Purpose of the study. Solving the problem of searching for prognostic factors of metastatic lesion of regional lymph nodes among the morphological and molecular characteristics of the primary breast tumor will bring modern oncology closer to finding the optimal model for individualizing diagnosis and treatment of breast cancer.

Materials and methods. The statistical analysis of clinical data and morphological factors obtained in the oncology department of the breast pathology of the Voronezh regional clinical oncological dispensary during a comprehensive study involving 223 patients was carried out. Only the stages I T1N0M0 and IIa T2N0M0 were taken into account.

Results and discussion. The study found that patients with a lack of metastases are characterized by a relatively smaller average tumor size (20.43 ± 9.28 mm) than in patients with metastases (27.43 ± 12.4 mm), with 25 % of them having Size ≤10 mm, 50 % – from 10 to 34 mm and 25 % – ≥ 34 mm. The difference in groups on the basis of “age” is absent. A statistical relationship (p < 0.05) between the biological tumor subtype and its histological diagnosis, between the biological tumor subtype and histological diagnosis and the absence / presence of metastases in the lymph nodes (p <0.0001) was established.

Conclusions. Thus, it was established that the histological and morphological study of the primary tumor provides the necessary information not only to determine its sensitivity to different types of systemic treatment and the choice of therapeutic tactics, but also to solve the problem of predicting the metastatic lesion of regional lymph nodes in breast cancer patients.

The rate of triple-negative breast cancer is 10–24  %, and in recent years it’s one of the most studied subtypes of breast cancer due to its clinical aggressiveness and a small number of molecular targets.

The study objective is to evaluate effectiveness of different NAPCT regimens including their dependence on the presence of mutations in the ВRСА 1, 2, СHEK2 genes.

Materials and methods. The study included 40 female patients with triple-negative breast cancer. The patients were monitored from 2012 to 2016; surgical treatment was performed at the P.A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center, Ministry of Health of Russia. Median patient age was 45.9 (31–69)  years. All patients received neoadjuvant polychemotherapy (NAPCT) per different regimens. Then the patients underwent surgery of different volume (from radical mastectomies to resections), and in 25 % of cases reconstructive breast surgery was performed. In 5 patients with BRCA1, – 2 mutations, prophylactic subcutaneous mastectomy with immediate reconstruction with an implant was performed; 2 patients refused prophylactic mastectomy; in 1 patient with СНЕК2 mutation, metachronous multiple primary breast cancer was diagnosed, previously she didn»t undergo prophylactic mastectomy, and 6 years later cancer in the second breast was diagnosed.

Results. The study included 11 patients under 40 (27.5 %), 4 (50 %) of them in the group with mutations in ВRCA1, -2, CHEK2.

The study demonstrated high effectiveness of NAPCT regimens per the АС + Т scheme and weekly injections of doxorubicin 25 mg/m², cisplatin 30 mg/m², and paclitaxel 100 mg/m². Grade IV treatment pathomorphosis for NAPCT per АС + Т scheme was achieved in 50.0 ± 7.9 % cases, for intensified regimen – in 62.5 ± 12.5 % cases.

Median follow-up duration for this patient group was 22.1 months, and during this time disease progression was observed in 3 patients: in the 1st patient continued growth on the thoracic wall and brain metastases were diagnosed, in the 2nd patient – lung and supraclavicular lymph nodes metastases, in the 3rd patient – metastases in the cerebellum. In all of these patients, grade IV treatment pathomorphosis wasn»t achieved.

Conclusions. The study demonstrated high effectiveness of NAPCT in patients with triple-negative breast cancer of different stages: objective response rate was 90.0 ± 4.7 %, grade IV treatment pathomorphosis was 50.0 ± 7.9 %.

Grade IV treatment pathomorphosis for NAPCT per АС + Т scheme was achieved in 50.0 ± 7.9 % cases, for intensified regimen – in 62.5 ± 12.5 % cases. Rate of grade IV treatment pathomorphosis was higher in patients with hereditary form of the disease (62.5 ± 18.3 %) compared to the group with sporadic breast cancer (46.9 ± 8.8 %), р >0.05. In all patients, 2-year disease-free survival was 92.5 %, 2-year overall survival was 95 %.

Introduction. In 70 % of patients with metastases of breast cancer in the ovaries, ovarian damage is detected simultaneously with the primary tumor, which affects the choice of tactics for diagnosis and treatment of such patients.

Materials and methods. The data of 30 patients with breast cancer with ovarian metastases and 35 patients with breast cancer without metastatic ovarian damage, which comprised the main and control groups. The groups were comparable in terms of main demographic and clinical features. Results. In the study of distant indicators, it is proved that the presence of metastases in the ovaries is a reliable adverse factor predicting a 3-year overall survival of patients older than 50 years who are in menopause and who received combined treatment.

Conclusions. Surgical treatment significantly increases the 3and 5-year overall survival of breast cancer patients with ovarian metastases (83.3 %), while the combined treatment of such patients does not significantly affect overall survival despite the high sensitivity of breast cancer to chemotherapy. This may be due to the fact that the patients included in the study who received the combined treatment had metastases to other organs (liver, lungs, bones).

