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ELEMENTE DE ONCOLOGIE A TEGUMENTULUI SI
PARTILOR MOI
ANATOMIA PIELII
FIZIOLOGIA PIELII
1. FUNCTIA DE PROTECTIE
2. SENSIBILITATEA
3. TERMOREGLAREA
4. CICATRIZAREA
5. ROLUL ESTETIC
FIZIOPATOLOGIA TUMORILOR
Trauma
Radiaia !"#ara
Ra$%#% &
L%$iu'i#% (r%%)i!%'%
Imu'"!u(r%!ia
Fa*"ri +%'%i*i
TUMORI BENIGNE
,ERATOZA SEBOREICA BENIGNA
C-ISTELE DERMOIDE
C-ISTELE EPIDERMOIDE
C-ISTELE PILOASE
C-ISTELE MUCOASE
MILIA
C-ISTELE MI&OIDE
PAPILOAMELE /ERUCI /ULGARE
LEZIUNI PREMALIGNE
7/25/2019 Elemente de Oncologie a Tegumentului Si Partilor Moi
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,ERATOZA ACTINICA
CARCINOMUL BAZOCELULAR
EPIDEMIOLOGIE
I'*id%'a0 35 *a'*%r% d% (i%#% #a 1 (%r!"a'%a'
56 di' a*%!%a !u' EBC
Bar7ai 8%m%i 21
EBC ESC 41
C%# mai 8r%*9%' *a'*%r d% (i%#% #a ("(u#aia a#7a: '%"7i!'ui #a '%+ri !au
a!iai*i
A(ar% i' !(%*ia# #a (a*i%'i ; 5 a'i
C%a mai 8r%*9%'a um"ra a(arua #a 'i9%#u# 8%%i !au (% $"'%#% %)(u!%
Fa*"ri (r%di!("$a'i 0
%)(u'%r%a *r"'i*a #a !"ar% !i 9a'< mai a#%! #a (%r!"a'%#% *u u' %' d%!*=i! #a
*u#"ar% >radiaii u#ra9i"#%% !i i"'i$a'%?
#%$iu'i *ua'a% *r"'i*% (r%%)i!%'% >)%r"d%rma (i+m%'"!um?
raumai!m% (r%%)i!%'% >ar!uri?*ar*i'"+%'i *=imi*iar!%'i*
8a*"ri +%'%i*i
FIZIOPATOLOGIE
Tum"ra ma#i+'a (ri' d%@'ii%.
S% *ara*%ri$%a$a (ri' %9"#uia a+r%!i9a #"*a#.
Nu m%a!a$%a$a d%*a 8"ar% rar #im8ai* !au =%ma"+%'.
Nu a(ar% i' +%'%ra# (ri' ma#i+'i$ar%a !ru*uri#"r %(i%#ia#% maur%
(r%%)i!%'%.
P#%a*a i' +%'%ra# di' !rau# 7a$"*%#u#ar a# %(id%rmu#ui !au di' %(i%#iu#
+#a'd%#"r !%7a*%% !au 8"#i*u#i#"r (i#"!i.
S% 7a'ui%!% i'!a *a (rima #%$iu'% a(ar% i' d%rmu# (a(i#ar !au !u7(a(i#ar.
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Tra'!(#a'ar%a d% %(id%rm '"rma# (% u' d%rm #%$a 'u im(i%di*a a(ariia
*a'*%ru#ui< i' !*=im7 %)i!%'a u'ui d%rm '"rma# a*"(%ri d% %(id%rm #%$a
'u (r"du*% 'i*i " m"di@*ar%.
-i!"(a"#"+i*0 *%#u#% ai(i*% ara'a% i' (a#i!ad% u'%#% (%!% a#%#%< #a
(%ri8%ria #%$iu'ii< (r"du*a'd " r%a*i% @7r"a!a *ara*%ri!i*a.
