В данном учебном пособии представлены фундаментальные моменты, необходимые для понимания особенностей и сравнительной характеристики анемий, а также основные аспекты, отражающие морфологию гемобластозов, понимание которых является ключевым элементом для дальнейшего изучения диагностики и лечения лейкозов и лимфом. Доступное изложение материала позволит эффективным образом использовать имеющиеся знания при подготовке к лекциям, практическим семинарам и зачётам в рамках курса патологической анатомии. Учебное пособие предназначено для использования в образовательном процессе студентов по специальности «Лечебное дело» (31.05.01), ординаторов по специальности «Патологическая анатомия» (31.08.07) и «Онкология» (31.08.57), аспирантов по специальности «Патологическая анатомия» (3.3.2) и «Онкология» (3.1.5), врачей-патологоанатомов и врачей-онкологов.

В данном учебном пособии собраны все лекции курса патологической анатомии ФФМ МГУ имени М.В. Ломоносова. Общая продолжительность видеозаписей более 50 часов. К каждой лекции имеется краткая аннотация. Доступное изложение материала позволит эффективным образом использовать имеющиеся знания при подготовке к практическим занятиям, коллоквиумам и зачётам в рамках курса патологической анатомии. Учебное пособие предназначено для использования в образовательном процессе студентов по специальности «Лечебное дело» (31.05.01), ординаторов по специальности «Патологическая анатомия» (31.08.07) и «Онкология» (31.08.57), аспирантов по специальности «Патологическая анатомия» (3.3.2) и «Онкология» (3.1.5), врачей-патологоанатомов и врачей-онкологов.

В данном учебно-методическом пособии представлены основные аспекты, отражающие закономерности классификации, строения и развития опухолей человека, понимание которых является ключевым элементом для дальнейшего изучения диагностики и лечения опухолей. Доступное изложение материала позволит эффективным образом использовать имеющиеся знания при подготовке к лекциям, практическим семинарам и зачётам в рамках курса патологической анатомии. Учебно-методическое пособие предназначено для использования в образовательном процессе студентов по специальности «Лечебное дело» (31.05.01), ординаторов по специальности «Патологическая анатомия» (31.08.07) и «Онкология» (31.08.57), аспирантов по специальности «Патологическая анатомия» (3.3.2) и «Онкология» (3.1.5), врачей-патологоанатомов и врачей-онкологов.

In 139 patients with verified gastric cancer, the infiltration of the postoperative material with CD8+ cells was analyzed. Automated morphometric analysis of immunostained slides was performed separately in different specimen sites (tumor center, invasive edge, and peritumoral mucosa). The mean area of infiltrating CD8+ cells in the tumor center and in the invasive edge was not predictive, while in the peritumoral mucosa it provided a new negative predictive factor (hazard ratio 2.10; confidence interval 0.87-4.92, Cox regression) reliably associated with the TNM stage (hazard ratio 1.91; confidence interval 0.91-4.61, Cox regression).

Cancer-associated fibroblasts (CAFs) — mesenchymal cells in the tumor stroma, play one of the leading roles in tumor progression in many different tumors, including colorectal cancer. Scientists have described many markers for CAFs, but none of them is specific. We performed immunohistochemistry tests using five antibodies (αSMA, POD, FAP, PDGFRα, PDGFRβ) to investigate CAFs in three zones of 49 colorectal adenocarcinomas: apical, central, and invasive edge. We revealed the reliable correlation between high PDGFRβ and PDGFRα value in the apical zone and deeper invasion (T3–T4) ( p = 0.0281 and p = 0.0137). High αSMA level in apical zone ( p = 0.0001), αSMA level in central zone ( p = 0.019), POD level in apical zone ( p = 0.0222), POD level in central zone ( p = 0.0206) and PDGFRβ level in apical zone ( p = 0.014) correlated reliably with the presence of metastasis in lymphatic nodules. For the first time, focused on the inner layer of CAF adjacent to tumor complexes. We observed that cases with inner αSMA expression were significantly more often ( p = 0.023) characterized by the presence of regional lymph node metastasis compared with cases with mix of CAF markers ( p = 0.007) and with cases with inner POD expression ( p = 0.024). The found relationships between the level of markers and the presence of metastases indicate their clinical significance.

