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The paper discusses the problem in replacing extensive bone defects after adequate resections in patients with locomotor system tumors, defines a concept of an adequate operation, and provides an original classification of osteotumors by the extent of a tumorous process. After extirpation of the clavicle (including resection of the manubrium sterni and the first rib), scapulectomy, inter-scapulothoracic, pelvic, and proximal fibular resections, the author does not replace bone defects, without deteriorating the surgical functional outcomes. In 135 patients, defects were replaced by variously designed endoprostheses (in 23 of them this was done after total removal of the femur or humerus). Postendoprosthetic complications developed in 14 patients: early suppuration (n = 3), metallosis and late suppuration (n = 3), endoprosthetic fracture (n = 5), and intraoperative bone fracture (n = 3). Bone fracture occurred while mastering the procedure and failed to affect therapeutical functional results. In extensive long bone diaphysial defects and combined bone and soft tissue defects, the author used autografting on micro-vascular anastomoses in 34 patients or defect replacement in the Ilizarov apparatus in 8 patients.

Diagnosis of musculoskeletal tumors is quite often difficult and for the accurate diagnosis close collaboration of specialist in orthopaedic oncology, morphologist as well as roentgenologist is required. The more precise diagnosis of bone tumors can be made at specialized Centers (but not centers for general oncology) where roentgenologists and morphologists are trained for musculoskeletal tumors. Leading role in the collaboration of orthopaedic surgeon, roentgenologist and morphologist belongs to the clinician. These theses are confirmed by adduced clinical observations. The causes of diagnostic mistakes are analysed.

The case of preoperative diagnosis of peripheric primitive neuroectodermal tumor (pPNET) of the chest with damage of body sternum in 21-year-old patient is presented in Native literature for the first time. CT and echography data as well as serum tumor-markers level are given. The detection of tissue-markers and electronic microscopy data are the most reliable diagnostic methods. However clinical and routine morphologic examinations are important as well. Our patient received neoadjuvant chemotherapy followed by chest resection and plasty by osseous-musculocutaneous flap on vascular pedicle. Efficacy of polychemotherapy with vincristine, cyclophosphan, farmorubicin and platidiam is proved. Nine months after operation no tumor relapse and metastasis were observe. In spite of relatively low sensitivity of pPNET to cytostatic drugs, combined treatment with neoadjuvant is the most justified. Original method for the plasty of chest defect with no application of artificial materials provides favourable conditions for wound healing with good and satisfactory cosmetic outcomes.

Among the various methods of treating patients with tumors of the skin, a special place is occupied by the Vreden-Ikonomov method. It consists in resection of the affected part of the bone, its digestion (boiling) and replantation

The founders of the method of segmental resection of the limb as an alternative to its amputation are Russian surgeons P.I. Tikhov and N.A. Bogoraz. At the beginning of the 20th century, they put forward the idea - to preserve the unaffected peripheral (functionally most valuable) section of the limb on the main vessels and main nerve trunks in case of tumors of the bones of the limbs, resecting its central section (segment).

Primary gastric cancer is an extremely rare finding in young people. This applies to both children and adolescents [7, 9] and is true even for a sample of patients up to 40 years of age. According to McGill et al. [8], gastric cancer accounts for only 0.05% of malignant tumors of the gastrointestinal tract in children and adolescents. It is generally accepted that the manifestations of stomach cancer in young people practically do not differ from those in older age groups. Usually, developing gastric carcinoma proceeds under the guise of peptic ulcer and the correct diagnosis is made only in the later stages, which determines an extremely unfavorable prognosis for this disease. Histologically, gastric cancer in such patients is most often an undifferentiated adenogenic cancer with a diffuse-infiltrative type of growth.

The paper provides the first interim analysis of a database including information on 806 metastatic kidney cancer patients receiving targeted therapy in the cancer facilities of the Moscow Healthcare Department. It shows a comparative analysis of the periods of first-line targeted therapy with different drugs until progression is established.

