MINISTRY OF HEALTH OF UKRAINE

Kharkiv National Medical University

 

Approved

on the methodical meeting Department of Oncology № 1

Head. Department

MD, professor Starikov VI

'30"August 2011

Methodical and guidance For independent work of students

 

Course 5

Faculty of Medicine (specialty "General Medicine", "Pediatrics", "Prophylactic medicine")

Study Subject: Oncology

Module number 1

Content module № 2

 

Theme 7       Skon cancer, melanoblastoma, lymphomas

 

Number of training hours -5

 

 

Kharkiv 2011

Topic

Malignant tumors of the skin occur often. Despite the fact that these tumors belong to the so-called "surface" localization experts are not rare and out of nedbanymy forms.

Effect of irradiation on the sunny thinning ozone layer is one of the major risk factors in people personally with fair skin. Etiological factors are ionizing radiation, burns, scars, effects on mouse skin `which, accessories and chronic attitude and others.

Most of the skin tumors are rodent ulcer, squamous cell carcinoma, chalk Nome. Oncologists should always pa soft favorites, such as databases and tumor liomy and squamous cell carcinomas are more common in the elderly, while melanoma is often found in relatively young people and has an aggressive nature and Clin chnoyi flow. Therefore, before the oncologist decrees are the problem not only primary and clarifying diagnosis and treatment of malignant tumors of the skin, but also evaluate the effectiveness of various methods of medi n ing this disease, early detection of relapse after a medication in the bathroom

Limfohranule matoz (LGM) - is one of the most difficult problems at district kolohiyi. Incidence LGM in different countries varies in width at cal scale. Features localization and abandonment process considerably faceted tion in the possibility of effective treatment. In common illnesses stages at ryuvan unfavorable prognosis. Oh nkonastoroha, proper evaluation of clinical manifestations, the use of needle biopsy or histological studies and Jenny and timely referral of the patient in onkostatsionar can significantly improve the results of treatment.

 

Know:

1. Etiology of skin cancer.

2. Etiology, epidemiology, pathogenesis and pathological anatomy melanoblastom.

3. Classification R W in stages and in TNM.

4. Clinical picture of the LGM.

5. Surgical, radiation, chemotherapy P III, LGM and modern schemes of combined and complex treatment.

Be able to:

Collect and interpret history correctly but patients with precancerous im disease.

To conduct palpation of lymph nodes.

Palpation distinguish benign skin disease.

Work plan and examination of the patient, based on a survey of the patient, formulate clinical diagnosis and treatment plan in case PU, melanoblvstomy, LGM.

 

Materials control baseline (rising levels) of students: test questions, test items

Test number 1

A patient 52 years complains of appearing on the skin of the glans penis formation, which is growing rapidly. During the inspection determined at k ruhle limited, bright red, flat, agonizing with velvety surface formation about 1 cm in diameter. What is the likely diagnosis?

A. Erytroplaziya Kairi;

B. Squamous cell carcinoma;

C. Papilloma;

D. Rodent ulcer;

E. Chancre.

 

Test number 2.

The patient in '28 revealed tumor of skin left leg flesh to about loru with ulcers in the center with a diameter of 3 cm, which does not heal 2 months, Zoom b tween complete inguinal lymph nodes on the affected side for 1 to 2 cm in diameter. Expose f ing diagnosis - melanoblastoma skin left leg with metastases to inguinal l and mfovuzly. What signs indicate disease?

A. The presence of tumors on the skin of the lower leg.

B. The presence of tumor, covered with sores on the skin of the shin, lumps in n and hu.

C. The presence of tumor that does not heal, the skin of the shin, lumps in n and hu.

D. Only the presence of enlarged lymph nodes in the groin.

E. Size of the tumor and lymph nodes.

 

Test number 3.

