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EDITOR-IN-CHIEFProf. S.O. Podvyaznikov

DEPUTY EDITOR-IN-CHIEFMD, DMSci A.M. Mudunov

EXECUTIVE EDITORMD, CMSci D.R. Naskhletashvili

EDITORIAL BOARDProf. R.I. Azizyan (Moscow) MD, CMSci S.B. Aliyeva (Moscow)Prof. V.F. Antoniv (Moscow) MD, DMSci A.A. Akhundov ()MD, DMSci V.Zh. Brzhezovsky (Moscow) Prof. V.I. Borisov (Moscow)MD, DMSci, RAMSci Corr. Mem. A.V. Vazhenin (Chelyabinsk)MD, DMSci I.V. Vikhlyanov (Barnaul)Prof. N.A. Daykhes (Moscow)Prof. V.V. Dvornichenko (Irkutsk)Prof. V.B. Karakhan (Moscow)MD, DMSci L.G. Kozhanov (Moscow)MD, DMSci M.A. Kropotov (Moscow)Prof. E.G. Matyakin (Moscow)MD, DMSci V.S. Medvedev (Obninsk)MD, DMSci A.U. Minkin (Archangelsk)Prof. A.A. Nikitin (Moscow)Prof. V.O. Olshansky (Moscow)Prof. A.I. Paches (Moscow)MD, DMSci, RAMSci Acad. V.G. Polyakov (Moscow)MD, DMSci, RAMSci Corr. Mem. I.V. Reshetov (Moscow)Prof. A.F. Romanchishen (St.-Petersburg)MD, DMSci P.O. Rumyantsev (Moscow)Prof. P.V. Svetitsky (Rostov-on-Don)Prof. S.I. Tkachev (Moscow)MD, DMSci, RAMSci Acad. E.L. Choynzonov (Tomsk)Prof. G.V. Ungiadze (Moscow)

FOREIGN EDITORSProf. G.B. Adilbaev (Kazakhstan) MD, CMSci I.V. Belotserkovsky (Belarus)MD, PhD T. Braunschweig (Germany)Prof. Yu.E. Demidchik (Belarus)Prof. D.I. Zabolotny (Ukraine)Prof. G. Margolin (Sweden)Prof. K.M. Mardaleyshvili (Georgia)MD, PhD D. Pendharkar ()Prof. Ch.R. Ragimov (Azerbaijan)

:115478, , , . 24, . 15, ,3- . ./: +7 (499) 929-96-19www.abvpress.rue-mail: abv@abvpress.ru

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ISSN 2222-1468 .2012. 4. 170

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.. IV : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

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.. , .. , .. , .. , .. , .. , .. , .. , .. , .. , .. , .. , .. , .. , .. - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

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.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

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7ontents

EDITORIAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

DIAGNOSIS AND TREATMENT OF HEAD AND NECK TUMORS

V.B. KarakhanSurgery for tumors of the fourth ventricle: the characteristics of accesses and the role of endoscopic techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

D.R. Naskhletashvili, V.A. Gorbunova, A.Kh. Bekyashev, V.B. Karakhan, E.A. Moskvina, E.V. ProzorenkoRole of targeted therapy in the combination treatment of patients with kidney cancer and metastatic brain involvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

V.E. Vanushko, V.V. Fadeev, P.O. RumyantsevThyroid hormone therapy principles after surgery of thyroid tumors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

E.A. Glezerov, D.S. Svyatoslavov, V.D. Skvirsky, D.V. RogozhinSome issues of surgical treatment policy for larynx cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

D.V. Sikorsky, S.O. Podvyaznikov, A.A. Chernyavsky, A.N. VolodinExpediency of temporal tracheostomy in patients surgically treated for discontinuity of the mandibular arch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

REHABILITATION IN PATIENTS WITH HEAD AND NECK TUMORS

A.A. Kulakov, V.M. Chuchkov, E.G. Matyakin, R.I. Azizyan, I.S. Romanov, A.M. Mudunov, S.O. Podvyaznikov, M.A. Kropotov, I.M. Gelfand, M.M. Tarasova, M.V. Chuchkov, M.N. ZamaletdinovRehabilitation of cancer patients with defect and complete secondary adentia after removal of both upper jaws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

A.A. Kulakov, V.M. Chuchkov, E.G. Matyakin, I.S. Romanov, A.A. Akhundov, A.M. Mudunov, S.P. Fedotenko, N.N. Fedotov, S.O. Podvyaznikov, M.A. Kropotov, T.Yu. Marilova, M.M. Tarasova, A.Sh. Tkhostov, M.V. Chuchkov, V.V. AgapovPatients psychosomatic status before and after orthopedic correction of maxillofacial defects. . . . . . . . . . . . 40

E.G. Matyakin, A.A. Akhundov, A.M. Mudunov, N.N. Fedotov, M.M. Tarasova, S.O. Podvyaznikov, M.A. Kropotov, A.V. Chizhova, T.A. Petrova, A.A. Kulakov, V.M. Chuchkov, V.V. Agapov, M.V. ChuchkovMethods for correction of rhinophonia in patients with acquired maxillary defects. . . . . . . . . . . . . . . . . . . . . 46

ORIGINAL REPORTS

P.O. RumyantsevIntraoperative neuromonitoring as a method of motor nerves functional visualization. . . . . . . . . . . . . . . . . . . 49

REVIEWS

O.A. SaprinaSquamous cell carcinoma metastases to the cervical lymph nodes without a primary focus being detected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

P.V. SvetitskyOn oral cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

CASE REPORTS

Yu.M. Bogdaev, M.A. Vozmitel, T.I. Nabebina, A.Ch. Dubrovskiy, A.G. Zhukovets, S.A. SemyonovMultiple bone metastasis of benign meningioma: a case report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

E.N. Novozhilova, A.P. Fedotov, V.N. Grinevich, V.I. Kozlov, I.V. KuzminA rare case of alveolar sarcoma of the parapharyngeal space . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

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Surgery for tumors of the fourth ventricle: the characteristics of accesses and the role of endoscopic techniques

V.B. KarakhanN.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow

The use of current accesses to the tumors of the fourth ventricle, which fill and compress from the outside its cavity, was assessed in 28 pa-tients. Original associated endomicrosurgical techniques were used. Two groups and five topographic types of fourth ventricle tumors are identified. Basic accesses telovelar and supracerebellar eliminate the necessity of dissecting the vermis cerebelli. The key endoscopic technique is to provide a simultaneous survey of the lower and upper poles of a tumor during its removal. The technique of trochlear removal of metastatic nodes from the fourth ventricle is shown.The benefits of endoscopic techniques are to early examine the vulnerable vascular and neural structures blocked by a tumor at the access step; to reduce the volume of an access itself and the traction of cerebellar and truncal structures; to completely survey the Sylvian aqueduct without additionally displacing or dissecting the vermis cerebelli; to maintain optical sharpness within sight of differently remote microstruc-tures. Overall, incorporation of the endoscopic method realizes the principle of mini-invasive neurosurgery.

