[Morphological procedure for rectal cancer].

The morphological study of surgical specimens in rectal cancer involves assessment of the quality of mesorectumectomy, examination of serial sections of a tumor growth area, and study of the proximal, distal, and circulatory ends of resection as a criterion for the quality and efficacy of surgery. The circulatory end of resection is regarded as positive when it has tumor cells inside or within 1 mm of it and the performed surgery is unradical. The data obtained with the use of this technology make it possible to most fully estimate the site and extent of a tumor process, to identify a number of important prognostic factors, and to assess the quality of a performed surgical intervention and preoperative diagnosis. The procedure is adapted to the standard technological equipment of morbid anatomy units.

[Prognostic factors for the definition of the extent of lymphadenectomy by the early gastric cancer].

The predictive role of submucosal invasion and metastatic spread to local lymph nodes at early gastric cancer was analyzed. Material from 32 patients was morphologically and immunohistochemically analyzed. The prognostic value of the depth of invasion, tenascin and positive MMP2 and MMP9 staining, proliferative activity and microvascular solidity in the lesion were studied. Watch lymph nodes were detected in 22 patients with the diagnosed early gastric cancer. The method is appropriate only by early cancer and in combination with other macro- and microscopic factors. Its' efficacy was 100% in the group of the early cancer (n=15), whereas in the group with the locally spread cancer the sensitivity, accuracy and specificity were 76, 71 and 100%, respectively. Though larger series are necessary to make definite conclusions about the predictive value of watch nodes in gastric cancer.

[Videoendolaryngeal surgery in primary local laryngeal amyloidosis with involvement of the upper third of the trachea: case report].

Laryngeal amyloidosis is a rare pathology (0.5-1% of all benign laryngeal newgrowths). Five patients with local laryngeal and tracheal amyloidosis were successfully diagnosed and treated endoscopically in the endoscopic department of the P.A. Herzen Moscow Research Cancer Institute in 1987-2007. Videoendolaryngeal operations were performed with application of Nd:YAG laser, argon-plasma coagulation and their combination. The patients were followed up for 15 years maximum. Two most interesting cases of primary local laryngeal amyloidosis with involvement of the upper third of the trachea are presented. Foreign and domestic literature data on diagnosis and treatment of respiratory amyloidosis are reviewed.

[Combined endolaryngeal videoendoscopic surgery and photodynamic treatment of patients with recurrent laryngeal and tracheal papillomatosis].

Two-stage combined treatment of chronic recurrent papillomatosis of the larynx and trachea has been designed and tested in P.A. Herzen Research Cancer Institute. Stage I of the treatment consisted in endolaryngeal videoendoscopic surgery with Nd:YAG-laser destruction, argon-plasma coagulation and electroresection of the papilloma; stage II - postoperative photodynamic therapy (PDT) to prevent recurrence. In 1995-2007 the treatment was given to 32 patients aged 10-66 years with recurrent papillomatosis of the airways with the disease history 5-58 years. In two thirds of the patients papillomatosis involved several parts of the larynx and trachea. Squamous cell papilloma was accompanied with dysplasia of the first-second degree in 10 (31%) patients, dysplasia of the third degree - in 4 (12,5%), cancer in situ - in 3 (9,4%) patients. Human papilloma virus (HPV) was detected by hybridization in situ in 96%. The course of the treatment resulted in a complete regression (CR) of papilloma in 25 of 32 (78%), partial regression in 7 patients. The recurrence-free interval averaged 32 months (maximal 7 years) in 14 of 25 patients with CR. HPV was eradicated in a group of patients with persistent clinical remission. A 6 to 19 month follow-up recorded papilloma recurrence in 11 patients. The recurrence-free period increased 2,5-fold. In patients with dysplasia of degree I-III and cancer in situ (n=17) CR of dysplasia and preinvasive cancer foci was achieved in 15 (88%) patients.

[Stomach precancer]. / Predrak zheludka.

