[Assessment of the metastatic potential of localized forms of colorectal cancer]. / Otsenka metastaticheskogo potentsiala lokalizovannykh form kolorektal'nogo raka.

OBJECTIVE: To assess the risk of recurrence after surgical treatment is an integral part of the management of patients with colorectal cancer. The AJCC/UICC TNM staging system, in which the risk is identified by grouping the patients on the basis of anatomical elements, is commonly used. Despite the simplicity of implementation, significant heterogeneity remains within each stage group. A better tool for predicting a recurrence is needed in the era of multimodal treatment. SUBJECTS AND METHODS: A total of 1350 archival colorectal cancer cases during 2012 to 2015 were retrospectively analyzed; among which the investigators identified 3 patient groups: 1) 53 patients with non-metastatic colon cancer for at least 5 years; 2) 45 patients with metachronous metastases detected during the same period; and 3) 53 patients with synchronous metastases. Among the estimated 31 parameters, the investigators used a multidimensional analysis to select 6 most significant prognostic factors that were included in the final model based on a logistic regression analysis. The resulting model was applied to assess the risk of metastasis after cytoreductive surgery. It was internally and externally validated in an examination group (n=25). RESULTS: The model has a sensitivity of 97.78% and a specificity of 96.23%, improving the risk stratification for metastatic colon cancer. The factors in the model include extramural venous invasion, the severity of budding, the expression of E-cadherin and ß-catenin, the proportion of cytotoxic CD8+ lymphocytes of the total number of T lymphocytes in the microenvironment, and the ratio of newly formed vessels to tumor stromal microvessel density. CONCLUSION: Using morphopathological factors, the resulting model allows better consideration of tumor specificity in a particular patient, thereby providing a more individual prediction of outcome than that provided by the AJCC/UICC TNM staging system. By identifying patients at both high- and low-risk for metastasis, the model can be useful to plan treatment and to choose clinical management tactics for patients with colorectal cancer.

[Fibroepithelial tumors of the anogenital mammary-like glands]. / Fibroépitelial'nye opukholi anogenital'nykh mammaropodobnykh zhelez.

Mammary-like glands are a normal anatomical component of the anogenital region. The tumors occurring in them morphologically mimic the similar diseases of the breast. The paper presents a case of vulvar fibroadenoma with leaf-like outgrowths and apocrine metaplasia in a 38-year-old female patient. It describes the clinical and morphological characteristics of fibroadenomas and benign phyllodes tumors in the anogenital region.

[Anogenital mammary-like glands and related diseases. Part 2. Malignant tumors of the anogenital glands]. / Anogenital'nye mammaropodobnye zhelezy i sviazannye s nimi zabolevaniia. Chast' 2. Zlokachestvennye opukholi anogenital'nykh zhelez.

Mammary-like glands are a normal anatomical component of the anogenital region and can give rise to many benign and malignant tumors that morphologically mimic the similar diseases of the breast. The literature review is complemented by a description of 199 cases of malignant tumors of mammary-like glands. The paper presents the clinical and morphological characteristics of various malignant tumors of mammary-like glands, including extramammary Paget's disease, ductal, tubulolobular, adenoid cystic adenocarcinoma, low-grade phyllodes tumor, etc.

[Anogenital mammary-like glands and related lesions. Part 1. Benign tumors and tumor-like disorders]. / Anogenital'nye mammaropodobnye zhelezy i svyazannye s nimi zabolevaniya. Chast' 1. Dobrokachestvennye opukholi i opukholepodobnye protsessy anogenital'nykh zhelez.

Anogenital mammary-like glands represent a normal anatomic constituent of the anogenital area and may give rise to many benign and malignant tumors that morphologically mimic similar breast diseases. The literature review is complemented by a description of 286 cases of benign tumors and tumor-like processes in the mammary-like glands. The paper presents the clinical and morphological characteristics of papillary hidradenoma, fibroadenoma, benign phyllodes tumor, lactating adenoma, sclerosing adenosis, pseudoangiomatous stromal hyperplasia, etc.