Background: Bone sarcomas are extremely malignant prone to rapid hematogenic metastasing. Evaluation of biological marker expression by the tumor is important not only for the search of new potential chemotherapy targets, but for the assessment of the disease prognosis.Aim: A comparative evaluation of matrix metalloproteinases (MMP)-2, -7, -9 and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the serum of patients with primary bone tumors and in healthy people to identify their potential association with the histological characteristics of the tumor and the disease prognosis.Materials and methods: A comparative study of serum MMP-2, -7, -9, and TIMP-1 levels was performed in 54 patients with primary bone tumors (malignant, 45 patients, including central osteosarcoma in 21, periosteal osteosarcoma in 4, Ewing's sarcoma in 11, primary chondrosarcoma in 6, undifferentiated pleomorphic sarcoma in 3, and borderline giant cell tumors in 9) and in 26 healthy individuals with the use of the immunoenzyme technique (Biosource, USA, for TIMP-1 and R&D, USA, for MMP-2, -7, and -9). Results: The TIMP-1 levels in the serum of patients with central and periosteal osteosarcomas were significantly higher than in the serum of healthy controls (р = 0.038 and p = 0.007, respectively). The MMP-9 levels in patients with bone malignancies were significantly lower than that in the normal controls (p < 0.05). There was a positive correlation between serum TIMP-1 and MMP-9 levels in patients with central, periosteal and Ewing's sarcomas (r = 0.37, p = 0.024). No significant differences in the 5-year survival rates related to serum TIMP-1, MMP-2, -7, -9 levels were found in patients with bone sarcomas. However, in those with osteosarcoma and serum MMP-2 > 160 ng/ml, the overall 5-year survival rate was 1.6-fold higher than in those with lower MMP-2 levels, and in those with ММP-9 levels < 377 ng/ml, the 5-year survival rate was 1.4-fold higher than in patients with ММP- 9 > 377 ng/ml. The worst 5-year survival (33%) was found in the patients with serum ММP-2 levels of less than 160 ng/ml and ММP-9 of more than 377 ng/ml. Conclusion: The results obtain suggest that the expression of MMP-2, MMP-9 and TIMP-1 could be associated with pathophysiological changes related to growth and metastatic process of bone sarcomas and osteosarcoma, in particular. This area could be an object for further studies on levels of these biomarkers and their prognostic value in bone malignancies.

The purpose of the study was to determine the role and place of whole body MRI with DWIBS in diagnosis of human loco-motor system oncologic pathology. Two hundred fifty six patients with presumptive diagnosis of oncologic disease were examined. Obtained signal was evaluated by true signal intensity scale in minimal examination volume (voxel), either drawn through the volumetric lesion or in an isolated area of arbitrary shape. Study results were verified using standard MRI protocols (T1, T2, STIR), contrast enhancement, MSCT, radionuclide and morphologic examination. High sensitivity of the technique to pathologically changed tissues with reduced water diffusion coefficient was demonstrated. Magnetic resonance diffusion-weighted whole-body imaging with DWIBS may be recommended as noninvasive screening technique for the diagnosis of both primary and secondary (metastases) oncologic process.

The purpose of the study was to determine the role and place of whole body MRI with DWIBS in diagnosis of human loco-motor system oncologic pathology. Two hundred fifty six patients with presumptive diagnosis of oncologic disease were examined. Obtained signal was evaluated by true signal intensity scale in minimal examination volume (voxel), either drawn through the volumetric lesion or in an isolated area of arbitrary shape. Study results were verified using standard MRI protocols (T1, T2, STIR), contrast enhancement, MSCT, radionuclide and morphologic examination. High sensitivity of the technique to pathologically changed tissues with reduced water diffusion coefficient was demonstrated. Magnetic resonance diffusion-weighted whole-body imaging with DWIBS may be recommended as noninvasive screening technique for the diagnosis of both primary and secondary (metastases) oncologic process.

Objective. The developing and introduction the quality of life (QL) automatized assessment in oncourological patients in clinical practice.Subjects and methods. General questionnaire EORTC QLQ-C30 and modules (QLQ-PR25 and QLQ-BLM30) were selected for QL assessment. The software tools of hospital information system were used for development. There were surveyed 236 oncourological patients.Results. Forms of unitary and dynamic researches were developed for result visualization, interactive modules were developed for data complex analysis. The first results of QL assessment were received. The highest values were in role and social functions (medians were equal 100 points). Fatigue, pain and sleeplessness were disturbed patients most of all (medians — 33,3, 16,7 and 33,3 points respectively). The median of Global health status was not high, only 50 points. There were analyzed three nosological groups of patients: urinary bladder cancer, renal cancer, prostate cancer. And the lowest values of functioning scales were in patients with urinary bladder cancer; also these patients complained of dyspnea reliably more often.Conclusions. The developed technology of quality of life study can be used as a good methodological base for assessment of cure efficiency not only in early postoperational period, but during treatment, and in late time after termination of course of treatment.

