Introduction. The hypothalamic-pituitary-gonadal axis (HPG) is the most important part of the hormonal system that controls testicular function in men. It is known that testicular neoplasms (TN) can disrupt the regulation of HPG due to the occurrence of hormonal imbalance. However, changes in HPG in patients with TN have been little studied, especially before the start of treatment. Aim: to assess the degree of hormonal disorders affecting HPG in men with TN before treatment. Material and methods. The study included 49 patients with newly diagnosed TN. The concentration of total testosterone (T), free testosterone (cT), estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone binding globulin (SHBG) and prolactin (PRL), as well as tumor markers (β-HCG, AFP) were measured in all men; the body mass index (BMI), tumor size, bad habits and surgical history (treatment of cryp- torchidism, varicocele) were evaluated. Clinically significant T deficiency (DT) was defined as the level of total T <8 nmol/l or the level of T in the range of 8-12.1 nmol/l, taking into account free T <243 pmol/L. Results. There were statistically significant differences in hormone levels between patients with normal 30 (61,2%) and high 19 (38,8%) values of cancer markers (p<0,05). A high concentration of β-hCG was associated with a decrease in the level of FSH and LH below normal values (p<0,001) and an increase in the level of total T (p=0.019), cT (p=0,01) and E2 (p=0,003) compared with patients without hypertension. an increase in this cancer marker. Laboratory signs of DT were found in 15 (30,6%) patients, mostly with normal β-hCG values (p=0,025). However, a causal relationship was not established due to a small sample in this subgroup. The probability of developing DT in men with a history of cryptorchidism (22,4%) was 6,56 times higher (95% CI: 1,532 – 28,120; p=0,021). Correlation analysis revealed the relationship between LH (p=-0,351; p=0,014), FSH (p=-0,3; p=0,041), E2 (p=0,323; p=0,03) and tumor size. When analyzing hormone levels depending on age, smoking and BMI, no statistically significant differences were obtained (p>0,05). Conclusion. Abnormalities in HPG were detected in 30% of patients with TN before treatment. One third of the men had laboratory signs of DT. Further studies involving more patients are required to develop practical recommendations.

Introduction. Testicular cancer (TC) mostly affect young men of reproductive age. Several studies have shown correlation between the level of sex hormones in testicular cancer and serum tumor markers. However, currently, the relationship between hormone levels before orchidectomy and the clinical and pathomorphological characteristics of the tumor has not been sufficiently studied. Aim of the study: to analyze the relationship between hormone levels and the clinical stage and histological characteristics of the tumor in patients with testicular cancer and to develop prognostic models. Material and Methods. This prospective single-center study included 66 patients with testicular cancer. Localized, locally advanced and metastatic testicular cancer was diagnosed in 55 (83.3 %), 9 (13.6 %) and 2 (3.0 %) patients, respectively. A preoperative assessment of hormones such as total and free testosterone (T), estradiol (E2)), gonadotropic hormones (LH, FLH, Prolactin) and b-HCG was carried out. Patients were divided into 2 groups depending on the histological structure of the tumor: seminoma (n=31) and non-seminoma (n=35). The following parameters were assessed: tumor size, lymphovascular invasion and rete testis invasion. Results. In non-seminoma tumors, the values of sex hormones and beta-hCG were higher, but the values of gonadotropic hormones were lower compared with typical seminomas (p<0.05). High concentrations of b-HCG were observed predominantly in pT3 compared to pT1 stages (p=0.018). Correlation analysis revealed a connection between total (ρ=0.351; p=0.004) and free T (ρ=0.342; p=0.008), E2 (ρ=0.292; p=0.022), b-HCG (ρ=0.244; p= 0.048), LH (ρ=-0.287; p=0.039), FSH (ρ=-0.264; p=0.04) and the size of the primary tumor. The presence of rete testis invasion was accompanied by a low LH value and a high b-HCG value compared to patients without this prognostic parameter (p=0.015, p<0.001, respectively). Prognostic models were developed to determine the probability of histological structure and the presence of rete testis invasion (p<0.001) with high sensitivity (82.1 % and 76.5 %) and specificity (76.9 % and 100 %). Conclusion. The findings suggest that non-seminoma tumors are associated with changes in the pituitary-gonadal (HPG) axis. The high values of sex hormones and low values of gonadotropic hormones before orchidectomy are associated with a large size of the primary tumor. Additionally, a low LH value and a high b-HCG value are predictors of rete testis invasion. High b-HCG levels are associated with more aggressive tumor biology and poor prognosis.