CLINICA
; 5 a'i
L%$iu'i a(aru% *u #u'i a'i i' urma
Z"'% %)(u!% 23 !u(%ri"ar% a#% 8%%i
Cr%!%r% #%'a i' dim%'!iu'i
C=iar !i um"ri#% r%*idi9a% *r%!* #%' !i (" a(ar%a #a a'i ("!"(%ra"r
E)*%(ii0 (a*i%'i imu'"d%(rimai:
um"ra i'9ada'a i' mu*"a!% >(#%"a(a !u(%ri"ara< i'9a$ia a(arau#ui
#a*rima#< a 'a!u#ui !i a !i'u!uri#"r< a *"'u'*i9%i< a "r7i%i !i a "'*iu'ii di'r%
%+um%'u# 'a$a# !i m%m7ra'%#% mu*"a!%?
FORME CLINICE
FORMA NODULARA
*%a mai 8r%*9%'a
a(ar% i' !(%*ia# #a 'i9%#u# %)r%miaii *%8a#i*%
a!(%* d% '"du# (a# *"#"ra *u *%'ru "m7i#i*a !i mar+i'i r%#i%8a%< (%r#a% d+. di8%r%'ia# *u MM?
FORMA SCLEROZANTA
(#a*a um"ra#a a#7+a#7ui% (#a'a *u mar+i'i (r"! d%#imia%< *u !u(ra8aa #u*i"a!a
!au *i*ari*%a#a< *ar% u#*%r%a$a ardi9
TRATAMENT
CARCINOMUL SPINOCELULAR
EPIDEMIOLOGIE
Tum"ra ma#i+'a *u "ri+i'% %rai'"*iara
S% *ara*%ri$%$a (ri' a'a(#a$i%< raa d% *r%!%r% ra(ida !i *a(a*ia% d%
m%a!a$ar% a(r%*ia7i#a
1 *a$ #a **a 15 d% (%r!"a'%
Fa*"ri (r%di!("$a'i0
radiaia !"#ara !i i"'i$a'a:
#%$iu'i (r%ma#i+'%0 )%r"d%rma (i+m%'"!um< 7"a#a B"%'< #%u*"(#aia:
%)(u'%r%a #a *ar*i'"+%'i *=imi*i >ar!%'i*< a$7%!< +udr"a'%?:
radi"d%rmia *r"'i*a< *i*ari*i ("!*"m7u!i"'a#%< u#*%r% *r"'i*%:
+%'%i*i0 8""i(uri 1 !i 2:
imu'"!u(r%!ia:
CLINICA
A(ar *%# mai 8r%*9%' #a 'i9%#u# 8%%i !i mai'i#"r
;6 di' um"ri#% *ar% a(ar (% mai'i !u' ESC
Tum"ri#% *ar% a8%*%a$a 7u$%#% im(#i*a mai d%! 7u$a i'8%ri"ara !i !% ("
a!"*ia *u #%u*"(#aia: 8umau# %!% d% a!%m%'%a u' 8a*"r adii"'a#
(r%di!("$a'
F"rmaiu'%a um"ra#a ("r'%!% d% #a #%$iu'%a (r%di!("$a'a< *ar% d%9i'%
i'amaa !i i'duraa< a("i i!i mar%!% dim%'!iu'i#%< mar+i'i#% i%! i' r%#i%856? !au =%ma"+%'a >156?
TRATAMENT
A*%#a!i *a !i *%# a# EBC
Di' *au$a a+r%!i9iaii mai mari< %!% '%*%!ara " %)*i$i% *=irur+i*a#a *u
mar+i'i d% !i+ura'a "'*"#"+i*a mai %)i'!% !i mai (r"8u'd%
Tum"ri H 2 *m *u mar+i'% d% !i+ura'a d% 45 mm (a'a #a 1 *m
P"a% @ '%*%!ara %9idar%a +a'+#i"'ara i' *a$u# um"ri#"r ; 2 *m !au a *%#"r*u ("%'ia# mar% m%a!a$a' >*a( !i +a?