The data of 67 kidney cancer (KC) patients with bone metastases, who had been treated at Moscow City Cancer Hospital Sixty-Two in 2002 to 2009 and had undergone skeletal bone surgery, were retrospectively analyzed. The role of surgical treatment for bone metastases from KC was assessed and the factors influencing the patients survival were determined. Surgical treatment for bone metastases from KC was ascertained to yield satisfactory results in improving the quality of life and increasing survival rates in the patients.

The paper provides the first interim analysis of a database including information on 427 metastatic kidney cancer patients receiving targeted therapy in the cancer facilities of the Moscow Healthcare Department. It shows a comparative analysis of the periods of first-line targeted therapy with different drugs until progression is established.

In 2003 malignant neoplasms (MN) of the urinary system and male genital organs affected more than 43,000 people in Russia, amounting to 9.4% in the structure of total cancer morbidity. In 2012, the incidence of urologic cancers at only three sites (prostate, kidney, and bladder) was 12.1%. In the same year, Moscow showed the proportion of patients with new-onset urologic cancer, which accounted for one sixth (16.5%) of the total MN morbidity and almost one fifth (18.5%) of the total number of registered cancer patients.

The data of 60 patients with metastatic kidney cancer involving the vertebrae who had undergone different-volume surgery were retrospectively analyzed. The role of surgical volume was assessed. In patients with solitary spinal metastases, their radical removal was found to lead to better quality of life and longer survival. Puncture vertebroplasty with bone cement in patients with spinal metastatic involvement permits one to avoid traumatic fixing operations, without reducing the median survival at the same time.

The expression of MMP-1, -2, -9 and TIMP-1 was studied in 10 benign cartilage-forming osteal tumors (5 osteochondromas and 5 chondromas) and 39 chondrosarcomas (14 central, 4 periosteal, 7 dedifferentiated, and 14 secondary tumors). No expression of MMP and TIMP-1 was detected in benign cartilage-forming osteal tumors. In chondrosarcomas, the expression of MMP-1 was detected in 84.6%, of MMP-2 in 71.8, of MMP-9 in 97.4, and of TIMP-1 in 82.4% cases, the levels of expression of these markers varied from 10 to 60%. The expression of MMP-1 was not associated with patient gender, maximum size and degree of differentiation of the tumor, but was linked with age. The expression of MMP-1 was more often detected in central and dedifferentiated chondrosarcomas; the expression of MMP-1(+) was significantly associated with 3-year relapse-free and 5-year overall survival of the patients. The expression of MMP-1 in the tumor was associated with unfavorable course of the disease. The values of MMP-2 expression in chondrosarcomas did not reflect the main clinical morphological characteristics of the disease and its prognosis. The level of MMP-9 protein expression in chondrosarcomas ≥40% is prognostically unfavorable, while

Case of chronic hemorrhagic villous synovitis (CHVS) of the spine in 20-years old male is presented. Tumorlike formation was located in lumbar region. The initial diagnosis was the benign tumor which was removed. Two years postoperatively the recurrence with light neurologic deficit was detected. MRT revealed multi- nodulous formation with homogenous structure and 11.8 x 8.7 cm in size. The formation spread rightly, posteriorly and infiltrated into soft tissues and iliac bone. Biopsy results suspected malignant histiocytoma and symptomatic treatment was recommended. In specialized hospital repeated biopsy was and CHVS was diagnosed. Pathologic focus was removed and destroyed L3 spinous process and lateral sacrum were resected. Postoperatively radiotherapy (60 Gy) was given. Seven months after surgery no recurrence was detected. Diagnostic problems are discussed. In CHVS authors recommend to use the combined treatment.

Author speaks an active supporter of the wide application of plastic surgery methods in clinical oncology. The experience of Department of Plastic and reconstructive Surgery at Moscow Municipal Clinical Oncologic Hospital has showed that application of different microsurgical technique of autotransplantation allowed to significantly widen the indications to organsaving operations in malignant tumors of loco-motor system, considerably improve both oncologic and functional results of treatment.