Coding of the causes of death of patients with diabetes mellitus (DM) in the Russian Federation is one of the long-discussed problems, due to the comorbidity of diabetes and cardiovascular diseases (CVD) and a number of contradictions in the key regulatory documents regulating the statistics of mortality in this category of patients, which acquires particular relevance in the context of the coronavirus pandemic, due to its negative impact on the outcomes of the course of COVID-19 and mortality risks. In pursuance of the decisions of the Minutes of the meeting of the working group under the project committee of the National Project «Health» on identifying patterns in the formation of mortality rates of the population dated January 20, 2021 No. 1, chaired by Deputy Prime Minister of the Russian Federation T.A. Golikova, experts of two directions - endocrinology and pathological anatomy, prepared a Draft of agreed recommendations on the Rules for coding the causes of death of patients with diabetes, causing the greatest problems in terms of the use of ICD-10 when choosing the initial cause of death, including in the case of death from CVD and COVID-19.

A 31-year-old man admitted to clinic with complains of occasional pains in the right upper quadrant unrelated to the food. Results of laboratory tests were in the normal range. There were wall thickening of the ascending colon with sites of calcification located intramural according to abdominal contrast-enhanced multislice computed tomography. The above-mentioned structures accumulated contrast during a venous phase of computed tomography. A barium X-ray was performed, filling defects in right colon were detected but barium follow throughs was normal. Multiple dilated vascular structures of variable sizes l affecting the bowel submucosa in ascending colon for more than 10 cm were detected during the colonoscopy. The patient was diagnosed with hemangiomatosis of colon. Because of the high risk of massive large-bowel hemorrhage and malignization the laparoscopic right hemicolectomy was performed. Morfologic findings were interpreted as vascular malformation of colon. The patient has been activated fully on 1-st day after surgery, discharged on 5-th day in hospital. Gastrointestinal (GI) vascular malformation is an infrequent disorder of blood vessel formation characterized by existence of tumor-like vascular structures through the entire GI tract. Nowadays there is no single approach to the management of this group of diseases. Surgery is the only radical metod of the treatment of vascular malformation. The laparoscopic approach has substantional advantages in treatment of this infrequent group of diseases.

Background: A high worldwide incidence of colorectal cancer defines the importance of search not only for effective treatment methods, but also for risk factors for the cancer development and its worst prognosis. The influence of many genetic factors, environmental characteristics and lifestyle features has already been proven, and recently the attention of researchers is being focused on the study of microbiota and, in particular, various parasitic intestinal diseases in the context of risk factors for colorectal cancer. Clinical case presentation: we demonstrate an incidental finding of parasitic invasion signs during the pathomorphological examination of the surgical specimen in a patient without an epidemiological history. Conclusion: Further studies are needed not only to confirm and substantiate the role of micro- and macroorganisms inhabiting the intestine in the development of oncological diseases, but also to identify individual links of pathogenesis, pathological pathways and signaling molecules involved in carcinogenesis. Research like this could help broaden knowledge about both the risk factors and predictors of colorectal cancer and the potential sites for targeted therapy.

A 60-year-old man admitted to the clinical center due to weakness, episodes of jaundice. The laboratory date revealed elevated levels of total bilirubin - 112.5 µmol/l (range 8,5-20,5 µmol/l) and direct bilirubin - 60.8 µmol/l (range 4,3-4,6 µmol/l), elevated hepatic enzymes (aspartate aminotransferase [AST]: 95 U/l (range ≤ 40 U/L), alanine aminotransferase [ALT]: 301 U/l (range ≤ 30 U/L). When performing esophagogastroduodenoscopy, a polyp of the large duodenal papilla with a spread to the terminal parts of the bile and pancreatic ducts was revealed, and a biopsy was taken. Diagnisis: Tubulovillous adenoma of the major duodenal papilla with epithelial dysplasia II-III. Complications: Multiple choledocholithiasis. Mechanical jaundice. Liver failure. Surgery: laparoscopic duodenotomy, papillectomy, choledocholithotomy, performing of choledochoduodenal anastomosis, duodenoplasty and abdominal drainage. The postoperative period was taking its normal course. Polyps of the large duodenal papilla are relatively rare form of tumors of the gastrointestinal tract, which may not manifest clinically, or, as the above case, lead to severe pathological conditions. Currently, there is no single approach to the treatment of this group of diseases. Some authors propose a pancreatoduodenal resection, but the risks of this operation associated with high postoperative morbidity and mortality are not always justified. The case is unique because the described procedure is less invasive and affects the minimum number of organs. Laparoscopic approach has significant advantages in the treatment of this infrequent pathology.