Patient 55 years, suffering from diabetes for 10 years. Vick at Nana left thigh amputation 6 months ago. Troubled sores in the area after I operational scar that appeared 1.5 months ago, shortness of breath. Ikuvannya L maz I we no effect. In the groin area of dense, elastic, painless knot to 2 cm in diameter. In the area of postoperative scar crater ulcer 2x4 cm flabby granulation and necrotic bottom. Cytological conclusion would zskri ka with expression of ki - squamous cell carcinoma. What research should be done to stand in ing stage of the process in the first place?

A. Radiography of the chest;

B. Computed tomography of the chest;

C. Angiography;

D. Scanning;

E. Ultrasound retroperitoneum.

 

Test number 4

The patient in '82 on the skin of the trunk multiple dense pu's tench from 0.3 to 1 cm in diameter. Peripheral lymph nodes were not enlarged. When cytology - elements undifferentiated carcinoma, but in ne - squamous cell carcinoma. What further and rolled teak?

A. Cryodestruction formations.

B. Removing tumors.

C. Additional examination of the patient by the organs and systems of the sighting and sentenced hoyu the esophagus and lungs.

D. Deleting entities after chemotherapy.

E. Observing the patient.

 

Test number 5

Patient 65 years. is onkohirurhichnomu department with a diagnosis of squamous cell skin cancer cheek. What should be the treatment strategy in state and nomu case?

A. Radiation therapy - hormone therapy.

B. surgery - postoperative radiotherapy + complex medi tion n.

C. neadyuvantna vnutriarterialna chemotherapy + radiotherapy + tion and operas

D. preoperative radiotherapy + surgery + complex medi tion n.

E. operation + hormone therapy.

 

Test number 6

Patient B. '31 at preventive examinations on the left half of December Dr. Noah cells detected elastic, rounded, smooth, rolling swell n junction, purple-bluish color to 1.5 cm in diameter, spadayetsya when pressed. Lymph nodes were not enlarged. Your preliminary diagnosis?

A. Cancer left breast.

B. Mastopatia left breast.

C. Pigmented nevus.

D. Hemanhyoma.

E. Melanoma.

 

Test number 7

Patient N., 21 years appealed to the doctor complaining of increasing li m fovuzliv neck and left inguinal area. Examination: R-graphy WGC - p and tolohiyi found. Zag and lnyy blood - red cells-4, 1x10 ¹² / l, Hb-122 / L, L-9, 4x10 ⁹ / l, f-4%, b-0%, 2% p-, p-64% l-22% m 8% ESR-12 mm / h. When needle biopsy found Sternberg cells. Your Doctor and ahnoz?

 

A. Limfohranule matoz

B. lymphosarcoma

C. Metastatic lymph nodes

D. Leukemia

E Limphadenitis

 

Test number 8

Patient N., 21 years appealed to the doctor complaining of increasing that m perature t and la to 37.2 ⁰ C-37, 3 ⁰ C for 3 weeks, lumps in the neck and left axillary region and hone to 1.5 cm . In laboratory examinations in blood: erythrocyte sedimentation rate 35 mm / h, white blood cell count 8.8 x 10 ⁹ / L, lymphocyte Penny at 8%, increased fibrinogen to 7.7 g / l. In the X-ray shadow of mediastinal enlargement. What preliminary diagnosis can put patients at th?

A. Chronic les and Cossack

B. lymphosarcoma

C. Hodgkin's disease.

D. Infectious m at nonukleoz

E Limphadenitis.

 

Test number 9

Patient '17 complains of general weakness, night sweats pronounced, generalized itching, pi t d raising the body over the past 15 days to 38.5 ^0. Palpable determined increased to 2-cm, painless neck l and mfovuzly left. Tot. blood: Hb - 90 g / l; Lake. - 9h109 / l, ESR - 40 mm / h. Diagnosis?

A. Limfohranul e matoz

B. AD onichnyy lymphocytic leukemia

C. Tuberculosis

D. lymphadenopathy

E lymphosarcoma.

