Irina G. Frolova

Benign neoplasms of the tracheobronchial tree are rare, accounting for approximately 7-10 % of all primary lung tumors. Endobronchial lipoma is an extremely uncommon benign tumor, comprising approximately 0.5 % of all bronchial tumors. These benign tumors typically have a rounded shape, a distinct capsule, and an elastic consistency. Morphologically, lipomas appear as mature adipose tissue separated by connective tissue septa. Intrabronchial location within the tracheobronchial tree is the most common; this type of tumor growth is observed 4-5 times more often than perior exobronchial lesions. The absence of pathognomonic symptoms and clinical manifestations, coupled with the slow growth of the tumor, often leads to late diagnosis. The primary goal in treating endobronchial lipomas is to eliminate bronchial obstruction and prevent irreversible changes to lung tissue. For large tumors obstructing the bronchial lumen or the presence of significant secondary changes to the lung tissue, endoscopic removal is not advisable. Surgical treatment, including segmentectomy or lobectomy, is the optimal option. Here we present a case of successful combined diagnostic approaches for rare endobronchial lipoma. Case presentation . A 79-year-old man presented with benign tumor in the left bronchial tree, with minimal respiratory symptoms. A chest computed tomography revealed a fat-density lesion within the lumen of the left lower lobe bronchus with partial obstruction of the bronchial lumen. Bronchoscopy demonstrated a mass lesion extending into the lower third of the left main bronchus. Conclusion. The presented clinical case demonstrates the challenges associated with the timely diagnosis of endobronchial lipomas and highlights the importance of the multidisciplinary approach utilizing imaging, endoscopic, and histopathological examination for diagnostic verification and treatment planning.

Peritoneal carcinomatosis is one of the most challenging problems in modern oncology, due to its unfavorable progression pattern for malignant tumors in various locations. It is also a relatively rare occurrence in the progression of cervical cancer and is more common in tumors in other locations. The prognostic significance of peritoneal involvement in cervical cancer remains unclear. The impact of neoadjuvant chemotherapy on the peritoneal area and tumor spread also remains poorly understood. According to various authors, peritoneal carcinomatosis occurs in 1–6 % of patients with malignant cervical tumors. In this case report, we presented a rare case of peritoneal carcinomatosis associated with recurrent cervical cancer.

Background . Luminal breast cancer, comprising 60–80 % of cases, is characterized by a high frequency of bone metastasis, necessitating continuous surveillance for early detection of distant metastases. Traditional imaging methods have limited sensitivity, especially for small lesions. Therefore, the development of highly sensitive methods for early diagnosis is relevant. Targeted radionuclide imaging of the gastrin-releasing peptide receptor (GRPR) using antagonist-based radiopharmaceuticals, such as [ ^99ᵐ Tc]Tc-DB8 is a promising non-invasive method for detecting small lesions. The aim of the study was to demonstrate the potential of [ ^99ᵐ Tc]Tc-DB8 for detecting bone metastases in patients with luminal breast cancer. Case report 1 . A 51- year-old woman diagnosed with stage IIIC right breast cancer (T2N3M0), with multicentric growth, metastatic involvement of the axillary and subclavian lymph nodes, underwent SPECT/CT 2 hours after the intravenous administration of [ ^99ᵐ Tc]Tc-DB8 at a protein dose of 80 μg. The detection of a high-uptake [ ^99ᵐ Tc]Tc-DB8 lesion in the right 5th rib, confrmed as a lytic bone destruction on CT, indicated a high suspicion of bone metastasis. Followup chest CT showed an area of uneven sclerotic changes, interpreted as a response to therapy. Case report 2 . A 42-year-old woman was diagnosed with stage IV right breast cancer (T1N1M1), metastatic involvement of the axillary lymph node, and multiple bone metastases. A SPECT/CT performed 2 hours after the intravenous injection of [ ^99ᵐ Tc]Tc-DB8 at a dose of 80 μg revealed high uptake of the radiopharmaceutical in the primary tumor, metastatic lymph nodes, and extensive bone metastases. Specifcally, the radiopharmaceutical accumulated in the L2-S2 vertebrae, the right ilium and ischium, and the posterior segment of the 7th rib on the right, identifying these as metastatic sites. Conclusion . Results of the clinical study on [ ^99ᵐ Tc]Tc-DB8 demonstrated its high effcacy in detecting bone metastases in patients with luminal breast cancer.