[Ectopic adrenal cortical adenoma in the spinal canal: A case report and a review of the literature]. / Ektopicheskaya adrenokortikal'naya adenoma pozvonochnogo kanala: nablyudenie iz praktiki i obzor literatury.

Ectopic adrenal cortical neoplasms are extremely rare. The authors describe their own case of intradural, extramedullary conus medullaris adenoma that occurred in a 55-year-old woman, which was clinically accompanied by lumbar pains, left leg numbness, and left foot weakness during 10 years. The mass was histologically composed of rounded and polygonal cell fields with rounded, regular nuclei and abundant eosinophilic and clear cytoplasm. There were no necroses or mitoses. The cells were immunohistochemically positive for cytokeratin AE1/3, vimentin, inhibin-α, melan-A, and synaptophysin. An ectopic adrenocortical adenoma was diagnosed after ruling out myxopapillary ependymoma, meningioma with oncocytic transformation, paraganglioma, metastatic renal cell carcinoma, and adrenal cortical carcinoma. In the opinion of most investigators, extra-adrenal tumors develop from ectopic adrenal cortical tissue. To date, only eight intraspinal adrenal cortical tumors have been described. These tumors should be considered in the differential diagnosis of central nervous system masses located in the lower spinal canal.

[Spindling in melanomas].

The paper summarizes biological, morphological and clinical aspects of spindling in malignant melanomas.

[Immunohistochemical and genetic profiles of melanomas with spindle cell morphology].

OBJECTIVE: to comparatively study the immunohistochemical profile and to analyze mutations in the BRAF and N-RAS genes. MATERIAL AND METHODS: The spindle cell melanomas taken from the Institute's archives were divided into 6 groups according to the results of clinical and morphological analyses and follow-up studies. Immunohistochemical examination was conducted in 58 cases, including 19 nodular spindle cell melanomas, 10 superficial spreading melanomas, 4 combined melanomas, 8 sarcoma- toid melanomas, 13 mixed desmoplastic melanomas, and 4 pure desmoplastic melanomas. RESULTS: All tumors of the spectrum in question expressed S100, SOX10, KBA.62, nestin, and cyclin D1. The rate of positive staining was 80% for MITF, 69% for PNL2, 61% for HMB45, 58% for Melan A, 36% for CD117, and 35% for SMA. The expression of HMB45 and Melan A was diffuse and marked in the groups of nodular and superficial spreading melanomas; sarcomatoid and mixed desmoplastic melanomas showed only scattered stained cells; pure desmoplastic melanomas were negative to these markers. SMA immunoexpression was observed in only sarcomatoid and desmoplastic types. Dual S100 staining showed a separate actin-positive myofibroblast-like population disappearing in more cellular zones. EMA, claudin 1, and DOG1 were negative in all cases. BRAFV expression was detected in 14% (in 2 nodular and 1 superficial spreading melanomas) and correlated with the presence of mutation. NRAS mutation was found in 1 nodular spindle cell melanoma. Desmoplastic melanomas did not harbor the above mutations. CONCLUSION: This study indicates the variant heterogeneity of spindle cell melanomas, as confirmed by clinical, morphological, immunohistochemical, and molecular examinations. The findings may be useful in the differential diagnosis of these tumors.

[Myxoinflammatory fibroblastic sarcoma: clinicopathologic and immunohistochemical analysis].

