Prípad SD-IAP 505
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Transcript of Prípad SD-IAP 505
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Prípad SD-IAP 505
B. RychlýCytopathos s.r.o.
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Klinické údaje
• 31-ročná žena• v anamnéze Hodgkinov lymfóm• pri cholecystektómii pre chelecystolitiázu
vykonaná klinovitá resekcia solitárne suspektného ložiska v pečeni
• v. s. MTS
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materiál z operovanej medzistavcovej platničky
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Verhöeff
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Orceín
Van Gieson zelený trichróm
Viktorka
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Naša diagnóza
Segmentálna atrofia pečene, stage II / nodulárna elastóza
pečene
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• 18 cases• Verhoeff - Hematoxilín• Verhoeff - van Gieson
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Segmentálna atrofia pečene• zriedkavý pseudotumor• častejšie u žien, unifokálny• najčastejší príznak bolesť horného pravého
kvadrantu• prevažne subkapsulárne• 1,8 - 10 cm• abnormálne hrubostenné cievy (len
intralezionálne), často trombotizované, rekanalizované
• biliárne cysty
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Stage 1 - 4• 1 – kolaps parenchýmu so zachovaním
portálnych polí, občasnými ostrovčekmi zachovaného parenchýmu a s duktulárnou reakciou
• 2 – minimálna až žiadna duktulárna reakcia, zvýšená miera elastózy
• 3 – takmer výlučne elastóza, občasné malé ostrovčeky hepatocytov
• 4 – end stage, ložisko fibrózy
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Elastika?• v poškodených tkanivách sa môže tvoriť
nadmerné množstvo (dezorganizovaných) elastických vlákien
• v pečeni normálne v stenách ciev, malé množstvo v portálnych poliach a okolo centrálnej vény
• pri poškodení produkujú portálne fbroblasty• prečo tak exuberantne?
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Abnormálne cievy• vyvolávajúci impulz ischémia?
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Dif. dg.• amyloidóza• epiteloidný hemangioendotelióm• cancer- asociovaná elastóza (cholangio CA,
MTS adeno CA)
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Záver• zriedká lézia (poddiagnostikovaná?)• klinicky napodobňuje tumor
ďakujem za pozornosť
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Senec 2014, 20. – 21. júnMalcolm Hayes, B.Sc., M.B.,Ch.B., LRCP, MRCS, M.Med. Path, FRCPath,
FRCPC – Medical Director
Malcolm Hayes is a pathologist at the BC Cancer Agency (BCCA) in Vancouver. Dr. Hayes has worked at the BCCA since 1993 and has broad expertise in surgical pathology and cytopathology and major interests in breast, skin, gynecological and soft tissue pathology. He is a Clinical Professor of pathology at the University of British Columbia and a Fellow of the Royal College of Pathologist of UK. He has many years of expertise in diagnostic immunohistochemistry based on employment of this technique in the work up of a large volume of challenging consultation cases referred to the BCCA "Primary Unknown" tumour group.
1. Lesions that can be mistaken for malignancy
2. Challenging cases in breast pathology2 x 1 hod.