No 41 (2015)



Gurov A.N., Balkanov A.S., Katuntseva N.A., Ogneva E.Y.


Rationale: Analysis of the cancer incidence and mortality in the population is of major importance for planning of measures aimed at improvement of organization of medical care to cancer patients, ensuring high quality and availability of this type of medical care.
Aim: To evaluate cancer-related incidence and mortality rates and structure among the population of the Moscow Region depending on patient gender and tumor localization.
Materials and methods: The estimation and analysis of incidence and mortality rates was performed based on the Reporting Form of the Federal Statistic Surveillance #7 “Information on disorders related to malignant tumors” in the Moscow Region in 2014. For mortality analysis, including that among pediatric patients, we used data from the State Statistics Service of the Moscow Region.
Results: In 2014, there were 25 600 new cases of malignancies diagnosed in the Moscow Region, that corresponded to the incidence rate of 363.2 per 100,000 of the population. The leading types of newly diagnosed tumors in men were prostate cancer, as well as tracheal, bronchial and lung cancers (54.2 and 47.0 per 100,000 of male population, respectively). In women, the highest incidence rates were found for breast and skin cancers (86.0 and 58.9 per 100,000 of female population, respectively). According to the data from Rosstat, in 2014, the overall cancer mortality rate in the Moscow Region was 228.1 per 100,000 of the population. Among the causes of cancer mortality in men, the leading one was tracheal, bronchial and lung cancer (22.2%), followed by stomach cancer (13.3%) and prostate cancer (8.1%). In women, the leading cause of cancer mortality was breast cancer (16.6%), followed by ovarian, uterine and cervical cancers (14.1%) and stomach cancer (11.4%).
Conclusion: Based on the results of medical and statistical analysis of cancer incidence and mortality rates, the main direction of improvement of medical care to cancer patients and the ways for further development of specialized medical care in the Moscow Region were chosen.

Almanac of Clinical Medicine. 2015;(41):6-11
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Filipenko M.L., Shamovskaya D.V., Oskina N.A., Oscorbin I.P., Khrapov E.A., Ovchinnikova L.K., Gershteyn E.S., Kushlinskii N.E.


Aim: To develop a highly sensitive real-time polymerase chain reaction (PCR) system for detection of somatic mutations in 542 and 545 codons of exon 9 and 1047 codon of exon 20 of PIK3CA gene comprising more than 80% of all somatic mutations in this gene for application on histological material without macroand microdissection, and to analyze associations between these mutations and clinical and pathological characteristics of breast tumors.
Materials and methods: The Allele-specific real-time PCR method with signal detection by TaqMan probes was used. For determination of its analytical sensitivity, plasmids carrying the mutations studied were constructed by standard genetic engineering methods using mutagenesis. DNA samples carrying various mutated/wild type DNA ratios (5.0; 2.0; 1.0; 0.5, 0.25%) were prepared. Results: Multiplex allele-specific real-time PCR method for detection of most common mutations in PIK3CA gene: p.E542K c.1624G>A, p.E545K c.1633G>A, p.H1047R c.3140A>G, p.H1047L c.3140A>T – was developed and optimized.
Analytical sensitivity of mutation detection comprised 0.5% for p.E542K and 0.25% for p.E545K, p.H1047R and H1047L enzyme.
Conclusion: The method developed for detection of somatic mutations in PIK3CA gene is sufficiently sensitive, specific and efficient, that allows to propose it for a routine screening in clinical diagnostic laboratories for evaluation of disease prognosis and monitoring of response to therapy and its modification.

Almanac of Clinical Medicine. 2015;(41):12-18
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Gershteyn E.S., Kushlinskiy D.N., Korotkova E.A., Isaeva E.R., Ermilova V.D., Laktionov K.P., Adamyan L.V., Kushlinskii N.E.


