Siu m vinh Trung ThnhBv St Paul

Anatomie

Ph n c thaiGalactocele

K thut thm khmThm khm lm sngT th ngT th nmu d: phng, tn s caoMode harmonique:

Ch nhC triu chng lm sng ph n

Ch nhtrong cc trng hp b xung cho chp vMt tuyn v: type 3 hoc 4Khi trn phim chp vTn thng s thy trn lm sng nhng khng thy trn phim hoc cc v tr hn ch ca mammoProthseBilan trc iu tr U v (tm cc tn thng km theo)

Triu chng hc theo BIRADSCu trc m tuyn vng nht

Triu chng hc theo BIRADSCu trc m tuyn vKhng ng nht

Khi/n: chim v tr trong khng gian v nhn thy trn 2 mt phngc m t bi 7 c imHnh dngHng (so vi mt phng da)BGii hnCu trc mBng m pha sauCu trc m ln cn

Hnh dngTrnOval: VPP lnh tnh = 84%Khng u: VPP K = 62%

V tr ca khi so vi mt phng da:Song song: trc ln ca khi song song vi mt phng da: VPP lnh tnh = 78%Vung gc: VPP K = 69%

AdenofibromeCCI

AdenofibromeHng ca khi vung gc vi mt phng da

Ranh giiR: VPP lnh = 90%Khng r: kh xc nhTo nhiu gc nhnNhiu thyTua gai

Ranh gii rNhiu thyRanh gii khng rTo nhiu gc nhn

Hnh tua gai

Cu trc m ca khiRng mTng m (so vi nhu m tuyn)Gim mng mHn hp

Cu trc m hn hp (tng sinh ng tuyn)Cu trc m hn hp (Papillome)

Bng m pha sauKhng cTng m pha sauBng cn m pha sau

Khng phi bt k khi no c bng cn m pha sau cng l K (khi nhiu cu trc x)Mt s K khng c bng cn pha sau

Cu trc m lin kCu trc ng tuynHnh nh co ko cu trc xung quanh(Distorsion architechturale)Dy t chc daCo ko da, nm v

Vin halo tng m(K+++,abcs)

Nt vi haKh nh gi trn SAGm nt micro v macro canxi ha (>0.5mm)

MicrocalcificationACR 5

Phn b mch muKhi u tng sinh mch nghi ng c tnh Phn tch ph Doppler t c ngha phn bit

Khi nghi ng K +++Hnh dng khng u + b khng r + bng cn m VPP > 90%

Hnh oval + v khi mnh, tng m + trc // VPP lnh tnh > 98%

Bng phn loi BIRADS theo ACRBIRADS 0: cn thm phng php CHA khcBIRADS 1: khng c bt thngBIRADS 2: tn thng lnh tnhBIRADS 3: tn thng nhiu kh nng lnh tnh (kh nng c tnh 95%)BIRADS 6: tn thng c tnh bit

ACR 2Nang dch n thun: b r, rng m, oval, tng m pha sau.Hch bn trong tuyn v: khi oval, b r trung tm tng m, ngoi vi gim m.Fibroadnome calci haHamartome: khng cn theo di hoc cc phng tin CHA khc

ACR 3Nang dch khng in hnhNang hn hp: nang c km cu trc c, vch dy, thnh khng uTn thng c nhiu kh nng lnh tnh: trn hoc oval, b u, //, khng c yu t nguy c : Fibroadnome theo di 4-6 thng gim tn sut sinh thit

ACR 4Bao gm nhng cu trc khi thiu cc tiu chun lnh tnh cn tin hnh sinh thit hoc chc ht t bo

ACR 5Cn c kt qu m bnh hc tin hnh lm bilan nh gi xm ln v iu tr

U lnh tnhFibroadenomeTumeur phyllodeHamartomeU nh (Papillome)So hnh sao (cicatrice radiaire)

FibroadenomeU lnh tnh ph bin nht, thng ph n tr (

Hnh nh trn siu m:: T phyllode, adenome lactant, lipome, hamartome, hch, kyste pidermique,T c tnhThi x tr: Theo di lm sng 30t mammo. Th khng in hnh biopsie