Introduction : Solitary fibrous tumor (SFT) — a rare mesenchymal tumor of fibroblastic origin. Solitary fibrous tumor is not a tumor of the pleura itself, unlike diffuse mesothelioma. The SFT was first described by E. Wagner in 1870. Non-specific clinical manifestations of solitary fibrous tumor complicate the diagnostic search and significantly expand the differential diagnostic range. Purpose : To demonstrate a rare case of solitary fibrous tumor of the pleura and to show, using a clinical case as an example, the difficulties of its diagnosis. Materials and methods : Multislice computed tomography (MSCT) of the chest organs performed to the patient with complaints of cough and shortness of breath during intense physical activity. Formation was detected with clear contours, a heterogeneous structure, located subpleurally was revealed. Results : The presented observation demonstrates non-specific radiological manifestations of a solitary fibrous tumor and illustrates the importance of correct interpretation of data and choice of diagnostic algorithm.

Introduction. Giant cell tumor (GCT) of bone is a relatively rare neoplasm. Its malignant transformation in the form of sarcomatous changes occurs in 8–10 % of cases. The literature lacks data on radiological signs and differential diagnostic criteria of primary malignant GCT of bone. Clear guidelines on the density range of the affected area for differential diagnosis are also absent. Aim. To analyze dynamics of tumor density changes in patients with malignant GCT of bone using computed tomography densitometry. Materials and methods. Ten patients (mean age 45.8 ± 4.2 years, range 28–58 years) with malignant GCT of bone were examined. All underwent treatment with denosumab with subsequent surgical intervention. Bone changes were assessed visually. Densitometric analysis was performed in accordance with a method developed by us involving determination of tumor density in Housefield units (HU) and relative tumor density index (k) (ratio between tumor density and density of the unaffected limb at the same level). Results. After 6 injections of denosumab, a clear sclerotic rim appeared at the tumor periphery containing thin lines of ossification. Analysis of densitometric parameters showed that tumor density after denosumab administration increased from 46.3 (median (Мe) 35.0; interquartile range (IQR) 51.4) HU to 88.8 (Мe 84.8; IQR 118.4) HU, while relative tumor density index increased from 0.33 (Me 0.22; IQR 0.45) to 0.68 (Me 0.62; IQR 0.89). Earlier we have published threshold values of these parameters (≥139.5 HU and ≥0.97, respectively) at which probability of residual tumor is lowered (sensitivity 81.8 %, specificity 96.6 %). Taking into account these values, 9 of 10 patients required continuation of therapy. Conclusion. Computed tomography densitometry allows to evaluate changes caused by denosumab therapy in patients with malignant GCT of bone. According to radiological data, progression of this disease has unique features. Taking into account histological types of malignant GCT, longer periods of observation and denosumab administration or changes in treatment tactics at the preoperative stage can be considered, as well as potential use of this drug in other primary bone tumors.

