Introduction. Difficult diagnosis, aggressive progression, and absence of an increase in treatment effectiveness (especially in patients with osteosarcoma and Ewing sarcoma) make malignant tumors of the bones a significant medical problem. Use of traditional therapy methods is often associated with development of drug resistance and frequent recurrences. Therefore, there is a need for new treatment strategies and overcoming of the limitations of traditional methods through their improvement, combination or substitution to achieve higher survival, lower recurrence rate, and wider availability for patients with bone tumors. Aim. To present a clinical observation of the use of a new method of radical intraoperative thermal ablation for bone tumors, assess exposure tolerance, long-term oncological and functional results. Clinical observation. This article presents a clinical case of the use of a new radical treatment method for a patient with tibial osteosarcoma who underwent intraoperative thermal ablation using a new domestic complex of local hyperthermia “Phoenix-2”. Results. A session of intraoperative thermal ablation was performed in the operating room under anesthesia directly in the wound for 48 minutes. Access to the tumor-affected bone was performed with the standard oncological approach (en-block), the bone was not transected or removed. A constant heating mode of 90 °С was used, assuming a gradual increase in temperature. Thus, 60 °С reached 20 minutes, and the temperature at the end of high-temperature exposure was 78 °С (inside the medullary canal). The operation time was 2 hours 30 minutes. The postoperative period proceeded without complications. After 38 months of follow-up, examinations did not reveal any recurrence or progression in the patient. Conclusion. The technique of radical intraoperative thermal ablation using a local hyperthermia complex Phoenix-2 is effective and allows to widen the toolkit of treatment methods for patients with bone tumors. It can serve as an alternative or addition to organ-preserving surgical treatment without costly reconstruction stages.

Introduction. An additional or the only way to treat tumors of the chest wall is often a surgical method, which inevitably results in a post-resection defect. Reconstruction of extensive chest wall defects remains an unsolved problem for surgeons around the world.The study objective – to present the long-term oncological and functional results of treatment of a patient with multiple locally recurrent leiomyosarcoma after reconstruction of an extensive post-resection chest wall defect using superelastic 3D frame modules made of titanium nickelide. Reconstruction of the chest wall with 3D modules after extensive block resection showed the possibility of not only restoring the anatomy in the area of the post-resection defect, but also maintaining the biomechanics of breathing in the postoperative period.Clinical observation. This study presents a clinical case of extensive resection and successful one-stage reconstruction of the chest wall skeleton with 3D superelastic titanium nickelide modules in a patient with recurrent leiomyoma with locally recurrent leiomyosarcoma.Results. The superelastic modules did not limit the width of the resection during the operation and ensured long-term stability of the position of the reinforcing elements of the artificial framework. Control examinations showed no tumor recurrence after 12 months and maintaining patient performance.Conclusion. The effectiveness of the proposed reconstruction expands the possibilities of treating patients with tumors of the chest wall.

Background. Giant cell tumor of bone (GCTB) is a common benign lesion accounting for 4–9.5 % of all primary bone tumors. Although surgery is considered the method of choice in the treatment of GCT, however, denosumab, a genetically engineered drug with a novel mechanism of action, has been recently used to treat GCTB. Histological examination of a surgical specimen is undoubtedly the most objective method for assessing the effectiveness of the treatment. However, in some cases it is necessary to assess the effectiveness of conservative therapy at the stages of its implementation.The purpose of the study was to compare CT-densitometry findings with histological findings in GCTB patients treated with denosumab.Material and Methods. The study included 30 patients aged from 28 to 59 years with histologically verified GCTB, who received targeted therapy with denosumab followed by surgery. The changes in tumor structure during denosumab therapy and surgical specimens of the tumor were assessed. Results. The relationship between the CT-densitometry findings and histopathological findings of surgical specimens was revealed in GCTB patients treated with denosumab. Conclusion. CT-densitometry findings were shown can be used topredict pathological response of the tumor to denosumab treatment.