Background: The insulin-like growth factor (IGF) signaling system plays a major role in development and progression of various malignancies including ovarian cancer, and its components are considered as potential diagnostic and prognostic markers and the objects of molecular targeted therapy.
Aim: Comparative evaluation of IGF-I and IGF-II, and IGF-binding proteins (IGFBP)-1, 2 and 3 content in blood serum and tumors of ovarian tumor patients, analysis of their associations with key clinical pathologic characteristics of ovarian cancer and evaluation of clinical value of these markers for disease diagnostics and prognosis.
Materials and methods: IGF-I, II, IGFBP-1, 2 and 3 levels were measured with standard ELISA kits (Mediagnost, Germany) in blood serum and tumor extracts of 74 patients with ovarian cancer, 16 patients with benign and 14 with borderline ovarian tumors. The control group comprised 77 healthy women.
Results: Three potential serological markers of ovarian cancer, namely IGF-I, IGFBP-1, and IGFBP-2 were revealed. The best sensitivity to specificity ratio was demonstrated for IGFBP-2: at a 370 ng/ml cut-off level, these indices were 87 and 79%, respectively. The diagnostic markers found in our study were also associated with the prognosis of overall survival in ovarian cancer. In the multivariate analysis, low IGF-I serum levels retained its independent unfavorable prognostic value. The disease prognosis is influenced also by IGF-II and IGFBP-1 content in the tumor tissue.
Conclusion: In ovarian cancer patients, there is a disbalance of IGFs/IGFBPs. Some components of this system could be potentially used as diagnostic and prognostic markers of the disease.

Almanac of Clinical Medicine. 2015;(41):19-27
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Balkanov A.S., Molchanova G.S., Petrushkina N.N., Rybolovlev A.V.


Aim: To analyse the level of insulin oversecretion in patients with glioblastoma, which during adjuvant radiation therapy (aLT) received dexamethasone at daily doses of 4 or 8 mg.
Materials and methods: The study included 81 patients with brain glioblastoma. Dexamethasone 4 mg was administered intramuscularly for 6–7 weeks (duration of aLT) to 66 patients who had not been previously treated with dexamethasone (group 1). In group 2, 15 patients received dexamethasone at daily dose of 8 mg i.m. for 6 to 7 weeks before aLT, whereas during aLT, their daily dose of dexamethasone was reduced to 4 mg. Levels of C-peptide, insulin and cortisol were studied at one day before and one day after completion of adjuvant radiation therapy.
Results: Patients from group 1 showed a significant increase of blood insulin (from 64.2 ± 40.9 to 105.2 ± 124.9 pmol/l, р < 0.05) and C-peptide (from 2.3 ± 1.0 to 3.2 ± 1.3 ng/ml, р < 0.05) within their reference ranges, as well as a significant decrease in blood cortisol (from 513.1 ± 163.6 to 82.7 ± 114.7 nmol/l, р < 0.001) at 6 to 7 weeks after dexamethasone administration at daily dose of 4 mg. Increase of daily dexamethasone dose from 4 to 8 mg did not lead to a substantial increase in blood insulin and C-peptide levels, but the level of C-peptide in group 2 exceeded its upper normal limit (3.8 ± 1.2 ng/ml). After reduction of dexamethasone dose in group 2 from 8 to 4 mg, there were no major changes in insulin and C-peptide levels, whereas the level of blood cortisol in these patients continued to decline (to 33.7 ± 13.4 nmol/l, р < 0.05).
Conclusion: The use of dexamethasone at a daily dose of 4 to 8 mg in glioblastoma patients during adjuvant radiation therapy led to oversecretion of pancreatic insulin, which is most likely a consequence of insulin resistance.

Almanac of Clinical Medicine. 2015;(41):28-34
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Lyubimova N.V., Toms M.G., Churikova T.K., Kharitid T.Y.


