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    1. Herzen Moscow Cancer Research Institute, branch of National Medical Research Radiology Center (Moscow, Russian Federation)

    Abstract:Introduction. Melanoma as a specific kind if dermal malignant neoplasms had been first described by Laennec as far back as 1806. On statistical evidence, frequency of a primary skin melanoma in Russia is 1.2-1.9 % among all malignant tumors. In 1820 H. Norris was the first, who discovered “a fungiform stomach disease” in a patient with skin melanoma. According to data of recent papers, metastatic lesions in the gastrointestinal tract in patients with skin melanoma are detected more than in 60 % cases at autopsy, but never diagnosed at treatment stage. Metastatic stomach lesions in patients with skin melanoma are usually asymptomatic, or symptoms are of non-specific. Classification of these lesions at first proposed by Ji Yong Ahn in 2014, and it described three macroscopic forms of melanoma metastases in gastrointestinal tract: nodular, exophytic and flat pigmented. Most of them are usually pigmented, amelanotic metastases are very rare. Objectives. The primary objective of this clinical case descripton is to show the possibilites of multimodal endoscopy, including confocal laser endomicroscopy, in metastatic stomach lesions diagnostics. Methods. Patient K., male, 69 years old, had admitted to the P. A. Herzen Moscow Cancer Research Institute, due to a district oncologist’s referral with a diagnosis “Malignant tumor of hepatopancreatobiliary region with metastases in lungs and dextrocerebral hemisphere. Chronic gastric erosions». Patient had been comprehensively examined in our institution: MRI has confirmed presence of metastatic tumor in dextral temporal region; CT described solitary metastases in the left lung inferior lobe and pancreas cervix. Multimodal upper GI endoscopic examination had been performed, including white-light high-resolution endoscopy (WLI-HD), narrow-band imaging (NBI) with optical magnification 80x (NBI-ME), endoscopic ultrasonography (EUS) and confocal laser endomicroscopy (CLE), using Cellvizio system. Results. At upper GI endoscopic examination, four nodular, eroded on top, lesions sized from 0,5 to 2 cm had been detected in the in the subcardia and in upper, middle and lower thirds of the gastric corpus. Taking in mind, that lesions are multicentric, it was necessary to differentiate primary gastric B-cell lymphoma and metastatic stomach lesions. With NBI examination, it had been discovered, that pit pattern in lesions is regular and there were no signs of surrounding mucosa pathology. Also, no significant changes of intrapapillary capillary loops shape had been detected with NBI-ME. With EUS, it had been revealed, that lesions are hypoechoic, originating from deep part of mucosa, not invading submucosa. We have performed CLE and it had been detected, that in eroded lesions there was absence of glandular or pit structures and presence of chaotically (densely in some areas) located dark irregularly shaped, considerably enlarged, tumor cells nuclei. According to these findings, we have concluded, that lesions are poor-differentiated solid tumors, probably - multiple amelanotic metastatic melanoma. Precise biopsy was performed. Due to presence of considerable neurological disorders a microsurgical resection of the dextral temporal lobe tumor was performed, not waiting for routine pathology or immunohistochemical examination. One week later, pathologists confirmed amelanotic epithelial cell melanoma metastases in gastric mucosa and resected brain tumor mass. Conclusion. Thus, metastases to the stomach mucosa are not so rare events in patients with late stages of neoplastic process at skin melanoma. Multimodal endoscopic examination with CLE provides valuable diagnostic data of stomach tumor morphology, not only carcinoma, but a solid tumors too.

