Vol 27, No 3 (2022)

AIM: To evaluate the prognostic value of quantitative CD8+ T-lymphocyte counts in the peritumorotic zone of renal cell cancer.

MATERIAL AND METHODS: The material of 74 patients after operative treatment for renal cell carcinoma with complete 5-year follow-up was retrospectively analyzed. Of the 74 patients, 56 were alive by the 5-year follow-up, and 18 had died of cancer. After immunohistochemical staining, CD8+ T-lymphocyte distribution density in the peritumorotic zone of carcinomas was determined in 3 representative fields of view at ×400 magnification and correlated with the clinicopathological characteristics of neoplasms and overall 5-year patient survival rate.

RESULTS: The high level of CD8+ T-lymphocyte infiltration in the peritumoral zone of carcinomas was seen in stages III–IV of the disease (p=0.0000001), in tumors >7 cm (p=0.0000001), in Fuhrman grade III–IV anaplasia (p=0.001), in metastases (p=0.0000001) and in the shorter total survival rate of patients (p=0.0003). High CD8+ T-lymphocyte count was also observed in men (p=0.001) and in cases of unclassified cancer.

CONCLUSION: In the light of the need to search for new prognostic criteria in renal cancer, we conclude that a high level of peritumorous zone infiltration by CD8+ T-lymphocytes is an unfavorable prognostic factor. Assessment of peritumorous zone infiltration by CD8+ T-lymphocytes may serve as an additional prognostic factor in renal cell carcinoma.

Pancreatic cancer is one of the most serious problems of modern oncology. In the Russian Federation, pancreatic cancer, along with a fairly small share in the structure of the incidence of malignant neoplasms — 3%, ranks first in annual mortality (68.2%), and is also a nosology with the most unfavorable prognosis among tumors of the gastrointestinal tract. The current standard of first-line therapy is FOLFRINOX (FOLFIRINOX, a combination of 5-fluorouracil (5-FU), leucovorin, irinotecan, and oxaliplatin) or gemcitabine plus albumin-bound nab-paclitaxel.

One of the main obstacles to the action of chemotherapeutic drugs is the microenvironment of fibro-solid stromal tumors, which include pancreatic cancer. In order to potentiate the action of chemotherapy and combat the tumor microenvironment, at the present stage, drugs are being considered for influencing the programmed death 1 (PD-1) gene and cytotoxic T-lymphocyte antigen 4 (CTLA-4). Approximately 10–15% of malignant neoplasms of the pancreas are believed to be associated with hereditary mutations, while all neoplasms have somatic mutations in different combinations of driver genes. One of the most common mutations are BRCA1/BRCA2 gene mutations. Poly-ADP-ribose polymerase inhibitors, like cisplatin, have shown promise as a treatment for tumors with BRCA mutations.

Another subtype of pancreatic cancer is characterized by microsatellite instability. Unlike the above mutations and phenotypes, which affect only a small proportion of patients with pancreatic cancer, mutations in KRAS (Kirsten homologous rat sarcoma viral oncogene) are found in 90–95% of cases of pancreatic malignancy and may be a significant factor in pancreatic tumorigenesis. Another frequently mutating gene for a number of malignancies is ARID1A, which encodes a tumor suppressor protein, a subunit of the SWI/SNF chromatin remodeling complex.

The future of conservative therapy for pancreatic cancer is a complex treatment that includes both chemotherapy and targeted therapy and immunotherapy, the implementation of which is impossible without a deeper study of genetic mutations, molecular mechanisms of invasion and development of pancreatic malignant neoplasms, as well as extensive testing for genetic mutations in the clinical practice of specialized institutions.

Synovial sarcoma is a rare aggressive malignant mesenchymal tumor that accounts for 2.5–10.0% of all sarcomas and is most often found in the soft tissues of the extremities, especially near large joints. Primary synovial lung sarcoma is quite rare and accounts for 0.5% of all primary malignant lung neoplasms. The tumor is sensitive to chemotherapy, but the main method of treatment of synovial lung sarcoma remains surgical. Publications devoted to this topic, are presented by clinical observations due to the rare occurrence of the disease, therefore, each such observation is of scientific and practical interest.

We present a clinical case 65-year-old patient with a tumor of the right lung with a diameter of more than 25 cm. Repeated attempts to perform transthoracic puncture both in our department and in other hospitals for the biopsy were unsuccessful. Taking into account the progression of the disease, the appearance and increase of the respiratory failure clinic, the impossibility to exclude the malignant nature of the process and the good functional status of the patient, a decision for surgery was made. The patient underwent right pneumonectomy with mediastinal lymph node dissection. The postoperative period was complicated by intrapleural bleeding, for which a rethoracotomy was performed. After recovery, the patient was discharged from the hospital in a stable condition.