Key words: tumors of the fourth ventricle; neuroendoscopy, telovelar access

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5. Matsushima T., Inoue T., Inamura T. et al. Transcerebellomedullary fissure approach with special reference to methods of dissecting the fissure. J Neurosurg 2001;94(2):25764.6. Mussi A.C.M., Rhoton A.L. Jr. Telovelar approach to the fourth ventricle: microsurgical anatomy. J Neurosurg 2000; 92(5):81223.7. Tanriover N., Ulm A.J., Rhoton A.L. Jr, Yasuda A. Comparison of the transvermian and telovelar approaches to the fourth ventricle. J Neurosurg 2004;101(3):48498.Karakhan V.B. Endofiberscopic intracracranial stereotopography and endofiberscoppic neurosurgery. Acta Neurochir Suppl (Wien) 1992;54:1125.

8. rneczky A., Tschabitscher M., Resch K.D.M. Endoscopic anatomy for neurosurgery. Stuttgart, New York: Thieme, 1993, p. 245255.9. Rhoton A.L. Jr. The cerebellar arteries. Neurosurgery 2000; 47(3 Suppl): s2968.10. .., .., .. . , - . . .: . . .. , 2007. . 612.

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D.R. Naskhletashvili, V.A. Gorbunova, A.Kh. Bekyashev, V.B. Karakhan, E.A. Moskvina, E.V. ProzorenkoN.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow

In patients with kidney cancer (KC), the rate of metastatic brain involvement is 2-11%, is steadily growing, and is one of the important rea-sons for treatment failures in these patients. Surgery and radiotherapy, including radiosurgery, must be considered as optimal treatments for patients with KC and brain metastases. Systemic drug therapy has recently played a more and more increasing role in the treatment of patients with a progressive brain tumor process. At the same time, there are no exact pharmacokinetic data on drugs registered for the treatment of disseminated KC in respect to their concentration in the human central nervous when they are used in therapeutic doses. On the basis of the data of the literature review and the results of the authors studies, it may be concluded that while none of the target agents has still shown any significant advantage over others in treating KC patients with brain metastases. All the drugs have demonstrated their ability to achieve a clinical and X-ray verified objective effect (as stabilizations in most cases) in treating brain metastases. The most data are available on the therapeutic efficacy of sunitinib and sorafenib. In case of progressive brain tumor process, drug treatment should be indi-vidually discussed in each situation in accordance with standard approaches to treating patients with disseminated KC.

Key words: kidney cancer, brain metastases, targeted therapy

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1. Ammirati M., Cobbs C.S., Linskey M.E. et al. The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 2010;96:8596.2. Besse B., Lasserre S.F., Compton P. et al. Bevacizumab safety in patients with central nervous system metastases. Clin Cancer Res 2010;16:26978.3. Choueiri T.K., Duh M.S., Clement J. et al. Angiogenesis inhibitor therapies for metastatic renal cell carcinoma: effectiveness, safety and treatment patterns in clinical practice-based on medical chart review. BJU Int 2009;105:124754.4. Culine S., Bekradda M., Kramar A. et al. Prognostic factors for survival in patients with brain metastases from renal cell carcinoma. Cancer 1998;83:254853.5. Dalhaung A., Haukland E., Nieder C. Leptomeningeal carcinomatosis from renal cell cancer: treatment attempt with radiation and sunitinib. World J Surg Oncol 2010;8:36.6. Elfiky A.A., Cho D.C., McDermott D.F. et al. Predictors of response to sequential sunitinib and the impact of prior VEGF-targeted drug washout in patients with metastatic clear cell renal carcinoma. Urol Oncol 2010; doi:10.1016/j.urolonc.2010.01.008; [Epub ahead of print].7. Escudier B., Bellmut J., Negrier S. et al. Phase III trial of bevacizumab plus interferon alpha-2a in patients with metastatic renal cell carcinoma (AVOREN): final analysis of overall survival. J Clin Oncol 2010; 28:214450.8. Escudier B., Eisen T., Stadler W.M. et al. Sorafenib for treatment of renal cell carcinoma: final efficacy and safety results of the phase III treatment approaches in renal cell cancer global evaluation trial. J Clin Oncol 2009;27:33128.

9. Feldman D.R., Baum M.S., Ginsberg M.S. et al. Phase 1 trial of bevacizumab plus escalated doses of sunitinib in patients with metastatic renal cell carcinoma. Genitourinary Cancer 2009;27:14329.10. Gleave M.E., Elhilali M., Fradet Y. et al. Interferon gamma-1b compared with placebo in metastatic renal-cell carcinoma. New Engl J Med 1998;338:126571.11. Gore M.E., Hariharan S., Porta C. et al. Sunitinib in metastatic renal carcinoma patients with brain metastases. Cancer 2011; 117:5019.12. Guirgis L.M., Yang J.C., White D.E. et al. Safety and efficacy of high dose IL-2 therapy in patients with brain metastasis. J Immunother 2002;25:827.13. Haznedar J., Patyna S., Bello C.L. et al. Single and multiple dose disposition kinetics of sunitinib malate, a multitargeted receptor tyrosine kinase inhibitor: comparative plasma kinetics in non-clinical species. Cancer Chemother Pharmacol 2009;64:691706.14. Helgason H.H., Mallo H.A., Droogendijk H. et al. Brain metastases in patients with renal cell cancer new targeted treatment. J Clin Oncol 2008;26:1524.15. Hu S., Chen Z., Franke R. et al. Interaction of the multikinase inhibitors sorafenib and sunitinib with solute carriers and ATP-binding cassette transporters. Clin Cancer Res 2009;15:60629.16. Hudes G., Carducci M., Tomczak P. et al. Temsirolimus, interferon alpha, or both for advanced renal cell carcinoma. New Engl J Med 2007;456:227181.17. Iwamoto F.M., Lamborn K.R., Robins I.H. et al. Phase II trial of pazopanib (GW786034), an oral multi-targeted angiogenesis inhibitor, for adults with recurrent glioblastoma (North American Brain Tumor Consortium Study 0602). Neuro Oncol 2010;12:85561.