Background: Neuroendocrine tumors (NET) is a heterogeneous group of neoplasms characterized by hypersecretion of biologically active sub- stances that manifests by specific syndromes and determines the clinical course of the disease. The most common NET types are those of gastrointestinal tract. The obligatory biochemical marker used in the examination of NET patients is chromogranin A (CgA).
Aim: Evaluation of the CgA value for diagnostics and monitoring of gastrointestinal NETs.
Materials and methods: A comparative study of plasma CgA levels was performed in 146 patients with gastroenteropancreatic neuroendocrine tu- mors and 66 healthy individuals using the enzyme immunoassay “Chromogranin A ELISA kit” (Dako A/S, Denmark).
Results: CgA levels were significantly higher in patients with NETs of all localizations, such as pancreas, stomach, gut, small and large bowel, than in the healthy subjects (р < 0.000001). In NET patients, CgA secretion was highly variable, with the highest value in the group of patients with gastric NETs (102000 U/l). The highest CgA medians were detected in patients with small intestinal (183.9 U/l), colon (148.4 U/l) and pancreatic (135.9 U/l) NETs. There was an association between CgA secretion and extension or activity of NETs, with the highest median values in patients with hepatic metastases (395 U/l) and those with carcinoid syndrome (352 U/l). The clinical significance of CgA as a NET marker was assessed using the cut-off value of 33 U/l, calculated according to the results in the control group. Overall diagnostic sensitivity of CgA in NET patients was high (85.8%) with a specificity of 98.5%. Conclusion: The results obtained confirm a high sensitivity of CgA as a NET marker whose determination helps to improve accuracy of diagnostics and to assess NET prevalence.

Almanac of Clinical Medicine. 2015;(41):35-39
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Babkina I.V., Bondarev A.V., Shchupak M.Y., Boulytcheva I.V., Soloviev Y.N., Makhson A.N., Aliev M.D., Kushlinskii N.E.


Background: Bone sarcomas are extremely malignant prone to rapid hematogenic metastasing. Evaluation of biological marker expression by the tumor is important not only for the search of new potential chemotherapy targets, but for the assessment of the disease prognosis.
Aim: A comparative evaluation of matrix metalloproteinases (MMP)-2, -7, -9 and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the serum of patients with primary bone tumors and in healthy people to identify their potential association with the histological characteristics of the tumor and the disease prognosis.
Materials and methods: A comparative study of serum MMP-2, -7, -9, and TIMP-1 levels was performed in 54 patients with primary bone tumors (malignant, 45 patients, including central osteosarcoma in 21, periosteal osteosarcoma in 4, Ewing's sarcoma in 11, primary chondrosarcoma in 6, undifferentiated pleomorphic sarcoma in 3, and borderline giant cell tumors in 9) and in 26 healthy individuals with the use of the immunoenzyme technique (Biosource, USA, for TIMP-1 and R&D, USA, for MMP-2, -7, and -9).
Results: The TIMP-1 levels in the serum of patients with central and periosteal osteosarcomas were significantly higher than in the serum of healthy controls (р = 0.038 and p = 0.007, respectively). The MMP-9 levels in patients with bone malignancies were significantly lower than that in the normal controls (p < 0.05). There was a positive correlation between serum TIMP-1 and MMP-9 levels in patients with central, periosteal and Ewing's sarcomas (r = 0.37, p = 0.024). No significant differences in the 5-year survival rates related to serum TIMP-1, MMP-2, -7, -9 levels were found in patients with bone sarcomas. However, in those with osteosarcoma and serum MMP-2 > 160 ng/ml, the overall 5-year survival rate was 1.6-fold higher than in those with lower MMP-2 levels, and in those with ММP-9 levels < 377 ng/ml, the 5-year survival rate was 1.4-fold higher than in patients with ММP- 9 > 377 ng/ml. The worst 5-year survival (33%) was found in the patients with serum ММP-2 levels of less than 160 ng/ml and ММP-9 of more than 377 ng/ml. Conclusion: The results obtain suggest that the expression of MMP-2, MMP-9 and TIMP-1 could be associated with pathophysiological changes related to growth and metastatic process of bone sarcomas and osteosarcoma, in particular. This area could be an object for further studies on levels of these biomarkers and their prognostic value in bone malignancies.