The study was made of 568 cases of "initial" cancer cases, 825 morphological substrates of the polyps and 90 ones of chronic gastric ulcer. Chronic gastritis was the most frequent precancer disease (88.7% of cases). Malignant polyps accounted for 10.7% and chronic ulcer for 0.6% of cases. Relevant criteria for risk groups are proposed. Severe epithelial dysplasia as a morphological manifestation of gastric precancer can serve a marker of the risk of malignant transformation.

[Immunomorphologic characterization of various parameters of stomach cancer invasion]. / Immunomorfologicheskaia kharakteristika nekotorykh parametrov invazii raka zheludka.

25 cases of advanced stomach carcinoma were studied immunomorphologically with the use of the antibodies panel to the carcinoembryonic antigen and meconian antigen B1, collagen types IV, I and III, laminin, Ki-67, P-105, factor VIII. Secretory and proliferative activity of tumor cells was shown unrelated to histological structure and degree of tumor differentiation. The more was proliferative activity the weaker was the secretory function. Formation of the basal membrane (BM), the degree of collagen formation and angiogenesis in the tubular adenocarcinoma did not depend on the differentiation level and the degree of tumor cells secretory activity. On the contrary, carcinoid component was characterized by pronounced angiogenesis and tendency to correlation between the degree of differentiation and the degree of BM formation. Stomach carcinoma is a heterogeneous group of tumors whose various morphological features may have an independent prognostic value.

[Combined treatment of stomach neoplasms]. / Kombinirovannoe lechenie raka zheludka.

The results of treatment of 394 patients with gastric cancer were analysed to compare the effectiveness of surgical and two variants of combined treatment (preoperative irradiation with intensive-concentrated IKK method and dynamic DFD dose-fractioning). The advantages of combined treatment over surgical treatment are demonstrated. The 3-year survival in the combined treatment is 70.2%, in surgical treatment 34.5 +/- 6.2%. The advantages of SDF preoperative irradiation over IKK irradiation are revealed, that is proved by the increase of the 3-year survival rate (76 vs. 56.7%), and decrease in the rate of recurrence from 50 to 27.3%. The addition of metronidazol leads to increase of anticancer effectiveness, that is proved with the examination of tumor pathomorphosis and the rates of survival.

[Initial signet ring cell carcinoma of the stomach]. / Nachal'nyi perstnevidnokletochnyi rak zheludka.

The analysis of 49 cases of T1 initial signet-ring cell carcinoma of the stomach showed the intestinal differentiation to be a main type of differentiation making doubtful Lauren's classification of the stomach carcinoma. This differentiation proceeds in various directions as indicated by the presence of different types of mucins, antigens and endocrine granules. The presence of the endocrine granules and characteristic structural arrangement allow singling out neuroendocrine tumours (24.5%) from the group of signet-ring cell carcinomas. It is emphasized that thorough morphological preoperative control is necessary in the choice of treatment.

[An immunohistochemical study of pepsinogen type C in the gastric mucosa and in stomach cancer]. / Immunogistokhimicheskoe izuchenie pepsinogena C v slizistoi obolochke i rake zheludka.

129 cases of non-malignant gastric lesions and 171 cases of gastric carcinoma were studied immunohistochemically for pepsinogen C. PgC was constantly expressed at the bottom of the gastric glands irrespective of the disease. PgC was much more frequently observed in cancer patients (p < 0.001). PgC-positive were carcinoma tissues (38%), particularly of the intestinal type (53.4%), but also in mixed (40%) and diffuse (15.5%) types. PgC-negative carcinomas were more frequently observed in combination with PgC-positive areas of the surface epithelium (p < 0.001) and intestinal metaplasia (p < 0.05). PgC-positive dysplastic foci were observed in both groups of PgC-positive and PgC-negative malignant tumours.

[pT1 cancer of the rectum and sigmoid without signs of adenomatous background]. / Rak priamoi i sigmovidnoi kishok PT1 bez priznakov adenomatoznogo fona.