18. Kim A., McCully C., Cruz R. et al. The plasma and cerebrospinal fluid pharmacokinetics of sorafenib after intravenous administration in non-human primates. Invest New Drugs 2010; doi:10.1007/s10637-010-9585-1; [Epub ahead of print].19. Kirchner H., Strumberg D., Bahl A. et al. Patient based strategy for systemic treatment of metastatic renal cell carcinoma. Expert Rev Anticancer Ther 2010;10:58596.20. Kuhn J.G., Chang S.M., Wen P.Y. et al. Pharmacokinetic and tumor distribution characteristics of temsirolimus in patients with recurrent malignant glioma. Clin Cancer Res 2007;13:74016.21. Lagas J.S., van Waterschoot R.A., Sparidans R.W. et al. Breast cancer resistance protein and p-glycoprotein limit sorafenib brain accumulation. Molec Cancer Ther 2010;9:31926.22. Larkin J., Gore M. Is advanced renal cell carcinoma becoming a chronic disease? Lancet 2010;376:5745.23. Lukas R.V., Chmura S., Nicholas M.K. Management of central nervous system metastases from renal cancer. Emerg Cancer Therap 2011;2:15768.24. Massard C., Zonierek J., Gross-Goupil M. et al. Incidence of brain metastases in renal cell carcinoma treated with sorafenib. Ann Oncol 2010;21:102731.25. Medioni J., Cojocarasu O., Belcaceres J.L. et al. Complete cerebral response with sunitinib for metastatic renal cell carcinoma. Ann Oncol 2007;18:12823.26. Motzer R.J., Hutson T.E., Tomczak P. et al. Sunitinib versus interferon alpha in metastatic renal cell carcinoma. New Engl J Med 2007;356:11524.27. Motzer R.J., Escudier B., Oudard S. et al. Phase 3 trial of everolimus for

25

42012

metastatic renal cell carcinoma: final results and analysis of prognostic factors. Cancer 2010;116:425665.28. Muacevic A., Siebels M., Tonn J.C. et al. Treatment of brain metastases in renal cell carcinoma: radiotherapy, radiosurgery, or surgery? World J Urol 2005;23:1804.29. Muldoon L.L., Soussain C., Jahnke K. et al. Chemotherapy delivery issues in central nervous system malignancy: a reality check. J Clin Oncol 2007;25:2295305.30. Murata J.I., Sawamura Y., Terasaka S. et al. Complete response of a large brain metastasis of renal cell cancer to interferon-alpha: case report. Surg Neurol 1999;51:28991.31. Nicholas M.K., Lukas R. Immunologic privilege and the brain. In: Arnason B.G., ed. NeuroImmune Biology: The Brain and Host Defense, Vol. 9. London, UK: Elsevier; 2010. P. 169181.32. OReilly T., McSheehy P., Kawai R. et al. Comparative pharmacokinetics of RAD001 (everolimus) in normal and tumor-bearing rodents. Cancer Chemother Pharmacol 2010;54:62539.33. Ranze O., Hoffman E., Distelrath A. et al. Renal cell cancer presented with leptomeningeal carcinomatosis effectively treated with sorafenib. Onkologie 2007; 30:4501.

34. Saitoh H. Distant metastases from renal carcinoma. Cancer 1988;48:148791.35. Samlowski W.E., Majer M., Boucher K.M. et al. Multidisciplinary treatment of brain metastases derived from clear cell renal cancer incorporating stereotactic radiosurgery. Cancer 2008; 113:253948.36. Shuch B., LaRochelle J.C., Klatte T. et al. Brain metastasis from renal cell carcinoma: presentation, recurrence, and survival. Cancer 2008;113;16418.37. Shukla S., Robey R.W., Bates S.E. et al. Sunitinib (Sutent, SU11248), a small-molecule receptor tyrosine kinase inhibitor, blocks function of the ATP-binding cassette (ABC) transporters p-glycoprotein (ABCB1) and ABCG2. Drug Metab Dispos 2009; 37:35965.38. Sperduto P.W., Chao S.T., Sneed P.K. et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4259 patients. Int J Radiat Oncol Biol Phys 2010; 77:65561.39. Stadler W.M., Figlin R.A., McDermott D.F. et al. Safety and efficacy results of the advanced renal cell carcinoma sorafenib expanded access program in North America. Cancer 2010;116:12729.

40. Sternberg C.N., Davis I.D., Mardiak J. et al. Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J Clin Oncol 2010;28:10618.41. Thibault F., Billemont B., Rixe O. Regression of brain metastases of renal cell carcinoma with antiangiogenic therapy. J Neurooncol 2008;86:2434.42. Valcamonico F., Ferrari V., Amoroso V. et al. Long lasting successful cerebral response with sorafenib in advanced renal cell carcinoma. J Neurooncol 2009; 91:4750.43. Vogl U.M., Bojic M., Lamm W. et al. Extracerebral metastases determine the outcome of patients with brain metastases from renal cell carcinoma. BMC Cancer 2010;10:480.44. Vredenburgh J.J., Cloughesy T., Samant M. et al. Corticosteroid use in patients with glioblastoma at first or second relapse treated with bevacizumab in the BRAIN study. Oncologist 2010;15:132934.45. Yamanaka K., Gohji K., Hara I. et al. Clinical study of renal cell carcinoma with brain metastasis. Int J Urol 1998;5:1248.46. Zeng H., Li X., Yao J. et al. Multifocal brain metastases in clear cell renal cell carcinoma with complete response to sunitinib. Urol Int 2009;83:4825.

26

42012

() - . . - , , , - () . -, . - , ,

: 3,7 %, - 1/3 .

, - -. (0,44,0 /) (. ).

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: rumyantsev.pavel@endocrincentr.ru

() . , , () 0,1 /. , - . - , - . , , . , , - 1 , .

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Thyroid hormone therapy principles after surgery of thyroid tumors

V.E. Vanushko, V.V. Fadeev, P.O. RumyantsevFSBI Endocrinology Research Center, Ministry of Health of Russia, Moscow

Thyroid hormone administration after thyroid tumors surgery is a part of complex treatment strategy. In case of papillary, follicular and poor-differentiated carcinomas suppressive treatment regime is indicated with target TSH level 0.1 IU/l. Intensity and duration of TSH suppressive treatment regime depends on tumor recurrence risk group and presence of severe cardio-vascular disease. In case of medullary and anaplastic thyroid cancer require substitutive treatment regime as well as after benign tumor surgery. If patient has been undergone par-tial thyroid resection by reason of benign tumor the suppressive treatment necessity would be settled in terms of postsurgical TSH level. Thereafter on substitutive or suppressive L-thyroxine treatment patient has achieved target TSH level the further control of it is conducting half in year and annually later.

Key words: thyroid, tumors, hormone therapy

27

42012

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28

42012

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29

42012

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30

42012

2 4 % . 2010 . 6298 : III 34,7 %, III 49 %, IV 17,3 %.

- - 5060 % [1].

35 % III IV - , (), - 35 % - [2]. - (35 % ). -, - , - .

- .

- T3N0M0, III - 20072009 .: - 150 . , , - , - 7 (4,6 %) .

2010 2011 . 95 T3N0M0, III . - 43 , - - . , , . , -, 30 79 : 63 -, 2 (4,5 %) 41 (95,5 %) .

