Background Thymomas are very rare malignances, with an estimated incidence of 0.15 cases per 100.000. Metastases of Thymoma are usually involved the pleura, pericardium or diaphragm, whereas the probability of extrathoracic metastases are extremely low. Success in the treatment of thymomas mainly depends on the radicalism of the performed operation. Materials and methods Since 2008 33 Thoracoscopic Thymectomies were performed in the thoracic department of the N.N.Blokhin Russian Cancer Research Center. The right-sided approach was in 23 (69,7%) patients, 7 (21,2%) operated on the left and 3 (9,1%) patients had combined approach. We include 26 patients with similar characteristics of the primary tumor operated from sternotomy approach to compare direct and long-term results of surgical treatment. Results Thoracoscopic approach in comparison with sternotomy in surgical treatment of non-invasive Thymomas significantly reduces the incidence of postoperative therapeutic complications (p < 0.01). There was a decrease in the frequency of postoperative surgical complications (p = 0.08). Conclusion Thoracoscopic thymectomy in comparison with thymectomy from open surgical approach contributes to a significant decrease in the length of patients' stay in the intensive care unit and hospital, and the duration of analgesia with narcotic analgesics in the postoperative period. All of the above factors contribute to shorter periods of functional recovery of patients and a full return to a normal lifestyle.

Aim. The study objective is studying the possibility of endosonography in the diagnosis of tumor and pretumor pathology of the larynx, oropharynx and laryngopharynx. Materials and methods. Endosonographic study was conducted in 20 patients with tumors and suspected tumors of the larynx, laryngopharynx and oropharynx. Results. The use of endoscopic ultrasound (EUS) method was useful and important in determining the thickness and structure of the tumor, with hyperplasia of the lingual and palatine tonsils. Endosonographic picture of fibrous changes after surgery and post-radiation changes, lack of blood flow in the fibrous tissue and blurred contours gave additional information in the differential diagnosis of tumor and non-tumor changes. The results of the ultrasound examination performed in the standard B-mode for the presence of tumors, cysts and formations, suspicious of the tumor of the submucosal layer of the oropharynx and larynx, which were not determined by endoscopic examination, were confirmed. Conclusion. Obtaining a sonographic image simultaneously with endoscopic examination of the formations in the submucosal layer of the oropharynx and larynx will shorten the diagnostic algorithm of the study in patients with pathological changes in this area. The use of endosonography made it possible to confirm the data obtained by ultrasound examination in B-mode and which were not confirmed by endoscopic examination.

Objective: to determine the possibilities of contrast-enhanced ultrasound (CEUS) in identifying and evaluating the efficiency of chemotherapy in patients with colorectal liver metastases (CLM).Material and methods. The investigation enrolled 28 patients with CLM. The patients were divided into two groups: Group 1 – 15 pretreatment patients; Group 2 – 13 posttreatment patients with process stabilization. All the patients underwent standard B-mode ultrasound of the liver and that using the contrast agent SonoVue ® (Bracco, Italy), by recording and estimating the parameters of the intensity-time curve (CIV). Liver CEUS assesses the nature of contrasting metastases in three phases (arterial, venous, and delay ones).Results. The investigators identified three types of contrast agent accumulation in CLM in the arterial phase: along the periphery of the lesions (in 60% of the patients of Group 1, in 76.9% in Group 2), homogeneously over the entire volume (in 26.7% in Group 1 and in 0.08% in Group 2), in parallel with intact liver parenchyma (13.3% in Group 1 and 23.02% in Group 2). In the delay phase, more metastases were detected in 4 cases (14.3%). Estimation of CIV parameters showed a difference at the beginning of contrast enhancement stages between the patients in both groups. Group 1 exhibited the early contrasting of liver metastases (19.3 sec); Group 2 displayed the late washout of a contrast agent (65.9 sec).Conclusion. CEUS versus B-mode ultrasound improves the imaging of liver metastases. The change in the vascular architectonics and hemodynamics in CLM after chemotherapy is reflected in the alteration of the rate of contrast accumulation and washout from the metastases, which allows CEUS to be used in the evaluation of the efficiency of this treatment.