On the basis of analysis of the histological structure of 1,095 polypoid and nonpolypoid tumors, the frequency of detection of "primary" carcinoma and its clinical and histological features were studied. It is shown that one third of pTI category carcinomas are devoid of signs of a preceding adenoma. Polypoid primary carcinomas account for only 15.8% of cases. The prevailing plaque-like, flat, and ulcerated tumors invade the submucous layer more frequently than malignancy adenomas of the corresponding size and produce metastases to the lymph nodes more frequently. The tumor develops against the background of precancerous and dysplastic changes in the epithelium in the nonpolypoid mucosa and in the adenomas. The indications for economical operations in primary carcinoma, in distinct from those in malignancy adenomas, should be determined with caution.

[Neuroendocrine stomach carcinoma]. / Neiroéndokrinnyi rak zheludka.

Morphology of the neuroendocrine stomach tumours, including carcinoid tumours (CT) and so-called carcinoids of complex structure is studied (189 tumours of patients operated in the Institute), 164 tumours are studied using routine histological methods including Grimelius methods. Immunophenotyping with the use of antibodies to VIII type keratin, carcinoembryonic antigen, meconial intestinal antigen B1MA, Factor VIII, IV-type collagen and laminin were performed in 25 cases. Neuroendocrine carcinomas represented a group of 86 tumours (45.5%), 28 (14.4%) of them were carcinoid tumours and 58 (30.7%)--complex carcinoids. Among CT, moderately differentiated tumours predominated (18), 4 tumours were poorly differentiated and there was a combination of structures in 6 tumours. The conclusion is made that neuroendocrine stomach carcinomas are epithelial tumours with a complex functional differentiation manifesting in different types of secretion: neuroendocrine and non-endocrine characteristic of stomach epithelium.

[The immunohistochemical study of trophoblast beta 1-globulin expression in cancer and in the mucosa of the large intestine]. / Immunogistokhimicheskoe izuchenie ékspressii trofoblasticheskogo beta-1-globulina v rake i slizistoi obolochke tolstoi kishki.

The expression of pregnancy-specific beta-1-globulin (SP1) was studied in cancer-affected and nonaffected colon mucosa. The antigen was revealed in 19 out of 50 (38%) cases of carcinoma and in 1 out of 4 cases of ulcerative colitis. SP1 was found neither in noncancer colon mucosa nor in transitional mucosa and adenomas. The antigen was detected in the epithelium and stromal macrophages of carcinoma. SP1-positive cells were located mainly in the sites of tumor invasion. The results allow considering SP1 the tumor marker suitable for immunohistochemical diagnosis of colon cancer.

[The potentials for the organ-preserving treatment of early stomach cancer]. / Vozmozhnosti organosokhraniaiushchego lecheniia rannego raka zheludka.

The oncological substantiation of endoscopic and economical surgical treatment of T1N0-1M0 gastric carcinoma in 46 patients was appraised. The results were studied with due regard for the peculiarities of early gastric carcinoma (EGC) revealed in 290 patients after standard surgical management. It was established that organ-preserving treatment of ECG is possible--5-years survival was 96.2%. Endoscopic removal can be considered radical only in T1P1 tumors without invasion of the lymphatic vessels of the wall and was of a multistage character in 86.2% of cases. Careful surveillance after its completion is necessary. Surgical treatment in indicated in repeated recurrences; they were encountered in 44.8% of cases. The causes of the recurrences were noncoincidence of the macroscopic and histological boundaries of the tumor (33.6%), multicentric growth (30.4%), and invasion of the submucosa. Metastases are encountered in the lymph nodes in 9.1% of cases in economical treatment. In T1N0-1M0P1-2 carcinoma, absence of multicentric growth, and III degree dysplasia in the surrounding mucosa (reflecting increased risk of multicentric growth) the volume of organ resection may be limited on condition that P1 lymphadenectomy is performed. The results of organ-preserving treatment are comparable with those of surgical treatment conducted in a standard volume.

[Immunohistochemical study of the expression of trophoblastic beta-1-globulin in the gastric epithelium of man in stomach cancer]. / Immunogistokhimicheskoe izuchenie ékspressii trofoblasticheskogo beta-1-globulina v épitelii zheludka cheloveka pri rake étogo organa.

The expression of specific-pregnancy beta 1-globulin (SP1) was studied in gastric mucosa with chronic gastritis. The expression of SP1 was revealed in focus of intestinal metaplasia, dysplasia as well as in cover epithelial cells.