The experience of total resection of long bones in 32 patients with malignant and metastatic tumors is presented. When tumor was located in the femur the bone defect was filled in by Sivashs implant complex; when the tumor was located in the shoulder - individual custom polymeric implants were applied. After clavicular extirpation no defect was filled in, however it did not affect functional disability of the hand and when the patient was dressed the cosmetic defect was not seen. In vast damage of the humerus diaphysis and intact epiphyses the authors recommend to perform diaphysis resection followed by the application of autograft from fibula on microvascular anasthomosis. After those operation the hand function was completely preserved. In patients with metastatic damage total resection of long bone was carried out in case of solitary metastase as well as in multiple metastases with pathologic fractures or with the risk of pathologic fractures. The indications for total resection of the femur in metastatic tumors should be strictly limited because of severity of the operation. Total resection of long bone with correct planning and careful operative technique versus amputation and exarticulation gives the same oncologic outcome and herewith provides significantly higher of patients life.

During the period from 1972 to 2002 six hundred ninety three patients with primary and metastatic tumors have been operated on at Moscow oncologic hospital # 62. Preserving operations have been performed in 86% of patients with 11% recurrence rate. After amputation and exarticulation tumor relapses were recorded in 18% of patients. At strict observance of the ablation principles the recurrence rate did not exceed 2%. It has been shown that the use of modern plastic and reconstructive surgical techniques, including the microsurgical ones, significantly increases the potentialities of the performance of adequate (radical and ablastic) preserving operations in patients with loco-motor system tumors and thus improves the quality of life in this group of patients.

The paper gives a rare case of soft tissue chondroma in a 55-year-old female woman who has unsuccessfully received physiotherapeutic procedures for more than 6 months due to misdiagnosis. The patient detected the tumor herself. Clinical and X-ray diagnostic difficulties are considered. Differential diagnosis was made between synovial chondromatosis and chondrosarcoma. A correct diagnosis could be established only at open tumor biopsy. The neurovascular fascicle, tendons, and an intrinsic group of shoulder muscles could be preserved during radical surgery. The problems in the morphological diagnosis of extraskeletal chondroma are discussed in detail. The results of organ-preserving resection are presented.

A total of 109 patients with chondrosarcoma were operated on in 2005-2007. Classical primary chondrosarcoma was verified in 77 cases; secondary and periosteal chondrosarcomas were confirmed in 28 and 4 patients, respectively. By analyzing their findings and the data available in the literature, the authors considered the current problems in the classification and diagnosis of the most common types of cartilaginous malignancies. New techniques, including cytogenetic assay, significantly alleviate this problem. However, the most precise cytogenetic assays are expensive and not always accessible for usual oncological care. The principal criteria in practice are a clinical picture, the results of radiation studies, and the standard histological method that establishes the differentiation of chondrosarcoma, the extent of a process, and the specific features of tumor growth. Immunohistochemical assay are of no crucial importance. In some cases, fine-needle biopsy may provide useful information to make a decision on treatment policy.

Bizarre paraostial osteochondromatous proliferation (BPOP) is a reactive process composed of bone and cartilage attached to the surface of a bone, the condition was first described by Nora et al. as a reactive proliferation involving small bones. A case of a 76-year-old male represents the first description of BPOP in the Russian literature. The patient has a history of trauma, the duration of symptoms being more than a year. Xray study shows suspected secondary chondrosarcoma. The benign space-occupying lesion BPOP is verified after wedge resection of the phalanx. The described condition seems to occur more frequently than reported in the literature. Current imaging techniques and histological study permit avoidance of diagnostic errors and correct choice of the scope of treatment.

Desmoplastic fibroma (extra-abdominal desmoid) was first identified as an independent nosological form in 1958 by H.L. Jaffe [6]. This tumor differs significantly in its course from the desmoid of the abdominal wall. It has a pronounced ability to infiltrate the surrounding tissues, there are frequent cases of tumor spread to the vessels and nerves. The disease usually affects soft tissues. Extra-abdominal desmoids often occur in the area of ​​the shoulder, chest wall, back, and scapula [1, 6]. Desmoplastic bone fibromas are extremely rare. So, R. Buhm et al. [5] described two cases of this tumor affecting the tibia. According to their data, by 1996 only a few dozen cases of bone lesions were presented in the literature. N.P. Petrovichev [3] described the case of femoral desmoid. In the book by S.T. Zatsepin "Saved surgery for bone tumors" [2] reports on operations on the forearm in two patients with recurrence of desmoplastic fibroma. Surgical interventions were accompanied by resection of the bones of the forearm. The observations are interesting, but in neither case are there any clinical or radiological data that could indicate damage to the bones of the forearm by desmoid, and the author himself does not indicate this. We did not find other publications on desmoplastic bone fibroma in the domestic literature. According to N.N. Petrovichev with reference to the work of H.J. Spjut, published in 1971, only 6 cases of femoral injury were described in the literature by that time.

