Nga Werohanga a Phyllodes Tumor o te Uma.

Mo te Turoro me te ahua

He wahine 27-tau te pakeke (kua mārena hou), he puku roa kei roto i tōna ū matau, ā, i tirohia ki tētahi atu wāhi. I kitea i roto i te matawai ultrasound o te ū he puku kua kapi, he hypoechoic te rahi, 32mmx23mm. I kitea i roto i te Fine Needle Aspiration Cytology (FNAC) he Fibro Epithelial Lesion, he tino tūponotanga he Fibroadenoma. I whiriwhiria e te tūroro he maimoatanga matawhānui me te tirotiro tonu.

I muri i ngā marama e 3, ka piki ake te rahi, ā, i whakaatuhia e te matawai ultrasound he 8mmx53mmx51mm te rahi o te whara, he totoka tetahi wāhanga, he pūngāwerewere tetahi wāhanga, me ngā haruru nekeneke me te pupuhi e karapoti ana. Ko te whakaaro o te tohunga hihi-X kua heke te rahi o te fibroadenoma me te mumura e karapoti ana.

Tauari Take

I tēnei wā, ka tae atu te tūroro ki a Tākuta Uma Krishnaswamy, he Kaitohutohu Taote Uma me te Oncoplastic i ngā Hōhipera Apollo, Chennai. I kitea i roto i te whakamātautau he puranga ngawari, 10cm x 10cm te rahi i roto i te uma matau e tata ana ki te Nipple Areola Complex, e toro atu ana mai i ngā wāhanga 6 karaka ki te 9 karaka me te nui o te marō kiri. I tino tohu te tātaritanga haumanu he Giant Fibroadenoma me te pirau me te haematoma kāore anō kia whakatauhia i muri i te FNAC. Ko te tātaritanga tuarua he pukupuku Phyllodes o te uma, tera pea he kino.

Kāore i kitea he rerekētanga o te toto toto i mua i te pokanga i roto i ngā tawhā toto o ia rā. I whakahaerehia he whakamātautau ultrasound hei wāhanga o te ara Triple Diagnostic. I kitea he puranga totoka, he āhua mārama, he kapi, he 66mm x 53mm te rahi, he kikokore, he pūmua me te nekehanga Brownian. He iti noa te rere o ngā toto toto o roto i whakaatuhia e te Colour Doppler. Anō, ko ngā kitenga Radiology he tohu mō te Fibroadenoma e pirau ana me ngā haematoma e karapoti ana.

I whai ake i tēnei i roto i taua nohoanga anō me te koiora ngira matua i arahina e te whakaahua. E 60ml o te toto hou, i mimitihia, ā, ka whakakīia tonutia, kia kore ai e taea e te Kaiwhakaora Ira-ā-roto te haere tonu ki te koiora i te wehi kei totohu. Nā tēnei huihuinga i ara ake ai te tūponotanga he whara papillary intracystic me te toto, he pukupuku Phyllodes rānei.

I te whai i te ara tātaritanga, i mahia he MR Mammogram. I whakaatuhia he whara kua kapihia, he hetero-intensity, me te ihirangi necrotic me te hemorrhagic pea. Kāore he kōrero tātaritanga anō i riro mai.

Te Tauari o te Ao

He maha ngā wero i roto i te whakahaere pokanga o ngā pukupuku Phyllodes o te ū, ahakoa he pai, he kino rānei. He mate kua roa nei e mōhiotia ana, ā, he iti iho i te 1% o ngā pukupuku ū katoa te maha. Heoi anō, he nui ngā wero i roto i te tātaritanga i mua i te pokanga me te wehewehe i waenga i te Phyllodes Pai me te Phyllodes Kino, ahakoa he maha ake ngā whara pai. Ka nui ake te uaua o tēnei wero nā te tikanga pokanga hei tango i a rātou me te taha mārama hei ārai i te hokinga mai, me te tiaki hoki i te āhua o te ū. He mea nui tēnei nā te mea ka puta ngā pukupuku Phyllodes i roto i te rōpū tau taitamariki (25-30 tau) i roto i ngā taupori Āhia, he nui ake ngā wāhine, ā, he onge ngā tāne e pāngia ana e te Gynaecomastia.

He tohungatanga ki nga Whare Hohipera Apollo

I muri i te aromatawai whānui me te aromatawai whakamoe, ka haria te tūroro ki te pokanga me te whakaae whai muri. Ko ngā kitenga he puranga necrotic kua kapi katoa, me te toto tawhito me ngā toto totoka, me te ngako mumura me te pupuhi e karapoti ana. I tangohia whānuitia te puranga. Hei whakakī i te korenga o te rōrahi, i mahia he Intra mammary Flap Reconstruction. I tukuna te tūroro i muri i ngā haora 24.

I whakaatuhia e te tirotiro histopathology he puranga totoka me te kiko kikokore 9x6x4 cm te rahi me te rauemi whero pouri. I whakaatuhia e te tirotiro karuārai he whara neoplastic me ngā āputa kua whakakikoruatia ki te epithelium me te stroma pūtau spindle me te mitosis marara me ngā taha mārama. (Pikitia 3).

I whakaatuhia e te whakamātautau histochemistry ārai mate: Ko te uara Ki67 o te 7 me te p53 he kino. Nō reira, ko te whakaaro he Phyllodes o te taumata rohe me te iti o te kaha kino. Nā te mea kāore i te wātea arumoni he panui ira mō ngā whara Fibroepithelial i Inia i tēnei wā, kāore i whaihia.

Nga Hohipera Apollo - Nga Ora Pa

I whakatau te tīma maha-mātauranga i ngā Hōhipera Apollo ki te haere tonu me te Radiotherapy. I te otinga o taua mahi, kei raro tonu i te tirotiro tata a te tūroro. I tino makona te tūroro nā te mea kāore anō kia hoki mai te pukupuku Phyllodes tae noa ki tēnei wā, ā, he tino pai te hua o te whakapaipai.

Whakaaturanga a te manawanui

I makona te tūroro ki ngā ratonga me te maimoatanga e tukuna ana e ngā Hōhipera Apollo.

[Tapanga id = "attachment_32227" hāngai = "alignnone" whanui = "700"] Pikitia 1: Whakamātautau Ultrasound o te ū matau

[Tapanga id = "attachment_32228" hāngai = "alignnone" whanui = "700"] Pikitia 2: MR Mammogram

[Tapanga id = "attachment_32229" hāngai = "alignnone" whanui = "700"] Pikitia 3: He whakaahua iti e whakaatu ana i ngā awaawa kua whakarārangihia e ngā paparanga rua
epithelium me te pikinga o te pūtau stromal me te atypia
(whakanui x400)

[Tapanga id = "attachment_32226" hāngai = "alignnone" whanui = "700"] Pikitia 4: Ki 67: 7

ahua {
whanui: 100% !nui;
whakatikatika-kuputuhi: pokapū;
}