Background. Endometrial cancer is a common oncological disease of the female reproductive system. Treatment is based on a comprehensive analysis of FIGO staging, degree of differentiation, invasion, and molecular genetic profile of the tumor. Aim: comparative analysis of the metabolic characteristics of the primary tumor based on PET/CT results with [18F]FDG and key prognostic factors of endometrial cancer according to morphological and immunohistochemical studies. Material and methods. A retrospective analysis of 34 patients with morphologically verified endometrial cancer who underwent PET/CT prior to surgical treatment with [18F]FDG. The relationship between the quantitative metabolic characteristics of the primary tumor: the standardized accumulation level (SUVmax), the metabolic volume of the tumor (MTV) and the total glycolytic index (TLG) of the primary tumor with the histological type, degree of differentiation (Grade), the depth of invasion into the myometrium, the presence of lymphovascular invasion and damage to the lymph nodes was investigated. Results. A statistically significant strong positive correlation was found between SUVmax and the degree of neoplasm anaplasia (ρ = 0.68, p 0.001). The SUVmax values significantly differed between the Grade groups: Grade 1, 7.25, Grade 2, 7.22 and Grade 3, 12.80 (p 0.001). Non-endometrioid histological types and the presence of LVI were also associated with higher values of SUVmax, MTV, and TLG. A moderate positive correlation of SUVmax with the depth of tumor invasion into the myometrium was found (ρ = 0.58, p = 0.001). Conclusion: quantitative metabolic characteristics of the primary tumor obtained by PET/CT scans with [18F]FDG can be used for predictive risk stratification as part of a personalized approach to endometrial cancer treatment, as they are closely related to the main histopathological prognostic factors of biological tumor aggressiveness.

Introduction. R Rhabdomyosarcoma is the most common type of sarcoma in children, which can affect the genitourinary system. Treatment protocols for patients with rhabdomyosarcomas of the prostate and bladder differ, particularly regarding the need, extent, and timing of surgical treatment. Currently, there are two main treatment protocols for rhabdomyosarcomas of the bladder and prostate: the European (SIOP), approved by the International Society of Pediatric Urology, and the North American one, supported by the Children's Oncology Group (COG). Both protocols share the use of neoadjuvant chemotherapy after biopsy of the lesion to clarify the diagnosis. However, the North American protocol recommends further radiotherapy to prevent dysfunction of pelvic organs after surgery, while the European protocol advocates for surgical correction after chemotherapy. Moreover, there is no unified approach to selecting the surgical treatment method. Specialists use both organ-preserving and organ-sparing operations. Objective. To describe a clinical case of using robotic cystoprostatectomy as a radical treatment method for a patient with prostate rhabdomyosarcoma. Clinical case. The paper describes a clinical case of a 13-year-old boy with prostate rhabdomyosarcoma who received staged chemotherapy and radiotherapy. Since residual tumor tissue remained, the child underwent radical surgery, including robotic cystoprostatectomy with the creation of bilateral ureterostomy. Conclusion. In this case, it was decided to opt for a radical surgical treatment method — cystoprostatectomy with removal of the bilateral ureterostomy. This decision was based on the presence of residual tumor tissue according to MRI data, as well as after numerous blocks of chemotherapy and radiotherapy. This approach allowed the patient to undergo an adjuvant course of chemotherapy without the risk of postoperative complications, such as infection of the intestinal reservoir in cases where it is created simultaneously with cystoprostatectomy.

Endometrial cancer remains one of the most common malignancies in women, and its incidence is particularly increasing in developed countries. Despite the well-known promotive role of excessive exposure to estrogen, many other details of the pathogenesis of endometrial cancer remain unknown. Recent studies have elucidated the emerging role of the resident microbiota in the progression of various diseases, including cancer. Next-generation sequencing demonstrated that the uterine cavity, previously considered sterile, contains a composition-rich microbiota. In this work, we determined the differences in the composition of the intrauterine microbiota between patients with endometrial cancer and its precursor—endometrial hyperplasia.