Background. Pseudosarcomas of soft tissues can cause diagnostic and treatment challenges. On the one hand, it is difficult to make a nosological diagnosis based on a biopsy specimen of a tumor; on the other hand, it is difficult to determine the most appropriate treatment strategy based on a histological pattern.The purpose of the study was to analyze available literature data and systematize the histological characteristics of the chondroid lipoma and pseudosarcoma.Case description. We present the case of chondroid lipoma in a 57-year-old female patient with atypical clinical symptoms. This case shows the difficulties of differential diagnosis of soft tissue sarcomas. Using a clinical example of chondroid lipoma, a rare soft tissue tumor, and an analysis of literature data, the authors showed the importance of a detailed study of the obtained material, a qualified description of the morphological picture, in those cases when the diagnostic conclusion cannot be unambiguous about the malignancy of the tumor process. Additional biopsy is not always possible to clarify the histotype of the tumor. The presented observation shows the difficulties of differential diagnosis of soft tissue sarcomas. Minimally invasive biopsy provides no a full appreciation of histological structure; therefore, if there is a suspicion for chondroid lipoma, it is necessary to perform total surgical biopsy followed by a morphological study using the immunohistochemical method.

АТИПИЧНЫЕ ПРОЯВЛЕНИЯ ОСТРОГО МИЕЛОБЛАСТНОГО ЛЕЙКОЗА -ТРУДНОСТИ ДИАГНОСТИКИФролова И.Г

Diagnostic imaging of bone sarcomas of the pelvic girdle using computed tomograpgy, sonography and scintigraphy was performed on 59 patients with the aim to determine the precise tumor localization and to assess tumor spread. Features of tumor spread into the pelvic bones involving all layers of the bone were found. The main trends in spread of soft tissue component in bones of the pelvic girdle were studied.

The efficacy of the chest wall reconstruction with TiNi implants was assessed. Between 2007 and 2014, 21 patients with malignant tumors of the skin, soft tissues, ribs and sternum (sarcomas and metastases) underwent replacement of post-resection chest wall defects using the original Ti-Ni constructions. A total of 28 surgeries were performed including 19 single-stage reconstructions or 2 delayed reconstructions. The average square of the defect was 127 cm2 (40 to 323 cm2). results. Spontaneous breathing was restored on the day of surgery in 27 (96.4 %) cases. Chest carcass recovery was achieved in all cases. The amplitude reduction was observed in 10 (36 %) cases and complete elimination of pathological chest wall flotation was achieved in 18 (64 %) cases. Complications requiring surgery were observed in 3 (11 %) patients. At a long-term follow-up, 10 patients are alive. conclusion. The technique combining the use of TiNi alloy structures and complex autotissue grafts with axial type of blood supply allows chest wall cancer with extensive local spread to be successfully treated.

Literature data on the potential value of ultrasound imaging in diagnosis of soft tissue sarcoma were analyzed. Ultrasound in B-regime was used to assess the extent of soft tissue sarcoma, Doppler ultrasonography was used to study tumor vascularization and sonoelastography was useful to differentiate benign from malignant tumors of soft tissues. The analysis of diagnostic value of ultrasound in detection of soft tissue lesions was carried out. Criteria characterizing various histological types of tumors were identified.

Literature data on the potential value of ultrasound imaging in diagnosis of soft tissue sarcoma were analyzed. Ultrasound in B-regime was used to assess the extent of soft tissue sarcoma, Doppler ultrasonography was used to study tumor vascularization and sonoelastography was useful to differentiate benign from malignant tumors of soft tissues. The analysis of diagnostic value of ultrasound in detection of soft tissue lesions was carried out. Criteria characterizing various histological types of tumors were identified.

The review aimed to assess the role of local hyperthermia in combined modality treatment of soft tissue sarcoma. The recent randomized trials have shown significant benefits from local hyperthermia in patients with soft tissue sarcoma. When combined with radiotherapy, hyperthermia has a complementary and additive effect. Extensive researches have also shown that hyperthermia improves the efficacy of many chemotherapeutic agents. Besides the increased effectiveness of radiotherapy and chemotherapy, hyperthermia has many anti-cancer effects and improves treatment results in patients with soft tissue sarcomas.

