Russian Journal of Oncology

BACKGROUND: Solid tumors (solid — firm, non-hematopoietic, i.e. developing not from cells of the hematopoietic system) constitute the majority of malignant tumors. The most important factors for their development are: size, degree of sprouting into surrounding tissues, spread throughout the body in the form of regional and distant metastases.

The most common (those having the highest incidence rate) solid malignant tumors in Russia are: lung, stomach and breast cancer. The most life-threatening (those having the worst survival rates) are liver and pancreatic cancer. We paid particular attention to the impact of coronavirus infection pandemic on morbidity, mortality as well as registration quality of patients with solid malignant tumors. In order to evaluate the effectiveness of conducted anticancer measures, we calculated survival rates of patients.

AIM: To calculate and evaluate the survival rates of patients with the most common and life-threatening neoplasms in Russia.

MATERIAL AND METHODS: We based our study on the data of the International Agency for Research on Cancer, reference books of Moscow Herzen Research Oncological Institute (Russia) and N.N. Petrov National Medical Research Centre of Oncology (Saint Petersburg, Russia), as well as databases of population cancer registries of Saint Petersburg and the Northwestern Federal District of Russia.

Data processing was performed using licensed programs MS Excel 2013–2016 and STATISTICA 6.1. Modified Eurocare program was used to calculate survival rate, as well as mathematical, bibliographic and statistical methods.

RESULTS: The first part of the study analyzed the main regularities of changes in morbidity, mortality and quality of registration of patients with the most common and life-threatening solid malignant tumors in Russia. The incidence of lung and gastric solid malignant tumors has significantly decreased, while the incidence of breast, liver and pancreas cancer has increased. A significant impact of the coronavirus infection pandemic was revealed, and the main changes in age-specific indicators were traced.

CONCLUSION: Upon the background of general decrease in mortality of the Russian population from malignant tumors, an increase was noted for mortality from life-threatening localizations (liver and pancreatic cancer), which is confirmed by calculations of the index of accuracy.

BACKGROUND: Determination of the cytogenetic origin and morphological type of metastatic or primary tumor determines the prescription of therapy and affects the efficiency of patient’s treatment. Currently, a number of publications evaluate the potential of cytological diagnostics of melanoma.

AIM: To evaluate the significance of diagnosing metastatic melanoma by fine-needle aspiration biopsy and primary melanoma by using the skin and mucosa imprints.

METHODS: In a retrospective study, a comparative analysis of cytological melanoma samples, in comparison with clinical and anamnestic information and the results of histological, immunohistochemical, and molecular genetic studies, was carried out. Information about 109 patients from the cancer registry of the Altai Regional Oncology Dispensary (Barnaul, Russia) for 2022 was used in the study. Traditional and liquid-based methods for preparing samples were used. The samples were stained using Pappenheim and Papanicolaou methods. In some observations, cytological material was used for molecular genetic studies. Using the cancer registry data of the dispensary, the results of histological and of molecular genetic studies, and a final conclusion was given about each patient.

RESULTS: Fine-needle aspiration biopsy was carried out in 80 patients. Tumor smears were obtained from 29 patients. The cytological diagnose “melanoma” was consistent with the data of histological and immunohistochemical studies (p <0.001) for all 109 patients. Melanoma was diagnosed for the first time in 66 (60.5%) patients. In other cases, the process of progression was noted within the period from one year to 20 years. Epidermal melanoma was noted in 101 (92.7%) cases, including 9 patients with acral melanoma, and 2 cases with localization on the vulva. Melanomas of mucosa were found in 5 cases (4.5%): in the rectum and anal canal, vagina, and in 2 cases on the hard palate. Non-epidermal (uveal) melanomas metastases were diagnosed in liver by fine-needle aspiration biopsy in 3 patients (2.8%). Based on the cellular composition, epithelioid cell melanoma was determined in 81 (74.3%) patients, mixed cell in 14 (12.8%) cases, spindle cell in 9 (8.2%), pigmentless in 2 (1.8%) cases and nevoid melanoma in 1 (0.9%) case. The mutation status was determined in 96 patients (88.1%). Of these, in 8 patients it was determined using cytological material. In epidermal melanomas, mutations in codon 600 of exon 15 of the BRAF gene were found in 43 (44.8%) patients, including 2 cases of acral melanoma. Mutations V600K, V600E/Ec were found in one patient each. In mucousal melanomas: Q61R mutation was found in exon 3 of the NRAS gene (vaginal melanoma), G12C mutation was identified in exon 2 of the NRAS gene (anal canal melanoma). In uveal melanomas, the assessed mutations were absent (it is necessary to determine mutation is GNAQ11 and BAP1 genes).

CONCLUSION: Cytological diagnosis of melanoma by fine-needle aspiration biopsies and imprints from the tumor mass is a highly informative method that allows diagnosing melanoma and verifying the tumor subtype. The obtained results indicate tumor heterogeneity and differences in mutational status depending on the location of melanomas. The molecular classification of melanoma is important when choosing individualized therapy.

Pancreaticoduodenal and distal resections are crucial components of pancreatic cancer treatment. Pancreatic fistula is one of the most common complications of these surgeries. The main criterion for the diagnosis of pancreatic fistula is the increase of amylase drain level more than 3 times from the normal blood level. Pancreatic fistulas worsen the long-term results of cancer treatment and increase the risk of bleeding per an erosion of visceral vessels, pancreatitis and peritonitis, as well as increase the duration of hospital stay. Risk factors for pancreatic fistula can be split in two categories: patient-related and procedure-related. The patient-related risk factors are: male sex, age more than 70 years, small or large diameter of the pancreatic duct, epithelial type of the malignancy, comorbidities and a high volume of drainage fluid in the postoperative period. Surgical risk factors are: the severity of intraoperative blood loss, “soft” pancreas, duration of surgery and surgical techniques.

The most effective method for fistula prophylaxis is intraoperative risk evaluation with initial pancreatectomy in case of high risk. At the same time, it is possible to use medical glues and pharmacological methods for prevention and treatment of postoperative pancreatic fistulas, but further investigations are required. Thus, prevention and treatment of postoperative pancreatic fistulas is a crucial component of management of patients who undergo surgery for pancreatic malignancies.

Merkel cell carcinoma is a rare primary malignant skin tumor with epithelial and neuroendocrine differentiation, which is usually characterized by an aggressive course with frequent local recurrence and a high metastatic potential. This article presents a clinical case of diagnosing Merkel cell carcinoma with secondary lesions of the adrenal glands, which is a rare localization of distant metastasis of this tumor with a low survival prognosis. Merkel cell carcinoma is difficult to diagnose due to its rare occurrence and can be mistaken for another dermatological disease. The patient's medical history was analyzed, starting from the outpatient stage of medical care until hospitalization for diagnostic surgery. The article is valuable for doctors of any specialty due to the difficulties in differential diagnosis of adrenal incidentalomas.