Purpose. Gestational trophoblastic disease (GTD) coexisting with a steadily progressing pregnancy is an extremely rare condition presented in the literature as a single case or case series of successful delivery. The purpose of this study was to describe five cases of GTD and present possible management strategies for such patients. Methods. Clinical data of five pregnancies with coexisting GTD were identified within the Almazov National Medical Research Centre from 2018 to 2021. Results. Three cases of multiple pregnancies with complete hydatidiform moles and two cases of singleton pregnancies with intraplacental choriocarcinoma and invasive hydatidiform moles were identified. Three pregnancies were prolonged and ended with preterm deliveries. Malignant transformation of the GTD accounted for 60% of the cases. The condition of newborns was based on the level of prematurity and functional immaturity, and in all cases, it was aggravated by anemia. Conclusion. GTD coexisting with progressing pregnancy is threatened by the risks of preterm delivery, miscarriage, hemorrhage, and disease progression and requires monitoring in a multidisciplinary clinic experienced in the management of patients with malignant tumors during pregnancy. In cases of prolonged pregnancy against the background of GTD, we suggest the following monitoring during pregnancy: pelvic, abdominal ultrasound/MRI (without contrast), prenatal invasive fetal karyotype testing in cases of singleton pregnancy, lung X-ray/CT with uterine shielding, weekly assessment of β-hCG levels, and dynamic monitoring of the fetus. The following postnatal monitoring should be performed: morphological examination of the placenta, weekly assessment of β-hCG levels up to normalization, then monthly assessment up to six months, and control of β-hCG level of the newborn.

Introduction/Background Primary ovarian site manifestation of lymphomas are sporadic neoplasms, accounting 0,2–1,1% of all cases of extranodal non-Hodgkin's B-cell lymphoma predominantly with unfavorable prognosis. The accompaing of these diseases with pregnancy is an extremely rare condition that causes difficulties in diagnosis and treatment Methodology Pregnant thirty-nine-year-old patient after In vitro fertilization with Pre-implantation Genetic Diagnostics due to mutation in the CFTR gene which was diagnosed after cystic fibrosis (with severe lung/digestive system disorders) in the first child. At gestational age (GA) 24 weeks ORADS-4 ovarian neoplasm was detected. Non-contrast MRI discovered a solid lesion measuring 14,5x8,8x10,5cm in the left ovary with signs of true diffusion restriction and ascites. Due to pain, peritoneal symptoms an emergency operation was performed: laparotomy, left adnexectomy, omentectomy (due to preoperative rupture of the tumor with hemorrhage and adhesions to the omentum). Morphologically high-grade B-cell lymphoma, not otherwise specified (HGBL-NOS) with Ki67–97% was detected (figure 1). After whole body MRI scanning tumor changes of the paraaortic lymph nodes were diagnosed. Taking into account strong wish of patient to maintain pregnancy, the high-grade lymphoma, the risk of worsening the prognosis the DA-EPOCH-R chemotherapy was initiated. Results After three cycles of DA-EPOCH-R chemotherapy (with reduction of tumor foci up to 98% without significant toxicity) the cesarean section was performed at GA 37 1/7. Newborn: boy, weight: 3080 g, Apgar 8/9, healthy. The patient continuing treatment in the hematology department with ongoing tumor reduction. Conclusion The combination of non-Hodgkin's B-cell lymphoma of rare localization (ovaries) during pregnancy is extremely uncommon morbidity with possibility of prolonging pregnancy along with treatment in a specialized, multidisciplinary medical center. This makes it possible to conduct a full-fledged examination, prescribe adequate and timely treatment while minimizing risks to the fetus, prolong pregnancy to full term, and create conditions for the birth of a healthy child. Disclosures Nothing to disclose

Introduction. Epispadias is an extremely rare disease. Epispadias in women is 5–6 times less common than in men. The incidence of female epispadias ranges from 1 in 160,000 to 480,000 live births. Epispadias can be diagnosed by a thorough examination of the genitals. Treatment of epispadias is only surgical, which is quite difficult and requires experience. The literature that discusses female epispadias is very limited. In this article, we would like to report on the surgical treatment of isolated epispadias in a 3-year-old girl at the Almazov National Medical Research Center. Clinical case. A 3-year-old girl presented with the main complaint of urinary incontinence since birth, during the day and at night. Urinary incontinence was not caused by physical activity and was not aggravated by eating/drinking. Physical examination showed that the external genital organs of the patient have underdeveloped labia minora, abnormal urethra, bifurcated clitoris. Laboratory results were within the normal range. Voiding cystourethrography revealed urine leakage during the filling phase. The bladder wall was normal, there was no vesicoureteral reflux. The patient underwent simultaneous surgical interventions, consisting in plastic surgery of the urethra and reconstruction of the bladder neck, plastic surgery of the clitoris and labia minora. There were no intraoperative and postoperative complications. After 1 week and 6 months of observation, the patient achieved urinary retention, the surgical wound healed primarily. Discussion. Epispadias is a rare condition that can vary in severity from mild to severe. Severely, splitting of the entire urethra occurs, involving the bladder neck, causing permanent urinary incontinence in the patient. Cases of epispadias are quite difficult to diagnose. The doctor should dilute the labia majora and carefully conduct a physical examination. The objective goals of the surgical treatment of epispadias are to achieve urinary retention, restore the anatomy, function and cosmetic appearance of the urethra and genitals. One-stage reconstruction is a modern surgical technique used to treat isolated epispadias in women. Conclusion. Epispadias in women is a rare congenital anomaly that is often not detected in childhood. For isolated epispadias in a girl, one-stage surgical correction is currently preferred.