Almanac of Clinical Medicine. 2015;(41):40-45
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Balkanov A.S.


Background: The rationale for distant gamma therapy (DGT) in prostate cancer patients is the data of its effectiveness in combination with modern planner devices, as well as lower costs, compared to the use of a linear accelerator.
Aim: To access the impact of DGT based on a 3D planning software “Amphora” on the 5-year survival rate depending on the main predictors of treatment efficacy in prostate cancer patients.
Materials and methods: The study included 34 prostate cancer patients who received low-dose DGT (total focal dose of 62 to 70 Gr). Androgen deprivation was used in 73.5% of patients for 6 to 12 months.
Results: The patients with a baseline pros tate-specific antigen level < 20 ng/ml had the highest 5-year survival rate of 86%. There was no significant difference in a 5-year survival that depending on a total focal dose (< 64 Gr; ≥ 64 Gr) of DGT if used in combination with androgen deprivation. Conclusion: This data represents only the first step in establishment of the criteria to choose the type of DGT in prostate cancer patients. The optimization of a treatment strategy based on a thorough analysis of data, including that on comorbidities and their severity, would make the use of DGT more rational that will reduce costs of treatment.

Almanac of Clinical Medicine. 2015;(41):46-51
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Polyakov P.Y., Bychenkov O.A.


Aim: To increase the efficacy of radiation therapy of malignant epithelial cell skin neoplasms with the use of radiation sensitizers of hypoxic tumor cells.
Materials and methods: The study was performed in 517 patients with basal cell (n = 361) and squamous cell (n = 156) skin cancer, 274 (53%) of whom had T2 and 243 (47%), T3 tumors. Patients with locally advanced and metastatic tumors were excluded from the study. The following treatment modalities were used: distant gamma-therapy, short-distance radiation therapy and combined radiation therapy with the use of non-conventional dose fractioning at total local doses equal to 72–73 Gr. The sensibilization of hypoxic tumor cells to radiation therapy with metronidazole was done by targeted delivery of the drug to the tumor by means of topical application of Coletex-M drapes impregnated with metronidazole in a high concentration (up to 20 mcg/cm²). The second method of radiosensibilization of hypoxic tumor cells was based on a preliminary use of low intensity laser radiation onto the tumor. As a source this radiation, a helium neon laser was used with the power of up to 12 mVt and the wave length of 0.63 to 0.89 mcm, duration of sessions from 3 to 15 minutes. The control group comprised 192 skin cancer patients who underwent radiation therapy without the use of radiation sensitizers.
Results: The use of metronidazole and low intensity laser radiation within the radiation therapy of T3 skin cancer patients, compared to the treatment without the radiation modifiers, significantly improved the immediate cure rates (full tumor regression at 1 to 1.5 months after completion of radiation) from 75.5 ± 3.1% to 89.2 ± 1.9% (р < 0.05). In the group with basal cell skin cancer that underwent radiation therapy combined with metronidazole, there was an association of its radio-modifying effect and tumor size. Short-distance roentgenotherapy of patients with T2 basal cell skin cancer and tumor size of < 4 cm was equally effective, irrespective of the use of metronidazole: the immediate cure rate was 94.8 ± 2.2% (92/97 patients) in the metronidazole group and 89.8 ± 3.9% (53/59) in the control group. With the combined radiation therapy of T2 basal skin cancer patients with the tumor size of 4–5 cm, the immediate cure rate was increased significantly from 73.2 ± 6.9% (30/42) in the control group to 88.2 ± 3.7% in the metronidazole group (67/76) (р < 0.05). With distant gamma-therapy of T3 basal cell skin cancer, this parameter was increased from 70.5 ± 6.8% (31/44) in the control group to 88.4 ± 4.8% (38/43) in the metronidazole group (р < 0.05).
The radiation-sensitizing effect of metronidazole and low intensity laser combined with the distant gamma-therapy of T3 basal cell skin cancer was significant and similar: the immediate cure rate with the use of metronidazole was 85.9 ± 4.6% (49/57), and with the use of low intensity laser, 84.6 ± 5.0% (44/52), compared to 66.0 ± 6.9% (31/47) in the control group (р < 0.05).
Although the relapse rate after radiation therapy with metronidazole or low intensity laser was lower by 5–11%, compared to that after the radiation without modifiers, there was no statistically significant difference after a 3-year follow-up.
Conclusion: A significant benefit of radiation therapy combined with radiation sensitizers on the immediate cure rate of locally-advanced basal cell skin cancers was confirmed. It seems that radiation sensitizers of hypoxic cells do improve immediate results of cure without any significant effect on tumor relapse rate in the future.