.. , .. , .. , ..

: dssvyatoslavov78@mail.ru

, - (). 2010 2011 . 95 T3N0M0, III ( 52 ), 3 (5,7 %) 8 1 . 43 , . , 3 .

: ,

Some issues of surgical treatment policy for larynx cancer

E.A. Glezerov, D.S. Svyatoslavov, V.D. Skvirsky, D.V. RogozhinMoscow Regional Oncology Dispensary

The paper proposed a procedure that can prevent peristomal recurrences in patients with larynx cancer after laryngectomy (LE). In the pe-riod 2010 to 2011, LE was performed in 95 patients with III stage T3N0M0 larynx cancer (according to the conventional procedure in 52 cases of them), among whom periostomal recurrences were identified in 3 (5.7%) patients in the period 8 to 12 months. A study group comprised 43 patients in whom LE was combined with paratracheal fat removal on both sides they are all currently observed without a tumor relapse and metastases. The above data may suggest that some patients with tumor spread to all 3 laryngeal segments and with fold part involvement and its transition to subfold one need paratracheal fat removal.

Key words: peristomal recurrence, paratracheal fat

31

42012

( 37 6 - ). 23 (53,5 %) 3 , 11 (25,5 %) - , 9 (21 %) . 27 (62,7 %) , 16 (37,2 %) () - () 4648 6 6670 2 , - . - , - 4 (9,3 %) -, 3 , - .

52 - 23 79 : 48 (92,3 %) 4 (7,6 %) -. , 31 (60 %) , 18 (34,6 %) 2- - C 4648 .

, , - . 3 (5,7 %) .

- . , - : . - - , . , - , . ( 10 10 - 400 ), . . [35].

-, 3 - , .

1. .. . ., 1983.2. .. . .: , 1989. . 161168.

3. Ghaffari S. Cancer, stem cells and cancer stem cells: old ideas, new developments. F1000 Med Rep 2011;3:23.4. Koukourakis M.I., Giatromanolaki A., Tsakmaki V. et al. Cancer stem cell phenotype relates to radio-chemotherapy

outcome in locally advanced squamous cell head-neck cancer. Br J Cancer 2012 Feb 28;106(5):84653. doi: 10.1038/bjc.2012.33.5. Mannelli G., Gallo O. Cancer stem cells hypothesis and stem cells in head and neck cancers. Cancer Treat Rev 2012;38(5):51539.

32

42012

40 -- , - 1- - , 1 ( 2010 . . ) 2005 2011 .

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Expediency of temporal tracheostomy in patients surgically treated for discontinuity of the mandibular arch

D.V. Sikorsky1, S.O. Podvyaznikov 2, A.A. Chernyavsky 3, A.N. Volodin11Oncology Unit One, Oncology Dispensary, Branch One, Nizhny Novgorod;

2Department of Oncology, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow;

3Department of Oncology, Radiotherapy, Radiodiagnosis, Nizhny Novgorod State Medical Academy, Ministry of Health of Russia

The paper analyzes clinical observations of 40 patients with locally advanced and recurrent oropharyngeal cancer, who underwent multi-component surgery with simultaneous removal of a primary tumor and cervical lymph outflow tracts, which was accompanied by discontinu-ity of the mandibular arch with concurrent tracheostomy.

Key words: oropharyngeal cancer, tracheostomy, tracheostoma

33

42012

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34

42012

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: podvs@inbox.ru

C 1969 2012 . 102 . 90 , 12. - ( ), . - ( ) - 1015- .

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Rehabilitation of cancer patients with defect and complete secondary adentia after removal of both upper jaws

A.A. Kulakov1, V.M. Chuchkov1, E.G. Matyakin2, R.I. Azizyan2, I.S. Romanov 2, A.M. Mudunov2, S.O. Podvyaznikov 2, 3, M.A. Kropotov 2, I.M. Gelfand 2, M.M. Tarasova2, M.V. Chuchkov 4, M.N. Zamaletdinov 5

1Central Research Institute of Dentistry, Moscow;2N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow;

3Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow;4Peoples Friendship University of Russia, Moscow;

5I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia

In 19692012, prosthetic replacement was performed in 102 patients with postoperative maxillary defects, including 90 patients with com-plete secondary adentia and 12 with total maxillary defect. Procedures for fixation of immediate prostheses (protective plates) were improved; practical guidelines were elaborated to transform the protective plate into a primary permanent prosthesis with an obturator. The primary permanent (forming) prosthesis is recommended in the postoperative period (on days 1015).

Key words: maxillary defect, secondary adentia, forming prosthesis

35

42012

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36

42012

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37

42012

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38

42012

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39

42012

. 2 6 .

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40

42012

-

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: podvs@inbox.ru

- 88 : 38 , 50. , --, : . , 88 (100 %) , 16 (18,2 %) - , 7 (7,9 %) . - -. , - , , . -, , , . . . .

: - , ,

Patients psychosomatic status before and after orthopedic correction of maxillofacial defects

A.A. Kulakov1, V.M. Chuchkov1, E.G. Matyakin2, I.S. Romanov 2, A.A. Akhundov 2, A.M. Mudunov 2, S.P. Fedotenko 2, N.N. Fedotov 2, S.O. Podvyaznikov 2, 3, M.A. Kropotov 2,

T.Yu. Marilova2, M.M. Tarasova2, A.Sh. Tkhostov 4, M.V. Chuchkov5, V.V. Agapov 61Central Research Institute of Dentistry, Moscow;

2N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow;3Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow;

4M.V. Lomonosov Moscow State University;5Peoples Friendship University of Russia, Moscow

6Moscow State University of Medicine and Dentistry

A medicopsychological study of the time course of psychic changes was conducted in 88 cancer patients with defects of facial soft tissues (n = 38) and maxilla (n = 50). Since the patients visit to an oncologist, the diagnostic-stage depth of mental disorders was rather various: from mild asthenia to depression. Thus, 88 (100 %) patients were found to have an anxious feeling, 16 (18.2 %) had affective-shock reac-tions; 7 (7.9 %) had reactive depression. In the postoperative period, anxiety-depressive syndrome gave way to astheno-depressive one. After hospital discharge, the reactive state became less tense during psychosocial readaptation, the characteriological personality changes were increasingly more pronounced in the forefront in the patients. They became anxious, suspicious, unconfident about themselves, sensitive, tried to avoid difficult situations in life. The circle of interests was limited to thoughts on their own health. Combination therapy with psycho-tropic drugs was used to correct the mental status of patients with acquired maxillary defects in the study group. The dosage of the drugs was individually adjusted according to the degree of psychopathological manifestations.