A 31-year-old man admitted to clinic with complains of occasional pains in the right upper quadrant unrelated to the food. Results of laboratory tests were in the normal range. There were wall thickening of the ascending colon with sites of calcification located intramural according to abdominal contrast-enhanced multislice computed tomography. The above-mentioned structures accumulated contrast during a venous phase of computed tomography. A barium X-ray was performed, filling defects in right colon were detected but barium follow throughs was normal. Multiple dilated vascular structures of variable sizes l affecting the bowel submucosa in ascending colon for more than 10 cm were detected during the colonoscopy. The patient was diagnosed with hemangiomatosis of colon. Because of the high risk of massive large-bowel hemorrhage and malignization the laparoscopic right hemicolectomy was performed. Morfologic findings were interpreted as vascular malformation of colon. The patient has been activated fully on 1-st day after surgery, discharged on 5-th day in hospital. Gastrointestinal (GI) vascular malformation is an infrequent disorder of blood vessel formation characterized by existence of tumor-like vascular structures through the entire GI tract. Nowadays there is no single approach to the management of this group of diseases. Surgery is the only radical metod of the treatment of vascular malformation. The laparoscopic approach has substantional advantages in treatment of this infrequent group of diseases.

Background: A high worldwide incidence of colorectal cancer defines the importance of search not only for effective treatment methods, but also for risk factors for the cancer development and its worst prognosis. The influence of many genetic factors, environmental characteristics and lifestyle features has already been proven, and recently the attention of researchers is being focused on the study of microbiota and, in particular, various parasitic intestinal diseases in the context of risk factors for colorectal cancer.Clinical case presentation: we demonstrate an incidental finding of parasitic invasion signs during the pathomorphological examination of the surgical specimen in a patient without an epidemiological history.Conclusion: Further studies are needed not only to confirm and substantiate the role of micro- and macroorganisms inhabiting the intestine in the development of oncological diseases, but also to identify individual links of pathogenesis, pathological pathways and signaling molecules involved in carcinogenesis. Research like this could help broaden knowledge about both the risk factors and predictors of colorectal cancer and the potential sites for targeted therapy.

The article presents analysis of national and foreign legislative documents concerning issues of expertise of quality of medical care according cases of lethal outcomes (Universal Declaration of Human Rights, the Constitution of the Russian Federation, ICD-10, Federal laws and sectoral orders). It is established that key elements of system of medical care quality control (levels of control, authorized authority, forms of control, sources of development of criteria of quality evaluation, criteria of quality evaluation) are determined legislatively and reflect main requirements of international documents. The criteria of medical care quality evaluation are developed by groups of diseases of conditions on the basis of corresponding of medical care support Procedures, medical care Standards, Rules of implementation of laboratory, instrumental, pathologico-anatomic and other forms diagnostic analysis and Clinical Recommendations (records of treatment) related to issues of medical care support. The shortcoming of the Russian Federation legislation is an inadequate reflection of sources of development of criteria of medical care quality evaluation and relevant incompleteness of the very criteria of medical care quality evaluation. Therefore, their application by experts to issues of evaluation of medical care quality is complicated that effects formation of expert conclusion and negatively affects detection and prevention of possible violations during medical care support. The outdated normative regulation of clinical pathologic anatomic conference is noted as an important form of control of medical care support according cases of lethal outcomes. The necessity of alterations and additions in particular currently in force documents concerning issues of expertise of medical care quality, including according cases of lethal outcomes.