Background . Depending on the stage or location of the tumor, kidney resection or nephrectomy is the gold standard of treatment for renal cell carcinoma Preservation of organ function is essential for patients with localized tumors, especially with one kidney, chronic kidney disease, proteinuria, or multiple/bilateral masses. An important goal of kidney resection is to preserve the functional activity of the organ; however, the surgery leads to its decrease because of the loss of vascularized nephrons and irreversible ischemic damage. Description of the clinical case . A 24-year-old female was diagnosed with cT1bN0M0, Stage I right kidney cancer. An abdominal cavity and retroperitoneal MSCT with intravenous contrast showed a mass in the right kidney, extending into the renal sinus and causing pyelocalicoectasia. A laparoscopic resection of the right kidney was performed using the patented technique developed at the P.A. Herzen Moscow Oncology Research Institute and providing selective intra-arterial cold ischemia. This was prompted by the complex tumor anatomy, which indicated a prolonged kidney ischemia. Conclusion . Cold arterial perfusion has several advantages. First, it quickly cools the renal parenchyma to 25 °C, enabling faster and more comfortable kidney resection and suturing. Second, it eliminates the reverse venous blood fow caused by the positive perfusion pressure in the collecting system. Third, it does not imply the additional objects (for example, ice or clamps) in the work area, therefore not affecting the intraoperative view. The literature suggests hypothermia as the method of choice in most diffcult cases (resection of a single kidney, a large-diameter tumor, a high R.E.N.A.L. index).

The question of optimal times and indications for radiotherapy (adjuvant or salvage) after surgical treatment of prostate cancer remains unanswered. Therefore, studies of this problem are essential and important for clinical practice. The article evaluates the effectiveness of adjuvant radiotherapy compared to salvage radiotherapy in the context of recurrence-free survival and associated adverse events. In 3 randomized clinical trials and meta-analysis, adjuvant radiotherapy did not show improved recurrence-free survival compared to salvage radiotherapy. The choice between adjuvant and salvage radiotherapy should be based on individual patient history and the risk of recurrence. Delayed radiotherapy can help some patients to avoid excessive treatment and associated adverse events.

Introduction. Survival rates and treatment algorithms for patients with bladder cancer (BC) depend on the depth of tumor invasion, in particular on the presence of the bladder muscle layer invasion and extraorganic spread. To assess the depth of bladder invasion, the VI-RADS system was developed in 2018, which is based on multiparametric MRI (mpMRI). According to published studies on the VI-RADS effectiveness, there is a high diagnostic accuracy for identifying formations with probable invasion into the muscle layer. The data on BC extraorganic spread are limited and the issue of assessing the sensitivity and specificity of this system requires further study. Aim of the study. To evaluate the diagnostic performance of mpMRI using the VI-RADS system in detecting muscle invasion and BC extraorganic growth. Materials and methods. A prospective study was conducted in the clinics of the National Medical Research Radiological Centre and included 75 patients aged 19 to 85 years, of which 39 (52%) had been newly diagnosed with BC, 36 (48%) had a relapse or continuous tumor growth. All patients underwent pelvic organs mpMRI on a tomograph with a magnetic field induction of 1.5T, followed by transurethral resection (TUR), TUR-biopsy of the bladder or cystectomy no later than 6 weeks after scanning.. The description of the bladder tumor included its measurements, localization and VI-RADS scale assessment. The data obtained by mpMRI were compared with the results of the morphological study using statistical analysis. Results. According to the results of the study, the overall VI-RADS scale sensitivity for categories above 3 (the presence of muscle invasion is equivocal) was 95.15% [90.11%; 99.95%], above 4 (muscle invasion is likely) – 92.59% [82.11%; 97.94%], specificity was determined at the level of 47.62% [25.71%; 70.22%] and 80.95% [58.09%; 94.55%] respectively. When assessing extraorganic spread in 30 patients, the sensitivity was 83.33% [62.62%; 95.26%], specificity – 83.33% [35.88%; 99.58%]. The accuracy and positive predictive value also had high levels from 80 to 95%, in contrast to the negative predictive value (55.56%). Conclusion. The scale for BC invasion depth assessing VI-RADS is characterized by high rates of sensitivity, specificity and accuracy, in particular when used in determining extraorganic spread.

