De-escalation of neoadjuvant therapy for HER2‑positive breast cancer remains one of the key trends in modern oncology. The search for treatment regimens that reduce toxicity without compromising antitumor efficacy remains a clinically relevant challenge.
Purpose of the study. To evaluate the immediate efficacy (pathological complete response rate) and safety profile of a de-escalated 12‑week neoadjuvant THP regimen (paclitaxel, trastuzumab, pertuzumab) in patients with early HER2‑positive breast cancer.

Patients and methods. A prospective single-center study conducted at the P. A. Hertsen Moscow Oncology Research Institute included 55 patients with verified stage IIA–IIB HER2‑positive breast cancer. All patients received THP neoadjuvant therapy consisting of 12 weekly infusions of paclitaxel (80 mg/m²) combined with dual HER2 blockade (trastuzumab + pertuzumab, 4 cycles). The primary endpoint was the pathological complete response (pCR) rate (ypT0/is ypN0). Secondary endpoints included the toxicity profile and the rate of breast-conserving surgery.
Results. A pathological complete response was achieved in 34 (61.8 %; 95 % CI 48.6–73.5) of 55 patients in the overall cohort. Subgroup analysis revealed a statistically significant association between efficacy and biological subtype: the pCR rate was 76.2 % in non-luminal HER2‑positive cancer compared to 52.9 % in the luminal subtype (p = 0.04). High tumor grade (G3, 87.5 %) and high Ki‑67 index (>30 %, 73.2 %) were also significant factors associated with a high probability of pCR. The rate of lymph node metastasis eradication in patients with initial cN1 status was 85.0 %. The safety profile was favorable: no cases of febrile neutropenia or grade 3–4 toxicity were recorded, and no dose reductions were required.
Conclusion. The de-escalated 12‑week THP regimen demonstrates high immediate efficacy, comparable to standard platinum-containing regimens, with an exceptionally favorable safety profile. The results support the use of this regimen as a de-escalation option, particularly for patients with non-luminal tumor subtypes and those at high risk of toxicity from standard treatment regimens.

Purpose of the study. To evaluate the diagnostic performance of intraoperative fluorescence lymphography in patients with colorectal liver metastases (CLM).
Patients and methods. The study included 55 patients with CLM who underwent intraoperative fluorescence lymphography with indocyanine green (ICG) during laparotomy to guide hepatic hilum lymph node dissection (LND) and liver resection. The first three fluorescent lymph nodes (LNs), defined as sentinel lymph nodes (SLNs), were identified within 30–45 minutes after peritumoral ICG injection. LND was performed with excision and labeling of SLNs and all fluorescent LNs detected during the observation period, as well as lymph nodes from stations 12, 13, and 8, regardless of fluorescence. Liver resection was subsequently performed.
Results. In six of 55 patients (10.9 %), no SLNs were visualized. These patients underwent LND with removal of lymph nodes from stations 12, 8, and 13; histopathological examination revealed no LN metastases in this subgroup. In the remaining patients (89.1 %, n = 49), SLN fluorescence was observed. Histopathological analysis demonstrated lymphogenous metastases in 11 of 55 patients (20.0 %). In four of these 11 patients (36.3 %), selective LND based solely on preoperative imaging and intraoperative assessment would have failed to identify and remove metastatic LNs. The sensitivity of ICG lymphography was 100 %: in all 11 patients with nodal metastases, at least one SLN (SLN No1, No2, or No3) was involved. In two cases (18.2 %), metastatic involvement was detected only in SLN No3, with SLN No1 and SLN No2 being negative. Only one of the 11 patients (9.1 %) had additional metastatic LNs beyond the SLN basin; in this patient, all three SLNs were metastatic.
Conclusion. Hepatic hilum LN metastases were detected in one in five patients with CLM. Reliable preoperative or intraoperative identification of metastatic hilar LNs remains challenging. ICG-guided SLN mapping enables more precise lymph node dissection. Further studies are required to determine whether this approach improves long-term oncological outcomes after liver resection for CLM.

