Abstract: Background: leiomyosarcoma of veins is a rare group of sarcomas of mesenchymal origin, which develops from smooth muscle cells of vascular . Vascular leiomyosarcoma occurs in 2-5% and have a slow growth. It is rather difficult to diagnose this disease on the basis of only clinical symptoms, most often patients are worried about oedema and pain in lower limbs. To establish the diagnosis, it is necessary to use data of instrumental methods of examination, such as ultrasound, magnetic resonance imaging (MRI) and multispiral computed tomography (MSCT) with intravenous contrast enhancement, which allow to determine the tumor localization, prevalence, involvement of the vessel wall in the process, as well as to exclude distant metastases. The final diagnosis is made according to immunohistochemical studies. Aim: was to study the importance of radiadiagnostics methods in case of such rare disease as leiomyosarcoma of the external iliac vein. Material and methods: 67-year-old woman with complaints of oedema of the lower limb, was examined: an ultrasound study of inferior vena cava and veins of lower limbs, magnetic resonance imaging (MRI) and multispiral computed tomography (MSCT) with contrast enhancement, fine-needle aspiration biopsy Patient underwent operation: «removal of the pelvic retroperitoneal tumor with resection of the external iliac vein' segment and pelvic lymph node dissection.» Histological examination: leiomyosarcoma, G2 FNCLCC. Results: control MSCT - data on the recurrence of the iliac vein tumor and metastatic lesion of organs of chest, abdominal and pelvic cavity were not obtained. Conclusions: a complex of diagnostic methods allows you to properly diagnose. And among these methods, multiphase computed tomography is one of the best imaging method, which shows not only the localization of the tumor, but also helps in staging, excluding or confirming vein thrombosis, solving the issue of resectability of the tumor and identifying distant metastasis. References 1. Le Minh T, Cazaban D, Michaud J. et al. Great saphenous vein leiomyosarcoma: a rare malignant tumor of the extremity-two case reports. Ann Vasc Surg. 2004; 18(2): 234-236. 2. Yucel Yankol, Nesimi Mecit, Turan Kanmaz et al. Leiomyosarcoma of the retrohepatic vena cava: Report of a case treated with resection and reconstruction with polytetrafluoroethylene vascular graft. Ulus Cerrahi Derg 2015; 31: 162-165. 3. Tripodi E, Zanfagnin V, Fava C. et al. Leiomyosarcoma of the Right Iliac Veins presenting as a pelvic mass: a case report. Obstet. Gynecol. cases Rev. 2015; 2 (3): 1-4. 4. Mei Zhang, MDa, Feng Yan et al. Multimodal ultrasonographic assessment of leiomyosarcoma of the femoral vein in a patient misdiagnosed as having deep vein thrombosis: a case report. Medicine. 2017: 96(46): 1-5. 5. Pavlov A.YU., Garmash S.V., Isaev T.K. i dr. Sovremennye predstavleniya o lejomiosarkomah ven zabryushinnogo prostranstva. Obzor klinicheskih sluchaev. [Modern ideas about leiomyosarcoma veins retroperitoneal space. Review of clinical cases.] Onkourologiya. 2016; 12(2): 92-96 [in Russ]. 6. Watanabe K, Tajino T, Sekiguchi M. et al. h-Caldesmon as a Specific Marker for Smooth Muscle Tumors. Am. J. Clin. Pathol. 2000; 113 (5): 663-668. 7. Weiss SW, Goldblum JR. Enzinger and Weiss's Soft Soft Tissue Tumors. 6th ed. 8. Gonzales-Cantu Ye.M., Tena-Suck M.L., Serna-Reyna S. et al. Leiomyosarcoma of vascular origin: case report. Case Rep. in Clinical Pathology. 2015; 2(4): 60-64 9. Мацко Д.Е. Современные представления о морфологической классификации сарком мягких тканей и их практическое значение. Практическая онкология. 2013; 14 (2): 77-86. 10. Чуканов Е., Никитина О., Марио Таха. Лейомиосаркома нижней полой вены. Променева дагностика, променева терапiя. 2014; 4: 69-72. 11. Ahluwaliya A., Saggar K., Sandhu P. et al. Primary leiomyosarcoma of inferior vena cava: an unusual entity.. Indian Journal of Radiology and Imaging. 2002; 12(4): 515-516. 12. Dzsinich C., Gloviczki P., Van Heerden J. A. et al. Primary venous leiomyosarcoma: a rare but lethal disease. Journal of Vascular Surger. 1992; 15(4): 595-603. 13. Kaprin A.D., Galkin V.N., Zhavoronkov L.P., Ivanov V.K., Ivanov S.A., Romanko Yu.S. Synthesis of basic and applied research is the basis of obtaining high-quality findings and translating them into clinical practice. Radiation and risk. 2017; 26(2): 26-40.
