Problems of metastasis (literature review)

Despite significant successes in the development of medical sciences, the study of oncopathology issues still occupies a leading place due to the identification of a large number of advanced cases of the disease. Firstly, this may be due to the rapid growth of a malignant tumor, for example, against the background of immunodeficiency. Secondly, with late treatment of patients, when they already have distant metastases. The success of treatment of any oncological process primarily depends on the timing of the diagnosis: the earlier the tumor is diagnosed, the greater the chance of a positive outcome and an increase in the life expectancy of the cancer patient. The most formidable complication of oncopathology and the main cause of death from it is metastasis, which often reduces to zero all the effects of therapy. Metastasis remains a mystery today. So, despite the large number of various theories, the question of the spread of the tumor throughout the body has not yet been resolved. There is no definite answer to the question: do metastases metastasize? The mechanisms of the influence of hormones on the processes of metastasis have not been fully studied. Difficulties in diagnosis are associated with the lack of clinical manifestations before the appearance of metastases, the inability to track and compare changes in tissues and organs in vivo, the non-specificity of the results of available research methods, and the lack of control of the spread of metastases throughout the body. Experimental studies on laboratory animals can provide answers to these and many other questions. In a review of the literature, a study of the main issues of metastasis is conducted.

Combination approach to diagnosis and treatment of an elderly patient with chronic Ph-negative myeloproliferative neoplasm and concomitant surgical pathology. Clinical observation

Chronic myeloproliferative neoplasms (CMPN), Ph-negative, are of clonal nature, develop on the level of hematopoietic stem cell and are characterized by proliferation of one or more hematopoietic pathways. Currently, the group of Ph-negative CMPN includes essential thrombocythemia, primary myelofibrosis, polycythemia vera, myeloproliferative neoplasm unclassifiable.Identification of mutations in the Jak2 (V617F), CALR, and MPL genes extended understanding of biological features of Ph-negative CMPN and improved differential diagnosis of myeloid neoplasms. Nonetheless, clinical practice still encounters difficulties in clear separation between such disorders as primary myelofibrosis, early-stage and transformation of essential thrombocythemia into myelofibrosis with high thrombocytosis. Thrombocytosis is one of the main risk factors for thromboembolic complications, especially in elderly people.A clinical case of an elderly patient with fracture of the left femur developed in the context of Ph-negative CMPN (myelofibrosis) with high level of thrombocytosis is presented which in combination with enforced long-term immobilization and presence of additional risk created danger of thrombosis and hemorrhage during surgery and in the postoperative period.

Experience in treatment of glial tumors using the CyberKnife device

The study objective is to determine the effectiveness of stereotactic radiotherapy in treatment of glial cerebral tumors.Materials and methods. Results of using stereotactic radiotherapy in treatment of recurrent cerebral gliomas in 30 patients and primary glial tumor in 1 patient who couldn’t receive traditional radiotherapy were analyzed. Treatment was administered both to adults (n = 22) and children (n = 9). Prior to treatment all patients underwent pre-radiotherapy preparation in the form of contrast-enhanced magnetic resonance topometry of the brain, computed tomography with topometry, as well as positron emission tomography/computed tomography with amino acids (n = 21).Results. During treatment 2 patient developed grade II toxic reactions requiring emergency medical help. In 29 patients, treatment did not cause any complications. At the time of article preparation, 7 patients were alive; maximal follow-up period was 55 months, median follow-up duration was 8 months.Conclusion. Stereotactic radiotherapy can be used for disease stabilization. The results show effectiveness and safety of stereotactic radiotherapy as a salvage method of local treatment in patients with recurrent glial tumors of the brain.

BRAF-mutant melanoma of the skin during pregnancy with dichorionic diamniotic twins. Clinical case

Per the majority of authors, melanoma is the most common tumor diagnosed during pregnancy (31 % of all malignant neoplasms). In approximately 1/3 of women melanoma developed in child-bearing age is diagnosed during pregnancy or in the postpartum period. However, only some retrospective studies analyzed the effect of pregnancy on melanoma development, and conclusive data on development, progression and treatment of BRAF-mutant melanoma is lacking. In this subpopulation of patients, BRAF status supposedly can negatively affect disease outcome irrespective of treatment methods.The article presents a clinical case of recurrence of melanoma with the BRAF V600E mutation during pregnancy. The patient underwent lymph node dissection during pregnancy prolongation, after labor she received antitumor drug therapy with МЕК and ВRAF inhibitors. Melanoma recurrence during pregnancy did not worsen treatment outcomes for the mother and embryo.