Serous endometrial carcinoma (SEC) and clear cell endometrial carcinoma (CCEC) are among the most aggressive subtypes of endometrial cancer (EC), characterized by a high risk of recurrence and metastasis. Mitochondria play a key role in steroidogenesis and cellular metabolism; however, their contribution to hormonal and metabolic tumor adaptation in rare forms of EC remains poorly understood.
Purpose of the study. To comprehensively assess the levels of sex hormones, their receptors, cortisol, and glutathione in mitochondria isolated from SEC and CCEC tissues.
Patients and methods. This prospective study included 41 patients with rare forms of EC. Mitochondria were isolated from tumor tissues – 21 SEC and 20 CCEC. The control group was composed of 20 samples of endometrium unaffected by tumour. Concentrations of estrone, estradiol, estriol, testosterone, progesterone, estrogen receptors (REα, REβ), androgen receptors, progesterone receptors (RP4), cortisol, cholesterol, and glutathione were determined by enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using Statistica 10.0 software.
Results. In mitochondria obtained from SEC and CCEC, compared with tumor-free endometrial mitochondria, levels of testosterone and progesterone were increased by an average of 1.5‑fold, estriol by 1.8‑fold and 2.2‑fold, REβ by 3.5‑fold and 1.8‑fold, RP4 by 2.4‑fold and 5.2‑fold, and the REβ/REα ratio by 2.2‑fold and 1.9‑fold, respectively. Estradiol, REα, and androgen receptor levels exceeded control values only in SEC mitochondria, by 2.0‑fold, 1.8‑fold, and 2.2‑fold, respectively. Cortisol and cholesterol concentrations in mitochondria from rare endometrial cancer subtypes were 1.9–2.5‑fold higher than in tumor-free endometrial mitochondria, while glutathione levels were increased by 1.9–2.4‑fold.
Conclusion. SEC and CCEC are characterized by the formation of a unique mitochondrial hormonal microenvironment with estriol predominance and a high REβ/REα ratio, which may mediate suppression of apoptosis and enhanced proliferation. Differences in receptor profiles indicate distinct mechanisms of hormonal signaling, potentially determining specific features of the clinical course of each tumor subtype. Accumulation of cholesterol and cortisol in the context of elevated glutathione levels indicates metabolic reprogramming aimed at sustaining steroidogenesis and resistance to oxidative stress and apoptosis.

Partial nephrectomy is the treatment of choice for localized renal cell carcinoma. Following organ-sparing surgery, extracellular matrix remodeling processes develop in renal tissue and are regulated by the balance between matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). Conventional assessment of renal function based on serum creatinine levels does not reflect local tissue remodeling processes.
Purpose of the study. To evaluate the dynamics and interrelationship of TIMP‑1, MMP‑2, and serum creatinine levels in patients with renal cell carcinoma after partial laparoscopic nephrectomy, and to determine their association with progression of chronic kidney disease (CKD).
Patients and methods. This prospective study included 633 patients with localized renal cell carcinoma who underwent partial laparoscopic nephrectomy or tumor enucleation. TIMP‑1 and MMP‑2 levels were measured using enzyme-linked immunosorbent assay (ELISA), and serum creatinine was determined by a kinetic colorimetric method preoperatively, on postoperative days 7 and 30, and at 12 and 24 months.
Analysis of CKD progression was performed in a subgroup of patients with complete 24‑month follow-up (n = 119). CKD progression was defined as transition to a higher CKD stage. Correlation analysis, subgroup analysis, and multivariable logistic regression modeling with ROC analysis were performed.
Results. A transient increase in TIMP‑1 levels was observed by postoperative day 7. MMP‑2 demonstrated marked variability, with a peak in median values at 1 month (p < 0.05). A weak positive correlation between TIMP‑1 and MMP‑2 was detected on day 7 (r = 0.10; p = 0.012). No significant association was found between these markers and serum creatinine levels (p > 0.05). At 24 months, higher TIMP‑1 levels were independently associated with CKD progression (OR = 3.6; 95 % CI 1.5–8.7; p = 0.004). The model demonstrated good predictive performance with an AUC of 0.81.
Conclusion. MMP‑2 and TIMP‑1 reflect specific features of postoperative extracellular matrix remodeling and do not correlate with serum creatinine dynamics. Elevated TIMP‑1 levels in the late postoperative period are associated with CKD progression and demonstrate prognostic potential.

