Vol 14, No 3 (2018)

Objective: an immunohistochemical analysis of the characteristics of a recurrent tumor in breast cancer. Materials and methods. The statistical processing of immunohistochemical analysis’ results was performed and the most frequently encountered molecular-genetic subtypes of breast cancer with the development of local relapses were formulated. The analysis used a standard immunohistochemical panel, which is the “gold standard” for diagnostic in Russia today, and includes the expression of receptors for sex hormones (estrogen and progesterone), expression of the human epidermal growth factor HER2/neu receptor gene, and the index of proliferative activity Ki-67. The 2nd stage of the work was the evaluation of the dynamics of changes in the immunohistochemical characteristics of a recurrent tumor in comparison with the primary one. Results and conclusion. The most common local recurrence provides by triple-negative subtype of breast cancer (42 %). The changes in the immunohistochemical characteristics of a recurrent tumor in comparison with the primary one affected only the index of proliferative activity Ki-67 in the direction of its increase by 12 %.

A little studied question is the development mechanism, timely diagnostics, treatment and prevention of the fibrocystic breast disease at patients with insulin resistance. One of the possible perspective directions of pathogenetic impact on tissues of a mammary gland at the mastopathy associated with a giperinsulinemiya and insulin resistance is use of metformin. Now clinical trials on use of metformin at cancer of mammary glands continue. Data on use of medicines of this group at patients with fibrocystic breast disease in domestic and foreign literature are absent. Objective: assessment of influence of metformin on clinical displays of fibrocystic breast disease and ultrasonic characteristics of a parenchyma of mammary glands at patients with insulin resistance.Materials and methods. As therapy of fibrocystic breast disease patients received metformin in a dose of 1500 mg a day. Dynamic control of a clinical picture of a disease and ultrasonic indicators of a parenchyma of a mammary gland carried out in 3 and 6 months from the beginning of therapy. Results and conclusion. In 6 months of therapy there was a reliable decrease in frequency of a mastalgiya, change of an ultorasound picture of mammary glands: echogenicity of a parenchyma of mammary glands – became sredeny in 95,9% of cases, there was a reliable reduction of thickness of a parenchyma of mammary glands (from 15.5 mm to 10. 5 mm) and diameter of lacteal channels (from 1.7 mm to 0.9 mm). The obtained data on positive influence of metformin on the clinical course of mastopathy and structural changes of a parenchyma of mammary glands at patients with fibrocystic breast disease and insulin resistance allow to consider similar approach as the perspective direction of pathogenetic influence at such pathological association.

This systematic literature review aims to explore currently accepted risk factors for breast cancer, including reproductive status, overweight, radiation, breast radiological density, benign lesions, family history of breast cancer and mutations in breast cancer predisposition genes. The review also covers measures to prevent breast cancer.

Adjuvant hormone therapy is considered the gold standard of therapy for hormone receptor-positive operable breast cancer. The approach to adjuvant hormone therapy in premenopausal patients has changed significantly in recent years. This change was caused by clinical trials, which have confirmed the advantage of adding ovarian suppression to tamoxifen or aromatase inhibitors monotherapy. Individual approach to choosing an appropriate regimen of adjuvant hormone therapy in premenopausal patients with breast cancer should be based on the assessment of risks for relapse, expected effectiveness of treatment and evaluation of drug safety.

Organ-sparing surgeries for vulvar cancer (VC) include wide excision of perineal tissues or hemivulvectomy. The advances in the treatment of VC reduce the risk of complications in patients with somatic pathology and preserve reproductive function in young patients with minimal risk of disease recurrence. The development of new approaches to VC therapy based on currently accepted clinical and morphological criteria will help to improve treatment outcomes. Materials and methods. We retrospectively analyzed the data on 252 patients with VC. Of them, 58 participants had stage I VC, 103 had stage II VC, 79 had stage III VC, and 12 had stage IV VC. The majority of patients (n = 152) underwent vulvectomy; 100 patients underwent extended vulvectomy. Results. Tumor size and depth of invasion are independent prognostic factors determining overall patient survival. The overall survival rate in patients with tumors of 1.5 cm or smaller was 91.7 %, whereas in patients with tumors >2 cm the overall survival rate was 62.2 %. Thefive-year survival rate was 53.9 % in individuals with tumor invasion >1 cm and 84.6 % in individuals with tumor invasion <0.5 cm. Conclusion. We have developed the criteria for minimal vulvar cancer: tumors <2 cm, tumor invasion <5 mm, tumors located outside theclitoris, no tumor emboli in the vessels, no multifocal growth.