C=irur+ia M"=! %!% %)r%m d% 8"#"!i"ar% !i ar% ra% im(r%!i"'a'% d%
9i'd%*ar% i' im(
Ra% d% !u(ra9i%uir% d% 256 #a 5 a'i ( (a*i%'ii *u m%a!a$%
MELANOMUL MALIGN
BIOLOGIA CELULELOR PIGMENTARE
M%#a'i'a r"# d% (r"%*i% a %+um%'%#"r 8aa d% radiaia !"#ara
I' im(u# d%$9"#arii 8%a#% m%#a'"7#a!ii mi+r%a$a d% #a 'i9%#u# *r%!%#"r
'%ura#% i' %(id%rm !i d%rm !i !% di8%r%'ia$a i' m%#a'"*i%
M%#a'"*i%#% !u' *%#u#% d%'drii*% *ar% (r"du* +ra'u#% d% m%#a'i'a !i #%
ra'!8%ra (ri' d%'dri% a#"r *%#u#% %(id%rma#% *u !*"(u# d% a #% d%("$ia
D%'!ia%a d% m%#a'"*i% i' (i%#% di8%ra d% #a " $"'a #a a#a< dar 'umaru# #"r
'u %!% !%'!i7i# di8%ri d% #a " ra!a #a a#a. C%%a *% di8%ra %!% dim%'!iu'%a
m%#a'"*i%#"r< d%%rmi'aa +%'%i*.
LEZIUNI PIGMENTARE
NE/II ALBASTRI0 ma"ria%a '%9i#"r !u' mar"'%+ri d%"ar%*% m%#a'i'a %!% !iuaa
!u(%r@*ia# !i a7!"ar7% #umi'a. Da*a '%9u# *"'i'% m%#a'i'a !iuaa mai i'
(r"8u'$im%
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NE/II CONGENITALI0 (r"du* (i+m%' i'*a d% #a 'a!%r%. S% 7a'ui%!% *a ar @
(r%*ur!"ri ai m%#a'"mu#ui ma#i+'. Aiudi'% a**%(aa0 %)*i$i% *=iru+i*a#a *a mai
*"m(#%a i'ai'% d% (%ri"ada ad"#%!*%'%i.
NE/II DISPLAZICI0 '%9i *"m(u!i *u m%#a'"*i% i' "'*iu'%a d%rm"
%(id%rmi*a< d% dim%'!iu'i mari >1*m?< *u !u(ra8aa ma*u#ara< mar+i'i'%r%+u#a% !i *u#"ar% 9aria7i#a. -i!"#"+i*0 =i(%r(#a$i% m%#a'"*iara< *%#u#% *u
ai(ii 'u*#%ar% !i *i"(#a!ma a7u'd%'a.
MELANOMUL MALIGN
L%$iu'i (#a% !au '"du#ar%< *u =i(%r(i+m%'ar% mar*aa< %ri%m !au
!a'+%rar%.
-i!"#"+i*0 m%#a'"m i' !iu m%#a'"*i% ai(i*% *ar% mi+r%a$a d%a!u(ra
"'*iu'ii d%rm"%(id%rmi*% !i !% "(r%!* i' ("riu'i#% !u(%ri"ar% a#% 8"#i*u#i#"r
(i#"!i !au a#% du*%#"r %**ri'%. M%#a'"m ma#i+' m%#a'"*i%#% ai(i*% r%*
di' "'*iu'% i' d%rm.
D%(i+m%'ar%a i'ra#%$i"'a#a %#%m%' *#i'i* d% dia+'"!i* ("$ii9.
R%(r%$i'a di!ru+%r%a u'"r *%#u#% ma#i+'% d% *ar% "r+a'i!m< i' i'*%r*ar%a
a*%!uia d% a "(ri (r"*%!u#.
L%$iu'i !iua% *%# mai 8r%*9%' i' (i%#%< dar *ar% (" a(ar%a !i (% mu*"a!a
"ra#a< 'a$"8ari'+%< %!"8a+< 9a+i' !i r%*.