Key words: maxillofacial defects, quality of life, psychopharmacotherapy

41

42012

-

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, -, , 16 (18,2 %) - - . , . , , - , - . - 5 (5,6 %) , 16 (18,2 %).

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42

42012

, , . - 9 (10,2 %) .

- , , , . , , , .

(20 - 22,7 %) - - . - , . - , , , . - , -, - . - -, 7 (7,9 %) . , , -, . - . , , - , , -, .

- - , , , , , , ; , -, , - . .

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, , ( - , 1996).

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43

42012

. - , - .

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(F33.1) 32,20 % (19 );

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44

42012

4) - - (F41.2) 20,33 % (12 ).

-10, 3 - , -, , - - (, , , - ).

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, , (HDRS-21) , 95 % - , , , - .

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45

42012

. .

, 2-, 3- - . 6- - ( < 0,05) , (0 1 ( ) HDRS-21). 82,2 % (24 -) , HDRS-21 50 % , ( 19,3, 6- 8,7).

, , 5 (17,2 %) , HDRS-21 4925 % - , . - , - , .

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, , - - (SOFAS) - , , .

- , - , - . - -- - -.

, 73 % 100 % -- -. - - , - . - - , - -, 94 % .

46

42012

, , - , . ; -

. , - - (. 17).

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: podvs@inbox.ru

63 . 100 % - , . , - . - . : ( , , , , , ); ; () . - , .

: , ,

Methods for correction of rhinophonia in patients with acquired maxillary defects

E.G. Matyakin1, A.A. Akhundov1, A.M. Mudunov1, N.N. Fedotov1, M.M. Tarasova1, S.O. Podvyaznikov 1, 2, M.A. Kropotov1, A.V. Chizhova1, T.A. Petrova1,

A.A. Kulakov3, V.M. Chuchkov3, V.V. Agapov4, M.V. Chuchkov51N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow;

2Russian Medical Academy of Postgraduate Training, Ministry of Health of Russia, Moscow;3Central Research Institute of Dentistry, Moscow;

4Moscow State University of Medicine and Dentistry;5Peoples Friendship University of Russia, Moscow

Speech recovery sessions were conducted in 63 patients with acquired maxillary defects. Assessment of speech quality in patients after audi-tory maxillary resection without a prosthestic has indicated 100 % significant rhinolalia, indistinct articulation. Prosthetic defect replace-ment completely corrects speech dysfunction and creates conditions for forming correct speech stereotypes. Speech therapy sessions and testing are aimed at increasing the performance of the speech apparatus and at improving the automatizaton of speaking skills. The tech-niques to remove nasal emission include: articulation exercises (activation of the muscles of the lips, cheeks, tongue, pharynx, neck, and larynx); speech respiratory gymnastics; phonopedic (vocal) exercises.The elements of rational psychotherapy have extensive applications during each session and include suggestion, an emotional exposure to correct personality disorders, as well as pedagogical elements.

Key words: maxillary resection, rhinophonia, speech recovery sessions

47

42012

.

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1) ;

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48

42012

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49

42012

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: rumyantsev.pavel@endocrincentr.ru

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Intraoperative neuromonitoring as a method of motor nerves functional visualization

P.O. RumyantsevFSBI Endocrinology Research Center, Ministry of Health of Russia, Moscow

Surgical damage of motor nerves is one of the serious complication which deteriorates patients life quality as well as being often a cause of disability. In the article are reflected the methodological aspects of intraoperative neuromonitoring. This method is auxiliary and not sub-stituting the surgical visualization of nerves, but significantly facilitates nerve disclosure as well as functional integrity. Intraoperative neuro-monitoring permits to reduce the unintended injury or motor nerves during the operation. This is extremely actual in cases of atypical nerve dispositions, reoperations and when surgery is executed by inexperienced surgeon.

Key words: intraoperative neuromonitoring, motor nerve, surgical complications, recurrent laryngeal nerve

50

42012

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. (0,20,5 % ) , . , - .

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51

42012

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52

42012

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53

42012

-, , [1]. , - (), . , . - , - , , .

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, 10 % - [8].

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: isabekian@mail.ru

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Squamous cell carcinoma metastases to the cervical lymph nodes without a primary focus being detected

O.A. SaprinaDepartment of Craniomaxillofacial Tumors, N.N. Blokhin Russian Cancer Research Center,

Russian Academy of Medical Sciences, Moscow

The paper presents a review of literature on the most unstudied problem in head and neck oncology the diagnosis and treatment of patients with cervical lymph node metastases without a primary focus being detected.

Key words: squamous cell carcinoma, cervical lymph node metastases, primary focus

54

42012

. , 81 % 100 % [811], - 57 % [12, 13]. - , , , -, .

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55

42012

.

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5- (2004) Y. Yalin et al. [41]. 40 , , . - 54 %. 13 - -.

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(32,6 %) . 5- 55 % [43].

, - , , , -, , - .

, S. Iganej et al., - - , , , , , 32 3 % ( = 0,006). N1N2 . 5-- (N1N3) 53 % [44].

, 2009 . 140 , 2 [45]. 1- 76 , - , 2- -, 64 , , . 2 - 66 . - , 1- - 35 /2. 1- (68,4 %), 53,1 %.

5 60 , ( ) 31,06 21,01 , 6 60 , ( ) 39,42 21,33 .

73 -, 20,5 % - , [46].

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, D. Beldi et al., 113 , 19802004 . 87 ,

56

42012

22 , -, 91 - . 52,2 % , 47,8 % - . - 67 , 45. , 18 % ().

21 - N1, 64 N2, 28 N3. - , (57,6 %), , (24 %) [48]. - (24,6 %), - (10,1 %), . - . , , - , , - , . , P.J. Colliter et al. 9 %, 18 % 14 % [49]. S.P. Reddy et al. , , - . - , , , , [32].

, - : 11 33 % [50, 51]. - - . - . , -

, - , , [52, 53].

, . - , , N, [42, 54, 55]. , H.S. Erkal , N1N2 , N2bN3. - - , 5- , [50, 56].

, . M.J. Kirschner (1997) 5- - , - 9 % 63 % [57].

, - . - , .

, - , - - .

, - , - . -, , (, -) .

1. .., .., .. . - . 2010;1(37).

2. Bell C.W., Pathak S., Frost P. Unknown primary tumors: establishment of cell lines, identification of chromosomal abnormalities, and implications for a second type of tumor progression. Cancer Res 1989 Aug 1;49(15):43115.

3. Guarischi A., Keane T.J., Elhakim T. Metastatic inguinal nodes from an unknown primary neoplasm. A review of 56 cases. Cancer 1987 Feb1;59(3):5727.4. Muir C. Cancer of unknown primary site. Cancer 1995 Jan 1;75(1 Suppl):3536.