Objective: to evaluate the possibilities of ultrasound elastography for differentiation of reactive and lymphomatous superficial lymph nodes (LN).Materials and methods. The prospective study included 138 patients with enlarged superficial LN. Based on a previous histological examination, patients were divided into two groups: 1st group (n = 108) – patients with non-Hodgkin’s lymphomas and Hodgkin’s lymphoma; 2nd (n = 30) – patients with reactive (inflammatory) changes in superficial LN. All patients underwent ultrasound elastography of the enlarged LN using ARFI technology.Results. According to the results of ultrasound elastography, the average, minimum, and maximum shear wave velocities for enlarged LN in lymphoma (1st group) were 2.616 ± 0.684; 1.980 ± 0.557 and 3.351 ± 0.987 m / s, respectively; for LN with reactive changes (2nd group) – 1.704 ± 0.223; 1.414 ± 0.209 and 2.027 ± 0.261 m / s, respectively. Thus, the average, minimum, and maximum values of shear wave velocities significantly different between the groups (p ˂0.001). The cut off values of the average shear wave velocity in the differential diagnosis of lymphoma and hyperplasia are determined at the level of 2.05 m / s, with a sensitivity of 88.5 %, specificity of 100 %, and AUC of 0.942 (p ˂0.001).Conclusion. Ultrasound elastography demonstrated statistically significant differences in shear wave velocity in the enlarged superficial LN in lymphoma and in inflammatory processes that can be used as a preliminary non-invasive differential diagnosis of enlarged superficial LN in these conditions.

The study objective is to assess the capabilities of ultrasonography in the diagnosis of oropharyngeal squamous cell carcinomas and in the evaluation of treatment efficacy (changes in tumor volume).Materials and methods. This study included 98 patients (27 (27.5 %) females and 71 (72.5 %) males aged between 20 and 78 years with oropharyngeal tumors; of them, 12 (12.2 %) patients had recurrent tumors. Sixty-seven (68.4 %) participants had their tumors located in the tonsils; 31 (31.6 %) patients had tumors of the root of the tongue; 47 (48.0 %) patients presented with tumors invading adjacent tissues; 57 (58.2 %) patients had their lymph nodes involved. Thirty-two patients were operated at the first stage of treatment, whereas 66 (67.3 %) individuals received induction chemotherapy followed by sequential chemoradiotherapy. Treatment efficacy was evaluated 2 weeks following the completion of the second course of induction chemotherapy. We assessed tumor volume, its structure, type and intensity of vascularization, and the number and size of lymph nodes affected by metastasis. Ultrasonography findings were compared with the results of fibroscopy, X-ray computed tomography (CT) and magnetic resonance imaging (MRI) performed 2 weeks following the completion of the second course of induction chemotherapy (no later than 7–10 days).Results. The disagreement between histology and ultrasonography findings reflecting tumor volume (of either newly diagnosed or recurrent tumor) was statistically insignificant. The results of X-ray CT were more likely to be in agreement with histology than the ultrasonography results (85.0 % vs 70.0 %); however, this difference was not statistically significant. Data of X-ray CT and ultrasonography on the tumor volume demonstrated no significant difference between them. MRI and ultrasonography findings on the tumor volume were consistent in 50 % of cases. We identified the most common changes in the structure of the oropharyngeal tumors typical of positive and negative dynamics after 2 courses of induction chemotherapy. Patients with positive dynamics demonstrated a significant decrease in tumor volume detected by all diagnostic methods used (ultrasonography, X-ray CT, and MRI). There was a significant negative correlation between the efficacy of treatment assessed by ultrasonography and the grade of therapeutic pathomorphosis assessed by histology (r = –0.69; р = 0.0014).Conclusion. The accuracy of ultrasonography for the estimation of oropharyngeal tumor volume and its spread is comparable with that of X-ray CT and MRI. The disagreement between these methods was statistically insignificant. Ultrasonography is a more sensitive method for the evaluation of patient response to treatment than clinical data.