CRITERII DE DIAGNOSTIC
A. A!im%ria #%$iu'ii *ar% !% ra'!8"rma di' r"u'da i' "9a#a >*r%!%r% i'dim%'!iu'i?.
B. Mar+i'i '%r%+u#a%< *a r%$u#a a# ra%#"r i'%+a#% d% *r%!%r% a#% 8"rmaiu'ii.
C. M"di@*ari d% *u#"ar%< r%(r%$a'a'd +ra'u#% (i+m%'ar% d%(u!% #a ada'*imi
di8%ri% i' d%rm< i' 8u'*i% d% raa d% i'9a$i%.
D. Diam%ru# #%$iu'ii ; mm.
E. S%m'% d% i'amai% %ri%m< um%8a*i%
F. L%$iu'% !im("mai*a (ruri< dur%r%< !a'+%rar%
A C 0 ma"r%
D F 0 mi'"r%
Su!(i*iu'% d% dia+'"!i* 0 1 !%m' ma"r !au 3 mi'"r%
CLASIFICARE CLINICA
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STADIUL I0 m%#a'"m #imia #a #"*u# d% "ri+i'%< 8ara !%m'% !i !im("m% d%
i'9a$i% r%+i"'a#a !au #a di!a'a. O 8"rma (ari*u#ara " r%(r%$i'a #%$iu'i#%
!a%#i% !iua% #a *ai9a *m di!a'a d% um"ra (rimara !i *ar% *"'8%ra u'
(r"+'"!i* mai r%$%r9a. Su(ra9i%uir% 6 #a 5 a'i< dar *ar% 9aria$a i'
8u'*i% d% *ara*%ri!i*i#% m"r8"#"+i*% !i ada'*im%a i'9a$i%i< (r%*um !i d%
!%)u# (a*i%'u#ui !i #"*a#i$ar%a 8"rmaiu'ii um"ra#%.
STADIUL II0 um"ra (rimara a!"*iaa *u +a'+#i"'i #im8ai*i r%+i"'a#i (a#(a7i#i.
Su(ra9i%uir% 46 #a 5 a'i. Pr"+'"!i* i'u%'a !i d% 'umaru# d% +a'+#i"'i
im(#i*a
STADIUL III0 (a*i%'i *u d%%rmi'ari !%*u'dar% #a di!a'a. I' +%'%ra# 8"rma
8aa#a d% 7"a#a. M%a!a$%#% %+um%'ar%< di' %!uu# *%#u#ar !u7*ua'a !au
#im8ai*% au u' (r"+'"!i* mai 7u' d%*a *%#% 9i!*%ra#%. Pa*i%'ii *u
m%a!a$% !ri* *%r%7ra#% !u(ra9i%ui%!* mai mu# d%*a *%i *u im(#i*ar%
*%r%7ra#a !i (u#m"'ara. A*%!ia< #a ra'du# #"r< au " %9"#ui% mai 7u'a d%*a
(a*i%'ii *u m%a!a$% =%(ai*% !u 9i!*%ra#% mu#i(#%.
CLASIFICARE MORFOLOGICA
MELANOM CU DISEMINARE IN SUPRAFATA0 56 di' "a#. Fa$a d% %9"#ui%
(% "ri$"'a#a >a'i? i'ai'% d% di!%mi'ar%a i' (r"8u'$im%.
MELANOM NODULAR0 236 di' "a#. Di!%mi'ar% i' (r"8u'$im% >#u'i?.
Pr"+'"!i* mai (r"!.
MELANOM LENTIGO MALIGN0 a(ar% #a (a*i%'i i' 9ar!a< (% $"'% %)(u!% #a
!"ar% !au (% #%$iu'i (r%%)i!%'% >#%'i+" ma#i+'?.
MELANOM ACRAL0 #"*a#i$a (% (a#m%< (#a'% !i !u7u'+=ia#. Fr%*9%'
'%dia+'"!i*a #a im(. Su(ra9i%uir% d% 126 #a 5 a'i.
