Comparative Analysis of Blood Plasma Proteome in Patients with Renal Cell Carcinoma

Comparative mass spectrometric analysis of protein composition was carried out in 36 blood plasma specimens from patients with renal cell carcinoma and 20 specimens from donors. Analysis of protein composition of plasma specimens devoid of the major protein fractions showed a 20-50% higher level of protein identifications in patient' specimens. Specimens of the control and experimental series were similar by protein composition, 70-80% identifications in experimental and control series coinciding. High similarity of biological processes with participation of the proteins identified in both series was observed. The greater part of proteins in both series were located extracellularly and were exosomal (specimens from renal cancer patients) or vesicular (specimens from healthy volunteers).

[Morphological features of IgG4-related lesions at various sites]

OBJECTIVE

To determine the morphological features of IgG4-related lesions and to improve pathomorphological criteria for diagnosing various clinical variants of IgG4-related disease.

MATERIAL AND METHODS

Biopsy and surgical materials from 100 patients with tumor-like lesions at various sites (63 cases of IgG4-related lesion and 37 cases of non-IgG4-related inflammatory processes) were studied. Histological and immunohistochemical studies were conducted to determine the absolute counts of CD138+ cells, IgG+ and IgG4+ in the inflammatory infiltrates, as well as IgG4/IgG and IgG4/CD138 cell ratios.

RESULTS

When IgG4-related disease manifested, pancreatic, lacrimal, and salivary gland lesions prevailed. Brisk lymphoplasmacytic infiltration is characteristic for tissue damage in the eye, salivary glands, thyroid, pancreas, and skin. The formation of moiré fibrosis was specific to damages to the pancreas, liver and bile ducts, and eye tissues. Obliterative phlebitis is most often observed in pancreatic and salivary gland lesions. According to international criteria, the frequency of achieving the required level of IgG4+ plasma cells in each organ was high in lesions of the pancreas, bile ducts, and lymph nodes and that was low in lesions of the salivary and lacrimal glands and skin. The IgG4+/CD138+ and IgG4+/IgG+ cell ratios exceeded 40% in all cases.

CONCLUSION

The morphologic diagnosis of IgG4-related disease is based on the detection of lymphoplasmacytic infiltration, moiré fibrosis, and obliterative phlebitis, as well as on the calculation of the absolute number of IgG4+ plasma cells in the inflammatory infiltrate and on the determination of IgG4+/IgG+ and IgG4+/CD138+ cell ratios. The number of IgG4+ plasma cells depends on the location of the lesion and on the phase of the process.

[Clinical and morphological characteristics of parathyroid carcinoma]

Parathyroid carcinoma (PTC) is a rare malignant tumor with the clinical manifestation of hyperparathyroidism, reliable morphological signs of invasive growth, and poor clinical prognosis. The differential diagnosis of PTC due to the rarity of this pathology, not always explicit morphological criteria, and the lack of a certain immunohistochemical panel is complex and needs further clarification. The paper summarizes an update on the clinical and morphological characteristics of PTC.

[A case of cutaneous protothecosis]

The paper describes a case of a rare opportunistic infection, such as skin lesion caused by achlorophyllic unicellular algae of the genus Prototheca. It provides a detailed pathologic description of the foci of cutaneous protothecosis, such as pandermal inflammatory infiltrate, granulomas, pseudoepitheliomatous hyperplasia, and intraepidermal abscesses. Criteria for pathogen detection in histological sections are given.

[The growth factor of endothelium of vessels and its receptors type I and II in blood serum in patients with kidney cancer: clinical morphological correlations.]

