We present a rare combination of two tumors (clear cell renal cell carcinoma with well-differentiated renal neuroendocrine tumour) in a 67-year-old man. To the best of our knowledge, English literature presents only one similar clinical case and we are the first to describe this tumor combination in Russian. The renal tumor was discovered accidentally on abdominal ultrasound. The patient had neither complaint, nor clinical signs of carcinoid syndrome, nor tumours in his medical history. CT scan showed a heterogeneous tumor, being 35×35×30 mm in size. It was in the upper segment of the left kidney, deforming the contour of the kidney, without renal pelvis expansion. We performed nephrectomy using the da Vinci Surgical System. The postoperative period was uneventful; no complications were reported. Macroscopically the tumour presented as a round encapsulated node of a variegated structure. Microscopic examination showed that the tumor consisted of large cells with clear cytoplasm and monomorphic small round nuclei (nucleoli were determined at ×400). In some regions of the tumor, we detected small polygonal cells, with ovoid nuclei with granular chromatin, forming solid, ribbon-shaped structures and spindle-cell patterns. The neuroendocrine component revealed strong expression of chromogranin A, synaptophysin, CD56, S-100, pancytokeratin, and СK7. Histological and immunohistochemical studies, we diagnosed a combination of clear cell renal cell carcinoma (Grade I–II by Fuhrman classification) and renal neuroendocrine tumour (Grade I), pT1aN0. The size of the neuroendocrine component was of 7×3 mm; the index of proliferation Ki-67 was less than 1.0%; and the mitotic index was less than 2 ×10 HPF. After nephrectomy this patient needed close monitor because renal neuroendocrine tumours are very rare and have a higher malignant potential than renal cell carcinoma. Keywords: urological pathology, kidney tumor, clear cell renal cell carcinoma, neuroendocrine tumor, immunohistochemistry

The authors characterize a rare variant of Langerhans cell histiocytosis in a child of early age. Multiple-system form including liver damage is characterized by a particularly severe course, especially in early childhood. The authors report clinical, morphological and immunohistochemical data of the patient aged 1 year and 11 months. It is shown that timely diagnosis of this disease should be carried out in close cooperation of surgeons and morphologists.

Описание случая полиомавирусной нефропатии в сочетании с острым клеточным отторжением в динамике. Подтверждение диагноза потребовало анализа не только морфологической картины, но и результатов иммуногистохимического исследования, клинических и лабораторных данных.

The paper describes a case of chromophobe renal cell carcinoma growing into the muscular layer of the descending colon and with metastases in 4 lymph nodes of paranephral tissue in a 66-year-old woman. The tumor had a zonal structure with an alternation of epithelioid and sarcomatoid structural sites and with the signs of grades I, II and III according to the grading system by Paner and et al. (2010). The sarcomatoid renal component occupied about 70.0% of the tumor. There was a pronounced immunohistochemical reaction with VEGF-A (5 scores), a high Ki-67 proliferation index (70%), and a large number of tumor cells with nuclear p53 expression (85%) in the areas with minimal differentiation and sarcomatoid elements (Grade III). These signs can serve as criteria for the aggressive behavior of the tumor. A large volume of the sarcomatoid carcinoma component and a strong reaction with VEGF-A are indications for targeted therapy with anti-VEGF drugs.