Almanac of Clinical Medicine. 2015;(41):52-59
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Vysotskaya L.L., Golenkov A.K., Trifonova E.V., Mitina T.A., Kataeva E.V., Chernykh Y.B.


Aim: To assess long-term efficacy of firstand second-line tyrosine kinase inhibitors in non-selected patients with chronic myeloid leukemia in a real-life clinical setting.
Materials and methods: The assessment is based on long-term results of a prospective single center comparative clinical trial that was based on non-selected groups of 116 patients with various stages of chronic myeloid leukemia being treated with a first generation tyrosine kinase inhibitor imatinib, and of 44 patients being treated with a second generation tyrosine kinase inhibitor nilotinib. We analyzed all-cause mortality, progression-free survival from April 2005 to April 2013, with a median of the follow-up of 128 months.
Results: In 116 patients with chronic myeloid leukemia treated with imatinib, the Kaplan-Meier survival estimate was 120 months. In 44 patients at an early chronic phase, 5-year overall survival and progression-free survival was 93.2% and 8-year overall and progression-free survival was 79.5%. In 44 patients at a late chronic stage, 5-year overall and progression-free survival was 95.5%, 8-year overall and progression-free survival, 72.7%. In 28 patients at acceleration phase, 5-years overall survival was 78.6% and 8-year overall survival, 46%. Median of overall survival in patients treated with nilotinib was not reached. During 78.6 months of combination treatment with cytotoxic agents, tyrosine kinase inhibitors of the first (imatinib) and second line (nilotinib), overall survival was 100%.
Conclusion: In clinical practice, inclusion of patients with chronic myeloid leukemia and imatinib resistance (disease relapse) or imatinib intolerance into the treatment program with frontline therapy with general cytotoxic agents and thereafter with firstand second-line tyrosine kinase inhibitors significantly improves overall survival.

Almanac of Clinical Medicine. 2015;(41):60-65
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Belousov K.A., Golenkov A.K., Kataeva E.V.


Aim: To assess efficacy of the “7 + 3” regimen in non-selective groups of patients with acute myeloid leukemia (AML).
Materials and methods: We retrospectively assessed medical documentations (inand out-patient case histories) of 105 AML patients who were on treatment in MONIKI from January 2002 to December 2011, with evaluation of clinical and hematological characteristics of patients, remission rates depending on age, serum lactate dehydrogenase (LDH) levels and time from diagnosis to the start of treatment, as well as overall survival.
Results: In total, the standard regimen “7 + 3” was effective in 58% of AML patients. Remission was achieved in 70.5% of 17 patients with normal LDH levels and in 50.9% of 53 patients with high LDH levels (р < 0,05). In the patients aged from 18 to 30 years, the remission rate was 81%, in those from 31 to 60 years, in 61%. In the elderly patients (from 60 years and older), remission was achieved in 29% of cases (р < 0.05 compared to each of two other age groups). Remission was associated with the time from diagnosis to the start of treatment, being 16.7% in those where this time period exceeded 10 days and 60.8% in those where this time was less than 10 days (р < 0.05). The median overall survival was 11 months in the total group, 15 months in the patients who achieved remission after 2 treatment cycles and 6 months in those who did not respond to treatment. Comparison of the 2 groups with different AML types did not reveal any difference in the treatment results: overall survival in М0–М2 was 11 months and in М4–М5 10 months.
Conclusion: Treatment of AML patients with “7 + 3” regimen provides a good anti-tumor effect. Achievement of remission depends on patient age, time to the start of treatment and LDH levels. The results obtained in non-selective group of patients are comparable to those published on selected group of patients.