Плацентарная недостаточность (ПН) и ее осложнения — многофакторные заболевания, ведущие к перинатальной заболеваемости и смертности. Урокиназная система задействована в формировании плаценты и может быть рассмотрена как участник патогенеза ПН. Целью работы было исследовать ассоциацию однонуклеотидных полиморфизмов (SNP) генов белков урокиназной системы с развитием ПН, их влияние на экспрессию соответствующих белков в плаценте и ее строение. Обследованы 114 женщин с физиологическим течением беременности и родов и 48 пациенток с преэклампсией и/или задержкой роста плода (ЗРП), 95 новорожденных детей (беременность с преэклампсией и/или ЗРП — 60, физиологическое течение беременности и родов — 35). Проведено генотипирование при помощи ПЦР в реальном времени, морфометрическое и иммуногистохимическое исследования фрагментов плацент. Выявлены ассоциации между развитием ПН и наличием у матери — аллеля C rs4065 (в группе ПН — СС-СТ 64,1%, TT 35,9%, в контрольной группе — СС-СТ 25,6%, TT 74,49%, ОШ (95% ДИ) — 6,83 (2,63–17,79)), аллеля A rs2302524 (GG-GA 20,5%, AA 79,5% против GG-GA 48,1%, AA 51,9%, ОШ (95% ДИ) — 0,27 (0,1–0,71)), у плода — аллеля C rs4065 (СС-СТ 76,4 %, TT 23,6% против СС-СТ 69,6%, TT 30,4%, ОШ (95% ДИ) — 1,37 (0,45–4,17)), аллеля C rs344781 (TT-TC 69,1%, СС 30,9% против TT-TC 95,7%, СС 4,3%, ОШ (95% ДИ) — 5,02 (1,07–23,6)). Многофакторный анализ подтвердил значимость генотипа плода по rs4065. Экспрессия uPA была ниже при ПН (медиана (95% ДИ) — 116,45 (100,5; 128,74) против 126,09 (113,76; 139,19); р < 0,05). Ассоциации SNP c экспрессией белков выявлено не было. Васкуляризация зависела от генотипа матери по rs4065 (стромально- сосудистое соотношение при генотипе CC — 0,17 (0,15; 0,19), CT — 0,18 (0,15; 0,21), TT — 0,23 (0,2; 0,27); p < 0,05). Таким образом, высокий уровень uPA в плаценте и наличие генотипа rs4065 TT у плода носят протективный характер в отношении развития ПН.

A 60-year-old man admitted to the clinical center due to weakness, episodes of jaundice. The laboratory date revealed elevated levels of total bilirubin—112.5 μmol/l (range 8,5–20,5 μmol/l) and direct bilirubin—60.8 μmol/l (range 4,3–4,6 μmol/l), elevated hepatic enzymes (aspartate aminotransferase [AST]: 95 U/l (range ≤ 40 U/L), alanine aminotransferase [ALT]: 301 U/l (range ≤ 30 U/L). When performing esophagogastroduodenoscopy, a polyp of the large duodenal papilla with a spread to the terminal parts of the bile and pancreatic ducts was revealed, and a biopsy was taken. Histological examination detected tubulovillous adenoma with epithelial dysplasia II–III stage. DS: “Tubulovillous adenoma of the major duodenal papilla with epithelial dysplasia II–III”. Complications: “Multiple choledocholithiasis. Mechanical jaundice. Liver failure.” Considering the inability to carry out endoscopic treatment, recurrent nature of the jaundice it was decided to perform surgery: laparoscopic duodenotomy, papillectomy, choledocholithotomy, performing of choledochoduodenal anastomosis, duodenoplasty and abdominal drainage. The postoperative period was taking its normal course. Duration of staying in the intensive care unit—4 days. Enteral fluid intake started on the 2-nd postoperative day. Enteral feeding was restored in a 3 days. Polyps of the large duodenal papilla are relatively rare form of tumors of the gastrointestinal tract, which may not manifest clinically, or, as the above case, lead to severe pathological conditions. Currently, there is no single approach to the treatment of this group of diseases. Some authors propose a pancreatoduodenal resection, but the risks of this operation associated with high postoperative morbidity and mortality are not always justified. The case is unique because the described procedure is less invasive and affects the minimum number of organs. Laparoscopic approach has significant advantages in the treatment of this infrequent pathology.

A new alloplastic high-permeable material based on tricalcium phosphate with Kelvin architectonics created by stereolithographic 3D-printing was studied in vivo. A monocortical defect of the femur was modeled in rats and the material was implanted into the defect area. In 24 weeks, the animals were euthanized and histological examination of the defect area was performed. One femur fracture with fixator migration was recorded after implantation of the studied material and the reference chronOS synthetic material. The studied material demonstrated better osteoconductive properties then traditional osteoplastic material, which was seen from greater number of bone trabeculae and their area in the defect area.