The role of renal biopsy in a patient with multiple synchronous cancers: a case report

A 51-year-old male with a long history of tobacco smoking presented to the outpatient clinic with left renal colic. A renal ultrasound revealed a mass in the left kidney. The patient was admitted to surgical clinic of Russian Scientific Center of Roentgen-Radiology of Rosmedtechnology. A renal biopsy and subsequent histopathological tests revealed adenocarcinoma of the right kidney of most likely metastatic origin. This discovery has lead to vigorous diagnostics search for the primary tumor. Finally, the following diagnosis was established: Primarily-multiple synchronous cancer: cancer of the left kidney T1N0M0, cancer of the thyroid gland T2N0M1, metastasis to the right kidney and lungs. The patient had left kidney and thyroid gland removed and was successfully treated with radioiodine therapy. The patient remains alive and well 7 months since his admission to our clinic. We report this case to emphasize the importance of the renal biopsy and thorough histological analysis, which made it possible to diagnose thyroid cancer in this patient

Gene-Activated Materials in Regenerative Dentistry: Narrative Review of Technology and Study Results

Treatment of a wide variety of defects in the oral and maxillofacial regions requires the use of innovative approaches to achieve best outcomes. One of the promising directions is the use of gene-activated materials (GAMs) that represent a combination of tissue engineering and gene therapy. This approach implies that biocompatible materials will be enriched with gene-carrying vectors and implanted into the defect site resulting in transfection of the recipient’s cells and secretion of encoded therapeutic protein in situ. GAMs may be presented in various designs depending on the type of material, encoded protein, vector, and way of connecting the vector and the material. Thus, it is possible to choose the most suitable GAM design for the treatment of a particular pathology. The use of plasmids for delivery of therapeutic genes is of particular interest. In the present review, we aimed to delineate the principle of work and various designs of plasmid-based GAMs and to highlight results of experimental and clinical studies devoted to the treatment of periodontitis, jaw bone defects, teeth avulsion, and other pathologies in the oral and maxillofacial regions

Proton re-irradiation of unresectable recurrent head and neck cancers

Background: This study presents a retrospective analysis (efficacy and toxicity) of outcomes in patients with unresectable recurrence of previously irradiated head and neck (H&N) cancers treated with proton therapy. Locoregional recurrence is the main pattern of failure in the treatment of H&N cancers. Proton re-irradiation in patients with relapse after prior radiotherapy might be valid as promising as a challenging treatment option. Materials and methods: From November 2015 to January 2020, 30 patients with in-field recurrence of head and neck cancer, who were not suitable for surgery due to medical contraindications, tumor localization, or extent, received re-irradiation with intensity-modulated proton therapy (IMPT). Sites of retreatment included the aerodigestive tract (60%) and the base of skull (40%). The median total dose of prior radiotherapy was 55.0 Gy. The median time to the second course was 38 months. The median re-irradiated tumor volume was 158.1 cm3. Patients were treated with 2.0, 2.4, and 3.0 GyRBE per fraction, with a median equivalent dose (EQD2) of 57.6 Gy (a/b = 10). Radiation-induced toxicity was recorded according to the RTOG/EORTC criteria. Results: The 1- and 2-year local control (LC), progression-free survival (PFS), and overall survival (OS) were 52.6/21.0, 21.9/10.9, and 73.4/8.4%, respectively, with a median follow-up time of 21 months. The median overall survival was 16 months. Acute grade 3 toxicity was observed in one patient (3.3%). There were five late severe side effects (16.6%), with one death associated with re-irradiation. Conclusion: Re-irradiation with a proton beam can be considered a safe and efficient treatment even for a group of patients with unresectable recurrent H&N cancers.