57

42012

5. Seddon D.J., Williams E.M. Data quality in population-based cancer registration: an assessment of the Merseyside and Cheshire Cancer Registry. Br J Cancer 1997; 76(5):66774.6. Bernal M.P., Cazar E.L., Estevez R.A. et al. Tumor primitivo desconocido. Rev Latinoamer Oncol Clin 1988;20(5):519.7. Jungi W.F., Osterwalder B. Approach in metastasis with unknown primary tumor. Schweiz Med Wochenschr 1990 Sep 1; 120(35):12739.8. .. - (, , ). . . . . ., 1978.9. Cheng A.T.L., Dorman B. Fine needle aspiration cytology: the Auckland experience. Aust N Z J Surg 1992; 62(5):36872.10. Rapkiewicz A., Le B.T., Simsir A. et al. Spectrum of head and neck lesions diagnosed by fine-needle aspiration cytology in the pediatric population. Cancer 2007; 111(4):24251.11. Murthy P., Laing M.R., Palmer T.J. Fine needle aspiration cytology of head and neck lesions: an early experience. J R Coll Surg Edinb 1997;42(5):3416.12. Tandon S., Shahab R., Benton J.I. et al. Fine-needle aspiration cytology in a regional head and neck cancer center: comparison with a systematic review and meta-analysis. Head Neck 2008;30(9):124652.13. Howlett D.C., Harper B., Quante M., et al. Diagnostic adequacy and accuracy of fine needle aspiration cytology in neck lump assessment: results from a regional cancer network over a one year period. J Laryngol Otolog 2007;121(6):5719.14. Ellis E.R., Mendenhall W.M., Rao P.V., et al. Incisional or excisional neck-node biopsy before definitive radiotherapy, alone or followed by neck dissection. Head Neck 1991;13:17783.15. McGuirt W.F., Greven K., Williams D. III, et al. PET scanning in head and neck oncology: a review. Head Neck 1998;20(3):20815.16. Greven K.M., Keyes J.W. Jr, Williams D. III, et al. Occult primary tumors of the head and neck: lack of benefit from positron emission tomography imaging with 2-[F-18]fluoro-2-deoxy-D-glucose. Cancer 1999;86(1):1148.17. Fogarty G.B., Peters L.J., Stewart J. et al. The usefulness of fluorine 18-labelled deoxyglucose positron emission tomography in the investigation of patients with cervical lymphadenopathy from an unknown primary tumor. Head Neck 2003;25(2):13845.18. Veit-Haibach P., Luczak C., Wanke I., et al. TNM staging with FDG-PET/CT in patients with primary head and neck cancer.

Eur J Nucl Med Molecul Imaging 2007;34(12):195362.19. Johansen J., Buus S., Loft A., et al. Prospective study of 18FDG-PET in the detection and management of patients with lymph node metastases to the neck from an unknown primary tumor. Results from the Dahanca-13 study. Head Neck 2008; 30(4):4718.20. Miller F.R., Karnad A.B., Eng T. et al. Management of the unknown primary carcinoma: long-term follow-up on a negative PET scan and negative panendoscopy. Head Neck 2008; 30(1):2834.21. Kothari P., Randhawa P.S., Farrell R. Role of tonsillectomy in the search for a squamous cell carcinoma from an unknown primary in the head and neck. Br J Oral Maxillofac Surg 2008;46(4):2837.22. Jereczek-Fossa B.A., Jassem J., Orecchia R. Cervical lymph node metastases of squamous cell carcinoma from an unknown primary. Cancer Treat Rev 2004; 30(2):15364.23. McQuone S.J., Eisele D.W., Lee D.-J. et al. Occult tonsillar carcinoma in the unknown primary. Laryngoscope 1998; 108(11):160510.24. Randall D.A., Johnstone P.A.S., Foss R.D. et al. Tonsillectomy in diagnosis of the unknown primary tumor of the head and neck. Otolaryngol Head Neck Surg 2000; 122(1):525.25. Kazak I., Haisch A., Jovanovic S. Bilateral synchronous tonsillar carcinoma in cervical cancer of unknown primary site (CUPS). Eur Arch Otorhinolaryngol 2003;260(9):4903.26. Koch W.M., Bhatti N., Williams M.F. et al. Oncologic rationale for bilateral tonsillectomy in head and neck squamous cell carcinoma of unknown primary source. Otolaryngol Head Neck Surg 2001; 124(3):3313.27. Safa A.A., Tran L.M., Rege S., et al. The role of positron emission tomography in occult primary head and neck cancers. Cancer J Sci Am 1999;5:2148.28. Bataini J.P., Rodriguez J., Jaulerry C. et al. Treatment of metastatic neck nodes secondary to an occult epidermoid carcinoma of the head and neck. Laryngoscope 1987;97:10804.29. Carlson L.S., Fletcher G.H., Oswald M.J. Guidelines for radiotherapeutic techniques for cervical metastases from an unknown primary. Int J Radiat Oncol Biol Phys 1986;12:210110.30. Lefebvre J.L., Coche-Dequeant B., Van J.T. et al. Cervical lymph nodes from an unknown primary tumor in 190 patients. Am J Surg 1990;160:4436.31. McCunniff A.J., Raben M. Metastatic carcinoma of the neck from an unknown

primary. Int J Radiat Oncol Biol Phys 1986; 12:184952.32. Reddy S.P., Marks J.E. Metastatic carcinoma in the cervical lymph nodes from an unknown primary site: Results of bilateral neck plus mucosal irradiation vs. ipsilateral neck irradiation. Int J Radiat Oncol Biol Phys 1997;37:797802.33. Weir L., Keane T., Cummings B. et al. Radiation treatment of cervical lymph node metastases from an unknown primary: An analysis of outcome by treatment volume and other prognostic factors. Radiother Oncol 1995;35:20611.34. Abbruzzese J.L., Abbruzzese M.C., Hess K.R. et al. Unknown primary carcinoma: natural history and prognostic factors in 657 consecutive patients. J Clin Oncol 1994;12:127280.35. LeChevalier T., Cvitkovic E., Caille P. et al. Early metastatic cancer of unknown primary origin at presentation. Arch Intern Med 1988;148:20359.36. Lembersky B.C., Thomas L.C. Metastases of unknown primary site. Med Clin North Am 1996;80:15371.37. Muir . Cancer of unknown primary site. Cancer 1995;1:3536.38. Pasterz R., Savoraj N., Burgess M. Prognostic factors in metastatic carcinoma of unknown primary. J Clin Oncol 1986; 4:16527.39. Pentheroudakis G., Briasoulis E., Pavlidis N. Cancer of unknown primary site: missing primary or missing biology? Oncologist 2007;12:41825.40. Van de Wouw A.J., Janssen-Heijnen M.L., Coebergh J.W. et al. Epidemiology of unknown primary tumours; incidence and population-based survival of 1285 patients in Southeast Netherlands, 19841992. Eur J Cancer 2002;38:40913.41. Yalin Y., Pingzhang T., Smith G.I. et al. Management and outcome of cervical lymph node metastases of unknown primary sites: a retrospective study. Br J Oral Maxillofac Surg 2002;40(6):4847.42. Klop W.M., Balm A.J., Keus R.B. et al. Diagnosis and treatment of 39 patients with cervical lymph node metastases of squamous cell carcinoma of unknown primary origin, referred to Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, 197998. Ned Tijdschr Genehieskd 2000; 144(28):135560.43. Mistry R.C., Qureshi S.S., Talole S.D. et al. Cervical lymph node metastases of squamous cell carcinoma from an unknown primary: outcomes and patterns of failure. Indian J Cancer 2008;8:548.44. Iganej S., Kagan R., Anderson P. et al. Metastatic squamous cell carcinoma of the neck from an unknown primary: management options and patterns of relapse. Head Neck 2002;24(3):23646.

