Relevance. Pulmonary lesions of infectious etiology in oncohematological children are common and, in some cases, may be accompanied by a lethal outcome. When pulmonary tissue lesions on the background of hematopoiesis aplasia in the post-chemotherapy period is shown bronchoscopy to determine the genesis of the identified changes.Aim. To determine the diagnostic value of bronchoscopy with BAL in children with oncohematological diseases.Materials and methods. 25 bronchoscopies with BAL were performed on the basis of the endoscopic department of the Research Institute of Pediatric Oncology and Hematology.Results. According to the results of the study in 72% of cases a microbiologic agent was detected. The most frequent pathogens obtained by the results of cultures were Haemophilus parainfluenzae, Streptococcus oralis, Neisseria macacae, Streptococcus peroris and Pseudomonas aeruginosa.Conclusions. Bronchoscopy with BAL in children with blood system tumors is a highly informative method of pathogen detection and determination of the etiological cause of infiltrative-inflammatory changes in the lungs.

Background. Melanoma of the skin is characterized by a rapid progression and early metastasis. It has been shown the disseminated tumor cells, which are often found in the bone marrow, has an important prognostic value. The study of disseminated tumor cells in melanoma might be one of the possible additional sources of information about the nature of the disease and potential application points for drug therapy. Aim. To study the frequency of detection of disseminated tumor cells in the bone marrow in melanoma, depending on the clinical and morphological characteristics of the tumor. Materials and methods. The study included 67 patients with a verified diagnosis of melanoma who were examined and treated at the Blokhin National Medical Research Center of Oncology from 2014 to 2019 years. Male patients accounted for 50.7% (n=34), female patients 49.3% (n=33). The average age of patients: 50.11.6 years. Immunological and morphological examination of the bone marrow were perfomed. Morphological examination was performed by two independent morphologists. Disseminated tumor cells were evaluated by flow cytometry among all nucleated cells (Syto41+) based on the expression of the HMB-45 antigen and the absence of expression of the CD45 panleukocyte antigen (FACS Canto II, USA, Kaluza Analysis v2.1). Statistical data processing was performed using the IBM-SPSS Statistics v.21 Results. Morphologically bone marrow damage was not detected in any case. Disseminated tumor cells (CD45-HMB-45+) in the bone marrow of melanoma patients were detected in 62.7% (n=42) of cases by flow cytometry. The frequency of bone marrow damage in the early stages is not lower than in advanced ones (p=0.029). This is clearly seen in the enlarged analysis. The percentage of DTC detection. At stages I and II was 60.0% (6/10) and 84.6% (11/13), respectively, at stages III and IV 44.4% (8/18) and 65.4% (17/26). In addition, the frequency of detection of disseminated tumor cells in the bone marrow was higher in young patients (p=0.02). There was no correlation between the frequency of bone marrow damage depending on BRAF status. Conclusion. The connection of disseminated tumor cells with the clinical and morphological characteristics of the melanoma has been established. Melanoma is characterized by frequent bone marrow damage, even in the early stages, in young patients.

Aim. To determine the diagnostic value of endosonography in primary and secondary esophageal tumors. Materials and methods. Between 2018 and 2022, 118 patients with primary and secondary esophageal changes were managed at the Blokhin National Medical Research Center for Oncology. Primary changes imply invasion of the esophagus directly by a tumor, secondary changes mean invasion of the esophageal wall by a tumor from outside, and the transition of a tumor from the stomach to the esophagus. Results. All patients had esophagogastroduodenoscopy combined with endoscopic ultrasound performed. Besides estimating the tumor invasion depth in the esophageal wall and the possible involvement of other structures at a distance up to 5 cm from the esophagus, the proximal margin of the tumor was examined. According to esophagogastroduodenoscopy and endoscopic ultrasound examination, the difference in the proximal margin was not more than 1.0 cm. The difference in results may be due to the submucosal nature of tumor growth. Conclusion. Endoscopic ultrasound examination is the most important diagnostic method to determine the proximal margin of the primary and secondary esophageal tumors and evaluate the degree of invasion into the esophageal wall, which is an essential factor for the treatment choice.

Introduction. Malignant central airway obstruction and malignant tracheoesophageal fistula in the context of tumor development are potentially life-threatening conditions which usually require immediate intervention. Airway stenting is one of the safest and most effective methods of airway patency restoration in patients with malignant obstruction of the central airways and restoration of continuity in patients with malignant tracheoesophageal fistula.Aim. To evaluate the significance of self-expandable metal stents in palliative treatment of patients with malignant central airway obstruction and malignant tracheoesophageal fistula.Materials and methods. Between 2017 and 2021 at the N. N. Blokhin National Medical Research Center of Oncology, 55 patients were observed and treated and underwent trachea stenting per the results of bronchoscopy in combination with esophagogastroduodenoscopy. The 1st group included 25 patients with malignant tracheoesophageal fistulas, the 2nd group included 30 patients with malignant central airway obstruction.Results. In the 1st group, stenting was successful in 25 (100 %) cases which allowed to adequately seal the fistula. Stent migration was observed in 1 (4 %) patient with tracheoesophageal fistula in the context of stenosing cancer of the thoracic esophagus. In the 2nd group, stenting was successful in 30 (100 %) cases. Stent migration was not observed in this patient group. In both groups, there were no complications after stent implantation. Installation of tracheal stent allowed to improve patients’ quality of life and provide a possibility for successful special treatment through low-trauma manipulation.Conclusion. According to the obtained data, endoscopic trachea stenting is the most important method of palliative treatment of tumor-related trachea lesions with development of tracheoesophageal fistulas, malignant central airway obstructions and associated sub- and decompensated pulmonary insufficiency.

Introduction. Melanoma is a malignant tumor that develops from melanocytes, has a high malignant potential and is characterized by early and aggressive metastasis. Just like with many other malignant neoplasms, melanoma can be clinically manifested by metastases in the absence of a primary focus. In the world and in Russia, there has been a steady increase in the incidence of melanoma over the past thirty years. Identifiation of the primary focus with an established diagnosis of metastases of a malignant tumor during life occurs no more than 25 % of cases. Even at autopsy, the primary focus is found on average in 15–20 % of patients, subject to a complete examination of the patient during his lifetime. The prognostic value of identifying the primary focus in melanoma remains unclear.Objective. To improve the diagnosis and treatment of patients with melanoma metastases without an identifid primary focus by assessing the signifiance of various factors, including the fact that the primary tumor was detected.Materials and methods. Since 2005 to 2019 at the National Medical Research Centre of Oncology n. a. N. N. Blokhin (Moscow, Russia) 196 patients with metastases of melanoma in the lymph nodes were observed and treated. Patient medical history were analyzed retrospectively and prospectively. All patients were followed up on an ambulatory after treatment. The inflence of the main clinical and morphological characteristics on the survival rates of patients was assessed. Patients with a morphologically confimed diagnosis of melanoma metastases in