[Predominantly intraductal low-grade differentiated adenocarcinoma in young man with long time mask clinic of chronic pancreatitis].

The authors present the case of diagnosis of low-grade adenocarcinoma of the pancreas, a man 34 years old, a long time to mask clinic chronic pancreatitis. Laboratory and instrumental investigations, including tumor markers CD 19-9, CEA, ultrasound, CT, MRI showed no reliable data for the presence of tumor. On the other hand, a young man of 34 years present credible evidence of chronic pancreatitis, in the form of a typical pain, a significant increase in serum am- ylase and lipase, and the presence of parenchymal and ductal signs of pancreatitis in visual research methods. Diagnosis of tumors, including obtaining morphological material, pre-operative pain relief were obtain by endoscopic methods. Histological examination of surgical specimens was detected a rare type of poorly differentiated adenocarcinoma of the pancreas tubulo-papillary structures, with predominant intraductal growth and a minimum depth of invasion due to pronounced fibrotic outcome variables, which leads to a complex disease diagnostics. After 1.5 years, after adequately performed surgery the patient was revealed metastases to the liver.

[A case of Richter's syndrome].

The paper provides a morphological and immunohistochemical account of diffuse large B-cell lymphoma developing in a patient with chronic lympholeukemia--Richter's syndrome. There is a mismatch between the histological and cytological structure of a tumor in the bone marrow and lymph node.

[The detection rate of the esophageaL GERD complications among residents of the Leningrad Region (according to the data of esophagogastroduodenoscopy tests)].

This article presents the analysis of 24384 endoscopic investigations of the upper gastrointestinal tract in population of Leningrad region with symptoms of dyspepsia during the period 2007-2011.The results revealed erosive esophagitis in 5.4%, peptic strictures of the esophagus--0.2%, the columnar-lining esophagus (Barrett's esophagus)--1.1%, and esophageal adenocarcinoma--0.045%. This data shows a high prevalence of esophageal complications of GERD in a local population of Russians.

[Influenza virus reproduction in the endothelial cells of human blood vessels].

The current epidemic strains of the influenza subtypes Y5N1, H3N2, and H1N1 can be reproduced in the cultured human endothelial EAhy926 cells with an infective activity of 3.0-4.5 Ig TCD50. These findings were confirmed by the analysis of the autopsy material from patients who had died from influenza during the 2009-2010 epidemic, which showed influenza virus HA and NP proteins in the pulmonary blood vascular endothelium. The results obtained reflect a new aspect of the pathogenesis of influenza, which is important for the design of antiviral agents and for the development of combination therapy.

[The combined treatment of peptic esophagus strictures in patients with gastro-esophageal reflux].

The clinical picture of peptic esophagus strictures in 16 patients with gastro-esophageal reflux was analyzed. The strategy of the combined treatment, including surgery, has been thoroughly substantiated. The method of endoscopic dysphagia elimination has been described. The possibilities and technical features of antireflux gastroesophageal reconstructions were analyzed. Early and long-term follow-up results were obtained and used in practical recommendations.

[A clinical and anatomical analysis: reality, problems, ways of improvement].

A clinical and anatomical analysis comprises pre-commission (dissection), commission, and post-commission stages, each of which is characterized by its tasks, resource costs, and organizational forms. Subjective and objective factors influencing the content and efficiency of dissecting operations have been identified and analyzed; patterns affecting the quality of analyses of fatal outcomes have been established. To enhance the demand for and efficiency of postmortem activities, it is appropriate to reconsider a system for monitoring the results of autopsies, specifically, by excluding the categories "discrepancies" and "iatrogenias" from institutional and federal reports, as well as from the list of the quality indices of the work of healthcare organizations, by increasing attention to the analysis of reasons for defects in medical care. The necessity of improving the analysis of fatal outcomes requires that the level of both primary postgraduate and special training of a modern pathologist should be qualitatively increased so that the growing needs of practical medicine are met.

[Columnar-celled metaplasia and adenocarcinoma of the esophagus in inhabitants of the Leningrad oblast (by the data of esophagogastroduodenoscopy)].