 

Test number 10

The patient in '23 limfohranul e matoz / disease Hodzhkina / second stage of the lesion cervical-supraclavicular lymph nodes and lymph nodes left with is redostinnya. Histologically, mixed-cell variant. Select the best method of treatment bath?

A. 3 courses of chemotherapy / TSOPP /.

B. 3 courses of chemotherapy / TSOPP / + radiotherapy for radical b Noah apps and my above diaphragm

C. Radiotherapy for radical program on all nodes above diafra g we

D. Radiation therapy for all groups of lymph nodes on both sides diafra g we

E Radiation te rapiya the left cervical-supraclavicular area

 

Standards of answers: 1 - B, 2 - C, 3 - E, 4 - C, 5 - B, 6 - D, 7 - A, 8 - C,

9 - A, 10 - B.

 

Final Test clinical case studies

Task 1.

The patient complains of '65 appearing on the face sores, to about May does not heal, formed thick bundles in place. On examination, the skin of the right cheek determined rounded liykovydni ulcers covered with yellow in cotton gray crust with valykopodibnymy edges. Also marked infiltration of underlying tissues. What is the likely diagnosis?

A. Melanoma skin.

B. Bazalnoklitynnyy skin cancer.

C. Squamous cell skin cancer neorohoviyuchyy face.

D. Squamous cell skin cancer orohoviyuchyy face.

E. Keratopapiloma skin.

 

Task 2.

Patient S., 21, turned in oncologic dispensary about the increased "mole", which gradually increased from 3 mm to 1 cm in diameter. The skin of the chest is the formation of soft consistency browned on w and Rocky stem diameter of 1 cm, the skin around is not changed. Previous e iahnoz?

A. Melanoma skin.

B. Bazalnoklitynnyy skin cancer.

C. Squamous cell skin cancer neorohoviyuchyy.

D. Squamous cell skin cancer orohoviyuchyy.

E. Keratopapiloma skin.

 

Problem 3.

Patient 70 years complains formation appearing on the skin and ear p kovyny. The skin of the ear is defined by two tenacious, Bumpy, Oct. color at first nodule on a broad basis, 5 and 7 mm in diameter, which merge together. Peripheral lymph nodes were not enlarged. What additional research is crucial to clarify the diagnosis?

A. Common blood and urine;

B. Biochemical analysis of blood;

C. Urine for Bence Jones protein;

D. Cytological verification by fine needle biopsy;

E. Cytological verification by zskribka surface formations.

 

Problem 4.

Patient M., '31 complaining about the presence of the formation of the skin of the nose, which is rapidly increasing in size. On examination of the skin and nasal defined etsya dense tumor with rough, crusty, size and rum to 0.5 cm. Peripheral lymph nodes were not enlarged. In cytological d at slidzhenni zskribka of formation obtained conclusion - orohoviyuchyy flat at cell carcinoma. What is your tactic?

A. Clear formation of crusts mazove treatment.

B. Hospitalize patients in the surgical ward.

C. Refer the patient to an oncologist.

D. Run dermatoscopy.

E. Refer to the beautician.

 

Task 5

Patient 29 years old, complained of the presence of pigment formation with mo k Nuti center in transitional folds right breast, but I have deposited 1.5 months. Mammary glands are the same size, not deformed. If n and lpatsiyi tumors in the breast parenchyma is not defined. Peripheral Lee MF in ouzl and not enlarged. What is the most specific method of examination in railway and nomu case?

A. mammography;

B. duktohrafiya breast;

C. smear-imprint cytology of the tumor;

D. computed tomography of the chest and its organs;

E. axillary lymphography collector.

 

Problem 6

Patient M., 76 years old, complained of the presence of a smooth seal in the left parotid, found that 5 years ago. Addressed through collection and lshennya formation in size and sores last. She studied samolikuva Mr. tion - handles ulcer infusion of herbs. When the smears dia g noz set cytologically - rodent ulcer. The doctor decided VIC at Nata excision of the tumor. How should the cuts be made?