OBJECTIVE: To study the specific features of myxoinflammatory fibroblastic sarcoma (MIFS), by providing clinicopathologic and immunohistochemical evaluations of neoplasms and the biological behavior of these tumors and analyzing their recurrent forms. MATERIAL AND METHODS: Ten cases of MIFS were examined with emphasis on its clinicopathological and immunohistochemical features. RESULTS: In 9 cases, the tumor involved the acral part of the extremities; in one case, it was located in the superficial tissues of the thigh. All neoplasms had a classical histological pattern of MIFS. Four cases developed local recurrences most likely due to the inadequate volume of surgical intervention. Three tumors held its original histological form, but one showed marked histologic progression. Immunohistochemically, all the tumors expressed vimentin. Some cases exhibited a positive reaction with CD68, factor XIIIa, and podoplanin. CONCLUSION: Despite altered morphological patterns, the immunoprofile of recurrent MIFS was retained. A tendency for recurrence requires that the resection margins should be meticulously investigated to exclude residual tumor.

[Changes in the WHO classification of soft tissue tumors].

This article reviews key changes in the current 2013 World Health Organization Classification of soft tissue tumors.

[Renal urothelial carcinoma mainly composed of signet-ring cells].

Autopsy study of an 80-year-old man has identified his renal tumor metastasizing to the heart, lung, and liver as urothelial car- cinoma; at the same time some cells in the main tumor and all cells in the metastases had a signet-ring phenotype, but neither mucicarcimine nor alcian blue stained the cell cytoplasm. The paper provides the histological and immunohistochemical pattern of the tumor and emphasizes its exclusive rarity. Attention is drawn to the possibility of signet-ring cell transformation in the cells of different tumors, including nonepithelial ones.

[Clinical course of cutaneous melanoma of the head and neck, and the factors affecting patient survival].

It was found that melanomas of the skin of the head and neck, compared to the trunk and limbs, were characterized by a greater proportion of men, an older average age of the patients, high frequency spindle cell tumors, more frequent synchronous distant metastasis and worse survival. Melanomas, which are localized on the skin of the neck and scalp, have similar aggressive clinical course and are characterized by worse overall and disease-free survival than skin melanomas on the trunk and limbs. However, melanomas of the skin on the ear and face proceed more favorably as compared to skin melanomas of the scalp and neck. Multivariate regression analysis using Cox models showed that the melanoma of the head and neck Breslow tumor thickness was the strongest predictor of overall survival. For skin melanomas of the neck and scalp Breslow tumor thickness was the only significant independent factor for overall survival. In melanoma, skin and ear predictors of survival are: sex, age and tumor thickness. In skin melanomas of the face and ear predictors of survival were sex, age and tumor thickness.

[Epithelioid hemangioendothelioma of the mediastinum].

The paper describes a rare case of mediastinal epithelioid hemangioendothelioma characterized by a population of fusiform cells, metaplastic osteogenesis, and aggressive behavior. A 5.5x4-cm encapsulated mass was found in the anterior mediastinum of a 19-year-old female patient. A bone density tumor was sealed with lung tissue and it occluded the lumen of the left subclavian vein. Microscopically, the tumor was composed of foci of the so-called "blister cells" typical of epithelioid hemangioendothelioma, anastomosing chains of epithelioid cells in the microhyaline stroma, diffusely located bone trabeculae, and hemorrhagic stroma. Fusiform cells were present in considerable quantities. A moderate cellular and nuclear polymorphism occurred when mitotic figures were absent. Tumor cells expressed Flil, vimentin, CD31, and CD34. Multiple metastases were detected in the liver and lung. They had the similar morphology.

[The gastrointestinal stromal tumor of the stomach in child: characteristic of diagnostics].

The observation of stromal gastric tumor of 12 years old girl has been investigated. The diagnostics was carried out on tumor biopsy taken by a laparoscopy. An evident edema of stroma caused "pseudo-papillary" organization of epithelioid cell neoplasm prevented the right diagnosis established only by immunohistochemical staining of CD117 and CD34 markers. The absence of mutations in C-kit and PGFRA genes uncovered by molecular-genetic analysis is typical for stromal gastric tumors in child. The next gastric resection allowed to estimate tumor appearance and localization, histological organization, and to repeat immunohistochemical studying. This observation confirmed the correctness of diagnosis and established high level of Ki67 proliferative activity (12-15%) determined prescriptions of target medicamental therapy.