Abstract: Aim: was to increase the level of differential diagnosis of thyroid nodules by evaluating their rigidity according to two ultrasound techniques - compressive elastography and shear wave elastography. Materials and methods: study is based on the result of analysis of complex clinical anc ultrasound diagnostics, performed for the period from 2010 to 2015 , on the base of ultrasound department of «Central Clinical Hospital of Ministry of Internal Affairs» of the RF in Moscow, and Medical Radiological Research Center named after AF Tsyba - FGBU branch of «National Medical Research Radiological Center» MoH Obninsk. Results: performed shear wave elastography, obtained quantitative data of rigidity of benign nodules and papillary carcinoma. Used methods of nonparametric statistics and ROC-analysis. Statistical processing was performed in SPSS 13.0 program. For benign nodes median of regidity was 15.6; 2,5-97,5 percentiles - 3,6-81,3; for papillary cancer: median 112.92; 2,5-97,5 percentiles - 13,5-196,4. Then followed an orange and yellow-red: blue color was not more than 20%, but mostly he was absent. In case of papillary cancer we observed two-color, three-color, four-color and six-color color, with prevailing of two colors - purple and blue. Conclusions: both types of elastography - compressive and shear wave elastography - help to improve the differential diagnosis of thyroid cancer. Informativeness of shear wave elastography is higher, in comparison with compressive elastography. References 1. Kotljarov P.M., Harchenko V.P., Aleksandrov Ju.K., Mogunov M.S., Sencha A.N., Patrunov Ju.N., Beljaev D.V. Ul'trazvukovaja diagnostika zabolevanij shhitovidnoj zhelezy [Ultrasonic diagnosis of thyroid diseases.]. M.: VIDAR. 2009: 239S [In Russ]. 2. Mit'kov V.V., Huako S.A., Cyganov S.E., Kirillova T.A., Mit'kova M.D. Sravnitel'nyj analiz dannyh jelastografii sdvigovoj volnoj i rezul'tatov morfologicheskogo issledovanija tela matki (predvaritel'nye rezul'taty) [Comparative analysis of data of shear wave elastography and results of uterine body morphological study (preliminary results)]. Ul'trazvukovaja i funkcional'naja diagnostika. 2013; 5: 99-114 [In Russ]. 3. Sencha A.N., Mogutov M.S., Patrunov U.N. et al. Kolichestvennie i kachastvennie pokazateli ul’trazvukovoi jelastografii v diagnostike raka shhitovidnoj zhelezy [Quantitative and qualitative indicators of ultrasound elastography in the diagnosis of thyroid cancer.]. Ul'trazvukovaja ifunkcional'naja diagnostika. 2013; 5: 85-98 [In Russ]. 4. Osipov L.V. Tehnologii jelastografii v ul’trazvukovoi diagnostike. Obzor. [ Elastography technologies in ultrasound diagnostics. Overview.] Diagnosticheskaya radiologiya i onkoterapiya. 2013; 3,4: 5-23 [In Russ]. 5. Parshin V.S., Yamasita C, Cib A.F. Zob. Ul'trazvukovaja diagnostika. Klinicheskii atlas [Ultrasound diagnostics. Clinical atlas]. Nagasaki-Obninsk. Universitet Nagasaki, 2000; S 106 [In Russ]. 6. Parshin V.S., Cib A.F., Yamasita C. Rak shhitovidnoj zhelezy. Ul'trazvukovaja diagnostika. Klinicheskii atlas [Thyroid cancer. Ultrasound diagnostics. A clinical atlas. In Chernobyl materials.]. Po materialam Cyernobilya. Obninsk. MRNC RAMN. 2002; S 230 [In Russ]. 7. Parshin V.S.,Yamashita S., Tsyb A.F. Ultrasound Diagnosis of Thyroid Diseases in Russia. Obninsk-Nagasaki. 2013; S147. 8. Cib A.F., Parshin V.S., Yamasita C. Ul'trazvukovaja diagnostika zabolevanij shhitovidnoj zhelezy [Ultrasonic diagnosis of thyroid diseases.]. M.: Medicina. 1997; S 329 [In Russ]. 9. Asteria C., Giovanardi A., Pizzocaro A., Cozzaglio L., Morabito A., Somalvico F., Zoppo A. US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid. 2008; 18: 523-531. 10. Cantisani V., D'Andrea V., Biancari F., Medvedyeva O., Di Segni M., Olive M., Patrizi G., Redler A., De Antoni E.E., Masciangelo R., Frezzotti F., Ricci P Prospective evaluation of multiparametric ultrasound and quantitative elastosonography in the differential diagnosis of benign and malignant thyroid nodules: preliminary experience. Eur. J. Radiol. 2012; 81: 2678-2683. 11. Vorlander C., Wolff J., Saalabian S., Lienenluke R.H., Wahl R.A. Real-time ultrasound elastographya non-invasive diagnostic procedure for evaluating dominant thyroid nodules Langenbecks Arch. Surg. 2010; 395: 865-871. 12. Bojunga J., Herrmann E., Meyer G., Weber S., Zeuzem S., Friedrich-Rust M. Real-time elastography for the differentiation of benign and malignant thyroid nodules: a metaanalysis Thyroid. 2010; 20: 1145-1150. 13. Gharib H., Papini E., Paschke R., Duick D.S., Valcavi R., Hegedus L., Vitti P American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr. Pract. 2010;16: 1-43. 14. Moon H.J., Kim E.K., Yoon J.H., Kwak J.Y Clinical implication of elastography as a prognostic factor of papillary thyroid microcarcinoma. Ann. Surg. Oncol. 2012; 19: 2279-2287.