The progress in treatment of kidney cancer is related to application of anti-angiogenic medications. Therefore, investigation and searching for new molecular markers characterizing its angiogenic activity is actual still. The purpose of study is to compare VEGF, VEGFR1 and VEGFR2 in blood serum of healthy people, patients with cancer and benign tumors of kidney and to analyze their relationship with main clinical morphological characteristics of neoplasms. The study sampling consisted of 94 patients with cancer and 10 patients with benign tumors of kidney. The control group included 80 individuals. The concentration of analyzed proteins was determined using QuantikineТ (R&D Systems, USA), a reagents' kit for direct immune enzyme analysis. The content of VEGF, VEGFR1 and VEGFR2 in blood serum of patients with cancer of kidney was reliably higher than in control group. The level of VEGF also was increased in patients with benign tumors. Under threshold level of VEGF of 365 pg/ml the diagnostic sensitivity of detection of primary cancer of kidney amounted to 67% and specificity - 70%. The stage of disease and T and N indices were correlated only with VEGFR1 level. The relationship between level of markers and histological structure and degree of differentiation of cancer of kidney was not established. Therefore, VEGF and its receptors have a limited diagnostic value under cancer of kidney but they can be applied for monitoring and prognosis of efficiency of anti-angiogenic therapy.

[Gastric cancer concurrent with IgG4-related disease: A clinical case and a review of literature]

The paper presents the data available in the literature on IgG4-related disease (IgG4-RD) concurrent with malignancies at different sites, as well as possible common pathogenetic mechanisms of their development and morphological diagnostic criteria for IgG4-RD. The authors give their own observation of gastric signet ring cell carcinoma concurrent with morphologically verified IgG4-RD.

[Kaposi's sarcoma in the grafted lung]

The paper provides a clinical note. A 45-year-old patient suffered from severe primary emphysema and underwent bilateral lung transplantation. A year after surgery, exercise dyspnea again appeared in the patient. Lung computed tomography revealed multiple rounded soft tissue masses; thoracoscopic biopsy and further histological examination proved the development of Kaposi's sarcoma in the patient. The tumor disappeared completely following corrected immunosuppressive therapy. After 22 months of transplantation, the patient died from gastrointestinal bleeding. This case is of interest due to that Kaposi's sarcoma develops extremely rarely in the allogeneic lung after its transplantation.

[Solid pseudopapillary tumors of the pancreas: clinical and morphological characteristics, specific features of their immunophenotype, and diagnostic problems]

OBJECTIVE

To analyze 60 cases of solid pseudopapillary tumors (SPTs) of the pancreas, to reveal their most characteristic clinical and morphological features, and to study their possible histogenesis.

MATERIAL AND METHODS

Sixty cases of SPTs of the pancreas underwent clinical, morphological, and immunohistochemical (IHC) examinations; a comparison group consisted of 86 pancreatic tumors of other histogenesis.

RESULTS

It has been shown for the first time that SPTs are characterized by the nuclear expression of claudin 3 and the cytoplasmic expression of claudin 7. It has been also ascertained that the aberrant perinuclear (dot-like) expression of CD99 is a unique feature of these tumors.

CONCLUSION

SPTs of the pancreas are distinguished by a diversity of clinical manifestations and morphological features, but have a unique immunophenotype, which can differentiate them from other types of pancreatic tumors.

[The morphological parameters of cell regeneration in gastric carcinomas and their prognostic value]

OBJECTIVE

To make an integrated assessment of the proliferative activity of gastric cancer (GC) (Ki-67 and mitotic index - MI) and the degree of tumor cell apoptosis (apoptotic index - AI), by calculating the cell regeneration coefficient (CRC) in relation to the histological variant and functional immunophenotype (IPT) of a tumor and to determine if there is a possible association of the above indicators with adjusted 4-year relapse-free survival rates.

SUBJECTS AND METHODS

Surgical specimens obtained from 55 patients with CC were examined. The tumors were divided into histological variants in accordance with the International histological classification criteria (WHO, 2010) and into IPT by a set of the produced mucins MUC1, MUC2, MUC5AC, MUC6, and the glycoprotein CD10. MI and AI were estimated from the number of mitoses and apoptotic bodies in the 5-microm-thick hematoxylin- and eosin-stained tumor histological sections; Ki-67 was determined by scoring the number of its immunopositive nuclei per 1000 counted tumor cells at x1000 magnification.

