Problemi ginekologa, citologa in patologa pri ...
Transcript of Problemi ginekologa, citologa in patologa pri ...
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
Problemi ginekologa, citologa in patologa pri interpretaciji
citoloških in histoloških izvidov
Miroslav Gračak*, Ana Katarina Seher**, Alenka Repše Fokter**, Simona Šramek Zatler**, Snježana Frković Grazio***
*Ginekološka ambulanta, ZD Žalec
**Splošna bolnišnica Celje
*** UGK Ljubljana
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
2010
‐ 47 letna pacientka‐ obisk pri ginekologu: strah pred nosečnostjo‐ ginekološko brez posebnosti‐ zadnji citološki izvid: ?
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
2010
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
Ocena BMV
• Bris manj uporaben(ni endocervikalnih/metaplastičnih celic)
• Bris normalen
(normalne ploščate celice)
• Priporočilo: bris ponoviti
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
2010
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
2010
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
2010
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
2010
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
Ocena BMV
• Huda diskarioza ploščatih celic
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
Nadaljnji potek
• opravljen LLETZ (november 2010)• invazivni ploščatocelični karcinom porcije, malocelični tip, brez poroženevanja v pregledanem (T1b)
• >7 mm horizontalni premer, globina invazije 5 mm (T1b)
• ni izrezan v zdravo (v endocervikalnem robu)• epitelij na površini CIN1
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
Nadaljnji potek
• Histerektomija z bilateralno adneksektomijo in pelvično limfadenektomijo (december 2010)
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
histerektomija
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
histerektomija
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
histerektomija
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
histerektomija
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
histerektomija
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
histerektomija
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
histerektomija
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
histerektomija
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
histerektomija
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
histerektomija
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
adenoskvamozni karcinom ?
(WHO)
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
slabo diferenciran adenokarcinom ali skvamozni karcinom?
(WHO)
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
Skvamozni karcinom Endocervikalni adenokarcinom
p63 >95% (difuzno) 20% (le fokalno)
CEA 30% 80‐90%
CK5/6 >90% >90%
p16 >95% >90%
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
p63
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
p63
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
p63
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
CEA
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
CEA
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
CEA
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
Histološka diagnoza
• invazivni endocervikalni adenokarcinom, slabo diferenciran
• 2‐2,5 cm horizontalni premer (upoštevajoč tumor v LLETZ‐u) in globina invazije 6,5 mm (T1b1)
• karcinomska limfangioza• resekcijski robovi bp• endometrij in obojni adneksi brez posebnosti• bezgavke brez zasevkov (skupno 0/29)
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
Endocervikalni adenokarcinom
• 90% vseh cervikalnih adenokarcinomov
• običajno zmerno diferencirani
• sinhroni AIS in CIN pogosto prisotni
• čeprav imenovani “mucinozni” pogosto v morfološko ni jasne mucinske produkcije
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
LLETZ
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012
Zaključek
• če bi pacientki in ginekologu “podarili” uporaben bris, bi se vrnila v presejalni program in prišla na pregled s simptomi!
• zanesljiva določitev histološkega tipa in/ali stadija tumorja je v vzorcu LLETZ‐a lahko težavna, včasih celo ni mogoča
• ob vsakem histološkem pregledu je priporočljivo, včasih pa tudi nujno, opraviti ponovni pregled prejšnjih citoloških in histoloških preparatov
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3. Izobraževalni dan programa ZORA – ZORA 2012Brdo pri Kranju, 20. april 2012