Lesion of the nipple-areola complex in patients with breast cancer

The article presents data about the lesion of the nipple-areola complex in breast cancer. In 2015-2016 surgical treatment was performed in 101 breast cancer patients, different in size but with the mandatory removal of the nipple-areola complex. There are analyzed the dependence of the lesion of the nipple-areola complex from histological types of breast cancer, molecular subtypes, multicentricity, the location of tumor in the breast. The most significant criterion was the dependence of the lesion of the nipple-areola complex from the distance between tumor node and the nipple

Lesion of the nipple-areola complex in patients with breast cancer

The article presents data about the lesion of the nipple-areola complex in breast cancer. In 2015-2016 surgical treatment was performed in 101 breast cancer patients, different in size but with the mandatory removal of the nipple-areola complex. There are analyzed the dependence of the lesion of the nipple-areola complex from histological types of breast cancer, molecular subtypes, multicentricity, the location of tumor in the breast. The most significant criterion was the dependence of the lesion of the nipple-areola complex from the distance between tumor node and the nipple

Первичная фолликулярная карцинома почки. Клиническое наблюдение и обзор литературы

Primary thyroid-like follicular renal cell carcinoma is an extremely rare type of renal cell cancer with low malignancy potential and relatively good prognosis. It has not been included into the World Health Organization classification of renal tumors. This tumor is characterized by morphology similar to primary thyroid follicular cancer, but with different immune phenotype, which is important for morphological diagnosis. Surgery has been recognized as the only curative treatment. We describe our own observation of follicular renal carcinoma in a 68-year old man, in whom renal tumor was identified during his regular examination due to past colon cancer. The disease was asymptomatic. The patient had elective laparoscopic nephrectomy. At pathological assessment, the tumor looked like a follicular thyroid neoplasm. Immunohistochemistry revealed no expression of RCC, TTF-1, thyroglobulin, CD-10, synaptophysin, and chromogranin A. The differential diagnosis included metastatic primary thyroid malignancy as the most probable diagnosis, as well as highly differentiated neuroendocrine tumor and the so-called “thyroid kidney” that might occur in long-standing chronic pyelonephritis. Conclusion: The case of primary follicular renal carcinoma illustrates that this rare renal tumor is heterogeneous both in its structure and tumor cell immunophenotypes. Longer follow-up and accumulation of larger numbers of the disease is needed. This would allow for a more objective assessment of its prevalence in the population, of its clinical characteristics and morphological variability.Первичная фолликулярная карцинома почки (англ. primary thyroid-like follicular renal cell carcinoma) - чрезвычайно редкий вариант почечноклеточного рака с низким потенциалом злокачественности и относительно хорошим прогнозом, не включен в классификацию опухолей почки Всемирной организации здравоохранения. Эта опухоль характеризуется сходным морфологическим строением с первичным фолликулярным раком щитовидной железы, но отличным от нее иммунофенотипом, что важно для морфологической диагностики. Хирургический метод признан единственным методом радикального лечения. Описано собственное наблюдение фолликулярной карциномы почки у мужчины 68 лет, у которого при контрольном обследовании по поводу рака толстой кишки в анамнезе обнаружена опухоль почки. Заболевание протекало бессимптомно. В плановом порядке выполнена лапароскопическая нефрэктомия. При патологоанатомическом исследовании опухоль была похожа на фолликулярную опухоль щитовидной железы. При иммуногистохимическом исследовании в клетках опухоли отсутствовала экспрессия RCC, TTF-1, тиреоглобулина, CD-10, синаптофизина, хромогранина А. Дифференциальная диагностика проводилась в первую очередь с метастазом от первичной опухоли щитовидной железы, с высокодифференцированной нейроэндокринной опухолью, а также с так называемой тиреоидной почкой, развивающейся при длительном хроническом течении пиелонефрита. Заключение. Представленное нами наблюдение первичной фолликулярной карциномы почки свидетельствует о том, что этот редкий вариант опухоли почек неоднороден и по особенностям строения, и по иммунофенотипу опухолевых клеток. Необходимо увеличение периода наблюдения пациентов и накопление большего числа случаев данного заболевания. Это позволит более объективно оценить частоту встречаемости этих опухолей в популяции, их клинические характеристики и морфологическую вариабельность