RESULTS

The values of Ki-67, MI, AI, and CRC in GC were found to be significantly related to the tumor histological variant and IPT; and MI, AI and CRC were also associated with adjusted 4-year relapse-free survival rates. The Ki-67 index in the gastric carcinomas is of no prognostic value, which is most likely to be attributable to the inadequacy of this indicator for the estimation of the biological potential of tumors growing in the tissues with constantly regenerative cell populations, which is peculiar to the epithelium of the gastric mucosa, particularly to that of the necks of the glands, which most GCs are histogenetically related to.

CONCLUSION

Thus, the values of MI, AI, and CRC are best used as additional prognostic factors in patients with GC. At the same time, the prognostic value of Ki-67 in GC has been overestimated, as shown by the authors' data.

[Comparative clinical and morphological characteristics of incidental and symptomatic renal cell carcinoma]

Over the last two decades, marked increase in detection of incidental or asymptomatic renal cell carcinoma (RCC) in developed countries was observed. The study included 268 patients aged from 25 to 92 years with RCC, which underwent evaluation and treatment in urology clinic MRSRCI for the past 5 years. There were no significant differences in the frequency of histological types of RCC between incidental and symptomatic tumors. Among incidental neoplasms with clear- cell structure, tumor with small size--up to 4 cm (T1a stage) and moderate to high degree of differentiation (G 1-2 according Fuhrman) were predominant. Papillary variant of RCC was detected at a higher stage of the disease and characterized by a high degree of nuclear atypia, which indicates its high malignant potential. Chromophobe RCC was usually diagnosed at T3 stage. The average age of men and women with chromophobe RCC was 46.5 +/- 6.8 years; there were no age difference in patients with symptomatic and incidental RCC. Among the benign tumors of the kidneys, angiomyolipoma was most commonly diagnosed--in 13 (53.8%) cases. Thus, incidental tumors have a better prognosis than symptomatic tumors.

[Incidental renal cell carcinoma: clinical and morphological features]

This article is devoted to the evaluation of features of incidental, or asymptomatic renal cell carcinoma (RCC). The study included 268 patients with RCC aged 25 to 92 years who underwent examination and treatment in the urological clinic MRSRCI for the last 5 years. 163 (60.8%) patients had incidental renal tumors (Group 1), 105 (39.2%)--symptomatic renal tumors (Group 2). In incidental renal tumors, tumor nodule was smaller compared with symptomatic RCC--5,74 +/- 3.0 vs 6.4 +/- 3.6 cm. Stage I and II disease was diagnosed in 130 (79.7%) patients in Group 1 and only in 69 (65.7%) patients in Group 2 (P < 0.05). No significant differences in the distribution of the degree of nuclear atypia according Fuhrman nuclear grade were identified. The organ preservation surgery were performed more frequently in incidental RCC than in symptomatic RCC, in 47 (28.9%) and 21 (20%) cases, respectively; in addition, regional and distant metastases were diagnosed less frequently. With this in mind, it should be suggested that incidental tumors have a better prognosis than tumors with clinical manifestations.

[A case of IgG4-related sclerosing disease with lymphadenopathy and thymus involvement]

The paper describes a case of generalized lymphadenopathy clinically recognized as malignant lymphoma in a 59-year-old woman. Her death occurred from bilateral pneumonia. Autopsy also showed a tumor-like mass in the thymus. On histological examination, the lymph nodes, thymus, and spleen exhibited an intensive polyclonal IgG4+ plasma cell infiltration. Lymphoid plasma cell infiltration with increased count of IgG+ plasma cells, progressive sclerosis, and phlebitis obliterans were found in the pancreas and peripancreatic adipose tissue, liver, kidney, epicardium, thyroid, pituitary, skin, and other organs. The case was regarded as IgG4-related sclerosing disease manifesting itself as lymphadenopathy and thymus enlargement.

