The article presents the results of a multicenter study of the treatment results of 35 patients with a preliminary clinical diagnosis of "adrenal cyst" who underwent various types of surgical operations or underwent non-surgical management. Radical operations were performed in 13 patients, puncture treatment in 22 patients. The incidence of tumors with cystic transformation among all patients with a preliminary clinical diagnosis of adrenal cyst was 15.4%, of which pheochromocytoma was 13.4%. Of the 13 operated patients, pheochromocytoma was detected in 23.1% of patients, in 76.9% benign tumors with cystic transformation and simple cysts were detected.
BACKGROUND: Adrenal cysts are rare neoplasms of this localization. Among all tumors of the adrenal glands, cysts occur in 5–10%. Parasitic cysts due to echinococcal disease — up to 7%. Randomly identified cysts during X-ray examinations are observed in 5–9%. According to the results of autopsies, cysts amount to 0.06–0.18%.
AIM: Evaluation and improvement of the results of differential diagnosis and treatment of patients with a preliminary clinical diagnosis of adrenal cyst.
MATERIALS AND METHODS: The analysis of the results of examination, treatment and follow-up of 52 patients with a preliminary clinical diagnosis of "adrenal cyst" who were treated in six hospitals of the Moscow Department of Health from 2009 to 2023 was carried out. A retrospective analysis of CT images was performed in all radically operated patients and in 8 who underwent puncture treatment. CT criteria for simple cysts and tumors with cystic transformation are described, taking into account morphological results in radically operated patients. The long-term results of surgical treatment were evaluated in comparison with the results of observational (nonoperative) management tactics.
RESULTS: Reliable CT criteria of a simple adrenal cyst have been identified, on the basis of which indications for surgical or non-surgical treatment of patients have been proposed. A comparison of the results of dynamic observation, sclerosis and radical surgery revealed that sclerosis is characterized by the highest frequency of complications (13.5%) and the lowest efficiency, and adrenalectomy / resection is characterized by a high frequency of "vain operations" — in 10 out of 13 cases (76.9%) in the absence of absolute indications for surgical treatment. The frequency of discrepancies in clinical and morphological diagnosis (cyst/tumor) was 8 out of 13 operated patients (61.5%, p-value <0.0001), and the frequency of critical discrepancy (cyst/pheochromocytoma) was 3 out of 13 operated (23.1%, p-value 0.044). At the same time, the reverse interpretation of the data obtained is of clinical importance: the decision on surgical treatment in this group of patients was 
correct in 23.1% of the operated patients — in the case of pheochromocytomas, whereas in the remaining 10 out of 13 cases (76.9%) there were no absolute indications for surgical treatment.
CONCLUSION: Nonoperative management (dynamic follow-up) of patients with simple adrenal cysts is characterized by the best results in comparison with both types of surgical treatment.

BACKGROUND. A feature of papillary thyroid carcinomas is the frequent lymphogenic spread. First of all, the lymph nodes of the central zone are affected. According to current clinical guidelines, preventive lymphodissection is currently not indicated. At the same time, the detection of "hidden" metastases can lead to a change in the stage of the disease, stratification of the risk group for recurrence, and influence treatment tactics. Our study is aimed at identifying the key factors influencing metastasis to the lymph nodes of the IV neck group. AIM: The study is aimed at identifying key factors influencing metastasis to the lymph nodes of the sixth group of the neck in the initial stages of papillary thyroid cancer.

MATERIALS AND METHODS. A single-center uncontrolled study was conducted, including 319 patients with papillary thyroid cancer without clinical signs of regional lymph node metastasis (T1-2N0M0, stage I). All patients underwent thyroidectomy with preventive central cervical lymphodissection. RESULTS. Among 319 patients, a "hidden" metastatic lesion of the lymph nodes of the central zone was found in 36.4%. Multifactorial analysis revealed predictors significantly increasing the risk of metastasis: age <55 years (p=0.008), extrathyroid invasion (p=0.016), male gender (p=0.017), tumor size >1 cm (p=0.026).

CONCLUSIONS. An increased risk of "hidden" central lymph node metastatis in papillary thyroid cancer with cN0, was detected in patients younger than 55 years old, with the presence of extrathyroid invasion, males and tumors larger than 1 cm. These factors should be taken into account when choosing the amount of surgery.

Hypoglycemic syndrome (HGS) is a symptom complex that develops due to an imbalance in the blood glucose maintenance system with the development of hypoglycemia and is stopped by the administration of glucose. One of the most relevant methods at the present stage for the diagnosis of hereditary causes of HGS is whole exome sequencing. The description of two cases in the same family (mother and daughter) is presented, when using whole exome sequencing with the study of genes responsible for HGS, it became possible to establish an accurate diagnosis of a combined hereditary pathology (multi ple endocrine neoplasia type 1 syndrome (MEN1) and maturity-onset diabetes of the young 12 (MODY12)) and to determine a clear management strategy for patients. The presented family case highlights the importance of an extended genetic examination for an accurate diagnosis of the disease; confirms the need for MEN1 gene sequencing in young patients of the risk group, even if primary hyperparathyroidism has not yet manifested in them; once again demonstrates the variability of phenotypic penetrance of hereditary diseases (in particular MEN1 and MODY12); It recalls the expediency of considering the use of in vitro fertilization with preimplantation genetic testing in order to prevent the transmission of hereditary diseases to offspring; highlights the complexities of imaging diagnostics of neuroendocrine tumors

