AIM: To assess the degree of concordance between the immunohistochemical (IHC) phenotype of breast cancer and the results of multigene mRNA expression analysis using the RAM100 panel with NanoString nCounter technology and to discuss the implications of discordance for IHC reference assessment.
METHODS: The study included 84 cases of invasive breast cancer; all underwent IHC analysis using a standard panel (estrogen receptors (ER), progesterone receptors (PR), HER2 and the proliferative activity marker Ki-67) and molecular genetic analysis of 28 key RAM100 genes using NanoString nCounter.
RESULTS: Discordance between IHC-defined subtype and RAM100 subtype was detected in 34.5 % (29 / 84) of cases; in 21 % (18 / 84) the discrepancies concerned subtypes for which fundamentally different systemic therapy regimens are recommended. BRCA1 mutation was detected in four cases, with two cases showing discordance for both ER and HER2 status. In paired samples (primary tumor / metastasis), phenotype change was recorded in one observation at a 3-year interval.
CONCLUSION: IHC subtyping of breast cancer cannot be considered equivalent to molecular subtyping. The phenotype change phenomenon requires verification at the mRNA and genome level. Determination of nCounter count thresholds for each biological group is a separate task requiring larger series with mandatory IHC slide review.

BACKGROUND: The advancement and refinement of surgical treatment approaches for breast carcinoma facilitate the preservation of a high quality of life in patients following reconstructive procedures, particularly in cases of substantial breast volume and pronounced ptosis.
AIM: To compare the immediate and long-term outcomes and quality of life in patients undergoing two-stage versus one-stage reconstruction after skin-sparing mastectomy in breasts exceeding 150 mL in volume.
METHODS: A retrospective analysis of treatment outcomes was conducted in 115 patients of comparison group 1 with a breast volume exceeding 150 mL. Supgroup 1 (n = 53) comprised patients who underwent mastectomy with two-stage (expander / implant) reconstruction in 2011–2015; group 2 (n = 62) comprised patients operated on in 2016–2020 using the newly developed “Method of reconstruction after subcutaneous mastectomy with preservation of the nipple-areolar complex in large breast volume with grade 3–4 ptosis” (patent RU 2654583 of 21.05.2018). Operative duration, blood loss, and postoperative complications (Clavien–Dindo classification) were documented. Disease-free and overall survival were evaluated using the Kaplan–Meier method; quality of life was measured using the Breast-Q questionnaire before surgery and 6 months after treatment. Parametric and non-parametric methods were employed at p <0.05.
RESULTS: Mean operative duration was 219.0 ± 12.97 min in group 1 and 114.8 ± 7.77 min in group 2 (p = 0.000); intraoperative blood loss was 222.7 ± 26.2 and 62.3 ± 3.73 mL, respectively (p = 0.000). The postoperative complication rate was 33.96 % versus 16.13 % (p = 0.026), with no implant protrusions documented in group 2 (p = 0.000). Five-year disease-free (73.32 % versus 73.89 %; p = 0.787) and overall survival (88.39 % versus 90.45 %; p = 0.578) were comparable. All Breast-Q scales demonstrated statistically significantly higher quality of life in group 2.
CONCLUSION: The implementation of the proposed one-stage reconstruction approach is associated with a statistically significant decrease in postoperative complications, enhanced quality of life, and cost-effectiveness, with no divergence in long-term treatment outcomes.

AIM: To evaluate the possibilities of energy Doppler ultrasonography and ultrasound tomography in the early diagnosis of endometrial cancer and ovarian cancer. To evaluate the intraendometrial blood flow of endometrial polyps and endometrial cancer, as well as the intraovarian blood flow of benign and malignant ovarian tumors using high-tech ultrasound methods Introduction: Early diagnosis of endometrial cancer and ovarian cancer continues to be a complex and relevant problem. The use of energy Doppler ultrasonography and ultrasound tomography allowed not only to visualize small vessels and assess their hemodynamic characteristics, but also to analyze slices less than 1 mm thick and reduce the number of artifacts that complicate the interpretation of the data.
METHODS: The study was a single-center retrospective, selective study conducted at the Russian Scientific Center of Roentgenoradiology. The pelvic ultrasound examinations were performed using the eSaote Pro device with transvaginal and volumetric transvaginal sensors in 2D mode with the use of energy Doppler mapping and ultrasound tomography.The study included 383 patients with a histologically confirmed diagnosis: 141 patients with stage Iа–Ib endometrial cancer, 86 patients with endometrial polyps, 64 patients with localized or relatively localized ovarian cancer without clinical manifestations of ascites or with minimal free fluid volume in the pelvis (stage Iа–IIb), 72 patients with benign ovarian tumors, and 20 patients with ovarian tecomatosis.
RESULTS: The analysis of non-invasive endometrial carcinomas in patients of reproductive age showed an increase in ovarian volume of more than 12 cm3 in the first phase of the menstrual cycle and a multifollicular structure of the ovaries. Summarizing the data of complex ultrasound diagnostics of malignant and benign ovarian tumors, a number of criteria can be identified that suggest a borderline condition or malignant growth:
•   in postmenopause, the structure of non-enlarged ovaries is heterogeneous, iso-hypoechoic, or hypoechoic, with smooth or irregular contours; the presence of blood flow foci with low resistance indices;
•   in the structure of cystic-solid formations, there is a local increase in blood flow in the structure of the solid component and the detection of low-resistance blood flow loci (it should be noted that the structure of the solid component is also iso-hypoechoic);
•   thickening of the pelvic peritoneum without ascites or with the presence of ascites;
•   neovascularization in a malignant process is characterized by multiple shunts.
CONCLUSION: Patients with impaired fat and carbohydrate metabolism, both in the reproductive period and in menopause, are at risk of developing endometrial cancer, especially those with a family history of cancer. The presence of intraendometrial blood flow loci may be a manifestation of both hyperplastic process and endometrial cancer. Ovarian neoplasms containing solid inclusions and parietal solid components in cystic chambers, even with single blood flow loci, are highly likely to be malignant.

