Ihe ịma aka nke Phyllodes Tumors of the Ara.

Banyere onye ọrịa na ọnọdụ

Otu nwanyị dị afọ 27 (onye lụrụ ọhụrụ), nwere akpụ akpụ n'ime ara aka nri ya nke a tụlere n'ebe ọzọ. Nyocha ultrasound nke ara gosiri na ọ bụ ihe mkpuchi, hypoechoic ọnya 32mmx23mm n'ogo. Cytology nke ọma agịga aspiration (FNAC) gosiri na ọ bụ ọnya fibro Epithelial, ọ ga-abụkwa fibroadenoma. Onye ọrịa ahụ ahọrọla ọgwụgwọ na-agbanwe agbanwe na-esochi ya mgbe niile.

Mgbe ọnwa 3 gachara, enwere mmụba na nha na nyocha nke ultrasound gosiri ọnya ahụ ka ọ bụrụ 8mmx53mmx51mm n'ogo, akụkụ siri ike na akụkụ cystic, na-emegharị emegharị na edema gbara ya gburugburu. Echiche onye na-ahụ maka redio bụ na Fibroadenoma ugbu a nwere mmebi cystic na mbufụt gbara ya gburugburu.

Ọnọdụ ikpe

N'oge a, onye ọrịa ahụ gosipụtara Dr. Uma Krishnaswamy, Onye ndụmọdụ Breast & Oncoplastic Surgeon na Ụlọ Ọgwụ Apollo, Chennai. Nnwale ahụ gosipụtara ịdị nro 10cmsx10cms, nnukwu cystic na ara aka nri dị n'akụkụ Nipple Areola Complex, na-agbatị site na elekere 6 ruo elekere 9 nke nwere nnukwu ọnya akpụkpọ ahụ. Nchọpụta ụlọọgwụ ahụ gosipụtara nke ukwuu maka nnukwu Fibroadenoma nwere mmebi yana post FNAC butere hematoma na-edozibeghị. Nchọpụta nke abụọ bụ akpụ Phyllodes nke ara, ikekwe ọ dị njọ.

Usoro ọbara ndị a na-eme tupu ịwa ahụ egosighi ọnweghị ndakpọ nke coagulation. Emere nyocha nke ultrasound dị ka akụkụ nke ụzọ nchọpụta Triple Diagnostic. Nke a kpughere 66mmx53mm, akọwapụtara nke ọma nke ọma, kpuchiri ya, cum cystic mass siri ike na mmegharị Brownian. Agba Doppler gosipụtara ntakịrị mgbaba vaskụla dị n'ime. Ọzọkwa, nchoputa Radiology na-egosi na Fibroadenoma na-emebi emebi na hematoma gbara ya gburugburu.

A na-esochi nke a n'otu oche ahụ yana ihe biopsy Core agịga na-eduzi ihe onyonyo. 60ml nke eziokwu, a na-achọ ọbara ọhụrụ site na njuputa ngwa ngwa, na-egbochi Interventional Radiologist ịga n'ihu na biopsy maka egwu ọbara ọgbụgba. Ihe omume a mere ka o kwe omume na ọ bụ ọnya papillary intracystic nwere ọbara ọgbụgba ma ọ bụ akpụ Phyllodes.

N'ịgbaso ụzọ nchọpụta ahụ, a na-eme MR Mammogram. Nke a gosipụtara ọnya kpụ ọkụ n'ọnụ na hetero nwere ọnya necrotic na hemorrhagic nwere ike ime. Enweghị ozi nyocha ọzọ a ga-enwe.

Ọnọdụ zuru ụwa ọnụ

Nlekọta ịwa ahụ nke etuto Phyllodes nke ara, ma ọ dị njọ ma ọ bụ nke na-adịghị mma, nwere ihe ịma aka. Ọrịa a bụ nke siri ike nke ọma, na-enwe ihe na-erughị 1% nke etuto ara ara. Otú ọ dị, e nwere nnukwu ihe ịma aka na nchọpụta mbụ na ọdịiche dị n'etiti Benign Phyllodes na Malignant Phyllodes, ọ bụ ezie na ọnya na-adịghị mma na-adịkarị. Ihe ịma aka a na-abawanye site na usoro ịwa ahụ nke a ga-eji wepụ ha n'akụkụ doro anya iji gbochie nlọghachi azụ, yana ichekwa ọdịdị nke ara. Nke a dị mkpa karịsịa dịka etuto Phyllodes na-eme n'ime obere ụmụaka (afọ 25-30) na ndị bi na Eshia nwere oke ibu na ụmụ nwanyị na ọ na-adịkarịghị na ndị ikom nwere Gynaecomastia.

Ọkachamara na ụlọ ọgwụ Apollo

Mgbe nyocha izugbe na ọgwụ anestetiiki gasịrị, a kpọgara onye ọrịa ahụ maka ịwa ahụ site na nkwenye ama ama. Ihe nchoputa a bu nke kpuchiri akuku, necrotic mass nke nwere obara ochie na mkpụkọ, nwere abụba na-egbu egbu na edema gbara ya gburugburu. A na-ewepụ ihe dị ukwuu nke oke ahụ. Iji mejupụta mperi olu, a rụgharịrị nrụgharị flap intra mammary. Achụpụrụ onye ọrịa ahụ ka awa iri abụọ na anọ gachara.

Nyocha histopathology gosiri 9x6x4 cms siri ike cum cystic mass nwere ihe friable uhie gbara ọchịchịrị. Microscope gosipụtara ọnya neoplastic nwere oghere epithelium nwere oghere yana stroma cell spindle nwere mitosis gbasasịrị agbasa na akụkụ doro anya. (Foto nke 3).

Immuno histochemistry Nyocha kpughere: uru Ki67 nke 7 na p53 na-adịghị mma. Mmetụta ya mere bụ Phyllodes nke akara oke oke nwere ikike ọjọọ dị ala. Dịka panel Genomic maka ọnya Fibroepithelial adịghị ugbu a na azụmahịa na India, a naghị achụ ya.

Ụlọ ọgwụ Apollo - Ndụ na-emetụ n'ahụ

Ndị otu Multidisciplinary na Ụlọ Ọgwụ Apollo kpebiri ịga n'ihu na Radiotherapy. Mgbe emechara otu ihe ahụ, onye ọrịa na-anọ n'okpuru nlekọta anya. Afọ ojuju ndị ọrịa dị elu n'ihi na enwebeghị nlọghachite nke etuto Phyllodes ruo taa na nsonaazụ ịchọ mma abụrụla nke ọma.

Akaebe onye ọrịa

Onye ọrịa nwere afọ ojuju maka ọrụ na ọgwụgwọ a na-enye n'ụlọ ọgwụ Apollo.

[okwu id = "ihe mgbakwunye_32227" mezie = "alignnone" obosara = "700"] Ọnụọgụ 1: Nyocha ultrasound nke ara aka nri[/okwu]

[okwu id = "ihe mgbakwunye_32228" mezie = "alignnone" obosara = "700"] Foto 2: MR Mammogram[/okwu]

[okwu id = "ihe mgbakwunye_32229" mezie = "alignnone" obosara = "700"] Onyonyo 3: Igwefoto foto na-egosi ọwa mmiri ndị ejiri akwa bi akwa akwa
epithelium na ụba stromal cellularity na atypia
(x400 na-ebuli elu)[/okwu]

[okwu id = "ihe mgbakwunye_32226" mezie = "alignnone" obosara = "700"] Foto 4: Ndi 67: 7 [/okwu]

ọgụgụ {
obosara: 100% !dị mkpa;
ederede-nhazi: etiti;
}