The article presents an analysis of results of 24 384 endoscopic examinations of the upper gastrointestinal tract in population of the Leningrad oblast with symptoms of gastric dyspepsia during the period from 2007 to 2011. The detection of the columnar-celled metaplasia was 1.1%, adenocarcinoma of the esophagus--0.045%. Esophageal adenocarcinoma occurred in 3.95% of cases of the column-celled esophagus. Barrett's esophagus was revealed in males more often than in women (56.5% and 54.5% respectively). The peak incidence of esophageal adenocarcinoma in males was at the age from 46 to 60 years (36.4% of patients), in females--from 61 to 75 years (27.3% of patients). Intestinal metaplasia was detected in 72.7% of cases with esophageal adenocarcinoma: The diagnosis of long and short segment of column-celled esophagus revealed no significant difference in the development of esophageal adenocarcinoma.

[A pathologist's thoughts on the cytological diagnosis of thyroid neoplasias].

Terminological and classification aspects are of great importance in the systems approach to managing endocrinological patients, including those with thyroid cancer. The 2007 Bethesda (USA) thyroid cytological study classification system contributes to the improvement of patient selection results for surgery for cancer evidence. Experience with more than 120000 cytological studies and more than 4500 examinations of intraoperative thyroid specimens could reveal some gap between the cytological interpretation of thyroid pathology and the evaluation of individual morphological phenomena that are particularly important in the differential diagnosis of follicular neoplasias, rare variants of papillary carcinoma. Among other things, there was evidence that it was inexpedient to use the term "dysplasia" in relation to the follicular epithelium and in both cytological and histological practice. Analysis of the results of consultations could reveal the most common diagnostic errors during morphological studies.

[Pathogenic aspects of influenza during the epidemics caused by A/H1N1v virus in 2009-2010 according autopsy data].

The paper is based upon the results of clinic-pathological and virological correlations in 29 lethal cases of influenza in Saint-Petersburg and Leningrad region during the epidemics 2009/2010. Immunohistochemical analysis of lungs, heart and brain using monoclonal sera to HA and HP proteins of influenza virus, virological and morphological analysis of experimental influenza in mice infected by A/WSN/33 (HIN1) and A/California/07/09 (H1N1) viruses had been carried out. In the majority of investigated strains was proved the amino acid mutation with replacement D222G. The replication of virus was demonstrated at the late stages of diseases, but the desquamation of respiratory epithelium and cytoproliferative weren't found out. Besides the "influenza cells", previously described by A. V Zinserling the cells with enlarge light nuclei were observed. Patients with influenza died from respiratory distress syndrome with minimal bacterial infection. We've established that H1N1 virus not only damages the cells of respiratory epithelium and alveolar macrophages but it can injure endothelium of different organs and neuroglia. The questions which have to be discussed are listed.

[The informative value of the criteria of cytological diagnostics of tumors of the thyroid gland].

The authors present a comparative analysis of preoperative cytological investigation of 65 bioptates of the thyroid gland obtained by the method of fine-needle aspiration puncture biopsy and smears-prints of the same tumors made during the operation. The analysis was made according to 10 cytological criteria. The degree of correspondence of the cytological and histological investigations was determined in nodular goiter and carcinomas of the thyroid gland. The maximal specificity and sensitivity was noted in capillary carcinoma (95.3% and 100% respectively).

[Topical problems in the organization of cytological studies in departments of pathology (the experience of a cytological center as part of the Leningrad Regional Department of Pathology)].

Cytological studies of biopsy specimens in the Center of Cytology are one of the promising lines in the activity of the Leningrad Regional Department of Pathology. For the time being, there is no standard for cytological activities. This fact adversely affects the training system of laboratory physicians and assistants, the organization of their work in health care facilities, and the testing quality system. Cytological studies are a promising method in the morphological evaluation of biopsy specimens and surgical material and they should be considered as a morphological method in morbid anatomy.

[Standardization of pathoanatomic activities in performing specialized and high-tech morphological studies].

The study reports the standard for the activity of an immunohistochemical laboratory. The standard includes a staff list, objective calculation, and planning the salary in accordance with a real amount of work. On performing the high-tech and labor-intensive morphological studies, the actual spent time essentially differs from the current standards, which requires implementation of organizational, financial, economic, and methodological measures at the federal level.

[New approaches to organization of clinicoanatomic analysis in prophylactic and therapeutic institutions].

The experience of Leningrad regional department of pathology in dealing with clinical-pathological analysis is shown. The definition of the medical care defect has been formulated. The classification of defects (mistakes) in medical care and their causes are presented. All the medical mistakes are divided into 2 groups: hospital and pre-hospital. They are classified according to the type of medical care, reflect mistakes in a diagnostic process and a treatment. It is suggested that improvement of the postgraduate medical education and certification system in pathology must be updated. Positive experience in clinical-pathological analysis in regional clinical hospitals is presented.