Chotupa cha phyllodes ndi chotupa chosowa kwambiri cha bere, chomwe chimawonekera kale kuposa khansa ya m'mawere. Nthawi zambiri zimakhala zabwino, koma pali mitundu yoyipa yowopsa. Chithandizo chomwe chimakondedwa ndi opaleshoni, yomwe nthawi zambiri imakhala yabwino, ngakhale kubwereza komweko sikungaletsedwe.

Tanthauzo

Phyllodes chotupa ndi osowa chotupa cha bere, amene amayamba mu connective minofu. Ndi chotupa chosakanikirana, chotchedwa fibroepithelial, chomwe chimadziwika ndi kuchuluka kwa maselo a epithelial ndi maselo ogwirizanitsa, pamene ambiri a khansa ya m'mawere amakhudza maselo a glandular. 

Zotupa za Phyllodes zimagawidwa m'magulu atatu:

• ambiri (pakati pa 50% ndi 75% malinga ndi olemba) ndi zotupa zowopsa (giredi 1)
• 15-20% ndi zotupa zam'malire, kapena malire (giredi 2)
• 10 mpaka 30% ndi zotupa zowopsa, ndiye kuti khansa (giredi 3), yomwe nthawi zina imatchedwa phyllodes sarcomas.

Zotupa zamtundu wa 1 phyllodes zimakula pang'onopang'ono ndipo nthawi zambiri zimakhala zazing'ono (za dongosolo la centimita), zimakula mofulumira komanso zotupa zazikulu za phyllodes (mpaka 15 cm) nthawi zambiri zimakhala zoopsa.

Zotupa zowopsa za phyllodes zokha ndizomwe zimayambitsa metastases.

Zimayambitsa

Zomwe zimayambitsa kupangika kwa zotupazi sizikudziwika bwino.

matenda

Chotupacho, chomwe chimapanga misa yosinthika yodziwika bwino, nthawi zambiri imapezeka panthawi yodzifufuza kapena kufufuza kwachipatala pokambirana ndi amayi.

Kukula kofulumira kwa misa yodziwika yomwe inalipo kale kungasonyeze kuti ali ndi matenda, komanso motsogozedwa ndi zaka za wodwalayo.

ZITHUNZI

Mayeso omwe amakonda kujambula ndi mammography ndi ultrasound, koma MRI imatha kupereka chidziwitso pazochitika zinazake. Komabe, kuyezetsa kumeneku sikumapangitsa nthawi zonse kuyesa kalasi ya chotupa cha phyllodes, kapena kuchisiyanitsa ndi fibradenoma, chotupa cha m'mawere chofananira.

biopsy

Percutaneous biopsy (kutenga zidutswa za minofu pogwiritsa ntchito singano yomwe imayikidwa pakhungu) imachitika motsogozedwa ndi ultrasound. Zimalola kutsimikizira kwa histological: minyewa yomwe imatengedwa imawunikidwa pansi pa maikulosikopu kuti adziwe momwe chotupacho chilili.

Anthu okhudzidwa

Zotupa za Phyllodes zimatha kuchitika pazaka zilizonse koma makamaka zimakhudza amayi azaka zapakati pa 35 ndi 55, ndipo zimachitika kwambiri pakati pa zaka 40 ndi 45. Chifukwa chake amawonekera mochedwa kuposa fibradenoma, yomwe imakhudza atsikana kwambiri, koma kale kuposa khansa ya m'mawere.

Amayimira zosakwana 0,5% za zotupa za m'mawere.

Zowopsa

Ofufuza akukayikira kulowererapo kwa zinthu zosiyanasiyana zoyambitsa chibadwa pakuwoneka ndi kukula kwa zotupazi.

Zotupa zambiri za phyllodes sizipweteka ndipo sizimayenderana ndi axillary lymphadenopathy (palibe zokayikitsa, zolimba kapena zotupa zotupa m'khwapa).

Pa palpation nodule imakhala yolimba, yoyenda ikakhala yaying'ono, imamatira ku minofu ikakula.

Zotupa zazikulu zimatha kutsagana ndi zilonda zapakhungu. Nthawi zambiri pamakhala kutuluka kwa nsonga kapena kutsika kwa nsonga.

opaleshoni

Chithandizo makamaka chimatengera kuchotsedwa kwa zotupa zomwe si za metastatic, kaya zowopsa kapena zowopsa, ndikusunga malire otetezeka a 1 cm. Opaleshoni yochirikiza ndiyofala kwambiri kuposa mastectomy. Izi zitha kukhala zofunikira ngati zichitikanso mwamakani.

Axillary lymph node dissection sikuthandiza kwenikweni.

Radiotherapy

Radiotherapy ikhoza kukhala chithandizo chothandizira matenda oopsa a phyllodes, makamaka ngati ayambiranso.

mankhwala amphamvu

Kuthandiza kwa chemotherapy ngati chithandizo chothandizira zotupa zowopsa za phyllodes kumakambidwa pazochitika ndizochitika. Njira zomwe zimagwiritsidwa ntchito ndizofanana ndi zomwe zimagwiritsidwa ntchito pochiza ma sarcoma a minofu yofewa.

Kuneneratu kwa zotupa za phyllodes nthawi zambiri kumakhala kwabwino, osabwerezanso zaka 10 mwa amayi 8 mwa 10 aliwonse, mosasamala kanthu za kalasi ya chotupacho. 

Zobwerezabwereza za m'deralo, komabe, zimakhalabe kawirikawiri. Nthawi zambiri zimachitika mkati mwa zaka ziwiri za opaleshoni, koma zimatha kuwoneka pambuyo pake, zomwe zimafunikira kuwunika pafupipafupi. Zotupa zowopsa zimayamba kuyambiranso.

Chotupa cha phyllodes chomwe chimabwereranso chikhoza kukhala chaukali m'chilengedwe kuposa chotupa choyambirira. Nthawi zambiri, m'malo mwake, idzakhala ndi khalidwe labwino kwambiri. Chifukwa chake, zotupa zina zowopsa zimatha kubwereranso ngati zotupa za khansa, kapenanso kusintha kwa metastatic. Kuopsa kwa metastasizing kumakhala kwakukulu pamene chotupa chachikulu cha phyllodes chinali choopsa.

Pakachitika mobwerezabwereza m'deralo, chotchedwa "catch-up" mastectomy imapereka chiwongoladzanja chachikulu koma chimakhalabe chodula, chomwe nthawi zambiri chimakumana ndi amayi omwe adakali aang'ono. Ubwino wa radiotherapy ndi / kapena chemotherapy amakambidwa pazochitika ndi gulu ndi gulu lazaumoyo.

Kudziwikiratu kumakhalabe koyipa ngati kubwereza mwamphamvu kumabweretsa kuoneka kwa metastases. Kuyankha kwa chemotherapy sikukhalitsa, ndipo imfa imachitika mkati mwa miyezi 4 mpaka 6. Choncho kuyang'anira kuli ndi ntchito yofunikira.