The article describes clinical observation of locally advanced metastatic anaplastic thyroid cancer. Difficulties in instrumental and laboratory diagnosis of this pathology and the role of molecular diagnosis in search for highly effective treatment are discussed.

Seborrheic keratosis is the most common benign tumor of the epidermis. Rarely the tumor develops in the perineal area and quite rarely is large. For the Leser-Trelat syndrome these tumors is a marker of a malignant disease even before the symptoms are appeared, as well as a manifestation of the paraneoplastic process. In our case report, a giant perianal seborrheic keratoma was the reason for the clinical examination of the patient and stomach cancer was detected. As a result, we demonstrated a successful experience of surgical treatment of seborrheic keratoma of the perianal area and determined an algorithm for the treatment of stomach cancer.

Primary cutaneous diffuse large B-cell lymphoma, leg type, is diagnosed in 20-25 % cases of all primary cutaneous B-cell lymphomas, primarily in elderly women (older than 70 years). The disease has aggressive recurrent progression and worse prognosis than other variants. The standard antitumor drug therapy are such regimens as R-CHOP and CHOP-like programs including anthracycline antibiotics. Use of these programs can be limited by the presence of cardiovascular and other concomitant disorders.

Due to the limited variety of combinations of antitumor agents, low frequency of diagnosis of this immunomorphological variant of lymphoproliferative disease and absence of a single algorithm of drug therapy, every clinical case is interesting and informative.

In the presented clinical case, an 80-year-old female patient with primary cutaneous diffuse large B-cell lymphoma, leg type, and concomitant pathology of the cardiovascular system underwent 2 courses of R-CVP regimen drug therapy without anthracyclines. A significant antitumor clinical effect was achieved in the form of complete tumor regression. Treatment was not accompanied by significant toxicity which allowed to complete therapy.

Aim. To evaluate advantages and disadvantages of transoral ultrasonography (US) in tongue cancer.

Materials and methods. US was performed in 165 patients between the ages of 15 and 85 years with malignant tumors of the mobile tongue (74 (44.9 %) women, 91 (55.1 %) men).

Among 165 patients, 144 had primary tongue tumor. The study also included 21 (12.7 %) patients with recurrent tumor which clinically could be represented by a true recurrence (tumor development 6 months after the end of treatment) or by continued growth (tumor development less than 6 months after the end of treatment). The study included patients with tongue tumors Т1 - 50 (30.3 %) patients, Т2 - 78 (47.3 %) patients, Т3 - 16.4 % of patients, Т4 - 6.1 % of patients.

Three types of approach to tongue tumor visualization were used: submandibular, transoral, and transbuccal with a standard linear transducer (4-9 MHz) and intraoperative linear transducer (5-14 MHz). In total in 165 patients with tongue tumors, 147 (89.1 %) transoral US, 86 (52.1 %) submandibular US and 25 (15.2 %) transbuccal US examinations were performed.

Results. Among 165 patients, agreement between the sizes measured using US and histological examination was observed in 142 (86.1 %) patients taking into account 15 % error.

With increasing tumor thickness and, correspondingly, T criterion, increased frequency of agreement between US data and histological data was observed. Thus, for T1 stage frequency of agreement with US data was observed in 61.8 % of cases, for Т2 stage in 81.1 % of cases, for Т3 stage in 93.8 %, and for Т4 stage agreement was observed in 100 % of cases.

Frequency of agreement with histological data in evaluation of tongue tumor thickness for transoral approach was significantly higher than for submandibular approach (р = 0.014). Transoral technique was more accurate for measurement of thickness of primary tumors - 80.3 % of results agreed with histological examination, and for recurrences frequency of agreement was only 33.3 %. Submandibular approach for primary tumors showed accurate measurements only in 67.6 % of cases, in recurrent tumors in 58.3 % of cases. Transbuccal approach also showed higher measurement accuracy for tumor thickness in primary patients (70.0 %) compared to recurrent tumors (40.0 %).

Conclusion. Use of transoral ultrasonography significantly improves clinical staging of tongue tumors at the preoperative stage.

Background. Acute ischemic cerebral circulation disorder and myocardial infarction occupy one of the first places among the causes of postoperative mortality in patients with malignant tumors of thoracoabdominal localization. The issue of the role of molecular genetic factors of cardiovascular risk in the development of these complications has not been resolved at present.

Objective. To analyze the effect of polymorphisms of hemostasis system genes on the development of coronary artery and cerebral artery thrombosis in patients with malignant tumors of thoracoabdominal localization.

