Hepatocellular carcinoma (HCC) occupies a leading position among malignant liver tumors, is often characterized by an aggressive course and an unfavorable prognosis for patients. The search for reliable biomarkers capable of predicting individual risk for each patient at early stages, as well as determining a personalized approach to treatment, are key factors influencing patient survival. Objective. Assess the expression of 14 microRNAs in the tumor tissue of patients with HCC, its association with the aggressive course of the disease, BCLC stage, and tumor size. Material and methods. The study included 22 patients with aggressive and non-aggressive HCC, in whom the relative expression level of 14 microRNAs was determined in tissue samples obtained after trepan biopsy or surgical liver resection, as well as the level of AFP in blood plasma. Results. Statistically significant differences between the groups were found for miR-192: the median expression level of miR-192 in the aggressive course group was almost 2 times lower and amounted to -76.9 units (Q1; Q3: –54.8; –34.8) versus –45.5 units (–118.6; –54.2) in the second group (p=0.0083). The area under the ROC curve for miR-192 was 0.87, sensitivity was 81.8%, and specificity was 72.7%, which exceeds the similar indicators for serum AFP (63.6% for both parameters). A moderate negative correlation was found between tumor size and the expression of miR-122 (p=–0.50; p=0.018) and miR-192 (p=–0.45; p=0.036). When comparing BCLC stages (A, B, B3+C), significant differences were obtained for miR-20a (p=0.01), miR-18a (p=0.03), and miR-192 (p=0.03). No statistically significant associations were found for the other microRNAs. Conclusion. The decrease in miR-192 expression is associated with an aggressive course of HCC and has diagnostic value superior to AFP. The negative correlation of miR-122 and miR-192 with tumor size confirms their role as suppressors of tumor growth. The obtained data justify the feasibility of further studying miR-192 and miR-122 as promising biomarkers for stratifying the risk of HCC progression.
Objective. To improve local treatment efficacy and reduce neurological mortality in patients with multiple intracranial melanoma metastases using extreme hypofractionation of the whole-brain irradiation dose. Material and methods. The study included 45 patients with multiple melanoma metastases to the brain. Patients were divided into 2 groups. Group 1 (study group) received treatment with WBRT with a total dose of 6.5 Gy, 3 times weekly, with a total dose of 26 Gy. Twenty-four patients were treated. Group 2 (control group) received treatment according to clinical guidelines with WBRT with a total dose of 3 Gy, daily, with a total dose of 30 Gy. Twenty-one patients were treated. Results. Median survival was not statistically significantly different: 4.500 months in the study group versus 4.017 months in the control group, p=0.3436. The immediate effectiveness of therapy is demonstrated by better local control in the study group with a decrease in the average total volume of foci (p=0.0199) from 19.8 cm3 to 10.65 cm3 (by 46.21%), the average number of foci (p=0.0481) from 18.26 to 14.95 (18.13%) during the control study after 2 months, against a decrease in the average total volume of foci from 21.83 cm3 to 20.14 cm3 (by 7.32%), the average number of foci from 38.38 to 47.92 (an increase of 19.9%) during the standard treatment regimen. Effectiveness was also noted in improving the mean prognosis on the GPA scale from 0.913 before radiation therapy to 1.421 (a 35.75% improvement) in the study group, compared to an 11% improvement from 0.7188 before radiation therapy to 0.8077 (p=0.0144). Conclusion. Further study of the investigated method is required to confirm the efficacy and safety of this fractionation regimen in the treatment of patients with multiple intracranial melanoma metastases.
We report a rare clinical case of a well-differentiated liposarcoma (atypical lipomatous tumor), sclerosing subtype, arising from the pancreas in an 80-year-old female patient. The tumor initially presented as a painless bulging mass in the mesogastric region and, based on imaging studies, was interpreted as a lesion of uncertain origin, possibly related to the stomach or retroperitoneal tissue. During surgical intervention, the tumor was found to originate directly from the body of the pancreas, as confirmed by macroscopic and histological examination. Histologically, the tumor was characterized by a predominant fibrous-sclerosing component with areas of atypical lipomatous tissue, which posed significant challenges for differential diagnosis. Immunohistochemical analysis revealed subtotal nuclear expression of MDM2 and CDK4, along with heterogeneous cytoplasmic and nuclear expression of p16, consistent with tumors within the spectrum of well-differentiated liposarcoma. This case highlights the exceptional rarity of liposarcomas with a primary origin in the pancreas, the diagnostic complexity of their morphological evaluation, and the importance of a comprehensive approach including immunohistochemistry. The clinical significance of this observation is underscored by the successful radical surgical treatment performed in an elderly patient.
Two rare clinical cases of synchronous gastric gastrointestinal stromal tumor (GIST) and locally advanced adenocarcinoma are presented. In both cases, complete pathological regression of gastric adenocarcinoma was achieved following different neoadjuvant therapy regimens. In the first case (74-year-old female patient D.), neoadjuvant chemotherapy with the FLOT regimen was administered for cT3N0M0 gastric cancer (stage IIB), followed by D2 gastrectomy. Complete pathological response was confirmed (ypT0N0, Becker grade 1a). Morphological examination incidentally revealed a subserosal GIST measuring 0.5 cm in diameter with absent mitotic activity and a progression risk of 0% (Miettinen 2006). In the second case (76-year-old male patient G.), within a clinical trial, neoadjuvant chemoradiotherapy (total dose 46 Gy with capecitabine and oxaliplatin) was delivered for cT3N1M0 gastric cancer (stage III), followed by D2 gastrectomy. Pathological examination demonstrated complete tumor regression (ypT0N0, Becker grade 1a) and identified a 1 cm GIST with a progression risk of 0%. The patient declined adjuvant chemotherapy and remains disease-free after 67 months of follow-up. These observations illustrate a rare combination of two tumors of distinct histogenesis in which complete pathological response of gastric adenocarcinoma to neoadjuvant treatment was achieved.
Objective. To analyze the safety and diagnostic value of transthoracic robot-assisted CT-guided lung tumor biopsy. Material and methods. A retrospective analysis of 537 biopsy procedures in patients with solid lung lesions ≥1 cm in diameter was conducted. Biopsies were performed under synchronized multislice CT guidance using the PERFINT MAXIO robotic navigation system. The yield of informative material, diagnostic parameters (sensitivity, specificity, accuracy), and complications assessed using the Clavien-Dindo scale were assessed. Results. Informative material was obtained in 91.8% of cases (493/537). The sensitivity of the method in verifying malignant tumors was 93.9% (95% CI 91.2—96.0%), specificity was 100% (95% CI 96.3—100%), accuracy was 95.1% (95% CI 92.9—96.8%). Complications developed in 15.5% of patients (83 patients): pneumothorax — in 11.0% (59 patients), of which drainage of the pleural cavity was required in 83.1% of cases (49 patients); hemothorax — in 2.8% (15 patients); hemoptysis — in 1.7% (9 patients). Complications of I-II degree (not requiring invasive interventions) were registered in 6.3% of patients. There were no fatal outcomes. No statistically significant differences in complication rates or diagnostic efficacy were found between 16G and 18G needles. Conclusion. CT-guided transthoracic robotic-assisted biopsy demonstrates high diagnostic accuracy (95.1%) and an acceptable safety profile, allowing it to be recommended for the verification of malignant lung tumors.
