ObjectiveTumors arising in BRCA1/2 mutation carriers are characterized by increased platinum sensitivity; however, it is unknown whether this feature should be considered while choosing between primary surgical versus systemic treatment. This study aimed to compare outcomes of ovarian cancer patients undergoing either primary surgery or interval cytoreduction based on BRCA1/2 status.MethodsThe study included consecutive ovarian cancer patients, who were treated at the N.N. Petrov Institute of Oncology (St Petersburg, Russia) from 2000 to 2013 and who underwent complete or optimal cytoreductive surgery. A comparison of disease outcomes was performed for the total group of ovarian cancer patients as well as for 69 BRCA1-mutated and 151 sporadic high-grade serous advanced-stage ovarian carcinomas. Frequency comparisons were performed by Chi-square test or Fisher exact test. Disease-free interval and overall survival were analyzed by Mann-Whitney U-test and Kaplan-Meier method. Hazard ratios were calculated by Cox regression analysis.ResultsThe analysis included 283 consecutive patients who underwent optimal cytoreduction (size of residual tumor <1 cm (n=156)) or complete tumor excision (n=127) on primary surgery (n=168) or after neoadjuvant chemotherapy (n=115). 84 patients carried germline mutation in BRCA1 (n=77) or BRCA2 (n=7) genes, while 199 ovarian cancer patients were classified as sporadic. High-grade serous ovarian cancer patients treated with neoadjuvant chemotherapy had a lower disease-free interval compared with those undergoing primary surgery followed by adjuvant therapy (7.8 vs 14.2 months, p<0.001). This difference was attributed mainly to sporadic cases (5.1 vs 12.2 months, p<0.001), while BRCA1-associated cancers had a similar disease-free interval regardless of the sequence of treatments (12.5 vs 15.8 months, p=0.53). When treated with neoadjuvant chemotherapy, BRCA1-mutated patients had improved overall survival as compared with sporadic cases (45.7 vs 25.3 months, p=0.007), while patients subjected to primary surgery showed similar overall survival irrespective of BRCA1 status (54.6 vs 53.9 months, p=0.56). A total of 29/61 (48%) BRCA1/2-associated patients relapsed as a single local tumor; this was lower in sporadic cancer patients (38/134 (28%); p=0.01).ConclusionIn BRCA1 mutation carriers, the oncologic outcomes are similar when comparing primary surgery versus neoadjuvant chemotherapy. In addition, BRCA1-mutation carriers often have a single site of disease when diagnosed with recurrent ovarian cancer.

Are submitted the data about typical and atypical options of a trunk Genle, to his arhitectonics, topography, existing classifications, morphometric characteristics and cclinical value of anatomic features. It shown, that the anatomy of a trunk of Genle and his inflows has the expressed variability, and practically it isn’t described in Russian-speaking literature. Appreciable number of various options of formation of a trunk of Genle, various frequency of occurrence of these options, morphometric indicators, apparently, depends on the size of selection of the studied objects, a sex and other reasons. Classification is created, reflecting results of a research, and presenting data in foreign literature. It reveal, that, despite a large number of the described versions of the description of this anatomical structure, there is no uniform idea of the veins forming this trunk. Nosological examples are analyzed, showing need of control of options of formation of a trunk of Genle and his morphometric features at expeditious and diagnostic manipulations on organs and vessels of a peritoneal cavity. Without comprehension arhitectonics of roots and inflows of a portal vein, there is a great risk of a surgical mistake which can lead to lethal complications. In general, cases in point are important for surgical practice, in particular, for abdominal surgery and an onkokhirurgiya.

To study the role of retroperitoneal lymphadenectomy in epithelial ovarian cancer (OC) the work was divided into two parts. In the first part for a retrospective analysis 852 patients with stage I-IV OC, who were treated from January 2000 to January 2014, were selected to investigate the localization of the first relapse of the disease. In the second part, prospective from August 2016 to April 2017, in 28 patients with stage I-IV OC the surgical stage of the combined treatment was supplemented by iliac-pelvic and para-aortic lymphadenectomy; in this group the results of surgical staging were studied. The incidence of isolated recurrence in para-aortic lymph nodes in the group of early OC was 3/28 (11%), in pelvic 2/28 (7%), whereas in the group of advanced OC - in para-aortic lymph nodes 9/24 (37%), in iliac-pelvic 10/24 (42%), combined in pelvic and para-aortic lymph nodes 5/24 (21%). In the prospective group the lesion of pelvic and para-aortic lymph nodes was observed in 2/28 (7%) of patients with the presumed I stage of the disease and in 2/28 (7%) with the presumed stage II, which resulted in re-staging of the disease. In 2 cases the clinical IA and IB stages were re-staged to IIIA and this required 6 courses of chemotherapy. In 2/28 (7%) patients metastases to para-aortic lymph nodes were detected in the absence of pelvic lesions.

Background: Schwannoma is an extremely rare non-epithelial tumor of the pancreas. Less than 50 cases of pancreatic schwannoma have been described in the literature over the past thirty years and only few cases report has described its findings on Fine-Needle Aspiration (FNA). Preoperative diagnosis of pancreatic schwannoma can be particularly challenging. Pancreatic schwannomas may mimic other, more common pancreatic lesions, such as cystic neoplasms, solid neoplasms, neuroendocrine tumors. Cytomorphological verification of the diagnosis is difficult due to the similarity of Schwannomas with other non-epithelial tumors from spindle cells. Therefore, pancreatic schwannomas have a very high rate of misdiagnosis. Objective: demonstration preoperative diagnosis and treatment of a rare pancreatic tumor. Materials and methods: Here we present a case of preoperative cytomorphological diagnosis of pancreatic schwannoma in a 58-year-old man. During magnetic resonance imaging, computed tomography and endosonography (EUS), the patient was diagnosed the tumor in the head of the pancreas with a diameter of up to 7 cm. For morphological verification of the process, a fine needle aspiration puncture of the formation was performed under EUS control. Diagnosis of pancreatic schwannoma was established by cytomorphological examination of cell block material using immunocytochemical method. Conclusion: the analysis of the result of cytomorphological diagnosis of pancreatic schwannoma is presented.

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