DIFERENCIJALNO DIJAGNOSTIČKA PROBLEMATIKA ABDOMINALNIH TUMORA - PRIKAZ SLUČAJA.
In: Timocki Medicinski Glasnik, Jg. 40 (2015-10-01), Heft 4, S. 270-275
Online
academicJournal
Zugriff:
Only physical methods of examination in the form of inspection, palpation, percussion and auscultation are not sufficient for the early detection of tumours of the abdomen, and it is necessary to apply contemporary imaging techniques. This paper presents a patient with abdominal tumour and explains the problem in differentiating the origin of the tumour despite modern diagnostic procedures. Case report: A female person , aging 60, was sent to the Department of Surgery for the bloated stomach, poor appetite and occasional heartburn. During the examination of the abdomen, the doctor observed a palpable flank mass measuring about 15x15cm, clearly circumscribed, of firm consistency and subjective light mobility in the abdomen; the abdomen above the chest level, hard palpation, insensitive to pain. After the laboratory testing which showed an increase in leukocytes (WBC 14.4) and a significant decrease in hemoglobin (HGB 67) and erythrocytes (2.14), with calm tumour markers CA19-98.00, CEA 2.11, the patient was subjected to ultrasonic testing whereby the presence of heterogeneous, predominantly hypoechoic mass in the abdomen was confirmed. Considering that with this method it was not possible to differentiate the origin of the tumour, the patient was sent to the CT of the abdomen whereby the presence of heterodensitysoft-tissue formation in the ventral abdomen from the height of kidneys to small pelvis was confirmed and it raised the suspicion of genital origin of the tumour which was why the patient was referred to a gynaecologist. The gynaecological examination did not determine the origin of the tumour and then we searched for the level of tumour marker CA-125 in order to prove the possible genital origin of tumour, namely the ovary. According to the findings of immunohistochemistry, the level of CA-125 was 149, which was almost four times higher than normal findings. After consultations with the anaesthesiologist, a surgical intervention was scheduled. The patient was operated under general endotracheal anaesthesia, where the exploration of the abdomen found that the tumour was of ovarian origin. Ex tempore histopathologic findings indicated a benign change. The ovary with the associated tumour was removed completely. The patient was successfully recovering at the Department of Surgery with adequate treatment and care. Definitive histopathological findings confirmed the existence of ovarian cancer. Conclusion: In spite of modern diagnostic methods (X-rays, ultrasound and CT examinations), the origin of the tumour was discovered with surgical intervention. In addition to educating the population for early reporting to the doctor at the first signs and symptoms of a disease, it is necessary to improve the existing and discover new methods of examination by means of which we will easily decide whether a patient will be treated with medications, radiological therapy or chemotherapy or they should opt for surgical procedures. [ABSTRACT FROM AUTHOR]
Uvod: Samo fizičke metode pregleda u vidu inspekcije, palpacije, perkusije i auskultacije nisu dovoljne za rano otkrivanje tumora abdomena, već je neophodna i primena savremenih radioloških metoda. Ovaj rad prikazuje pacijenta sa abdominalnim tumorom i objašnjava problem u diferenciranju porekla tumora i pored savremenih dijagnostičkih procedura. Prikaz slučaja: Osoba ženskog pola, starosti 60 godina, upućena je na odeljenje hirurgije zbog nadutosti stomaka, oslabljenog apetita i povremene gorušice. Tokom pregleda u abdomenu se uočava palpabilna tumefakcija veličine oko 15x15cm, jasno ograničena, čvrste konzistencije, subjektivno lake pokretljivosti u trbuhu. Abdomen iznad ravni grudnog koša, palpatorno tvrd, bolno neosetljiv. Nakon laboratorijskog ispitivanja koje je pokazalo porast leukocita (WBC 14,4) i značajan pad hemoglobina (hgb 67) i eritrocita (2,14), uz mirne tumorske markere CA 19-9 8,00; CEA 2,11, pacijentkinja je podvrgnuta ultrazvučnom ispitivanju gde je potvrđeno prisustvo heterogene, najvećim delom hipoehogene mase u abdomenu. S obzirom na to da ovom metodom nije bilo moguće diferenciranje porekla tumora, pacijentkinja je upućena na CT abdomena gde se potvrđuje prisustvo heterodenzne mekotkivne formacije u ventralnom delu trbuha, od visine bubrega do u malu karlicu, i postavlja se sumnja da je tumor genitalnog porekla zbog čega se pacijentkinja upućuje ginekologu. Ni ginekološkim pregledom nije bilo moguće utvrditi poreklo tumora pa se pristupilo izradi tumorskog markera CA-125 ne bi li se dokazalo eventualno poreklo tumora od genitalnih organa, tj. ovarijuma. Po nalazu imunohemije nivo CA-125 je 149 što je skoro četiri puta veće od normalnog nalaza. Nakon konsultacije anesteziologa zakazana je hirurška intervencija. Pacijentkinja je operisana u opštoj endotrahealnoj anesteziji, gde se eksploracijom trbuha konstatuje da je tumorska promena ovarijalnog porekla. Ex tempore patohistološki nalaz ukazuje na benignu promenu. Ovarijum sa pripadajućim tumorom odstranjen je u celosti. Pacijentkinja se uspešno oporavlja na odeljenju hirurgije uz adekvatnu terapiju i negu. Definitivnim histopatološkim nalazom utvrđeno je postojanje karcinoma jajnika. Zaključak: Uprkos savremenim dijagnostičkim metodama (rendgenska snimanja, ultrazvučni pregledi i CT) poreklo tumora je otkriveno hirurškom intervencijom. Pored edukacije stanovništva za što ranije javljanje svom lekaru pri pojavi prvih simptoma i znakova bolesti, neophodno je usavršavanje postojećih i otkrivanje novih metoda pregleda uz čiju pomoć ćemo lakše odlučiti da li pacijenta tretirati medikamentnom, radiološkom ili hemioterapijom, ili se, pak, treba odlučiti za operativne postupke. [ABSTRACT FROM AUTHOR]
Titel: |
DIFERENCIJALNO DIJAGNOSTIČKA PROBLEMATIKA ABDOMINALNIH TUMORA - PRIKAZ SLUČAJA.
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Autor/in / Beteiligte Person: | Jović, Marko ; Narodović, Ljubiša ; Kero, Marija ; Marinković, Milomir |
Link: | |
Zeitschrift: | Timocki Medicinski Glasnik, Jg. 40 (2015-10-01), Heft 4, S. 270-275 |
Veröffentlichung: | 2015 |
Medientyp: | academicJournal |
ISSN: | 0350-2899 (print) |
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