CLASIFICARE !ISTOLOGICA
CLASIFICAREA CLAR"0 ada'*im%a i'9a$i%i i' (i%#% !au i' %!uu# !u7*ua'a ar%
*%# mai im("ra' r"# i' !a7i#ir%a (r"+'"!i*u#ui m%#a'"mu#ui.
Ni9%# I0 M%#a'"m i' !iu
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INDICELE BRESLO#0 r%(r%$i'a +r"!im%a ma)ima a um"rii< i' mm< d% #a 'i9%#u#
!rau#ui +ra'u#"! (a'a i' ("riu'%a %i *%a mai (r"8u'da.
E$ALUAREA BOLII SISTEMICE
E)am%' *#i'i* *"m(#%
Saii +a'+#i"'ar%
Radi"+ra@i (u#m"'ar% !i a7d"mi'a#%
T"m"+ra@% *"m(u%ri$aa d%*%#%a$a #%$iu'i *u diam%r% d% 3 mm !au mai
mi*i
Lim8a'+i"+ra@%
Bi"(!ii a#% +a'+#i"'i#"r !a'i'%#a
T%='i*i ima+i!i*% 8"#"!i'd a'i*"r(i m"'"*#"'a#i radi"a*i9i
TRATAMENTUL C!IRURGICAL
Si'+uru# raam%' *urai9
E!% +%'%ra# a**%(a *a #%$iu'% d% +r"!im% H
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G%'%ra"ar% d% *"'r"9%r!%
O7#i+a"rii i' !adiu# II >ad%'"(aii (a#(a7i#%?
E@*a*ia% '%(r%*i$aa *"m(#% (%'ru !adiu# I
S% (" (ra*i*a 7i"(!ii +a'+#i"'ar% (%'ru %9id%'i%r%a mi*r"m%a!a$%#"r
S% i'd%(ar%a$a i' 7#"* +ru(u# r%!(%*i9 d% +a'+#i"'i *%r9i*a#i< a)i#ari=amarr"mu# #i("@7r"ma"! a# '%r9i#"r?
Li("ma"$a di8u$a
Li("ma"$a !im%ri*a
N%9u# #i("ma"! *ua'a !u(%r@*ia#
-i7%r'"mu#
LIPOSARCOMUL
E!% u'u# di'r% *%#% mai 8r%*9%'% !ar*"am% a#% adu#u#ui !i ar% 5 !u7 i(uri0
1. Li("!ar*"mu# 7i'% di8%r%'ia >#i("mu# ai(i*?
2. Li("!ar*"mu# mi)"id
3. Li("!ar*"mu# *u *%#u#% r"u'd%
4. Li("!ar*"mu# '%di8%r%'ia
5. Li("!ar*"mu# (#%i"m"r@*
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Li("!ar*"mu# 7i'% di8%r%'ia >#i("mu# ai(i*?
Li("!ar*"mu# mi)"id
LIPOSARCOMUL MALIGN5
a(ar *u (r%di#%*i% (% *"a(!%< *a%"daa r%r"(%ri"'%a#
mar%a ma"ria% a(ar #a adu#< dar %)i!a !i *a$uri #a *"(ii >115 a'i?
au *a (u'* d% ("r'ir% *%#u#% (rimii9%< rar adi("*i% maur%
*#i'i*0 8"rmaiu'% um"ra#a d% dim%'!iu'i 9aria7i#% >*%#% r%r"(%ri"'%a#% ("
au'+% +i+a'%?< d% *"'!i!%'a i' +%'%ra# 8%rma< dur%r"a!a< '%ad%r%'a #a (i%#%a'+i"7#a!"mu# Naa+aa?
3. -%ma'+i"mu# i' i'a
4. -%ma'+i"mu# 9%ru*"!
5. A'+i"mu# i' *ir%a!a > a'+i"mu# !%'i#?
. -%ma'+i"mu# *a9%r'"!
