Cov Kev Sib Tw ntawm Phyllodes Cov qog nqaij hlav ntawm lub mis.

Hais txog Tus Neeg Mob thiab tus mob

Ib tug poj niam hnub nyoog 27 xyoo (tshiab sib yuav), muaj pob ntev ntev hauv nws lub mis sab xis uas tau soj ntsuam lwm qhov. Kev kuaj ultrasound ntawm lub mis qhia tau tias nws yog ib qho encapsulated, hypoechoic lesion 32mmx23mm loj. Fine Needle Aspiration Cytology (FNAC) qhia tias nws yog Fibro Epithelial Lesion, feem ntau yuav yog Fibroadenoma. Tus neeg mob tau xaiv kev kho mob nrog kev saib xyuas tsis tu ncua.

Tom qab 3 lub hlis, muaj qhov loj me thiab kev kuaj xyuas ultrasound qhia tau tias qhov mob ua rau 8mmx53mmx51mm hauv qhov loj, ib nrab ntawm cov khoom thiab ib nrab cystic, nrog kev txav echoes thiab ib puag ncig oedema. Radiologist lub tswv yim yog tias Fibroadenoma tam sim no muaj cystic degeneration thiab ib puag ncig o.

Case Scenario

Nyob rau lub sijhawm no, tus neeg mob tau nthuav tawm rau Dr. Uma Krishnaswamy, Tus Kws Pab Tswv Yim Rau Lub Cev & Oncoplastic Surgeon ntawm Apollo Tsev Kho Mob, Chennai. Kev tshuaj xyuas tau qhia txog 10cmsx10cms kev sib tw, cystic loj nyob rau hauv lub mis sab xis nyob ib sab ntawm lub Nipple Areola Complex, txuas ntxiv los ntawm 6 teev sawv ntxov mus rau 9 teev tsaus ntuj nrog cov tawv nqaij tawv nqaij. Kev kuaj mob tau pom zoo heev ntawm Giant Fibroadenoma nrog degeneration thiab tom qab FNAC induced unresolved haematoma. Qhov thib ob kev kuaj mob yog Phyllodes qog ntawm lub mis, tejzaum nws malignant.

Cov txheej txheem ua ntej ua ntej cov ntshav tsis qhia tias tsis muaj coagulation abnormality. Kev kuaj xyuas ultrasound tau ua raws li ib feem ntawm Triple Diagnostic pathway. Qhov no tau qhia txog 66mmx53mm, ib feem zoo txhais, encapsulated, khoom cum cystic pawg nrog Brownian txav. Xim Doppler pom qhov tsawg kawg nkaus hauv vascular ntws. Ib zaug ntxiv, qhov kev tshawb pom Radiology tau qhia txog qhov degenerating Fibroadenoma nrog ib puag ncig haematoma.

Qhov no tau ua raws li nyob rau hauv tib zaum nrog Daim Duab Qhia Core Needle Biopsy. 60ml ntawm frank, cov ntshav tshiab tau aspirated nrog tam sim ntawd refilling, tiv thaiv tus Interventional Radiologist los ntawm kev mus rau lub biopsy vim ntshai hemorrhage. Qhov kev tshwm sim no tau ua rau muaj peev xwm hais tias nws yog ib qho kab mob Intracystic papillary nrog los ntshav lossis Phyllodes qog.

Ua raws txoj kev kuaj mob, MR Mammogram tau ua tiav. Qhov no qhia tau tias muaj qhov mob hnyav thiab mob hetero nrog cov ntsiab lus necrotic thiab hemorrhagic. Tsis muaj cov ntaub ntawv kuaj mob ntxiv kom muaj.

