Vol 17, No 3 (2025)

Primary malignant tumors of the chest wall account for less than 1 % of all neoplasms, with chondrosarcoma constituting 20 % of these. Secondary chondrosarcomas developing against the background of pre-existing enchondromas or osteochondromas (both solitary and multiple, as seen in Ollier’s disease or Maffucci syndrome) are even rarer. The slow growth of such neoplasms often leads to late diagnosis, and the complex anatomy of the localization poses challenges for specialists, requiring thorough preparation and coordinated work of a multidisciplinary team. The available literature contains limited reports on the surgical treatment of chondrosarcoma of the sternoclavicular joint, the I–II ribs, and/or the sternum, with few observations documented.

 This article presents a literature review dedicated to this issue, as well as two rare clinical cases of patients  with chondrosarcoma of the upper thoracic aperture, which are of interest to oncologic orthopedists, thoracic  and vascular surgeons, as well as diagnosticians.

 Synovial sarcoma is characterized by a typical transcript SS18::SSX. However, despite a common pathogenesis  and similar therapeutic approaches, opposite responses to therapy are sometimes observed. Supposedly, this can be associated with additional and alternative pathways of genetic and epigenetic regulation.
 In this review, the problems of synovial sarcoma  diagnosis, pathogenesis and new therapy methods, including targeting epigenetics, are discussed.

Introduction. Giant cell tumor (GCT) of bone is a relatively rare neoplasm. Its malignant transformation in the form of sarcomatous changes occurs in 8–10 % of cases. The literature lacks data on radiological signs and differential diagnostic criteria of primary malignant GCT of bone. Clear guidelines on the density range of the affected area  for differential diagnosis are also absent.

 Aim. To analyze dynamics of tumor density changes in patients with malignant GCT of bone using computed tomography densitometry.

 Materials and methods. Ten patients (mean age 45.8 ± 4.2 years, range 28–58 years) with malignant GCT of bone were examined. All underwent treatment with denosumab with subsequent surgical intervention. Bone changes were assessed visually. Densitometric analysis was performed in accordance with a method developed by us involving determination of tumor density in Housefield units (HU) and relative tumor density index (k) (ratio between tumor density and density of the unaffected limb at the same level).

 Results. After 6 injections of denosumab, a clear sclerotic rim appeared at the tumor periphery containing thin lines of ossification. Analysis of densitometric parameters showed that tumor density after denosumab administration increased from 46.3 (median (Мe) 35.0; interquartile range (IQR) 51.4) HU to 88.8 (Мe 84.8; IQR 118.4) HU, while relative tumor density index increased from 0.33 (Me 0.22; IQR 0.45) to 0.68 (Me 0.62; IQR 0.89). Earlier we have published threshold values of these parameters (≥139.5 HU and ≥0.97, respectively) at which probability of residual tumor is lowered (sensitivity 81.8 %, specificity 96.6 %). Taking into account these values, 9 of 10 patients required continuation of therapy.

 Conclusion. Computed tomography densitometry allows to evaluate changes caused by denosumab therapy in patients with malignant GCT of bone. According to radiological data, progression of this disease has unique features. Taking into account histological types of malignant GCT, longer periods of observation and denosumab administration or changes in treatment tactics at the preoperative stage can be considered, as well as potential use of this drug in other primary bone tumors.

Introduction. Desmoid-type fibromatosis is a rare locally aggressive tumor originating in connective tissue and characterized by locally destructive invasive growth, high recurrence potential and absence of metastases. In recent years, attempts to standardize the treatment of this disease were made but all current therapy methods have disadvantages and do not guarantee absence of disease progression.

 Aim. To evaluate safety and efficacy of radiofrequency ablation in patients with desmoid tumors.

 Materials and methods. The study included 9 adult patients of both genders (4 men and 5 women) aged 21–65 years with morphologically verified diagnosis of desmoid tumor of the soft tissues with extra-abdominal location. All patients in the study group underwent control examination prior to the procedure. The treatment was performed in several stages at low volume (2–50 cm3) taking into account tumor size. Efficacy was determined using pain syndrome regression per the VAS and Watkins scale, as well as Karnofsky Performance Status Scale. Safety was evaluated per the Clavien–Dindo Scale.

 Results. Analysis of pain syndrome dynamics per the VAS and Watkins scale before and after treatment was performed. For both VAS (p = 0.004) and Watkins scale (p = 0.014), statistically significant changes were observed. Pain syndrome decreased to 50 %, and the percentage of patients declining analgesics increased to 66.7 %. Analysis of the performance status per the Karnofsky scale also showed statistically significant changes (p = 0.015). Mean value increased to 90 %. No complications were reported at the time of the study.

 Conclusion. Radiofrequency ablation showed itself to be a safe and effective method for treatment of desmoid tumors. However, further studies are necessary involving more patients.

Introduction. Cutaneous melanoma is a malignant tumor of neuroectodermal origin developing from melanocytes (pigment cells) of the skin. It is characterized by aggressive growth, high risk of metastasis and progression.

Aim. Retrospective study of outcomes of surgical treatment of cutaneous melanoma with biopsy of the sentinel lymph node and subsequent intervention on regional lymph nodes/observation and evaluation of risk factors of disease progression.

 Materials and methods. Retrospective cohort study was performed at the Nizhny Novgorod Regional Clinical Oncological Dispensary. The study included patients with cutaneous melanoma who underwent surgical treatment with biopsy of the sentinel lymph node.

 Results. Risk factors for disease progression were analyzed, and the unfavorable prognostic value of the thickness  and presence of ulceration of the primary tumor, the presence of melanoma metastases in the sentinel lymph node,  as well as the age of patients and the driver mutation of the tumor were demonstrated. Lymphadenectomy performed after a biopsy of the signaling lymph node and the localization of the tumor had no effect on the disease outcome.

The Ewing sarcoma is one of the two most common bone tumors that occur during childhood and adolescence. This pathology in more than 50 % of cases occurs in the 2nd decade of life and is rare in adults older than 30 years. In men, the Ewing sarcoma develops more often (male-to-female ratio is 1.5:1). This disease is rare in Black patients and Asians. Ewing sarcoma usually occurs in the metaphysis or diaphysis of the long bones of the extremities. Lesions of the pelvic region, ribs and shoulder blades are less common. The most common foci of metastasis are the lungs, bones, and bone marrow.

The article describes a clinical case of treatment of a 12-year-old girl with Ewing sarcoma of the pelvic bones (chemotherapy with a surgical stage: single-stage bone grafting of the resected section of the pubic bone using a rib graft).

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