Чувствительность первично-множественного синхронного двустороннего рака молочных желез к неоадъювантной химиотерапии

Objective — to evaluate the sensitivity of multiple primary bilateral synchronous breast cancer (BC) to neoadjuvant drug therapy. Subject and methods. The investigation enrolled 14 patients with multiple primary synchronous BC who received drug treatment at the first stage of combined treatment. Eleven patients underwent 6 to 8 cycles of neoadjuvant polychemotherapy (NAPCT); targeted therapy drugs were simultaneously added to taxane-containing regimens in 2 patients with HER2-positive tumors. Results. The mean age of the patients was 44.3±13.8 years, which was substantially younger than that of the total population of BC patients. The histological pattern of tumor nodules in both mammary glands was the same in 11 patients and the tumors in the mammary glands were different in 3 patients. Therapeutic pathomorphism (TP) was absent in 2 (8.3%) cases; it was poorly expressed (grade 1) in 4 (12.5%) cases, grades 2, 3, and 4 were seen in 7 (29.2%), 6 (16.7%), and 9 (33.3%), respectively. None of the 7 patients with the edematous-infiltrative form of BC achieved grade 4 TP despite its different biological types. The immunohistochemical study showed that edematous infiltrative BC was presented as a luminal type in 5 cases, as a triple-negative one in 1 case, and as a luminal type B, HER2-positive in 1 case. Nine of the 28 cases achieved complete TP in the primary tumor, but only one patient had it in both tumors with different biological types. Conclusion. In most cases, the reaction of synchronous tumors to NAPCT did not coincide in the same patient. A complete pathomorphism was most common in the triple negative type (33.3±16.6%), which corresponds to the current ideas on the behavior of this aggressive biological type of BC. The authors consider it necessary to further study the reaction of synchronous tumors to neoadjuvant therapy and to accumulate clinical materials for the reliable confirmation of the findings, which is important for the development of an adequate treatment policy and theoretical knowledge of the pathogenesis of drug sensitivity/resistance of breast tumors.Цель исследования — оценить чувствительность первично-множественного двустороннего синхронного рака молочных желез (РМЖ) к неоадъювантной лекарственной терапии. Материал и методы. В исследование включили 14 пациенток с первично-множественным синхронным РМЖ, которые на I этапе комбинированного лечения получили лекарственное лечение. У 11 больных проведено от 6 до 8 курсов неоадъювантной полихимиотерапии (НАПХТ), у 2 с НER2-позитивными опухолями одновременно к таксансодержащим режимам добавляли препараты таргетной терапии. Результаты. Средний возраст больных составил 44,3±13,8 года, что существенно меньше по сравнению с общей популяцией больных РМЖ. Гистологическая форма опухолевых узлов у 11 пациенток была одинаковой в обеих молочных железах, у 3 опухоли в молочных железах отличались. Лечебный патоморфоз (ЛП) отсутствовал в 2 (8,3%) случаях, был слабо выражен (I степень) в 4 (12,5%), II степень была в 7 (29,2%), III степень — в 6 (16,7%), IV степень — в 9 (33,3%) случаях. Из 7 пациенток с отечно-инфильтративной формой РМЖ ни у одной не был достигнут ЛП IV степени, несмотря на его различные биологические типы. По данным ИГХ-исследования отечно-инфильтративный РМЖ в 5 случаях был представлен люминальным типом, в 1 случае — тройным негативным и в 1 — люминальным типом В, HER2-позитивным. Полный ЛП в первичной опухоли был достигнут в 9 из 28 случаев, но лишь у одной пациентки в обеих опухолях с различными биологическими типами. Заключение. Реакция синхронных опухолей у одной и той же больной на НАПХТ в большинстве случаев не совпадала. Наиболее часто полный патоморфоз отмечен при тройном негативном типе (33,3±16,6%), что соответствует современным представлениям о поведении этого агрессивного биологического типа РМЖ. Мы полагаем, что необходимо дальнейшее изучение особенностей реакции синхронных опухолей на неоадъювантное воздействие, накопление клинического материала для достоверного подтверждения полученных данных, что важно для выработки адекватной тактики лечения и наработки теоретических знаний патогенеза лекарственной чувствительности/резистентности опухолей молочной железы