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45. Shukla P., Gupta D., Bisht S.S. et al. Metastatic squamous cell carcinoma neck with occult primary: A retrospective analysis. Indian J Med Paediatr Oncol 2009 Oct; 30(4):12430.46. Stenson K.M., Huo D., Blair E. et al. Planned post-chemoradiation neck dissection: significance of radiation dose. Laryngoscope 2006 Jan;116(1):336.47. Argiris A., Smith S.M., Stenson K. et al. Concurrent chemoradiotherapy for N2 or N3 squamous cell carcinoma of the head and neck from an occult primary. Ann Oncol 2003;14(8):130611.48. Beldi D., Jereczek-Fossa B.A., DOnofrio A. et al. Role of radiotherapy in the treatment of cervical lymph node metastases from an unknown primary site: retrospective analysis of 113 patients. Int J Radiat Oncol Biol Phys 2007;69(4):10518.49. Colletier P.J., Garden A.S., Morrison W.H., et al. Postoperative radiation for squamous cell carcinoma metastatic to

cervical lymph nodes from an unknown primary site: outcomes and patterns of failure. Head Neck 1998;20:67481.50. Strojan P., Anicin A. Combined surgery and postoperative radiotherapy for cervical lymph node metastases from an unknown primary tumour. Radiother Oncol 1998;49:3340.51. Medini E., Medini A.M., Lee C.K. et al. The management of metastatic squamous cell carcinoma in cervical lymph nodes from an unknown primary. Am J Clin Oncol 1998;21:1215.52. Browman G.P., Hodson D.I., Mackenzie R.J., et al. Cancer Care Ontario Practice Guideline Initiative Head and Neck Cancer Disease Site Group. Choosing a concomitant chemotherapy and radio-therapy regimen for squamous cell head and neck cancer: A systematic review of the published literature with subgroup analysis. Head Neck 2001;23:57989.53. Bourhis J., Pignon J.P. Meta-analyses in head and neck squamous cell carcinoma.

What is the role of chemotherapy? Hematol Oncol Clin North Am 1999;13:76975.54. Friesland S., Lind M.G., Lundgren J., et al. Outcome of ipsilateral treatment for patients with metastases to neck nodes of unknown origin. Acta Oncol 2001;40:248.55. Grau C., Johansen L.V., Jakobsen J., et al. Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol 2000;55:1219.56. Erkal H.S., Mendenhall W.M., Amdur R.J., et al. Squamous cell carcinomas metastatic to cervical lymph nodes from an unknown head-and-neck mucosal site treated with radiation therapy alone or in combination with neck dissection. Int J Radiat Oncol Biol Phys 2001;50:5563.57. Kirschner M.J., Fietkau R., Waldfahrer F., et al. Therapy of cervical lymph node metastases of unknown primary tumour. Strahlenther Onkol 1997;173:3628.

59

42012

() () .

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. 1, 1970 . 10 ( 100 000 ), 90- , . , 2009 . - (7,9) 7,2 [2].

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On oral cancer

P.V. SvetitskyDepartment of Head and Neck Tumors

Rostov Cancer Research Institute, Ministry of Health of Russia, Rostov-on-Don

The paper analyzes a rise in the incidence of oral cancer in the Rostov Region since the 1990s. The study has indicated that this rise is asso-ciated with regional population growth due to the forced migrants after the collapse of the USSR. Financial problems, unbalanced nutrition, poor oral hygiene, and depression in this group of patients have contributed to the higher incidence of precancers and cancers.

Key words: oral cancer, morbidity, forced migration

1. ( - )

1970 1975 1980 1985 1990 1995 2000 2005 2009

2,4 2,8 3,1 4,8 6,5 6,8 7,1 6,9 7,9

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60

42012

10 500 [3], (- 280 ) 30 000 [4]. - - [5].

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61

42012

. , 2010 . ( 100 000 ) -, , (9,3), - (9,1) (9,08). (8,5) - (7,9) [1].

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1. .., .., .. 2010 . ., 2011. . 5657.2. .., .. - -. . .. 2010;2(21):589.

3. Robert Koch Institut Berlin. Krebs in Deutschland 20032004. Haufigkeiten und Trends. 6. Auflage, 2008.4. Kornblut A.D. Clinical evaluation of tumors of the oral cavity. In: Thawley S.E. et al. Comprehensive management of head and neck tumors. Saunders, Philadelphia, pp. 460479.

5. Bairagi S.P. A descriptive study of oral cancer in Assam. 6th International Congress on Oral Cancer. India, 1999. P. 99.6. Oral cancer. http://en.wikipedia.org/wiki/Oral cancer. 28.04.12.7. . .. .. . ., 1955.

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62

42012

8. Zain R.B., Rahman Z.A.A., Fukano H. et al. Oral habits, serum micronutrients and oral mucosal lesions among the indigeneous people of Sarawak. 6th International Congress on Oral Cancer. India,1999. P. 157.9. .. . . . - . . , 2007.10. .. . .: . .: , 1979. . 245250.11. Haddad R.I., Shin D.M. Recent advances in head and neck cancer. N Engl J Med 2008;359(11):114354.12. Nouri A.M.E., Cannel H., Oliver R.T.D. Expression of various molecules in solid tumours. 6th International Congress on Oral Cancer. India, 1999. . 46.