This article presents a systematic review of international and domestic experience with the use of trastuzumab deruxtecan in patients with HER2-positive and HER2-low metastatic breast cancer. Based on an analysis of key registration studies (DESTINY-Breast01, -03, -04), and confirmatory clinical trials (DESTINY-Breast02, -12) and real-world clinical practice data from the Clinical Oncology Dispensary No. 1 (Krasnodar) (n = 22) and Federal Scientific Clinical Center of the Federal Medical and Biological Agency of Russia (n = 6), the article summarizes the specifics of drug administration in the Russian healthcare setting, its efficacy profile, and manageable toxicity. A clinical case of a patient with HER2-positive mBC and brain metastases is described in detail, demonstrating long-term disease control (more than 15 months) with trastuzumab deruxtecan therapy in the second line after progression during treatment with a combination of trastuzumab, pertuzumab, and docetaxel. Practical recommendations for clinicians on monitoring the key adverse event – interstitial lung disease and pneumonitis – have been formulated.

Inflammation influences all stages of tumor development and progression, as well as therapeutic response. Only through careful study of every aspect of the biology of the malignant process can we make real advances in the fight against cancer. A combination of anti-inflammatory approaches targeting the tumor microenvironment should be combined with the use of more complex and selective tumor-killing drugs. The future of anticancer therapy lies in drugs targeting procarcinogenic inflammation.

The article highlights the issue of the possibility of performing risk-reducing mastectomy as a cancer prevention for hereditary diseases. A review of the scientific literature has been conducted confirming the advantage of this operation. A clinical case of bilateral subcutaneous mastectomy with simultaneous implant reconstruction in the presence of a mutation in the BRCA1 gene is described.

Hodgkin lymphoma (HL) is one of the most common malignancies affecting young adults of reproductive age. Given the high long-term survival rates, fertility preservation has become a critical aspect of comprehensive patient care. Alkylating agents (procarbazine, cyclophosphamide), which are included in standard chemotherapy regimens, exhibit the highest gonadotoxic potential. However, cases of synchronous HL in monozygotic twins followed by controlled ovarian stimulation are extremely rare in the literature.
Aim. To present a clinical case of successful controlled ovarian stimulation using Aromatase inhibitors and recombinant follicle-stimulating hormone (rFSH) with subsequent oocyte cryopreservation in two patients with synchronous classical HL prior to the initiation of antitumor therapy.
The study included two monozygotic female twins born in 2000 with newly diagnosed classical HL. The first patient was diagnosed with stage IIA disease (international prognostic index 0.4), the second with stage IVB (international prognostic index 1). Both patients underwent controlled ovarian stimulation using a protocol with Aromatase inhibitors and rFSH, followed by transvaginal oocyte retrieval and vitrification of mature oocytes prior to chemotherapy. After completion of the fertility preservation procedures, the patients received polychemotherapy according to the ABVD regimen (6 cycles) and BEACOPP-14 (8 cycles), respectively. Treatment response was assessed by positron emission tomography / computed tomography.
A total of 7 and 5 mature oocytes were successfully retrieved and cryopreserved in the first and second patient, respectively. Both procedures were well tolerated, with no adverse events requiring protocol modification  or discontinuation. Following completion of chemotherapy, both patients achieved complete metabolic response  on positron emission tomography / computed tomography.
This case report demonstrates that controlled ovarian stimulation with Aromatase inhibitors and rFSH followed by oocyte cryopreservation is a feasible and effective fertility preservation strategy in patients with synchronous HL, including those with advanced-stage disease requiring intensive chemotherapy regimens. This observation underscores the critical importance of early multidisciplinary collaboration between oncologists and reproductive medicine specialists to ensure timely fertility preservation in young patients.