Introduction. 199Tl-chloride scintigraphy is used for visualization of malignant tumors and benign lesions including inflammation. Differentiating of them is performed by permanent and independent retention index, but not always effective. Purpose: improve the differentiating of malignant tumors from benign lesions using 199Tl-chloride scintigraphy. Materials and methods. Results of 97 patients’ 199Tl-chloride scintigraphy with 119 regions of hyperfixation in malignant tumors (n=68) and benign lesions (n=51) were studied. Lesions were localized in musculoskeletal system (n=89), in lungs and mediastinum (n=25) and other organs (n=5). Results. Sensitivity, specificity, positive, negative predictive value and accuracy 199Tl-chloride scintigraphy in differentiating of malignancies from benign lesions were 75.0%, 86.3%, 58.1%, 93.2% and 84.0%, respectively using optimal value of permanent and independent retention index RI=0.89 (RI=DR/ER). Significant correlations between retention index (RI) and 199Tl-chloride hyperfixation in early phase of scintigraphy (ER) in group with malignancies (r=-0.70, p=0.00001) and benign lesions (r=-0.76, p=0.00001) were revealed. As a consequence, method for differentiating malignant tumors from benign lesions with optimal dependent relative retention index RI(relative)=RI+0.055-ER and cut-off value RI(relative)=0.98 4 was proposed (sensitivity, specificity, positive, negative predictive value and accuracy 199Tl-chloride scintigraphy in differentiating of malignancies from benign lesions were 83.8%, 86.3%, 73.8%, 92.0% and 85.5%, respectively). Statistically significant (p=0.01) improvement of efficiency of 199Tl-chloride scintigraphy diagnostics in differentiating of malignant tumors from benign lesions using relative retention index (RI(relative)) compared with independent retention index (RI) were revealed by ROC-analysis. Conclusion. The optimal value of permanent and independent retention index for differentiating of malignant tumors from benign lesions are RI=0.89. Efficiency of 199Tl-chloride scintigraphy diagnostic in differentiating of these processes improves using of relative retention index.

Potential use of nonspecific tumorotropic indicators 99mTc-MIBI, 67Ga-citrate and 199Tl-chloride for the differential diagnosis of malignant tumors and benign processes in 151 patients with 191 lesions were studied. 199Tl-chloride scintigraphy, but not 99mTc-MIBI and 67Ga-citrate scintigraphy can be used in differentiating of these lesions. The optimal value of 199Tl-chloride retention index (RI) for their differentiating is RI (199Tl-chloride)=0,89. The use of relative retention index RI (relative) with the boundary value RI (relative)=0,98 improves the differentiating of malignant tumors from benign pathological processes

BACKGROUND:201Tl chloride scintigraphy allows malignant tumors of the locomotor apparatus to be diagnosed. The capacities of scintigraphy with 199Tl chloride, a 201Tl chloride analog, in addition to routine visualization of malignant tumors of the locomotor apparatus, have revealed its untypical variants.OBJECTIVE:to study the specific features of 199Tl chloride scintigraphic visualization of malignant tumor processes in the locomotor apparatus.SUBJECTS AND METHODS:199Tl chloride scintigraphy was performed in 85 patients having 107 foci of involvement presented with malignant (n = 57) and benign (n = 50) tumor processes.RESULTS:Malignant tumors were scintigraphically visualized in 98.1% of cases. Three types of their visualization were identified and studied; these included positive (82.4%) and rare: negative (7.8%), and mixed (9.8%) types associated with the specific features of the histological structure, metabolism, and blood supply of neoplasms and with the pharmacodynamic features of 199Tl chloride. The negative and mixed types, unlike metastatic neoplasms, were highly specific to primary or recurrent malignant tumors.CONCLUSION:Consideration of the negative and mixed types of scintigraphic visualization in addition to routine positive one permitted the sensitivity of diagnosis of malignant locomotor tumors to be increased from 90.4 to 98.1%, without reducing the specificity of 199Tl chloride scintigraphy.

A case of late radiation-induced osteonecrosis 15 years after combined treatment with intraoperative radiation therapy and external beam radiotherapy for synovial sarcoma of right shoulder girdle has been described.