Introduction: Adrenocortical cancer (ACC) is a rare malignant tumor that originates in the adrenal cortex. Despite extensive molecular-genetic, pathomorphological, and clinical research, assessing the malignant potential of adrenal neoplasms in clinical practice remains a daunting task in histological diagnosis. Although the Weiss score is the most prevalent method for diagnosing ACC, its limitations necessitate additional algorithms for specific histological variants. Unequal diagnostic value, subjectivity in evaluation, and interpretation challenges contribute to a gray zone where the reliable assessment of a tumor’s malignant potential is unattainable. In this study, we introduce a universal mathematical model for the differential diagnosis of all morphological types of ACC in adults.Methods: This model was developed by analyzing a retrospective sample of data from 143 patients who underwent histological and immunohistochemical examinations of surgically removed adrenal neoplasms. Statistical analysis was carried out on Python 3.1 in the Google Colab environment. The cutting point was chosen according to Youden’s index. Scikit-learn 1.0.2 was used for building the multidimensional model for Python. Logistical regression analysis was executed with L1-regularization, which is an effective method for extracting the most significant features of the model.Results: The new system we have developed is a diagnostically meaningful set of indicators that takes into account a smaller number of criteria from the currently used Weiss scale. To validate the obtained model, we divided the initial sample set into training and test sets in a 9:1 ratio, respectively. The diagnostic algorithm is highly accurate [overall accuracy 100% (95% CI: 96%-100%)].Discussion: Our method involves determining eight diagnostically significant indicators that enable the calculation of ACC development probability using specified formulas. This approach may potentially enhance diagnostic precision and facilitate improved clinical outcomes in ACC management.

Stomach cancer continues to be a global health problem, ranking 5th among cancers and 4th among the causes of death from cancer in the world. Autoimmune atrophic gastritis is a chronic autoimmune disease characterized by the production of antibodies to parietal cells and intrinsic factor, followed by atrophy of the mucous membrane of the body and fundus of the stomach. Chronic autoimmune inflammation can lead to damage to the genetic apparatus of the cell and trigger a multi-stage process of carcinogenesis. Our article presents an unusual case of three different gastric tumors, including adenocarcinoma with microsatellite instability, in a patient with autoimmune gastritis.

Аim: to analyze a series of cases of dysplasia and early gastric cancer developed in patients with autoimmune gastritis (AIG), and to identify their clinical and morphological features.Materials and methods. The study included six cases of detection of early gastric cancer on the background of AIG. Four out of six patients underwent endoscopic treatment, and in three out of six cases patients underwent endoscopic mucosectomy with dissection in the submucosal layer. One patient underwent endoscopic surgery in 2017, he continues annual dynamic follow-up without signs of tumour recurrence. A female patient with type 1 neuroendocrine tumour and mild dysplasia is awaiting treatment.Results. In five out of six patients with AIG, the localization of lesions prevailed in the stomach body, while all detected tumours were early ones, and according to the immunophenotype — of a gastric type. The presented cases of tumours were not accompanied by hyperplasia of neuroendocrine cells directly in the area of the tumour itself, but only in the surrounding gastric mucosa. Additionally, several cases of early gastrointestinal stromal tumours were found, which were characterized by low proliferative activity and had small sizes.Conclusion. The predominance of pseudopyloric metaplasia in the surrounding mucosa allows us to consider pseudopyloric metaplasia as a potentially significant change in the gastric mucosa of patients with AIG that may precede the development of gastric cancer.

ЦЕЛЬ ИССЛЕДОВАНИЯ Определить предикторы агрессивного течения адренокортикального рака (АКР). АКР — редкое злокачественное новообразование коры надпочечников, прогноз которого вариабелен. В настоящее время прогнозирование течения заболевания и клинического исхода у пациентов представляет значительные трудности, так как многие вопросы лечения АКР не изучены или требуют уточнения. В частности, не полностью определено прогностическое значение маркеров, которые применяются в клинической практике. МАТЕРИАЛ И МЕТОДЫ Выполнены гистологическое и иммуногистохимическое исследования операционного материала новообразований надпочечников. В исследование были включены 73 пациента с гистологически подтвержденным диагнозом АКР: 51 (69,9%) женщина и 22 (30,1%) мужчины в возрасте от 17 до 82 лет. Для анализа выживаемости использовалась регрессионная модель Кокса. Статистически значимые факторы (p<0,05) в соответствии с результатами независимого регрессионного анализа были включены в анализ методом Каплана—Мейера с последующим попарным сравнением с помощью log-rank-теста. РЕЗУЛЬТАТЫ С повышенным риском рецидива ассоциируются наличие патологических митозов, избыточная секреция альдостерона, смерти — IV стадия по классификации Европейской рабочей группы по изучению опухолей надпочечников (ENSAT), рецидива и смерти — значение митотической активности >20, индекс Ki-67 >12, классический вариант. Независимыми предикторами безрецидивной выживаемости являлись митотическая активность и гормональная активность, общей выживаемости — митотическая активность и стадия по классификации ENSAT. ЗАКЛЮЧЕНИЕ В настоящей работе выявлены потенциальные предикторы течения АКР, которые доступны для применения в рутинной практике. На основании совокупности клинических, морфологических, иммуногистохимических данных, используемых при диагностике АКР, может быть получено представление о выживаемости пациента.

The analysis of the tumor microenvironment, especially tumor-infiltrated immune cells, is essential for predicting tumor prognosis, clinical outcomes, and therapy strategies. Adrenocortical cancer is a rare nonimmunogenic malignancy in which the importance of the presence of immune cells is not well understood. In our study, we made the first attempt to understand the interplay between the histology of adrenocortical cancer and its immune landscape using cases from The Cancer Genome Atlas database and the Endocrinology Research Centre collection (Moscow, Russia). We showed that the oncocytic variant of adrenocortical cancer is characterized by intensive immune infiltration and better survival, and it is crucial to analyze the effect of immune infiltration independently for each histological variant.