Elemente de Oncologie a Tegumentului Si Partilor Moi

7/25/2019 Elemente de Oncologie a Tegumentului Si Partilor Moi

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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


2/21

,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.


3/21

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%


6/21

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


7/21

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


8/21

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


9/21

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@*


12/21

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%'"!


16/21

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*?


17/21

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$


18/21

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

Documents

Elemente de Oncologie a Tegumentului Si Partilor Moi