[Variants of gastric carcinomas according to immunohistochemical mucins and CD10 expressions]

Mucins and glycoprotein CD10 expression in 55 carcinomas of the stomach has been studied by immunohistochemistry. According to a profile of mucins and CD10 expression, 3 immunophenotypic variants of carcinoma were founded: gastric, intestinal and gastro-intestinal. Gastric and gastro-intestinal variants were more frequently than intestinal one. The correlation between the expression of investigated markers and histological type of carcinoma wasn't revealed The estimation of Ki-67 index has shown that the highest proliferative activity (>20%) in carcinomas with gastric phenotype has been found more often than in gastro-intestinal ones.

[A solid-pseudopapillary tumors of the pancreas]

The review presents an update of solid-pseudopapillary pancreatic tumors, a rare and inadequately studied type of tumors that are predominantly encountered in girls and young women. It discusses the problems in the diagnosis based on the histological and imunophenotypical uniqueness of these tumors, which allows them to be differentiated from other types of pancreatic tumors with a less favorable prognosis. The correct diagnosis of a solid-pseudopapillary tumor determines the management tactic that requires no radiation or chemotherapy in the vast majority.

[Role of immunohistochemical study of extracellular matrix components in the estimation of the malignant potential of adrenal pheochromocytomas]

The changes occurring in the extracellular matrix structure and composition greatly affect cell behavior. The present investigation has indicated that active tenascin-C expression is observed in malignant pheochromocytomas, suggesting the altered composition of the extracellular matrix, there is also activation of metalloproteinase-9 and cyclooxygenase-2, which play an important role in many biological processes, including the invasion and metastatic spread of tumor cells, as well as in neoangiogenesis. Benign pheochromocytomas display a slight immunopositive staining of these antigens.

[Angiomyolipoma of the secondary contracted kidney in a renal graft recipient]

The special feature of the presented case is a combination of various pathological processes which developed in the recipient's kidney after renal transplantation, such as chronic glomerulonephritis progressing to nephrosclerosis; benign tumor to angiomyolipoma, xantogranulomatosis, and thesaurismosis which develop after massive infusion therapy.

[Advisability of identifying the categories of discrepancy between clinical and postmortem diagnoses]

In the paper the author tries to explain the formality and frequently groundlessness of categorization into three groups of divergence between clinical and postmortem diagnoses. She believes that such an assessment valuation is inadequate for the judgment about the quality of a therapeutic-and-diagnostic quality and that the clinical diagnosis should be made in due time.

[Expression of type 1 and type 2 mucins in colonic epithelial tumors]

Expression of MUC-1 and MUC-2 was investigated with immunohistochemical staining (PAP-method) in 5 cases of adenomas and in 60 cases of colorectal adenocarcinomas. The expression of MUC-1 and MUC-2 can be useful for diagnosis and prognosis in patients with colorectal carcinoma.

Vascular endothelium growth factor in the sera of patients with adrenal tumors

Serum levels of vascular endothelium growth factor were measured in 43 patients with adrenal tumors and 25 healthy subjects. The mean blood levels of the factor in patients with adrenal tumors significantly surpassed the control. No correlations between the level of vascular endothelium growth factor, patients age and sex were detected. The levels of this factor were maximum in patients with adrenocortical cancer, but its mean level differed negligibly from that in other morphological variants of tumors. The level of vascular endothelium growth factor tended to increase with increasing the stage of adrenocortical cancer. A direct correlation was revealed between the level of vascular endothelium growth factor and tumor size in adrenocortical cancer and aldosterone-producing adenoma. Presumably, vascular endothelium growth factor is involved into mechanisms of growth, invasion, and metastatic growth of adrenocortical cancer.

[To differential diagnosis of esophageal cancer and other diseases with the similar clinical symptoms, by using traditional X-ray study]