. -%ma'+i"mu# ar%ri"9%'"!
. -%ma'+i"mu# 9%'"!
. -%ma'+i"mu# *u *%#u#% 8u!i8"rm%
1.-%ma'+i"mu# %(i%#"id
11.Gra'u#"mu# (i"+%'i*
12.Gra'u#"mu# (i"+%'i* i'ra9%'"!
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13.-%ma'+i"mu# i'ramu!*u#ar
14.-%ma'+i"mu# !i'"9ia#
15.-%ma'+i"mu# '%r9i#"r (%ri8%ri*i
1.E*a$ii 9a!*u#ar%
1.-i(%r(#a$ia (a(i#ara %'d"%#ia#a
-%ma'+i"mu# *a(i#ar
-%ma'+i"mu# *a9%r'"!
-%ma'+i"mu# ar%ri"9%'"!
-%ma'+i"mu# 9%'"!
A'+i"ma"$a
-%ma'+i"%'d"%#i"mu#
-%ma'+i"%'d"%#i"mu# a("!i8"rm
TUMORI /ASCULARE MALIGNE
A'+i"!ar*"mu# *ua'a
A'+i"!ar*"mu# a!"*ia *u #im8%d%mu#
A'+i"!ar*"mu# !a'u#ui
A'+i"!ar*"mu# i'du! d% radiaii
Sar*"mu# #ui ,a("!i
TUMORILE /ASELOR LIMFATICE
Mar%a ma"ria% !u' *"'+%'ia#%.
Su' mu# mai rar% d%*a =%ma'+i"am%#%.
1. Lim8a'+i"mu# >=i+r"mu# *=i!i*?
2. Lim8a'+i"ma"$a
3. Lim8%d%m #"*a#i$a ma!i9
4. Lim8a'+i"!ar*"m
Lim8a'+i"mu# >=i+r"mu# *=i!i*?
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Lim8a'+i"ma"$a
TUMORILE BENIGNE ALE NER/ILOR PERIFERICI
Tum"ri#% 7%'i+'% a#% '%r9i#"r (%ri8%ri*i !u' i'*#u!% (ri' *"'9%'i% i' *adru#
um"ri#"r d% (ari m"i !i di8%ra d% a*%!%a (ri' *a%9a a!(%*% im("ra'%.
Tum"ri#% %*ii '%r9i#"r !u' d% "ri+i'% '%ur"%*"d%rmi*a !au di' *r%a!a
'%ura#a.
Su' i'*a(!u#a% d% %(i !au (%ri'%r9< *ara*%ri!i*a *% 8a*i#i%a$a %'u*#%%r%a
#"r.
R%(r%$i'a *%# mai im("ra' +ru( d% #%$iu'i 7%'i+'% a#% (ari#"r m"i i' *ar%
ra'!8"rmar%a ma#i+'a %!% r%+u#a.
E)i!a d"ua i(uri (ri'*i(a#% d% um"ri 7%'i+'% a#% %*ii '%r9i#"r 0
S*=a''"mu# >d%'umi i'ai'% '%uri#"mu#?
N%ur"@7r"mu# *u 9ariaii#% #"r !i !i'dr"am%#% a!"*ia%.
Mai %)i!a *a%9a #%$iu'i (!%ud"um"ra#% a#% '%r9i#"r< *um ar @ 0
N%ur"mu# raumai*
N%ur"mu# #ui M"r"'
Ga'+#i"'u# %*ii '%r9u#ui
S*=a''"mu# ar% urma"ar%#% 9aria'%0
S*=a''"mu# #"*a#i$a
S*=a''"mu# *u m"di@*ari d%+%'%rai9%
S*=a''"mu# *%#u#ar
S*=a''"mu# (#%)i8"rm
S*=a''"mu# %(i%#"id
S*=a''"ma"$a
S*=a''"mu# m%#a'"i*
N%ur"@7r"mu# ar% r%i 9aria'%0
L"*a#i$a
Di8u$
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P#%)i8"rm
Tr%7ui% m%'i"'aa '%ur"@7r"ma"$a !au 7"a#a 9"' R%*#i'+=au!%' *ar% ar% #a
ra'du# %i d"ua 8"rm% 0 NF1 !i NF2< (rima @i'd *%a mai ra!(a'dia.