[Extracranial meningioma: morphological and histogenetical aspects and relations with perineurioma].

The clinicomorphological, immunohistochemical, and ultrastructural characteristics of 11 cases of extracranial meningioma versus 79 soft tissue perineuriomas were studied. There were significant similarities (cell morphology, immunoprofile, ultrastructural features of perineurial differentiation) of both entities. Considering the point of view that arachnoid and perineurial cells are anatomically, embryologically, and functionally related, it is most possible that extracranial meningiomas may be derived from perineurial cells (or their progenitor cell) rather than from displaced arachnoid cells.

[The morphology and differential diagnosis of neuroglial heterotopias and related tumors].

The paper reviews the data available in the literature and a clinicomorphological analysis of 15 cases of neuroglial heteropias and related tumors retrieved from the joint databases of Sikl's Department of Pathology, Pilsen, Czech Republic, and the Department of Pathology, Petrov Oncology Institute, with emphasis on the histological, immunohistochemical and ultrastructural features, as well as differential diagnosis.

[Morphologic and differential diagnosis of sclerosing perineurioma].

The paper discusses morphologic and immunohistochemical characteristics of sclerosing perineurioma. Generally, it is well circumscribed and consists of tiny spindle-shaped plump epitheloid cells embedded in collagenous hyalinized matrix. Immunohistochemically, it was represented by EMA+, S-100, AE1/AE3, CAM 5.2, smooth muscle actin and desmin. Being benign, tumor was identified by differential diagnosis using fibroma of tendon sheath, sclerosing one, glomal tumor, giant cell tumor and sclerosing epitheloid cell sarcoma.

[Morphologic features of reticular (retiform) perineuroma].

The report deals with 8 cases of reticular (retiform) perineuroma, a rare soft-tissue variant of the latter. It presents as a lace-like pattern of long cytoplasmic outgrowths of tumor cell clusters in myxoid or tender collagenized stroma. Despite its potential for infiltrative growth, perineuroma has a benign clinical course.

[Expression of cytokeratins in tumors with perineural differentiation].

Twenty tumors with perineural differentiation (1 intraneural perineurioma, 10 conventional soft tissue perineuriomas, 3 reticular, 3 sclerosing, 1, atypical, and 2 malignant ones) were studied using a panel of antibodies directed against epithelial antigens. Seven (35%) cases were stained for CK14, 3 (15%) for AE1/AE3, and 2 (10%) for CAMS.2. These tumors showed focal expression of cytokeratins with labeling only a portion of cytoplasm. All tumors were negative for CEA, CK5/6, CK7, CK8, CK10, CK13, CK18, CK19, and CK20. The results of this investigation may be useful in the differential diagnosis of perineural tumors.

[Intraneural perineurioma: clinical and morphological characteristics and a molecular genetic study of the neurofibromatosis type 2 gene].

The authors describe 4 cases of clinically, morphologically, and immunohistochemically typical intraneural perineuriomas that occurred in women aged 17 to 24 years. The tumors involved median, radial, ulnar, and palmar nerves and were 3, 2.5, 1.5, and 1.2 cm in the largest diameter. None patients had signs ofneurofibromatosis type 2 (NF2). One case was studied for mutation of the NF2 gene and heterozygous splice-site mutation at the acceptor splice site between exons 12 and 13 (agGG --> aaGG) was revealed. Two patients were followed up: they were disease-free for 10 and 15 years.

[Peritoneal gliomatosis in immature ovarian teratoma].

The paper describes another case of peritoneal gliomatosis associated with immature ovarian teratoma in an 11-year-old girl. This rare condition is characterized by military inclusions of mature glial tissue on the peritoneum or omentum and should be differentiated from malignant germ cell metastases.