The principal purpose of the paper is to assess the role of the X-ray section of current radiation diagnosis in obtaining objective information and interpreting it in esophageal cancer. The study was methodically based on its serial studies, by comparing the data of clinical, radiation, and endoscopic diagnosis with those of morphological studies of the biopsy specimens taken at resection for cancer of the esophagus and the upper stomach, and histologically examined them in diseases running with the similar clinical symptoms. The complex of radiation techniques included traditional X-ray study (compact filling, double contrasting). A specially developed procedure that allowed physicians the opportunity to examine the cardioesophageal area in the fragmentary fashion was used during morphological studies. In cancer of the upper stomach, the lower esophageal segments were also involved in the process in 79.9%. It should be also noted that this number of observations includes some cases that clinical symptomatology and endoscopy strongly suggest cancer of the lower third of the esophagus. The authors have arrived at the conclusion that the present-day X-ray semiotics of esophageal diseases running with the similar clinical symptomatology permits their differential diagnosis just before the use of endoscopy and histology of biopsy specimens and that the unique advantage of radiation diagnosis over endoscopy is to specify the initial site of a tumor, namely, to detect primary gastric damage in cardioesophageal carcinoma.

Reductase Activity of 17β-Hydroxysteroid Oxidoreductase in Prostatic Tumors of Different Histological Structure

Reductase activity of 17beta-hydroxysteroid oxidoreductase in biopsy specimens of prostatic cancer and benign hyperplasia, and prostatic intraepithelial neoplasia and serum concentrations of testosterone, 5alpha-dihydrotestosterone, 4-androstene-3,17-dione were compared in patients and healthy individuals. Reductase activities of 17beta-hydroxysteroid oxidoreductase in soluble fraction of prostatic biopsy specimens decreased in the following order: prostatic cancer>prostatic intraepithelial neoplasia>>benign prostatic hyperplasia. No differences in serum concentrations of testosterone, 5alpha-dihydrotestosterone, 4-androstene-3,17-dione between these three groups of patients were found, while the mean serum concentration of these androgens in patients with prostatic tumors did not surpass the threshold normal values for men. Hence, high reductase activity of 17beta-hydroxysteroid oxidoreductase can be associated with pathogenetic mechanisms of human malignant prostatic tumors.

[Differentiated approach to medicine phonophoresis in complex treatment of cicatrical deformations]

135 patients aged 18 to 55 years with cicatrical alterations in the larynx were under observation. The treatment included phonophoresis of contractubex, colitin and elastolytin. The study found the necessity to take into account the age of cicatrical deformations when treating them. The most effective in treatment of formation cicatrices (6 to 12 days old) are medicines containing heparin (contractubex), which prevent the formation of pathologic cicatrices (keloid and hypertrophic ones). After the formation of the cicatrice is completed, medicines containing enzymes are more effective, because these "garnet" collagen and thus favor the mechanism of the reversion of pathologic cicatrical formation.

[Vascular endothelial growth factor in patients with prostate cancer and benign prostatic hyperplasia]

The authors examined 25 patients with prostate cancer (PC) and 36 patients with benign prostatic hyperplasia (BPH). In the group of patients with morphologically verified PC mean serum level of vascular endothelial growth factor (VEGF) was significantly higher than in patients with BPH (p < 0.05). The study demonstrated strong negative association between VEGF and prostate specific antigen (PSA) levels (r = 0.72, p < 0.05) in PC patients. There was no association between VEGF serum level and the stage or malignancy of PC (Gleason score). In benign prostatic glands moderate VEGF expression was observed only in basal cells, whereas in cases of PC all tumor cells displayed active VEGF expression; the difference was significant (p < 0.05). High serum VEGF levels and its active expression in patients with PC suggest an important role of angiogenic factors in the pathogenesis of this disease. The negative association between VEGF and PSA serum levels in PC indirectly confirms antiangiogenic activity of PSA, shown before.

[The role of gastroesophageal reflux in malignization of post-burn and peptic esophageal strictures]

The subjects of the study were 221 patients with cicatrical esophageal strictures. 62 (28.5%) patients had peptic strictures, and 159 (71.9%)--post-burn strictures. 67 (30.3%) patients underwent esophageal resection with one-stage intrapleural esophagoplasty with the stomach, 152 (68.8%) patients--gullet bougienage in combination with surgical intervention or as an only treatment. The study revealed 8 cases of squamous cell carcinoma in patients with post-burn strictures, and 3 cases of squamous cell carcinoma in patients with peptic strictures. In 2 cases the researchers found early stage of esophageal cancer (verrucose carcinoma)--in 1 patient with post-burn stricture and 1 patient with peptic stricture. The results suggest an important role of chronic gastroesophageal reflux in the oncogenesis of esophageal squamous cell carcinoma in patients with post-burn and peptic strictures.