[Cytomorphological criteria of atypical hyperplasia and cancer of the endometrium based on data from a multivariate statistical analysis]. / Tsitomorfologicheskie kriterii atipicheskoi giperplazii i raka éndometriia po dannym mnogomernogo statisticheskogo analiza.

Multifactorial statistical analysis was used to identify differential diagnostic cytological features of glandular hyperplasia, atypical hyperplasia and well-differentiated adenocarcinoma of the endometrium. Twelve cytological features were identified for calculating linear discriminant function. The effectiveness of the diagnostic algorithm depends upon the diagnostic value of the sample and proficiency of the cytologist.

[The proliferative activity of stomach cancer and evaluation of its individual radiosensitivity]. / Proliferativnaia aktivnost' raka zheludka i otsenka individual'noi radiochuvstvitel'nosti.

An indirect immunofluorescent method with polyclonal antibodies to thymidine was used to assess the proliferative activity (PA--percent of cells in the S-phase of the cell cycle) of 79 stomach tumors from primary cancer patients. Stomach cancer PA was shown to vary from 0.1 to 69.7%. PA did not depend either on a tumor size or a degree of the involvement of regional lymph nodes. The mean PA of well-differentiated adenocarcinoma was slightly lower (14.9 +/- 4.7%) than that of low differentiated ones. Of 79 patients a tumor process was interpreted as a resectable one in 62. They were given preoperative irradiation at a total focal dose of 36 Gy followed by operation. In addition to initial investigation PA in tumor biopsy specimens was assessed after delivering a dose of 12 Gy. PA changes at the beginning of a course of irradiation were compared with a degree of a radiation injury of tumor tissue after a course of irradiation was discontinued in 32 (explorative laparotomy was performed in 30). It was shown that tumor radioresistance could be predicted in unchanged PA indices of their increase at the beginning of a course of irradiation with the probability of 95%.

[The paraneoplastic phenotype of human gastric glands studied using the carcinoembryonic antigen-specific lectin crustacin]. / Izuchenie paraneoplasticheskogo fenotipa zhelez zheludka cheloveka s pomoshch'iu rakovo-émbrional'nogo antigens spetsificheskogo lektina krustatsina.

The expression of CEA was studied with the help of rabbit antibody and CEA-specific lectin-krustacin in pepsinogen positive gastric glands near carcinomas and in gastric mucosa with intestinal metaplasia and dysplasia of the epithelium without neoplasia. CEA-krustacin was revealed in 20 out of 41 cases and CEA-antibody in 2 out of 41 cases of gastric glands in mucosa near carcinomas. The results of investigation discover the development in the gastric glands near carcinoma subcellular components. Paraneoplastic phenomenon was found in the majority of the cases.

[The morphological characteristics of dysplastic changes in the endometrium]. / Morfologicheskie osobennosti displasticheskikh izmenenii éndometriia.

Morphological characteristics of endometrial precancerous changes (dysplasia) are given with special reference to the degree and the direction of differentiation (endometrial, metaplastic). On the basis of these data the signs of endometrial carcinoma are standardized.

[An immunohistochemical study of the localization of embryonic prealbumin in the gastric mucosa in chronic gastritis and hyperplastic polyps]. / Immunogistokhimicheskoe izuchenie lokalizatsii émbrional'nogo preal'bumina v slizistoi obolochke zheludka pri khronicheskom gastrite i giperplasticheskikh polipakh.

The location of embryonic prealbumin (EPA) was investigated by indirect immune peroxidase test in gastric mucosa: 16 cases of chronic gastritis without malignant tumour and in 48 cases of gastric carcinoma. EPA in the mucosa was found in 35% cases of carcinoma outside the tumour and 31.3% cases of mucosa without tumour. The highest expression of EPA was found in stromal component of hyperplastic polyp without malignancy. Comparison of EPA and carcinoembryonic antigen in tissue did not reveal the presence of correlation between these oncofetal markers. Most likely this antigen is of a reactive nature and it can not be used for the evaluation of the probability of gastric mucosa malignant transformation.