Almanac of Clinical Medicine. 2015;(41):66-71
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Koryakina E.V., Potetnya V.I.


Background: Studies of biological effects of low dose radiation are important due to exposure of large patient groups to low radiation doses during therapeutic and diagnostic procedures. Details of biological effects of neutron irradiation have been poorly studied, including cytogenetic effects of its low doses, although they could be important during neutron therapy and for development of normatives on radiation protection with ion accelerators, including therapeutic ones.
Aim: To study patterns of structural chromosomal damage in mammalian cells exposed to 14.5 MeV neutrons at doses up to 1 Gy.
Materials and methods: Cytogenetic effect of 14.5 MeV neutrons was evaluated in human blood lymphocytes and Chinese hamster ovarian cells CHO-K1 in the dose range of 0.1–1.2 Gy, dose rate range 0.3–60 mGy/min, pulse frequency 50, 5, and 0.017 Hz. Chromosome preparations were conventionally prepared. All types of chromosomal aberrations were included into the analysis.
Results: In the 14.5 MeV neutron dose range studied, both cell cultures demonstrated the same dose-effect pattern: a drastic increase of chromosomal aberrations frequency at doses of 0.12–0.15 Gy, with a somewhat lower increase of the number of aberration in the dose range 0.3–0.5 Gy and regular linear dose dependence thereafter. This pattern was found both on the total chromosome aberrations frequency and on dicentric (lymphocytes) and paired fragments (CHO-K1) frequencies.
Conclusion: The results obtained indicate the existence of a phenomenon of hypersensitivity and induced radio-resistance in human lymphocytes and Chinese hamster ovarian cells (CHO-K1) following irradiation with 14.5 MeV neutrons.

Almanac of Clinical Medicine. 2015;(41):72-78
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Nemtsova M.V., Kushlinskii N.E.


The review describes the current views on urothelial carcinoma carcinogenesis. Based on the up-todate genetic studies, molecular pathways determining the development of superficial and invasive bladder cancers are considered. It was demonstrated that the development of noninvasive bladder tumors occurred predominantly through oncogenes activation, while the genesis of invasive cancer is based on inactivation of tumor suppressor genes. Principal mechanisms of multiple and recurrent bladder tumors development are discussed including its monoclonal and oligoclonal models.
One of the most promising nowadays approaches is the determination of new generation markers, such as molecular genetic abnormalities in the hereditary apparatus of the cell underlying its malignant transformation. Molecular markers' panels used for diagnostics, prognosis, and monitoring of urothelial carcinoma patients are analyzed.

Almanac of Clinical Medicine. 2015;(41):79-88
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Delektorskaya V.V.


This review deals with the  analysis of up-to-date concepts  of various types  of human  neuroendocrine tumors of the bronchopulmonary system and the thymus. It summarizes the information on the specifics  of  the  recent  histological  classification from 2015 and  criteria of morphological  diagnosis taking into account  histological and  immuno   data on key molecular markers involved in the development of neuroendocrine tumors of the bronchopulmonary system  and  the  thymus  are  also presented.
Almanac of Clinical Medicine. 2015;(41):89-96
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Rozanov I.D., Semashkova A.E., Balkanov A.S., Terpigorev S.A., Stepanova E.A.


