Matambudziko ePhyllodes Tumors ezamu.

Nezve Murwere uye mamiriro

Mumwe mukadzi ane makore 27 okuberekwa (achangobva kuroorwa), aiva nebundu renguva refu muzamu rake rekurudyi iro rakaongororwa kumwewo. Kuongorora zamu re Ultrasound kwakaratidza kuve rakaputirwa, hypoechoic lesion 32mmx23mm muhukuru. A Fine Needle Aspiration Cytology (FNAC) yakaratidza kuti iFibro Epithelial Lesion, inogona kunge iri Fibroadenoma. Murwere akasarudza kurapwa kwechinyakare nekutevera nguva dzose.

Mushure memwedzi mitatu, pakava nekuwedzera kwehukuru uye ultrasound scan yakaratidza chironda chacho kuva 3mmx8mmx53mm muhukuru, zvishoma zvakasimba uye zvishoma cystic, ine maungira anofamba uye edema yakakomberedza. Mafungiro eRadiologist aive ekuti iyo Fibroadenoma ikozvino yaive necystic degeneration uye kuzvimba kwakatenderedza.

Case Scenario

Panguva ino yenguva, murwere akapa Dr. Uma Krishnaswamy, Consultant Breast & Oncoplastic Surgeon paApollo Hospitals, Chennai. Ongororo yakaratidza hunyoro hwe 10cmsx10cms muzamu rekurudyi rakatarisana neNipple Areola Complex, rinobva pa6 O'clock kusvika 9 O'clock zvikamu zvine mavanga akakura eganda. Kuongororwa kwekiriniki kwaikurudzira zvikuru kweGiant Fibroadenoma ine degeneration uye post FNAC yakakonzera kusagadziriswa haematoma. Chechipiri chekuongorora chaiva bundu rePhyllodes rezamu, zvichida rakaipa.

Routine preoperative blood parameters yakaratidza kuti hapana coagulation abnormality. Ongororo ye Ultrasound scan yakaitwa sechikamu cheTriple Diagnostic nzira. Izvi zvakaburitsa 66mmx53mm, yakanyatsotsanangurwa, yakavharirwa, yakasimba cum cystic mass ine Brownian kufamba. Ruvara Doppler yakaratidza kuderera kwemukati vascular kuyerera. Zvekare, zvakawanikwa zveRadiology zvairatidza kuderera kweFibroadenoma ine hematoma yakatenderedza.

Izvi zvakateverwa mukugara mumwechete neMufananidzo unotungamirwa Core Tsono biopsy. 60ml yechokwadi, ropa nyoro rakatsvagwa nekukasira kuzadzazve, zvichidzivirira Interventional Radiologist kuti isaenderere kubiopsy nekutya kubuda ropa. Chiitiko ichi chakapa mukana wekuti yaive Intracystic papillary lesion nekubuda ropa kana bundu rePhyllodes.

Kutsvaga nzira yekuongorora, MR Mammogram yakaitwa. Izvi zvakaratidza kuvharwa uye hetero intense lesion ine inogoneka necrotic uye hemorrhagic content. Pakanga pasina mamwe mashoko ezvekuongorora aifanira kuva nawo.

Worldwide Scenario

Iyo yekuvhiya manejimendi yePhyllodes tumors yezamu, ingave yakaipa kana yakaipa, izere nematambudziko. Chirwere ichi chakanyatsogadziriswa, chine chiitiko chisingasviki 1% yezvipembenene zvezamu. Kune, zvisinei, matambudziko makuru mukuongororwa kwekutanga uye kusiyanisa pakati peBenign Phyllodes uye Malignant Phyllodes, kunyange zvazvo zvipembenene zvisingawanzoitiki zvakanyanya. Dambudziko iri rinowedzerwa nemaitiro ekuvhiya kuti ashandiswe kuvabvisa nemuganhu wakajeka kudzivirira kudzokazve, pamwe nekuchengetedza cosmesis yezamu. Izvi zvinonyanya kukosha sezvo Phyllodes tumors inoitika muboka rezera rechidiki (25-30 makore) muAsia vanhu vane preponderance muvakadzi uye kashoma muvarume vane Gynaecomastia.

Nyanzvi muApollo Hospitals

Mushure mekuongororwa kwese uye anesthetic, murwere akatorwa kunovhiyiwa nemvumo ine ruzivo. Zvakawanikwa zvaive zviya zvekuvharirwa zvishoma, necrotic mass ine ropa rekare uye magwara, ane mafuta ekuzvimba akatenderedza uye edema. Kubvisa kukuru kwehuwandu kwakaitwa. Kuzadza kushomeka kwevhoriyamu, Intra mammary Flap Reconstruction yakaitwa. Murwere akaburitswa mushure memaawa makumi maviri nemana.

Ongororo yeHistopathology yakaratidza 9x6x4 cms yakasimba cum cystic mass ine rima tsvuku friable material. Microscopy yakaratidza neoplastic lesion ine epithelium mitsetse nzvimbo uye spindle cell stroma ine yakapararira mitosis uye yakajeka mariji. (Mufananidzo 3).

Immuno histochemistry ongororo yakaratidza: Ki67 kukosha kwe7 uye p53 kuve isina kunaka. Mhedzisiro saka yaive Phyllodes yegiredhi yemuganhu ine yakaderera yakaipa kugona. SeGenomic panel yeFibroepithelial lesions parizvino haiwanikwe mune zvekutengesa muIndia haina kuteverwa.

Apollo Hospitals - Kubata Upenyu

Chikwata cheMultidisciplinary paApollo Hospitals chakafunga kuenderera mberi neRadiotherapy. Pakupera kwezvimwechetezvo, murwere anoramba ari pasi pekutariswa kwepedyo. Kugutsikana kwemurwere kwaive kwakakwira sezvo pasati pave nekudzokororwa kweBundu rePhyllodes kusvika parizvino uye mhedzisiro yecosmetic yanga yakanaka.

Uchapupu hwemurwere

Murwere akagutsikana nerubatsiro uye kurapwa kwaiitwa kuApollo Hospitals.

[Caption id = "attachment_32227" swatanudza = "alignnone" width = "700"] Mufananidzo 1: Ultrasound kuongororwa kwezamu rekurudyi[/ Caption]

[Caption id = "attachment_32228" swatanudza = "alignnone" width = "700"] Mufananidzo 2: MR Mammogram[/caption]

[Caption id = "attachment_32229" swatanudza = "alignnone" width = "700"] Mufananidzo 3: Photomicrograph inoratidza madhakisi akaiswa nebi layered
epithelium uye yakawedzera stromal cellularity uye atypia
(x400 kukura)[/caption]

[Caption id = "attachment_32226" swatanudza = "alignnone" width = "700"] Mufananidzo 4: Madz 67:7[/caption]

mufananidzo {
hupamhi: 100% !inokosha;
zvinyorwa-zvinongedzera: pakati;
}