Refinement of Animal Experiments: Replacing Traumatic Methods of Laboratory Animal Marking with Non-Invasive Alternatives

Reliable methods for identifying rodents play an important role in ensuring the success of preclinical studies. However, animal identification remains a trivial laboratory routine that is not often discussed, despite the fact that more than 6 million rodents are used in animal studies each year. Currently, there are extensive regulations in place to ensure adequate anesthesia and to reduce animal suffering during experiments. At the same time, not enough attention is paid to the comfort of rodents during routine identification procedures, which can be painful and cause some complications. In order to achieve the highest ethical standards in laboratory research, we must minimize animal discomfort during the identification phase. In this article, we discuss traumatic methods of identification and describe several painless methods for marking in long-term experimental studies. The use of non-traumatic and non-invasive methods requires the renewal of marks as they fade and additional handling of the rodents. Laboratory personnel must be trained in stress-minimizing handling techniques to make mark renewal less stressful

Modern Breast Cancer Surgery 1st Central-Eastern European Professional Consensus Statement on Breast Cancer

This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified on the basis of the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The recommendations cover non-operative, intraoperative and postoperative diagnostics, determination of prognostic and predictive markers and the content of cytology and histology reports. Furthermore, they address some specific issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, and some remarks about the future

Post-Implantation Inflammatory Responses to Xenogeneic Tissue-Engineered Cartilage Implanted in Rabbit Trachea: The Role of Cultured Chondrocytes in the Modification of Inflammation

Immune responses to tissue-engineered grafts made of xenogeneic materials remain poorly studied. The scope of current investigations is limited by the lack of information on orthotopically implanted grafts. A deeper understanding of these processes is of great importance since innovative surgical approaches include the implantation of xenogeneic decellularized scaffolds seeded by cells. The purpose of our work is to study the immunological features of tracheal repair during the implantation of tissue-engineered constructs based on human xenogeneic scaffolds modified via laser radiation in rabbits. The samples were stained with hematoxylin and Safranin O, and they were immunostained with antibodies against tryptase, collagen II, vimentin, and CD34. Immunological and inflammatory responses were studied by counting immune cells and evaluating blood vessels and collagen. Leukocyte-based inflammation prevailed during the implantation of decellularized unseeded scaffolds; meanwhile, plasma cells were significantly more abundant in tissue-engineered constructs. Mast cells were insignificantly more abundant in tissue-engineered construct samples. Conclusions: The seeding of decellularized xenogeneic cartilage with chondrocytes resulted in a change in immunological reactions upon implantation, and it was associated with plasma cell infiltration. Tissue-engineered grafts widely differed in design, including the type of used cells. The question of immunological response depending on the tissue-engineered graft composition requires further investigation

188 Re Zoledronic Acid in the Palliative Treatment of Painful Bone Metastases

188Re Zoledronic acid (188Re-ZA) is new radiopharmaceutical which may have advantages over other bone seeking β-emitters due to high radiation energy of 188Re, and metabolic effect of zoledronic acid.In the phase I-II of the study therapeutic dosage of 188Re-ZA was estimated. Pharmacokinetics, dosimetry and safety were assessed in the dose escalation study. Twenty-one (3, 3 and 15) breast and prostate cancer patients with multiple painful bone metastases received 35, 45 and 55 MBq of 188Re-ZA respectively. In the next step 42 new patients were randomized in 2 groups (188Re-ZA in dosage of 45 MBq/kg and 89SrCl2 in dosage of 150 MBq) to assess safety and efficacy of the radiopharmaceuticals, the follow up lasted for 9 weeks.Absorbed dose to the bone marrow is respectively low 0.26±0.06 Gy. The dose escalation study shows that 188Re-ZA the dosage of 55 MBq/kg is safe, no significant hematologic or any other toxicity is observed. 89SrCl2 in a dosage of 150 MBq, as compared to 188Re-ZA in a dosage of 45 MBq/kg demonstrates similar efficacy, but the effect starts faster in 188Re-ZA group. By the end of the follow up some patients demonstrated pain recurrence, this may indicate the need for repeated courses of treatment. Though many patients with widespread bone metastases and the higher base level of alkaline phosphatase were in the 188Re-ZA group, in the majority of cases of both groups stabilization of the disease was achieved and continued for at least two months. Both radiopharmaceuticals demonstrated acceptable safety profile. Although trend in reduction of hemoglobin level was observed, especially in the group of patients with baseline anemia, both radiopharmaceuticals significantly impact on the platelet counts (PLT) only. As it was predicted by dosimetry data, 188Re-ZA in a dose of 45 MBq/kg is safer, by the week 6 the PLT counts in the 188Re-ZA group became almost the same as baseline and even higher in the week 9, while in the 89SrCl2 group in the week 9 PLT counts remained below the baseline; the difference was statistically proven. It seems that patients with breast cancer, in contrast to those with prostate cancer, have benefit (not statistically significant) in overall survival: 20.7 vs 15.6 months regardless dosage or type of radiopharmaceutical