Risk factors for renal cell cancer (RCC) recurrence, including its local form, include stage and high Fuhrman grading system score, regional lymph node involvement, microvascular invasion, tumor necrosis, positive surgical margin, and sarcomatoid or rhabdoid tumor differentiation. Objective. The study analyzes data from Moscow Research Oncological Institute named by PA Herzen to determine the predictors of local recurrence of kidney cancer based on the data from surgically treated patients with local recurrent RCC. Material and methods. We analyzed retrospectively data from 87 patients who were divided into 2 groups: 1-st, patients with detected local recurrence of kidney cancer (n=43), and 2-nd, control group (n=44). The following predictors were evaluated: tumor size, tumor histotype, tumor stage, Fuhrman grading system, surgical margin status, tumor necrosis, sarcomatoid and rhabdoid changes, microvascular invasion, hemorrhage and invasion of collecting system components (CSS), renal capsule, and perirenal cellular tissue and primary treatment. Results. The risk of local recurrence was higher in the primary tumor, over 40 mm in diameter (OR=5.8, p<0.001), as well as microvascular invasion and focal hemorrhage (OR=15.1, p=0.001 and OR=3.3, p=0.008, respectively). Both univariate and multivariate analyses showed a negative effect on the risk of local RCC recurrence only for tumor necrosis (OR=15.4, p<0.001 and OR=53.6, p=0.002, respectively) and high Fuhrman grade (OR=10.9, p=0.042 and OR=5.7, p=0.032, respectively). The most significant predictors of local renal cancer recurrence are tumor necrosis (p<0.001), microvascular invasion (p=0.019), positive surgical margin (p=0.009), and high Fuhrman grade (p=0.04). High Fuhrman grade (3–4) of malignancy (HR=1.9, p=0.042), tumor diameter (HR=1.0, p=0.054), positive surgical margin (HR=3.5, p=0.001), and tumor necrosis (HR=2.3, p=0.029) were found to be the most significant factors influencing 5-year local recurrence-free survival rate. Conclusion. The course of renal cell cancer is determined by multiple interrelated and independent prognostic factors.

Introduction. Currently, CT and MRI do not reliably differentiate oncocytoma, angiomyolipoma with minimal fat and renal cell carcinoma, and therefore most patients with localized solid renal tumors undergo surgical treatment. Identification of differential signs of benign formations according to imaging methods would make it possible to change the therapeutic tactics in more than a third of cases in patients with newly diagnosed small renal masses (less than 4 cm). Purpose. The aim of the study was to evaluate the diagnostic efficacy of diffusion-weighted MRI (DWI) in the differential diagnosis of solid renal masses. Materials and methods. А prospective study, which included 90 patients aged 34 to 79 years with primary solid renal masses who were examined and treated at the Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation was conducted in the period from February 2019 to October 2021. Before surgery, all patients underwent MRI of the retroperitoneal organs using DWI with b-factors of 0–800 s/mm2 and 0–1000 s/mm2. The diffusion coefficient was quantified on two ADC maps for renal masses of various histological types and the obtained values were compared with each other. Results. According to the results of the statistical analysis, the values of the diffusion coefficient for benign tumors were significantly higher than for RCC (p < 0.05). There was no statistically significant difference between clear cell, chromophobe and papillary types of RCC in terms of diffusion coefficient both at b-factors of 0–800 s/mm2 and at 0–1000 s/mm2. Conclusion. Using DWI we can suggest a benign genesis of a solid renal mass. Differential signs for RCC of various histological types according to diffusion-weighted images were not identified.