Introduction/Background Anaplastic large cell lymphoma associated with a breast implant (BIA-ALCL) is a rare form of T-cell non-Hodgkin's lymphoma first described in 1997 and officially recognized by the WHO in 2016. The diagnosis is made based on aspiration of the fluid around the implant and the positivity of the CD30 sample. In the world literature 3 cases of BIA-ALCL associated with pregnancy are described. Methodology A 36-year-old woman with gestation age (GA) 26 weeks was admitted with pain in the left breast 5 years after bilateral augmentation. Upon admission, there were no obvious signs of neoplasia or lymphadenopathy. According to ultrasound of the mammary glands and regional lymph nodes, there were no changes outside the periprosthetic capsule. A fine-needle aspiration biopsy was performed. Immunocytochemical examination of periprosthetic fluid: tumor cells positive for CD30, CD4, CD2, negative for ALK, Pan SC (AE1/AE3), which corresponds to the diagnosis of BIA-ALCL. Ultrasound of the pelvic organs, abdominal cavity, MRI of the chest (non-contrast): bilateral seromas on the periphery of breast implants, absence of other pathological formations (stage IA according to the TNM classification) (figure 1). Surgical treatment with the explantation of endoprostheses and the surrounding fibrous capsule in a single block on both sides at 29 weeks GA. Results Dynamic monitoring with no signs of progression up to vaginal delivery (40 weeks GA) was performed. A healthy girl, Apgar 8/9, was born. Follow-up including 18F-FDG PET/CT was performed 3 and 12 months after delivery: no pathological changes were detected. Conclusion The described case complements the limited available data on this topic, emphasizing that BIA-ALCL should be taken into account for diagnosis in the presence of spontaneous periprosthetic seroma with late onset even during pregnancy and that histological diagnostic signs of the disease do not differ in a pregnant woman. Disclosures Nothing to disclose

The inner parts of the human body are usually inspected endoscopically using special equipment. For instance, each part of the female reproductive system can be examined endoscopically (laparoscopy, hysteroscopy, and colposcopy). The primary purpose of colposcopy is the early detection of malignant lesions of the cervix. Cervical cancer (CC) is one of the most common cancers in women worldwide, especially in middle- and low-income countries. Therefore, there is a growing demand for approaches that aim to detect precancerous lesions, ideally without quality loss. Despite its high efficiency, this method has some disadvantages, including subjectivity and pronounced dependence on the operator's experience. The objective of the current work is to propose an alternative to overcoming these limitations by utilizing the neural network approach. The classifier is trained to recognize and classify lesions. The classifier has a high recognition accuracy and a low computational complexity. The classification accuracies for the classes normal, LSIL, HSIL, and suspicious for invasion were 95.46%, 79.78%, 94.16%, and 97.09%, respectively. We argue that the proposed architecture is simpler than those discussed in other articles due to the use of the global averaging level of the pool. Therefore, the classifier can be implemented on low-power computing platforms at a reasonable cost.

Trophoblastic neoplasias are rare tumors, accounting for less than 1 % of malignant neoplasms of the female genital tract. Trophoblastic tumors associated with developing pregnancy are extremely rare. The article presents the successful experience of diagnostics and treatment of intraplacental chorioncarcinoma associated with progressing pregnancy.

Gestational trophoblastic disease (GTD) is a rare tumor characterized by spectrum of trophoblastic proliferative disorders associated with pregnancy. These neoplasms occur in less than 1% of female genital malignancies. There is a high curability of the disease even in the presence of disseminated process with the ability to preserve reproductive function. However, this is possible if timely diagnosis and adequate treatment tactics were applied. The article presents a review of the literature and the summary of guidelines of treatment of this malignancy.