ФИЛЯРИОЗ МОЛОЧНОЙ ЖЕЛЕЗЫ. КОМПЛЕКСНАЯ ЛУЧЕВАЯ ДИАГНОСТИКА И ЛЕЧЕНИЕ

F ilariasis is a tropical disease caused by the parasite Dirofilaria repens. The lesion of the breast occurs in 10%. Purpose. To present a clinical case of a woman with breast pathology. Materials and methods. The condition did not manifest clinically. Detection of atypical cyst in the breast using ultrasound technology and its subsequent biopsy allowed to confirm the pathology. Results. The possibilities of an integrated approach in the diagnosis of breast lesions and minimally invasive treatment of a patient with a parasitic lesion of the breast are demonstrated.Ф иляриоз - это тропическое заболевание, вызванное паразитом Dirofilaria repens. Поражение молочной железы встречается в 10%. Цель. Представить клиническое наблюдение женщины с патологией молочной железы. Материалы и методы. Состояние клинически не проявлялось. Выявление атипичной кисты в молочной железе с применением ультразвуковых технологий и последующая ее биопсия позволили подтвердить патологию. Результаты. Продемонстрированы возможности комплексного подхода в диагностике поражений молочной железы и малоинвазивного лечения пациентки с паразитарным поражением молочной железы

Breast filariasis. Complex diagnostic and treatment [ФИЛЯРИОЗ МОЛОЧНОЙ ЖЕЛЕЗЫ. КОМПЛЕКСНАЯ ЛУЧЕВАЯ ДИАГНОСТИКА И ЛЕЧЕНИЕ]

Filariasis is a tropical disease caused by the parasite Dirofilaria repens. The lesion of the breast occurs in 10%. Purpose. To present a clinical case of a woman with breast pathology. Materials and methods. The condition did not manifest clinically. Detection of atypical cyst in the breast using ultrasound technology and its subsequent biopsy allowed to confirm the pathology. Results. The possibilities of an integrated approach in the diagnosis of breast lesions and minimally invasive treatment of a patient with a parasitic lesion of the breast are demonstrated. © 2019 Russian Electronic Journal of Radiology. All rights reserved

New procedures for determining resection margins during organ-sparing surgery in patients with breast cancer

Breast cancer (BC) occupies a leading place in the structure of cancers among the female population worldwide. The number of breast cancer patients currently tends to increase in the 30–45-year-old group. Organ-sparing treatment (OST) is recommended to improve quality of life in the patients. The operation involves the excision of a segment with a breast lump, but achievement of negative resection margins is mandatory. The latest data show that to achieve the purity of resection margins, indents of up to 2 mm and 1 mm are currently recommended for ductal carcinoma in situ and an invasive form, respectively. Despite the existing data on the safety and benefits of OST, 20 to 30% of patients with invasive or non-invasive BC usually undergo a reoperation. The increased number of repeated resections, and especially mastectomies, leads to severe psychological and physical traumas in women, substantially worsening the quality of life. It is important to correctly mark resection margins during surgery. The paper presents up-to-date methods to examine resection margins intraoperatively. It includes techniques, such as micro-CT, Cherenkov luminescence imaging, radiofrequency spectroscopy-based “Margin Probe”, and fluorescence imaging. The use of the most promising techniques and their long-term results are described. © A group of authors, 2020

Treatment options of breast cancer patients after breast-conserving surgery with positive margins R1

