Endoprosthesis replacement is the basic method of limb salvage. It allows to improve quality of a life of oncologic patients and does not worsen the disease forecast. At the moment all large joints can be replace with megaimplants. Indications and contraindications for endoprosthesis replacement at oncologic patients are practically defined. A prominent aspect of a favorable outcome of operation is purposeful planned preparation of the patient both careful preoperative planning and definitions of the oncologic status of the patient. Infectious complications after endoprosthesis replacement make 10-12%, instability and fractures of implants - to 14 %. Endoprosthesis replacement is a method of a choice of reconstruction of bone defects at sick of malignant tumors. This method of treatment provides good functional result and allows to supervise a tumor at the majority of patients.

In a current of two years with 2008 for 2010, to six patients with primary malignant and aggressively benign bone tumors of the distal tibia executed six operations, in value of tumor resection with the subsequent reconstruction of defect by an anklejoint endoprosthesis. In group of patients there were five males and one female, with a mean age of 30 years. Among the treated patients 2 were with an osteosarcoma, 2 with Ewing’s sarcoma and 2 with giant cell tumor. The mean duration of followup after the operation was 14,7 months (7 to 28). Reconstruction of the distal tibia defect was carried out using oncological modular endoprosthesis of the ankle joint. Median recurrence free survival during 2,4 years was 83%. Progressing of the primary disease is revealed in 50% in the form of occurrence of the distant metastasis in lungs. A mean functional result assessed with the using of the MSTS system and consisted 75%. During the whole follow up period non of six patients had complications such as periprosthesis infection, instability of a design of endoprosthesis or its fracture. One patient with osteosarcoma half a year after endoprosthesis was installed, revealed a local recurrence during conservative treatment, amputation has been executed. To achieve good clinical and functional results absolute indications for reconstructive operations of an anklejoint should be strictly followed with careful selection of patients according to the results of conservative treatment.

Background. Vulvar sarcomas (VS) are very rare tumors with a frequency of less than 1-2 % from total number of malignant tumors of a vulva. VS arise in female of a wide age range. Materials and methods. We present the clinicopathologic and immunohistochemical features of 4 cases seen in our institution over a period of 5 years (between January, 1st 2006 and April, 30th, 2010). This is a review of the prospective clinical research of patients with vulvar sarcoma, consisting of endometrioid stromal sarcomas (n=2), primary vulvar Ewing’s sarcoma (n=l), aggressive angiomyxoma (n=l). Results. Anamnestic, diagnostic, morphological data, characteristics and results of treatment of patients with subtypes of VS are presented taking into account features of morphological characteristics. All patients have received the surgical, combined, complex treatment in N.N. Blokhin Russian Cancer Research Center. The analysis is carried out in the presented group VS with rare morphological subtypes taking into account different aggression. Conclusion. Sarcoma of the vulva in adults is often published as a case report, given their very infrequent occurrence. Acknowledging and correctly applying restrictions and advantages of such researches which do not belong to «the gold standard» type, it is nevertheless quite possible to apply successfully the saved up data for the development of medical science and for practical public health services.

Complex research which helps to answer a part of the questions, concerning phyllodes tumors treatment diagnostics was carried out. These tumors are characterized as tumors that have a two component structure with the predominant development of mesenchymal component, which in sarcomas is the absolute part. In molecular genetic position it is shown, that germinal mis-sense mutation R1699W of BRCA1 gene carriers have high probability of malignant phyllodes tumor developing and allelic losses at locus D22S264 ofTP5 gene determine the progression of the disease.

Uterine sarcomas (US) are rare mesodermal tumors comprising 2-7% of all malignant uterine neoplasms. They are the most malignant tumors and differ from a uterine cancer on features of metastasis and tactics of treatment. More than half of patients with uterine sarcoma in different terms have local recurrence and distant metastasis after primary treatment. Treatment algorithms of recurrent uterine sarcomas differ enough. Still there’s no uniform approach to this question. However the surgical method remains the basic method of treatment. Surgeons face great difficulties because relapse of uterine sarcomas quite often extends on other pelvic organs. Despite it, surgery gives chance to achieve long remission.