Background. Treatment of patients with locally advanced pelvic cancer remains challenging. The use of modern surgical techniques has expanded the feasibilities of performing multivisceral resections (MVR) in this category of patients. However, the postoperative period in patients who have undergone MVR is associated with a high risk of developing postoperative complications. The purpose of the study was to assess the short-term and long-term treatment outcomes in patients with locally advanced and multiple-primary pelvic cancer. Material and Methods. From 2009 to 2021, 114 patients treated in the clinics of Cancer Research Institute of Tomsk National Research Medical Center underwent MVR for primary or recurrent rectal cancer (n=40, 35.1 % and n=4, 3.5 %, respectively), female reproductive cancer (endometrial cancer: n=18, 17.1 % and recurrent ovarian cancer: n=18, 17.1 %), primary and recurrent bladder cancer (n=15, 13.2 % and n=2, 1.8 %, respectively), synchronous multiple primary pelvic tumors (n=8, 7.0 %) and extraorgan mesenchymal tumors of the pelvis (n=4, 3.5 %). Paraneoplastic complications were observed in 31 (27.2 %) patients. Invasion to more than 2 adjacent pelvic organs was diagnosed in 52 (45.4 %) cases. Total pelvic evisceration (TPE) was performed in 9 (7.9 %) patients, including 5 (4.4 %) patients who underwent TPE for primary rectal cancer with extensive local spread and 4 (3.5 %) patients who underwent TPE for multiple primary cancer: 2 (1.75 %) for synchronous primary rectal cancer and bladder cancer and 2 (1.75 %) for primary rectal cancer and recurrent bladder cancer. MVR for rectal cancer was the most common (n=101, 88.6 %). Resections with the formation of colorectal anastomosis were performed in 75 (65.8 %) cases and obstructive resections of the rectum were performed in 14 (12.5 %) cases. Urinary tract surgeries were performed in 66 (57.5 %) cases. One-stage plastic surgery of the resected segment as a transposition of one or both ureters into the bottom of the bladder was performed in 22 (19.3 %) cases. Heterotopic and orthotopic plastic surgery of the bladder was performed in 19 (16.6 %) and 5 (4.4 %) cases, respectively. Combined uterine extirpations, including vaginal resection, were performed in 52 (45.4 %) cases. Grade III postoperative complications according to the Clavien–Dindo classification occurred in 18.4 % of cases. Urological complications were the most common (8.7 %). Postoperative mortality rate was 0.8 %. The assessment of the long-term outcomes was carried out using the example of patients with rectal cancer (n=45), as the most homogeneous and largest subgroup. The overall 3-year survival rate was 71.1 % and the relapse-free 3-year survival rate was 60.0 %. Conclusion. Treatment of locally advanced pelvic cancer requires extensive surgeries performed by a multidisciplinary team of surgeons. The immediate results can be assessed as satisfactory. In case of resection of the urinary tract as a component of MVR, regardless of the primary localization of the tumor, primary plastic surgery of the bladder and/or ureters is preferable. Long-term outcomes allow us to consider MVR as a method of choice in the treatment of this group of patients.

Background. Currently, there is a steady trend towards an increase in the incidence of both synchronous and metachronous multiple primary malignant tumors (MPMT). However, metachronous polyneoplasia of the pancreatobiliary tract is relatively rare, and there have been very few reports on successful treatment of this malignancy. Case presentation. In September 2014, the patient K. was diagnosed with adenocarcinoma of the ampulla of Vater (T2N0M0, stage Ib) and underwent gastropancreatoduodenal resection with the creation of pancreatic-gastric anastomosis at the Abdominal Department of Cancer Research Institute of Tomsk National Research Medical Center. There were no complications in the postoperative period. At a 6.5-year followup, no evidence of disease progression was found. In April 2021, a follow-up examination conducted at the Cancer Research Institute revealed a large lesion on the distal part of the pancreatic stump with no clinically significant manifestations. Diagnosis of MPMT was confirmed by transgastric endoscopic ultrasound-guided biopsy. Histological and immunohistochemical examinations revealed undifferentiated ductal carcinoma of the pancreas. Considering the metachronous tumor localization, pancreatic stump extirpation with resection of the posterior wall of the stomach and splenectomy was performed. No complications occurred in the postoperative period. The patient received replacement therapy for exocrine pancreatic insufficiency and individual correction of carbohydrate metabolism. At a 15-month follow-up, liver metastases were detected, and palliative chemotherapy was administered. The patient died 6 months later due to disease progression. The survival time was 99 months after the first surgery and 21 months after the second surgery. Conclusion. We report a rare case of metachronous cancers of the ampulla of Vater and pancreatic stump developed with an interval of 6.5 years. The patient underwent successful curative resections consecutively. The overall survival time from the date of diagnosis was 99 months.