Neutrophils, the predominant leukocytes of the innate immune system, are increasingly recognized as potential participants in processes that either promote or suppress tumor development, depending on the tumor's biological characteristics.
Purpose of the study. This narrative review aims to analyze and summarize current knowledge on the functional plasticity and heterogeneity of neutrophils, as well as their dual role in the pathogenesis of cancer and sepsis. Particular attention is given to shared mechanisms of neutrophil dysregulation in these conditions and to the prospects for developing targeted therapeutic strategies.
Materials and methods. A selective literature search was conducted in the PubMed, eLibrary.ru, and Scopus databases covering the past 15 years using the following keywords: “neutrophils”, “cancer”, “sepsis”, “neutrophils in cancer and sepsis”, “immune dysregulation in cancer and sepsis”, “neutrophil plasticity in tumor and infection”, “immunotherapy and sepsis in cancer patients”, “oxidative stress in neutrophils”, “neutrophil–lymphocyte ratio”, and “sepsis-induced tumor growth”. Publications were selected based on their scientific significance, relevance to the topic, and compliance with contemporary evidence-based medicine standards.
Results. The analysis revealed the dual role of neutrophils in cancer and their complex interactions within the tumor microenvironment. The review discusses two neutrophil subtypes, N1 and N2, which exert opposing effects on tumor biology. It also examines the role of neutrophils in the formation and function of neutrophil extracellular traps (NETs), which contribute to cancer progression through their involvement in inflammation, angiogenesis, and metastasis. In addition, the review highlights shared mechanisms of neutrophil involvement in cancer progression and sepsis in oncology patients, with particular emphasis on activated neutrophils and NET formation.
Conclusion. Integrating current knowledge on neutrophil involvement in cancer progression and sepsis in oncology patients may guide future research toward the development of more precise and effective therapeutic strategies for cancer complicated by sepsis, ultimately improving patient outcomes.

Purpose of the study. To analyze published data on the incidence and characteristics of surgical complications following oncoplastic resections in patients with breast cancer (BC).
Materials and methods. The results of 27 domestic and international publications published between 2013 and 2025 were analyzed. Relevant sources were searched in the PubMed, Cochrane Library, and eLibrary databases.
Results. According to the literature, the most common complications after oncoplastic resections in patients with breast cancer included wound dehiscence (3–9 %), seroma/hematoma (2–5 0 %), liponecrosis (1–5 %), infectious complications (4–20 %), and ischemic complications (0.8–2.5 %). The frequency and nature of surgical complications following oncoplastic and reconstructive procedures have been investigated in numerous studies. It is evident that the development of complications after reconstructive procedures may negatively affect patients’ quality of life. A thorough analysis of the causes of complications and strategies for their management allows surgeons to objectively assess the advantages and limitations of different techniques when planning the extent of surgical treatment.
Conclusion. The literature review indicates that various oncoplastic resection techniques, despite the potential occurrence of complications, are not associated with a statistically significant deterioration in aesthetic outcomes or oncological treatment results. However, careful patient selection is required to minimize the risk of surgical complications when choosing among different oncoplastic resection techniques.

