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#16
21.12.2017, 00:14
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Интересно, а как подтвердили доброкачественность процесса у Вашей супруги, если железу и удаляют при етой патологии только потому, что никак не могут отличить аденому от карциномы ни при пункционной биопсии, ни при цитол. исследовании во время/после операции?
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#17
21.12.2017, 00:26
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Клинический диагноз:suspicio C-r щитовидной железы Iа кл.гр.
Хирургическое лечение: правая доля пролиферирующие фолликулярные аденомы на фоне АИТ Хашимото, перешеек-АИТ Хашимото, левая доля фолликулярная аденома на фоне АИТ Хашимото |
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#20
21.12.2017, 00:47
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Вы английским владеете? понять сможете написанное ниже или может через переводчик, особенно выделенное?
Follicular carcinoma has microscopic features that are similar to a follicular adenoma. However, a follicular carcinoma tends to be more cellular with a thick irregular capsule, and often with areas of necrosis and more frequent mitoses. A follicular carcinoma cannot be distinguished from a follicular adenoma based on cytologic features alone. It is distinguished from a follicular adenoma on the basis of capsular invasion, vascular invasion, extrathyroidal tumor extension, lymph node metastases, or systemic metastases. Capsular invasion is defined as tumor extension through the entire capsule. A follicular neoplasm with tumor invasion into but not through the entire capsule is considered a follicular adenoma [4]. Vascular invasion is defined as tumor penetration into a large caliber vessel within or outside the capsule. Tumor invasion of a large vessel with an identifiable wall and an endothelial lining is definitive morphologic evidence of vascular invasion. Vascular invasion is the most reliable sign of malignancy. Follicular carcinoma is divided into minimally invasive and invasive variants based on morphologic criteria. Minimally invasive follicular carcinoma is an encapsulated tumor with microscopic penetration of the tumor capsule without vascular invasion [4, 5]. Minimally invasive follicular carcinoma is a less aggressive tumor with a disease-free survival that has been reported to be similar to a benign follicular adenoma [6, 7]. However, there are reports of some patients dying of minimally invasive follicular carcinoma [4]. Patients with minimally invasive follicular carcinoma tend to be younger than patients with invasive follicular carcinoma, and it has been suggested that minimally invasive follicular carcinoma may be a precursor to its invasive counterpart [8]. Invasive follicular carcinoma is defined as a follicular carcinoma with vascular invasion and/or extension beyond the tumor capsule into the adjacent thyroid parenchyma. It is associated with a worse prognosis. It has been subdivided into moderately invasive and widely invasive variants based on the presence of angioinvasion with or without capsular invasion versus extensive invasion of the capsule and the thyroid parenchyma [4]. Van Heerden and colleagues reported a 10-year disease-specific mortality of 15%–28% in patients with invasive follicular carcinoma [6]. Invasive follicular carcinoma is defined as a follicular carcinoma with vascular invasion and/or extension beyond the tumor capsule into the adjacent thyroid parenchyma. It is associated with a worse prognosis. It has been subdivided into moderately invasive and widely invasive variants based on the presence of angioinvasion with or without capsular invasion versus extensive invasion of the capsule and the thyroid parenchyma [4]. Van Heerden and colleagues reported a 10-year disease-specific mortality of 15%–28% in patients with invasive follicular carcinoma [6]. |
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#22
21.12.2017, 01:09
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указание на "пролиферирующие фолликулярные аденомы" в правой доле в диагнозе может косвенно намекать, что это была не аденома, если были даже карциномы в миним. пролиферацией, то у каждого пятого обнаруживаются метастазы, причем в ~40% из них во время операции, а в ~60% уже после оной и факторами риска был возраст после 45 лет (отпадает в вашем случае) или размер опухоли более 4 см (это неизвестно), гематогенные метастазы могли быть причиной церебрального тромбоза вен:
251 patients with minimally invasive FTC underwent initial surgery at our hospital. Their median follow-up period was 7.2 years. There were 194 women and 57 men. Their mean age at the time of surgery was 46 years. Distant metastases were diagnosed in 54 patients (21.5%). In 22 of them distant metastases were diagnosed at the time of the initial surgery (M1), and in the other 32 they were diagnosed during the follow-up period. Age at initial surgery, sex, primary tumor size, histological findings (differentiation, and extent of vascular and capsular invasion), completion total thyroidectomy, and distant metastases at initial surgery were assessed as prognostic factors for distant-metastases-free survival (DMFS) and cause-specific survival (CSS). Univariate analysis showed that age (45 years or older) and primary tumor size (4 cm or more) were significant prognostic factors related to postoperative distant metastases in the group of 229 patients without distant metastases at time of the initial surgery. The cumulative survival rate was significantly poorer in M1 patients, patients aged 45 years or older, and patients whose primary tumor size was 4 cm or more. Multivariate analysis showed that age was a significant prognostic factor both for DMFS and CSS. Outcomes and prognostic factors of 251 patients with minimally invasive follicular thyroid carcinoma. [Ссылки доступны только зарегистрированным пользователям ] |
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#25
21.12.2017, 01:42
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Цитата:
что сейчас планируют делать врачи с Вашей супругой? назначены ли дообследования? попробуйте все-таки как можно скорее добраться до результатов проведенных обследований |
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#26
21.12.2017, 20:03
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Проводится противоотечная терапия, антибиотики, противовирусные препараты, поддержание гемодинамики, борьба с осложнениями. Доп. обследования нет. МРТ и КТ в реанимации нет. МРТ в другой больницы, везти её туда боятся чтоб не ухудшить состояние. По истории при переводе из неврологии она была в Коме 2-3. В реанимацию инфекции, со слов врачей, она поступила в коме 4.
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#30
23.12.2017, 11:53
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Состояние крайней тяжелое, трахеостому еще не ставили. Рефлексы все отсутствуют. Продолжают лечение. По ЭЭГ ставят смерть коры мозга. Дополнительные исследования в виде МРТ возможно только в Краснодаре, куда ее не хотят брать.
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Линейный вид