[Clinicomorphological correlations in idiopathic and immunosuppressive forms of Kaposi's sarcoma]

Clinicomorphological correlations are presented for 136 patients with idiopathic and immunosuppressive types of Kaposi's sarcoma (KS) with spot, plaque and tumour manifestations. Early symptoms of KS (spot stage) as well as regressed and angiomatous elements are difficult for pathomorphological diagnosis which should be performed regarding clinico-anamnestic data. The help in the diagnosis may be observation of DNA HHV-8 sequenses in PCR from tissue biopsies and positive immunohistochemical reaction of endotheliocytes and fusiform tumour cell to CD34.

Expression of biomolecular markers (Ki-67, PCNA, Bcl-2, BAX, BclX, VEGF) in breast tumors

We carried out a retrospective immunohistochemical study of Ki-67, PCNA, Bcl-2, BAX, BclX, and VEGF expression in tumors of two groups of breast cancer patients with favorable and unfavorable course of the disease. Considerably enhanced VEGF expression was detected in tumors of patients with early relapses of breast cancer. High VEGF expression was paralleled by high level of Ki-67 and PCNA expression in tumors. It can be hypothesized that expression of VEGF, Ki-67, and PCNA in primary tumor can be used for predicting the course of breast cancer or detecting the patients at a high risk of early relapses.

[Combination of pulmonary lymphangioleiomyomatosis (LAM) with angiomyolipoma (AML) of the kidney and multilocular cystic nephroma]

A rare case of pulmonary LAM in combination with AML and multilocular cystic nephroma of the kidney in a 18-year-old female is described. Granules of the melanosomic type in AML, HMB-45 antigen and steroid receptors expression in LAM and AML were observed.

Serum Interleukin-6 in Patients with Adrenal Tumors

The mean blood content of interleukin-6 in patients with adrenal tumors was much higher than in healthy donors. No correlations were revealed between interleukin-6 level, patients sex and age, stage and duration of the disease. Interleukin-6 concentration was maximum in patients with adrenocortical cancer. A negative correlation was found between interleukin-6 level and blood cortisol concentration in patients with cortisol-producing adenoma. In patients with aldosterone-producing adenoma, interleukin-6 level tended to correlate negatively with plasma renin activity.

[The specificity of expression of molecular biological markers in tumors of the mammary gland]

Data are described on a retrospective immunohistochemical study of the Ki-67, PCNA, Bcl-2, BAX, BclX and VEGF expression in tumors of two groups of patients with breast cancer (BC) and with the favorable and unfavorable clinical courses. A reliably high level of VEGF expression was detected in tumors of patients with an early BC relapse. Apart from VEGF, higher levels of the Ki-67 and PCNA expression were registered in tumors of the discussed patient's category. It can be suggested that the expression parameters of VEGF, Ki-67 and PCNA in the primary tumor can be made use of in evaluating the BD prognostications or describing the features of high-risk groups with a high probability of early disease relapses.

[Vascular endothelial growth factor and insulin-like-growth factors in prostate cancer. ]