13. Miguel R.E.V., Villa L.L., Cordeiro A.C. et al. Prevalence of HPV in oral and oropharynx scc. 6th International Congress on Oral Cancer. India, 1999. . 88.14. Cancer of the oral cavity and pharynx. www.cdc.gov/nohss/guideCP.htm.23.05.2006.15. Guha N., Boffetta P., Wunsch Filho V., et al. Oral health and risk of squamous cell carcinoma of the head and neck and esophagus: results of two multicentric case-control studies. Am J Epidemiol 2007;166(10):115973.16. General Information About Lip and Oral Cavity Cancer. http://www.webmd.com/cancer/tc/ncicdr0000258017 general-information-about-lip-and-oral-cavity-cancer. 03.05.2012.17. Kamijo R. Role of P53 tumor suppressor

gene in proliferation and transformation of oral mucosal keratinocytes: studies using P53 gene knock out mice. 6th International Congress on Oral Cancer. India, 1999. . 62.18. Cancer of the oral mucosa. http://emedicine. medskape.com/article/1075729-overview. 20.06.2012.19. Oral cancer. http://www.cancer.gow/cancertopics/types/oral. 25.04.2012.20. Head and neck cancer. http://www.cancer.gov/ cancertopics/factsheet/Sites-Types/head-and-neck/print. 25.04.201221. Oral cavity cancer: survival trends in England. http://www. Ncin.org.uk/publications/data_briefings/oralcaner.aspx. 19.06.2012.22. Cancer of the oral cavity. htt://www.patient.co.uk/doctor/Mouth-and-Tongue-Cancer. htm. 23.05.2012.

63

42012

- , . 150200 . - .

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Multiple bone metastasis of benign meningioma: a case report

Yu.M. Bogdaev, M.A. Vozmitel, T.I. Nabebina, A.Ch. Dubrovskiy, A.G. Zhukovets, S.A. SemyonovN.N. Alexandrov Republican Scientific and Practical Center of Oncology and Medical Radiology,

Minsk, Republic of Belarus

Reports of metastatic meningiomas are rare. The previous existence of a cranial neoplasm, the non-contiguous site of metastasis and the close histological resemblance point towards the metastatic nature of extracranial lesion.

Key words: meningioma, metastasis, diagnosis

64

42012

, - () . . - EMA , GFAP, CD34, S-100, HMB-45. - panCK, CK 34bE12 ( ).

- / . , - , .

. -

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1131 % [2]. (90 %) , -, -, ( ) , [2]. - 15 % - 10 . - (Grade II) (Grade III) 34 % 100 % [2].

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65

42012

- , - . [8]. . , (, / - ) - [9]. , - - II [10]. , , -- - .

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1. Som P., Sacher M., Strenger S.W. et al. Benign metastasizing meningiomas. Am J Neuroradiol 1987;8(1):12730.2. Louis D.N., Ohgaki H., Wiestler O.D. and Cavenee W.K. WHO classification of tumours of the central nervous system; 4th ed. IARC Press 2007, Lyon; p. 309.3. Drummond K.J., Bittar R.G., Fearnside M.R. Metastatic atypical meningioma: case report and review of the literature. J Clin Neurosci 2000;7(1):6972.4. Figueroa B.E., Quint D.J., McKeever P.E., Chandler W.F. Extracranial

metastatic meningioma. Br J Radiol 1999; 72(857):5136.5. Hasan R., Marshall M.C. Jr, Mehdi M. et al. Meningioma metastatic to thyroid gland. Endocr Pract 2001;7(5):3704.6. Williamson B.E., Stanton C.A., Levine E.A. Chest wall metastasis from recurrent meningioma. Am Surg 2001; 67(10):9668.7. Kros J.M., Cella F., Bakker S.L. et al. Papillary meningioma with pleural metastasis: case report and literature review. Acta Neurol Scand 2000;102(3):2002.8. .., ..,

.. ( ). 2007; 5:4851.9. .., .., . - . 2009;3:569.10. Antinheimo J., Sankila R., Carpen O. et al. Population-based analysis of sporadic and type 2 neurofibromatosis-associated meningiomas and schwannomas. Neurology 2000;54(1):716.

66

42012

- 0,51,5 % , 6,5 %. ( 70 %) 3060 [13].

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A rare case of alveolar sarcoma of the parapharyngeal space

E.N. Novozhilova, A.P. Fedotov, V.N. Grinevich, V.I. Kozlov, I.V. KuzminMoscow City Hospital Sixty-Two

The paper describes the rare malignancy alveolar soft tissue sarcoma. The tumor was located in the parapharyngeal space; it was detected during pregnancy.The authors give the data available in the literature on the clinical manifestations of this disease, the specific features of morphological dia-gnosis, and treatment policy. The described case focuses on the complexities of diagnosis and preoperative preparation and surgical techniques.

Key words: alveolar soft tissue sarcoma, parapharyngeal space

67

42012

, MyoD1 . - S100. - TFE3. TFE3 , - ASPL-TFE3.

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68

42012

- 10 (. 3).

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1. Genin ., Rechavi G., Nagler A. et al. Myofibroblasts in pulmonary and brain metastases of alveolar soft-part sarcoma: a novel target for treatment? Neoplasia 2008 Sep;10(9):9408.2. Nickerson H.J., Silberman T., Jacobsen F.S. et al. Alveolar soft-part sarcoma responsive to intensive chemotherapy. J Pediatr Hematol Oncol 2004 Apr;26(4):2335.3. Portera C.A. Jr, Ho V., Patel S.R. et al. Alveolar soft part sarcoma: clinical course and patterns of metastasis in 70 patients treated at a single institution. Cancer 2001 Feb;91(3):58591.4. Ladanyi M., Lui M.Y., Antonescu C.R. et al. The der(17)t(X;17)(p11;q25) of human

alveolar soft part sarcoma fuses the TFE3 transcription factor gene to ASPL, a novel gene at 17q25. Oncogene 2001;20(1):4857.5. Argani P., Antonescu C.R., Illei P.B. et al. Primary renal neoplasms with the ASPL-TFE3 gene fusion of alveolar soft part sarcoma: a dis-tinctive tumor entity previously included among renal cell carcinomas of children and adoles-cents. Am J Pathol 2001 Jul;159(1):17992.6. Inci E., Korkut N., Erem M. et al. [Alveolar soft tissue sarcoma]. HNO 2004; 52(2):1459.7. Poroshin K.K., Krylov L.M., Kudryavtsev B.N. [Alveolar soft tissue sarcoma]. Arkh Patol 1989;51(5):518.8. Strunk T., Bastian P.J., Ellinger J. et al. [Aggressive course of a malignant alveolar

soft tissue sarcoma]. Urologe A 2007; 46(10):14224.9. Ogose A., Yazawa Y., Ueda T. et al. Alveolar soft part sarcoma in Japan multi-institutional study of 57 patients from the Japanese Musculoskeletal Oncology Group. Oncology 2003;65(1):713.10. Casanova M., Ferrari A., Bisogno G. et al. Alveolar soft part sarcoma in children and adolescents: A report from the Soft-Tissue Sarcoma Italian Cooperative Group. Ann Oncol 2000;11(11):14459.11. Pang L.M., Roebuck D.J., Griffith J.F. et al. Alveolar soft-part sarcoma: a rare soft-tissue malignancy with distinctive c