Objective. A comparative analysis of the immediate and long-term outcomes of total and subtotal hysterectomy with excision of the mucosal and muscular layers of the cervix in patients with benign uterine diseases. Patients and methods. A total of 366 patients aged 41 to 57 years were examined. Patients were divided into two groups: the study group (n = 254), which included patients who underwent laparovaginal subtotal hysterectomy with excision of the cervical mucosal and muscular layers using a modified cutting instrument (surgical cutter), and the comparison group (n = 112), which included patients who underwent total hysterectomy. All operations were performed by a laparoscopic approach. The duration of postoperative outpatient follow-up was 1–48 months. Results. In 88.6% of patients in the study group, there were no pronounced vegetative-vascular and psycho-emotional disorders, exacerbation or worsening of chronic somatic diseases; 56.3% of patients in the comparison group had clinical manifestations of the post-hysterectomy syndrome. Deterioration in the quality of sexual life (reduced libido and/or anorgasmia) was observed in 9.4% and 36.6% of women in the study and comparison groups, respectively. Vaginal vault prolapse was revealed in 3.6% of patients in the comparison group and vaginal vault granulation – in 4.5% of patients 2-3 years after surgery. No similar complications were registered in the study group. Conclusion. Subtotal hysterectomy with excision of the cervical mucosal and muscular layers using the presented technique can serve as an alternative to total hysterectomy in patients with benign uterine pathology. Preservation of the uterine suspensory apparatus, innervation, and blood supply of the cervical stump and the upper third of the vagina reduces the risk of pelvic floor anatomical and functional disorders and minimizes the possibility of post-hysterectomy pelvic organ prolapse. The proposed method of hysterectomy helps to reduce the duration of surgery, blood loss, the risk of intra- and postoperative complications, to minimize the development of cervical stump diseases and improve patients’ quality of life. Key words: subtotal hysterectomy, total hysterectomy, cervical mucosal and muscular layer excision, laparoscopy, surgical cutter, post-hysterectomy syndrome

Интерстициально распложенный рудиментарный рог матки (ИРРРМ) — крайне редко встречающаяся аномалия производных мюллерова протока. ЦЕЛЬ ИССЛЕДОВАНИЯ Оценить возможности и особенности проведения робот-ассистированной резекции (РАР) ИРРРМ у девочек-подростков. МАТЕРИАЛ И МЕТОДЫ Проведен анализ историй болезни и особенностей робот-ассистированного оперативного вмешательства, результатов гистологического исследования и катамнеза у девочек 13, 14 и 15 лет с ИРРРМ. РЕЗУЛЬТАТЫ Несмотря на выраженность болевого синдрома (по ВАШ — 8,7±1,2 балла), продолжительность заболевания до установления диагноза составила 2,3±1,5 года при менструальном возрасте девочек 3,3±1,2 года. Продолжительность операции 166,7±28,9 мин, доконсольный этап 43,3±5,8 мин. Основные затруднения возникали при идентификации границы между канализированной половиной матки и замкнутой. Хирург ориентировался на визуальные и тактильные ощущения. Установка на сохранение целостности канализированной части в 1 случае привела к тому, что при патоморфологическом исследовании в иссеченной части не выявлена эндометриальная ткань. Объем кровопотери 25,0±21,8 мл (10; 50). Болевой синдром в последующие 6 мес наблюдения отсутствовал у всех пациенток. ЗАКЛЮЧЕНИЕ Робот-ассистированная резекция у девочек дает возможность бескровного удаления интерстициально расположенного рудиментарного рога матки, полной ликвидации болевого синдрома после операции. Основное затруднение возникает при идентификации границы между половинами матки.

Робот-ассистированная хирургия — это современный метод высокотехнологичной медицинской помощи, применяемый в том числе оперативной гинекологии. ЦЕЛЬ ИССЛЕДОВАНИЯ Оценить преимущества и возможные ограничения использования роботической хирургии, вероятные пути дальнейшего применения при основных нозологических формах гинекологических заболеваний, являющихся показанием к выполнению оперативных вмешательств у девочек-подростков и женщин в возрасте от 13 до 49 лет. МАТЕРИАЛ И МЕТОДЫ Проведен ретроспективный анализ случаев роботических операций у девочек-подростков и женщин репродуктивного возраста за период 2011—2021 гг. на базе ФГБУ «НМИЦ им. В.А. Алмазова» Минздрава России. Изучены продолжительность операции, объем кровопотери, длительность госпитализации. Оценены субъективные впечатления применения роботической системы при различных типах вмешательства на органах малого таза. РЕЗУЛЬТАТЫ Проанализировано 446 случаев, среди которых в 9,5% — это девочки-подростки. Выделено 5 групп пациентов по типу нозологии и объему оперативного вмешательства с применением робототехники: 1-я группа — овариоцистэктомия (n=166): средняя продолжительность операции 95±20 минут, средний объем кровопотери 40±20 мл; 2-я группа — операции при эндометриозе (n=51), средняя продолжительность операции 144±31 минут, средний объем кровопотери 85±20 мл; 3-я группа — миомэктомия (n=113), средняя продолжительность операции 130±30 минут, средний объем кровопотери 150±50 мл; 4-я группа — промонтофиксация (n=97), средняя продолжительность операции 122±24 минут, средний объем кровопотери 55±18 мл; 5-я группа — реконструктивные операции (n=19), средняя продолжительность операции 168±29 минут, средний объем кровопотери 43±6 мл. Дана субъективная оценка технических преимуществ и трудностей роботической хирургии при разных нозологиях. ЗАКЛЮЧЕНИЕ Анализ десятилетнего опыта использования робот-ассистированных систем в репродуктивной гинекологии показал, что роботический метод представляет собой эволюционный этап развития эндоскопической хирургии. Организация работы с учетом обозначенных в исследовании преимуществ и недостатков метода обеспечит рациональный отбор пациентов для роботохирургии и обозначит пути ее дальнейшего развития.

