Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumor observed in 2 % of all leiomyosarcomas. Less than 400 cases are described in the literature, in Russian publications not more than 30. Computed tomography is the most accurate diagnostic method for determination of tumor location, presence or absence of thrombosis and its severity, evaluation of resectability. We present a case of a patient with leiomyosarcoma of the IVC with preoperative diagnosis of adrenocortical carcinoma of the right adrenal gland with tumor thrombosis of the IVC and tumor advancement into the right kidney. During intraoperative revision the tumor was evaluated as primary leiomyosarcoma of the IVC with thrombosis of the iliac veins up to the retrohepatic segment of the IVC and advancement into the right adrenal gland and vascular structures of the right kidney and its pole which was confirmed by histological examination. Surgery is the main method of treatment of leiomyosarcoma of the IVC. Long-term results depend on the volume and radicality of operation. Reconstruction of the IVC is not always necessary. Despite high recurrence rate, there is no consensus on adjuvant treatment. The best results are achieved through interdisciplinary approach involving an oncological surgeon, chemotherapist, vascular surgeon, anesthesiologist. Perioperative planning, coordination, and adherence to oncological methods are crucial for recovery.

Esophageal cancer is one of the hardest to treat malignant cancers. Patient prognosis remains unsatisfactory despite considerable progress in surgical, radiation, and drug treatments. Surgery remains the main form of treatment for this pathology as it is the only radical treatment method. The objective is to evaluate short-term treatment results for cancer of the cervical esophagus and laryngopharynx after large-scale resection with reconstruction and plastic surgery stage. A clinical case of locally advanced squamous cell carcinoma of the mucosa of the cervical esophagus is presented. Use of free radial fasciocutaneous flap for reconstruction of the cervical esophagus with preservation of the pharynx is described. Problems of diagnosis and surgical treatment of this pathology from the point of view of our clinic’s experience are considered. We show that radial forearm flap can be used for reconstruction of the pharynx and cervical esophagus during circular resections.

Neuroendocrine tumors are rare type of tumors of the gastrointestinal tract. Mostly the patient is diagnosed rather late, the tumors don’t have specific symptoms and there are no sensitive and specific methods of early diagnostics of the disease. Also, to date, the choice of antitumor treatment methods is limited. The article presents a clinical case of effective treatment of a neuroendocrine tumor of the colon with high level of microsatellite instability. After palliative partial colectomy, atypical resection of the liver, female patient with metastatic cancer of the descending colon has been receiving therapy with checkpoint inhibitors (PD-1) which led to long-term stabilization of the process.

In current conditions, increased life expectancy led to increased cancer morbidity. Presence of pain syndrome with significant intensity caused development of numerous guidelines on its treatment. Currently, pain management is based on the stepwise multimodal approach of the World Health Organization. In our opinion, wide application of narcotic analgesics is a disadvantage of this method. This pharmaceutical group has a significant number of adverse effects including addiction, development of hyperalgesia, and potential effect of increased rate of cancer recurrence.

The study objective is to optimize the stepwise approach by addition of continuous multimodal analgesia. We aim to develop the principles of complex approach to pain management including new combinations of pharmaceuticals of different modalities and new techniques of continuous safe administration using innovative devices.

The article presents a prospective description of a series of clinical cases in which new combinations of pharmaceuticals were administered in the context of complex treatment of pain syndrome of significant intensity. Objective evaluation of pain syndrome was performed using the Numeric Rating Scale.

Multimodal intravenous pain management using mobile devices administering a mixture of pharmaceuticals in conjunction with basic peroral therapy and widely accepted discrete stepwise approach of the World Health Organization showed first positive results. In our opinion, further studies will allow to 1) decrease the rate of chronic pain syndrome in oncological patients; 2) treat pain syndrome of almost any intensity with preserved quality of life.

The first results are encouraging; they show satisfactory effectiveness of the method and its safety. It is necessary to continue studies to develop and standardize the intravenous mixture composition for pain management in the context of the main clinical syndromes determining pain.

The study objective was to evaluate the impact of medical  hospital volume on short-term colorectal cancer treatment results.

Materials and methods. The retrospective study included 93 patients with colorectal cancer operated on by one surgeon at two medical centers in Moscow from 2018 to 2020: 32 patients of the first group were operated in tertiary medical center (N.I. Pirogov National Medical and Surgical Center) and 61 of the second group – in regional low volume hospital (Centrosoyuz Hospital). The endpoints of the study were the short-term outcomes: surgery duration, blood loss, postoperative hospital stay, intra- and postoperative complications, lymph node harvested and the quality of specimen.

Results. Surgery duration as well as blood loss in two groups were similar (258 min vs 240 min, p = 0.47 and 100 ml and 100 ml, p = 0.89, accordingly). Hospital stay after surgery was significantly less in the first group (9 days vs 16 days, p <0.01). The frequency of postoperative complications of type I–II according to the Clavien–Dindo classification was higher in the first group (6/8 vs 1/8, p <0.05) but reoperations performed more in the second group due to III Clavien–Dindo complications (2/8 vs 7/8, p = 0.012). Grade 2–3 rectal cancer specimen quality was 94.7 % vs 77.8 %, p = 0.13 and harvested lymph nodes >12 was 71.9 % vs 78.7 %, p = 0.485 in first and second group, respectively.

