Hepatocellular carcinoma (HCC) accounts for 75% to 95% of all cases of primary liver cancer. The number of cases of newly diagnosed hepatocellular cancer (HCC) in the Russian Federation in 2019 accounted to 9324. Currently, the method of transarterial chemoembolization (TACE) is widely used for the treatment of patients with malignant liver tumors. Various methods of transarterial embolization of the liver are used, including selective or superselective catheterization and the use of various chemotherapeutic and embolizing agents. In recent years, calibrated synthetic microspheres loaded with a chemotherapeutic agent have been developed. They ensure uniform and prolonged release of the drug and the achievement of high concentrations of the chemotherapeutic agent in tumor cells. The method of transarterial embolization of the liver using grains containing the drug is known as DEB‑TACE (Drug‑eluting bead transarterial chemoembolization). The traditional TACE (conventional transarterial chemoembolization), technique is also widely used, in which a chemotherapeutic drug is administered together with lipiodol, and then with occlusive material. When comparing the techniques, no differences were found in their safety profiles. Despite the fact that transarterial embolization of the liver is considered a safe procedure, it is not without the risk of complications, the most common of which are acute cholecystitis and leukopenia. Also, a frequent undesirable phenomenon after transarterial chemoembolization of the liver is postembolization syndrome, which includes abdominal pain, hyperthermia up to 38 ° C and nausea. One of the rare complications occurring in less than 1% of cases is a complication of liver TACE – the development of a liver abscess against the background of tumor necrosis. It is believed that the formation of an abscess can lead to the formation of fistulas: hepaticobronchial, hepaticoduodenal, hepaticogastric, etc. Our article presents a rare clinical case of hepatogastric fistula formation after liver TACE.
Inflammatory myofibroblastic tumors (inflammatory myofibroblastic tumors) IMT in the clinical practice of an oncologist are very rare diagnostic findings. Currently, the bulk of scientific publications about IMT are devoted to reviews of clinical cases. If initially IMT were considered as pseudo-tumors, now they are classified as intermediate fibroblastic/myofibroblastic tumors according to the WHO histological classification. Management of patients with hepatic IMT are debatable today. Hepatic IMT are mostly benign lesions and characterized by spontaneous regression without any treatment. However, sometimes therapeutic and surgical treatment of these lesions is necessary. Many authors recommend surgical treatment, as with conservative treatment, some patients develop relapses. This rare observation demonstrates our experience of liver resection for inflammatory myofibroblastic liver tumor in 76 year-old patient.
According to GLOBOCAN, there were about 18 million new cases of cancer and 9.6 million deaths from malignancies worldwide in 2018. Renal cell carcinoma is a malignant tumor characterized by the loss of the VHL gene, which leads to increased angiogenesis. The potential of immuno-oncology and anti-angiogenic drugs has significantly improved outcomes for patients with metastatic renal cell carcinoma. The phase III CheckMate 9ER study compared the efficacy and safety of nivolumab plus cabozantinib versus sunitinib in the first-line treatment of patients with metastatic clear cell renal cell carcinoma. The advantages of nivolumab plus cabozantinib over sunitinib in terms of progression-free survival, overall survival, and objective response rate were generally similar across subgroups based on IMDC risk, PD-L1 expression, and the presence or absence of bone metastases. We present a case report of metastatic renal cell carcinoma. The patient has been on cabozantinib plus nivolumab therapy for 12 months, with a partial response achieved. Treatment was well tolerated; the profile of adverse events was consistent with that in the clinical study.
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