E)i!a " !ra'!a #%+aura i'r% '%ur"@7r"ma"$a NF1 !i '%ur"@7r"mu# d% i( di8u$ !i
(#%)i8"rm.
Tra,amen,ul unei ,umori cu,ana,e
Pro,ocol
E7amenul &erma,olo/ic
E7amenul RMN8CT
Tra,amen,ul c3irur/ical
E7amenul 3is,o%a,olo/ic
Tra,amen,ul oncolo/ic
Con,rolul %os,o%era,or %erio&ic
E7amenul &erma,olo/ic
I&en,i1carea %re-um,iva a ,i%ului &e ,umora
Orien,ea-a asu%ra e7ci-iei in su%ra(a,a
E7amenul RMN8CT
Punerea in evi&en,a a e7,ensiei ,umorale
CT %une mai .ine in evi&en,a a(ec,area s,ruc,urilor osoase
RMN evi&en,ia-a mai 1&el le-iunile %ar,ilor moi
Orien,ea-a asu%ra e7ci-iei in %ro(un-ime
E7amenul RMN
C"m(arai9 *u %)ami'ar%a CT< r%$"'a'Ka ma+'%i* (%rmi% u' *"'ra! !u(%ri"r a#
(rKi#"r m"i *u 9i$ua#i$ar%a !u(%ri"ar a d%a#ii#"r a'a"mi*%. A*%a!a 8a*% *a
%)am%'u# RM ! @% '% !u(%ri"r *%#ui CT ' *ara*%ri$ar%a !ru*uri#"r mu!*u#ar%< a
%'d"a'%#"r< a #i+am%'%#"r< *ari#au#ui i m%'i!*uri#"r ari*u#ar%. D%(i!ar%a
m"di@*ri#"r (a"#"+i*% d% #a 'i9%#u# mdu9%i "!"a!% %!% d% a!%m%'%a '%
!u(%ri"ar ' *a$u# r%$"'a'K%i ma+'%i*%.
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U' a# a9a'a a# %)ami'rii RM *"m(arai9 *u *%#%#a#% i(uri d% i'9%!i+aKii
ima+i!i*% >radi"+ra@%< CT< !*i'i+ra@%? %!% r%(r%$%'a d% 8a(u# * %!%
'%i'9a$i9 i '%iradia'.
I'di*aKii#% ma"r% d% RM !u' um"ri#% d% (rKi m"i< "!%"'%*r"$%#% a!%(i*% i
#%$iu'i#% ari*u#ar% >i'ama"rii !au raumai*%?.
S,a&iali-area ,umorilor &e %9r:i moi im%lic9 o cola.orare s,r;ns9 i ana,omo%a,olo/0
C%#% mai mu#% i'8"rmaKii d%!(r% %)%'!ia um"ra# #"*a# !% "7Ki' *u au"ru#
ima+i!i*ii. A!8%#< r%$"'a'Ka ma+'%i* %!% *a(a7i# ! (r%*i$%$% dim%'!iu'%a
um"rii< %)%'!ia #"*a# ' 8u'*Ki% d% (#a'uri#% 8a!*ia#% i d% #"*a#i$ar%a
*"m(arim%'a#.
E)am%'u# RM %!% d% %#%*Ki% ' id%'i@*ar%a i'9a$i%i !ru*uri#"r "!"a!%< ari*u#ar%!au '%ur"9a!*u#ar%. E!% i'di*a *a 'ai'% d% 7i"(!i% ! !% 8a* " %9a#uar%
ima+i!i* mi'uKi"a! a %)%'!i%i #"*a#% a um"rii.