Тo compare morphological changes and results of immunohistochemical (IHC) identification of viruses (polyomaviruses, adenoviruses, and herpesviruses) in the biopsy specimens with their clinical manifestations in recipients of renal transplants.Morphological and IHC studies were conducted using 71 needle renal transplant biopsy specimens from patients in the study group and 10 renal biopsy specimens from those in the control group. A number of clinical indicators were estimated.IHC examination revealed the expression of adenoviral antigens more commonly in patients with posttransplant nephritis than in recipients without nephritis or in control individuals (p<0.05). The association of patient age and time after kidney transplantation with the severity of viral damage was confirmed: graft loss in children occurred within the first months of surgery (p<0.05). Polyomavirus was detected by PCR in patients with the morphological patterns of polyomavirus nephropathy. Determination of HSV-1 and HSV-2 in the biopsy specimens showed no significant associations with morphological changes.By taking into account a variety of factors that influence the development of viral nephritis, morphological and IHC examinations should be combined with evaluation of clinical findings.Цель исследования - сопоставление морфологических изменений и результатов иммуногистохимического (ИГХ) определения вирусов (полиомавирусы, аденовирусы, герпесвирусы) в биоптатах с клиническими проявлениями у реципиентов почечных трансплантатов. Материал и методы. Морфологическое и ИГХ-исследование проведено на материале 71 пункционной биопсии почечных трансплантатов и 10 биоптатах собственных почек пациентов контрольной группы. Оценен ряд клинических показателей. Результаты. При ИГХ-исследовании экспрессия антигенов аденовируса чаще выявлялась у пациентов с посттрансплантационным нефритом, чем у реципиентов без нефрита или в контрольной группе (p<0,05). Подтверждена связь возраста пациентов и сроков после трансплантации почки с тяжестью вирусного поражения: у детей потеря трансплантата наступала в первые месяцы после операции (p<0,05). У пациентов с морфологической картиной полиомавирусной нефропатии выявлен полиомавирус методом ПЦР. Определение HSV-1 и HSV-2 в биоптатах не показало достоверных ассоциаций с морфологическими изменениями. Заключение. Учитывая разнообразие факторов, влияющих на развитие вирусного нефрита, целесообразно сочетать морфологическое и ИГХ-исследование с оценкой клинических данных.

The paper describes cases of disseminated small-cell carcinoma after kidney transplantation from a deceased donor to two patients. Microscopic examination showed that the kidney graft tumor consisted of tightly packed small rounded cells with hyperchromatic nuclei and a narrow cytoplasmic rim with invisible nucleoli. The mitotic index was 25-40/2 mm2. Azzopardi's phenomenon and crush artifact were detected in the tumor. Giant cell and large cell components were 30-40% of the area of sections. Immunohistochemical examination revealed the expression of synaptophysin, chromogranin A, CD56, TTF-1, HMWK, СК7, СК18, and Ki-67 (80% of tumor cells). Histological findings and immunophenotype in both cases led to the conclusion about combined small cell carcinoma with renal graft involvement. Both patients died from tumor dissemination 9 and 11 months after transplantations. In reviewing the literature, the authors found only one such observation.

Due to the development of organ transplantation and its accompanying immunosuppression, recent years have been marked by the higher incidence of opportunistic viral infections that are of considerable importance among posttransplantation complications. A variety of viral infections, the possibility of their concomitant or subtle course, and the ability to cause life-threatening complications in recipients make relevant the description of existing diagnostic methods. The article summarizes the data available in the literature on the etiology, clinical symptoms, and morphological manifestations of viral infections, such as polyomaviruses, adenoviruses, herpesviruses, including HSV-1, HSV-2, cytomegalovirus (CMV), and Epstein-Barr virus. It describes the principles of differential diagnosis of kidney transplant damage caused by these viruses and that with acute cellular and humoral rejection, which plays an important role due to opposite approaches to treating these diseases.

Differences in the functional structure of streptomycete complexes isolated from ecotopes with varying degrees of contamination by heavy metals (HMs) have been revealed using data on the growth kinetics of representatives of the genus Streptomyces in the presence of lead, zinc, and copper ions. Streptomycete complexes isolated from moderately polluted soils (residential areas and garden plots in the city) and highly polluted soils (transport and industrial areas) are enriched in representatives reacting to metal ions (3 mg/L) by an increase in radial growth relative to the complex isolated from the soil of the control site, while the accumulation of biomass in a liquid medium containing 10 mg/L Pb2+ is less intensive in the former complexes than in the latter.