This article presents a systematic literature review to assess the survival outcomes of patients with bilateral renal cell carcinoma who underwent nephro-preserving surgery. Patients with bilateral renal neoplastic lesions represent a rare subpopulation, numbering, according to different authors, from 2 to 6 % of the total RCC group. Despite the increase in the number of cases of bilateral RCC, the number of works devoted to the study of the features of surgical intervention, prognosis factors, treatment outcomes and survival of this cohort of patients is limited, and a number of important questions regarding this problem remain unresolved. Currently, the only effective method of treating bilateral renal cancer is nephro-preserving surgery in the volume of bilateral renal resection / nephrectomy with resection of the contralateral kidney in case of synchronous lesion or resection of a single kidney in case of metachronous lesion. This strategy avoids or reduces the risk of developing renal failure and its consequences after surgery. Conclusion. Nephro-preserving surgery for bilateral renal cell carcinoma is the only effective method to achieve satisfactory oncological results with a low incidence of complications.

Solid pseudopapillary tumor of the pancreas is an extremely rare neoplasm of the exocrine portion of this organ, which affects mostly young women and is characterized by a low malignancy potential and a relatively benign clinical course. According to the literature, even in disease progression as metastases, the overall 5-year survival rate is more than 95%. The paper describes a clinical case of a female patient with a solid pseudopapillary pancreatic tumor regarded as a metastatic neoplasm in the retroperitoneal space after surgical treatment previously performed in 2001.

Primary thyroid-like follicular renal cell carcinoma is an extremely rare type of renal cell cancer with low malignancy potential and relatively good prognosis. It has not been included into the World Health Organization classification of renal tumors. This tumor is characterized by morphology similar to primary thyroid follicular cancer, but with different immune phenotype, which is important for morphological diagnosis. Surgery has been recognized as the only curative treatment. We describe our own observation of follicular renal carcinoma in a 68-year old man, in whom renal tumor was identified during his regular examination due to past colon cancer. The disease was asymptomatic. The patient had elective laparoscopic nephrectomy. At pathological assessment, the tumor looked like a follicular thyroid neoplasm. Immunohistochemistry revealed no expression of RCC, TTF-1, thyroglobulin, CD-10, synaptophysin, and chromogranin A. The differential diagnosis included metastatic primary thyroid malignancy as the most probable diagnosis, as well as highly differentiated neuroendocrine tumor and the so-called “thyroid kidney” that might occur in long-standing chronic pyelonephritis. Conclusion: The case of primary follicular renal carcinoma illustrates that this rare renal tumor is heterogeneous both in its structure and tumor cell immunophenotypes. Longer follow-up and accumulation of larger numbers of the disease is needed. This would allow for a more objective assessment of its prevalence in the population, of its clinical characteristics and morphological variability.

Background. Adrenal glands are the site of solitary synchronous and metachronous metastases in non-small cell lung cancer (NSCLC). The presence of solitary adrenal metastasis from lung cancer provides survival benefit; however, currently, there are no exact treatment algorithms. Objectives of the study: to assess shortand long-term treatment outcomes in patients with adrenal metastases from NSCLC. Material and methods. Treatment outcomes of patients undergoing adrenalectomy for NSCLC were analyzed. Results. From 1993 to 2014, 13 patients (11 males/2 females aged between 44 and 78, median age 58 years) with solitary adrenal metastases (adenocarcinoma (n=7), squamous cell carcinoma (n=4), large cell carcinoma (n=2); synchronous metastases – 5 cases (38.5%) and metachronous metastases – 8 cases (61.5 %), underwent adrenalectomy (one patient was given stereotactic radiation therapy for brain metastasis). Laparoscopic adrenalectomy was performed in 10 (76.9 %) cases, open adrenalectomy was performed in 3 (23.1 %) cases. The average adrenal tumor diameter was 74.6 ± 13.3 mm (25–170 mm). In the early postoperative period, two lethal outcomes were recorded. The median follow-up time after adrenalectomy was 20 months (3 to 267 months), the average follow-up time was 51.5 ± 23.5 months. The 3-year overall survival rates in patients with synchronous and metachronous metastases were 25.0 ± 2.2 % and 57.1 ± 1.9 %, respectively; however, the differences were not statistically significant (p=0.63; LogRank). The extent of surgery, morphological tumor type and status of regional lymph nodes produced no influence on the survival rate (p>0.05). Conclusion. No factors influencing survival in patients with solitary adrenal metastases from NSCLC were identified.