In this study we are developing predictive models for a length of stay after a gynecological surgery, complications and the length of the surgery using machine learning methods. The study was performed with the data of patients with the diseases of the female reproductive system. The patients were admitted to the Almazov National Medical Research Centre (Saint-Petersburg, Russia) within the period 2010-2020. The study included 8170 electronic medical records of inpatient episodes including 3500 operation protocols. The data included anamnesis of life, anamnesis of disease, laboratory tests, severity, outcome of a surgery, main and comorbid diagnosis, complications, case outcome. The dataset was randomly split into 70% train and 30% test datasets. Validation with the test dataset provided the following prediction metrics for the length of stay after a surgery model. Training score: AUC of ROC: 0.9582230976834093; K-fold CV average score: -8.73; MSE: 5.65; RMSE: 2.83.

Necrotizing enterocolitis (NEC) develops primarily in premature infants and is characterized by high mortality. The most significant factors of NEC pathogenesis are gut dysbiosis, bottle feeding, and excessive inflammation. The intestinal microbiota of premature infants is characterized by lower bacterial diversity, increased proportion of potentially pathogenic microorganisms (such as Proteobacteria, Enterobacteriaceae), and decreased abundance of anti-inflammatory commensal bacteria. Molecular mechanisms of NEC pathogenesis and intestinal dysbiosis involve immune disorders, including excessive TLR4 signaling in response to bacterial lipopolysaccharides, as well as metabolic dysfunction associated with prematurity, enteral nutrition, and changes in the functional activity of the microbiota. Comprehensive pathophysiological mechanisms underlying NEC require innovative approaches to their investigation, such as metagenomics, metabolomics, and proteomics. Identification of potential biomarkers of NEC development and progression using omics technologies is one of the most promising methods to study this pathological condition. Key words: biomarkers, gut dysbiosis, metabiotics, metabolomics, metagenomics, microbiome, necrotizing enterocolitis, probiotics, proteomics, etiopathogenesis

In Russia, cervical cancer presents a major problem in women’s health, since the incidence and mortality rates have not decreased compared with other European countries. The reasons are insufficient coverage by vaccination against human papillomavirus and flaws in screening. As a result, there

Altered pelvic venous circulation, which may occur due to pelvic venous congestion and varicose veins of the vulva, may be among the causes for developing chronic pelvic pain syndrome. Pelvic congestion syndrome (PCS) is characterized by chronic discomfort in the pelvic area, which may be aggravated during coitus or acquire orthostatic position, and result in severe dysfunction of the pelvic organs. Varicose veins of the vulva develop due to obstruction of the veins, increased venous pressure, and venous insufficiency in the pelvis. Varicose veins may be isolated or associated with varicose veins of the lower extremities. The diagnosis and treatment of such patients are limited by the lack of definitive clinical criteria for early diagnostics, which were discussed in the current study.

Endometriosis of the anterior abdominal wall is a rare disease comprising 0.3–3.5 %. In turn, its diagnosis is quite challenging due to the nonspecific picture, including pain in the anterior abdominal wall during menstruation. Upon clinical examination, a thickened area may be observed in the anterior abdominal wall, usually in the area of tissue involved in surgery. Ultrasound examination is a simple, economical, and reliable method of choice to diagnose extragenital endometriosis. Here we describe a case report of the patient after surgery of anterior abdominal endometriosis localized in the rectus abdominis muscle in the umbilical region and confirmed by ultrasound test and morphological examination of excised macroscopic sample.