To study the levels of vascular endothelium growth factor (VEGF), insulin-like growth factor of type I and II (IGF-I and IGF-II), prostate-specific antigen (PSA) and their correlations in prostatic cancer (PC) and benign prostatic hyperplasia (BPH), we examined 38 PC patients (mean age 66.6 +/- 5.5 years) and 80 BPH patients (mean age 60.3 +/- 2.5 years). Serum concentrations of VEGF, IGF-I and IGF-II were measured using kits made by R&D (USA), PSA by Boehringer Mannheim (Germany). Sensitivity and specificity of the tests were analysed by plotting the curves. The serum VEGF concentration in PC patients was 518.9 +/- 60.7 pkg/ml, in BPH patients--267.9 +/- 99.9 pkg/ml (p < 0.001). The IGF-I and IGF-II it was 178 +/- 19 and 136 +/- 9 ng/ml (p < 0.05), 400 +/- 31 and 351 +/- 23 ng/ml (p < 0.05), respectively. The ratio of growth factor concentration to PSA concentration in the blood serum in BPH patients was higher than in PC patients (p < 0.01). Sensitivity and specificity of PSA (4 ng/ml) made up 85.7 and 57%, VEGF (151.5 pg/ml)--76.2 and 57.6%, IGF-I (157 ng/ml)--57.6 and 50%; IGF-II (392 ng/ml)--57.5 and 50%, respectively. Sensitivity and specificity VEGF/PSA was 85.7 and 70%; IGF-I/PSA--84.2 and 75%; IGF-II/PSA--84.2 and 79.6%, respectively. Thus, the ratio of concentrations of IGF-I, IGF-II and VEGF to PSA level in blood serum has high sensitivity and specificity for PC detection. Clinical implications of serum levels of VEGF, IGF-I and IGF-II for prediction of PC course and detection is to be elicited.

[Effectiveness of lamivudine in the treatment of chronic HBeAg-negative viral hepatitis B: results of continuous therapy for 18 months]

The efficacy of monotherapy with one of the analogues of synthetic nucleosides (lamivudine) was studied in 22 patients with chronic viral hepatitis B (CVHB). The specific feature of the selected group was that there was no serum HBeAg, which is usually regarded as a sign of viral mutation. The time course of changes in the activity of blood and hepatic inflammatory processes and viral replication were studied at equal intervals. There was a direct correlation between the suppression of viral replication and the regression of activity indices, such as ALT, serological markers, DNA of viral hepatitis B, and the morphological constituents of the Knodell index) during lamivudine therapy. However, there were no substantial changes in the parameters of fibrosis throughout the treatment. Therapy resistance was revealed in 3 of the 22 patients with CVHV. Its basis was the mutation of hepatitis B virus in the YMDD-motive, which was detected in 2 of the 3 patients.

[Cancer of the upper stomach: current problems of its diagnosis]

Data on 1248 cases of stomaches radically operated on for cancer at the surgical departments of the Moscow Regional Research Clinical Institute in 1971 to 2000 were used to study a number of problems associated with cancer of the upper stomach, by regarding the present-day role of radiation diagnosis as of paramount importance. The following radiation diagnostic techniques were assessed. Among them there were traditional X-ray studies (in each case), the new radiation diagnostic techniques: ultrasound study and computed tomography (CT) (750 studies), magnetic resonance imaging (MRI) (120 studies). The potentialities of radiation diagnosis and endoscopy performed in all cases are compared. A specially developed procedure for exploring endophytic forms of gastric cancer was employed in the morphological studies of the material. The incidence of cancer of the upper stomach and its association with the esophagus are presented; some aspects of the morphogenesis of cancer of this site are discussed. The relationship of its clinical symptoms and its radiation image has been studied. In the authors' opinion, the past two decades' rise in the incidence of proximal gastric cancer is one of the main problems in diagnosing gastric cancer that continues holding its stand in the general structure of cancer morbidity. The tendency for diffuse and mixed forms to increase in the morphogenesis of gastric cancer provides evidence that radiation techniques should be actively used in its diagnosis. It is necessary to apply classical double-contrasting X-ray study and endoscopy on equal grounds as basic diagnostic methods at early stages. Only their concord use may change the poor situation associated with the diagnosis of cancer at this site. CT and MRI as additional techniques may substantially provide more required diagnostic information. This is first and foremost associated with difficulties in gastric endoscopic study when esophageal cancer is apparently proved.

[Adrenocortical tumors with neuroendocrine differentiation]

18 adrenocortical tumours and 5 pheochromocytomas were studied immunohistochemically. Expression of synaptophysin and chromogranin A was found in cells of cortical adenomas, "frontier" neoplasms and in 20-75% of carcinoma cells, this ultramicroscopically was confirmed by observation of typical neuroendocrine granules. Some groups of cells of cortico-medullary tumours also expressed proteins of neural differentiation (protein S-100).