Metastatic lesions of the thyroid gland are extremely rare: in the English-language literature, only 24 clinical cases of colorectal cancer metastasis to the thyroid gland were previously reported. We present a rare clinical case of metastatic thyroid carcinomatosis in a 39-year-old female patient who underwent combined treatment for rectal cancer. In 2018, the patient underwent a laparoscopic-assisted anterior resection of the rectum, with extended lymphadenectomy and preventive ileostomy for rectal cancer (adenocarcinoma), followed by 8 courses of chemotherapy. For the first time, a node in the right lobe of the thyroid gland was detected in August 2020, at the same time a fine-needle aspiration biopsy was performed, the cyto logical picture of which was characteristic of papillary carcinoma, class VI according to Bethesda. In September 2020, the patient underwent surgery in the amount of thyroidectomy, lymphadenectomy III, IV, VI levels of the neck on the right. In order to clarify the histogenesis of tumor foci, an immunohistochemical study was performed (SK-7, SK-20, CDX-2 (DAK-CDX-2), SATB-2 (EP281)). Histological examination of the right lobe of the thyroid gland revealed a metastasis of low-grade adenocarcinoma of the intestinal type with a desmoplastic reaction of the stroma, extensive foci of necrosis, and tumor thrombi in the lumen of blood and lymphatic vessels. In 3 lymph nodes, metastases of poorly differentiated adenocarcinoma with subtotal replacement of lymph node tissue were also detected.

Pheochromocytoma (paraganglioma) is a hormonally active tumor originating from the chromaffin tissue of the sympathoadrenal system, secreting a large amount of catecholamines. In the overwhelming majority of cases, this tumor is located in the adrenal glands; however, as early as 1953, I.J. Zimmerman et al. first described a clinical observation of a paraganglioma of the bladder. Since then, there have been publications in the global literature regarding the treatment of around 250 cases of this pathology. The diagnosis of bladder pheochromocytoma is often made late, even in the presence of the typical clinical symptoms described above. Early diagnosis of neuroendocrine tumors in atypical locations can be achieved by conducting tests for catecholamines, chromogranin A, and metanephrines in blood and urine. Given the rarity of this location, the complexity of diagnosis, preparation for surgery, and intraoperative challenges, this topic remains relevant. The removal of bladder pheochromocytoma can be performed through a transabdominal approach using modern endovideosurgical technologies, particularly the da Vinci robotic system, which ensures rapid resection of the bladder and minimizes the intraoperative hypertensive crises that may arise. This article presents a clinical case of bladder pheochromocytoma with robotic-assisted tumor removal.

We present a case of urinary bladder pheochromocytoma with robot-assisted tumor resection. 

The correlation between pheochromocytoma/paraganglioma (PHEO/PGL) and cyanotic congenital heart defects is rare but not coincidental. Research suggests that the development of PHEO/PGL in these patients maybe explained by chronic hypoxia, disruptions in the sympathetic nervous system, and potential genetic predisposition. These factors may provoke the tumor transformation of chromaffin cells. Additionally, diagnosing PHEO/PGL in patients with heart defects is complicated by hemodynamic disturbances that mask the characteristic sympathoadrenal crises of PHEO/PGL. The occurrence of these neoplasms can exacerbate the clinical course of congenital defects due to increased catecholamine secretion, leading to vasoconstriction and worsening hypoxia. We present two clinical cases of PHEO/PGL in the context of congenital heart defects, with patients observed and treated at the N.N. Blokhin National Medical Research Center of Oncology and the A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery. These observations emphasize the importance of vigilance for symptoms of tachycardia and uncontrolled hypertension in such patients. Despite their rarity, the relationship between these pathologies must be considered for accurate diagnosis and optimal treatment selection.

In this case report the authors inform about primary hyperparathyroidism (PHPT) caused by an atypical tumor of the parathyroid gland. The diagnosis of PHPT was established only six years after the patient developed disease-specific complaints. According to scintigraphy with 99mTc-technetril and multislice computed tomography, a giant adenoma of the parathyroid gland on the right was identified. Considering the increased risk of the patient having a malignant neoplasm of the parathyroid gland, extended surgical treatment of PHPT was performed in the enblock volume. The operation was accompanied by resection of the right recurrent nerve. The reconstruction was performed with the formation of an epineural anastomosis with the medial portion of the fibers of the right vagus nerve, covering the suture line with a vascular coupling from a free graft of the branch of the saphenous jugular vein. Treatment allowed to achieve remission of the disease, but was complicated by the development of right-sided laryngeal paralysis. Vocal function was restored due to the achievement of the medial position of the right vocal fold and motor compensation of the left half of the larynx.