Виртуальная сонография молочной железы. Опыт клинического применения

The aim: to evaluate the diagnostic effectiveness the automated breast volume scanner (ABVS) ACUSON S2000 (Siemens, Germany). Material and methods: The volume data sets were collected from 97 patients and a database containing 27 women with no detectable lesions in multimodal examination (BI-RADS 1), 18 women with clearly benign lesions (BI-RADS2), and 29 women with known breast cancer (BI-RADS5) was created. An independent examiner evaluated all the ABVS data on a separate workstation without any prior knowledge of the patients’ histories. Results. The diagnostic accuracy for the experimental ABVS was estimated as 88%. The independent examiner detected all breast cancers in the volume data resulting in a calculated sensitivity of 100%. After the ABVS examination, there were a high number of requests for further examination in 66%. Over-diagnosis was estimated 24 %. Conclusion. The specificity was 40%. Given the fact that during the application of ABVS no breast cancer was missed - the ABVS must still be regarded as an experimental technique for breast ultrasound, which definitely needs to undergo further evaluation studies.Цель: оценить диагностическую эффективность автоматизированного УЗ-сканера всего объема молочных желез (ABVS - the automated breast volume scanner) ACUSON S2000 (Siemens, Германия). Материал и методы. Обследовано 97 пациентов (n=100), из них по данным комплексного лучевого обследования патологические образования в молочных железах не были выявлены (BI-RADS 1) у 27, с отчетливо доброкачественными образованиями (BI-RADS 2) было 18, патоморфологически подтвержден рак молочной железы (РМЖ) (BI-RADS 5) - у 29. Все данные сканирования были оценены независимым экспертом - лучевым диагностом на специальной просмотровой станции без предварительной дополнительной информации о каждой пациентке. Результаты. Чувствительность метода автоматизированного сканирования в выявлении патологии молочных желез составила 100%, диагностическая точность ABVS - 88%. Независимый эксперт установил диагноз РМЖ молочной железы в 26 (90%) случаях из 29. По результатам автоматизированного сканирования молочных желез в 66 (66%) случаях было рекомендовано дообследование с применением комплекса лучевых методов. Гипердиагностика составила 24%. Таким образом, специфичность ABVS-обследования была равна 40%. Выводы. Учитывая тот факт, что ни один из случаев РМЖ не был пропущен, первый опыт использования ABVS показал обнадеживающие результаты и необходимость в дальнейших клинических испытаниях автоматизированной системы сканирования молочных желез

Радионуклидная визуализация молочной железы с использованием специализированной гаммакамеры высокого разрешения CZT в диагностике и оценке эффективности лечения больных раком молочной железы (обзор литературы)

Breast Specific Gamma Imaging (BSGI) or Molecular Breast Imaging (MBI) is a highly sensitive and specific diagnostic method in activity assessment of pathological lesion including breast cancer and its metastases. Not being a competitor to X-ray mammography this technology provides more information in case of patients with dense breast glandular tissue and it can also be an additional diagnostic method in the algorithm of early diagnosis of breast cancer.Планарная маммосцинтиграфия по методике Breast Specific Gamma Imaging (BSGI) является высокочувствительным и специфичным методом диагностики активности патологического очага, в том числе первичного рака молочной железы и его метастазов. Не являясь конкурентом рентгеновской маммографии, технология позволяет получить дополнительную информацию при плотной железистой ткани и может служить дополнительным диагностическим методом в алгоритме ранней диагностики рака молочной железы