Background. Prostate cancer (PCa) remains one of the most relevant problems in oncology. The incidence and mortality of PCa is constantly rising in Russia. The rate of annual increase in the number of new PCa cases is the highest among all malignancies in Russia and reaches 87.7 % over 10 years (from 2008 to 2018). Approximately one-third of patients have high-risk PCa. This article analyzes the outcomes of surgical treatment in high-risk PCa patients.Objective: to evaluate survival of patients with high-risk PCa after surgical treatment and analyze prognostic factors affecting survival.Materials and methods. This retrospective study included 1507 high-risk PCa patients who have undergone surgical treatment at P.A. Herzen Moscow Oncology Research Institute. Study participants were divided into groups to assess the effect of preoperative prognostic factors on patient survival after surgery. The following factors were analyzed: level of prostate specific antigen >20 ng/mL, Gleason score 8—10, and сТ3—4 clinical stage.Results. Median follow-up time was 58 months. The five-year biochemical relapse-free survival rate in the general group was 57.4 %; five-year overall and cancer-specific survival rates were 94.4 % and 97.7 %, respectively. The incidence of biochemical relapses and survival rates depended on the presence and number of risk factors in the groups studied (p <0.0001). The frequency of local relapses and disease progression also depended on the number of risk factors: the more poor prognostic factors the patient had, the lower was the survival.Conclusion. To find an optimal treatment strategy for high-risk PCa patients after surgery, we recommend using an extended classification (depending on the number of risk factors), since the number of prognostic factors affects survival rates.

Purpose. To evaluate the effectiveness of intraoperative ultrasonography (IOUS) in the surgical treatment of kidney tumors.Patients and methods. Possibilities of IOUS application in the surgical treatment of kidney tumor according to the results of examination and surgical treatment of 145 patients (95 men and 50 women) diagnosed with kidney cancer were evaluated. The patients were divided into 2 groups: group 1 (comparisons) — 76 patients; during the examination and treatment, the IOUS method was not used, group 2 (basic) — 69 patients, who during the surgical treatment used the IOUS method to further clarify the localization, the size and boundaries of the tumor formation.Results. The use of IOUS helped to reduce the frequency of nephrectomy (11.9% in the comparison group and 8.7% in the main group), and reduce the frequency of intraoperative complications, which amounted to (8.7% against 13.2%). The frequency of damage to the spleen and the transition to open surgery did not differ. The use of IOUS allowed to characterize in detail the anatomical features of the tumor, its vascularization and to implement the RENAL prognosis: favorable — in 50.7% of patients, unfavorable — in 15.9%.Conclusion.When performing kidney tumor surgery, it is recommended to perform IOUS of the affected kidney in order to further clarify the boundaries of the tumor lesion to improve the effectiveness of the operation.

The existing data on regulatory T cells (Tregs) in prostate cancer suggest that these cells may penetrate the prostate gland malignant tissue, suppressing antitumor immune response, thus promoting aggressive clinical course and low survival of the cancer patients. Evaluation of T cell subpopulations from the tumor microenvironment has shown that the number of CD4+Tregs is associated with inferior clinical prognosis. In particular, each additional CD4+Treg cell has been shown to cause a statistically significant increase in prostate cancer mortality by 12%, regardless of other clinical factors. There are several possible explanations for the increased infiltration of prostate cancer tissue with regulatory T cells. Firstly, malignant cells or tumor-associated macrophages are capable of secreting chemokine CCL22, which has an affinity for the CCR4 receptor expressed on Treg cells. Secondly, cytokines secreted by prostate tumors, such as TGF-β, may regulate the FoxP3 expression, thus expanding the Treg population. TGF-β, in turn, is a multifunctional cytokine that promotes survival and proliferation of transformed cells, including prostate epithelium, as evidenced by increased amounts in the patients with metastatic disease.