A. top to bottom;

B. upwards;

C. along the lines of tension of skin;

D. along the branches of "crow's feet";

E. right to left

 

Problem 7

Patient K., 68 years old, turned to the doctor complaining of feeling drive at mfortu and pain in the back of the neck, weakness, sensitivity is smite Noah area. Described symptoms noted for several months. On examination means pitting under a crust of pidrytymy edges and sanious from at kremlyuvanym. Which methods of examination do you recommend to verify the diagnosis?

A. Ultrasound;

B. trepan-biopsy;

C. ekstsyzi and on biopsy;

D. complete blood count;

E. zskrebok.

 

Task 8

Patient 55 years old, suffers from diabetes for 10 years, calls Mr. nulasya complaining of increasing pigment formation of the skin lateral behavior p Their neck left. Surgeon for UTO h tion began ekstsyzi diagnosis and biopsy well. Where can ekstsyzi and lead to biopsy or moderate form of height and tion in melanoma?

A. postoperative wound.

B. lymphostasis.

C. massive hematogenous metastasis

D. Mr. limfohe no metastasis

E. low immunity.

 

Problem 9

Patient, 28 years old, male, asthenic constitution addressed Derm and toloha complaining of itchy skin, weight loss, fever up to 38 ⁰ C in the evening. The patient was prescribed desensybilizu yu chu and hepatotropic therapy for 20 days. The effect of treatment was not, began to disturb night sweats, skin rash pustular back appeared. after treatment in the patient surgeon was appointed antybakteri and lnu and Immunotropic therapy. Objectively, besides the aforementioned changes proved collection and lshennya 2 lymph nodes right axillary area; lymph nodes up to 2.5 cm, soft flexible, mobile, not soldered between themselves and others and TC nynamy

A. Staph hroniosepsis

B. Limfohranulem and TOZ

C. Pyoderma skin

D. lymphosarcoma nodes right accessories and polar plots

E. Retykulosa p coma right axillary area

 

Problem 10

The boy 9 years revealed conglomerate lymph nodes in the neck on the left. Lymph nodes with a diameter of 1.5 cm, painless, not interconnected and environ at some extra and we tissues. The liver and spleen were not enlarged. Symptoms of intoxication percent in the TNI. In the blood: erythrocyte sedimentation rate 30 mm / h, 68% neutrophils, 18% lymphocytes, cells of Sternberg. The most probable diameter d noz?

A. Nonspecific lymphadenitis

B. Acute Leukemia

C. Infectious mononu k leoz

D. Toxoplasmosis

E. Lymphogranulomatosis

 

Problem 11

Patient '38 complains of weakness, fever up to 38 ^0, night sweating. Sick almost 3 weeks. Asked the doctor, treated over HIVZ - no improvement. 3 days ago I noticed increased limfov in fusion neck with law. Asked the oncologist was made ​​puncture lymph nodes. B and revealed Sternberg cells. What is the preliminary diagnosis?

A. Non-Hodgkin's lymphoma

B. Limphadenitis

C. Lymphoma Berkita

D. Lymphogranulomatosis

E Metastases at PLN quality tumors of the head and neck

 

Task 12

Patient in '38 was a doctor with complaints of shortness of breath, and odutlov dence at least lychchya. On examination - a doctor noticed an increase nezluchenyh interconnected nodes neck subcutaneous veins of the face and neck sharply expanded. Shadows among the wall at very advanced. Permissible your dia g noz?

A. Limfohranule matoz

B. Lung Cancer

C. Esophageal cancer

D. Cancer of stomach

E Colon w ki ki

 

Standards of answers: 1 - B, 2 - A, 3 - E, 4 - C, 5 - C, 6 - D, 7 - E, 8 - C, 9 - B, 10 - E, 11 - D, 12 - A.