[Plasminogen activators of urokinase and tissue types and their inhibitor (PAI-1) in cytosol fraction in thyroid diseases]

Enzyme immunoassay (ELISA) was used to estimate the levels of plasminogen activators of urokinase (uPA) and tissue (tPA) types and one of their inhibitors (PAI-I) in the cytosolic fraction of the thyroid in 129 patients with malignant and benign tumors and various non-cancer diseases of the gland. Tumors from patients with thyroid cancer displayed the lowest levels of tPA and the highest levels of uPA and PAI-I, while those from patients with benign thyroid diseases, including adenoma, had high concentrations of tPA and relatively low levels of uPA and PAI-I in the tissue of the diseased organ. At the same time, the lowest levels of uPA and PAI-I were found in patients suffering from toxic goiter with and without adenomatosis. In terms of uPA and PAI-I levels, patients with nodular colloidal goiter were intermediate between those with toxic goiter and adenoma, on the one hand, and those with thyroid cancer, on the other.

[Current problems in the diagnosis of gastric cancer]

Based on their own long-term experience in diagnosing gastric cancer and by taking into account the fact that clinicians and diagnosticians analyze this problem insufficiently objectively, the authors of the paper try to convince the reader that it is necessary to revert to the problems of its diagnosis again. They proceed from recent new reports on gastric cancer pertaining to both its morphological forms and diagnostic capacities wherein current radiation diagnosis requires its active return to the problem of its detection. This standpoint of the authors is based on the date of over 6000 comprehensive studies of the stomach, of them 2800 cases have been diagnosed as having tumor lesions. In addition to the assessment of current radiation diagnosis of gastric cancer, which involves both routine X-ray study and ultrasonography, X-ray computed tomography, and magnetic resonance imaging of the stomach, the authors express their opinion on some organizational issues without which the diagnosis of this disease cannot be improved.

[Extrapulmonary inflammatory myofibroblastic tumor]

Literature data and three cases observed by the authors are described. Extrapulmonary inflammatory myofibroblastic tumor (EIMT) presented with proliferation of spindle cells with myofibroblast phenotype. Frequent recurrences and indefinite prognosis make to treat these lesions as true tumors. EIMT malignancy hyperdiagnosis is possible as morphologically it and some soft tissue sarcomas are alike.

[The role of stem and pluripotent cells in differentiation and the neoplastic transformation of pancreatic cells]

Certain differentiation-specific antigenic determinants are characteristic of pancreatic cells at each stage of embryonic development. Using immunohistochemical markers, we have demonstrated that the cells of several pancreatic tumors express some fetal proteins characteristic of embryonic cells of the pancreas. We propose that the presence of fetal antigens and proteins in the tumor is a sign of a lower tumor differentiation and a less favorable prognosis.

[Immunohistochemical study in differential diagnosis of benign and malignant lesions of the thyroid gland]

The paper is devoted to immunohistochemical (IHC) investigation of various benign and malignant proliferating lesions in the thyroid with a special focus on borderline lesions--atypical adenomas (AA) and focal adenomatous areas (FAA). All papillary carcinomas (PC) and FAA in Hashimoto thyroiditis demonstrated strong immunoreactivity for CK-19. More than 50% of PCNA-positive cells were detected in most of the investigated carcinomas; in FAA, and in AA PCNA expression was not so prominent but higher than in other adenomas and nodular goiters. Strong expression of vimentin by follicular epithelium was detected in PC. In FC, AA and FAA it was focal from moderate to strong. In other cases immunoreactivity to vimentin was weak or absent. Thus, it is worth to form on the basis of histological and IHC results the group of thyroid proliferating processes with possible malignant transformation. AA and FAA with more than 10% PCNA-immunoreactive cells and vimentin expression from moderate to strong should be included in this group. Further observation of our patients will enable to assess malignant potential of this processes. Besides, CK-19 expression is an additional criterion for the diagnosis of early PC.