The risk of pulmonary embolism (PE) in cancer patients  is 4–7-fold, compared to other  patient  categories. PE is the  second  most frequent  cause of death  in the first year after cancer diagnosis. PE is diagnosed in 7.5% of patients with malignant brain tumors, in 1 to 25% of those  with gastrointestinal tumors, in 4.5 to 17.5% of those with breast cancer and in 4 to 10% of lung cancer patients. The risk of PE is higher with surgical interventions and chemotherapy, as well as in metastatic tumors. In 13% of cases, PE may be the first symptom of cancer manifestation. For prevention and treatment of PE low molecular weight heparin (LMWH) and warfarin are   used. The risk of recurrent  PE is 2-fold lower with LMWH. The frequency of bleeding with LMWH and warfarin treatment is from 14 to 19%. Placement of a cava filter is indicated  only if anticoagulation is inefficient.  New oral anticoagulants,  which act as selective thrombin  or Factor Xa inhibitors, are not used in cancer patients. Thus, diagnostics and treatment of PE is a very urgent  problem in oncology that requires new approaches to be looked for.
Almanac of Clinical Medicine. 2015;(41):97-102
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Grishina E.E.


Rationale: Orbital metastases comprise about 15% of all orbital malignancies. An orbital metastasis is to be suspected if there is a mass in the orbit of a cancer patient. Nevertheless, a non-tumor process in the orbit of cancer patients is also possible, as well as occurrence of a second cancer of the primarily multiple tumor type.
Aim: To identify characteristic signs of a metastatic tumor of the orbit to perform differential diagnosis with other tumor and non-tumor orbital disorders and to establish an algorithm for a correct diagnosis and perform an adequate treatment of an orbital disease.
Materials and methods: We retrospectively analyzed case histories of 81 patients with malignant tumors of various organs and an orbit abnormality. Seventy four (74) of them had orbital metastases (64 women and 10 men aged from 18 to 87 years; median age, 45 years); the second malignant orbital tumor was represented by a non-Hodgkin's lymphoma in 5 patients (4 women and 1 men aged from 55 to 78 years, median age 61 year). Two men of 64 and 66 years had orbital inflammation imitating a metastatic tumor. In addition to ophthalmological assessment and orbital CT, assessment of visceral organs and systems was performed in all patients to exclude any relapse of primary tumors and metastases in other organs.
Results: The most prevalent among orbital metastases was a focal form of the tumor growth adjacent to the orbital wall (mainly, the upper one), with gradual development of a non-painful exophthalmos and abnormalities of eye movements. The same clinical manifestation was typical also for a non-Hodgkin's lymphoma of the orbit. An acute inflammation of orbital tissues in cancer patients did not have a clear clinical manifestation and simulated an orbital metastasis.
Conclusion: For a nearly diagnosis of orbital metastasis it is necessary to perform a combined analysis of past history, clinical manifestation and results of morphological assessment of a tumor biopsy sample.

Almanac of Clinical Medicine. 2015;(41):103-109
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Nikitin A.A., Akhtyamov D.V., Sipkin A.M., Akhtyamova-Givirovskaya N.E., Korsakova N.A., Lamper A.G.


The odontogenic myxoma is a benign, locally advanced neoplasm of the maxillary or mandible cells. Its clinical and radiological manifestation corresponds to a malignant process that complicates the diagnosis and leads to a block resection of the jaw. An intraoperative express biopsy with an urgent histological examination allows to avoid a traumatic surgical intervention and to carry out a full postoperative rehabilitation of patients. A rare clinical case of a maxillary tumor growing into the nasal cavity and orbit with the destruction of the alveolar bone is presented. The article describes the diagnostic approach, planning and surgical treatment of the patient with the disease.
Almanac of Clinical Medicine. 2015;(41):110-114
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