Background: Overweight and especially obesity are associated with the risk of the development and progression of colorectal cancer. It can be assumed that there are multifaceted interactions between the tumor and adipose tissue during anti-tumor treatment. Cancer cells secrete exosomes, extracellular vesicles affecting the microenvironment of the tumor and promoting its progression or regression. The presence of transcription/translation/folding factors (heat shock proteins (HSPs), matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) in exosomes secreted by irradiated cells and cells exposed to hyperthermia, indicates the cell adaptation to the thermal and radiation stress. Aim: To analyze the MMPs, TIMP1, and HSPs on CD9-positive (CD9+) exosomes, as well as on exosomes of adipocytic origin (FABP4+) in rectal cancer patients with overweight/obesity under thermoradiochemotherapy (TRCT) and their association with the immediate treatment efficacy. Methods: Since 2021, 20 patients (of those 8 men; median age 59.0 [52.0; 63.0] years, median body mass index 29.6 [28.5; 33.1] kg/m2) with morphologically verified rectal cancer (T3-4N0M0 and T3-4N1M0, differentiation grade G1–G3) have been participating in the study. They were treated with TRCT: external gamma therapy (2 Gy, 1 fraction/day, 5 days/week, total focal dose 54 Gy), chemotherapy with capecitabine (825 mg/m2 twice daily) combined with local hyperthermia (42–44 °C, 60 min, 3 times/week, 10 sessions). The TRCT efficacy was assessed by RECIST 1.1 and ESGAR criteria. Blood samples for exosomes were taken from the patients at baseline (point 1), in the middle of the treatment course (point 2), at 6 to 10 weeks after the end of TRCT (point 3), and at 6 months after point 1 (point 4). Small extracellular vesicles were isolated from plasma by ultrafiltration with double ultracentrifugation. The isolated exosomes were characterized by transmission electronic microscopy, flow cytometry and nanoparticle trajectory analysis (NTA). Results: TRCT resulted in complete tumor regression in 13/20 of the rectal cancer patients and partial regression or stabilization in 7/20. Four subpopulations of CD9+ and FABP4+ exosomes associated with the TRCT efficacy were identified (CD9+MMP2+, СD9+MMP2+9+TIMP1+, СD9+MMP2+9+TIMP1-, and FABP4+MMP2+9-TIMP1+). Compared to the CD9+ exosomes, the adipocytic vesicles had higher MMP2 expression (p = 0.026); however, the adipocyte vesicles subpopulation were virtually free of vesicles with combined MMP2 and MMP9 gelatinase expression. The HSPs expression by circulating exosomes at various TRCT steps was associated neither with direct treatment efficacy nor with the vesicle type. Conclusion: The expression of MMPs and TIMP1 on CD9+ and FABP4+ exosomes is associated with TRCT efficacy. In the future, vesicular markers could be used to build prognostic models, to identify patient groups with an unfavorable prognosis, and to personalize treatment and follow-up.

Background. Overexpression of Her2neu occurs in 15–20% of patients with gastric cancer and correlates with an unfavorable prognosis. Case report. We report a case of pathological complete regression of resectable gastric cancer with Her2/neu overexpression. The patient received combined modality treatment including 8 cycles of neoadjuvant chemotherapy with mFLOT + trastuzumab followed by R0 resection. The addition of targeted therapy did not have a negative impact on the perioperative period. Histolohical examination of the surgical specimen revealed pathological complete response (Mandart TGR1). Currently, the patient has been followed-up for 27 months without signs of disease relapse. Conclusion. Total neoadjuvant chemotherapy with mFLОТ+ trastuzumab for operable gastric cancer with Her2/neu overexpression allows us to hope for improved long-term treatment outcomes.

The purpose of the study was to develop and evaluate the technique for volumetric tumor segmentation based on diffusion-weighted magnetic resonance imaging (DW-MRI) in predicting and assessing the response to chemotherapy in patients with bladder cancer (BC). Material and Methods. We examined 26 patients with morphologically verified transitional cell carcinoma of the bladder. The group was characterized by the presence of one or several tumors with a size of 17 to 46 mm. Before planning chemotherapy according to the M-VAC scheme, a study and post-processing of DW-MRI with volumetric segmentation of lesions, assessment of the volume and apparent diffusion coefficient (ADC) in the entire tumor mass were performed. According to the ADC data, shape of the tumor and its relation to the bladder wall, the coefficient (C) for predicting the response to chemotherapy was calculated. Results. In the cases with a coefficient value below 0.51, a high risk of treatment failure was predicted, at C≥0.74, a positive effect of treatment was predicted. With a value of 0.51≤CConclusion. The method of volumetric segmentation makes it possible to predict and evaluate bladder cancer response to chemotherapy with a sufficiently high accuracy. The advantages of the method are the possibility of assessing the tumor regardless of the degree of filling of the bladder, with non-contrast MRI, and with large lesions.