a b s t r a c tBackground: Nowadays multiple primary tumor is characterized by growth and development of two or more tumors in one patient. The total world sickness rate ranges from 1% to 37%. The presence of four or more tumors in one patient is rare case and presented as casuistry. Case presentation: We showed a case of multiple primary tumor with metahronic lesion of the thyroid, uterus and breast, followed by synchronous benign tumors of the subcutaneous fat, urinary bladder and gallbladder were considered. The development of all malignant tumors in all cases was accompanied by the presence of benign precancerous processes. Analysis of neoplasia histology shows the predominance of poorly differentiated forms of cancers in women with increased aggressiveness of cancerous tissue in each subsequent case and the growth of metastatic ability. The influence of heredity on the tumors progress is confirmed by immunohistochemical characteristics of cancer cells. Steroid-sensitive tissue of the uterus and breast in both cases didn't express ER and PR, in all cases the tissue had overexpression of Ki-67, p53, bax and bcl-2 receptors. The results of DNA testing for determination the Lynch syndrome revealed the presence of microsatellite instability in genetic material. The results of studies revealed the absence of mutations in these genes (MLH1, MSH2 and MSH6). Despite the negative results of the study, it doesn't exclude the possibility of Lynch syndrome for 100%, and its presence may be caused by the mutations of other genes (PMS1, PMS2 and MLH3), responsible for DNA repair. Unfortunately there wasn't any opportunity to study their mutations. Conclusions: While studying the anamnesis of life and disease of women it was revealed that she had multiple primary tumor with lesions of the breast, urinary bladder, thyroid, uterus and other organs. This study shows that neoplastic tissue in all cases had high rates of cell proliferation, their antiapoptotic stability, expression of prognostically unfavorable-receptors, and absence of favorable prognostic markers. Histological study revealed high rates of malignant neoplastic tissue. It indicates to the existence of common mechanisms of malignant tumors and their genetic predisposition that can be clearly observed in many generations of patient.

Peculiarities of differential diagnosis of benign pulmonary tumors and its significance for the surgical tactics choosing

Lung cancer is one of the main causes of death from malignant neoplasm all around the world. For the purpose of personalized treatment immunohistochemical determination of specific proteins (biomarkers) presence in tissues and biological fluids is needed. Today management of patients with lung cancer is directly associated with determination of genes mutations: EGFR, ALK, ROS1 and rate of PD-L1 receptors expression. Depending on the PD-L1 expression level blockers of these receptors can be used as the first, supportive and second / third line therapy. As the first line of therapy for patients with high expression level of PD-L1 (≥ 50 % TPS) Pemblizomab is recommended, while for patients with moderate levels (PD-L1 1 – 49% TPS) PD-L1 blockers can be used only as a second / third line of therapy. In numerous clinical trials efficiency and safety of Pemrolizumab, Nivolumab and Atezolizumab have been proved. Testing of Avelumab, Durvalumab, as well as combined drugs – Ipilimumab and Tremilimumb are still going on.

Lung cancer is one of the major causes of death from malignancies. That is why the article devoted to the issue early diagnosis of lung cancer. The objective of the work is to consider the features and prospects of using the most modern methods of diagnosis of lung cancer. The introduction of the latest technologies is essential for quality screening of lung cancer patients. Gradually, there is a growing interest in developing strategies around the world to better assess the risk of human lung cancer, increase screening sensitivity, and reduce costs. The methods of early detection of lung cancer are described in the article: determination of the concentration of volatile organic compounds (LuCID method), endobronchial ultrasound (EBUS method), FISH-marker method, basic principles of the Nano-Nose device. Despite some advances in our country in the diagnosis of lung cancer using common advanced methods of computed tomography and biopsy, the introduction of foreign experience in lung cancer screening is necessary, because the current state-of-the-art methods of diagnosis allow to detect cancer.