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    Full text is published :
    Pirogov S.S., Sokolov V.V., Kaprin A.D., Sokolov D.V. et al. METASTATIC LESION OF THE STOMACH WITH MELANOMA OF THE SKIN: POSSIBILITIES MULTIMODAL ENDOSCOPIC DIAGNOSIS. Experimental and Clinical Gastroenterology Journal. 2017;144(08):79-86
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    1. N.N. Blokhin Russian Cancer Research Center (Moscow, Russian Federation)
    2. N.I. Pirogov Russian National Research Medical University (Moscow, Russian Federation)
    3. Evrogen Lab LLC (Moscow, Russian Federation)

    Keywords:Cholangiocarcinoma,moleculartumortesting,BRAF V600E mutation,targeted therapy,dabrafenib,trametinib

    Abstract:We report a case of successful targeted treatment of a patient with metastatic cholangiocarcinoma refractory to chemotherapy and immunotherapy. After detection of BRAF V600Emutationinpatient’stumor, dabrafenib + trametinib combo was started which led to dramatic improvement in patient’s general condition and regression of most of the lesions. Effectisongoingafter6monthsoftargetedtherapy. This case demonstrates potential efficiency of a molecularly targeted approach to treatment of advanced cancers.

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      8. Loaiza-Bonilla A., Clayton E., Furth E. et al. Dramatic response to dabrafenib and trametinib combination in a BRAF V600E-mutated cholangiocarcinoma: implementation of a molecular tumour board and next-generation sequencing for personalized medicine // Ecancermedicalscience. - 2014. - Vol. 8. - P. 479.
      9. Hong D. S., Morris V. K., El Osta B. et al. Phase 1B Study of Vemurafenib in Combination with Irinotecan andCetuximabin Patients with Metastatic Colorectal Cancer with BRAF V600E Mutation // Cancer Discov. - 2016. - Oct 11. - DOI:10.1158/2159-8290.CD-16-0050.

    Full text is published :
    Peregudova M.V., Zaretsky A.R., Breder V.V., Romanova K.A. et al. THE EFF ECTIVENESS OF TARGETED THERAPY IN A PATIENT WITH BRAF-POSITIVE METASTATIC CHOLANGIOCARCINOMA. Experimental and Clinical Gastroenterology Journal. 2017;144(08):87-90
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    1. State funded medical institution “City clinical hospital № 15 named after O. M. Filatov” Department of healthcare of Moscow (Moscow, Russian Federation)
    2. State funded institution of higher professional education “Moscow State Medical and Dental University of A. I. Evdokimov” (Moscow, Russian Federation)

    Keywords:kidney damage,antiviral therapy,monoclonal antibodies to CD 20,rituximab (mabthera),mixed cryoglobulinemia,cryoglobulinemic vasculitis,chronic viral hepatitis C

    Abstract:As a clinical case we discuss cryoglobulinemic vasculitis of high activity with predominant kidney damage associated with chronic viral hepatitis C. The result of the treatment by monoclonal antibodies to CD 20 receptors - rituximab (mabthera) - confirms the efficiency of the drug in case of severe cryoglobulinemic vasculitis persistent to the standard treatment, with underlying chronic viral hepatitis C. After the therapy the hemodynamic indexes have stabilized, the hemorrhagic rash did not recur, cryoglobulinemia, proteinuria and hematuria decreased. Unfortunately the immunosuppressive therapy contributed to the increase of transaminase and cholestasis, which leaded to the need of the antiviral therapy for the elimination of the virus and relapse prevention. However, the ways of diagnostics and treatment of the patients with chronic viral hepatitis C with extrahepatic symptoms are not developed, represent serious problem and need to be further studied; the scheme of testing and antiviral therapy should be worked out.

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    1. "Polyclinic № 3" of Affairs Management of the President of the Russian Federation (Moscow, Russian Federation)

    Abstract:Provides data for the treatment of constipation in 37 women in various stages of pregnancy. Highlighted that in addition to dietary measures requires taking laxatives, in particular Forlaks, has a mild laxative effect, long persistent effect and aftereffect, not causing side effects.

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    Burkov S.G. CONSTIPATION IN PREGNANT WOMEN: A MODERN VIEW ON THE PROBLEM. Experimental and Clinical Gastroenterology Journal. 2017;144(08):97-100
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