Tumeur phyllodeTng sinh ca t chc lin kt v biu m quanh ng tuynPhn ln lnh tnh, ti pht 20%La tui trung nin (40-50)C th c cu trc dch do hoi t trong khi u

SA: khi kch thc ln (1-20cm), gim m khng ng nht, nang dch nh bn trong, ranh gii r, khng c vi ha. Khng phn bit c vi Fibroadenome T1W chy mu bn trong khi ng thi gi c tnh *

(*) YabuuchiH, Soeda H, Matsuo Y, et al. Phyllodes tumor of the breast: correlation between MR findings and histologic grade. Radiology 2006; 241: 702709

PapillomeLm sng +++: chy dch t pht,1 bn, dch trong hoc dch muKhi nh, trn, ranh gii r, calci ha + gin ng tuyn vng sau nm v pha trn v di ca khi.iu tr: phu thut hoc strotaxie

Tr, 205LS: khi di ng, khng chy dchTn thng lnh tnh nhng hay gp c tin s K v trong gia nh swiss cheese disease Juvenile Papillomatosis

Hay gp ph n tin mn kinhLnh tnh, do s tng sinh ca nguyn bo x-cPseudoangiomatous Stromal Hyperplasia( PASH)

Tn thng c tnhK biu m ng khng xm nhp (CCIS)K biu m ng xm nhp (CCI)K th ty (Cancer mdullaire)K th nhy (mucineux)K th nh (papillaire)K tiu thy khng xm nhpK tiu thy xm nhp

K biu m ng khng xm nhp (CCIS)Ch yu pht hin trn mammo: microcal (mnh,thnh m)SA: kh pht hin, khi nh nhiu thy, gim m.

K biu m ng xm nhp (CCI)

CCI

CCI

CCI

CCI

CCI

CCI 5mm

Metas hch

TNMM MtastasesM0:M1:Mta adno di n TT0: khng c TTis:insituT1: 5 cms NN0: N1 mobileN2 fix

T4Tin lng sng >5yT1: 90%T2: 70%T3: 50%T4: 20%

K tiu thy xm nhp 10% K xm nhp, 20% 2 bnHnh nh bng cn m pha sau v co ko t chc xung quanh +++Hnh tua gai, tng sinh mch

K th ty (Cancer mdullaire)B r, t khi c vi haTng sinh mch, Mt t bo rt cao tng m pha sau kyste

K th nhy (Cancer mucineux) kyste

Bnh l vimLm sng +++Dy t chc di da, gin cc khoang bch mch, tng sinh mchAbces: ph n trSA: khi gim m, b r hoc khng u

K di cn vHim, K nguyn pht: mlanome, phi, thn, tiu ha, lymphome, neuroblastomaSA: nhiu khi, ranh gii r, tin trin nhanh khi u lnh tnh

Cas cliniqueN 70tDiag Nang HematomeAbcesPapillomeK papillaire

N 50t, chy dch mu 1 bnpapillome

49t, s thy khi v triXt nghim tip theo?Hng x tr?Fibroadenome+++

N, 52t, khi s thy ngc triPseudoangiomatous stromal hyperplasia (PASH)

Lymphoma

QCMTr li ng hoc sai:

a. T or F: d dng phn bit tn thng c trn siu m khi v gm nhiu t chc m

b. T or F d dng phn bit nang dch trn siu m khi v gm nhiu t chc x tuyn

QCMK v c dng nang dch hay gp nht l:K th ty (Medullary)K th nh (papilary)K th ng (tubular)Tn thng c nang khng bao h l K

QCMSiu m v hu dng nht sau khi chp v trong trng hp:

Khi khng nhn thy trn phim chp vV khng i xngTn thng c nt vi ha nhKhi nh hnh tua gai trn phim chp v

QCMPhn loi Birads: (chn nhng cu ng)ACR 2 nn theo di nh kACR 4 phi lm t bo hc (sinh thit)ACR 0: khng cn lm xt nghim g khcACR 1: khng cn lm xt nghim khc, khng cn theo di

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