Journal of Modern Oncology

Background. Anemia is a common complication in patients with colorectal cancer (CRC), affecting 30–67% of patients, depending on the stage and location of the tumor. Anemia, blood loss as well as allogenic hemotransfusion all worsen immediate and long-term outcomes for the patients.

Aim. To analyze the effectiveness of patient blood management (PBM) in patients with II–III stage CRC undergoing elective surgery.

Materials and methods. We analyzed in a prospective way the results of surgical treatment in 100 stage II–III CRC patients with iron-deficient anemia who underwent surgical treatment in Moscow State Budgetary Healthcare Institution “Oncological Center No. 1 of Moscow City Hospital named after S.S. Yudin, Moscow Healthcare Department” in 2022–2023. PBM included out-patient anemia correction with ferric carboxymaltosate, intraoperative blood loss minimization as well as smaller volume of postoperative blood control and more definitive indications for blood transfusion. Control group was retrospective and included 100 patients with anemia and stage II–III CRC who underwent surgery in 2019–2021 without anemia correction and other PBM interventions.

Results. The groups were comparable according to patient sex, body mass index, tumor location, the extent of surgery. However, patients in the control group were younger and less morbid. There were no adverse reactions after ferric carboxymaltosate infusion. Mean hemoglobin before correction was 91.2±10.1 g/l and 121±17 g/l before surgery (р<0.001). The use of PBM significantly reduced the intraoperative blood loss volume (66 vs 112 ml, р<0.0001) as well as the incidence of severe postoperative complications (OR 0.36, 95% CI 0.19–0.68; p<0.001). In particular, patients in the study group had a lower incidence of anastomotic leakage (0 vs 8; p<0.001) and wounds infections/eventrations (3 vs 10; p<0.001).

Conclusion. The use of PBM in patients with CRC and anemia has a potential to reduce the number of postoperative 

The use of anti-HER2 therapy has dramatically changed the prognosis of patients with HER2+ breast cancer both in the early and advanced stages. New options that demonstrate the effectiveness of treatment of patients with HER2+ breast cancer can significantly increase the median progression-free survival and the overall frequency of objective response, the duration of this response. Some of them are still approved only in the first-line treatment of the metastatic form, either neo- or adjuvant regimens (for example, pertuzumab). At the same time, the antitumor conjugates being created, such as T-DM1 or T-DxD, have a common link in their structure – the monoclonal base antibody trastuzumab. Despite all the success of this class of drugs, progression occurs at a certain stage in these patients, and it is trastuzumab in combination with various chemotherapeutic regimens and/or drugs of other classes that remains the standard of late-line therapy and ensures the prolongation of patients' lives.

Background. Secondary hyoid tumors are extremely rare. There are few documented reports of metastases into hyoid in patients with distant localizations of malignancies, such as breast, lung, kidney, liver, and sigmoid colon cancers. The article describes a rare case of metastases of advanced gastric cancer to the hyoid bone.

Aim. To present a clinical case of isolated metastatic lesion of the hyoid bone in a patient with primary advanced gastric cancer, demonstrating the possibility of increasing the duration and quality of life using polychemotherapy.

Results. A 54-year-old male with synchronous pain in the throat and epigastrium when swallowing solid food and weight loss underwent esophagogastroduodenoscopy, which showed a defect in the mucosa along a small curvature in the middle third of the stomach. Histological examination showed colloid cancer. Combined positron-emission and X-ray computed tomography (PET/CT) with ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) revealed a gastric tumor with radiopharmaceutical hyper uptake, serous membrane invasion and involvement of paragastric, celiac, retroperitoneal, and mediastinal lymph nodes. The entire hyoid bone was swollen with fragmentary cortex destruction. Stage IV gastric cancer cT4bN3аM1 was diagnosed with metastases to the hyoid bone, mediastinal, and retroperitoneal lymph nodes. The patient received eight cycles of polychemotherapy with the XELOX regimen and reported the resolution of sore throat and epigastric pain. The results of PET/CT with ¹⁸F-FDG showed sclerosis of the cortical layer of the hyoid bone and no abnormal radiopharmaceutical uptake. The patient has been alive for 13 months.

Conclusion. Hypoglossal bone metastases are extremely rare in patients with advanced colloid cancer. Such case was described for the first time. The method of choice for diagnosing and assessing the extent of the tumor is PET/CT with ¹⁸F-FDG. Palliative polychemotherapy can increase the duration and improve the quality of life.

Background. Adrenal ectopy is a congenital anomaly of the endocrine system. It occurs in less than 1% of the adult population. Ectopy lesions consist mainly of cortex and a minimal amount of medulla. Ectopic adenomas of the adrenal cortex are small, non-functional, asymptomatic, and usually found incidentally. They are found in the kidney only in 0.1–0.6% of observations.

Aim. To present a rare case of non-functioning ectopic adrenocortical adenoma in the renal sinus.

Results. A 56-year-old man underwent a routine medical examination, and an ultrasound showed a tumor in the renal sinus. According to X-ray computerized and contrast-enhanced magnetic resonance imaging (MRI), a soft tissue vascularized mass in the renal sinus on the right was found, 29×15×20 mm in size. The density on the Hounsfield scale was +15HU with heterogeneous contrast uptake (up to +75HU), and the mass was closely adjacent to the renal artery and vein. No abnormalities were detected in the adrenal glands. According to MRI, the tumor had a heterogeneous structure with a signal reduction in T2 mode with diffusion restriction. Morphological verification was impossible due to anatomical features. A nephrectomy was performed for suspected renal cell carcinoma of the renal hilum. In pathohistological examination, the tumor was represented by light and eosinophilic cells; immunohistochemistry revealed a pronounced expression of SF1, Melan A, and CYP11B2 biomarkers. Ectopic cortical adrenal adenoma in the renal sinus was diagnosed. The patient was examined in 3 months, and no recurrence or functional activity was detected.

Conclusion. Ectopic adrenocortical adenoma in the renal sinus is extremely rare and usually non-functional. X-ray computed tomography and MRI are sensitive methods for localizing ectopic adrenal tumors. The density value of the mass in the native mode of 10–20 HU indicates a high intracellular lipid content. A surgical method is recommended for the treatment of functional and non-functional adenomas. The final diagnosis is established by histological and immunohistochemical examinations.

The advances in the treatment of patients with germ cell tumors enable long-term follow-up for the recovered patients and determine the probability of mature teratoma recurrence and relapses. This complication is referred to as growing teratoma syndrome. Studies have shown that the risk of recurrence is high and depends on the timeliness and extent of surgery. The key to successful treatment is the awareness of doctors and patients about this disease, regular and thorough examinations, the inclusion of computed tomography in the examination plan, early diagnosis of the syndrome and the identifying a paradoxical response to chemotherapy, timely and complete surgical removal of a germ cell tumor.