Conclusion. Hospital volume does not affect rectal cancer specimen quality, surgery duration and blood loss, if the surgical interventions are performed by one experienced surgeon but associated with the incidence of postoperative complications and the length of stay.

Multiple myeloma (MM) is a B-cell malignant tumor; its morphological substrate – plasma cells – produces monoclonal immunoglobulin. Primarily, MM is diagnosed in elderly people and is characterized by a variety of clinical manifestations caused by plasma cells infiltration and organ damage. Despite successes in MM therapy, in the majority of cases recurrences of MM or refractory process are observed. In this case, the choice of antitumor drug is usually made depending on its tolerability, toxicity, and availability. Selection of correct treatment can be complicated by such frequent clinical manifestations of MM as osteolytic vertebral lesions leading to development of pathologic compression fractures which in some cases cause spinal cord compression and full immobility in the patients with MM.

A clinical case of a 62-year-old female patient with refractory MM is presented. Pathologic compression fractures of the Th12 and L2 vertebral bodies with massive extraosseous component at the Th12 vertebra level posed a threat of spinal cord compression. At the 1st stage, percutaneous vertebroplasty was performed, then antitumor therapy with daratumumab without increased intercycle intervals which significantly increased patient’s quality of life.

Pulmonary arteriovenous malformations are a rare congenital pathology observed in 2–3 individuals per 10,000, and 10 % of cases are diagnosed in children in the first several years of life. Arteriovenous malformations are vascular abnormalities of the cardiovascular system presenting as pathological anastomoses (shunts) between the arterial and venous systems which leads to direct shunting of nonoxygenated blood from the arterial bed into the venous bed bypassing pulmonary capillary network. Frequently, diagnosis of pulmonary arteriovenous malformations is made in rather neglected cases. Pulmonary arteriovenous malformations is hard to diagnose and treat, therefore it requires special attention from surgeons and clinicians which prompted us to describe a clinical case of a young 27-year old male patient with signs of significant chronic hypoxia (saturation (SpO₂ ) – 84–86 %, hemoglobin level – 185 g/L, erythrocyte count – 6.13 million/μL, hematocrit – 51.8 %; during examination: acrocyanosis, nail clubbing; complaints of vertigo, decreased tolerance of physical activity, breathlessness during physical activity). Computed tomography in the S8, S9 segments showed arteriovenous malformation, size about 70 × 70 mm. Patient underwent radical treatment in the form of right lower thoracoscopic lobectomy which led to an immediate increase in oxygen saturation (SpO₂ ) to 99 %. This clinical example shows that surgical method of treatment is the most radical, and thoracoscopic intervention in a young patient significantly decreases the volume of injury and promotes quick recovery and return to active life.

Background. Quality of life (QL) is no less important question in modern oncohematology than longstanding survival rate and convalescence. Pediatric patients with lymphomas have high chances for recovery, that’s why it is important to provide a good QL during and after end of anti-cancer treatment. In Russia aspects of QL are not give up in pediatric oncohematology and used questionnaires are translated and poor adopted for our country.
The study objective is to evaluate parameters of QL in pediatric patients with lymphomas and their parents during anti-cancer treatment and to assign abilities for improvement of QL.
Materials and methods. From January 2018 to January 2020 fifty primary pediatric patients with lymphomas and fifty their parents were enrolled the study. All the patients were treated in the Chemotherapy Hemoblastoses Department No. 1 of Pediatric Oncology and Hematology Research Institute of N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia. The analysis of QL parameters was performed by Scale “Life satisfaction” of E. Diener, psycho-emotional tension was assessed by questionnaire “Your filling healthy” (for parents), mental activity, motivation, emotional tonus, psychic tension and comfort were analyzed by L.A. Kurgansky and T.A. Nemchin method.
Results. 50 % parents and 60 % of children with lymphomas had medium level of life satisfaction. High life satisfaction level was unusual for respondents of pediatric age (0 %) and parents (8 %). During anti-cancer treatment children had low mental activity (60 %), motivation (44 %) and emotional tonus (60 %). It should be noted that psychic tension level in 60 % of children also was low.
Conclusion. Anti-cancer treatment, stay in hospital, changed habitual condition favour to decrease QL of patients and their parents, which resulting in low mental activity, embrace of the world around, emotional tonus, not enough life satisfaction. For QL improvement it is necessary to work with psychologists, teachers, social workers, performing of art therapy. A large amount of work should be done with persons closest to child and parents, with whom they will communicate after end of treatment.

Ultrasound-guided fine-needle aspiration is an invasive intervention which is used for diagnosis of additional formations of the walls of the gastrointestinal tract, as well as focal pathologies beyond it. Many reports indicate high diagnostic effectiveness and safety of this method but with increasing number of aspirations endoscopists start to encounter rare complications of this manipulation. The article presents a description of a rare complication which arose during transesophageal fine-needle aspiration, as well as a correct algorithm of patient management in the post-manipulation period.

Determination of the correct strategy of patient management led to favorable outcome of the complication and determination of the final clinical diagnosis.