Aim of the study. To evaluate results of surgery alone in the treatment of aggressive fibromatosis during past 4 years. Materials and methods. From January 2006 till January 2010 in the dept, of orthopedic surgery 32 patients with extra abdominal aggressive fibromatosis underwent 38 surgeries (6 patients received additional surgeries due to local relapses). 9 male (28%) and 23 (72%) female patients were included in the trial. Median age was 31 year (16-70 y.o.). 12 patients (37,5%) out of 32 were with primary tumor, 18 (56%) with relapse tumors and 2 (6,5%) patients with undefinitive surgery made elsewhere. 12 (37%) patients out 32 underwent preplanned bone resections and 11 reconstructive surgery was done. Results. In 12 (31%) pathology reported positive margins (Rl) and the wrest were R0. 11 patients had disease progression 3 to 18 month after the surgery, 4 patients were lost of follow up. 7 patients are undergoing conservative treatment for tumor recurrence. 21 (66%) patient is alive without progression with follow up from 3 to 49 month (median follow up 17 months). Following negative prognostic factors were observed: multifocal tumor growth, tumor volume more then 1000 cm³, tumor location near the joints, in soft tissues of forearm, arm, hand, lower leg and foot. Conclusion. Negative margins does not guarantee that tumor will not relapse even with addition of RT or/and chemotherapy and in opposite, sometimes in patients with positive margins recurrence is not observed.

Nowadays diagnostics of gastric malignant lymphomas is still a big challenge due to wide polymorphism of visual picture and is frequently misdiagnosed with cancer or non-epithelial gastric tumors. Aim of the study. To improve ultrasonic diagnostics of gastric non-Hodgkins lymphomas by novel differential and diagnostic criteria. Materials and methods. 250 patients with gastric non-Hodgkins lymphomas and 40 patients with macroscopic non-epithelial gastric tumors were evaluated. All patients underwent esophagogastroscopy following EUS scanning and tumor biopsy. Results. EUS scanning during ambulatory primary patient evaluation may exclude epithelial tumors from differential diagnosis and suppose its histologic structure according to underlying tumor gastric wall layer, presence of capsule, contours characters, echostructure homogeneity and regional lymphoid collectors condition. After detailed evaluation of these parameters final impression can be made and biopsy method maybe chosen. EUS picture of various non-epitelial tumors had specific signs which allowed to carry out differential diagnostics from gastric non-Hodgkin lymphomas during scanning.

Among patients suffering from diseases such as skin melanoma, skin cancer and soft tissue sarcoma, there is a group with locally advanced forms. Standard treatment options may not be effective. For some patients, limbsparing approach is often not possible. Amputation decrease quality of life. Isolated regional perfusion - the method of temporary isolation of the affected limb with the implementation of cardiopulmonary bypass and chemotherapy agents loaded in it. The method of ILP was developed to be able to achieve regional concentrations of chemotherapeutic agents that are 15 to 25 times higher than can be reached with systemic administration, but without the systemic sideeffects. Melphalanbased ILP is associated with complete response rates of 40-50%, and overall response rates of 75-80%. When Tumor Necrosis Factor-alfa was introduced in the isolated limb perfusion model by Lejeune and Lienard in 1988, complete response rates of 80-90% were reported. Multicenter trials confirmed that TNFbased ILP was a highly effective new method of induction biochemotherapy for extremity soft tissue sarcomas with a 20-30% complete remission rate, a 50% partial remission rate and a limb salvage percentage of 80%. We treated 2 patients in RCRC N.N. Blokhin RAMS with isolated limb perfusion with melfalan and mild hyperthermia. Progression not observed for 9 months.

Neurofibromatosis type I is a autosomal dominant hereditary disorder caused by NF1 gene mutations. The main molecular mechanisms contributes to tumor formation in neurofibromatosis type I is angiogenesis stimulation and ras, AKT-mTOR signaling pathways activation. We show that these tumors expressed c-kit and VEGF. Information about clinical trials of target therapy for neurofibromatosis I type patient treatment is cited.

The comparative analysis of IL-6, rIL-6R levels and of general AP activity in blood serum of 159 patients with different malignant and benign bone tumors was carried out. Medians of serum IL-6 levels were found significantly higher in bone sarcomas (5,3 pg/ml), benign tumors (3,2 pg/ml) and also in giant cell tumors (GCT) (3,9 pg/ml) than in control group (1,2 pg/ml, p=0,0001). The highest IL-6 levels were observed in malignant fibrous histiocytomas (MFH) and also in Ewing's sarcomas. As for IL-6 receptors, no differences were observed in rIL-6R levels among bone sarcomas, benign bone tumors and also GCT. The reverse correspondence between initial rIL-6R serum levels (before treatment), treatment pathomorphosis and malignancy level were demonstrated in EwS and OS. rIL-6R serum levels correlated positively with tumor size (T) especially in chondrosarcomas (ChS). Also the positive correlation was shown between general AP activity and both of tumor size and metastasizing (p=0,02) and additionally malignancy level in patients with bone sarcomas. Reliable differences were found in AP serum activity between benign and malignant bone neoplasms. Combination of IL-6 level and of general AP activity was evaluated as the most significant for relapse-free survival prognosis in patients with bone sarcomas by multifactor analysis.