Laparoscopic ultrasound provides a wide range of intraoperative diagnostic capabilities during endoscopic abdominal procedures. The absence of key limitations inherent to radiographic cholangiography makes laparoscopic ultrasound a potential alternative method for diagnosing complicated forms of cholelithiasis.
Purpose of the study. To summarize current evidence on the use of laparoscopic ultrasound during surgical interventions for biliary tract diseases.
Materials and methods. A literature review was conducted of publications from 1997 to 2024 indexed in PubMed and Google Scholar using the following keywords: “laparoscopic ultrasound,” “intraoperative ultrasound,” “radiographic cholangiography,” “acute cholecystitis,” “laparoscopic cholecystectomy,” and “choledocholithiasis”.
Results. Analysis of the selected studies highlights the specific ultrasound semiotics of the biliary tract. Comprehensive visualization and interpretation of the structures within the hepatoduodenal ligament contribute to safer surgical procedures and reduce the rate of unplanned conversions. Laparoscopic ultrasound demonstrates high diagnostic accuracy in detecting choledocholithiasis, comparable to radiographic cholangiography. However, only a limited proportion of surgeons routinely incorporate laparoscopic ultrasound into their practice.
Conclusion. Laparoscopic ultrasound represents a viable alternative to radiographic cholangiography. Its advantages include the possibility of repeated intraoperative use, reduced risk of bile duct injury, and shortened overall diagnostic time.

To date, surgical treatment remains the main therapeutic option for patients with chest wall tumors. Given the importance of preserving the structural integrity of the thoracic cage during extensive resections, the choice of reconstruction method for post-resection chest wall defects remains one of the key challenges in thoracic surgery.
This clinical case report presents the treatment outcomes of a 64‑year-old female patient diagnosed with primary multiple metachronous malignancies who underwent rib resection followed by alloplastic reconstruction using a patient-specific 3D implant made of a nickel–titanium alloy. The implant was designed based on an individualized model and featured a double-locking mechanism using clamp-type fixation. At the 12‑month follow-up, no evidence of tumor recurrence was detected; the implant remained stable, the physiological volume of the thoracic cavity was preserved, and no signs of paradoxical respiration were observed.

The proposed patient-specific modular 3D implant is convenient for intraoperative placement, allowing minimization of the risk of bleeding and infectious complications, as well as reduction of operative time. The technique of sternal and rib reconstruction using a patient-specific modular 3D implant is safe and effective and can be widely implemented in clinical practice.

Cerebellar-type multiple system atrophy (MSA-C) presents significant challenges for early diagnosis due to the absence of specific biomarkers and its clinical similarity to other forms of ataxia. The presented clinical case highlights the importance of dynamic monitoring of magnetic resonance imaging (MRI) changes for confirming the diagnosis of MSA-C and demonstrates the characteristic temporal evolution of key neuroimaging markers.
A clinical observation of a 47‑year-old patient with progressive cerebellar ataxia and autonomic failure (orthostatic hypotension, urinary incontinence) consistent with established diagnostic criteria for MSA-C is presented. Brain MRI findings obtained in follow-up with a 7‑month interval are of particular value. First detection of the highly specific “hot cross bun” sign for MSA-C – a cross-shaped area of hyperintense signal in the central pons. Progressive thinning of the middle cerebellar peduncles (by 3 mm), cerebellar vermis atrophy (by 2 mm), and enlargement of the fourth ventricle and pontine cisterns were also documented. These changes objectively correlated with the progression of cerebellar clinical symptoms in the patient.
The findings of this clinical case indicate that dynamic MRI evaluation is an indispensable method in the diagnosis of MSA-C. The appearance of the pathognomonic “hot cross bun” sign and quantitatively measurable progression of atrophy in specific posterior fossa structures (the cerebellum, middle cerebellar peduncles, and pons) over a short time interval represent highly specific radiological criteria that allow reliable differentiation of MSA-C from hereditary ataxias even in the absence of definitive biomarkers. Early and sequential MRI with assessment of imaging changes over time significantly improves the accuracy of antemortem diagnosis of this severe neurodegenerative disease.