Materials and methods. The study included 163 patients operated in the Oncological Department of Surgical Methods of Treatment No. 11 (Thoracic Oncology) of the N.N. Blokhin National Medical Research Center of Oncology in 2018-2019. Two study groups consisted of patients with myocardial infarction (n = 62) and ischemic stroke (n = 24) in the perioperative period or in the anamnesis. The data of patients with a history of both myocardial infarction and ischemic stroke (n = 4) were taken into account in both groups. The control group (n = 81) included patients who had no severe concomitant cardiovascular pathology, including a family history. A molecular genetic study to determine polymorphisms of the genes of the hemostasis system was performed in the Laboratory of Clinical Oncogenetics of the N.N. Blokhin National Medical Research Center of Oncology using the reagents “Cardiogenetics of Thrombophilia” (DNA Technology LLC, Russia; RU No. FSR 2010/08414 dated 11/22/2016).

Results. In patients with malignant tumors of thoracoabdominal localization who have suffered a myocardial infarction, in comparison with patients without cardiovascular pathology, a statistically significant difference in the frequency of carriage of homozygous variants of the genes FGB (χ² = 8.18, p = 0.005), ITGA2 (χ² = 9.48, p = 0.003), PAI-1 (χ² = 4.45, p = 0.035), heterozygous forms of genes F5 (χ² = 4.0, p = 0.046), ITGA2 (χ² = 14.72, p <0.001), ITGB3 (χ² = 4.28, p = 0.039), as well as the total frequency of genetic aberrations in these genes. In the group of patients who suffered an ischemic stroke, a statistically significant difference was determined relative to the control group in the frequency of carriage of the heterozygous variant of the mutation in the F2 gene (χ² = 6.881, p = 0.009), the homozygous form of the mutation of the ITGA2 gene (χ² = 15.724, p <0.001), the heterozygous variant of the mutation in the ITGB3 gene (χ² = 3.861, p = 0.05), as well as the total frequency of carrying mutations in these genes. The study did not obtain a significant difference in the studied and control groups with respect to the frequency of polymorphism carriers G/A of the F7 gene (coagulation factor VII) and G/T of the F13 gene (coagulation factor XIII) associated with a reduced risk of thrombotic conditions. In all patients who had a myocardial infarction, and in 91.7 % of cases, several procoagulant polymorphisms were noted in the genotype of patients who had an ischemic stroke; in the group of patients without cardiovascular diseases, this indicator was 53 %, the difference in the groups was statistically significant (χ² = 39.61, p <0.001; χ² = 11.685, p <0.001, respectively).

Conclusion. Based on the results of a molecular genetic study of factors associated with a high thrombogenic risk, a statistically significant difference in the frequency of occurrence of polymorphic markers F5 G1691A, FGB G(-455)A, ITGA2 C807T, ITGB3 T1565C, PAI-1 4G(-675)5G was revealed in patients with thoracoabdominal localization tumors who had suffered a myocardial infarction, and F2 G20210A, ITGA2 C807T, ITGB3 T1565C who had suffered an ischemic stroke, compared with cancer patients without concomitant cardiovascular pathology. The data of the conducted study make it possible to identify groups of oncological patients with increased risk of developing cardiovascular complications in the perioperative period and take additional measures to prevent thrombotic complications.

Osteosarcomas are rare tumors with aggressive biology. It is important to refer such patients to a high-volume center, where an accurate diagnosis and optimal treatment are more likely to be performed. In contrast to Ewing's sarcoma, conventional osteosarcomas are believed to be generally resistant to radiation therapy, and the main treatment modalities are surgery and chemotherapy. In this clinical case, we demonstrate the efficacy of combined treatment of osteosarcoma of the femur.

Preoperative chemotherapy allowed to evaluate tumor sensitivity to systemic treatment in vivo and optimize adjuvant treatment after R0 resection which allowed to achieve complete clinical response to treatment.

Causes of mechanical jaundice are extremely varied and can be either malignant or benign. The main causes of malignant nature are cholangiocarcinoma and pancreatic ductal adenocarcinoma, while common benign causes of obstructive mechanical jaundice are choledocholithiasis and chronic pancreatitis. Rarer causes of this severe complication are not extensively described in literature.

Supporting therapy is a necessary component of successful antitumor treatment in patients with both solid tumors and malignant blood disorders. Adherence to administration protocol for antiemetic drugs aimed at prevention of induced gastrointestinal complications (nausea and vomiting), allows to improve patients' quality of life and treatment compliance. Development of a combination antiemetic drug (netupitant/palonosetron) simultaneously affecting 2 main mechanisms of nausea and vomiting as well as its easy administration allowed to significantly improve control of these complications in patients with solid tumors and patients with malignant blood disorders.

We present a literature review on the effectiveness of netupitant/palonosetron and describe our own experience of using this antiemetic drug for prevention of chemotherapy-induced nausea and vomiting.