Ossifying fibromyxoid tumor (OFMT) is a rare tumor of unknown histogenesis. It consists of chains and trabecules of ovoid cells in the fibromyxoid stroma (ICD code 8842/0). Tumor is frequently surrounded in part by a capsule of laminar bone. It is more frequent in males 14-79 years of age, mean 44 years. Soft tissues of extremities is a preferable location, but body, neck, oral cavity, mediastinum and retroperitoneal tissue can also be the site of OFMT. More than 100 OFMT cases are reported abroad. It is frequently masked by other tumors of soft tissues. We describe 3 cases in our country: 2 in 65 and 66 year old females and in a 44 year old male. Lipoma and soft tissue sarcoma were suspected clinically. Fibroblasts were found cytologically before operation in one case. Diagnosis was established after total biopsy of the tumor. One of the females is under observation after the operation without recurrence during more than two years. Preoperative diagnosis is sometimes possible when characteristic osteoblastic foci are observed.

A suigical intervention called extremity resection was developed. It consists in removal of the entire segment of the extremity (including bones, joints, muscles and skin) after preisolation tluoughout its extention of great vessels and nerves wlrich are preserved. With a tumor in the bones forming a knee joint, the operation ends with the application of the exterior fixation apparatus to achieve consolidation of the femur and the tibia. Then osteotomy is perfonned at one or two levels and the extremity is extended in the apparatus. A bone defect may be replaced by an endoprosthesis on the arm where shortening lesser affects the function after resection of an extremity segment with the ulnar joint. Eight patients with various malignant tumors were operated on in accordance with this procedure.

Technique of chest reconstruction after sternum resection in its metastatic lesion is presented. This technique includes three methods of reconstructive surgery. For pleura defect closure greater omentum on a vascular pedicle is used. Bony frame is reconstructed using special fast hardening plastic plates. These plates are produced during surgical intervention. Whole construction is covered by vascularized thoraco-dorsal muscular-cutaneous flap. The application of that technique enabled to successfully perform radical operation in 3 with severe metastatic lesions.

The author's conception on adequate operations is set forth. He considers adequate only those operations which are performed radically with abidance by ablastemic rules and consideration of the principle of a sheath structure and location after A. I. Rakov, with maintenance of the function of the operated on limb to a maximum degree. Both resection and amputation may be adequate as well as inadequate. The principle elaborated by N. A. Bogoraz and P. I. Tikhov underlies adequate resections. The author's data on the late-term results (follow-up periods of over 20 years) of resections after Tikhov-Linberg in malignant tumors of the ++brachio-scapular region are presented.

The paper deals with analysis of data on 37 cases of scapular neoplasms who had undergone such radical function--saving surgery as interscapular-thoracic resection ( Tikhov - Linberg 's operation) (27) or scapulectomy (10). Modifications of both procedures developed by the authors are described. Their application was followed by an improved functional status as compared with other surgical procedures. Oncological status of 30 cases of primary scapular malignancies is discussed: 23 patients were recurrence- and metastasis-free during a follow-up period of 10 months-18 years (21 patients were operated on more than 5 years ago).

The results of surgical treatment of 12 patients with metastases in long tubular bones are presented. Palliative surgery-reaction of the heads of bones or removal of the entire long tubular bone with prosthetic replacement--was performed in all cases. All the patients went through the operation well and were discharged from hospital. Pain subsided in all cases and the patients make satisfactory use of the operated extremities. The average survival time by the data of this report was 10.6 months. No local recurrences after bone resections were registered. Due to palliative surgery for metastases into long tubular bones, the patients do not suffer from pain, are mobile and self dependent again. A long survival time may be expected in some cases (solitary metastases), when such palliative procedures are employed.