Ntiaj teb no Scenario

Kev tswj kev phais ntawm Phyllodes cov qog ntawm lub mis, txawm tias benign lossis malignant, yog fraught nrog cov teeb meem. Tus kab mob no yog ib qho tsim tau zoo, nrog qhov tshwm sim tsawg dua 1% ntawm tag nrho cov qog mis. Txawm li cas los xij, muaj cov teeb meem loj hauv kev kuaj mob ua ntej thiab kev sib txawv ntawm Benign Phyllodes thiab Malignant Phyllodes, txawm tias qhov mob benign muaj ntau dua. Qhov kev sib tw no yog sib xyaw ua ke los ntawm cov txheej txheem phais kom siv tau los ua kom lawv muaj cov npoo meej kom tsis txhob rov ua dua, nrog rau khaws cia lub cosmesis ntawm lub mis. Qhov no yog qhov tseem ceeb tshwj xeeb tshaj yog cov qog nqaij hlav Phyllodes tshwm sim hauv cov neeg hluas uas muaj hnub nyoog qis dua (25-30 xyoo) hauv cov neeg Esxias uas muaj cov poj niam ua ntej thiab tsis tshua muaj rau cov txiv neej nrog Gynaecomastia.

Cov kws tshaj lij ntawm Apollo Tsev Kho Mob

Tom qab kev soj ntsuam dav dav thiab tshuaj loog, tus neeg mob raug coj mus rau kev phais nrog kev pom zoo. Cov kev tshawb pom tau hais tias ntawm ib feem ntawm qhov encapsulated, necrotic loj nrog cov ntshav qub thiab cov hlab ntsha, nrog rau cov rog nyob ib puag ncig thiab oedema. Ib tug dav excision ntawm pawg tau ua tiav. Txhawm rau sau qhov ntim tsis txaus, Intra mammary Flap Reconstruction tau ua tiav. Tus neeg mob tau tso tawm tom qab 24 teev.

Kev kuaj mob histopathology pom tau tias muaj 9x6x4 cms khoom cum cystic loj nrog cov khoom siv friable tsaus liab. Microscopy tau pom ib qho mob neoplastic nrog cov kab mob epithelium lined qhov chaw thiab spindle cell stroma nrog tawg mitosis thiab cov npoo ntshiab. (Daim duab 3).

Immuno histochemistry kuaj pom: Ki67 tus nqi ntawm 7 thiab p53 kom tsis zoo. Qhov kev xav li no yog Phyllodes ntawm qib ciam teb uas muaj peev xwm tsis zoo. Raws li Genomic vaj huam sib luag rau Fibroepithelial lesions yog tam sim no tsis muaj kev lag luam hauv Is Nrias teb nws tsis tau nrhiav.

Apollo Tsev Kho Mob - Kov Lub Neej

Pab neeg ua haujlwm ntau yam ntawm Apollo Tsev Kho Mob tau txiav txim siab ua haujlwm nrog Radiotherapy. Thaum ua tiav qhov qub, tus neeg mob tseem nyob hauv kev soj ntsuam ze. Kev txaus siab ntawm tus neeg mob tau siab vim tias tsis muaj qhov rov tshwm sim ntawm Phyllodes qog rau hnub tim thiab cov txiaj ntsig zoo nkauj tau zoo heev.

Tus neeg mob daim ntawv pov thawj

Tus neeg mob tau txaus siab rau cov kev pabcuam thiab kev kho mob hauv Apollo Tsev Kho Mob.

[Npe duab daim id = "attachment_32227" dlhos = "alignnone" dav = "700"] Daim Duab 1: Kev kuaj mob ultrasound ntawm sab xis ntawm lub mis[/caption]

[Npe duab daim id = "attachment_32228" dlhos = "alignnone" dav = "700"] Daim Duab 2: MR Mammogram[/caption]

[Npe duab daim id = "attachment_32229" dlhos = "alignnone" dav = "700"] Daim duab 3: Photomicrograph qhia cov ducts lined los ntawm ob txheej txheej
epithelium thiab nce stromal cellularity thiab atypia
(kev loj hlob x400)[/caption]

[Npe duab daim id = "attachment_32226" dlhos = "alignnone" dav = "700"] Daim Duab 4: Ki 67: 7[/caption]

daim duab {
dav: 100%! tseem ceeb;
text-align: chaw;
}