Surgical procedures of cervical spine tumors includes two steps – removing of the tumor and stabilization. Making of the fixation on the cervical spine requires carefull examination of the patient before the surgical treatment and high accuracy intraoperation control, due to the potential risk of iatrogenic damage of the spinal cord, nerve roots or vertebral artery is the most often on cervical spine. Decreasing intraoperation radiation level on patient and surgical crew is as important problem. The decision of all questions is the use of the computer assisted navigation system. This method allows to make fixation with various type of screws or making intraoperation control of the bone needle biopsy, vertebra- or kyfoplasty with high accuracy, minimal risk of iatrogenic damaging and decreasing radiation level (because of the shortening work time or stop using standard methods of placement control – computer tomography or X-ray).

Osteosarcoma (OS) is the most common primary malignant bone tumor of connective tissue origin it affects teenagers in a very aggressive way. It causes significant harm with poor prognosis, and it is very difficult to cure. during the past two decades, the emergence of neoadjuvant chemotherapy of osteosarcoma has greatly improved the survival rate of osteosarcoma patients (5 year survival 60–70%). nearly half of these patients are not sensitive to chemotherapy drugs and die due to lung metastasis within 2 to 3 years.
The majority of patients (80%) have small tumor foci transferred into their systemic blood before treatment; the importance of improving long-term survival in patients by controlling lung metastases through effective drug and gene regulation has been increasingly recognized. the invasive ability of tumor cells is one of the important factors in their capacity to metastasize to distant locations in the body. Production of woven bone by tumor cells defines the neoplasm, however, variable amounts of cartilage and fibrous tissue matrix are often encountered as accompanying components. Osteoblastic, chondroblastic and fibroblastic types comprise the 3 major cell types of OS, but the percentage of cell type and matrix will vary in any individual case. The role of the pathologist is becoming more important because of the modern genetic and molecular and IHC markers in diagnostic procedures, the pathologists must rise to the occasion.

Pathologic fracture of long bones – threatening complication of the tumor process. Modern methods of diagnostics and combined treatment allow organ-preserving operative intervention in patients with primary and metastatic bone tumors.

Giant-cell bone tumor (GCT) make up 15–20% all cases non-malignant bone tumor. treatment opportunities based on new understanding mechanism of osteoclastogenesis. Denosumab – fully humanized monoclonal antibody (IgG2) to RANK ligand.
Blocking of RANK ligand prevent bone resorption and increasing bone mass 18 patients conclude in study. From 16 to 65 y.o.
13 female and 5 male. Histological verification in all case. 120mg Denosumab per cutaneous injection in 1,8,15,28 days of first month and after that 1 injection per 28days. treatment duration – 18 month.
In all cases we have good and quick response – reduce pain, function recovery. x-ray picture after 2 month therapy show osteosclerosis of bone lesion and cortical layer recovery.
Conclusion Denosumab is a good treatment fore GCT. In case of unresected lesion and difficult localization may be is the single. more patients and time is need to further research

Purpose. To confirm the feasibility and necessity of sentinel lymph node (SLN) examination in patients with clinically localized cutaneous melanoma after removal of the primary tumor.
Materials and methods. The study involved 43 patients with clinically localized cutaneous melanoma who had undergone sparing or wide-local excision treatment at place of residence. SLN examination was performed using the domestic radiopharmaceutical 99mTc-Technephit and domestic specialized gamma-detector «radical».
Results. In all 43 patients, sentinel lymph nodes were identified and examined with biopsy. Subclinical SLN metastases were detected in 10 patients (23.3%), i.e. practically in every fourth patient, and all of them underwent radical lymphadenectomy. In three of these patients (30%), metastases to other lymph nodes were found. The detection rate of SLN metastases increased with level of invasion: Clark level ≤II – 0.0%, III–IV – 21.4%, V – 66.7%; Breslow’s thickness ≤1 mm – 0.0%, 1–2 mm – 12.5%, 2–4 mm – 15.8%, ˃4 mm – 66.7%. The detection rate of SLN metastases was twice as high in patients with ulcerous tumors (31.2 versus 15.0% without ulceration). It was also higher in slight lymphoid infiltration or in its absence compared to moderate and marked lymphoid infiltration: 29.4% versus 18.8%, respectively. During the follow-up period after SLN biopsy, no regional recurrence was noted.
Conclusion. It is feasible and necessary to examine SLN in patients with previously removed cutaneous melanoma. SLN examination helps prevent a regional recurrence in every fourth patient.

