Kaposi's sarcoma is a malignant vascular tumor associated with human herpesvirus-8 (HHV-8). The disease primarily affects the skin, mucous membranes, lymph nodes, and even internal organs in late stages. Kaposi's sarcoma of the penis is usually found in patients infected with human immunodeficiency virus (HIV) and is exceedingly rare in HIV-negative patients.In this article, we report 2 cases of Kaposi's sarcoma in a 42-year-old and 55-year-old patients. Both patients denied any homosexual relationships. Their tumors were represented by 5-mm nodules located close to the external urethral orifice. Both patients have undergone tumor excision. Histological and immunohistochemical examinations demonstrated Kaposi's sarcoma. The 55-year-old-patient had positive nuclear staining with anti-HHV-8 antibodies in the tumor cells, although no anti-HIV antibodies were found in his serum. The 42-year-old patient had a clinically significant increase in the level of human papillomavirus 51 (HPV-51) DNA detected using polymerase chain reaction in his urethral swab sample (3.2 х 10 5 Lg). Both patients were alive after 36 and 34 months, respectively, without signs of disease progression.
Renal cell cancer metastases without evidence of a primary tumor are extremely rare. These variants are usually showed as a spontaneous description of single clinical cases. Aim.This contribution is a clinical follow-up of synchronous renal cell cancer metastases of unknown primary site. Results.A 52-year-old patient U. with a history of increased blood pressure, up to 170/100 mmHg for the last 5 years, who had undergone many instrumental examinations, including ultrasound examination, because of this disease. The computed tomography of the abdomen showed a 4975 mm heterogeneous tumor in the right adrenal gland in October 2017. The combined positron emission and X-ray computed tomography showed a 795441 mm mass in the right adrenal gland, associated with elevated fluorodeoxyglucose metabolic activity SUVmax 7.25. Focal accumulation of the radiopharmaceutical SUVmax 4.31 in a 171124 mm mass was detected in the space of bifurcation in the mediastinum. The lytic lesion (1015 mm) was found in right superior L3 articular process. The patient underwent retroperitoneoscopic adrenalectomy and thoracoscopic removal of mediastinal tumor in November 2017 because of the oligometastatic nature of the process. The histological study identified clear-cell carcinoma with areas of papillary structure in the right adrenal gland. The immunohistochemical study showed carcinoma cells intensively expressing CD10, and some other cells RCC. The immune phenotype of the tumor was identified as clear-cell renal cell carcinoma. The immunohistological and immunohistochemical analysis reviled the metastases of the same variant of renal cell carcinoma in one of 9 lymph nodes. The patient was treated with pazopanib. The primary renal tumor was not detected during the dynamic observation, including the application of annual combined positron emission and X-ray computed tomography. The patient is alive without disease progression with a follow-up of 32 months. Conclusion.Metastases of clear-cell renal cell carcinoma, including adrenal gland, without evidence of a primary site are extremely rare. The main method of treatment is a combination of surgery and targeted therapy, providing long-term local control of the course of the disease.
Key words: thyroid gland, metastases, renal cell carcinomaВведение Рак почки составляет 3,9 % от общего числа онко-логической патологии [1] и 90 % всех злокачественных новообразований почки [2]. Пик заболеваемости при-ходится на 50-60 лет. У мужчин рак почки развивается чаще, чем у женщин (соответственно 4,7 и 3,3 %, или 7-е и 9-е места [1,3]).Метастатическое поражение щитовидной железы является редким случаем, хотя эта железа после надпо-чечников наиболее васкуляризирована [4][5][6][7][8]. В лите-ратуре этот факт объясняют, ссылаясь на гипотезу R. Willis (1931), согласно которой быстрый ток крови через щитовидную железу препятствует прилипанию опухолевых клеток и, кроме того, высокое содержание кислорода и йода тормозит развитие злокачественных клеток [9].Так, H. Chen и соавт. (1999) при ретроспективном исследовании выявили за 8 лет только 10 случаев ме-тастатического поражения щитовидной железы в 1 уч-реждении [10]. K. Kobayashi и соавт. (2015) 15 лет на-блюдали 10 пациентов с метастатическим раком щитовидной железы при почечно-клеточном раке [11]. В клинике Мейо за период в 55 лет выявлено 14 паци-ентов с аналогичной патологией [12].О метастатическом поражении щитовидной желе-зы сообщается в 1,4-3 % случаев среди всех операций на этом органе [13][14][15][16][17][18]. Причем среди всех злокаче-ственных новообразований чаще всего метастазируют опухоли почки (48,1 %), колоректальный рак (10,4 %), рак легких (8,3 %), рак молочной железы (7,8 %), ме-ланома (4 %) и саркома (4 %) [17,[19][20][21]. Но по ре-зультатам вскрытий частота метастазирования коле-
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