results indicate a high prevalence of precancerous pathology in the oral mucosa structure diseases

(25.7 %) and a long wait for specialized medical care.

This review discusses current aspects of the diagnosis and treatment of adenoid cystic carcinoma of the trachea and larynx. It describes different variants of surgical treatment, radiotherapy, combination therapy, endotracheal interventions using endoscopic techniques and physical methods, grafting, tracheal transplantation, complications, and oncological and functional treatment outcomes. We also analyze clinical aspects of adenoid cystic carcinoma of the larynx, most common tumor location, difficulties associated with morphological verification, and controversial issues related to surgery volume, considering that this disease is rare and clinical experience is often insufficient.

According to the literature, metastatic brain damage in kidney cancer occurs in 6.5 % of patients. The introduction of new techniques associated with the use of targeted drugs, immune checkpoint inhibitors and innovative radiation therapy techniques can significantly increase patient survival. Effective drug therapy and local control of brain metastases are of paramount importance for predicting overall survival and quality of life for patients. This literature review summarizes the scientific literature data on the use of local and systemic methods of treatment in patients with metastases of kidney cancer to the brain.

Cutaneous melanoma is characterized by an aggressive course associated with a tendency to metastasis. For a long time, the prognosis of patients with metastatic melanoma remained extremely poor. However, the introduction of immunooncological drugs into clinical practice has changed the approaches to the treatment of patients with metastatic melanoma, and fundamentally improved the prognosis and quality of life of such patients, which undoubtedly became a breakthrough in the treatment of this pathology. This article presents a clinical case of the treatment with immunological drugs of a patient with metastatic melanoma of the skin with lymph nodes of rare localization with a complete tumor response.

The study objective – to present a unique clinical observation of the successful treatment of tracheoesophageal fistula using laser exposure.

Case report. Patient H., 51 years old, applied to the Moscow City Oncology Hospital No 62, Moscow Healthсare Department on January 22, 2018, with a diagnosis of thyroid cancer (multicentric growth), T3N0M0 (hospital No. 1974 / 43). Thyroidectomy was performed on 03.08.2009, removal of a recurrent tumor with resection of the esophageal wall and trachea – 03.02.2021. Histological examination No. 5589 / 56662–56668 dated 09.02.2021: papillary cancer with invasion of the wall of the esophagus and trachea. Resection within unaltered tissues. A mobilized sternocleidomastoid muscle was used to separate the esophagus and trachea. A nasogastric tube was used for 14 days. The wound on the neck healed by primary intention. The patient began to eat through the mouth. A day after the removal of the probe, facial emphysema began to grow intensively, which was accompanied by a cough. The nasogastric tube is reinserted. With fluoroscopy of the esophagus and with pharyngogastroduodenoscopy, a tracheoesophageal fistula was revealed along the right lateral wall of the trachea, about 0.5 cm in size, 1.5–2 cm below the level of the vocal folds. On endoscopic examination a week later, the fistula was already 1.0 cm in size. Conservative therapy and surgical treatment were carried out. Due to the flexible laser fiber, a phased effect on the fistula wall was carried out, both from the esophagus and from the trachea. Within a week after the first session, the fistulous opening decreased by 2 times. Then 2 more sessions were carried out with an interval of 10 days. During endoscopic examination from 05.05.2021 the fistula between the trachea and the esophagus is not defined. The mucous membrane is epithelized, smooth. Swallowing is free.

Conclusion. Thus, the problem of treating patients with tracheoesophageal fistulas is extremely complex and versatile. The localization of the fistula, its size, and the clinic’s capabilities for treating a patient are of great importance.