Introduction: in organ-preserving operations for breast cancer, the risk of recurrence is associated with many factors, including positive resection margins. The article presents data from the literature, which considers the risk of relapse depending on the positive, close and negative edges of resection. The purpose of this study was to increase the effectiveness of treatment of breast cancer patients after organ-preserving operations with positive resection edges. Materials and methods: the study included 1219 patients with breast cancer who underwent organ-preserving and oncoplastic resections of the breast. Urgent cytological and histological intraoperative examination of the resection edges is analyzed in detail, and the marking of the resection edges is presented. The clinical and morphological characteristics of patients with breast cancer at R0 and Rl are presented. Results: positive edge of Rl resection was diagnosed in 53 cases, which was 4,3±2,8%, in oncoplastic resections in 4,1±1,1%, in classical breast resections in 4,6±0,7% (p>0,05). In the group of patients with Rl, multicentricity of the tumor was diagnosed in 11,1±5,3%, and monocentric tumor was detected in 4,1 ±0,5%. Further tactics in the case of Rl detection were as follows: in 21 cases, radiation therapy was performed on the breast, in 32 cases, re - operation: resection of the edges - in 14 patients, radical mastectomy - in 9 patients, subcutaneous mastectomy with simultaneous reconstruction with autologous flaps or endoprostheses - in 9 patients. In the group of patients with re-operation, 43,7% of the planned study showed no signs of malignancy, 56,3% showed a residual tumor, while 31.3% were diagnosed with cancer in situ. So in the case of resection of the edges in 5 cases, a residual tumor was diagnosed in the resected edges, which was 35,7%, and in the case of mastectomy, a residual tumor was detected in 68,4%. Re-operation in R1 after oncoplastic resections was performed in 71,4%, and in classical resections in 56,4%, which correlates with the literature data. Conclusion: in two groups of patients after organ-preserving operations with positive resection margins, no local recurrence was detected during the follow-up period from 1 to 60 months, and distant metastases, namely, lesions of the bones of the skeleton, were diagnosed in 2 patients. Thus, with a positive edge of resection after organ-preserving surgery, both surgical treatment and radiation therapy can be performed. Although the presence of a tumor in the colored edges of resection is clearly associated with a high frequency of local relapses, but the relapse is also influenced by the biological characteristics of the tumor and the body. Individual characteristics are the basis of tumor biology, and the extent of their influence on long-term results is not reduced due to the wide surgical margins of resection. © 2020 Izdatel'stvo Meditsina. All rights reserved

LAPAROSCOPIC RESECTION OF THE HORSESHOE KIDNEY FOR RENAL CELL CARCINOMA

Renal fusion is one of the most common kidney anomalies. The most frequent is horseshoe kidney, characterized by a fusion of the poles (typically the lower poles) of the kidneys. We described a clinical case of a malignant tumor in the right half of the horseshoe kidney (stage 1 cancer, CT1aN0M0) in a man aged 65 years, who underwent laparoscopic resection. It was shown that laparoscopy is no less efficient than open surgery. However, in planning the operation, it is necessary to use spiral computed tomography for three-dimensional reconstruction of the organ and identification of its anatomical features caused by aberrant blood supply to horseshoe kidney

Особенности дифференциальной диагностики слизистого и слизистого микропапиллярного рака молочной железы