Gra&in/ul 3is,olo/ic
d%%rmi'a +radu# d% ma#i+'ia% a# u'%i um"ri !i r%(r%$i'a m"du# (ri' *ar%
!% *ua'i@*a +radu# d% di8%r%'i%r% (ri' a(#i*ar%a u'ui !% d% *ri%rii
=i!"#"+i*%0 +radu# d% *%#u#aria% (#%i"m"r@!mu# *%#u#ar !au a'a(#a$ia a*i9ia%a mi"i*a > 8r%*9%'a !au a'"rma#ia%a mi"$%#"r? +radu# d% '%*r"$a %)(a'!i9ia%a !au i'@#rar%a !i *r%!%r%a i'9a$i9a.
Gradul (G)
G? Bine &i(eren:ia,
G@ Mo&era, &i(eren:ia,
G Sla. &i(eren:ia,
G Ne&i(eren:ia,
Tumora (T)
T? Diame,rul cm
T?a Tumor9 su%er1cial9
T?. Tumor9 %ro(un&9
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T@ Diame,rul cm
T@a Tumor9 su%er1cial9
T@. Tumor9 %ro(un&9
Adenopatii (N)
N F9r9 a&eno%a,ii re/ionale ,umorale
N? A&eno%a,ii re/ionale ,umorale 23is,o%a,olo/ic4
Metastaze (M)
M F9r9 me,as,a-e
M? Me,as,a-e la &is,an:9
S,a&iali-area ,umorilor mali/ne &e :esu,uri moi 2ACC4
Gradul (G)
G Beni/n
G? Tumor9 mali/n9 cu /ra& mare &e &i(eren:iere
G@ Tumor9 mali/n9 ne&i(eren:ia,9
Extensie tumorala (T)
T? In,racom%ar,imen,al9
T@ E7,racom%ar,imen,al9
Metastaze (M)
M F9r9 me,as,a-e
M? Me,as,a-e la &is,an:9
S,a&iali-area ,umorilor mali/ne musculo+sc3ele,ale 2Musculos*ele,al
Tumor Socie,'4
Tra,amen,ul c3irur/ical
Lar/imea e7ci-iei
E7ci-ie cu .is,uriul elec,ric= in .loc
Recu%a
Mo&ul &e aco%erire a &e(ec,ului re-ul,a,
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Su,ura &irec,a
Plas,ie PLD
Lam.ouri locale Cu,aneo/rasoase
Fasciocu,ane
Musculo (ascio cu,ane
Lam.ouri ,rans(era,e li.er
Su,ura &irec,a
Gre(a PLD
Lam.ouri locale
Lam.ouri &e ,rans(er li.er
Trans(er li.er &e lam.ou muscular la,issimus &orsi %en,ru recons,ruc,ia
(e,ei
Trans(er li.er &e lam.ou muscular la,issimus &orsi %en,ru recons,ruc,ia
(e,ei
E7amenul 3is,o%a,olo/ic
Pu'% dia+'"!i*u# d% *%riudi'% a# 8"rmaiu'ii um"ra#%
D%%rmi'a' (%'ru *"'duia %ra(%ui*a u#%ri"ara
Conclu-ii
E)i!%'a u'ui !i!%m i'%+ra< a u'%i r%%#% i'8"rmai*%< #a 'i9%#u# u'ui !(ia# ar
8a*i#ia a**%!u# ra(id #a ima+i!i*a< a#% %)am%%'% (ara*#i'i*%< raam%'< 7a$a d%
da% a'a"m"(a"#"+i*a
Su**%!u# i'%r9%'i%i *=irur+i*a#% i' im( d%(i'd% dir%* d% a(r%*i%r%a %)%'!i%i
#%$iu'ii (ri' %)am%'u# (r%"(%ra"r RMN !i " %)*i$i% #ar+a *=iar i' (r%$%'a u'"r
a!(%*% ma*r"!*"(i*% a(ar%' '"rma#% a#% %+um%'u#ui
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