Osteosarcoma treatment methods have not been changed for last twenty years. There are five main drugs (such as cisplatin, doxorubicin, methotrexate, ifosfomide, etoposide) which are usually used in different combinations and doses. Results of survival are approximately similar. Five-year overall survival of patients with localized osteosarcoma is 75% and five-year event-free survival is 62%. Survival results of patients with metastatic osteosarcoma are much worse, five-year overall survival is 34% and five-year event-free survival is 20%.
Relevance topic is associated with the fact that the results of treatment osteosarcoma are not satisfactory and optimal therapeutic strategy is unknown. In this connection, new programs are developed based on the experience of pre-existing protocols, taking into molecular-biological features of osteosarcoma cells. Different studies of signaling pathways, tumor microenvironment open the way to possibility of using target therapies (small molecules inhibitors and monoclonal antibodies), cell-cytokine therapy.

The aim of the study was to improve the diagnosis of lymphatic and hematogenous metastasis of soft tissue tumors in children with disseminated lesions.
Material and methods. WBMRI was performed on 15 patients with soft tissue tumors: 13 had malignant lesions, 2 had benign lesions. 7 men, 8 women; age from 1.5 to 16 years. MR imaging was performed using a SIeMenS MAgneToМ AVAnTo 1,5T and SKYRA 3T (germany). WBMRI was performed with T1-se and T2 – STIR sequences in coronary projection. We analyzed the sensitivity, specificity, PPV, NPV of WBMRI in detecting metastasis.
Results. 13 patients were determined disseminated forms of soft tissue tumors with presence of the primary tumor, 2 patients had metastases of the primary lesion that was not detected. Skeletal metastases were found in 5 children, of whom 4 in the bone marrow. 7 patients had enlarged lymph nodes, 1 patient in this case had a false positive result on WBMRI. changes in the lung tissue were detected in 3 patients and were confirmed with CT of the chest. In 1 patient with small foci of up to 3 mm, identified in the CT of the chest is given a false negative conclusion on WBMRI. other organs (spleen, peritoneum, pleura, brain), as the metastatic character of malignant forms of soft tissue tumors, and in particular lesion at the neurofibromatosis type 1 is identified at the WBMRI in 3 patients.
Conclusion. WBMRI showed high information content to identify the primary pathological process and metastatic. Sensitivity of WBMRI and SSC for the detection of bone metastases – 98% and 47.1%, specificity – 100% and 100%, respectively.
WBMRI is more informative for the detection metastases of the target organs than abdominal ultrasound: sensitivity – 100% and 66.7%, specificity – 100% and 100%, respectively. WBMRI gives way ultrasound study lymph nodes: sensitivity – 100% and 100%, specificity – 87.5% and 100%, respectively. WBMRI gives way CT of the chest to identify MTS in lung: sensitivity – 75% and 100%, specificity – 100% and 100%, respectively.

Soft tissue sarcomas belong to a rare group of highly malignant tumors that respond poorly to chemotherapy. A case of a 50-year-old male patient suffering from a tibial chondrosarcoma of the soft tissues is presented; the disease progression after first-line chemotherapy was revealed and treatment with autologous dendritic cell vaccine was initiated. During vaccine treatment for 19 months the patient’s condition is stable. his treatment continues.

This article is devoted to the clinical case of patient with osteosarcoma of calcaneus, a rare localization. Osteosarcoma is high-grade tumor of skeleton and compose 6% of all bones tumors and bone dysplasia, 62% of malignant tumors of bones and 18% of all malignancies in children. Approximately 80% of the metastases are localized in the lungs, metastasis only in the bones, or both in bones and lungs observed in 20% of patients. Patient underwent neoadjuvant and adjuvant chemotherapy and surgery – extirpation of the right calcaneus with the replacement of the defect with thoracodorsal flap.