High mammographic density (MD) is a risk factor of breast cancer. The article discusses the relationship between MD and risk of breast cancer and proliferative benign breast disease (BBD), the impact of BBD treatment on MD. The types of MD according to BI-RADS (Breast Imaging Reporting and Data System) are considered. High MD is an independent and strong risk factor for breast cancer, proliferative BBD and precancerous lesions in mammary tissue. Long-term pathogenetic treatment of BBD reduces MD. The drug progestogel, transdermal micronized progesterone, eliminates the imbalance of estrogens and progestins in the mammary tissue, which is the main pathogenic mechanism of the development of BBD. The clinical experience of the evaluation of the effect of progestogel on MD is presented. Progestogel® in monotherapy was prescribed to patients with BBD in the form of cutaneous applications once a day, daily 2.5 g per each mammary gland for 3 months. Patients underwent 3 courses of treatment for 3 months with a break between courses of 1 month. Before the treatment and 1 year after the treatment, mammography was performed. Progestogel reduced MD in patients with BBD.

Mammography with an evaluation of MD is recommended as an objective criterion for evaluating the efficiency of treatment of BBD and chemopevention of breast cancer.

Objective – clarification of the nipple-areolar complex’s (NAC) angioarchitecture.

Materials and methods: search for articles which include the description of the breast angioarchitecture, the description of the several NAC’s blood supply sources and substantiated anatomic data presentation was performed by continuous sampling method in scientific databases. In addition, the information in available anatomic and surgery books was analyzed without special criteria for the selection of used medical literature.

Results. The NAC’s vascularity was grouped in three systems: the medial, which consists of superficial branches of a. thoracica interna and a venous system, which flows into v. thoracica interna system, the central deep system, which consists of perforators of a. thoracoacromialis and aa. intercostales, and the lateral vascular system, consisting of vessels which variably originate from a. thoracica lateralis, a. axillaris and a. thoracoacromialis.

Conclusions. The using of the stable medial vascular system is anatomically substantiated. The central vascular system can be used as additive blood supply source. The lateral system can be used only after pre-examination.

Benign and malignant tumors of the organs of the female reproductive system are the most common diseases requiring medical and surgical treatment. They are rarely the cause of acute complications. However, the thromboembolic disease is a serious illness, sometimes causing death due to acute the pulmonary embolism. Venous thromboembolism secondary to Benign and malignant tumors of the organs of the female reproductive system should be considered in a female presenting with abdominal mass and pelvic pressure. Thromboembolic disease secondary to large tumors should be treated with anticoagulation then hysterectomy. The article presents an analysis of modern literature on optimal prevention of the pulmonary thromboembolism in patients with tumors of the female reproductive system. There are analysis data of 17 (0.7 %) cases of the pulmonary thromboembolism that occurred of 2358 gynecological and oncogynecologic patients.

Endometrial cancer (EC) is one of the most common pathologies among gynecologic cancer patients: It ranks the 3rd in the structure of oncological diseases in women in Russia. Early manifestation of various bleedings and good tumor visualization with ultrasound therapy allow to detect uterine cancer at stages I–II in almost 80 % of patients. Moreover, mortality due to progression has remained stable in the last 10 years. In this regard, detailed study of prognostic factors affecting the course and prognosis of the disease is timely and important for improvement of long-term results. One of the factors of unfavorable prognosis is old age. In this article, characteristics of the clinical course of uterine cancer in women after 70 with concomitant extragenital pathology are considered, and possible improvements for treatment quality of these patients are proposed based on literature results.

The objective is to advance methods of treatment of uterine cancer in older patients and to obtain proven facts of improved prognosis for inclusion into clinical guidelines.

Introduction. Development of hereditary ovarian cancer (OC) and breast cancer (BC) is caused by genetic abnormalities in the DNA reparation system consisting of more than 100 genes. However, currently in the majority of medical centers in Russia, diagnosis of hereditary OC and BC consists of determination of the most frequent mutations (8 points) in the BRCA1 and BRCA2 genes using polymerase chain reaction (PCR). Moreover, these mutations are common in Slavic population while in other populations they are rare or altogether absent.

The study objective is to perform a population analysis of mutations in the reparation system genes which must be considered during chemotherapy prescription.

Materials and methods. Using next-generation sequencing (NGS), we analyzed reparation system genes in 139 blood samples of Tatar female patients with hereditary OC and BC. To compare mutation rates, 67 blood samples from Slavic female patients examined at the Federal Research Clinical Center FMBA (Moscow) in 2014-2016 were analyzed by real-time PCR.

Results. Real-time PCR has shown a 5382insC (NM_007300.3:c.5329dup)  mutation in 36 % of Slavic patients. The same mutation was observed only in 7 % of Tatar women. Performed NGS analysis of 139 Tatar female patients with hereditary BC and OC has identified 61 mutations in the reparation system genes, one third of which (28 %) didn’t belong to the BRCA1/BRCA2 genes.

Conclusion. The NGS method allowed to identify rare mutations characterizing different ethnic groups facilitating prescription of optimal chemotherapy.

Endometrial cancer (EC) typically is treated surgically. Because of the adjuvant treatment implications, complete surgical staging including lymphadenectomy is recommended for high-risk ECs. Sentinel lymph node mapping has the potential to provide information about lymph node metastasis while avoiding potential complications of extended lymph node dissection.

Small cell carcinoma of the vagina is a very rare manifestation of neuroendocrine tumors. In the article, a review of literature on this problem and description of the clinical course and treatment of small cell carcinoma of the vagina from 3 our observations are presented. Personalized approach and combination treatment are, in our opinion, the main principles of treatment of these patients.