Objective - to analyze the clinical and pathomorphological characteristics of types A and B mucinous breast cancer (BC) and micropapillary carcinoma with obvious mucus production. Subject and methods. The paper analyzes the results of examination and treatment in 38 patients. Early-stage (I and IIA) BC was diagnosed in 81.6% of cases in the study. The patients’ mean age was 60.2±7.9 years (range 33-78). The distribution of the patients according to the stages of BC was as follows: 18 (47.4%) patients with Stage I BC, 13 (34.2%) with IIA stage, 3 (7.9%) with IIB stage, 2 (5.3%) with IIIA stage, 1 (2.6%) with IIIB stage, 1 (2.6%) with IIIC stage. The lymph node status was pNin 33 cases with no lymph node metastases in mucinous BC and pNin 5 cases with invasive micropapillary carcinoma (IMPC) of the breast. The multicentricity of tumor nodules was diagnosed in 4 (10.5%) cases; the number of tumor nodules was from 2 to 3 in the breast, as well as in all cases in mucinous BC. The distribution of the patients according to the molecular biological type of a tumor was as follows: luminal A tumor in 21 (58.3%) cases, luminal B Her2-negative cancer in 11 (30.5%), luminal B Her2-positive tumor in 3 (8, 3%), and triple negative BC in 1 (2.9%). There was a triple negative BC type in 1 case of IMPC of the breast, a luminal B Her2-positive type in 3 cases of mucinous BC, and luminal types of the tumor were diagnosed in the other cases. Results. Lymph node metastases were found in 5 (13.2%) cases. In this investigation, all the patients with lymph node metastases had one type of cancer - invasive mucinous micropapillary carcinoma. At the same time, mucinous micropapillary carcinoma was confirmed by biopsy only in 1 female patient. During the follow-up, 38 patients with mucinous and mucinous micropapillary BC were found to have distant metastases in none of the groups. The investigation revealed the following relationship of lymph node metastatic spread: the metastases were diagnosed as T1 in 10% of cases, T2 in 15.4%, and T3 in 25%. Conclusion. The task of a pathologist is to identify and correctly differentiate invasive micropapillary carcinoma with obvious mucus production from simple mucinous carcinomas types A and B in the preoperative period of the examination. So, only a study of sentinel lymph nodes can be performed in only simple mucinous breast carcinoma; axillary lymphadenectomy should be carried out in micropapillary carcinoma with obvious mucus production. Treatment policy for invasive micropapillary BC with obvious mucus production should be more aggressive, while that for mucinous cancer is minimal.Цель исследования - проанализировать клинические и патоморфологические особенности слизистого рака молочной железы (РМЖ) типа А и В и микропапиллярного рака с выраженным слизеобразованием. Материал и методы. В статье проанализированы результаты обследования и лечения 38 больных. В исследовании в 81,6% случаев диагностированы начальные (I и IIА) стадии РМЖ. Средний возраст пациенток 60,2±7,9 года (33-78 лет). Распределение по стадиями РМЖ: I - 18 (47,4%) пациенток, IIA - 13 (34,2%), IIB - 3 (7,9%), IIIA - 2 (5,3%), IIIB - 1 (2,6%), IIIС - 1 (2,6%). Состояние лимфатических узлов: рN0 - 33 случая, при этом метастазы отсутствовали в лимфатических узлах при слизистом РМЖ, рN1-3 - 5 случаев при инвазивной микропапиллярной карциноме (ИМПК) РМЖ. Мультицентричность опухолевых узлов диагностирована в 4 (10,5%) случаях, число узлов в молочной железе от 2 до 3 и во всех случаях при слизистом РМЖ. Распределение в зависимости от молекулярно-биологического типа опухоли следующее: люминальный тип А в 21 (58,3%) случае, люминальный тип В Her2-негативный в 11 (30,5%), люминальный тип В Her2-позитивный в 3 (8,3%), тройной негативный тип в 1 (2,9%). При ИМПК РМЖ в 1 случае выявлен тройной негативный тип опухоли, а при слизистом РМЖ в 3 случаях - люминальный тип В Неr2-позитивный, в остальных случаях диагностированы люминальные типы опухоли. Результаты. Метастазы в лимфатических узлах обнаружены в 5 (13,2%) случаях. В исследовании все пациентки с метастазами в лимфатических узлах имели один тип рака - инвазивную муцинозную микропапиллярную карциному. При этом только у 1 пациентки по данным биопсии была подтверждена муцинозная микропапиллярная карцинома. За период наблюдения у 38 пациенток со слизистым и муцинозным микропапиллярным РМЖ отдаленных метастазов не обнаружено ни в одной из групп. В исследовании выявлена следующая зависимость метастазирования в лимфатических узлах: при T1 диагностированы метастазы в 10% случаев, при T2 - в 15,4%, при T3 - в 25%. Заключение. Задача врача-патологоанатома - выявить и правильно дифференцировать инвазивную микропапиллярную карциному с выраженным слизеобразованием от простых муцинозных карцином типа A и B в предоперационном периоде обследования. Так, в случае только простой муцинозной карциномы молочной железы можно выполнять только исследование сигнальных лимфатических узлов, а при микропапиллярном раке с выраженным слизеобразованием необходимо производить подмышечную лимфаденэктомию. Лечебная тактика при инвазивном микропапиллярном раке молочной железы с выраженным слизеобразованием должна быть более агрессивной, тогда как при слизистом раке она минимальна