BACKGROUND. Obesity is associated with a decrease in ovarian reserve in women of reproductive age, which contributes to the development of infertility. It is assumed that weight loss may improve female fertility. Bariatric surgery is the most effective treatment for morbid obesity; however, data on its impact on ovarian reserve parameters remain limited and conflicting. AIM. To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) on ovarian reserve markers in women of reproductive age with obesity.

MATERIALS AND METHODS. Women aged 18 to 40 years underwent anthropometric assessments, evaluation of carbohydrate metabolism, and indirect ovarian reserve parameters (plasma anti-Müllerian hormone [AMH] and antral follicle count [AFC]) at baseline and 12 months after LSG. According to the level of AMH after LSG, patients were divided into two groups: Group 1 — women with AMH <1.1 ng/mL, indicating a decrease in ovarian reserve (n=19), Group 2 — those with AMH ≥1.1 ng/mL (n=30).

RESULTS. The study included 49 women with a median age of 31.0 [29.0–33.0] years. 12 months after LSG, all participants achieved weight loss and improved carbohydrate metabolism parameters. Initially, the AMH in all women were ≥1.1 ng/mL, which indirectly indicates a preserved ovarian reserve. Plasma AMH levels increased from 2.2 [1.5–3.0] ng/ml to 2.5 [0.9–3.0] ng/ml after LSG, but this change was not statistically significant. Both groups, stratified by postoperative AMH dynamics, were comparable in age. Group 1 (demonstrating postoperative AMH reduction) exhibited significantly higher body mass index (BMI) and HOMA-IR values both pre- and postoperatively, along with a more prolonged history of obesity. These patients also presented with lower baseline AMH and AFC values, with all patients (100%) reporting maternal history of early or premature menopause.

Correlation analysis revealed an inverse relationship between postoperative AMH and baseline BMI, BMI dynamics after breast cancer, HOMA-IR index before and after surgery, as well as with the duration of obesity. At the same time, a direct correlation was found between postoperative AMH and preoperative AMH levels, as well as with AFC before and after the intervention. Correlation analysis demonstrated significant inverse associations between postoperative AMH levels and: preoperative BMI, postoperative BMI reduction, preoperative and postoperative HOMA-IR indices, and duration of obesity. Conversely, we observed positive correlations between postoperative AMH and both preoperative AMH levels and AFC measurements obtained before and after the surgical intervention.

CONCLUSION. The impact of LSG on ovarian reserve in reproductive-age women remains insufficiently studied. The observed decline in ovarian reserve markers in some patients highlights the need for further research to optimize personalized treatment strategies for obese women of childbearing age.

BACKGROUND: The most aggressive head and neck malignant tumours are still a great medical and social problem due to the known difficulties both at the diagnostic stage and in the choice of molecular-personalized treatment strategy. The most rapid and accurate morphological (histological, immunohistochemical, molecular genetic) diagnosis is of fundamental importance. Fine-needle aspiration biopsy is often insufficient for these tasks, particularly in large, rapidly growing tumors and after radiotherapy, when pronounced fibrosis reduces the diagnostic yield of cytology. An alternative to incisional biopsy — which carries anesthetic risks in patients with bulky cervical tumor masses — is core needle biopsy, which enables procurement of representative tissue cores for comprehensive histologic, immunohistochemical, and molecular-genetic studies within a short timeframe.

AIM: To evaluate the diagnostic yield, clinical utility, and safety of core needle biopsy in the workup of anaplastic thyroid carcinoma, lymphoproliferative disorders, and other aggressive neck tumors, including the feasibility of performing valid histologic, immunohistochemical, and molecular-genetic assays on the obtained material and the impact of the results on initial therapeutic decision-making.

MATERIALS AND METHODS: In the period 2017–2025, a total of 131 core needle biopsies were performed at Saint-Petersburg State University for patients with anaplastic thyroid carcinoma, lymphoproliferative diseases and other aggressive tumours. The technique of core needle biopsy of neck tumours is described in detail.

RESULTS: Among all patients who underwent core needle biopsy, on the basis of histological and immunohistochemical methods the diagnosis of anaplastic carcinoma was established in 79 patients (60.3%), lymphoma — in 22 patients (16.8%), other tumours and non-tumours — in 30 patients (22.9%). According to the data of genetic studies, BRAFV600E mutation was detected in 27 patients with anaplastic carcinoma, one mutation in NRAS codon 61 of Q61K type (181C>A); one case of mutation in NTRK3 gene (ex15) was detected.

CONCLUSION: Core needle biopsy of thyroid, neck tumours and neck lymph nodes is a simple, minimally invasive and effective intervention with high informative and diagnostic value. The advantage of this method is the possibility of obtaining sufficient material to study the structural and cellular characteristics of the tumour, to perform valid immunohistochemical and molecular genetic studies.

Papillary thyroid carcinoma (PTC) is the most common form of differentiated thyroid cancer and it is generally characterized by an indolent course. The role of the ability to invade blood vessels and its impact on the prognosis in PTC remain uncertain. The authors conducted an electronic search of publications within the PubMed database. A number of studies demonstrate angioinvasion ceasing to be an independent factor of poor prognosis upon multivariate analysis. The existence of conflicting data on the prognostic role of angioinvasion in PTC may be explained by the difficulty in differentiating between blood vessel and lymphatic vessel invasion, as well as by the use of different criteria for true angioinvasion during morphological examination of surgical specimens. Literature data on the prognostic role of the extent of blood vessel invasion in PTC are limited to a few studies and do not allow for conclusions to be drawn regarding any threshold value for risk of recurrence stratification. When examining tumors of larger size, the dependence of the number of detected invasion foci on the number of examined tumor sections becomes particularly relevant. The issue of the prognostic value of angioinvasion as a risk factor for recurrence and progression of PTC, and as a possible basis for choosing more aggressive treatment tactics, requires further investigation.

INTRODUCTION. A leydigoma is a hormone-active tumor that develops from Leydig cells that produce testosterone. Excessive production of testosterone by the tumor in pre-puberty boys leads to gonadotropin-independent premature puberty. The main treatment method for leydigoma is surgical. The volume of surgical intervention remains the subject of discussion.

DESCRIPTION OF THE CLINICAL CASE. A patient aged 4 years and 7 months was admitted complaining of an increase in the size of the right testicle and penis for one and a half year and progressive hair growth at the base of the penis for two months. An increase in testosterone secretion, echographic signs of bulky formation of the right testicle and negative indicators of cancer markers were revealed at the place of residence. As a result of the examination, a leydigoma of the right testicle was suspected. In order to exclude the malignant process, computed tomography of the abdominal cavity, retroperitoneal space and small pelvis with X-ray contrast enhancement was performed. No volumetric formations or foci pathologically accumulating contrast agent in the abdominal cavity and retroperitoneal space were detected. A scrototomy and removal of the tumor of the right testicle were performed.

CONCLUSION. Leydigoma is a testicular disease that is accompanied by a clinic of premature puberty. The rarity of this pathology has a significant impact on the timing of diagnosis. They are usually late, which entails irreversible changes that appear in the patient's body due to prolonged hypersecretion of testosterone. The main treatment method is surgical. The choice of surgical tactics is justified by the size of the tumor and the risk of malignancy. Patients require long-term follow-up due to the risk of developing premature gonadotropin-dependent puberty and its consequences.